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Home My WebLink AboutGLACIER VIEW HEIGHTS BLK D LT 13Glacier View Heights Block D Lot 13 #050-491-15 ,..; ....... ., ANCHORAGE AREA BOk,. gH ~ Department of Environmental Quality ~ 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM ~ ~ :_JT-/~ LEGAL DESCRIPTION _ SEPTIC TANK'. DISTANCE ~ .../ INSIDE LENGTH ~ /__ INSIDE WIDTH. MAILING ADDRESS NUMBER OF ~_~ COMPARTMENTS LIQUID DEPTH ...... LIQUID CAPACITY .,-'/(-~/J' -/? _GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER /g~.OR WIDTH LINING MATERIAL~di _ - ~,~_ CRIB SIZE: DIAMETER__ BUILDING FOgNOATION ...... NEAREST LOT LINE--~ ADDITIONAL ABSORPTION DEPTH __ DISTANCE FROM: WELL TOTAL EFFECTIVE ,)~ / ¢ ABSORP'FION AREA (WALL AREA) ~-, oO~4 SQ. FT. WELL: TYPE f t/~j~_/~ CONSTRUCTION BUILDING NEAREST' FOUNDATION I_OT LINE CESSPOOL OTI4ER SOURCES APPROVED__ _. DISAPPROVED ...................... DEPTH _ NEAREST SEPTIC SEWER LINE -lANK REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: LOT SLOPE:_ REMARKS: DIAGRAM OF SYSTEM E:,E~I::'FIF,:TP1EiSi't" (')F HERt.T['I F:li",l[:' IEi",iV I I~: ~i t"!FIE!i]',!'i'!q! F'F' i:' "l"F:'r%l' ~ CIN ;~:SfJ.E~ E. TI..t[:,OR: Iq[).., 6fl'.,!C:I.IC~Fi:Ff6iE:., ~ 242d; M I I',Ii'4I::SCFf'FI t'II::IM I f, lt..IFI NUME:EI;.'. CIF' E:EE:,ROOMS = :~: '/:;O I L. Iq:FIT :[ NG ,:: '.'_.'.;IZ~ f:'"r,.-'[3F;: ) ~--.- ::1.. ;:!: ;2 TFIE F;:E(;¢J]:F'.E[:, S]:2:E OF THE SOIL. FIB2i;ORF'TTON S'.r'E;TIEH ]:5;: THE L. EI'qCiTH [:,IMENsZIOI"~ IE; THE LENGTH ,::It',! FEZE'f'::, OF THE "FRENE:I~I TFI['{ DE:F'TH OF' 61 TRENCH OF.'. PIT I~'~; THI:'."Z. C, IS.';I'FINC:E: E~E:Tld[~:E':N THE S:,I. JFi:I::I::'IC:[i~: O!:::' THE: GF.'.OLII'.,ID Ri'.,ID THE BOTTOM OF TH[E E:;~-,:CF:I',,,'FITIOF,I ,::Ii'.,l FIFIIl.:~:'f'::,. THERE IX NO .S;[ET NI[:,TFI F'OIR TRENCHES. '1'1-1[£ C~i[;.'.F:I',,,'[~:L.. DE:[:'TH I r.S TFI[~ MI f.,III'ILII"I DEPTH O1::' EiF;'.FI',,,~[;L E!~F:':'f'!-,.I~EN f'II'.,fE.', THE: F30TTOM OF: THE E:',,-.,'C:FIVI::I"I"]:OI'.4 ,:: ]:hi ,F~'.' ~.~:: ~G:~" ~!.j :.C F.". ~-C: ~E::, ~LCE; ~E F" 'T' :'ii: ~:Z: '"If'" IFil ~'..~ ~-<:: :E-."; % S~ E~i': ~:"~-~ ::IL E;F:IE:KF t L J_. I NG OF FIN'¢ 'S;'¢F.;TE:.M N I THOUT F':I: Nf-:IL. i IqSF'ECT.t' ON FIND I::IF:'F'F~:EWFIL. DE:F'I::ff~:'I'MENT I.,.tIL.I... BE SUB...I'ECT TO PROSECUTION. H 1 t"41 I"IIJPI D 1%TFINCE BETI,.IEEN R NELL F~I'.4[:, RN'¢ ON'""S I TE SENF!C:iE :LE~E~ FEE'I" FOR R F'F.:ZVFtTE NELL OR 20(£~ FEET FOR'. FI [::'LIL:~I.. :I: C: HELl .... SPEC :[ F' I E:f:l'r 101"4S RNL':, C':OI'.~SJTF:',LICT I ON [:, I FtGF.:FII"IS; FIR![E [:~'v'FI I L.FIE;LE "1'O I :[ NS"['FtLr. L.I::IT I ON. :[ CEF..'T I F'V 'rHR'f' ::L: t I:~f'l FRf,III...IFIR I-4ITH THE REC,'.!LIIREI"IEI'.,ITL:,, FOF,' ON..-E;ITIE 5;EI.,.IE:F:~; FINE:, I,.iEL.LS; i::!5; 'i};IET F'OF.:TH B'¢ THE: MUN I C I PFIL. I '¥'¢ OF FII'.,IC:HORRGE. 2: I !.,IIL.L INSTRL.L THE s'~-'r~;"r'Er,1 IN RC:COE'.DRI',IC':E: I.,!I'l"l.-I TI-IE CO[.':,E::.:;. :ii:: I UNDER2;TIaND THFIT THE F'.E:r~IDENC:E I5; F-..'EMODEI..E:D TO !NCI,J..I[:'E FIPPL I CFINT E!:ERi",I 1' E k:L I Nli-:: Department. of EnvironmenLal Qu~l 3330 "C" S~ree~ Anchorage, Alaska 99503 SOiI,S I,OG - I'EROI,ATION TEST Performed for ].zL~.ZttOi~% ~:~!/,,~.& . Date Perfornled..~?j.C$_~:m?~_(~ This form reports: Soils log ~ ~erco/a~ion ~e~ Dep [h Feet 7- 8- 9- 10- ll - 12- 13 14- Was ground water encountered? _- //0 If. yes, at what depth? Reading Date Percolakion rate Gross Time mi nu re. Net Time Depth to Water' Net Urop .Proposed 'installa~-~-~-n': Seepage Pit . Drain Field ....... De.p~h of Inlet . Depth to,bottom of pit or trench , __ ~..li_~._S. ~..._~.._._,.F_..