The URL can be used to link to this page

Home My WebLink AboutBEAR VALLEY BLK 4 LT 2Bear Valley Block 4 Lot 2 #020-431-23 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211221 PID Number: 020-431-23 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name EMILY K. ARCHULETTA ABSORPTION FIELD ❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound Site Address 9141 SNOW BEAR DRIVE, ANCHORAGE ❑ Other Phone Number o f Bedrooms Soil Rating Total depth from original grade 3 1 GPD/SF 2.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.0 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision BEAR VALLEY Block Lot 4 2 Fill added above original grade VARIES 2.17 - 4.27 Ft. Gravel length 2 @ 45' 90 Ft. Township Range Section Gravel width 5 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 450 Ft2 2 8.5 Ft. Well 50'+ 50'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ® Other ADVANTEX Manufacturer ORENCO / ANCH. TANK Capacity 1500 Gal. Surface Water 50'+ 50'+ __ Material COMPOSITE PLASTIC Number of compartments 2 Lot Line 5'+ 5'+ __ NA Foundation 10'+ 10'+ -- LIFT STATION Manufacturer ORENCO Capacity 1500 Gal. Remarks Alarm location BASEMENT Electrical installed by CAPSTONE Installer A+ PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection dates: 1st 11/9/21 2nd 11/9/21 Location and description 3'd 11/10/21 4" 11/11/21 TOP OF SONOTUBE ON-SITE WATER AND WASTEWATER SECTION APPROVAL -=A. Conditional Approval: Date low"' '00,*: 49 TH ....�:* • • • • • • • • • • •vim• Septic System A roved Approved rt / % • Curtis Huffman - �/% n ��j�``cis. CE 128991 N a —2 Date Z 7 / 1� lF�•. 11/19/20�1•�QG pROFEWQAW ,i\\�,`11� Note: this approval does not include well permit requirements. io..,. ncinnin n PERMIT: OSP211221 PID: 020-431-23 A—C=55.1' B—C=33,4' A—D=58,4' f'" 89.73 AX20 POD MH MT CO B—D=37,5' SPUTTER A—E=58.8' 85.95 1500 -GAL 6.82 B—E=40.3' FAP 2.0 ADVANTEX 8 A—F=71.8' TANK 84•43 CO ORIGINAL GRADE EMILY & ZACK ARCHULETTA B—F=54,5' THz,-, A-6=70,5' it C SEPTIC SECTION B—G=65.8' SCALE, NTS A—H=84,6' IE B—H=78.4' �tA � OF �� 01111 �0 9 TH tis xuffman I XCE 128991 11 /19/2021cs DPRSSI0-0-' BEAR VALLEY BLOCK 4, MT CO VO FINAL GRADE 90_50 86.23 ORIGINAL GRADE EMILY & ZACK ARCHULETTA FILTER FABRIC THz,-, ORG/OL C r 23 94.23 FIRST WATER SEWER ROCK !3 83� GM/SM/ml DATE: FINAL GRADE MT CO 85.42 SURVEY: HOLT 83.0 DRAWN: FWCS ORGINAL GRADES -0 GRND.WTR. 11 I FILTER FABRIC O 5.5' PAGE: 6/10/21 FirstWaterAK©gmoil.com 14' _00 8,.00 BOH SEWER ROCK 69.00 50 80.50 -"\ RELATIVE ELEV. TO LOWER TRENCH �tA � OF �� 01111 �0 9 TH tis xuffman I XCE 128991 11 /19/2021cs DPRSSI0-0-' BEAR VALLEY BLOCK 4, LOT 2 SUPPORT®SERVICES: PREPARED FOR: EMILY & ZACK ARCHULETTA 9141 SNOW BEAR DRIVE C ANCHORAGE, AK 99515 FIRST WATER CONSULTING DATE: 11/19/2021 13030 Sues Way SURVEY: HOLT Anchorage, Alaska 99516 DRAWN: FWCS (907)350-9566 SCALE: 1" = PAGE: 1 OF 1 1 FirstWaterAK©gmoil.com �tA � OF �� 01111 �0 9 TH tis xuffman I XCE 128991 11 /19/2021cs DPRSSI0-0-' MUNICIPALITY OF ANCHORAGE 0r1 -Site Water & Wastewater Program PO Bo?c 1966"4 4700 Elmwe Road Anchorage, Alaska 995113-6050 Mane; (907) 343-7944 Fax; (947} Y3 -79t,7 h?tp:f-Wnw�.nrj0.or&neite 0 n -5 ate Wastewater Disposal System Permit Poem -it Numbor: O P211221 Fork Type; SeMir, U p9 ra d& Tax 4iperr- Numnbc�r: 0204312;3000 Sit -9 Legal Andress: BEAR VALLEY ELK 4 LT 2 G_3242 Site Klailirig Address: 9141 SNOW BEAR DR, Anchorage Owner: ARC1-i U LETTA Ml LY K Desitin Engineor; FIRST tiaVATER CONSULTIMG Th is perm it is for th c co Dstru ction of, EffectIve [date: Expiration Data Lot Size Irt Sq Fl_ Total B-edrooms, 6,x2412021 QQ4j ZO22 45915 Q Disposal Field Q Septic Tank I-1 Holding Tank ❑ Privy ❑ Private Well ❑ Waler Storage 3 All co nstructivTt s h al l be i n at; cardan ce with: 1. The altoohed approved d$!�ign. 2. All requ Womenks specified in Anchorage Mkinicipel code Chapters 1.5,55 and 15,65 and the Slate of Alaska Waslewater Disposal Regulations (1 SAAG72) and Drinking Water Regula ions (IELAA�;80) 3. The vvo: emla i lcr cods: i c quirGj io;�p iooa duOr ig lh i ; it lutml lrf liuri- Thio esmyiriwesr d h dll m l.ify they Development ervIces Oepsr tent par AMC 15.65. Provide nojlfrcallon by caIihmg (907) 343-7904 (2417). 4, From Qcteber 15 to April 15, a sub�surface soil absorption system under conalruttion during freezing weather shall be either_ 2, Opened ;nd C:Iased on the same day, or h. Covered, sealed, and heated to prevent freezing S pcc i al Provision s - To util ize the r�iuced ve rtira1 cepa ration to seasonal high gro undwater For an AVNs, the field n eeds to to pressurized or split into 20 ft segments- I n th is case, the field s are being split into 22.5 ft segments, but the fi-elds are significantly ov$T-sizer Therefore, the 22-Sftsagrmnnts is acGeptaf l -o. -i R$aeiuod By: i-: Issued By, —14F 6)24 0121 121 Date: D2tp:. MUNICIPALITY F Development Services Department'' On -Site Water & Wastewater Section Parcel I.D. 020-431-23 ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) EMILY ARCHULETTA Day phone _ Mailing address 9141 SNOW BEAR DRIVE, ANCHORAGE, AK 99516 Site address 9141 SNOW BEAR DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) BEAR VALLEY B4, L2. Legal description (Township, Range & Section) Lot Size 45,915 Sq. Ft. Number of Bedrooms 3 Phone- 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade Q Duplex (D) ❑ Holding Tank ❑ Renewal ElMultiple 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: 4- X9-5 Waiver Fees: Date of Payment: 6Z!�15 Z l Receipt Number: Permit No. OS P 12 Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13021 Montego Circle, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com June 14, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: BEAR VALLEY BLOCK 4, LOT 2 The septic field has been found failed, possible encroaching groundwater and we request a septic permit to upgrade the system on the above referenced lot. We propose to install two shallow trenches with and Advantex system to serve the existing 3-bedroom residence. The design is based on the recent test hole conducted on June 3, 2021. The slopes are moderate at 10-15% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Attachments: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211221, Rebecca Carroll, 06/24/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211221, Rebecca Carroll, 06/24/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211221, Rebecca Carroll, 06/24/21 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: BEAR VALLEY B4, L2 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/14/2021 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 GM-SM/ml 5 6 7 8 9 10 11 12 13 14 15 BOH 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 6/10/21 30 min 6 1 4/16 30 min 6 1 4/16 30 min 6 1 5/16 PERCOLATION RATE 24 (MIN / INCH) TEST RUN BEWTWEEN 3 & 4 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: 7 DEPTH TO WATER AT MONITORING: 5.5 DATE: 6/10/21 TESTHOLE # 21-1 DATE PERFORMED: 6/3/21 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: ZACK ARCHULETTA 6/14/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211221, Rebecca Carroll, 06/24/21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES/j�®�, ¢3� 2- Environmental Health Division -3 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES I Khps�q * CHgk-,> H00 TO SEPTIC ABSORPTION WELL Address