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HomeMy WebLinkAboutGLACIER VIEW HEIGHTS #4 BLK 1 LT 1Glacier View Heights #4 Lot 1 Block 1 #050-491-49 Municipality of Anchorage Page / of _3 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 Permit Number: Sb✓ 97 oa /_F PID Number: o!o- y9/ -Y9 Name:Wastewaer /, /l Aa�ELL T FE'R <-uso� tSystem: m New 0 Upgrade Y Address: a 7Ja o F'11 it o./ .6 k, ABSORPTION FIELD P 1 cI „n✓ .S ,7 Phone: 3Ka99, No. of Bedrooms: Q Deep Trench O Shallow Trench O Bed O Mound O Other LEGAL DESCRIPTION Soil Rating: 0• Total Depth Item original grade: GPD/SqF . Lot: Block: Subdivision: A y I I Depth lopipe bottom from glglNl pude: 3.5 Gravel depth beneath pipe .LAcle4 V,(-ej Ft. .5..6 Fl. Township: Range: Section: Fill added above original grade: Gravel length: .� _ Ft. -)-C-a37 = Zil Ft. WELL: 0 New O Upgrade Gravel width: q S Numberolllnes: Onw"befeeenleit / oc. Ff. -2 FI. Classification (Private, A,B,C): Total Depth: Cued To: Total absorption area :A Piga meleriel: V? A%F /S3 Ft. I53 Ft. Nj SO. Ft. <Ito Driller. -W De;UiN Oats Drilled: Stalk Wala Laws: Installer. -f0 Eis Dale installed: 09 -lo -F7 M 09 -os -9 90 Ft. Fr Yield: Pump Set al: / Casing Height Above Ground: TANK GPM rty V//n" FL .,i Ft. SEPARATION DISTANCES 0Septic 0Holding 0S.T.E.P. To aapllc Abawplionl4Tokl,g k;Mdsls Ma ulaclurer. Gp&city In gallons: From Tank iNld fwwer Line, Nr "04OF' /�ii� / (7 WeU r v cot Material: Number of Compartments: -2 Wai re /no /oaf LIFT STATION Lot r /Size In gallons: Manufacturer.LineFoundation � / r"Pumpon'level at: :Plfmp off" level at: High water alarm at: Curtain PumpMWEModel Electrical Inspections performed by: Drain Remarks: .• BENCH MARK Location and Description: T>q, Mr i, . r o rr .n,nr:C Assumed Elevation: .. /oa EN O 9 L^ S & S ENGINEERING /0-97 Inspections performed by: iAalOO�tst `�— Z ��0 '�!l Eagle River, Alaska 99577 2nd 9 -i t - 9 7% �..M.••n _ 7,�` l00ERT c COWAN 3a,0 9 -to -98' fl �.' CE.B801 h•r Department of Heal and Hu an Services approval Reviewed and approved by: Dale: 72-01d (Rev. 9,11) MOA 25 PERMIT NO, SW970215 PAaE 2 O? 3 Municip~[ilv oF Anchor'c~e DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVlRONHENTAL SERVICES DIVISION P,O, Box 196650 m Anchorage, Ataska 99519-6650 ITe~ephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT1, BLOCK 1, GLACIER VIEW HEIGHTS P.I.D. NO, 050--491--49 DBL1 DBL2 NEW TRENCHES 1250 GAL. SEPTIC TANK NEW WELL SCAI~ 1" = 40' LOT 2 ROB~I~T C, COWAN CE -8801 PERMIT NO. SW970215 PAGE 3 0¥ 5 Municip. o, Litv oF Anchoraae DEPARTMENT OF HEALTH AND HUHAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O, Box 196650 eAnchorage, Ataska 99519-6650eTe[ephone~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ].scA[. LOT1, BLOCK 1, GLACIER VIEW HEIGHTS P.[.D, NO. 050--491--49 A B FCO 12.0' 18.5' ST1 16,5' 44.,0' ST2 25.5' 52.0' DBL1 27.0' 53.5' DBL2 28.0' 54.0' F S 28.5' 5,3.0' C01 2,.3.0' 4,3.0' MT1 47.5' 48.0' C02 50.0' 50.0' CO,3 $8.0: 59.5' MT2 55.5, 61.0' C04 57. 62.0' ST1 $T2 NEW 1250 GAL , S,T, CO8 = 95.8' /--C04 = 97,6' COt / MT2 = 87.0'~ CO1 MT1 C02 GRADE COl = 97,t' = 98,0' CO1 = 92.6' C02 = 92.7' NO WATER FOUND 80.9' B.O.H. SCAI.~. 1" = 40' ~Vi~W DRILLING, Inc, P,O, Box 110378 · 10330 Cid Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 .~ .?~' ~ F _Use of Wel~DOMESTIc Owner--DAR] :ELL FERGUSO_N_ Location (a~dress of: Township, R~e, Section, if ~own; or dist~ce ma~ roa~ o~ c~L~ ,? "' De~th o~ H,ole~_~ ~eet C~ed to_ 1 5 3 fee~ Static water leve; ,_~ 0 .ft, ~;::; :~bel°w) l~d su;~ace. Finish o~ well (check one) open en~ ( i ~creen t ~; Perfcratet ( ;; '~;;',L. ..... .... -- .............. · ~f?~'~i: iq A Describe sc ,een or perforati°'n~c~ , ~, ,,.,, :: .. :~ _ft. ~a~l~,~s,~, ~ (minute) for_~ We~ pumping t,~st a~ .,,,~ ,~ :. ;. , of drawdo~ 'n from static ~?e!iffJ~ ' ~4.~t, :,,~:~;i,,~ :~;NOTE: WELL DRY GROUTED NZTH 2 SACKS OF BENTONITE ~ ~'~; ,. GRANULES WEt~ tOG Depth in fe~t ir( m ground surface 6f,:f6rmations penetrated, size of material, color and hardness __Z___TO-fE .-- - ..TO J. 2~ J 35 TO_I tEL: SANDY 2GPM 1 4g_TO.--] .:~ 3. _ ~0_.. TO_,~ __frO_ ---- TO ....... ,TO ...... __~0_._ REC IV-ED- --D-~~Orage ~p~. r'~eaJth & Human Services 1 -- cUSTOMER ~-/~../~N M-W DRILMNG, Inc. i'V-~~''' P.o. so~ l~O~B · ~o olu S.w=~u Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 ~001 DRILLING LOG Well Owner DARRELL FERGUSON ,Use of WeIiDOMESTIC Location (address of: Township, Range, Sect/on, if known; or distance main road LOT 1. BLOCK 1 ~ GLACIER VIEW HETGHTS //4 RA~T,~ '~ TV1~; AT,A~KA ~ize of c~g. 6" DePth of Hole ~ ~tatic water leve' 9 O ~t. ~f~: :~low) Sr~een ( ); Perforated ~ ,~/ ~ ' feet Cased to 153 feet land surface. Finish of well (check one) open end ( X ); Describe screen or [ Well pumping test of drawdown from static Date of )epth in feet from fround surface __Q,, TO_2 .. (minute) for 1 hou~ with 100% ft. : WELL DRY GROUTED WITH 2 SACKS OF BENTONITE GRANULES WELL .LOG penetrated, size of material, color and hardness -- 2 TO 81 135 TO 144 144_TO,. 148 148_TO 153 -- TO ~L: SANDY 2GPM SMAI --_TO --TO TO ~TO ----_TO TO TO -- TO AUG $1998 Municipality of Anchorage --D-a,QL Nea!th -~= Human 1 -- CUSTOMER ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MA~N EXTENSIONS SEWER&WATER INSPECTION ENGINEERINGSTUDIES WELL INSPECTION & FLOWTEST SITE PLANS ROAO OES[GN SOlLTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM OESIGN CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED SEP 5 1997 Municipality o~ Anchorago Dept. Health &Human Services The septic in~pegtions for qt~,_ ~eferenced property were performed on q~o/~ 7 and /47 . Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the ~'~r~ow/~u'~'~$v~W~o be completed. If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP ' SUITE 204 ' EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUM~Z~N SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970215 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:REPASKY JOHN JR & DEBRA A OWNER ADDRESS:27220 FALLON DRIVE CHUGIAK, AK 99567 PARCEL ID:05049149 PAGE DATE ISSUED: 7/25/97 EXPIRATION DATE: 7/25/98 LEGAL DESCRIPTION: GLACIER VIEW HEIGHTS #4 BLK 1 LT LOT SIZE: 46488 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC T~fK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. ALL REQUIREMENTS SPECIFIED IN A/qCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18A_AC72) ~ND DRINKING WATER REGULATIONS (18AAC80) . THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SA~ME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS ISSUED BY: DATE: DATE: Rick M?strom. Mayor Mtmicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage. Alaska99519-6650 hltp: v,,ww.chanchorage a.< September 25, 1998 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 1 Block 1 Glacier View Heights #4 Waiver Request #WR980061, PID #050-491-49, SW970215, HA980298 Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 8 feet from the absorption field to the property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-site Services ljw #7 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver ReView WOrksheet WR#[~'bQq~(~g%\DL PID# 050-491-49 HA# ~q~l~Permit # SW970215 Date Received: September 18, 1998 Legal Description: Lot 1 Block 1 Glacier View Heights #4 Engineer: Robert C. Cowan, P.E., S & S Engineering Applicant: 17034 Eagle River Loop Road, Suite 204~ Eagle River, Alaska Darrell J & Diane M Ferguson 99.577 Waiver Requested: lot line waiver of 8 feet Criteria: Points: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: ~ ~/~/~F~., /~7~ Date: N Reviewer Rec #: 04190/5401 Amount: $ 115.00 Date Paid: Sept 18, 1998 ROBERT C. COWAN, R E. ROBERT A. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING S [UDIES AND REPORTS WELL INSPECTION & FLOWTEST ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTEONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN September 17, 1998 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED SEP '18 1998 Municipality of Anchorage Dept. Flealth & Human Service9 REFERENCE: Lot l, Block 1, Glacier View Heights Subdivision #4 Request you grant a waiver roi' the separation distance between the leachfield and the property line for the referenced properly at 8 feet. If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. ROC/mg Enclosure 17034 NORTH EAGLE RIVER LOOP o SUITE 204 . EAGLE RIVER, ALASKA 99577 ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN July 16, 1997 CIVIL ENGINEERS (9O7) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 1, Block 1, Glacier View Heights Subdivision Addition No. 4 Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property, Test holes were excavated and percolation tests performed. The approxhnate location of the test holes are located on the attached site plan. The monitoring tubes within the test holes have been checked and fbund to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robeil C. Cowan, rtE. RCC/mg Enclosure MUNICIPALIf¥ OF '-",NCHORAGE ENVIRONMENIAL SERVICES DIVISION JUL 'i 7 1997 RECI:IVED 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 SITE-PLAN DESIGN ©0 :lEU) lmlPl / , / <~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PER FO RM E D F OR: ~-% JJ~ ~'~ ~ ~ P,'~"~/~ ~"'" ' DATE PERF LEGAL DESCRIPTION:~~ d~ ~ ~ Township, Range, Section: 1 2 3 4 5 6 7 8 9 I0 11 12 13 14 15 16 17, 18- 19- 20- WAS GROUND WATER ENCOUNTERED? SLOPE S L IF YES, AT WHAT ~ O DEPTH? p E SITE PLAN Depth Io Water Afler_ ~onitering? ~-~/'"~" Date: Reading Date Gross Net Depth to Net Time Time Water Drop ,'¢~ 1o ~ ~//~ ,//~,, %,0~ ~ G~ "//~ - ',~ (~ ?, ~/¢~ % _ PERCOLATION RATE /~/S (mmutes/mch} PERC HOLE DIAMETER S & S/ENGINEERING / ...... / 17034 Eagle River Loom Road NO. 204 /;' ~/ PERFORMED BY:E , " I //'~--r~ CERTIFY THAT THIS TEST WAS PERFORMED IN "~- -agie River, Alaska 99577 ~./// / ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE-~IN EyECT ON THIS DATE. DATE: (~ / ~ ~/) C~ ~ 72-008 (Rev. 4/85) ~ , {ENGINEI~.R;,S SEAL) Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ,.~., 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG PERCOLATION TEST PERFORMED FOR: ~ - DATE PERFORME~;;,]~/~,~ LEGALDESCRIPTION:~,~qL {~ /~ ~ Township, Range, Section: SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth lo Waler Alters_ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE B (m~nutes/mch) PERC HOLE DIAMETER COMMENTS Z/~ ~. , /,~s~ fl b,~¢ ~~P 7~~,~ 4~,~ t~ ~__.~,_~,,,._ ~, , / PERFORMED BY: 1Z034 Ea~le Rive~ Loop Read No, ~ ~ ,.;/ ~/~ ~ CERTIFY THAT THiS TEST WAS PERFORMED IN Ea le R'ver A asea 995 ,~CT ( / r~ ~ / C~ ACCORDANCEWIT~LL~TACEANDMUNI~ALGUIDELINES ON THIS DATE. DATE: 72-008 (Rev. 4/85) mnc; ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. HEALTH AUfHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & PLOW TEST SITE PLANS ROAD DESIGN SOIl_TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE W~STEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 1, Block 1, Glacier View Heights Subdivision Addition No. 4 July 16, 1997 GENERAL: The scope of this project includes the installation ora 1250 gallon septic tank and two leaclrfield trenches to serve the proposed four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manuPacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or slfifting of the tank. All standpipes on the septic tank shall extend a nfinimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 1, Block 1, Glacier View Heights Subdivision Addition No. 4 July 16, 1997 A foundation cleanout shall be installed one to four feet from the building foundation, h~ the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 fl. from the tank. The first cleanout, in line, shall be to clean toward the leacbfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil baclcfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approxhnately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Bacldill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thi~g,-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Page Three Lot 1, Block 1, Glacier View Heights Subdivision Addition No. 4 July 16, 1997 Type of Pip_e Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, lVlh'afi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leaclifeld gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to cun'ent M.O.A. or D.E.C. requirements, which ever requh'ement applies. INSPECTIONS: Typically there will be a mininmm of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be baclcfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Page Four Lot 1, Block 1, Glacier View Heights Subdivision Addition No. 4 July 16, 1997 Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressm~ed distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons pe~To~xning work on this project or the failure of the contractor to cmry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to ttfis project. CONTRACT OR/INS TALLER Municipality of Anchorage 1GE eG Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-491-49 COSA # &9c1,3to46 Expiration Date: s - dg// � 1. GENERAL INFORMATION Complete legal description Glacier View Hts #4 Block 1, Lot 1 Location (site address) 22416 Eagle Glacier Loop Eagle River AK 99577 Current Property owner(s) KoosmAN ANDREW, FUENTE LINDA Day phone 696-5553 Mailing address same Lending agency Mailing address Real Estate Agent Mailing Address Day phone Cher Hampton Day phone 261-7590 Dynamic Properties Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 NorthRim. Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 2/17/2012 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 septtipare subject to these various and dynamic characteristics and are outside the control of the R.{` evaluator of the well and septic stem. P Y 5. DSDSIGNATURE ✓/ Approved for � bedrooms. Steven W. Eng Disapproved.. Conditional approval for bedrooms, with the following Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: L L4L Original Certificate Date: Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Glacier View Hts #4, Block 1, Lot 1 Parcel ID: 05049149 A. WELL DATA — Public Water Well type P If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 9/8/97 Sanitary seal (Y/N) Y Total depth 153 ft. Cased to 153 ft. FROM WELL LOG Date of test 9/8/97 Static water level 90 ft. Well production 7 g.p.m. WATER SAMPLE RESULTS: Coliform Pass colonies/100mL Nitrate ND mg/L Wires properly protected (Y/N) Y Casing height (above ground) 30 in. AT INSPECTION 2/6112 90.2 ft. 6 g.p.m. Arsenic: ND ug/l Date of sample: M2 Collected by: nr B. SEPTIC/HOLDING TANK DATA 17 Tank Type/Material Septic/Steel Date installed 9 0 Tank size 1250 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 8/19/11 Pumper iR's C. ABSORPTION FIELD DATA Date installed 9/10/0 Soil rating (g.p.d./ft2 or ftz/bdrm) 0_8 System type Trench Length 74 ft. Width 2.5 ft. Gravel below pipe 5_5 ft. Total depth 11.5 ft. Eff. absorption area 814 fe Monitoring tube Y Depression over field N Date of adequacy test 2/6/12 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 35 in. Water added 600 gal. New depth 37 in. Elapsed Time: 60 min. Final fluid depth 35 in. Absorption rate > 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) unknown 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 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100' + On adjacent lots 100'+ Public sewer main NA Public sewer manhole/cleanout NA Sewer /septic service line 25'+ Holding tank na Animal containment areas 50'+ Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 10'+ Absorption field 51+ Water main na Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 8'+ * Building foundation 10'+ Water main na Water Service line 10'+ Surface water. 