HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 22AEagle River
Valley
Ranchettes
Lot 22A
#050-223-23
Municipality of Anchorage
• On-Site Water and Wastewater Program • (907) 343-7904 Page / of y
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number:Os?! 7/0/z/ PID Number:6 S 0z ?3z.?
Dwelling: pit Single Family(SF) ❑ Duplex(D) ❑ Multiple (SF and/or 0) Project: ❑ New 4g- Upgrade
Name: ABSORPTION FIELD
Address 1Deep Trench ❑ Shallow Trench E] Bed ❑ Mound
/ref571AjC 4IJ T y �'IZ•4AJ ,.Q ( 0 Other
Phone / Number of Bedrooms Soil Rating Total depth from original grade
72 �7 . 300 3 (J. C GPD/SF /O. 5 Ft_
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision BlockLot S Ft. 7 Ft.
Mae-- 0(1,1(12_ V liAy,e4, r
.a+ 'r-C-1 )2,4 Fill added above original grade Gravel length
Township Rana Section —
Ft. 5—ciz Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 2.5 Ft. -- — Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist between trenches
From
Tank Field Lift Station Tank Line 750Ftp i
Ft.
•
Well — _ — TANK *'Septic ❑S.T.E.P. ❑Holding 0 Other
rbil(m- _ Manufacturer/ ,t �j Capacity
Surface Water GQ,f. r 4/V C if Q f24 . /�-- /Q(� 0 Gal.
/QQ f Material Number of compartments
Lot Line Q /1- /0 /, _ NA 3 TCL L p_
Foundation /O if (0 — LIFT STATION //4
l Manufacturer Capacity
Curtain Drain t/A_1( v v� Gal.
Pump on level at Pump off level at High water alarm at
Remarks
in. in. in.
Pump make and model Electrical Inspections performed by
Installer + /� , / PIPE MATERIAL House to tank Tank to
/v C DA S j3�3 drainfield y�3Q,�L f
F Drainfield Co/MT
Inspector `�� r.v� BENCH MARK (Assumed elevation) / 0 ft ![�
Inspection `� Location and description
dates: 1 2 7 2nd "7 6 e ,
aro 5 ,-//7 4th ��//q�l 7 ��
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
•Os Aske,
Conditional Approval: . Date P
'ft
•JAN• do'
_.\ L 1' Date C-I 7
Inspection Report_9-1-12.doc
AS-BUILT MEASUREMENTS
A B C
FCO 22 30
ST1 42 39
ST2 48 41
DCO 51 40
DV/C01 79 42
MT 75 33
CO2 23 23
Twenty Grand Road
Decommissioned Old
New Diverter Seotic Tank/Crib
Valve (DV) ER UPC
d
C❑1
DCO L 3% Slope
Shafer --__________ ' �2•
TH cS
M
, s��
New 1000 Gallon
u
3% Slope () i= O TH1 Septic Tank
fco w/ Double Cleanouts
Lot 23B TH Zu:
17' & Dry � �,
s02 Q 3 Burn Lot 22B
I
3% Slop: e
,4'
et Septic
S
et
w
-4a
Keybox 10' Utility Easement
Lot 23D Lot 22C Lot 22D
eptic
i\.",,
� EAGLE RIVER VALLEY 1 = 40
NORTHR/M ;*;49m*\ RECORD
ENGINEERING _ RANCHETTES LOT 22A
PO Box 770724 �---a--�-�-�-�-��-�-
w __.�..__, LAY❑UT
Eagle River, Alaska 99577 sews 4 WASTEWATER REC❑RD
907. 694. 7028 ',�`' ' UPGRADE SEPTIC 6/19/17 [SHEET:
6/19/17 3
Foundation Cleanout Elevation @ 96'
Tank Cleanouts Elevation @ 92' •
Fin ade Opposing Cleanouts Between Septic Tank & Trenches
4 Foot Cover
or Equal
To Diverter Valve of' Trenches
:,—Elevation @ 91.5'
1000 Gallon Steel
levation @ 92' 'Anchorage Tank' Elev tion @ 91.3' Mounded Cover To Match Terrain
Monitor Tube
Solid Pipe leanout
Elevation @ 94.5'
Original & Final Elev
Filter Fabric 3.
Elevation @ 91' ;• :
!.. !=!=i=!=!='=.
=1:.i;C;.:'= 10.5'
Elevations Both Ends , ,,,.,.,:*..,.,
P:•:•_�_•:��.
Drain Rock '. != =•=i 41;e
P.: P.; is is is
Elevation @ 84' P. P=�`0.;OZ0 Oz
P.: r.7 is is is i i:.
TH Elevation @ 78' (Dry) -"�"�"�
2.5'
NOR THRIM 1,;1- '
s TRENCH END VIEW EAGLE RIVER VALLEY
ENGINEERING �s'* '49m
; SEPTIC TANK PROFILE RANCHETTES LOT 22A
17237 Beor Pow Circle +µ sr...
Eagle River, Alaska 99577 ++ s/ �i
= SEPTIC SYSTEM
907.694.7028 '+ .0 `q4?
UPGRADE RECORD Dote: wn BSE 1' - 5 T3 Of 3
6/19/17 !Droy:
I SE
S❑ILS LOG - PERC❑LATI❑N TEST
TI- IM Date Performed: 5/19/17
ENGINEERING
Performed For: Dean
Legal Description: Eagle River Valley Ranchettes Lot 22A
DEPTH
(FEET)
Organic T.H. Location: See Attached Design
1 -
2 - IC:P ;1...-"-:.:
3 -
4 - ; 1Q. .:Q:: SP Sand
5 _ - ::0. w/ Gravel
_ Low Silt
6 Groundwater? No
7 - Depth --
8 - p Fine Sand Water Depth
After Monitoring.None Date: 5/28/16
10 - # Date Gross Time Net Time Depth Net Drop
: . :.,.
