HomeMy WebLinkAboutNUNAKA VALLEY BLK S LT 8Nunaka Valley
Lot 8
Block $
#006-162-08
Municipality of Anchorage Page l of 35
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL'SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · -r'elephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: '~¢,/~1~05~ PIDNumber: ~O~//¢?-.,-~
Name;Wastewater System: D New ~ Upgrade
Address:
~H b~ ~p~ ~ ABSORPTION FIELD _
Phone: No. of BeSoms: ~eep Trash ~ Shallow Trench ~ Bed D Mound ~ Other
LEGAL DESCRIPTION so, Rating: Total Depth from original grade:
Lot: 8lock: Subdiv~ion: Depth to pipe bollom from original grsde: Gravel depth beneath pipe
Township: Range: Section; Fill added above original grade: Gravel length:
Number of lines: Distance between lines:
WELL: ~ New ~ Upgrade Gravelwidth: ~'~ Ft. J [ --~ Ft~
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller: Date Drilled: Stalic Water Level: Installer: Date installcd~
Yield:GPM Pump Setat: Ft. CssingHeightAboveGround:Ft. TANK
SEPARATION DISTANCES u Septic B Holding U S.T.E.P.
TO Septic Absorption Lifl Holding ~ublic/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~ 6~, l%~ ~ ~. ¢ ¢
Material: Number of Compartments:
Well' ~ ~ ~ ~ 5T~ ~L-- ~
Surface
w~t~ ~ ~ ~IE' LIFT STATION
Lot I ~ Size in gallons Manufacturer:
~ ~ "Pump on" level at: "Pump off" level at: High water alarm at:
Foundation ~l
Curtain Pump Make & Model Electrical Inspections performed by:
Remarks: BENCH MARK
Location and Description:
Assumed Elevation: ~ ~ ~
-ENGINEER'S SEAL
Inspections performed by: ~ ~. Dates: ls~ }
Department of Healt~ and ~uman ~ervices approval
Reviewed and approved by: ~/ ~~ Date: /-~7
72-013 (Rev 9191) MOA 25
ADDITIONAL EASEMEN?
76 SO, FT.
MH -- W INV 89.97
NW INV 90.02
5' SANITA£Y SEiCEE' EASEML-Nf
5' SAN[TABY SEMEB EASEMENT
o o10" BIRCH
TREES
/ " oT~EES
T~EES
7
\ /
1.5' \ SFIING TIES:
\ AC 7
o\~ \ BC l&5
°°\4 \ AEAD 4517'5
TREES ~ BD 18
~E ~6.~
TREES o ~ ~ AF SS SEWER PIPE
~ ~ BF ~7
AG 2,5 FT
ONE
SIORY
FRAblE
HOUSE
II*V 9 fl deep / QNF
HOUSE
TOBBEN SPURKLAND P.E.
205 W 15TH. AVENUE
ANCH, AK. 99501
.(907~ 279-5916
£OT 8 B£OCE $ NUNAIfA
1404 RICHARDSON DRIVE
SHERLE BERflLSOH
SEPTIC SYSTEM AS BUUILT
DATE: NOV, 14, 1996
SHEET: 1/$ GRID: 1458
PM SH/960558 PID // 006-162-08
IE 95.7
SILT
.,oi.2 __
d,5 £~ oF Sep%ic
TEE
ZOO0 ~ol Sept,'c fen/<
PR/NARY TRENCH
;¥onitor
Cleon
C!eon
,gtondord ?:enche:;
4 5' W/de
35' Long
9' ~eep
d,S' Set/er
4' Cover
C[eonoUtS ~'x,
Hon,'to~ ~'
4' Cover
~ IE 95. 7
91.3
Exlzf, 5round
Cover
-~'~%~r Tank
INSUL~I[ON
~, IE 96.86
lOOO 9oL septic fonl<
~EA/CFI' t'v/,4~,, STOOP
A££UNEP ELEI/ ]00,00
'TBBBEN SPURKLAND P.E,
PO3 WlSth ave
Anc½opoge Ak 99501
II
LOT 8 BLOCK ,g NUNAKA
$£?T/0 $~S?£M $Ctt£MA[IC
I I SEPTIC SYSTEM AS BUIL'I
DATE~ NOV. 14, 1996
SHEET: S/S GRID: ;.438
.PN 5W960558 PlO // 006-162-08
T.SPURKLAND P.E.
203 W. 15th. AVE. SUITE 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
Municipality of Anchorage
Department of Health and Social Services
820 1 Street
Anchorage, Alaska 99501
Subject:
As Built
Lot8, BlockS Nunaka Valley
PID 006-162-08
SW960358
November 14, 1996
RECEIVED
NOV ~15 1996
M~tfiCil.)~l t
Pt. Health &
Gentlemen;
We are submitting As Builts for this propelCy. The septic system was replaced on 11/7/96. Due
to road conditions sufficient sewer rock tbr the intended ttn'ee bedroom system was not available.
The trench was up to 5 feet wide, requiring twice the amount of rock than anticipated. The end
product is an undersized t}u'ee bedroom system or an oversized two bedroom system. The residence
contains two bedrooms. We request approval for a two bedroom system.
Yours
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM {UPGRADE) PERMIT
PERMIT NUMBER:SW960358
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:BERTELSON SHERIE
OWNER ADDRESS:1404 RICHARDSON DR
ANCHORAGE, ALASKA 99504
DATE ISSUED:10/29/96
EXPIRATION DATE:10/29/97
PARCEL ID:00616208
LEGAL DESCRIPTION:
NUNAKA VALLEY ELK
S LT 8
LOT SIZE: 6386 (SQ. FT.)
NUMBER OF BEDROOMS: /~ THIS PERMIT: ~ ~6~p//~/gP
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 AMD THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (~8AAC72) AND DRINKING WATER REGULATIONS (ISAACS0) .
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 BY: T~~
ISSUED BY: ~~[,~ ~
DATE: 3/, 6
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 8 BLOCK S NUNAKA VALLEY S/D
1404 RICHARDSON DRIVE
Municipality of Anchorage
Department of Health and Social Services
820 1 Street
Anchorage, Alaska 99501
September 29, 1996
We are submitting an application for a septic system upgrade for this lot. Lots 7 and 8 are the only two lots in this
subdivision that is not cmmected to public sewer. Lot 8 can not be co~mected to public sewer unless the sewer lines are
extended. The cost of a mainline extension is prohibitive. A replacement of the existing septic system is the only
practical alternative. The present septic system has failed, requiring constant pumping to prevent sewage to surface.
This submittal consist of three (3) drawings showing the present improvements on the lot and the adjoining properties,
(sheet I/3), the proposed improvements of the lot, of which only the well and septic system are subject to this permit
application, (sheet 2/3), and a schematlc of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable
testholes are also enclosed. The septic system design is based on the following:
No Ground Water or Impervious Layer to 15 ft.
Use Standard Trench
Soil Rating. < 1 rain/in - 1.2 gal per sq.ft/day See Sieve Analysis
No. of Bedrooms 2 Make system for 3
Required Area per Bedroom: 150/1.2 = 125 sq.ft..
Total area required: 125 x 3 = 375 sq ft.
Outlet Existing Tank 3 feet below ground
Testbole depth 15 feet
Bottom Rock At 9 feet
Top Rock At 4 feet
Rock Depth 5 feet
Total Trench Length 375 / 10 = 37.'~,ft
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH 37.5 FT
TOTAL WlDTH 2 FT
TOTAL DEPTH 9 FT
ROCK DEPTH 5 FT
COVER 4 FT
1000 GAL SEPTIC TANK
Abandon existing concrete tank by removing top and fill tank with gravel.
Due to unstable soil, place sewer rock at trench is excavated.
There are no wells or septic system in the vicinity of this proposed system that will be affected by this installation.
There are no surface or subsurface drainage facilities on this or the adjacent lots.
N
~i~I
85 0 £5
N
//
/
F/1 LL£Y
TOBBEN SPURKLAND P.E. II
203 W 15TH. AVENUE
II
ANCH. AK. 99501
i(907~ 27~-~1~
LOT 8 YLOCK S NUN/IIOI
1404 RICHARDSON DRIVE
SHERLE EERHLSON
SEWER SERVICE DESIGN
DATE: HA~ 21, 1996
SHEET: //J GRID: 1438
ELEVAH~tNS ABE FB~kt 4tV ,'I£?UNED ELEVATI~/\;
~ ~F !OgO0 ~IlV T~tP 17F HffE EX/$HNd M/WH~LE.
~ '~-x. / MH .... W INV 89.97
~_~ n: ,/ SANIT~f~Y SEWEf~ EASEMENT
"~'~"~ '- d~b~-'~-~' ~"~--:'''', ,~ %-r," mm'H
~$~'/~ /X /~ ~gTREES
/b /~ / . ~0 /~ ~', ' ~*' / FRAME
TREES o ~ u~ SEWER PIPE~
x ~ I1,1 5Z5 fl long
III 9 ft deep
%%' % , i gol septl~k
III ~ / ~d~'. STOre(
IH~ FRAME
PIPE~ HOUSE
ONE
k STORY
x FRAME ~ ~ ~
remove reRl~ce fence .... ~
~ ~ ~ TOB1EN
~o o ,o ~o~X~o ~ ~o ~o ~o ~;~,,z ....................
SCA LE; '
TOBBEN SPURI<LAND P.E. II
II
205 W 15TH. AVENUE
ANCH, AK. 99501
(907] 279-3916
LOT 8 B£OCK S NUNAKA
SHERLE EE£TILSON
FALLEY
SEWER SERVICE DESIGN
DATE: ~tAI 21, 1996
SHEET: I/5 GRID: 1458
SILT
[]
Foundation C[eon out
1250 gaI Sept,': tank
PRIMARY FRENCH
k/on/tot
CIeon {}ut
C/mo nou ts
Hon/~or
Cover
3X5' Lon9
?' Deep
5' ..%e~i.'er roc/(
4' Cover
SCALE
6fl
4' P/,?~ Cover' H
~ ova-er Toni(
IL
]000 go[, ~epS'c ~onl<
}/EIVCH MA,PtC
ASSU/TD ELE~X ]00,00
TB]}BEN SPURKLAN]} P.E.
~03 WlS~h f~ve
Anchor'o, ge ak 9950]
LOT 8 BLOCE ,g NUNAIGA
SEPtiC SYSTEM SCHEMATIC
PROPOSED COMSIRUCIION
I/ALLEY
SEPTIC SYSTEM DES~EN
I)ATB: SEPT. 29, 1996
SHEET: ,~//~ G~IZ): Iz/28
Municipality of Anchorage
DEPARTMENT OF HEAL'TH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S
PERFORMED FOR:
LEGAL DESCRIPTION:
4
?
8
10
12
18
17
~0
Township, Range, Section:
COMMENTS
SLOPE
ENCOUNTERED?
IF YES, ATWHAT
DEPTH?
Oeplh tO Waler Alle~:~ ~'//~,?/~ .~
/~0niledn[~7 ~ Dale:
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
TEST RUN BETWEEN ----_ FT AND .... FT ~
PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED iN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; ,
72-008 (Rev.
0'_~/19,/'J~'_~'3~ lO: 46 9072773177 F'HUKAII ,:_-:OI.ISULTII'I,:i~i PAGE
.Z
~.>
Z
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 5A I E I_
Certificate of On -Site Systems Approval
Parcel I.D. 006-162-08
1. GENERAL INFORMATION:
Expiration Date: 109- C I � , au ��
Complete legal description NUNAKA VALLEY; BLOCK S. LOT 8
-0 rtJc
Location (site address) 1404 Richardson.2trt*Anchoraqe 99504
Current Property owner(s) Brian & Katherine Kubitskey Day phone 223-3672
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
Z Single Family (w/wo ADU)
1-71 Duplex
El Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
2
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
1771
Individual
0
Individual Water Storage
F1
Holding Tank
D
Community Class Well
EJ
Community
17]
Public Water System
0
Public Sewer
1771
WaiverNariance request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $_S 50
Date of Payment 12 0 a o21
Receipt Number 0 2 1 k2 6
COSA # 0 5 C_ 2 I I r7 0 (0
Date:
Waiver Fee $
Date of Payment
Receipt Number,
Waiver #
E
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: Garness Engineerinq Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507
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 system/s on the date/s 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 upon 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 system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; 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 fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
V_ System #1 Approved for
System #2 Approved for
Disapproved
Conditional approval for
Date: t Z4 021
#AECC884
Q. bedrooms
bedrooms
ON-SITE `sem
G�
bedrooms, with the following �i I t•WATER AND ^
�aggT!__V'ATER o
'VT sERU�G ,
By: Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist is
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other Tav\ k 0-F a&Q � so rX
03
COSA Checklist
Legal Description: NUNAKAVALLEY; BLOCKS, LOT
if more than I septic system on lot: COSA Checklist # of
A. WELL DATA
[] Well log isfiled with Onsite (or attached)
Date drilled
Total depth ft
Cased tof
IEI Sanitary seal is functioning correctlyWires are properly protected
r'y protected
Casing height (above ground) in.
Date oi flow test for C 0
Static water at beginning of test ft,
\�
B. TANK DATA
Age ofbank(s) 25years
Tankiype/mataria| _'~_,~
Measured operating fluid level inseptic tank 48"
#1 Standpipes/foundation o|e t rd drawing
Date ofpumping � =~2 Z I
D. ABSORPTION FIELD DATA DEEP TRENCH
Parcel ID: 006-162-08
Structure served by this system
W Well production at time of test
Water storage tank volume gallons
'
Well disinfected oliform test? Yes No
E] C 0 m bacteria is Negative
Nibatemg/L F] Nitrate less than MRL (ND)
Arsenic _____ug/L E�Arsenic less 'than MRL (ND)
Collected by
Date of Sample
G. LIFT STATION
F7Required maintenance completed
Age oflift station —yeens
Lift station material
N/A
Which oysbamtested (date installed) 11/7/96
Adequacy test /1mo1�tda&s
E-111ALL standpipes present per record drawing
Results [Z]Pass For 2 bedrooms
To -Lai measured depth from grade 10 18 ft (max)
Fluid depth prior totest 0 in
K8 58
from grade
Measured �5
Water added 334gal
F� N/A— pressurized field ��
New depth 0in
�� Monitor �o to bottom of If state
== � '
O
Elapsed time min
depth into effective
----
��Code'requiredsoi|ooveroverfie|d
Fine|f|uiddep�h in
--
��Syotempreooaked
3OO+
Absorption rate ____�gpd
(Required ifvacant for greater than 3Odays prior to
Any rejuvenation treatment (past 12mnntho) NONE
date of test)
°30O8
Gallons introduced 8a||ons
If yes, enter N��
' ----
Comm ants/Oefioiencies:~pne'ooxxPERFORMED um1xmu1
COSA Checklist yellow sheet
1,
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if cornMUnity well)
Septic Tank/Lift Station onLot >107
F-1Yes
if No
Community Sewer Manhole/Cleanout >1UO'
Surface Water >10O'
01 Yes ifNoft
Property Line >6'
F,/7IYes
N F-1
ifNoft
F-71 Yes ifNoft
A El Yes
if No
ft
ing Tank >10O' El Yes ifNoft
Ne
Private Wells >10O' Yen ifNoft
Private Wells >1O0'
Animal Containment >5O' 1771 Yes ifNo____ft
ea
ifNoft
Yee
ifNoft
Surface VVaLer>1OO'
Community Wells >2UO'
Yes ifNoM
Manure/Animal Excretal Storage > 100'
Con ewerMain >75' F-1YesifNoft
ifNo____ft
F-1 Yes ifMoft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required
Building Foundations >1O'
F-1Yes
if No
+9 ft
Surface Water >10O'
01 Yes ifNoft
Property Line >6'
F,/7IYes
Yes
ifNoft
Wells onAdjacent Lots:
Water Main >1U
Absorption Field >5'
Yea
Yen
ifNoft
Private Wells >10O' Yen ifNoft
Private Wells >1O0'
Yes ifNoft
Water Main >1O^
ifNoft
Yee
ifNoft
Surface VVaLer>1OO'
Community Wells >2UO'
Yes ifNoM
Water Service Line >1O'
�1Yes
ifNo____ft
lfseptic tank iounder driveway comment below
Fron, Absorption Field on Lot to* (Please enter distances if less than required)
Bui|dingFoundation >1O'
�� �+Yes
�+
ifNoft
|fabsorption field isunder driveway comment below
Property Line >10'
F,/7IYes
ifNoft
Wells onAdjacent Lots:
Water Main >1U
Yea
ifNoft
Private Wells >10O' Yen ifNoft
Water Service Linn> 10'
Yes
ifNoft
Community Wells >20O' k1 Yeo ifNoft
Surface VVaLer>1OO'
Yeo
ifNoft
F. ENGINEER'S COMMENTS
*MET CODE ATTIME [lFINSTALL _ TANK LOCATED UNDER LOW LYING DECK
ABOUT 12"TA||^^AE|[lUNDERNEATH SHED THAT |S SITTING (lNCINDER
G. ENGINEER'S CERTIFICATION
/ certify that / have determined through field inspections and review
ofMunicipal records that the above systems are /nconformance with
MOA COSA guidelines in effect on this date.
CCOSA ""hecklist yellow sheet
#AECo884
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Septic Tank Advisory
Certificate of On‐Site Systems Approval # OSC211706
Subdivision: Nunaka Valley Block:S, Lot: 8
The septic tank for this property is 25 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
Project Name: OSC211706
Project Description: NUNAKA VALLEY BILK S LT 8
Review Comments List Date: 12/14/2021
Changemark note #01, asbuilt.pdf
Septic tank shall be readily accessible for pumping (AMC 15.65.205B.2). Please address (i.e. access
hatch in deck, extend standpipes to surface, etc).
Responded by: SONJA BLEWETT- 12/14/211:24 PM
There is access Hatches
Parcel I.D. #.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 3434744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
006-162-08
1. GENERAL INFORMATION
Complete legal description NUNAKA VALLEY SUBDIVISION: LOT 8. BLOCK S.
Location (site address or directions) 1404 RICHARDSON DRIVE ANCHORAGE. AK 99504-
Property owner SHERLE BERTELSON Day phone (907) 274-.~838
Mailing address 3506 WINGATE DRIVE ANCHORAGE. AK 99505
Lending agency Day phone
Mailing address
Agent MOLLY MURPHY W/ PRUDENTIAL VISTA
Address 4-241 "B" STREET ANCHORAGE. AK 99505
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water xxx
NOTE:
Day phone
(907) 522-5725
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
Holding Tank
Community on-site
Public sewer
NOTE:
xxx
ff community wastewater system, provide wdtten confirmation from State ADEC
lng to the legality and statue of system.
72q325 (Rev, 1/91 ) Front MOA #21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $800.00 at,
or prior to, closing for the engineering services provided. I
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 fudher vedfy that based on the information obtained from the Municipality of
Anchorage files and from my investigation and in~spection, the on-site water supply and/or wastewater
disposal system is in compliance with all Municip~al and State codes, ordinances, and regulations in effect
on the date of this inspection. , d I
NameofFirm ALASKA,VCA'=""""""~ER&'I\ iA~¢N,~,TEROONSULTANTS,INc. Phone (907)337-6179
Address 6901 DEBARIC'ROADI ~ /2~¢:-AN~OHORAGE, ALASKA 99504 / l' _
Engineer's Signature ~- ',f~/~ ,I, ~/~ J Date ~/¢(~//Cc
system in accordance with ADEC and M/O,~ Dt~ tS Guidelines & Regulations. The reported results described the
performance of the system under the conditions ;ncountered at the time of the test, and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend
on the local soils condition, ground water levels that may fluctuate during the year, and the water
usage of the family being served by the system. These conditions are outside the control of
the evaluator of the system. Satisfactory test results do not guarantee future performance
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or pady is not authorized,
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
P/' Approved for ~
Disapproved
Conditional approval for
bedrooms
bedrooms, with the following stipulations:
Additional Comments
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. 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 responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) 8ack MOA fY21 Computer Version
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
Health Authority Approval Checklist
Legal Description: NUNAKA VALLEY S/D; _OT 8, BK S, Parcel I.D.:
006-162-08
A. WELL DATA
Well Type PUBLIC If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed ~
Total depth Cased to ....--/ Casing height (above ground)
Sanita~ Wires propedy protected (Y/N)
FROM WELL LOG
Date of test ~
Static water level ~
g.p.m.
AT INSPECTION ~
.~.-~ g.p.m,
WATER SAMPLE RESULTS:
Coliform
Nitrate
Date. ~ : -
Collected by:
- r acteda. -
B. SEPTIC/HOLDING TANK DATA
Date installed 11/7/96 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A
Date of Pumping 9/25/00 Pumper McDONALDS PUMPING
YES
C. ABSORPTION FIELD DATA
Date installed 11/7/96
Length 35' Width
Soil rating ~ or ft2/bdrm) 1.2 System type: TRENCH
4' TO 5' Gravel thickness below pipe 4.5' Total depth 1 O'
Effective absorption area 315 SQ. FT. MonitoringTubeprasent(Y/N) YES Depression over field (Y/N) NO
Date of adequacy test 9/25/00 Results (Pass/Fail) PASSED For 2 Bedrooms
Fluid depth in absorption field before test (in.); 0" Immediately after 595 gal. water added (in.): 0"
Fluid depth 0" (ins) Minutes later: 0
Peroxide treatment (past 12 months) (Y/N) N/A
72-026 (Rev. 3/96)* Computer Version
Absorption rate =. 300+ .
If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallons
' level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
PUBLIC WATER
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+
Water main/service line 10% Surface water/drainage 100%
Absorption field 5%
Wells on adjacent lots 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
F, ENGINEER'S ~/E~I
I carfify that I,l~avelc
of Municipal ~ecor~ls
with MOA H~A gu[d
Signature
Engineer's Nam~,~_
Date
10'+
Building foundation
100'+
NONE KNOWN
10'+
Driveway, parking/vehicle storage area 10'+
Wells on adjacent lots 100'+
rn,~c~.t~ru ~ld inspections and review
[ystems are in conformance
~this date.
JEFFREY A. GARNESS
Water main/service line 10'+
HAAFee$ ~,oL~
Date o~ Payment
Receipt Number
72~26 (Rev. 3/96)* Computer Vemlon
Waiver Fee $.
Date of Payment
Receipt Number