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HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES #1 BLK 5 LT 20Mountain Valley Estates lock Lo't 20 050- 651 -12 I' Municipality of Anchorage Page 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 ~nspection Report Permit Number: ,.~ ~¢f'70~"7~ PID Number: O~o - ~J - J ~: ~A~ ~~' Wastewater System: ~ New ~ Upgrade Address: ~'~,~ ~o ABsoRpTioN FIELD Phone: _ ~ ~ Deep Trench ~ Shallow Trench O Bed B Mound ~ Other No. of Bedrooms: Total Depth from original grade: Township:~ R~nge: ~ SectJon:~ I.~t -- H I Ft. (~ ~ ~ ll~' ~O~Fi. WELL: ax~s~ New ~ Upgrade Gravelwidth: ~1 Number of lines: Distancebetweenlines: Ciassificstion (Private, A,B,C): Total Depth: '~ Total absorption area: Pipe material: / / Driller:~~ ~ate Drilled: StaticWater Level:Ft, Installer:~oU~ ~o~ ~O~T, Date Installed: ~[ Y ield://GPM Pump Set at: Fi. Casing Height Above Grou;~: TANK SEPARATION DISTANCES e Sepfio U Holding I Material: Number of Compadments: Surface Water lOOt+ Ioo'~ ioof+ -- -- LIFT STATION Lot I , + Size In gallons: Manufacturer: Pump Ma~e & Model Electrical Inspections performed by: Drain BENCH MARK Location and Description: J Assumed Elevation: Inspections performed by: s&s ENGINEERIN~ Dates: 1st J l-3-q% Department of Healt~and H~an Se~ices ap ~, ~, ~'.,, Reviewed and approved bY: Date:/Z- ¢-¢Z *;"~4~-~,~' ........ / / 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW970378 PAGE 2 OF 5 Pi u Q i~ ip..o,l,i ~ y_o. F Anchoraee DEPARTMEN/ C)l- HI:ALIbi AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,E], Box 196650 eAnchorage, Atosko 99519-6650eTe~ephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEH AND/OR WELL INSPECTION REPORT LEGAL LOT 20, BLOCK 5, MOUNTAIN VALLEY ESI'ATES f~l P.I.D. NO. 050--651--12 NEW 1250 S,T.E,P, TANK / -NEW PRESSURIZED TRENCHES A B FCO 1.5' 29.5' ST1 52.0' 49.0' ST2 57,5' 52.5' MH 59,5' 53.5' MT1 40,5' 60.0' MT2 95.5' 102.0' MT5 45.5' 57.0' MT4 101.0' 105,5' ~ GREENHOUSE PERMIT NO. SW970378 PAGE ,3 OF 3 Hunicigc~i-t;v o£ AnchoPc(~e DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAl SERVICES DIVISION P,O. Box 196650 OAncho~'clge, A~aska 99519-66500Te~ephone~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 20, BLOCK 5, MOUNTAIN VALLEY ESTATES ~¢1 P.I.O. NO. 050--651--12 ST1 ST8 ~- 98.6' i981 MH /F]NAL GRADE FINAL GRADE-',. MT1 MT1 = 99.5, '~M~ ~/MT2 101.2' MTi = 94.8'~ MT2 = 94.8' SAND FILTERy MT8 MT4 MT3 = 99.6' MT4 = 101.9' /INSULATION~.~. ..' ] MT3 = 95.5 MT4 = 95.6' 1' SAND FILTER--/ 96.0' ,& WATER FOUND 90.1' 85.1' B.O.H. De¢.15 '97 11:15 SOUTH FORK CONST TEL 907-694-1122 P. 1 FRON EO$ ELECTRIC !ED'S ELECTRIC I.NC. AN~HO~AO~, A~SKA ~S~ 1 I: OSAM 14, 1.997 I~OU:II'iI¢OI~ CONSTRUC[ION ' 122'50 SPRINOBRDOK DRIVE' ' 'EAGLE RIVBIt. ~ AK 9957'7 SU~JEC[': SBP'flC LIFI,' 5¢~'~%1'0N, LOr 2i) BLOCK 5, ~,DUTAIN V~LBY EST~I'}JS INSPE~'~D suBJEcI' PRO.}I~' ~'D FO~D NO APFA~ CODE DI~t;ICIBNCIB$. YALDEZ ANCHORAal Fax TI'~NK YOU, DWAYNE R. BRUNS t~D'S t!LIi¢CI'RIC, i'NC. LICENSE ¢~972 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10- 11 12 13 14 15 16 17 18 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST ,.,,~ ...... DATE PERFORMED: Township, Range, Section: ~ALLE¥ E ~l'A'r~ ~ I SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT J ~) DEPTH? ~ p E Oeplh to Waler Alter,_ · Monitoring? Date: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ...,~ 'Z ~o,~- - ~" ' PERCOLATION RATE __ TEST RUN BETWEEN (mmutes/~nch) PERC HOLE DIAMETER FT AND __ FT PERFORMED BY: 1 71~3z[ F.