HomeMy WebLinkAboutVALLEY VIEW TERRACE BLK 2 LT 16 REMVail
y View
Terrece
Block 2
Lot 16
#050-3§2-21
· Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~Wc~-~oq~2 PIDNumber:
Name: Wastewater System: [] New ~ Upgrade
Do~o ~.
^ddre~: ABSORPTION ~I~LD
Phone: INo. of B~rooms: ~ Deep Trench ~ShallowTrench DBed DMound ~Other
LEGAL DESCRIPTION SoilRating: ~, · GPD/Sq. Ft. Total Depth from original grade:/ ~
Lot: Block: Subdivision: Pep h o p pe bo om from original grade: Gravel depth beneath pipe
Township: ~ Range: ~ Section: Fill added above origin81 grade: Gravel length:
I
I
Gravel width: Number of lines: BJstance between lines:
WELL: D New D Upgrade ¢ Ft. Z IR Ft.
Classification (Private, A,B,C): Total Depth: Cased TO; Total absorption area: Pipe material: ~
Yield: Casing Height Above Ground:
SEPARATION DISTANCES d Septic U Holding ~S.T.E,P.
TO Septic Absorption Lift Holding Public/Privste Manufacturer: Capacity iB gallons:
From Tank Field Station Tank Sewer Lines ~6~ ~ ~¢0
Material: Number of Compartments:
~ SurfaCewater ~' g/ ' ¢' -- LIFT STATION
Lot Size in gallons: I Manufacturer:
"Pump on" level at: ~ "Pump off" le~el at: ~ High water alarm at:
Curtain Pump Make & Model ~ E~ectrical Insp ctions performed by:
Remarks: ~A~VE~ ~ ~gq2oo~ ti/~Z/q3 BENCH MARK
t Location and Description:
Assumed Elevation:
ENGINEER'S SEAL
Department of Heal. and Human Services approval .,~
72-013 (Rev. 9/91) MOA 25
· Perf~it No.SW930452
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 ° Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
VALLEY VIEW TERRACE, BLOCK 2, LOT 16 05055221
Leg PID No.:
INTEGRITY VERIFIED
sc~u~ f' = ~q'
.............................................................................................................................
CO1 ~ ·
~00' '
· .~ ................... ~ ~ ~ ......... ~ ~ ~A~.
A Bi c
C0i 52.5 -! 24.5
MH 52.5 --~ 25.5
MTI 120 125 --
MT2 139.5 144 --
U:I'3.1.6:i..... !.,5~.,~ -
MT4 143 17! --
ED'S ELECTRIC INC,
3138 COMMERCIAL DRIVE
ANCHORAGE, AI..A~;KA 99901
VALDEZ
ANCHORAGE
(907) 272-4591
Fax 274-6265
November 9, 1993
S&S Engineering
±70o. Eagle Rlver Road
~ag~e R~ver, A£aska 99577
Subject: ~: ' ' ' _ ' ' r
~ec.2r~ca~ Inspection on hlf_ Station
Mile '~
~, Eagle River Road, u~
e~e River,
Dear Sirs:
The electrical .... ~ e~t-o_, of the sub4~cz
violations
violations at o,-,~ · .... .
Thank you,
EDrS ELECTRIC, INC.
Ed Strout
Operations Hanager
ES/der
for
code
PAGE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930432
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAblE:OESAU DONALD B &
OWNER ADDRESS:P.O.BOX 770827
EAGLE RIVER, AK 99577
DATE ISSUED:10/14/93
EXPIRATION DATE:I0/14/94
PARCEL ID:0503522t
LEGAL DESCRIPTION: VALLEY VIEW TERRACE BLK
16 REM
2 LT~
LOT SIZE: 41643 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
1
SPECIAL PROVISIONS:
WAIVER NO. WR930066 APPROVES A LOT LINE SETBACK OF ONE FOOT
AND DRAINFIELD TO CREEK, OF 66 FEET AND DRAINFIELD TO C.M.P.
OF 60 FEET.
ISSUED BY:
/
DATE:
DATE:
Tom Fink,
Mayor
Ntuni llpality of Ancl ra ¢
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
October 14, 1993
Robert Shafer, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject:
Waiver Request for Lot 16 Block 2 Valley View Terrace
Waiver Request #WR930066, PID ~050-352-21, SW930342
Dear Mr. Shafer:
Your request for a waiver(s) of the required 100 foot horizontal
separation of a septic system to the surface water has been
approved. The approved separation distance(s) are 66 feet from
the drainfield to the creek; drainfield to 12 inch C.M.P. of 60
feet; and lot line of 1 foot. 36 C~fek ~0 SdOda; 7~
· !
This waiver approval applies to the existing septic system to
surface water separation only. Any future upgrade to the septic
system will require all separation distances be met or another
approval from this department. Should the operation of the
subject wastewater disposal system cause any contamination or
degradation of the subject surface water, this waiver will
become void.
Civil Engineer
On-site Services
On-site Services
ljm:#5
MUNICIPALITY OF ANCHORA~_
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR#~ PID# 050 352-21
Date Received: October 11, 1993
Applicant:
HA#
Permit % ~O~[ ~..
Legal Description: Lot 16 Block 2 Valley View Terrace Subdivision
Engineer: Robert Shafer~ P.E. S & S Enqineerinq
17034 Eaqle River Loop road,Suite 204, Eaqle River, 99577
Delores Oesau
Waiver Requested: Drainfield to creek of 66 feet; drainfield to the
12" C.M.P. of 60 feet; lot line of/q feet ) S~/Cm~ ~0 ~s0_~m/Sr~'g_~k
·
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
3. Other:
Waiver is Granted: d~a~q~_ Waiver is NOT Granted:j
List Conditions or ons for above:
~D a t e :/ /~/~/~ ~
/ x / ~/~me of Rev{ewer
Rec #: 250309/0579
Amount: $ 920.00
Date Paid: 10-11-93
ROBERT SHAFER, P.E,
ROGER SHAFER, P.E.
October 4, 1993
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORI3~¢
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERINGSTUDIES
ANDREPORTS
WELLINSPECTION
& FLOWTEST
SiTE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
~ECHAN[CAL
INSPECTIONS
Municipality of Anchorage
DEPARTMENT OF HEAL TH AND HUMAN SERVICES
825 L Street
PO Box 196650
Anchorage, Alaska 99519-6650
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
OCT 1 I 199;~
RECEIVED
REFERENCE: Valley View Terrace Subdivision, Block 2, Lot 16
Request you issue a permit to upgrade the septic system serving the
referenced property, and grant the following waivers for the horizontal
separation distance between: (1) the proposed pressure distribution
drainfield to the creek at a distance of 66 feet; (2) the proposed pressure
distribution drainfield to the 12" C.M,P. at a distance 60 feet. Also a
property line waiver to 0 feet.
A test hole was excavated and a percolation test performed in the area of the
proposed upgrade. At time of excavation water was encountered at 5 feet and
after seven day water monitoring water was found at 5 feet. The approximate
location of the test hole is located on the attached site plan.
We do not anticipate any adverse effects on neighboring properties by the
installation of the proposed septic system. A property line waiver at 0 feet is
requested in order that the proposed drainfields will be located outside the well
radius and the maximum distance from the creek,
The referenced waivers should be granted for the following reasons:
CREEK:
The creek as shown on the site plan will be relocated and placed
into a 12" culvert. This will further remediate any possible
contamination.
ON SiTE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
Valley View Terrace Subdivision, Block 2, Lot 16
August 10, 1993
The creek has a relatively small flow rate and tends to diminish
towards late summer and becomes nearly non-existent during the
frozen winter months.
The elevation of the stream at the inlet of the culvert is well above
the proposed pressure distribution drainfield location.
The outlet of the culvert will be over 100 feet from the proposed
drainfields.
If you have any questions or require additional information for your review
please contact us.
P.E,
~/'RAS/LSU/Isu
' ,1" = ~40' UPGRADE
SCALE
m
MIN.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:~LJL~ ~I
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
SLOPE SITE PLAN
WASGROUNDWATER
ENCOUNTERED?
IF YES, AT WHAT ~-~! SL
O
DEPTH? P
Gross Net Depth to Net
Reading Date Time Time Water Drop
Depth ID Water After/~~'' /
Monitoring? ~ Dote:
PERFORMED BY: $ & S ENGINE.ERING I /,~/
17034 Eagle R~ver Loop Road, No. 2~1
72-00B (Rev. 4/85)
PERCOLATION RATEr~ (minutes/inch) PERC HOLE DIAMETER
CT ON THIS DATE. DATE:
ON-SITE WASTEWA TER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MA TERIAL SPECIFICATIONS
REFERENCE: Valley View Terrace Subdivision, Block 2, Lot 16
GENERAL:
1.
The scope of this project includes the installation of a 500 gallon septic
effluent pumping (S. T.E.P.) system and two five foot wide drainfields to
serve the three bedroom residence located on the referenced property. The
existing septic tank is to be excavated to verify its integrity. If of poor
integrity, the tank is to be abandoned and a new 1250 gallon S.T.E.P.
system installed. The existing leachfield is to be abandoned in place.
Construction shaft be in accordance with the approved site p/an and design
drawings; Municipal permit with any special provisions or conditions; and aft
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary
underground utility locates.
Unless specifically agreed otherwise, the property owner shaft be
responsible for final grading areas subsequently depressed from soil
settling. On all leachfield mound systems, the property owner shall be
responsible for ensuring a satisfactory vegetation growth over the mounded
area.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing
their own systems must also receive prior approval from the Municipal
Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
Page Two
Valley View Terrace Subdivision, Block 2, Lot 16
October 4, 1993
3.
All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Septic tanks installed with less than 4 ft. of cover shaft be insulated.
A foundation cleanout shall be installed one to four feet from the building
foundation. In the line between the tank and the leachfield there shaft be
two adjacent cleanouts (unless an effluent pumping system exists within the
septic tank). These cleanouts shall be located on undisturbed soil not more
than 10 ft. from the tank. The first cleanout, in line, shaft be to clean toward
the leachfield. The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shaft be such that a positive slope exists
away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shaft be within 2 inches of level. If the sidewalls
of the excavation become smeared, they must be raked or scratched
(ruffed-up) before gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to be installed level with
the perforations faced downward. Gravel is then to be placed over the
distribution pipe to provide a minimum of 2 inches of cover over the pipe.
