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MOUNTAIN VALLEY ESTATES BLK 1 LT 1
Mountain Valley Es'ta Block ! Lot I #050-631-22 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .5'//-.," ~',..¢~¢.~ ~ PID Number: ~_~o(~¢/~ Name: ~ ~~. WastewaterSystem:D New ~pgrade Add~.,~: ~o~- so,~/~ ~¢' -</~¢~ ~/~'¢. ABSORPTION FIELD Budloorns: LEGAL DESCRIPTION So, Rating: Total Depth from original grade: Lol: Block: Subdivision: DeCh to pipe botlom Irom odginal grade: Gravel depth benealh pipe Township:~ ~ Range:/~ ISe °~ct . ~ Fill added above~.~originalgrade: Ft. Gravel length: Number of lilies: Distance belween fines: WELL: ~¢~D New ~ Upgrade erave~ deplh: ¢. 0 Fl. /' ~ FL Classification (Private, ~,C): Total Deplh: Cased To: Total absorption area: Pipe material: ~riller: Date Drilled: Slalic Waler Level: Installer: Yield: Pump Set at: Casing Heighl Abovo Ground: G,M .~. ~. TANK SEPARATION DISTANCES ~..~io d HCdin~ U To 8eplic Absorption Lig Holding Public/Private Manufacturer: Capacity in gallons: Malerial: / Number of Compartments: Surface Water .... ~ LIFT STATION Lot Size in gallons; Manufacluror: Line ~ / ~ ~ ~ Curtain ~ ~ Pump Make & Mode[ Electrical Inspeclions performed by: Drain ~ ~ Remarks: ~¢~ ¢~~ ~ ~ BENCH MARK / ~ / ~ Location and Description: Assumed Elevalion: ENGINEER'S SEAL Inspections performed by: % ~¢~' Bates: 1st ¢/~/~ ~ ~'" ~*~ '"~' ..... .... .,,, 2nd Department of Health~ ,,~~and Human Services approval ""~ ~Z ""- ' * ~/STg%~ 72-013 (l/gl) MOA 25 Pa-rolL No. SW930338 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 ' Anchorage, Alaska 99519-6650 · Telephone 5zL3-~-744 On-Site Wastewater Disposal System and/or Well Inspection Report LOT 1, BLOCK 1, MOUNTAIN VALLEY ESTATES SEC. 3.3, T14N, RlW 05063122 Legal Description: PID No.: o WELLi SCALE: 1"=40 2 / / / / TABLE OF REFERENCE DISTANCES OBJECT DISTANCE TO INVERT REMARKS A B EL. C01 I 19.0 6.2 98]5 I CLEANS TO TANK C02 19.1 9.9 98.10 CLEANS TO HOUSE SH 2G.4 30.7 97.66 (INLE1 INVENI ELEVAIION) ST2 53.5 57.6 97.27 (OUTLET INVERT ELEVATIO~ CO5 I 57.5 I 41.1 I 97..33 I CLEANS TO TRENCH C04 I 38,9 I 42.4 I 97..301 CLEANS TO SEPTIC TANK C05 92.9 94.7 97.30 CLEANS TO SEPTIC TANK PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930338 DESIGN ENGINEER:BRUST AND ASSOCIATES OWNER NAME:STEARNS TIMOTHY H OWNER ADDRESS:505 S. MOUNT SHASTA BLVD. MT. SHASTA, CA 96067 DATE ISSUED: 9/02/93 EXPIRATION DATE: 9/02/94 PARCEL ID:05063122 LEGAL DESCRIPTION: MOUNTAIN VALLEY ESTATES BLK 1 LT 1 LOT SIZE: 50289 (SQ. FT.} NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING.SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: DATE: BRUST & ASSOCIATES Engineers - Planners - Surveyors 1610 Dimond Drive Anchorage, Alaska 99507 (907) 562-7878 September 1, 1993 Municipality of Anchorage Department of Health and Human Services On-site Services 825 "L" Street Anchorage, Alaska ATTN: Mr. James Cross RE: Lot 1, Block 1, Mountain Valley Estates Sincerely, Dear Mr. Cross This letter and attachments will supplement my August 12, 1993 letter which submitted a permit application for an on-site waste disposal system at Lot 1, Block 1, Mountain Valley Estates. The following are attached. 1. Revised drawing of proposed on-site system, dated 9/1/93. 2. Revised trench design, dated 9/1/93. The trench cross section and length were revised to allow for seasonal ground water fluctuations. A 54' long trench will be able to serve this property. I recommend that a permit for the on-site system be issued. BRUST & ASSOCIATES Engineers - Planners - Surveyors 1610 Dimond Drive Anchorage, Alaska 99507 (907) 562-7878 August 12, 1993 Municipality of Anchorage Department of Health and Human Services On-site Services 825 "L" Street Anchorage, Alaska RE: Lot 1, Block 1, Mountain Valley Estates This letter and attachments is to accompany a permit application for an on- site waste disposal system at Lot 1, Block 1, Mountain Valley Estates. The following are attached. 1. Drawing of proposed on-site system. 2. Soils log. 3. Trench Design. This lot is served by a private well, which is adequate. The adequacy test on the soil absorption failed. There also were indications that the system had recently backed up in a basement floor drain. I performed a percolation test on 7/3/93 and found that a 47' trench would be able to serve this system. The septic tank is only 88' from the well. As this is an old tank I recommend it be replaced rather than try to justify a waiver. Development on adjacent properties will not be adversely impacted by construction of the proposed system as distances to adjacent features would be in compliance with applicable requirements. Replacement of the septic tank will remove the encroachment into the 100' protected well radius. Slopes on this lot are moderate, and average about 8%. Drainage is to the northeast. I recommend that a permit for the on-site system be issued. Sincerely, ~'x -/' _ ~'"/~.~ ~" ~' X ~ 100' R~ ~ ~' %~ ~ < . ~ , ~PROP. 54' TRENCH % ~ ¢~x EXIST. ST o/~%~ ~'// onn.R ~ -¢ ~ - EXIST. COt° ~x~// / ~ ', XX ~ ~ IO0'R PEAK ORIOINAL GROUNO NOTES: ~ FILL 1. REMOVE EXISTING SEPTIC TANK. ~ S~Lf BARRIER INSTALL FOUNDATION CLEANOUT. _~~ 2. INSTALL NEW 1000 GAL SEPTIC TANK ~ ~X. ............ ~¢¢ RFBRATEbpipE ~P~ e" - ",~ 5. CONSTRUCT TRENCH 6' FROM ~ e ~ %~.~ SEPTIC TANK, AND NO CLOSER THAN ~ SEPTIC ROCK ~ ~ 49¢h ~ ~ D 14' TO EXISTING TRENCH, ~..,,,~. ................................... ~.....~ ~ ¢~~,~?~,;, 2. ,, ~ 4. BACKFILL A MINIMUM OF 5' OVER ~ ~ ~ ~ ..... : ~¢ SEPTIC ROCK. ~, STANLEY BRUST · ~ ~ ¢~% No. cs-gs6 g % ~ V~7~ ................ ,~ TYP[CAt_ T~ENCH CROSS SECTION ~Oe~FESS 10~~ N,T.S. "" BRUST A ASSOCIATES CNECXD ~', Se SEPTIC SYSTEM DETAILS ~; 9/~/e~ ENGINEERS-PLANNERS-SURVEYORS SOALE; 1" = ~00' 1610 DIMOND DRIVE (907)562-7878 LOT 1, BLOCK 1 ANCHORAGE, ALASKA 99507 OOe NUMBER; 937 MOUNTAIN VALLEY ESTA~S Municipality Gl Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL~DESCRIPTION: / / DATE PERFORMED: Township, ~n~e, Section; 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2o COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT /'/~ 0 DEPTH? p E Monitoring? //"~ Date:_ . Gross Net Depth to Net Reading Date Time Time Water Drop ",,.- 7,, t',~ 7,' P~ .~ / 7~ ~.,a a ~~ /~ PERCOLATION RATE '~' '~ (minutes/inch] PERC HOLE DIAMETER TEST RUN BETWEEN ~ FTAND ~--~ FT. ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4~85) A & lo I)I~ILLING COMPAN~ F'lS[~fl'"l I T NO. F:I F'I:::' L :1: C: F:Ii'4 "F LO C F:IT ]: I~.'ll",~ L. EGRL [...EFF ::3 :[ ZE H 11'41 HUH l) ]: ~Tf:INCE: 13EI"I.,JEEN R 1.4EL. L FIND RN"¢ O1'.,1-.-'=5 :LE10 FEE'T' F:'OF.: R PF:'.):',,,'Frf'E 14ELL OF,.". 2E~E!~ FEET FOR FI F:'IJBL]:C HE.'.I....t .... 14ELI... LEIG:iE; FIRE F.'tEC..!IJ]:F.'.'EE:, FIN[':, I'"IUST BE F::ETLIIE:I'.,IED TO THIE [:,F..'rPF:II:E'.THENT H:['I"HII'.,I Z.":~;::.~ E:,F:l'.r':i:~; C3F THE HELl... COHI::'I_E:T I 01'.,I. '.:E;PEC :1: F ]:. CFIT IONS RI'41:.', C:OI'4'L:;TI~.I.JE:TI 01'.,I P I FIGF;.'.FIH2~; ARE R',,,'FI I L..I::IE',I.JE TO I i'.,I¢,~;LI[E'.E F'F;;rOI:'EI:;?. :[ ~4 sr'l"l:lLL FIT ]: Ot"4, :[ E:EF.:T I F'"¢ 'I'rHFI'r' t: :1: F'IH I::'RHiL. I RF.: 1.4]:1~H 'THE REQUIREi'"IEN1-'S FOF.: ON-".:.'.';ITE r~;EP.IER2; F¢',II:> i.4E":L..I...~5 Rr~.5:51ET F'OF;.':TH B"r' "f'HE HUN I C :[ Pr:IL I T'T' OF FII".,tCHOF.:FIGE. 2: i F-IiLL. :I:N'L-';'T'FILI.~ THE S'¢'L";TEH :[I'.,I I=IE:COF.c.I)FtI'.,IE:E I,.IITI-.I 'THE CO[::,t.:i:~;. GRE~,,FR ANCHORAGE AREA BOR,.. ;GH Department of EnvironmentaJ Quality 3330 g Street Anchorage, Alaska 99503 NAME g4 LOCATION INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE ~i~/1"~ . FROM WELL'~''''/ //'~ MANUFACTURE MATERIAL INSIDE LENGTH COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITT¢~'~'-~ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL .~/J'J~/ FOUNDATION NUMBER OF LINES f/ DISTANCE BETWEEN LINES ABSORPTION AREA % DEPTH: TOP OF TILE TO FINISH GRADE NEAREST LOT LINE /'~.2 [ TOTALOF LINEsLENGT~ ~.~ /F//¢ TRENCH W,DT.C¢',N. TOTAL EEEECT,VE SQ. FT, LENGTH OF EACH LINE '~ :;~ / ~/ / DEPTH OF FILTER .~ ! ~ MATERIAL BENEATH TILE _~. ABOVE TILE IN, TYPE _._ BUILDING FOUNDATION__ CESSPOOL APPROVED _CONSTRUCTION NEAREST NEAREST LOT LINE .... SEWER LINE OTHER SOURCES DISAPPROVED DEPTH __ SEPTIC SEEPAGE TANK , SYSTEM REMARKS DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTEM BY: ~'~ '~/'~' '~' INSTALLED SEWER LINE DEPTH: LOT SLOPE: REMARKS: Form EQ-032 1::4 I:::' F' L,. ]: C Fl I'q T L O C FI'T' ]: O 1'4 L. E I:.~ F:I L :, ":, . ..f E:.,1 IE.H E.F.:. E, JE, HI;IHE:LETON E:I:)::.:: :~ ~ .... ;' ' ....... " " H '[ 3HL RN[::, I)R :I: ',,,'E I....J. B::L HT. Vf:~L.L.[':7¢ E~;T FI[::,E:,¢J:J.. I_OT Id[:,:, .. :: .' .. .:, ~ .: I E. il ): E;: TRENCH 'T'"r'F:'IE OF ':J.';O ]: L ' -"- ' Fi BT T ON '-' '" ....... I'"IFIX :[ HI...IH blIJHE:ER OF E FE,F.':: f"l'::'; = :.E: -",].,~.E. THE RI:E:SOF,.':F'TION .: r.:.' 1 f:.ll 3::iT,: 'THE: I:~:EgCJ :1: I:;;:EEE:' ' ....... '* -'OF E30 :[ I_ -' "- ...... "[' H E L E N G 'T' H E:, :1: H E 1'.45 ]: O N :[ E; TH E L. E N G T 14 ",:7 I1'-,I ' F' E [:'." F ::, O F T H E "f' Fit E:I'.,I C H O F: I::, F: F:I :[ i'.4 I'-:' :1: E I... D. THE B, EI:::'TH OF FI TF:ENCH OR F'];T ~.5 THE D:[f~.iTf:II'.,ICE !~E~IEI"HEEN THE S;IJR'.F:I~(::E O1::: THE: GI:;i:OUHD RI'.,ID THE E~O"I'TOH OF THE E;,.,',E:FIVRT :[ ON ,::]:lq FEET::,. l" H EF.:E :t: :5 NO SET kl :[ I::,TH I::.'O F:'. T F'.E:Iq E:H E E;. TblE: (!iI:E'.FI',,,'EL DEF'TH :[% THE I','I]:i'-,IIHIJH E:,EF'TFI OF GITFI'v'EL. EtE'f'IdEEN THLE OUTF'FILL.. I:::' ]: I::'E: F:INB, THE E~O"f'"I"OH OF THE E:';.,:CFI',,,'FITIEIIq ,:::I:N F'EET::,. 15;F:tE:I'(F :[ LL Z NG OF F1N"r' ':':;"~"E;'TE:I'"I I.,.I :1: 'T'HOIJT F .1. NFIL :1: NE;F'E:CTI EIN FIN[::' FIF'F:'ITEI',,,'FIL. [::,Ei:I:::'FII:;UI~HIENT 14 :[ I....I... BE 'SUEiL:iE:C'T' TO F'I~:O::SECI...IT ]: ON. H :t: N :1:I','11...11','1 [::, :[ :E;TFII'.,IE:IE I:~iffE'Ti.,.IIE:E:N FI 141EI_L. F:II",t[';, l::ll'.,l'.r' ::1.OO FIEI~iCI" F:'C.~/7 Fl F:'I:;;::['v'FfTi:E I.,.IE:LL.. EIE: 200 F'E:E:T I:::Eff;.: I:::1 F't...IE=I....:[C I.,.111:-:1....I ..... 14EI...L L.X:)GEi; l:::li:;i:l!ii: I:;Ui!~X;!U:[F.'.EI:::, FII'.4C, HU!E;T E=E': I:;;:ETIJF.'.I'4ED "D:)THE: E:,Ei:F:'FIF':"I"HE:NT I.,.IITH]:N :ii:E) [::,Fi"r':!~; OF:' "i'HiE I.,.lli~:l_l... COHF'LIE'FION. E;F'IEC:I:I-:'.T.C'I:::IT]:OI'4% FIN[::, CCJN~F.,'T'F.:UCT:[OI",I iT, :I: F~GI-:..'.Rf'I~; FII:;;:E: I::I',,,'FI:I:LF:IE~LE: :[ N E;"I'FH..J._I::FI" :1: ON. I CE:R'I":[F'~T' THFIT :1..: t 1::1t'"1 FFiH:I:L.:[I::IF~: H:I:TH '1"HE REg!I.J]:RIEHIENT:i3 FOR ON-.-:E; ].' TI!!: :!5liii:14E:l:;L'::':; FIN[) HEL. I..,.::~; FI:E; :E;tET I::'OI:~:'FH B"r' "FHIE HUN I C I F'I::IL l T"r' OF' FINCHOEff:tGE. ;:2: :[ 1.4 ]: L.I_ :!: NE;TFIL. I._ THE E;'T'"'"FTEH I N FIF:COF.'.DFII'.,ICE I.,.I ]: TH 'TI...IIE: CODE:::.i;. 2:: :1: IJI'.41::,EI'TSTRiq[::, THFIT THE EII'.4.-'.E.; ]: TIE E;EHER 'L:..;'T'~;TEH HFI"r' F::EQU:I:I:~:Iiii: I!ZNLF:ff:,:GEHIii:NT :[1:: 'T'HIE I:;;:IE:!~;II::'IEI"4CE .1:!5 F.:EI"'IODE:L. ED TO II'4CLI.JDE 1'"IOITE THI:II",I 2: E',E[.':'I:~'.OE$'I:E;. Dep~vtment of Health ,uxd Environmental Protection 2516 E. Tudor Road Anchorage, Alaska 99507 276-2221 S()II,S I,()(; --I'I'~I{~)I,ATI()N TEST Performed for.. Le~jal bescripti~.:_~_/ ..... TtHs form reporLs: Soils log .... ~-]~ "~-~-~---'P~-F~bq~q~, LesL ............. Feet 6- 7- 8- 9- 10- 11 - 12- 13- 14- Was ground water encountered? if yes, at Wildt depth? ._~.._: :Z:._._._ :__-. :-_ i-_. .._ ::_: _--__._~.__L:;_:__:::_:...:_~__-:. ::'-_:.-. ::;: :"'-;.:': i : : : : : :.Ll : : :-. -_: :; :-_-: :.;.~ :.:: :":-_':_': :":': -.. L ::::::::::::::::::::::::::::: :-_': ' :_ ..... -_'_-_ :-.:::: :. :: :':': ::: :':::::: :.: -_~-_-. 77_:'-._-_':_-_ '_:: :': 2 :-. :: 2-_::: 7: Z_Z_-T:" ':: L : LT_:iL ZZ Percol a(.ion raLe minute. 'Proposed i.stallatlon: oeepa.rle Pit £~£/~'<;/~ brain Field COI,IMENIS: · t:~ 0,t0 <a/~q)--(]7"~.'~ ............... '-". ................... Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-631-22 COSA# ©% llilO Expiration Date: 7- I /-11 GENERAL INFORMATION Complete legal description MOUNTAIN YALLE¥ ESTATES, BLOCK 1, LOT 1 Location (site address) 5010 RANDI COURT, EAGLE RIVER, AK 99577 Current Property owner(s) FRANCIS STANFIELD & SAUNDRA SENIOR Day phone Mailing address PO BOX 772451 EAGLE RIVER, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Mailing Address EDWARD DAVISON - KW Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ,3 Individual Well [] Individual On-site I~-di~)i-d fi ~l-Wa-t er ~0 ~g e [] i~}~/id~i'~oiding Tank CommunitY'Class __ Well ' [] Community On-site Public Water System [] Public Sewer [] TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: 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 and/or 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 pdvate 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 vedfy 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. DaD SIGNATURE Approved rot Disapproved. Conditional approval for Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 04/08/2011 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundWater levels that may fluctuate dUring the year and the water usage of the family being served by the system. The operational life of all Well and septic systems are subject to these vadous and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how Iong a ' .~~: system will function satisfactory for current or future _.~.. ~,... :~:':'".'.~!'~: i,:'!:ii:i..:~!~.-.. occupants or can ArcTerra guarantee that no unseen - .:~~~.:;..:..~'-~' ~~' encroachments, deficiencies or discrepancies exist. , ~~ ..~.~.~. bedrooms. " bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ~'~~Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw 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: MOUNTAIN VALLEY ESTATES, BLOCK 1, LOT 1 A. WELL DATA Well type P]U~VATE If A, B, or C provide PWSID # Well Log (YIN) ~_ Date completed: 4/21~1991 Sanitary seal (Y/N) Y__ Wires properly proteCted-(YIN) Total depth 145 lt. Cased to 47 lt. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 4/20/1991 3/24/20/1 Static water level 33 ff. 33 ff. Well production 3 g.p.m. ~.4 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100mL Nitrate 0.102 mg/L Arsenic: ND ,rng/I Date of sample: 3/?.5/20/1 Collected by:. Al*cTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/1~1993 Tank size 1000 gal. Number of Compartments _2 Cleanouts (Y/N) ~ Foundation cleanout (YIN) _.Y Depression over tank (Y/N) __N High water alarm (Y/N) 'N Date of pumping 3/2~11 Pumper IRs C. ABSORPTION FIELD DATA Date installed 9/14~1993 Soil rating (g.p.d./ff~ or ft2/bdrm) 1.2 System type Tnmch Length 54 ft. Width 4 f. Gravel below pipe 3.5 lt. Total depth 8.$ ff, (Measured 3/24111) Eft. absorption area 378 fi2 Monitoring tube Y Depression over field _N_ Date of adequacy test 3/24/20/1 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 30 in. Water added 450 gal. New depth 42 in. Elapsed 'i~me: 1440 min. Final fluid depth 28.8 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Nlf yes, give date -- Parcel ID: 050-631-22 D. LIFT STATION Date installed "Pump on" level at ~ Datum in. E. SEPARATION DISTANCES Size in gallons ~Pump off' level at ~ Cycles tested in. Manhole/Access (Y/N). High water alarm level at in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorpl~on field on lot 100'+ Publi.c sewer main Sewer/septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lois 1.00'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Service line 10'+ Surface water 100'+ Curtain drain 50'+ (None Known) COMMENTS Water main 10'+ Driveway, parkingNehicle storage ...1.0'+ Wells on adjacent lois 100'+ The septic leachfield is operating in the top one-third of the effective depth. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspecb'ons and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Pdnted Name ~KF. NNFT~ M. DUFl~US Date ,//812011. COSA Fee $490.00 Date of Payment C/.~/~_~ - / [ Receipt Number ~--~1 ~-"~ ~-~ (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS Ref.# 1111052001 Client Name ArcTerra Engineering and Surveying Printed Date/Time 04/06/2011 11:45 Project Name/# Mountain Valley Est. BI, L1 Collected Date/Time 03/25/2011 12:30 Client Sample ID MNT. VALLEY EST. B1, L 1 Received Date/Time 03/25/2011 14:45 Matrix Dfinkin~ Water Technical Director Stel~hen C. Ede PWSID 0 Saml~le Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 03/31/11 04/04/11 NRB Waters Department Total Nitrate/Nitrite-N 0.102 0.100 mg/L SM20 4500NO3-F B (<10) 03/30/11 AYC Microbiolo~ Laboratory E. Coli Total Coliform Negative 1 100mL SM20 9223B A 03/25/11 DLC Negative 1 100mL SM20 9223B A 03/25/11 DLC -"¢'~~,,~/~f~'-4/ ...~~ ' ASBUILT SEWARD - .~=.,~,~ = ~o~u~Al,.~ up SURVEYING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE S~: FOLLOWING DESCRIBED PROPERTY: / I~~/~ ~{~~~~~/. DATE:~ - AND ~AT NO EN~OACHMENTS E~ST EXOE~ AS ~~J INDICATED. IT IS THE RES~NSIBILITY OF THE ~',~ OWN~ TO D~ERMINE THE EXISTENCE OF ANY GRID: WHICH DO NOT ~PEAR ON THE RE~D~ ~BDI- - VISION PLAT. UNDER NO CIRCUMSTANCES S~ FB: ~'.. ~Y DATA H~EON BE USED FOR CONSTRUCTION ~p-~ OF FENCE LINES, OR FOR EST~LISHIN6 ~ND- DRAWN~ ARY LINES. Municipality of Anchorage Development serVices Department Buildihg Safety Division On-Site Water and 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. 050 - ~,.~!- r,~.,.~- CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Bate: GENERAL INFORMATION Complete legal description ';L CT" t Location (site address or directions) Current Property owner(s) Mailing address Lending agency Day phone Mailing address Real Estate Agent Mailing Address EVA I~,.q~ (2~.,~L~,- t;.~le[' (eu,-,c I~.fL qe~77 Un/ess otherwise requested, HAA w#l be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class .~ Public Water System Well 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 5 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 sample results less than 30 days old. (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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are} in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address Engineer's Printed Name 5. DSD SIGNATURE 1.,/ Approved for . Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HA,A. Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Cedificate Date: Municipality of Anchorage Development Services Department Bu~g Safety Division On-Site Water & Wastawater Program 4700 South Brogaw St. P.O. Box 196650 Anchorage, AK 99519-6650 w~n~.ci.anchorage.ak.us HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description". [-o'~ t A. WELL DATA : ' '" ~ ': Well type ~ Data completed Total depth I ~[~' fl, ,,- Date o~ t~st Static water level Well production ff A, B, c~ C pn~ffie PWSID # ._ sa.,a./,,a (Y/N) ~/ · ' Well Log (Y/N) w~ prope~y protected (Y/N) "/ Casing height (above ground) ~/-/ in. FROM WELL LOG ft. g.p.m. AT INSPE.C~ON 9///7/0/ lt. g.p.m. WATER SAMPLE RESULTS: Coliform ~) colonies/100 mi. Nitrate ~'~mgJ~. Date of sample: 0/7/~! Cattected by: Other bacteria ~,~'~ cctonies/100 mi. B. SEFTIC/HOLD/NG TANK DATA TankType/Material .~E~)Tt ~.; STYE[ Tank size I~ gal, Number of C~mpartments ,-~ Foundation ctaanout (Y/N) ~ Depmssk~ ever tank (Y/N) I~ Data of pumping ~/;~/~ I Pumper ~ C, ABSORPTION FIELD DATA Cleanaute (Y/N) "// N~gh water aarm (Y/N) I'-/ Date install. ~/~//q~> Soil rating (g.p.d./~ ee4~bds,m) ~ ~ Length ~ a. ~ ~ ~. TO~I depm ~.~ ff. Eft. absoma~ ~ ~ · M~i~dng tu~ ~ Dam of ad.uaw test ~ ~/e , ~su~ (Pas~Fail) ~ Fluid dep~ in abso~fi~ ~ld ~f~ ~t ~ ~. Water add~Ogal. Elaps~ Time: ~ m~. Fi~l flu~ d~ ~ in. ~tion rate >= ~y ~uvenafi~ ~a~ (past 12 ~.) ~ & ~pe) ~ System type I ~2EH/.. ~ Gravel below pipe ~,~'" ff. Depression over field For ~ bedrooms New depth t_~n. Y -~-'~) g.p.d. If yes, give date v/ D. UFT STATION Date installed 'Pump on" level at Datum Size in gallons ~ 'Pump off'l.l.l~ in. Cycles tad Manhole/Acce_ _ s~ (Y/N) High water alarm level at Meets alalm & clmuit requirements? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SepUc tanldilff station on lot IO~t,~ Absorption field on lot Public sewer main T"//A Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cteanout H/,/~ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation .~ Property line .;;> Water main I"/~,~ ; . . , Water service line Wells on adjacent lots 7' / ~ .... Absorption field SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ! o Building foundation Water Service line ) .~' O Sudace water ~"~ ~0 Curtain drain ~ lo Wells on adjacent lots Water main 1,4/~ Driveway, parking/vehicic storage F. COMMENTS , . ... 4~.--~.~.¥~t,'~.~ -. ~. o. E.G,.ES.'$ ¢ .c.Tio. · ' ' HAA Fee $ '~ Waiver Fee $ Date of Payment /~J'~-/./O / Date of PaYme, n~... Receipt Number 'J ~:~7'~, ~ Receipt Number (Rev. ~ 2./00) 9C~5~15301 T-T58 P.OZ/G$ Sample 0.500 U 0.500 ~'1. EPA3OO.o (<10) ~/18/ot SCL X,Lc:E'ob:L ol og),' ~doo~ato~Z Coliform 0 coVlO3rnL SMIS~222B MUNICIPALITY O'F 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. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING NAA # Location (site add'ress or directions) Property owner Mailing address Lending agency Mai'ling address Agent Address 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,/~/~//.~'~'-' Address //¢//0 Engineer's signature Phone Date J DHHS SIGNATURE ,'~ Approved for 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does th is 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. 72~325 (Rev, 1/91) Back MOA ~21 (~ Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Z'~7,¢-¢~ .<',¢¢- ..~.7,, ~"?x/,~,4~'/E//c-' Parcel I.D. A. Well Data Well type Log present (Y/N) / Total depth / Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ¢/~'¢/7 7 Driller./~. J Cased to /7"¢7/ Casing height Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ¢'~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION .g.p.m. ~ Petroleum tank ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout WATER SAMPLE RESULTS: Coliform J,~7¢/: ~/ Z~'~/-? Nitrate Date of sample: ~/~/¢¢¢ :~-/~ ~ ~:*/J/¢o' /¢/'/~¢edcted b/y: B, SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Other bacteria Tank size /'O0~ (~ Compartments Foundation cleanout (Y/N) ,/// Depression (Y/N) ///'/¢ Alarm tested (Y/N) '~'-~-¢-,~- Pumper ?~""~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /0,/,/ On adjacent lots ,, To property line ,~ ~ Absorption field Surface water/drainage /~-~" Foundation ,¢~-..¢~' Water main/so.ice line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Length ,_.~/7z / Width .~' / Total absorption area ,.~ / ;~ ~','~ Cleanout present (Y/N) Date of adequacy test ,¢ ¢- ~-'---~ -}~Xcp ~;A. Results (pass/fail) Water level in absorption field before test Soil rating (GPD/FF) / 2%- Gravel thickness ,.~..~-- Peroxide treatment (past 12 months) (Y/N) System type Total depth "~ / Depression over field (Y/N) /'~ for /~',/-~ Bedrooms After test ,4//2 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ///7/ On adjacent lots / / Property line //,~ To building foundation On adjacent lots Sudace water Curtain drain To existing or abandoned system on lot //~ Cutbank /¢/'/¢ Water main/service line ~,.-~/.~~'>~/'~"-'~' .¢'/4/¢- ~:' / Driveway, parking/vehicle storage area /~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to ail MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name HAA Fee $ ~O'~ ¢ ¢J~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back CItEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKa,99518 TELEPHONE (907) 562-2343 · Chemlab ~ Client 5~,:2:i~ FAX: (907) 561-5301 Ordared ~y :$. Project Name Projects PW~ID :U~ Collectsd :04/07/g3 ~eceivM :04/08/93 YlOR[ Order :64769 Report Completed :04/12/93 Technical Dlrectox :STEPHEN C. EDE Released Sample RDU?INE SA~I.g COLLECTED BY: $, B~.UST, QC Allowable Extract Analysis Per,myLar Results Qual. Umts Method Limits DeLe Date I~t NIIBAYE-N 0.10 U mg/l EPA 353.2/300.0 10 04/09/93 LLH Soe Special Instruct. Ion, Abov~ UA - Unnva~leble " Se~ Sample Ken~rks ~bove ~ - Not Analyzed U - Uudatected, ~eport6d valu, ls the practic~! quantification limit. LT - Less Than D - Secondary dilution. GT · Greater Than ~ S~S Member o' the SGS Group (So¢iOtd G~n~rale de Surveillance) GENERAL INFORMATION (a) MUNICIPALITY OF ANCHORAGE DEPARTMENr OF HEALTH AND ENVIRONMENTAL PR~ ~ ECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1/13/86 Legal Description (include lot, block, subdivision, section, township, range) Lot 1 Blk 1 Mtn Valley~r, T14N R1W Sec.93 Location (address or directions) (b) Applicant NameRay Mann Telephone: Home 694-94q7 Business 786-8160 Applicant Address $R-9317 ~,agle River 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder:[~:; Buyer []; Other [] (explain); (d) Lending Institution Security Title (Terry) Address Eale River, Alaska Telephone 698-8070 (e) Real Estate Company and Agent Re/Max Realty - VirKinia Kolfield Address EaRle River, Alaska Telephone 694-4200 (f) Mail the HAA to the following address: PiCk-up by applicant TYPE OF RESIDENCE Single-Family:~ Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (~1/84) ENGINEERING FIRM PROVIDINL ~SPECTIONS, TESTS, FILE SEARCH, DA' ~,ND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, 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 disposat system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ........ ~- Telephone Name of Firm EAGLE RIVER EN6~N~-blt~I'~u Address EAGLE RIVER, AK 99577 ///Z~,~-'~ P. 0. BOX 773294 Date 694-5195 '6. DHEP APPROVAL Approved for ";~'h/'*:~(~)bedrooms by ~'-y~'~'~' '~' ~lc''~''-J~' Approved ~ Disa~l~;ved Con~t~o~na, Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~¢'- '/ ~t~ ~ ~'~s Well Classification Well Log Present (Y/N) Y Total Depth / ~,S- / Cased to z¢, '? Static Water Level '~o / ,,~- ?,, ,., 5'~,. ,-..~..~¢ Casing Height Above Ground /-~ '"' DG~. OF HEAIJH & ~NYIRQNM~NTA~, PROTECTION Electrical Wiring in Conduit (Y/N) Separation Distances from Well: RECEIVED To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole /w//,4 Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) ,d../ Date Completed ~/./~'-}- ¢./.~ '? Yield .~'- Depth of Grouting Pump Set At ~ Sanitary Seal on Casing (Y/N) ./P' Depression Around Wellhead (Y/N) ~ ; On Adjoining Lots /~b~ / ; On Adjoiaing Lots '~-/o¢, / To Nearest Public Sewer To Nearest Sewer Service Line on Lot ¢-,=2.~' ' Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size /,~ Standpipes (Y/N) /V Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenaace Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well -'~',¢ / To Property Line +1¢ / To Water Main/Service Line 7'-/O Course ./z//,/ No, of Compad. ments Foundation Cleanout (Y/N) Date Last Pumped ; for ~- Temporary Holding Tank Permit (Y/N) ,4,//.4 To Building Foundation .5- / To Disposal Field '~--~J ~'~ e .~ / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /05-" To Building Foundation ¢,~ o / Lot ,'¢-..3~~ To Water Main/Service Line ¢'/o / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field -~...z '/ Depth of Field /// Gravel Bed Thickness '7/ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line "~/¢ / To Existing or Abandoned System on ; On Adjoining Lots '¢-.-¢¢ / To Cutbank (if present) ,,~./o~'-,~ ,,z/'/4 /o / Comments LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm .Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed J,~'~-~- Date //)/~/)'¢ ~ Company ~/L~,/~'~,F, MOA No..~'7- ~ .2/~'- Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) nicip litYof P.O. BOX 665O ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MA Y OFf DEPARTMENT OF HEALTH & HUMAN SERVICES January 27, 1986 Lou Butera, P.E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Lot 1 Block 1 Mountain Valley Estates Subdivision Waiver Request, WR86-007 Dear Mro Butera: This Department hereby waives the horizontal separation required by 18 AAC 72-021 for the distance between the septic tank and well on the subject lot. This separation distance requirement has been waived to 88 feet. This waiver is valid for the existing three bedroom home. Any upgrade of the existing septic system will invalidate this waiver. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw EAGLE RIVER ENG [NEER[NG SE ¥1ICE5 ~~~ Eagle River, Alaska 9957'7 ~~ ..... rl'elel) tl °1~: e (90~) 69~ - 51~~ .~ ~/~3/86 Susan Oswalt Municipality of Anchorage Health Department 825 L Street Anchorage, Alaska 99501 Ref:Lot 1, Block 1, Mountain Valley Estates MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED Dear Susan; On behalf of my client, Mr. Ray Mann, I am submitting the following information in support of a request for waiver of separ- ation distance. The wavier requested is private well to septic tank distance of 88 feet, as exists. The following information is available in support of and to assist you in your determination. 1. The well log show the well to be drawing from an artesian aquifer at a depth of 129' that is overl_a~i.-n by solid bedrock. 2. The soil conditions at the leachfi~eld area, as described in the soils log are dense gravel-sand with a rating of 110. 3. As no bedrock was encountered at the leachfield site it can be assumed that the bedrock surface slopes away from the well toward the leach area as desired. 4. The surface topography directs any possible seepage from the septic tank away from the well area, (5% avg.) 5. The house foundation,(full basement) is situated between the well and septic tank locations and is adjacent to the septic tank. 6. There is no indicated water table to a depth of 15' 7. population density in the area is low. Mr. Mann may be reached at his office number 786-8160, if further action is required. I will be out of town until February 6 but can be reached through my answering service. Sincerely; Leu Butera, P.E. MUNICIPALITY OF ANCHORAGE MUNIC~PAI.ITY OF ANCHORAGE DEPT, OF I:~D\LTiI & ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI(~ViRONMEN1.AL PRO~ECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION JU~, ~. 2 1979 Telephone 264-4720 r-1 r"/"'l-i%lF"r~ A...OVA. DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing, 1, PROPERTY OWNER PHONE Robert C. Hambleton Out of State MAILING ADDRESS 8009 Dunsmore Road, Richmond, VA 23229 PROPERTY RESIDENT (If different from above) PHONE Vacant - Contact A~ent for a~ointment 694-9555 2, BUYER PHONE Raymond R. Mann --0- MAILING ADDRESS ...P.O. Box 249t c/o AREAt Inc. Realtors, ~.a~le River, AK 99577 3, LENDING INSTITUTION I PHONE 1 Coast Mortgage, Attn: Joella 279-0665 MAILING ADDRESS P.O. Box 1200 Anchoraqe, AK 99510 4, REALTOR/AGENT I PHONE Myrna Johnston, AREA, Inc. RealtorsJ 694-9555 MAILING ADDRESS P.O. Box 249 Eaqle River, .A.K 99577 ....... 5, LI~GAL DESCRIPTION Mountain Valley Est. Block 1, Lot. 1 STREET LOCATION Mile 5.0 Hiland Road 6, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY Installed for 3 [] One [] Four [] Other__. [] Two [] Five [] MULTIPLE FAMILY bedrooms [] Three [] Six 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8, SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) **If individual/on-site, give installation date ] 0 ,/ 2 F; ,/ T F; . If system is over two (2) years old ail adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSP ECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEIVI PERMIT NUMBER E~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC.._.UTILITYifTankishomemade ~~'~ Connection Verified iNSTALLER []Septic Tank.or [] Holding Tank Size: ! ~J~'~ (~) SOILS RATING give dimensions: TYPEOFTANK MANUFACTURER ,~.~ ,1~- TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS J~/"A P P R O V E D FOR '~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)