HomeMy WebLinkAboutSUN VALLEY NORTH BLK 4 LT 4Sun Valley
No th
Block 4
Lot 4
#050-652-15
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page Of
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number:.OSP251114 PID Number: 050-652-15
Dwelling: E Single Family (SF) n with ADU n Duplex (D) El Two Single Family Project: n New E Upgrade
Name
PAUL & SJOFN WEISNER
ABSORPTION FIELD - EXISTING
n Deep Trench n Wide Trench n Bed El Mound
Site Address
22253 ELKHORN CIRCLE, EAGLE RIVER
❑ Other
Phone
Number of Bedrooms
Soil Rating
T depth from original grade
1 4
/STotal
GPD F
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
SUN VALLEY NORTH 4 4
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft
Ft.
Ft.
Well
100'+
25'+
TANK 0 Septic El S.T.E.P. 1771 Holding E] Other
Manufacturer
INFILTRATOR
Capacity
1530 Gal.
Surface Water
100'+
Material
PLASTIC
Number of compartments
2
Lot Line
10'+
NA
Foundation
10'+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electrical installed by
Installer HILAND EXCAVATION
Tank
PIPE MATERIAL House to tank 3034 drainfieldto
3034
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspectes:tion 15' 5/15/2025 2' 5/16/25
da
Location and description
3 rd 4'" ITOP
OF MANHOLE MH)
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
� NQ
A4
Conditional Approval: Date
TH
Septic System
Approved
Curtis Huffman
-
Date
CE128991
*\� Amp-
6
P0 - - ROFESVAt��\
Note: this approval does not include well permit requiremYes.'
,
1W r-0-
(Rev Ub/UZ/ 18)
5
4
.
9
'
28.8'
2
7
.
0
'
10.0'
1
8
.
1
'
28.8'
4
B
R
R
E
S
I
D
E
N
C
E
S
H
E
D
DRIVEWAY
DR
I
V
E
W
A
Y
PID:050-652-15 PERMIT:OSP251114
FIRST WATER CONSULTING
SUN VALLEY NORTH BLOCK 4, LOT 4
LEGEND
FOUND 5/8" REBAR, NO CAP
EDGE OF GRAVEL DRIVEWAY
UTILITY PEDESTAL
DECK
PADMOUNTED TRANSFORMER
RECORD DATA PER PLAT #83-297
SEPTIC PIPE
WELL
5
4
.
9
'
28.8'
2
7
.
0
'
10.0'
9
.
8
'
10.0'
1
8
.
1
'
28.8'
R
E
S
I
D
E
N
C
E
S
H
E
D
S H E D
SEPTIC TANK LID
TIMBERLINE SURVEYING AND MAPPING
17035 BARONOFF AVE
EAGLE RIVER, AK 99577
907-242-5320
ryan@timberlinealaska.com
FILE NO.: 25.074
SCALE: 1" = 40 FEET
DATE: 5/23/2025
SHEET: 1 of 1
MOA GRID: SW0758
AS-BUILT OF:
ADDRESS: 22253 ELKHORN CIR, EAGLE RIVER, AK
LOCATED IN: ANCHORAGE RECORDING DISTRICT
LOT 4, BLOCK 4SUN VALLEY NORTHPLAT #83-297
SCALE: 1" = 40 FEET(11"x17")
40'0' 80'
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP251114
Work Type: SepticTank Upgrade
Tax Code Number: 05065215000
Site Legal Address: SUN VALLEY NORTH BLK 4 LT 4 G:0758
Site Mailing Address: 22253 ELKHORN CIR, Eagle River
Owner: WEISNER PAUL C & SJOFN C
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
4/29/2025
4/29/2026
88187
❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: Issued t0
Issued By:
Date: 4/29/2025
Date:
4
MUNICIPALITY OF
Development Services Department Ar
On -Site Water & Wastewater Section
Parcel I.D. 050-652-15
ON-SITE SEPTICMELL PERMIT APPLICATION
Property owner(s) WEISNER PAUL C & SJOFN C
Day phone
Mailing address PO BOX 772752 EAGLE RIVER, AK 99577
Site address 22253 ELKHORN CIRCLE EAGLE RIVER, AK 99577
Legal description SUN VALLEY NORTH BLOCK 4 LOT 4
Number of Bedrooms 4
Engineering Firm FIRST WATER CONSULTING
Building Permit Number
Not Applicable R
APPLICATION IS FOR:
APPLICATION IS AN:
(® all that apply)
Absorption Field
❑ Initial ❑
Septic Tank
® Upgrade
Holding Tank
❑ Renewal ❑
Privy
❑
Well
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Permit/Rush Fees:
Date of Payment:-
Permit No.
Waiver Fees:
Date of Payment:
Waiver No.
Phone: 907-343-7904
Distance:
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / FirstWaterAK@gmail.com
!
!!
April 25, 2025
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: SUN VALLEY NORTH BLOCK 4, LOT 4
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install an IM-1530-gallon Infiltrator plastic
septic tank per the attached design to serve the existing 4-bedroom residence for current
functionality and future consideration or flexibility.
Groundwater was noted in the MOA on-site file from 5.6’ to 7.9’ and possibly higher in
elevation for seasonally adjusted groundwater. If determined at construction or if groundwater is
encountered during installation that may influence install, an epoxy coated steel septic tank,
anchoring or other action may be required. The lot and area are served by private water and any
encroaching wells, easements, … must be staked prior to construction. The design will not
impact any of the neighboring properties. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251114, Ben Cogger, 04/29/25
Municipality of Anchorage
On-site Water and Wastewater
REMEVVED FOR CODE CO A
OSP251114, Ben Cogger,
DESIGN DETAILS:
INSTALL A NEW IM -1530 INFILTRATOR SEPTIC TANK. ANCHOR AS NEEDED PER
MANUFACTURERS SPECS. MAINTAIN 10'+ FROM FOUNDATION, 100' TO WELLS, 100' TO
SURFACE WATER, 5' TO FIELD & DECK SUPPORTS WITH 4' OF COVER OR INSULATION.
INSTALL PER AMC 15.65, 15.55, & MASS... TANK BEDDING, SEPARATIONS, MATERIALS,...
1
811 �
Jrv� pRIJE N� 1� X011
GRP VACANT
\ / �--� DESIGN BASED FROM
SUN VALLEY NORTH BLOCK 4, LOT 4
PREPARED FOR:
PAUL & SJOFN WEISNER
22253 ELKHORN CIRCLE
EAGLE RIVER, AK 99577
FIRST WATER CONSULTING
13030 SUES WAY
ANCHORAGE, AK 99516
907-350-9566 FirstWaterAK®gmail.com
LOT 5
VLR, S 10/20/1994 DIGITIZED AS
SUPPORTISERVICES: •�,`�`�
FWESAwl
OF .ALS
C %* 9TH *�
0
DATE: 04/25/2025 rtis Huffman AO
SURVEY: VLRc�, CE 128991 `p
DRAWN: FWCS e $ Af
SCALE: 1" = 40' , 04/25/25 w
PAGE: 1 OF 1 J�?Obvsslo'0'
I
SEPITC
LST
AREA
3 0 3A1113
p
N�
LOT 4
w
DCOMMISSIONEXISTING
INSTALL
& W 530 -GAL
PLASTIC SEPTIC TANK W/
PRE & POST DC09 &
RECONNECT TO EXISTING
EXISTING 1994
SEPTIC FIELD'"'
FIELD. ANCHOR AS NEEDED
PER MANUFACTURERS SPECS.
0
y
FCOIO.O'
C`7�
�•
o
DCOO
CO MH DCO
13,O'
�y
m
o 29 0
'-STAKE
WELL RADIUS
�E
PRIOR TO
VERIFY & MAINTAIN CONST.
t7
5'+ TO FIELDS
NO WELLS WITHIN
& 100' To
M
100' OF PROPOSED
PRIVATE WELLS.
SEPTIC TANK
WELL
1
811 �
Jrv� pRIJE N� 1� X011
GRP VACANT
\ / �--� DESIGN BASED FROM
SUN VALLEY NORTH BLOCK 4, LOT 4
PREPARED FOR:
PAUL & SJOFN WEISNER
22253 ELKHORN CIRCLE
EAGLE RIVER, AK 99577
FIRST WATER CONSULTING
13030 SUES WAY
ANCHORAGE, AK 99516
907-350-9566 FirstWaterAK®gmail.com
LOT 5
VLR, S 10/20/1994 DIGITIZED AS
SUPPORTISERVICES: •�,`�`�
FWESAwl
OF .ALS
C %* 9TH *�
0
DATE: 04/25/2025 rtis Huffman AO
SURVEY: VLRc�, CE 128991 `p
DRAWN: FWCS e $ Af
SCALE: 1" = 40' , 04/25/25 w
PAGE: 1 OF 1 J�?Obvsslo'0'
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.
VEl -
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
Fr~)7~ Ft. toil/ Ft~ /o(~ From Ft. to Ft..
From/~/ Ft. to)~Ft.~tqTur~ g:c~ From Ft. m ~Ft.
From/~ Ft ~20ffFt ~Z~ ~oC. ~ From Ft ~ ~Ft.
From F[ to Ft, From Ft. to __Ft.
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
/
/ ~'~ ) Z~ // "~'~..v
DATE - Star(~d Ended ~
PERMIT NUMBER
' C)/2
KIND OF FQRMATION:
...................... ~ ~ & F'r,m Ft.
From Fi. to ['1. CO~[~ ~ ~ From
' -'~- Fr )m" Ft.
From .......... FI. to ..........Ft ...........................
From ...... FI, to ....... Ft ........................
From ...... Ft. Io ......... FI.__
From ......... FI, lo .... Ft .........................
From
From FI, Io .... FI.
From ....
bIISCL, INFORblATION:
to FI,
to_ ,_ FI.
lo .... Ft,
{o ........ F t,
to_.__ Ft.
lo. _ Ft.
to~_FI.
to ..... Ft.
From ........ Ft. lo ..... FI .........
From____.~Ft. to.,,~ ,;-FI .....
From ....... FI, to .Ft
From ....
From ....... FL to .... FI ..........................
From ......
From ....... FI. lo .... Ft ..............................
DRILLER'S NAME
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
Ill
W
__ w ~ z
rr I-- 0
0
(D
LU 0~'1- ~ E~ L1
~ ~ ~ W 0
w ~e wz
(D
LL
0
LLJ
0
Z
U.I
I-.
0
-r:
n.
LLI
-t-
z
PERMIT NO. LEGAL DESC. L 4. B 4, SUN VALLEY N SUBD PID
0
z
0
'OTH5
DETAIL SITE PLAN --
DRA?TNBY: dCD 'ROJEC[ TAYLBR LOT, L4, ]?4 ~ ~
OF
CHECKED BY: BO[ SUN VALLEY NBRTH SUBD. ~' 3
VEl o ----,,oB
SCALE: 1"= 40' 0~]~
PERMIT NO. LEGAL DESC. L 4, B 4, SUN VALLEY N SUBD PtD
za: J~d~
~wm~-
~Zo~z
w
W
0
LLI
o
W
o
CE
o
PROFILE AN3 DETAILS ~
D~,~w,~¥: ~co ;:~0~EC~ TAYLOR LOT, L4~ B4 -- 3 ~
OF
C~ECK~D,¥: WOESUN VALLEY NORTH SUBD, ~ 3
.o~ ,.,:,o,- VEl ~ ,o~ ~o
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)
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Parcel ID 050-652-15
Certificate of On -Site Systems Approval
OSC251187
Expiration Date:
Legal description SUN VALLEY NORTH BLK 4 LT 4
Site address 22253 ELKHORN CIR
Current property owner(s) WEISNER PAUL C & SJOFN C
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
By:
Zor
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 Service 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 submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
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-,l �-
Complete legal description SUN VALLEY NORTH BLOCK 4 LOT 4
Location (site address) 22253 ELKHORN CIRCLE EAGLE RIVER, ALASKA 99577
Current property owner(s) PAUL & SJOFN WEISNER
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: RE Private Well serving # 1 dwelling units
El Other Non-public well as regulated by MOA E] Water Storage
M Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: FNIJ Private Septic ❑ Private Septic serving 2 dwelling units
Fj Holding Tank F] Community Septic or Public Sewer
5. SEPTIC TANK: El Steel � Plastic n Concrete E] Fiberglass
Age NEW _See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: 0 AWWTS E] Bed F-1 Deep Trench 0 Wide Trench 0 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 $ IJ
Date of Payment 5—
COSA # S
Waiver Fee $
Date of Payment
Waiver #
COSA Appficafion—Apr2025.doc
COSA Checklist.docx
COSA Checklist
Legal Description: SUN VALLEY NORTH BLOCK 4 LOT 4 Parcel ID: 050-652-15
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 12/22/1994 Total depth 205 ft
Cased to 181 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA *6/11/2024
Static water level at beginning of test 190 ft.
Well production at time of test 5.7 gpm
Water storage tank volume None gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 0.711 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 4/25/25
Comments _*Forge Engineering conducted well flow test & this is a COSA renewal w/ a new tank install.
B. TANK DATA
Measured operating fluid level in septic tank NA - NEW
Date of pumping NA
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) 9/16/1994
ALL standpipes present per record drawing
Total measured depth from grade 3.8 / 3.8 ft (max)
Measured depth to pipe invert from grade 1.9/2.1 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
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) N
If yes, enter date
Adequacy test date *6/11/2024
(E / W TRENCHES)
Results Pass
Fluid depth prior to test 8/0 in
Water added 864 gal
New fluid depth 7.5/0 in
Elapsed time 1440 min
Final fluid depth 0/0 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 18 in (MOA 1.5’ ED)
Effective depth used 0 in (Final Fluid Depth)
Effective depth (ED) remaining 18 in
Comments/Deficiencies: *Forge Engineering conducted septic adequacy test on 6/11/24. On 4/25/25 trench fluid
depths were measured at 3 & 0 inches. No known freezing issues.
COSA Checklist.docx
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 FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 05/24/2025
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
05/24/25
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
Q
w ,n w
Z •Q�
r
pro
D
tvJO
Z w w
*S—BUILT
S 00'05'50"
204.69'
z\
�O �O
C_ C�
G, 4 BR HOUSE
EL 1732.1
(BSM'T FLR)
�n
(A
F--
U D
�Oa
CIL Z� '
w Q
N w
�Nm
wow
Z rr
c�
U)
r cv
Q
Wom
Zia
0� 1r) O
Or,Z
U — D
ui
V) W U0
74
L
N
w
U e
w
J
W
O
Q
O w /
O
J
O W
O ~
/ . p Q�
Q'
Q
Z ctj�
O
Oa,O
U T Z
3 JO
NWI..
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
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