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HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES BLK 2 LT 15�� ,�� `�� M�� �. ��, �� ���c� � ''' �� � � i� � � �' � � �� � � �� �� �- �� � � * v � �� y, cis' ," �^W-� z= �� b r'€� t fig* "^z� �"� '� �; ,"" � � ��� � 1 a31 "' � � � '' � inspection ReporLI-1-12.doc Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP1 71327 PID Number: 050-631-07❑ New Upgrade Name: William & Joan Johnson ABSORPTION FIELD Deep Trench n Shallow Trench n Bed ❑Mound Address 4815 Highland Road El Other __51 Phone Number of Bedrooms Soil Rating Total depth from original de 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade -_�Grdepth . _-Ft. beneath pipe Ft. Subdivision Block Lot Mountain Valley Estates 2 15 Fill added above original grad 5--' 1;_-, Ft. Gravel length FL Township Range Section Gravel width :�� Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total- sorption area Number of trenches Dist. between trenches Tank Field Tank Line W Ft. Well 101.1 N/A N/A I N/A 58.4 TANK El Septic El S.T.E.P. El Holding 1771 Other Manufacturer ANCHORAGE TANK Capacity 1 000G,L Surface Water 1070- N/A N/A N/A Material Number of compartments Lot Line 43.2 N/A N/A STEEL 2 NA Foundation 45.3 N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ N/A N/A N/A Gal. Remarks TANK REPLACE ONLY Pump on level at Pump off level _aL--' in. High water alarm at in. Pump Pump make model model Electrical Inspections performed by Installer Tank EMATERIAL House to lank to 3034 drainfie d DEANS CONSTRUCTION Drainfield CO/MT 3034 Inspector PANNONE ENGINEERING SERVICES BENCH MARK (Assumed elevation) 1687.Oft Inspection,Location 1 11/8/17 8/15/18 and description dates: 3 Id 2- 4°i— O.G. At House Point B COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp 0. A Conditional Approval: Date '49 even annone Approved Date CE 8149 inspection ReporLI-1-12.doc t V� k�V INELL E \ \ V \ \ \ A 3BDR `INSTALLED 1000q SEPTIC TANK \ _ — \ SFD e i _iNj DCO AFTER. \\ \ DECOMMISSIONED 1000 SEPTIC l 1655 \ \ \ \ TANK (E) PER MOA CODE ./,r ..--� 43.2 1 r 6,0 t, v DRIVEWAY \ \ ? e 70 1 1 � \ t 1075 E t 690 \ �4 \ ILI' t 1705 z2 F, —w WATER LINE / 00 0 0 WELL RADIUS 0z Q ¢ - o 4 w J 4 m — 55 — 55 NEW SEPTIC 0v v od ABBREVIATIONS —------- 67g° - TH TEST HOLE (P) PROPOSED (E) EXISTING CO CLEAN OUT NO. 1000 SEPTIC FC FOUNDATION CLEANOUT �a TANK 674 FS FLOW SPLITTER MT MONITOR TUBE NO. TYP TYPICAL PROFILE SCALE: NTS N PAMONE ENG SVC, LLC Date- RECORD ateRECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 12/21 /t8 PHONE (907) 272-8218 FAX (907) 272-8211 `••�••••• Scale • 1" = 50' • '• •`•••• P.I.D. NO MOUNTAIN VAI -LEY ESTATES B2 L15 s--- S -631-07 DRAWN ACP WILLIAM & JOAN JOHNSON "$even :`E�annope` PERMI--,m 0. 4815 HIGHLAND ROAD OSPI71327 EAGLE RIVER, AK Sheet 2OF2 A— iq J T i 60.9 47.2 65.5 52.7 WT2 GCQ1 67.9 55.8 DCO2 1 67.9 56.1 z2 F, —w WATER LINE / 00 0 0 WELL RADIUS 0z Q ¢ - o 4 w J 4 m — 55 — 55 NEW SEPTIC 0v v od ABBREVIATIONS —------- 67g° - TH TEST HOLE (P) PROPOSED (E) EXISTING CO CLEAN OUT NO. 1000 SEPTIC FC FOUNDATION CLEANOUT �a TANK 674 FS FLOW SPLITTER MT MONITOR TUBE NO. TYP TYPICAL PROFILE SCALE: NTS N PAMONE ENG SVC, LLC Date- RECORD ateRECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 12/21 /t8 PHONE (907) 272-8218 FAX (907) 272-8211 `••�••••• Scale • 1" = 50' • '• •`•••• P.I.D. NO MOUNTAIN VAI -LEY ESTATES B2 L15 s--- S -631-07 DRAWN ACP WILLIAM & JOAN JOHNSON "$even :`E�annope` PERMI--,m 0. 4815 HIGHLAND ROAD OSPI71327 EAGLE RIVER, AK Sheet 2OF2 4,,,H,` A,ir,0p MUNICIPALITY OF ANCHORAGE , ,;! On-Site Water&Wastewater Program �= ; ,r,� PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http:l/www.muni.org/onsite ; 1), l Ai 1in•.