HomeMy WebLinkAboutVALLEY VIEW TERRACE BLK 3 LT 1Valley View
Terrace
Lot 1
Block 3
#050-352-10
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Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water & Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: NOT ASSIGNED AT THIS TIME PID Number: 050-352-10 ❑ New N Upgrade
Name:
BRENT AND SARAH DAVENPORT
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ound
Address:
23431 UPPER TERRACE STREET, EAGLE RIVER, AK 99577
❑ Other
Phone: No. of Bedrooms:
Soil Rating:
Total Depth from origin .
616-318-0942 3
GPD/Sq. Ft.
Ft_
LEGAL DESCRIPTION
Depth to pipe Invert from original grade:
Grave pth beneath pipe:
F
Ft
Subdivision: Block: Lot:
Fill added above original grade:
Gravel length:
VALLEY VIEW TERRACE 3 1
.,`
Ft.
Ft.
Township: - Range: Section: -
Gravel width:
Ft.
Beds Number of lines:
Distance between lines:
FL
SEPARATION
DISTANCES
Total absorp area:
umber of trenches:
Dist. between tranches:
Septic
Absorption
Lift
Holding
Public/Private;_r�_�Tank
Field
Station
Tank
Sewer Lines
SQ. Ft.
Ft.
Well
100'+
-
25'+
TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑ Other
Manufacturer.
**
GREEK
capacity:
**1250 Gal,
Surface Water
100'+
z
N/A
Lot Line
5'+
0
w
Material:
Number of compartments:
**STEEL
2
LIFT STATION
Foundation
*5'+
-
-
Curtain Drain
NONE KNOWN
Manufacturer.
c
Gal.
Remarks: *MET SEPARATION DISTANCE AT TIME OF INSTALLATION.
"Pump on" level at
ump ofl level at
1"P
High water alarm at
**THIS IS DOCUMENTATION OF A SEPTIC TANK THAT WAS INSTALLED
Pump Make 8 Model
Electrical Inspections perkmned by
10-12 YEARS WITH NO PERMIT. SEE ATTACHED REPORT.
PIPE MATERIAL
House to tank EXISTING Tank to D3034
drainfield
Installer 'UNKNOWN
Drainfield EXISTING CO/MT D3034
Inspector GEG, Ltd.
BENCH MARK (Assumed elevation)
100.00 Ft.
Inspection
Location and Description:
Dates: 1 St **8/14/2019 2nd
3rd - 4th
BOTTOM OF SIDING BY GAS METER
ENGINEER'S SEAL
Community Development Department Approval.����
� % %,,,'��
.•X P, ••••..
�.** #��
Conditional approval: Date:
A 4L
■........ ....... ..............
.. .... ..........�
,
♦ '; y A. rn ss : �v ■
CE -7953 ' ,°*=i
Approved: li Date: `� l Z 5-
40pROFESS�
�••
LICENSE r Ilk I %Ilk
#AECC884
Inspection Report_1.1-12.doc
PERMIT NUMBER:
NO PERMIT ASSIGNED AT THIS TIME RECORD DRAWING
LOT 2, BLOCK 1;
PARKSIDE S/D
40' DRAINAGE EAS
i \
A B �
FCO 11.0 34.2
ST1 14.5 35.5 \
/ SCALE: ST2 20.8 38.5 \ \
millimill NOTE: SWING -TIES GENERATED
/ 1, = 50' FROM SCALING DISTANCE FROM
LANG & ASSOC. AS -BUILT SURVEY %
PARCEL ID NUMBER:
050-352-10
/
/
/
LOT 3, BLOCK 1;
/ PARKSIDE S/D
/
/
/
/
/
- 15' MEA ELEC ESMT
EXISTING WELL "- ` I FINSTALLED
EXISTING SEPTIC TANK.BELIEVED TO BE 1250
GALL
GREER STEEL SEPTIC TANK THAT
N 10-12 YEARS AGO WITH NO PERMIT.
LOT 3, BLOCK 2; # 3 BEDROOM EXISTING DBL CO'S (DBL1 &DBL2)
VALLEY VIEW TERRACE S/D HOUSES
y
r., GENERAL
` LOCATION OF 25'
j `'� GRAVEL > '' :v..�.'J.O.`+ �� `\`'�.
O' DRIVEWAY ` •'• X 80' SEPTIC
EASEMENT FOR
LOT 2
LOT 2, BLOCK 1;
VALLEY VIEW TERRACE S/D
\ /�\ i aQ • GRASSY AREA
OVER DRAINFIELD
/ EXISTING DRAINFIELDS 70` -
/ NEW CO AND MT INSTALLED •; ;} c4
55' SEPTIC `\
/ 8/13/2019 BY ARM SEPTIC SERVICES. EASEMENT
PASSED ADEQUACY TEST ON 8/24/2019.
�R \
/ LOT 5, BLOCK 2; ` ~
/ VALLEY VIEW TERRACE S/D %� ` Q`
NOTE: THIS DRAWING IS FOR DOCU=10-12YEARS
ASEPTIC TANK THAT WAS INSTALLEAGO WITH NO PERMIT. INSTALLER , LOT 6, BLOCK 2;
VALLEY VIEW TERRACE SID �•
c.
- •__.� .<< ���. � � ENGINEERING -SALES�CONSULTING.,.. - ...
3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 338-3246WEBSITE: www.gamessenginmdng.com
.•••
PREPARED FOR:
P HONE NUMBER:
PAGE NUMBER:
1 n
BRENT AND SARAH DAVENPORT
616-318-0942
2 OF 3
PROJECT/LEGAL DESCRIPTION:
DRAWN BY:
•�
VALLEY VIEW TERRACE S/D; BLOCK 3, LOT 1
J.L.M.
