HomeMy WebLinkAboutMAJESTIC VALLEY ESTATES BLK 4 LT 5Majesti*c Va . I ley
Estates
Block 4
Lot 5
#050-731-32
Municipality of Anchorage
On -Site Water and Wastewater Section ° (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: SW020408 PID Number: 050-731-32
Dwelling: Single Family (SF) with ADU Duplex (D) Two Single Family Project: New Upgrade
Name
TOM BOLLIN
ABSORPTION FIELD - EXISTING
Deep Trench Wide Trench Bed Mound
Site Address
26130 IMPERIAL DRIVE, EAGLE RIVER
Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
5
0.6 GPD/SF
3 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.5 Ft.
Gravel depth beneath pipe
1.5 Ft.
Subdivision Block Lot
MAJESTIC VALLEY EST. 4 5
Fill added above original grade
VARIES +/- 3.06-3.2 +/- Ft.
Gravel length
(2 @ 98') 196 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
1256 Ft2
2
10 Ft.
Well
100'+
100'+
25'+
TANK Septic S.T.E.P. Holding Other
Manufacturer
PREMIER & FAT ALBERT
Capacity
1000 & 550 Gal.
Surface Water
100'+
100'+
Material
HDPE
Number of compartments
1 & 2
Lot Line
10'+
10'+
NA
Foundation
10'+
10'+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks System not documented at time of construction.
See attached letter.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 Tank to
3034
Installer TWEED EXCAVATING
dra afield
Drainfield 3034 Co/MT 3034
Inspector S&S — Per MOA DOCS / FWCS-FINAL
BENCH MARK (Assumed elevation) 100 ft
Inspection ��' 11/01/2002 2�d 1/24/2020
Location and description
3`d 4"'
GARAGE SLAB
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Conditional Approval: Dated
,
'' 'a
Septic System
Curtis Huffman
Approved -A°°
�
Date lQ —2-01��Jr
° ClE71f2Z3o9os ��c`
Note: this approval does not include well permit requirements.��
(Kev U5/U1/"I 6)
MAJESTIC VALLEY ESTATES BLOCK 4, LOT 5
c�
Z A
�O
zo40 co PAVED
cV0 o� " o`" _ D/W
LOT `v 1
100'
WELL
RADIUS
PID: 050-731-32 PERMIT: SW020408
e� e 0 T
p� C *co
Mj D Eo DCO
SYST. F DIV LOT 5
CO MT BLOCK 4
G o
0
H T TH#3
CO
MT
THr- 0
J
I
\ CO
A—C=63,2'
B—C=56,6'
A—D=66,1'
B—D=59.5'
A—E=71,8'
B—E=64,2'
A—F=81,2'
B—F=66,3'
A—G=97,8'
B—G=43.3'
A—H=117,2'
B—H=62.4'
A—I=154,6'
B—I=126,3'
A—J=144,6'
B—J=121,3'
FCO Co Co CO CO CO DIV Co
R MT CO O n n n
FABRIC do INSUL
PER OWNER PHOTOS
EXISTING UPPER FIELD
CA
O
O
n
(W
Zr) SCALE, i' = 4i
MT CO
I I I I 76.37 FINAL GRADE
75.22 74.30 FINAL GRADE
FABRIC do INSUL RADE
PER OWNER PHOTOS
71.90
70.7 70.65
EXISTING LOWER FIELD
68.90 68.90 BOH —14'
TH#3 do #4
8/26/2002
SEPTIC SECTION DRY
SCALE, NTS
PREPARED FOR: SUPPORTSERVICES:
I 1k
TOM & REBECCA BOLIN ���, OF At,,,
26130 IMPERIAL DRIVE Fwcs ""-,�k
EAGLE RIVER, AK 99577 *irtis
H
�.
0, JiIIiIl
FIRST WATER CONSULTING DATE: 1/20/2020 Huffman wx
13030 SUES WAY SURVEY: JLS CE 128991 ��Af
ANCHORAGE, AK99516 DRAWN: FWCS 1/20/2020
" = 40 �FEssto��'
(907)350-9566 firstwaterAK®gmail.com SCALE: 1 AV
INSUL
PER- 87.25
PER
WNER
owNER FD
87'00
500—GAL 71'87
1,000—GALLON
HDPE 85.85
HDPE
HDPE
S.T.
SEPTIC TANK
FABRIC do INSUL
PER OWNER PHOTOS
EXISTING UPPER FIELD
CA
O
O
n
(W
Zr) SCALE, i' = 4i
MT CO
I I I I 76.37 FINAL GRADE
75.22 74.30 FINAL GRADE
FABRIC do INSUL RADE
PER OWNER PHOTOS
71.90
70.7 70.65
EXISTING LOWER FIELD
68.90 68.90 BOH —14'
TH#3 do #4
8/26/2002
SEPTIC SECTION DRY
SCALE, NTS
PREPARED FOR: SUPPORTSERVICES:
I 1k
TOM & REBECCA BOLIN ���, OF At,,,
26130 IMPERIAL DRIVE Fwcs ""-,�k
EAGLE RIVER, AK 99577 *irtis
H
�.
0, JiIIiIl
FIRST WATER CONSULTING DATE: 1/20/2020 Huffman wx
13030 SUES WAY SURVEY: JLS CE 128991 ��Af
ANCHORAGE, AK99516 DRAWN: FWCS 1/20/2020
" = 40 �FEssto��'
(907)350-9566 firstwaterAK®gmail.com SCALE: 1 AV
FIRST WATER CONSULTING
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
January 24, 2020
Municipalities of Anchorage
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: MAJESTIC VALLEY ESTATES BLOCK 4, LOT 5
During the COSA process it was discovered that inspection report for the septic upgrade that
occurred in 2002 under permit number SW020408 was not submitted. Based on visual
observations / measurements, photos provided by owner and discussions with the owner — it
appears that the system was installed per the permit. MOA documents show inspection was
called on 11/1/2002 and the photos provided by the owner are date stamped with 11/2/2002. The
inspection report is being submitted with the COSA.
Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
F�r �s
C 11(L11NG SERVICE
1.1 i F, 1/.11451 EVi .1.
i SRP PUR I& P I A NN I tIG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
Name
DISTANCES
FROM
SEPTIC
ABSORPTION
WELL
AddressTO
TANK
FIELD
WELL
03/
10-31
�U /
Phone(s)
Per No.
No. of Bedrooms
S`) 023 0
3
LOT LINE
LEGAL DESCRIPTION
Lot 5
Block 4
Subdivision
`` c
i (1•Q
1/Y)
�I r- V G L
FOUNDATION
Township, Range,
Section
NA I 2 , / 2
/ 1 , I �^' 2-3
AS-BUILT DIAGRAM (Show location of well,
driveway, water bodies, etc.) N.T.S.
septic system, property lines, foundation
TANKS
SEPTIC ❑ HOLDING
Manufacturer
Capacity in gallons
ANG1,J G ✓!(
/000
N`a
Material
No. of Compartments
TYPE OF SYSTEM
3'
❑ TRENCH ❑ BED X W. DRAIN ❑ OTHER
r
r
Depth to pipe bottom from
Total depth from original grade
b
original grade
/.S FT
QS_" FT
{'
��
o
Fill added above original grade
Gravel depth beneath pipe
-2 FT
FT
F;
r`
�
LIJ
Gravel length
Gravel width
Tatem+/ F4?' FT
.r FT
t'-
Total absorption area
Distance between lines
IY
605z//� SQ FT
/O FT
E
+u
>u
Number of lines
Soil rating
Pipe material
13 9 SQ FT
L/ITm 3 v 3 y F'fiO
Installer C !t C� \, 'q �(A 1
Z� I /
Date Installed
/I/�
GI YntcSS L•✓
/0 � r7
WELLS h
® PRIVATE FYI.ri/-1` ❑ OTHER (Identifv)
Classification (A,B,C) Total Depth
I
Installerna
Dale Installed:
r r=�
REMARKS: ue
'2 .2
'
Q GI �G NO f
�N,r /7 / G f pPFF� Ili.• C! J�J /WH � . r >
Scale:
q /J ,/
/Grti Over- %%,-A/�Fl$/� P/nr;^.r Inspections Perrormed by:
�. •'
IN�F?R6'6EAL
'1-.
