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Home My WebLink AboutEAGLE RIVER VALLEY RANCHETTES LT 22BEagle River Valley Ranchettes Lot 22B #050 - 223 - 24 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN 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 Nam~[DNNJ, I~..J, 1;;2__i,p'"!~.¢_,,"-//' Wastewater System: D New ~Upgrade ~'°~:~.~lr°°m': ~eepTrench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION ~o,,,~*~n~: ~'~GPD/Sq. Ft. TotalDepthfromoriginalgr~:~ Lot: ~ BIock:~A ~~V~~SuhdivisiOn: 3epth to pipe bottom from oriBinal gra~e: Ft. Grawl depth beneath pipe ~/ Fb Township: J Rang~ . Fill added above original grade: Gravel length: WELL: U New U Upgrade Gravel width:--~Ft. Number of lines:l,~Bistance between lines:~[~ Ft. Clas~inati~n {private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller; Date Drilled: St~ticWater Level: installer: Date installed: Yield: GPMIr ~um. s.~ .,: .,.,Ic"i'9 Height Above Ground:Fh TANK SEPARATION DISTANCES ~eptic ~ U Holding ~ S.T.E,P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacdy in gallons: Well ¢¢~ ~¢~ ~ ~ ~¢% MAteria~~ Nu~berofCompartments: SurfaCewater I¢¢% I¢¢% ~ ~ ~ LIFT STA~ Lot ~' ,~, ~ Size in gallons: I Manufac~ Foundation I¢1 icl ~ ¢ ~ "Pump on" lo% J "~p ~" I~el at: I High water alarm at: CurtainDrain ~ ~¢~ ~ ~ ~ Pump.,ode, I ElectdcallnspecUonsperformedby: Remarks: ~, ~[~ ~ ~ BENCH MARK Location d Description: I Assumed Elevation: E~A~ Department of Heard Human Services approval [, Reviewed and approved by: Date: ~z 72-013 (Rev. 9/91) MOA 25 Permit No. ~W~3OOgl Page ~ of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN 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 Description: EAGLE RIVER VALLEY RANCHETTES, LOT 22B PID No ' 05022324 CO NEW 1000 GAL CO \94,1' N.T.S. C01! · ' ~- o4.~' 88.B' · 82,8' NO WATER FOUND C~o~EW 1000 GAL ~6 ~PUC T~ 72-013 A ( R 6~'. 9/91 ) MOA 25 A ¸B C01 14.8' 153.9' co3 $3.8' i~3.5' ~? 5t ao MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930061 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:RIFFEY JOHN W OWNER ADDRESS:18910 TWENTY GRAND RD EAGLE RIVER, ALASKA 99577 PAGE 1 OF DATE ISSUED: 4/20/93 EXPIRATION DATE: 4/20/94 PARCEL ID:05022324 LEGAL DESCRIPTION: EAGLE RIVER VALLEY RANCHETTES LT 22B LOT SIZE: 17955 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. DESIGN WILL BE ALTERED SO TRENCH "L" IS ELIMINATED. PROVIDE ADDITIONAL SOIL TEST AS NEEDED FOR REDESIGN. RECEIVED BY: ' ~/~ DATE: ISSUED BY: ~/~-~-w~__ DATE: HSALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPSCTIONS April 12, 1993 ROBERTSHAFER, PE ROGERSHAFER,PE CIVIL ENGINEERS (907) 694-2979 FAX 694 1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Eagle River Valley Ranchettes, Lot 22-B Request you issue a permit to upgrade the septic system serving the referenced property. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. Attached is the proposed upgrade design. This property is served by a Community water system. There are no protective well radii which encroach upon the property. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. If you have any questions or require additional information for your review, please contact us. Sincerely, RJS/LSU/lsu ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 r' .~ 20' SCALE SITE PLAN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 4 5 6 7 8 9 10 11 13- 14- 15 16- 17 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? Township, Range, Section: s L o P SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN__~ FT AND --~° FT CERTIFY THAT THiS TEST WAS PERFORMED IN MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# GENERAL INFORMATION Complete legal description Lot 22B; Eagle Riv~ Va~ey Ranchet~ Location (site address or directions) 18910 TwenZq Grand Eaqle. River, AK Property owner John Riffey Day phone 694-$771 Mailing address 18910 Twenty Grand Drive Ea~l~ River~ AK Lending agency BILL: WESTERN RELOCATION At, n: Rosemary Justino Mailing address 83 Wooster H~qhts Road Danbury, Connecticut Agent 06810 Day phone Day phone Ad dress 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, ~/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 17034 Eagle Engineer's sig natu~~ Phone Date = DHHS SIGNATURE Approved for -'~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 engineee~, work. ....... 72~125 (Rev, 1/91 } 8ack MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~'-c~' '~'''~' ~ A. WELL DATA Parcel I.D. Well type ~ 0 j~- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot g.p.m. ; On adjacent lots AT INSPECTION ;On adjacentlots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B, SEPTIC/HOLDING TANK DATA Date installed zCCJ Cleanouts ,(7,Y,)N) ~' Foundation cleanout(~/N) High water alarm (Y~]~b Date of pumping /~(,~ Compartments y Depression (YI~ Alarm tested (Y/N) /~- {.,A-- Pumper t-~ ¢:::~k.~..~ Well(s) on lot To property line ~- ~ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent Absorption field Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at ~vel at High water alarm level .---~'"~ Cycles tested Meets MOA electrical codes SEPA~CE FROM LIFT STATION TO: ~¢'on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA .- '~.-L. ~°t~ Soil rating Width ¢-~' Gravel thickness Date installed Length -1'~'~ ~ Results (pass/fail) Peroxide treatment (past 12 months) Total absorption area Depression over field (Y~ Cleanouts present~/N) /~' '~ystem type Total depth Date of adequacy test /'-~'t for ~'~ ~-" ~'~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: / Well on lot ~7/'c, O ~' ~ On adjacent lots ~'[~ ~ Surface water Curtain drain To building foundation On adjacent lots ~¢, \~c> Property line ~ ~---'\ To existing or abandoned system on lot Cutbank ~'~' ~/~'~ Water main/service line ~ '~- Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify t~nformed to all MOA and HAA guidelines in effect on the date of this inspection. /"- HAA Fee $ / ~¢ ¢ ¢~3 Waiver Fee: $ Date o; Payment ~-/~ ~ ~ Date of Payment Receipt Number ~{/~ 7~ ~2 .~ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 MUNICIPALITY OF ANCHORAGE DEPARTMENT DP "SALT" E"V'"ON"E"TA' PROTECT'ON 825 L Street - Anchorage, Alaska 99S01 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE 1. PROPERTY OWNER MAILING ADDRESS PROPERTY RESIDENT (If different from above) 2. BUYE~Q~ MAILING A¢DRESS ' MAI LING ADDR ESS PHONE 4. REALTOR/AGENT MAILING ADDRESS PHONE 5. LEGAL DESCRIPTION STREET LOCATION ,~, .._,~ ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROON1S [] One [] Four [] Other [] Two [] Five ~ Three [] Six 7. WATER SUPPLY [] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ~[. COMMUNITY since June 1975, For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach log if available,) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date ! ~'-] ~ . If system is over two (2) years old an adequacy test is required [] PUBLIC UTI LITY by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSP ECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DR I LLE D [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Varified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line [;~__~PPROVED FOR ~ BEDROOMS~DI)~ q,~o GR~ ~' \O ~L" [] CONDITIONAL APPROVAL (letter must accompany certificate) -.~ ~~O t) [] DISAPPROVED L~\~-~ \-t ;~ ~t~P~. %c~i.*~ ~o ~o¢ DATE BY (Title) ~' LEGAL DESCRIPTION 72-010 IRev. 3/78) Received From Address