HomeMy WebLinkAboutGLACIER VIEW HEIGHTS #4 BLK 3 LT 5Glacier View Heights #4 Block 3 Lot 5 #050-501-29 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 NOV Wall of 2 ONSITE WASTEWATER INSPECTION REPORT Permit Number: OSP131265 PID Number: 050-50-129 Dwelling: FNI Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New 0 Upgrade Name: LESLIE WENDEROFF ABSORPTION FIELD ❑ Deep Trench El Shallow Trench El Bed El Mound Address 22740 EAGLE GLACIER LOOP 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 — GPDlSF — Ft. LEGAL DESCRIPTION Depth to pipe invert from original gradeGravel Ft. depth beneath pipe — Ft. Subdivision Block Lot GLACIER VIEW HEIGHTS #4 3 5 Fill added above original gradeGravel _ Ft. length " Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines -- Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line __ F. — -- Ft. Well 100'+ — 25'+ TANK III Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK capacity 1250 Gal. Surface Water 100'+ Material Number of compartments Lot Line 10'+ — STEEL 2 NA Foundation 51+ _ LIFT STATION Manufacturer Capacity Curtain Drain I N.O. -- -- -- -- __ Gal. Remarks EXISTING SEPTIC TANK Pump on level at in. Pump off level at I __ in. High water alarm at I -' in. ABANDONED PER MOA REQUIREMENTS Pump make and model Electrical Inspections performed by PIPE MATERIAL Housetotank 3034 Tankto3034 drainfield Installer DEAN CONSTRUCTION Drainfield — C01MT Inspector LARS SPURKLAND BENCH MARK (Assumed elevation)100 It Ins daction 1� $/27/13 Location and description tes: 2nd 3m 4m BOTTOM SIDING AT W COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL ZFAg`11� Conditional Approval: DateP P7 le i...... —AIR . SPURK ANO ; OW J 5..00 (11�F0 PROF�S Approved Date a /C� \ Inspection Report_9-1-12.doc GLACIER VIEW HEIGHTS #4 SID /BLOCK 3 LOT 5 NSTALLED NEW 1250 GAL SEPTIC 4 BDRM TANK. CONNECTED TO DRAIN FIELD 4 B A ABANDONED EXISTING B SEPTIC TANK PER MOA CODE REQUIREMENTS D C NOTE.: THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. BDUBLE CLEANDUTS CONNECTED TO EXIST DRAINFIELD 3+ FEET COVER P' INSULATION sso FOUNBATRN CLEANOUT 1250 GALLDN SEPTIC TANK BENCH MARK BOTIOM SIDING i ASSUMED ELEVATION 100 FEE! P03 V 15TH. AV£NU£ SPURKLAND ENGINEERING GLACIER VIEII HEIGHTS 14 BLK 3 LT 5 SEPTIC SYSTEM ASBU/LT ANCIL AK. 99501 LESLIE WENDERI FF BATE, DCT PB, 2013 (907) 279-3916 P2740 EAGLE GLACIER LOOP, EAGLE RIVER, AK 99577 1 SHEETr 1/1 GRID, SV159 PERMIT # DSP 131265 PID # 050-501-29 GLACIERVIEVHEI6NTS4B3L5-ASBBVG SWING TIES A B / S.T. C.O. C 20' 14' \ / S. T. C. 0. D 26' 11.5' / 125 150 \ 25 0 PS 50 75 100 SCALE I' = 50 F7, NOTE.: THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. BDUBLE CLEANDUTS CONNECTED TO EXIST DRAINFIELD 3+ FEET COVER P' INSULATION sso FOUNBATRN CLEANOUT 1250 GALLDN SEPTIC TANK BENCH MARK BOTIOM SIDING i ASSUMED ELEVATION 100 FEE! P03 V 15TH. AV£NU£ SPURKLAND ENGINEERING GLACIER VIEII HEIGHTS 14 BLK 3 LT 5 SEPTIC SYSTEM ASBU/LT ANCIL AK. 99501 LESLIE WENDERI FF BATE, DCT PB, 2013 (907) 279-3916 P2740 EAGLE GLACIER LOOP, EAGLE RIVER, AK 99577 1 SHEETr 1/1 GRID, SV159 PERMIT # DSP 131265 PID # 050-501-29 GLACIERVIEVHEI6NTS4B3L5-ASBBVG On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131265 Tax Code Number: 05050129000 Work Type: Septic Permit Effective Dates: August 15, 2013 to August 15, 2014 Design Engineer: SPURKLAND ENGINEERING Subdivision: GLACIER VIEW HEIGHTS #4 Site Legal Address: GLACIER VIEW HEIGHTS #4 BLK 3 LT 5 G:0159 Owner/Address: HUGHES JEFFREY H & WENDEROFF LESLIE R 22740 EAGLE GLACIER LOOP EAGLE RIVER AK 995779527 Site Mailing Address: 22740 EAGLE GLACIER LOOP, Eagle River Lot Size in Sq Ft: 49273 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage 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 (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF ANCHORAGE