HomeMy WebLinkAboutSUN VALLEY NORTH BLK 4 LT 6un Valley
NoPth
lock 4
Lot 6
050-652
-13
Municipality of Anchorage Page / o!
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater DiSposal System and/or Well Inspection Report
N~m~= ~/e~-~ ¢. ¢ ~, L~4~ CA~A~ Wastewater System: ~New ~ Upgrade
Address: ~"/0 Z. ~'~ ~¢'/~¢ ABSORPTION FIELD
*ho..: 777-~Z°°,.,: ~DoeoTronch ShamlowTrench UBoO UMound UOther
LEGAl. DESCRIPTION so,,.,.0: /. D GPD/Sq. Ft. TotalDeplhfro}~iglnalgrade:
WELL: ~ New B Upgrade travelwldlh: j / Number of llnes: IiDislancebelw0enllne~:
~lassglcatlon (Prlvste, A,B,C): Total Depth: Ossed To: Total absorption area' Pipe material:
SEPARATION DISTANCES a Septic U Fielding B S.T,E.P.
To 8eplic Absoratfon Lilt Holding PubHc/Prlyal{ Manulactu~er: Capacllyln gallons'.
Fro~ Tank Field Station Tank Sewer Llne~
Number of Compartments:
Surface /----- LIFT STATION
Ourtaln
Remarks: BENCH MARK
Location and Descrlpllon:
Department of Head,.and Human Services approval
Reviewed and approved bY: - Date://-/¢ -¢~
72-013 {Rev, 9/91) MOA 25
PERMIT NO SW980196. PAG~ 2 OF 3
Municip. alit; o¢ AnchoF'o, Qe
DEPARTMENT OF HIEA~_THAND HUM'AN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O. []ox 196650 eAnchorage, ALaska 99519-6650eTetephone~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 6, BLOCK 4, SUN VALLEY NORTH
P.LD. NO. 050.-652-15
ELKHORN
CIRCLE/ ~ //~o°
EASEMENT
<
O
E~
E~,
O
CB
1,0T 9
ALT. SITE---x . n
~ ',', ~EW TRENCH
','?,,
SEPTIC TANK~u *' uBL!. I
co_-
LOT 6 ~
r~s~Iv NO. SW980196
PAGE 3 OF 3
MunicipaLit; oF Anchorac~e
DEPARTHENT OF HEA~THAND HUIVTAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.B. Box t96650 ®Anchor'age, Ato, skc, 995].9-6650®Tetephone, 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL NSPECTION REPORT
LBGAL LO'7' 6, BLOCK 4, SUN VALLEY NORTH
P.I,D. NO, 050-652-13
A B
FCO 6.5' 13.0'_.
S~1 10.5' 9.0'
ST2 18.0' 9.5'
DBL1 21.0' 11.0'
OBL2 22.5' 12,0'
C01 28,0' 15,5'
~-T1 48.0' 34.0'
~-02 90.0' 76.5'
CO1
MT CO~
MT = 96,8'~,.~ [Jcol = 9§.3'
__ /leOS 97.2'
II
CO1 = g2.2'_~
CO~ = 9~,0'
MT = 87.8'-~
TH· WATER FOUND 82.8'
BOH 81.§'
SCALE 1" = 40'
by
SULLIVAN X 'I'EI rELL$
KO. lOX ilO~/l~ I]HU~K, ALAII K~ Itel? · TILEPHOfll Itl 4/it
ADDRESS
PEEMIT NUMBER~ DI~
T~ 'IN~'IFiCATION NUMBER ~-~
M~h~ ~ DHIII~:
~h of ~11:
Pum~ng ~]:~ i~r~hrl. ~mping
~}~ d
Oepth: ~m (~ .~t, ~ '~ ..~e~
Pump ~ ~pth:
Pump 8i~. ~hp B~nd Ne~.
