HomeMy WebLinkAboutMAJESTIC VALLEY ESTATES BLK 3 LT 9
'~AME
MAILING ADDRESS
LEGAL DESCRIPTION
MUNICIPALITY OF ANCHORAGE
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
/
PHONE
[] NEW
~JPGRADE
LOCATION
We ; Absorption area
[ DISTANCE TO: I /OO' I
Manufacturer -- __ ~ __ ~/']~ .
Liq' capacity in gall°ns I iF FI~E 'M. ~
/~ O,i) ........ Du: Inside le)g~
DISTANCE TO' IWell
' I I
Manufacturer
We
mSZANC~ TO: I //0
NO, of lines . ] Length of each lifleO~/
I Top of tile to f~ish grJde ~, ~
Length Width
Type of crib Crib diameter
DISTANCE TO:
Well
Class ~- Depth
DISTANCE ~0: Building foundation
Dwelling
Foundation
Driller
Sewer line
Total length of lines
Material beneath tile
Dwelling
Material ¢,
*,,~1 .,-~L
IWidth ._ _.
Material
Nearest lot line ~,.~/~ ~ ~
Trench widt>~ inches
~0 inches
NO, OF BEDROOMS
PERMIT NO.
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Distanc~ b/~wee ~ n/es
/
Total effective absojd~tion area
Depth
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
PERMIT NO.
Total effective absorption area
Nearest lot line
Distance to lot Fine
Septic tank
PERMIT NO,
Absorption area(s)
APPROVED~ & ~
! ~¢~'~L~ RIVI~R, At. ASK&
72-013 (Rev. 3/78)
XL
DEF:'AR'T'MIENT OF' HEAL.TH AND ENVIROIxlMEIqTAL. F:'FIOTEC/TION
8,~ L STREET~ AII(..,HOFd.~bE, Al< 9950:L
264-4720
PERM I '1" 1'40
DATI.T I SSLIED
84()67() UF'GRADIE
/07/84.
APPI_ I CAIqT: SLJE GAI...I.., I ON
ADDRESS: % SD.S IEN(3INEERING
EAGLI:::, AK 99577
CONTAC'T' F:'HONE: "694-2979
I,,,.FZGAI_ DESC',R :1: F':
I_OT SI ZIE:
SUBDIVISION: MAJEu]lC VAL. I_EY
SE[]TIOIxI: o~r ~ .... ,
TOWNoH.[I-: 14hl
54465 (SQ.F'T., ORACI~Eo)m
LOT: 9 BL(]CI<: 3
FiANGE: .1. W.
I certify that:
1, I alii ~'amiliar wi'Lin 'Lhe r'equivements for' on-si'Lc sewer's and we].ls a~[~
for'th by 'Lhe Munic::Lpali'Ly oF Anc:l']oPage (MOA) arid 'Lhe Sta'Le of Alaska,,
2. Z will install the system in acEopda~l]c:e w:L'Lh all I'lOf~ codes and
arid in c:ompliarlce with the design cr'it~pia of th:Ls per'mit,,
3. I will adh(ape to a].l MOA and State o¢ Alaska pequiPements Cot the set back
distal"JCeB Cpom Blqy existing well, wastewat, ep disposal syst. em aP i:)ul:)lic
sewePage system on t.I'~J.S Of any ad.jace)rrL [)1' n~ar'by lot..
IF A L..IF'I" STAT'ION IS INSTAI,..L,ED IN AN ARE'.]A COVERED BY I.~I[)A BLJILDING CEIDIES,
THEN (1) AN ELEC, TRICAI_ F'IEFddI'I' AND INSPECTICIIq MLIST BE CIBTAIIqED; (~2) AS-BIJII.,.TS
WIL. L NOT BE ~F'F'R[]VED WZ'TI4OLIT ~hl ELECTRZCAI_ ZNSPEC'rZON REI::'ORT~ ~ND (3) 'T'HIE
IEL.,IECTIRICAI_ WC]RK MUST BE DONE'BY A LICENSED ELECT'F(ICIAN.
