HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 12DOnsite File
Eagle River
Valley
Ranchettes
Lot 12D
#050-222-28
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211113
PID Number: 050-222-28
Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family
Project: ❑ New ❑ Upgrade
Name
VIK JAMES & KATHLEEN
A1.�SORPTION FIELD
❑ e Trench ❑ Wide Trench E]Bed ❑ Mound
Site Address
19002 Whirlaway Road Eagle River
Other
Phone
Number of Bedrooms
Soil
Soil Rating
Total depth from original grade
3
D/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from origina'lg
de
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
EAGLE RIVER VALLEY RANCHETTES 12D
Fill added above original grade
Ft,
Gra lel length
Ft.
Township Range Section
Gravel width
Ft.
Beds:
Number of Lines
Distamce between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between t ches
From
Tank
Field
Tank
Line
Ftz
t.
Well
>1 0��
it I n
NA VA
�A
N /�
/-�
TANK MSeptic E]S.T.E.P.
El Holding ❑ Other
Manufacturer
greer
Capacity
1250 Gal.
Surface Water
>100,
NA
NA
NA
Material
Number of compartments
Lot Line
>10'
NA
NA
I NA
NA
plastic
2
Foundation
>1 0'
NA
NA
NA
UET STATION
Manufac are
_
Capacity
Gal.
Remarks
Alarm location
Elec '_ stalled'�
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
Installer
JRs Septic
Drainfield CO/MT3034
Inspector Brent Western
BENCH MARK (Assumed elevation) 100 ft
Inspdectio ts, 5/2'1/2021 8/4/2021
Location and description
2�a
3`d 4th
bottom of siding
point B
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
Date
,�.,c� •'' `�.����
1 7H
Date
Septic System
Approved
Date R ,1 .9o2l
No.CEt,
���®�PROFESSO -
Note: this approval does not include well permit requirements.
LOT 21 C
THESE PROPERTIES ARE SERVED BY AWWU
AND THERE ARE NO WELLS WITHIN 200'.
NEIGHBORING SEPTIC IS > 10'
FROM PROPERTY LINE
I MT
I
I
I
DCO
EXISTING 52' x 30" x96"
EFFEC TI VE DEP TH TRE CH
WHIRLAWAY ROAD
CO FCO B
V �
NEW 1250 GALLON
TANK SLOPE 7%
LOT 12E — -
-w w W - w-- w
3 BEDROOM
HOUSE
LOT 21 DI LOT 20C
WA TER LINE ALIGNMENT VERIFIED
PRIOR TO CONSTRUCTION
-W--W --W
SCOPE OF WORK
1. REMOVED EXISTING SEPTIC TANK.
2. PLACED NEW 1,250 GALLON PLASTIC SEPTIC TANK AND TIED INTO
EXISTING ABSORPTION SYSTEM. THE TANK WAS PROVIDED WITH
MINIMUM 20" 0 MANWAY RISER SERVING THE FIRST COMPARTMENT.
3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS
SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND
15.65.
Tank Replacement Record Drawings Prepared for
James and Kathleen Vik
19002 Whirlaway Road, Eagle River Alaska 99577
EAGLE RIVER VALLEY RANCHETTES LOT 12D
OSP211113
EKLUTNA ENGINEERING, LLC
19162 MOUNTAIN ROAD
CHUGIAK, ALASKA 99567
(907) 406-1058
DATE:
JB I' 1
8/10/2021
CLT
SCALE: 1" = 30'
PID: 050-222-28 SHEET 2 OF 3
•
LOT 11 C
W
No •
4.6
92.0
9.0
MARK
A
W
SV1
34'-2"
M
SV2
36'-5"
18'-2"
DCO
37'-7"
21'-0"
0O
O
w
O
I—
J z
z
m
Q
O
W
OJ
111J
� O
U
No •
4.6
92.0
9.0
MARK
A
B
SV1
34'-2"
13'-5"
SV2
36'-5"
18'-2"
DCO
37'-7"
21'-0"
Tank Replacement Record Drawings Prepared for
44 0
James and Kathleen Vik .•�P�E OF 440
19002 Whirlaway Road, Eagle River Alaska 99577 `?� ''•: ��
TH �.
EAGLE RIVER VALLEY RANCHETTES LOT 12D�
OSP211113 �'
EKLUTNA ENGINEERING, LLC DATE: 8/10/2021 "" "'.....................
�� �; C TIS TOWNSEND � i
04
19162 MOUNTAIN ROAD �♦;; No. C/o 199•:
DRAWN: CLT � s ••' �jE.. �
CHUGIAK, ALASKA 99567 SCALE: 1" = 5' �Y •• ( f.. ���
(907) 406-1058
PID: 050-222-28 SHEET 3 OF 3
0
WHIRLA WA Y
h
V
M
•MH
� N �
403
OF
c . 49 TH
N SHANE A. HOLT w�a
OP, LS -6914
n Pa .. e
FAROMMI-MIN910fII]
DECK
S11vGLEF4M/L y 11
0
0SE
um
0 N DECK
CONCRETE STAIRS
10' UTILITY EASEMENT
I��E.Y�xlfb7(�I�Ki><�TiI�]
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES ANDIOR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANYENTITY NOT ON THE RECORD PLAT
ARE NOT SHOWN HEREON, UNLESS NOTED.
NOTE. FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANYPAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW ANDIOR ICE.
ROAD
AS -BUILT SURVEY I" =20,
NO CORNERS SET THIS DATE
/HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
L0T12D, EA GL E RI VER RA NCHE TTES SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED ATANCHORAGE,ALASKATHIS — DAYOF
AUGUST 2021
HOLT LAND SETRVEYINi
9309 GROVER DRIVE
ANCHORAGE,AK 9950
MUNICIPALITY OF ANCHORAGE a%cnc
On -Site Water & Wastewater Program 10 '::So
PO Box 196650 4700 Elmore Road a
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http:llwww.munLorglonsite Q'
De parement
On -Site Wastewater Disposal System Permit
Permit Number: OSP211113 Effective Date: 5/3/2021
Work Type: SepticTank Upgrade Expiration slate: 5/3/2022
Tax Code Number: 05022228000
Site Legal Address: EAGLE RIVER VALLEY RANCHETTES LT 12D G:0054
Site Mailing Address: 19002 WHIRLAWAY RD, Eagle River
Owner: VIK JAMES I & KATHLEEN L Lot Size in Sq Ft: 17955
Design Engineer: EKLUTNA ENGINEERING, LLC* Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: Water service line location shall be confirmed prior to construction to verify minimum 10 ft
bV
separation between water service line and septic system.
Received By: / Date:
Issued By: A1trGd L� Date: a'l /
MUNICIPALITY OF ANCHORAGE
Development Services Department F. r Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 050-222-28
Property owners) JAMES & KATHLEEN VIK
Mailing address 19002 Whirlaway Road
Site address 19002 Whirlaway Road Eagle River AK 99577
Eagle River
Day phone
AK 99577
Legal description (Sub'd., Block & Lot) EAGLE RIVER VALLEY RANCHETTES
Legal description (Township, Range & Section)
Lot Size 17,955 Sq. Ft. Number of Bedrooms 3
LT 12D
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) El
(w/wo AD U)
Septic Tank
0
Upgrade
(D) ❑
Holding Tank
❑
RenewalDuplex
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above informs bn is correct. I further certify that this is in accordance with
applicable Municipal Codes. / , j
Z/ZP Z(
(Signature of property owner or authorized agent)
Permit/Rush Fees: j �$zz S Waiver Fees:
Date of Payment: �i -2- _2( Date of Payment:
Receipt Number: U701q D Receipt Number:
Permit No. (iSP2-1 ] lI 3 Waiver No.
GADevelopment Services\Building Safety\On Site Water and WastewaterTormsUient FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211113, Rebecca Carroll, 05/03/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211113, Rebecca Carroll, 05/03/21
AM11rAr wlV rE'ea�
i
f
.•--�• ® n1 �nt
/p d
^)ra�resi Hind o '�
k
a
ffir
3 • • � oz.s 3
v
Q
OF At.
49i ='k 1
••e..•.•oe.e•.eeese.eo•os.e. �� /lid G%Y�.•%IY ��+��ff
S /t�f'• -' f 111 301
• .1••ee•e••o•eae•e vee Ne=e.•�� �9 �i��/•��:•t/. /33.OQ
Shone A. Holt • Q � w �
ri ••,
is 6914
�t9Fo p+..•,•�••,..�a 4 AS -BUILT •St]RVEY NO CORNERS SET THIS DATE
Y hereby certify that i have performed a Nortgagea'h
inspection of the following described property
I
Itlf-0fNAT10�1 HEnEON IS FOR THE USE OF LENDING Lot 12D Ea s River Ranchettes Sub,
11101101,15 SPECIFICALLY TO SHOW ANY CONFLICTS 1
WEEN EXISTING STRUCTURES AND FLATTED LOT LINES
EASEMEIITS MID 13 NOT 10 BE USED FOR POSITIONIN3 Anchorage Recording Diatrict.Alaska and that the improve-
4TIONAI STRUCTURES OR FENCELINES. vtents situated thereon are within the property linea ancf
do not overlap or encroach on the property lying adjacaut
theretoethat no improvements on property lying adjacent
thereto encroach on the premises in question and that the.
;EHENTS OF RECORD.OTHEA THAN THOSE are no roadwaye a transmission lineseor other visible ease-
•NN ON THE RECORDED PLAT, ARE NOT menta on said property except as indicated hereon. Dated
NN HERR-Oli at Anchorage, Alaska
this 6th qday of Juns 1991
f MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NO. OF BEDROOMS
. DISTANCE TO* ~ ~H RLIC O C D~llin7
~ [~ No'°f lines / "englh ~,in~ Total le~* ~i~, Trench J~
Length Width ~pth P~RMIT
~ Buil~ng'l~n~tion Nearest lot line
DISTANCE TO: Well
~ DISTANCE TO: Building foundation S~er line Septic tenk Absorption erea(s).
OTHER
PIPE MATERIALS
REMARKS E '
APPHOVE~., ~ lg0X , DATE LEGAL
72~113 (Rev. 3178)
MUN I C I PAL I T'Y OF ANCHORAGE
DEPARTMENT OF HEALTH,AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
ON--SITE SEWER PERMIT~
PERMIT NO:
DATE ISSUED:
.840878
10/15/84
APPLICANT:
ADDRESS:
CONTACT PHONE:
BILL BETHEL
% S&S ENGINERRING
EAGLE RIVER, AK 99577
694-2979
LEGAL DESCRIP: SUBDIVISION: E.R. VALLEYRANCHETTE LOT: 12D BLOCK:
SECTION: 7 TOWNSHIP: 14N RANGE: 1W
LOT SIZE: 17955 (SQ.FT. OR ACRES)
MAX.BEDROOMS:·
Listed below are the options available to you in designing your septic
system. Choose the option that best~fits your site.
NA
TRENCH BED W~ DRAIN
DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0
GRAVEL DEPTH (FT.) 8.0 0.5 5.5
TOTAL DEPTH (FT.) 12.0 4.5 7.5
GRAVEL WIDTH (FT.) 2.5 24.0 5.0
GRAVEL LENGTH (FT.) 51.0 45.0 87.0**
GRAVEL VOLUME~ (CU.YDS.) 40.2 40.0 64.5
TANK SIZE (GALS) 1~000.0 ** 1,000.0 ** 1~000.0 **
SOIL RATING (SQ.FT./BR) 268 259 268
** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
** TANK MUST HAVE AT L.EAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set'
forth by the Municipality of Anchorage (MOA) ~and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design c~iteria of this permit.
5. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 5 bedrooms and
any enlargement will ~equire an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICA~.RMIT AND INSPECTION MUST'BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROV~I~WI~M~OUT AN ELECTRICAL INSPECTION REPORT; AND <5) THE
ELECTRICAL WORK ~ST B~ DONE BY A LICENSED ELECTRICIAN.·
SIGNED ~~ ~_ ..... ..... DATE: ~_ ~~
APPLICANT:
ISSUED BY ~_~_~~___.__..:_~__ ~DATE: ~,~~~
/V unicip nty
o¥
Anchorage
P O Uf~',~ 6-650
ANCHORAGE. ALASKA 99502-0650
(907) 264-411 !
TONY~NOWZ£$
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit #: 840841
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 12D Eagle River Valley R Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
Sipcerely,
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
ERMIT NO:
~DATE ISSUED:
iAPPLICANT:
iADDRESS: ~
~CONTACT PHONE:
I"IUN I C I PAL I.TY OF- ANCHORAGE .~'
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE~ AK 99501
2~4-47P__0
ON--SITE SEWER PERMIT
840841
lO/O /G4
RONALD E. FIELDER
125 EAST FIREWEED, SUITE
ANCHORAGE, AK 99505
277-5702
I02
LEGAL DESCRIP:
LOT SIZE:
'MAX BEDROOMS:
SUBDIVISION: EAGLE RIVER VALLEY R LOT:
SECTION: 7 TOWNSHIP: 14N RANGE: 1W
15400 (SQ.FT. OR ACRES)
5
BLOCK:
Listed below are'the options available to you in designing your septic
syste~. Choose the option that best fits your site.
TRENCH BED. W- DRAIN
DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0
GRAVEL DEPTH (FT.) 8.0 0.5 5.5
TOTAL DEPTH (FT.) 12.0 4.5 7.5
GRAVEL WIDTH (FT.) 2.5 24.0 5.0
GRAVEL LENGTH (FT.) 51.0 45.0 87.0 **
:GRAVEL VOLUME (CU. YDS. ) 40.2 40.0 64.5
'TANK SIZE (GALS) 1,000.0 ** 1,000.0 ** 1,000.0
SOIL RATING (SO.FT./BR) 268 259
** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE 'RUNS (NOT EXCEEDING 75 FT. EACH)
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
'I certify that:
1. I am familiar with the requirements ~or on-site sewers and w~lls as set
forth by the Municipality of Anchorage (MOA) and the State o~ Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
5.ii will adhere t~ all MOA and State of Alaska requirements ~or the set back
distances from any existing well, was~ewater disposal system or public
sewerage system on thi~ or any adjacent or nearby lot.
4. I understand that this permit is valid ~or a maximum of 5 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALEED IN AN AREA COVERED BY MOA BUILDING CODES,
?HEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED~ITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE
!ELECTRICAL WORK M~T_~R~E DONE BY ~ LICENSED ELECTRICIAN.
· ...........
APPLICANT:~ RONA'~~DER · / / --
ISSUED ~~~ ...... DATE: _~~/~¢
SOILS LOG
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
LEGAL DESCRIPTION:
o r~'~ ~ ~ sLo. E
1
PERCOLATION
TEST
825 L, Street, Anchorage, Alask~ 99501 264-4720
SOILS LOG - PERCOLATION TEST
t~L=7'14~4- OATE PERFO.MED: [~
,.<"/ L TiY
4-
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
~ " ~ ~0 ', Cy~ ~,"
PERCOLATION RATE
TEST RUN BETWEEN t~ FT AND 7
CERTIFIED ~~-----~/'
COMMENTS
6-
7
8
9
10
11
12
13.
14
15
16
17
18
19
20
No. 1457.E
MUNICIPALITY OF ANCHORAGE
Development Services Department r Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-222-28
1. GENERAL INFORMATION
Expiration Date: _f ,avtA d 5, aW 3
Complete legal description EAGLE RIVER VALLEY RANCHETTES LT 12D
Location (site address) 19002 Whirlaway Road Eagle River AK 99577
Current property owner(s) VIK JAMES & KATHLEEN Day phone
Mailing address 19002 Whirlaway Road Eagle River
Real estate agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
AK 99577
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
[_]
Private Septic
Fx_1
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
[
Public Sewer
❑
Waiver request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ SSD
Date of Payment $ y 2
Receipt Number 0 (01 3�
COSA# 05C 2 t Jy _�
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Eklutna Engineering, LLC Phone 907.406.1058
Address 19162 Mountain Rd Chugiak AK 99567
Engineer's Printed Name Curtis Townsend, PE Date
..
6. DSD SIGNATURE.°"""'""
Geese
,�
V System #1 Approved for 3 bedrooms : '�t'T
Date `< - _Z0
No. CE 11904
System #2 Approved for bedrooms ��OFESSIO?a AV
Disapproved ���-isoO�
Conditional approval for bedrooms, with the following stipulations:
A"e o>1 Iy 4ou 1.2 I. Ind ike ,t<<<<cccctttt��r
�' V e \I W1
a �esi ; ; ON-SITE
W TER
LkV\ noWv% �o rnuCk Of i-t\e "Lk Sed:z r-1 IAIASV�IJVATER z^
PROGRAM
By: Original Certificate Date: F 1 d- 02 1
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 Checklist blue sheet
COSA Checklist
Legal Description: EAGLE RIVER VALLEY RANCHETTES LT 12D
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground in.
Date of flow test f SA
Static r level at beginning of test ft.
omments public water system
B. TANK DATA
Age of tank(s) 'c1 years
Tank type/material septic plastic
Measured operating fluid level in septic tank new
❑■ Standpipes/foundation cleanout per record drawing
Date of pumping new
D. ABSORPTION FIELD DATA
Parcel ID: 050-222-28
Structure served by this system
Well production at time of test gpm
Water storage tank v e gallons
Well disinf for coliform test? E] Yes ❑ N
oliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance com
Age of lift station veart
Lift stationmaterial
Comment
Which system tested (date installed) 1984
Adequacy test date 3/25/2021
❑■ ALL standpipes present per record drawing
Results [DPass For 3 bedrooms
Total measured depth from grade 9 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 4.6 ft (min)
Water added 721 gal
❑ N/A — pressurized field
0
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
f 0
Elapsed time min
depth into effective 1.2'
70Code-requiredsoil cover over field
Final fluid depth 0 in
❑ System presoaked
Absorption rate ' 450 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) no
date of test)
Gallons introduced gallons
If yes, enter date
Comments/Deficiencies: water never presented itself in the monitor tube throughout the test.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
ivate Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station o
> 100'
e Sewer/Septic Line > 25' F,-'� Yes
if No ft
o ' Tank > 100' [✓ Yes
if No ft
if No
ft
Neighboring Tank > 100'
F Yes
if No
I ft
Absorption Field on Lot > 100'
Fv� Yes
if No
ft
Neighboring Absorption Fie
0'
ft
Private Wells > 100'
P( Yes if No ft
Q✓ Yes
if No
ft
Co nity Sewer Main > 75'
Yes
if No
ft
Community Sewer Manho eanout > 100'
❑✓ Yes
if No ft
e Sewer/Septic Line > 25' F,-'� Yes
if No ft
o ' Tank > 100' [✓ Yes
if No ft
Animal Containm 50' R✓ Yes
if No ft
Manure/Animal Excreta Storage >
Yes
n Yes
I ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
F✓
Yes
if No
ft
Surface Water > 100'
F✓ Yes if No ft
Property Line > 5'
[✓
Yes
if No
ft
Wells on Adjacent Lots:
0
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100'
P( Yes if No ft
Water Main > 10'
FV -1
Yes
if No
ft
Community Wells > 200'
❑✓ Yes if No ft
Water Service Line > 10'
F✓
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
(D
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
ED
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
El
Yes
if No
ft
Community Wells > 200' F Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
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.
COSA Checklist yellow sheet
.... ; n� �.,..T wns
Data
' �-
�d�FC�s No CE 119 \V�`
FEWONP��� .�
ENGINEERS
Parcel I.D, #
1,
MUNICIPALITY 0FANCHORAGE
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
?/
GENERAL INFORMATION
Complete legal description
Eagle River Valley Ranchettes, Lot 12D
T14N R1W Sec.7
Location (site address or directions) 19002 Whirlawoy Road
Property owr~er FDIC
Mailing address
Lending agency
Mailing address
Agent N/A
Address
1966392 Anchorage. AK
Day phohe 261-7400
99519
Day phone
Daypho~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: -.~
TYPE OF WATER SUPPLY:
NOTE:
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 OFWASTEWATER DISPOSAL:
NOTE:
Individual on-site X
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.
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 ~'.,~gl~, l~ivr, t- 1~n_o~n~,~.,'in_cr ~?~'i~"es Phone 694-~1 q~
Address P.O. Box 773294, Eag].e R~.vm:, AK 99577
Engineer's signature
Date
DHHS SIGNATURE
~ Approved for
~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: ~ . _ _ Date .
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type
If A, B, or C, attach ADEC letter.
Parcel I.D. ~ ~-~_~
ADEC water system number
Log present(Y/N)
Date completed
Driller
Total depth Cased to
Casing height
Sanitary seal (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
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
; On adjacent lots
g.p.m.; .~
Absorption field on lot
;On adjacentlots
Public sewer main
Public sewer manhole/cleanout
Public sewer service line
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date Installed ~) ~"~P,/(~ Tank siZe
Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y <'---
Compartments
Depression (Y/N)
High water alarm (Y/N) /X/
Date of pumping (~ ?/9!
· Alarm tested (Y/N) "
/'//~ Foundation
/O ~ Water main/service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To propertyline
Surface water/drainage
On adjacent lots
Absorption field
~,.o~ (R..:~,~) ~on~ ~o^~'~ CONTINUED ON BACK PAGE
C. LIFT-STA~
Date installed
Size In gallons
v(~nt (y/N)" '
Manufacturer
' ~ Manhole/Access (Y/N), ,
"pump on" level at ~ "Pump off" level at
High water alarm level
Meets'MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed ~)~7" ~
' 5z' jo"
Le. ngth Width
:~;r0tal a, bsorPtion area ~3~.. f~ Z
,LDepression Over field (Y/N)
'~:l~esults (paC'/fail) P4 ss
Peroxide Ireatment {past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ,/',//~ ' On adjacent lots ~/'
2?'
To building foundation
On adjacent lots '/' ,.-~ ·
Surface water /~//,4
Curtain drain /~//,~
Soil rating 2/0~'
Gravel thickness
Total depth
System type
F'
Cleanouts present (Y/N)
Date of adequacy test
for -~ --
If yes, give date
Propertyline /~) /
To existing or abandoned system on lot
'/' I[.)'
bedrooms
Cutbank /,//.,4 '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_tZze,.date of this inspeciion.
Engineer's Name
Date ~/'~//'//
NAA Fee $ //",',~/'~,
Date of Payment '~-~" ~'~/
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-029 (Re~. 3~91) eack MOA 21
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
July 2, 1991
WALTER J. H/CKEL, GOVERNOR
563-6775
FOR: Eagle River Engineering Services
PWSID 21O875
My review of the records on file In this office reveals that the Nod'ok Ulities: Eagle River
Ranchette Subdivision Class A Public Water System, is in compliance with the provisions
of 18 AAC 80.060, State of Alaska Drinking Water Regulations.
Sincerely,
Keven K. Kleweno
Lead Engineer
r"" .UN~C~PAUT~ OF ANCHORAGE
DEPA.T.E.T OF.EALT. A.~ E..V, RO.ME.TAL
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR H~LTH AUTHORITY APPROVAL
o~ o.-s,~ s~w~. ~.~ w~. ~c,u~
264~720
Application Date
GENERAL INFORMATION
(a)
(b)
(c)
Legal Description (include lot, block, subdivision, section, township, r~nge)
Location (address or directions)
Applicant Name ~ ~~~q~elephone: Home
Applicant is (check one): Lending Institution g; Owner/builder ~; Buyer ~: Other ~ (explain);
Business ~'~! ~
"~, ,~
(d) Lending Institution l..[IJl'1~_~;~
Address 4'/~O
(e) Real Estate Company and Agent
- Address
Telephone ~-7~z-/~;//
Telephone
· (f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single-Family I~Multi-Family I-] Other
Number of Bedrooms -'~
3.WATER SUPPLY
~ndiv!dua~ we, n Communityl~ PUUicD
Note: If community well system, must have written Confirmation from the State Department of Environmental Conservation
' .attesting to the legality and status.
Onsite ~ Public I-I Community I-I Holding Tank I-I
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
ENGINEERING FIRM PROVIDI~INSPECTIONS, TESTS, FILE SEARCH, ['~'~ 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
~uthority 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. _ l
Nameof Firm ~f"t,x.~;r~ ~ ~~ ~ Telephone -~[-~[~]
Engineer's Seal
DHEP APPROVAL
Approved for ~. ('~%edrooms by,~
Approved ' Disapproved
Terms of Conditional Apl~roval
Conditional
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
t~' OF ^NCHO~'UkGt: MUNICIPALITY OF ANCHORAGE (MOA)
^. WELL DAT~c~C''*~'~j ~0
Well Classification C o I'Y~ I.~u~,L~
2~1--4720
If A, B, C, D.E.C. Approved (Y/N)
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/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
CleanoutJManhole
Water Sample Collected by
Water Sample Test Results
Comments J
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression A~N)
__ ~k"dj~ ning Lots
.,"~o Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed C~
/0/"3"//8~/~ SizeI~'o '~ .o. ot Compartments
Standpipes (Y/N) ~.~-~ Air-tight Caps (Y/N) L/.~ ~ Foundation Cleanout {Y/N)
Depression over Tank (Y/N) /~ O Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) /~. i0, * ; for
Holding Tank High-Water Alarm (Y/N) ~J, I~. Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~ILC~(~~
To Property Line
To Water Main/Service Line
Course
Comments ~ r~'Or~ ~ ~ ~-~
To Building Foundation ~ I
To Disposal Field /0"
To Stream, Pond, Lake, or Major Drainage
Page I 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 (Y/N)
Results of Last Adequacy Test
~.~O. ~///~:~.~V Type of System Design
Length of Field
Depth of Field
Gravel ~ Thickne~
Standpi~ Pre~nt (Y/N)
Date of ~st Ad~uacy Test
Separation Distance from Absorption Field:
To Water-Supply Well 1-o~00 t
To Building Foundation
Lot
TO Water Main/Service Line ~.~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
U
To Property Line I0r
To Existing or Abandoned System on
; On Adjoining Lots ~' ~
To Cutbank (if present) /'J I~ *
D. LIFT STATION
Date Installed f
Size in Gal, lensL
"Pump On' Level'al....._
High Water Alarm Leveler'--.
Tested for
Electrical Codes (Y/N)
Dimensions
Pumping Cycles during Adequacy Test. Meets MOA
** Check P/~itted Be~m Rating Against HAA Request **
I certify t h atarlT'ave che~tifd, verified, or conformed to ail MOA a)q d HAA guidelines in effect on the date of this inspection.
.
Date of Payment
Amount: $
Page 2 of 2
Engineer's Seal
United Bank Alaska
COMMERCIAL BANKING CENTER
June 1, 1987
Health Department
Municipality of Anchorage
437 E Street
Anchorage, Alaska 99501
Re: Lot 12D Eagle River Valley Ranchettes
Dear Sir or Madam:
The above referenced property is owned by United Bank Alaska.
This house has been under construction since 1984 and has never
been occupied. The water was turned on for the first time May
19, 1987, by Norfolk Utilities. Alpine Construction has recently
been awarded the contract for final completion of this project.
If you have any questions concerning this project, please do not
hesitate to contact me.
Sincerely,
Property Manager
Special Credits Department
MCL/aa
440 EAST 36th AVENUE ,, ANCHORAGE, ALASKA 99503 · (907) 276.1911
DEPT. OF ENVIRON MENTAL CONSERVATION T,~,~o.o: ~9o7~
Address:
ANCHORAGE/WESTERN DISTRICT OFFICE---_ ·
437 "E" STREET, SUITE 303 ~"O~N~ P~O~(:~ON 274-2533
ANCHORAGE, ALASKA qgso1
UUN 8
RECEIVED
DATE: Hay 28, 1987
PWS I J).# 210875
To Whom it May Concern:
According to records on file in this office the
R~NOPEI~ES
Water Regulations
EAGLE RIVER VAI,LI~F
Water System is in compllance with the State Drinking
£or monthly bacteriological s~J~pling.
Sincerely, ~
Michael P. Lewis
Environmental Engineer