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HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES BLK 1 LT 5Mountain Valley Estates Block 1 Lot 5 #050-631-18 Municipality of Anchorage Development Services Department Building Safety Division j' Onsite Water 8 Wastewater Program, 47DO South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.8650 www.cl.anchorage.ak.us (907) 343-7904 Page 1 of 3 Onsite Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO10239 PID Number. 050-631-18 Nome: Wastewater System: O New ■ Upgrade PHIL WRIGHT Address: 1000 EST DIMOND SUITE 200 a ANCHORAGE. AK 99515 ABSORPTION FIELD Phone: No. o1 Sedroome: (907) 694-7407 4 WDeep Trench ClStwlbw Trench OBed ClMound 00ther LEGAL DESCRIPTION =a p`a"° 1.2 on" n Twat a•ab i 3.2-15.o n Lot: Block: Subdivision: o.Wh to pipe son" Lem "Ind p'eet aro..t eeplh Wveaw OW 8.09 5 1 MOUNTAIN VALLEY EST. 5.12-6.88 n rt. Township: Range: Section: — — — rel edea awwo w4lnd gran: arv.•1 t•ngtn. 33 0 n. n. 0,91W elduc Wwnb•r N ever awtawe k•t.vee ens WELL: O New O Upgrade 2.5 n. 1 — rt C1w..inwtion PrMol•. A.B.C. iolal Caved Te: Total ob•olption ena 528 n. PIPs rtwt~. D 3034 dt SCH 40 PVC n n so. veer': ow word: stow water Rmex: ew SOUTH FORK CONST. okutoo.a w 7/16-20/01 �j,\5'�NO Pump set AL `°•kn Hwgld Above `'wand: TANK CPY R r SEPARATION DISTANCES ■Septic ClHolding OS.TZP. 0Other To Septic Tank AbsorrppVon Mld Un Station Holdup Tank ge/Pdwt• sewer tkr ANCHORAGE TANK in gao 1250 From Well 100'+ 100'+ 100'+ — 25'+ yotsdoL STEEL Nona. M aa'pwt.. : I 2 Surface water 100'+ 100'+ 100'+ - - LIFT STATION Lot Une 5'+ 10'+ 5'+ — — sae in gees^' 15O Nmnaocwe . NCS THRU RAY'S SERVICES et kwel at:•lam Kpn water at: Foundation 5'+ 10'+ 5'+ — — 41- 41" 45" ►'•nv WM e: Wdeb D•coral kwpoctk. peAarase W. Curtain Drain NO KNOW 20 OSI 05 HHF JAMES SADOWSKI BENCH MARK Remarks: ABANDONED EXISTING SEPTIC SYSTEM tocauoe and averdpum: TOP OF GARAGE SLAB ® POINT "B" PER UPC. INSULATED NORTH HALF OF TRENCH PER EXCAVATOR A. a "d D..otrn' 99.78 R towgKeR'g trrx o� 0 Inspections performed by' AWWC, INC. Dates: 1st 7/16/2001 G ° ' Q 2nd 7/17/2007 3rd 7/18/2001 Q t ff a Gamess ­ V �QO� Department of Health and Human ServI es approv7�i�o/2o01 J� c 7953 ; od�p Reviewed and approved by: Date: 7' �4-0� �04edPrareeslao°��� ��40000� (R«. ,vow) PERMIT NUMBER: AS-BUILT DRAWING PARE ID 050-631-18 SW010239 — — — — =0� EJRLV FISEMEM --- i A B ST1 38.7 54.6 I ST2 44.5 58.8 Mill 46.3 59.9 .Y MT1 44.6 45.5 �p MT2 74.9 70.5 / MH2 52.0 64.6 �f \ A jCD / NEW 1250 GALLON SEPTIC TANK NEW FIBERGLASS UFT STATION 1 PROVIDED BY RAYS SERVICES MT7 II M,H2 II g � I II m NEW DRNNFIEID EXISTING DRAINFIELD AND SEPTIC TANK WERE ABANDONED PER UPC DA o0 ♦Y� 7/21/2001 0� 44 d DRAWN BY: JAG 0 ALASKA WATER & «'ASTE'"'ATER 9°O� S CONSULTANTS, INC. = 40• *(/' • •• 6901 DEBARK ROAD. SUTE to • AWHORAGE, AK 99504 • "4"(907)337-6179 • FAX 907)358-3246 •• p ;J ff Gam S: PREPARED FOR: PHONE NUMBER: WRIGHT (907) 694-7407 PACE NUMBER 2 OF 3 PHIL pY/ QQQ�y�' ., C 953 . �'`FOp LEGAL DESCRIPTION: MOUNTAIN VALLEY ESTATES S/D; LOT 5, BLOCK 1, t, ...... u40�df'�oleesio�o��� D�Oppoo� TYPE OF WORK: AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE PERMIT NUMBER: SW010239 AS -BUILT DRAWING PARCEL ID NUMBER: 050-631-18 TOP OF MANHOLE - 99.18 TOP OF TANK OUTLET 94.71 FINAL GRADE DOUBLE CLEAN -OUTS 98.85-99.15 30 INCH DIA. FIBERGLASS TOP OF TANK INLET - 94.71-\ 4.71?NEVW PUMP STATION AS PROVIDED BY RAYS SERVICES. INVERT OF 1.23 INCH PVC UNE TO THE DRNNFIELD - 92.83 1250 GALLON STEP TANK WAS CONVERTED TO A 1250 SEPTIC TANK. BAFFLE INVERT OF TANKLON INTLET - 94 16TANWDAD TME OIfEREfIDE OFBOTTOM OF LS. 90.00 RSION PERFORMED BY SOUTH FORK CONSTRUCTION. INVERT OF OUTLET FINAL GRADE - 101.75-102.67 THE TEST HOLE WAS DEEPENED TO 21 FEET. NO GROUNDWATER. BEDROCK. OR IMPERMEABLE SOILS WERE ENCOUNTERED. THE DEPTH OF THE GRAINFIELD WAS EXTENDED TO 15 FEET (MAX.) BELOW THE ORIGINAL GRADE AI ASID WATER & «WASTER7ATER CONSULTANTS, INC. 6901 DEBARK ROAD SUITE 29 • ANCHORAGE AK 99504' EHONF (907)337!179' FAX (907)336-574 REPARED FOR: PHONE NUMBER: PHIL WRIGHT (907) 694-7407 INVERT AT UFT STATION INLET - 90.21 -ORIGINAL GRADE 104.16-105.94 FABRIC INSULATION OVER NORTH PORTION OF TRENCH THAT HAS 2 FEET OF SOIL COVER. NO INSULATION ON THE SOUTH PORTION OF THE TRENCH WITH 3'+ OF SOIL COVER. INVERT OF PIPE (1.23 INCH PVC WITH 0.25 INCH HOLES EVERY 24 INCHES) 99.06 BOTTOM OF ?TCH - 90.97 7 MOUNTAIN VALLEY ESTATES SUBDIVISION; LOT 5. BLOCK 1 OF WORK: PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE C.J.G. N.T.S. 3 OF 3 1 'Oj frfi r I A.' 3 Sent By: South Fork Construction; 694 1122; ' SOUTH FORK CONSTRUCTION P.O. Box 770567 EAGLE RIVER. ALASKA 99577 ro (907) 694.1351 FAX (907) 694.1121 ' Alaska Water & Wastewater Consultants 6901 DeBarr Rd. N21B : Anchorage, Alaksa 99504 Jul -23-01 12:17PM; Page 111 DATE July 23, 2001 SUBJECT Electrical inspection Lot 5 Block 1 Mountain Valley Estates > On July 22, 2001 ElectricAl journeyman, James Sadowski (license #200451 19754 - contact 0622-1953 or 441-3732) inspected the electrical portion of the septic system lift station on the above property. Wo code violations Were apparent, and all workmanship Was satisfactory. — SIGNED ❑ PLEASE REPL Y ❑ NO REPLY NECESSARY ru+r�L 4•>.�r>n*a.�dte..��as� MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 13, 2001 Expiration Date: Jul 13, 2002 Permit Number: SWO10239 Parcel ID: 050-631-18 Legal Description: MOUNTAIN VALLEY ESTATES BLK 1 LT 5 Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: Owner Name: Phil & Rhonda Wright Lot Size: 88361 SQ. FT. Owner Address: 1000 E. Dimond Blvd. Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , AK 99515 - This permit is for the construction of: Disposal Field F-1 Septic Tank E] Holding Tank ❑ Privy Private Well Ej Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: 7113 1 1Q1 Date: 7-13-01 Municipality of Anchorage • -� Development Services Department Building Safety Division ..... Onsite Water 6 Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.akus (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. 050-631-18 Permit Number 010239 Day phone 694-7407 address (2) Legal description (Section, Township & Range) N/A Lot Size 'TgZ-)(C2 ( A=eSG.FL Number of Bedrooms 4 THIS APPLICATION IS FOR: ❑ Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage Sewer Upgrade 0 THIS PROPERTY CONTAINS: ❑ Hot Tub 1:1Jaa�l ❑ Swimming Pool Water Softening Unit Therapy Pool I certify that the above information Is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER do WASTEWATER CONSULTANTS INC. Permit Fees: 3 oQ - 00 Date of Payment tla 7p l Receipt Number. &'-171 Waiver Fees* Date of Payment Receipt Number. ALASKA WATER F� WASTEWATER .....-..-+...�«.++ CONSULTANTS, INC. July 13, 2001 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: REVISED COVER LETTER: Septic System Upgrade Design for Lot 5, Block 1, Mountain Valley Estates Subdivision To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system consists of a 1250 gallon septic tank and deep trench type drainfield that is currently in a state of failure. The trench is placed on a bench that was cut into a slope that is approximately 100% in grade. The trench is at the toe of a steep slope and roughly 15 feet away from a 100% cutbank. We are proposing to expand the width of the existing bench and place the cut material downhill of the existing pad so as to lengthen and widen it about 10 feet. The new trench will be located approximately 10 feet west of the old trench, and 35 feet away from the edge of the expanded pad. In short, the new trench will be at least 35 feet away from a slope that is greater than 25%. We request that the required 50 foot setback from this slope be waived to 35 feet based upon the following justification: • The entire area is very heavily vegetated which should prevent effluent from surfacing downhill from the trench. • The existing trench has been in use for over 19 years, and even at is surcharged state, there is no indication effluent has surfaced downhill from the trench. • The soils are very porous which would indicate that the effluent would not travel laterally. Based upon these factors, it is our opinion that there is minimal risk with the granting of this waiver. We are proposing to excavate the existing 1250 gallon septic tank and verify the integrity. If of poor integrity, the septic tank is to be replaced with a new 1250 gallon septic tank. Comments regarding the design are summarized as follows: 6901 Dcbarr Road, Suite 2B • Anchorage, AK 99504 Ph: (907) 337-6179 • Fax: (907) 338-3246' Website: akwwc.com SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that an application rate of 1.2 gallons/day/ft2 should be used and that the insitu sandy soils should act as a sand filter. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 500 ft2 f. Total Depth: 13 feet (Maximum) g. Effective Depth: 6 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 42 feet long k Effective absorption area = 504112 SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. We are 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 I.S. NOTE: Attached is a site plan drawing, a design drawing, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic systent. 6901 Debarr Road, Suite 2B' Anchorage, AK 99504 Ph: (907) 337-6179 • Fax: (907) 338-3246 0 Website: akwwc.com --f--- Lm EASEMENT --A------ ---- 10 _m---- I - I REVISED DESIGN DRAWING 1 s Bta�NG y0U fO0M w'rr: PROPOSED NEW ORNNFIELD: EXCAVATE A TRENCH THAT IS 13 FEET DEEP (MAXIMUM), 2.5 FEET WIDE, BY 42 FEET LANG. ADD a FEET OF CLEAN, WASHED, SEWER DRNNROCK. INSTALL FOUNDATION CLEANOUT THE EXISTING SEPTIC TANK IS TO BE EXCAVATED AND THE INEGRTTY VERIFIED. IF OF POOR INECRTTY, THE EXISTING SEPTIC TANK IS TO BE COMPLETELY / ABANDONED AND A NEW 1250 GALLON SEPTIC TANK BE INSTALLED IN THE SAME AREA. INSTALL DOUBLE CLEANOUTS $K I1 F LSD EXISTING CUTBANK: 100[ SLOPE DOWN FROM PARKING PAD PAST TO THE EXISTING BENCH. THIS BANK SHALL BE EXCAVATED OUT AND THE MATERLIL PLACE OVER THE • EXISTING CUTBANK (DOWNHILL FROM THE • TRENCH) SO AS TO CREATE A PAD ON WHICH TO INSTALL THE NEW DRAINFIELD. THE NEW TRENCH WILL BE 35+ FEET FROM A DOWNHILL SLOPE THAT IS 25R+. . DATE: 7/12/2001 • :' DRAWN BY: '� 7 , .. J.W.M./J.L.M. ��( ALASKA «'ATER S WASTEWATER SCALE: CONSULTANTS, INC. 1 ^ = 40'.... ....... 6901 DEBARK ROAD. SUTE 2R • ANCHORAGE. AR "SM • I910NE (907)]57-0179' FAX (907)376.1246 REPAREO FOR: PHONE NUMBER: PAGE NUMBER D •• .•. •••••••.• PHIL & RHONDA WRIGHT 694-7407 2 OF 2 QQ p' J ff y A. ess,* : GAL DESCRIPTION: Q c, E-7953 MOUNTAIN VALLEY ESTATES S/D: LOT 5, BLOCK 1 e. ' •.,,, o``� rPE OF 4poo*10 DESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE EtiSEMEHT - -4--- -- - I-------- 10 UT1lfN ---- REVISED DESIGN DRAWING Y I 699064 PROPOSED NEW TRENCH. THE HILL SHALL BE EXCAVATED AND THE PAD EXTENDED SO AS TO ENSURE THE NEW TRENCH IS AT LEAST 35 FEET AWAY FROM A SLOPE THAT IS 25R+ 7/12/2001 DRAWN BY: J W.M./J.L.M. ALASKA «TATI✓R & WASTIEAVATIJR SCALE: CONSULTANTS, INC. 1 = 40{ 6001 CERAM ROAD. RUTS tB • ANCHORAGE. AK "504 • PHONE (907)337-6170 • FAX (007)33613i46 REPARED FOR: PHONE NUMBER: PACE NUMBER: PHIL do RHONDA WRIGHT 694-7407 2 OF 2 EGA. DESCRIPTION: MOUNTAIN VALLEY ESTATES S/D; LOT 5. BLOCK 1 YPE OF WORK: -,-0005ED SITE PLAN SHOWING FINAL PAD AROUND SEPTIC SYSTEM .... 