HomeMy WebLinkAboutGLACIER VIEW HEIGHTS #4 BLK 2 LT 7Glocie View
Heights
lock 2
Lot 7
050- 501
-39
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201212 PID Number: 050-501-39
Dwelling: Z Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Z Upgrade
Name
TIMOTHY & MICHELE MCLAIN
ABSORPTION FIELD
® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
22813 EAGLE GLACIER LOOP, ER
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
0.6 GPD/SF
10 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4 Ft.
Gravel depth beneath pipe
6 Ft.
Subdivision Block Lot
GLACIER VIEW HTS. #4 2 7
Fill added above original grade
VARIES 0.5 - 4.2 +/- Ft.
Gravel length
2 a 38' 76 Ft.
Township Range Section
Gravel width
2 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
912 Ft'
2
12 Ft.
Well
100'+
100'+
25'+
TANK ® Septic ® S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1250 Gal.
Surface Water
100'+
100'+
Material
HDPE
Number of compartments
2
Lot Line
10'+
10'+
NA
Foundation
10'+
10'+
LIFT STATION
Manufacturer
ORENCO / GREER
Capacity
1250 Gal.
Remarks Original field abandoned in place. Better
material / no fill found at ex installed 6' ED -10' max.
Alarm location
GARAGE
Electrical installed by
DRS ELECTRIC
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Installer JRs
Drainfield 3034 CO/MT 3034
Inspector FWC
BENCH MARK (Assumed elevation) 100 ft
Inspection 151 7/16/20 7/17/2020
Location and description
2nd
3`d 7/20/20 4" 7/22/20
BOTTOM OF SIDING
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
OF A,Q�®��
• '
Conditional Approval: Date
��Q ' ' • :�,f
-49 �- ........��
System
r �.. Curtis Huffman..0
Aep�o
pp
Date7 Z 2 U
•:�
�� F •, CE 128991
�• . 7/22/2020. •����,�
�apROFESSI�NP -:
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
PERMIT: OSP201212 PID: 050-501-39
�S
7
INSTALLED PARALLEL SSS,,
TO SLOPE - FLAT GRADE
PL STAKED 10' OFF PL G
T
MT H TH2O-1 753
<O
eZ/T- 6 F
2 MT WELL STAKED
MT NEW 1250 -GAL AT CONST.
E HDPE STEP
D �
C M
EXISTING FIELD ABANDO ED DECK
(� • IN PLACE - NOT CONNECTED g
� WALL A � FCO
ORIG.TANK DECK
(� A FILLED
CONCRETE 16?
m
SUi
CANT o C i ENTRY S
a m CANT
SCAL 1" = 30 CONC 14.3'
A -C=13.2' MT MT
B - C = 2 8.0 ' FCO 8.40 MH MH 98.33 FINAL GRADE 100.52 FINAL GRADE 99.12
A - D =17..3' ORIGINAL GRADES 2
FILTER FABRIC TH2O-1
B - D = 3 0.1' 90.45 1' ORG/OL
A - E = 4 6.5' SPUTTER 94 32 94 32 BETTER SOILS FILL
ENCOUNTEREDL5'
B - E = 6 9.3' 89.87 1250 -GAL SEWER ROCK AT CONST.
HDPE 88.32 88.32 NO FILL
A -F=59.7' STEP TANK
102.52 MT FINAL GRADE MT 98.82 GM
B -F=80.6 98.32
A -G=70 1' ORIGINAL GRADE
FILTER FABRIC GRND.WTR.
B - G = 81.0'18' 6/25/20
A - H = 5 5.1' 4.32 94.32/BOH
SEWER ROCK 80.32
B -H=65 2' SEPTIC SECTION gg.3Y 88.32
SCALE; NTS 7 —\ I
GLACIER VIEW HEIGHTS #4 132, L7 SUPPORT$SERVICES: �]\j�
PREPARED FOR: /��� OF '"� \'
TIMOTHY 8c MICHELLE MCLAIN �� TH �'71�
22813 EAGLE GLACIER LOOP' * 9
EAGLE RIVER, AK 99577
FIRST WATER CONSULTING
DATE: 7/23/2020 ` rtis Huffman ,'�;
13030 Sues Way SURVEY: JLS 1 CE 128991
Anchorage, Alaska 99516DRAWN FWCS ' 7/23/2020e W
(907)350-9566 SCALE: 1" = 30' A�sSlp��ti
firstwaterAK®gmail.com\`,��
18207 Stillwater Dr., Eagle River, AK 99577 907-351-5163
July 22, 2020
To whom it may concern,
This is to confirm that the lift station was installed at 22813 Eagle Glacier Loop with all wiring
done per NEC.
If you have any further questions feel free to contact me at 907-351-5163
Thank you,
David R Stevenson
Owner
DRS Electric, LLC
EAGLE RIVER ROAD
N19�4°?1'Ar. "dlll
L —2 01.96'
R=3975.00'
012
N
00
rn
F*
N54°21'45"W
N
— —
EAGLE GLACIER LOOP
.� _...
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
GLACIER VIEW ESTATES No.4
LOT 7 BLOCK 2 PLAT 54-77
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: DATE: SCALE: E -MAIL -
JULY 21, 2020 1"=30'
20-046 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PT
JLS SWO159 200153
* — FND 518" REBAR
o ..A ,L LAIrI) >i
AW �� ��
'Ilk.yk
J001' 49TH
RA .........?A
...,...... .. ....... „_,
• • . . . . . . . . . . . . • . . • • • . . .
; ; • .�
•.JJOHN L. SCHULLER.• Q
LS -10408 �'
�,, ' • . •' 1•��� ® 1831 Talkeetna Street .
' d AW Anchorage, Alaska 99508
, Aro fes l Lo,� (907) 227--1455 office
s 40na.�•�'�� (907) 274--4992 fax
7/14/2020
ON-SITE SEPTICMELL PERMIT APPLICATION
Parcel I.D. 050-501-39
Property owner(s) TIMOTHY & MICHELLE MCLAIN Day phone 9073820485
Mailinq address 22813 EAGLE GLACIER LOOP, EAGLE RIVER, AK 99577
Site address 22813 EAGLE GLACIER LOOP, EAGLE RIVER, AK 99577
Legal description (Sub'd., Block & Lot) GLACIER VIEW HTS. #4 B2, L7
Legal description (Township, Range & Section)
Lot Size 43563 Sq. Ft. Number of Bedrooms 3
APPLICATION 1S FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
X❑
Initial ❑
Single Family (SF)X❑
(w/wo AD U)
Septic Tank
21Upgrade
ElDuplex
(D)
ElHolding
Tank
ElRenewal
El
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:. Ljy &, 26
Date of Payment: 61.3 0
Waiver Fees:
Date of Payment:
Receipt Number: 9063521 Receipt Number:
Permit No. O S P 2 012 1 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350 -9566 / firstwaterAK@gmail.com
June 30, 2020
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: GLACIER VIEW HEIGHTS #4 B2, L7
The property owner has requested we obtain a permit to upgrade the failed septic system of the
above referenced lot. We propose to install two pressurized deep trenches and 1250-gallon
STEP tank to serve the existing 3-bedroom residence. The design is based on the recent test hole
conducted on June 18, 2020. Groundwater was observed at test hole excavation and monitoring
at 16. A retaining wall is 35 from the closest proposed trench with. The base of the retainining
wall is approximately the same elevation of the top of the effective depth.
The slopes are moderate at 0-5% at the proposed upgrade location. A retaining wall is 35 from
the closest proposed trench. The base of the retaining wall is approximately the same elevation
of the top of the effective depth of the proposed trenches. The lot and area are served by private
water. The design will not impact any of the neighboring properties. Please contact us if you
have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201212, Rebecca Carroll, 07/14/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201212, Rebecca Carroll, 07/14/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201212, Rebecca Carroll, 07/14/20
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: GLACIER VW. HTS. #4 B2, L7
PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 6/29/2020
DEPTH
FEET
OG
SOILS
1
ORG/OL
2
3
4
FILL
5
6
7
8
GM
9
10
11
12
13
14
15
16
17
18
BOH
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
6/25/20 30 min 6” 1 8/16”
30 min 6” 1 7/16”
30 min 6” 1 7/16”
PERCOLATION RATE 22 (MIN / INCH)
TEST RUN BEWTWEEN 6 & 7 FT
PERC HOLE DIAMETER 6”
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: YES
IF YES, AT WHAT DEPTH: 16’
DEPTH TO WATER AT MONITORING: 16’
DATE: 6/25/2020
TESTHOLE # 20-1 DATE PERFORMED: 6/18/2020
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: TIM & MICHELE MCLAIN
6/29/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201212, Rebecca Carroll, 07/14/20
iwo
EAGLE RIVER ROAD
gfr
0
QO
0
Ln
N
co
N54 21 45 W
Ln
n
�N54021'45"W ' 0 45.20'
153.24Cn 10
WEI__L
1 1D
NoSkV��V_7 D
msniom
110.3"
110 Ln
\16 .0 -
Ln
82.8' N
10-
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SEPTIC ���'� !-�
VEN T 6- C
(t yp)
PAVED
Li D/W :;7
LC)
00
LOT 7
BLK 2 N
L=SVA LL
10' T&E ESMT
L=201.96 R=3975.00'
Ln
OMEN* EAGLE GLACIER LOOP
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF: FND 5/811 REB AR
GLACIER VIEW ESTATES No.4
C!Q = LOT 7 BLOCK 2 PLAT 84-77 -4%41
-,��D S
John L. Schuller. Have conducted a 0 F 4 LAIVI) V
SURVEY CERTIFICATE: I., APW
A
< 4s"
physical survey of this property as shown on this drawing and that the AW I
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should 100, 49TH .7
any information on this drawing be used for construction of fences.
�O .....=. ...... ........... .
structures, improvements, or for establishing boundary lines. A
..................
