HomeMy WebLinkAboutSUN VALLEY HEIGHTS BLK 1 LT 5Onsite File
Sun Valley
Heights
Block 1
Lot 5
#017-062-25
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211207 PID Number: 017-062-25
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
Michael Boozenny
ABSORPTION FIELD
® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
13341 Alpine Drive, Anchorage
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
0.6 GPD/SF
11.0/11.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
6.65/6.74 Ft.
Gravel depth beneath pipe
4.35/4.26 Ft.
Subdivision Block Lot
Sunvalley Heights 1 5
Fill added above original grade
0.80-2.73/0.33-2.17 Ft,
Gravel length
69/59 Ft,
Township Range Section
Gravel width
3 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
i Absorption I
Holding Sewer
Total absorption area
Number of trenches
Dist, between trenches
From
Tank
! Field
Lift Station Tank Line
1000 Ft z
2
101+ Ft.
Well
1001+
1001+
i
TANK FZ] Septic ❑ S.T.E.P. [IHolding [IOther
Manufacturer
Greer
Capacity
1250 Gal.
Surface Water
f100'+
100'+
Material
Plastic
Number of compartments
2
l
Lot Line 57+
101+
1 NA
Foundation 101+ 10'+
ATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electr Iled by
PIPE MATERIAL House to tank Tank to
D3034 drainfield D3034
Installer
JR's
Drainfield D3034 CO/MT D3034
Inspector Arcterra Consulting
BENCH MARK (Assumed elevation) 100 ft
Inspection15i 7/13/21 2�a 7/14/21
a
Location and description
3,0 7/15/21 4", 7/20/21
Garage door foundation
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
���'�,.�'"�"''°�•.,++��
49 THS
KEN. M. PFt15J�r
AW
��`��, CE 1 eAir'
Septic System
Approved Date 9 6 ,202 f
zir�
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
AS -BUILT SYSTEM DETAILS/SITE PLAN
SUN VALLEY HEIGHTS BLOCK 1 LOT 5
`• �:• .�` GRAVEL r
D/W
M OLD EXISTING
A NEW 1250 EXITING TRENCH
\ GAL TANKIpLrrrm
PIT
\ i
x
coop \ 10
-x-x x_x
A-C=26.9`A-0=68.4'
B -C=47.3'
B-0=94.4'
A -D=28.1'
A
IA
-P=67.9'
B -D=48
7'
B
-P=93.8'
A -E=30.0'
-Q=112.3'
2 B -E=50.8'
B
-Q=135.5'
N A -F=34.3'
A
-R=111.2'
B -F=55.6'
B
-R=134.5'
J A -G=35.5'
B-15=56.9'101.15
A -H=36.8'
y
o
, B -H=58.2'
A -I=50.9'
B -I=76.3'
R
A -J=80.9'
``
a B -J=106
7'
A
A -K=80.7' y 1250 GAL
B -K=106.5' TANK
SEP IC
A -L=82.0' 93.9
J B -L=107.8' [
A -M=121.1'
B -M=145.0'
ff A -N=121.9' SCALEi NTS
, B -N=145.9'
(n
46 i OF .At,4' ■
�f _ f
�* 4TH *�
M S
C $ w
1 41 ■
Ln n Esrnt
Cu Anchor
- 5• ST�SMT�
W
o ~
ly
TRENCH 1
FINAL_GRADF
SEWER ROCK
69'
TRENCH 2
1DL3 FINAL _GRA
SEWER ROCK
PREPARED FOR:
MICHAEL B❑❑ZENNY
13341 ALPINE DR,
ANCHORAGE, AK 99516
FIELD BOOKS
BOUNDARY- N ZA
STMNG: N/A
ASBUILT: JLS
DWG. FILE:
ACAD FILE FILE
59'
COMPUTED:
DRAW KSD
CHECKED' KMD
DATE 8/3/ L
GRID: SW292'
'IDB N°' 21035
Permit ❑SP21207
PID# 017-062-25
O
0
Q
Kv
SCALE: 1' = 40'
6.74
I
4.26
82.34 o+
un41%-mer
SCALEi NTS
NS
82.09, 25„
(N81'54'Sdo
¢' 1 C, *A ASF. LOT 5 l
v - ; F• ty,0�o BLK 1 I
OFG� SAH ! lr 0
X � t
d �
x m .
O`� Ln x • SEPTIC
VEN 7 ll
10E(t,p} l
—X—x- x—x� 1
30' f-
1 T
12.5N85'15'1 a"E 254.86' (255.41' R)
BASIS OF BEARING
0
i
�DEARMOUNRO���.�l��
I ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
SUN VALLEY HEIGHTS
LOT 5 BLOCK I PLAT 70-233
SURVEY CERTIFICATE: 1. John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Linder no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: it is the owners responsibility to determine
the existence of any easements, covenants. or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: �Jgyj
9C,&, a-uar,
30, 2021 1 •=40' 3:UL11erftk.n.t
21-108 r. 10com BYIQFM "am. scat nac
JLS I SW2930 210245
FNa BRASS CAP IN PIPE
FND 518" REBA€t
OF
49TH
.. ..
HN L. SCHULLER•- h
IS -10408 41
10
11 eo, ' �, .'�j . G+ Sym•
,1�r fesSion a\ L4—
%> LAND
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227--1455 office
(907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211207
Work Type: Septic Upgrade
Tax Code Number: 01706225000
Site Legal Address: SUN VALLEY HEIGHTS BLK 1 LT 5 G:2938
Site Mailing Address: 13341 ALPINE DR, Anchorage
Owner: BOOZENNY MICHAEL
Design Engineer: ARC TERRA CONSULTING INC
This permit is for the construction of:
Q Disposal Field Cf Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
1„cnr
j � !
F,
llepartmetit
6/23/2021
6/23/2022
43070
❑ Private Well ❑ Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
El
q'Yehe, aka,, cy, reel sed clLLe 4-o de"er 4-cu^kv, o"A 4e+ +L-IXK
ca.►��-i c. � �, a�4e. d . .. �?�y�,�- ?' I y � Zo Z t
Received By: Date:
Issued By: Date: 3p
MUNICIPALITY OF ANCHORAGE
Development Services Department ^`€ Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I. D. 017-062-25
Property owner(s) Michael Boozenny
Mailing address 13341 Alpine Dr. Anchorage, AK 99516
Day phone
Site address 13341 Alpine Dr. Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Sun Vallee Heights Block 1 Lot 5
Legal description (Township, Range & Section)
Lot Size 43,070 Sq.
