HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 30Cogle I iver
Valley
Ronchettes
Lot 30C
¢¢050- 224
-08
~, ~GRE! ..R ANCHORAGE AREA BOF'"IGH
~,~n~,~ Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~:~a{ j'~e~,l~ MAILING ADDRESS. PHONE
LOCAT,ON LEGAL DESCR,PT,ON
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER
MATERIAL
NUMBER OF
COMPARTMENTS
INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPACITY. I~)OO GALLONS.
SEEPAGE PIT:
~,' ' ~'~
NUMBER OF PITS i DIAMETER OR WIDTH 17 , LENGTH DEPTH.
q' 6'
LINING MATERIAL C~)l,..~_.¥,e-~ CRIB SIZE: DIAMETER DEPTH , DISTANCE FROM: WELL
BUILDING FOUNDATION'"~Of TOTAL EFFECTIVE
, NEAREST LOT LINE I~f . ABSORPTION AREA (WALL AREA) .~(P
ADDITIONAL ABSORPTION
WELL:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION--, LOT LINE SEWER LINE TANK __, SYSTEM .
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
iNSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. LQ-031
'~~ i~)\~ GrEATEr ANchOrAgE Area Borough
DEPARTMENT OF ENVIRONMENTAL QUALITY
:3330 "C'° STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
NAME OF APPLICANT
INSTALLATION LOCATION
LEGAL DESCRIPTION ~f~
MAILING ADDRESS
PHONE
INSTALLATION OF: SEPTIC TANK --'' ~ SEEPAGE PIT
T. PE A.D S,ZE DP FAC,L,TY TO BE S RVEO
FINANCED THROUGH TO BE INSTALLED BY
DRAIN FIELD . OTHER
SOIL TEST RESULTS
HOTEl THIS PERMIT I$ HOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED .
FINAL INSPECTION: 2:4 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
~INIMUM DISTANCES, REQUlREMENI'~ DIAGRAM DP
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT ~ ~ , DRAIN FIELD .
SEPTIC TANK TO SEEPAGE PiT WALL I ~
SEPTIC TANK ~ SEEPAGE PIT ~ O , DRAIN FIELD
DRAIN FIELD , ALSO CON$1DER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK. I t) C~ SEEPAGE PIT
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OR
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 21~-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE /~/ S / 7'/ APPLICANT'S SIGNATURE i ~'~'~'~. ~"~,~
FORM NO, ~Q'016
Municipality of AnchOrage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-2'2'4-08
GENERAL INFORMATION
Complete legal description
Location (site address)
COSA#
Expiration Date:.
Eagte Riven Va[fey Ranchet~e$, Lo~ 30C
18847 Twenty Grand Road
Cherie Unekar 694-643!
Day phone
Current Property owner(s)
Mailing address
Lending agency
Mailing address
18847 Twen¢¥ Grand Road
Day phone
Real Estate Agent
Mailing Address
Cindy Wit$on Dayphone 694-642'9
RE/MAX- Eagte River
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public SeWer []
The Municipality of Anchorage Development Services Depadment (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners; Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for propedies served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my. investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
N.or-I:hRira Engineer-in9
Name of Firm
P,n, :Box 770724
Address
S"l:ev e tn9
Engineer's Printed Name
DSD SIGNATURE
t~,?'~' Approved for ~
Disapproved.
Conditional approval for
bedrooms.
Phone
Date
694-70~8
10/14/10
bedrooms, with the following stipulations:
PROGRAM ...
-. ..
~TSE ,..
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: /0 ~ / ~" /~
(Rev. 11/05)
Municipality of Anchorage.
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.orglonsite
(907) 343-7904
· CERTIFICATE OF ON-SITE S~YSTEMS APPROVAL CHECKLIST
LegalDescription: EagLe Rlve~/~he-I;-I;es, Lo~C 30CparcellD. 050-P;~4-08
A. WELL DATA
Well type ,
Date completed
Total depth '
Publ, if ~/~er
If A, B, or C provide PWSID #__
Sanitary seal (Y/N), '
Cased to ' ft.
FROM WELL LOG
Well Log (Y/N) ,
Wires properly protected (Y/N)
casing height (above ground)
AT INSPECTION
Jrt,
Date of test '
Static water level ' ft.
Well production ' g.p.m.
WATER SAMPLE RESULTS:
g.p.m.
,. Coliform ', colonies/100 mL Nitrate '
· Arsenic: ug/L date of sample: '
B; SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size 1000
__ gal.
Foundation cleanout (WN)
mg/L
ConcreCe
.Number of.Compartments' 1
Y
Depression over tank (Y/N) .
Other bacteda , 'coloniesll00 mL
Collected by: ,
N
10/7/74
Date installed
Cleanouts (Y/N) Y
High water alarm (Y/N) N
'Date of pumping
9/89/10pumper
J,R,'s
System type S P
Gravel below pipe. 6 ft.
Y N
Depression over field ~
For 3bedrooms
New depth_?L0, in.
Absorption rate >= 450+ g.p.d.
If yes, give date
C. ABSORPTION FIELD DATA
Date installed I0/7/7Z~oil rating (g.p.d./ft2 or ft21bdrm) 185
Length 17
10
Total depth ~ ft.
Date of adequacy test
Fluid depth in absorption field before test 12 in.
Elapsed Time: 60 min. Final fluid depth 12:> in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
ft. Width 16 ft.
Eft. absorption area 3cj~ft~ Monitoring tube
10/1/10 Pass
Results (Pass/Fail)
Water added 4
D. LIFT STATION
Date installed na
"Pump on" level at. na in.
Datum nn
SEPARATION DISTANCES
Size in gallons, na
'Pump off" level at .~.c in.
Cycles tested ,~,~
' SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
'Public sewer main
Sewer/septic service line
Animal containment areas
Manhole/Access (Y/N)
High water alarm level at na
Meets alarm & circuit requirements?
Publ, ic Wai;er
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10' + 10' +
Property line ~ Absorption field
Water main 10'+ water service line 10' + Surface water
'Wells on adjacent lots 100' +
5/ +
100' +
in.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10' + Building foundation 10' +
Water Service line 10' + Surface water 100' +
Curtain drain na Wells on adjacent lots 100' +
F. COMMENTS
Water main 10'+
Driveway, parking/vehicle storage
10~ +
G. ENGINEER'S CERTIFICATION
I certify 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 date.
Engineer's Printed Name Si;eve En9
Date 10/14/10
COSAFee $, 4-/ q 0
Date of Payment. /c.~ "' / I~ ---/0
Receipt Number O t.//.~' 9 J O
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
ASBUILT
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY;
AND THAT NO ENCROACHMENTS EXIST EXI~EPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS~ COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SEWARD & ASSOCIATES LAND SURVEYING
SCALE: /
DATE"
ORID=
FB:
694-082~
MUNICIPALITY 0f ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
050-224-08 ~r' ' HAA# ~OLOIL~
GENERAL INFORMATION
Complete'legal description
Lot
30C;-Eaqle River Valley Ranchettes
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailin. g address
Agent
Nancy Johnson
18847 Twenty Grand
Address
18847 Twenty Grand Rd.
Eaqle River, AK
Day phone
Eagle Riverr AK
Day ~hone
Day phone
694-5952
99577
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
3
TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
xX'
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OFWASTEWATER DISPOSAL:
NOTE:
Individual on-site xx
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, 1/91) Front MOA#21
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 ~s inspection.
Name of Firm ~ Phone
Address ,~3.2(~ ~
Engineer's signature
, date o/f t,~i
~_~99~04 Date
=
DHHS SIGNATURE
Approved for //P Ebedrooms.
Disapproved.
Conditional approval for
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 requiraments. Employees of DH HS 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% work.
Municipality of Anchorage RI CFIVED
DEPARTMENT OF HEALTH & HUMAN SERVICES ....
Environmental Services Division
825 L Street, Room 502. Anchorage, Alaska 99501- (907~i'3:43'4-7474v~)
Mumc~pality of Anchorage
Health Authority Approval Checkli.~pt' Health & Human Service~
Legal DescriptionEA(;LE RIVER VALLEY RANCHETTES: LOT 30C Parcel I.D.:
A. WELL DATA
Well type .... If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date'completed /
Cased to _ __ , Casing height (abov~
__ __ Wires prope~d (Y/N)
FROM WELL LOG ~PECTION
~ g,p.m. ' g,p.m.
Nitrate Other bacteria
Collected by:
Date of test
Static water level
Well production
WATER SAMPLE~
Coliform ~
D. D. D. D. D. D. D. D. D.~~sample:
B. SEPTIC/HOLDING'TANK DATA
Date installed ~ n/7/7,~
Foundation cleanout (Y/N)
Tank size ~nO0 Number of Compartments 1 Cleanouts (Y/N)YES
yE~; Depression (Y/N) ~]n High water alarm (Y/N) NO
Date of Pumping 9/17/99
C. ABSORPTION FIELD DATA
Date installed 1 n./7/74
Length * 17' Width '1
Effective absorption area*396 go FT
Date of adequacy test 9/1
Fluid depth in absorption field before test (in.);
Fluid depth 7" (ins) Minutes later:
Pumper .SANITARY P H M PFR.C:;
I.PER INSPECTION REPORT (10/7/7~.) AND P,EVlOUS H,A,A.I
Soil rating (g.p.d./ft~ or ft~/bdrm) '125 System type ~
Gravel thickness below pipe *6' Total depth 8'-8.5'
Monitoring Tube present (Y/N)~..q~ Depression over field (Y/N) No
bedrooms
Results (Pass/Fail) PASS For ,~
0" Immediately aftems8 gal. water added (in.):
1~.5 Absorption rate = ~-50+ cl.p.d.
Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION a~~
Date installed Size in g
Manhole/Access (Y/N) ~ "Pump off" level at*
High wa~ a~ 'D~tum
C~.C.Y.~Ied
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
On adjacent lots
~Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO:
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10' -{-. Water main/service line 10'+
Sudace water 1 ~)0'+ Driveway, parking/vehicle storage area 50'+
Curtain drain ~
F, ENGINEER'S CERTIFJCATION///
Signature ~
Engineer's Na~he/ / _~EFFREY A. GAENESS
Date ~
Wells on adjacent lots
effect on this date.
200'+
[-7955 .' &~
HAA Fee $. ~"
Date of Payment ,,/
Receipt Number ,~,~, ,~,,~
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
· DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
· ' OF ON-SITE SEWER AND WATER FACILITY
· 264-4720
Application Date ~/~/°C~f
1. GENERAL INFORMATION
Legal Description (include lot, block, subdivisi~, section, towDship, range~}., · / //
Location (address or directions) ,
Applicant Name ~,~,'~']:~,/~.~4~/'.-.~ Telephone: Ho~./TZ~ 5/d~ / Business
(b) .....
A Ii'cant Address/~ /,~m ~"c;.~ ~",. ~ '
(c) Applicant is (check one): Lending Institution []; Owner/builder~; Buyer []; Other [] (explain);
(d) Lending Institution
Address '
(e) Real Estate Company and Agent
Address ~ ~
Telephone
(f) .--MEil the HAA to the following address:
PH. 6~4-2379
2. TYPE OF RESIDENCE
Single-Family,~ Multi-Family [] Other
Number of Bedrooms ~
WATER SUPPLY
Individual Well [] Community,~'Publi~
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsit~' Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 c,l,s4~
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with ali Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm ~ *~ ~ ~P~'~C~l~;~_~ Telephone
Address ! '~,',~.~E
Date ............ ~ . _
DHEP APPROVAL. ~ ~ - ~
Approved for '~"'~ bedrooms by ~/~ '~'~-~ _.~_O_~ Date
Approved ~ Disapprovect~ ~ ' / Conditiona%
Terms of Condition~pproval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal D,~.~scription:
~,4UN~a~,^Lrn, o~ ANC~OZ~Z3~
DEPT. OF HEALTH
~IRONME~AL PROTE~IO~
'JUN ?
Well Classification
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Ho~ Tank on Lot ~
To Nearest Edge of Absorption Field on Lot ~
To Nearest Public Sewer Line Cleanout~Manhole
If A, B, C, D.E.C, Approved (Y/N)
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Water SamPle Collected by
Water Sample Test Results
; Date
Comments
B. SEPTIC/HI~I~I~TANK DATA
Date Installed I (_3 - ~- r7z~ Size 1 ~ No. of Compartments
Standpipes~N) Air-tight Caps~) Foundation Cleanout
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N) '
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/44etd~Tank:
To Water-Supply Well ~.-t..-'"~ ~-~
To Property Line ~ (~3 ~ -{--
To Water Mafia/Service Line I Course tJ
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To DisPosal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026{11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~"'/~'-~"
Date Installed (~:) ~ r'/ ~ ~/_~
Width of Field ( ?
Square Feet of Absorption Area
Depression over Field (Y~[~.'
Type of Syste? Design
Length of Field I ~" /
I
Depth of Field ')~
Gravel Bed Thickness ~ ~
Standpipes Present'N)
Date of Last Adequacy Test
Results,of Last Adequacy Test
Separation Distance from Absorption Field: · --
To Water-Supply Well '~'~'-~
To Building Foundation "~C:'.'.'~
Lot
To Water Mc!=.'Service Line { ~ 5~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line I
To Existing or Abandoned System on
; On Adjoining Lots ~ IH''
To Cutbank (if present) ,
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date Of this inspection.
Skqned ,~ E, ~, E ,::.[,~ ..... ~' :-, Date
Com an ~ P Y
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 {11/84)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received K~X 11/25/74
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
VA
11/26/74
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
Smiley's Realty
Eagle River AK
Cousineau Bldrs.
Phone: 694-2114
Phone:
Legal Description: Lot 30C, Eagle River Valley Ranchettes
Location: Twenty Grand Road Eagle River
5. Type of facility to be inspected
6. Well Data: COMMUNITY
A. Type
e
C. Construction
Sewage Disposal System:
Single
No. of bedrooms 3
B. Depth
D. Bacterial Analysis
A. Installed 1974''~:' "-':',:.-.:'i73B. Installer Hamilton Excavating
C. Septic Tank: 1. Size 1000 gals 2. Manufacturer Hamilton
D. Seepage Pit: 1. Absorption Area 396 sq ft 2. Material Concrete
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
· Absorption area
, Other contamination
18' , Absorption area
18'
C. Absorption area to nearest lot line
,Sewer Lines
30'
EQ-034 (1/74) Page 1 of two pages
~ Pa§e 2 of two pages - Re~'~xst for Approval of Individual F~")r & Water Facilities
Lot 30C, Eagle River Valley Ranchettes
Legal Description
Comments
Approv Disapproved Date
L/ Approval\Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
11/26/74
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)