__,.~..~__.~....~:_~.,.:,O ...... ~ '~ c~q.~__.G~ .... ,-. .-, ...: ,../,, m. l :,o~ ~ ..... ..,~~ ~2~ m~_. ~.., ....... ¢;erI fie rilling by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ,. ',' 5 ADDRESS LEGAL DESCRIPTION DATE - Started .... PERM1T NUMBER DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING --'~ KIND OF FORMATION: From From From From From From ' Ft. to From : Ft. to From :~ Ft. to From ' Ft. to From__Ft. to From____Ft. to From Ft. to__ From Ft. to From__Ft. to____ From Ft. to From Ft. to From __Ft. to Ft. to ' ~ Ft, to. : ~ Ft. to ~ / Ft. to ] / Ft. to / ' Ft. '>Ft. - ,, '~ Ft. ) 7j Ft. , ~(; ~> Ft. Ft Ft. iff' !i ~;:~,~ ~¢/- '~ / Ft Ft Ft Ft Ft. Ft. Ft From Frmn From From From From From __Ft. to.___ Ft. Ft. to __Ft Ft. to. Ft ____ Ft. to_ Ft Ft. to_ Ft. Ft, to Ft, Ft. to Ft Ft. to Ft Ft. to Ft. Ft. to . __Ft From Ft. to Ft. From____Ft. to .... Ft From Ft. to__Ft From__ Ft. lo Ft From Ft. to Ft. From Ft. to Ft. From Ft. to__Ft MISCL. INFORMATION: DRILLER'S NAME ./., 4>*'/ / / ,/' / AS.BUILT i hereby certify that I'hnve surveyed the ~ollowlng Anchorage Recordl.g Precinct, 'Alaska, and that the improvements situated theffeon are within the proppwty lines ~nd do not overhp~or e~croach on tlxe property ~, ~g ndiaeent thereto that no imprOvemunts on pro?- rtv lying adjacon[ IhereLo encroach on the premises In ~u~s~lon and that q~e'e are no roadways, transr~ssion nes or other vi.dble easements on said property excep~ ~,s indicn[ed hereon. , : Dated at Ea~!e River, Alaska thi* g-Z ~xm day of ~:~:'~x ..... l'9Z~ I[OBEIIT C, JOHNSON SCALE: llegisterdd Land Su~:eyor No. M0-I2 1' := ~ ~ Box 456, Eagle l~iv'er, Alaska ' , Phone 694.25,t3 ' '~UNICIPALITY 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 Parcell.D.# ~,-~-L/c~\- /-~ NAA# 1. GENERAL INFORMATION Complete legal description Lot 13... Block "D"; Glacis, View H¢igh~ Subdivis Location (site address or directions) 1555 Myrtle Drive Property owner Mailing address Lending agency Mailing address Stephen P. & Natalia Carboy Day phone 696-2862 HC83 1540 M~rtle Drive Eagle River, Alaska 99577 City Mortgage ATTN: John Mart~n Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. $ . NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: XX Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: ×X 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. 72-025 (Rev. 1/91) Front MOA ¢f21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown betow, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address _ Engineer's signature ]7034 Eagle River Loop Road No'. 204 Phone bedrooms. DHHS SIGNATURE _/'~ Approved for 5 Disapproved, Conditional approval for Date bedrooms, with the following stipulations: Additional Comments Date __ 'Fhe 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. 72-025 (Rev ~/91} Back MOA Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,,f- I.'~ ~/., If A, B, or C, attach ADEC letter. Date completed Cased to ~ C~, Parcel I.D. ADEC water system number ~0 ~ t,~ _ "~1~ Driller Casing height Wires properly protected (~N) A. WELL DATA Well type Log present I~YN) Total depth Sanitary seal ((~/N) FROM WELL LOG Date of test Static water level \ Well flow t Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot \ Public sewer main ~ I/x-- Sewer service line g.p.m. AT INSPECTION g.p.m~ .... ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform C:~ ~'°~'/l¢o~J~ Nitrate Date of sample: ~-' '5 t¢¢1 ~ B. SEPTIC/HOLDING TANK DATA Date installed \ ~"J L~ Cleanouts ~¢7N) ~l High water alarm (Y/~ Date of pumping (:~, ~ ~ ~'t ~/~ Other bacteria i~,-~ ~ ~J- ¢. Collected by: S & _~NG~NEERING 17034 Eagle River Laop Road No. 204 Eagle River, Alaska 99577 Tank size \oc, o ,¢u'v-~';7~ Compartments Foundation cleanout (Y/~;I~ r-~ Depression (Y/(]~ ¢'~ Alarm tested (Y/N) fi '~' ¢' ~¢-- Pumper _~-~, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~.c~ ~.,L. On adjacent lots \~c~ To property line ~ ~'~¢ Absorption field Surface water/drainage ~. c~ c~ ~ .F Foundation Water main/service line. 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size an gallons Vent (Y/N) High water alarm level Meets MOA electrical codes._¢(-¢l~ S~FROM LIFT STATION TO: Well on tot On adjacent lots Manufacturer Manhole/Access (Y/N) :~ ~ "Pump on" level at ~p off" level at ~ Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed \ Length \ L¢~ Width Total absorption area "~ Depression over field (Y~:,b) Results.~ail) Peroxide treatment (past 12 months) Gravel thickness -]-~' ..... Total depth Cleanouts present (~i¥N) _ Date of adequacy test for "~. ¢', ~.r7..¢.._ (-5.) bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ \~ Surface water Curtain drain To building foundation On adjacent lots --z~o On adjacent lots_ ~, C)C) ~ .v.-- Property line To existing or abandoned system on lot Cutbank ~ Ij~- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, 17034 Eagle R ver Leo Eoa ~¢~ oo, %?/~ 8 Signature ' p dine; ~¢,~ ~" ~ , .~ , ~.,~ Date ___ ~ .,~[ .., .... ~ .... ~. '""_~7~,~) HAA Fee $ // 7~) ~D~7) Waiver Fee: $ ,, Date of Payment ~¢d.//~ 9~.~ Date of Payment Receipt Number 2~/fi" L'~',~ff'') Receipt Number MUNICIPALITY OF ANCHORAGE .~ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~-~'~ ~.¢(L% ~ ~.~ ~ --\ ~ HAA # ~\ -~--%,°--?~ E'3~ / 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 13; B¢.o~k D; Gla~¢.r V~o.w Hcdgh~ So.b~'.v~on (b) Location (address or directions) 1555 Myrtle, Ea.ql¢ Rive.% Alaska Fr e. ddi~. Mac Property owner Telephone: (home) Business Mailing Address (c) Lending Institution NBA Mailing Address Telephone (d) Real Estate Company and Agent JACK WHITE C01dPA/,/Y/Barbara Critte. nde. n Address 10928 Eaql¢ Rive. r Road, Ea.q~¢. River, Alaska 99577 Telephone 694-5500 (e)Mail the HAA to the following address: (or check here [~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle. River Road. Suit~ 204 Eagle. Riv¢.r. Alaska 99577 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms 3 3. WATER SUPPLY Individual Well ~}( Community [] Public [] 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 O~-siteX~[ Public [] Cornmunity [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. ?~-o2~ ¢~. z/~) Page 1 of 2 A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authorily Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: If A, B, C, D.E.C. Approved (Y/N) t~//A Well Log Present (Y/N) ~ __ Date Completed Total Depth_.,~.(o(~ Cased to ./O~,~- Depth of Grouting Static Water Level _ / Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/,HoM;,-~ Tank on Lot / To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~/~ To Nearest Sewer Service Line on Lot Water Sample Collected by _ ~.