HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 11DEagle River
Valley
Ranchettes
Lot lib
#050-222-03
Municipality of Anchorage
Development Services Department
· Building Safety Division
On-Site Water & Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 ~'~
www.ci.anchorage.ak.us (907) 343-7904 Page 1
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number:. SW020085 PID Numbon 050-222-03
"°re':THOMAS SMITH Wastewater System: [] New · Upgr~3de
~dre.= ABSORPTION FIELD
19043 MAN O' WAR ROAD * EAGLE RIVER, AK 99577
No. of Bedrooms:
Ph°n":(907) 696--1725 3 IDeep Trench rlShallow Trench 13Bed mUound mOther
LEGAL DESCRIPTION 0.6 ~ ,, lO.0-1
- 11D EAGLE RIVER VALLEY RANCHETr£S 2.25-3.25
- -- - SEE DWG. -- 54+
WELL: [] New [] Upgrade 2.5 .. II
.,~..~.~./ ,. ,. 837+ ,a. ~ D-3034/ F-81
--' 23/2002
.. CCC CONSTRUCTION -
SEPARATION DISTANCES .s. puc =Holding m $.T.r' P. 13 Other
'~_~'~o sepu¢ ~orpUon u~t Hold~,g ~,'~ PREMIER PLASTIC 1000
Tank I%ld Station Tank
Wall N/A N/A - -- 25'+ PLASTIC 2
Su,a=o Water lO0'+ ~00'+ - - - LIFT STATION
Lot Une 5'+ 10'+ - -- -I
Foundation 5'+ 10'+ -- -- -- '~'~" -- ' ~'-' ' I' ----'""--'~'-- '
Curtain Oroln NOiNE KNOW- "'-'~~----~'~'ls.'..;;`.;
BENCH MARK
EXISTING SEPTIC SYSTEM ABANDONED PER UPC Bo'FrOM OF SIDING NEAR POINT "A'
I~--~ ~ ~ -' 100.00
' "- . ,
·
Inspections performed by: AKWWC, INC. Dates: 1st 5/21/2002
grd 5/23/2002 }~ ~t,~'~."'-
· Development Serviges Departm_ent .~.pprova, ~0~%.~;". I.. {[£-~953_.'~.....~
AS BUILT DRAWING
p~RUIT NUMBER: 050--222--03
SW020088 -
K BOX ~ ~ ~ _
......
~ . ~ N~ 1000 G~ON
~H~ ~ ~ / 'PREMIER P~C'
//
~[tl ~ SEP~C T~K
t A B
l ~ ST1 10.0 33.3
~ ST2 12.1 34.4
1~,2k1,. B~. ,',., '~.' ~. DBL1 16.4 34.6
N~ O~Nn[~ ~ '" ":""" "
· · ".. ~' 'J,'... DB~ 16.9 34.3
"" ~'"'; ",: C01 37.0 58.2
~ "?.~ 4. '~- MT1 36.4 57.1
~ ~ '"'['", ~ C02 30.2 16.2
.' .', .~; . 4 ..
"'" 't '¢ ' MT2 27.1 14.9
~.: :...... ¢...
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NOTE: ALL JOINTS FROM THE FOUNDATION
TO THE N~ SEPTIC TANK WERE ENCASED
IN CONCR~E.
MAN O' WAR ROAD
~SI~ ~TER & WASTEWATER ~ c.J.o. .
THOMAS & ~UEL~ SMITH (907) 696-1725 2 OF $
~ o=.,~o.: Q~r..,'". ......... '"~
EAGLE RIVER VALLEY RANCH[lIS SUBDIVISION; LOT 11D,
AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE '~A%~
BUILT DRAWING
PE~ NUUB~:~ AX- 050-222-05
SW020088
98.41-98.55 =
~P OF T~K A~ J = ~~P OF T~K AT
I~ Or BUNG 'PREMIER P~IC' m~ OF BUNG AT
, CONSULTANTS, INC. N,T.S.
THOMAS & ~UEL~ SMITH (907) 696-1725 ~ OF 3
PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
05/29/2002 ~D 10:37
FA~ 907 562 6321 ~ CHILDRENS CLINIC
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MUNICIPALITY OF ANCHORAGE
Development Sen~Ices Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: May 02, 2002
Expiration Date: May 02, 2003
Permit Number: SW020088 Parcel ID: 050-222-03
Legal Description: EAGLE RIVER VALLEY RANCH~- I lES LT 11D
Design Engineer: 0041 AK Water & Wastewater Consultan' Site Address: 019043 MAN-O-WAR RD
Owner Name: Thomas and Louella Smith Lot Size: 17955 SQ. FT.
Owner Address: 19043 MAN O WAR RD Total Bedrooms: 3 Permit Bedrooms: 3
EAGLE RIVER, AK 99577-8336
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewatar Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under consb'uction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Parcel I.D.
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
050-2~2-o3
Permit Number ~ [x.,~?? 008~,,
Property owner(s)
Mailing address (1)
Mailing address (2)
THOMAS SMITH c/o GREATLAND REALTY
11411 OLD GLENN HWY * EAGLE RIVER. AK
Day phone 694-9125
Zip Code 99577
Legaldescdption(Lot, Block&Sub'd.) EAGLE RIVER VALLEY RANCHETTE$ SUBDMSION: LOT 11D.
Legal description (Section, Township & Range)
Lot Size /'~,, ~ ~"" Acre~ ~
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
Well Only []
WaterStorage []
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Jacuzzi
Water Softening Unit
I cedify that the above informat'on is correct. I further certify that this application is being made for a
Si?gle Family Dwelling and is in accordance with applicable Municipal codes.
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ALASKA WATER &: WASTE'WATER CONSULTANTS~ INC.
Permit Fees:
Date of Payment:
Receipt Number:.
Waiver Fees;
Date of Payment:
Receipt Number:.
ALASI(A WATER WASTEWATER
CONSULTANTS, INC. ' .......
April 24, 2002
Municipality of Anchorage
Development Service Department
Building Safety Division
On-Site Water & Wastewater Program
P.O. Box 196650
· Anchorage, Alaska 99519-6650
Reft Septic System Upgrade for Lot 1 ID, Eagle River Valley Ranchettes Subdivision
To whom it may concern:
The existing 3 bedroom house is served by a public water system and a private septic system.
The existing septic system consists of a 1000 gallon septic tank and a crib type drainfield. The
existing crib is located immediately adjacent to the foundation and therefore your department
would not issue an H.A.A. for it. Therefore an upgrade is going to be required. A test hole was
excavated west of the existing septic system in the area ofthe septic upgrade. The septic system
will be designed around the 30 foot radius of this test hole. We are proposing that a new 1000
gallon septic tank and a deep trench type drainfield be installed. Comments regarding the design
are summarized as follows:
1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that due to the overall appearance of the soils, an
application rate of 0.6 gallons/day/~ should be used.
2. TRENCII DESIGN:
a. Percolation Rate: 24 minutes/inch
b. Allowable Application Rate: 0.6 gallons/day/ft2
c. Number ofBedmoms: 3
d. Design Flow: 450 gallons per day 2
e. Minimum Absorption Area: 750 It
f. Total Depth: I 1 feet (max.)
g. Effective Depth: 7 feet
h. Width: 2.5 feet
i. Reduction Factor: N/A
j. Minimum Length: 54 feet
k. Effective absorption area = 756 it2
e
SURFACE WATERS: There are no surface waters within 100 feet of the proposed
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akww¢.com
upgrade.
4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography of
this property is a 10% to 15% percent running from approximately notheast to southwest, in
short, there are no slope concerns. The trench is to be installed parallel to slope contours.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
NOTE: .~ttached is a site plan drawing, a design drawing, a soil log, and a 7 page construction
specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
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F...R. VAJ. J.E"Y RANCHL. I~~'' F...R. VALJ.[Y RANCHLHI~ I~R, VALLLry RANCIIt. lit~ IrR. VALL/Y RA.NCHbi~t.b Ir,R. VALL[Y RANCHblit.b
S/D; ~ 21D S/D; LOT 20C S/D; LOT 20D S/D; LOT 19C I S/D; LOT 19D I
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WHIRl. AWAY ROAD /ALL PROPERTIES SHOWN SERVED BY ___
-'--I PUBLIC WATER AND PRIVATE SEPTIC.I
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F...R. VALLry RANC~LHL~ tR. VALI.~ RANCHbHt.~ F..R. VN.LrY RANCHETTCS tR. VALLrY RANCHt. H~.~ E.R. VAJ. LL~ RANCHbHt.~
S/D; LOT 120 S/D; LOT 11A S/D; LOT 11B S/D; LOT IOA S/D; LOT 108 I
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___(PROPOSED $[PT1C ~U
SEE DESICN PACE (2 OF' 2) ' I
[.R. VNJ.EY RANCHL~it.~ F..R. VALLEY RANCHE'r~$
E.R. VALLEY F..R. VALLEY F-R. VALLEY RANCHEI'I~S S/D; LOT 10C S/D; LOT 100 I
RANCHEI'TES RANCHETTES S/D; LOT 11C
S/D: LOT 12B S/D; LOT 1,¢ '1~ ~ X I
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MAN O' WAR ROAD .... _~..
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EXiSTiNG
3 BEDROOU I
HOUSE |
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E.R. VALLEY RANCH["TT~S ER. VALL-FY RANCHET~S [.R. VALLEY RANCH~FTES ER. VAJ. J. EY RANCHETI~S F...R. VALLEY RANCH~'I'~$
S/D; LOT 3B S/D; LOT 2A S/D; LOT 2B S/D; LOT lA S/D; LOT lB I
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~R. VALLEY RANCHMib~ F-R. VALLEY RANCHEIT[S E.IL VALLEY RANCHE'r~s F-R. VALLEY RANCHEITES E.R. VALLEY RANCHEI'~!
S/D; LOT 3D S/D;, LOT 2C S/D; LOT 2D S/D; LOT lC S/D; LOT 10
THOMAS & LAUELLA SMITH 696-1725 I OF' 2 ' "vv';-~'~'.~':'''
-..' ·
EAO E R,VER VA ' Y RA.O" S SU D,V,S'O" LOT ,,D
SITE PLAN FOR PROPOSED SEPTIC SYSTEM UPGRADE
NOTE: THE CONTRACTOR SHALL HAVE THE WATER
SERV1CE UNE LOCATED BY A PROFESSIONAL UNE
LOCATOR PRIOR TO CONSTRUCTION. ANY JOINTS OF
THE SEWER SERV1CE UNE WITHIN 10 FEET OF THE
WATER LINE ARE TO BE ENCASED IN CONCRETE.
~PROX1UATE LOCATION OF
WATER SERVICE UNE APPROXIUA~ LOCATION OF
KEf~OX ~---~ -- __ ~--.WA"~.R SERV1CE UN£ ..........
/ CL[ANOUTS (DBL)
/ / bit - -- SEFtlC TA~K
E~ISTINO SE:PTlC TANK AND CRIB
[ f v ~ ~ ~f ~ ~INSTA~ FOUNDA~ON
L--. EXISTING
I GARAGE 3
Housr
....:~: .. o .
~ PROPOSED DRAINnELD. EXCAVAlI: A
TRENCH 1HAT IS 11 FEET DEEP MAXIMUM
BY 2.5 FEET WIDE BY 54 FE_rT LONG.
~DD 7 FEET OF' CLEAN. WASHED SE'WER
DRA]NRO¢IC INSTALL TRENCH pARalan
TO SLOPs:. CONTOURS.
MAN 0' WAR ROAD ....
.................... C.J.G.
ALA$I~_ ~,YATER & ~,YASTE~VATER ~*'~ ,!~:~i .4..~.!.f.! ~...L.'2~i~
CONSULTANTS. INC. 1"----~0'
THOMAS SMITH (907) 696-1725 ~' OF' 2
EAGLE RIVER VALLEY RANCHETTES SUBDIVISION; LOT 11D,
DESIGN OF PROPOSED SEPTIC SYSTEM UPGRADE
. . .........
................................. ................ · " --,~:- '"'-~l
ALASI(A '~vVA'I'ER & ~STE%~TER
, ~.." 49~ '-~
, ~ON~OLT~NT~. IN~. L...; ....................... ; ....
[S01L LOG - PERC0~ION ~ESI[ ............................ :....~
~ DESCRIP~ON: ~CLE R~R VALL~ ~CH~S S/D; LOT 11D,
PERFORMED FOR: ~0~ SU~ DA~: 4/18/2002
ORGANICS ITEsT HOLE
~ /FILL I In ATI N
2 : ~72~:~ GW ~ ORG
~ ,~:i:~ GP ML
,
SW MH
SP CH /
SM OH
DEPTH TO DATE / ~, 3 e~R~U
GROUNDWATER ~ ~:~ HOUSE
D~ 4/18/2002
OM/SM
DENSER '
w/ DEPTH DATE READING~ CLOCK NET TIHE WATER LEVEL NET DROP
TIHE (HINUTES) READING (INCHES)
4/18/2002 1 3:12 - 6' -
2 3:42 30 4 3/4' I 1/4'
3 3:42 - 6" -
4 4:12 30 4 3/4' I 1/4'
5 4:12 - 6' -
6 4:42 30 4
16~
17~
1B--
PERCOLATION RATE 24 (HIN,/INCH) PERC, HOLE DIA, . 6 (INCHES)
19-
TEST RUN BETWEEN 8.0 FT, ~D 8.5 FT.
20-- A FOUR HOUR PRESOAK WAS PERFORHED: ~ YES ~ NO
SOILS LOGGED BY:J~ON WOOD / JODY MAUS PERCOLATION TEST PERFORHED BY: JODY MAUS
COHHENTS:
PERFORMED BY ~W,W,C,. INC, I, JE~R~ ~ G~NESS, CERTI~ T~T ~IS W~ PERFORMED IN ACCORD~CE
W~H ~ ~ATE ~D MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St. /~t .
P.O. Sox 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us v~.
(907) 343-7904 AL~
CERTIFICATE OF HEALTH AUTHORITY APPROV
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 050-222-03
1. GENERAL INFORMATION
Expiration Date: ~-'"' '~ (~ - 0 "~
Complete legal description EAGLE RIVER VALLEY RANCHETFES S/D; LOT 11D
Location (site address or directions) 19043 MAN O' WAR DRIVE · EAGLE RIV£R~ AK
Current Property owner(s)
Mailing address
Lending agency
THOMAS AND LOUELLA SMITH Day phone 696-1725
19043 MAN O' WAR ROAD * EAGLE RIVER, AK 99577
Day phone
Mailing address
Reel Estate Agent
Mailing address
CINDY UNDBLOM w/ GREAT LAND REALTY Dayphone 694-9125
11411 OLD GLENN HICHWAY" EAGLE RIVER, AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Note:Alaska Water and Wastewater Consultant$, Inc. shall be paid $~,3~.5 ~-at, or pdor J
to closing for the engineering services provided. '
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4. STATEMENT OF INSPECTION BY ENGINEER
As ceA'fled by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority 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 vedfy 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 afl applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER &: WAs~EWATER CONSULTANTS. INC.
Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
Phone 337-6179
Date
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described 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 soils condition, greundwater levels that may
fluctuate durfng the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee futura performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWC. Inc. can therefore not previde
any warranty or future estimate of how long the system ~I1 continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor wfll it confer any legal right whatsoever.
5. DSD SIGNATURE
~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the ~owing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
~.-" ON-SITE '.
~ ; WASTEWATER
-~ <~,,'. .' ~,,, ~
~,,~ '... .,.' ,,-,'
Manitenance Agreements :'"~,~,O~F~ T CF~'C~"~~'''
Supplemental Engineer's Reort ~'4/Y~,U~ ~ ~ t ~ ~ ~ ~'
Other
Original Certificate Date: ,.~'"-- .~ ct - 0 ~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wasfewafer Program
4700 5outh 8regaw St.
P.O. Box 196650 .,N~homge, AK g951g-6650
www.cLenchorage,ek,us
(9O7) 3434~04
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: EAGLE RIVER VALLEY RANCHLIit~ $/Di LOT 11D Parcel ID: 050-222-0,1
A. WELL DATA
Well type ~ If A, B, or C provide PWSID# N/A ~ ~
Date completed Sanitary s~l.~g~t,~---~Wlres pmberly protected (Y/N)
lt. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test ,""/ "/"/
Static water ldvei J It, J It'
Well preduction J g.p.m. J g.p.m.
WATER ,SAMPLE RESULTS:
Coliform - colonies/100 mL Nitrate - mg~. Other bacteria - colonies/100 mi.
Amenic: - mg./L. Data of sample: - Collected by: -
B. SEPTIC/HOLDING TANK DATA
Tank Typa/Materlal PLASTIC
Tank size 1000, gal. Number of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping NEW Pumper
Date installed 5/21-23/2002
Cleanoute (Y/N) YES
High water alarm (Y/N) N/A
ABSORPTION FIELD DATA
Date installed ~ Soil ratlng ~ ~¥odrm) 0.6
Length 54+ It. Width 2.5 It,
Total depth 11.4 It. Eft. abso~3tlon area 837+ It2 Monitoring tube YES
Date of adequacy test NEW Results (Pass/Fail) -
Fluid depth in absorption field before test - in. Water added - gal.
Elapsed Time: - min. Final fluid depth - in.
Any rejuvenation trea~nent (past 12 mo.) (Y/N & type)
System type TRENCH
Gravel below pipe 7.75 It.
Depression over field NO
For 3 bedrooms
Now(Jepth - in.
- g.p.d.
Absorption rote >=
- If ye", give date
D, LIFT STATION
Date installed Size in gallons , Manhole/~es~f~
"Pump on' level at in. "Purer alarm level at in.
Da..~m -------'-----------~Cyctes tested. Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
PUBLIC WATER
On adjacent lots
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field.
Water main 10'+ Water sewice line 10'+ Sudace water.
Wells on adjacent lets 200'+
100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water se;vice line 10'+
Curtain drain NONE KNOWN
COMMENTS
Building foundation. 10'+
Surface water 100'+
Wells on adjacent lots 200'+
Water main 10'+
Driveway, parking~'ehic~e storage 10'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections end
rm4ew of Municipal mcor~ls that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
JEI-I-I<EY A. GARNESS
HAA Fee $
Date of Payment
Receipt Number
(R~v. 12/01)
WaNer Fee $
Date of Payment
Receipt Number
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Servtces 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
Location (site address or directions)
Property owner
Mailing address
Lending agency.
Mailing address
Agent· ~--~,~-
Address
Day phone
Dayphone,
:, Unless Otherwise requested, HAA will be held for pickup " ""
2. 'NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
' Community well ..........
· . Public water ~ .......
from ....... -o' . ..... -c'-,'.
. NOTE. If communl well system, provide written confirmation - ,o ...... , ,5,r, ..
ty State ADE~ gttest- "
lng to the legality and status 'of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
.- Community on-site
:r-'-":'-7~': :... Public sewer =-:,' ~' :~::':?"-:"':,':.'-~':.' .........
:"' :NOTE: :'If community wast~water syste~n~4p~'O'vi~e' ~vHtten confirmation from State ;ADE~
attesting to the legalityari~l'§i~i~ '~f~'~t~. .... '" "' .............. - ....
5. STATEMENT OF INSPECTION BY ·ENGINEER '
As certi~ed bi; 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 ~afe, functional and ad~luate for the number of t~.rooms
and type of structure Indicated here'n. I furtherverify that based on the Information obtained from
the Municipality of Anchorage filas and from my investigation and Insl:~zfion, the on~ite water
supply and/or wastewater.disposai sYStem is iQ compl.iance ~ith all Municipal and State codes,
ora~.4'_nances,,..,,~and,.-o .'- .-... in. effect^ ,~,, a ~,, ,,~ *h~ I ~,,~-~in ,,n ,.,~ ,,a,~ ,,. ~,,s .n~......-n.
regqlations . . . . .... .,.,.
' '" ' Phone - ~'~'~'
Narhe of Firm - -
unvi*; ~. ~',"'/;* .... '*'** ..,
20210 Dclna]ar St.
Add~ Chugi.k, ~/. ,/5~? ~' ......
· ": :" ' "*'*' ' :' '/.J.~~' Date
Engineer's signature / .
- ~.~. ~ *..'~. :.~ ...:_...:~:-~*~**,.
~. ,~.~.....'..- ....
6. DHHS SIGNATURE · · ~,,~o~/T0~L~/~,,'q'...,,.. ..
. . ·, - - , ",*'2 ..... ...... 'x ·. · . . - - *' '-. ~,~**' ;~',~,.'~, '.
' "-~ ...... 'Approved ~or ~ bedrooms. .
Cor~ditional approval for bedrooms, with thb f011o'Wifi~ '~ti,__l~ti~)n-~!'; *,., ,, '-
~ ~ ~d?itional Comment~ ............. ~ .
,,,',, g .~.;Jl,I '- ~ ' .,., . .
.... ...... ...... .. ., .... ....... ............. .......... ,
?._,~' · :-'"~ "*"2'/' .... ~' ;'" ~,¢ .... . . . , ~... z .-- _
'"~ ' *'. BV:.! /_.~-r."v~--v ~ /'-,-~' ,-'- ' . , .,~../
o"*~ , L *,/ .t · ' · · .... ./.
.- · , ~. I ~':'-/ * ~ ..- . · ' .-
.".a . .*'/. .'~'~ .- .... .: ~ ..'. .........................
, ~.~.~ .
.. ., .....................
"',,.;,:~ Th'~"~ici~alitY of Anchorage Department of Health and Human Services (OHHS) Is?ues Health Authority
"APl~;~a! 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 pu mhasers of homes
and their lending institutions in order to satisfy ~:~r tala federal and state requirements. Employees of D~H$.do not .~ ~ - -
~' con. du.ct In..s ..pe...c~i.?,ns ,o.r.,analyze data before .a certifica!_e is issued. The Municipality o.f. Anchorage..b n, ot.
responsib[? for errors or omissions In the p,ro. fessional engln,.e~..~s ,.w~.rk. 'C =' ' ~ ' " ....
Legal Description:
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel I.D.
Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A. B. or C. attach ADEC letter. ADEC water system number,
Date completed Driller
Cased to Casing height
Wires pmperiy protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
g.p.m. ., g.p.m.
Septic/holding tank on lot
Absorpticn field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
; On adjacent lots
; On adjacent lots
.Public sewer manhole/cleanout
Petroleum tank
Coliform
Date of sample:
Nitrate Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed /
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
/
Tank size /ooo compartments,
Foundation cleanout (Y/N) ~ Depression (Y/N)
'~',/~- Alarm tested (Y/N) :~
SEPARATION DIST~CES FROM SE~IC~OLDING T~K TO:
Well(s) on lot
To property line
Surtace water/drainage
On adjacent lots "'~"~- Foundation
Absorption field, ,Water main/se~,ice line
CONTINUED ON BACK PAGE
C. UFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
'Pump on" level at
Meets MOA electrical codes (Y/N)
ManufaCtUrer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
On adjacen~ lots
Surface water
Well on lot
D, ABSORPTION FIELD DATA
Date Installed /
Length' ~ W'~h
· Total absorption area
Date of adequacy test ~ /°/7~esuits (Pa~s/fall)
'Water level In absoq~ion, lleld before test
Peroxide treatment (past 12 months) (y/N) /t/'
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
To building foundation
On adjacent lots
Surface water ! ~/""-
Curtain drain
F_ ENGINEER'S CERTIFICATION
Soil rating (GPD/Ft2) /'/'"',~.,~,~--'.J System type
~' .Gravel t~ickn~ss' ~ ' ' Total depth //'/
Cleanout present (Y/N) Y Depression over lieid (Y/N)
.for
After test
It yes, give date.
On adjacent lots ~//~- ' Property line
~;';. To existing or abandoned system on lot
Culbank /~,//"~ Water main/sewice line
Driveway, parking/vehicle storage area
I cer~fy ~hat I have checked, vedfied, or c~focned to all MOA and HAA guidelines in effect on the date of this ~nspec~on.
I:~vld R. Dayton
Signature 20210 Donatar F'
Engineers Name Chugiak, Alaska
Date
Waiver Fee $ ' '
Date of Payment
Receip{ Number
HAA Fee $
Date of Payment
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~,~JNICIPALITY OF A~OEAGE
825 L Street - A~hor~, AI~k~ ~1 DEPL OF H~ALTH &
E~IRONMENTAL P[,OTE~ION
ENVIRONMENTAL ENGINEERING DIVISION
REQUEST FOR ~PROVAL OF INDIVIDUAL WATER AND SEWE~g[ D I
James and Pat Hamilton
MAILING ADDRESS
BOX 1153 Eagle River, Ak.
PROPERTY RESIDENT (if different from ebo~e)
99577
2. BUYER
Harry Finch III
MAILING ADDRESS
BOX 117 Genora Street Eagle River, Ak. 99577
LENDING INSTITUTION
People's Bank and Trust
MAILING ADDRESS
PHONE
94-2652
PHONE
PHONE
PHONE
79-7511
644 West 8th Avenue Anchorage, Ak.
4. REALTOR/AOENT
Joyce Gardner Red Carpet Great Land Realty
MAILING ADDRE~
P.O.Box 633 Eagle River, Ak. 99577
~ LEGAL DESCRII~TIO.
LllD Eagle River Valley Ranchettes
STREET LOCATION
Man O' War
~ TYPE OF RESIDENCE NUMBER OF BEDROOMS
~'I SINGLE FAMILY I"'1 One I--I Four
I-'1 Two r-I Five
[] MULTIPLE FAMILY I-~ Three [] Six
7. WATER SUPPLY
[] Other
r-~ INDIVIDUAL·
COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DIBIK)SAL BY&! cM
· ATTACH WELL LOG. A well log is required for ail wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
(~] INDIVIDUAL/ON.SITE**
[] PUBLIC UTILITY
I ind v dual/on-s~te, give insta at on date 1967
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
,
72~t 0(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO I-'1 FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL 3EPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
-'IPUBLIC UTILITY
Connection Verified INSTALLER
[--ISept~c~var~ or I--IHolding Tank
Size: ! ~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line
WELLTO:
I
I
Absorption Area to nearest Lot Line
5. COMMENTS
~PPROVED FOR _~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must at. company certificate}
[] DISAPPROVED ,//
LEGAL DESCRIPTION '
724310 (Rev. 3/78)
DAVID A. SLENKAMP
ROBERT A. SHAFER
MECHANICAL ENGINEER
694-9055
Oune 15, 1981
CIVIL ENGINEER
694-2979
MUNICIPALITY OF ANCHORAGE
DEPT. CF H,_*ALTH &
ENVIRONM2NTAL F';.CT2CTION
Greatland Realty
ATTENTION: Joyce Gardner
P.O. Box 633
Eagle River, Alaska 99577
1 7 1981
RECEIVED
Dear Ms. Gardner,
Reference: Lot liD: Eagle River Valley Ranchettes: Hamilton Property
A sewage system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank was
pumped and verified to have a capacity in excess of 1000 gallons.
The seepage pit was charged with 1000 gallons of water and after
a 24 hour period all the water which had been added had percolated
out of the crib.
It can be concluded from'this test that the waste water disposal
system located on this property is currDntly functioning adequately2
However it cannot be guaranteed against subsequent failures.
If we may be of further assistance, please do not hesitate to call.
Sincerely,
cc: Peoples B~nk and Trust
ATTENTION: Shirley .Hall
Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3.. Legal Description:
4.
5.
-GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
2330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 3/13/7S
Time of Inspection
Date of Inspection 3/14/75
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
TOh31S eI~.Cl
VA
Area Realty
Phone:
Phone:
Lot llD, ~agle River Valley R,~nd~ettes
Location: )Ian O'hTar Road
Type of facility to be inspected
6. Well Data: Ca,munity
®
Single
No. of bedrooms
A. Type
C. Construction
Sewage Disposal System:
A. Installed 1967
B. Depth
D. Bacterial Analysis
Installer
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
1. Size 1000 gal 2. Manufacturer
1. Absorption Area 8xSx6 2. Material Log
Total length of lines
, Absorption area
, Other contamination
, Absorption area
C. Absorption area to nearest lot line
, Sewer Lines
EQ-034 (1/74)
Page 1 of two paqes
Legal Description
Lot liD, Eagle River ValleY Ranch~tte,s
Co~.~ents
Approved~Disapproved Date S/l~/?~
Approval kValid for one year from date signed
Greater Anchorage Ar~a Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date'
EQ-034 (1/74)
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WAT£R FACILITIES
(Fill OUt in T~ate)
lta,~ ~of person requesting approval__~//~/~
~a~ of proper'cy:owner
Numb~x,.~ ~edrooms in house ~
Water ~nalysls:
a. BacTerial
b. Detergent., ""' .
Well data:
a, type~.
b. Depth__ ~).~,
c. CaslnE Size
d. Distance ~rom well to sest existing o~ ~sed~.~k~
2. Septic tank :
3, Seepage A~ea__
6, Other sources of Possible contam[natton~ [,e,~ creeks~ lakes,
ho~ses, ba~ drainage ditch~ etc.
~ame oE septic ta~k ma~u£actu~
[, ~f "home ~ade" show dia~r:m on reverse side o~ this
- [, Distance to prope~y line. to house ~undation
Sewage disposal system·
a. Age of system__ / 7~'! ~
b. Septic tank capacity in gallons
C.
dj
~ · Perc~] at lon~
f. ?er¢oletlon Test performed by,
Use ~Y,e ~ve~e
~,t~c ta~k location, d~sposa~ area location, location of percolation test,
a~ dl~ction of ~round slope.
The [,,~'~n~.~tlon on tkls f~m Is. true an~cor~ct to the best of my knowledge.
' ~a~e S~ned
T~O BE FILLED OLrl~ BY HEALTH DEPAP, T!.I£NT PEI~SOI'INEL
~e above described sanitary facilities are hereby approved, .subject to the
.... ~-_~llowin~ condltions..
Conditton~:
The above described Sanitary facilities are disapproved for the following
"Approval ~s valid for one year follow[n[ the date of approval.
~- CPJ:cw