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain n/a Wells on adjacent lots 100'+ F. COMMENTS `Waiver in file. 411 %' /,1q Lj'i S /A/ LOAF r! E�s�� 0A1 / n 4 �,� .gyp G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and'¢ °'� 3 rt -1 = �aee;aya.a sa e review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. €? .... ie` `_ ^ ° • ^° a Engineer's Printed Name Steve Eng fi °"° PE 6256 =; Date 2/17/2012 .rte COSA Fee $490.00 Waiver Fee $ Date of Payment `aJI j 0' Date of Payment Receipt Number (Lao n (2/ Receipt Number (Rev. 11/05) NSq+ F9• pS,� \ NOTE: DUE TO SNOW NOT ALL CLEAN OUTS LOCATED \ SHOWN ON PREVIOUS AS -BUILT y \ DONE BY S & S ENGINEERING. "9• p� Z Q ` LOT 12 Sr.e EXISrn HWBE \ \\ 35+ //\•�� I p .0 WELL O� \ 1 :iiiiiii ...............:::::.::... ....-.- l Sg ^ i 1 3 4 5 s'-:": -_i E 286.18, LOT 2 2.5 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. USTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE LJ OT SURwY SURVEY TYPE ❑ FOMOAPON AS -BUILT SYMBOLS ❑ ONAL STRUCTURE AS-BUI.T SET REBAR ®i`i DR AGE ASPHALT ❑ PLOT PLAN ... BUILT ... L07 SUR\EY ... APHY O FOUND REBAR �.� WOOD FENCECONCRETE c El 5 -BUILT ... NO CORFIEfi RECQiTIiTCAIION AS�IIYT ... NO ERS opl A OO ASSUMED ELEV. ® 'tt'i(-1F METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE TO FINISHED GRADE AND UTIUTY CONNECTIONS AND TO DETERMINE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION a,,' �•AAA�E � +, Prepared by Robert E. Johns, Jr. & Assoc. PLOT PLAN �.+1 MaY qal I M'w PNHb.y ..,.Itl M.1ut Ja•.� N Gue'6tl h..w, �E amt I nor. rawa a rrsrts.e a s n. rot mn.. .. P.•........... • �` 11 Professional Land Surveyors on .^«moo• aw xx� s aernwm. no+. t� + ••• •�+ 1700 Brink Drive ANCHORAGE. ALASKA 99504 ; t +• / $Cale - Rec. Lot S.F. Rem Plat FIIe No. FOUNDATION AS-BULT ^�•• •• •••/ 1" —50' WL RaWr E �Mn., Jr. 11 r MI I YAGaar lrr mm KK NNM M ii.'� ..... ... ...../ ••••R •• }O Date Sune a 01/31/12 Orawn b . '' REI Checked 9WL w. as m me •. ROS . JOH C % Date Dram: 02/01/12 Grid: SW0059 W,O 12-18 e�is m V v1a °a FINAL STRUCTURE AS -BUILT I. RaOreC.bM1iu,#„Fwpy 412 S �� '+ �. ,ve► Il�f Legal Description: GLACIER VIEW HEIGHTS #4 p,ay Wntl nn. r.r�ma m wan .v.vr s W. .evewn m aw ke ma amt s ar e�.p• ...... y:.•� BLOCK 1 LOT 1 Municipality of Anchorage r . Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 05b-UqI-4CI COSA# OtODjal Expiration Date: 7-- 11- 04 1. GENERAL INFORMATION Complete legal description C-1 I ac (I y- !li x u r Hti o Ino s dw L L I_ aR 1 Location (site address) )-. 4 I Lc E og l t Cain i'er Loop E-- - Current Property owners) K (t n I -Tin � I o r Day phone 350 - 0.)� I Mailing address -P.O- -Rnx -113Sa�1 , -ACafE P-Ivt2, AK. IS-f�-3S 2y Lending agency Day phone Mailing address Real Estate Agent C'Mia ►"��,rc4i- Day phone (AM -(o-112 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 13' Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 Eagle River Engineering Services Phone &9q - '5196 ue Address Fa 11A Rker AK 99577 Engineer's Printed Name C1it i son zI,ie e- R- VJoe)d Date 6 5. DSD SIGNATURE Approved for i' _ bedrooms. Disapproved. Conditional approval for bedrooms, with the followir Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By/rA %/h Ykm12i Original Certificate Date: (RwAIM5) Municipality of Anchorage a • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.orglonske (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: CA- I A6.4 r ✓ i.q„v hH S. # 4 i L- I B ) Parcel ID: 05S0 - ti Q 1- A. WELL DATA Well type-JlLva4 e- If A, B, or C provide PWSID 9 _ Date completed/q7 Sanitary seal (D1) _Yf,5 Total depth i sU ft. Cased to 153 k. FROM WELL LOG Date of test / S 49 -7 Static water level e) 0 n. Well production -4 g.p.m. WATER SAMPLE RESULTS: Colkorm _R coloniesl100 mL Nitrate e_ mg/L Arsenic: -,JZ' mgll Date of sample: 3�L/0(a B. SEPTICMOLDING TANK DATA Tank Type/Material si ez1 Tank size 10d5_0 gal. Number of Compartments ,L Well Log 6)N) YC -5 Wires properly protected (DN) YEC Casing height (above ground) min. AT INSPECTION 4 1-7 f O6 + 5. 'i g.p.m. Other bacteria �2 coloniesl100 mL Collectedby: Cl,ar(� �l�aharini Date installed 9 � to I'18 Cleanouts (9N) )"Es Foundation cleanout (YIN) rf J Depression over tank (Y((w1) A/0 High water alarm (YQ A/D Date of pumping I IV oto Pumper � S —PAM Pill 9 C. ABSORPTION FIELD DATA Date installed `) / 101 Cl Soil rating (g.p.d.Wdrrri) o -R Length —f 44 ft. Total depth JL_5 ft. Width a.5 ft. System type _r7¢Jnk_1 Gravel below pipe 15-5 ft. Eff. absorption area $J_,_fe Monitoring tube Yt -5 Depression over field _&IC Date of adequacy test '3/1-7/0(, Results Fail) fXS5 For 4 bedrooms Fluid depth in absorption field before test�tW In. Water added_J00 gal. New depthg,Qin. Elapsed Time: 1_j• Qmin. Final fluid depth /-�Q in. Absorption rate >= r400 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y6D& type) r cma lcriowin If yes, give date N /A D. LIFT STATION Date installed Size in gallons Manhole/Access (Y!N 'Pump on' level at _ in. 'Pump otr level at4o in. LA VHH�igh water alarm level at in. Datumycles tested Meets alarm & circuit requirements? EPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/1*91stien on lot -x100' On adjacent lots -1 IOU' Absorption field on lot Public sewer main + Sewer /septic service line + 2,S ' On adjacent lots t 100 ' Public sewer manhole/cleanout �- r vc>' Holding tank . -Is Animal containment areas 1-100' Manure/animal excrete storage areas t too, SEPARATION DISTANCES FROM SEPTIC/MGM* 6 TANK ON LOT TO: Building foundation * S ' Properly line 415 ' Absorption field + S ' Water main + it), Water service line -r 10' Surface water -4100 ' Wells on adjacent lots -f I00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line - S Building foundation r 10 ' Water main t 10, Water Service line t 10' Surface water + 1 CO' Driveway, parking/vehicie storage 3,O' Curtain drain + So ' Wells on adjacent lots f l o O F. COMMENTS I ]i l 11 Owl - G. S G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Cft1?XWPrW 9- k�O Date Y,22:A6 O COSA Fee S 3 'E2 -- Waiver Fee $ _ Date of Payment -41-71a6 Date of Payment Receipt Number F)-5-© 6 Receipt Number (Rev. t M) • Rtctoutonr: • MUNICIPALITY OF ANCHORAGE -7W-714e, • ^' DEPARTMENT OF HEALTH & HUMAN SERVICES 7 -It t p0 Division of Environmental Services law On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# 050-491-49 HAA# 1. GENERAL INFORMATION •: Complete legal description Lot 1, Block 1, Glacier View Heights #4 Location (site address or directions) 22416 Eagle Glacier Loop L.Propprtyowne'r'Darrell & Diane Ferguson Dayphone 343-4199 ..Mailing address Lending agency Day phone Mailing address Agent Partners/Cindy Wilson Day phone 694-4994 Address"11940 Business Blvd., Eagle River,.AK 99597 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State AD EC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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. 7Z=(R«.1N1( From MOA621 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 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 s a c_ ENGINEEOING Phone rO q `f —1� -7 y 17034 Eagle River Loop Road No. 204 Address c,of Ar' Engineer's signature 6. DHHS SIGNATURE M Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date 1/g/aa L va \ ROBERT G COVIAN '0,,% CE -6801 bedrooms, with the following stipulations: / Date — _ 1'9' 0 0 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 courtesyto purchasers of homes and their lending institutions in orderto 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. r2.= M. IM) Sao W0Am FEB 08 SM Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICEPWACALsuvKz3 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L / : �rio4/C-2 V/6 -PV /`/7TT Parol I.D.: %%5d - �7 / A. WELL DATA s1- Well type ;PA) Vl -7 E�' If A, B, or C, attach ADEC letter. ADEC water. system number Log present&M) L> Date completed Total depth 3 Cased to 5-3 Casing height (above ground) / of - Sanitary Sanitary sea ) / Wires properly protectwo.) L FR M W LL LOG AT INSPECTION Date of test Z Qy Static water level Well production T g.p.m. `/ ° rP f'% 9•P•m. WATER SAMPLE RESULTS: Coliform 0 Nitrate O • S Other bacteria d Date of sample: Z 'T Collected by: B. SEPT[WHOLDING T NK DATA c/ Date installed ��t an size /Z� Number of Compartments 0 Cleanouts&)� Foundation dean (Yc� Depression(Y/6 "d High water alarm (YM)Date of Pumping Z©Pumper C. ABSORPTION FIELD DATA Date Installed /O Soil rating (g.p.diV or ft2/bdrn) Q• System we �QJ lYL'ff Length 74 Width�— Gravel thickness below pipe S , Total depth Effective absorption area ��� Monitoring Tube presen (6)%:1 Depression over field (Y6� Date of adequacy test X Results (Pass/Fali) As f For / ZIP— bedrooms Fluid depth in absorption field before test (in.); Imy aiatef fter_ gal. water added (in.): Fluid depth (ins) Minutes later. Absorption rate = a.p.d. Peroxide treatment (past 12 m If yes, give date 72-026(Rev.3193• ' SV,4 q s7gc -.'#° �Aa o•, t.e• .4�4me„J D. LIFT STATION Date installed Manhole/Access(Y/N) _ High water alarm level at' Cycles tested E. SEPARATION Size in gallons on" level at• 'Datum 'Pump air level at' SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot //Oz) / On adjacent lob f -70-- Absorption field on lot/h�yy(""//� / f On adjacent lots / Public sewer main ! r'1 Public sewer manhole/cleanout At - Sewer Sewer /septic service line Z5 Lift station /,///4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 15 r� Property line S 110( Absorption field Sit Water main/service line Surface water/drainage / Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTJOY FIELD ON LOT TO: Property line tJ a Building foundation Water main/service line �� f Surface waterDf Driveway, parking/vehicle storage area /'f Curtain drain /t/ W(-- ��//11el VA/ Wells on adjacent lots /Cly F. ENGINEER'S 1 certify that I have determined thru field inspections and review of Municipal in conformance with MOA yu' alines in effect an this date. Signature s r�Z `,L,. U, Engineer's Name R09L 2T C. C©wN,J Data /oo � `o HAA Fee $ y d 0 . Date of Payment 0'a"— DO -0e) 7 1 Receipt Number 0-1 / �� 72-026 (Rev. 3/98)' Waiver Fee S Date of Payment Receipt Number WORT C. COWAN CE -Eaol 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 Parcel I.D. Cf 1. GENERAL INFORMATION Complete legal description Z'~?~ // Location (site address or directions) Pr, operty owner Ma"ii!in g address ,. Lending agency Ma,!li n,g address Agent Address Day phone Day phone Day phone. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (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 furtherverifythat 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. S & S ENGINEERING Name of Firm 17~-~4 F-.u;~ ~,~v~r ..~. ..... , ....... Add ress Eagle River, Alaska 99577 Engineer's signature . ,-~r//~j4./~ '~/7~--~ Phone ~'qq'- ~¢1 ~¢1 Date c///7 //~ ,¢ DHHS SIGNATURE ~_ Approved for '¢ Disapproved. Conditional approval for bedrooms. bedrooms, with th~ following stipulations: Additional Comments Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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. 724TzS(Rev. l,'91) Back MOA#21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ~r~{,~ ~{dcj~-/J/ ~--L/,I~/~/~ J~¢Z~ J~/'~,~¢2 ¥/-~ Parcel I.D.: (~,~'O~ '/~J' ~//',¢ A. WELL DATA Welltype /~/~'4 ~¢ If A, B, or C, attach ADEC letter. ADEC water system number Log present ~N) "/~b _5 Date completed Total depth / ~ %' Cased to J,~' ~ / Casing height (above ground) Sanitary seal ((~/N) Wires properly protected ~Y~N) ~'~-&;:~ FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform © Nitrate O. I Other bacteria Date of sample: ¢:~.~..¢_~o,.~ ~ -~- ~'/~' Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~ -'/~- ~?'? Tanksize /¢~.3'~o Number of Compartments ~:~ Oleanouts (Y/N)___ Foundation ~?¢mout. Date of.p~i'ng ' 2//~: .:_" C. ABSCRpTION FIELD DATA Date, ii.nstalled , Length . '7 ~-I Width Effective'absorption area Date of adequacy test ~/~ ~/./4¥.2 Depression (Y/Lf~) /v o High water alarm (Y/I~ /~, ¢2 Pumper Soil rating (g,p,d,/ft2 or.4tc-Cbdrm) (~, (~ System type ~/) ~'~-~, Gravel thickness below pipe. ~ /~' Total depth ¢f Monitoring Tube present ~'/N) Y~-J' Depression over field (Y/~_ For Results (Pass/Fail) .~ .~trn em em em em em em em em em~,;~ t e l y after Absorption rate = If yes, give date __ gal. water added (in.): .g,p.d. Fluid depth in absorption field before test (in.); Fluid depth (~s~Minute~ate~: Peroxid~eJreatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* bedrooms D, LIFT STATION Date installed ~-- SEPARATION DISTANCFS FROM WELL ON LOT TO: Manhole/Access (Y/N) High water alarm level at* Cycles tested SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum Septic/holding tank on lot /¢O C/ On adjacent lots Absorption field on lot /¢0 / '/ Public sewer main Sewer/septic service line "Pump off" level at* On adjacent lots /0¢) ~'/ Public sewer manhole/cleanout ~/'~ Lift station ~ / ") SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation / 5- Property line ~ ~ Absorption field Water main/service line / o -J- Surface water/drainage /o~ -~ Wells on adjacent lots / o -t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Building foundation ¢~. t Property line Surface water /CO r / Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ,/Co / / ENGINEER'S CERTIFICATION ,',' I certify that I have determined thru field inspections and review of Municipal recorC~,'~f,CF"~e'~tlo~,~. ?c~Ci?s are Date ~ //7 / ~)- ~ ~.~: C~:880i ,, HAA Fee $ ?~ ~'~' ~7~ Date of Payment ~'//~/'~ ~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Filed for Record 4t Request of: First American Title Of Alaska AFTER RECORDING MAIL TO: Name City Mortgage Corporation Address 121 W. Fireweed Lane City, State Zip Anchorage, AK 99503 Escrow Number: 9810573 -ALR OWNERS NOTICE OF CONIPLETION NOTICr IS I IERERY GIVEN, pursuant In A.S. 34.35.071 that Darrell .1. Ferguson and Diane M. Ferguson or P.O. Itos. Vhnendorr AFIt, AK 99508 is the owner of the rollowing described property: Lot 1, Block 1, GLACIER VIEW HEIGHTS SUBDIVISION, UNIT NO. 4, according to the official plat thereof, filed under Plat Number 84-77', Records of the Anchorage Recording District, Third Judicial District, State of Alaska. Thal on lite 91h day or December. 1998 , work was completed on lie constriction, allcmlion, or rcpnir of the building or improvements located thereon by Darrcll J. Ferguson and Diane 111. Ferguson , the original contractor. That Notice of Intend to Record this Notice or completion was given to all persons having given Notices of Right to Licn or asserted a Stop Lending Notice on the above mentioned property at least five days before the recording or this document. Dated tris day 9th of December 1998 OWNER: Darrcll J. Fer—gTmn Diane M. Ferguson STATE OF ALASKA I ss: Third Judicial District Darrcll J. Ferguson and Diane M. Ferguson , being duly sworn, upon oath, disposes and says: I have rid the foregoing Notice of Completion, know the contents thereof, all and singular, and �(lie statements contained therein arc true as I believe. [Farrell J. Fcrgr son 'Difine M. Ferguson STATE OF ALASKA ) ) Si. Third Judicial District ) TI IIS IS TO CERTIFY tial on this 9th Day or December 1998 before one the undersigned NotaryPublic, persomlly appeared Darrell J. Ferguson and Diane M. Ferguson known to me and to me known to be the individunt(s) described in and who executed the foregoing inslrument ; and They acknowledged to me that They signed the same freely and volunlarily for the uses and purposes therein set forth. WITNESS my hand and official seal. Notary Public in and for Alaska My coinntission expires: na