EXCLUSION NOTES: it is the owners responsibility to detemiine Vj .......
1� _/10 . : *%'.'
JOHN L. SCHULLER.. 0
the existence of any easements, covenants, or restrictions which *. , _7'11�1
0
do not appear on the recorded subdivision plat. LS -10408 . . -11. 0,
1831 Talkeetna Street
4V
WORK ORDER NUMBER: DATE: SCALE. E-MAJU 6C r I Anchorage, Alaska 99508
JUNE 29, 2020 1"=30' AGW
DRAWN BY. CHECKED BY, GRID NUMBER- BOOK/PAGE: Of (907) 227-1455 office
20-046 JAS SW01 59 200152 essionc (907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAILING A D DR ESS 2F~)X,
LEGAL DESCRIPTION
PHONE ~NEW
dCV'-'?'/?/ E UP R^DE
¢,?2-'? 2'
LOCATION
I DISTANCE TO: I /d).;? '
F-z I Manufacturer _
~ingall~n~[' , ............
I ~ DISTANCE TO: F®
%-- ~ Manufacturer
O I Well ~--
~ ~ I DISTANCE TO: I //¢ ~
~ ~ ~ ~ No. of lines - ~ Length of each line /
~ N Top of tile to }inish.gr~de -
~ ~ I Type of crib Crib diameter
~ DISTANCE TO:
Well
~ lClass Depth
~ DISTANCE TO: Buildin9 foundation
·
Absorption area ~lli
Mater
Width
Inside leng!h .
Dwelling /
NO. OF BEDROOMS ~::~?
Material
Nearest lot line.,_,._.. /
Trench widt~
~ ~'/-) inches
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Foundation //f/.) ¢_ PERMIT
Total length of I~S,~2 r
Material beneatJ¥ til~
Depth
Crib de~p~A
Building fo6ndation Nearest lot line
Driller
Distance between lines
Total effeqtiYe absor~ion'area
PERMIT NO.
Total effective absorption area
Distance to lot line
PERMIT NO.
Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
R EMAR KS
( er ifieh rflling
~OC Co, dba
SULLIVAN WELLS
P.O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND /~/2...
ADDRESS ,' ;~ ":'',"
LEGAL DESCRIPTION"
DATE- Started -~ ('/'/? -qZ Ended
PERMIT NUMBER
'!
DEPTIt OF WELL ":'- / /
STATIC LEVEL OF WATER FT.
%RAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From ~) Ft. to '~ :)'' Ft.
From Ft. to Ft.
From .4 ~
From ~'TJ Ft. t o;' '~ 'r Ft
From , Ft. to .... ' Ft.
Fromm:?, Ft. to -?: '7, Ft.
From -'): '7 Ft. to -')" )-. Ft,
From__Ft to Ft.
From____Ft. to Ft
From__Ft. to Ft
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft
From____Ft. to__Ft.
From__Ft. to__Ft.
From Ft. to Ft.
- /
Fronl--
From__
From___
From
From
Fronl
From
From___
Fronl
From__
From
From __
From_ __
From
From
From
From
Ft. to.__Ft.
Ft. to____Ft
Ft, to__Ft
Ft, to__Ft
Ft. to__Ft.
Ft. to EbNiSO~?N'r'~
Ft. to__F~.E? 5 ~\~
__Ft. to____Ft. _ ,~ r' I \ I V,- ~'~
Ft. to~Ft,
Ft. to__Ft.
Ft. to__Ft.
Ft. to Ft
~Ft. to_~Ft.
~Ft. to~Ft.
Ft. to~ Ft.
MISCL. INFORMATION:
I)EPARTMIZNT GF FIEAL/TI4 AND ENVIRDNMENTAL. I:::'ROTECTION
825 L STREE]T, ANC, HDF~AGE.~ AK 99501
264-4'720
PERMI'I" NO
DATE ISSUED
A F"PI.... I CAIxlT
ADDRESS:
CONTACT F:'HONE
L. EGAL DI~SC',R I P:
I....DT SIZE:
840587 HAND WRITTEN
07 / .'1. 8/84
I)ALE
BOX 7.71986
EAGLE RIVER, AK
694-4494
9'~5T7
SUBDIVISIOI'~: GLACIER VIEW HTS
SE.'CTION: 16 TOWNSI4IF:': 141xl
46000 (E;Q. FT. OR ACRES)
I_OT". 7 BLOCE': 2
RANGE: IW
I certify that:
1. I am t'amilia~ with the requirements fop on-sJ.'Le sewers; and ,z-;et].s as stat
forth by 'Lhe Municipality of Anchorage (MOA) and tl~e State of A'.l. as.~::a,,
2. I wi].I instal], the system in accorclance wi{h all MOA codem and regulat, ion~:,
and in compliance with the design c:riteria of 'Lh:i.s permit.
3. I will adhere to all MOA and State of Alaska requirements for the se'L back
clistanrzes from ~r'iy existing well, wastewa'Ler disposa], system or' public
sewerage system on this or any adjacent on nearby lo'L.
