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HomeMy WebLinkAboutSUNNY VALLEY LT 2Sunny Volley Lot 2 #050-354-27 e Municipality of Anchorage '° :•" Development Services Department Building Safety Division .. Onsite Water and Wastewater Program, 4700 Bragaw SL P.O. Box 196850 Anchorage, AK 995196650 Page t of 2 www.ci,onchorage.sk.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO70042 PID Number. 050.354-27 7"O Wastewater System: ❑New ®Upgrade 7 WHISTLING SWAN DR. FAIRBANKS ABSORPTION FIELD Ph" wme. a e.aoome D Deep T a id ® shenow Troch D Bed O M "W Dover LEGAL DESCRIPTION Sod Re" Total DM from onp,el prpa 5 GPDr a 1.5 Fr. swa lot D•yrn a Fps bon.n fromrW orp p•de GrnM eapin e.r•m py 2 SUNNY VALLEY 0.5 Ft. 1 Ft To-^MW Range s•Gwn Fa adds actor• org" veW ' or" L.pm14N 11W 16 2.5 Fr. 40 Fr. Well: ❑New [I Upgrade Gr.retw morkworww °""'°'n " "' 5 Fr. 2 2.5 Ft CM,wk an (Pri see. A B. C) Tom Depen cued w Taal aeadpaan • ea, Pp• Memel EXISTING PRIVATE Fr. I Fr 200 FP ASTM 3034 Ori•r Dae DMed Sung WOW L" "alwOtl• rmWed Ft GREYS CONSTRUCTION 412912007 Y.M P" SM M Crp H•VN AO Grave TANK GPM FLo Ft SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ® Other. ADVANTEX To Septic Absorption Lift Holding blk/Pnvate w.a, ca,qty From Tank Field Station Tank Sewer Line ANCHORAGE TANK 1500 Gar Wel +100' +100' +100' — +25' STEEL '°� 2Cpmp.nm.n. s„ dwwr. +100' +100' +100' — LIFT STATION Lo Law +5' +10' +5' — 250 G.i ORENCO FpurlMm +5' +10' +51 — 'Puny an'erx. 44 'pv,pW e.•i■ 40 Hph w....m at 45 In H k own Dr.n +50' 1+50'---j. +50' — Pump Le.• a Lwde1 EeWral kwp•morn p•d.mW by OSI P30-05 HUNTRE LYNX R•nrMa ADVAWEXSYSTEM BENCH MARK Louim w D•wgem. TOP OF DECK AT CORNER 100 FL +!i, Inspections performed by: CHRIS WOOD Dates: 1" 4/28/2007 2 412912007'' Development Services Department Approval r v Conditional Approval Date: I. CHOTOPHER R WOOD N. CE11OUT Reviewed and approved bY Date: fZ �pts i"a (R.r owa) Permit No. SW070042 Page 2 of 2 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT ON—SITE WATER & WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SUNNY VALLEY LOT 2 050-354-27 PV P INSULATION O� Yy YPA 7 •V tkAVEI! o • • 0p,K'Ay• f • '.. ' • (00 • SCALE 10-44W W 5'X40' DRAINFIELD HOUSE B. • TH-1 OLD SEPTIC TANK FF_ ABANDONED PER MOA ' po 7 P Off REQUIREMENTS F O OPf LOT2 NEW 1500 GAL ADVANTEX W/ AX -20 FILTER POD AND ORENCO LIFT BASIN O - CLEANOU:TUBE - WELL '4� 3>• •' / ITOR AELEVA IDN: (NOT TO SCALE) TANK 1500 GAL 95.8 ADVANTEX 91.8 98.1 91. 97.1 MT -1 MT -2 IWE IF DECK ELEVATION 100' _ GROUND T, B.¢ \ TH-1 FILTER SAND 96.1 NO: G.W.T .1 90.6 BOTTOM OF T.H. 5//2007 ENGINEER'S SEAL 000000p�0 41 OF AC'9�� .................... CHRISTOPHER R. WOOD.: CE -10387 �40000�0 INSULATION 5' YPA •V tkAVEI! o • • FILTER SAND 96.1 NO: G.W.T .1 90.6 BOTTOM OF T.H. 5//2007 ENGINEER'S SEAL 000000p�0 41 OF AC'9�� .................... CHRISTOPHER R. WOOD.: CE -10387 �40000�0 MAY-10-2007(THU) 11:21 EAGLE RIVER ENGINEERING (FAX)907 694 3297 Rising bon F (.ectric. Inc. 14916 Voodland Drive EagRiver. ver. AIC 99577 (907) 622-6777 M' May 10, 2007 Douglas Grey Grey's Construction 2320 North River Circle Eagle River, AK 99577 Re: Lot 2 Sunny Valley Subdivision Dear Douglas: The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. Sincerely Kevin S. Hombuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 cc: file MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW070042 Legal Description: SUNNY VALLEY LT 2 Design Engineer: 0848 EAGLE RIVER ENGINEERING SEI Owner Name: JOHN ZULIGER Owner Address: 1487 WHISTLING SWAN DRIVE FAIRBANKS. AK 99712 - Date Issued: Apr 26, 2007 Expiration Date: Apr 25, 2008 Parcel ID: 050-354-27 Site Address: 022243 LAKE VIEW DR Lot Size: 132422 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑,/ Disposal Field 0 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: Issued By. F 1 F\ r Date: (0 Date: zf 0 Municipality of Anchorage Development Services Department Building Safety Division On -Site i Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 t Anchorage, AK 99519-6650 rF www.muni.org/onsite (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. fJ:5-b' 3rJ(-t' a7 - Property Mailing phone _' 4-1 - 773 Code 41`17 I -L, Site address a..:>,U3 /_Ltk�L iii&] h, Erg. Zip Code 11015'77 Legal description (Sub'd, Block & Lot) Legal description (Township, Section & Range) T/ 4d 12/tV SAr,. /b Lot Size 13,1-10 4 _L ;L Sq. Ft. THIS APPLICATION IS FOR ([Dail that apply): Absorption Field Upgrade Septic Tank [x Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms r3:[F��3�L•Lj�L•I:IF3��:F Initial ❑ Upgrade [' Renewal ❑ certify that the above information is correct. I further certify that this application is being made for a Single FamiVDwelling aV is in opcordange with applicable Municipal Codes. of property owner or authorized agent) Date of Payment: Date of Payment: Receipt Number: "1 3183 Receipt Number: (Rev. 11105) Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW RD. Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax April 25, 2007 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Sunny Valley Lot 2 Narrative & Permit Application Dear Mr. Roth: Eagle River Engineering Services (EKES) was contacted by the owner of the property noted above to perform a COSA inspection. It was determined that the leachfield was surcharged, and a new leachfield would have to be installed. A test hole and soils percolation test has yielded silty sand and gravel, GM, with a percolation rate of 7 minutes per inch. We propose to utilize an Advantex treatment system to minimize the size of the leachfield due to topography constraints created by the existing failed system, steep slopes, and the on-site well radius. Please see attached site plan and leachfield cross section. We are proposing to install the leachfield 35' feet from a steep slope. In our cross section, we have detailed the worst case scenario for the slope setback, showing accurate locations of the proposed leachfield to the slope break. From this cross section, it can be seen that no additional fill will be required to meet the theoretical 25% for 35' slope line. There is a seasonal drainage ditch approximately 100' from the proposed leachfield site. We have asked that the contractor check this ditch for visible flowing water at the time of the leachfield installation. If any visible water is noted, the contractor shall contact the engineer immediately to devise a solution prior to installing the leachfield. The proposed 3 bedroom septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, so there is room for wells, septic systems and alternate sites. 2. Immediate neighboring septic systems are all +20' distance, and no private (or community) wells within 100' of the proposed septic system. 3. Drainage will not be affected and is not a major consideration in our design. 4. A Category III Advanced Wastewater Treatment System shall be utilized thereby reducing any chance of future leachfield failure or potential contamination. \2003\07-023SEI TICNARRATIVE Installation of this 3 bedroom upgrade will not adversely affect the wells or septic systems or reserve areas on adjacent lots. If you have any questions please call our office at 6945195. Sincerely, jRNT SERVICES ncpa N2003\07-023SEPTICNARRATI V E Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW RD Suite 201 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ONSITE SEPTIC SYSTEM—MOA CERTIFIED INSTALLER LEGAL: Sunny Valley Lot 2 April 25, 2007 A. GENERAL 1. The septic plan is for a3 bedroom single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and arc to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. A licensed surveyor should locate any utility casements and exact 100' radius from the existing and neighboring onsite wells. 7. The excavation is to be exactly in the arca shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavationsshall be filled and monitor tube removed. 9. It Is highly recommended that a licensed land surveyor mark the location of the 100 -foot well radius prior to installing the septic tank and leachfleld. B. ADVENTEX SYSTEM AND SEPTIC TANK 1. Septic tank shall be a fiberglass or steel 1500 -gallon tank capacity of MOA approved construction for use with Advantex system. Install as per current manufacturers recommendations for conditions in Alaska. 2. Install one AX -20 filter pod over septic tank capable of trcating450 gallons per day of waste now. 3. If gravity feed can not be achieved, Install Orenco 24" pump basin PB -2496 outside septic tank, with OSI pump model P30-05 and controls to allow 23 gallon dosing of septic leachficld. Set pump float to 13.5" above pump, timer for 1 minute dose time. Controls to be installed to MOA code by licensed electrician familiar with OSI applications. Controls to include a dedicated phone line and web based monitoring system. 4. A municipal inspection report or receipt from a licensed electrician shall be provided to the engineer verifying lift station wiring to all applicable codes C. DRAfNF1ELD 1. The drainfield is to be located as shown on the site plan. 2. The total depth of the initial drainfield excavation is to be approximately 3' deep, relative to existing ground elevation and end in native sandy GM -type soil. The excavation shall remove only the topsoil and layer and any landscaping rill above this layer 3. A one -foot minimum layer of sand is to be installed, and shall be used to level up the trench and to create a 6 foot separation from bedrock to the bottom of the leachficld. The top of the sand layer shall be level, plus or minus 1.5". 4. An eighteen -inch layer of sewer rock is to be placed over the sand layer (fifteen inches if lilt station is utilized). The 4" effluent piping (1" if lift station is required) is to be buried within the gravel layer with 2" of gravel cover over the piping. 5. The completed drainficld gravel and piping is to be covered with lypar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of Y or equivalent is to be placed over the bed. Mounded side slopeson uphill side and ends are not to exceed 3:1. 12003\07-023-Advantex spec SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM — NIOA CERTIFIED INSTALLER LEGAL: Sunny Valley Lot 2 April 25, 2007 Continued: 7. The septic tank and Icachficld must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = Y maximum GRAVEL DEPTH = 1' under effluent pipe, 2" over pipe (1 feet total) SAND DEPTH= 1' minimum DRAINFIELD LENGTH= 35' DRAINFIELD WIDTH = 5' SOIL RATING= 5 GPD/Ilz BEDROOM CAPACITY= 3 EFFLUENT PIPE (GRAVITY)= 1 run of 4" perforated pipe meeting MOA specifications. EFFLUENT PIPE (IF LIFT STATION IS REQUIRED) = 1.25" HDPE from pump basin to Icachficld then I" manifold to 1" PVC with 1/8" holes oriented down spaced at 1.5' OC. 2 pipe runs in Icachficld 2' between pipes 1.5' from sidewalls and end of trench. SEPTIC TANK = 1,500 Gal Advantex compatible tank w/ AX20 filter pod and lift basin Twenty-four (24) hours notice required for all inspections \2003\07-023-Advantex spec 1 M M 0 \ \ \ 0 SEPTIC +30' �— VO LOT3 \ \ 0 \ Z 33' SECTION LINE EASEMENT CHECK FOR SURFACE WATER WITHIN 100' OF PROPOSED SYSTEM IF PRESENT, NOTIFY ENGINEER NO WELL +200' NO SEPTIC +3d LOT2 HOUSE ' IABANDDN E)OS INc SEPTIC .� 1 TANK PER MOA STANDARDS / AND ENGINEER'S DIRECTION N �e23• ly WELL +200' M 0 V SEPTIC +30' INSTALL —^ to NEW 5'%10' DRNNFIELD J`T$� MSDVA' TE%TALL NEW 1500 GAL A / A%-20 FILTER P00A/ AND ORENCO UFT BASIN IWELL i 14 I WELL +200' — sEPnC +30' ® - TEST HOL •- MONITOR TUBE •C Ss, C - SEWER CLEAN OUT + - WELL LOT8 \ — — - EASEMENT ` PROPOSED LEACH FIELD \ \ \ _ _ _ 151 e� ©- DRILEACH FIELD DRIVEWAY LOTS 0 WELL SEPTIC SITE PLAN LEGAL: SUNNY VALLEY LOT 2 OF OWNER: JOHN ZULLEGER 0*.CHRISTOPHE� A. CONTRACTOR: GREY EXCAVATION JOB 07-023 DATE:4/20 2007 SCALE 1 "=50'EACLE RIVER ENGINEERING SERVICESC10387 A10421 VFW RD. SUITE#201 EACLE RIVER, AK. 99577 X10 (907) 694-5195 FAX.(907) 694-3297 WFZ Ot WHO/ 1 O vow w P• 1 2K Nn• '�11 so �WWe) i10 �J Z o'er LLJ vl vJ O N (/) It O z \ r \ W .. V J W LV n co N V co co Q Li a N Ztk of wwko o C3 Z Q) off.. :•� � rrLLJn Z. R. W to LO r"V, r�` ro c O Wa�o ' wow��-' Municipality of Anchorage Development Services Department Building Safety Division • +1 On -Site Water and Wastewater Program 4700 South Bragew SL P.O. Box 1968W Anchorage, AK 98519-0850 r 1vww.d10choraae 9k -Ir (907) 3137904 Performed For, Legal Description: Depth (Feet) 1FIM- OQ4 Soils Log -Percolation Test. 7OH&I Z Lt l f-G,f 2 Date ;;UA/"Y 1/ALLZ`/ L07 Z.. Township. Range. Section: _TTir Qlh/ St G.�(�• Qw 3- E,( n_v ,1n) G)vA 4J CILi'( oNO 4 Ga/toez, s - a t 7 K t I WAS GROUND WATER ENCOUNTERED? NC7 A 8 IF YES• ATVNIAT DEPTH�" 7 L L Depth tD WatarAner 0 Monitoring? D2,/ P Date: y/LJ/() 6 rcnY nVlC uwmtltN h ", COMMENTS TESTRUNBETWEEN "5,5 FT ANDq. 5 FT PERFORMED BY: C±IQ7S RTIFY PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPA GUIDELINES IN EFFECT ON THIS DATE. DATHAT ES TE Z� 7 �7 ci,� 'ii■.��..■. �r�sfl'�i��' fir. rcnY nVlC uwmtltN h ", COMMENTS TESTRUNBETWEEN "5,5 FT ANDq. 5 FT PERFORMED BY: C±IQ7S RTIFY PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPA GUIDELINES IN EFFECT ON THIS DATE. DATHAT ES TE Z� 7 �7 ci,� EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694.5195 ERES Project No.: 06-121 Calculated By: CW Date: 4/25/2007 Legal: Sunny Valley Q] Single Family 3 Bedroom Dwelling Advantex System TEST HOLE 1 Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = Percolation rate = Wastewater application rate = Required absorption area = Trench width (W) = Gravel depth (D) = 450 gallons 6 minutes per inch 5 gallons per day per square foot 90 square feet 5 feet 1 feet Required length = Shallow trench factor • Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor= 0.88 3.0 � '('� 6oRow� dr S�N� 2' T" %Orpw` - op s6%Jf-fZ Pvck' Total Excavation Depth = � feet Required length = ale feet • 3S' y/Z5107 06-104 AdvantexdrainfieldCalc 11:01 AM4/25/2007 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ro*j ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet -Anchorage, Alaska 99507 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEPHON I-//— E NEW GCl/ �(I ❑UPGRADE MAILI HADD J� LEGAL DESCRIPTION L Z Sc-,( tiA LOCATION NO. OF BEDROOMS Oy DISTANCE TO: Absorptioy ara (� Dwellip� r S PERMIT 6zIJ N az w� Manufact r f Marten / J i ( No. of compartments-p G W Li ci in gallons O� UO IF HOMEMADE: Inside length Width Liquid depth D s-' DISTANCE TO: Well Dwelling+-- PERMIT NO. JO'2 O Z F Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well/ a FoundasiynD NearesJ.lq� line �f PERMIT IyN� (/ .Y LLz Z w ~ No. of}iges /57L/ Total Ig Vjives / Trenchdth ty C inches Distance bet ef�s /U Q F Top f V]e to fii sh gr de Material beneath tile ,Af 7 U` Total of g ive absor n a yy,, C� inches ri'J II" Length Width Depth PERMIT NO. w (7 i r Type of crib Crib diameter rib de Total effective absorption area w ° Liu rn DISTANCE TO: Well Buildring foundation Nearest lot line J Claaf'I epth v DvIller Distance to lot line PERMIT NO. J / / w � DISTANCE TO: Buildin undation Sewe ine Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATI G INSTALLER i{ REMARKS tN r - _ - sae. •.•e• `fit �� •••• all P lI �O a V C-/ / ✓ t. • Af(f 1 /h/�AlppO,J/ •a /,{��/"/Q� y/ M16 Fhb. i5c 1457-E .'��'�.ai� UN 1 dr'•. f/ %6 a' 'rj I P ®Qa'�ROFk3St4�'� L)EL(- Z— o /K � APPROVED ° DATE AL �1V„ ALAGLAMiL'� ' a s75 F^r PH, 6U4-Pr70 72-013 (Rev. 3/78) Permit # MUNICIPALITY OF ANCHORAGE Department,nf Health and Environmental Protection 825 Street, Anchorage, AK. .9501 � 1%���Bli e 264-4720 /in( jry� # # # HANDWRITTEN PERMIT # # # P� ele (� WELL AND_ON-SITE SEWER PERMIT 5 i Applicant: £ Co ScS L cation: Atl< Address: Number: Legal Description: L a La&_ Cy Lot Size: 2S'� — Type of Soil Absorption Syste s: / 7-/yll" lVlt✓ Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) DEPTH The Requi d Size of the Soil sorption System Is:' LENG GRAVEL DEP H / O WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPT IC(F 1-) TANK SIZE = G��� GALLONS * # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ' * # * TWO(Z) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 $--AT * # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will s all the syst m in accordance with codes. (3) I un51 rst nd that e n -site sewer system may require enlargement if the resi e del to include more that 3 bedrooms. Signed: / Issued by:� scant j /� c / Date: ncC SWP/024(1/81) / 7 C VVV / /5• SS. 0 �Z m I& / �� //%i!, t3%C.GeQ, ,Q�.,�.� nw vC�C'a✓F%l���Z�✓i >�a•� �•$ • � •-yea �I g ' • a ma .rd.. -- — A a 0 N iA n O G N !� i `a Vii► C y p� w R \}1�\ w N \y T � Uy p CJ P- S g ' • 0 0 -- — f , �NXrn z f O0 A a 0 N iA n O G N !� i `a Vii► C y p� w R \}1�\ w N \y T � Uy p CJ P- �o ep g ' • 0 0 -- — f , f O0 p� =w «<o A a 0 N iA n O G N !� i `a Vii► C y p� w R \}1�\ w N \y T � Uy p CJ P- �o ep g ' • nE 2 m Ja n Oym A a 0 N iA n O G N !� i `a Vii► C y p� w R \}1�\ w N \y T � Uy p CJ P- C� SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: B-7jte PI'045 S100all /t--rRr;5—5 DATE PERFORMED:_7v—�i!l,12,13-$ LEGAL DESCRIPTION: /-y/7— Sya`/l e—V DEPTH SLOPL SITE PLAN (FEET) �_ C'l y`yC2611LS f�p �5c9/� F—F—F—F--]I IM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 VG'y-x G0M1'CBGt 51,11- 'y Gvn u� WAS GROUND WATER ENCOUNTERED? /o 6,776w of 00te— IF YES, AT WHAT DEPTH? &1A 106)16 1w)5'o�tk�cl - —6 OF Atq :* nes`L Thode CE 5035 d Y Reading Date Gross Time Net Time Depth to Water Net Drop 72-008 (6/79) 7-/2 U 7Z d 7-i?- >v t V% 7-12 �`z) -30 `711 7-12 7-/3 L C 37 / D PERCOLATION RATE b L/ (minutes/inch) TEST RUN BETWEEN % FT AND 6 FT PERFORMED BY: JCt141 e'$ / t �/nisc;i P CERTIFIED BY: 72-008 (6/79) -7 DATE: t`� Nf SOILS LOG MUNICIPALITY OF ANCHORAGE +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 9 4' lJ PP0L9SS/0I'lcj LL17.e r, )�ISC�S DATE PERFORMED: � ' J,.� l��' O '- / 7'- G� LEGAL DESCRIPTIOT HN: �^G / JCAL1 n lam, % I�Q SLOPE/ 1 n SITE PLAN (DF (FEET)] 1 } UI^nCtN ICS �Ok!S(ii ✓ �� 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMM kf �ev-yr Cow, pit WAS GROUND WATER / ENCOUNTERED? IV o �aiTo�o� NQIe IF YES, AT WHAT „ /, DEPTH? —7�R PA .re. Note re;Scit.Ne - -3 % t 181rtes V Thodo ? 0a 4.CE 5035 Reading Date Gross Time Net Time Depth to Water Net Drop // 25 0 6-/ 176- J�fgs z AL IX 6-� 2 0 6 �1 2 `Ji'X45 X116 G-� 216 6 i� z 2 6 id 21� 16 / evv PERCOLATION RATE Cl® (minutes/inch) TEST RUN BETWEEN FT AND 6 FT PERFORMED BY: - ki a CJS Ll) Th!'- CERTIFI ED BY: 72-008 (6/79) `--' DATE: �J Z7eoc - ale Zeny � �9 - may% l � � . E.IGIfdE�RINt� A IN RIVER, AtASW.10,,5n - Q J Q N WL9 >w co Cl) ku O O 3 . •a (O. [Fu OJ a r O o f Z 8 o- W W z W Lam, : : Q w >_ azw � J J �O i i 61 s1i c...i mj i w W � W W W ,! w � s v Q F o m • w R W li J O W 00000000 i Q J Q N WL9 >w co Cl) ku i O O . (O. [Fu GFi. tz. X: to S as o f Z 8 o- W W W W Lam, : : Q f ;'• "I: : {: � i �O i i 61 s1i c...i E i i F W W W � z � s z • 3 J W li V; I W W W 00000000 i i O O . (O. [Fu GFi. tz. X: to S as LF Z 8 o- CZ3 ; .a.i.. : Q ' 2 � s W W W W J i � • W li V; I W W W 00000000 i LL W W W if 1. w L W. Cac, ca; w - cr: %. O O O C G CFt. LFr. aj W C i i i Q C O y1 W O O O C W. m i o �. z i O O . (O. [Fu GFi. tz. X: to S COLU C LF Z 8 o- CZ3 ; .a.i.. : Q ' 2 � s W W W W W W _W W fL W W W W 00000000 i LL W W W if 1. w L W. Cac, ca; w - cr: %. i O O (O. (O. (O. c; u, 2 � s W W W W W 7 r2: P�t i- ii Fi. -7i i LL W W W if 1. i O O O O (O. (O. (O. c; u, W W W W W Gt £L f' q ".c- • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 050-354-27 1. GENERAL INFORMATION Complete legal description SUNNYVALLEYLOT2 Expiration Date: ✓ 0 -1�z Location (site address) 22243 LAKE VIEW DRIVE EAGLE RIVER AK 99577 Current Property owner(s) JASON & HEATHER TOOLE _ Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 1229 TOMAHAWK DRIVE #A JBER AK 99505 _. M Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class —Well F] Public Water System ❑ WaiverNariance request for: Day phone lumBMI TTA' JUL 1 i 2014 TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received b 1 y: Date: r,. COSA to be released to the engineer, unless othb ii requested by the engineer. COSA Fee $ c-;t10\'t COY , Ne Waiver Fee $ _ Date of Payment �� [ �� (A. ;3- Date of Payment Receipt Number OowJ �-3y ( %eceipt Number COSA # � � �J a �j �2 �nl�ry,` Waiver # k i ^� $�t�0/ 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 ARCTERRA CONSULTING INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6/28/14 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. '�, OF 14I 6. DSD SIGNATURE P fiF.6'\EI'H N. DOFF' System #1 Approved for bedrooms. �+ -�; System #2 Approved for bedrooms. `nE 69` .� Disapproved. Conditional approval for bedrooms, with the following stipulations. By: Original Certificate Date: 7'-1 The Munici ity f Ag -,'rage Development Services Division (DSD) issues Certificates of Onsite 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 bluesh et_t0.10.12do 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: SUNNY VALLEY LOT 2 Parcel ID: 050.354.27 A. WELL DATA Weil type PRVr If A, B, or C provide PWSID # Date completed 1984 Sanitary seal (YIN) Y Total depth 115 ft. Cased to 25 ft. FROM WELL LOG Date of test 611211984 Static water level 65 ft. Well production 7 g.p.m. Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 36+ in. AT INSPECTION 1130114 ft. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate NO mg/L Arsenic: _AtD—ug/L Date of sample: M269= 7�IJ/y Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1500 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (YIN) N Date of pumping C. ABSORPTION FIELD DATA Date installed 412912007 Cleanouts (YIN) Y High water alarm (YIN) N Date installed 412912007 Soil rating (g.p.d./ftZ or ftZ/bdrm) 5 System type SHALLOW TRENCH - ADVANTEX Length 40 ft. Width 5 ft. Gravel below pipe 1 ft. Total depth 4 ft. Eff. absorption area 200 ft2 Monitoring tube Y Depression over field N Date of adequacy test 612612014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 465 gal New depth 12 in. Elapsed Time: 180 min. Final fluid depth 3 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed 4/2712007 Size in gallons 250 Manhole/Access (Y/N) Y "Pump on" level at 44 in. "Pump off' level at 40 in. High water alarm level at 45 in. Datum Bottom of Tank Cycles tested 2 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main 75'+ Sewer /septic service line 25'+ On adjacent lots 1001+ On adjacent lots _ 1001+ Public sewer manhole/cleanout 100'+ Holding tank 1001+ Animal containment areas 50'+ Manure/animal excrete storage areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 54 Property line 51+ Absorption field 54 Water main 101+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 104 Water main 10'+ Water Service line 101+ Surface water. 100'+ Driveway, parking/vehicle storage 104 Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 1001+ F. COMMENTS See attached A+/Anchorage Tank maintenance log. G. ENGINEER'S CERTIFICATION I certify that / 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. OF AL " , Engineer's Printed Name KENNETH M. DUFFUS �2 Date 6128114 1 q C) TH* + +, COSA brown sheet 10-10-12.doc F` P IXNNEI M. D�1 S q / 7116 �' , Ar �toFrseloti?i' .� ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this Day of J • ,,-, of 20 A„ by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description). 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On -Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC') 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: By:'� ....__._ — — (signature) Date: jstr y �c2So:, 72r2(r- (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) a4 The foregoing instrument was acknowledged before me this.f.�' day of . r4A1V a 1z 20A,by NO ARY PUBLIC FOR ALASKA My Commission expires: i 9 c!, 'L0 tti MUNICIPALITY: By: (signature) Date: name) Title: CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 05n -35t1-0?:' 1. GENERAL INFORMATION COSA # D� D 133 Expiration Date: Complete legal description S� /11,0. Vtlt.L,EY LCE 2 - Location (site address) 43 ot'�c�c 1/e«� J -)e. Current Property owner(s) ,1Cti.-) Day phone Hq 1- 777'13 Mailing address _ f 4 R--1- 'a2ln -f fi:y 51'0nr, A; F- r,i _bnr„LS A -K IT7/.0- Lending agency Mailing address Real Estate Agent Mailing Address KE-Lt-iiz— /,s//L"AriS Day phone Day phone V toss-otherwlse requested,-COSA will be held by DSO for pickup. - --2.—NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 Municipality of Anchorage [K Development Services Department 2�' Building Safety Division Individual Holding Tank On -Site Water and Wastewater Program ® B 4700 Bragaw Street ❑ P.O. Box 196650 Anchorage, AK 99519-6650 Public Sewer ❑ www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 05n -35t1-0?:' 1. GENERAL INFORMATION COSA # D� D 133 Expiration Date: Complete legal description S� /11,0. Vtlt.L,EY LCE 2 - Location (site address) 43 ot'�c�c 1/e«� J -)e. Current Property owner(s) ,1Cti.-) Day phone Hq 1- 777'13 Mailing address _ f 4 R--1- 'a2ln -f fi:y 51'0nr, A; F- r,i _bnr„LS A -K IT7/.0- Lending agency Mailing address Real Estate Agent Mailing Address KE-Lt-iiz— /,s//L"AriS Day phone Day phone V toss-otherwlse requested,-COSA will be held by DSO for pickup. - --2.—NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: [K Individual On-site 2�' ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. .: gle River Eng!, leering Services Name of Firm 1C421 VFW Rd.. Sutra 201 Phone Vlq- 5r q 5 ceg Address a River, AK 99677 Engineer's Printed Name Date S. DSD SIGNATURE &y` q{�g7pPHERRW000 `L CE1Q387 , _Lzl� Approved for 3 bedrooms. •...., ,.- Disapproved.�10r1PY Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rw 11N5( Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsde (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ��� ✓rn+.r 62ZL4 Lc* Parcel ID: © r A. WELL DATA Well typed i(, If A. B, or C provide PWSID # Date completed ICIF+ Sanitary seal ON) Total depth 1 15 fL Cased to 5 ft. FROM WELL LOG Date of test b I ). / W+ Static water level fr 5 ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform _ colonies/100 mL Nitrate k"' mg/L Arsenic: _ mgll-*- Date of sample: ± as �% B. SEPTICIHOLDING TANK DATA Well Log (DN) (#j - Wires properly protected (Y%N)vL Casing height (above ground) U3_in. AT INSPECTION I�f ISrCE+ X13 ft. 9— p.m- Other bacteria _,(2f colonies/100 mL Collected by: 9z nlztnie 11 rindirllct Tank Type/Material 422f c_.�/ Sly a -e Date installed 107 - Tank size I_, cC gal. Number of Compartments Cleanouls (YIN) Ye 4 Foundation cleanout (YIN) I "e _- Depression over tank (Y6 L(L High water alarm (YAM t, Jo Date ofpumpingAfew (y4x(eiiavPumper i'l In C. ABSORPTION FIELD DATA Date installed 1) -fSoil rating g.p.d. orft2/bdrm) 5 System type C�,aQpe,,.)-lrrncG, Length '/0 ft. Width 5 ft. Gravel below pipe I ft. Total depth N- ft. Eff. absorption area 2L0_ft2 Monitoring tube c Depression over field Date of adequacy test dfr (&) (rnS+ruc{ic'n Resuks ( as Fail)S UUFor —9bedrooms Fluid depth in absorption field before test 0 in. Water added gal. New depth_O in. Elapsed Time: Qr min. Final fluid depth 'r in. Absorption rate >= 4-50 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ✓in,7.e if yes, give date /7 let D. LIFT STATION Date installedrrjSize in gallons 5n Manhole/Access&N) Ye,)— 'Pump on' level at 4 4- in. 'Pump ofP level at 4 in. High water alarm level at 45 in. Datum Cycles tested h1l r 0 (,AnSJnr( jiipeets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot +Ino' Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas +toD' On adjacent lots +10n On adjacent lots +10c), Public sewer manhole/cleanout 7"loo' Holding tank + -1 S ' Manure/animal excrete storage areas 1100 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: �r Building foundation r S Property line Absorption field * � Water main 4 10 ' Water service line +I O ' Surface water -r 1C, cam' Wells on adjacent lots a 100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 41o, Building foundation + 1c) ' Water main 4 1r)' Water Service line + 10 Surface water - r (^O' Driveway, parking/vehicle storage + -:)LS Curtain drain +50 ' Wells on adjacent lots -4-too' F. 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. Engineer's Printed Name Cti�46>z Q i CWSTWMIt Date ' 'SAO T10 1 1%.%% CHM COSA Fee $ 'f o — /7Sr Ktt Sl% -- Date of Payment Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number SGS Ret.N 1071695001 Client Name Eagle River Engineering Project Name/N Sunny Valley L2 Zulcger Client Sample ID Sunny Valley L2 Zulcger Matrix Drinking Water PI5'SID 0 Sample Remarks: All Data/fImes arc Alaska Standard Time Printed Date/time 05/0812007 15:21 Collected Date/time 041252007 14:15 Received Date/time 04252007 14:50 Technical Director Stephen C. Ede Allowable Prep Analysis Pammder Resole PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/03/07 05/08/07 TK Waters Department Total Nitratc/Nitrite-N ND 0.100 Microbiology Laboratory Total Coliform 0 mg/l, SM204500NO3-F C (<IO) col/IOOmL SM209222B A (<I) 05/05/07 JDS 0425/07 DLC r ......v i •Q•.�la s� CHIS DATE.. SEWARD & ASSOCIATES LAND 0 1 HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE FOLLOWING DESCRIBED PROPERTY a OF A4°°N su�,vy v��EY saw mar z DATES '9 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS iz��d „/�P.•' j • .5�0, INDICATED. IT IS THE RESPONSIBILITY OF THE TH r...:.. ....... OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: r } d EASEMENTS, COVENANTS, OR RESTRICTIONS .•!r WHICH DO NOT APPEAR ON THE RECORDED SUBDI- �j .. Duan. Mer4 S.w / VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB` / � •. LS- 9 ANY DATA HEREON BE USED FOR CONSTRUCTION 6s�-' 1 ° CP O OF FENCE LINES OR FOR ESTABLISHING BOUND- D��� ARY LINES. RAWN �ek°� dmf A4y►�,r Munici aI't f A h T6V�� �r �rboov�— F i y o nc orage • Development Services Department B< Building Safety Division; On -Site Water and Wastewater Program ' 4700 South Bragaw St. s " ` T " Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 W IF CERTIFICATE OF HEALTH AUTHORITY APPROVAL 7111 FOR A SINGLE FAMILY DWELLINGS t Parcell.D. 050 3SN 27 HAA# Expiration Date: I. GENERAL INFORMATION Complete legal description !2LI IJ`/ VA L-1.8-1/ Lm Location (site address or directions) _ ZZZ y 3 /„ A «t U ht�.7 D R �A �i ftz"✓!r r2 Current Property owner(s) _ :T0t J 1,4 1 P LI= Day phone 619 ' 2-24/ Mailing address 222N3 �4;r �/—c, , Z�f^qr� , 12T,&2 4jr 99572 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address U 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 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: Individual On-site 19101� ❑ 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 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. Eagle River Engineering Services Phone 6q y SI 9 S Name of Firm Address Eagle River, AK 99 Zr Wnop Date �(il3o/vY Engineer's Printed Name C-14 5102'i�iZ �— I 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: Maintenance Agreements HAA Checklist X Supplemental Engineer's Report Septic System Advisory Well Flow Advisory Other Original Certificate Date: _3 i By: (Rev. 01102) l.lu111U1 U11Ly Oz ancnorage Wires properly protected (Y/N) Developmen- t`Services Department Casedto Building Safety Division " "Sitete'r On & WasEewaterograrh"'— i /hl2 .- ,...�- �` � ' wool anchorage ak :y J°zV�#alp V , G li4 Grt us .. ...» " .� ..ti .... c ..:. .�...-,eM'd¢ `Y%it'�"'^'iPYw«.�-.✓v" rrn » w +n.«x.�..o- .a fts L i7'/ L DaTi+c1111. li G.^/ vi"441 aanitary seai (Y/N) –)L_ � klG Wires properly protected (Y/N) G,�^'•,< '2.`r 'i LSA«--=? .amd .t ttl,'h x. < Casedto _��ft Casing height ra overground` AT INS P-ECTIO i /hl2 y � V fts �x( .'ft. n -9 p m 6. • g.p.m. • wwnn'wiew�ufir-"mpC+em.v�muww+cwwra.uwxgw.ufi. _colornes/100 ml f�trate 0 � mg /I Other bactena 2 colonies/100 ml: Mg./I. Date of sarnole•="V141n4 i,:– ! a—a _ -...— va IC IIIJIdIICU_ Number of Compartments Z Cleartouts &N) Depression over tank (Y/ IQ High wateralarm (Y( 16) A/�} Soil rat!ng (S.p or ft2/bdrm) 33C� System type P ` '5'woy Width Z '� _ g GravehbeTow pipe _�_ ft. uuxa a° ai v 5E f. absorption area if390 ftZ Monitoring tube�� µ Depression over field _AkD Results (Pas)Fet1) P,+65 For . bedrooms TR3 F�4��Z2/WZ F�nuh/yoJ57 d before es m. Water added gal New dept ` in. mr U & "'XA44 '6A346 Finaffluid depth' In Absorption rate >= g,p.'d ;past 12 mo.) (Y/N'8 type) A) e) If ves.`oivP date D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at - in. "Pump Off" levcf at High water alarm level at in. Vy Meets alarm & circuit requirements? Datum ��J Cycles tested - E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO. w ' on � I $ On adjacent lots 'r 100 Septic tank/lift l ri .......�_....��..,„„•..m„�..__....,�..�..,.w�,_.�.....�._M..�.. �., _ ��,kb:� I ffyc� Absorption field on Jot 9557000( On ad'acent lots Public sewerm'ain (-f00 Public sewer manhole/cleanout T Sewer /septic service line 1 2S Holding tank SEPARATION DISTANCES FROM SEPTIC/HeH3.1 d TANK ON LOT TO Building foundation 5 Property line Absorption field $ w. Water main 1 /042 r Water service line t/0 r Surface water t- /00 Wells on adjacent lots fitOD SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO; Property line + $0 r Building foundation s Water main !00 Water Service line t10 Surface water f Ryp Driveway, parl'aR@Poeli�e�4 -- Curtain drain Wells on adjacent lots 1-100 F. COMMENTS eePT1C 'iR 1ILIC Z>J _..�RieR 70 �.wu �« G ENGINEER'S CERTIFICATION .S,F 1 certify that I have determined through field inspections and TH. review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. ••• Engineer's Printed Name i hgAZS7 9WX CHRISTOPHERRWOOD =� CE1$87 � Dater� Zl— HAA Fee $ i430 -a jWaiver Fee $ Date of Payment g` 3d ibq Date of Payment Receipt Number 5-�(Dgb ILK Receipt Number (Rev. 12101) MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 44 On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # OSo - 3�y - a- 2 HAA# I1C49(r;C5gI 1. GENERAL INFORMATION Complete legal description Got 2 Ste'"yG!/mss Location (site address or directions) N v c� Jar ve Property owner Soh ✓ 6✓oif T<��> /r4�r Day phone Mailing address X1,3 Z� �e Lending agency "% Mailing Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 7M25(Bev.1/91) From MOA#21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate forthe number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 1� nepg • er En �9 Address � Semeag Phone v- s ss 294, Ba River, ATC 99577-3294 - Engineer's signature ��S �- Date 6 — //-/— 5 7 6. DHHS SIGNATURE (/Approved for Disapproved. Conditional approval for Additional Comments bedrooms. bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev.1/91) BaCk MOAM MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage DEC 20 1996 • — DEPARTMENT OF HEALTH 8c HUMAN SERVICES Environmental Services Division RECEIVE 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: SUNN`/ l/& -e`l W "2— Parcel I.D.: OSD - 35L% Z 7 A. WELL DATA Well type PJ2/VYfT6 If A, B, or C, attach ADEC letter. ADEC water system number JVM Log present (Y/N) yr�S Date completed (1 /Iay/ Total depth // Cased to / % 133e-,QP_DCK Casing height (above ground) JCS Sanitary seal (Y/N) Date of test Static water level Well production FROM WELL LOG WATER SAMPLE RESULTS: Coliform Olo �g� 695' % ST '671- Nitrate Wires properly protected (Y/N) i/rS AT INSPECTION 9/ 1, g.p.m. G g.p.m. 0,1 YN 6/ L Other bacteria Date of sample: 29�j'(n Collected by: B. SEPTIC/NOLDM TANK DATA 0 Date installed /o/A/ Tank size 11900 Number ,of/Compartments � Cleanouts (Y/N) Foundation cleanout (Y/N) Y6S Depression (Y/N) NG High water alarm (Y/N) NIA / Date of Pumping IZ�11'�&to Pumper � /2S C. ABSORPTION FIELD DATA �C F? 8 Date installed 10 y Soil rating (g.RA4ft2-or ft2/bdrm) 330 System type T_4F/r/&P Length Width d Gravel thickness below pipe S Total depth 9-S Effective absorption area __43 iii Monitoring Tube present (Y/N) Depression over field (Y/N) Nb Date of adequacy test 102 - 5- -9 b Results (Pass/Fail) ?eSs For -� bedrooms TREncH-/("PPe-) Fluid depth in absorption field/before test (in.); Immediately after gal. water added (in.): 7 Fluid depth / (ins) Minutes later: 0/d Absorption rate = tys-' g.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level a * Cyc( ested E. SEPARATION DISTANCES level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot 95 — y2 On adjacent lots Public sewer main sewer /septic service line t "Pump off" level at* 4 Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOtMNG TANK ON LOT TO: Foundation Property line Absorption field S N.r. i Water maim/service line ve^fief Surface water/drainage f/00 Wells on adjacent lots )ere,( Mf# CA. ­r */o ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 6d1 Building foundation /S / NOT dER171&1/ Water main/service line eG6L ,z )/yn s4e /o Surface water 7 -/(✓U Driveway, parking/vehicle storage area Curtain drain oUoT rNo1c' n rra oN ear -Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that-thp above`systerns are in conformance with MOA HAA guidelines in effect on this date. Signature ya e Engineer's Name S00/5 a Date /1 /.tr -�i6„ a HAA Fee $ ✓OD o Waiver Fee $ / ol2%r 6-n Date of Payment Date of Payment Z S l_� / \/ Receipt Number � �iD27 � Receipt Number 72-026 (Rev. 3/96)* Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax June 14, 1997 Jim Cross, P.E. Municipality of Anchorage On -Site Services P.O. Box 196650 Anchorage, AK 99519-6650 Re: Sunny Valley, Lot 2 Dear Mr. Cross: RECEIVED JUN 17 1997 Municipality of Anchorage Oept. Health & Human Services In the spring of this year a conditional Health Approval was issued for the above referenced property requiring the installation of a monitoring tube on the 3`d of 3 trenches of the leachfield system. When we recently started to do the work we discovered that what we had thought was a cleanout on the 3`d trench was actually a monitor tube. This tube extends down the correct distance and it matches the expected gravel depth. As monitor tubes were required for each trench but not cleanouts we are assuming that the condition can now be taken off the health approval and have included a new form for your signature. If you have any questions, please call our office at 694-5195. Sincerely, Louis Butera, P.E. G:\wpdocs\1996\95-114a-Itr ." Municipality of Anchorage Department of Health and Human Services -� 825 "U Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor January 13, 1997 Lou Butera, P.E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 2 Sunny Valley Subdivision Waiver Request #WR970001, PID # 050-354-27, HA960547 Dear Mr. Butera: Your request for waivers of the required 100 foot horizontal separation of a private well to three on-site wastewater disposal fields has been approved. The approved separation distances are from the private well to trenches of 97 feet, 97 feet and 95 feet. This waiver approval applies to the existing on-site wastewater disposal system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. jShtcerely, �W mes P. Williams ivil Engineer On-site Services JPW/Ijm; BancBoston Mortgage Corp. MUNICIPALITY OF ANCHORAGI!,—) Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR970001 PID# 050-354-27 HA# HA960547 Permit # Date Received: December 20, 1996 Legal Description: Lot 2 Sunny Valley Subdivision Engineer: Lou Butera P E Eagle River Engineering Services 32ga Qr- po Box 773�i, Eagle River, Alaska 99577 Applicant: BancBoston Mortgage Corporation Waiver Requested: Private well to three (3) private leachfield trenches of 97 feet, 97 feet and 95 feet. Criteria: 1. Geology: Points: A. Water Table 0'9� B. Soil Sorption a rJ C. Permeability D. Water Table Gradient o2 E. Horizontal Separation oZ TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: N__ Waiveris NOT Granted: List Conditions or Reasons for above: keopD/NG App, �Nf 6F Date: M 7 11//h7b`! !E2 a/N7 F120M THE AEAJ S F0/2 olz T,# ay S-4 Rec #: 02541/4028 Amount: $ 920.00 Date Paid: Dec 20 1996 n LJ �C%L S1rPZlc, ��SPEC7.dN hp�D27 � �J�Yr/NEFjjS �f%7'( S�ry�p7�� ?=-2 W>L,�_ " (LO -C . ^ I a 0V628ueDE,v �z 'i t1'' e SAND 4 CMF—L Q S&LS /EST �`oT % C) — 1:2 ,S/LT/ 6,ZAUr, I� s7w�c F,zw.� &-v7 lx er UnwA. D o 8 1.0 P=Q- TPAE Tekfm+rlcY OIL .1D12�if0N 6o"Yz l2, -,i i3` =� Sd' Of SwiG-cv 4. s�I'S PU. = 4 545 Prs LWIA16 Cuay6 S+ro at1 hS Pxf EU6mr. Ccw m m5wst_ _ ( L �1/}�2 cRAUEtiTT S7"!£ DLP NOT Nwp- uaFA S A uer=.9cE SgLof� C(_S,�UNDu�•lYd� &DAD. f#fle W/LL 4,tAC I`S/0 SI ,U �S 477 1 S! •\ � -L rJjc'Y.R�70E,R'iNN 1 00 3 Tom—Tom—_ Fps = o•9Y t-z.Sfil•}t�.ora.a - Eagle River Engineering ,Services Louis Butexa, P.E. P.O. Box 773294. (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax December 18,1996 Jim Cross, P.E. Municipality of Anchorage On -Site Services P.O. Box 196650 Anchorage, AK 99519-6650 Re: Sunny Valley, Lot 2 Dear Mr. Cross: On behalf of our client we are applying for determination of waiver of separation distance for the above referenced single family property. The requested waivers are for separation distances of 97', 97' and 95' from private well to three private leachfield trenches. A site plan is attached showing the serial trench layout. An adequacy test was done on the upper two fields with each one meeting adequacy. The lowest trench was not utilized and the exact location is unknown however it is reasonable to assume it is located within 97-95' from the well based on asbuilt records and the location of the other two fields. The well log for the subject property and for several nearby properties are attached. The subject well was drilled in 1984 to a depth of 115'. The original well log shows overburden and sand/gravel to 1T, then a layer of bedrock from 17-40' and again from 47-89'. Layers of fractured bedrock are also found from 40'-47' and 89'-93' with a final layer of bedrock from 93'=113',. Water was found.at 40'-47' and 89'-93', with the well continuing on to a depth of 115'. We recorded a static water lever of 46'. This indicates a bedrock aquifer with several fractured bedrock layers providing the water, supply. The neighboring wells are consistent with the subject well, showing initial layers of clay and hardpan material overlaying bedrock to aid in the protection of the bedrock aquifer. , Well` logs also demonstrate continuity of the soil and aquifer conditions. The bedrock plane slopes steeply to the south as evidenced by the depth to bedrock on all lots to the South of lot 2. As the ground surface slopes to the South at an average of 45-55% the bedrock plane slopes kan evengreater angle in the same direction. Our well flow test, which was limited by the produc66yixate of the pump, produced an average flow rate of 6 gallons per minute with a total drawdown of 31"from static water level. G:\wpdocs\199605-114a-Itr The on-site sewage disposal inspection report was dated October 22, 1984. There were also three Health Authority Approvals issued, in 1984, 1988 and, 1993. Current and historic water samples showed satisfactory results. In the current nitrate test result, no nitrates were detected, which is a good indicator that the well is not impacted by this leachfield. Near surface soil characteristics of the area are well documented. The immediate subsurface soil is typically a silty sandy gravel (GM) with no indicated near surface water table to the typical test hole depth of twelve feet. Percolation testing on the lot showed 60 minutes/inch which was rated at 330 SF/BR. Based on the long term water sample history and the small distance being waived, we do not anticipate a significant negative impact on the water supply by allowing this waiver. Please review the attached file research data and if you have any questions, please call our office at 694-5195. Sincerely, Louis Butera, P.E. G:\vvpdo cs\ I996\95- l 14a-Itr 41 k,6wW LEND f1/ _\ l 0vN» tt Flt i ; g 'yli A6#3 Is 3 •'Qj :}cry at,a '^F'&., ��rv. ate` • ,.sa ',,. , z 31 Itor a,✓ NI , 0�0 ,r' � • y M wrGt I \ b JO �_ O •A A• ASBUILT-NO CORNERS SET THIS DATE. SEWARD b ASSOCIATES LAND SURVEYING I HEREBY CERTIFY THAT I HAVE SURVEYED THE I' _ i 1 i, yo sa r%vy z ' DATE, 4 INDICATED. IT IS THE RESPONSIBILITY OF THE GRID, OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS sw s8 WHICH DO NOT APPEAR ON THE RECORDED SUBDI- FB' b 41 k,6wW LEND f1/ _\ l 0vN» tt Flt i ; g 'yli A6#3 Is 3 •'Qj :}cry at,a '^F'&., ��rv. ate` • ,.sa ',,. , z 31 Itor a,✓ NI , 0�0 ,r' � • y M wrGt I \ b JO �_ O •A A• ASBUILT-NO CORNERS SET THIS DATE. SEWARD b ASSOCIATES LAND SURVEYING I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE, FOLLOWING DESCRIBED PROPERTYi yo sa r%vy z ' DATE, AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE GRID, OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS sw s8 WHICH DO NOT APPEAR ON THE RECORDED SUBDI- FB' VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. ,e, -f' W%'% r �, • Duane Mark Seward LS -6918 '.....•••. ACP s MUNICIPALITY OF ANCHORAGE 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 /J �r L�' PHONE NEW (2U SSS/ONc, 9LULce S LCt[ - ❑UPGRADE MAI LI ADD LEGAL DESCRIPTION - L- Z S&( Ai,v LOCATION / - J NO. OF BEDROOMS U Y: - DISTANCE TO: WW��� 7 Absorptig ape Dwell 'pg__ PERMIT N M RI Z r a ZQ Manufact e ^ ! - N1q�teci No. of compartmente-j w Li p ci m gallons IF HOMEMADE:. Inside length - Width. Liquid depth D� zf DISTANCE TO: Well Dwellings C. PERMIT NO. ,.. _ Manufacturer - Material Liquid capacity in gallons DISTANCE TO: -- Well / 2? Foundayq� Nearest' ne PERMIT fyO. N p w = G Z�(� -. f (��L /ll JLLLx) No of s Le bf Total l§ t fji nes Trench th. it - ': inches Dista fe,bet g7��wes Q H O Top f tfile fI(�ish gr Material beneath tile ,f Total et ive absor a �( � C9 �•. inches .�5 - /.300 w Length Width Depth PERMIT NO. C7 i F w° Type of crib Crib diameter rib de Total effective absorption area W DISTANCE TO: Well BuildFrig foundation Nearest lot line - J CI epth , U D ler Distance to lot line PERMIT NO. - DISTANCE TO: BuildinoTounclation Sewerfine Septic tank Absorption area(s) - OTHER PIPE MATERIALS SOIL TEST RATVG INSTALLER L - 4 REMARKS- / / G PJ�'G/ UGC 1e d�W 0 r / AN 466 : NO 6 ,64Yvii�l % , No. 1457-E ?' 2w„r R i AROFE 3S\0`a,�s i : 2 .., I LL /�CEi 1,4 APPROVED ;. a - � DATE AL: SRS 196X 311VER. ALASKA ly�,;{�1;1wZ1,577 E' PH. 04079 72-013 (Rev.3/76)-""—'-`----G77 - MUNICIPALITY OF ANCHORAGE Department.of Health and Environmental Protection 825 1Street, Anchorage, AK. ` 9501 /u 264-4720 S Permit # # # # HANDWRITTEN PERMIT t WELL ANDS( ON-SITE SEWER PERMIT Applicant: z£�y c)ulccniailing Address: n : � ?hnLdcatiSo;S Jf.) oNNumbbe: o Legal Description: G 2 wU� E Lot Size:— Type of Soil Absorption Syste s: 7_1Y1Y �'14J Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Requi Size of the Soil.Absorption Sy/ste�m. Is:' �E;ccfuerticovi� DEPTH LENG _GRAVEL DEP H �� WIDT) The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(H TANK SIZE = Oo0 GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # # TWO(Z) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 3� I certify that:, (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will s all the syst m in accordance with codes. (3) I un rst nd that e n -site sewer system may require enlargement if th resi e del to include more thatl /3 bedrooms. Signed: Issued by: Z4�iL1c' #1tc'a'nt_ %/ A/ Date: Sin un t' t 12 SWP/024 (1/81) Cir 6 ° Re4 na �°��n`t -A'A V%00. Wy°t���rl �� I) 6o() rn T m� n O Z O rn vD C o O=n Quo z m („ CA r T rn Srl 1 j_ 72413 R.u. 01781 -- -- - r MUNICIPALITY OF ANCHORAGE k ENVIRONMENTAL ENGINEERING DIVISION ` 72413 R.u. 01781 -- -- - MUNICIPALITY OF ANCHORAGE l�\ DEPARTMENT OF HEALTHA ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION ` 825 L Street • Anchorage. Alaska 98501 Taiephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT - -- NAME 1/-�I ,. /^I 1I SFi HONE NE -- W ' �!R�CJ�SSJO N•'!iL �. UCCE 5- CC([/ I� I IT• ❑UPGRADE MAILI JADD LEGAL OESCRIPT ION :OCATION / n J /� - S/ , L NO. OF BEDROOMS U DISTANCE TO: /Ot' / Abvorpuoy a�a Dail' t [i { PEHMITN N• /+- a:2 Manulxr/ MJ 1; N..al eoq.Rrgenee-� N� jnowns nzV7Width 1 IF HOMEMADE. Invme 4ngln Liquid tleo'n -- OOi DISTANCE TO: Nell ` UWIIing PERMIT NO. I�4 MnnulaClurer —��� Material Liquid capacity in pliant o= DISTANCE TO: Wall GC7 / founmgy� Ne.m',4ne! PERM Tyv� 4 W W 2 2 H W No. ofL• }N ul 1 dl ToI Vines Trench u"dS 4Inches tJ v � � Ll Dwen 4,r: ' /V 5 r e iAmm"al beneath its / / iop 1 Jtia IyvvM1 gr &171 Or Toull r e"1ve a�Efbr �}j p O t J1 C� intoe{ ./ll • /.iC/' Lanetn 1v,din Omfh PERMIT NO. W Qf• Type of sip Crib dia�nm 'rib de Totalelleetiw ebswpeidn area N6 DISTANCE TO: WB Build elwnyuon Neemt lot line CI>� AePIM1 tl_ D ,ler �_ Dn NnO to IPI Ime [PERMIT NO. W DISTANCE T0: Sn Budmn undedoSin,,,'me Seaidunk AbwrPtionereelfl OTHER PIPE MATERIALS L/ SOIL TEST RATI G -3go / INSTALLER REMARKS 1 PXLLiLra/I-! 1,14 kii ' 4' lily✓ ».r.. i �i C ' Hs LLA4 Lf,FtJL Lar> �' ,t P//r'E ciJ � as I APPROVED H• DATE AL SRO 108X Nn,ALE EC4i1 RIVER ALASM I PN. G9}2;70 72413 R.u. 01781 -- -- - E) JOE -GIELAROIA%IKI DMIPUNQ Cl - L"TW ALASVM SOWM ALAWA PC am "A" "M ftwk am" M" Ma OF LAW IM -11 MU DUMCWTami ISM- 65rr.' In ban net. U,.,rjy I/ STATX LZM OF WAMM MAW MW ff. '959 WAW LL-RM— ra - STARM June 12, 1964 'L PER ML 420 gals. hour .... ... GAL ------ - iWas 12, 1964 KM OF CAPING 2=- 40 4DOFFONMATM: FM 0 FT. TO LZ Fr. _AyegrbW FROM — fr. TO FT. FROM 32 MTO j!z ff. FROM — ff. TO FROM i7p MTO r 4e FT. Bedrock FROM -_ FT. TO FT. FROM _360— FT.. TO U2 Fr. X=wticck_&_iater FROM Fr. TO FT. FROM 47 MTO FT. BEBrock FROM FT. IF!RDM no MTO FT. Fmct Rm* A water FR 4#tOz Fr., C)f FROM 93 FT. TO FT. Bedrock FT. TO Fr. COA FROM FT. TO FT. FROM W FT. To FT. FROM FT. T0' Fir. FRCWAjj�o FT. FR= —FT. TO Fr. FROM —Fr. TO FT. FROM Ff. TO Fr. FROM Fr. TO rr FWAN MTO FT. FROM _".ToFT ;a- VGVMATM: Pant 10 FT ofix. bottom. ----- -------- 30 es or waxTw"4'r. > oval- ()vEa&l0ep vi V •-�.w: • - - SOILS LOG c irk :. �.. ,•� � MUNICIPALITY OF ANCHORAL J13 PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION -.ST T IM L. 9000. AndwSp. AWA •8601 264820 SOILS 1.03 — PERCOLATION TEST /t7 2 E %y '3 !o;It-. ' PERFORMED FOR: t'DATE PERFORMED: lJ 4' j /•0}P55Q� /ONCjtTPnA2PL 206 11 2-S7" '31 Y 47- :sum 1 ✓_��_' 216 '..'LEGAL OESCRIPTION: C. JiiZT7T SITE to LlI SL s/6 E» z 26 PLAN Or9aNK5—TopSol� 1s 2 3 4 8 8 7 8 �0 10 12 13 14 18 16 17 (yery Gvwtpo4r) WAS GROUND WATER V / ` "- ENCOUNTERED? �[�(.�� 0' 0 TO N'1 0 O Bc�" �'e IF YES, AT WHAT /, E *., DEPTH? �/�/i/^p-'� ate` De..� NoI ' ♦~*�� OF•A%� .t CE 5035 RMdlnS Dote Gron Tin» Not Thew th to Water Net .: `.^ /t7 2 E %y '3 !o;It-. ' 6—/ 206 11 2-S7" '31 Y A 216 / p 2 %s s/6 z 26 PERCOLATION RATE 60 IminutM/Itech) TEST RUN BETWEEN .S FT AND FT o -Fre/Bz PERFORMED BY: t l A IM (OS L? (' CERTIFIED BY: 72-005 (6/75) PERFORMED FOR: -!? f �� Prr4 53/rtic1 ,.. . rlfl/'JrS C 5 DATE PERFORMED: LEGALTDESIMPTIO4D / S uN N _ y �Q I''Q. y_ _. 19 20 evrn�cwrc�- T OrtjaH%c-S /7cPsc.I 1/erY CcwtPat- s d 1-y G yo oed WASGROUNDWATERn/G - `' ENCOUNTERED? �V O 8o77oNt o r Nolo E IF TES, AT WHAT DEPTH? N/A P6r4 lw')e Pr o -oat —5 *fLI" CE 50 Rwdlno Octc Crow Timc Not Tkna Goth to wow NK Drop ' /U /D -116 a O 7-/3 600 PERCOLATION RATE - - A O (mirwtw/frKhl - - TEST RUN !ETWEEN 5� FT AND �_ FT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES�i 1 Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING s Parcel l.D. # n{ci - ��,+ 1' �7 - P Y lti - �i i' HAA # (� W\') Olt-, 1. GENERAL INFORMATION Complete legal description Lot 2; sunny valley subdivision Location (site address or directions) 22243 Lakeview Drive River, Alaska Property owner Lloyd Fanter Day phone Mailing address c/o Greatland Realty 11411 Old Glenn Hwy, Eagle River, Alaska 99577 Lending agency Day phone 694-9125 Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 -,4 XX Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system.. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 021 - 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 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 verifythat 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. 5 & S ENGINEERING Name of Firm..... Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for �� CAedrooms. Additional Comments Phone!`//��Z%%ci z bedrooms, with the following stipulations: By: � C�icv Date /0— '7-93 WTIC1 The Winicipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsibIG for errors or omissions in the. professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:// 2 1�la4/2 Parcel I.D. A. Well Data Well type (/a If A, Log present (Y N) B, or C, attach ADEC letter. ADEC water system number _ completed 6 —1z-0 4- Driller r � r �r/�Gf9rI�GJS�/ r, Total depth //,.s— Cased to Z 5t Casing height /Z f Sanitaryse(Y N) Wires properly protecte (Y ) 6�g-lo I.2oC[_r Ido / CASE 0 7_0 FROM WELL LOG AT INSPECTION Date of test ��/? �£� 14 c `o z n Static water level S� '�j Irl) -0Z Well flow y I v Pump levell /mss / �Lc`' n z C C SEPARATION DISTANCES FROM WELL TO: ti C r R Zoo f ; On ad acent lots �Dc� Z Septic/h tank on lot 1 Absorption field on lot ��D f ; On adjacent lots /OD Public sewer main Public sewer manhole/cleanout Sewer service line f Petroleum tank %V D E WATER SAMPLE RESULTS: / Coliform �y Nitrate _ r 2 Z of Other bacteria Date of sample: %�/ 3 �9 3 Collected by: B. SEPTICA11BUB08-TANK DATA Date installed g Tank size 00 _Compartments 2 Cleanout (Y ) Foundation cleanoutJYN) Depression (Y N) High water alarm (Y/N) N� Alarm tested (Y/N) / %� 13 —Pumper C% - Com. Cif rlJov l f�Gc Diti 9 Date of pumping G P —�/ SEPARATION DISTANCES FROM SEPTIC94e TANK TO: Well(s) on lot _LOO 4- On adjacent lots A2 Foundation '�5- � � r To property line /5 Absorption field 6; Water main/service line t Surface water/drainage ND/)0 6C NOW J G✓r -0--H AJ /Oo 7z-ozs(a/sa)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed I Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at _rT"Pump off" Level at ------ High --High water alarm level Cycles teted— Meets MOA electrical codes (Y/N) SEPARATI6N-3BTA ROM LIFT STATION TO: Well on lot On-adiacent lots-- ---- Surface water D. ABSORPTION FIELD DATA Date installed gle q Soil rating (GPD/Ft2) System type T�ho�je Length /3 �1 / Width .30 Gravel thickness c5— / Total depth g l Total absorption area Z1O Sf Cleanout present((Y/) Depression over field ()/N Date of adequacy test 28 3 Results (pass/fail) s for Bedrooms Water level in absorption field before test / 2 er After test 2 2 rr Peroxide treatment(past 12 months) ( /N / n /If yes, give date 7/e4c`j es LU c7 N .S7� /,L 6 v.� ['l-( Q/�2yJ� <✓ P_ � 6t -v- e le 7lv e �Y>'n�4 SEPARATION DISTANCE FROM AB90RPTION FIELD TO: Well on lot 1017 f On adjacent lots d00 Property line 10 r To building foundation IS �- To existing or abandoned system on lot 1CD Jyvy0� /�LL 5lopE On adjacent lots Guibarri 2_0 Water main/service line /O f I Surface water /II ,6 !O 0 4 Driveway, parking/vehicle storage area 2 Curtain drain /y O,J E // ter/ U w /,J E. ENGINEER'S CERTIFICATION I certify that I have checked, verified P-epnformed to all MOA and HAA guidelines in effect on the date Gtr inspection. t X W3 7i e�t� of v I s � G/ s!�✓e `� h5 15:: Signature S GINEERING G Engineer's Name 1 41 a River Loop Road No. 2wlee Date ogle River. Alaska 99577 HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back 0 —(/3 Waiver Fee $ Date of Payment Receipt Number • MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # (% h 0 35-4 27 HAA # �� a 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2, Sunny Valle Location (address or directions) Mile High— Lake View Dr. (b) Property owner Rick Pitts Telephone: (home) 694-5960 Business Mailing Address P-0- Box 774571 Eagle Ei3Zeri Ak 99577 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Ara Coldwell Ranker Bob.Martin Telephone (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family U Number of bedrooms 3 3. WATER SUPPLY Individual Well ER Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site IR Public ❑ Community ❑ Holding Tank ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025(Rev.7/88) Page 1 of 2 5. 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 my investigation of this Health Authority Approval 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. p Name of Firm s; g, c cNa)NEERING Telephone 0 17034 Eagle River Loop Road No. 204 Address Eagle River Alaska 99577 Date , .. 1416 1487.4 6. DHHS APPROVAL Approved for 3 bedrooms by Date 27-89 Approved..—Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipalityof Anchorage is not responsible for errors or omissions in the professional engineer's work. 72025 (Rev. 7/08) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGF MUNICIPALITY OF ANCHORAGE (MOA) #MONIV'ENTAL SERVICES DIVISION • Health Authority Approval (HAA) C )C; 2 4 1988 CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Z A. WELL DATA Well Classification t� �'���� If A, B, C, D.E.C. Approved (Y/N) Well Log Present(LVN)_—Date Completed )Z " Total Depth LVOT Cased to Depth of Grouting Static Water Level Pump Set At Yield (a, C) 6+2v -tel 4 Casing Height Above Ground 12� . 4:� Sanitary Seal on Casing 4VIN) I! Electrical Wiring in Conduit (3P/N) h Depression Around Wellhead (Y/d SEPARATION DISTANCES FROM WELL: 1 To Septic/Holding Tank on Lot 1 4- On Adjoining Lots 1 To Nearest Edge of Absorption Field on Lot 1 Lc_� ; On Adjoining Lots ti ����� To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole ._fie— I +' To Nearest Sewer Service Line on Lot y Water Sample Collected by S` S � lr�ix°n t ; Date :J Water Sample Test Results Comments - l-1 -'&B B. SEPTIC/11+964ANG ANK DATA Date installed Size 64--A� No. of Compartments Z Standpipes �9/N) — Air -tight Caps M/N) `' Foundation Cleanout 07N) _ Depression over Tank (YP TS ate Last Pumped Pumping/Maintenance Contact on File (Y/N)� ; for -J Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/Y 0b9+l4aTANK: 7 1 To Water -Supply Well ( c� '�- To Building Foundation To Property Line 14- To Disposal Field 7 � To Water Main/Service Line I -A To Stream, Pond, Lake or Major Drainage Course r Comments 72-026 (Rev. 7188) Front Page 1 of 2. A, C. ABSORPTION FIELD DATA Soils Rating in Absorption Strat 3�n� O P-� Type of System Design T� � ) Date Installed i Length of Field Width of Field ria Depth of Field 8 Gravel Bed Thickness Square Feet of Absortion Area 3g p� Statndpipes Present4PPN)Y Depression over Field (Y/a /`J Date of Last Adequacy Test Results of Last Adequacy Test(l— SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well oa f h ! To Property Line f o To Building Foundation S To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line (v To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course 1 ba /,4 - To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION r A Date Installed Size lrL Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access(Y/N) "Pump Off" Level at Pumoin ng Adequacy Test. "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 S & S ENGINEERING 17034 Eag a rver . Company .—_ Eagle aWw Alaska 99577 Date z�) 0, MOA NoY T%D � Receipt No. 0 5' 6% //P > 69 �o ,94 Date of Payment %D `- Amount: $ /70 •_-JO 72-026 (Rev. 7/88) Back OF '� 1t eer's�S>?� H+bart A. •1i No. 14574 a -'Tor Receipt No. 14®qy r; ,• Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 1"r (a) Legal Description (include lot, block, subdivision, section, township, range) 67 Location (address or directions) �4�4�- (b) Applicants Name (/I� { ��� Telephone - Home — Business Applicants Address 1/ f- o nom= -/:Z, (c) Applicant is (check one) Lending Institution ; Owner/builderrV ; Buyer E__1; Other [::�:j (explain); _ (d) Lending Institution A \0 '&-I)= Telephone Address (e) Real Estate Co. & Agent 14C/l_1�1 Address Telephone 0 (f) ­M-zil the HAA to the following address: 2. Type of Residence Single -Family Number of Bedrooms 3. Water Supp Multi -Family Other (describ Individual Well= Community 1:�J 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 Public Community Holding Tank 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] YF � 5. 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, Y verify that my investigation of this Health Authority Approval 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 regula- tions in effect on the date of this inspection. , i Name of Firm Telephone Address en 2 !9 t . a a8rt Date (ENGINEER SEAL) 6. DHEP Approval Approved for bedrooms Approved Disapproved Terms of Conditional Approval CAUTION Condit 91221 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/D18 [Page 2 of 2] 7--19-84 ( - MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) OCT 2 CHECKLIST - FEBRUARY 1984 RECEIVED A. WELL DATA Legal escription: ZJL"111 61n' Well Classificati r/ �e^/i If A, B, or C, D./E.C. ApprovedfY74N) i Well Log Present (Y i) Date Completed Yield Total Depth �/1_ Cased to z "��- I�pth of Grouting Static Water Level rj Pump Set At r, Casing Height Above Ground 0 Sanitary Seal on Casin t()E Electrical Wiring in Conduit (Y Depression Around ibllhead Separation Distances from We To Septic/He1dj^g-,Tank on Lot IC 0 f ; On Adjoining Lots &A-iOiF U: To Nearest Edge of Absorption Field on Lot 00 ; On Adjoining Lotsty a CIF U To Nearest Public Sewer Line %a' To Nearest Public Sewer Cleancut/Manhole /U / /4- To Nearest Sewer Service Line on Lot /00 . Water Sample Collected By -5'i-5 Z Z? rh)ee,/1ti Date /ti /2-,, /ig k -1 -- Water Water Sample Test Results S,9/s�i4C Zc7�� Comments B. SEPTIC/firTANK DATA Date Installed Size No. of Compartments �- Standpipes (Y Air -tight Caps (Y Foundation. Cleanout Y ) Depression over Tank (S* Date Last d Pumping/Maintenance Contract on File (Y/N� for Holding Tank High -Water Alarm (Y/N) %� Temporary Holding Tank Permit (YIN)�� Separation Distances from Septic/ Tank: / To Water -Supply Tibll ( To Building Foundation To Property Line /D 7— To Disposal Field 4 To Water Mair./Service Line h To Stream, Pond, Lake, or Major Drainage Course N L:.) Nr Receipt # 3C�loi��v Date Paid: Amount: [Page 1 of 21 2-15-84 C. ABSORPTION FIELD ARTA Soils Rating in Absorpt' on StrataType of System Design Date Installed 1Y f Length of Field !.7 47Z� Width of Field 1 ` Depth of Field 1 avel Bed Thickness e�(53 ` Square Feet of Absorption Area 1✓ s`_3 ;�r Standpipes Present((Y ) Depression over Field ( Date of Last Adequacy Test ti Results of Last Adequacy Test AJV L 2% Separation Distance from Absorption Field: To Water -Supply Well 10-c) To Property Line To Building Foundation �S / To Existing or Abandoned System on Lot ; On Adjoining Lots t!( /t" 0 ra U To Water 1/Service Line AC) /— To Cutbank(if present) A,'20AJ'I To Stream/Pond/Lake/or Major Drainage Course /1✓v n M To Driveway, Parking Area, or Vehicle Storage Area Z Comments /1 t 0 d -J iF D. LIFT STATION Date Installed Dimensions Size in Gallonsa hole/Access (YIN) "Plump On" Level at Level at High Water Alarm Level at t//Tvent (YM) Tested for PumpingACycles during Adequacy Test. Meets LMCA Electrical Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Wa! Signed <h.Y Sa u�i� I..T`ilit=Y Dat., eA ems,: Company;. ��L< ��a �fT MOA No. �' ' ' BR�3 Za e 2 kBl/d5/s 3 �.58akr �¢® 1457.E O FDAlt f»..'ONP�®�� [Page 2 of 21 ®on 2-15-84