HomeMy WebLinkAboutGLEN EAGLE BLK 2 LT 2 "' Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES " ENVIRONMENTAL SERVICES DIVISION i"571 P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: __.~k, kJ c~ :~ O~O~ _ PID Number:_ O~"O~ ~O~ -[~ _ Name: ~ A' ~)U~ WastewaterSystem: D New ~Upgrade L Address: ~ ~ ~ ~ ABSORPTION FIELD Phone: &~4--~ No.~edrooms: ~DeepTrench U Shallow Trench UBed UMound aether L E G A L D E S C R I PTI O N Soil Rating: Total Depth from original grade: Lot: Block:' Subdivision: Depth to pipe bollom f/om original grads: Gravel depth beneath pipe Township:, / . /Range: /. ', ~ Section: / Fill added above original grade: Gravellenglh~ ~.. WELL: ~ New ~ Upgrade ~ravelwi~th: Z ~"' Number of lines: Oistanc~belweenlines: Classification (Private, A.B,C): Total Deplh: Cased To: Total Csorption area: "~ Pioe material: -- Driller: Dale~rilled: Slatic Water Level: Inslaller: ~ Date inst¢l¢: Yield: Pump Set al: Casing HeignI Above Ground: ~ TO: ~ Absorplion Holding ~Privalo Manufacturer: Capacity in gallons: Wel] i]O~ ]~,~ ~/~ ~/~ :~),~ Material: S~ Number of ~mpartments: Surface Water 1~5/* _ ~ ~'O~ ~Ol~ bll I Foundation 501 ~~/l ¢ "~m, o."Tl.~..,,, ~t:".m. 4f°ff"level, at: High water 4~l¢ alarm at: ~ Curtain ~ ~e ~ ,m, m~. ~ md., I Electrical Inspections performed by: Remarks~~ ~u~,~ ~&~uM A BENCH ~ARK J ;Location and Description: Assumed Elevation: Department of Healtt~d Hu~ Services approv'al4' RevieweOandapproveOby/~~~ Date:/ ¢¢¢~ 72-013 (Rev. 9/91) MOA 25 'Permit No. ~wq-~3~oq Legal Description: ¢/~ Pa~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN~ERVI(~ES ENVIRONMENTAL SERVICES DIVISIQN P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well In'~pection Re, port C.-Le.~ ~Z.~L~ <-,/v PID No,: ob-o- NE'~q IZ~O G~J ~ ~ F~ LgEJLL. ON LOT' R o BY-. 2.. 105' PermitNo. ~w9.'¢o4'o01 .,. Page M'0nicipality of Anchorage .,.DEPARI'MENT 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 LegalDescription: ~.o'~':-~ ~:z~, ~-L~,~u ~:.,~b~. ~-~/~ PIDNo,: 72-013 A {1/93)" ( erl fie Drilling by DOC Co. dba SULLIVAN. WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 /97 / ~. Ended / DEl'TH OF WELL STATIC LEVEL OF WATER FT. GALS, PER }'IR _ ff.~? 0(2} ...... : KIND OF"FORMATION: Fro,~;' b !0 Ft. :7" F;~;~'~.=''': !fi.t;.~:;. F,. From/:~ Ft.,o ~.[~_Ft. F~om ' ' Ft,'to , Ft. ~, ', .~romz, t. to Ft. ",: ' ;' ::~ i};',~ ,'-; ' :?'. ~f~ Ft. to Ft,. :,;.: ~.From Ft. to Ft. ~ From Ft. to Ft, From____FI. to_ From Ft. to , From Fl. to From__Ft, to_ Ft._ .Ft. ,Ft Ft. Ft. , Ft. Ft. Ft. ."~,' From Ft. to Ft. -;m:,'~From "".-'" Ft;to~ ., ' Ft. ' From__Ft. to.___ Ft. ,. From Ft. t~ Ft ' .,;, .From . Ft, to Ft · .From" ' Ft. to Ft, ' From Ft,' to Ft. ,,.',FroM' ':' Ft, to Ft. :'Y:':':FroIp~ :;, ".,, Ft. to Ft. From_ Ft. to_.--> Ft From Ft. to_ _Ft From__Ft. to__ Ft. From.__Ft. to____Ft. From .Ft. to_ _Ft MISCL INF.0RMAIION: PAGE 1 OF 1 I 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 (UPGRADE) PERMIT PERMIT NUMBER:SW930409 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:MILLER DEBRA A OWNER ADDRESS:1578 EAGLE RIVER ROAD EAGLE RIVER, ALASKA 99577 DATE ISSUED:10/05/93 EXPIRATION DATE:10/05/94 PARCEL ID:05060114 LEGAL DESCRIPTION: GLEN EAGLE BLK 2 LT 2 LOT SIZE: 55724 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION 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 (iSAAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 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 SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: __~/~-~ ISSUED BY: ~/ DATE DATE: Tom Fink, Mayor / un cipality of Anc,.orage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 October 5, 1993 Jeff Garness, P.E. Alaska Water & Wastewater Services 8471 Brookridge Drive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 2 Block 2 Glen Eagle Subdivision Waiver Request ~WR930062, PID #050-601-14, SW930409 Dear Mr. Garness: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 1 foot from the trench to the property line and 20 foot separation distance to the cutbank. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services ljw~7 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet ~ ~ 050-601-14 WR~ ~ PID# Date Received: September 27, 1993 HAW Permit Legal Description: Lot 2 Block 2 Glen Eagle SubdiVision Engineer: Jeff Garness, P.E., Alaska Water & Wastewater Services 8471 Brookridge Drive, Anchorage, Alaska 99504 Applicant: Debbie Miller Waiver Requested: Lot line - 1 foot from trench to property line and 20 foot separation distacne to cutbank Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special. Conditions: Points: 3. Other: Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: Date: Rec #: 25224 Amount: $ 115.00 Date Paid: Sept 27, 1993 Alaska Water & Wastewater Services "Preserving the Last Frontier" Sept, ember 25~ 1995 Munic:i, pality ef Ancherage Dmpartment ef Heal't:h and Human Services Division of Enviponmental Sepvioes P.O. Box 196650 ~nchorage, R}aska 995L9-.-6650 Ref; Septic ¢~ ~ ~ oyotern Upgrade for- Lot 2,, B][c)ok 2, G].(;;r'l I,{ag].e Subdivision. Te whohl it Bay corx?er-n: ¢~t;tach(~;d :i.s the app],ication,~ site plan, ar'rd design draHing% for the subject sep'l;j c system r'eplac;ernent. COlTirflel'lt S F'8¢JaP(JJng the propos(~)cl syslJe~ 1. TRENCH I)ESI6N: ~s cai'] be seen from Feviewing the at;taclned percolation t;e.sk results, t;he soil "pelfl<ed" bel;ween J,'-5 nlirltJtes/:i, lqch at the location proposed for the system. For a t~ench eystem, this cor'r-esponds to an appticat:ior] Fate O'ff ],.2 gpd/fk2. Z am however opting to tJse afl appl:[catl, or~ rate o'f' I gpd/ftz. Since the existing home has 5 bedn(')oms, the lx) lsal design f],e~ is 450 gpd Based upon this, the minifnum amounl; of absor-ption area is 450 'l:l;:e. The proposed 'lsrencl'~ 4. feels deep, of ~I~Z(:sI'~ orl].y 5,,75 feets J,s stlitab/Le soiiL, and 60 feet long. Th:i.s corresponds te an absorption area of 450 ft2. 2. [Existing Well Hust Be abandoned: The ppesence of I;he creek, whS, ch parallels the west pPoperby ].~ ne, and the locaisior~ c)f the ~e'l. 1 on Lot 5, Bk 2, Glen Eagle dictates that the septic system be ./,coated on the soui',heaet corner' of the l(')t,, /Jnfoptul']at;ely, the e><~st~ng ~Je'l, 1 lecaLed in this ar'ea and ~gi),l have to be abandoned. The we].] ~4il]. be located near' lshe southw(;et, eennen ef the propenty corner, and just outside the ut:(lJ, ty easemen I-; (about; 30 feet from P, he 8>(istil'~g ~:~eplcic ,.:system). See atl:,ached s:i, te plan,, 5. One Foot Separation Distance From Trench to Property Line, and 20 Foot Separation Distance to Cutbank: The sub:)e(,*,t trench ~i],L be install, ed on a. bel'~ch just east of the driveway. Freln the bench, the properlsy slopes al:, arl appr-(:)ximate grade of 15% down t;owarde the wesb, ther~ drops about 5 'leah (50ss si. cpc) a~, the dnive~ay, and is genena].].y Telephone - Fax $~8-$246 · 8471 Brookridge Drive · Anchorage, Alaska 99504 fla'h f;heneafl:;er' until, one appr'oaches the west pl'oper'ty line, Nher-e it slopes at, approximately 1()~ d(,}~,al to 'lobe cK'eek.. The elevation e'~ the dPiveuay is several fe(}~ loner %ban f~;~,'~ at their, closest po~nts~ assuming the trench is crowded Based upon the lecakion, o'F adjacent ~el].s and ~eptic Thene is some pot, en~al for waste~ater t;o migpate to.ar-ds [she outbar'~k and sur'face~ however-, I th-i. nk the pogen'bSal min:imal due to the por'osi gy ()f the existing soils, whic~h ~J.]