HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES #1 BLK 4 LT 5Mountain
Valley Estates
or,
k 4
Lot 5
#050- 661- 19
Municipality of Anchorage
Community Development Department Page 1 of 3
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: OSP161173 PID Number: 050-661-19 ❑ New Upgrade
Name:
Mark & Diane Mew
ABSORPTION FIELD
❑ Deep Trench ❑� Shallow Trench ❑ Beds Mound
Address
3923 Birdsong Drive, Eagle River, AK 99577
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
2.0GPD"F
r 3.0 Ft.
_
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.5 Ft.
Gravel depth beneath pipe
0.5Ft.
Subdivision Block Lot
MOUNTAIN VALLEY ESTATES 4 5
Fill added above original grade
2.1 Ft
Gravel length
45.0 Ft.
Township Range Section
Gravel width
5.0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
225 Ftp
1
NAFt.
Well
102.2
114.0
105
N/A
N/A
TANK ❑ Septic I] S.T.E.P. ❑ Holding I] Other
Manufacturer
Anchorage Tank/Orenco
Capacity
1500oal.
Surface water
100+
100+
100+
N/A
Material
Fiberglass
Number of compartments
2
Lot Line
5+
10+
82.6
N/A
NA
Foundation
18.4
34.7
21.0
N/A
LIFT STATION
Manufacturer
Orenco
Capacity
500Gal.
Curtain Drain
50+
50+
50+
N/A
Pump on level at
Pump off level at
High water alarm at
Remarks
43 in.
40 in.
45 in.
Pump make and model
P2005
Electrical Inspections performed by
Rising Son
PIPE MATERIAL House to tank 3034 drainfield Tank to
3034
Installer
Dean Construction
Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) 100ft
Inspection n
1 8/17/16 8/18/16
Location and description
dates: 2w
3itl 4,h
Top of Deck
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp.
Conditional Approval: Date
• !9�p��t�
•
i�Q •
n �annorai:
.
Itt+�
CE 8149.%
Approved Date Iy 201
Inspection Report_1-1-12.doc
SM
R E
/ 20 ?EO
% /
2-0,
ME w PSER
/ P SUftF
' pPED /
WELL (E)
I F I
A° 1 0O Og SEPTIC TANK
1D2 2 �•� ABANDONED PER CODE
A B /INSTALLED NEW 1500g ADVANTEX TANK
MH1 29.0 22.7 I 3 BR
WITH AX20 POD AND DOUBLE CLEAN OUT
C1 47.5 34.0 HOUSE E B TH-1
4 (y� A `SJ N •
wW—�W DRAIN FIELD (E) IN FAILURE
I• F MH ss 71LF x 5.0'W x 05ED x 2.5'TD 3 RE -USE AS RESERVE
a; REMOVED PIPE CONNECTING .
C) TRENCHES AND CAP END OF
EASTERN TRENCH
2�
REMOVED 31 LF EXISTING SOUTHWESTERN TRENCH
AND ALL BIOMATTED MATERIAL
2pq, REPLACED ANY OVER -EXCAVATION FOR BIOMATT
WITH SAND
INSTALLED 45LF x 5.0'W x 0.5'ED x 3.0'TD
I INSTALLED >3' OF COVER
INSTALLED MONITOR TUBE AND CLEAN OUT
AT EACH END
n
[j1\_SEPTIC AREA (E)
NOTES
PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
)RAWING
DRAWN BY:
MOUNTAIN VALLEY ESTATES,
MARK & DIANE
3923 BIRDSONG
EAGLE RIVER, AK
BLOCK 4, LOT
MEW
DRIVE
99577
DRM
PLAN
J
10/5/201,,-
Scale
0/5/201,Scale
*: TH 1"=50'
. ... .. .... . P.I.O. NO
50-661-19
Steven •R. annome PERMIT NO.
+�4. CE 8149 �% OSP161173
sL
Sheet
2 OF 3
POD
1500g ADVANTEX
TANK (N)
(PRE -ASSEMBLED)
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 3(450 gpd)
TANK SIZE: 1500g ADVANTEX
W/ AX20 POD
PERC RATE: 47.6 MPI
SOIL RATING: 2 GPD/SF
AREA ROD: 225 SF
SYS. TYPE: WIDE TRENCH 0.5'ED
MIN LENGTH: 45 LF _
90.2
89.7
PROFILE
LEGEND
—W— WATER LINE/
WELL RADIUS
USED PRIMARY (NEW)
45LFx5.0'WxO.5' E.D., 3.0' TD
TOTAL AREA: 225 SF
RESERVE FIELD(E): _
71 LFx5.0'WxO.5' E.D., 2.5' TD -
SS — NEW SEPTIC
TH-1
PIPE INV
90.2 s
89.7 H
ROCK
6.v
837 v -
GM
az -
H]0 XG
BOB/IB /N/,6
ABBREVIATIONS
TH
TEST HOLE
W
0
W
m
0
J-
ti
r O
O
CLEAN OUT NO.
M#
MONITOR TUBE NO.
Z
1
Z
O
z
O Z
z
W o
z
6
- `FILTER FABRIC p
0 nu
EXISTING
(P)
PROPOSED,
TYP
TYPICAL
r 4" m PERF PIPE
POD
1500g ADVANTEX
TANK (N)
(PRE -ASSEMBLED)
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 3(450 gpd)
TANK SIZE: 1500g ADVANTEX
W/ AX20 POD
PERC RATE: 47.6 MPI
SOIL RATING: 2 GPD/SF
AREA ROD: 225 SF
SYS. TYPE: WIDE TRENCH 0.5'ED
MIN LENGTH: 45 LF _
90.2
89.7
PROFILE
LEGEND
—W— WATER LINE/
WELL RADIUS
USED PRIMARY (NEW)
45LFx5.0'WxO.5' E.D., 3.0' TD
TOTAL AREA: 225 SF
RESERVE FIELD(E): _
71 LFx5.0'WxO.5' E.D., 2.5' TD -
SS — NEW SEPTIC
TH-1
PIPE INV
90.2 s
89.7 H
ROCK
6.v
837 v -
GM
az -
H]0 XG
BOB/IB /N/,6
ABBREVIATIONS
TH
TEST HOLE
EA
EACH
FCO
FOUNDATION CLEAN OUT
T#
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
M#
MONITOR TUBE NO.
R. 1.
RIGID INSULATION
DCO
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
(E)
EXISTING
(P)
PROPOSED,
TYP
TYPICAL
NOTES: PANNONE ENG SVC, LLC
RECORD DRAWING.........
P.O. BOX 100217 ANCHORAGE, AK 99510 r �.
PHONE (907) 272-8218 FAX (907) 272-8211 iq�P
LRLN BY:
MOUNTAIN VALLEY ESTATES, BLOCK 4, LOT
MARK & DIANE MEW Steven R. Par
3923 BIRDSONG
DESIGN DETAILS EAGLE RIVER,DRIVE
AK 99577
11'', S0�/N 52016
*�
�JP.I.D. NO
'ERMIT NO.
OSP161173
Sheet
3 OF
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP161173
Tax Code Number: 05066119000
Work Type: Septic Upgrade
Permit Effective Dates: July 19, 2016 to July 19, 2017
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: MOUNTAIN VALLEY ESTATES
Site Legal Address: MOUNTAIN VALLEY ESTATES BILK 4 LT 5 G:0758
Owner/Address: MEW MARK T & DIANE Y
3923 BIRDSONG DRIVE EAGLE RIVER AK 995770000
Site Mailing Address: 3923 BIRDSONG DR. Eagle River
This permit is for the construction of:
Lot Size in Sq Ft:
Total Bedrooms:
t3*1 Jn
88558
3
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received B
Issued By
By
Date:
Date:
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
q:32 Gamy
ANCHORAGEK JUN"2016
Phone: 907-343-79174
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 050-661-19
Property owner(s) Mark & Diane Mew
Mailing address 3923 Birdsong Drive, Eagle River, AK 99577
Site address 3923 Birdsong Drive
Day phone
Legal description (Sub'd., Block & Lot) Mountain Valley Estates, Block 4, Lot 5
Legal description (Township, Range & Section)
Lot Size 88,588 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial
❑
Single Family (SF)
❑x
(w/wo ADU)
Septic Tank
1ZUpgrade
❑X
Duplex (D)
F-1Holding
Tank
ElRenewal
El
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5/09—
Date
5/a9—
Date of Payment: &W&
Receipt Number: 0,5/M G
Permit No. O&O/ / ,3
Permit App_.- ::.._c
Waiver Fees:
Date of Payment.
Receipt Number:
Waiver No.
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: stevec@i)anengak.com
10 June 2016
Subject: Mountain Valley Estates, Block 4, Lot 5 .
Septic System Upgrade Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade septic system to be issued for this property. The proposed
system will serve an existing three-bedroom (3) house. Currently the lot is developed. This lot and the surrounding lots are
served by private wells. There are no wells within 100' of this system.
1. Soils. One test hole was performed on this lot by PES in June of 2016, and groundwater was monitored for at least
seven days. Ground water was observed at a depth of 9' below the surface in the test hole monitor tube after the 7 -
day monitoring period. Bedrock was not encountered in the test hole. Based on the results of the percolation tests
and overall soils appearance; an application rate of 2 gallons/day/square feet was used for a Cat III wastewater system
in the area of the test hole.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed
drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches.
4. Topography: The existing topography slopes generally from west to east at approximately 20% in the area of the
upgrade. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50'
separation all steep slopes.
The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells
within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM /' PED ABBREVIATIONS
NO. BEDROOM: 3 (450 gpd) 20 •y �y TH TEST HOLE
TANK SIZE 1�0 A9 20 PODEX '� O EA EACH
NG ESMt 'FCO FOUNDATION CLEAN OUT
OIRLCRATING47.6 MPI2 G D/SF J' 20 P' gDR WPjER C# CLEAN CLEAN
OUT NOOUT NO.
.AREA ROD: 225 SF �MPRPEO - M# MONITOR TUBE NO.
SYS. TYPE: WIDE TRENCH 0.5'ED / R.I. RIGID INSULATION
,MIN LENGTH: 45 LF SA \ DCO DOUBLE CLEAN OUT
USE PRIMARY (P): W/ DV DIVERTER VALVE
W� 3 FS FLOW SPLITTER
,45LFx5.0'WxO.5' E.D., 30' TO (E) EXISTING
TOTAL AREA: 450 SF
(P). PROPOSED
RESERVE FIELD(E):WELL (E) TYP TYPICAL
71 LFx5.0'Wx0.5' EO., 2.0' TO - I / i 105.6 5
3 BR 1000g SEPTIC TANK (E)
ABANDON PER CODE
!y l HOUSEINSTALL 1500g ADVANTEX TANK
(E) WITH AX20 POD AND DOUBLE CLEAN OUT
11A z .20
W W
Iw 5.0 DRAIN FIELD (E) IN FAILURE
o; 71 LF x 5.0'W x 0.5'ED x 2.5'TD
\\RE -USE AS RESERVE
h ? v I
209 ill
(///✓/ REMOVE PIPE CONNECTING o I
TRENCHES AND CAP END OF _
TH-1 EASTERN TRENCH
2py
I
REMOVE 31 LF EXISTING WESTERN TRENCH AND ALL BIOMATTED MATERIAL <
REPLACE ANY OVER -EXCAVATION FOR BIOMATT
WITH SAND
• INSTALL 45LF x 5.0'W x 0.5'ED x 3'TD
INSTALL 3' OF COVER OR RIGID INSULATION
INSTALL MONITOR TUBE AND CLEAN OUT
•
—AT EACH END —
� I
LEGEND
lilx_SEPTIC AREA (E) — W WATER LINE/
WELL RADIUS
�7�77�� 7�� �T /� SS NEW SEPTIC
NOTES: P" O'` JGl`IG SVC, T ` �t Date
-OR CONSTRUCTION��QF.A�gsl�l 7/18/201fi
P.O. BOX 100217 ANCHORAGE, AK 99510 S
PHONE (907) 272-8218 FAX (907) 272-8211 %gop �ylj Scale
DRAWN BY: *.../ P.1-0 NO
DRM
MOUNTAIN VALLEY ESTATES, BLOCK 4, LOT 0-fi61-19
/ Steven R. Ponnone pERM1T N0.
MARK & DIANE MEW /
/ �� CE 8149�� OSP161173
3923 BIRDSONG DRIVE � � _
PLAN EAGLE RIVER, AK 99577 ,'I�1��OfESS10NP`� Sheet
\�` `�� 1 OF 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TEST HOLE 1
Ni
GPI SILTY GRAVEL
GM I WITH ROCKS
GM I SILTY GRAVEL
DATE PERFORMED: 06/01/2016
SOILS LOG - PERCOLATION TEST
SLOPE SITE PLAN
I 3 BR
HOUSE y>
(E)
W W—f
ip3 /
J
O
X
TH
TH-1
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
DEPTH?
DEPTH TO WATER AFTER
MONITORING? -9.0'-
DATE: 06/09/2016
SLOPE
TH
X
READING DATE
CLOCK
TIME
NET TIME
WATER
LEVEL
READING
NET DROP
1 6/1/2016
9:30
--
8.32
--
2
10:00
30 MIN
8.96
0.64
3
10:00
—
8.32
—
4
10:30
30 MIN
8.95
0.63
5
10:30
—
8.32
—
s 1 1
11:00
1 30 MIN
1 8.96
1 0.64
SOIL TEST RESULTS/ANALYSIS
• PERCOLATION RATE 47.6 (min/inch)
• PERC HOLE DIAMETER 6'
• TEST RUN BETWEEN 2.5 FT AND 3.5 FT.
• TEST RUN FOR OVER AN HOUR, LAST THREE
READINGS PROVIDED.
COMMENTS: Test hole excavated by DEAN CONSTRUCTION. Test Hole was presoaked before Perc test.
PERFORMED BY: Joseph Lawendowski. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES:
D♦,�77��77T'7��77 N7�7� EN �^1 T i w
PCl1\1\Ol\ij ENG �1.1 Llh.
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
�`OF AC`\li
ig�P 9+��
*: TH ��
..... ... ..:
5teve'n'R"Pannone j
I+�CS. CE 8149 \?�
+1tt f"P,pO S p=�+�
Date
FOR CONSTRUCTION
Scale
NTS
DRAWN BY:
MOUNTAIN VALLEY ESTATES, BLOCK 4, LOT 5050-661-19
MARK & DIANE MEW
3923 BIRDSONG DRIVE
EAGLE RIVER, AK 99577
DRM
P.LD. NO
PERMIT NO.
OSP161173
SOILS LOG
sn2 eOF 3
SPECIAL PROVISIONS TO SPECIFICATIONS
1, ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55,
2, SCOPE OF WORK: INSTALL NEW SOIL ABSORPTION SYSTEM AND ADVANTEX TANK W/ AX20 POD.
3, GROUNDWATER WAS ENCOUNTERED AT A DEPTH OF 9 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST
HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 9 FEET BELOW EXISTING
GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4, THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) HAD THE WELL LOCATION AND SEPTIC LOCATION
STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM
STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.0 W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6, THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7, THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES WERE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED -LINE AS -BUILT DRAWINGS TO THE
ENGINEER. THE RED -LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10, THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF
EXCAVATION, TOP OF PIPE WITH CLEAN -OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
1 1 THE CONTRACTOR SHALL PROVIDE DATA (UPON WHICH THE RECORD DRAWING WILL BE BASED) THAT REPRESENTS
THE PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE
ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN
DEFECTS BY THE CONTRACTOR.
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING.
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS -BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY: TITLE:
DATE:—
, TES PANNONE ING SVC, LLC
CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
DRAWN BY:
DRM
MOUNTAIN VALLEY ESTATES, BLOCK 4, LOT
MARK & DIANE MEW
3923 BIRDSONG DRIVE
DESIGN DETAILS EAGLE RIVER, AK 99577
*
7/18/2016
Scale
NTS
P.I.D. NO
..... ... .. .. :..
Steven Re
-P"� CE 8149 1
�c
I1;`P�.S....
050-0 -
PERMIT N0.
OSPI61173
Sheet
3 OF 3
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/0I3 WELL INSPECTION
REPORT
NAME\\
PHONE
�VV
❑ UPGRADE
MAILINGADDRESS
���✓-'Will �
� 1
LEGAL DESCRIPTION
L C�
!! Irl VI
LOCATION
NO. OF BEDROOMS
DISTANCE TO:
Well
6C�- I
Absorption area
Dwelling
PERMIT NO.
g
c�
Z
a
Manufacturer
Material
No. of compartments
LU F
rn
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
�'DISTANCE
TO:
Well
Dwelling
PERMIT NO.
_j a
= zz N
Manufacturer
Material
Liquid capacity
0
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO.
w3:
wj LL z
Z
No. of lines
LengtP of ea6h line
`�^"�
Total length of Ines
Trench width
Distance between lines
F- w
w
�—
t� ].,.
inches
N
To of tile to finish rade
p 9
Material beneath the
Total
t
effective absorption
area
0
v—
inches
Length
Width
Depth
PERMIT NO.
to
D
R F
wa
Type of crib
Crib diameter
Crib depth
Total effective absorption area
LU
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth
Driller
Distance to In line
PERMIT NO.
W
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
-
SOI L TEST RATI NG
INSTALLER
.
�
CSO
REMARKS
APPROVED DATE LEGAL
cvio %naV. 0/fol
MUNICIPALITY OF ANCHORAGE
Department f Health and Environmenta'
825 Street, Anchorage, AK.
264-4720
Permit #* * * HANDWRITTEN PERMIT
WELL ANDD - ON-SITE SEWER
Drotection.���F�/�'/
,9501
PERMIT
a
Applicant: � ���I Mailing Address: � y
Location: Phone Number:
Legal Description: �L� (
Type of Soil Absorption System Is:
Trench: Drainfield: _ Seepage Bed: _
Maximum Number of Bedrooms:
Lot Size:
Holding Tank:
Soil Rating(sq.ft/br) /1--% 0
The Required Size of the Soil Absorption System Is:
DEPTH 3 I LENGTH �.� l GRAVEL DEPTH �i1GWIDTH
DTH
��`
The length dimension is 'the lenctth(in feet) of. � ee'tr c 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 outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(1I6-L-B-I-NG) TANK SIZE = '/OQ 0 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(Z) 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 31, 1 9 u 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 enlarg ent if
the resp enpe remodeled to include more tha 3 bedroom .
c1:
Si ne�
g �� Issued by:, _��,
plicant
Date: �.3 .. � \
SWP/024(1/81)
PERFORMED
LEGAL DESCRIPT
DEPTH
IFEET)
2 ��91
3-
4-
5 45
�M
6
7
8-
9-
10-
11 1011
12
13-
14-
15-
16-
17
314151617
18-
19-
20-
COMMENTS
81920
COMMENTS
PERFORMED BY:
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
625 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG — PERCOLATION TEST
DATE PERFORMED: tit" lem
SITE PLAN
®'SOILS LOG
❑ PERCOLATION
TEST
�iF-'1"rrA
I—a - :7- 41.4,
S
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9 `4
� -y moo eco 6o ov Op
rs � r yY ep !y
e 9 Iyy
n 1
Russell L. Gystor o°
No. 4286-E
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
oil
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
■
M■■■■■■I�
11
WHO
r
:oil■■■■■■■
aUSHEM■■
oil
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
d
r
PERCOLATION RATE
TEST RUN BETWEEN
CERTIFIED BY:
(minutes/inch)
FT AND _.__ FT
DATE:-'miZ6 o%!gz
� r r i ` rb Drttftn r
it
by
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE - Started Ended
PERMIT NUMBER
KIND OF FORMATION:
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
From
Ft. to
Ft.
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MISCL. INFORMATION:
DRILLER'S NAME
IF::.,
F, F, IFY' . , , I F :-
. V-1 I Fil 111..1"1-1 1:1 N1? E P--1 T. 1. i,..l 1 -1 N I f: I I (J 11:: 1 :I 1'.1
1'-,l f ". ki I 'I F VA G 1: 1
L . I..) 1::l I 7:1: I'l
ID'I. I -IT
L. 1:1:, 1.3
.......... .. .... .... .... .....
I PAP'
i p\
MUMCIPAUTY OF ANCHORAGE gk�
Development Services
p ices Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-661-19
1. GENERAL INFORMATION
Expiration Date: Nov 3, 0201 1
Complete legal description Mountain Valley Est B4 L5
Location (site address) 3923 Birdsong Drive
Current property owner(s) Christian Langford
Mailing address
Real estate agent
2. TYPE OF DWELLING:
Fx� Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
El
Private Septic
F1
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 17 5 (re,,,,). j * 4
Date of Payment `$l3 1,P, V I
Receipt Number 0 5 LI 19G
COSA# OSC2 1 i L/ M
Waiver Fee $
Date of Payment
Receipt Number
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time
of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on
the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not
guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot
provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole
benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buyers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E.
6. DSD SIGNATURE
✓ System #1 Approved for -3 bedrooms
System #2 Approved for bedrooms
Disapproved
Phone (907) 745-8200
Date Z (01057(
P• •
Steven (I�nncne
C E 8'1 A9
qb
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date: 0 3 ,Z,0,2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Van
y SE
=-� WP ��•
`;PEER 0�
�o W
J RoGhP
By: Original Certificate Date: 0 3 ,Z,0,2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Mountain Valley Est B4 L5
If more than 1 septic system on lot: COSA Checklist # 1 of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 6128/83
Total depth 92.5 ft
Cased to 92.5 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 5/4/2020
Static water level at beginning of test 62.9 ft.
Comments
B. TANK DATA
Age of tank(s) 4 years
Tank type/material Adv- """
Measured operating fluid level in septic tank uk
❑ Standpipes/foundation cleanout per record drawing
J
Date of pumping / i / a !
D. ABSORPTION FIELD DATA Shallow Trench
Which system tested (date installed) 2016
❑ ALL standpipes present per record drawing
Total measured depth from grade 4.75 ft (max)
Measured depth to pipe invert from grade 4.25 ft (min)
❑ NIA — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 050-661-19
Structure served by this system 1
Well production at time of test 4.21 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑ Yes No
❑ Coliform bacteria is Negative
Nitrate •514 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Pannone Engineering
Date of Sample 7/28/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 5/4/2020
Results ❑✓ Pass For 3 bedrooms
Fluid depth prior to test 4/0 in
Water added 450 gal
New depth 616 in
Elapsed time 280 min
Final fluid depth 4/0 in
Absorption rate '450 gpd
Any rejuvenation treatment (past 12 months) no
If yes, enter date
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
2 Yes
if No
Neighboring Tank > 100' M Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No
Absorption Field on Lot > 100' M Yes
if No
ft
Holding Tank > 100' P/1 Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' El Yes
if No
❑✓ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' E✓ Yes
if No
ft
[✓ Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' [Z] Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
0 Yes if No ft
Property Line > 5'✓0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
M✓ Yes
if No
ft
Private Wells > 100' 0✓ Yes if No
Water Main > 10'
0 Yes
if No
ft
Community Wells > 200' Yes if No _
Water Service Line > 10'
E✓ 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' ✓D Yes if No ft If absorption field is under driveway comment below
Property Line > 10'✓0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100'
Water Service Line > 10'
Z✓
Yes
if No
ft
Community Wells > 200'
Surface Water > 100'
✓0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date. G
COSA Checklist yellow sheet
ft
ft
®✓ Yes if No ft
0✓ Yes if No ft
•mow, �,
..Steven fR. •fPannw,)e'
a` a; .9 . ;w
08/02/2021 08:49 8686770 QPLUS
*VarM wo Reid Maintenance Report
Annual InsFiection
'. Property QvmerlTraok3ng ty
Megan Volkov & t Kristian Langford
W Adds,,
3923 Birdsong Dr ve, Eagle River AK 99577
Ax 3RD tor! County ID it
ASC -140032 OSP161173
Retrieve O&M Info
Daily flow
Rectrc ratio_
Timer Settings;
Perform Field Sarnp, fng/Observations
TZE,
1=2r--ill i6_9l d„ ,, }
or of sample
Typlca! Ij-��j Must, ❑ Earthy ❑Moldy
Non -typical U SUlfid : ❑ CAbba a
F ❑Decay
Oily flim In PVU yea 'N No
Foam in tank yea NNo
Check Control panel
Reeirt; Arrt s ��
p DISohargo Amps
Audible and visual alam „ �OK
Mal tone (telemetry onJy dYes NI No
Inspect/Clean Pump f Ite9tam
r
Signature
Clean
fdSc3
olons
Role
million
a
AnchOrageTank
907-272-3543
Inspect
Rlscr/Lid ... ....
Splice Box ........... ........
Float Cord
..
Floats.. _ . ,..
Pump ......... ...............
(907) 555-5555
Biotube0 Fifter. ..... . • , , , ,
PaRTU
bate of Last inrttpn424,OZ
Bictubo Pump Vault .... ,
1/05202
Recirculating Winer,Vijv ..,
Comments 1 \)
•�
r
Signature
Clean
fdSc3
olons
Role
million
a
AnchOrageTank
907-272-3543
inspect/Service Other System Components
Inspect Crean
Disinfection Equipment Inspect Clean
Disper-I Laterals/Orifice.
Observations i � . _ ''S
Additlonal Services Rendered `
❑ Cleaned textile sheets? [J Replaced UV Items?
C] Roplacod/Usod other items?
Parts Used: W c Warranty, g - Billable (✓ appropriate salecUon}
W B Item Plumber Description
PPQiel/Safety inspection
RSV reinstalled
LN Manifold reconnected; flush valves closed
SU
mlttary/ReCOmrn®ndations
S"tem performing; no further action neoded
D Cali for sa,vice
Lids bolted on
Control panel reactivated
❑7bnk neods pumping
❑ Other?
Fax completed form to -
operator
r_arry Betts
cont=tPnono
(907) 555-5555
Pod *
4/1.11. d
PaRTU
bate of Last inrttpn424,OZ
RTU133419
1/05202
Measure sludge/Scum
Sludge
Scum
1st Compartment Cu
Previous
Cur Previous
2nd Compartment Cu nt
Previous
C
Y Previous
Inspect/Clean AdvanTex Filter
OdorInspect
Normal
BI°maty Normal
R
❑Pungent
(�
Clean
I-Aterals/Orificeg. N
�J,
Brftlgirtg/pandtng: N Nona/Mlnor
Excessive
❑ Excessive
Pad Bottom
Intake Vent
Inspect/Clean Discharge Rump
Systern
Inspect
Riser/trd 0
inspect Cloan
splice Box El
Floats
Float coals ID
Pump
inspect/Service Other System Components
Inspect Crean
Disinfection Equipment Inspect Clean
Disper-I Laterals/Orifice.
Observations i � . _ ''S
Additlonal Services Rendered `
❑ Cleaned textile sheets? [J Replaced UV Items?
C] Roplacod/Usod other items?
Parts Used: W c Warranty, g - Billable (✓ appropriate salecUon}
W B Item Plumber Description
PPQiel/Safety inspection
RSV reinstalled
LN Manifold reconnected; flush valves closed
SU
mlttary/ReCOmrn®ndations
S"tem performing; no further action neoded
D Cali for sa,vice
Lids bolted on
Control panel reactivated
❑7bnk neods pumping
❑ Other?
Fax completed form to -
Certificate of On -Site Systems Approval
Parcel I.D. 050-661-19
1. GENERAL INFORMATION
Expiration Date: �6 11 Q0
Complete legal description Mountain Valley Est B4 L5
Location (site address) 3923 Birdsong Drive
Current property owners) Mark & Diane Mew
Day phone
Mailing address Same
Real estate agent
Day phone
2. TYPE OF DWELLING:
Rx Single Family (w/wo ADU)
F-1 Duplex
R Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well RX
Private Septic
El
Water Storage El
Holding Tank
E]
Community Well R
Community
EJ
Public Water System F]
Public Sewer'
F]
Waiver request for: Distance:
j
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time
of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on
the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not
guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot
provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole
benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buvers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name
Steven R. Pannone P.E.
6. DSD SIGNATURE
System #1 Approved for �3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
Phone (907) 745-8200
Date Z—l3
P14,; ;��s�4e
Steven R. I'ennone
FFG . CE 8149 t�
FD
bedrooms, with the following stipulations:
-yam i
ITER AND m
WASTL:VvATER �z
P— R
JJ/JJI t FNT SERy���``�,,
f
By: G, ti _ Original Certificate Date: l X
�
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Mountain Valley Est 134 L5
If more than 1 septic system on lot: COSA Checklist # 1 of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 6128/83
Total depth 92.5 ft
Cased to 92.5 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 5/4/2020
Static water level at beginning of test 62.9
Comments
B. TANK DATA
Age of tank(s) 4 years
Tank type/material Ad-,'F,bC,
in
Measured operating fluid level in septic tank uk
❑ Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA Shallow Trench
Which system tested (date installed) 2016
❑ ALL standpipes present per record drawing
Total measured depth from grade 4.75 ft (max)
Measured depth to pipe invert from grade 4.25 ft (min)
❑ N/A — pressurized field
On Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 050-661-19
Structure served by this system 1
Well production at time of test 4.21 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑ Yes R No
❑ Coliform bacteria is Negative
Nitrate .438 mg/L ❑ Nitrate less than MRL (ND)
Arsenic 1.323 ug/L ❑ Arsenic less than MRL (ND)
Collected by Pannone Engineering
Date of Sample
C. LIFT STATION
5/4/2020
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 5/4/2020
Results ®✓ Pass For 3 bedrooms
Fluid depth prior to test 4/0 in
Water added 450 gal
New depth 6/6 in
Elapsed time 280 min
Final fluid depth 4/0 in
Absorption rate >450 gpd
Any rejuvenation treatment (past 12 months) no
If yes, enter date
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'
✓0
Yes
Community Sewer Manhole/Cleanout > 100'
[D Yes
if No
ft
M Yes
if No
Neighboring Tank > 100' 0✓ Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No
Absorption Field on Lot > 100' F✓ Yes
if No
ft
Holding Tank > 100' R✓ Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' ✓�. Yes
if No
F✓ Yes
if No
ft
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' M Yes
if No
ft
E] Yes
if No
ft
ft
ft
ft
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' P(l Yes if No ft Surface Water > 100' Yes if No ft
Property Line > 5'
✓0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
[✓
Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200' ✓Q Yes if No ft
Water Service Line > 10'
Q
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'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' U Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
� ��4• \ J, .'x`•91
Stever F7 Pannone
YU'-ESSN
bblbbl2b1b 1b:2b 8b�b((b
AHLUS
F'A6E by
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No loop 0 as man M 0 IN am
(�
MWBonn MEN pin 11 a IN ME III Wall
a
Il
Field Maintenance Report
Annum Inspe �tivn
pmpArtyo m rnVooking *
Mark & Dune Mew
Sita Addrnsj
3923 Birdsong Driv; . Eagle River AK 99577
Pod
AX Srte Itis k county Ib 4. A
AX -140032 OSP161173 424102
Retrieve OW Info
Daily flow_
Recirc ratio _y__
Timer sottings:
Perform Field Samp ng/Obseirva"Ons
NTU (iS/�:t NTUS) p 1 (8.9) �('+-G)
. 1 �f V
Odor of Sample
Typical 0MU:1 t ❑ Ea thy ❑ Moldy
Non -typical 2Surf le ❑Cabb�NQ
aag-❑Decay
oily f,'ihn kt pvu , lyes
Foam in tank . lyes Na
Check Contras para" I
Reom: Amps �- Dittchargo Amps
I a. �
Audible and visual r!i 'MIS OK
Coal tont {telemetry nty) ❑ yrs No
inspect/Clean Puna ) System
Inspect Clean
Mwr/Lid ........ ....
Splice Box ....... ...........
Float Cards . , .... ............
Floats ........... .... . ..... ?�.
Pump ..................
J
Blotubt° Filter ... . ...... . ... .
Blotube Pump V31A rf�
Rocirculating Spliit- r Valvt.. - - ... jL{ V]
comments
Signature
AnchorageTank
907-272-3543
opdm for
Larry Betts
oontaot Phoria
(947) 555-5555
RTU VUL tt Oa" of tact U f!PM Mn
RTU133419 05/2312019
Measure Sludge/scum
Sludge Scum
1otCarnpartmant Cur Previous Cumont Previous
2nd Comp rtment Current Previous Current Previous
Inspect/Clean AdvanTex Filter inspect Clean
Odor: Normal ❑ Pungont LatoralslOfifices i
wtomah Normal ❑ Excaesivo Pod Bottom
Btidging/Poncling: None/Minor ❑Extessiv9 I intake Vent V' Y-'
inspect/Cl®aln Discharge Pump System
Inspect Inspect Clean
Riser/Lid ❑ Fleets ❑ ❑
SpGo4 Box ❑ Pump D ED
Float cords
ln,spect/Service tither System Components Inspect Clean
inspect Clean
(Disinfection Equipment CNspetsal latera1g10rifiCG
oobservationsA.,i—
Addltfonal Services Rendered
[] Cleaned textile sheets? ❑ Replaced UV Items?
❑ Replaced/Used Other Items?
Parts Used. W = Warranty, B = Billabla (✓ appropriate selection)
__- – U.,..I4 n"Inrintlan
Final/Safety Inspection
[ZRSV rtlhstailed Lids boit9d on
,I(.r�i Mantrold roconnected; flush valves closed Control parol roactivati d
Summa WRecornmendations
❑ Syatom performing; no further action needed ❑ Tank needs pumping
o Call for aervbO* ❑ Other?
Date
Fax completed form to 1-806-384-74014
MUNICIPALITY ANCHORAGE
=11100101,01 1
0-3011 ;Z DIVARMA"1401--
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered int as of this / 5— Day of a a of 207- 0 , by and between
herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Sstems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as
located at (legal description)
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
.�-Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
eV4- It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
4 , Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
4V- Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
d �
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
caner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
ZW—Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
wner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018)
Page 2 of 3
OWNER:
By:
.(signature)
1,- g', (print name)
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
Date: :5— - 1,Y—. 2 C7
- pft
The forel i instrument was acknowledged before me this 1'6 day of /via ul
"0
20, b A -
NOTARY PUBLIC FOR ALASKA,
MY Commission expires:
vy
MUNICIPALITY:
By:
(signature) Date:
(Print name) Title:
(rev. 05/18/2018) Page 3 of 3
HOUSE DETAIL
Scale: 1 = 30'
TD 0.8'x1.6'
CANT
O
-0
z
O
U)
0 as
®'
z
rth L4
Cn
00
30.0'
Lot 4
'271
7
40' PEDESTRIAN &
DRAINAGE EASEMENT
100' PROTECTIVE RADIUS ":�,7.8'xI2.4' LEAN-TO
10
7
0
8 8.2'xl2.4' SHED
PROTECTIVE
I' )' 1 2 4'
L
2 X �2 .4
Tn
ti0
S1C'PTIC PIPE
MANHOLE
TREATMENT POD
MANHOLE
SEPTIC PIPES
O
0
to
189.3'
Lot 5
88,558 S.F.
N 89'59'55"W 270.6-0
Lot 6
W,
Tract G-1
PLOT PLAN --- AS BUILT _X_ ... .. SCALE —.11-2= &QL_ ....GRID __Q �O758__ Project No. ----20-103/
Al —
11500 Daryl Avenue, Anchorage, Alaska 99515-3049 --
Lang & Associcifes, inc. (907) 522-6476 Phone
(907) 522-4625 Fax
Professional Land Surveyors ken0langsurvey.com OF A4
A ._ ......... �-'ql ��
lonothan0langsurvey.com
I hereby certify that I have surveyed the following describedproperty:
LOT 5, BLOCK 4, MOUNTAIN VALLEY ESTATES — ADDITION No. 1 (PLAT No. 74-17) 4
If .... ...... 9 .
Anchorage Recording District, Alaska, and that the improvements situated thereon are ......
within the property lines and do not encroach onto the property adjacent thereto, that
no Improvements on the prop" lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
IWIff �NN*Eff k G.
easements on sold property except as indicated hereon.
Dated this the Day of t V; 4' 'In L.S-5202..-*
------- - L- a Anchorage, Alaska .......
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
/ �_.
1.
(b) Property Owner, Telephone: Home Business
Mailing Address_
(c) Lending Institution//e ��� �� /_S� Telephone —
Mailing Address
(d) Real Estate pany and Agent _
Address Co�Q % Z
o
Telephone Q r d 3eFO d
(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
17034 Rople River Loop Road o, 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 the legality and status.
4. SEWAGE DISPOSAL
Onsite 131 Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 fPev 8/861 Front
5. ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DA'i w 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 5 & 5 ENGINEERING Telephone (moi Z"? 7 5-
17034
17034 age Klyer LOOP K d No. 204
Address
Date
/Z
6. DHHS APPROVAL All /
Approved for i�11Z bedrooms by ' Date �C�ir� `.ACL, &SZ
Approved N. Disapproved Conditional
Terms of Conditional Approval
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.
Page 2 of 2 72-025 (Rev 8/86) Back
MUNICIPAIffI' OF ANCHOP.A�bNICIPALITY OF ANCHORAGE (MOA)
ENVIRONMENTAL SEKVICES "VPaLTH AUTHORITY APPROVAL (HAA)
7 CHECKLIST - FEBRUARY 1984
i; 1+ 1987 264-4744
Ri�^•' 1f 6i� yp {g•°tV Legal Description: n Loi S 3 'I'tL/
A. WELL DATA
Well Classification • i If A, B, C, D.E.C. Approved (Y/N) _ M/1
Well Log Present&?1) Date Completed —60 " e3 Yield 5 S &Pm --
Total Depth C/Z• Cased to 9Z S Depth of Grouting
Static Water Level (ao. s' Pump Set At /-
Casing Height Above Ground —
Electrical Wiring in Conduit &N)
Separation Distances from Well:
To Septic/Hofd#Fg=TaM on Lot
r
To Nearest Edge of Absorption Field on Lot /r 5 I
Sanitary Seal on Casing (67N)
Depression Around Wellhead (Y/&P
— ; On Adjoining Lots /C: I.f
On Adjoining Lots iwrf
To Nearest Public Sewer Line -1 To Nearest Public Sewer
Cleanout/Manhole �/� To Nearest Sewer Service Line on Lot ZS r+
Water Sample Collected by Date i/ -ZS -•F37
Water Sample Test Results Sxj, ten / Fo& + ''�Ac_T,
Comments V-Ic=r_r_ Ftp 7r FoeMu-r� �r-L5 -f3i X02 yNn°5
B. SEPTIC/H01D4ii4K DATA
Date Installed (aSize /000 No. of Compartments Z -
Standpipes (Y/ ) Air -tight Caps&N) Foundation Cleanout (bN)
Depression over Tank (Y& Date Last Pumped I 2-'r
Pumping/Maintenance Contract on File (Y/N) N/A- ; for
Holding Tank High -Water Alarm (Y/N) N//' Temporary Holding Tank Permit (Y/N) �lA
Separation Distances from Septic/Holding Tank:
To Water -Supply Well /cz To Building Foundation
To Property Line /�`f To Disposal Field _,Q
To Water Main/Service Line f 5 '-f To Stream, Pond, Lake, or Major Drainage
Course (o,>' -F
Comments) Q' S ;�KV'VGtnic_ SP 8 -fl2z
Page 1 of 2
72-026 (Rev 8/861 Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata y 5L> 0/132 Type of System Design L, X,1 �>tax/,4 IZILZ' 6
Date Installed t9-/-iL' 133 Length of Field c> Z.
Width of Field SI Depth of Field --7 • 5
Gravel Bed Thickness ta'
Square Feet of Absorption Area Si ock Standpipes Present O/N)
Depression over Field (Y/& Date of Last Adequacy Test / 1- Z.5 -87
Results of Last Adequacy Test Sari B2.
Separation Distance from Absorption Field:
To Water -Supply Well r / 5' To Property Line /o
To Building Foundation 2-» To Existing or Abandoned System on
Lot NIA ; On Adjoining Lots 30 14
To Water Main/Service Line t,>14To Cutbank (if present) NIA
To Stream/Pond/Lake/or Major Drainage Course /L%>14
To Driveway, Parking Area, or Vehicle Storage Area Z b 14
Comments
D. LIFT STATION
Date Installed
Size in Gallo
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) —
Comments
" Check Permitted Bedro
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Rating Against HAA Request'"
ping Cycles during Adequacy Test. Meets MOA
I certify that I hav ecked, verified, or conformed to all MOA and HAA guidelines in
do ,�IEERING
Signed : �,50 {e_ Uver Lola. R®acl Ne 2d�ate 97
CompAny �siyer, Alaska 99577 MOA No.
Receipt No. o2 -(nt) / — 0 d,'/
Date of Payment -7
Amount: $
/6 a
Page 2 of 2
72-026 (Rev 8/86) Back
the date of this inspection.
", f
^ a
I
HEMIC
,VNAt,Y!'W; BY
M. KJ. !'N VC, U,Ey
&, �0 : f"I : , 'If, ��,(
" j%,
R. I G, ort!- Al. 1
ij U, RlY6k, LOOP idl— fl34
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zi I
ustfljl,e
,ivitflan
W10,
Pate pi"Dort 1 r Inteu. UNC I C p m lit;
k"id eased by
kopot Lr)
Tv
to.. 61 %GS
N I T.W'3JE- 0 fjq
ti)
ta: O MA'b: u.
wi key "'d 11 jlrlF;tl ucl; Ions Awl("
NE t4mErl
j-, ;J�ltll"
ldo Reitimum c
w
rkuAbove-
i liv: [lot' o a ! v J, - - L ie n
ij eat or lhx
eo'-1 .< I -i
Time
APPLIC. AT PILLS OUT UPPER HAL, ONLY
Property Owner
` - . -
Phone
9.,1(.'
Mailing Address
Date
Zip Cade
,
Buyer /
Date
Address
,
Zip Code -
Inspector
Lending Institution
1 -
_ _
Phone
Address
Zip Code
Realty Co. &Agent
r
1�_�=_,l.>
Phone
J
Address
Zip Code
Legal Description
Field Notes: Qr C. O
Street Location�f�,i
O, /' C'
Type of Residence
_ n p
7" Single Family
i
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
`'"/
'CONDITIONS
OF APPROVAL
Individual
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
'LJ Community
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
BY:
Sewer Disposal
y
Date Sewer Installed
Well To Absorption
" Individual
'❑ Public Utility
k
-�
Year Individual Installed:
When Connected to Public Utility:
��
❑ Holding Tank
Well to Tank
Septic Tank Size �o
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
eo'-1 .< I -i
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
r
1�_�=_,l.>
Field Notes: Qr C. O
MUNICIPALITY OF ANCHORAGE
A..
EPT. OF
ENViRJ\;vi�NIAL PRi2OicCT10N
_ n p
( Zj) APPROVED BEDROOMS
'CONDITIONS
OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE �v /0-83
BY:
Soils Rating
Date Sewer Installed
Well To Absorption
Area l Q b
Well Lo Received
��
7
Well to Tank
Septic Tank Size �o
2.023 (3182)
1