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HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES BLK 2 LT 2Mountain Valley Estates Block 2 Lot 2 #050-631-10 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191425 PID Number: 050-631-10 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: HEATHER WAGNER ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 4933 HILAND ROAD, EAGLE RIVER, AK ❑ Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 3 GPD/S F Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot MOUNTAIN VALLEY EST 2 2 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 -- -- Ft. Well 100'+ NA NA NA NA TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface water 100'+ NA NA NA Material Number of compartments 2 Lot Line 5'+ NA NA NAHDPE NA Foundation 10'+ NA NA NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA NA NA NA Remarks Existing septic tank decommissioned Pump on level at in. Pump off level at in. High water alarm at in. per code, new tank installed 5' from & connected to existing field w/ COs. Pump make and model Electrical Inspections performed by Installer JRs PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034. Inspector FWCS / MNA BENCH MARK (Assumed elevation) 100 ft Inspection ddates: Is' 10/7/19 2nd 10/9/2019 Location and description 3`d 41h SEPTIC TANK MANHOLE COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL e OF AL \ Conditional Approval: Date ���.���..�. 49 TH� MICHAEL N. 62CN- No.CEAN9469 �10/ 10/19. App ed W Date 0® e``o� MOUNTAIN VALLEY ESTATES B2, L2 PID: 050-631-10 PERMIT. OSP191425 A -C=38.4' B -C=36.2' A -D=43.5' B -D=40.1' SCALE: V = 30 SEPTIC SECTION SCALE: NTS SUPPORT SERVICES: PREPARED FOR: HEATHER WAGNER ��`��' �F AL`g ' III MOUNTAIN VALLEY ESTATES B2, L2 Of* 49 TH 9* 4933 HILAND ROAD, EAGLE RIVER, AK 99577 t4o Michael N. Anderson, P.E. DATE: 10/14/2019 -A MICHAEL N. ANDERSON Sj No. CE 9469 'e 4661 Natrona Ave. DRAWN: FWCS �� 10/14/2019��1� Af ff Anchorage, Alaska 99516 AftFESSION0ti (907)727 8864/FAX: (907)345 1,391 SCALE: 1" = 30' 9/26/19 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. 050-631-10 Property owner(s) HEATHER WAGNER Day phone 9078549444 Mailing address 4933 HILAND ROAD, EAGLE RIVER, AK 99577 Site address 4933 HILAND ROAD, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) MOUNTAIN VALLEY ESTATES 132, L2 Legal description (Township, Range & Section) Lot Size 49,110 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank ® Upgrade ® Duplex (D) ❑ Holding Tank ElRenewal ❑ 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. FW (Signature of property owner or authorized agent) Permit/Rush Fees: n aa5/ Waiver Fees: Date of Payment: �7 /V'6` i9 Receipt Number: n 759 6,U Permit No. 05 P l g i L1 a S Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 September 20, 2019 On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: MOUNTAIN VALLEY ESTATES B2, L2 To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3- bedroom house. The lot and area are served by private water. The proposed design will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191425, Rebecca Carroll, 09/26/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191425, Rebecca Carroll, 09/26/19 �+ MUNICIPALITY OF ANCHORAGE �� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION y� J/ 825 L Street - Anchorage, Alaska 99501 Telephone 2644720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 2;�In4l/ — ,� /� PHONE EW UI`GRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS DISTANCE TO: Well 60� Absorpbo area—/ Dwelling 5 PERMIT GL Vy a. Q W'. Manufxturer Materi No. of compartmer, W Liq. ip c ty in gallons (�� IF HOMEMADE: Inside length Width Liquid depth 6 y J0Z DISTANCE TO: Well Dwelling PERMIT NO. =Z F Manufacturer Material Liquid capacity in gallons W = DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. W LL D f2 W No. of Imes I Length of each I' e / Total length of /IJN'�n�es 1f� / Trench width 3 Inches Distance betwe�,/y 1' s IV �/ , 'it;: p Top of tile to finish grade / / 3 — Material beneath tile p inches Total effective absorption area ti 4) W Length Width Depth PERMIT NO. V Q H W6 Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J Class OL /IE{/�I Depth Driller Distance to lot line PEH MIT NO. u' i DISTANCE T0: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TE TRATING / Q INSTALL � � REMARKS i APPROVV DATE LEGAL 6 ht 13 (Rev. 3/78) L/ Ie MUNICIPALITY OF ANCHORAGE k/ Departmer^ of Health and Environment^', Protection 825 L Street, Anchorage, AK. 995 264-4720 Permit # 01 HANDWRITTEN PERMIT * * * ' W L//JJAND�O-ON-SITE SEWER PERMIT n �7 Applicant: Mailing Address: Location: - Phone Number: Legal Description: L�C%iC /,VC ,, -;,1 Type of Soil Absorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: The i DEPTH Required Size of LENGTH ,SS Lot Size: Seepage Beds Holding Tank: Soil Rating(sq.ft/br) /,O the Soil Absorption System Is: 1 ,GRAVEL DEPTH WIDTH _ The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(H66BI?G) TANK SIZE _ �0o n GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * ' * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this departmen will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require the re si nce is remodeled to include more that b ro Signed: Issued by: that G 11�pplicant Date: J -4,Z 0 3 SWP/024(1/81) and wells as t if 0- SOILS LOG . MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION • moi'• TEST • 825 L. Street, Anchorage, Alaska 99501 264-0720 - ' SOILS LOG— PERCOLATION TEST PERFORMED FOR:G DE�uG/'dA �� L DATE PERFORMED: ,zo ISS LEGAL DESCRIPTION: LOT �K Z /Y/r- a'/1lLLeTI S'T �. tz dTS 7, 561 SLOPE SITE PLAN 1 • M L `z a c.T t pf/60 t 2- U/t Z44'ez s 5 M - ✓t_re IAn.;&"�, m 4 Q" r,1t� 3 t -do yE / t1D 3.0 �,�ie 4 5 �ArrQ Wrr LI 6Q4dELt 6 SP 11 a 6.Pf:`/B,F 7- 8- 9-6,41 69 6,41 St�7y tv�rid�z�e� So.Jv 10 ZSv s/ati/�L WAS GROUND WATER 11 ENCOUNTERED? SP �a�d Id/ltd/Fc �_—_I IF YES, AT WHAT DEPTH? 13 14 15 16 17 18 19 20 PERFORMED 72.006 (6/79) V � C r L F Reading Date Gross Time Net Time Depth to Water Net Drop A PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIED DATE:Q` i MUNI 1=1 <�L- I TY OF FtMC�HKZIRi=iGE DEPARTMENT C HEALTH AND ENVIRONMENTAL : )TECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 WELL KErwr 1 I T PERMIT NO. ( 821204 ) APPLICANT DEAN DELUCIA BOX 234 E.R. 99577 694-3424 LOCATION LEGAL L2B2 MOUNTAIN VALLEY ESTATES LOT SIZE 999999 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER. LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER. INSTALLATION. PERM I T EXF" I REE~ DECEMBER 31 r 1 E3c^•2 I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED APPLICANT DEAN-DELUCIA I SSUED BY--tA o -DATE--,! _040 01 Ljj" �� V4. 0 afirb Brilting"Eag b) DOC Co. ana SULLIVAN WATER WELLS P.O. BOX 272, CHLIGIAK, ALASKA 99567 • TELEPHONE 6882759 1 OWNER OF LAND i y DEPTH OF WELL -_`- ADDRESS - STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION ^ DRAW DOWN FT. DATE - Started Ended GALS. PER fill PERMIT NUMBER KIND OF FORMATION: KIND OF CASING From Ft. to Ft. Ft. From Ft. to FI. From Ft. to From Ft. to Ft. - ' ` From Ft. to Ft. From Ft. to - Ft. - " - From Ft. to Ft. From Ft. to Ft. 1.4mm Ft. to Ft From Ft. to Ft. " ' 't From Ft. to Ft From Ft. to Ft. ^' From Ft. to Ft. From Ft. to Ft. -From Ft. In R. From FI. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. 1111 S C L. INFORMATION: From Ft. to From Ft. to Ft. From Ft. In Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft �. c DRILLER'S NAME E I) LR�js MUNICIPALITY OF ANCHORAGE 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. 050-631-10 1. GENERAL INFORMATION Expiration Date: i -.r), a - ao -2 69 Complete legal description MOUNTAIN VALLEY ESTATES BLOCK 2, LOT 2 Location (site address) 4933 HILAND ROAD EAGLE RIVER AK 99577 Current property owner(s) HEATHER WAGNER Day phone Mailing address Real estate agent 4933 HILAND ROAD EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 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: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5-6b Waiver Fee $ Date of Payment ! o f --7-11 q Date of Payment Receipt Number )41562,[Z Receipt Number COSA #5 C (Q I Liq� Waiver # Distance: 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 ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 10/7/2019 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 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 well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by FI(CS and Anderson Construction & Engineering. 6. DSD SIGNATURE System #1 Approved for -� bedrooms System #2 Approved for bedrooms Disapproved A OF A4 tA Vr t MU N. At4 VMX- 10/7/19 ..' i Conditional approval for bedrooms, with the following stipulationQ�kW0l(((f((( 90 ON-Sirp o ATER ANQ m M r- PROGRLi,7 L� L Original Certificate Date: 1 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other COSA Checklist Legal Description: MOUNTAIN VALLEY ESTATES BLOCK 2, LOT 2 Parcel ID: 050-631-10 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 12/1982 Total depth 140 ft r Cased to 24 ft (INTO BEDROCK) ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 9/30/2019 Static water level at beginning of test 92 ft. Well production at time of test 4.1 gpm Comments B. TANK DATA — 10/7/2019 - 1000 GAL Age of tank(s) NEW years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate • ( I mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FW!C5 Collected by = Date of Samples C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA — 60'L x 2.5'W x 4'ED — 110 SF/BR = 360+ SF Which system tested (date installed) 6/1983 ® ALL standpipes present per record drawing Total measured depth from grade 8_5 ft (max) Measured depth to pipe invert from grade 4.5 ft (min; ❑ N/A — pressurized field S Monitor tubes go to bottom of effective. If not, state depth into effective Adequacy test date 9/30/2019 Results 0 Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 13 in (15" below invert) Elapsed time 1215 min ® Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ gpd (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: Sump extended 28" below invert at time of test. Extended w/ ST install to 4' below F SCS COSA Checklist copy 3.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below ® 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' F. ENGINEER'S COMMENTS Animal Containment > 50' ® Yes if No ® Yes if No ft _ 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: 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 I certify that I have determined through field inspections and reviewOF `Aor Z.�� of Municipal records that the above systems are in conformance Air with MOA COSA guidelines in effect on this date.�.' *.49 Tx • MICHAEL N. ANDERSON.- No. CE 9— 10/10/19. 04'Af COSA Checklist copy 3.docxA QSAVr F''ESSIO� ft ft ft ft ft ft ft ft M I BIRDSONG DRIVE 0 .96 ____SOI '53'47"W 61.09' 0 16 :2 ANCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: MOUNTAIN VALLEY ESTATES ®= FND REBAR LOT 2 BLOCS{ 2 PLAT 73-152 OF N, SURVEY CERT'IFICA"I E: L John L. Schuller. Have conducted a physical survey of this property as shown On this drawing and that the AN • ' improvements situated hereon are within the property lines and no . enchmachments exist other than noted. Under no circumstance should �* :' 49 any information on this drawing be used for constriction offences, structures, improvements, or for establishing boundary lines. �, • • • : , , •C FF� 1•" EXCLUSION NOTES: It is the owners responsibility, to determine the existence ofany easements, covenants, or restrictions • •.. .. • ..... ' '' °fl, '.SgkN L. SCHULLER; which `0 i LS do not appear on the recorded subdivision plat. WORK ORDER NUM8ER: IDATE: 3ClJL -10408 �e '•,rs?•!2. _-Nut OCT 12, 2018 1"=40' �1.O "' • "' d ins 19-103 cRAxN er. ascan a a o waAa BQOK PAG JL5 SWO658 190156 ��rOfessionot �� �@'���•oam'�' �, D SUR 4- 'IV 'j,n •� 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsfte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. COSA# 0q0 y/U Expiration Date: 2 /SLo 1. GENERAL INFORMATION Complete legal description Lot 2; Block 2; Mountain Valley Estates Location (site address) 4933 Hiland Rd. Eagle River Current Property owner(s) David McLean Day phone 694-°933 Mailing address PO Box 90456 Anchorage, AK 99509 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Q Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal andlor water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As 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 fime of installation. Name of Firm S a s Engineering Phone 694.2979 Address 15861 S. Birchwood Loop Chugiak, AK 99567 Engineer's Printed Name Robert aShafer 5. DSD SIGNATURE &'f Approved for 3 bedrooms. Disapproved. Date ✓% Conditional approval for bedrooms, with the following stipulations: '—'- Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: _it`ll4 W0_rX n r OG�L� Original Certificate Date: i (R. I INS) Municipality of Anchorage • '` Development Services Department - Building Safety Division" — On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description:i o�Z; 1�1k2 ` MpJn�A:^ \10A\(!1 CA Parcel to: 0-60* 631- ID A. WELL DATA Well type l JA If A, 6, or C provide PWSID # _ Well Log (Y/N)� Date completed *1 SL Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth A� ft. Cased to'-� f(. Casing height (above ground) • i Yi it in. FROM WELL LOG �cJ AT INSPECTION Date of test Static water level / 63 ft. /(50 ft. Well production '1.1] g.p.m. —I.4 �— g.p.m. WATER SAMPLE RESULTS: q Coliform colonies/100 mL Nitrate 10 1 mg/L ,1 r Arsenic: _P ug/L date of sample: 1 �� B. SEPTICIHOLDING TANK DATA 11 -- Tank Type/Material Tank size 4QOd gal. Number of compartments 2 Other bacteria J�K colonies/100 mL Collected by: S 'eL s- imp Date installed 3 Cleanouts(Y/N) �l I Foundation cleanout (Y/N) Depression over tank (Y/N) ti High water alarm (Y/N) Date of pumping /� E O Pumper 15 RLI M Ir I'Mk C. ABSORPTION FIELD DATA Date Installed _qv� Soil rating (g.p.d./ft2r ft /bdrm) I �System type Length ft. Width z . s— ft. Gravel below pipe ft. Total depth ft. �til E�fff.