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VALLEY VIEW ESTATES #1 BLK 2 LT 5
Valley View Estates Block Lot 5 #050-521 -51 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241390 PID Number: 050-521-51 Dwelling: RE Single Family (SF) El with ADU 171 Duplex (D) R Two Single Family Project: R New RE Upgrade Name SHARON WHITE ABSORPTION FIELD R Deep Trench X Wide Trench [:1 Bed FJ Mound Site Address 26000 BERRYHILL ROAD, EAGLE RIVER, AK 99577 El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-240-3392 3 1.0 GPD/SF1 9' MAX. Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 4.07 Ft. Subdivision Block Lot VALLEY VIEW ESTATES #1 2 5 Till added above original grade SEE DWG. Ft. Gravel length 46 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES TO Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 460 F12 Ft. Well 100'-+- 100+ — - 25'+ TANK A Septic 0 S.T.E.P. E] Holding E] Other Manufacturer INFILTRATOR SYSTEMS Capacity 1060 Gal. Surface Water 100'-1. 100'+ — - Material Number of compartments Lot Line 5'+ 10'+ - - NA PLASTIC 2 Foundation 110'+ 10'+ - - ATION Manufacturer Capacity . Remarks WELL RADIUS AND LOT LINE FLAGGED/ Gal. STAKED DURING CONSTRUCTION location Alarm location Elec r i talled by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield PRECISION GENERAL Drainfield D3034 CO/MT D3034 Inspector GARNESS ENGINEERING BENCHMARK (Assumed elevation) 98.98 ft Inspdates:ection Is, 3/11/2025 2nd 3/12/2025 Location and description 3'd 3112/2025 41h TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional Approval: Date 4 Septic System Approved f ey gess., CE-7953 Date- N e: this approval does not include well permit requirements. AIGN PrO& f 'N�� ECC884 jKevu5tu2ht9) - PERMIT NUMBER: RECORD DRAWING I N G PARCEL ID NUMBER: I OS P241390 050-521-51 i 11� � SRR NEW DRAINFIELD %DOUBLE EANOUTS ////'C' (DBL3 & DBL4) �o NEW IM1060 \ \` INFILTRATOR SEPTIC�TANK /YJA, X001 DBL1 PHONE NUMBER: 16.534.2 PAGE NUMBER: DBL2 907-240-3392 15.8 35.4 MH 52.7 34.5 72.0 ST, 47.4 31.7 70.6 DBL3 50.0 36.5 75.9 DBL4 50.7 37.5 76.9 C01 51.4 38.5 77.9 MT' 52.1 40.0 79.6 CO2 90.5 83.6 123.4 MT2 88.4 1 81.0 120.7 NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD. \ \ .i';n{jsT _ EXISTING WELL i ) yOG FO � -• 1 DOUBLE A/ NOTE: PER THE CONTRACTOR, THE 1 CLEANOUTS Aa / OLD SEPTIC TANK WAS REMOVED \ (DBL1 &DBL2) a, - - / AND DISPOSED OFFSITE AND THE \\ N / OLD DRAINFIELD WAS \ / DECOMMISSIONED IN PLACE. \ / \ SCALE: � — -- - 1p' UT'L)Ty/ EASEMENT ~� GARNESS ]ENGINEERING GROUP, Ltd ENGINEERING SALES ' CONSULTING 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, ALASKA' PHONE (007) 337.6179 'WEBSITE; vrnw.gamos ngineering.c PREPARED FOR. PHONE NUMBER: PAGE NUMBER: SHARON WHITE 907-240-3392 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: VALLEY VIEW ESTATES #1; BLOCK 2, LOT 5 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 3/1412025 4 ........... ............................ io .. ... ....... ..r'i'G�..... 0 cT\ a e} . G nsss' \= i ♦#," CE - LICENSE o t cep p'•��,.1....,. (� 1, tee. ®`p� RU�ESS, ®� LICENSE AA®'`%a'® PERMIT NUMBER: RECORD DRAWING I N G PARCEL ID NUMBER: OSP241390 � 050-521-51 TOP OF MANHOLE LID = 98.98 FINAL GRADE ST1 = 97.26-97.59 TOP OF TANK INLET = 94.78 2" OF INSULATION TOP OF TANK (PER CONTRACTOR) OUTLET = 94.80 NOT SHOWN FOR CLARITY INLET OUTLET INVERT OF PIPE INLET = 94.23 1060 2 -COMPARTMENT INVERT OF PIPE INFILTRATOR SEPTIC TANK OUTLET = 93.96 "ARNESS EN"IN"I"RIN' "ROUP, Ltd a x t .t. ,amu m xwY ENGINEERING - SALES �, CONSULTING 3701 E. TUDOR ROAD, SUITE 101 - ANCHORAGE, ALASKA' PHONE (907) 337.8179' WEBSITE: www.gamessengineedng.com PREPARED FOR: ORIGINAL GRADE GEG C01 MT1 TH#1 FINAL GRADE CO2 MT2 @ HIGHEST POINT = 97.93 = 97.76-97.9 907-240-3392 INVERT OF DIST. 3 OF 3 LINE = 93.00 ES FEET WIDE VALLEY VIEW ESTATES #1; BLOCK 2, LOT 5 BOTTOM OF TYPE OF WORK: EXCAVATION = 88.93 RELATIVE ELEVATION OF GROUNDWATER ON 11/18/2024 = 83.43 RELATIVE ELEVATION OF GROUNDWATER ON 3/6/2075 = 82 43 "ARNESS EN"IN"I"RIN' "ROUP, Ltd a x t .t. ,amu m xwY ENGINEERING - SALES �, CONSULTING 3701 E. TUDOR ROAD, SUITE 101 - ANCHORAGE, ALASKA' PHONE (907) 337.8179' WEBSITE: www.gamessengineedng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: SHARON WHITE 907-240-3392 3 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: VALLEY VIEW ESTATES #1; BLOCK 2, LOT 5 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 3/20/2025 v CE -79 ••j� �F�.............. 3 Z' / `,' .........••.. LICENSEt gyp.ioESS\3�t*w* #AECC884 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241390 Work Type: Septic Upgrade Tax Code Number: 05052151000 Site Legal Address: VALLEY VIEW ESTATES #1 BLK 2 LT 5 G:0263 Site Mailing Address: 26000 BERRYHILL RD, Eagle River Owner: WHITE SHARON K Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 11 /27/2024 11 /27/2025 43621 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: `'�=' � Cvf F. Date: Issued By: Date: // � Z / 3 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-521-51 Property owner(s) SHARON WHITE Day phone Mailing address 26000 BERRYHILL ROAD, EAGLE RIVER, AK 99577 Site address 26000 BERRYHILL ROAD, EAGLE RIVER, AK 99577 907-240-3392 Legal description (Sub'd., Block & Lot) VALLEY VIEW ESTATES #1; BLOCK 2, LOT 5 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (0 all that apply) Absorption Field Fv_1 Uzi Initial ❑ Single Family (SF) nX Septic Tank nX Upgrade (w/wo ADU) Duplex (D) ❑ Holding Tank ❑ Renewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes, (Signature of property owner or authorized agent) Permit/Rush Fees: 5 q 25- Date of Payment: Receipt Number: 0305ct6- Permit No. O—C--) 10 'Z_ Ll / -3 Cl 0 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241390, Curtis Townsend, 11/27/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241390, Curtis Townsend, 11/27/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241390, Curtis Townsend, 11/27/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241390, Curtis Townsend, 11/27/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241390, Curtis Townsend, 11/27/24 Lot 4 0 CV) Rz::3403.04 L`247 `��0,10 .85 rn —Septic vent 23off o 101 Chain link fence (typ) co -0 0 Z Im P481015158"W 0 We103.7- ll erg CV U*) T_ 269.71 _r Lot 6 F- QY 0 Z 8513J OF . . . & I AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following . AW described LOT 5, BLOCK 2, AM tom,VALLEY property: VIEW ESTATES ADDITION No. 1 49th Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying 00 ?ZN � ) 11 -1 00 . ..... adjacent thereto, that improvements the lying W,� 10 iza eth L Wal&ka oo iza;e L. no on property AW adjacent thereto encroach on the premises in question and -kl 8036 - LS that there are no roadways, transmission lines or other SCALE: V= 50' AM •* I * 4W visible easements on said property except as indicated Z % )# hereon - Dated at Anchorage, Alaska this 30th of AUGUST, 2024. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED —day EKED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON UNLESS OTHERWISE NOTED. DMS, FB 24-4, pg 12-13 BE Engineers and Surveyors 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence, structure or other improvements unless otherwise noted. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law, Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. ~. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~-~Z PHONE E~EW Manufacturer~ Materi~l~ No. of co~tpartm0nts /0~O IF HOME.DE: DISTANCE TO: No. of lines ~ Length of each~n~/ Total length~ofrli~es Trench ~d~, inches Distance betwe~ Top of tile to finish grade / 72-013 (Rev, 3/7~ F'ERM l T NO. f:'tF:'F'I .. ! CFihrr L OCFFi' I O1',1 !')EPFtFe. TMENT OI;:' HEFIL. TH FIND I'EW,,,q :E.:2'.:~ "'L.' S'i"RF~E-!'., RNC:HOI~'.IaGE., FIK. ;264..-,47'2~Z~ F:tNE:'I:;dYH & ELF~Ii'.,!E 8ERf~?'r' I'IILL LRNE ER -f'T'F:'E CIF SOIL FIEF_:i;OI:.~tE:T]:Eli",I S"r'STEPI I9;: I"iFI::'~IP1LIM Iql...IM[3[:il:,~: OF E~E'I)ROOMS = 3 4EI25 E. ]:RD '-:-':OIL. RFrI'ING (Sl]! F:'T/'BR)= :l.~SEi THE I;i:E6!I..I!,:~:E[:, '_-'.i;!2tE OF THE '.E;OIL FIE:%ORP]"ION S?STEM IS: THE LEIqGTH [)II','IENS:i:ON IS THE LENGTH KIN FEET) OF THE TRE.'U, CH OR f::,RF:IINFIEI..[:,. TH[:.: DEPTH OF 13~:TRENCH OIq: PIT !S THE DI:.:::TFINC:E E~ET.k.IEEN THE SIJRFFIC[E OF:' THE GF?.OtJh!,D FIN[) THE E~O'I"TOM O1:: 'THE' EHCFI',,,'FITION (If.,!, F:EE]-). TFIEI-RE IS NO SET HIDTFI r::OR TRENCHES. FHE GRFI',,,'EL,. [:,EPTH IS THE I','!II',IIP'IUM D, EF"T'H OF:' GRFW[EL E~ETI.,]EEI'.,I THE OUTI-:FILL !:::IND THE 8OTTOM OF THE I/!::qC61',,,'F:fT I ON ( I i'.,! FEET ). PERHiT Fff:I'::'LICFINT I.-II::l:ii; THE RESF'ONS]:I~i~!L:[T'.? "FO INFORM TI-.I!'/:: DEPFIRTMENT DURING THE l HS]¥::IL.[..FIT l ON i Hsr.:'ECT I Obis OF FINk' 14ELL S FI[:,JFICENT TO T'H I S P[;.'.OF'El::ff'"r' FIN[:' 'T'FIE t",IUI"I[i~EX;[: OF RE~'i:i;I[)EHCEg;-i"HF:IT THE HELL I.,.IILL 'i:';ER',,,'E. Eq::ICKF :1: L.L I NG OF: F¢',N' ?'r%"FEM .kl t TI.-IOLIT F:' I NFl[_ I f',ISF'EC:T I O1',! FIN[) RPPRO',,"F:IL. B'¢ TH :1: S [)E]::'I:::fRTMENT HILL E:E SLIEL.)'EC:]'~TO MIJN E:' ~ STFff',ICE: FEET FOR F'I F'RI',,,'Frr[E HELl...; OR TO 2[z.3 FEET FROH F'! [.:'l...l[~l...:iZC HEL.L [)EPEH[)ZNEi IJF'CiN TNE 'F','PE OF' F'[..m~LK: I,.IEI..[.. CF'FFIER REE:R.II REMENTS MFI? I:aF'F'l_.'r'. SPEC):[: ! CFIT:[ OI"~S FIBI[) CC$,ISTRUCTi ON I:> I F!GRFIMS F:f[;?.E F:P,,'fa):I..FfE&fE TO ZHSURE F'ROF'ER IN:STFILLfaT]/ON. ! CEI:¥F I F'"r' THFIT :1.: ]: RM FFff'IlLIFiR HITH THE RE);:!LJ:[F;:E:MEHTS FOR ON'-"SZTE %EIqER:i~¢ FIND HELL.S FIS SET I::'ORTH E~h" ]'NE Mt_INZC:I PFIL. ZT'¢ OF FINCHORFIGE. 2: Z I.'.IZLL. ZN'.STRLL THE S'¢STEM N"4 f~C:CORDFIh!CE HITH THE CODES. 3: I t. JN[:'ERSTFIND THI:¥f' THE ON-Si]E '.SEI.,.tER SYSTEM Pff:l"r' RE6!UIRE ENLFIRGEZMEN-F iF ']"fiE: I:;;:ESIC'ENE:E ):S I';~:EME[[)EL. ED TO INCLUDE MORE T!"IRN 3 BEDROC[HS. V3. 2 NUMBER TP-1 Date Completed: 5-23-79 SOIL DESCRI PT[ON ORGANIC MAT~.RIAL, OL-- -- .5' SILTY SAND W/SOME GRAVEL, SM Numerous Cobbles 2' SAND W/SOME GRAVEL,. TRACE SILT, SP Numerous Cobbles 7.5' boulder 11' boulder 14'T.D. LOCATION SKETCH No Scale NOTE: D[STANCES SHOWN ARE APPROXIMATE AND HAVE NOT BEEN MEASURED BY SURVEYING M£THOOB. EXPLANATION ~"~ ~ ORGANIC MATERIAL irs Liftle Visible Ice 0:10' Vx __ !~'~ .3~..A,S' L--ICE DESCRIPTION ~$~ (~Ss, 72, 57. I% , 85.9 pcf ~ BEDROCK ~ FROZEN GROUND kKII-WNILE DRILLINO TYPICAL SOILS LOG I A.B-AFTERBORIN$ SAMPLER TYPE SYMBOLS ~ ~ ORGANIC ~ GRAVEL SOIL SYMBOLS I DWN'E' R'R' SCALE. ~?SULTANTS, INC. I] F Lot 5, Block 2, ....................... ~Valley View Estates ~ ~aska GRI0. SW263 /PRO'J. NO- 95117]t [,OWG. NO A-01 J May 23, 1979 R&M No. 951171 Bud Robertson Box 1598-A Eagle River, Alaska 99577 Subject: Soil Investigation for Sanitary Sewer System, Lot 5, Block 2, Valley View Estates, Eagle River,Alaska Dear Mr. Robertson : At your request of May 23, 1979, we conducted a subsurface soils investi- gation at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with those procedures required by the Municipality of Anchorage Department of Health and Envirorm~ental Protection. This investigation, which was accomplished on May 23, 1979, consisted of a test hole excavated to a depth of 14 feet below the existing ground surface. The test hole was sited according to your instructions and its location is shown in attached Drawing A-01. Excavation was accomplished with a Case 580 backhoe, and all material excavated was continuously monitored by an experienced engineering geologist. The topography at the excavation site is generally steeply-sloping to the south. At the time of the investigation the site had original vegetation consisting of aspen trees and alders. The top of the test hole was located at original ground surface. The soils encountered in the excavation are shown in the test hole log in Drawing A-01. This log displays specific conditions encountered at the test location. However, subsurface conditions may vary in other parts of the lot without any apparent surficial evidence of the change. Groundwater was not encountered and bedrock was not encountered. At the time the hole was excavated seasonal frost was not present and permafrost was not encountered. Based on the visual classification of the soil and the requirements set forth by the Muncipality of Anchorage, a percolation test was not necessary within the test hole on the subject lot. [:,EF'ARTHENT OF_ HEALTH RNF.:, EI'-.F,,'IF:ONHENTFtL F'F.'OTF::T!L-N 825 "b' ,STI~:EET., AN.F.':HL-~:F!CJE., iff-:::. I-.I5_'L_ L F' I! F,4-; Fl -[ T ) 'LIE:ANT ~f:,~[:'F:E[4 LORE:, DOX ..... EFIOLE RIVER :FITI ON 'v'AL L E N-' ',,,' .t ~_ ~.,~ i!:~L. LD E~2 ',,,'ALLEY VIEN EST L. LqT SIZE El SQUFIF'.E FEET II"IIJH DIS;TRNCE E:ETHEEN R HELL AND ANY ON-SITE SENRGE D~SF'C~SRL '_:;YSTEH IS FEET FOR R F'RI'.,,'RTE HELL; OR TO 2E~0 FEET FROH R PUDL.~C NELL DEPENDING UPON THE TYPE OF F'UBL~C lqELL. I_ LOGS ARE REE~U:[RED FIND HLIST BE RETU~:NED TO THE DEPARTf'IENT HITHZN ~':E~ THE NELL COHPLETION. !El4: REC!LIIREHEhlTS ['IF4Y APPLY. SPECIFIC:FITIONS AND C:ONSTRUCTII3N DIFtGRAI'IS FIRE :IL.ABLE TO INSURE PROPER INSTALLATION. ::'EERFI I T E:=-~: P I E:E'.L5 [:.E L--:EI-'-IE?E F-: 2-: ::L_. :~_ ERTIFY THAT [ FIF1 FAHILIFIR 14ITH THE RE¢~LIIREHENTS FOR ON-SITE SEI.4ERS AND I,IELLS RS SET ;:FPI BY THE I'ILINICIPRLITY OF RHCHORRGE. :[ 14ILL INSTALL THE SYSTEI'I tN RCCORC, RNCE i4ITH THE CODES. NED: ............................................... ~.~'L I CANT FINDREN LO~:D OWNER OF LAND ADDRESS DATE-Started ~-/ .- 77¥ Ended -,,? ,/ 7, GALS. PER HR PERMIT NUMBER .... ? ~,o '~-- / ~ KIND OF CASING (ger!ifieh Drilling by ENVIRONMENTAL ;'kC::ECTION A & L DRILLING COMPANY JAN 4 BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2§88 RECEIVED · .', ,,,,~ -. ,> DEPTH OF WELL STATIC LEVEL OF WATER FT. KIND OF FORMATION: From : Ft. to / Ft. .",.~,,~';¥/'d/d/d,~.'o From-- From__Ft. to ~ Ft. / ~ fi/,'~Cd] r~-y',", From~ From Ft. to From -= 7 Ft. to //:' Ft. (~,::52do--~ From~ From Ft. to t ~" Ft. t~ ~: <~ ....... i~'d~O / ¢ cT,--~ Frmn~ From. ~ ' ~, 'Ft. to /'~.~' Ft. 4,~'~A:~.¢~ From~ From / ~ ?c From~ From ~.Ft. to Ft. From. i /: Ft. to "): Ft~ /[J,9'~c~%,~.: From From .~:.'4' Ft. to 4 :'~, Ft. /az~y?~Eoc, x~. /3x~ ~ From From~Ft. to Ft. / d 5- C ? ~d-' From From ~ : c Ft. to ( 4l c~ Ft. /~,,-,¢z4 4~¢, ~&.. From From ~.Ft. to Ft. From From Ft. to Ft. From From Ft. to.~Ft. From~ From~ Ft. to.~Ft. From~ From Ft. to Ft, From Ft. to Ft. Ft. to___Ft. Ft. to Ft. .Ft. to Ft, Ft. to Ft. .Ft. to Ft.. Ft. to Ft. Ft. to.__Ft. Ft. to___Ft. Ft. to___Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. .Ft. to Ft. Ft. to Ft. Ft. to Ft, MISCL. INFORMATION: DRILLER'S NAME MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 050 -521-51 Certificate of On -Site Systems Approval OSC251165 Expiration Date: 9/30/2025 Legal description VALLEY VIEW ESTATES #1 BLK 2 LT 5 Site address 26000 BERRYHILL RD Current property owner(s) WHITE SHARON K X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: 0 Original Certificate Date: 5/12/2025 This Qertificatre of -On -Site Systems Approval (COSA) is intended to demonstrate the subject i)evelopment tem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other 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. 050-521-51 Complete legal description Valley View Estates #1 132 L5 Location (site address) 26000 Berryhill Road *Eagle River AK 99577 Current property owner(s) Sharon White Day phone 907-240-3392 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: FNI Private Well serving #_1_ dwelling units [__J Other Non-public well as regulated by MOA E] Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic 171 Private Septic serving 2 dwelling units 171 Holding Tank El Community Septic or Public Sewer 5. SEPTIC TANK: 1771 Steel X Plastic 1771 Concrete F -I Fiberglass Age New - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: n AWWTS 171 Bed F1 Deep Trench 100 Wide Trench n Seepage Pit Waiver request for: Expedited review requested: 1771 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 $ "? lio Date of Payment -5-1 q LP 5- COSA Waiver Fee $ Date of Payment Waiver # COSA App1!cat1o%Ap2025.doc COSA Checklist Legal Description: VALLEY VIEW ESTATES #1; BLOCK 2, LOT 5 Parcel ID: 050-521-51 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA 0 Well log is filed with Onsite (or attached) Well production at time of test ***1.0+gpm Date drilled 8/11/1978 Total depth 240 ft Water storage tank volume N/A gallons Cased to *28'-10" ft Well disinfected for coliform test? ❑ Yes MR No 0 Sanitary seal is functioning correctly 0 Coliform bacteria is Negative 0 Wires are properly protected Nitrate 3.58 mg/L ElNitrate less than MRL (ND) Casing height (above ground) 12+ in. Arsenic ug/L 0 Arsenic less than MRL (ND) Date of flow test for COSA 9/30/2024 Collected by GEG, LTD. Static water level at beginning of test ** ft. Date 9/30/2024 Comments *TO BEDROCK'*SWL READING WAS 36.8' USING "NORMAL" SETTING ON WELL PROBE AND AT 220.4' USING "DEEP" SETTING ON WELL PROBED (3120/2025). ***PREVIOUS COSA'S (HAA'S) INDICATED FLOW RATES OF LESS THAN 1 GPM. MOA WELL ADVISORY RECOMMENDED. B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 3/11-12/25 Al ALL standpipes present per record drawing Total measured depth from grade 9.0 ft (max) Measured depth to pipe invert from grade 4.8 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. 