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Home My WebLink AboutEAGLE RIVER VALLEY RANCHETTES LT 10DOnsite File Eagle River Valley Ranchettes Lot 10D #050-222-01 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201052 PID Number: 050-222-01 Dwelling: ■❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name Estate of Hubert M. Lewis ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 10514 Crestview Ln. Eagle River, AK 99577. ❑ Other Phoneof Bedrooms Soil Rating Total depth from original grade 907-830-3227Number 8 3 Existing GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Eagle River Valley Ranchettes 10D Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well N/A N/A N/A N/A >25 TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1,000 Gal. Surface Water >100' N/A N/A N/A Material Number of compartments Lot Line >5' N/A N/A N/A NA Plastic 2 Foundation >10' N/A N/A N/A LIFT STATION Manufacturer Capacity Remarks Tank is insulated. Gal. Tank only placed under this permit. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Northern Excavation Drainfield Existing CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection 15' 4/7/20 Location and description 3" 4`h Threshold of garage man door. ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF Conditional Approval: DateAN N 49 th - . }M.i�.. 19 .......................J. ............`. .� . �� •MICHAEL E. ANDERSON �' ® �J, No. CE-4381 Ze Septic System Approved Datemob'F,p°••.,,,4/8/2020...••''��'� ®a �® ®t)c`R®®®S�S\t d®s® Note: this approval does not include well permit requirements. kf uv uu/uel IO1 EAGLE RIVER VALLEY RANCHETTES, LOT 1 OD PERMIT # OSP201052 I I I LOT 10-A I LOT 10-B LOT 10-C LOCATION OF KEY BOX PER AWWU RECORD. EXISTING SEPTIC TANK FILLED w/ NATIVE MATERIAL & ABANDONED IN PLACE. NEW PLASTIC 1000 GALLON SEPTIC TANK w/ 20" MANWAY. EXISTING SEEPAGE PIT TO REMAIN IN SERVICE. -------------- E-T-' GINEERGE 10' UTILITY EASEMENT LOT 10-D —1 tion A FB GARAGE MAN O WAR ROAD PLAN AS -BUILT PID # 050-222-01 I B I m SV 22.7 22.3 2C0 1 25.0 cn m o Ic: z m ID N mz Im m z I 0 50 100 FEET 1"=50' A B MH 19.0 18.9 SV 22.7 22.3 2C0 1 25.0 1 24.6 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE EAGLE RIVER VALLEY RANCHETTES. LOT 10D PERMIT # OSP201052 PID # 050-222-01 PROFILE AS -BUILT (NO SCALE) 2" INSULATION LOT 10-B S 89059'15" E 133.00' EOF- ED' EOE, EOH- - E❑ EOI_vl� -� GUYANCHOR OVERHEAD UTILITY WIRE 10' UTILITY EASEMENT UTILITY UTILITY POLE PEDESTAL W �? GRAVEL DRIVEWAY I F -A LOT 10-C p C31 0 0 W 0 LOT 10-D 17,955 sq. ft. ASPHALT DRIVEWAY CANTILEVER 28.0' N 2 -STORY w °D FRAME O HOUSE CONCRETE 27.5' 21.5' �S) N SEPTIC fJ CLEANOUT v 0 22.0' I�I l=4 SEPTIC STANDPIPES I;I aD GRAVEL DRIVEWAY N 89059'15" W 133.00' – – — MAN O WAR ROAD NOTE DRIVEWAY LOCATION IS APPROXIMATE DUE TO 0 15' 30' SNOW AND ICE COVER. I Cn O 0 IC 0 m - ID m m _ m W z fill O 0 34.9' I W 0 50' 50' I n m U) m D Z m 'NN\\\\N\tttt *: 4 9 LH ... ., . ..... i '• Buku Saliz o r LS -14837 4? R4 ��tltttFES IOV AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE LOT 10-D, EAGLE RIVER VALLEY RANCHETTES RECORDED SUBDIVISION PLAT (63-129A) ARE NOT SHOWN HEREON. SUBDIVISION THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT AND IS SUBJECT TO ANY INACCURACIES THAT SUBSEQUENT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE BOUNDARY SURVEY MAY DISCLOSE. WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR DATED THIS 8th DAY OF APRIL, 2020, ATANCHORAGE, FOR ESTABLISHING PROPERTY BOUNDARIES. ALASKA FIXED HEIGHT, LLC NO CORNERS SET THIS DATE SCALE V'= 30' Land Surveying Services 907.290.8949 WWW.FIXEDHEIGHTCOM JOB # 20035 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201052 Work Type: SepticTank Upgrade Effective Date Expiration Date: Tax Code Number: 05022201000 Site Legal Address: EAGLE RIVER VALLEY RANCHETTES LT 10D G:0054 Site Mailing Address: 10514 CREST VIEW LN, Eagle River Owner: LEWIS HUBERT M Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy C ol� y f ■. v Department 4/2/2020 4/2/2021 Lot Size in Sq Ft: 17955 Total Bedrooms: 3 ❑ Private Well ❑ 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 Received By: �p Issued By: Liu Date: L` Date: EPLjWS MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERM/ELL PERMIT APPLICATION Parcel I.D. 050-222-01 Property owner(s) Estate of Hubert M. Lewis Day phone Mailinq address 10514 Crestview Lane, Eagle River, AK 99577 Site address Same Legal description (Sub'd., Block & Lot) Eagle River Valley Ranchettes Lot 1 OD 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 ❑ Initial ❑ Single Family (SF) x❑ (w/wo ADU) Septic Tank 19Upgrade RXDuplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ 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: aaE Date of Payment: q11 016126 Receipt Number: Qfs2up Permit No. DJC P QA1 Q a Permit App_.;-:•,�. c Waiver Fees: Date of Payment: Receipt Number: Waiver No. PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) April 1, 2020 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Eagle River Valley Ranchettes Lot 10D – 10514 Crestview Lane Septic System Design Dear On-Site Services Engineer: The owner of the above lot intends to sell his 3-bedroom home and the existing septic tank has failed. We are submitting this design and permit application for the installation of a new septic tank. The attached site plan identifies the location of the home and the proposed septic tank location. No conflicts exist between this proposed system and any other septic system on this lot or adjacent lots. This lot and all adjacent lots are served by a public water system. There are no wells that pose any conflict with the new septic tank location. The new tank will be a minimum of 10’ from all segmentsof the foundation and more than 5’ away from the existing seepage pit. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE 4/1/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201052, Rebecca Carroll, 04/02/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201052, Rebecca Carroll, 04/02/20 LOT 10-B S 89059'15" E 133.00' Eli Ell EDS, EO n ED ED—L H'�] � -.1 GUYANCHOR OVERHEAD UTILITY WIRE 10' UTILITY EASEMENT UTILITY UTILITY POLE PEDESTAL I W �? GRAVEL [DRIVEWAY I Z CANTILEVER RECORDED SUBDIVISION PLAT (63-129A) ARE NOT SHOWN HEREON. SUBDIVISION THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT O 28.0' BOUNDARY SURVEY MAY DISCLOSE. o 2 -STORY w ENCROACHMENTS EXIST EXCEPTAS INDICATED. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON N cOFRAMEo BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR LOT 10-C Q fHOUSE l CONCRETE 27..5'' 21.5' 3 I.1 N W � N Cn v O O O 22.0' SEPTIC STANDPIPES LOT 10-D 17,955 sq. ft. - GRAVEL DRIVEWAY ASPHALT DRIVEWAY N 89059'15" W 133.00' W 0 - - — MAN O WAR ROAD NOTE DRIVEWAY LOCATION IS APPROXIMATE DUE TO 0 15' 30' SNOW AND ICE COVER. I Cn O 0 IC 0 I� O m - ID m m _ Im w Z Cn Q O 34.9' I I W 0 50' 50' I n m U) m D Z m I AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE LOT 10-D, EAGLE RIVER VALLEY RANCHETTES RECORDED SUBDIVISION PLAT (63-129A) ARE NOT SHOWN HEREON. SUBDIVISION THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT AND IS SUBJECT TO ANY INACCURACIES THAT SUBSEQUENT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE BOUNDARY SURVEY MAY DISCLOSE. WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR DATED THIS 16th DAY OF MARCH, 2020, ATANCHORAGE, FOR ESTABLISHING PROPERTY BOUNDARIES. ALASKA FIXED HEIGHT, LLC NO CORNERS SET THIS DATE SCALE 1" = 30' Land Surveying Services 907.290.8949 WWW. FIXEDHEIGHT COM JOB # 20035 GI~,~TER ANCHORAGE AREA BORO~-LG,," HEALTH DEPARTMENT ~ 327 E~,GLE ST. ANCHORAGE, ALASKA 99501 279~2S1! INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ~)~'~)- 2-~-~.- 0 I LOCATION J~/./)2./)' SEPTIC TANK: MAILING ~"~/'~'~--'~ ~d"'~-~'X-'~ ~"~-~ PHONE~,,~'.-.~ ADD,E55 LEGAL DESCRIPTION .~~~ DISTANCE FROM WELL~)~,~'~. MATERIAl ~.~-~/'~.~'~'~'~'~" NUMBER OF COMPARTMENTS LIQUID CAPACITY /~ ~ GALLONS. INSIDE LENGTH INSIDE WIDTH / LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF FIlS / OUTSIDE DIAMETER LINING MATERIAl ~--~:~/l~/~ _.~-----~T~-~ NEAREST LOT LINE -~ ~ / ~/' JOTAL EFFECTIVE ABSORPJlON AREA ~ALL AREA) / / / OR W,DT./'~72 .. LENGT.--Z 3~..DEPT. DISTANCE FROM WELL ~'.~.,,,'"~,,'"~, , BUILDING FOUNDATION SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL "/7 . FOUNDATION ~ LOT LINE TOTAL LENGTH IN. TOTAL EFFECTIVE NUMBER OF ~ ABSO~ AREA SQ. FT. LENGTH OF EACH LINE IN. ABOVE TILE WATER ~..,~" SAMPLE DEPTH OF FILTER MATERIAL BENEATH TILE DEPTH: TOP OF TILE TO FINISH GRADE WELL: ~ ~""~""/~'/'~'""J~"~ DISTANCE FROM TYPE C~'~Z~,~- . DEPTH ~ , BUILDING FOUNDATION. Ov~' .. NEAREST ~/~/ NEAREST SEPTIC ~ SEEPAGE ~ OTHER LOT LINE SEWER LINE TANK . SYSTEM . CESSPOOL SOURCES DIAGRAM OF SYSTEM DISTANCES: ~ t ' ': .... ~"~"~'~: ...... ~x/~/ , -, .: :-_'__.'_.:' ~ ," ' ' ~ -":!" ' F~'~-::-' ' '":{'"' - ' ....... 7'i .........· , ---:' ' ~',-/-? i----~--- ..... ! ..... l' :' ': .: , t . -.,~ ...... ::. ...... .. -:: ~. ;~ :.~',:~': . ' ........... ~ ............. : ......... --:-~----------4-,~. ~r'~. ~ ,._.~(~,_~'.-'~ ~" ' ............. ; - . ;, I ~, t*) ~ -,' /, /, '--~ ..... ~ .............. : ' ~- .... 2 ~'~///, .: ..... .......... ~ ..... " '4 - '~1 · . ' .......... I.:::::.: :' .,eT'~ ':."::: : 4 DAT~ APPROVED__ GREATEI ANCHORAGE AREA ROUGH HEALTH D~AR~iENT 327 ~le St. Anchor~e, Ah~ ~501 279-25H SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT ~I~/Z5 ~C~ MAILING ADD"ESS PHONE N0~ APPLICATION TO INSTALL: SE'ICTANK /~SEEPAG~ PIT ~.DRAIN FIELD ~"E~ TO SERVE THE FOLLOWING FACILITY - ~ ~~.~ ~.. ~ ~ PERCO~TIDN TEST RESULTS ~ ANTICIPATED DATE OF COMPLETION ~ -- ~OWTO BE FILLED OUT BY HEALTH DEPARTMENT ' THIS IS TO SERVE AS ~~ ~ .PERMIT TO INSTALLA ~ .... ~~..~ ' ~ ~E'ICTANKSIZE-/PPg~Z'YPE~.'~'~SEEPAGE AREA ~¢- T;PE DIAGRAM OF SYSTEM DISTANCES: Health Authority I certify that l am familiar with thc requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE APPLICANTS SIGNATURE. ~GREAT£R ANCHORAGE AREA DOROU~H~ IIEALTH DEPA~T[!ENT 327 EAGLE STREET ANCHORAGE, ALASKA' 99501 Legal Description: Lot Thzs Form Re~orts a: Sozls Log Depth Feet $ . CAS£ # II/ Was Ground Water Encountered? If Yes, At What Depth Reading Date Gross Time Net Time Location Sketch Depth To H20 Net Drop Proposed In~tal~$eepage Pit L-"' Drain Field Depth Of Inlet ' ' D · ' - ~0..~T~: , . f~~ ,~. ~o ~otto:.of ? or ~.~ //, Test Performed 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. 050-222-01 1. GENERAL INFORMATION Expiration Date: Do- Complete o Complete legal description Eagle River Valley Ranchettes Lot 1 OD 11 Location (site address) 10514 Crest View Lane Eagle River, AK Current property owner(s) Estate of Hubert Lewis Day phone Mailing address Real estate agent 10514 Crestview Lane, Eagle River, AK 99577 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑■ Water Storage ❑ Holding Tank ❑ Community Well Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: _ _ Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ Waiver Fee $ Date of Payment `t lq j.2�o Date of Payment Receipt NumberQ $21 / 4) Receipt Number /��} COSA # ( 5c, V d 11 L(q Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below,, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based onthe information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Civil Engineering Phone 907-522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 4/9/2020 .•�. ........OF " �OF.....Ar a��• 49th ',his 6. DSD SIGNATURE a""''"'""' �nm�nmwam�.mmn...... � System #1 Approved for bedrooms 0 rr MIDHAEL E. ANDERSONQCC,. d#� No. CE -4381 `' ZAV System #2 Approved for bedrooms �� 419i2020 ,.�'�'`+' Disapproved ♦# 1�e *ies$a soe�e Conditional approval for bedrooms, with the following stipulations: ------------- WATER AND =. WASTEv��ATER o X' ' By:"6�_46Original Certificate Date: q9�oO 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 i Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Eagle River Valley Ranchettes, Lot 1 OD If more than 1 septic system on lot: COSA Checklist # of 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 Parcel ID: 050-222-01 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ 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 Static water level at beginning of test ft. Comments Property is served by a water system. #MLDk ` vw* I C- B. TANK DATA Age of tank(s) <1 years Tank type/material Septic/Plastic Measured operating fluid level in septic tank New ❑ Standpipes/foundation cleanout per record drawing Date of pumping New tank placed - 4/7/2020 D. ABSORPTION FIELD DATA Seepage Pit Which system tested (date installed) 6/11/1970 ❑ ALL standpipes present per record drawing Total measured depth from grade 12.4 ft (max) Measured depth to pipe invert from grade *NSA ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 2/24/20 Results [DPass For 3 bedrooms Fluid depth prior to test 0 in Water added 1174 gal New depth 0 in Elapsed time 30 min ORCode-requiredsoil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate >450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: *Pit has 6' effective depth per MOA files. Invert cannot be measured. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑✓ Yes Septic Tank/Lift Station on Lot > 100' ft N/ACommunity Sewer Manhole/Cleanout > 100' N/A r7 Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No N/A ft Private Sewer/Septic Line > 25' ❑ Yes if No N/A ft Absorption Field on Lot > 100' ❑ Yes if No N/A ft Holding Tank > 100' ❑ Yes if No N/A ft Neighboring Absorption Fields > 100' if No N/A Animal Containment > 50' F-1Yes if No N/A ft F-1Yes if No ft Community Sewer Main > 75' ❑Yes if No N/A ft Manure/Animal Excreta Storage > 100' r]Yes if No N/A 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 ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200' ✓❑ Yes if No ft 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' 0 Yes if No 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' 0 Yes if No ft Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l 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 F _meg 49th ia.u.n aa.n s .uaae eats s.sauua� uaae.naeerenansuusaaea.naema..uun. � o MICHAEL E. ANDERSON d w g :f No. CE -4381 a M 4/9/2020 , *•°° �� s 0Fp °a°.......... Oot��ffiac� 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~-~O -3-3.~.-~ I HAA# *-~ t~.-~---- ,-,(~ i 1. GENERAL INFORMATION Complete legal description Lot 10D; Eagle River Valley Eanchettes Locationt(site address or directions) ]]517 Old Glenn HWy, Eagle River, AK · Property owner'. 'Lee & C. ail Raymond Mailing address-.: 11517 Old Glenn 'Lending agency ~Mailing. address ....; Day phone 694-6364 Eagle River, AK 99577 Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3 'v NOTE: Individual well Community well XXX Public water If community well system, provide Written confirmation from State ADEC attest- ing to the legali? 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. 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 Auth6dty 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 flies 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 ENGINEERING River, Alaska 995~ Phone Date DHHS SIGNATURE · ~/ Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Auth(~rity Approval Certificates based only upon the representations given in paragraph 5 above by an Independent professional engineer registered In the State of Alaska.Th~ 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. IV~JNI~IPAU'I'Y OF ~I~AGE Municipality of Anchorage DEPAR~ENT OF HEAL~ & HUMAN SE~ICES JUL 15 1997 E~mnmen~l Se~i~s Division L st, t, · V E D Health Authority Approval Checklist LegalDascription: ~ IO_~ ~ ~Au~F_.~ ~d~4~/F.%ParcalI.D.: O.~O-~-O ( A. WELL DATA Well type j~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production ' WATER SAMPLE RE/~: I~ple: If A, B, or C, attach ADEC letter. ADEC water system number ~"1 Date completed ~' Cased to Casing~ ground) Wiras,~;i~q~erly protected (Y/N) FROM WELL LOG ~ AT INSPECTION g.p.m. Nitrate Olher bacteria Collected by: B. SEPTIC/HOLDIN..~T~NK DATA Date installed~ "~' - - '"Tank size ~ Number of Compa."lmenta . Foundation cleanout (Y~ I~ Depression (Y~) C. ABSORI~ION FIEU~ DATA '~....; Datainst~lled' ..__,- , - S..?llrating (g.p.dJfForfff/bdrm)~.~-Systemtype Length ;~/.Z/ Width' ]'.4-~/=, / Oravel thickness below pipe /~/ Totaldepth ~' / Effecttve abso=tion area 45~' Monitoring Tube prasent (~IN) ?~,~ Depmsalon ov~, flald (y(~ .,~_~ Data of adequacy test Results I) ~ For .-~. ~,C~. bedrooms Fluid depth in a/osorption field before test (in.);, ~// Immediately efter?,a:~l~d, water added (in.): Fluid depth ~) (in~) Minutes letar: ~O Absorption rate = ~- .~_~ O.p.d. Peroxide treatment ~ 12 mon~) (Y/N) ~ Ifps, gh~ dato D. LIFT ST~ Date installed / ~ Size in gallons Manhole/Access (Y/N) ~ ~t' _ ~ *Pump off' level at* High water alarm level at* _ *Datum ~ Cycles tested. ~ ~ E. SEPARATION DISTANCES ~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~j::7~/ Jr On ~_d?_c~nt lots Absorption field on lot ,.~") '~ __ On adjacent lots Pu~ Public sewer rnsnhole/cleanout S'-ewer/septic service line Uff station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ;:~ P.roperty,line I (~/+ Absorption field Water main/service line IO/ + Surface water/drainsge ! _/~O/ + Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line !/~/Jr Building foundation ~ · '&: Water matn/sewice line Sudace water ./~)C)/ '~ Driveway, paddng/vehicle storage ama Curtain drain Wells on adjacent lots :_.. R ENGINEER'S CERTIFICATION ~" · -, I certify that I have determined thru field inspections and review of Municipal ~ystems are in conformance with MOA .HAA guidelines in effect on this date. ,~r~ Da,. -,,,. 7 ,.~.. .. ',IL ~'~ ': :-$'~ Waiver Fee $ Date of Payment Receipt Number MUNICllSALiTY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10P Location (address or directions) 10514 C~ VZ~ Lan~ (b) Property owner ALASKA USA FED.C. REDZT UN]'(~l~lephone: (home) Mailing Address ".- " Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address P.O. 8ox 196613 Telephone USA F.C.U. Attn; Jim Leura Anchorage. A~a~ka 99519-6615 (e) Mail the HAA to the following address: (or check here,~, if hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road No. 204 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms .~ 3. WATER SUPPLY Individual Well CI Community r~c Public r-I Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site,EX Public [] Community [] Holding Tank 1'1 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 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 Telephone S & $ ENGINEERING Address 17034 Ea~le River L~p Road No, 2~ Date 6. DHHS APPROVAL Approved ,or'~..~oedrooms by Approved .~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. ~l'he Municipality Of Anchorage is not responsible for errors or omissions in the professional engine.er's work. ~s (...,. ?m)e.,,, Pa g e 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) ~ , Health Authority Approval (HAA) -. CHECKLIST ;-FEBRUARY lg84 343-4744 Legal Description: - Z..o"~' / O lE, ql Well Classification I~1 ~ "' Well Log Present (Y/N) Daie'Com eied ' · - pl Total Depth Cased to Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (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 .To Nearest Sewer Service Link on Lot Water Sample Collected by Water Sample Test Results Comments~¢ ~ ; On Adjoining Lots '~ J'"" ~ ; On Adjoinin'g Lots To Nearest Public Sewer Cl~anouFManhole' ; Date B. SEPt'lC/HOLDING TANK DATA , ~- II-'~o ~ ~.~Date Installed L) K':". Size --LD-OO~ No. of~Compart ments ~ ~f.,,. Standpipes (Y/N) ~ A~r-hght Caps (Y/N) f.~ Foundation }CI~, .~JDepression over Tank (Y/N) /,,J Date Last Pumped · ~."~, ~, ~Pumping/Maintenance Contact on File (y/N) k)/V~ for ~c ~',, Hold,ng Tank H!gh-Water Alarm (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) pj~.?~' SEPA~IATION DIsTANCEs FROM SEPTIC/HOLDING TANK: ~.~ To Water-Supply We, Il ' ~C::~ + To Building Foundation ~'~ To Property Line ! 0 7- To Disposal Field To Water Main/Servic~ Line ' I ~ + To Siream, Pond, Lake or Major Drainage Course ~ C:l:~ t.),'''''' C. ABSORPTION FIELD DATA i.~:~ ~ ~ ~ Type of System Design Soils Rating in Absorption Strata Date Installed ' ~ ~ ~ · , Length of Field Width'Of Field 0~. (~' ~ Depth of Field O ~ Gravel Bed Thickness Squat; Fa'et of Ab:s~:Aio , Statndpipes Present Depression over Field (Y~ ~ Date of Last Adequacy Test Re= .=ofL. tAdeq =cyT t SEPARATION DISTANCE FROM ABSORPTION FIELD: ~ ~ ~'/ To Property Line ! 0 '/" Z/~- ' To Existing or Abandoned System on ; On Adjoining Lots '.f t t3 To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course /~/~ To Water-Supply Well To Building Foundation Lot ~J/~ To Water Main/Service Line To Driveway, Parking Area, or Vehicle Storage Area Comments .... . ~. - D. LIFT STATION ~t~'~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Tested for Meets MOA Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) p Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Comments **Check Permitted Bedroo~ Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in, Inspection. Signed Company Date MOA No. ~ ~. S ENGINEERING 17034 Eagle River Loop Road No. 204 .- .gie ~/r, A. ~'L,~~':'''7 · ~ Receipt No. Waiver Fee: $ (.Date of Payment · Page20f2 ' .' STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATiON / A~;CHOP~.GE ~;ESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 At;CHOP~.GE, ALAS:{A 99503 (907) 563-6775 June 27, 1990 FOR: S & S Engineering Attn: Roger PWSID: .9 21087~ According to the records on file in this off,ce, the ~ ~ W~ter System is in co..nplianco t~ith the State of Alaska Drinking Water Regulations. V;:C: r s Sincerely, EnvLronment~l F~e~ Officer LEGAL ~ Ic~' ' I~*T~.';;~P'j~"''-~ . - I --,-~~;~'~3. 5 ' I I ' APPLI(""NT FILLS OUT UPPER HAl--', ONLY Prope. rly Owner ~ ~, C- .~ ~ %. e.-,~"~.. Phone Mailing Addrees I (.~ <~ C ~_~ ~'~ U'- * L,,J Zip Code Address Zip Code Address Zip Code Address Zip Code Type st Residence ~..~ffn °le Family [] Multiple Family NO. of Bedrooms Water Supply [] Individual ATTACH WELL LOG. A well log Is required Ior &Il wells drilled since June 1975, ~--,"~mmunlty For wells drilled prior to Ihat date. give well depth (attach log I1 available). Sewer Disposal ~pu~ Ivldual Year Individual Installed: [] Holdlog Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector fnspeclor Inspector ~UNIC' PALl'Pt' OF Field Notes: DEPT. OF tf--'/.LTIi £NVIRO~MZNTAL RECEIVED (.~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAP~ROVED ( } CONDITIONAL APPROVAL* Well to Tank Septic Tank Blze TECH ENGINEERS, INC. CIVIL · SA,VITAFIY December 3, 1983 Jacob and Dana Smith 165 Crestview Lane Eagle River, AK 99577 Re: Septic System Adequacy Test, Lot 10d, Eagle River Valley Ranchettes Dear Mr. and Mrs. Smith, On December 2, 1983 we performed a septic system adequacy test on the above referenced lot. We checked with the Municipal Environmental ~ealth Department and were unable to find as-built information on the existing septic system. We were also unable to find the location of the absorption system on the lot. We did, however, find the septic tank location. 1D00 ~allons of clear water w~re discharged into the sept~ ~y~t-m at a measured rate and the level in the tank did not rise abo__ve the static level. This is well within the required test criteria for a 3;bedroom residence. From this we determined that at the time tested the system is adequate for a 3-bedroom residence. As part of the testing procedure the septic tank was pumped and the volume was verified to be 1000 gallons. ~ If you have any questions, do not hesitate to call. rely yours Vernon L. Rdelfs. PE 13 LE DOUX LANE * EAGLE RIVER, ALASKA 99577 * TELEPHONE (907) 694-3574