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HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 5 LT 4River View Estates Block 5 Lot 4 #050-792-29 (Rev 05102118) Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211417 PID Number: 050-792-29 Dwelling: M Single Family (SF) El with ADU El Duplex (D) n Two Single Family Project: F] New M Upgrade Name John and Tracy Brauchle ABSORPTION FIELD ❑ Deep Trench X Wide Trench n Bed n Mound Site Address 21230 Failing Water Dr El Other Phone Number of Bedrooms Soil Rating depth from original grade 1 3 0.6 GPD/SF ITotal 5.9 - 6.3 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.6-3.8 Ft. Gravel depth beneath pipe 2.5 Ft. Subdivision Block Lot River View Estates 5 4 Fill added above original grade 0-0.3 Ft. Gravel length 48' + 48' Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft, SEPARATION DISTANCES Toi Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 750 Fe 2 6 Ft, Well I >100' >1 00' NA I 'N A NA TANK @IJ -1 Septic 0 S.T.E,P. [1 Holding El Other Manufacturel GREER 11000 Capacity Gal, I I Surface Water > 100, > 100, NA NA I Material PLASTIC Number of compartments 2 ii Lot Line 1>10' >10' NA NA NA FoundationNA 7.7' >10' NA LW-T-S-TATION Manufacturer —�... Capacity Gal. Remarks Alarm location Electrics iti bei y PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer JRs SEPTIC Drainfield 3034 CO/MT 3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection 1z' 10/20/2021 Zd 10/23/21 Location and description dates: 31d 10/24/2d 01 10/30/2 6 garage slab at point A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp or- A/-,, k_�b Conditional Approval: Date *Y 40 Mi ........... tL'VT sy leo. CEIA04 PROt�Y FESS , Septic System Approved Date 11181ad.?� Note: this approval does not include well permit requirements. 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MUNICIPALITY QF ANSHORAGE On-Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 9€519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http :l/wvw. mu ni. o rglonsite Effective trate: Expiration Date: Lot Size in $q Ft: Total tsedrooms: On-S'ite Wastewate,r Disposal System Perrnit Permit Num,ber: OSP21 141 7 Work Type: S'eptic UPgrade Tax Code Number: 05079229000 Site LegalAddress: RIVER V,IEW ESTATES BLK 5 LT 4 G:0357 Site Mailing Addr:ess: X23A FALLING WATER DR, Eagle River Owner: BRAUCHLE JOHN K & TRACY A Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: El Disposal Field M $eptic Tank fl Holding Tank il erivy fl Private Well [J Water storage All construction shall be in aceordance with: 1. The attached approved design, z. niiiequlrements'specified iriAnchorage Municipal code Chapters 15.55 dnd 15.65 and the State of Alaska Wastewater Disposal Regulations (18MC72) ind Dr'inking Water Regulalions (1BAAC8O) _ 3. The wastewater code reqiires inspections duiing the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notifieation by ca'lling'(907) 343-7'gA4 {2417). _4. From Octonir" '15 to Ailr.il '15, a subsurtace soil absorption system under construction dur:ing freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing ;*'' h* Sil4 t= Special provisions: Locate the beginning of the field to confirm that the 5' separation between the tank and field F willbe met. F'*w' i 'ins'' ,lt o^r". I al r -f z-oz r ox., lqlzr,/zt 1 t12J2021 10t1212022 44984 3 Received By:lt MUNICIPALITY OF ANCHORAGE Development Services Department \ 4 Phone: 907-343-7904 On -Site Water & Wastewater Section --'' Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-792-29 Property owner(s) BRAUCHLE JOHN K & TRACY A Day phone Mailing address PO Box 771648 Eagle River AK 99577 Site address 21230 Falling Water Dr Eagle River Legal description (Sub'd., Block & Lot) RIVER VIEW ESTATES Legal description (Township, Range & Section) Lot Size 44,084 Sq. Ft. Number of Bedrooms 3 BLK 5 LT 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank 0 Upgrade 171 Duplex (D) ❑ Holding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees:.-0_15� 5 Date of Payment: 912x12 1 Receipt Number: 0'f3cfl D Permit No. 417 7,1 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewate r\Forms\C lie nt FormsTermit Application.doc Eklutna Engineering, LLC curtistownse nd @gma il.com October 9,2021 Subject: River View Estates Block 5 Lot 4 New Septic System Permit osP 21,1,417 I am writing to request a septic system installation permit for the above referenced property. The proposed system will serve a 3-bedroom house. Soil logs, design calculations, site plan and design drawings are enclosed for your review. Soils. The test hole was dug near the house as shown on the plan view. Two percolation rates were measured in the same strata of soil. The average rate of these two tests is used to determine the required absorption area of the trenches. Soil Absorption System Design. See Sheet L ofthe design package. Wells. This and neighboring properties are served by private water wells. There are no wells within 100' of the system. Neighboring Wastewater systems. lmmediate neighboring septic systems are all +10' distant from the property lines. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least L00 feet from all surface water and drainage ditches. Topography: This property slopes downhill towards the north and east. In the area where the trench is to be placed the eastern end of the trench sections is closest to the steep slope of 47%. This separation from the trench is more restrictive than to the north. The criteria of 15.65.2L0 B.l.d can't be met, as the proposed field draining the house is less than 50' up- gradient from the 47% slope. The 'steep slope' provisions of this code will apply. Construction of the septic system will meet all the conditions of 15.65.210 B.4.a i, ii, iv. ' 15.65.210 8.4.a iii will apply to this case and all existing vegetation on the 47% and 50% slopes will remain intact. The slopes will not be disturbed. 15.65.210 B.4.a.v The disposal field is less than 100' up-gradient from any slope exceeding 46%. As shown on sheet 3 of the design package, a line of 46% slope starting at2.5'above the invert of the perforated pipe does not daylight the existing ground for at least 35'. The well log for this property shows that there is no bedrock till at least a depth of 30'. The soils in this area have an average percolation rate of 18.9 mpi. The proposed installation will not affectthe future development of this or the surrounding lots. Sincerely, Curtis L. Townsend, P.E. 1. 2. 3. 4. 5. 6. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211417, Deb Wockenfuss, 10/12/21 i./Jif) j \i\i froUO &UOzzo< q+TZ-Lt \[=E PI Fv:kO(l z ^H RhH : 9.d < o, il-F '. 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OF BEDROOMS i / Absoi ptiioon at ca DISTANCETO: 12 DwellinO / i /© PFRM/IT NO. .A--.---"� �[JC �0 •�'j'a' /ifs(©G'.i• I- Z Manufacturer ^ R� f Material No. of compartments U) �Llq. rapacrt in gallons Inside length IF HOMEMADE: Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. 0._- Q Manufacturer Material Liquid capacity in gallons w w T� DISTANCE TO: '--"-"�G ---- Well /) / if Foundation��v Nearest l of l ine .15 �D P�E R�M�IFN�O�.�i� L -j u. z w No. of lines Length of ea h lite �_- _ _ Total length lines Trench �wi Distance between lines E- - - T'0_------- .310 incises Material beneath the / Top of tile to finish grade I oral effective absorption area - - -Width inches® - �-Length --��-- Depth----------��� PERMIT NO. w 4 F- Crib depth Total effective absorption area Type of crib Crib diameter w° in --- --_ DISTANCE TO: _ Well _ Building foundation Nearest lot !ine "-- —" Class _ Depth v Driller^ Distance to lot line PERMIT NO. d 1_ DISTANCE TO. Building foundation Sender line Septic tank Absorption areas) - -- OTHER _ PIPE MATERIALS V SOILTESTRATINGI've _ i'-- - Im 125 Pd - INSTALLER --- --- - - - REMARKS PC _Q oeo 011 - - -- - -- - \ � ♦ _96LIQe ^ 4�yt, a— �errs`�oea.�ti ° �Ici.:.f i 1n � V i AAs �o , l t l.�i .. e ®% 4, e- A P'PA 0>1 ED� - - DAI-E LEGAL -n_ntzip,,, imi I- �1UNICIPALITY OF ANCHORAGE,-, Department/ ` Health and Environmentaj rotection 825 _ Street, Anchorage, AK. 1501 264-4720Arit Permit#�_ * * * HANDWRITTEN PERMIT * * * WELL AND/040 ON-SITE SEWER PERMIT Applicant: Mailing Address: AX �%�3 u��•. Location: Phone Number: Legal Description: O/ y IJ��s lt;e4p Qsl)Ei�' Lot Size: Type of Soil Absorption System Is: Trench: Y Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms:_ Soil Rating(sq.ft/br) 1.25^ The Required Size of the Soil Absorption System Is: �y f DEPTH a LENGTH 3 d GRAVEL DEPTH S WIDTH The length dimension is the length (in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(MYED- G) TANK SIZE = /000 GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * *.* TWO M INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection.and approval by this departmen will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlarge nt if the reUdence its remodeled to include more that 3 b oms. Signed: n-f/s. /�4- Issued byn /Applicant '- Date: SWP/024(1/81) MUNICIPALITY OF ANC:HUKAbt Department Health and Environmental rotection 825 _ Street, Anchorage, AK. .7501 �� 04�Lr 264-4720 ae HANDWRITTEN PERMIT # Permit ?i� WELL AND/(3* ON-SITE SEWER PERMIT C Applicant: Mailing Address: Location: Phone Number: Legal Description: /rA/ _ 9' Of Type of Soil Absorption System Trench: 'K,_ Drainfield: _ Lot Size: Is. Seepage Bed: Holding Tank: Maximum Number of Bedrooms: -_ Soil Rating(sq.ft/br) I ;e 5 The Required Size of the Soil Absorption System Is: r DEPTH LENGTH --3 6v . GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(If& B ) TANK SIZE _ /DC>A GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. PERMIT EXPIRES DECEMBER 31, 1 9 3 # I certify that: (1) I am familiar with the requirements for on-site sewers set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require the re§jidence is remodeled to include more that 3 be Signed: r_ %7 - '?, Issued by: Applicant Date: / `a SWP/024(1/81) and wells as enl t if LAY SOI LS LOG -° MUNICIPALITY OF ANCHORAGE / s DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST :\ �• 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: L -/A,/ -Ac- DATE PERFORMED: 2-2-63 LEGAL DESCRIPTION: L d % \j PG � C -K �� , V% yl,� �-�7-L) DEPTH-(A/n�/ �y?��/y �y8/ - M, --00- SLOPE��TT��;; SITE PLAN (FEET) •rj,C- ,26)A -1 n is 2 3 4 J C% 12 13 14- 15 4 15 16 R. Mlfe e y t , n 17 18 Y� 'yQ i8a i9t!ssu: .JD O Bso ,ii 19 G7 .zr Y NO. 2113,.E G 20 c? " �� G 4 i•ti&-7 NITT/-h Lf"J lid WAS GROUND WATER L ENCOUNTERED? O � P E IF YES, AT WHAT DEPTH? - Reading Date Gross Time Net Time Depth to Water Net Drop ■l Jim 1 111111` ■■■I ■■� Mi■■■.■ ■..■■■ ,�.�■ �� G 4 i•ti&-7 NITT/-h Lf"J lid WAS GROUND WATER L ENCOUNTERED? O � P E IF YES, AT WHAT DEPTH? - Reading Date Gross Time Net Time Depth to Water Net Drop is cr'-ts':+' •;;,', Baa:' PERCOLATION RATE p TEST RUN BETWEEN ._.. COMMENTS/L- % A%/��t�7�ZS~��=% PERFORMED BY d�7e - ,%""'" `-� _CERTIFIED 72-008 (6/79) 1,>/A (minutes/inch) FF AND-- FT TE: [P"12 -7-e---? 11 Trri dirb Brining log by OOC Co. dba SULLIVAN WATER WELLS P. 0. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND DEPTH OF WELL ADDRESS STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION DRAW DOWN FT. DATE • Started' Ended GALS. PER HR PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From Ft. to , Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to_ Ft. From Ft. to - - Ft. i _ Froin -Ft. to Ft. From Ft. to -,Ft. From Ft. to Ft, From - Ft. to Ft. From Ft. to Ft. From Ft. to Ft. - From Ft. to Ft. From- —Ft. to , Ft. " From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to-Ft.From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft, to Ft. MISCL. INFORMATION: DRILLER'S NAME MUNICIPALITY ID Development Services Department `` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-792-29-000 Legal description RIVER VIEWESTATES BLK 5 LT 4 Expiration Date: 9/20/2023 Site address 21230 FALLING WATER DR Eagle River AK 99577 Current property owner(s) BRAUCHLE JOHN K & TRACY A X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: a Original Certificate Date: 6/20/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaUune 2022 MUNICIPALITY F ANCHORAGE ll Development Services Department= = Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050 792 29 Complete legal description RIVER VIEWESTATES BLOCK 5 LOT 4 Location (site address) 21230 FALLING WATER Current property owner(s) BRAUCHLE 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass Age 2 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 0 Waiver Fee $ Date of Payment ��3�23 Date of Payment COSA # 0S c �- j ) Waiver # COSA Application—June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Phone Engineer’s Printed Name Date C&M ENGINEERING CHARLES BALZARINI, PE 6/9/23 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 J www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. n5b--qq;" COSA# 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address RIVERVIEW ESTATES, LOT 4, BLOCK 5 21230 FALLING WATER DRIVE • EAGLE RIVER, AK 99577 JOHN -&4*ER 5Q 1 TU—r, Day phone 223-2246 21230 FALLING WATER DRIVE • EAGLE RIVER, AK 99577 Day phone KATHI OLMSTEAD w/ REMAX Day phone 696-2209 16600 CENTERFIELD DRNE ' EAGLE RrVER, AK 99577 Unless otherwise requested, COSA will be held by DSO for pickup. I 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 5. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage (les and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date f3 /Zv/o q- Engineer's Comments: In conducting this evaluation, GEG, UD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 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 identifiablo features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the 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 conror any legal fight whatsoever. Conditional approval for Attachments: COSA Checklist t� Septic System Advisory Well Flow Advisory Nitrate Adviso bedrooms, with the filowing stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort ry Other By: (R" 11105) WASTEWATER Original Certificate Date: 8 -2 a- — 0 7 Municipality of Anchorage • -r Development Services Department Building Safely Division On -Sae Water 6 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 995198650 www.muni.orglonsite (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: RIVERVIEW ESTATES. LOT 4. BLOCK 5 Parcel ID: D 50 - -7172 -.2 q A. WELL DATA Weli type PRIVAlt If A, B, or C provide PWSID# N/A Date completed 3/9/1983 Sanitary seal (YM) YES Total depth 140 ft, Cased to 32.5 ft. FROM WELL LOG Date of test 3/9/1983 Static water level 37 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform (3 colonies/100 ml. Nitrate AJO mg./L. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/1/2007 34 ft, 4.5+ g.p.m. Other bacteria U colonies/100 ml. Arsenic: A) 10 Date of sample: 8/1/2007 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/15/1983 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 8/7/2007 Pumper JR's PUMPING C. ABSORPTION FIELD DATA Date installed 9/15/1983 Soil rating (g.p.d./R'or m 125 Length 40 ft. Width 3 ft. ••RELD MEASURED 80 INCHES. System type ' TRENCH Gravel below pipe "5 ft. Total depth ■9.3 ft. Eff. absorption area 400 ft' Monitoring tube YES Depression over field NO Date of adequacy test 8/1/2007 Results (PassIFaIQ PASS For 3 bedrooms Fluid depth in absorption field before test •20 in. Water added 450 gal. New depth80in. Elapsed Time: 1065 min. Final fluid depth 64 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access(YIN) "Pump on" level at —in. 'Pump off` leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A — — Sewer /septic service line 25'+ Holding tank N/A — Animal containment areas 50'+ 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 N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION .G %-!.'•• I certify that I have determined through field inspections and * y. review of Municipal records that the above systems are in •' • •' • • • "" • • • • • •' • ' • • • • conformance with MOA COSA guidelines in efled on this Q date. •• of r y A. ess.. �p Engineer's Printed Name JEFFREY A. GARNESS 1y E-7953 \�:O Date e P�oreeeW^a'� COSA Fee &'V30- CSO Date of Payment 91 P-0 o 7, Receipt Number. 10 �? O y U % (Rev. I IM) Waiver Fee $ Date of Payment Receipt Number SGS ReLN 1073805001 All Dale%rrimes are Alaska Standard Time Client Name Ganncss Engineering Group, Ltd. Printed Dalelrime 08/152007 16:21 Project NamdN Riverview Est L4 D5 Collected Daterrime 08/012007 16:00 Client Sample ID Riverview Est L4 145 Received Daterrime 08102/2007 11:15 hlatrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: 4500-NO3 - Total Nitratc/Nitritc - The matrix spike recovered below the QC criteria. The batch LCS is within QC limits. Allossahle Prep Analysis Parameter Results POL Units Method Container ID Limits Dale Date Inil Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 08/08/07 08/15/07 hill Waters Department Total Nitntc/Nitritc-N ND 0.100 Microbiology Laboratory Total Coliform 0 mg/L Sh1204500NO3-r 11 (<I0) col/IOOmL Sh12092220 A (<I) 08/07/07 1DS 08/02/07 SDP Municipality of Anchorage •. �s • Development Services Department' Bulling Safety Division .. , .. On -SRO Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www cLanchorageAkus (90T) 343-7904 . CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-792-29 HAA# 1140/ d (a 1) 1. GENERAL INFORMATION Expiration Date: 3 -1 i - O 12— Complete legal description T'RNER NEW ESTATES SUBDIVISION• LOT 4, BLOCK 5, Location (site address or directions) FALLING WATER DRIVE • EAGLE RNER, AK 99577 Current Propertyowner(s) c/o BOB BROCK x/ DYNAMIC PROPERTIES Day phone 261-7603 Mailing address Lending agency Day phone Malting address Real Estate Agent BOB BROCK w/ DYNAMIC PROPERTIES Day phone 261-7603 Mailing address 3111 "Co STREET, SUiTE 100 • ANCHORACE. AK 99503 Unless ofhenviss requested. HAA will be held by DSD forplckup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well O Individual Water Storage Community Class Well ❑ Publlc Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of tiCe (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 retssued 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 englneees work Note: Alaska Waterand Wastewater Consultants, ins shag be peld 5150.00 at, orprior to closing for the eng/needngservices pmvfded. A. STATEMENT OF INSPECTION 8Y ENGINEER As cerG6ed by my seat afraed hereto and as of the vartdaHw► date shown below. I verryy that my Investigation, based on procedures outlined In the Heaffh Authority Approval Guldelines for Mls eppffcation, shows that the on-site water supply and/or wastewaterdrsposal system Is(am) salla, funcbbnel and adequate forihe numberof bedrooms and type of structure Indicated herein. 1 further verify Mat based on the InfannsUon obtained from the Munkipardy of Anchorage files and from myk"stigation and lnspectfon, the onsite watersupptyand'arwastewater disposal system ls(em) In compffance With elf apprrcable Munidpal and State codes, ordnanees, and regulations In effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS. INC. Address 6901 DEBARR ROAD, SURE 2B • ANCHORAGE. AK 99504 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In oanduc ft Mis eVWU&W r. AWWr, bc. attempted to p Af# a f mugk consdenfOvs engl w ft analysts ofMe system In swwdeme WM ADEC and AICA DSD GuWdtnes 6 RWaflona. The reported resuks desWbed Me pwkmwnce ofMe system under Me condkkxu oncow red at Me eme orMe test, and sopereWn distances messured to readily 1denhttable Iesivres. The operstbnat Rte of a# wells and ssptic systems depend on the but so& cmdkbn, gramdwaterkvNs Met may fluchrsts during Ms year. and Me water usage of Me lomfybehg served by, Me system. TAass oondtbrts are outride Ms aronbd of the eva4rsforofMe syrfarn. Satishdory lost resuks do not Werantss AMR0 performance of Ms system, nordo Msyguumf" Met Mere ars no hWen defects or encroachments. A WWG Irm can Merehxs trot poNds SPY werrany or Acture estimate of how brp ON system wet continue to meet the operationalteq *gmonts of Me ADEC orMOA DSD. no content of Mls report is lbr Me sole baneet of Me owrwosted above. Anyre6ence upon or &= dMls report by any oMarperson orperyls not suModud, nor wW k oonferany kgNdght whatsoever. S. DSD SIGNATURE phone 337-6179 Date I/ l Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the Plowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory `tlty �t`(O FAIr;ri V� �•.• •. 'O��i \. WATER AND 9'r�ITER' PROGRAM 1 Manitenance Agreements 1%%,,� Supplemental Engineer's Reort Other 6y / �` LOriginal Certificate Date: IA -11-01 0tw./zoor Municipality of Anchorage • '' Development Services Department Bulmv Division Orem WWdw a Wastewater Pmw m 4T00 SarEn Srepaw St P.O. B=19llOSC An homp9. AK 995196650 rr"xLsndfareg&skAW (M 3tXMU HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Won type EMI- If A, B. or C provide PWSIDti N/A Dam completed 3/9/83 Sankary teal (YIN) YES Total depth 140 R. Cased to 32.5 R. FROM WELL LOG Date of test 3/9/83 Static water level 37 R. Wall production /5 9 -P.M. WATER SAMPLE RESULTS: cditm _�_ colonleeloo ml. Nitrate 1.63 rwiL. Wel Lop (YIN) YES ULLIEZ-71=7=1Q0r3 Casing height (above ground) 12+ in. AT INSPECTION 9/5/2001 43 R. 4.5+ g.p.m. Other bacteria 0 color"100 ml. Dateof sampie; '11/14/2001 Collected by: AWWC. INC. e. SEPTI MOLDING TANK DATA Tank Type/Matadet STEEL Data installed 9/15/83 Tank size 1000 pal. Number of CampwtTwft 2 Clearwuts (YIN) YES Foundation cleanout (YM) ,= Depresslon over tank (YM) NO High water alarm (YM) N/A Date of pumping 9/5/2001 p-umper JWS PUMPING C. A830RPTION FIELD DATA *FIELD MEASURED $.8 F PRE—SOAKED WRH 8755 GG ALLONS OF WATER ON 9/5/2001 Data installed 9/15/03 Sol rating (g p.dJRb� 12S� System type TRENCH Length 40 R. Width 3 R. Gravel below pipe 03 R. Total depth .—@.LR. Elf. 81380 )0n area 400 R' Monbft iube_W_ Depression over field NO Date of adequacy test 409/8/2001 Results (Pa33/Fetl) PASS For—.L—bedrooms Fluid depth In absorption field before test 6 In. Wster added 11 gal. New depth s4 1n. Elapsed Time: t • 183min. Fkud Nuid depth._ In. Absorption ram 2— 450+ 9.p.d. Any nlwarmtlon treatment (past 12 mo.) (YM a type) NONE KNOWN If yes. give date — D. UFT STATION Size In gallons 'Pump on' level at _in. High water alarm level at in. Cycles Meets alarm 6 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOTTO. Septic tanMIft statlon on lot 1001+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public Bower manhole/deanout N/A Sewer /septic service line 250+ Holding tank _ N/A SEPARATION DISTANCES FROM SEPTICfHOLDWG TANK ON LOTTO. Building foundation 5'+ Property One 50+ Absorption Sold 5'+ Water main - N/A Water service fine 100+ Surface wffter 100'+ wens on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One 101+ Building foundation 10'+ Water main_ N/A Water service One 10'+ Surface water 100'+ Driveway. parldrVNetdde storage 250+ Curtain drain NONE KNONN Web on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I cw* that I haw determined through field inapecllons and review of Mw*4v1 records that the above ayafems are in conformance with MOA HAA gu10alrnes M affect on fhb date. Engineers Printed Nara — JEFFREY A. GARNESS Date HAA Fes S - Date of Payment 111;271:2W Receipt Number- �aof 1-7 (R... t?rao) Waiver Fee $ Date of Payment zoo ¥ m nea O1o=4Wa MUNICIPALITY OF ANCHORAGE ° DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section 44 P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel LD. #C,� 1�'� - a`� HAA # _ IA`ti1 Lri 1"1 1. GENERAL INFORMATION Complete legal description Lot 4; Block 5; Riverview Estates Location (site address or directions) NHN Falling WAter Drive Eagle River, AK Property owner Mike Ulestad Day phone Mailing address 'P.O. Box 208 Anchorage, AK 99506 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone 694-0966 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. Q By: 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 S & S ENGINEERING Phone fl'-/- 2- 9 G� age rver oop oa o. Address Eagle River, Alaska 99577 Engineer's signature �— �� �-2 Date 7 4 Z 7 DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments aIITIC', ti A �! 4 CE -8801 �8 r. bedrooms, with the following stipulations: 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 DHHS does this as a courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rw. 1/91) Back MOA 1121 00* Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist vi�_ s Legal Description: (�� (�i L �. rj . ii Fk T2. �rView �5dle5Parcel I,D.: ��cyo A. WELL DATA iv- If a If Well t e yp�w-- A� _ A, B, or C, attach ADEC letter. ADEC water system number Log present 0i)— iJip� pate completed . Q j Total depth i Cased to % �/Casing height (above ground) 12-" + Sanitary sealVN) FROM WELL LOG Date of test Static water level Well production , g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: 7 / 7 / 1 7 B. SEP'T'IC/HOLDING TANK DATA Wires properly protected (1 1) AT INSPECTION 7` 2_- U • 3 6 Other bacteria 6 Collected by: S & S ENGINEERING age Iver Loop Road No. 204 [� Eagle River, Alaska 99577 Date installed I rA 3 Tank size ��,��� �qa� . `—�"` Number of Compartments Cleanouts ( N) •C.°s Foundation cleanout Depression (Y N High water alarm (Y/N) Date of Pumping //u ��1, 7 Pumper ;vi'� Gln C. ABSORPTION FIELD DATA Date installed! _ q (�_ Soil rating (g.p,d./ft2 or ft2/bdrm) 1215- 1,- ' System type 1_ Length.._ d7ft Width _ Gravel thickness below pipe _& depth Effective absorption area 7t Monitoring Tube present O)IJE-s- Depression over field Date of adequacy testResult - ass ail) r I For bedrooms Fluid depth in absorption field before test; in, �_ ( ) I Immediately after gal, water added (in.): �1�wt Fluid depth —�/ ' (ins) Minutes later:Absorption rate = _ Z t D —9-p.d. Peroxide treatment (past 12 months) (Y/N) � If yes, give date 72-026 (Rev. 3/96)* y` /^%a/. G'��/'�✓pt,." �.UDICsYlf�3' .5"� I`�i�LD ti1F_fi�iCJ/L�lnl>� iS 4>..l' (60.��''t I�IS� �� D. LIFT STATION Date instal a Size in gallons Manhole/Access (Y/N) "Pump on" level at* ,Pump off' level at' High water alarm level at' `Datu Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I(X2' On adjacent lots 00 i Absorption field on lot { On adjacent lots I W Public sewer main {f�O 1 Public sewer manhole/cleanout { Sewer /septic service line Lift station + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation + Property line I UI + Absorption field �n Water main/service line 1 t7 f Surface water/drainage 00/ % Wells on adjacent lots (00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 Building foundation �� Water main/service line T Property line ID g Surface water { 0) + _Driveway, parking/vehicle storage area Wells on adjacent lots it) .) * Curtain drain ZS ! I- F. ENGINEER'S CERTIFICATION ►vat Q�y ms are 1 certify that 1 have determined thru field inspections and review of Municipal recon �� .rW.`;y ��,� in conformance with MqO/AJ HAA-QUIdeli es in ffect on this date. N Signature .uY Engineer's Name a 6/. Q '°�` RoeERT C. CCZN CE - 8801 Date • b1'aat�"�' Waiver Fee $ HAA Fee $ Date of Payment Date of Payment ` Receipt Number F� Receipt Number 72-026 (Rev. 3/96)` r� S G] JUL-00-1997 14:21 (-16t t5 i HIYI.MUKHUC C7&E,�nrsnuwmsntal �sac�rr Services ���i CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By MID Parameter Nitrate -N Total Coliform 973590003 S & S Engineering NIA L4 g5 Rivcrview Est, O.S Tap Drinking Water 0 Client POt/ Printed Date/Time 07/08/97 12:58 Collected hate/Time 07/02/97 16:35 Received Date/Titne 07/03/97 10:00 Technical Director: Stephen C. Ede Released By Allowable Prep Analysis Results PQL Unit Method Limits — Date Date [nit 0.236 0.100 mg/L SM18 6500-NO3P 10 max 07/03/97 JUL 0 col/100ML SM18 92226 07/03/97 TMW MUNICIPALITY OF ANCHORAGE •I! DEPARTMENT OF HEALTH & HUMAN SERVICES N� Division 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 I.D. # L�2D -lq -Q Q � 1. GENERAL INFORMATION Complete legal description HAA# QQ �g2C Q Lot 4; Block 5; Riverview Estates Subdivision Location (site addressor directions) Falling Water Drive Property owner Richard and _Ka-hy_Monyer Day phone Mailing address Lending agency NORWEST MORTGAGE Day phone Mailing address ATTENTION* D Agent Dawn Dawes/MCKENZIE REAL ESTATE Day phone Address p.o. Box 772922 Eagle River Alaska 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 694-9035 NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC I ttesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 921 5. ri STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S S ENsf$fE6Rfff6 Phone Address 17034 Eagle River Loop Road No. 204 Engineer's signature DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date 2-Z�i —92 aWdOngev !