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Home My WebLink AboutGLENN VIEW ESTATES LT 7 Municipality of Anchorage Pi.aa I of ~_ r)EPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 * Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~ ~00~ PIDNumber:_OS~ Name: 4~; Wastewater System: ~New D Upgrade Address: P~o.~: ~ Deep Trench XShallowTrench ~Bed DMound ~Other ~ Total Depth from original grade: LEGAL DESCRIPTION SoilRating: I'~ GPD/Sq, Ft, 7' Lot: -~~BI°ck: ~, ~Subdiv~i°n:~ ~, Depth to pipe bottom~¢from original grade: Ft, Gravel depth beneath~ pipe Ft. Township: Range: ~ Section: ' Fill added above original grade: Gravel length: ¢ Number of lines: Distan WELL: New D Upgrade Gravel width: ~ Ft. J ~n lines: Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: j Drier: ~ Date Drilled: StsticWater Level: Installer: Date installed:~_ Pump Set at: Casing Height Above Ground: Yield: ~5 GPM U~Kdopd ~,. o-& ~,. TANK SEPARATION DISTANCES ~eptic D Holding D S.T.E.P. To Septic Absorption Lift Holding Public/Privat~ Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~,[40~ ~ Well- jO01t ~001~ ~ % ¢~¢~ Material: ¢T~6L Number of Com~ments: Surface Water ~OOl~ ~00'~ ~ LIFT S'TAI'ION~~ Line [0 ~ JO ~ Manufactt~~ ~ "Pump on 'Pump off;; level at: water alarm at: Foundation /O I~ ~ 0 t ~ ~ P~e & Model Electrical Inspections pedormed by: Drain Remarks: BENCH MARl( Location and Description: Inspections performed by: ,ss ENe,N'E"INe Dates: 1st 5-J-77 E~ ~le River, A~ka 995~ 2nd Department of He~lth and~ma~ 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW970063 PAGE 2 OF 2 Municlp~(i±y of-' Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O, Box 196650® AnchoF'a9e, At~sk~ 99519 6650 ®Te(ephone', 343 4744 ON-SITE WASTEWATER DISPOSAL SYSTEH AND/OR WELL INSPECTION REPORT LEGAL LOT 7, GLENVIEW ESTATES P.i.n NO. 051--521--44 A B FCO 7.5' 31,0' ST1 28.0' 43,0' ST2 34.0' 47.5' DEL1 39.0' 53.0' DBL2 41.0' 54,5' C01 48.0' 81,0' C02 82.0' 107.0' MTL 83.5' -109,0' NEW TRENCH ~_____.~_~. ~-~" NEW 1000 GAL. SEPTIC TANK~ THREE BDRM HOUSE SITE STi 100.7' NEW 1000 GAL SEPTIC TANK N.T.S. FINAL GRADE SCALE 1" = ,lO' C01 ,,-'" ~C02 99.2' ' ...... h' CO1 = 9a.9' 89.1'/ ~o ~AT~ ~OU~ '~.~.[.':.:'_:.~¢~;. 83.~' B.O.~. JUN--02--97 r40N 10 :~9 AM M--W DRILLING 9~? 545~289 P. ~1 M-W DRILUNG, Inc, P,O, E, OX 110~578 ~ 10330 Old ~oward Highway (907) 349-853,5 ANCHORAGE, ALASKA 99511 DRILLING LOG Owner I~OVA~ CONST. R[JC~ION ~. UseofWe]!n~M~R~TC Location (address of: Township, Range, Section, if known; or distance main road. .... SURDTVT,q TON SOUTH PETERS CREEKL ALASKA Size of casing 6" Static water level~ 4 2 Screen ( ); Depth of Hole. 2~4 0 feet Cased to._~-~eet .ft. ~o/~f;--~below) land surface. Finish o~ we]/ (cheek one) open end ( .~,- Depth in feet from grom~d surface JUN 5 1997 x ); ',~[ WELL LOG , Municipality of Ar, c,..~ '{ i::.(~ "~: .: uep];. Heaim & i Gl,ye d~ta'il~ of formations penetrated, size of materlal~ color and hardness 0 TO_ 2 2 .To. fTC___ ___i~TO 1~1 181 TO_._218 218.TO. 240 .TO. , .TO. ANDY __ .TO_, .... TO ,TO. ....... TO= __ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970063 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:INNOVATIVE CONSTRUCTION OWNER ADDRESS:3601 RASPBERRY, UNIT 40 ANCHOKAGE, ALASRA 99502 PARCEL ID:05152126 ('~%t--..~[--~ DATE ISSUED: 4/17/97 EXPIKATION DATE: 4/17/98 LEGAL DESCRIPTION: L ~/~ ~ LOT SIZE: 64948 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 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 SANE DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED DATE: DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & ELOWTEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECNANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ) CErL MuNiC,PALR-Y OF ANCHORAGE S RVlC S ROBERT C. COWAN, R E. APR 0 8 1997 ROBERTA. SHAFER, RE. CIVIL ENGINEERS April 4, 1997 RECEIVED (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 7, Glenn View Estates RECEIVE Municipality of Anch¢ Dept/4ealth & Human Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At -the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, the monitoring tube was found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, 2/ ~/~Cowan, ~CC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 I SITE PLAN I DESIGN I ~$ z~m PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~_~.~/ %/~1~1 Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? ~ p E OepthtoWalerAlter ~ , Moniloriflg? ~.