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Home My WebLink AboutSUN VALLEY HEIGHTS BLK 5 LT 7Onsite File #017-062-46 A test hole is required for the alternate drainfield shown on OSP191445 record drawing prior to permitting to confirm separations to impermeables and seasonal high groundwater, as well as percolation rate. Municipality of Anchorage On -Site Water and Wastewater Program ° (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191445 PID Number: 017-062-46 Dwelling: F91 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑t Upgrade Name: Mark & Barbara Madden ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 6440 Gunnison Drive Anchorage, AK 99516 Phone Number of Bedrooms 727-7947 4 LEGAL DESCRIPTION Subdivision Block Lot Sun Valley Heights 5 7 Township Range Section SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer From Tank Field Tank Line Well >200' N/A N/A N/A >25' Surface water >100' N/A N/A N/A F-1 Other Soil Rating Total depth from original grade Existing Trench GPD/SF Depth to pipe invert from original grade Gravel depth beneath pipe Ft. =ill added above original grade Gravel length Ft. ravel width Beds: Number of Lines Distance between Ft. Total absorption area Number of trenches Dist. between tren Ft TANK lE Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1500 Material Number of compartments Ft Ft. Ft. lines Ft. ches Ft. Gal. Lot Line >5' N/A N/A N/A NA Plastic 2 Foundation >10' N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Tank serial #: 1415 Pump on level at Pump off level at High water alarm at Tank permit only. in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank to Installer drainfield D3034 Denali Excavating Drainfield Exist. CO/MT Inspector J. Williams BENCH MARK (Assumed elevation) 100 ft Inspdection 15 10/10/19 2 nd Location and description 3rd 4th Bottom of siding @ point A. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date Approved ' �i Date pp n iaNc�,uvu ��cNvi �_c- i- i c.uv� 10/24/19 4"OFESS�O�"®�0® Engineer: Legal Description Parcel ID: Permit: Report Type: Municipality of Anchorage On -Site Water and Wastewater Program P.O. Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Review Comments FORGE ENGINEERING EPLANS SUN VALLEY HEIGHTS BILK 5 LT 7 01706246000 OSP191445 SepticTank As Built Review t I.)epartment 11/1/2019 Completed By: R.Carroll The application has been reviewed and the following comments have been generated. These are to be satisfactorily addressed prior to MOA approval: 1. Please confirm septic tank is at least 5 ft from any deck supports. 2. Permit was for 3 -bedrooms and site plan labels house as a 3 -bedroom. Inspection report notes 4 -bedrooms. Please confirm. 1) Site visit confirms that the tank is at least 5' away from any deck post. 2) The permit was meant to be for 4 bedrooms, the septic trench was designed for 4 as well. Plan as -built has been corrected to reflect 4 bedrooms and is attached. 100500 FEET 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT DV - DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND FILE TH PERMIT # OSP191445 PID # 017-062-46 SUN VALLEY HEIGHTS, BLOCK 5, LOT 7 A B MH 34.1 SV 36.2 2CO 37.0 FS 36.8 12.7 16.9 18.8 29.6 11/22/19 G U N N I S O N D R I V E 10' UTILITY EASEMENT 10' CEA ROW ESMT (MISC BK 204, PG 978) RAP DRIVE ENCROACHES ONTO LOT 6, BLOCK 5 CLASS 'A' COMMUNITY WELL 200' RADIUS 4-BDRM HOME 1,500 GALLON SEPTIC TANK. EXISTING ABSORPTION TRENCH. 65' LONG x '3' WIDE x 7' EFFECTIVE DEPTH. TOTAL DEPTH '. EXISTING ABSORPTION CRIB PLAN AS-BUILT FS ALTERNATE SITE: 72' LONG X 3' WIDE X 7' EFFECTIVE DEPTH ABSORPTION TRENCH. TOTAL DEPTH 11'. APP. RATE .6 GPD/SF. DIVERTER VALVE REMOVED AND FLOW SPLITTER VALVE PLACED 11/19/19. SUN VALLEY HEIGHTS, BLOCK 5, LOT 7 PERMIT # OSP191445 ENGINEERING km PROFILE AS -BUILT (NO SCALE) PLAT # SUN VALLEY OBLOCK 77.206 DETAILmmom BUILDING ®F AL a Co 49TH 09 00.0000000002® du ��. ® Je fery A. Gosioldi o a •. LS -6091 ��AV s'rn '•• 10/17/2019 pr�fession01 �-O(l I HEREBY CERTIFY THAT I HAVE SURVEYED THE -PROPER I i DEPIC I ED ABOVE LAND ENCROACHMENTSGASTALDI LLC ��! RESPONSIBILITYSURVEYING, IT IS THE OF OWNER TO Li DETERMINE THE EXISTENCE OF ANY EASEMENTS, { r,r 200 COVENANTS-- - s DO NOT ANCHOKA 99507 l�� APPEAR ON THE RECORDED SUBDIVISION PLAT. PHONE , ... UNDER NO CIRCUMSTANCESDATA GRID D,TE JHEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. SW2938 10/17/2019 ANCHORAGE RECORDING DISTRICT, ALASKA is NOTE: NO CORNERS SET THIS DATE DETAILmmom BUILDING ®F AL a Co 49TH 09 00.0000000002® du ��. ® Je fery A. Gosioldi o a •. LS -6091 ��AV s'rn '•• 10/17/2019 pr�fession01 �-O(l 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*//Wvm,.muni,org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191445 Work Type: SepticTank Upgrade Tax Code Number: 01706246000 Site Legal Address: SUN VALLEY HEIGHTS BLK 5 LT 7 G:2938 Site Mailing Address: 6440 GUNNISON DR, Anchorage Owner: MADDEN MARK G & BARBARA M Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: �ment e epartrnetit 10/7/2019 10/6/2020 77206 ❑ 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: / 4't Date: rf Issued By: '16Date: la EPLWJS MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-062-46 Property owner(s) Mark & Barbara Madden Mailing address 6440 Gunnison Drive Anchorage, AK 99516 Site address Same Day phone 727-7947 Legal description (Sub'd., Block & Lot) Sun Valley Heights, Block 5, Lot 7 Legal description (Township, Range & Section) Lot Size 77,206 Sq. Ft. Number of Bedrooms Three (3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑X (w/wo ADU) Holding Tank El Renewal❑ (D) ElRenewal Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. a 0"9—, (Signature of property owner or authorized agent) Permit/Rush Fees: a Z' Waiver Fees: Date of Payment: I [x.119 Date of Payment: Receipt Number: 66557 r) Receipt Number: Permit No. ! 9 IL1gJ5 Waiver No. Permit App_-'-:- Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191445, Rebecca Carroll, 10107119 kNEENG I N G PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) October 2, 2019 MOA Development Services Department On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Sun Valley Heights, Block 5, Lot 7 — 6440 Gunnison Drive Septic System Design Dear On -Site Services Engineer: The septic tank on the subject lot has surpassed its useful life and must be replaced. We are submitting this design and permit application for the construction and placement of a new 1,250 - gallon septic tank. The attached site plan identifies the location of the home and the septic system along with the new tank location. The lot is served by a community water system. No conflicts exist between this proposed tank and any other well or septic system or the water service line on this lot. The new tank will be constructed a minimum of 200' from the existing community well and 100' from any private wells. It will also be 100' from surface water and more than 5' from the existing absorption trench. Please r eferto the attached plan sheet forthe septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. • 49th . Y...Y.NIIP. xn. YYUY YYY.YYYYi..EY.....� .a SMICHAEL E. ANDER50N 4 �� :• No. CE -4381 •�� 10/2/19 •••,�+4.pRQFESSI•C�!�:W' 1 (MIS LO n -site Water and Wastewater SUN VALLEY HEIGHTS, BLOCK 5, LOT EWED FOR CODE COMPUA OSPI91445, Rebecca Carroll, ICY RAP DRIVE ENCROACHES ONTO LOT 6, BLOCK 5 LOT 6 0' CEA ROW ESMT / C BK 204, P G 978) Ix / M \ PLACE NEW 1,250 GALLON SEPTIC TANK w/20" MANWAY. EXISTING ABSORPTION P REMAIN IN S N CLASS W COMMUNITY �\ WELL200' RADIUS 2 T4 GE ENGINEERING O m DECOMMISSION EXISTING TANK PER MOA CODE. / CONNECTTO EXISTING FLOW DIVERTER VALV 1 CRIB TO ERVICE. EXISTING ABS91RPTION TRENCH TO REMAIN lb(SERVICE. NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATERWITHIN 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. 0 50 100 FEET 1"=50' LOT 8 CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANC FS - FLOW SPLITTERVALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE � MUNICIPALITY OF ANCHORAGE / • - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENGINEERING DIVISION UENVIRONMENTAL 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE iNEW t E- i_� `- ._ 7) �77 E] UPGRADE MAILING ADDRESS ` 5 IZA,-Jain—X737 77? C, -- LEGAL DESCRIPTION LOCATION �) NO. OF BE ROOMS 7 Well ��Absorption area Dwelling PERMIT NO. DISTANCE TO: c>Y Gal�lf-tVNll l6 8`'�O$7.� Manufacturer F• Z Material No. of compartmen s /� riles TARN sT t G L. TI — Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth f ✓1 � G aOZ DISTANCE TO: Well Dwelling PERMIT NO. Tz Manufacturer Material Liquid capacity in gallons O Wg DISTANCE TO: Well � Foundatio�ryry Nearest lot lin�� /b PERMIT NO. _ 9,3Gc�77., LG a6 �JNI Y'� J LL z F Z No. of lines % Length of each line _ FJ �— J Total length of lines _— L-`+' Trench width 7, �, inches Distance between lines ..'.-'_— Top of tile to finish Material beneath tile Total P. grade -.0 tmp effective absorption area Length Width Depth PERMIT NO. w (7 oF Type of crib Crib diameter Crib depth Total effective absorption area ui yj DISTANCE r0: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank Absorptoniareals) OTHER _—�® -- PIPE MATERIALS _ As, rM v��%L7 SOIL TEST RATING P, A) -is — INSTALLER MMIC. o /A ,t Py� — - o I T w�—I REMARKS fy�.49TH • S/�`f / p�/�(io f♦••••i •yJ i•••• yj�•Ts ufo r pp A" — N 227_ 97 ,w Q �r JUNE 25, 19714— pp�� J– �.,s • 1� — s EAPROVED DATE LEGAL sON VQLL l_ l(, 72-013 (Rev. 3/78) N ^ 8 II_. -R N" •.N �. N.-::: _N. E Y "R IL._. ]L 1f " x" C)F:_ 0=11-4 li p_ tl 0 E_ 1-- "V DEPARTMENT 1. HEALTH AND ENVIRONMENTAL i "OTEQTION•I / 325 ''L..' STREET, FINdi=47taE, AK, :E: 'Itaa. 20 N =:� II°" -4 '_.-- "=5 IN.....T. E -r: "-;., F==' C ,P r -i.. K FI Ez E fl� �=° VI 3:: 1_ PERMIT NO. C 830873 APPLICANT .JERRY I= FERGUSON SRA E';OX 'r 7:':O;441, 13LINNdh5 ipa •;aq=J ,, _ LOCATION UPGRADE L..EiGAL- L B5 'SUN VALLEY HEIGHT. LOT SIZE 999999 S:i,,:=:= FEET TYPE: OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS q. SOIL RATING (SQ F'T/BR)= AZ�ftC`iTi � THE REQUIRED SIZE SOIL_ ABSORPTION SYSTEM _ 1.,�.E, r_1r= THE: J IS: C3 FQ g'::.p ""e ffE B._._ IE d & -_ IF 71-6— ._W „- � -7 THE LENGTH E)JI'IEr--lcION IS THE LENGTH 0:N FEET) OF THE TRENCH OR DRAIN+IF':I:EL.D. THE:: DEPTH OF A TRENCH OR PIT .IS THE DISTANCE BETWEEN THE SURFACE OF THE GRiII_IN+ID Fll''D THE: BOTTOM OF THE EXCAVATION (IN FEET). HERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE. AND THE BOTTOM OF THE EXCAVATION (IN FEEQ. IFe p'- o_ m i.. R :N F;^' Eft E: E:x c Er.: N . T...:1 li:.: T... R -:.:I N°,N E':_ Q T '". EE:._- �.. GgEN �'_: � mN N=:=o r 'll II_. N....._ 01'4 PERMIT APPLICANT HFI_- THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AI''•D THE. NUMBER OF RESIDENCES THAT THE WELL WILL Ei:RVE. _...._....._... -E" IAN N_ -II 2.". o :B: P4 15 F7 EE N _T_::E' (3104!S_; F� E= E:: 94", H E N:: -m R_J TC F --:'E.-: IL. _..,...._.......... BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE: SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL... AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I:; :i.00 FEET FOR A PRIVATE: WELL.., OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPE.I''•DINI. UPCH''•I THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WEL...L. TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER L.IN'•IE. ]::'r.:; 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS FII'+ID CONSTRUCTION DIAGRAMS FIFE FI'•rr'ITI_I=I[aE..E TO INSURE PROPER INSTALLATION. 11"' E'E_ a,..y N:::a" :M N' =' N . 'fcr.;: N:> E::: = n'. tl : II °'N N'E IC:: If " . _11.j. it. "ON Is - I. CERTIFY THAI J..: :I: PINT FAMILIAR WITH THE'REQUIREMENTS FOR ON-SITE SEWER'S FIND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. T WIL..L... INSTALL THE SYSTEM IN F0.::CCiF:DhTNdE:E: bII`rH "rl-IE CODES. fEIF: E'ip.N_•:c�ITE ..:CL�.IEF=: ,. . 1 UNDERSTAND THAT '='' SYSTEM MAY REQUIRE ENLARGEMENT IF THE: . RESIDENCE 15 REMODELED TO INCLUDE MORE: THAN 4 BEDROOMS. 0-''z SIGNED ECAN••IT J'li<F::RY E FERGUSON ISSUEDE3','.__.( mal.:_......%`�—v�.rx.�/1 v` --- DATE --------------- V4.0 PY SOILS LOG -� MUNICIPALITY OF ANCHORAGE C DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERC0LAT1oN • TEST 825 L. Street, Anchorage, Alaska 99551 264-4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:-�q, A loon cY•cuV a'LZIq / DATE PERFORMED:--8L2-c? _ 8 3 LEGAL DESCRIPTION:_ i_ of S_S vn VA11etq fl,h5 hI0 /f sj$30zg SLOPE SITE PLAN .f;i% OI- o an3e brow" onrn. c St,;, GPt. br-u.I�n 1tr� s,.•tdy gM�el WrianS ✓:e0.••tr. Sr1 moi s+ SII'I?1 Sn•�Ay grr.rCl bro••n(6(�tK N 5 . DateGross Time Not Time Depth to - Water Net Drop 17 - 'L,U3 io L41E3 d �o ) 9; og 1s. 4 N 5 WASGROUNDWATER No L ENCOUNTERED? 0 P IF YES, AT WHAT it DEPTH? _ - I A•�i a_ 92rY _...n h1a -- 1. k . Reid, Jr. ��•. o. 2251•E 20 '; PERCOLATION RATE._ 20 o_.,(minutes/inch) ^ TEST �RUN BETWEEN .�.__�r t- FT AND Y FT COMMENTS Soy I �ict� S' 210 1] IL 'Fiort L( tx� lar Reading - . DateGross Time Not Time Depth to - Water Net Drop N31 - 'L,U3 _ L41E3 yz ) 9; og 4 sv to I_q� , 06 ON A! I Fil q0 a.OU .OS WASGROUNDWATER No L ENCOUNTERED? 0 P IF YES, AT WHAT it DEPTH? _ - I A•�i a_ 92rY _...n h1a -- 1. k . Reid, Jr. ��•. o. 2251•E 20 '; PERCOLATION RATE._ 20 o_.,(minutes/inch) ^ TEST �RUN BETWEEN .�.__�r t- FT AND Y FT COMMENTS Soy I �ict� S' 210 1] IL 'Fiort L( tx� lar Reading - . DateGross Time Not Time Depth to - Water Net Drop N31 - 'L,U3 _ L41E3 yz ) 9; og 4 sv to I_q� , 06 Lj 2.a5 Fil q0 a.OU .OS PERFORMED BY:. 'Dol CERTIFIED t, ' 72.008 16/79) DATE: DFP/,r r,r OP IIIA IH'.N_) t , 1" i( I A 1_ P R OT[_.' I:; (Permit $: 820898 January 31, 1983 TO: Permit Applicant Subject: Lot 7 Block 5 Sun Valley ]]eights Subdivision A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well :Log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-bu.ilts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerely ( d Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 1� 11Y1 t -A I r_. I =i L_ I T'Y CA F= n r4 iC:- F--+ R F=1 Ca E DEPARTMENT Lit- HEALTH AND ENVIRONMENTAL PnOTECTION 825 'L.' STREET, ANCHORAGE, AE'. 99501 26,4-4720 CA t -.F —_'_ jr T F_ "a En FSI FE F-1 U F=" e_; F�--, H Ea EE Fes' E IF-: r•1 .l" T PERMIT NO. ( =2089+ ) APPLICANT _TERRY FERGUSON PO BO; 10-1881 345-7132 LOCATION LEGAL L7B5 SUN VALLEY HTS LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 225 THE REQUIRED SIZE OF THE: SOIL ABSORPTION SYSTEM I S : _91 r C_ F- n% E_L_ C+EF=`TH= 163 THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET), THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE: EXCIAVATION CIN FEET). F= E, :p LJ :[ F= E_ E-+ in E_ F=` T 11=_ T F=1 t -d K ,F. I v E_ _ A_;2!5 i0 C3 n L_ L_ -"t -.fl PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCIES THAT THE WELL. WILL SERVE. -F- I., I 03 C: ' _ + 114 fo F=' F_ t_- T I CA F' -d fs Frd FZ E F`� E= Ca 1_I 1E F? E rl� BACECFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY CSN -•SITE SEWAGE_ DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR, 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE:: AVAILABLE TO INSURE PROPER INSTALLATION. F= EF F1 P1 I T E_ >4 Fes' I FRA =_ _ . E> E_ C. E_ r•11= IE Fes"' :_3_- .2 = -1. LY 0:2! I C:E`.TIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENE: IS REMOD LED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED:. __._- ----_--_- PXP I ANT _TE Y-FERGUSOPd ^-_'______ �L ` _ 6 ISSUED BY__._ �` � 'L I �;_ D � }f, 2` ti --p�L�_ zC%�c. l ATE_.-.[.�� __.___-___ L -- `AZT 14. 0 in- NAME LOCATION SEPTIC TANK: DISTANCE FROM WELL -- INSIDE LENGTH GRE ':R ANCHORAGE AREA 60. IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS LEGAL DESCRIPTION PHONE 2'/ T3&0 ( .{.. d��s �, t'C -COMPARTMENTS- --INSIDE NUMBERPARTM / �'yl.SrC' C / COM` MANUFACTURER MATERIAL �ENTS __ INSIDE WIDTH ___LIQUID DEPTH LIQUID CAPACITY) ' Z""6' GALLONS. SEEPAGE PIT: NUMBER OF PITS / —. DIAMETER LINING MATERIAL6C'e _ CRIB SIZE: BUILDING FOUNDATION_, NEAREST LOTT�LIINE ABSORPTION AREA (WALL AREA) 7-,5 SQ. I -T. ADDITIONAL ABSORPTION -5011 ZZG p/ /M WELL: (O7>7M(()7/'�/ h1q%/' TYPE_ 1-3 OR WIDTH_, LENGTH_, DEPTH FOUNDATION �- DIAMETER --DEPTH-9— DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOTT�LIINE ABSORPTION AREA (WALL AREA) 7-,5 SQ. I -T. ADDITIONAL ABSORPTION -5011 ZZG p/ /M WELL: (O7>7M(()7/'�/ h1q%/' TYPE_ /CONSTRUCTION BUILDING NEAREST FOUNDATION LOT L.INE_ CESSPOOL OTHER SOURCES APPROVED_ DISAPPROVED DISTANCES: INSTALLED BY: PIPE MATERIAL: /Ca`/f LO_4 LOT SLOPE: REMARKS: APP -5 No� COhp yC��PC1 r �PC o n' _ Form No. En -031 NEAREST SEWER LINE REMA DEPTH SEPTIC TANK. DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM N e DATE 0' __ G '2� — / N'- APPROVED M GREATER ANCHORAGE AREA BOROUGH `'DEPARTMENT OF ENVIRONMENTAL QUALITY PERMITNO 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274.4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT -S MAILING ADDRESS 1/3// PHONE�J�� INSTALLATION LOCATION LEGAL DESCRIPTION _ 7 !/ INSTALLATION OF: SEPTIC TANK ___- SEEPAGE PI `_ v --, DRAINELD _-_, OTHER TYPE AND SIZE OF FACILITY TO BE SERVED_/��(/✓%�'/n��/��/�'I�'h-/{�.f/Y�/,�, ,.,y� ,/��/� _ FINANCED THROUGH _ _ TO BE INSTALLED 6VSOIL TEST TEST RESULTS _-��L-- _ NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL T667 COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF' ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMIENT OF ENVIRONMENTAL. QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK TYP MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC; TANK FOUNDATION TO SEEPAGE PIT __y/ _, DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK � f , SEEPAGE PIT (, DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK ___ SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK. Z//5j- / SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STRICAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS, GRAVEL BACKFILL CONFORM TO BOROUGH RE ULATIONS REGARDING INSTALLATION. G.A,A.R. OR \\ LICENSC13 DEBIGNICR SIZE'ra � • TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE RCQUIREMENTS Oh GREATER ANCHORAGE. AREA BOROUGH ORDINANCE NO, 110.60 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ``- APPLICANT'$ SIGNATURE ev_, DATt � _..Lem FORM NO, KO.010 (-.ArA TER ANCHORA T Art; A fir! ;I{ HUALTdi aEPA .9'di£IPf CASE 4 327 LAti114: `1'6tEE'!', ANCHOR ACE, ALMKA 99501. PP"x'forlmd For Kaa�yv� Johnson - Pate A ,.n��'Irf"O,:' 14 June 74 Legal I)etcript�$irn� 3 oe �% ce: _:x This Perm Reports a; Sni xsx.i Suneteb� l;a$`XX....�i ez c�iiti`on 'i'es, a„ Depth F`xet gold Characteristics 1 Gm The Gm is fairly com- Pacted with a low water content. There Is some erratic Gw and Sw bodies but these account for less thah 5% of the total sed - Invents. Location Sketch tdas Ground Wtr.ter £noounta+red? No If Yes, At What Depth 4Pa Reading Date Groes TamaNot Tlm: Depth To H20 Nat Drop PrnposociInstal �t o f "N,aaUaga ric�- AXX GraiOr n :'; a i: MUNICIPALITY 0.�;�70%m Development Services Department On -Site Water & Wastewater Section Parcel 1. D. 017-062-46 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: NO -4 Complete legal description Sun Valley Heights, Block 5, Lot 7 Location (site address) 6440 Gunnison Drive Anchorage, AK Current property owner(s) Mark & Barbara Madden Day phone 727-7947 Mailing address 6440 Gunnison Drive, Anchorage, AK 99516 Real estate agent 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: M Day phone TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Holding Tank ❑ X Community ❑ ❑ Public Sewer, ❑ Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ `IL D + `l 3 Date of Payment l i 10�(�1 t 9 1 i12 2119 Receipt Number ()(10(191/00 COSA # (� sr (q 15iI2 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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 Michael E. Anderson, P.E. Date 11/20/19 6. DSD SIGNATURE System #1 Approved for q bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: '�3 o ERc� A �/A,4Tc�A.�D m == op E PIToG64A 111C1111,�\\ B i `�(i Gl Original Certificate Date: o� If f Y Ori9 q 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 yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) 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 Adequacy test date 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) If yes, enter date Comments/Deficiencies: *Trench and seepage pit were tested separately for adequacy. A flow splitter valve was installed connecting the trench and pit for continuous usage. The combined trench and pit provide sufficient absorption area to serve a four bedroom home. Sun Valley Heights, Block 5, Lot 7 017-062-46 11 1 COMMUNITY WELL <1 SEPTIC/PLASTIC 67" New Construction - 10/10/19 Trench/Seepage Pit* 10-25-83/6-27-74 11-12/11-7 4 12.0'/13.9'19/20 6.7'/5.9 1424/702 64/51 1440/1188 5.3'/8' 57/25 >600 No ✔ 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 ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If 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 Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 11/19/19 - Community Well >200 NA ✔ NA NA >200 NA NA NA NA NA ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Lot is served by a community well. Diversion valve removed and flow splitter valve installed 11/19/19. System is adequate for a four bedroom home. 15T Municipality of Anchorage Development Services Department \ / Building Safety Division On-site Water and wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-06246 COSA Expiration Date: —11-10-7 1. GENERAL INFORMATION Complete legal description Sun Valley Heights Blk 5 Lot 7 Location (site address) 6440 Gunnison Drive, Anchorage, AK 99516 Current Property owners) George J. and Brenda S. Dickison Day phone Mailing address 6440 Gunnison Drive, Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Jerry Dewhurst/ Remax Day phone 907-257-0113 Mailing Address 110 E. 38th Ave., Anchorage, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ individual On-site El Individual Water Storage ❑ individual Holding Tank ❑ Community Class A Well El Community On-site ❑ Public Water System ❑ Public Sewer ❑ I The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems proval are required for the transfer of Title (�xi-ept�etween spouses or grope es serve y a sing e- amily onsite wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Certificate of Onsite Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn Watkins Engineering, Inc. Phone 907-349-1851 Address PO. BOX 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis, P.E. Date 5. DSD SIGNATURE __jZ Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following M WY W. Ellis CE-tos77 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By: lv. Original Certificate Date: I (R«.1 ws) Municipality of Anchorage Development Services Department Building Safety Division On-Slte Water & Wastewater Program 4700 Bragaw Street P.O. Bax 198650 Anchorage, AK 99519 650 www.mrmi.orglonsile (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal ru--'n*on: Sun Valley Heights Blk 6 Lol 7 Parcel ID: 01708248 A. WELL DATA Well type A If A, S, of C provide PWSID # 219962 Date completed_ Sanitary goal (YIN) Total depth R. Cased to ft. FROM WELL LOG Date of test Static water level rt Wen production g.p.m. WATER SAMPLE RESULTS: Coliform NA colonles/100 mL Nitrate mglL Merck: _ mgll Date of sample: 8. SEPTICIHOLDINO TANK DATA W811 LOU (YIN) Wires properly protected (YIN) Casing height (above ground) fin. AT INSPECTION NA fl O.P.M. Other bacteria cdonieWl00 mL Collected by: Tank Type/Material Steel Date Installed 10)25189 Tank size 1260 Sol. Number of Compartments Cleanouts (YM) Y Foundation Beano t (YR4 Yes DWMWcn over tank (YIN) No High water alarm (YIN) No Date of pumping 8M4M Pumper A+ Home Services ' i C. ABSORPTION FIELD DATA Date installed 8/2874 Sol rating (g pAAe or ferodrm)225 System We Seepage Pit ' Length 19x1943x11 R Width NA R. Gravel below pipe 8 ! fL Total depth 19.76 ft. Eft. absorption area ZLje Monitoring tube Yes Depression over field No Date of adequacy test 7/24/2008 Results (Pass/Fag) Pass For 3 bedrooms I — Fluid depth in absorption field before test 14 le. Water added _6_gal. New depth 47.6 Elapsed Time: 120'1027 min. Fled fiufd depth 99.6128.6 h. Absorption rate >• 450 g,p,d.d, Any rejuvenation treatment (past 12 mo.) (YIN &type) No If yes. give date &T D. LIFT STATION Date instsned PIA Size in gallons 'Pump on' level at _ in. 'Pump ofr level at _ in. Datum Cycles bested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot NA Absorption paid on lot Public sewer main Sewer /septic service line Animal containment areas Manhole/Access (YIN) High water alarm level at in. mom alarm 8 circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/deanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 15' Property line50_+ Absorption geld 10'+ Water main 200'+ Water service line * Surface water 1004 Weds on adjacent lots 220 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 28'+ Building foundation 28' Water main 150'+ Water Service line 50'+ Surface water 1001+ Niveway, poMnOvehide storage 100'+ Curtain drain none known Wells on adjacent lots 215 F. COMMENTS: On AtAgust 1 2008 the old crib was reconnected, and a DCO and diverter valve Installed after the tank The crib was presoaked with 2005 gallons of water on July 21. 2000 and tested on July 24. The 1983 trench O. ENGINEER'S CERTIFICATION ,t" I certify that I have determined through Aeld inspecdons and review of Municipal records that the above systems are m cordiomrance with MOA COSA guidelines in elTect on this date. Engineer's Printed Name Cindy W. Ellis, P.E. L'I47W. E111121 CE. Joey Date kT COSA Fee $ �� Waiver Fee $ Date of Paymentfi04 Date of Payment RecelptNumber $S1i5 A Receipt Number (Rev. tIM5) P scone 0� AW S�oiU L T Lot - '7 Block Anchorage Recording Precinct, Iska fl 17- PROR9V-, - S64vED BY MMv" ,V?Y.. WELL: .. A U M 1# T! f,_% M1192 I •,1�ai f �19fOp•••••.••••••1Np�� -4 �•�d�'f Ear ,jet.I •d • SfPT[C_S.EtS • .s • L WI SUKVEY CERTIFICATION LEGENDg¢r Ihereby Certify that lhaw aurveyedthepropertyShownanddescribed IZaBrosscopped monumentrecoered •-�--y✓ hereon, and that the hnprovemerds situated thereon are wlthin the prop- o a Iron pipe and/or robot recovered erty lines and do not overlap or encroach on odjocenx property and that no a a 2x2 hub B tock recovered Iniprovemerea on odiment property overlap or enuooch on the premises • a'.Sre"x 3d'rebar set this survey in question and that there are no roadways, utility Urea or cher 9tslble easements on said property except as Indicated hereon. Scale/ir /�r Date w•n -O9 Prepared by: R.L, Lot)dSN Rey/s/ere0 LonC Surveyor Ref. F. B. W. 2938 �0-53 (9071779-6200 519 W. EIgAM Avs. Anc[xrogs, Alb0o, 99501 Pro�w ypf: i 6.eorge 4 Brenda Di -7 Sun Valley Heights Block 5 Lot 7 Existing Septic System George ). & Brenda S. Dickison Parcel ID: 017-062-46 Cindy W. Ellis, RE August 15, 2006 Scale 1 Inch m 30 ft c0 vi Watkins Engineering, Inc. P.O. Box 110443 Anchorage, Alaska 99511-0443 Phone: (907) 349-1851, Fax (907) 349-1934 Sump 49�H* MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL F�OR� A SINGLE FAMILY DWELLING Parcel l.D.# �1`l—dln�=Lllo_(X2r_�_ HAA#��°I� 1. GENERAL INFORMATION Complete legal description _ Lot 7• BKock 5;` Sun Va.22eu Neight6 Location (site address or directions) 6440 e. AK Property owner Deborah Fengu6on Day phone 345-7133 Mailing address 6440 Ganni6on V)tive Anchwtage, AK 99516 Lending agency Day phone Mailing address ------ Agent _ Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 y 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water -- Day phone ze NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL.: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rnv. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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. Narne of Firm Address 17034 Eagle River Loop Engineer's signature 6. DHHS SIGNATURE Approved for ��''r/� i� bedrooms. Disapproved. Conditional approval for Additional Comments Phone L'_ Z —Date //G--�, bedrooms, with the following stipulations: By: J - Date 9 --1-c _ 9 v 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. 72-025(Rov.1/91) Back MOAM21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo aK .S SvAlymcgy' Parcel I.U. / 7—— He/r({7-5 5/D A. Well Data Well type CoMMLNL/ � If A, B, or C, attach ADEC letter. ADEC water system number�5z Log present (Y/N) Date completed _ Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/ s FROM WELL LOG INSPECTION 7-7 o z z n Date of test o z n N. Static water level rill N Well flow _g.p.m. g.p.m:< to Pevel1 C�.1 ti C y C rt SEPARATION DISTANCES FROM WELL TO: Septic/ha,H+q-tank on lot ZGY> ; On adjacent lots /Z r _ Absorption field on lot _ -Cx� f ; On adjacent lots Public sewer main Public sew anhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria gat of sample: Collected by: B. SEPTIC/HftON G TANK DATA Dateinstalled �3 Tank size ��— Compartments CleanoutsbN) _Foundation cleanou (Y/) Depression (lQN N� High water alarm (Y N) �_Alarm tested (Y/N) 4 Date of pumping - q/ 2-CD/ys Pumper ANOM 6E2V/GES SEPARATION DISTANCES FROM SEPTIC/#et91+46 TANK TO: Well(s) on lot %J _On adjacent lots ZAP Foundation To property line / () r� Absorption fieldr _Water main/service line. r , Surface water/drainage 72-026 (3/93)' Front P6YL (NSAECTIO/J Poa6"Cr CONTINUED ON BACK PAGE C. LIFT STATION &bOJL P�ESG-N7 Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DIST D. ABSORPTION FIELD DATA LIFT STATION TO: On adjacent lots Manufacturer Manhole/Access (Y/N) tested off" Level at Surface water Date installed o/?_S� 3 Soil rating (GPD/Ft2) 225:'_18KZ Systemtype JK(,Wctf r / 1 � Length 6S Width 3 Gravel thickness % Total depth I I Total absorption area c/ /D Cleanout present Y)N) YE.S Depression over field (YQ(l t° Date of adequacy test %12 Z/ y3 Result pass fail) PASS for 4 (FcUrz) Bedrooms 3 Water level in absorption field before test S / 4 After test S7 Peroxide treatment (past 12 months) (Y/N) ND/J6 KA)OW A) If yes, give date /V/A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: 1 /G L s fl Well on lot NSA On adjacent lots 2 C CCN ZAJT'Y Property line To building foundation 41 To existing or abandoned system on lot Nc)1-11 fozfEG-D-J✓ r On adjacent lots 20 r fi Cutbank Nv/06 /°&6-��Ojf Water main/service line ZS r Surface water /CSO r F Driveway, parking/vehicle storage area S i�- Curtain drain !%D.yL Kit�kJA� Pew lNsrcr� 1m�2i E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all S & S ENGINEERING Signature 117034 riagle Div.... 1 Engineer's Name Eagle River, Alaska 5 � v Date HAA Fee $ t�3c')0 .ria Date of Payment -,2 —F Receipt Number a 5-;2 � / a W 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number GREATER ANCHORAGE AREn BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV 2. Property Owner: L) r) Mailing Address: P, i1 5, Day Phone l j lvloo� 3. Name of Buyer: Mailing Address: Day Phone 4. Name of Lending Institution v J Mailing Address: Phone 5. Name of Realtor or Agent: Mailing Address: Phone 1 6. Legal Description: bI/ 1iii Location: 7. Type of Facility to be inspected: A" 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Bdrms Type of System; Public Utility Individual (on-site) If Individual, date of installation k