Eagle River Engineering Services
.eX 77 2
r l j
li)
Date. Eagle River, Al( 99577
c.:
/
yN �V &j rva )jf_c�' / I✓ U/G( �C/,✓�r %'r CNG/ y6gN O/ �
f p '�,
G. _.. I-G-c -�-'n-• '+tate ov 4S `s-�E^So "c -�
l certify that [his inspection was performed according to all a 'F
YO C�t� tout: A. •u H2IG
�i P4
�q��1
Municipal and State guidelines In ellect on this date:
_1
eop
Health Department Approval:/0—';Z0 —F5
�)
12-U13 (s/ab)
,r"
Municipality of Anchorage
Mark Begich, Mayor
Building Safety Division
P.O. Box 1966550 • 4700 Bragaw Street
Anchorage, Alaska 99519.6650 • (907) 343.8301• Fax (907) 343-8200
September 24, 2003 http://ww .mmi.org
Tom Bolin
26130 Imperial Drive
Eagle River, AK 99577-9628
Subject: On -Site Water and/or Wastewater Permit.
Permit Number: SW020408
Legal Description: JMC16stic-Valley'Estates BIock 4 Lot 5"
Dear Mr. Bolin:
SLD
An On -Site Water/WastewaterPermit, number SW020408, issued by this office for a single-family
system, will expire on October 11, 2003. This permit was valid for 365 calendar days.
If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit.
If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to
this office for review, approval and documentation. This as -built inspection report must be signed by
the licensed Professional Engineer who inspected the installation of the system. As -built inspection
reports are required to be submitted within 30 days of the completion of the system.
If no system was installed under this permit, and you are still planning to install a well or wastewater
disposal system, a new permit must be obtained from this office. A new permit for a second year may
be issued for a fee of $100.00 if the renewal application is received on or before the expiration date of
the original permit.
When applying for a new permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well
permit.
If you have any questions, please call this office at 343-7904.
Sincere ,
Jam Cross, P.E.
Ma ager
On -Site Water and Wastewater Program
Enc: Copy of permit
G
0 Y .a MUNICIPALITY OF ANCHORAGE
tr Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Oct 11, 2002
Expiration Date: Oct 11, 2003
Permit Number: SW020408
Parcel ID:
050-731-32
Legal Description:
MAJESTIC VALLEY ESTATES BILK
4 LT 5
Design Engineer:
0003 S & S Engineering
Site Address:
026130 IMPERIAL DR
Owner Name:
Tom Bolin
Lot Size:
54556 SQ. FT.
Owner Address:
26130 IMPERIAL DRIVE
Total Bedrooms:
5 Permit Bedrooms: 5
EAGLE RIVER , AK 99577-9628
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must 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 ( 1SAAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Mm
Date: /0/, -S -/o 2 -
Issued By: 'i" /1 \ Date:
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
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0 S'O -1 3 1 - 3 ;t- Permit Number SW
Property owner(s) Tom Qo t -t &I Day phone 'F `f/ -7Y a f
Mailing address (1) a C 130 1 r' P 64 i h L PR I v 6
Mailing address (2) rt,4(c LC /�r utLft , #K Zip Code Cl 4I5- 77
Legal description (Lot, Block & Sub'd.) L Of Q1DG /114 1 e, 4Ileyr514
Legal description (Section,, Township & Range)
Lot Size I , .55_p Acr s/Sq.Ft.
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only ❑
Well Only
❑
Sewer and Well ❑
Water Storage
❑
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub ❑
Jacuzzi
❑
Swimming Pool ❑
Water Softening Unit
❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
S & S ENGINEERING
�f 17034 Eagle River Loop Road N0. 204
2 417e , Eaale River, Alaska 99577
(Signature of property owner or authorized agent)
Permit Fees: y �i�t�• ° Waiver Fees:
Date of Payment: iy / 5, l 0 Z Date of Payment:
Receipt Number: d 6 6 5 Receipt Number:
(Rev. 12/00) ..
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, RE.
CIVIL ENGINEERS
(907)694-2979
FAX (90i) 604-1211
0C *a bay- 8, 2002
HEALTH AUTHORITY
APPROVALS
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
SEWER&WATER
Anchorage, AK 99519
MAINEXTENSIONS
REFERENCE: Lot 5, Block 4, Majestic Valley Estates
SEWER&WATER
INSPECTION
It is requested that you issue a permit to replace the septic tank and install new
trenches to serving the existing five bedroom dwelling on the referenced property.
ENGINEERING STUDIES
Test holes were excavated and percolation tests performed. The approximate locations of
AND REPORTS
the test holes. are located on the attached site plan. At the time of excavation 8/26/02 no
water was found. After monitoring, ground water was not found.
WELL INSPECTION
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
&FLOWTEST
areas or drainage patterns by the installation of the proposed septic tank. The installation
of this septic tank will not prevent any future development on any of the adjacent
properties.
SITE PLANS
If you require additional information, please contact us.
Sincerely,
ROAD DESIGN
//��
wjzdvL -
Robert C. Cowan, P.E.
SOIL TEST
RCC/bjj
Enclosure
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
1 "S;
40'
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Municipality of Anchorage->:+_ENOIN .. x
Development Services Department i
Building Safety Division f .
y�r On -Site Water and Wastewater Program -
4700 South Bragaw SL ••• '"" -
P.O. Box 196650 Anchorage, AK 99519-6650 T i ROBERT C. COWAN i
' www.cLanchoraoe.ak.010�'•.� CE - 8801 ,r ��• �
(907) 343-7904
Soils Log - Percolation Test +,hioz6 a� r
Performed For: Ll�� Datat�e'Performed: (J qj 0
Legal Description:
ice_. I
14-
15-
16-
17-
18-
19
20 -
COMMENTS
Ni
WAS GROUND WATER w'
ENCOUNTERED? / V 0
5
IF YES, AT WHAT DEPTH? L
Depth to Water After O
Monitoring? E
Date:
Depth
o
(Feet)
1-
G/`i ILL
3-
4-
0
-
5-
6-
6-78-9-12-13-•0
7-
8-
9-
12-
13-
-0
14-
15-
16-
17-
18-
19
20 -
COMMENTS
Ni
WAS GROUND WATER w'
ENCOUNTERED? / V 0
5
IF YES, AT WHAT DEPTH? L
Depth to Water After O
Monitoring? E
Date:
PERCOLATION RATE Z -1,t' {mfnuteunch) PERC HOLE DIAMETER ,Fj r•
TEST RUN BETWEEN ,_FT AND 6 FT
PERFORMED BY: Vj (C"Oti, 07 C"V•'C I �-
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL
"ZOM CERTIFY THAT THIS TEST WAS
IN EFFECT ON THIS DATE. DATE:
FAM"
PERCOLATION RATE Z -1,t' {mfnuteunch) PERC HOLE DIAMETER ,Fj r•
TEST RUN BETWEEN ,_FT AND 6 FT
PERFORMED BY: Vj (C"Oti, 07 C"V•'C I �-
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL
"ZOM CERTIFY THAT THIS TEST WAS
IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage NGINE I t
Development Services Department Jw
Building Safety Division p:. "" .
On -Site Water and Wastewater Program �. «1'••`'.`% -••x^'^µ
4700 South Bragaw Sl.
P.O. Box 196650 Anchorage, AK 99519-6650 y 't ROBERT C. COWAN l+`�
•` www.ci.anchoraoe.ak.usC�lC.-8801 •.`^J�'
(907) 343-7904 .pE «,• ��.��, r
Soils Log Percolation Test
Performed For: ' G�/y n 7•� Dale Performed: 8 2(p 02
Legal Description: %5 , �lG 4 ; _ �%i�y (�S%/(� J� f S
Depth
.p.
(Feet)
1_ 0 •0
2-G'O
3-
°
e,
4
5-.0.
6-
7-
8-
12-
-
8-12- 'o -
13- 0
14-
15-
17-
18-
19-
20-
COMMENTS
0
WAS GROUND WATER
Date
ENCOUNTERED? A/O
Net Time
Depth to Water
s
IF YES, AT WHAT DEPTH? `�
L
Depth to Water After
O
P
Monitoring?
E
Dale:
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
P�))'oWCAle_
C
0
30
0-
30
30
/ %2
0
C)
�0
'30
3
PERCOLATION RATE (minolesAnch) / PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND ;J FT
PERFORMED BY:ly{ IGN�'fc7� � (�L/AIL�i _X41W � - �lyr---- CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATEAND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE
S&
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAINEXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERINGSTUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURALS
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 5, Block 4, Majestic Valley Estates
September 24, 2002
ROBERTC. COWAN, P.E.
ROBERTA.SHAFER,PE
CIVIL ENGINEERS
(907)694-2979
FAX (907) 694-1211
GENERAL: (I r an sn Yw r c{is c r e )
1. The scope of this project includ/eptic
bandonment of the existing septic
tank, installation of a 1000 gallotank and a 550 gallon septic tank,
extension of the existing trenche,nstallation of new trenches to serve
the existing five bedroom residence located on the referenced property.
2. Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit or ADEC Authority to Construct with any
special provisions or conditions, and all applicable State and Municipal
Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary underground
utility locates.
4. Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling. On all
leachfield mound systems, the property owner shall be responsible for
ensuring a satisfactory vegetation growth over the mounded area.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department or ADEC if required, for system installations.
Owners installing their own systems must also receive prior approval from
the Municipal Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
Page 2
Lot 5, Block 4, Majestic Valley Estates
September 24, 2002
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
5. A foundation cleanout shall be installed one to four feet from the building foundation.
In the line between the tank and the leachfield there shall be two adjacent cleanouts.
These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank.
The first cleanout, in line, shall be to clean toward the leachfreld. The second cleanout
shall be to clean toward the septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
LEACHFIELD BED INSTALLATION:
Excavate the proposed Bed Area to the depth shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the bottom of the excavation becomes
smeared, it must be raked or scratched (ruffed -up) before gravel or sand placement.
2. If a sand layer is required, place sand over entire excavation to the required depth shown
on the design. The top of the sand layer must be within 2 inches of level.
3. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution
pipe must be installed level with perforations down. Gravel depth below the perforated
pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall
be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall
be a minimum of twelve (12) inches.
4. The perforated distribution pipes must be no more than six feet apart. The distance
between the outermost perforated distribution pipes and the sidewall of the absorption
bed must be no more than three feet.
Silt barrier material 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.
6. Monitor tubes shall be of four (4) inch diameter, installed at 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 depth shall be perforated six (6) inches
below the bottom of the horizontal distribution lines. The monitoring tube should not
extend below the bottom of the gravel surface.
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 finished
grade over the bed must be mounded to prevent the formation of a depression after settling.
Page 3
Lot 5, Block 4, Majestic Valley Estates
September 24, 2002
8. A mound system is to have the upper six inches of top soil and be seeded for vegetation.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipally
approved septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pine
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, Femco,
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 current MOA or ADEC requirements.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
1. 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 4
Lot 5, Block 4, Majestic Valley Estates
September 24, 2002
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. 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 perform the work outlined in these
specifications and plans and in accordance with the attached MOA permit or ADEC Authority
to Construct. There will be no contractual arrangement existing between the contractor and S &
S Engineering.
S & S Engineering 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.
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
M U N I C I P A L I T Y O F A N C H O R A G E
Department of Health & Human Services y
825 L Street, Anchorage, Alaska 99501 343-4720
ONSlTE SEWER to SEPTlC TANK [ERMIT
K������/l
Permit Number: G90230 Upgrade �8~x`�o
Dat'(,') lssued: 10/05/89 Engineer Designed
Owner Name: RODNEY D. MILLS Day Phone:
Owner Address: BOX 1721
EAGLE RIVER, AK 99577
Parcel Id: 05O-731~32
Lot Legal: Subdivision: MAJESTIC VALLEY LST, Lot: 5 Block: 4
Section: 23 Yownship: 14N Range: 1W
Lot Size 54556 (sq"Ift. or acres)
Max Dedrooms: This Permit: 3 ToLal Capacity: 3
SEPTIC TANK: Minimum total septic tank capacity: 11,000 lons, Each septic
tank must have at least 2 compartments" Depth to top of septic tank(s) < 4"0
�eet requires insulation over Lank (s).
THIS SYSTEM MUST BE INSTALLED IN ACCORDANCE WITH ENGINEER/S
DESIGN DATED 10/4/89; AND ANY DEVIATION THEREFROM MUST BE
APPROVED 8Y DHHS PRIOR TO CONSTRUCTION" DHHS MUST BE NOTIFIED
PRIOR TO ALL INSPECTlONS, THIS PERMIT IS FOR A 3 BEDROOM SINGLE
FAMILY RESIDENCE ONLY, AND EXPIRES ON 12/31/B9" THE EXISTING
TANK AND TRENCH MUST BE PROPERLY ABANDONED`
I CERTIFY THAT:
1, I am Ifamiliar with the requirements Ior on --site sewers and wells as set
�orth by the Municipality of Anchorage (MOA) and the State olf Alaska.
2, I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria (ii this permit,
3. I will adhere to al1 MOA and State o/ Alaska requirements for the seL back
distances �rom any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot"
4. I understand that this permit is valid for a maximum of 3 bedrooms. I
also understand that the capacity of the total system is 3 bedrooms and
any enlargement will require an additional permit.
Signed: DATE: �/1
(Owner> RODNE
lssued By DATE:
EAGLE RIVER
ENGINEERING SERVICES
P. O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694.5195
oD JrStra vs/lc✓ /�>J_irJ
SHEET NO _.___ _ —__ _ _.... _. _ OF_
CALCULATED BY----
CHECKED
V__CHECKED BY---
SCALE-
Y—.SCALE_ !l4 --cJ
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
OCT 51989
RECEIVE®
TAN I[
I -L AN
w
I1XV.1t l'l-, ,, V, G;UI
L
Nc Ti- LFJ cn er.,. r": Cr'vo
.i.w r'rtr 7� O<✓�'JJcce i"/.ENC Jy
INSr+LA TG FL o4J LiN� S Chi,
MUNICIPALITY OF ANCHORAGE FIGURE 7-23
DEPT. OF HEAUH &
ENVIRONMENTAL PROTECTION RELIEF LINE DISTRIBUTION NETWORK
;MT 51989
RECEIVED
Distribution Pipe
Absorption
Trenches
Follow Contours
Distribution Pipe
low From Pretreatment Unit
- A
Ends Capped
Relief
Line
�A Distribution Pipe and
Relief Trench to be Level
Line
Relief
Line
279
SPECIFICATIONS FOR ON—SITE SEPTIC SYSTEM
LEGAL.: MAJESTIC VALLEY Ei5'i'.. LOT 5. 11LC)GK /I.
A. GEN EwRAL
1 . the well and septic plan are -For a single f arnily r°e-;idencae only.
'rhe drawing and or site: plan shall be a pram: of this spe-cii'icat -1on.
Al'I material and workmanship shall mc�et the Anchorage Department
of Health and State Department Of Environmental Conservation requil-e-
rnents .
<1. All r�c)i I tests are adv isory to the des fan cand are -to be ver'if -led CJr
modified -in the- field by the= ong"ineer,
.
5. All excavations and depths are advisory and are to be vcri-ie>d or,
modified in 1: ho field by the contractor, to meet: Municipality or
Anchor,agn. Department of Envi i-onmenta l Conservation rectu-frements.
6. The excavation is to be exaci:ly in the area shown on the site p -lar;.
any deviation r,c:quires engineer approval.
7. It is always roe, ornmencled that a surveyor locate the noamost 'lor
position and the location of any easernents.
0. DRAINFIELD
1. The drainlield - is to follow t:he natural land contour, to mall, nto -I n
uniform total depth of the trench bottom_
2. The bottom of the drainf"ield shall be level, plus or, rninus
3. The total depth CJI thea dr'ainfield excavation "I: not uCo €?xc'eed 2.5'
at any point.
�. The sewer line is to be connected into the new soptic tank.
Ei. Thc; drainfield gravel is to be covered with typar or, fabric: mate=rit:�l
6. Soil car combination of soil and extruded board insulation to a depth
of 4' or equivalent is to be place- over, the drainfio'ld.
7. the area over, the drainficld -is to be -finish graded to pr,ovent-
pond ina of surface water runnff.
8. The sept "ic tank and Ieac,hf-ield must not be closer than 100' to anv
..
exist-nca pr7vates we I I , 150' to any ("lass "0' we'l l , or 200 "i'taia to any
community well
RIECOMMENDCD LEA.CI-iF'J:EIA) DIMCN5TOivl5
TOTAL DEPTH =- 2.5' GRAVEL_ DEPTH -- 1 '
DRAINI-'IELO LENGTH � 03' DRAINFICL_D WIDTH
Absorption Area = 415 SF.
5oi1 Rat"ina -- 13S average
fledr^oorn Capacity =- 3
Septic lank Size, 1000 gal
***NOTE: NEW 1000 GALLON TANK REQUIRED. EXISTING TANK PROPERLY ABANDONED.
TO M.O.A. CODE.
_ f -
0' IMPERIAL DRIVE
76' 21' Id' W 206.00 --
100' NE
¢ —,---- GR
,.iii//:•i}' �
HSE
I
I
L6 I
NEIGHBOR
WELL +100'JCIE°NCN TANK °
W �
CREEK
+1401
� TH i
z
NEW TANK
ABANDON� APPROX.
EXIST TRENCH
�JSHED LOC.
d-TH2
O-5
Hmft1 as.
1 O'
2 — 42' LONG
5' WIDE
1' GRAVEL
2.5' TOTAL DEPTH
TRENCHES
S S3, 79 ,��/</�y
S91,FMENT \
F \
\
oQ \
19 - TEST HOLE
• - MONITOR TUBE
o - SEWER CLEANOUT
$ - WELL
i+m++i H+ - LEACHMELD
- - EASEMENT
.1lO !I NliNN CNr•in,+/ O/'n/NJ
SEPTIC SITE PLAN
LEGAL: MAJESTIC VALLEY ESTATES LOT 5 BLK 4
OWNER: N/A
_CONTRACTOR: RASMUSSON ENTERPRISES__
JOB # 89_111 DATE: -10/02/89 SCALE 1" 50'
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
T
0
to NEIGHBOR
SEPTIC +30'
`d WELL +100'
00
SOILS LOG
MUNICIPALITY OF ANCHORAGE
• +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION V1 PERCOLATION
TEST
825 L. Street, Anchorago, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: izm Nyy �-t.._-�l DATE PERFORMED: ci — 25 — Dci
LEGAL DESCRIPTION: I KS L��T _L; . U \LLE V 1�eST/yT ISoT 5 13L -0(-K 4
EPT hI SLOPE _ SITE PLAN
/ /•/ 1 1 .t�\TOP SOL L
2
o.
3 °
0
4 G'
5 0a-
6rGVc_1
6
O
7
8
0
O
9
Iv
11
12
13
20
COMMENTS
PERFORMED BY:
72-008 (6/79)
WAS GROUND WATER S
ENCOUNTERED? liS OLCJ 'X'J
P
IF YES, AT WHAT / E
DEPTH? 2 S
7dsj, m :r
1
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
50AK
�I-2S-wi
12:3 -7 3 0
10 /'1 i n
�
/b to
3
2 Ib
it,
Z
JZ'.41 ,OD
3
I 00 00
PERCOLATION RATE r (minutes/inch)
TEST RUN BETWEEN FT AND FT
FT
Eagle River Engineering Services
P, 0 @el( 77$294 --
Eagle P.iver, AK 99577
633-5195
CERTIFIED BY: � DATE: dl a'/. 1
W SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 204-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: \() C NV� L DATE PERFORMED: /� L J r,I _
LEGAL DESCRIPTION: N\A:��Q)T l(L VA\_LF-J L -Q -T )-RjLO(—I`` 4
-REPT(-� SLOPE SITE PL�AN�j����
9
10
12
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
SOAK
0
13
�o
I Z 14, 0o
/
14
15
IZ 25 • o0
5 iL
16
17
18-
19-
20-
COMMENTS
81920COMMENTS
WAS GROUND WATER S
ENCOUNTERED? YLs L — 07
0
P
IF YES, AT WHAT E
DEPTH? 6 • S
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
SOAK
0
�o
I Z 14, 0o
/
2
IZ 25 • o0
5 iL
WAS GROUND WATER S
ENCOUNTERED? YLs L — 07
0
P
IF YES, AT WHAT E
DEPTH? 6 • S
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
SOAK
I Z 14, 0o
/
2
IZ 25 • o0
5 iL
1
/Z. 4L .3a
5g'6, �
4,e ,
PERCOLATION RATE y (minutes/inch) _ /5Z
TEST RUN BETWEEN FT AND 3'5FT
Eagle Rivar Englneering Services
PERFORMED BY: CERTIFIED BY: vim_ DATE:_ 1
Eagle I?iver, AIC 99577
G9*5195
72-008 (6/79)
�. vIUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME _
PHONE
10NEW
_
C^: /44& 1../5 ?
r �, ; •" `:.� �L'
❑UPGRADE
MAILING ADDRESS .�
-, � .> �= F%F;-t_r. /moi 4>.C=/�_, ��,c�. �% �i-5' 7 7
,%��>•?C :
LEGAL DESCRIPTION
l ; f� � K. �/ �.S T/e: Y is
c7- •� , ./!,/`%,i j>/igC c c %`.
LOCATION
NO. OF BEDROOMS
TO:
Well _
C
Absorption area
Dwelling t�
PERMIT NO.
9DISTANCE
Y
1- Z
Manufacturer
Material
No, of compartments
Uj
N
Liq. capacit in gallons
'F CA
IF HOMEMADE:
Inside length
Width
Liquid depth
OJ
DISTANCE TO:
Well
Dwelling e
PERMIT NO. s
t7Z
Z C
S—F
Manufacturer
Material
Liquid capacity in gallons
0
w
TO
DISTANCE :
Well -
Foundation i
Nearest lot line
PER)MIz NO. ,
j_
=
J LL z
No, of lines
Length of each line
Total len th lines
Trench h
Distance
'
of
n
widd
betweg17 les
V11
F- z
:3 t".
j
'_7 �) inches
Top tile to finish
Material beneath
F
of grade
tile 0
v6 absorption area
/ inches�I�J,/=T'�
Length
Width
Depth
PERMIT NO.
LU
0
4< 1_
a
Type of crib
Crib diameter
Crib depth
Total effective absorption area
ru
N
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
DISTANCE T0:
Building foundation
Sewer line
Septic tank
Absorption areas)
OTHER
PIPEMATERIALS,rz"C-,•j-
q
SOI L TEST RATING
INSTALLER
REMARKS
11
2well 4 a Aj
l
r Gr 6-27-79
5
t
—J
foA
�eo01 X154[ VVUefUi G "l E�
u
a Ic
APPROVED DATE LEGAL
// .:.j'`T
72-013 (Rev. 3178) D Y /.L -_-
DEPHRTHENT OF -�HLTH HND �HVIRONMENll�L P|~`1�CTI;N
820 /L/ .REET/ HNCHQRGGE/ RK. 9S5-
264-4728
K 03P0 FIRM~—oil A -1051 S: 11 1:y`1ETV: 1071"Hw? A -1
PE�MIT NO ( 7�9212 )
HPPLlCA1T CNIFORLES CA QUMBOX ]2] EHGLE !VR 688 2790
LOCHTION 6. 5 MI UP E. 'F!. YHLLEY RD
LEGHL L5 B4 MRJESTIC V8LLEY EST 1 ZE 54800 SQUHRE FEET
TYPE OF SOIL 1-1 OV! TRENCH
MHXIMUM NUMBER OF B2DROOMS = ] SOIL RHTING (48 FT/80= 191
THE RE8UIRED SIZE OF THE SOIL 8BSORPTION SYSTEM 100:
THE LENGTH DIMENSIOH IS THE LENGTH (IN FEET) 0F THE TRENCH OR DRHINFIELD
THE DEPTH OF R TRENCH OR PIT lS THE DISTHNCE BETWE2N THE SURFHCE OF THE
GROUHD MAD THE BOTTOM OF THE EXCHV�TION (IN FEET)
THERE IS NO SET WIDTH FOR TRENCHES
THE GRRVEL DEPTH IS THE MINlMUM DEPTH OF GRFIVFTHE OUTFHLL PIPE
RND THE BOTTOM OF THE EXCHVHTION (IN FEET).
K� P IS "so U :1 Q FT: U; :0 E77 to" - FX 171 -T - 5? 1, 1 v< Ki :1 �7 Fv�-- 4.401SKY, plo Vol A..E~4 71 Fv I 74�
PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
lNSTHLLHTI0N IONS OF HNY NELLS HDJHCENT TO THIS P10PERTY HAD THE
�UMBER OF ��S}DEN��S THFIT HELL WILL SERVE
��C1, a'! so > 3: 141 IS W H Q W x 470 14140 M FQ KP.-: �: --�: -� 1'. .,i � r l IF -� �i'� �� -.:� !1�
B17KFILL1110 OF MW SYSTm QITHOUT FINHL INSFUTTlOT1 F10D HP110VRL BY THIS
DEPHRTMENT HILL 8E SUBJECT TO PROSECUTION.
MIHIMUM DISTHNCE BETWEEN H WELL HHD HNY ON~SITE SENHGE DISPOSRL SYSTEM I:::i:
100 FEET FOR H PRIYRTE WELL/ OR
1j0 TO 200 FEET FROM H PUBL}C WELL THE TYPE OF PUBLlC WELi,
WELL LOGS 80 REQUlRED HND MUST BE RETURNED TU T{1E gEPHRTMENT NITHIN ]0 0HYS
OF
TIAL �ELL COMPLET��N
OTHEk R��U����ENTS MY QPPLY. SPECIFICT11I0445 MAD CONSTRUC[/ON DlHGMMS ME
HVOILHBLE TO INSURE PROPE� INSTHLLHTIOH
�057 lot vel 711 0- K F70 X RON: TH AS Fly 1wo: Q POK W 0 oil ps: PTO �? it^" 1'�0,G -!i
I CERTIFY THAT
1 l HM FRMILIRR WITH THE REQUIREMENTS FOR HS SET
FORTH BY THE MUNICIPHL7TY OF RNCHORHGE.
2 I WILL INSTMLL THE SYSTEM IH HCCORDHNCE WITH TUE CODES
]� I UN�ERSTHND EN
THAT THE OSITE ER SEWSY�TEM MyREQUIRE LHRGEMENT lF THE
N—
RESIDENCE IS RE THHN ] BEDROOMS
HC.1�LE� & POGHNY DEVB'OPMENT
-
Lux 90, Davis St., Eagle River, Alaska 99577
694.2774 or 688-2280
Russell Oyster Earl Ellis
694.2774 SOIL LOG 688-2280
Soils Et Foundations Land Development
Performed for: Name:c
� i1 11,7„ e.,.,,,,,,,
Tel. No. 0
Mailing
Address:
`ox 6'3 ;.,•_ .3 ;.';.�
:L.i a-,, a_, ;7
Legal Description:_ Lot
-5, __1;<
1!•,
Depth (feet) SoJI Characteristics
0
1 ,IL -- Alt tops<dl wil th roots at':a 02'_?3nies.
2
3—
It —l4
275 :3q. ft./8r.
Parcol�tion Ibite 2.125 :inchas / 60 minutes
.Silty Sandy ':naval. = 23 tninutas / irtch
Cobbles to f3 inches.
= 245 sq. ft./Ba.
G':J •-
S-andy l:raV9l with •-o'bblos o 12 inn .138.
. 'ry al?g,1112' 1,1tol'ials.
t.'I sandy GrgVel.
12 --Gd -- S rL33> wi_ti] cao!)I�s Lo 12 iL.c-os,
131 Vory an;;ttl.:Lr , z ;•s: ial s.
14e�, aali •- �.il �.',•j :7FL':i :;1Y.���.i�'y. �• �I•i'� ;�:�.-t./T•.
15
16
o'; tc: n of pit.
100 sq. ft./Br,.
2i{5 ,•:1. f I-, .
r.+
rti
e+e...a.a+ b+..•+.i.•.
./ ry
NO. 1745-E
eJ�,• .• ,• `N�
v B8$ROFESS10yP�"i
Ground Mater Encountered: Yes—_—_ Na_�__�_ If yes, that depth ��®•.��;��.,��
Proposed Installation: Seepage PitDrain Field"A
Comments:
Performed by: Dater =
t
Eq
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MUNICIPALITY F ANCHORAGE
o� s
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-731-32 Expiration Date: - a`�C r 20 20
1. GENERAL INFORMATION
Complete legal description MAJESTIC VALLEY ESTATES BLOCK 4, LOT 5
Location (site address) 26130 IMPERIAL DRIVE, EAGLE RIVER, AK 99577
Current property owner(s) THOMAS & REBECCA BOLIN Day phone
Mailing address 26130 IMPERIAL DRIVE, EAGLE RIVER, AK 99577
Real estate agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise
requested by the engineer.
COSA Fee $� Waiver Fee $
Date of Payment t 23Z- Date of Payment
Receipt Number i�3 2. S_S�- Receipt Number
COSA # S 2(D( Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 1/22/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWFS
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms
•4�i,t
et
TH
IJ Curtis Huffman
C E 128991 . • c���/
1/22/202,0.R
t1� PROFESS O •:
bedrooms, with the following\``\\\6OF l���f
�� OIC—SITE v ,�
WATER ANEW
-11),a))ww))I,.
y. a Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
r AUIFATS]:lLVil:1►I&J
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: MAJESTIC VALLEY ESTATES BLOCK 4 LOT 5 Parcel ID: 050-731-32
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) Water storage tank volume 900 gallons
Date drilled 3/3/1983 (Red!jM Well disinfected for coliform test? ® Yes ❑ No
Total depth 195 ft ® Coliform bacteria is Negative
Cased to 40+ ft Nitrate 0.4 mg/L ❑ Nitrate less than MRL (ND)
® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND)
® Wires are properly protected
FWCS
Casing height (above ground) 12+ in. Collected by « & Sullivan
Date of flow test for COSA 12/30/2019 & *1/24/2020
Static water level at beginning of test 175 ft. Date of Sample 12/30/22019 & 1/27/20
Well production at time of test *0.12-.15 gpm
Comments *Sullivan well production test / calculation at time of chlorination. May consider hydrofracking well
deepening, .... to increase low water production.
B. TANK DATA
Age of tank(s) 17 years
Tank type/material SEPTIC / HDPE
Measured operating fluid level in septic tank 47"
® Standpipes/foundation cleanout per record drawing
Date of pumping 1/23/2020
D. ABSORPTION FIELD DATA
Which system tested (date installed) 2002
® ALL standpipes present per record drawing
Total measured depth from grade 5.4 ft (max)
Measured depth to pipe invert from grade 3_6 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 12/30/2019
Results N Pass For 5 bedrooms
Fluid depth prior to test 7 in
Water added 750 gal
New depth 13 in
Elapsed time 1440 min
® Code -required soil cover over field Final fluid depth 4 in
® System presoaked Absorption rate 750 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test) If yes, enter date
Gallons introduced 1200 gallons
Comments/Deficiencies: TestedoES
nly half the system — the lower trench presoaked and tested. FW
Presoak Minimum Volume: 98'xl.5'xl.5' x 0.4 = 735 gallons.
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Water Service Line > 10'
® Yes
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100' ® Yes if No
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100' ® Yes if No _
Water Main > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No _
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that / have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
At
TH
.. ...........:.. 0
Curtis Huffman f
CE 128991
NA IP
ft
ft
ft
ft
ft
M
ft
ft
ANCHORAGE RECORDING DISTRICT, ALASKA
ASBUILT OF:
MAJESTIC VALLEY ESTATES SURD
LOT 5 BLOCK 4 PLAT 77-27
SURVEY CERTIFICATE: 1. John L. Schuller; Have conducted a
physical survey of this property as shown on this drawing and drat 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 offences,
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:DAZE SC.ItE: E--
JAN 17, 2020 1"=S0'
20-002
ORA A B WECKED BY f CD AVuB£A: BOOK PAGe
JLS SWO363 200103
OO = FND REBAR
OF.4
* `I9TH
'-.JOHN L. SCHULLER, o
D LS -10408
s
PDL »DR&
4
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
DEVELOPMENT SERVICES DEPARTMENT
On -Site water and wastewater Section
www.muni.org/onsite
Well Water Advisory
Certificate of On -Site Systems Approval # OSC201017
Subdivision: Majestic Valley Estates, Block: 4, Lot: 5
907-343-7904
Fax: 343-7997
This well's productivity was determined to be .12 gallons per minute. The minimum
well productivity required under (AMC 15.55) for a 5 -bedroom residence is .52
gallons per minute or 150 gallons per day per bedroom. Maintain current water
storage
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Ma�hng Address P O Box 196650 *Anchorage, Alaska 9 * w w
9519 6650 w muni org
IL
ANCHORAGE RECORDING DISTRICT, ALASKA
ASBUILT OF:
MAJESTIC VALLEY ESTATES SU13D
LOT 5 BLOCK 4 PLAT 77-27
SURVEY CERTIFICATE: 1, John L. Schuller, I -lave conducted a
physical survey of this property as shomi on this drawing and that die
improvements situated hereon are within the property lines and no
enchroacbments exist other than noted. Under no circumstance should
any information on this drawing be used for construction offences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to detemtine
the existence of any casements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: onrE SG.tE: a-uNL•
JAN 77, 2020
20-002 wuxr er. aiecKm Bycxo H00 : —so VF
JLS SW0363 200103
O =FND REBAR
**49TH
.. ........ I .. 1.".....:...
.... /�-�..................
%JOHN L. SCHULLER! c
s LS -10408
0, .. f_ r... a5;
®V�Ofessiono�
[.
LAND
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
—_ __
O
IL
ANCHORAGE RECORDING DISTRICT, ALASKA
ASBUILT OF:
MAJESTIC VALLEY ESTATES SU13D
LOT 5 BLOCK 4 PLAT 77-27
SURVEY CERTIFICATE: 1, John L. Schuller, I -lave conducted a
physical survey of this property as shomi on this drawing and that die
improvements situated hereon are within the property lines and no
enchroacbments exist other than noted. Under no circumstance should
any information on this drawing be used for construction offences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to detemtine
the existence of any casements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: onrE SG.tE: a-uNL•
JAN 77, 2020
20-002 wuxr er. aiecKm Bycxo H00 : —so VF
JLS SW0363 200103
O =FND REBAR
**49TH
.. ........ I .. 1.".....:...
.... /�-�..................
%JOHN L. SCHULLER! c
s LS -10408
0, .. f_ r... a5;
®V�Ofessiono�
[.
LAND
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE ARL
• '- DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services N1
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # (s o - 3 / 3 HAA # M �) Q I
1. GENERAL INFORMATION
Complete legal description rot 5 Block 4; Majestic Valley 1,57arE f
Location (site address or directions) NHN Imperial Drive
+` Eagle River
Property owner Ashley Marquardt Day phone 696-2026
Mailing address —P•0- ,Box 772554 Eagle River, AK 99577
Lending agency _ ° Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
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 (Rev. 1/91) Front MOA e21
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.
Name of Firm S & S ENGINEERING Phone 6 cty- xq -7 %
17434 Eagle River Loop Rona PAo.
204
Address y le gimer,,Alaslw 9957
Engineer's signature Date S—b-9 /1 7
�ti�.ROBERT 9�jg`CW,1��
CE
6. DHHS SIGNATURE
_ Approved for 2 bedrooms.
Disapproved:
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
1- �- 2 —77
By: Date 0
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-M(Rw.1/91) Back MOAM21
k
B. SEPTIC/HOLDING TANK DATA
Date installed �� - 15r-5 Tank size 100 O Number of Compartments , Cleanout
Foundation cleanou (/) _ Depression (Y4W ri High water alarm (Y/N) l
Date of Pumping -ci Pumper 0 M P i
ABSOF#P.TION FIELD DATA ( j� \
Date'installed 1 `� - U `j Soil rating (g.p.d./ftz or ftz/bdrm) 43`) g�System type �" g_p'i N
Length Width Gravel thickness below pipe _LTotal depth SS
Effective absorption area 4 Ill S`� onitoring Tube present &l)Depression over field (Y&_-,�)_
Date of adequacy test 5 Resul Pas ail) _ Pf For _ 3 bedrooms
Fluid depth in absorption field before test (in.);i 4? H Immediately afterSDv gal. water added (in.): /6 N
Fluid depth (ins) Minutes later: I 40 Absorption rate = W _a g.p.d.
Peroxide treatment (past 12 months) (Ya 1J)d 1, If yes, give date _ IJ`/4
72-026 (Rev. 3/96)*
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343Af�WNALIIY OFOCHORAGE
ENVIRONMENTAL SERVICES DIVISION
Health Authority Approval Checklist MAY 3 Q 199
Legal Description:
L -oar 4 -n C_ Parcel I.D.,_0 S
A. WELL DATA
Well type
i
If A, B, C, ADEC letter. ADEC
or attach water system number
Log present &)
Date complet�(d 3 �3 -83
Total depth
1 5 Cased to Casing height (above ground) I Z
Sanitary seal ON)
—Wires properly protected 6%)
FROM WELL LOG AT INSPECTION
Date of test
Static water level1�
o FT. �� VkO��4 t0c�
Well production
2< <' g.p.m.
WATER SAMPLE
RESULTS:
Coliform
U Nitrate Other bacteria _ f�
Date of sample:
5 '-,-� / - ! % Collected by: � `� e'�c, Q- • _
B. SEPTIC/HOLDING TANK DATA
Date installed �� - 15r-5 Tank size 100 O Number of Compartments , Cleanout
Foundation cleanou (/) _ Depression (Y4W ri High water alarm (Y/N) l
Date of Pumping -ci Pumper 0 M P i
ABSOF#P.TION FIELD DATA ( j� \
Date'installed 1 `� - U `j Soil rating (g.p.d./ftz or ftz/bdrm) 43`) g�System type �" g_p'i N
Length Width Gravel thickness below pipe _LTotal depth SS
Effective absorption area 4 Ill S`� onitoring Tube present &l)Depression over field (Y&_-,�)_
Date of adequacy test 5 Resul Pas ail) _ Pf For _ 3 bedrooms
Fluid depth in absorption field before test (in.);i 4? H Immediately afterSDv gal. water added (in.): /6 N
Fluid depth (ins) Minutes later: I 40 Absorption rate = W _a g.p.d.
Peroxide treatment (past 12 months) (Ya 1J)d 1, If yes, give date _ IJ`/4
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
E. SEPARATION DISTANCES
"Pump on"
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 100 k
Absorption field on lot
Public sewer main
Sewer /septic service line 2S I
Size in gallons
"Pump off" level at"
On adjacent lots 1 nL-.>k �
On adjacent lots 1 0 0 1
Public sewer manhole/cleanout I l�
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation S� l� Property line 1 Absorption field t o
Water main/service line Surface water/drainage X00 t� Wells on adjacent lots I,00
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
k
Property line (� 1 Building foundation 10 1 Water main/service line 1 a
Surface water L D o
Driveway, parking/vehicle storage area
Curtain drain `��y-pbt"Jr-) Wells on adjacent lots 1,L-,0
F. ENGINEER'S CERTIFICATION
g �
I certify that t have determined thru field inspections and review of Municipal records jj�^tems are
in conformance wit A7714
nes in effect on this date. ��P.�.N•^»••.., '�s. 4
Signature
Engineer's Name6'Z7 C- �'e�✓y✓ /
Date 5 ROBERT C. COWAN�@ Z
yCE - 8801 rw f
HAA Fee $ ?
Date of Payment 5�d
Receipt Number
72-026 (Rev. 3/96)`
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
M E M O R A N D U M
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO. 11,49y02/a
During a recent Health Authority Approval on-site inspection
and test of the potable water supply well on Lot S
Block 4 of NYUTIc Muir ESTATES Subdivision, the well's
productivity was determined to be .3s gallons per minute.
The minimum well productivity required by this Department
(AbIC 15.55) for a -3 bedroom residence is .3/ gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering
lawns and garder_s may be required.
This advisory mint be attached to all copies of the subject
Health Authority Approval.
HEALTH AUTIIORITY
APPROVALS
SEINER & WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
S&S\
,ine-enrnq
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
WELL RECOVERY TEST DATA FAX(907)694i211
CLIENT: L� I' 1 A4-6
WELL LOCATION (legal):
TEST DATE: 6 - 21 -0[7
WELL DEPTH: C1
CASING DEPTH: o + "A A F-"-F-J
vE Il.f4'
TESTED BY: jr-Aq m=,,3
WELL DRILLER: 5
,RATE DRILLED:
TEST PROCEDURE:
MISC DATA:
OFF
1)
Draw water down to pump.
Casing Height:
17,
2)
Shut pump off 15-60 min.
Sanitary Seal?
_
ES
D
-record time
Wires in Conduit?
e5
-record meter reading
Grading O.K.?
qr S
3)
Turn pump on. Drawdown.
Pump Depth:
4)
Shut pump off.
Samples Taken?
�� 5
,S; z
-record time
Date:
S'ZI
OFF
-record meter reading
4
5)
Calculate gal./min. recovery.
TEST DATA: START TIME: I, I . °2
STATIC WATER LEVEL: ` I
TRIAL PUMP TIME METER GAL./MIN.
1
OFF
l
ON
OFF
os
D
2
OFF
Q o
�J
ON
OFF
7 ' 62
3
OFF
,S; z
ON
OFF
4
OFF
P
ON
OFF
5
OFF
ON
OFF
RESULTS: WELL CURRENTLY PRODUCES: 2� (� oT�j �E� V�Oog__
FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR.
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
MAY -29-1997 07:54 ME ESI ANCHORAGE 9075515301 P.02iO3
CT&E Environmental.Services Inc.
'ZOIL Laboratory Division rsir.►�i�si�ir�r�rri�rs �re�P,trror orrri�
Drinking Nater Analysis Report for Total Colifor
READ IIYSTR UCTIOXS OX REVERSE SIDE BEFORE COL L ECTIrti'C SAMPL,
NIUST BE COMPLETED BY WATER SUPPLIER
a PUBLIC WATER SYSTELNi l.0. #
PRIVATE WATER SYSTEM
Semi ,RE ultce r� O Send to ums
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SAMPLE DATE:
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SAMPLE DATE:
Month
Day Year
SAMPLE TYPE:
<L Routine
O Treated
Witter
❑ Repeat Sample (for routine sample
0 Untreated
Witter
with 1:115 ref. no._ )
o Special Purpose
Time
Collected
SAMPLE LOCATION
Collected
By
r
_
rn Bacteria 200 W. Power Drive
Anchorage, AK 99518-1605
Tel: (907) 562.2343
Fax: (907) 501-5301
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to bc:
Satisfactory
0 Unsatisfactory
0 $ample over 30 hours old, results may
be unreliable
Q Sample too Jong in transit; sample should
not be over 43 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received (neO
Analysis Began -Z D r S
Analytical Method: 12( Membrane Filter
1) NINIO-,NIUG
• Numberofcolonte5/100ml.
Lab Ref. No. Result, Analyst
e
' 0.1
d O _ Izy
9725434'
Sent to Anch Fbk% don ❑
Fu..ed
Time: _
Client notified of unsntisfnctory results:
Phoned Spoke with Faxed
Dile: Time: _
BACTERIO&;ICAL NATER ANALYSIS RECORD
Mi/117-MUG Result: Tot31 Coliform E. col;
?tembrnno F'iltpr; Direct Count (/ /� Colonies/100 nil
Veriticatian: LTB 8(;B C0LIF1Rdl` r,vrc'• r—.v.Mm'NY r/C"Val
Fecal Caliform Confirmation un -rxn<,xuarriv
Final ,.Ntembrane Fi w• Results - Cvlirurm/too ml
Reported By ! Dme !r,ZAPI
Time / hrPAR 1OFs
'&r Microbio109Y Drinking Water
09ram oert::Uication 5tatus is
ovisional as of 4/8/97,
= -- ---___ _ _ ... Member of the SGs Drovp 1506616 GAndra[eve Survelllanco)
ENVIRONMENTAL FACILITIES IN AL45KA, CALIFORNIA. FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI NAW iegtt;v nuin t.,eer .nor,.u•
MAY -29-1997 07:55 ME ESI ANCHORAGE
CT&E ReFJ
Client Mame
Project Name/#
Client Sample IA
Matrix
Ordered By
PWSID
CME Environmental Services Inc.
972543001
S & S Engineering
L 5 B4 Majestic Valley
L5 B4 Majcstit: Valley
Drinking Watez
C
9075615301 P.03iO3
Client ]POI/
Printed Date/mime 05/29/97 07:47
Collected Date/Time 05/21/97 13,15
Received Date/Time 05/22/97 10:00
Technical Director: Stephen C. Ede
Released By
allowable Prep
perametcr Results PoL Units Mmthod LimitS Date
Nitrate -N 0.659 0.100 mg/L SM18 6500-NO3F 10 max
Tota( Coliform 0 col/100mL SM18 92228
Analysis
Date Init
05/27/97 GCP
05/22/97 A14V
TOTAL P.03
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES M r
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # MC) -11)) - ?)Q
MAA # 1 Q5Qk_)1-F1
1. GENERAL INFORMATION
Complete legal description Lot 5; Stock 4; Majestic VaZtey Estate
Location (site address or directions)
NHN ImpeAiat D4,ive
Property owner Rodney U. & Ban.baaa J. M.i.P. 4 Day phone
Mailing address HC 1 Box 132A So.Cdotna, A2a6k.a 99669
Lending agency
Mailing address
Day phone
Agent Geonge Penkims PERKINS REALTY Day phone 694-3594
Address FagPo Rivoh�APtthFtn 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: -7 \,4
3. TYPE OF WATER SUPPLY:
XX
Individual well
Community well
Public water
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 XX
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(Rev. 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.
Name of Firm S & 5 ENGINEERING Phone
Address 17034 Eagle River Loop Road No. 204
Eagle River, Alaska
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
AN
Date -1 — �2
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
wTic
Date l7
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 (Rev. 1/91) Back MOA Q1
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LoN ' Parcel I.D.
Jcn,L"g-..i F 5`f.
A. WELL DATA
Well type P(2-l.l kll If A, B, or C, attach ADEC letter. ADEC water system number r
Log present ®/N) Date completed �'� g3 _/k Driller . - W 1u tlkms
Total depth ) `t S f Cased to 14 01,1 A -
Casing height 12 _
Sanitary seal&N)
Date of test
Static water level
Well flow
Pump level
Wires properly protected cq/N)
FROM WELL LOG
2.0 E5r g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 1yCt
Absorption field on lot t L -,>f> k
Public sewer main ' �I
1 a'
Sewer service line
AT INSPECTION
n
ll� T'r7
r
n
En 0
r -n
L
m
fv
V, G
v
On adjacent lots _ b ca
�
_
On adjacent lots — 1 b D t
Public sewer manhole/cleanout
Petroleum tank
/a
S'kk
WATER SAMPLE RESULTS:
Coliform 'U Lo�ti goo +� A Nitrate �' t "1 m om! Q Other bacteria
Date of sample: �' �� `� Z Collected by:S & S ENGINEERING
—f703�Eag a Ever L.Vup KUMVI aw.
B. SEPTIC/HOLDING TANK DATA Engle River, Alaska 99577
Date installed \0- Tank size 1bGc> Compartments _ 2
Cleanouts O/N) �_ Foundation cleanout O/N) _y Depression (Y&y4
High water alarm (Y& Alarm tested (Y/N)
Date of pumping Pumper -5 �F voaL
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ��� , On adjacent lots 1 00
To property line l o tk Absorption field ly
Surface water/drainage
Foundation 4 I `
Water main/service line. lol k-
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
Meets MOA electrical
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
SEPARATtQ-N'61STANCE FROM LIFT STATION TO:
on lot
D. ABSORPTION FIELD DATA
On adjacent lots
_. ----"Rump off' level at
Cycles tested
Surface water _
Date installed lz_� • `e'y`1 Soil rating �3q 0/System type \L06- DF -0-n-1
Length Sg 1 Width S ( Gravel thickness 1 Total depth
Total absorption area !11(0 II�oy . Cleanouts present (ON)
Depression over field (Y6) 7—` Date of adequacy test ' 2 Z
'�
Results fail) P � for "I A (�) r bedrooms
Peroxide treatment (past 12 months) (Y/9 J° ,6( 6 KAo\,4,� If yes, give date f 1 `l� _
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
v�
Well on lot l o U On adjacent lots t('Ot k Property line_
t �—
To building foundation To existing or abandoned system on lot
k- ,
On adiacPntlots �p 1Cuthank '_\ Dr Wntarmain/sarvicalina
Surface water Ivo I Driveway, parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
5 & S ENGINEERING
Signature 17034 Eagle River Loop Road No. 204
[.age River, Alaska 99577
Engineer's Name
Date
HAA Fee $ f y
Date of Payment 7/31 1/?2 2
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
1 �r
moo`'%
this inspection.
Date of Payment
Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
c
F =`�g� A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
LAOORATORY 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
ANALYSIS RESULTS for INVOICE # 55870
Chemlab Ref.# 92.3466 Sample # 3 Matrix: WATER
Client Sample ID L5 B4 MAJESTIC VALLEY EST
PWSID UA
Collected JUL 13 92 @ 15:30 his.
Received JUL 14 92 @ 15:15 his.
Preserved with AS REQUIRED
Analysis Completed JUL 15 92
Laboratory Supery s STEPHEN C. EJIE
Released By : C - V(
Client Name :S & S ENGINEERING
Client Acct :SNSENGP
BPO#
Req#
Ordered By :R. SHAFER
Send Reports to:
1)S & S ENGINEERING
2)
...,
PO# :NONE RECEIVED
................... .............................................................................................................._
Parameter
Results Units
Method
Allowable Limits
-------------------------------------------------------------------------------------------------------------------------------------
NITRATE-N
0.19 mg/1
EPA 353.2
10
Sample ROUTINE SAMPLE COLLECTED BY: RAY.
Remarks:
-Y69O61 'Tests Performed..............
See Special Instructions Above UA -Unavailable
ND. None Detected See Sample Remarks Above
NA- Not Analyzed LT -Less Than, GT -Greater Than
111#90 SGS Member of the SGS Group (Societe G6n6rale de Surveillance)
N
M
Juty 29, 1922
ROBERT SHAFER. P_E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
Mn. George Perkin.6
PERKINS REALTY
1719 Eagle River Road
Eagte River, AQaska 99577
SEWER &WATER
MAIN EXTENSIONS
REFERENCE: Lot 5; Bkock 4; Majutic va tey E6ta.tes Subdivision
Dean Mn. Perkin
SEWER &WATER
INSPECTION
D .F p
Atyour request a blow tent was per6ormed on .the we.2.2 wcving .the
4e6ereneed property on July 29, 1992.
The static water Levet was measured in the welt at 168 beet below the
ENGINEERING STUDIES
o6p the weft easing. A meter was connected to the water system and
AND REPORTS
.top
the 6�2ow turned on butt. A6ter 6.c6teen minutes .the water Levet was
drawn down to the pump (192 beet). The pump was ,then shut ob6 and the
water eeve2 was a22owed to recover bon approximatety 6.i6teen minutes.
WELL INSPECTION
At that time .the pump was ,turned on again and the water 2.evet. drawn
& FLOW TEST
back down to ,the pump white ,the water quantity was metered. This
process was repeated severat b.ive times with reasonably consistent
resutts .
SITE PLANS
From this test we have bound the weft to currently produce
approximately 27 gallons per hour (GPH). This 6iow rate is not
guaranteed to remain constant, subsequent va4iations can occur.
ROAD DESIGN
16 we may be o6 6urther serv.iee, please contact us.
'.
I Sincerely,
solL TEST
ROGER J. SHA ER, P.E.
RLS/ss
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
e/1 4 0 A f" -0 (� �At-'(Aql
o
r,A - l� LP
IM
VA
�(' 1 UP ,O
2 I CT V +
2j 6.,;P�
-�,Zq-92�-
S & S ENGINEERING
17034 Eaglo River Loop Road No. 204
Eagle River, Alas!kh 49M,
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO. �t.L `� %
During a recent Health Authority Approval on-site inspection and
test of the potable water supply well on Lot Block
of �f Subdivision, the well's productivity
was determined t(6 be gallons per minute. The minimum well
productivity required by this department (AMC 15.55) for
a bedroom residence is 6�,)/ gallons per minute.
Although the subject well currently exceeds this minimum
requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of
noncritical water uses such as washing cars and watering lawns
and gardens may be required.
This advisory must be attached to all copies of the subject
Health Authority Approval.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
- - - 825L Street- Anchorage, Alaska 99501--- - - - _ - -
ENVIRONMENTAL ENGINEERING DIVISION
0*
Telephone 264.4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incompleterequests will not be processed. Please allow ten (10) days for processing.
1. PR ERTY OWNER1 PHONE
,} 1
MAIN D RESS \ �/
P6 �k--Z
PROPERTY RESIDENT (if different from a o e) ( PHONE
2. BUYE - - - - - - PHONE
MAILING ADDRESS —
��^rne�n
3. LENRING INSTITUTION PHONE
Lszc:� �Ull�� srk-ULtt41SLeC��e,
hA&II INE: Anr)RRRS
5. LEGAL DESCR_ PTION
U��5 - -& \
STREET LOCATION
UL14:4 -
� YU LUL
6. TYPE, F RESIDENCE
NUMBER OF BEDR OMS
4her
\[�
SINGLE FAMILY
❑ ' One Four ❑
❑ Two ❑ Five
❑
MULTIPLE FAMILY
❑ Three ❑ Six
7. -WATER SUPPLY - —_
\9P.
INDIVIDUAL* -
*ATTACH WELL LOG. -A well log is required for all wells drilled
❑
COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑-
PUBLIC UTILITY
depth (attach log if available.)
8. SEWGE DISPOSAL SYSTEM
p
INDIVIDUAL/ON-SITE**
`*If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required -
❑
PUBLIC UTILITY -
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLt
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
CJ' SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE IYHREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
P INDIVIDUAL
Cl COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER �t
DEPTH OF WELL
DATE DRILLED-
LOG RECEIVED - - -
3. SEWAGE DISPOSAL SYSTEM
OP-KIDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
7?
INSTALLER
Vptic Tank or ❑ Holding Tank
Size: 1000 If Tank is homemade
give dimensions:
SOILS RATING
q
TYPE OF TANK
MANUFA TUBER
TOTAL ABSORPTION AREA
co� —r
MATERIAL -
4. DISTANCES
WELLTO:
Septic/Holding Tank
9 a,�
Absorption Area
O3
Sewer LineNearest
Lot Line
Absorption Area to nearest Lot Line _
5. COMMENTS
0;�—APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED 1.
DATE
BY (Till 1 - -
LEGAL DES I ION
72-010 (Rev. 3/78)