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HomeMy WebLinkAboutSUN VALLEY BLK 3 LT 1Sun Valley Block 3 Lot 1 #078-131-03 On -Site Water 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: OSP151265 Tax Code Number: 07813103000 Work Type: Well Initial Permit Effective Dates: August 04, 2015 Design Engineer: Subdivision: SUN VALLEY to August 03, 2016 Site Legal Address: SUN VALLEY BLK 3 LT 1 G:0858 Owner/Address: TAYLOR JAMES R 50% & MCDOWELL PATRICIAA 50% 3308 SUN VALLEY DRIVE EAGLE RIVER AK 995770000 Site Mailing Address: 3308 SUN VALLEY DR, Eagle River Lot Size in Sq Ft: 101178 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy N Private Well Y 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. a t ' s'aI( (5) /05 Gal freer tva+er +ankj gr./ Received By: Date: FAO cr. Issued By: L` � (/t/ �_, Date: Tom- Ab MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program L Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 0j8- r3/— 03— Property owner(s) 3—Propertyowner(s) J4ffi 4Zfyte,.-5-Oiu bottc,r,_.,04fhays 'Day phone (o9/-52,on Mailing address 330g %4A/fit e 1t titter -A-64r tit vac 414-, 9y5t-1 Site address 5 ,414fE Legal description (Sub'd., Block & Lot) chum (%/}LC.Cj t&4/r 3 tor Legal description (Township, Range & Section) Lot Size /0/1175' Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (10 all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage E APPLICATION IS AN: Initial Upgrade Renewal TYPE OF DWELLING: Single Family (SF) 0 (w/wo ADU) Duplex (D) 0 Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: 0 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Sign property ized agent) Sin ure of er Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. Permit App_9-1-12.doc Waiver Fees: Date of Payment: S -4-is Receipt Number: ric$P' Waiver No. 24 HOUR SERVICE LICENSED & BONDED 11723 Old Glenn Hwy. • Eagle River, Alaska 99577 (907) 694-6646 • Fax (907) 694-0527 RESIDENTIAL • COMMERCIAL • INDUSTRIAL COMPLETE PLUMBING AND HEATING REPAIR & SERVICE 08-03-15;09:51AM;From:Greer Tank, Inc To:6940527 ;9072489212 # 1/ 11 lap.? wriw.U,,.u,y+,„eranecurwscomponents/Listings.asp?TradeName... NSF Product and Service Listings These NSF Official Listings are current as of Monday, January 21, 2013 at 12:15 a.m. Eastern Time Please contact NSF International to confirm the status of any Listing, report errors, or make suggestions, Alert: NSF is concerned about fraudulent downloading and manipulation of website text. Always confirm this information by clicking on the below link for the most accurate information: http:/Avww.nsl:ordCertMed /PwsComponents/Listings.asp?TradeNamo=Dow+DPDA X02 D3220+NT+7+1-iigh+Density+ Polyethylene -I -Resin& NSF/ANSI STANDARD 61 Drinking Water System Components - Health Effects NOTE: Unless otherwise indicated for Materials, Certification is only for the Water Contact Material shown in the Listing. Click here for a list of Abbreviations used in these Listings. Dow Chemical Company (The) 1803 Building Midland, MI 48674 United States 989-638-6231 Facility : Red Deer, Alberta, Canada Potable Water Materials Trade Designation Potable Water Materials Dow DPDA-3220 NT 7 High Density Polyethylene Resin Protective (Barrier) Materials Tirade Designation Tank Material Dow DPDA-322o NT 7 High Density polyethylene Resin Number of matchingManufaoturers is 1 oft Water Water Contact Contact End Use Temp Material A,F,P D. HOT PE Water Water Water Contact Contact Contact Size Restriction Temp Material >=5gal. D. HOT PE 1t21/2013 11:33 AM Changed Fomloea Formolene LLPPE to DOW 0PPA-3220 HOPE. 0 N V d m 4a3 z 4=c% 12 a•, A 0 R IQ ae V N i T N G� 1 Q z x a,= z 0 040 L1 0 R O 0 = :I N 4) 2 0 N 0 0 0 0 t c 3 N PgO V 4 January 0.2012 OO Dwg No. 120111 4) $ z E 4) GENERAL NOTES: 4- d O_ 0 N N 0 qi 0 0 0 0 a a E 4.)5 44 R ON a2 m m 15 0 vfIIHI 1 Int Municipality of Anchorage OCT 1 201 • Community Development Department Page 1 of 3 On -Site Water & 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 OSP131302 PID Number: 078-131-03 • New ®Upgrade Name: JAMES TAYLOR ABSORPTION FIELD Address: 3308 SUN VALLEY DR *EAGLE RIVER, AK 99577 0 Deep Trench 0 Shallow Trench • Bed • Mound 0 Other Phone:No. of Bedrooms: 694-5600 3 Soil Rating: CPD/Sq. Ft. Total Depth from original grade: pt, LEGAL DESCRIPTION Depth to pipe Invert tram original grade: Grovel depth beneath• •e: Ft Subdivision: Block: Lot:PL SUN VALLEY 3 1 Fill added above original grade: Gray :ng h: Ft. o hip: —l_ e: Rection:Gravel — width: � Bede Number of line: Distance between lines: SEPARATION DISTANCES (\S�Nij C rt. Total absorpf• area Number of trenches: Dist. between trenches: To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines S0. Ft Ft Well 100'+ EXISTING — — 25'+ TANK Septic 0 S.T.E.P. •Holding ❑Other Surface water 100'+ EXISTING — — Manufacturer. ANCHORAGE TANK Capacity: 1000 Gal. Lot Line Sit EXISTING — — N/A Material: STEEL Number of compartments: 2 Foundation 5'+ EXISTING — — LIFT STATION Curtain Drain Manufacturer capacity: NONE KNOWN Gal. Remarks: OLD TANK WAS DECOMMISSIONED PER UPC "Pump or; level at 'Pump or level at Hi r alarm at: Pump Make & Mode • °trical Inspections performed by: PIPE MATERIAL Tank to House to tank D3034 D3034 drainfield Installer JR'S PUMPING Drainfield EXISTING CO MT EXISTING CO/MT GEG, Ltd. BENCH MARK (Assumed elevation) Inspection 100.00 R. Dates: 1st 9/17/13 2nd — Location and Description: 3rd — 4th — TOP OF CONCRETE SLAB © PORCH STEPS Community Development Department Approval Conditional approval: Date ENGINEER'S SEAL _ 4p i st„sc. O.. •S'�Jh0 D j / Approved r) rl l Date• a �3 QO QA9i ` 44or 44oapro f ey A. ernes: CCCE�TT 79 3 - ww •'11.343•' �A``GO fession6a ��k0000�t5 PERMIT NUMBER: OSP131302 AS -BUILT DRAWING PARCEL ID NUMBER: 078-131-03 EXISTING DRAINFIELD (EXACT LAYOUT OF DRAINFIELO IS UNKNOWN) NEW 1000 GALLON SEPTIC TANK. DBL3&4 ST2 ST1 DBL1&2 100' WELLMD 10' Ding Dm9 Esmt GAR SS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 9111E 101 • PNCHOR GE. N( 99507 • PHONE (907)337-0179 • FAX (907)338-3248 • WEBS 1IE: wwgamvann9Mnedn9.tom 701 E. TU PREPARED FOR: JAMES TAYLOR PHONE NUMBER: 694-5600 LEGAL DESCRIPTION: SUN VALLEY; BLOCK 3, LOT 1 TYPE OF WORK: AS -BUILT DRAWING (Rev. 01/05) PAGE NUMBER: 2 0F 3 DRAWN BY: PNB DATE: 9/27/13 PERMIT NUMBER: OSP131302 AS -BUILT DRAWING PARCEL ID NUMBER: 078-131-03 w13L r( 2" INSULATION PER JR'S PUMPING (DAVE MERO) ON 9/30/13 FINAL GRADE = 99.14-99.25 ST1 ST2_ TOP OF TANK TOP OF TANK AT INLET = 96.63 19ggggg__�gg_ AT OUTLET = 96.63 INVERT OF BUNG AT INLET = 96.01 GARN.ESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS .. 3701 E. TUDOR ROAD, SUITE 101 • NICHORAOE, N( 99507 • PHONE (907)337-6179 • FAX (907)338-3248 NOTATE: •w..gonisengi PREPARED FOR: JAMES TAYLOR PHONE NUMBER: 694-5600 PAGE NUMBER 3 OF 3 INVERT OF BUNG AT OUTLET = 95.89 LEGAL DESCRIPTION: SUN VALLEY; BLOCK 3, LOT 1 DRAWN BY: PNB TYPE OF WORK: PROFILE AS -BUILT DRAWING DATE: 9/27/13 A. a ass: 9.i. E-795 N`G e Ppro f e ssioro 4opoo�� (Rev. 01/05) 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: OSP131302 Tax Code Number: 07813103000 Work Type: Septic Permit Effective Dates: September 11, 2013 to September 11, 2014 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: SUN VALLEY Site Legal Address. SUN VALLEY BLK 3 LT 1 G:0858 Owner/Address: TAYLOR JAMES R 50% & MCDOWELL PATRICIA A 50% 3308 SUN VALLEY DRIVE EAGLE RIVER AK 995770000 Site Mailing Address: 3308 SUN VALLEY DR, Eagle River Lot Size in Sq Ft: 101178 Total Bedrooms: 3 This permit is for the construction of: N 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 By: Issued By: Date: M03 Date: %/%03 MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 01- - j3J -63 Property owner(s) JIM TAYLOR Mailing address 3308 SUN VALLEY *EAGLE RIVER, AK 99577 Phone: 907-343-7904 Fax: 907- 343-7997 Day phone 244-0742 Site address 3308 SUN VALLEY *EAGLE RIVER, AK 99577 Legal description (Subic!, Block & Lot) SUN VALLEY; BLOCK 3, LOT 1 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: (R all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage El APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance' — I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. gaomel 2/35//3 33;9. t6SPI3/30l Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS August 29, 2013 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Tank Upgrade Sun Valley; Block 3, Lot 1, To whom it may concern: The existing three (3) bedroom house on the referenced property is served by a private well and septic system. The existing septic tank is in a state of failure and needs to be upgraded. We are proposing to decommission the existing tank and replace it with a new 1000 gallon septic tank We are unaware of any adverse impacts this installation may have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Siicerely, e Pres P.E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com TANK DESIGN ONLY f , 00 imoos i TTNTa W ASTERS G ENtER7ICES Sat .4t..eakt deewmul f EXiS11111G. DRAINFIELD— (EXACT LAYOUT OF DRAINFIELD IS UNKNOWN) INSTALL DOUBLE C/O'S AFTER TANK. PROPOSED 1000 GALLON SEPTIC TANK. INSTALL DOUBLE C/0'S PRIOR TO TANK IF A FCO IS NOT PRESENT. SUN VALLEY TRACT C—) XISTING 1000 GALLON SEPTI ANK TO BE DESOM SIGNED - R UPC. II NOTE: THE CONTRACTOR SHALL HAVE ALL WELL RADII FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. I z I \ \ SUN VALLEY; BLOCK 3, LOT 2 \ \ N \ GARNESS ENGINEERING GROUP, Ltd. • -+�� CONSULTANTS & GENERAL CONTRACTORS ,Kti 701 E. TUDOR RMO, SUITE 101 • SNCH OWE. AK 99507 • PHONE (907)337-6179 • FAX (907)338-3218 • YtSSITE ww.9amemangineeringcem PREPARED FOR: JIM TAYLOR PHONE NUMBER: 694-5600 LEGAL DESCRIPTION: SUN VALLEY; BLOCK 3, LOT 1 TYPE OF WORK: TANK DESIGN UPGRADE PAGE NUMBER: 1 OF 1 fp DRAWN BY: OV 9• • . CE -7e' PNB 0� �4 dp�o fes siott ���000�oo DATE: 8/29/13 �i= 'DEPARTMENT I e �� MUNICIPALITY OF ANCHORAGE 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 NAME /� Carr I.So+e // ✓ PHONE Gftl--. 747 NEW MI UPGRADE MAILING ADDRESS i R— 5' 3 f S C,S- Ce leI ve r 4 1( 9'5C? 1 LEGAL DESCRIPTION L01- 1 g//C3 Steti Ua //e SI 46.1v .r/L/N K /w -rec. 3'3 LOCATION p .+-J /14'4' se, 4 / •--Co tr / /= v r /C NO. OF BEDROOMS 3 c? -- F• z Si I. DISTANCE TO: Well /00 .t Absorption area S / Dwelling ,l/a'1- TN PERMIT NO. g' $-0,3 9 $ Manufacturer 6n -cc,- Material S5' ee / No. of compartments Liq. capacity in gallons Ivo 0 IF HOMEMADE: Inside length _ Width --- Liquid depth 6 i' JOZ 2 z ct DISTANCE TO: Well Dwelling . PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE c_ IDRA FIELD TRE H DISTANCE TO: Well /°0 I FoundationNo'Y S+� Nearest lot line RR /Drt NO. PERMIT NO. 35 No. of lines Length of each line a -7 Total length of lines _ / 9' 7 •Tat width a ° -incises- Distant; between lines Top of tile to finish grade/ Length a i.f. /h..,a 4f ` gbabe ✓ relay_F Width Material beneath tile inches Depth Total effective ab orption 9jea G. 2 77 (,-/ PERMIT NO. w 0 4 I- wa vi Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J w Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS Afj�o%r✓,e-d 1°(/ c Sc;rei � r SOIL TEST RATING -AT","^"`(— finis-t INSTALLER S6.,'n ri- k C0,76-±., cXBSy0R% REMARKS /1 UAIP/�-7704/ TGE/{-.✓6t.ep' '& !� /2D. 't _ii �. <0,°a Ev 7 ��� eras . A OF 44 )n '� _ 1 Fi.hde w„ �T .• i:. jN 01 kiC CS CQ eC ~:. t) 0.-, ii 1111 1 _ _ m , 1 D B'e •.•. tops - 'Cla\•_e I . -au-fir t0 S Louis A. 6utera : Wo I iANK i�, t,�'• CE -6736 . w® Co, P'�1 t��i'{ep�•. •••.•••�PV�'� Eagle River Engineering Services 'k-WAFEreJwN�� � B-Enr17329* 1L0osa%4— Eagle /liver, AK 99577 C re K fr94-5195 `` ((�� 1 \ L`CX( YLm i . o0l CY-\ A�:Y 1L4 0 fi AS €--)\--1 KIQ . CiTt•( ED r1 rrII \\ & F T -rE l l)`� L4..Q UOx"{ �51,tC5 `iC� \a k'.ILLL:'s� \. C_lu`��'�'t�1."C Cl E'��Ilf�l�l� -� l_E.c., l vi lal /Arks- e h 4. 72-013 (Rev. 3/78) gS BIG DIPPER MUNICDIEPATIIOFOHEALTF AH &RGE ENVIRONMENTAL PROTECTIOAi DEC 261985 :DRILLING REcuvo 7529 E. 6th Avenue • Anchorage, Alaska 99504 • (907) 333-6435 July 19, 1985 Disotell Const. SR 9385 Eagle River, Alaska 99577 Dear Sir: The following information is your copy of the well log for the property located at rtot:_1, B_1_ock. Sun Vailay__Subdiv-:a�sion.;: _This should be retained as your permanent record Of improvements to your property. WELL LOG 0 To 28 Brown Sandy silt, gravel 28 35 Sandy silt, gravel 35 41 Brown sandy silt, gravel 41 45 Gray sandy silt, gravel 45 48 Brown silty gravel 48 55 Gravel, WATER 5-6 GALLONS PER MINUTE STATIC WATER LEVEL 25 FEET STATEMENT 55 Feet drilled and cased @ $19.00 per foot = $1,045.00 Thank you for specifying BIG DIPPER DRILLING for your water well needs. Sincerely, 7e/YJ C. R. Kron Owner Licensed • Bonded • Insured «i ij. j I A ::R: ;L:]::1:'. P' A IL_ :ic 'T "Nu` P::U 1'.: n' =Y. INI f.:: P- 1 if;7;14= c.. ^u iF.E IE': DEPARTMENT (JF HEALTH (hall:) ENVIRONMENTAL PROTECTION -825 L STREET, , ANCHUFRAGE, AK 99501 264....4720 ChM— is ..t.. E E :.:n IE_ WI -N "n a r. F" t:: IR:li'i PERMIT NO DATE ISSUED; (-iPF'L.. i 1:7AN'I ADDRESS! CONTACT PHONE:;; I....E(f:3(L., L)E:(SCR:(I L.JJI E3:(zia MAX BEDROOMS: 850395 07/e:8/85 CARL. D1SO'l"ELL SR '9:.:85 EAGLE RIVER„ AK 995'77 694-5797 SUBDIVISION; SUN VALLEY SECTION; 33 TOWNSHIP; 141NI 2.32A (80.FT OR ACRES) LOT; 1. RANGE; 1W BLOCK 1._:1st.ed below are the options available to you iri designing your septic system. I,IiIi(J!-e• the option thaat, beg-#: f:I:t:r: your •x,i.t..r.?. DEPTH 7(.:i PIPE BOTTOM (FT.) GRAVEL DEPTH (FT.) 1'lrrAI_. I:)EPrI-I (FT.) G)RAVI'':1._. WIDTH (FT.) GRAVEL LENGTH (FT.) GRAVEL L. VOL...UME (CLI. YDEi. ) T(-1NK SIZE (GALS) SOIL RATING (:ri(,.I-T./)3I'i) 2.5 ar. * 0. 3.0 17.0 34.0 21.5 1.000.0 125 004c. '• Op s, vva_ cA_RA IL _Dety3Q. n&Q- OA _A, 0 tL9-wk okJ (,.04', jw k Fuac'g_ . x..n DEF''tH TO PIPE BOTTOM <: 3. FT. _QUIRES INSULATION ** DEP='T'H TO PIPE BOTTOM <C 4.0 ET. MAY REQUIRE A LIFT STATION 6- iY TANK MOST HAVE AT LEAST TWO COMPARTMENTS I certify t..hatr, I am familiar with the rt quirementsc for on-site sewers and wells, as pet forth by the Municipality of Anchorage (MOA) and the State of Ai4aska. I will install t:.Iiz system in accordance with all NIOA codes and regulations, and in compliance with the design criteria of this permit. I will ac.II-Eare to all MBA and State of Alaska requirements for the s,et back: c:liStanc::es from any existing well, wastewater disposal system 01' public sewerage system on this or any ad,Jacent or nearby lot.,, 1 understand thast this pt:errnit is, valid for a maximum of 3 bedrooms and any enlargement, will requires an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN .(t) AN E:LECTRICAI... PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-I'3UILT$ WILL. NOT -BE APPROVED WITHOUT AN ELECTRICAL.. INSPECTION REPORT; AMIE) (:i'r) THE ELECTRICAL WORK MUTT k;5DCINE BY A L1: SE/ ELECTRICIAN. c.r ��-d'-y,2dC1 (FARE.. P1 a0TEI_.I_ SIGNED APPLICANT I:8Lil.JEED F Y 7 DATEg . / / 6‹ DATE 0/Fa— • ' r l , MUNICIPALITY OF ANCHORM ,E _. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Di'f,47 Cumsr LEGAL DESCRIPTION: !_or- / .L3,c-b0./. 3 OC'bRNIC 6? !as 9t (14c 4 o1 n N. OT trio b-tY v1/4t RTc2 41. 7' 7-10 -84d 10 11 12 13 14• 15 16 17 �,�-e1e1yA A gc4i\ a "':s4- s,, J , PAnd A. Stuck., , 41..4. 18 • c No. 14.77.E ; ��r 39 19 aP6..�ces„'NSe ` 20 - COMMENTS DATE PERFORMED: 7'_/J.$ 41 _SL& 4 V 4 L y SLOPE -14 SITE PLAN WAS GROUND WATER S ENCOUNTERED? l� IF YES, AT WHAT DEPTH? -//-8 P E F Al- 7— .Reading ".Reading Date Gross Time Ne Time Depth to Water Net Drop Pree OF Al n%t , _.'�6. .Ally 19: •etl.r><r reit Yr �s�-e Iit in �� �r • Rsber1 A. 51 NO. 14670 e ear • tW',j� - .` .WiN. SEP Ot `6:9 r PA.:rrs.o! at- pa..•- /� . '11/"a1{1.9101*_ /nye PERCOLATION RATE 1 TEST RUN BETWEEN /vt oAd/ra a Lr(rz____ZTh &has .0/yz- a 'I -UDR C Ne: 'FORMED BY: -vv _47t rt_sr 7' I.QINEL: IN"t� f3. 190X ,- /\Lr-%bKA t L( PH. 604.2C7V (minutes/inch) FT AND FT I MttcK 7-/8) ._I i CERTIFIED BY 1 'jar ms's lk s 1/4// $t 4 /' /3%ci Sept .Pe,./ /5 Gvrce_a- Ord, 3 ✓fecA--oor.. {'�MS LC 7`25- 56 sAJ rct#nj /ea c7. OR_ Geo d-- /C?C3.-e{ t -cf-. a'sa,) cover 2' Fora.., .Ins,. /than N.C. -�'. �G-e'cA Lrne i %a' ylrn ve. e/ ^5' /0n5 // 3 / 7`0 7i4 / dee) th A/ ce ceC{r 7`Ie r, n / I-f'7o t. n r.Li.GI Seri / Co ve-r / 3 / U'F JP�/ .e G'YF ve 1, %'.e C 6 J, 46 ALSorL /ro. -e ren ,9es;,✓hc,7 Oe C% d,je 7f so,/ e'en-ot7teu•,J CV7tenf.e 7-Ans-c -e/c c -cLe l ,n So.' / /03' a, %'' 0 49 tai rs'`''' t v vona •••1.00,, aosa e.o..° y _e y e5 cr,ret( fw :a m ; Louis A. 6uforci a W'ir1 ®J, oaa ,CSM �� V�ROFESSO,r,?9 �3 PA unicilpa1ikt y Anchor ge POUCH 6-650 ANCHORAGE. ALASKA 99502-0650 (907) 264-4111 Ir)/1( »N(V.;LS MA YO H DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit IP: 840614 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 1 Block 3 Sun Valley Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. 'If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264•-4720. Sincerely, Keith E. Bandt, Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 11 iL.JI IND 1 C I F ( R._. 1 it V 0 IP"" IA N if_.": II -G ID Ft a' "-r iE3 IF-" DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0225 L STREET, ANCHORAGE, AK 99501 264-4720 C31114.— r_7 T: -1'- N:=: °ID N ::.IW la IR - I[ N__ L. IF =i E :.Ft N'O'N :ft -T PERMIT NO% DATE ISSUED: APPL. I CANT ADDRESS: CONTACT PHONE: LEGAL. DF.SCRIP: LOT SIZE: MAX BEDROOMS: 840614 07/24/04 C /O - S & Si ENC 1 G. DEAN CONSTRUCTION SRF 196X EAGLE RIVER, AK 99577 694--2979 SUBDIVISION% SUN.VALLEY SECTION: 4 TOWNSHIP: 13N 101.1.7S (SO.FT. OR ACRES) Listed br;!low•aare the options avall.able to system. Choose the option that be?st. fits DEPTH TO PIPE. BOTTOM (ET..) GRAVEL. DEPTH (FT.) TOTAL. DEPTH (FT.) BRAVE_ WIDTH (FT.) GRAVEL. LENGTH (FT.) I:JRAVEL. VOLUM' (CID. YDS. ) TANK: SIZE (GALS) SOIL RATING (SGI.FT./DR) n EEO 5 #..p. 0.5 3.0 17.0 t4.0 x'.1..4 1,000.0 J.25 * • LOT: 1 RANGE: IW -BLOCK% 3 you in designing your septic your site. d4-44_4es 0-4.424, /te�w G .*.* DEPTH TO PIPE I3OTTOM < 3.5 FT. REGIUIRES INSULATION ** DEPTI-I TO PIPE DOTTOM - : 4. 0 FT. MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements for on --site. sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA nodes and regulations, and in compliance with the design criteria of this permit. I wi11 adhere to all MOA and State of Alaska requirements for the set back distances from any ekisting well, wastewater disposal- system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of :i bedrooms and any enlargement will require an -additional: permit. IF A LIFT STATION I;INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELEI::yR_CA._ PERMIT AND INSPECTION MIDST BE OBTAINED;' (2) AS--BLIILTS WILL NOT DE APF;ROVED WITE T AN ELECTRICALINSPECTION REPORT;,—AND (3) THE - ELECTRIC;AL WO, I1USi � '- BY A LICENSED ELECTRICIAN* SIGNEDDATE• ' APPLICANT: :/C:. S & 8 ENO16. DEAN CONSTRUCTION ISSUED BY DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR:_ Di=Ain,4 CDpLSI- LEGAL DESCRIPTION: 2 3 8- 9- 10- 11 - 12- 13- 14- 15- 16- 17- 18- 19- 20 - 0Q.64f.t 1 C (3t� Pas Fir /4e (307Tol- . 6t'- F4o1-.0 yt,£ RTC -_2 .4-r -7' /7-10-£34) OF " •/Q{ =1A 4.i :! Roblin A. shah, •t., •. No. 1457.E ....:•••••; 4. - . . t. COMMENTS SOILS LOG gI,L(�I ❑ PERCOLATION TEST DATE PERFORMED: 7-11-8c7 4./ SLOPE 1.1 -1 I4 WAS GROUND WATER ENCOUNTERED? ry =us- L IF YES, AT WHAT / E C7 -8 DEPTH? DEPTH? SITE PLAN jJ Coit) r= 4 Reading Date Gross Time Ne Time Depth o Water Net Drop PERCOLATION RATE nn� �-�-•� TEST RUN BETWEEN /\ DAllfro 1", /N6 / Li74rr t4. .T f//d9 (minutes/inch) FT AND —. FT �hIG�KF4�� WrkrN-. fit C) 4f�INSY '196r�, 19G3s CERTIFIED BY 4# DAT PH, 694,.2TO 11,/$Ise f" r? PERFORMED BY 72-008 (6/79) Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 078-131-03 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) JIM TAYLOR Day phone 694-5600 Mailing address Real Estate Agent SUN VALLEY; BLOCK 3, LOT 1 Expiration Date: 3308 SUN VALLEY DRIVE *EAGLE RIVER 3308 SUN VALLEY DRIVE S 2. TYPE OF DWELLING: ▪ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Day phone a -1h) ' 1 73 OK %r f * d v ® ,g.Wv TYPE OF WASTEWATER DISPOSAL: Individual Well 111 Individual On-site 1 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ waiverNariance request for: `3ra a Io..1 C-1 Distance: — Received by: ` COSA to be released to the engineer, unless otherwise requested by the engineer. Date: e7a—i / 16-- COSA' COSA Fee $ 52-(O - Waiver Fee $ 215 Date of Payment 2h/116 n Date of Payment -111 /IS C ! Receipt Number O`-ASR2.G Receipt Number 011-1 o64 COSA# nSG51435 Waiver# DSVi5110(p 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101* ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG provided an engineering evaluation of the well andforseptic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during Ole evaluation.The operational !deo( all wets and septic systems depend on a variety of variables including, but not limited to, so!! conditions, groundwater levels (that may fluctuate during the year), qualify ofconstrudlon (materials and workmanship), and the water usage of the famiy utilizing the system's. These' conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system's; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative welt or septic system can be installed on the property in rhe event either of the current systems fall. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the i0(ormation provided in this report by any other person or petty, including but not limted to subsequent property purchasers, is not authorized. In short, GEG duavows any legal duty to anyone other than the personipady who paid for this report. 6. DSD SIGNATURE ' System #1 Approved for 3 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date el tot bs- • • I Gaines 1 S C: ♦-4j CROP $S\T:e.� 0 oe heti'' `�1/4‘ ON-SITE �oite; WATER AND r"" m WASTEWATER z^ In PROGRAM d O)J) t SER\J\Ct'' ' bedrooms, with the following stipulations: By: Original Certificate Date: ,5 ca LJ - The Mtcip yrage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 10!12112) Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SUN VALLEY; BLOCK 3, LOT 1 A. WELL DATA Parcel ID: 078-131-03 *525 GALLONS OF WATER STORAGE IN HOUSE. SEE ATTACHED PHOTOS. Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 7/19/1985 Sanitary seal (YIN) YES Total depth 55 ft Cased to 55 ft Well Log (Y/N) YES Wires properly protected (Y/N) Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 7/19/1985 7/23/2015 Static water level 25 ft. 18.5 ft Well production 5-6 g.p.m. *0.20 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.113 mg./L. Collected by: GEG. Ltd. Arsenic: ND ug /L Date of sample: 7/24/2015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size 1000 gal. *DOUBLE CLEANOUT PRIOR TO TANK SEPTIC/STEEL Number of Compartments 2 Date installed YES 12+ in. 9/17/2013 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (YIN) NO High water alarm (Y/N) Date of pumping 4/23/2015 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE N/A Date installed 7/15/1985 Soil rating (g.p.d./ftorTbdr� 125 System type BED Length 27-33 ft Width 20 ft Gravel below pipe 0.5 ft Total depth *7.58 ft. Elf. absorption area 620 ft2 Monitoring tube **YES Depression over field NO Date of adequacy test 7/23/2015 Results (Pass/Fail) PASS Fluid depth in absorption field before test 2.5 in. Water added 1000gal. Elapsed Time: 423 min. Final fluid depth 2 in Absorption rate >= For 3 bedrooms New depth ***9 in. 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date — 2" STANDING WATER IN DOUBLE C/O'S PRIOR TO START OF TEST (BELLY IN LINE?). **PER ELEVATION SHOTS, THE MT EXTENDS 6.5 INCHES BELOW THE INVERT OF THE LATERAL. ***2.5 INCHES ABOVE INVERT IN C/0 ADJACENT TO MT. D. LIFT STATION Date installed "Pump on" level at Datu Size in gallons Manhole/Access (Y/N in. "Pump off level - ' . High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Septic tankllift station on lot On adjacent lots Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent Tots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation * Water main N/A 100'+ Public sewer main N/A N/A Water service line 10'+ Surface water 100'+ Curtain drain Driveway, parking/vehicle storage 10'+ NONE KNOWN Wells on adjacent lots F. COMMENTS *FIELD APPEARS TO BE 6" AWAY FROM FOUNDATION (SEE ATTACHED WAIVER REQUEST) **MEASURED 108.38' FROM NORTHEAST CLEANOUT IN BED TO WELL ON TR—C2. EXACT LOCATION OF NORTHWEST CORNER OF BED IS UNKNOWN. IN SHORT, SEPARATION DISTANCE FROM DRAINFIELD TO WELL ON