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HomeMy WebLinkAboutSUNNY VALLEY LT 26,Sunny Vail Y Lot #050-354-01 Nw O N 00 Ln C to L 1 I I w I / a O W �. M'O'd 1 ,OE 00 0 %D L a P. -- Lo a � a w \ c - ` J V99 LU v I J 6 0ZZ co o U O Q Zs:Z. W \ 9 bl L-0 O 0 h V-4 � a I o.. m M ; p.. ` Z 2 M N I O � m El)a 2 -0 1 Z ui `� r ( a41 0 L m 3 1 �O O L a ai I y a J CL I m2 NE I N N Q) N -4 m °)� L 0 1 N L M W O F6 O' 0 u 76 a) I N LL7 107 \ (0) 8E'ou 3.,00.00.005 96'OEE M.10 XP AOS - ---------3AI&(73>M71S3M 3 --= - - PI -86107 73/1 v(VE) j0 3003 00 CY O O (8)6b'6ZC 3„00,00.00N 1 a� Iw P. -- Lo a w \ c - ` J V99 v I J 6 0ZZ co o U O Q Zs:Z. I� \ 9 bl ti i � a =AVM.gAld(7 IWO o> ; p.. ` Z C + + N � m O -------------------- N �\ 11+,, LL -_j Li r., ^'1 `t � E v; v Z3 0 ) C ¢maxXI X- Xadz.\ o. > ti N N I N N �w I +/ 662 �\2de., °)� o 0 Z p y 0 M M N F6 O' CO In W 0 �E ,T p \nyp W III .Y I ¢ \ O N ro api `p nyp \+ W _nyo @ v fl i g I a v K b'bZ Q I nyo s v a -o C M ”I a . 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' ~ ~ /I / LOCATION / / NO. OF BEDROOMS ~ DISTANCE TO: ] Well/~/.~ Absorption ~e~ Dwelli~ ~ ~ ~ Manufacturer ~ O ~ DISTANCE TO: I O ~ ~ Manufacturer Material Liquid capacity in 9ellons ' DISTANCE TO: Well /O~O + Foundat~ + Nearestl~n~ ~ r~ m No. of lines~ Length ¢ line Total lengt~ ~ of~ines Trenc~C~- inches Distan,~tw¢~= ~ ~ Top of tile~ fi~sh gra~ / // ~al be~t~ile ~/ Total effective absorption area Length Width ~epth ¢ PERMIT (P Type of crib Cr,b di~ Crlb depth Total effective absorption area ~ WeB Building foundation Nearest lot llne ~ DISTANCE TO: ~ ~ Dlass~/~ ~ ~ Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) . OTHER INSTAELER / REMARKS / ............. :':L E'3 ':"'c 72-~(Rev. 3/78) / ~ ( e fie Drilliug og OOC Co, dba SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2769 LEGALDESCRI~ION d ~,26, .,~,fO,.O DATE - Sta~ed ~),/~¢:~) Ended PE~IT NUMBER DEPTH OF WELL STATIC LEVEL OF WATER FT. DRATM DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From (9 Ft. to :-~ Ft. From "~ Ft. to ~') ) Ft. From .i)~ Ft. to ~/~,/: Ft. From "?~-~' Ft. to :~ & Ft. From--Ft. to Ft. From ;(~ _Ft. to 0 [ .Ft. From Ft. to Ft. From __ Ft. to Ft. From Ft. to__.Ft. From __ Ft. to Ft. From Ft. to__Ft From __ Ft. to.__ Ft From Ft. to__.Ft From __ Ft. to Ft. From Ft. to Ft. From __ Ft. to Ft From Ft. to Ft. From From From__ From From From From From From From From From From From From Ft. to__ .Ft. to Ft. to Ft. to Ft. to Ft. to Ft. to Ft. to_ Ft. to Ft. to - Ft. to__ Ft. to Ft. to__ Ft. to ___Ft. to__ Ft. to Ft. to.__ Ft. Ft. Ft. ~UNICIPALITY OF ANCHORAQE ~NVI~'~i'4MSN1A. /'ROt ECflC)Iq Ft. Ft.~ Ft. Ft. Ft. Ft Ft Ft Ft Ft. MISCL. INFORMATION: DRILLER'S NAME '¢' "':' ' .... ~F'F'L Z CFIN T LOC:RT Z ON L_£CGRL P,,- F.:EQL!]:RED ,-"'~ .... ::,].,~E. EIF' THE: c',-'~? FIE'.E--OtTF'TZON ..... r ._ TE. f7 'THE LENG-FH E:'Ib'tENST'"f. I:.E; -FkB' FNG';- '::IN FEE:T) O1:' THE TF:ENC:H CRt '~:':* n'"~: ," ' ' .................. · IN ! ....... L*... THE F"i:'~'"rFi riF ~ 'TRFN-:H O~: F':[T T,:: 7"H[~ [:'ZE;TRNCE D~THEEN THE c ~,F-,:p.F- CF THE GF:OUHt") RN[) THE E:OTTOH NF THF' F"*'""~'c4'T'T THERE P::; N-I "'F~.' .... :,-...7 !.'.I]:DTH FOR TFi:ENCHE~;. · r -~F , H,._ HIN]:HIJH '"F:' RND THE BOT'T':H OF THE E,.