BORE I.I~.l~ DATA
DEPTH
NOV G 1998
Human
ATTENT ON: ~t is th~ r~lpon~lblll~ o~ thl property owner to i~bmit ~ ropy o! ~a wail ~og to the proper lluthodty. MunlC~pell~
of Anchorage: Deperlment of I.,~Blth & Human 8ei'vlce~ end/or Doplrtment of Envimnmerffal
Oepadment of Envlronn~nlai
Fi0~NICIPALITY OF D~NCHORAGE
DEPD~RTMENT OF HEALTH D~kTD ~ SERVICES
BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW980196
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAi~E:CALLAHAN MICHDNEL C & V LU33~NN
OWNER D~DDRESS:510 L STREET STE 400
ANCHOP~GE DJ~ASKA 99501
DATE ISSUED: 6/22/98
EXPIP~TION DATE: 6/22/99
PARCEL ID:05065213
LEGAL DESCRIPTION:
SUI~ VALLEY NORTH BLK 4 LT 6
LOT SIZE: 72579 (SQ. FT.)
NLrMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCOI~ANCE WITH:
THE ATTACHED APPROVED DESIGN.
ALL REQUIREMENTS SPECIFIED IN ANCHORAGE ~0NICIPAL CODE CHAPTERS
15.55 D~kvD 15.65 ~ND THE STATE OF ~J~ASKA WASTEWATER DISPOSAL
REGULATIONS (18Z%AC72) Z~ND DRINKING WATER REGULATIONS (18~%AC80).
THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE:
ROBERT C. COWAN, P.E.
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
&FLOWEEST
SITE PLANS
ROAD DESIGN
SOiLTEST
PERCOLATION
TEST
STRUCTURAJ_&
MECHANICAL
INSPECTIONS
DESIGN
June 8, 1998
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 6, Block 4, Sun Valley North Subdivision
Request you issue a permit to install a septic system and well to serve the proposed
fonr bedroom house on the referenced property.
One test hole was excavated and a percolation test performed. The approximate
location of the test hole is located on the attached site plan.
At the time of excavation 6/1/98, water was encountered in the test hole. After seven
days of ground water monitoring, the ground water monitoring tube reflected that water
level was found to be at 11 feet.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas, o1' drainage patterns by the installation of the proposed septic system
There are no points of contamination within the proposed well radius that can be seen
on the attached site plan.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/mg
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLI-- RIVER, AL,~KA 99577
m
1" = 60'
SCAL£
~ca
oo~ o
m_mO
DESIGN
m o ~
COTTON GRASS DRIVE
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DAT~
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18-
19-
20-
COMMENTS
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED? ~/~ -'~
IF YES, AT WHAT )1 ~/I). / SL
DEPTH? pO
E
Oeplh to Water Alter ~ /~j /
Mogilorillg? )l _. Date: (~ 'a ~
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE '~', ~ (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN '~ . FT AND ~ FT
S & S ENGINEERING -//,~'
,. v~-, ~.~ ........... v ~ ~O. ~ I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WII~tLR~7~8~AL GUIDELINES IN EFFEC¢ ON THIS DATE. DATE:
72-008 (Rev. 4/85)
ROBERT C. COWAN, P.E.
SEWER&WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
DESIGN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
REFERENCE: Lot 6, Block 4, Sun Valley North Subdivision
Jun 8, 1998
GENERAL:
The scope of this project includes the installation of a 1250 gallon septic tank
and a leachfield trench to se~we the proposed four bedroom residence located on
the referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible fbi' obtaining any necessary underground
utility locates.
Unless specifically agreed otherwise, the property owner shall be responsible for
final grading areas subsequently depressed fi'om soil settling.
Contractors installing wastewater disposal systems ~rrust be certified by the
Municipal Health Department for system installations. Owners installing their
own systems must also receive prior approval fi'om the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pmnping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of the
tank.
All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
17034 NORTH EAGLE RIVER LOOP SUITE204 EAGLE RIVER, ALA~KA99577
Page Two
Lot 6, Block 4, Sun Valley North S/D
Jun 8, 1998
A foundation cleanout shall be installed one to four feet fi'om the building foundation.
In the line between the tank and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic tank). These cleanouts shall
be located on undisturbed soil not more than 10 ft. fi'om the tank. The first cleanout, in
line, shall be to clean toward the leachfield. The second cleanout shall be to clean
toward the septic tank.