~lp R!ve." I..99~. ,~,c.~,'d [~ ,~¢j~. I , .,,..¢?'-'~'~ CERTIFY THAT 'rH~S TEST WAS PERFORMED IN ACCORDANCE WIT~I~t~J/~L~J¥~,~I'E~t~t~Ig~I~AL GUIDELINES IN EFFECT ON THISDATE. DATE: '~! /! ~ / ~¢~-~/ ;'2-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUM/LN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970378 DESIGN ENGINEER:S & S ENGINEERING OWNER NANE:PETERSON MATTHEW K & OWNER ADDRESS:HC 85 BOX 9440 HIL~ND ROAD EAGLE RIVER, AK 99577 DATE ISSUED:10/22/97 EXPIRATION DATE:10/22/98 PARCEL ID:05065112 LEGAL DESCRIPTION: MOUNTAIN VALLEY ESTATES #1 BLK 5 LT 20 LOT SIZE: 70368 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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) A/~D 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 A_ND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROV,If%IQNS.:~ ~,~ ~.w~ ~;'~,~'~-} RECEIVED BY: ~4L ~,~ DATE: ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECT[ON ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST S~TE PLANS ROAU DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONS[TE WASTEWATER DISPOSAL SYSTEM DESIGN October 7, 1997 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Se~wices P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 20, Block 5, Mountain Valley Estates No. 1 SubdiviSion Request you expedite issuance of a permit to upgrade the septic system serviog the three bedroom house on the referenced property. THE EXISTING SYSTEM IS IN A STATE OF FAILURE AND CAUSING UNSANITARY CONDITIONS. Also request you issue a lot line waiver to the north property line at 1 foot. A test hole was excavated and percolation test perfmuned. The approximate location of the test hole is located on the attached site plan. At the time of excavation water was found at 9', and after high ground water monitoring water was found at 6'. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. We request you expedite the isuance of this permit due to the unsanitary conditions. If you require additional information, please contact tis. Sincerely, Robert C. Cowan, P.E. RCC/mg MUNICIPALITY OF ANCHORAGb: ENVIRONMENTAL SERVICES DIVISION OCT 1 0 1997 RECEIVED Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 $~ALE 10' UTILITY EASEMENT SITE-PLAN mo z-u © 0 It/) (~ m~.rnm z <m©~ >xm © mFzr- o ~ mc) o m~ ~> 7r- PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 8 9 10 11 12 13 14 15 16 17 18 19 20 ~o~TAi ~' ',]A~c~¥ ~'S'FA'rF..~ SLOPE Township, Range, Section: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh lo Water A.er ~, SiTE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop t c~-IG-fl] IZ,: IZ, --- ,..% Vz'~ ----- · I .,,.. S '4 17.:1~' PERCOLATION RATE TEST RUN BETWEEN~"~ FTAND fl __FT COMMENTS PERFORMED BY; ~O~ ~agle E;ver LeoF ~-,~ ~. 2~~ /~/C.. ~,~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE Wl~ ~ ~~L GUIDELINES IN EFFECT ON THIS DATE. DATE: /0 72-008 (Rev. 4/85) ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVALS SEWER &WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & PLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE W/NSTEWATE R DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 20, Block 5, Mountain Valley Estates No. 1 Subdivision October 7, 1997 GENERAL: 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 on the referenced property. The existing 1000 gallon septic tank is to be excavated, pumped, crashed, and abandoned completely. The existing bed is to be abandoned completely. 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 necessaly 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 Depm.tment for system installations. Owners installing their own systems must also receive prior approval fi'om the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a ccrtiffed 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 20, Block 5, Mountain Valley Estates No. 1 Subdivision October 7, 1997 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet fi'om 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. fi'om the tank. The first cleanout, in line, shall be to clean toward the leachfield. 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 (roughed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced dowmvard. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt ban'ier must be installed between the final gq'avel layer and the native soil backfill. Ensure the silt barrier covers the entire gq'avel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimmn of 12 iuches above final gq'ade. The portion of the monitoring tube extending through the gravel shall be perforated fi'om 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. 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 20, Block 5, Mountain Valley Estates No. 1 Subdivision October 7, 1997 MINIMUM MATERIAL 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 Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 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, Femco, or equal). A pe~Tneable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All 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. 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 be backfilled before this inspection. Page Four Lot 20, Block 5, Mountain Valley Estates No. 1 Subdivision October 7, 1997 The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessm'y, 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 perfon~ 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 tlzis project or the failure of the contractor to cany out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER  MUNICIPALITY OF ANCHORAGE DEPAR'rMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT . ) r~n-°-N E /I~NEW MAILING ADDRESS ~EGAL DESCRIPTION NO. OF BEDR~ DISTANCE TO' ," -' ~ ~ ~ Manufac~(~ / / No. of compar,~nts Liq~in~e~ OhS Inside length Width Liquid depth ~ / ~.O/ (~ IF HOMEMADE: ~ ~ DISTANCE TO: Well ~ Dwelling PERMIT NO. ~ Manufacturer__ /~ Material Liquid capacity in gallons Well ~ DISTANCE TO: ~ Foundation Nearest lot Hne PERMIT NO, :~ ~ ~ ~o, of lines h Total length of line~ Trench width D~stance between inches -- Top of tile to finish grade / ~ Material beneath tile Total effective absoFption aFea I inches Length ~ Z6 ~'~ Width ¢,~- D~pth ,~ / ~i( ~ ~:'~k,~ PERMIT~ ~ Type of crib_ Crib dia~let~[ Crib de~ Total effec{ive absorption area __¢ DISTANCE TO: /~y~ 1Building fo~nCati~n . --~ -- ~ ¢ Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation ~ Sewer line Septic tank Absorption area(s) OTHER ....... ~IPE MATERIALS p __~ SOIL TEST RATIN~ . ¢~ : / 2: ; / INSTALLS> R E MAR KS ' "~V [ D OAT[ LEGAL fD ~.~ WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol ~ GeophysicGISurveys LOCATION OF WELL {Please complete either la, lb or lc.) 18oroughI 8ubd,v,,,o. ?1 Anch t. Valley 120J 5 I [~Of-Of-Of- ~J DIRECTION PROM ROAD iNTERSECTIONS DISTANCE AND Street Address and Area of Well Location 2. WELL LOG Malerlcl Type _ S~nd~ gravP. 1; silt Black rock and water 16. WATER WELL CONTRACTOR'S CERTIFICATION: Top 78 Drilling Permit No, A.D.L. No. Section Feet Below Surface Serf om T°wnshlp N ~'~ I Range Er'-) Merldicn sE].} wO ~, OWNER OF WELL~v~, ~tt ?eter~o~ 843. W. llth Apt. 309 Anchorage, Ak. ~99501 4. WBLL DEPTH~ (final) ~. DATE -- ~ -. 8~ 86 ' fl- ~0 OF COMPLETION No, 7. USF,3~ Oomeetlo [] Public Supply [] Indaalr¥ [] Irrl~otIan [] Reohur~e [] Cornma¢loul [] Test Well ~ Other: ~ CASING: [] Threaded ~ Welded dlam, In. tc~__ ft. Depth Stlokup ft. 9, FINISH OF WELL: Type: Slot/Mesh Size: Sat belwean Bock filling I0, STATIC WATER LEVEL: ff. [] Above or [] Below land aurfoce Equipment used: t Length :. fl. and Gravel pock . / / Date II. PUMPING LEVEL below lend outface and YIELD __ff. offer ~hrs. pumping __9,p.m. ~ft. after ~hre. pumplng~g.p.m' I~.GROUTING Wall Groa,ted: [] Yea [] NO Moterlel; [] Neet Cemenl [] Other; I;5, PUMP; (if available): tip Length of Crop Pipe ____ft. cupaolly --__ [] Subm. [] dar [] Centrifloal [] Other 14. REMARKS: ~o~uct.io~ o£ lO G?M 15. Water Tamperoture .__o [] F [] C This well was drilled under my )urlsdlcllon and Ibis report Is true to the best of my knowledge and belief; M~gnu'son' Drilling _4A 5385 Registered Business Nome Contract Licons~ Number ~ddre~,; P.O. Box 770504 Eagle River, Ak., Form 02-WWR {11/81) Copy Di$1ributior,: WRITE-Stele OGBS~ PINK-OriIIor, CANARY'Customer MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmenta~ ~rotection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ WELL AND/OR ON-SITE SEWER PERMIT Applicant: ~D"<~%~ ?~&~r-- ~'~ S , Mailing Address: · -u LOcation: LEgal Description: L~O 6 ~ Type of Soil Absorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: ~ Phone Number: /~ r. ~~ ~Z~Lot Size: Seepage Bed: ~ Holding Tank Soil Rating(sq.ft/br) DEPTH ~-~ The Required Size of the Soil Absorption System Is: LENGTH ~G_ ~ ~ ~ . GRAVEL DEPTH ~ ~'' ¢-o.--c,L..o.,,_.~DTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between 'the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HeLD~-NG) TANK SIZE : /C)~C) GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee~ 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 ~ 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. S igne~: .,,~__~.~.y~ Issued by: _ Applicant Date: SWP/024 (1/81) SOILS LOG PERFORMED FOR~--~ LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 82B L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST /- 10¸ 11 12 t6 17 18 [] PERCOLATION TEST WAS G R O U N D WAT E R :~:-~,..,j,-'- ~ ENCOUNTERED? 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I",tE:L. UD[E I'IORE TFtRI'.,! :2i: E',E:DF~:OOHS. F:'EF.'.H .T, T FIPF'L..t.' CFIF,IT HFI:5 THE t~:E~E;F'ONS ;I; F.'.',' Z L. Z 'T"¢ TO t I",IFOIE:H F'E:R:~;ONI',,I[i% DUF.: ;[ NG THE: ~[I",tSTFIL. t...RT.T. OI'.,I :r.N:~F'EC'T'ION:.=.; OF FIN"r' I.,.IEL.L..:~i; FI[)J'FIC:E:NT TO TH:[:~ I::'ROF'EI:~;:T'¢ Rt",I[::' 'THE: t",tLJi"IE:ER (DF' F..'IE:E;.TE.'Ei",tCE:5 TFIFFT THE: ,b. IE':LL. kl:[L.L. '5;E[~:',,,'E:. J:l= t~ L..]:FF S'T'RTtON IS'i iNS"FF:EZ..ED., l=lI',l EL.[~:C::'I"[T.':iC;I=IL. F'E:RI"I :[ "I" laND .T.N:SPEC:'t"ZON t'II.J::Z]" E:E': OBTFI;[NE.F..,. Fl:~i;'"'Bt..IZi...."i":!i; CRt',INOT E:E Fff:'F'ROV[ED I,.I;[THC)UT RI'q EL..ECTF..'ZE:FIL' ~[N~2;F'E;C"f'.TON REF'ORT. THE E;I...ECTF4'.:[CFtL t.4C)RK HI...I:ST .I.' CFINT: HF:ITTHEI.4 F'E:TIEF.:SOh! :I;'=~;ZLtlL"'TI;::, EW: [;,FFTE: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite · . (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.. O50-65~.-12 Expiration Date: GENERAL INFORMATION Complete legal description Mountain Valley Estates #3. Bk ,; Lot 20 Location (site address) 422~; Johnny Drive, Eagle River, AK 995'-77 Current Property owner(s) Mailing address Lending agency Mailing address Matthew Peterson Trust /-+225 Johnny Drive, Eagle River, AK 99477 Day phone 3oz-97z9 Day phone Real Estate Agent Eva Loken/Prudential JW Vista Day phone _.689-6476 Mailing Address z66:{,; Centerfield Dr., Eagle River, AK 99477 Un~ess otherwise requested, COSA will be held by DSD for pickup. · .:;' ',NUMBER OF'BEDROOMS: TYRE~OF -WATE~'SUPPL y: "i J~idividU~!~well [] i~dMdbai'water Storage [] Community Class Well [] Public water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties' served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems 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 period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Pannone Enqineering Services, LLC Phone 272-82z8 Address P.O. Box lOO2~-7, Anchorage, AK qg?.o Engineer's Printed Name Steven R. Pannone, P.E. Date ('rZf7/,'"~ f Engineers Comments: in conducting an adequacy test, I attempt to pro¥ide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSO SIGNATURE ~ Approved for '~> bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: -.. ....O_NzSITE '. ~-; ~aI~RAND · '-'._. : th'ASYEWATER .' 't~'-'.' PROGRAM ..' -'-'---,;%2" .... :"Yjjj)))))}))),¢ · Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ,;~)~"~ Original Certificate Date: ''~- Mtmicipality of Anchorage Development ServiceS Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ... Mountain Valley Estates #~. Block =; Lot 2o A, WELL DATA Parcel ID:. ono-6n~-~.2 Well type P Date completed =ol=nl~e8~ Total depth. 86 ft. Date of test Static water level Well production ~o WATER SAMPLE RESULTS: Coliform ~E..~ colonies/100 mE Arsenic: ~Jb ug/I SEPTIC/HOLDING TANK DATA If A, B, or C provide PWSID # ~ Sanitary seal (Y/N)_Y_ Cased to...80 ft. FROM WELL LOG =.oh. nh.98:l g.p.m. Nitrate'('~L ~-~lg/L Date of sample: 61=12ea~. Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) z~2 AT INSPECTION 61',12o.,3. , ~ ff. 6.=l g.p.m. in. Collected by: ..Laura Pannone Tank Type/Material Anchorage Tank Steel Number of Compartments _= Depression'over tank (Y/N) N Pumper JR's Pumping Tank size z2~o gal. Foundation cleanout (Y/N) Y Date of pumping. 616/2o~.a C. ABSORPTION 'FIELD DATA Date installed :txlnh. qq? Cleanouts (Y/N) y High water alarm (Y/N) Y Date installed A~l?l~nq? Soil rating (g.p.d./~ or ~/bdrm) .0.8 Length ~.~.8 ft. Width 'i Total depth ~ ft. Eft. absorption area n_~o ft2 Date of adequacy test 61~l~o~a Results (Pass/Fail) ~ Fluid depth in absorption field before test o_. in. Elapsed Time: 3S min. Final fluid depth _o in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Monitoring tube Y Pass System type Shallow Trench Gravel below pipe. Depression over field N For 3 bedrooms Water addedzrso gal. Absorption rate >= ~o+ If yes, give date New depth_~ in. g.p.d. LIFT STATION Date installed "Pump on" level at .~ in. Datum Bottom of Tank E. SEPARATION DISTANCES Size in gallons "~,~o "Pump off' level at 3~ in. Cycles tested ~+ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot xoo+ Absorption field on lot ~o+ Public sewer main N/A Sewer/septic service line 25+ Animal containment areas xoe+ Property I!ne ~.e+ Water Service line 25+ Curtain drain None Known COMMENTS Manhole/Access (Y/N) Y High water alarm level at 44 Meets alarm & circuit requirements? Y in. On adjacent lots ~.oo+ On adjacent lots ~.oo+ Public sewer manhole/clean(~ut N/A Holding tank xoo+ Manure/animal excrete storage areas xoo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation xo. Property line Water main N/A Water service line ~5+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation xo+ Surface water ~.oo+ Wells On adjacent lots ~.oo+ Absorption field Surface water Water main N/A Driveway, parking/vehicle storage Gm 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 COSA guidelines in effect on this date. Engineer's Printed Name steVen R. Pannone, P.E. Date ~z~c~7/[[ COSA Fee $ Date of .Payment Receipt Number Waiver Fee $ ~at~ of ~aym~nt R~ipt ~umber (Rev; 11105) SGS ReL# 1112207001 Client Name Pannone Eng. Srv. Printed Date/Time 06/07/2011 15:52 Project Name/# Mtn Valley Est #1 B5 Lt 20 Collected Date/Time 06/01/2011 14:00 Client Sample ID Mtn Valley Est #1 B 5 Lt 20 Received Date/Time 06/01/2011 15:40 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/01/11 06/06/11 NRB Waters Department TotalNitrate/Nitrite-N 0.188 0.100 mg/L SM204500NO3-F B (<10) 06/03/11 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 06/01/11 DLC Total Coliform Negative 1 100mL SM20 9223B A 06/01/11 DLC ASBUlLT SEI~ARD & ASSOCIATES I HERESY CERTIFY THAT I HAVE SURVEYED THE i r,tu I HAl Ne ENCROACHMENTS EXIST EXCEPT AS / INDICATED. IT IS THE RES~ONSlOILITY OF THE ........... OWNE~ TO DETERMINE THE EXISTENCE OF ANY GRID:" .......... EASEMENTS~ COVENANTS~ OR RESTRICTIONS ~VHICH DO NOT APPEAR ON THE RECORDED SUBDI .... , · VISION PLAT, UNDER NO CIRCUMSTANCES SHOULD · ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR'FOR ESTABLISHING BOUND',, -~A~N---'~~ ARY LINES. JRs iPumping PO Box 7734] $ Eagle River, AK 9~77 (907) 694-6454 Bi~nn_l?ormation Maff Petemon 4225 Johnny Drive Eagle River, AK 99577 (g07) 694.7993 IJob Site Information Laura w/Pannone 4225 Johnny Drive Eagle River, AK 99577 (907) 694.7993 Additional Location Comments Diagram: 3rd house on left - ~s are on large log home w/red roof. Pipes are on the corner (left) side of home at ground level. 30ft from house, north 10ft off dw. Job Description; P-O- Number: Terms: Salesrep; Map Book: Crees ?,treats: 1500g Net 30 Dawn-Dawn Johnny Drive Service Agreement Number, 033516 Order Date: 02.Jun-2011 Service Date: 06-Jun-2011 Technician; Bruce Tax %: 0 Job Type: Repeat Map Gild: '~ 60- - Job Comments: Last Serv '07/31/2007' tank normal back flushed 1 time clean outs are clear 1500g Gallons Planned; 1500 Gal. Actual: .... , Hose Length: 2 Double Tank~ [] Pump System: ~, Baffles Inlet: [] ........ Baffles Outlet; [] ~ Service Type Septic Service 15K Qty Prico Each Tax? 1 $260,00 No NonTaxable Total Eslimetad Charges; $260.00 Actual Charges: Customer agrees to the terms and conditions shown. THIS IS A BINDING. AGREEMENT. Extension $260.00 Taxable To,al Tax Total $o.oo $o.oo Actual Grand Total $280.00 Signatur, p ~ Title of Customer Representative Date Accepted by JRe Pumping Date Accepted For your added convenienoe we accept; Dlcover, Vi.sa and Master.Card payments over the phone. After 30 Days account will be turned over to COLLECTIONS.. $30,00 For NSF Checks.Returned. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRON~iNTAL HEALTH DEPARTMEN~ OF t{EALTH .~ND ENVIRONMENTAL PROTECTION APPLICATION FOR H~LTH AUTHORITY APPROVAL CERTIFICATE Legal Description (includ§ 1Qt, block, s~divis~,o~, section,~t~f~shik0., range) Loca~j~ioTn ~ad~ress or diracti~ns~ ~O ~ ~ ~ ~ ~- c~ Buyer ~ ; Other ~ <explain>; (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. T~e of Residence Sin. gle-Family,~' Number of Bedrooms Multi-Family Other (describe) _W_a t e r Sup pti!