..]. a],],o~ 'fop r'apid (Jo~n~ard mov(]ment o'f t;h(] I am unawares of any impac:ts t[~a'l; t;l'~,~'~:(.~ installatior~ ~ou]d .,mp~...e on ad~ac:snt ~ells, or- se}pt;lo Systems~ I'f you have any quest;ion, please call me a 55Y-d,.~.79. 'T~P, ~00.00 .Iq' lqO,O0' IHO.OO'-- -- 7 6~'. g3 ' 76q, ~6' I '6q. $7' ~o~.0 ute-n`'-`= 17 OSI © 1~ ri : ~i I ....... , : : i ; , ~ :~ : : : ; ~ : ~ : ~- ~ EFFLUENT PUMPS --- , ~-F"f' i ,-TT'T-h"~- d--?'!"'f-'f-d-T'! I --~"T-~ :-'?";'-T'T" -:'-~'d-':'-F':-?-T' ["72 I I' "!'~' ' . :.: · : : . ~. : · :., :: .... ; 200SIHH ..... L...L.-".. _.L.!......;..:...I..LL.!... 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T ..... ? ....... ~ ........... ~-~ ...... ~-~-'~-r ..... .. I. . ~ . , ~~':, ........ ~,4-~-.:~' ........ ~ ,...,'~, ........... ......~ ................... ~ ~ .......... , .....?~, ' ..... . ........... .~ ,..~...~' ...... ~..~-.~ ....... .....:-~'~..?,'..~.' , ~ ~ ~ ~ ~ ~:: ~5~._}.~ : ~ ~ , 5_: .:.: ..L.~ ..,..~..,.~._:..~_~..~-..~.~_L~..~...h..;-~-~ ~ ..H.....~.Z..;..z.~-'.-.~. , ~ , .......... ,_...Z..~.~ .................................... i ........................................................................ ,-..,... :: -........: ......... r..~-:.-"'T ~J ;2 '-~-~ 2~. ~: ~ ~ _~_ [_ ~_~ .... ~_~.¢.~..~..._.~..2~-~.-~-..2...~ ....... :-.i-~..~ ..... ~_;..2 ...... ~~;..b~ ............................... ~.....~-d...~.. ................... ~ ....................................................... ~ ........................................ ~.. ,~.J . J_ ~ ,..~_.L..~.; ~ L ...~..~,..7,~ ; ~. ; ;-. J .... ;..;....J...: ......... ;.....~ ........... ~.--;.H-..-..L.;...~-.~ ...... , % :~. ' : .... ~ .... h~ ~ ;~ .... ~~' ' ~J~..~ : --I ......... , i .... , : : . ~"'~;~ '"~;-'~ OSI 10 HH- 8 Stage ........................................ ,-~..~d~n.n~ nT.n. , ~ta,a ,'-":'""~' ...... ,.4 ........... ~: : l: : ' ~ , ~. ~ ~l~ - .... Z~..~_~: ~ ,..[ ...... ....... NE-F DISCHARG~ GPM iiiii ...... ~ RECEIVED I'{~alth & Human Servi~bs PERFORMED FOR: LEGAL DESCRIPTION: 1 2' 9 10 1I Municipality of Anchorage ' DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST SLOPE 04o.oq' __ / WAS GROUND WATER ENCOUNTERED? ~ 0 , L IF *ES, ATWHAT ¢ /A '' O DEPTH? _ P E Depth to Water ~ll~r~ J~ Monitor[nD2 _ "1t' Dale: SITE PLAN Gross Net · Depth to Net Reading Date Time Time Water Drop ZOMMENTS PERCOLATION RATE /~ ~- (minutes/inch) PERC HOLE DIAMETER /~, ~ TEST RUN BETWEEN __~ FT AND ,. FT PERFORMEOBY; ,-.~F- (_.~/3_i~J,/E:::~ I ,,~m--.~- ~__~X~J-'/_~J~_~..~ OERTIFY THAT THIS T?T WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNIC PAL GUIDELINES IN EFFECT ON T~IIS DATE. DATE: C~ /'~-I ,/ C-7,.~ . 72-008 (Rev. 4/85) Tom Fink, Mayor ' N unicipality of Anchorage ., Department of Health and Human Services 8;!5 "L" Street " P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4?44 October 5, 1993 Jeff Garness, P.E. Alaska Water & Wastewater Services 8471 .Brookridge Drive Anchorage, Alaska 99504 .Su~$ect~ Waiver ~equest for Lot 2 Block 2 Glen Eagle Subdivision Waiver Request #WR930062, PID ~050-601-14, SW930409 Dear Mr. Garness: Your request for waiver of the required 10 foot separation be%weeD a septic system and a lot line has been approved. The