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HomeMy WebLinkAboutBEAR VALLEY BLK 1 LT 7Bear Valley Block 1 Lot 7 #020-431-13 kmev uoiuu 1 u) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211214 PID Number: 020-431-13 Dwelling: Al Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑I■ Upgrade Name David T Peters ABSORPTION FIELD El Deep Trench ❑Wide Trench El Bed EJ Mound Site Address 9340 Honey Bear Lane ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade (907) 952-0213 4 Existing GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Bear Valley 1 7 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well >100' N/A N/A N/A >25' TANK RI Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1250 Gal. Surface Water >100' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line *4' N/A N/A N/A NA Foundation >10, N/A N/A N/A LIFT STATION Manufacturer Capacity Remarks *Waiver # OSV211035 Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer Denali Excavating Drainfield D3034 CO/MTD3034 Inspector J. Mlllette BENCH MARK (Assumed elevation) 100 ft Inspection 15t 6/24/21 Location and description dates: "d 4 Top of flashing under window near septic tank 3 th V ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 1 OF A Conditional Approval: Date • •'9�Q�a�� W���'�, Co 49 TH .... ........ 0 Septic Sys / Approve p Z ( ip—� f Benjam> Schiller �� �F'• CE 12592 ••`��® K,,�. Date 6/25/21 Av�� PROFESSION `� Note: Note: this does ��® approval not Include well permit requirements. �— kmev uoiuu 1 u) BEAR VALLEY SUB, BLOCK 1. LOT 7 PERMIT # OSP211214 PID # 020-431-13 �-EXISTING ABSORPTION NEW 1250 -GAL SEPTIC TANK w/ 20" MANWAY EXISTING SEPTIC TANK REMOVED & DISPOSED OF EHGINlENING • 49 — ..:� .......... - nja Bei Schiller CE l�����IFR•. June 25 2021�.��(���® �loe�PROfESSIONP�.� _ HONFY BE/,R-CANE ~' I 1 00'WELL RADIUS �— UTILITY EASEMENT METAL FENCE .l .� f EXISTING WELLI �❑ ❑ ❑ j { GARAGE ODEN FENCE { / 4 i L HOME BUILT ON PILINGS r FOUNDATION, SEPARATION f DOES NOT APPLY., 4zi _ w w LOT 7 W BLUE BEARY ESTATES LOT 1 (VACANT) a 2C0 SV� FCO 0 50 100 FEET 1 "=50' A B MH 10.3 13.2 SV 8.2 1 17.5 2C0 7.8 18.8 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE PERMIT # OSP211214 a �� ENGINEERING PID # 020-431-13 PROFILE AS -BUILT (NO SCALE) *7. 49 TM . �. .......... ' • . • . •. Benja'n Schiller ' (��Fc •. CE 12592 HJT •. une 25, 2021 . • V 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: OSP211214 Work Type: SepticTank Upgrade Tax Code Number: 02043113000 Site Legal Address: BEAR VALLEY BLK 1 LT 7 G:3242 Site Mailing Address: 9340 HONEY BEAR LN, Anchorage Owner: PETERS DAVID T Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date l l'17t i t epa i'mien t Lot Size in Sq Ft: Total Bedrooms: 6/22/2021 6/22/2022 52954 Disposal Field Q Septic Tank Holding Tank Privy Private Well Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Date: Z 2 4 ® u ici ality of Anchorage I)r.p;ntment P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On-Site Water and Wastewater Program X X X* VARIANCE/WAIVER REVIEW x x* x Waiver#: OSV211035 COSA#: PID#: 020-431-13 Legal Description: Bear Valley Bilk 1 Lt 7 Engineer: Forge engineering Permit#: OSP211214 Your request for a waiver of the required 5 feet horizontal separation from the septic tank to the property line has been approved. The approved separation distance is 4.0 feet. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ..................................... a Z N M M 0 0 0 M M 0 a ... C .................. 0 M M 2 M M. 1 Waiver is Granted: X Waiver is not Granted: Date: 6 -Z Approved by: Name of Revi ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■.■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ O ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ . **** VARIAN C E/WAIVER REVIEW **** APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank ❑X Upgrade Duplex ❑ (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Tank to lot line and Tank to foundation waiver Distance: 41 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. { 1 (Signature of property owner or authorized agent) Permit/Rush Fees: 4 a Q 5 Waiver Fees: 5 Date of Payment: (" / / ( 1-2021 Date of Payment: Receipt Number: 0 Receipt Number: Permit No. C)S P g 1 Waiver No. 0 S V�2 1( 03 5 Permit App__- :- June 21, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 6/21/21 Subject: Bear Valley Sub B1 L7-9340 Honey Bear Ln. Septic tank replacement Dear On-Site Services Engineer: The owner of the above lot intends to sell their 4-bedroom home on the property and the existing septic tank is beyond its 30-year life expectancy. Therefore, we are submitting this permit application for its replacement. The property is serviced by a private well that is located greater than 100’ from the proposed tank location. No septic system on this lot or adjacent lots will have any effect on the proposed septic tank location. Due to the configuration of the existing septic system and limited space, we are requesting a variance waiver to allow the tank to be 4’ from the west property line. A waiver was granted for the existing tank without issue. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211214, Deb Wockenfuss, 06/22/21 // // // Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' EXISTING ABSORPTION TRENCHES TO REMAIN IN USE NEW 1250-GAL SEPTIC TANK w/ 20" MANWAY CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND BEAR VALLEY SUB, BLOCK 1 LOT 7 FEET 0 50 100 4' NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. HONEY BEAR LANE 4-BDRM HOME UTILITY EASEMENT 10' UTILITY EASEMENTWOODEN FENCE METAL FENCE GARAGE 100' WELL RADIUS 2CO ENSURE TANK IS NOT PLACED DIRECTLY BENEATH STAIRS FCO 6/18/2021 DECOMMISSION EXISTING SEPTIC TANK PER UPC HOME IS BUILT ON PILINGS FOUNDATION SEPARATION DOES NOT APPLY Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211214, Deb Wockenfuss, 06/22/21 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 DISTANCES �j3ai e e TO SEPTIC ABSORPTION Addresss FROM TANK FIELD WELL Sok &i3/ &W H 99Soy Phone(s) Permit No. No. of Bedr oms WELL // j • LEGAL DESCRIPTION Lot7 Block � Subdivision_ Township, Range, Section / 0��•r��/`D. V TANKS SEPTIC ❑ HOLDING Manufacturer A V i?�K Capacity in gallons /X:5_0 Material No. of Compartments ,s7­ew/ Y TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade Total depth from original grade �..� FT 91 FT, Fill added above original grade Gravel depth beneath pipe ff % FT FT Gravel length Gravel width 1 y3 FT FT Total absorption area Distance between lines /5'_ ��� SQ FT FT Number of lines Soil rating /3S SQ FT Pipe material /D 1>303 Installer ;4u 0/ c"'A/7" Date Installed % 53C 88 9 WELLS X PRIVATE ❑ OTHER (Identifv) Classification (A,B,C) Total Depth Cased to FT FT Installer I Date REMARKS: UP4Wfr FOR 1.7 BbAHS. ,4v37444 TRadal 3,r4& =X13 51ghS- 0W MPM `Tiq�lK ` %l//ILTCA Inspections Performed by:/ t .qo 1-A ve �EV�GM�_• Date: certify p�that this inspection was performed according to all —QO _ LOT LINE S S FOUNDATION AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etc.) I 1� 4- I - ,T— .,r y v .-- Municipal and State guidelines in effect on this date: Health Department Approval: �/L/A C J. iia!' �- Date: 72-013 (3/85) 1 ENGINEER'S SEAL MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4�20 ON-SITE SEWER PERMIT Permit Number: 880141 Upgrade Date Issued: 07/29/88 Engineer Designed Owner Name: ROBERT J. BIN%CK Owner Address: P.O. BOX 6231 ANCHORAGE, AK 99502 Day Phone: 561-5040 Parce1 Id: 02O-431-13 Lot Legal: Subdivision: BEAR VALLEY SUBD. Lot: 7 Block: 1 Section: 6 Township: 11N Range. 2W Lot Size 59400 (sq.{t. or acres) Max Bedrooms: This Permit: 1 Total Capacity: 4 SEPTIC TANK: Minimum tota1 septic tank capacity: 1,250 ga1lons. Each septic tank must have at least 2 compartments. Depth to top o[ septic tank(s) < 4.0 {eet requires insulation over tank(s). INFORM D.H.H.S. PRIOR TO 181" & 2ND INGPECTIONS BY EN8INEER, IF AFTER OFFICE HOURS, CALL 343-4681 AND LEAVE A MESSA8E. CONSTRUCT PER ENGINEERS ATTACHED APPROVED DESIGN. THIS PERMIT EXPIRES 12/31/88. THIS PERMIT FOR A GINGLE FAMILY REGIDENCE ONLY. I CERTIFY THAT: 1. I am /amiliar with the requirements {or on-site sewers and we1ls as set �prth by the Municipality o� Anchorage (MOA) and the State of, Alaska. 2. I will insta1l the system in accordance with al1 MOA codes and regulations, and in compliance with the design criteria o� this permit. will adhere to alI MOA and State o[ Alaska requirements for the set back distances {rom any existing well, wastewater disposal system or pub1ic sewerage system on this or, any adjacent or nearby lot. 4. I undepstand that this permit is valid [or a maximum o[ 1 bedrooms. % also understand that the capacity o[ the total system is 4 bedrooms and any enlarg ment will require ant, ional permit. Signed: _____ (Owner> ICK Issued By: ^��v�-f�' DATE: ---------------�--------------------- T---------�---- �' Municipality of Anchorage (� , r1l, �W__ )IJ Department of Health and Human Services 825 "L" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 1, 1988 Lee Reid, P.E. Alaska Environmental Control Services, Inc. 1412 West 33 Avenue Anchorage, Alaska 99503 Cjhr15 Subject: Waiver Request for Lot 7 Block 1 Bear Valley Subdivision Waiver Request #WR88-043, Permit #880141 Dear Mr. Reid: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 5 feet. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely,, J'�v Daniel J. Roth Civil Engineer On-site Serivices DJR/ljw#7 Municipality of Anchorage Department of Health and Human Services dhh5 825 "L" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 July 18, 1988 Robert M. Piazza 2644 Forest Park Drive Anchorage, Alaska 99517-1326 Subject: Waiver Request from Lot 7 Block 1 Bear Valley Subd. Dear Mr. Piazza: The owner of Lot 7 Block 1 Bear Valley Subd. has recently requested a waiver of the required 10 foot setback to a portion of his septic system from the common lot line between his lot and lot 6. Our records indicate you are the owner of lot 6. He is requesting this waiver because of the configuration of lot 7 and the location of his well. An approval of this waiver would allow a portion of the septic system being constructed on his lot to be five foot from the common lot line. The Department intends to grant this waiver based upon the engineering study submitted to us by his engineer which indicates this encroachment will not adversely affect the future location of on-site facilities for lot 7. If I do not hear from you within ten days of the date on this letter, the waiver will be granted. I can be reached at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On -Site Services cc: Leroy C. Reid, Phd., P.E. Municipality of Anchorage Department of Health and Human Services 825 "L" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 Jul\/ 18, 1988 Robert M. Piazza 322 Harbor Point Loop Eagle River, Alaska 99577 Subject: Waiver Request from Lot 7 Block 1 Bear Valley Subd. Dear Mr. Piazza: C�hhS The owner of Lot 7 Block 1 Bear Valley Subd. has recently requested a waiver of the required 10 foot setback to a portion of his septic system from the common lot line between his lot and lot 6. Our records indicate you are the owner of lot 6. He is requesting this waiver because of the configuration of lot 7 and the location of his well. An approval of this waiver would allow a portion of the septic system being constructed on his lot to be five foot from the common lot line. The Department intends to grant this waiver based upon the engineering study submitted to us by his engineer which indicates this encroachment will not adversely affect the future location of on-site facilities for lot 7. If I do not hear from you within ten days of the date on this letter, the waiver will be granted. I can be reached at 343-4744. Since -rely, Daniel J. Roth Civil Engineer On -Site Services cc: Leroy C. Reid, Phd., P.E. A EC s ALASKA RUIROMPTAL COnTROL S6RUIRS, InC. v 6ngineerinq S 6nuironmental Studies 7III y 5, , 193,3 M11llicip�ll.ity of Anchorage Dep;.lrt.ment or He<i1 th & F1r11nan Sery tcos 325 L Street Anchor�lge , AK. 9950:1 Re: Lot 7, Block 1, Beal Valley Subdivision The existing system, although adequate for the water vo_l nme , is inadequi.Ifi:e in size. The ashtii,lt- Shows the System to be ii feet long but it. is Only 24 feet_ The house is F1 -t bedroom hoi1Se Find not Fliree bodrooms . The existing system is, both too small and too close to the lot l-ine, 'file end of the existing system Is slightly Over 5 feet from the lot line. The Flr lett: undeveloped. The IIP.w larger Septic tank CaI1 not be placed to coIlform to ,he cede unless the sytit:em is moved. The sys em c<in noi. lie, nloVeci t;nle`>t; C:he I1,7r'll i; moved, As only the ends of the existing System wotild encroach on the exisLin,- lot by 5 feet. It: i_.; elollbtful if it. would inhibit. the future, development. of l;Ilis .1.oi:. "91e a 'alli:lllb of the 1�?a :icer of t:he� sys �:em to 5 Beet o f the loi- line will Ilo t- cre::tte a health hazard. T therefore regtlest yr sting of the wcli.Ver from "100 feet to 5 feet-.. Sell : OF A4 REI4, JR. ; 0Ok ! Cc 22251 Ori••., ... �d_ 1200 West 33rd Auenue, Suite 13 • Anchorage, Alaska 99503o(907) 561-5040 70323 A Ec s ALASKA RUIROWnTAL COnTROL 56RUIC6S, InC. o Engineerinq 6 Enuironmental Studies 07/07/88 CURT CARLEY SELLER—MARRIOT HOST RELOCATION COMPANY CURT CARLEY C/O REMAX REALTY COMPANY C/O REMAX REALTY COMPANY ANCHORAGE AK ANCHORAGE AK LEGAL:BEAR VALLEY SUBDIVISION BLOCK 1 LOT 7 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE -2/16/88 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 336 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 533 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A :HOME OF 4 BEDROOMS. SEP'T'IC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 GALLONS 250 GALLONS FOR THIS HOUSE OF 4 BEDROOMS. THE SEPTIC TANK/PACKAGE PLANT HAS NOT BEEN PUMPED THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE SUPPLY OR WAS�T�EW PC *�•9T 4 w g O, C. R@ID, JR. : p %CE • 225110 I5 INADEQUATE BY WITHIN THE PAST YEAR. PIPING FOR THE WATER 1200 West 33rd Ruenue, Suite B • Anchorage, Alaska 99503. 907) 561-5040 err 9�onals A EC S ALASKA RU1R0MMAL COnTROL SCRUIUS, InC. a Engineerinq & 6nuironmental Studies ` PECIFICATMN11, VOR A . R ?�XCIJ TYP1: W1ASTFWA'fF,P i)ISPOSA : SYC; 'EM BEAI: VALLFV SUBDIVISION, BLOCK 1., LOT 7 1.0 GFNERAL .:, The drawings. sheets 1 through 4, -;hal. l be a part: of th i.s specification. 