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VALHALLA BLK 3 LT 8
Valhalla lock Lot 8 015-212 -08 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PermitNumber: OSPloltq~t PIDNumber: Ol~-2tZ-o~ Name: J~ya.r~ ~]OOr~ Wastewater System: ~ New ~ Upgrade Address: 12~[~ ~,'l~rn~ ~o~c/ ABSORPTION FIELD Phone: Number ~ Bedrooms: ~ ~DeepTrench ~ Shal[owTrench ~ Bed ~ Mound U Other: LEGAL DESCRIPTION So, Rating: Total Depth from original grade: [,~ GPM/FL2 I Z Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: To.ship: Range: Section: Fill added above original grade: Gravel Length: Well: [Th{i-~ ~ New ~ Upgrade G,~w,w,~th: Nu~¢of,.~s: I Distance be~een lines: ~ Ft. Ft. I Classifi~tion (Private,%, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Drillen Date Drilled: Static Water Level: Installer: Date Installed: Yield: I Pump Set at: Casing Height Above Ground: GPM] Ft. R. TANK SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. ~ Other: ~ Manufamure':4 ~ Capacity: To Septic Absorption Lift Holding 'ubli~Pdvate Tank Field Station Tank Sewer Line A~& 0~C ~ GaL Well ~00~ [~[+ ~/A ~/~ ~[~ Material: ~,~] Number °f C°mpaflments: SuffaceWater tOOl+ [OO1+ ~l~ ~/4 ~: LIFT STATION Man~a~urer: Lot Line [~1~ ~0[~ ~/~ ~/~ ~ ~~l~// Foundation ~,~ ,O,~ ~/~ ,/~ "Pump on" level at: High water ala~ at: Remarks:T, k BENCH MARK Lo~tion and Description: Assumed Elevation: Inspections peRormed by: C&~5 ~qm~[~& Dates: 1st to15/2010 Development Se~ices Depa~ment Approval :/ // / "~.. .. .,~-~,, ':?' ' ~ ?' Reviewed and approved ~ Date: ~¢~ / Lot 6 Lot 5 (VACENT) Lot 13 7 INSTALLED 3-BEORO0g SEPTIC SYSTEI~ 1000 GALLON SEPTIC TANK LENGTH 40 FEET P/lOTH 2.5 FEET TOTAL OEPTH 12 FEET ROCK DEPTH 8.2 FEET COVER 4.0+ FEET 8 EXISTING SEPTIC PER UPC REOUIRE~ENTS iNSTALLED BULL OIVERTER VALVE SWINC, TIES A B C I5.0' 42.0' O I8.5' 47.5' E 21.0' 50.5' F 22.0' 51.0' G 23.0' 51.0' H 30.5' 50.0' I 33.5' 35.0' J 47.5' 29.5' I I NOTE: THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROI~I ON-SITE WATER AND WASTE WATERI DEPARTMENT DOCUNENTATION. ALL LOCATIONS SHOWN ARE APPROXINA TE. 25 5~ 75 11111 125 SCALE; ]' = 50 Fl:, 49~h Lot 7 Lot 5 Lot 4 SPURKLAND No, CE-11500 SPURKLAND ENGINEERING 203 W 15TH. AVENUE ANCN. AK. 99501 (907) 279-3916 [12216 VALHALLA BLOCK $ LOT 8 RYAN BLOOM WILDERNESS ROAD, ANCHORAGE, AK 99516 SEPTIC SYSTEkl ASBUILT DATE: DEC. 2, 2010 SHEET: 2/3 GRID: 2756 PERMIT #£$P101197 PID # 015-212-0~ VolhallaB3L 8Bl, dwg I 0 O0 0 0 o :~ ~ __ ~. ~ 1.000 gal Septic tank Standard Trenck~ 2~ 40' Long ~.,. ~ .............. . ................. ~ ..... NO SCALE / Mon/%or ~Cleonouts/ E.g ELEV.= 9&g' '= - ' ELEK 95 5 .... ~1~ ~" I 8,8 P% oF Septic Rock 2-IN INSUrer/oN OVEe rAN/( lOOO 9oL sep$/c B.O.H. ELEK=80.8' ND SCALE NO WAFER BENCH WANK BOUOW DOOR SILL ASSUWED ELEVA f/ON 100 FEEl SPURKLAND ENGINEERING Y~HALL& B~OCK 3 LOT 8 SEPTIC S~STE~ ~S~UILT 203 ~15~h Ave Anchor:Qe Ak 99501 NYAN BLOOW DATE, 2EC. e79-3916 12216 WI~ERNE~ DRIVE, ANCHORAGE, AK SHEET~ J/~ GRID~ 2736 PENWIT ~ 0SP101197 PANCEL ID ~ 015-2~2-08 VALHAL~B~LSD~.DWG Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSP101197 01521208000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: September21, 2010 to September21, 2011 Design Engineer: SPURKLAND ENGINEERING Subdivision: VALHALLA Site Legal Address: VALHALLA BLK 3 LT 8 G:2736 Owner/Address: BLOOM RYAN & JANE A 12216 WILDERNESS RD ANCHORAGE AK 995162243 Site Mailing Address: 12216 WILDERNESS RD, Anchorage Lot Size in Sq Ft: 16000 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www. muni.org/onsite (907) 343:7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 0 ?I I/ 7 Parcel I.D. Property owner(s) Mailing address Site address -- ~c,~,~ - Legal description (Sub'd., Block & Lot) V'~! ~o,\~.~ Legal description (Township, Range & Section) Lot Size I ~, ~0OO Sq. Ft. Number of Bedrooms Day phone Ancl o , A ~,Z. ip Code Zip Code THIS APPLICATION IS FOR ([~ all that apply): Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] 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. I ' (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: Environmental Consulting and Design SEPTIC SYSTEM DESIGN VALHALLA BLOCK 3 LOT 8 Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 September 13, 2010 Subject: Septic System Installation Permit 12216 Wilderness Road Ladies and Gentlemen: I am writing to request a permit to upgrade the septic system for the above referenced property. The proposed system will serve a 3-bedroom single-family residence. The existing system was installed in 1980 and is at the end of its service life. A Soil log, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Calcs: No Groundwater observed to a depth of 18 feet below ground surface (9/13/2010) Soil Rating. From Testhole 9/3/2010 4.4 min/in = 1.2 gal per sq.ft/day No. of Bedrooms 3 Required Area per Bedroom: 150/1.2 =125 sq.ft. Total area required: 125 x 3 = 375 sqft System: We are proposing a 1000 gallon septic tank, and a deep trench absorption field. The absorption field will be 40 feet long and 2 feet wide and contain 8 feet (640 sq.ft, effective) of sewer rock. Soils: A test hole was excavated on September 3, 2010. See the attached soil logs. Ground water was monitored for through September 13, 2010. Ground water was not observed. Surface Water: The are no surface waters within several hundred feet of the proposed septic system upgrade. Topography: The lot slopes to the west at approximately 5%. Waivers: None required. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net Environmental Consulting and Design The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, Lars Spu~land, P.E. Civil Engineer 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net I Lo~: N LoS 6 Lot 5 (VACENT) 7 Lot 4 NOTE: THIS IS NOT A SURVEYED PLAT. WELL ~ SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER OEPARTII~ENT DOCU/~ENTATION. ALL LOCATIONS SHOWN ARE APPROX//~A TE. 300 50 100 150 800 ~o50 SCALE; 1' = 100 FL SPURKLAND ENGINEERING 205 1~I 151'N, AVENUE ANCH. AK. 99501 (907) 279-$916 RYAN BLOOkl DA[E: SEPL 15, 2010 12216 PtlLDERNESS ROAD, ANCHORAGE, AK 99516 SHEET: 1/$ GRID: 27J6 PERMIT # SP/OSOXXX PID # 015-212-08 VolhallaB3LSBl, dwg I I Lot 7 I I Lot 13 / TAHK PER UPC REQUIREMENTS ~~' / ~ / ~ ~% Lo ~oc~no~s r~ ~o~ o~-s~r~ ~r~ ~a ~sr~ ~r~ ~....L...~...~~ DEPArTmENT DOCU~ENTArlO~ ALL LOCADONS SHOWN A~E SPURK~ND ENGINEERING VALHAL~ BLOCK 3 LOT 8 SEPTIC SYSTEU DESIGN 20~ · ~STH. AVENUE RYAN BLO0~ DATE: SEPT. ~, 20~0 ANCH.(907) 279-~9~6AK' 9950~ ~22~6 ~ILDERNESS ROAD, ANCHORAGE, AK 995~6 SHEET: 2/~ GRID:27~6 PERMIT ~ SWO~OXXX PID ~ 01~-~1~-08 VolhoHoB3LSDi, d~9 Standard Trench; c°' iF/de 40' Long 12' Deep 8' Sewer rock 4' Cover NO SCALE 0 O0 - 0 0 WOO gal Septic tank 0 Silt £orrier /-- Monitor /-- Cleonout5 8.0 £t o£ Septic Rock Effective __/ 1000 gal septic tank NO SCALE SPURKLANB ENGINEERING II 203 ~15th Ave Anchoro§e Ak 99501 279-3916 VALHALLA BLOCK 3 LOT 8 RYAN BLOOM 12216 WILDERNESS DR/YE, ANCHORAGE, AK SEPTIC SYSTEM DESIGN ])ATD SEPTEMBER 13, £010 SHEETI 3/3 GRII)I 2736 PERMIf tf SWO4OOXX PARCEL ID If 015-212-08 VALHALLABSLBD$.DWG Development Services Department ~~ Building Safety Division C,,~.' On-Site Water and Wastewater Program . 4700 EImore Road P.O. Box 196650 Anchorage, AK 99507 ~ ' ;' www.ci,anchora,qe.ak.us Soils Log - Percolation Test rtt: Municipality of Anchorage I ....... ,..?' · Date Performed~ ~S~e~~'"~ Legal Description: Valhalla Block 3 Lot 8 Township, Range, Section: Slope Site Plan 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 15- 16- 17- 18- 20- COMMENTS Pre Soak WAS GROUND WATER ENCOUNTERED? No s IF YES, AT WHAT DEPTH? ........ L O Depth to Water After p Monitoring? ~)£/ E Date: Reading Date Gross Time Net Time Depth to Water Net Drop 9/3/2010 1:00 pm 0 min 9.125" 6.75" 9/3/2010 1:10 pm 10 min 9.625" 2.375" 7.375" 9/3/2010 1:20 pm 20 min 10" 2.25" 7,625" 9/3/2010 1:30 pm 30 min 10" 2.375" 7.75" 9/3/2010 1:40 pm 40 min 10.125" 2.25" 7.875" 9/3/2010 1:50 pm 50 min 10" 2.25" 7.75" 9/3/2010 2:00 pm 60 min 2.25" PERCOLATION RATE 4.4 (minutes/inch) TEST RUN BETWEEN 5 FT AND 6 PERC HOLE DIAMETER 6 FT PERFORMED BY: Spurkland Engineering I - CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEL I'~ES N EFFECT ON THIS DATE. DATE: /I NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WEL'L INSPECTION REPORT LEGAL DESCRIPTION I Well I Absorption area Dwelling DISTANCE TO: > /~.~' Manufacturer Material Liq.DiSTANcECapacit¥//~,.~,~JnTO;gallons Well IF HOMEMADE: DweHinglnsidelength Width DISTANCE TO: ~ / (~: ~.~ ' ~--finish grade , r~ DISTANCE TO: Class Depth Driller DISTANCE TO: Building foundation Sewer !ine OTHER PIPE MATERIALS SOIL TEST RATING Depth Crib depth ' Building foundation I N STA L L E R REMARks '-~ PHONE ~'N EW ' I ¢~ 1980 No. of compartments Liquldd~h~C[i V~'[~ -- PERMIT NO. Liquid capacity in gatlons PERMIT NO. Distance between lines inches Total effective absorption area PERMIT NO, ITotaJ effective absorption area Nearest lot tine Distance to lot line PERMIT NO, Septic tank Absorption area(s} '.~/~(:%~ ' APPROVED DATE LEGAL SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DePth OF DRILLED AT THE RATE Of $18.~0 PER FOOt. PROPERTY OWNER 143 7: ee.f.o LOCATION Of WELL SITE £,:/'., DrillEr __~ CJ~ WELL LOG: 0 .... 27' S~ ~ COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. $2645.50 WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF THANK YOU VERY MUCH. DAT~ BERNIE ~J~AUS OF RAMPART DRILLING WORKS SERVICE CHARGEOF IV a% PER MONTH WILL SE ASSESSED ON PAST DUE ACCOUNTS. I::ll:::'I:'t ifl Ilii:Eli!i: ',/l::ll.ltl':II.I F:I Si,"li:' t'I il~!: I._I::'I",K~ I'II I::' ~ i'"IE:N5; :f: Oi',l !i :!!; -It Il:i!: ! l'i!:I",ll:'i'I I] ,:: till: [)~ilF"!ll Cfi::: I'] -FI~:I!iJ",ICI.t I:)f;i: I::'!1' :1:'.-; I"ltl':: E:Ct:'.!.:;Tt::II'.,IC:~: I!!~li:'l'f,.tfi!~!:I',l III!! :!!;l.Jf::fl::!:::l(:::!:!i (:d::: I!'!!: GI:;?t:::II.IH[) F:!N1) I'l'lh: ti?,Cl'l I'CIH OF' !tllii: I: ::'0::::F:I',,,'t::It ):OH ,:::lin l:::' l :: li i: 'l ::, I!I1_!:I::i:I:~ ISi; I',P:) ::::;I::~T [,.t:l:!::,l'lt F'OI:;i: I !i~! C:it:i:t::l',,,'li~I. I:,Ii}:I:::"il-I :l:t':i; 'I'I'll:i: M J:l',l I HI_IH I::,i:i:F"l' I::ll',!!::, ! I'll l!',l)l' i CII'I OF: I'I'IE !i::::'O:::Fl',,,'f::It" :1: Ot",l I::'h:f;i:l'l :i: I FIF:'F't '! I:t':lI",l'l' Ilt:::l!:i; I'i1[!!: l:~'l:} ::!:t':'i:)?.~,~; I I",k~;-i I::l! .LF:Ii' .I i: M :i' M'::;I:::'F'I":'I i Ihl'::; 'IF F:li'.,l~.l.' t,l~i:t.f t!~; F:It)..TFIC[ii:t",IT TO 11 :, I:::'t:;?.t:l!::'l}:l:;iI'th-' I::!H[) fl'I!:: I',,!l..t!"tt~l:::!:: Cfi::: lift: '.; i: l::,l:l'.,ll:'::~!:t:; TI'IF:IT Ftt"! FIIH t Ii I::!t,.: !.,I :!: 1 II TI'Il:i:: I:i:E)::!LI If, h' 'II I1: HI.,II'.,! 1[ C: ): I:::'l:::ll I I "/ :!:I. [. )'t'.,I'!F[FII 'l'I Ifl !';',":~; I li:t'"l L.I~,I[)!::I;:::;It:II'-,!I::, 'IIIFI'I Flit: (Ih,l'"~;I'll:~. ::;~}:1.1!~:1:;~: :?,~.':~Fl"[~lfl I"11:::1'.~" F;~:i~:I:~:II._I:I:F~t~: E:i'.,II I::ff:p:51~:l'll:i'.,~i I:::iF'I:::'I ):CI'II",IF I. II'.,I[)IZ~I:;~:C~iI::?.i:)IIHI) I -I'l) April 30, 1979 R&M No. 951119 Underground Ventures Ltd. P~O. Box 4-1953 Anchorage, Alaska Attention: Thomas Worden Subject: Soil Investigation for Sanitary Sewer System; Don Dahl Property, Lot 8, Block 3, Valhalla Subdivision, Anchorage, Alaska Dear Mr. Worden: At your request of April 23, 1979, we conducted a subsurface soils investi- gation at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with those procedures required by the Municipality of Anchorage Department of Health and Envirorm~ental Protection. This investigation, which was accomplished on April 27, 1979, consisted of a test pit excavated to a depth of 18 feet below the existing ground surface. The test pit was sited according to your instructions and its location is shown in attached Drawing A-01. Excavation was accomplished with a Drott 40 backhoe. Ail material excavated was continuously monitored by an experienced engineering geologist. The topography at the excavation site is generally gently-sloping to the west. At the time of the investigation the site had original vegetation consisting of 8 inch diameter birch and spruce and alder thickets. The top of the test pit was located at origiual ground surface. The soils encountered in the excavation are shown in the test pit log in Drawing A-O1. This log displays specific conditions encountered at the test location. However, subsurface conditions may vary in other parts of the lot without any apparent surficial evidence of the change. Groundwater was not encountered and bedrock was not encountered. At the time the pit was excavated seasonal frost was not present and permafrost was not encountered. A percolation test was performed in a 2-foot hole at the depth of 6 feet in an adjoining test pit. The data in Table 1 show average infiltration from the depths ~ndicated to the bottom of the hole. The measured percolation rate was 17 minutes per inch. We appreciated this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if we can be of addi- tional service. Very truly yours, R&M CONSULTANTS, INC. Ernest R. RahaSm Staff Geologist Gary ~eologist ERR:GS/rm/AT&SI-C GORING NUMBER TP-1 Cate Completed: 4-27-79 LOCATION SKETCH No Scale = _= :~. SOIL DESCRIPTION __ ~.~A~IC MATERIAL .5' -- ~ SILT W/SOME GP~VEL AND SOME SAND, GM Scattered Cobbles ~' e' Lot 8 p~ GRAVELLY SAND W/SOME SILT, GM .l~'~est Pit 1 Lot 9 'O 6' to 11 ' , Encountered more cobbles · ' EXPLANATION " SILTY SAND W/SOME GRAVEL, SM ~--UN;'~OZ£~/ G~OUND ~ ORGANIC MATERIAL ~ ' ~ Little Visible Ice 0:10' Vx ,~, ~.~ , . -- ~.~ i~ ~ . Ss,72, SZ 1%,85.9pcf ~ ~ ? I ! LwAr¢. CONT¢Nr i BEDROCK ]_S'T.D. TYPICAL SOILS LOG ] SAMPLER TYPE SYMBOLS SOIL SYMgOLS i .~ ORGANIC MATERIAL Little Visible Ice 0:10' Vx :~'~'~ --~Ae ~-/C£D£SCR/PTION ~:~ .. ~'5 (~Ss, 72, 5Z io/o, 85.9 pcf BEDROCK ~-"'- .... Lot 8, Block 3 ~E. 4i~279_l ............ ~l~L~T~.~s~,..l~;jj Valhalla Subdivision GRID. 2736 __%;___~j [[ ......... ~OILS LOG ~chorage, Alaska PROJ. N0.951119 ~-J -- oW~.NO A-O~ Time PERCOLATION'TEST Table 1 R&M NO. 951119 Elapsed Time Inches Drop in inches 11:50 0 0 1 1.5 1.5 3 2.25 .75 5 2.50 .25 10 3.0 .50 20 3.5 .50 30 4.25 .75 40 4.75 .50 50 5.25 .5O 60 6 .75 1.75 inches 17 minutes per inch MUNICIPALITY OF ANCHORAGE f Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 015-212-08 Certificate of On -Site Systems Approval Expiration Date: ! Z 2 / Z Legal description VALHALLA BLK 3 LT 8 Site address 12216 WILDERNESS RD Anchorage AK Current property owner(s) NICK DUNCAN X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: Z zo Z_3 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory X Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE o" Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-212-08 Complete legal description Valhalla Block 3 Lot 8 Location (site address) 12216 Wilderness Rd. Anchorage, AK Current property owner(s) Nick Duncan 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: © Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: © Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 13 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed © Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ �� S /(� Waiver Fee $ Date of Payment �I �2� Date of Payment COSA # rl S� Z (2, S Waiver # COSA Application—June 2022 Septic System Absorption Field Advisory Certificate of On -Site Systems Approval # OSC231356 Subdivision: VALHALLA, Block: 3, Lot: 8 During the absorption field adequacy test, 86 inches of standing water was observed in the absorption field. This indicates approximately 87% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P O Box�196650 *Anchorage, Alaska 99519 6650 *www muni org Legal Description: Valhalla block 3 Lot N Parcel ID: ul-�-212-ub If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 7 Well log is filed with Onsite (or attached) Date drilled 5/9/79 Total depth 143 ft Cased to 143 ft ❑✓ Sanitary seal is functioning correctly V Wires are properly protected Casing height (above ground) 22 in. Date of flow test for COSA 8/30/23 Static water level at beginning of test 79 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 9/1/2023 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 10/5/2010 ❑ ALL standpipes present per record drawing Total measured depth from grade 12.7 ft (max) Measured depth to pipe invert from grade 4.1 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑✓ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Well production at time of test 4.0 qpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ✓❑ No 0 Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L✓❑ Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 8/30/23 STATION ❑ Require tenance completed Age of lift station rs Lift station material Comments: Adequacy test date 8/30/23 Results J❑ Pass Fluid depth prior to test 86 in Water added 450 gal New fluid depth 98 in Elapsed time 1440 min Final fluid depth 86 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 98.2* in Effective depth used 86* in Effective depth remaining 12.2* in Comments/Deficiencies *Field operating in the top 10% of its capacity at time of inspection. COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ✓❑ Yes if No Community Sewer Manhole/Cleanout > 100' ✓❑ Yes if No ft W] Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' © Yes if No ft Absorption Field on Lot > 100' Z Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50'✓❑ Yes if No ft ❑✓ Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓❑ Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ✓❑ Yes if No ft Surface Water > 100'J❑ Yes if No _ Tank to Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ✓❑ Yes if No ft Private Wells > 100'✓❑ Yes if No _ Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' Q Yes if No _ Water Service Line > 10' ✓❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS M, ft ft G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. wilt The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The + �� �'r rV now 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 i t and the water usage of the family being served by the system. The operational life of all well and septic w systems are subject to these various and dynamic characteristics and are outside the control of the evaluatorA of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. /* r" KENNETH m DU U t' C£ 71 i 6 � + * : w !. COSA Checklist June 2022 aGE UV • Municipality of Anchorage =¢ On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-212-08 1. GENERAL INFORMATION Complete legal description Valhalla _Block _3 Lot 8 Expiration Date: acua Location (site address) _12216 Wilderness Road, Anchorage, AK Current Property owner(s) _David Cerna, Mailing address Real Estate Agent 12216 Wilderness Road, Anchorage, AK 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone -___ 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �.5v _ Waiver Fee $ _ Date of Payment Z Date of Payment Receipt Number l�%�� q Receipt Number COSA # 02� 1.2 S`�� 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 _ARCTERRA CONSULTING, INC. _._ _ Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name _KENNETH M._DUFFUS , Date3%z/ Engineers 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 septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen .� Chi _A encroachments, deficiencies or discrepancies exist. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms.�\cTl� N�rE', 10, �1ol System #2 Approved for bedrooms.rr, • Ir t4G:351�'��� .mp' Disapproved. �`�► ®-®►'�' Conditional approval for bedrooms, with the following stipulations: I{ _ * -The-re- 1�s cam- t C717C�_r t . ��Co�Se of a� 3�3-�a1I -fir. s� By: ��' ? d----_�_._ aF Wy6 r, " 0 n `i'h ! S n G Original Certificate Date: 5_a 5�o?Ga 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_ Nitrate Advisory Septic System Advisory X Arsenic Advisory Well Flow Advisory Other COSA blue sheet -10-10-12 doc Legal Description: COSA Checklist Valhalla Block 3 Lot 8 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA X Well log is filed with Onsite (or attached) Date drilled 5/9/79 Total depth 143 ft Cased to 143 ft j Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 22 in. Date of flow test for COSA 5/7/21 Static water level at beginning of test 89 ft. Comments B. TANK DATA Age of tank(s) 11 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49 ® Standpipes/foundation cleanout per record drawing Date of pumping 10/13/2020 A+ Services D. ABSORPTION FIELD DATA Parcel I D : 015-212-08 of Structure served by this system Well production at time of test 4.0 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes '1 No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 5/7/21 FT STATION ■❑ Requ�r aintenance completed Age of lift station Lift station material Comments rs Which system tested (date installed) 10/5/2010 Adequacy test date 5/7/21 ® ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 12.7 ft (max) Fluid depth prior to test 84* in Measured depth to pipe invert from grade 4.9 ft (min) Water added 450 gal ❑ N/A — pressurized field New depth 93* in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective [1 Code -required soil cover over field Final fluid depth 84* in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: *Field operating in the top 10% of its ccs uc.i[N at time of inspection. 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' 0 Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft [0 Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' 2] Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' 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' 0 Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' 0 Yes if No ft 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' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with 4gm MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Septic System Absorption Field Advisory Certificate of On‐Site Systems Approval # OSC211254 Subdivision: Valhalla, Block: 3, Lot: 8 During the absorption field adequacy test, 84 inches of standing water was observed in the absorption field. This indicates approximately 86% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. N 0 ° i o CD o C: o �_ m t� r r too, y 0 _ �. Q o CDCD • - I s . CD o 0 CD ° w N895900W 160.00 30 �> N cn N �.�� ��� 0 0 ° ��H o� ' �~ �' cn add C o r-� I x 43.4 x x L 0 r A 0 CC - En� o CD o� ® x !`'54.5 SHED cn Z o CD 16.2' N m w s No CD ° -°� (� Z �cn c O �. ������ �CD y r o o o 14.0' o �o c� I s; �vS. M oCDO f m C 0 _� � ° � � � a a � �''� x N 22.0' 49.5 O o > j CD CD � CD ° x PAVED WALK � __u4h.F— o C x mo = X p I �7 .,W-R � .� ba`& • \� \l �-ks� ��2 •': :'•S 1 r I x o m n J O Cf) J C 5.3' OF C/) �'ir Z m m Q0 O i.1� cry r •�' : 00 m CO� 00 c.n O co,. OFAco C) wp C� � n —i I x I r4-� � n26.3' 5.3 w o - � &J 00 0 • co o •�/ 0 p x I • FP x p O 1 s�, • .. ' .. e.Yo o 0 e O r: A. dMW �0 I x x Z77 �* 11.7' � S C HLT•L L X--X--_x v SHED x I .' — x X- x—x_x— x x— mooco o�0�� N89°59'00"W 160.00' CD cocn c� I Ocn �? �0CDCD � 03 01� �ZZ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTFI & 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. # (;.")~ - ~\.~(~'~x~ NAA# 1. GENERAL INFORMATION Completelegaldescription /~,o,-C ~"-'~Loc~ ..~ \/¢,L IJrfi, LLA ~/~ Location (site address or directions) /'Z_~. /~, L~ t6-~,~--~'~,,J~c, ~.,5A~ Property owner Mailing address Lending agency Day phone Day phone Mailing address Agent ~1 LL ~.,v,'-P~--¢~ Ad dress Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev ~/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 verifythat 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 %~:~A~,~c~,~ ¢__ Address EngineeYs signatur~ ,~~--~ Phone Date '3/~/~.~ DHHS SIGNATURE Approved for 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-O25(Rev. l/91) 8ack MOA~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICESJ~ ~. C LE I V Environmental Services Division 825 b Street, Room 502, Anchorage, Alaska 99501, (907) 31~A~74~ 1998 Health Authority Approval Checklist ~ Municipality of Anchorage uept. Health & Human Services Legal Description: (. ~, ~ ~ k(,¢,L.~,4/.t.~, Parcel I.D.: A. WELL DATA Well type~"~f~-~UJ~'7-~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth / q~.. Sanitary seal (Y/N) Date completed Cased to /z~ t V FROM WELL LOG g.p.m. Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION t Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform '~' (-~ ~ Date of sample: '~ /2-2-/ ~'~ B. SEPTIC/HOLDING TANK DATA g.p.m. Nitrate ¢, ~ ¢ ~O Other bacteria "~ Collected by: -.~ · ~ .~'~A~JO~.J/-4~ Date installed ~- ~ - ~: Foundation cleanout (Y/N) Date of Pumping '7~ -( C, ABSORPTION FIELD DATA Date installed ~,-;j- :~ Length ~t Width Effective absorption area Date of adequacy test ~'~ /~-( Fluid depth in absorption field before test (in,); Fluid depth '~,~ (ins) Minutes later: / Peroxide treatment (past 12 months) (Y/N) Tank size /~- ~ Number of Compartments _~ Cleanouts (Y/N) "~ Depression (Y/N) ¢U/ High water alarm (Y/N) ~ Pumper /~ ~,,¢4 ~z- ~¢-~¢~Q- System type'--j~IP-~-~ c J¢ c~ ( Total depth /~:~- ~ Monitoring Tube present (Y/N) ~- Depression over field (Y/N) ~ Results (Pass/Fail) '~r~,.S.% For ~ Soil rating (g.p.d./fF ~ ~ Gravel thickness below pipe Immediately after_~66) gal, water added (in.): Absorption rate = ,¢~¢ro .g,p.d. If yes, give date bedrooms /t 72-026 (Rev, 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) p~He~ "Pump off" level at* '/%~Datum High water ~ Cycles-test'Sd E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot / c~ -4- Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout ,'~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO; Foundation / .~ t Property line g, ¢, -4 Absorption field ~-- Water main/service line zOO t Surface water/drainage !~ "F Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain /82 ~ Building foundation '~ 6) t Water main/service line ;:~-,~-'/ ~C~--~q'~ Driveway, parking/vehicle storage area Wells on adjacent lots / ¢'d~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of in conformance with MOA HAA guidelines in effect on this date. are HAA Fee $ Date of Payment Receipt Number 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) Application Date Legal Description (include lot, block, subdivision, section, township, range) Location (~ddress or directions) (b) Ap~iicant Name ,.~7~E' ~'/~ /~t~'t'~ Telephone: Home Business Applicant Address ' ~'"-/¢~e¢'7¢.~ /~ (c) Applicant is (check one): Lending Institution []; Owner/builder~¢; Buyer []; Other [] (explain); (d) Lending Institution Address Telephone ~-,.~ - 7~¢0 (e) Real Estate Company and Agent _/ Address ~-~'¢¢ ' ,,~/'#~P 7~"~¢..~ Telephone (f) Mail the HAA to the following addrescs:~ ¢ , TYPE OF RESIDENCE Single-Family'~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well"~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department o! Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite)~ Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-o~5 EN¢~INEERING FIRM PROVIDI INSPECTIONS, TESTS, FILE SEARCH, E ~ AND INFORMATION 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 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 '/~"~ Telephone Address /Z-~ ~.'~) ..~3~4 /~, _5'U/7'E"~ ,,,~/d,~. Date ~"- DHEP APPROVAL Approved for "/~'~'"~'¢~/~edrooms by ,2~'~'~'''~'--~ Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMJ:NT OF HEALTH AND ENVIRONMENTAL Pr~OTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~7-~T,F ¢'?; ,,¢z,,~/¢ Telephone: Home Business Applicant Address --'~'--~t~,'¢~ ,, /'¢"/L (c) Applicant is (check one): Lending Institution []; Owner/builder~; Buyer []; Other [] (explain); (d) Lending Institution /r-~' ~:~*~ Telephone Address (e) Real Estate Company and Agent /L/t~l~'f~;~l Address ,Z--¢¢~/ /,//~ Z 7-/~¢W/' (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms -'~ Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-o25 m,84~ ENGINEERING FIRM PROVIDI, INSPECTIONS, TESTS, FILE SEARCH, D. A AND INFORMATION 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 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 -/'¢&¢¢ ~ Telephone Address /~'~ Date Y/~'/~' DHEP APPROVAl. Approved for -/z'~'~-~"5~bedrooms by Approved Disapproved Terms of Conditional Approval Date Conditional ~ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (1 ~/84) ,I~.,I~INICIPALITY OF ANCHORAGE (MOA) . ~c'~,O~'~E~'L-~q'H AUTHORITY APPROVAL (HAA) ~ O~ ~ Gg5 Ow~ ~¢~ ~ CHECKLIST - FEBRUARY 1984 ~ ,~.~ ~ ~ 264-4720 ~" .nO~ ~ ~ov Legal Description: ~' &~ ~'~Y~ WELL DATA Well Classification ~/~'/~ If A, B, C, D.E.C. Approved (YIN) Well Log Present~j~) Date Completed ~5~ ~"~ ~ ~ield Total Depth /~ / Cased to /~ z Depth of Grouting ' ~ ~ ,~ Static Water Level ("~ ~',~" ?' ~ Casing Height Above Ground /' ~ Electrical Wiring in Conduit (Y/N) 5Z,'- /_;:,,~//~¢/;r¢ Separation Distances from Well: / To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Pump Set At Sanitary Seal on Casing(/~4) Depression Around Wellhead (Y&~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole /~2't Water Sample Collected by /~- Water Sample Test Results :f'//-~/ Comments (~:~ /dZYJ~ £~,'~'-' '7z~1 To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date ~/,~t,'" A-~' ?/'Tt~ ~,~¢/~',,~ ?~/ 4d~z~, SEPTIC/HOLDING TANK DATA Date Installed ~'.~ "?"7¢ Stand pipes~'~)N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /¢~,~ /~¢..,,/.i Size ~/7 S~' Air-tight Caps .L~Y~'N) No. of Compartments Foundation Clean~)u~-~N) Date Last Pumped Temporary Holding Tank Permit (Y/N) To Building Foundation /~ ~,.*~ ~ ~¢~'/t/~.¢ ~ To Property Line To Water Main/Service Line Course ? To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(~1/84) C. ABSORPTION FIELD DATA ~r' Soils Rating in Absorption Strata Z/O'L) Date Installed /¢ 'Z~,-,¢o A.~/'~' ~.,'/,5-A,/z.'r- Width of Field ~ Square Feet of Absorption Area Depression over Field (Y{~I~ Results of Last Adequacy Test Type of System Design Length of Field ¢~/~ ~ Depth of Field /~" / Gravel Bed Thickness ~' Standpipes Present~/~) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /'dC ~ ¢' To Building Foundation Lot ~-'~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ? To Property Line ,/D To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) _ /',/,~/~ Comments D. LIFT STATION Date I~"st-a IL¢.~ ,/ Size in Gallons % // "Pump On" Level at ~ High Water Alarm Level at Tested for ~-~"'~. Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) '"'"-~, Comments --"'""~ ** Check Permitted Bedroom Rating Against HAA Request ** ' .... I certify that I ha~¢ch~,cked,~verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Company /~ MOA No, Receipt No. /~/ ~ O ~ ~ Amount:$ -- -- /¢¢~ 72026(11/84) INSPECTION APPOINTMENTS 'TIME, i ,, c_~,~Ov~//,/ ( (',~ / /~ (~__~ ~ TIME TIME DATE ' DATE DATE INSPEC~r ~ ~ INSPECTOR INSPECTOR MUNICIPALI~ MUNICIPALITY OF ANCHORAGE OEPT. OF H"ALTII & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RONMEN]'AL ( ENVIRONMENTAL SANITATION jbiq 1 3 1980 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAGILITIE8 MAILING ADDRESS 2, BUYER PHONE M&ILING ~DDRESS R~A~TOR/AGENT ~AILI~G E.~EDAL DEscRiPTION STREET LOCA~'IbN DoT S, TYPE OF RESIDENCE NUMBER OFtBEDROGMS [] One [] Four (~ SINGLE FAMILY [] Two [~ Five [] MULTIPLE FAMILY ~ Three [] Six [] Other 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available,) ,~ SEWAGE DISPOSAL SYSTEM [~' INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE ~NSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer__Line Nearest Lot Line Absorption Area to nearest Lot Line E. COMM'E 'TS /APPROVED :::5 .ED.OOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~ DATE BY 72-010(Rev. 6/79) 825 "L" S'rREE I- ANCHORAGE, At ASKA 99501 (907) 26,1 ,1111 June 17, 1980 Stephen/Barbara Anderson Star Route A Box 1583 Anchorage, Alaska 99507 Subject: Lot 8 Bloc]< 3 Valhalla Subdivision Approval for your individual sewer and water facilities can not be granted until the fo]lowing items have been completed: (1 The water analysis report be delivered to this department from Chem Lab, 5633 B Street, for our review. (2 A well log submitted to this department for our review. Your permit for the installation of an on-site sewer system has expired as of December 31, 1979. We have not received the as-builts of the installation in this office. If a private engineer inspected the system, please send us the report for our review and files. The well that is used for watering is to close to your sewer system. It will need to be physically disconnected and abandoned because the aquifer is within the 100 foot protective radius. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/l~w cc: Alaska Muhual Savings Bank Mortgage Loan Department 1503 Wesh 3~ Avenue 99503 I certify that Barbara Anderson appeared before me this 18th day of June, 1980 and proved her identity to me. My Commission i¥1ay '25, 1981 GREATER ANCHORAGE AREA BOROUGH o-~L w_~.~~-'~ Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received ~/~//2 ~¢<- Time of Inspection /-- / 5 ~o ~' 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: REQUEST FOR APPROVAL OF INDIVIOUAL SEWER &WATER FACILIIIES ,, FOR ~ W~ ,' ,' ..... I ' [z--2 ' Phone: 3. Legal Description: ~ ~P ~2~ L-~ ~///~~'-.'~ ~ 4. Location: ~ ~/~//~--~ '~[- ..~1~-~ 5. Type of facility to be ~nspected ~ . ~o. of bedrooms 6. ~ell ~ata: A. Type ~-~c]~ B. Depth /.~ C. Construction /}~¢¢m~.~z,¢m~,~ D. Bacterial Analysis 7. Sewage Disposal System: A. Installed /~g~--~' B. Installer ~/~ ~c~~ c. Septic m..~: 1. S~ze ~-,._~ ~. ~anur~t~e~ //~-~/ 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines __, Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line __ EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Req ~st for Approval of Individual . er & Water Facilities Legal Description L ~ ~ ~/ ~/~,~_.,Z/~._ '~'. Comments Approved Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM x~ certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ-034 (1/74) Stephen Andersen ^nchorago, ^1 as ka 995D7 SUUJ[¢/': Lot: 8, l)lock 3, Valhalla Subdivision A set,mr and uater survey uas made on Lira subject lo~ by. tht$ depart}:ient. 'rB(: we.;{1 ~as located t~ the daylight Base~nt. Th{~ base}~ong entrance and Lhe ~oll are located at ~round level. The dtstanc~ from the w~ll [o ghe sept, ia gank ts slxt, y (60) feet. The distance to the soepag~ pit is sl~[F..stx (66) feet. A 10~ foot separation from the well go the seepage pit is required by the Greater Anchorage Ama Borough Ordinance N2g-6B. 'i'he seepago pit ~,till need to im re'located to ohtah~ the proper dtsgance during the 197~. coast)action season. Please contact tlHs depart~mnt wi'ttdn thirty (30) days frol~l tim Yack)pt of this le~tor to advtst~ us ~hen you ~tili he abl(~ to complete the work. Upon the relocation of ti~u s(tepago pit, tills departr.~)nt t~lll be able to al)prove tBe sewt)J, and water system. A permit from this departhiant is rcquirc'd bt)Fora work is do}{e oo tim If you ))ave any questions ro(.lardi))O IJills matter, please contact (~J at 274-456l, extension} 133. Sincerely, Lyml S. Coati Sanitarian ~I cc: :lattonal t)ank of Alaska