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GLACIER VIEW HEIGHTS #4 BLK 3 LT 6
Glacier View Heights #4 Block 3 Lot 6 #050-501-30 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201377 PID Number: 050-501-30 Dwelling: Al Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New W Upgrade Name SHEREE NEWTON F§SORPTION FIELD o El DeTrench ❑Wide Trench El Bed undOther site Address 22808 EAGLE GLACIER LOOP, EAGLE RIVER, AK 99577 Phone Number of Bedrooms Soil Rating Total depth f original grade 972-965-6127 3 ASF Ft LEGAL DESCRIPTION Depth to pipe invert from original a Gravel depth beneath pipe Ft. Subdivision Block Lot GLACIER VIEW HEIGHTS #4 3 6 Fill added above original Gr g I length V.riship r.alige JGVtiVll Ft. Ft. Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES To' Septic I Absorption I ; I Holding Sewer Total orption area Number of trenches Dist. between Nqches From Tank I Field 1 " - `--"-" I Tank I Line Ft'- Well 100'+ EXIST.- - 125'+ TANK A Septic ElS.T.E.P. [IHolding ElOther Manufacturer GREER TANK Capacity 1 nnn=I I Surface vvaier I.. , "1 Ul)' + 1 �..,.,.T EMS 1 . — — I Material Number of compartments Lot Line 15'+ EXIST. - - NA HDPE PLASTIC 2 1 VVIIV aIIVII I.,. I U T 1-".11 � Cn10 1 _ � _ LIFT STATION a er Capacity Gal. Alarm location installed by I Remarks PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer NORTHERN FXC;A\/ATION nminfip.fd FYIST_ nniMTn3n34 Inspector JODY MAUS , GEG CONSULTANT BENCHMARK (Assumed elevation) 100.00 e Inspection- 1'` 10/9/2020 Location and description 2,d 3a _ 41A - BOTTO OF.SUNG AT SO ITH CORNER ELC R,OF HOUSE (POINIIT"R".) r ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stomp oo6oZ�Ol O OF iuiiuitiui iai APNruvai. UdLu � i t .,�1 j'11V� 7. C )a 00 F� Septic Syste .ref A,Ga>,,.4ss: �0 ' 19V es� Approved , l 1� - ��� Date Q 2 i 2D s� �� - j( Fro �ne eJ''U.a.l �. ��N,ofessio0000 Note: this approval does not include well permit requirements. I #AECC88400000 I tKev U57uz/-ILS) PERMIT NUMBER: PARCEL ID NUMBER: OSP201377 RECORD DRAWING 050-501-30 TOP OF MH LID = 99.87 TOP OF TANK @ INLET = 96.77— INVERT OF BUNG @ INLET= 96.12 FINAL GRADE = 98.77-99.08 low NEW 1000 GALLON GREER HDPE SEPTIC TANK ARN SS ENGINEERING ROUP, Ltd ENGINEERING SALES CONSULTING 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 • PHONE (007)337-6179- FAX (007) 338-3245 - WEBSITE: n gamewerv0l ein0.mm PREPARED FOR: PHONE NUMBER: PAGE NUMBER SHEREE NEWTON 972-965-6127 3 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: GLACIER VIEW HEIGHTS SID #3; BLOCK 3, LOT 6 J.L.M. TYPE OF WORK: DATE: ,,- RECORD DRAWING OF SEPTIC TANK UPGRADE 10/14/2020 TOP OF TANK @ OUTLET = 96.77 " OF INSULATION s?Ef2L INVERT OF BUNG @ OUTLET = 95.89 PERMIT NUMBER: PARCEL ID NUMBER: OSP201377 RECORD DRAWING 050-501-30 _7 \—EXISTING WELL ° a\\ ° / `�l •lam %d a d / d OIC/\ ° \ 0 d \ Al a o .. a ° G OLD SEPTIC TANK WAS \ \ T -soup LG DECOMMISSIONED PER UPC \ PER THE CONTRACTOR \ O INSTALLED DOUBLE CLEANOUTS (DBL1 & DBI -2) EXISTING 34' LONG BY 17' WIDE DRAINFIELD. PASSED SEPTIC ADEQUACY TEST ON 8/28/2020 A B FCO 24.1 16.3 NtW7000-UALLUN MH 1 27.7 1 22.1 GREER SEPTIC TANK _J S11 1 30.2 25.5 \♦ // naL 1 R1 3 D912 1 32.0 27.6 NOTE: SVVING-TIE INFORMATION FROM N HOUSE CORNERS TO SEPTIC STANDPIPES WERE GENERATED BY SCALING EXISTING FENCE LINE DISTANCE FROM AUTOCAD DRAWING v IILT SIVCU FI\Vl.i LAIDG Ai:C ASSOC. SCALE: AS-BUURVEY ATED 10/12/2020. womMmu —ii /1"=20' 4110 4 �d ENGINEERING SALES CONSULTING �; ' � 3701E. TUDOR ROAD. SUITE 167• ANCHORAGE, AK 99507PHONE (907) 337-6179- FAX (907) 338-3246' VVESSITE: vrmv.gamesseng.meo.ymm ••••r•••{•.�•f ••• .............. ..i ..... 00 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: @ (n - Je fFeY A. Garnes5 Lv SHEREE NEWTON 972-965-6127 2 OF 3 '� i �"Ay 6 S CE -79 "` ; AV PROJECTILEGAL DESCRIPTION: DRAWN BY: GLACIER VIEW HEIGHTS S/D #3; BLOCK 3, LOT 6 J.L.M. Q�FO ' TYPE OF WORK: DATE: LICENSE $� N'QFES�S\0 � RECORD DRAWING OF SEPTIC TANK UPGRADE 10/14/2020 #AECC884 / HOUSE DETAIL Scale: 1 = 40' DECK ao .0- 2.0'X5.3' CANT \ \ -0. C"i 110 - F�� of s '� ( \� ClIr 100* PROTECTIV RADIUS C, 2.0' CANT '—WELL c� Lot 5 —IAA HOLE 9 \ \ 'L PIPES WOODEN FENCE 0 MEA MTA EASEMENT r. �' 10' DRAINAGE EASEMENT Lot 1 d Lot 7 1 Lof 6 49,326 S.F. 15, 01 ,j _ Lot 10 Lot 9 PLOT PLAN — — — AS BUILT —X— SCALE 1 60' GRID Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in C (907) 522-6476 Phone 5 Fox 2-462 Professional Land SurveyorS (907) 5kenClan2gsurvey.com OF 4 lonoihan*longsurvey.com D . ....... 1 hereby certify that I have surveyed the following described property: LOT 6, BLOCK 3, GLACIER VIEW HEIGHTS — UNIT No. 4 (PLAT No. 84-77) 49TH Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed ....... I �0 - �N H Gt LANG premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. .LS -5202.• Dated this the Day of — — — — — — — I — — — — — — - at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201377 Work Type: SepticTank Upgrade Tax Code Number: 05050130000 Site Legal Address: GLACIER VIEW HEIGHTS #4 BLK 3 LT 6 G:0159 Site Mailing Address: 22808 EAGLE GLACIER LOOP, Eagle River Owner: NEWTON SHEREE M Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: me,nr *o S, v el)artmerit 9/22/2020 9/22/2021 49326 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy . ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B Issued By: ?r�(`/ Date: q 3/,/—I Date: i 3 �_NWIUNICIPALITY OF ANCHORAGE Development Services Department � �° Phone: 907-343-7904 On -Site Water & Wastewater Section � `-�' Pax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-501-30 Property owner(s) SHEREE NEWTON Day phone 972-965-6127 Mailing address 22808 EAGLE GLACIER LOOP, EAGLE RIVER, AK 99577 Site address 22808 EAGLE GLACIER LOOP, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) GLACIER VIEW HEIGHTS #4; BLOCK 3, LOT 6 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Date of Payment: Absorption Field ❑ Initial ❑ Single Family (SF) 0 Receipt Number: (w/wo ADU) Septic Tank 0 Upgrade RX Permit No. 05P2O137 7 (D) ❑ Holding Tank ❑ RenewalDuplex ❑ 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: 6 S -6- QV _O Waiver Fees: Date of Payment: 9 (1 "'z 6 O Date of Payment: Receipt Number: 0 0 �? G Receipt Number: Permit No. 05P2O137 7 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201377, Rebecca Carroll, 09/22/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201377, Rebecca Carroll, 09/22/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201377, Rebecca Carroll, 09/22/20 Sonja Blewett From: aknewton <aknewton@att.net> Sent: Saturday, September 05, 2020 8:23 AM To: Jody Maus Cc: kathy@greatlandreality.com; Sonja Blewett Subject: RE: 228080 Eagle Glacier Loop - Well and Septic tests Jody, In the 12 years that I have lived here, I have never had a freezing problem with septic or water. Not one time has either frozen. I hope this satisfies the statement request. If not, please let me know if you require something more formal. Regards, Sheree Newton -------- Original message -------- From: Jody Maus <Jody@garnessengineering.com> Date: 9/4/20 11:24 AM (GMT -09:00) To: aknewton@att.net Cc: kathy@greatlandreality.com, Sonja Blewett <Sonja@garnessengineering.com> Subject: 228080 Eagle Glacier Loop - Well and Septic tests Sheree, On 8/28/2020, we tested both the well and septic system and pulled water samples on you r property. Both the well and septic appear to meet the MOA requirements for well flow rate and the absorption rate for the drainfield. As you are aware, the septic tank is 36+ years old and needs to be upgraded to obtain a Certificate of Onsite Approval (COSA) from the MOA. I have completed the tank upgrade design package to obtain the permit from the MOA and it is currently being review by my boss. Once we have a permit, Sonja from our office can give you a list of contractors to install the tank for you. I will have her contact you about this. while onsite, we did note that a portion of the drainfield is slightly shy on cover and we need a statement from you stating that you have not had any freezing issues with the septic system. Please email me a statement in regards to this if this is a true statement. I am currently working on the COSA paperwork to finalize this as well and need this statement letter. Once the tank is permitted, installed, and documented, we can finalize the COSA completely. Please let us know when you obtain a buyer and we can make sure the COSA is issued prior to your closing date. Please feel free to email or call my mobile if you have any questions. 2.0' CANT 10' DRAINAGE—// EASEMENT I hereby certify that I have surveyed the following described property: LOT 6, BLOCK 3, GLACIER VIEW HEIGHTS — UNIT No. 4 (PLAT No. 84-77) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on sold property except as Indicated hereon. Dated this the Day of --72.L- �40 . at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. 49TH! A......... KENNETH LANG —5202. *1 LS AECC963 Lot 10 Lot 9 PLOT PLAN AS BUILT X— SCALE —1" = 60' GRID Project No. N 20-523/A1 Lang & Associates, inc. 11500 (907) Daryl Avenue, Anchorage, Alaska 522-6476 Phone 99515-3049 Professional Land Surveyors (907) 522-4625 Fax ken0langsurvey.com OF A jonothon*langsurvey.com I hereby certify that I have surveyed the following described property: LOT 6, BLOCK 3, GLACIER VIEW HEIGHTS — UNIT No. 4 (PLAT No. 84-77) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on sold property except as Indicated hereon. Dated this the Day of --72.L- �40 . at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. 49TH! A......... KENNETH LANG —5202. *1 LS AECC963 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 82.5 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE '~!~1 EW MAILING ADDRESS LEGAL DESCRIPTION Absorption area Dwelling Material Width ND. OF BEDROOMS PERMIT NO~.~ //t~ ~'~ No. ,p~.ompar t me n ts LOCATION Well / DISTANCE TO: I-- ~ / Manufacturer ~ Liq. capacity in gallons ! I IF HOMEMADE: ~2~ DIS/TANCE ' ~:~,..~ O TO: Well ~O--~ Manufacturer --r, I Well- ~3: I DISTANCE TO: I ~ .~ ~ I NO. of lines ¢,~ I Le,n.~th of each line ~ I- / Top of tile to finish grade --u~ I Length Width ~'~ ~ ~ Crib diamete~ d IC'"'s Depth .~ I Building foundation DISTANCE TO: l' Material Nearest lot line ,~,~ ,T-,c-h~ ~;~ width, Inside length Liquid depth Dwelling PERMIT NO. Liquid capacity in gallons Foundation PERMIT NO. Total length of lines Material beneath tile Depth inches Distanc~e between lines Total effective absorption area PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorpt on area(s) OTHER PIPE MATERIALS SOIL TEST P~ATING INSTALLER ¢' REMARKS ' LEGAL Lz s 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: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- COMMENTS /, / 3 ~Icrt'C4 ! PERFORMED BY: SLOPE SITE PLAN WAS GROUND WATER /C.~- SL ENCOUNTERED? . 0 IF YES, ATWHAT /~Y ~'~'~,~'~;5 DEPTH? S ~,,,,~ Reading Date Gross Net Depth to Net Time -Fime Water Drop R~E-RGGc~-C~T4G~N- RATE / ~ ,~~ '~'~(minutes/inch) TEST RUN BETWEEN ~-~- FT AND -.-~ FT 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 TelephoBe 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT '"~AM E "~AILING ADDRESS _ [] UPGRADE ~-EGA L DESCRIPTION ~OCATION NO, OF BEDROOMS ~ ~ DISTANCE TO: Well Absorption area Dwelling PERMIT NO. ~ Z Manufacturer Material No. of compartments kiq. capacitg in ~ollons Inside length ~idth IF NOMEMADE: Liquid depth C~ ~ DISTANCE TO: ~ell Dwelling PERMIT NO. O ~ ~ Manufacturer ~; -- ~ Material Liquid capacity in gallons Q Well Foundation Nearest Jot line PERMIT NO. ~ ~ DISTANCE TO: =j Z ~ No. of lines Length of each line Total length of lines Trench widtb Distance between lines F' ~ ~ Top of tile to finish grade Material beneath tile ~ Total effective absorption area ~ ~ inches Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m DISTANCE TO: Well Building foundation Nearest lot line ~ Olass ~y~ ~[ ~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank ~/ ~ /d~ ~- ~ /_ Absorption area(s)~oO ~_ OTHER ~IPE MATERIALS SOIL TEST RATING REMARKS WATER WELL RECORD S'I'ATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol ~ Geophysicol Surveys LOCATION OF WELL , (Pleclo complete either lo, lb or lc.) DJ Borough I Su~)dlvlelon I-I~)t I BIo¢lq _._._._._._.~ I/4 qtrll. LSeclion Well ~ 2 SerGe/ Addres* ond ArGo of Woll Location E. WELL LOG M oterlal Type ----'i~~ gravel Feet Bolow Surface Top Gravel and silt 2 ---~ravel, silt sand,' ~-gt-er '16 45 Gravel, sand, silt --' Gragel, clay ~Llt Softom 2 16 76 Gravel, silt, sand, water 100 104 0tilling Permit Ne. A.D.L. No. OWNER OF W~LLMr · Ray Pelletier Shasta Construction Address: 6710 E. 16th Anchorage, Ak. 99504 4. WELL DEPTH: (flnol) ~ ft. O. DATE OF COMPLETION 5-----25 -- -84,- s. []Cch,. toc, [.~o,ory E}D~'¥on [] 7, USE:~ Ocmeetlc [] Public Supply ~_~ Indus!fy E~ Irrigut,on ~] nech<~rge [] Commerlcol ~ Tell Well ~ Other: 8I CASINO: I~ Throaded¥'%f~ Welded 9. FINISIt OF WELL= Typo; Olomdter: SIol/Me~h Slse; Lensth L Rockflliing .Orovo] pack ft. ,o, STAT,C WAT~. ~EVE'~,~n~.,., .,,. 5_j~/ 8, [] Abovc or ~ 8clew lend ~urf~co D~to Equipment used: rE,GROUTING Well Grouted: [] Yea [] No Material: [] I'~oot Cement [] Other: PUMP: (if oyallobte} HP Length of Drop Pipe ft. capacity [] Subm. [] der [] Centr[ficol E~ Other Production of 3 GPM WATER WELL CONTRACTOR'S CERTIFICATION: I§. Woter T~mperofure .__o [-~.F Th[: woll wal dritlod under my Jurlsdlcllon and Ihls reporl is Irue 1o the bosl of my knowledge and boiler; Magnuson Drilling AA 5385 A~ro,:__ P.Oo BOX 770504 Eagle River, Ak. 99577 Signofl: Authorized a e p r o $ e~t~ll v~e/--' ~ []C Form OE-WWR (11/81) Copy Dlstribullon: WHITE-State DGGS, PIHK"Oriller, CANARY-Customer UdgOC PALO 7 Y OF HCH0FRI,„ Development Services Department ? Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-501-30 Expiration Date: 5 2 Z3 Legal description GLACIER VIEW HEIGHTS #4 B3 L6 / Site address 22808 Eagle Glacier Lp Eagle River Current property owner(s) Tammy Kostoff and William Prevatt X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUMUPAUTY OF Development Services Department On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-501-30 Complete legal description GLACIER VIEW HEIGHTS #4 BLOCK 3, LOT 6 Location (site address) 22808 EAGLE GLACIER LOOP, EAGLE RIVER, AK 99577 Current property owner(s) TAMMY KOSTOFF & WILLIAM PREVATT Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 3 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ _ _ 6 Date of Payment2 ,3 1aA22 COSA # 5r r-2 26 -,I'-Ll3Ur�3 Waiver Fee $ Date of Payment Waiver # COSA Applicatiorr.doc Legal Description: GLACIER VIEW HEIGHTS #4A BLOCK 3 LOT 6 Parcel ID: 050-501-30 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled 5/26/1984 Total depth 104 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 102 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) 18+ in. FWrS Date of flow test for COSA 1/31/2023 Collected by Static water level at beginning of test 48 ft. Date 1/31/2023 Well production at time of test 2.3 gpm Comments WELL CAP OVER SANITARY SEAL. B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 1/31/2023 — ONE STOP ❑ Required maintenance completed, if AWWTS Comments: 2020 HDPE TANK INSTALLED D. ABSORPTION FIELD DATA Which system tested (date installed) 7/25/1984 ® ALL standpipes present per record drawing Total measured depth from grade 4 ft (max) Measured depth to pipe invert fromrq ade 2.3* ft (min) ❑ N/A — pressurized field. ® Per record drawings, field is insulated. ® Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 1/31/2023 Results 2 Pass Fluid depth prior to test 0 in Water added 540 gal New fluid depth 3 in Elapsed time 1310 min Final fluid depth DRY in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in Comments/Deficiencies: No known frost or freezing issues per owner & MOA docs. Elevation shots show approximately 1' effective depth from invert above to bottom of SW monitoring tube. Most likely dry w/in 2 hours of septic test Per original MOA inspection report it appears that septic system may have been insulated COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes _ if No ft ®Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water >' 100 _ ®Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN PE Date 2/7/2023 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 �-` q 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 tea*t construction (workmanship & materials), the water usage of the family being served by the i�f%``•• ••'�i ��� 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 or NO 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 & FWcsCUrtIS Huffman /� ��'••• CE 128991 • �,�� oj !ij F% • , 2/7/2023 .����� dpROFESStOVA COSA Checklist.docx klI �Z_L' . Municipality ®f Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 050-501-30 Expiration Date 1. GENERAL INFORMATION: Complete legal description GLACIER VIEW HEIGHTS 44; BLOCK 3 LOT 6 Location (site address) 22808 EAGLE GLACIER LOOP, EAGLE RIVER AK 99577 -'q1-zd2/ Current Property owner(s) SHEREE NEWTON Day phone 972-965-6127 Mailing address 22808 EAGLE GLACIER LOOP, EAGLE RIVER AK 99577 Real Estate Agent KATHY GERACI Day phone 242.5276 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distanc Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $—H 12., 5U CCPV CCS Date of Payment 1011 9' D � O Receipt Number COSA # DSGZOl57S 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system GG �Fv\kA� in accordance with the guidelines and regulations established by the Municipality of Anchorage and �'`C •.• }t' ;<� i industry practices. The reported results describe the condition of the system/s on the date/s of the �.'� •' ? 5 '•vtA evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells ��;'� THr and septic systems depend upon a variety of variables, including but not limited to, soil conditions, �/ � • • • •s• �_�-, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and1'1 i;+.! ..........'' ....... are outside the control of GEG. Satisfactory test results do not guarantee future performance of the �n� �'- o fr 2y AF Garness; systemis; therefore, GEG makes no warranty (express or implied) regarding the future performance of In N j 79 the well or septic system. GEG makes no representation whether an alternative well or septic system l� s Ej" 3 can be installed on the property in the event either of the current systems fail to perform adequately in Gi' �c, �• • • ��� the future. The content of this report is for the sole benefit of the person/party that retained GEG to ����a��oFess °^O� perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 • � �yLrI�TGIl�IGZ� System #1 Approved for bedrooms `��lOF System #2 Approved for bedrooms `9m� Disapproved _`��\eP Z ON-SITE WATER AND Conditional approval for bedrooms, with tl f�llc-IstiptyltC,s: m J PROGRAM A �Ji� ,�F )y' 1) t: y: `kyv\, Original Certificate Date: 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc A i Legal Description: GLACIER VIEW HEIGHT #4; BLOCK 3, LOT 6 Parcel ID: 050-501-30 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5125/84 Total depth 104 ft Cased to 102 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 8/28/20 Static water level at beginning of test 41.3 ft. Comments Structure served by this system 1 Well production at time of test 2.6 gpm Water storage tank volume NIA 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 GEG,LTD. Date of Sample 8/28/20 B. TANK DATA >station N Age of tank(s) NEW years tenance com Tank type/material aysTic ye Measured operating fluid level in septic tank NEW ial❑ Standpipes/foundation cleanout per recorddrawing Date of pumping NEW D. ABSORPTION FIELD DATA BED (SUMP1 / SUMP2) Which system tested (date installed) 7/25/84 Adequacy test date 8/28120 ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 3.83 ft (max) Fluid depth prior to test 0 / 0 in Measured depth to pipe invert from grade *2.2 ft (min) Water added 492 gal ❑ N/A — pressurized field New depth 2.75 / 1.75 in * ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 70 min depth into effective * F-1Code-requiredsoil cover over field Final fluid depth 0 0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 'A MAJORITY OF DRAINFIELD APPEARS TO HAVE 2+ FEET OF, BUT SUMP 2 ONLY MEASURING 1.87 FEET OF COVER. NO FREEZING ISSUES PER OWNER (SEE ATTACHED STATEMENT). SUMPS APPEAR TO BE DEEPER THAN DRAINFIELD BOTTOM. MEASURING 11.5 TO 13 INCHES OF EFFECTIVE IN SUMPS COSA Checklist yellow sheet 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' 0 Yes Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' F71 Yes if No ft Private Sewer/Septic Line > 25' F� Yes if No ft Absorption Field on Lot > 100' E] Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ft M Yes if No ft Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' F71 Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Yes Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' M Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' M Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' I✓ Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS C�-�:L�11>• L� �;���3iiI;�L�l�1I�I:l I certify that / 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 o— A,�� i .T.. 1...... a.......... �O V . Y ...s....:... ,J r, y A, Garn!ess; CE -795 yQ�ed pyo r e S sion�do #AECC884 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ti) - r)D COSA # Expiration Date: 1. GENERAL INFORMATION Complete legal description Glacier View Heights #4 SID, Block 3, Lot 6 Location (site address) 22808 Eagle Glacier Loop, Eagle River, Alaska 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Michael D. (Dane) and Janet McLendon 211 Chris Ryan Lane, Toney, AL 35773 Day phone Day phone Audrey Mason, REIMAX of Eagle River Day phone (907) 622-8236 (907) 622-3344 16600 Centerfield Dr., Ste. 201, Eagle River, Alaska 99577.7702 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. 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 Stale 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite 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 Douglas T. Kenley, P.E. Address 9606 E. North Star Orde, Palmer, Alaska 99645 Phone (907) 7461073 Engineer's Printed Name Douglas T. Kenley Date '?• Z5 • 08 S. DSD SIGNATURE Approved for —3—bedrooms. i Disapproved. Conditional approval for bedrooms, with the following Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: -ZEOriginal Certificate Date: jp• 11,05) a Municipality of Anchorage Development Services Department Building Safety Division ti Yi"y On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Glacier View Heights M4 SID, Block 3. Lot 6 Parcel ID: 050-501-30 A. WELL DATA Well type Private If A. B. or C provide PWSID # _ Well Log (Y/N) Y Date completed 5r26I64 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth too ft. Cased to 702 ft. Casing height (above ground) 34 in. FROM WELL LOG AT INSPECTION Date of test 5/zslaa Static water level 40 ft. Well production 3 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate ND mg/L Arsenic: ND mg/I Date of sample: 7/1/06 B. SEPTIC/HOLDING TANK DATA 7/21108 . 37.9 ft. 2.7 9 - p.m -Other bacteria 0 colonies/100 mL Collected by: F. Kenley Tank Type/Material Septic/Steel Dale installed 7/25/64 Tank size ' 1250 gal. Number of Compartments 2 Cieanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N/A Date of pumping 12105/07 Pumper JRs Pumpers C. ABSORPTION FIELD DATA Date installed 7/25/84 Soil rating (g.p.d./ft= or fe/bdrm) 125 sq. ttfidrm System type bed Length 7 34- ft. Width 17' ft. Gravel below pipe 0•5' ft. Total depth 2.5" ft. Eff. absorption area 578 ft2 Monitoring tube Y Depression over field N Date of adequacy lest 7/21108 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 642 gal. New depth 1-3/4 in. Elapsed Time: 47 min. Final fluid depth o in. Absorption rate >= 450 g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date NIA D. LIFT STATION Date Installed Size in gallons Manhole/Access (Y/N) `Pump on' level at _ in. "Pump off" level at_ in. High water alarm level at in. Datum Cycles tested Meets alarm 6 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot 100+ft. On adjacent lots 1100+ ft. Absorption field on lot 110+ft• On adjacent tots loo+ft. Public sewer main NIA Public sewer manhole/cleanout NIA Sewer /septic service line 25+ ft. Holding tank NIA Animal containment areas 50+ ft. Manure/animal excrete storage areas 1100+ ft. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5.5 ft. Property line 45± ftft. Absorption field 18 ft. Watermain NIA Water service line 10+ft• Surface water 100+ Ft Wells on adjacent lots too+ ft. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 20+ ft. Building foundation 36+ ft. Water main NIA Water Service line 10+ftv Surface water 100+ ft. Driveway. parkingtvehicle storage 35+ ft. Curtain drain None kr— 10exist Wells on adjacent lots 100+ I'm F. COMMENTS: From MOA records. "Re depth of absorption field. MOA records Indicate 2' Insulation. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines In effect on this date. Engineer's Printed Name Douglas T. Kenley Date 'I -V) •08 COSA Fee $ L-fw Date of Payment i-/X3/og Receipt Number ( b F36 (Rev. 11105) Waiver Fee $ _ Date of Payment Receipt Number ALIT ...8 S..RI .,, YaKF INI1r0I s R Fq 00. WELL �z0'10, 7j4 • \ `\ T .._._ _ IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VIS. D VALL BE RIVEWAYS, EW CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS, SEPTIC CI.[ANOU75. SIDEWALKS. DRIVEWAYS. TO FBNISHEO GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ErC.. ARE SHOWH IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE UasTENCE Or ANY EASEMENTS. COVENANTS OR RESTRICTIONSMAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. PPEAR THE R IN ION P AT. I UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CCNsTRJCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITYFOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. RrPRIYAICTION MAY CAUSE ERRORS IN SCALE. Prepared by SURVEY CERVICATION ���...����� .•.'E of 'At Robert E. Johns, Jr. & Assoc. run IN.".........., 4w X` .•• SII Professional Land Surveyors •,, , r w ••� « •w.•r ra r v 1 b.• Nr r rWr. w r r r ..�• . C:I •• III 17DO DRINK DR. ANCHORAGE ALASKA 99504 .e�.r rrr.w ror rwr tiw .rr. rw r {1 T �, xd.: R•c. Lot S.F. Pec. PURI M Na lot' FOUNDATION AS -PAT • , ♦ Date sur yeC Oram DY. R.T Chocked a)9 XT ....�...�.......W..I r ! ...... .... ............� 6-24-03 Data Dm. Grid; .SY4159 W.0. 8142 Irrrr . r r r rri R ERT E. JR.•7 0 i«rN.r ♦•4 21 6-25-08 '.w WI D..vk'tlan: FINAL STRUCDJRE AS-/IA.T �� •i•�% ....r•' �o�� �, rr �NWIC Fr. r. •r+T..Wrrl ew• F•rr.. kY ..w r r ............ •�.� ✓������� Lot 6 Block 3 �•"M� Glacier View heights ❑ tar aAncY SURVEY TYPE SNUB= ASPHALT ❑ FMWAT04 AS-EUIT • SET REBAR r 0* DRAINAGE ❑ FMK EIMNCIMIC A T O FOUND REBAR P -P -a WOOD FENCE ..:�•—"' CONCRETE ❑ FLDT FUK ... A T. NOT 111 11E ... TDPaOR.VHT _ _ dW_ ASSUMED ELEV. aF METAL FENCE .._._ _ IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VIS. D VALL BE RIVEWAYS, EW CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS, SEPTIC CI.[ANOU75. SIDEWALKS. DRIVEWAYS. TO FBNISHEO GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ErC.. ARE SHOWH IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE UasTENCE Or ANY EASEMENTS. COVENANTS OR RESTRICTIONSMAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. PPEAR THE R IN ION P AT. I UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CCNsTRJCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITYFOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. RrPRIYAICTION MAY CAUSE ERRORS IN SCALE. Municipality of Anchorage O 'yt Bb • -- Development Services Department -i Building Safety Division On -Site Water and Wastewater Program , 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cii.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. -J�/ - 3d- "o — e2 HAA # dAQ,72,nS / Expiration Date: 10-11-02- 1. D -//-0Z 1. GENERAL INFORMATION Complete legal description Laf 6, ?w Ile";/AS- Location (site address or directions) Current Property owner(s) A4?Zy' / d 4o9 man len Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address eeO.gc,Y /yr Wig: " /, ,r e",e " " eC%J�'7 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: S 3. TYPE OF WATER SUPPLY:' Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional eneineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 Address 996o E• A141 Phcne _9e7 -7-Y6 -/0 93 Engineer's Printed Name Date 42.7( • c Z k:Tk11 ' sY 5. DSD SIGNATURE Approved for L bedrooms. fl CE BtT! Disapproved. ,l''� Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: ../ !ii/. /"a -C/ Original Certificate Date: %—I/-4') /r (R«. OIJ021 Municipality of Anchorage *A. Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw SL u P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST 44 Legal Description: Lotet. � 3, C/�r���r �/.�sv �;•fs %Parcel ID: A. WELL DATA Well type)U A tc If A, B, or C provide PWSID # _ Date completed ZLVeIFY Sanitary seal (Y/N) Total depth /D y fL Cased to /OR fL FROM WELL LOG Data of test .2 f 5� Static water level R Well production 3 g.p.m. WATER SAMPLE RESULTS: CcUforrn 0 oolontes/100 ml. Nitrate •.2 mgA. Arsenic: ,0 mg./I. Date of sample: 6A2 B. SEPTIC(HOLDING TANK DATA Well Log (Y/N) �Y Wires property protected (Y/N) Casing height (above ground) n. AT INSPECTION Oz it g.p.m. Other bacteria O oolonies/100 ml. Collected by: r i Tank Type/Material S dee / Date installed Tank size ,/� SD gal. Number of Compartments Cleanouts (YM)y Foundation cleanout (Y/N) -.y_ Depression over tank (Y/N) �V _ High water alarm (Y/N) _ Date of pumping Aad• 1,9,.Pea Pumper 7' X PamPiLY% C. ABSORPTION FIELD DATA Date installed o?f Soil rating (g.p.d./R? or tl tJ J .L .T System type 6c� Length 3 •/ R Width / ft Gravel below pipe G " 7z y i!%nsr/N /jAn Total depth a's "" R ER. absorption area .S%6 1t2 Monitoring tube _.y_ Depression over field Date of adequacy test o Z Results (Pass/Fail) T,v3S For 3 bedrooms Fluid depth in absorption field before test 0 in. Water addedwoe gal. New depth --I in. Elapsed Time: 9/ min. Final fluid depth 1g in. Absorption rate >= y3O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 1Y If yes, give date D. LIFT STATION Date installed 'Pump on" level at _ in. E. SEPARATION DISTANCES Size in gallons 'Pump off Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot /CO t f/ Absorption field on lot //0 Public sewer main /Y4V Sewer/septic service line a?S> Fi Manhole/Access (Y/N) level at in. Meets alarm & circuit requirements? On adjacent lots /490.,A f /. On adjacent kits / 00 r f,'* Public sewer manhole/cleanout /✓/A Holding tank l� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation L. s f/ Property line Absorption field /X F>. Water main !rZ&_ Water service line �St ,cf Surface water iDo f T. Wells on adjacent lots 100PI f>r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line o?D> FI. Building foundation 36 +' f%' Water main A//_& Water Service line o?6t fr. Surface water /6o 7' r. Drkwvay, parking/vehicle storage 5'St fY Curtain drain N©nc Wells on adjacent lots /4ge t of . F. COMMENTS G. ENGINEER'S CERTIFICATION I cer* that I have determined through field inspections and t review of Municipal records that the above systems are in t,0 conformance with MOA HAA guidelines in effect on this date. 1100• • Engineers Printed Name Date G•2�•OL ,�+ HAA Fee $ X75 • as Date of Payment % /2 A oZ Receipt Number a �-Sq y' (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number S c rl CFar,/..a C' Zlor 9 7 ♦,YJ II�. ac � w.k n 'P;;., L , N. K o`_/. I., 11 0 AS -BUILT I hereby certify that 1 have surveyed the following described property.; Le)7- b y Bloc f 3 � '� �'� ;•,. ' ? �'+ Anchorage Recording Precinct, Alaska, and that the improve- ,:' - • merits situated thenen art within the property lines and do not overlap or encroach on the property lying adjacent thereto, that •'•:` '•• �'.r : no improvements on property Iving adjacent thereto encroach on the in and that then premises question are no roadways, ;s..;...�.;...•f „, .: transmission lines or other visible casements on said property except as indicated hereon. Dated at Earle River, Alaska this day ofCJ rtJ I)? ? ROBEi<r c. )OHVSON -;�C's�f SCALE: , Registered Land Surveyor No. i4!_S Box 77-04i6, Eagle River, Alaska 99577 . - - - Phone (907) 694-2543 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # _(~ - ~L¢'~[ ~~(~) NAA #_ GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ ~ TYPE OF WATER SUPPLY: Individual well ;,,4, Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves_ti~gation 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 "~"), l~,_ [-~-'d,,~ ~P,~' Phone Address ;~c) ~ ~~ E'~ ~ ~,/L~c P ~.~ Engineer's signature ~~'~, ~ Date 6. DHHS SIGNATURE )'"' ;'~'~"r"~ Approved for ~7~'z~-~L/~./~ bedrooms. Disapp¢oved. 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 this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Bsck MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST / Legal Description: /.~¢r- A. Well Data Well type P~' ,~//'f'Z¢ Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number ')/ Date completed ,~',/z.$/~ ¥ Driller /¢~ Cased to /'o,z, Casing height )/ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG S~PARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot I Public sewer main Sewer service line ~ ~' '-~- AT INSPECTION 'l / / g.p.m. .¢~¢' g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Z WATER SAMPLE RESULTS: Coliform Date of sample: 7/I ~/~'~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Nitrate ¢2 r / o' Other bacteria Collected by: -}'~ ~'L Tank size /~-~£¢ Compartments ,2. Foundation cleanout (Y/N) ¥ Depression (Y/N) ~/~ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot j To property line Surface water/drainage On adjacent lots Absorption field /~ ¢- Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed Length ~ ~/ Width Total absorption area Date of adequacy test Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested On adjacent lots Surface water Soil rating (GPD/FF) ¢' 17 Gravel thickness Cleanout present (Y/N) '?///~,//~) -~ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) /f,/' System type Total depth y' Depression over field (Y/N) After test If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots l oc~-~ Property line To existing or abandoned system on lot Cutbank /~///'~ Water main/service line Driveway, parking/vehicle storage area ~-~o~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA Date HAA Fee $ /'TE) "(~ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number D. R, DAYTON, P.E., R.L.S. ~xx~l~)~x~J~ Chugiak, Alaska 99567 20210 Donalar (907) ~'~ 696-2417 July 15, 1993 WELL FLOW TEST Legal Description: Lot 6, Blk 3, Glacier View Heights ~4 Date of Test: July ]_3, 1993 Well Depth: 102' Static Water Level: 40' Requirements: 3 BR - 450 gallons per day Test: The well was tested with the existing pump through an outside hose bib. The well produced 475 gallons in 160 minutes. The pumping rate was 3.0 gpm with a maximum drawdown of 54'. The well is currently producing adequately for a 3 bedroom home. D. R. DAYTON, P.E., R.L.S. ~-~i~ Chugiak, Alaska 99567 20210 Donalar @o71 696-2417 July 15, 1993 ADEQUACY TEST Legal Description: Lot 6, Blk 3, Glacier View Heights ~4 Date of Test: Jult 13, 1993 Septic Tank: 1250 Gallon, 2 Compartment steel tank Absorption System: ]_7' x 34' bed Soils Rating: 125 sq. ft. per bedroom Requirements: 3 Bedroom - 450 gallons per day Test: 475 gallons of water were pumped into the bed. There was no rise in the liqiud level in the bed. There was no water standing in the bed before or after the test. The absorption bed is currently functioning adequately for a 3 bedroom home. Parcel I.D. # MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be comp eted prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 6; Block 3; Glacier View H~ights Location (address o~' directions) NHN Eagle Glacier Loop (b) Property owner~'ary Brown/Christine Nelka Mailing Address Telephone: (home) (c) Lending Institution -' Telephone Mailing Address (d) Business RealEstate Company and Agent GREATLAND REALTY ATTN: RAe Address 11411 Old Glenn Highway Eagle Rive% Alaska 99577 Telephone' 69'4-9125 : " '' (e) Mail the HAA to the following address: (or check here ~,, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING Eagle River, AlasEa 99577 2. TYPE OF RESIDENCE Single-Family ~X Number of bedrooms. 3: WATER SUPPLY Individual Well ~x Community [] Public [] Note: If community well system,' must have written confirmation from the State Department of Environmental · Conservation attesting to th legality and status. : 4. SEWAGE. DISPOSAL·,. .:. ... :, ~ On-site ~x,~,:Public [] Community [] . Holding Tank [] ' · Note: If commumty well system, must have written conflrmabon from the State Department of Environmental · CorfS'~vation ~tt~'sti~g' (0 the legality a~d.status: ....· . . : . : 72-025 (Rev. 7/88) Page 1 of 2 ' 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, As certified by my seal affixed hereto and,aS of the validat¢ Health-Author ty Ap~8~i'~show'~': t~a't-i'tfie oh'~site:'water''su ' functional and ad~qu'~i'e'"'f~¢th~ number of bedroo~s'an~l type of,st based 'oh the information obtained from the Municipality o .. inspection, the o~fl'-'~it&'.~Wa(e'rr'§dPl~l,)'aHd?~Sr:~A§(e~te'r ~li~ State codes, o rdiiiahde'~';~i~'rCd rec~ ulati6n~iii effect oh"the'date o ..Name of Address ._-, .$ & $ ENGINEERING 170'34 Eagle Ri~er Loop Roa8 No. 204 ' ' Eagle E[ver~ Alaska 99577 Date '- .:~ 6. DHHS'APPRO Apprc Ap[: .Terms of .Cot The Municipality of AnChorage Department of Health and Human Services(E cerificated based only upon the representations given in paragra[ registered in the State of Alaska. ~,he DHHS does this as a courtesy~tc institutions in order to satisfy certain'federal and state requirements. Em Or analyze data before a certificate is issued.'The Municipality of Anch0!ag, in the professional engineer's work. , 72-025 (Rev. 7/88)Back Page 2 of 2 A. WELL DAT%.~ Well Classification _ ~ ,"tO?/~_ Well Log Present (Y/N) ~ Date Completed Total Depth J o/-¢ / ' Cased to ( Static Water Level .~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /'~/,~ To Nearest Sewer Service Line on Lot MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 If A, B, C, D.E.C. Approved (Y/N) ¢J_~ Depth of Grouting - Pump Set At Yield _~. "~' ~p/V~ Sanitary Seal on Casing (Y/N) L~ Depression Around Wellhead (Y/N) /'d Water Sample Collected by ~ '¢ ~ ~-¢?~¢e~¢'¢~(., ; Date '-"¢-- Water Sample Test Results ~')P~ff~(~,.-.-.~C~E_."~o¢'~ j ¢~¢,~'/"¢--¢i~ bL Comments ; On Adjoining Lots / / (0 o "f ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed ~ - 2,5:P.~ Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) . SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK: ! ~ ~--o No. of Compartments 2- Air-tight Caps (Y/N) t1 Foundation Cleanout (Y/N) L/ /~ Date Last Pumped '"'¢ -- .~ ~- ~ C) &)//'2i 'for -~ Temporary Holding Tank Permit (Y/N) /J//~ To Building Foundation To Disposal Field To Water-Supply Well To Property Line To Water Main/Service Line C ss pool To Stream, Pond, Lake or Major Drainage Course Comments ~ ¢-to'~-I'c_ ~¢/~ ¢) ¢_.(J ~u, 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed "~ - Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~/~'),~. Type of System Design Length of Field ~ Depth of Field 2' Gravel Bed Thickness ~ '~ ~ ? ~ ~ Statndpipes Present (Y/N) /~ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~ 2.~ To Existin~ or Abandoned System on · On Adjoining Lots ..~ O To Cutback (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7~88) Back S & $ ENGINEERING ~.7024 E~g]e R!;,er [.ee~ K'~ad No, 204 Eagle River, Alaska 99577 Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHOI~GE plVlSION OF ENVIRONbDZNTAL HEALTtI DEPARTMENT OF [DfakLTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ~tEALTH AUTHORITY APPROVAL CERTIFICATE 1. General In formation Application Date ~z~//?'~.~[~ ..... (a) Legal Description ~include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name. -f~/'~,''/a Applicants Address ~6'~ (c) Applicant is (check one) Lending Ins~itutJ. on [~-'Z Buyer ~__~; Other~[ (explain); ~"~-1%~'~ ~v''.~' (d) Lending Institution ~.~ c 79,=, c /-¢,~ Telephone - Home Business ; O er/ uilaor ZilI ; Telephone Address (e) Real Estate Co. &'Agent Address J~,~ ~Z /~,,/~ Telephone (f) Mail the }biA to the following address: 2. T~e of Residence Single-Family~ Number of Bedrooms 3. Water Suppl__y Multi-Family~-7~ Other (describe) r Note: If community well system, must have written cor~firm, ation from the St~te Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite~~ Public _~-_! Community ~_~ Holding Tank ~i~ Note: If community well system, must haw: written confirmation from ~he State Department of Enviroomental Conservation attesting to the legality and status° [Page 1 of 2] 15. .En__~ineerin~ Firm Providin.~In_~q~2_e.c_tion___~s,__T~;s_t~ File Search~, Data and Information e As certified by my seal affixed hereto and as of the validation date shorn, below, I verify that my investigation of ~his Health Authority Approval shows that the on-site water supply and/or wastewater disposal, system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supp].y and/or wastewater disposal system is in compliance x~xith all Municipal and State codes} ordinances~ and regula~' tions in effect on the date of this inspection. Telephone Address ~;~ ~ ~ ~o 2225-[~ '~.? DHEP Ap~row~l ~ '~'~)l ~JUHE 25~ 1971 .',';~ Approved for Approved ~ Disapproved ~__ Conditional ........ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPAR~ENT OF I{EALTH AND ENV._RO~MENTAL PRO£ECTION (DHEP) ISSUES ~']ALTt! AUTHORITY APPROVAL CERTIFICATES BASEl) SOLELY UPON THE REPRESENT'- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIObb%.L ENGINEER REGISTERED IN THE STATE OF AI~SKA. T~iE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND TIiEIR EENDING INST.IU~IONS IN ORDER TO SATISFY CERTAIN FEDERAL A>U) STATE REOUIRE- MENTS. EMPI, OYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR z~qALYZE 1)AT~ BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOIl ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SF~L) RR4/ej/D18 [Page 2 of 2] 7-19-84 A® MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification f~/'~ ~ Well Log P~esent (Y/N) Total D~pth IO ~ Cased to Static Water Level Casing Height Above Ground Elect~zical Wiring in Conduit (.Y/N) Separation Distances f=om Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line M[JNICIPALH'Y OF ANCItORAQ~ DEPL OF HEALTH & ~NVII~ONMENTAL pEO'I'bC'[ION~ Legal Description: ~"~7~ ~ %V/~?' [~' If A, B, ~ C, D.E.C. ~p~o~d(Y~) 1~t~ ~/~- ~ Yield ~pth of G~outing Sanit~y ~al on Casing (~).~ ~ession ~ound ~l~ead ~Y~) Date C~tpleted Pump Set At Cleanout/Manhole /~ ~ To Nearest Sewer Service Lir~ on Lot Water Sample Collected By ~.~ ; Date ~>/~/~'~/ Water Sample Test Results -J'~J",~,~ ¢- J-~y ; On Adjoining Lots /~O /~ 7~ ; On Adjoining Lots To Nearest Public Sewer CQt~t~nts S . IC/HOL I Date Installed ~./Df.~/~ V Size ./~=~ ]~0 NO. of CQ,~nts Standpims (Y~) .~ Ai~-tight Caps (Y~) ~/ Foundation Cleanout ~ession o~ Ta~ (Y~) ~ ~te ~st P~d ~ P~ing~intenan~ ~n~a~ ~ File (Y~) ~ ; fo~ _~ Holding Ta~ High-Wate~ Ala~ (Y~) ~/ ~a~y Holdi~ Tank ~mit (Y~) ~p~ation Distance f~ ~ptie~olding Tank: To Water-Supply ~11 /~ ~ To ~ilding Foundati~ To ~o~ty Li~ ~--~' To Dis~sal Field /~ To ~ter Mai~vi~ Li~ /~ / To S~e~, Pond, ~e, ~ ~jo~ ~aina~ Counts [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7/~ 3-/F ~ Width of Field / ~ / Square Feet of Absorption A~ea ,_~-~ 3 ~ Depression over Field (Y/N) /~;c3 Date of Last Adequacy Test Results of Last Adequacy; Test ~/~a ~a~ T~ Separation Distance from Absorption Field: To Water-Supply Well /~ '~- To P~operty Line ~--~ Type of System Design Length of Field ,~ ~/ ~ Depth of Field ~ Gravel ~d Thick.ss / ~ ~ Stan~i~s ~esent (Y~) To Building Foundation ~ 5- / To Existing or Abandoned System cn Lot /¢/z~ ~ On Adjoining Lots ~,~ /$~<; W,~,~£ To Water Main/Service Line '/~ f- To Cutbank( if present) ~z~ To Stream/Pond/Lake/o~ Major Drainage COL~Se /Z/-o~ ~C TO D~iveway, Parking A~ea, c~ Vehicle Stc~age A~ea ~ ~ Co~'~e nts D. LIFT STATION ~/~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dim~ ns ions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA C~ents ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, o~ conforn~d to all MOA HAA Guidelines in effect on the date of this inspectiog~~ Company ,~ ~Z-/~ ~ ~ /f_/3~. ' Date MOA NO. ~ ~.~IN~ '.~ KB1/d5/s [Page 2 of 2] 2-15-84