1.2 All iwiterials and workmanship shall meet. the requirements of the Municipality of Anchor,ige, Department of Health & Human the conditions of the permit., and all applicable ruler; and regulations currently in effect:. .3 All elevations and depths are advisory, rand are to be verified or modified in the field by the engineer or inspecting agency, i_4 It .s the respons=ibility of the owner or :i.nsta:iler to a-df.ere to approved desllgns for installation, m;i.intairl the specified sepi!rzti.ol, distances, and have the appropriate inspections. 1.5 If the tnstallati_on is not inspected. by an AECS engineer, AICS will. not: be respnns_ible for the _installed systean. All engineer at AEC, should be consulted prior to construction to determine the number of inspections that will be required rind to expla=in what. these inspections will. involve. 2.0 SEPTIC TANK 2, 1. If there is lin existting septic Lank, P. may be used if IL meets :he capacity requirement for the residence and the approval of the MOA. 2.2 The septic tank shall be <:a. UPC Approved two compartmnent tank, constructed of 1.2-1gauge steel with bitumast:.ic coating and set: level on undis t:urbed soil. If thc> tank Is barr:i ed at. a depth of n feet or less, it must be insulated with an overlying layer of 2 inch burial type polystrene rigid board insulation. 2.3 The septic tank and t=rench shall be a minimum of 100 feet from ally pi w=ale well or 'body of water, i50 feet from Clrass C wells, <:and 200 feet from Class A or B wells, unless otherwise specified. Less than the; required separation distance must have prior approval or waiver by ADEC or MOA. 2.4 The septic tank shall he is minimum of 5 :feet from the house foundation, and a minimum of i fee` from the absorption area. 2.5 Piping shall be fitted with a mechanical watertight caldet, coupling. on the outlet_ and inlet of the septic tank. Piping shall he 4-ir:cgl solid PVC ASTM D3034 or cast. iron, sloped it minimum of 1/9inch per lineal foot. If the piping is buried at �, depth of 4 feet or les:, 1200 West 33rd Auenue. Suite B 9 Anchorage, Alaska 99503 9 (901) 561-5040 it must be insulated with i)n overlying _! oypr or 2 inch burial type polystrene rigid board insulation. 2.6 Cle noutm shill be installed as designated and capped with air--Ught rain caps (Jim caps or equivalent), and extended a minimuiti of 1 foot: above ground level. 2.7 If a Lift station is required it shall be a combination lift: station septic tank per Anchorage Tank and Welding, Inc, design, Specifications are attached. 3.0 Absorption Area. 3.1. The ;ravel for the trench shall be 0.5 to 2.5 inch, screened rock with .less than 3% passing #200 sieve residual. All substitutes must: have prior PHHS approval. 3,2 The bottom and sides of the excavation shall be raked with the backhoe blade to insure that it has not been compacted during excavation. The bottom elevation shall be level. 3.3 Monitor standpipe (s) shall be placed as shown in the drawings, and shall be 4 inch rigid PVC ASTM D3034, or cast iron. The section shown with holes may be 0.5 inch holes drilled on 6 -inch centers on opposing sides of the pipe, or sa regular section of perforated sewer pipe clamped to a solid section with either a no hub coupling or a solvent joint. A rubber rain cap Kim cap or equivalent) shall be installed over the top of the pipe. 3.4 The distribution pipe shall_ be perforated 4 inch rigid PVC with a minimum crush strength of 1500 lbs and shall_ meet the approval of DHHS for use as drainfield pipe. All distribution pipes shall be laid level. 3.5 Trenches may be paralleled, but must have a miniAum separation distance between the, trenches of 10 feet or 2 times the gravel depth (whichever is greater). 75 feet is the maxinnm allowed linear iengtb of any trench. 3.6 If the final grade over the trench is less than 4 feet above grovel, insulation is required, using burial type polystyrene rigid board insulation. There shall. be 1. inch of insulation for every food- of soil less than the required 4 feet of cover, but there must be at- least tleast: 24 incases of soil cover even though _insulation is used. The solid pipe extending from the septic, tank to the drainfield shall also have 4 feet of cover or an equivalent layer of insulation to prevent freezing of the line, 3.7 If insulation is not: necessary, the gravel shall be covered with a layer of nonwoven Geotextile fabric (such as Mirafa.i, Fibret_ex 200 grade, Po3 y Filter X or equivalent), 4.0 INSPECTIONS 4.1 A minimum of two :inspections are required for the installation of the trench. The first inspection will be of the open excavation to assure that the system is installed in the proper soil strata, correct_ depth and meet minimum specified design parameters, 4.2 The second inspection will be rafter placement of the gravel, monitor standpipe and distribution pine to verify proper installation and position prior to backfill. . d.> The, inspection of the septic tank iIlstallation Can be incorporated with any one of the above listed inspections. Municipality of Anchorage i•••� �' DEPARTMENT OF HEALTH & HUMAN SERVICES �• •�•�•• •••••; i; 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ` ;• "° Y c•REID�la.. • Ott, _ PERFORMED FOR: `— U r � �� r /P `1 _ DATE PERFON'Eki 'Z" qU�us►� LEGAL DESCRIPTION: I J i�F � r [/a y s�, Township, Range, Section: 7-//,1) ,e _� 41 C 6 pI-DEPS SLOPE SITE PLAN 1 P.i 3 4- 5 6 4•7r' 7 i 8- 9- 10- 11 910 11 uq 12- 13 14 15 16 17 18 19 1<111� 91 ./ Co 2 r'SC S111zl 74D "ne !�✓dreg nUS. !✓ e T/e SBrt � a/earp,v.,-,s , �o �✓e s +� Cf���.( HJOT dP_KSY'_ 13o�/der s q4 ed hb r/� S WAS GROUND WATER ENCOUNTERED? ` S V S IF YES, AT WHAT L DEPTH? �°?'� O P E 7 Depth to Water After S� Monitoring? /-- Date: 14 � . G ®®®® Depth • .. EMN -_---� 20 IUI PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 1 / TEST RUN BETWEEN FT AND FT COMMENTS %C�sY 1t 04 94i % In r -'c `t Jlio . t� Xo 7�7 / 10.9 AS' fc r S,.4e— sys�i .. c •, dtsGoJe•i� � 6�/ i7.o'�' Js s�ou� So.�s a� 5c�:�..� hre{{ Co>rsP Sa.�cr!r PERFORMED BY: `- • ' • I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: -7/5,( F 72-008 (Rev. 4/85) Sh e e 4- L 4 y 1 -5epf,c- veil k e „4uve 7e M O N ' l .� j. r� w N Q q4 � 41 cA oScct h � 34° x -5epf,c- veil k e „4uve 7e M O N X .� j. r� w N Q q4 � C cA oScct neck 48D 5 t. Frrn ao Wd P1I�n� V Fd n N • /40.00 < F -C I C r- ? t t 1 X .� j. r� w 0 h � 34° x A T 01 r N - OF .A4,1'4 i8 g 34 ° Ar �C�..•.... 0 • Ir. �••`®�f 0 Co ;9999.. .............. � II f9 900,,9 . ...00990.• h v 1 S f o w n 0.0 LER C. REID, JR. -- �'��•' S CE - 2251 fF 0.0.0.....•°• Qct y,^c �� NOTE. DN sire This As, -built shall not be used for any purpose other than financing requIrements Under no circumstances should any da a--hereon--Wused for �> construction or for estabiishring i� boundary or fence lines. AS -BUILT NO CORNERS SET THIS DATE 9q 0578 10 51, W 180.00 .� F- OF ALI�9 %%4- Fred 4-Fred Walotka : I , '4t �i;. '. NO. 32555 •• ``' .�40 .o• IoRoki;.. v• %-V a� ®m EASEMENTS OF RECORD, OTHER THAN lq%% . THOSE SHOWN ON THE RECORDE/D� A! PLAT ARE NOT SHOWN HEREON. , W I= I hereby certify that I have performed a Mortagee's in- spection of the following described property: Block 1, f3,_.ear Ve llev SHdd. Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated attA.�� Anchorage,Ala ka this —L—day of vk k1 e 19 FRED WALATKA & ASSOCIATES o� Engineers and Surveyors ALASKA ENVINUNMENIAL Joe `e vv" CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B SHEET NO. Of ANCHORAGE, ALASKA 99503 CALCULATED BY `d DATE r g - (907) 561-5040 CHECKED BY DATE 4" I.D.SOLIO PVC. ASTM 03034 CLEANOUT JIM CAP tOR EQUAL) 4" RIGID POLYSTYRENE INSULATION, DIRECT BURIAL TYPE i T e�e1�� MIN iFINISHEO GRADE Q" MAX BACKPILL--- 2' MIN IN i NOTE: SEE SPECIFICATIONS FOR CLARIFICATION OF INSTALLATION. 7,61 ,dear V,//,, S✓J Q I.D. PERF PVC (HANCOR OR EQUAL) Ifl III O SCREENED GRAVEL 0.8--2.8- DIA. O O on 0 BACKPILL--- 2' MIN IN i NOTE: SEE SPECIFICATIONS FOR CLARIFICATION OF INSTALLATION. 7,61 ,dear V,//,, S✓J MUNICIPALITY OF ANCHORAGE 0 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME, O , PHONE I -/ -�r,J' j '91NEW ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION Lol -2 A I /q LOCAT ON &' _6 NO. OF BEDROOMS V Y DISTANCE TO: Well Absorpti n area r Dwellin �e� PERMIT O. H Z W Manufacturer Material r No. of compartments y Liq. capacity in gallons � IF HOMEMADE: Inside length Width Liquid depth Y JAZ DISTANCE TO: Well Dwelling PERMIT NO. 0ZF< Manufacturer Material Liquid capacity in gallons w = DISTANCE TO: Well Foundation f f (? ' (Q 1 Nearest t I'n PER IT NO J LL Z F Z w No. of lin s Length f e h line i . • Total len th lines Trench widt inches Distance b tween lines G H Top of the to finish grade M/ (� Material beneath tile �� inches Tot I eff ctive absgrption area w Length Width Depth PERMIT NO. CL F- W °L Type of crib Crib diameter Crib depth Total effective absorption area WWell y DISTANCE TO: Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS � 6461 k" c� m SOIL TEST RATING rn 6 FD lr' INSTALLER �- J L�/9,�!{1 J ' tC. REMARKS aD CDATE LEGAL 72-013,96v. 3/78) U THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM lS: Q Q Q Q- T -i — J. WE! �K hi CIA K 1-1= 73 fl. K3 Q f! 11 K L.. Q K 1' - I- f i= Kil:� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCAVATION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE QRHYEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCAVATION (IN FEET) 1Q?KQk.J:1 EQ!EEQ n3EFQ-T-1:C0 -1-1004K 101: 10EH= J,fQQQ PERMIT HPPLICHNT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THHT THE WELL WILL SERVE. ___ 004 Q -N oil > 1: 14M n3 FO EE C2 -E- 1: T�h 1"M Q 011 FY EF FQ Ell fit RJ :1: K K K> BACKFILLING OF HN9 SYSTEM WITHOUT FINAL INSPECTION HND APPROVAL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. 0=4 FEZ Q 10 1: K Q 1-0 1=1 1: FT EE 25 ED EE 11 EE V1 Q EE F? TO K , K 705 To El;� (Ponstruction gest XaL "ONE TEST IS WORTH A THOUSAND OPINIONS" 3919 SP�NARo ROAD, SUIT0 A I► ANCHORAGE, ALASKA >1i �9A3 f77.02 1 May 3, 1975 Alaska Land Development Services 4546 Business Park Blvd. Anchorage, Alaska '99503 Re: A Subsurface Soils Investigation on the Bear Valley Subdivision looated on Clark's Road Gentlemen: Transmitted herewith are the results of our observations of the subsurface soils investigation performed by Alaska Test Lab and Denali Drilling on May 2, 1975 in the Bear Valley Subdivision. ' We were initially contacted by Mr. Bill Tucker on the morning of May 21 1975, requesting that Mr. Jim Mack of our Company be present during the actual drilling operations to act as an independent observer. Mr. Mack would then observe, classify and rgcord the soil types encountered in the three test holes scheduled for this project. Mr Rolf Strickland would also be present to observe the drilling and sampling procedures. The three test holes were drilled and our observations are presented in the three test boring logs enclosed in this report. In general, the soils encountered var from silty sandy Gravels (GM) to gravelly silty Sands (SMT. No ground water or bedrock conditions were observed. The soil types occuring on this subdivision are considered suitable for on-site sewage disposal systems it accordance with the Department of Environmental Quality ( GAAB ) repul ations. If we can be of f4rthop assistance, p]@ape gg4tsot pur office. Very truly yours, CONSTRUCTION TEST DAB James D. Mack L4bgratpry $ JDMldt n ALASKA TESTLAQ Mr. Bruce Gunnells 1125 Orca Anchorage, AK 99501 4040 "B" STREET ANCHORAGE, ALASKA 99503 (907) 278-1551 .August 16, 1978 W.O. #A18589 Subject: Subsurface Investigation for Suitability of On -Site Sewer, Lot 7, Block 1, Bear Valley Subdivision Gentlemen: Transmitted herein in accordance with your instructions are the results of the above referenced investigation as performed by us on August 11 and 14, 1978. The scope of this project is investigation for suitability of an on-site sewerL.ge system. Included in this transmittal are: Test Hole Location Sketch Figure 1 Test Hole Log Table A Explanatory Information Sheets 1-3 The exploration was conducted using a Nodwe'.l mounted Mobile Drill Model B-50 drill rig with a continuous flight solid stem auger. The rig is owned and operated by Denali Drilling, Inc. Drilling was supervised and the test holes logged by Mr. T.L. Barber, Geologist with Alaska Testlab. The percolation test was run by Mr. Joe Williams. The test hole was placed at the approximate location shown on Figure 1. The log of this test hole is included as Table A of this report. In interpreting the log it would be helpful to utilize the explanatory information contained in Sheets 1 to 3 of this report. When drilling was completed a 3/4" slotted PVC pipe was inserted in the hole to aid in determining the free water level. For the percolation test, the test hole was filled with water and left overnight to saturate. On returning the next day, the hole was refilled with water and the drop in the water level carefully monitored over the next 60 minutes. This procedure is not a standardized percolation test, however, we understand that the Municipality of Anchorage, Department of Public Health and Environmental Protection prefers tests performed in this manner to evaluate a site for a proposed on-site sewerage system. Mr. Bruce Gunnells August 16, 1978 Page 2 Using the above test, the observed minimum percolation rate was 8.0 minutes per inch. No water table was observed during drilling, but it should be noted that the free water level normally fluctuates seasonally and with precipitation. A i, We hope this report meets your present needs. If we can be of further service, please feel free to contact us. f Sincerely, ALASKA TESTLAB Melvin R. Nichols, P.E. Laboratory Manager MRN:rb Enclosures Lot 7, Block 1 Table A W.O. #A18589 ! Bear `►alley Subd. Logged By: T.L. Barber Date: August 11, 1978 Depth in feet From To Soil Description !I 0.0' 1.0' Brown Organic Overburden. 9.0' - 16.0' F-1, brown Silty Sandy Gravel, GM, wet, high density. Bottom of Test Hole: 16.0' Frost Line: None Observed Free Water Level: None Observed p O O O O- O O. O. 