HomeMy WebLinkAboutVALLEY VIEW TERRACE BLK 3 LT 9Vail
y View
Terrace
lock
Lot 9
050- 352
-02
~ Municipality of Anchorage Page ./ of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~'~0/pzT~ PID Number: ~_~'c~ ~_- ~.~.._
Name:
_~-/'&: V~ Wastewater System: ~ New ~pgrade
Total Depth from original grade:
Lot:~ ~ck: ~Subdiv~i°n:~/~ ~ ~epth to pipe bo~om~,~from original grade: Ft. Gravel depth beneat~ ~Pe Ft.
Township: /~ I Range: /~ I S~tion: /~ Fill added above original gra~ Ft. Gravel length: JO ,,.
WELL: ~ N.w ~ UpgF~de IGrevelwldth: . : Ft. Numbe~fiines:
Clarification (Private, A,B,C): Total Depth: Cased TO: 'Toter absorption area' Pipe material:
Date instated:
SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P.
From Tank Reid Station T~k ~wer Un~ ~H ~ /t
Su~ace
Water ¢/OO) '- ~/~ LIFT STATION
Line ] ~/
Foundation ~' J~' ~/~ 'mp~mP °W' 'eve' ~O~' level at: mHigh water ala~ at:
, P~el m ~ectri~l Inspections pedo~ ~y:
Drain
Remarks: BENCH MARK
Inspections pedormed by~ ~ ~ ~ Dates: 1st ~/~/~
~t% CE - 6736
Depadment of Health and Human Se~ices approval
Reviewed and approved by: ~~ ~ Date: 7'~0-* ~ ~'~'~'~'%%%~
72-013 (Rev. 9/91) MOA 25
Permit No.
-- ~/--~'~-/~/7~ Page 2 of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519 6650 · Telephone: $45-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
2
Legal Description: VALLEY VIEW TERRACE L 9 BLK 3
PlO No.: -- ,¢:P~--~- --'~'~- -~9...
· -- MONITOR TUBE
o -- SEWER CLFANOUT
~'~ -- WELL
...... EASEMENT
N
1000 GAL SEPTIC TANK
TRENCH
S~/ING TIES
A C = 17,5
B C = 19.8
B-D 22,1
ELEVATIDNS
(NOT TB SCALE)
SCALE' t"=50'
7/8/96
ENGINEER'S SEAL
0¢". LOUIS A. BUTERA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960104
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:STEVENS TONY
OWNER ADDRESS:P.O. BOX 773453
EAGLE RIVER, ALASKA 99577
DATE ISSUED: 6/06/96
EXPIRATION DATE: 6/06/97
PARCEL ID:05035202
LEGAL DESCRIPTION:
VALLEY VIEW TERRACE BLK
3 LT 9
LOT SIZE: 126324 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION 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 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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.
SPECIAL PROVISIONS:
RECEIVED BY: ~~ ~'
DATE: ~'~ f~
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 fei
Eagle River, AK 99577-3294 (907) 694-3297
May 15, 1996
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re:
Valley View Terrace Lot 9, Block 3
Narrative & Permit Application
Dear Mr. Cross:
The proposed septic upgrade is to replace an existing log seepage p~t system. We have located
the upgrade in the only spot that is practical for installation of the system. Due to the nature of
the soil conditions, it is possible to accomplish this installation in a minimal area. We will
require a slight variance to change in slope setback to 35'. This should not be a concern as the
soil is permeable and the trench is oriented perpendicular to the slope so the end of the trench
is the closest point. The slope is established and well vegetated.
The surrounding lots are large, but have limited reserve area due to the lot layouts which place
most of the lot area behind the homes on a steep slope. In its proposed configuration, the
trench is 10' from the lot line, and the immediate neighboring septic systems are all +30'
distance. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\1996\96-OI5A-NAR
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL:
Valley View Terrace Lot 9, Block 3
05/09/96
GENERAL
i. The septic plan is 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
requirements.
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 in the field by the
contractor to meet Municipality of Anchorage 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.
SEPTIC TANK
1. Septic tank shall be an MOA approved, 1,000 gallon tank with cleanouts.
2. The existing tank and/or leachpit shall be pumped, crushed and filled.
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 14' at any point.
4. The sewer line is to replace the existing sewer line that leads to the existing pit.
5. The effluent line within the trench shall be laid level within 0.03'.
6. The trench gravel is to be covered with typar fabric material.
7. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
8. The area over the trench is to be finish graded to prevent ponding of surface
water runoff.
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 = 14' GRAVEL DEPTH = 10' under pipe, 2" over pipe
TRENCH LENGTH = 28' TRENCH WIDTH = 3'
SOIL RATING = 0.8 GPD/fta BEDROOM CAPACITY = 3
SEPTIC TANK = 1,000 gallons
Tweuty-four (24) hours notice required for all inspections.
\1996\96-015a-spc
'X.X~~ ~ U - TEST HOLE
%' ~ WELL
NO SURFACE WATER ~. - .... EASEMENT
NO KNOWN CURTAIN DRAINS ~ PROPOSEO LEACHFIELD
LEOAL: VALLEY ViEW TERRACE LOT 9, BLK
CONTRACTOR: N~A
JOB~ 96 015A/DATE: 05/15/9¢I SCALE 1"
A
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, AK 99577
(907) 694-5195
JOB
SHEET NO.
CALCULATEO BY.
CHECKEDBY
SCALE.
qb
OF.
DATE
LEGALi· Vailey View, Tei'ra~e .Lotgi Btock 3 ' : '
: 05/0~/96: : : ~ . : ~
3 ~ledroofn Sihgie Fami}y ResidenCe i , ~ : · : :
3 BR x 150~gpd --..450 gpd
450 gpd / 0.8 Soil absbrption ~atd fo~ trehch! =: 56~ S~
562SF / (10 x2) = 28 length · ; = . : . :
TrenchDimensibns:i.. i : : ; :
' Length ' ' ' '28'~
Width ~ 3'
Gravel d¢iSth -10'
Totat depth 14':
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERFORMED:
Township. Range. Section:
SLOPE SITE PLaN
1
4-
5-
7-
10 - WAS GROUND WATER
ENCOUNTERED?
11
IF YES. AT WHAT
DEPTH?
1:'1-
S
14-
15-
16-
17-
18-
19-
20
PERCOLATION RATE '" ~'''z '~ (m,nutes~,nch) PERC HOLE DIAMETER
TEST RUN EETWEEN--~ ~ FT AND FT
COMMENTS
PERFORMED BY: /~/~' ~' I ~ CERTIFY THAT THiS TEST WAS PERFORMED IN
08/15/96 THU M):3§ FA/ 90? 502 ~J_3~ VISTA REAL ESTATE
RECEIVED
~c~, ~ ~s~t Munic~pahty ~l A~cnorage
Dept, Health & Human
Z19 ~ 40 _ ~actures and ~mtl ~ater seaPs.
OWNER'S MANUAL
for
Series S4A S4B S4C S4D S4X S6A
E379B
January, 1968
MUNICIPALITY
DEPT, ! &
S6B
~ ~ tion of pump to requlred depth.
If
enters
t
~ ~ ~ ~ ~ ~,, ~~b0ve pump, check that annular area between pump and weJJ
........ ~., ~~.. ~ ~i ~ ,, Ur /~nsin~ is sufficient to ensure ~n ~dequ~te flow of water to the
particular installation. Handle pump and cable carefully, and do where there is a history of sand in tbe well.
not load other material on top of them. This is very important ~ ' ~
because of the precise alignment of the assembly and the ruiner- . .'Refer ~o factor~ for recommendations if pump is not to be
........ ? stalled 9~rtlcal~y ~s ~n ~ well.
BARREL TEST z' ~ .¢?".~ALLAT-10N RECORD
Carry out the following test prior to installation. ~ ~. % ~/~ecord the following detads at the hme of mstallat~on, and retina
1 Support pump n a barrel of water so that ntake is submerged. ~''/ for future reference.
name btes of motor and control box. Instn I a I ne sw,tch .be- Installed by _~_~.~Z___.~,_ _~_..~..z¢~;...~
tweenp pawer supply and control box. Check that tK ~'~i~ch. i~ . '~- ' Date of Instalbtion--..--~-[__ ........ ~ ........ ~-~--~--~. ....
open, and then connect motor cable to control box. ~Cbnnect a Catalog Figure Number ........... : .......... ~ ..............................
single-phase motor in accordance wit~ Figures 4 an~l. ~' A three-
phase motor requires a magnetiC, starter equlppe~.~vith quick-trip.
3. THREE-PHASE UNI~: ONLY. Hold putmp'shell an~'a~ly
power momentarily ~y snappi'ng llne swi~ quickly on a~d off.
If rotation is co[rec~, ~eactlon of sh~ll~ill be cJ~ckwlse when
viewed from ~mp/dJschnr~e (that I~, pum~ft will be seen
toalter rotation. /~. ~ "
4. Run pum~ fo?'a,~w ~conds to check that it is in working
order. This will avid expense ~installMg and withdrawing a
unit damaged in
SUITABILITY"OF WELL
Motor Make.--~/.~zc -~-~-~'- Motor Serial
Motor Hp- ___._7_/_~,~_.__volts._* ~--~----~---;phase:~.-------/--------cYcles
Maximum allowable current ............. ....~-__
WELL: Inside diameter .......... ~ ........ in. Dep~..-~,~--~'~---ft.~"~,
Standing Water Leve~_ ..... -~----~--c~- ....... - -~t- below ~_0J~n~
Depth to lowest perforation .T_____~...-~----..--ft- below ground
DROP PIPE: S~ze ......... ~'~ ......... m. Length..._-~..~--.---~...---ft.
(Refer to following section)
POWER CABLE: Size ..................... in. Length-.---'~.~----~?-.~-.--ft.
HYDROCEL Ordering Number ...... No. ef HYDROCEL$ ..........
Distance of HYDROCEL(S) from well ................................... ft.
Pipe size between well and HYDROCEL(S) ............................ in.
Pressure switch setting: ........... cut-in .......... cut-out, lb./sq. In.
INSTALLATION EQUIPMENT
EQUIPMENT REQUIRED: tripo~ with chain blocks, or rig with
power hoist; pipe clamps; ohmmeter or megger.
Be sure that the equipment is strong enough to llft the total
of pump, drop pipe, and water in the drop pipe.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 050-552-02
1. GENERAL INFORMATION
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
VALLEY VIEW TERRACE S/D; BLOCK 5, LOT 9
23951 UPPER TERRACE ST * ANCHORAGE, AK * 99577
MICHAEL MORELLI
P.O. BOX 775273 *
Day phone
EAGLE RIVER, AK * 99577
Day phone
250-0561
D'ETTE OWENS W/ KELLER WILLIAMS Day phone 440-2313
101 W. BENSON BLVD, #503 * ANCHORAGE, AK * 99505
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
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 samples. (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 ced'/fled by my seal affixed hereto and as'
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 inspectien, 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 GARNESS ENGINEERING GROUP, Ltd..
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone 557-6179
Date
Engineer's Comments:
In conductingthis evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & RegulationS: The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of afl wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
~ Approved for ~
bedrooms.
Disapproved.
Conditional approval for
By:
Attachments:
COSA Checklist
Septic System Advi.sory
Well Flow Advisory
I ~11 LI c~ L~;;
(Rev. 11/05)
bedrooms, with the following stipulations:, t,,
· ~;~'~ OF 4~,~.
~::C ,~V~'' ......
..
~. WATER AND
~, ".,. PROGRAM
Arsenic Advisow '"~///
Maintenance Agreements
Supplemental Engineer's Repod
uther
Original Certificate Date: /l//~ ;7,//~//
Municipality of Anchorage
Development SerVices Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.rnuni.org/onsite
' (907),.,343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Legal Description:
WELL DATA
Well type PRIVATE
Date completed
Total depth 403
VALLEY VIEW TERRACE S/D; BLOCK 3, LOT 9
*DEEPENED AND DOCUMENTED ON 8/1/1996.
**ASSUMED BASED UPON SURROUNDING WELL LOGS.
Ifa, B, or C provide PWSID# N/A
,,,1971
'8/1/1996 Sanitary seal (Y/N) YES
~.ft. Cased to'. **BEDROCK
Date of test
Static water level 1 66
Well production ,3.6
WATER SAMPLE RESULTS:
Coliform (~ colonies/100 mi.
