HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 4 LT 6Onsite File
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MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
(Nev uoiuu 1 u)
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP201189
PID Number: 050-721-05
Dwelling: X Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade
Name
Allen Jedlicki
ABSORPTION FIELD
❑ Deep Trench ®❑ Wide Trench ❑Bed El Mound
Site Address
21230 Running Brook Cir.
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
1.2 GPD/SF
7.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
5 Ft.
Gravel depth beneath pipe
2.5 Fl.
Subdivision
Block Lot
River View Est
4 6
Fill added above original grade
0 Ft.
Gravel length
48 Ft.
Township Range Section
Gravel width
5.0 Ft.
Beds: Number of Lines
n/a
Distance between lines
n/a Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
375 F0
1
n/a Ft.
Well
100'+
100'+
i
25'+
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1250 Gal.
Surface Water
100'+
100'+
Material
Number of compartments
Lot Line
5'+
10'+
NA
HDPE
2
Foundation
10'+
10'+
I
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
Installer
Deans Construction
Dralnrield 3034 CO/MT3034
Inspector Pannone Engineering
BENCH MARK (Assumed elevation) 793.0 ft
Inspdection X51 7/23/20
7/24/20
Location and description
3'd 7/24/20
2�d
4"' 8/6/20 1
SE Bottom House Trim
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
A� k�
Conditional Approval:
Date
OF
q
If
C�
Steven R. Pannone
Septic Syste �
��� . CE 81 49
Appr e
I
Date -(7,092,)
Note: this approval does not include well permit requirements.
(Nev uoiuu 1 u)
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NOTES: PANNONE EMG SVC LLC (C.l. 1088) """` r, REVISIONS DATE
RECORD DRAWING PHONPO. BOX
X71807 0 UFAX,( K 9615 8201 _ ��?J S08 E10/2020
60'
RIVER VIEW EST B4 L6 P.I.D. NO
DRAWN ACP ALLEN JEDLICKI " - — 050-721-05
;' c; sro�eCE-8149 nono , �5 PERMIT NO.
SITE PLAN 21230 RUNNING BROOK CIR %s. .- OSP201189
EAGLE RIVER, AK 99577n;0�, SHEET
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\ 7
LOT 7 '9
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Legere General Notes
L'�"-,I Electric Meter
LTA Tel. Pedestal
/_FA Elec. Pedestal
rk,)SStorm Brain
W; Water Well
;,'S) Septic
Gas Meter
® Deck
O Concrete Bollard
1.
2.
3.
4.
Lot 6, Block 4
1t
E ,�F..AL IIII
Disclaimer _=_ P� ' J j -is 11
This document is created for the purpose of a single property transaction - This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible r /�!�
and is subject to Federal Copyright Laws. improvements and conditions at the time of the survey, This document does not constitute a boundary 4 H
&� H
Excepting for gross negligence, the liability for this Survey,Shall not exceed
survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the
responsibility of the Owner to determine the existence of any easements, covenants, or restriction f rj �r_�..
the cost Of preparing this survey, which do no appear on the record plat. Under no circumstances should this document be used for • • • • • • • • • • • • • • • . •1! • • ......... ,.
All measurements/setbacks are to the visual/apparent building footprint. construction or for establishing a boundary or fence line. ¢3 Pierr_ M. Strasler c
��
All dimensions to property lines are plus/minus 0.1 ft: G, N�. LS -9812 •P0 15 30 60 �j �r� 08/05/2020 J�
C5
Seale in Feet r ��O ESSIONA �O
lilt R F 4 `�
p
AN AS -BUILT SURVEY OF
LOT 6, BLOCK 4
RIVER VIEW ESTATES SUBDIVISION
21230 RUNNING BROOK CIRCLE
CONTAINING: 47,813 S.F.
RECORD PLAT: 75-131
PREPARED BY. FRONTIER
FRONTIER SURVEYS, LLC It
650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518"•.
907-460.1686
DRAWN BY: NB DATE: 8/03/2020 pRAWING ID: 20-346
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201189
Work Type: Septic Upgrade
Tax Code Number: 05072105000
Site Legal Address: RIVER VIEW ESTATES BLK 4 LT 6 G:0357
Site Mailing Address: 21230 RUNNING BROOK CIR, Eagle River
Owner: JEDLICKI ALLEN E
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft
Total Bedrooms:
trent
°- s�
'r V
Dcpartment
7/7/2020
7/7/2021
47813
Q Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
3
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
j' Special Provisions:
j' 01�—The Engineer is to do a test hole prior to the construction of the septic field. Construction may proceed at your
own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As -
built Inspection Report. If the results require a design change, construction of the system will stop pending On -
Site review and approval.
\ The test hole shall be deep enough to demonstrate separation between bottom of existing drainfield and
groundwater. Otherwise, the existing drainfield shall be abandoned.
CDS` 1 1�es�yn G�unoC_ dtAe-ro nc,,j
Received By:
�tidG�J��
Issued By:
Date: r/
Date:
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
I.
Parcel I.D. 050-721-05
Property owner(s) Allen Jedlicki
Mailing address 21230 Running Brook Circle
Day phone
Site address Same
Legal description (Sub'd., Block & Lot) River View Est B4 L6
Legal description (Township, Range & Section)
Lot Size 47,813 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑X Initial ❑
Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑x Upgrade
Duplex (D) El
Holding Tank ❑ Renewal❑
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 55b Waiver
Waiver Fees:
Date of Payment: (0[ a2� Date of Payment:
Receipt Number: Receipt Number:
Permit No. L Aj r� �q Waiver No.
COVID-19
Permit App__• 9-59x' DISCOUNT APPLIED
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201189, Rebecca Carroll, 07/07/20
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NOTES: PANNONE ENG SVC, LLC (C.O. 1088) ".......REVISION S DATE
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, A 99510 7/21/2020
PHONE (907) 272-8218 FAX (907) 272-8211
SCALE
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RIVER VIEW EST B4 L6th
P.I.D. NO
DRAWN ACP ALLEN JEDLICKI'.•Steven R. Pannone -. 050-721-05
c .• cE-9149 PERMIT NO.
21230 RUNNING BROOK CIR 4,�� •.,- OSP201189
SOIL LOG EAGLE RIVER, AK 99577 SHEET
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NOTES: PANNONE ENG SVC, LLC (C.O. 1088) ".......REVISION S DATE
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, A 99510 7/21/2020
PHONE (907) 272-8218 FAX (907) 272-8211
SCALE
IL
NTS
RIVER VIEW EST B4 L6th
P.I.D. NO
DRAWN ACP ALLEN JEDLICKI'.•Steven R. Pannone -. 050-721-05
c .• cE-9149 PERMIT NO.
21230 RUNNING BROOK CIR 4,�� •.,- OSP201189
SOIL LOG EAGLE RIVER, AK 99577 SHEET
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NOTES: PANNONE ENG SVC, LLC (C.O. 1088) ".......REVISION S DATE
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, A 99510 7/21/2020
PHONE (907) 272-8218 FAX (907) 272-8211
SCALE
IL
NTS
RIVER VIEW EST B4 L6th
P.I.D. NO
DRAWN ACP ALLEN JEDLICKI'.•Steven R. Pannone -. 050-721-05
c .• cE-9149 PERMIT NO.
21230 RUNNING BROOK CIR 4,�� •.,- OSP201189
SOIL LOG EAGLE RIVER, AK 99577 SHEET
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NOTES: PANNONE ENG SVC, LLC (C.O. 1088) ".......REVISION S DATE
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, A 99510 7/21/2020
PHONE (907) 272-8218 FAX (907) 272-8211
SCALE
IL
NTS
RIVER VIEW EST B4 L6th
P.I.D. NO
DRAWN ACP ALLEN JEDLICKI'.•Steven R. Pannone -. 050-721-05
c .• cE-9149 PERMIT NO.
21230 RUNNING BROOK CIR 4,�� •.,- OSP201189
SOIL LOG EAGLE RIVER, AK 99577 SHEET
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P.RP�PdOfdE ENG SVC LLC (C.i. 1088) E
FOR CONSTRUCTION P.O. BOX 1807 PA! PER, AK 39645 /16/2020
PHONE (907) 745-8200 FAX (907) 745-8201 __��?• '' SF9'4, REV 1: 6/30/2020 EE
= REV 2: 7/2/2020 1" = 60'
RIVER VIEW EST B4 L6 EV 3: 7/21/2020 F -LD. NO
DRAWN ACP ALLEN JEDLICKI ..... 050-721 -05
c• sto CE -8749 nonePERMIT N0.
21230 RUNNING BROOK CIR '%s, �= OSP201189
SITE PLAN EAGLE RIVER, AK 99577°
r, A�•r t�:� SHEET
,. 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL
PROTECTION
ENVIRONMENTAL ENGINEERING
DIVISION
825 L Street - Anchorage, Alaska 99501
Telephone 264.4720
\ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
;KNEW
t10 n_` �('Ld in Aj,
, ��1�
❑ UPGRADE
MAI,LI_NG ADDRE S
4299k d5l S/qAJ A
-
LEGAL DESCRIPTION
,,,,` am-
,C.., � I e , 6c.�
LOCATION
LOCATION
NO. OF BEDROOMS
U
DISTANCE TO:.
Well 1
/��c l` t, ,
Absorption ar a
_
Dwelling
.��,
PERMIT N
- xJ � •C/
y
wG
Manufact re
Mater _
No. of compartments
Liq. cyaapaci y in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
Well
Dwelling
PERMIT NO.
C1 Z
DISTANCE TO:
iManufacturer
Material
Liquid capacity in gallons
p
w 2
DISTANCE TO:
Well n
Foundations n
Nearest lot line
PERMIT NO.
u. Z
zw
No. of lines
Length of each i e
-�
Total len th o dines
j
Trench width
inches
Distance between lines
a—a
h
Top of Tile to finish grade
Material beneath Tile
Total effective absorption area
0
L
7 inches'
Length
Width
Depth
PERMIT NO.
w
tg
Q H
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
wa
Lu
Well
Building foundation
Nearest lot line
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT NO.
r
ea
w
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
OTHER
PIPE MAT RIALS
C'Q Igo-)
SOI L TEST RATING
C!
�r
n
INSTALLER
//
REMARKS
.f✓
If
APP,KOIJED ,r /fLEGAL
)DATE
-2 2 1.45
ilDN
11007KAK YQUA
;? "?
MY RITOWHAD STAT Op THE WAL AMADISTA011 "A (t 1:5 :
wounlo"A OR— A Wpm K. , F� SO GO I - R.J;W. : A 12Y 1 A WR A 1 V PT 1. Q 12 oil V 1-1
!I ORC, 10 AS 0, x 14H ST 1=0 45V 47 Y X PIT VQ!:�---7 to: TH ITT k .0 1 lot VO V A
NG R7 ANY SIXTEM WITARD F 11 MAL. 1 BY
NVIDAYMPAT 1411j. BE WJ1 Jk�C-.*-1 11:) ODI' -d -
MINIMUM D1501FRACT BF114751`1 H PUT AND 11,1 4, IAWjjjw Qj,thf% DISPRON, S"NOT
ft I i 1,11:::11 ]:.-. Mr -t -L.; Cl I -!
Tk) !?00 FER FROM A FUMIC PUT DEFIEWIMS UUMN JjHn MV OF F313FATC KAFIV
CifflFt-l! MAY MORY SPECAFMATTIMS f=11 II DIFAIRAMS ARF'
f:Vy'f:! T 1 1 * 1. 1 :( JR[--: 1 k! 1::i F, I. --, [:: i,..[!: �; I 1'-[ 1 - 1 - Fj 1- ]: C1 11.
i! :" : II 1: ; 11 a1. - "�- �:: P : a - .-!! !,- ��-° iC.11-:. T"! by, 1,.1: to - !� � 11I.— :4 'IN 0--..
CONSULTING GEOLOGIST
SOX 476-M, STAR ROUTE A o ANCHORAGE, ALASKA 99507 • PHONE 344-7071
SOILS LOG
Performed for 6f r(L ` C WUC OTT Date J A (O h
Location gO1 N(Q �Yow )Jv,, SE c_. ,-�t��l�lk 4
v t P sus--- a I V i S tar
0
2
4
6
a 8
w
a
3.0
•rl
41 12
a,
v
Q 14
16
20
Soil Type Water. Level
Remarks
Total Depth of Excavation I A Material at Total Depth
Groundwater
a, -I --Not Reached
Depth, if Reached
Classification Method
L('�'Visual
( ) Sieve Analysis
Bedrock
i
Not Reached
Depth, if Reached
Gary T. Player, Consulting Geologist
G(0.0e
Total Depth of Excavation I A Material at Total Depth
Groundwater
a, -I --Not Reached
Depth, if Reached
Classification Method
L('�'Visual
( ) Sieve Analysis
Bedrock
i
Not Reached
Depth, if Reached
Gary T. Player, Consulting Geologist
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920406
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:MILLER BRUCE L &
OWNER ADDRESS:13140 MIDORI DR.
ANCHORAGE, AIC 99516
PARCEL ID:05072105
LEGAL DESCRIPTION: RIVER VIEW ESTATES BLK 4 LT 6
LOT SIZE: 4781.3 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
DATE ISSUED:12/09/92
EXPIRATION DATE:12/09/93
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
PROVIDE WRITTEN CONFIRMATION
BEEN PROPERLY ABANDONED.
RECEIVED BY:
ISSUED BY:
T THE EXISTING WELL HAS
DATE:
DATE
L 5P NIS
01x9 3 1 V 0 S ON 1VId
o�r�s
1AA _A
�j X13018 9 10-1
NOIldIHOS30 IV93"1
6L6Z-t,69 X106)
L1966MISVIV'd3AId315V3
�uGiVa0ad ad0u0i1�d3uAI�d r31E�)V3 b�£OL 4� 'lift
o4op pJooaJ ago saouoIslp pun s6ulJnaq puo `p84o01pu1
8sIMja44o ssalun wn4op pownsso uo pasoq suol4ona13
;old uolslnipgns papiooaj a44 uo joaddo
4ou OP4314M su0143lJ4saJ JO's4uouanoo 's4uawasoa
Auo;o a3u04slxa 044 aulwJa4ap 04 puo'suo14oauuoa
sa14ll!4n puo 0poA4slui; 04 OA14010J apoJ6 bulpllnq
posodoad F;lean 04 'uo!ioni4suoo o4 joljd 'japlinq jo
JauMo 844 ;o A411lglsuodsai 044 sl 41 -4uallo dq papinoid
sl 0awasoa;0 uo14dijosop ssalun uMo4s 4ou aJo 4n1d
uoisinipgns pjooai uo.6ulioaddo4ou 24uawas03 : S3ION
Ctrs - s1 •., �,
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1�
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTI
DATE - Started —
PERMIT NUMBER
te
w.kntiftrb DrittingSaar
by
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 * TELEPHONE 694-2588
Ended
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From
Ft. to
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MISCL. INFORMATION:
DRILLER'S NAME
���Z C; 1 W 10 R. . 1 'T ",-u ." I, - -jJ �II-A U�: :g 11:1::l p IE"ll�
DEP8RTMENT OF HEHLTH HND ENVIRONMENTAL PROTECTION
STREET/ HNCHORHGE, HK9950i
� 264~4720
yr-,UA::l[
PERMlT NO. ( 771018 )
�PPLlCHNT FRONTIER REHL ESTHTE BX1161 E�R� 694~91]8
�OCHTION
.EGHL RIVERVIEW S/D LOT SIZE 0 SQUHRE FEET
IINIMUM DISTHNCE BETWEEN H WELL HND HNY ON~SITE SEWHGE DlSPOSHL SYSTEM IS
100 FEET FUR H FIR IVHTE WELL UR 200 FEET FOR H PUBLIC WELL
� 1ELL LOGS HRE HND MI TO THE DEPHRTMENT WITH�N ]0 DHYS
OF THE WELL C:OMPLETION.
JTHER REQUIREMENTS MHY �PPLYSPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE
HVHILHBLE TO INSURE PROPET INSTHLLHTION.
