HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES #1 BLK 4 LT 2Mountain
Valley Estates
Block 4
Lot 2
#050-651-21
UBMITTA
Inspection Report_1/-1-12.doc
Municipality of Anchorage VJAN PIS 2012
Community Development Department Page 1 of 3
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP11116-7
PID Number: 050-651-21 ❑ New ❑✓ Upgrade
Name:
DAVID MILLER
ABSORPTION FIELD
❑ Deep Trench ❑� Shallow Trench ❑ Bed ❑ Mound
Address
PO BOX 770095, EAGLE RIVER, AK 99577
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
1.2 GPD/SF
82 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original graded
yO�:4-F..*
r vel depth beneath pipe
42 Ft.
Subdivision
Block Lot
MOUNTAIN VALLEY ESTATES 1
4 2
Fill added above original gradeGravel
2-3 Ft
length
50 Ft
Township Range
Section
Gravel width
5Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
450 Ft'
1
Ft.
Well
100'+
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Gal.
Surface Water
100'+
Material
Number of compartments
Lot Line
10'+
NA
Foundation
10'+
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
50'+
Remarks DIVERTER VALVE INSTALLED BETWEEN
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
OLD AND NEW TRENCH
Pump make and model
Electrical Inspections performed by
PIPEMATERIAL Housetotank Tankto
drainfield
Installer
DEAN CONSTRUCTION
Drainfield F810 CO/MT F810
Inspector LARS SPURKLAND, P.E.
BENCH MARK (Assumed elevation) 100ft
Inspdates: 1" 8/1/2011 8/1/2011
Location and description
2nd
3m 0
GARAGE SLAB
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval:
Date
r cE•0F_A.44 1
49 T �i
SPURKLAND.; j
11100
41IV9
�—Z-
tl,\\\\
Approved
Date a !a
`1�N
Inspection Report_1/-1-12.doc
In
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I F
I THI
I
SLOPE
INSTALLED
sS INSTALLED 3-90ROOM ORA/N FIELD
INSTALLED BULL RUN DIVERTER
LENGTH 50 FEET
- WIDTH 5.0 FEET
SLS ) 24Z DEPTH 10.2 FEET (F.C)
ROCK DEPTH 4.2 FEET
COVER 6.0 FEET
SLOPE> RV
l SLOPE
A
N
SWING TIES A B c ` 7
OR. DVTR. C 53' 59' CC7
OF. a0. D 64' 63' A\
OF. MT. £ 84' 86' \
Or C.O. f 105' 108' Q
S
I
y I
Lot 2 I
0
P
0
NOT£.• TMS IS NOT A SURVEYED PLAT. WELL & SEPNC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATIONS ALL LOCATIONS SHOWN ARE
APPROXIMATE.
25 0 25 50 75 100 125 150
SCALE: 1' = 50 FT
I
I
I
I
J
BENCH MARK. GARAGE SLAB
ASSUMED ELEVATION: 100.00 FT
2ru W 15 Nfjllvccr(INu MOUNTAIN VALLEY ESTATE /1 BLOCK 4 LOT 2
IIRECORDOR71NG
,2Qq03CCJp/W 1/K(STH.gAVENUE DAVE MILLER DAT£N.12012
T9O7j 271-39161 41,71 BIRa.7aNOF ON, tAULt RlvrM, AK sssrr SHEL-r 2/4 area: swasB
PERMIT # 0SP111168 PID # 050-651-21 MVEB4L2Dc?DVG
Shallow Trenchi
5' Wide
50' Long
10.2' Deep (FG,)
4.2' Sewer rock
6' Cover
I. H. 13
E.G. ELEV.=89.8'
Elev.=85.8'
Elev.=81.6'
B.O.H. ELEV.=73.8'
NO GROUND WATER OBSERVED
NO SCALE
x
Connected to
Exisltng Tank
42 Ft of Septic Rock
Effective
NO SCALE
r ter
BENCH MARK GARAGE SL9B
ASSUMED ELEVATION 100
ISPURKLAND ENGINEERING I I MOUNTAIN VALLEY ESTATES 11 B4 L2 I I SEPTIC SYSTEM SCHEMATIC
203 W15th Ave DAVE MILLER DATE1 JAN. 11, 2012
Anchorage Ak 99501
a7a_IoIA 4131 BIRDSONG DR., EAGLE RIVER, AK 99577 SHEET. 3/3 GRID, SV758
I PERMIT / OSP111168 PARCEL ID 1050-651-21 MVE84L2D3.DWG
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP111167
Tax Code Number: 05065121000
Work Type: Septic Upgrade
Permit Effective Dates: July 29, 2011 to July 28, 2012
Design Engineer: SPURKLAND ENGINEERING
Subdivision: MOUNTAIN VALLEY ESTATES #1
Site Legal Address: MOUNTAIN VALLEY ESTATES #1 BILK 4 LT 2 G:0758
Owner/Address: MILLER DAVID J & PATRICIA H
PO BOX 770095 EAGLE RIVER AK 995770095
Site Mailing Address: 4131 BIRDSONG DR, Eagle River Lot Size in Sq Ft: 60750
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage
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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:_
Issued By:
Date: 7 `1 < <
Date: 7 �� ��
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 s Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Department
On -Site Water and Wastewater Program
Ment S,
t.
N
Department
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP111168 COSAM Permit#:OSP111167
PIDM 050-651-21
Legal Description: Mountain Valley Estates #1 Block 4 Lot 2
Engineer: Spurkland Engineering
Applicant: Dave Miller
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the excessive slope has been approved. The approved separation distance is 18.0 feet.
This waiver approval applies to the existing and proposed absorption fields only. Any future
upgrade to the on-site wastewater disposal system will require all separation distances be met or
another approval from this department.
...............................................................................
Waiver is Granted: X Waiver is not Granted:
Date: ( 6 Approved by:
Name of Reviewer
............................................................... ..............
Rec#: 091109 Amount: $200.00 Date Paid: 7/20/11
**** VARIAN C E/WAIVER REVIEW ****
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-4651-7-
Property
50-651-2
Phone: 907-343-7904
Fax: 907-343-7997
Property owner(s) Dave /%116P_ Day phone 616 - 5y59
Mailing address $31 8 rJ so,,y Nye, f -Ad e: Riven, A K 775-47
Site address — Set on E —
Legal description (Sub'd., Block & Lot) Aoknf oan 1%allw E6i46lt 1 61K L01 2,
Legal description (Township, Range & Section)
Lot Size 60, 750 Sq. Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR:
THIS APPLICATION IS AN:
(® all that apply)
Initial ElAbsorption
Field
Septic Tank
❑
Upgrade
Holding Tank
❑
Renewal ❑
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Slope vlaivtA
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
LC1___1 so
(Signature of Or
owner or authorized agent)
ermiiRush Fees: 53 C� Waiver Fees: au 0 -
Date of Payment:
Receipt Number: L c)
Permit No. C;E>e 1 `�,
GABuilding\On Site\Forms\Client FormsTermit App_01 041 1.doc
Date of Payment: 1 1111
Receipt Number: e,
Waiver No. CS ,10 j XI
(Rev. 1/11)
,.SpuMandg g
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
MountainValley Estates #1 Block 4 Lot 2
Municipality of Anchorage July 28, 2011
Development Services Department
On Site Water and Wastewater Program
4700 Elmore Road
Anchorage, Alaska 99519
Subject: Septic System Installation Permit
4131 Birdsong Drive
Ladies and Gentlemen:
I am writing to request a permit to upgrade the septic system for the above referenced property.
The existing trench no longer meets the house hold requirements and must be upgraded. The
proposed system will serve a 2 -bedroom single-family residence. Soil logs, design calculations,
a site plan, design drawings and construction specifications are enclosed for your review.
Design Calcs: No Groundwater observed to a depth of 16 feet below ground surface
(7/7/2011)
Soil Rating: From Testhole 6/30/2011
1.2 min/in = 1.2 gal per sq.ft/day
No. of Bedrooms Z3 L, 5
Required Area per Bedroom: 15011.2 = 125 sq.ft.
Total area required: 125 x 3 = 375 sqft
System: A new shallow trench subsurface absorption field will be installed it will be 45 feet
long and 5 feet wide and contain 4 feet (450 sq.ft. effective) of sewer rock.
Soils: A test hole was excavated on June 30th, 211. See the attached soil logs. Ground water
was monitored for through July 7th, 2011. Ground water was not observed.
Surface Water: A french drain runs along the west side of Birdsong Drive. This is greater than
50 feet from the proposed drain field.
Topography: The lot slopes to the east north east. The slope in the area of the proposed drain
field is approximately 15%. The slope increase to greater than 25% approximately 40-50 feet
from the proposed drain field location.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
13
SpUft�andEnoflaermg
,., Environmental Consulting and Design
Waivers: The existing drain field is only 18 feet from the slope break. The existing system
has been operating since 1979 and no evidence of effluent day -lighting has been observed. Slope
Waiver. See attached slope profile.
The installation of this septic system will not prevent wells and septic systems from being
installed on the adjacent lots. The proposed septic system will not change the general slope of
the area. Ponding and/or concentration of surface runoff will not result from this installation.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
Lars 1purkland, P.E.
Civil Engineer
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
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NOTE.• THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC J �.���P�� OF N.o
.LOCATIONS TAKEN FROM ON-SITE WATER AND WAST£ WATER C.�
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE = 1�
APPROXIMATE. 4 t h
....::....................... ...........
;. .. �
LAR SPURKLAND •
���✓J,� JOC1500��=50 0 50100 150200 250 300'SCALE: 1' = 100 FT.;::����
SPURKLAND ENGINEERING MOUNTAIN VALLEY ESTATES 11 BLK 4 LOT 2 SEPTIC SYSTEM DESIGN
2031.99501 TH. AVENUE
ANCH. AK. DAVE MILLER DATE. JULY 12, 2011
(907) 279-3916 4131 BIRDSONG DR., EAGLE RIVER, AK 99577 SHEET- 1/4 GRID. SW758
PERMIT # OSPI110XX PID # 050-651-21 MVEB2L 4DI.DWG
, SLOP:
4
I THI
\ ' SLOPE ISS
SLOPE ) 257
si INSTALL 3-8EDROOM DRAIN FIELD
INSTALL BULL RUN D/VERTER
LENGTH 45 FEET
- WIDTH 5.0 FEET
SLOPE ) -157 MAX DEPTH 10 FEET
ROCK DEPTH 4 FEET
COVER 4.0 FEET
SLOPE ) 257
�s,ti
ISLOPE
F A V
N
C
Lot 2 �,
♦ Q' � I
Well
♦ Q I
OF
AV
' 49 h
NOTE.• THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC �..:......,
.... .. ...... ...........
LOCATIONS TAKEN FROM ON WATER AND WASTE WATER �" ""' ■
LA S SPURKLAND
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE ♦ t^ =
APPROXIMATE. �1c No. CE -11500 -11,C-1
25 0 25 50 75 100 125 150
SCALE, 1' = 50 FT, BENCH MARK. XXXXXXX
ASSUMED ELEVATION. 100.00 FT
SPURKLAND ENGINEERING MOUNTAIN VALLEY ESTATE #1 BLOCK 4 LOT 2 SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE DAVE MILLER DATE. JULY 12, 2011
(NCH. AK. 99501 4131 BIRDSONG DR., EAGLE RIVER, AK 99577 SHEET. 2 4 GRID: SW658
907 279-3916
PERMIT # ESP111XX PID # 050-651-21 MVEB4L2D2.DVG
Shallow Trench,
5'
Wide
45' Long
10'
Deep Max
4'
Sewer rock
4'
Co ver
Sit t Bar
4,0 Ft o f Ser
Effective
NO SCALE
ti
Connect to
Exisitng Tank
Monitor
/-- Bull Run Di ver ter
/VL/ 3(,MLL
SPURKLAND ENGINEERING MOUNTAIN VALLEY ESTATES p B4 L2 SEPTIC SYSTEM DESIGN
203 W15th Ave
Anchorage Ak 99501 DAVE MILLER DATE: JULY 12, 2011
279-3916 4131 BIRDSONG DR., EAGLE RIVER, AK 99577 SHEETi 3/3 GRID, SV758
PERMIT # OSPXXXXXX PARCEL /D / 050-651-21 MVE84L2D3.DWG
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Municipality of Anchorage!
Development Services Department 0 co r
Building Safety Division 4 ,
* On -Site Water and Wastewater Program
4700 Elmore Road °
P.O. Box 196650 Anchorage, AK 99507 - `��- 'C (P '
RS . SPURKLAND,• =
www.ci.anchoraoe.ak.us � n• �
(907) 343-7904
Soils Log - Percolation Test It ROFESSIO�
Performed For: u� c (tii,1` E 2 Date Performed: un 7j L, .ZL� 1
Legal Description: �ounTa�n �� Z.11ev CS�,�TQI� C3�k�{ Lo l Z. Township, Range, Section:
Depth
(Feet
G P"CsA N' L'7
4-
5-
o0
7- 1v i1
C�
8- c �J
v
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
WAS GROUND WATER
Date
Gross Time
ENCOUNTERED?
��
C
Net Drop
s
IF YES, AT WHAT DEPTH?
L
Depth to Water After
o
P
Monitoring?
—
E
Date:
it
10 { IAYr
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
c , 30.�,>1
,
1U
4
it
10 { IAYr
I l All,
/ it
PERCOLATION RATE 1, L (minutes/inch) PERC HOLE DIAMETER (0
TEST RUN BETWEEN f ' FT AND FT
PERFORMED BY: Liao
C
PERFORMED IN ACCORDAN E WITH ALLSTATE AND MUNICIPAL GUID
VA0KJ CERTIFY THAT THIS TEST WAS
IN EFFECT ON THIS DATE. DATE: V ? 9I
/ \ U
Municipality of Anchorage
�\ Development Services Department
Building Safety Division
On -Site Water and Wastewater Program. 4700 S. Bragaw SL
P.O. Box 196650 Anchorage. AK 9951M650 Page I of Z
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. G\ l/0101-75 PID Number. 050— bS I — A I
Noma
AV 1 n M 1 L-t_h= R Wastewater System: ❑New El Upgrade
Address P.O. Z px 77 o v R 5 e TL
Peon. NunEar W-@M'oerlle
LEGAL DESCRIPTION
Bloc% La svD `odr:
14 2 NtOJNTAIM VAt,l1=y
lr w ,nip Range Sedan
ABSORPTION FIELD
O Dead TTaMn 0 S1MIIpe TrarKN 0 Bod O Mound O 0~
So, Ratalg Taal Depot Iran m@rul grade
GPD*"
Dapm u P*e bm" am WV" rAda Gravel dean parraam Ppe
R STArk Ft. /�
Fa added oda m
ova'^•l pada' avMargm.
Well: ❑ New El Upgrade
Ca,r6anm tPrwau. A, a, cl TMA DaPm. cow to
it. it
DI -110,\> DauM
Ded'. Static WaIMl.".
weld y I Pw Set of I Cauq H"M Ap Gr r
GPM F1. FL
Ft
L\� Ft.
Grant waA. C� Hamper a wF' Onanu palwaan I+y,
�\ FL I h
Taal ae,WPt*n wee: /i t P"MatMM.
FIS
Irutaw Dau InHallod.
TANK
SEPARATION DISTANCES
VLSeptic D Holding ❑ S.T.E.P.
❑ Other.
To Septic Absorption Lift Holding Public/Private Ml
cope ty
From Tank Field Station Tank Sewer Line
,\NL" , I PtN1C
j!'VppGai
Mat"
Numder W Cd Jlm em,
We' Ito
5T L-'I_L
surface wear N I J.
LIFT STATION
Sita. Mawra,l w
Lot U"
Gal
'Pump M. MVM st 'Pump Wr io N at
wgn wall! a. mal
Fpuwnpn ,S �
In in
n
Curtnn
Pure Make a Mod" El*cV"kupacpms Pod m by
Dnm
Rem. m%
BENCH MARK
%V�i
Dtc'f' Y'M�•� G�.-KSt�,roli Z ��
IJ�Ttoty! J i M%N 5r
Engineer's Stamp
Inspections performed by: 0, s .
Dates: 1" 640(0'r -
2nd
Development Servic Department
Approval
Reviewed and approved I /// (t_
Date: kit Zlo y
JR. I1O01 / 1
.
1 ` .
I = •
1 r I REPLACED [XlST1WG 0000 UL TAW �
W C WN ISM CIL. TANK \
ENCH MARK
R100.00 A 9 r
A ACC J4 T Nb `
BC H
•.;_.;. , 2—BELYPLY7Y AD 325
> BO 58
� 1
—9453
0
1 1
25 0 25 50 75.. 100 125 150
SCALE, 1' = 50 FT.
1500 SDW TAMC
IFfN SPMKLAND
No. CE -2223
TOBB£N SPURKLAND P.E. I I HOUNTABY VALLEY ESTATE /1 BLOCK 4 LOT 2
103 W 15TH. AVENUE BIRDSONG
ANCH. AK. 99501 DAVID MILLER
(907) 279-3916
PERHIT # SV020175 PID # 050-651-21
e
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BEACH MARLL.•- ROT= SLL w
ASSEW LIEVAI kt 100.00 n
SEPTIC SYSTEM AS BUILT
DATE: AUG. 20, 2002
SHEET.1/1. GRID: SW651
MVE0402LBVG
1'3 i
e 2:30 �,...
MUNICIPALITY OFANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jun 18, 2002
Expiration Date: Jun 18, 2003
Permit Number: SW020175 Parcel ID: 050-651-21
Legal Description: MOUNTAIN VALLEY ESTATES #1 BLK 4 LT 2
Design Engineer: 0007 Tobben Spurkiand, PE Site Address: 004131 BIRDSONG DR
Owner Name: David Miller Lot Size: 60750 SO. FT.
Owner Address: PO BOX 770095 Total Bedrooms: 2 Permit Bedrooms: 2
EAGLE RIVER, AK 99577.0095
This permit is for the construction of:
❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
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 DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: 7�
Issued By:1,QAt�l
Date: 6 // 9 )0 7 -
Date:
Date: C11810Z
f 't
Municipality of Anchorage 0
Development Services Department •:`• 1"�'`'
4 --•
Building Safely Division . • : •�; "??��
On -Site Water and Wastewater Program; 5
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ek.us
(907)343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0150— & G I — 2 i Permit Number SWOZO17F
Property owner(s) DAA L �> M I LL -P 2 Day phone
Mailing address (1) 70. Pwe 7700 g a C' IrL
Mailing address (2) Zip Code iq 57%
Legal description (Lot, Block & Sub'd.) Le,T as 13 k of V4 OjK�t'Ln Vail-cy Cg's 44e
Legal description (Section, Township & Range)
Lot Size (�V, 75-D Acres q.Ft.
Number of Bedrooms Z
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
❑
Sewer and Well
Cl
Water Storage
71
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi'
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
I certify that the above information is correct. 1 further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized
Permit Fees: / �/00ud
Date of Payment: t,(%Z /O it -
Receipt Number: S/ 6A.
(Rev. 12:00)
Waiver Fees:
Date of Payment:
Receipt Number:
\
1 \ \
1 �^7 An4CE EX/S W 1000 CAL MW \ �
L 1. PM 1500 CAL TANK,tS 1.'. Q
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1500 SElW W
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?ATO ••SPURKLAND f .••�
.�: \J♦ ✓ No. CE -2225"
a ....
25 0 25 50 TS 100 125 150
SCALD P = 50 FT
Vi -t -.,,-r,
BENCW MARK.• CARACC SLAB
AM" 18800 R
T OARS5 W 15TH. AVENUE SPURKLAND E. MOUNTAIN VALLEY &STATE /I RX7 ! LOT 2 SEPTIC STST£AI DESIGN
(NCH. 7 9916 I 1 DAVD MUER l SHEET 1/1 12CR1DOOSW651
(907) 279-3916
PERMIT # SI✓020XXX PID P 050-651-21 NVE04021M
MUNICIPALITY OF ANCHORAGE
I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT
NAME •• \\ P� -.�_ P ONE
�t� �"%/y (�.,.iv /�(,/ ❑ UPGRADE
MAILING ADDRESS , oe k //�6 /
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LEGAL DESCRIPTION
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LOCATION
LOCATION
NO. OFYROOMS
1,7
DISTANCE TO:
Well
��v`
Absorption are�r
Dwelliny (,�
PERMIT'N0 62 3
U Y
e. Z
UJ FQ-
Manufacturer �,y,
r7iPiIle
Mater ial---
No, of com artments
y
Liq. a acily in gallons
(�
IF HOMEMADE:
Inside length
Width
Liquid depth
DISTANCE "r0:
Well
Dwelling
PERMIT NO.
2 Z
Manufacturer
Material
Liquid capacity in gallons
DISTANCE TO:
Well
(�
Foundation,/ ,�.,
a
Nearest Igt�ng.�
PEP( T�,VO
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F Z LU
No, of lines
Lengt t f, eagft irye
( -�
Total lei h line
-
Trencl width
O inches
Distance b vyegn I' e
; �A
Q N
Top of rile to fini de
MateLi i be ath //
Total effective ioryarea
gr
t
abso
Q
ICY"
Length
Width
Dep h
PERMIT NO.
LU
0
Q F-
IL a
W
Type of crib
Crib dia t r
Crib depth -
Total effective absorption area
Lu
Well
Building foundation
Nearest lot line
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
�
DISTANCE T0:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
I/SOILTENG
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INSTALLER
REMARKS
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No. 1457•E ,"e '+'
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APPRO D DATE�/� LEGAL
72-013 (Rgh.3/78)
�
0EPRR1MEHT 0F it. HLTH OND 'ENYlROHMENl}lL Ti1 UH
STRE[T, OCR CH0RHGE, 9"r 93501
264-47�1m;
F nS�
PERMIT HU ( 7906�] )
HPPLIWIN l
L0lSTZE 57008 �QUHRE FEET
lHE WAY IITA) SIZE OF THE SOIL 9053101lO01 SYSTEM IS�
[HE LENGTH DIMENSION 1 THE |ENGTH (lH FEET) 0F THE [REk?CH U|o My, INFIQ D
7HE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETNoEN THE SURFRCE UF THE
GROUMD HND THE GOTT0M OF THE EXCRVRTlON (IN FEET)
THERE IS NO SET WITH FOlo TRENCHFS.
THE GRHYB. DEPTH IS THE MINIMUM DEPTH OF G01010 BETNEEN ll}E 01!TFHL1 PlPE
RND THE BOTTOM OF THE EXCRVHTION (IN FEEl)
h Q F- Q k A Y WN YT 1 �> y 15 P 7� 1 "?F � K r � 1'"04940 VV T &tH= � Q' 04 ITY ::;: il �S; -il !.; ,U: :::
PERM]T RPPi,lCRNT HHS THE RESPONSIRILITY TO lNFORM lllIS DEPHRTMENT fW;RING THE
l�STHLLRTlON {NSPECTI(WAS OF WAY HEL|S HDJHCENT [O THIS PROPERTY HND THE
H;MBER UF RESIDEMCES THHT THE 1% J. WlLL SERVE
---
-If ��� < § 1 0 1: KNOWN1707 1'1 4 "441m; 11 PP W. K �0 [ � 41 r 1. P A �Q£�I �'ml �-~-
8HCKFILLIOR! OF HNY SYSTEM WITHOUT FICAP L INPECT(ON HND HPPRUVHL BY THIS
DEPHR[M04T NlLL OE SU8JECT TO PKOSECUTlOH.
!; o V'i::!U- 1 111 1 q 7: V N" 1 hV7E0 5: 1 OAPT f � H I - E G �E14: . WR, ��W4.::'
� CERT[FY THRT
1� I HM FHMIL!HR NITH THE RFQUIRFMEPATS FOR Cot ~S1TE WERS HND WELLS HS SEi
11010 11 BY THE MUMICIPH|.TTY 0F HNCHURHGE
2� I |�ILL INSTHLL TH� SYSTEM IN RCCORDRNCE NlTU THE CODES
I I UNDERSTHND THHT THE ON~SITE SEWER SYSTEM M8Y REQUIRE ENLHRGEMEAT IF TUE
RESlDENCE IS REMUDELED 10 (NCLUDE MORE THRN ] BEDROOMS
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
\ Pouch 6650, Anchorage, Alaska 99502 276.2224
—� SOILS LOG — PERCOLA'T'ION TEST
PERFORMED FOR: �014,4j �4OSJ/DJATE PER FORMED:
LEGAL DESCRIPTION:
1-770-7-11 SLOPE SITE PLAN
(FEET) 'O/� /J L 4
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6171819
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COMMENTS
WAS GROUND WATER/f% t� S
ENCOUNTERED?
O
/syr
IF YES, AT WHAT E ��—
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
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PERCOLATION RATE /✓ 7 (minutes/inch) I
TEST RUN BETWEEN r FT AND S L FT
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PERFORMED BY: 5 1 CERTIFIED
72-008 (7/76)
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MUMCWAUTY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-651-21 Expiration Date: 5- 4�' Z/
1. GENERAL INFORMATION
Complete legal description MOUNTAIN VALLEY ESTATES #1 BLOCK 4, LOT 2
Location (site address) 4131 BRIDSONG DRIVE, EAGLE RIVER, AK 99577
Current property owner(s) RODGER LETENDRE
Mailing address
Real estate agent
Day phone
97 HACKETT HILL DRIVE, HOOKSET, NH 03106
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5 5 U Waiver Fee $
Date of Payment
Receipt Number Z 1 Q H (-1
COSA# OS Call 300
Date of Payment
Receipt Number
Waiver #
Distance:
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 5128/2021
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 maintehance. The operational life of all well and septic systems are subject to 11:� �51l
1�
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q: • • • ..
for current or future occupants or guarantee that no unseen encroachments, deficiencies or 01 - '9 �r
discrepancies exist can be given by First Water Consulting & / *� 9TH '•*
6. DSD SIGNATURE r� Curtis Huffman
System #1 Approved for bedrooms rt♦+�Fc�s•, CE 128991
System #2 Approved for bedrooms <<kF, ROFSSONP�F�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date: (p —
OF«((rf4i
c�
WATER AND
WASP]WATER
`ATER z
JJ�JJ�
SAM _
SER\►\G
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist I
Legal Description: MOUNTAIN VALLEY ESTATES #1 BLOCK 4 LOT 2 Parcel ID: 050-651-21
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 10/24/1979
Total depth 76 ft
Cased to 76 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 24+ in.
Date of flow test for COSA 5/13/2021
Static water level at beginning of test 43 ft.
Well production at time of test 1.09 gpm
Comments
B. TANK DATA
Age of tank(s) 19 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 49"
® Standpipes/foundation cleanout per record drawing
Date of pumping 5/12/2021
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/1/2011
® ALL standpipes present per record drawing
Total measured depth from grade 9_2 ft (max)
Measured depth to pipe invert from grade 5 ft (min)
❑ N/A - pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® Nc
® Coliform bacteria is Negative
Nitrate 0.51 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
FWD'
Collected by
Date of Sample 5/13/2021 -
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 5/14/2021
Results N Pass For 3bedrooms
Fluid depth prior to test 33 in
Water added 500 gal
New depth 42 in
Elapsed time 1400 min
® Code -required soil cover over field Final fluid depth 33 in
® System presoaked Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced 2000 gallons If yes, enter date
Comments/Deficiencies: AT TESTING - FIELD IS OPERATING IN THE TOP 1/3 OF THE 4.2' ED. FW`�
ORIGINAL 1979 FIELD SATURATED
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
Wells on Adjacent Lots:
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® 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 Surface Water > 100' ® Yes if No ft
Property Line > 5'
® Yes if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes if No ft
Private Wells > 100' ® Yes if No _
Water Main > 10'
® Yes if No ft
Community Wells > 200' ® Yes if No _
Water Service Line > 10'
® 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
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l 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.
.... . TM `......... ,
.,......t:.�:..V
• Curtis Huffman
¢� �Fc/. CE 128991
5131/2] J. •'`i��.
M
fi
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Parcel 1. D. 050-651-21
$iFET7
Certificate of On -Site Systems Approval
Expiration Date: �� I C L/
1. GENERAL INFORMATION
Complete legal description Mountain Valley Estates #1, Block 4, Lot 2
Location (site address) 4161 Birdsong Drive, Eagle River, AK 99577
Current Property owner(s) David & Patricia Miller Day phone
Mailing address P.O. Box 770095 Eagle River, AK 99577
Real Estate Agent
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: TWO
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
F-1
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
Ell
Public Sewer
rl
WaiverNariance request for:
Distance:
Received by:`, Date
COSA to be released to the engineer, unless otherwise requested by the engineer. -
Oo
COSA Fee $ �0Waiver Fee $
Date of Payment L) Date of Payment
Receipt Number 61- Receipt Number
COSA # i>sc 3 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage 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 Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 4/13/2014
Original Certificate
Tl, �nrcrpality of Anchor is Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations g, �n in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not respons.cle for enors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet a c
t,
�f6fl
r'
6. DSD SIGNATURE
Y�Z
✓ System #1
yry{
Y•
Approved for
bedroomsa-
r
System #2 Approved for
bedrooms
_
Disapproved
Conditional approval for
c�,.. _...
bedrooms, with the following stipulations: ``
Original Certificate
Tl, �nrcrpality of Anchor is Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations g, �n in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not respons.cle for enors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet a c
If more than 1 septic system is on the lot:
COSA Checklist # _of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Mountain Valley Estates #1, Block 4, Lot 2 Parcel ID: 050-651-21
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 10/24/79 Sanitary seal (YIN) Y
Total depth 76 ft. Cased to 76 ft.
FROM WELL LOG
Date of test 10/24/79
Static water level
Well production
No Record ft
3
g.p.m.
WATER SAMPLE RESULTS
Coliform 0 colonies/100 mL Nitrate •347 mg/L
Arsenic ND ug/L Date of sample: 2/4/14
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,500 gal. Number of Compartments 2
Foundation cleanout (YIN) '
Date of pumping 05/2013
Well Log (Y/N) Y
Wires properly protected (YIN) Y
Casing height (above ground) >12 in.
AT INSPECTION
2/5/14
47 ft.
1.02 9.p -m.
Collected by: S. Gilbert
Date installed 6/20/02
Cleanouts (Y/N) Y
Depression over tank (Y/N) N High water alarm (Y/N)
Pumper Sanitary Pumpers
1
C. ABSORPTION FIELD DATA
Date installed 8/1 /11 Soil rating (g.p.d./f:2 or ff/bdrm) 1.2 GPD/SF System type 5' Wide
Length 50 ft. Width 5 ft. Gravel below pipe 4.2 ft.
Total depth 10-11 ft. Eff. absorption area 500 ftz Monitoring tube Y Depression over field N
Date of adequacy test 2/4/14 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 14 in. Water added 550 gal. New depth 25 in.
Elapsed Time: 600 min. Final fluid depth 14 in. Absorption rate >= 450 g p d
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons Manhole/Access (YIN)
in. "Pump off' level at in. High water alarm level at
Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >1 00' On adjacent lots >1 00'
Absorption field on lot >100' On adjacent lots >100'
Public sewer main N/A Public sewer manhole/cleanout NIA
Sewer /septic service line >25' Holding tank N/A
Animal containment areas Manure/animal excrete storage areas >100,
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main >10 Water service line >10
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Propertyline >10' Building foundation >10'
Water Service line >10' Surface water >100'
Curtain drain >50' Wells on adjacent lots >100'
Absorption field
>5'
Surface water >100'
Water main N/A
Driveway, parking/vehiclestorage >10,
F. COMMENTS
Flow Diverter Valve and Second Absorption Trench On Site.
Waiver Granted to Allow Absorption Trench to be 18' From Slope > 25%.
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.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 4/13/2014
COSA brown sheet to-1412.doc
OF 44 11to
qw
GD Eff ,Y-
in.
•A„�MICHAEL E. ANDER-20N
J : CE -4381 ®®
LLJ
D
I
PLOT PLAN AS BUILT X SCALE 1" = 50'
TRACT G1
GRID SW758 Project No. L14 -013A1
Lan 8C ASSOClatt3S inc.11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Long (907) 522-6476 Phone Qoo��O
Registered Land Surveyors (907) 522-4625 Fax oOF
�
ken®langsurvey.com / jonatharMangsurvey.com v�� .......•
I hereby certify that I have surveyed the following described property: �O�P.•' SOI
LOT 2 BLOCK 4, MOUNTAIN VALLEY ESTATES (PLAT#74-17) Off: 9
Anchorage Recording District, Alaska, and that the improvements situated thereon are V * 49TH
TH f
within the property lines and do not encroach onto the property adjacent thereto, that Q"
no improvements on the property lying adjacent thereto encroach on the surveyed Q
premises and that there are no roadways, transmission lines or other visible L7' : """""' •" .. "a
easements on said property except as Indicated hereon. QO c KENNETH G. G c
LS -5202
Dated this the o Day of �`I�t w7. Lul at Anchorage, Alaska o04n%9n_ .'' ` ��1�''
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.
t
b
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF 11FALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
I. General Information
Application Date /K - V, • --; r.(
(a) Legal Description (include lot, block., subdivision section, township, range)
Loc tion (a dre///j or 'Jj�irections)
(b) Applicants Name �/(1(c .1
__� _! Telephone _home Business
Applicants Address /.--
(c)
.
(c) Applicant is (check one) Lending Institution
Buyer ; Other E --l- > Owner/bui-lder-r
(d) bending Institution Telephone
Address
(e) Real Estate Co. h Agent �,: i"t_ - 6001 0 arac j,
Address
Telephone
(f)'Ma.il, the HAA to
2. T e of Residence
N_._s_L_
Single -Family FA
Number of Bedrooms
3. Water
Individual Well
the following address:
Multi—Family
y
Community
Other (describe
Public
Note: If community well system, must: have written confirmation from the State
Department of: Environmental. Conservation attesting to the legality and status.
4. Sewage
Disposal.
onsite
�.77'1.-
Public
Community
Holding Tanka
EJ ��
Note: If community well system, must have written confirmation from the State
Department- of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
5.
G
N
I
Engineering Firm Providing 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 illy investigation of this Health Authority Approval show: 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 regula-
tions in effect on the date of this inspection.
Name of Firm --- — Telephone—___-
Address
Date
Vis-- *,°�•tI � �dlF � j��'� °. e� �11
ila n`.�s (���� •ani
(ENGINEER SEAL)
�- 4t
DH17P Apd�o
rval
Approved for. bedrooms
Approved l Disapproved
Terms of Conditional Approval
a'f
�j
l / n
By
1_.<_ G�✓�Dat:
,12__ Conditional
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY. UPON THE; REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/ej/DI8
[Page 2 of 21
7--19-'•84
_ £ i- - FMA_ AiRTiHMi TIIWIR Ll;' 1777,77 77
7v_7e7_
.
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
A. WELL DATA
Well Classificati L (1fa %fF_ If A, B, or C, D.E.C. Approve ( )r r
Well Log Presen ( Date Completed A) Yield --/!C r
Total Depth Cased to Depth of Grouting --
Static Water Leve]. Pump Set At �i K
Casing Height Above Ground 53r Sanitary Seal on Casing/(Y -)
ll�< ,
Electrical Wiring in Conduit (Y Depression Around Wellhead ( )
Separation Distances from Wel
To Septic/Holding Tank on Lot On Adjoining Lots /L1�
To Nearest Edge of Absorption Field on Lot On On Adjoining Lots
To Nearest Public Sewer Line '�J /G
Cleancut/Manhole_ N i' To Nearest
Water Sample Collected By ✓yl/%'O'C/ LZ
Sample Test Results
To Nearest Public Sewer
Sewer Service Line on Lot "
Da tee /0 G A,
B. SEPTIC/HOLDING TANK DATA
Date Install d ~ L" Size No. of Compartments �2
Standpipes (Y Air -tight Caps ( /#Y/ ) Foundat')n Cleanout(X
Depression over Tank (/i Date Last Pucrped ��(? /s' A
Pumping/Maintenance Contract on File (Y/N)A for
Holding Tank High -Water Alarm (Y )f✓ /-) Temporary Holding Tank Permit (Y )
Separation Distances from Septic/Holding Tank:
To Water -Supply vbll 13o To Building Foundation
To Property Line /y - To Disposal Field '.6
To Water Main/Service Line _ y To Stream, Pond, Lake, or Major Drainage
Course aw a�-
Comments A/ c> i✓ i'
l
(Page 1 of 21
2WI5p84
C. ABSORPTION FIELD EATA
Soils Rating in Absor tion Strata �� ii"�' Type of System Design
Date Installed l� 7% Length of Field �� y f
Width of Field Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area Standpipes Present (Y NI
Depression over Field W Date of Last Adequacy Test C% llLk 46'
Results of Last Adequacy 'lest
Separation Distance from Absorption Field:
To Water -Supply Well �> To Property Line /&'
To Building Foundation To Existing or Abandoned System on
Lot %10lJ(:-- ; On Adjoining Lots /L'0 /--. °
To Water 79a4az-/Service Line -50 / To Cutbank(if present)
To Stream/Pond/Lake/or Major Drainage Course ti N
To Driveway, Parking Area, or Vehicle Storage Area �3 C-1
Continents .OU 0 '= `
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons Manhole/Access (YM)
"Pump On" Level at 11PLmp Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping ycduring Adequacy Test. Meets MOA
Electrical Codes(Y/N)
Continents
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA`HAA Guui s� in effect
on the date of this inspection.
') Y � i1
Signed Date J E� v6jls` --r''��,
MOA No.
�• • •lwV own y9 Rh. l..�I�
KB1/d5/s a N"rt A.'5ho6vr
•� �('�� ' w
AT
p•e•
Op,
'
(Page 2 of 21
2-15-84
r j tet,,,, s
5. LEGAL DESCRIPTION
DAItRECEIVED
STREET LOCATION 1
/7/
INSPECTION APPOINTMENTS
6. TYPE OF RESIDENCE
TIME
SINGLE FAMILY
TIME
TIME
® Two ❑ Five
/1
❑ Three ❑ Six
7. WATER SUPPLY
DATE
))_
® INDIVIDUAL* *
DATE ^�
DATE
INSP TOR .
F
❑ PUBLIC UTILITY
INSPECTOR
INSPECTOR
-
MUNICIPALITY OF ANCHORAGEppN�
�` AI�{�f�08err-
DEPT. OF I!=ALTH &
KOTECTION
❑ PUBLIC UTILITY
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONVIRONMENTAL
825 L Street - Anchorage, Alaska 99501
•
DEC 2 1 1979
ENVIRONMENTAL SANITATION DIVISION
Telephone 264.4720
RECEIVED ECEIVE
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPE'RTY0yVNER
a,
_
/PHONE
(� (�
7
MAILING ADDRESS
-
PROPERTY RESIDENT (If different from above)
PHONE
2. BUYER
PHONE
MAILING ADDRESS
3. LENDING} INSTITUTION
/—e-- _f� . S ,
HONE
MAILING ADDRESS
z
4. REALTOR/AGENT
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
ZC�T %3Zo cfr %Taf/c� ���,.
STREET LOCATION 1
/7/
/J
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS - -
SINGLE FAMILY
❑ One ❑ Four ❑ Other _
® Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
® INDIVIDUAL* *
ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
B. SEWAGE DISPOSAL SYSTEM
-
J INDIVIDUAL/ON-SITE**
YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
1 '
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) '
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE
❑ TWO
❑ THREE ❑ FIVE ❑ OTHER
❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
,n '
1�
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septicc Tank or ❑ Holding Tank
r ian
SizeIf Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL -
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
3 APPROVED FO $ t-� BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY
72-010 (Rev. 6/79)