~ ¢ ~'~ Water Sample Test Results _ Comments Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Yield ' 'f-' ;On Adjoining Lots / O(~ "1c' [ [// ; On Adjoining Lots / O62 '# To Nearest Public Sewer Cleanout/Manhole ~/~ B. SEPTIC/HOLDING TANK DATA Datelnstalled ¢¢ si×e StanOpipes (Y/N) F Depression over Tank (Y/N) [OOC) No. of Compartments Air-tight Caps (Y/N) ~/ Foundation Cleanout (Y/N) Date Last Pumped / Pumping/Maintenance Contact on File (Y/N) /v///~f ; for ~ Holding Tank High-Water Alarm (Y/N) /~/~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: [ To Water-Supply Well __.[ CO ~' To Property Line ~/¢ ~) /~ To Water Main/Service Line / 0 'lc To Stream, Pond, Lake or Major Drainage Course Comments -~-b~_~% ',~¢}~_' ¢aq ~ O) To Building Foundation ,~"-~ To Disposal Field [Z/ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~' -'~/o Width of Field /' ~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~JX~t"~ Type of System Design / Length of Field Depth of Field / O Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / / / To Building Foundation Lot To Water Main/Service Line ,/O To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line /7/ O ' ~ To Existing or Abandoned System on ; On Adjoining Lots ~'~O 7c To Cutback (if present) /-~0 ~ 4/0' Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/ Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERING Company Date MOA No. 17034 Eagle River Loop Road No, 204 Eugig,-Rivc:,, A!a.~.k.~. 99577 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~o~ Anchorage, Alaska 99518 ?,~0~ Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER o Pu,,,o w^TE, SYSTEM ,.D., :~P.~VATE WATE. SYSTm Name S & S ENGINEERING Phone No. blai~mg Add~.a~le River, Alaska ~'957'/. ,~,~ City State Mo. Bay Year SAMPLE TYPE: ,~..~%Routine Check Sample {for routine sample with lab ref. no. [] Special Purpose Zip Code Treated Water Untreated Water SAMPLE NO. LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,-~atisfactory [] Unsatisfactory [] Sampletoo long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: Membrane Filter No. of colonies/100 mi. Lab Ref. No. Result* J FTq I-~ I Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC Membrane Filter: Direct Count Verification: LTB BGB. Final Membrane Filter Result~ Reported B~~ ~'' Date Time: Too Numberous To Count Col[lorm/lOOml / Collform/100ml ?-/~ - ?? /,3'~--~__ e.m. p.m. OB = Other Bacteria CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ,~,Z~.~o.~,.~' FEDERAL TAX ID # 92-0040440 AItAL¥SIS REPORT BI SAMPLE for Work Order ~ 14753 Date Report Printed: JUL 13 89 ~ 14:50 Client Sample ID:L13 BD GLACIER VIEW HTS PWSID :UA Collected JUL 10 89 @ hrs. Received JUL ii $9 @ 16:45 hts. PreserYed with :AS REQUIRED Client Name : $ & S ENGR Client Acer : SNSENGP P.O.# NONE REC'D Req # Ordered By : Analysis Completed :JUL 12 89 Special Instruct: Send Reports to: 1)S & S ENGR 2) Chemlab Ref ~: 6223 Lab Smpl ID: 1 Matrix: WATER Allowable Paramster Tested Result/Units Method Limits NITRATE-N ND(D.iO) ms/1 EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. 1 Tests Performed ' See Special Instructions Above UA~Unavailable ND~ None Detected "See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT-Greater Than · i -j 3l WATI':R ,,1¢,, LY Oilier Individual Wel~/~ .... Cornmunity |L] Public [.TJ ,/ . . . Note: if community well system, must have written confirmation from the State Depa~ lment of £ ]v ro ~ ~e ~tal Conservatio ] ~-:ttesting to the legality and status. Page 1 of 2 On$ite Public l_-J. Community |~ Holding Tank [] No(e: If commu nity,,,,,~ll system, must have written Confirmation ff'oi]~ lhe State D~; :)arb~ent of EnvirOnmental Conservation attesting ~o the legality snd status. CAUTION Yhe Mundpality of Anchorage Dcpa~rnent of Health and Environmental ?rotection (DHEP) issues Health Authority App¢oval certificates based solely upon the representations given in pmofjrai)h 5 above by an independent professional engineer registered in ti~e Sta!o of Alaska. The DHEP does this as a courtesy to pu~cha:~ers of homes and their lending institutions in order to aatisfy certain federal a~/d state requirernents. Emt)loyees el DHEP do not conduct inspections or . analyze data before a cerl. ificalo is ~ssued. The Municipality el Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 ?2-025 [11/84} MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: A4UNICIPALITY OF ANCHORAQE DEpy, OF HEALTH & ENVIRONMENTAL PROTECTION WELL DATA Well Classification Well Log Present ~N) Total Depth "~..~¢6;~ ' Static Water Level Casing Height Above Ground Electrical Wiring in Conduit ('~N) Separation Distances from Well: To Septic/HeMim:j Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed LoC [ \ ¢'~ t~ Yield Depth of Grouting ~-- Pump Set At LJ~f~-. "~ Lc ~' Sanitary Seal on Casin~N) Depression Around Wellhead (Y/~'~-'~'~ Cased to /Ob,5-- ' ; On Adjoining Lots / ~:;~ ~ To Nearest Edge of Absorption Field onlLot To Nearest Public Sewer Line IJI/~'/-- Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ' · , On Adjoining Lots / E~- c;~ /--/~ To Nearest Public Sewer Nearest Sewer Service Line on Lot //._/~/~-/,,,.3/_,, ; Date ~' ~ / B. SEPTIC/HDL-Dllq'6f'TANK DATA Size To Property Line To Water Main/Service Line Course Date Installed Standpipes ~)'N) Air-tight Cap~/N) Depression over Tank (Y~___~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/44el~i~§ Tank: To Water-Supply Well No. of Compartments Foundation Cleanout (Y/~_~. [)ate Last Pumped /~ ,,,,3//,~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ! To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DA'rA soils Rating in Absorption Strata Date Installed // Width of Field Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy 'Test Type of System Design Length of Field //-,¢ Depth of Field / Gravel Bed Thickness Standpipes Present ~¢/N) Date of Last Adequacy Test / Separation Distance from Absorption Field: To Water-Supply Well /! ~'¢ To Building Foundation Lot ~/,A To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line '7~-- / To Existing or Abandoned System on ; On Adjoining Lots "~, /~' "~ To Cutbank. (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) pup Off" Level at Vent (Y/N) . roping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t~a~~a~(~..,.,~.~ ,~¢~i~f~d or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed ,~-J~--~r~ Date ,JUN I 6 1986 Compar~-;~.6L_l::~l~l~-~)~3~-- MOA No, ~'~'(--~") ''~ Receipt No. Date of Payment Amount: $ ~ Page 2 of 2 72-026 (11/84) 'snims pue uo!leAJeSUOO le:lUaUU uo.hAUSt ,to luawHedeQ [] ~iue]. 8u!plOH ~ Ai!untutuoo [] 3!lqnct [] al!suo q¥SOdSIQ ~ Jo l abed · snlels pue AlileSel e41 Ol 6u!lseile UO!ll~AJaSUOO lelUetUuo~!^us~ Jo ~uaLul, JedaQ alelS e41 LUO~I UO!~eLLIJ!:IUOO uallp~ eAeq mmu '~UelSAS Ila~A Xliun~u~uoo ti :elON [] Oilqncl E] ~l!untutuoo ¢q IleA& lenp!^ipul AlddnS '8 Jaqlo ~-- stuooJpai~ IO JaqgunN [] ~l!LUeq-!lin~ E~AI!tUe::l-elSUiS :ssa.ippe 8u!~OllOI eql. o] VVH @ql I!e~ auoqdela± (~) sse~ppv ¥/'i7--- lua6v pue Auedu~o:D OlelS~ le@U (a) 0'[~66 )tV ' 8.1~'~d. OL[OLIV--s-9~tT-~ ssa.Opv (suo!]joaJ!p JO ssoJppe) uo!leooq 9~6T , ~ £.