~rF. VFI-Ft:N ,::IN FEET>. ._.. !,~ Di TF':a ..... F:'ZF'E C,F'[;,H"~ RF'F'LZC:FINT H~ .. THE F::E:~;F'ON~;]:E::[L]:T'.r' "i"O Z ,,PJn.., 'THZS DEF'RRTHENT E:'IJF~ZNE~ TFIE ]:N:STFILLFI'FIC$1 ~NSF'EC-FD:)I'.4E; "'iF' ......... ,~*-' F'RLJF'E. RT"r~ ,u~[. 'Fi4C NUHE~EF: F'F RE:SZDENCE~; T'HF!T 'T'H~:' ........ ~'" ~-..~ C~ ":" "-':" ':" ZC ~- ~ ~; F::= J~' .--- T E~F-FF"[ It"~q 0F' FIN'T' ':'"-' ', ......................... .......... · :,lE!l HI'TH()UT r"~*,-, E:'EF'RF:TH~NT I.,.~ Z LL E~E :E;IJE .YE 7T TO F:'FIC~SEC:LIT I ON. ZE~C~ FEET FO~: R F'F:IVFFFE: HEL. L OR :jF~l;~ T0:2m;~ FEW~ FIE:OH R F'~[:'I T~ ........... - ........... HELL. - ~=~'~ NE. ZNla ,JrLl~'J THE T?F'[ ElF F't E_'r": HELL. OF THE I.,.!ELI COHPLET:[ON. ' ...... F" ~ ~-';E.~ ~.'~ Z' 'T" ~,:= ........ :::- -- ........ . .......... ..,- "='~' ,-,.,.. -~... Z :E~:T~F"T' THFFF Z: T ~P'I FFII"iILIRN: I.,.I:[TH THE c',,--- ~ F'O~: FIN--'::TT~r "-CrhF'-,,'"; ,,- ,- ..... :,,.:~. ~:.m= FINE:, N~:LI - '- ':' '::'F' ' FOF:TH D'f THE HUNJ:CIF'~L.]:T't' 2: i HILL INfS-FRLL THE E;VSTEH ........ I F~.:. CL!E.,~,. q: i !lhOf:FqTF"4', ... ' ...... , .......... ... '"_ :' E.= E=--'' ,. .................................. POUCH 6-650 ANCHORA©E. ALASKA (907) 26,1 4 I 1 i January 4, 1982 Robert D. Warpack 4222 Piper St Anchorage, AK Permit ~ Subject: A permit 810972 LOT 26 SUNNYVALLEY SUB issued by this department for a well and/or sewer system has expired as of December 31, 1981. 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 should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for files. If there are at 264-4720. our any further questions, please call this office Sincerely, Sewer and Water Program Enclosure: Copy of Permit PERMIT NO. RF'F'LICRN'F LOC~TION !_EGRL ROBERT D. HRRF'RC:K SPRING ST. & HESTLRKE DF:. LOT 26 SUNNMVRLLEM SUB 4222 PIPER ST LOT SiZE 274-8119 ,4.~560 SQURRE FEET' TYPE OF SOIL tBBSORF"I"!ON S'¢ST'EM tS: TRENC:N MRX!MUM NUMBER OF BEDROOMS SOIL,. RRT!NG THE REL.]UtRED SIZE OF THE SOIL RBSORPTION S'¢STEM IS: [/. [E F" -F b~ .... SM b.. E:f'4 ~:3 "F ~4 == :1. :1, ,¢2::, ,Z/S: E:L~ ia '-.-' E [ .... E/-. E£ F" "]'"' ~-~ == 'THE LENGTH DIMENSION IS THE LENGTH (IN PEET) OF 'THE TRENCH OR DRR!NFIEL. D. THE [:,EPTH OF R TRENCH OF.: PIT tS TNE DISTRNCE _SETHEEN THE SL.~RFFIC:E OF' TNE GROUND FIND TNE BOTTOM OF THE EXCRVRTION ,::IN FEET). TNERE ILS NO SET NIDT'H FOR TRENCHES, THE GRR',/EL DEPTH I:.S 'THE MINIMUM DEPTH OF GRR',/EL BETHEEN TNE OUTFRLL PIPE FIND 'THE BOT'T'ON OF THE E::<CR',/RTiON (iN FEET'). PERMIT BF'PL. ICRNT HRS THE RESPONSIB!LI"FL,' TO INFORM 'THIS DEPRRTMENT DURING THE iNSTRLLFFi'ION INSPECTIONS OF RN"¢ NELLS RDJRCENT TO THIS PROPERT'¢ RND ]'HE NUMBER OF RESIDENCES THRT ]"HE HELL HILL SER',,,'E. 8RCKFILLtNG OF RNS' S'T'STEM NITNOUT FiNRL INSPECTION RND RPPROVRL,, B'¢ THIS DEPRRTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM [:,ISTIaNC:E BETWEEN Fl NELL RND HN'¢ ON-SITE SEWFtGE DIS:;POSRL S'¢STEM IS :L00 FEET FOR R PRI'¢BTE HELL OR ±50 T'O 2~:~E~ FEET FROM R PUBLIC HEL. L DEPENDING LIPON THE T'?'PE OF PUBLIC P, IELL.. MINIMUM DISTRNCE FF.:OM R F'RI'¢RTE HELL TO R PRIVRTE SEHEF.' LINE IS 2.5 FEET RND TO R CONNUNIT¥ SEHER LINE IS 75 FEET. HELL LOGS RRE REQUIRED RND NL.IST E:E RETURNEE:, TO T'HE [)EF'RRTMENT 1.4ITHtN 21:0 OF THE I.,.IELL COMPLETION. OTPIER REQUIREMENTS MR'Y' RPPL.'Y'. SPECIFICF4T'IONS FIND C:ONS'I'RUCT!ON DIAGRRh'IS RRE R',,,'RILRBLE TO INSURE PRCIPER INSTRLL. RTION. I ±: FORTH E?¢ TNE b'IUNICIPRLIT? OF' RNCHORRGE. 2: I P.I!L.L tNSTRLL THE S"¢STEM IN RCCORDRNCE HITH THE CODES. 3:: I UN[:'ERST~4[) THRT TNE ON-SITE SEPJER S'¢STEM MFI¥ REQUIRE ENLFIRGEMENT IF TNE RE~][:'ELE[) TO INCLUDE MORE THHN ~: BEE:,RO0r'~S. CERTIFY TFIRT I BM FRMILtRR WITH THE REQI...IiREMENT'S FOR ON-SITE SEFtERS RND HEL. L.S RS SET' PERFORMED FOR: LEGAL DESCRIPTION: 4- 5- 7- 8- 9- 10- 11- 12 13 14- 16- 17= 18- 19 20 COMMENTS DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 [] SOILS LOG [] PERCOLATION TEST SOILS LOG - PERCOLATION TEST C~PE//~y ITE PLAN _/ Rober! A. Shof No. 1457-E WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? GrossNet Depth to Net Reading · Date Time TimeWaterDrop · ~., /~_:Yo ~o //¥I'/~" 3 ,, /z;~ /° /z~~ ~ ., ~ p ,o /~ ~', ~/,~" PERCOLATION RATE ~ (minutes/inch) PERFORMED BY: 72-008 (6/79) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING ~ (E Parcel I.D. 050-354-01 GENERAL INFORMATION Complete legal description Location (site address) COSA # / Expiration Date: Sunny Valley S/D, Lot 26 9323 W. Lake Drive, Eagle River, Alaska Current Property owner(s) Mark and Teresa Beck Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Audrey Mason 11525 Old Glenn Hwy., Eagle River, AK 99577 Day phone 622-3344 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class __ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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 engineer'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 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 Douglas T. Kenley, P.E. Address 9806 Northstar Circle, Palmer, Alaska 99645 Engineer's Printed Name Phone (907) 746-1073 DSD SIGNATURE ~ Approved for .--~ Disapproved. Conditional approval for Douglas T. Kenley Date bedrooms. bedrooms, with the following stipulati,~s~ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X (Rev 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Sunny Valley S/D, Lot 26 Parcel ID: 050-354-01 A. WELL DATA Well type Pdvate IfA, B, or C provide PWSID #~ Date completed 6/21/82' Sanitary seal (Y/N) Y Total depth 80* ft. Cased to 80* ft. FROM WELL LOG Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION Y Y 20 in. 12/11/2009' 23* 6+* Date of test 6/21/82' Static water level 16' ft. Well production 40* WATER SAMPLE RESULTS: g.p.m. g.p.m. Coliform Negative colonies/100 mL Arsenic: ND mg/I B. SEPTIC/HOLDING TANK DATA Nitrate ND mg/L Date of sample: lO/lO/lO Other bacteria colonies/100 mL Collected by: F. Kenley Tank Type/Material Steel/Owner Made* Tank,~ze...~25,0'~ gal. Number of Compartments 2 ~ F[t~iion'/fioan~ut (Y/N) ¥ Depression over tank (Y/N) .'Sate of p~m~ping '~'~/1~10 Pumper . ~SO~P~ION;FiE'LD DATA Date installed 6/1/82' Length 116' ff. ff. ~otal depth . ,~,8~ ,ft. Eft. absorption area 1160' ~ Monitoring tube Date of adequacy test 12/11/09' Results (Pass/Fail) Pass* For 3 bedrooms Fluid depth in absorption field before test 35* in. Water added 450* gal. New depth Elapsed Time: 1440' min. Final fluid depth 35* in. Absorption rate >= 450* Any rejuvenation treatment (past 12 mo.) (YIN & type) None Known* If yes, give date System type trench* Gravel below pipe 5* ft. Y DepreSsion oVer field N 50* in. g.p.d. Date,installed 6/.1/82' Soil rating (g.p.d./~ Or ~/bdrm) 320* Width 3* Cleanouts (Y/N) Y N High water alarm (Y/N) N/A JR Pumpers D. LIFT STATION Date installed "Pump on" level at __ in. Size in gallons "Pump off" level ~t Manhole/Access (Y/N) ~_~. ' '..,. ~g Water alarm level at ' ' in. E. SEPARATION DISTANCES Cycles tested Meets alarm &-circuit requirements~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 116 ft. Absorption field on lot 100+ ft. Public sewer main N/A Sewer/septic service line 25+ ft. Animal containment areas 50+ ft. On adjacent lots 100+ ft. On adjacent lots 100+ ft. Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100+ f. Building foundation 13 ft.* Water main N/A Wells on adjacent lots: 100+ ft. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line 85 ft.* water service line 25+ ft. Absorption field 27 ft. Surface water 100+ ft. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 37'ft. Water Service line 40+ ft.* 50 ft. Curtain drain None know. to exist F. COMMENTS: * From MOA records on file by Steven R. Pannone, P.E. An inspection made on the monitoring tube in the leach field revealed 8,-3/8" of water from the bottom of the tube. The property was inspected for any changes since the last COSA. and none were found. A new survey iwill be submitted because the one on file does not show the Well. Water main N/A Driveway, parking/vehicle storage Building foundation 20+ ft. Surface water 100+ ft. Wells on adjacent lots lO0+ ft. 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 Douglas T. Kenley P.E. Date ~ ~ . ('~7., i/O COSA Fee $, Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Douglas T. Kenlev 9806 E. Northstar Circle, Palmer, Alaska 99645 (907) 746-1073 October 15, 2010 Mr. Jeff Poet Municipality of Anchorage On-site Services 4700 S. Bragaw Street Anchorage, Alaska Re: Re-issuance of COSA certificate Sunny Valley S/D, Lot 26 9323 W. Lake Drive, Eagle River, Alaska Property Owner: Mark Beck Dear Jeff: This letter is a request for issuance of a new Certificate of On-site Systems Approval. An adequacy test was performed on the above-mentioned property on December 11, 2009, by Pannone Engineering Services and a COSA was obtained from your office on January 15, 2010. An inspection was made of the property at the time a water sample was taken on October 10, 2010, at which time the monitoring tube showed 8-3/8" of seepage from the bottom. If anything else is required, please contact me at (907) 746-1073 or 243-5372. Sincerely, Douglas T. Kenley, P.E. Municipality of Anchorage Development Services Department · Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK g9519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Complete legal description cos^# Expiration Date: /-/ -' / 0 Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 'Sunny Velley SID lot ~6 9~2~ West Lake Dr Eagle River, AK qg~/"/ Mark Be(:k 932~lWest Lake Dr Eagle River, AK qq~77 Day phone 3~7-95o6 Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class. Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL= Individual On-site [] Individual Holding Tank [] Community On-site ~ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval ere 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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 engineer'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 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 5ervi(;e~, LLC Phone 272-82z8 Address P.O. Box ~O0;CtT. Anchorage, AK qqsz(~ Engineer's Printed Name Steven R. Pannone. P.E. Date //~-/~-o/~ Engineers Comments: In conducting an adequacy test, I attempt lo provide a thorough, conscientious englncering analysis of thc systcm in accordance with MOA DSD Guidelines & Regulations. Thc reported rcsuhs dcsai~c the performance of Ibc system undcr the conditions encountered at thc time of the lcsL, and separation distances mcasurcd to rcadily identifiable fca[urns. Thc operational life of all wells and septic systems depend on the local soil condition, ~'ound water [cvcls that may fluctuate during thc year, and thc water usage of thc family bcing served by the system. These conditions are out,[dc thc control of the evaluator of this system. ,.MI systems eventually fail and satisfactory test results do no[ ~arantee future performance of Ihe system, nor do they guarantee that there arc no hidden defects or encroachments. P'E~ can therefore not provide any warranty for future performance nor give any estimate of how long thc system will continue to meet thc operational requirements of thc MOA DSD. Thc con[tnt of this report is for the sole bcncfit of thc owner lis[cd above. Any reliancc upon or usc of this report by any other person or party is not authorized nor will it confcr any Icgal right whatsoever. 5. DSD SIGNATURE ~ Approved for .~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsen!c Advisory Maintenance Agreements Supplemental Engineer's Report Other [,~1 .~"~)0~O rigina, Certif,cate Date: Municipality of Anchorage Development Services Department Bultding Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description:. ~;unnvVallev Lot 26 A. WELL DATA Well type Private Date completed 61;zx, lz q82 Totaldepth 8z ft. FROM WELl.. LOG ParceliD: o5o-~5~-o~ If A, B, or C provide PWSID # __ Sanitary seal (Y/N) y Cased to 8~, ft. Well Log (Y/N) y Wires properly protec, ted (Y/N) Casing height (above ground) AT INSPECTION in. Date of test 6h.h.98', Static water level 36 ft. ~3 ft. Well production ~,o g.p.m. 6+ g.p.m. WATER SAMPLE RESULTS: ~ Coliform O .colonies/100 mL Nitrate u,. I c) mgJL ' Other bacteria 0 colonies/100 mL Arsenic: ~"i :Ug/1 Date of Sample: J'Z.?[OI Collected by: .Lu~.~ t'~,~.~'-:~-~,~ ~ B. SEPTIC/HOLDING TANK DATA : i: Tank Type/Material Steell Owner Made ' Date Instailed 6/~/:~8:~ Tank size .,;~o gal. Number of Compartments :~ Cleanouts (Y/N) y Foundation cleanout (Y/N) y Depression over tank (Y/N) n High water alarm (Y/N) pla Date Of pumping 9191"oog Pumper'~lR'~ Pumping C. ABSORPTION FIELD DATA , i Date Installed 61~h~8~ S0il rating (g.p.d./ft~i°r ~/bdrm) ~=o :, . System type trench Length ~.x6 ft. Width .3 ' ' ~t. Gravel below pipe 5 Total depth 8_ ft. i Eft. absorption area a~ Monitoring tube v Depression over field Date of adequacy test a',laal2ooq Results (Pass/Fail) pass . : For 3bedrooms Fluid epth In absorption field before test 35 in. i Ii Water added~.~ gal. : Elapsed Time: a_Ct, o_ min. Final fluid depth 35 in. Absorption rate >= &,~o Any rejuvenation treatment (past 12 mo.) (Y/N & type) Non~ Known If yes, give date New depths~ in. g.p.d. D. LIFT STATION Date installed 'Pump on" level at In. Datum Eo SEPARATION DISTANCES Size in gallons "Pump off" level at __ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas Manhole/Access (Y/N), High water alarm level at Meets alarm & circuit requirements? On adjacent lots ~.oo, On adjacent lots . Public sewer manhole/cleanout nla Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line 85 Absorption