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HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 27DEngle River Valley Ranchettes Lot 27D #050-224-01 • Municipality of Anchorage * t+�r•, Development Services Department Building '� / Safely Division -��• On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 www.cl.anchorage.ek.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: _5W 05-019 PID Number: ©SD^.:�aL/—Q/ 01-10 •m• /n� Kot 't5 Wastewater System: ❑ New ja Upgrade Ada•••��3� e.0Drat cS�- r e Uje ABSORPTION FIELD Mont bc� & — —7 3o NunD•r a d eanr O DW Tr"r11 C(BMnow Tr•rrA 0 ab O Mound O OIMr LEGAL DESCRIPTION sw Ri" I 7aY Dpm hema pna p.ee BioQ' la^� SuhdNM jIj/ aJ • ! Q Q e1I CDOd f DeDm roppe halon ham enpvW pW.' �.SFI. FI. Gr"depth eery "D. 1SQYiN �5it Town.rvp- Rerge Hanan: Fd •dd•d ahoye w9n•I grade Gr•r1I tenoth FI. r T 1= 1 1. Well:Grev.l ❑New [I Upgrade rldm Nurro" en.. Drmrin h•Iw", ha•• 36 , Depth. tl..u, t) T•e 'W`7 14 U FI. TWW a FI an M.1•r I. Ft 0~ ,5OFIr 5 Ml.e $I.nGWIat..v" FI Inw~ (I.vtPa(F —` � Q /1�� D.1•In«.Y•e 7-PR-09 —0 YINd pant/ B" el ."np N•pht Aeow Ground J r C / 6 GPM F+. Fl TANK SEPARATION DISTANCES lrseptic 01 -folding OS-T.E.P. ❑Other. To From Septic Tank Absorption Field Litt Station Holding Tank ubiic/Prlvateetla Sewer Line « r 71 .p�w,lqr W�Gal well I Of oO �� ��' 1 � M.1"ul R Mathew a CamN np.n•n 1 S 9 sarece w•I" f /�/j �Wt LIFT STATION Lath* 3�' I� 1 .. « .�"". . I Fa.M•nOrl Cr pu,p on Nva e1 'pumpo H�ph rel" •Iwm•1 au ti NIn Cunt"one. punyz 8 Mod EI•ar l •F,peceon. pMarMd hY R•m"k• " 1 <e ; r BENCH MARK ^ .../lJ\ Lanwn.nd De.Gnvnan. /� go r a S( I ( .!F ,1•w 1•r.hpn 1103 FL Englneer's Stamp /Of 41. •.W N.• i �',r,?•e.•'-�'�ii,, SiSENGINEERING Inspections performed by: 1le River Lad, Noop Dates: 1" y , ,05 Development Services DepartmentApproval Reviewed and approved by: Date: q-:2 %- r 144744 ` IRev ILWI C 1• PERMIT No. SW050191 PACE 2 OF 3 DEPARTMENT ANDhHUM9AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 27D, EAGLE RIVER VALLEY RANCHETTES P.I.D. No. 050-224-01 27A LOT 27B ------------------------ 1 _ _ _ — — — — — KEYBOX — 10,UTILITY EASEMENT _ C04 -�CO2 y OLD THA �P TRENCH SUMP EXISTING I W COIS MTl ° C01 NEW TRENCHES MT2 CO3 FS (ZABEL) OV (BULL RUN) 1 ` EXISTING 1000 GALLON FIBERGLASS SEPTIC TANK ST2 OBL28 W (VERIFIED 7-18-05) DSLI SHET1 -� - 1 5 . GRAVEL DRIVEWAY FCO B A TBM EXISTING I V) 3 BEDROOM I w GARAGE HOUSE I � I I . DRIVEWAY I I SCALE. 1- . 30• ENCIS`TrAMP TWENTY GRAND ROAD '"«': � _t A. = r:: i. uh W7.1 r . PERMIT No. SW050191 PACE 3 OF 3 DEPARTMENT AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Atnskn 99519-6650 • Tetephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 27D, EAGLE RIVER VALLEY RANCHETTES P.I.D. No. 050-224-01 MTI = 78.2 C01 MTl CO2CO1 = 88.0'""AMT3 CO2 = 81.9 FINAL GRADE tj�2" INSULATION,,,, ),IFsC01 = 78.8' R,. _. CO2 = 78.8' MT2 = 77.1' CO3 CO3 = 85.1' C04 = 80.7' I CO3 = 77.7' j C04 = 77.7' A J 9 A FCO .._19.0' 19.5' 1 �' WATER FOUND ® 69.1' STI 17.5' 28.0' 67.1' B.O.H. ST2 15.5' _1 34.0' �DBL1; 15.5' 1 35.5' DBL2' 15.5' 36.5' �DV 35.5'_ N. T. S. IFS__ 38.0' _49.5' 51.5'-_ (C01 41.0' ENGINEE AM iCO2 __48.0' __ ­ 73.0' _57.0' 1 63.0' `MTI 48.0 i 42.0 CO3 64.0 36.5' 76.5'.._ �C04_104.0' - _ IMT2 ' _65.5' 37.0' _ C05 ,55.5' 74.0_j /` MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 23, 2005 Expiration Date: Jun 23, 2006 Permit Number: SWO50191 Parcel ID: 050-224-01 Legal Description: EAGLE RIVER VALLEY RANCHETTES LT 27D Design Engineer: 0003 S & S Engineering Site Address: 