11 -
1 5/28 0 -- 7' --
12 - : 2 5/28 10 10 min. 10.5' 3.5'
13 - 6-:::... .
3 5/28 12 -- 7' --
14 - 4 5/28 22 10 min. 10.5' 3.5'
15 _ 5 5/28 25 -- 7' --
16 - . : 6 5/28 35 10 min. 10.5' 3.5'
17 - 7 5/28 37 -- 7' --
18 - 8 5/28 47 10 min. 10.5' 3.5'
5/28 50 7'
19 - 9 -- --
20 - 10 5/28 60 10 min. 10.5' 3.5'
21 - Percolation Rate 3 rain./inch Perc Hole Diameter 6"
Test Run Between 3' and 4'
Comments: Precnaked. Measured to near ct 1/1 F,th inch.
Performed By NorthRim Eng. I .-- CERTIFY THAT THIS TEST WAS
Performed in Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE. DATE: 5/28/17
"�� TESTHOLE LOG
NORTHRIM *:491h * TH1
ENGINEERING � ...
PO Box 770724 -,x.�. t
'
Eagle River, Alaska 99577
907.694.7028 '� r? GEOTECHNICAL tee: �:'
5/28/17 ram
72-013 (RBJ. 3/78) " G/
MUNICIPALITY OF ANCHORAGE
\l
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING
DIVISION
t�
825 L Street • Anchorage, Alaska 99501
Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR
WELL INSPECTION REPORT
NAME
PHONE
❑ NEW
UPGRADE
MAILING A1Q -SS
S e S eOV - sR
LEGAL DESCRIPTION
L ii pc
s
LOCATION
NO. OF BEDROOMS
ZO
DISTANCE TO:
Well
Absorption area
Dwelling
PERMIT NO.
D
�Y
;:z
Q
Manufacturer EX 1 sTlN C�
Malarial
No. of Compartments
~
N
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
d Y
DISTANCE TO:
Well A /
Dwelling
PERMIT NO.
—10Z
V
_ FQ•
ManufacturerMaterial
Liquid capacity in gallons
O
DISTANCE TO:
Well
Foundation /
"30 •t
Nearest lot fine /
PERMIT NO.
W =
L'
1�
Z W
No. of lines
Length o eat lid^
Total lengyth II�.lirfs
Trench width
Distance between lines
i.0 `
3Q inches
I-
O
Top of tile to finish rade
9 /�
Material beneath the
Z. inches
Total offe5uve eObs tion area
W
Length Width
Depth
PERMIT NO.
W
Qa F•
Type of crib Crib diame er
Crib depth
Total effective absorption area
W
W
DISTANCE TO: Well
Building foundation
Nearest lot line
J
Class Depth S
psill>:q N�
Distance to lot line
PERMIT NO.
1
J! G
W
DISTANCE TO: Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
14
PIPE MATERIALS
c
_-NtY
_
15I'lov
Exi sT/
V41,
r7
PvC,
SOIL TEST RATING
INSTALLER
TUIR
-e EXc
REMARKS
�. At
V~ q�-,
Roblrrt A. Shukr
No. 14,7-C i
1
APPH
) DATE LEGAL
ERD 13G::
72-013 (RBJ. 3/78) " G/
MUNICIPALITY OF ANCHORAGE
Department --°f Health and Environmentr""Protection
825 Street, Anchorage, AK. J9501
26 -472
4 0
Permit #� * * * HANDWRITTEN PERMIT
� � WE AND /OR ON-SITE SEWER PERMIT
Applicant: �//> %/ Mailing Address/` <J�/�J G11�
Location: �� GIC<1' cam• Phone Number:
Legal Description: /- ZZ
Type of Soil Absorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms:
The Required /Si�ze of
DEPTH - LENGTH b C-7
Lot Size:
Seepage Bed: Holding Tank:
Soil Rating(sq.ft/br)
the Soil Absorption
.GRAVEL DEPTH 6
System Is:'
t !�
WIDTH 3o
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet)._�
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = � L4_4ALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* *.* TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection.and approval by this departme
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fe
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 * * *
I certify that: .
(1) I am familiar
set forth by
(2) I nder l
u
(3) I under
d
Signed
t
SWP/024(1/81)
with the requirements for on-site sewers and wells as
the Mpnicipality of Anchorage.
1 th ystem in accordance with codes.
the on-site sewer system may require enlargement if
remodeled to include more that 3 bed oms.
Issued by:/
Date:
❑ SOILS LOG
MUNICIPALITY OF ANCHORAGE
\i DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
OLATION
825 L Straat, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST L
PERFORMED FOR: nN/ �� 775=1< -,DATE PERFORMED: v/ —/V '.9 5
LEGAL DESCRIPTION: C— I,- e— ^1 fi
PEPJJI
011
1 r i S/Gty��nol
2-
3-
4-
5-
6-
7
3 45 6 7 0
9-
10-
11 10 11 ' 4
kJ
12-
134-
14
213
14
15
16
17
1s
19
2-31 1,6ee--
lave /
OF
'IY'Lis:.Vr.."'"'
Robert A. Shots
No. 1457-E
WAS ROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SLOPE
aReading
Data
Gross
Time
Net
Time
Depth to
Water
Net
Drop
AW
30
!0
-1/y
3N
20
PERCOLATION RATEy (mi utas/inch)
TEST RUN BETWEEN FT AND F7
COMMENTS / '
. $ & ?? 1730INEEKNU
PERFORMED BY;. - fiRI3 ISOX
72-008 (6/79(
3
August S. 1971
Ilmar Peterson
1341 N. Northern Lights Blvd.
Anchorage. Alaska
Subject: Lot 22A. Eagle River Valley Ranchettes Subdivision.