njapi Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-501-29 Property owner(s) Leslie Wenderoff Day phone 250-2048 Mailing address 22740 Eagle Glacier Loop Rd., Eagle River, AK 99577 Site address Same Legal description (Sub'd., Block & Lot) Glacier View Heights #4 Blk 3 Lot 5 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field❑+�T1t Initial ❑ Single Family (SF) ❑ Septic Tank Q �'~ Upgrade Q (w/wo ADU) Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: NONE Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owner or Permit/Rush Fees: o;b_0' Waiver Fees: Date of Payment: q 17.113 ` W Date of Payment: Receipt Number: Receipt Number: Permit No. M V9 k3�2de5 Waiver No. Permit App_9-1-12.doe &,-Ak SpOWEnd Environmental Consulting and Design August 8, 2013 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Elmore Rd. AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION Glacier View Heights #4 Block 3 Lot 5 Ladies and Gentlemen: We are submitting an application to upgrade the septic tank for this lot. The existing septic tank serving the above referenced has been compromised and the owner would like to replace it. The submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. Sincerely, Lars purkland, P.E. 203 West 15`" Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net GLACIER VIEW HEIGHTS #4 SID /BLBCK 3 LOT S 1V / NSTALL NEW 1250 GALLON SEPTIC 4 BORM TAN K. CONNECT 10 DRAIN HELD.R ABANDON IXISTING SEPTIC TANK PER MOA CODE REQUIREMENTS 25 0 25 50 75 100 125 150 \ SCALE., 1' = 50 FT NOTE. THIS IS NOT A SURVEYED PLAT. WELL & S£P77C LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. DDUBL£ CLEANDUTS 4 FEET COVER CONNECTED TLT EXIST DRAINFI£LD IR50 GALLON SEPTIC TANK FLNIMBATION CLEANDUT SPURKLAND ENGINEERING GLACIER METE HEIGHTS 14 BLK 3 LT 5 SEPTIC SYSTEM 203 W 15ThAVENUE LESLIE WENDEROFF DATE, AUG 8, 2Q13 ANCH AK. 99501 (907) R79-3916 02740 EAGLE GLACIER LOOP, EAGLE RIVER, AK 99577 1 SHEET, 1/1 GRID, SV159 PERNIT # OSP 111XXXX PID # 050-501-29 GLACIERVlEV106HTS4B3L5.DVG Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES FNVIRONMENTALSERVlCES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Sk;/-,'~? O /-~' PIDNumber: (~O-~Oi- Address: Phone: No. of Bl~fooms: LEGAL DESCRIPTION Lot; Block: SubdivLsion: ~ Township: Range: Section: WELL: [] New [] Upgrade Classification (Private. A,B.C): Total Depth: Cased To: Ft. Ft. Date Drilled Static Waler Level: Ft. Pump Sel al: Casing Height Above Ground: GPM Ft. Ft. SEPARATION DISTANCES Driller: Yi(Id: TO From Well- Surface Water Lot Line Foundation Curtain Drain Remarks: h.l L~ Inspections performed by: Wastewater System: [] New ¢,~Upgrade ABSORPTION FIELD [] DeepTrer:ch []Shallow'French ~)Bed []Mound []Other Soil Rating: O, .~ G P D/,~.,-F-~ Depth to pipe bottr)m from original grade: Fill added abovr* original grade: ~ Ft. Gravel width: Total absorption area: '75-o sa. Ft. Installer: Total Depth from original grade: O' Gravel depth beneath pipe ~)t ~' F t..~_ Gravel lenglh: .~ 0 FL Number of lines: Distance between lines: ~'~ ¢ Ft. Pipe material: Date installed: 7//~'/- TANK ~',Septic [] Holding [] S.T.E.P. Public/Private Manufacturer: Sewer Lines Material: .7_..¢~¢..,~.4... ~._. Capacity in gallons: ~j Number of Com,~ments: LIFT STATION Size in gallons: Manufacturer: "Pump on" le,.6 at: "Pump off" level at: Pump Make & Model Electrical Inspections performed by: BENCH MARK Location and Description: High water alarm at: Dates: Department of Hea,~n_,~d Human Services approval Reviewed and approved by: _ ~'~ : ~ ENGINEER'S SEAL 72-0 3 (Rev 9/91) MOA 25 N / / / ! :- 50 F F I00 1~5 150 SWING TIES: A AC 44 FI- BC 14 AD 50 BENCH tdA£K BD 26, 5 AE 99 BE 70 AF 89.5 /~ C BF 82 OLD BED TOBBEfl SPURKLAND P.E, 203 W 15TN. AVENUE ANCH. AK. 99501 _(907) 279-,5916 [GLACIER l/lEft: tIEIGHTS //4 B£K 3 LOT 5 MICHAEL /dEEHAN 22740 EAGLE GLAC/D? LOOP SEPTIC SYSTEM AS BUILT BATE: JULY 17, 1997 SHEET; 2/5 GRID: SWI5(~ PE£M]? # SW970t76 PiP i! 050-501 £9 5Vt-tOSO32, DW5 1250 GAL SEPTIC TANK ANCHORAGE TANK 4-INCH MONITOR ( ) ZD 200 DIVERTER ~/ ,I-INCH DISTRIBUTION PIPE 0 4-INCH MONITOR SIi4NDARD BED x 6-M. IL VISOUEEN CLEANOUTS AND ~ON/TOR 15 FT X 50 FT [2" SoWo[ ~oo~ / / LEVEUNG SAND CPp ROAOSAND 4" oisfibuyon Pipe . WS ~ 5' 6-50-97 /"~ L ELEK 8p~ 1250 gal tank SILT BARRIER TOBBEN SPURKLAND P.L GLACIER VIE~f HEIGIt%~ ,~4 Elk 3, Lo~ 5 SEPTIC SYSTEM AS BUILt 205 W 15TH. AVENUE ~gNCH AK. 99501 MICHAEL MEEHAN DATE: JULY 17, 1997 07)' 279-5916 22740 EAGLE GLACIER LOOP SHEEL' ~/5 OR/D: SWIS9 PERMIT ~ SW970176 050-501-29 GVHOSO55. DWC PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970176 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:MEEHAN MICHAEL J & SANDY M OWNER ADDRESS:22740 EAGLE GLACIER LOOP EAGLE RIVER, ALASKA 99577 DATE ISSUED: 7/08/97 EXPIRATION DATE: 7/08/98 PARCEL ID:05050129 LEGAL DESCRIPTION: GLACIER VIEW HEIGHTS #4 BLK 3 LT 5 LOT SIZE: 49273 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN kNCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS {18AAC80). 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 SA_ME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. INSULATE LINE BETWEEN SEPTIC TANK & DISPOSAL FIELD. 2. VERIFY INTEGRIT%~/QFt! SEPTIC, TANK AT TIME OF CONSTRUCTION. RECEIVED BY: / -----_. DATE: ISSUED BY: ~/~/~//J~' ('X~ ~7~// ~.~ [~! dd DATE Eagle River Engineering Services Louis Butera, P.E. p.o. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax June30,1997 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re ~ Glacier View Heights #4, Lot 5, Blk 3 Narrative & Permit Application Dear Mr. Cross: The proposed well and septic system will have very limited impact on adjacent properties for the following reasons: 1. The sun'ounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity and lot size. 4. Drainage will not be affected and is not a major consideration in our design. There is a foundation type curtain drain that is located well above the leachfield and will not impact the upgrade leachfield where it is located. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \i997\97-034-NAR Eagle River Engineering Services Louis Butera, P,E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694~3297 fax Glacier View Heights #4 Lot 5 Block 3 - 06/30/97 Single Family 4 Bedroom Dwelling LEACHFIELD SIZING 4BR = 600gpd Soil perc rate -- 2.5 minutes/inch Soil acceptance rate = 0.8 gpd/SF Required absorption area = 750 SF Bed size 50' long, 15' wide G:\WPDOCS\1997\97-013-CAL I 87-88-1997 81:86PM PRUM ~.~. ~ngineerln~ ~oc~. ~o Eagle River Engineering Services Loui~ Bueera, P,E. F,©. Box 7?B~ 9~ (90?) 69a~-5195 ~1 Ea~l~ Ri~r, ~ 99577-329~ (907~ 69~-329? ~ SPECIFICATIONS FOR ON-SITE SEPTIC SYSTE~ LEGAL: Glacier View'Heights ~4, Lot 5, Blk 3 7/8/97 - Revised 1. The well ~ septic pl~ is for a single family residence only. 2 The drawlng and ~r site pl~ shall be a pa~ of this specification. 3. All mater [als ~d :wot~ship shall meet ~e Anchorage Dep~m~t of Health requkements. 4. All soil t~ sts ~e ~dvisou to ~e design and are to be verified or modified in the field by ~e engineer. AH excavations ~d depth~ are advbo~ and are to be verified in the field'by the contractor to meet Munieipa [i~ of hnehorage requirements. 6. I~ is the ~ ~spoasiblli~ of the owner to obtain all neeessa~ pemits or eagements and to locate any adjacent ~ ~ltbt~mily wells. 7. The exca,'ation is to be exactly in ~e ~ea shown on the site pl~, ~y deviation requires engineer approval 1 8. It is always recommended that a su~eyor locate the ne~est lot line position ~d the location ~f any easement.. 9- Any remaining open test hole excavations shall be filled. 