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HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 28CEagle River Valley Ranchettes Lot 28C #050-224-04 Municipality of Anchorage On-Site Water and Wastewater Program • (907)343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181290 PID Number:050-224-04 Dwelling: [' Single Family(SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New UI Upgrade Name: ABSORPTION FIELD Kristy and Jeremy Estrada Address ❑ Deep Trench ❑■ Shallow Trench El Bed ❑ Mound 19031 Twenty Grand Road Eagle River 99577 El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 1.210.273.8687 3 0.8 GPD/SF 9.94 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 5.94 Ft. 4 Ft. Eagle River Valley Ranchettes Lot 28C Fill added above original grade Gravel length Township Range Section 2.56 Ft. 56' - 4" Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 5 Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line 563 Ft2 1 Ft. Well NA NA NA NA NA TANK 0 Septic Li S.T.E.P. ❑Holding El Other Manufacturer Capacity Surface Water >100' >100' NA NA Anchorage 1000 Gal. Material Number of compartments Lot Line 22' 9'-11' NA NANA Steel 2 Foundation 10' 23' NA NA LIFT STATION Manufacturer Capacity Curtain Drain NA NA NA NA Gal. Pump on level at Pump off level at High water alarm at Remarks north end absorption field is 9' away from property line. sound end absorption in. in. in. field is 11' away from property line Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 03034Tank to 03034 Installer drainfield Territory North Constructors, LLC Drainfield D3034 CO/MT 03034 Inspector Curtis Townsend, PE BENCH MARK (Assumed elevation) 100 ft Inspection dates: 1r' 9/6/18 2nd 9/8/18 Location and description Sod 9/10/18 4'h 9/11/18 top of deck in backyard COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp °F'a•Cgs � Akt Conditional Approval: Date i ';(.t. 4` 'F ft *:491 " \ ''* ol I Curtis L.T, nsend �! ø.• Date 42pi...,t-I l F*; •No.CE{1904 '�� r ill,P.R.0rESSIONP" Approved 2avtJJ -71 r►� Date c 2 5/4 l��\���-~� (ft, Ciw)ci Inspection Report_9-1-12.doc I r LEGEND DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM ---EXISTING WATER LINE NO. BEDROOM: 3 (450 gpd) --x— PROPOSED SEPTIC TANK SIZE: 1000 GAL LOT 28-A PERC RATE: 7.3 MPI SOIL RATING: 0.8 GPD/SF —AREA REQUIRED: 563 S.F. _ -#� —x—x SYSTEM TYPE: WIDE TRENCH 4' ED I 10' UTILITY EASEMENT RF: 0.50 — 11! J-- — — — — O 'l I �2 9 MIN LENGTH: 56.3' ) MT N x 680' NEW 56'-4" x5' x4' I I ~ ED ABSORPTION TRENCH T .412' I I, I �� II EXISTING TANK I BENCH, TOP REMOVED I I I -~ 1OFDECK i 6g0 I ' r Ln DECK I III '\TH, �'_1_ j k`?Q I '► 'A� a I /(/ N I C''e I l0' ►1 X �. I } len \61\* • 104141 DCO 24' I 3 BEDROOM HOUSE FCO C CARPORT HOUSE N -- X — - ~ O A I 1 1 J MARK A B SV1 25'-3" 14'-1" NEW 1000 GAL SEPTIC TANK CO1 39'-6" 25'-0" /6go LOT 28-C MT 84'-9" 59'-9" CO2 89'-9" 64'-7" r W i- I- W m zI- > > Jz 8 R Is FO O O DwI Z 0 O O ` D a O pZ YQ Y< 0 o 0 r Z Z W Z W C 0 U O w w 0W QJ QJ G o_i I-0 I-o _ /2'3 FINAL GRADE " oz LL c� ^74 f /—ORIGINAL GRADE 1C0.5' pj -9974 FABRIC ORS IFILTER DAIN ROCK 6" ABOVE PIPE INVERT \ 44 4 DIA PERFORATED DRAIN PIPE 94.5/ 1,000 G 9434 Q3�R \ . STEEL TANK SEWER ROCK I GM/SM 90.2V 89.8 7 SEPTIC SECTION, SCALE 1" = 10' NO GROUNDWATER 9/7/2018- 83.74 Septic Design Prepared for ..so"F�ii4_ Kristy and Jeremy Estrada �.kp� .•�• q��S�.♦. 19031 Twenty Grand Road, Eagle River, Alaska 99577 ;:' •• '�:` 49TH � •••••••�;� �� LOT 28C, EAGLE RIVER VALLEY RANCHETTES % : OSP181290t_____ • • EKLUTNA ENGINEERING, LLC DATE: 9/14/2018 %,'P\„*".. CURTIS TOWNSEND;ih:. V-',%.*: No. E 11904 c 1 1 91 62 MOUNTAIN ROAD DRAWN: CLT j�` 5�110/.0° •'.4,�� CHUGIAK, ALASKA 99567 SCALE: 1" = 30' �.p ••'''•.(... �•� (907) 355-9820 PID: 050-224-04 SHEET 2 OF 2 ��1, ;"'1� Municipality of Anchorage »` s;, P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 •• (907) 343-7904 •• Fax (907) 343-7997 _ Dc p a r tin rnr http:llwww.muni.orq/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV181073 COSA#: Permit#: OSP181290 PID#: 050-224-04 Legal Description: Eagle River Ranchettes Lot 28C Engineer: Eklutna Applicant: Kristv Estrada Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 9 feet. This waiver approval applies to the Exisitng absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. Notarized letter(s) of non-objection have been received from the owner(s) of the affected adjacent property. X Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: q-2.q-oe Approved by: Name of viewer Eklutna Engineering, LLC Curtis L Townsend, PE E-mail: curtistownsend@gmail.com September 17, 2018 Subject: Eagle River Valley Ranchettes, Lot 28C Upgrade Septic System Waiver Request Design Narrative Permit OSP181290 This is a design narrative to describe changes made during construction and to request a property line waiver.The proposed system will serve an existing three (3) bedroom house.The existing drain field is in failure and will be decommissioned.The existing septic tank will be removed and disposed of.The system will utilize a replacement 1,000 gal septic tank and new wide trench. 1. Soils.One test hole was performed in the vicinity of this system by Eklutna Engineering in August 2018,and groundwater was monitored through September 8, 2018.Ground water was not observed to a depth of 16' below the surface in the test hole monitor tube into September 2018. Bedrock was not encountered in the test hole to 16'. Based on the results of the percolation tests and overall soils appearance; an application rate of 0.8 GPD/SF was used for a conventional wastewater system in the area of the test hole.A portion of the new trench is outside of the 30' radius of the original test hole. During construction,the soil was visually compared to the soil within the 30' radius and found to be the same classification. 2. Soil Absorption System Design. A permit was issued to construct a deep trench with 6' ED.Once construction started, it was realized that the tank was deeper than expected. Based on conversations with MOA OSD personnel, it was determined that a wide trench would be a better system to construct to avoid digging a new test hole. 3. Wells.This lot and the surrounding lots are served by AWWU water.There are no wells within 200' of the proposed septic system.The house to the east of this subject property is at least 24' away from the common property line.The water valve box was not located on the eastern property, but it is at least 24' away from the common property line.The new trench on the subject property is at least 9' away from the property line,so there is sufficient clearance from the neighboring water line. 4. Neighboring Wastewater systems.The septic system serving the property to the east of this subject property is 70'away from the common property line.The new trench on the subject property is at least 9' away from the common property line.The neighboring property to the east will have sufficient room to construct a new field within their property without being impacted by our subject wastewater system. 5. Surface Water:There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 6. Topography:The existing topography on the lot generally slopes from south to north, with a slope of approximately 8%across the entire property.The area where the new drain field will be placed is a flat area that allows for the effective depth of the trench to remain in the design absorption layer.There are no steep slopes within 50'of this system. The proposed drain field will maintain 50' separation from all steep slopes. 7. Utility Easement:There is a 10' utility easement on the northern end of the property.The new trench does not encroach on this easement. The proposed installation will not affect the future development of this or the surrounding lots. Sincerely, Curtis L.Townsend, P.E. Attachment LOT 28-A (S 89'59'15" E) (133.00') - , -*--- UFi�f'=-'--0,-„ A__,0---n-=�AfT=x-, ,Hu - LEGEND ` \' - 10' UTILITY EASEMENT k �x� i— _ -6- , EXISTING WATER VALVE U (.) EXISTING SEPTIC VENT KSHED r-xi 7)7_680' °° 8' x 12' J `'"1 i QCO EXISTING SEPTIC CLEANOUT \- r --1L _i"- EXISTING POWER POLE --- --x---—x——x——x-- EXISTING 6' WOOD FENCE r- — — -- EXISTING OVERHEAD UTILITY ^ —OHU-----OHU o /� DECK o ...--.//' — — EXISTING EDGE OF GRAVEL DRIVEWAY tri 18.2' _�/ -`-- \ �cb6N` EXISTING CONTOUR 10' INTERVAL p �t o 3' X 8' CANTILEVER _N I \ - W '`OF ALS\U x t "' N _ . •16 22.2' . 1-STORY 23.5 '38.7 ` ��/��Q:• ' .�r J o O x M 5) IWOOD (7) D . v'�•• `' .7 �TA I v, FRAME . •co o M ' 49 TH i� '• o _ N HOUSE w o H r, ' . . . Z x `xN N 63.9' ) ! M I� . .: . Y . . . .. . . . . . . d DEC Da na M.Rumfelt • AV EAGLE RIVER VALLEY aO ��°c�F.•. No�.11. ,i'2 i‘,.(t,"..01 � RANCHETTES /( !1 F�p•8 F`'S���a� r 7.,-,-------5(?) , k ESSIONA` ILOT 28- ------7--- O NORTH ASBUILT - NO CORNERS SET THIS DATE PLAT 63-129A - r I HEREBY CERTIFY THAT I HAVE PERFORMED (N 89'59'15" W) (133.00') A SURVEY OF 1 60' RIGHT-OF-WAY LOT 28-C, EAGLE RIVER VALLEY 1 M „ M RANCHETTES, ANCHORAGE RECORDING TWENTY GRAND ROAD DISTRICT, ALASKA, AND THAT THE IMPROVEMENTS AS DEPICTED — HEREON EXIST AS SHOWN IN RELATION TO NOTES: THE PROPERTY LINES. EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON 1. PROPERTY LINE IS RECORD PER PLAT 63-129A RECORDED PLAT No. 63-129A ARE NOT EAGLE RIVER VALLEY RANCHETTES, ANCHORAGE SHOWN HEREON UNLESS OTHERWISE NOTED. V )) v1 RECORDING DISTRICT. ,� � J� DATE: 9/25/2018 FB: 18-003 G N SURVEY & MAPPING 2. ALL VISIBLE ABOVE GROUND FEATURES OF THE SU U S. BARNYARD qR., wA�w�, AK sN EXISTING SEPTIC SYSTEM WERE LOCATED AT THE GRID: NW 54 DRAWN: DMR 289TIME OF SURVEY AND ARE SHOWN HEREON. MYNA RUMFELT(907)301-5177 SCALE: 1" = 30' FILE: 18-003AB ME 0*` - oe MUNICIPALITY OF ANCHORAGEts nr On-Site Water&Wastewater Program ��;� • '2.1..‘;. PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r. w. http://wwmuni.org/onsite .s+" Vfi pa '' Dv l <'rtmtni 4''CHORAV' On-Site Wastewater Disposal System Permit Permit Number: OSP181290 Effective Date: 8/30/2018 Work Type: Septic Upgrade Expiration Date: 8/30/2019 Tax Code Number: 05022404000 Site Legal Address: EAGLE RIVER VALLEY RANCHETTES LT 28C G:0054 Site Mailing Address: 19031 TWENTY GRAND RD, Eagle River Owner: ESTRADA JEREMIAH V & Lot Size in Sq Ft: 17955 Design Engineer: EKLUTNA ENGINEERING, LLC* Total Bedrooms: 3 This permit is for the construction of: 2 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well 0 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 (24/7). 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: The proposed drainfield is not quite parallel to slope contours. Verify that the maximum excavation depth along the entire length of the drainfield does not exceed 10 feet, unless a deeper test hole is provided and On-site is notified. ,\\N , Received By: Date: IIssued By: . Date: 30 F MUNICIPALITY OF ANCHORAGE • . t t •-� Development Services Department " K Phone: 907-343-7904 On-Site Water& Wastewater Section = Fax: 907- -7997 8919 ) ON-SITE SEPTIC/WELL PERMIT APPLICATIONLI AUG 2 2 2018 Parcel I.D. 050-224-04 z. Property owner(s) Kristy and Jeremy Estrada Day phone 1.210.273.86. / a s 8 9 c)A Mailing address 19031 Two-4j.G and I?oaot&, AK 995'77 Site address Sw Legal description (Sub'd., Block & Lot) Eagle River Valley Ranchettes Lot 28C Legal description (Township, Range & Section) Lot Size 17,955 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field Q Initial ❑ Single Family (SF) [x] (w/wo ADU) Septic Tank 0 Upgrade Q ❑ Duplex (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Aif Distance: I certify that the above informatio is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 450 Waiver Fees: Date of Payment: COP-4112 Date of Payment: Receipt Number: a253ai0/. Receipt Number: Permit No. o5 P 1 t O Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Eklutna Engineering, LLC Curtis L Townsend, PE E-mail: curtistownsend@gmail.com August 30, 2018 Subject: Eagle River Valley Ranchettes, Lot 28C Upgrade Septic System Permit Request Design Narrative Permit 0SP181290 This is a design narrative for a permit to install an upgrade septic system to be issued for this property. The proposed system will serve an existing three (3) bedroom house.The existing drain field is in failure and will be decommissioned.The existing septic tank will be removed and disposed of.The system will utilize a replacement 1,000 gal septic tank and new deep trench. 1. Soils. One test hole was performed in the vicinity of this system by Eklutna Engineering in August 2018, and groundwater was monitored for at least seven days. Ground water was not observed to a depth of 16' below the surface in the test hole monitor tube in August of 2018. Bedrock was not encountered in the test hole to 16'. Based on the results of the percolation tests and overall soils appearance;an application rate of 0.8 GPD/SF was used for a conventional wastewater system in the area of the test hole.4' of cover will be required over the length of the trench so as to ensure that the effective depth of the trench will not be in the organic layer. 2. Soil Absorption System Design.See Sheet 1 of the design package. 3. Wells.This lot and the surrounding lots are served by AWWU water.There are no wells within 200'of the proposed septic system. 4. Neighboring Wastewater systems. Immediate neighboring septic systems are all+30' distant. 