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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 ?> x rn o e a roCA pS I 4� a `o M o I o on x�,�� tv x N \ to 00 tri tJ0y 1 —o-- awawasrt anon ,o� am d r � O H H H o/. 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 R __ 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 6L j t Vel o ��� A'trl, A-�1 ki,*L0-� 11 Z —de_t ,C�il_> -V--t./ o �i� E� t�-� t4tk_,, l2 s1c���2C __.. E .._... __ E.. _. MND uji rwva_-I-. _._.. _._. 1.\1.. �.... ... .... 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. 1 ....�::� ........ t.'.�,^::. • Curtis Huffman >� CE 128991 ,• ����� ��'sTF;�• • aZ2s/2Qze•-Q�� '0 PROFESS100�.� ft ft ft ft ft ft ft ft 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 1 1 1 GRAVEL pR1VE I 301 9 T it J Lu LU 83 7' t C.O,S x 2-1 °uM7 n/ C.O.S X 2 � I 0 CO'SX i q Ul I� �I � t°••• ANCHOR ESMT j WE 255.14' 1 DE ARMODN ROAD 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 FWNDATKW AS -816T SYMBOLS r�^--�� • SET REBAR DRAINAGE L"J::;:::J ASPHALT FINAL SFNIJCTURE AS-IWLr....... O FOUND REBAR .@._g_.g, 4000 FENCE .:.::tl•::.,: CONCRETE PLOT. PLAN ... AS-HINLT ... LOT SUftMY ... TOPWWHY 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 Inw+N'�Ubi tlh NrS�reawW htltl0".'"^ "� r ♦ \�.,......., „♦,�Q;,.• ••• �j Professional Ladd Surveyors aw m Ora'" a °"'°itl Mw N,ma a atawHW art M ¢,e bt wmn a uu aex a n r mw.v new r♦� ** # 1700 Brink Drive. ANCHORAGE, ALASKA SSW4 Scoie: 115 _ gryi '4 V Ree. Lot S,F. Rac. Plot File No. u,oM+ao• mu W.10 OF 49th . .$JO FOUNDATION AB-BUILY a._ y •••� Y¢ Date jurv¢ d; 0 28 f U�I L.Oi1 Otowfl b q Y• 11�� C%¢Cketl b7y.(� � �f JMK 6 NNM E JNm•. A'.. tweE xNfy maL i � Iww pMmmWmN-¢e urwy or fM. mt meemtoA mar, AgrF ` ,�•r / a _ ..../ • .. ':' r.'e mq ' 'snow. ma Ma,maUm w eae. h~' ae we mt na .aeawnmanm m aNW `t , ROBEflf E. JOHNS JR r a s :• a - Date Drown: 05!2'3/15 Grid: 2938 W.D. 15-175 FINAL STRUCTURE AS-SUIL�04 r ''• :..4121—S oc b f 11 '"•.,, Lego[ Description: s, Roexl a +•nm, r; IwwsT e.re uae Mw P.rlwmaF mi AHerl �rn'•Y i 1M • �.'' ♦ e •..,,..... " :+ C d t- of 5 BLOCK 1 anaewrs e+ mb xt ana Uol U t a mnolw. • p 4r iiwis ::"+'♦ Sl IN VALLEY HEIGHTS e� Municipality of Anchorage Development Services Division On -Site Water and Wastewater Program menr S No e v n a N epar meat **** 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 nm - Jaqskal My Commission Expires: 3 a ;dq pUg41G ��4� OF A�,��� fi f C li,v�iv 6 y, • 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�,°�, IttF are