1. If noted m the permit under special provisions ~e septic mk is to be uncovered at the end for inspectimt by the.engineer. Any new septic rank shall be a minimum of 1250 gallons ~d shall be of approved ~OA &sign. C. BED The Tops 0il ~d org~ic layer is to be removed down to soil noted as GW-GM on soil log for the designate t ~ea o~the leachbed, following ~e natural l~d contour, and le~ open for inspection. B~d area is to be scad~ed. 2. A layer o s~dy pit run material with <5% fines passing ~200 sieve is to be ~sed as needed to level the bo2o~ n of bed excavation to a total depth of ground surface level as measured from the highest point of t ed excavation (uphill side), The bo~om of the bed excavation shall be level, plus or minus 1.5". 3. A 1' sewer gravel layer shall be placed over leveling sand, The leack pipe is ~o be placed in ~e gravel with 2" of gravel covering ~e pipe. 5, ~e effluent line ~s to be 4"- 3034 PVC from the tank to the bed, and FS10 ;.perforated pipe within the bed. 6. The bed i on the do 7. Soil or cc over the Px.ECOMME? BOTTOM GRAVEL BED LENG'I SOIL RATIIq SEPTIC TAI~ \1997\97-034-,, ravel i~ to be covered with typar fabric material, a layer of 6 mil vbqueen is to be placed vnside edge of l~aohbed gravel layer to prevent effluent surfacing, mbination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed ,ed. Mounded side slopes not to exceed 3:1, contour uphill side into existing slope. ])ED L.'EACHFIELD DIMENSIONS: SEWER GRAVEL LAYER = Ground Surface ~ highest point of hill( see above) [CKNESS = 6" under pipe, 2" over pipe = 50' BED WIDTH= 15' = 0,8 GPD/sf BEDROOM CAPACITY-- 4 [= 1250 gallon T~venry-four (24) hour~ notice required for all inspections. :c.doc TOTAL P.02 Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR; LEGAL DESCRIPTION: DATE PERFORMED: Township, Range, Section: 1 2 3 4 5 6 7 8 9 10- 11 12 13- 14- 15- 16- 17 18 19- 2O COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? ~",~'~ SITE PLAN S L IF YES, AT WHAT ..~/ O DEPTH? p E Oeplh 10 Water Alter ,, M0nil0ring? .~":J Dale: ~-3o-? ~ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE o~, J- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FT AND ~ FT PERFORMED BY: /~/~ ~ i' I ~~'~'-2~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~:~f~ ~,~' a0 ~ ~; ? 72-008 (Rev. 4185) · V~o~, · /'/~ //' ~-~et ' .. q?--.v- % /,: ~~. ~ -.-~.~ % n~ /~,, ~ .~'~ ~ /~ . . ~ AS-BUILT . · ~ ~.. '~ %'~.~ I hereb ce~ffy that I hav~ su~eved ~e ~olow n~ de~nbvd .. . ~.....~_.~~--~-~,,¢? '~- ~ ~ . ~ .. ~ .. ..._ . ~~~= ~ ~ ~ .... . , ., ,... ~,, - . ~ .. .. .. q ~ff , '.,, . ~ OFESS~~ no improvements on pmpeay lvin~ ~djac~nt thereto encroach . : ." . ~~' on the p~mise~ in questmn an~ that there ~re'no roadways.  wansm~sion lines or other vNible'easemems on said prope~' :,..., . , · . .. . except as indicated her~n. . .: ' ROBERT C. JOHNSON ~ ~'L..; ' SCALE: Reg~ter~d ~nd Su~ev~ No:~LLS {~ 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 INSPI:CTION REPORT NAME PHONE /X~NEW - "~AI LING ADDRESS -~GAL DESCRIPTION LOCATION NO. OF BEDROOMS l Well Absorption area Dwellin9 PERMIT NO. ~ Manufacturer Material tm ~ ~ Liq. capacity in gallons Inside length Width ~'~/ Liquid depth ~ ~ DISTANCE TO: Nell Dwelling PERMIT NO. · --~O ~ < Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot lin / PERMIT NO. No, of lines ~ Length of e~ch line Total lengthgf lines ~ width Distance between ~Jnes p , (o t~msn,grade / ~¢~ Materia eneatb tile Total effective absorption are~( Length Width Depth PERMIT NO. ,~ ~ Type of crib Crib diameter Crib depth Total effective absorption area I~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer lin~ . Septic tank Absorption area(s) PIPE MATERIALS ~, . , . . ,?) APPROVED D~TE LEGAL. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST /~ SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE!PERFORMED: SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18- 19- 20- WAS GROUND WATER ,, , S ENCOUNTERED? /V'C ~- L O E IF YES, ATWHAT DEPTH? Reading Date Gross Net Depth to Net Time 'rime Water Drop RATE TEST RUN BETWEEN COMMENTS /, /-~ J,'lCTr'¢ PERFORMED BY: CERTIFIED BY: ~ .DATE: '72-008 (6/79) MUNICIPALITY OF Development Services Department l On -Site Water & Wastewater Section ANCHORAGE Certificate of On -Site Systems Approval Parcel I.D. 050-501-29 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: w_ ! r Z I Complete legal description Glacier View Heights #4 Sub, Block 3, Lot 5 Location (site address) 22740 Eagle Glacier Loop (ER) Current property owner(s) Robert & Lori Scott Day phone Mailing address Real estate agent 22740 Eagle Glacier Loop, Eagle River, AK 99577 Chantelle Smith 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone (318) 464-2782 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic W Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment Date of Payment Receipt Number. U % 7 7 Receipt Number COSA # OSC211068 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 Forge Engineering Phone (907) 522-7773 Address 1399 W 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 2/25/21 Aw c� 0TH Fgsll 6. DSD SIGNATURE .. System #1 Approved for bedroomsBenja chillerr J • • S I �..• •.� System #2 Approved for bedrooms ��� Fc��, •, CE 12592 Disapproved !`k%pROFESSOPAW Conditional approval for bedrooms, with the following stipulations: ON-SITE m WASTE.V ATER Z �i�P_ PROGRAM . p BY Original Certificate Date: ^ Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Glacier View Heights #4 Sub, Block 3, Lot 5 Parcel ID: 050-501-29 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) k * Well production at time of test 5.2 gpm Date drilled 06/06/84 Water storage tank volume gallons Total depth 238 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 235 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 26 in. Collected by FORGE ENGINEERING Date of flow test for COSA 2/17/21 Date of Sample 02/17/21— 2/17/21,Static Staticwater level at beginning of test 36 ft. Comments *Well info taken from previous COSA. No well log available. B. TANK DATA Age of tank(s) 8 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 48 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 2/12/21 JR D. ABSORPTION FIELD DATA Bed Which system tested (date installed) 07/15/95 OR ALL standpipes present per record drawing Total measured depth from grade 4.2 ft (max) Measured depth to pipe invert from grade 3.4 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 Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ired maintenance completed Age of lift statin years Lift station material Comments: NIA Adequacy test date 2/17/21 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 815 gal New depth .5 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate '800 gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' U✓ Yes Community Sewer Manhole/Cleanout > 100' r✓ Yes if No ft Q✓ Yes if No ft Neighboring Tank > 100' F/ Yes if No ft Private Sewer/Septic Line > 25' 7✓ Yes if No ft Absorption Field on Lot > 100' F/ Yes if No ft Holding Tank > 100' E✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment>'50' ✓� Yes if No ft ❑✓ Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' �✓ Yes if No ft ✓0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' F/I Yes if No ft Property Line > 5 U✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200'✓0 Yes if No ft Water Service Line > 10' 0 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' U✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓1 Yes if No ft Private Wells > 100' U✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' F✓ Yes if No ft Surface Water > 100' 0 Yes if No ft 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. COSA Checklist yellow sheet 49 7H 7_1--B�enjachiller k% • CE 12592 • �`4� F� /�lF�• . 2/25/21 , •t*2 ���FapROFESSIONP SPH 'r'AA • Municipality of Anchorage ARi ,ofc. --_ !� On -Site Water and Wastewater Program (907) 343-7904Rk'. p Ey6i Certificate of On -Site Systems Approval Parcell.D. 050-501-29 1. GENERAL INFORMATION Complete legal description Expiration Date: % _ /" GLACIER VIEW HEIGHTS #4 BLOCK 3 LOT 5 Location (site address) 22740 EAGLE GLACIER LOOP. EAGLE RIVER, AK 99577 Current Property owner(s) LESLIE WENDEROFF Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 250-2048 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well rX_1 Individual x❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ --- Waivan'Variance request YNONE r: Distance:_ Received by: L " 2 i1L_ Date: i COSA to be released to re en�ineer, unless otherwise requested by the engineer. COSA Fee $ 6&. WI Date of Payment _ /it) I I Ll Receipt Number 61 q z/6 / COSA# 03C1g16774 Waiver Fee $ Date of Payment Receipt Number Waiver # S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm SPURKLAND ENGINEERING Phone 279-3916 Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE _Z System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 3/7/14. � t - Conditional approval for bedrooms, with the following stipulations: By: 0 -, %%, ,-/ .,Original Certificate Date:- The Mu f Ancli mge 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. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet f ! .. Nitrate Advisory Arsenic Advisory Other >s Conditional approval for bedrooms, with the following stipulations: By: 0 -, %%, ,-/ .,Original Certificate Date:- The Mu f Ancli mge 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. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet f ! .. Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: GLACIER VIEW HEIGHTS #4 BLOCK LOT 5 Parcel ID: 050-501-29 A. WELL DATA Well type PRIVATE Date completed 6/6/84 Total depth 238 ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 235 ft. FROM WELL LOG 6/6/84 35 3.0 WATER SAMPLE RESULTS ft. g.p.m. Coliform NEG colonies/100 mL Nitrate NO mg/L Arsenic NO ug/L Date of sample: 2/25/14 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments Foundation cleanout (Y/N) Y Date of pumping NEW Well Log (YIN) N Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 6/26/13 37 5.2 ft. Collected by: ANSON MOXNESS Date installed 8/27/13 Cleanouts (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Pumper C. ABSORPTION FIELD DATA Date installed 7114/97 Soil rating0.8 BED (g.p.d./ftz or ft2/bdrm) System type Length 50 ft. Width 15 ft. Gravel below pipe 0'S ft. Total depth 2'8 ft. Eff. absorption area 750 ftZ Monitoring tube Y Depression over field N Date of adequacy test 6/26/13 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 6'0 in. Water added 750 gal. New depth 7'0 in. Elapsed Time: 1440 min. Final fluid depth 5'0 in. Absorption rate >= 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off" level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main NA Sewer /septic service line 25+ Animal containment areas 50'+ Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 1004 Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main NA Water service line 10'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100'+ Curtain drain 50+ Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION t certify that t 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 LARS SPURKLAND Date 3/6/14 COSA brown sheet 10.10-12.doc Absorption field 5'+ Surface water 100+ Water main NA Driveway, parking/vehicle storage 10' r F•A�gtPl) 43_ 9 i Of, ... SPURKI.AND,; 1 00 C�<� 0 in. - 4. V15 \ 8394 F \ \Gf 60 Lot st C< 9 \'9 Lot 4 \ \�Qo� S� 7 CSO \ g7 A Lot 5 \ Op \ �-X L�Re 2 Seo a' ve 1.5 OH c , w5w r1`L' •O sr0 2 0s a 9� y� s ryry� she lam` re fence ° �eQeBe° �POjr Septic vents Wire fenc tis30 Septic vents aac h� Sl�s Ga 0' 272 deck D� •S/ Off` Sauna Lot 6 Tr. C Note: Septic vents are approximate due to snow and ice. 49th00 00 00 I� ...... a` �J00 3255—S� I 1Y0FCBSIeNAI %11� EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. RCJ, FB 14-1, pg 62-63 SCALE: 1 "= 40' AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have pertomred a Mortgagee's inspection of the following described property: LOT 5. BLOCK 3, GLACIER VIEW HEIGHTS UNIT No 4 Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 4th day of March ,2014. FRED WALATKA & ASSOCIATES BE(907-248-1666) Engineers and Surveyors 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 GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Day phone Lending agency Mailing address Agent L'~ !4c.~.~ Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '~' TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holdin9 tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewaterdisposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, lfurtherverifythatbased 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, / bedrooms. DHHS SIGNATURE /,V Approved for Phone _Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 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 th is 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. 1/91) Back MOA Legal Description: A. WELL DATA Well type i7~-- Log present (Y/N) Total depth Sanitary seal (Y/N) t~u~c~^u~,,, o~ ^~c~o~e~ Municipality of Anchorage ~NWRONM~Nr^L ~¢v~c~.~ D~,~, DEPARTMENT OF HEALTH & HUMAN SERVICES JUL 1 8 199~ Environmental Services Division Street, Room 502. Anchorage, Alaska 99501. (907)~-~7~ ~ ~ 825 L Health Authority Approval Checklist If A, B, or C, attach ADEC letter. ADEC water system number Date completed FROM WELL LOG Cased to Casing height (above ground) ,/., Wires properly protected (Y/N). / AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform N Date of Sample: B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (Y/N) Date of Pumping ~'///~ ,3¢,7~'l g.p.m, 'Z~ g,p.m. Nitrate ~k~ I') Other bacteria Collected by: ,~-/~ ,~---~ Tanksize ./,~-~-0 Number of Compartments ~ Cleanouts(Y/N) 7 Depression (Y/N) ~ High water alarm (Y/N) Pumper C. ABSORPTION FIELD DATA Date installed 7/t Z)"-/~) Length ~0 Width Effective absorption area Date of adequacy test. Fluid depth in absorptien field before test (in.); Fluid depth f//' (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Soil rating (g,p.d,/ft2 or ft2/bdrm) ~). ~ SyStem type '~- Gravel thickness below pipe ~ ._Total depth Monitoring Tube present (Y/N)_~_ Depression over field (Y/N) Results (Pass/Fail) For Immediately after ""/gal, water added (in.): c'/' Absorption rate ~ = .g.p.d. If yes, give date '¢~-~ bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Size in gallons "Pump on" level at* On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station *Datum "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: //-/o SEPARATION DISTANCES FROM SEPTIC/HeEDtN6-TCC4K ON LOTTO: Foundation I ~,~ Property line ~ 0 Water main/service line ,,~,~ Surface wateddrainage ~/o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field ~-0 ~' Wells on adjacent lots ,~ /~-.-o Property line ~ Building foundation ~ Water main/service line Surface water 17"[ I o Driveway, parking/vehicle storage area "~ Curtain drain 1~ I C~ Wells on adjacent lots "~ / ~ ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Signature ~ ~/-°~~ ?~~... Engineer's Name Date HAA Fee $ "/ ' 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAl_ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~-~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, Location (address or directions) (b) Applicant Name ~/W£7-~4 ~'d,'t,',F¢~.?, _ Telephone: Home /~.,/~ _ Business Applicant Address r~ OD ~ ~ "~/ /¢, ,/¢,~? ~.~4 ~, ,.-¢,~. ,z ~',,¢F- .-~ ~"~ 0 (c) Applicant is (check one): Lending Institution,J~; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution -/'~-*.~-'~ L'~c:(/¢!g-'~' (~ '/~-/'""' /~--- Telephone _-- . Address (e) Real Estate Company and Agent .... Address Telephone (f) Mail the HAA_Io the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms ~'/ Other WATER SUPPLY Individual Well.~ Community[] Public[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite'[~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-(i25~11 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMAI'IOI,,t - ~ ::: ~' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th~s ~iealth Authority Approval shows that the on-site water supply and/or wastewater disposal system is sale, functional and adequate for the number of bedrooms and type of structure indicated herein, I fudher verify that based on the information obtained from the Municipality of Anchorage fifes 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. Eagle River EngJn0~rin~ S0~lcc~ Name of Firm ---r~Eff4 Telephone Address Eagle ~iver, AK 99577 DItEP APPRO~L _~~ Approved for~'~'''-~, ___ bedrooms b Date '~A~.~ %7~'~'~ Approved Disap~~~ Cond,fional 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 abeve by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes 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 responsibk; for errors or omiss'ions in the professional engineer's work. Page 2 of 2 WELL DATA MLINICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: If A, [% C, D.E.C. Approved (Y/N) Well Classification Well Log Present (Y/N) ,~/ Date Completed ~'-e'¢- ~: /',;~¢'";/ Yield ~-~ Total Depth ~ '~ ~ / Cased to _~- .7.5- / Depth of Grouting _ Static Water Level -~ .~'- / Pump Set At .,¢~-' Casing Height Above Ground ~-~ /¢' /'' Sanitary Seal on Casing (Y/N) ~? Depression Around Wellhead (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding 'rank on Lot ,/,0<:;~ /'- To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /¢/(.r~.~ ,~. Water Sample Collected by _ Water Sample Test Results Comments ; On Adjoining Lots /~ ?'- /'~-¢ / ; On Adjoining Lots /,d¢.~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date __ N B. SEPTIC/HOLDING TANK DATA Date Installed 7/'/~ ~' Standpipes (Y/N) .~/' Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High.-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ,/~/2 /-~ To Property Line _ To Water Main/Service Line /~/'~ Course ,,'~/d'h Size ./D, ,~-¢ No. of Compartments ~ Air-tight Caps (Y/N) _ ,,;P/ Foundation Cleanout (Y/N) ?,,v/ Date Last Pumped ,/¢/¢ ~,-~ ; for ~- Temporary Holding Tank Permit (Y/N) -/~.,./~ __. To Building Foundation ' //7/" To Disposal Field /~, '* To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of ~ Square Feet of Absorption Area Depression over Field (Y/N) /L~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /'~) To Building Foundation ' ~ Lot /%/~ To Water Main/Service Line .5~o; To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /~£~/~/¢~-~' ~ ,..,~/ s:,.// Type of System Design Length of Depth of Field / Gravel Bed Thickness ~ ''/ Standpipes Present (Y/N) Date of ,Last Adequacy Test To Property Line ~ ¢// To Existing or Abandoned System on ; On Adjoining Lots '"~ '-~ -~- To Cutbank (if present) ,/z-"d.-~ ,rE D. LIFT STATION Date Installed ~ Size in Gallons "Pump On" Level at ~ High Water Alarm Level at Tested for ~ Electrical Codes (Y/N) ~ Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** 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 '- '- '- '- '- '- '- '- '- '~ ./~'~ Date Company /-~./~. /¢' ~ 1~-~*, S~OA No. Date of Payment B"~ ~ ~ %~ Amount: $ ~ 5 o~ Page 2 of 2 72-026 (11/84}