5. Surface Water:There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 6. Topography:The existing topography on the lot generally slopes from south to north, with a slope of approximately 8%across the entire property.The area where the new drain field will be placed is a flat area that allows for the effective depth of the trench to remain in the design absorption layer. There are no steep slopes within 50'of this system. The proposed drain field will maintain 50' separation from all steep slopes. The proposed installation will not affect the future development of this or the surrounding lots. Sincerely, � l Curtis L. Townsend, P.E. Attachments \' 30/ (7/ LOT 28—A - ----_ _�11'_ . _.. -x.+ .- T... _-x ---1^._—A. X__ ...x.._ — _— / / Ii Al I' �.. SHED CO MT 12' I Q I I 'I 7 M� ;�r 1 REMOVE EXISTING I IFI i �I NEW 47'X30"X6' j X 1000 GAL TANKi c�; I, EFFECTIVE DEPTH I I TH / ABSORPTION I P� 1 TRENCH x ��O• I .� CO n ND MN .- I p I o0 10' , DCO N O I 3 BEDROOM _ —+ I HOUSE SVt S ' 0 --X __-. - •--J i J LOT 28—C NEW 1000 GAL + GRAVEL SEPTIC TANK ! DRIVEWAY I • — II._ 1 ___i- - - - • • <6 LEGEND --•— EXISTING WATER LINE PROPOSED SEPTIC SCOPE OF WORK 1. DECOMMISSION EXISTING ABSORPTION TRENCH AND REMOVE EXISTING SEPTIC DESIGN PARAMETERS TANK IN ACCORDANCE WITH ANCHORAGE MUNICIPAL CODE. PRIMARY SEPTIC SYSTEM 2. PLACE NEW 1,000 GALLON SEPTIC TANK NO. BEDROOM: 3 (450 gpd) AND NEW 47' LONG X 30" WIDE X 6' TANK SIZE: 1000G EFFECTIVE DEPTH ABSORPTION TRENCH. AT ` PERC RATE: 7.3 MPI NO TIME SHALL TOTAL DEPTH OF SOIL RATING: 0.8 GPD/SF EXCAVATION EXCEED 10'. AREA REQUIRED: 563 S.F. 3. ALL CONSTRUCTION TO BE IN ACCORDANCE SYSTEM TYPE: DEEP TRENCH WITH ALL REQUIREMENTS SPECIFIED IN 47' X 30" X 6' EFFECTIVE DEPTH, 4' COVER. ANCHORAGE MUNICIPAL CODE CHAPTERS Septic Design Prepored for .. 'n"11 • ' F tiff 44.and Jeremy Estrada ,,' ..•• .'s< * 19031 Twenty Grand Road, Eagle River, Alaska 99577 �P 4 •v 49 Tri ' ' OA LOT 28C, EAGLE RIVER VALLEY RANCHETTES s i i EKLUTNA ENGINEERING, LLC DATE: 8!2912018 % • ,:: �`' E 11904 19", 62 MOUNTAIN ROAD DRAWN: DMR .r' '•j,No. Ir.': ` CHUGIAK, ALASKA 99567 SCALE: 1" _ ,.� '`.••••• /r.••'•• ��• (907) 355-9820 30 ami ``tFESS\ �-i4s PID: 050-224-04 SHEET 1 OF 2 �•1es®veVI- SOILS LOG — PERCOLATION TEST 1— OB ORGANICS II 2— i r' 3— i I LSI r 6— I 7N 8- , IX I, M 9— GM/SM SILTY GRAVEL I I 10— & SAND I ` /// 11— I L-- I ,2— I ________ , .' '1 I 13— 1 1 14— , -� LOT 28—C 16 BOH WAS GROUND WATER DATE PERFORMED: 8/14/2018 ENCOUNTERED? NO IF YES, AT WHAT DEPTH? DEPTH TO WATER AFTER S) MONITORING? NONE DATE: 8/21/18 NET WATER NET NO. DATE CLOCK TIME TIME LEVEL DROP (MIN) READING 1 8/14/2018 17:15/17:25 10 6" — 4-3/8" 1-5/8" 2 ' 8/14/2018 17:25/17:35 10 6" — 4-3/8" 1-5/8" 3 8/14/2018 17:36/17:46 ' 10 6" — 4-3/8" 1-5/8" 4 8/14/2018 17:47/17:57 10 6" — 4-5/8" 1-3/8" 5 8/14/2018 17:59/18:09 10 6" — 4-5/8" 1-3/8" 6 8/14/2018 18:10/18:20 10 6" — 4-5/8" 1-3/8", 7 8/14/2018 18:21/18:31 10 6" — 4-5/8" 1-3/8" PERCOLATION RATE: 7.3 MIN / INCH PERC HOLE DIAMETER: 6" TEST RUN BETWEEN 4 FT AND 5 FEET. COMMENTS: IN THE FIRST THIRTY MINUTES, 6" OF WATER SEEPED AWAY COMPLETELY. PERFORMED BY: CURTIS TOWNSEND. I CURTIS TOWNSEND CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 8/14/18 Septic Design Preporeci for .4,61,11smiii•, Kristy and Jeremy Estrada •'*.E•Or !iC �4. 19031 Twenty Grand Road, Eagle River, Alaska 99577 '''' - .* • / . . i ,:t••• LOT 28C, EAGLE RIVER VALLEY RANCHETTES T * ...% ' .0 % . 4 0 EKLUTNA ENGINEERING, LLC DATE: 8/21/2018 0.� :.cu IS TOWNSEND/ 19162 MOUNTAIN ROAD DRAWN: DMR �. ' No. Z21/1904 - CHUGIAK, ALASKA 99567 = •� '�O ''' .•r••••�'\,�•� SCALE: 1" 50 te, E \Ct4 (907) 355-9820 o"1•""**- • PID: 050-224-04 SHEET 2 OF 2 ,ASvtwq 3v P�;G SOIL TEST RATING /.�t s- ¢' INSTALLER Grin REMARKS ate, Ex r .r 7`i.,i se ri yr, ., K 75'//e-1 'Cr✓i / _+ C o.. c r G 7f Car., Le 74 l Aleve q��oi^y .� OF q t`1411 Louis A. Butes N' Vr i.Fii 1 _.•OOZ ' \ 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 NAME PHONE NEW ,i� v eci n Ccs rl,-Ccc LUr� �i%C/ 7`•// 7 UPGI MAILING ADDRESS v 9 3S' Z), LEGAL DESCRIPTION 1.0 t �' e E Ze /Pry 24 a%te 17`rr T /4/4/ t a w-re-.1,�P1 LOCATION NO. OF BEDROOMS Cas t� fr•�%t„ 3 WellcIw R Absorption area Dwelling PERMIT NO. ,SQQ DISTANCE TO: ^d C� r / s' — U .Y wZQ Manufacturer Geer Material S'G, No. of compartments Z F to Liq, capacity in gallon t /000 IF HOMEMADE: Inside le th �g Width Liquid depth G Y DISTANCE TO: , Well Dwelling PERMIT NO. J Z Z O _ < Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: I Well t Foundation /J Nearest lot line ' PER T UO. S OoZ J u. Z No. of lines Length of each line ' Total length of lines Trench width Distance between lines P? W 4� 4. 30 inches Top finish Material beneath Total of tile to grade Z/ tile / effective absorption area o G inel es so y V N Length Width Depth PERMIT NO. W iF- Type of crib Crib diameter Crib depth Total effective absorption area Wa WWell Q)DISTANCE Building foundation Nearest lot line TO: .i Class Depth Driller Distance to lot line PERMIT NO. J W }+ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER I I I I IT= PIPE MATERIALS ,ASvtwq 3v P�;G SOIL TEST RATING /.�t s- ¢' INSTALLER Grin REMARKS ate, Ex r .r 7`i.,i se ri yr, ., K 75'//e-1 'Cr✓i / _+ C o.. c r G 7f Car., Le 74 l Aleve q��oi^y .� OF q t`1411 Louis A. Butes N' Vr i.Fii 1 _.•OOZ 7_(A�e� I>_-' 14 q lJ APPROVED DATE LEGAL C �4 S to let r�-,-z Ra ^ e- .4 �f '•013 IRev. 3178) ---------- ■■■■■■i��l�lE�■11 0011■■■■■A■■11 I■■S"::=::I■■■1' ■■■■■■■■■■■1' I■■■EMMM■■■■1 IMENFARIN■■■■■N 7_(A�e� I>_-' 14 q lJ APPROVED DATE LEGAL C �4 S to let r�-,-z Ra ^ e- .4 �f '•013 IRev. 3178) M 4_.A" a QC 16=` n L- I -r "%e GD I- e--% t 1 4 Cv I--1 C3 F"' a'=`u C= -p Ir• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 525 L STREET, ANCHORAGE, At; 99501 264-4720 PERMIT NO: e502'7 DATE ISSUED: 05/29/f35 o APPLICANT: C/O E R ENG'G SVS DEAN CONSTRUCTION Q� D�1 ADDRESS: P D SOX 77.294 '� lig' ' EAGLE RIV�--R,.AI-- 99577 CONTACT PHONE: 694-911.7 LEGAL DESGRIP: SUBDIVISION:. E R VALLEY RANCHETTE LOT: CSC PLOCf;: P.IA ' SECTION: 14 TO't.NSHIP: 14N RANGE: 21W LOT SIZE: 20000 (SO.FT. OR ACRES) MAX BEDROOMS: 3 � Listed below•are the options available to YOU in dosigning your septic system. Choose the option that best fits your site. -T- rz '— VA 12 1 HE 1D, a4 r11 DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL_ DEPTH (FT.) 6.0 0.5 3.5 TOTAL DEPTH (FT.) 1.0. �> 4.5 7.5 GRAVEL WIDTH (FT.) �.5 17. 0 5. Ij GRAVEL LENGTH (FT.) 32. 0 34. o 41, 0 GRAVEL VOLUME (CU.YDS.) 19. 21.5 x;0.4 _ TANK SIZE (GALS) 1,000.1) ,M 1,000.0 -Yx- 1�iWir,si x� SOIL RATING (SO.FT. /BR) 1^ 125 ii 5 n '+ TANI: MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements for on-zite sc4crss and va^].lsaz forth by the. Municipality of Anchorage (MOA) and the .Stat.e of Alas"<a. 2. I will install the system in accordance with x:,11 110A code a.nd regulatio;.�, and in compliance with-tho design criteria of this permit. I will adhere to all MOA and St.-kte of Alazk:a rcquirr_ments far th_ set bacl: distances from any,existing•well, wastewater di_posrl systum.. or public sewerage System on this .or any adjacunt or nearby lot.. 4. I understand that this permit is. valid for r, maximum of 31 bedroo.is .s:,nd, any enlargement will requirean ,additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA E'UILDING CODES- THEN ODESTHEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAIN71); (2) AS-DUILTS WILT- NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (.') THE ELECTRICAL WDr--W MUST BE DONEDYA LICENSED ELECTRICIAN. SIGNED DATE: P ��----------------------------- — S APPLICANT: C/O E R ENG'G*SVS DEAN CONSTRUCTION ISSUED BY J ��-� PATE: /y� eYr a__a r�.r g C : g r=• r� r` _ -r � � r= . � rye C; r—>i Ca ff—�: � � � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 C3 Pyr -- tE; 3 _r 1_= E3 IE X si r- FR IP' E 0=i r'"'J a _T_ PERMIT NO: 850057 HAND WRITTEN DATE ISSUED: 02/08/85 3 ;5 0 2_-" 1 APPLICANT: S & S ENG'G. LOWRIE CHOWDER ADDRESS: SRS 196X EAGLE RIVER, Al- 99577 CONTACT PHONE: 694-2979 LEGAL DESCRIP: SUBDIVISION: E R VALLEY RANCHETTE LOT: 20C BLOCK: NA SECTION: 7 TOWNSHIP: 14N RANGE: 1W LOT - SIZE; 20000 (SG?.FT. OR ACRES) LOT LOCATION: TWENTY GRAND I certify that: 1. I am familiar with the requirements for on-site sewers and wells as sat. forth by the Municipality of Anchorage (MOA) and the State of Alask:a., 2.I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set bacF::' distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APF'ROV '.TROUT AN ELECTRICAL INSPECTION REPORT; AND (=) THE ELECTRICAL WORkK,MUST D Y A LICENSED ELECTRICIAN. SIGNED / DATE:! APPLICANT:It 7-7 S ENG'G. LOWRIE CROWDER J ISSUED BY , � DATE: �1,s ,u'� ice- • NAME LOCATION GREP`'f ANCHORAGE AREA BORA-'..,iH Department of Environment Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE r NUMBER OF FROM WELL Cetlti"� -1' MANUFACTURER ^ MATERIAL /42tZCOMPARTMENTS / INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY e%e-7GALLONS. TILE DRAIN FIELD: �� "' TOTAL LENGTH 5_ DISTANCE FROM WELL +ch FOUNDATION /0NEAREST LOT LINE �� OF LINES ; NUMBER OF LINES DISTANCE BETWEEN LINES h/� TRENCH WIDTHj.-_�IN. TOTAL EFFECTIVE ABSORPTION AREA 3 ?S_ SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE__EL__IN. ABOVE TILE IN. WELL: TYPE C6i'�^�w� CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION , LOT LINE , SEWER LINE , TANK , SYSTEM , CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: Form PW.027 DIAGRAM OF SYSTEM F io C. Ie i fS� G 9�Th�"k C1101y dmf 3 3vz�� 75 APPROVED tc PD G.A.A.B. e PJT GREA�'--' ANCHORAGE AREA BOF~H 'q�pt •'4 DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. / * 3330 •'C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 C`cnrMvw' � W�7`jr2, SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT K �'p1h� Uil''Alfl ?MAILING ADDRESS INSTALLATION LOCATION`O"rf�'� r'C LEGAL DESCRIPTION .4 p r A 8/ Ic C'e/lr "ei•yr IffA,- C�' a PHONElLZ-Z.2//y INSTALLATION OF: SEPTIC TANK so� //�� SEEPAGE PIT DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED ✓ ' - �- ' `L ,A/./' FINANCED THROUGH TO BE INSTALLED BY ,v �' D VC II'a SOIL TEST RESULTS `� -- NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED ` r r T ~ FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE t_ MINIMUM DISTANCES, REQUIREMENTS .� / SEEPAGE AREA 512E --M579TYPE -*-* FOUNDATION TO SEPTIC TANK v FOUNDATION TO SEEPAGE PIT Ord r DRAIN FIELD U , SEPTIC,TANK TO SEEPAGE PIT WALL 'eq-'er/`' f A��Ay/�F/ �d� T ~G T SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK / SEEPAGE PIT fl—J DRAIN FIELD _f V"c ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK 1 0 / . SEEPAGE PIT DRAIN FIELD , SEPTIC TANK, _. SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. / SCR{ �N,rd Nr C / fie u" Rr Wo GRAVEL BACKFILL l P' CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A,A OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCH DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, DATE APPLICANT'S SIGNATURE FORM NO. EQ -01 6 DIAGRAM OF SYSTEM .O E AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE GREATER ANCIIORAM ARL'A L'OROUt,ii Department of Lnvironmental Quality a 3330 "C" Street Anchorage, Alaska 99503 SOILS 1,0G - PEROI.ATION T1iST Performed for— Legal This form reports: Soils loges Depth Feet 2- 3- 4- 5 6 7- S/,o _ --Date Perfonued % n'a -> rcolation test 6� i 14 - Was ground water encountered? /1y _� If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate minute. -Proposed installation: Secp'age Pit Drain Field Depth of Inlet Depth to bottom of pit or trench _ COMMENTS: y.�.ti '��_ __--------- Performed ITY_. �_ `fit_ ��� Certified [3y:Date:--_,— E(J-040 (6/74) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-224-04 1. GENERAL INFORMATION Expiration Date: '144- .2 5 . 'a® I 9 Complete legal description Eagle River Valley Ranchettes Lot 28C Location (site address) 19031 Twenty Grand Road Eagle River 99577 Current property owner(s) Kristy and Jeremy Estrada Day phone 1.210.273.8687 Mailing address 19031 Twenty Grand Road Eagle River 99577 Real estate agent Lindsay Bergeron 2. TYPE OF DWELLING: 0 Single Family (w/oADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Day phone 907.952.7222 Private Well ❑Private Se ' Water Storage ❑ Community Well ❑ Community Public Water System 0 Public Sewer Waiver request for Field to Property Line Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: DISPOSAL: Distance: 9' COSA Fee $ 01 Waiver Fee $ ' Date of Payment 9 Or i n I Date of Payment �T ~�d C� �17/ Receipt Number COSA # 75GI I q q Receipt Number Waiver # QSV 1f/ (D77 -� -fir 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. Name of Firm Eklutna Engineering, LLC Phone 1.907.355.9820 Address 19162 Mountain Road Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date 17 SEPT 2018 =� WATER AND z- 6'� ' By:la"6jut.XkT/�M u� Original Certificate Date: � �. � � 5 ;.2.01 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 OF F4, TH •' • 6. DSD ///SIGNATURE �' j"' i�a:G J' ... System #1 Approved for bedrooms � 'a ; CurtisL�T�ov�nser " 3 Date— `t—'� rs; * System #2 Approved for No. CE 1190•t •�� r.✓ bedroom srF •.• ����F�PROFESO0.-Ow Disapproved Conditional approval for bedrooms, with the following stipulations: =� WATER AND z- 6'� ' By:la"6jut.XkT/�M u� Original Certificate Date: � �. � � 5 ;.2.01 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 Lot 28C If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 3� Total depth ft 3 Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments no well on site, served by AWWU B. TANK DATA Age of tank(s) 'f 1 years Tank type/material steel ❑ Standpipes/foundation cleanout per record drawing Date of pumping new tank installed 9/6/18 D. ABSORPTION FIELD DATA Parcel ID: 050-224-04 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform 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 completed Age of lift station years Lift station material Comments: no lift station Which system tested (date installed) 9/11/18 Adequacy test date ❑t ALL standpipes present per record drawing Results ❑ Pass For bedrooms Total measured depth from grade ft (max) Fluid depth prior to test in Measured depth to pipe invert from grade ft (min) Water added gal ❑ N/A — pressurized field New depth in ❑■ Monitor tubes go to bottom of drainfield. If not, state Elapsed time min depth into effective ❑■ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) If yes, enter date Gallons introduced gallons Comments/Def ciencies: new absorption field completed 9/11/18 COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes s ft Surface Water > 100' Septic Tank/Lift Station on Lot > 100' Property Line > 5' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft X�No ft Neighboring Tank > 100' ❑ Yes if No ft Private S eptic Line > 25' [:]Yes if No ft Absorption Field on Lot> 100' E] Yes if No Private Wells > 100' Holding Tank> 100' E] Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Community Se ain > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ✓0 Yes if No ft Property Line > 5' ❑✓ Yes if No ft Driveway/Parking > 0' ❑✓ Yes if No, comment Absorption Field > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: ❑✓ Yes if No ft Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No ft Driveway/Parking > 0' ❑✓ Yes if No, comment Property Line > 10' ❑ Yes if No 9' ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft F. ENGINEER'S COMMENTS On the south end the absorption field is 11' away from the property line, on the northern end the field is 9' away from the property line. G. ENGINEER'S CERTIFICATION I certify that / 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 ENGINEER'S ST P Amwp ... r. r �cUrtis:. T ........... . • . Date Wj NO.0 11 OF! Parcel I.D. 050-224-04 Municipality of Anchorage $ '_ Onsite Water and Wastewater Program (907)343-7904 snfxr Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Eagle River Val Expiration Date: ) /-z- -? 6 Ranchettes, Lot 28C Location (site address) 19031 Twenty Grand Rd. Current Property owner(s) Robert & Erika Beachler Day phone Mailing address Real Estate Agent 19031 Twenty Grand Rd. Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) j ❑ Duplex ISp . ❑ Multiple Dwellings (Single Family and/or Duplex) FEB 14 2014 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual FX71 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ P auiiC'v"vater System Public Sewer Waiver,variance request for: Received by. F'�` ' Date: r COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 4Jd_(0 Waiver Fee $ Date of Payment c 61 t �^ Date of Payment Receipt Number 68"36q Vl Receipt Number COSA#_ �� ���� 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. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 1/24/2014 Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: Z Z I The Municipality of Anchologe 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet;-:, c If more than 7 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist ?-vi Legal Description: Eagle River Valley Ranchettes, Lot 28C Parcel ID: 050-2)t4-04 A. WELL DATA Well type Public If A, B, or C provide PWSID # AWWU Well Log (YIN) Date completed Sanitary seal (YIN) _ Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Date installed 6/15/1985 Cleanouts(Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping I LZ-7Ly Pumper :5k'-5 Ai t � BRP C. ABSORPTION FIELD DATA Date installed 6/15/1985 Length 42 ft. Soil rating (g.p.d.tft2 or ft2/bdrm) 125 SF/BR System type Deep Trench Width 2.5 ft. Gravel below pipe 6 ft. Total depth 11,8 ft. Eff. absorption area 504 ft2 Monitoring tube Y Depression over field N Date of adequacy test 1/22/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 63 in. Water added 451 gal. New depth 72 in. Elapsed Time: 1440 min. Final fluid depth 63 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off' level at _ Cycles tested_ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS " See Attached Letter 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. Engineer's Printed Name Steven R. Pannone Date 1/24/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ Pannone Engineering Services, LLC P.O. Box 100217 Consulting Engineers Anchorage, Alaska 99510 Ph (907)272-8218 Fax(907)272-8211 WELL & SEPTIC SYSTEM ADEQUACY INVESTIGATION Legal: Owner: Residence: Number of Bedrooms Septic System: Tank Size: Absorption System Type: System Dimensions: Absorption Area: Soil Rating: Installation Date: Date of Investigation: Eagle River Valley Ranchenes, Lot 28C Robert & Erika Beachler 19031 Twenty Grand Rd. 1,000 (Steel) Deep Trench 42' x 2.5' x 6' ED 504 Square Feet 125 SF/BR 6/15/1985 1/22/2014 Test Procedure: Septic System: System was inspected visually and measured. The drain field was found to have 48" or more of cover. The field was measured and found to have 63" of water prior to the test. During our investigation, we added water to the drain field at a rate of 4.1 gallons per minute (GPM) for 20 minutes. After our 20 minute reading the water level had risen to the lateral pipe located 72" from the bottom of the system. At this time we slowed the rate of the water going into the system to 0.7 GPM and the water levels stopped rising. The water levels stayed consistent through the rest of the test. Due to these results, it is apparent to us that this system is 95% used. The system does pass but there is no guarantee on how long it will continue to work adequately. Separation distances were measured and found to meet MoA requirements from well to tank, septic field, lot lines, and surrounding systems. Well: This property is served by a public water system. Conclusion: Based on the test performed and information obtained from MoA records, this septic system appears to meet the code and operational requirements of the MoA for a 3 bedroom house. This system is 95% used and nearing the end of its life time. SPECIAL NOTE: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Page 1 of 2 Inspector's Qualifications Mr. Pannone is a registered Civil Engineer specializing in the planning, design and construction of sanitation facilities. He is a life long Alaskan with more than 20 years of engineering and construction experience. Mr. Pannone's background includes experience in survey, design, construction, testing, and monitoring of engineered projects. He has worked all over the state of Alaska, including extensive time in the arctic and remote regions. He takes a practical approach to design, taking into account how and who is going to be doing the construction. He has hands on experience in the construction of water and wastewater systems, buildings and large earth works projects. Mr. Pannone is a certified ADEC water/wastewater designer and sanitary surveyor. Mr. Pannone is the founder of Pannone Engineering Services. This privately owned company was founded in February of 1991. The company has specialized in the design, testing and installation of on-site water and wastewater systems. Pannone Engineering Services have performed engineering designs, analysis and evaluations of water and wastewater systems throughout Alaska. The types of systems have ranged from small single-family wells and septic systems to large commercial systems serving greater than 100 people daily. Page 2 of 2 .12 9 m a 8 N tXlST'P'G HOUSE � E z N 6"2. 28.0 Poltctl m 40.9 1 a M M I ¢ 5 89'59'15"E 133.0 I; I D 0 In i TWENTY GRAND ROAD r 1 I s1 7/27i00 AS BUILT. 48-47 DATE - FLD. BK. A. ,49n _ rli"_ 0. Fleming LS -n5- '.Car 73 ' arP....••' , '+w-Ohrrabeot TES: Easements not appearing on record subdivision T are not shown unless description of easement is Willed by client. It is the responsibility of the owner builder, prior to construction, to verify proposed Iding grade relative to finish grade and ainities tnectigns, and to determine the existence of any emenis, covenants, at restrictions which do not ,ear on the recorded subdivision plot. ✓otions based on ossumed daitm unless otherwise toted, and bearings and disionces ore record dots. ,g&$ SBS Engineering "T44 EMiP MU loot ao' [ABLE RM, awstu, !0=7 (207)W4-2979 LEGAL DESCRIPTION LOT 28-C EAGLE RIVER VALLEY RANCHETTES PLAT NO: SCALE GRID 65-128-A i"�30' NW 54 3 28—A S 89'59'15'E 133.0 1 r P P P P 10' U73LITY EASEMENT _- ------ ----- r•,_ --- max --- - - sox - - •�tcEY a.o• 0 J 28—C o j O s.9 e.o' 5• PL- SEPTIC i 18.2' STD -PIPES (TYP) 3 Ii an a 29—D n Jj 2.2 - x k"�--x-- .12 9 m a 8 N tXlST'P'G HOUSE � E z N 6"2. 28.0 Poltctl m 40.9 1 a M M I ¢ 5 89'59'15"E 133.0 I; I D 0 In i TWENTY GRAND ROAD r 1 I s1 7/27i00 AS BUILT. 48-47 DATE - FLD. BK. A. ,49n _ rli"_ 0. Fleming LS -n5- '.Car 73 ' arP....••' , '+w-Ohrrabeot TES: Easements not appearing on record subdivision T are not shown unless description of easement is Willed by client. It is the responsibility of the owner builder, prior to construction, to verify proposed Iding grade relative to finish grade and ainities tnectigns, and to determine the existence of any emenis, covenants, at restrictions which do not ,ear on the recorded subdivision plot. ✓otions based on ossumed daitm unless otherwise toted, and bearings and disionces ore record dots. ,g&$ SBS Engineering "T44 EMiP MU loot ao' [ABLE RM, awstu, !0=7 (207)W4-2979 LEGAL DESCRIPTION LOT 28-C EAGLE RIVER VALLEY RANCHETTES PLAT NO: SCALE GRID 65-128-A i"�30' NW 54 3 Municipality of Anchorage • Development Services Department Building Safety Division *AC On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050.224-04 HAA # Ja © 3 Q �. 0 Expiration Date: G - - O y 1. GENERAL INFORMATION Complete legal description Lot 28C, Eagle River Valley Ranchettes Subdivision Location (site address or directions) 19031 Twenty Grand Road - Current Property owner(s) Katherine Le Blanc Day phone 694.1722 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 19031 Twenty Grand Road Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Three 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well Public Water System ❑ Day phone Day phone 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 5 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 sample results less than 30 days old. (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. 4. 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 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 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. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 5/21/2003 5. DSD SIGNATURE —AZ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other ",,,,,., By: i Original Certificate Date: �� - - O 3 (Rev. 12Do) Municipality of Anchorage *A1 Development Services DepartmentBuilding Safety DivisionOn-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 28C. Eagle River Valley Ranchettes Subdivision Parcel ID: 050.224-04 A. WELL DATA Well type A Date completed Total depth ft. Date of test Static water level Well production If A, B, or C provide PWSID # 210875 Well Log (YM) Sanitary seal (YM) Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: Coliform colonies/100 ml. Date of sample: B. SEPTIC/HOLDING TANK DATA ft. g.p.m. Nitrate mgA. Collected by: Wires properly protected (YM) Casing height (above ground) in. AT INSPECTION Other bacteria ft. 9 - p.m - colonies/100 mi. Tank Type/Material SeoticlSteel Date Installed 611511985 Tank size 1.000 gal. Number of Compartments j Cleanouts (YM) Y Foundation cleanout (Y/N) Y Depression over tank (YM) H High water alarm (YM) N Date of pumping 551]812003 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 611511985 Soil rating (g.p.d.e or ft2/bdrm)125 SFMDRM System type Deea Trench Length 25 ft. Width 3 ft. Gravel below pipe 'K A 9 ft. Total depth 11j6. ft. Eff. absorption area 45 ft= Monitoring tube Y Depression over field N Date of adequacy test 511412003 Results (Pass/Fall) Pass For I bedrooms Fluid depth in absorption field before test nj in. Water addedul gal. New depthM. in. Elapsed Time: 0j min. Final fluid depth JS in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) jy I If yes, give date T D. LIFT STATION Date installed "Pump on" level at Datum in. Size in gallons "Pump off" level at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? Septic tankAift station on lot NIA' On adjacent lots NIA Absorption field on lot NIA On adjacent lots NIA Public sewer main NIA Public sewer manhole/cleanout NIA Sewer /septic service line NIA Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >>F Absorption field >5' Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots >21V SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water _ >100' Driveway, parking/vehicle storage >5' Curtain drain None Noted Wells on adjacent jots >200' F. COMMENTS G. ENGINEER'S CERTIFICATION pL.. ..4 ; 1 certify that / have determined through field inspections and review of Municipal records that the above systems are in ,............. ....... 49th . conformance with MOA HAA guidelines in effect on this date. .: M, •, CN kEL E. ANDERSON i Engineer's Printed Name Michael E. Anderson. P.E. ���sf , No. CE -,]91, Date 512112003 ��+♦ �� P p F«�s�.•�• HAA Fee $ .3 7 5 f-0 Date of Payment 9- ZZ"C Receipt Number 35'48 /5 (Rev. 12/00) Waiver Fee $ _ Date of Payment Receipt Number 2 lk W a LX ,00'ssl M.00.O1400 N a >z 1 3:)N3d aoa6.9 _ L O 1 1 > s, W° N �0. toC I m nL zn�oc °u n°aGG w� F T O co Er co N pWW I w p to Pol F W a ,00'ssl M.00.O1400 N a >z 1 3:)N3d aoa6.9 _ _ 1 1 > s, W° I W• N F T C) co Er co N pWW I vG p o • 1 � rli M �y �u 1 1 d Q 1 .n .2'92 o a 1 u 7 �'i0n r•xl � N�� ' N �'�ItlV 'liAYb'J ,� b • r OS W _ N rn I CL U h o co I co a Z 1 WI N iv w) i Us, a aI Ey2 wl } I ail I rl �O CdI x ,y I 41 1x x 3 _O —t .9 I . 00'5£ 1 M.OQ.01900 N ti I� 0 N F W a a >z 02 > W° W• N co Er co N pWW ' 0 PC ax o Q) p rli M w �u Q .n U` m A �'�ItlV 'liAYb'J LLI �I Municipality of Anchorage !� Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.ancho rag e.ak.us (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. OSO-ate y —Oi HAA# &&�,03gO Expiration Date: 1. GENERAL INFORMATION Complete legal description Z42T ' z�• Location (site address or directions) Z923/ 11me 7V 60,. E O Current Property owner(s) .�i �� / �O/ /SO��/ Day phone l �!G - 03 `� 9 Mailing address �� Lending agency Mailing address Day phone Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding Tank Well ❑ Community On-site 5� Public Sewer ■ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independen: professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served b% a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipalit} of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-c25t=ai 01oor 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S& S ENGINEERING 6 q y- a cl Name of Firm 17n3d F2gle nr„e_ L-00Road No. 204 Phone Address Eagle River, Alaska 9957) / Engineer's Printed Name 6. DHHS SIGNATURE Approved for _3 bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Date 7�_� c� %� ��•'""" �`C;qS it AK qe i ROBERT C. COWAN Cc .8801 do bedrooms, with the following stipulations. Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: o "0 Expiration Date: G - 4 - ^• 1 Reissue Date: :5-CG5 (Rev. 01 00)• «CEIVED Municipality of Anchorage JUL 28 200 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 41(.WAU-1Y QF ANCH 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)%3R4-74,4, srRvicF� D" Health Authority Approval Checklist Legal Description: L �"06 V /�1/�iLl Parcel I.D.: A. WELL DATA SP Well type 1 L If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESU Coliform Date of sample: Date completed Cased to FROM WELL LOG (above ground) protected (Y/N) AT INSPECTION 9— p.m-Nitrate Other bacteria Collected by: g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed 1985- Tank size Id"� Number of Compartments z; Cleanouts6/N)ES Foundation cleano(Y N) C� Depression (Y� Mb High water alarm (Y/N) 7 Date of Pumping Pumper ng IS- C. SC. ABSORPTION FIELD DATA r Date, installed S� Soil rating (g.p.d./ft2 rft2/bdr /ZS System type ld-'e-w6 f Length _ `,�S Width y�A J� Gravel thickness below pipe 9 Total depth Effective absorption area 3 onitoring Tube prese Depression over field (YS Mb Date of adequacy test Results ( ss�/ For �ff�GC� bedrooms Fluid depth in absorption field before test (in.); �%d it Immediately after!W gal. water added (in.): -4L / Fluid depth .3 67 (ins) Minutes later:_ Absorption rate = 9-p.d. Peroxide treatment (past 12 months) (Y/N)GVD/✓4°�QIPZW If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at' _ Cycles tested E. SEPARATION DISTANCES "Pump on" 'Datum Size in gallons "Pump off" level at' SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot Public sewer main Sewer /septic service line lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /{ Property line S /� Absorption field Water main/service line 74 -Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: O, Property line _ � 0 /�' Building foundation � � -� Water main/service line Surface water _� Driveway, parking/vehicle storage area Curtain drain /V OA/& Wells on adjacent lots M 14 F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal recur �h�ab6Ygms are in conformance with MOA HAA guidelines in effect on this date. C> ., 44 Signature_ /L+/K7/,,;,,,,,,p Engineer's Name C • yc ® ROBERT C. COWAN Date —7 a`d/oa �6+if�4 CE -8801 f, HAA Fee $_ Waiver Fee $ Date of Payment ©7 � D t) Date of Payment Receipt Number d1 Cp� ��• Receipt Number 72-026 (Rev. 3/96)' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L28C Eagle River Valley Ranchettes Subdivision Location (address or directions) (b) Applicant Name Lowrie Crowder Telephone: Home 688-3366 Business 694-5500 Applicant Address Jack White Realty E. R. (c) Applicant Is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other ❑ (explain); - (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Jack White Realty -Lowrie Crowder Address E.R. Telephone 694-5500 (f) Mail the HAA to the following address: -S&S FnIZinpPring SRB 196X Eagle River, Alaska 99577 694-2979 2. TYPE OF RESIDENCE Single-Family9k Multi -Family❑ Other Number of Bedrooms (3) Three 3. WATER SUPPLY Individual Well ® Community ❑ Public ❑ Note: If communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite kk Public ❑ Community ❑ Holding Tank ❑ 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 nazsu1.a4) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 the date of this inspection. Name of Firm Address — Date Telephone Engineer's Seal This office has received written confirmationfrom the Engineer (Eagle River Engineering Services) that.the conditions of June 15, 1985 have been met. Therefore, this property meets MOA requirements. ,1��1 Ilii 6. DHEP APPROVAL 'Approved for (3) Shxee''•bedrooms bYA Date Approved xX Disapproved Conditional Terms of Conditional Approval f 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 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIROM ENTAL HEALTH DEPARTMENT OF HEALTH AND EI6VIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (inp.,lude lot, blqf k, subdivis on, sect n, to sh , range) 01 Location (address or directions) (b) Applicants Name Applicants Address 1e Crl octl-c l 6' /, IC:0 Business (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer [� ; Other [� (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent J.gG�� Ge'lnl L( PG/�1� ��LT!/-e C 14nt \ Address Telephone LL v (f) Maly the HAA to the following address: S & E131W=R1h = SRB 'f96X ' 'r.+l.li.i. Gt7r . ♦ ..... �11 ii1'-7- i 2. Type of Residence Single -Family = Multi -Family Number of Bedrooms Other (describe) 3. Water Supply Individual Well Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Holding Tank 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 21 r r� 5. EnaineerinA Firm Providing Inspections, Tests, File Search, Data and Information As certified -by my seal affiaed.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 with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. S & [`1i�InlEEHM1 i Telephone Name of Firm c j e.,v►cALASKA T,71 p1�d Address -- M. _69�i-237D -► SOF A,1���� . -- Date 6. DEEP Ap2roval •; Approved for', bedrooms By Approved Disapproved Terms of;Conditional Approval -1N A I/, • C/%rI ice./7U tMw/A / L.�'.A A. Sharer No. 1417-E Date �/ p Conditional X Nc�.J i �oo ar t-1 t"0101 lJ E, "l —K TO zFf A 6 7,09/" w/ TN X-NF/� /HET/>OdS f%P/�'Oekwro r3jr�'NE �.O.fl., %e rn �T ' �S�oa57 /S S ue-D -3/4g--5 . - .W- 1,04(1 T,1 LJ THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDETPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HO!1ES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 M ill '• . , l4 _ rMUNICIPAEM OF ANCHORAGE (MOP) HOMM AUTHORITY APPROVAL (HAA) CHECRLISr - FEBRUARY 1984 A. WELL DATA Legal Descriptio RE CE 1 V E D Well Classification If A, B, or C, D.E.C. Approve"(Y Well Log Present (YM) Date Completed Yield Total Depth Cased to Depth of Grouting_ Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (YM) Electrical Wiring in Conduit (YM) Depression Around Wellhead (Y_ Separation Distances fron Wall: To Septic/Holding Tank on Lot ZOO �� i On Adjoining Lots � -F To Nearest Edge of Absorption Field on Lot Z c%) i On Adjoining Lots Zw �<- To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By i Date Water Sample 'Hest Results M Date Installed Sime l©940 No. of Compartments Standpipes Air -tight Caps Y ) e/ Foundation Cleanout Depression over Date Last Pumped Pumping/Maintenance Contract on File (Y /j" ; for Holding Tank High-water Alarm (Y lol' Temporary Holding Tank Permit (Y /4- Separation Distances from Septics Tank: r To Water -Supply Well Zen o �� To Building Foundation � To Property Line /O � To Disposal Field cS To Weter Main/Service Line To Stream, Pond, Lake, or Major Drainage Course wti tv e AA-) Cohcei ci �4prWvL 4:4f ACf 09ve A%It . ./ Receipt # AN� q�anle w i!� I-tyoutie 1&,4F Date Paid: - - 1j wou f dthe sori A--, 6- Amount: 4�v [Page 1 of 2) & r A(ee y. 2-15-84 r. C. ABSORFMCN FIELD DATA Soils Ming in Absorption Strata � Type of System Design n [� Date .Installed 7S Length of Field 2S ` Width of Field 3 " Depth of Field 43 Gravel Bed Thickness / Square Feet of Absorption Area ,�� Standpipes Present Y Depression over Field ( Date of Last Adequacy lbst OGT Ifi8s Results of Last Adequacy lost ftr Separation Distance from Absorption Field: To Water Supply M ll 2004- To Property Line / D -�- To Building Foundation 2 (9 1 f To Existing or Abandoned System on Lot A O N 6 t On Adjoining Lots LTD 1 o To Water Main/Service Line Z0 sl To Cutbank (if present) /V D ^f F To Stream/Pcnd/Lake/cr Major Drainage Course A) -0 N If To Driveway, Parking Area, or Vehicle Storage Area Sy Comments iU G N /Z D. LIFT S=ON Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at Off" Level at High Water Alarm Level at L 1 JgL,Vent (YM) Tested for Electrical Codes(Y/N) Comments f ing Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have decked, verified, or. aanfcrmad to all MOA HAA on the date of this inspection. r --_J Signed Date3- 7 c5 Ccsrpany 8��8�e WM4E18��t��w��,FQQyAa�tt1n}��� MORA No. fJ I IT. � AUSYA . C-5 RBI /d5/s _ PM. fi8q-2y79_ (Page 2 of 21 effect 2-15-84 APPLIC"`VT FILLS OUT UPPER HAL. 'PNL-Y ' Property Owner Time Time Donna Webb Date T271-3795 Mallin; Address P. O. Box 184 , - Anchorage, AK Zlp Code 99510 Buyer Len Powell ' Address Box 7,' Twenty Grande, Eagle River Zip code 99577 Lending Institution Phone Alaska Mutual rte. 1..L1•�- Address -Eagle River, AK Zip Code 99577 694-9571 Realty Co. 3 Agent Totem Realty, Inc: ` 'CONDITIONS OF APPROVAL Phone Lori Crowder Address P n TIOX Paql ` var,Zip Code gcjc;77 C94-9494 Legal Description Lot 128C, Eagle River Valley Ranchettes Street Location Twenty Grandw Well Log Received Type of Residence Z 7 —7" 30' 0 Single Family 3 ❑ Multiple Family No. of Bedrooms , ❑ Other Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. N Community For wells drilled prior to that date, give well depth (attach log If available). ❑ Public Utility Sewer Disposal 2 Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank --- NOTE: THE INSPECTIONYEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. �Q_plresf'�-vtd^nc� y0 /=earr-o�e. J MIA,&lam e-"PY - C) Yn/1r1, l.,,-JnC- Time Time Time Time Date Date Dale Date Inspector Inspector Inspector Inspector``, Field Notes: C C • .. rte. 1..L1•�- (3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Solis Rating Date Sewer Installed 1 Well To Absorption Aret Q tM p„ , Well Log Received Septic Tank Size Z 7 —7" 30' Well to Tank rav3 ryRl N k�-VCf, �NMEL� i October 27, 1983 ROBERT A.SHAFER CIVILENGINEER 694"2979 MUNICIPALITY OF ANCHORAGE CEPT. OF H -/.LTH A ADEOUACYTEST ENVIRON)r,`NTAL PROTECTION WATER AND SEWER INSPECTION WELL INSPECTIONS ANDFLOW TEST n ,1 SI PLANS No/ -� �`�1j ROAD DESIGN ST ONSITEONSITE WASTE WATER DISPOSAL SYSTEM DESIGN RECEIVED EXCAVATION WORK Totem Realty ATTENTION r Laurie P.O. Box 911 Eagle River, Alaska 99577 Dear Laurie, Reference: Lot 28C; 'Eagle River Valley Ranchettes A sewer 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 of 1000r gAllons. The absorption trench was tested by a continuous flow of water over a period of 4a hours without any adverse effect on the system. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However the system cannot be guaranteed against subsequent failure. If we may be of further service, please do not hesitate to contact use CC: Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA 99577 ���. W �C�ub October 3, 1983 Totem Realty, Inc. Lori Crowder P. O. Box 911 Eagle River, AR 99577 Subject: Lot 23C, L'agle River Valley Ranchettes Donna Webb, Owner Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: 0 `Phe septic tank, pur,iped with a receipt submitted to this 011-1 department. ° An adequacy test needs to be perforro:ed on the existing aching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needy to be submitted to this office for our review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Surely, -� Cory Willis, R.S. Acting Sewer & Plater Program Manager Cw58/ej/E2 Enclosure