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HomeMy WebLinkAboutJUNIPER VALLEY BLK 3 LT 4Juniper Valley
Block 3
Lot 4
#050-751-30
MUNICIPALITY OF ANCHORAGE
? tIA 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 VA99@ffEtQ4
REPORT
NAME
PHONEy
LIJKNEW
•�J('�J h.a�t Y•� �L�Ly'LE �•--1
' �"
tC�(4 _, IZ'7•Y'
❑ UPGRADE
MAILING ADDRESS
7-1+11_
L(2-kOt t_ . x-4_ «(ei � ,j `j
LEGAL DESCRIPTION
��y5
l.)-+.,,) \\ ,+��
.Y. �
p
& 6
LOCATION
NO. OF BEDROOMS
u
DISTANCE TO:
Well t
, ��U
bsorption area
-� f
Dwelling
PERMIT NO. ,F
.---»� .�' /\
®Y
H Z
[MaflUfactUrer
Material
No. of compartments
W Q
i _
ed
q. capacity in gallons
Inside length
Width
Liquid depth
1-rte.
IF HOMEMADE:
_�.-.••----
--
-----
°0z
DISTANCE TO: Well D ailing
PERMIT NO.
©z Q
T I-
__
Manufacturer
Material
_
Liquid capacity in gallons
8
Well I
Foundation t
Nearest lot litre
PERMIT NO.
w •
DISTANCE TO:
� .
) _-t
-----------�
w_
.0 u. •
No. of line
Len th Qpf ea h line
g
Total length oflinesTrench
ACS
width
Distance betty t fines
��S
z
Lrlp�g 1
Cap inches
Top topf�nish
Material beneath tile
Total
m
of tile grade f f
%Jtv
effective absorl on area
".�t (V `-•t,j
i,
inches
�"`�'
Length
Width
Depth
PERMIT NO.
ui
Q h
Type of crib
Crib diameter
ri depth
Total effective absorption arca
as
w
N
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
w
Building oundatio4..`he11
rr Ijiie''.•
I';•
Septic tank
Absorption area(s)
DISTANCE TO:
�cr,�
; _,�
y. �1M1r I:c4
•r.
OTHER
rid
.. °
$":`
PIPE MATERIALS �' •y „$,._,� ,.•
6°a °•a• a .aur.-; a,°n-°
SOIL TEST RATING a +• +• •+••••^
f6ort R. Shofar
p'
°n— hto 1ASf
INSTALLER V jr)
REMARKS �� rE�✓�,
.-.1—p."T i Y•�i )lr�J+'•I�..r�lJ
1 t
1..,
1
PPR VED DATE
LEGAL
x lYzi .;f �
tn�vC
/yn
January 31, 1983
TO: Permit Applicant
.Permit #: 820526
Subject: Lot 4 Block 3 Juniper Valley '-Subdivision
A permit issued by this department for an individual we1l.
and/or_ on-site sewer system has expired as of December_ 31_,
1-982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call. this office
at 264--4720.
Sincerely
``\•
c--Z�
Robert C. Pratt, R.S.
Acting Program Manager.
Sewer and Water_ Program
RCP/l.jw
enc: Copy of Permit
SWP/057
DEPHRTMEMT HEHLTH HN0 EMVIROMMENTHL OTE`
825 'L' STREET, HwCHORHGE, HK99581
2�4~4720 \
PERMIT NO ( 820526 )
THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS�
I CERTIFY THHT
1� I HM FHMILlHR HITH THE REQUIREMENTS F8R ON.SITE SENERS HND |�ELLS HS SET
FORTH BY THE MUHICIPRLITY OF HNCHORHGE
2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE NITH THE CODES
]� I UNDERSTHND THHT THE ON~SlTE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THHN 7 BEDROOMS
ART
- _
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lip.9
c
i
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t'..- I _ ..i OWN
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t 7`-_- ,}' i3gU .' 111".m 1 0 �UvlodvI-.'
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f = r _ ? 1i.1 r0 :(Own 1 1i �_., 1. is I:1--_i'i-I JAY? f t(I. I'
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it"i
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-
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it)
- ill .11i 7_ 13 100
".1
:1 I 1 nin. TKY i:f (11 !-1-11-`�•_
PERFORMED
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
�SO`ILS LOG — PERCOLATION TEST
t treqJ ec,, DATE PERFORMED:
LEGAL. DESCRIPTION:_
D PTH �� •t i�v�C �L (/t
t ,
2 G c`
—.3 C' C
4-
6 6
7 c.
8 (,t
9
10 �.
11 -
12
13
14
15
16
17
18 c
19 �g/
4
20
COMMENTS
PERFORMED BY:
72-008 (6/79)
cz-
`." 64t h
r� %
°
�^ Kul>art A SAa r i
XSOILS LOG
❑ PERCOLATION
TEST
SI E PLAN
WAS GROUND WATER 1..� L -
ENCOUNTERED?
0
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
I ime
Net
Time
Elk
PCs
MEN
RINE
njow
No
mm..
NMN
ME
OL
M,
N
XSOILS LOG
❑ PERCOLATION
TEST
SI E PLAN
WAS GROUND WATER 1..� L -
ENCOUNTERED?
0
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
I ime
Net
Time
Depth to
Water
Net
Drop
1457.-
V
PERCOLATION RATE .(minutes/inch)
OFE$$Cti Qi9 TEST RUN BETWEEN FT AND FT
CERTIFIED
DATE:1%141^I
M -W DRILLING, Inc.
P.O. Box 10.378 • 10300 Old Seward Highway
(907) 349.8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner John Fraley
of Well DomestiO
Location (address of: Township, Range, Section, if known; or distance main road _
LIQ B3 Juniper Valley Subdivision
casing
61" 3$0 21 b'"
Size of casing Depth of Hole— feet Cased t 7 feet w
w/ AFS liner
Static water level ��� ft. (aJx (below) land surface. Finish of well (check one) open end XXX
Static )
Screen ( ); Perforated ( ).
Describe screen or perforation None
Well pumping test atm—gallons per xMJST .. (minute) for 1 hours with loch K?CX
of drawdown from static level.
Date of completion May,12,1983
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
OL -To 3
3 To fro
80 TO 217
217 218
TO
218 Tn 225
225 TO 359
TO-
-TO-
TO-
TO-
TO-
-TO-
-TO
OTOTOTOTOTOTO
TO
Casing stickup
Sandy gravel.
Silty sandy gravel
Boulder
N W WACertifisd Conirj�;
f�tificate NO'N. 8}¢—Wte'r
3—CONTRACTOR
I B 9 rQ 7 •
G U
•-4.71
� Municipality of Anchor. •
'�� o�..f s
On-Site Water and Wastewater Progr: 8 Izo�
(907) 343-7904 a.. AUG 3 0 2017 ETY
a w
Certificate of On-Site Systems Ap • 5\
01b9L°'
Parcel I.D. 050-751-30 Expiration Date: i 1; 9 - ( r`
1. GENERAL INFORMATION
Complete legal description Juniper Valley Block 3 Lot 4
Location (site address) 3946 Mariah Dr. Eagle River AK 99577
Current Property owner(s) Paul Schmit Day phone 907406-3829
Mailing address Same
Real Estate Agent Day phone
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
0 Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for. Distance:
Received by: Date: ctiti 17
COSA to be released to the engineer. ess otherwise requested by the engineer.
COSA Fee $ 4 5240 Waiver Fee $
Date of Payment X3131//7 Date of Payment
Receipt Number o6/52ac Receipt Number
COSA# ' f)(,/7/11401 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.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave. Suite 203
Engineer's Printed Name Benjamin Schiller Date ° 14e0
It tae49
6. DSD SIGNATURE yrs O0OD0
iC ge 1.tialco ;
System #1 Approved for 2— bedrooms 4i.� .._ pee m
System #2 Approved for bedrooms 0 � '&1��` @'a'Q
ftVi ��p
Disapproved
Conditional approval for bedrooms, with the following stipulations:
A-\/%42A,A-ed-e k I's 2 Oi Qat/ S
\-s` OF- V rC�O r
„pi
Jam'
ON-SITE
WATER AND
WASTEWATER
cr PROGRAM
47.c-
Original Certificate Dater ( ��
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 blue sheelj c
If more than 1 septic system is on the lot:
COSA Checklist 4 of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description:
Juniper Valley Block 3 Lot 4 Parcel ID: 050-751-30
A. WELL DATA
Well type
Private If A, B, or C provide PWSID 4 Well Log (YIN) Y
Date completed 05/12/83 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
all
Total depth 380 ft. Cased toy ft. ?, Casing height (above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of test 05/12/83 08/17/17
Static water level 200 ft. 220 ft.
Well production 4 gpm 0.35 g p m
WATER SAMPLE RESULTS:
Coliform NA colonies/100 mL Nitrate -552 mg/L
Arsenic NAug/L Date of sample: 08/10/17 Collected by: Forge Eng.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/SteelDate installed 1983
Tank size 1000 gal Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) NA
Date of pumping 08/11/17 Pumper JR's Septic
C. ABSORPTION FIELD DATA
Date installed 1983 Soil rating (g.p.d./ft2 or ft`/bdrm) 1 1 0 System type 5 Wide
Length 40 ft. Width 5 ft. Gravel below pipe 3 ft.
Total depth 6.5 ft Eff. absorption area 344 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 08/17/17 Results (Pass/Fail) Pass For 2 bedrooms
Fluid depth in absorption field before test 20 in. Water added 500 gal New depth 31 in.
Elapsed Time: 1 380 min. Final fluid depth 22 in. Absorption rate >= 300 g.p.d.
N
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100' On adjacent lots >100'
Absorption field on lot 100' On adjacent lots >100'
Public sewer main NA 7 75' Public sewer manhole/cleanout NA ->)00
Sewer/septic service line >25' Holding tank NA 7 ?ca
r NA
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
>5' >5' >5'
Building foundation Property line Absorption field
Water main NA > lo' Water service line >10' Surface water >100'
Wells on adjacent lots >1 00'
ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main NA 7 101
Water Service line > Surface10' water > Driveway, parking/vehicle storage X10
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION '6.4016 . C, �j4///Q
I certify that I have determined through field inspections and MP, 4.
.••'' -tea , ��
review of Municipal records that the above systems are in rxd
r • T , 1 .Y
conformance with MOA COSA guidelines in effect on this date. ji,Tw •
Benjamin Schiller
Engineer's Printed Name s To,.....,
Date 08128/17 e. « /1 Si /
o ,
# •''VADIIW•' dr
414°1 uE Qo®.
COSA brown sheet 10-10-12.doc
• Municipality of Anchorage L• u.
i ' .-
I Development Services Department
Building Safety Division S,F E T Y
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Certificate of On-Site Systems Approval (COSA) # OSC 171401
During a recent COSA on-site inspection and test of the potable water
supply well on Block 3, Lot 4 of Juniper Valley subdivision, the well's
productivity was determined to be .35 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 2-bedroom
residence is .2 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
D]
Parcel I.D. 050-751-30
Municipality of Anchorage
On -Site Water and Wastewater Program a
(907)343-7904 < snrery
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description JUN
Expiration Date: 9-30-1-4
Valley, Block 3, Lot 4
Location (site address) 3946 Marlah Dr.
Current Property owner(s) Secretary of Veterans Affairs
Day phone _
Mailing address 155 Van Gordon St. Lakewood, CO 80228
Real Estate Agent
Day phone
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑
Duplex
��'ia� r
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3 MAY 2 3 2014
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual F�
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Puioiic'v""Vater System ❑ Public Sewer ❑
Waiver/Variance request for.,
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 52-(� -
Date of Payment 5lf'a3 h L
Receipt Number o4-7-'-)
COSA# �L1�(IZl^1
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.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Alk. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
System #1 Approved for .3 bedrooms
System #2 Approved for bedrooms
Disapproved
Date 4/23/2014
Conditional approval for bedrooms, with the following stipulations:
By: /� �i� Original Certificate Date:J
The Munici ality f A orage 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet f c
If more than 7 septic system is on the lot:
COSA Checklist # + of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Juniper Valley, Block 3, Lot 4
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 5/12/1983 Sanitary seal (Y/N) Y
Total depth 380 ft. Cased to 217 ft.
FROM WELL LOG
Date of test 5/12/1983
Static water level 200 ft.
Well production 4 g.p.m.
Parcel ID: 050-751-30
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 18+ in.
AT INSPECTION
4/18/2014
216 ft.
0.49
9-p m.
WATER SAMPLE RESULTS:
Coliform AA?--colonies/100 mL Nitrate0. L�_ff mg/L
Arsenic Nb ug/L Date of sample: t Collected by: AG>
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,000 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping 4/21/2014 Pumper JR's Pumping
Date installed 1983
Cleanouts (Y/N) Y
High water alarm (Y/N) N
C. ABSORPTION FIELD DATA
Date installed 1983 Soil rating (g.p.d./ftz or ftZ/bdrm) 110 SF/BR System type Shallow Trench
Length 40 ft. Width 5 ft. Gravel below pipe 3 ft.
Total depth 7 ft. Eff. absorption area 344 ftz Monitoring tube Y_ Depression over field N
Date of adequacy test 4/21/2014 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 13 in. Water added 500 gal. New depth 16 in.
Elapsed Time: 20 min. Final fluid depth 13 in. Absorption rate >= 450+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
in.
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons _
"Pump off"level at
Cycles tested _
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 100+
in.
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS (/
AS — t, a.L
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date 4/23/2014
COSA brown sheet 10-10-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 110+
in.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci. anchorage. ak.us
(907)343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # 141217
During a recent COSA on-site inspection and test of the potable water
supply well on Block 3, Lot 4 of Juniper Valley subdivision, the well's
productivity was determined to be 0.49 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 3 -bedroom
residence is 0.31 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information
obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm S a s Engineering
Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567
Engineer's Printed Name Roberta Shafer
Phone 694-2979
Date
>R
5. DSD SIGNATURE
� • � 1477•!
l✓ Approved for 3 bedrooms. 4
QTF9Fo ,•�•��",•
Disapproved. l46�a�F
Conditional approval for bedrooms, with the following stipulations:
N
-ft
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: OAetllOriginal Certificate Date: J'�- g —�
(R" IM)
Municipality of Anchorage
' Development Services Department '
Building Safety Division
On -Site Water & Wastewater Program ' • "
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
1 It3 v tf�
Legal Description:_ LOQ- ; f;�k ��n;n r�ll) ParcellD:D'6 SSI -3o
A. WELL DATA
Well type C�vEI t If A, B, or C provide PWSID # _ Well L
09�) �c..e5_
Date completedG I2/S Sanitary sealN) 5 Wiresro rl 6i )
p pe y protected /N y -t
Total depthaEo ft. Cased toZt "' t9
�_ft. Casing height (above ground) r* in.
FROM WELL LOG
Date of test ! L d 3
AT INSPECTION
Z $ eo
Static water level '2,00 ft.
o?cZ I ft.
Well production y.0 g.p.m.
n, g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitratemg/L
Other bacteria v colonies/100 mL
Arsenic: � ug/L date of sample% G 0 7
Collected by: S S' .kms 1" of
B. SEPTIC/HOLDING TANK DATA
I
Tank Type/Material Se A; L S�t,'
G
Date installed % 13
Tank sizetoo() gal. Number of Compartments
Cleanouts (9N) e S
Foundation cleanout N �°'S tank Depression over tafVU ® _
_ P
l
High water alarm (YA@ AJy
^�(Y
Date of pumping rJ I Pumper J a- • S
PJ MD (n q
C. ABSORPTION FIELD DATA
Date installed 135
Length 4
Soil rating (g.p.d./ft2 o ' r // U
Width S
ft.
System type
Gravel belowlpipe 3 ft.
Total depth -1: ft. Eff. absorption area-Yfi—ft' Monitoring tube P� _ Depression over field 6t0
Date of adequacy test C� l Result (Pas Fail) i� t S CI For � bedrooms
f 13,,
Fluid depth in absorptijonn� field before test �'� in. Water added al. New depth, 1� in.
Elapsed Time: S Final fluid depth Zt In. Absorption rate g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) /P/O/jd IVOO! yes, give date
y�2�'�
D. LIFT STATION,
Date Installed
'Pump on' level at
E. SEPARATION DISTANCES
Size in gallons
`Pump off level at _ in.
Cycles tested
(Y/N)
High water alarm level at
Meets alarm ti circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1004 On adjacent lots
Absorption field on lot 1004
Public sewer main A
Sewer /septic service line /--")o It
Animal containment areas 1190AJIE
[OC) 4
On adjacent lots — ( Leo A Al
Public sewer manhole/cleanout A -
Holding tank /��4
i
Manure/animal excrete storage areas _4t -
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
�
1 st
l7
Building foundation 1( Property line _.�_1_ Absorption field
Water main I& Water service line 10f Surface water ADS+
Wells on adjacent lots foo f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: '' /
Property line I L)+ Building foundation %_ Water main /••u 1 R'
Water Service line to* Surface water 1Q0 + Driveway, parking/vehicle storage IN
Curtain drain n/r,nk "00 Wells on adjacent lots IMO+
F. COMMENTS
G.
I certify that I have determined
review of Municipal records th,
conformance with MOA COSAgL
Engineer's Printed Name
Date
COSA Fee $_
Date of Paymenl
Receipt Number
(Rev. 11105)
o Z
field Inspections and r ��i f ` r ~%�q
love system in jti�
1 effe on t is ate. / y No.. """"
Mev
Waiver Fee $
S /}%/ 9 Cl Date of Payment
Receipt Number
In.
AvErb -
Ivs
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Nater Well Advisory
Certificate of On -Site Systems Approval (COSA) # 090123
During a recent
COSA on-site
inspection and test of the potable
water
supply well on
Block 3, Lot 4
of JuniperValley subdivision, the
well's
productivity was determined to be 0.33 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 3 -bedroom
residence is 0.31 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
SCS ReLN
1091540001
Client Name
S & S Engineering
Project Name/N
L4;B3;Juniper Vally
Client Sample ID
L4;B3;1uniperVally
Ntatric
Drinking Rater
PN'SID
0
Printed Date rime
05/042009 16:52
Collected Date/rime
04212009 12.55
Received Date/time
04212009 14:35
Technical Director
Stephen C. Ede
Sample Remarks:
Parorneter
Results
POL
Units
Medal ContainerlD
Allowable
Limits
Prep Analysis
Date
Date
Init
Metals by ICP/HS
Arsenic
ND
5.00
ug/L
EP200.8
C
(<10)
0428/09 05/01/09
NRB
Waters Departmant
Total Niirate/Nitritc-N
ND
0.100
mg/L
SM20 450ONO3-F
B
(<10)
0423/09
1DZ
Microbiology Laboratory
TotalColifotm
Negative
1
100mL
SN1209223B
A
0421109
DLC
E. Coli
Negative
1
100mL
SM209223B
A
0421/09
DLC
F
O
a
0 0 0
C C C
0 0 0
3 3 3
r r r
y y y
O O O
N N N
N N N
a a a
A n A
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4
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Municipality of Anchorage
i., Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196"050 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Parcel LD
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
0S -o --7.i1-30
1. GENERAL INFORMATION
HAA go 305-64'
Expiration Date: a. - S'• 0 1_�
Complete legal description Lot 4 • Blocker; i- �i�,,Pr vat 1Py
Location (site address ordirections)3946 Mariah Dr vP, FA41P River- AK
Current Property owner(s) Day phone
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Lau= mi 1 * on _ Day phone694-4200
Mailing Address 16600 Centerfield Dr'�J AK
Unless otherwise requested, HAA will be held by DSD for pickup. jf l5l0
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
91
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
91
Individual Holding tank
❑
Community On-site
❑
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 4 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) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. 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 be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional enaineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation,
based on procedures outlined in the Health Authority 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 SSS Engineering Phone 694-2979
Address17034 North Eagle River Loon- SrP 704 Eagle River, AR 99577
Engineer's Printed Name _%� 0 8f.? r C Co cw9.J Date 1113103
S
5. DSD SIGNATURE re'.."
� ,• t ROBERT C COWAN
_AZ Approved for _ bedrooms. CE -8801
Disapproved.
"•••-•••" .
Disapp
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: GiJ. Original Certificate Date: 1 1- S_-03
)Rev 01102)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program ' I TV
4700 South Bragaw St.
P.O.Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
//--H--EALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LCE4 ; 3; ��uNyn�LY/�L1F7 Parcel ID:�— 79/- 30
---�-.. sly
A. WELL DATA
Well type lrZIE7If A, B, or C provide PWSID #= Well Log (Y/N)
Date completed!F11014413 Sanitaryseal (YM) Wires properly protected (Y/N) y
Total depth 7J r
p �ft. Cased to �ft. Casing height (above ground) r8 in.
FROM WELL LOG AT INSPECTION
Date of test S /Z /O o3
Static water level rZco ft. Z Z Z ft.
Well production 4 • D g.p.m. • d g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml.' Nitrate 0- / mg.A. OthcIll "98INImi,it1olonies/100 ml.
Arsenic: mgJl. Date of sample: 10�a8�03 Coli 17034 Eagle River Loop Road No.404
Vga vv
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material�r„fi I 6voz" Date installed I%P3;K
Tank size /GCO gal. Number of Compartments Z Cleanouts (Y/N) _ I/
Foundation cleanout (Y/N) Depression over tank (Y/N) —:�Si High water alarm (Y/N) Al
Date of pumping 10131,03 Pumper ,T21 S
C. ABSORPTION FIELD DATA
Date installed I OS*, Soil rating (g.p.dJft2 or 2/bd 10 System type 4f;,VC ff
Length 40 ft. Width ft. Gravel below pipe �� ft.
Total depth —fL ft. Eff. absorption area 544ft2 Monitoring tube _� Depression over field tJ
Pass/Fail PA -:S
Date of adequacy test 10 3 !' Results
( ) For -3 bedrooms
oe
Fluid depth in absorption field before test 9Z41n. Water added gal. New depth 7& lin.
Elapsed Time: I& min. Final fluid depth ';O�in. Absorption rate >= 46-0 g.p'.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed AJ /4
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (YIN)
"Pump off" level at _ in. High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanknilt-et6on on lot
r
Absorption field on lot 1004-
Public
00'1"Public sewer main N A
SeAw /septic service line 2 ► r -
On adjacent lots
100
On adjacent lots I b 0 ►
Public sewer manhole/cleanout N
Holding tank NA-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I
d -
Building foundation 'r Property line 4' Absorption field
Water main__OA-� Water service line 1
'I— Surface water 1
Wells on adjacent lots 10 O t�
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line i o ►4" Building foundation '4- Water main
N
Water Service line 1 ''- Surface water, l 00 t� Driveway, parking/vehicle storage
Curtain drain /Jet1f NOW Jwells on adjacent lots �w
t : "
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and . _ ...
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.. .
Engineer's Printed Name 9 0 ,0k't;C-
Date 1d/3/a3
HAA Fee S 3 7 5 a J
Date of Payment
Receipt Number i a
(Rev. 12101)
�L
,
o ; ROBERT C. COWAN f
I0 .. CE -8801 ;
Waiver Fee $
Date of Payment
Receipt Number
r r�
.�
1.14
11-03-03 02:58PM FROM -CUE ESI, SGS ENV SERVICES
Sf;-S-L-
SGS Ref .#
1037064001
Client Name
S & S Engineering
Project Name/N
L4, B3 Juniper Valley
Client Sample ID
L4, 83 Juniper Valley
Matrix
Drinking Water
Sample Remarks:
9075615301 T-485 P.02/03 F-993
All Dates/Times are Alaska Standard Time
Printed Date/Time 10/31/2003 15:51
Collected Date/Tlme . 10/28/2003 14:30
Received Date/Time 10/29/2003 14:40
Technical Director QSte Ede
Released
Allowable Prep Analysis
PalatnCwr Results PQL Units Method ContaincrID Li]nit
Limits Date Date
Waters Department
Nitrate -N 0. too U 0.100
Microbiology Laboratory
mg/L BPA 300.0 B (<=10) 1029/03 JJB
Total Coliform 0 col/100mL SM1892228 A (<=j) 1029/03 DKC
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES ''dUTP OF ANCHORAGE
0*
Division of Environmental Services MrNiA( <rRVICESDtYISION
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650 JUL 2 2 1997
343-4744
CERTIFICATE OF HEALTH AUTHORITY R 6 C E I VE E D
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I. D. # U S o -7 S i e 3 HAA # 0 P�9_�
1. GENERAL INFORMATION
Complete legal description Lot 4; Block 3; Jun
Location (site address or directions) NHN Mariah
Property, owner Sazanne & Rodger Ewy Day phone 696-7336
Mailing address 3946 Mariah Drive Eagle River, AK
Lending agency National Bank of AK Day phone 257-3615
Mailing address Attn: Pat Angevine
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 'I
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) Front MOA A21
1
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MUNICIPALITY Of AN(J10RAO
Municipality of Anchorage ENVIRONMENTAL SERVICES DIVIS
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division JILL 22 1997
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4RECEIVED
7tltl44� / r�
Health Authority Approval Checklist
Legal Description: l�� �.�v� \ iy> rcel 1.D.:_ 0 0 S-
A. WELL DATA
Well typey��� _ If A, B, or C, attach ADEC letter. AD EC water system number
Log present (Y/
Date completed -5-- /-), - F-3
Total depth 3 � D _ Cased to 07/ 7 r Casing height (above ground)
114
Sanitary seal&/N) Wires properly protecteg6N) _
FROM WELL LOG AT INSPECTION PI PF 6V
Date of test
S--(Z-R3
Static water level
Well production g.p.m.
WATER SAMPLE RESULTS:
tT 1 C
1J S. "41 L444 ffL
/I D 9 -10 -m -
Coliform , Nitrate Q, % 0 2 Other bacteria
0.6s r-e%n.pled
Date of sample: _ `%-.l 7 i 7 Collected by: 5 ` S
XlY
Q B. SEPTIC/HOLDING TANK DATA
Date installed i 9&3 Tank size loa'a Number of Compartments Cleanouts /l )
Z
Foundation cleanout((! N) Depression (Yor-1 High water alarm (Y/N) ,
+o Date of Pumping 7-
r'1
C. ABSORPTION FIELD DATA
Date'installed 83 Soil rating (g.p.d./ft2 or ft2/bdrm) ! -system type LA) 77-; 4--��
�l Length' 7� Width _ Gravel thickness below pipe 3 Total depth
Effective absorption area ? Monitoring Tube present (Y)N)--�/_ Depression over field (YAP i"
Date of adequacy test S- / l Result as Fail) S For 3 bedrooms
Fluid depth in absorption field before test (in.), Immediately after3S'"gal. water added (in.): ---
vi 4 -
Fluid
Fluid depth (ins) Minutes later: e\90 Absorption rate7J o �- g.p.d.
Peroxide treatment (past 12 months) (Y(% yes, give date I�
72-026 (Rev. 3/96)*
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�I CT&E Environmental Services Inc.
Laboratory Division
Drinking Nater Analysis Report for Total Colifor
REA D INSTRUCTIONS OrV REVERSE SIDE BEFORE COLLECTING SAMPL!
MUST BE CONIPLETED BY WATER SUPPLIER
d PUBLIC WATER SYSTEM I.D.0
PRIVATE WATER SYSTEM
Srnd Ret U -„ / Send Jnvo/iyce
,r��L//Vj 7 f&7/
��tv Dote Oluua
SAMPLE DATE: 22 1.51.1 I M
Nfonth Day Year
SAMPLE TYPE:
®
-h
kRoutine
❑ Treated
Water
❑ Repeat Sample (for routine sample
❑ Untreated Water
with lab ref. no. )
Date:
Time:
❑ Special Purpose
Time
Collected
SAMPLE LOCATION
Collected
By
Plcu Print
,-n Bacteria 200 w. Potter Drive
Anchorage, AK 99518.1605
Tel: (907) 562.2343
Fax: 1907) 561.5301
TO SE COMPLETED BY LABOPLATR? ORY
An ysis shows this Water SAMPLE to be:
Satisfactory
a Unsatisfactory
❑ Sample over 30 hours old, results may
be unreliable
D Sample too long in transit: sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new snmplcvia spe ial delivery mail.
Date Received
Time Received 10 0—.
Analysis Began - /:13(�)
Analytical Method: 41110vtembrane Filter
. ❑ ty1l".10-MUG
• Numberofcolonics/100ml.
Lab c iNo,__ Result" Analyst
97.4272
®
-h
$enr to A.D.E.C.
Anch Fbks
Jun W
Faxed
Date:
Time:
Client notified of unsntisractoty results:
❑ ❑
Phnntd Spoke with Faxed
Date: Time:
BACTERIOLOGICAL NATER ANALYSIS RECORD
NIMO \IUG Result: Total Coliform
E. Cali
Membrane Fitter. Direct Count 0 Colonies/100 n l
VeriGeation: LTB BCH COLIFIRM_
Fecal Coliform Confirmatiru �j
Final Membrane Filter Results K-✓ Coliform/100 ml
Reported By -(4 Darc Time q— hrs
Comments:
IIcrCO ruu iYygmm7 ru Gwnf
OH -Ort,d 11"Wiu
rvi ISOS Member of the SGS Group (Socimi GAnArale de Surveillance) sem_
10i10'd 10ESi9SL06
39Ua0H9Nd IS3 3219 8G:I1 L66i-80– d
CT&E Ref.X
Client Name
Project Name/X
Client Sample W
Matrix
Ordered By
PWSID
CT& Environmental Services Inc.
ei
974038002
5 & 5 Engineering
N/A
Lot 4 Bk 3 Juniper
Drinidug Water
Parameter Results
Client PDX
Printed Date/Time 07/30/97 12:29
Collected Uate/Time 07/24/97 13:45
Received Date/Time 07/24/97 17:10
Technical Director: Stephen C. Ede
0 Released By
Nit rate -N 0.102
Total Coliform 40 OB W/O COLI
Allowable Prep Analysis
PQL Units _ Method Limits _ Date Date lniC
0.100 ms/L SM18 4500-No3F 10 max 07/25/97 ,12d
SM18 92220 07/24/97 TMW
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
Parcel I.D. # 05-O 75-/-"23C) HAA # V,
1. GENERAL INFORMATION /
Complete legal description eL.�Y'3_ M)Petlz y'4"Lt✓�
F
3
4
Location (site address or directions)
Property owner
19 4,A)
DA -w&)
F/�LL=-Y
Day phone 6W -Z2-7,4
Mailing address
�Q 2� '
)%�
���� ��
�� �- q9h
Lending agency
Mailing address
Day phone
Agent C��vu,Ly Z1 6&f—W. Wik-2rt/J Arz Day phone C76 -96W
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site X—
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) F1onl MOA 1121
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 verifythat 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 David R. Dayton P.E. Phone
20210 Donalar 5t,
Address
Engineer's signature
6. DHHS SIGNATURE
A— Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date ZZAf3
v y
c ,n
1 c R4
r s `
�n a. �u• ;4ac�r 7
[)uvid a. °Dayton
° rqo. 2205-t
bedrooms, with the following stipulations:
fay: 4tu� Date e— -5--93
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.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L4 63itno)GK-/G Parcel I.D. bSd 7S/ z,?"
A. Well Data
Well type & V4-7.2 If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) _ Date completed Driller ✓li-W
Total depth Cased to 35:2� 4=g�5 Casing height
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump levell
FROM WELL LOG
f�/ 43
7,00
SEPARATION DISTANCES FROM WELL TO:
Wires properly protected (Y/N)
AT INSPECTION
u/C
(7u,uo, F",V, w�Fe_�
c. )VAP&6c-nonce
1-0 PL:'s-mD Uig Y,n E rvs J av,-
S�iL
t.}7 W •�
W 4 7- g.p.m.
K K-- r�
U Z
v
Septic/holding tank on lot
On adjacent lots /v�>
M
- 1 y
a
Absorption field on lot
On adjacent lots
Public sewer main _ A.)
Public sewer manhole/cleanout
n
Sewer service line
Petroleum tank A-) -6
WATER SAMPLE RESULTS:
Coliform
C%
Nitrate 0, / C)
Other bacteria cn
Date of sample: T7��i /� 3 Collected by: 0 o 0
B. SEPTIC/HOLDING TANK DATA
Date installed I9 S�) Tank size I D o O Compartments
Cleanouts (Y/N)
High water alarm (Y/N)
Foundation cleanout (Y/N)
,y.
01
Depression (Y/N)
lAlarm tested (Y/N) AJ�i3�
Date of pumping/l3 / Pumper
SEPARATION DISTANCES FROM SEPTIC/H®L-BMh1&TANK TO:
Well(s) on lot _On adjacent lots Foundation
To property line O+ Absorption field S Water main/service line
Surface water/drainage 1 0C> f -
/S_
'1�1/
6:5-
72-026
S`
0
`Z
72-026 (3/93)• Front CONTINUED ON BACK PAGE
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swoaapae ao} ZFUU,
(Ilayssed) sllnseut lsal Moenbepe to ala(]
(N/A) Plal} aano uolssaada(]
/vI/l Z -1-/S gldap lalol
(N/M luesaad lnoueelO
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(N/.l) sapoo laouloala VON slaaW
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la lana -1„}}o dwndl,
le banal „uo dwndA
(N/,k) ssaooy/alo
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lana) waale aalenn q6!H
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/ NOLLVIS kill '0
D. R. DAYTON, P.E,, R.L.S.
HQUOUNIUM Chugiak, Alaska 99567 (907) MMM
20210 Donalar 696-2417
July 26, 1993
ADEQUACY TEST
Legal Description: Lot 4, Bl.k 3, Juniper Valley Subdivision
Septic Tank: 1,000 gallon, 2 compartment, steel tank (DHHS Records)
Absorption System: 40'long x 5' wide x 3' deep trench (DHHS Records)
Soils Rating: 110 sq. ft. per bedroom
(DHHS Records)
Requirements: 3 BR - 450 gallons per day
Test:
Water was pumped into the absorption trench while measuring volume,
time, and liquid level rise. After pumping was stopped, the liquid level
drop was measured at timed intervals.
The results were graphed on a graph of time and gallons absorbed and
extrapolated to 24 hrs.
Results:
The absorption system is currently functioning adequately for a
3 bedroom home.
Qt
C°eoe n.•
a ;r.eosv us
° W
,,,'• Uach: R. Daylon 1 W
?205 -E=d
�
�I` `2J'ROFESU) -
D. P. DAYTON, P.S., R.L.S.
MUMMAM` Chugiak, Alaska 99567
20210 Donalar
July 26, 1993
WELL PLOW TEST
Legal Description: Lot 4, Blk 3, Juniper Valley Subdivision
Date of Test: July 25, 1993
Well Depth: 380 ft.
Casing Depth: 217'
Static Water Level: 200 ft per well log
Requirements: 3 BR - 450 gallons per day, 0.3125 gpm
(907) MAM
696-2417
Test:
As the pump drop pipe is hung from the well cap, static water level
and drawdown measurements were impractical.
The flow was tested by pumping the water level down to the pump
and measuring the flow for 4 hrs.
Results:
The well produced a constant flow of 0.93 gallons per minute
with the water leve]. at the pump. The daily volume at the pump level
is 1339 gallons per day.
The well is currently producing adequately for a 3 bedroom home.
A
t'
,.• :n Uavi, F. Dayton
„ ,;' r:o. 2205-E
o°UP�y®
to PR0FESS'J', —
COMMERCIAL TESTING & ENGINEERING CO.
ENVIRONMENTAL LABORATORY SERVICES
SINCE 106
REPORT
of ANALYSIS
5633 B STREET
Chemlab Ref.#
:93.3635-1
ANCHORAGE, AK 99518
Client Sample
ID :L4 B3 JUNIPER VALLEY
TEL: (907) 562-2343
Matrix
:WATER
FAX: (907) 561-5301
Client Name
:DAVID DAYTON, P.E.
WORK Order
:68733
Ordered By
Report Completed
:07/29/93
Project Name
Collected
:07/25/93 @ 14:00 hrs.
Projectit
Received
:07/26/93 @ 11:30 hrs.
PWSID
:UA
Technical Director:STEP E � E�
Released By
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: D.R.D.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
--------------------------------------------------------------------------------------------------
Nitrate--N 0.10 U mg/L EPA 353.2/300.0 10 07/27 LLH
* See Special Instructions Above UA = Unavailable
** See Sample Remarks Above NA = Not Analyzed
U = Undetected, Reported value is the practical quantification limit. LT = Less Than
D = Secondary dilution. GT = Greater Than
"INSGS Member of the SGS Group (Societe Generale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA
C
MUNICIPALITY OF ANCHORAGE:
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CLRTIFICATE OF INSPECT ION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILI EY
254-4720
Application Date _ i - tk-S
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
C
isE eT2 _—_VA1 L t Location (address (address or directions)
(b) Applicant Name. v—t t ___C'� Telephone: Homer- "���` Business
Applicant Address
(c) Applicant is (check one): Lending Institution D ; Owner/builder Buyer C1 ; Other D (explain),
(d) Lending Institution — ---_ Telephone
Address ---
(e) Real Estate Company and Agent
Address
Telephone
(f) .Mail- the HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family,, Multi -Family El Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well Vzr Community E1 Public D
Note: If community well system, must havewritten confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsiteo Public El Community El Holding Tank El
Note: If community well systern, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 77-O 5 (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 bedroorns 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 --_•,.--- Telephone
s t ,
Address ----
t
Date
s. �NEP APPROV 1
Approved for ': ul _.-
_ bedrooms by -�_ ,. J
' n– -------- - j
Date
Approved — _
-- Disapproved __—
_— Condidin I _
Terms of Conditional Approval
----
i 1
Ae
rr
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
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTII,,,
MUNICIPALITY OF ANCHORAGE (MOA)
2 2 5' HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
RECEIVED 264-4720
Legal Des�r-ilp-tion:
A. WELL DATA
I If A, B, C, D.E.C. Approved (Y/N
Well Classification PP )
Well Log Present (U)N) Date Completed `1- Yield z-2 ,
I I
Total Depth - Cased to Depth of Grouting
Static Water Level` ��= Pump Set At J
Casing Height Above Ground ,>(r_� Sanitary Seal on Casing l)
Electrical Wiring in Conduit('N) Depression Around Wellhead (Y(Q
Separation Distances from Well:
To Septic/H..Izldd pg Tank on Lot On Adjoining Lots ti=
To Nearest Edge of Absorption Field on Lot � ��` ; On Adjoining lots _V '
To Nearest Public Sewer Line _ To Nearest Public Sewer
Cleanout/Manhole 3 T To Nearest Sewer Service Line on Lot 1A--) '-
Water Sample Collected by -� L�� `^� ` ; Date �71
Water Sample Test Results—
Comments V�\ ►� - l i SF�rs iFkte \Ajge�
"'�'yL,,
B. SEPTIC/fff tk -TANK DATA
Date Installed `N V_2'?2 Size zs No. of Compartments
StandQSG
pipestN) _� Air tight Caps ON) Foundation Clea oub-(-Y�
Depression over Tank (YO / Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) _NlI14 ; for �
Holding Tank High -Water Alarm (Y/N) Jn Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/-Hntdfrrg"Tank:
To Water -Supply Well __— , 0-� To Building Foundation
To Property Line
To Water Main/Service Line _.
Course
Comments
Page 1 of 2
72-028111/841
I,,
To Disposal Field
N
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption StrataType of System Design
Date Installed \EL," Length of Field 4-�D,
Width of Field lacµ Depth of Field —
Gravel Bed Thickness
1W
Square Feet of Absorption Area ��'�' Standpipes PresentON)
Depression over Field (Y/P Date of Last Adequacy Test o p
Results of Last Adequacy Test
Separation Distance from Absorption Field:
i
To Water -Supply Well ?�
To Building Foundation
Lot `— {
To Water Main/Service Line Vc� It A—
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle,Storage Area
Comments
D. LIFT STATION
Date Installed
d
To Property Line
To Existing or Abandoned System on
On Adjoining Lots "2-o �r
To Cutbank (if present)
N )>n
Dimensions
Size in Gallons f Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Level at AA Vent (Y/N)
Tested for
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I have checked, verified, or conformed to all/MOA and HAA guidelines in effect on the date of this inspection.
Signed3a �° t '1f31f�F i ihlCx Date ley
12� k�n+�
Cornp�fV I LV�1 , t11 IC Jaz MOA No. (&'S — Oo3
V0. 604-P979
Receipt No. C�:=t
Date of Payment q1._.
c P c�Cs
Amount: $ �--
Page 2 of 2
72-026 (11/94)
■ ••vl-C Jw'