Final grading over the septic tank shall be such that a positive slope exists away fi'om
the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of
the excavation shall be within 2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock)
placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tabes shall be of four (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final grade.
The portion of the monitoring tube extending through the gravel shall be perforated
fi'om the bottom of the trench to the invert of the distribution pipe. This is equivalent to
the effective depth of the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent the formation of a
depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
Page Tln'ee
Lot 6, Block 4, Sun Valley North S/D
Jun 8, 1998
The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting
engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco,
or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform
to cun'ent M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of ttu'ee (3) inspections required during the installation of
the wastewater disposal system. These inspections will occur as follows:
I. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
Page Four
Lot 6, Block 4, Sun ValleyNo~h S/D
Jun 8,1998
The second inspection must be conducted after the placement of the silt barrier,
gravel, disthbution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting
engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a
pre-construction meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractors activities.
The owner shall contract with the contractor to perfo~Tn the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S & S Engineering. S & S
Engineehng shall be the owner's representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor
to carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
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. 050-65Z-13
1. GENERAL INFORMATION
Complete legal description ,.~un Valley
COSA#
Expiration Date:
NOrth, BlOck 4, Lot 6
Location (site address) ;)2350 Elkhorn Circle, Eagle River, AK 99577
Current Property owner(s) Natalie Harrison & Phiilip Price Day phone
Mailing address 5201 E Northern Lights Blvd. Apt 1 W, Anchorage, AK 99508
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __ Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] Individual Holding Tank [-"]
[] Community On-site
[] Public Sewer r~
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site 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 Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues 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 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 vedfy 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 Firm ARCTERRA CONSULTING, INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFF-US Date 11/18/10
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the
water usage of the family being served by the system. 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,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
~ Approved for C.~
Disapproved.
Conditional approval for
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
bedrooms.
bedrooms, with the following stipulations:
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev. 11/05) /
Original Certificate Date:
t /
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Sun Valley North., Block 4, Lot 6
A. WELL DATA
We!t.t~Pe~.~, If A, B, or C provide PWSID # Well Log. (Y/N):,~
Date completed 6/26/1_998 Sanitary seal (Y/N) ~ Wires properly protected (YIN) ~
Total depth 200 f. Cased to 1-52 ff. Casing height (above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of test 6/26/1998 11/10/2010
Static water level 110 it. 151 f.
Well production 1-0 g.p.m. 4.49 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEC colonies/100mL Nitrate 0.876 mg/L
Arsenic: ND mg/I Date of samplei 11/11/2010 Collected by: AzcTerra
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Sept[c/Steel Date installed 7/22/98 Tank size 1_250 gal.
Number of Compartments _2 Cleanouts (Y/N) ¥ Foundation cleanout (Y/N) __. Depression over tank (Y/N) N
High water alarm (Y/N) N Date of pumping 1-1/1-0/1-0 Pumper ~Rs
C. ABSORPTION FIELD DATA
Date installed 7/22/98 Soil rating (g.p.d./ff2 or ff2/bdrm) L2 System type Deep ?zeach
Length 64 ft. Width --3 ff. Gravel below pipe 4ff. Total depth 1-1-.1-6 ft. (Measured 11/10/10)
Eft. absorption area 51-2 fi2 . Monitoring tube Y Depression over field N
Date of adequacy test 1-1-/1-0/201_0 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 25 in. Water added 67o gal. New depth 35 in.
Elapsed Time: 1-320 min. Final fluid depth 25 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NIf yes, give date ---
Parcel ID: 050-652-1 $
D. LIFT STATION
Date installed
"Pump on" level at __
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off' level at~
Cycles tested
in.
Manhole/Access (Y/N).
High water alarm level at in.
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+.