.:} 1 G NI::.D
AF:'F:'I-i C..ANT
DATE::
·. MUNICIPALITY OF ANCHORAGE ~::i:~
DEPARTMENT OF tlEALTH & ENVIRONMENTAL PRO-I"ECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOI~,I'
NAME
MAI LING ADDRESS
LEGAL DESCRIPTION
~,J NEW
.[~_ .] UPGRADE
LOCATION !NO. OF ~EDROOMS
¢;,/y //.~.~ u.//* zF/¢;z~- ~/~g ~C~
'-~ Tw., I Absorption area ' Dwollinq ~ PERMIT NO
/ DISTANCE TO: I / ~.-~ / I ~/ ' (7' - ~<:~'~./
~ -- IL c~ cal~ff~T ........ ~e~ ~ Width .... ~ Licui. t d
' ~ ['~DISTANCE 're '[ Well .... [ Ow~li,,~ ........ ~
~- ~ [Manufacturer -~ Material Liqaid capaciw in gallons
~'~IDis.._N ..... ~ ... f [Foundation -~. l/N~ar~TFi~-----
~ ~ ~ [ No. of lines [ Length of eacl~ line [ Total Ion~lth of lines [ Tronc ~ w at Dis race bet~nu~
~k: ~ Topof tdetofln,shgrade _. I /Matermlbeneath tile - ITotal
~ k ~ of crib Crib diameter ~ Crib do ~th - ...... ['~'o~7~'~tTve ~;]o~[~ m ~'r~
~, DISTANCE TO:
'%--p%--. ..... .... ..............
~ ~ --~: ....................................... ~ .....
1
~ DISTANCETO Building founda on Sewer ine S01)tic tank _AbsoH~tion
OTHER
PIPE MATERIALS.41',4~. i. ';,:¢ v,.'/:'/: /'i/',/: ~..~/./,__
fl, 4,7. ;, /" d
SOIL TEST RATING
INSTALLER
- ?
REMARKS
APPROVED DATE
72-013 (Rev. 3/78) 29 - 12 ' . /_ /~1v¢,-£-//
i ~ I-'NVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/QR WELL INSPECTION REPORT
-~AME TPHONE [ []NEW
MAI LING ADDRESS
OC.T,O. NO. O, , OOMS
~ Well Absorption ar~a Dwe ling ~ j PERMIT NO.
DISTANCE TO: /
F, ~ Manufacturer Mat~ial No. of compa~ents
Uiq. capacity in Ballons Inside length Width Eiquid depth
j~ IF HOMEMADE:
~ ~ ~ DISTANCE TO: Well Dwelling PEHMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
~[ DISTANCE TO: Well //~ , Foundation,/ ,' Nearestlotline PERMITNO.
-Z::: ' '77 D :: 11'
No. of I?es Length of each~line , 'rotal len~t~ of lines Trench width Distance between lines
N ~ ~ Top of tile to finish grade I Material beneath tile --' ' Total effective absorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
[u Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance t~ I~t line PERMIT NO,
~ Building foundation Sewer line Septic tank Absorptioa area(si
~ DISTANCE TO:
OTHER
~IPEMATERIALS~?'~9, F, ~Z~ V,//:/~
SOIL TEST RATING
INSTALLER
~EMARKS
¢~ ~h t Earl P. Ifl(i~
APPROVED DATE LEGAK
'l'!...l[~: M:::ZNGTH E:, Z HETI'.,!?i; ].' CIF! ]: :E; ']"Ht!~: !..EbKii]'H ,:: ]:1',! F'E:F.'::T ::, OF: TI'IF: TF:ENOI.! OR [)1:;;:1::!:( i"fi::' ]: iE:! ..i),.
'filE; E:,E::I:::'TH CtF:' FI TF:F:I'.,IC:H (:)F: F':[T :(¢!; THE: !), :( :i!!;Tt::Ii'.-!CE P, li~:TiqE[Zix! 'i'!-IE ::;UF:!::FICZ Ctl:- 'i'!..!l!ii:
(:!i[;.':()lJi'.,l[.':, I::~1'.~.[:, THE: E:(]rI"]'OH OF' THE E',:.:;CF~',/F:Ff' ): ON
THE[~:E if!!; NO S[:':T H:r. DTH F;'OFi:
TH!C (3Fiff:Pv'l~l.. [)E:t::'Ti.I :[:E; THE: H):b!iPIUt'1 I)?.(I::"]'H
I::ff..]..[:, THE: BOTTC!!'q 0[.::' THI:E FiZ;:.:;C:I:::!',/Ft"[' ):Cflq ,:: ): N !:'!~:I:~7i' ).
i',! Z N )]lql._lH t?, ]: :E;"f'f:INCE BE!:Tt.,.hri:EN f'l I,.t!!D.i_. FtI"~D F:II'.,i'.~' OI'.,!-S :r 'fi.i: ::qEt,.!f:~(':iU !)
:~.~:.~!;:!l I::'F/[i::T !::OFf'. P, F'I~:]Z'v'FITI:~: !.,.lEI_I._.; (:fi;i:
::i..:~iit;::.i 'l"O ;~::.'!~11~1 I::I~i:[:'71' I::rl:;~]C:lJ'q 17t F't. JBL ZC: H:E::[.I.. [)[!:!:::'EI"'!D.'i:f':K:i !JF'OI"! Tiff}:
HE!...[. i..OCi::i!; f:If;;:[~ F;'.E(.!LIZ(F'i',EE:' Fti"'ID HU:::i;T I131~: I:;.:FiTl'l..tFtlqE:D T(')THE I?'F:PI:::Ib;:'f'HF:NT
OF' ']'HIE: FIF;L.t. COhIPL..Ii~.T]:CIN.
()'I'I'iE~I;~: I:;i:I~X;:!U ]: F~:EI"IENT~5 I"l.f:'l"/ F~F:'PL'~". :~:F:'I!!ZC: ]: I::' ]: C:FiTZ CIl'"!'-:i; FIHI:.':' (]:OI'"!:~!;TI:;i:tJ(::T
f:i~',"[::iZ!.F:l[:ill.[g; '1'O ):t"~:!~;I,..l[~:li!~ PF",OF'[!~:R
:( E::!TF~'.'T ]: !::"r' '!"HF'!T
:L: :[ Ri"1 F'FII"IZi.):f:'II::~: I'.lZ'f'f'l 'f'l'"lF: !;::[!Zt~.:!l..lZ!:f;;:[~:l'"l~:!:l",!"i'~!; t7(3t:;': ()l":l'-:~;Z('i"l~: S[(I'.!IZi:;;::E; FIND HF:~I..L'.E;
F'OF~:'i"H B"r' THE: HUbiZ[CZF'FIL. Z['!'"r' OF
2: ]: I'1 :[ t..I.... :[ t",!?I'!::~L.L. '['1'1[~: Z"~':::7'i'I~:P1 ]: Iq FICC:CII:;:DlaI",IC:F~: I,.! :t: TH 'I'HE}:
2:: ]: UI",~D[}~:[;:'}F'i'I:::IblI]) THFIT 'i'TffF ON'"SJ:TE :(~;E:I'.t[~:I~'. :E;"~"::i;'i'I}~:Ff P!F't"d t:;;:[3XI..IZF'.EZ [~:blL.f:~F~'.CJE:HIFI',!'! ]:F' !'I'IE~
&
08-E
Russe# Oyster
694-2774
Soils ~ Foundations
Performed for:
GEO'. -CHNICAL 8' DEVEL
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Name:
~iling Address:
SOIL LOG
Legal Description:
Depth (feet)
0
2~
3~
6
7~
8
10~
13
1F
16
Soll Characteristic%
?MENT CO.
Earl Ellis
688-2280
Land Development
Tel. No,
Ground Water Encountered: Yes No If yes, what depth~
Proposed Installation: Seepage Pit__Drain Field
Comments: ~ _
Performed by: Date:
CHUGIAK, ALASKAKODIAK, ALASKA
688-3199 144 486-4826
DRILLING CO.
