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Home My WebLink AboutGLEN EAGLE BLK 2 LT 1 REM Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221309 PID Number: 050-601-01 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑® Upgrade Name Helen McGaw ABSORPTION FIELD ❑ Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 23800 The Sun Loft Dr Eagle River Other Phone Number of Bedrooms Soil Rating Total depth from original grade 2 D/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Subdivision Block Lot Glen Eagle 2 1 REM Ft. Fill added above original grade Ft. Gr 711th Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between tr ches From Tank Field Tank Line Ftz Well >100' NA NA NA NA TANK IN Septic ❑ S.T.E.P. ❑ Holding ❑ other Manufacturer GREER Capacity 1000 Gal. Surface Water >100' NA NA NA Material Number of compartments Lot Line >5' NA NA NA NA PLASTIC 2 Foundation>10' NA NA NA LI TATION Manufacturer Capacity Remarks Gal. Alarm location Electrics Iled by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield JRs Septic Drainfield Co/MT 3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspe tion 1s' 9/14/2022 2�a 9/22/2022 Location and description Y1- 41t� - top of riser first tank compartment ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Approval: Date qConditional .4. D V; IFI •,* �� .... f ............. •, L. o ' i,d — -- Septic Sya em _� Approved Ds �� F'• �.•'s CE 11 Q4 l Date �3 2 +�c�sl� No. ,qs AW F� PROFESSIDN��V.� Note: this approval does not include well permit requirements. /RPv nF/mn R\ 1A ow 1 LJ < CL 1 U 0 0 �w� 3:w L-- J t:il J r M (3, 'i . 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U) C) CU W < Z w 3: _wj Li > LJ (D F- < < < w -j > 0 o o U) o- cr LLI M kNI (D N0 v o 0)( z 0 D w (D 0 < C w LLJ Z w < (D 0) 00 C) 0 00 L N - v o Zzi c. N8931'17E,110.29 IV 8345'26—W6 6 OF q�-9S,4p0 ' 49 LH*( °.' SHANE A. HOLT .' m 10 LS -6914 O� 6Af1AC 3 z DECD S-VG[E FAA QY ;1ousE 400DRE7: tSALL .fit trl. T/'FINF0RI1ATICNNERfCh/1 FOR 111TUS [fN'J;NGlN5TlIUT /CNS SPfCIFICAtL VTOSHOV/ANY CONFLTCTS8ETWfFNEX15T/N 51R CTURESAA'D PLATTED I OT11NESANDIO TASFIVINTSANDS NOT TC BE USED FCR PONTOlVlN4 ADDITO(At ST.RCCTURES, UJPP,O✓EM_NTS uR F£NCELMS f45!AffNT5O! R&70V), O7Hfn TN 1N INOSE APPfARiNv ON 7H£ RfCORO PLAT, ARf NOT 5HOVIN HEREON( UNLESSINOICA TEO) NOTE ffNCFLiNES 7NFT M11AYA➢FEAR ON T{'/S DRAY//NSAREN07 TO BE USfO TOTIETERh1,VF PROPERTY LINES OR POS/TUNADDITIONA! 1MPROVEVENTS. .4NVPAlING5HOIVNHFR,'ONIf,;YBIAPIRCViA!Aff DUflOfXCISSIV SNOIIANO/ORY,F. \.• �sCi \Ti�F 00 k �0 AS -BUIL T SURVEY I" = 50' 140 -NERS SET THS OATE HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 16L0L'K:6LEN EAGLESUB (LESS 7HATFORT/ON +AKEN FCR RIG.HTOFMAY ASS1,04VION DRAWNG NO, S C550(1). ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS ii) -,i DAY OF SEF7EMBER , 2022 HUL T LA,i'C SURVE/lNG 2709 Gn'OVi:ROHrVe is51S 2?7-i: EC,Z22_?Eri63'S�GCLh'f" 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: OSP221309 Work Type: SepticTank Upgrade Tax Code Number: 05060101000 Site Legal Address: GLEN EAGLE BLK 2 LT 1 REM G:0160 Site Mailing Address: 23800 THE SUN LOFT DR, Eagle River Owner: MCGAW HELEN G Design Engineer: EKLUTNA ENGINEERING, LLC" This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: �o f f� l epartm��nt 8/16/2022 8/16/2023 84242 ❑ Disposal Field 10 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 By: Date: Issued By: Date: z z MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 05060101000 ANCHORAGE ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) MCGAW HELEN G Day phone Mailinq address PO BOX 771252 EAGLE RIVER, AK 99752 0000 Site address 23800 THE SUN LOFT DR Eagle River AK Legal description (Sub'd., Block & Lot) GLEN EAGLE BLK 2 LT 1 REM Legal description (Township, Range & Section) Lot Size 84,242 Sq. Ft. Number of Bedrooms 2 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank X ❑ Upgrade X pg ❑ ❑ (D) Holding Tank ElRenewal ElDuplex 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 Murtipipal Codes. (Signature of owner or authorized agent) Permit/Rush Fees: to�� 5 Date of Payment: 6z), Receipt Number: Permit No. Waiver Fees: Date of Payment: Receipt Number: 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 OSP221309, Deb Wockenfuss, 08/16/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221309, Deb Wockenfuss, 08/16/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221309, Deb Wockenfuss, 08/16/22 APPROVED as being in compl with Title 21, AMC, for the fol wi g use(s): r Date:. Pqq ti �r y 9 �Z SEP ?