019131 TWENTY GRAND RD Owner Name: AL ROBERTS Lot Size: 17955 SO. FT. Owner Address: 19131 TWENTY GRAND RD Total Bedrooms: 3 Permit Bedrooms: 3 EAGLE RIVER. AK 99577-8332 This permit is for the construction of: ❑✓ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. ENGINEER NEEDS TO PROVIDE VERTICAL SEPARATION BETWEEN THE WATER & SEWER LINE CROSS-OVER WITH AS -BUILT INSPECTION REPORT. CONNECTION JOINTS FOR PRIVATE SEWER LINE NEED TO BE SEALED IN AREA OF CROSS-OVER FOR ABOUT 10 FEET ON EITHER SIDE OF WATER LINE. PRIVATE SEWER LINE CONNECTION JOINTS NEED TO BE SEALED BY GLUE AND SHRINK WRAP. Received By: Issued � Date: z8 o Date: G z Municipality of Anchorage Development Services Department e . Building Safely Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Q50'Q2Y-Q +! Permit Number SW Property Mailing address (1) 1113 Day phone D 16`7301 Mailing address (2) Ea0./e P.VC/f'171\ ^-7 I Zip Code q%.E7�/7 � Legal description (Lot, Block & Sub'd.) Lal d / ), 0 le ISIyti �gn� (%A��� 4eHe'S Legal description (Section, Township & Range) Lot Size / 9 Acre /Sq.FI. THIS APPLICATION IS FOR: Number of Bedrooms 3 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 5d THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. (Signature of property owner or authorized agent) Permit Fees: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 I • VO Waiver Fees: Dale of Payment: Date of Payment: Receipt Number: Receipt Number: (Rev. 12/00) C14 TEALTNAUTMMTY APPROMS SEWER ILWATER MAIND(TETSIO S SEWERS WATER INSPECTION EN(ANEERNGSTUdES ANG REPORTS WELLNSPECIgN III FLOW TEST SITE PLANS ROAD DESIGN SOITEST PERCOLATION TEST STM=LNVL AECNANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSOSTEM DESIGN ROBERTC. COWAN. P.E. ROSERTA. SHAFER, P.E. CMLENGINEERS (907)894.2979 FAX (907) 894-1211 June 13, 2005 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 27D, Eagle River Valley Ranchettes S/D It is requested that you issue a permit to install a septic system upgrade to serve the existing three bedroom dwelling on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation (5-10-05), water was found at 12 feet. After monitoring, ground water was found at 12 feet. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, —0z lvv�^-- Robert C. Cowan, P.E. RCC/bjj Enclosure 17034 NORTH EAOWWAR LOOP 4 SUM 204 c WLh WVER AtasKA 99377 1" = 30' DESIGN SITE—PLAN 9�0 1 C b Ln (n Ln 4 rOim� >� •C o Omm m z e w f''(rlj> D I--� w...•e� :. YN Ul O b moo I m00 1 No`" C £ m -� "gym I 0r-7 I O�N�v� ar 'Co y I-0� 1 I--3 o II 3 0 11 vtA= 10 1 NON rl rvi 1 cn I O -0 O C I o C) . . D a N�� 1 o I aoO M n C: m s m � , G� jo '^ Eoo -fix I p ::. 1-3 Go. -11•-1 D •3C ? (� % p^ F 50x0 -' I 1 ►'1 N nC ro3= ' DRIVEWAY nX'O zn ml O 1 O p� m gyp xl O 1 N H I To Ln a w p ���_II; 1M -Ni Zr o �1 cnrri 1 ,l V I --I SOV) Moo OMMO i `J tnOZ p o = N �� I m xAis �iZ I p p p plxl 1 K7� O -; <>O N- C� N p 9 MR CREST VIEW LANE t MR as }.. : l ,,c.. AI :� ! t +. a •�'� D—Z� e'afe�`Dt v a ...rS 1" = 30' DESIGN SITE -PLAN Hca o'F \o Ln o rn <_ :oma ASA � o in p � ^X�� z O�rn w v�sz 11 OD w �nYs 7 < 1-3 N I n I acnes d ; D � I r oom I v C�7 I � rn 0 to C' om o I0 >I ii�u7 I v I N opo o v�aN �w3o C : o CT7 CT: �:n_� >n tnOZ S n o I I r'' mOO O `~ I O fmm C, r Ory `Z 00* Z== nrAa. IX I I C: o DRIVEWAY mm O < ML< 00 I o F I w N �O V 3• I � \-J W ^ H O O �+ I N=mXm m ^ Dm IIiI = MO, +OZ n = o o 00 #wD 2 _DPpN OO o Nw I ., ncc rriCi �o N V ms'o�� > > ~ O H n � Y L•. w • rn cp CREST VIEW ' LANE _ o o' a:E Pp\`' s�� ��r 1" = 5' DESIGN PROFILE '^��'• c0 Un O Q1 x.. io O.ONO 0 mm > 0-1 Z5 -n 0 m % um�a tb N < y ® m O %. A N !A N D O n NOw 0 F m [ry 9 y O cn .. oil KnW a O AOA 1V f*I m �G)p I1) D t v p00 N Z J T Z C7 .. 