~ ~ Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ tmlnules/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~-,,~' FTAND "'~*¢ FT COMMENTS ,~O'T'l"ofv't. E2¢:~ ~ o¢41'r'ogll,~,, '"r'~, ~- J ~ ~' ~,~, S & S ENGINEERING PERFORMED D~Y~,O~~ Eagi~ R]vur Loop R~a~ ,%~. CERTIFY THAT THiS TEST WAS PERFORMED IN ACCORDANCI~III~I~q~.TJ~}I~k~/~L~ICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /"/// '7 / ~ 7 72-008 (Rev. 4/85) MUNICIPALITY F ANCHORAGE Development Services Department f� p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-521-44-000 Expiration Date: 4/11/2024 Legal description GLENN VIEW ESTATES LT 7 Site address 23405 GLENN HILL CIR Chugiak AK 99567 Current property owner(s) ATWOOD ADAM JACOB & JOCELYN AM 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: 2/22/2024 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 x Arsenic Advisory Other COSA Approval—June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 05152144 Complete legal description Glenn View Est L7 Location (site address) 23405 Glenn Hill Cir Chugiak Current property owner(s) Jocelyn and Adam Atwood 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: 0 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: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: M Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 27 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench 0 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 $ Waiver Fee $ Date of Payment Z / I/V Date of Payment COSA # OS C 2 �1 / 0 1-10 Waiver # COSA Application—June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: 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) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade 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) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 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’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft 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 Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’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 Phone Engineer’s Printed Name Date Pannone Engineering Services Steven R Pannone P.E., F. ASCE 2/20/24 MUMCIP LITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT o '� On -Site water and wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241040 Subdivision: Glenn View Estates Block: , Lot: 7 907-343-7904 Fax: 343-7997 The septic tank for this property is 27 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. MUNICIPALITY OF ANCHORAGE Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-521-44 Legal description GLENN VIEW ESTATES LT 7 Site address 23405 GLENN HILL CIR Expiration Date: 7/25/23 Current property owner(s) ADAMS JENNIFERJO PETERS &JAMES THAD X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: ��"� Original Certificate Date: 4/25/23 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 X Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services DepartmentPhone: 907-343-7904 On -Site Water &Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-521-44 Complete legal description GLENN VIEW ESTATES LOT 7 Location (site address) 23405 GLENN HILL CIRCLE CHUGIAK AK 99567 Current property owner(s) JENNIFER & JAMES ADAMS 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 26 - 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 $.-67:5 0 Date of Payment / to to - COSA # OSG 23 l00 Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: GLENN VIEW ESTATES LOT 7 Parcel ID: 051-521-44 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) Date drilled 5/6/1997 Total depth 240 ft Cased to 240 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 4/7/2023 Static water level at beginning of test 140 ft. Well production at time of test 5.3 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 4/4/2023 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 48” Date of pumping 4/1/2023 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/5/1997 ALL standpipes present per record drawing Total measured depth from grade 9.9 ft (max) Measured depth to pipe invert from grade 6.6 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. (ED) If not, state depth into effective 3.5’ OF 4’ ED Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 4/6/23 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 4/7/23 Results Pass Fluid depth prior to test 2 in Water added 580 gal New fluid depth 5 in Elapsed time 1320 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 6 in. (ED – Sewer rock) Effective depth remaining 42 in Effective depth missing 6 in (Assumed per shots) Comments/Deficiencies: Approximate total measured depths from existing grade & ED per elevation measured shots. 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’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft 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 Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 4/21/2023 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 applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any 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 & 4/21/23 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT o '� On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC231084 Subdivision: Glenn View Estates Lot 7 907-343-7904 Fax: 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this COSA / property is 26 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range $10,000 or more, not including engineering, surveying, or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank. _ i Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O.CERTIFICATE Box 196650 Anchorage, Alaska OF343-4744 HEALTH AUTHORITY 99519-6650 APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # * 1. GENERAL INFORMATION HAA # Comptetelegaldescription Lot 7; Glenn View Estates Locat,ion (site address or directions) NHN Glenn Eagle Rive~, AK Property owner Innovative Construction Day phone 248-8835 'Attn: Kris Husa Mailing address 3601 RaspbErry Rd . Hn~ h 40 Anchoraqe, AK 99502 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well xxx 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. xxx 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 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. S & S ENGINEERING Name of Firm .......... Address Eagle River, Alaska 99577,,, Engineer's signature ~?/~/7~//~ /~'~-~- Phone Date DHHS SIGNATURE ~/ Approved for ~-~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: /~ ?¢,4. ~ ¢~,.~Z~.~/ Date ~.~'/'~ cf/¢? 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 DH HS 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~)25 {Rev. 1/91) Back MOA ~'21 MUNICIPALIT¢ OF ANCHO~A~ Municipality of Anchorage ENVIRONMENTAL SERVICE$ D~ DEPARTMENT OF HEALTH & HUMAN SERVICES SEC) ] 6 1997 Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501. (907) V E D Health Authority Approval Checklist Legal Description: L~'q~ ~r ~.~--,,,,-.~ v i,.~,.~ ~-r~Tr,¢, Parcel I.D.: A. WI-'LL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present~l) ~, Total depth 2./10 1 Date completed Cased to ;~"~.0 / Casing height (above ground) Sanitary seal (~N) ~¢5 Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA FROM WELL LOG g.p.rn. Nitrate O, .~"~ ~- Wires properly protected ("~N) _ .~TION Other bacteria Collected by:. Date installed -__Tank size Foundation cleanout ~,/~1) [4~,~q Depression (Y~')). Date of Pumping "-'~ Pumper ~ C. ABSORPTION .FIELD DATA ':~., Date inStalie(~' ~[~? i.' Soil rating (g.p.d./fF or fF/bdrm) I. Length ~'~';2~ / Widt.h ~/ Gravel thickness below pipe Number of Compartments g.p.m. S & S ENGINEERING 17034 Eagle River Loop Read No. 204 Eagle River, Alaska 99577 ,~ Cleanouts ~N)_~?'_~ High water alarm (Y/N) kl/? System type .+.o Total depth _ Effective absorption area _~'~)'~ -~r Z, Monitoring Tube present(~N)'!r-'~ Depression over field (~_ Date of adequacy test N~..._~ Results (Pass/Fail) ~ For _ -m ~:E:. bedrooms Fluid depth in absorption field before test (in.); " Immediately after ~ gal. water added (in.): Fluid depth ~ (ins) Minutes later: -'~- Absorption rate = ~ .g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION~--.~ Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons t* off" tevel at* "Pump *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main On adjacent lots On adjacent lots Sewer/septic service line Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ ~+ Property line ¢~, 4- Absorption field Water main/service line !L)~ '~' Surface water/drainage lbo ;~F Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ~ 0~J ~ '~ ENGINEER'S CERTIFICATION rd~.~ certify that I have determined thru field inspections and review of Municipal race ~.~ms are I in conformanc~e~l~x~A~.. A guj dol ines in offoct on this da te. Signatur. Engineers Name Date HAA Fee $ ~/'~' ~ Date of Payment Receipt Number ,==~c~ ~"~'~d~J' 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number