field :~7 Building foundation Water service line 50+ Surface water ;~oo+ Water main pla Wells on adjacent lots ~.eo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ;~o+ Water main. pla Property line 37 Surface water ~,oo+ Driveway. parking/vehicle storage Water Service line ~,o+ Curtain drain none known Wells on adjacent lots ~oo+ F. COMMENTS Estimated z~% of svstem life remaining 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. P.E. Date ~ I/ ~,l/C, Waiver Fee $ Date of Payment Receipt Number COSA Fee $ Date of Payment Receipt Number . (Rev. 11/05) .in. SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1096562001 Pannone Eng. Sty. 9323 West Lake Rd ER 9323 West Lake Rd ER Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 01/08/2010 9:34 12/I 1/2009 0:00 12/I 1/2009 14:32 Steohen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Rcsul~ LOQ Units Mcthod Container ID Limits Date Date Init Metals b~ ICP/MS Arsenic 5.00 ug/L EP200.8 C (<10) 12/15/09 01/06/10 NRB Waters Department Total Nitratc/Nitrite-N 0.100 U 0.100 mWl. SM20 4500NO3-F B (<10) 12/I 6/09 RJT Microbiolo~ Laborator~ Colony Count 0 Total Coliform 0 Fccal Coliform 0 col/100mL SM20 9222B A (<200) col/100mL SM20 9222B A (<1) col/100mL SM20 9222B A (<1) 12/11/09 DLC 12/I 1/09 DLC 12/11109 DLC 3 .~G,O0oO0 ~ U [~ r.° Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and WasteWater Program 4700 South Bragaw St. P.O, Box 196650 Anchorage, AK 99519-6650 www;cLanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O,5"O-3~'-o t' t. GE EI~ti;F~I~MATION Mailing address Lending' agency ~ ~ Mailing address Real Estate Agent Mailing Address HAA# ~L('- 09jO~, E×piration Date: / - / ? - le~aLde~afi~tbn ~U~ V~LL~ ~/~ / e°cat°n(sitea~drb~p~directi°ns) ~ ~ ~ ZO~ Current Prope~y Owne~(S~ ~~ ~4~ Day phone ,. ~/~ Day phone UnleSs otherwise requested, HAA will be held by DSD for pickUP. NUMBER OF BEDROOMS: ..~ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: t~ Individual On-site J~ [] 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 engineer's work. 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 AuthcJrity 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 ali applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm /~/~),/'~"'/'-[1~'''~ l'~'t- ~.~AJb~''f~J~''~'/~4J Engineer's Printed Name ~T-~d~: ~.~¢.J(;' DSD SIGNATURE V'"' Approved for Disapproved. Phone Date bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory (Rev. 01/02) X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Anchorage Parcel ID' ft. Well Wires properly protected Collected tank Eft. absorp ............. !~r~ ~t~/~r~,~ ) .~ 0 System t~pe'.~;~' ~.~J c.('r pipe .~ ft. __ft2 Monitoring tube~ y DepressionOver field /,,/' "Pump off" level at CYC!eS te~!ed Meets alarm & circuit req~ ts? EF S P~p~(y ine /~ ~''¢' Building foundation WateFService line _ 70 ' * Surface water WeJis on adjaCent ~ots On adjacent lots / ~) ~ ~'~ On adjacent 1ors ~ Public sewer manhole/cleanout S~ib~ lih'~ '~/~ re Holding tank ON DISTANCES FRO~ ~Ep~!p/~p~pI~G TANK O~ LOTTO: Property line /g~ Absorption field Water se~ice line /~ Surface wmer /0~ ~ ~o~ ~STANCE FROM ~;~i6~'~L~ ~'~OT tO~ ~'~ Water main Driveway, parking/vehicle storage Of Municipal reCordS that the aho~f~ systems are in MOA HAA ~)d~iin'~'i~bffebt C Steven PE 6256 waiver Fee $ Date of Payment Receipt Number ---31~9.49 FT S 00'00'02' E