HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 2D2,0
-. 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
Name:
· /-~'//z~ Wastewaler System: D New ~Upgrade
~ ~ ~ ~ ~. ~ ~ ABSORPTION FIELD
Pho.e: ~ ~ INo~eedr~m,: ~DeepTmnch O Shallow Trench DBed DMound OOthe,
LEGAL DESCRIPTION so,,.....:
~ & GPD/Sq Fl ~ '
Township: / Range: ~ ~ctlon: Fill add~ a~ve original grade: Gravel
WELL: D New D Upgrade Gravel~ Ft. ~ a~1'*~
SEPARATION DISTANCES s septic o Holding O S.T.E.P.
Well ~ ~ ~/~ ~ ~ ~/~ Malarial: Numar of Compa~meflts:
w.~er ~ ~ LIFT STATION
Foundatlon~/i./~ ~ "Pump °n' level 't: I"Pump°ff"leve"t: IH'gh wate''larm't:
Remarks: ~ ~./,~/ BENCH MARK
ENGINEER'S SEAL
Inspections performed by: ~r Dates: 1st ~/z~/~x - · ---
Department of Health ~ H~an Se~es approval · ~,~-.,~ .. c~,~
Reviewed and approved by: Date: ,~;yr~:,~..~ ~, ...
'Permit No. ---C'c~' ~'/~-*//~ Page "~ of ~
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:
Elevations_.
HOUSE
i
CITATION ROAD '
SCALE s 1'=40'
- TEST HOLE
- MONITOR TUBE
- SEWER CLEANOUT
- - WELL
LEACHFIELD
EASE?ENT
95.0
72413 A i~1) MOA 25
PAGE 1 OF 1
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:SW910113
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:SECRETARY OF HUD
OWNER ADDRESS:222 W. 8TH AVENUE
ANCHORAGE, ALASKA 99513
DATE ISSUED: 5/21/91
EXPIRATION DATE: 5/21/92
PARCEL ID:05022103
LEGAL DESCRIPTION: EAGLE RIVER VALLEY RANCHETTES
LT 2D
LOT SIZE: 17955 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 2
THIS PERMIT IS FOR THE CONTRUCTION 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 (iSAACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
DATE: ~'-' ~/- 9/
//, ' O O ct. .
Louis Bulera. P.E.
Regislered Civil Engineer
May 15, 1991
lohn Smith, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Lot 2D, Eagle River Valley Ranchettes
Narrative
Dear Mr. Smith,
The proposed septic upgrade will have very limited impact on adjacent properties for the
following reasons:
I. The area has a community well system allowing sufficient room for septic
replacement.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, homes are existing with many upgraded already. Our
upgrade is +30' from common lot lines.
4. Drainage will not be effected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
P.O. Box 7~3.9.1 · Eagle River. Alaska 99577 · Telephone (907) 69.1-5195 · Fax (907} 694-3297
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Lot 2D, Eagle River Valley Ranchettes
A. GENERAL
1. The septic plan is for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of
Health and State Department of Environmental Conservation
requirements.
4. All soil tests are advisory to the design and are to be verified or
modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified or
modified in the field by the contractor to meet Municipality of
Anchorage, Department of Environmental Conservation requirements.
6. The excavation is to be exactly in the area shown on the site plan,
any deviation requires engineer approval.
B. TANK
A new 1,000 gallon tank is to be placed as shown on drawing.
Existing tank is to be pumped, crushed and filled with compacted
N.F.S. material. Pit run material is acceptable.
C. TRENCH
1. The trench is to follow the natural land contour to maintain uniform
total depth of the bed bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 10' at any
point.
4. The sewer line is to be connected into the new leachfield to allow
effluent overflow to the old leachfield.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth
of 4' or equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of
surface water runoff.
8. The septic tank and leachfield must not be closer than 100' to any
existing private well, 150' to any Class "C" well, or 200 feet to any
community well.
RECOMMENDED LEACHFIELD DIMENSIONS
TOTAL DEPTH - 10* GRAVEL DEPTH = 5* TRENCH LENGTH
TRENCH WIDTH ~ 30" ABSORPTION AREA = 500 FT~
SOIL RATING = 0.6 GPD/FT~ BEDROOM CAPACITY = 3
SEPTIC TANK SIZE ~ ~1,000
NOTE: This upgrade is to provide 2 bedroom design capacit~ to a~.ieachfield
'that is absorbing at a one bedroom rating.
HOUSE
8
OOT~K
CITATION ROAD
NO KNOWN CURTAIN DRAINS
SEPTIC SITE
PLAN
LEGAL: LOT 2D EAGLE RIVER VALLEY RANCHETTES
OWNER: HUD
CONTRACTOR: N(/A
JOB # 91-035IDATE: 5/15791I SCALE 1" = 40'
A EAGLE RIVER ENGINEERING
P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907)
SERVICES
694-3297
I~ - TEST HOLE
· - MONITOR TUBE
o - SEWER CL[ANOUT
+ - WELL
HmHm+- PROPOSED LEACHFIELD
EASEMENT
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anehor~e, Alask. 99501 264-4720
SOILS LOG -- PERCOLATION TEST
[] SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION:
SLOPE
SITE PLAN
2-
3
4
5
6
7
8
9-
10-
11-
WAS GROUND WATER
ENCOUNTERED? ~t.)O Si_
IF YES, AT WHAT ~L~ r ~
DEPTH?
12-
13-
Gross Net Depth to Net
Reading Date Time Time Water Drop
14-
15-
16
17
18
19
20-
COMMENTS.
PERCOLATION RATE .(m nutetl rich)
TEST RUN BETWEEN ~ FT AND '~ , FT
PERFORMED BY:
72-008
Rivor Eng)neerlng Service~
River, AK 99577
6~f.-$1 g5
CERTIFIED BY:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. StrNt, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:,
DATE PERFORMED:
LEGAL DESCRIPTION:
4-
5-
6-
7-
8-
10-
11
12
13
14
15
16
17
18
19
20
SLOPE
SITE PLAN
Idlllllll r
IIIIIIIIiii1'1
IIII1-11111 II~J
iiiiii
III
III
II III I I
I,,,,,lllt
WAS GROUND WATER S
ENCOUNTERED? /Y~' ~
IF YES. AT WHAT
DEPTH? 7~d ~c-~Z/'
,~, ~-//,/,, ~
Reading Date Gross Net Depth to Nat
Time Time Water Drop
COLATION RATE / ~ (minutes/inch)
TEST RUN BETWEEN '~' FT AND ~ FT
COMMENTS
PERFORMED BY:
72.008 (6F/9)
MoTe River Enc:n-crm'l 9
P 0
Eagto {Tlvcr, AK 9957'
69-t-5105
CERTIFIED BY:~ DATE:
A Eagle River Engineering Services
11940 Business Blvd, Suite ~205
'P.O. Box 775294
Eagle River, Ak. 99.577
694-5195
Fax 694-3297
Legal:
Owner:
Type of test: .
El Well Flow Test IJ~Septlc Test Only El Well & Septic Test [3 Other:
Meter Monitor Well Tank GPM PSI Remarks
Time Reading Level Level Level
.~:~ ~'~? "'2 '~'~ ~°"~'-"~) '/"
~;~.~. ~,~/~ I1.~ I~,~
( ! MUNICI.^L'T¥ OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEL; J'ION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTION
LOCAT,ON
Liq. capacity in gallons IF HOMEMAD~E
DISTANCE TO: Well
NO. OFBEDROOMS~.~
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Manufacturer Liquid capacity in gallons
Wel
D,ST^NCETO: I ~^~/. ·
~ of tile to finish grade ~'~ j
W~dth
Inside length W,dth
Total length o~ / Trench ~ inches
Materia} beneath tile ~.~) inches
Depth
Crib depth
PERMIT NO.
Crib diameter
Well
Depth
Building foundation Nearest lot line
Driller Distance to lot line
Building foundation Sewer line Septic tank
OTHER
PIPE MATERIALS~(~
SOl L TEST RATII~G~,8 C
INSTALLER
REMARKS
I"IUI'-I 1' C 1' PAl... 1' T"r' OF AI'-.IC]:HO ~.RGE
-' DEPARTMENT OF HEALTH AWD ENVIROMMErITAL PROTECTION
'.'. 825 'L' STREET, AtICHORAGE, AK.
0~(7 264-4720
·I--S ITE SEI---IER PEAr'1 I T
PERMIT ti' . 90484 )
APPLICANT
LOCATION
LEGAL
NED SEVERISON BOX 452 CITRTIOtl RD.
CITRTIOtl RD
LOT 2D EAGLE RIVER VALLEY RRtIC LOT SIZE
22000 SQUARE FEET
TYPE OF SOIL ABSORBTIOfl SYSTEM IS: TREHCH
tlRXlMUM NUMBER OF BEDROOMS
SOIL ~RTING (SO FT/BR>= 289
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= ~12 LE~GTH= ¢6 GRAVEL DEPTH= 8
THE LENGTH DIHENSION IS THE LENGTH (IN FEET),OF THE TRErICH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTRt;CE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IH FEET).
THERE IS t'lO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEtI THE OUTFALL PIPE
RI-ID THE BOTTOM OF THE EXCAVATION (IH FEET).
REQU I RED SEPT I C T~}.-. S I --~'E= ieee GF~LLO~S
PERMIT APPLICRHT HAS THE RESPONSIBILITY TO ItIFORM THIS DEPRRT~fENT DURING THE
INSTALLATION IHSPECTIOMS OF AMY HELLS ADJACENT TO THIS PROPERTY AND THE
t1UMBER OF RESIDENCES THAT THE HELL WILL SERVE,
T&,IO ( 2 ;:. I t-.ISPECT I Or-IS ARE REQL~ I RED
BRCKFILLIHG OF ANY SYSTEM WITHOUT FINAL IfISPECTIOtl AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTIOM.
MIfIIMUM DISTRfICE BETWEEH A HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL; OR
150 TO 200 FEET FROM A PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIOt. IS AND CONSTRUCTIOt~ DIAGRAMS ARE
AVAILABLE TO IHSURE PROPER INSTALLATION.
PER~I I T EXP I RES DECEF~le..ER _?...4 .. '4 97_q-
I CERTIFY THAT
l: I AM FAMILIAR WITH THE REQUIREMEtITS FOR OIl-SITE SEWERS AND HELLS AS SET
FORTH BY THE HUt~ICIPRLITY OF ANCHORAGE.
2: I WILL IHSTALL THE SYSTEM Ill ACCORDANCE WITH THE CODES.
3: I UtIDERST~t~ T~RT THI 'OtI-SITE SEWER SYSTEM MAY REQUIRE EHLARGEMENT IF THE
V~. 2
PERFORMED FOR:
· EOA. DESCR,.,ON=.
2
3
4
5
6
7
8
9
10
1!
MUNICIPALITY/F ANCHORAGE
DEPARTMENT OF HEALTH~D ENVIRONMENTA1 PROTEC"rlON
Pouch 6.650, ~lK~age, Alaska 99602 '276-222'l
SOIL~;R:~ --PERCOLATION TEST
ENCOUNTERED?
SLOPE
12
14-
15-
w- /-/d /.. /~
18-
19-
SOILS LOG
PERCOLATION
TEST
DATE P,.FOR.ED=/~ /~- 72'
IF YES, AT WHAT
DEPTH?
Gross Net Depth toNet
Reading Date Time Time Water Drop
z ,, 4;~,I xo,,,,,~ ,~,h' /~',
" 5P ~o~,~ ~
PERCOLATION RA~rE ~ (minutes/inch)
TEST RUN BE~E~ , FT AND
q,- -'1
GP~,S,-~.TER ANCHORAGE AREA BOROUC',~,
t ' HEALTH 'DEPARTMENT
:327 EAGLE ST. ANCHORAGE, ALASKA 99501
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ' "
ADDRESS ~ ~ [fl~.~l~ ~. PHONE
SEPTIC TANK:
DISTANCE FROM WELl. /~/.'T"~'~ /MATERIAL ~'"~7~'(:'-"~'~/
LIQUID CAPACITY /~ GALLONS. INSIDE LENGTH
NUMBER OF ~
C~C)M P~ R TM~..blJ, S
INSIDE WID/H DEPIH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
/ OUTSIDE DIAMETER__OR WIDTH /~'~
,<"- ,":"~ ,~/~-,'/~ . DISTANCE EROM WEL, /~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGT. //// ,DEPT. ~* /
TILE DRAIN FIELD:
DISTANCE FROM WELL
FOUNDATION
NUMBER OF LINES
DISTANCE BETWEEN LINES
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
WELL:
TYPE DEPTH
NEAREST SEPTIC
LOT LINE ., SEWER LINE ., TANK
., NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
DEP/H OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WATER
SAMPLE
DISTANCE FROM
BUILDING FOUNDATION
SEEPAGE
, SYSTEM CESSPOOL
DIAGRAM OF SYSTEM
NEAREST
OTHER
,, SOURCES
DISTANCE/S:
DATE '~ ~?~~~ APPROVED
' -GREA'I'Ek .. NCHORAGE AREA .. ROUGH
ttEALTII DEPARTMENT
327 Eagle St. Anchorage, Aia~,a 99501 279-2511
Case No.
NAME OF APPLICANT. Wlllle Kay
RESIDENCE ADDRESS
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
North St Rt 1 C/O Wagley Const
MAILING ADDRESS Kenal, Alaska PHONE NO.
LOCATION OF INSTALLATIONE-R- Valley Ranchettes Sut
LEGAL DESCRIPTION Lot twn-D
APPLICATION TO INSTALL: SEPTIC TANK X , SEEPAGE PIT X , DRAIN FIELD.
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS.
, OTHER
TO BE INSTALLED BY Dart Co Bell
ANTICIPATED DATE OF COMPLETION.2~} Hay 69
BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
,PERMIT TO INSTALL A .
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
. SEPTIC TANK SIZE /~,~/'~ TYPE SEEPAGEAREA~TYPE
DIAGRAM OF SYSTEM
DISTANCES:
Health Authority
I certify that 1 am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLICANTS SIGNATURE
Parcel I,D. #
1.
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
050-221-03
GENERAL INFORMATION
Complete legal description
Eagle River Valley Ranchettes Lot 2D
Location (site address or directions)
19051 Citation Road, Eagle River
e
Mailing address
Agent
Address
Property owner James & Katherine Pagels Day phone 694-9125 msg
Mailing address 19051 Citation Road, F_,'~91e River, AK 99577
Lending agency ~'y. ~n~,t??/o',t Al~ort Day phone 263-0722
Great Land Realty/Cindy Lindblcm Day phone 694-9125
11411 C~lrl ~l~,nn Htv~_~. ~3gl~ River. Ak
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
NOTE:
99577
Individual well
Community well
Public water x
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
x
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 Eagle River Eagienering Services
Address P,O. Box 773294, Eaqle River, AK
Engineer's signature ~
Phone 6._94-5195
99577
Date
DHHS SIGNATURE
Approved for 3
__ Disapproved.
__ Conditional approval for
bedrooms.
:...
b~rooms, with the following stipulations:
Additional Comments
'..The M~'iicil~ality of ~h0rage Department of Health anc ~ =an Services (DHHS) issues Health Authority
Approval Certificates based only upon the representation...~en In paragraph 5 above by an independent
professional engine"er registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to sa[~sfy certain federal and state requirements. Employees of DHHS do not
conduct ir.~ ,ections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsib, or errors or omissions in the professional engineer's work.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Ancflorage, Alaska 99501· (907) 343-4744
Health Authority Approval Checklist
Lcgal Dcscriplio.:
A. WELL DATA
Well type /~//~,Y~/~
Log prcscm (Y/N)
Total depth
Saldta~., scol (Y/N)
Date of lest
Static water level
/,//4
If A, B, or C. attach ADEC let~-r. ADEC water .system muuber
Date completed J
Cased to Casing h~ig~above ground)
W~propcrly pmtec~d (Y/N)
FROM WELL LOG/ AT INSPECTION
Well production ,/
WATER
Coliform
SEPI'IC/ilObDING TANK DATA
Date insudlcd ~)~,y~?/~ I Tauk siz~
Foundation
g.p.m, g.p.m
Nitrate
Colieaed by:
Other bacteria
/OOD N,,mhc~ofCompanmcms ~ Cicammis(Y/N) y
Dapr~ssion (y/N) N& nigh wa~r alarm (Y/~r)
ABSORFrlON FIELD DATA
DateinstaUod ~'/17/9! Soil ra~m~ (g.p.d./fl:or fl:fudrm) ~'/"~ System ly~e
Graved thickness bedow pipe ~ ToI~I dgplh ~:~
Effecfiveabsorption ama ~dff~ Mo~itormgTube pmsrn[(Y/N) )/~--.-~ Depre~ion over field (Y/N)
Fluid dcpthiuabsorp~ou ~¢idbcforctesl (in.); ~ Imrn,~ii~,tclyat~r~o 8al. walerndded (in.):
Fluiddcpth :~3 (ins.)Minutcs later: ,2,~o ,..~, Absorption rate = ~1~ g.p.d.
Peroxide Irgal~ent (pasl 12 months) (Y/N) /%///"" Ifye~. give date ~
E+
urt S AT,ON
Dam installed
Manhole/Acc~s (Y/N)
High water ~lnrm level al*
Si~ in gallons
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding Innk on lot
Absorption field on lot
: On adjacent lots
"Pump off'* level al*
Public sever main ~ Public sewer mnnholc/clennout
Sewe~ Lift station
SEPARATION DISTANCES FROM Sf~-i]~O TANK ON LOT TO:
Building foundation ~ ~ Pmpe~y. linc ~'/~ ~ Absorption field
Watermain/se~icelin~ ,,o' Sudacewater/d~inngc ~/"/00 / Wclls on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION Fllq .F~ ON LOT TO:
Building foundation ~'/~ '
Surface water ~/00 /
Wnter mnin/service line ~'/~ ·
Driveway. parking~ehicle storage n~a ~"/~
Wells on adjacent lots ~ ~,-~0 / . Propc~., line
HAAFee $ ~0 ' ~
Dam of Paymcm ~ ~ ~" ~ <~ ~
Rev. 8/95 OSS: lum.wk.doc
Waive' Fe~ $
Date of Paymem
Receipt Number
Parcel I.D. #
1.
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
050-221-03 HAA# ~:~ ~ C~ ~:::). ~'--y~ _~.~--~
GENERAL INFORMATION
Complete legal description
Eagle River Valley Ranchettes, Lot 2D
T14N RlW Section 7
Location(siteaddressordirections)
19051 Citation Road, Eagle River
J
Property owner t{tm
Mailing address 222 w.
Lending agency N/A
Mailing address
Day phone 271-4342
8th Avenue,(Box N064), Anchorage, AK 99513
Day phone
Agent
Address 640 w. 36th Avenue, suite 1, Anchorage,
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
NOTE:
Sandy Hjelmsted/Associated BrO~hone 563-3333
AK 99503-5807
Individual well
Community well X
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:
x
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.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
in. vestigation 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.
NameofFirmEaole River Enqineerinq Service~ Phone 694-5195
Address P.O. Box 773294, Eagle River, AK 99577
Engineer's signature
DHHS SIGNATURE
~' 'Approved for
Disapproved.
Conditional approval for
bedrooms,
bedrooms, with the following stipulations:
Additional Comments
By:
Date/- 2
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.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type
Log present(Y/N)
,5~,,~z~' ~_'//,,~',~ Y'/Lt£Y Z"~/~/~#ET~',~Parcel I.D.
/..o~-
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Total depth Cased to
Sanitary seal (Y/N)
Casin
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
Public sewer'main
Sewer service line
g.p.m.
AT INSPEi
; On adjacent lots
; On adjacent lots.
Public sewer manhole/cleanout
.Petroleum tank
WATER
Nitrate
~ple: Collected by:
Other bacteria
R. SEPTIC/H~L=~N~ TANK DATA
Date Installed 4")~,/'~/~ / Tank size
Cleanouts (Y/N) Y~ -~ Foundation cleanout (Y/N)
High water alarm (Y/N)
Date of pumping /~/~/.,J
Compartments ~-
Depression (Y/N)
Alarm tested (Y/N) ~/~
~ /)~//].~('./) Pumper ' A,//,'~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /'~/,~ On adjacent lots
-To propertyline :~,~ ~ Abs(~rption field
r
Surface water/drainage //~//~ '
72-026 (Rev. 7/91) Fro~t
Foundation. ~ '
Water main/service line /'~ ·
;~ · ! '; CONTINUED ON BACK PAGE
C. LIFT STATION --
Date installed *' * "' ~Manufacturer * .;
Size ln gallons ' ' "": ~' ': '" ""*'"~~)' '" ' '
Vent (Y/N) ': ' "Pum'p on" I~ ~ ' "PumP*o. ff" level at: * ~ ' ~
High water alarm level _-..-~,~.~t~ Cycles tested ' ' _. ',,_
MOAelec~~... . .: .,. :,, . ..~:'
Mee. ts
SEPARATI~.~ISTANCE FROM LIFT STATION TO:' . - - - :' ', ' '
_
W~n lot ' On adjacent lots - ' ' ' -' Surface water - ':: :' :
D. ABSORPTION FIELD DATA
I'.ength '~,~' Width 3 j
-Totalabsor~tionarea ~00 '/ £YI~7'/F/~
,~- Depression*o'v;r field (Y/N) ,~/~'
Results (pa~s/fail) ' ,Z~,4~ 5
Peroxide treatment (past 12 months) (Y/N)
Soil rating
Gravel thickness ~' · ' Total depth
Cleanouts present (Y/N)
: : Oat~of~d~qua~Ytest A/~'k/
,,*
System type
If yes, give date '
bedrooms
-SEPARATION DISTANCE FROM ABSORPTION ~:iELD TO:
'Wellonl0t ~ * on adjacent lotS' ~/~-~/~' Pro~er~iine' .~'5 · '"
To b~ilding* f0undatic~n ' ' ~' //!" To existing or abandoned system on lot ~.. Z>
'Onadj~centlots '~ -~'~' Cutbank '/~/,'~ Watermain/serviceline ' ,F.~ /
Surface water Driveway, parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I ha ked, d, o ed to all MOA d HAA g effect o of this i/~$pectio * '
ve chec verifie r conform an uidelines in n the date n.
· - ,: ,_. ,~.~ . ~. ~ ~'
.... , . . .... . . .~ - ~.... ,..,,.?~ .:
Signature ~ ~" ~' :':~ "~ ~'
Enginee~sName ~~-~-~ .... :'~~" ~ ~4~l[;*~ ~*~ ~.''[;
C/~ ~/ ~/ z- /' ~ ,,' " ~ "~;'~'= .............
Date ~ ~ ~ ' : ~ d
~ tou[~ A
~ ~e ' . 8utera · ~
-' ' ' . ;: . ~ ' ~O~EsS~O¢"~ · '
HAA I~e(~'$ Waiver Fee: $
Date of Payment )~ - Date of Payment
Receipt Number~ Receipt Number
72-026 (Rev. W91) B~ck MOA 21
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99503
WALTER J. HICKEL, GOVERNOR
(907) 349-7755
January 23, 1992
FOR: Eagle River Engineering ServiCes
PWSlD # 210875
My review of the records on file In this offiCe reveals that the Norfork Eagle River
Ranchettes Class"A' Public Water System, is in compliance with the routine coliform
bacteria sampling requirements listed In Table C, and with the Inorganic sampling
requirements listed in Table B of 18 AAC 80.200.
Sincerely,
Keven K. Kleweno
Environmental Engineer
· . KKK/cf
b
Parcel I.D. #
1.
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
z ? .AA # .# ¢I O z
GENERAL INFORMATION
Complete legal description
Ea~le River Valley P~tnchettes, Lot 2D
T14N R1W Sec,7
Location (site address or directions) ~en~ ~-~-=~-~n,~
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone 271-4342
~;);) w. Rt-h Av~n.e. (Bo× N064). ~chorac~e..a~ 99513
N/A Day phone
Rmndy Rj.l.~d/Ams~iated Brokers Day phone 563-3333
640 W. 36th Avenue, Suite l, N~chorage, ~ .99503-5807
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well
Community well X
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
NOTE:
X
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 clisposal 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 'P,,m~l,r, Rivr,~' l~ngin~,m~"in? ~:~.]'"~ic:t-,~ Phone 6q4-51q5
Address P.O. Box 773294, Eagle River, AK 99577
Engineer's signature
Date ,~'.,,//~/'/~/
Se
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
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 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.
Legal Description:
A. WELL DATA
WeI~ type
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number, ~/0~..~
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
Public sewer main
Public sewer service line
AT INSPECTION
g,p.m, g.p.m.
·; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank ~'~
z
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
Collected by:
Other bacteria
Bo SEPTIC/HOLDING TANK DATA
Date installed (~'//'~/9 !
Cleanouts (Y/N) ¥
High water alarm (Y/N)
Date of pumping ,4'/~/d
Tank size /' ~)~) Compartments
Foundation cleanout (Y/N) ¥ Depression (Y/N)
/'/ Alarm tested (Y/N)
~YST'~/? ' "
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) onlot ,.v~ ~ Onadjacentlots ~'~ ~ Foundation
To propertyline ~-~ ~ Absorption field ' .~ ~'
Surface water/drainage ///,/[I ~
A/
Water main/service line /~'
~-~2~(~,.~! F,~t uo^=~ CONTINUED ON BACK PAGE
C. LIFT STATION
Da-t~'installed ' -
Size in gallons~"'"""'""~.'
Manufacturer
Manhole/Access (Y/N)
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N) ~
"Pump on" ]evelat "Pump off" level at
'~. Cycles tested
Su ace water
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
~.Date Installed ~)~//~79!''' Soil rating
: ~'-,Len'~th ,,~) 'Width --~ '
;--:'Total absorption area
:-~Depression over field (Y/N)
~-:'=Resuits (plss/fail) ' ~/~//~4
Peroxide treatment Cpast 12
System type '~)~-~'~ ' ~-'~--~-/'/C-'/'/
Gravel thickness 5"' / Total depth
· '~"~ Cleanouts present (Y/N)
Date of adequacy test
for -~ bedrooms
/~//,~ If yes. give date '
On adjacent lots
Surface water
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ On adjacent lots ~-~)'/ ~ Property line ~ ~
To building foundation /~ ~ To existing or abandoned system on lot ,~.~ ~
· Cutbank Water main/service line ~'~ ~
/"//'/~ Driveway. parking/vehicle storage area ,~ /
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect~on the d~t,e of this inspection.
· ,. , ,,., c~ o. ,,~..,..... % ,. ,,
Signature ._ . ~o...',-' . · ...... ,
"AA Fee $ /"~'~(:~ ~
Date of Payment 7- ~ ' c~/
Receipt Number ~"~'~ (r~(]~))
Waiver Fee: $
Date of Payment
Receipt Number
' ?': , 'i. ' GENERAL INFORMATION
{~ 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~
! '' :' ia) ~.~al'D~es'cription (in'glude lot, block, su?~v, ision, section, township, range)
· .... Location (addre~ ~r dire~ion~
· ..~' (~). Applicant Name (:~'~_~/zl,,~..~" Telephone:Home ~/"'~/~'/ Business ~,~/_~//<2~/". "
.PP ~7'¢ - . '~, / , /,/ ~- ~' ..-.
(C] Applicant is (check one): Lending Institution I-1; Owner/b~tder~; Buyer r"l; Other"~ (explain]; _
",(d) L;ndinglnstitutio~~:~'''~w'~'' V-~ Telephone _~, ~'-- ~,..5'"'~. ..
.... '" Address ~'-~ *' - ~ /~ ~'~' - ~' '~ ~ '
' '~ (e) Real ~tate Company and Agent ~
~ .. Address' ~' ~~~~~// ' "-
.... --T, phoA : '
...... (~e H~ to Ihe following address:
. ~ ~ / .
TYPE OF RESIDENCE
Single-Family ~J~ Multi-Family D
Number of Bedrooms "~
Other
WATER SUPPLY
Individual W~II ri Community I"l Public.,l~'
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite/J~. Public r"l Community ri Holding Tank n
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-o25111/8,4)
· ENGINEERING FIRM PROVIDINb tNSPECTIONS, TESTS, FILE SEARCH, DA'~,.* AND INFORMATION
. ....As certified by my seal affixeo-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 all Municipal and State codes, ordinances~ and regulations in effect on
' ' :: the date of this inspection.
.. -. Name of Firm ' ~ ~ ~ r-.'~C.,~['~.~lNCl Telephone
8RB lg6X .... '
' ' ' '-' Address .'. _ ~ * ·
. '" Date ' --"-- '~1~2~-~:1~' ""', '"'~ '-- _~_f,~ ~../~:~.~"
. .
~ ~',," 'L~
, -.. ~ '&. ',,,, ,,-'~.~,,,
Approved for bedrooms by te
'i' Approved ~["~ Disapprove~ '' Conditional
Terms of Conditional Approval
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
· 72-025(11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
NIUN~:IPAUTY OF ANCHORAGE
DEPT, OF HEALTH &
ENVI,~ON,V~E NTAL PROTECT/oN
,,.,,,o i V E D
Legal De~. __
WELL DATA
Well Classification
A
II A, B, C, D.E.C. Approved~N)
Well Log Present (Y/N)
Total Depth
Static Water Level
Date Completed
Cased to ~,~ I~epth of Grouting
/~ Pump Set At
Yield
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~; On Adjoining Lots
To Nearest Public Sewer Line
CleanouUManhole
Water Sample Collected by
To Nearest Public Sewer
To Nearest Sewer Sen/ice Line on Lot
; Date
Water Sample Test Results
Comments l::>,N,J, ~,
B. SEPTICF~-D~IG TANK DATA
Date Installed ~'-~-.~t- ~
Standpipes ~N)
Depression over Tank (Y/J~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separ~ation Distances from Septic~q tc,;,;;h~ Tank:
To Water-Supply Well '~ '.4--
To Property Line ~. ~
To Water Main/Sen/ice Line
Course
Size ~ No. of Compartments
Air-tight Caps ~3N) Foundation Cleanout
Date Last Pumped
/
/A- ; 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 -
Width of Field
Square Feet of Absorption Area
Depression over Field
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation ~ ~4--'
Lot
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present/N)
Date of Last Adequacy Test
To Water Main/Sen/ice Line ~.-c::> t.,~.
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To P~;operty Line
To Existing or Abandoned System on
; On Adjoining Lots
T~j Cutbank (if present)
Comments
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 orr' Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
*' Check Permitted Bedroom Rating Against HAA Request **
I certify thai I have checked. ~e~'iiied. or conformed to all M(~A and HAA guidelines in effect on the date of this inspection.
Company ""- ,u~ ~IVc~ A~S_~ ~;~OA No.
Receipt No. ~) .~'~ ~' 'q -"
Date of Payment C:~.,....~, _~.~
Amount: $ ~ .~ c~'
Page 2 of 2
DEPT. OF ENVIRONMENTAL CONSERVATION i
ANCHORAGE/WESTERN DISTRICT OFFICE
· ~37 #E" STREET, SUITE 303
ANCHORAGE, ALASKA gg501
:!
BILL SHEFFIELD, GOVERNOR
274-2533
'To Whom it May Concern:
&~cording to records on.~ile in this office the
(ater Syste~is in compliance with the State Drinking
W)ter Regulations
Sincerely,
' '
"' APPLIC'kNT FILLS OUT'UPPER HA,~."ONLY
Address Zip ~e
Multiple
F~mlly
U~llty
Inspector Inspector Inspector Inspector
Field Notes:
( ~APPROVED ~DR~M~ ' "Dopt. 0f_.l,lea;t~ &
*CONDITIONS OF APP~nmenfal
Prote~ion"
( ) DISAP~OVED
~ils Rating , Da~ ~tall~ Well To ~sorpflon Area Wetl L~ R~elv~
Well lo Ta~k Septic T~k Size
MUNICIPALITY OF ANCHORAGE D~P?. OF; -*.LTif &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONE''I/~'~O'~M[N~AL F;O;[CTION
825 L Street · A.dmr~g~, Alad~ 99501
AUG 2 8 1979
ENVIRONMENTAL ENGINEERING DIVISION
RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
PROPERTY RESIDENT (If different from ~bow)
2, BUYER
MAILING ADDRESS
MAILIN~ ADD~ESS
PHONE
PHONE
PHONE
$. LEGAL DESCRIPTION f ~ ~'/~ /~, '~/'.'~'~"
STREET LOCATION . /~ ~ -- · -
8. TYPE OF RESIDENCE NUMBER OF BEDROOMS
One r-1 Four
,'~ SINGLE FAMILY Two r-I Five
I-'1 MULTIPLE FAMILY ~' Three I-'1 Six
I-'1 Other
7. WATER SUI~LY
[] 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
[] PUB LIC UTI LITY depth (attach log if available.}
8. SEWAGE DISPOSAL SYSTEM
~' INDIVIDUAL/ON-SITE"
[] PUBLIC UTILITY
"If individual/on-site, give installation data /"~'~__~ ~:~. -{)Ex
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONL
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
r-I SINGLE FAMILY [] ONE r-i THREE [] FIVE I'-I OTHER
[] MULTIPLE FAMILY I'"] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] I NDIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
I'--ISeptic Tank or I'-'lHolding Tank
Size: If Tank is homemade SO~LS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
Absorption Area to neerest Lot Line
5. COMMENTS
PPROVED PDR __3 BEDROOMS
[] CONDITIONAL APPROVAL (letter must ac~el~ )any certificate)
[] DISAPPROVED
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
DAVID A. SLENKAMP
ROBERT A. SHAFER
ClVILENGINEER
694.2979
MECHANICAL ENGINEER
694-9055
~glo r~vor~ Ala~I~ 99ff77
RECEI.V.£D.
Lot 29; Facle R[ve~ Valley ~neJ~e%to~
A eewcr ~'ste~ ed~qu~c~ t, et ~s p~rformed on tho ~yctem loc~tel on
the refm-en~c~l property Au~t 7 end g~ 1979 per your roque~t.
The llunlcipsllty :~eo.-d- ~hov that this t-nk w.o instnllod in 19z~9.
Tho eoopar, o pit, rna full of tinter en~ eppro~mnto!y 1000 L~Llonl
~oro retired. ~he pit ~o then roc~r~ocl vlth appror~tely 2330
~llon~ off fro-~h t~ter.. After c p~od of ~. ho~ tho ~tor love~
in the pit re?n~nml e~Fro:.-[mto]7 tho ~.-o,
It ~n I~ concluded t~t tho eoptle t'~ ~s ede~te for yo~ 3 ~
~o pit, tho pit ie ~ot e~c~to end an ~p~ of tho ~te~ ~ ~
A perr~t for ~p~radi~g the e0'cf, o= mn ~ obLn~ ~ tho IMdplt~
~1~ and ~o~n~l
If ~ ~n ~ of
Tot~ ~1~
Depart:eat off lte~lth end l~nv/ornanntnl
Protection A[~enc~y'
SRB 196X EAGLE RIVER, ALASKA