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Home My WebLink AboutSUNNY VALLEY LT 7 REM Municipality of Anchorage Page J of '.~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343~4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name: ~ ~ ~ ~ A~' Wastewater System: D New ~ Upgrade ~'~': ~'=~ ABSORPTION FIELD Phone: ~q ~ -- j ~ ~ Deep Trench ~ Shallow Trench D Bed ~ Mound ~ Other LEGAL DESCRIPTION O.~ GPD/Sq. Ft.I Subdiv~io~ )epth to pipe bo~om from original grade: Gravel depth beneath pipe Township: IRange:,-- ISection: -- Filladdedab~veorlgina, rade:..~ -- ~.O~ Ft. Sravellength: ~ I Ft. WELL: ~.~t~~ New ~ Upg~ ~ravelwidth: ~1 Numberoflines: ~Dis~nce~eenfin~: Pipe material: Clarification (Private, A,B,C): T~ Cased TO: Total absorption area: Y~ GPMIPump Set at: Ft, I Casing Height Ab°ye G r°u~: TANK SEPARATION DISTANCES ~s~ptic n Ho~ding ~ S.T.E.P. TO Septic A~sorption Lift Holding )ubli~Private Manufacturer: CapaciW in gallons: S~a~* -- LIFT STATION Line Foundation Iot~ ~ ~ Cu~ainDrain ~ ~o~, ~1~ ' ~ Pump~el IElectd~llns~ctionspedormedby: Remarks: ~ IBSr~ ~ ~d~ ~ BENCH MARK ~ I A"umed E'evat'°n: 'OO. O ~t, Depa~ment of Health and Human Se~ices approval Reviewed and approved by: ~~ ~. Date:~-2- ~ ~ 72-013 (Rev. 9/91) MOA 25 AS BUILT DRAWING P OE.,. NUM.ER: PERMIT NUMBER: SW980432 ' 050-354-24 X X 5 ~'~x~$~ ~X / ~N~ 1300 GALLON DBL2 26.7 36.4 .......... / FD 27.5 40.5 - / C04 118.5 - 77.5 C05 137.0 - 87.0 ~ ~ EXISTING CRIB ~SHED ~ MT1 ARE ~PROXI~T[, BUg TO THE STEEP N~ D~INFIELD ~AS~PARTNERsWATER AND WAS~WA~R CONS~TA~S, ~C. ~~~.h&u" '~'~ PHONE: (907) 337-6179/F~: (907) 33B-3246 LEGAL DESCRIP~0N: SUNNY VALLEY SUBDIVISION; LOT 7, ~PE OF WORK: AS-BUILT OF SEPTIC SYSTEM UPGRADE ................ :-. P~EP~ED ~O~: GARY & LYNNE MAUSS P.OUE UUM~E,: 0~'.... C/O REAL ESIATE ATIN: CINDY WILSON 244-1930 h~ " PERMIT NUMBER: AS BUIL~ DRA~ING PARCEL ID NUMBEE: SW980452 = 050-354-24 ~W BOO d~kON A~S~ WA~R AND WAS~WA~R CONS~TANTS, INC. ~~/ PHONE: (~07) 3~7-6179/F~: (907) ~g-324~ '" ,u,,~ w~,~ ,u,o,~,,,o,, ~OT *. r*:*..~Sl....:....~ PROFILE AS-BUILT OF SEPTIC SYSTE~ UPGRADE ....... ******~ ,o, ~ARY * LYNN* .AUSS *.o.* ,,,*** ~?~-~_:~,_,~, ...- ~ ~/o PARTNERS REAL ESTATE ATTN: OINDY WILSON 244-19~0 J.L.M. N.T.S. 3 OF 3 rOfesslO MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995~9-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 06, 1998 Expiration Date: Nov 06, 1999 Permit Number: SW980432 Legal Description: SUNNY VALLEY LT 7 REM Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Gary & Lynn Mauss c/o Partners R.E. Owner Address: 11940 Business Blvd. Eagle River, AK 99577- Parcel ID: 050-354-24 Site Address: 022144 LAKE VIEW DR Lot Size: 121556 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 is permit is for the construction of: Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99504 (907) 337-6179 - Fax (907) 338-:3246 Consulting Engineers December 17, 1998 RECEIVED Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 DEC 22 1998 Municipality ol Anchorage Oept. Health & Human 8ervicee Reft Septic System Upgrade Design and Conditional Health Authority Approval for Lot 7, Sunny Valley Subdivision To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. On November 06, 1998, your department issued a permit to upgrade the existing septic tank. On November 23, 1998, anew 1300 gallon septic tank was installed and connected to the existing crib. At the time of construction of installing a ne monitoring tube in the crib, it was deternfined that the crib was in a saturated state. An adequacy test had previously been performed and had passed according to some assumed measurements, but after the excavation of the crib was done, it was found that the assumed measurements were incorrect. We request that your department amend the permit to upgrade the drainfield. Also, we request that your department issue a Conditional Health Authority Approval (HAA). It is our opinion that there is ample justification for the issuance of a Conditional HAA by the following: · The existing crib appears to be functioning due to the fact that it is not backing into the septic tank and them are no indications of daylighting effluent. · Due to the steep slopes above the proposed drainfield, it would be very challenging for an excavator to install the sewer service line in winter conditions. · Accessibility to the property is very limited, especially during winter conditions, and will cause a drastic increase in cost making it unfeas~le for our client to afford. The upgrade will be installed prior to June 15, 1999. Comments regarding the proposed design are sumnmrized as follows: ]. SOILS: A test hole was excavated and a percolation test was performed in the test hole. The soils below the organics is a GM/SM material to a depth of 16.5 feet (bottom of test hole). A perco latioatest was performedbetween the depth of 6.5 feet to 7.0 feet and found the percolation rate to be 5 minutes/inch. No groundwater was encountered at the time of excavation and aRer seven days, the monitoring tube waschecked and found to be dry. 2. TRENCH (PRESSURIZED) DESIGN: a. PercolationRates: 5 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 563 tt2 f. Maximum Total Depth: 9 feet (on uphill side) g. Effective Depth: 7 feet h. Width: 2.5 feet i. Reduction Factor = N/A j. Minimum Length: 45 feet k. Effective absorption area = 630 ft2 (563 112 OK) 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the design, the slopes above the of the proposed drainfield are greater than 25%. We propose to install the new drainfield at the toe of an existing cutbank that was created by the exc~avation of a abandoned access driveway~ Below the proposed drainfield, the grade is a 15% to 20% slope running from approximately north to south. The trench is to be installed parallel to the slope contours. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. :ss, P.E., ~.~_ SERVED BY PRIVATE ! -- -'~. -'""'~L-'-- / LOT 4, SUNNY VALLEY S/D ~ ~ "~'-,-~'--. J SERVED BY PRIVATE ~~ / ~~¢ .~ ~. ~---. --'~ PRWA~' /~ ~ _ I~x~ ~ '~ ~'-- ~S~ WA~R A~ WAS~WA~ CONS~T~S, ~C. ~u..~ w~.~ ....,~,.,o.. ~o~. ...... -... [~.~2.. ~...:, ,~ ~ ) P · .: 4 , PREPARED FOR: GARY AND LYNN MAUSS PHONE NUMBER: ~-~,~o ,~,j ~......... c/o PARTNERS REAL ESTATE ATTN: CINDY WILSON '-..... J.L.M. 1 : 100' 1 OF 2 '~~ ~ /kf'/ / J 1300 GALLON PREMIER ~l- ~. /FDOt[ / / PLASTIC" SEPTIC TANK. ~ / _~ .~/ (INSTALLED 11/2~/g8) .~/ CRIB TO BE ~/ / v US~-~S'~ RESERVE SITE. ~ / ~ (E~CT LOCATION IS UNKOWN) ~/ / .~ PROPOSED t / ~/ ~ E~CAVAT~' D~E~.B~ / '/ ADD 7 FE~ OF CL~N, ~/~ / / WASHED SE~.~ T/~-. / / IN.ALL TRENCH PARALLEL T" TO s,o, CO,TOU,S. / ~ ~~co .&,/ / .., TH~ T~ / 7320 E, CHESTER HBGmS CIRC~, ANCHOraGE, ~ 99504 SUNNY VALLEY SUBDIVISION; LOT 7 DETAIL FOR SEPTIC ~YSTEM UPGRADE ~~:' "~:"'~ ,R[~A~SO foR: GARY AND LYNN gAUSS 244-19~0 c/~ PARTNERS REAL ESTATE ATTN: 61NDY WILSON ~¢~. "., J.L.M. 1 = ~0~ ~ OF 2 ~rofe~a[o°~-~~ ALASliA WATER. Sr. WASTE, WATER CONSULTANTS, INC. ] '~'~'= ...... .~/~ 7320 E. CHES~..TS. C~.CU~ ' A.CHO.~GE. ^K. 9.~0~ ! DATE PERFORMED: 12/9/98 ~h~ f'. C -7955 ." ,~<~ .... , ..." .,¢~ I TEST HOLE ¢1 [ ~&%'-~ "* ........... o, ORGANICS ~EPTH ~ f12~ ~SOIE ~C~SS g CAT ONS #, k~ ~q~c vl~', ~ GM ~ CL ISIT ~ aEDROOM ~ -" ~ ~L I r'= mo' I % /~, HOUS~ ~SW Iltlllll NH ~. ~ ~'/(SEEPAGE2 OF2) ~EPTH TO ~.~ t / 12ROUNDWATER .... ~ I] GM/SM DRY ,2/./.. ~ DRY 12/16/98 (~x (SEE DESIGN, PAGE 2 OF 10 DATE RE,lNG CLOCK NET TINE WATER LEVEL NET DROP 11 TIHE (HINUTES) READING (INCHES) 12/10/98 1 6:57 ~ 6" 13 3 7:07 6" 4 7:17 lO MIN, 4" 2" 14 ~ 5 7:17 6" 6 7:27 10 MIN. 5 7/B" 2 1/8" 15 7 7:27 6" ~s~ - . 7:~7 ~0 ~. ~ ~ 7/c' ~ ~/." B.O.. 9 7:57 6" ~ 11- 7:4~ -' 6" . 