~ Individua Well Oo=unity f__--] Note: If community well system, must have written confirmation from the State Department of F. nvironmental Conservation attesting to the legality and status. 4. _S.a~wage Dis.~o~?[_ Onsite ~ Public ~_~ Community [2~ Holding Tank ~ Note: If community well system, must have written confirnmtion from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineerin~ Firm Providin~ ..... Inspections, ..... Tests~, File Search~z~Data. _ and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on--site water supply and/or wastewater disposal, system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the info~ation obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or ~stewater disposal system is. in compliance ~th mll Municipal and State codes, ordinances, and regula-- tions in,.effect on the date of this inspection. Name of Firm ~t ~~ Telephone Approved for Approved /__ Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT~ ATIONS GIVEN IN PARAGRAPtt 5 ABOVE BY AN IND,:PENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES ~i]IIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. ~IPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TIlE MUNICIPALITY OF ANCtlORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-~84 Ac MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPAtlTY OF ANCHORAQB DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED Well Classification Well Log P~esent ~/N) Total Depth -~ ~ / Cased to , Static Water Level ~ / Pump Set At Casing Height Above Ground 30// Electrical Wi~ing in Conduit ~) If A, B, o~ C, D.E.C.. Approved(Y/N) Date C~%)l/ete d- Depth of G~outing. Sanitaz. y Seal on Casing ~N) Depression A~ound Wellhead (~-~ Separation Distances f~om Well: To Septic/~ Tank on Lot /~ / ; ~ ~joining Lots To ~a~est ~ge of ~so~ption Field o~ Lot/~ ~' ; ~ Adjoining Lots To Newest ~blic ~ Line ~/~' To ~est Public ~ Clean. t/Manhole , ~ To ~est ~ ~v~ ~i~ on ~t Wate~ S~le Collected By ~"~"~N~'N~,~'-; ~t~ B. SEPTIC/HOLDING TANK DATA Date Installed ./~3~:/(3--~37 Size //dcT~c/~ No. of Cc~pa~tm~nts Standpi~s ~) Ai~-tight Caps ~) Foundation Cleanout (Y~ ~p~ession o~ Ta~ (~ Date ~st ~d P~ing~intenan~ ~n~act ~ File (Y~)~/~ ; fo~ ~ -- Holding Ta~ High-Wate~ ~a~ (Y~)~ ~a~y Holdi~ Tank ~r~t (Y~) ~p~ation Distan~s ~ ~ptic~t~Tank: / TO Water-Supply ~11. /~ ,-- To ~ilding Foundati~ TO ~o~rty Li~ ~ ~, TO Dis~sal Field To ~ter Main/~rvi~ Li~ '~/~- To S~e~, Pond, ~e, ~ ~jor ~aina~ co=se Comments [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field /~--.~//~ Type of System Design ~ Length of Field 3~~ / Depth of Field 3 / Gravel Bed Thickness ~ ~/ ~ ~/~ Square Feet of Abs<o~p. tion Areaj'~ Standpipes P~esent~3~N) Depression ove~ Field'(Y~ ~?~ last Adequacy Test Results of last Adeqq~acy Test Separation Distance from Absorption Field: To Water-Supply Well /~ ~5 To P~operty Line To Bqilding Foqn~ation .~-~ z~- To Existin~ or ~Abandoned System on Lot ~/0--/~ ; On~j/~ining Lots ~ ~ ff~ To Wate~ Main/Service Line Y~- To Cutbank(i~ present) // TO Stream/Pond/Lake/o~ Majo~ D~aina~e Course //~ To D~iveway, Pa]~king Area, o~ Vehicle Sto~age Area -~ /~'~-- Cor~ents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo~ Electrical Codes (Y/N) Comments Dimsnsions Manhole/Access (Y/N) "~/~f" Level at ////.//~..__ Vent (Y/N) Pumping ~les du~ing Adequacy Test. //7 Yeets MOA ** Check Pe=mitted Bedroon Rating Against HAA Request I certify that I have checked, verified, o= conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed ~ KB1/d5/s ' [Page 2 of 2] 2-15-84