SUN VALLEY TRACT C2 IS UNKNOWN. G. ENGINEER'S CERTIFICATION 1 certify that t 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 JEFFREY A. GARNESS Date chat s - (Rev. 11105) II•Ti Je /_ V s pps E-,7954 -795 pr••Sit 6`S. UDeap'4( C�P O�O ��0000q�o Municipality of Anchorage P.O. Box 196650 •4700 Elmore Road Anchorage. Alaska 9951976659 • (907)343-7904 • Fax (907) 343-7997 httoalwww.mupLora/Onsite Develppment Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: osv1511Q6 COSA#: osc15i43S Permit#: PID#:078.131.0S Legal Description: Sun Valley B -S L.1 Engineer. Garnett.; .Entl fleerina,.Grou Applicant JInaTaylor Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the foundation has been approved. The approved separation distance is 0.5 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater dispogai system will require all separation distances be met or another approval from this department E The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. [] Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. I Adjacent properties are not affected by this waiver. • iiii■ .'iii'iysiiuiiiiii-ini*uun ii1r Fjssiliiii•'P i.j..I.-•firs, u Waiver is not Granted: Waiver is Date: -'v2 O - /` GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS August 13, 2015 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 Ref: Sun Valley; Block 3, Lot 1— Request for waiver for the purposes of obtaining a Certificate of Onsite Systems Approval (COSA) To whom it may concern: The referenced property is served by an onsite well and septic system. During a recent site visit for a well and septic adequacy test, it was observed that the drainfield is sitting approximately 6" from a foundation addition on the home. It should be noted that the top of the drainfield (bed type system) is approximately 6.75' deep at this location, and the foundation is a basic 48" deep foundation with a shallow crawlspace. In short, the drainfield would need to be severely surcharged before it would daylight in the crawl space of the home. Our justifications for a waiver are as follows: • Depth of the drainfield appears to be below footing • Shallow foundation/crawlspace • The encroachment has existed for several years • The drainfield passed an adequacy test At this time, we request that your department issue a waiver for a drainfield to foundation separation horizontal separation distance of 0'. If you have any questions, please contact myself or Rob Campbell at (907) 337-6179. 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com I NOTE: THE CONTRACTOR SHALL HAVE ALL WELL RADII FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION tT:,Is.11N :MO GALLON SEP ly/TANK TO BE /DESO,ISSIONED ^R UPC. EXISTING — — GARAGE" i EXISNNG DRAINFIELD -.,.,. (EXACT LAYOUT DRAINFIELD IS UNKNOWN) INSTALL DOUBLE C/O'S AFItrc TANK. PROPOSED 1000 GALLON SEPTIC TANK. INSTALL DOUBLE C/O'S PRIOR TO TANK IF A ECO IS NOT PRESENT. GARNESS ENGINEERING GROUP, Ltd. - .¢.anr_a-:7:».t CONSULTANTS & GENERAL CONTRACTORS TUB ROH). SUITE ICH • N4cHcRLE. /)( 99507 • PHONE (907)337 -MO • FM (907)336-324' WFESn& rw mawaAEI PREPARED FOR: I PHONE NUMBER: PAGE NUMBER: JEM TAYLOR 694-5600 1 OF LEGAL DESCRIPTION: SUN VALLEY; BLOCK 3, LOT 1 TYPE OF WORK: TANK DESIGN UPGRADE DRAWN BY: PNB 8/25/13 LeP1 4a, 7A-0.":-- ycZ 5r O �c ASBUILT b, 11 at. �A,% Sa knr eOf • TC I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE FOLLOWING -DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: EASEMENTS, COVENAA'TS; OR RESTRICTIONS S✓✓ Ea - WHICH DO NOT APPEAR ON THE RECORDED SUBDI VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FE' ANY DATA HEREON BE USED FOR CONSTRUCTION 740 7a OF FENCE LINES, OR FOR ESTABLISHING BOUND- — - ' — ARY LINES. OhAw'N: SCALE: f41'�si �� La oh .(-37s" SEWARD & ASSOCIATES LAND SURVEYING 694- DATE per. ., psk ; iH v 4. 1.° 131>iCIJYl1 SAvM39vNIb210 + ► • IN ■ ■ • • N N 1+ N N f+ N NO '1 OT O /1 0 0 Z Arocm,�c z �G5 .,o`..00000,.�.fp 3N r m VI r W r t.0 ( a' , d 0 O= oNNPJNNrr=�O i+00r i1•03N T-. c 0000000-•mOcs5. r aw'mNmra" dam a `X Ii I{gO W NOOOry O ¢0 CO, O T rQ000o W r. rt Re$a ,...- 9_ a p Tc—_?; - 0 ; aloyuetJ uisegyo;ea wseg yaaeD pauuoj puqg S30ON AVM39VNIVi10 0 O a. n' lauueto ueda payissel3 4ON payisselJ 40N - fl leguaaod - d pa4eu6!sapun - 0 ■ 0 m a. c O uogenie,r, aaeJapoW - uoiaenleA y61H - pII SONb'119N spuepaM VOW veN ` MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 J_22.Y Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1 Block 3 Sun Valley T34N R1W Sec. 33 Location (address or directions) Sun VallejL Rd. (b) Applicant Name Carl Disotell Telephone: Home 69/1-5797 E3usiness 694-5797 Applicant Address SR -918_5 Eag]_e River Ak 99577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder El ; Buyer C) ; Other ❑ (explain): (d) Lending Institution NL Telephone Address (e) Real Estate Company and Agent NIA Address Telephone (f) Mail the HAA to the following address: PI c]mp- by en 'i neer 2. TYPE OF RESIDENCE Single -Family n Multi -Family 0 Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well Lel 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 W Public 0 Community C1 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 (11/64) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date ra/3A-r EAuLETIIVErIWINS;Ate »6. ser✓,a., EAGI_ERLVER PIt 4r4b. P. 0. BOX 773294 fi94-bi9� 6. DHEP APPROVAL Approved for `71 -"P rd' bedroomsby Approved __ Disapproved Terms of Conditional Approval Telephone `.�,9.. °°aoo°ra aoa .'v .,, lCl °° CC? / 7 0°/2 ii Ol tu.:l 1 -^1 qa rig �t yc o] own'pt„.0 0. ° "/y° iac°°[-j[leer's Seal�Tr Louis A. hutera 8 bGI °00:(1000. CE -6736 o �' C 6)eDoe00,xow; °°\-f:r 9 ci.nol:5S10.0::�S3 x_21 -3--z-1) Date Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 (11/89) A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4726 Legal Description: �0f' / /y Li /c / c.v MUNICIPALITY OF ANCHORAGE . DEPT. OF HEALTH -& ENVIRONMENTAL PROTECTION UEC 0 31965 RECEIVED fel c., If A, B, C, D.E.C. Approved (Y/N) /2-1/41 Well Log Present (Y/N) Date Completed CR / 91r Yield Total Depth 5-5— Cased to SS - Static Water Level ;LS" � l �3`"" /5) Casing Height Above Ground / Electrical Wiring in Conduit (Y/N) c Separation Distances from Well: To Septic/Holding Tank on Lot /G A♦7 Depth of Grouting /1//4 .S- G,v; j^70... G.9 Pump Set At 1Cc757.. Sanitary Seal on Casing (Y/N) y Depression Around Wellhead (Y/N) ^/ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Aln- Cleanout/Manhole /Ven - ; On Adjoining Lots /0 (5 f • On Adjoining Lots '/00 To Nearest Public Sewer To Nearest Sewer Service Line on Lot car' Water Sample Collected by E=s cc &t. -i En'5 r, ; Date ' 1/ LIAs— Water Sample Test Results Comments Sufis{�}zr B. SEPTIC/HOLDING TANK DATA Date Installed 7/ J'/b-r Size /°C'" G -s/ No of Compartments Standpipes (Y/N) Y Air -tight Caps (Y/N) Depression over Tank (Y/N) Foundation Cleanout (Y/N) _/ /✓ Date Last Pumped 4/e`4-/ Pumping/Maintenance Contract on File (Y/N) 'v r Holding Tank High -Water Alarm (Y/N) y�i+ Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line '“/0 To Water Main/Service Line "-/o Course r/G ;for Temporary Holding Tank Permit (Y/N) To Building Foundation "3 2 To Disposal Field 5 / To Stream, Pond, Lake, or Majo Drainage Comments / Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /a s 41.26/e Type of System Design e --ea Date Installed TaA /,a -r Length of Field 33 Width of Field de' Depth of Field &' S � Gravel Bed Thickness �4 Square Feet of Absorption Area 6 (2-0 Standpipes Present (Y/N) Y Depression over Field (Y/N) ' - NO Date of Last Adequacy Test New Results of Last Adequacy Test "Vaud Cc..,, d ct,g Separation Distance from Absorption Field: To Water -Supply Well /os � To Property Line 7/O To Building Foundation To Existing or Abandoned System on Lot n/��- ; On Adjoining Lots 3� To Water Main/Service Line . }/ To Cutbank (if present) '"O To Stream/Pond/Lake/or Major Drainage Course ioo To Driveway, Parking Area, or Vehicle Storage Area /(2 Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed -- Date /$spis Company 7,572 ` S MOA No S'T — acr Receipt No Date of Payment2/3/5s' Amount: $ 6C) 3�YS Page 2 of 2 72-026 (11184)