_003 9b C 33 ti hti.8a m ASBUILT—NO CORNERS SET THIS DATE.,` SEIJARD tr ASSOCIATFS I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWINO DESCRIBED PROPERTY, Glen Eagle Subd.,Lct 1,Blk. 2 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY of THE OWNER -TO DETERMINE'THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI— VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. -SURVEYING 688-456 SCALE: 1"=60' o,.��iQ 4.1 �@ DATE: v •' �S �''� '�' 3-29-92 •'•. 49TH ••�* c r... .......... r.': ^ GRIDt SW 160 ... . .�. Duan. Mark Seward ,•: II �4 'b �•.• FB, 27-26 `p4 LS - 6918 DRAWN, PA DMS Municipality of Anchorage Page DEPARTMENT 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 N~~¢ ¢~¢~ ~~ Wastewater System: ~ New ~pgrade Address: ~¢~ ~ ~ ~¢~ ABSORPTION FIELD Phone: No. of ~ms: ~~ ~ Deep Trench ~hallow Trench U Bed U Mound ~ Other LEGAL DESCRIPTION sci, Rating: ~'~ GPD/Sq. Ft. Total Depth from original~rede: __ Subdivi~on: 0epth to pipe botlom Irom original grade: Gravel depth ~ Ft. ~ Ft. Township:~/Range:J~ Section:~ Fill added above~ L~-~°rigi nal grad¢: , Ft. Gravel length: ~/ Ft. Gravel ~ ~ ~ / I Number of lines: [ Dislance betwee~ lines: WELL: g New Q Upgrade .... ~ Ft. ~.~~ Cji. Ft. ~;a~,A,B,C): Total Depth: Ft. CasedTo: Ft. Total absorption area:__~Q. Fi. Driller: Dat~rilfed: Static Water Level: Installer: Date installed: Yield:GPM~ump Set a~:] Ft. Casing Height Above Ground:Ft. ~ ..... TAN K SEPARATION DISTANCES ~eptic~ / __ ~:loId~(~ ~ S.T.E.P. TO Seplic Absorption Lilt Holding Public/Priwte Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Well ~0~' j~ I ~ ~ ~, ~ Malerial: Number ol Comparlments: Surface ~ LIFT STATION Lot ~%/ ¢ ¢ s}~ i. ater alarm at:"Pump o~" Curtai~ ~MC ~ ~C ~ ~ ~mpMake~Mod;I ~tricallnspectionsperformedby: Remarks: BENCH ~ARK Location and Description: I Assumed Elovalion: ENGIN~[~EAL ,n p ct ons p rformed t s: Department of Health and Human Services approval Reviewed and approved by: ~ ~ Date:_¢-¢ -¢~ 72-013 (1/91) MOA25 PermitNo. ,~,~c:~,~,.(::~ [,~ Page '~f of ~ Municipality of Anchorage DEPARTMENT 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 Legal Description:~ ;~/--t1~~, ~1~b-~¢-~' '~-',t~"_~.~-PID No.: ~'~¢~::~t~:~t 72-013 A (2/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920125 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HOUCHEN CHRISTY F & OWNER ADDRESS: HC83 BOX 1592 EAGLE RIVER, AK 99577 DATE ISSUED: 6/04/92 EXPIRATION DATE: 6/04/93 PARCEL ID:05060101 LEGAL DESCRIPTION: GLEN EAGLE BLK 2 LT 1 LOT SIZE: 93555 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS UPGRADE SYSTEM MUST BE INSTALLED AN ACCORDANCE WITH THE APPROVED E~G~NEER'Sp-~$IGN DATED 5/25/92 DATE: DAT': May 24, 1992 ROBERTSHAFER. P.E RQGERSHAFER. PE CIVIL ENGINEERS (907) 694-2979 FAX 694 1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELt. INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT 02' HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: Glen Eagle Subdivision, Block 2, Lot 1 We request you issue a permit to upgrade the septic system serving the referenced property. An adequacy test was performed on the existing system and the absorption capacityfof the system was found to be inadequate. During the ~ ~est the system was found to be encroaching groundwater. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. Water was seeping into the test hole during excavation and after seven days of monitoring water was at 9' We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincerely, Roger J. Sh~fer, P.E. RJS/lsu 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 UPGRADE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PEFICOLATION TEST LEGAL DESCRIPTION: Township, Range, Section: SLOPE SITE PLAN 10 11 I2 13 14- 15- 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ~ DEPTH? Depth to Water Alter ~ Monitoring? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (m,nutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN "~ FT AND '~ FT COMMENTS PERFORMED BY: S & S ENGINEERING , /.(~-_-i:%/ i/__~/1/'1 ¥ 17034 Ea_qle River Loop Road No, 204 WIT E l LGUIDELINES ACCORDANCE ~0~ ~', ~~ IN EFFECT ON THIS DATE, CERTIFY THAT THIS TEST WAS PERFORMED IN MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC"FION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL DESCRIPTION ~CATION Well .~ ~ ~ ~ / I Absorption ar~a~ I Dwelling ~1 /~ PERMIT NO. ~ ~[ 'D~STANCEZO' I~, ~ ~D~Ui~ 1~ DISTANCE TO Well Building foundation -~ Clas~ . ~ ~) Depth Driller ~istance ~o Io~1 ~e PERM T NO -- ~ ~ ~ 'F ~ Bu Id ng. founcat on Sewer I ne Sept c tank /Absorpt o area(s} ' ' I ' OTHER PIPE MATERIALS SOIL TEST RAT,N° ~00 ~z ,/Z2~ INSTALLER REMARKS LEGAL PERMIT NO. MLII1'-.i I C: I F'F:tL. I 'TY C,F DEPFIRTMENT OF HEFILTH FIND ENYIROI'.4MEi'.,ITFIL PROTECTION 82'5 '"L" STREET., FINCHORFIGE., Fit:::. SI.950:.t 264-4720 blELL. FI1'-.IlC2., C.~1'-~-- S ]: ~F'E .'~; EE bJIE F~.' F'EP..If"I I: 'T 800056 ) APPLICANT LOCATION LEGAL BRFID DICKEY SRR BOXZ :l. Gi]¢ E. R. SUN LOFT DR LOT 2[ BLK 2 GLEN EFIGLE _.UE, LOT TS'PE OF SOIL FIBSORPTIOH SYSTEM IS: TRENCH 694-.-~2,:9 :~0000 SQURRE FEET MFIXIMUM NUMBER OF BEDROOMS SOIL RFITIHG (SQ FT/BR)= Z.'.00 THE REQUIRED SIZE OF THE SOil_ RBSORPTION SYSTEM IS: IE:, E: P T ~-~ = 7 L_E f-~GTH=, ::k Z.< F.z"; ,S F~: R".¢" E L C. E F"Tt4 ..... ~- THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF' 'THE TRENCH OR DRRINF'IELD. THE DEPTH OF FI TRENCH OR PIT IS THE DISTFINCE BETI4EEN THE SIJRF'F:ICE OF THE GROUND FIND THE BOTTOM OF THE EXCFIVFITION (IN FEE]"). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OUTFFILL. PIPE: AND THE BOTTOM OF THE EY, CRVRTION (IN FEET). IF~:: E i2~ El I R E E:, $ E F" T I ,]: T R !'4 t,:; :5 ;l: Z E =, :L ~-Z~ ¢'£~ ,Z~ ~J t=~ L_ L. Lq ~'".~ .?3 F:'ERMIT FIPPLICFINT HAS THE RESPONSIBILITS' TO INFORM THIS DEPFIRTMEI'.,1T DURING 'THE INSTI=ILLFITION INSPECTIONS OF FINS' WELLS FIDJRCENT TO THIS PROPERTS' FIND THE NLIMIBER OF RESIDENCES THR'r THE WELL WILL SERYE. ......... T[-~] ( 2 ) I 1'-,I'5F"ECT I 01%1..?, ARE F~E,;,.I._I I F.",E [:, BACKFILLING OF FINY SYSTEM WITHOUT FINFIL INSPECTION FIND FIPPROVFIL BS' THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTFINCE BETWEEN R NELL RN[:, RNS' ON-SITE SEWAGE DISPOSFIL SYS'f'EM I'=; ::L08 FEET FOR Ft PRIVFITE WELL OF,'. 21.58 TO 200 FEE'[ FROM FI PUBLIC NELL DEPEN[:,ING UPON THE TS'PE OF PUBLIC WELt_ MINIMUM DISTFINCE FROM FI PRI',,,'RTE WELL. TO FI PRIVFITE SEWER LINE IS ':25 FEET RN[:, TO R COMMLINITS° SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED FIND MUST BE RETURNED TO THE [:,EPRRTMENT WITHIN }i'.0 [:'FAt'S OF ]'HE WELL COMPLETION. OTHER REQUIREMENTS MFIY FIPPLS'. SPECIFICRTIONS AND CONSTRUCTION D~RGRFIMS ARE FI',,,'FII:LRALE TO INSURE PROPER INSTFIL.LFITION. PERf~I I T E:'~P I l--lES [:,ECEI'4BEF-.: ]:::_'L.. I CERTIFS' THAT l: I AM FFIMILIFIR WII'H TFIE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS FIS SET FOF.'TH AS' THE MUNIC'IPRLITS' OF FINCHORFIGE. · ':~: I WILL INSTFILL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]:: I LINDERSTRN[:, THAT THE ON-SITE SEWER SS'STEM MAY REQUIRE ENLARGEMENT IF THE RESI[:,ENCE IS REMODELED TO INCLUDE MORE THAN ]: BEDROOMS. , s ...... / December 31., 1979 Brad Dickey Star Route Box ]_613 Eagle River, Alaska 99[577 Permit {~ 790597 Subject: Lob !P~]_oc;~ 2 (;len Eagle Subdivksien ~¼ A permit issued by =~,is department for well and/or sewer system has expired. .~erml~-s are issued o~! a calendar year baszs, as stated on the permit, by authority of Municipal ordinance. if you have drilled the well, a well log should be sent: to this department to document the installation date. s~al_at.