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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.
(Rev 05102118)
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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
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Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211417, Deb Wockenfuss, 10/12/21
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On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211417, Deb Wockenfuss, 10/12/21
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On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211417, Deb Wockenfuss, 10/12/21
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On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211417, Deb Wockenfuss, 10/12/21
_ MUNICIPALITY Or ANCHORAGE
DEPAR'LMFNT OF HEALTH & ENVIRONMENTAL PROTECTION
I' ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 "telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM ANWOR WELL INSPECTION REPORT
/®N ,y ®3 E NEW
/ /1©A1S 7-/-'Lj&%1 El UPGRADE
MAILING ADDRESS
/In� a Boy ��� � �c� 9_��_ dye_ .� <r 1'95 %7
LEGAL DESCRIPTION � _ ✓ —�_ _
zc�
LOCATION _ a
NO. 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
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--
-
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^
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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_
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From
Ft. to - -
Ft. i
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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