Arsenic: ~ i'~ ug./L,
SEPTIC/HOLDING TANK DATA
FROM WELL LOG
8/1/1996
.ft.
g.p.m.
NitrateO,
Date of sample:l 0/21/2010
CHECKLIST
Parcel ID: O~"O
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
10/21/2010
103 ft.
1.62 g.p.m.
*YES
YES
12+ in.
Other bacteria O colonies/100 mi.
Collected by: GE(:; Ltd.
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanou,t (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 1. O I I ~ J J. O Pumper. ALASKA
ABSORPTION FIELD DATA [*BELOW EXISTING GRADEI
Date installed 6/28-7/~1/96 Soil rating ~or ft2/bdrm) 0.8
Length 30 ft. Width '5 .ff.
Total depth '12.3 ft. Eft. absorption area 600. ft2 Monitoring tube YES
Date of adequacy test *'10/22/2010 Results (Pass/Fail) PASS
Date installed 6/28-7/1/1996
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
SEWER AND DRAIN
Fluid depth in absorption field before test 0 in.
Elapsed Time: - min. Final:fluid depth 0
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type TRENCH
Gravel below pipe 10 ft.
Depression over field NO
For 3 bedrooms
Water added 450 gal.
in. Absorption rate >=
NONE KNOWN If yes, give date
New depth 0 in.
450+ g.p.d.
*NOTE: MT ONLY EXTENDS 8.66' BELOW INVERT OF DRAINPIPE. 3' SOIL COVER SATISFIED.
**HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD WAS PRE-SOAKED ON 10/21/10 PER JEFF
POETS INSTRUCTIONS WITH 1000+ GALLONS OF WATER.
Dm
LIFT STATION
Date installed
"Pump on" level at
in.
Size in gallons
"Pump off" level__at~,
Manhole/Access (Y/.~ J
High water alarm level at.
in.
E. SEPARATION DISTANCES
Cycles tested
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on' lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
100'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation *5'+ Property line 5'+
Water main N/A Water service line. 10'+
Wells on adjacent lots 100'+
Absorption field 5'+
Surface water. 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water service line
Curtain drain
COMMENTS
*PER 1996
'10'+
10'+
NONE KNOWN
Building foundation 10'+
' · Surface water 100'+
Wells on adjacent lots. 100'+
Water main N/A
Driveway, parking/vehicle storage 10'+
INSPECTION REPORT.
G. ENGINEER'S CERTIFICATION
! certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date )1 {~/' O
COSA Fee $ V¢
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment,
Receipt Number,
0U-16-20i0 09: ~? FROM: 69408~0 TO: Z383246
FOLLOWING DESCRIBED PROPERTY~
AND ~AT NO ENriCHMENTS EXIST ~CE~ AS
INDICA~D. IT IS THE RES~NSIBILI~ OF THE
OWN~ ~ D~ERM~NE THE ~ISTENCE OF ANY
E~EMENTS~ COVENANTS~ OR RESTRICTIONS
WHICH DO NOT ~PEAE ON THE RE~D~
VISION PLAT. UNDER NO CIRCUMSTANCES
~Y DATA H~EON BE USED FOR CONSTRUCTION
OF FENCE LIN~, OR FOR EST~LISHING ~ND-
ARY LINES.
[2]
ASSOC!ATES LAND SURVEYING ' 6 9 4 - 0 8 2 9
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
050-352-02 HAA # \4 ~r~le, C'i.Zk/Z)q
GENERAL INFORMATION
Complete legal description
Valley V±ew ?errace Lot 9, Block 3
Location (site address or directions)
NHN Upper Terrace Street, Eagle River
Property owner
Mailing address
Lending agency
Mailing address.
Anthony Stevens
Day phone
P.O. Box 773453, Eagle River, Ak
Alaska Home Mortgage/Vern Rush
99577
Day phone
P.O. Box 196850, Anchorage, AK 99519
694-5195 msg
563-3033
Agent Vista,Real Estate/Pam Reynolds
Address 4241 B Street. Anchorage. AK 99503
Unless otherwise requeste~ HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
NOTE:
Day )hone 242-9975
Individual well
Community well
Public water
X
If community well system, provide written confirmation from State ADEC ~t~est-
lng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
x
Holding tank ;"
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 {Rev. 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that m~;y
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 flies 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
~- -- '~ '~-~ 08/13/96
Engineer's signature ~ .~-~--~r~- Date
DHHS SIGNATURE
-- Approved for ~'
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Corfiments
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
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lendihg institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
Legal Description:
A. WELL DATA
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division AU{~
825 L Street, Room 502. Anchorage, Alaska 99501 · (907)j~z~4~/~ r~
Health Authority Approval Checklist
~,~b/~,Y ~1~' "~-,G/d_.~O_.Z~ Parcel I.D.:
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
,",)." V~~' Date completed
-r .~o' Cased to /-- ~ / CaSing height (above ground)
~-~ Wires properly protected (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG AT INSPECTION
/
///
g.p.m. --~' ~'~
g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: O ~.//~ ?/~ ~
Collected by:
Other bacteria ~)'
B. SEPTIC/HOLDING TANK DATA
Date installed ~//~//~' Tanksize
Foundation cleanout (Y/N) Y~5
Date of Pumping /t/~.g~
/'~)~ Number of Compartments. ~ Cleanouts (.Y/N)
Depression (Y/N) ~ High water alarm (Y/N) ~/,~
Pumper
C. ABSORPTION FIELD DATA
Date installed ~ ?/~//~ ~
Length .~0 / Width
Soil rating (g.p.d./fFor"4~ ~ ~/ System type
~ ~ Gravel thickness below pipe /0 ~ Total depth /,~,
Effective absorption area
Date of adequacy test
Fluid depth in absorption field before test (in.); ,A///]-
Fluid depth .,k/[/~ (ins) Minutes ater: /
Peroxide treatment (past 12 months) (Y/N) /"//-/~
Monitoring Tube present (Y/N) ~/~5 Depression over field (Y/N) .
Results (Pass/Fail) /~/]5--~ For ~
Immediately after ~ ga!. water added (in.):.
Absorption rate = ~ g.p.d.
If yes. give d~{e
bedrooms
72-026 (Rev. 3/96)*
Date installed Size i~)_ga~
Manhole/Access (Y/N) ~evel at* "Pump off" level at*
High water ~~ *Datum
cycled
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/hailing tank on lot
Absorption field on lot
,-Public sewer main /~//.~
Sewer/septic service line /~) (~ /
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout /'4/.4
Lift station -/"//-~-
SEPARATION DISTANCES FROM SEPTIC/HE)EDING TANK ON LOTTO:
Foundation (/~ / Property line /~ / Absorption field
Water real.service line Z/G / /
Surface water/drainage /-/(-'?¢P . Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
/
Property line /¢ Building foundation /,;2 f Water meJn/service line
Surface water /~/0~) / Driveway, parking/vehicle storage area
Curtain drain
/'./~)/.IE ./]/~/~.,IiZ~¢./~''~- Wells on adjacent lots
F. ENGINEER'S CERT F CAT ON
I certify that I have determined thru field inspections and review of Municipal
in conformance with MOA HAA ~uidelines in effect on this date
Signature ~~
Engineer's Name &~15 ~ ~,
Date ~ ~ 7~ ?~
HAA Fee $
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
08x'12x96 15:~9 CT&E ESI RNO~ORRGE ~ 90? 894 3297 N0.625 Q~
CT&E Environmental Services Inc.
Laboratory Division
200 W. Potter Ori~
A~ehovage, AK gt~)51 IB-1605
Tek (907} fi62-2343
Fax: (907} 1561-5301
CT&]~ Ref,#
CiVet Nmne
Prqjeot Name/#
C{ient Smnple ID
Matri~
O~lered By
96~fi3fi00]
~agle River Engineering
Valley View Terrace 913
V'atley View Terrace 9t3
D~ul~ng Water
Client PO//
Printed Date/Time 08t10/96 17:17
Collee~ed DateJTin~ 08/07/96 ~9:2~
Received Dated~nm 08/08/96 10:15
Tee_huical Dlre~or
Allowable Prep
EIIVIBONMENTAL FACILITIE~ }IV Al. ASEA. C/~[,IFOHNIA. ~LO~.II)A, iLLINOIS. MAEYLAHD, MICHIGAN. MI~I~OUR(. NEW JERSEY, OHIO. W~ST VIRGINb