FROM TANK FIELD l9 oriTrl ":E> WELL Phone(s) Permit No. No. of Bedrooms LOT LINE A— LEGAL DESCRIPTION Lot Block Subdivision FOUNDATION J+ to W Township, Range, Section -2_-%"J AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, ;k '. driv%way, water bodies, etc.) TANKS It li.,,v I 1 -5- 1 SEPTIC HOLDING El A l -2,L L2>1's'll -xdI 40 al 40 L,ul -a 1 5; w , ' Manufacturer Capacity in gallons NA LM Material No. of Compartments Z TYPE OF SYSTEM XTRENCH El BED El W. DRAIN El OTHER 7 All Depth to pipe bottom from original grade Total depth from original grade '*" FT 5 FT• Fill added above original grade Gravel depth beneath pipe Q FT FT Gravel length 'l Gravel width 9 5?P +2--A = 7- FT 3La 1* Total absorption area Distance between lines eAA SO FT 12, FT Tj 11 dt Number of lines Soil ratting Pipe material ZLeO SOFT 3o jJ Installer Date Installed &-C\C> WELLS vil R1 �9 PRIVATE 0 OTHER (Identillv) Classification (A,B,C) Total Depth Cased to FT rZ Installer Date Installed: REMARKS: -k- 2_' L -i FT & - GUlit S /A i -J Scale. Inspections Performed by: ENGINEER'S SEAL jj Date: vK6 A t4 IZ_C_ Ld b C-7 it Art -FIC. Wile /aeo 'k L S ENGINEEk;0ri certify that 11 Inspect' n was performed according to all as le River Loop 16 unicipalla§1 ;date. M 7 !V;e; Eag —12 Health Department Approval: D ate: 72-013 (3/85) Al - MUNICIPALITY OF ANCHURAG� Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343 Q N --S I T E S E W E R P E R M I T /' °~~-� Permit Number: 900259 Upgrade Date Issued: 08/27/90 Engineer Designed Owner Name: MARY & CHRIS HOOPS Day Phone: Owner Address: 9141 NORTH SNOW BEAR 345-7395 ANCHORAGE, AK 99540 Parcel Id: 020-431-23 Lot Legal: Subdivision: BEAR VALLEY Lot: 2 Block: 4 Section: 6 Township: 11N Range: 2W Lot Size 45915 (sq.{t. or acres) Max Bedrooms: This Permit: 3 Total Capacity: 3 SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) { 4.0 feet requires insulation over tank(s). INSTALL PER ENGINEERS ATTACHED DESIGN. NOTIFY DHHS PRIOR TO EACH INSPECTION. VERIFY WITH MOA PUBLIC WORKS IF ELECTRICAL PERMIT IS NEEDED. THIS PERMIT IS ISSUED FOR THE EXISTING 3 BDRM SINGLE FAMILY DWELLING ONLY AND EXPIRES ON 12/31/90. I CERTIFY THAT: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. I. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms. I also understand that the capacity of the total system is 3 bedrooms and any enlargement will require an additional permit. Signed: DATE: ---..... ..... . ..... -..... ..... ... -»~^ ruorcr1'nn�� Issued By: DATE: I LEGAL DRAWN DATE _ _G ^ I SHT. f 69d A. iShofa, No. 1157-€ FES; EM��T ak -- ZO I _�� ✓l / 0 5�c; Le�gchfeld Co 0 '"T _ s Go OT4 field , to b�� _ Mr AbAlvd C Ofd �� GO GC °/"��'� FYIS M 1 gid 5 1 k --,s ��SIGN � tt-ECIA 3 di� -- 0o4`�'regjv�red u5E -3 4'grmued y `cover Nofe: /�JdprnjAfe- v ->(_111S wA;ro, oc 0 fcposcd SepfiG, p W No public 2C0' cf�� CoScci SE�ti�. m Q c rJtRAGte,' t hAll {ae -e,sPoNs�bleororeeti fi��_Jfi �et��5 ro fotlo I � w Go+vfo 01, C, r !,q V A W a it J OO i�r9Ci � u S v -)Nowe gar 1�c ive �v�' ell Iw C. �Cy •o � � Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ^ set$ reM».x•44»• ••. •• > 825 "L" Street, Anchorage, Alaska 99502-0650 •40 44•x4 •w•••Y•MYw Y*°�♦ SOILS LOG — PERCOLATION TEST 'Nobed A. Shafer �, ••� No. 1457-E tom_ PERFORMED FOR: �ci< W LT T[- Cpb6i-2A)i'G�A-)f DATE PERFORMED: LEGAL DESCRIPTION: &,SIC I)AIIP_a Township, Range, Section: DEPTH SLOPE SITE PLAN -A%F Efk^ 0j- 1 � o 2 p/ /O 3 /O� I 4 [5/V\ ZL08181r 5 /.0/ � 0/a 7 8 o, a 9 %off 10 O /a WAS GROUND WATER /O ENCOUNTERED? �o 11 s •O/p IF YES, AT WHAT L O DEPTH? 12 Of E Y �� Depth to Water After 13 �O H Monitoring? — Date: —a:1"D 14- 15- 16- 17 4151617 18- 19- 20- COMMENTS 81920COMMENTS Net Depth to Time Water FI� PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER_ TEST RUNZ��A' FT AND ( FT -}I C)v- �D T c <� 1 i N9 PERFORMED B�1:7034 Eagle River Loop Road No, tagle River, Alaska 77 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUID S IN 72-008 (Rev. 4/85) CERTIFY THAT T IS TEPT WAS PERFORMED IN ECT ON THIS DATE. DATE: MUNICIPALITY OF ANCHORAGE o 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 4Arr-,� `Y'e A_Son PHONE 0.7618 IeTNEW ❑ UPGRADE MAILING ADDRESS 3039 ^DQnnIngton LEGAL DESCRIPTION Lot 2 B Lt V-ilcy LOCATION ��//Q SV'6w ea+- 6* (l NO. OF BEDROOMS 3 UY DISTANCE TO: Well j 0 Absorption area 31 Dwelling 58 PERMIT NO. 8 z0 613 F- Z w Manufacturerh Ah cit 0r-a Material .S I-ee 1 No. of compartments 2 H Liq. capacity in gallons Idp�j IF HOMEMADE: Inside length Width Liquid depth ❑ Y JaZ DISTANCE TO: Well Dwelling PERMIT NO. O Z 4 Manufacturer Material Liquid capacity in gallons ❑ w = DISTANCE TO: Well Z Foundation 8b Nearest lot line 3 0 } PERMIT NO. Z66 I'3 J LL Z P Z w No. of lines i Length off�each line Total length of lines L �� Trench width inches Distance between lines — QrrTop e of tile to finish grade / 2 Material beneath tile t Og inches Total effective absorption area 8 2-8 a' W Length Width Depth PERMIT NO. QF Uj a w Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W 3: DISTANCE T0: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS PV C C SOIL TEST RATING INSTALLER a k7 i i� M C' H2nr Z �� (N � � � Y REMARKS pc we, lin e e cn Aj O e j1 $I10N Cor r%Ve APPROVED DATE LEGAL 'Tl Z Z. Lot 2 434 U@-,, V&%E3 72-013 (Rev. 3/78) WATER WELL RECORD VZRM MUOC & STATE OF ALASKA -- M DIm DEPARTMENT OF NATURAL RESOURES A ---bo""p_7 Division of Geological 9 Geophysicol Surveys Drilling Permit No. 1_8[A7IAW DF WELL --� ��--��T�oGi cowloMte either -lo. Ib or IC.) A.D. L. No. lo. Borough Subdivision Lot Bbek 1/44trs. Section No. Township Np Range EQ Meridion 2 P,af_of_of— 60 WO la DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS b. OWNER OF WELL: Harry Te -,sen Address:_ .. ar Valley Street Address and Area of Well Location !. WELL L06 Feet Belowface 4. WELL DEPTH: (final) 225 S. DATE OF COMPLETION! 7 _ _ ? Material Type Top Bottom - ft. 40 5 S. O Cable tool ® Rotary 0 Driven ❑ Dug ,7r. yely 0 Auger bJettod ❑ Bored ❑ Other: *.,.,, br-yvm silt C :: 5.4 54 T. USE: `3! Domestic 0 Public Supply 0 industry 0 irrigation 0 Recharge D Commerical Q Test Well 0 Other: ' '`15 r C • ;r r]—, ,— 8.0A ThnodN ® Welded dime. in. to_7L_ ft. Depth weight lbs./ ft. diem. In, to ft. Depth Stickup It. z, rock white streak 1 150 rt t+ ft p 9 $. FINISH OF WELL: - Type: Dlamotsr: Elat/Mosh site: Length: Sot between ft. and ff. Growl pock STATIC -WATER LEVEL:__ 78 _ft. I-- _ -- -- — -11L - - Date QAbove or 9 Balow land surface Equipment used: ---- ----- --- — '-- `" -""- - "TT: -PUMPING -LEVEL -below -land surface and YIELD ft. attar bra. pumping IC-) ft. offer hrs. pumping g.p.m. 111.6110UTING Well Grouted: D Yes C3 No Material: 0 Neat Cement 0 Other: I$. PUMP: (if available) HP m Length of Drop Pipe ft. capacity g.p.m. a a O sub". [] Jet Centrifical 0 Other r n 310yd 3ca�0 N-LIV3Hd0 •ld 14. REMARKS: e vdt DiNn 16. WATER WELL CONTRACTORS CERTIFICATION: - 16. Wotor Temperature a O F 0 C Tris well mat 4lrillsil under my jaristictlon and -this report Is trusts the bast of my knowledge and belief; ' ernes i',rilling & Eaterprises AA 3327, Registered Business Nems Contract Llkanso Number Box 1 Ake, 99507A.dress: Z x�v n St, SRS k 12- Signed: Data:�' _s� #ufborl Reprssentollva niri� D! -t1 WK T(fli(t) Cepy o+.+ribatlon: WHITE•Stofe DGGS, PINK -Driller, CANARY CuftoaMr E> E= F" -F IA= ;1L w1L'0? �K 44 C2i -T- R -A= A- 27 C3 K FA A? K L_ ��-v t -i= �'�� 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 AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRHYEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F.!! F___ G -A LJ 1: F-� K E> in EO F"l- I C7 �� I F--= --1L C-1 CA CA C3 FA L_ L_ C3 rA A.:, PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -T- tAl 0 �.2 _" > 1 t- 4 "z - - F="��X 010 r -4'_E:- F=1 FR E= FT Er 0 R.J I M 1=E [0 BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING ��!IA I C7 I to" fow 6- 1 "T_ "lye C:K F::- F. -I 44 CD 14 0 FQ FA 0 1EE DEPARTMENT r � HEALTH AND ENVIRONMENTAL �OTECTION '-~ WELL TO H PRIVATE 825 ' STREET, STREET, HNCHORHGE, HK 9Y-01 TO H COMMUNITY SEWER LINE IS 75 FEET. 264-4720 WELL LOGS ARE REQUIRED AND MUST ` ��L.- foh 1"A E> IrA I -VE= In Ev C4 IEH F." Fo"�� PERMIT NO. ( 820613 ::- OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS APPLICANT HPPLICHNT HHRRY TEDSON ]0]9 DENNINGTON DRIVE 99504 337-0764 LOCATION KEELM14 X 0- 1=041=1 :1 t RF_ -.7_3 LEGAL L2 B4 BEAR VALLEY SUB LOT SIZE 222222 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 206 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E> E= F" -F IA= ;1L w1L'0? �K 44 C2i -T- R -A= A- 27 C3 K FA A? K L_ ��-v t -i= �'�� 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 AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRHYEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F.!! F___ G -A LJ 1: F-� K E> in EO F"l- I C7 �� I F--= --1L C-1 CA CA C3 FA L_ L_ C3 rA A.:, PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -T- tAl 0 �.2 _" > 1 t- 4 "z - - F="��X 010 r -4'_E:- F=1 FR E= FT Er 0 R.J I M 1=E [0 BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNEVTO THE DEPARTMENT WITHIN 30 DAY,--..--. OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. KEELM14 X 0- 1=041=1 :1 t RF_ -.7_3 I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIQNED:________________________________________ APPLICANT HARRY TEDSON - y°7 ISSUED BY-�� y��_____DHTE__Ll�L��~~ ___ V4.0 `kis. � �#rte#" fes- f -3s �` t#t�"= �tgf'd�t�t�ttt►�E#'t=� ��Tiv:�'3�b� --47?0. r +'Pty F+ Nrt i T 2�9 1m tm rim inc� t LOAf Iii '5th It_ qLRlt P r r Qq4 5ej I'r : TPEP-OM i"t t. t iii; tM #-0s NVWQ s-� WAW I •5 n f L PAT i �G i`'r 1 E1 iJ t #cc it ts' [ i ! X13 I t_ t�irs' :tom I ON S'll s W -M t 11 7.5 �� -r�--f - .. :� :�... _ � � r-s=� �r-�� =��- �. -� =s��: ��-•�-�_.._ -� Mrs �--= �` l H*- Ljt u t'N v tP?F-m 1tv1 t• ? �� t 'aTM S3°i t T:tis" ! t'3c lR'Fi t k t Att# t ' fWm i i F# i A t HiM t10 P t T t5 rW-- 0 t'r TAI, -PX ?a£ mec-N tw gjpFAt..,, t i= rHe �- ;' IS il-18>1 r ` id 1- 04 Frio 1.?'p �'h-� ?`,+��.^? Tv [ ".z r� m l3! ��1 a`� i'�. i t i j}?y 'p'fr�i_ <? 'WEEN TW Lu rl" s� ?t l t'!' � I t`A Y MRS i t3 f=, i i [ s._ try rs t ► s'k'i i#�! t':• i3� A:? 'f ! F f71 i s F# t A T I t i i. T i+ €': s3;= '. i_t ° ria �. :.=¢ r s•t �'s t_i? T r'•gkuir-=. 3+ t 3'r- ! _;. i t.AEF�t�"s 7'HA r TWE Ems# i.. 4d f [_t a=�, T!-# D e::2 :14 #-cam I -A ,+ l F: IHC. sp:J.hf' ,I #..#_ U-b.a I.li' MV 5 S f em w 1 i*mai r F (f*V- Aw W"* I+7'�h� q.P''it THIS ' 9 T':?i�til' is Y o t iM t h 1i tot •-; r � EttE rkEEM A 44-cl—s ANW. M,'� Y 014 - S t F'8Z, S0•WW311i: C E'5 fl` .- 3'f"" r t 1 033 �= k E i FOR A Pf< f ,19?M T F- WA i,_ ry T.. �9 rs�s ';�;� w T �= IM A Pt_f . f c 4 f wipf--.F•j+ I ttF Ft#t.bi €�c'} PRIX! A 15RfYAT;E HELL TO A PRIVAl'l;- 'ShcWlC UI t5 FF -Er +' I� _t t. � '� =z f .� IR,- i4 -W r�itx� r s ti t t1 l z�' rs� "!"# � 'AR it iT Ski f3� f "r ;r QF Tom: I*- -L r) r i?'.?f 1 tea'e%t! i"u't* ',Y.�rw l tt�iT ism; iu s�+r�=Ta t' is tai;i°# rte: t F::= s* TO t N9JR; Pkl3Pf-- I�'.� rs:P-1SAT r t3N I 111 FA14 iL IAI1-4 t TH ITIE kElA-f I9FT. `IT' FOR Or- RID to "I". Fr t'-s..V'rP. %3't= TTS P1t St:' t ",` .. i i'r` rte' ;i!?A► NULL i l �'3 t', �_� rHE T T'`.� rE ff t m sv �. f.�i .cli*�� +� f T� i � }�'1c1�'3, ''' � k.�t...�'1 ��1'-�� '��#� �'� t�i�-'"r s F� '.��i•l�iti �'e� T��t± �'}e�'t' i�`�1�`+.i fie` �h��.t'r.i�t`T t�' �'#-1�; , "= t �'t�:x F •s #'►VET i Lo to I t+�Lt..V: t mAtz rHm. 7 1Ro3 t;. .� t _ LTJ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST � I PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 organic -15J1+ YOCk SLOPE WAS GROUND WATER S ENCOUNTERED?� _ L O P rel gr ave I IF YES, AT WH AT E DEPTH? .1 Irn SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop +)42-0/7— 1 H t"' 12:06: 1 -051 .J '2" . Q J 3 iZ l0 t2:I01JQ A6I ,z:20; 0 ICS .5 .09 2:31 10 ,5 ,C7 t Hz.O/ t2 ;3z 2.; z tD ,Q 20 PERCOLATION RATE J� �16•"?6(minutes/inch) TEST RUN BETWEEN ISL- FT AND FT COMMENTS ��' d /A3Aizx& aa~TWFrEN 3 X4°`!1— 1/7- PERFORMED 7 PERFORMED BY: 72-008 (6/79) CERTIFIED BY: DATE:47— /7-1I� 2- MUNICIPI Lill( OF ANCHORAGE � Development Services Department p P Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-431-23 Expiration Date: 1. GENERAL INFORMATION Complete legal description BEAR VALLEY BLOCK 4, LOT 2 Location (site address) 9141 SNOW BEAR DRIVE, ANCHORAGE AK 99516 Current property owner(s) EMILY K. ARCHULETTA Day phone Mailing address Real estate agent 9141 SNOW BEAR DRIVE, ANCHORAGE AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone r.,?-`(- 2020 - 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ -5 5 O t $ Z JD(C,oNDtZkONA) Waiver Fee $ Date of Payment=10,2�a21 i0IZ7I Z l Date of Payment Receipt Number a 15 21 2, T I V 5 Receipt Number COSA # O S C a 11 (o 3 3 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/22/2021 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 yAt �1 these various and dynamic characteristics and are outside the control of the evaluator of the l` well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q: • • • • • for current or future occupants or guarantee that no unseen encroachments, deficiencies or ��•• •9 `� discrepancies exist can be given by First Water Consulting &% *: ••* FwC5 TH ....... ........ ... .. .. 6. DSD SIGNATURE ��' •'•' "•'- • ' • Curtis Huffman System #1 Approved for 3—bedrooms ��F��s•,• CE 128991. �' 1 lFR • .10/22121 System #2 Approved for bedrooms like\OFESS0 4 Disapproved Conditional approval for 3 bedrooms, with the following stipulations: A Original Certificate Date 8ER\AU` 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 Legal Description: BEAR VALLEY BLOCK 4 LOT 2 Parcel ID: 020-431-23 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 7/1982 Total depth 225 ft Cased to 76 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 5/10/2021 Static water level at beginning of test 55 ft. Comments B. TANK DATA Age of tank(s) NEW TANK years Tank type/material ADVANTEX / COMPOSITE PLASTIC Measured operating fluid level in septic tank *NA ® Standpipes/foundation cleanout per record drawing Date of pumping *NEW TANK D. ABSORPTION FIELD DATA Which system tested (date installed) NEW FIELDS ® ALL standpipes present per record drawing Total measured depth from grade 3.9 ft (max) Measured depth to pipe invert from grade 3.4 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Structure served by this system Well production at time of test 3.7+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 2.91 mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by NE Date of Sample 10/4/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW FIELD Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min ® Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons FW`� Comments/Deficiencies: 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' ❑ Yes if No *50'+ ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *50'+ ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ❑ Yes if No *50'+ ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ❑ Yes if No *50'+ 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 *5'+ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ❑ Yes if No *50'+ ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ❑ Yes if No *50'+ ft F. ENGINEER'S COMMENTS * SYSTEM MEETS CAT III SEPARATION DISTANCE REQUIREMENTS. G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. ' 7H r.. •..............� Curtis Huffman �� ''F� •, CE 128991 ,• i�`�i �� F'�'odl/22/�1•��AM- N 89 58'16" E 246.72 OF A t e%% �. 49 TH* 0� _ THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ;o CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS. AND 15 s SHANE A. HOLT �O NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. Q LS -6914 , •' So`o0 EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN 4ppa d o HEREON (UNLESS INDICATED) res sionak NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE D�OOoop� PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY 1" = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 2, BLOCK 4, BEAR VALLEY SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS _17 TH DAY OF _NOVEMBER , 2021 12861, FB 170-33 219-33 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223.8615 MUNICIPALITY F ANCHORAGE Development Services Department `' ' T p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-431-23 Expiration Date 1. GENERAL INFORMATION Complete legal description BEAR VALLEY BLOCK 4, LOT 2 Location (site address) 9141 SNOW BEAR DRIVE, ANCHORAGE, AK 99516 Current property owner(s) EMILY K. ARCHULETTA Day phone Mailing address Real estate agent 9141 SNOW BEAR DRIVE, ANCHORAGE AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone -,?- C'- 2 ©2 z 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55 0 t $ Z 9a Ch0tZtbWAL) Waiver Fee $ Date of Payment 10 2 5/-20,;21 1o1 I Z I Date of Payment Receipt Number a 15 212, ? 1 I V 5 Receipt Number COSA # O S C,� 116 3 3 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 FIRST WATER CONSULTING Phone 907-350.9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/22/2021 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 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 & FkS 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for vtS bedrooms bedrooms Aw.~oF`�lit *: 49 7N .....�:* ...V�.1.`. . '. Curtis Huffman 19 CE •C1o/zz�2a •��A�� PROFESSIQ0P -.0 bedrooms, with the following stipulations: V-.,Vt, J ��L\iY OF`�� By: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage 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 WATER AND m '= ATER Z ::z- m PRnr-,r A o ; o `ri VI` _� By: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage 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 Legal Description: BEAR VALLEY BLOCK 4 LOT 2 Parcel ID: 020-431-23 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 7/1982 Total depth 225 ft Cased to 76 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 5/10/2021 Static water level at beginning of test 55 ft. Comments B. TANK DATA Age of tank(s) *NEW TANK PENDING years Tank type/material ADVANTEX /FIBERGLASS Measured operating fluid level in septic tank NA ® Standpipes/foundation cleanout per record drawing Date of pumping * D. ABSORPTION FIELD DATA — NEW FIELD PENDING Which system tested (date installed) NA ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: Structure served by this system _ Well production at time of test 3.7+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 2.91 mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FEES Date of Sample 10/4/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW FIELD PENDING Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date I 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' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No 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 ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *PROPOSED SYSTEM MEETS CAT III SEPARATION DISTANCE REQUIREMENTS. G. ENGINEER'S CERTIFICATION l 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. .d.c�i� • Curtis Huffman CE 128991 •.•�'aw,� 'opROFESS ON��w��.� ��N''dq`�`�� ft ft ft ft ft ft ft ft F�'Fst Wder - 0 0 N S U L T I N G k2i�y Al Y 13030 Sues Way, Anchorage, AIC 99516 907-350-9566 / firstwaterAK@gmail.com gmail.com October 27, 2021 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: CONDITIONAL COSA LEGAL: BEAR VALLEY BLOCK 4, LOT 2 Due to unprecedented events contributing to material and labor shortages, we are requesting a Conditional COSA for the above referenced property. The pending permitted 3 -bedroom septic system upgrade has been impeded due these conditions and other factors with no known date on when the Advantex system components may be available. The system will be installed once the components become available. The system has been working for the occupants and granting of this Conditional COSA will not impact any of the neighboring properties or pose a public health risk. Attached is the awarded bid from A+ Services and escrow letter from title for the pending installation. Please contact us if you have any questions. Sincerely, i Curtis Huffinan, P.E. F`15[ I,P 7 NHING m • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 020-431-23 1. GENERAL INFORMATION Complete legal description Location (site address) � dL 4.# $g.. Expiration Date: 7 �3//S Bear Valley, Block 4, Lot 2 9141 Snow Bear Dr. Current Property owner(s) Alan Jeffries Mailing address Real Estate Agent 9141 Snow Bear Dr. 2. TYPE OF DWELLING: [71 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual n Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance Received by: �. �!/ Datet COSA to be released to the a gin er, unless otherwise requested by the engineer. COSA Fee $ 8q 1_ (.0y Waiver Fee $ _ Date of Payment L/ P3&6 Date of Payment Receipt Number 0(10 6 Receipt Number COSA# Llnos i& 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. 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 System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Date 3/13/2015 ven no CE -8149 ` i Conditional approval for bedrooms, with the following stipulations: By: LA L�� Original Certificate Date: The Municipality of Anch9 age Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet ° - .. ff more than 7 septic system is on the lot: COSA Checklist # + of + Structure served by this system + Certificate of On -Site Systems Approval Checklist s Legal Description: Bear Valley, Block 4, Lot 2 020-431-23 Parcel ID: A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 7/1982 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 225 ft. Cased to 76 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 7/1982 3/12/2015 Static water level 78 - ft. 63 ft Well production 10 g.p.m. 5.4+ g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 0.82 mg/L Arsenic ND ug/L Date of sample: 3/12/2015 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/12/19.82 Tank size 1,000 gal. Number of Compartments -2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 2/13/2015 Pumper Isaacs Pumping Service C. ABSORPTION FIELD DATA Date installed 9/8/1990 Soil rating (g.p.d./ftp or ftz/bdrm) 