�l absorption area S6bfef Monitoringiube �P� Depression over field A% 0 Date of adequacy test 1 tf c Results (Pass/Fail) For r23 bedrooms Fluid depth in absorption field before test ( in. Water addedgal. New depth2I in. Elapsed Time: [FZmin. Final fluid depth in. Absorption rate >=_tL�g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date '�- JWSS�\p On`'1 ex dr, t�a�a,, t i n•le D. LIFT STATION rn Date installed 'Pump on' level at _in.. E. SEPARATION DISTANCES Size in gallons ,==--IVa—nFioIe1Access (Y/N) level at _ in. High water alarm level at in. Cycles tested Meets alarm b circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot �) On adjacent lots Absorption field on lot 10e) I+ On adjacent lots / y d 04 - Public sewer main ,via- Public sewer manhole/cleanout 1 Sewer /septic service line Holding tank /V//), Animal containment areas O 4 Manure/animal excrete storage areas fU 0 SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: I, Building foundation Property line -9Absorption field S 4 Water main O Water service line /bit- Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 4 Building foundation —lD 4 Water main Water Service line MIA Surface water 1.66I'f Driveway, parking/vehicle storage 1 O 1 Curtain drain V\t A'q-' kn06-r\ Wells on adjacent lots (E)0 F. COMMENTS c� ROL,J Y\A- Ask cehi-ee�- SJ1o5�yJ�h�' xfac,'0A(eAS VAJ,y pC-e G. ENGINEER'S CERTIFICATION 1 !certify that I have determined through Geld inspections andP'�.`�•.ws review of Municipal records at t above s ste s are i y„ •'. '��' �;, P Y conformance with MOA COSA id nes i effe t o th date. Engineer's Printed N me f • Date 8 is •+. _ COSA Fee $ Waiver Fee $ Date of Payment t� Z / Date of Payment Receipt Number. o0 5y (o% Receipt Number (Rev. t 1/05) Municipality of Anchorage • Development Services Department ° Building Safety Division On -Site Water ti Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING RC_f$SUe_ Parcell.D. 050-631-10 HAA# O4/U0yc? 1. GENERAL INFORMATION Expiration Date: L2 Complete legal description MOUNTAIN VALLEY ESTATES SUBDIVISION: LOT 2. BLOCK 2 Location (site address or directions) 4933 HILAND ROAD • EAGLE RIVER, AK. 99577 Current Property owner(s) JOHN EDMONDS Day phone 696-6894 Mailing address P.O. BOX 142541 • ANCHORAGE. AK. 99514 Lending agency Day.phone Mailing address Real Estate Agent Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As 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 Health Authority 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 riles 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 Finn GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Engineers Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSO Guidelines 4 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are -outside lhocontrol of the evaluator of the system_Satisfact� test -- —results do not guarantee future performance of the system; nordo they guarantee that - there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5.—DSD SIGNATURE ✓ Approved for bedrooms. Disapproved. Phone 337-6179 Date )'! zo Qoo�0 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: t� HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other • ON-SITE WATFR AND WASTEWATER PROGRAM By; Original Certificate Date: (Rw. 12101) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 ' HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MOUNTAIN VALLEY ESTATES ; LOT 2, BLOCK 2 Parcel ID: 050-631-10 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 12/1982 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 140 ft. Date of test Static water level Well production Cased to 24 BR ft. FROM WELL LOG 12/1982 96 ft. 4.0 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: N/A mg./L. B. SEPTIC/HOLDING TANK DATA Nitrate 1.84 mg./L. Casing height (above ground) 12+ in. AT INSPECTION 2/27/2004 1109 ft. 3.7 g.p.m. Other bacteria 0 colonies/100 ml. Date of sample: 8/19/2004 Collected by: GEG, Ltd. Tank Type/Material STEEL Date installed 6/1983 Tank size 1000 gal Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 6/2/2004 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 6/1983 Soil rating (g.p.d./ft'or Ibdnn 110 System type TRENCH Length 60 ft. Width 2.5 ft. ! Gravel below pipe 4.0 ft. Total depth •7.33 ft. Eft. absorption area 360+ ft' Monitoring tube "YES Depression over field NO Date of adequacy test 2/27/2004 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test _11n. Water added 611 gal. New depth25 in. Elapsed Time: 3188 min. Final fluid depth 8 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN if yes, give date — **SUMP ONLY ,EXTENDS 35' BELOW INVERT. D. LIFT STATION Date Installed "Pump on" level at _in. E. SEPARATION DISTANCES Size In gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank - N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and p �?- ` 44 � \ �* review of Municipal records that the above systems are in p •.. "' • ... ' 'j�" • ' • "' • "' conformance with MOA HAA guidelines in effect on this date. O e Y . . G ....... .... es * Engineers Printed Nae JEFFREY A. GARNESS0� E 7953 e) Date —f�:rl3o o�% Op�� • ........ .4�w 4^e 60 �a_y Pr HAA Fee $ Date of Payment Receipt Number (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage .° • Development Services Department Building Safety Division -'/ OnSito Water & Wastewater Program 4700 South Bragaw St, S, P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us �, -q -0V (907)343-7904 t CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 050-631-10 HAA# 1. GENERAL INFORMATION Expiration Date: 0 Complete legal description MOUNTAIN VALLEY ESTATES SUBDIVISION, LOT 2, BLOCK 2 Location (site address or directions) 4933 HILAND ROAD • EAGLE RIVER, AK. 99577 Current Property owners) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOHN EDMONDS Day phone 696-6894 P.O. BOX 142541 * ANCHORAGE. AK. 99514 Unless othenvise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As 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 Health Authority 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 GARNESS ENGINEERING GROUP, Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the Gine of the lost, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the We/ soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the solo benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Phone Date 337-6179 Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other ON-SITE IMATCD AKIn WASTEWATER By:�Original Certificate Date: T (Rev. 12101) Municipality of Anchorage --1 Development Services Department Building Safety Division On -Site Water & Wastewater Program . 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MOUNTAIN VALLEY ESTATES ; LOT 2, BLOCK 2 Parcel ID: 050-631-10 A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N/A Dale completed 12/1982 Sanitary seal (Y/N) YES Total depth 140 ft. Cased to 24 BR ft. FROM WELL LOG Date of test 12/1982 Static water level 96 ft. Well production 4.0 —g -0-m. WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ In. AT INSPECTION 2/27/2004 109 ft,, 3.7 — 9 -p.m - Coliform 0 colonies/100 ml. Nitrate 2.66 mgJL. ` Other bacteria 0 colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 5/24/04 Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 6/1983 Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 6/2/2004 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 6/1983 Soil rating (g.p.dJft'or bdnn 110 System type TRENCH Length 60 ft. Width 2.5 ft. Gravel below pipe 4.0 ft. Total depth '7.33 ft. Eff. absorption area 360+ ft' Monitoring tube "YES Depression over field NO Date of adequacy test 2/27/2004 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before lest'? in. Water added 6111 gal. New depth 25 in. Elapsed Time: 318 min. Final fluid depth , 8 in. Absorption rate >= 450+ g,p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date **SUMP ONLY EXTENDS 35". BELOW INVERT. D. LIFT STATION Date Installed "Pump on" level at _In. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements?. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'k Water main Wells on adjacent lots 100'+ Water service line 10'+ Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION v I certify that I have determined through field inspections and p 9 H review of Municipal records that the above systems are in ""' • .. .' • ... ' ' "" ' • • •' conformance with MOA HAA guidelines in effect on this date. t7 J ffr y arnes Engineer's Printed Name JEFFREY A. GARNESS �Qa-P �' E 79 `�pv 0 4s • ...... • •' 6°00 Datedpro/esst000 a HAA Fee $ `iWaiver Fee $ Date of Payment log Date of Payment Receipt Number �� Receipt Number (Rev. 17/01) v 02/20/2004 18:55 2582157 ADM ...m....n♦c an �� qyy—tl�—Y f I Ut SM SOZ ECWRRD ` H*34uc LRHA 6umv Ym r �� EDMOv�DS sly{g�Na R el i I PAGE 01/01 wjuuz 4933 NiL14►1r) 4. , E' °► "OEe, r9i I t, 8 - Q 4, i'df 4 ' I '04"w, - I,`o • 60 I I4,,7 10 vY a ASBUILT I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE, pro • OF AC`�� FOLLOWING DESCRIBED PROPERTYO .arzavrauvs�i6YEt�!®r�®.f'a DATES i,�P�'•'.•• . _s��� AND THAT NO ENCROACHIAENTS GIST E=DT A5 ).�!/�i i �� TA�♦ � INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDo CAscmENTs, ccvENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECOttDED SUBOI- ♦ �j'; a.+. M♦h Lr..A. i VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD F8 1� �•., Is-a9ta 0 ANY DATA HEREON 8E USED FOR CONSTRUCTION �� S.s t;�A •• • �S�i , OF FENCE 1_INES. OR FOR ESTABLISHING BOUND- DRAYl1l< <t�aq:•* ART LINES. pitz� MUNICIPALHO • .. DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED 343-4744 dUL 21 1997 CERTIFICATE OF HEALTH AUTHORITY Dept. of Anchors APPROVAL FOR A SINGLE FAMILY DWELLING pt. Health &HumanServicesoa Parcel l.D.# OSO— 63/ —/o .HAA# 1. GENERAL INFORMATION Complete legal description tot 2; Block 2; Mountain Valley Estates Location (site address or directions) Mile 5.1 Hiland Rd. Eagle River, AK Property owner Jeff & Alexandra Sands Day phone 695-1647 Mailing address P•O. Box 24474 Anchorage, AK 99524 Lending agency Vista Mortgage/ PR Aranrh Day phone -- Mailing address Agent Eva Loken/ Vista Real Estate Day phone 689-6476 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxr, Community well 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. 7eam(Ftw.1191) FWJ MOAht 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Ad Phone '61111 — a' q 7 5 17034 Lags Address Eagle River, Alaska 99377 Engineer's signature 6. DHHS SIGNATURE Approved for -- bedrooms. Disapproved. Conditional approval for Additional Comments M 11ITIC Date '7 /1/ /17 7 OF � �w�at�cr't. wwnN "rte `SCE -.8801 �l tl`�!a: Jam••«....« ..r,`� bedrooms, with the following stipulations: Date 7 30 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. naa)R...iAi) e.c. MOAnt Ogp08 Of Ml\gA t AC>n�SERVICESON1S1041 CtS'IIROtJMEt11 Municipality of Anchorage 2 1991 DEPARTMENT OF HEALTH & HUMAN SERVICES dUl- 1 Environmental Services Division rE,V 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 342h4 Health Authority Approval Checklist Legal Description: 'SZ. oun} Vh I le N Parcel I.D.: Q _9 O C' A. WELL DATA Well type PQg�t VATF If A, B, or C, attach ADEC letter. ADEC water system number Log present &Y/)' Date completed p Total depth Cased to a4 fi.r2. Casing height (above ground) /� f Sanitary seal �1(V) �gS Wires properly protectedYON) t FROM WELL LOG AT INSPECTION Date of test Static water level 400 Well production 4.0 g.p.m. 4. D { g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate 1 . 04 E/L Other bacteria Date of sample: Collected by:IS i5 tG B. SEPTIC/HOLDINGTANK DATA Date Installed 83 Tank size 1400 Number of Compartments Z Cteanouts ON)—aa Foundation cleanout 6N) ifeS Depression (Y(9 —UO—High water alarm ( lq Date of Pumping ..3-110 k1 Pumper 1� S C. ABSORPTION FIELD DATA .. ' Date Install ed .. -6&l... ' ' Soil rating (g.p.d./ft' or ftl/bdrm) /!D a System type 7ROH4W Length '.. O-_' Width Z.5 Gravel thickness below pipe y Total depth �• 5, Effective absorption area IL Monitoring Tube present(ON)Lk< Depression over field (Y® Date of adequacy test Results((Pa-g'ail) PASS For 3 bedrooms Fluid depth in absorption field before test (in.); 43 ,r Immediately aftetM gal. water added (in.): 61'y Fluid depth ' �� (ins) Minutes later._ f t) Cf Absorption rate = '450 a.p.d. Peroxide treatment (past 12 months) (YM) -�OuF' �tuLa,4 If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATtON,, Date Installed \ Manhole/Access (Y/N) _ High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons at - 'Pump off" level at* Septic/holding tank on lot trnr + On adjacent lots Imp Absorption field on lot Ir)r) + On adjacent lots ion Public sewer main N�A Public sewer manhole/cleanout �/A Sewer/septic service line Zfj�+ Lift station t DOr'+- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation �� + Property line 50f Absorption field 5 Water main/service line ID Surface water/drainage IW Wells on adjacent lots IDO SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10 r f Building foundation (Qr+ Water maintservice line Inr+ r Surface water Int)} Driveway, parking/vehicle storage area jnrt Curtain drain 1JA Wells on adjacent lots Ion /+ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recoms are in conformance with0lj�A� A fines in effect on this date. %'yt Signature //z`^� w ! 9t �'� 1*-,jSt o Engineer's Name �` d �'��-r �. �u ✓�q.✓ .� ,•• -.r �.,.�� i J y WhIRT t C04 Data a/ / `7 7 FV iCE-8801 sly. HAA Fee $ 3,�Z A 5D Date of Payment 72 Z4 1 27 Receipt Number 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE M E M O R A N D U M SEPTIC SYSTEM ADVISORY HEALTH AUTHORITY APPROVAL NO. HhC0 0298 Prior to a recent adequacy test on the septic system for this lot, LtS inches of standing water was observed in the absorption field. This indicates that approximately 84•b % of the absorption area is inundated. Although . this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Health Authority Approval. -MUNICIPALITY OF ANCHORAGE HEAL DEPARTMENT OF HEALTH & HUMAN SERVICES • Division of Environmental Services r. _ On -Site Services Section �' ' • _ .• P.O. Box 196650 Anchorage, Alaska 99519 6650 =+ 343-4744 CERTIFICATE OF HEALTH AUTHORITY ' = APPROVAL FOR A SINGLE FAMILY DWELLING ' Parcel I.D. # HAA # W Q S O li q 1. .GENERALINFORMATION ­-Compiete legal description Lot 2; B4oc1z 2; Mountacn llafzey Eatatea r , . _. do _... _ Mi Ce 5.1 Hitand Road Location'(Sith address or directions) -`wner_; = B66 SeymouA - Day phone 696-1754 Property jMailingaddress=' HC 85 Box 9417 Eagle Riven, AK 99577 •Lending agency ' ' ' Day phone T' Mailing address ,. Agent Evarlohen/ REMAX OF EAGLE RIVER Day phone 694-4200 Address 16600 C2.,it6igiiBd Dnive Eagti ReveA. AK 99577 ,, Unless otherwise requested HAA will be for pickup �--. 2 NUMBER OF BEDROOMS 3` rn < Iq.+1� 3 TYPE OF�WATER SUPPLY _ m4. r Indrndual wco­ ell r -- „Community well Pubiicwater c 2 NOTE If community_well system, provide written confirmation from Statg,ADEC attest •:• �� E Ing to the legality and status of system. ` '•ill �' 4. TYPE OF WASTEWATER DISPOSAL _ a_ilndIvIduaI on-site xxx J t .�:+. t i.i.: ...1��.'�.iw_`b7.:C:f:°-1 _ I f _ - , .. z. " •�- 'i'- � .� � .n iJE : n Holding tank ` 1 4 a, SCornmunity on-site.. Pu",.bli lc sewer r .vim.. .- •• f. N+ Er t:.Ni, NOTE: If community wastewater system, provide written confirmation frdr State ADEC attesting to the legality and status of system.' - Lc II-ri;BM.VYtI Nan MOAm C _. ...M« .... •,{i •i.l lir 7, , + �t :: a r I i ':I IL - r is ,, I Y.. . S. STATEMENT OF INSPECTION BY ENGINEERi � , 1'! ii':;. i a .1 j. �-!l h'�- �:� i .aJl j.(Ir It r1 �ray; ?'; �'ir I+t Y'dir¢>'t4"^nn•iiA'^i •r,f`,'I. a.., t�F�l .,• f a ", As certified by, my seal affixed hereto and as of the validation date shown'below, I verify that my Investigation of this Health Authority ,Approvai application shows that the on-site water supply and/or wastewater disposal system is sate, functional and adequate for the number of bedrooms and type of structure indicated herein. I Iurther,verifythat based on the Information obtained from the Municipality of Anchoge f railes 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 EDIGIIIEERIl19 Phone 17034 Es Address gle Rlve L pki .:',1..'../7�9t' Engineer's signature Date r ' . It'll i 1' 15` '`��OF�`�• 1 I . .: " y+�• 'ROBERT C COWAN!? . it Vil90 6 l DHHS SIGNATURE 1 i `, 1 fit FRCIE,StOt� ,C irti.+;�q1 !/+' r: tatiRl►a}1['C� Approved ,for ''I •1 i , ••I l� 1 '{ +, '', fi'ii� l �I I I-�£ I Disapproved. Conditional approval forA I L I bedrooms; with eV stipulations: •.r .11 r 1 I, ; r: .., `1 �'A 'I«t ..i �. •:1 I" ';' f 7(-I:r,.l'., .• ., "�- � Y'a � � � 'I, 'bl-1 �'' :�,I 1 'rr Iril I'r`• l��t�ii7'� '. _Additlonul Comments � - •.Jd l�i 1 .1. t+•: r Ul•.Ilf 1.1.1/,,•. 1 1 I . :I' 1. Inc- +•' ). " L't'+ • + 1 ; 'a 1't r ti (1O ♦t L{!'r #: I"'li .0 C+ I Date By:d 3 S it al j I I, L '° , I r,i,Mf:�,I h'Illtii LaZ"ii r 1 }•'; `e ' , CAUTION i. The Municipality of Anchorage Department of Health and Human Services (DH I�S) issues Health Authority Approval Certificates based only upon the representations given In:paragraph,5'above by an independent professional engineer registered In the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions in'order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections.or.analyze,data,before;a;certificate is�Issued. �The Municipality of Anchorage is not I �* 111.t., responsible for errors or omissions in the professional engineer's work . 1, 1 ¢n. f7.il uil;?i1{i'/ _•' �$1 Y L; i' �:� �i t U':j'Ni',.� j:}• n-W(FtW.uvq B=k (MO7 621 ...�.:1♦`*'9trr Y: Sia: y ,y�.« ' Municipality of Anchorage Department of Healtti and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lor2 2 t qtr+ \I a Lt4Lv 4.r Parcel I.D. OSo Loa 1 10 A. Well Data Wen type ?Aklp- If A, B. or C, attach ADEC letter. ADEC water system number 111A Log present ON) Date completed 12—s 2 Driller S v %,A Total depth %40' Cased to 7A' S.Iz. Casing height 1221.1 - Sanitary seal aN) J Wires properly protected U/N) J FROM WELL LOG AT INSPECTION z Date of test 12-e2_ S-Ile_q� rn -c Static water level q co' `i e' l'1 M W v, o Well flow 'i, o g.p.m. t,•s g.p.m.� Pump level/ OIL- N C SEPARATION DISTANCES FROM WELL TO: z " Septictholding tank on lot I oo; On adjacent lots Absorption field on lot 1 oo iy ; On adjacent lots o 1k Public sewer main �1 a Public sewer manhole/cleanout �A Sewer service line 1-!51*' Petroleum tank 25 �+ WATER SAMPLE RESULTS: Coliform 0 Nitrate 2.53 Other bacteria b Date of sample: Collected by: S S S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed • Tank size 1 oo d Compartments Z CleanoutsjONq J Foundation cleanout®N) Depression (Y4D r� l High water alarm " Alarm tested (Y/N) " Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1001 On adjacent lots 100 14- Foundation S t4- To +To property line S Absorption field `3 • Water main/service line I o 1 Surface water/drainage 1 b o %k 72-M PAM*Fmm - CONTINUED ON BACK PAGE C. UFT STATION Date Installed Manufacturer Size In gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level 'Pump on' levet at Meets MOA electrical codes (YM) SEPARATION LIFT STATION TO: at lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed -33 Soil rating (GPD/F12) 1I L - d ell- System type 1-14?AI C 14 Length loo' Width Z.S Gravel thickness � �Total depth -7.51 Total absorption area 4 be. e-,,. Cleanout present �/ _Depression over field (Y® Date of adequacy test 6" ( t. _C1 5- Resufts_<0Nail) PASS for 3 Bedrooms Water levet In absorption field before test 12_" After test 2+" Peroxide treatment (past 12 months) (ya) 4z 0 r, 9--.A c A A If yes, give date �� a SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot l oo Tk On adjacent lots loo' - Property line I c" 4 To building foundation 1 t I TO existing or abandoned system on lot 'AA, adjacent lots 30 �} Cutbank I ti Water main/service line 1� Surface water !oo Driveway, parkingIvehicle storage area 1,5, alp Curtain drain E. ENGINEER'S CERTIFICATION r I cenify that l have checked, verified, or conformed to all MOA and HAA guidelines in of Mis inspection. _r'rfZ�� � 5, Signature r �,..*. Engineers Name ✓t d'4-fx % C. CO WRQ✓ 10 ROBERT C. COWAN J`4 Cc - 8301 l Date S �i �1S' Of r�•. r�3 HAA Fee $ C�.6.m "� Date of Payment Receipt Number 72-026 PSM' Back Waiver Fee $ Date of Payment Receipt Number 1 Time APPLI('WTILLS OUT UPPER HAI'O'�ONLY Property Owner Time Time Mailing Address -r, , C) r �.: -� _ : - '\ Zip Code �. J j :�, ) _], l Buyer Date � d / Address ICraL.7 . LM C', : ! . =n i Zip Code Lending Institution 1-,-i lVuGrCt�-a-.( � r�,,--r-(,� moo. C-:/ r�l/� Phone Address j7 P/�[,�{1, /--^%,..moi. �) f)-�'t--vt S�-Y < /./ G� C Zip Code k_ Realty Co. & Agent (�,f /y-`-- /�1. J �) (� C, .TIL C �� �t e-', 7`AL Lf- // Phone Address 7�" �!, !�• /'� l' ,2 l/ I Code Legal Description /Zip ��.(9�� Street Location Type of Residence DateSP-Wer Installed Single Family ❑' Multiple Family No. of Bedrooms ❑ Other WWell Water Supply Individual Septic Tank Size 0 .ATTACH WELL LOG. A well log Is required for all wells drilled June 1975. ❑ CommunityFor ❑ Public Utility I' since wells drilled prior to that date, give well depth (attach log If available). Sewer Disposal , Individual ❑ Public Utility Year Individual Installed: When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date � d / Inspector Inspector Inspector Inspector Field Notes: ' /�� ©• ( v �_ DI �j z4e;_0 2 u JUN 2 41983 k_ '•Munic!pality of AnchOragd' " ne t. of Health & ( 11 APPROVED BEDROOMS 3 'CONDITIONS OF APPROVAL EnVI(Lnniental r0 eC i0n ( 1 DISAPPROVED ( 1 CONDITIONAL APPROVAL - DATE _57-, BY: BY: Soils Rating DateSP-Wer Installed Well To Absorption Area Well Log Received WWell to Tank Septic Tank Size 0 6N