'O. ;O O t7 � ryv p lj N O O 0 o H H H1-3 H H y to c) f w Lu O ko %,a G) ice` co co ril H y y y H H y H y N ^ i i i i i l' it 47 ND i t ?VID LA d lei (D n in E 1� r C7 C 's9, rri ►rJ � 'si k! hi rzi k! ►ri ' ►ri +sJ d rn � H H cn Y � Z O to ►�i i� �� R - ►�i O Ki iai 0 c� Z � Cri ra tri H H H H H H H H H H 'H y io O O O O O O O O O 1 H y H H HH. i'-3 H_ H H ►3 H �3 r w IP c � ®(i { i MUNICIPALITY F ANCHORAGE�S Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-431-13 1. GENERAL INFORMATION Complete legal description Bear Valle Location (site address) 9340 Honey Expiration Date: '"l - Sub, Block 1, Lot 7 Bear Lane Current property owner(s) David Peters Day phone Mailing address Real estate agent 9340 Honeybear Ln, Anchorage, AK 99516 Jin Chen 2. TYPE OF DWELLING: ❑n Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone (907) 952-0213 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑w Private Septic ❑■ 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 $ 8 n Date of Payment — 2 9 —Z I Receipt Number 0W/ COSA# 0 S CJ, 1 1 3 5� Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 6/25/21 �F'gsl� s e*: 49TH* I 6. DSD SIGNATURE .. ' .. t System #1 Approved for l bedrooms �� Benjarri�rySchiller System #2 Approved for bedrooms �F��s •, CE �t� lF�6/225/215/21 _ PR Pitt? .i Disapproved 11 ROfi s1 Conditional approval for bedrooms, with the following stipulations: �g ON-SITE G� m^_ = rr_9 WAST`!? V'ATFR z Ji? -k PROGRAM 0 B- Original Certificate Date: -20-21 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Bear Valley Sub, Block 1, Lot 7 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10/11/1978 Total depth 190 ft Cased to 29 ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 27 in. Date of flow test for COSA 5/17/21 Static water level at beginning of test 32 ft. Comments -►. Age of tank(s) <1 years Tank type/material Septic/Plastic Measured operating fluid level in septic tank N/A 0 Standpipes/foundation cleanout per record drawing Date of pumping Installed on 6/24/21 D. ABSORPTION FIELD DATA Deep Trench Parcel ID: 020-431-13 Structure served by this system Well production at time of test 1.3 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.885 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 5/27/21 n STATION ❑ Requir aintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 7/29/88 Adequacy test date 5/17/21 0 ALL standpipes present per record drawing Results [ZPass For 4 bedrooms Total measured depth from grade 12.75 ft (max) Fluid depth prior to test 42 in Measured depth to pipe invert from grade *n/a ft (min) Water added 662 gal ❑ N/A — pressurized field 53 New depth in 0 Monitor tubes go to bottom of effective. If not, state 1440 Elapsed time min depth into effective 0 Code -required soil cover over field Final fluid depth 41 in ❑ System presoaked Absorption rate >600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) _ Gallons introduced gallons If yes, enter date Comments/Deficiencies: 'No cleanouts for invert measurement. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below ❑v Yes if No ft M 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' F. ENGINEER'S COMMENTS Animal Containment > 50' ✓0 Yes if No ft Q Yes if No ft is required. ** Waiver # OSV211035 Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ✓❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *N/A ft Surface Water > 100' ❑✓ Yes if No ft **4 Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10'✓❑ Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10'✓❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ®✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' F71 Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *Building is on piling so no separation is required. ** Waiver # OSV211035 G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet OF ..:........... Benjarr�-,Schiller /d �F, • CE 12592 , • c`v��� PR0FESSION�`�� � ft ft S N 0014 ` S2 " W 33096 I fn �o S N 0014 ` S2 " W 33096 I P, G Z� -crTl Fri A" p, CJ (D m j :o g Co noNCo rl 1014 S N 0014 ` S2 " W 33096 I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by rrgal affixed hereto and as of the validation date shown below, t vedf that my investlgati6n,4b'Ssed procedures outlined in the Certificate of On -Site Systems Apprtval Guidelines for this application, shows.that the on-srite water supply and/or wastewater disposal system is (are) safe, functibQ and adequate . for the number? bedrooms and type of structure indicated here in. .I further verify that based on the t atron obtained from the Municipality of Anchorage riles and from my investigation and inspe�lion, the . on- water supply and/or wastewater disposal system is(are) in compliance with all applicable Mur fci al and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 5 17-/0" Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time ofthe test, and separation distances measured to readily identifiable features. The operational lire of all wells and septic systems depend on the local soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _Z Approved for _ f bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory t� Supplemental Engineer's Reort Nitrate Advisory Other 1AY OFf4cy��� J` ON-SITE .�c= WATER AND ; m= WASTEWATER : PROGRAM By: �j'`(��/ I{/, Original Certificate Date: a-/-) R rR.. I vnst Municipality of Anchorage (• Development Services Department Building Safety Division On -Site Water & Wastewater Program ' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ,CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: -_ BEAR VALLEY S/D, LOT 7, BLOCK 1 Parcel ID: A. WELL DATA WELL PUMP SET AT 140' PER ARCTIC PUMP AND WELL. 140 GALLONS OF STORAGE IN WELL CASING. Well type PRIVATE If A. B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10/11/1978 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 190 ft. Cased to 29 (TO BEDROCK ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/11/1978 5/12/08 Static water level ARTESIAN ft, 38 ft, Well production 5.0 g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0"747 mg./L. Other bacteria 0_colonies/100 ml. Arsenic: 1.76 ug./L. Date of sample: 4/22/2008 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date Installed 7/29/1988 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 4/6/2008 Pumper MCDONALDS : PUMPING C. ABSORPTION FIELD DATA 1 NORTH TRENCH BE W EXISTING GRADE 1) 9/8/1978 2; SOUTH TRENCH Date Installed 247/Z9/198s Soil rating (g p.d./ft'' /bOd 13 ft. GraSystvel be ow pips em type AL 1 RE8N5H n Length 2 23 ft. Width 2 1 )�•13.7 1) 384 /-2) 253 Total depth 2)*9.6 ft. Eff, absorption area oo? ft' Monitoring tube YES Depression over field NO Date of adequacy test **5/11/2008 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth in absorption field before test "1 88 in. Water added 634 gala New depth"'69 in. Elapsed Time: 397 min. Final fluid depth 47 In. Absorption rate >= 600+ g,p.d- Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date "TEST PERFORMED ONLY ON SOUTH (1988) TRENCH. 1988 TRENCH WAS PRESOAKED WITH 655 GALLONS ON 5/6/08 AND WITH 620 GALLONS ON 5/8/08. ***WATER WAS SLIGHTLY VISIBLE IN CLEAN OUT D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" level atm . High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: *PER INSPECTION REPORT Building foundation "5' Property line *0 M� Absorption field "5' Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent tots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 'PER INSPECTION REPORT Property line 'S' Building foundation '6.5 Water main N/A Water service line 10'+ Surface water 1009+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS **WAIVER AMENDMENT REQUESTED. SEE ATTACHED LETTER. NO POST TANK CO WAS LOCATED IN THE FIELD BUT TANK IS ABLED TO BE CLEANED, FROM THE TRENCH COMING BACK TOWARDS THE TANK. 440 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and p;'.f--,%••.'r. review of Municipal records that the above systems are in 0•'""' . • • .. ..... conformance with MOA COSA guidelines in effect on this date. �O '•. a A. G ess Engineer's Printed Name JEFFREY A. GARNESS �Ow E— X11 z�oP Date ��dPro f esslo% o COSA Fee R /J,3 O 4 1 7 S F U S F{ Date of Payment 'S / Z ! C7� Receipt Number (0 7 19 (Rev. 1 V05) Waiver Fee $ Date of Payment Receipt Number DDO000�9 Municipality of Anchorage • Development Services Department j Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Nater Well Advisory Certificate of On -Site Systems Approval # 080136 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 1, Lot 7 of Bear Valley subdivision, the well's productivity was determined to be 0.66 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. ;.76Aohe� BearQ�e:.. Bb • � i I c 14" Gi oaf 2 5!Y Px. . ..Z3 a �dn 4= Jdicil- ti/o�: P:l;m�.s fiof stioW;,. :iT'Z7jMKN5av's . 'ARECTtD 8'8 - Oo W .. tz X59] r......• .. AS -BUILT NO CORNERS SET THIS DATE! I hereby .ecrtiy tbat I. have performed a M sp-ection:of the following Qescribed property Block 1. Bear Va l,/el, Sabd. Anchorage Recording precinct, Alaska, and that the Improve- ments situated thereon are within the property lines and do 'not overlap or encroach on the property lying adjacent there- to, 'that no Improvements on property lyingpdiacent thereto encroach on the premises In Question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. - Dated at chorage, this—[_day of 04 )1 Co 19 K.d W06A N0. 34533 q �9F O•A90(2cr,nuM ••••.... w•'••Np�a �* d LS .Pcnrl:/�ef all Y AS -BUILT NO CORNERS SET THIS DATE! I hereby .ecrtiy tbat I. have performed a M sp-ection:of the following Qescribed property Block 1. Bear Va l,/el, Sabd. Anchorage Recording precinct, Alaska, and that the Improve- ments situated thereon are within the property lines and do 'not overlap or encroach on the property lying adjacent there- to, 'that no Improvements on property lyingpdiacent thereto encroach on the premises In Question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. - Dated at chorage, this—[_day of 04 )1 Co 19 .P;1 LS .Pcnrl:/�ef all Y � . j`1e.vGS Ex AS -BUILT NO CORNERS SET THIS DATE! I hereby .ecrtiy tbat I. have performed a M sp-ection:of the following Qescribed property Block 1. Bear Va l,/el, Sabd. Anchorage Recording precinct, Alaska, and that the Improve- ments situated thereon are within the property lines and do 'not overlap or encroach on the property lying adjacent there- to, 'that no Improvements on property lyingpdiacent thereto encroach on the premises In Question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. - Dated at chorage, this—[_day of 04 )1 Co 19 GARNESS ENGINEERING GROUP, Ltd_ . CONSULTANTS & GENERAL CONTRACTORS - May 12, 2008 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Lot Line Waiver Amendment for Bear Valley; Block 1, Lot 7 To whom it may concern: Per our inspections and after close review we have found that the septic tank lies approximately 2 feet away from the west lot line We request that your department amend the existing 5 -foot lot line waiver from the west property line to the septic tank to 2-feet.The neighboring lot 6 is vacant per MOA records. We are unaware of any adverse impacts this waiver would have on adjacent wells or septic syAems. If you have any questions, please contact us at 337-6179. Thank you for your assistan .E., M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: www.gamessengineering.com RECEIVED MUNICIPAUTY OF ANCHORAGE FEB 1 d 200 • DEPARTMENT OF HEALTH & HUMAN Division of Environmental Services ,pivot,#", TAL SERvx_E On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 -''CERTIFICATE OF HEALTH AUTHORITY APPROVAL'FOR A SINGLE FAMILLY DWELLING Parcel l.D.# 020-431-13 HAA# 1. GENERAL INFORMATION Complete legal description. AilLy SijRr)MS1QN• "r OT 7Rt OCK 1 Location (site address or directions) 9340 HONEY BEAR LA Property owner W11 L .Ar, AND NRA HINMAN Day phone (3155) 673-0901 Mailing address c/o PRUDENTIALVISTA ATTENTION- GREG RROOFRICK Lending agency Day phone Mailing address Agent nRFG QRQQFRIC� ,,, / PRt tr1FNTIAI VISTA Day phone 773-7299/727— 9627 - • Address 4241 -R- STREET ANCHORAGE AK 99503 Unless otherwise requested, HAA will be held to pickup. M� 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XX _ Community well r Public water • NOTE: If community well system, provide written confirmation from State ADEC attest -'9 Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xx Holding Tank Community on-site Public sewer . _ NOTE: If community wastewater system, provide written confirmation from State ADEC Ing to the legality and status of system. . 72-M (Rev. 1191) Font MOA 021 Computer Version r z 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and inspection, a on-site water supply and/or wastewater disposal system is In compliance with all Municipal and to codes, ordinances, and regulations in effect on the date of this Inspection. Name of Firm Engineer's Signature1x _ __11aska,Water '�V Wastewater Consultants, Inc. Shall be PAID 34.— at, . or prior to, closing oir the Engineering Services Provided. 6. DHHS SIGNATURE Approved for bedrooms Disapproved Conditional approval for *-, Additional Comments By: Phone (907) 337.6179 2 bedrooms, with the following stipulations: Dated -a 3 -D O 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 conductlnspections 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. V91) Back MOA #21 Computer Version Municipality of Anchorage t_*1R F C E 1 V E D DEPARTMENT OF HEALTH & HUMAN SERVICES - Envimnmental Services Division FEB 1 a 2000 825 "L' Street, Rm 502 Anchorage, Alaska 99501 (907) 3434 . . .47...�.4„ Lit w,v_nUKAG . V ir.;NMLNTAL SERVICES OIVI” Health Authority Approval Checklist Legal Description: BEAR VALLEY SUBDIVISION: LOT 7, BLOCK 1 Parcell.D.: 020-431-13 A. WELL DATA Weil Type PRIVATE If A. B, or C, attach ADEC letter. ADEC water system number N/A Log present (YIN) YES Date completed 10/11/78 Total depth 190' Cased to 29' (TO BEDROCK) Caging height (above ground) 12"+ Sanitary seal (YIN) YES Wkw properly protected (YM) YES FROM WELL LOG Date of test 10/11/78 Static water level ARTESIAN Well production 5.0 g.p.m. AT INSPECTION 1/13/98 37' 1.3 g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate VQ Other bacteria n Date of sample: of — I - O D Collected by: A.W.W.C.. INC. B. SEPTICIHOLDING TANK DATA *HOUSE HAS BEEN VACANT SINCE PUMPING. Date installed 7/29/88 Tank size 1250 Number of Compartments 2 Cieanouts (Y/N) YES Foundation deanout (YM) YES Depression (YIN) NO High water alar (YM) N/A Data of Pumping $1/15/99 Pumper A+ HOME SERVICES 1) NORTH TRENCH s� PR'H THE F°u owrNc. C. ABSORPTION FIELD DATA ) ass cAu9Ns ON 1/e/99. 154 GALLONS o 1) 9/8/78 2 SOUTH TRENCH t/11/99. ac 557 GALLONS ON 1/13/99. Data installed 2) 7/29/88 Soil rating (g.p.dJII2 or f 2r0dr) 135 System type TRENCHES 124' 1 2.5' 1) 8' 1) 13.7' Length 2 23' Width 2 3.0' Gravel thickness below pipe 2 5.5' Total depth 2) 9.9' (1 — 384/2 — 253) Effective absorption area 637 TOTAL Monitoring Tube present (YM) YES Depression over field (YM) NO Date of adequacy test 1/15/99 Results (Pass/Fall) PASS For 4 Bedrooms Fluid depth In absorption field before test (Ina; 28" Immediately after 794 gal. water added (In.): 57" Fluid depth 32" (Ins) Minutes later. 1350 Absorption rate = 600+ Peroxide treatment (past 12 months) (YIN) NONE KNOWN K yes, give data ----- 724= (FW. s195p CMVUW VWdM D. LIFT STATION Date installed Size Manhole/Access High water alar level at*_"Pump off level or *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Sepfidholding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100' On adjacent kris 100'+ Public sewer main - N/A Public sewer manhole/deanout _ N/A Sewedseptic service line 25'+ LIR station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: *PER INSPECTION REPORT Foundation 'S' Property One 'S' Absorption field 'S' Water maintseryce line 10'+ Surrace water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: *PER INSPECTION REPORT Property line 'S' (WR88-043) Building foundation '6.5. Water main/service line 10'+ Surface water 100'+ Driveway. parldng/vehlde storage area 10'+ Curtain F. ENGINEER'S Iceal&met I ofMunid n with M Engineers /le/d InspeWons and review systems are M conformance 3n th/s date. HAA Fee S ' Thep Date of Payment 2Jl Lilco Receipt Number 5 m C 59 210 72am mn Ser cwvuw vawm Wells on adjacent lots 100'+ Waiver Fee Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES H88-0314 DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 7 Block 1 Bear Valley Subdivision (TllN R2W Section 6) Location (address or directions) 9340 Honey Bear (b) Property Owner Robert J/June A B� &e: Home(Marriott HostuAQpcation) Mailing Address PO Box 6231, Anchorage, Alaska 99502 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Curt Carley, Re/Max Address 2600 Cordova, Suite 100, Anchorage', Alaska 99502 Telephone 276-2761 (e) Mail the HAA to the following address: or: Check here if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family Ek Number of Bedrooms Four (4 ) 3. WATER SUPPLY Individual Well [Rx Community El Public O Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ®x Public ❑ Community 0 Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/86) Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Alaska Environmental Cons tro lTA&iThgkpe s, Inc. Address 1412 West 33 Avenue, Anchorage, Alaska 99503 Date Engineer's Seal This is a retype from the department's file copies. The original Certificate apparently has been lost. 6. DHHS APPROVAL Approved for Four (4) bedrooms by�, d P, - ZX -Z -Date August 3 , 19 8 8 Approved XXXXXXXXXXX Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/86) Back A. WELL DATA MUNICIPALITY OF ANCHORAGE (MO.,j HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: 407– 7at/?R ✓'/ 711AI R44J 5.6-e- 6 Wall raaccifinafinn- / ;e1t.1AV If A R r. n F r. Annmvori /V/N1 /4/14 Well Log Present6N) Date Completed /0 7Yield Mx'75" Total Depth /90 Cased to Depth of Grouting W14 r Static Water Level _ �..� Pump Set At Casing Height Above Ground t Sanitary Seal on Casing Y N) Electrical Wiring in -Conduit&) Depression Around Wellhead (Y( Separation Distances from Well: i To Septic/Holding Tank on Lot ��o ; On Adjoining Lots To Nearest Edge of Absorption Field onof ��• ; On Adjoining Lots To Nearest Public $ewer Line To Nearest Public Sewer Cleanout/Manhole To Sewer Service Line on Lot aS 7arest Water Sample Collected byf �►' Gtr ; Date 7'y� �� �� ^"T �f �• Water Sample Test.Results �/ ('.nmmantc A PJAL` AAsJ -7WT B. SEPTIC/HOLDING TANK DATA Date Installed ' Size /LSO No. of Compartments y StandpipesON) Air -tight CapsVN) Foundation Cleanout UN) Depression over Tank (Y19 l// Date Last Pumped 14 Pumping/Maintenance Contract on File (Y/N) � A ; for Holding Tank High -Water Alarm (Y/N) —Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well ne" To Building Foundation Jr To Property Line S To Disposal Field A) To Water Main/S& ice Line /a To Stream, Pond, Lake, or Major Drainage Course /0,V 10– Comments Pagel of 2 72-026(11/84) A 7 a f Aix ✓Au*Y C. ABSORPTION FIELD DATA Depression over Field (Y© Date of Last Adequacy Test ,- -14 -ff O el41AI 4 Results of Last Adequacy Test A&Z uAIV" 7K� Separation Distance from Absorption Field: To Water -Supply Well To Property Line r% To Building Foundation �•S To Existing or Abandoned System on Lot /lam ; On Adjoining Lots oa -,A- To `To Water Main/Service Line �� �"f" To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /Oa I, - To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION =ledSizelons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Purfl`r_*�Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha he d, veri ied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �' . Date „►�GG► OF A4 CompanyMOA No. P'�F:''•�•••'•��r0 Ar Receipt No. �.y: 4 H ��ir♦� Date of Payment C—� 0•••�•• • •• •••..••:... Amount: $ ✓ �` •. Y �. RE R. •• M CE . 2251*s S toe 4► Page 2 of 2 i,\ri►� 72-026 (11/84) /3S 7TRE.�c� Soils Rating in Absorption Strata Type of System Design/ Date Installed o)el4- 9 78 ui+k�" '7-Lti-� `a Length of Field v e/4' +'� ' A. Z-3 Width of Field a�/�- y'� uPEi. i, Depth of Field 0416 17 NP57• r Gravel Bed Thickness oA/h $ NPS �S Square Feet of Absorption Area �D3 Standpipes Present ®N) Depression over Field (Y© Date of Last Adequacy Test ,- -14 -ff O el41AI 4 Results of Last Adequacy Test A&Z uAIV" 7K� Separation Distance from Absorption Field: To Water -Supply Well To Property Line r% To Building Foundation �•S To Existing or Abandoned System on Lot /lam ; On Adjoining Lots oa -,A- To `To Water Main/Service Line �� �"f" To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /Oa I, - To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION =ledSizelons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Purfl`r_*�Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha he d, veri ied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �' . Date „►�GG► OF A4 CompanyMOA No. P'�F:''•�•••'•��r0 Ar Receipt No. �.y: 4 H ��ir♦� Date of Payment C—� 0•••�•• • •• •••..••:... Amount: $ ✓ �` •. Y �. RE R. •• M CE . 2251*s S toe 4► Page 2 of 2 i,\ri►� 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Datr 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal DescriptionF'(,'tn!ilude lot, block, subdivision, section, township, range) �r � a`��`�� �L�x ✓,�� V, �. Location (address, or direr tns) (b)-: Propert)y:,yOwnerh *77, 7 elephone: Home Mailing Address (c) Lending Institution. Mailing Address (d) Real Estate Company and Agent Address 2666 [�AoY� Ir�Q Telephone Z74'a74 / (e) Mail the HAA to the followina address: or: Check here List contact p�on and day phone nymber below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms _ Telephone elf,er if hold for pick up. Business 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front t, 7 Al 'sov ✓AZA?l 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address /g/ "h/0 oweb, AAe 99 3 Date 2 /" e -K- 6. DHHS APPROVAL Approved for 1f&= bedrooms by Approved — X , Disapprove( Terms of Conditional Approval 4" aZ Date "7 ow Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8/86) Back E DAILY DRILLING LOG PENN JERSEY DRILLING CO. 2833 East 72nd Avenue Anchorage, Alaska 99502 344-2612 OWNER OF LAND .............. -------------••-- ----..............._ , -.................•----.........--•-----......._. .. DEPTH OF WELL -----•---------- " Y40 •---•------ ------------------------------------------------------------------------ ADDRESS...................•---•------•---•--...---•----.........----•---•--•---•---••-•--•----.............---•--...-•--• STATIC LEVEL OF WATER FT ---------------------------------------------------- ------------------ --------••-------WELL—SITE........--•--•-----------------•--•-•-••-•------•--•-•-----••-•-•-----••... WELL—SITE ........................................................................... ................................. DRAW DOWN FT ------------------ -•-•-•-••--••-•-----.....-----•-•-•--------•-----------------------------. DATE—STARTED....................................................... , :78 ----------•-..... GALS. PER HR. S 60H --•-•----•-•---•----•----------- ------- ------------------- -- KIND KIND OF CASING------------ DATE—ENDED ................. ........`................................... ....................................... ......•..... ----------------•-------------- :j -------------------- ---------- KIND OF FORMATION: FROM...............(3........ FT. TO ---------- .............. FT._P Pc4f ........................... FROM- FROM-•----•... ............... FT. TO----------- ----------- ---FT.- ------------ -- ---------- FROM---- ----•---••--. FT. TO FT._.__G rc v e l t 5akj - FROM .......................... FT. TO ------------------••......FT.-----•------....... .............. ZZ 29 6yc%(e4 FROM...... FT. TO FT._Cluy..k . FROM. FT. TO FT. z9 Igo aej zaCk FROM.......................... FT. TO .......................... FT ...................................... -- FROM----..-... ..... FT. TO ------------------......--FT.----- ...................... FROM.......................... FT. TO .......................... FIT .................................... FROM----- .................... FT. TO .......................... FT............................ ........... FROM.......................... FT. TO .......................... FT ........................................ FROM..........................FT. TO .......................... FT......................................... FROM.......................... FT. TO -------------------------- FT------- -------- ------------------ FROM---------- ..............FT. TO- ........................ FT.--------.............. ...... ---------- FROM --------- ---------FROM--------- - ------------FT. TO.... --------------------- -FT.------------- ......... -- ---- FROM......-----•------------ -FT. TO .................. .... FT................. --------- ------------- FROM ... ------------FROM--- ------ - - ---------FT. TO .......................... FT...................... ---------------- FROM..........................FT. TO..... ... -------------- FT.- ------ ............. ---------- ------ FROM------------ ............. FT. TO .......................... FT......................................... FROM----------------------- .FT. TO- --------------------- -XT .......................... ------------- FROM..........................FT. TO .......................... FT......................................... FROM------......-- ---------..FT. TO------------ .......... -FT ............ ................. ---------- FROM..........................FT. TO .......................... FT......................................... FROM... ------------ ......---FT. TO .......................... FT- ....... ----------------------------- MISCL. INFORMATION: 4�,ery Wi)t=er-YKhl�!kn,4 ©✓ WL' -tC� Oct aPffax DRILLER'S NAME ................... ....... ._... -•--------.i..- -----•------ -....... ........ .......... ........ A EC S ALASKA RUIROURTAL COnTROL SCRUIUS, IX Q Cngineerinq & 6nuironmental Studies Aligns i .1 19188 188 Mimici- paiity of Anchorage lie, or (-.iliE nl. of IIE o 1, \.h ±c lhim In Sere_*, res, ;2; F, Sf_r'eri ;nc1;Oriige, AK 99501. F7: Bear Vo I l ey Subd i v.i. s i_on , P>i L7 Peor Vii'. Rodd: -s•Wt ripgi''IdO of t'e sewer syt9tem is, comp .Ie(.c; The tj-i e ch i`.-; 6.5 feel.. From -"Aw hnr( f., :it its elnsae,7- nolo":_ The trench v7aS installed in SP/GP soill which had caved a n lit it few 1 oc ;) I I ons II okl n5 some of Mile 1�rench g e'F i=or ( ban ' 'e i' No credit is being given for extra. wj(Ith. TItc hoii-ie 1-`.z 1)IJ i I i, on ld 1 It g's . The wise Ali_ groond s11Y_'f ince i.s covered W i 'ch wood ski -rting. Since. there, is no standard coil' -,rel. c' fomidaL i oil, 5 ro ti ')eparaiion Lo 1_he house wl i -I noir. haver a i i v eFJ'et i'. oiI =. itE1 'c)L.se :m c;(l,_r:_,)-1`. yoll approve 1-hc t,rerlrh Location. If yon 'rave on;T Iiic'si:.iulls, ,ilc z;e c; l l rv.w ei p %,t ® >r �•4 T" i% ROY C. REID, e 1+ CE - 2251••: �� •. Aj�w C. Wien Terhni cim, 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (901) 561-5040 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. of H;,;,A 1711 &828 DEPARTMENT OF HE=ALTH & ENVIRONMENTAL PROTECTION ENVIRO Alaska 99501 NMEN7AL PROTECTION L Street - Anchorage, i' ENVIRONMENTAL ENGINEERING DIVISION SEP 14 1979 Telephone 264=4720 n REQUEST FOR APPROVAL OF INDIVIDUAL' WATER AND SEWER�Rt'F�4I�aED DIRECTIONS: Complete all parts on page 1, incomplete requests will not be processed. Please allow ten (10) days for processing. 1. P.BAWTY OWNER j', PHONE ❑ One ❑ Four ❑ Other SINGLE FAMILY MAILI GADDRESS /1 MULTIPLE FAMILY( PR PERTY RESIDENT (if different from above) �.o PRONE Y� INDIVIDUAL* 2PHONE ❑ COMMUNITY since June 1975. For wells drilled prior to that qte, give well ❑ PUBLIC UTILITY MAILING ADDRESS 3. LENDING INSTITUTION PHONE old wran MAILING ADDR S R141_ I J60 ci '" UL1At>LS 4. REALTOR/AGENT PH NE MAILING ADDRESS .•�....`� S. LE L DESCRIPTION STREETLOCATIOlq 8. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY 1:1 ❑ Five MULTIPLE FAMILY( Three ❑ Six 7. WATERS PP INDIVIDUAL* *ATTACH WELL LOG. 'Awell log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that qte, give well ❑ PUBLIC UTILITY depth (attach log_ if available.) 8. SEWAGE DISPOSAL SYSTEM **If individual/on-site, installation date INDIVIDUAL/ON-SITE** give If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED y TIME TIME TIME DATE 3 DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 3 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ . .MULTI,Pl,E F MILY NUMBER OF'BEDROOMS ❑ ONE ❑ THREE ❑ 'FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL' I ❑ COMMUNITY1 1:1PUBLIC,UTILTY Connection Arified PERMIT NUMBER DEPTH OF WELL DATE pRILLED '• _ LOG RECEIVED 3. SEWAGE DISPOSAL. SYSTEM ❑INDIVIDUAL/ON -$ITE ❑PUBLIC UTILITY L Connection Verified I PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Iding Tank Size: CGS If Tk is homemade give dimensions: SOILS RATING TYPE OF TANK I MANUFACTURERS L6t:�241 TOTAL ABSORPTION AJEA MATERIAL 4. DISTANCES t WELL t0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to neares Lot Line 5. COMMENTS t APP COVED FOR 3 BEDROOMS ❑ CON ITIONAL APPROVAL (letter must accompan ertificate) DISA PROVED DATE .-- BY (Title) LEGAL DESCRIPTION z 72-010 (Rev. 3/78)