Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MOUNTAIN VALLEY ESTATES BLK 2 LT 14
Mountain Valley Esta Block 2 Lot 14 #050-641 - 11 Municipality of Anchorage Page 1 of. ,3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Al(]sko 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000311 PID Number: 050--64-1 --11 Name:RON FELLOWS Wastewater Syetem." [] New · Upgrade S, ddress: MILE 5.5 HILAND ROAD EAGLE RIVER, AK ABSORPTION FIELD No. of Bedrooms: ~h°ne:(907) 696--05,39 3 IDeap Trench DShellow Trench DBed [DMound BOther LEGAL DESCRIPTION 4.0 GPD/Sq. r~ 6.5-7.0 14- 2 MTN. VALLEY EST. 3,5-4-.0 F~3 F~. -- -- -- 1.6-2.0 r~ 54 0rovol wkNh: Number of ~ne.: IDr.~on~ bet,e., WELL: [] New [] Upgrade 5,0 F~ 1I - ..,~.1\~-G r~ r~ 4504' sa. r~ASTM D-3034./F-810 SEPARATION DISTANCES = s,ptio rn Hordlng rlS.T.E.p. To Septic Absorption Uft Holding ~ublio/P~ivote From Tank Reid Station Tank Sewer tines ANCHORAGE TANK 1000 Well 100'+ 100'+ - 25'+ STEEL 2 s.~oce lOO'+ ~oo'+ - - LIFT STATION ~ Water Lot 5'+ 10'+ __ -- ~ ~onufacturer~ Line Foundation 5'+ 10'+ -- -- NONE KNOW[q Drain Remarks: BENCH MARK TOP OF TRIM ABOVE FRONT DOOR IA~.umed El,'.'utron: 1 18.47 .... ...:.. ......... ::¥.1 Inspections performed by: AWWC, INC, Dates: 1st 8/24/2ooo 2nd 8/24-/2000 · ~ ~J , · ~'d~..,,~ ~ .~,....¢ ....... ', 3rd 8/28/2000 '.J~ !~' rey/~,. ~ar, fiess." Department of Health and Human Services approval (i~ ,.~ ....... Reviewed and approved by: D~,¢/,/~'~/ ~/. /0~, Date: ~>'~ 1-o0 %~,~,~o~,o~ PERMIT NUMBER: AS BUILT DRIVING PARCEL ID NUMBER: SWO00311 ' 050-641 -I 1 ¢1 ~ ,~,n\~3~............-""~ , DBL1 32.19 42.09 ~ ~ ~ .. t NOTE: EXISTING ~ ~ ~ ~ ~ % /~ SeT~C TAXX , ~ ~ ~ ~ ~.~ // ~EXlSTING DRAINFIELD -- ~ ~ ~ ¢ / S~"~ // + / TO BE USED AS %. ~ ~ ~ / ' S~2~/ ~ / A RESERVE SITE I~ '~ -- ~ ~ - INSTALLED FLOWj""i ' ~ . ~ ~ , DIVERTER (FD) ~ ~ ~ // DATE: ~ . ~S~ ~VATER & W~TE~VATER C.J.~. PREPPED FOR: PHONE NUMBER: PA~E NUMBER: RON FELLOWS (907) 696-053g 2 OF 3 ~;;f;;~¢'~;;~;;;;~""~ MOUNTAIN VALLEY ESTATES S/D; LOT 14, BLOCK 2, ~E OF WORK: Pro .~ ~o~0~ AS-BUILT OF SEPTIC SYSTEM UPGRADE '~";o~%": AS-BUILT DRAWING AI ~AS~ WATER & WASTEWATER c.~.~. 6901 DEBAR RO~. SUITE ZB · ~CHO~GE, ~ 9950~" PHONE (907)337-6179 * F~ (907)338-3Z~6 j f ~)~..~ PREPPED FOR: PHONE NUMBER: PA~E NUMBER:~ ~., RON FELLOWS (907) 696-0559 ~ OF ~ )~ t~eFfre A~r~es~;/'"~ MOUNTAIN VALLEY ESTATES S/D; LOT 14, BLOCK 2, '~,,.~.; ............ -~;~ PROFILE AS-BUILT OF SEPTIC SYSTEM UPGRADE MUNICIPALITY OF ANCHORA GE Department of Health and Human Services On-Site Sen/ices 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: Aug 21,2000 Expiration Date: Aug 21,2001 Permit Number: SW000311 Legal Description: MOUNTAIN VALLEY ESTATES BLK 2 LT 14 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Pon Fellows Owner Address: PO Box 771484 Eagle River, AK 99577- ParcellD: 050-641-11 Site Address: Lot Size: 45882 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 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: t. 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: / Oate: Date: /¢-- 2/--¢D ALASI(A WATER & WASTEWATER August 8, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Upgrade Design for Lot 14, Block 2, Mountain Valley Estates Subdivision To whom it may concern: The existing 3 bedroom house is served by a private well and septic sy~isting septic system consist of a 1000 gallon septic tank and a deep trench typ~Qdain£~The existing drainfield is completely saturated and must be upgraded prior to the sale oTrlTe house. A test hole was excavated west of the existing septic system. The proposed septic system will be designed around the 30 foot radius of this test hole. We are proposing that a new 1000 gallon septic tank and a five foot wide drainfield be installed. Comments regarding the proposed septic design are summarized as follows: 1. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layers are a GM to GM/SM material to a depth of 14 feet (bottom of test hole). No groundwater was encountered at the time of excavation. The monitoring tube was checked seven days later and found it to be dry. A percolation test was performed between the depth of 7.0 feet to 7.5 feet which had a percolation rate of <1 minute/inch. It is our opinion that the insitu sandy soils will act as a sand filter and that a application rate of 1.0 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.0 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 ft2 f. Total Depth: 7.0 feet (max.) g. Effective Depth: 3 feet h. Width: 5 feet i. Reduction Factor: 0.58 6901 Deban' Road, Suite 2B - Anchorage, AK 99504 ~ Ph: (907)337-6179 - Fax: (907)338-3246 i. Minimum Length: 54 feet long j Effective absorption area = 466 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached design, the average topography in the area of the proposed septic system is a 10 to 15 percent slope running from approximately west to east; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Jeffr~ ~t Presi pti NOTE: Attached is a site plan drawing, a design drawing, two soils logs, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B - Anchorage, AK 99504 - Ph: (907)337-6179 ~ Fax: (907)338-3246 LOT 6, BLOCK 5, ~N. V~ EST. S/D RON FELLOWS (907) 696-0539 ~GAL BESCRIP~ON: MOUNTAIN VALLEY ESTATES ~E OF WORK: SITE P~N FOR SEPTIC SYSTEM UPGRADE ~TE: THE CONTRACTOR SHALL HAVE THE 100 FOOT WELL RADIUS FLAOGED BY A RECiSTERED LAND SURVEYOR \ 8/8/2ooo A~SI~ ~V~FER & WASTEWATER J.L.M. CONSULTANTS, INC.~ ..... 1" = 30' RON FELLOWS (907) 696-0559 2 OF 2 DESIGN Of SEPTIC SYSTEM UPGRADE LEGAL DESCRIPTION: MOUNTAIN VALL~ ESTATES S/D; LOT 14, BLOCK 2, ~ ........................... PERFORMED FOR: RON FELLOWS DATE PERFORMED: 8/1/00 ~ N.-'-f' DEPTH ~ (f ORGANICS SOIL C~SSIFICATIONS / ~ ~ ~ / ~ISITE PLAk ~ GP ~ ML i GC OL ~ ~SW MH ¢~"~ SP CH SM OH ltNll OM/SM 3ROUNDWATE~ DEPTH TO DRY 8/1 DATE/OO__ DRY 8/8/00 Z PRO 'OSED SEPTIC UPG~DE ~ --- ~o ~ DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIHE (HINUTES) READING (INCHES) 12 18 19 PERCOLATION RATE <1 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20 TEST RUN BETWEEN 7.0 FT. AND 7.5 FT. COHHENTS: PERFORMED~YiA~SKA WATER & WASTEWATER. I, JEFFR~ A. GARNESS, CERTI~ THAT THIS WAS PERFO~ IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DEPTH TO DATE SROUNDWATE~ DRY 8/1/00 DRY 8/8/00 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAI LING ADDRESS LEGAL DESCRIPTION LOCATION ~ ,/ DISTANCE TO: ~<~1- ~ Manufacturer ~h- L q. cai Well ! Absorption area · "'r"lO0 /0 ~ DISTANCE TO: IF HOMEMADE: Well Inside length Dwelling Well DISTANCE TO: No. of lines / Length of each,~line Top of tile to finish grade Length Width Type of crib Crib diametol DISTANCE TO: DISTANCE TO: Well }undation Foundation Total length of lines Material beneath tile Depth Dwellinq Material Width Material Nearest lot line 1~- ft.., Trench width r? (cinches OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS NO. OF BEDROOMS PERMIT NO. No, of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance be~ i~il~es'~TM PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Sewer line Distance to lot line Septic tank ¢ PERMIT NO. ~.. -I ~' Z' '"~ ~' ' (' '" '"'"'~ ~ 1Absor pt i.o.~n area(s) APPROVED 72-013 (Rev. 3/78) DATE LEGAL 'THE !.IEI'.,tGYH !) ]: HE:I'.,!:~i; :[ CH'-,! '?:!~ 'T~hi": I....,~:i',.!(]iTH ,::]:!.,I F:'!::i:E:'T::, OF' THE: TF!Ei' !)[i'~F'TH O1::: t:::l 'l'l:;;:lii:?.,lC:l.!. OF;i: I:::'Z"t" :[:~ 'rl"H[~: E:__.::,,'t ....... I h.l['.,,¢:i::'l. E!:F~:')"I,.)f:!!:[~]i'.,! '!'HE: 'E;L F;'I::'.:::I'*,? O]::: 'fi.liE G F'. ]) F F, R H E:, "I"I-li!E ::: '" 'T"" ": I"' E!I:::' "i"H E: E:'.' '": F!' ' F:I T .t: C'!I'.,! ,:: ]: I'..I F:'E:[ii: T "l'H[ii:l:;;:E ]::iii; H():E;[:'71" I,! :!: !:::,'1'1-t [:;C~[;;: "i'F:'I::_:".i'"H[~¥_.. 'FI.dE EiFi'FI' % !)(:.':F'TF! :I: :5 THE !"! :[ I'.! :( HI..IH r',{::F:'T!.I O,~::' ":;I:?F 'v'.:.:'.. !3[ii:TI,.illiL'EN T!..tlE OI I'T'I:::'Fi .......... F::' ]: I': !:::I['.,!E:, 'l'Hli:~ F: '"'i ......... ,1 OF: Ti...h~i: F .......... _ ........... · ,L" :.. F.[r'l'.,I ,'Zi'.,l H ): !",! ]: t"It...IH E:, :[ :E;'TI::ff.,iC:E Ei;E'TI.,.![:~Zi:I'.,I I::1 HE!...L I::ll'.,!E:, F:It'.,!¥ OF,l-...:.::; ]: "I"E: :~i;[EI,.ff:!G[E E:, ]: :SF'OE;FIL. :~?'r':E;¥E?'I :i: ~; ::t..