Ft.
Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
®
Initial ❑
Single Family (SF)
(w/wo ADU)
Septic Tank
Upgrade
Duplex (D)
ElHolding
Tank
❑
Renewal ❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Dea Duffus
(Signature of property owner or authorized agent)
Permit/Rush Fees: 595
Date of Payment: q 1a D a
Receipt Number: 0 (0 7 0 5 6
Permit No. 06102-1120-7
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211207, Rebecca Carroll, 06/23/21
WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN
SUN VALLEY HEIGHTS BLOCK 1 LOT 5 PID# 017-062-25
e J '•d
a
d '
qate.
1-
HOUSE
a
CO O —..____.•._
\/ INSTALL NEW
1250 GAL TANK
TANK u EXISTING
o PIT
10
cm4Anchor—E_-
V1 ,'
LJ
O
EXIST! G o
Scale: 1'= 30'
FLAG PROPERTY LINES DESIGN DETAILS /
WELL RADII & EASEMENTS 4 BDRM X 150 GPD = 600 GPD,''�`�-C'�"w
PRI❑R TO CONSTRUCTION 600 GPD/0.6 GPP PER SQ. FT.—/1000 SQ. FT
(1000 / 2' X' 16`GRA EL) - FT. TRENCH � j -7
USE 2 TRENCHS-' 4K (L) X 3' (W) X (D)
Total clepth off system is 11' max from °original grade.
Total depth of gravel below clistributlon pipe is 6' .
°o+. EXISTING CRIB AND TRENCH VITH A NOTES:
SPLITTER TO BE USED AS RESERVE AREA 1. INSTALL 1250 GAL. TANK & INSULATE TANK IF <4' COVER,
NO PUBLIC WELLS WITHIN 200' OF
n PROPOSED SYSTEM. 2, INSULATE TRENCH WITH 2' HD BURIAL FOAM IF < 3' OF FILL,
NO PRIVATE WELLS WITHIN IOD' OF MIN, 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ.
m PROPOSED SYSTEM EXCEPT AS NOTED.
NO SEPTIC SYSTEMS WITHIN 200' OF 3, INSTALL 2 PRE TANK & POST TANK CO'S PER CODE,
-
PROPOSED WELL EXCEPT AS !!O'TED. 4, TANK TO HAVE MIN, 20' MANWAY RISER PER CODE.
t
5. CONTRACTOR WILL ENSURE MINIMUM 2'G SLOPE INTO SEPTIC TANK,
6. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC.,. PAGE 1 0
a
Ar
,FL Nk
<C, 1Q� PREPARED FORCE f
cC, MICHAEL BOOZENNY
13341 ALPINE DR.
e * 4 TH * ANCHORAGE, AK 99516 rm
CE -7 fit`
j
RELD BOOKS
COMPUTM
BOUNDARY: N A
DRA": KSD
SrkONG: NLA
C14ECKED: KMD
ASBUILT: —
DATE: 7/21/21
DWG. FILE:
DRnz SW2938
AcAD F" -E: FILE
" "' 21035
a �
A v
� x
Z \
m
•,1, ry�4
� PeJ :V ULT I NG 5 hyo
FR AK. 9g577 973
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211207, Rebecca Carroll, 06/23/21
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: -5 W 9 80`1 `1 9 PID Number: 0/ OO J - 5
Name:
Wastewater System: ❑ New Q Upgrade
Address: p o. �;)� X� r G
ABSORPTION FIELD
_(, 4 G - oc��ln
Phone:
3 /J
No. of Bedrooms:
Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating: //
&
Total Depth from original grade:
C71 GPD/Sq. Ft.
Lot:/-- Block: Subdivision: _
l SuN
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
J V4 Z ZZ 'y 1,1E//,f'
�5 Ft.
Ft.
Township:
_–
Range:
..—.
Section:
Fill added above original grade:
Gravel length: )
/, -5 - .5 Ft.
(6 J Ft.
WELL: ❑ New ❑ P rad
Gravel width:
Number of lines:
7
Distance between lines:
Ft.
Ft.
Classification (Private, A,B,C):
nta Depth:
Cased To:
Total absorption area
Pipe material:
CO /1A M 6f N / / v
Ft.
Ft.
j % 7 SO. Ft.
4S7 -1'A
Driller:
Date Drilled:
Static Water Level:
Installer:_
Date installed:
C
Ft.
' (J
3 c�
Yield:
Pump Set at:
I
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
[R Septic ❑Holding ❑S.T.E.P.
To
Septic
Absorption
Lin
Holding
Public/Private
Ma
ufacturer.
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
6 f /,, C'[
Well -Material:
s7c c
Number of Compartments:
1 a
Surface
LIFT STATION ;
Water
/00
/
Lot
i
/
Size in gallons:
Manufacturer:
Line
Lt/.-�
fa
/
Foundation
– l
"Pump on" level at:
_�P mp off" level at:
High water alarm at:
Curtain/
_
---
Pump Ma e -&Model
Electrical Inspections performed by:
Drain
/�D/�L
-.�/di�e/
Remarks)
BENCH MARK
Location and Description:
JS /\A = jo -" G k.lnL
Assumed Elevation:
loo Ft
ENGIH�R'S ���4
�k
/ C9/
,I t -f i�• M1 ,' �lJ
Inspections by 790341=an1e a;yer Loop Read No•®q�s: 1s )
✓ ` � -
performed
Eeg a
,)
liCiVeir, Alaska 995772nd -S )19
�d RODENT C. COWAN
d+gs.� ce•aeol
9j
fes` fly
++ta;4i'<-m��ys'
Department of Health and Human Services app %o�l
—Date.
Reviewed and approved by:%
72-013 (Rev. 9/91) MOA 25
PERMIT No. SW980449
PAGE 2 OF 3
of
DEPARTMENT OF pC JEA�Th�l �,fN®hl�i�V"Vi,D\0 SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 *Anchorage, Alaska 99519-6650 0 Te'l"ep honei 343-4744
SM
AN -SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 5, BLOCK 1, SUN VALLEY HEIGHTS P.I.D. NO. 017-062-25
11
LOT 4
/ w
WATER LINE LOCATION„ I
ESTIMATED / w
DRIVEWAY w I
w I
G� EXISTING CRIB Imo.