Dear Mr. Peterson:
It 1s possible that an approved sewer and water system
can be installed on the subject property. A permit has
already been issued to Install a sewer system on the lot.
Sincerely.
Lynn S. Coad
Environmental Specialist
cc: FHA
st
Municipality of Anchorage •
On-Site Water and Wastewater Program
_ (907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcell.D_ 050-223-23
Expiration Date: 5---2:3 - e
1. GENERAL INFORMATION
Complete legal description Eagle River Valley Ranchettes Lot 22A
Location (site address) 18850 Twenty Grand Road,Eagle River, AK
Current Property owner(s) Riddle
Day phone 907-980-5452
Mailing address same
Real Estate Agent David Windsor O. RE/MAX Dynamic Day phone 907-727-3300
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 C Well ❑ Community ❑
Public Water System ® Public Sewer ❑
Received by: ���1�•► Date: �/` 0 7
Y
COSA to be released to the engineer,unl Jotherwise requested by the engineer.
COSA Fee $ ,c1(7 7 Date:
Date of Payment 3// 77/1 Date of Payment
Receipt Number 03 (07 Receipt Number
COSA# Q C {-71 D ?7 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 6/19/2017,
OF At 'tt
tea ,• .
, fi
6. DSD SIGNATURE s
System #1 Approved for - bedrooms. ": ' ` '
ve
di r'., Sten :i'_ Lr.
System #2 Approved for bedrooms. (10)..,'"°� 4f/(/2�6/
Disapproved. nPROFi:Ss :•
Conditional approval for bedrooms, with the following stipulations:
Iyr�i�C
. ON-SITE
)N-SITE
WA
AND m
„Y WASIFtn,ATER
ri PROGRAM
By: 6 -19-11 Original Certificate Date: 3-2-0-i 7
The Municipality of Anchorage Devlopment 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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9.1.12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of Ori-Bute Systems ApprovaB CheckBflst
Legal Description:&9 /2 /vvi- v /!e j hL4� t , L 224Parcel ID:Q.5$OZZ 3 e
A. WELL DATA fuh JCC- wat-et-
Well type If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
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 Nitrate mg1L
Arsenic ug1L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S �/ S r6EL Date installed 5 f/ 7
Tank size /6,00 gal. Number of Compartments Z Cleanouts (YIN)
Foundation cleanout(Y/N) Depression over tank (YIN) N High water alarm (Y/N) A/
Date of pumping A ,EL) Pumper
C. ABSORPTION FIELD DATA Alf
Date installed 5/23//7 Soil rating (q.p.d./ft2 or ft2/bdrm) Q.(P System type 'rrti,.t, 4
Length 547/ ft. Width Z-S ft. Gravel below pipe 7 ft.
Total depth/0 5 ft. Eff. absorption area 750 ft2 Monitoring tube Depression over field iv
Date of adequacy test Ai .t41 Results (Pass/Fail) I / For 3 bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION /!A
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO: f 4CG 44j1411154"
Septic
14T//-
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /C1'14.- Property line /D ''f" Absorption field /6 -f-
Water main / C1 '* Water service line 70 '4- Surface water /DO '-t-
Wells on adjacent lots lDG
ABSORPTION FIELD ON LOT TO:
Property line /0 t Building foundation /a '1- Water main /D /r
Water Service line /O =f- Surface water
Q 'f' Driveway, parking/vehicle storage 2 Q 'f'
Curtain drain UN k" Wells on adjacent lots //' .0 '1—
F. COMMENTS
£9t- 0 7;0r:--;;A)c co,J,JcT-A V/4
p/v&z 7-5-K 0G1/6
G. ENGINEER'S CERTIFICATION �:%:-..`+�,41,_
r11
1 certify that 1 have determined through field inspections and �'�p�,.••• A**....,1/4;;I:II
review of Municipal records that the above systems are in d "4 .•17 $.
conformance with MOA COSA guidelines in effect on this date. * r kV ...,.3 ' ,.
• Engineer's Pri ted Name S / ✓r' Eiv ',-
Engineer's / t5-6.
e1; �
Date ‘�! 9 .'----c'0,-,s Steven W. Eng •. `��
r / 7 1 W. PE 25 ...ea*,
Ar
..
Au ',UFESS\Us ,�
COSA yellow sheet_2-6-15.doc
. i
t N
_,r c
TWENTY GRAND ROAD
.a
r,,
S,49'59'15"E 133.0 ' r
rr rr ---_i jI I
i____ \\.....
•
WOODEN FENCE
/ • . : 1 WOODEN FENCE
cc! •GRAVEL •
-
SEPTIC .2 DRIVEWAY:..
PIPES .. .