waived distance is 1 foot from the trench to the property line and 20 foot separation distance to the cutbank. This approva], applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services ljw~7 MUNICIPALITY OF ANCHORAGE DE RTMENT OF HEALTH AND HUMAN SER ES .. Environmenlal Health I)ivision - '-~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Address Bedrooms LEGAL DESCRIPTION TANKS ~ SEPTIC ~Xr~' ~ HOLDING No TYPE OF SYSTEM [~'fRENCH ~ BED ~ W. DRAIN ~ OTHER or,glnal grade ~'-- ~ Fl Y FI Fdl added above ougmal grade Gravel del)Ih berleaH~ p~pe Tola, absorph( ...... ~ 7B- s0 [TIC WELLS ~ PRIVATE/:,r,~./~,_ [] OTHER (Identify) ~'~;'~'iE~'FE'TiZEZ7 ....... 17°t~ep~- FT O.~ed to ~Tnst~l,( JDate Installed REMARKS: ('~,., /~' .-, c.t~. DISTANCES  SEPTIC ABSORPTION TANK FIELD WELL WELL /:2 ¢' I ~13 '- LOT LINE ~,~ ~<"~5 - /¢4- / FOUNDATION ~.~-' ~-/) ~¢.~ / AS-BUILT DIAGRAM tShow local,on of well. sephc system, properly hnes. fOLmdahon, driveway, water bodies, elc) Scale: 694-5195 Health Deparlrnent Approval: ~~ : -~/~ Dale ¢~__~7 ..................... e59,71' NO CONFLICTING WELLS EA~F..MENT EXISTING LEACH FIELD NEW [.EACH FIELD ~-,,,.~ CLE^NDUT - · SCALE~ 1' = 50' WELL AND SEPTIC SITE PLAN LEGAL: LOT 2, BLOCK 8, GOLDEN HILLS OWNER: MR, J[]HN PEAC[]CI< C[]NTRACTDR: N/A EAGLE RIVER ENGINEERING SERVICES PD BX 773894 EAGLE RIVER, AK, 99577 694-5195 "% '~' ~ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST LEGAL DESCRIPTION: ,Z o/' ¢q., ~/4'~..¢ SLOPE SITE PLAN 1 2, 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS - / GROUNDWATER S P ;, AT WHAT /¢ ~w.,-'/~tc'J E Gross Net Depth to Net Reading Date Time Time Water Drop 3OLATION RATE /~- (minutes/inch) TEST RUN BETWEEN FT AND ---- FT PERFORMED BY: 72-008 [6/79~ E,~gb/~lvor t:ngtneerlng 8~rvJce8 P. 0. BOX 773294 Eagle Hiver, AK 99577 694-5195 C ERTIFIEDBY: DATE: SPECIF'ICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: (:~OL l)iNq I'{ I.i I/,5 ;: t,O i 2 ? [~t.()(.)K 2 '1 R F;l',!Ol'i ! , '1 RECOMMENDED LEACHFIELD DIMENSIONS 'I(]'iAI ])I}:P'IH :7 '7' (;RAV[;I. P[:I,)llt : (~" 'i[:~t Ix!Gl] IWFIGII'I :: bO' ] RI htOIl t4]D]}] :~()" NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTIQN REPORT /4I MAILING ADDRESS LEGAL DESCRIPTION Liq, c city in gallons DISTANCE TO: Manufacturer IF HOMEMADE: DISTANCE TO: No, of lines each line Top of tile to finish grad~ / ,~_ Length Width Type of crib Absorption ~area tInside length Foundation .~./ Material Near~Jot line:?~ /.*L. ~.2 ('.~' inct~es beneatb tile, /~ ~ ,th "~ ~" ~ (;~/'/d~'//~('/'/ inches NO. OFBEDROOMS .i~) DISTANCE TO: Class Crib depth Well Building foundation Depth Driller Building foundation Sewer line Materiak"J~.).7(.~-'' ., ~' No. of compartments r~ Width Liquid depth PERMIT NO. Liquid capacity in gallons T NO, Distance between I~ Total effe;tive absol-pti~ area PERMIT NO. Total effective absorption area OTHER PIPE MATERIALS REMARKS Nearest lot line Distance to lot line PERMIT NO. Septic tank [Absorption area(s) PERMIT NO. DATE LEGAL PERM!T NO. I"1 LI I'-..I ~ E.'. ][F' A I_ :E T '-r' C) F: A I'-.! Cf: !--I C) ~]: ~:t Ii E / DEPARTMENT r'-' HEAL'tH FIND EN'¢IRONMENTAL ~ ?.OTECTION ~~-~ oZ._, ¢, STREET., RNC:HORFIGE., Ri(. 9~ .,± 264-4720 '-- ~ -" ' I.]" i-4ELL RI"4L-:.' C'~P4--:=- I TbS i'; EP. IE.~. I='E RI"1 RPPLICANT Kb, tier LOCRT I OH / ' TYPE OF SOZL RBSORBT]ON 5Y'STEbl ~S' %¢~¢/q MRXIMUM NUMBER OF BEDROOM= =~ ~OIL RRTING (SQ FT, E,R)= THE RE.~..IREP SIZE OF THE SOIl. RBSORPTION SYSTEM IS' LOT SIZE ~?~/-2¢?/~QLIARE FEET o THE LENGTH DIMENSION IS THE LENGTI4 (IN FEET) OF Tt4E TRENCH OR DRRINF'IELD. THE DEF'TH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RN[:, THE BOTTOM OF THE EXCRVRTION (IN FEET:). THERE IS NO SET WIDTH FOR TRENCHES. THE C~RR'.?EL DEPTH IS THE HINItdLIM DEPTH OF GRAVEL BETWEEN THE OLITFFILL PIPE AND THE BOTTOM OF: TIdE EXCHVRTIOH (IN FEET). E.~:f~!L! I F-:EB, SEPT I C TANK _S.. I ZE= / ~ ~ © L-'IRI_I_C'II~4S; PERMIT APPLIC:BNT HAS THE.-'. RE_,PON_IBILIT¥ TO INFORM THIS DEPRRTMENT DLIRING THE INSTALLHTION INSF'ECTIOHS OF RNV WELLS AD.YRC:ENT TO THIS PROF'ERT¥ RHD THE "~Uf~BER OF RESIDENCES THAT THE ~4ELL NILL SERVE. TI..4C~ ( 2 ) I P,i::"; F'E'-: C: T I Of--IS ARE REC41J I I~:E[: BACKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION AND APPROVAL BY TI4IS DEPRP, TMENT WILL BE SUBJECT TO PROSECUTIOH. MINIMUM DISTRNCE E,'ETWEEN Fi WELL FIND RNY ON-SITE SEI,IRGE DISPOSRL SYSTEM IS 100 FEE]' FOR R PR I',/RTE HELL.) OR ~50 'l'O 200 FEET FROM R PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC DELI... WELL LOGS RRE REC4UIRED RND MUST BE RETURNED TO THE DEPRRTMENT NITHIN ~0 DRYS OF THE NELL COMPLE]ION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRLICTION DIRGRRD1S RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PEF.:I'"I I T E~-:,"F' I I~.ES [)EC;EMBEF-: _-'~:-'-:t.., 1.'-:). 80 I C:ERTIFY THRT 1: I RM FAMILIAR WITH THE REQUIREMENTS FOR OH-SITE SEHERS RND IUELLS AS SET FOR~FH BY THE MUNICIPALITY OF RNCHORRGE. 2: I WIt. L INSTRLL THE SYSTEM IN RC:CORDRNCE i4ITH THE CODES. ): I UNDERSTRND TI-IRT THE ON-SITE SEWER SYSTEM MRY RE6!UIRE EHLRRGEMENT IF THE RESIDENCE IS REMODELED TO If. ICLL;DE MORE THRN ) BEDROOMS. RPPLIC:RNT / / ~ SOILS LOG PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2221' SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST I 6' 7 8 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE SITE PLAN ~ , s Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) ~, --~ -- ,p I' , , TEST BUN BETWEEN ~ FT AND /1 / / 72 008 (7/76} 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Z < Z ? On-Site Services Section P.O. Box 196650 Anchorage, Alaska ' 99519-6650 .... '? 343-4744 - ' - '2.. :7~,~ ,..: . . :: ~ ~ -. :.. ~._... , . .. ' .:~ ' ~ ...... '-'~ ' .... : 'CERTIFICATE OF HEALTH AUTHORITY 1 APPROVAL FOR A SINGLE FAMILY DWELLING 1, GENERAL INFORMATION · ' "~ ' " . .... Uo~.~I -. gr-_ -z } 4gL~ ~O--- ~/~ ... C~r~'plete legal description_ MUNICIPALITY OF ANCHORAGE · -" "- ;~' DEPARTMENT OF HEALTH & HUMAN SERVICES : '' Division of Environmental Services -; ?-L~cation (site'address or directions) ~. '~.A-/~L~'- C2-~,,/E:¢-. " Day phone '. -- '% Lending ~gency' -~-'~ ¢ A Day phone --:' NOTE:. If co'mmuni~ well system, 'provide written confirmation from sta~ADeo 4. TYPE OFWASTEWATER DISPOSAL: "- NOTE: If communi~ W astewater sYstem, provide wri~en confirmation fr°m sta'te'~OEC a~esting to the legali~ and status of system. 72-025 (Rev. 1191) Front MOA ~21 STATEMENT OF INSPECTIOI~I ~" i~NGINEER 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 ~,~a~f~e~.t~&the date o' this inspection. ;.' ', Wastewater Services Ph6ne'" '=J 3'7-- (~/7~ -' Name of Firm ..... · 8471 Brookrldge Dr, ........ -Engin.fs signature~ "~L: OF..A The Municipality of Anchorage Department of Health and Human Services (DHH8) 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 satisfl/certain federal and state requirements, Employees of DHHS do not co~duct inspections or analyze data before a certificate is issued, The Municipality of Anchorage ~s not responsible for errors or omissions in the professional eng~ nest's work.:- - ..... . ' 72-025(Rev. 1/91] Back MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L~q- 'Z_j ~//_'Z, ~LC__.,d Parcell.D. ~.~'-~ -- GO/-/~r-- A, Well Data Well type P(2--[V¢~ ~-b~--- If A, B, or C, attach ADEC letter. ADEC water system number ~/,4 Log present (Y/N) ",¢ ~= ~ Date completed <:~,/ci 4-- Briller Total depth .~ ~ / Cased to -75/- (0" Casing height .4- Sanitary seal (Y/N) ~ ~__g~ Wires properly protected (Y/N) FROM WELL LOG Date of test / Static water level Well flow I O SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot 1% %/~- Public sewer main ~/~ Sewer service line ~oO - .g.p.m. AT INSPECTI~DN ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ¢l/I/~I z~- Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Other bacteria Collected by: Tank size t ~z-~'L~ Compadments ~--- Foundation cleanout (Y/N) _"yJ?~-_~ Depression (Y/N) /"J Alarm tested (Y/N) ".-/t~-~ ..-q Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J~© / + On adjacent lots / O~/+' - -- Foundation To property line ~r ~ / '~ Absorption field ~ o/ -- Water main/service line Sudace water/drainage / © .¢5 /~ ": 72-026 (3/g3)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level '~ ~ ~ Meets MOA electrical codes (Y/N) "Pump on" level at "4 E--% Manufacturer Manhole/Access (Y/N) "-/~ ~" "Pump off" Level at ~ /" 4~-4e s tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot / I 0 / + -- On adjacent lots D. ABSORPTION FIELD DATA ~ (cl/Z/q 4'~- 6/'/c/~) Soil rating (GPD/FF) I,. '~. Date installed Width ~ / Gravelthickness 4. o~ Length ~ '0 / Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) ,,~¢~C) ~'~-~- Cleanout present (Y/N) ~ ]~ &rd~."~ Results (pass/fail) I0¢'/+ -- Sudace water I 0 ,.~ "~ Bedrooms System type -T' Total depth -~. ip~..¢_ ~6'u,-ZE: P/'~'e'pression over field (Y/N) for After test /x//,4 If yes, give date f¢//4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ :~'~' To building foundation On adiacent lots Surface water Curtain drain On adjacent lots Property line Cutbank To existing or abandoned system on lot /.4- ZO - ~m~-.'~' Water main/service line Driveway, parking/vehicle storage area Dcz.~) UJ~L~t.-- ~ ~J~"cJ g :T-. E::, P /~"~::~- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, orc//ormed to all MOA and HAA guidelines in Signature Engineer's Nam/ // (/~~ ,,~, ~/-~¢/A/-~>~__~' ite of this inspection. HAA Fee $ 72~) Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number CT&E Ref.# Matrix Client Sample ID Client Name Ordered By Project Name Project~ PWSID CT&E Environmental Services Inc. Laboratory Division >> .o8o1-1 Laboratory Analysis Report WATER KITCHEN SINK - L2 BLK2 GLEN EAGLE S/D AK WATER & WASTEWATER SERVICES JEFF GARNESS UA WORK Order 12956 Printed Date 03/03/95 @ 15:07 hrs. Collected Date 02/28/95 @ 11:55 hrs. Received Date 03/01/95 @ 08:30 hrs. Technical Director STEPHEN C. EDE Released By ~ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: GARNESS. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 0.10 U mg/L EPA 300.0 ION 10 03/01/95 MCE * See Special Instructions ** See Sample Remarks Above U - Undetected, Reported value is the practical quantification limit. ~ = Secondary dilution. UA = Unavailable NA = Not Analyzed LT = Less Than GT = Greater Than 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 - T~ACT SCALE EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON, ~EAR;~ AS-BUILT' NO CORNERS SET THIS DATE hereby certify that I have performed a Mortgagee's inspection of the following described property: LoT 2, BL, OC~...rZ~ Anchorage Recording Precinct, Alaska, and that improvements situated Ihereon are wi[bM the property lines and do not ovedap or encroach on Ihe property tying adjacent thereto, that nc, Improvements On property tying adjacent thereto encroach on the premises in question and that there are no roadways, transmission tines or other visibte easements on said property except as indicated hereon. Dated at Anchora§e, Alaska this 4 -,-~^ day of ~ '~,'~,~Q ,~'/' 19 ~_.~_ FRED WALATKA & ASSOCIATES (907) 248-1666 Engineers and Surveyors Halmar Electric ~0 Box 1864 Palmer AK 99645 Ph. 745-8883, 696--8883 To: Hamann Constr~ction Po Box 617 Eagle River AK 99577 Dater Ref: Res. 9-21-94 Lt.2,Blk.~ Glen Eagle Subdiv, Debbie Miller This is to certify that on site sewer lift statien at above mentioned property has been wired in accordance with the National Electrical Code and manufactures specification. Systems we:ce checked and performed as specified in the system~ manual. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date AUGUST 18, 1987 GENERAL INFORMATION ..(a) Legal Description (include lot, block, subdivision, section, township, range) GOLDEN HILLS: Lot 2, Block 2 T12N, R~W, Section 14 Location (address or directions) 10100 CURVY ST, ANCHORAGB (b) Applicant Name ALrD~-~/ ~SON Telephone: Home NA Business 694-4200 Applicant Address ~ ?72849; EAGLE RIVER AK 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other]~[ (explain); (d) Lending Institution FRDAf,ASJ(A C,~T UNION Telephone __2.76-1011 ArZTN: Kathy Mathews Address POH'CH' 7-505 ~ ANCHORAGE AK 99510 (e) Real Estate Company and Agent RE/MAY OF EAGT,F, RIVRR AnN; ~L~).~ MASON Address P.O, D:)X 772849, EAGL~i: Rl-vT~, AK 99577 Telephone 694-4200 (f) Mail the HAA to tile following address: FOR PICKUP BY EAGLE RIVER ENGINEE, RING 2. TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms _ ~ ; 3. , WATER SUPPLY Individual Well ~ Community [] Other Public [] 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 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. 72-025 (11/84) '~JOM s,Jeeu!6uo leuo!ssejoJd eql u! suo!ssFuo Jo s JO J J8 Jo} elq!suodseJ leu s! eOeJoqouv }o Xqled!o!uniAI eq/'penss! s! eleoU!~Jeo e eJo}eq m, ep ez,qeue JO suo!loedsu! Tonpuoo leu op cl3Ha to seeXolduJ3 'slueuJeJ!nbeJ elels pue leJepe~ u!elJeO ~js!les eT JepJo u! suo!lnl!lsu! 8u!puel J!eql pue seuJoq }o sJeseqoJnd el Xsepnoo e se s!ql seep d3Ha eqJ. 'm~selV }o eielS eq~ u! peJelS!6eJ JeeU!6Ue leUO!SSe}oJd luepuedepu! ue ,~q @AOqe g qdgJ§eJed u! UeA!I~ SUO!lelu@s@Jd@J eq~ uodn/~lelOS peseq seleoi}ipeo le^oJddv ,qpoqlnv qlleeH senss! (d3H(]) uo!loeloJd lelUeUJUOJ!AU3 pue qlleeH Io lUeLUpedea ebeJoqouv jo ~l!led!ounv, l Not±nvo le^oJddv leUO!l!puoo jo SUUJeL leUOB!puoo pe^oJddes!a /~ peAoJddV '9 A£~66 ~6~-~6~ euoqdale± ~ ~[~hl~[ H'IUV%f ~f/6gk..££ XC~ 'O'c[ sseJppv ~Lff. UJ.J\HLff~ UNZ~I~LdINIUN~ '~ wJ!:J }o eWeN · uo!loadsu! s!ql jo amp aql uo lee}ia u! suo!lelnlba~ pue 'seoueu!pJo 'sepoo eleJ$ pue led!o!unlAl lie qi!M eoue!lduJoo u! s! uJeIsXs lesods!p JeleMeiSeM ~o/pue Xlddns JaleM el!s-uo eLll 'uo!loedsu! pue uo!lee!lse^u! ALU LU04 pue sell} aeeJoqouv ~o XT!led!o!un!AI aql LUO~J peu!e~qo UO!~eLU~O}U! eq~ uo paseq leLi1A}!JeA JeLl:lan} I 'u!eJeq peleo!pu! eJnlonJls }o ad,q pue suJooJpaq ~o JequJnu eql ~o} elenbepe pue leUO!loun} 'ejes s! LuelsAs lesods!p JeleMelSeM ~o/pue Xlddns mieM e~!s-uo eLi~ ~,eqi SMOqS leAo~ddv/q!JoqlnV LllleeH S!LH bo uo!leJ~!lse^u! XLU Jetll/~dJe^ I 'MOleq UMOLIS ejep uo!lep!le^ aLI1 JO se pue oje~eq pex!