268 SF/BR System type Deep Trench Length 3$/34 ft. Width 3/3 ft. Gravel below pipe 6/6 ft ss�/ss Total depth ft. Eff. absorption area a 864 ftz Monitoring tube Y Depression over field N Date of adequacy test 3/12/2015 Results (Pass/Fail) Pass For 3— bedrooms Fluid depth in absorption field before test 44/51 in. Water added 458 gal. New depth 44/69 in. Elapsed Time: 560 mina Final fluid depth 44/51 in. Absorption rate >= 450+ g.p.A. Any rejuvenation treatment (past 12 mo.) (Y/N &.type) No If yes, give date D. LIFT STATION Date installed 9/8/1990 "Pump on" level at 43 in. Datum Bottom of Tank E. SEPARATION DISTANCES WELL ON LOT TO Size in gallons 5tio "Pump off" level at 40 in. Cycles tested 4 Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ Manhole/Access (YM) Y High water alarm level at 45 Meets alarm & circuit requirements? Yes On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service tine 10+ Wells on adjacent lots 1`00+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Curtain drain 50+ Surface water 100+ Wells on adjacent lots 100+ Absorption field _5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage110+ F. COMMENTS *2" rigid insulation over field per inspection report. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records4hat the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date COSA brown sheet 10-10-12.doc 3/13/2015 in. 4 ap�zmO�T '`+gym.. Zwyo SZrZCyTNA ON ZNApyD ZOANZOamZ yy ZS mry y>OONMA zOny2��? 3Z'��mA OZN AAD ZN <09 �21^O om AN A <00 ?pCm N 9� A A O - Zar �Oy aN9Z c3 zc�s ym mZ m�j ONA ZO . ' rryT MN . yr x ZO m y A r c Z m O OOUO ortSDZ Z cT ZN m yy o'm 0 TFN. y Z T A m O Z T F 3 u y� Z 2 T i>mp Z!^pF N ND / / / / 2 D Om -i <D rOH O (n D m m H m V l n 3mlA HS 2 -gym- O A C O yO W O N S A 2 r D O NW O m g = m T{ N VJ 2 m H m r 0 C D m W 3 O r n y A A<Am nr.OA n f<il { ODirimA �zm y Z Z 3 0 n{ m m m m " m `n m1 O04 ) IMo.S It D OM m N O H V N D IA+ H N > Z r W m D O C A r m 2 DH mOD 2 m 1 { m l v H N O• lAA A H C O v mHD mvm m m mi {3 ZOA 2 n2• m aag Dmz D n m o 2y t�112$ 2 � C W DSD mMH m N H m N D nFn { Zy `ons O m �. ,nient MUNICIPALITY OF ANCHORAGE se Community Development Department p, Department Right of Way Section v ENCROACHMENT PERMIT R151254 THIS AGREEMENT, made this 6th day of April, 2015, by and between Alan C. Jeffries and their heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State of Alaska, hereinafter called the "PERMITTER". WITNESSETH: WHEREAS, PERMITTEE is the owner of the following described real property: BEAR VALLEY, BLOCK 4, LOT 2, according to the official records thereof, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTER owns and/or maintains the real property more particularly described as follows: The 20 FOOT UTILITY EASEMENT located in the northern portion of PERMITTEES property as shown on Plat No. 76-0209, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTEE has placed two (2) stand pipes and septic fields upon the referenced real property which encroaches approximately 2 feet upon the PERMITTER'S 20 foot Utility Easement. NOW, THEREFORE, it is mutually agreed between the parties hereto that: 1. The PERMITTER, acting through the Director of Community Development Department, hereby grants to the PERMITTEE the privilege of allowing 2 stand pipes and septic fields to encroach approximately 2 feet upon the PERMITTER'S 20 foot Utility Easement, as shown on "Attachment A," included herewith. 2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless, the Municipality, its officers and employees, from any and all lawsuits, claims or actions brought to any person for or on account of damage to property or injury, disease, illness or death of persons, including all costs and expenses incident thereto, arising wholly or in part from or in connection with the existence of, alterations, maintenance, repair, renewal, reconstruction, operation, use or removal of the encroaching stand pipes and septic fields, as placed upon the PERMITTER'S Utility Easement. 3. The PERMITTEE shall not assign or transfer any of the rights granted herein to another individual or company without first notifying and securing the approval of the Director of Community Development Department. 4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S real property whatsoever, except only the encroachment rights described herein. 5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days written notice to the PERMITTEE. The PERMITTEE agrees upon such notice of revocation, to move said encroachment(s) from the Utility Easement in which it is placed. Should the PERMITTEE refuse or fail to comply with said written notice, the PERMITTER may, without further notice to the PERMITTEE, remove or cause to be removed the encroachment(s), and the PERMITTEE hereby agrees to reimburse the PERMITTER for all costs incidental to the removal thereof. In addition to the mutual promises heretofore made, the PERMITTEE has paid the PERMITTER a one-time permit application fee of $115.00. The PERMITTER hereby waives the annual fee of $300.00. IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day and year first hereinabove written. GRANTEE: GRANTOR: MUNICIPALITY OF ANCHORAGE Alan C. Jeffrie , r &*ack L. Frost, Jr. Right of Way Supervisor STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on this 1t� day of Yaq"�3 , 2015, before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared Jack L. Frost, Jr., known to me to be the Right of Way Supervisor for the Municipality of Anchorage, Alaska, who executed the foregoing instrument, and he acknowledged to me that he executed said instrument as the free and voluntary act and deed of said corporation for the uses and purposes therein mentioned, and that he was authorized to execute said instrument. NESS my hand and official seal on the day and year first above written. NuuWrr�[�� 1UEW...N }� NOTARY PUBLIC in and for Alaska A&SUG ��t My Commission Expires: STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on this day of L 2015, before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared Alan C. Jeffries, known to me to be the individual named herein who executed the foregoing instrument, and he acknowledged that he did so freely and voluntarily for the used and purposes therein mentioned, and on oath stated that he was authorized to execute said instrument. WITNESS my hand and official seal on the day and year first above written. ``��ttutuur[rrgf TARP and for Al aka My Commissi n Expires: / 7 �'NOTARy'• . • j0UBL1G �q�•.....'.. ��,ow OF �� MUNICIPALITY OF ANCHORAGE �•' ��y,��s7 .�; $ ., p 4 ' DEPARTMENT OF HEALTH &HUMAN, SERVICES , Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 ( `343-4744 "All CERTIFICATE OF HEALTH AUTHORITY, APPROVAL FOR A SINGLE FAMILY DWELLING'". Parcel LO., d ao YJ I - P3 . 0f4,HAk# 1 GENERAL INFORMATIONa1+�a�1.i_, 'Complete legal description Lot 2; Stock 4;' Bea,% VaUey _.. q J rt Location (site address or directions) 9141 N. Snoui Sea& ani,ve. ' c �3 Anehoaage, AK • r ,F erty owner's Norm Z� eamen Day phone 345 5081 y +s ,. MCailing address- 9141 N_ Sv►nu) Rom Dh - QnnG�nran�QK 9951 •„ Qng ing aggncY Day, phone � ailing �address rAY F �' n ,,en ,►<r Day phone , 7 �, ,�ra�'"�'' _ .,wF«.- •..._,+�i.iRe„t�,. �• . r«d-i�i�:�,,,1«M�r, "��_ �p�;e� Y� x'�.x�.�t^.�._�,� e• � •r- ti so^ .;- _.. <Y � A-. 't �� '3'�'��,',�r-d"� i ��xt r� � ~`"Ta:', Address rt d xr fibs a xz, adXaf Sr fq MR. ,^� 3 8 = finless otherwise requested, HAA will be held for pickup 5#— c £'+.�.. r i a e' .�w.r `•�s "'^. 1 `. r�x ti,Jt r� Z y Fi'w ear d717 �7L} to ii NUMBER OF BEDROOMS:.3^ �,� �, t -y �L.y'� >Y r:. r ,#..:... .t._., ,.. ,.. y kwa:t++a:r•.T •.f:1�n+w -.. �I ��<• tryro ryL,�,. � r^ Mas+IV4 F^ STYPE OF WATER SUPPLY t.*oMY s. .Individual well^ XXX""'�,.�,J � � �> x ,ukas i Girt' v Ri, + 1 ,r<. + -'.4 w., t .•p rz �1 �kz Commurnty well - �x.. ��'- z 1 F RS�� di'i '� V ��'tiM •'4 _ \ -�` 7 ;l � HiP1�.a rvr"w �' d � .tlj � i' S i�� y� � � �' F W r �. Public water sem. 1 VA �* ..w..w•wiy,., 1�ws+d,G,a+G.k� wa NOTE , If community, well system, provide written confirmation from State'�ADEC attest r .'ing to the legality and status of system. R " 4. _ E OF WASTEWATER DISPOSAL: TIndwidual onsite XXX ti ., u:✓ a � ,�._ �,x Y' �,s� "�k'ki ¢.�.�Er ...r� ,.a J iT: �'X �•,p?ir.� � ,is , p_ .�'7 - .-8 9 t ,3 ,S 1°`��fwk i�y, � S�a�1� �`f � r > J r 1 'y�,�•n� q � k t'� : ,. l�Siei Yrw ,pJ Ae:i"3 {'w% X r� X t...•.'r°� i'� i`�{j5 ' 4` {'�1�'i 4 {,"!r Y � R ..�'<4 to A < -1t•, , �:� E , Public sewery .,;`". . .�,i z� �• �,-.-e , .... :` tom;-? .... m� `7".`..t't` .. .�, NOTE: If community wastewater, system, provide written confirmation from State ADEC . attesting to the legality and status of system 72-M (Rev, 1/91) Front MOA 021 S. STATEME I T' OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation. of this Health Authority Approvalapplicationshows 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, ordinancesi andregulations in effect on the date of this inspection. 5 & S: ENGINEERING Phone me Naof Film a ` 'AI N Rine r 'Alaska M77 _.Address - Engineer's signature Date ....r.,.�it.r.:.r . df :�,r:i� . x � F ... r+ wrrt .M .ary l., x.. .}f h'H !f Y'M Y�'•M') .i ,ry ).. , n rn m✓rrr � tifiv,a +i rr f s xrA a u ROBERTC COWAN' - r: / c CE -8641 'DHHS-SI NATURE { A rOVed fore'"__ "" '� bedrooms fa W r uy, �. iFi7e51r�rJ!dil»cfsa it a.eNiVlYvk'.x hiM-w.•+.nw.AV" r+• p pproved a r k r (Qi ,. 'Cs•IPpYi _t >,f�!>k't`'�9k 1V 'i•1`2ri'.�•µ..- C nditional a royal for . bedrooms, with. the following stipulatwns i �f¢� , } r r-' 5, %[:. ii"br iv i 1 , q fix y tt { f C f..rK > � 1h�.j-c: eir��lobi � :::r. ,�:• r . �s•i 1r. .m:� �a �'�� "•, �'. c;� �kr •-",�'�{ �&�gjY;'.�'kk.F tr r L;"Mr.C�'id+l•njt 7.°�ii -'��l1 1-.t .� r�A �" -S, . � y. �N t"�n. . 4 . Additional Comments 33 q tiyp ani I..1 � .rs f� in + 1. ,r. a'f1F.W . 1 � . . , rt•Nw ... ., i. ' �' t t3y. Date . t >rr>< At .,Mrs:,i •t . •+• r, tq :h +; :£'"%' i.' '.j 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct insp tions or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for � rrors or omissions in the professional engineer's work. ; 72.= (Rev. 1/91) BWk I MOA N21 Municipality of Anchorage Department of Health and Human Services ok HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1-0r a gLk I , 13„4* v,+Li.ty Parcel I.D. () a"0 y 3 / - oZ 3 A. Well Data Well type PR' v -4Yf- If A, B, or C, attach ADEC letter. ADEC water system number Log present &N) y F S Date completed 7 / T `Z Drillery1,'Al � / / e Total depth a s Cased to Casing height Sanitary seal WN) Wires properly protected (6)N) FROM WELL LOG AT INSPECTION Date of test i 42 -7 /� r Static water level 7 �( 7 Well flow / 0 g.p.m. g.p.m. Pump levell v ik u `h SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 106 r Absorption field on lot _ ro p ` t Public sewer main Sewer service line N /.+ S`0 ( 4” ; On adjacent lots /00 74 - On On adjacent lots /,o ° ` t Public sewer manhole/cleanout Petroleum tank N6-6_ WATER SAMPLE RESULTS: Coliform 0 Nitrate ©. a Date of sample: -7 / (C / 9 S_ Collected by: B. SEPTIC/I 11@EBFNf TANK DATA Date installed I ( ��' Tank size I oy Cleanouts ON) 'y4--5 Foundation cleanout (Y)N) -J 1 N /Iq x.vc c✓ 0) D4,c,(.c,,V a Other bacteria S 4-5 cvcc.v� Compartments :1 _Depression (Y/to High water alarm N) -'� "` `f Alarm tested (Y/N) N 4 Date bf pumping -7 /1'// q S`" Pumper R,) ro R c To •� SEPARATION DISTANCES FROM SEPTIC/HBEBii'4G-TANK TO: Well(s) on Iqt / a f On adjacent lots To property line -t- Absorption field r i Surface water/drainage Q 'OV a Foundation / -f- Water Water main/service line _ _/ a / 72-026 (3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent ('N) of/& -SQ/ 00 "Pump on" level at High water alarm level. 1� 't If Meets MOA electrical codes (SON) %� f SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer —Manhole/Access (Y/N) VtJ I X- "Pump off" Level at Well on lot /00 / 4' On adjacent lots D. ABSORPTION FIELD DATA Cycles tested ) 0 6 /-J— 3 Surface water it2, )aJ / 7711 Date installed 9 /'K/ `1 Soil rating (GPD/Ff) a' 6 � �" 2l'�`R System type `i -i qtr S Length 3T y- 3 Y "' 71 -Width 3 Gravel thickness Total depth Total absorption area % Cleanout present &N) %' -t Depression over field (Y)Q N / Date of adequacy test l 1 `� Results ass fail) f 1 for 3 Bedrooms Water level in absorption field before test G/. M I �' r "''"� After test t G Peroxide treatment (past 12 months) (Y/@ 1J 0 If yes, give date -X- Tksrho L*.37- T4ta.C,(4 o'vLY � 44,s7- 7-rt�c—CAK 54;-V A 4-rc0 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ) 0 0 t �` On adjacent lot To building foundation 10 I i On adjacent lots )L0 I Cutbank Surface water 10 v Curtain drain N o ^", K lu 0 w A) E. ENGINEER'S CERTIFICATION s / o ° t Property line _To existing or abandoned system on lot t f N 1 Water main/service line � 4- / Driveway, parking/vehicle storage area 3 0 1 certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on Signature --�4Z }Z✓moi Engineer's Name /e 6,6 i- � r- 6- Ccs a,4 Date -7 /X1 / q S HAA Fee $ c�J .Ai Date of Payment ��/l�5 Receipt Number 72-026 (3/93)' Back *f .- of this ir; n. �o ROBERT C. COWAN i K CE - 8801 r w` Waiver Fee $ Date of Payment Receipt Number SEPTIC SYSTEM ADVISORY HEALTH AUTHORITY APPROVAL NO. AI 9J 0,300 Prior to a recent adequacy test on the septic system for this lot, inches of standiung water was observed in the absorption field. This indicates that approximately 61. % of the absorption area is inundated. However, this system did meet the minimum absorption requirements for a _S bedroom residence. This advisory must be attached to all copies of the subject Health Authority Approval. � j MUNICIPALITY OF ANCHORAGE • .� Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # (qE) _ Lkll -Q � HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2; Block 4; Bear Valley Subdivision Location (address or directions) 9141 North Snow Bear, Anchorage, Alaska (b) Property owner Mailing Address Mary and Chris Hoops (c) Lending Institution Mailing Address Telephone: (home) Business Telephone (d) Real Estate Company and Agent FORTUNE PROPERTIES/Carol Bennett Address 3000 A Street, Anchorage, Alaska 99503 Telephone 562-7653 (e) Mail the HAA to the following address: (or check here [�, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eaqle River, Alaksa 99577 2. TYPE OF RESIDENCE Single -Family IN Number of bedrooms 3 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 th legality and status. 4. SEWAGE DISPOSAL On-site IN Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 3 ;o 3 abed H08e (891L A88) SZO-EL ->taom s,jeauibue teuotssa;oid ay; ui suoissiwo ao saoije aoj atgtsuodsaa;ou si abeaoyouy;o Aj!ledioiunW ayl •panssi si a;sotpim a aao;aq elep azAteue ao suot;oadsui Ionpuoo;o;u op SHH4 p saaAotdw3 -s;uawaatnbei a;e;s pue Ieaapa; uie;aao Alsi;es oliepio ui suoi;n;t;sut butpuai Aiay; pue sawoy jo siaseyoind o; Aselinoo a se sty; scop SHH4 ayl •e>{sety ;o a;e;S ay; ut paia;sibei Jeauibue leuoissa;oad l.uapuedepui ue Aq anoge g ydej6eaed ut uaAib suoi;e;uasaadaa ay; uodn Aluo paseq peleoipiao tenoaddyA;uoy;ny y;ttaH sansst (SHH4) saotAaaS uewnH pue y;teaH;o;uaw;aedaa abeaoyouy;o A;!ledioiunW 441 teuot;tpuo0 ale(] AfR�A CM14 ��•.l � I"�# a '. �'j-\1L5�' •�'�'j, iJ6aOR, '�'. CS ' �, �yL @GMNtl 011PfnF.oe JB J89u1fAV 4l �aqs $ a �� !`_ag�a e• sra Ak penoaddy teuot;tpuo0;o swaal panoiddesia panoaddy Aq swooapaq cool panoaddy �6~• �/ ^ 0 IVAOblddV SHH4 '9 a;eQ r Y', LLS66 e3jselbr'J9A1jl 916e3 FOVOJM oal dool JOAIH el e3 t E LI ssaappy gNIN99NIJN3 S'8 S hauoydatal wail ;o aweN •uoi;oodsui sty; jo a;ep ay; uo;oelp ui suoi;etnbaa pue 'saoueuipao 'sapoo a;e;S pue tedtotunyq Ile ql!m eouettdwoo ui si wa;sAs iesodstp as;emelseen ao/pue Atddns as;enA a;ts-uo ay; 'uoi;oadsui pue not;ebi;sanui Aw'woa; pue sett} abeaoyouy p A;iledioiun" ay; wo.I; peuie;qo uoi;ewio;ui ay; uo paseq ;ey; A!J9A aay;jnj t -uieaay pa;eoipui ain;oni;s;o ads(; pue swooapaq ;o .Iagwnu ay; ao; a;enbape pue teuot;oun; 'a;es si wa;sAs tesodstp ja;emelsena ao/pue Atddns aa;enn a;ts-uo au; ;ey; snnoys ienoaddy A;taoy;ny y;teaH sly;10 not;ebt;sanui Aw lsy; A;iaaA t 'nnotaq unnoys a;ep not;eptteA au; }o se pue o;away paxt;je teas Aw Aq patpliao sy NOIIVW»OdNI aNV V1Va 'HOUV3S TIN 'S1S31'SNO1103dSNl ONIMAOad W81:1 ONId33NION3 'S 0'& �R��G�S MUNICIPALITY OF ANCHORAGE (MOA) \G\Qpy��vS�C �O • '� Health Authority Approval (HAA) ,�'�� CHECKLIST - FEBRUARY 1984 Q 343-4744 Legal Description: 1ct P_ bloc. K 4 &Ar OA11eI� A. WELL DATA Well Classification FIAM 1 1U If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) tj Date Completed —T=S3 Z Yield 44. 21 !RQM Total Depth aaS Cased to %Depth of Grouting Static Water Level ! Z Pump Set At u k' Casing Height Above Ground 2-44 Sanitary Seal on Casing (Y/N) — Electrical Wiring in Conduit (Y/N) 4 Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / 04 r ; On Adjoining Lots Od To Nearest Edge of Absorption Field on Lot F2!� �t ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole NIA To Nearest Sewer Service Line on Lot a 5 t Water Sample Collected by Zk `L S� ;Date Water Sample Test Results `mosfAC_i-QdAC_ 'if V, -- to Ata Comments B. SEPTIC/HOLDING TANK DATA Date Installed 8-/.1—Size / Doo No. of Compartments z Standpipes (Y/N) u Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) &I Date Last Pumped _'Z I Pumping/Maintenance Contact on File (Y/N) I+V AA ; for A) I / !A Holding Tank High -Water Alarm (Y/N) A)/A —Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well / O Z% To Building Foundation To Property Line To Disposal Field To Water Main/Service Line role To Stream, Pond, Lake or Major Drainage Course Comments S�of� i6omped 6u AuMIorNc� 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA 10 Soils Rating in Absorption Strata Z 6S Type of System Design T_R_ A)C_hC S Date Installed _ — �( O Length of Field -ho t,-,, Width of Field 3 b Depth of Field 1 Gravel Bed Thickness Square Feet of Absortion Area 4 Statndpipes Present (Y/N) _ Depression over Field (Y/N) /,i Date of Last Adequacy Test 1'.),q New Results of Last Adequacy Test Iq SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well I ren �� To Property Line i n To Building Foundation 0 f To Existing or Abandoned System on Lot 3C �t ; On Adjoining Lots So �t To Water Main/Service Line (� �'I" To 'Cutback (if present) AJA To Stream, Pond, Lake, or Major Drainage Course /,��/✓� To Driveway, Parking Area, or Vehicle Storage Area —a C) �+ Comments D. LIFT STATION Date Installed — ?� — r9 O Dimensions y � o �� X y I Size in Gallons OD Manhole/Access (Y/N) `1 e S "Pump On" Level at 3 3 "Pump Off" Level at High Water Alarm Level at 3 /go Vent (Y/N) `7 Tested for Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request" Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. Signed �}P}�ERING �s Company 171134 Ea le River Loop Road No. 204 � Ea.AW River, Alas a 9Y5Z7r' Date !? Z 5;� As'`' s. MOA No. C—C 3 Receipt No. aS C -A-(--3 Date of Payment /a—/— 90 Amount: $ A/70. Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 ' w0 t�pp�o�f this AOGI, F� M A � LA sO RATORIES CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 Client Sample ID:L2 B4 BEAR VALLEY PWSID :UA Collected SEP 18 90 @ 14:20 hrs. Received SEP 19 90 @ 15:02 hrs. Preserved with :AS REQUIRED ANALYSIS REPORT BY SAMPLE for Work Order # 27353 Date Report Printed: SEP 27 90 @ 00:34 Client Name S & S ENGINEERING Client Acct SNSENGP P.O.# NONE RECEIVED Req # Ordered By : R. SHAFER Analysis Completed :SEP 24 90 Send Reports to: Laboratory Supervis x PHEN C. EDE 1)S & S ENGINEERING Released By G��J 2) Special Instruct: Chemlab Ref #: 903746 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits --------------------------------------------------------------------------------------------------------------- NITRATE-N 1.3 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY RDJ. 1 Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected `" See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than 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 V. Application Date ;9"—// // o a 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, su DoT 8wee if BmV L (address or directiorfs) )sz- section, township, range) (b) •; Prope(ty Owner ��:� Telephone: Home Business 'Mailing Ad'dr2ss .� (c) 'L'endin'g Institution 11 Telephone •Mallfng Address (d) Real'Estafe Company and -Agent 4MM V71 Address Telephone (e) Mail the HAA to the following address: or: Check here 0, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family �r Number of Bedrooms J 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 0 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 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 intvesti" J' ' ..this Health k +: i .bo-r�..a�QkQ�l1!�Ai°'1'. 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.he information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on ite, water supply and/or, . wastewater disposal system is in compliance with all Municipal and State codes, ordinances, an regulations in effect on the date of this inspection. ,.z{ st"6' ` tti,- "# Name of Firm Telephone 2-71 Ali f � x Address...., Date NAk7j- W/o*> ee t . .. -_. AVA Z , Icy% fr,01 Poo to Mr� ��# •: �¢ '=� j 3, j678TIG 7iW& 7#1YW g•6400ORCE_ % T r & { rir 1, kvVhl' M i Sa l f t !it CAUTION y ,' 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 th it lending institutions m order to satisfy certu'in,federal and state requirements. Employees of DHHS do not conduct ins ections or"analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or orris ions in the professional engineer's work. Page 2 of 2 i c MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: /_07-z— B�cK /3' Edit' ✓rQtC.�� 7-11V z7 -4J SEZ- A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present/N) Date Completed 7 / tZ Yield ' 7 6?11 i Total Depth yLS� Cased to 7(0 Depth of Grouting Static Water Level '�` 516-. 1 Pump Set At Casing Height Above.Ground ? Sanitary Seal on Casingg)N) Electrical Wiring in COnduit(!9N) Depression Around Wellhead (Y© Separation Distances ;from Well: , To Septic/Holding Tank on Lot On Adjoining Lots �� f To Nearest Edge of Absorption Field on Lot /� ' ; On Adjoining Lots To Nearest Public Sewer Line AJ/4 To Nearest Public Sewer i Cleanout/Manhole /g To Nearest Sewer Service Line on Lot Z� Water Sample Collected by /Gf �' �.; Date Water Sample Test ROsults 13� T --�"� N/ Comments )f T /,# f� M7— kJIA ZARrAu� 4" ,40fj4 — 4,0/77^ 2 To 400i-Zle /,c/ 'r*AR& B. SEPTIC/HOLDING TANK DATA Date Installed �Z �Z Size Ar" No. of Compartments 17— Standpipes ON) Air -tight CapS&N) Foundation Cleanout(91N) Depression over Tank (Y1 l% Date Last Pumped -y Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) �% Temporary Holding Tank Permit (Y/N) A) 4 Separation Distances from Septic/Holding Tank: To Water -Supply Well �4 To Building Foundation 5-x To Property Line � To Disposal Field To Water Main/Service Line /d f To Stream, Pond, Lake, or Major Drainage t Page 1 of 2 72-026 (Rev 8/86) Front I_L a1/ aALI LIQ/ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed S- /I-��Z' Type of System Design Length of Field Width of Field 71-15' Depth of Field // Square Feet of Absorption Area Depression over Field (Y — Results of Last Adequacy Test Gravel Bed Thickness K/O Standpipes Present (YoI Date of Last Adequacy Test /Z ly`87 Separation Distance from Absorption Field: To Water -Supply Well /? To Property Line jo r To Building Foundation �� / To Existing or Abandoned System on r Lot ; On Adjoining Lotsf- �t To Water Main/Service Line /o To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course i To Driveway, Parking Area, or Vehicle Storage Area /601 Comments rial�rTi.�ll2- �o �at.4'TE,q�c%/r�E /,./ Jpf>H /988. D. LIFT STATION �CTate-It3si�lled . Size in Gallons �c "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 ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Cycles during Adequacy Test. Meets MOA I certify that I haveck%� verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed G%=---�. L-"". Date /2 /� % %a Company �GS MOA No. �7 OL f r O;c of, Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (Rev 8/86) Back J0 ••.• P••++:�» • mo•• "air OY C. REID, JR. S� „�•.• CE .2251 ` e fW• �,,yo�%SStw�a�,� MUNICIPALITY OF ANCHORAGE Q 3 3 DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES 4ERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 17— 7 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) [.oT Z i3�e,c' S� /�cA� ✓�u-��i % i/.J �z�.,l SES � Location (address or directions) 9� 41i Mai . aEx'e az . (b) Property Owner AIR DD Telephone: Home Mailing Address Business (c) Lending Institution COusffd11* f -,e7_6^S__ Telephone Mailing Address ` �7/ �c% ?� 11L /L -/t:: (d) Real Estate Carmpany and Agentj-/,e-�f!� l �� AgSlle Address y Telephone (e) Mail the HAA tb the followina address: or: Check here X12, if hold for pick up. List contact person and day phone number below. { 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY E 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 CJ 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. w Page 1 of 2 72-025 (Rev s/es) Front Lz 5,1 15e, -K ✓�zc 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 S Fiirm Telephone f o Address /20u j3 19110- sail— /3 9953 Date / Z 7 Cs�/hi�•�.4-L - iPc��/ 9A)e401E 41dQ4- JA) //Z95 /.I elAlDui7— /,/ tNNhvX2 /988, �.`� A4.9 �� T B�/cEf 1r�/�Pi�G y � • • y'' 7H 6 g C. REID, JR • � /r E - 2251 •: ¢� Cdn�i�iaY�S �d /70)01 � •. c QGC�SS �r` �G1/yc.�01r� • �I,��ef� ipn3��s� 6. DHHS APPROVAL J v Approved for -3 bedrooms by Date / � —77— CJ 7 Approved Disapproved Conditional Terms of Conditional Approval 49OVE CONDI IoNr q iar BE oHPLETE 8Y jrume /, /988 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 Bias) Back \'01, HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 Ei STREET •ANCHORAGE, ALASKA 99518 •TELEPHONE (907) 562-2343 ANALYSIS REPORT BY SAMPLE IaBORATORIES Client PO# Req #: Client Smpl ID: L2 B4 BEAR VALLEY, 12-11-87 Sample Rec' d : 12-11-87 Ordered By : A. W 1 EN Send Reports To: AECS 1200 W 33RD AVE., STE B ANCHORAGE, AK 99503 Special Instruct: Chemlab Ref #: 8595 Lab Smpl ID:' t Matrix: WATER Parameter Tested Result/Units ------------------------------------------- —----------- ---------- NITRATE-N 1.2 MG/L Work Order No. 4319 C1 ient Account AKEcsRP Date Report Prin ed•� Released By /.� Reports Address #2 3w Allowable Method Limits 10 Sampl a ROUTINE SAMPLE Remarks: ANALYS I S COMPLETED 12-14-87 LABORATORY SUPERVISOR STEPHEN C. EDC --------------------------------------------------------- 25 Tests Performed See Special Instructions Above ND= None Detected ** See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than e MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date _/6A4,44 (a) Legal Description (include lot, block, subdivision, section, township, range) L61 2 0P-4- BEARy6LiEY -f/2iy 9 3t Sties Z,�- Location (address or directions) S*A20L&j QF -49 -S-r— (b) -r- (b) Applicants NameCpyN;i PL£S5,'AP&ER Telephone - Home68e-2ziZusiness�'6Z-634_,5- Applicants Address 3 8 2 0 LA (c) Applicant is (check one) Lending Institution; Owner/builder ; Buyer � ; Other [-::I (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: C��►., tri^, 2. Type of Residence Single -Family � Multi -Family Number of Bedrooms 3 3. Water Supply Individual Well Community M Other (describe) Public M 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 E:1 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] I .- f.— [U -r V /T I 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 regula- tions in effect on the date of this inspection. Name of Firm EC S L Telephone r� -- Address / Z D D /'t ) 3 Date 6. DHEP Approval Approved for bedrooms • AW'd4' (ENGINEER SEAL) Approved Disapproved Terms of Conditional Approval V r ® - By Dae�At e CAUTION Conditional •••� • yd �► •••.•.1111•• • oy C. Reid, J 4� No. 2251E ••• oto 00aff THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) �'d 7-19-84 L 2 13 It a EA o V,4 LLE Y C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2 ©G 01 Type of System Design tRE,ve 1-�- Date Installed MZ/ e — Length of Field 45' Width of Field 3C) Depth of Field + ` Gravel Bed Thickness 9 ' Square Feet of Absorption Area g $'� 6. Standpipes Present (!�/N) Depression over Field (YO Date of Last Adequacy Test _-J f Results of Last Adequacy 'lest ld-J /Ja Separation Distance from Absorption Field: To Water -Supply Voll ! 2C, To Property Line To Building Foundation. g(3` Z.j To Existing or Abandoned System cn Lot tiJig' ; On Adjoining Lots '>30' To Water Main/Service Line To Cutbank(if pres6nt) /V/14 To Stream/Pond/Lake/or Major Drainage Course )�__,Q To Driveway, Parking Area, or Vehicle Storage Area 6- �- Comments pleg As - Q3u �s r^ ' l.��} jC;L"P- 4f= 8104 � 2 ) D. LIFT STATION Date Installed A/ A Di nsions Size in Gallons Manhole/Acce (Y/N) "Pump On" Level at ' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumpi Cycl during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, conformed to all MOA HAA G LdL in effect on the date of this inspection. Signed Date 2 Y 8%Q,••c;"A: Y'�•�ti.�� Comps A,EC 5_j,, MOA No STJ2% -O Z 1 -*see KBl' sees* d5S / / ••r toy C. Reil, Jr. is ••• No. 2251 •E �� qF°A•°•,0ti,. , ,� (Page 2 of 21 2-15-84 TEDSEN CONSTRUCTION CO. 3039 Donnington Drive Anchorage, Alaska 99504 (907) 337-0768 Contractor License No. AA0653 0 o �' C'dn cern � S• �%�-'fir'- / S �l� r �t l"� "`�-� � r � S7%>t 6V-';'4