~;~l;~l F'EE'T F:'OR F! t:;:'F~:Z',/FI'TE h.![~:L..L.. O1:~: :L~;?.I "i'O ;;~::(~el i:::'[~:~¥[' [:'[~:O!'d I:::1 I::'L.IEH..:[C HELL. UF'OH TH[E ¥"FF:'E OF' i::'U[3!...ZC: HELl. I'"1Z ?',! ]: !"ti.J1"I !::, :[ ?FF:ff.,IC:!Z F:'F;:CH'"I !::~ F'F: ;!: 'v'F!¥E I,.IEL. L. "1'O !::! [:'F,?. ]: VI::ITE :5!E!.,.IE!:;;'. L.. ]: ?.,!E :I: :~:; ;Z~]~ F'E~Z'I" 'TO !::~ C:OHI'dL.Ii'.,]:[T'¢ ~:E:H[EF: L.]:NE :1::{:; 7~; FI',,,'F:t Z L..!:::IEH.._IE ¥O :[ h,!~;I..IF;:E: F'F;:OF'EF~: :[ t"4:~;TF:IL..LFTT ]: ]: C:EI:¥'[':i: F:'"? YF!F?i' ::L: :[ !::11"! F't:::IH ): L. ): FIr;;: I.,!:["['!..I 'FFIE Fi:!iE[;:!U]:I:~:EHE!'..!T:iii; FOR Ed'.,F..:iii;]:'l'E: :iii;!:EHE:l'~::5 FIND F:'ORYH E','¢ 'Fi--~E i"!UI'.,! :[ C :[ F'FIL.. :[ ']"¢ OF' F:IF,ICHC~RI:::iGE. 2: ]: !.,I Z L.L.. :!: !",?5'f"F!L.L THE :5'.r'~7'I"E:H ]: !q FIE:E:OF:DFihlC:E: I.,.! :!: YH 'THE 2.:: Z U!",E:,[EF;::STi:::!!'.,!E:, 'T'i'.IFiT 'f'F!E CH",I-...'5:[TE: :SE!,.!EF~: :;?'~%¥EH HI:::I? F;;:E~:;¢...I:[I:;;:E iENI_..F:!t:;',:E~[/H!EhFf' ZF' 'T'H!~E FIF'I:::'L ]: C:F!I",!"!' !:::'J~¥:!l",~ I:::,!~:I..L.I~:::: ]: Ff / O & E ENG.NEERING & DEVELO, Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 MENT CO. Russell Oyster 694-2774 Performed for: Mailing Address: Legal Description: Depth (feet) 0 6__ 7__ 10__ Soil Characteristics Earl EIII~ SOIL LOG 688-2280 PLOT PLAN 11__ 13 15__ 16__ Ground Water Encountered: Yes Proposed Installation: Seepage Pit__ Comments: No ~ If yes, what depth Drain Field, ~ PERC. TEST Performed by: ~'~ (ger,ifie Drilling by DOC Co, dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND - ' DEPTH OF WELL ADDRESS ,' ', :; :( f .... ' . LEGAL DESCRIPTION DATE - Started PERMIT NUMBER Ended STATIC LEVEL OF WATER FT. DRAW DOWN Ft. GALS. PER HR '." KIND OF CASING KIND OF FORMATION: From From From From From From From From From From From From From From From From Ft. to Ft, __ Ft. to , ,, Ft. Ft, to.__ Ft Ft. to ,: Ft. Ft. to Ft, Ft. to / ' :'~ ,Ft. __Ft. to. : , .Ft. Ft. to Ft. Ft. to ,~ ' Ft~ __.Ft. to Ft. Ft. to__Ft, Ft. to__Ft Ft. to__Ft Ft, to Ft __Ft. to__Ft. Ft. to__Ft. 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. From Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME PERMIT NO. [:,EF'FIF.:"I'MENT OF HERLTH FIND EN',,,'IRONMENTI::I/.. Ps.':O'rECTION :_--:25 '''~ STREET., FINC:HORRGE., FIK. 92 264-4720 ( 82:L20]: ) FIF'PLICFtNT 'TON"¢ [:,ELI...IC:IR BOX 22:4 E.R. 99577 L. OCFtTION LEGRL_ L±4 E:2 MT ',,,'FILLE"r' E'::;TFITE:i.:, L.O]" 'SIZE 694-]:424 999999 S6P..ItBF,;:E FEET MINIMLIM [:,ISTFINCE BETP.IEEN Ft [4ELL FIN[:, RN"r' ON-SITE SEI.,.IRGE [.',ISPOSRL SYSTEM IS ±00 FEET FOF.: R PRI',,,'RTE WELL OR ±50 "rE) 200 FEET FROM FI PUBLIC I.,.IELL [:,EF"ENDING UF'ON THE T"¢PE OF PUBL. IC kIEL[_ MINIMUM [:,ISTtBNCE FROM R F'RI',,,'RTE I.,.IEL. L TO R F'RI'¢FtTE '::;EWER LINE IS 25 FEET Bf.,ID TO FI COMMUNIT'-r' SEWER LINE IS 75 FEET. I.,.IELL LOG'_'5 FIRE REQUIRE'g, RND MUST E:E RETURNED TO THE [:,EPRRTMENT FIITHIN 3:0 DR'CS OF THE HELL C:OMPLETION. OTHER RE6PJII.;..'.EMENT9 I'"lR"r' RF'PL"r'. SPECIFICRTIONS RND CONL=.;TF.:UCTION [)IRGRRP'IS RRE FI',,,'RILFIBL. E TO IN'.SURE F'ROF'ER INSTRLLFITION. I C:ERTIFY TPIFtT ±: I Rl'd FRI"~ILIFtR ~4I'f'H THE RE6!LIIREMENTS FOR ON-SITE SEI.,.IEF.'.% RN[-" 1.4EL. L$ RS SET FORTH B"? THE I"ILINIE:IF'RLIT"r' OF RNCHORFIGE. 2: I MILL INSTRLL THE S'¢STEM IN RCCOR[:'FINCE MITH THE CO[:'E:S. S I GNE[:': ......... .t__'~¢'~_ ~ ........... RF'F'L I CAF, IT TON"r' [:'ELIJC I FI Lr:,r 'r .... '¢4. 0 MUMUPALITY 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. 050-641-11 1. GENERAL INFORMATION Expiration Date: l 1 — z & ^Z 07 0 Com lete in al descrl tion MOUNTAIN VALLEY ESTATES BLK 2 LT 14 P g p Location (site address) 4719 Hiland Rd Eagle River AK 99577 Current property owner(s) BRAUNSTEIN BRIAN Day phone _ Mailing address Real estate agent 4719 Hiland Rd Eagle River AK 99577 Olga Persinger 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 907-310-0641 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -I /2, 5U. CO Ul D Waiver Fee $ Date of Payment JAI /20 Date of Payment Receipt Number C)6 �� O3 1 Receipt Number COSA # 05G2_O I L 7 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 Eklutna Engineering, LLC Phone 907.355.9820 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date 8/20/2020 6. DSD SIGNATURE System #1 Approved for _a_ bedrooms System #2 Approved for bedrooms OF `k4 Curtis ' T .... d ..... 