}}e leaS ,~LU Xq peu!lJeo sv NOIJ. VI~IblO:INI aNV VIVa 'HOblV=l$ ~-114 'SlS~.L '$NOI/O=IdSNI 9NlalAO~ld IAI~II4 9NII:I=I=INI!DN:1 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY '1984 264-4720 MUNtCIPALII'Y OF ANCHORAGE Legal Description: ~'~/~¢¢ ENVIRONMENTAL SERVICES DIVISION AUG 1,987 Well Classification .~¢[~'¢",~/~¢~ ! ~ [1 If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ,/ Date Completed ~--/~¢ -- ,2~ Yield 4~' Total Depth /-S- ~ / Cased to l~x-3 Static Water Level //3 / Casing Height Above Ground /,.~ u Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /~,//4 Cleanout/Manhole Water Sample Collected by Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) .~L,' Depression Around Wellhead (Y/N) ; On Adjoining Lots ~/~'¢ / ; On Adjoining Lots To Nearest Public Sewer Water Sample Test Results To Nearest Sewer Service Line on Lot '¢'~-25~ / /~'$/'"~ ~ ~' ; Date ;z,.~..~ ~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed /2 ?~ 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 ',¢'4"¥- ?~- / To Property Line ~'~ / ~' To Water Main/Service Line .c- Course *'-/~ ' Size }~-S"'~ No. of Compartments Air-tight Caps (Y/N) .Y Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) ~J / To Building Foundation ~-- To Disposal Field 2; '/ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'-5 /¢,4¢ 7 Width of Field Square Feet of Absorption Area Depression over Field (Y/N) 'g-/ Results of Last Adequacy Test Separation Distance from Absorption Field: ..... To Water-Supply Well . //-/'-J" To Building Foundation ~//-2 / Lot /¢z~ / To Water Main/Service Line '/-/~' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~.,-~? ~¢ ¢.,/4¢-x' / Type of System Design Length of Field ,.(~-',.S- / Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Properly Line To Existing or Abandoned System on ; On Adjoining Lots Qg','; / To Cutbank (if present) 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 ** SI certifYigned that .,,~'""/'"'~'<:~--'¢-I~cked'~-:~-~'"~ "~verified' or conformedDate to~.//all M?~__~,/d''¢and HAA2, guidelines in effect on the date of this inspection. Company ~,~'~ ~-/' MOA No. Receipt No. ¢/0 (-~ / 0 ~ / ~/~ Date of Payment ~/,,/f/~T ^mou.t: $ /Q Page 2 of 2 72-026 { 11/84) DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME DATE DATE DATE INSPECTOR . INSPECTOR I NSPECTOR~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENTOFHEALTH&ENVIRONMENTALPROTEOTION DEPT. 825 L Street - Anchorage, Alaska 99501 ENVIRONMEN]>,L (~) ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 DI RECTION8: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROPErTy OWNER ~_ PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from ~bove) PHONE 2. BUYER ~ PHON~ MAILING ADDRESS / 3. LENDING~¢:) ~J tINSTITUTION~ ~t ' ~ / , , , MAILING ADDRESS 4, REALTOR/AGENT ] PHONE' I 5, LEGAL DESCRIPTION STREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [~] Four ~ SINGLE FAMILY [~] Two [~] Five ~1 MULTIPLE FAMILY ~ Three [~] Six E~] 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.) 0. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALl_ED, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6179) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE ,[] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] iNDIVIDUAL/ON -SITE DATE iNSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~Septic Tankor [] Holding Tank Size:'- ~-/.~)-~-O If Tank is homemade SOILS RATING give dimensions: // TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Lin~ WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~"'~X'PPROVED FOR ~" BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED .,~~..~ DATE