� r 696 i6 491h ROGRR J. HAFER Jr bedrooms, with the following stipulations: NUTIr The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA N21 e Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST � Legal Description: ��� \�v� �/�J y I G -,A ( Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number A\� Log present (DN) Date completed �''cA - b'� Driller Total depth �-A Cased to ti , e--� \ Casing height \'L 4 - Sanitary seal &N) Date of test Static water level Well flow Pump level I -ROM WELL LOG EE v\L Wires properly protected O`N) AT INSPECTION 2 - Z\—c%UUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION' F((� 1 1992 g.p.m. ��1P g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot�e b' p ; On adjacent lots Absorption field on lot D n\ ; On adjacent lots Public sewer main �11'< Public sewer manhole/cleanout Sewer service line �'`j \ Petroleum tank _ IJ \� WATER SAMPLE RESULTS: Coliform b Igoo�A Nitrate •7-S N`�'�• Other bacteria Date of sample: -Z\ Collected by: 5 & 5 ENGINEERING 17034 Eagle River L0013 ��Oad mo. 904 Eagle River, Alaska 99577 R. SEPTIC/HOLDING TANK DATA Date installed C\ - \•`s 'q�l Tank size Compartments �— Cleanouts YON) �!4 Foundation cleanout (2YN) �SlT— Depression (YO High water alarm (Y/9) tl� Alarm tested (Y/N) Date of pumping Z -1, C-> — `12, Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot \ob\k- On adjacent lots o Foundation 1b�� To property line l C 1 k Absorption field \ Z-\� Water main/service line— U — Surface water/drainage \• ®p \ 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 codes Manufacturer Manhole/Access (Y/N) p off'level at Cycles tested SEPARATION-DfSTANCE FROM LIFT STATION TO: lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed 1\ - \ S - li�';s Soil rating 12S ISSN System type Length -A 01 Width 7-R thickness Total depth Total absorption area Depression over field (YAW Cleanouts present*/N) Date of adequacy test 7- - 2\ -C_�Z Results as fail) pn"ss for bedrooms Peroxide treatment (Past 12 months) (Y6 r� V- , b \.J A,.k If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ b r� \ -t- On adjacent lots \ o'a \ } Property line \ \A - To building foundation \� To existing or abandoned system on lot On adjacent lots Cutbank 0— Water main/service line 1 �� Surface water \�� Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on.,thg date of this inspection. 6�d D6 eE ol6 e�ODei Vy S S ENGINEERING e Signature E�,GX 36 �% e. e�U Q Eagle River, Alaska 9957% 6.fla OOOAC&866®' •3o a e r, o Engineer's Name v, n�'"" A A Date Z l. ' �t7:r "r �'• No. U215 HAA Fee $ I / d Waiver Fee: $ Date of Payment a _ �,_2" %U Date of Payment Receipt Number Z Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CIFIFE 4IICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING a ENGINEERING CO. 5633 8 STREET ANCHORAGE_. ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561.5301 ANALYSIS RESULTS for INVOICE 1 51327 Chemlab Raf.1 92.D692 Sample f 1 Netzm WATER lient Semple ID : L4 B5 RIVERVIEW EST. S/D WSID : UA -ollected FEB 21 92 1 11:30 has. ecaived : FEB 21 92 0 12:25 hrs 'reserved with AS REQUIRED ,nalysis Completed FEB 24 92 ,aboratory YSupKirigol QST✓EPHEN C.gEDEE� � Client Name :S & S ENGINEERING Client Acct :SNSENGP BPOI Regf Ordared By :R. SUPER Send Roporte to: 1)S & S ENGINEERING 2) ?Of ;NONE RECEIVED . ............................... ................ J..................CPI.,.,...........................n................................ Parameter Results Units Method Allowable Limits ------ ----------------------------------- NITRATE-- -------------•-----------------------------------------------------••------------- 0.25 m9/1 EPA 353.2 1.0 n Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks, .......................... ........... .,.............................................................................................. 1 Tests Performed See Speolal Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LTJLese Than, GT•Groater Than 19i Member of the SGS Group (SociOth GBndral© do Surveillance) MUNICIPALITY OF X,�!CHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH ANIS ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFIC;K 1. General I nf_or-'mat icn (a) Legal Description (include lot, Z_ zle dy <- X'16ce-1 Location (address or directions) Application Date subdivision, Section, township, range) e') S Z (b) Applicants Nano Applicants i:ddlre;ss (c) Applicant is (check one) Lending Institution �� Owner/buildor �{di ��-��� � ^Y Buyer �� Y other f�- (explain); (d) [anding Institution It le Address (e) Ictal Estate Co. & Agent Address Telephone 2. lype p[RIsidencon Single-Farmily Number of 1?,�drecrro 3. mater Supply Indiv:ldua1 in, 11. F% 1, Multi -Family 00 Other (descr_iLbe) CrrraunityI Public j Notes If ocurunity «1.1 system, must have written confirmation f`.rcm t -he State Cepartm;nt of Envircnlrerta.l Conservation attesting to the legality and ;status. Is the well adequate for the number of bedrooms specified in tlli,��i A Ci�Ti) 4. Sewaf e Disposal ll 1?ublic Corlimr:iHolding Onsite uty HoldiTank �_ - �� a Is the wastewater disposal system adequate for the number of Ledr0c us (Y)FI) ivlilhiC.!I--1iry q J HOM% (Page 1 of 2.1 t. n 1-1 4_04 19 5, Enaineerina NFirm Providim (nspectiens bsts Cata and Informati.c ( T c�"rt:ify that -i have checked, verified, or conformed to all MOA HAA Guidelines in effect cn ie dater'r i �z ispecticr.. ,y X' > Date Nam of Frm Address Signed by �k s�8ltw'�5'�} Date (ENGINEER SEAL) G.DH P Approval Approved for t' hedroons Approved F� Disapproved Tums of Conditional. Approval 'Pe t3y ell Condit:icral Abe Municipality of Anchorage Departient of t-balth and Environmental Protection; Com.; not guarantee the continued satisfactory performance of the water supply ard,icr the wastewater disposal_ system This approval indicates that., as oE-' the val.i.da�ior d=it-! shcTr above, based on the data and information furnished by an er:gireer regi! tered it the State of Alaska, the water supply and wastewater disposal system is safe and One - t ional for the number of t:edroc-,n and type of structuYee indicated. (1AI E, :P SEAL ) 7. Mail the HAA to the following address KB2./d5/s [Page 2 of 21 9 - 1 7 n A MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classificati If A, B, or C, D C. pproved(Y/N)_ _ C' � Yielder OO s Well Log Present (Y } Date Completed 9 i'vy De of Grouting Total Depth l d Cased to p th g Static Water Level 3/)/ Pump Set At a K Casing Height`Above Ground fJ Sanitary Seal Electrical Wiring in Condui (Y ) Depression Around Separation Distances from Vb ll: on Casing (/ie) In�llhead ('f ` To Septic/HeidimgTank on Lot 100 70L , On Adjoining Lots /00 /- To Nearest Edge of Absorption Field on Lot /00 7/- ; On Adjoining Lots IeO y� To Nearest Public Sewer Line /V 1q To Nearest Public Sewer Cleanout/Manhole N f To Nearest Sewer Service Line on Lot Water Sample Collected By!T E�2� SCO/n; J Date Water Sample Test Results Comments A 0 1J e__ l B. SEPTICS TANK DATA Date Install d /'/JI SizeNo. of Compartments , Standpipes {Y Air -tight Caps (Y Foundation Cleanout Y . Depression over Tank Date Las Pumped Pumping/Maintenance Contract on File a1 ( for Holding Tank High -Water Alarm (Y /4 Temporary Holding Tank Permit ( /� Separation Distances from Septic/Holding Tank: To Water -Supply Will lt90 t To Building Foundation ®- _ To Property Line /0 -f-To Disposal Field / �- To Water Me+"/Service Line 57? 04�To Stream, Pond, Lake, or Major Drainage Course W Comments I.ITY OF ANCHORAGE DEPT. 0,F r;' ALIH 8 VIR0,.ii clviAL h'i2UTECTION [Page 1 of 21 / ) - R E C E Y V E D, _ � C/ 2-15-84 1- - C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed/> B� Length of Field zl4o Width of Field 6 �' Depth of Field or Gravel Bed Thickness C) d` Square Feet of Absorption Area Standpipes Presen -(/[d) Depression over Field (-, Date of Last Adequacy Test Al Q 4/ Results of Last Adequacy Test %i -e- 4] Separation Distance from Absorption Field: To Water -Supply Nbll To Property Line To Building -Fo/undation l To Existing or Abandoned System on Lot /� On Adjoining Lots Air To Water /Service Line To Cutbank(if present) Al / /,- To Stream/Pond/Lake/or Major Drainage Course rel % To Driveway, Parking Area, or Vehicle Storage Area JV_0 201 Comments D. LIFT STATION Date Installed Dimensions Size in Gallons a ole/Access (YM) "Pump On" Level at IIIf" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request I certify that havd checked, verified, or, conformed to all MOA HAA in effect on the date thi k /a t! Signed ;o� Date O Company MOA No.SRO Isax .A �.� EtrEili�f / KB1/d5/S dpi �l=, AVER, All.St rr�� . A•hw+ A. Sho I- ::af I 41H. �i &p -vW No. 1457-E cc (Page 2 of 21 2-15-84