GP4P
FCO
TBM NEW TRENCH?
NEW 1000 GAL.
SEPTIC TANK DBL1 AT" I
DBL2
DIVERTER VALVE (DV)
--
SCALE V = 40•
AD
DE Aj M _ TSS RO ERT C. 01
al.
PERMIT NO. SW980449 PAGE 3 OF 3
Municipality of Anchora e
DEPARTMENT OF HEALTH AND �I�PM�AN SERWCES
ENVIRONMENTAL SERVICES DWISI®N
P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Tele hone, 343-4744
ON-SITE WASTEWATER MSPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 5, BLOCK 1, SUN VALLEY HEIGHTS P.I.D. No. 017-062-25
A B
FCO
IN GARAGE
STI
ST2
ST 1
1 8.0' 29.0'
102.3'
FINAL GRADE
ST2
24.0' 34.5'
DBL1
26.0' 36.0'
DBL2
26.5' 36.5'
MT
43.0 41 .0
NEW
C01
67.0 59.0
95.0' 1250
S.T.
GAL
94 8'
MT1
66.5 59.0
CO2
125.5 1 1 2.0
MT2
1 26.0 1 1-2
MT1 C01
MTI =
MT CO2
CO1 = 100.1'
MT2 =
98.6'
98.6'
CO2 = 98.6'
COI =
92.2'
SR
CO2 =
92.1'
N. T. S.
MTI =
86.1'
MT2 =
86.1'
thi
THA BOH 80.1'
..��yl:rl.z.d�N'
NO WATER FOUND
T� ROBERT C. COWAN
G,���•., CE -8801
.0
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Nov 18, 1998
Expiration Date: Nov 18, 1999
Permit Number: SW980449 Parcel ID: 017-062-25
Legal Description: SUN VALLEY HEIGHTS ELK 1 LT 5
Design Engineer: 0003 S & S Engineering Site Address: 013341 NENANA PL
Owner Name: NANCY & CLYDE FARRINGTON Lot Size: 43070 SQ. FT.
Owner Address: PO BOX 86 Total Bedrooms: 3 Permit Bedrooms: 3
SOLDOTNA , AK 99669-0086
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: It _ I g
Date: r//—/P — /8
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX (907) 694-1211
November 11, 1998
HEALTHAurFioRlTv
MUNICIPALITY OF ANCHORAGE
APPROVALS
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
SEWER & WATER
MAIN EXTENSIONS
REFERENCE: Lot 5, Block 1, Sun Valley Heights Subdivision
SEWER & WATER
INSPECTION
Request you issue a permit to install a septic system to serve the three bedroom
dwelling on the referenced property.
A test hole was excavated and percolation test performed. The approximate location of
ENGINEERING STUDIES
AND REPORTS
the test hole is located on the attached site plan.
At the time of excavation 11/7/98 water was not encountered in the test hole. After
seven days of ground water monitoring the monitoring tube was dry.
WELL INSPECTION
& FLOW TEST
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the
SITE PLANS
adjacent properties.
If you require additional information, please contact us.
ROAD DESIGN
Sincerely,
SOILTEST
/)
Robert C. Cowan, P.E.
RCC/rdp
PERCOLATION
TEST
Enclosure
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
" ___ 50' 1 DESIGN I DETAIL
O)W (7) P. N tN d
(11om L�7
In 0
T' Zmmm Z m II 3
s ; 7 C) n -p p
to
m
tA
a A
o � t=o CAo�oodi
I "
H o o
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rn o e a
roCA
pS I 4� a `o
M o I o on
x�,��
tv x N \ to
00
tri
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am
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I �� p '��11Ii �•• W D .� f
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Mj/ t" / 10n/
DATE PERFORMED:
LEGAL DESCRIPTION: 40 ? S 5 L 0 C K 1 Township, Range, Section:
I nd s S o N Y r1 L L z y h 616• N T j SLOPE
r -rpt
2
3 c a )J
4 /\
5
. a
6
7 e
8
A) A" -I
9
10
i
11
12
t
31415 13-
14-
15
16
17 13.0.8.
IRI
19
5'It_r t,rlru
J d d 4 6„44114L
WAS GROUND WATER N O
ENCOUNTERED?
S
IF YES, AT WHAT L
✓ O
DEPTH? p
E
Depth to Water After
Monitoring? Dale: //-/✓ `/ -9�'
ROBERT C. COWAN
SITE PLAN
4
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
-I APAP"
joy
:30
DC7
30 .,,
L, /y .
1 .,Yr,
y'/y ,•
Rkrr I
11 O
36 ,•„
S'
/XU
30
20 "
ILII PERCOLATION RATE a � � � (minutes/inch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN FT AND V FT
COMMENTS
S & S ENGINEERING �! iL% GII
G
PERFORMED BY: I r•—
% CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loop Road No. 204 /
ACCORDANCE WIT&,b16RT*T AraIb&L"@ffL GUIDELINES IN EFFECT ON THIS DATE. DATE: 1' ? y ( 01 -d
72-008 (Rev. 4/85)
HEALTHAUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROADOESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
nG
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 5, Block 1, Sun Valley Heights Subdivision
November 11, 1998
GENERAL:
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX (907) 694-1211
1. The scope of this project includes the installation of a 1000 gallon septic tank and
leachfield trench for the existing three bedroom house located on the referenced
property.
2. Construction shall be in accordance with the approved site plan and design drawings,
Municipal permit with any special provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary underground utility
locates.
4. Unless specifically agreed otherwise, the property owner shall be responsible for final
grading areas subsequently depressed from soil settling.
5. Contractors installing wastewater disposal systems must be certified by the Municipal
Health Department for system installations. Owners installing their own systems must
also receive prior approval from the Municipal Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction
shall include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final
grade.
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
Page 2
Lot 5, Block 1, Sun Valley Heights S/D
Nov. 11, 1998
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
5. A foundation cleanout shall be installed one to four feet from the building foundation.
In the line between the tank and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic tank). These cleanouts shall
be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in
line, shall be to clean toward the leachfield. The second cleanout shall be to clean
toward the septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The bottom of
the excavation shall be within 2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock)
placement.
2. Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final grade.
The portion of the monitoring tube extending through the gravel shall be perforated
from the bottom of the trench to the invert of the distribution pipe. This is equivalent to
the effective depth of the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent the formation of a
depression after settling.
Page 3
Lot 5, Block 1, Sun Valley Heights S/D
Nov. 11, 1998
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pike Perforate olid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting
engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco,
or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform
to current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of
the wastewater disposal system. These inspections will occur as follows:
Page 4
Lot 5, Block 1, Sun Valley Heights S/D
Nov. 11, 1998
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting
engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a
pre -construction meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S & S Engineering. S & S
Engineering shall be the owner's representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor
to carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOMNSTALLER
. GRE' 7R ANCHORAGE AREA BOr IGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPOR'r ON-SITE SEWAGE DISPOSAL. SYSTEM_ f_
NAME_ h� �� �i� / /��1'1 MAILING ADDRESS _rk." 7�4L9' �� �/(JPHONE
LOCATION_ --�_���/G� ---LEGAL DESCRIPTION--//� •�//f���IL��C� ��Ci�C� r�
SEPTIC TANK: Jj'}!G f��r;,!Y_E✓c i/a/-;/ (G%i
DISTANCE i ��i/•%-�'> �'� NUMBER OF
FROM WELL ILL -MANUFACTURER- `' MATERIAL J��"" COMPARTMENTS --/—/—
INSIDE LENGTH_— INSIDE WIDTH —LIQUID DEPTH__LIQUID CAPACITY` GALLONS.
SEEPAGE PIT:
NUMBER OF PITS—. DIAMETER OR WIDTH LE:NGTH�; DEPTH
LINING MATERIAL G//�Ol��l�='CRIB SIZE: DIAMETER -2—DEPTH. DISTANCE FROM:
��// / TOTAL EFFECTIVE
BUILDING FOUN DATION�L'. �>(��I'4EA REST LO'r LINE ABSORPTION AREA (WALL AREA) SO. FT.
15-1�� •0a _..•; •il
WELL:
TYPECONSTROCTION-ax/-''id//c"lf DEPTH --' _DISTANCE FROM:
BUILDING _ NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE_—, SEWER LINE '--- TANKS SYSTEM
CESSPOOL —
APPROVED
OTHER SOURCES
. DISAPPROVED__ REMA
DISTANCES: 1 /, J" )
INSTALLED BY: �<'-
L�
' a
PIPE MATERIAL:Z/r'���''�/
LOT SLOPE: io Via ;= T
REMARKS: _—
Form No. EQ -031
le/
DIAGRAM OF SYSTEM
DATE
ROVED
L
`j
,, GREATER ANCHORAGE AREA BOROUGH
a`'/�/,II�I�IjI ljjjj���'I DEPARTMENT OF ENVIRONMENTAL QUALITY �,L `J PERMIT NO.
'��I II �I '��� )) 3330 "C" STREET ANCHORAGE, ALASKA 99503
\��V�jIV11I01II IIlYI^lUl�ll��%/�/� TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT-- 10 - 42, 79'- Y) �
NAME OF APPLICANT
MAILING ADDRESS
In N
PHONE
INSTALLATION LOCATION -1"1�_
i � ^`
LEGAL DESCRIPTION _ rw � `
INSTALLATION OF: SEPTIC TANK-oSEEP/JQGE PIT `�- DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED 3 '
FINANCED THROUGH c - TO BE I TALLED BY --
SOIL TEST RESULTS "-�`c `'"�''"' ��-OTEI THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTI IPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL. QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. ,
SEPTIC TANK SIZE. OO TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT " ^l / DRAIN FIELD --
/FIf
SEPTIC TANK TO SEEPAGE PIT WALL-�,��^J,,`
SEPTIC TANK -� SEEPAGE PITv" DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK SEEPAGE PIT 1 ""
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK _-, SEEPAGE PtT _
DRAIN FIELD
SEPTIC TANK, SEEPAGE PIT! GO DRAIN FIELD
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
SEEPAGE AREA SIZE ✓'�Y..3� X�Oi �y E
zV x2Vx
DIAGRAM OF SYSTEM
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
G.A.A.B.
OR
i` LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ( , 4
[DATE V'�2 — APPLICANT'S SIGNATURE ` A ./� �
FORM NO. EQ -016
coniftuation r-Je1F Zag
"One test is worth a thousand opinions"
��eaur�onaonD. wnaE,nL�KA ueooDatP.'„Pe`333-0472
rformed
Performed For ��LL//_to
l.enal nescrintion: Lott B1ocI:�_Subdivision__&16 _ /�ssu�
This Form Renort:s Soils l.oq_•--Percolation est_--,
nenth
_Feet Soil Characteristics
2
3 Cqn4,t,4-d4 S�1,4
4 __ aj/h `ple:)7Z)
5 --
r,.,� LVo66/mss
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Was Ground Water Encountered?_,A%U
IF Yes, At what Denth?
0100
Acr
L_J
R e a d i n q
Date —Gross Time Net Time Depth to H2O
Net Drool
i
40
I
n
0100
Acr
L_J
R e a d i n q
Date —Gross Time Net Time Depth to H2O
Net Drool
Percolation Rate Minute
Prnoosed Installation: Seenaae Pit Drain Field
Depth of Inlet_ _Denth To Bottom [f Pitt Or Trench
r n M A F NTS : ,� 'a;_—'S '� Gj lL����.Q—Q/3A� . f[.CP4_i, —
Test Performed By
44M Mi PSIV-
_.rte,____--,�
Data Certified By:
Date:
C
�. • ,
GREATER ANCHORAGE AREA BOROUGH
FROM: DEPARTMENT: _ SUBJECT: 107-
INITIATED
0%INITIATED BY:......_DATE OF MEMO.. /�
73
DATE ANSWER
o
TO: DEPARTMENT: �LLIhI} 1�(J�-�(�1�(_ _ � (Q-1 _ REQUESTED:
RECEIVER: _. _... _. ..
REQUESTED ACTION SCHEDULE
FOR INFORMATION ONLY PREPARE BACK-UP INFORMATION
FOR IMMEDIATE ACTION '' CALL ME BEFORE YOU ANSWER
FOR YOUR CONSIDERATION NEED YOUR RECOMMENDATION
OTHER
i
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t Vel o ��� A'trl, A-�1 ki,*L0-� 11 Z —de_t ,C�il_> -V--t./ o �i�
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Municipality of Anchorage
On -Site Water and Wastewater Program =
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. _0.17-062-25__ _ Expiration Date:J� 1 o�ovc J
1. GENERAL INFORMATION
Complete legal description Sun Valley Heights Block 1_Lot 5
Location (site address) 13341 Alpine Dr. Anchorage . AK
Current Property owner(s) Michael Boozenny Day phone
Mailing address
Real Estate Agent
13341 Alpine Dr. Anchorage,
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
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
Waiver/Variance request for: Distance:
Received by: _ Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 9 -go
Date of Payment S164 I
Receipt Number 66?7ei �T
COSA# 0SC� 11'155
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING,_ INC.Phone 696-611.1
Address - 20441 PTARMIGAN BLVD., EAGLE _RIVER, AK 99577__ _
Engineer's Printed Name KENNETH M. DUFEUS _ Date
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and 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 `Qb- `%,
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
6. DSD/ SIGNATURE
System #1 Approved for "( bedrooms. t��1 LT" "
ff ✓ ' ` .�'
01
System #2 Approved for _ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
v g.
J
i�
K7
By:C�n,,, '�/J))))i))1j1''
V�^ Original Certificate Date:
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 Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet -10-10-12 doc
COSA Checklist
Legal Description: Sunvalley Heights Block 1 Lot 5 Parcel ID: 017-062-25
If more than 1 septic system on lot: COSA Checklist # of
L DATA
❑ Well"' - ed with Onsite (or attached)
Date drilled
Total deh ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments
B. TANK DATA
Age of tank(s) New years
Tank type/material Septic[Plastic
Measured operating fluid level in septic tank New
91 Standpipes/foundation cleanout per record drawing
Date of pumping New Tank 7/13/21
D. ABSORPTION FIELD DATA
Which system tested (date installed) New 7/15/21
® ALL standpipes present per record drawing
Total measured depth from grade 13.73 ft (max)
Measured depth to pipe invert from grade 4.26 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies.
COSA Checklist yellow sheet
Structure served by this system
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
ug/L ❑ Arsenic less than MRL (ND)
Collected b74�
Date of Sample
IFT STATION
❑ Requi ,aintenance completed
Age of lift station years
Lift station material
Comments.
Adequacy test date New
Results []Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Li on Lot > 100'
if No
Community Sewer Manhole/Cleanout > 100'
Yes if No
ft
❑ Yes if No ft
Neighboring Tank > 100' ❑ Yes i
ft
Private Sewer/Septic Line > 25' ❑ Yes if No ft
Absorption Field on Lot > 100' ❑ Yes if No
ft
ng Tank > 100' ❑ Yes if No ft
Neighboring Absorption Fields > 100'
if No
Animal Contain 50' ❑ Yes if No ft
❑ Yes if No
ft
Water Main > 10'
® Yes
if No
Manure/Animal Excreta Storage _
Community Sewer Main > 75' ❑ Yes if No
ft
❑ Yes I 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'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
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
i certify that / have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
MUNICWALITY
4,
Development Services Department _ Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 017-062-25� P „(mss 7- Z 3" zOZZ
1. GENERAL INFORMATION
Complete legal description SUN VALLEY HEIGHTS BLOCK 1, LOT 5
Location (site address) 13341 ALPINE DRIVE, ANCHORAGE, AK 99516
Current property owner(s) MICHAEL BOOZENNY Day phone
Mailing address 13341 ALPINE DRIVE, ANCHORAGE, AK 99516
Real estate agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
®
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distan
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $_'! 12.,5'0 COMO Waiver Fee $
Date of Payment 7 f 2 1261 ..0 2 b Date of Payment
Receipt Number �J 1 5�,3 1 Receipt Number
COSA# 0JGZD137y 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/24/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. 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 in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the �_2t ' \l`
system and maintenance. 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 P�
well and septic system. Therefore, any estimate of how long a system will function satisfactory:1�,�
for current or future occupants or guarantee that no unseen encroachments, deficiencies or r%
49
discrepancies exist can be given by First Water Consulting & FKS *� lli .....*
. .. ... /
.... ... V �.1..`
DSD SIGNATURE r • '. Curtis Huffman j
System #1 Approved for bedrooms rf �s ._ CE 128991`��r
F S5 N1'%
pRO��
System #2 Approved for bedrooms %\\ EWQ0a
Disapproved
Conditional approval for bedrooms, with the following stipu`Mti((Tfmf((,,r
Vv �GIPALIT�0 /4
FRV/CES
By: -- Original Certificate Date: 77—Z 1 "20 Zr,)
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.
ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory n
Other &4,t A q a l �/✓
Legal Description: SUN VALLEY HEIGHTS BLOCK 1 LOT 5 Parcel ID: 017-062-25
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA — COMMUNITY WATER CLASS "A"
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth _ft
Cased to _ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) _in.
Date of flow test for COSA
Static water level at beginning of test _ft.
Comments
B. TANK DATA
Age of tank(s) 21 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 49"
® Standpipes/foundation cleanout per record drawing
Date of pumping 7/21/2020
D. ABSORPTION FIELD DATA
Which system tested (date installed) 3/29/1999
® ALL standpipes present per record drawing
Total measured depth from grade 10.8 ft (max)
Measured depth to pipe invert from grade 4.8 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
Well production at time of test _gpm
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate _mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by_
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 7/23/2020
Results 0 Pass For 3 bedrooms
Fluid depth prior to test 59 in
Water added 600 gal
New depth 72 in
Elapsed time 1440 min
® Code -required soil cover over field Final fluid depth 59 in
❑ System presoaked Absorption rate 450+ and
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: Trench is operating in the top 1_'_of_the 6' ED (85% saturated). Secondary crib available.
FWES
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well) NA — COMMUNITY WELL
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No _
ft
Private Sewer/Septic Line > 25' ® Yes
if No _
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No _
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 _
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
® Yes if No
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
® Yes if No _
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
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DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section t
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC 201374
Subdivision: Sun Valley Heights Block 1 Lot 5
907-343-7904
Fax: 343-7997
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 21 years old. Typical replacement costs range from $8,000 to $11,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
Mailing Address P OBox 196650'* Anchorage, Alaska 99519 6650 *www muni org
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 017-062-25 Expiration Date: _61-L I ZI7
1. GENERAL INFORMATION
Complete legal description SUN VALLEY HEIGHTS; BLOCK 1, LOT 5
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
13341 ALPINE DRIVE *ANCHORAGE, AK 99516
BRUCE JACKSON
Day phone
13341 ALPINE DRIVE *ANCHORAGE, AK 99516
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
748-1637
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class A Well
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance-requeslfoc
Distance: .
Received by: 'l
COSA to be released to the
COSA Fee $ 5u0
Date of Payment ('016-1t5-
Receipt
'016-1t5-
Receipt Number
COSA# c DC,15
Date:
Waiver Fee$ a�S�,/
Date of Payment (0
Receipt Number 60aa0rA
Waiver# cy?V1 5— 1O, 1
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. 1 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 GARNESS ENGINEERING GROUP, Ltd.
Address 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 Municipality of
Anchorage and industry practices. The reported results describe the condition of the systems on the
date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden
defects or encroachments may exist that were not identified during the evaluation. The operational
life of all wells and septic 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 conditions can
vary, and are outside the control of GEG. Satisfactory test results do not guarantee future
performance of the 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 car) 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 information provided in this report by any otherperson orparty, including but not
limited to subsequent property purchasers, is not authorized. In short GEG disavows any legal duty
to anyone other than the person/party who paid for this report.
6. DSD SIGNATURE
/Y-_ System #1 Approved for _� bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
M
bedrooms.
bedrooms, with the following
Phone 337-6179
Date 6 S �S
�llllllUiiit!
�V "Y
�= ON-SITE Gfi
g WATER AND
qR6, WASTEWATER oz
PROGRAM
Original Certificate Date:
The Municipality or Ancho ge Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatatio s 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 ^-IL Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
fp— mnM
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: SUN VALLEY HEIGHTS; BLOCK 1, LOT 5 parcel ID: 017-062-25
A. WELL DATA
Well type A
Date completed
Total depth ft.
COMMUNITY WATER
If A, B, or C provide PWSID# 212005 Well Log (Y/N)
- Sanitary seal (Y/N)_ Wires properly protects
Cased to ft.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft,
WWI_ uction g,p.m,
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate mg./L.
Arsenic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
ground) in.
ft.
Collected by:
Tank Type/Material SEPTIC/STEEL Date installed 3/26-29/99
Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 10/6/14 Pumper A+ HOME SERVICES-.
C. ABSORPTION FIELD DATA •BELOW EXISTING ORAo WEST MT/EAST MT
Date installed 3/26-29/99 Soil rating .p.d./ft r ftlbdrm) 0_6 System type DEEP TRENCH
Length 63 ft, Width eft, Gravel below pipe 6 ft.
Total depth *10.83+ft. Eff. absorption area 756 ft2 Monitoring tube YES Depression over field N0_
Date of adequacy test 5/21/15 Results (Pass/Fail) **PASS
For 3 bedrooms
Fluid depth in absorption field before test L in. Water added 1029 gal. New depth 36-5/48 in.
Elapsed Time: 1200 min. Final fluid depth 22-5/3 in. Absorption rate >= 450+ g.p.d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date -
**1999 TRENCH TESTED ONLY.
1999 TRENCH INFORMATION LISTED ONLY, 1974 CRIB INFORMATION ON FILE WITH MOA.
CONDITION OF THE 1974 CRIB WAS NOT INSPECTED.
D. LIFT STATION
Date installed Size in gallons Manhole/Access(YM)
"Pump on" level at in. "Pump off" level High water alar level at in.
Cycles tested - Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankni t station on lot
Absorption field on
Public sewer main
Sewer /septic service line
On adjacent
On adjacent lots
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line *UNKNOWN Surface water 100'+
Wells on adjacent lots 100'+ PRIVATE/200'+ PUBLIC
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line **7' Building foundation 10'+_ Water main 10'+
Water service line *UNKNOWN Surface water 100'+ Driveway, parking/Vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PRIVATE/200'+ PUBLIC
F. COMMENTS
*REASONABLE TO ASSUME 10'+ BASED UPON LOCATION OF KEY BOX, HOUSE AND SEPTIC SYSTEM.
*SEE ATTACHED LOT LINE WAIVER REQUEST.
sdiit Al -
G. ENGINEER'S
I cer* that 1 have determined through field ffi4m*ons and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printsc{JNa/fie _ JEFFREY A. GARNESS
Date SOI s/' 5-
(Rev. 11105)
259.40
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UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR E`?A8LISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE IMTIAL TRANSACTION ONLY AND ASSUMES RNANCIAI. LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING, REPRODUCTION MAY CAUSE ERRORS IN SCALE,
Lor suRVEY SURVEY TYPE
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4� ASSUMED ELEV. .)I M X METAL FENCE W000 DECK
KCERTIMAMN A AiUILT ... N6 CORNERS SET
PLOT PLANS & LOT SURVEYS
NOTE:
IT IS THE RESPONSIBILITY OF THE 'BUILDER OR OWNER, PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
CONSTRUCTION, TO VERIFY
PROPOSED BUILDING GRADE RELATIVE
SHOWN. FENCES WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION
Prepared by
Robert E. Jahns, Jr. & Assoc.
PLOT PLAN
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**** VARIANCE/WAIVER REVIEW ****
Waiver#: SV151051 COSA#:OSC161260 Permit#:
PID#: 017-062-25
Legal Description: Sun Valley Heights Block 1 Lot 5
Engineer: Garness Engineering Group
Applicant: Bruce Jackson
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 7.0 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.
® The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized, letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
-..}.....y•r..•....:.........r............. ...... ..... Now ... .......
...r..r......�.-
Waiver is Granted: X Waiver is not Granted:
Date: Approved by: /Pcfi
Name of RevievioF
VARIANCE/WAIVER REVIEW ****
GARNESS ENGINEERING GROUP. Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
June 4, 2015
Municipality of Anchorage
PO Box 196550
4700 Elmore Road
Anchorage, Alaska 99519-6650
Planning and Development Services Department
On -Site Water and Wastewater Program
Ref: Sun Valley Heights, Bl, L5 - Separation Distance Waiver — Drainfield to Lot Line
To whom it may concern,
The 1999 trench drainfield on the subject property encroaches approximately 3 feet into the utility
easement that parallels the east lot line. This puts the trench approximately 7 feet from the lot line.
We are requesting that your department waive the required 10 foot separation distance between
the drainfield and the lot line to 7 feet. The septic system on the lot to the east (Sun Valley Heights,
B1, L6) is over 70 feet away from the subject property line. There are no apparent adverse impacts
associated with the granting of this waiver.
If you have any questions, please call or email.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507.1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
POST IN A CONSPICUOUS PLACE
ALL WORK MUST BE INSPECTED
Field Inspection Request required 2 working days in advance of starting work
and 2 working days in advance for final inspection. Call (907) 343-8206
(voice recorder) for scheduling. Permit is not valid without the call-in and also
must include the one -call ticket (utility locate) number.
MUNICIPALITY OF ANCHORAGE
RIGHT OF WAY DIVISION
Pir. IT nP 1A/
Construction
Contact
8151754
6/17/2015
PWDEW
See reverse for requirements/remarks.
I have read and understand both sides of this permit. I agree to the terms and conditions; and I certify that all work will
comply with federal, state, and municipal codes and regulations and the provisions of this permit.
Signature:
Date: / t `13
Construction Requirements and Notes:
1 - The permittee shall post a copy of the permit in a conspicuous location at the place to which the permit pertains before any
work there is started and shall remove the permit only after the Right of Way Inspector has accepted the work as being in
compliance with the permit.
2- All construction shall be in accordance of the Municipality of Anchorage Standard Specifications (MASS), 2009 Edition,
applicable municipal codes and regulations and the approved drawings and special provisions of this permit.
3 -Permanent paving, recycled asphalt payment (RAP), chip seal, sidewalks and curb and gutter must be replace within 7
working days after underground work is completed.
4 - This permit has been issued based on the assumption that the information contained in the plans and supporting
information is correct. Any and all omissions are the responsibility of the permittee. Any change in the scope of work requires a
revised or new permit and TCP.
5 - Permittee is responsible for locating and protecting all utilities and survey markers in the work vicinity. For locations, call
"Locate Call Center of Alaska", (907) 278-3121 or (800) 478-3121.
6 - All underground installations within a public place shall be buried at a minimum depth of forty-two inches (42") below the
final surface elevation i.e. bottom of drainage ditches, road shoulder, or finished grade.
7 - The right of way shall be restored to the same, if not better condition, than it was prior to the contractors' work being
performed. The work shall be performed vigorously and continuously, until completed to the satisfaction of the Municipal Right
of Way Inspector.
8 - Changes in the approved road closures or scope of work resulting from emergency circumstances may be allowed during
construction. It shall be the responsibility of the contractor to notify the Permit Office 343-8206, and/or obtain an approved Traffic
Control Plan (TCP) . It shall be the contractor's responsibility to notify the following agencies: Fire Dispatch 267-4950, Police
Dispatch 786-8900, Alaska State Troopers Dispatch 428-7200, People Mover 343-8253 and School Bus 742-1207 or 742-1209.
9 - The contractor shall erect signs, barricades and detours in accordance with the U.S. Department of Transportation "Manual
on Uniform Traffic Control Devices", Part VI - Traffic Controls for Street and Highway Construction, Maintenance, Utility and
Emergency Operations. Failure to do so may result in fines being assessed under Title 14 for work not in conformance with a
permit.
10 - The Municipality has the right to inspect and/or reject materials and workmanship not to Municipal standards, to stop work
until corrections are made, or to require removal of the facility and to charge time and equipment to the Permittee to correct the
facility if they fail to comply with the conditions of the permit.
11- Contractors' acceptance of this permit constitutes acceptance of the Municipality's bonding requirements, and is contractor's
pzent
/ MUNICIPALITY OF ANCHORAGE
4 Community Development Department
1 Right of Way Section v
Department
ENCROACHMENT PERMIT R151754
THIS AGREEMENT, made this 17th day of June, 2015, by and between Bruce A. Jackson and
their heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of
Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State
of Alaska, hereinafter called the "PERMITTER".
WITNESSETH:
WHEREAS, PERMITTEE is the owner of the following described real property:
SUN VALLEY, BLOCK 1, LOT 5, according to the official records thereof, on file in
the office of the District Recorder, Anchorage Recording District, Alaska, and;
WHEREAS, PERMITTER owns and/or maintains the real property more particularly
described as follows:
The 10 FOOT UTILITY EASEMENT, located on the east portion of the
PERMITTEES property as shown on Plat No. 70-0233, on file in the office of the
District Recorder, Anchorage Recording District, Alaska, and;
WHEREAS, PERMITTEE has placed a septic pipe upon the referenced real property which
encroaches approximately 3 feet upon the PERMITTER'S 10 foot Utility Easement.
NOW, THEREFORE, it is mutually agreed between the parties hereto that:
1. The PERMITTER, acting through the Director of Community Development
Department, hereby grants to the PERMITTEE the privilege of allowing a septic
pipe to encroach 3 feet upon the PERMITTER'S 10 foot Utility Easement, as
shown on "Attachment A," included herewith.
2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless,
the Municipality, its officers and employees, from any and all lawsuits, claims or
actions brought to any person for or on account of damage to property or injury,
disease, illness or death of persons, including all costs and expenses incident
thereto, arising wholly or in part from or in connection with the existence of,
alterations, maintenance, repair, renewal, reconstruction, operation, use or
removal of the encroaching septic pipe, as placed upon the PERMITTER'S
Utility Easement.
3. The PERMITTEE shall not assign or transfer any of the rights granted herein to
another individual or company without first notifying and securing the approval
of the Director of Community Development Department.
4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S
real property whatsoever, except only the encroachment rights described herein.
5. The PERMITTER reserves the right to revoke this permit upon twenty (20)
days written notice to the PERMITTEE. The PERMITTEE agrees upon such
notice of revocation, to move said encroachment(s) from the Utility Easement
in which it is placed. Should the PERMITTEE refuse or fail to comply with
said written notice, the PERMITTER may, without further notice to the
PERMITTEE, remove or cause to be removed the encroachment(s), and the
PERMITTEE hereby agrees to reimburse the PERMITTER for all costs
incidental to the removal thereof.
In addition to the mutual promises heretofore made, the PERMITTEE has paid the
PERMITTER a one-time permit application fee of $115.00. The PERMITTER hereby waives the
annual fee of $300.00.
IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day
and year first hereinabove written.
GRANTEE:
Bruce A. Jackson ner
GRANTOR: MUNICIPALITY OF ANCHORAGE
ack L. Frost, Jr.
Right of Way Supervisor
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY that on this 11 -0A day of 2015, before
me, the undersigned, a Notary Public in and for the State of Al ska, duly commissioned and sworn as
such, personally appeared Jack L. Frost, Jr., known to me to be the Right of Way Supervisor for the
Municipality of Anchorage, Alaska, who executed the foregoing instrument, and he acknowledged to
me that he executed said instrument as the free and voluntary act and deed of said corporation for the
uses and purposes therein mentioned, and that he was authorized to execute said instrument.
WITNESS my hand and official seal on the day and year first above written.
E WYgrT
�•NOTARy'•.
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
NOTARY PUBLIC id and for Alaska
My Commission Expires: q1-111-1
ss.
THIS IS TO CERTIFY that on this /9 day of L/UA/*F, 2015, before
me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as
such, personally appeared Bruce A. Jackson, known to me to be the individuals named herein who
executed the foregoing instrument, and she acknowledged that she did so freely and voluntarily for
the used and purposes therein mentioned, and on oath stated that she was authorized to execute said
instrument.
WITNESS my hand and official seal on the day and year first above written.
llllllQ((((Uff"
�P'"MO,:
-- /ANOTAO ARYPUICnD
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Jaqskal
My Commission Expires: 3 a
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•
MUNICIPALITYHEALTH
& HU RAGE
O DEPARTMENT of HEALTH &HUMAN SERVICES q
Division of Environmental Services
On -Site Services Section �f 9
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING LQ� _2
Parcel I.D. # 017-062-25 HAA #� �1i
1. GENERAL INFORMATION
Complete legal description Lot 5, Block !,'.'Sun VaIle'y` eights
Location (site address or directions) 13341 Alpine Drive, Anchorage
44 ;.
lF�gperty,owner - Syde &Nancy Farmington Day phone 260-3345
Q q4 `;` " P bx 86, Soldotna, AK 99669
: 3
;° Mailin'rg'address,•
,,,Lending agency ' Day phone
t
mailing address .,
Agent Dean 'O'Malley/Nova Properties Day phone229-2014
Address' 8340 Rainy Place, Anchorage, AK 99518
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well xxx
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxx
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA 421
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 5 a c ENGINEERING Phone 6 Q
17034 Eagle River Loop Road No. 204
Address
Engineer's signature
6. DHHS SIGNATURE
1/ Approved for I 11RE E bedrooms.
Disapproved.
Conditional approval for
Additional Comments
IN
Date '3 / ct /,j q
bedrooms, with the following stipulations:
The Municipa:;ty of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Cerdicates based only upon the representations given in paragraph 5 above by an independent
professional e-lgineer registered in the State of Alaska. The DHHS does this as acourtesyto 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. 1M) Beck MOA #21
s,
Municipality of Anchorage RECEIVED
DEPARTMENT OF HEALTH & HUMAN SERVICES SEp 09 1959
Environmental Services Division y
825 L Street, Room 502 •Anchorage, Alaska 99501 • (AM/� ANCHURAGE
A. ERVICES DIVISION
Health Authority Approval Checklist
Legal Description: Lo'i S (ilk, / S "tJ y4L1L&Y Yr) Parcel I.D.: 0 1' 7 - d 6 .l a
A. WELL DATA
Well type L 1,-4 s S A If A, B, or C, attach ADEC letter. ADEC water system number 6 ° 5 -
Log
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
Date completed
Cased to
FROM WELL LOG
WATER SAMPLEALSULTS:
Coliform
of sample:
B. SEPTIC/HOLDING TANK DATA
Nitrate
(above ground)
Wires properly protected (Y/N)
g.p.m.
Collected by:
AT INSPECTION
Other bacteria
Date installed 3 / )- l / cl `I Tank size % o d U Number of Compartments '-3- Cleanouts6/N) y�
Foundation cleanout C -PA -46E Depression (Y N U High water alarm Y/0i ✓� u
Dateof Pumping Pumper
C. ABSORPTION FIELD DATA
Date installed 7 / G� �) Soil rating (g.p.d./ft2 or ft2/bdrm) 6 System type T R ✓cN L%F1
Length 6-3 Width 3 Gravel thickness below pipe G Total depth i
Effective absorption area S ( Monitoring Tube present( /N)Yds Depression over field (Y, (I ,
Date of adequacy test IJ ��f - ^J 4 �-d Results (Pass/Fail) For -3 bedroc
Fluid depth in absorption field before test (in.);
Fluid depth
Peroxide
72-026 (Rev. 3/96)*
(ins) Minutes
12 months) (Y/N)
n.):
Absorption rate = g.p.d.
If yes, give date
D. LIFT STATION
Date installed
Manhole/Access(Y/N)
High water alarm level at*
Cycles tested
Size in gallons
"Pump on" level at*
"Pump off" level at*
E. SEPARATION DISTANCES
Cy w6rh:2
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer /septic
On adjacent
adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ) Property line 6 S Absorption field
r r
Water main/service line c f Surface water/drainage /o o r Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line 10 Building foundation S 7
I
Water main/service line / C
Surface water �') 4- Driveway, parking/vehicle storage area 10
Curtain drain
P 16 V bl
F. ENGINEER'S CERTIFICATION
Wells on adjacent lots
I certify that I have determined thru field inspections and review of Municipal
in conformance wit MM A HAA guidelines in effect on this date.
Signature
Engineer's Name
Date c1 I q �1
HAA Fee
Date of Payment
Receipt Number l� �' Lo -k 1A C
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
n 4 ROBERT C. COWAN f ��
'CE -8801 r�,°�,
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