HomeMy WebLinkAboutGLACIER VIEW HEIGHTS #4 BLK 3 LT 13AGlaci r View Heights Block 3 Lot 13A #050-501-52 Municipality of Anchorage Page 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 We~l Inspection Report Permit Number: .~.)qSO~.'-~H PID Number: Name: ~ ~ Wastewater System: ~New ~ Upgrade Address: ~O VA~A~O ~. ~%~A S~O7 ABSORPTION FIELD Phone: No. of Bedrooms: 3~-~ ~ ~ Deep Trench ~ShaHowTrench ~Bed ~ Mound ~Other L E GAL D E S C R I PTI O N so, .~t~.g: To~ ~.t~ ~o~ O.~ ~ GPD/Sq. Ft. Subdivhion: ¢~ Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: ~ Range: ~ Section: _~ Fill added~ above~ ~,~°riginalgrade: Ft. Gravel length: ~/ Ft~ WELL: ~ New B Upgrade Gravelwidth: Number of lines: Distancebelweenlfnes: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~IVAT~ I~o Ft. I~O Ft. IOO~ SO. Ft. 5(~.qO / F~IO Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: ~ GPM Pump Set at: ~ Ft. Casing Heightl~Ab°ve Ground:Ft. T~ SEPARATION BISTANOES ~ s~,tio c~ Ho~di,¢ ~S.T.~.,. To Septic Absorption Lift Holding Publio/Private Manufacturer: Capacity in gallons: From TanX Field Station Tanb Sewer Lines A~( ~o~A~ Well- 15o' tqo~ I~ ~ ~ ~ Material: ~L Number°fC°mpartments: Surfaoe Lot , , Size in gallons: Manufacturer: ~ ~ ¢ "Pump on" level at: "Pump off" level at: High water alarm at: Cudain ~0~ ~ ~ ¢ ~ o ~ Pu~p Make & Model Electrical Inspections performed by: Location and Description: Assumed Elevation: E~~AL Department of Health and Human Services approval 72-013 [Rev. 9/91) MOA 25 SW950244 2 2 Permit No. Page of 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 LOT 15, BLOCK $, OLACIER VIEW HTS. //4 05050146 Legal Description: PID No.: ST 1 MT 1 MT3 SYSTEM · 97.8' WATER FgUND 7~16-95 i A B ¢co 45' lO' $T1 21' 15' $T2 .25~..t 8-'~ idH 27' 20' ~4T1 64' 59' btT2 81' 62' biT3 74' 69' MT4 90' 79' SCALE: YELL 72-013A(1/93) * NEW S, / 250 TAN K ROBERT C. COWAN CE - 8801 ]0-26-1995 12:19PM FROM EAGLE ELECTRIC INC. 997 3~ 8827 P EAGLE ELECTRIC INCORPORATED -'[-7'0', ELECTRICAL CONTRACTING Co~truction · Mnintcnance , Remodels · Code Upgrade · Statewid~,Service · Lidensed, l¢o~dedand~r6ured · 772'k Schoor~Street, Suite 1 ' Anchorage, Alaska 99518.3038 · (907) 344~7121 · FAX (907) 344-082¢' P.O. Box 8Z1(~2 '~ WasilI~, Alaska 99687-1682 , (907) 373-688~. 'SULLIVAi WATER WELLS ~'.0. I~OX 670~72, {IHUOIAK, ALASKA ~0567 o TgLEPHONI~ 08~.27'69 DATE -Started - Ended ~ GALS KIND OF FORMATION~ From R 'Fi. to '7 _~,i.~-O~'.e .C~,~,,) ~m. .r,.,o~ ~.. From ~ ~Ft. to~l Et_. ~'~ lc From, ~ ] Ft. to~Ft, ~g~ Fromm, Fl. to, Ft~ , ............ ~Ft. to_. From__F~. to, Ft,. From ' ~Ft. to ~Ft. From _F¢.to __Et .... Fr~m Ft, to Ft From ....... Et, to _Ft Erom~Ft. tO. Ft-_ Ftom_~Ft. to~Fti~ From__Fi. to _Ft. From_ Fr[:'m ~Ft. FrOm .... Ft. to____Ft._ From___ Ft lo_ , ,.'Ft. From~ Fr~ ~O~.[ - · From__FL to .... Froot Ft. to__ Ft. ~.~._~ FrOm_ Ft. to FL MISCL INFORMATION: Dept. Health & Iqurn~, ..... ) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 'IL" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950244 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SPINELL HOMES INC OWNER ADDRESS:9210 VANGUARD DRIVE ANCHORAGE, ALASKA 99507 4687 DATE ISSUED: 8/28/95 EXPIRATION DATE: 8/28/96 PARCEL ID:05050146 LEGAL DESCRIPTION: GLACIER VIEW HEIGHTS #4 BLK 3 LT 13 LOT SIZE: 49760 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL 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 (iSAACS0) . 3. 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) 4. 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 SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT PREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. July 20, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 13; Block 3; Glacier Vi¢~ H~ights #4 Request you issue a permit to drill a well and install a septic system to serve the proposed three be~oom house on the referenced property. T~st holes were excavated and percolation tests performed. The approxiamate locations of the test holes are located on the attached site plan. At the time of excavation water was encountered at six feet in test hole #I and six and a half fe~t in test hole #2 and after seven day ground water monitoring water was found at six feet and six and a half feet respectively. There are no protective well radii which encroach upon the property. There are no points of contamination within the, proposed well radius which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring w~, septic systems or drainage patterns by the installation of the proposed septic system. If you require any additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/sm ~n~losure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 o EAGLE RIVER, ALASKA 99577 1"::60' SCALE SITE PLAN DESIGN N.T.S. SCALE PROFILE 0 DETAIL 0 co · PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 2O COMMENTS (ENGINEER'S SEAL) .. Township, Range, Section: WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN S / IF YES, AT WHAT (, ~¢ OL DEPTH? p E Deplh 10 Waler Alter ~o. 3" '7 (o ~'- ~0nilering? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop '7/(,/~S- ,,~o is~- .,,,, ~.o " '. Is- I).75' j :o 6 II, oo PERCOLATION RATE (~ 0 (minutes/tach) PERC HOLE DIAME1 ER ~- FI AND FT TEST RUN~ BETWEEN Y. 17, 3' PERFORMED BY: ] 703zlviagie River Loop Road No, 2~ ~ CER] IFY 1 HAT THIS TEST WAS PERFORMED IN ,---, ,'-- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGALDESCRIPTION:~LhCI~,'L V/~&./ HG7~ DATE PERFORME~..'Qc,~7',,,,,,~,J,~" ~x ~.' ~ '[.~'-' ~-/?:-~.- -,'~t:~' Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 I4 15 16 17 18 19 2O COMMENTS ~ × C,~vd TIo/V ~ f~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? 7~ ..~' IF YES, AT WHAT ~ 0 DEPTH? p E OeptllloWaterAIter ~ / ..7//~/~3.- M[mitori,g? Bale: Gross Net Depth to Net Reading Date Time Time Water Drop '7/~/q5' , o~ /I. 8-" 'LS~ /S',-,~ 12~0 d.~-~ ' ~0 ~ ~ ,~,~ 10.>- 0, ~'" · ' frS- ~5'~l~,d /0,O O.~-r' PERCOLATION RATE ~ 0 (minutes/tach) PERC HOLE DIAMETER __ TEST RUN BETWEEN .__ ''~ FT AND ____iq/ FT 'P.//. '$ 6y PERFORMED BY: ~&'I~"~INt~ERI"" , Z//~///~'/~ ~ CERHFYq'HA'i/]HISTE/$'TWASPERFORMEDIN 17034 Ea le River Loo Road No. 204 ~. 0 ~ 5~ l n, R I n Cj ROBERT C. COWAN, RE. ROBERTA. 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 ONSIfE W,~ST EWAT E R DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 13, Block 3, Glacier View Heights July 19, 1995 GENERAL: The scope of this project includes the installation of a 1250 gallon wastewater S.T.E.P. system (septic tank) and a pressurized absorption bed to serve the proposed three 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. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. De 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 manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 13, Block 3, Glacier View Heights ~4 July 19, 1995 3e All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. De A foundation cleanout shall be installed one to four feet from the building foundation. In 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 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. 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. PRESSURIZED MOUND SYSTEM INSTALLATION: 1. Any peat or organic matter must be removed from the elevated mound site. The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. 3e The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. The side slopes of the top layer of the mound system must not be steeper than 33% (3:1). The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. The distribution pipes are to be embedded in sewer rock. Care should be taken to backfill in such a way as to prevent damage to the piping system. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Page Three Lot 13, Block 3, Glacier View Heights ~4 July 19, 1995 Backfill 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 thirty-six (36) inches. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: ~ype of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No 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). Do A permeable nontoxic silt barrier (Typar 3401, MJ_rafi 140N, or equal) must be installed between the final leachfield grave], layer and the native soil backfill. Alii leachfield 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 current M.O.A. or D.E.C. requirements. Page Four Lot 13, Block 3, Glacier View Heights ~4 July 19, 1995 INSPECTIONS: Typically there will be a minimum 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 backfilled 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. The final inspection is to occur upon final grading of the property. Often there will be more than 'these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized 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 sha].l 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. Page Five Lot 13, Block 3, Glacier View Heights t~4 July 19, 1995 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry 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 this project. CONTRACTOR/INSTALLER N .T.S. SCALE 4;~ cu o O_ ::~ C) ,~>z O~© 0 ~-q O0 DETAIL o 0 \ b¥o F-- a~ 11'-6" EFFECTIVE C Z L 1 2' DEEP ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. August 23, 1995 CIVIL ENGINEERS (907) 694~2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN E~TENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 RE: Curtain drain on Lot 13; Block 3; Glacier View Heights ~ 4 Dear Mr. Cross: This is to inform you of the curtain drain installed on Lot 13; Block 3; Glacier View Heights ~t 40 The curtain drain was installed to lower the groundwater in the immediate area. Prior to the installation of the curtain drain the depth to groundwater was six and one half feet below grade. After installation, the depth to groundwater is ten feet below grade. These depths were measured from a monitoring tube which was installed approximately fifteen feet, downhill, from the curtain drain. Request you issue the On-Site Well and Septic permit for the referenced property. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 . EAGLE RIVER, ALASKA 99577 Parcel I.D. 1. Municipality of Anchorage 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 GENERAL INFORMATION Complete legal description CO A# d sC I; Expiration Date: // - 30 '- / ~___ Glacier View Heights #/+ BIk ~ Lt 13A Location (site address) 226oz Columbia Glacier Loop, Eagle River Ak. 99577 Current Property owner(s) Triple J Aimone Family Trust Mailing address Lending agency Day phone Mailing address 226o~ Columbia Glacier Loop, Eagle River Ak. 99~;77 Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. Day phone 2. NUMBER OF BEDROOMS: 3, TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class __ Public Water System Well 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 CQSAs 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 cedes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Boxloo217, Anchorage. AKqq,;lo Engineer's Printed Name Steven R. Pannone, P.E. Date {' ~:~'Z~ Engineers Comments: In conducting mi adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. 22qe reported results describe tim performance of the systera under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfamory test results do not guarantee future pefforn~ance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warrm~ty for future performance nor give any estimate of how long the systanl will continue to meet the operational ~ requirements of the MOA DSD. The content 0f this report is for the sole benefit of the owner listed above. Any rehance upon or use of this report by any other person or party Is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE \/ Approved for ~ bedrooms. Disapproved. Conditional approval for __ bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other 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 Heights #/~ BIk ~1Lt ~A A. WELL DATA Well type Private Date completed 8/1/~995 Totaldepth ~6o ft. If A, B, or C provide PWSID # __ Sanitary seal (Y/N)_Y Cased to z6o .ft. FROM WELL LOG 81a/zaq~ O ParcellD: o~a-noz-~2 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) .