�1�4
TYPE OF WORK:
DATE:
LICENSE
-._ RECORD DRAWING OF SEPTIC TANK UPGRADE
8/28/2019
#AECC884
Frey Garn ss'=:AV
C -7 ..
�5����••
PERMIT NUMBER: RECORD DRAWING
NO PERMIT ASSIGNED AT THIS TIME
FINAL GRADE
= 101.3-101.5
EXISTING SEPTIC TANK. BELIEVED
TO BE A 1250 GALLON STEEL
SEPTIC TANK. INSTALLER
INVERT OF BUNGUNKNOWN AND BURIAL RATING
AT INLET = 93.85_j/
3.85 UNKNOWN. INTEGRITY VERIFIED ON
(ASSUMED) 8/14/2019 BY GEG, LTD.
BOTTOM OF TANK
IN ST1 = 89.60 -
EXISTING CMU BLOCK RETAINING
WALL WITH DECK SUPPORTS ON TOP
OF WALL (SEE ATTACHED PHOTOS) -
NEW 2" STEEL MONITORING
TUBE SLEEVED IN 4" PVC PIPE.
INSTALLED BY ARM SEPTIC
SERVICES ON 8/13/2019
'8/30/2019 - THE PE SEAL ON
THIS DRAWING DOES NOT
ADDRESS THE STRUCTURAL
ASPECTS OF THE DECK. IT
ONLY ADDRESS THE
GENERAL LOCATION OF THE
DECK SUPPORTS.
EXISTING 1983 DEEP
TRENCH DRAINFIELD
INVERT OF BUNG
AT OUTLET = 93.77
(ASSUMED)
BOTTOM OF TANK
IN ST2 = 89.69
DECK BEAM
•
V
ENGINEERING SALES CONSULTING
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 338-3246' WEBSITE: w ,gamessengineering.=
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
BRENT AND SARAH DAVENPORT 616-318-0942 3 OF 3
PROJECT/LEGAL DESCRIPTION: DRAWN BY:
VALLEY VIEW TERRACE S/D; BLOCK 3, LOT 1 J.L.M.
TYPE OF WORK: DATE:
�,_ RECORD DRAWING OF SEPTIC TANK UPGRADE 8/30/2019
PARCEL ID NUMBER:
050-352-10
EXISTING PIER BLOCK
WITH DECK SUPPORT
PIER BLOCK WITH
DECK SUPPORT
PIER BLOCK WITH
DECK SUPPORT
-EXISTING SEPTIC TANK. BELIEVED
TO BE A 1250 GALLON STEEL
SEPTIC TANK. INSTALLER
UNKNOWN AND BURIAL RATING
UNKNOWN. INTEGRITY VERIFIED ON
8/14/2019 BY GEG„LTD.
.�OF�aaa 11
....:........ ........... .....
/ C;t-/ • :�-7 AV
LICENSE +,111II& •
#AECC884
\� !40' DRAINAGE
Lot / EASEMENT 1/ Lot 3
--------/�--.t-----�' --- --
N 90'00'00"E 253.44'
1.7'x21.1' CANT \ y43 1 STORY RESIDENCE
.4V 2$0 w/ FULL BASEMENT
•'"� LWELL D \ 16,2'x27.3' DECK Lot 1 15' ELECTRIC
2.5'x5.5' CANT
28,749 s.f. EASEMENT
r �•
yy SEPTIC PIPES
J
Lot Z \ MN oigz.
' GRAVEL ' .' SEPTIC FOR
/ DRIVEWAY"_ 2.4' CANT \ LOT 2 •,„a
4.0' CANT \ Lot 2
/ 6,5" BALCONY \ ry
0
_10' CLEARING \
EASEMENT
~\, 55' SEPTIC EASEMENT
(BK. 1014, PG. 685)
\.
PLOT PLAN AS BUILT X SCALE 1 " = 50' GRID SW 0160 Project No. 18-234 Al
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone
(907) 522-4625 Fax
Professional Land Surveyors ken0langsurvey.com p F A ,� ,9 4
jonothan0longsurvey.com
I hereby certify that i have surveyed the following described property:
LOT 1, BLOCK 3, VALLEY VIEW TERRACE SUBDIVISION (PLAT No. P-574) 49!-H*
Anchorage Recording District, Alaska, and that the improvements situated thereon are """""
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
U� '• KEN LAN<r
easements on said property except as indicated hereon.4(0
V
Dated this the Day of 1'\Atc Y 1 � I' at Anchorage, Alaska A .........
Qk%ROr'-SSIONA- �4
It is the responsibility of the owner to determine the existence of any easements, kk` n�.'��`''
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
Municipality of Anchorage
I) o.tR)t
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997
Development Services http:l/www.muni.orglOnsite
Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV191080 COSA#:OSC191416 Permit#:
PID#: 050-352-10
Legal Description: Valley View Terrace Bilk 3 Lt 1
Engineer: Garness Engineering Group
Your request for a waiver of the required 10 feet horizontal separation from the absorption field to
the foundation has been approved. The approved separation distance is 5.0 feet.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
Waiver is Granted: X Waiver is not Granted:
Date: 4.11,17— h Approved by:
Name of Review
**** VARIAN C E/WAIVER REVIEW ****
ON-SITE SEPTICMELL PERMIT APPLICATION
Parcel 1. D. 050-352-10
Property owner(s) BRENT AND SARAH DAVENPORT (NEW OWNERS) Day phone -616-318-0942
Mailing address 23431 UPPER TERRACE STREET, EAGLE RIVER, AK 99577
Site address 23431 UPPER TERRACE STREET, EAGLE RIVER, AK 99577
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section)
Lot Size 'Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field ❑ Initial El
Single Family (SF) El
(w/wo ADU)
Septic Tank FX Upgrade El
Duplex (D) ❑
Holding Tank D Renewal D
Multiple Dwellings ❑
Privy M
(SF and/or D)
Private Well n
Water Storage M
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
TANK TO RETAINING WALL WITH DECK SUPPORTS
Distance: 3'
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GAIDevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTennit Application.doc
GARNESS ENGINEERING GROUP, Ltd
ENGINEERING - SALES CONSULTING
August 30, 2019
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
r
Ref: COSA, Documentation of Septic Tank, and Waiver Request for Valley View Terrace
S/D; Block 3, Lot 1
To whom it may concern:
The referenced property is served by a private well and septic system. The original
septic system was installed in 1983 and consisted of a 1000 -gallon steel septic tank
with a deep trench type drainfield. The new owners of the property bought this house
last year and a COSA was not obtained. We performed a site visit on the property and,
based upon the location of the tank, suspected that the tank may have been upgraded.
The new buyers provided us a copy of the disclosure statement provided by the sellers
to them which states that the septic system is 10-12 years old. The new owners, Brent
and Sarah Davenport, have contacted the previous owners, Paul and Karen Davis, and
they stated to them that they upgraded the tank with a new Greer steel septic tank 10-
12 years ago. We performed records research on this property and there is no record of
the septic tank upgrade. In short, it appears this septic tank was installed without permit
and has not been documented. On 8/13/2019, Arm Septic Services, installed a new
monitoring tube and a new cleanout in the drainfield for testing purposes. On 8/14/2019,
the end and a partial sidewall of the septic tank was exposed just below the waterline to
confirm the integrity of the tank. GEG Consultant, Jody Maus, observed the end and
partial sidewall of the septic tank and did not find any holes. While onsite, Mr. Maus
observed the tank being pumped by JR's Pumping. JR's Pumping pumped 1250 gallons
out of the septic tank and have noted that on their pumping receipt (see attached). The
spacing between the cleanouts for this tank are approximately 8 feet apart which also
indicates that this tank is most likely a 1250 -gallon Greer steel septic tank. Based upon
this limited information, we are providing you an inspection report and record drawings
for this formerly undocumented tank. We have discussed this with Tim Eklund and he
stated we would need to apply for a septic permit, pay the permit fee, and
simultaneously submit the record drawings/inspection report for this tank. Attached is
the permit application for this tank.
3701 East Tudor Road, Suite 101 ° Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 ` Fax: (907) 338-3246' Website: www.garnessengineering.com
Page 2 of 2
WAIVER REQUEST:
While onsite, we found several things that require a waiver. The following is a list of
these items and the requested separation distance:
1. Septic Tank to Retaining Wall with Deck supports: During our site visit, e
measured 5'-10" from the edge of the cleanout to the edge of a -3 foot t II CMU
retaining wall that has two deck supports (see attached photos). Given e tank
should have a 2.5 foot radius, the edge of the tank to the edge of there aining
wall should be approximately 3.5 feet. To be conservative, we are req esting a 3-
foot waiver from the tank to the retaining wall. There are also additio I deck
supports with pier blocks that support the deck. Two (2) of these directly over
the tank when we first arrived on property; however, the owner has modify the
deck so that the deck supports with pier blocks are not directly over the tank
perimeter. Attached are photos of this modification for your review.
2. Drainfield to Retaining Wall with Deck supports: During our site visit, we
measured 8'-2" from the edge of the cleanout to the edge of a -3 foot tall CMU
retaining wall that has two deck supports (see attached photos). The width of the
drainfield is unknown, but we assume it is less than 3 feet wide. Given this
assumption, the retaining wall should be approximately 6.75 feet from the
drainfield. To be conservative, we are requesting a 6 -foot waiver from the
drainfield to the retaining wall.
3. Drainfield to Foundation: The previous HAA stated the drainfield was 10'+to the
foundation; however, based upon our septic record drawings we have recently
performed, the drainfield could be theoretically be closer to the foundation than
the required 10 feet. To be conservative, we are requesting a 5 -foot waiver be
granted. The foundation at this possible encroachment is a slab on grade. In
short, the drainfield should not adversely impact the foundation.
We are unaware of any adverse impacts this installation would have on adjacent wells
or septic systems. If you have any questions, please contact us at 337-6179. Thank
you for your qostance.
NZOM3,
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com
M
,,t--`7'73 5'q
EASEMENT
FOR VALUE RECEIVED, MICHAEL D. NORMAN and SHARON K. NORMAN, do
hereby grant an easement and right-of-way over the following described property,
to -mit:
An easement of the south 55 feet for use as a gravel drive-
way and an area used for a septic system on the following
described parcel of property, said areas being more particu-
larly set forth in Exhibit "A" (As -Built Survey), attached
hereto and incorporated by reference:
Lot One (1), Block Three (3), VALLEY VIEW TERRACE SUBDIVISION
according to the official plat thereof, filed under Plat
Number P-574, Records of the Anchorage Recording District,
Third Judicial District, State of Alaska.
The easement and right-of-way over and across said area of land is for opera1.
-
tion and &dintenance of a driveway over, along and across said property
described above for ingress and egress to the following described parcel of
property, and for operation, repair and maintenance of a septic system on the
above described property. Said ingress and egress will not be limited to any
cause, and will be for the exclusive use and benefit of the following described
parcel of property, to -wit:
i
Lot Two (2), Block Three (3), VALLEY VIEW TERRACE SUBDIVISION,
according to the official plat thereof, filed under Plat
Number P-574, Records of the Anchorage Recording District,
Third Judicial District, State of Alaska. j
The septic system located upon Lot 1 above described shall be for t
sole and exclusive use of Lot 2 above described and said septic system shall
be maintained by and for the use of Lot 2 until such time as an approved
replacement septic system and/or access to community sewer shall be placed on
Lot 2. The driveway located upon Lot 1 above described shall be for the use
of Lot 2 until such time as a replacement driveway shall be placed on Lot 2.
The maintenance of said driveway and septic system shall be done in
a reasonable manner and no unnecessary waste shall occur. All costs of re-
pair and maintenance to be borne by the owner(s) of Lot 2.
This esement and right -of -may shall run with said properties and be
binding upon the undersigned, and their heirs and assigns and shall inure to
any person, firm or corporation who shell hereafter acquire title to said
properties.
DATED this � day of
Y�)fc�-2 , a983.
KICHAEL D.
NDRMA
SHARON K.
NORMAN
STATE OF ALASKA ) C.
ss.
THIRD JUDICIAL DISTRICT
The foregoing instrument was acknowledged before me this;o 0- day
of ���1 ra,,,L�r 1983, by MIICC�H,AEL D. NORMAN and SHARON K. NO .
'Fbtary Public in and forACask
My commission expires: &--5�
STATE OF ALASKA
E
TARY PUBLIC
JEA14NE NIEE
MAR 22 '96 11:43AM TRANS ALASKA TITLE ANCH P.2i3
PAM 0102
vASTrtr'N•1'
roR Coon Attn vAtttpat.r• CO•tcTDERATTON, the re=elpt and 6uffi-
cien-y whereof are hereby a-knovledged and con4-estrd W.?.W.
CONSTRt1CT70N, T*fC., Grantor hereby quit:>}aiRt and Conveys to
SHAV,0H X, "rNnnTCKS and NTC11AE1, A. RnT'nl C'lf, their respective
eu^aessors, helr'a or assigns, r'fAntces, the following das=rihed
property:
An easement for the nonex^lissive ute of Lot T, Block 3
valley view Terrace cubdivlaion a-cotding to the official plat
thereof r r5-14, Anchorage RCcorfllnq District, third audicinl
time as , Statro �fdAreska for ia:ementse for septicasystem and/ormaviceas tontil Va
time as an app P
community or muni:ipal' sever Shall be plAced upon or made
available to Raid i.ot 2. Any and all maintenance, repair and/or
upkeep of said septic ,System shall be in a reasonable manner and
no unne:essary waste, dpmaae or injury to the easement shall
occur. The cost of any push nnlntenan:e, repair and/or upkeep
shall he borne by and at the sale cost and expense of the
ownerlsi of said Lot 7.
ppcCRTPTTnN
Yrom a point beginning 45 feet Northeasterly
from the Eouthwestcrly most point on the houndary
between Lot' 1 and 2, Alo:k 3. Valley View Terrace
SubdiviSlOh, plat ps 74, Anchoraee pezording District,
ThirA ludi:Jal District, State of Alaska proceed 75'
Northeasterly alonq said boundary theme proceed along
a line perpendiculAr to said boundary in a florthwestcrly
dirw:tlon for a distance 0' A0 feet, thence proceed South-
westerly alone a line parallel to said boundary for a dis-
tan-e of ?S feet thence in a Sout►icnaterly direction along
a line perpendicular to tale! boundary bacV. to the point or
beginninq.
$TRS i�N7 Tr.NF^4rr1T
Lot 1, Rlo_k 3, irailey View Terrace SvhOivision
according to the official slat thereof r5 74, Anchorage
Re:ordinq District, Third judicial District, State of
Alaska.
This is an casement appurtenant running with the land in
favor o` the dominant estate.
nATUD- November ,�_ . )QP.<
W.J.W. C014s"rpUCTION, INC.
Niiliam I. Walker
President
RETURN TOt
RAth.1$R F-4AN'C1At SE"M
d7' 7 1 J""'E S PARI: BLDG G
A"CH.AX 9)503
ATIN,
MAR 22.'96 11.43AM TRANS ALASKA TITLE ANCH
7
0103
1184
STATF. OF ALASKA
Z as
THIRD .-111nTCIhr- bISTRIC? 1
'•" da of November. n
TRTR TS TO CFRTIfY that on the Y
1904, before mt, the undernigntA, a Notary— Pru li= in aetSonailY
State of Alaska, duly commissioned and sworn as su=h• p
appeared WT1.LT>tN J. WAt.KRR to me known to be the president o`_
N.•T.a CONSTRUCTION, TNC., a corporation, and known to r.•e to be
the person who executed•the within instrument on behalf of the
to me that the sane
COordtlon herein named, and aokhowledgeA
tp
was signed as A fret at and deed of the saidcorporation for the
uses and purpose$ therein stated and pursuant to its Bylaws or a
resolution of its Board of bireators.
WITNESS my hand and notarial seal the day and year la$t
above written. i rte:; ., f%,,.-� �•
"tar17u c n an tor.. a
••• +:1 State of Alaska -
Coc:rmiealone txpires:' 1 S �•
RmTM TCt
:757 , ,_1 :'S P.... , s.)G C
1�T714-,J-
-pa732a
?taw 5 1218 Y�'6`1
REQUE51ED 81
1ODRESS
P. 3/3
J
G 7
40' DRAINAGE
Lot 2EASEMENT Lot 3
—Z
N 907.6-00-E 2.53,44'
1.7'x21.1' CANT 1 STORY RESIDENCE
4-2s, wl FULL BASEMENT
WE 16.2x27.3' DECK Lot 1
2.5'x5.5' CANT 28,749 q.f.
SEPTIC PIPES
Lot 3
GRAVELSEPTIC /FOR
r
DRIVEWAY W CANT "'T 2
4W'. CANT
.,6,5"' BALCONY
io, CLEAF
EASEMENT
UP
C�-
, . 0/'/
"15' ELECTRIC
EASEMENT
Lot 2
55' SEPTIC EASEMENT
(BK. 1014, PG, 685)
PLOT PLAN AS BUILT JL 'SCALE _4L,-59_ GRID sw 0,16D Project No; 18-2aw1
1.1500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Assoclafes, inc. .(967) 522-6476 Phone
(907) 612-4625' fax X§_�P At''
Professional Land Surveyom ken0longsurvey.com C)F "
,Nll 1
lonothon0lonasurvev.com
I hereby certify,that I have surveyed the following described propertyi
LOT 1, 000 3,'VALLEY' VltW TERRACE SUBDIVISION (PLAT No. P-674)
Anchorage- Recording Distrl6t, Alaska, and that the Improvements situated thereon are
within the property '-J.ln*9:'deist do not tnerbach onto the property adjacent thereto, that
no Improvements on. the - property lying adjo'cint thiirifd enorbadh on the surveyed
promises and that. there, are no roadways, transmission lines or other visible
easements on sold property except as indicated hereon.
Dated this the — 'Z10 bay. of 70t"b . , at Anchorage, Alaska
It Is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plot.
491U
KEN LAN
0
NAME
:,~_.~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVlRONM£NTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE
RESS
[] UPGRADE
LEGAL DESCRIPTION
D,ST^NCE TO: We,, i Abso,pt,o. ar,a (5_ Dwelling
Liq.~c/~t~n--gallons IF HOMEMADE Inside~ength . W dth ~
DISTANCE TO: IWel,
Manufacturer / ~
NO. OF BEDROOMS
No. of compartments.--..,
Material
Well ~ ] ~/~ Foundation - ~./f~_ Nearest lot Iir~__~O(~-
DISTANCE TO: ~J
No. of,ine,/ I Length ?.~.~? Tot al ,e.¢~l~,f )i nes Trench wi~l~?]~, i rich es
Top of tile to finish grade ! Material beneath tile
" '7'Z~ inches
Length Depth
Type of crib Crib diameter
Building foundation
Well
DISTANCE TO:
Building
Liquid depth
DISTANCE TO:
PERMIT NO.
Liquid capacity in gallons
effective s r tio a
PERMIT NO.
Total effective absorption area
Nearest lot line
Distance to lot line
Sewer line Septic tank
OTHER
INSTALLER
REMARKS
APPROVED DATE
72-013 (Rev. 3/78)
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological ~ GeopnyslcolSurveys
~.~ .:. w ~.~ .-,3-'/41''-i'1''':'/'='" ' T°'l~lhlPNn '' '
v~ ....... , . '--of',,--,~--' .' ~D~.' wD
{ ' ~ ~"~ '"-- Subm ' ~" ~'nfr f c~' "0 Other
' : , ~, 0 . 0 0 .
.':'-:::.~ : l~ ' .
16. WATER WELL CONTRACT~R'~ CER~IFICATIONt 15. Water TemPerature o : ~ F: L:: ~ C
ormOZ'WWR (11/81) Copy Olslrlbutlon: WHITE'~toIe O6OS, PINK-Or~]IIr,,'C~H~R~"'GusIomlr
c
~_.~UNICIPALITY Of ANCHORAGE
· . Department! f Health and Environmenta~rotection
825 ~J Street, Anchorage, AK. ~9501
264-4720
~'~ ~ ~ ~ HANDWRITTEN PERMIT ~ ~ ~
Permit
WELL AND/OR ON-SITE SEWER PERMIT ~
Applicant, ~,/O~ ~~/'~ Mailing Address: ~ ~
Location: ~ .~/~¢ ~ Phone Nu~er:
Legal Description. : ~ / ~ ~8/~ ~~ Lot Size:
Type of Soil ~sorption System Is: /
Trench: ~ Drainfield: Seepage Bed: Holding Tank:
Max~ N~ber of Bedrooms: ~ soil Rating(sq.ft/br) /~~, .....
The Required Size of the Soil ~sorption System Is: '
GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench 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 min~ depth of gravel between the outfall pipe and
om
~ ~ REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any welts adjacent to this property and the nu~er
of residences that the well will serve.
~ ~ ~ TWO(2) INSPECTIONS ARE REQUIRED ~ ~ ~
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Einlm~ distance from a private well to a private sewer line
is 25 feet and to a co--unity 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 cohstruction diagrams are
available to insure proper installation.
~ ~ ~ PERMIT EXPIRES DECEMBER 31, i 9 8 3 ' '
I certify that:
(1) I ~ f~iliar with the requirements for on-site sewers and wells as
set forth by the Municipality of ~chorage.
(2) I w11~sta11 the s~tem in accordance with codes.
th~re~ ~emod~ed to include more that 3 b~ooms.
--~p~icant ~ /~ ~
~ / Date: /
SWP/024 (1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, A{aska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
.ERrORMED FOR: 'g''-'-
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
DATE PERFORMED:
LOPE
11
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
SITE PLAN
WASGROUNDWATER ~
ENCOUNTERED? ~ ~
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE AI~//(~ (minutes/inch)
TEST RUN BETWEEN FT AND -- FT
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[~' SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION:
1
2
4
5
9
SLOPE
SITE PLAN
10
11
12
13 I'~C~ow ~ ~L/5
14
15
16
17
18
19
20-
COMMENTS
~ ' PB,
WAS GROUND WATER ~/~
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Cross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
?
TEST RUN BETWEEN . FT AND FT
Munici•pality of Anchorage �";_G 1, All,
g
On -Site Water & Wastewater Program
(907) 343-7904 V
SEP 0 4 2019
CERTIFICATE OF ON-SITE SYSTEMS APPROVA
C-1
Parcel I.D. 050-352-10 Expiration Date: ZZ
1. GENERAL INFORMATION
Complete legal description VALLEY VIEW TERRACE S/D; BLOCK 3, LOT 1
Location (site address) 23431 UPPER TERRACE STREET, EAGLE RIVER, AK 99577
Current Property owner(s) BRENT &SARAH DAVENPORT (NEW OWNERS) Day phone
Mailing address
Real Estate Agent
23431 UPPER TERRACE STREET
2. TYPE OF DWELLING:
0 Single Family (w/wo ADLI)
F-1 Duplex
❑ Multiple Dwellings (Single Family and/or Duplex
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
r_1
Community ClassWellD
Public Water System
El
A NY,
Pape 0�_
,,re,
616-318-0942
OF WASTEWATER DISPOSAL:
Individual Holding tam
Community On-site El
Public Sewer El
WalverNariance request for. TANK/ DRAINFIELD TO DECK SUPPORTS& DRAINFIELD TO FOUNDATION Distance: 3'/ 6.5'& 5'+
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
F�� _ c��i�'t1��13I�����L�Ii[3'l�iCr].1►1_�I�.3
As certified by my seal affixed hereto and as of the validation date shown below, 1 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
Address
GARNESS ENGINEERING GROUP, Ltd.
3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the
guidelines and regulations established by the Municipalityof Anchorage and industry practices. The reported results describe the
Phone 337-6179
qj
10
Date f3 lW'
condition of the systems on the date/s of the evaluation. Separation distances were measured to readilyidentifiable features.
4
Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic
i e
systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during
the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These
AT
conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
a ��•
systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system.
/
GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the
..
current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the
0.
information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not
♦ G�
#�_
authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report.
ti
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved.
Conditional approval for
By:
LICENSE
#AECC884
bedrooms.
bedrooms.
441
bedrooms, with the following stipulations:
Original Certificate Date:
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS: -
COSA Checklist _, Nitrate Advisory
Septic System' Advisory Arsenic Advisory ,
Well Flow Advisory,_. Other
(Rev. 10112/12)
Legal Description:
COSA Checklist
VALLEY VIEW TERRACE S/D; BLOCK 3, LOT 1
If more than 1 septic system on lot: COSA Checklist # 1 of 1
Parcel ID: 050-352-10
Structure served by this system 1
A. WELL DATA
Adequacy test date 8/24/19
0 Well log is filed with Onsite (or attached)
Well production at time of test *2.3'+ pm
Date drilled 8118183
Water storage tank volume NONE gallons
Total depth 150 ft
Well disinfected for coliform test? ❑ Yes O Nc
Cased to 52.5 ft
R Coliform bacteria is Negative
0 Sanitary seal is functioning correctly
Nitrate 1.28 mg/L ❑ Nitrate less than MRL (ND)
0 Wires are properly protected
Arsenic ug/L ■❑ Arsenic less than MRL (ND)
Casing height (above ground) 12+ in.
Collected by GEG, LTD.
Date of flow test for COSA 8/24/19
Date of Sample 8/12119
Static water level at beginning of test 25.1 ft.
Absorption rate 450+ gpd
Comments *FLOW MAY HAVE BEEN RESTRICTED BY SEDIMENT FILTER
Any rejuvenation treatment (past 12 months) NONE
B. TANK DATA C. LIFT STATION
Age of tank(s) 10'12 years ❑ Required maintenance completed
Tank type/material 'STEEL Age of lift station years
Measured operating fluid level in septic tank "50.5° Lift station material
❑ Standpipes/foundation cleanout per record drawing Comments: 'NEW TANK RELIVED TO BE INSTALLED 10-12 YEARS AGO.
Date of pumping 8/14/2019 SEE ATTACHED DOCUMENTATION LETTER AND RECORD DRAWINGS.
"PER ARM SEPTIC SERVICES ON 8/28/2019 AFTER LINE BETWEEN TANK AND DRAINFIELD WAS REPAIRED.
D. ABSORPTION FIELD DATA DEEP TRENCH
Which system tested (date installed) 6/1/83
Adequacy test date 8/24/19
FNI ALL standpipes present per record drawing
Results ❑✓ Pass For 3 bedrooms
Total measured depth from grade 12.2 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 7.4 ft (min)
Water added 941 gal
❑ N/A — pressurized field
0
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
0
depth into effective '58"
Elapsed time min
IMECode-requiredsoil cover over field
Final fluid depth 0 in
171 System presoaked
Absorption rate 450+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NONE
date of test)
Gallons introduced N/A gallons
If yes, enter date
Comments/Deficiencies: 'NEW 2" STEEL MONITORING TUBE SLEEVED IN 4" PVC PIPE (D3034) BY ARM SEPTIC SERVICES ON 8/13119.
SEE ATTACHED REPORT.
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
if No
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft✓V
Yes
if No ft
Neighboring Tank > 100' M Yes
if No
ft
Private Sewer/Septic Line > 25' QQ Yes
if No ft
Absorption Field on Lot > 100' F� Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' Yes
if No It
R-1 Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑r Yes
if No
It
❑r Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
Q Yes
if No
ft
Wells on Adjacent Lots:
Private Wells > 100' Yes if No
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100'
Q Yes if No ft
Water Main > 10'
Yes
if No
ft
Community Wells > 200'
0 Yes if No ft
Water Service Line > 10'
0 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' El Yes if No ** ft If absorption field is under driveway comment below
Property Line > 10'
El
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Q
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'
Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
"PER INSPECTION REPORT AND PREVIOUS HAA'S. WEST END OF DRAINFIELD DOES NOT HAVE A CLEANOUT
NOT ABLE TO VERIFY SEPARATION DISTANCE BETWEEN WELL AND DRAINFIELD. * SEE ATTACHED REPORT AND
WAIVER REQUEST FOR TANK AND DRAINFIELD TO FOUNDATION (DECK SUPPORT/RETAINING WALL AND TO FOUNDATION).
oo600p
G. ENGINEER'S CERTIFICATION
I certify that l have determined through held inspections and review
of Municipal records that the above systems are in conformance with p H O
MOA COSA guidelines in effect on this date. g
0 ........ ... . . ....... .......D
..... .r ...... ......
.Je G
�
Q7 q,- : 00
4� s�- . fAoo
COSA Checklist yellow sheet ( oho
ofe slo a
#AECC884
ft
ft
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. # ./~) ~r~'(~j _ ~ ~'~. --/~_~ HAA# {"[~~[Of'O ~'~) ~'-
1. GENERAL INFORMATION
Lot 1, Block 3, Valley' View Terrace
Complete'legal
description
Location (site address or directions) 23431 Upper Terrace
Property owner Paul Davis Day phone 696-7664
Ma ngaddress 23431 Upper Terrace, Eagle River, AK 99577
Lendin'g agency
U~ilin. g address
Day phone
Agent
Address '
;Day phone
Unless otherwise reque~t~, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
XXX
NOTE:
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
XXX
TY~E OF WA~TEWATER 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.
72q)25(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
Address
Engineer's signature
$ & S ENGINEERING
17034 Eagle River Loop Road No. 204
EagJe River~ flla~.~.~ e. gE77~
Phone
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with thee following stipulations:
Additional Comments
Date / 2. - 2 2 - ~'~
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 pumhasers of homes
and their lending institutions-in order to satisfy certain federal and state requirements. Em ployees of DH HS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
RECEIVED
Municipality of Anchorage NOV 3 0
825 L Street, Room 502 · Anchorage, Alaska 99501 · (90~-~'4
Health Authority Approval Checklist
Legal Description: ~.-d'T' // ~g~g:'~ .~; ]/~Z..~/~/~J' Parcel I.D.:
A. WELL DATA
Well type P,~--!
Log present (Y/N) L~/'~..,
Total depth
Sanitary seal ~/N)
Cased to
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
FROM WELL LOG
Date of test
Static water level
Well production
Casing height (above ground)
Wires properly protected ~)N)
AT INSPECTION
g.p.m.
WATER SAMPLE RESULTS:
Coliform G
Date of sample: ]//~- ~ / ~/
B. SEPTIC/HOLDING TANK DATA
Nitrate
?. G '7 Other bacteria
Collected by: ~ ~ .~ ~-~'/c~-/Ar'E~;-'~?-J,'V/-~-'
Tanksize /~ ~
Number of Compartments __
Date installed
Foundation cleanout~')N) c~,~, Depression (Y~ /t,/~ High water alarm (Y/N)
Date of Pumping /[//&~/~'~S. Pumper
C, ABSORPTION FIELD DATA
Date installed ~/I~~'
Length ;~z/ Width
Effective absorption area .~
Date of adequacy test
/
Fluid depth in absorption field before test (in.); "~ Immediately after~'/'~gal, water added (in.):
Fluid depth ~ (ins) Minutes later: .~C.3 Absorption rate =
Peroxide treatment (past 12 months) (Y/N) /~'~]zl~'~/~'//~/A/ If yes, give date
~- Cleanouts. ~"~N)
4/*
Soil rating (g.p.d./fF or fF/bdrm) /~
Gravel thickness below pipe
Monitoring Tube present(~/N) /7~-~ Depression over field (Y~)
Results (Pass/Fail) /,~55 For /,~"~-~'~ bedrooms
System type ~--~:,-V~
Total depth /~-
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at* /
Cycles tested /
Size in gallons
"Pump on" level at*
*Datum
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ,/O(~ -'/
Absorption field on lot ('~ / '¢
On adjacent lots
On adjacent lots
Public sewer main
Sewer/septic service line .Z'~- /'¢- Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ;~,- ¢',¢- Property line ,-~- "zz- Absorption field
:
Water main/service line ~?:.~ ¢ Surface water/drainage /¢(2 /.¢- Wells on adjacent lots
/
Public sewer manhole/cleanout
/
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
Building foundation
F. ENGINEER'S CERTIFICATION
I cert'fy that I have determined thru field inspections and review of Municipal recor~'tl~'a~'ih~ ~b&~,s"~,stems are
in conformance with MOA HAA guidelines in effect on this date.
Water main/service line ~_,~
Driveway, parking/vehicle storage area ~::)~ /
Wells on adjacent lots [00 /'/-
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 & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
050-352-10 HAA# HA920061
1. GENERAL INFORMATION
Complete legal description Lot 1 Block 3 Valley View Terrace Subdivision
Location (site address or directions) Terrace Drive
Property owner
Mailing address
Bill Welch Day phone _694-8115/344-1717
PO Box 770329, .Eagle River, Alaska 99577
Lending agency
Mailing address_
Agent _
City Mortgage % Julie North Day phone
121 West Fireweed Lane, Anchoraqe, Alaska 99503
Day phone
Address -- --
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Three (3)
TYPE OF WATER SUPPLY:
NOTE:
XXXX
individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
NOTE:
72~)25 (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 furtherverify 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
Address
Engineer's signature
DHHS SIGNATURE
~'~- Approved for
Disapproved.
$ & $ ENGINEERING
Eagle River, Alaska 99577
Phone
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~025(Rev. I/91) Back MOA~I
{~ Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~-~'~"\ ~'~,~_'Z~ ~[~'L.-t.~'~%/ ~,J~-~Parcel I.D.
A. WELL DATA
Welltype ~dL~//Nt'~:~-~ IfA, B, orC, attach ADEC letter. ADEC water system number
presen~:~/N)
Log
Total depth ~C) ~ Cased to ~/--- .~' ~ Casing height
Sanitary seal~YN) ~' ~ Wires properly protected
FROM WELL LOG AT INSPECTION
Date of test ~_~. ~:)"L~
Static water level 'Z.~~ '2.~
Well flow ~¢ .~:) g.p.m. ~'"~ ~
Pump level ~-
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~C)~' t4-- ; On adjacent lots
Absorption field on lot ~c~o ; On adjacent lots
Public sewer main '~'lp¢- Public sewer manhole/cleanout
Sewer service line '~-'~ ~ ~ Petroleum tank ~..~..
WATER SAMPLE RESULTS:
Coliform ~:)/"'~ ~'~/~°° '~ o--~ ~ Nitrate
Date of sample:
B, SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts t~N) y
High water alarm (Y4~
Date of pumping
Collected by:
Other bacteria
S & S ENGINEERING
!?03~. £=g!_, ~!~,~ [~? I~oad No. 204
Eagle River, Alaska 99577
Tank size [.ooo &~ Compartments
Foundation cleanout (~/N) ~ '~ Depression (Y/~)
/"[ Alarm tested (Y/N)
~'~/ ~ Pumper ~"'. ¢-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ ~ ~'~ On adjacent lots ~ C~C> t.~Foundation ~ 'Y
To propertyline ~ t'~ Absorption field \~ Water main/service line )~t'~
Surface water/drainage ~, C>c:> ~ '~
72-026 (Rev. 7/91) Front
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at
High water alarm level j~s tested
Meets MOA electric~
ANCE FROM LIFT STATION TO:
On adjacent lots _ Surface water
D. ABSORPTION FIELD DATA
Date installed '~ - / - 'i5~-~ Soil rating \?~' ~/¢'¢-.- System type "~'¢Z.¢.~(~
Length ,.-z~.?~) .Width .-z~=,~ [ Gravel thickness U, ~ Total depth
Total absorption area "¥'-1~ ~
Cleanouts presen~N)
Depression over field (Y/~__~ /~ Date of adequacy test ~
Results ~)fail) ~.~ for '1"'¢J ¢-¢_~-.. (_"~, bedrooms
Peroxide treatment (past 12 months) (Y/~) I,J.~lJF,_. I/I,..~0~,,.{ If yes, give date ¢1/,- ___
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot / of':)
To building foundation
On adjacent lots
Surface water
Curtain drain ~ IA-
On adjacent lots I'o,~ \ '~ _ Property line
~ I '~ To existing or abandoned system on lot
Cutbank ~/A-- Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, orconformed to all MOA and HAA guidelines in effe¢
te of this inspection,
S & S ENGINEERING
Signature 17034 Eaole River Loop Road N~
Eagle River, Alaska ~95~.
Engineer's Name
Date '""
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA
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
Application Date /'/--//~ "~--'
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township,.~
Location (address or directions)
Applicant Name ~;[( ~L*Q~ Telephone: Home
Applicant Address ~ '~¢~ ~
(b) Business ~[-~
(c) Applicant is (check one): Lending Institution []; Owner/builde¢~ Buyer []; Other [] (explain);
(d) Lending Institution
Address ~ bt ¢,t_z.~ ~ ~,- G ~
(e) Real Estate Company and Agent
Address
Telephone
(f) 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.
72-025 (I $~84)
Page t of 2
'5.
ENGINEERING FIRM PROVIDIN~'=,NSPECTIONS, TESTS, FILE SEARCH, DA'I~"~ND 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, functionar 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 ~ ~, . 8~ ~ ~ ~ Telephone
Address ~'~,
// -/
DHEPAPPROV~ ~ .(, .~'~
Approved [~d · Disapproveld~ Conditiona~
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
ApprovaJ 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 h.omes 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 01/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
WELL DATA
WeiJ Classification
Well Log Present ~,~N,) Date Completed ~1.,~
Total Depth ./~-'O · Cased to
Static water Level ~___..~ ,r
Casing Height Above Ground
Electrical Wiring in Conduit ~1~
Depth of Grouting "-
Pump Set At ,//"//~'
Sanitary Seal oh Casing~
Depression Around Wellhead
Separation Distances from Well: '
To Septic/Holding Tank on Lot ,,/OB "~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ..,/~4) '~ ~' ; On Adjoining Lots
To Nearest Public Sewer Line ,~'/'/~-F To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
To Nearest Sewer Service Line on Lot
B. SEPTIC/HOLDING TANK DATA
Date Installed /~,~ Jt ~
Stand pipes~N)'- Air-tight Capsd~N')
Depression over Tank.(~/~)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /~t~ ! ,4-
To Property Line ' /Z)
To Water Main/Service Line
Course
Comments
Size ~/~(--') O No. of Compartments
Foundation Cleanou~/l~)
Date Last Pumped
:for
Temporary Holding Tank Permit (Y/N)
To Building Foundation /~ I ¢-
. To Disposal Field /~-'~" ~ ~
~ ~ _ To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
~ ABS'ORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field ~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
Type of System Design
Length of Field t~ ~
Depth of Field 1/¢'~
Gravel Bed Thickness ~
Standpipes Present~AN~
Date of Last Adequacy Test
To Property Line
To Building Foundation
Lot ,,,4¢/,~.. . ; On Adjoining Lots
To Water Main/Service Line ,,,,'L/'/~ct.- ":FO t~)To Cutbank (if present)_
To Stream/Pond/Lake/or Major Drainage Course
TO Driveway, Parking Area, or Vehicle Storage Area
Comments
To Existing or Abandoned System on
,/~ /'~'
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA.~nd HA¢, guidelines in effect on the date of this inspection.
Signed ~ Date
Company, ~~ MOA No
Date of Payment ¢ -I b- ~o ~
t
Page 2 of 2
72-026 (11/84)