HomeMy WebLinkAboutSUN VALLEY BLK 3 LT 4 Onsite File
Sun Valley
Block 3
Lot 4
#078 - 121 - 02
Municipality of Anchorage
Community Development Department Page 1 of 2
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181286 PID Number: 078-121-02 ❑ New El Upgrade
Name:
ROBERT & KATHERINE KOCH
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
3120 SUN VALLEY DRIVE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
SUN VALLEY 3 4
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
FC
Number of trenches
Dist. between trenches
Ft.
Well
100+
N/A
100+
N/A
(E)
TANK ❑ Septic 0 S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1250G,1.
Surface Water
100+
N/A
100+
N/A
Material
Number of compartments
Lot Line
5+
N/A
5+
N/A
NA
STEEL
2
Foundation
10+
N/A
10+
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
50+
N/A
50+
N/A
ORENCO
250 Gal.
Remarks **USED EXISITNG CIRCUITS AND WIRING
Pump on level at
TIMED in.
Pump off level at
TIMED in.
High water alarm at
45in.
Pump make and model
P2005
Electrical Inspections performed by
'*
Installer
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
JR'S SEPTIC SERVICES
Drainfield CO/MT 3034
Inspector Pannone Engineering Services
BENCHMARK (Assumed elevation) 1731.0ft
Inspection .1
dates: 9/5/18 2- 1 /28/19
3rd 4th
Location and description
EDGE OF DRIVEWAY PAD
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: Date
-��`'n
„ � of Ak,�
teven '�. Pannone'
CE 8149
A=-
Approved %62�f/`� Datekk
u WPCCIIUII NePorC_ I- I- 1[.00C
ABBREVIATIONS
TH
TEST HOLE
(P)
PROPOSED
(E)
EXISTING
CO
CLEAN OUT NO.
MT
MONITOR TUBE NO
TYP
TYPICAL
—w w — WATER LINE /
WELL RADIUS
— SS — SS — NEW SEPTIC
1250 g S.T.E.P.
TANK
WELL E
E NORTH SCALE : 1"= 50'
\ UV
�-- W
ALL MEASURMENTS
ARE f 1.0'
A B
Ti 39.7 38.3
LS 46.8 45.7
PROFILE
SCALE: NTS
NOTES:
PANNONE ENG SVC, LLC
P.O. BOX 1807 PALMER, AK 99645@'�.'•.^t
PHONE (907) 745-8200 FAX (907) 745-8201
F
z
�
o
0
8
zz
Q
w W
N
J J
U U
i
J
O.G. F.G.
F
1730.0
Sheet
2 OF 2
1250 g S.T.E.P.
TANK
WELL E
E NORTH SCALE : 1"= 50'
\ UV
�-- W
ALL MEASURMENTS
ARE f 1.0'
A B
Ti 39.7 38.3
LS 46.8 45.7
PROFILE
SCALE: NTS
NOTES:
PANNONE ENG SVC, LLC
P.O. BOX 1807 PALMER, AK 99645@'�.'•.^t
PHONE (907) 745-8200 FAX (907) 745-8201
�!-
.•
7 .
AD '
a en nrioRe'
CE 2 20
�'r�Ev:oB/23/2015'
Date
2/7/2019
RECORD DRAWING
Scale
1" = 50'
SUN VALLEY B3 L4
ROBERT & KATHERINE KOCH
3120 SUN VALLEY DRIVE
EAGLE RIVER, AK
P.I.D. NO
8-121-02
DRAWN ACP
PERMIT NO.
OSP181286
SITE PLAN
Sheet
2 OF 2
fNN
•,�moo MUNICIPALITY OF ANCHORAGE nr ^ S
• On-Site Water&Wastewater Program
.'s { , PO Box 196650 4700 Elmore Road •
v r
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
Jhttpa/www.muni.org/onsite -
I)cpartment
4hcNoaxot'
On-Site Wastewater Disposal System Permit
Permit Number: OSP181286 Effective Date: 8/29/2018
Work Type: SepticTank Upgrade Expiration Date: 8/29/2019
Tax Code Number: 07812102000
Site Legal Address: SUN VALLEY BLK 3 LT 4 G:0858
Site Mailing Address: 3120 SUN VALLEY DR, Eagle River
Owner: KOCH ROBERT H JR & KATHERINE C Lot Size in Sq Ft: 83741
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 2 Septic Tank 0 Holding Tank 0 Privy d Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
` - /�
Received By: ,leI.7l / i X X Date: t/
Issued By: }(A► yt,. C9 t- Q Date: $ 29
-cmgg9nc EPL11414-2
MUNICIPALITY OF ANCHORAGE
Community Development Department • _ / Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water&Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel 1.D. 078-121-02
Property owner(s) Robert & Katherine Koch Day phone
Mailing address P.O. Box 773444 Eagle River, AK 99577
Site address 3120 Sun Valley Drive Eagle River,AK
Legal description(Sub'd., Block& Lot) Sun Valley B3 L4
Legal description(Township, Range & Section)
Lot Size 83,741 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(0 all that apply)
Absorption Field ❑ Initial ❑ Single Family(SF) ❑X
(w/wo ADU)
Septic Tank ❑x Upgrade x❑
Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well •
❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
Dis tance:
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: .215" Waiver Fees:
Date of Payment: 2/2-11/8 Date of Payment:
Receipt Number: 0.0 1(1�Ot(� Receipt Number:
Permit No. 05P1 S `�D Waiver No.
Permit App :• :....:c:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181286, Rebecca Carroll, 08/29/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181286, Rebecca Carroll, 08/29/18
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTr-'CTION
ENVIRONIVIEN'I'AL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
PHONE L []NEW
E~ UPGRADE
DISTANCE TO:
Mal~ufacturer
DISTANCE TO:
LOCATION
Well/r~ /~L. A b s o r p t i ~.~,~e a//~.~--~, Dwelli~.~ ./
Well ~Dwellin9 Material
DISTANCE TO: Well of~l/~ Foundation
No. of lines Length Total length of lines
of tile to finish 9rade ~ I Material beneath tile
Length
Type of crib
Well
DISTANCE TO:
lepth
DISTANCE TO: Building foundation
Nearest lot line
Trench width
inches
Crib d h~2.~__.~
Driller
Sewer line
No, of compar~_nts
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
Distance between lines
Total effective absorption area
PERMIT N~ .4
Distance to lot line
Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING
7~781
DATE
Permit
Applicant:
MUNICIPALITY OF ANCHORAGE
Department f Health and Environmenta ?rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
phone Nu er:
Location:
Size:
/
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: ~ . Holding Tank:
Maximum Number of Bedrooms: . %_~_ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH ~--- LENGTH/~,k'.-~(L . GRAVEL DEPTH ~" WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = ~-~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) [NSPECTION$ 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 8 3 * * *
I certify that:
(1) I ~n 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 b~dr/~ms.
Applicant TM Date: /~/ /O~b~
SWP/024(1/81)
SOILS LOG
MLINIClPAI..ITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION ']'ESl'
PERCOLATION
TEST
( DA'rE PERFORMED:
¢'~ S LO P/P~ SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YL--S, AT WHAT
DEPTH?
// Depth to
Or ss Net Net
- Time Water Drop
1
2
3
4
5
6
7
8
9
10
11
12
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
PERFORMED BY:
~H. 694'.2070
72-008 (6/79}
%o
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT O~ NATURAL RESOURES '.
Division of Geologicol E~ Geophysicol Surveys
Orlllfng Permit Ho.
LOCATION OF WELl. (Pieole complole either la, lb or lc.) A.D.L. No.
DISTANCE FROM ROAD 3. OWFJER OF WELL; ·
DIREcTI(~N
INTERSECTIoNs
AND
2. WELL LOG Feel BelOw ~. WELL.~EPTH: [flnol) 5. DATE OF
~olerlol Type Top Dollom _
- Type: Dlomeler:_
Slot/Mesh 81~e: Length:
- Sol bllweon ft. ond fl.
... Dock flllihg Grovel pock
..... lO. STATIC WATEa LEVEL: f~.
' ' D Above Or ~ ~elow lend sur~ece Dora
" '" Equipment utld:
~ II. PUMPING LEVEL below Ion~ lurfoce end YIELD
. ~ft. Drier ~h~l, pumplng.
_ .. ~ft' oiler hrs. pumplng, , , g.p.m.
, '- 12.GROUTING Vl~ll Otoul~d~ ~ Yo~ ~ ~o
Molerlat: ~ Nool Comen~ ~ Ofher:
13. PU~P~ (if ovolloble}
Llpglh of Drop Pipe __fl. copocily ~.p.m.
· 16. WATER WE~L CONTRACTOR'S CERTIFICATION: ,.
~tS, Wolot T~mpefulure o ~ F ~ C
Thlt well wOs drilled unOee m~ Jutltdlollon ond Ihlt ~epoH I~ Itue Io Ihe betl of my knowledge o~d boiler;
';"':'~t:~ ~.~ :,, i.. ].it ~ A.:,
Registered Business Nome Conlrocl License
ro~m OZ-WWR [11/81} Copy DlstHDulion: WHITE-~Iole DOGS~ PI~IK-DtlIIote CANARY-Call,mit
WATER WELL RECORD
STATE OF ALASKA
*DEPARTMENT O~ NATURAL RESOURES
Division of Geologico[ ~, Geophysicol Surveys
LOCATION OF WELL
I~.-. ] DIS TA NC E
Fill
Grave.l , da:ap soil
C:ravr,~l, clay, si!b, cobble 23
Cr~.val, sandt silty water
(L~',,e!, c!~J7 ].20
~;ou] d~r 130
L:ravol, ~ilt~ watar
16, WATER WELL CONTRACTOR'S CERTIFICATION:
0 4
4 3
12o
130
$. [~ Ooblo 1001 [~olory [[]Drive. L~Dug
~ Aug~r [~dot'e~ ~] Rored
CASING: ~p;T~J d~d [] W~ld.d
diem. 6 ,. ,..~'Lz___~_ft. o.plh Welghl. 7 lbs./It.
ft,
I0. STATIC WATER LEVEL:
~ Above o~ [] ~elow Iond surl~ce Dole
Equipment used:
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
Application Date //~///'-.-~/~ ~'
GENERAL INFORMATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~'¢'~ ~,¢'~ _ Telephone: Horr~_ ~'~2~4 ~-~"~ ¢ Business"~'~¢-&'-~--~--~
Applicant Address ~2 ¢,==,~9 ~~ ~? d'l~' ,,
{c) Applicant is (check one): Lending Institution []; Owner/builder,~; Buyer []; Other [] (explain);
(d) Lending Institution ,¢f~'"-~'~fC4cJ ~Z ~..~__~_~3-',-.~ Telephone
Address ~?~.¢"L¢~,~.,~ ~/~~.,-~._,
(e) Real Estate Company and Agent .~ ~
Address
(f) "t',.r/~th(~ HAA to the follow, lng address:
TYPE OF RFSIDENCE
Single-Family~¢' Multi-FamilL,.~
Number of Bedrooms
Other
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.
SEWAGE DISPOSAL
Onsite ~ Public [] Community [] Holding Tank []
Note: If corn reunify 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 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, [)ATA 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 & $ ENGINEERING
SRB 196X
Address
Date
EAGLE RIVER, AK 99577
Telephone _
DHEP APPR O~.~~ ~
Approved for _.~]~4/~ ,~)edrooms by
\ cAUi'IION
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 requi[ements. 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 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Lega Descrienon:
DEPT. OF HEALTH ,s
ENVIRONMENTAl. PROTECtiON
? 1980!
RECEIVFD
WELL DATA
Well Classification
Well Log Present ~.¢/N)
Total Depth ~/~ZJ Cased to '-/O ~'¥'
Static Water Level
Casing Height AlCove Ground /~J~ ''/'
Electrical Wiring in Conduit
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lol
To Nearest Public Sewer Line
-"~' J;~ f A. B, C. D.E.C. Approved (Y/N) __
. Date Completed ~ '~ /~ ~~"~ Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing ~N)
Depression Around Wellhead (Y/~
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
Cleanout/Manhole ,/v,//:j To Nearest Sewer Service Line on Lot
-.
Water Sample Collected by ~=,~-~' ~'",~' ~/~¢--~'/~'¢-' ; Date __ /
Water Sam. p.l,e Test Results _. ,,~,,~ 7"/~"~,'¢~,,,'~' ¢¢
B. SEPTIC/HOLDING TANK DATA
Date Installed ./O -,75'-¢,.~
Standpipes CN) -
Depression over Tank (Y~,~
Pumping/Maintenance Contract on File (Y/N)
Holding 'rank High-Water Alarm [Y/N) ~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well _ { (2¢ ¢-~
To Property Line ~..o/W-
To Water Main/Service Line _ ~r) ~'-t'
Course /~O "'J'
Size ~'OCD No. of Compartments
Air-tight Caps ~/N) _ Foundation Cleanout
Date Last Pumpea ~/
;for "'-'-~
Temporary Holding Tank Perr¢ t tY/NI
To Building :oundation
To D seosal Field
To Stream, Pond, Lake. or Major Drainage
Comments
Page 1 of 2
72-02601/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /~ ~ ~-~ . of System Design
Date Installed /~ -z¢'-,¢ /Length of Field
/¢" / Depth of Field-
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/~
Gravel Bed Thickness
Standpipes Present~/N)
Date of Last Adequacy Test
~f
f
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well / ..5'~) ! ~
To Building Foundation ~
Lot /k~¢/"¢1
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line /~::2 /.4-
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
/ OO
Comments
D. LIFT STATION
Size in Gallons 75"~/f~- /~E r~-? o,.,~ Manhole/Access
"Pump On" Level at ,~ .;'Pump Off" Level at
High Water Alarm Level at /'40/.JL~ 2'"/z4,¢~ /~$ ~'ac.,b~ent (y/~
Tested for /~b~ ¢¢~,~ ~%~ ~-~ f-4 (~ ~w~.g3 Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked verified, or conformed to allMOAMO and HAA guidelines in effect on the date of this inspection.
$ & $ ENGINEEI ING _.
Signed Male ,,- .-
CompaqLEAE-~:~,i~]~gi(~7,7 MOA No.
Receipt No. ¢'~'¢<¢? 4~¢ / ~
Date of Payment /~//~1//
Amount: $ ~_~"~,
Page 2 of 2
72-026 (11/84)
MUNICIPALITY OF ANCHORAGE
DI--PARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CEBTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SiTE SEWER AND WATER FACILITY
264-4720
Application [)ate
GENERAL INFORMATION
(a)
(b)
(c)
Legal Description (include lot, block, subdivision section, township, range)
Location laddress or direcfionsl ~
Applicant Name ~~ ~ Telephone: Home ~~ Business
Applicant AddresJ ~ ~ ~ ~ //~ ~ ~J ~ P ~
Applicant is (check one): Lending Institution ~; Owner/builder~ Buyer D; Other ~ (explain);
(d) Lending I~stitution
Address
Telephone
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of BeOrooms ~
Other
WATER SUPPLY
Individual WellX Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~ 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 {1u84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, [)ATA 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 ol structure indicated herein. I further verify that based on tile 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, ordiaances, and regulations in effect on
the date of this inspection.
Name of Firm
5 & ~5 Engineering
Address SRP~ 196x
Date Eagle River, Alaska 995T/
Telephone
DHEPAPPROVAL ~*~ ~ ,/~ ,'
Approved ,~/', DisapproveU Conditional 'J
Terms of ConditioVnal Approval
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 Slate 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 requirernents. 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
DEPT. OF HEAL'I'H &
I~NVIRONMENT^L PROTECTION
WEI. L DATA
MUNICIPALITY OF ANCHORAGE (MO~,)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
RECEIVED
· ega, Des°rip.o.:
Well Classification "~t¢,,~ ~f'~."r~ If A. B, C. D,E.C. Approved (Y/N)
Well Log Present~/,N~ Date Completed _ ~' I~'~''~ Yield
Cased to f'~ ~ ~'
Total Depth _ l"~
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on ~ot
To Nearest Public Sewer Line
Depth of Grouting
Pump Set At
Sanitary Seal on Casing
Depression Around Wellhead
On Adjoining _ets
; On Adjoining Lots
To Nearest Public Sewer
Cleanout/Manhole '-- To Nearest Sewer Service Line on LOt
Water Sample' Collected by '~ ~ ~-~"4~.1 ~4 .~...rc~fc,,J ~ ; Date /"¢/~ Z~ -' ~ ~.'
Water Sample Test Results ~,'r'{...%
Comments
B. SEPTIC/HOLDING TANK DATA
To Water-Supply Well
To Property Line
To Water'Ma+cf/Service Line
Course
Date Installed lO .-I'",~,"~
Standpipes ,~1~. Air-tight Gaps
Depression over Tank.,¢¢~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (YIN) ~/~
Separation Distances from Septic/Holding Tank:
Size [f~::~("~ No. of Comoartments _
Foundation Cleanout ~,N~
Date Last Pumoed
; for
Temporary Holding Tank Permit (Y/N)
. To Building Fotmdation
To Disposal Field
To Stream. Pond, LaKe, or Major Drainage
Comments
Page 1 of 2
72~026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /~~ /~' ~:~
Width of Field /(¢l
To Water-Supply Well
To Building Foundation
Lot
To Water M=iWService Line
Square Feet of Absorption Area
Depression over FieldZ, Y(¢~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Stream/Pond/Lake/or Maior Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Depth of Field
Gravel Bed Thickness
~'7~''~ Standpipes Present
Date of Last Adequacy Test
Type of System Design '~,"~
Length of Field ~-'-~' ~
¥,
/'
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
D. LIFT STATION
Date Installed ~ O- t't~ ~(!~:;~ '~ Dimensions
Size in Gallons ~'~-~,~i// ~/0c1~.¢'_3/~',l~',¢ ¢~ Manhole/Access~
/ f /
"Pump On" Level at ~ ¢~
"Pump Off" Level
High Water Alarm L~vel at ~ Vent (Y~
Tested for ~ ~-- ¢ ~ ~-~¢ ~¢~Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N) _ ~ ~"~¢~'~ '~
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed
Company
Receipt No.
Date of Payment
Amount: $
Date ¢/~/~
MOA No.
Page 2 of 2
72-026 {11/84)
APPLIC NT FILLS OUT UPPER HAl. ONLY
Buyer ~ '
Address Zip Code
Phone
I/ /'/U.. ~ +( '
Address )~'!~ ~( ) /~.' /:,~' ~ )
Realty Co. & Agent
Address
Zip Code
Zip Code
Phone
/
Type of Residence
~ Single Family
Multiple Family No. of Bedroom-s · ~)
[] Other
Water Supply
'~,lndividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
[] Community For wells drifted prior to lhat date, give well depth (attach log if available).
[] Public Utility
Sewer Disposal , .
~c/Individual Year Individual Installed:
ublic Ulillty When Connected to Public Utility:
[] Holding Tank
Time
Date
Inspector
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQ(JEST BEFORE PAOCESSING CAN BE INITIATED.
Time
Date
Date
Inspector
Date
Inspector
Field Notes:
~*~PPROVED BEDROOMS
D SAPPROVED
CONDITIONAL. APPROVAL'
I "~ O ] Well Log Received /'"-'"~
I Septic Tank Size / ~ O O
Date Sewer Installed Well TO Ahsorptlon Area
( 0 ~(~ WelltoTank I ~'~
ADEQUACY TEST
WATER AND SEWER INSPECT[ON
WELL INSPECTIONS AND
FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
ON SITE WASTE WATER
DISPOSAL SYSTEM DESIGN
EXCAVATION WORK
ROBERTA, SHAFER
January 9, 1984
CIVIL ENGINEER
694-2979
Art Allen
9420 Highland Road
Eagle River, Alaska
99577
Reference: Lot 4: Block 3: Sun Valley subdivision
A well and sewer inspection was performed on the system located
on the referenced property, as you requested. All the clean outs
for the septic system were visible and equipped with adequate
seals. The well was equipped with an adequate sanitary seal and
the well. wires were in conduit. The ground around the well
casing was adequately sloped away from the well.
At the time of this inspection a water sample was taken and
submitted to Chemical and Geological Laboratories of Alaska for
coliform bacteria analysis. The results of this 'test were satisfactory.
If we may be of further service, please do not hesitate to contact
us.
Sin .y
cc: Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA 99577
4P Aiv
MUNICIPALITY OF ANCHORAGE Rus/Ai
Development Services Department \ '; Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 078-121-02 Expiration Date: 9 — 11-1
1. GENERAL INFORMATION
Complete legal description Sun Valley Block 3 Lot 4
Location (site address) 3120 Sun Valley Drive
Current property owner(s) Robert & Katherine Koch Day phone
Mailing address PO Box 773444 Eagle River, AK 99577
Real estate agent Day phone
2. TYPE OF DWELLING:
x Single Family (w/wo ADU)
Duplex
n Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well [ Private Septic
Water Storage ❑ Holding Tank
Community Well [ Community ❑
Public Water System U Public Sewer ❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ ',O Waiver Fee $
Date of Payment s/as7/i9 Date of Payment
Receipt Number 03011'8'C7 Receipt Number
COSA# 0 6001 1l V 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.
Name of Firm Pannone Engineering Services Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E. Date
6. DSD SIGNATURE * 49 Ili ',Ps..
It
• 1•
--,�� System #1 Approved for bedrooms $} •
evert -anriope
System #2 Approved for bedrooms i .. CE 8149
Disapproved .'''A
Conditional approval for bedrooms, with the following stipulations:
#,>9 pJ,_1T Y rQ�,1/4iir
vv
14/AST FR'�INp 0
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re-no
o P
SAM O
i JSERV)C',�s}�N,
By:� `� � , Original Certificate Date: —y
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
COSA Checklist
Legal Description: Sun Valley B3 L4 Parcel ID: 078-121-02
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system 1
A. WELL DATA
0 Well log is filed with Onsite (or attached) Well production at time of test 5.95 gpm
Date drilled 1983 Water storage tank volume n/a gallons
Total depth 136 ft Well disinfected for coliform test? ❑Yes ❑✓ No
Cased to 132 ft 0 Coliform bacteria is Negative
0 Sanitary seal is functioning correctly Nitrate 0.440 mg/L ❑ Nitrate less than MRL (ND)
0 Wires are properly protected Arsenic ND ug/L ❑Arsenic less than MRL(ND)
Casing height(above ground) 18,, in. Collected by Garness Engineering Group, Ltd
Date of flow test for COSA 5/9/19 Date of Sample 05/07/19
Static water level at beginning of test 17.2 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) <1 years 0 Required maintenance completed
Tank type/material 5 `s` Age of lift station <1 years
Measured operating fluid level in septic tank 48" Lift station material Steel
■❑ Standpipes/foundation cleanout per record drawing Comments:
Date of pumping n/a
D. ABSORPTION FIELD DATA Bed
Which system tested (date installed) '0/15/83 Adequacy test date 7/3/18
0 ALL standpipes present per record drawing Results Pass For 3 bedrooms
Total measured depth from grade 4 ft(max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade ft(min) Water added 450 gal
0 N/A—pressurized field New depth 0 in
0 Monitor tubes go to bottom of effective. If not, state Elapsed time 240 min
depth into effective
❑■ Code-required soil cover over field Final fluid depth 0 in
Absorption rate <450 gpd
❑ System presoaked
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) n/a
date of test) If yes, enter date nla
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
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' Community Sewer Manhole/Cleanout> 100'
❑✓ Yes if No ft El Yes if No ft
Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line >25' 10 Yes if No ft
Absorption Field on Lot> 100' 0 Yes if No ft Holding Tank> 100' 0 Yes if No ft
Neighboring Absorption Fields> 100' Animal Containment> 50' 0 Yes if No ft
0 Yes if No ft
Manure/Animal Excreta Storage> 100'
Community Sewer Main> 75' 0 Yes if No ft 0 Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations> 10' 0 Yes if No ft Surface Water> 100' 0 Yes if No ft
Property Line> 5' 0 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0 Yes if No ft Private Wells> 100' 0 Yes if No ft
Water Main> 10' 0 Yes if No ft Community Wells >200' 0 Yes if No ft
Water Service Line > 10' 0 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' 0 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' ✓C1, Yes if No ft Private Wells> 100' ❑✓ Yes if No ft
Water Service Line> 10' 0 Yes if No ft Community Wells> 200' 12 Yes if No ft
Surface Water> 100' 0 Yes if No ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that t have determined through field inspections and review . 1
of Municipal records that the above systems are in conformance with *149 7H I\ %.*
MOA COSA guidelines in effect on this date. 05/23/19 ,A.4..
"$leveeannome
CE 8149 .;
COSA Checklist yellow sheet `�Rl '