HomeMy WebLinkAboutSUN VALLEY BLK 1 LT 3,Sun Valley
Block I
Lot 3
#078-101-03
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191420 PID Number: 078-101-03
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
CHRISTOPHER BURNS
ABSORPTION FIELD -EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
3127 HILAND ROAD, EAGLE RIVER
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
2
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Fill added above original grade
Ft.
Gravel length
Ft.
SUN VALLEY 1 3
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.
Well
100'+
--
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1000 Gal.
Surface Water
100'+
--
Material
HDPE
Number of compartments
2
Lot Line
10'+
--
NA
Foundation
10'+
--
[LIFT STATION
Manufacturer
Capacity
Gal.
Remarks Tank insulated & installed 5'+ to deck supports.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 drainfield Tank to
3034
Installer �Rg
Drainfield CO/MT 3034.
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspection
V 10/9/19 nd 10/10/19
Location and description
3`d 4'"
BOTTOM OF WINDOW SILL
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
4�2�'��
of A-:4l>>i
• •
Conditional Approval: Date
r�Q•��'' •�,�,�
• Curtis Huffman
���
Septic System
Approved - Do ,
�MA Date �/�1)011)0
�F631 *- CE 128991 •.•� �/�
s� •
��aF� 1/5,20?Q.
. �� AW
,t F�PROfESS10NA�.�
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
A -C=17.2'
B -C=30.7'
A -D=21.1'
B -D=33.2'
A -E=23.8'
B -E=34.5'
SUN VALLEY BLOCK 1, LOT 3
LOT 3 EXISTING
2BR—HOUSE
PID: 078-101-03
PERMIT: OSP191420
13 LK 1 B
A INSTALLED NEW
MH MT 1000—GAL ST
C CO W/ INSUL
STAKED / D E DCO 5'+ TO
WELL RADIUS CO DECK
PRIOR TO
CONST.
F`
�a
SUMP
SCALE; 1" = 30
SEPTIC SECTION
SCALE: NTS
PREPARED FOR: SUPPORT�SERVICES: OF \4 \
T�
CHRIS BURNS
SUN VALLEY BLOCK 1, LOT 3 / * 9 TH �� 1�
c
3127 HILAND ROAD, EAGLE RIVER, AK 99577 1111111' 0,
FIRST WATER CONSULTING DATE: 1/27/2020 I` rtis Huffman /
SURVEY: KGL ✓ CE 128991 w
13030 SUES WAY DRAWN: FWCS11/27/2020 j
ANCHORAGE, AK 99516 SCALE: 1" = 30' IN \ p'�FESSIo�A'v i
907-350-9566 firstwaterAK®gmail. com \�_'�
woo
)IdVd 31d1S H3donHO
PLOT PLAN ___ AS BUILT _X— SCALE _1--_ 100_ GRID _ SW 0859__ Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates inc. (907) 522-6476 Phone p0O�0 O
(907) 522-4625 Fax o00 4 O
Professional Land Surveyors kenolongsurvey.com o of
jonothanOlangsurvey.com SOP ..s DO
I hereby certify that I have surveyed the following described property:
LOT 3, BLOCK 1, SUN VALLEY SUBDIVISION (PLAT No. 82-79)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property Imes and do not encroach onto the property adjacent thereto, that
no Improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the _?IDS_ Day of _t���e;,------ _ at Anchorage, Alaska
It Is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
49TH
K�.LANo
i 3'IL -1&�lq � G
s O2. e°oma
4�Op�°FEssIONA� �' o�
AECC963
9/25/19
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 078-101-03
Property owner(s) CHRISTOPHER & JENNIFER BURNS Day phone 9076323362
Mailing address 3127 HILAND ROAD, EAGLE RIVER, AK 99577
Site address 3127 HILAND ROAD, EAGLE RIVER, AK 99577
Legal description (Sub'd., Block & Lot) SUN VALLLEY B1, L3
Legal description (Township, Range & Section)
Lot Size 334,575 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑ Single Family (SF)
(w/wo AD U)
Septic Tank
®
Upgrade ®
(D) ❑
Holding Tank
ElRenewal
ElDuplex
Multiple 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.
E'
W ,
(Signature of property owner or authorized agent)
Permit/Rush Fees: Ava50 Waiver Fees:
Date of Payment: !2 %Q l ` l Date of Payment:
Receipt Number: 0'36%A1p Receipt Number:
Permit No. 11512/gZ t121Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Michael N. Anderson, P.E.
Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345 -3377 / Fax 345 -1391
Support Services
Brent M. Western
907-440-4601
September 18, 2019
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: SUN VALLEY BLOCK 1, LOT 3
To whom it may concern:
The owner has requested we proceed forward to obtain a septic permit to upgrade the
aged septic tank on the subject lot. The proposed upgrade will serve the existing 2-
bedroom house (3-bedroom system).
The lot and area are served by private water. The proposed design will not impact any of
the neighboring properties due to the lot layout. Please contact Brent M. Western or me if
you have any questions.
Sincerely,
Michael N. Anderson, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191420, Rebecca Carroll, 09/24/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191420, Rebecca Carroll, 09/24/19
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 2.64-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AN[)/OR WELL INSPECTION REPORT
' PHONE
LEGAL DESCRIPTION
DISTANCE TO: W~'L~C~rC I NJ
No. of 'iyes I Length (,~gJ/fine
Type of crib
Well
DISTANCE TO:
Depth
Building foundation
DISTANCE TO:
lotal length o~ lines
~lb e n eat h tll~
Depth
C~ib depth
~j~TE W
[] UPGRADE
NO. OF BEDROOMS
PERMIT NO.
No, of compartments
Liq u i~J._d ep~t h.}_
PERMIT NO.
inches
PERMIT NO.
Total effective absorption area
Nearest lot line
OTHER
REMARKS
APPROVED
72-013 (Rev. 3/78)
OWNER OF LAND
'ADDRESS F".~
LEGAL'DESCRIPTION /'' ,'~
DATF, - Started .. t .,. ~ · .:
PERMIT NUMBER
(ger, tfieh rtlltrtg,
by
OOC Co. dl~a ·
SULLIVAN WATER WELLS
P. O, BOX 272, CHUGIAK, ALASKA 09567 · TELEPHONE 688-2759
·
~t · .) .
.,'~ ,', ',.'~ "'/ /5, ..r2 t''dc · '/,.,,,.I :j/,'./.%.~r,/,DEPTII OF WELL . r:.. ¢ ,e ....
· . ~TATIC LI~VEL OF W~TER:FT. ,/'
DRAW DOWNFT,'"
KIND OF FORMATION:
From "~ Ft. to
From., :. FI, to
From ."', )'/. F.!, io ..
Froin. ¢:, ',~ ·. Ft. to
From ': i' )t Fl. to
From~ .' ..:. Ft. to . .
From..l.~.; Ft. to , .
From.. :: -.:.. Ft, to . .
From~Ft.
From..'.".';'. ',"Ft.
From,.?:'}·) Ft.
From Ft.
F~om' "i":~" Ft.
From -.-"' '~ ..Ft.
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From~Ft. to
From Ft. to ... Et. ~
· From ' ' Ft. Io--~.Ft;:
: From: · Ft, to______~.Fi,..'
· Froin~Fl. to ' Ft._.
From .... Ft.'to · ~t
/. '; f Ft. /~ 7,4,;, '~ .', .' Fr~m
;:, ~. :'i' Ft. : f' ';/.C,~ '... ;:': t;'-"' ;;t.:: 4:j Fri~,n '
· ~/."~ Ft.. ,~ :'t~/~ .... ;:' .' '?.9·. F,.'.'c',':'/~ From' ·
to _ _FI, ,.v..,/::: /" . 'From
to ; '." ) Ft..-'"c' ?~./x.~.'.' t, 'i{,,1..- ./.'.' From
FI, to 'Ft.
'Ft, io Ft,'.
'FI. to Ft..
MISCL, INFORMATION:
i 4 ', ,~ : ,, ;'4,'.
Ft..
Fron~" Ft. to. FI.
FI; to . .
From
From~F{. to Ft..
DRILLER'S NAME,d"::-..:-' ' ..~"..,
by
DOC Co. dDa
SULLIVAN WATER WELLS
P,O, BOX272 CHUGIAK, ALASKA 99567 ~ TELEPHONE 688-2759
OWNER OF LAND __!',', ;:,~'
ADDRESS ' ~' '/J, i ~
LEGAL DESCRIPTION / ,'
DATE - Started _
PERMIT NUMBER
Ended "
...i-_ DEPTII OF WELL ~ .,]~ ,' '
STATIC LEVEL 017 WATER FT,
DRAW DOWN FF.
GALS. PER HR .~ t,
KIND OF CASING ' -' '/ ~
KIND OF FORMATION:
From : Ft. to--
From_ Ft. to ' ~
Froll: Ft. to FI
Fronl Ft to _Ft_
From '. r ~ Fl, to
.Ft._., .',,.',',' , .,i --__ Frmn Ft to__ Ft._
From --Ft. to : .Ft.
From ~ .' Ft. to '' .Ft.
From ' Ft. to . Ft.
From Ft. to_.~ -','.Ft,_
From . ,,. Ft.
From Ft.
From Ft,
From -' · ' Ft.
to _.Ft. - ___.
to ' ' Ft. - , ,
to ' r Ft. ~,
From Ft. to_ Ft~
Frmn__ Ft [o__ Ft.
From Ft. to Ft.
From Ft. to_ Ft.
From Ft, to Ft._
From __Ft, to__ Ft.
From _ Ft. to__ Ft.
From _ Ft to Ft
From Ft. to .Ft ....
From Ft. to_ Ft
From , ' Ft. to'_Ft. ·
From . Ft. to_ .' '_Ft
From Ft. to _Ft,_
From , Ft. to .Ft._
From Ft. to .Ft
From
From
From
From
From
MISCL. INFORMATION:
Ft. to_ Ft.
.__Ft. to_
Ft. to__ _Ft,
.__Ft. to
DRILLER'S NAME
[:ONTACT~I f) il ,,
SRB !96×
EA(:)L.Iii: R:!:Vti:R~ AK 99'.::17'/
69/I...?.979
TANK S]:ZE (GALS) ],000,,0 :':'~ :~.:O00,,O ':~'~'
~.¢:. 'TANK I'i~,J;:, , l J(t/.. AT I.,iEAST 'l't.gE) (.,()! !I I., Ih i.I I
:i: I:::'
'1'I lIEN
N :1: II
Iii:I.E:(]]'lq'.]:(]AL ME)RI<
]: l,,~:i.].:l. :i. lts't'.u]) 'I:.h(.:~ sy~Fl.:.,:t!m :i. il a,::::i:::l]Pi::h:~.i'l,::::('~ ~.'.IJ.'l:t~ ,'t].]. ME),"I
al'ICl :i.n c:cm'd::l]:i, arl!::,:.! ?,~it'.ll 'i.hc) d,:::,s:J.(jil (:::p:i. ltc:i';L?/ (:)~ 'ttl~:i.~
:[ t.,~:i. 1].~',t(:Jl'i~l"(.:~ 'l:.c) :':¢.1:1. M(]A and S't'a't.~, (:~' A:f.?:t~d.::.~ uu, qu:i.r',':mo:~d'~!i ¢~:u' (iii,:.) .::i~':,;'. back
I...]:F:'T S"I'A'T:i;Ot;! tS ]:NST(il I.t]:~}' )ZN AN AREA C(:)VI~E]:~!~:):) ~}Y MOA ~.:',LJ]:[):):[NG
(:I:) (]1'.I IEL.I~:E;'I'R;I:CAI. F'EF~f¥1IT AND ]: NSI:::'IECT :!: (::)N MUS"I ))!~: O))TA
NOT BIE ¢iF'F'R~]VIE):) MITIlE)(?I' AN E].I~:E:"F;~IC(I!. :i:N(;I:::'IEC'F!(:)N R',~:F'OR~i I::! .I:CTR ]: C :I: Ah! ,,
~ ~(.h,I I . 1 ...
MUNICIPALITY OF ANCHORAGE
DEPARTIVIENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
SLOPE
2
3
5-
9-
DATE PERFORMED:
S GROUND WATER
:OUNTERED?
1
1
AT WHAT
13
14
15
16~
17
18
19
2O
A. Sherfor
Ho, 1457-E
Gross Net Depth to Net
Reading Date
Time 'Rme Water Drop
4~ ~ ~'o~ ~ ' ~ %"
PERCOLATION RATE '~O (minutes/inch)
TEST RUN BETWEEN ~ FT AND ~ FT
CERTIFIED BY:
DATE;
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAl PROTECTION
825 L Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
[] SOILS LOG
g
PERCOLATION
TEST
PERFORMED FOR;
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9-
DATE PERFORMED:
SLOPE SITE PLAN
10-
11
13
14
15
16
17
18
19
20
,
IF YES, AT WHAT
DEPTH?
Cross Net Depth to Net
Reading Date
Time 'rime Water Drop
PERCOLATION RATE ~'~ (minutes/inch)
TEST RUN BETWEEN ~[O . FT AND ~1 , FT
COSA Checklist
Legal Description: SUN VALLEY BLOCK 1, LOT 3 Parcel ID: 078-101-03
If more than 1 septic system on lot: COSA Checklist #
of
Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 6/1985
Total depth 260 ft
Cased to 136 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 9/5/2019
Static water level at beginning of test 154 ft.
Well production at time of test 6+ gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 1.82 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample 5/7/2020
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) <1 years
Tank type/material SEPTIC / HDPE
Measured operating fluid level in septic tank NEW
Standpipes/foundation cleanout per record drawing
Date of pumping NEW
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/30/1985
ALL standpipes present per record drawing
Total measured depth from grade 10.0 ft (max)
Measured depth to pipe invert from grade 6.6 ft (min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective 3.4’
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date 9/5/19
Results Pass For 3 bedrooms
Fluid depth prior to test 0 in (5” Rise First 100 Gallons)
Water added 610 gal
New depth 8 in
Elapsed time 25 min
Final fluid depth 0 in
Absorption rate 450 gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Comments/Deficiencies:
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
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
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Property Line > 5’ Yes if No
ft
Absorption Field > 5’ 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 septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10’ Yes if No
ft
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
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No
F. ENGINEER’S COMMENTS
G. ENGINEER’S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
5/20/2020
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Parcel I.D.
'1.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAHILY DWELLING
o7 -1Ol-O /
GENERAL INFORMATION Expiration Date: '7
Complete legal description .~ SUN VALLEY SUBDIVISION; LOT 3, BLOCK 1,
Location (site address or directions) 3127 HILAND ROAD * EAGLE RIVER, AK 99577
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agen~
Mailing address
LARRY & MARRY VENDL Day phone 694-4781
3127 HILAND ROAD * EAGLE RIVER, AK 99577
Day phone
BARBARA CRHIENDEN w/ PRUDENT~AL V~STA Dayphone 689-1802
16635 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public 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 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water 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 errers or omissions in the professional engineer's
work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ I ~-?..~--at, or pdor I
to dosing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As ce~fied by my seal affixed hereto and as of the validation date shown below, I vedfy that my
invesb'gation, based on procedures outlined 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
forthe number of bedrooms and type of strecture indicated herein. I further vedfy that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS. INC. Phone
Address 6901 DEBARR ROAD, SUITE 28 * ANCHORAGE, AK 99504
Engineer's Printed Name JE~-I-~EY A. GARNESS, P.E.
Date
337-6179
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local sorts condition, groundwater levels that may
fluctuate du~fng the year, and the water usage of the family being served by the system.
These conditions ara outside the control of the evaluator of the system. Satisfactory test
results do not guarantee futura performance of the system, nor do they guarantee that
thera ara no hidden defects or encroachments. AWWC, Inc. can therafora not provide
any warranty or future estimate of how long the system will continue to meet the
operational raquiraments of the ADEC or MOA DSD. The content of this report is fur
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
I/ Approved for "~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the fllowing stipulations:
,'-"-~ ~.' "" ' ' · ;~0~
..
~-~." WATER AND '- m...
Attachments:
HM Checklist
Septic System Advisory
Well Flow Advisory
~ ;. WASTEWATER: ..'
. '. PROGRAM .' ~
..... ...
Manitenance Agreements -'.)./.), ,,,'EIVT 5~..',' ,~ '
,92z//)~llH;~, ,-
Supplemental Engineer's Reor~
Other
Original Certificate Date: ~ - '~ - O ~._
Municipality of Anchorage
Development Services Department
Bulk:ling ~afety Division
On-Site Water & Wsstewater Program
4700 Sout~ Bragaw St.
P.O. Box 196650 Ancflorage, AK g9519-6650
www.d.anchorage.ak.us
(g07) 343-7904
Legal Description:
A. WELL DATA
Well type I~rVAT~
Date completed
Total depth 260
HEALTH ~,UTHORITY ,~PPROVAL CHECKLIST
SUN VALLEY S/D; LOT 3~ BLOCK 1~ Parcel ID: 078-101-0,~
If A, B, or C provide PWSID# N/A
Sanita~/seal (Y/N) YES
Cased to 155.67 fl.
Date of test
Static water level
Well production 15
WATER SAMPLE RESULTS:
Coliform ~ colonies/100 mi.
Amenic: ° OI;~i rog.IL.
SEPTIC/HOLDING TANK DATA
,lt.
g.p.m.
FROM WEIILOG
/19 5
195
Nitrate · ~t-~"/' mg./L.
Date of sample: 3/22/2002
2
Depression ever tank (Y/N) NO
Pumper
PBEL.OW FINAL GRADI~I
Soil rating (g.p.d.~lt~)r(~) 225
Width 3.0 fl.
Tank Type/Material STEEL
Tank size 1000 gal, Number of Compartments
Foundation cleanout (Y/N) YES
Date of pumping 8/;}/2001
ABSORPTION FIELD DATA
Date installed
Length 57 It.
Well Log (Y/N)
Wires pmparly protected (Y/N)
Casing height (above ground)
AT INSPECTION
3/22/2002
159 ,fl.
5.85 ,g.p.m.
12+ in.
Other bacteria J colonies/100 mi.
Collected by: AWWC, INC.
Date installed 5/50/85
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
JR'S PUMPING
Totaldepth 1~) fl. Eff. absorpflonaraa 684. fl= Monltoriogtube YES
Date of adequa~/test 3/22/2002 Results (Pass/Fall) PASS
Fluid depth in absorption field before test 0 in. Water added 720 gal.
Elapsed Time: 25 min. Final fluid depth 11.5 in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date.
~*FIRST 1;]8 GALLONS CAUSED RISE OF 15'. NEXT 582 ~NS CAUSED NO RISE.I
System type TRENCH
Gravel below pipe 6 ft.
Depression over field NO
For 3 bedrooms
New depth .13 in.
450+ g.p.d.
D. UFT STATION
Data installed Size i~ gallons M~
'Pump on" level at in. "Pu_.~,.~_~. High watar alarm level at in.
~ ~ Cycles tested. Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot'100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/ctaanout N/A
Holding tank N,/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property line
Watar main N,/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line 10'+ Building foundation 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
Absorption field 5'+
Surface watar 100'+
Water main N/A
Driveway, parking/vehicle storage 25'+
*WELL TO ST1 SHOT WITH TOTAL STATION = 10.!,.12'
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal mcorcls that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Prin/t~d N~me
Date ~/Z* ~/0 2.
JEFFREY A. C-;ARNESS
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Data of Payment
Receipt Number
04/05/02 F~! ].0:28 FA/ SSOSJOO YZSTA I~.AL ESTATE ER ~002
.. ASBUIL¥-.NO CORNr'R'~ $(~T THIS
I ~RE~ CER~FY .THAT I HA~ ~D THE
~NG DES~B~
~ ~ D~i~E THE ~IS~ O~
E~T~, ~N~S, OR ~STRI~]C~S
~l~ ~ ~T ~ ~ THE RE~ ~l-
VISION ~T. U~NO CIR~MS~CES
~ DAY& H~ ~ US~ F~
;RID:
~R-29-02 01:0$PU FROIA-CTIE ENVIrONmENTAL
· - CT&E Environmental
9075615301
T-~I~ P.02/O~ F-245
CT& E ReL#
Client Nnme
Project Name~
Client Sample ID
Matrix
Ordered By
PWSID
1021505001
AK Water & Wastewater Consultants Inc.
Sun Valley S/D; Lot 3, Bk 1
Sun Valley S/D; Lot 3, Bk 1
Drinking Water
Sample Remarks:
SW7421 GF Metal - PQL for 1021505001 was tnizcd due to mat'ix interference.
Nitrate-N
All Date-dTlmes are Alaska Standard Time
Printed Date/Time 03/29/2002 13:04
Collrcted Date/Time 03/22/2002 12:35
Received Date~Hme 03/22/2002 16:00
TKhnlcel Director Stephen
R.leased
limits Date Date
EPA 200.9 {<0.05) 03/2E/02
EPA 200.9 (<0.015) 03/29/02
0.437 0.200 mg/L EPA 300.0 (<101 03/22/02
Init
JMP
JMP
JDT
l~ic::ob:l, ology Labo::at:ory'
Total Coliform
I OB. No Coli
col/100mL SMI8 92Z2B
03/22/02 KAP
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HI=ALTH AUTHORFrY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
1. GENERAL INFOFiMA'rrlON
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name .~~-~.Q-~ Telephode: Home ~'~; ~o~-~--- Business
Applicant Address ~ ~J~[~ ~~ ~, - ~~ ~. ~ ~'~
(c) Applicant is (check one): Lending institution ~; Owner/builder~ Buyer ~; Other ~ (explain);
(d) Lending Institution ~..U..~f',,.r/'~-~_.- .I~,/>,,~(-- 'telephone
Address '~_L~ ,..~:. ¢L~-~_~/X.~_~_ .~
(e) Real Estate Company and Agent
Address
(f)
Telephone
M~t"the HAA to the following address;
Pi-i, 69~29~9
TYPE OF RESIDENCE
Singie-Familyl~[ Multi-Family
Number of Bedrooms '~
Other
3.
-: '; : attesting to the legality and status.
: 4. SEWAGE DISPOSAL
WATER SUPPLY
Individual Well~ Community ['1 Publicl~
Note; If community well system, must have written confirmation from the State Department of Environmental Conservation
· . Onsite,J~ Public [] Community [] Holding Tank ~
,. .... . ~ Note: If commumty well system, must have written confirmation from the State Department of Environmental Conservation
' attesting to the legality and status.
' ' 72-025 [11/84}
: , .Pagelof2
ENGINEERING FIRI~ PROVIDINaJ INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 shows that the ()n-site water supply and/or wastewatcr d~sposal system is safe, functional and adequate
for the number of bedrooms seal type of structure indicated herein. I further verity 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.
N~me of Firm ~~ Telephone
Address ~R~ 106~
DHEP APP
Approved ,or'~-,/~f~'~-~-'-~-~_~.. tied rooJ~C-..w"
, ,~ .~ , "~.~ ~ ~S ~ V,~ '
~pprovod % .... '~ ;,_ ~is~pprov~ ~. Conditional.
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of ~ealth and~ Environmental Protection (DHEP) is~,ues Health Authority
Approval certificates based solely upon the repre,mntationo givens, in paragraph 5 above by aa ind(,pendent profeSSioni~l
eng near reg stered n the State of Alaska. The Df-IEP does t ~ s a. a c( urtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4728
Legal Description
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECT/ON
WELL DATA
Well Classification
Well Log Present
Total Depth 'Z--.O~ c>/
Static Water Level
~,1~,, If A. B, C D.E.C. Approvea (Y/N)
Date Completed Lc, - ~,~ ~-- Yield
_ Cased to I.'~ ~ ~ Deoth of Grouting ~
Casing Height Above Ground
Electrical Wiring in Conduit
Separation Distances from Well:
To Septic/14ek¢~ Tank on Lot
Puree Set At
Sanitary Seal on Casing ¢)N)
Deeresslon Around Wellhead (Y/4~
On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~'~ I~,~ : On Adjo~mng Lots
To Nearest Public Sewer Line ¢/~ To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
~/'P' To Nearest Sewer Service Line on Lot ~
B. SEPTIC/I~ TANK DATA
Date Instelled -~-~-~-~-~-~-~-~-~"~'~
Standpipes ~N) Air-tight Caps
Depression over Tank (Y/.I~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~'~/'~
Separation Distances from Septic/14~Idh'~9 Tank:
To Water-Supply Well ~ c>'~.- ~-~'¢
To Property Line I ~ ¢-~
Line _
To Water Main/Service ~,/lA ( o~-~r'
Course
Size I~c:='*~' No, of Compartments Z- ~
___ Foundation Cleanout~/N)
Date Last Pumoed ~ ~
~//~ for ---
Temporary Holding Tank Permit IY/N)
To Building Foundation ['Z..,
To Disposal Field
To Stream Pond. Lake. or Major Drainage
Comments
Page 1 of 2
72-026(11/84}
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~=~¢"~:~
Width of Field
Square Feet of Absorption Area
Depression over Field (Y,~P
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
'~')~n~ Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
J Standpipes Present(i~N)
Date of Last Adequacy Test
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots '-~'~::~ ¢"~
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed Dimensions
Size in Gallons
Manhole/Access (Y/N)
"Pump On" Level at
High Water Alarm Level at
Tested for
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ¢'~ ','?: ? ~"!l;~l~.~l!~?,~''~I~'~' Date
Compae~ ~= ~E[~. AL~:~ ,~,'~' ,. MOA No.
Receipt No," ...... ~ ~ ~S%
Dateof Payment ~ ' I~~ ¢
Amount: $ ~
Page 2 of 2
72-026 (11/84)