3.
A silt barrier must be installed between the final gravel layer and the native
soil backfill. Ensure the silt barrier covers the entire gravel surface before
placing backfill.
Monitor tubes shaft be of four (4) inch diameter and installed approximately
in the locations shown on the design. The portion of the monitoring tube
extending through the gravel shaft be perforated from the bottom of the
trench to the invert of the distribution pipe. This is equivalent to the
effective depth of the gravel as noted on the design.
Page Three
Valley View Terrace Subdivision, Block 2, Lot 16
October 4, 1993
Backfill over the final gravel layer must not be less than twenty-four (24)
inches. Insulation must be installed when the backfill depth is less than
thirty-six (36) inches. The finish grade over the trench must be mounded
to prevent the formation of a depression after settling.
MINIMUM MA TERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the
inspecting engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Company Styrofoam HI or equal).
o
Septic tank inlets and outlets shaft be fitted with watertight couplings
(Caulder, Femco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must
be installed between the final leachfield gravel layer and the native soft
backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with
less than 3% passing the #200 sieve.
7. When sand is being used as a filter material, it's gradation specifications
must conform to AMC 15.65.060D.
Page Four
Valley View Terrace Subdivision, Block 2, Lot 16
October 4, 1993
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the
installation of the wastewater disposal system. These inspections will occur as
follows:
The first inspection must be conducted after the excavation of
ditches, pits, trenches, or beds and before the installation of any
gravel. A septic tank may be set in place, but may not be backfilled
before this inspection.
The second inspection must be conducted after the placement of the
silt barrier, gravel, distribution lines, standpipes, cleanouts, and
insulation, but before the placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the
installation of multiple trenches, sand filters, pressurized distribution systems, etc.
Thus, the inspecting engineer is to be contacted at least24 hours prior to the start
of construction. If necessary, a pre-construction meeting will take place on-site.
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
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO, OF BEDROOMS
[Well IAbsorptionarea~ I Dwelling I PERMITNO.
No. of line Length f e~ch ne
~ Top of tile to finish grade / / Material beneath tile Total ef focti~i~et
~ (~ ~ G incbes
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well ~uilding foundation Nearest lot line
~ DISTANCE TO:
OTHER
.~. MATEmAUS N
SOIL TEST RATING / ~
INSTAELER
REMARKS
13 (Rev. 3/78)
Permit ~~ /~/ ~ .,~~ ON-SITE SEWER PERMIT
Applicant: ~,lU,, ~ Mailing Address: I ---
Location: Phone Number:
Legal Description: /0~/¢ ~ ~//~/ ~ ~ Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: ~ Seepage Bed: Holding Tank:
Maximum Nuraber of Bedrooms: ~% Soil Rating(sq.ft/br)~ /~--O
The Required Size of the Soil Absorption System Is:'
DEPTH LENGTH --~ ~
GRAVEL DEPTH
~MUN I C I PALITY OF ANCHORAG~E~ ~']~
Department' !f Health and Environment~ ~,ProtectiO/~Z / ~
825 ,. Street, Anchorage, AK. ~39501 '~
264-4720 ~~-
~ ~ ~ HANDWRITTEN PERMIT ~ ~ ~
The length dimension is the length(in feet) of or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* ~ REQUIRED SEPTIC(~B~) TANK SIZE = /~C~P GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this departmen~
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee~
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer.line~
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
~ ~ ~ PERMIT EXPIRES DECEMBER 31, 1 9 8 3 ~ ~ ~
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more theft
Applica~nt ~
SWP/024 (1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
4-
5-
6-
7 :
8-
9-
10~
11
13- .
14-
15-
16
17¸
18-
19-
COMMENTS
72-008 (6/79)
[] SOILS LOG
[] PERCOLATION
TEST
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
' ~ --Z~i Net Depth 'o Net
Reading Date Time Water Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND . FT
UMCIPALITY OF ANCHORAGE
c",
_ r.
Development Services Department. Phone: 907-343-7904
On -Site Water & Wastewater Section Fax. 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050 352 21
1. GENERAL INFORMATION
Expiration Date: 10 Z [ -2/
Complete legal description VALLEY VIEW TERRACE BLOCK 2 LOT 16
Location (site address) 23745 EAGLE RIVER ROAD
Current property owner(s) REEVES
Mailing address
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
F-1
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: NONE Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $S
Date of Payment 2 0 21
Receipt Number 5 3 a�
COSA # OSG?_ \ 14 Q8
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation.
Name of Firm C&M ENGINEERING Phone 8545558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 7/10/21
DSD SIGNATURE
4 System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
OF A�gs�l
*: 49 TH /J�1 •*
i• I
%J ..• ..
rJJ • CHARLES G BALZARI111 .
�Fc•. CE -13854 .••Fiw
`��
,l FOPROFESS\*
Conditional approval for bedrooms, with the following stipulations:
�I,llY OF ttttfrr.,.
ON--
o WATER AND r'n
mR
RROGAAnn
�Jll�>> � � E RV 1 � 111>�\•;
1�..- Original Certificate Date: rZ
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory
Arsenic Advisor
Other '` 82 '�cr.►��
A -d SCS C a�
Legal Description: VALLEY VIEW TERRACE BLOCK 2 LOT 16 REM Parcel ID: 005 352 21
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
A. WELL DATA
Adequacy test date 6/30/21
❑ Well log is filed with Onsite (or attached)
Well production at time of test +2.6 gpm
Date drilled 6/4/83
Water storage tank volume 0 gallons
Total depth 180 ft
Well disinfected for coliform test? ❑ Yes ❑ N
Cased to 43 ft
❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly
Nitrate mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected
Arsenic 3.372 ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) +12 in.
Collected by C&M ENGINEERING
Date of flow test for COSA 6/30/21
Date of Sample 6/30/21
Static water level at beginning of test 75 ft.
Absorption rate +450 gpd
Comments Well was drawn down to —110' then pumped sustained at 2.6 gpm with no drawdown
B. TANK DATA
Age of tank(s) 6 years
Tank type/material SEPTIC STEEL
Measured operating fluid level in septic tank 51
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 6/8/21
D. ABSORPTION FIELD DATA SHALLOW TRENCH
C. LIFT STATION
❑ Required maintenance completed
Age of lift station 27.5 years
Lift station material steel
Comments: visible portions of lift station inspected for signs of leakage
corrosion was noted on riser, but no evidence of holes or leaks
Which system tested (date installed) 1993
Adequacy test date 6/30/21
❑ ALL standpipes present per record drawing
Results [Z]Pass For 3 bedrooms
Total measured depth from grade 7 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade ft (min)
Water added 450 gal
❑ N/A — pressurized field
3
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
1440
Elapsed time min
depth into effective
01Code-requiredsoil cover over field
Final fluid depth 0 in
F-1 System presoaked
Absorption rate +450 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NA
date of test)
Gallons introduced gallons
If yes, enter date NA
Comments/Deficiencies: DATA RECORDED FOR UPPER TRENCH. LOWER TRENCH SIMILAR. LOWER TRENCH REMAINED DRY DURING TESTING
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
®✓ Yes
Yes
Community Sewer Manhole/Cleanout > 100'
❑✓ Yes
if No
ft
❑ Yes
if No ft
Neighboring Tank > 100'✓71 Yes
if No
ft
Private Sewer/Septic Line > 25' ❑✓ Yes
if No ft
Absorption Field on Lot > 100'✓0 Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Yes if No
Water Main > 10'✓❑
Animal Containment > 50'✓❑ Yes
if No ft
❑ Yes
if No
ft
❑✓ Yes if No.
Water Service Line > 10'✓❑
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' ❑✓ Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'✓❑
®✓ Yes
Yes
if No
ft
Surface Water > 100'
0 Yes if No.
Property Line > 5'✓❑
Water Main > 10'✓❑
Yes
if No
ft
Wells on Adjacent Lots:
❑✓ Yes
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100'✓71
Yes if No
Water Main > 10'✓❑
Yes
if No
ft
Community Wells > 200'
❑✓ Yes if No.
Water Service Line > 10'✓❑
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
®✓ Yes
if No ft
If absorption field is under driveway comment below
Property Line > 10'
❑✓ Yes
if No ft
Wells on Adjacent Lots:
Water Main > 10'✓❑
Yes
if No ft
Private Wells > 100' ❑✓ Yes if No
Water Service Line > 10'
❑✓ Yes
if No ft
Community Wells > 200' ❑✓ Yes if No
Surface Water > 100'
❑ Yes
if No 81 ft
F. ENGINEER'S COMMENTS
WAIVER ON FILE FOR LIFT
STA TO SURFACE WATER FOR 37'
NO SURFACE WATER OBSERVED WITHIN
100' OF SEPTIC TANK
G. ENGINEER'S CERTIFICATION
l certify that / have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date. 7/21/21
COSA Checklist yellow sheet
of Al
419 TH
CHARLES G BALZARNI
Fc CE -13854 • �`� �'
. ,-
F�PROF• SIONP�,.-
Iii
ft
ft
ft
ft
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water &Wastewater Section
Fax: 907-343-7997
Lift Station/Pump Vault
Owner -SVS Street Address
? "P S'--}
Septic Tank:
-Sludge level A/ -C inches Pumping: required es -Pumping completed es n
Lift station:
-Pump basket cleaned e no -Effluent filter cleaneds no
-Control floats cleaned no -Proper float settings co irmed e no
-Operation satisfactory "05 no
Alarm System:
-Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling feQ no
-Alarm system operation atisfacto not satisfactory
Manhole Riser
-Ground water intrusion at riser to tank connectiones o
-Ground water intrusion around pipe penetrations es •Weep hole functionaley s no
-Manhole lid: Functional (9 no Insulated e no Properly Secured e no
Other
-All manufacturer required inspections and maintenance completedes no
•iiii-i
�1�y ; T off�'�- f4�- 4= t� S' �F- c.cA��c�€ f.► �`��, el e.✓� �+ SC/^' � '7�rntlz
terlet S ficAy" g 1,d Br453v WAS R4,4P95> mow^ 4
Qualified Maintenance Provider:
Technician �--
Company C f Al
Date of maintenanc
Signature/ //, Date
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Lift Station for Valley View Terrace Block 2 Lt 16 REM
Dear Reviewer,
The above referenced property is currently served by a 3 bedroom septic system with a lift station that
was installed in 1993. Due to the age of the tank, leakage and possible groundwater infiltration are a
concern.
We visually inspected the visible parts of the basin and riser. Corrosion was observed on the steel riser,
but no rust holes or penetrations were observed. There were no observable signs of leakage in the riser
or it's interface with the tank.
When we arrived on site, the tank level was above the pump shutoff level. When we pumped the tank
down, there was no visual or audible sign of water intrusion. A water level below the pump shutoff level or
water leaking in from the soils after the basin was pumped down would indicate the tank was leaking.
Please do'not hesitate to contact me at 907-854-5558 or by email cabalzarini(o)gmail.com with any
questions or concerns.
Sincerely, --o-OF A kk
Charles Balzarini, PElaw
7/28/21 AW
AllCO
CHARLES G BALZARil
CE -13854 • �������
Septic 'Tank Advisory
Certificate of On -Site Systems Approval #OSC 211408
Subdivision: Valley View Terrace Block 2 Lot 16
Starting at 20 years of age the MOA issues Advisory's for steel tanks. The steel tank for this
property is 27 years old. Typical replacement costs range from $8,000 to $11,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 -year-old steel tank MAY look like.
Mailing Address P O Box 196650 *Anchorage, Alaska 9951916650 *www mum org �
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS. APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-352-21
1. GENERAL INFORMATION
Complete legal description
Expiration Date: //_/~) '- //-//
Valley View Terracef BLOCK 2f LOT 16
· Location (site address) 23745 EAGLE RIVER RD, EAGLE RIVER, AK 99577
Current Property owner(s) Andrew Reeves
Day phone 854-2685
Mailing address same
Lending agency
Day phone
Mailing address
Real Estate Agent
Audrey Mason
Day phone 622-3344
~ailin, g Address
UnleE$ bthe/:~W'~ requested, COSA will be held by DSD for pickup.
' 'Z~:., .
NUMBEROF B'~:DROOMS: 3
'~PE 0F WATER SUPPLY:
IndiVidual Well []
Individual Water Storage []
CommUnity Class Well []
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm NorthRim Engineering
Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
Date 6/29/2011
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow
and absorption rates may change due to subsurface conditions that may not be observed from the surface,
changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the
water usage of the family being served by the system The operational life of all well and sep. tj.q.,~4,~ms are
· . .· .
subject to these various and dynamic charactensbcs and are outside the control of the
evaluator of the well and septic system.
DSD SIGNATURE ~'~~~
~ Approvea for ~ Dearooms. ~-,'.-
Cond~bona approval for bedrooms, w~th the following st~pulabo~%--~;.,~
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
WASTEWATER .
¢ . PROG M ' -
Arsenic Advisory ///)~ ~ t)~ ~"
Maintenance Agreements
Supplemental Engineer's Repo~
Other
Original Certificate Date:
Municipality of Anchorage
Devei,opment Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Valley View Terrace, BLOCK 2, LOT 16
A. WELL DATA
Well type PRIVATE IfA, B, or C provide PWSID # __ Well Log (Y/N) Y_
Date corn pleted 6/4/83 Sanitary seal (Y/N) _Y
Total depth 1_80 ft. Cased to 43 ft.
FROM WELL LOG
Date of test 6/4/83 6/1_4/2011
Static water level 140 ft. 70.2
Well production 5 g.p.m. 3.5
WATER SAMPLE RESULTS:
Coliform NF.G colonies/100mL Nitrate <MRL mg/L
Arsenic: 3.96 mg/I Date of sample: 6/13/2011 Collected by: NIUm Eng.
B. SEPTIC/HOLDING TANIK DATA
Parcel ID: 050 -352-21
Wires properly protected (Y/N~) Y
Casing height (above ground)! 50+ in.
AT INSPECTION
g.p.m.
Tank TYpe/Material Septic/Steel Date installed 6/23/83 Tank size 1000 gal.
Number of Compartments _2 Cleanouts (Y/N) Y_. Foundation cleanout (Y/N) Y_ Depression over tank (Y/N) _N
High water alarm (Y/N) N Date of pumping 3/30/1_1_ Pumper SanJtat7 Pttatpers
ABSORPTION FIELD DATA
Date installed 1_1/20/93 Soil rating (g.p.d./~ or ft2/bdrm) 0.8 System type Sba]Iow Trench
Length 88 ft. Width --5 ft.. Gravel below pipe !.5 ft. Total depth _6 ft:
Eft. absorption area 563 ~ Monitoring tube Y
Date of adequacy test 6/14~1_
Fluid depth in absorption field before test 0.0
Depression over field _N
Results (Pass/Fail) Pass For 3__ bedrooms
in. Water added 4,50 gal. New depth 0.0
in.
Elapsed Time: 60 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NIf yes, give date
D. LIFT STATION
Date installed 11120J93
"Pump on" level at 91 in.
Datum Top
E. SEPARATION DISTANCES
Size in gallons 500
"Pump off" level at 97 in.
Cycles tested 3
Manhole/Access (Y/N) Yes
High water ala~Tn level at 85 in.
Meets alarm & circuit requirements? Y
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1-00'+
Absorption field on lot 1-00'+
Public sewer main NA
Sewer/septic service line 25%
Animal containment areas 1_00,+
On adjacent lots 1~00'+
On adjacent lots 100'+
Public sewer manhole/cleanout NA
Holding tank 100'+
Manure/animal excrete storage areas
Em
Property line 1% *
Water Service line ,50'+
Curtain drain (None Kaown)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 1-0'+
Water main NA Water service line 1_0'+
Wells on adjacent lots 1-00'+
SEPARATION.DISTANCE 'FROM ABSORPTION FIELD ON LOT TO:
Building foundation 1-00'+
Surface water 81_'+ *
Wells on adjacent lots 1-00'+
Absorption field 100'+
Surface water 85% ·
Water main NA
Driveway, parking/vehicle storage 1-0'+
Waiver Fee $
Date of Payment
Receipt Number
COSA Fee $490.90
Date of Payment
Receipt Number
(Rev. 11/05)
COMMENTS
I,ce~ffy that I have ~termmed though field inspections~.and~
mwew of Mumcipal ~s t~t the a~.ve sy~ems am
conformance w~h MOA COSA gu~lines in effect on this date.
Engineer s Pfint~ Name Ste~e E~
A,
ANALYTICA
GROUI'
Northrim Eng
Attn: Steve Eng
17237 Bear Paw Circle
Eagle River, AK 99577
907-694-7028
Fax: 907-694-7026
Client Sample ID: E.R. 1
Sampling Location:Vt&[,[~.~ ~rt¢,,o
Client Project: ER 1 -
Sample Matrix: Drinking Water
COC #:
PWS#:
Residual Chlorine:
Comments:
B~ LI~
SP-Analytica, Inc.-Anchorage
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date: 6/28/2011
Receipt Date: 6/13/2011
Sample Date: 6/13/2011
Sample Time: 12:00:00PM
Collected By: SE
Flag Definitions:
MRL = Method Reporting Limit
MCL -- Maximum Contaminant Limit
B = Present also in Method Blank
H = Exceeds Regulatory Limit
M = Matrix Interference
J = Estimated Value
D = Lost to Dilution
** = RL higher than MCL; target not detected
TNC = Too Numerous to Count - result rejected
CF = Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Lab#: A1106135-01A
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
4500-NO3E (Aqueous) - Nitrate+Nitrite pres Test was conducted by: Analytica - Anchorage
Nitrate-Nitrite as Nitrogen <MRL mg/L 0.10 10 6/25/2011 6/25/2011 MC
Lab#: A1106135-01B
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
9223B-PA (Aqueous) - Coliforms in DW
E. Coli Pass PASS/FAIL 1.0
Total Coliform Pass PASS/FAIL 1.0
Lab#: A1106135-01C
Test was conducted by: Analytica - Anchorage
1 6/13/2011 6/13/2011 KM
1 6/13/2011 6/13/2011 KM
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
200.8/200.8 (Aqueous) - Family Well Water I
Arsenic 3.96 ug/L
0.15
Test was conducted by: Analytica - Thornton
10 200.8 6/16/2011 6/16/2011 RM
Page 3 of 3
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-352-21
1. GENERAL INFORMATION
Complete legal description
HAA #
Expiration Date:
Lot 16 Block 2 Valley View Terrace
Location [site address or directions) 23745 EaRle River Road, Eaqle River, .AK 99577
Current Property owner(s) Cathy & Ed Ailport Day phone 694.4285
Mailing address 23745 Eaqle River Rd., Eaqle River, AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent Katherine Donohue/Prud. - Vista Day phone 244-6939
Mailing Address 4241 B Street, Anchoraqe, AK
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
3
Well
TYPE OF WASTEWATER DISPOSAL:
[] ndividual On-site []
[] Individual Holding tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSDI 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 transfer of
title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to home owners. 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 less than 30 days old. 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 wot.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone En,q. Svc. Phone 272-8218
Address P.O. Box 1029547 Anch, AK 99510 "-
Engineer's Printed Name Steven R. Pennons, P.E. Date.
Engineers Comments: In conducting an adequacy test, I attempt to provide athorough conscient ous ·
engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations The
re ' .. ,~ -
ported results describe ~he performance of the system under the cuntht~uns encountered at the time of ~-~
the test, and separation d~stunces measured to readily identifiable features. The operational life of all ~ 69~..*"
ells and sePtiC systems depend on the local sod contht~on, ground water levels that ma fluctuate ~
· . . . y. ~X:
during the year, and the water usage of~e family being served by the system. These conditions are ~
outs]de the control of the evaluator of'this system. All systems eventually fail and satisfactory test results ~'" "--~ ........... '~'""~
do not S arantee f. tare perforce of the system, nor do they,uarantee ther oo hidden defect
or eneroachments. PES cen therefore not provide any warranty for future performance nor give any ~ ~'r~'~7 ~:~ ~'~
estimate of how long the system will cuntinue to meet the operational requirements of the .~'~DEC or ;~.(
MOA DSD The content of th s re,,ort is for the sole ~-~., ~ ~.~ - ...... ~'a
or use of this report by any other person or party is not authorized nor will it confer any legal right -- ''
whatsoever. . ~ o
6. DSD SIGNATURE
v'~ Approved for "~ bedrooms.
Disapproved·
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
By: ~--~_Lt (~. [~_C~..LF~ Q)~ L~._ Original Certificate Date: /(~/~,/~
Expiration Date: I / ~7-"~:~3 Reissue Date: ~
(Rev. 11/99)
/
Maintenance Agreements
Supplemental Engineer's Report
Other
X
5
ft
Y_ Depf~ on qJ/ef tgn~ N
MonitoringtiJb~ ~ .......... D,~;~Ce'~io n oy~f ~ld
~- ' ' New depthS.~._~$ in.
Final fluid d~Pih Dryin ............ A_~_s~[pt~?~,n.l.r..a~t_~ f~7 450+ g.P.~'
ate ~nstalled 1112011993 Size in gallons 500 Manhole/Access Yes
"Pump on" level at 2._~8 in"Pump of~' le~e/at ' 2~'i'~:~' High' ~Vater ~larm level at 34 in
Datum ,, Botto~ of'T~E ..... ~yci~s ~te:a.,"~:'-%:: ' .... '"'~'"' ~'-Me~'~'~;a:~:~ '~irc~"i~ ~quirements? y
S EPA~TION"'DT~
Septic tan~lifl station on lot '~00+ O~adjacefltl0ts 100+
Absorpt on field 0dl6t ,'i'0~* .,,~O~ ~ja~{ I'~"t~'-
Public sewer'main 100+ ..... Public sewer manhole/cleanout 100+
Sewer/septic se~iceline,, 50+ " Holding tank ~00+
SEPA~ON-Df~T~'~g
Building foundation 5' Properly line 25+ Absorption field 150~
Water main 50+ Water se~ice line 25+
Surface water 85~
Drainage 85" ' ..... Wells on adjacent lots _J00+
S E pA ~Ti-O~,~FS~ .
Property line 1~ Building foundation 100+
Water Service line,, 75+ SurfaCe water ...8~i**
Curtain drain None Observed. Wells on adjacent
OMMENTS~//~ ,n'~ ~ ( [ _~ t
Water main '75+
· . Driveway, parking/vehicle stooge 100+
certify that I have determined through field/nspecbons and
review of Municipal records that ~he abov~ Systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Nar~e Ste~n
Date
Nc CF 8~49
HAA Fee $ ~_-"~,~ ?o .............. ---- Waiver Fee $
Da~e of Payi~*e~t' ' [*("~ ! ,~,/,f'bq ...... Date of Payment
Receipt Number... ~-~O~ j~ ~ . \Pr~., Receiet Number
(Rev. 11T99)
Pannone Engineering Services, LLC
Consulting Engineer
(907) 272-8218, 22%3522 Ceil
P.O. Box 102954
Anchorage, AK99510
(907) 272-8218 Fax
TO:
FROM:
DATE:
Additional Note to Health Authority Approval
Whom it may concern
Steven R. Panno~z____.__.----~
10/3/04
SUBJECT: Health Authority Approval
Lot 16 Block 2 Valley View Terrace
23745 Eagle River Road, Eagle River, AK 99577
While conducting the adequacy test and inspection for this property, PE Services, LLC
conducted an in-depth investigation to verify the separation distances between the
septic system and surface water and the existing private well. The septic system is, as
stated on the as-built drawing, the required distances to surface water. The existing lift
station was measured to be 36 feet from the existing surface water {creek toward the
southwest portion of the tot). The lift station was not included in the 1993 waiver
request. PE Services discussed this issue with Mr. Dan Roth with the MOA DDS. He
indicated that the lift station should have been included in the original waiver and will
waive the separation distance to 37 feet at this time.
PE Services measured the separation distances between the well and the existing
monitor tubes on the drain fields. The distances were measured as follows: well to
north monitor tube - 105.6 feet; well to south monitor tube - 106.8 feet. We were
unable to locate the exact end of the drain field. Based on the As-bu~it Drawings
obtained from the MOA, the end of the drain field is located exactly 100 feet from the
well. PE Services was unable to substantiate this information since there is no clean-
out at the east end of the drain field. The only way to verify this distance positively is to
excavate the end of the drain field and expose the exact end. This procedure is outside
the normal procedure in obtaining a Health Authority Approval. I discussed this issue
with Mr. Dan Roth, and he was convinced and satisfied that the drain field was as
shown on the record drawing and met the separation distances as required by Title
15.65 AMC."
GS R~f~
3lent Name
'rojece Name/#
:llent Sample ID
~atrix
104636100!
Pannone Eng,
L16, B2, Valley View Terr~=~
L16, B2, Vall~ View T~ce
DrYing Watg
0
All Dates/l'imes are Alaska Standard Time
Printed Date/Time ] 0/04/2004 6::58
Collected Date/Time 09/27/2004 12:15
Received Datefrime 09/27/~4 13:45
PQL
Units M~ao~ Containgr ID ~,imi~s Date Date Init
NRra~-N
O, IOOU
0,100 mffL EPA 300.0 B (<=10) 09/28!04
Total Coliform
9 OB, No Coli
eol/100mL gM20 9222B A
09/27104 DKC
ASBUILT-NO CORNERS SET THIS DATE. S~A~D
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY: /'~- ~'
....
~'-*~'~'~-~-V ~-'/~A:x ~~ Lo~/~ ~[~'~ DATE:
AND ~AT NO EN~OACHMENTs EXIST ~CE~ AS ~
INDICA~D. IT IS THE RES~NSIBILiTY OFTHE
~N~ ~ D~ERMINE THE ~ STENCE OF ANY GRID:
WHICH DO NOT ~PEAR ON THE RE~D~ ~BDI-
VISION P~T. UND~ NO CIRCUM~TA~CES'~ FB:
OF FENCE LIN~ OR ~R E~iSHiNG ~ND~ 'DRAWN,
ARY LINES. ~/~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ~)~-')- %~'~\ HAA# i'~c~)'-I~)c~
GENERAL INFORMATION
Complete legal description
Lot 16... Block '2: Valley View Terrace
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Dolores 0~sau
Box 770827
Mile 5.1 Eag£~ River Road
Ea~l~ River, AK 99577
Day phone 694-9118
E~gl~ River. AK 99577
Day phone
Agent
Address
Day phone
=
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
3
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXX
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
S & $ ENGINEERING
Address 17o~4 Ea[t[e Ki~er Loop Road N~
Engineer's signat~e River, Alaska 9~57~
Phone
Date
DHHS SIGNATURE
/~' Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulation§:
Additional Comments
Date /2. -/7- ~'.~
'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
prof,~ssional 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
respur~sible for errors or omissions in the professional engineer's work.
Municipality of Anchorage /~
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
A. Well Data
We,,
Log presen~N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed 6J/L~I ~
Cased to
FROM WELL LOG
I
/do
Driller
Total depth
Sanitary sea,N)
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Casing height
Wires properly protected (Y~)
AT INSPECTION
Septic/~ldif~'tank on lot
Absorption field on lot
Public sewer main
Sewer service line
g.p.m.
; On adjacent lots /~:~(-~ ~
; On adjacent lots //00 ~./L.
Public sewer manhole/cleanout
Petroleum tank /~rE) ~) ~=
/2 "4-
WATER SAMPLE RESULTS:
Coliform (~ Nitrate
Date of sample: ////Q- ~ / ¢~
B. SEPTIC/NI~L-D~G TANK DATA
~e ,] ~/I/L- Other bacteria
$ & S ENGINEERING ,
Collected by: ] 7034 ![agle River LooP Roa~ N{~. 204
Eagle E['ve'~, Alaska
Date installed ~ / ~_~ Tank size /~0~ Compadments
CleanoutGN) y~,c Foundation cleanout(~N) /-~J' Depression (Y~)
High water alarm (Y/N) ~ / j/2~ Alarm tested (Y/N)
Date of pumping MOO, /G,~'_...~ Pumper ~ ~
SEPARATION DISTANCES FROM SEPTIC/'R,~I~I~ TANK TO:
Well(s) onlot ~/~0 '/-- Onadjacentlots //~)(~
To property line /~) ~ Absorption field /,.D~ '~
72-026 (3~93)* Front
Foundation ~
Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y~N) k/'~ J' "Pump on" level at
/
High water alarm level
Meets MOA electrical code~4) _~) '% ~ I 6 ~ ·
SEPARATION DISTANCE FROM LI~ STATION TO:
Well on lot /¢~ ~
Manufacturer /~JC /-f-
Man h cie/Access ~"Y)/N) (/
"Pump off" Level at
Cycles tested
On adjacent lots / O,.~ Surface water
Date installed
Length ~:~ ~ '
Total absorption area.
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
///~.c~ /~c~ff Soil rating (GPD/Ft2) E¢' (:~ System type
Width ~'- ( Gravelthickness /, ~ Totaldepth
~ .~ Cleanout present) V¢ ~ Depression over f e d (~.
/~ ~ ~ Results (pass/fail) / ~ for ~~ Bedrooms
~ / ~ Aftertest ~/~
~ ~ If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /<::9 (:9 On adjacent lots //_~2(9 :z~ Property line
To building foundation //<9 ' ~- To existing or abandoned system on lot
On adjacent lots ~,.~ 1.7L- Cutbank ,/,.2o/-,~/~' Water main/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 on the date of this inspection·
HAA Fee $ ~.-~)0- ,~'P~"~
Date of Payment
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
APPLIq-'NT FILLS OUT UPPER HAI~'IONLY
Buyer
~ Single Famil¢
~ ~ Other
~ tz in ~ Ju~e
Water Supply ' ~ ATTACH WELL'[OG.3~w~I Icg is required for all wells drilled s C
Individual
~ Community For wells drilled prior to t~ date, give well depth (attach Icg if available). 1975.
~ Public Utility
Year Individual Installed:
Public Utility When Connected o Public Utility~ ' .
D Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG cAN BE INITIATED.
Time Time Ti% .~~ Time
Date
{ } 6ON'ITIONALAPPROVAL*By;DATE~/~., -- ~¢~/~--~ } ~ ~ ~ ~ ~ ~ ~}'
~ ~ - ~j J U L 0 8 1983 I
Munlmp~,ly ~f Anchorage"
"Dept. of Health
Environmental Prolection"
Soils Rating Date ~wer Installed Well To ~sorption Area J '~ O Well Log Received