Public sewer main ~3'+
Sewer/septic service line 25'+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank 1-00'+
Manure/animal excrete storage areas l_O0'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation $'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 1-00'+
Wells on adjacent lois 1-00'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Fm
Property line 10'+ Building foundation 10'+
Water Service line 10'+ Surface water 1-00'+
Curtain drain 50'+ (None Known)
COMMENTS
Water main 10'+
Driveway, parking/vehicle storage 10'+
Wells on adjacent lots 1-00'+
Gm
ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KF. NNE'[T-[ M. DUI~S
Date 11/18/2010
COSA Fee $490.00
Date of Payment ///~~r~
Receipt Number ~/__~ ~ I ~_~
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www. ci.anchorage .ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.DL 050o6~;2-1 3
1. GENERAL INFORMATION
Expiration Date: ] ,2,. - ,2../lZ '- 0 ~
Complete legal description
· Location (site address or directions)
:Current Property owner(s) Michael &
Mailing address
Sun Valley North: Block 4: Lot G
223.~0 Elkhorn Circle: Fa_ale River: AK gg-~77
Luann Callahan Dayphone 696-~;~31
Lending agency
Day phone
Mailing address
Real Estate Agent
Les Bailey- Prudential Vista Dayphone 68g-K464
Mailing Address 1GR3~; Centerfield Drive: Eagle River: AK gg577
Un/ess othe/wise reques/e'd, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: __4_
3. TYPE OF WATER SUPPLY:
· ';'" ~lndividualWe
Individual'Water Storage
' Corhmunity Class
"'"Pub'lid' Wate~ System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] Individual Holding tank
I-] Community On-site
[] Public Sewer
I
The Municipality"of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
'/~pproval (HAA) based only upon the representations given in paragraph 4 by an independent professional
civil en, gineer registered in the State of Alaska, Certificates of Health Authority Approval are required for the
transfer of title (except between spouses) for propedies served by a single-family on-site wastewater disposal
and/or water supply system. DSD also issues HAAs upon request to homeowners, Certificates of Health
Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well
and may be reissued with new water sample results. (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 Health Authority 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 Firm KND ENGINEERING: Inc.
Address 20441 Ptarmigan Blvd.= Eagle
Engineer's Printed Name Ker~peth M. Duffus
River.. Al( 99577
Phone (907) 696-6111
Date 9/18/2003
Engineer's Comments:
This investigation was completed in compliance with
ADEC and MOA regulations. 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 and the water usage
of the family being served by the system. 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, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
,?._~o ..'
i 1/V^STEWATER:
PROGRAM
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements ~"'-~,;::~n'~*'-x~'
Supplemental Engineer's Report
Other
Odginal Certificate Date: ~ -,=,~-- ~ ' 0--~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7g04
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SUN VAII I=y NORTH B4~ L6
A. WELL DATA
Well type_,0.r.~ If A, B, or C provide PWSID #
Date completed_~z/_~=.~a/_~ Sanitary seal (Y/N)Y
Total depth Z00 ft. Cased to _.l.,SLft.
FROM WELL LOG
6/26/1 998
11o fl.
1 0 O.p.m
Parcel ID: 050-6SZ-13
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Well Log (Y/N) y
Wires properly protected (Y/N) ¥
Casing height (above ground) 2 '
AT INSPECTION
1at7 ft.
3. B 1 g.p.m.
0 col°nies/100 mI.Nltrate ~g./I.Other bacteria 0 coloniesll00 mi.
NA mg./L Date of sample:.~
Amenic:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Matertal.__~ate installed ~__
Number of Comparlments Z Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) I~
Date of pumping_..~,,~~ Pumper SANITARY
Collected by:
C. ABSORPTION FIELD DATA
Date installed.Z/_.,:~,/_.,~._.~_~oil rating
Length 64 ft. Width ;~
.Tank size 1250 gal.
.. High water alarm (Y/N) N
(g.p.d./ft= or ~/bdrm)1.2
ft. Gravel below pipe
Total depth I~ ft. Eft. absorption area 5_t2 ft~ Monitoring tube ~ Depression over field N
Date of adequacy test ~/:~7/03 Results (Pass/Fail) _.~ For at bedrooms
Fluid depth in absorption field before test 28 in. Water added_~.D_ gal. New depth 37 in.
Elapsed Time:_.l.~ min. Final fluid depth ZZ in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
System type ~
ft.
D. LIFT STATION
Date installed
'Pump on" level at in.
Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallons
'Pump off' level at
Cycles tested.
Manhole/Access (Y/N)
in. High water alarm level at
Meets alarm & circuit requirements?
100'+
Septic tank/lift station on lot 1
Absorption field on lot 1 00'4'
Public sewer main ?5'4'
Sewer/septic service line 2S'+
On adjacent lots I O 0 ' 4'
On adjacent lots 10 O' +
Public sewer manholelcteanout
Holding tank 1 0 0' 4-
Property line 5' +
Water service line 1 0 ' +
SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK ON LOT TO:
Building foundation S'+
Water main 1 0'4-
Wells on adjacent lots 1 O0'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field 5 ' +
Surface water 1 O 0' +
Property line 10'+
Water Service line 1 O'+
Curtain drain 50'+
COMMENTS
Water main 1 0' 4'
Driveway, parking/vehicle storage I O ' +
Building foundation 1 O' 4-
Surface water 100 ' +
Wells on adjacent lots 1 00 ' +
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 HAA guidelines in effect on this date.
Engineer's Printed Name Kenneth M. Duffus
Date ¢J/1 ~/7003
in.
HAA Fee $375.00
Date of Payment
Receipt Number
(Rev. 1~01 )
Waiver Fee $
Date of Payment
Receipt Number
;907 5615301
CT&E Environmental Services Inc.
200 W. Potter Drive
'A.achorage, AK 99518-1605
Telephone: (907) 562-2343
Facsimile: (907) 561-5301 :
200 W. Potter Drive
3/ 3
3rinking Water Analysis Kepo~t for Total Col]fo:m Babt~ria
· Tel: (~7) 562-2~3 ' ' '
· ·*J(e&F .
Treated Writ. er
Tlm. e Collected
· 'Collected
~ Sample ~v~r 30 hou~ old, results may
A~ult~
1035556 ;.
,l'~h Fbk~ Jura ~
' ~ ~xxed
~: _ : ~ T~ "
· Client no'fi.ed o,f ~]saflsfacto~ result:.
Phbned · Sp~ke with
Dat~i ' 'r~mc
SAMPLE TY~B: ';.. ' '
0 Speclhl Pu~gse
~ ' C61enie~l~O mi
BGB · COLIFIN, M
Coliform/lO0 mi
C0wlm~rtt$:
M~(~-MUG Result: Total Ci~llform . .
M[emb~t~e~rtlter: Direct Count
· Verification: L'FB
Fecal Coliform Confirmation ,_
Final Membrane Filter Results
l~axed
;
CI. EANOUTS
X I~.1'
SHED
TWO STORY
LOg HOME GABION
LOT g
2?.4' DECK
N 89'48'27'E 160.01'
/' · , LOT 8
PLOT PLAN ASBUILT ~- SCALE I - ~o GRID. sw 759 Proleof No. o~-;~44
'LQrln & Associates-- |nc. 11500 Daryl Avenue, Anahorage, Alaska 99515
.. ~ . ~: ' (907) 522-6476 Phone
Keglsfered Lana surveyors (907)522-4625 Fax
Anchorage R~mording Dldrlot, Alawka, and that the ImPrOVements Mluatod ~.~:..'/i QTH "~~ '..'~
thm~n om wlthln the m~erly Ilmm and d~ nd encroach onto the m~merlv ~ ,*, :.,'. . .: .......... . ..... .',....;
ndlaeenf thar~ that ~o fmpr~vernents on the properly lying ndlaee~f ~ller~io ~.'
enereeeh on fha Burve~ed premlee~ and that there are no rmzdv~, fmnlmlm~/on
Ilne~ or G~4r visible emmments an ~zld prepe~y aX~lg as Indlmztsd hereen, -~-~'._-.-.'_::::_':.~-'_~'~.-['.'_":' ~'.
- -~,~, -..... ...' ~'~ ~ ·
~t ~ the re,pon,n,,~y o~ the own,r to detsrndn, m, ,x~,tsno, of any ,a,m~nents,