7-1m N o >01 c� M gn M � r o� m O ? Y rr7 n �7 � O Y N � n H � rn J ri a � n N y a f O 1. Is _ n 5 Off! PERFORMED LEGAL 1 at ` 2 r 0 4 6 Q 6 `4 7 a 6 � to - It o it _ ej 17- 13 4 14 16 16 17 18 19 20 COMMENTS F100EFITC. COWAN. CE. tI00ERT A. SI IAFER, PE. CML ENGINEERS (907) 694-2979 FAX(907)694.1211 `alley K4,74 o� nlC5 GM Stu/Au) (L71T" gtSYnL� DATE e, Section: SLOPE ER, ROBERT C. C. COWAN f CE-8801j� WAS GROUND WATER ENCOUNTERED) s _ _ IF YES, AT WI IAT t L DEPTH? y c E. Depth to Wiles Aller Q �1 Monitoring? 631e: SII Reeding Data Ti Grote Nat Depth to Net B Time me Water Drop PERCOLATION RATE��11 14WIlvinch) PERO HOLE DIAMETER T� 'n / PERFORATED BY: 5 & S ENGINEERING ��f' .4 1— CER71FY 7otAT T BS T T WAS PERFORMED IN t 17034 Engle ver twp oa o. G13 05- ACCORDANCE Wlpjdµ�TpjfAft 1�tq�ML GUIDELINES IN EFFECT ON THIS DATE. DATE: 72 -me (Rea 4/8.5) . S& W.ALTHAMHORRY APPROVALS SEWERS WATER AWNEXTENSKM SEWERSWATER PISPECIION ENGINEERPRTSTUDIES ANDREPORTS WELLHSPECTION AFLOYTEST SITE PIANS W&TEST PERCOLATION TEST STFIX"MAa l Lecmvw x 94PECTIM ON SFTE WASTEWATER DISPCSALSYSTEIA CUM HOBERTC. COWAN, P.E. ROBERT A. SHAFER, P.E. CIVILENGINEERS (907)694-2979 FAX(907)694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 27D, Eagle River Valley Ranchettes Subdivision June 13, 2005 CeI�1.l�I;7LrA 1. The scope of this project includes the installation of new septic trenches with a 2' sand filter to serve the existing four bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. S. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 17034140KH EAGLE kwEA LOOP 1 SURE 204 t L:AGLE LOVER. ALASKA 99377 Page 2 Lot 27D, Eagle River Valley Ranehettes SID June 13, 2005 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. G. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page 3 Lot 27D, Eagle River Valley Ranehettes 3/D June 13,2005 Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. hill►lhillldNDliD11UM39xy11["a 11117N3 Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type ofPipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Page 4 Lot 27D, Eagle River Valley Ranchettes SM June 1 3, 2005 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER MUHMP„UTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-224-01-000 Expiration Date: 7/13/2024 Legal description EAGLE RIVER VALLEY RANCHETTES LT 27D Site address 19131 TWENTY GRAND RD Eagle River AK 99577 Current property owner(s) BURNS CASEY T & MELISSA L X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 7/13/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other Fiberglass septic tank is 48 years old. COSA Approval June 2022 MUNICIPALITY F ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050 224 01 Complete legal description EAGLE RIVER VALLEY RANCHETTES LOT 27D Location (site address) 19131 TWENTY GRAND Current property owner(s) BURNS 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ■❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑■ Fiberglass Age - See advisory if steel older than 20 years see comment on checklist 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ �/ 5� Waiver Fee $ Date of Payment 6 26 `� z3 Date of Payment COSA # oS. C Z l Z j _S- Waiver # COSA Application—June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA 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 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 Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. 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) If yes, enter date Adequacy test date 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 – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) 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 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 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 Phone Engineer’s Printed Name Date C&M ENGINEERING CHARLES BALZARINI, PE 6/19/23 i 7 f. .. 7 • otic H. T' _ f •40..;r,.c- `$ ;., b73c.po W � ri 9` �\ t.9►.3I AS -BUILT I hereby certify that 1 have sorve ed the following described property: © /— 2-7 ` 7 CC- ` — --- ! /,J�F a r Anchorage Recording' Precit*i�rt, Alaska, and that the improve- ;' ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the. premises in ,question and that there are no roadways, rf 0 3 transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this . day of 200 S ROBERT C. JOHNSON -f &L •;'�� SCALE: Registered Land Surveyor No: 88( L5 Bog 77-0456, Eagle River, Alaska 99577 j" Phone (907) 694-2543 • Municipality of Anchorage = A On -Site Water and Wastewater Program K (907)343-7904 5:.==r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 050-224-01 1. GENERAL INFORMATION Expiration Date: 0-/ -/'7 Complete legal description EAGLE RIVER VALLEY RANCH ETTES LOT 27D Location (site address) 19131 TWENTY GRAND ROAD EAGLE RIVER, AK 99577 Current Property owner(s) ERIK & TERI JOHNSON Day phone Mailing address 19131 TWENTY GRAND ROAD, EAGLE RIVER, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNariance request for:, COSA to be released to the engineer, COSA Fee $ '52-� —J Date of Payment 9117115 Receipt Number 6323? COSA# oczysIH38 requested by the engineer. Waiver Fee $ Date of Payment Receipt Number. Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-379 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name _KENNETH M. DUFFUS 8/13/2015 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a - —_`� system will function satisfactory for current or future r Off, occupants or can ArcTerra guarantee that no unseen v AZ 4, deficiencies or discrepancies exist. / �� t��,, '/A nTi/ 6. DSD SIGNATURE _V_�System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. KSNNE7`H N. I(Ut eT / (t' )711 = / F F'ESSIOh�� Conditional approval for bedrooms, with the following stipulations: . e By: t �� , ' / C t, Original Certificate Date: The Mbrrrcipalky bf *ai6rage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbl esheel_70.10.12.dw 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: EAGLE RIVER VALLEY RANCHETTES LOT 27D Parcel ID: 050-224.01 A. WELL DATA — PUBLIC WATER Well type If A, B, or C provide PWSID # Well Log (YIN) Date completed Sanitary seal (YIN) Y Wires properly protected (YIN) Total depth ft. Cased to _ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Arsenic: _ ug/L Nitrate _mg/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC /FIBERGLASS Tank size 1000 gal. Number of Compartments 1 Foundation cleanout (YIN) Y Depression over tank (YIN) N Date of pumpinPumper JRs C. ABSORPTION FIELD DATA Collected by: Date installed 7/30/1975 Cleanouts (YIN) Y High water alarm (YIN) N Date installed 4/18/2005 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.0 System type SHALLOW TRENCH Length (40'.