HomeMy WebLinkAboutSUN VALLEY NORTH BLK 4 LT 4Sun Valley
No th
Block 4
Lot 4
#050-652-15
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SFRVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: '~'/~/ ~/O/~2'd; PID Number: ~
~y~ ~e~ ~ ~/~/~/ ~ Wastewater System: D~ew D Upgrade
~ ~ ~o~ ?~ ~,~-b ~ ABSORPTION FIELD
Phone:~.~4/ ~/~ ~ No. of B ooms. I D Deep Trench ~hallowTrench ~Bed ~Mound DOther
LEGAL DESCRIPTION so, Rating: Tolal Depth from original grade:
Township: /y~ Range: / ~} lSectio~: .~ ~ Flfl ,dded above original grade: Gravellength:
7 "~,/*~,
WELL: ~ew B Upgrade araveldeplh; Number ol lines:ID~
SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P.
Surface
Wat~, .... - -- LIFT STATION
Foundation ~ ~ ~ ~ .... "Pump on' level at: "Pump off';
Remarks: BENCH MARl(
Location and Description: ~'
ENGINE~.~'~AL
Inspections performed by: ~ Dates: 1st
~'- ~ No CF~'~"/
Department of Hen Hu rvices approval
Reviewed and approved by ~ ~b Date: ~ ....
72-013 (1/91} MOA 25
PERMIT NO. SW940176 LEGAL DESC. L. 4, B 4, SUN VALLEY N SUBD PID 05065215
AS-3U};LT
EXISTING WELL~
5' WIDE SHALLOW
ABSORPTION
EXISTING
ON SITE SEWER
CO
GAL
SEP I1C
~ f~/ RADIUS
TRENCH BR
LL
AREA PLAN VIEW
~^~"~ ~ ~°~ TAYLRR LOT, L4, B4
OF
~.~o<~o.~, ~.o~ SUN VALLEY NORTH SU33.
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SCALE: r'=mo'
PERMIT NO. SW940176 LEOAL DESC. L 4, B 4, SUN VALLEY N SUBD PID 05065215
xA S- 18 U I L'T
0
>
DESIGNED BT: VLR NO DATE REPLACEMENT BED
D.A~NO~: .~oD TAYLOR LOT. L4, B4
OF
c,Eo.<Eo,¥: woe SUN VALLEY NORTH SUED. / 4
SCALE: I '=40' O~]~a~ ~ 9408
PERMIT NO. SW940176 LEGAL DESC. L 4, B 4, SUN VALLEY N SUBD PID 05065215
AS-SUTL. T
0 L,J I£)
<I~o
J
0
DATE: I I/29/94
DESIGNED 8¢: VLI!
NO
RE~4SIONS
DATE
PRBFILE AND DETAILS
,*o,~c, TAyLE]R L. DT, L4, B4
SUN VALLEY NBRTH SUB13,
VEl Cons ul~an ~s
4
dOB NO
9408
Zac's Well Drilling
~ And Pump Service
P.O. Box 521068
Big Lake, Alaska 99652
376-0227
KIND OF FORMATION:
FromL~'~ FL to/~C~Ft. ~e~o~ (l~y From Ftto ~Ft.
~r~/~ $ ~t. to/7~ m. //~ /~ ~ ~om ~Ft. to
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From Ft. to Ft. From Ft. to __Ft.
From Ft. to 'Ft~ From Ft. to Ft.
CONTRACTO~ ~
, /
UI I IIVAN
P.O, ~OX 670212, CHUGiAK, ALASKA 99~? * TELEPHONE 688,21~9
/
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DATE - Star(~d Ended ~
PERMIT NUMBER
' C)/2
KIND OF FQRMATION:
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From Fi. to ['1. CO~[~ ~ ~ From
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From .......... FI. to ..........Ft ...........................
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bIISCL, INFORblATION:
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DRILLER'S NAME
NORTHEItN TESTING U BORATORIES, INC.
:J350 INDUBTRIAL AVENUE FAIRaANKS, ALASKA 99791
2506 FAIRBANKS S~REET ANCHORAOE, ALASKA (907) 469-3110. FAX 4§~.3126
99503 (907} 277-B378 * FAX 274-B645
Jame~ N, & Holly M. Taylor
H085 BOx 9335 Hlland Rd,
Eagle River Ak 995?7
Atti~ I
Our Lab#~ ........
Loeation/ProJeott Garage Tub
¥ou~ Sample
sample Matrizt Water
Lab
Report Date:
Date Arrivedl
Date Sa~pledl
Time Sampled~
Collected By~
~[/o4/94
:o/3:/9~
~o/3~./94
* Definitions *
B = Below Regulatory Min.
H = Above R~gulatory Ma~.
M = Matrix Interference
D = Lost to Dilution
HDL = Method Deteetioll Limit
Date Date
Number Method Parameter Units
................................ Result * MDL Prepared Analy~ed
A13524~ EPA 353,3 Nitrate-N
mg/1 0.76 0.10 11/01/94
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPm~TMENT OF HEALTH AND HUMAN SERVICES Z~
P.O. BOX ~0, 8~ "~" ST~T, ~OOM ~0~
~CHO~GE, ALAS~ 99519-6650 ~ ~jj,) ~ / ~,~,
ON-SITE WELL ~ WASTEWATER DISPOSAL SYSTEM PE~IT
PERMIT NUMBER:SW940176
DESIGN ENGINEER:VEI CONSULTANTS
OWNER NAME:TAYLOR JAMES N & MOLLY M
OWNER ADDRESS:9516 LAURA LEE CIRCLE
EAGLE RIVER, ALASKA 99577
DATE ISSUED: 6/16/94
EXPIRATION DATE: 6/16/95
PARCEL ID:05065215
LEGAL DESCRIPTION: SUN VALLEY NORTH BLK
4 LT
LOT SIZE: 88187 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AiYD HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
RECEIVED BY:
VEl Consultants
Civil Engineering and Surveying Consultants
Serving Ali of Alaska
June 6, 1994
Mr. Dan Roth
Municipality of Anchorage
Department of Health & Human Services
825 L Street
Anchorage, AK 99501
1345 Rudakof Circle, Suite 201
Anchorage, Alaska 99508
Fax: (907) 338-5386
Phone: (907) 337-3330
RECEIVED
,JUN g 1994
Municipa! ',y ol Ai,cilorage
Dept. Health 8-. Human Services
Re: Lot 4, Block 4, Sun Valley North Subdivision, Taylor Well and Septic System
Dear Mr. Roth,
With this letter we are resubmitting the above referenced septic system design along with
additional groundwater monitoring information, which I believe will alleviate your concerns
about monitoring the seasonal high groundwater condition.
The attached groundwater monitoring information is consistent with our experience in the
South Fork (Eagle River) Valley. In this area, break-up continues into May. We have
found in the past that the seasonal drainages are running and groundwater levels are at
their highest for approximately one (1) month after break-up, as the snow on the slopes
above the Valley continues to melt.
For digging the test holes, we used a local excavator, Mr. Bob Dean, who lives across
the road from the project site. At the time Mr. Dean, who is very familiar with the South
Fork Valley, indicated that the groundwater was at its seasonal high.
As a fall-back position in the future, I am confident that groundwater levels are deeper at
the upper end of the property to the northeast. However, to use the back lot area with
its higher elevation would require a lift station.
I personally feel that it would be overly conservative and an unnecessary expense to
require additional groundwater monitoring or additional test holes at this time.
if you have any questions, please do not hesitate to call. ". ,., :%
Sincerely,
VEl C,,ON SU LTAN'f~
Vernon L. Roelfs, PE//¢
Attachment: As Noted
Consultants
Civil Engineering and Surveying Consultants
Serving All of Alaska
May 19, 1994
1345 Rudakof Circle, Suite 201
Anchorage, Alaska 99508
Fax: (907) 338.5386
Phone: (907) 337-3330
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, AK 99501
Re:
Lot 4, Block 4, Sun Valley North Subdivision
Well and Septic System
Gentlemen:
MUNICIPALI'I~ OF
ENVIRONMENTAl. SERVICES DIVISION
I IAY ] 9 1994
REC, ElYED
Our client, Jim Taylor, requests an on-site well and sewer permit for the above referenced lot.
Attached is the design for the septic system, consisting of three (3) 8-1/2" x 11" sheets with
three (3) soils Icg-percolation tests. Lots in the area are generally in excess of two (2) acres in
size and there is little chance of interference with neighboring lots. The subject lot and the
adjacent lots slope toward the South Fork of Eagle River to the west. Slopes generally range
from 8% to 15%.
Soils consist of well-drained silty-sandy gravel with one (1) foot of topsoil. Groundwater was
monitored during the summer and fall of 1992. During that time we had high altitude snow melt
and wet weather, and the highest groundwater measurements were recorded. Depths to
groundwater in the proposed septic area were approximately eight (8) feet. The slope of the lot
and the subsurface gradient is toward the South Fork of Eagle River, which is approximately 700
feet west. There would be no impact on any of the three (3) adjacent lots.
The proposed well is located near the center of the lot. With the sparse population in the area,
we anticipate no biological problems with the well.
If you have any questions or concerns, please do not hesitate to call.
Sincerely,
VEl CONSULTANTS
Principal
Attachments: As Noted
PERMIT NO, LEGAL DESC. 4, B 4, SUN VALLEY N SUBD PID
ON SITE SEWER
60
05'
SHALLOW
1250 GAL
TRENCH
EXISTING
DATE: 5/18/94 RE',A SIONS 3HEET CONTENTS
SHEET NO
AREA PLAN
DESIGNED BY: VLR NO. DATE
ORAl. DY: ~CD TAYLUR LDT, L4, B4
OF
C.EOKE08,: ROE SUN VALLEY NFIRTH SUB:D, ~ 3
VEl --
SCALE: 1"=100' onsultants
PERMIT NO. LEGAL DESC. L 4, B 4, SUN VALLEY N SUBD PID
DESIGNED BY: 'tLR NO. DATE REPLACEMENT BED
- i /
D.A~: Jc~ TAYLDR LF1T, L4, B4 OF
C.ECKED"','~ "OE SUN VALLEY NBRTH SUBD, ~ ~
VEl ·
SCALE: 1':40' Consultants e4oe
PERMIT NO. LEGAL DESC. L 4, B 4, SUN VALLEY N SUBD PlO
TO LOWER TRENCH IVERSION VALVE
3 WAY DIVERSION VALVE
INSTAL LEVEL, PROVIDE
OPERATOR HANDLE W LABELS,
WESTERN U~ILITIES ~ DV4 OR
NA31ONAL DWERSIRED ~ NDS 575
EL 1715
EL 1710
EL 1705
EL 1700
EL 1695
TO HOUSE
190 180 170 160 150 140 130 120 tlO
REPLACEMENT BED PROFILE
REPLACEMENT BED DETAILS
D.^~*sY: oco TAYLOR LOT, L4, B4
OF
C.~CK~D.',': .o~: SUN VALLEY NORTH SUB]3. ~ ;;:::,
SCALE: VERT 1"=10' Oz"/SUJ~;~ti'/~S 9408
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PERMIT NO. LEGAL DESC. L 4. B 4, SUN VALLEY N SUBD PID
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DETAIL SITE PLAN --
DRA?TNBY: dCD 'ROJEC[ TAYLBR LOT, L4, ]?4 ~ ~
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CHECKED BY: BO[ SUN VALLEY NBRTH SUBD. ~' 3
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SCALE: 1"= 40' 0~]~
PERMIT NO. LEGAL DESC. L 4, B 4, SUN VALLEY N SUBD PtD
za: J~d~
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PROFILE AN3 DETAILS ~
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C~ECK~D,¥: WOESUN VALLEY NORTH SUBD, ~ 3
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SCALE: VER 1"=10' onsul~an~s ~4os
Nlunlclpallty of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED
4-
§-
6-
7
8
g
10
12
13
14
15
16
17
18
19-
20-
DATE PERFORMED:
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED? ~/~' 5
SITE PLAN
. S
IF YES, AT WHAT _./~, ~,,~.'.' OL
DEPTH? p
E
Reading ,~D~ t~,~.,,. Gross Net Depth to Net
Time Time Water Drop
/ ,:' O q
q 3 :/;~ ~ ~- ~/q _
PERCOLATION RATE ,'~,* O (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN X FTAND -~FT
COMMENTS
PERFORMED BY: I ~'/t ~.)~ / 1~'<~ CERTIFY THAT TNIS TEST WAS PERFORMEG IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE:
72-008 (Rev, 4/85)
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
,EGA, DESCR,PT,ON= L ~ ~ ¢. 5' V/I~ //~ /. /. E, yrownship. Range. Section:/C/~,k~7',/¢'
SLOPE SITE PLAN
4-
5-
6
7
8
9
10
12
13
14
15
16
17
18
19-
20-
WAS GROUND WATER
ENCOUNTERED? .
IF YES, AT WHAT
DEPTH?
Deplh to Water After ._..~ /
MonDoring? "'/. '7 Date:
Reading AZ) ,~ a./~Z~ Gross Net Depth to Net
' Time Time Water Drop
PERCOLATION RATE '~' '~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FTAnD ~:/ FT
COMMENTS
PERFORMED BY: I ~/~'"~/~) ~;~ ~/~Z'~ CERTIFY THAT THIS'rEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, ARchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED POR=
DATE PERFORMED;
1
2
3
4
6
7
8
9
10-
11-
12
13
14
15
16
17
18-
19-
20-
COMMENTS
Township, Range, Section: ~T'I~.,.~(~//~/' 7-~/~"-
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED~
~onitorinD?
/~ Gross Net Depth tO Net
Reading at
-- ~ Time Time Water Drop
_ ~ /o,//
PERCOLATION RATE "~'<~ (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN ~Z FTAND 3 F'r
PERFORMED BY: I -~~,.~..~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: __'r-~"~?~7~ ~ "~,/ / ~ ~' Z,
72-008 (Rev. 4/85)
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOIL8 LOG -- PERCOLATION TEST
PERFORMED FOR:
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
Township, Range, Section: ,,/~ 7'/~/ )'"~//~l ~/'~, 7'/t7/"~,~
SITE PLAN
SLOPE
WAS GROUND WATER
ENCOUNTERED?
TJ --
s
IFYES, ATWHAT ~-' / 0L
DEPTH? ~/ p
E
Depth lo Waler Allot
Monitoring?
Reading ~z~ ~'~ Gross Net Depth to Net
'rime Time Water Drop
/ 0 ~,~'"
PERCOLATION RATE /" ~'--- (minutes/inch) PERC HOLE DIAMETER
TESTRUNBETWEEN__~' FTAND --~ FT
PERFORMED BY: I ~-~"'/ '~--~:) ~'/i~'*'~" CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72'008 (Rev. 4/85)
Certificate of On -Site Systems Approval
Parcel I.D. 050-652-15
Legal description SUN VALLEY NORTH BLK 4 LT 4
Site address 22253 ELKHORN CIR
Current property owner(s) WEISNER
Expiration Date:
10/17/2024
X The On -site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 8/2/2024
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 X Arsenic Advisory
Other
COSA Approval_June 2022
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. 050-652-15
Complete legal description Sun Valley North Block 4 Lot 4
Location (site address) 22253 Elkhorn Circle, Eagle River, AK 99577
Current property owner(s) Paul & Sjofn Weisner — Day phone
2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: MN Private Well n Private Well serving 2 dwelling units
n Private Well serving 3+ dwelling units n Community Well or Public
F-1 Water Storage
4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic 0 Private Septic serving 2 dwelling units
F1 Holding Tank El Community Septic or Public Sewer
5. SEPTIC TANK: RN Steel r_1 Plastic [-I Concrete ❑ Fiberglass
Age 29 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: r-1 AWWTS M Bed E] Deep Trench OR Wide Trench R Seepage Pit
Waiver request for:
Expedited review requested: R
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 $ �_60
Date of Payment AL-1
COSA # O5C, Z (-k I -Z
Waiver Fee $
Date of Payment
Waiver #
COSA Application —June 2022
MUNICIPALITY RAG
DEVELOPMENT SERVICES DEPARTMENT � '�1 907-343-7904
On -Site Water and Wastewater SectiOn � � «� � Fax: 343-7997
www.muni.org/onsite -�
Holding Tank Advisory
Certificate of On -Site Systems Approval # OSC241212
Subdivision: SUN VALLEY NORTH Block:4, Lot: 4
The holding tank for this property is 29 years old. The average life for a steel tank
is 20 years.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
1.01
Forge Engineering
6/4/24
10/17/23*
Alaska Quality Septic*
N/A
Benjamin Schiller, P.E.
(907) 522-7773
August 1,2024
To whom it may concern,
I am writing this letter in regards to the septic system at my home.In the many years of owning my
home at 22253 Elkhorn cir.Eagle River,AK we have never had any issues with freezing or backing up
during the winter months or at any time.The septic system has always remained in good working
order.
Thank you,
Sjofn Weisner
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VElConsultants 1345 RUDAKOF CIRCLE SUITE 201, ANCHORAGE, ALASKA 99508 (907} 337-333C
5
SCALE: 1"=50' !GRID: SW758, SW7591DRAWN BY: JCD CHECKED BY: VLR PROJECT NO: 9408
I HEREBY CERTIFY THAT ! HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY, LOT 4, BLOCK 4
SUN VALLEY NORTH SUBDIVISION ANCHORAGE RECORDING DISTRICT, ALASKA, AND
THAT (MPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT OVERLAP OR
ENCROACW ON TH'' PROPERTY LYING ADJACENT THERETO, THAT NO IMPROVEMENTS ON PROPERTY LYING
ADJACENT THERETO ENCROACH ON THE PREMISES IN QUESTION AND THAT THERE ARE NO ROADWAYS
TRANSMISE!ON OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS INDICATED HEREON.
DATED THIS 20 1H DAY OF OCTOBER, 1994 ANCHORAGE, ALASKA.
EASEMENTS, COVENANTS AND RESTRICTIONS OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION
PLAT ARE NOT SHOWN HERE.
Municipality of Anchorage
Development Services Department
· Building Safety Division
· On-Site Water and Wastewater Program
· .... ' 4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O /
1. GENERAL INFORMATION
HAA# InOlOO O
Expiration Date: ~, .-. ('~,- c:) I
Location (site address or directions)
CurrentPrope~owner(s) ~ ~t~,
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Un/ess otherwise requested, HAA will be held by DSD for plckup.
NUMBER OF BEDROOMS: '~/
Dayphone
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~
Individual Holding tank
Community On-site
[] Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of A/aska. Certificates of Health Authority Approval ere required for the transfer of
title (except between spouses} for properties served by a single family on-site wastewater disposal end/or water
supply system. DSD also issues HAAs upon request to homeowners. Cedificates of Health Authority Approval ere
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates ere valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto end as of the validation date shown below, I verify that my investigation.
based on procedures outfined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verity that based on the Information obtained from the
MunicipaIity of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm //~-~".~' ~__~-~',,//7/'~"'~ Phone ~"~ 7- ~0
Engineer's Printe'a Name'/~,,7~,,,1 L ~c~e//?' ga,e 4~) r / SO/Or,
DSD SIGNATURE
[,,"/ Approved for
Disapproved.
Conditional approval for
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Sragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchoroge.ak.us
(9O7) 343-?g04
Legal Desoriptlon:
HEALTH AUTHORITY APPROVAL CHECKLIST
t Y. 81/< Y. ^ ,D:
!
WELL DATA
Well type ,~O,,.,~,,-~,~ IfA, 8, or C provide PWSlO #
Date completed ! X>//cI~I . Sanitary seal (Y/N) y
Toteldepth ~"~)~fl. Casedto /~J lt.
FROM WELL LOG
Date of test / ~. - 2. ¥ - ,?c/
Static water level t/ ~ ~" ft.
Well production ~'-- ~" g.p.m.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
%..~il
y
WATER SAMPLE RESULTS:
Date of sample: ///,T. ~/~'~ /
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material '~"'/~" /
Nitrate ~ ~ mgJI. Other bacteria ~) colonies/100 mi.
Date installed ~'/'~
Cleanouts (Y/N)
High water alarm (Y/N)
Tank size/~ ~'~ gal. Number of Compartments
Foundation eleanout (Y/N) y Depression over tank (Y/N)
Data of pumping
Pumper "~',,~
/
C. ABSORPTION FIELD DATA
Da. installed q//~/'~ So, rating (g.p.d./~o~f~/bdrm)~' ~ ~,e/~Systamtype..~/,~/~,,~o ~','~'~
Length ,/~ "Z-. ft. Width ~" fl. Gravel below pipe ~ ft.
Totaldepth ~,%"-'ff. Eff. absorption area ?/&) ft2 Monit~ingtube/V~$ Depression over fleid
Date of adequacy test ,~./]//~' / Results (Pass/Fail) /t~:~. For ~/ bedrooms
Fluid depth in absorption field before test .2° ~'in. Water added ~O~gal g'o~A New depth ~ l in.
Elapsed Time: ,.~._~Dmin. Final fluid depth ~.~'in. Absorption rate >=
Any rejuvanetion lreatmanl (past 12 mo.) (YIN & type)
UFT ~-'TATION
Date installed ~
'Pump on" level at in.
Datum
Size in gallons
'Pump off' level at
Cycles tested
in*
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot / / '~-
Absorption field on lot / ~-- ~
Public sewer main ,~"7 ~'
Sewer/septic service line 7.,~
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK ON LOTTO:
Building foundation ~// Property line ~ ~
Water main ~ ~,,/~ Water smvice line ?~:>
Wells on adjacent lots ~ ~3 7 .
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water Service line
Curtain drain
Building foundation
Surface water
Wells on adjacent lots
Absorption field / S
Surface water ,/[//'~
Water main ,,~-,')//~
Driveway, paddng/vehicle storage ~'- ~
F. COMMENTS
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name /~",,~0/~ ~-
Date
CE 5107
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAl. AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 * FAX 456.3125
8005 SCHOON STREET ANCHORAGE, ALASKA 99518 (907) ~49.1000 * FAX ~19.1016
POUCH ~40043 PRUDHOE BAY, ALASKA 997~4 (907) 659 2145 * FAX 659.2146
VEl Consultants Report Date: I/'29/01
Date Arrived: 1/24/01
1345 RudakofCircle, Suite 201 Sample Date: 1/23/01
Anchorage, AK 99508 Sample Time: 18:10
Atm: Collected By:
Client ID: Laundxy ** Legend **
Client Project fi: I~t~L - Method Repon Level
MCL = Max. Contamimant Level
Source: ....... B - Pre,eh! In Meflmd Blank
NTL Lab#: AI70635 E - Estimated Value
Sample Matrix: Water M - Matrix Interference
H - Above MCL
Comments: D - Lost To Dilution
Date Date ]
Method Parameter Units Result MRL Prepared Analyzed
SM 4500 NO3 E
Nitrate-lq mg/L 0.60 0.10 !/24/01
Reported By: Wendy M. Mitchell
Anchorage Chemistry Supervisor
FEB 3 2001
VEl CONSUL'[AN'rS
Ch'Il Engineering and Su~eylng Consultants
Sen'lng All of Alasla
TRANSMITTAL LETTER
1345 Rudakof Circle, Suite 201
Anchorage, Alaska 99508
FAX: (907) 338-$386
Phone: (907) 337-3330
TO:
Municipality of Anchorage
Development Services Department
On-site Water and Wastewater
DATE:
ATTN:
SUB J:
PROJECT NO:
February 15, 2001
L4, B4, Sun Valley North Sub'd
Taylor I lealth Authority Approval
0102
Transmitted herein:
COPIES
DESCRIPTION
Certificate ofllealth Authority Approval, Signed and Stamped
l lealth Authority Approval Checklist, Signed and Stamped
Well Log Extension, dated 12/22/94
NTL Total Coliform Analysis, 1/23/01 sample
NTL Nitrate Analysis, 1/23/01 sample
Septic Tank Pumping Receipt, 1/25/01 pump date
These are transmitted:
As Requested
For Your Review and Comments
X For Your Approval
For Your Information
For Your Files
REMARKS: Well was extended from 154 ft to 205 ft in December 1994. Attached well log documents
that extension. Please call Realtor, Becki Powell for pickup when complete. 244-5881.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P,O, Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROV^, FOR A S Ne _E FAM.Y DWE,UN
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner ~'¢z¢..~..~ /(.:/,' //¢//'~, ~'/. 'T',~.[? //¢ /'- Day phone
/ - /
Lending agency Day phone
Mailing address
Agent
Day phone
Address
Unless otherwise requested, HAA will be held for pickup,
NUMBER OF BEDROOMS: __ 4'
3. TYPE OF WATER SUPPLY:
Individual well
NOTE:
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Community on-site.
Public sewer
Community well . - - '
Public water ' ' '
If community well system, provide written confirmation from Sta, te. ADEC '~ttest- ~,,
ingtothelegalityandstatusofsystem. ,. ¢., '~ ~ ~ , ·
NOTE:~ I'f community ~asteW ater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev, I/91) Front MOA#21 .r.
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.
Engineers signature ~ ~ ~ Date
DHHS SIGNATURE . /
~/~ Approved for ~ bedrooms.
/
Disapproved. ' ' '
Conditional approval for
bedrooms, With the following Stip~Jlaiions:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates 0ased only upon the representations g~ven 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 satisty cbrtain federal and state requiCements. Employees of DHHS do not
conduct inspections or ana yze data before a certificate is issued The Municipality of Anchorage is not
responsible for errors or om~smons ~n the pr,o, fe, s,s~onal eng~n, eer's work. r ' ~ ' ~'
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~'~'.¢/~, x¢/'~ ~ 5'c~/~ ~,'~ ~//d~ ,4~)o~//f Parcel ,.D. ,~%-0~' '¢-/7~/ 4~-
A. WELL DATA
Well type ~/'/'~'~
Log present (Y/N)
Total depth
Sanitary seal
If A, B, or C, attach ADEC letter.
Date completed
Cased to //~-' z'~/
FROM WELL LOG
Date of test 7,//~/
Static water level / /
Well flow
Pump level /
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot //
Absorption field on lot / Z._~ /
Public sewer main
Sewer service line
ADEC water system number
~/~ '~/ Driller
Casing height /,
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: ~/g2//~' //~ ~/
/ /
Collected by:
Other bacteria /~,¢/7d Z~z~7C¢¢./d~_¢/
/
SEPTIC/HOLDING TANK DATA
Date,.sta,,ed
¥
Cleanouts (Y/N) /V C ~'
High water alarm (Y/N)
Date of pumping
Tank size ,/,~ '¢~'2 /(?~// Compartments
Foundation cleanout (Y/N). ///~ ¢' Depression (Y/N)
- Alarm tested (Y/N) ,/~///"~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ///A ~' On adjacent lots ~- '~' 7
To property line_ ~ 4//
Surface water/drainage
/
Foundation
Water main/service line ¢~' '
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 cedes (Y/N)
Manufacturer
Manhole/Access iY/N)
"Pump off" level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed /¢/5~-/~/~
Length /z/, ~,. Width
Total absorption area
Soil rating ,¢¢~- ~"' ~'~,'~/~'~f:'System type
Gravel thickness ~. ~ Total depth
~ Cleanouts present (Y/N) ~ ~
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Date of adequacy test /'~"~ ~¢ ~.~-'/'.~
for /¢//,/¢ bedrooms
,/b///~ If yes, give date .////,~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot / ~ ~ /
To building foundation
On adjacent lots 2
Surface water
Curtain drain
_On adjacent lots Z ¢ ¢ / Property line //0 /
To existing or abandoned system on lot
Cutbank /"L/'//~ Water main/service line // ~ /
Driveway, parking/vehicle storage area ~- ~ /
E, ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
oc)
HAA Fee $
Date of Payment
Receipt Number ~'~
7fl-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number