11NOMINVI 1 Y' '.1 ����
I CERTIFY THHT
1� I HM FHMlLIHR WITH THE REQUlREMENTS FOR ONPSlTE SEWERS HND WELLS AS SET
FORTH BY THE MUNICIPRLITY OF HNCHORHGE
WILL INSTRLL THE SYSTEM IN HCCORDHNCE WITH THE
DCHNT FRONTIER REHL ESTRTE
April 28, 1970
111772 3 0
Jolin Gro.sts
33ox
Eaq]-(% Rivor, AlaBka
.1lubi ect, 0.
A -00Y'Diit ),)Y Ud-S for woll and/or on -c -i -C,
,.I L, �
�I
SO'k,qer Jj,t,.tajla-cion on Lot 6 Block 4 River B s View tc atos
subivisioll 11a's Since the Oulte'a e"mr.."eds one, (1)
Year o
D -r - '1 17
I t1w ovon-L. You E."HIJ. pi,111 to install the woll
on-s-itn sovyor -;Ysteral, tj I )c�rpjjt- is, acocjuimcL The original
soil tcslu lxxv bo nelod to obtain a cuirrcmit pennit.
.1
rf {:h(; well ha!f b( -cm c1rij.1cdo is wo.11- locy Should be Son't
to thi", depit'r-braent to CI(')(,11Twl-IL. t1m. iwtal IE tion date.
KC you htive any re-gardinq tho above mattav#
please colitic{; 1"Id's o-J7:I'.jc(-, at 264-4720.
Ties, N. Buchholz#
vtlenlor spocialist
T'will j I i
�������U��4� ��� �U���������
DEPHRTMENT OF HEHLTH HND ENVIRONMENTHL PROTECTION
825 'L' STREET. HNCHORHGE/ HK99501
279-2511
it ..UK�&K_ If KE.0u I 11'.'. '11
PERMIT NU ( 772]0 )
HPPLICHNT JOHN GROSS BO
LOCHTION
LEGHL L6 B4 RIVER VIEW ESTHTES
MINIMUM DlSTHNCE BETWEEN H WELL HND
WELL LOGS HRE REQUlRED HND MUST BE RE
OF THE WELL COMPLETION.
SPECIFICHTIONS HND CO I RUCTION DIHGR
lNSTHLLRTlON/
���� �� ���� ������I�
l CERTlFY THHT
1� l HM FGMILIHR WITH REQUIREME S F �SITE SEWERS HND WELLS HS SET
FORTH 8Y THE MUNICIPH| Y OF HNCHOR E�
STHLL THE STEM IN H lHE CODES
�
MUNICIPALITY OF ANCHORAGE
Development Services Departments Phone: 907-343-7904
On -Site Water & Wastewater Section �J Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-721-05
1. GENERAL INFORMATION
Complete legal description
River View Est B4 L6
Location (site address) 21230 Running Brook Cir
Current property owners), Allen Jedlicki
Mailing address
Real estate agent
same
2. TYPE OF DWELLING:
R Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Expiration Date: I 1
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
El
Private Septic
Fi
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distan
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 2 10 co UI ID
Date of Payment f —12'2- t' ZD
1
Receipt Number 0 �O 123(
COSA#_ 05r: 201`122
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures
outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or
wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated
herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time
of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on
the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not
guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot
provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole
benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buyers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E. Date
OF Ai_lq
6. DSD SIGNATURE .. .. ...
System #1 Approved for bedrooms S ever '. "r'onrclae
r��.. CE 31 ?0
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
QS`��l�Y
_ WATER AN�1—�'
WAST`'V-AA TER z .,
PROGRAM
0 111111
Fag -2
B V\" Original Certificate Date:_
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: River View Est B4 L6
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
❑® Well log is filed with Onsite (or attached)
Date drilled 12/92
Total depth 140 ft
Cased to 20.5 ft
M Sanitary seal is functioning correctly
Q Wires are properly protected
Casing height (above ground) 14 in.
Date of flow test for COSA 611012020
Static water level at beginning of test Artesian ft
Comments Artesian Well - plug at top of well casing.
B. TANK DATA
Age of tanks) 7231
20 years
Tank type/material se "'E
Measured operating fluid level in septic tank n/a
Fffl� Standpipes/foundation cleanout per record drawing
Date of pumping n/a
D. ABSORPTION FIELD DATA Wide Trench / Deep Trench
Which system tested (date installed) 7/24120
0_1 ALL standpipes present per record drawing
Total measured depth from grade 7.5 ft (max)
Measured depth to pipe invert from grade 5.0 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
0 Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies: Deep Trench in failure installed new 5 -wide Trench
COSA Checklist yellow sheet
Parcel ID: 050-721-05
Structure served by this system 1
Well production at time of test 2.4+ gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑✓ Yes ❑ No
Al Coliform bacteria is Negative
Nitrate 0.200 mg/L ❑ Nitrate less than MRL (ND)
Arsenic 1.00 ug/L ❑ Arsenic less than MRL (ND)
Collected by Pannone Engineering
Date of Sample 8M 8118
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date n/a
Results [DPass For 3 bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate '450 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
IN
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if fess than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Yes
if No
Community Sewer Manhole/Cleanout > 100'
F,71 Yes
if No
ft
[z] Yes
if No
Neighboring Tank > 100' E] Yes
if No
ft
Private Sewer/Septic Line > 25' [Z] Yes
if No
Absorption Field on Lot > 100' F71 Yes
if No
ft
Holding Tank > 100' F/� Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' R Yes
if No
M Yes
if No
ft
if No
ft
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes
if No
ft
0 Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' E✓ Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
0 Yes if No ft
Property Line > 5'✓Q
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100'[]✓ Yes if No
Water Main > 10'✓0
Yes
if No
ft
Community Wells > 200'✓� Yes if No
Water Service Line > 10'
Fv� 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'
P/1
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' Yes if No
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'✓[)
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION OF• AL,
certify that I have determined through field inspections and review`. •:9
of Municipal records that the above systems are in confomnance with A 49 TH 1
MOA COSA guidelines in effect on this date. ) s
�1 'Steven R. Pannone
CE 814.9
COSA Checklist yellow sheet
ft
ft
ft
ft
Municipality of Anchorage °
�Development Services Department � Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak. us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 050-721-05 HAA# 04 b_q
Expiration Date.'
1. GENERAL INFORMATION
Complete legal description Lot 6 Block 4 Riverview Estates
Location Visite address or directions) 21230 Running Brook Circle Eagle River, AK 99577
Current Property owner(s) Laura & Russel Simkins Day phone 696-5150
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
21230 Running Brook Circle Eagle River AK99577
Day phone
Alnslee Philips CRR Prudential Vista Day phone 244-8584
4241 B Street Anchorage AK 99503
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may reissued with
new water sample results less than 30 days old. 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.
(Rev. 11199)
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 Health Authority Approval Guidelines for this Health Authority Approval
application shows that the on-site water supply and/or wastewater disposal system is safe, functional and
adequate for the number of bedrooms and type of structure indicated herein. 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Eng. Svc. Phone 272-8218
Address P.O. Box 102954, Anch, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date l O
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, ponscientious
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
401
the test, and separation distances measured to readily identifiable features. The operational life of all
A LJ,
wells and septic systems depend on the local soil condition, ground water levels that may fluctuate
®r
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 defect,; R -
or encroachments. PES can therefore not provide any warranty for future performance nor give any
%8
estimate of how long the system will continue to meet the operational requirements of the ADEC or
C)
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
�1
whatsoever.
6. DSD SIGNATURE
Lff_� Approved for -; bedrooms.
Disapproved.
. ranno
E 8149
fiCFESSI(: i
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements;;
Supplemental Engineer's Report,
Other
By: Original Certificate Date:
Expiration
(Rev. 1199)
•
Reissue
B: LIFT STATION
Data installed Si/eNv allo Manhole/Access y r
"Pump on" level at _ io"Pum level at in High water alarm level at in
Datum j)c a ested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM W ELL ON LOT, TO
Septic tank/lift station on lot 110+' "" On adjacent lots 100+
Absorption field on lot 120+ On adjacent lots 100+
Public sewer main 100+" Public sewer manhole/cleanout 100+
Sewer /septic service line 25+ Holding tank 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
n.n..nmNN^+�+°^`"MhYv r..4tiwwfM1'-X"^w xtikx
Building foundation 6+ Pro a "line 10+ :� _ Absor p tion field
Water main 100+ "' Water service line 25+ Surface water 100+
Drainage 100+ Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD,ION,LOT TO:w
Property line 10+ Building foundation 15+' Water main 1004--
Water
00+"uWater Service line 25+ Surface water 100+ Driveway, parking/vehicle "storage 40+` `
Curtain drain None Observed Wells on adjacent lots 100+
F. COMMENTS
House Occupied by 1 person for 3 years. *Per AW WC dated 10/27/98 C,;LLtk5*�'•* �7 �
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and 49 TM0
. ....
.
�
review of Municipal records that the above systems are in � ."�............ ......... .
conformance with MOA HAA guidelines in effect on this date.... .. ......%n,.�
�......
Steven onnone: i
Engineer's Printed Name Steven R Pannone P E �1� n No. CE 8149 •
Date 4����ESS\�••.
HAA Fee $ Waiver Fee $
Date of Payment v Date of Payment
Receipt Number �tP / kA Receipt Number
(Rev. 11`/99) w
`e
1'$L via.. �•
'n'om «e3 grogg a, ..pl
arud gu' �e
r.aaigxm $ � E
h
N
n / h
s�,sasc"
£0i£0'd TTcT b69 L06 0NILaBNIDN9 S'85
l
tz
.f
s�,sasc"
£0i£0'd TTcT b69 L06 0NILaBNIDN9 S'85
l
L1
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
050-721-05, HAA# 1�11��i-I01�
1. GENERAL INFORMATION
Complete legal description Lot 6 • Block 4 • Riverview Estates
Location (site address or directions) Running Brook Circle/Waterfall Drive
Eagle River, AK
Property owner Denise Steil
Mailing address HC85; Box 9413 Eagle River,
Lending agency
Mailing address
Ase ,i _
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 ;
3. TYPE OF WATER SUPPLY:
Individual well xx
Community well
Public water
Day phone —
AK 99577
Day phone
Day phone
384-7442
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xx
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rov.1/91) Front MOAM21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify 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 o is inspection.
Name of Firm
Alaska Water & Wa ter Phone 33 7 J G / % S
Address
Engineer's signature
ALASKA WATER & WASTEWATER CONSULTANTS INC
IS TO;BE PAID AT CLOSING FOR"
ENGINEERING SERVICES PERFORMED.
6. DHHS SIGNATURE
y Approved for
Disapproved.
�_ bedrooms.
Date ItIl Z
®cO �X0FES5V)
�0�oo�mo
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
M
Date// -25--q9
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(Rw. 1/91) Back MOA #21
o
Municipality of Anchorage.r14luiilNYfi'..`r l:nl.;r[tuicff�ldl^
DEPARTMENT OF HEALTH & HUMAN SERVICES Nov � � 199
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: LoY �� &At- 9.i\/Ea-\1(au3 �sTnTc]_ Parcel I.D.: -7 al
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number W /
Log present ON) YES Date completed
�
Total depth 140 Cased to 20 1S� Qewoma&c i Casing height (above ground)
Sanitary seal O/N) Yes Wires properly protected ON) yGs
FROM
/I WELL LOG AT INSPECTION//
Date of test ► ! n Z l A / z?. A
�r
Static water level t�
Well production �� g.p.m. , 9.p -m.
WATER SAMPLE RESULTS:
Coliform II Nitrate •ADD m9 A Other bacteria
Date of sample: t J�� f �' Collected by:
B. SEPTIC/BOLDING TANK DATA
Date installed 9 hZ��g Tank size I ZSo Number of Compartments 2 Cleanouts (V/N) YES
Foundation cleanout O/N) YES Depression (Yo /J o High water alarm (Y/O No
Date of Pumping 10 °iS Pumper -�9- Pu Y\A rJ v
C. ABSORPTION FIELD DATA
Date installed 9 A 2 7 d Soil ratin
g
1
Length '21 Width 2
(mor 2/bd $5 System type '(RufA61�
Gravel thickness below pipe (o Total depth 8
Effective absorption area 252 9� Monitoring Tube present (21N) Yas Depression over field (Y/Q °`I t
Date of adequacy test 1 o �23% n � Results as Fait) Pass For , be
25.5" eEuo0 iN'jr--SZf 311 2" gEw�
Fluid depth in absorption field before test (in.); - Immediately after„ gal, water added (in.):
5.5 Belk'°UJ
Fluid depth irwr 4 (ins) Minutes later: (o7 Absorption rate = 450 g.p.d.
Peroxide treatment (past 12 months) (Yo Noy e kWv'r' If yes, give date
72-026 (Rev. 3/96)* S �r� �'4�� ��-T✓�C ��
faocs�LAQr
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level
*Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallons
at"
"Pump off" level at*
Septic/holding tank on lot
10a +
On adjacent lots
100 1 -I -
Absorption field on lot
1001 +
On adjacent lots
I 0C)t -f
Public sewer main �
/
It-\
1
Public sewer manhole/cleanout N
Sewer /septic service line
i
ZS 1
Lift station
N
SEPARATION DISTANCES FROM
SEPTIC/F� TANK ON LOTTO:
�
Foundation 5
Property line
t
S -1' AbsorP tion field
5I 'f•
Water main/service line to � i- Surface water/drainage 100t-1- Wells on adjacent lots—
SEPARATION
ots_SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line I c Building foundation (01f- Water main/service line
Surface water 10C it Driveway, parking/vehicfe storage area
Curtain drain tJaaE Wells on adjacent lots I de k
F. ENGINEER'S CERTIFICATION
44% CSF" A i
f certify that I h e of r fn d r field inspections and review of Municipal
in conforma an wit gui elines in effect on this date.
Signature k,v
Engineer's Nam _ C� 1-t • C,,�6 S S
Date // / 2 / % 'n
HAA Fee $ Waiver Fee $
Date of Payment c7 / / �� Date of Payment
Number
Receipt ( �'��
P � Receipt Number
72-026 (Rev. 3/96)*
•7.953
�l;�1�,90.FF.SSlO �
1oo1-f
0
i+
are
Alaska Water & wastewater Consultants, Inc+
7320 East Chester Heights Circle — Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246 /
Consulting Engineers (�
October 27, 1998
Denise Steil
HC 85, P.O. Box 9413
Eagle River, Alaska 99577
RECEIVED
fM 19 19911
NeiUfllCipahty U1 Ario of ge
Dot. Hclalth & Human Sor Icee
Subject: Inspection of Private Well & Septic System. Riverview Estate, Lot 6, Bk 4.
Dear Ms. Steil:
Per your request, we inspected/tested the well and septic system serving the subject property.
The results of the field investigation and adequacy tests are summarized as follows:
A. WELL: The static water level on 10/23/98 was 8 feet below the top of the casing (BTC).
Water was pumped from the well, at an average rate of 2.97 gpm for 128 minutes (380 gallons).
During the first 20 minutes of the test, the level dropped 16 feet in the casing (26 feet BTC). The
water level remained stable throughout the rest of the test, indicating that the well was recovering
as fast as the water was being pumped out. Based upon our test results, it was determined that
the capacity of the well exceeds the Municipal requirements for a 3 bedroom house (450 gallons
ler day).
B. SEPTIC SYSTEM ADEQUACY TEST:
® The drainfield is a trench type system that is 3 feet wide, 21 feet long, and has an effective
depth of 6 feet (252 square feet of absorption area). The drainpipe invert could not be seen
in the sump, but we were able to hook what we believe to be the top of the drainpipe at
approximately 70 inches below the top of the sump. In short, it appears that the drainpipe
invert is 74 inches below the top of the sump. The sump only extends about 46 inches below
the invert (should be 72 inches).
e We initially attempted the test on 10/16/98 but found the sump to have 39 inches of thick
black sludge in it (about 4 inches below the pipe invert). We were concerned
the that
the
monitoring tube may be fouled, so we arranged to have the sludge pumped out (the fields
6/98 we
wa
not pumped). This was done on 10/21/98 when the tank was pumped•
On attempted to run water into the septic system, however, the water system only produced
about 100 gallons before the low pressure switch shut the pump off. We informed you of the
problem.
• 'An attempt to test the system was made again on 10/22/98, but the well pump kept shutting
off. We contacted you regarding the need for repairs to the pressure switch, and the leak in
the pipe ( in the well). The repairs were made by Sullivan.
• The test was run on 10/23/98. Prior to starting the adequacy test the water level was
approximately 25.5 inches below the drainpipe invert, indicating that the trench was about
65% full. Over a period of 100 minutes, 311 gallons was introduced into the trench sump,
causing the liquid level to rise 23.5 inches (2 inches below the assumed invert). An additional
69 gallons was added over the next 28 minutes, and the liquid level in the sump remained
stable. It was noted at that time that water was backing up into the septic tank. Some
unknown percentage of the 69 gallons went into the septic tank. If it is assumed that all of the
69 gallons went into the tank, then 311 gallons caused a rise of 23.5 inches, which
corresponds to 13.2 gallons per inch. It should be noted that liquid backed -up into the septic
tank before the level reached what was believed to be the sump invert.
• The recovery was monitored for 67 minutes, during which time the level dropped 3.5 inches,
indicating an absorption of approximately 46 gallons. Water was introduced into the trench
again, at a rate of 3.73 gpm, until water backed up into the tank. After the introduction of 41
gallons the system was again full. The elapsed time from the previous point at which the
system was full was 78 minutes. This corresponds to an absorption of approximately .53
gallons per minute.
• Based upon this data, it was determined that the absorption rate of the trench exceeds 450
gallons per day, as required for a 3 bedroom house; however, it should be noted that the
system had to be felled to 100% of its capacity in order to achieve this absorption rate.
C. SEPTIC TANK: According to the MOA records, the septic tank was installed in August of
1978, it is made of steel, has two compartments, and a capacity of 1250 gallons. Steel septic
tanks typically have a structural life of 20-25 years. No warrantee is made regarding the life of
the septic tank.
NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not
limited to, seasonal surface water infiltration, groundwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age),
type of substances deposited in septic system (cigarette butts, sanitary napkins, mist. objects),
and the amount of water being introduced on a continual basis. Consequently, the results of this
adequacy test are only valid for the specific day of the test. Furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected. No warrantee is made regarding the future performance of this well or septic system.
D. CLOSING: Prior to applying for an MOA health certificate, we will need a copy of a current
as -built survey showing the drainfield pipes and the well. In addition we will need to pull water
samples, and submit a check, payable for $300.00 to the Municipality of Anchorage. If you have
any questions, please con ct me at 337-6179.
Sincerely,
Jeffre G ess, P.E., M.S.
o MUNICIPALITY OF ANCHORAGE
1& DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # HAA #
1. GENERAL INFORMATION
Complete legal description Lot 6; Block 4; River View Estates Subdivision
Location (site address or directions) NHN Running crook Circle
Carol Hawn -Miller Day phone 269-4709 wk
Property owner 345-2096 hm
Mailing address 13140 Midori Drive, Anchorage, Alaska 99516
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev 1,91) Rom MOA 021
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. 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 s & 5 � GINE°RING Phone
17934 Eagle River Loop Rca j1o. 204
Address a ?3 62ilr.^r. aaska 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Additional Comments
bedrooms.
By.
Date 1—
IAr
�Y
o
P41
.aa
op
bedrooms, with the following stipulations:
Date d
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72025 (Rev. 1191) Back MOA 021
® Municipality of Anchorage
Department of Health & Human Services_
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:_ � V_4_ �1� \�� �� Parcel I.D.
A. WELL DATA rA
Well type ?i?�\ykVz� If A, B, or C, attach ADEC letter. ADEC water system number
Logpresent&N) Date completed \2-117— Driller
Total depth kCased to Za �5 ¢-- Casing height
Sanitary seal101- N)
Date of test
Static water level
Well flow
Pump level
Wires properly protected l&N)
FROM WELL LOG
4.® g.p.m.
X
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot IL�k
AT INSPECTION
l„ o
�1
-A
x o �
c�
N
Q
�.
a
Ln
g.
1
�a
uo
On adjacent lots
Absorption field on lot deb\ �- ; On adjacent lots \eO1_4
Public sewer main �1� Public sewer manhole/cleanout A\ A
Sewer service line 7-e5t Petroleum tank
SAMP
WATER LE RESULTS:
D N
(jvVl I IV
Coliform 111Ic0vvtA Nitrate
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed V�1 b Tank size
kk
Other bacteria - (�orA �_
Collected by: S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Cagle River, Alaska 99577
SC) Compartments
CleanoutsON)Foundation cleanout(2N)_Depression (Y&
High water alarm (YCNJ I\ Alarm tested (Y/N) lJ1I&,
Date of pumping Nti-tiP�> -�'1y
Pumper _ �� • �SSPba
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot C' �\ On adjacent lots l b0
To property line Absorption field _
Surface water/drainage \,ob
Foundation
Water main/service line Lo
72-026 (nev. 7191) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y
Meets MOA electrical co Y/N)
SEPARA DISTANCE FROM LIFT STATION TO:
I on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off"'Ievel at
Cycles tested
Surface water _
Date installed 1011 9 Soil rating g� System type
Length ZI Width 3 Gravel thickness Lo Total depth 1 0�
Total absorption area -21 Cleanouts presentaN)
Depression over field (Y&) ti Da of adequacy test \ 17- -31 —CA Z
Resultsdass>°fail) PDcS5 for r—D �
V-(4 y _ bedrooms
1
Peroxide treatment (past 12 months) (Ya �DI,� 4t�6,,l If yes, give date
CSL Q—(yC F�� , Scn ts. 3fS2 ik9?" \tk-L-
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot fou O On adjacent lots 1 0 0 Property line 1 o t k
To building foundation To existing or abandoned system on lot fA
On adjacent lots _2�o � Cutbank A.N Water main/service line
Surface water 1 00 Driveway, parking/vehicle storage area SoE
Curtain drain a N
E. ENGINEER'S CERTIFICATION
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on -the -date of this inspection.
5 & " ENGINEERING
Signature 170.24 Eagle liver Loop Road No. 2()4
g art c )ver, Alaska 99577
Engineer's Name
Date
HAA Fee $ 1 -)c:).C_'(-�
Date of Payment
�,5�9--?D
Receipt Number a � 3Ipc) (t S`l
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
I J.15HAFFn
No. 4215
v.pg0FC",�1O��t'.,
e�~WEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TE$TING & ENGINMAING CO.
5C'33 8-STREE1 ANCHORAGE, ALASKA 99519 TELEFfiONC (907) 502-2343 FAX: (907) 591:301
ANALYSIS R65008 for INVOICE t 61991
Chemlab E.et.t 92,7435 Benple 1 7 Hetr.iv WATER
Client Sample ID L6 E9 RIVER VIEW E81. Client Raw :s G S ENGI)IEERINO
MID UA Client Acct :3NRENGP
Cellsetad 12/30/92 A ii:ss hte. RPOI pot ,NONE RECEIVED
Received 12/31/92 / 15:20 hra. Regi '
Preserved with oyderod 6y :R. 3RAPER
Analysis Complotod : Gl/R4/93 Bond Ranorts to:
laboratory 1)° & S fNOIMIFOG
Releaeod Ey : % '" 2)
................/.......«./.G...............«.......__...,.......x._ ......,....... ....... .................... .x. ............
Paramoter Roeulte Un1ts Method Allawnhle Llmit.e
NITR!'IE-N ND(0,10) a7/1 EPA 353.2/300.0 10
Samplo AOUJINE 8ANPLE COLLFQ11) F: RAI.
Renarke
..e....... x .......... e....,.......
...4.e.--w..xu....un.-uneaw.........e...vx_...eeee.x_.....eu....ww........................«x-.
1 Teets Performed See Special InetruotionsAbase UA-Qnesailablo
ND- None Detocted See Semple Remarks Abova
NA- Not Analyzed 0 -Lona Than, GT-Gteeter Than
(2N 1.71 Msmber of the GGS Group (SOCI6l6 C6n6fG1e rG SUrV01I1ance)
-'
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME - -((
TIME
DATE
DATE
DATE
DK SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
INSPECTOR
INSPECTC
INSPECTOR
iZ INDIVIDUAL* *
ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT: OF I;i:''LTl1 &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIKIRONMENTAL' ri;OIECTION
825 L Street - Anchorage, Alaska 99501
•
JUN 2 J 981
ENVIRONMENTAL SANITATION DIVISION
Telephone 264.4720
����
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWL ��1'490`
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER
PHONE
t� f:a �-Z'�' V I I— <_r=_
r
O���e"�
MAILINGADDRESS
T,o gpy 1911 let S' 4r w A /L 55 S^J
PROPERTY RESIDENT (If different from above)
PHONE
NnruP--'
2. BUYER
PHONE
MAILING ADDRESS
9 1 Z, -ro e- Pt r i I, ,4A)c N, A f< 9 17r y
3. LENDING INSTITUTION
PHONE
4D F rz-.DE RPy L '!-:A tJ t fO kV S l-aAA
MAILING ADDRESS
4. REALTOR/AGENT
PHONE
V4
MAILING ADDRESS
5. LEGAL DESCRIPTION
LeK le fat;rtI�i�f2UlEo.1
STREET LOCATION
6.. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑ One ❑ Four ❑ Other
DK SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
54 Three ❑ Six
7. WATER SUPPLY
iZ INDIVIDUAL* *
ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE
YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) t_ -w
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ SINGLE FAMILY
❑ ONE ❑ THREE
❑ FIVE ❑ OTHER
❑ MULTIPLE FAMILY
❑ TWO ❑ FOUR
❑ SIX
2. WATER SUPPLY
PERMIT NUMBER
❑ INDIVIDUAL
DEPTH OF WELL
❑ COMMUNITY
DATE DRILLED
❑ PUBLIC UTILITY
Connection Verified
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
❑INDIVIDUAL/ON -SITE
DATE INSTALLED
❑PUBLIC UTILITY�,_l
Connection Verified
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: /�L .9- 0 If Tank is homemade
SOILS RATING
give dimensions:
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
,�,.t f�'}%a
v_4�"'Y\>•,Z�3}'l..,a,�.4({/.ttMn./ E:..�_
�.�L.:) _%7+F:,...�
?j
n
Na'' APPROVED FOR
/\ BEDROOMS
>CONDITIONAL APPROVAL
(letter must accompany certificate)
❑ DISAPPROVED
t
DATE
BY
72-010 (Rev. 6/79)