+ 501) 90 ft. Width 5 ft. Gravel below pipe 0.5 ft. Total depth 6.3.8.3 ft. (Measured 8/11115) Eff. absorption area 450 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/11/2015 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 1.5 & 2.5 in. Water added 490 gal. New depth 4 in. Elapsed Time: 1380 min. Final fluid depth 0 & 2 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo:) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES - PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access(Y/N) High water alarm level Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation 5'+ Property line 54 Absorption field 5'+ Water main 104 Water service line 101+ Surface water 1004 Wells on adjacent lots 200'+ 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 50'+(NONEKNOWNI Wells on adjacent lots 200'+ 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 COSA guidelines in effect on this date. w� \ OF AL Engineer's Printed Name KENNETH M. pUFFUS Date 8102015 9 KENIMH D COSA canary sheeL_2-6-15.doc , s B / .rr s coN .i in. Municipality of Anchorage •' Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage-ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 050-224-01 HAA# 65 ?)t= Expiration Date: ! - 2, % - O 1. GENERAL INFORMATION Complete legal description int 9.71)r.,gr1P River vA11Py RAnrhPttes siihdivision Location (site address or directions) 14111 TcPn1*3r r'rand Rd Current Property owner(s) Al Roberts Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 696-7301 19317 Second St. Eagle River, AK 99577 Unless otherwise requested. HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 Day phone Day phone Yt1A7/S- TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site 0 ❑ Individual Holding tank ❑ ❑ Community On-site ❑ 1B Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and Slate codes, ordinances, and regulations in effect at the time of installation. Name of Firm S 6 S Engineering Phone _694-2979 Address 17034 N. Eagle River Loop Ste. 204 Earle River, AK 99577 Engineer's Printed Name Robert A. Shafer Date ` ZJ O,S Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: 0'� Original Certificate Date: I -a %- 0.67 (R•v 01102) ��^'.•Y•Tr 5. DSD SIGNATURE >. a esr^ Approved for `,, �• bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: 0'� Original Certificate Date: I -a %- 0.67 (R•v 01102) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LT 2i (' b I eau5 -RWN2 U otLCk! �r El Parcel ID: C) 5 O -ZZy -O 1 A. WELL DATA t?0� 1C L�t�tE�2 Well type _ Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE RE If A, B, or C provide PWSID # _ Sanitary seal (Y/N) _ Cased to ft. FROM WELL LOG 9— p.m- Coliform colonies/100 ml. Nitrate mg./I. Ar c: mg.A. Date of sample: B. SEPTIC/HOLDING TANK DATA TankType/Material '5 -FC- )L Ig'Ee4,_Wr�s Tank size 1000 gal. Number of Compartments I Well Log (YIN) Wires properly Casing heigbkgbove ground) in. ft. Other bacteria Collected by: colonies/100 ml. Date installed Cleanouts \tr Foundation cleanoutdON) _S Depression over tank (Y/M _L)0 High water alarm (Y4V AJC Date of pumping 115 OS Pumper S�S (7um1PiAX* C. ABSORPTION FIELD DATA _ Date installed 7 1 `8 OS Soil rating (g.p.d./ft' or ft /bdrm) LD System type S fli4ccn ry ( 1 XsJU'f r r Length 40. ' ft. Width s ft. Gravel below pipe o,5 ft. Total depth te ft. Eff. absorption area q9) ft2 Monitoring tube If e, Depression over field NO Date of adequacy test NXU-) 5 vn Results (Pass/Fail) Fluid depth in absorption field before lest — in. Water added= gal. Elapsed Time: =min. Final fluid depth =in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Absorption rate >= For bedrooms New depth= in. If yes, give date 9.p -d. D. LIFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) Pump off level at_in.high-weterat� level at in. Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: POF L(C lf—�v.-rt_V,- Septic tank/lift station on lot Absorption field on lot Public sewer main line On adjacent adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ( Property line g5 , Absorption field 5 �+ r r r Water main I d Water service line Surface water 100 ?— Wells on adjacent lots 13 H SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Iz% Building foundation '3-3_ Water main I U ( t rt Water Service line f I �� Driveway, parking/vehicle storage f 0 + Surface water U r Curtain drain nN=15- ICA)a1 Wells on adjacent lots 0 fk F. COMMENTS G. ENGINEER'S CERTIFICATION r 1' r' 1 " " •tip I certify that I have determined through field inspections and ; 4 ?Ij*1 e a > review of Municipal records that th above systems are in conformance with MOA HAA uidel a in eNect on tl ' b te. ; • «..... A. f:.... Engineers Printed Name c; 1(S s Date HAA Fee $ fi36 'a Date of Payment 9� d ae Receipt Number ���4e (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number 1 hereby certify that I have surve}}•ed the following described property : l— 0 7- ?_ 71 ----- ca ./�. 1;rY•fr Vr l/Ti�:'�1:-•�_f cS1 "Anchorage Recording Precinct. Alaska, and That the improve• ments situated thereon are within the property lines and do not overlap or encroach on the pn+pert'v lying adjacent thereto, that no improvements on property Ivin • adjacent thereto encroach on the premises in yuesnon and l9at there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this day of _d[!�" 21X1 ROBERT C. 101INSON ? F_'. �•i• SCALE: < Registered Land Surveyor Na. 886.1-5 1" Zen ik+x 77-04%, Fatale River. Alaska W577 ('hone ('N17) 6y4-2543 • IN n r i' I rt. -a <t• . " � r< 1. t Gr lr_v� ��� r rlt. 1. �._e- • 1 �RIY^1 L � 1 jl •-�. '�.`•Y q� i•• to `•+�tf:?i 1 n•i Iti 1C?131 T- 11• i_ rJ T y' G N f,J [t AS -BUILT 1 hereby certify that I have surve}}•ed the following described property : l— 0 7- ?_ 71 ----- ca ./�. 1;rY•fr Vr l/Ti�:'�1:-•�_f cS1 "Anchorage Recording Precinct. Alaska, and That the improve• ments situated thereon are within the property lines and do not overlap or encroach on the pn+pert'v lying adjacent thereto, that no improvements on property Ivin • adjacent thereto encroach on the premises in yuesnon and l9at there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this day of _d[!�" 21X1 ROBERT C. 101INSON ? F_'. �•i• SCALE: < Registered Land Surveyor Na. 886.1-5 1" Zen ik+x 77-04%, Fatale River. Alaska W577 ('hone ('N17) 6y4-2543 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program v 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: S&S ENGINEERING Legal description: EAGLE RIVER VALLEY RANCHETTES LOT 27D o 'o`MSY i. { O ZD The attached paperwork has been reviewed and Is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. _ ❑ Additional soils information needed. ❑ Water monitoring results inadequate. ❑ Discrepancy in information submitted. _ ❑ Topographic information missing or inadequate. _ ❑ Incomplete; missing _ ❑ Incomplete; missing _ ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. _ ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ® Other. -WHAT KIND OF DIVERTER VALVE AND FLOW SPLITTER WILL BE USED? WHAT IS THE VERTICAL SEPARATION BETWEEN THE WATER & SEWER LINE CROSS-OVER. CONNECTION JOINTS FOR PRIVATE SEWER LINE NEED TO BE SEALED IN AREA OF CROSS-OVER FOR ABOUT 10 FEET ON EITHER SIDE OF WATER LINE. Name of reviewer: JOE GOODALL Date: 6/20/2005 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK