HomeMy WebLinkAboutVALLEY VIEW TERRACE BLK 2 LT 14Onsite File
err
ce
Valley View k m,.
f
W ater storage tank has been
replaced. For a COSA the tanks are
to be inspected to confirm that they
Easement Agreement
(�-
Thomas J. Lord is the owner of (Lot 14; Block 2; Valley View Terrace Subdivision), and executes this
agreement on behalf of the owners of Lot 15; Block 2; Valley View Terrace Subdivision, hereinafter
referred to as the "Dominant Parcel."
Both properties are within the Anchorage Recording District, Third Judicial District, State of Alaska, as
shown on the attached drawing, Appendix A.
In order for the Dominant Parcel to utilized the wastewater treatment system, the owner(s) of Lot 14;
Block 2; Valley View Terrace Subdivision, hereinafter referred to as the "Servient Parcel," hereby
provides an easement as described in Appendix A for the septic tank, lift station, and effluent line to an
absorption field located in the Dominant Parcel.
In granting this easement, the Servient Parcel will provide access for the maintenance of the lift station
and pumping of the septic tank from the driveway to the Servient Parcel.
Signature of Owner / Servient Parcel— *Signature of Owner orninant Parcel
ninant Parcel
Thomas J. Lord Karen Hoffman
Date Date COY/123 /
STATE OF )ss.
JUDICIAL DISTRICT I COUNTY OF
The foregoing instrument was acknowledged before me this day of -OLja i —
20 d 41', by I' W3�-Al H A.IA -r14-&,oAc 7-
--L<A
in the capacity of..Oldf�
W.'"""M/k
WN
IM -1
Return to: Tweed Excavating
17034 N. Eagle River Loop Ste. 202
Eagle River, AK 99577
lic in and for
ission expires // J,+A) 06
APPENDIX A
LEGAL LOT 14& 15, BLOCK 2, -VALLEY VIEW TERRACE
SEPTIC
AREAA
C
DRIVEWAY
LOT 15
v
SCALE
6
6
Douglas T. Kenley. P.E. 9806 E. Northstar Circle, Palmer. Alaska 99645 (907) 746-1073
October 22, 2008
Municipality of Anchorage
On -Site Services
4700 South Bragaw
Anchorage, Alaska
Re: Mr. Gary Rice, Owner
Valley View S/D, Block 2, Lot 14
23627 Lower Terrace Street
Eagle River, Alaska
DOCUMENTATION OF WATER STORAGE TANK
A 525 -gallon holding bladder, Model 11 BUFDA-98MT, manufactured by Burch Manufacturing
Company, Inc., was installed on September 27, 2008, by Alaska Pure Water under a stairwell off of
the garage area. All plumbing, pumps and water storage bladder are marked for potable use.
I f there should be any questions, please call me at (907) 746-1073 or 243-5372.
Sincerely,
Douglas T. Kenley, P.E.
PEH8176
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Permit Number: SW070301
Legal Description: Valley View Terrace Block 2 Lot 14
9r_ '/2 L/l
Date Issued: Oct 31, 2007
Expiration Date: Oct 30, 2008
Parcel ID: 050-352-19
Design Engineer: 0069 DOUGLAS T. KENLEY Site Address: 23627 Lower Terrace Street
Owner Name: GARY RILE Lot Size: 38051 SO. FT.
Owner Address: 23627 Lower Terrace Street Total Bedrooms: 3 Permit Bedrooms: 3
Eagle River . A 99514 -
This permit Is for the construction of:
❑ Disposal Field ❑ Septic Tank ❑ 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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, seated, and heated to prevent freezing.
Received
Date: 7� m
a Municipality of Anchorage
-Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
Parcell.D.
Property
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
C, .4'0 -,Ifz
G'..iell'
phone
Mailing address 10ic Zip Code "O4"47
Site address W,& Zip Code 994772'
,f Alb,
Legal description (Sub'd, Block & Lot) 444zcV aO�4d to d'C X, Lorry
Legal description (Township, Section & Range)
Lot Size 1.6
j as/, ZB _Sq. Ft.
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
❑
Septic Tank
❑
Holding Tank
❑
Privy
❑
Private Well
❑l
Water Storage
,
L•]
Number of Bedrooms
THIS APPLICATION IS AN:
Initial
Upgrade
❑
Renewal
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property ownerl6r authorized agent)
Permit/Rush Fees: 179- Waiver Fees:
Date of Payment: C& Z12 7 Date of Payment:
Receipt Number: I0037`7 /0�mw Receipt Number:
(Rev. 11105)
Douglas T. Kenley, P.E. 9806 E. North Star Circle. Palmer, Alaska 99645 (907) 746.1073
October 11, 2007
Municipality of Anchorage
On -Site Services
4700 South Bragaw
Anchorage, Alaska
Re: Mr. Gary Rice, Owner
Valley View S/D, Block 2, Lot 14
23627 Lower Terrace Street
Eagle River, Alaska
COVER LETTER
This letter is in response to your On -Site Sewer/Well Submittal Comment Sheet dated 10/1/07,
requesting additional information regarding the permit for installation of a holding tank.
The 525 gallon holding tank, Model # FDA 98MT, manufactured by Burch Manufacturing
Company, Inc. is proposed to be installed by Alaska Pure Water under a stairwell off of the garage
area.
If there should be any questions, please call me at (907) 746-1073 or 243-5372.
Sincerely,
D � glat . enley, P.E
PE#8176
5605502 - Line 1APWP INC
11,01 27 09.25-2007 116
MANUFACTURING COMPANY, INC.
The Easy, Economical Way
to Store or Haul Liquids
Multiple Uses. For parks, nurseries - anywhere
water sources are scarce, the Kolaps-A-Tank pro-
vides a mobile, reliable source of water. It is made
from material that is NSF/ANSI Standard 61
approved for contact with drinking water.
Unmatched Economy. The Kolaps-A-Tank is the
least expensive means devised to haul liquids on
virtually any vehicle you have available. Initial
cost is substantially lower than any comparable
fiberglass or poly tank on the market. For the
value, you can't beat the Kolaps-A-Tank. The fust
tanks made are still in the field after years of out-
standing service.
Superior Strength. Made of rugged 30 oz. 8130
XR-3 PW material. The Kolaps-A-Tank resists
chemical contamination, mildew, rot, and solar
heat exposure.
It's electronically heat sealed and capable of with:
standing severe outdoor exposure, including 40o
temperatures!
Versatile Capacity. The Burch Kolaps-A-Tank
can be handled easily by one man and yet holds
from 73 to 1340 gallons! It can be filled and emp-
tied in minutes with a centrifugal force pump or
drained by gravity flow. Six sizes are available, to
fit pickups and many standard wagon boxes. On
hayracks, the Kolaps-A-Tank is self-supporting.
Just thread rope over the tank, through the D -ring
guides, and tie it down.
j2 Line 1APWP INC r 11 02.25 -. 09.25-2007 216
Convenient to Fill, Drain Quality 11/2" gate
valve is mounted on 8" PVC extension pipe for
easy draining. Big 10" diameter flexible sleeve on
top makes tank simple to fill.
SPECIFICATIONS
Model No. Approximate Size
FDA 50MT 40" x 50" x 12" (102cm x 1
80" x 73" x 16" (203cm x
65" x 98" x 18" (165cm x
6'xIO'x2'(1.83mx304,
Tx12'xTOIAmv2(./-
Compact, Easy to Store Even the largest
Kolaps-A-Tank an be folded up and stored in an
19" x 19" x 19" carton.
Approx.
Shipping Wt
Gals. Liters Lbs. KG
x 30cm) 73 276 11 5
5cmx41
x
I FDA714MT 7'x14'x2'(2.13mx427mx 61
From covered wagons to
turkey saddles...
Burch Manufacturing has been making quality textile
products for agriculture, industry, and more than 100
years. if a product you need an be made of canvas or
vinyl coated nylon - chances are, we an sew it, or heat
sea! it. Send us your specifications and we will be happy
to provide you with a free estimate.
Sales & Service:
x
1
1
1340 5072 69
1
1
29
MA YUFACTErMG Cod1PAW JWC.
618 First Avenue North
Fort Dodge, Iowa 50501
Phone: (515) 573-4136
Far. (515) 573-4138
E -Mail: info@burchmfg.com
www.burchmfg.com
Manufacturers afcanvas and synthetic uxHkgroducts since 1882. xR3pW-a
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 99519650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Doug Kenley
Legal description: Valley View, B2 L14
®Permit ❑C.O.S.A. []Inspection Report
The attached paperwork has been reviewed and is being returned for the following reasons:
1. Provide a cover letter that
a) States the location of the tank.
b) States that it will be able to be filled from the exterior of the house, and that it will be
clearly and permanently marked • Potable Water.
c) States that all plumbing and pumping components of the tank will be NSF approved.
Name of reviewer. Deb
Date: 1011/07
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name / DISTANCES
O Hl O I OC Tn CCDTIf anCn CGTIniu
D,Q /414
Phonate)
6sy-9a,
Lot � Block
Township. Range, Section
Ti v.✓ A
X SEPTIC
Manufacturer
A"c,,k lam`
AN
S ec' /,f
I Bedrooms
3
FROM
WELL
LOT LINE
Scale:
iP?AcE
FOUNDATION
Inspections Performed by:
AS -BUILT DL
driveway. water
TANKS
❑ HOLDING
Capacity in gallons
lavo
TYPE OF SYSTEM
4� TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from Is—
Total depth from original grade
original grade
10 FT P FT
Fill added above original grade Gravel depth beneath pipe
Y FT ST
Gravel length Gravel width
$•O FT 3 FT
Total absorption area Distance between lines
415-0 SOFT /O FT
Number of linesSoil rating Pipe material02- /,Sd SO FT�tfy1 ^fd 3y �g-/O
Installer Date
Installetl
Oyw.vcr 7/7
WELLS
19 PRIVATE ❑ OTHER (Identifv)
Classification (A,B,C) Total Depth Cased to
FT FT
Installer Date Installed:
I REMARKS: ( i%tc— QuIt5
Municipal and State guidelines in effecton
ate:
Health Department Approval:
72-013 (3/85)
WELL
Yroo /y3s7 t-10o(7S3
r
tShow location of well, septic system. property lines, founds
U
Date: 7-28-99
TH
a v
'teA oeaedvaeoe aa°oaovo °
e.°+.
Louis A. Butera
CE -6736
PROFESSION��
Scale:
Inspections Performed by:
- -
Nile Rivor Engineering Services
€a
-
Date: P. 0. Box 773294
Eagle River, AK 99577
-
` * 'P
4� 719.8 6U4.5195
�a
6T
cerlify that this inspection was performed according to all
Date: 7-28-99
TH
a v
'teA oeaedvaeoe aa°oaovo °
e.°+.
Louis A. Butera
CE -6736
PROFESSION��
NI U I\I 1: C I P A L I T Y O f= ANCHORAGE
Department of Health & Human Services )
8.25 L Street„ Anchorage, Alaska 99501 343-4720 i57
O N -- S I T E S E W E: R & W E I L P E R 11 1: T
Permit Number: 880050
Date Issue& 05/10/88 Engineer Designed
ATE F_X MES:121YIAYB
Owner Name: TDM LORD Day Noone:
Owner Address„ P.O. BOX 140382 694--9264
ANCHORASE:, AK 99514-002
Parcel Id: 050-352-19
Lot Legala far_bdivisaon:VALLEY VTE TIRRACE: Lot_: 14 Block
f-2
Section; 15 Township: 14N Range; 1W
Lot Size 1.13A (sq. ft.. or acres)
Marc Bedrooms: This Near•mita 1 Total Capacity; /N6LE f,4,,?1Le RASIPEW66
SEPTIC 'T'Alalk.a Minimum total septic tank capar_it.ya tp000 gallons. Each septic
tank must have at least 2 compartments. Depth to top of septic tank (s) c: 4.0
feet requires insulation over tank(;).
WELL: Log must he submitted to Municipality of Anchorage Department:. of Health
and Human Services within :0 days of well completion.
INFORM D.H.H.S, PRIOR TO IST w 2ND INSPECTIONS BY ENGINEER, IF
AFTER OFFICE HOURS CALL.,,343--4687. AND LEAVE MESSAGE:.
CONSTRUCT PER ENGINEERS ATTACHED AP'PROVE'D DESIGN
I CERTIFY THAT:
1. :E am familiar with the requirements for on-site sewers, and walls as set..
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. C wil.l install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. 1: wi.l.l adhere to all MOA and Stater of Alaska requirements for the ,et back -
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. 1 understand that this permit is valid for a maximum of 3 bedrooms. I
also understand t.heat the capacity of the total system is Z bedrooms and
any enlargement will require an additional permit.
Signeda �z — DATE:
(Owner) TOM LORI)
Issued Dy: �� `%!�' Q DATE, 5'_�8-88
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 14, BLOCK 2, Valley View Terrace
A. GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of
Health and State Department Of Environmental Conservation require-
ments.
4. All soil tests are advisory to the design and are to be verified or
modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified or
modified in the field by the contractor to meet Municipality of
Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits
or easements and to locate any adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan,
any deviation requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line
position and the location of any easements.
B. TRENCH
1.
The trench is to follow the natural land contour to maintain
uniform
total depth of the trench bottom.
2.
The bottom of the trench shall be level, plus or minus 1.5".
3.
The total depth of the trench excavation is not to exceed 8 '
at any
point.
4.
Two trenches 25' in length are to be constructed so that the
upper
trench overflows to the lower trench.
5.
The trench gravel is to be covered with typar fabric material.
6.
Soil or combination of soil and extruded board insulation to
a depth
of 4' or equivalent is to be placed over the leachfield.
7.
The area over the trench is to be finish graded to prevent ponding
of
surface water runoff.
8.
The septic tank and leachfield must not be closer than 100'
to any
existing private well, 150' to any Class "C" well, or 200 feet
to any
community well.
RECOMMENDED LEACHFIELD DIMENSIONS
TOTAL DEPTH = 8' GRAVEL DEPTH = 4.5' TRENCH LENGTH = 50' TRENCH WIDTH = 30"
Soil Rating = 150Fl pp�vvC-D
Bedroom Capacity = 3 b m�N
Septic Tank Size = 1000 i��
! �J SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ML PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
= SOILS LOG - PERCOLATION TEST
PERFORMED FOR: 19 YGC '/ DATE PERFORMED: c/ � t
LEGAL DESCRIPTION: 'Z')r //r+��e� U7�w T�'rr�-c-�' j/yam✓/( /7✓-fcc,/s
OSL SITE PLAN
F E O,2 GA^I[G I F I I
1
U
2 n
3 0
4
5
6
7 �Z:)
8-
10-
11
10 11 U
12 P
13-
14
3
14
15
16
17
18
19
(GM)
S.It� ra. ody Gravel
/v3 0 /f'<'
WAS GROUND WATER
S
AJ0 L
ENCOUNTERED?
Net
Time
Depth to
Water
O
S o�c y
'n"raeeo P
IF YES, AT WHAT
V qys E
DEPTH?
Reading
T Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
S o�c y
K
20 I PERCOLATION RATE 0-' 6 (minutes/inch)
L�
TEST RUN BETWEEN FT AND FT
COMMENTS /vrJE Adm /C� 1U /SO 0/,Q7p
Eagle River Engineering Services CERTIFIED BY: DATE: -F; /6 fid'
PERFORMED BY:
Eagle River,DuA AK 99577
6945195
72-008 (6/79)
LOT
NSEMENT
<ISTING LEACH FIELD
- W LEACH FIELD
..�EANOUT -
SCALE, V = 60'
WELL AND SEPTIC SITE PLAN
e f'
LEGAL, LOT 14,
BLOCK 2, VALLEY VIEW TERRACE
OWNER; MR. TOM LORD
age ..nrn..e.aeon onoaocuaoa.+oar- ^
-.ONTRACT❑R; OWNER
=AGLE RIVER ENGINEERING SERVICES
30 BX 773294
_AGLE RIVER, AK. 99577
'394-5195
t?.-. .5sa„Deva..
Louis A. 0utera
CE -6736 d
b)
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
OWNER OF LAND
� OAO
DEPTH OF WELL
CK c,
From Ft. to e� Ft.��
ADDRESS
From.
STATIC LEVEL OF WATER PT.
From Ft. to FL
LEGAL DESCRIPTION
1
!, RWA%^ DOWN FT.
From -- FL to i `^ Ft.
N47-1
DATE - Started
Ended t%i)'
GALS. PER HR
`f1Ro c o. r- idd LAOIC/From
Ft. to Ft.
nn p
c ljrV'3 6 ti'<t4G /C
From.
PERMIT NUMBER
X 2sf®�
� - �' - --
KIND OF CASING
From
KIND OF FORMATION:
From Ft. to e� Ft.��
C aJ_)(j
From.
Ft. to Ft.
From Ft. to FL
".) l` -o i1�ie"'"t
From
Ft. to Ft.
From -- FL to i `^ Ft.
N47-1
From
Ft. to Ft.
From 1 --L Ft. to —JS Ft.�1`S'
`f1Ro c o. r- idd LAOIC/From
Ft. to Ft.
From-15:11Ft. toP Ft.4%
c ljrV'3 6 ti'<t4G /C
From.
Ft. to Ft
From Ft. to ".'? LFt:
jr-'/Is2'o 4. 4 131-t4G r`: c f
From
ft. to Ft.
From_ Ft. to Ft.-4ri
1 4,4 �1 ,S�
From
Ft. to Ft.
From 5s"". Ft. to 1:x.3 Ft./
ee:>'�. k. 134,4(Z 1�
From
Ft. to Ft.
From Ft. to I ! F[
f-1144 6R!il'1�33 Its
-From
Ft. to Ft.
From (T/ Ft. to-tll--Ft.
f ?c F✓ t'' c 131,#G(* -
From tAl lw,01` 0 OF AN ORAGE
&
...
From �•{ � Ft. to _�%' 3 Ft.
,, tyn�;�t, ,;4
;r'�%d oc /c �� �
DEPT. OF
NTAL PRpTECf10N.
,From ENVIRQgd� Ft.
From._F[. to Ft.
t )0sJr i 'y .ft^:8r/t r`i,'E>yt'I
From
_ ` EtjJjN
From: ;;{ Ft. to r),;0? Ft.t�"-
�I A? '6 GiC.(�.
From
—E�f i F\E to
`G' YFt.
From Ft. to Ft.
-
From—)t.
o
From Ft. to Ft.
From
Ft. to Ft.
From Ft. to FL
From
Ft. to Ft.
From Ft. to Ft.
From
Ft. to Ft
MISCL. INFORMATION:
/ It
(
44-
.� DRILLER'S NAME f,� t / .,,f..
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
�+ F Anchorage, AK 99519-6650
i www.muni.orgionsite
tttt (907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL`
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _ 1)58~ 3 )-,g - I q COSA # b�D 9CE
Expiration Date: i�i: /M
1. GENERAL INFORMATION
Complete legal description valley mew't, Mick 2. Lot 14
Location (site address) 23627 Lower Terrace Street, Eagle River, Alaska
Current Property owner(s) Gary L and Marione R. Pico Day phone (907) 240 121
Mailing address 3315 w. 3rd Streot, Anaoordes, washirgton 98321
Lending agency Day phone
Mailing address
Real Estate Agent Bennie ring, ring's Real Estate Day phone (907) 6W2276
Mailing Address 21708 Old Glenn Hwy, Chuglak, Alaska
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: • 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
[]
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 invesc
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this apptation,
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
Address 9806 E. North Star Grde, Palmer, AK 99645
Engineer's Printed Name '{
5. DSD S�NATURE
Approved for bedrooms.
Disapproved.
Phone (907) 746-1
Da
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
--- Well Flow Advisory -- -- — Supplemental Engineers Report --- --
Nitrate Advisory Other
By: _er�
Original Certificate Date:
(R~.,,a )
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Boa 198850
Anchorage, AK 99519.8850
www.muni.org/onaite
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Descriptron: Vasey VW& Twr8m s/n awac a Lau
Parcel 10:
A. WELL DATA
Well type Prhate If A, B, or C provide PWSID #
Data completed 2rt2/ee Sanitary seal (YIN) Y
Total depth azo R. Cased to 17.3 ft.
FROM WELL LOG
Data of test 5fa Was
Static water level 47 ft.
Web production 2 g.p.m.
WATER SAMPLE RESULTS:
Colifonrl 0 wW10sH00 mL Nitrate 0.1 mg&
Arsenic: 5 M94 Date of temple: etae/07
e. SEPTI (HOLDING TANK DATA
Web Log (YIN) Y
Wires property protected (YM) Y
Casing height (above ground) --min.
AT INSPECTION
9/27/07
49.6 ft
41ft W is g.p.m.
Other bactena 0 0010nies/100 mL
Collected by: _ F. Kenley
Tank TypelMatedal _ ee0ndsmal Data installed 7nw8e
Tank size 1Aoo gal. Number of Compartments Cleanout- (YIN) Y
Foundation cbarput (Y" v Depression over tank (YIN) N High water alarm (Y/N) wA
Data of pumping 10/&07 Pumper J.R. Pumps
C. ABSORPTION FIELD DATA
Data installed 7/10/89 Soll rating (g.p.d.lftt or fta/bdrm) 150 SYttem type bwlch
Length 26.27.b3 ft. Width 3 ft. Gravel below pipe 31/1 b 4-112 ft.
Total depth a fL Eff. absorption area 450 ttz Monitoring tube Y Depression over fteld N
Date of adequary test w27/07 Results (Pan/Fall) Paas For 3
bedrooms
Fkrid depth In absorption held before test 0/15.1/2 in. Water added505 gal. Now depth 3-114/27-3r4 In,
Elapsed Time: 263 min. Final fluid depth 223-3/4 in,
Absorption rate >= 450 g.p.d.
Any reluvw"00n treatment (past 12 mo.) (YM & type) N
H yes, give date N/A
D. LIFT STATION
Date installed Size in gallons Manhoie/Access (YIN)
'Pump on level at_ in. 'Pump off"
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanklllR station on lot 1101 R
Absorption field on lot 120+8
Public sewer main NIA
Sewer (septic service line 25+ R
Animal containment areas T5+ R
at in.
Meats alarm d circuit rawiremenbT
On adjacent lots 100+ R
On adjacent lots 100+ Ft
Public sewer manhoie/deanOut WA
Holding tank
WA
Manure/animal excrete storage areas 1001 ft
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
5+ ft Property line 20+ RR Absorption held s" R
Water main
wA Water service fine 25+ ft Suriaee water 100+ ft
wells on adjacent lots 1001'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line la+ R Building foundation 76+ fr Water main NA
Water Service line 25+ It Surface water lee+ ft Driveway, parldNIvehids staa0e 51 it
Curtain drain ca. a ' 10 "'o Wells on adjacent lots `1001 R
F. COMMENTS' See asacned 001Nia' i thse1'
G. ENGINEER'S CERTIFICATION
I certay that 1 have determined through Field inspections and
review of Muni ipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name D xgllas T. Kelley
Date to - I i ' (.)"I
c 30 —1 / Qct
COSA Fee $
'
/
Date of Paymerd j�1y
Receipt Number ff r V o T -
(Rev. ItroS)
waiver Fee $
Date of Payment
Receipt Number
p)uglaSj'Kenky --------------- 2806 E,14orth Sjxr Circle, F I W.
Oskar"
`—
(vo?).2+G107�
October 11, 2007
LMAa
Valley View Terrace S/D, Block 2, Lot 14
Comments for the tan COSA form:
A total of 505 gallons was introduced into the leach field. The system favored going into
the lower trench. Although the lower trench did not absorb quite enough for the 450 -
gallon requirement, with the upper trench still available, the system passed. The well is
low producing. A 525 -gallon bladder tank was installed. The well recovery did verify
the requirements of 450 GPD. The sonar instrument was unable to get past an obstruction
in the well casing so an accurate GPM calculation was not available. It is safe to assume
that it was in the 1 GPM range. It produced 3.8 GPM in the 2 hours 13 minutes of testing
time on the well. The bladder still had at least 20 gallons in it. A four-hour test with the
new holding tanks still would not produce the 3 GPM, which is required by some lending
institutions.
Douglas T.
SCS ReEN
107511800/
Client Name
Douglas Kenley P.E.
' All Dales/fimes arc Alaska
Standard Time
Project Name/#
ClientSample ID
flosc Dib Lot 14 DIk2 VaIleyVicw
Printed Date/time
10/122007 8:32
hlatds
llose Dib L0t14 DIk2 VallcyVicw
" ` '' Callecird Datdlime
09262007 15:45
Drinking Watcr
• •-• Received Date/time
0926/2007 17:25
Technical Director
Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter ResultsPQL Units Method Container ID Limits Date
Date Init
Metals by ICplms
Arsenic ND 5.00
uVL EP200.8 C (<I0) 10/03/0710/10/07 MII
Waters Department
Total Nitrate/Nitrite-N PSD
Microbiology Laboratozy
Total Coliform 0
0.100 m91L SM204500ND3.F 'D (,to)
col/IOOmL SM209222D A &1)
10/02/07 IDS
0926107 SDP
no". 41 "t Savt
i3�,—ksc_�
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.ci.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. Sj S 0 -_3 6"9L -_L9 HAA # 05- D O g 7
Expiration Date: 6;— 19 — O s
1. GENERAL INFORMATION
Complete legal description .Lo 1/f�, 810,A'�V, 114ZLeg lll'CW �Cr//9GG
Location (site address or directions)
734.77 4ouve*- fCrrp cP Sf� Sf,-
/ eei'uer, f%F'
Current Property owner(s) 7,15em, 9 s /0,0- ci Day phone 6 aH- Sl 7,F
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
® Individual On-site
El
Individual Water Storage
❑ Individual Holding tank
❑
Community Class Well
❑ Community On-site
❑
Public Water System
❑ Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm Qou�z 14_!rf Alern ley Phona`�07) 74/G0
-!75 '
Address 9gGD L- Pi.6F•'i) xh,
Engineer's Printed Name' 12ees /19s 2A iiPn req Date qtir'.%
OF
5. DSD SIGNATURE of VIP.,. IAStlBW
CE 8178.
Approved for bedrooms.; _
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:Original Certificate Date: 3'" 1.9-0-5,
(Rn. 0102)
Municipality of Anchorage
Development Services Department
Building Safety Division
Ort -Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196850 Anchorage, AK 99519.6650
www.ci.anchorage.ak.us
.(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 4�ALleL1�l'a<✓ Parce110: 0-6-0 35'91-11
A. WELL DATA
Well type t cam le If A. B, or C provide PWSID #
Date completed ? as/07 Sanitary sea[ (YM)
Total depth at a o ft. Cased to / 7• R
FROM WELL LOG
Date of test
Static water level �1'i ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform O colonies/100 ml. Nitrate 4• / mg./l.
Arsenic: A(IA mg.A. Date of sample: �o,;
B. SEPTICIHOLDING TANK DATA
Weil Log (Y/N) V
Wires properly protected (YM) _41
Casing height (above ground) min.
AT INSPECTION
f/R ft.
g.p.m.
Other bacteria D colonies/100 ml.
Collected by: f.e-d Alen IV 91
Tank Type/Material SCAII'cls f' -e/ Date installed
Tank size 1000 gal. Number of Compartments o2 Cleanouts (Y/N) �V
Foundation cleanout (YM) Depression over lank (Y/N) High water alar (Y/N)
Date of pumping Y// 03 Pumper ,ries Purneing
C. ABSORPTION FIELD DATA
Date installed 10 Soil rating (g.p.d./fe o rm -L§2) System type _71-.-cnc,4
Length gU 7t.2 9-,1-3 fL Width 1 .:7 ft. Gravel below pipe Oso Ali ft.
Total depth ..Z� R Eff. absorption area `LrW Monitoring tube_. V Depression over field 41 _
Date of adequacy test f /3 / s- Results (Pass/Fail) r r SS For _. bedrooms
Fluid depth in absorption field before test /// in. Water added L66gal. New depths in.
Elapsed Time: /80 min. Final fluid depth /4in. Absorption rate >= -e/SD g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) A/ If yes, give date —
D. UFT STATION
Date installed
"Pump on" level at _ in.
E. SEPARATION DISTANCES
Size in gallons
'Pump off' level
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
e tic ift station on lot Aif /-r
Absorption field on lot /s't 0 �x>t
Public sewer main NSR
Sewer /septic service line
Manhole/Access (Y/N)
at in.
Meats alarm & circuit requirements?
On adjacent krts�', / D O -,e f f
On adjacent los / ,� n t G f
Public sewer manhole/cieanout /IR
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line "2 D t /7.' Absorption field 6 f let
Water main dYzd Water service line d,5- r /'t Surface water / 0 0 t lef
Wells on adjacent lots /0o —y"'t
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /fr, , Gf Building foundation 7 J� /f: Water main iY�is
Water Service line /00 t- f% � Surface water Driveway, parking/vehicle storage
None Rncw-
Curtain drain rn e r • c t• Wells on adjacent lots / 0 %T
F. COMMENTS Tct/ /r eni'lei/n9 fates roere. e, iVe/-F,'Ile" or /„qdD 1,5freiet'er So
sysz Un^hle fo 7e-r0'e-V" /-ur!rify -/ie J/ a/c J0 Stale/per
The /nS ec7'1cn pe -,yo v-71. v,v "ve—yit „4Io Jys� n=0-
G. ENGINEER'S CERTIFICATION �a�� ���� �'•._�9it..
1 certify that I have determined through field inspections and -0Go..
•�
0 : 4 TH
review of Municipal records that the above systems are in 0..
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Aouoley, f /Se,- II,- CE $176
Date. RAJA 101< r •.:
HAA Fee $ 'T,: -C ""
Date of Payment 15
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
U
Lf
01
yV
Oi
h
N
7v
~
u
N
h
tV
7r
N
�f
in
n
x
iA
IN
'l
i0
A
m
O
16
OJ
P
b
n
♦
n
n
•
n
H
H
t
h
;
x
h
x
H
N
03-14-05 04:30PM FROM -CUE ESI. SGS ENV SERVICES
Lsfi$—
SCS Rc0
1051258001
Client Name
Douglas Kenley P.B.
Project Name/
L14 Bk2. Valicv View Terrace
Client Sample ID
L14 13k2 Valley View Terrace
Matrix
Drinking Water
Location/Well ID
Dist Sys CIP 038-08
Sample Remarks:
9075615301 T-177 P.02/04 F-941
All Dates rimes are Alaska Standard Time
Printed Date/time 03/11/2005 14:40
Collected Date/Time 03/09/2005 12:00
Received Date/time 03/09/2005 13:23
Technical Director C. Ede
Released 8
Allowable PteP Anolysis Init
Panmeter Rauh PQL Unita Method Cantainer lD Iimin Pete Dnte
Watere Department
Nitrate -N
0.100 U 0.100 mG/L EPA 300.0 B 03/09/05 CAM
Microbiology Laboratory
Total Coliform
COI/100m1. SM2092220 A (<-1)
03/09/05 DKC
U3-14-05 04:30PM FROM-CTtE ESI, SGS ENV SERVICES 9075615301
SGSICTILE F-WRONMENTAL SERVICES
Drinking Water Analysis Report for Total Coliform Bacteria
READ INSVWCT% MS OM REVERSE St9S B!FONS ca.►ECTWO SAWLS .
MUST SE COMPLETED s, WATER SUPPLIER
❑ pumx WATER SYSTEM IDS—
QPRNAT[Wj
send Results G . Send we" t.—
r
w� s �a'fL idSMR s71'%.
�/,Lo�oJcyJv<K�e' er
"/,J.ruoe.oc�
,q¢, 99zoz
SAMPLE col—LECTION: r .r. ewe +��
0,7 O! ZOOS,
Date: laws � Tw
M
Tbnm d s�
tatatlea: [.a d.�Z v cc6
1J��er
TrenePartse Meme as co"mr Other:
m tab Byl _
0 BE COMPLETED BY LABORATORY
T-177 P.03/04 F-941
200 W. POTTER DRIVE
ANCHORAGE. ALASKA 130515
Tel' W7-5624343
Fm 907-5515301
tab P.1 bl .
'{os+zseigl
SAMPLE TYPE: .
u Rou6no O Treabd Waw
Repast sampts tmilreated Water
(refer to lad.no 1
e❑ specialPurpoaa
Sam�leylP—°�
_ �a�„d.,,,craobanaw:
Date: 9-1Sr�
NeaWla meTa WMlesU
Tune:. 13�_
11
Temo.+ Q�✓MI
— ❑ .
w
c emote tacaama
Delivery Method:
Received By'
conlffwW
.....
•• t3a t riotoaleal Water Artalvala Itacord
Analysis S t; la Dri !?i C5
Analysis
Analylkal Method:
Merwane Fzsr
[] MMO-MUG (PIA)
MM04 W tPtA) RESULTS'
Tow cara„m
E. caR
❑ RUSH SAMPLE I
Phone S:
Fax M
MEMBRANE RLIER RESUIDolor*Y1oftL
Dveu cane
VerFbalkr[
Tr rr. LbGB
Bca:
sen[m ADEC:
AMC FSK NK
OaWTMne:
Sentb ClenC '
Pllonad � ' Faxed Q
p�WTbns'i
T,dlc
�j Satisfactory
❑ UnsatisfadOry
.'t
�001Iti
nnn t
- NI'MARD h ASSOCIATES LAND SURVEYING 694-0829
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: I
FOLLOWING DESCRIBED PROPERTY tI
vr��l�� P¢zrfas��vr/s'erz DATE. �`�� ��• A�q �'� i
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS t/�S r%� ' Sf
INDICATED. IT IS THE RESPONSIBILITY OF THE H 1't
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID " ••B r�� !
EASEMENTS, COVENANTS, OR RESTRICTIONS fw,�o i
WHICH DO NOT APPEAR ON THE RECORDED SUB01- �j Diene Mlrk Seward j
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: } <�
15-5918 �
ANY DATA HEREON BE USED FOR CONSTRUCTION ���'�S �1 °�; •..• `c��!
OFFENCE LINES OR FOR ESTABLISHING BOUND-
ARY LINES.