•nt 4yc H oQF4t On-Site Wastewater Disposal System Permit Permit Number: OSP171327 Effective Date: 10/25/2017 Work Type: SepticTank Upgrade Expiration Date: 10/25/2018 Tax Code Number: 05063107000 Site Legal Address: MOUNTAIN VALLEY ESTATES BLK 2 LT 15 G:0658 Site Mailing Address: 4815 HILAND RD, Eagle River Owner: JOHNSON WILLIAM C & JOAN D Lot Size in Sq Ft: 46794 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 2 This permit is for the construction of: ❑ Disposal Field Il Septic Tank ❑ Holding Tank El Privy ❑ Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing "nII II /' Received By�j C , +/' Date: Issued By: Iii ttuA eiwytig ( Date: 1020 1 7 MUNICIPALITY OF ANCHORAGE 14 ir.. '..) -----7----.:—:----, Community Development Department ` or, Phone: 907-3 0 Development Services Division Fait`r7'7, 7 - . On-Site Water& Wastewater Program !! OCT 1920'7 ON-SITE SEWER/WELL PERMIT APPLICATION Z'D r � P�ti 4• Parcel I.D. 050-631-07 Property owner(s) Joan & Williams Johnson Day phone Mailing address 4815 Hiland Rd. Eagle River, AK 99577 Site address 4815 Hiland Rd. Legal description (Sub'd., Block & Lot) Mountain Valley Estates 62 L15 Legal description (Township, Range & Section) Lot Size 46,794 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E)all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. __,..._ _____---V (Signature of property owner or authorized agent) Permit/Rush Fees: 9-16. Waiver Fees: Date of Payment: II f l q/19 Date of Payment: Receipt Number: 0 G 00 $ Receipt Number: Permit No. OSPi ! -? Waiver No. Permit App_ - ::_c Pannone Engineering Services iic Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com October 19, 2017 Subject: Mountain Valley Estates B2 L15 Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1,000g Septic Tank to replace an existing 1,000g Septic tank to be issued for this property. The existing tank has completely failed. It will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1,000g septic tank that will be connected to the existing drain field. The existing tank is located approximately 100'+ from the well. The proposed tank will be placed outside the existing well radius. All required separation distances will be met. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5'4- from any property line, building foundation or drain field 10'+ from any water line 100'+ from any surface water 100'+ from any private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, „Are Ur 49 T" ,: i.. ...�. ..a • 1i Steven R Pannone s' •�j •'• Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 .----01---- ---• II �r - �,� N/ 1-- IG c SCALE �r b y eI?' p7tit* Y N r � " V \ �Tu\1 v I ZD r if ' ' /1•1 _ \ Q , . Xpi• , ,, _ . , L:\/04 �t • " f yV J Z e4 =1 6 J Iy Ii ''1" co yAe* 'Tv-- -r-x-e-iie-- q IL�� GO IP- \, —'t c.1� / \,r?,i i � m lk CP‘ i ' \\ 6 • ; ' .fu cna Ct M V \,_.r I, I a .N} . 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 MAI LING A,~ DR ESS L EG~A L D ES .C~R I PTIO~ LOCATION I Ma n u factu re{~_ ~""~ ~,1 ~r Liq'cT i i a"°ns , ,OME DE: D STANCE TO' Well I Manufacturer ' I Well , ~ ~ DISTANCE TO: I Top of tile to finish grade Length Wi~ Type of crib Crib diameter DISTANCE TO: Well lClass Depth DISTANCE Buildin9 foundation TO Inside length I Width Dwelling Depth OTHER Material Nearesy~ I?~e ITrench inches ~EW UPGRADE NO. OF BEDROOMS PERMIT NO. No. of co~rtm~ents Liquid depth PERMIT NO, Liquid capacity in gallons Tot ffect'v rption PERMIT NO, Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line Sewer line Septic tank LEGAL PERMIT NO, Absorption area(s Permit Applicant: MUNICIPALITY OF ANCHORAGE ~oO Department Health and Environmenta3 ~rotection 825 L Street, ~chorage, AK. 79501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT Phone Number: Location: Size: Legal Description: Type of Soil ~bsorption System Is: 'Trench:~ Drainfield: Seepage Bed: __ Holding Tank: Maximum Number of Bedrooms: ~ Sci. 1 Rating(sq.ft/br) ~- DEPTH The Required Size of the Soil Absorption System Is: ! LENGTH ~ . GRAVEL DEPTH J~L WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfal! pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /(~ _ GALLONS * * Permit applicant has the responsibility' to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * * I certify that: (1) I am ~familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the res%dence %s remodeled to include more that 3 bedrxp~ms. Signe~: ~/~./~/~<~ ~, Issued by: ~ A~plicant ' SWP/024(1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTI~CTION 82B L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [J2J'"'~' SOILS LOG ' [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 \ ~to 7 ~8 9 10 11 12 13 14 15 16 17 18 19 2O i ' SLOPE i t WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE P ~',~ N Gross Net Depth to Net Reading Date Time Time Water Drop Rus~oll L, No. 4286-/~ r~ PERCOLATION RATE (minutes/inch)  TEST WY BETWEEN COMMENTS ~ ~-'~"&"-~i ,~ ~C~~ ~' [~ ~C ~, PERFORMEDgY: j ~ ~.~ CERT~FIEDBY: ( er, ifie Drilling by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER Ended DEPTH OF WELL STATIC LEVEL OF WATER FT. DRA~/DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: 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,_ From Ft. to Ft From__Fi. 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. From Ft, to Ft. From __Ft.t~__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 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, From__Ft. to Ft, From Ft. to__Ft. From Ft. to Ft. From Ft, to Ft, MISCL. INFORMATION: DRILLER'S NAME Tom Fink, Mayor unicipality of nchora ¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 December 22, 1988 Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 15 Block 2 Mountain Valley Estates Subdivision, Waiver Request Number WR88-075 Dear Mr. Shafer: Your request for waiver of the required 100 foot separation of a septic bank to a private well has been approved. The approved separation distance is 94 feet. This waiver approval applies to the existing septic tank to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer Acting Program Manager On-Site Services DJR/ljw#6 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER iNSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN · '1 /4 ,z~ .~?xBE~,~ A. SHAFER CIVIL ENGINEER Dec~ber 16, 1988 694-2979 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 15; Block 2; Mountain Valley Estates Subdivision Request you grant a waiver for the horizontal separation distance between the private well and the septic tank located on the referenced property at a distance of 94 feet. The septic system was installed under a hand wirtten permit issued by your department in June, 1983. The installation was inspected and approved by a Municipal inspector in September, 1983. The inspection noted a distance of 100 feet between the well and septic tank on the inspection report, however, we have surveyed the horizontal separation distance to be 94 feet . We believe the inspection probably recorded the slope distance. A Health Authority Approval (HAA) was also issued in January, 1984. A risk analysis has been performed and it appears that no bacterialogical pollution is possible from this source. Attached for your review are the following documents: I. A plot plan showing the relative distance between the private well and septic tank. 2. Risk analysis waiver review worksheet. 3. Coliform and nitrate analysis of water taken ~rom the well located on the referenced property. 4. A well log for the referenced well. It is our opinion that the horizontal separation distance prescribed by 18AAC72.021 is not required in this case. pleas e If you req~tional information, contact us. / Sin~r ely, 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE MUNICIP'ALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~-~ HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 15; Block 2; Mountain V~16y Estates Subdivision; Location (address or directions) Hiland Road (b) Property owner ~,.H.F.C. ¢557!3 Mailing Addres¢;2_0 East $4th Av(',nue (c) Lending Institution Mailing Address Telephone:(home) Anchorage, A,¢a~ka 99505 Telephone Business (d) Real Estate Company and Agent R¢,/Max of EagZ¢. Riu¢.r Attn: Address 16600 Centerfield Drive, Suite #204, Eagle River, Ak. 99577 Telephone 694 (e) Mail the HAA to the following address: (or check here)i~:, if hold for pick up.) List contact person and day phone number below: $ & $ ENGINEERING 7034 Eagle I~Iv,,r Le~np-Roa~Ner¢~4 Fragle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family,~ Number of bedrooms 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community .well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site,~( 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION . As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional.and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date S & S ENGINEERING 17c124 En~nlR l~;ver Loop Ron~ nO: ~CI4 Eagle River, Alaska 99577 Telephone 6. DHHS APPROVAL Approved for Approved Disapproved Conditional 7- Terms of Conditional Approval The MunicipalityofAnchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated 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 DHHSdonotconductinspections or analyze data before a certificate is issued. The MunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 .,x :!'~.~(:iMUN ICI PALITY OF ANCHORAGE (MOA) ~ Health Authority ApprOval (HAA) ('~'1],,~,~,~ CHECKLIST- FEBRUARY 1984 · ,~ 343-4744 ~" ~) :,;~'~? ~ ~:??' ,~ Legal Description: ~o~ / ~ ~ ~/~/~ Well Classification ~ ~ z~/~ ~-~ ~ IfA, B, C, D.E.C Approved (Y/N) Well Log Present (Y/N) ~t__ Date Completed ~ - 50--~.~ Yield ~,~ Total Depth /~O Casedto ~' Depth of Grouting ~ ( ~-Id~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Pump Set At L.) f~' Sanitary Seal on Casing (Y/N) i.~ Depression Around Wellhead (Y/N) /~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot "~ ~'/1L To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments '7~ \.2~. It)C_.C' ; On Adjoining Lots / O0 /7 ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole /0o 'f- 13, SEPTIC/HOLDING TANK DATA Date Installed R. -/~ -~._~Size ! ©O~ No. of Compartments Standpipes (Y/N) 1 Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~//~' Foundation Cleanout (Y/N) Date Last Pumped ~ _~_ ..z. ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ! To Property Line To Water Main/Service Line ___/O To Stream, Pond, Lake or Major Drainage Course / CO /'/'- Comments .-:_~J),~/~ '~L'0~ To Building FOundation /"/'O' 1 To Disposal Field ~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ - Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field ~ravel Bed Thickness /'¢ ~'~ ~ ~ Statndpipes Present (Y/N) /kJ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation '~-~' Lot To Water Main/Service Line / O /'/- To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~~ (c~c.--.c~d¢ I~ ~. To Property Line / O/'/' To Existing or Abandoned System on ; On Adjoining Lots 30 To Cutback (if present) IOO /t 7o/w_ D. LIFT STATION Date Installed ~ Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for % Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. 17034 Eagle River Loop Roac{ No. 204 F.~Me River, Alaska 99577 ~. -'~.~. ~-~ o 17 0 Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 C_HEMICAL GE__OLOGICAL. ORATOR1ES .OF ALASKA INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAi~LE fo~ Wo~k Ordez ~ 19843 Date Report Printed: FEE 19 90 @ 10:5~ Client Sample ID:LIS, B2 MI. VANNEY ESTATES PWSID :UA Collected FEB 13 90 @ 13:30 hrs. Received FEB 14 90 @ 12:00 hrs. Preserved with :AS REQUIRED Client Name : S & S ENGR Client Acct : SNSENGP P,O.3 NONE RECEIVED Req ~ Ordezed By : R.3. SUAFER Analysis Completed :FEB i6 90 Send Reports to: Laboratory Supezviso; :S~EP~EN C. EDE 1)S & S ENGR Special Instruct: Cherolab Ref ~: 900100 Lab Smpl ID: 5 Matrix: WATER Allowable Paramete~ Tested Result UrLitS Method Limits NITRATE-N 1.04 mR/1 EPA 353.2 lO Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY R,J. SHAEER. Tests Performed ' See Special Instructions Above UA-Unavailable None Detected *' See Sample gamarks Above Not Analyzed LT=ness Than, GT=Greater Than ACHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SLIPPLIER ,~, PRIVATE WATER SYSTEM Name Phone No. $ & S ENGINEERING Mailing Address City SAMPLE DATE: 17034 RaCe River Loop Road No. 204 Eagle River, Alaska 99577 Stale Zip Code Mo. Day Year SAMPLE TYPE: Routine Check Sample (for routine sample with lab ret. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE Time Collected NO. LOCATION Collected Rv 4 [ J TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~l~Satisfactory [] Unsatisfactory ~ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received ~ ~ /¢7/~ PO Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ret, No. Result* I-[3 I i FTq I Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LTB Final Mernbrane ~___._~~ TNTC = Too Numberous To Count BGB Collform/100ml ' -----~Da t e Time;. Collform/100ml o -/5'- ?6 OB = Other Bacteria MUNICIPALITY OF ANCHORAGE ~  Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# ~ -- - 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 15; Blocb 2; Mountain Valley_Estates s~Sdivision Location (address or directions) (b) Property owner Mailing Address AHFC AHFC #58713 Te ephone: (home) .Business - (c) Lending Institution --/qo_&t_~la~cd?rt.qage--- _ -- Telephone 694-787_~ Mailing Address -- E~le Riv&~Ala~ba (d) Real Estate Company and Agent ~E/~AX OF~AGLE R~VE~- Eva L~Ee~ Address ~ 166~0~¢~¢~ Drive, S~t6 204 E~ Alas~z~ 9.~57~ Telephone ~ 694-4 ~0 (e) Mail the HAA to the following address: (or check here~ if hold for pick up.) List contact person and day phone number below:' S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms ~ .-- 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site EX, Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. Page 1 of 2 72-025 (Rev. 7/88) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATICN' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGI~IEERtN~ Telephone 17034 Eagle River Loop Road No. 204 Address Eaclle River, Alaska 99577 Date 6. DHHS APPROVAL Approved for~'-'J~/~)bedrooms by Approved ,/~ Disapproved Terms of Conditional Approval "1 Conditional Date The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated 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 DHHSdonotconductinspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 7vo25 (Aev. 7/88~ Back Page 2 of 2 ~, ,~¥ OkC~_K~[~klTY OF ANCHORAGE (MOA) · ~t~,~'/~L s~Rvl~§~t~hority Approval (HAA) ~' CHECKLIST, FEBRUARY 1984 ,c pF 2 1989 343-4744 Legal Description: ~ RECEIVED WELL DATA Well Classification / t.~'~ \~J~ Well Log Present~.~N) "hf Date Completed Total Depth t,z~~ Cased to_~¢¢ Depth of Grouting ~ ' Static Water Level ~"¢¢ ~ Casing Height Above Ground Electrical Wiring in Conduit f~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot "'7¢c~ To Nearest Edge of Absorption Field ~)n Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ~,I~ ~ ~:~ ~¢.~'~-~d;~ ; Date Water Sample Test Results ~"1~~ If A, B, C. D.E.C. Approved (Y/N) Yield ~'. \ ~_~ Pump Set At Sanitary Seal on Casing Depression Around Wellhead ; On Adjoining Lots \ [:;:~c~~''~¢ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed ~-[¢ ¢ ¢----"~ Size ' 6:;~ No. of Compartments ~ Air-tight Caps~N) ~ Foundation Cleanout ~ ..... ~ _~ Date Last Pumped Standpipes ¢~'/N) '7/ To Water-Supply Well To Property Line To Water Main/Service Line Depression over Tank Pumping/Maintenance Contact on File (Y/N)~ / Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Stream, PortO, Lake or Maior Drainage Course Comments ; for ,-/, Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ \~' ¢2~/I;~--~'- Type of System Design Date Installed ~ ~'~.~ - ~-P"~'~ Length of Field ~ I Width of Field ""~ ~:~l Depth of Field Gravel Bed Thickness "'1 ~ ¢:" Statndpipes Present Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well TOLotBUilding F o u n d al~ i~t:~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area \ t~::N~ To Property Line \~ ~Jr To Existing or Abandoned System on ; On Adjoining Lots \ ~ To Cutback (if present) Comments D. LIFT STATION ~ ~ Date I~ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) ~Off" Level at Vent Cycles st. Pumping ~e **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines ~n~e~f.~f~.ef 4 ~u~['~.date Of,'thls... inspection. ~... ~L~,~' ~,].~,~, .: Company 11034 Eagle Ri~er I. oop Reed Ne. 284 Eagle K~ur~ a,-~ ....... Date ~/~ Z~/ ~;~;~:~ ~~eal MOA No. ~ ~ ~ 7 d~ ~_ Receipt No O~//¢ Z O ~ ¢ Receipt No. Date of Payment ¢~- ~/- %~ Waiver Fee: $ Amount: $ ~/'~ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 10697 Date Report Printed: DEC 5 88 @ 12:19 Client Sample ID:L15 B2 MTN VALLEY EST, PWSID :UA Collected @ hrs. Received NOV 30 88 @ 15:00 hfs, Preserved with :4 DEG. C Client Name : S & S ENGINEERING Client hect: SNSENGP P.O.~ NONE REC'D Req ~ Ordered By : R. SCHAEER Analysis Completed :DEC 1 88 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)S & S ENGINEERING Special Instruct: Chemlab Ref ~: 3598 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 1.2 m9/l EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. 1 Tests Per£ozmed ' See Special Instructions Above UA~Unavailable ND= None Detected '* See Sample Remarks Above NA= [tot Analyzed LT~Less Than, GT~Gzeater Than APPLIC ~IT FILLS OUT UPPER HAL ONLY Address // '-~-~ Lending Institution ; Phone Realty Ce. & A~nt ¢ , . /, - Phone Type of Resi~nce ~ Single Family ' ~ Multiple Family No. of Bedrooms - . ~ Other ~ater Supply ~ Individual ATTACH WELL LOG. A w~l icg is required for all wells drilled since June 1975. /~ Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal  Individual Year Individual Installed: Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time q~ O~ Date Date Date Da e~"~ Inspector Inspector Insp~tor Insp~tor Field Notes: ~¢1 , ~¢~._ ~ Cx ~t MUNICIPALI~ OF ANCHORA ¢~ ~, PEPT, OF I~W,LTII ~0 ~ ~ ~ ' ENVIRONMLN1AL. PROT[CT[O], RECEIVEP 8oils ~aling Dsle ~wer Insl~lled W~II To A~sorplion Area W~ll Log Received Il S~' il 5-- WelltoTank /~O SeptJcT~kSJze / OOO-' -- 72-023 (3182)