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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
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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~
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