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Home My WebLink AboutEAGLE RIVER VALLEY RANCHETTES LT 23B Onsite File Eagle River Valley Ranchettes Lot 236 #050 - 223 - 22 Wastewoter system approved for 3 - bedroom . 4 - bedroom permit for tank only . Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181006 PID Number: 05022322 Dwelling: I Single Family (SF) ❑ Duplex (D) [' Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade Name: DAN ABTS ABSORPTION FIELD Address ❑ Deep Trench [' Shallow Trench ❑ Bed ❑ Mound 18830 TWENTY GRAND ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 -- GPD/SF -- Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot -- Ft.-- Ft. EAGLE RIVER VALLY RANCHETTES LT 23B Fill added above original grade Gravel length Township Range Section -- Ft. -- Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES -- Ft. -- -- Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line -- Ft2 -- -- Ft. Well __ __ __ I __ TANK I]Septic ❑S.T.E.P. 0 Holding ❑Other Manufacturer Capacity ANCHORAGE 1250 Gal. Surface Water +100 -- -- -- Material Number of compartments Lot Line +5 -- -- NA STEEL 1 Foundation +5 -- -- -- LIFT STATION Manufacturer Capacity Curtain Drain +50 -- -- -- _- __ Gal. Remarks TANK REPLACEMENT ONLY Pump on level at Pump off level at High water alarm at OLD TANK DISPOSED OF PER MOA CODE -- in. -- in. -- in. NEW TANK RATED FOR 10' BURIAL Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield GUARANTEED SERVICES Drainfield NA CO/MT3034 Inspector CHARLES BALZARINI BENCH MARK (Assumed elevation) 100 ft Inspection 1sr 1/26/18 2"d Location and description 3rd 41" TOP OF GARAGE SLAB AT MAN DOOR COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp„.o...votaNNa .S- ..F A 4."1 ori,; --..:5;,, II Conditional Approval: Date R co-, :y , 'gin 49TH iia oo t,;,citC ARLES G a zARINI; #4.t7;,:\ No.GS � , 4 ieF , `i+ 1.,-.4s;.,77., <G,. , ‘'1/4Vb.woo,”" Appro./es c_.._ -,A _ Date 3-9''(V Inspection Report_9-1-12.doc dlik ;47 "‘"X-INV. / R?vEY '. N . • )e.19:_ ._------- - ,_, CHARLES G BALZARINt °I • ,,,13,,c. ...- ( Any ,I�FDPROFESSIO��`�-� BM TOP OF GARAGE \‘��x\`. GARAGE SLAB LEGEND AT MAN DOOR HOUSE • MONITOR TUBE A EXIST. DRAIN=IELDS . 0 NEW 1250 I 0 GAL. TANK I VEXIST. DRAINFIELDS I I - - \__ _ FENCE SWING TIES A B C 30.18 26.4 PLAN — S .AF: 1 30' +100.0' TOP FOUNDATION 99.33 +4.5' COVER 1250 GAL TANK 95.1 95.4 SCHEMATIC ELEVATION - SCALE: NTS LEGAL DESCRIPTION: EAGLE RIVER VALLEY RANCHETTES LOT 23B C&M ENGINEERING SERVICES OWNER: DAN ABTS DATE:2/16/18 REV: ?DRAWN: CB REF: 907-854-5558 SEPTIC RECORD DRAWING • • • • 4. TWENTY. 6-12-A' fJD. R04D a o 0 ril . 5139 °Y 9115 "E . I I I (33•0'0 1 / 4, o 1 / c`rzAvrl_ I , U I • DR rvE 1_ C•"4.144. /- - - . /4.8: t.: 1. 31t _�. vi i~1 • a 35.2 t) X 1 4 4411' r / S� Yo h • N a W� : /4•V NMEN 0 Irk- A- 1 `� x. 340,0. X ._._51;:t.:___...x I �It 14'� 0 9.3 CAW,. 0 to L.I ii 0 4 141 ^^_- septic tri RC .. raC4 LE p ! sy J1.m 01ft Ewe.: 1 H= 30' QOI SIun4 plp•s �, O 17 / \ MEt4L 9'0 o yr <A4 rnrnk Fcnca SRO o 23 EC /0' dr/L1 T'/ eASel,-lE,vr. ._ / 33. 00 589 " 59' /5 " E' ~�' EASEMENTS OF RECORD, OTHER THAN THOSE SHONN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON, At 13v,It No Corners Set This pro Book No. Peg. No. FILE IN N112 SK's.} 5EC, 7, TI4N1 RIW, 5M. 401,4V%,7‘,1 I hsrepy Ce/Illy th.t I Nvi surveyed the tolbwlng deeorltted property. Lot,_—&lock .i OF At n EAG,E,E RIVER VALLEY RANCNE7TE5 Anchorp. ..cordi�+g.IA#.,C, Aatk., .rd that _A%P'�0..•"'•`*SW: 4 fel +1 the Improvements ultu.ted thir.on ere within the property lines end Oo not over'•)) 0' r(,' T�,I •ncro.ch on the property lying •citscolt choreic), that no Irt�pr0.srnenq on property / QT�uy ly,ng ed�.Cent thereto •nCrOech on the Premises in question end that there Me n0 rosa0wsy$, / * �.7.W ,� tr.ntmiiion lines •M• •w• .•........ .•• e or Other yi.lol• Mt.mentl On said Drop.rty except M k+d1ateQ Mr•on. ��fie •• .•• •..•......•.....j..." If t e 74 /%/;0, Ms.Ms. i3054 :ill Anctw.gi•,.Ah.kta ` 0 C T l 776 - f, er �JN,�1PAt�`,'OA, MUNICIPALITY OF ANCHORAGE N. c•-, �,,,cnr / • On-Site Water&Wastewater Program P �° ''S PO Box 196650 4700 Elmore Road 1' Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite .. i Department On-Site Wastewater Disposal System Permit Permit Number: OSP181006 Effective Date: 1/19/2018 Work Type: SepticTank Upgrade Expiration Date: 1/19/2019 Tax Code Number: 05022322000 Site Legal Address: EAGLE RIVER VALLEY RANCHETTES LT 23B G:0054 Site Mailing Address: 18830 TWENTY GRAND RD, Eagle River Owner: ABTS DANIEL Lot Size in Sq Ft: 17955 Design Engineer: Balzarini Charles Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 11 Septic Tank 0 Holding Tank 0 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: 1. A cleanout is required 1 to 4 feet from the foundation. If there is no existing foundation cleanout, one must be rwi added under this permit. 2.Verify that tank is a minimum of 10 feet from the water service line to the house. Received By: Date: I. /1 /2'(4/ Issued By: 0." ja,1_• / Date: IIMI MUNICIPALITY OF ANCHORAGE ad* Community Development Department , Phone: -343- 17 Development Services Division fi. i•f Fa :907 t3 On-Site Water & Wastewater Program • j .1" - , ON-SITE SEWER/WELL PERMIT APPLICATION a 'ft� L018 3 t. ti U Parcel I.D. (---) J- 0D3 -� p zi 01 r .Q 9,�� Property owner(s) V:4 E4- Ir3TS Day phone 7 7' P Mailing address , ,.' 7 Lfo p i A '1-Z&,4 .-t/b Site address an7 LW P T,kVV .1,AZ i. Lv6 Legal description (Sub'd., Block & Lot) L/46 L>; Riv 4 \J'4 (.4, ...7N P .i.i g iv 'c `D r ,d3 Legal description (Township, Range & Section) /J Lot Size I �� q5 5 Sq. Ft. Number of Bedrooms 11 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) p (w/wo ADU) Septic Tank E3 Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings E Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. / — _ (Signature of property owner or authorized agent) Permit/Rush Fees: 3444- Waiver Fees: Date of Payment: 1113113 Date of Payment: Receipt Number: Q 13 Receipt Number: Permit No. 05P) 'joO(o Waiver No. Permit App_9-1-12.doc Municipality of Anchorage Onsite Water&Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System Repairs for Eagle River Valley Ranchettes Lot 23 B Dear Reviewer, The above referenced property is in urgent need of a septic tank replacement.We are requesting approval to replace the existing 30 year old 1250 gallon steel tank with a new 1250 gallon moa approved septic tank. The owner may wish to upgrade to a 4 bedroom system in the near future, however there is an immediate need to replace the tank. All work shall be completed in accordance with MOA standards By a Certified Installer and the following Specifications: The existing tank will be pumped and disposed of properly, in accordance with moa requirements.The new tank shall be of MOA approved construction with two 4" cleanouts and will be installed in the same location as the existing tank. The tank shall be installed level, and within the excavation created by removing the old tank. The bottom of the excavation shall be leveled and compacted sufficiently to prevent settling of the tank.The new tank shall be insulated with no less than 4' of cover, and the manufacturer's maximum burial depth shall not be exceeded.The ground surface shall be sloped to prevent ponding. The new tank shall be installed in accordance with the separation distances required by 15.65.050A. The tank will be installed: Greater than 5'from the property line, building foundation, and drain field. Greater than 10'from any water main or service line. Greater than 100'from any surface water. Greater than 100' from any private well, and greater than 200' from any public or community well. Due to the rapid need for replacement, a site plan will not be prepared prior to commencing work, however we have verified that the 1992 inspection report is still accurate, and we have verified that no separation distance requirements are not currently met. A record drawing will be prepared to document the tank replacement. Thank you for your time in reviewing this permit request. Please do not hesitate to co;;;";et 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. �� .i- !! =•PE,.....�� Re � Sincerely, 4P.81: �' Charles Balzarini, PE ' , 49�► ��♦j r rreess 9alzarin :Q: •-cp .. CE.13854 ear Permit No. 61'-11'Z0Z7f-g Page of moi" Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: 12-% L- 01/4L ,,.e( +-lG4k6 5Le:57-PTD o: e:)' 6)2-- Co+ caz co ,, '''>T2 . - rrrl -3 cf) , I • IiI ` IIr�9 II' III s III S.T. L'9So �!1 Ile e4_,.., J a) .Z g31- ►.L' t.4 - *nu rsa-_:> I____. e--4)1 i.-1-4,1-a?", 4t,./ coz VX0h 33' G G co3 l tp° — yM re pt c.,04Z o I -I-yc It r'tr t SD' '4-2`% \\ ' � o' #reol fUvimar.yE-Prt c -14cr 1 t t,?rZ ✓ \\ \ N ..,� F , -ID O gC,41�1 I ' was$ 70 Xly C Q F.t.lCl t .,0r�....0M....00 d h. /*r s9 tl rn � � co rill Goo- ,.� '49IV... I Vi; 111�. s0 RO ER SHAFER !liff- L � 0` %� No. 215 :?: 4 i�`;;` � 72.013 A(2/91)MOA 25 Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Nam~t..l~t~j.~ ~. ~~ Wastewater System: D NeW ~pgrade Address: ~ ~~ ~~. ~ r ABSORPTION FIELD Phone:~.~ ~No.o~rooms: ~eepTrench ~ Shallow Trench ~Bed ~Mound ~Other LEGAkOESCRiPTiON so,,,.~,.,: ~ '~GPO/Sq. Ft. Total Depth from original gr~d~ Township: Range: Section: Fill added above original gra~/ Ft. Gravellength: ~/ Ft. WELL: D New ~ Upgrade Gravel~ ~ /Ft. Numberoflines:~ JDistance~eenlines:[ [~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption ama: Pipe material: ~J~ Driller: Date Drilled: StaticWaterLevel: ~nstaller: ~~ Dateinstalled;~j~ Yield: ~ Pump Set at: ~ Casing Height Above Ground: SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P, To Septic Absorption Lift Holding Public/Pdvat~ Manufacturer: Capacityin gallons: From Tank Field Station Tank Sewer Lines ~ ~ Well ~1+ ~1~ ~ ~ ~ Ma~~ Numberof~pa~ments: Sudace W.ter ~'~ [~'* ~ "- ~ LIFT STATION Foundation ~ I [ ~ I ~ "Pump on" level at: ~ ~High water alarm at: Remarks: ~l~l~ ~t~ ~ BENCH MARK Location and Description: I Assumed Elevation: of Hea~nd Human Se.ices approval '~'~~~ ReviewedDepartmentand approved by: ~~ Date'. ~'/- ~ 't---~=~----~'~0FESSt~_. · 72-013 (1/91) MOA25 PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920228 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DRAEGER ELAINE H WHEELER OWNER ADDRESS:18830 TWENTY GRAND RD EAGLE RIVER, AK 99577 DATE ISSUED: 8/13/92 EXPIRATION DATE: PARCEL ID:05022322 LEGAL DESCRIPTION: EAGLE RIVER VALLEY RANCHETTES LT 23B LOT SIZE: 17955 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. 1 OF 1 8/13/93 RECEIVED BY: ISSUED BY: SPECIAL PROVISIONS: Permit No. ~---~J/-~*~-~'~ Page ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report of ~ 72-013 A (2/91) MOA 25 ROBERT SHAFER, P.E ROGER SHAFER, P.E. August 3, 1992 CIVIL ENGINEERS (907) 694~2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DES~G N SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL iNSPECTIONS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Eagle River Valley Ranchettes, Lot 23-B Request you issue a permit to upgrade the septic system serving the referenced property. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. Attached is the proposed upgrade design. This property is served by a Community water system. There are no protective well radii which encroach upon the property. As can be seen from the site plan this lot is large enough for another future upgrade. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. If you have any questions or require additional information for your review, please contact us. Sincerely, ROGER J. RJS/LSU/lsu ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~--~4, ~ ~ ~ ~ 1 2 3 4 5 6 7 8 9 10 11- 12- 13- 14- 15- 16- 17 18- 19- 20- COMMENTS DATE PERFORMED: WAS GROUND WATER ENCOUNTERED? Township, Range, Section: L IF YES, AT WHAT DEPTH? / O P E Moailoring?7 . SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ~"~ TEST RUN BETWEEN . PERCOLATION RATE ~'~'~ (minutes/inch) PERC HOLE DIAMETER "~/" FT AN~" FT ACCORDANCE WITH Eagle River, AP~ska 99577 72-008 (Rev. 4/85J ~ CERTIFY THAT THIS TEST WAS PERFORMED iN EFFECT ON THIS DATE. DATE; ~"'7~'-q~-''-'- I" =30' SCALE UPGRADE HORAGE DEPARTM--"[NT OF HEALTH & ENVIRONMENTAL PRO~'~CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE /J []NEW MAILING ADDRESS LEGAL DESCRIPTION kOCAIIO~ ~ ~- NO. OF BEDROOMS PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in ~llons ~O DISTANCE TO: ~ Foundation~ Nearest~/Oll°t line PERM~ ~ No. ofl~es Length ofeachl ne ~ Totall~th,of lines~/ Trench wi~ Distance between lines - ' ~ ~ A~'~ inches Total effective ab,orption ~ Top of tile to finish grade 2¢~' Materi~lbeneath die X/ inches area Length Width ~epth PERBIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ W~II Building foundation Nearest lot line ~ DISTANCE TO: ~ Cla~ ~ e~ep{h Driller Distence to lot line PERMIT ~ DISTANCE TO: ding foundation Sewer line Septic tank Absorption area(s} OTHER SOl L TEST RAIl N~ INSTAELER ~ : i~ ~J 72q)13 (Rev. 3/78) M~fCIPALITY OF ANCHORAGE .~ · 825 ~ Street, Anchorage, AK. ~IF9501 ~. ~ HANDWRI TT~N PERM 2ermzt ~l~qO ~ ~ ON-SITE SEWER PERMIT Location: Legal Description~ ,Type of Soil Absor~ System Is: Trench: ~/Drainfield: M~ximum Number of Bedrooms: ~L~ DEPTH Phone Number: Size: Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) /~--0 The Required Size of the Soil Absorption System Is: l_Q_ .LENGTH ~QC~ GRAVEL DEPTH ~f> WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE Per_mit applicant has the responsibility'to inform this dep~rtment during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 2 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the sysuem in accordance with codes. (3) I un,stand that the on-si~e sewer system may require enlargement if the/reSidence is ~e~odeled to include more that 3 be~ms. Signe~: A~c~nt - Issued by: //~//~ Date: ! SWPI024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street. Anchorage. Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST J~ SOILS LOG [] PERCOLATION TEST SLOPE SITE PLAN 1 14- 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date .~,~e~,~ ,. Time Water Drop ,, ~'~.. ~.. CE-~=S_ PERCOLATION RATE (minutes/inch) COMMENTS TEST RUN BETWEEN FT AND -- FT 72-008 (6/79) ATER ANCHORAGE AREA [ ' OUGH Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTE/~ NAME "~-'"'~"~/'~--':~R'~'~'"'C'/~")'~'~'~'4/MA~LING ADDRESS ,/_'~2.'~ "7~. ~"~ ~"~/~'"~. PHONE LOCATiO ,~,~'~,.~'/'/-...- ,,~/~_2~"',,~-~ ~"'~//~/' . LEGAL DESCRmTION ,~',,~' SEPTIC TANK: DISTANCE ~,'"~"/""~/'g'/~//~"'~// NUMBER Of FROM WELL ~f,/,,,~ ~.-~..~ MANUFACTURER ~;~.~MATERiAL ,~..~// 7~//~ COMPARTMENTS INSIDE LENGTH ~ INSIDE WIDTH -- ..LIQUID DEPTH ~-- .LIQUID CAPACITY /., ¢::7¢~ .GALLONS, SEEPAGE PIT: /6 x.~,'~.,,/~,'~-<,,~/5-/,r~. NUMBER OF PiTS J DIAMETER ---- OR WIDTH LENGTH DEPTH LINING MATERIAL '/~-~ CRIB SIZE: DIAMETER~4",~.[~EPTH ~' / DISTANCE FROM: WELL ,~.~,,.,~7'~-,~.., . TOTAL EFFECTIVE BUILDING FOUNDATION':~'~'~' "~ NEAREST LOT LINE L~O ~'~ ABSORPTION AREA (WALL AREA) ,-~-'~T'/'~'~ ~ SQ. FT, ADDITIONAL ABSORPTION WELL: ~__.<~/~"1/~// UA//'7-~/ TYPE CONSTRUCTION BUILDING NEAREST NEAREST FOUNDS-, LO~I'"L':%N~ ~SEWER LINE C ES/,,SP'O O L , OTHER SOURCES APPROVED DISAPPROVED REMARK5 DEPTH. DISTANCE FROM: SEPTIC SEEPAGE/// TANK~ INSTALLED PIPE MATERIAL: LOT SLOPE: REMARKS: Form pw-o2a DIAGRAM OF SYSTEM • • cc b,, •/tc.� Municipality of Anchorage °'' On-Site Water and Wastewater Program �,ia i i ; (907) 343-7904 Certificate of On-Site Systems Approval Parcel I.D. 05022322 2- 10 _2_6Expiration Date: 1. GENERAL INFORMATION Complete legal description Eagle River Valley Ranchettes Lot 23B Location (site address) 18830 Twenty Grand Current Property owner(s) Dan Abts Day phone 727-8958 Mailing address Real Estate Agent Day phone ��67 8 9 707 2. TYPE OF DWELLING: ti lb,,,. „ ;:, , ,. �,-.3 ❑ Single Family (w/wo ADU) Di Duplex a MAIL 0 t Cul, 3 ❑ Multiple Dwellings (Single Family and/or Duplex) 1-4- ti 3. NUMBER OF BEDROOMS: 3 !`0l 6 8 L 9 �'� 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank 0 Community Class Well ❑ Community 0 Public Water System 0 Public Sewer ❑ WaiverNariance request for: none Distance: Received by/ Date: //e/16 COSA to be r eas o the engineer,unless otherwise requested by the engineer. COSA Fee $ glAOg• 10 Waiver Fee $ Date of Payment 3 1111/0 t g Date of Payment . Receipt Number O✓(1)L/ P Receipt Number COSA# O SC W(O S 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 Charles Balzarini Phone 907-854-5558 Address 30840 Prudhoe Bay Ave Engineer's Printed Name Charles Balzarini Date 02/18/18 * 49T .OF A/ All . ' *Gl 6. DSD SIGNATURE • • '�• 1C System #1 Approved for 3 bedroomsfit FA j HARLES G BALZARIN% . System #2 Approved for bedrooms f F 138 Disapproved 4 �, $klF9. //fit•• •; pR0 .ESSIO��-,� Conditional approval for bedrooms, with the following s;1p?kr -�,0.- - • -sd -SITE o WATERm AND WASoN TEWATh PROGRAM �; sER\A By: Original Certificate Date: `( 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_f - c If more than 1 septic system is on the lot: COSA Checklist# 1 of1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: EAGLE RIVER VALLEY RANCHETTES LT 23B Parcel ID: 05022322 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 1/26/18 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) NO Date of pumping N/A - NEW Pumper N/A C. ABSORPTION FIELD DATA Date installed 8/22/92 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.45 System type TRENCH Length 96 ft. Width 3 ft. Gravel below pipe 5.5 ft. Total depth 10 ft. Eff. absorption area 1056 ft2 Monitoring tube Y Depression over field N Date of adequacy test 2/10/18 Results (Pass/Fail)PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Waler added 600 gal. New depth 6 in. Elapsed Time: 1440 min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date N/A 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: Building foundation +5' Property line +5' Absorption field +5' Water main +10' Water service line +10' Surface water +100' Wells on adjacent lots+100' 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 +10' Curtain drain +50' Wells on adjacent lots +100' F. COMMENTS SYSTEM COULD BE CONVERTED TO 4+ BEDROOMS WITH FLOW SPLITTER. OLD SYSTEMS APPEAR TO BE IN GOOD CONDITION. G. ENGINEER'SEER'S CERTIFIC _Any •• • • i R� Ili I certify that I have determined through field inspections and ,,,,Ne *<,:frs;#0001 review of Municipal records that the above systems are in ••conformance with MOA COSH uidelines in effect on this date. • ' . • 001 Engineer's Printed Name CHARLES BALZARINI 01, • ;j.` • • • •VOI Date02/18/18 " . - " • • • 4 CHARLES G BALZARINI ," 4� CE-13854_ q ,� * a • FD''ROFESSIO V" COSA canary sheet_2-6-15.doc � � ` � Parcel I.D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Property owner Mailing address Location (site address or directions) ~~ ~c~ ~ Day phone Lending agency Day phone .Mailing address Agent Address ill Unless otherwise requested, HAA will be held for pickup. Day phone NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water X~ X~ MUNICIPALITY O~ ANC. HORAGE ENVIRONMENTAL SERVICES DIVISION AUG 2 6 1996 RECEIVED NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system.. 4. 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. 72q325 {Rev. 1/91) Front MOA#21 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 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 ~'~J 0G~..(0~J F___-~/_.,,~/J ~'-ETL/~,/C- Phone Address PI~ ~'Ox, ~-,-~0 77,.~ ~d/,4 c.~d.~ 6 (.~' ~rt~._. Engineers signature ~~ ~ ~ Date w DHHS SIGNATURE ~ Approved for I, [t~,-..~.~.-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 D I: F' DEPARTMENT OF HEALTH & HUMAN SERVII3,1t~ E I V E D Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 3~,3J~74~(~ 1996 Legal Description: ~;'/' ~3~i Well .~ype A Health Authority Approval Checklist · ~"-,4gd/c" ~.l,v'~'/2_ Parcel I.D.: Municipality of Anchorage Dept. Health & Human Services 05'0 Z7_.~ ZZ_ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Total depth Cased to Casing height (above ground) Sanitau seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria g.p.m. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Iqbq Foundation cleanout (Y/N) Date of Pumping Tank size /, ~.~O Number of Comparanents ~.. Cleanouts (Y/N)___ Depression (Y/N) /~'/ High water alarm (Yfi'ff) /~ Pumper ~ ~$ Y C. ABSORPTION F1ELD DATA Date installed Z~- Soil rating (g.p.d./fl2 or fi2/bdrm) o 5t~''' System type ~-'~i Length ~,~ t '~-'"'"~ ,~ Gravel thickness below pipe ~. Width ~ ,'~ Total depth _ Effective absorption area /, OS'~ r-"Et~Vlonitoring Tube present(Y/N) y' Depression over field (Y/N) Date ofadequacy test ~/zg/q~ Results(Pass/Fail) ~$.~ For ,.~ bedrooms Fluid depth in absorption field before test (in.);t~ .~ ~'l '~ Immediately after .~.~OOgal. water added (in.): lq Fluid depth ! ~'/ (ins.) Minutes later: ~q~ Absorption rate = ~> ~'O g.p.d. Peroxide treatment (past 12 months) (Y/N) /xJ If yes, give date D. LIFt STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot 0,4 /.or' · Size in gallons "Pump on" level at* *Datum ; On adjacent lols .; On adjacent lots "Pump off' level at* Public sewer main Sewer/septic service line Public sewer manhole/cleanout Lffi station SEPARATION DISTANCES FROM SEPTIC/I-IOLDING TANK ON LOT TO: Building fom~dation :~ I Property line ~:~Z,-t Absorption field Water main/service line '>'/0 Surface water/drainage > It70 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation / ~ t Water main/serdce line >i0 / Surface water >100 t Driveway, parking/vehicle stumge area Curtalndrain /x~O~,/O'" 0,,,4 ~o'r" Wells on adjacent lots ~ZOOt F. ENGINEER'S CERTIFICATION Engineer's Name fill Date Property line Z~ t HAA Fee $ ~. ~ DateofPayment P/~,~'~ ~:~ Receipt Number ~ Rev. 8/95 OSS: haa.wk.doc Date of Payment Receipt Number August 26, 1996 Municipality of Anchorage Department of Health and Human Services Onsite Services Section P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 23B, Eagle River Ranchettes Subdivision Certificate of Health Authority Approval Dear On Site Services Engineer: On August 22, 1996, I inspected the septic system on Lot 23B, Eagle River Ranchettes Subdivision. The septic tank was installed in 1989 and the deep absorption trenches in August of 1992. The as-built for the trenches indicates parallel trenches 39' and 57' in length. The design of the trenches, however, has made the second trench an overflow trench as it is completely dry. The first trench has a total of 51" of water and has been absorbing all the water generated in the house over the past four years. During the adequacy test 250 gallons of water was placed in each trench. Trench No. 1 inceased in volume from 51" to 60". Trench Ne. 2 went from 0" to 19". After 14 hours both trenches had reverted back to their original states. The trenches, therefore, are capable of absorbing more than the required 450 gallons of water per day. Sincerely, Michael E. Anderson, P.E. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of E~vironmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 23-B; Eagle River Valley Ranchettes Subdivision Location (site address or directions) 18830 Twenty Grande Eaqle River, Alaska Property owner Mailing address Elaine Wheeler Day phone 653-7787 hm 552-2970 wk Lending agency Mailing address. Day phone Agent Carole Bennett/FORTUNE PROPERTIES Day phone Address 3000 A Street, Anchorage, Alaska 99503 562-7653 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site xxx 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. 72-025 (Rev 1/gl) Front MOA#21 '~Jo~ S,JGeU!bUD leUO!SSejoJd aH), u! suo!ss!wo Jo sJoJJa ~o,~ eiq!suodsaJ ~,ou s! @beJoqou¥ ,~o X~!led!o!unl~ aq.L 'p@nss! s! a~E,o!,t!~Jao 13 aJo~q e~ep ~ZXleUe Jo suop, oDdsu! lonpuoo ~ou op SHHQ ~o s@a/~oldW~ 'siuewaj!nb~J ~le~s pug leJ@pgj u!e~Jao/~sj),es o~ Jap JO u! suo!~n~!~su! bu!pu~l J!~ql pue s@woq Jo sJsseqoJnd o~,~sD~J nod ~ se s!q~ s@op SHHO eq.L 'eHSel¥ ~o e~e~S eq~ u! paJe~,s!baJ Jaeu!bu8 i~uo!sse~oJd ~uapuedapu! ue /,q a^oqe § qdeJ§B~ed u! ua^!8 suoRelueseJd@J eql uodn ~luo paseq se),eoWl~@C) le^oJddv A~poqin~, qlleeH senss! (SHHQ) seoi/deS UBLUnH pub q~,leeH ~o lueuJtJede(] eSeJoqou¥ ~o ,~!led!o!unlAI eq/ s~uewwoo leUO!~!ppv :suoi~elnd!~,s DU!MOlIOJ eq~ q:~!M 'swooJpeq 'swooJpeq euoqd ~)?. 'Oh] peo~l doo'l Je^RJ ~15e3 P~O£ [ JOJ le^oJdde leuol~!puoo 'pe^oJddes!o S JO~ pe^oJddv ~ :IEtrI/~'N~)I$ SHHa eJn~eu6!s s,Jeeu!bu3 sseJppv wJ!-I ~o eweN · uo!~oedsu! s!q~, ¢o elep eq~ uo ~oege u! suo!~elnSeJ pue 'seoueu!pJo 'sepoo e~elS pue led!o!uniA1 lie qIF~ @oUeildWOo u! s! Lue~s,~s lesods!p ~e~et~e~se/~ ~o/pue ,~lddns ~ele~ el!s-uo aql 'uo!loedsu! puc uo!le§!lse^u! XLU LUO~¢ pue sew eSeJoqouv woJ¢ peu!elqo uo!leLuJoju! eql uo peseq ~eq~ Xj!Ja^ Jeq~Jnj I 'u!eJeq pe~eo!pu! eJn~on~s jo ed/~ puc suJooJpeq Jo JequJnu eql ~o,t e~enbepe pue leUOR, ounj 'ejes s! LUe~S,~S lesods!p ~e~e~Ae~se/~ Jo/pue Xlddns ~ele/~ el!s-uo @ql leql s~oqs uo!~eo!ldde le^o~ddv/~lMoq~nv qlleeH ,~w ~Bq:~/~JiJe^ I 'MOleq UMOqS e~ep UO!:~ep!leA eq~ Jo se pue o:~eJeq p@x!~ I~eS ,~w ~q pe!,t!~eo "9 EF:I=INION=I All NOI.LO=IdSNI .,-I0 J.N=IIN=IJ.V.I.S '~ Municipality of Anchorage Department of Health & Human Services Legal Description: "~_~---H~ ~---~LX~-[~, A. WELL DATA Well typ~ll-lLxt, J F~LIf A' B, or C, attach ADEC letter. Log present (Y/N) Date completed HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. C~--~'~:~ ~'~ ADEC water system number Driller Total depth __Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ¢~''~ Absorption field on lot g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Dateinstailed Ic~z:~ Tanksize 1'~4~) ~I~L--~ Compartments Cleanoutsl~lN) y Fou ndation cleanout (Y~') ~Depression / ¢:~.~(~ High water alarm (Y{~ ~,/-~,, Alarm tested (Y/N) ~ Date of pumping ~1' J l"~ I~'~-- Pumper ---~,'~. '~---~ '"~'~ r"~ :~:::>~l't'~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot h'~/,~:~' On adjacent lots ~ ''''lc' Foundation To property line ~--~'2-'/ Absorption field Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA eloctrica~_ SEPARATION DI.~T'ANCE FROM LIFT STATION TO: Well on Io.~,.~ On adjacent lots "Pump on" leve. gJ.af ' "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Gravel thickness ~,~ Cleanouts present~) Date of adequacy test for ~ Date installed Length ~[,,I Width ~:~'~ Total absorption area ~z~/~o Depression over field (Y~) Results (pass/fail) ~,[~,l/.-J '~--~"./~'T~ Peroxide treatment (past 12 months) (Y{~ Soil rating ~,~ /-~1::~:)/'~'~'- System type -'[~7~'~:~ ~'~ Total depth bedrooms If yes. give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot t,J/./%. On adjacent lots ~L.~- Property line To building foundation [ ~..~/ To existing or abandoned system on lot On adjacent lots ;:~"~- Cutbank I',J~i,J~_~ ' q~Vater main/service line Surface water I z~I'-f'- Driveway, parking/vehicle storage area Curtain drain ~:)/~'~-~ ~-hJ~)t, tJ ~ . E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ & S ENGINEERING i 703'4 Eagle River Loop Road No, 204 Signature Engineer's Name ~ Date ~ ~ Date of Payment ~' - ~ 5-- ? ~-~ Receipt Number 72-(Y26 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD,, SUITE 3-470 ANCHORAGE, AK 99503 WALTER J. HICKEL, GOVERNOR June 26, 1992 FOR: S & S Engineering PWSID # 210875 My review of the records on file in this office reveals that the Norfolk Utilities Class "A" Public Water System is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200. Sincerely, Rachel Clark College Intern RC/cf MUNICIPALITY OF ANCHORAGE k...~ ~~ DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner ~f , L.), ~'~. Telephone: Home Business Mailing Address (c) Lending Institution" ,/~Z..~. ~'I~F-~I r'~ ~ Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the foliowino address: or: Check here::~-, if hold for pick up. List contact person and day phone number below. S & S ENGINEEI~ING 17034 Eagle Ricer Lo,~p Roa~l No. 21~ Eagle ~.iver, Aiasi(a 995~/ TYPE OF RESIDENCE Single-Family'~~-- Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public/~ Note: If community wetl system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, SEWAGE DISPOSAL Onsite/'~ Public [] Community [] Holding Tank [] Note: If community well system, must have written coqfirmation from the State Department of Env ton mental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/861 Fronl ~ ~o 8 eOed NOI.Ln¥O leAoJddv leUO!].!puoO lo pa^oJddes!Q 'xX// peAoJddv muo!i!puoo '9 euoqdale2 uo ~oe,ye u! 9uo!lelnlSeJ pue '980LIeU!p JO 'sepo0 e~),S pue jedio!untAI lie q]!M e3ue!ldLUoo u! 9! uJe19~9 lesode!p JeleMe1$eM ]o/pue ,~lddns JeleM el!s-uo eql 'uo!loedsu! pue uo!]eB!lee^u! ,~LU LUOJ~ pue Selg eBeJoqou¥ lo /,l!led!munl~ eql LUOJI peule~qo UO!IeLUJOIU! eql uo peseq leq~ ,~Jpe^ JeqIJnl I 'u!eJeq peleo!pu! eJnlon~s lo ed/,1 pue eLUOOJpeq jo Jeqtunu eql Jot e]enbepe pue leuo!Iount 'ale9 9! uJe~$/~9 lesods!p Je]eMe~seM Jo/pue Xlddns JeleM el!9-uo eq~ ~eqlsMoqs le^oJddv,~lpoqlnv qlleeH S!ql jo UO!~I-~O!],SeAU! ~LU ~eq],/,t!JeA I 'MOleq UMOqS mep uo!~ep!le^ eql Io se pue o~eJ@q pe×!lle lee9/,LU ,~q pey!]Jeo sv NOI/VlNt:IOdNI ONV VJ.VO 'HOt:IV=IS :a'll.:l 'SJ.S=IJ. 'SNOIJ. D=IdSNI ~)NIQIAOMd INt:lld 9NIbI=I=INION3 .g MuNiCiPALiTY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVI,~(~.J'II¢iClPALiTY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) APR ]- 8 1988 CHECKLIST-FEBRUARY 1984 264-4744 RECEIVED Legal Description: WELL DATA A Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by If A, B, C, D.E.C. Approved) Date Completed Yield Cased to ~ ~ / Depth of Grouting ~ "'J /A Pump Set At /, - Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) "~:2(~ I~¢ ; On Adjoining Lots ~_..~2c~ I./c ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Water Sample Test Results SEPTIC/HOLDING TANK DATA Date Installedt~.~...,~ ~ q Size ~.~'~r~ ~,~.~ No. of Compartments Standpipes~N) y Air-tight Caps ~/N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) r~/~:~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Foundation Cleanout CC?N) ";/' Date Last Pumped , for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field Course To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026 (Rev 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Type of System Design Length of Field Depth of Field Gravel Bed Thickness '"~6¢~2~ Standpipes Present4C;~N) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~---¢---~ ~ lJ~ ~ ~'~ LC;r'-~¢"~, ~~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) r-'%/,~' Dat~ Dimensions Sizein Gallons % Manhole/Access (Y/N) "Pump On" Level at ~ __ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for Electrical Codes (Y/N) Comments Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HA.A guidelines in effect on the date of this inspection. Signed .c .. ~,m~GINEERING Date Receipt NO. ~ ~ 2~ Date of Payment Amount: $ Page 2 of 2