'. WE SERVE ALL ALASKA
• POST OFFICE BOX 42 — CHUGIAK, ALASKA 99567 ,.
OWNER OF LAND ............... ..... ......... ...... ---� `� ,,✓
......................................... DEPTH OF WELL..............................................................,,;.,.�..t..;............. .
.. :. • .. ,. .1 .
ADDRESS..................................................................................................... STATIC LEVEL OF WATER FT.................................................................
• � � `*-,` � — � � �"J?
WELL SITE .....................
.......................................................................... DRAW DOWN FT........................................................................................
�. DATE —STARTED ................
...................................................................... GALS. PER HR...........................................................................................
-
Jpl
{
DATE— ENDED........................................................................................... KIND OF CASING......................................................................................
KIND OF FORMATION:
r,� r .tel (x,. .. x� /� %,
- 1 FROM ...................... FT. TO ...::................. FT.................................... FROM ....................... FT. TO ....................... FT..................................
FROM.... FT. TO ...................... FT....................................
... ............... FROM ....................... FT. TO ........................ FT.................................
rt1
FROM ...................... FT. TO ....................... FT.................................... `` ... O ...... ...........................
FROM .................... FT. T .................. FT.....
FROM .... " �, �� E
................. ......................................................... FROM ....................... FT. TO ........................ FT....................,...........�
low-
�. �.
1- FROM .. tz t
�.. ...................... FT. TO ........... ......... FT.................................... FROM ....................... FT. TO ........................ FT.................................
' FROM .... ... ... FROM ....... ..........
.................. FT. TO .. ... ........... FT.................................... .................... FT. TO ........................ FT............. ...
FROM...................... FT. TO ...................... FT..........................................
FROM ................. FT. TO ........................ FT............................ .
FROM...................... FT. TO FT.................................... FROM ....................... FT. TO ........................ FT.................................
FROM...................... .. ................................... FROM ................. FT. TO ........................ FT..................................
FROM...................... FT. TO ...................... FT.........................................
FROM ....................... FT. TO ........................ FT, ................................
FROM ...................... FT. TO ...... .......
......... FT .................................... FROM ....................... FT. TO ....................... FT..................................
FROM . FT. TO
�= ...................... FT. FROM ....................... FT. TO ........................ FT.................................
1
.` MISCL. INFORMATION:
c_ DRILLER'S NAME ..................... ....................................................................................
•
•
• c.- Municipality of Anchorage -<E /10eo
On-Site Water and Wastewater Program
(907) 343-7904 '�'v n
SAFETY
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-731-25 Expiration Date: I A q 0
1. GENERAL INFORMATION
Complete legal description MAJESTIC VALLEY ESTATES,BLK 3,LOT 9
Location (site address) 25935 IMPERIAL DR, EAGLE RIVER,AK
Current Property owner(s) WILTON GUNN Day phone
Mailing address SAME
Real Estate Agent Day phone
, 23456
ty:sits,,2. TYPE OF DWELLING:
Single Family (w/wo ADU) Q9�V� � o
❑ Duplex ,
E Multiple Dwellings (Single Family and/or Duplex) 0`. N
OJo 3
3. NUMBER OF BEDROOMS: 3 6(9 +
Cgs7 z0
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual IZ
Individual Water Storage ❑ Holding Tank ❑
Community.Class Well ❑ Community E
Public Water System ❑ Public Sewer 0
Waiver/Variance request for: Distance:
Received by: /441i Date:
f/i (71 r
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ ill?119 Waiver Fee $
Date of Payment YDate of Payment
Receipt Number f..-e -. Receipt Number
COSA# 6-AwitWL:"
Waiver#
O.sG 17/32.6
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.
Name of Firm MIKE N ANDERSON,P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON,PE Date 1/18/18
('�eno°°u ' °• t
6. DSD SIGNATURE j. 0.0 oo
!/ i\
1111CHAc N. \•�
y; {, L . AIL IJLr Sr.'.:
System #1 Approved for 3 bedrooms. e(r ��•, C1-94S9
mac; ° / l
System #2 Approved for bedrooms. � ��7 p /(•�,:,
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
`\QP�c •-i or-
/ar) 141 I\S q Years DI c _ beraJP-
ON-SITE
P i 5 ) —97.6)''.;YPl`r5 -� WATER AND
O WASTEWATER oz
PROGRAM �d
It>FMT SER\A6c
By: - ARA/ Original Certificate Date: g/?St/
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 blue sheet_10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: MAJESTIC VALLEY ESTATES, BLK 3, LOT 9 Parcel ID: 050-731-25
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 5.30-80 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth 187 ft. Cased to 187 ft. Casing height(above ground) 24"+
FROM WELL LOG AT INSPECTION
Date of test 5-30-80 7-20-2017
Static water level 21 ft. 75 ft.
Well production 0.5 g.p.m. 0.49 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 2.43 mg/L
Arsenic: ND ug/L Date of sample: 1.8.18 Collected by: Mike Anderson
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 6-9-78
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) NA
Date of pumping 7-14-17 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA—1985 SYSTEM TESTED
Date installed 6-9.78&8.9.84 Soil rating (sf/bedroom) 144.100 System type DEEP TRENCH
Length 38-20 ft. Width 2.5 ft. Gravel below pipe 8&5 ft.
(A t2 /ZvO
Total depth_/ft. q Eff. absorption area 730 ft Monitoring tube Y Depression over field N
Date of equacy test 7-20-17 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 18" B110 in. Water added 300/450=750 gal. new depth 1"B1/32 in.
Elapsed Time: 1350 min. Final fluid depth 11"BELOW INV/0 DRY in. Absorption rate >__450_g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
jr- (Qfzi-c , /`-(T .-e(-0-14.$ c9Q\(v) S, I r(vW (hvrvi` � ��
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in.High water alarm level at in.
Datum _ Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10 Water main 100'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(None Known) Wells on adjacent lots 100'+
F. COMMENTS
COSA RE-NEWAL WITH NEW WATER SAMPLE. ALL INFO TAKEN FROM 7-27-17 ARCTERRA FIELD NOTES AND TESTING,500
GALLON WATER STORAGE IN GARAGE,1978 FIELD IN TOP 20%,1984 SYSTEM DRY. SEPTIC TANK IS 40 YEARS OLD,TYPICAL
LIFE IS 25 YRS
4f. 1.1
G. ENGINEER'S CERTIFICATION „';'‘ �� ••••
•5- .:tt
,r ty•• ••"6
7 j
I certify that I have determined through field inspections and r* 49TH ••
;
review of Municipal records that the above systems are in 40.4. ••' •• !
conformance with MOA COSA guidelines in effect on this date, .•.• •
rte''. MICHAEL N. ANDERSCNiR.
Engineer's Printed Name MIKE N. ANDERSON, PE 1c•. CE 9/4/449
Date 1/18/2018 •
;`\•`��� ,
COSA canary sheet_2-6-15.doc
6-D
Municipaliof Anchond
On -Site Water and 'Wastewater Progra
(907) 343-7904
A FIE T
CERTIFICATE OF ON-SITE SYSTEMS OVAL z �06
Parcel I.D. 050-731-25 Expiration Date:
1. GENERAL INFORMATION
Complete legal description MAJESTIC VALLEY ESTATES BLOCK 3, LOT 9
Location (site address) 25935 IMPERIAL DRIVE, EAGLE RIVER, AK 99577
Current Property owner(s) WILTON & CATHERINE GUNN — Day phone
Mailing address
Real Estate Agent
25935 IMPERIAL DRIVE, EAGLE RIVER, AK 99577
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
E] Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
0
Community Class Well
El
Public Wafer System
0
VVaiverNariance request for:
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
0
Holding Tank
El
Community
El
Public Sewer
F-1
Received iz, �._ Date:
q9SA to be released_I_G, �e- eer, unless otherwise
requested by the engineer.
COSA Fee $_ 626
Date of Payment _-q- -
13111?
Receipt Number
COSA#
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance:
5. STATEMENT QFINSPECTION BYENGINEER
As certified by my seal affixed hereto and an of the validation date shown below, | verify that my inveuUgoUon,
based on procedures outlined in the Certificate ofOn'Sitn Systems Approval Guidelines for this app|ination,
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 verifythat based onthe information
obtained from the Municipality of Anchorage files and from my investigation and inapoution, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State ondeu.
ordinances, and regulations ineffect atthe time ofinstallation.
Name OfFirm ARCTERRA CONSULTINGJNC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 7/2712017
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS (ENGINEERING, SURVEYING, CONTRACTORS, ETC... ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. 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 N,
encroachments, deficiencies or discrepancies exist. AM, 'F
6. DSD SIGNATURE 4 Tl --1
System #1 Approved for bedrooms.
KENNIETH 1. DU
System #2 Approved for bedrooms.
Ilk
Conditional approval for bedrooms, with the following stipulations:
Ov
op
MO
y: Original Certific
The Municipality ofAmchonsga Development Services Division (DSD) issues Certificates n[On'SKe Systems Approval (COS/) 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:
C{}8ACheCkist X Nitrate Advisory,
Septic System Advisory Arsenic Advisory,
Well Flow Advisory ___�Other
Umore than 1 septic system is on the lot:
/ Cua*Cnecmxaof
Structure served bvthio system
Legal Description: MAJESTIC VALLEY ESTATES BLOCK 3, LOT 9 Parcel ID:
A. WELL DATA
Well type 9fBT IfA,B.orCprovide PVVS|D#__
Date completed Sanitary seal (YYN)y
Tnby| depth 187 ft. Cased to_1}7_ft,
FROM WELL LOG
Date oftest 5-30-1980
Static water level 21 ft.
Well production 0.5 Q.p.m.
WATER SAMPLE RESULTS:
Co|ifonniea/ 00 mL Nitrate 0, g/L
Arsenic: g/L Date ofsample: 7120/2017
B.SEPTlCKHOLDlNGTANK DATA
Wires properly protected (//N)y
Casing height (above ground) _���_in.
AT INSPECTION
712012017
75 ft.
g.p.m.
Collected by: ARCTERRA
TankType/Meteha| SEPTIC I STEEL Date installed 6/911978
Tank size _Y000_gal. Number ofCompartments 2 C|eanouta(YYN)
Foundation cleanout (Y/N)y Depression over tank (YYN) lW High water alarm (YYN)
Date ofpumping Pumper
C. ABSORPTION FIELD DATA ~'roFIELD MTEXTENDS ONLY s.rBELOWINVERT <80
Date installed Soil rating (g.pd.m'or*zlbdnn) 1441100 System type DEEP TRENCH
Length ft. Width 2.5 ft. Gravel below pipe 815 ft.
Total depth ft. Ef[ abborption area 6081200 ft2Monitoring tubo,f Depression over field 1N
-
Date ofadequacy test Reou|te(Pase/Fai0 PASS For %bedrooms
Fluid depth in absorption field before test n. VVataraddn gal. New dept in.
BapoedTime: 1350 min. Fino|fluiddapth in. Absorption rate >=450g.pd.
Any rejuvenation treatment (past 12mo.)(Y7N&type) N |fyes, give date________
D. LIFT STATION
Date installed
"Pump on" level ai
Datum
U,
Size ingallons __
"Pump off'|eve|at
Cycles tested
r,
Manhn|e/Acceao(Y/N)
High water alarm level atMeets alarm & circuit requirements?