~6 AT INSPECTION 8h./,12o3.:z ff. o ft. g.p.m. /*.9 g.p.m. 2~ Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Arsenic: ND ug/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Tank size ~,~o gal Foundation cleanout (Y/N) Y Nitrate o.:188 mg/L Date of sample: Number of Compartments _z Depression over tank (Y/N) N Collected by: PES Date installed Cleanouts (Y/N) Y High water alarm (Y/N) Y Date of pumping ;~ -- 17 ' ( ~ Pumper J R Pumpers C. ABSORPTION FIELD DATA Date installed q/'q]/qqg Soil rating (g.p.d./ft2 or ft2/bdrm) o.,-n _oDdlsf Length ,;6 ft. Width ~8 ft. Total depth 3, ft. Eft. absorption area zoo8 ft2 Monitoring tube Y Date of adequacy test 813.,.l:zoa2 Results (Pass/Fail) Pass Fluid depth in absorption field before test o_ in. Elapsed Time: zoo min. Final fluid depth _o in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N System type Bed Gravel below pipe o.~ Depression over field N For 3, bedrooms ft. Water added~.qo gal. New depth_o_ in. Absorption rate >= ~,,;o+ g.p.d. If yes, give date D. LIFT STATION Date installed qlq/2qqc "Pump on" level at/.~ in. Datum Bottom of Tank E. SEPARATION DISTANCES Size in gallons ~2=;o "Pump off" level at 3~ in. Cycles tested o~ Manhole/Access (Y/N) Y High water alarm level at z,~, in. Meets alarm & circuit requirements? Y SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot zoo+ Absorption field on lot 3.0o+ Public sewer main 7=;+ Sewer/septic service line Animal containment areas ~.oo+ On adjacent lots On adjacent lots zoo+ Public sewer manholetcleanout Holding tank ~.oo+ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation =;+ Water main zo+ Wells on adjacent lots zoo+ Property line 5+ Water service line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line zo+ Water Service line zo+ Curtain drain =;o+ F. COMMENTS Building foundation zo+ Surface water 3.00+ Wells on adjacent lots Absorption field 5+ Surface water zoo+ Water main 2o+ Driveway, pan~inglvehicle storage 20+ 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 Steven R. Pannoneo P.E. Date / '-~.--~ COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Lot 15 Lot 15A 99,492 s.f. / / Lot ;~ / / / / / / / 10' DRAINAGE EASEMENT~ Lot 4 MEA & MTA EASEMENT SHOP (IYPICAL) CLEANOUTS ASPHALT PROTECTIVE WELL RADIUS MANHOLE STORY RESIDENCE WITH FULL BASEMENT FENCE / ~ / Lot 12 PLOT PLAN AS BUILT X SCALE 1" = 60' GRID SW 159 Project No. 12-166 La n g (907) 522-6476 Registered Land Surveyors (907) 522-4625 ken~langsurvey.com / Jonathon~langeurvey.com & Associates, inc. 11500 Ooryl Avenue, Anchorage. Alcskc 99515-5049 Phone Fox I hereby certify that I hove surveyed fha following described properly: LOT 15A, BLOCK 5, GLACIER VIEW HEIGHTS UNIT NUMBER 4 (Plot No. 2007-50) Anchorage Recording DlslHef, Aloeko, Grid fhcf fha Improvements sltuofed fheroon ore wlthln fha properly lines end do not encroach onto fha property adJocenf thereto, fhof no Improvements on fha property lying odjccent thereto encroach on the surveyed promises and thai thoro ore no roadways, fronsmlsslon lines or other visible easements on sold properly except os Indicated hereon. oared this fha ?~1~ Day of /~ucluT.T , ?.~\~- , cf Anchorage, Alcska It la fha responelblllfy of fha owner fo determine the existence of cny easements, covenants, or resfHcflone whlch do not oppeor on fha recorded subdivision plot. 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 1. GENERAL INFORMATION Complete legal description Lot !3; Block 3; Gla~¢,~ Vie~ Heights #4 Location (site address or directions) NHN Columbia Glacier Loop Eagle River, AK Property owner · Ma.iling address Lending agency Mailing address Agent Address Matt Bower 9210 Vanguard Drive Anchorage, Day phone AK 99507 344-5678 Day phone Day phone = Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well XXX 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: XXX 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my inves~Lgation 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 & s ENGINEERING 17034 Eagle River Loop Road No. 204 Address Rag · River. Aleska 99577 Engineers signature _' .~.)' ., , Phone [:)ate DHHS SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. 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. 72~25{Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 34.3-4'744 Legal Description: LoT WELL DATA Well type Log present i~N) Total del)th Health Authority Approval Checklist 1"~, ~:.oc~B, (~cAc.tm,"f:~',J ¢'r$. /Parcell. D.: O~5o~o¢'4.La If A. B, or C, attach ADEC letter. ADEC water system number Date completed ~/q 6- Cased to J(~O Casing height (above groand) Sanitary seal (~',I) t/,k:~ Wires properly protected FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: (2) 0 m Coliform Date of sample: __ ~-~¢2~ ~ '~ ,.