~o~ of the If an enginee[- has inspected the in '~- ~ ' ~ on-site sewer system, please i~ave them send us the as-builts for our files. If there are any {urther ouestlons, please office at 264-4720. Sincerely, // .--, Les N. Buchholz, R.S. Senior Environmental Specialist enc: Copy of Permi~ PERMIT NO. FIPPL I CANT Lf.')CRT ! 01''4 LEGRL BRI=ID DICKEY SUN LOFT DR L'l 82? GLEN ERC'IL.E BOX :t6JLz, E. R. L.O'I" SIZE "rYP~.! OF SOIL RBSCRBTION _,¢~TEM I=,. IRENCH MFt:'~:IMUM NUMBER OF BEDROOMS 90000 S[.ILtRRE FEE'F SOIL F:R'rlNI3 ,.'.'2;E! FT, BR..~ 2~00 THE REQUIRE[:, SIZE OF THE SOIl.. RBSORF'TION SYSTEM IS: THE LENCITH DIMENSION IS THE L.ENGTH (IN FEET> f.)F' THE TRENCH OR DRRINFIEL. ID. TI--IE [)EP'rH OF R TRENCH OR PiT I.S THE [~ISTFINCE BEI"I.,IEEN THE SURFFIC:E OF THE 8ROUND FIN[::, 'file BOTTOM OF THE EXCFtVRTION '::IN FEET), THERE IS NO SET HIDTH FOR TRENCHES, THE ~RRVEL DEPTH IS TH_E.,,HINI./,1UM DEPTH OF GRAVEL BETNEEN THIS OLI'rFF1LI, PIPE RND TI-'~Z BOTTOH OF THE EaCFt',¢TION <IN FEET). / F'ERMIT ,RPPLICRNT HRS THE ~NS~B~UITY TO I-¢IFOP, M THIS DEPARTMENT DURING THE INECFRLLRI'ION INSPECTIONS OF RNY NELL~"; RD,.I'RCEN'I' TO THIS PROPERTV RND THE HLIMBER OF RESIDENCES.; THFIT 'tHE NELL HILL, SEFIVE, [.,F~C. KF ILIi. INL~ OF RNY50_., rEM NITIqOUT FINRL 'IN,.-:,PEL, TION~ "FIND FIPF'ROVSL,. Ei:Y THIS DEPRRTMENT NILL [.,E SUBJECT TO PR[SECUTION. MINIMLIM DISTRNCE BETWEEN FI WELL RND FIN"r' ON-SITE SEI4RGE DISPOSRL SYSTEM IS :t.00 FEET FOR R PRIVFITE NEL. L.~ ~50 TO 208 FEET FROM R PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC NELL. NELL LOGS RRE REQUIRED RND D1U':.~T BE RETURNED TO THE DEPFIFII"MENT NITHIN OF ]'HE HELL COMPLETION. OTHER RE;.,'IUIREMENTS MRY RPPL,V. SPECIFICR'f'IONS RND CONt~TFIUCTION DIRGRFII"IS FIRE RVRILRBLE TO INSURE PROPER INSTFILLRTION. I CERTIFY THRT ±: I RM FRMIL, IRR NITH THE REQUIREMENTS FOR ON-SITE SENERS RNB, WELLS ~S SET FORTN 8Y THE MUNIClF'RLITY OF RNCHOR~6E. 2: I 14ILL INST~LL THE SYSTEM IN RCCORDRNCE WITH THE E:ODES, ;~: I UNBERSTRND THRT THE ON-SITE SE~,,IER S~STEM MRY REt~UIRE ENLRROEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3: BEDROOMS. .... ............ : ........................... IGNEb: '[Sqt ED BY ~' -" V'-~/~'~" ~-~/-' ['ATE fo Z Z ~ ...... ......... ............... .......................... .......... ......... :0 & E ENL~NEERING & DEVELOr'MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Name:_ ~,~,/0/.~ SOIL LOG Earl Ellis 688-2280 Tel. No. ,~ ¢'¢ '~¢ Mailing Address: Legal Description: Depth (feet) 0 Soil Characteristics 8__ 9__ 10__ 11 PLOT PLAN PERC. TEST Ground Water Encountered: Yes. Proposed Installation: Seepage Pit__ Comments: No P'~ If yes, what depth Drain Field__ Performed by: Date: 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O: O: : :. ' : ' : : ~ : 0 0 0 ,~ 0 0 0 0 0 0 : : : : : d ~--~ d oi cci 0 0 0 0 0 0 0 0 0 0 0 0 MUNICIPALITY OF ANCHORAGE Development Services Department 1 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-601-01 Legal description Glen Eagle Block 2 lot 1 REM Site address 23800 The Sun Loft Dr, Eagle River AK Current property owner(s) Helen McGaw Expiration Date: X The On-site system(s) is/are approved for 2 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By:�'' /� 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 ApprovMjune 2022 MUNICIPALITY OF ANCHORAGE 0 Development Services Department 7 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. 05060101000 Complete legal description GLEN EAGLE BLK 2 LT 1 REM Location (site address) 23800 THE SUN LOFT DR Eagle River AK Current property owner(s) MCGAW HELEN 2. ON-SITE SYSTEMS SIZED FOR 2 BEDROOMS Day phone 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: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age <1 - 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 Waiver Fee $ Date of Payment �I ��'l�7iZ' �6703t�N Date of Payment COSH # ® 7,2� fqp Waiver # COSA Application—June 2022 Legal Description: Glen Eagle Block 2 Lot 1 REM Parcel ID: 050-601-01 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 1980 Total depth 320 ft Cased to 120 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) >24 in. Date of flow test for COSA 8/2/2022 Static water level at beginning of test 120 ft. Comments Well production at time of test 2.4 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes Al No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date 8/2/2022 B. TANK DATA C. STATION Measured operating fluid level septic tank ` yr ❑ Requiredm nance completed Date of pumping 1 yr Age of lift station y ❑ Required maintenance completed, if AWWTS Lift station material Comments: Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 1992 ❑ ALL standpipes present per record drawing Total measured depth from grade 6.83 ft (max) Measured depth to pipe invert from grade 3.83 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. no 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) no If yes, enter date Adequacy test date 8/2/2022 Results Q Pass Fluid depth prior to test Water added 387 gal New fluid depth 22 it Elapsed time 1400 min Final fluid depth 17 in Absorption rate '300 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 36 in Effective depth used 17 in Effective depth remaining 19 in Comments/Deficiencies: CO3 was not found. CO2 is working, MT is present and connected to trench. 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' Building Foundations > 10' Fw� Yes Community Sewer Manhole/Cleanout > 100' no if No ft no Yes if No ft Neighboring Tank > 100' no Yes if No ft Private Sewer/Septic Line > 25' ❑Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' QYes if No ft Neighboring Absorption Fields > 100' Community Wells > 200'- ® Yes if No ft Water Service Line > 10' Animal Containment > 50' ❑ Yes if No ft no Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft 0 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' Fw� Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' g Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' R Yes if No ft Private Wells > 100' F0_1 Yes if No ft Water Main > 10' R Yes if No ft- Community Wells > 200'- ® Yes if No ft Water Service Line > 10' ME 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 _ C G,- C Phone 907.406.1058 Engineer's Printed Name / (l- )1 S' ?� G S Frl s,(j Date Z Z. Z_. 00 'Aeh ENGINEER'S T A" Data--- �FCj • tom. CE 11904 �� pR0FESS1a�'^� COSA Checklist—June 2022 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.# ~).~-(,~¢b \ -C~\ 1. GENERAL INFORMATION Complete legal description HAA # ~ Lo ~-~. Lot I; Block 2; Glen Eagle Subdivision; Location ('S~'ie"addr~ss ~'r'directions) Mile 5 Eagle River Road Propert'y owne~ ,',','E,!~ine & Christy Houchen Mailing address Day phone Eaqle River, Alaska 99577 Lendin'g a~ency' Mailing addre§~" Agent OAWN_DAWS Address Day phone M¢~¢n~/¢ ~¢a! Estate Day phone Old Glenn Highway, Eagl6 River, Alaska 99577 694-9035 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water XX 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 X× NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fronl MOA ~21 .~Jo~ s,jesu!bue leuo!sse,t°Jd ell) u! SUO!99!LUO JO SJOJJG JO~ elq!suodseJ )ou s! ebe;oLiouv to /~).led~o!unH aLIi_ .penss! s! eleoU!~ueo e eJoteq e)ep ez/~lBUS Jo suo!)oedsu! )onpuoo lou op SHHG to see/~oldua3 .slueLueJ~nba; e)els pub leJePe~ u!e~Je3/~9!)es ol jap Jo u! suo!lnL1su~ bu!puel; ali) pub seuJoLi ~o sJeseLioJ nd o)/~se~J no9 e s~ sill) seop SHHG aLII 'e39elV ~o e)e)S eq~ u! p@jels!beJ Jeeu!bue leuo!ssejoJd )uepuedepu! uB/~q e^oqB § LidejbeJed u! ua^ih suo!lB)ueseJdeJ eli) uodn ~lUO peseq 9e)BOU!~JeD le^oJddV ~)!Joq)nV q~IBeH senss! (sHHG) ~@o!/ue9 uB~unH pub q)leeH jo )ueuJ~aedeG eSBJoLiouv ~o ~Lled~o!unH eq.L ~ - s),ueujUUoo leUOR!PP¥ :suo!),elnd!~s fiuF~oll°t ell), ll),pA 's~uooJpeq e3~C] · suJoo~peq I JoJ i~AoJdde leUO!),!Pu°O · peAoJddesmc] ~ Jot peAoJddV ~ =l~flJ.~fNOIS SHHO eJnleub!s sjeeu!buEt 'ON p~oa 8OOl .re^la eiB"ilt t, li:OZ I, "9 ( Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~/L.-¢~ _.~.¢%~-~ L--.~ ~L~ ,'('~--~. Parcel I.D. A. WELL DATA Well type~ ,~!~/ Logprese t~/N) IfA, B, orC, attach ADEC letter. ADEC water system number Date completed J~--)/~ [:)riller ~-~'"// Cased to J ~ / Casing height Total depth Sanitary so~/N) Wires properly protected(~) ~ Date of test Static water level Well flow Pump level FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main _~"~ ; On adjacent lots ; On adjacent lots ___ Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform ,~' Nitrate Date of sample: ~'/ B. SEPTIC/HOLDING TANK DA'rA Date installed '¢~7/~__+ Cleanouts(~N) y High water alarm (Y/N) __ Date of pumping ~, ['~ '7t~/¢~_... Other bacteria Collected by:_ ~'% Tank size I ~:~P~:::::E~ ~ ~ /_~ Compartments Foundation clea nout~N) ~ ,' Depr. ession (Y~) Alarmtested:(~/N) ~ ~/~. Foundation_ ,¢~ / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I~ ! __ On adjacent lots To property line ~-~- / . __Absorption field Surface water/drainage I ~C)~-.) r ~ I ~¢-~ I Water main/service line. I~ I_~- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level N~./~~ Meets MOA electrical codes (Y/ SEPARATION D~M LIFT STATION TO: Well on lot~ On adjacent lots D. ABSORPTION FIELD DATA Date installed Length '~ / Total absorption area Depression over field (Y,/~ Results (pass/fail) Width Peroxide treatment (past 12 months) (Y/N) t"~/-~ . Manufacturer ~ Manhol~ss (Y/N) ~ "Pump off" level at Cycles tested Surface water Soil rating Gravel thickness Cleanoutspresen (~N) Date of adequacy test for Total depth '~'~ ! bedrooms If yes, give date -- SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 50 To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~t _.p. Property line To existing or abandoned system on lot Cutbank 1',~ ~.v~ Water main/service line Driveway, parking/vehicle storage area IoI E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect Signature Engineer's Name Date $ & S ENGINEERING 17034 EeCa River Loop Road No. 204 Eagle River, Alaska 99577 HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE - DEPARTMENT OF HEALTH & HUMAN SERVICES ¢~d~0~l~. ¢f DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date Septem~)er 8, 1987 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot I; Block 2; Glen Eagle Subdivision Location (address or directions) Sun Loft Drive (b) Property Owner Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address P.O. Bo~ 771699, Telephone 694-5500 Geno Cast~qne~,¢~ Telephone:Home 694~7064 Business SR Box 1590, Eagle River, Alaska 99577 Telephone 694-7872 Eagle River, Alaska JACK WHITE COMPANY/Lynda Banner Eagle River, Alaska 99577 (e) Mail the HAA to the followina address: or: Check here~, if hold for pick Lip List contact person and day phone number below. S & S ENGINEERING/694-2979 17034 E~~ Road~ Suite 204 Ea~l~_ Rx'ver~ Alaska 99577 ordered by Lynda Banner TYPE OF RESIDENCE Single-FamilyxE~ Number of Bedrooms WATER SUPPLY Individual Well~ Community[] Public[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public[] Community[] Holding Tank[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/86~ Fron~ ')pOM s,Jaaujbua leUO!SSajoJd aq~ u! suo!ssiuJo Jo sJOJJa JOj alqisuodseJ lou s! abeJoqouv jo A~Jlediolun!/N eq/'penss! s! aleo!J!]~a3 e aJojaq eiep ezAleue Jo suo!~oadsu! lonpuo3 ~ou op SHHC] jo saeAolduUq 's:!ueuJeJ!nbeJ alels pue leJ@pej u!epa3 Ajs!les ol Jap Jo u! suo!ln]!~su! bu!pual J!aql pue sau~oq jo sJ@seqoJnd ol Asapno3 e se s!qi saop SHHQ aqJ_ 'e)lSeW Jo @leis alii U! paJ@ls!b@J Jaeu!bua leUO!SSajoJd luapuadepu! ue Aq a^oqe S qdeJ§eJed u! ue^!b suo!leluasaJdaJ aqi uodn /~lUO paseq saleo!j!peo le^oJddv/qpoqlnV qlleaH sanss! (SHHQ) saoi^JaS ueLunH pue q~leaH lo lueuJpedac] abeJoqou¥ jo Al!led!ojunlAI eql N01/11¥3 leAoJddv leUO]i!puoC) jo sWJal leUO!i!puoO paAoJddes!C] A~/ paAoJdd¥' e~eQ 1~0~; 'ON peoU do~1 ~e~!~l ell~ I~0/I. sse~ppv auoqdelal 9~'~ ............ ~ -~ wJ!j Jo aWeN .g WELL DATA Well Classification Well Log Present ~N) Total Depth Static Water Level MUNI.C.,IPALITY OF ANCHORAGE (MOA) ..,,LI'I¢ 0 H~/~Eti~j,~A,~T[HORITY APPROVAL (HAA) ~M,~br(AL :"' -' CHECKLIST - FEBRUARY 1984 ': ' 264-4720 Legal Description: Casing Height Above Ground Electrical Wiring in Conduitd~N) Separation Distances from Well: To Septic/H-et~rC'ank on Lot To Nearest Edge of Absorption Field o8 Lot / To Nearest Public Sewer Line /~ ~ ~, If A, B, C, D.E.C. Approved (Y/N) Date Completed __~ ~ ~ '~ t, ~;~L~ Yield Cased to I ~ Depth of Grouting I"'g'"~2 ' Pump Set At k-~'~¢~ "~2 ¢~ ,4 Sanitary Seal on Casing Depression Around Wellhead (y/~i) ! ( ~7.~''~ ; On Adjoining Lots t, ~_-~C::;,IW- \.,)._~ t ; On Adjoining Lots t, ~'~-~ 1'4- To Nearest Public Sewer Cleanout/Manhole I'~/~' T~) Nearest Sewer Service Line on Lot Water Sample Collected by /,2 ~ ~-~ ~::;~-'-~r~f~C-"'~t'"'~ ; Date Water Sample Test Results ~--~2,~'~'~~ ~ ~~ Comments ~ ~ [-~ ~ ~ ~ ~~(~ B. SEPTIC/I~,,.~ TANK DA'rA Date Installed '¢¢¢¢d Standpipes~'N) Air-tight Caps ~N) Depression over Tank Pumping/Maintenance Contract on File (Y/N_.~) ,/ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holdi~g*Tank: To Water-Supply Well . To Property Line '~r~ To Water Main/Service Line I ~ I.~ Course Comments Size _Ld;::~;;;~ No. of Compartments Foundation Cleanout(~N) / Date Last Pumped ~ ~ /'~- ~5/~/~, ;for Temporary Holding Tank Permit (Y/N) To Building Foundation ¢¢¢ ~-~ To Disposal Field ~, ~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata '~'¢¢ 1"~',~¢''~ Type of System Design Date Installed ~¢f .~"::~ ~;~O Length of Field ["'~"~" f Width of Field Square Feet of Absorption Area Depression over Field (Y,(~j~. Results of Last Adequacy Test Separation Distance from Absorption Fi%d: To Water-Supply Well To Building Foundation Lot ~ To Water Main/Service Line I Depth of Field Gravel Bed Thickness Standpipes Present (g~) Date of Last Adequacy Test 4:~ .~\,~ ~ ~'~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~ ~"'~ ' To Existing or Abandoned System on ; On Adjoining Lots "2-~,~ { ~ To Cutbank (if present) ,~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Bating Against HAA Request ** I certify that I have checked, verified, or conformed to all MO..~ and H/AA guidelines in effect on the date of this inspection. Signed ,~ & $ ENG;~,~,RIN,G Date Campan~7034 Eagle River. L~ Road No~ No. ~~ ~ ' ~"~',"'~% ..... Eegle River~ Alaska 995~ Receipt No. ~0/~O/ ~ Date of Payment ~ ~/¢ Amount:$ /Cd o~ Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHOFIAGE OEPARTMFNT OF HF-ALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTI'-IORITY APPROVAl_ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 6EN~IiAI~ ff,iFORIV1ATION [.c0al Description (include lot. block, subdivision, section, township, range) I~l], ~., [:et I Glen Eagle S,/D, T]_4~1¥~ Sec 15 I.ocatio~ (address or directions) ~.:/:~_~__~_[,:q:~e River Rd, (b) At)phcant Name ,_]_Q~ _J~_,___S_a~V._~IZ_ ....... Tetephone:llome _694-7961 [Business _~/~ .......... Applicant Address ~B_, Box ~590 Eagle Riv_e~ ~_~_~ag]=e River, AK 99577 (c) App ca ~t is (check one): Lending Institution O; Owner/builder ~; Buyer [~]; Other [J (explain); ~ (d) Lendinglnstitution Rainier Morbg~ge~ .......... Telephone Address ..... 47_~..7_ B_us_i~3_.e__s~A P6r~_,_~lvd.~_~n~L~!~age~ A[ aska (e) Real Estate Company and Agent _~.__C6~pe~ Anchor Address _~20 East 4th Ave. Anchorag.~_,._~_laska Telephone ~.]~:7.6 6 ~ ..... (f) Mail the HAA to the following address; TYPE OF RESIDENCE Single-Family L~ Multi-Family E[ Other Namber of Bedrooms .... WATER SUPPLY Individual WelPE..t: C.,.)mmunity [] Public Note: It community well system, must have written confirmation from the State Depart ment of Environmental Conservation attesting to llqo legality and status Page 1 of 2 SEWAGE I)ISPOSAL Onsite [il Public ['_] ComrTlunity [_-] Holding Tank [Z] Note: I1 commundy well system, must have written conlirmation from tho State Department of Environmental Conserw]tion attesting to the legality and status. ENGINEERING FIRM PROVIDING INSPECTIONS, 'TESTS, FILE SEARCH, DATA AND INFORt~CIATION .... AS codified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation el this Healtl] 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 tile 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 regutations in effect on the date of this inspection. Name of Firm Telephone Address ......... EABLL?_.~. o '~-¢J~6 8~),qOE8 ..................................... 694-5'195 Approved _~ Disapp ro'Ce'~ Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon Ihe representations (.given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. Tile DHEP does this as a coudesy to purchasers of hornes and their lending institutions in order to satisfy certain federal and state rcquuomel~ts. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. ~lhe M¢tnicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 el 2 MUNICIPALITY OF ANCHORA~[~ DI~PT OF HEALIH & ---- , [ATFJYlUNICIPALITY OF ANCHORAGE (MOA) EHVIP, ONMENT^L PP, O~ .~ ~EALTH AUTHORITY APPROVAL {HAA) ?,~[~ ~ 0 ~5~ CHECKLIST- FEBRUARY 1984 ~ 264-4720 R[CEIV[D Legal Descdpt,o.: ~- WELL DATA Well Classification ,r-~,¢/t,/-'s Well Log Present (Y/N) Total Depth ~,~c, z Cased to Static Water Level '/'~'~ / Casing Height Above Ground Electrical Wiring in Conduit (Y/N) _ /V Separation Distances from Well: To Septic/Holding 'rank on Lot To Nearest Edge of Absorption Field on Lot If A, [3, C, D.E.C. ApProved (y/N) __ ,'¢//'~4 Depth of Grouting ,'~',/4 Pump Set At Sanitary Seal on Casing (Y/N) ,,' Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line /'¢"~ To Nearest Public Sewer Cleanout/Manbole /¢~ '~- To Nearest Sewer Service Line orl Lot Water Sample Collected by _ ~',~,'~./-'~ '- ; Date __ ~// Water Sample Test Results -~ '~'¢ Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) _ Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well _ J~'~;) To Property Line /0 ~ To Water Main/Service Line Course /Z,/¢,/~ ,~_ ~-~7'.Z/,-, J~/~ / /~,~o_ Size /¢,¢~ (>4 ( No. of Compartments ,/~ Air-tight Caps (Y/N) ~' Foundation Cleanout (Y/N) Date Last Pumped ¢' /)~,~ ; for _ Temporary Holding Tank Permit (Y/N) To Building Foundation '-/~'/~:~ /' To Disposal Field /~ / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ~T¢~.~l~' ,'~.c.~..y Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation o/'¢5 Z Lot To Water Main/Service Line ?¢ /~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field /~-~ / Depth of Field '7 / Gravel Bed Thickness ~' / Standpipes Present (Y/N) Date of Last Adequacy Test >,, / ?.,°r- To Property Line ?o / To Existing or Abandoned System on ; On Adjoining Lots ~ <¢7 ¢' To Cutbank (if present) /,Q '¢- D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company ·/~',/¢,z~,j~, MOA No. Receipt No. ~ f~ ~ ~'~ ~.~. ~ ;:V,~:~ % ~ ¢. Engineer's Seal Amount: $ Page 2 of 2 DAT~ RECEIVED INSPECTION APPOINTMENTS -- · DATE DATE INSPECTOR INSPECTOR INSPECT~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~Nvi~ONMENTAL 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION [}~'?' i; I900 Telephone 264-4720 REQUEST FOR APPROVAL OF 'NDIVIDUAL WATER AND SEWEI~A~'I[~IJFI~¢ U DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER I PHONE Brad DickeyI 694-9239 MAILING ADDRESS St. Rt. Box 194, Eagle River, 99577 PROPER'rY RESIDENT (If different from above) PHONE New House- Vacant '2. BUYER PHONE Marc P. Springer 274-7488 MAILING ADDRESS 631 West 32nd Ave, Anchorage, Alaska Apt. 15D 3. LENDING INSTITUTION I PHONE Alasha Mntnal Savin~s.~ ~LoanI 274-3561 MAILING ADDRESS 60~ ~. 5kb Ave.. A~chora~e. Alaska 4. REALTOR/AGENT I PHONE Jack White C_o,- Larry MauldenI 277-1553 MAILING ADDRESS 320] C. St.. Anchorage, Alaska 99503 5. LEGAL DESCRIPTION Lot 1, Blk 2, Glen Eagle Sub. STREET LOCATION NHN Sun Loft Dr., Eagle River 6. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ~-I Four :~ Two [] Five [] Three [] Six ~] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SY,~TEM X~X INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY 1980 YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCO?~PANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or []] Holding Tank Size: { O~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line INearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS DATE [~-""'APPROVEDFOR . <p BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED