HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 21BEagle River
Valley
Ranchettes
Lot 21B
x#050-223-26
GRi R ANCHORAGE AREA B(
Department ;3f3E0n;ir~;=;ntal Quality
Anchorage, Alaska 99503
JGH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
· OCAT,ON T* ¼
MAILING ADDRESS
LEGAL DESCRIPTION
PHONE
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
~ NUMBER OF
MATERIAL ~ ~..,- COMPARTMENTS
LIQUID DEPTH LIQUID CAPACITY ~)0 GALLONS.
SEEPAGE ff'~':
NUMBER OF PITS I
LINING MATERIAL
BUILDING FOUNDATION
DIAMETER/~'~) OR WIDTH ,"~/. LENGT~
CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE __ ABSORPTION AREA (WALL AREA)
ADDITIONAL ABSORPTION
TYPE CONSTRUCTION
BUILDING NEAREST
FOUNDATION '. LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
NEAREST
SEWER _INE
REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK __ SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE=
REMARKS:
Form No. EQ-O31
DIAGRAM OF SYSTEM
DATE (-J~/~ ~ ['"/~"' APPROVED
/ I ~.A~'A~B.'
OEF~MENT OF ENVIRONMENTAL QUALITY PERMIT NO
SEWAG£ DISPOSAL SYSTEM ~ APPLICATION AND PERil
FINAL INSPECTION: 24 HOUR NOTICE RE(~UIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRON~IENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
FOUNDATION TO SEPTIC TANK '~
~EPT,c TANK To ..... ~,~ ~ /~
SEPTIC TANK * SEEPAGE PiT
DRA N F ELD ~ ~ , ALSO CONSIDER AREA WELLS,
DRAIN FIELD ~0 ~* , SEEPAGE PIT
~,~ ~.~, f~ ~, ~..~ ~,./~o
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOLE.
4 INCH DIAMETER CAST IRON B[PHON PIPEB ON SEPTIC TANK AND BEEPAGE PIT
[ CERTIFY THAT I AM FAMILIAR WITH THE RECtUIREMENT$ OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-E8 AND THAT THE ABOVE
DESCRIBED 5YBTENI IS IN ACCORDANCE WITH BAlD CODE.
~ICANT'B
FORM NO, £Q-016
Sell
Location Sketch'
w~s.~ou~ .stew ~*ooa~te~ea~ ~/~ % 4 I'""~'~'t~-~':~z~
Rea zn ate c, Net
4 L-
Time Depth To H20 i -
' Net Dnop
..ep%ed Installat/on: Seepage Pit l.--' Drain Field
Depth Of Inlet_ ~- ~' Depth TO Bo~t-~m 0~--b-~* n~ ~ .... ~ , -
COMM ........ . ~ . ~ ...... ' ~'~ncn /D '
Test Perfo~d By: pc tee ~ 4-. ';' ~' 4 , 7 *u
Data Certified By~~ '
Da~T- ~--~~. i~ ~ ~ 1~70
® Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-223-26 Expiration Date:
1. GENERAL INFORMATION
Complete legal description Eagle River Valley Ranchettes Lot 21 B
Location (site address) 19010 Twenty Grand Rd.
Current Property owner(s) Tyson Shiver
Mailing address
Real Estate Agent
Day phone 406-690-6385
19010 Twenty Grand Rd. Eagle River Ak, 99577
Laura Halverson
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY:
Individual
Individual Well
❑
Holding Tank
❑
Individual Water Storage
❑
Community
❑
Community Class_ Well
❑
Public Sewer
❑
Public Water System
Waiver/Variance request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $
Date of Payment �3
Receipt Number. �( (1�7
COSA# 6�)6=66(
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111
Address 20441 PTARMIGAN BLVD.. EAGLE RIVER. AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future 401-
occupants
occupants or can ArcTerra guarantee that no unseen or
encroachments, deficiencies or discrepancies exist.
* 4 g T l l�� x �.
6. DSD SIGNATURE
System #1 Approved for ` ?� TH M D LIS 0
3 bedrooms. ,
System #2 Approved for bedrooms. 1 nFp �� EcG~i
�'Rol'ESSIOti�� .i
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
y rr
OF iii
oN. o
IRA
l ^�
Original Certificate Date: r 2 zy
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 blue sheet 10-10-12.doc
Legal Description:
COSA Checklist
Eagle River Valley Ranchettes Lot 21 B
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments
B. TANK DATA
Age of tank(s) 7 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 49
Standpipes/foundation cleanout per record drawing
Date of pumping I Z-. - 2- d — P7
D. ABSORPTION FIELD DATA
Which system tested (date installed) S/7/13
ALL standpipes present per record drawing
Total measured depth from grade 9 ft (max)
Measured depth to pipe invert from grade 4 ft (min)
❑ N/A — pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 050-223-26
of Structure served by this system 1
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:
Adequacy test date 12/19/19
Results Q Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 450 gal
New depth 13 in
Elapsed time 60 min
Final fluid depth 0 in
Absorption rate 450+gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No ft
0 Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes
if No
ft
0 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'
® Yes if No _
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
0 Yes if No _
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
0 Yes if No _
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' 0 Yes if No
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
ft
ft
ft
`ii
ft
•
• •
Municipality of Anchorage �5 6 74'� ,P''f
On-Site Water and Wastewater Program c., .
(907) 343-7904 Q FEB T. ,
• n
Certificate of On-Site Systems Approval
!2 4
Parcel I.D. 050-223-26-000 Expiration Date: 7- I 0
1. GENERAL INFORMATION
Complete legal description Eagle River Valley Ranchettes L21 B
Location (site address) 19010 Twenty Grand Rd Eagle River, AK 99577
Current Property owner(s) Michele Phillips Day phone 719-331-5910
Mailing address 19010 Twenty Grand Rd Eagle River, AK 99577
Real Estate Agent }; Jennifer Flanagan Day phone 907-350-0881
2. TYpE-.OF DWELLING:
Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank
Communitylass Well ❑ Community
Public Water System Public Sewer ❑
WaiverNariance request for: Distance:
Received by: /At. Date: 272-67)P
co -A.to be released to the engineer,unt otherwise requested by the engineer.
COSA Fee $ 5 Waiver Fee $
Date of Payment 61 I3/i8 Date of Payment
Receipt Number lit[ 3r3( Receipt Number
COSA# O ,
ti31Us-z) Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certifed.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 Alaska Rim Engineering Phone 907-745-0222
Address 9131 E. Frontage Rd
Engineer's Printed Name Mary L. Shreves Date 2/7/2018
ys.„..0.n.rpd5Ot
�• ' OF AC Bite
40,
:•.:770/.." * -.1 ":"
. 9TH .
6. DSD SIGNATURE "
X System #1 Approved for bedrooms ;. ... Mary 0.
heves : �=
System #2 Approved for bedrooms s '
o' ll, °•. CE 9351 ;N?• �`®�
`fi®
Disapproved ®B/F;PROfESS\O' e��►
Conditional approval for bedrooms, with the following stipulations: 0
IVY OFA..
ON-SITE ' ••
WATER AND
WASTEWATER z"
.c PROGRAM '
ccio O
By: 1 �., 1------- —OGL Original Certificate Date: '(n (O
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 blue sheet_f '.<
X1 8 9 707
If more than 1 septic sy-s - is • le ; :4,
COSA Che • '-t _ • . i
^
Structure served b• • is sys em 7
sr —_3I22018
Certificate of On-Site Systems Approval C e klist j
li °I 6 8 0
Legal Description: Eagle River Valley Ranchettes L21 B Parcel ID: 050-223-26-000
A. WELL DATA
Well type Public If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
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 Date installed 8/7/2013
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 7/18/2017 Pumper JR'S Pumping
C. ABSORPTION FIELD DATA
Date installed 8/7/2013 Soil rating (g.p.d./ft2 or ft2/bdrm) 1 .2 System type DeepTrench
Length 61 ft. Width 3 ft. Gravel below pipe 5.1 ft.
Total depth 8.5 ft. Eff. absorption area 622 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 2/7/2018 Results(Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 519.8 gal. New depth 9 in.
Elapsed Time: 45 min. Final fluid depth 0 in. Absorption rate >= 519.8 g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) None Known If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot 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:
5'+ 5'+ 5•+
Building foundation Property line Absorption field
Water main 101+ Water service line 101+ Surface water 100'+
Wells on adjacent lots 200 +
ABSORPTION FIELD ON LOT TO
1+ 1 0'
Property line Building foundation + 10 +
Water main
Water Service line 101+ Surface water 100 + Driveway, parking/vehicle storage 101+
Curtain drain 501+ Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION i`ti111
1
I certify that I have determined through field inspections and ,:. OF A�-16' i
. Si I/
review of Municipal records that the above systems are in � ,,N. -:..- • ;� I�
conformance with MOA COSA guidelines in effect on this date. �» �i' 9 �j
Engineer's Printed Name Mary L. Shreves • '1 ' z • o
Date 2/7/2018 . . .""' •
13 Mary L. Shreves • 4,
//' 6's•' CE 9351
.'• z
";11111 FESS - `
0 COSA canary sheet_2-6-15.doc
1
• 7180
TWENTY GRAND ROAD
— — — — —
Y.
O 0
coco
S89°59'15"E 133.00
O ,a ~�L
COcD ,,,, ......... <c‘ -.....:..... ---...-..
u� O
to
° Septic vent ' _ co
Lot 21A \34 16.4— in Lot 20A
p Wood fence/// v 2.0 O el O
O N 2 Story Frame c ,
Z ° o ° ° CO House O
Septic vents 38.4 I Z
y deck 0
17.0—
` •
o.
Lot 21B
8 --Shed
rs-
reenhouse
ire fen
_ t________.
/ /
/ / /10' tility Easement
S89°59'15"E 133.00
Lot 21C
Lot 20C
Lot 21D
4%.`N.N.N't\, RECERTIFIED 2-18-20154PV
•A ! I AS-BUILT NO CORNERS SET THIS DATE
� -• ' • . -q ,
,��Q.' .54—_,„i, I hereby certify that I have performed a Mortgagee's inspection
-(')• 49th ��,� . l of the following described property: LOT 218,
r!> •.:•• /\ * EAGLE RIVER VALLEY RANCHETTES SURD.
Anchorage Recording District,Alaska,and that the
/ E+..Fred Wald tka ,P. / improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
,/'PI,•. 3255 – S .••J.
_ adjacent thereto,that no improvements on the property lying
11'Pe • • a y �, adjacent thereto encroach on the premises in question and
F• • • • •AL•0,a ANY that there are no roadways,transmission lines or other
SCALE: 1"= 30' visible easements on said property except as indicated\\�� hereon.
Dated at Anchorage,Alaska
EASEMENTS OF RECORD, OTHER THAN this 8th day of October ,1975.
THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES
PLAT ARE NOT SHOWN HEREON.
FB 75-11, pg.20 BE (907-248-1666) Engineers and Surveyors
MUNICIPALITY Of ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DiviSion of Environmental Servibes
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Location (site address or directions)
Property owner
Mailing address
Lending agency
J-~/'ZZ~"~'7'7"/~2'~ Day phone ~:~:f'~-~:-~
· ~ ~..~ ~. ~
Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water ~
If community well system, provide written confirmation from State ADEC attest- .
lng to the legality and status of system.
4. TYPE OFWASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my s.e~! affixed hereto an,.d .~s of the validation date shown below, I verify that my
investigation of this Health Authority Appr(~val application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from.my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Engineer's signature
D~vic{ R. Dayton P.E.
20210 Donalar St.
Ckuniak."Alaska ~6;7
Phone
Date
DHHS SIGNATURE
~J Approved for
bedrooms.
Disapproved.
__ Conditional approval for
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. 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:
A. Wall Data/~/o,¢/~=~--
Well type""~,~t-~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth
Sanitary seal (Y/N)
Cased to Casing height
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Wires properly protected (Y/N)
g.p.m.
; On adjacent lots
ATINSPEC~ON
g.p.m.
; On adjacent lots
Public sewer manhole/cleanout
Sewer service line
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Nitrate Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed *//~t//* ~F
Cleanouts (Y/N) '
High water alarm (Y/N)
Date of pumping
Tank size ! ~ Compartments
Foundation cleanout (Y/N) ~ ~-~ ,.,,;.., D~pres~ion (Y/N)
,~/~/~ Pumper ~'~ ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots
Absorption field
Foundation ~
Water main/service line
72-026 (3/93)* Frorlt CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length
Total absorption area
Date of adequacy test
Water level in absorption field before test
Soil rating (GPD/Ft~) ~ ES" .s~ System type ~-,~-3~-,~
Width ,z, .G~vel thic~ess ~ T~ depth /~
~O ~ Cl~nout present ~/N) ~ Depression over field ~)
~~ Resul~ (~s~il) ~ for ~ Bedrooms
~' After test ~/
~ If yes, give date
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~/o~
To building foundation
On adjacent lots /o
Surface water
Curtain drain
On adjacent lots /V'~, ,,.~- Property line ~ 45)
;~ >'~ To existing or abandoned system on lot
Cutbank ,/~///~ Water main/service line Z 5'-~"'
/~o ~ Driveway, parking~ehicle storage area ~ &:)
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the~.~_~,.~ inspect/on.
·
2o2m st
..... f
~-nglneer s marne ~ - ~ ~ '~'- ~, ~ -. . · -~-
/ / ~ ~ m; Dawd R. Dayton
Date ~/~../~',~' t ~,,, ~. 2~-~
~ Fee $ ~O , ~ 0 Waiver Fee $
Da~ ~ Pa~e~ ~ ~/--?~ Date of Payment
Re~ipt Numar ~1~1 Receipt Number
72-026 (3/93)* Beck
D. R. DAYTON, P.E., R.LS.
~~ Chugiak, Alaska 99567
20210 Donalar
(907)
696-2417
August 30, 1993
ADEQUACY TEST
Legal Description: Lot 2lB, Eagle River Valley Ranchettes
DaYe of Test: August 25, 1995
Septic Tank: 1000 gallon, 2 compartment, steel tank
Absorption System: 60' x 3' x 7' effective depth trench
Soils Rating: 225 sq. ft. per bedroom
Requirements: 3 BR - 450 gallons per day
(DHHS Records)
(DHHS Records)
(DHHS Records)
Test:
Water was pumped into the absorption trench while measuring
time, volume and water l~vel rise. After pumping was stopped, the
water level drop was measured at timed intervals.
The results were plotted on a graph of time and gallons absorbed
and extrapolated to 24 hrs.
Results:
The absorption system is currently functioning adequately
for a 3 bedroom home.
NOTE:
There was 5.4' of water standing in the trench before the test.
After 24 hrs the water level was the same.
This water in the trench may indicate the system is in its
waning years.
APPLIOJ IT FILES OUT UPPER HAI. DNLY
Phone
Address
Legal Descn[
Zio Code
Zip Code
Zip Code
Code~
Street Locatio~
Type of Residence
Single Family
~l~ult iple Family
[] Other
No. of Bedrooms
Phone
Phone
Water Supply
[] Public Utility
Sewer Disposal
Individual
~' Public Utility
[] Holding Tank
A~'ACH WELL LOG. A w~l log Is reeuired for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth lattach log If available).
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Dater Date Date Date~
Inspector Inspector ' Inspector Inspector -
Field Note' .'. ,'-~.~ ~
(~ ) AP~OVE~ aE~OOMS *CONDm~S OF A~OWCDept. of Hea~ &
( ) ~m~.~ov~ E~vir~l ~1~:~"
( ) CO~ITIONAL APPROVAL*
DATE
Soils Rating Date ~wer Installed Well To ~sorption ~rea Well Log Received
Well to Tank ~ptlc T~k Size
EXCAVATI 0 N
WORK
July 24, 1983
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
D±c~ Brown
1715 Blue Spruce
Eagle River, Alaska 99577
Dear Mr. Brown,
Reference: Lot 21B~ 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
~ns. The absorption trench was tested by a continuous
Of waterover a period of 48 hours.. The average flow
~during this time exceeded 479 per day.
It can. be concluded from this test that the waste water disposal
system serving the residence located on this property is currently
functioning adequately for three bedrooms. However the system
cannot be.guaranteed against subsequent failures.
If we may be of further service, please do not hesitate to
~contact us.
Municipality of Anchorage
Department of Health and Environmental .Protection
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 9-30-75
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Cony.
Veal Construction
S.R.A. Box 354-A Phone:
same Phone:
3. Legal Description:
4. Location:
Lot 2lB, Eagle River Valley Ranchettes
Twenty Grande Street
5. Type of facility to be inspected
6. Well Data:
A. Type community s cem
C. Construction
7. Sewage Disposal System:
S.F.D.
No. of bedrooms 3
B. Depth
D. Bacterial Analysis
A. Installed 6-16-75 B. Installer self
C. Septic Tank: 1. Size 1000 9al. 2. Manufacturer
D. Seepage Pit: l. Absorption Area 840 sq.ft. 2. Material
Greer/steel
deep trench
, Absorption area
, Other contamination
, Absorption ~rea
, Sewer Lines
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
~ P~fl~ge 2 of two pages -
L~a). O~sc~Iption
Req~t for Approval of Individual
)r & Water Facilities
Lot 21B, Eagle River Valley Rancheytes
Coneents
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental
DIAGRAM OF SYSTEM
Date
Qua 1 i
certify that the infomation contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)