~] olec] uo!leoilddV NOLL¥1fiiI:IOJNI' IYH~IN:I9 'l A±IqlOVJ U31VN~ {]NV U3M3S fl±IS-NO JO 9VAOUddV AIIbIOHIFIV HJ. qV3H UOJ NOIJ_O3dSNI JO 3J. VOIJIIU30 H/I'~/':IH '~¥.LN::IINNOt:IIAN.-1 ::10 NOISIAIQ NOlIO~l.l. Ol:ld IYJ. N::ilNNOUI^N:I aNY HI-I¥:iH 40 .LN::]I,~I/HYd::IC] ::IgYUOH:)N¥ JO AIF'rVdlOINI31~I ':~Jo~ S,,le@U!eue leuo!ss@jmd CHI u! suo!ss!uJo JO s Jo J Jo Joj alq!suodsaJ lou s! aeeJOglOUv jo XHled!o!unH eH/'panss! s! eleo!l!Hao e eJo|eq elep ezXleue ~o suo!~oadsu! lonpuoo :lou op cFJHC] jo seeXOldUJ:l 'slUeLUe~!nbeJ elels pue le~epeJ u!eHe3 X~s!les oh Jep~o u! suo!lnl!~su! 8u!puel ~!eql pus SeLUOll JO s~esetlo~nd ol Xsel~noo e se S!ql seop cJ~]HC] aqJ. 's>lSelV jo @Isis eql u! pe~e~s!ee~ ~esu!eu@ leUO!SSejmd luepuedapLH us Xq e^oqe ~ qde~§eJed u! ua^!8 suo!leluasa~da~ aql uodn ~lelOS paseq seleo!l!Heo le^oJddv XH~oqlnv qlleeH senss! (cl-]HQ) uo!loa~mcl lelU@LUUm!^U:I pue HHeaH 1o ~UaLUHeded eee~oqouv ~o ~Hledpunv,~ eqJ. NOI.Ln¥O q6~g-t,69 ~,6~iZ X08 '0 'd (~9/Ll)9~O-~ ~ ~o ~ eSed s~ueuJuuoo f2~//I,/ os~noo ebeu!eJC] JO[eV~ Jo 'eHe-I 'puod 'uJeaJ]S o/ / ,~/ ple!:l lesods!c] Ol / ._¢_~_ uo!~epuno-j 6u!pl!n~3 o± ,/~//./~ (N/A) ~lbUJed >lUel 8u!plOH XJeJoduJe/ Joj '. -f'd/.¢ ///¢/ pedu~nd ~seq eled /V (N/A) ~nouealO uo!lepuno-I /~ ¥.LVO )iNVl !DNla'IOH/Olld::IS '~ 4'~,~_/ ~ ~/ z- ,./ ~.¢' sllnSebl lSel eldUUeS JeleM ¢¢/~q/ eloquevw1noueelo 1~,~/ - eu!q ~eMaS o!lqnd lse]eeN o/ loq uo ple!-I uo!1dAosqv Io asp3 ~se]eeN o/ o9 / ~o-I uo >~uej_ 6U!plOH/O!ldes ol ¥1VO "l'r:l ~ NOIIDglO~'d qVIN-2VVNO~I^HJ ~¢ HI'IV~tl -JO 'Id:Jcl '30VFJOHDNV 40 XZIl"/dlgl'F[FiY'l :uo!].d!JosoG lefio-1 I~861- A~IVN~JG3-1 - 181'1)103H::) (VVH) 'lVhOEIddV AJ. IEIOHIfl¥ HI'IVgH (vOtN) gSVEIOHON¥ ~O All'lVdlOINniN ,¥ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~//7~ Width of Field /'~ / Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy 'rest Separation Distance from Absorption Field: To Water-Supply Well / To Building Foundation '5-;~Z~- / Lot TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field /~', ' Depth of Field /'~ ~ Gravel Bed Thickness 0,5" '" Standpipes Present (Y/N) Date of Last Adequacy Test /O -/~' - ~'~- To Property Line ,~ 9 / To Existing or Abandoned System on ; On Adjoining Lots ¢'_~'c: -'" To Cutbank (if present) Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. MOA No. Company Receipt No. Date of Payment /~-/'/'~'~ Amount: $ Page 2 of 2 72-026 (11/84) r/IIJNICIPALITY OF ANCHOI:tAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVI.SION OF ENVIRONMENTAL HEALTH ER ¢!l.',t, ~fg: O1' ~N'J' :C, llOf., FOFI HEAt. TH AUTHORITY APPROVAL OF ON-51'fE SEWER AND WATER FACII_.ITY 264-4720 Application Date GENERA[,, (a) Legal [.)q--c.r i;q oil (iriclud.e lc t. bock, subd vision, section, township, range) , I// o. [ Location (address or 0if(?ctio0;) (c) Applicant is (check ore): Lending Institution E]; Owner/builder~; Buyer []; Other [] (explain); {d) Lending Institutior) .................................. Telephone Address (e) Real Estate Company and Agent Address (f) ~L~i tho ~tAA to tine following address: TYPE OF RESIDENCE Single-Family'S,. Multi-Family [] Number of Bedrooms _9 Other WATER SUPPLY Individual We~ Community [] Public [] Note: If community w'el~stem, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,~-~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Deparlment of Environmental Conservation attesting to the legality and status. 