19�.• DateZ Zo No. CE 1 904 I&DpROFESsi6N 1_ Disapproved -`vara® Conditional approval for bedrooms, with the following stipulations: CtM ©12--oLa �-Q rUCCp (?C i Ca-Vf &9 �J �o �T J G J l jcq�— KK—NTY OF ON-SITE'v�, WAND Tr_-iT ITER o PROGRAM �., . Original Certificate Date: V—�0 -2 oco 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other A1C P Zd yr 1 Legal Description: MOUNTAIN VALLEY ESTATES BLK 2 LT 14 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1982 Total depth 120 ft Cased to 74 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) + 18 in. Date of flow test for COSA 8"2/2020 Static water level at beginning of test 62 ft. Comments B. TANK DATA Age of tank(s) 20 years Tank type/material septic Steed Measured operating fluid level in septic tank 50 ❑M Standpipes/foundation cleanout per record drawing Date of pumping 5/11/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 2000 ❑ ALL standpipes present per record drawing Total measured depth from grade 8.66 ft (max) Measured depth to pipe invert from grade 5.5 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 Parcel ID: 050-641-11 Structure served by this system Well production at time of test 6.1 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.460 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 8112/2020 r C. LIFT STATION ❑ Required maintenance Age of lift station Lift stationmaterial Comment Adequacy test date 8/12/2020 Results DKPass For 3 bedrooms Fluid depth prior to test 0 in Water added 795 gal New depth 0 in Elapsed time 120 min Final fluid depth 0 in Absorption rate ' 450 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' r✓ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 7/1 Yes if No ft Private Sewer/Septic Line > 25' ED Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' 0 Yes if No ft Water Main > 10' Animal Containment > 50' P-1 Yes if No ft 0 Yes if No ft 0 Yes if No ft Water Service Line > 10' [Z1 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' 0 Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' [Z1 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 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' 21 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 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 DEVELOPMENT SERVICES DEPARTMENT , On -Site Water and Wastewater Section www.muni.org/onsite Septic Bank Advisory Certificate of On -Site Systems Approval #OSC 201447 Subdivision: Mountain Valley Estates BLK 2 Lot 14 907-343-7904 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 20 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 Atliiress P Box 196650 *anchorage, Alaska 99519 6650 * uG,Wiw urn org 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.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. 1. 050-641-11 GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: Complete legal description Location (site address or directions) MILE 5.5 HILAND ROAD Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MOUNTAIN VALLEY ESTATES SUBDIVISION; LOT 14, BLOCK 2 * EAGLE RIVER~ AK 99577 DAVE DUFFY CONTACT AGENT Day phone 694-5565 Day phone PETE FERRIS w/ DYNAMIC PROPERTIES Day phone 3111 'C' STREET * ANCHORAGE, AK 99503 229-1637 Unlessothe~e~queste~ HAAwillbeheldbyDSD~rpick~. 2. NUMBER OFBEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 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. Note:Alaska Water and Wastewater Consultanls, Inc. shall be paid $.~ at, or pfior to closing for the engineering services provided. 4, STATEMENT OF INSPECTION BY ENGINEER As cergfied by my seal affixed hereto and as of the validation date shown below, I ved[y that my investigation, based on procedures outlined in the Health Authodty Approval Guidelines for this application, shows that the an-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedreoms and type of strt/cture indicated herein. I further verffy 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 b'me of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B "ANCHORAGE, AK 99504 Engineer's Printed Name JEFF~E'Y A. CARNESS, P.E. 357-6179 Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineertng analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results desc#bed 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 ali wefts 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 the control of the evaluator of the system. Satisfactory test resutta do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encmachments. AWWC, Inc. can therefore not prov~de any warranty or future estimate of how long the system wi//continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the $o/e benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor wi//it confer any legal tight whatsoever. DSD SIGNATURE ~ Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: .-.. : WASTEWATER .' Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements ~, ~,~ Supplemental Engineers Reo~ Other Original Certificate Date: Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 South 8ragaw GL P.O. Sox 196650 Anctmmge, AK g9519-6650 w~v.cl.anchorege.ak.u~ (9O7) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MOUNTAIN VALLEY EST. S/Dj LOT 14, BLOCK 2 Parcel ID: WELL DATA Wall [y~ PRIVAI~ If A, B, or C provide PWSID~ N/A Date completed 7/1982 Sanitmy seal (Y/N) YES Total depth 120 ft. Cased to 74 ff. Date of test FROM WELL LOG 7/1982 Static water level 55 .ft. Well production 3.5 g.p.m. WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi. Arsenic: .~O~ mg./L. 050-641-11 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 8/28/2000 56 .ft. 2.6-1. g.p.m. 18+ in. Nitrate o 7~r mg,/L. Other bacteria ~ colonies/100 mi. Date of sample: ~'/~ Collected by: AKWWC, INC. TRENCH 3.01 Depression over field__ SEPTIC/HOLDING TANK DATA *INSIDE CRAWl. SPACE Tank Type/Material STEEL Date installed 8/24/2000 Tank size 1000 gal. Number of Compartments 2.. Cleanouts (Y/N) YES Foundation deanout (Y/N) ~ Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping ~ Pumper JR'S PUMPING ABSORPTION FIELD DATA & t.,~l~ ~ ~ ',,~=~' o~). Date Installed'1¥ 8,/24/2o0o Soil rating ~or fl~)drm) 1.0 System type Length 54. ff. Width 5 .ft. Gravel below pipe ft. Total depth ~.l-e.ss fl. Eft. absorption ama 450+ ft= Monitoring tube YES NO Date of adequaoy test ~ NEW Results (Pass/Fail) - For 3 bedrooms Fluid depth in absorption field before test - in. Water added - gal. New depth - in. Elapsed Time: - min. Final ituid depth - in. - g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) - Absorption rate >= N/A If yes, give date D. LIFT STATION Date installed Size in gallons ~_ "Pump on" level at in. "Pump off= n. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES Septic tank/llft station on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: 100°+ 100'+ N/^ 25'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: · Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ · Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Absorption field 5'+ Sudace water, 100'+ Water main N/A Driveway, parkingJvehide storage 10'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspec~ons and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) - OHo Waiver Fee $ Date of Payment Receipt Number RPE-]5-02 NON 02:49 PU Dyna,;c Properties ASBUILT-NO CORNERSI THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY~ Hountain Valley £Stnte. s,Lot 16,Blk. 2 AND THAT NO ENC~OACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED StJBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SFIOLLD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, .OR.FO.~ E~k'TABLISHIN$.BOUND._ ARY LINES. Sk'14ARD & ASSOCIATE~ LAND SUrViVING 688-~566 . _...... · l DATE' -- ~,...."' ~ ........ . ,~..~' . 2-28-91 ~'~ ' ~L' '~ ~ · _~/~;a .... ~...~...... { awm .......... Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Sita Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343~.744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 050-641-11 1. GENERAL INFORMATION Complete legal description MOUNTAIN VALLEY ESTATES S/D: LOT 14. BLOCK 2. Location (site address or directions) MILE 5.5 HILAND ROAD EAGLE RIVER, AK 99577 Property owner RON FELLOWS Mailing address P.O. Box 771484 Lending agency Mailing address Day phone EAGLE RIVER. AK 99577 Day phone (907) 696-0559 Agent JIM EWlNG W./ FORTUNE PROPERTIES Day phone (907) 562-7655 Address 2525 "C" STREET ANCHORAGE. AK 99505 Unless otherwise requested, HAA will be held for pickup. 2, NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community weft 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 ing to the legality and status of system. 72~25 (Rev. 1/91 ) Front MOA fY21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,150.00 at or prior to, closing for the engineering services provided. 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 fudher vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and in., ~ection, the on-site water supply and/or wastewater disposal system is in compliance with ali Municil~ on the date of this inspection. .~, NameofFirm ALASKAWAT~"~ .~'~,~ Address 6901 DEBARR/ROAD/ Engineer's Signature (. In conducting this evaluation, system in accordance with ADEC and MOA performance of the system under the conditic ~nd State codes, ordinances, and regulations in effect ER CONSULTANTS, INC. Phone (907) 337-6179 /,~ ~TE 2B_ AN 3HORAGE, ALASKA 99504 Date ~ /-% ?/(25 1pled to~rovide a thorough, conscientious engineering analysis of the HS Guidelines & Regulations. The reported results described the encountered at the time of the test, and separation distances measured to readily identifiable features. The o )erational life of all wells and septic systems depend on the local soils condition, ground water 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. AWWC, Inc. can therefore not provide any warran6, for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. 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. 6. DHHS SIGNATURE ~ Approved for .3 Disapproved Conditional approval for bedrooms bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 1t91) Back MOA #21 Computer Version RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Divisi~U-G ~9 2000 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 UI~IlI~IPALITY OF ANCHORAGE 'EN~DNMENTAL SERVICES D~VtS ON Health Authority Approval Cl~ecK~lSt .... Legal Description: MOUNTAIN VALLEY EST. S/D; LOT 14, BLOCK 2, Parcel I.D.: 050-641-11 A. WELL DATA Well Type PRIVATE Log present (Y/N) Total depth 120' Sanitary seal (Y/NI YES Date completed Cased to 74' IfA, B, or C, attach ADEC letter. ADEC water system number N/A 7/82 Casing height (above ground) 18"+ YES Wires propedy protected (Y/N) YES Date of test FROM WELL LOG 7/82 AT INSPECTION 8/28/00 Static water level 55' 56' Well production 3.5 g.p.m. 2.6+ g.p.m. WATER SAMPLE RESULTS: Coliform '~ Date of sample: 8/28/2000 Nitrate ~ ~.~--~) Other bacteda Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA *INSIDE CRAWLSPACE Date installed 8/24/00 Tank size 1 O00 Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) *YES Depresmon (y/N) NO High water alarm (Y/N) N/A YES Date of Pumping NEW Pumper C. ABSORPTION FIELD DATA Date installed 8/24/00 Soil rating ~or ft2/bdrm) 1.0 System type TRENCH Length 54' Width 5' Gravel thickness below pipe 5.01' Total depth 8.1'-8.96' Effective absorption area 450 SQ. FT. Monitoring Tube present (Y/N) YES Depression overfield (Y/N) Date of adequacy test NEW NO Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/g6)* Computer Vemion Results (Pass/Fail) For_ 3 Bedrooms - Immediately after - gal. water added (in.): - - Absorption rate = - - If yes, give date - D. LIFT STATION ~ '~ .i '~ ~ Date installed , ,,, ~__ __ __ Manhole/Access (YIN) ~evel at* "Pump off' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100% Public sewer main N/A Public sewer manhole/cleanout N/A Sewedseptic service line 25'+ Liflstation N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 10'+ Surface wateddralnage 100'+ Wells on adjacent lots 100% SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10% Water main/service line 10% . Surface water 100'+ Driveway, parking/vehMe storage area 10% Curtain drain NONE KNOWN F. ENGINEER'S CERTIFIp~ATI. J~)~ of Municipal r~ord$ Signature ~ EngineePs N~ field inspections and review systems are in conformance on this date. JEFFREY A. GARNESS Wells on adjacent lots 100'+ ' A. ~d~'ness.. ~ ;-7953 ..," ~ .' ~ HAA Fee $ ~ ~ ~ Date of Payment ,,~//~ ~' /'~'~¢ 72.026 (Rev. 3/96)* Computer Version Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~'-~(/'/- / ) NAA# ~ GENERAL INFORMATION Complete legal description ~ot 14; Block 2~ Mountain Valley Estates Location (site address or directions) 9382 Hi,and Road Eaqle River, AK Property owner Mailing address Lending agency Mailing address Agent Address Lydia Housb~r~ Day phone C/0 REMAX EAGLE RIVER Attn: Eva Loken 16600 C¢~rfigld Dr. Eagle River, AK 99577 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 #21 Se 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 effect on regulations in the date f this inspection. Name of Firm __~ Phone ~/'.,~"/~.~.2 .~ Address 17034 Eagle River L~p ~d ~ -- ~ E ngineeFs signatu ro~ ~~~ DHHS SIGNATURE Approved for ~'~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 72-025 (Rev. 1/91) Back MOA ~1 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~m--\~ ~¢¢"2.-. ~1',~ ~,~.,~.,~ E:~.r, Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed "'7 ~ '~ 7.~ Driller S ,~, ,J Cased to ~/~' Casing height Wires properly protected [t~N) A. Well Data Well type Log present (~) Total depth Sanitary seal Date of test Static water level Well flow "5 ,~" Pump level1 FROM WELL LOG AT INSPECTION g.p.m. ~', ¢'- g.p.m. ; On adjacent lots ; On adjacent lots SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ ~ Absorption field on lot \ o ~ Public sewer main Sewer service line \ Public sewer manhole/cleanout Petroleum tank .?..~- vF WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: "~ -' ~'~1 , ~ z~ D, ~ "~ Other bacteria 0 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts ~,t) ,-7/ High water alarm (Y,~.. Date of pumping Tank size \ c:~_~o Cornpartments Foundation cleanout ~1) :¢¢' ¢ Depression (Y/~ Alarm tested (Y/N) -~2.,. ~- ~'/¢ Pumper ~. SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK TO: Well(s) on lot \~ ~ t~- On adjacent lots To property line ~ ~'~ Absorption field Sudace water/drainage ~ ~ 72-026 (3,'93)' Front Foundation ~5'- ' Water main/service line t~ ~'~ OONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N). "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DI~OM LIFT STATION TO: W~ on lot On adjacent lots Manufacturer Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed Length '~ Total absorption area Date of adequacy test --'~,~' .-, ,~ 7..- Soil rating (GPD/Ft2) \¢,o ~ Width ~ ~ Gravel thickness ,G ~ ~¢ Cleanout present.C~N) t · ~- / ~ ~ z/ Results (~fail) ¢',,k¢~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y_~. .System type L~~ Total depth Depression over field (Y~ for ~ Bedrooms After test /'¢" If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots I c~o ¢ ~ Property line '~ ~ To existing or abandoned system on lot Cutbank .'J//~ Water main/service line ~ ~'- Driveway, parking~vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformedtc~J¢~ and HAA guidelines in Signature $ & $ ENGINEEEI ]7034 Eagle Rive,~3~3~J~/~d No, 204 Engineers Name Ea~lle Eive~, Alas'kaL~5??/ ' HAA Fee $ ~O,-~e-~ Waiver Fee $ Date of Payment ~'~ ¢~ ~ ¢''/' Date of Payment Receipt Number /'~ ~_(oL~-c~-~ Receipt Number te of this inspection. 72-026 (3/93)' Back MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMtLY DWELLING Parcel I.D. # ~)~ -~DL\\- \\ NAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 14; Block 2; Mountain Valley Estates Subdivision; Location (address or directions) 9382 Highland Road (b) Property owner Mailing Address AHFC #44765 W.A.#91626 Telephone: (home) Business. (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address 10928 Eagle River Road Eagle River, Alaska 99577 Telephone 694-5500 (e) Mail the HAA to the following address: (or check here (~xif hold for pick up.) List contact person and day phone number below: JACK WHITE COMPANY ATTN: Lqnda Banner S & S ENGINEERING 17034 Enala. I~[ve~.oop-J~,~a~ Eagle River~ Alaska 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting'to th legalit,2 and status. 4. SEWAGE DISPOSAL On-site~. Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ~ As certified by my seal affixed hereto and as of thevalidationdateshown below, I verify that my investigation oftl~is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address17034 ~a~jie River Loop Road No, 204 .Eagle River, AlasR:a 99577_ Date Telephone 6. DHHS APPROVAL Approved fbr '-~ bedrooms by ApproVed /~.__ Disapproved Terms of Conditional Approval Conditional TheMunicipalityofAnchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S above by an independent professionalengineer 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 DHHSdonotconductinspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. 78-025 (Rev. 7/88) Back Page 2 of 2 ~ MUNICIPALITY OF ANCHORAGE (MOA) f'~,~Cf'~¢l Health Aulhority Approval (HAA) ,-' ~ CHECKLIST- FEBRUARY 1984 ,' .~'~%,, 343-4744 ' ,~'g~ ~ Legal Descri tion' ~e~/~ A. WELL DATA ~,, ~ Well Classific~0n ~ (~ N~I~ If A, B, C, D.E.C. Approved Well Log Present (Y/N) __~ Total Depth I ~O Cased to . . Static Water Level -%'-'<~ ' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / Co To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To 'Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Date Completed 7.-/ ~2.__ "74 ~ Depth of Grouting Yield Pump Set At o/(" Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) [ 00'+ ; On Adjoining Lots / CO -h ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole f B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) L1 _Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on FOe (Y/N) . Holding Tank High-Water Alarm (Y/N) /~/~ No. of Compartments Temporary Holding Tank Permit (Y/N) Foundation Cleanout (Y/N) ~ AU Date Last Pumped /-~ ~ ~ ~, - ~ 0 ; for -- SEPARATION DISTANCES FROM SEPTIC/HCLDI,N-61 TANK: To Water-Supply Well t To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course To Building Foundation .~'~ ~" / 7'0 Disposal Field ! O I00'% 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strat,a,~,/' [ ,00 q/~¢~ Type of System Design Date Installed ~ %.~_~L -- ~.> Length of Field "~¢5-' 1 ~' .,~ -- Gravel Bed Thickness Square Feet of Abs'~on .A~.~"N~ z-l/% 6 Statndpipes Preset ( / ) Depression over Fiel~/(N~~- % _ __. Date of Last Adequacy Test Resultsof Last Adequ~;~ Test ~¢r'~f .%~¢~."~¢'? -- .~ SEPARATION DISTANCE FROM ABSORPTION FIELD: / Co -F To Property Line / To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Existing or Abandoned System on ; On Adjoining Lots ~e 'Y- TO Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at /',,J '~.,'-~'/% Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** inspection.I certify that I have;~ ~;.check~ed".'., ~N,.;i,'3¢~;:i''i':r-''verified' or conformed to all MOA and HAA guidelines :.i.I !ifict ~th.~i:, da e ell. i ~ this Date '~¢ ~ "~ ¢'~ / ~V~'¢¢, ., ......... ".x '-..'.' Receipt No. ~ %- ~ 5 -k~¢ %~- Receipt No. Date of Payment cfi/ Waiver Fee: $ Amount: $ /~ Date of ~aymont 72-026 (Rev. 7/88) Back Page 2 of 2 Il'ires.. Time , ,ii~ ~)ate Date Date '~ nspector Inspector Inspector Comments ,,~,~--/'.-,.,~13.~ Conditional Approval ~ __ '~.~--~.z~_~ MUNICIPALITY OF ANCHORAG~' ~Ljg,~0 ,-.._ 0 j~._~ " ~"' '-[)ate Sewer Installed Permit No. ~~/.D,~,-O'~z Septic Tank Size / ~ - 2~ cJ - ,~. Holding 'rank Size Soils Rating Well To Absorption Area Well Log Received / Well to Tank JoQ,- ]~ -~,~ APPLICANT FILLS OUT LOWER HALF ONLY "-Property Owner ~'}'[.J~--~:(-t(. (~?.C-L-f '~_.~_a.~.~,_ C~ L:.,...~ (.)~ ~ Phone Lending Instltu~_,t~n ~: (~ ~) Phone _ ' f ,- Address ' " / i ~ p- '~ ~ ~ ,' -J' 7 -JO ' Street Location ,-/~ ¢' ~!? 00.4.~.0( r~O~( ' 'l'ype¢. f Residence C3 Single Family [] Multiple Family No. of Bedrooms [] Other Wat e.C,.Su p ply ~ZI-Individual ATTACH WELL LOG, A welt Icg is required for all wells drilled since June [] Community 1975, For wells drilled prior to that date, give well depth (attach Icg if _ El Public Utilit~y available.) Sew~Je Disposal tt~ IndiviOual Year IndiviOual Inetalled: [] Public Utility When Connected to Public Utility:. _ El Hoidin~l Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.