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Home My WebLink AboutEAGLE RIVER VALLEY RANCHETTES LT 31C ) Municipality of Anchorage Page ._L. of ' ' DEPARTMENT OF HEALTH AND HUMAN SERVICES ,,i ENVIRONMENTAL SERVICES DIVISION P.O. Bo~< 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .<'~l,~[/~("),_.~__ ! PID Number: ~O-~ Name: ~ ,~~ Wastewater System: D New ~Upgrade t~q +~.,~ ~ F~t~ ~;~,~ ~5~ ABSORPTION FIELD ,,on.: ~.~ I,o.o,.e=roo~=:~ iXDeepTrench..ShallowTrench ~Bed DMound OOther LEGAL DESCRIPTION so.,.,.,:O. ~ GPD/Sq Ft. TotalDepth fromorigin~gjade: Subdiv~ion: .Oepth to pi. boil0, f.m 0dg~l~.de: Gravel depth .neath ' - Ft. WELL: ~:~ Q New D Upgra~ mave, wlmh: ~ ,5' Number of li~e,: Classification (Private. A.B.C): Tot~ C~ TO: Total absorption ama: Pipe material: Yie,d~~ OPM ,l Pump ~t at: Et. I~ingHeightA~veGrO"nd:Ft. &~*a ~ TANK SEPARATION DISTANCES o Septic ~ Holding ~.E.P. To Septic ~so~tion LI~ Holding 3ubli~vate Manufacturec ~ ~paciW in gallons: From Tank F~ld S~tion Tank ~wer LIn~ Sudace w,te~ I0o'+ I~'~ ~ -- ~ - LIFT STATION Remarks: BENCH MARK [ ':T~ ~' ~um~ Elevation: Inspections pedormed by: s [ s ~.IN;EEIN~ Dates: 1st I~1/~ ./~~_, Depa~ment of Health and Human ~e~lces approval ,~?~ :: ........... Reviewed and approved by: Date: .~ 72-013 (Rev. g/91) MOA 25 Permit No. SW960351 Page 2 of 2 ' Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 1966~0 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~ (bT 51C, FAC;,I F RIVER VALLEY RANCHETTES PID No.: O50-224-10 l B FCO 13 0' 59.5; 10' I. TIL. ESMT. "'" .......... UT1 d ST1 15 O' 54.5' ~ _~ : I DBL2 23 5' 62.5' / ~ (,~..,,~. ~oc.) I / I FD 29 O' 67.5' /X x,, X,, / .cml C01 50 O' 68.0' CO. )// . .~..~ 002 500' 69.0' /',. ~x~/~,~/ ~:~I/--I~XJSTI~,G ,o0o CAL. iCO$ 6C O' 76.O' NEW TRENCI"F"// .~.- ~ ~ CONCRg"I~ SEPTIC TANK CO4 75'0' ;; 2.0' I MT1 75 5' 112.5' ~ I ,,~T~ ~ ~c ~ I ~'~'"' ' ["- EXISTING I HOUSE iz~ LOT 51C scR~z t' - 40' I I TWENTY (',RAND ROAD CO1 FINAL GRADE~ MT C02 .-'--CO3 = 95.1'* / C04 = 95.1'* BE COM] £TED IN SPRING OF 1997 C04 = 91.3' 79.3' B.0.H, 'IF¢~3 N ......... 72-013 A [Rev. 9/91) MOA 25 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 PAGE i OF PERMIT NUMBER:SW960351 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SHEEHAN MICHAEL D & OWNER ADDRESS:18809 TWENTY GRAND RD EAGLE RIVER, AK. 99577 DATE ISSUED:lO~16~96 EXPIRATION DATE:10/16/97 PARCEL ID:05022410 LEGAL DESCRIPTION: EAGLE RIVER VALLEY RANCHETTES LT 31C LOT SIZE: 17955 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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 ~. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. September 27, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY A~PROVALS SEWER&WATER MNN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUOIES AND REPORTS WELLINSPECTtON FLOW TEST SITE PLANS ROAD DESIGN TEST P~RCOLATION TEST STRUCTURAL& WECHAN~CAL INSPECTIC~+~S CN SITE WA~TEWATER D~POSAL SYSTEM DEStGN MUNICIPALITY OF ANCBORAGE Department of ~ealth and ~uman Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 31C, Eagle River Valley Ranchettes Request you issue of a permit to upgrade the septic system serving the existing three bedroom house on the referenced property. A test hole was excavated and percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was after seven day ground water monitoring, tube was found to be dry. Attached is the proposed upgrade design. encountered and the monitoring This property is served by a Community Water System. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION SEP 3 0 1996 RECEIVED 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577 -- LEGAL LOT 31C, EAGLE RIVER VALLEY RANCHETTES /~~ ~~ DESIGN CRITERIA: ~q[~EE~J'¢ SOILS = 0.8 GPD/SO.FT. TRENCH CRITEBIA: ~ 8' DEEP ~ 6, EFFECTIVE -..,w =z~ 2.5' WIDE LOT' 31B 47' LONG LOT 3lA CONTRACTOR IS REQUIRED TO < L~c~ j ~.~,~ O~TAIN UTILI~ LOCATE<: ~ P.,O. ~o A.Y EXCAVATION ~ LOT 52B . WORK. ~ (~PROX. L~.) (~PROX. LOC.) 0 LOT 50A ~ (~PROX. L~.) (~;~c.) ~P ~ tT~ ~EXISTI~G '1000 GAL. (~"~. ~.) FROPOSEB TRENC~ i~ /%~xJ~ /CCNCRETE SEPTIC TANK J ~ /~ ~ . ~D ~q~NED COMP~ELY; AND REP~CED ~ CO I TO BE ~ANDONED ~ SUC I RI R ..... ' I. LOT 52D LOT 31C lo LOT 51D LOT 30C I ' I TWENTY GRAND ROAD ALL PROPERTIES SHOWN ARE SERVED BY A CCMMUNITY WATER SYSTEM. NO WEL~ WITHIN 200' OF SEPTIC SYSTEM. m kOl 248 kOl 23~ kOl 238 Ckl[~l kOl 22~ ~ ~LL PORIION8 OF ~]TH ~SS TH~ 3.5' OF ~' COVER REQUIRE INSU~TION. PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13- 14 15- 16- 17- 18- 19 20 COMMENTS Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~' ,.,.. ,o .., .¢.~' ~' DATE FERFO~ED~, '~ 2 · ~'~.J I'...~ [~¢~ ~l~lownship, Range, Section: ~ WAS GROUND WATER .ii ENCOUNTERED? S L~ IF YES, AT WHAT / O DEPTH? p E Depth te Water Nter Monitoring? Og~' DaP ''[- 2~'-'~ ~, SITE PLAN tsl"r irA, /' Dross Net Depth to Net Reading Date Time Time Water Drop ~ ~;H~ " F~/b'', '/~" PERCOLATION RATE ~ (m,nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN .~' ~''~' F? AND q- ~' FT S & S ENGINEERING ,3~/'.~Y ~. PERFORMED BY: i 20~4 Eagle River [~p Roa6 ~o. ~"/~' ' CERTIFY THAT ?~lS TE~T WAS PERFORMED IN ACCORDANCE WIT~O[~~ GUIDELINES IN EFFECT ON ~HIS DATE. DATE: ~ /~fl / ~ 72~ (R~. 4/~) ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. CIVIL ENGINEERS SEWER&WATER MA~N EXTENSIONS SEWER&WATER INSPEC~ON EN~NEERINGSTUDIES AND REPORt'S WELL INSPECTION & FLOW TEST SITE P!.AN~ $OILTEST PERCOLATION TEST STRUCTURAL& MEC~IA~ICAL II, ISPECTIONS ON ~TE WASTEWATER E~SPO~AL S~TEM CF. SIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS (9O7)694-2979 FAX(907)694-1211 REFERENCE: Lot 31C, Eagle River Valley Ranchettes September 27, 1996 GENERAL: 1. The scope of this project includes the installation of a leachf, ld trench to serve the three bedroom residence located on the referenced property. The existing septic tank is to be excavated to verify integrity. If of poor inegrity, the tank is to be pumped, crushed, and abandoned in place; and a new 1000 gallon septic tank is to be installed. The existing crib is to be abandoned as such that it may be used in the future. 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. The contractor shall be responsible for obtaining any necessary underground utility locates. e Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 0 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: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. e Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577 Page Two Lot 31C, Eagle River Valley Ranchettes September 27, 1996 Septic tanks installed with less than 4 ft. of cover shall be insulated. 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. Final grading over the Septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INST~?~.%TION: 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. 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. 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. e 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 Five Lot 31C, Eagle River Valley Ranchettes ' September 27, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other Persons perfo~,~ng 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 Page Three Lot 31C, Eagle River Valley Ranchettes September 27, 1996 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. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. ® e The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM FS10 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted w~th watertight couplings (Caulder, Fernco, or equal). 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. 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 'confozm to current M.O.A. or D.E.C. requirements, which ever applies. Page Four Lot 31C, Eagle River Valley Ranchettes September 27, 1996 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: 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. 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. 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 contract6rs activities. ~.,~ The owner shall contract with the contractor to perfo~L the ~0rk outlined in these specifications and plans and in accordance with the attached M.O.A. 'permit.. There will be no contractual arrangement existing .between th~. ~c0ntractor 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. De part ment ~ ~On;irs~nre~nt~l Qualit ¥ ' Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAILING ADDRESS PHONE SEPTIC TANK: DISTANCE I! NUMBER OF I FROM WELL MANUFACTURER H~tt~l"O~ MATERIAL (,~oMC~e~ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH lIQUID CAPACITY, /~)00 GALLONS. SEEPAGE PIT: NUMBER OF PITS I DIAMETER ~10RWiDTHj.T'' LENGTH /~'~ DEPTH LINING MATERIAL I ~~ CRIB SIZE: DIAMETER.--/~DEPTH DISTANCE FROM: WELL BUILDING FOUNDATION ~OI NEAREST LOT LINE ® TOTAL EFFECTIVE , ABSORPTION AREA (WALL AREA) '~ C~(~ ADDITIONAL ABSORPTION. WELL: -- TYPE ~mJ,141.1nt~'X CONSTRUCTION DEPTH / BUILDING NEAREST NEAREST SEPTIC FOUNDATION I , LOT LINE , SEWER LINE TANK ~ CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form NO. EQ-031 DATE APPROVED .~A.A~B.~ GrEATEr ANChOrAgE ArEA BOl~0Ugh 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4961 SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT ~l/'~t"f~t~ ~-'/~(~C' { _~J MAILING ADDRESS FINANCED ~HROUGH SOIL TEST RESULTS PHONE L/ / . DRAIN FIELD OTHER · NOTE:~ THIS PERMIT IS NOT VALID WITHOUT ~OIL TE:$T COMPLETION DATE ANTICIPATED FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /00~ ~.~ TYPE (/7~,~/-~ SEEPAGE AREA SIZE, /~ Z/~ TYPE ~/~-' MINIMUM DISTANCES, REQUIRE;M~'NTS / FOUNDAT,ON TO SEEPAGS P'T 00 / DRA,N F,SLD ~ SEPTIC TANK TO SEEPAGE PIT WALL ./ 5 SEPTIC TANK . SEEPAGE PIT . DRAIN FIELD TO NEAREST LOT LINE. WELL TO SE~,C TANK l~~ DRAIN FIELD WATER ~AIN TO SE"TIC TANK ,/~ DRAIN FIELD SE~IC TANK, '/~ , SEEPAGE P~T TO RIVER, LAKE. STREAM. ALSO CONSIDER AREA WELLS, 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. DIAGRAM OF SYSTE:M I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF C~REATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. FORM NO, £O-016 u�'GI8970 • 40010/GSC v <O • Municipality of Anchorage r \ On-Site Water and Wastewater Program Q DEC 0 4 e 1,,9j 4I (907) 343-7904 ; �A ., Certificate of On-Site Systems Approval :y Parcel I.D. 050-224-10 Expiration Date: Dec 06102018 1. GENERAL INFORMATION Complete legal description Eagle River Valley Ranchettes Lot 31C Location (site address) 18809 Twenty Grand Road Current Property owner(s) Helen Sheehan Day phone Mailing address 4525 S. Trellis Ave. Palmer, AK 99645 Real Estate Agent Day phone 2. TYPE OF DWELLING: El 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 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ WaiverNariance request for: Distance: • I. Received b • ` ; _•;A ,,! Date: �2/ (.F"//'7 COSA to be released to the engineer,unless otherwise requ=4 d by the engineer. COSA Fee $ 50 I - Waiver Fee $ Date of Payment /g-)i4/ /9- Date of Payment Receipt Number as SBC) Receipt Number COSA# 6507/u5S3 Waiver# ' 1 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. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 12/4/2017 AL 6. DSD SIGNATURE � System#1 Approved for 3 bedrooms •Steven R. •anno e• � �� — . CE-8149 .&A,41 System#2 Approved for bedrooms s•.• •� .� Disapproved �k ��••••''0\.&- Conditional approval for bedrooms, with the following stipulations: \`Z..•` 41 ��,�O f t;,q `c,, ON-SITE Ga WATER AND c�j WASTEWATER z t`�c PROGRAM • —/ SER\A6� By: RJfA Gvur(L g Original Certificate Date: 10246/aa1 The Municipality of Anchorage Development 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 S c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Eagle River Valley Ranchettes Lot 31C Parcel ID:050-224-10 A. WELL DATA Well type Public 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 mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 6/14/2016 Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 10/24/2017 Pumper JR's Pumping C. ABSORPTIOM6A4 Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 GPD/SF System type Deep Trench Length 47 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total de Eff. absorption area 563 ft2 Monitoring tube Y Depression over field N Date of adequacy test 12/4/2017 Results(Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test D in.j'�Water added 455 gal. New depth D in. ` ^ Elapsed Time: I 0 min. Final fluid depth V in. Absorption rate >= 450+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "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: 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 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots_100+ 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+ Wells on adjacent lots 100+ F. COMMS TS Oka- I'7` X 1 (.,Q I x l.9 ' Gtib Corweittot bj divLAk'L vtvg. 4pwveL I n /6)r74. G. ENGINEER'S CERTIFICATION ,....OF A Ar, �l lid I certify that I have determined through field inspections and • 4 review of Municipal records that the above systems are in 0*:,• • as i''‘ �,• ��y conformance with MOA COSA guidelines in effect on this date. % AV •• ‘9 0 Steven Pannone �� Engineer's Printed Name i••:�leveri I.•Isannone• CE-8149 Date 12/4/2017 O��14•• �/ COSA canary sheet_2-6-15.doc �r/e3y sem!/,s'-7‘-r/ x_30 X X xl -4e t p # k io'.44 �.t '1." --...k., 4 DQ Boz � 10 ;` b / aAl N y t — • t '`Nt, •• lat..... i \') n o 1,� 111118 1 i \ 6 N as ‘% .sZ� Z_5 > . P • ti � � 111 4 �� E IU M - P., t d e .�. ._......_.�..__�_...�._.. � .}._._---, G'Bf0°sy%S' /3.-g'e' ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE j" moo/ �,�.vs.ago FOLLOWING DESCRIBED PROPERTY; _ -•7 L OF A[ '�i �!�"�P/�Gir!/mss G �.9�/l.�B� Gam'"- DATE �� •. .s 4t AND THAT NO ENCROACHMENTS EXIST E�(CEPT AS i.4,,�s�7 ft c .. .� • '- INDICATED. IT IS THE RESPONSIBILITY OF THE - . : �� n !�`� ,, . $ OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: f , /,' EASEMENTS COVENANTS OR RESTRICTIONS .��-f"y I d WHICH DO NOT APPEAR ON THE RECORDED SUBDI- 0q %.. Duane Mark Seward •- 4.. a VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FS' /yz ' s •. t.S � OF FENCE LINES,ANY DATA N BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUND- "'- DRAWN; 1-141- ;`�-.' ARY LI NES. t,, ,rI,•�.? 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. # 050-224-08 GENERAL INFORMATION ..... Complete legal description :.' Lot 30C;. Eaqle River Valley Ranchettes Location (site address or directions) 18847 Eaqle property owner. Nancy Mailing address Lending ~gen~' ' .Mailin. g address ~ ' Agent Johnson 18847 Twenty Grand Address Twenty Grand Rd. River, AK Day p~one Eagle Riverr AK Day ~hone. Day phone 694-5952 99577 e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well XX ' Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-02~(Rev. l~11) Front MOAI21 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 ~liance with all Municipal and State codes, supply and/or wastewater disposal system is in com ordinances, and regulations in effect on the date Name of Firm Address of Engineer's signature DHHS SIGNATURE J~ 'Approved for ~ bedrooms. Disapproved. Conditional approval for ,is inspection. Phone 995O4 Date bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of 'Health and Human Services (~HHS) 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. '~2..(3~5(T~ev.I/91) ~ MOArZ1 Municipality of Anchorage F I: I V i: 13 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ....~- 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90~ ~,3'4~Z~{~, Mu~:c~pa{i~ ot Anchorage Health Authority Approval CheckllOs~pt' Health & Human Service~ Legal OescriptlonEAO~ BIVi~R VAII l~f RAN{~Hk'rI'ES: .LOT .30~ Parcel I.D.:. A. WELL DATA -. .... Well type ._.42LA~a.~A:~ If A, B, or C, attach ADEC letter. ADEC water system number _~/^ Log present (Y/N) Oatecompleted' / Total dePth Cased to . Casing height (abov~,.0d~ _ ~ Sanitary seal (Y/N) Wlres pmpe~d (Y/N) FROM WELL LOG .~T~IN~PECTION preduct~on J g.p.m. ' ' ' ~ _ g.p.m. Well WATER SAMPLE ~ Colffo~,,.~'" ,,, Nltn~te Other bacteria _ .~lte~ ~ample: ..... " Collected by: B. SEPTIC/HOLDING'TANK DATA Date installed lcl./'?'/4 Tank slze Founclation cleanout (Y/N) Y~ C. ABSORPTION FIELD 'DATA ! q_no Number of Compartments 1 Cleanouts (Y/N)YES Depression (Y/N) ~_n High water alarm (Y/N) NO Oats of Pumping ~ Pumper Date Installed ~ n./'-/./'/~t Soil rating (g.p.d.flF or IFrodrm) * Length. '17', ,, ,Wldth ~ .1R' Gravel thickness below pipe .15'Total depth 8'-B.5' Effective absorption area*~39E.SQ_EZ_ Monitoring Tube present (YIN)3cF. S._ Depression over field (Y/N) NO , Date of adequacy test., ~a./~ 7./Rq Results (Pass/Fall) ~ For 3 bedrooms Ruld depth in absorption field before test (in.); Ruld dePth 7~ . (ins) Minutes later: ~ 3.~ Absorption rate. 450+ g.p.d. Peroxlcle treatment (past 12 monthS) (Y/N)._~3J:E...E~:~}~ If yes, give date - 72-026 (Rev. 3/96)' D. UFT STATION ~ Date installed_ ~ ....... Manhole/Access (Y/N) ~.~....~~evel at* "Pump off' level at* 'Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~O/~u~tlTY (~- Septic/holding tank on lot On adjac~ Absorption field on lot ~..-~n~djacent lots Publlo sewer main ~Public sewer manhole/cleanout Lift atation SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 10°+ Sudace water/drainage 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10' t Water main/service line 10'+ · Surface water inn'+ Driveway, parking/vehicle storage area Curtain drain NONE KNOWN Wells on adjacent lots 200'+ '~ , certify that~ ~/I/err~l~ ,~ 'u field inspections and review of Municipal re~...t~/~~~ms are in conformance w~ff F~tA l IIde/ines in effect on this date. Y.~."'T'I/ll/_--~D"'?.;~ ~' I-IAA Fee $ ~ ~ ~'~ Waiver Fee $ Date of Payment ,,'/~/~./'~ Date of Payment Receipt Number ~.~-~.,,~,,,~ ~ _.Z/_~' .,~ .? Receipt Number 72-026 (Rev. 3/96)*