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HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES BLK 3 LT 7 Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: --~U~c/"/OI$1 PID Number: Name: ~ ~ ~¢~ Wastewater System: ~New ~ Upgrade Address: ~ ABSORPTION FI ELD No. of Bedrooms: Phone: 2~O-¢O¢O ~ O Deep Trench ~ShallowTrench UBed DMound BOther Total Depth from ordinal grade: LEGAL DESCRIPTION s°i'"~i~: O.~ ~o/sq.~t. ~.5' _ ~ Subdiv~ion: Depth to pipe bottom Irc i~inal grade: Gravel depth beneath pipe Township: ~ Range: . -- Section: ~ Fill added above~original. ~ ,grade: Ft. Gravel length: ]~ I F~ ~ Number of lines: Distance betwe~ines: WELL: ~New ~ Upgrade Gravel width: ~ Ft. ~ .~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: '~7~ %~¢¢¢d~ ~T¢~ ~L~ Da : StaticWater?vel: Installer: Yield: ~ GPM Pump~e)~: Ft. Casing Height Above Ground:; ¢ Ft. TANK SEPARATION DISTANCES CSeptic U Holding ~ S.T.E.~. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~¢~d~ T~ ~ ~ Well' IOOl+ JO0~ ~ ~ ~ Material: ~ Number of Compartments: SurfaCewater /00'* ~0¢'~ ) k LIFT STATION ~-¢_ LineL°t IO ~ ~o ~ Size in gallons: Manufacturer: ~ "P,mp on" level at: "~ off" level at: High water alarm at: -- Foundation ¢~ re2 u~~' Curtain ~.~ ~ ~ ¢ ~ ~- ~ P al Inspections ~e~formed by: Drain ~ Remarks: BENCH MARK Location ~nd Description: Inspections performed by: ~ ~ s ~,G~NE[~mNG ~S' 1st ¢ '~¢ "fi7 Eagle River, Alaska ~5~ - ' ' t~ RO~E.~ C. COWAN Department of Health and Human Services approval - ~ ..~,~' ~ Reviewed and approved by:~/~ ~. ~ Date: ~ ~ 7- ~ -~-' ..... 72-013 (Rev. 9/91) MOA 25 PERMIT :~o..SW970151 PAGE 2 OF 2 iVlunlclpotlty oF Anchorc~ge DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,E], Box 196650eAnchor*~ge, A~osl<o 99519-6650eTetephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LECAL LOT 7, BLOCK 3, MOUNTAIN VALLEY ESTATES P.].D. NO. 050--641--02 WELL~ ALL SWING TIES WERE TAKEN FROM AN AS-BUILT SURVEY PERFORMED BY DUANE MARK SEWARD NEW 1000 GAL. TANK 602 Mr2 $T2 OBL2 COl ST 1 ST2 / NEW ~ MT1 C01 = 77.7' / 1000 GAL ~ MT2 /C02 78.1' SEPTIC TANK & WATER FOUND 64.0' 56.5' B.O.H. INSULATION%, CO1 = 75.0' CO3 = C02 = 75.0' C04 = 68.7' MTi = 74.3 MT3 = 68.0 MT2 = 74,3' MT4 = 68.0' TRENCHES CO3 = 72.0' C04 = 72.5' MT3 MT4 ALT. SITE~x~ SCALE 1" = 40' ROBERT C. COWAN CE-8801 by [DOC Co, dba SULLIVAN' WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND (~, '~' I kJC~N~'~ bo"~c/-)eJ DEl'TIt OF WELL PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From () Ft. to From.C2 Ft. to From4 rt.,o From ~") Ft. to ~o~ ?~' Ft. to ~om /~]~.to From~Ft. to From~Ft. to.~ From~ Ft. to From~Ft. to From~Ft. to From FL From Ft. to From Ft. to . Ft. O,-¥-'/Z /,%~,d,.~ F~om r,. ~o Ft. . Ft. ,.f/'.VT C..4 ~ '7 ~ d~dJ'~e,'on, e,. to Ft. ri'om Ft m Fl Ft. .~" ~//~ From Ft. to~ Ft. Ft. From Ft. to Ft. Ft. ' From__ ~t. ~rom Ft ~ From Ft. ~ From Ft. ~, From Ft. From Ft. to Ft~ F,. ,o_R_E E iV E D Ft. to Ft, Ft. to AUGFt. 4 1997 Ft, ~unicipal~ mt Anchorage I~ept,~:f~T[h' ~ Human Services Ft. to Ft. MISCL. INFORMATION: ! PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970151 DESIGN ENGINEER:S & S ENGINEERING OWNER N~ME:THOMPSON JOHN OWNER ADDRESS:17343 SANTA M=ARIA DRIVE EAGLE RIVER, ALASKA 99567 DATE ISSUED: 6/25/97 EXPIRATION DATE: 6/25/98 PARCEL ID:05064102 LEGAL DESCRIPTION: MOUNTAIN VALLEY ESTATES BLK 3 LT 7 LOT SIZE: 116353 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORD/LNCE 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS ISSUED BY: ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. June 11, 1997 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN E~TENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 7, Block 3, Mountain Valley Estates S/D Request you issue a permit %0 drill a well and ins%all a septic system %0 serve %he proposed three bedroom house on %he referenced property. Test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation no water was encountered. After high season ground water monitoring, water was found at 6.5 feet in test hole ~1, and 6.5 feet in test hole ~2. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/mg Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1"--60' 80ALE SITE-PLAN DESIGN co ii ~:~"~ II o II z~ t~c.7 ~ 717' O0 '-ri/) Frl F,'I DESIGN DETAIL N.T.S. I ~IE 0 C C~Z inn PERFORMED FOR: Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: L.o.1- "~ ~1 ~i. ocK ,.~,~ 3 5 Township, Range, Section: SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19- 20- WAS GROUND WATER ENCOUNTERED? N S IF YES. AT WHAT DEPTH? ~ p Deplh to Water Alter ~'~/' ~/~ ~'7 Monitoring? ~ hate: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (m~nutes/~nch) PERC HOLE DIAMETER ~.~ I) TEST RUN BETWEEN ~ FT AND -~ FT COMMENTS I .. _ lZ~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ~e River Loop Road NO, 2~ ACCORDANCE Wl~¢a~;~eO~FAL GUIDELINES mN EFFECT ON THIS DATE. DATE: ~/ ~.~ ~// c,) ~/ 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 2 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S DEPTH?IF YES' AT WHAT ¢~ !~ pO Depth Io Water A~,~ ~ Monitoring? .~ ~ Date: '--~/ I Reading Date Gross Net Depth to Net Time Time Water Drop S ', l,/¢~ PERCOLATION RATE ,] '~ (m~nules/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN '~ FT AND ~ FT COMMENTS PERFORMED BY: ~,~Ao,~ ~.J.. ~ .... ~ --- ~---, ~,- -~- I ' /~/~ / ~./~-~ CERTIFY THAT ZHIS TEST WAS PERFORMED IN ACCORDANCE W~AB~t~~AL GUIDELINES IN EFFECT ON THIS DATE. DATE: g ~ 1 // ~ 72-008 (Rev, 4/85) ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER bt&IN EXTENSIONS SEWER & WATER iNSPECTION ENGINEERING STUDIES ANBREPORTS WELL INSPECTION & ELOWTEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 7, Block 3, Mountain Valley Estates S/D June 11, 1997 GENERAL: 1. e De The scope of this project includes the installation of a 1000 gallon septic tank and two five foot wide drainfields to serve the proposed three bedroom residence for the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. 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. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP SUITE 204 . EAGLE RIVER, ALASKA 99577 Page Two Lot 7, Block 3, Mountain Valley Estates S/D June 11, 1997 De Septic tanks installed with less than 4 ft. of cover shall be insulated. 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 (unless an effluent pumping system exists within the septic tank). 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 leachfieldo The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. e Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. e Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. De Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Lot 7, Block 3, Mountain Valley Estates S/D June 11, 1997 MINIMUM MAT~:RIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in 'the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 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. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever applies. Page Four Lot 7, Block 3, Mountain Valley Estates S/D June 11, 199'7 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: 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 bs backfilled before this inspection. 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. 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 M.O.A. permit. 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 and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/OWNER A1 aqO "At ASBUILT SEWARD &' ASSOCIATES LAND SURVEYING' 694a0~29''. I HEREBY CERTIFY .THAT I HAVE SURVEYED THE' SCALD FOLLOWING DESCRIBED PROPERTY, AND ~AT NO EN~OACHMENTS EXIST EXOE~ AS INDICA~D. IT IS THE RESPONSIBILITY OF THE//g ~/~ OWN~ TO D~ERMINE THE EXISTENCE OF ANY GRID~ E~EMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT ~PEAR ON THE RE~D~ ~BDI- VISION PLAT, UNDER NO CIRCUMSTANCES S~ FBi. ~Y DATA H~EON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR EST~LISHIN6 ~NB- —t ss i • \\ OT Municipality of Anchorage 4 On-Site Water and Wastewater Program mill a' (907) 343-7904 s> F E T Y Certificate of On-Site Systems Approval Parcel I.D. 050-641-02 Expiration Date: 7'12-- 1. GENERAL INFORMATION: Complete legal description ATELIER;BLOCK 1, LOT 6 Location (site address) 9350 Basher Drive*Anchorage 99507 Current Property owner(s) Stephan&Lindsey Jansen Day phone 227-6814 Mailing address 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: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: /� Date: 1/' /7/17, COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S Waiver Fee $ Date of Payment G° 11/17 Date of Payment Receipt Number ©OCC 6 L7 Receipt Number COSA# (9SC- 17/ 0 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 1J f fl(b o4aQ000p�� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system � OF A "\�� in accordance with the guidelines and regulations established by the Municipality of Anchorage and o 4 industry practices. The reported results describe the condition of the system/s on the date/s of the ow%P. O evaluation. Separation distances were measured to readily identifiable features. Hidden defects or - •./ II encroachments may exist that were not identified during the evaluation. The operational life of all wells 434 lei * D and septic systems depend upon a variety of variables, including but not limited to, soil conditions, i .•• VA groundwater levels (that may fluctuate during the year), quality of construction (materials and :0VA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and Si�' 0 are outside the control of GEG. Satisfactory test results do not guarantee future performance of the / e f i r-y A. . .-ss:• system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of Vh 9 ''. CE—f9 3 �`Q� the well or septic system. GEG makes no representation whether an alternative well or septic system 14,i. � •mac O can be installed on the property in the event either of the current systems fail to perform adequately in 04 e'o '.•!op .1`.L� �ao the future. The content of this report is for the sole benefit of the person/party that retained GEG to 1,�ed PrpfCSS��n�p perform the evaluation. Reliance upon the information provided in this report by any other person or ��OpOOoo�� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for I bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following sti ations: i, L, IA V8002�d z e:G1VM31SVM 6: a NV I91brM `9 lJS-NO c 0Nti , JO ,x.11-� By: ("--,.(—"---Ek(..,--, t-(- i 2-10 Ori9 inal Certificate Date: 1 (-2-17 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: ATELIER; BLOCK 1, LOT 6 Parcel ID: 041-03-120 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 8/23/96 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 86 ft. Cased to 85 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/23/96 9/6/17 Static water level 46 ft. 40.3 ft. Well production 5 g.p.m. 3.5+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate I•G`A mg./L. Collected by: GEG, Ltd. Arsenic: NO ug./L. Date of sample: 4/3/18 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 5/21-26/10 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping `I l f / Pumper MC rp ►t. 1 C C. ABSORPTION FIELD DATA `BELOW EXISTING GRADE AT MT Date installed 5/21-26/10 Soil rating CLOt2or ft2/bdrm) 1.2 System type TRENCH Length 50 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth *6.5+ ft. Eff. absorption area 500 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 9/7/17 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 16 in. Water added 1192 gal. New depth 33 in. Elapsed Time: 165 min. Final fluid depth 23 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date - INFORMATION REGARDING 1996 TRENCH IS IN MOA RECORDS. 1996 TRENCH CLEANOUT& MONITORING TUBES WERE NOT FOUND DURING 2017 GEG INSPECTION. 2010 DRAINFIELD WAS FOUND TO BE DRY DURING GEG SITE VISIT ON 4/3/18. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at .• wa er alarm level at in. - - •• _ Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots _ 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 1o0'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation •5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 1 oo'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *MET CODE AT TIME OF INSTALLATION loms%• 44 . OF ' ....�'�. G. ENGINEER'S CERTIFICATION ,P ..••.. •.♦ • I certify that/have determined through field inspections and ; 7'49 1, •• i\ ••.* �. review of Municipal records that the above systems are in 01\ ,.. „ conformance with MOA COSA guidelines in effect on this 0 date. ♦ J fr \ Ga ess = Engineer's Printed Name JEFFREY A. GARNESS . Gj.:••• CEJ— 3 ;i��� g .. Fp••••Li,/4!, i ..:�F�: Date if 1/l l g 144 pROFESS\�P4 4 • LICENSE k41%%wok*" #AECC884 (Rev. 10/12/12) co1g � 10 • ti f A�oP�E enc • Municipality of Anchor - On-Site Water and Wastewater Progra OCT 0 9 2017 (907) 343-7904 ' SAFE T Y yd ti/ Certificate of On-Site Systems A :P�_E s =�� y ppro Parcel I.D. 050-641-02 Expiration Date: l — 1 Z") 7 1. GENERAL INFORMATION: Complete legal description MOUNTAIN VALLEY ESTATES; BLOCK 3, LOT 7 Location (site address) 4680 Hiland Road *Eagle River 99577 Current Property owner(s) Bruce& Lisa Jayne Day phone 907-201-0889 Mailing address 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: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: / Received by: Date: (&/(a/ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5-7 (00 Waiver Fee $ Date of Payment /-01115//4' Date of Payment Receipt Number 6913(6 Receipt Number COSA# ��Gf�'1 �'� 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: r c,A/r? 4aooppp� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o' ' OF A %'% in accordance with the guidelines and regulations established by the Municipality of Anchorage and ,K\�•. ..• k::/ ,_Op practices. The reported results describe the condition of the system/s on the date's of the OSP Q evaluation. Separation distances were measured to readily identifiable features. Hidden defects or Q�.••• .)� '•� Q encroachments may exist that were not identified during the evaluation. The operational life of all wells Q - , 4 9 H iJ ••3*v and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials andf VA workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and / VA are outside the control of GEG. Satisfactory test results do not guarantee future performance of the 0 •,Jef;, a 11•. Gar -ss. system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of On 3 ' 4E— •'� . ,..'Q G' the well or septic system. GEG makes no representation whether an alternative well or septic system Q s 1 A-• .,a.451 can be installed on the property in the event either of the current systems fail to perform adequately in �4��, .•.J•4 .1 �°j� the future. The content of this report is for the sole benefit of the person/party that retained GEG to %pPaprOfCSgiOfd perform the evaluation. Reliance upon the information provided in this report by any other person or ��O4poo�o party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE 7� System #1 Approved for3 bedrooms System #2 Approved for bedrooms ``•t;k(((tifflr•rr Disapproved ;:` ��Y OFAJl/ Conditional approval for bedrooms, with the fc11 ing >�Ni,t ts: 'y WATER AND Wit-= "o WAS I EWATER z' PROGRAM o 914.. v1C<S • � SER By: ---- --"-,----:aagmPf Original Certificate Date: /O "/ z j 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.1O.12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description MOUNTAIN VALLY ESTATES BLOCK 3, LOT 7 Parcel ID: 050-641-02 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 6197 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 160 ft. Cased to 60 7 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 6/97 9/19/17 Static water level 56 ft. 54 6 ft. Well production 3 g.p.m. 04+ g p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd. Arsenic 112 ug./L Date of sample: 9/19/17 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/30/97 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 9/14/17 Pumper SANITARY PUMPERS C. ABSORPTION FIELD DATA BEL0W EXISTING GRADE AT MT EAST/WEST Date installed 6/30/97 Soil rating ..p.d./i'or ft2/bdrm) 0.8 System type DUAL SHALLOW TR4ENCH Length 60/60 ft. Width 5/5 ft Gravel below pipe 0 5/0.5 ft. Total depth '3 9+ ft. Eff. absorption area 600 ft' Monitoring tube YES Depression over field NO Date of adequacy test 9/19/17 Results (Pass/Fail) PASS For 3 bedrooms 319/400 Fluid depth in absorption field before test 0 in. Water added gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date - • D. LIFT STATION Date installed Size in gallons Manhole/Access(YiN) "Pump on" level at in. "Pump off' level at wa er alarm level at in. • - - Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage t0'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS ..,,��saaa ., 1 G. ENGINEER'S CERTIFICATION ���Q).••••••••••• •'•: +.. i certify that I have determined through field inspections and 4' . ha ha ••••�0 review of Municipal records that the above systems are in fa . 1,111 `� conformance with MOA COSA guidelines in effect •on this 0 . • • • • •i•, date. •I G •%.j f y A. Engineer's Printed Name JEFFREY A.GARNESS *1tJ'f•; —71531, ,• Date i(0/67/0 1144pROFESSIT�•� LICENSE 111%1, a�� *IAECC884 (Rev 10/12/12) - - - L:1/4---5" (771/1v76/1z ,8, Ui -- — i------------v) 7.-6py,..t,,,, , _, - 'J oc) , / \: 3 - j/ �', i , .._ oiI "�% , d // o , • Ir _• .. , o 0 0 l,..- o t'll \* '''/ IN P , (rii \` •r .-f .'"\\ • \(// 1x\,V/ �'�`�z, a 6467 1)i . u I • r I4‘ J • • c° T N. tf) ..,;: _: ,0 ,\ .__-________-____Ii' rP: , f 9 4f1 iir , v \/ lifil ,N / ti\-/ / . ' / . 1. / — 00'OL Z ti„ EO, %Q,O(7 N /ter ASBU ILT _ SEWARD & ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE. FOLLOWING DESCRIBED PROPERTY: �� OF A/ ', �'1ou tr7'A/�t/ I AL e.6 S/E57 TCS Lor 7,8z , . • DATE: Q' '..S�-0� AND THAT NO ENCROACHMENTS EXIST EXCEPT AS //1;:- ..'..4 INDICATED. IT IS THE RESPONSIBILITY OF THE 7/z�/y s*,: 4,,9i ' ' - r--7r i OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: 0 >� d EASEMENTS, COVENANTS, OR RESTRICTIONS ,5 k,/ Cv S8 0� Yy �Ce;-_- i -' WHICH DO NOT APPEAR ON THE RECORDED SUBDI- �+ •Ovens Mark Seward VISION PLAY. UNDER NO CIRCUMSTANCES SHOULD ~FB' 1+° „ 15;77...•• ! ANY DATA HEREON BE USED FOR CONSTRUCTION �g -' l� f $ ...4„,-,--• ar .• OF FENCE LINES, OR FOR ESTABLISHING BOUND- ` 4' APVIIJ DRAWN: �a�. � _.�♦ • • Municipality of Anchorage • f' Development Services Department16. r ` Building Safety Division 0'i $4. E T Y On-Site Water and Wastewater Program 4700 Elmore Street • P.Q. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On-Site Systems Approval # OSC 171477 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 7 of Mountain Valley Estates Subdivision. This inspection revealed an arsenic concentration of 112 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. • Municipality of Anchorage •• :u4, oa;fRM a's•i;li:a Development Services Department pry' Building Safety Division T On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On-Site Systems Approval (COSA) # OSC 171477 During a recent COSA on-site inspection and test of the potable water supply well on Block 3, Lot 7 of Mountain Valley Estates subdivision, the well's productivity was determined to be .4 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3-bedroom residence is .31 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 gardens may be required. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Waste,~rater Pr.ogram 4700'South Bragaw St. ' ' P.O. Box 196650 Anchorage, AK 99519-6650 ' ' www. ci. anchorage, ak. us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL .... -I-:0"(~ A'~INGLE FAMILY DWEELiNG Parcel I.D. GENERAEINFORMATi0N . · ' Location (site address or directior~s) ~/z~g'°~O /_//~,,~^r~ · Current Propehy 0w,n.er(s) ~<~ .?"~-V'f-Z'- '%~..,,~/~/ /~,I-nc,/e~ Day phone Mailing address Lending agency Day Fhcne 090 Expiration Date:_ .. Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA wi71 be held by DaD for £ickup. . 2. NUMBER OF BEDROOMS: '~ TYPE OF WATER SUPPLY: Individual Well -. Individual Water Storage r"l. Community Class __ Well. [] Public Water System [] · TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-.-ite [] Public Sevmr r-I The Municipality of Anchorage Development Sen/ices Department (DSD) Issues Certificates of Health Authori~ Approval (HAA) based only upon the representalJons given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Cedifi<::ates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a singl~family on-site waslewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Cedificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results· (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for propedJes sen/ed by Class A or B we!Is or ~. public water system. The Municipahty of Anchoraoe. is not responsible for errors or omissions in the pro.es~ional' -' engine.rs' o ' work. 4. STATEMENT OF INSPECTION BY ENGINEER As cei'tified by' my'seal affixed hereto and as of the validation date shown below, I verify that my investigation, ... based On' rocedures outlined in the Health Authority Approval Guidelines for this application, shows that the on P - . .. ........ -:,~,,.; ~s/am~ Safe fd{~cti(Jnal and adequate for the number ~f '.: Site water supply and/or wastewamr'a~spo~a, ~,~,,,, ~ . ~ "bedroorr{s and type of structQre indicated herein. I further verify that I~ased on the information obtained from the Mun~c~ al, of Anchorage files and from my invest~gati~r{'and'insp~ctionl the on-site water supply and/or wast°water disposal system is~are) In c~mp ~,~.~ w,u, ,~ r~- ,- .... '.-..;.:;' A roved for - .~ bedro ......' ....' ' ,~ · Disapproved ..... .....-........:..;.~ .....?~ ... ,,..,..... ;.. ?.-.. :....: . · .... . . .? ... .. . .. · ; ............. .. . .-..,.' ? .:.:~;< U.:.'~ -:'.',.'" '~'-'.' ";'~". · . .. - '...' , ' .. Attachments: HAA Checklist" · Sep(ic System Advisory~' -.-. .Well Flow Advisory · ". '. .... :."Maintenance Agreements Supplerfiental E. ngineer's Report .Other Certificate Date: T~ - ~' - (::::) ~ __ (Rev. 01~0'2) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORI ' APPROVAL CHECKLIST Legal Description;~tO(//~'~,~J v~'~¥..Z,.,~ ~-.~'F'~'~_,J~ . Z,. 07" ~ Z~F..,~Parcel ID: O-q'O-~" ¢/- O Z i . A. WELL DATA Well type ~1~ If A, B, or C provide PWSID # Well Log (Y/N) ¥/ Date completed ~/~? Sanitary seal (Y/N) ~' Wires properly protected (Y/N) ~/ Total depth J~'O ft. Cased to ,~'0 ft. Casing height (above ground) in. FROM WELL LOG Date of test . 4',/'e7 Static water level -,~'~" Well production AT INSPECTION WATER SAMPLE RESULTS: Coliform . (~ colonies/100 mi. Arsenic: ~ mg./t. B. SEPTIC/HOLDING TANK DATA Nitrate ~ mg./l. Other bacteria O , colonies/100 mi. Date of sample: .~_~/O.T Collected by: ~.~/~ ' [- Tank Type/Material Tank size /4)<I<3 gal. Number of Compartments Foundation cleanout (Y/N) ~ Depression over tank (Y/N) ,/,./ Date of pumping. ~/,..~G/O_~ Pumper ,_..T./~'. -~' c. ABSORPTION FIELD DATA Date installed ~'/,~0/0~ Soil rating (g.p.d./ft Length /~:::1' ft. Width ~ ft. Date installed. Cleanouts (Y/N) y High water alarm (Y/N) .~,/.~t System type -.~,~Z./. ~ Gravel below pipe <:~ .5'- ft. Total depth ~ ft. Date of adequacy test ~ Results (Pass/Fail) ~ Fluid depth in absorption field before test ~ in. Water added,~d gal. Elapsed Time'.-~O min. Final fluid depth ~ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) Eft. absorption area g~¢ ft: Monitoring tube.~ .Depression over field For ~ bedrooms New depth E' in. ,~'OO' ~ g.p.d. If yes, give date D. UFT ST^T ON Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at Cycles tested in. ManholelAccess (YIN) High water alarm level at Meets atan"n & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic*tank/lift station on lot /,,.~ / Absorption field on lot /~' ~ ~ Public sewer main Sewer/septic service line /2 ~ / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LO7 TO: Building foundation //7 ' Property line Water main ,A//~ Water service line _'~*~'~' Wells on adjacent lots /~0' '~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: On adjacent lots On adjacent lots Public sewer manhole,lcleanout Holding tank Absorption field Surface water ,, Water main Ddvowsy. par?.inglvehicle storage Property line Water Service line Curtain d rain/~A F. COMMENTS Building found,~tion L Surface water, ~;~_~_? Wells on adjacent lots in. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name .__~'7'~'V'~' ~/,,/~ Date ~,/2/43~ ~' HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number IV X O polo 03 "/A/ N 270.00 L' f'i-'B3p Q O� L `�Ob7,3 /6�%/1/�c ASBUILT SEWARD & SURVEYING I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY: we 0� A *40 1?ouvlA/.V 041-ZEi'Z57`ATESLoT 7j 9Z&, DATE: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. 1T IS THE RESPONSIBILITY OF THE 7 �`-� �� i * ,: 4 N � OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDS �""" "'•'• •A EASEMENTS, COVENANTS, OR RESTRICTIONS 511/ 4p5s I�I. y* WHICH DO NOT APPEAR ON THE RECORDED SUBDI- 0� . ..... •••• Diene Mark Seward 0 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: 1� •. LS -6916+ ANY DATA HEREON BE USED FOR CONSTRUCTION 69 `4 lO +1 `2�,'••• AOF RY FENCE OR FOR ESTABLISHING BOUND - DRAWN: �V 6 'a L' f'i-'B3p Q O� L `�Ob7,3 /6�%/1/�c ASBUILT SEWARD & SURVEYING I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY: we 0� A *40 1?ouvlA/.V 041-ZEi'Z57`ATESLoT 7j 9Z&, DATE: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. 1T IS THE RESPONSIBILITY OF THE 7 �`-� �� i * ,: 4 N � OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDS �""" "'•'• •A EASEMENTS, COVENANTS, OR RESTRICTIONS 511/ 4p5s I�I. y* WHICH DO NOT APPEAR ON THE RECORDED SUBDI- 0� . ..... •••• Diene Mark Seward 0 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: 1� •. LS -6916+ ANY DATA HEREON BE USED FOR CONSTRUCTION 69 `4 lO +1 `2�,'••• AOF RY FENCE OR FOR ESTABLISHING BOUND - DRAWN: �V 6 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# LO 'fO~-(~/ -O 1. GENERAL INFORMATION Complete legal description Lot 7; "HAA # ~'~ ~OL~'~ ~ ~L-[~ Block 3; Mountain Valley Estate s Location (site address or directions) NHN Hiland Rc~d Eagle River, AK ' "John Thomcon ProPerty owner ' Mailing address. .-,!.7343 Santa Maria Drive Day phone Eagle Riv e~, AK 240-2020 99577 ' "Lending agency ".. Mailing address Day phone Agent Address .Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site .NOTE: XXX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72q)25 (Rev. 1/91) Front MOA If21 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, lfurtherverifythat 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 Ad dress Engineer's signature $ & S ENGINEERING i7034. Eagle ~iYer Loop Eagle River, A. laska ~577 Phone Date ~'/~¢/q 7 DHHS SIGNATURE ~ Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date 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 cou rtesy 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. 72~25 (Rev. 1/91) Back MOA W21 MUNICI?ALII¥ OF ANCHL)I(AG[ ENViROh'~ENTAL ,~F. Rvic~S DIVISION Municipality of Anchorage AUG 04 1997 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division E E C E ! V E ~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A, WELL DATA Well type Log present Total depth Sanitary seal ~N) Health Authority Approval Checklist ~L_'~::~' ..~, /~.~w',,4~;~ [/'.,'~6Y Parcel I.D.: Date of test Static water level Well production ¢50 -~q'/-o¢ if A, B, or C, attach ADEC letter. ADEC water system number Date completed ~/'/~7 Cased to 60. ~; '/' Casing height (above ground) Wires properly protected FROM WELL LOG AT INSPECTION '-~ g.p.m. /"~'~¢ g.p.m. WATER SAMPLE RESULTS: Coliform O Date of sample: '7 ~c2 3 "~' ~' Nitrate /' / ~1 Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~-/-/~c~-C/'~ Tanksize Foundation clear)out (~). Date qf~Pumping -/"F.,u,f Pumper C, ABSORPTION FIELD DATA Length /cwo ~ Width IOoO Number of Compartments ~ Cleanouts(~J, lt4) Y~'.5 Depression (Y(~. ¢'~/0 High water alarm (Y/I~_ /O/o' Soil rating (g.p.d./fF or fF/bclrm) O .~ _ System type Gravel thickness below pipe ¢ z~ Total depth Effecti~/e Cbsorption~.._ area--~/--' ~'OO ¢' Monitoring Tube present (~4) ~¢'-~ Depression over field (Y~,). Date of ad~q'uacy test" //~b<~ Results (Pass/Fail) For ~-- bedrooms Fluid depth in absorption field before test (in.); Immediately after ~-gal. water added (in.): Fluid depth (ins) Minutes later: --'----- Absorption rate = _g.p.d. Peroxide treatment (past 12 months) (Y/N) ....... ~ * If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons *Datum E. SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line 10o'4 On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation -~/'/' Property line /O/+ Absorption field Water main/service line c/Ow Sudace. water/drainage ~/oc~'4- Wells on adjacent lots SEPARATION DISTANCE'FROM ABSORPTION FIELD ON LOTTO: Property line /o ~ Building foundation [o ~ Water main/service line Sudace water /~o '~ Driveway, parking/vehicle storage area Curtain drain ~/~ Wells on adjacent lots /0o ENGINEER'S CERTIFICATION I certi~ that lhave determined thr~ field inspections and review of Municipal records~~~s in conformance with M~A~ ~idelines in effect on this date. ~~ Signature ~~~,-~. Engineer's Name /¢0~ 4<~ C, EO HAA Fee $ Date of Payment ~//'~ / ~ ~ Receipt Number f tO: T-- :} Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)*