4.4.1•{•VP..N..... DATE READING 12-0 CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) r\1 ,•// �', ` ,. � e . .—., ' •vol] ALASKA WATER , &; WASTEWATER EO CONSULTANTS. INC. 901 DERARR RO 504 • _41 . 90 Q\ 81'0 SOIL LOG — PERCOLATION TEST . . ............... LEGAL MOUNTAIN VALLEY ESTATES S/D: LOT 5, BLOCK 1 f e Gamess. DESCRIPTION: QQ a 7953 bpi C PERFORMED FOR: PHIL & RHONDA WRIGHT DATE: 6/18/2001 Q��'e^•.,,•• •,;�c40p PTtl eet ORGANICS .•.•• ���44°O0000�a ( ===: -- TEST HOLE 1 1 SM SOIL CLASIFICATIONS GWORG --- 3 e OI 0° so c i.; GP ML I aoeo 0 I^ GM CL 1 IXIsnNG zo ooeoe°O4 °o GC OL BEDROOM 4 °°°° 00 ° SW MH HOUSE 000 \ •• •�• SP CH \ 5 Doo°e°o �i SM i OH °°p a SC 6 O° O000000 7 DEPTH TO DATE °p0 nc0o GROUNDWATER TH/. B 000 DRY 6/18/ 2001 o°o°Oo°o° IXsm DRY 6/25/2001 SEPDO 9 coi SYSTEM SITE PLAN MIX OF 1 =100' 10 °°o° ooe;ooa SW&GW 00 000p °°a o° SOILS 11 c poe 0000 o� op°e 12 ooe y0 000 00006 eo 0 0� °o e 13 o e oo .....0-0100, 00 ;o °oo 00 °0°e o0e0e00 15 °o°o°o° oogo°o0 p0 0e000 0°0 16 O°O° °000°00 17 00 0000 op °poo o0e0e00 poo°e00 00 opo° PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6e (INCHES) 19 B.O.H. TEST RUN BETWEEN 5.5 FT. AND 6.0 FT. 20 COMMENTS: THE INSITU SANDY SOILS SHOULD ACT AS A SAND FILTER. PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS W S PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: L6 0 DATE READING 12-0 CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) r\1 \N DATE READING 12-0 CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) M�Nv`v . r\1 \N tJs 9 Gam' EO SORO P8 per �QG N0� Q\ 81'0 MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I g ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION C Cd L sQ Gid 2.4 LOCATION j NO. OF BFOOMS v Y DISTANCE T(: Well Absorption area T- Dwelling PERMIT NO. a Q LU N Manufacture,/ 'r", h _� Materia , /� (i No. of compartments Liq. c a tjngallons �� IF HOMEMADE. Inside lengthF Width _ Liquid depth j z DISTANCETO:�� WellDwelling , - PERMIT NO. .; - 2 Z Manu faetli rer -- �' Maters-'' _-- -"`Liquid cap cit} in gallons - --- —" A DISTANCE TO: _ Well,9 - Foundation Nearest lot lin i PERMIT NO. / .5a U. z Z No. of linesLength /')e- of each ji r Total length of li esn t / Trench width 2(i inches Distancebpt een lines /j CLi CCE. Top of tile to finish grade ' ` Material beneath tile _ �- ides n Total effe tive absorptkeJ��J LU Length Width Depth PERMIT NO. rL a 0. w Type crib -rib di< eter ib depth Total effectiv sorptio Lu DISTA E TO: Well Buil r g foundation crest lot line _j s ) N Depth Driller Distance to lot line PERMIT NO. Lu DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER LEGAL PIPE MATERIALS-- SOIL TEST RATING 9� /6_5 ` r � / _7D J 1 NS{T/A L� REMARK APPROVED DATE 72-013 (F&w. 3/78) Aa 01-1 @__A g'-,1.1 1. 1— f-1 L... '1 11' - Hwa IF HIA 0_11 H`;�" F1 TYPE CIF SO ABSCIF.PTICiP-1 'S'i'STEM IS: TRUICIA P1F7"-1IM1JP1 P-41-11"IB'f R OF BEDROCIPI.C..; 4 SOIL RATTr-K3 C'SI'D FJ'/E;R)--, J.'3 SI",ZE ul."' THE 'CHL ABSOk`PTirIP.4 S'TSTEM IS: PA '-IF 0 ... 1 -.1, Cii F,'�. g1- %.' IF -7. 0 .:Hr*, 0 RHE . =_- IS THE LE't-IGTH TPI FEET) OF THE TF,P-4CH OR TIE DE:PTFI CCF F"i TRU-1CM DEF'FIF"T1,1131"l- CIF HEAL'I"l-I ANCI �, I . 'I U: _� 1. THE Ee":C` VATION (IN FEET.). 'ITIERF- I'S NO 5 ;I ' S -F R E E -1 Al`-,JCHORAOF.� A I.: . .7 C 1 5 0 1 GRAVEL c C) MINII,,IUM DEP14-1 OF' GF.f`V-?EL BE"TkIEDA THE OIJIT-FILL PIFIE FiP.,ID THE 1301"1"1"'111 6 LJ E'e,::CA%-'FITIOI'-,I i"'Iti FEET). P, ..IF 3r: ®D 9"'R ... ... 1 .7- F _7 '" **- r 1- jo F, E, RMI T 11-41 .1. 8.1-04:1,5 0 F.1 P F, I.A.' C F1 N"I HFIL-TER J l-::'ARWCIS;K J. 1545 HIDIr-T C'I,--I 5 C'OLITI-I FOR[:` L RAhIC, CT E R A I... I #; AIIb o L. C T I Z E 57654. '..:QUF:lRE FI -ET TYPE CIF SO ABSCIF.PTICiP-1 'S'i'STEM IS: TRUICIA P1F7"-1IM1JP1 P-41-11"IB'f R OF BEDROCIPI.C..; 4 SOIL RATTr-K3 C'SI'D FJ'/E;R)--, J.'3 SI",ZE ul."' THE 'CHL ABSOk`PTirIP.4 S'TSTEM IS: PA '-IF 0 ... 1 -.1, Cii F,'�. g1- %.' IF -7. 0 .:Hr*, 0 RHE . =_- IS THE LE't-IGTH TPI FEET) OF THE TF,P-4CH OR TIE DE:PTFI CCF F"i TRU-1CM OF:. F',11" 'I"HE DPE..'TANi-E BE"I"14EEP-1 THE IRFACE" OF "I"FIE' P-41) THE F3OTTI'..'M OF' THE Ee":C` VATION (IN FEET.). 'ITIERF- I'S NO E F WIDTH FOR TRENCFIP:.'. GRAVEL DF,.:'F`,"f*H THE MINII,,IUM DEP14-1 OF' GF.f`V-?EL BE"TkIEDA THE OIJIT-FILL PIFIE FiP.,ID THE 1301"1"1"'111 ("IF TI -IE' E'e,::CA%-'FITIOI'-,I i"'Iti FEET). P, ..IF 3r: IF 4 411 __ =0 P, 1 _-E! VL :I- 12-21.'"_ IF1 L.- H__.. Cil IP,11 F1F4'.T','P1IT FIFIPLJJ.:izj,rr i,iizis THE 17' IT' TO INFORIel 111IS DEPAR"I"PIP-4"I' D1 IF , ING THE OF AM' I. -JELLS FID -JAI :EPIT TO TFII.C.,' FIROPER PT, THE. N11-IMBER CIF THAI" THE IxIELL. WILL S.ER1,A,.. IF;'? FEE C. -A 1.-.1 1 c� E " 1 C -- ----- ....R,_ RAO cfl I" R" A _HJ="E1 C- T OF Ahl'T' TEr-'I F'INAL. IN'SPEC "I"TOPI AN['. DEPj::iF:TMEhIT 14I1._.L BE SUBjI.-"C'f' TCI PROSECU"FION. F_-':ETWEEr--I A AP -AD ANY Eld A I-! E I.' P-.;PFr5AL. s --Y, ;'Tl: H 1..00 FE.FT Ff iF ,A Pl?PMTE WEL.L., OR 150 TI'I 2F0 FEET F'Fn,fJP1 i:::i I;::,1_.1BLIC': WE! L. DEI: ENDING jjpON TFIFI- ''PTI 'E OF' PUIDLIC WEL.L. 11INIMLIM DI.STAr-,IC:F' FTP011 A PRI'vATE IdELL TO FI PRIVATE LINE IS Ff..'E'l ANI) TO I::1 COMMI INI"TY '_,";EWER LINE I.C.; 7'.5 FEET. AND CON'S"I"RUCTICIV-.1 DIFIGki'Fil"'I'S 19PPL.Y. FiVAILABIJ."." TO IN,..;UF,E PROPER P.P.5-TALLATION. 11-_ _-­_* -1 �..j _y -y- J=, I.—H .."E" C�H F_ 3 VE F. I CERTIFY THAT J.: I API FFIWILIAR WITH THE REQUIREMPATS F'OF: C.0-1-'~';1: TE: '.:.:;FHEF11; Fl::; SET FC11"PIT1 T HE MLINI "'I PAL IPT' ("W" AP.-IDICIFIFIGE. 'D A N C. 1-',' 14 1 T t -1 TH E C 0 1' E 1 4.121._1... P-4,1.5"FALI.- THE IhI Fv*._ THF11" THE ON-SITE SEkIER S"T'c.,',TEl`1 MAY REG!UIF',.E IF' TFIE ff 5"I'AP-4C. D I UP ."Ir R'... I f::.ESI1.`jENCE IS RF'.MODE"L.EC, TO I I%l C L L) 1) E PlFiRE THAN ;7V I G hl E C, ADPL .'_:ANT WALTEP, .3 ......... .. ..... ....... PERFORMED LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 10 11 12 13 14 15 16 17 18 19 20 �.` SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION EJ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST P' / / v � j'e,e) / WRSV S GROUND WATER EOUNTERED? �4��' f C I YES, AT WHAT DEPTH? A COMMENTS PERFORMED BY: - 72 -008 (6/79) [,y' OFKa' t r Roberti �........ A. S fer J f No. 145 .E �8 Oa `••.......•'�FC��.s SLOPE DATE PERRFORMED:2t� —r—T AID S L 0 P E L Reading Date Gross Time Net Time Depth to Water Net Drop P 10 PERCOLATION RATE TEST RUN BETWEEN S & S Engineering CERTIFIED FT AND (minutes/inch) FT DA r tlb I)y DOC , d1la SULLI'VAN WC0ATEN WE L44S P. 0. BOX 272, CHUGIAK, ALASKA 99567 c TELEPHONE 688-2759 OWNER OF LAND DEPTH OF WELL ADDRESS STATIC LEVEL OF WATER FI'. LEGAL DESCRIPTION 01XI DRAW DOWN Fr. DATE -Started Ended GALS.PERI-IR PERMIT NUMBER KIND OF CASING KIND OF FORMATION From Ft. to� Ft. From Ft. to---- Ft— From -Ft. to /—Ft. Ft. to i, From F From,-- Ft. to- From Ft. to Ft.--,---, - Fioni Ft. to Ft. From Ft. to Ft. i' Froin_-- Ft. to _ ------F Ft.- From —'l— —Ft. to 1 Ft. From Ft. to---- Ft— Froni_t_ Ft. to i, Ft, From,-- Ft. to- Ft. From I Ft. to Ft. From. - From Ft. to Ft.- i Foin From- Ft. to I Ft._ From- rt. to Ft. 't. t o From —Ft, to—--Ft­/L'�-�� From -----Ft. to— ----Ft. From-- 1 FL to From---- ---Ft. From—Ft. to_ Froin.- -Ft. --ft—­­�-'� From ---� �j'' Ft. to Ft. From ----Ft. to -------Ft. From Ft. to Ft. From —Ft. to_._ -_,_Ft. From- --Ft. to __Ft,_ 'mN­(, From-_ Ft. to Ft. From--,%'i--Ft. to--L�� _ Ft. From ------Ft. MISCL. INFORMATION DRILLER'S NAME---: i Legal Description M o L) Al -r,"� I v,4 L t- C -y Pump Installation Date: ^ _' Z Pump Intake Depth Below Top of Well Casing: 33&et Pump Manufacturer's Name: ��� eY v14•� Pump Model: q S 2/ Pump Size -hp Pitless Adapter Burial Depth: I O feet _ Property Owner Name & Address: , 6C EL -1 KrtE$ s S403q Rpt) Q, -r Pitiess Adapter Manufacturer's Name: 1✓I "�"'� '� a..T Pitless ydapter Installer: �l Y%� >°l 'ell Disinfected Upon Completion ?-K, s � NO Mahad if Dlsunfei jon: � � Comments: 9 Pump Installer Name: Attention: The ptanp installer shall provide a pump installation log to the DSD within 30 days of pump installation. '. (i � _... 3 � • i i - dill. n _ Mark Begich Mayor Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Legal Description M o L) Al -r,"� I v,4 L t- C -y Pump Installation Date: ^ _' Z Pump Intake Depth Below Top of Well Casing: 33&et Pump Manufacturer's Name: ��� eY v14•� Pump Model: q S 2/ Pump Size -hp Pitless Adapter Burial Depth: I O feet _ Property Owner Name & Address: , 6C EL -1 KrtE$ s S403q Rpt) Q, -r Pitiess Adapter Manufacturer's Name: 1✓I "�"'� '� a..T Pitless ydapter Installer: �l Y%� >°l 'ell Disinfected Upon Completion ?-K, s � NO Mahad if Dlsunfei jon: � � Comments: 9 Pump Installer Name: Attention: The ptanp installer shall provide a pump installation log to the DSD within 30 days of pump installation. Parcel I.D. 050-631-18 Municipality of Anchorage ip ` On -Site Water and Wastewater Program c" (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Expiration Date: Mountain Valley Est. Block1, Lot5 Location (site address) 5039 Randl Ct Current Property owner(s) Jocelyn Krebs & Susannah Morgan Day phone Mailing address Real Estate Agent 5039 Randi Ct Day phone 2. TYPE OF DWELLING: ti S �ai� 0 Single Family (w/wo ADU) ❑ Duplex JUN 13 2014 ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Il Individual Q Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System H Public Sewer ❑ WaiverNariance Received by: 1 tt,' t + Date: %f -? COSA to be released to the4gngineer, unless otherwise requested by the engineer. COSA Fee $ 52Z� ' Date of Payment (a II 31!! ly C Receipt Number 6on�t COSA# o5CJS 1251 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE V�' System #1 Approved for Lis bedrooms System #2 Approved for bedrooms Disapproved Date 6/11/13 k1k ......aP9��i 49 TH annann CE -8149. ` Conditional approval for bedrooms, with the following stipulations: By: �� Original Certificate Date: 7' The uni ip of tc age Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet E - ., c If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Mountain Valley Est. Block 1, Lot 5 Parcel ID: 050-631-18 A. WELL DATA Well type Private If A, B. or C provide PWSID # Well Log (Y/N) Y Date completed 11/16180 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 340 ft. Cased to 180 ft. Casing height (above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test 11/16/80 5/10/13 Static water level 267 ft. 267 ft. Well production 2.0 g,p,m. 7.0+ g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 2 99 mg/L Arsenic ND ug/L Date of sample: 5/28/2014 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 6/10/2014 Pumper JR's Pumping Date installed 7/16-20/01 Cleanouts (Y/N) Y High water alarm (Y/N) Y C. ABSORPTION FIELD DATA Date installed 7/16-20101 Soil rating (g.p.d./ft2 or fe/bdrm) 1.2 GPD/SF System type Deep Trench Length 33 ft. Width 2.5 ft. Gravel below pipe 8.1 ft. Total depth 11.7 ft. Eff. absorption area 528 ftz Monitoring tube Y Depression over field N Date of adequacy test 5/10/13 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 627 gal. New depth 25 in. Elapsed Time: 110 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed 7/16-20/01 Size in gallons 150 "Pump on" level at 43 in. "Pump off' level at 41 in. Datum Bottom of Tank Cycles tested 3 E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ Manhole/Access (Y/N) Yes High water alarm level at 45 Meets alarm & circuit requirements? Yes On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 110+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I 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. Engineer's Printed Name Steven R. Pannone Date COSA brown sheet 10-10-12.doc 6/11/13 Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ in. S' { 1} i i Srx" S f F' �Za t r' 1 t JA.el'ARD -.4X S1Sl 0( ]EREBY CERTIFY .TH IVr 111AVE SUPVEYEi) THE LL011AVINE DESCRIBED PROPERTY' _ )]GATED. IT IS THE RE$P=1 ISILIT`f'OF THE NJER TO DETERMINE THx-' Ei(iS EMCE OF ANY CRID SEMENTS, COVENANTS, OR RrESTRICrIONS � ^ ICH DO NOT APPEAR ON THE RECORDED SUDDI- 10M PLAT ,UNDER NO CIRGUivI5TANGFS SF;O I.}C8»=ftm..4?C ti f*1^f\ e=hL^V. nhnft«;»y,.ii n+!•a+v r. ' S' { 1} i S F' Y t MUnlclpal1 of Anchorage Development Service'"s a De ltment Y`;ti4,BulidirigSayfetytiDlvLs�Ion�tp5ip1� ` JI 6 ite water 8 Wasteweier Program t f F , ,t• , `J+ ,R 1, �, ' t. •' :' 4,�fj4~7UOSoufh_B�pawSt�'e 'i 1,1« 1, ,f, . •`..�, � ,, P 0. Box 196850 MChorege 'AK 99519 66501 I n' J t} t til 1 ry.` •• ' .r` + c i c, .1> 5 tdr.4is+,, WWW.d.erlCllprB �ak.USl tjc,�dr `''<r �t i ''� t r , <: > + tYs' s e ,r,• +tffR(907)343-7904+->,.tr , v.%r ti ,r •' , ' 'r ,., '.' }! .^i i.�j•.t�,S n, ti �, �+..� i I 1.�r7 r a .:•eta t ,1t�. r 1 .. ��•... J .. J.ta.» •J4+ �F�A f.y61!41•�il;wJ,•%L..r��TP a *i r.?ra. > -,.. .I..1 � rt r CERTIFICATEOF, HEALTH+AUTHORIT�YtAF PRO VAL`:-: OR!' '(S INGLIFF"AM I+LYa DVIIELL` ING Parcel l.D,`- 050 631=18 c ';' rCJ� a7L'tir�lra J F" u,N bLt.p ^ / 7 r,, ._ J 2 J to ♦r + HAA# f. /"T4 t O ( S t �: 1 / ' .. `* . ,., r' i W r• 4.yJ yt.r9 t.,,r 1 i }.i 1L4FIk:+L tiir`3 I i F t 1 GENERAL INFORMATION 3 ' Expiration Date O i stir �� - ac' �, �...f� h; i' N.• t '+. q1. �1 ,}t'Jt wa.iy� x-i ti5 1 I•s , r / i!•f { �!}! I. n t•. r , i,.,..,�,, •.rwO4s ldt �+ U>: ^aFt Com I 4 p ete legal description MOUNTAIN aVALLEY!ESTATES� LOT45 YBLOCK ' ' t' "' `' "�• i". Location (site ad dress ofdirections)fi t 9424rHILANDfROAD-,MILE45'1�. -"�• r r f%(• r��•'Y't�'f I" r.,,1 t•.!t}i lu I) f� l,l. •i'Pn 1K Jr t"- , ,{ 1 Y . i , � i T,✓r � 'trt.{ -.�,y l 1.. i,• .. � �,t IK� Yr{ ', `.t _i I', )i+ �. ,r JJl art - •l Y jf; Current Pro @ ' " , xs +. ,'f'.. .»fi .r J p rtyowner(s) PHIL & RHONDAtWRIGHT> s+, . Day phone `694 7407, i �� ��t ft r �- ., ., `.: Y v 1 JF a •{ i�q• ; .v f[�'? �-!tri 1 , 1 l f d J �� ., •,r• Hw a J l ' ry t F 3 r ' a ME ailing address 1000 ' Dll OND SURE 200 99515 ; t � 'r 2.��•ir�.t S nr' ttrr'.}r1+.,L !� ,r•c '.,`t .t �. tlrt� t,a t'!�)ti Jiq' t ,'i fll rhily 4 i;<T� }Zy. ,frit( ,- Lendingagency . t J: tY� Jr: Vr<r-'f.... ion Jt. Day phorie�t r 4 r -.._ 4�,. a •, }, I is},,.r .. JA tir i47. I+Jti .,;t+•"l "7t .} r.blivxY r!f�ti �yy-J, '„ ^+r . '�' Maung address . ... .,.. +...?L,: i... .,,.• hn.:1'rar ,.X },:,,.,;:� bt...h t f t Real Estate Agent EVA 'LOKEN ,w/-PRUDENTIAL VISTA L Day phoria' 689 6464'-'. Mailing address , 16635 CENTER FIE LD DRr-EAGLE=RIVER, AK. 99577 •, .: ••r. , , r is , Unless otherwise requested, HAA will be held by DSD for pickup 2. NUMBEROF.BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Weil ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $2945.00 at, or prior to closing for the engineering services provided. 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 Neatth AutttonryApproval Guidelines !or this application, shows that the on-site watersupplyand wastewaterdisposal system ls(are) safe, functional and adequate for the number of bedrooms and type of structure?ndi00 herein. l lurcher verify that based on the information obtained from the Municipality of Anchorage files and Irom my investigation and Inspection, the on-site water supplyanW r wastewater disposal system ls(are) Jn compllance with all applicable bfunlcfpal and State codes, ordinances, and regulationsln effect at the time ollnstaUation. Name of Firm •AKA WATER & PIASTEWATER CONSULTANTS, INC. Address- 6901 :DEBARR ROAD, SUITE 2B ' ANCHORAGE, AK 99504 Engineers Printed Name JEFFREY A GARNESS, P.E. Engine`er's Comments In conducting this evaluation, AKM, Inc. altempted to protide a thorough, consctentious engineering anaysls of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily Identifrablo features. The operational He of all wells and septic systems depend on the local solls condition, *groundwater levels that may . fluctuate during the year, and the water usage of the familybeing served by the systom. 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 theyguarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provfde any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for —4— bedrooms. Disapproved. Phone 337-6179 Date r, 4'3 lot Conditional approval for bedrooms, viith the fllovting stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Mlanitenance Agreements Supplemental Engineer's Reort Other ON-SITE WATER AND WASTEWATER • PROGRAM By: g r y Original Certificate Date: -7 - 2- (R... (acc) Municipality of Anchorage ' Development Servi'ces Department Building Se"Dlrlebn � a • e r . On-site Water a Wastewater Program 4700 South Bragaw St P.O. Baur 108850 Anchorage, AK 995158850 wwwxLanchoregeAkua (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MOUNTAIN VALLEY ESTATES: LOT 5. BLOCK 1 Parcel ID: 050-631-18 A. WELL DATA Welt type PRWATE If A. B. or C provide PWSID# N/A Date completed 11-80 Sanitary seal MM -M. Total depth 340' R Cased to 180' 8'fL FROM WELL LOG Date of test 11-80 Static water level 260 ft Well production 2.0 — g -p.m -WATER SAMPLE RESULTS: Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12'+ In. AT INSPECTION 7/18/2001 222' fL 5.0+ g.p.m. Coliform 0 colonies/100 ml. Nitrate 3.16 mgA. Other bacteria 0 colonies/100 ml. Date of sample: 7/18/2001 Collected by: AWWC. INC. B. SEPTIC/HOLDING TANK DATA TankType/Materiai ANCH. TANK/ STEEL Data Installed 7/16-18/2001 Tank SIZE 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alarm (YIN) YES Date of pumping NEW Pumper. C. ABSORPTION FIELD DATA Data installed 7/-16-18/2001 Sop rating.p.d r1t'Podrm) 1_2 Length 33 ft Width 2.5 R System type TRENCH Gravel below pipe 8 It. Total depth•12.23-11.off, Eff. absorption area 528 g' Monitoring tube YES Depression over field N2 Date of adequacy test NEW Results (Pass/Fall) – For 4 bedrooms Fluid depth In absorption field before test = in. Water added =gal. New depth =1n. Elapsed Time: = min. Final fluid depth = in. Absorption rate >= - g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) - K yes, give date - D. UFT STATION Date Installed 7/20/2001 Size in gallons 150 Manhole/Acoess (YIN) YES 'Pump on" level at 38.5 in. 'Pump ofr level at3B.5_.in. High water alarm level at a5 lo, Datum BOTTOM OF TANK Cycles tasted NEW Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On edjaoent lots 100'+ Public sewer manhole/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property One 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One 10'+ Building foundation 10'+ Water main N/A Water service One 10'+ Surface water 100'+ Driveway, parkingAmhide storage 00' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 'END OF TRENCH IS AT THE DRIVEWAY G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections and *! review ofMunidpal records that the above systems ere /n conformance with MOA HAA guldefines In effect on this date. Engineers Printed Namp JEFFREY A GARNESS •�f•., 79 Data gl2-+ a t p�•.,o P•..... 0 •.r.., HAA Fee $ 300 . c'd Date of Payment7114 1 01 Receipt Number 7 (0 4 8 (Rev. IZOM Waiver Fee $ Date of Payment Receipt Number. MUNICIPALITY OF ANCHORAGE DORM DEPARTMENT OF HEALTH & HUMAN SERVICESDivision of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. # SSL- Lb_'� - lc� HAA # 0P3 Q(-1.;� � 1. GENERAL INFORMATION Complete legal description lot 5; Btock 1; Mountain Va tey E4.tateb Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent _ Address 9424 Hitand Road Ph.lt 9 Rhonda Wk ght 9424 Hitand Road E KEY BANK Day p�hOne -694-7407 to Riven, Ak. 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 \'j 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public, water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA U21 I& VOW HDEO (l6/l 'AUU) 9Z0-ZC -�aoM s,aaaui6uo leuolssaload agl ui suoissiwo Ao saoaaa aol alglsuodsai IOU si ebeaogouV to Ll!ledlolunlN agl 'ponssl si aleol}llaao e aaolaq elep azAleue ao suoijoadsui lonpuoo lou oP SHHQ to sea (oldw3 •sluawailnbaa aleis pue leaapal uleUao llslles olaapao ui suollnl!lsu! bulpual alagl pue sawoq to saasegoand of lsoUnoo e se slgl saop SHHa agl'eNsuIV to alelS agl u! pWals160a aaauIBua leuolssaload luapuadapui ue (q anoge g gdw5eied ul uan16.suoilelu9saadai agl uodn Aluo paseq soleoilpiao lenoiddy (luogln'd glleaH sonssi (SHHa) saolnaaS uewnH pue glleaH to luawlaedap a6eaogouV to Al!IedioiunW agl r 6 — 8Z — 8 ale(] sluawwoo leuolllppy mollelndlls 6uimollol agl pm 'swooapaq aol lenoidde leuolllpuoc) •p9noaddes14 swooapaq aol panoaddV 3un.LdNrJIS SHHa 9 ��" a1SS3�Qifd �Q �1d�eooa a. •��o ��J��q, a �7p Cr'aooU 4n• t/J} V ,^• 9 g'ON n �• /�i _ e 83.qVH j ij7.E)o d /.O ei•.BRA.0444�C46.6l41ctM�- 4% c V, 3d+yw ainleu6ls s,aaauibu3 LL566 e)iSeIV 'a9nl1 01623 'VQZ'ON Pe0a doo:, wanly al e� Vo' c. ssaaPPt/ auogd 'JNI21aMON3 S T S wail to aweN •uoijoadsui slgl to alep agl uo loaga ui suollelnbai pue 'saoueulpao 'sapoo alelS pue ledloiunW !le qj!m aouelidwoo ui si walsAs lesodsip Awmalsem Jo/pue Alddns aaleM ells-uo agl'uoiloadsu! pue uo1le61lsanu1 AW woll pue salt} a6eaogouV to Aj!IedlolunW agl woal paulelgo uollewaolul agl uo paseq legl AI!aan aaglanl l -ulaaag paleolpul aanlonals to ads I pue swooapaq to aagwnu agl aol alenbape pue leuollounl'ales sl walsAs lesodsip aalemalseM Ao/pue AIddns Aalem ells-uo agl legl smogs uolleolldde lenoaddV /\luoglnd glleaH slgl to uolledllsanul Aw legl Aluan l 'Molaq uMogs alep uo!lepllen aql to se pue olaaaq pexllle leas Aw /q pailllaao sV 833NIJN3 AG N01109dSNl d0 LN3W31d1S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: -©r V� o� ����Parcel I.D. A. WELL DATA Well type eV-AJIf A, B, or C, attach ADEC letter. ADEC water system numb Log present YON) Total depth 3 A Sanitary seal Y�N) Date of test Static water level Well flow Pump level "Q) — Date completed Driller S�w�'Jrn-\ Cased to ( `b U, Casing height 1 ILI N Wires properly protected (ON) FROM WELL LOG 'L0U 2, C;' g.p.m. J t� SEPARATION DISTANCES FROM WELL TO AT INSPECTION 6l 2- �V b�p�toJS �pm.,.S�S R— S�i.� p�v ra,r-_ �o rr rz >Lcr g.p.m. g �tiomrlcc J,a�c,Sa,A.I Septic/holding tank on lot X00 \� ; On adjacent lots c-) �k Absorption field on lot oo ; On adjacent lots (bo k Public sewer main 1 Public sewer manhole/cleanout Sewer service line ?� (� Petroleum tank 2� , WATER SAMPLE RESUf: Coliform D Lv v °S;"Q Date of sample: -1 ' 1 I ' B. SEPTIC/HOLDING TANK DATA w�/ Nitrate .2 cA Other bacteria ria 2 Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date installed g Tank size �2<y Compartments 2 Cleanouts&N) Foundation cleanout (Y& M Depression (Y6?�% High water alarm (Y,(�}1 /J Alarm tested (Y/N) 1-1/4 Date of pumping Pumper GES S POOL, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot o d t P On adjacent lots I Da Foundation To property line f S / Surface water/drainage bsorption field Water main/service line 0 6 / f" 22' 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical co ie/N) Manufacturer Manhole/Access (Y/N) SEPARA3JON DISTANCE FROM LIFT STATION TO: I on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date install/ed �� S 1Soil rating �3 S System type Length `� t Width 3 V Gravel thickness S Total depth 9 7 Total absorption area S7o _tCleanouts present (YIN) 7 Depression over field (Y/A __- /4 Date of adequacy testi/ �' Z 3 –�1 2 Results/fail) fr�S for i a) bedrooms Peroxide treatment (past 12 months) (Y& �8i j 1"I tJIJ If yes, give date 0� LV( �6 0") "-rti.� CX 3 F,;;, y Qom" U on, Peroxide DISTANCE FROM ABSORPTION FIELD TO: Well on lot Lb oy On adjacent lots � U Property line 10 t k To building foundation to t To existing or abandoned system on lot On adjacent lots �o Cutbank ?! I Water main/service line C) k Surface water 1 0 o I Driveway, parking/vehicle storage area to I Curtain drain SIA E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guic i & S ENGINEERING Signature ''C":" fade River Loop Road Nn 904 "arts:. ;�ivas Alaska 99577 Engineer's Name Date HAA Fee $ C7 Waiver Fee: $ Date of Payment —�� a— Date of Payment Receipt Number 3/ 5 Receipt Number 72-026 (Rev. 3/91) Back MOA 21 0 S 2 3 7�_*3 sction. i MUNICIPALITY OF ANCHORAGE MIMCIPAi,T7.'Y OF ANCHORAGE DEPT. OF HEALTH 8, DPfISION OF ENVIRONMENTAL. HEALTH ENVIRONMENTAL PROTECTION DEPAR"CtAr:IdYP OF HEAT,TH AND ENVIRONMENTAL PROTECTIO r'�KILICALTICAi _VPR HF;ALTd X57HORI T Y APPROVAL, CERTIFIC ®� 1, C��nr+�al Inf<;*Tn�ti a� Application Dapp VAL (a) Legal Cos7ripticn (includF lot, block, subdivision, rection„ township, range) Location (addrews or directions) (e) Real Estate Co. & Agent �- �I" - Cc ,1I/ - (b) Applicants Nares 1=4,C -f, �ot�r -K t r:f-'%f( .0 e Telephone Applicants Address (c) Applicant is (chcc_•k ore) Lending Institution. Buyer F__�J ; Other [-�71 (explain); ; Owner/builder F� ; g , is Telephone (d) Lending Institution �1i..1C• Address (e) Real Estate Co. & Agent �� � �I" Address Telephone 2. lypee _or Ibsidence Single -Family Number of Bedrooms 3. Water Supply 101 1 Multi. -Family Other (describe Individual Well Community Public Note: If community well system, must have written confirmation frcm the State Depa-rtment of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified i.n t:his HAA (Y 4. Sewage Disjosal Onsite Public Community Holding Tank Is the wastewater disposal system adequate for the ramber_ of bedroom (Y W, [page 1 of 2] r 5..Engineer.inq Firm ProvidinLInspections, 'Ilsts, Data and]Information I certify that ve checked, verified, or conformed to all MOA HAA Guidelines in effect on t dat s ction. Si- fie%l / i Date Name o'F rm Telephone ": 9PE7C Address �p�}��•a Al %'60, ��+ a 6 Signed by Date (ENGINEER SEAL) 6.DHEP Approval Approved for bedrecros Approved Disapproved Terns of Conditional Approval .6.000g".4e it ffib o q • o. -X 1` ag •.. sio NAW1 A. MOW ki By s /1 �liL S� Da to'/ tS l Conditional The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, }cased on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s (Page 2 of 21 2-.15-84 A MUNICIPALITY OF ANCHORAGE (MOA; HEALTH AUTHORITY APPROVAL (HAA' (/ CHECKLIST - FEBRUARY 1984 OL'_ A. WELL DATA Well Classification 2z:_ If A, B, or C, D.E.C. Approved(Y/N) AJ114 Well Log Present Date Completed _/ 116 g Yield / . Total Depth s ?Z10 CAse to !�O Depth of Grouting Static Water Level _ Z60 Z7OPurrp Set At Casing Height Above Ground le _ Sanitary Seal on Casing Y Electrical Wiring in Conduit (Y ) Depression Around 'Kblihead Separation Distances from Well: To Septic/Heid*nq Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot; On Adjoining Lots To Nearest Public Sewer Line IJ 14 To Nearest Public Sewer Cleanout/Manhole Af Z To Nearest Sewer Service Line on Lot Water Sample Collected ByS oS rAl r lRee.,41 ; Date Water Sample Test Results S'hTi /�� e- 7'L -,re Cents We (l Y/'e VCeW 0 A4 C!v r--/ / J F T /J 41S7'EF/r_, B. SEPTIC�`-TANK DATA / Date Installed/ /3 size 2 S`c� No. of Compartments 2 Standpipes (Y Air -tight Caps (Y Fbundatior. Cleanout Depression over Tank ( ) Date Last Pumped 2 - 8 Pumping/Maintenance Contract on File (Y/NtLJ for /J /a Holding Tank High --Water Alarm (Y/f Temporary Holding Tank Permit ( 14 Separation Distances from Septic/Holding Tank: To Water -Supply V411 /C26 / To Building Foundation 2,2 To Property Line /O 74 To Disposal Field To Water Main/Service Lire Sb To Stream, Pond, Lake, or Major Drainage Course AJ Comments z!�/o pn GI 2e / RiI U-{% he cc -f P n �L•C SLf/ a, / I "'o row¢• [Page 1 of 21 2m15-84 C. ABSORPTION FIELD DATA Soils Rating in Absor do Strata /. jsr Type of System Design Date Installed ���3 Length of Field Width of Field ,3 Depth of Field ravel Bed Thickness 490 A/ Square Feet of Absorption Area �2a Standpipes Present 474), v Depression over Field ( Date of Last Adequacy Test �e-o 3-8 Cf Results of . Last Adequacy Test/E,4 c TOsc y Separation Distance from Absorption Field: To Water -Supply Fkll ��5. To Property Line �d To Building Foundation ��� To Existing or Abandoned System cn Lot ` is ; On Adjoining Lots To Water Main/Service Line _<_6 ;F4 To Cutbark(if present) ZD To Stream/Pond/Lake/cr Major Drainage Course Z D0 To Driveway, Parking Area, or Vehicle Storage Area 1315" - Comments D. LIFT STATION Date Installed Diirensions _ Size in Gallons Manhole/Access (YM) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (YM) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (YM) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t I ha e checked, rified, or conformed to all MOA HAA Guidelines in effect on the da of thi Signed Date 4 4 �° •� 4} Company MOAN E unit, 19E3{�. rA 451 v.. KB1/d5/s 1, ! w° il.bwt A. IRia** w� d,�, Mka. 13i 7.6: o :i• �• nom^''`„ �. [Page 2 of 21 ey pROFk5510��,„*""�x s+►'"`'2-15-84 Time Time s Date Date Date Inspector Inspector Inspector Comments Conditional Approval WN "I otic/ A.w�vi C /> = L Date Sewer Installed Permit No. Septic Tank Size ( v Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank kA) APPLICANT FILLS OUT LOWER HALF ONLY Property Owner 37AW W6W ls Mailing Address f �. " `, V-()N/ .AvOcW i"/ l�Ut 'Phone -" {s Buyer V����.t iC i��7 IV iPit Ya ��lc.4Vc�LU�' v Address )(W - Lending Institution IY S YJrr=iN-✓1c_ `:: \jt NC)� �.-0-Fl1'6 Phone Address A) ILI ( C:j (_1 ( �� �' 4 Realty Co. & Agent Phone Address Legal Description L01- Street Location !�Quc-+� -For- j< f1 Q v Type of,.Reesidence tlSingle Family ❑ Multiple Family No. of Bedrooms ❑ O her Water upply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utilit available.) Sewa isposal Individual Year Individual Installed: 17 Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time APPLIQ T FILLS OUT UPPER HALF MY Time PropertyPioperty Owner l -�_ �' �! y'%, Ci%�> G*JS (� Phone Mailing Address (° _��' -? r}. r<•� -9 �v/ Zip Code Date Buyer Date 6 Inspector Address Zip Code Lending Institution _ Phone Address / / Zip Code Realty Co. &Agent ,J/ /-�_-�:C' 1 (� �-� %i>J�t1-/ C __ �: d •t.'�, /2l (-rte.;-� FJ Phone Address O " 100 Zip Code n - Legal Description �' .`S FJ _ ��•l O U /�'/ 71//-) b/i? Well To Absorption Area Well Log Received 41e f Street Location —> Type of Residence Single Family rMultiple Family No. of Bedrooms ❑ Other Water Supply ,Indlvidual " �- ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. � Community For wells drilled prior to that date, give well depth (attach log If available). ❑ Public Utility - Sewer Disposal Individual Year Individual Installed: LJ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time a� Date Date Date Date 6 Inspector Inspector Inspector Inspector Field Notes: V VDEPT. MUNICIPALITY OF ANCHORAGE PROTECTION i is ENVIRONMENTAL ONIv1cNTAL PROTECTION MAY RECEIVEQ L,j.Ftf'PROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE Y /3 BY: i Soils Rating Date Sewer• In tallied Well To Absorption Area Well Log Received 41e f Well to Tank Septic Tank Size 72023 (3102) Municipality ®f Anchorage P.O. BOX 754 EAGLE RIVER, ALASKA 99577 (907)694-2131 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION i Upon your application for Health Authority Certificate approval for the individual sewer and water facilities cannot be granted Gunttil the following circled items have been completed: A well _log submitted to this office for our files and review. 2. The top of the well casing should be sealed so that it is water tight. 3. The depression or pit around the well casing needs to be filled with impervious type soil so that it slopes away from the well casing. 4. The well casing needs to be extended twelve (12) inches above ground level. Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and must be encased in conduit. 6. The water facilities were not turned on at the time of the scheduled inspection. Please call this office for another appointment. 7. The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. 8. Expose the well for our inspection to determine proper construction, also to insure minimum distance requirements are met between the well and sewer system. g. The septic tank pumped with a receipt submitted to this department. 10. The septic tank pumped with a receipt submitted to this department. The total number of gallons pumped needs to be on the receipt and verified by a registered engineer as to the actual number of gallons pumped. This is to verify the size of the septic tank. 11. Expose the septic tank manhole to verifty its existence. 12. Locate and expose the cleanout to the seepage pit and/or leaching area for our inspection. This is to insure the minimum distance requirements are met between the well and sewer system. 13• A four (4) inch cleanout needs to be installed to the septic tank. 13a. A four (4) inch cleanout needs to be installed to the leaching area. 14. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. 15. A maintenance contract for the Jet unit serving the sewer system needs to be obtained from Consteel Company, 376-5919, and a copy submitted to this office for our review and our files. 16. The permit for the installation of the on-site sewer system will expire December 31,198 . We have not received the as-builts of the installation in this office. If a private engineer inspected the system, please send us the report for our files and review. 17. The application shows the number of bedrooms exceeds the number the on-site sewer system was originally designed for. An upgrade will be required. Prior to any upgrade, a permit needs to be issued from this department. 18. An outside water tap was not available. Please call this office to make arrangements to have an inspector to meet you at the site. 19. The depression over the sewer systems will need to be filled so that surface water drains away from the sewer system. 20. The standpipe to the sewer system need caps on them. 21. The water sample could not be taken due to silt content (turbidity). The well should be flushed clear by turning on a garden hose until clear water is evident over an extended period of time. Please contact this department for a resampling appointment.