72-025 01,84) Page 1 of 2 ENGINEERING FIRM PROVIDII,,,.4 INSPECTIONS, TESTS, FILE SEARCH, D~-,, A AND INFORE~IATION 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 ~E, ~--t-- ~;% ...... Address .~,¢. ~ Date Telephone DNEP APPROV~L ..... ... Approved fo~'''~j~'~-'':~'~ bedrooms ~ /f~',~.~z.- Date_ Approved ._~'~ Disapproved _ Condition~ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in tile State of Alaska. The Dt-IEP does this as a courtesy to purchasers of hoFnes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 engineerls work. Page 2 of 2 72 025 (11/84) WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MfJA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAG;! DEPT. OF HEALTtl & EN¥IROhlMENT/=,,L PRGTECi'/Oi I Well Log Present(~,N) Total Depth '~-,~O Static Water Level /(',¢//, .5"~ ' Casing Height Above Ground ~ ~ Electrical Wiring in Conduit~.,..~) Separation Distances from Well: To Septic/Hr4din.~g. Tank on Lot To Nearest Edge of Absorption Field on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed. ~/..~ - /~/-'7 ,~ Yield Cased to ~', -;.~,,'./~/~,-.~ Depth of Grouting ~ Pump Set At ~.-¢"r~"; / Sanitary Seal on Casing Y~N) Depression Around Wellhead (YN~ ; On Adjoining Lots ///~./z ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole -~ To Nearest Sewer Service Line on Lot '-~' Water Sample Collected by ~"~-'-~ ~. ; Date Water Sample Test Results ~- ,"¢~"7"~ 5' /C:=~_(_ .-~-~,~.¢~..¢¢./ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~N) Air-tight Caps Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~//- To Property Line /'~ To Water Main/Service Line ,,/0(-.) ! Course Size /O O0 ~ No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped /¢ '-/~-' ,~'~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field __ To Stream, Pond, Lake, or Maior Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELr) DATA Soils Rating in Absorption Strata Date Installed i¢7¢ Width of Field - Square Feet of Absorption Area Depression over Field (Y/~_¢~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //~ / To Building Foundation '7 i~ Lot ~P/J3,~. Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (~N) Date of Last Adequacy Test To Water Main/Service Line -//¢/! d~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Properly Line /'//¢¢' 1~- To Existing or Abandoned System on ; On Adjoining Lots /QcC~f/C- To Cutbank (if present) --~ too r.¢_ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~;~ & ~,~ ~;;.~;iM~,~ii~k'4 Date ComDany~ Receipt No. - ~, Date of Payment Amount: $ MOA NO. '¢~,~::20-~ Page 2 of 2 72-026 (11/84J DA~:E RECEIVED INSPECTION APPOINTMENTS TIME T, ME T,ME , ~'.C::~ ~'-- yk~l/ ', MUNICIPALITY OF ANCHORAG~ MUNICI~LITY OF ANCHORAGE DEPT. OF INALTH DEPARTMENT OF H~ALTH & ENVIRONMENTAL PROT~NMENrAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION NOV Telophono 2~4.472o .o.A...OVA. o. DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing, 1, PROPERTY OWNER PHONE ~AI LING ADDRESS PROPERTY RESIDENT (If different from able) PHONE ~Y~d~ ~. ~/~ ~g~ · 2, B~YER ~ PHONE MAILING ADDRESS 3, LENDING INSTITUTION PHONE MAILING ADDRESS MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE " SINGLE FAMILY [] MULTIPLE FAMILY NIJMBER OF~BEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM ~ I NDIVIDLJAL/ON-SITE** [] PUBLIC UTILITY \ qq~), YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL IJSE ONLY 1. 'rYPE OF RESIDENCE NUMBER OF BEDROOMS [~ SINGLE FAMILY [] ONE [] 'THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [~ FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] iNDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVI DUAL/ON -SITE -DATE INSTALLED []PUBLIC UTILITY Connection Verified __ INSTALLER [~]Septic.._Tank~.or [] Holding Tank Size:. /'~P--~ If Tank is homemade -SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER~-~ ,-<-~ TOTAL ABSORPTION AREA MATERIAL .~ ~ 4. DISTANCES Septic/Holding Tahk ~Abs'orpt' Sewer Line Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS I~'"'APPROVED FOR ',-~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 79-O10 IRev. 6/79) DAVID A, SLENKAMP ROBERTA. SHAFER MECHANICAL ENGINEER CIVIL ENGINEER 694-9055 694-2979 November lt~ 1980 MUNICt?ALIIY OF ANCHORAGE DEP]. OF t'!.'.L]: & ~NV-' '-IRONMEN1AL ;; > Area Realty ATT~TION: Virginia Kohfield P.O. Box 249 F~gle P~.ver~ Alaska 99577 I.I( l 2 i Dear Virginia~ Reference: Lot 13; Block D; GDacier View Heights A sewer system adequacy test was performed on the system located on the referenced property per your request. The septic tank was pumped and verified to have a capacity of 1000 gallons and after a period of 24 hours approximately 589 gallons had percolated out of the crib. It can be concluded from this test that the septic system is currently functioning adequately for the three bedroom residence. If we may be of further assistance, please do not hesitate to call. Sincerely, __ ~)B!']RT A. 'SHA~ER, P.E. Department of Health and Enviornmental Protection Transamerica Title Insurance Co. SRB 196X EAGLE RIVER, ALASKA DF. PARTML ,'~F_-I~EA[.TH AND ENVIRONMEN L PROTECTION 825,--~I// Street, Anchoraa~. Alaska 99501 j~f-J~ Date Received: December 16, 1977 tit: Time [~,~/~A,~22~--- ' ~2: Time ~3: Ti~e Date /-~$.7~ ~q/[~S Date Da~e Insp ~_ Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska National Bank of the North Mailing Address: Phone: 2. Property Owner: Bernie/Bonita Kline Mailing Address: Box 627 99577 Phone: 272-4441 3. Legal Description: Lot 13 Block D Glacier View Heiqhts Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of BedrOoms: Number Of Bedrooms: Three 5. Well System: Individual well (x) Comanunity/Public System ( ) Permit ~ Depth of Well 260' Well Log on File ~) Construction ~ffJ~~%. Bacterial Analysis~' 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # 'l/~ Septic Tan]< Size Absorption Area Installed i976 Installe~ /, ~!1~.) ~o~l-q. . Manufacturer I ~ ~</.%D, Soils Rate t ~Q,.') Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Let Line ]?age Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 13 Block D Glacier View Height Comments: Affadavit Attached: '(' ) Approved: Letter Attached: ( ) Disapproved: Date: Department Worksheet: REALTORS' 3. Name of Mailing 4. Name of Mailing REQUEST FOR APPROVAL OF INDIVIDUAL~ & WATER FACILITIES Type of Inspection: CMRO VA FHA CONV Property Owner: ~z~%~¢._~,~'~,/~//~.~~'~ .~'~" ~01~/ ~ /~ _ Ma i 1 lng Address: ~] ~- ~'~Y~, ~(~~ Z:~/~[)aY. Phone Buyer: ~]~Z m ~ '~] ~" ¢:/~ &'~. Lending Institution: ~X~2~,~ ~'Z_. ~/61/~ d/~- Address Phone blame of Realtor or Agent: Mailing Address: ~'~ ~,~ ~, Location: /ff ~ /~-~-- 7. Type of Facility to be inspected: No. Bdrnls. ~ Water Supply Type of Supply: Public Utility __ Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility __ If Individual, date of installation: Individual (on-site) REALIOR ' AREA, INC. REALTORS Anchorage "C" St. Office 3300 C Street East Anchorage ~] Eagle River Eastgate Office Parkgate Office 5437 E. Northern Lights P.O, Box 249