Loading...
HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 32BCOSA Checklist NEW FIELD.docx COSA Checklist Legal Description: EAGLE RIVER VALLEY RANCHETTES LOT 32A Parcel ID: 050-224-18 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC &/OR CLASS “A” WATER Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 65” Date of pumping 4/10/2024 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station NEW years Lift station material PLASTIC Comments: 1000-gal 2 compartment. D. ABSORPTION FIELD DATA Which system tested (date installed) NA - NEW ALL standpipes present per record drawing Total measured depth from grade 11.5 ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date NEW FIELD Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – NEW FIELD – NOT TESTED Effective depth (per record drawings) 84 in (MOA 7’ ED) Effective depth used 0 in Effective depth remaining 84 in Comments/Deficiencies: Approximate total measured depths from existing grade. Existing septic field (crib/undoc trench) abandoned in place. No baffle in existing concrete septic tank so installed 1000-gal lift station tank. No foundation cleanout (FCO) apparent and servicing can occur from inside plumbing. COSA Checklist NEW FIELD.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No *5+ ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No * ft Water Service Line > 10’ Yes if No * ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *Per MOA record documents and time of installation of GAAB 1973 along with the attached AWWU docs. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 6/6/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 06/06/24 Eagl River Valley Ranchettes Lot 32 050- 224 -19 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 4 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSPl11303 PID Number: 050-224-19 Kenneth Kvitek Wastewater System: [] New [] Upgrade Address: 18728 War Admiral Road ABSORPTION FIELD Phone: Number of Bedrooms: [] Deep Trench [] Shallow Trench [] Bed [] Mound [] Other: LEGAL DESCRIPTION So, Rating: Total Depth from original grade: 0.8 GPD~Ft~ 8.4 Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 32B Eagle River Valley Ranchettes 4.4 Ft. 4 Ft. Township: Range: Section: Fill added above originar grade: Gravel Length: 0 Ft. 25 pt. Well: [] New [] Upgrade Gravelwidth: Number of lines: I gistance between lines: 5 Ft. 1 - Ft. I Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Matedat: AWWU pt. Ft. 250 Ft2 3034 PVC Driller: Date Drilled: Static Water Level: installer: Date installed: Ft. Flintstone Enterprises 11/2/2011 Yield: Pump Set at: I Casing Height Above Ground: GPM Ft.I Pt. TANK SEPARATION DISTANCES [] Septic [] Holding [] S.T,E.P. [] Other: T~_To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity: From ~ Tank Field Station Tank Sewer Line Anchorage Tank 1250 Gal. Material: Number of Compartments: Well N/A N/A NIA Steel 2 Surface Water 100+ 100+ ~ / LIFT STATION Lot,ina 26.2 40.5,~ Size: Manufecturer~ Gal, Foundation 9.2 31.0 "Pump on' level at: "Pump oft" level at: High water alarm at: in. in. in. Curtain Drain N/A N/A Pump Make & Model Electrical Inspections performed by: Upgraded existing field by expanding to accommodate a four BENCH MARK Location and Description: bedroom house. Garage FF Assumed Elevation: 100.0 Ft. Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1st 11/2/2011 2nd 1113/2011 Development Services Department Approval ar Conditional Approval Date: ~:fl~*.Steven R. Pannone~,~ ;~ ~ ///'J/.~/~Z--~,/~//.//" / 'L"~b~ ' "'r~'" N°' CE ~'~+v " .~' , ... %'. Reviewed and approved by: ~,::Y--'/, /~ ate: / / - 7- /  A B C FC 17.6 2.0 T1 15.6 15.5 T2 20.9 21.2 .~ DC 23.2 23.1 i ECl 53.4 54.7 ~ C1 63.6 57.8 ~ ,~ F1 49.9 44.6 _~ ~ M1 50.2 42.8 ~ g F2 63.6 33.5 /"-~ ~- M2 61.0 33.8 WAR ADMIRAL ROAD ~ 1000gABANDoNESEPTICpERTANKooDE(E) ~ ~ 32A ~ ~ /,L~o~ SE~T,C 4BR RESERVE FIELD ~ ~ D/W , /! / TANK (P) . 25LFxS'Wx4'ED, 7'TD- NEWFIELD EXPANSION ~0%'~~;::~'~ ~~ ~F1 /'/ J ~ ~I"CU WATER SEm~C (g) ~ ~0.01 ¢~ ~¢~0~ F1 e~ ~ / / SERVICE ~%~r/// ~ SEPTIC (E) 570 SF) EXPANDED FOR 4 BR. ~ 31A~ ~ _ - - w W ~ ~ w~ ~, N~ w~ 3~c 3~D .... ~ / 31c~" 8"~C. ~ ~ CONN 'CTED TO MID- ....... ~'~ ~ ~ ~6~'+ r~F FIELD EXlST'G SEPTIC ~ CONNECT TC EXlST'G EXIST'G SEPTIC ~ EXIST'G SEPTIC NOTES: P~O~ ~G ~C, L~ ~co~ ~AW,~O ~.0. ,0X ~00~ ~,C,0~O~, ~X ~0 ~" PHONE (907) 272-8218 FAX (907) 272-8211 ~... ~..~ fa sc=~e ~..-~~ '...~ ~"=~o'  P.I.D. NO EAGLE RIVER VALLEY RANCHETTES, LOT 32B_. onno~e KENNETH KVITEK ',~~C~ PERMIT NO. 18728 WAR ADMIRAL ROAD IE'*~:.. ..%¢~ OSPl~}o5 PLAN EAGLE RIVER, AK 99577 ~II?~¥~ Sheet SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK WAS IN ACCORDANCE WITH THE All'ACHED SPECIFICATIONS. 5. SCOPE OF WORK: INSTALLED 4- BEDROOM ADDITION TO SOIL ABSORPTION SYSTEM AND NEW 1250g SEPTIC TANK. 4-. NO APPARENT WATER TABLE WAS OBSERVED TO A DEPTH OF 14- FEET AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14- FEET BELOW EXISTING GRADE. 4 BR ADDITION ~ 15~' 104.1-- 985~ ~N t '~ 1986 94.5-- ~NNXN~-GRAVEL BEDDING .~--DRAIN FIELD (E) GM/ i ~-4" 0 PERF PiPE I,~-93'6 SM 6.8 ~DRA N ROCK -140 J -87.7 NOTE: F~SeFVe dFainfield identical to addition. No groundwmteF SECTION monitoFed o o o o ~o o o ~ o ~.~/ EXIST'GFIELD ~3034PVC 4.0 SEPTIC 97.7~ ~ : : ~--97.7 93.7-- ' ' --93.7 5-WIDE TRENCH DESIGN PARAMETERS LEGEND 4 BEDROOM UPGRADE SEPTIC SYSTEM NO. BEDROOM: ¢ (600 gpd) ~W- WATER LINE/ ABBREVIATION$ TANK SIZE: 1250g SEPTIC WELL RADIUS CU COPPER PERC RATE = 6-15 MPI A.C. ASBESTOS CONCRETE SOIL RATING: 0.8 GPD/SF ~ 88 ~ NEW SEPTIC TH TEST HOLE AREA RQD: 750 SF FC FOUNDATION CLEAN OUT EXISTING FIELD = 570 SF T¢ TANK CLEAN OUT NO. NEED TO ADD = 180 SF C~ CLEAN OUT NO. SYS. ~PE: 5-WIDE TRENCH 4' E.D. M~ MONITOR TUBE NO. MIN LENGTH: 18LF USED: R.I. RIGID INSU~TION 25 LF X 5' WIDE, 4' E.D., 8' TD DCO DOUBLE CLEAN OUT ADDING 250 SF DV DIVERTER VALVE TOTAL AREA: 820 SF FS FLOW SPLICER RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 EAGLE RIVER VALLEY RANCHETTES, LOT 32B~ ~~~h~6&& ~ 050-224-19 KENNETH KVITEK ~¢~ CE 8149 .~ PERMIT NO. 18728 WAR ADMIRAL ROAD f~i~... ...~ DETAILS EAGLE RIVER, AK 99577 ,li~¢ta~M/Sf~W~,~.,,ur~o.~2~ Sheet Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSPl11303 05022419000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: October 26, 2011 to October 25, 2012 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: EAGLE RIVER VALLEY RANCHETTES Site Legal Address: EAGLE RIVER VALLEY RANCHETTES LT 32B G:0054 Owner/Address: tO/ITEK KENNETH L 18728 WAR ADMIRAL RD EAGLE RIVER AK 995778328 Site Mailing Address: 18728 WAR ADMIRAL RD, Eagle River Lot Size in Sq Ft: 17955 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Notice: Spill-over trenches are not allowed. Received By: Issued By: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www. muni.org/onsite (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-224-19 Property owner(s) Ken Kvitek Mailing address18728 War Admiral Road, Eagle River Site address 18728 War Admiral Day phone Zip Code 99577 .Zip Code 99577 Legal description (Sub'd., Block & Lot) Eagle River Valley Rachettes, Lot 32B Legal description (Township, Range & Section) Lot Size 17,955 Sq. Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR ([~] all that apply): Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal COdes. Pannone Engineering Services~ k[~,~~i~~~ (Signature of property owner or authorized agent) ush Fees: Date of Payment: Receipt Number: (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: Pannone En§ineerin§ Services LLC Steven R. Pannone, Principal Registered Professional En§ineer E-mail: steve@panen~ak.com October 18, 2011 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Eagle River Valley Ranchettes, Lot 32 Septic System Permit Upgrade Request Ladies and Gentlemen: I am writing to request a permit to construct an upgraded septic system be issued for this property. The proposed systems will serve an existing four-bedroom house. Currently the lot is developed with a three bedroom system. This permit will upgrade the field to accommodate a four bedroom house. The lot is served by AWWU Public Water. The existing septic system is operating adequately for a three bedroom home (see COSA OSCl11131). The reserve field will be based on a Category III Advantex system. The surrounding lots are served by AWWU Community water. 