IF A L. IFrT STATION IS INSTAL..LED IN AN AREA COVERED BY MOA BUILDING CODE:S,
THEN (1) AN ELEI]TI:~ICAL F:'ERMIT AND INSPIZCTION HUST BE OBTAINED; (2) AS'-BUII,..TS
WILL NOT BE APIZ'F~OVED WI'TI-'IOLJT AN IELECTRIC, AI_ IIxlSF'ECTIOI~I REF'GRT; AND (3) THE
E:L. ECTRIC',AI... WORK MLIST BE DONE BY A LICE]xlSED EI~ECTR]:CIAN.
SIGNED DATE:
APPL. ICANT': DAI_E CARLOS
Permit ~
Applicant: t./~L~:
Location: ~'r '/ ~/0c[~ ~ ~'a~,~A ~, /~-~ ~ Phone Nu~er:
Legal Description:~d ~i'~~ /~ /<) Lot Size:
Type of Soil ~sorption System Is:
Trench: Drainfield: Seepage Bed: ~ - Holding Tank:
Maximum N~ber of Bedrooms~ '~ Soil Rating(sq.ft/br) /~
MUNICIPALITY OF ANCHORAGE C-'~c~/'"=';~'/L /~'~/'~-~/
Department f Health and Environment~ Protection
825 L Street, Anchorage, AK. 99501
/
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND2~FON-SITE SEWER PERMIT
Mailing Address: ~f '~'-~/~"~/"
The Required Size of the Soil Absorption System Is:
LENGTH ~'~-/r~' GRAVEL DEPTH ~' WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /(~0 GALLONS * *
Permit applicant has the responsibility ~o inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departmen
will. be subject to prosecution.
MinJ.mum distance between a well and any on-site sewage disposal system is 100 fee
for a private well or ].50 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31~ 1 9 * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
S igne~: (_.~/I~' ~' ~/~ '~ ~ /~/'~' ~ ) ~/' ~
Date: /
,.~ .... //' ~ ~ /z~~
SOILS LOG
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
I0
11
12
13
14
15
16
17-
18-
19
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
SLOPE
WAS GROUND WATER hi S
L
ENCOUNTERED? (") O
IF YES, ATWHAT
DEPTH?
SITE PLAN
Gross Net Depth to Net J
Reading Date Time Time Water Drop
/
20 /'~ '~ r. E 5 ¢'":'~,: ~:~,-- PERCOLATION RATE
TEST RUN BETWEEN __ . _ ,~1 ~
FT
PERFORMED BY: {"/'Si ~ RIW~¢, AI, f~S~<& !;,~>~ CERTI FlED DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
B25 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
PERCOLATION
TEST
r
PERFORMED FOR: ,.-~.,a
LEGAL DESCRIPTION:
1
2
3
4
§
6
7
8
g
10
11
12
13
14
15
16
17
18
19
20
DATE PERFORMED:
V,~,~ ~ ~, ~,,~'rs '¥' Lot 7
SLOPE SITE p'LAN'
Block 2
~~AS GROUND WATER
ENCOUNTERED?
C. Reld, Jr.
No. 2251't~
JF YES AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
pER~CbLATION RATE_ '~'' '~ ~, t,, --(minutes/inch~
5.~' , FT AND ~' ~ FT
TEsT RUN BE~EEN =-
PERFORMED BY; '~'~:..J~'b ~ ~ ~-0~ CERTIEIEOBY: DATE:
This shows the location of the test hole ~n re,at,on to lot lines of the
?~o. (6/,m final plat. As no lot corners have been staked, the location was made from i.
street intersections, using a Brunton and tape, and therefore is rough.
Robbi e
MUNICIPALITY OF ANCHORAGI~
MEMORANDUM
From: Darcy, A.E .C.S. ,. Inc.
Date April 6 1984
Lot 7 BLock 2 Glacier View Heights S/D
Something is plugging the monitoring tube, looks
like it was cut off when they were clearing
trees. Unable to perform at this time, however,
the location of the test hole is:
Measurements taken today, as corner stakes have
been put in: SE corner of lot walk westerly
direction 100' is test hole. the measurement
that says 10' = 100' now.
Is the following stipulation on the issued
permit agreeable to you?
Note: Subject to verifiaation in the field
to dig to the 12' level for verification
of any water at that depth.
Laura
4-6-84
Signed
91-015 (Rev. 1/81}
MUMCWAUTY OF ANCHORAGE
Development Services Department " i� f Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I. D. 050-501-39
1. GENERAL INFORMATION
Expiration Date:
Complete legal description GLACIER VIEW HEIGHTS #4 BLOCK 2, LOT 7
Location (site address) 22813 EAGLE GLACIER LOOP, EAGLE RIVER, AK 99577
Current property owner(s) TIMOTHY & MICHELE MCLAIN
Mailing address
Real estate agent
Day phone
22813 EAGLE GLACIER LOOP, EAGLE RIVER, AK 99577
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 210 COV 10
Date of Payment 7//71
Receipt Number 2-7171
COSA# 05CZOJ--2,37
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. 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 in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWH
6. DSD SIGNATURE
'YC System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Date 7/16/2020
TH
.... ......:::�
I Curtis Huffman j
r�� ���/•, CE 128991 .•\�'q`�r�
pROF S �l1P��'",�,
Conditional approval for bedrooms, with the following stipulations:
By: l/� z Original Certificate Date: Zq
The Municipality of Anchor e Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist
Legal Description: GLACIER VIEW HEIGHTS #4 BLOCK 2 LOT 7 Parcel ID: 020-172-31
If more than 1 septic system on lot: COSA Checklist #
of
Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 4/1984
Total depth 212 ft
Cased to *40+ ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 6/4/2020
Static water level at beginning of test 68 ft.
Well production at time of test 3.2 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample 6/24/2020
Comments *Per MOA record docs.
B. TANK DATA
Age of tank(s) 0 years
Tank type/material STEP / HDPE
Measured operating fluid level in septic tank NA
Standpipes/foundation cleanout per record drawing
Date of pumping NA
C. LIFT STATION
Required maintenance completed
Age of lift station 0 years
Lift station material HDPE
Comments: NEW TANK
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/20/2020
ALL standpipes present per record drawing
Total measured depth from grade 10.8+ ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date NA – NEW SYSTEM
Results Pass For bedrooms
Fluid depth prior to test 0 in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Comments/Deficiencies:
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100’
Yes if No
ft
Neighboring Tank > 100’ Yes if No
ft
Absorption Field on Lot > 100’ Yes if No
ft
Neighboring Absorption Fields > 100’
Yes if No
ft
Community Sewer Main > 75’ Yes if No
ft
Community Sewer Manhole/Cleanout > 100’
Yes if No
ft
Private Sewer/Septic Line > 25’ Yes if No
ft
Holding Tank > 100’ Yes if No
ft
Animal Containment > 50’ Yes if No
ft
Manure/Animal Excreta Storage > 100’
Yes if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Property Line > 5’ Yes if No
ft
Absorption Field > 5’ Yes if No
ft
Water Main > 10’ Yes if No
ft
Water Service Line > 10’ Yes if No
ft
Surface Water > 100’ Yes if No
ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No
ft
Community Wells > 200’ Yes if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10’ Yes if No
ft
Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No
ft
Water Service Line > 10’ Yes if No
ft
Surface Water > 100’ Yes if No
ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No
F. ENGINEER’S COMMENTS
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.
7/22/2020
CERT
Parcel I.D. 050-501-39
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
FICATE
FOR A
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Br~ga._w. Street
P.O. Box 196650
Anchorage, AK 99519-6650 ..-' ~
(907) 343-7904
OF ON-SITE SYSTEMS APPROVAL
SINGLE FAMILY DWELLING
Expiration Date:
GLACIER VIEW HEIGHTS S/D; BLOCK 2, LOT 7
22815 EAGLE GLACIER LOOP * EAGLE RIVER, AK * 99577
ANGELA WYA'Fr
Day phone 694-4243
22813 EAGLE GLACIER LOOP * EAGLE RIVER, AK * 99577
Day phone
PETE JOHNSON W/ REMAX Day phone 850-1476
110 W. 38TH AVE, #100 * ANCHORAGE, AK * 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · Individual On-site []
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 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 samples. (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
umxeo .~ie~o ~.u as u~ u~e vc.~u~do,, uc.~ o,,~vv,, ~,~.., I Verify ~h~ ,,,~
As ceRified by my seal ..... ~ ..... ~ ~"~ "~"~-" - ~'~ ~ ..... ~' .... * ~* ~"
investigation, based on procedures outlined in the CeRificate of On-Site Systems Approval Guidelines for this appfication,
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 fuRher verify that based on the
information obtained from the Municipafity of Anchorage ~qes and from my investigation and inspecfl'on, the
on-site water supply and/or wastewater disposal system is(are) in compliance with afl applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Phone
557-6179
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
· In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system 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 soils condition, groundwater 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
~ Approved for ~'~
Disapproved°
Conditional approval for
bedrooms. ON-SITE
, WATER AND ·
= , WASTEWATER
· · %, PROGRAM
bedrooms, with the following sbpulabon~ ~ .
.....
Attachments: COSA Checklist
Septic System Advi,sory
Well Flow Advisory
(Rev. 11/05)
Arsenic Adviso,~/
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
Well type PRIVATE
Date completed 4/1984
Totaldepth 212 ft.
Date of test
Static water level 64 ,ft.
Well production 75 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi. Nitrate ND mg./L.
If A, B, or C provide PWSID# N/A
Sanitary seal (Y/N)yes
Cased to *40'+ .ft.
FROM WELL LOG
4/1984
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
10/28/2010
71 ft.
2.64 g.p.m.
YES
YES
2+ in.
Other bacteria__
Date of sample:l 0/21/2010 Collected by:
Date installed 7/9/1984
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
JR'S PUMPING
Arsenic: ND ug./L.