WOODEN FENCE-
•
z vi
iii . 9.4' o
O 49. 29.0 +� O
rx ri rr Q
Lot 23-B �;° 1 STORY RESIDENCE Lot 22-B
2.1'x4.5' ` U w/ DAYLIGHT BSMT. "'
"1 CANT = La c.4A o 0 26.0' Cn
b .1' 30.2' v ...,---t
i8
cv O
<
38.9' , - o le I
;'„. *,tiiltimCOVERED Lot 22_A r
PATIO 17,955 s.t. CHAIN-LINK FENCE
CHAIN-LINK FENCE CANT-z I
CANT
d SHED R 10' UTILITY
0
15.1' EASEMENTS
- - - -
f
- - - - - - -
N 89'59'15-W 133.00'
I
1
Lot 23—D Lot 22—C I Lot 22—D
I
I
I
NOTE: THE LOT IS SERVED BY A PUBLIC WATER SYSTEM
PLOT PLAN AS BUILT _x SCALE 1= 30' GRID NW 0054 Project No. 17-141/A1
Sc � + 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
•
•
Lang lA s s o c i a 1 e s , inc . (907) 522-6476 Phone �Q�QQQ�q
(907) 522-4625 Fax o O F A N
Professional Land Surveyors kenOlangsurvey.com . •„.s.(� L,q 4>
jonathanOlongsurvey.com oohs Dah
I herebycertifythat I have surveyed the followingdescribed properly: •
�� ~'� V
LOT 22-A, EAGLE RIVER VALLEY RANCHETTES (PLAT P-129A) p IP * 49TH /� .. Opp
Anchorage Recording District, Alaska, and that the improvements situated thereon ore D
within the property lines and do not encroach onto the property adjacent thereto, that �//yy i I
no Improvements on the property lying adjacent thereto encroach on the surveyed t//�' 'TA �: Kt7INEfH G. LAN . 4
premises and that there are no roadways, transmission lines or other visible
VV/�� . s�
easements on said property except as indicated hereon. 4� ��F - �C�� l� ��
0 -Q 520 . ' '
Dated this the Day of - , , at Anchorage, Alaska a4 BAR •• 9 4
�hp 0 SSIaNAt- "
It is the responsibility of the owner to determine the existence of any easements, 04�pOa4.`'
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
Municipality of Anchorage
Development Services Department _
Building Safety Division
On -Site Water & Wastewater Program
4700 BStreet
P.O. Boxox 19 19 650
Anchorage, AK 99519519
-6650 (^J
www.muni.org/onsite `
(907) 343-7904 \ `L
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. f6Q - =3- a�3 COSA#
1. GENERAL INFORMATION Expiration Date: I .2 0 ' 0
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
EAGLE RIVER VALLEY RANCHETTES: LOT 22A,
18850 TWENTY GRAND • EAGLE RIVER, AK 99577
PHIL PROBERT Day phone 696-0627
18850 TWENTY GRAND DRIVE ► EAGLE RIVER, AK 99577
Day phone
ERIC BUSHNELL w/ PRUDENTIAL VISTA Day phone
16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
689-6464
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
0
Public Sewer
❑
IhbMd icipaliVZfAnehi5ragoYDevetopYnoTitSerAeog-Departmen"DSD)7ssaes-CertiflcatesmfOnStte-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 samples. (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 engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verity that my
Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date t10L
Engineer's Comments:
In conducting this evaluation, GEG, LID. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described 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 dopend on the local soils condition, groundwater 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 lost
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benerit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will It confer any legal right whatsoever.
S. DSD SIGNATURE
V Approved for -3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the flowing stipulations:
G\Q� ' • O
ON-SITE
WATER AND
WASTEWATER
;.--P!R0G&AM—
Attachments: / "�v11111I
COSA Checklisty Arsentc-Advtsory
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
By. t Original Certificate Date:
ir
1P.v 11R 1
j Municipality of Anchorage
• Development Services Department
Building Safety Division
f O"Ite Water 3 Wastewater Program
4700 BragaW Street
P.O. Box 198650
Anchorage, AK 99519650
www.munlorg/onelte
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
'a4AeIG
Legal Description: EAGLE RIVER VALLEY RANCHETTES S/D: LOT 22A. Parcel ID: d '6-0 -2a 3 -23
A. WELL DATA
Well type
Date completed
Date of test
Static water level
Wed production
PUBLIC WATER
if A, B, or C provide PWSID# _ Well Log
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate
B. SEPTICIHOLDING TANK DATA
R.
g.p.m.
Date of sample:
Tank Type/Material UNKNOWN
Tank sae 1000 gal. Number of Compartments UNK
properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
ft.
g.p.m.
Date installed UNKNOWN
Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Date of pumping 4/21/2006 Pumper JR'S PUMPING
CRIB INSTALLATION DATE AND
C. ABSORPTION FIELD DATA DIMENSIONS ARE UNKNOWN
Date installed 6/1983 Soil rating (g.p.d./ftiDr4J§jRD 268 System type CRIB/TRENCH
ml.
Length 67 ft. Width 2.5 A. Gravel below pipe 6 ft.
Total depth 'a•310.s ft. Eft. absorption area 800 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 8/24/2006 Results (Pass/Fall) PASS For 3 bedrooms
+041 •'60.5
Fluid depth in absorption field before test 48 in. •*39 Water added 838 gal. New depth 90 in.
Elapsed Time: 1298 min. Final fluid depth 69 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM 6 type) NONE KNOWN If yes, give date —
'*CRIB/TRENCH SEE ATTACHED LETTER
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (Y/N)
"Pump ofr leve ig water alarm level at k1.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on
Public sewer main
Sewer /septic service line
areas
PUBLIC WATER
On adjacent kits
On adjacent lots
sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 100+ Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line .10'+ Building foundation 10'+ Water main 10'+
Water service line 100+ Surface water 100'+ Driveway, parldnghrehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent kits 200'+
F. COMMENTS
*CRIB UNKNOWN
O. ENGINEER'S CERTIFICATION
I cantly that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
data.
Engineer's Printed Name JEFFREY A. GARNESS
Date
COSA Fee S y� a o o
Date of Payment % r1 J � J () 4
Receipt Number C7 Q7 5(,C)
(Rev. 11/05)
Waiver Fee E
Date of Payment
Receipt Number
GARNESS ENGINEERING GROUP, Ltd.
._�� � CONSULTANTS & GENERAL CONTRACTORS
September 5, 2006
Municipality of Anchorage
Department of Development Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Subject: COSA for Septic System at Lot 22A, Eagle River Valley Ranchettes Subdivision.
To whom it may concern:
The subject lot has a 3 bedroom house on it which is served by public water and a private septic system.
The results of the field investigation and adequacy test are summarized as follows:
SEPTIC SYSTEM ADEQUACY TEST: The septic system consists of a 1000 gallon septic tank and a
crib (The installation date and dimensions of the crib are unknown). There is also a trench that is 2.5 feet
wide, 67 feet long, and has an effective depth of 6 feet. Prior to the start of the test the invert in the
trench was unable to be found due to a bent pipe. Prior to the start of the test the trench had 48 inches of
liquid in it and the crib had 41 inches of liquid in it. Approximately 369 gallons of water was added to
the crib, which caused a rise of 16 inches in the trench and caused no rise in the crib. An additional 469
gallons of water was added to the crib which caused the trench to rise an additional 26 inches (42 inches
total) and caused the crib to rise 19.5 inches (crib completely full). Approximately 322 minutes later the
trench was found to have dropped 15 inches and the crib to have dropped 16.5 inches. The septic system
was then checked approximately 1298 minutes later and found the trench to have dropped an additional
6 inches(21 inches total) and the crib to have dropped another 5 inches (2 inches lower than prior to test).
After completing the test the homeowner dug out the bent pipe and by using a stick with a hook attached
to it, what appears to feel like the invert was found approximately 34 inches of the bottom of the
monitoring tube. Based upon this data the trench was surcharged prior to the test. In short, in order to
utilize the upper portion of the crib, the trench must be surcharged. Regardless the crib/trench absorbed
450+ gallons per day.
If you have any qu"ions, please contact us at 337-6179.
.E., M.S.
3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamesscnginecring.com
0K 09/06/2006 09:39 9073449921
00
f�
i�
JRs Pumping
PO Box 773415
Eagle River, AK 99577
(907)694-6454
BIIII_ na Information
Phil Probert
18850 Twenty Grand Road
Eagle River, AK 99577
(907) 696.0627
JRS SEPTIC
Job Description:
12009
P.O. Number.
Order Date:
Terms:
Net 30
Salerop:
Kartia
Map Back:
$0.00
Cross Streets:
Job Slte Information
Phil Job Comments:
18850 Twenty Grand
Eagle River, AK 99577
(907)696-0627
Sun Beau Drive
PAGE 01
Service Agreement
Number.
019615
Order Date:
20 -Apr -2006
Service Date:
21 -Apr -2006 12:00
Techniclam
Tony
Tax W 0
Job Type: Repeat
Map Grid: 99
Last service 01/28/05 10009
— Clogged from house to tank. Go holding water.
Used snake, couldn't clear clog —
Pump Tank - L's Normal line clear from House c(o to
Tank
Additional Location Comments Dlagrrn: "' aim 872.bmp
a's an cedar sided home w/ green
trim, 3 car garage, camper in dw.
Septic In from.
F.
Service Type Qty Price Each Tax?
Septic Service 15K 1 $0.00 No
Gallons Planned: 1500
Gal. Actual:
Hose Length: 1
Double Tank: C3
Pump system:
Baffles Inlet: ❑
Baffles Outlet: ❑
Extension Actual
$0.00
Actual Charges:
Custrnar agreeat to ma terms and condlaons shown. THIS IS A BINDING AGREEMENT.
Signature and Tide of Customer Representative Date
Accepted by JRs Pumping Date Accepted
For your Waled com+nlar,"" accept American Exprase, Dicovr, Visa And Master Card payments ovr the phone.
After 30 Days accounts will be turned over to collections. $25.00 For NSF Checks Returned.
NonTaxeble Total
Tsxsble Toui
Tax Total
Grand Total
Estimated Charges: $0.00
$0.00
$0.00
$0.00
Actual Charges:
Custrnar agreeat to ma terms and condlaons shown. THIS IS A BINDING AGREEMENT.
Signature and Tide of Customer Representative Date
Accepted by JRs Pumping Date Accepted
For your Waled com+nlar,"" accept American Exprase, Dicovr, Visa And Master Card payments ovr the phone.
After 30 Days accounts will be turned over to collections. $25.00 For NSF Checks Returned.
SEP -25-95 MON 09;29
A
RE/MF IEP EAGLE RIVER FAX NO9076960214 P.02/03
l
h1
.YAP°sP �ir,•w
irr 06 .
Som '� o,•. �. 4 .
r CIO
•'• ••.�
• IlI
_% 1�
fS.J
U v I S, CA-rlo ° "T- Cr S �I301c,
io a—,r��Y .r..�e�.✓r
,T -NO CORNERS SET THIS DATE.
I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SC
FOLLAWINC DESCRIpED PROPERTY:
A'Keir,py�F'/s�Yp►f•,P./isr�Ri+3'l� !°r
AND THAT NO EWMACHMENTS EXIST EXCEpr AS DA
INDICATED, IT IS .THE
R RESPONSIBILITY OF THE
I!AQ TO DETERMINE THE EXISTENCC OF
EMENTS, COVENANTS, OR RESTRICTIONS Y GRID
WHICi1 DO NOT APPEAR ON THE RECORDED �I_ • '1'ws'v
VISION AL•4T, UNDERNO CIRCUMSTANCES SHOULD FBI
OF FENCE LINEN BE USED FOR CONSTRUCTION s7-dZ
ART LINES. �' OR FOR ESTABLISHING BOUND,
DRAWN-
.7...,�s
.77f
C
I b.
U v I S, CA-rlo ° "T- Cr S �I301c,
io a—,r��Y .r..�e�.✓r
,T -NO CORNERS SET THIS DATE.
I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SC
FOLLAWINC DESCRIpED PROPERTY:
A'Keir,py�F'/s�Yp►f•,P./isr�Ri+3'l� !°r
AND THAT NO EWMACHMENTS EXIST EXCEpr AS DA
INDICATED, IT IS .THE
R RESPONSIBILITY OF THE
I!AQ TO DETERMINE THE EXISTENCC OF
EMENTS, COVENANTS, OR RESTRICTIONS Y GRID
WHICi1 DO NOT APPEAR ON THE RECORDED �I_ • '1'ws'v
VISION AL•4T, UNDERNO CIRCUMSTANCES SHOULD FBI
OF FENCE LINEN BE USED FOR CONSTRUCTION s7-dZ
ART LINES. �' OR FOR ESTABLISHING BOUND,
DRAWN-
.7...,�s
.77f
Municipality of Anchorage
Development Services Department
Bu4Mp Seely Division
• �..! On-Sfh"*or and WUtlwW@r Pm9ram
4700 South &39aw SL
P.O. Box 196630 Anchorage. AK 995194650
ri•Tyw.VAa02raaa ak U
P07) 343.7904
Pfrf rt ed For.
L►aat t)es4wn•
ape+
Soils Log - Percolation Test
00 cc /1�lu�i 0
0816 P6rtonned: 7I)CIr•S
6-yeP:lcrVawriPr4r(je5t,,al0 Townihip•R/n9e.8/rtorc7ILI0, RI W. 56C
7 -CW 14Ot.0 L
(-17• ion
bm
TCA
PERFORMED BT;
PERFORMED INP
VYASCROUNDIHATER �^
ENCOUHMAED7 :l
IFYES.ATTdIATDEP 1V j(*W,- L
D•PIh IMWNMARar
M"Raln9T -t>R `/ '
1f1Z'
rcnvr ZDIAMETER
:FNS
THAT THIS TESTWA
:FNS DATE. DATE:
MUNICIPALITY OF ANCHUFIAGE
• DEPARTMENT OF HEALTH d HUMAN SERVICES
Division of Environmental Services APALITY OF ANCHOWAGE
On -Site Services Section ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744 OCT 01 1997
CERTIFICATE OF HEALTH AUTHORITY RECEIVED
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # c 5O HAA it
1. GENERAL INFORMATION
Complete legal description -- L -OT 224 , GLE R1v V�`l�y
Location (site address or directions) I 0 6 50 TU��z^ ( Cc�,.t0 QoZ1A
Property owner " r'" � 'r'eop--/ cox Day phone 696 — 4448
Mailing address S4ml=- lkS Azovc-
Lending agency tJ Day phone tV
Mailing address-
Agent
ddress Agent ^I Day phone N�rq
Address NIA
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: PLF�E �J-
Individual well `jam G,ar�Nt✓SS
Community well
Public water �C
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site x
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-=(AW.1/91) From MOA121
S. STATEMENT OF INSPECTION" Si'ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Alaska Water &
Name of Firm
Address
Engineer's signature
6. DHHS SIGNATURE
V Approved for t "REC bedrooms.
Disapproved.
Conditional approval for
Additional Comments See -
22
Phone ?37-617i
Date 71-2
Zr
bedrooms, with the following stipulations:
Date 10'7'97
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-M(P., uvn SWk ra m
Municipality of Anchorage Mul.OF
DEPARTMENT OF HEALTH & HUMAN SERVICESv
Environmental Services Division oc l i99
oom 502 o Anchorage, Alaska 99501 o
625 L Street, R Health Au horny Approval heckllst(907) 343-4744
RECEIVED
Legal Description: L -r Z2 a; t2 Parcel I.D.: 0s0 —223 —2.,3
{2atiaatE-t'"t'ES
A. M LL DATA
Well typed 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 und)
ires prope (Y/N)
Sanitary seal (Y/N)>LOG
FROMNSPECTIONDate
of testStatic
water level
Well production g.p.m.
WATER SAMPLE RES
Coliform Nitrate Other bacteria.02t
°Q
of sample: Collected by:
B. SEPTICJHOLOING TANK DATA
tr+q+ou��
thtltao�.�•J
Date Installed Tank size toaD Number of Compartments Cleanouts (Y/N)�
.LnL
Foundation cleanout (YM) Y Depression (Y/N) NO High water alarm (Y/N) fJA
t
7 W
L19AR, J. f -7s
Date of Pumping Pumper
C. ABSORPTION FlELD DATA t0 a,9 -t9 W S-ra 'LA'r tod O+c'rE Q"+� X10+ S IS
'T¢Da
�Q6 �0. J t s t'oL 19 3
1>,�M
6 83 26 6
Date Installed Soil rating (g p� or ft'/bdrn) System type 0 -alis
' Length %-7 Width 2051Gravel thickness below pipe 6 Total depth
Effective absorption area Monitoring Tube present (Y/N)Depression over field (Y/N) 0 O 1
O
Date of adequacy test 9/1'v 6,16 Results (P , ail) PA" For 3 bedrooms `m "
cftf L 43 y4
Fluid depth in abs field before test (in.); Tc 4 mmedlatey after Fugal. water added (in.): -rs " �J
41? a
Fluid depth Ttt (Ins) Minutes later: 2 Absorption rate = 4t -i)" a.p.d.
Peroxide treatment (past 12 months) (Y/N) NOW— leJar#J If yes, give date /J IA -
72 -02e (Rev. 3198)' 2 8 1FouRS (A'rER C9/�/97� • 36t/i" �, R�8
D.STATION
Date instaitad
Manhola/Access (V/N)
High water alarm leeyy�1%�
Gyel stee�fe d
E. SEPARATION DISTANCES
Septic/holding tank on lot
Absorption field on lot
Public sewer main
line
'Datum
FROM WELL ON LOT TO:
Size in gallons
On adjacent lots
Public sewer
Lift station
"Pump ofr level at*
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation :%0 rt Property line 20 r` Absorption field 5 +
r
I
Water main/service line _/O Surface water/drainaoe 10 } Wells on adlacent Iota +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
ears %
Property line T"O-1 ' le Building foundation / O + Water main/service line �D F
Surface water 100 /+' Driveway, parking/vehicle storage area 3or to 0-e+8 e/O
Curtain drain Nap— 114P.30W4 Wells on adjacent lots zao +
F. ENGINEER'S CERTIFICATION
„
Fri M, P flf_ 1.
field inspections and review of Munk*W
felines in effect on this date.
Signature
Engineer's Name J6644a,f A. �� S
Date 47& t 6 9�
HAA Fee $ io ' 4,jq 22
Date of Payment
Receipt Number �j�3lOiJ
72-026 (Rev. 3/98)'
Waiver Fee $
Date of Payment
Receipt Number
.� OF AZ h
iblM Ifo are
.S
MUNICIPALITY OF ANCHORAGE
M E M O R A N D U I.1
SEPTIC SYSTEM ADVISORY
HEALTH AUTHORITY APPROVAL NO.__qf\9]:aq57
Prior to a recent adequacy test on the septic system for
this lot, standing water was observed in
the absorption field. This indicates that approximately
re;n. 8 O % of the absorption area is inundated. Although
this system passed the adequacy test, the remaining life
expectancy may be limited.
This advisory must be attached to all copies of the subject
Health Authority Approval.
The existing absorption field is at least 80% failed at this time.
It should also be noted that during the adequacy lest the water level was over
the reported depth of the trench Iateral.The engineer was unable to verify this
since the standpipe to the Invert is bent at an extreme angle.
Effective Depth of Systerr
Before Tes'
Immediately after water addec
Next Day (End of Test;
approx. 1971 1983
Crib Trench
min. 43.5*1 72.00
36.501
58.75
43.251
75.00
36.251
57.75
Effective Depth - End of Test 7.25 14.25
Percent of system failed 83% SOY.
*fluid levels measured In Inches
SEP -25-85 MON 09:29
RE/MP-'-T EAGLE RIVER FAX NO_960214_ P, 02/03
rlviy.c,�r �v
^i •
ASBUILT-NO CORNERS~�p� —�
SE7 THIS DATE,
HEREBY CERTIFY -THAT
SI
I HAVE SURVEYED THE
DESCRIBED PROPERTY:
SC4LEt;44FOLWW'NC �
!arra!
�o
AND ftT NO ENCROACHMENTS.vera
EXI3T EXCEpr AS '
1MAhm NOIOAD. IT 19 -THE RESPONSIBILITY
DATE:
OF THE
TO DCTERMINE THE EXISTENCE
OF ANY
NOT I►TS, COVENANTS, OR RESTRICTIONS
GRID]
VIWl00
fOEAR ON THE RECORDED SUBDI-
NO 9TRS1 SOLD
ANY DATA N BE USED
4"w-rip".4"w-rip".PLI
FB:
LIN FOR CONR
ARY Lf FIImEES.INE3' OR FOR ESTABLISHINO �BMjyp.
'rj d?
DRAWN:
OiIsS
% 4k^. K �.-
Alaska Water & Wastewater
8471 BrookridgeDrive — Anchorage —Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
September 25, 1997
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Subject: HAA for Septic System on Lot 22A, Eagle River Ranchettes S/D.
18850 Twenty Grand.
To whom it may concern:
The subject property has a 3 bedroom house on it which is served by community water, and a
private septic system. My evaluation of the septic system is summarized as follows:
SEPTIC TANK: The existing septic tank is undocumented, consequently, it is uncertain as to
when it was actually installed. Based upon correspondence on file at DHHS it appears that the
initial septic system was installed around 1971. It is unknown whether the tank is made of steel or
concrete. If it is made of steel, it is reasonable to assume that it is approaching the end of its
useful life. If the tank is made of concrete, and has steel/cast baffles, it is reasonable to assume
that thebaffles are in poor condition. No warrantee is made regarding the future life of the septic
tank. Based upon the pumping records, the septic tank has a capacity of 1000 gallons.
UNDOCUMENTED CRIB: As is the case with the septic tank, the crib is also undocumented.
Consequently, it is unknown whether it is made of concrete, or logs, nor is it known what the
dimensions are. Based upon our filed observations, it appears that the crib has an operating depth
of at least 43.5 inches. The structural integrity of the crib (if is made of logs) is uncertain.
SEPTIC SYSTEM ADEQUACY TEST (9/19/97): The drainfield is a crib in series with a deep
trench. As mentioned previously, the dimensions of the crib are unknown. The trench is 67 feet
long, 2.5 feet wide, and has an effective depth of 6 feet. Prior to the start of the test the liquid
levels were 36.5 inches in the crib, and 58.75 inches in the trench. Five -hundred and four gallons
was introduced over a period of 56 minutes, which caused the levels to rise to 43.25 inches in the
crib, and 75 inches in the trench. Eleven minutes later the levels had dropped .175 inches in both
the trench and the crib. Twenty-eight hours later the liquid level in the crib was 36.25 inches, and
the trench was 57.75 inches. Based upon this data the system was deemed to be adequate for a 3
bedroom house (450 gallons per day).
NOTE: The adequacy of a septic system is iuifluenced by numerous factors, including, but not
limited to, seasonal surface water infiltration, groundwater variations, septic system
maintenance (frequency of septic lank pumping, usage of biological additives), condition of
drainpipe and pipe joints (which can be damaged by seismic activity and deteriorate with age),
type of substances deposited in septic system (cigarette butts, sanitary napkins, mist. objects),
and the amount of nater being introduced on a continual basis. Consequently, the results of this
adequacy test are only valid for the specific day of the test furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected No warrantee is made regarding the future performance of this septic system.
TRENCH SUMP: Upon inspection of the trench sump pipe, it could be seen that the solid
portion of the line was bent at an extreme angle, which prevented visual observation of the
drainpipe invert. Per the homeowner, the pipe had been in this condition since he purchased the
home. Should the pipe bend to such an extent that the joint separates, and the pipe fills with dirt,
it will be necessary to have it repaired. At this time, the`nump appears to be functional
if you have any questions, please contact me at 337-6179, 244-9612, or on my digital pager at
1-800481-1162. Thqnk you for your assistance
c.c. Tim and Terry Cox
ITY OF
® MUNICIPALEALTH & HUMANE
• DEPARTMENT OF HEALTH &HUMAN SERVICES
Division of Environmental Services 91
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # O 5-0 ':]L Z 3 ;IL 3 HAA # i E1`i--'JLVf' A
1. GENERAL INFORMATION
Complete legal description Lot 22A• Eaote. Rtvek Vatte.y Ranchtltte.s
Location (site address or directions) 18850 Twenty Gaand St.
Eaate. RiveA, AK
Property owner Detoaee d Renee Ta.Uman Day phone 696-1507
It MIA M(d
Lending agency
Mailing address
Day phone
Agent- • -VinaEnta Koh4ietdl R max o� E;at R� Day phone 694-4200
Address 16600 CenteAAietd D4iv¢ Eagte Riven., AK 99577
Unless Gtherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: -3
4. TYPE OF WASTEWATER DISPOSAL' z°
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-=(P.+.1A1) From MOA.21
° z
Individual well
,,
Community well
XXX n
v
Public water
T
w T
NOTE: If community well system,
< a
provide written confirmation harp Stare Al� attest-
Ing to the legality and status of system. 1=7
Cn
o
N ,n
T
4. TYPE OF WASTEWATER DISPOSAL' z°
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-=(P.+.1A1) From MOA.21
S. 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 furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm S i S ENGINEERING �� H _ a17 7 ��
Phone
Address EN4 River, Aleska 99577
Engineer's signature zdv�x% ( 'Z/�Zz ? Date 'I / / S / qr
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By:
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 engineers work.
mass m... un B. Ma. m+
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Municipality of Anchorage vjcE"
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DEPARTMENT OF HEALTH & HUMAN SERVICL6 SD,vis1
Environmental Services Division 3 /gg
825"L" Street, Room 502 0 Anchorage, Alaska 995070 (907k 74
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Health Authority Approval Checklist
Legal Description: Ltrr t ao Parcel I.D.: OSt.,> ZZ S z3
ir-'PA.
A. WELL DATA
Well type A, If A, B, or C. attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static eater level
Well production
WATER SAMPLE LILTS:
Colifo
ate of sample:
Date completed
Cased to
FROM WELL LOG
B. SEPTIC/IIOLDING TANK DATA
Nitrate
_ Casing height (above m
Wires grope rotcctcd (YIN)
AT INSPECTION
Collected by:
Other bacteria
9—
p.m-
Date installed 04- Tank size loon Number of Compartments utL ClcanoutsJ6�N)_\�_
Foundation dfan�t[0i4-- Depression (Y��_ High water alarm (Y&—LL—
Pumper Vjy, ,(-\'f:t-kptv-� T-"tc- Stzf-)
C. ABSORPTION FIELDDATA--IAI:o 15 fob t58S JPt,Roa� o,��y
Date Installed (. - 93 Soil rating (g.p.d.M2 or Iir/bdrm) Z (.S ystcm type
Length,_' . (07 • Width'4 Z• S Gravel thickness below pipe 1 e1 Total depth 10,
Effective absorption irca • &94 ca�c..Monitoring Tube prescnt(S>N)Sf Depression over ftcld (Y/! t�.(
Date of adequacy test 41 -11-917' Result�Fail) Pvss For 3 bedrooms
Fluid depth in absorption field before test (in.); 'S1 A V Immediately after736 gal, water added (in.): -5"40
Fluid depth - t*.'3 Minutes later:3�_ (in.) Absorption rate - p.d.
Peroxide treatment (past 12 months) (NO )--\Z) AC V-4"I,�Ifyes, give date 1,
D. LIFT STATION
Date installed
Manholc/Acccss (Y/N)
High water alarm level at*
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot Al,.- ; On adjacent lots 'i ld
Absorption field on lot �Iti ; On adjacent lots 'ale
Public sewer main IA Public sewer manholc/cIcanout
Saver /septic service line IIIA Lift station ��<s
SEPARATION DISTANCES FROM SEPTIC%H)L�B1ASf, TANK ON LOT TO:
Foundation < 14- Property line to [k Absorption field lbt k
Water main/service line to 14- Surface water/drainage 1 oo k Wells on adjacent lots too tk
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation I ot.t- Water main/servicc line 1 y tk
Surface water k> 41 Driveway, parking/vchicic storage arca 301 k
Curtain drain ',/A Wells on adjacent lots loo %A-
F. ENGINEER'S CERTIFICATION
/ certify that / have determined thru field inspections and review ofitfunicipal r r ms are
in
conjormance with h O fLL4 gy-delines - effect on this date. h` .'
Signature *(+ k
Q
Engineer's Name 4611A7- Cot -e","`....
} 110BUT G MWAN
CE -8801
Date c.r
HAA Fee S s " . CIO C� Waiver Fee S _
Date of Pavmcnt Date of Payment
Receipt Numberl��` (Oj /(J �1 Receipt Number
Rev. 8/95 OSS: haa.wk.doc