1. Soils. A single test hole was excavated by Pannone Engineering Service in October of 2011. See the soil log attached. Ground water was monitored for seven days. No ground water was monitored to a depth of 14 feet below ground level after the monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 0.8 gallons/day/square feet should be used for a conventional system and 5.0 gps/sf for a category III reserve field. Soil Absorption System Design. a. See Sheet 2 of the design package 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and the existing drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The topography in the area generally slopes to the north at 10 to 15%. Mailing: P.O. Box 100217, Anchorage, AK 99510...0217 Physical: 615 East 82~ Ave, Cuite B6, Ancho~'age, AK 99503 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 5. Drawing Markings: The Drawings are marked "For IVloA Review Only". When written notification that the review is complete and that there are no further comments is received from IVloA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, ~' 49TM ~ e.....&.,,.~~. m ........ ~.~.~,,,,~,,,.~ Steven R. Pannone, Owner/Civil [ngineer ~ttachments Maitif~g: P,O~ Box 1002t7, Anchorage, AK 995t0~0217 Physical: 62,5 East 82®. Ave, Suite B6, Anchorage, At( 9..,,.>05°~' Telephone: (907) 272-8218 FAX: (907) 272-S211 W 11.9 N86 18 1 / , WAR ADMIRAL ROAD /-- 1000g SEPTIC TANK (E) /ABANDONE PER CODE / /4BP RESERVE F~ 32B / ///-~25Og SEPTIC / / 'BASED ON CATIII SYSTM / , , , , ~ D/W I /, / TANK (P) - 25LFxSWx4ED, TTD-~ ~ / ,~ _~15,~ FIELD EXPANSION(P) ~ '~~~l /~I"CU WATER 25LFXS'WX4'ED, 8'TD ~ / TH I~ ~EC~I k/ SERVICE ~~~ 15.'&~ ~/~ABANDON CRIP PER CODE SEPTIC (E)~ ~[ ='~',~~ CAP LINE TO FIELD DRAINFIELD (E) 10.0~~-1~% SEPTIC (E)~ 8"A.C. WATER ~-CONNECT TC~ MID- MAIN- / POINT OF FI ~LD EXIST'G SEPTIC~ EXIST'G SEPTIC NOTES: P~O~ ~G ~C, L~ ~ OM A&~'I~ ~ o/25/~ FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 ~.- .... ';~ g*.'~~ k*g ~"=~o' 050-224-1~ EAGLE RIVER VALLEY RANCHETTES, LOT 32~ · · ~ PERMIT NO. KENNETH KVITEK '~, ~e ve ~ Em~ l~n n ~ 18728 WAR ADMIRAL ROAD ,~.. .~ xxxxxxxxx PLAN EAGLE RIVER, AK 99577 ~ ...... ~ Sheet -~~ 1 OF 4 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST cURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: INSTALL 4 BEDROOM ADDITION TO SOIL ABSORPTION SYSTEM AND NEW 1250g SEPTIC TANK. 4. NO APPARENT WATER TABLE WAS OBSERVED TO A DEPTH OF 14 FEET AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4 BR ADDITION ------------- 15% TH- 1 4.0 GM/ I ~i~ ~GRAVEL BEODING . SM ~:~! DRAIN FIELD (Z) IP .o S.O ~OIE: reserve droinfield o identicol to oddiUon. ~roundwoter SECTION ; monitored -14.0 o ~ o o ~ ~ z oo ~ ~ ~CONNECTTO ~4 o ~/ EXIST'GFIELD /3034PVC / / ~ ' ~250 ~ SEPTIC 5-WIDE TRENCH DESIGN PARAMETERS LEGEND 4 BEDROOM UPGRADE SEPTIC SYSTEM NO. BEDROOM: ~ (600 gpd) W WATE~ UN~/ ABBREVIATIONS TANK SIZE: 1250g SEPTIC WELL RADIUS CU COPPER PERC RATE = 6-15 MPI A.C. ASBESTOS CONCRETE SOIL RATING: 0.8 GPD/SF -- SS -- NEW SEPTIC TH TEST HOLE AREA RQD: 750 SF FO FOUNDATION CLEAN OUT EXISTING FIELD = 570 SF T¢ TANK CLaN OUT NO. NEED TO ADD = 180 SF C¢ CLEAN OUT NO. SYS. ~PE: 5-WIDE TRENCH 4' E.D. M~ MONITOR TUBE NO. MIN LENGTH: 18LF USE: R.I. RIGID INSU~TION 25 LF X 5' WIDE, 4' E.D., 8' TD DCO DOUBLE CLaN OUT ADDING 250 SF DV DIVERTER VALVE TOTAL AREA: 820 SF FS FLOW SPLICER ~~. D a t e NOTES: FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 ~..,~ · NTS  P.I.D. NO KENNETH KVITEK -.,~.,,~:~onno~e ~ PERMIT NO. 18728 WAR ADMIRAL ROAD~ ':~,i,,.~.. .