B. SEPTIC/HOLDING TANK DATA *INSIDE HOUSE.
Tank Type/Material SEPTIC/STEEL
Tanksize 1000 gal. Number of Compartments 2
Foundation cleanout (Y,,/N) *YES Depression over tank (Y/N) NO
Date of pumping 10/27/2010 Pumper.
C. ABSORPTION FIELD DATA [*BELOW EXISTING GRADEI'
Date ins{ailed 7/9/1984 Soil rating (g.p.d./ff2o~ 1 60
Length 40 ft. Width 2.5 ft.
Total depth '1,5,6 ft. Eft. absorption area 456 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 10/28/2010 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 78 in.
Elapsed Time: 120 min. Final fluid depth 85
Any rejuvenation treatment (past 12 mo:)(YIN & type)
Water added 450 gal. New depth 86 in.
in. Absorption rate >= 450+ g.p.d.
NONE KNOWN If yes, give date, -
NOTEi SYSTEM WAS 90% FULL. AT START OF TEST.
System type TRENCH
Gravel below pipe '~
ft.
0 colonies/100 mi.
GE(; Ltd.
Legal Description: GLACIER VIEW HEIGHTS S/D #4; BLOCK 2, LOT 7 Parcel ID: (~)~'~)'-~"0/-,~
WELL DATA *ASSUMED BASED ON SURROUNDING WELL LOGS. SEE ATTACHED.
D. LIFT STATION
Date installed
"Pump on" level at in.
Size in gallons
"Pump off" level._a.t-~,
Cycles tested
SEPARATION DISTANCES!
SEPARATION DISTANCES iFROM WELL ON LOT TO:
Septic tank/lift station on lot~
~ 100'+
Absorption field on lot
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas : 50'+
M a n hole/Access (Y_~N__) ~
High water alarm level at
.in,
100'+
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
Building foundation
Water main
Wells on adjacent lots
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
5';+ Property line 5'+
N/A Water service line 10'+
f. Oo'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field 5'+
Surface water, 100'+
Property line 10'+ Building foundation. 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots, 100'+
COMMENTS
Water main N/A ~
Driveway, parking/vehicle storage 1 '+
G. ENGINEER'S CERTIFICATION
! 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 JEFFREY A. GARNESS
Date II/
COSA Fee $ (7/
Date of Payment
ReCeipt Number
(REV. 11/05)
Waiver Fees
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci. anchorage, ak. us
(907) 343-7904
Septic System Advisory
Certificate of On-Site Systems Approval # 101283
During a recent adequacy test on the septic system for Block 2, Lot 7 of
Glacier View Heights ~4 subdivision, 86 inches of standing water was
observed in the absorption field. This indicates that approximately 90% of
the absorption area is inundated. Although this system passed the adequacy
test, the remaining life expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval
Municipality o.fAnchorage
Development Services Depa ment
Building Safety Division ~ ~.
On-Site Water & Wastewater Program.
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Parcel I.D.
1. GENERAL INFORMATION
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
050-~'-39
Expiration Date:
Complete legal description
Location (site address or directions)
Current Property owner(s) DALE
Mailing address 2451
Lending agency
Mailing address
Real Estate Agent
Mailing address
GLACIER VIEW HEIGHTS #4 BLOCK 2r LOT 7
22813 EAGLE GLACIER LOOP
&: CINDY CARLOS "
. Dayph0ne 522-6049
CINNABAR LOOP *ANCH. AK. 99507
Day phone
Day phone.
Unlessotherwise requester HAAwillbeheMby'DSD ~rplckup.
2. NUMBER OFBEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage , E~
Community Class ,Well [--]
Public Water System [--]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank r-1
Community On-site D
Public Sewer r-]
The Municipality of Anchorage' DeveloPment S~rvices Department (DSD) issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date ofissue for prepedies served by a private or Class C well and may
be reissued with new water samples. (CedifiCates 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.
STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation daie shown below, I verify that my
investigation, based on procedures outlined in the Health Authority 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
GARNESS ENGINEERING GROUP, Ltd.
.Address' 37'01 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 _~
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone
Date
537-6179
Engineer's Comments:: ' ' ''~ ~
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under th~ conditions encountered at the time of the !est, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate durfng the year, and the water usage of the family being sen/ed b~' the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee futura performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
op(~rational requirembnts of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
~ Approved for '~'
bedrooms.
· Disapproved.
Conditional approval for
bedrooms, with the fllowing stipulations:
.,.,%.-,-'"',,'
...
Manitenan~ Agreements
Supplemental Engineers Reo~
Attachments:
HAA Checklist
' Septic System Advisory
'Well Flow Advisory
Other
(Rev. 12/01)
Original Certificate Date: ,~-
Legal De cription:
A. WEEL DATA
· ~ype., ~ ~. IfA,_B, or,~'pr~vide PWSI.D# ;N/A~
/84 :Sanitary seal (Y/N).YES
Total depth fi- .... : Cased t~ ;:;40+ .ff.
Date of test
Statid water level 64
Well producbon 75
· WATER SAMPLE RESULTS:
' Colifoi~ 0 colonies/100 mi.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
~ 4700 South Bragaw St. -
P.O. BoXy196650 Anchorage, AK 99519-6650
;www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
GLACIER VIEW HEIGHTS #4 LOT 7~ BLOCK 2 Pa'rcel
Ce
FROM WELL LOG ~
,~ I g.p.m.
050-501 '39
Well Lig (Y/N)
'Wires properly 13rotected (Y/N)
Cas..ing he. ig.ht !~above ground)
.i
- AT INSPECTION
4/17/2064
'76
3.3+ 'i
Nitrate- '0.1 . rog.IL. Other bacteria __
YES
YES
24+ in.
g.p.m.
0 colonies/100 mi.
Arsenic: , , 'D,a~te"of sample: 4/20/2004 Collected
SEPTIC~H~ OLDING
Tank
T~P~lMate'rial STEEL i'" . Date installed 7/9/84
t'
Tank'Size 1000 gal. Number of Compartments 2 CleanoUts (Y/N) YES
Foundati¢'n,:. , ,clean°ut, . (WE) *YEs Depression overtank (WE) NO - High water,alarm, ~/N)
, SANffARY PUMPERS
' umper~ . .
ABS~P~ION FIlLD DATA'r ~ '. ~' :[.~. ;. ~: .
'~ .... i~ PBELOW ~I~ING
Dar lied 9/198, : Soi:lratin~'{ '.~.d./a~or 16o sys{e type
'~,. ~
Length :' [ 40 ff. . Wi~ 2.5 fl. Gravel below pipe
lotaldopth *~.~ ?. Eft. ~bsorption a.455 ~ Monitodn~ tubo**YES- ~oprossion ovorfiold__
Date 0f adequacy test. 4/19/2004 . i' . :~ ReSults (Pass/Fail). PASS ,
:".:, ~ . ' . .... ~.l~':" : ,'. ' - :
Fluid.~ePth in absorption field before test i 61 in:' Water added .594 gal.' ~
Elapsed ~ime: 939 min. Final fluid depth' 69 in. .'-~ Absorption rate >= 450-t-
' '
Any rejuvenation treatment (past 12 mo.) (WN & type) NONE KNOWN ~ If yes, ~ive date
: ::. [- . . "**SUMP E~ENDS 86 BELOW I~ERT ~
, ~,~ ***SEPTIC SYSTEM WAS.PRESO~ED WITH 995 GALLONS 0N 4/17/04
TRENCH
NO
For. 3 bedrooms
New depth 86.5in.
g.p.d.
D. LIFT STATION
Meets alarm & circuit requirements?
in. "Pump off; ' ' ' ~ m. ·High water alarm level at ' ' in.
On adjacent lots 100'+
Oh adjacent lets: ~ =7 , . 100'+
Public sewer manhole/cleanout
Date installed
· "Pump on" level at
E. SEPARATION DISTANCEs
~ Cycles tested
;
SEPARATION DISTANCES FROM WELL ON LOT ,TO:
Septic tank/lift station on lot 100'+
"Absorption rield-on lot loo'+
Public sewer main ' N//A
' ~ sewer/septic service line 25'+
'Holding tank ·N/A
sEPARATION' DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ' -
Building foundation' 5'+ · ; Property line ' 5'+ '~ Absorption field
Water main 10'+':,: ' . Water service line 10'+ ~, Surface water
Wells on adjacent lots
SEPARATION DISTANCE' FROM ABSORPTION FIELD ON LOT TO:
Property line ..... 10'+
Water service line 10'+
'Curtain drain :! NONE KNOWN
· Water main
DriveWay,
:5'+
100'+
Building foundation" 10'+
Surface Water 100'+
Wells on adjacent lots 100'+
F. COMMENTS
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 HAA guidelines in effect on this date.
Engineer's Printed Name
Date"
JEFFREY 'A. GARNESS
HAA F~e $' '·
Date of Payment
Receipt Number
(Rev. 12/0'1 )
Waiver Fee $ ,'
Date of Payment'
' 'Receipt Nur~ber
85/83/2884 14:04 907-522-5084
CARLOS TREE SERVICE
PAGE 82
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MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAl, tLEALTH
DEPARTMENT OF HEALTlt AND ENVIROI'~IENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVBL CERTIFICATE
1. General Infozmmtion
Application Date__.
(a) Legal Description (include lot, block,_.,subdivision, section, to~mship, r,ange)
..... /:.'; 4<
Location (address or directions)
(b) Applicants Namei-)~ rc ~'~ C~,x.H~ - d'~(~l ~'~ T~lephone -' Home Business
AppI~c.n,s Address /~' 4~ .... 7__~
(C) Applicant is (check one)Lending Institution
Buyer [~: ; Other: (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co, & Agent
Address
(f)
Telephone
Mail the HAA to the following address:
t ') ~ , -
2, j~l~f~p~, of Residence
Single-Family ~ Multi-Family
Number of Bedrooms ,.. >
Other (describe)
3. Water ~S.u_p...~l_~.
Individual Well,f~ .... Community ~ Public ~_7~
Note.: If community well syst;em, must have v~itten confiL~tation from the Stats
Department of Enviro~mntal Conservation attesting to the legality and status.
4..S~_eEag. e Di____~sp~osal
Onsite :~.. Public ::: Community ::: ltolding Tank ~i~[
Note: ~f community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
5. Engineering Flrm Providing Insljections, Tests~ File Search, Data and Information
As certified by my sea]. affixed hereto and as of the validation date shown below, I
verify that my investigation of this tlealth Authority Appreval shown that the on-nite
water supply and/or wastewater disposal sys~;em is safe, fuuctional 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 tn compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of thJ. s inspection.
Name of Firm
Address
(ENGINEER SEAL)
Approved for "-~ bedrooms
Approved /\ Disapproved
Telephone
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONbLENTAL PROTECTION
(DHEP) ISSUES ltEALTH AUTHORITY APPROVAl. CERTIFICATES BASED SOLELY UPON THE REPRESENT~
ATIONS GIVEN ]iN PARAGRAPII 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN TIlE STATE OF ALASKA. TIlE I)HF, P DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. FMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. TIU'] MUNICIPALITY OF ANCtlORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS 1N THE PROFESSIOFDkL ENGINEER'S WORK.
(DHEP SEAl,)
RR4/ej/D18
[Page 2 of 2]
7 -19-84
L:!i:T. OF I I!/:'l iii &
MUNTCIPALITY OF kNCHORAGB (MOA)
HFALTH ALTf~ORITY APPROVAL (HAA) /!lib ":'
CHECKLIST - F~BRUARY 1984 ....... r~ . .
i~.p ''/B
WELL DATA Lega~ Descr tion:.
'~f A, H, c~ C, m~..C~, .~pro~d(¥/~)
Date Cc~E)leted q/~F ~ield
Cased to ~O /'~
Depth of Grouting.
static Water ~l ~' P~p ~t At
Casing Height Above Ground ~O ~ Sanitary Seal' on Casing
Electrical wi~i. ng: in Conduit ~) Depression Around Wellhead
Separation. Distances' from Well:
To Septic/H~ Tank on Lot /~ ; On Adjoining Lots
To Nearest Edge of ~sorption Field or~Lpt //~ /
,. . ; On Adjoining Lots /
To Nearest Public Se~er
To Nearest' Public Sewer Line
/
Cleanout/~,01e , ~'/~ To Nearest Se~= ~rvi~____Li~ on Lot
Water Sample Test l~es~X~g ,m
Con, rents /~ /--~Z-~c''--) :~?qSJ-~'7'"~/~e?a~ '.7-7.{~ ~,/~Z--L.
Well Classification
Well Log P~esent (~)
Total Depth ~ ~/
SEPTIC~t~/8--TANK DATA
Date Installed r//~;~. ,Si~ /~Q~ No. of C~i~nts
Standpi~s ~) Air-tight Caps.) Foun~tion Cleanout ~)
~p~ession O~Zr Ta~ ~Y~ ~te ~st P~d ~ ~
P~ing~intenan~ ~n~act ~ File (Y~,) . ; for ~
Holding Ta~ High-Water ala~ (Y~) ~ X%~ra~y Holdir~ Tank ~rmit (Y~) ~
Separation Distances from Septie/q~ Tank:
To Water-Supply Well
TO P~operty Line
TO Water Mai nl~r.vi~e Line
Course
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in AbsorptionSt~ta
Date Installed ~/~./~ ~
Width of Field 3~ ~r
Square Feet of Absorption A~ea
Depression over Field
Results of Last Adequacy Test
Separation Distance frcm Absorption Field:
TO Water-Supply Well //~
/~-g~ 6Z5/~ Type of System
Length of Field ~
~p~ of Field
~a~l ~d ~ick~ss
/ Stan~i~s ~esent
~t~st A~a~ Test
TO Building ~/ndation ///.~ /~
Lot '/~ ; On A~j~ining
To Water Main/Service Line
To Stream/Pond/Lake/or Major D~ainage Course
To D~iveway, Parking Area, or Vehicle Stolrage Area
To P~operty Line
To Existing or Abandoned System cn
Lots ~l~3
To Cutbank(if,~ present) .'~'J/~
Con~ents
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
/' Vent (Y/N)
High Water Alarm Level at
Tested fo~ Pumping C~le/ du~ing Adequacy Test. ~ets MOA
Electrical Codes(Y/N)
//
Con~ents
/
** Check Permitted Bedroom Rating Aga~inst HAA Request **
I certify that I have checked, verified, o~ conforn~d to all MOA HAA Guidelines in effect
on the date of~:i~ ~:,this~ ~!"~i:'.~::.i.~,?~'!inspecti°n' O/~ /~
Signed , ..... :~:i: !>~ "~.'~ Date
~ ~ ~:,~',':.~,., MOA NO
[Page 2 of 2] "
2-15-84