18~ ~ 12 7:57 10 MIN. 4" 2 19~ PERCO~TION ~TE ~(HIN./INCH) P~RC. HO~ DIA. 6" (iNCHES) 20 1 TEST RUN BE~EEN~_/~6-5 ~, ~D~J~ ) / ///~ / f/ DATE. DATE: // DEPTH TO DATE 3ROUNDWATER DRY 12/9/9, DRY 12/10/98 DRY 12/16/98 Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle - Anchorage - Alaska 99504 Phone (907) 337-6179 - Fax (907) 338-3246 Consulting Engineers November 3, 1998 Municipality of Anchorage Department of Health and Human Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Septic Tank Upgrade for Lot 7, Sunny Valley Subdivision To whom it may concern: The existing 3 bedrpom house is served by a private well and a septic system that consists of a 750 gallon septic tank and a crib type drainfield. The septic tank size does not meet the minimum requirement cfa I000 gallons for a 3 bedroom house. We propose to excavate, pump, crush, and abandon the existing septic tank by burying on-site; and replace it with a new 1300 gallon "premier Plastic" septic tank. Double cleanouts are to be installed after the new tank and a foundation cleanout is to be installed. We request that you issue a permit to upgrade the septic tank. I am unaware of an systems. If you ha~ assistance. adverse impacts this installation would have on adjacent wells or septic any questions, please contact us at 337-6179. Thank you for your arness, P.E., M.S. ~ LOT 5, SUNNY VALLEY S/D / / J / t ~. "~--- / LOT 4, SUNNY VALLEY S/D I t ~ ~. '~-..~ WELL AND SEPTIC t ~ '~ ~ ~''-~ i LOT 3, SUNNY VALL~ S/D ~1 '~ ~-.. SE~O BY PRIVATE / ~ ~ ~ . I ~ EXIS~NG ~ '~ '~''' / ', ~ C ~/ ~2~ ............. 7'~ '~-~ ~ / LOT B, SUNNY VALL~ S/D ~S~ WA~R A~ WAS~WA~ CONS~TA~S, ~C. ~m~ ~ FA ~ SUNNY VALLEY SUBDIVISION, LOT 7,~~~~ ......... '...Z ........ : SITE P~N ". .... PREPARE~ FOR: GARY AND LYNN MAUSS PHONE NUUnEm '~ t._~~E-7955 .' .~ c/o PARTNERS REAL ESTATE ATTN: CINDY WILSON ~e~" ............. '~ 11/3/98 J.L.M. 1 = 100' 1 OF 2 A~{r~,ofossio~ _ // //CO~~U ~INSTALL DOUBLE CL~NOUT SEPTIC TANt( TO BE EXCAVATED, PUMPED, CRUSHED, AND ABANDONED. EXISTING CRIB DETAIL FOR SEPTIC TAN~ UPGRADE ~.~.,.~ ~eEOAeEO FOR: GARY AND LYNN MAUSS 244-1930 o/o PARTNERS REAL E~TATE ATTN: CINDY WtL$ON · MAR--28--96 THU 09:$4 PM SULLIVAN WATER WELLS by SULLIVAN WATER WELLS P.O. BOX 670272, CHUQIAK, ALASKA 9956T * TELEPH ONE ~.v~tss _~ 6 ~O'~ 151 ~61 ~ ~tff/q ST,kTICLEVELOF~AT[RFT- LEGAL D[Sc~I~Io~L~ ~ ,~0,6.'[~~ D~W DOWN ,Ft. Ft. __Fi From~Ft, to Ft_~ From .Ft. to From FI, to~ FI, From.. Ft, to From__ Ft. to__ From ~Ft. to FI-~ .~ From FI, lo--FI From Fi- to From Ft. to Ft.~ From Ft. to~ From~Ft. to__Fi. From. Ft. to__ From.. Ft. to Ft._ From Ft. to~. From .Ft. to. Ft. From Ft. to.__ From~~ Ft, to Ft._ From ~FI, to From ~Ft. to F¢. From ~Ft. to MISCL. INFORMATION: DRILLER'S NAME '" ANCHORAGE AREA BOR Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME/'~///~:7////~/~- ~'~':~-/~/' MAILING ADDRESS ~ ~ ~~ PHONE~ LOCATION ~//~- ~/~ ~/, ~ ~GAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER ~/~2C.~'~ZZ¢ ¢//M AT E R I A L INSIDE WIDTH .LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY ~7~-~' GALLONS. SEEPAGE Pit: NUMBER OF PITS LINING MATERIAL ~/'~--~ BUILDING FOUNDATION DIAMETER ~/OR WIDTH /~,/ LENGTH//~, DEPTH ~' / CRIB SIZE: DIAMETER DEPTH ~ / DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE/~/ . ABSORPTION AREA (WALL AREA) .SQ. FT. ADDITIONAL ABSORPTION TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION __ LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DEPTH NEAREST SEPTIC SEWER LINE TANK REMARKS. DISTANCE FROM: SEEPAGE S'~'STEM DISTANCES: INSTALLED BY: ~-~-'-~/~-~ DIAGRAM OF SYSTEM PiPe MATERIAL: LOT SLOPE: Form No, EQ-031 GREATEr ANCHORAGE AREA BOROUGh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE~ ALASKA 99503 TELEPHONE 274-456I PERMIT NO. SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT FINANCED THROUGH TO BE INSTALLED ~Y COMPLETION DATE ANTICIPATED . FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. EXC~AVAT~FFT INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRT]GHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. DATE 7.-~ APPLICANT'S SIGNATURE 0 8' E ENG~IWEERING 8' DEVELOPIf/t~¥T CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 333-5240 Russell Oyster Earl Ellis 694-2774 333-5240 Civil Engineering Surveying Soils ~ Foundations Land Development SOIL LOG Performed for: Name: %~.~--~ ~,~.y~ ~-~c~ Tel. No. '~77-~ .ailing Address: ~ ~ ~ ~c~.~, ~7 Legal Description: ~ ~ ~ ~ ~yN~w~ ~ ~,~ ~A~ Depth (feet) Soil Characteristics 3 4 5 12 Ground Water Encountered: Yes__ No ~ If yes, what depth Proposed InStallation: Seepage Pit ~'~ Drain Field Comments: ~ \q~''~' ~,~ ~'F/'~,,b ~,~-~':~ , "~-~","~ o~ Performed by: ~"'~ (~.~-~--,~' Date: MUNICIPALITY OF ANCHORAGE o.rff „+ Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval 5 /5/ 20 _Z-3 Parcel I.D. 050-354-24 Expiration Date: -2-3-2-023 Legal description Sunny Valley Lot 7 REM Site address 22144 Lake View Dr, Eagle River, AK Current property owner(s) George Kivlan X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: BY. Original Certificate Date: 11-3-22 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 41 MUNICIPALITY OF ANCHORAGE Development Services Department �� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-354-24 Complete legal description SUNNY VALLEY LOT 7 REM Location (site address) 22144 LAKE VIEW DR EAGLE RIVER, AK 99577 Current property owner(s) GEORGE T KIVLAN.... Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age _23 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ® Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 55L Waiver Fee $ Date of Payment l of al;o COSA # Date of Payment Waiver # COSA Application—July 2022 copy.doc Legal Description: SUNNY VALLEY LOT 7 REM Parcel ID: 050-354-24 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Well production at time of test 1.11 gpm Date drilled 4/3/1996 Total depth 160 ft Water storage tank volume NA gallons Cased to 160 ft Well disinfected for coliform test? ❑ Yes ® No ® Sanitary seal is functioning correctly ® Coliform bacteria is Negative ® Wires are properly protected Nitrate 0.378 mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) 36 in. Arsenic ug/L ® Arsenic less than MRL (ND) Date of flow test for COSA 8/4/22 FWIN Static water level at beginning of test 21 ft. Collected by Date 5/12/2023 Comments SHALLOW WELL W/ LOWER PRODUCTION — PEAK USE MAY NEED WATER STORAGE. B. TANK DATA C. LIFT STATION Measured operating fluid level in septic tank 47" ❑ Required maintenance completed Date of pumping 8/4/22 Age of lift station years ❑ Required maintenance completed, if AWWTS Lift station material Comments: 1300 -GAL PREMIER PLASTIC S.T. Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/14/73 ® ALL standpipes present per record drawing Total measured depth from grade 11.5 ft (max) Measured depth to pipe invert from grade *NA ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ® Monitor tubes go to bottom of effective. If not, state depth into effective *ASSUMED ® Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 8/7/22 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 8/8/22 Results ® Pass Fluid depth prior to test 0 DRY in Water added 600 gal New fluid depth 9 in Elapsed time <1440 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 0 in Effective depth remaining 72 in CRIB WAS DRY 5/12/2023 Comments/Deficiencies: SWITCHED FROM TESTING THE FIELD TO TESTING THE CRIB AS THE FIELD DID NOT PASS. *1998 COSA SHOWS 12' CRIB TOTAL DEPTH W/ 6' EFFECTIVE DEPTH. COSA Checklist—July 2022 copy.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' - - Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes — if No ft ®Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ®Yes if No ft Community Wells > 200' ® Yes if No ft WaterServiceLine > 10' - ® Yes if No -- ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907.350-9566 Engineer's Printed Name CUR_TIS HUFFMAN,PE Date 6/2/23 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & flaGS COSA Checklist—July 2022 copy.docx _49 7H Curtis Huffman F,>f�F0 .. • . • � �k� PROFESSIONS' Certificate of On -Site Systems Approval Parcel I.D. 050-354-24 Legal description Sunny Valley Lot 7 REM Site address 22144 Lake View Dr, Eagle River, AK Current property owner(s) George Kivlan Expiration Date: 2-3-2023 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date. 11-3-22 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Appraval_June 2022 l MUNICIPALITY OF ANCHORAGE Development Services Department �� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-354-24 Complete legal description SUNNY VALLEY LOT 7 REM Location (site address) 22144 LAKE VIEW DR EAGLE RIVER, AK 99577 Current property owner(s) GEORGE T KIVLAN.... Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age _23 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ® Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment COSA # Waiver # COSA Application—July 2022 copy.doc Legal Description: SUNNY VALLEY LOT 7 REM Parcel ID: 050-354-24 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled 4/3/1996 Total depth 160 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 160 ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 0.392 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 36 in. FWIC5 Date of flow test for COSA 8/4/22 Collected by Static water level at beginning of test 21 ft. Date 8/11/2022 Well production at time of test 1.11 gpm Comments SHALLOW WELL W/ LOWER PRODUCTION — PEAK USE MAY NEED WATER STORAGE. B. TANK DATA Measured operating fluid level in septic tank 47" Date of pumping 8/4/22 i ❑ Required maintenance completed, if AWWTS Comments: 1300 -GAL PREMIER PLASTIC S.T. D. ABSORPTION FIELD DATA Which system tested (date installed) 8/14/73 ® ALL standpipes present per record drawing Total measured depth from grade 11.5 ft (max) Measured depth to pipe invert from grade *NA ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ® Monitor tubes go to bottom of effective. If not, state depth into effective *ASSUMED ® Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 8/7/22 date Any rejuvenation treatment (past 12 months) N If yes, enter date C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 8/8/22 Results M Pass Fluid depth prior to test 0 DRY in Water added 600 gal New fluid depth 9 in Elapsed time <1440 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 0 in Effective depth remaining 72 in Comments/Deficiencies: SWITCHED FROM TESTING THE FIELD TO TESTING THE CRIB AS THE FIELD DID NOT PASS. *1998 COSA SHOWS 12' CRIB TOTAL DEPTH W/ 6' EFFECTIVE DEPTH. COSA Checklist—July 2022 copy.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Neighboring Absorption Fields > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Animal Containment > 50' ® Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water >100' _ ®Yes if No Tank to Property Line > 5' ® Yes if No ft Field to Property Line > 10' ® Yes if No ft Water Main > 10' ® Yes if No ft Water Service Line > 10' ® Yes if No ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' ® Yes if No Community Wells > 200' ® Yes if No If tank or field is under driveway comment below ft ft ft ft G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN PE Date 10/27/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic `� applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, �,. • ' • • • . local soil characteristics, groundwater levels that may fluctuate during the year, quality of s�t; •' • !� construction (workmanship & materials), the water usage of the family being served by the®� • �� system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the , • ; • , • , . • , , , • • , well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory P'F for current or future occupants or guarantee that no unseen encroachments, deficiencies or • • • • • �{ discrepancies exist can be given by First Water Consulting & FlJCS �• Curtis Huffman T ��c��'l ' • .0E 12 10/28991 •C��Q'��* 4ROFESSOW COSA Checklist—July 2022 copy.docx A= v my3fD - (� < H all O A r � y Q. 35, 0 rrn m o -~ o< m Z A x"1'1 m z m Q m CD °° m o°mam�� W Z 1 o -Oi-.t IQ t1 —M —fa 0— N 0+ I m m m N y V s Q VJ '10m .► CD Q m O Q..A+• Z m V J r r Z N -•� s0 o aooD-Zt� Q I m .� Q 0 I CD °0 I ° ��nm GL I 3-« I Q °Q.�.+��Q Q o ° is to *to m Q s(fj v Q :33 a m c O. y CL °' N m `U m m 1- 0.Q Q Baa)° 'i �%1 m Q3 j� °nos -00-o <G r o• M ?„ C f 3 m I� s� O sE5ta y' O m za" II Q Icn m X i 7 7 o m"O-0 o U) lo cr 1 >> ,m'im Q p Iti 0 14 -00 Q 0 o t? Q N -+, O Q q I m ?Qv�..i0 O aro 7�'�� j 3=cncnvl a"C m-.tQyo �(AAto NNa IM ym <3mM-. o= I 1 � 1* oQ � ym�Q. 32�a3 -Io y A tQ m 0) .1k, W3 ° mCmm Cntn'iirn3 iCO m z i O C -- p .K 3 � '0 m N m p 0 X S_ O G3 m A m s o H -* O m Q � -A« oQoo�pp� m z 0 o N A. -P O Q n D f% rC" Z. �% �N m Yl to IN)Ln /j t0 Z : N (4 C. _Ul 0, to {/ Cn r �p): 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 050-354-24 "~ HAA# GENERAL INFORMATION Complete'legal description Lot 7; Sunny Valley Subdivision - CONDITIONAL Location (site address or directions) Property owner Mailing address Lending agency 22144 Lakeview Drive .Anchoraqe, AK Gary a Lynne Mauss. Dayphone (505) 292-9695 C/O Partners Real Estate 11940 Business Blvd. Eagle River, Day Chone AK Mailin. g address. Agent Cindy Wilson/Partners Real Estate Address Day phone 244-1930 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well X× Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: XX Individual on-site Holding tank Community on-site Public sewer 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~21 5. , STATEMENT OF. INSPECTION BY ENGINEER: ~ r ~ ~ : ' As certified by my Seal affiX~ heret0 ahd ~Sbf~he Validation date shownbel(~w, 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 invest gatior~ 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 Name of Firm~( Address Engineer's signature REQUEST YOU ISSUE A CONDITIONAl HEALTH AUTHORITY APPROVAL DUE TO ~INTER CONDITIONS. SEPTIC SYSTEM TO BE UPGRADED NO LATER THAN 15 JUNE 1999 ALASKA WATER & WASTEWATER CONSULTANTSt BE PAID $2620.00 AT CLOSING, FOR E~NGINEERING PERFORMED TO DATE. the date of this inspection. g, ff/'E~ i~/75'/~/Y~ ,~¢~- 3~c :Phone ~ ~__ Date INSPECTIONS IN ESCROWED FOR INSTALLATION 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. ~- Conditional approval for '~"~ bedrooms, with th-e following stipulations: The septic system on this lot shall be upgraded pursuant to the attached permit #SW980432 no later than June 15, 1999. Money shall be placed ~n escrow for 1½ times the high bid from a minimum of three(3) bids. The h~'l~n~ ~ ~'~w ~-nd~ sb~11 b~ ~1~o~ ~ =~ ~ .... ~ C~rtificate of Health Authority Approval has been issued by this Department. If there Additional Comments 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.. RECEIVED Municipality of Anchorage DEC 2 2 1998 :, DEPARTMEN'F OF HEALTH & HUMAN SEi~:~jy~Ty oF ^NCHORAGE Environmental Services Divisio~3NVlRONMENTALS~:gViCEs PNI$1ON 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: Health Authority Approval Checklist X~A~-~'( ~'/0 ~ Lo-r -'/ Parcel I.D.: A. WELL DATA Well type Log present ~N) Total depth Sanitary seal (t~N) IfA, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to I ~,oI Casing height (above ground) Wires properly Protected (~N) FROM WELL LOG AT iNSPECTiON Date of test Static water level Well production 'Z..~ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate It g.p.m, I. ~-.. g.p.m. ~ ~ O'2-- ~,/~ Other bacteria (~ Collected by: /~. uJ. ,~1. ~. ~ I ~J C. B. SEPTICIr~R~i~TANK DATA Date installed '~/Z~>/]~~, Tank size I.~OO/~f,~w~_ Number of Compartments 'Z- Cleanouts(~)_ Foundation cleanout (~) "'~--~ Depression (Y~ /J o High water alarm (Y~ /'Jo Date of Pumping ~r--~ Pumper -- C. ABSORPTION FIELD DATA Dat~ installed e~H/'T_~ Soil rating (g.p.d./ft~ or fF/bdrm) Length Width Effective absorption area '''y' ~oo ~ Date of adequacy test 10/I $~ ~ O, Y,,. System type Gravel thickness below pipe ./4/~ Total depth '~ Monitoring Tube present (~N) YP.~.C Depression over field (Y/~) Results (Pass~ ~ Ic-~'~ L- For bedrooms /Oh'" Fluid depth in absorption field before test (in.); ~>~)~ Immediately after ~Bff gal. water added (in.): Fluid depth (~) ~'~'~ (ins) Minutes later: ~) mo~_~ ~,~. ~A~sorption rate = ~O + g.p.d. Peroxide treatment (past 12 months) (Y~ ~o~E ~ If yes, give date 72-026 (Rev. 3/96)* ~ TH~ S~sce~ ;5 ~o~d6 &~ ~ ~sm~ D. LIFT STATION I,~ /¢~ Manhole/Access (Y/N)~--'------------.~ ,,.2Ptn'h'~ on" level at* "Pump off" level at*. High water alarm le~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot I0o Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ 6, ~- Property line 1 0 ~ Absorption field _% 4- Water main/service line lo I.~ Surface water/drainage I°OI1' Wells on adjacent lots IOoI +' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line Surface water Curtain drain F. ENGINEER'S CERTIFICATION I certify that I hav.¢~l in conformanc~with/~ Signature ~, ~f'¢/ , '-"/'/' Engineers Nam6 Date ) 014- Building foundation 1 ~2 ~+ Water main/service line Ic~t -(- Driveway, parking/vehicle storage area kJoN~ ~4a~J~ Wells on adjacent lots Ioot'~ ~ned.~/~e~ inspections and review of Municipal ~~~ H nes in effect on this date. HAA Fee $ &~7'~d, ~ Date of Payment/,~ '- '~'~ --/~¢ Receipt Number ~¢~ ~/~/~,~ ,¢~¢ CZ¢~/~/~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 Parce[ I.D. # RELEASE OF CONDITIONAL HEALTH AUTHORITY APPROVAL CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-354-24 NAA# ~ ~ ,~ (~ ~'~ Lot 7; Sunny Valley Subdivision GENERALINFORMATION Completelegaldescription Location (site address or directions) P~operty owner M~!ling address Lending agency Mailin. g address 22144 Lakeview Drive Eaqle River, AK Gary & Lynn Mauss C/0 partners Rea]_ Estate Day phone 11940 Business Blvd, Day phone Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well X× Community well Public water 244-1930 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Eaqle River, Alaska Individual on-site Holding tank Community on-site Public sewer NOTE: XX If community wastewater system, provide written confirmation from State ADEC · attesting to the legality and status of system. Front MOA ~21 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/t~/~s inspection. Name of Firm ALASI~A..WCt (/~1~ w,~N~"r~~'"~/"f Address 6~1 DEB~ ~8U~ ~ , ;; CHO Engineel s signature *~ PLEASE RELEASE CONDITIONAL H.A.A. PERMIT #SW980432. :EPTIC SYSTEM HAS Phone 23'% DHHS SIGNATURE /~ Approved for -7-/'//~ ~.~' bedrooms. Disapproved. Date BEEN UPGRADED PUR~NT TO .... Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 DH HS 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. Legal Description: A. WELL DATA Municipality of Anchorage R E (~ E I V E D DEPARTMENT OF HEALTH & HUMAN SERVICES . - Environmental Services Division JUL 1 1999 825 L Street, Room 502 · Anchorage, Alaska 99501 · Dept, Health & Human ~erwces Health Authority Approval Checklist Well type ~ If A, B, Log present Y~N) Total depth /~O O ! Sanitary seal ON) y~-~- ~ or C, attach ADEC letter. ADEC water system number Date completed Cased to / ~ ~ / Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform '-~ Date of sample: Casing height (above ground) c'~ Wires properly protec!ed ~N) AT INSPECTION / // FROM WELL LOG g.p.m. /'8 --~ g.p.m. Nitrate SEPTIC/HOLDING TANK DATA Date installed ~/~/~ Tanksize JS~O Number of Compa,ments Foundation cleanout~N) ~ Depression (~ D~te ~ pumping ~ Pumper C. ~ABsORPTION FIELD DATA 'Dateinstalled ~/~ q/ ~ ~ I~"ength /'-//7I Width 3 Soilrating (g.p.d./ft~orff2/bdrm) O' <~ Systemtype ~ )0 ~-f~rt~,,. Oravel thickness below pipe /7,~ Totaldepth ~.7~'~o ~ Effective absorption area ~7~ ~ Monitoring Tube present (~N) y Depression over field ('1~ .. Date of adequacy test /,-3/) / , r~''''~ Results (Pass/Fail) Fl~~ Immediately after Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* For gal. water added (in.): g.p.d. bedrooms LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level E. SEPARATION DISTANCES "Pump off" level at* *Datum Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / _ On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ,~- / ~ · ~ Property line ~ '¢- Absorption field Water main/service line /(~ .'~ Surface water/drainage /~¢ .-/'- ! I DO .¢- I d ,¢ "-/- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /'~) ~ _ Building foundation ,/~ '¢- Water main/service line Surface water / ~0 "-/' Driveway, parking/vehicle storage area Curtain drain F. ENGINEER'S CERTIFICATION I certify that l h~C~cCCmi~¢'~ in conforman~e wit~/~/Hf ,~ Engineer,s Nam~eJ ~ Date 7/,/~"~J~ Id inspections and review of Municipal records #ines in effect on this date. HAA Fee $. Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY'DWELLING 1. GENERAL INFORMATION Complete legal description Lot 7; Sunny Valley. Subdivision Location (site address or directions) 22144 Lakeview Drive Anchorage, AK Property owner Mailing address Lending agency Mailing address Agent Address Wayne L. and JudV Patson Day phone 694-9338 P.O. Box 141261 Anchorage, AK 99514 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 "-~ TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attegt- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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) Fronl MOA #21 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 & $ ENGINEERING ]7034 Eagle River Loop Roa~ No, 204 Add ress Eagle River, A~aska 99577 ~ Engineer's signature ~/~ ' .F~ r'~ Phone DHHS SIGNATURE Approved for 3 Disapproved. Conditional approval for bedrooms, bedrooms, with the following stipulations: Additional Comments '['he Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certific~.~tes based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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. 72~25 (Rev, 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division Alaska 99501o MUNICIPALITY OF ANCHORAGE 825"L" Street, Room 502 · Anchorage, E~,Q~:~rJ~t~ERVICES~i~~-w~''~'''' ''- DIVISION Legal Description: A. WELL DATA Well type Log present~) Total depth Health Authority Approval Checklist APR 03 1996 RECEIVED If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ ~b Cased to ~ ~ c.. ¢-- Casing height (above ground) Sanitary seal ~q) FROM WELL LOG Date of test '"5 ~ L- Static water level I co~ Well production .Z, ~'- g.p.m. Wires properly protected g~N) AT INSPECTION WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of salnple: '5 ~- 2.-t~ ff ¢ B. SEPTIC/HOLDING TANK DATA Date iustalled ~-~{~'13 Foundation cleanout (Y~ Date, of Pumping C. ABSORPTION FIELD D~TA Date installed Collected by: Other bacteria S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Taltksize 7~ Number of Compartments / Cleanoutsl~q) ~/ Depression (Yd~ /J High water alarm (Y/H) '&/~- Pumper _T'._~. [g O~4F t~{f Soil rating (g.p.d./ft2 or ft2podrm) __ System type Lcl~gth ]'g> * Width / 5'- / Gravel thickness below pipe 6, r Total depth // Eff6ctive absorption area J 00 . Monitoring Tube present'N) ~/ Depression over field (YI~ Date of adequacy test h/~',g ~'6 Resultsc~ail) taA"~$ For .-~ bedrooms Fluid depth in absorption field before test (in.); .3 9/ Immediately after gal. water added (in.): ¢'6" 7 ~"~ Fhfid depth z/tt" (illS.) Minutes later: ~,~" Absorption rate ,/,fi3 4- = g.p.d. Peroxide treatment (past 12 months) (Y4~ /OoN,~ /g-n),~..v,4f yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pnm~F' level at* Ifigh water alarm level ~ *~lk~~~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic stax, icc line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanont Li~ station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ¢- I ~ Property line ~ t> ~ 4-- Absorption field Water main/service line t,O Surface water/drainage ~ o v Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Bnilding fonndation ~ ,0 k4--- Water main/service line [~ Snrface water ~ r> ~ ~ ~ Driveway, parking/vehicle storage area Curtain drain ~.O h. ;t-a)o,).~Wclls on adjacent lots ~ ~o t.J~ Property line F. ENGINEER'S CERTIFICATION I ce,'tif, v that I have dete,'mined th,'ufield inspections and review ofivlunicipal . . . , . m conformance wtth b/OA ~1 guidelines m effect on thts date. . . _ ' ... ~;, . _ -~t~ HAA Fee *~ ~ e dY Waiver Fee $ Rev. 8/95 OSS: haa.wk.dnc