HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 10CGRE/F' ANCHORAGE AREA BORr'" H
Department of Environmental Quality
3330 C Street
, Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~-'~/~¢~ ~/~,}~V' O~S~'~' MAILING ADDRESS .~'~/.~O /~/4~-/::~--/~-J~A~ k~J) PHONE
SEPTIC TANK:
DISTANCE
FROM WELL,
INSIDE LENGTH
MANUFACTURER -~'$C~'~"~ MATERIAL
INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LlaUID C APA(~ I T V ~'/'~7'~-'~G A L LO N S.
TILE DRAIN FIELD:
DISTANCE FROM WELL '/~/'~' FOUNDATION '~'"~" ·
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
~ TOTAL L E N GT/[-I_.~
NEAREST LOT LINE '~ OF LINES
TRENCH WIDTH~'~Z/ IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE
~,/ DEPTH OF FILTER
MATERIAL BENEATH TILE ~ IN. ABOVE TILE ~Z//' IN,
WELL: C/~f,~4'/~//~"/'"/7~ /d f~ )"'~'/'~ ' i~ ~' ~'/~
TYPE CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION , LOT LINE~, SEWER LINE__
CESSPOOL . OTHER SOURCES
APPROVED DISAPPROVED REMARKS
~DEPTH
SEPTIC SEEPAGE
TANK , SYSTEM
DISTANCE FROM:
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
DIAGRAM OF SYSTEM
DATE ~/~/~-'~ APPROVED
G.A.A.B.
Form EQ-O32
'GREA/'~'~, ANCHORAGE AREA BOR~'~,H
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 'C*' STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456!
9:,30
SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT
.A'"NG ADDRESS
NAME OF APPLICANT
INSTALLATION LOCATION
INSTALLATION OF: SEPTIC TANK
F,.ANCED THROUG.~ ,, TO .E ,.STALLEO ~BY
BO,~TEST RESU'TS I~'O/~/E,/ P-Il-?~--
COMPLETION DATE ANTICIPATED,
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 .~_ TYPE
MINIMUM DISTANCES. REQUIREMENTS
FOU~JDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
E/
SEEPAGE AREA SIZE
DRAIN FIELD,
SEPTIC TANK TO SEEPAGE PIT WALL
WELL TO SEPTIC TANK ~1I ,a~-~ SF~EPAOEpIT-- '
DRAIN FIEtLO , * ~"~ ~SO CONSI[~I~ AREA
TO RIVER. LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVAT'ION S FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PiT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL. BACKFILL.
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE APPLICANT'S SIGNATURE
FORM ilO.
~---,~ ~
0 ~ E GEOTECHNICAL ~!- DEVELOPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or
Russell Oyster Earl ~11i$
694.2774 688-2280
Soils [/Foundations Land Development
SOIL LOG
Perfor~ed~ for.:: J tia~e: o.q ~-.~t¢~- r. ~I V'~/~/L, ~. o~)u~.S.~,~/b ~ o~ T-el
Legal Description: Z 07- /~.. C: o,1 ~'"~-~s,':,~'/~/~E slT~,c)Lz!~
,Depth (feet)
. Soll ~haracterfstlc~'
3
6
7
8
9
10
11
12
/ ~r,- , Z~¢rr~/
Ground Water Encountered: Yes No ~
Proposed Installation:
Seepage Ptt
If yes, what depth
Dratn Fte~d
Co~ents:
Perfomed by:
Date:
.Eagle Rtver:.LooP Road,,.follow'.r. oad\.to"Han-o~W Road,,'turn,left.'..
':.~'onto.,Man~o-War.~.Road,.'tur'n;,,left;again.'at. r.oad.near;the':top of the
~'l :~ "'.'~,':'t ~ ;' ! ' '~ :'
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
Parcel I.D. # 0 ..~0
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~1 iCiPALITY OF ANCHORAGE
~.NTA~ SERVICES OIVISION
JUN 27r
1997
RECEIVED
1. GENERAL INFORMATION
Complete legal description
Lot 10C; Eagle River Valley Ranchettes
Location (site address or directions)
19111 Man O War Rd.
Eagle River, AK
.Property owne~'." Tom Elliott
: 'Mailing address .19111 Man O War Rd.
Day phone
Eagle River, AK 99577
269-0661
.., Lending agency
"..,' Mailing address
",Agent .- ,.
Address '"
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
3~v
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.
724)25(Rev, I/91) Front MOAI21
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 verifythat 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.
$ & $ ENGINEERI_N,G
Name of Firm ix0~4 F. ae;~ ~,;,~r ~F =~-'g ;-';. ""~ Phone ~ q 5/' 3- ~ '~ '7
Address Eagle River, Alaska 99577
Engineer's signature ~ .. Date' G/a c/Q3 7
DHHS SIGNATURE
X Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:.
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. Th.e 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.
~2-025(P, ev. 1/91) Back MOAI~I
MUNICIPAUI~f OF ANCHO~
Municipality of Anchorage a~n~ON~E~r~.SERWC~ ~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division JUN 2 7 1997~
825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744
RECEIVED
Health Authority Approval Checklist
A. WE~ DAT~~ ~
W~I ~e ~l ~ If A, B, or C, a~ch ADEC leUer. ADEC ~ter s~em number
Log present ~) ~ Date ~mplet~
To~l dep~ ~ Casing height (ab~ ground)
Sani~ seal ~) ~ Wires property pmte~ed ~)
Date of test FROM WE~ LOG ~ON
S~flc ~r I~1
WATER SAMPLE RESULTS:
Coliform ~
Date of sample:
Other bacteria
B. SEPTIC/HOLDINGTANK DATA
Dateinstelled lo/r / '~ 5" Tank size
Foundafion . oaoo
Date of PumPing "' '5/'/4/~;:~' Pumper
· .'_ : . ., / :'!.~'.
C, ABSORPTION
D~e,!..r~...ta!. !ed Z 0 / I ~/'~t"~'
.r ;;2
Effecth~ abSOrption area, ,' ~¢~, ~'
Date of adequacy test
g.p.m.
Number of Compartments
High water alarm (Y/N) l~J~i.
Soil rating (g.p.d./fF or fF/bdrm)/SZ'~+YBJ~ System type ~
Gravel thickness below pipe (~/ Total depth (:~ /
Monitoring Tube present (~IN) ~ ~ Depression over field (Y~!..~)
Results (Pass/Fail) J~S For '~'
Fluid depth in absorption field before test (in.); C) Immediately after~20 gal. water added (in.):
Flaid depth I ,t (ins) Minutes later: ~)5 Absorption rate ~ ''/'-'
= /4]//~ g.p.d.
Peroxide treatment (past 12 months) (Y/N) /~t~_/:; ~./J~t~L) If yes, give date
bedmorns
Size in gallons
Manhole/Access (Y/N) ~pon" level at* "Pump off" level at*
High water alarm level at* *Da'ttm~.
Cycles tested
SEPARATION DISTAN~LOT TO: .-
Septic/holding tank on~lot On adjacent lots
Absorption field on lot t lots
Public sewer main Public sewer ma~eanout
Sewer/septic service line Uti station '"-,...
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation t~ ' )r Property line j~ "~ Absorption field l0t~
Water main/service line ~O~r Surface water/drainage Ioo' -t Wells on adjacent lots
Ee
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line 't~)t+ Building foundation I~t~
Surface water ~DO I ~
Curtain drain k~_ / 1~
ENGINEER'S CERTIFICATION
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots lOG t +
I certify that I have determined thru field inspections and mvfew of Municipal records
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name
HAA Fee $ ~"~),
Receipt Number
~-~6 (R~. ~e)*
Waiver Fee $
Date of Payment
Receipt Number
DATE RECEIVED
I'NSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECT OR INSPECT OR NSPECT
/V~JNIClPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
)~. DEPARTMENT OF HEALTH & ENVIRONMENTAL PR~ENTAL PROTE~ION
825 L Str~ - Anchora~, Al~ka 99501
ENVIRONMENTALSAN{TATION DIVISIONFEB 2 ? 1981
Telephone 2~7~
RECEIVED
~E~UEST FO~ APPROVAL OF INDIVIDUAE ~ATE~ AND SE~E~FAOlEITIE8
DIRECTIONS: Complete all pa~s on page 1. Incomplete r~u~ will not ~ pr~. Please allow ten (10) days for processing.
1. PROPERTY OWNER I PHONE
MAI LING ADDR Efts
PROPERTY RESIDENT (If different from abo~) PHONE
2. BUYER PHONE
3. L~NDING INSTITUTION I PHONE
MAILING ADDRESS
4. REALTOR/AGENT ~ PHONE~
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
J~ Three [] Six
[] Other
7. WATER SUPPLY [] INDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.~
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
, THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMI L~' [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY ~'
[] INDI'VIDU~[~' ;' :"~"
. . - · DEPTH OF WELL
[] COMMUNITY '
DATE DRILLED
[] PUBLIC UTILITY *
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM' PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
•PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL ....
4. DISTANCES Septic/Holding Tank JAbsorption Area jSewer Li~e I Nearest Lot Line
WELL TO: ' · *' ....
Absorption Area to nearest Lot Line
5. COMMENTS
d *."; OVEDFOR BEDROOMS
[] CONDITIONAL APPROVAL (lette? must accompany certificate)
[] DISAPPROVED /,~
72-010 (Rev. 6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Etmet - Anchorage, Ata~k~ 99501
ENVIRONMENTAL ENGINEERING DIVISION . ,
Telephone 264-4720
DIRECTIONS: Compete all part~ on page 1. In;omplete mq~t~ will not b~ pro~ed. Please allow ten (10) days for procmsing.
1. PROP~..QWNER
MAILING ADDRESS
PROPERTY RESIDENT (if different from
~. BUYER -- ,/
MAILING ADDRESS
3. LENDING 1NSTITUTION/~ /~, ,
MAILING ADDRESS
PHONE
PHONE
REALTOR/AGENT
MAILING ADDRESS
6, LEGAL DES~PT~ / ~
STREET LOCATION
6. TYPE OF RESIDENCE ~ SINGLE FAMILY
[] MULTIPLE FAMILY
7, WATER SUPPLY
[] INDIVIDUAL*
~ COMMUNITY
[] PUBLIC UTI LITY
& SEWAGE DISPOSAL SYSTEM
[~Y~NDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
BEDROOMS -~
[] One [] Four [] Other
[] Two [] Five
[~'/Three [] Six
* ATTACH WELL LOG. A well log is reqUired for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
**If individual/on-site, give installation date /~ .
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
'*; THIS SIDE FOR OFFICIAL USE ONLY *
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY / I~
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: ~ If Tank is homemade SOILS RATING
give dimensions:
TYPE (~ T,~N~,.~~~ M A N U F A CT U R E R~./~/~.~.
TOTAL ABSORPTION AREA MATERIAL
Absorption Area to nearest Lot Line
5. COMMENTS
[~APPROVED FOR ,.~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
/-
DATE ~
~EGAL DESCRIPTION
72-010 (Rev. 3/78}
DAVID A. SLENKAMP
ROBERT A, SHAFER
MECHANICAL ENGINEER
694-9055
~grch 12, 1981
CIVIL ENGINEER
694-2979
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
Remsx Properties
ATTENTION:- Pon Ydller
2702 Gambell
Anchorage, Alaska 99503
Dear ~r. 1,[iller,
MAR 1. '7 1981
RECEIVED
Reference:' Lot lOC; Eagle River Valley R. nchettes; Terry Brown
Property
A sewer system adequacy test ~ss performed on the system located on
the referenced property per your request. The septic tank was pumped
and verified to have a capacity of 1250 gallons. The absorption
trench was teated by a continuous flow of approximately 600 gallons
of water over a period of 24 hours.
It can be concluded Erom this test that the se~ge system is currently
functioning adequately for ~,.fourbedroom residence.
If Me may be of further assistance, please do not hesitate to call.
~,~nicipality of Anchorsge
Department of Health and Enviornments1 Protection
SRB 196X EAGLE RIVER, ALASKA
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M. SULLIVAN,
MAYOR
DEPA,qTMENT OF tlEAL'TH AND ENVIRONMENTAL F'ROTECTIOI'~
March 3, 1981
Terry Brown
% Re/Max Properties
2720 Gambell Street
Anchorage, Alaska 99503
Subject: Lot 10C Eagle River Valley Ranchettes Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(1) The septic tank pumped with a receipt submitted to
this office.
(2)
An adequacy test needs to be performed on the existing
leaching 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 needs to be submitted to this office for our
review.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
CC:
Ruth La Bart
National Bank of Alaska
Pouch 7-025 99510
Ron Miller
% Re/Max Properties
2720 Gambell Street
99503