¢"-- B, SEPTIC/HOLDING TANK DATA Date installed 6~ _ ~ _q cj Tank size Foundation cleanout Date of Pumping _/',//A C. ABSORPTION FIELD DATA Date installed c~ - c] _ at cc' Length ~-~o' Width Nitrate O, lO Collected by: Depression (YcI~ /x/t> Pumper Other bactcria S & S ENGINEEEING Eagle i,~lver, Ala:ika 99577 Nmuber of Compartments g Cleanouts High water alarm (Y~ _ Soil rating~r fl2/bdrm) 0 Gravel thickaess below pipe O, co ' Effective absorption area lOC) Date of adequacy test System type Total depth Monitoring Tube present(~)'N) yes Depression over field (Y~ '-s¥%-mm,,~ Results (Pass/Fail) For ' --' bedrooms Fluid depth in absorption field before test (in.): Fluid depth ~- (ins.) Minutes later: Peroxide treatmeut (past 12 months) Immediately after ~ gal. water added (in.): Absorption rate = '-~ g.p.d. If yes, give date , Do LIFT STATION Date installed c~_ ~ _ Manhole/Access {~,I) High water alarm level at* Cycles tested ..~ Size itl gallons ~'Pmnp ou' lcvel at* 4'0 *Datuul '~Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line : On adjacent lots ~ o o' + : Oil adjacent lots ~ oo., Public sewer manhole/cleanout Lift station ~ o~ o SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundatioo ~ ~ Property line ~o Absorption field Water main/service line ~ o ~ + Surface water/drainage ~o ~+ Wells ou adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~o Surface water ~oo Curtain drain Water mai~ffservice line Io x4- Driveway, parking/vehicle storage area too 4-- Wells oil adjacent lots Ioo ~ 4- Properb,line '%0 F. ENGINEER'S CERTIFICATION ! certiJjv Ihat/have determined thru field inxpections and review o~Municipal recoi:~a~(ems are in con&finance u ith MOA IZ ~l~uideline6~effbct on this date· Eu ineer'sName ~O~'2&k~ C : C-O,~4~ HAA Fee $ ~ OD Waiver Fee $ DateofPayment :~/~/~*'~ DateofPayment ReceiptN,,mber /¢~/ C> 7 77) RcceiptNumber Rev. 8/95 OSS: haa.wk.doc 09×29×95 16: 42 COMMERC ! RL TEST ! NG ~ 90?6941211 Driizking Water Analysis Report for Total Coliform Bacteria ~ ~Nsrnr/crwNs otv~re~ smr.,~Ero~s co~c'r~o ~ST BE C0NWLETED BY WATER ~ P~VATE WATER 8YSTgM NO. 598 tTk~; Commercial Testing & Engineering Co. Er~vironmenta[ Laboratory Services ~~.¢z,,r~7.?:: ,5633 8 Street Anchorage, AK 99518-1600 Toh (907) 562-23¢.3 Fax: (907) 561.5301 UJ Send R~u~ ~ ~nd lnvoice SAMY'LE DATE: Month SAMPLE TYPE: >Q~ Rout[ne 0 Repeat Sample (for routine sample 'e,i'~h lab ret'..o. ) C~ SpeclaIPurpo~e Treated Wate~ Untreated Water TO BE COMPLSTED BY L/d3ORATORY Analysis shows this Water S)3~LE to be: Satisfactory U~salbhctoO' Sample over 30 hours old, re~uP.s 6qay be unreliable Sample too lens in tr~s',[; sample to bndica[¢ reliable results. Please send new umnple via speoiat dcliveD' mail. Date Rccei~ ed Time Ree~ Analysis Began Method: ~qvIembrane Filter 0 bhMO-MUO Number of cok,,,~--q 00 mi. Result* 95. ~.297 ~ ~- ,u~ch Fbks · . Analyse Dar*; Tim,: __ Clicwt notified of uasatisradory results: [] Phoned SToke vdth D~tg: Time: TEac Collected SAM~PLE LOCATION Collected By C orrffrle~'lt$: BACTERIOLOGICAL WATER ANALYSIS RECORD NiMO-MUG Result: Total Coliform E... Coll Membrane Filter: Direct Coun¢ Verification: LTB .. FeTal Coliform Con firm~tlou Final Membrune Filter Resull~ . MARYLAND. NEW Jt~RSEY. OHIO, UTAH, WEST VIRGINIA. ldatrix Client NaMe Ordered ~y CT&E Environmental Services Inc. Laboratory Division ~,~-~ Laboratory Analysis Report WATER ~,13 BLK~ GLaCiER VIEW ~ R. COWA~ Printed Date Collected Date Received Da~e UA 18455 10/04/9~ % 07:08 hrs. 09/28/9~ 09/28/95 Technical Dl~eoter ~TMPNEN c. EDE Sample Remarks: ~AMPLE COLLECTED BY: BOE C, QC Allowable Ext. Anal ~rameter Ro~i%~ Qu~I Units Method Limic~ D~te Dac~ Init Ni~ra~e-N 0.10 U m~/L EPA 353.2 i0. 09/29/95 DJ~ See special Instructions Above UA Und~teo[ed, Reported ~alUe i~ the p~acclcal quantifica~ion lil~£D, hT - Le~ Than Secondary dilution. GT - Greater Than 200 W PoltSr Dr;v~, Anchorage, Al( 99Sl 8-1 ~0S -- Tel: (907) ~82-2~4~ Fe~: (907) 561-5301 [NVI~ONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA