Loading...
HomeMy WebLinkAboutSUN VALLEY HEIGHTS BLK 3 LT 4Sun Valley Heights Block 3 Lot 4 #017-062-36 '" Municipali:ty of Anchorage Page_ / of~ DEPARTMENT OF HEALTH AND HUMAN SFRVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99,519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report PermitNumber: ~",,,3q705~5 PIDNumber: 017- o~ ~. - ~(¢ _ Name: ~ ~ HCa. ~U~7 Wastewater System: ~ New ~ Upgrade Address: ~ MU~T~ P~ ~ ABSORPTION FIELD Phone: ~ Z - ~+~ / lNo. of ~rooms: U Deep Trench U Shallow Trench ~ Bed U Mound ~ Other Total DepthJrom original grade: LEGAL DESCRIPTION SoilRating: 4 GPD/Sq. Ft, i ~ ' erO ~'4' ~' Subdiv~ion: ~ pi~e bottom from original grade: Gravel de )th beneath pipe Township: Range; Se0flo Fill added above original graCe: Gravel length: /. ~ e/ Number o[ lines: I DisUnce be,ween ,ines: : E] New ~ Upgrad Gravelwidth; /8/ Ft. ~ ~O /I Classilicati~,B,C):~ //T°tal Dept~¢t. ¢Cased To: Ft. Total absorption~oarea: · SO. Ft PIpeDEo~material:~ ~C~ ~O P~ Driller; ~ Dale Drilled: Sta[ic Water Le~el: Installer: ~ ~0~1 Date In~ ~talle: ~,~:~~~~.~- .am. Set.,,. ~~~.' ..i¢,*~oveero.n~: ~¢¢~'~¢~W/o ¢¢~'¢'7/~ TANK SEPARATION DISTANCES , ~Septic D Holding U S.T.E.P. To Se¢ic Absorption Lift Holding ~ublic/Priva~e Manufacturer: Capacity in gallons: From Tank Field St~Uon Tank Sewer Lines ~ ' ~ ~ Number of Compartments: Well- ?~0 + ~01. ~ ~ ~ ~ ~¢t ~ Material: ~L su.~o. ~o~ mo'* loc/* ~/~ /co/+ LIFT STATION Water Lot /. /~ / Size in gallons: ~ Manufacturer: / "Pump on" ;evel at: "Pump off" level at: High wa er alarm a Cu~ainDrain ~ ~ ~ -~ Pump~Make & Model J Electrical Inspections~, o,Ped°rmed~ by: Remarks: ~ ~ ~ ~ BENCH MARK ~ U~ O~l ~1 ~ /~L. Location and Description: ~(~7~ ~ ~' U. ~ ~O = ~OO.O~ AssumedElevatlon: [oO. cO ~N~ ~ ~I~ ~4&~ ~O~ ENGINEER'S.,,, . , .SEAL uepanment of Health and Human Seffices approval :~-~; ,,": .:,' Reviewed and approved by: ~/~ ~' ~ Date: /g'J~'q~ '~,~, */~o~:~","," ,~ 72-013 (Rev. 9/91 ) MOA 25 --AIR COMPRESSOR INSTALLED IN THE GARAGE, 3,25 PSI DN t GAUGE AFTER START-UP, LOCATION OF EXISTING LINE FROM THE HOUSE TING DOIJBLE C/D AS-BUILT SW8398 PIG, 017-06~-36 B TD SI = 16,0 C TO SI = 37,5 B TD S2 = 17,0 C TD S2 = 47,0 A TO MH = 52,0 D TO MH = 5G,O A TO MT1 = 93,0 B TO MTI = 07,5 EXISI']NG 1500 GALLON SEPTIC TANK :D 7/9A WITHOUT PERMIT NEW DDUDLE G ERAL LOCATION EXISTING DGUBLE C/O AFTER TANK 500 GALLON LIFT STATION EQUIPPED WITH INTERMITTENT OBSING TINER, NEW 1,25 INCH PVC SLOPED BACK L]FT STATION B3 DUG ON 11/80/97. LDO ATTACHED Wl'rtt AS- GUILT PACKAGE, HOLE Ge MT GENERAL LOCATION OF THE TERT PIT GOTI'OMLESS ISF GEE DETAIL BWG. NOTE, THE AIR COMPRESSOR IS A THOMAS INDUSTIRES, MI]GEL 5070, AS SUPPLIED BY ANCRGRAGE TANK, THE AIR LINE IS 3/8 INCH :)IA, AIR NOSE LINE, INSULATED WITH 1/2 INCH FOAM PIPE WRAP (R3 VALUED, INSIGE A 2 INCH SCH, 40 PVC JACKET, THE LINE )JURIES TO A MINIMUM DEPTR OF :t FEEl', SEPTIC AS-BUILT~ LOT 4, BK 3, SLJN VALLEY I-ITS, S/D, PREPARED FOR~ I~ERT HARTLEY PREPARE. D BY~ ALASKA WATER & WASTE:WATER I I DATE: 11/28/97 DRAWN* GARNESS SCALE: 1' = 30' \ ~ NLq I. INER LqN :BOTTOM, \ r-AIR LINE MT3~ \ / 8 TOTAL 3/4 INCH PVC ~ \ / /-LATERALS ~/ITH 1/8 iNCH lpg5 INCH PVC LINE -ROM THE -- ~ ~'r'T OT/, [ ~ I i . ' ------FLUSHING VALVE '-- ~ j [ ! I , ~ (-rYP) -FINAL GRADE: = 1DT,~-~- MIN, COVER = 3.2' -EXISTING FILL GRADE /----6 '~ LAYER OF 3/8" PEA GRAVEL. /-EXISTING FILL / ~/ITH THE PVC LATERALS BURIED .~x / / /-~ INCHES OF INSULATION ]~OARD ~ K~,~,,,.~ ~__~ ~._~.._~. ~,,-x~ / EXISTING FILL -,~~:~.~. :'~: ~ .' ... ,,' ,.,: ..': TEIP DF NATURAL J ,.~'~.~' ":-" ': ".". ', ".~,' '~':.': ?.2'.." '. ~',~ . DRGANIC PRDFILE :".,"2'."".,~""..~' '~,..'~,.,:.'o~:.':~':.',"~"~,':"~,'~/4~.~ AIR LINE INSTALLED .... · ; .:~,...,,.. ..... : ...... . .. '-~--~4' 8ELDk¢ THE TOP  DF SANI). TOP []F SAND = 103,64 %DEPTH BF SAND ]~ELB~/ THE AIR LINE VARIES INVERT [IF DRAINPIPE = 103,9 ..__FRBN .5 FEET TB 1 FEI[IT, TFIE AIR LINE IS AT ]3DTT[]M [IF EXCAVATIBN VARIED ELEVATII]N = i01,64 APPR[]X, FRBM 100.6 TB 101.1 BDTTEIHLESS ISF AS-BUILT SEPTIC SYSTEM UPGRADE ~ LDT 4, BK 3, SUN VALLEY HEIGHTS ~,,. ,,,,~. , ,, . , . PREPARED F-BR: ]~ERT HAR]LEY .. DATE, i1/B9/97 DRAWN, GARNESS SCALE, NTS ,~,~.~.~ AS-] tUILT 3RAWlNG GROUND OVER LIFT STATION IS 99,9 FEET, COVER = 5,3 FT, GROUND ELEV, - JO0,e COVER : 5,0 FEET OF TANK : 94,56 - 95,2 APPROX, / 1,25 INCH SCM 40 PVC LINE TO )~DTTI]MLES,~ IRF EXISTING 1500 GALLUN SEPTIC 'rANK [~ INSTALLED IN 1994 W/D A PERMIT, GALLQN ]IDTTOM TANK AT INLET = 90,38 GRADE f'ROM IISE UNKNOWN SEPTIC AS-:BUILI-: LDT 4, BK 3, SUN VALLEY HEIGHTS PREPARE]? F[]R~ BERT HARTLEY ALASKA WATER ~ WASTE~/ATER ]lATE: 11/29/97 I ])WN' GARNESS I SCALE: NTS D .I Fi .I I ~ i ~r~ rf~ Ir~7 ~I ~ ' /Y~6 ~r Ui[tuA~y rX~ I-2~ t'~ ~(I '~' iE~,'~ /~mi' ~ j J CORI[ECTiON8 ESSENTIAL AS EXPLAINED BELOW iNSi~O'i'OH 4 5 6 7 8 PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 10 Township, Range, Section: ~/~~- SLOPE SITE PLAN A I- N 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT l~' oL DEPTH? ~ p Deplh Io Waler AfLer /Q//t- /Q/A Monitoring? Dote: m Reading Date Cross Net Depthto Net Time Time Water Drop PERCOLATION RATE (mmutes/inch) PERC HOLE DIAMETER COMMENTS TEST RUN BETWEEN FT AND FT I ~'~'~'~ CERTIFY THAT THiS TEST WAS PERFORMED ~N ACCORDANCE WI~H ALL STATE AND MUNICIPAL GUIDEMNES IN EFFECT ON THIS DATE. DATE: 72-006 (Rev. 4/85} DEPARTMENT OF HEALTH & HUMAN SERVICES PERFORMED FOR:. LEGAL D ESC R I PTIO N: _.,~ (,.J 2 O~ 6~ 8 9 10 Municipality of Anchorage 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE ~/O. L.z"(,, ~ Township, Range, Seotio.: · SLOPE WAS GROUND WATER ENCOUNTERED? SiTE PLAN 11 12 13 14 15 16 17 18 19- A~L - $ IF YES, AT WHAT DEPTH? p E Monilorin~? Gross Net Depth t~: Net Reading Date Time Time Water Drnp ,, //~, ,--c PERCOLATION RA'rE~_~' (minutes/inch) PERC HOLE DIAMETER DY' TEST RUN BE'IWEEN ~,0 ~~,.1~ FT AND -'~'~'~ F~ ACCO, D'~" ~;':;;;TATE AND MUNICIPAL GUIDELINe; 'EFFECT ON THIS DATE. ~AT E'. 72-~8 (R~. 4/~1 PERFORMED FOR:. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 2 9 10 11 15 17 18 19 20. COMMENTS Township, Ranoe, Section: SLOPF SITE PhAN WAS GROUND WATER F_NCOUNTER ED? S DEPTH? P~ Depth lo Water ARer ~ . __ Monitoring'/ ~L_ Dale: (0/2.:~{~ I Gross Net Depth t~P Net Reading Date Time Time Water Drop 1~/~zl~'~ '-'Pl~'~o ?;% '- I:q£*~. _ I;g~ - ~,, - 2~ ~o~,~ ~'/~" 3~" ;~a/~;~5 ~S~,~ 6" / /' g" ..... t:9o t&~ ~VV" I ~1~" 3',~/H .- ~:%~ I%~,~ fi?q" I~1~" ~;I ~ I S~,~ ~VY~' I z/~" PERCOLATION RATE ~,6 tmmutes/inch) PERC HOLE DIAMETER ESTRONBETWEEN TANO--6Z ACOOR,A~JCEI~ ALL STATE AND MUNICIPAL GUIDELINESg~FFEOT ON THIS DATE. DATE: 72-008 (Rev; 4/85) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970398 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:HARTLEY A E & CAROL J OWNER ADDRESS:13211 MOUNTAIN PL ANCHORAGE, ALASKA 99516 DATE ISSUED:ill17/97 EXPIRATION DATE:il/17/98 PARCEL ID:01706236 LEGAL DESCRIPTION: SUN VALLEY HEIGHTS BLK 3 LT 4 LOT SIZE: 56905 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ISSUED BY: DATE: DATE: //'-/~--~7 7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504 (907) 33%6179 - Fax (907) 338-3246 Consulting Engineers November 2, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 ReP Sewer Upgrade for Lot 4, Bk 3, Sun Valley Heights S/D To whom it may concern: The existing 5 bedroom house is served by a private onsite septic system and a community well. The existing septic tank and seepage pit (concrete rings) were installed in 1994, without a permit. In short, the system is undocumented. A soils test was done near the seepage pit, and it was determined that the soil below a depth of approximately 8 feet was dense, bonded, damp, silt, that appeared to be impermeable (or very slow perking). The total depth of tl~e seepage pit is approximately 14 feet, with much of the effective depth in the tight soils. Based upon these findings, it is was determined that a new drainfield would need to be installed. Comments regarding the proposed upgrade are summarized as follows: 1. SOILS: Two soils tests were done, one to the south of the existing seepage pit, the other to the east of the seepage pit. Copies of the soils logs are attached. In both holes there was a suitable SM accepting soil overlying dense, impermeable soil. The SM~ soils perked from 3.8 min/inch to 8.6 rain/inch. No standing water was encountered after monitoring. Rather than install an extremely large bed, or trench system, we are proposing to install a bottomless Intermittent Sand Filter (ISF). The intent is to install the ISF near TH #2 (3.8 min/inch), and at a maximum depth of 3 feet. This will ensure a 4 foot separation distance to the tight underlying ML soils. The specifics of the design are summarized as follows: 2. ABSORPTION FIELD DESIGN: Bottomless Intermittent Sand Filter (ISF) a. Percolation Rate: 3.8 minutes/inch b. Allowable Application Rate for BSF: c. Number of Bedrooms: 5 4 gallons/day/ft2 d. Design Flow: 750 gallons per day e. Minimum Absorption Area: 187.50 ft2 f. Effective Depth: .5 feet of pea gravel with piping at mid point of stratum g. Width: 18 feet h. Length: 20 feet. i. EffEctive absorption area = 360 ft2 (>187.50 ft2 OK) j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank". 1. Sand Material: Central Paving Products "Winter Road Sand", or approved equal m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the #8 sieve. We are proposing to excavate down to a maximum depth of 3 feet, place 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 3, SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPItY: The lot is gently sloping, downhill from east to west at 5% to 8%, and from north to south at approximately 5%. The proposed ISF will be installed on a generally flat spot. In short, there are no slope concerns. 5. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Onsite Services office (5th floor, 9th & L St.). 6. CLOSING: I am unaware of any adverse impacts this installation would have on adjacent wells (there are none within 200 feet) or septic systems. If you have any questions, please contact me at 337- i179, or 244..9612. Thank you fbr yom' assistance. Sincer/~y/~ , P.E., M.S. LOT 5, DK 3, SUN VALLEY HEIGHTS S/D, PVT, SEPTIC SYSTEM AND CUMMUNITY WATER, SYSTEM AND COMMUNITY WATER, SEPTIC UPGRADE ON LOT 4, BK 3 WATER, WELL IS GREATER THAN RO0 FEET FROM THE PRUPDSED UPGRADE, SHADED AREAS REFLECT THE 200 EOUT RADIUS FRUH THE PRDP[ISED SEPTIC SYSTEM, AND WHERE IT ENCROACHES DN THE ADJACENT PROPERTIES LOT 7, DEARMOUN ESTATES, THE WELL IS GREATER THAN 200 FEET FROM THE PRUPDSED SEPTIC SYSTEM UPGRADE, SEPTIC SYSTEM UPGRADE: LOT 4, ]~K 3, SUN VALLEY HTS, PREPARED FUR: PREPARED DATE: 11/2/97 }3ERT HARTLEY ALASKA WATER & WASTEWATER DRAWN: GARNESS SCALE~ 1' = 100' :'-7953 A FOUNDATION C/O COMPRESS TO DE INSTALLED IN l'I4E GARAGE, PROVIDE A PRESSURE GAUGE (O-lO PSI), EXISTING 5 DEDRD[)M HOUSE. GENERAL LOCATION DF THE EXISTING UNDOCUMENTED 1500 GALl_UN SEPTIC TANK. TOE SIZE AND INTEGRITIY TO VERIFIED DURING CONSTRUCTION, THE INLET AND OUTLET INVERT ELEVATIDNS WILL AL~O DE ESTABLISHED. THE TANK WAS AUGUST DF 1994, WITMOUT A PERMIT, ATTACHED IS A COPY OF TME RECEIPT FORUM ANCHORAGE TANK AND WELDING, NEW AIR NEW 500 GALLON LIFT STATION WITH yINTERMITI'ENT DO§lNG TIMER PANEL 1,25 INCH PVC SLOPED BACK TO STATION WITH NB °BELLIES° NEW DOUBLE -TEST HOLE DD SYSTEM (CBNCRETE RINGS), INSTALLED TEST MULE Itl 1994 WITHOUT A PERMIT, TI] lie ABANDON- NOl'Em THE AIR C~MPRE~OR ~HALL BE A THBMA~ INOU~TIRES, MODEL 5070, AX ~UPPLIED ~Y ANCMORAGE TANK, THE AIR LINE ~MALL BE 1/8 INCH DIA, ~CH, 40 P~C, INSULATED ~ITR 1/8 INCH FOAM PIPE ~RAP (R3 VALUE), INSIDE A 8 INCH ~CH, 40 P~C JACKET, THE LINE ~HALL BE ~URIED TO A MINIMUM DEPTH OF 3 FEET. SEPTIC UPGRADD L_BT 4, BK 3, SUN VALLEY HTS, S/D, PREPARED FOR: BERT FIARTLEY PREPARED BY~ ALASKA WATER & WASTE;WATER iDATE, 11/8/97 ! ]]RAWN: GARNESS ISCALE, 1' = 30 1~25 INCH PVC HEADER, PVC AIR LINE TO SAND FILTER 1,25 INCH PVC ~ LINE FROM THE STEP TANK, ,,~ AIR LINE COIL SPACED AT APPPRBX 2 FEET, []RENCO "V/ASTEFLB~/~' TYPE: PRI]VIDED BY ANCHORAGE TANK, 4 INCH DIA, MONITORING TUBE AT EACH CORNER, SLOTTED 4~ SOLID PIPE -18' x ND LINER DN BOTTOM, NDTE~ DIMENSIONS OF ISF MAY BE CHANGED TO MEET LATEST DESIGN BY BRENCB & ANCH[]RAGE TANK, --FLUSHING VALVE (TYP), INSTALL PER THE 'DRENCD' DETAILS PRESStJRE DISTRIBUTION SYSTEM SIqALL BE PER ORENCB DESIGN, AND SUPPLIED BY ANCHORAGE I-ANI<, FINAL GRADE ~PRBVIDE 2" OF RIGID ,~NSULATION MOUND AS ' ~ ~ ~RIGINAL GRADE - .... -- i --=----~---------~AI~ LINE SHALL BE ~',. "' ~'~' '[ '. '; '? ~ ' .~t8 BELE]~ THE TOP ~ [ '~' *' ~'~"C" '~ "' ~"" "~[~ ~F SAND, 6 ~ LAYER BF 3/8~ PlEA GRAVEL X ~ FEET MIR, BF FILTER SAND, SAND SHALL ~ITH THE PVC LATERALS ~UNIED X BE CENTRAL PAVING PR[]BUCTS '~INTER MID~AY IN THE STRATUM, SAND", DR APPRHVED EQUAL, BBTTBMLESS INTERMITTENT SAND F LTER DETAIL SEPTIC SYSTEM UPGRADE ~ LHT 4~ BK 3, SUN VALLEY HTS, PREPA~IED FBR~ ~ERT HANTLEY ~~~., PREPARED ~Y, ALASKA ~A1-ER ~ ~ASTE~TER ~~95~..~¢~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION 'rEST 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN S IF YES, AT WHAT ~ ~) DEPTH? p E Deplh lo Water Afler MonilorinD? ~ Date: Gross Net Depth t~= Net Reading Date Time Time Water Drop q',16 IS~,~ qY~" lz/q'' PERCOLATION RATE I~.~ (minutes/,nch) PERC HOLE DIAMETER g ;~---- TEST RUN BETWEEN. 0,~'~_~_ FT AND 6~__ FT PERFORMEDB ~ I ~ _ CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) PERFORMED FOR: ~-~ LEGAL DESCRIPTION: 2 3 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TES'r 11 13 - , 14- 15 16 17 18 19 2O Township, Range, Section: SLOPE WASGROUNDWATER ENCOUNTERED? SITE PLAN IF YES, AT WHAT DEPTH? Monitoring? '~F~ ~ Gross Net Depth 'l~F Net ~C, 14 Reading Date Time Time Water Drop Ioj2.ol~l~- ~.'~lg - 6>~,~ 6~ ~ R~ ~',%/ u.g I~,,~6'~,,// ~" ~" PERCOLATION RATE~ ~' [minutes/inch} PERC HOLE DIAMETER TEST RUN BETWEEN ~'(~'~'g PT AND 2~,~.t/'~ FT PERFORMED By~/~C/J ~ P[~t~ I~/[ ?~ CERTIFY THAT 'rills TEST WAS PERFORMED IN ACCORDANCE ~H ALL STATE AND MUNICIPAL. GUIDELIN~ 'EFFECT ON THIS DATE. DATE: ' 03~/~ ~ 72'008 (Rev. 4/65) H~RTLEY cAS,: ~HIPPIH~ LIBT ANCHDRA6E TANK & I~LD]#6~ ]NC,, 2700 PORCUP[NE DRIVE ANCilORAE£~ ALASKA ~H~PPIN6 LIST 9HIP O/T CHECK DEGCRIPTiON GEPT]C TANK &500 6AL ,,'R ANCHORAGE AREA BOk , GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION_ 1~/\6>~'~'~-~~-' r4 ~_¢,~ LEGAL DESCRIPTION__~I. m S ~ W,~l SEPTIC TANK: i'~o~¢) 0 ~ ~ DISTANCE (~O¢¢'f¢' FROM WELL I~?~ MANUFACTURER INSIDE LENGTH INSIDE WIDTH NUMBER OF MATERIAL . COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY ~O~)_' GALLONS, Tq-L-E* D RAIN FIELD: ¢ TOTAL LENGTH I DISTANCE F'ROM WELL~--~('~FOUNDATION .~_~0 NEAREST LO'[ LINE ~ J~- _OF LINES ~'~.~.~.~.~.~.~.~-~0 ABBORPTION AREA ~G<) SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE ~ ~ DEPTFI OF FILTER . MATERIAL. BENEATH TILE _ ~ IN. ABOVE TILE ~ IN. WELL: C~dwv¢ TYPE _ BUILDING FOUNDATION CESSPOOl_ APPROVED CONSTRUCTION DEPTH NEAREST NEAREST SEPTIC SEEPAGE LOT LINE_ SEWER LINE TANK .... SYSFEM_ OTNER SOURCES DISAPPROVE[) REMARKS DISTANCE FROM, DISI'AN/ INSTALLED BY: ~ SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE, Form E~-032 DIAGRAM OF SYSTEM ::;i i i I ii',t ill; !;1' Iii',! i'i ~ i',! i i'ii i?i [) i ':': J fii',!i :i' [:;F I l,Jl: i'i',! [! ir.t~;i i i:ii'ji) l:li'ri~'? i II"~J' '::, i r! ~ : '?'i:;i'!i il ii !' i ':"i"I I':::l;:ti ?""?~';:: t J:'i'i i t i;li;! l':):i'" I i'1 till' i:i I':%? i ;'/I;ii I' i'.ii:i i Ili:i' :::'t:iI:'i i;i::'i--] i' i;!)i;:' II i:'1 il:Ii II : i"!!{i i ! i:ti't i:itH i J i I:ii': J'l il I'J I ~ Ii:' l::'l; l')i it !':'l::i'i!''i~'i i':i F(li';i! i lt'i"'';;i I t1: j'l !!'il i i'i ~!:'"' i I~J': i'i! i'"i i !: i i'ili i i ~''" ('ii-- ::i ' i L'i i ! ! i t'"!'~; i !'ii t i ! i!" '::'i"~:;::' i I~ i'i I i''l I:ti ;i ;i'tFi'i)l;:ti"~!l']:i:~ t"! I i 14 ii"i!:: l]i;i ii)ii'' ;:. i i i~"ll)i= i':i:'* i i:;ii"ii) ! Iii'; i' t t ii t IH' ''=' ] --I ~ '';i(i'ii;(i;? ~:;:'/~'/i !::H i"il'l"'' i':rl; !')i t'i E' '':';i i:'i i'r!i:i:( i% i':'t--i:it'ii :'i--i ~t;' i1i i i'll :i i ii)F i'~'iltl;;~i;] !!il;:li'"~ ~;i i'~i'i GREATER ANCHO3AGE AREA BOROUGH Depc~rtment o[Env ronmen al Qualit~'l~ 6,TER ANCHORAGE AREA BOROL'~H 3500 Tudor Road ~ Pouch 6-650 ~ N? 845 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION ADDRESS SEPTIC TANK: DISTANCE FROM WELL (~Ot'~l~}H~ 4~, LIQUID CAPACITY /~',;2 ('; 0¢ ~ r t __MATERIAl. GALLONS. INSIDE LENGTH NUMBER OF _COMPARTMENTS ) LIQUID INSIDE WIDTH__ DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER LINING MATERIAL ¢ (¢tt~ [ ¢[- ~ '~ - , LENGTH_ : , DEPTH DISTANCE FROM WELL(~I/?/?gr./,CL t~ Ci , BUILDING FOUNDATION NEAREST LOT LINE ~. (i! ~-t TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELt NUMBER OF LINES_ ABSORPTION AREA DEPTH: TOP OF TILE 10 FINISH GRADE FOUNDATION_ _DISTANCE ~TWEEN LINES SQ. FT. LENGTH OF EACH LINE 'NEAREST LOT LINE , OE LINES TRENCH WIDTH .DEPTH OF FILTER MATERIAL BENEATH TILE IN. TOTAL EFFECTIVE IN. ABOVE TILE__ WELL: TYP E~6/))/~"/ LOT LINE , DEPTH NEAREST ., SEWER LINE_ z.~ ~_-~- DISTANCE FROM , BUILDING FOUNDATION SEPTIC .~ ~ SEEPAGE TANK. , SYSTEM_ WATER SAMPLE ., CESSPOOl DISTANCES: DIAGRAM OF SYSTEM EmL~ '-,'- :'¥~/ ,,.~, GRf~AFER ANCHURAGE AREA BOROUGH DEP2 ;ENT OF ENVIRONMENTAL QUAi 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # Performed For J. COW~ERY Date Performed 4/29/72 Legal I)escrip~-~-~: Lot ~ Block 3 Subdivision Sun Valley Hts. This Form Reports Soils L---~'g × --- ~lF~.~co--~l'-~t-~-~-o'n Test Depth 6~ lO~~ ~6,~. Soil Characteristics Brown Clayey Silt, with Scattered Gravel Gray Sandy Gravel (GW) and Gray Sand (SW) and (SP) Was Ground Water Encountered? If Yes, At What Depth? No 9~ Reading Date t e~6-F~r c~ 'T~a t e Proposed Gross Time ~f~'nute Net Time Depth to H20 Insta]]'~-~: Seepage Pit Drain Fie'Id Net Drop Depth Of Inlet Depth To Bottom Of Pit ~r'Tf~nch' COMMENTS: 120 sq. ftTo-~'~nage area is required per bedroom with the crib set~ in the zon~ ~rom 5' to 15'. T~-t~'-P~r-'f-6-r-g~l By Carlls~6 .... ~a--~-~e~y:National Testi!~vs. Inc. Date: MUNICIPALITY OF ANCHORAGE MEMORANDUM Date: March 29, 1991 TO: Accounting & Budget, DHHS Fourth Floor FROM: On-site Services, DHHS Fifth Floor SUBJECT: Request for Refund - Account #2570-9426 Please make the necessary arrangements for the following refund. The applicant and/or engineer has requested this Health Authority Approval request be canceled. The applicant does not want the Certificate of Inspection at this time. No work or review has been performed on the paperwork, therefore, a refund is possible. Thank you. Lot 4 Block 3 Sun Valley Subdivision Health Authority Approval request ~HA910084 Receipt #22561/5697 Amount $170.00 Account #2570-9426 S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Laura J. Montgomery On-site Services cc: file  Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Sefvic'es Division Telephone: 343-4744 ON-SITE SERVICES FEE DOCUMENTATION DatePaid: B --C~/--? / Permit Number: N~me of Payer: ~am~.on C~ck) Mailing Address: (Off of chec~ % .~ . / ?¢; Legal Description(s): Z ~ '/~'3 ~ ~ Type of Payment: (lodicate Amounted)d ~ ~ealth Authority: ~7¢ -~ ¢%xcavator Permit: Sewer & Well Permit: Well Permit: Sewer Permit: Copy Request: 72-034 (Rev. 10/87) Engineer Permit: Pumper Permit: Well Driller Permit: Tank Manufacturer: (Waste Treatment) DISTRIBUTION: WAIVERS: Lot Line: Well to Tank: Well to Field . Field to Surface Water Tank to Surface Water WHITE--MASTER FILE CANARY--PROGRAM FILE Parcell.D. 017-062-36 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Complete legal description Sun Valley Heights; Block 3, Lot 4 Location (site address) 13211 Mountain Current Property owner(s) Deborah Bock Day phone 345-6611 Mailing address 13211 Mountain Place, Anchorage AK, 99516 Real Estate Agent Jim Murphey Day phone 720-7999 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF 5 4. TYPE OF WATER SUPPLY: 19 Individual Well ❑ Individual Water Storage ❑ Community Class A Well lid Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual 19 Holding Tank ❑ Community ❑ Public Sewer ❑ WaiverNarionce request for: n/a Distance: n/a Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 50% " Waiver Fee $ _ Date of Payment sJ /u 115 Date of Payment Receipt Number ©� 17� Receipt Number COSA # Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER sR' d 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 Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259 Engineer's Printed Name Jeffrey A. Garness In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the dates of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fall. The content of this report is for the sole benefit of the personlparty who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. 6. DSD SI ATURE DSD #1 Approved for _5� bedrooms IE The upor System #2 Approved for Disapproved Conditional approval for bedrooms Date a,// C bedrooms, with the following F ((ffb ON-SITE WATER AND o WASTEWATER PROGRAM of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: t/ COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other CCSAbWeshee S-1-12.doc 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: Sun Valley Heights; Block 3, Lot 4 Parcel ID: 017-062-36 A. WELL DATA Well type Community If A, B, or C provide PWSID # A Well Log /N Date completed Sanitary seal lies properly protected (Y/N) _ Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level WATER SAMPLE RESULTS: Coliform colonies/100 mL ft. g.p.m. 9 - p.m - Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA IDOUBLE CLEANOUTS PRIOR TO TANK. "SERVING 500 GALLON LIFT STATION. Tank Type/Material Septic/Steel Date installed 7/94 Tank size 1500 gal. Number of Compartments 1 Cleanouts (YIN) Yes Foundation cleanout (Y/N) "Y Depression over tank (YIN) N High water alarm (Y/N) "Yes Date of pumping 5/16/2014 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 11/24/97 Soil rating .p.d./ r felbdrm) 2 System typeBOTrOMLESS IDSF Length 20 ft. Width 18 ft. Gravel below pipe .26 ft. Total depth 2.54-2,8 ft. Eff. absorption area "360+ fe Monitoring tube Yes Depression over field No Date of adequacy test 3/24/2015 Results (Pass/Fail) Pass For 5 bedrooms Fluid depth in absorption field before test Dry_ in. Water added 980 gal New depths in. Elapsed Time: 0. min. Final fluid depth Dry in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None -known If yes, give date N/A "IDSF WAS UNDERSIZED 4%. APPROVED BY MOA ON 12/17/97. IN REALITY THE ISF IS PROBABLY AT LEAST 18.5'X20.5' (379 SFT. D. LIFT STATION Date installed 11/24/1997 "Pump on" level at TIMER in. Datum Bottom of Tank E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot _ Absorption Feld on lot Public sewer main Sewer /septic Size in gallons 500 "Pump ofr level at TIMER in. Manhole/Access (Y/N) _ High water alarm level at Yes Cycles tested Yes Meets alarm & circuit requirements? YES SEPTIC/HOLDING TANK ON LOT TO On adjacent lots On sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 10V+1209+ (PUBLIC) ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain None -Known Wells on adjacent lots 100'+120W+ (PUBLIC) F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed /Name Jeffrey A. Gayness Date COSA brown sheet 10-10-12.doc ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND &t->50 •(--I1. tit, 4VV 1 A THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this d90 Day of of 201�by and between h �Q (-� i G ,7jAn 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: Ft 1. Advanced Wastewater Treatment Systems Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AW WTS), described as located at (legal description). ,Sw v a,((W )FUt h k (d-(- y O6 C (, 3 2. Definitions. Alteration. Any change to the design or function of an AW WTS 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 0 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 Eanipment. 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. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: 6U59(( 417 (,,_ b. Municipality: Director, Community Development or designated authority 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. OWNEit. _ (signature) r f )1 1�G•� i %fy2q (print name) STATE OF�SI — ) Ada C6avt4- ss. 9TH > The foregoing instrument was 2015� by t se 1 i MUNICIPALITY: before me thi h expires:—' 7o:2 / By: (signature) Date: 14^7(p— ) Q44) day of Date: (print name) Title: gg4998BIBPlIpOpp Y• I `iF III /COQ, IvJJ._ Jp.Y4 e IIFIpp`phlal aiaHHaH,aH, 05/11/2015 07:18 6686770 APLUS PAGE 01 Syn V WNIC[PALiTY OG AMCHQRAQ)d • Community Development Dopartmax • On -Sirs Waoerh Wastewater Program P: 907-343-7904 • F: 907-343-7997 • P.O. boy; 196650 Anohomp, AK 99519-6650 • http://www.muni.org/bullding Intermittent Dosing Sand Filter ! 7.5' 66$g Maintenance Log Owner �! eb 6 1 e -bo,, K Street Address 1321 } r r—)P- fz < r,? icc e Phone__ ��4s (oro 1 I Legal Desc. PID Sentic iankia ' .Sludge level inches -Pumping: required es no -Pumping completed yes no AllaorPtion f=ield: -Liquid level inches -Flushing valves per approved designBLELO -All flushing valves opened, distribution lines flushed, and flushing valves closed r Lfft station: -Pump basket cleaned kk es o •Biotulte Affluent filter rleanncl es n2 Timer float setting -inches -High level float settingjjk lv hes -Reference point Zv •F Imp on 60 seconds •Pu!np off minutes •Cumula ive i`ifetime cycles 1 q 5' I G.? •CumulaNve run time IC)i hours -Operation satisfactory es AirSvsterrr: QICpvvnP i,c�, Low /�:� fJlanrn oK -Air pump filter cleaned es no -Airpressure l psi -Date of latest install or rebuild_ 2Q(DR _•1ir s,+stem operation atisfactory not satisfactor v Alarm System NGS -Dedicated electrical circuites no •Audible and visual alarm inside dwelling es no -Float setting ] to inches -Alan <<, system operation CLaLlsiaoton, not isian-tou ae Comments: I 1.�.!�....> •4i.sn(� P ......................................................... ... ........................ ..............�...... ........ ..... ..... ..... .......... ....... .......... ,... ...... ......... .......... I ... I ........ ........ ........ Malntenance Provider. Technician 1-G 4" 'rel .3 eA\--5 Date of maintenance G J� Company q -f' 140 p'i'le .5e %1y lce5 Signature 0z O Off" �'0 R�75o �o 0 T�91 N Pl a 84.2 r 2 Cm FLORAL LANE W � • J I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D, # CERTIFICATE OF HEAl_TH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING '~GENERAL INFORMATION Complete legal description Location (site, address er directions) / 15 ~// . , Property owner Mailing address Day phone [~ending agency Mailing address Day phone Agent Address Day phone _' Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 'TYPE OF WASTEWATER DISPOSAL: individual on-site 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#21 STATEMENT OF INSPECTION BY ENGINEER· As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature Alaska Water & Was¢ 7;~20-~st¢~est~, DHHS SIGNATURE ¢'~Approved for ~'['/~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ,/~¢~'"z'7-'¢~ d ~ Date 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. Thc DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Em ployees of DH HS 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. ~ONM~NTAt. $~RVIC~$ Municipality of Anchorage DEC, 0 ~) 1997 DEPARTIV]EN'I' OF HEALTH & HUMAN SERVICES i i io, 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) Legal Description: A. WELL DATA Health Authority Approval Checldist ~/Z..~ -~'0¢J' V'¢'~0(--¢=---'"7' Parcel I,D,: Well type (:.o~-.t~ - ~-12, o0 _%- If A, B. or C attach ADEC letter, ADEC water system number 'beg..~esent (Y/N) [)ate comeleted Total depth'"~'~-~_ Cased to Sanitary seal (Y/N)'~'~~i:LL LOG Date of test Static water level Well production WATER SAMPLE ,RF_.SULT~/ Coliform Dat~o~samp~e: B. SEPTIC/HOLDING TANK DATA Date installed Tank size Foundationcleanout (Y/N) Y Casing height (above grou. u.u.u.u.u.u.u.u.u~_ Wires ~ropeny pro~ ~dt~(Y/N) AT,.T..I~ P'~EOTI O N ..~ g.p.r g.p.m. Nitrate Collected by: Other bacteda"~',.~. /~'C)O Number of Compartments '~- Cleanouts (Y/N) Depression (Y/N) /,JO High water alarm (Y/N) Date ofP~mplng '¢r'/I/F'/cf=~'' Pumper C. ABSORPTION FIELD DATA Date installed Leng~n ';~-(-~ [ Width Soil rating (g,p.d,/fF Gravel thickness below pipe System type Effective absorption area ~--) + Monitoring Tube present (Y/N)~ '~/ Depression over field (Y/N) Jid depth in absorption fiel~'b"'~lom4~.~t..(~..~L- r - ~-n~edl.,.a~-~'y after, gal. ~ater added (in.): Fluid d(,pth _ _ (ins) Minutes later: Absor~o~l"mte,--=.~_._._... g,p,d. Peroxide treatment (past 12 months) (Y/N) If yes, give date ~0 eearooms 72-026 (Rev, 3/96)* D. LIFT STATION / Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested ~--~ E, SEPARATION DISTANCES Size in gallons ~-"~(~) "Pump on" level at* ¢'P *Datum ~7TM "Pump off" level at* "¢;"T-/~'-/'~/~ SEPARATION DISTANCES FROM WELL ON LOT TO: lots maiAbsorption field Onn lot -~~~tn~ofle/cleanout Public sewer Foundation /~ "~ Property line '"70 Water main/sen/ice line /E) ~'~- Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation c~/"~ Water main/sen/ice line Driveway, parking/vehicle storage area ~ Wells on adjacent lots ~/¢ ENGINEER'S CERTIFICATION I certify that l h. cv~ de~r~iin~ru ,Id inspections and review of Municipal r~ec~ inconforma~ew~h/~/q~gui~ ~esineffectonthisdate. .. ~ Signature ~~ ~ ~ ~('"" Engineer,sNa~Y~~~ ~'~ ~ HAA Fee $_ ~ ¢-~ ' ~ Date of Payment /~/-"¢/77 Receipt Number ~ 72-026 (Rev. 3/96)* 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 0: ON-SITE SF_WEF:I AND WATER FACILITY FOR SINGLE :AMILY DWELLING Parcel I.D. # ~'~'-'~ (~ - I ~'-'~ \ ~'~ NAA # . ~ ~o~. \ ~.~(.Z)(~).~ 1, GENERAL INFO RMATION [Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision section, townsh p, range) Lot 4; block 3; Sun Valley S~bdiuision; ~ / \ Location (address or directions) ) 9420 Hiland Road / (b) Property owner Jx~ ~ B6veJC. y Nichols T~; hon .. 9420 Hiland R~a ,' £¢ la~ 1 Ma~hng Address . ~ ~. R (c) Lendingl~stitution ~ ~ ~ ~ ~¢,epho~e_ MailingAddress ~ / k// (d) Real Estate Company nd Agent ~ Address ~~ ~ Telephone 5 ¢ (e) Mail the HAA to the followl~address; (or~re ~Xif hold for pick up.) List contact person and day~one n~w: ~ 2. TYPEOFRESIDENCE ~be r~ Single-Family [~X Number s 3, WATER SUPPLY _Business 561-2000 Individual Well ~ Comrnunity [] Public [] t~'~'°"' 'eta e De. pC~'tment of Note: If community well system, mus[ nave written confirmation from Conservation attesting to th legality ane status. ~) ¢,~k,,_ 4. SEWAGE DISPOSAL On-.site,~ Public [] Community [] Rolding Tank r- Note: f community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. Environmental 72-025 fRev. 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. Name of Firm Address Date $ 8~ s ENGInEERiNG Eacjle River, Alaska 9957~ Telephone 6. DHHS APPROVAL Approved for Approved bedrooms by Disapproved Terms of Conditional Approval Conditional Date 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 order to satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or analyze data before a certificate is issued. The M u nicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88)Back Page 2 of 2 ,~4 ,L41~ICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 Legal Description: A, WELL DATA Well Classification __,r~, ,,J~_~e~ ~/~'~ I ~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~1 Date Completed '¢/ - / ~ - ~ -~ Yield ~', Total Depth I-~-/Casedto Z,/O'4 Depth of Grouting ~ (_ Static Water Level 2. Casing Height Above Ground Electrical Wiring in Conduit (Y/N) 1 SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot [ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /'J/~ Pump Set At ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest Sewer Service Line on Lot Water Sample Collected by ~ %L-% J~-.~J~,l~-rt~ ;Date WaterSampleTestResults ~.~P~l.% ~ c~or'~ - ~&C-,'~¢.Ci~ Comments ; On Adjoining Lots f' OD ; On Adjoining Lots _ To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed !o-I~.~ Size Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) /V' Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ No. of Compartments (1 Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water~Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~ ~fP'~t'c- ,D©M,~ b~ To Building Foundation _ "~ J 'Fo Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test '¢/~ ~' Type of System Design Length of Field Depth of Field /Jr Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / '~f~ 1- To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line / 0 ~' To Existing or Abandoned System on ; On Adjoining Lots .-~O 1~ Io 'f To Cutback (if present) G0 '[ D. LIFT STATION Date Installed Size in Gallons /o - I ~-.-~ ,¢ ~ Dimensions %0" ~ %' ~¢tl ~ ¢o~,~ o~ Manhole/Access (Y/N) "Pump On" Level at ~" ,¢~d '~u~p Off" Level at / ~Q~o~~ o~,.~J~ ~ Vent(Y/N) High Water Alarm Levelat ~ ~ Tested for A d~%,,~c~ ~' '~ "~ ~ ~ h ~ % ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~od~ .,~ ;~pCCE ,'~ **Check Permitted Bedroom Rating Against HAA Request** I certify that inspection. Signed have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this i 70';~4 Ea3l¢ River Loop Road I%~o, 204 Date ~1~¢ / Receipt No. '~ ~ ~---(:~ ( (5--(:~ ceipt F Date of Payment 3 ~¢:~-- //--'~ / Waiver Fee: $ Amount:$ /p O~ ¢ ~ Date of Payment 72 026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA09518 TELEPHONE (907)502-2343 ANALYSIS REPORT BY SAMPLE for HORRorder# 32R57 Date Report Printed: MAR 15 91 @ 17:06 FAX:(907) 561-5301 Client Sample ID:L4 R3 SUN VALLEY S/D PW$ID :UA Collected M~R 12 91 @ 13:00 Received M/~R 13 91 @ 16:00 hrs. Pro~erved with :AS REQUIRED Cllemt Mama :S & $ ENGINEERING Client Acct :SMSENGP gPO $ PO ~ NONE RECEIVED Req $ Ordered By :R. SHAPER hnalyels Completed :MAR 15 91 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE I)S & S ENOINEERING Chemlab Ref #: 910920 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 0.40 mE/1 EPA 353,2 10 Sample ROUTINE SA~LE COLLRCTED BY: R,D.J. Remarks: 1 Teets Performed See Special Instructions Above UA-Unavailable ND- }lone Detected "See Sample Remarks Above NA- Not Analyzed LT-Les~ Than, GT-Greater Than -~/, CE RECEIVED I NSPFCTION APPOINTMENTS ~'~ME TIME TIME ENVIRONMENTAL SANITATION DIVISION ,JUN 2 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND LENDING INSTITUTION ~t~ J PHONE LEGAL DES'CRIPTION TREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS ~ -- One [] Four SINGLE FAMILY ~_ Two ~ Five [] MULTIPLE FAMILY E Three [] Six [~] Other 7. WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A well Icg ~s requ~reo for all wells drilled [~ COMMUNITY since June 1975. For wells drilled orior to that date, gwe we [] PUBLIC UTI LITY deoth lattach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SI'rE** ~,T{,~ L¥ 7'/YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSFECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [~ COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~[ ~) ?~ ,~ (~ ,,~_ ~,~\ ~'~ ~ Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: ~ If Tank is homemade SOILS RATING give dimensions: ~ '~ TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR EA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line. Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS " PROVED FOR BE ROOMB [] CONDITIONAL APPROVAL {letter must accompany certificate} [] DISAPPROVED j? 72-010 (Rev. 6/79) To,ben Spur land 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 Fin Hernandez Jack White Coo ~201 C Street Anvhorage~ Alaska 9950~ MUNICIPAUTY OF ANCHORAGE DHq OF ~ALFH & ENVIF.ONMENIAL ?F,O [ECflON R CEIVJ [) July 3~ 1981 SEWER i~gal loc at ion OYmz~r Re side~co Water Sewer Do. re of Test Test "~rooedure Lot 4-~ Block ~, Sun Val],ey On Mountain t?lace~ e£f ~Loral, o££ 9e Armov. n Bride ~ Bedrooms~ Two Storey Community System ~¥om Municipal Records: Tank 1~1250 gal and one ~00 gal Absorption System Concrete Ring Crib with 20 ffee~ of trench Absorption /~rea 660 sq.fb. Soil Rating 120 Installation Date Original System 1972, Upgrade ~n 1977 J~ly 2~ 1981 ]Both tanks were pumped en Ju].y 2~ 6VD gal of clean water was then added to crib at a cmmtant rate of 7.5 gal per min~ 1,2ow rate and liquid depth Jn tho trench ~ero monibored for 9© miu~Tho liquid lewd] in ~he t~ench rose one inch per 25 g~O. of water added. From 54 inchon at thc beg:innin~% of the test to 80 'inche~:; at the end of filling. Afte~ ~ hours of absorption the ].iquid level was 6;~ inches, after 20 hours ~]~ The system ab,,.;orbed more than 600 gal of water J.n a 20 hour period. Tho MlmJ.cip~£L Code requires an abserpb:Lon rate of 600 gal per 2~ hour period for a ~ bedroom house. This system meets 2his roqurcment. MUN I C ! PAL I TY OF ANCHORAI~' 3F HEAL-FII AND ENVIRONMEIN SEreet, Anchorage, Alaska 2']9.-25].1, exc. 224 or i.}25 Date ReeeJ.v~?d: / PROTECTION !)950] REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND W...lbR IA(.I].,11. I~o Lend in g Mai ] lng lnotlLUL.LOI3 Request: National Bank of Alaska o/ p ~h[ Address: Post Office Box 3-3859 99509 Phone: 279-2506 2. Property Owner: Claire E. Boldt Phone: 344-0027 MaJ. lJnq Address: Star Route A Box 372-F 99507 ~/ 3 3. Legal Desc:[J. ptJon: Lot ~ Block ~ Sun Valley Heights Subdivision 4: Sinqle .Family Residence: (x M. ul'hiple Family Residence: Nunl}~et oi Bedrooms: __Fli_v._e ....... Number o~ Bedrooms: 5. Well Systera: Individual_ wel] ( ) ColmuunJty/l>ublic System (x~ Permit ,~ Dephh of Well], Well Log )n FiJ. e ( ) Construction Batter ~aJ_ Ana].ysis · i' 6. Sewage Disposal System: On-sihe Sysuem (>Ix Public Utz]_ _cy ( ) PermJ_t ~ Sep-Eic Tank ~' '~ z Absorption Area 7. Distances: Well Septic Tank ~-o Absorpl_J. on Area Sewer ]line Nearesk [,o~ ].J. lle Absor )i;ior~ Area to Nearesh Lei. Lmne Two Department of Request for Approval Health and Environmental Pro'tect[on of Individual Sewer and Water FacJ_lities Legal Descr!ption: Lot 3 Block 4 Sun Valley___Hq~.g. hts Subdivision CoRllfle~ t s: Affadavit Attached: ( .).~_~.~ Letter Attache(]: ( Disapproved: Date: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PROTECTION c.~_East__T.~L~r Road,~.-.Anchora~e, Alaska 995_~0_4__ZZ6-~324- REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO__ 2. Property Owner:_ Claire E. Boldt VA_ _FHA Mailing Address: Name of Buyer:_, CONY × SRA Box 372-F Anchorage, Ak. Michael J. Bride 99507 Mailing Address:_ 4. Name of Lending Institution: National Bank of Alaska Mailing Address: PO Box 3-3859 5. Name of Realtor or Agent:_ Shennum Realty Day Phone:_ 344-0027 Day Phone:. 349-1511 (business) Phone: 279-2506 Mailing Address:_ Legal Description: Location: 236 E. 5th Avenue Phone:. Lot ~,t Block ¢~ Sun Valley Heights S/D 279-3511 Anchorage, Alaska 7. Type of Facility to be Inspected: SFR No. Bdrms. 5 Water Supply Type of Supply: COMMUNITY Public Utility rlndividual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System SEPTIC Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76) : "' '