0 Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 T STATION ❑ Require tenance comp) Age of lift station rs Lift station al ents: Adequacy test date NEW Results Q Pass Fluid depth prior to test NEW in Water added NEW gal New fluid depth NEW in Elapsed time NEW min Final fluid depth NEW in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 0 in Effective depth remaining 48 in Oe& 3 12&LS- 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 E 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' M Yes if No ft Holding Tank > 100' ❑■ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' QYes if No ft �■ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑■ Yes if No ft ❑i 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' Q Yes if No ft Surface Water > 100' E Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS g Yes if No ft 0 Yes if No ft Q Yes if No ft E Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' Yes if No ft E Yes if No ft If tank or field is under driveway comment below 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 Garness Engineering Group LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 0 ,Je re A. Gorness: 4� CE -7953 4pfe�.� .21. �o nENSE 'ZI rofessio0°oo COSA Checklist—June 2022 #AECC884 Lot 61MMONMEMI N81 -15,58,,W "'4:%XX % % % ` OFAft. AW AW 00 % r�lizobeth L. Walatka ow • AW 8036 -LS 44, - rr * . ..,.• . 9y.. sslom'- Vx EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON UNLESS OTHERWISE NOTED. DMS, FB 24-4, pg 12-13 BE 8513J RECERTIFIED 4-01-25 AS -BUILT NO CORNERS SET THIS DATE I hereby car* that I have performed a Mortgagee's inspection in accordance with ASPLS Standardsof the following described property:— LOT 5, BLOCK 2, VALLEY VIEW ESTATES ADDITION No. 1 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overiap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this... 30th — day of AUGUST , 2024. FRED WALATKA & ASSOCIATES, L.L.C. 907-248-1666 Engineers and Surveyors This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence, structure or other improvements unless otherwise noted. This drawing shag only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L Walatka is a violation of Federal Copyright taw. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www. ct.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-521-51 1. GENERAL INFORMATION Expiration Date: / ! '- ~ '7- O / Completelegaldescriptio. n VALLEY VIEW ESTATES S/O ~11 LOT 5, BLOCK 2 Location (site address or dlrecflons) 26000 BERRYHILL ROAD * EAGLE RIVER, AK Currant Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MARK SKIBIN5 Il& ~' Day phone 26000 BERRYHILL ROAD * EAGLE RIVER, AK 99577 Day phone 696-7544 ROGER MORRIS w/ PRUDENTIAL VISTA Dayphone 223-8188 16635 CENTERRELD DRIVE * EAGLE RIVER, AK. 99577 Unless otherwise requested, HAIl will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 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-slte Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the lransfer of title (except between spouses) for properties served by a single family on-site wastawater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval am valid for 90 days from the date of Issue for preporUee served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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 errom or omissions In the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ fA-Z ~- at, or p/for to closing for the engineering sen4cas provided. * STATEMENT OF INSPECTION BY ENGINEER As cerilfled by my seal affixed hereto and as of the validation date slxwvn below, I verify that my Investigation, based on procedures outlined In lhe Health Aulhodly Approval Guidelines for this application, shows that the on-site wat~ supply and/or wastewater disposal system is(am) safe, functional and adequate for the number of bedrooms and ~ype of struclum Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and InspecSon, the on-site water supply and/or wastewater disposal system is(am) In compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of InstallaEon. NameofFirm · ALASKA WATER & WASTE'WATER CONSULTANTS. INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFRL-'t' A. GAENESS, P.E. Date 337-6179 Engineer's Comments: In conduc~ng thls evalua~, AVi~/C, Inc; allempted l~ p~m4de a t~'~ough, consclentlous eeglneedng analy~ls of l~e sy~m ln acco~ance with ADEC and MOA DSD Guld~nes & Regulalfo~s~ The reposed msufls de~c~fbed the pen~3nan¢~ of ~ 5. DSD SIGNATURE Approved for -~ Disapproved. Conditional approval for bedrooms. ON-SITE WATER AND . . WASTEWATER I:~:lrooms, wilh the fllowlng stlpulafions.~ .. PROGRAM ~_, .. Attechments: HAA Checklist Septic System Advtso~j . Well Row Advisory Manitenance Agreements Supplemental Engineer's Reort Other Odglnal Certificate Date: Municipality of Anchorage Development Services Department or-~ warm'& w.~ewmr I~ 470o 8outh Bmgaw GL P~. ~ A. WElL DATA Welltype Date completed Total dep~ 240 It. HEALTH AUTHORITY APPROVAL CHECKLIST VA~,rY VE'W ESTATES S/D #1 LOT 5. BLOCK 2.~ Parcel ID: 050-521-51 DaM of test 6tefie water level Well producllon WATER 6AMPLE RESULTS: SEPTIC~OLDING TANK DATA IfA. D, erg Ixovlde PWSII~ 8/11/78 ~tlteP/~ (Y/N) YES Casedto 28.8 ft. FROM WELL LOG 8/11/1978 50 lt. 3 g.p.m. Tank Type/Mateflal STEEl. TankMze 1000 gal. Number of Compartmente 2 Fouttdalloocleanout(Y/N)*YI''~ Depre~loflovertell~(Y/N) NO Date of pumping ¢/16/2001 Pumper well Log Wit. properly protected Camo hetght (above ground) AT INSPECTION 4/16/2001 51 ft. 1.37 g.p.m. ABSOEFTION FIELD DATA Oate inst~ed e/2o/Te Length 38 lt. 12.+. In. *INSIDE OARA~E (SEE: PLUMBERS CE:R'T1FICATION ~.ll~r.~) Date Installed 8/20/1979 High water alarm (Y/N) N/A dR'e PUMPINO fating (g.p.d~150 Wtcflh 3 It. Toteldeplh 10.2 ~ Eff. abaorptionama 456 fi* Monltedngtube YES Dateofadequacytest 4/16/2001 Ra~dte(Pa./Fall) PASS Fluid depth In al~xptlon field before test 43 In. Water ildded 464 gal. Elapeed TIme: 315 min. F1nalflulddepth ,62 In. Abeoq~ionrate~, Any rejuvenation treatment (past t2 mo.) (Y/N & type) NONE KNOWN b"y~tem type TRENCH Gm'ag belaw pipe 8 It. Depm.ion over field NO For 3. bedrooms NeWdel~ 68 In. 450+ g.p.d. ff yes, give dete - D. UFT STATION Date Installed "Pump on' level at In. Datum E, SEPARATION DISTANCE~ SEPARATION DISTANCES FROM WELL ON LOT TO: Glze In gallons · Pump orr' leu;! et . Cymes teated Se~o lan~ff etaiton on lot Abso~piton field on lot .tO0'+ Public ~mwer m~n N/A Sewer/aepUo eewlce line 25'+ Ma nlx)fe/,a*"~ _- (Y~) In. High water elann level at in, Mee~s alarm & circuit requirements? Holding t~nk Cumin drain NONE KNOWN F. COMMEk'T8 *SE~ ATrACHED WANER REQUEST. On ea']e~ent lots 100'+ On ad~;ent lots 100'+ Public ~ewer manhole/cleanout N/A SEPARATION DISTANCF-.~ FROM SEPTIC/HOlDING TANK ON LOT TO,' Building foundation 10'+ I~operiy line 10'+ At:~orl~on item Water main N/A W~IN' 881%'h~ ffll~ 10'+ 8ur~cew~er Welts on adjacent Ints lOO'+ SEPARATION DIb"TANCI= FROM ABSORPTION FIELD ON LOT TO:. Pn3perly fine 10'+ Building fouttdat~l 10'+ Water ~dn Water eewtce lille 10'+ Surface water 100'+ Well~ on ed]acent lots ,100'+ 100'+ N/A I~, ~hlc~e ~xage ~o'+ O. ENGINEER'8 CERllF1CATiON I cerUfy that I have determined egough field InspecUons and review of Munlclpal mc~ffls that ~e above sysferns are In confonwance ~ MOA HAA guidellnes in effect on eds dafe. o/e/o/ 07/23/01 H0N 14:07 FA,T. 0896499 11723 OLD GLENN HIGHWAY EAGI.[ RIVER, ALASKA 99577 (907) 694~ TO ¥I$T~ ]~AL £$T~TI~ ER ~J L©O L~ 53528 >"'"'. TOTAL LA~OR TOTAL TOTAL OTHER Wod(o~emd by TAX $1g~ture Municipality of Anchorage Development Servlees Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw P.O. Box 196650 Anchorage, AK 99519-6650 www.¢i.anchorag¢.ak.us (907) 343-7904 Waiver Review Worksheet WR$: WR010068 PID~: 060-52t-61 H~#: HA010441 PermitS: Date Received: 06/16101 Legal Description: Vallev Vtaw Estates ~1 Block 2 Lot 6 Engineer, Jeffrey A, Garnese P.E.. Alaska Water and Wastewatsr Consultants, lac, 6901 Debarr Rd. Suite 2B. Anchoraoe, AK 99504 Applicant: Mark $klblnSkl Waiver Requested: 99 feet from well to tank Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: ~( Waiver Is not Granted: List Conditions or Reasons for above: ~'LrE Date: 8- 27-0/ .y: Name of Reviewer RecO: 6824 Amount: $625.00 Date Paid: 8/20/2001 . SE. PT'i (.4plgTFt - I S'. of,q. P. E. C. 5. J?. w. ?-7 ' - 7 'r~r~ T~AFe Per'r~ ~' ~.0' --/ =AL- · · ? ~, ¥ =.'f~-t' 2.~. I C,'. £0r$. C. 2.4 3,0 /.TF ~d OR~z OA, T"I~I.. 5'£PR'~fl. ~'t o~ x =.B-i' 2.o ~ROb,,O TOT'~91.. ALASKA WATER & WASTEWATER CONSULTANTS, INC. - August 9, 2001 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request and Health Authority Approval for Valley View Estates Subdivision #1; Lot 5, Block 2, The existing 3 bedroom house is served by a private well and septic system. During our site visit, separation distances were checked and we found that the existing septic tank was encroaching upon the 100 foot well radius. We request you grant a 95 feet separation distance waiver from the well on the referenced property to the existing septic tank. The well that serves the subject property was drilled on August 11, 1978, and the septic system was installed on August 20, 1979. The following items are justification for the waivers: · The well head is uphill from the septic tank/land the house is located between the well and the septic tank. If the septic system was to overflow, the effluent would not travel toward the well head. · The location of the septic system is in a very visible area so that if any effluent was to surface, it would be noticed and the problem corrected. The other path of contamination is subsurface migration wastewater should the tank begin to leak. As can be seen on the attached well logs, the aquifer ranges from 20 to 200 feet and the bedrock ranges from 18 to 101 feet. As can be seen on the attached well log for the referenced property, there is sand, gravel with clay to 5 feet and then hardpan soils to 27 feet (bedrock) that will serve to inhibit the migration of untreated wastewater into the aquifer. Recent water sample results indicated nitrate levels and coliform bacteria results to be satisfactory. Based upon the aforementioned facts, it appears that there is minimal risk associated with the 95 feet separation distance waivers. If you ha)'e any/~tions, please contact us at 337-6179. Thank you for your assistance. Presidl~nt~ L 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwe.com vRu. Dr ~Ew EST. S/O LOT g, BL(X:K 2, WHITE SPRUCE DRIVE 8/9/2001 ........ o~',,,', ,,,': m ~%...., ';'",~. 4 ~,:,~ ¢~.~*-~' '/ lA/:' ..'.o~.i~ AIA~IiA ",V~5;'~-t~ ~ ~'~;STEWATER sc.,4.r.:J'L'U' GERARD SKIBIN 696-7544 1 OF 2 VALLEY VIeW ESTATES SUSDIVISIO~ ~1= LOT 5. 8LOCK 2. SITE P~N FOR WAIVER REQUEST t~-t?RYHILL ROAD , I \\ / \ / \~ / \ ........................................................ J.L.M, , CONSULTA~S, INC. 1" : 40' ' GERARD SKIBIN 696-7544 2 OF 2 VAL~Y VI~ ESTATES SUBDIVISION ~1~ LOT 5, BLOCK 2, DRAWING FOR WAIVER REQUEST . ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Service~ Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-521- .~ GENERAL INFORMATION Complete legal description Lot 5; Block 2; Valley View Estates Location (site address or directions) Property o, wner Mailing address ~.,.Lending agency ;;~ailing address Age~ Chet & Jane Paris 26000 Berryhill Road Address 26000 Berryhill Road Eag]~ River, A;( Day phone Eagle River, AK 99577 Day phone Day phone 696-3247 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ' 3 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality aqd status of system. XXX 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-O25(R8¥.1/9~) Front MOA#'~I 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 Phone ~ ~ - ~c/ '7 <~ 17u34 Eagle River Loop Road No, 204 Address Eagle River, hAla~lka..~9577.,,/ DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date '['he 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 pumhasem 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 DEPARTMENT OF HEALTH & HUMAN SERVI~I~ 1 9 1998 Environmental Services Division MUNlClPALI'i'Y OF ANCHOP, AGE 825 L Street, Room 502 · Anchorage, Alaska Health Authority Approval Checklist LegalDescription: ~,~ ~ ~ V,4'(j.~,~ Vl~b,d ~?'~¢~#/ ParcelI.D.: A. WELL DATA Well type P~I v~E~ Log present~Y'~) I~, ~% Total depth ~'~P Sanitary seal ~) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~[ FROM WELL LOG ~,¢r.,~- Casing height (above ground) Wires properly protected {~N) AT INSPECTION WATER SAMPLE RESULTS: Coliform O Date of sample: ~'//~/~ SEPTIC/HOLDING TANK DATA Date installed ~/~0/~ Foundation cleanout (~ Nitrate ), ~ f Collected by: Other bacteria o Tanksize J~zLL Number of Compartments ~ Cleanouts~l) ~'?) Depression (Y~) ~ High water alarm (Y~ ~ ~ Pumper 1 ~-~ Date of pumping ABSORPTION FIELD DATA D~te installed (~ Soil rating (g.p.d./fF or I~ ~/~U System type Length ~i Width : Gravel thickness below pipe ~ /Total depth EffeCtive.absorption area +~ ~' Monitoring T~be present ~) ~ Depression over field (Y~ Date of adequacy test ~{~¢ Results~/Fail) ~ For ~u ~-~ bedrooms Fluid depth in abso/ption field before test (in.); ~0 ' Immediately a~er ~%,0 gal. water added (in.): Fluid depth ~ (ins) Minutes later: i ~ W ~ Absorption rate = ~ + g.p.d. Peroxide treatment (Past 12 months) (Y/N) ~ ~,~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT ST~ Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons level at*. "Pump off" level at* SEPARATION DISTANCES FROM WELLON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main fcc '+ On adjacent lots I¢¢ * '~ On adjacent lots /v/// Public sewer manhole/cleanout Sewer/septic service line ~ bf / ~t Lift station A//~/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Io' ~' Property line f o ' ~ Absorption field 'Water main/service line ~ ~+ Surface water/drainage /¢~ /¢ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line t b I-~ Building foundation I~' Jo Wells on adjacent lots Water main/service line Surface water I~o t ~' Driveway, parking/vehicle storage area Wells on adjacent lots I }?(~' / '~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records tha, t~,~r~e, ms are . in conformance with~M~A,t,/tA~ guidelines in effect on this date. Date HAA Fee $ ~ ¢ 0 ¢ ¢ 0 Waiver Fee $ .... ~'"' Dateo, Payment-'~// ?/?~ Dateof Payment ReoeiptNumber 0'5709 (O~l ) Receipt Number 72-026 (Rev, 3~96)* ROADDE$1GN PERCOIJqION IEST ROBERTC. COWAN. hE. ROSERTA. SttAFER. RE. CIVIL ENGINEERS (907) 694-2979 WELL FLOW TEST DATA WELL DEPTH: ~O x CASINe DEPTH: ~ x MISC D~TA: CASING tlEIGHT: I~'~ ~ SANITARY SEAL: WIRES IN CONDUIT: ~ GRADING O.K.: ~2 ~ BACTERIA AND NITRATE SAMPLES COLLECTED (dale): ~D oFF o~J TEST DATA: METER PUMPING DEPTH TO CLOCK READING RATE WATER REMARKS TIME (GAL) (GPM) (FT) 3: Iff ~o~ 1, o RESULTS: WELL CURRENTLY PRODUCES ,c~ GPM W THA ~ / DRAWDOWN TESTED BY: ~--'~ ~ ' FLOW RATE NOT GUARANTEED--SUBSEQUENT VARIATIONS CAN OCCUR. 1 z084 NOR Ill EAGLE R VER 100P · S )ITL 2~4 · EAGLE RIVER. A[.AS~ 99577 /~ CT&E Environmental Serviceslnc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 982338001 S & S Engineering Lot 5 Bk 2 Valley View Est. Lot 5 Bk 2 Valley View Est. Drinking Water 0 Sample Remarks: Client PO# 1443PX985596001 Printed Date/Time 05/27/98 00:45 Collected Date/Time 05/18/98 13:50 Received Date/Time 05/18/98 16:35 Technical Director: Stephen C. Ede Released Byg~~q ~ ResuLts PDL Units Method ^ttowabte Prep ^natysis Limits Date Date Init Total CoLiform Nitrate-N 0 cot/lOOmL SM18 92228 6.95 0.100 mg/L EPA 300.0 05/18/98 TM~ 10 max 05/19/98 05/19/98 RMV · - : '"-'$ MUNiCIPAUTYOFANCHORAGE ' '.' ~-'-:'":" ";- :~':. ', . .,' 'HE.~.Lm& HUMAN SER~ CES ............ · . :.' ~ .. ..~/J~ . , , Division of Environmental Servlce~ ...~ "" .! ,0 Bo rage ;~-Ia~'='99519-6650 ,~':'C,.~.',':'. .... 'i: ' .~ ~:~.~.'. i CERTIFICATE OF.._HEALTH AUTHORITY - '- : ' '" APPROVAL FOR ,,~ '~ S ~GI.:E FAM ........ :: . I ILY DWELLING ..::....'"-.: -ParcelI.D.# .0,~ O - ,.~'~-[ ·-'S'tl .... .-: .t:~.H..A,~..~:. I~Aq~'~"/~ ............ . · . .... · ......... . _.'-: _'; ~.:.. -~. . .... - - "' :.-_ _ -' ':': "2.'?*';':" ' ,. _ . · ........ .... - . . ___litTle 6.~ ' ' ' ' "*':~'~'"'~" ' '"' · "... '.:::...'?', Lbcatlon;(slte address or directions) ;: E~/.t P~v~ Road ......... .... , ..: · ..... ~ .~:'.,~:Property owner G~uut~ $~ Abb~ Day phone ' :-:::--. ;-~ ~, ~'Lendi~ age~.'~ -' ' --- ' Day phone ' --- '..: ~; ':'...: · ;'~:~ Mailing address '~ '~ ...... ' ..... .., ,. ...... ~, ....... ~.. ........ . , ..: .......... . ..... 5.~ :. · ,.'_- .... ..~,,~ ~r.,,~,~, SUPPLY ...... ~ ..... _~ ~ . . ............... , . · . · . I~UD{IC water ......... . ......... ,~ .....,, _[.; . . -' -..-~._. NOTE: _ If community well aystem, provide whiten confirmation fro.m Sta~e ADEC attest-, ~ ... ',':'" · .... .'- .' ..... · ~' .' ' .,:,.' ............... · .'- t'"! '. ~- ,...- . - .¢, :, ..., . · - , ....... .:- .... .- - ,~,~ ...... ; ,.- .--..,,,~, ...... ,-, ,~.~ · ... ~.~, ..... ;~`~.~-~.~`u.~.~-~:~`·~-~u~:?~``:~..~"~`~.~.~`~`~"`~.~.~`..~:~`~.~- .c,,' .... 't?~,.--i.7',~'*.~',~r~\~?.,' .... - ,,-.~-', ....... · Holdln tank-- ....... ~: ......... · . ......... .--,(,; ,, :,-- - ,. · ~. - - - -~.,~,~.~,'-~,,,~,,- Pub c sawer, - , .-. ~,.....~, .-. . ..., .... . . · -...-~ ,.:.-,.; -, .,,... :, ' NOT~, If communt~ wastewater s~tem, provlde wd~en confi~ation from State ~DEG ~x - . '.. - · affesting to ~e I~a!~and status ofa~tem. - · ~ * 5. -.:STATEMENT,OF INSPECTION BY ENGINEER.. ....... : ~* :.:*:,:-~¥,~.~'-~":F~-::';~.,i.-. ~:.~[~..'-'_'.*~--.: · "- : .... -*-,'+-~ .... ' * · .;.;~ '~' .' ".'~ *..' , .:-,*~*.' '!' ;,~-:*~. . . ,'.. '.* ~' --*- ,~ *;;'-.1:.-~.*~.~'~*~*:~-':~'~'2..:_ · 'As certified by my seal affixed hereto and as of the vshdahon data shown be ow,.! verify that my inve~tigation of~ this Health ~Aut~h .ori~ty~ppprov. a2 appll.c..a..tlon shows that the~n-site water supply ,' and/or wastewater ~isposal ,system.` ls ,sa.f.?, f.un~io, nal and adequate for th*e-nu'mbTer'"~f and ~1:~ of structure nd ~at~:t herren. I fu ,rther ver fy that bam~d on the Informabon obtained from th~ Muni~:i~liO~! A~'/:fio'd§'e fil~ ~nd lmm my inYas.ti_,qatiori andIn~l~t~on,'~ ' ': ........ the on.~ts*"~"~ater.:' . ~uppl¥ and/or wast~ater.d~po~l ~tem I,~ In eompllanm ~ith all Munl¢ipal and $~te ¢od~. ...... -. Name of Firm $ & S ~l~lN~.Rl~{} ........... ,.: '. '.-.~ ~ ~.%: ~=' . ' ~nd~on~ *~pmv~-for R~ ~ · ~r~ms?.wl~ ,~e [following ~pu~fions: By- - Date ,-.. ,-_ . ' · , ~Mumcl~hW of Anchomge.~t bf H~I~ a~ Human ~wic~ (DHHS) i~u~ H~ ,. ,' ,,'. orof~ionalenein~iste~ln~S~teofAl~k&~DHH~o~this~ac~to~u~ofho~'.~. Municipality o!. Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-c,'.r ~' ~ 'Z.- ~)<~ ~ ~/,,~,J ~- I Pamel I.D. A. Well Data Well type Log present (~1) 05-0 -~3.1--5'1 Total depth ~- ~o ' Sanitary seal (~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ,f-//-7<~ Driller )4 Cased to FROM WELL LOG Date of test Static water level ,5-b · Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septi~ tank on lot Io Absorption field on lot Public sewer main Sewer sen/ice line .~ ,3- ~'~' Wires properly protected (~N) AT'NSP C'ION g.p.m. /, / g.p.m. .217~ " ; On adjacent lots l~n · ; On adjacent lots l~o ~ ')'' Public sewer manhole/cleanout Petroleum tank Other bacteria /c3~ $ & $ ENGINEERING 17034 Emjle Ri~er Leep Reed Ne. Eagle River, Alaska ~5~ WATER SAMPLE RESULTS: Coliform ~) Nitrate O.? o Date of sample: ~,.~.. ~.~ /-.~o. ?,~-- ' Collected by: B. SEPTI~OLDING TANK DATA Date installed - ~.; e ~ Tank size / ooo Compa~ments Cleanouts ~) ~ Foundation cleanout ~ ~ Depression High water ala~ ~ ~ Alarm tested ~) ~'~ Date of pumping ~-/7~ Pumper ~. ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /oo ' On adjacent lots /od~ ,.c Foundation To property line / d · / Absorption field O"" Water main/service line Sudace water/drainage /~o ~'~ ' , ~ . =' CONTINUED ON BACK PAGE 72-(326 (3/93)' Front t''....i "~" '~ '.,.' '~ * ! : ',', ,' ~" . .,' ° . · C. LIFT STATION Date installed Manufacturer Size In gallons Manhole/Access (Y/N) (Y/N) 'Pump on' level at . 'P~ Vent High water alarm level Meets MOA electrical codes (Y/N) S~ION TO: Well on lot' On adjacefit lois Surface water D. ABSORPTION FIELD DATA Date installed ~--,~,~- '73' ~ Length ,.w ~ ~ Width Total absorption area Date Of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) ('~ Soil rating (GPD/FF) ~ I~/~z, System type 7'",z~,~'~/ Gravel thickness ' ~.- · Total depth cleanout present~lN) ~/ Depression over field (Y.~ ,2. t.z" After test ~ ~//" SEPARATION DISTANCE FROM ABSORPTION FIELD TO: To building foundation. On adjacent lots Surface water Curtain drain E. ENGINEER'S CERTIFICATION , On adjacent lots /~o · ~' Property line · ..?o x To existing or abandoned system on lot Cutbank ,.t/~ Water main/sen/ice line Driveway, parking/vehicle storage area I ce~*fy that I have checked, verified, or conformed to all MOA and HAA g~/delir~es in effect~o..~q~.e dat~ of this Inspecb'on. Engineer's Name' Date ;::k. {':3-,,t-- J.~'/,J'"" ~ ~,"'-,, CE-~801 ...,~?,,~ · , , - EM Fee $ ~'~"g · ~ Waiver Fee $ ; Date of Payment ~. ~'~-~ 7--' ~...~' Dat~ ~f Payment .eceipt Num r .ec ipt Number /24326 (3~93)' Back e3/02/19~5 14:59 5~76941211 PAGE: 82 ;K~ERT C.. COWAt, I, P.E. IK)I)ERTA. gHAF;~ WELL FLOW TEST DATA FAX (gOTT) 694-1211 WELLDEPTH: ~.~k* CA~INQDEPTH: At,~,.' ,~4,.. DATr DR~LLIN(3COMPLL'TED: ;-U-'*/I:) DRILLER: A1( ~- Z~,L-,(,(-,',~, MISC, DATA: CASING HEIOHT: 17..'~ SANITARY 8F_M,3 . WtR~ IN CONDUIT: %/ GRADING O,IC: BACTERIA AND NtTRATE 8~MPLE$ COLLECTED (d&te): I TEST DATA: METER PUMPING DEPTH TO CLOCK READING RATE WATER REMARKS TIME {GAL) (OPM) (FT) W~LL CURRENTLY PRODUCES ,, ~o / 1T.~TED BY: FLOW RATE NOT GUARAHTEED~UBSEQUENT VARIATIONS CAN OCCUR. Parcel I.D. # 1. 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 050-521-51 GENERAL INFORMATION Complete legal description Valley View Estates #1, Lot 5, Block T14N R1W Section 23 Location(siteaddressordirections) NHN Berryhill, Eagle River Property owner Andrew Lord & Elaine Morris Day phonb N/A Mailing address SRA Box 1740, Eagle River, AK 99577 Lending agency Mailing address Day phone Agent Jean Hohnstein/Marston 2804 W. Northern Lgts. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Address Unless otherwise requested, HAA will be held for pickup. 3 % x NOTE: Day phone Blvd., Anchorage, 248-2804 AK 99517 Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. X 4. TYPE OF WASTEWATER DISPOSAL: NOTE: 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 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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294 Eagle River, AK 99577 Engineer's signature -' ,,~ -,~,~.-¢-'2~.~.; Date DHHS SIGNATURE 7~.- Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date _~~,~ 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 pro'fessional 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 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ~5 Parcel I.D. 0.~0 - ~Z/~/ ADEC water system number Date completed 0~'/I//?~"' Drille? -"¢ Cased to .~' ? ' Casing height /~" Wires properly protected (Y/N) Y¢: Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION 3.~ g.p.m. O' b g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /00 / Absorption field on lot //4) ' Public sewer main /,,//,,4 IZub[ic sewer service line ~ · ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform - ~" Date of sample: Nitrate 2, ~' .,~ // /0//2/ Other bacteria t0///0./'¢// Collected by: B. SEPTIC/I'~ TANK DATA Date installed ~ ~/,~/? ~ Cleanouts (Y/N) ~'~ Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping Tank size ,//0~0 Compartments x~/O Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s) on lot /00 / To propertyline ~ / Surface water/drainage On adjacent lots /-/00 ' Foundation Absorption field /-~E:'t~'~/D Water main/service line CONTINUED ON BACK PAGE 72°026 Rev. 3/91) Fror~t MOA21 · ' C. LIFT STATION Date installed Size in gallons Vent (Y/N) SEPARA ' al ~)'~r-- TION DI~./~'ANCE FROM LIFT STATION TO: Wel~.l O.~Ot-- On adjacent lots D. ABSORPTION FIELD DATA Manufacturer J Man~ "Pump on" level at "Pump off" level at Cycles tested Surface water Date installed Length --~ ' Total absorption area Depression over field (Y/N) Results (pass/fail) Soil rating System type Width ~ ~ Gravel thickness ('p / Total depth '/-¢ -¢¢¢ / Cleanouts present (Y/N) Y¢~ ,z/'~ Date of adequacy test O ~/,~,.~o /2.¢,5' $ for . ~ Peroxide treatment (past 12 months) (Y/N) If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ,//¢ / On adjacent lots 7~/¢¢ Property line To building foundation *¢ '-~ ¢ / To existing or abandoned system on lot On adjacent lots ~ ~-~ ~ Cutbank ..A//.,4 Water.ma~/service line Surface water /*/./,¢ Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect, er~th¢,date of this inspection. Engineer's Name Date _ ~/~,A' 0,/~''~ HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 MUNICIPALITY O~ 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. # l(~O - ~ ~ ~ ~. 1. GENERAL INFORMATION Complete legal description HAA# Valley View'#1, Lot 5, Block 2 T14N R1W Section 23 ~ Berryhili, Eagle River Location (site address or directions) Property owner Andrew Lord ,c, F~l~ine Morris Day phone N/A Mailing address SPA Box 1740, Eagle River, AK 99577 Lending agency N/A Mailing address. Day phone Agent Jean Hohnstein/Mars ton Address 2804' w. Northern Lts. Blvd., Anchorage, AK Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water X NOTE: Day phone 248-2804 99517 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site X Holding tank Community on-site Public sewer If community wastewater system, provide written confirmatio.n from State ADEC attesting to the legality and status of system. 72-025(Rev, I/91) Front MOA#21 '~lJO~ %jeeu[Oue IBUO!SSejoJd eH), u! suo!ss!uJo Jo sJoJJe Jo,t elq!suodseJ ~OLI SI el~JOqOUV JO A~H~d!o!unlAI eqJ. 'penss! s! e~eo!~!~Jeo ~ eJojeq el~P ez~ieue Jo suoBoedsu! ),onpuoo ~ou op SHHQ ~o seeXoldLU:l .slueuUeJmb@J m,~ pu~ ~jepe,~ u~p@o ~sl),~s ol jepJo u suo ln~ ~,sul ~u pu@ J~eLB pu~ sm~oq jo sJeseLIOJ nd o~/~se~J noo e se slq~, seop SH HQ eli]. '~seiV lo m,~lS eq~ u~ peJelslSeJ Je@u §ue euo~ssejoJd ~uapuedepu! u~/,q eAoqe g qdeJ~J~d u! ueN8 suo!~e~ueseJdeJ eqi uodn XlUO peseq smeogt~eO le^oJdd¥ ,~poqln¥ qlteeH s@nss! (SHHa) seo!MeS ueLunH pu~ LBI~eH ,to ~uet,upedeQ el~Joqouv jo Xl!i~d!o!un[N eq.L s~uewwoo leuoB!PPV :suo.~elndqs 6U!MOIIOI eq~, q~!~ 'SLUOO~peq 'suJoo~peq LL§66 Jo~ leAoJdde leUOB!puoO 'pe^oJddes!C] JO~ peAoJddV ~ =II:tn.LYNDI$ SHH~ eJn),euS!s s,Jeeu!Su~ )iv. '.ZaAT..~I aT.6~i ' '¢6E~.LL xo~ 'O'cI sseJpp¥ '9 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: J,/&Z./.~Y 7"/ ~-,,V , ~./ ~, A. WELL DATA Well type Log present (Y/N) Y Totaldepth ~??¢~0 Parcel I.D. If A, B, or C, attach ADEC letter. Date completed Cased to / Sanitary seal (Y/N) ~/ ADEC water system number Oq//I/q~ Driller Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test ~'// Static water level Well flow , Pump level g.p.m. AT INSPECTION 0 ~,/,~Z2 . ~L~I½CIPALITY OF ANCHORAGE ~f-~,//~'~¢;~',;MENTAL SI:RVICES DIVISION oCT 2 5 1991 g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot "maw Absorption field on lot //~ Public sewer main Pu~ sewer servi~e line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ¢ Nitrate Date of sample: /0//~,/~ / Collected by: Other bacteria B. S E P TI C,~*~I(~D ATA Date installed ~/Z.~./~') Tank size .~,,~(~ Compartments Cleanouts (Y/N) /v Foundation cleanout (Y/N) ,'~ Depression (Y/N) High water alarm (Y/N) /¢//f Alarm tested (Y/N) Date of pumping 0~/,~/./~1 ~T,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1¢'~ / To property line ,¢o~;- Surface water/drainage On adjacent lots Absorption field Foundation ~o Water main/service line 72~026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK .PAGE C. LIFT STATION Date installed Manufacturer ~ Size in gallons M~/N) Vent (Y/N) "Pump on" level ~ "Pump off" lave at High water alarm level ~.ll ~ Cycles tested Meets MOA electrical codes~) SEPARATION~f~NCE FROM LIFT STATION TO: Well.~r~t On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed / Length ~/ Width Total absorption area Depression over field (Y/N) Results (pass/fail) Soil rating ./~ Z~,/,,~/~ Gravel thickness Cleanouts present (Y/N) Date of adequacy test for System type Z",~,C.'V¢// Total depth_ /'~' / bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //~ / On adjacent lots ¢'/~' ~ Property line ~ / . To existing or abandoned system on lot To building foundation On adjacent lots ¢'3,~ / Cutbank /~'/'~ Water main/service line ¢/o" Surface water ,4//4 Driveway, parking/vehicle storage area v-/,~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect'on,thermate of this inspection. · ~.,~;';,~" :- ~,': ~ ~; ~ Engineer's Name ..Z~,,~r ,,~., ~ :¢ ? ~,~ HAA Fees /?~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-028 (Rev. 3/91 ) Back MOA 21 ,~ ~ INSPECTION APPOINTMENTS ~ ) TIME TIME TIME DATE ~(~ ~l~ __~ DATE DATE , MUNJCIPALI~ OF ANCHORAGE DEPT, OF H~ALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTE~ION 825 L Street- Anchorage, Alaska 99501 N0V 8 1979 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 . _ ~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete aH parts on page 1. Incomplete requests will not be processed. PJease allow ten {10} days for processing. 1. PROPERTY OWNER PHONE MAI L'ING ADDRESS 2. BUYER PHONE 3. LENDING INSTITUTION PHONE MAILING ADDR~S 4. REALTOR/AGENT ~ ~ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCAT[0N ........ 6, TYPE O~ESlDENCE NUMBER OF~BEDROOMS ~ One ~ Four ~INGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [Z/ INDIVIDUAL/ON-SITE** /? '~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY ,~. , 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -BITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank. or []Holding Tank ('0 Size: J(~:~'-~ If Tank is homemade SOILS RATING give dimensions: ~ TYPE OF TANK MANUFACTURER FETAL ABSORPTION AREA MATERIAL / 4. DISTANCESwELL TO: Septic/Holding] 0 (~ Tank Absorption/~0 Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~ APPROVED FOR .2 BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72 010 (Rev. 6/79)