~ xxxxxxxxx DETAILS EAGLE RIVER, AK 99577 ~SgOg~~r~ '. ...... '~ Sheet -~~ 2 SOILS LOG - PERCOLATION TEST TEST HOLE 1 OR ORGANICS SLOPE SITE PLAN 1 -- WAR ADMIRAL ROAD 3-- GM GRAY SILTY 32A 32B ~ GRAVEL D/W HOUSE (E) . -- 1 7-- 8 -- BROVVN SILTY ~[ SAND AND H % 9 -- GM/SM GRAVEL -- 1 0% -- -- .... STIFF/HARD 10 -- DIGGING 15% : 31A ~V W W-- W-- W W-- -- W-- ~' UTIL',TWEASF 11 10' UTILITY EASE 12- 32C 32D 31C 13 -- WAS GROUND WATER SLOPE 14 ENCOUNTERED? N BOH · -- 15 IF YES, AT WHAT 16 -- DEPTH? -0-' TH X 17 -- DEPTH TO WATER AFTER MONITORING? -DRY~ 18 -- DATE: 10/18/11 19 i READING DATE CLOCK WATER TIME NET TIME LEVEL NET DROP READING DATE PERFORMED: 10/11/11 1 10/11/11 1:17 --- 5.72 --- 2 1:27 10 MIN 7.24 1.52 3 1:27 --- 5.72 --- 4 1:37 10 MIN 7.27 1.55 5 1:37 --- 5.72 --- 6 1:47 10 MIN 7.42 1.70 PEROLATION RATE 5.9 (rain/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 7 FTAND 8 FT COMMENTS: Test hole excavated by FLINTSTONE ENTERPRISES. Prec hole was presoaked. Test run for one hour. Last 3 readings reported PERFORMED 13Y: Steven R. Pannone~ P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: PANNONE ENG SVC, LLC ~.. oF AL .,'~, 10/25/11 FoR CONSTRUCT, ON P.O. "OX 100217 *NOHO"ACE. 99 10 ...... PHONE (907) 272-8218 FAX (907) 272-8211 Sco[e EAGLE RIVER VALLEY RANCHETTES, LOT 32B~~~ '"'--''""-~-~ -~--: ...... '?''~.~ P.I.D.050_224_19NTSNo KEN N ETH K VI TEK '¢&":S.~e~v'e'n_'_]i~'._'~n'n'6.~ & ,,~' '¢¢~.~..... CE 8149 -~.~".,~"~'~ PERMITNO. 18728 WAR ADMIRAL ROAD ,~,.~.. .:,~..~?~ xxxxxxxxx SOILS LOG EAGLE RIVER, AK 99577 ~ "' -" Sheet READING DATE CLOCK WATER TIME NET TIME LEVEL NET DROP READING ~ 10/11/11 1:17 -- 5.72 --- 2 1:27 10 MIN 7.24 1.52 3 1:27 --- 5.72 --- 4 1:37 10 MIN 7.27 1.55 5 1:37 --- 5.72 --- 6 1:47 10 MIN 7.42 1.70 AUXILIARY BASIN PUMP (N~C) 1 EA. ADVANTEX 24-" AUXILIARY 4" JIM CAP_ AX20 POD'-~ INSULATED PUMP PASSIVE '"*' ~ I RISER- BASI~(NiC AIR SLIDE SECTION OF 6" PIPE OVER THIS CONNECTION " 14'. TO PROVIDE SHEER PROTECTION- EXTEND TO BRIDGE EXCAVATION DESIGN PARAMETERS LEGEND 4 BEDROOM RESERVE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) --W- WATER LINE/ ABBREVIATIONS TANK SIZE: 1250g SEPTIC WELL RADIUS CU COPPER PERC RATE = 6-15 MPI A.C. ASBESTOS CONCRETE SOIL RATING: 5 GPD/SF (CATIll) ~ SS NEW SEPTIC TH TEST HOLE AREA RQD: 120 SF FC FOUNDATION CLEAN OUT SYS. TYPE: 5-WIDE TRENCH 4' E.D. T# TANK CLEAN OUT NO. MIN LENGTH: 12LF C# CLEAN OUT NO. USE: M# MONITOR TUBE NO. 25 LF X 5' WIDE, 4' E.D., 8' TD R.I. RIGID INSULATION TOTAL AREA: 250 SF DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER NOTES: PANNONE ENO SVC, LLC ~ _ .,~ Date ., ~?... 0I- A FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 ,~.. · PHONE (907) 272-8218 FAX (907) 272-8211 ~,~*~."~,9 TH NTS EAGLE RIVER VALLEY RANCHETTES, LOT 321~.- ~ ............ ~ P.kD. NO  050-224-19 KENNETH KVITEK PERMIT NO. 18728 WAR ADMIRAL ROAD *~. .:/.~ xxxxxxxxx DETAILS EAGLE RIVER, AK 99577 !~.?p/~OFESS\O~A~L_.v~?'43 ....... ~ Sheet -~~ 4 OF 4  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 /) IPHONE UPGRADE , 7 ~ Well ~ Absorption area Dwelling PERMIT NO. DISTANCE TO: I ~ Manufacturer ~/:~/~ a Material No. of compartments Liq. capacity in gallons IF HOME,DE: Inside length Width Liquid depth Well. /~.~ Dwelling PERMITNO. . ~ -- ~ Manufacturer // ' Material Liquid capacity in gallons ~ -~/J/~/~/~l Foundation ~ / ~ Nearest lot lin[/ PERMIt, NO. ;¢~ ~' b~w~ lines _~ ~ ~ No. of lines ~ Length Total li~es Trencht~width~ inches Dista~' ~ ~ ~ Top of tile~ finish grade Material.beneath tile ' Total elective absorption ar~ inches Length Width ~epth / PERMIT NO. ~ Type of cri~F ~, ~ib~~diameter __ Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line m DISTANCE TO: Class -- -- Depth Driller Distance to lot line PERMIT NO. ~ - ~ DIST~ 10: ~uildin~ foundation Sewer line Septic tank ~b~orption area{,} OTHER PIPE MATERIALS , ~ ~. ,~ ~ SOl L TEST RATI NG~ / REMARKS / AP~ROV~ - ~ DATE LEGAL ..... '72-013 (Rev. 3/78) V PERMIT I'-,10. RPPLICBNT KENNETH NOOD SRR ~.VE,,X EBGLE RIVER LOCRTION ;4RR ~.RDMIRBL LEGRL LOT i32~EBGLE RIVER VBLLEY' RRNC LOT SIZE TYPE OF SOIL RBSOR'p~ION SYSTEM IS: TRENCH DEPRRTMENT OF HERLTH RND ENVIF:ONMENTRL PROTECTION ~"~~~ 825 '"L"' STREET, RNCHORRGE, RI{. 9~501 264-4?20 ~ ~][4--'~--% I Ti 5EI..~EF-: LIP~-'~RR[:,E PERI4 I T (820626) 694-2974 ±6000 SQURRE FEET MR)'(IMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= lDO THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: [:-, E F' T I--i: -11 L E I'-J'_.~ T H = 57 6RR'..-'EL [:-,EPTH= 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETNEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET NIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETNEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE NELL NILL SERVE. TI-4~] ( 2 ], I f-~$PECT I ~] f-4'---"; RRE REL-'2. !_11 F-:ED E:RCKFILLING ElF RNY SYSTEM NITHOLIT FINRL INSPECTION RND RPPRO',..'RL BY THIS--. DEPRRTMENT N ILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETI4EEN R NELL FIND ANY ON-SITE SENRGE DISPOSRL SYSTEM IS 400 FEET FOR R PR IVRTE NELL OR 150 TO 200 FEET FROM R PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC NELL. MINIMUM DISTRNCE FROM R PR I '.,.'RTE NELL TO R PRIVRTE SENER LINE IS 25 FEET RND TO R COMMUNITY SENER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PEF-:r-1 I T E::-~P I F-:E$ DEC:-Et-IBER _..~=::2., :I.L-~- :~:2_ I CERTIFY THRT l: I RM FRMILIRR NITH THE REQUIREMENTS FOR ON-SITE SENERS RND NELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I NILL INSTRLL THE SYSTEM IN RCCORDRNCE NITH THE CODES. 3: I UNDERSTRND THRT THE ON-SITE SENER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. SIGNED: ISSUED V4. 0 [] SOl LS LOG PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 14 16 17 COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE PERCOLATION TEST Robert A. She PERFORMED BY: 72-008 (6~79) WAS GROUND WATER //~D ~_ ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop ........ 77 PERCOLATION RATE 7b'"'" (minutes/inch) ~'~ FT AND f~ FT TEST RUN BETWEEN t ~ ~..lY ,~ 7'" ~ ' ' DATE:Z~dU'"y / ANCHORAGE AREA BOF '"' H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER NUMBER OF COMPARTMENTS INSIDE WIDTH LIQUID DEPTH .LIQUID CAPACITY. /(~00 GALLONS. SEEPAGE PiT: NUMBER OFPITS / DIAMETER bV'OR WIDTH/&, LENGTH/b~ DEPTH LINING MATERIAL C~/~'1~'~' CRIB SIZE: DIAMETER.__~DEPTH DISTANCE FROM: BUILDING FOUNDATION ~/._._~t, NEAREST LOT LINE ~ TOTAL EFFECTIVE WELL ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION TYPE BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST , LOT LINE , OTHER 5OURCE5 DISAPPROVED DEPTH NEAREST SEPTIC , SEWER LINE. , TANK __, REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. LQ-031 DATE ~f' ~./q7~-~ APP R OV ED~ / / ~//G,A,A,B. GREaTEr ANChOraGE ArEa BOrOUgh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO., SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION DF= SEPTIC TANK ~" SEEPAGE PIT . /~'"- . DRAIN FIELD OTHER COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTI'CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ~O · DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL / SEPTIC TANK . SEEPAGE PIT TO NEAREST~___~. ~'~'1'~ '~"~ ('4'~ '" t ~'LOT LINE. ~,[~/7~''~ WELL TO SEPTIC TANK DRAIN FIELD I DRAIN FIELD , SEEPAGE PIT ALSO CONSIDER AREA WELLS. DIAGRAM OF SYSTEM WATER MAIN TO SEPTIC TANK DRAIN FIELD. SEEPAGE PIT SEPTIC TANK, , SEEPAGE PIT. ,. DRAIN FIELD TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHO~E AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE FORM N~Q-Ot 6 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o5o-224.-~.9 GENERAL INFORMATION Complete legal description Location (site address) COSA# O..~C ti 11 ~ l Expiration Date: ,5"/~q /I ;~ , Eagle River Valley Ranchettes S/D, Lot 32B x8728 War Admiral Road Current Property owner(s) Mailing address Lending agency Mailing address Kenneth Kvitek Day phone 69/+-9287 18728 War Admiral Road, Eagle River, AK 99577 Day phone Real Estate Agent Mailing Address Craig Nagunst Day phone 694-9x25 2. ,..NU, MBF~R OF` Bi~.DROOMS: 3:?' TYPEOF WATER'~:OPPLy: ,, IndividUa~ W,bl'l ' Indigi'd~al Water storage . :GOmmunity'Ciass Pul~'lic wat~- System Unle~s,oLherwise requested, COSA will be held by DSD for pickup. Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [--1 [] Community On-site I-'1 [] 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, 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 1_oo227, Anchorage, AK 9952o Engineer's Printed Name Steven R. Pannone, P.E. Date 22/7/2o22 Engineers Comments: In conducting an adeguacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil 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 this system. Alt systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that ~ there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for_the sole benefit of the owner listed .Steven R. Po ~ ~ above. Any reliance upon or use of this report by any other person or party is not authorized nor will it No. CE 8149 confer any legal right whatsoever. 5. DSD SI,.GNATURE Lj Approved for LTL Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 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/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Eagle River Valley Ranchettes SlD~ Lot A. WELL DATA Parcel ID: Well type Public If A, B, or C provide PWSID # ~ Date completed ~ Sanitary seal (Y/N)_ Total depth ~.ft. Cased to ft. FROM WELL LOG Static water level ~ ft. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION in. Well production ~_ g.p.m, g.p.m. WATER SAMPLE RESULTS: e~mg/L ~ Coliform colonies/100 mL Nitrat Arsenic: ~ ug/I Date of sample: Collected by:~'"'~~ SEPTIC/HOLDING TANK DATA Tank Type/Material Septic I Steel Date installed Tank size ==5o gal. Number of Compartments_~ Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping New Pumper ABSORPTION FIELD DATA Date installed 7/=,;/=.9'8= Soil rating (g.p.d./ft2 or ft2/bdrm) zgo SF/BR Length ~f~ ft. Width 1.~/ ft. Total depth-~5_ ft. Eft. absorption area 570 ft~,~l':f3~ Monitoring tube Y Date of adequacy test ~.12Al~,oS.z Results (Pass/Fail) Pass System type Deep Trench Gravel below pipe ~ ft. Depression over field N For~'bedrooms Fluid depth in absorption field before test ~-5 in. Water added~5o gal. New depths_9 in. Elapsed Time: 6_~o min. Final fluid depth ~_5 in. Absorption rate >=.4~,~ ~,O0-/- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION "Pump on" level at ~ in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pum~ } in. Cycles tested Meets alarm & circuit requlrem SEPARATION DISTANCES FROM WELL ON LOT TO: on lot Absorption field on I~ Public sewer main Sewer/septic service line Animal containment areas On adjacent lots On adjacent lots ~~ sewer manhole/cleanout Holding tan k-~"'~'--..~ Manure/animal excrete storage areas'"'""'" SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 9.2 Property line 26.*, Absorption field 2,i.6 Water main 56.4 Water service line 10 Surface water ~oo+ Wells on adjacent lots ~oo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 25.8 Water Service line Curtain drain 50+ COMMENTS 12.7 Building foundation =o+ Surface water zoo+ Wells on adjacent lots zoo+ Water main 20.7 Driveway, parking/vehicle storage zo+ Engineer's Printed Name Steven R. Pannone, P.E. Date New upgrade to existing field be expanding to accommodate a four bedroom house. ENGINEER'S CERTIFICATION I ce~ify that I have determined through field inspections and review of Municipal mco~s that the above systems are in ~.....[ conformance with MOA COSA guidelines in effect on this date. ........... COSA Fee $. Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number LOT ~2-A c~ LOT 52-C WAR ADMIRAL ROAD .~ WOODEN FENCE . 62.4/ -Ill N 89'57'15"E 153.00' .-. // · /---CHNN-UNK FENCE LOT $2-B 18,101 S.F. NOTE: 1) LOT IS SERVED BY PUBUC WATER SYSTEM POWER UNE PORCH // BI-LEVEL RESIDENCE 36/ 19.1' o x 18.5' CANT LOT 51-A x x x S 89'57'15-"W 133'~00' -/ LOT 52-D ,--.-SEPTIC CLEANOUTS ~10' UT1UTY EASEMENT LOT 3I-C PLOT PLAN AS BUILT X SCALE 1" = ;50' GRID NW 054 Project No. 11-068 La n g (907) 522-6476 Registered Land Surveyors (907) 522-4625 kenOlangsurvey, com/ JonafhanOlangsurvey.com &: Associofes, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-,5049 Phone Fax I hereby certify fhaf I have surveyed the following described properly: LOT $2B, EAGLE RIVER VALLEY RANCHETTES, (Plat 6`5-129A) Anchorage Recording District, Alaska, and that the improvements situated thereon are wlfhln the properly lines and do not encroach onto the properly adjacent thereto, fhaf no Improvements on the properly lying adjacent thereto encroach on the surveyed premises and fhaf there are no roadways, fransmisslon lines or other visible easements on said properly' except as indicated hereon. Dated this the "/--%~-? Day of F~ , ~.~3~\ , at Anchorage, Alaska If is the responslbillly of the owner fo determine the existence of any easements, covenants, or resfrlcflons whlch do not appear on the recorded subdivision plat. """ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township,,range) Location (address or directions) (b) Applicant Name ~,,~/,-~.3~--~ ~--~::,_r~- Telephone: Home Applicant Address ~/"~. ~ 'r"','~ ~'-,r'_-_' //[')/~,~--~' "' (c) Applicant is (check one): Lending Institution r-I; Owner/builder []; Buyer []; Other,~' (explain); (d) Lending Institution ~~/Lt.- ~,~_//~J~7./.-/ Telephone / Address Business ,,,7__, ~ (e) Real Estate Company and Agent Address Telephone (f) the HAA to the following address: TYPE OF RESIDENCE Single-Family,S' Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well [] Community [] 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 72-025 {11/84) 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 Telephone the date of this inspection. Name of Firm ~ ~, ~. Addr~ ' ~, - Date .PH, DHEP APPRO..~._VAL ~. _, Approved fo~'//'-/"~-~i! bedrooms by Approved , ' · Disapproved Terms of Condi'tional Apl~roval Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations 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 requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 WELL DATA Well Classification Well Log Present (Y/N) MUNICIPALITY OF ANCHORAGE(MOA)'" · P£O1£C7/o~ Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: HEALTH AUTHORITY APPROVAL (HAA) CHECKL'ISm i FEBRUARY 1984 : Legal Description: ~;T ifA, B, Cl D.E.C. Approve~:~N) Date Completed' Yield Depth/ef Grouting :~, / Pump Set At /~k'~ /~nitary Seal on Casing ( //~ression Around Wellhead (y/N) To Septic/He!d!r~g Tank on Lot ~--,~-'-?~'~ To Near'est Edge of Absorption Field on Lot To Nearest PublJc Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer '" ~" To NeareSt Sewer Service Line on Lot ' ; Date Comments SEPTIC/HeL-B+N~ TANK DATA '7 - 7:g Date Installed ~ Size No. of'(~ompartments Standpipes~N) Air-tight Cap~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Ho!al!rig Tank: To Water-Supply Well ~'"'~z:> To Property Line ~ C' To Water ,Mai,q/Service Line Course Comments Foundation CleanoUt([~) Date Last Pumped ; for ' ,: Temporary Holding Tank Permit (~iN) To Building Foundation To Disposal Field To Stream, Pond, LakeJ or Major Drainage Pagelof2" 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '~ '" ~ -~:-- Width of Field .~t"~ Square Feet of Absorption Area' Depression over Field (Y~t~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot t ~ Type ,of System Design Length of Field ~:~ ~ ~ Depth of Field J ~ Gravel Bed Thickness (~o~::) ~':~, "'t ~:~ c~ .~ Standpipes Present('E~l) Date of Last Adequacy Test I To Water Ma!n/Service Line ~ ~ -'~ : To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line I ._~ ~ To Existing or Abandoned System on ; On Adjoining Lots ~ .4- To Cutba'nk (if present) ~/A. D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manh ole/AcceSs (Y/N) "Pump Off" Level at Ven! (Y/N) Pumpi,ng Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all ~OA ar)d HAA gu de ines in effect on the date of this inspection. !MOA No. Receipt No. Date of Payment %-;X~ -~ Amount: $ Page 2 of 2 72-026 (11/84) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ~s~jta- '-'~ A Date Received September 16, 1976 C].~ ~/~._~ ~.,l~-'~,/~x~'~a~,~;~;O~ Time of Inspection q-D ' ~~ _1. '~~~ ~__1,~ ~~ Date of Inspection] - ~,-, ~t~.~~ REQUEST FOR APPROVAL OF ]. Approval requested by: Home Federal Savings & Loan Mailing Address: 535 D Street Phone: 272-1451 2. Property Owner: E~in & Jan~t'Miller _ Phone: Mailing Address: % Smiley's Realty, Gary 694'2114 3. Legal Description: Lot 32B Eagle River Valley Ranchettes 4~ Location: See directions on white copy 5. Type of facility to be'inspected Single Family''. No. of bedrooms 3 6. Well Data: Bell Utilities A. Type B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On-site system A. Installed 1973 B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines ., Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area' C. Absorption area to nearest lot line LQ-034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES Type of Inspection: CMRO VA ,~' FHA_ CONV 4. Name of Lending Institution: Mailing Aadress:~ ~'X 6. Legal Description: ~¢ T~ Location: ~ ~ 7. Type of Facility to be Inspected: Water Supply Type of Supply: Public Utility ~/"l~'/E'-~lndividual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3176) page ~ of two pages - Rei"~'st for Approval of Individual S'~r & Water Facilities Legal Description Lokt 32B Eaqle River Valley Ranchettes Comments Approved ]/4~x.?~.X"/~/~Djsapproved Date / i ' Approval\Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request ifor approVal to be a true and accurate representation of the subject sewer and water facilities and these facilities are ~operat~ng satisfactorily. SIGNED Date EQ-034 (1/74) I-. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road· Anchorage, Alaska 99507 279-8686 Date Received November 26, ·1973" Time of Inspection ]] :'30 am Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Aoproval Requested By: Address: 2. Prooerty O~ner: 3. Legal Description: 4. Location: FOR Smiley's Realty for Erwin Miller Eagle River AK Phone Phone: Lot 32B Eagle River Valley Ranchettes November 26 1973 694-2115 5. Type of Facility to be Inspected: Single Family ~;ellinq Number of Bedrooms: 2 6. Well Data: A. Type Conmunity Well B. Depth C. Construction 7..Sewage Dts~osal System: A. Installed ' 1973 C. --Septic Tank: D. 'Bacterial Analysis' 1. Size 1000 qals2. Insta!.ler Hamilton Excavatino Manufacturer Hamilton . D. Seepage Pit: '1. Size 16~16 2. MatertalConcrste Rinn~ E. Disposal Field: Total.%ength of Lines Distances: A. Well To: Septic Tank , Nearest Lot I. ine Foundation to Septic Tank , Absorption Area Absorption Area to Nearest Lot Line · Other Con'tamination "~ Abgorption Area , Sewer Lines · "' -~eq,Je~.t for Approval of : ~.vtdual Sewer & Water Factlitte/~, Pa.qe Two 9. Comments: // Approval Valid for One Year From Date Signed ~reater Anchorage Area Borough, DeF. artment of Environmental Quality DIAGRA~ OF SYST~.~ 'I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities located at: Signed Date GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road· Anchorage, Alaska 99507 279-8686 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SFWER & WATER FACILITIES FOR 1. Aoproval Requested By: Address: 902 South Lane Anchora.qe AK 99504 2. Prooertv O~ner: Same Phone .' Phone: 3. Legal Description: Lot 32 B.., Eagle Riwr Valley ~e~¢~ette~ Location: 5. Type of Facility to be Inspecte, d:_ $ingl. Family nwe!!ing Number of Bedrooms: 2-3 (two 6. Well Data: Conmunity Water A. Type C. Construction 7. -Sewege Dts6osal S.vs{em: A. Installed 1973 C. -.Septic Tank: 1. D. Seepage Pit: 1. B. Depth D. 'Bacterial Analysis' Installer Hamilton Excavatinn Size ilO00 9als'2. Manufacturer- ,~amiltnn Size 16xl6x6' 2. Material Concret~ E. Dtsposal Field: Total.~ength of Lines Distances: A, Well To: Septic Tank · Nearest Lot Line , Absorption Area · Sewer Lines , Other Contamination B. Foundation to Septic Tank "~ Absorption Area C. Absorption Area to Nearest Lot Line r(eq~e~t for Approval of Inoividual Sewer & Water Facilities Page Two 9. Comments: Aporova] Valid for One Year 'From Dat.e. Signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYST~.~ I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities located at: Signed Date