____
E SEPARATION DISTANCES
WELL 0NLOT TO:
Saptiotenk4ift station on lot On adjacent lots
Absorption field onlot Onadjacent lots
Public sewer main Public sevvermonho|e/o|eonout
Sewer /septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ONLOT TO:
Building foundation Property line _9± Absorption field
VVotermnin Water service line Surface water
Wells onadjacent lots
ABSORPTION FIELD ONLOT TO:
Property line Building foundation 10'+ Water main '
Water Service line Surface water Driveway, parking/vehicle storage
Curtain drain Wells onadjacent lots _jOO'+___
F. COMMENTS
500 -gallon water storage tank in house. 1978 field is operating in the top 15 of the 8' effective depth,, Septic tank appears to be
operating appropriately based on visual observations of tank levels and pumping.
G. ENGINEER'S CERTIFICATION ^
/owfify thmt/ have determined through field inspections and
review/ of Municipal records that the above syab*n7o are /n conformance
with MOA COSAguidelines /neffect nnthis date. ~�'�� —��Nk
-
wl OF AZ
Engineer's Printed Name
Date 712712017 9 ZHv
CO8Acanary oheoL2-845.dom
on
IMPERIAL DRIVE
0
ANCHORAGE RECORDING DISTRICT, ALASKA
ASBUILT OF:
MAJESTIC VALLEY ESTATES SURD
LOT 9 BLOCK 3 PLAT 77-27
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: DAM SCALE: a -MM -
AUG 26, 2017 1'=40'
17-0,58 MAM sr IOWMD BY GW ROME—r�
JLS SW0363 170149
= FND REBAR
F
00
..:..49�
........ '
tl
.L..
coo J . L. SCHULLER: o
LS -10408
6 Ago'
�.Of
essiondim�.
I
4 LAXI)
4
_A�
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
INSPECTION FOR HEALTH AUTHORITY APPROVAL-.---~'"~(~ .-,, Ic:~J~..~
CERTIFICATE
OF
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ///~/(~C ~/
GENERAL INFORMATION
(a) Legal .~,escription (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name .,~f--¢--~-~~--~ Telephone: I--Iome..J~
(c) Applicant is (check one): Lending Institution []; Owner/builderA; Buyer [-1; Other [] (explain);
(d) Lending Institution //"'¢~ ~'¢z~/~'~-~ Telephone
Address . ~-,, ~ / , ~.~.
(e) Real Estate Company and Agent '~
Address
e
(f) <-Marl'the HAA to the following address:
TYPE OF RESIDENCE
Singl~-Family~J/ Multi-Family
Number of Bedrooms
Other
''tl I tt
WATER SUPPLY
Individual Well )~ Community [] Public []
Note: If corem unity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~ Public [] Community [] Holding Tank
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDINU INSPECTIONS, TESTS, FILE SEARCH, DA~A 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 suppty and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
Telephone
the date of this inspection,
Name of Firm
Address
Date EAOL~K
DHEP APPROVAL
Approyedfor, ,.~
ApProved '~" Disapproved
Terms of Conditional Ap'proval
.\
bedrooms by .~¢7.~ ~ ../~/"~..~,.~L Date Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHFP) issues Health Authority
Approval certificates based solely upon the representations 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 requirements. 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.
Page 2 of 2
72-025 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
MUNiCIPALiTY OF
DEPT, OF HEALTH &
ENVIRONMENTAk PROTECTION
NOV 1 71988
_RECEIVED
Well Classification
Well Log Present (~N)
Total Depth t/r.~J:7
Static Water Legel
If A, B, C, D.E.C. Approved (Y/N)
Date Completed -~~'~ ¢' -(-.¢ ~) Yield
Cased to
Casing Height Above Ground
Electrical Wiring in Conduit CN)
Separation Distances from Well:
To Septic/Holding Tank on Lot /O(%/
Depth of Grouting ~
Pump Set At C~./,-_
Sanitary Seal'on Casing ~-Y~N)
Depression Around Wellhead (Y~'
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by ~ ~b-%L=~',~-" ~/~ ,..-q~.~.7/~ c~ ; Date
Water Sample Test Results .5-,4
Comments ~,~-~.-- ,~/~,~..P
/
/~6-/- ; On Adjoining Lots ?ccd-/-
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
l~ -/2___-
B. SEPTIC/HOLDING TANK DATA
Date Installed ~' -~' ' 78 Size /c.'-c~O No. of Compartments
Standpipes (~/N) Air-tight Caps ~)/N) Foundation Cleanoutd~/N)
Depression over Tank (Y~_,~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line /o/4-,
To Water Main/Service Line /o
Course /oc) /
Date Last Pumped //
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation cC /
To Disposal Field 5-/
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 6¢ -'~ -'~-/¢ ,.
Width of Field Z_,,s" /
Square Feet of Absorption Area
Depression over Field (Yt~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well / O Ot
/
To Building Foundation __ ~ !
Lot
Depth of Field /~// '-X-/t
Gravel Bed Thickness f~// .4(- -~"/
., _,~_Z_ ~r~ ¢ Standpipes Present
Date of Last Adequacy Test //-/~
To Water Main/Service Line ,"o /
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, o.~/Ve~cle Stora. ge ,Area
Co m:m e nts/~ ~-~//~/~/'"~'~
To Property Line '-'~/ / 7,~ L//-D /
To Existing or Abandoned System on
; On Adjoining Lots --¢"~
To Cutbank (if present)
/oo/+
D. LIFT STATION
Date Installed
/A
Size in Gallons //"/
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to allM CA and HAA guidelines in effect on the date of this inspection.
Signed ~
Company,~R_~F-~I~iX N .
Receipt N~GLE RIVERr AK 995~
Date of Payment
Amou.t:
Page 2 of 2
72-026 (11/84)
MUNICIPALITY OF ANCHORAGE , '
~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'rlON - , . ·
/.'~ ~1~ ) 825 L Street - Anchorage, Alaska 99501 .
~",.~ L~/~ ENVIRONMENTAL ENGINEERING DIVISION ' ·
~ Telephone 264-4720 .
REQUEST FOFI APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS= Complete all pej~on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROtPERTYOWNER ~ I ) '~ ' ' I PHONE
M/g~NG .z~;kORESS \ '" ~ ~,
PROPERTY RESIDENT (If different from ab~.~) L r-- PHONE " '
2, BUYER . ^ ['%> PHONE
MAI LTN G ADDR E~S'-- I J
3. L~,ND, ING INSTITUTION& . , ~ ~ ) .... / J / PHONE
MAILING ADDRESS ~ . ~ . I ~ -- .J I
4. REALTOR/AGENT d I PHONE
MAI LING ADDR ESS
5. LEGAL DESCRIPT'ION 1. , '
STREET LOCATION /"~_,~ . r "-- '
16, T PEXO'F RESIDENCE ~ ' ~ NUMBER OF BEDI~)MS \ ~
[] One [] Four [] Other .[' '
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7. WAT R~UPPLY -
b{J INDIVIDUAL* ~ ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior tothatdate, g ye we
[] PUBLIC UTI LITY depth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM
~ ~r~ w r~H~/r~ ~ -r'~** **lfindividual/on-site g've 'nsta at'on date .
__ I system is over two (2) years old an adequacy test is required J
L_J PUBLIC UTILITY by this Department.
NOTE; THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INIT ATED.
72-010(3/78)
,
THIS SIDE FOR OFFICIAL USE ONL
DATE R'EC[:IVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
E~;~/XSI NG LE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
I]~'/INDIvI DUAL DEPTH OF WELL
[] cOMMuNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~I~NDIVI DUAL/ON -SITE DATE INSTALLED
EZ] PUBLIC UTILITY ~
Connection Verified INSTALLER
E~'5~ptic Ta_nk.gr []Holding Tank
Size: /~)4~)~) If Tank is homemade SOILS RATING
give dimensions: /
TYPE~ MAN~
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption~Area Sewer Line Nearest Lot Line
WELLTO:
Absorption Area to nearest Lot Line
~1 CONDITIONAL APPROVAL {letter must accompany certificate)
[] DISAPPROVED
DATE BY (TiJJ4)
72-010 (Rev. 3/78)