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Home My WebLink AboutGLEN EAGLE BLK 2 LT 7Onsite File Glen Eagle Block 2 Lot 7 #050-601-03 ar, Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211443 PID Number: 050-601-03 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex D Two Single Family Pr ■ Name Vicky Hanson ABSORPTION FIELD [:1Deep Trench ElWide Trench ElBed ❑Mound ❑ Other Site Address 23841 Sunny Glen Dr Phone 907-223-2305 Number of Bedrooms 2 �ating GPD/SF Total depth from original grade Ft. LEGAL DESCRIPTION Depth to pipe invert original grade Gravel depth beneath pipe Ft. Ft. Subdivision Glen Eagle Block Lot 2 7 Fill added above original grade ravel length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distan etween lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area Number of trenches Dist. between trenches Ft2 Ft. Well >100' N/A N/A N/A N/A TANK ❑-g Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Infiltrator Capacity 1050 Gal. Surface Water >100' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation > 1 0, N/A N/A N/A TATION Manufacturer Capacity Remarks Gal. Alarm location Elects ' talled by Installer Anderson Contracting & Environmental Septic PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Drainfield N/A CO/MT D3034 Inspector J.Millette BENCHMARK (Assumed elevation) 100 ft Inspdection 15` 11/1/21 2nd 11/1/21 Location and description 3b 4'h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date ��P,OF AL,q�N, .49 TH fir 9 �. .........7. �, e % . Benjarrit'RiSchiller ��%r • C11ia2/292, . -'c-\§ ` � 1l�iF�pROFESSIONP\�� \®ROFiSS Septic System Approved Date %� .1 y G�/ Note: this approval does not include well permit requirements. iQo" nGinoi� Q� ar, Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEER1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MH1 PERMIT # OSP211443 PID # 050-601-03 GLEN EAGLE, BLOCK 2 LOT 7 A B 2CO1 10.5 MH1 14.5 SV1 19.6 A B 2CO2 22.9 18.8 21.2 25.3 28.0 FEET 0 50 100 2CO2 SUNNY GLEN DRIVE 2-BDRM HOME 11/18/21 T H E S U N L O F T D R I V E 10' UTILITY EASEMENT EXISTING SEEPAGE PIT TO REMAIN IN SERVICE NEW 1000-GAL SEPTIC TANK w/ 20" MANWAY 2CO1 EXISTING WELL w/ 100' RADIUS EXISTING WELL EXISTING WELL MOA MAPPED STREAM (UNNAMED) MOA MAPPING SHOWS A CREEK ALONG THE SOUTH PROPERTY LINE IN THE ROW DITCH. NO WATER HAS BEEN OBSERVED HERE OR ANYWHERE NEAR THE DITCH & THERE IS NO INDICATION OF WATER FLOWING FOR ANY EXTENDED PERIOD OF TIME SV1 PLAN AS-BUILT PROFILE AS-BUILT (NO SCALE) 95.9 92.0 96.3 99.32CO1MH1 SV12CO295.7 1050 GAL PLASTIC SEPTIC TANK Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A LENGINEER11/18/21 2" FOAM INSULATION PERMIT # OSP211443 PID # 050-601-03 GLEN EAGLE, BLOCK 2 LOT 7 o � 40, \ � S s82O34 � 4L)R��F' � IWELL F 2 \ S° O�JS F, \ n PpOS raa� N \ 00 \ I^+ A W \ \ 2 STORY RESIDENCE w/ WALKOUT BSMT. CANT Z DECK / 3.8'x9.8' BALCONY SEPTIC PIPES I 1q ��MANHOLE- C I F �. Lot 7 D.2'x H SED 44,098 S.F. a' POST & y 10' UTILITY RAIL FENCE EASEMENT - I WEST 190.00' SEE NOTE O M SUNNY GLEN DRIVE NOTE: THE GRAVEL DRIVEWAY ENCROACHES ONTO GLEN EAGLE PARK. PLOT PLAN --- AS BUILT _K- SCALE _1" =_50__ GRID _ SW 0160__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, i n c . (907) 522-6476 Phone 0pO00p00 (907) 522-4625 Fax oo Professional Land Surveyors kenOlangsurvey.com .F A jonathanOlangsurvey.com .............. �4 1 hereby certify that I have surveyed the following described property: LOT 7, BLOCK 2, GLEN EAGLE SUBDIVISION (PLAT No. 73-85) o * 49TH Anchorage Recording District, Alaska, and that the Improvements situated thereon are . . . .' . . . • . . . . . . . • • • . " • • •' .' . . . .� within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed .. .. ... FC. .... KENG premises and that there are no roadways, transmission lines or other visible QO �"�,o� easements on sold property except as indicated hereon. Q s� 1L lt.lZ\ F Dated this theDayAFD ' ....... gJp� ��,of __1`I�U��.�tiJ��l�--____, _�_�' `I_ at Anchorage, Alaska Q aR •"••�••" NOo 44� �Ff5SI0NAl- �o It is the responsibility of the owner to determine the existence of any easements, �4 SIONA- covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211443 Work Type: SepticTank Upgrade Tax Code Number: 05060103000 Site Legal Address: GLEN EAGLE BLK 2 LT 7 G:0160 Site Mailing Address: 23841 SUNNY GLEN DR, Eagle River Owner: HANSON VICKY Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: Z ent 0 V v. Uepai'tin ent 10/29/2021 10/29/2022 44098 Disposal Field Q Septic Tank Holding Tank Privy - Private Well Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date:O 2 q e_ 2 MUMUFAkLff Y OF HCH 0 FRA GE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-601-03 Property owner(s) Vicky Hansen Day phone 223-2305 Mailing address PO Box 771405, Eagle River, AK 99577 Site address 23841 Sunny Glen Dr Legal description (Sub'd., Block & Lot) Glen Eagle, Block 2 Lot 7 Legal description (Township, Range & Section) Lot Size 44,098 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank MUpgrade ❑X (w/wo ADU) (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: %2Z5 Date of Payment: I T. Receipt Number: 0-510-;0 Permit No. D,sP21 19 y3 Permit App_::- : :'-:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. October 28, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 10/28/21 Subject: Glen Eagle Block 2 Lot 7 – 23841 Sunny Glen Drive Septic tank replacement Dear On-Site Services Engineer: The owner of the above lot has a 2-bedroom home on the property with a septic tank that has reached the end of its life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the existing well and septic location. No conflicts exist between this proposed septic tank and any other well or septic system, whether on this lot or adjacent lots. Wells on this and adjacent lots are shown. The new tank will be a minimum of 100’ from all wells and surface water, and more than 10’ away from the foundation. Records indicate that there is a municipality-mapped stream along the south property line, where there is currently a roadside ditch in the ROW. We did not observe any standing or flowing water on our site visits, and there were no indications of regular water flow in this ditch. As there are no other options for the location of the septic tank, we request that this mapped ‘stream’ be reconsidered as a standard ditch for this permit. Please refer to the attached plan page for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211443, Deb Wockenfuss, 10/29/21 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND GLEN EAGLE, BLOCK 2 LOT 7 FEET 0 50 100 2CO NOTE: ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. SUNNY GLEN DRIVE 2-BDRM HOME October 28, 2021 T H E S U N L O F T D R I V E 10' UTILITY EASEMENT EXISTING SEEPAGE PIT TO REMAIN IN SERVICE NEW 1000-GAL SEPTIC TANK w/ 20" MANWAY 2CO EXISTING WELL w/ 100' RADIUS EXISTING WELL EXISTING WELL MOA MAPPED STREAM (UNNAMED) MOA MAPPING SHOWS A CREEK ALONG THE SOUTH PROPERTY LINE IN THE ROW DITCH. NO WATER HAS BEEN OBSERVED HERE OR ANYWHERE NEAR THE DITCH & THERE IS NO INDICATION OF WATER FLOWING FOR ANY EXTENDED PERIOD OF TIME Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211443, Deb Wockenfuss, 10/29/21 Municipality of Anchorage Page _ I of r)EPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 o Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,'~'_"~01 I0 ~, \ Address: LEGAL DESCRIPTION · S,,.~bdivisior~. ~ Township: ~Range: ~°n W~LL: D New ~ Upgrade _Classificati°n~ ~(Private'~A'B'C): Total Depth: Ft. Cased To: FI, Driller: Date Dr lied: Static Water Level: FI. Yield: [Pump Set at: /Casing Height Above Ground: GPMI Ft.l Ft. From Well Surface Water Lot Line Foundation SEPARATION IDISTANCES Curtain Drain Public/Private S__ewer Line~s Remarks: PID Number: ~4~ ~.¢ O [ (::~) --'-~ _ Wastewater System: [] New [] Upgrade ABSORPTION FIELD [] Deep Trench [] Shallow Trench []B/~ [] Mound []Other Soil Rating: Tot~Depth from original grade: GP[)/Sq. Ft. I./ Depth to pipe bottom Irom original grade: /Gravel depth beneath pipe Ft. Fill added above original grads: / Gravel length7 ____ // Ft/ Ft. Gravel depth: / Number of lines: 1 Distance belweea lines: ---- .,~ F t.~.~ ____ __b.~ _ Ft. Total absorption area: / Pipe material: ______~..~._ SQ FL ___- TANK "(~.,Septic [] Holding [] S.T.E.P. Manufacturer: ~ I Capacity in gallons: Material: I Number of Compartments: LIFT STATION P~mp Make & Model _.~l~& I~tions ~erforme~ by: BENCH MARK Inspections performed by~ IDepartment ct Health a~d Hu,~n~rvices approval 72-013 (1/91) MOA 25 Location and Description: Assumed Elevatiom Permit No. ~L-~.C:[ ~ ~ ~ ~ I Page ~ 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 · ' '"'" 1~ ~ PID No.: Legal Descr(ptlon:~.J~-~~,&,~?~[,.,~-~ ~. 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:SW910361 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:ALASKA HOUSING FINANCE CORP & OWNER ADDRESS:520 EAST THIRTYFOURTH AVE. DATE ISSUED:il/13/91 EXPIRATION DATE:il/13/92 PARCEL ID:05060103 LEGAL DESCRIPTION: GLEN EAGLE BLK 2 LT 7 LOT SIZE: 44098 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM AL1, 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 (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: November 8, 1991 ROBERTSHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER &WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELLINSPECTiON & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 7; Block 2; Glen Eagle Subdivision; Request: you issue a permit to replace the 1000 gallon septic tank serving the referenced property. Please refer to our letter of February 28, 1991 addressed to Lynda Banner of Jack White Company. The septic tank has not been excavated to verify its deterioration as of yet, however, we wish to have a permit on-site in case excavation finds the tank in need of replacement. If you have any questions or require additional information for your review, please contact us. Sincerely, ROGER J. SHAFER, P.E. RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 1 ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWINg DESCRIBED PROPERTY: Glen Eagle Subd.,Lot 7.Bik, 2 ~D ~AT NO ~MENTS EXIST ~C~ ~ INDICA~. IT IS, THE RES~SlBILI~ OF THE ~ ~ D~NINE T~ ~ISTEN~ OF ~Y ~TSt ~V~A~S~ OR RESTRICTI~S WMI~ ~ ~T ~ ~ THE RE~ ~I- VISI~ ~T, U~ NO CIRCUMSTANCES S~ ~ DATA H~ ~ US~ F~ C~U~ION OF FE~ LIN~ OR ~R E~LISHING ~ND' ARY LINES. 1"=40' 2-28-91 miD, SW' 160 19-08 DMS ROBERTSHAFER, P,E, ROGERSHAFER February 28, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPI"CTION & FLOW TEST SITE PLANS ROAD OESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM OESIGN M6. Lynda Banner JACK WHITE COMPANY 10928 Eagle Rivgr Road Eagle River, Alaska 99577 REFERENCE: Lot 71 Block 21 Glen Eagle Subdivisioni NHN Sunny Glen Road, Eagle River, Alaska Dear Lynda, At your request a flow test was performed on the w~l s~rving the referenced property on February 22, 1991. Th~ s~c w~ l~v~ w~ m~s~ed w~n ~ w~ ~ 121 ft. b~ow ~ ~p of th~ w~ ~4ing. A m~ ~ ~nn~d n~ thz pr~s~ ~nk a~ th~ flow ~n~ on f~. Aft~ 90 min~ ~ ~ l~v~ 4~b~z~d at 192 ft. wh~r~ ~ r~n&d througho~ th& d~on of th& 4 ho~ tt~t. From ~ t~t w& ~v& con~ud&d th& w~ to ~rr&~y pro~c& a mi~ of 8.3 ~o~ p~ min~& (GPM). T~S flow r~e is not g~ra~e&d to r~n co~, subs&qu&nt va~o~ ~n oc~. Water samples w~re taken and tested for coliform bacteria and nitr~l~:es. The resu~ wu~e satisfactory. D~ring the flow test an adequacy test was p~rformed on the septic system s~rving the referenced property. W~ w~ add~ to thz p~ w~ ~t~ l~v~ m~as~r~ w~ ~k~n from th~ mo~o~n~ lo~t~d ~ th~ s~pag~ p~. From t~ t~t ~ w~ con~d~ s~page p~ ~ ~rr~y fun~o~ng ad~q~y for a ~o b~droom ho~. How~v~, th~ s~pag~ p~ ~nnot b~ g~ra~ed subs~qu~ f~r~. Prior to the adequacy t~st the liquid lev~ in the septic was .m~asured. The tank was dry. On Monday Febru~J~y 25, 1991, 650 gallons of water w~re added to the septic tank. Immediately aft~ ~ w~ ~s ~nzd off th~ s~p~c tank w~ ag~n m~s~. Th~ s~p~c ~nk ~ ~y. We suspe~ thc septic tank to be sev~rly d~t~riorated. Prior to an approval bging gra~d on th~ s~p~c ~yst~ th~ s~p~c tank n~ to ~x~vat~d and i~p~d. If ~ ~nk ~ found to b~ of poor ~ susp~ed, th~ ~nk ~ to bz r~placzd. Th~ ~no~ and mo~o~ ~b~ ~ho~d ~ b~ ~xt~nd~d. The w~ cap need~ to be replaced. The rubber 9ask~ holding the cap tog~hgr is ~aged. T~ ar~ ~ f~ w~ ca~ng. Th~ ~" p~g hol~ ~r~ds ~ ~o s~pp~d. 17034 EAGLE RIVER LOOP. SUITE 204. EAGLE RIVER. ALASKA Page Two Lot 7~ Block 2~ Glen Eagl~ Subdivision~ NHN Sunny Glen Road F~br~ary 28, 1991 If we may b~ of furth~ s~rvi¢¢, pl~as~ contact C~Igm GRE' " ANCHORAGE AREA BOP Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM I SEPTIC TANK: DISTANCE / FROM WELL /.~¢ MANUFACTURER g,1~(~-¢.:..6- MATERIAt INSIDE LENGTH _ INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS / LIQUID CAPACITY /000 GALLONS. SEEPAGE PIT: · / ~:.' , ~., NUMBER OF PiTS / DIAMETER ~¢ OR WIDTH LENGTH~q, DEPTN LINING MATERIAL ~¢~(' CRIB SIZE: DIAMETER_ DEPTH /u~f DISTANCE FROM: BUILDING FOUNDATION .~1¢)! TOTAL EFFECTIVE NEAREST LOT LINE '~(~! ABSORPTION AREA (WALL AREA) WELL SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ~ I _CONSTRUCTION f4. /1~: DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER LINE TANK , SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PiPE MATERIAL: LOTSLOPE:~-/~6f / REMARKS: Form NO, EQ-031 P. O. [}ox ,1-1224 DE?T. { ' (907) 27.1-4(d ANCIIORAGE, ALASKA 99509 ~;;72'2 John Lvm cz* \VoH Owner - . Location (address o[: Township, Range, Section, if known; of distance main road .... Lot 7 Block 2 Glen Eagle Subd., At-~cho'rasc ~T 9 Size of casin1j 6 . Depth of Ilole 207 __ feet Cased to .]~9.6 _feet Static water level ft. (xbtx~) (below) land surface. Finish of well (check (>nc) open end ( xx ); Screen ( ); Perf(rated ( ). Describe screen or perforatJ(m Well pumping test at,i_ gallons pet' of drawdown from static level. (minute) for_._4~ __hours with ]_0~ Date of eompletion WELL LOG Depth in feet from !.q'ound surface Give details of formations penetrated size of material, color and hardness _0 TO__ 2 :re 1 n ] ,i 14 .TO 105 105 TO ].23 1~.) TO 131 TO _ TO._ TO_ ___ _TO__ __ TO ..... .TO_ Casing s t- J clcup - - Fill Gravelly hard pan Bed'~o~k; 5~0 te)? ~eeps 1 CUSIOMER O O O O co cy') M M O O CY) rn C: (15 LU ♦ n O LL V a_ a 0 2 U Z a qrl LL J c � U U) � L _ Q W Z Q a) U ^Ll �x W W c L c � E Q O > C/) 00 LO N O N LO rn C O ca Q x W O O O A O r O O LO O U cu d ti H J N J m W J Q W w —i (D O Q. U a) 07 a) J r - ti LO Q L a) N M W W J Z D �U) V 00 CY) N U) U) Q) -`o co a) i cY) `o a) O Q CU W cu U) a) U) a) C O a) X At Al N O N ti 6 co 0 U a) U c 0 d O`` p O CL N a) a. CL O 3 t V U) V N O O Fes- a) X aEi "a O O O 0o�=� 'a t4 N a) LO U)` o C Q_- m Q > Ln .= Q O Q > NN O Q U U) p �_ O (0 N � C/) 0 3 a) LO O_ .N �: z Q U E ., N > = a. 'a O Oca a) d O O. CL CLcL y E v = O U) m X N +' (q `~ to (n +, � �_/ o a) W W 70 C? �, E 'a O Q Z C O C Q p > O L Q. N d N a) O U) '> O p Z -Q +�+ U O LL 70 Q +; c`C a N O a) U c o Z- a) cC V N p N Q o Z W0 (A � N cco -C E = U Q O (� O N O N N Q. a- U Q Q Q (6 O Q Q cn ani CO a) O O a) cu 0 4- a) U Z O O o 0 H C7 aC:) LL O o Z J a o W Z U 'Wn V V - ti J N � Y � MJM Z 1. I11 IJI LU J Q Z w Z Z W J � cor)o N Q.. �L N U N N N •O ca 0) (1) N c O O a O U U N c O .O Q >, ca r1w A N U C fB cn 0 0 N 7 N O O W N N � d > d O CL Q Q. c O N w' E L c 0 d c N t c O d A N U L i v m 0) (1) c Q �L M m r tj a� a) LL C N :, j �1 J T ` v 1 C: v 1 6o E a� cv LL O O M O U 0 U d O O d L O — U cm N O a) n E O 3 O i>- U — L O .�2 (n CL O O U N O O N ) c O] > L ❑ E O ❑ U Ll c a) 3 � N U) C O O W N m > L ❑ 3 "Q + M C N O o o V 'N^ ^V^)` to i ■ ❑ � 0) -O O ❑ IL ❑ N U c U i (� ( O N c -c N c) ❑■ m m C7 O O _❑ > a. ■❑ O > ❑ (DQ ❑ J O U i d `m O — m El U) W N—Cf)°- J � F- Q ❑ �i N >, L L/) > Q ❑ o U) U U) 2 w WLU ❑ W � LU F- U) Y Z U) W O LL L H ZQ W¢ U)Q O a m N M t7 u N U C fB cn 0 0 N 7 N O O W N N � d > d O CL Q Q. c O N w' E L c 0 d c N t c O d A N U L i v m 0) (1) c Q �L M m r tj a� a) LL C N :, j �1 J T ` v 1 C: v 1 6o E a� cv LL O O M O U 0 U 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 C&M ENGINEERING CHARLES BALZARINI, PE 9/5/24 W O V Z ef LL r�a 1—' J V_ Z D H Z 0 UJ •� u �v Q a w ra Q 3: Ln (IJ LU " ce N � o h b\A Z O UJ 4� �mE a � � O v E J 4--• w V') LU 0 0 N E xv E v N E tin c N r- O `~ O > a--+ -a c L }' co O 0 .4 . O .� G� ro N U Ln O > O Q 0- a 4- O U E o c+O U U E N f6 V' N °' f° a w >� U c v Q •� U O N N cn � UD ;c u - Q W O O 'O N -0 mv_ Ln Q w O m bA " rn t 0 — > � v v 4 W =) tw 4O 0 � -0 " O O N (/i O a) 4-Jm E 0 v .— > vOi i O o m 0 a :Ll c o o _ 41 m v � N v — 4— O 0 o m 0 N v +, cn _ o f° U L N U O m ttio Lu u > i5 -0 =3O vl aJ > v E v m Q E 0 U -i v O J ? v c _ E `° c U U a + 0 "' a� > i O_ U r° o ma E fB N -C cp E L V; v L O E O 4- v� E m N m +j > N H MUNUFAUTYOFNCHORAGa Development Services Department s Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-601-03 1. GENERAL INFORMATION Expiration Date: 9 r 2 -2 - Complete legal description Glen Eagle Block 2 Lot 7 Location (site address) 23841 Sunny Glen Drive Current property owner(s) Vicky Hanson Day phone Mailing address PO BOX 771405, Eagle River, AK 99577 Real estate agent Charlotte Gaston 2. TYPE OF DWELLING: ❑e Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 Day phone (907) 312-3033 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well FEI Private Septic Q Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5-50 Waiver Fee $ Date of Payment - 2--Z- Receipt ZReceipt Number 77 ]) COSA# 05C22 1 LI -% Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 06/10/22 6. DSD SIGNATURE System #1 Approved for 2 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, 1 TV i✓ Ben)arr r ,Schiller ��,c'f1�c9 • . CE 12592 6/10/22. • ��. r��/ PROFE00_, �\\��1�� with the following supwauons: �� QA i , \jY OF ON-SITE WATER AND z� PROGRAM Original Certificate Date: '-2 S? Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet 1 Legal Description: Glen Eagle Block 2 Lot 7 Parcel ID: 050-601-03 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 11/05/79 Total depth 207 ft Cased to 129.6 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 06/08/22 Static water level at beginning of test 104 ft A17,01024"Im. B. TANK DATA Age of tank(s) `1 years Tank type/material SEPTIC/PLASTIC Measured operating fluid level in septic tank 43" ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 07/25/1973 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.5 ft (max) Measured depth to pipe invert from grade 3.6 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 6.9 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Structure served by this system Well production at time of test 3.5 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitratemg/L ❑ Nitrate less than MRL (ND) Arsenic 24.2 ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 06/08/22* C. LIFT STATION uired maintenance completed Age of lift sta years Lift station material Comments: Adequacy test date 06/08/22 Results ED Pass For 2 bedrooms Fluid depth prior to test 1 in Water added 315 gal New depth 3.5 in Elapsed time 1440 min Final fluid depth 0.5 in Absorption rate '300 gpd Any rejuvenation treatment (past 12 months) N/A If yes, enter date N/A E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' 0✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' p✓ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' ® Yes if No ft Water Main > 10' Animal Containment > 50'[]✓ Yes if No ft E✓ Yes if No ft 0✓ Yes if No ft Water Service Line > 10' r-71 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' MV Yes if No ft r/ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ✓M Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' M Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0✓ Yes if No ft Water Service Line > 10' r-71 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' U Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet TH �- .. Benlanchiller I 9 •. CE 12592 •��cQ� �F�•., 06i10i22 •��v� t , PROFESSO Arsenic Advisory Certificate of On -Site Systems Approval # OSC221277 Subdivision: Glen Eagle ,Block 2, Lot 7 A water sample revealed an arsenic concentration of 24.2 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Ma�lmg Address P O Box 196650 X 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, Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~ - Col;[~/ - 0% NAA # _~-~L-~c'l 1, GENERAL INFORMATION Complete legal description Lot 7; Block 2; Glen Eagle Subdivision Location (site address or directions) NHN Sunny Glen Lane/ Eagle Rivet/ Alaska Property owner AHFC ~28266 Mailing address WA ~103372 Day phone Lending agency Day phone Mailing address- Agent Lola Pederson/JACK WHITE COMPANY Day phone Address 10928 Eaqle River Road, Eaqle River/ Alaska 694-9032 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 2 ~ 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: xxx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/orwastewaterdisposal 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. Name of Firm Address · ~ & $ ~NGINEERING 7034 Eagle River Loop Road NO, 204 Phone Engineer's signature DH~ SIGNATURE Approved for Alaska 99577 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHH$) issues Health Authority Approval Oertificates b~sed only upon the representations given in paragraph 5 ~bove by an independent pro~es$ional engineer registered in the State of Alaska. The DHH8 does this as ~ courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH8 do not conduct inspections or analyze data before ~ certificste is issued. The ~uni¢ipality o~ Anchorage is not responsible for errors or omissions in the professional engineeFs work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type ~¢-vd,¥oC,,~- Log present Y~'4) Total depth "~'~ -~ ~ If A, B, or C, attach ADEC letter. ADEC water system number _ Date completed \\- ~'--1~ Driller 1 ~__c~, L¢~ Casing height Wires properly protected ~/'N) AT INSPECTION g.p.m. ~ .~ _Cased to Sanitary seal (~N) FROM WELL LOG Date of test Static water level Well flow Pump level / o~ ~'~,~. ; On adjacent lots ; On adjacent lots Public sewer manhote/cleanout Petroleum tank SE-'PARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ t~\\ Absorption field on lot / '~_ '¢¢\ Public sewer main r'~'//% Sewer service line "~. ~' \~ WATER SAMPLE RESULTS: Coliform ¢_) (_.-o ~"~/ t ~,,,¢(- Nitrate_ Date of sample: z~ -'7 .c/7-- B. SEPTIC/HOLDING TANK DATA Date installed \'"/~"~ ¢°t\ Cleanouts (~N) '~ High water alarm (Y/~} Date of pumping _ h~ ¢.~k, Collected by: Other bacteria S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Tank size \ ~:;~:)-z;~ (_~--u-- Compartments "-L. Foundation cleanout ~) ~o~ Depression (Y/~ ~ Alarm tested (Y/N) ~)~ %~ ~ Pumper ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot (¢ t,\ To property line \¢ \ Surface water/drainage On adjacent tots \ ~ k -b Absorption field ~, f--~ \ '~'-- Foundation Water main/service line_ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~ ~%'¢~les tested Meets MOA electrical codes (Y/~..--~ SE~ANCE FROM LIFT STATION TO: VCell on lot On adjacent lots Manhole/Access (Y/N) "Pu mp.~-f4~ev~f~- Surface water D. ABSORPTION FIELD DATA Date installed "~ Length "~'"/-~ ~ Width Total absorption area Depression over field (Y~) Results.~;]~fail) Peroxide treatment (past 12 months) (Y,~ Soil rating ~~2---~'~ ~f/¢rz.~ System type Gravel thickness l¢ ~ Total depth Cleanouts present~/N) Date of adequacy test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \'~'~ ~ On adjacent lots \ ~ ,.4- Property line To building foundation \~ t ¥- To existing or abandoned system on lot On adjacent lots '"~'c' ~ '~ Cutbank ~:;:~ ~ '~ Water main/service line Surface water \ ~ \¢¢ Driveway, parking/vehicle storage area Curtain drain ~/,~ bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. /,:? :, , : ~,~. ;iA Signature Engineer's Name Date 5 & 5 ENGINEERING 17034 ~a~i!e River Loop Roar. I No, ~a?le River, Alaska 99577 HAA Fee $ /'~(¢) ¢ ~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICFS 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 ~ICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICE.$ DIVISION L.,cU 30 1991 RECEIVED 1. GENERAL INFORMATION Complete legal description Lot 7; Block 2; Glen Eagle Subdivision Location (site add'ress or directions) Property owner Mailing address Lending agency Mailing address A.H.F.C.~128266 - 520 East $4th Avenue Anchorace, Day phone Alaska 99503 Day phone 561-1900 Agent / n~' f~r~,~H¢~ lACK WHITF Cr}MPANV Day PhOne ~94- ~50 Address 10928 Eagle River Road Ea_ql¢ River, Alaska 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF EIEDROOMS: TYPE OF WA'rER SUPPLY: Individual well Community well Public water NOTE: 2 ~ XX If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATFR DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91} Fronl MOA ~121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my,. investigation of this Health Authority Approval application shows that the on-site water supply and/or 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 s~,stem is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm AddreSs Engineeis signature S & S ENGINEERING 17n~ ~'~l~, ~h, or Loop Ro~_~ No, _2_/~ Eagle River, Alaska ~957Z Phone Date DHHS SIGNATURE ~ Approved for ~- Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ¢Y21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: L--~..~'2-'~ '~,!~ ~)~.l.-~-' ParcelI.D. A. WELL DATA Well type~.d~kV/./~'¢'~- If A, B, or C, attach ADEC letter. ADEC water system number Log present ¢¢~N) "-I Date completed //- /~-'7"~ Driller Total depth '"~'-P? Cased to \~, ~.~ I Casing height Sanitary seal~YTN) ~ Wires properly protected~-YCN) FROM WELL LOG AT INSPECTION Date of test Static water level ~. Well flow g.p.m. ~, '~ Pump level Soptic/holdin~ tank on lot Absorption fiolO on lot ~ubHc sowor ma~n _ Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: 1 '~"-t ~} ~-~! I~ f'~? ~ Other bacteria Collected by: ~ ~' '~ ~7",..~ B. SEPTIC/HOLDING TANK DATA Date installed ~'~-"-/~"-~-'~ I Tank size \ ~:~ Compartments Cleanouts ~) k~ Foundation cleanou~) ~7/~4 Depression (~ High water alarm (Y/N) , ~ A Alarm tested (Y/N) Date of pumping~ ~~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~,C;> ~ On adjacent lots \~l.~ Foundation To propertyline "¢[ E;;:>1 ~ _Absorption field ~,E:>\¢~'' Water main/service line Surface water/drainage ~ ~:~,-'-.~ I~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date~ Manufacturer Size in galfon'~.....~ ,, Manhole/Access (Y/N) ~iegnl water alarm leve(Y/N) i-'"~~n~' level at Cycles te;'t~%mp off" level at Meets MOA electrical codes (Y/N) __~ Well on lot On adjacent lots Surface wate~~ D. ABSORPTION FIELD DATA Date installed ~ '" ~'~'"'"~'2.2 Soil rating /~'~'~(Z~--' System type ! Length Width Gravel thickness Total depth ~'~ Total absorption area "'22~-'~ ~t~ Cleanouts present<~N) Depression over field (V/ot~ ¢ '~- Date ~.~adeq uacy test ResultS/fail) ~"~~.~ for ''''/\ ~'~ ~ bedrooms Peroxide treatment (past 12 months) (Y/_.j]~ ~'~ If yes, give date S. A.A ,ON .STANC ^.SO..T.ON ...'O TO: ¢¢, Well on lot t'~¢¢~ On adjacent lots ( (Q~ l..~b Property line To building foundation On adjacent lots "~c;~ Surface water ~ ,c~-~P Curtain drain .~ l c;~ t ~ To existing or abandoned system on lot Cutbank ~C~[''~ Water main/service Hne Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the, da~e_~f this inspection. $ & S ENGINEERING Eagle River, Alaska 99577 Engineer's Name ...... HAA Fee $ ~Oc~. Waiver Fee: $ Date of Payment (~'}~ % Date of Payment Receipt Number ( ~'~ ) Receipt Number ,r DA'i ~- RE'~0EIVED I_ . INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSP ECTOR /~UINILJI'ALIIY Ok ANCHORA~ MUNICIPALITY OF ANCHORAGE DEPT. OF DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~IRONMENTAL P~:OFEC'flON 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264;4720 I~ E C E ! V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS~ Complete all parts on page 1. Incomplete requests will not be proc~sed. Please allow ten (10) days for processing. PROPERTY RESIDENT (If ~re~t from above) PHONE MAILING ADDRESS ' / ~ '" ~_~ ; ./) 4. REALTOR/AGENT // ~ ~ ' f h J I .PHONE 5. LEGAL D~.~,,~PT{ON .~ g4/,f 6. TYPE OF RESiDeNCE J '/ NUMBER OF~BEDROOMS [] One [] Four ~---SINGLE FAMILY [~. Two [~] Five [] MULTIPLE FAMILY [] Three I~] Six [] Other 7. WATER SUPPLY I~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL I_OG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (a~tach (og if available.) 8. SEWAGE DISPOSAL SYSTEM ~INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MIJST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. "'?'''"X-""- ,' THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS .J [~'"-~SI NG LE FAMILY [] ONE [] THREE [] FIVE [~] OTHER [] MULTIPLE FAMILY i~;].-~Two [] FOUR [] six PERMIT NUMBER 2. WATER SUPPLY IZ~" 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 Tank or [] Holding Tank Size:. /c~ d~3 If Tank is homemade SOILSRATIN~J give dimensions: TYPE OF TANK , MANUFACTURER -~ ..~,' ABSORPTION AREA TOTAL ~-~ ~'~'/ MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line ] Nearest Lot Line I 1 WELL TO: Absorption Area to nearest Lot Uine 5, COMMENTS [~'~PROVED FOR ~ BEDROOMS F-I CONDITIONAL APPROVAL (lette~ must accompany certificate) DATE BY~ · ._ : I DA~'E R~ECEIVED INSPECTION APPOINTMENTS /~4¢ '~ ~.1~t~1~ iTIME TIME TIME INSPECTOR /~ ' DEPARTMENT OF HEALTH & ENVIRONMENTALPROTEE~T~6~ , . , /A~ ;-;,C'i[CiiON ~-- 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R C IVEt) REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIREOTIONS: Complete all parts on page 1, Inoomplete requests will not be prooessed, Please allow ten (10) days for processing, 1' PR~ERTYO~NER ¢0~ ~ PHONE MAILING ADDRESS PROPERT~SIDENT (If dif~rent from above) -- PHONE 2, BUYER ~ PHONE - MAILIN~DDHESS ~ . 3. LEN~NG INSTITUTION ~ PHONE MAILING ADDRESS 4. R EAL~GENT -~ ~ ~ P~ONE' 5. ~Ef~IAL DESCRIPTION [~ - SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY NUMBER OF~BEDROOMS [] One [] Four ~ Two [] Five [] Three [] Six [] Other E~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYS'FEM * ATTACH WELL L. OG. A well log is required for all wells drilled since June 1975, For wells dril)ed prior to that date, give well depth (attach log if available.} I~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY I~ ~'~__YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev, 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 3ERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection V~iified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM )ERMIT NUMBER E] I N DIVI DUAL/ON -SITE DATE INSTALLED [~]PUBUC UTILITY Connection Verified INSTALLER []Septic T_ank or [] Holding Tank Size: /(~ fTank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank IAbsorption Area ISewer Line I Nearest Lot Line WELL TO: I Absorption. Area to nearest Lot Line 5. COMMENTS / PPROVEDFOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY