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Home My WebLink AboutEAGLE RIVER VALLEY RANCHETTES LT 23A A~adress Phone: Township; WELL: Classd~cahon {Private. A.B.C): 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 Permit Number: ~'/-/--) '~5,,'3/~,'~ ~ PID Number: ~;:~43 ,,~ ~ ,..~2./ ~ /-/, c/. 2~. Wastewater System: [] New ,~pgrade ,4-,/E- ~'~'5'/5-:75~r ABSORPTION FIELD I No. of Be,~oms: ,,--,-,-,-,-,-,-,-~./-Deep Trench rl Shallow Trenchr-I I~ed [3 Mound [3 Other LEGAL DESCRIPTION so, I Range: ISoc,,O.: Fill added above original grade' ~. r'] New C1 Upgrade Gravel width: e~'~/ Ft Tolal Depth Irom orig~)l~grade: Gravel depth beneath pipe Gravellength: /~// · Ft GPM I Pump Sel at: SEPARATION DISTANCES ;~Septic(',.,/~-~,,~ [3 Holding [3 S.T.E.P. ~...,L... ,,,/,d~-~,~,4~ ?--,e,,//~-I / ~o Well Surface Water Lot Drain Remarks: LIFT STATION Size in gallons: I Manufaclurer: ~ "Pump on" level at: ~.~/l~eve1.1: I High water alarm at; Pump~ I ElectriCal Inspections performed by: BENCH MARK J Assumed Elevation: · ~..~.,~ENGINEER'S SEAL Inspections performed by: ~ .~ ................. Department o[ Health and Human Semites approval rP>~ ~. m~-~ Reviewed and approved by: ~ Date: 7-/2 -~ .~ 2;,~ ....... Permit No. SW930124 Page 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES of 2 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: EAGLE RIVER VALLEY RANCHETTES, LOT 23A PIDNo.: CO [ C02 I 1250 CAB .7' 05022321 SR SR '"~0.2' .o.2'-''~ I · 94.2' NO WATER FOUND I : I U~IL ESMT. -- ,- ,r-NEW 1250 CAB · " \SEPTIC TANK HOUSE ~ I \ FCO 20,4 33.4' COl 25.8 38.9 C02 32.0 44.0 C03 74.6 82.0 (;04 88.0 56.4 C05 75.0 24.0 C06 07.0 45.5 MT1 68.0 43.0 )JT2 87.0 50.0 PROPERTY SERVED BY, A COMMUNITY WATER SYSTE~. ~ 40" N~O WELLS 'WITHIN 200 OF SEPTIC SYSTEM I PAGE 1 OF i 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:SW930124 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SECRETARY OF HUD OWNER ADDRESS:222 WEST 8TH AVE. ANCH. AK 99513-7537 DATE ISSUED: 5/26/93 EXPIRATION DATE: 5/26/94 PARCEL ID:05022321 LEGAL DESCRIPTION: EAGLE RIVER VALLEY RANCHETTES LT 23A LOT SIZE: 17955 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: May 21, i993 ROBERT SHAFER, P,E. ROGER SHAFER. P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Eagle River Valley Ranchettes, Lot 23A Request ~ou issue & permit to upgrade the septic system serving the referenced property. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. Attached is the proposed upgrade design. This property is served by a Community water system. There are no protective well radii which encroach upon the property. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. SITE PLANS ROAD DESIGN If you have any questions or require additional information f.or ~view, please contact us. ert A. Shafer, P.E. ON SITE WASTE WATER DISPOSJM. SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577 LEGAL I DRAWN Z EAGLE RIVER VALLEY L. S. ULSHER j cKo. R.A.S. DESIGN CRITERIA: 4 BDRM = 600 GPD SOILS = 0.6 GPD/SQ, FT. 600/0.6 = 1000 SQ. FT. REQ'D j OA,E 5/20/e3 J'~"'. ' Or 1 ~,.~."~ ,,'.,., DEEP TRENCH: ~~~"' ..... '"' "' 4.5' EFFECTIVE," 7 . -~ : ~. (TWO TRENCHES 55.5' EACH) v/l~,~ .,. ~, ~ / I A'- SEPTIC rTANKS J I ~ / \ (Wm~ ~zo~rm ! { I~.J .... [ \ SEEPAGE I~T TO BE NO~: ~ po~o~ of ~ ~ ~ I~1 k I K req~es ~ation, I ~JX~x I PROPERTY SERVED BY A COMMUNTfY WATER S~STE~I. NO WELLS wYI'HIN 200' OF SEPTIC SYSTEM { Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 #L" Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LECAL DESCRIPTION:~,'C '~'~ ~-' ~ ~.~ T~nship. Range, Section: ELOPE 2 · 4- .* 5 SITE PLAN N 11; 14 18- WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Idoni~intl? I Reading Date Gross Net Depth to Net Time Time Water Drop 19- 20- PERCOLATION RATE TEST RUN BETWEEN ~ , ~ FT COMMENTS $ · $ ENGINEERING ,/// ",~ .*~' ' 17034 Eagle River Loop Road No. 204/~ )~'~ CERTIFY THAT THIS TE ST WAS PERFORMED IN ACCOR DANC r WITH ALL STATE AN O MUNICIPAL O MID ELINE/~y E FF~,~,~,~,~,~,~,~,~,~.;I' ON THIS DATE. DATE: 72-008 (Rev. 4/85} v j ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION P~ACTICES and MATERIAL SPECIFICATIONS REFERENCE: Eagle River Valley Ranchettes, Lot 23A GENERAL: 1. Se The scope of the project consists of installation of a 111' long soil absorbtion trench containing 4.5' of sewer gravel between 3.5' and 8' below ground level. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC T~NK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. page 2 Eagle River Valley Ranchettes, Lot 23A Se A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than l0 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ;~BSORPTION TRENCH/DRAINFIELD INSTALL~TION= Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed- up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. ® A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. page 3 Eagle River Valley Ranchettes, Lot 23A MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: TYPe of PiPe Perforated Sol~d Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). ® Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Se A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. page 4 Eagle River Valley Ranchettes, Lot 23A INSPECTIONS~ Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. me The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. MAILING ADDRESS · 1~ 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 [PRONE. -.~l [~NEW NO. OF BEDR~,~7 Dwelling~ /' PERMIT NO. Width Liquid depth PERMIT NO. Material Liquid capacity in gatlons "oundat'o;3q Total leng f I~e,~. Trenc idth// Distance bet . lines PERMIT NO. T~crib DIS~NCE TO: We~ Building foundation ~'J~ Class Depth ~n/i~ Driller ~ DISTANCE TO: Building Sewer line OTHER PiPE MATERIALS_ SOIL TEST RAT& REMARKS 72-0/~ (Rev. 3/78) / DATE LEGAL , ~o 2~f / .. DEPR~:TI'IENT r ~EC~LTH RND EN'./IRONHEt. ITRL r --'TECTION ,' 825 'L' STREET, RNCHOERSE, RK. - 264-4728 ~ ,3f-4--~ Z TE SEI.~E~: I_Ip~3RRDE F'E~:['I ! T PERI, lIT NO. ( 790656 ) APPLICANT SRNDRR HENZLE SRB 19ER E R 694 2?79 LOCRTZON 28 GRRNu LEGRL L22R E R VRLLE~' RRNCHETTES LOT SIZE 16888 SQURRE FEET TMF'E OF SOIL 8BSORPTIOH SMSTEf, I IS: TRENCH PiR:KIPIIJI,1 NIJHE:ER OF BEDROOIflS = 3 SOIL F:RTIHG THE REI)UIRED SIZE OF THE SOIL RE:SORPTIOH SVSTEPI C. EPTH= 1E~ LEf4GTH= ~.~ ISRR%¢EL DEPTt4= THE LENGTH DIfIEHSION IS THE LEHGTH (IN FEET) OF THE TREHCH OR DRRIf'~IELD, THE DEPTH OF R TREHCH OR PIT IS THE DISTRNCE E:ETI4EEH THE SUF:FRCE OF THE GROUND Rf-ID THE BOTTOfl OF THE EXCRVRTION (IN FEET). THERE IS t~O SET ~,IIDTH FOR TREHCHE~. THE GRRVEL DEPTH IS THE I'IlHIMLI~'I DEPTH OF GRRVEL BETHEEN THE OUTFRLL PIF'E RHD THE BOTTOm1 OF THE EXCRVRTION (IN FEET). ~:gl]!l_l ~ REO SEF'T I ~S TRf4~( S I ZE= 2E;8 ;E~ ~3RLLC~f-IS PERMIT RPF'LIC~NT HM_ THE RESPOHSIBILITV TO INFORr'I THIS DEF'R~:TNEHT DUF:ING THE IHSTRLLRTION IHSF'ECTIOHS OF RNV HELLS RD.TRCENT TO THIS F'ROF'ERTM RND THE NUHBER OF F:ESIDENCES THRT THE HELL HILL SERVE. TI4~D - (2) I f4SPECTIOf-IS RF:E F:Eg!I_IIF:EC, BRCKFILLING OF RNY SYSTE~I HITHOUT FINAL IHSPECTION RNB RPPRO'v'RL BY THIS DEF'RF:TMEHT HILL BE SUB.TECT TO PROSECUTION. f'IlHIHUfl DISTRNCE E:ETHEEN R HELL RHD RNV OH-SITE SEHRGE DISPOSRL _~_TErl IS &OO FEET FOR R PRIVBTE HELL OR 150 TO 200 FEET FROrl R PUBLIC HELL DEPEN[',ING UPON THE TYPE OF PUBLIC HELL. · OTHER REQLIIREf,IEHTS r'1¢*'~' RPPLM. SPECIFICRTIONS RND CONSTRUCTION DIRGRRftS RRE RCRILRBLE TO IHSURE PROPER IHSTRLLRTION. RED:r-11 T E2~P I RES BEOEr4BER ]:i.. 1979 ~ CERTIFV THRT 1: ~ RM FRr,IILIR~: I.I~TH THE REQUiREr,lENTS FOR ON-S~TE ~EHERS RHD HELLS RS SET FORTH BY THE NUNIC~F'RL~TY OF ~NCHO~RGE. 2: I HILL IH~TRLL THE SYSTEM ~N RCCORDRNCE HITH THE CODES. 2: ~ UNDERSTRHD THRT THE ON-S~TE ~EHER SYSTEM MRY REQUIRE ENLRRGEMEHT IF THE RESIDENCE ~5 REMODELED TO INCLUDE NORE THRN ~ BEDROOHS, ~ I 6NED: APPLICANT SANDRA HENZLE ____ .~ ~_~ ISSUED BY .............................. PH/b_I~=~.2~_L___ V4. PERMIT N0. ( > LOCRTION ~i0 TYPE OF SOIL RBSORBTION ~YSTEM ~RXI~U~ NUMBER OF BEDROOMS = SQUARE FEET SOIL RRTINa (SQ FI/HR)= a~ THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: DEPTH: /~,~ LE~-,IGTH= ~q GRFI%'EL DEPTH: C THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEP.TH OF B TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF ]'NE GROUND 8ND THE BOTTOM OF THE E×CRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFFILL PIPE RND THE BOTTOM OF THE E×CRVRTION (IN FEET)· ~' REQUXRED SEPT PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RE. IV WELLS RDJRCENT TO THIS PROPERT~ RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TWO ( 2 ) I I'-I_~PECT I 0~4--'S F~RE REQU I RED BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RF'PROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMU[1 DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVRTE WELL; OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION, PERI~I I T E×P I RES DECEMBER ~__-:1.~ I CERTIFY THRT '~: IRM FRMILIRR WITH THE REOUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RrlCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN IRCCORDRNCE WITH THE CODES. ~ I UNDERSTRND~T THE ON~SI~E SEWER SYSTEM MRY REQUIRE ENLBRGENENT IF THE I~UED BY ..... .= ~ ....... DRTE ..... ~= /0 V3. 2 t ~ [] SOILS LOG PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /~ P_E_R_COLATION SOILS LOG -- PERCOLATION TEST ~t~o ~'~1~' Z? ?- 7f~-c~ LEOAL DESCR,eT,ON: ~= T Z ~/~ DEPTH I - ~---T~ U I0- 11- 12- 16- DEPTH? SLOPE Reading 17- SITE PLAN 18- S L O P GROSS Nat Depth to Net Date Time Time Water Drop , ~o?' ~o~ I~" ! ~" PERCOLATION RATE ? ( ' te~/i c ) 'ERFORMEDBY: ~S~'~'~ CER'IFIEDB': ~~~/ DATE: ~ /) 72-0~ (7/76) '?,.: ANCHORAGE AREA BOI '"'IGH ~-,.~',~'~.. '. . .,~"~'.~: ;' .... :~,'- ...~ ..~.. , - .*, . ...' ~,.~..~,. '. ...:.....',..: .' T. ,. -~.~;~ ........... - .... [NSPECTION REPORT ON-51TE'SEWAGE.DISPOSAL.SYSTEM'.."- :~ t NCR. ~. NUMBER OF ~; FROM WEL~ MAnUfACTURER ~[~C~ MATERIAL '(/~/7~3 ~& COMPARTMENTS .~:':;I~SlDELEh~+'H' ':~ :" IhSIDEWIDTH LIQUIDDE~" ' IIQUIDCAPACIW /~6~ GALLONS. ~'~SEEPAGE PIT: -' ,-.~; NUMBER OF PITS / ~ - DIAM~ER_ oR WIDTH LENGTH7 _ :~EPTH - :' ;.:'LINING MATERIAL CRIB SIZE: DIAMETER--D~H DISTANCE FROM: WELL ,'~ ';~;'.' .' ,~, .~-~F~, ~ .. ~ ....... ' : / _ .~ ~/ TOTAL EFFECTIVE ~ BUILDING FOUNDAT ON ~0 . NEAREST LOT LINE . A~SORPTION AREA (WALL AREA) · "/~bDITIO~AL ABSORPTION ....... -., ~.TYPE--~//~.//~ ~ 'CONSTRUCTION :' DEPTH -'- "' DISTANCE FROM: - BUILDING N~AREST NEAREST SEPTIC SEEPAGE ..FOUNDATION ' LOT LINE , SEWER LINE' , TANK SYSTEM ..- CESSPOOL" OTHER SOURCES :L i 'APPROVED ' DISAPPROVED REMARKS ''~' -- ' ~ : "=~ '" · '. "'. ' ~ 'DATE' --~' APPROVE ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Lot 23A; Eaqle River Valley Ranchettes e Location (site address or directions) Eagle River, AK H.U.D. ~111-044745 Pro?erty owner Mailing address Lending agency Mailing address Agent Fran Shell/ Associated Brokers Address ~4n w ~6~h Ave Suite ~ Anchorage, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: NOTE: Individual well ' "' Community well Public water :xxx 18810TwentyGrand Rd. 99577 Day phone 36th Suite ~1 Anchorages--AK Day phone Day phone 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: 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 verity that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supl~ly and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and re~[asti~gll~li~L~N~t on the date of this inspection. Name of Firm 17034 Eagle RIv~' Loop R~ No. 204 Phone I~/'':~;? ~' · Eagle River, Ala~.a~577 Add~ess Eng,neer's signature . .~/-.'""~.----'-'"~ .... Date ~'/~///~ DHHS SIGNATURE _)~' Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,..c' '~.'~ ~ A. Well Data Well type ~ ~ j~ Log present (Y/N) Total depth" Sanitary seal (Y/N) Date of test Static water level ~ Well flow J SEPARATION DISTANCES FROM WELL TO: ~'~.,'L'~ I~,,J~Z--. Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to C~ FROM WEL~..,~..,-'~ AT INSPECTION g.p.m, g.p.m. SepticJholding tank on lot ~ =. ~ ~' ; On adjacent lots Absorption field on lot '7"~?'Jr ; On adjacent lots Public sewer main Public sewer man~ Sewer service line Petr.~eml~ WATER SAMPLE RESU~ Coliform ~Nitrate Other bacteria D~ Collected by: B. SEPTIC/HOLDING TANK DATA Date Installed Cleanouts~N) High water alarm (Y~ Date of pumping Tank size ~ ?--%'"-'" Compartments Foundation cleanout (~) ~ Depre~sio~ ~J' Alarm tested (y/N)~, ,'.:; -' ~//__~ Pumper,. Well(s) on lot '~'= .~ To property line "~'~ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ! On adjacent lots Absorption field ~.c:> Foundation /'~ Water main/service line \ 'l'3 t ~ CONTINUED ON BACK PAGE C. UFT ST. ATION Date installed Manufacturer Size in gallons Vent (Y/N) 'Pump on' level at High water alarm level ~....,~'-C~les tested Meets MOA electrical codes (Y/N)..~..~.--'"'~ ~~M LIFT STATION TO: '~lell on lot On adjacent lots Manhole/Access (Y/N) 'Pu D. ABSORPTION FIELD DATA Surface water After test If yes, g~ve date ""~ DateinstaIled {.¢,-1~"-~"5 Soil rating (GPD/Ft~) C:,,t.~ /~-; Systemlype '"['-,~z.;...~,c~,.~ Length ~ ~ \~ Width "~ Gravel thickness ' ~ ,~" Total depth Total absorption area /~o*~ Cleanout present~_..~) ~/ Depression over field C~ Date of adequacy test 'J//~ Results (pass/fail) ~/'~-.~ for ~ Bedrooms Water level in absorption field before test Peroxide treatment (past 12 months) (~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot . ...~...c>z) t 3,..- : L On adjacent lots Property line \~'- To building foundation ~ ~ To existing or abandoned system on lot \ On adjacent lots '"~,~ ~' ~' ~ [ , .I.- Cutbank ,~- Water main/service line Surface water \ ~, ~ Driveway, parking/vehicle storage area Curtain drain ~ ~ E. ENGINEER'S CERTIFICATION I cerb'fy that I have checked, v~, or conformed to all MOA and HAA guidelines in effect on the date of this inspecb'on. '-'1r703 I Eagle River Leep Roa~ No. 204 Engineer's Date Name HAA Fee $ /76 Date of Payment ~ --Z-.~ --~,.~ Receipt Number e~g/--~--,/ ~'~-~; Waiver Fee $ Date of Payment Receipt Number 724326 (3/93)' Back '~"M~JNIC PAMTY 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 ~-' ! ·. ' INFORMATION , " ' ,. - .1. GENERAL . :. · . ~ ;.. '* .(a) Legal Description (include lot block subdivision, section, towns_J.l~ip, range - . .... Location (~ddr~ or direction*) , :... . . -..~ Ii dre~ ' '" ~ : (c} A~nt is [check one): Len~in~ In'~tution ~; Ownor~uilder~; Buyer ~; Other ~ (explain); . ~ . : (d) ~n~,,,~ .e,~v,,~,,e ~.:. .... ., ' ~ :~(e]: Re~ ~ie company and Agent · : """ ~: Addr~ · - · ' Number of Bedrooms '7 3. WA~R SUPPLY Individual Well~ Community~ Public~ ' Note: If community well system, must have written confirmation from the State Depa~ment of Environmental Conse~ation - attesting'to the legality and status. .'.. 4. SEWAGE DISPOSAL ; .: Onsite 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 the date of this inspection. Name of Firm - - Date J ENGINEERING FIRM PROVIDING, ..,ISPECTIONS, TESTS, FILE SEARCH, DA'~.. AND INFORMATION · As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on Telephone 6. DHEP APPROVAL -: Approved for ~ · · Approved 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 [3HEP 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. Iv~INlaPAUIY Of ANOav,. 3E~UNiCiPALiTY OF ANCHORAGE (MO~i DE~. GF H~ & HEALTH AUTHORITY APPROVAL CHECKLIST- FEBRUARY ~9~ 9 5 L~al De~ripfion: RECEIVED WELL DATA Well Classification ,~ Well Log Present (WN) 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 ~r..,~'~ ¢4 To Nearest Edge of Absorption Field on Lot .~l.,y.-- To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results If A, B, C, D.F-C. Approved4~l) Date Completed Yield /Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC~TANK DATA Date Installed ~/~7~ ~ It~l'=l Size t'~. No. of Compartments ~" Standpipes~N) Air-tight Capsd~N) Foundation Cleanout~[~;:~l) Depression over Tank 43~N) Date Lest Pumped '~/~'~/~ 6~' Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/.14e~ Tank: To Water-Supply Well To Property Line ~c.~ 14- To Water Main/Service Line Course ~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026i 11/84 ) C. ABSORPTION FIELD DATA / Soils Rating in Absorption Strata '~..'~-~c ~ ~f _ Date Installed F:~-Z-"~-~'/'Z.. "~ Il, -"5 - "'/~ Widlh of Field -.-1'"~.~=~,...~14 Square Feet of Absorption Area Depression over Field (Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: Type of System Design Length of Field ~ 'Y ~ Depth of Field -'1'"~,~...~..,~ Gravel Bed Thickness ,..1'-(Z-~=,.34.. -..'rlz.~:~.~_~ Standpipes Present~) Date of Lasl Adequacy Test To Water-Supply Well To Building Foundation Lot ~/~ To Water Main/Service Line To Property Line t To Existing or Abandoned System on ; On Adjoining Lots % present) TO C~jtbank (if To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ,,'"-I~.~, 1::::~,~=,~,.~¢=,,*.---~f"~ ~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access {Y/N) "Pump Oil" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA *' Check Permitted Bedroom Rating Against HAA Request *' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 8& ~' Com ~a~O~ ~IV~ Date of Payment Amount: $ Page 2 of 2 72-026 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE. ALASKA ggS01 BILL SHEFFIELD, GOI/~RNOR Telephone: f.907) Addre:~: '274-2533 To Whom it May Concern: According to recordson,.~.tletntht$ office the ~~("V~ ter System' is in compliance with the St~e Drinking Water Regulations Sincerely, GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received May 7, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 9:30 a.m. 5-10-76 Monday Fred e 4. 5. 6. Approval 'requested by: Mailing Address: Property Owner: Mailing Address: Legal Description: Location: Dick Zobel Box 486, Eagle River 99577 Type of facility to be inspected Single Family Well Data: Co~%munity System A. Type C. Construction Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: Phone: Phone: E. Disposal Field: 8. Distances: Lot 23A Eagle River Ranchettes No. of bedrooms B. Depth D. Bacterial Analysis On-site system. B. Installer 1. Size 2. Manufacturer 1. Absorption Area 2. Material Total length of lines A. Well to: Septic tank Nearest lot line '~( Absorption area , Other contamination Foundation to septic tank C. Absorption area to nearest lot line , Absorption area 694-9115 3-4 , Sewer Lines EQ-034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 1. Type of Inspection: 2. Property Owner: Mailing Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES CM RO VA FHA 'MUNICIPALITY CF ANCHOP~OE DEPT. OF H-'.ALTH & ENVIRONM[NTAL I'[CT[CTION [:lAY ',' 1976 CONV Day Phone: 3. Name of Buyer: Mailing Address: Day Phone: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: ~I~D ~' ,~/-/~' ~c',~. /?~'/)~C'/~ 6. Legal Description: La Location: -,~'~1, Phone: Phone: 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 9~ Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual Individual (on-site) 72.003(3/76) Pa~e 2 of tM pages - Re~'-~t for Approval of Individual . ~ & Water Facilities · q~g~l-Oescription T. ot 23A Eagle tLLver Ranchettes Approv Oi sapproved Date ~'- \, Approval ~Valid for one year from date signed '~ Greater Anchorage Ar&a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the 'information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. EQ-034 (1/74) M c h o e u,,,,.. pality of 'An DATE' June 3, 1976 TO, The file FROM' SUBJECT, MEMORANDUM Environmental Services Manager Lot 23A Eagle River Valley Ranchettes As a result of a request by Dick Zobel, I checked with Wayne Cousineau, the builder of the house on Lot 23 A Eagle River Valley Ranchettes, Larry Hamilton, the excavator and installer of the on-site sewer system on this lot and my own field notes made at the time I was in the Eagle River office and find that on August 23, 1972 Hugh Burner and I inspected the sewer syste~ being installed on this lot and approved the system; i.e., 1,000 gallon septic tank with pit and'log crib seepage. A search of the files does not show a written approval made at the time of inspection. lair . ~nvironmental Services Manager JSS/ljh mack 486 ~577 Th~s is to certl£~ t~t & b°~o~gh a~rov~d sew~ ~yst~a, · gallc~eptictankaud lo~crA~ ~eeFa~e FA~, wa~ install~ion Lot 23AE&~le River V&lle~3Lan~het~ea ~ubdAv~oa~yHa~llton ~cav&~in~ du~An~Au~usk~ X~72. Zi you have any £urtlmr questions, ak 276-2221, extenolue 291. Simoerely, : please · To~h $. Blaix