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HomeMy WebLinkAboutGLEN EAGLE BLK 3 LT 8
Municipality of Anchorage Page · of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Waslewater Disposal System and/or Well Inspection Report
Permit Number: .~lgp.~O/¢&~ PID Number: ¢)~'O (~
~c~ ~y cF ~.U~ Wastewater System: [J New ~ Upgrade
~2z ~. E~ ~w-. ~o~ ~ q~/~ ABSORPTION FIELD__
~ Deer) ] rench~%hailow Trench i I Bed [ ] Mound I Other
LEGAL DESCRIPTION Soil qRt,qg lotal Depth f .... odginM grade
/
WELL:ri New [] Upgrade a ...... Iw,dth Numb ..... li .... Dis~ance~tweenl .....
SEPARATION DISTANCES ~s,,ph,: , 14Dialing II STEP
Well /[~ ~ [~ * __ -- ~IG Material ~ ~PP& Numhur°fC°mpartmenls
Surface ~ e
w~, /oo9 /0o'¢ ~ ~ ~ IFT STATION
Lot S,z } in Ft~dl )ns M~
Remarks: BENCH ~ARK
EN61NEER'S SEAL
Inspections performed by: ~leRi~r. Al',k'~5~ Dates: 1st //-/o-99
2nd// -// - ~
Department of Heal~ Huma~icos appr I
Reviewed and approved by~~~~- ~te:
Permit No. SW930468
Page 2 of 2
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: GLEN EAGLE, BLOCK 3, LOT 8 PIDNo.: 05060127
CO1
CO~
102.7
IO0.2L
" [] iNSU~L~,~'iON _~-~
NEW ~
1000 GAL ~-~
SEPTIC 98.9'
_TANI~ .
MT1 COd
97.2'
· 85.1' NO WATER FOUND
N.T.S.
CO1 113 I 34
C02 t19 I 37
C03 ]92 195
_~T~ f~.~j
FENCE
/
NEW TRENCH / - '-'- :o2 col /~
NEW ~ooo ~~ / ~
GAL SEPTIC TANK~ / "~ ~/ff
~_ 100'.WELL RADIUS
GRAVEL ~
DRIVE
l" = 4o'
ENGINEER'S SEAL
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930468
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:SECRETARY OF HUD
OWNER ADDRESS:222 W. 8TH AVE
ANCHORAGE, AK 99513-5737
DATE ISSUED:ill04/93
EXPIRATION DATE:il/04/94
PARCEL ID:05060127
LEGAL DESCRIPTION: GLEN EAGLE BLK 3 LT 8
LOT SIZE: 47410 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
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 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: DATE:
ISSUED BY: ~ J" DATE:
ROBERT SHAFER, P.E
ROGER SHAFER, P.E.
October 27, 1993
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL 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 OF HEAL TH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99519-6650
REFERENCE: Glen Eagle Subdivision, Block 3, Lot 8
We request you issue a permit to upgrade the septic system serving the
three bedroom house on the referenced property.
An adequacy test performed on the existing system for Health Authority Approval
purposes found the absorption capacity of the existing system to be inadequate.
A test hole was excavated and a percolation test performed in the area of the
proposed upgrade, The approximate location of the test hole is located on the
attached site plan. At the time of excavation water was seeping at 12 feet and
after seven day ground water monitoring water was found at 10,5 feet, Attached
it the proposed upgrade design,
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,
RAS/LSU/Isu
17034 NORTH EAGLE RIVER LOOt' ° SUITE 204 · EAGLE RIVER, ALASKA 99577
1" =40'
SCALE
I __
UPGRADE
Z
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Z
°~
z~
-<.~
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0
0~0 Z~
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o~q z~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
2
3
4
7
8
9-
10-
13
Township, Range, Section:
SLOPE
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water Aller/^ E_ ~
Monitoring? tv ~-' Date:
SITE PLAN
Gross Net Depth to Net
Reading Date
Time Time Water Drop
r /o//des! ,.,.. -
14--
15
16
17
18
19
2O
PERCOLATION RATE //.__.~___~ (mmu,es/,nch, PERC HOLE DIAMETER ~?
~~-- - CERTIFY THAT THiS TEST WAS PERFORMED
PERFORMED
BY:
ACCORDANCE W~~NiCIPAL GUIDE~FFECT ON THIS DATE DATE:
72-~8 (Rev 4/85) 17034 Eagle El~ L~p Read No. 2~ /
E~le River/Alaska 99S77
ON-SITE WASTEWA TER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MA TERIAL SPECIFICATIONS
REFERENCE: Glen Eagle Subdivision, Block 3, Lot 8
GENERAL:
1.
The scope of this project includes the installation of two five foot wide
drainfields to serve the existing three bedroom residence on the referenced
property. The existing septic tank is to be excavated to verify integrity. If
of poor integrity, the tank is to be abandoned and a new 1000 gallon septic
tank installed. The existing leachfield is to be abandoned in place.
Construction shall be in accordance with the approved site plan and design
dra wings; Municipal permit with any special provisions or conditions; and all
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary
underground utility locates.
Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soft
settling. On all leachfield mound systems, the property owner shall be
responsible for ensuring a satisfactory vegetation growth over the mounded
area.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing
their own systems must also receive prior approval from the Municipal
Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
Page Two
Glen Eagle Subdivision, Block 3, Lot 8
October 27, 1993
All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building
foundation. In the line between the tank and the leachfield there shall be
two adjacent cleanouts (unless an effluent pumping system exists within the
septic tank). These cleanouts shall be located on undisturbed soft not more
than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward
the leachfield. The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a positive slope exists
away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the sidewalls
of the excavation become smeared, they must be raked or scratched
(ruffed-up) before gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to be installed level with
the perforations faced downward. Gravel is then to be placed over the
distribution pipe to provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel layer and the native
soft backfill. Ensure the silt barrier covers the entire gravel surface before
placing backfill.
Monitor tubes shall be of four (4) inch diameter and installed approximately
in the locations shown on the design. The portion of the monitoring tube
extending through the gravel shall be perforated from the bottom of the
trench to the invert of the distribution pipe. This is equivalent to the
effective depth of the gravel as noted on the design.
Page Three
Glen Eagle Subdivision, Block 3, Lot 8
October 27, 1993
Backfill over the final gravel layer must not be less than twenty-four (24)
inches. Insulation must be installed when the backfill depth is less than
thirty-six (36) inches. The finish grade over the trench must be mounded
to prevent the formation of a depression after settling.
MINIMUM MA TERIAL SPEClFICATIONS:
Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the
inspecting engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must
be installed between the final leachfield gravel layer and the native soil
backfill.
Page Four
Glen Eagle Subdivision, Block 3, Lot 8
October 27, 1993
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with
less than 3% passing the #200 sieve.
When sand is being used as a filter material, it's gradation specifications
must conform to current M.O.A. or D.E.C. requirements.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the
installation of the wastewater disposal system. These inspections will occur as
follows:
The first inspection must be conducted after the excavation of
ditches, pits, trenches, or beds and before the installation of any
gravel. A septic tank may be set in place, but may not be backfilled
before this inspection.
The second inspection must be conducted after the placement of the
silt barrier, gravel, distribution lines, standpipes, cleanouts, and
insulation, but before the placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the
installation of multiple trenches, sand filters, pressurized distribution systems, etc.
Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start
of construction. If necessary, a pre-construction meeting will take place on-site.
GREA ER ANCHORAGE AREA BORL.,,?H
Q Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
/__ /iL ( , ,4; ,.,'..'
, PHONE
LOC ATi ON"7~ ~
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER _'/~'
INSIDE WIDTH
,~. :~r' 7' MATER~AL ~'- /"- :~- COMPARTMENTS '
LIQUID DEPTH _ _LIQUID CAPACITY /~' ~ ~' GALLONS.
SEEPAGE PIT: .~
NUMBER OF PITS / DIAMETER __ OR WIDTH -.~
LINING MATERIAL~'/~'/'/~''T~ CRIB SIZE: DIAMETER
BUILDING FOUNDATION NEAREST LOT LINE ¢
LENGTH ~' ?,' "'~D E PT H I~
DEPTH___ DISTANCE FROM: WELL
TOTAL EFFECTIVE .,,~"' ,'~--&
ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPIION
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
__ DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH _
SEPTIC
TANK
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
~2F:EFI'T [ 'v'E HCII.J:ii:; I N6i I I',ICi:
I.~E!: B:ii: GI_E:I'.4 EFI(~I E;
li!,lli:ll::)["ll:::i '!:Hid kl:::ft:;:'liii !:::iii'i' !
I'lFl::'::lf"lt..lt'l F41.1hlE::E1.41 Cfi: E:EI:)F:CIEd"I:E; =: :ii:
IF-lEi i~:EC!LI I F:E[::, :!!; I Z.E: OF 'THE ':::;CI I I.. FIF:'9;rgI-:~:F'"I" Z CIN ?¢:~;'I"EI,I 1 9;
'THE I..EHG-fFI E:' I HEN:!i; ]: ON I:E; 'FHIE LIEiqGTH
IHE I)E:F'"['H CIF FI TI~:ENE:H O~: F'I [ IhT, THE E:,I':~;T'Fgi"4C:E E',[-: I I.4EECf.,I IHE ;:;!;Ill;:1.::F:II'Ei ~d !t-il::
~:~ifE:OLINI) FIND THE E:EFFI'Oh'I OF 'THIE E;:-:;C:R'v'FIT];E~N
I HERE I:ii; NO :SE'T HIE:,'T'H F'OI~:
I'HE C~F~:FI',,,'EiL E:,EF'TH I :ii; THE f'l I i'-,I
~ql"41;:., 1.' HIE E:CFI"I'Cd'"I OF '7 HE; E::'::E:FI',,,'F~T I Ed"4 ':: I N FEEi:T ':,.
I"1] 1'-4.[1"tl..tM [)I'E-i;T'FtI"4C:E E:E:'.TF.IEE:N Ft HELL FINE:' FIN't' CIN-:i~;I1.-E ::~;EI.,IRI]~iFi: [)I:!i;F'l:]l:::i;l::41 '::','::i;'! i:!'l !'.:;
:LOE~ F:EE I' F'Ot;~: FI F'IE:I'v'FITE: [,.IE!;[...[... OF;: 200 FEEl FOF?. FI F:'I.JE:I, I[:. MEI...I..
i.,~EI_I. I...C.]i?:; FIR:E [g: [E C! IJ ]: F~: E I:) FIN[)I"II.I~E;'T E;Ei: ~:E'T'UI~tNE;E:, '1'O THE!: [::,[iF:'F:ff;;:I'I'IFi:M'1. t.,1[
OF I'HE I.,.IEL. I. E:Cd"IF'LE: T Z Ed"'4
E,F'EC ]: F ]: E:FFT' ]: ONE; f~t"4E:' C:Oi'-4:5]'F:.'I IC:'T' Z Of'4 [:, I Ft6i!~:FIh'lg; F~I~tE I:I',,,'FI J' L FIE:[ E I
1.' :[ F "," T' H Pt'1.'
FIt'I F:F~i'"I I I.... :[ FIR !-,.I
B'¥' THE: hlI. li'.~ICtF'FII., t'1"¢ C)F:' F:INCHCd;:FIC:iEi.
!-4 1 L.L..
I...II'.4[)FC~::E;']f::I~'.4E:, -1.'HFt-[ THE:~ ()l".F~:i~;1. 1.[~: :i~;[::I.,.IEF; ?'r':!~:'l't-~f't I'IFI'T' F;:E]E~Lt[FE:E!. Ei]l"41 F:ff;:C!iF:r'tF::?,i! ii::. if-it::
[)EI'.JC:E
Performed For
Leoal qescription:
This Form Renorts Soils Loq
2204 Cleveland Anchorage, Ala.~ka 99503
L'), ~- ~.~ Oat~ Performed
Lot ,f' Bl'ockc~'77; Subdivisinn___(]~,/~'~PercolationZ~-~,~,,~;~est
6
10
14
16--
18--
20
Was ~round Water Encountered?;~-~ ~m
I¢ Yes, At what Denth? /~'
I Readinq Date Gross Time Net Time Denth to H2C
Percolation Rate ~linute
Prnpcsed Installation: Seeoaee Pit Drain Field
Deoth of Inlet Deoth To Bottom Of Pit Or lrench
Tes~ Performed By
Net Dron
Date:
M-W DRILLING, INC.
DRILLING LOG
Well Owner
Use of Well
Location (address of: Township, Range, Section, if known; or distance main road__
Size of casing
Static water level
Screen ( );
Describe screen or perforation
Well pumping test at__gallons per (hoar)
of drawdown from static level.
Date of completion
.Depth of Hole__ feet Cased to feet
ft. (above) (below) land surface. Finish of well (check one) open end
Perforated ( ).
(minute) for hours with
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
);
ft.
TO
TO
TO_
TO_
TO
TO
TO_
TO
TO_
TO
TO
TO_
TO
TO
TO
2 -- STATE
I GENERAL INFORMATION
NIIMBER OF BEDROOMS:
1YPE OIF WATER SUPPLY:
I!uhv!dtt;d
4 TYPE OF WASTEWATER DISPOSAL:
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 system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm s & s ENGINEERING
17034 Eagle River Loop Road No. 204
Address ~%-,~A ~lwr, At.~.~ ~ ~q~.77 .~
Engineer's signature ~'-~/~/~/~ ~/ ~
Phone
Date ?o/~.~./q~
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 MOAft21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division ~vv//~o~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-_4~,~
Health Authori~ Approval Checklist
Legal Description:
A. WELL DATA
Well type ¢1~ ~J ~'¢~--~ If A, B, or C, attach ADEC letter. ADEC water system number
Log presenl~q) %{/'
Total depth ~) '
Sanitary seal(~4)
Date completed
Cased to ~,~, ;/
FROM WELL LOG
Date of test
Static water level
Casing height (above ground)
Wires properly protected~N)
AT INSPECTION
Well production /~5'- g.p.m. .~, O ~-
g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample: !
B. ~HOLDING TANK DATA
Date installed //-//~-~ Tank size
Foundation cleanout (~N)
Date of Pumping
Nitrate
Collected by:
Other bacteria ~
ENGINEERING
,~,¢4 ~-9;e ~iver Loop Road No. 204
:*~r, A~aska 99577
/~z:~o Number of Compartments ~L- Cleanouts ~,J)
Depression (Y<~ ~ High water alarm (Y/N)
Pumper .,.7'-.~, f~
C. ABSORPTION FIELD DATA
Date installed //- l/--'~
Length J~ G ! Width
Effective absorption area ~'-~ ~7 ~
Monitoring Tube presentc~J)__~_~ Depression over field (Y~) .
Date of adequacy test /o ~ / ~.- ~ ~- Results~ail) /~,4-~'~ For
Fluid depth in absorption field before test (in.); ?*' Immediately after ~/?~ gal. water added (in.):
Fluid depth ~" (ins) Minutes later: 7 Absorption rate
= g.p.d.
/
Peroxide treatment (past 12 months) (Y~). /J~)/J ~ /~)* -~ If yes, give date
Soil rating (g.p.d./fF or ft~/bdrm) ~, ~' System type J~,~/~f,,cd ~ ,--~_~J~ ~-
~' Gravel thickness below pipe _7 ! Total depth ~ /
bedrooms
/2..
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
_..------------~-- *Datum
~" level at*
F,
SEPARATION DISTANCES FROM WELL ON LOT TO:
~holding tank on lot //Z-
Absorption field on lot l::z-7 /
Public sewer main /5/4-
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM~"~-~C~HOLDING TANK ON LOT TO:
i-/
Foundation ! c3 J Property line /z~ Absorption field
Water main/service line [~ /..c Surface water/drainage /'~)a /~
/oo
/O/
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line !
Surface water / o o
Curtain drain
Building foundation -~ ~ ) Water main/service line
4..- Driveway, parking/vehicle storage area
/~,/'J ~--g "') Wells on adjacent lots / ~)o
ENGINEER'S CERTIFICATION
I certify that lhave determined thru field inspections and review of Municipal recor~~~s are
inconformancewithM~/~AtA~delin~jneffectonthisdate.
Signature
Engineer's Name
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
CT&E Environmental Services Inc.
Laboratory D~vlsion ..............
Laboratory Analysis Report
CT&E Ref.#
Client Name
Project Name///
Client Sample 1D
Matri~
Ordered By
PWSID
,~ample ReanarkS:
965282002
S & S Engil~em~
Eagle River Hgt./Glen Eagle SD
L8 B3 Gtcn Eagle S/D
Dmfldt~ Water
0
Cll~na 1'O//
Printed Date/Time 10/04/96 16:29
Collected Date/Time !0/03/96 11:15
Received Date/Time 10/03/96 15:55
Technical Director: Stephen C. Ede
Released By ..~r,~,~ ~'
Parameter Results P0L Units
Allowable Prep Anatyzi$
gethod Limits Date Date Init
Nitrote-N 0.332 0.100 m~j/L $M18 45D0'NOM 10104/96 [MS
Coliform 0 0 cot/lOOmL 5~18 9222B 10/03/96 TAV
200 W. Poller Drive, Anchorage, AK 99~18-1605 -- Tel (907} 562-2543 Fax: (907) 561-5301
3180 Peger Eoad, Fairbanks, AK 997OIL§471 -- To[: (907) 474.8656 Fax: (907) 474-9685
ENVIRONMENTAL FACILITIES iN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURi, NEW JERSEY. OHI0. W~SI VIRGINIA
zTL
il:l? CT&E ES[ ANCHORAGE ~ 90?6941211
N0.611 ~06
CT&E Environmental Services Inc.
I~ b o r a t o P/ D ivi S id n ~.`~'~..~'`.`~.`~.~~`~`~.`~'~`~-`~`~'~`'~`..~r`~`~'~`'`~``~`~r``~''~.`~.`~r.``~.~~
Drinking Water Analysis Report for Total Coliform Bacteria 200 w. ~o.er Oriv,
Anchorage. AK 95518-1605
READ I.N.,CTRUCTZONS ON ~VE~E $1DE BEFO~ COLLECTING SAMPLE Tek (907) 552.Z3~3
Fax: {907) 561-5301
MUST BE COMPLETED BY WATER Sb?PLI'ER
[] PUBLIC WATERSYSTEMLD.# l JJ'J j [ j
I~ PRIVAT£ WATER SYSTEH:
Sen d lnvoice
SAMPLE DATE:
SAgMPLE TYPE:
Routine ~ ..T~eated_Water
Repeal Sample (for routine sample [] UntreoTed Water
with lab re£ no. )
Special Purpose
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY L~J3OR,ATORY
Analysis shows this Water SAMPLI-~ to be:
.~ Satisfactory
0 U,'~satisfactory
0 Sample over 30 hou~ old, resuJ~ may
be unreliable
O S~mple too IonB in transit; s~mpl¢ should
nm b~ over 48 hours old a; examination
to jndici~e relimble result. Please send
new s~mple vi~ special dclive~ mail.
.... ~ ~b-~-'
Date Received
Time Received
Analysis ~Jega rs
Analytical Method: .~"'"Membr~ne Filter
g MMO-M'UG
* Number of ¢olonles/100 mi.
Lab Ref. No. Result* Analyst
0~ ~'~
Sen[ tO A.D.F-.C. Aneh Fbk..s Jun
F~xed
Client notified of unsatisfactory results:
Phon~.d Spok~ wtth Fnxed
Date: . Tim~,
BACTERIOLOGICAL WATER .M~/d,~YSIS RECORD
MMO.MUC Result: Totai Coliform
Membrane Filter: Direct Count
VeeJfielti0n: LTB
Fecal Coliform Confirmation
£. Coti
0 Coloniesl100 mi
COLIFIRM
Final ~embrane Filter Result~ Coliforml]00 mi
Co~,~: ':' AP':-'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ~)¢L,~ _ (~,\_ .~.'-~
1, GENERAL INFORMATION
Complete legal description
Lot 8; Block 3; Glen Eagle Subdivision
Location (site address or directions) NHN The Clearing Drive
Property owner H.U.D. C/0 ASSOCIATED BROKERS Day phone 563-333
Mailing address 640 W. 36th Avenue Anchorage, AK 99503
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 2 ~
TYPE OF WATER SUPPLY:
Individual well XX×
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#23
sluowwoo leUO[~!pp¥
:suo!lelnd[ls [~U[MOIIOJ aql ql!M 'suJooJpeq
JoJ leAoJdde leUO!l!pu'oc)'
'poAoJddes!a
'SbUOOJpoq ~ JOJ po^oJdd¥ -~
=II:In/VNIDIS SHHO
'9
t:i=I=INION=I Afl NOI.LO=IdSNI :10 .I.N=IIN=I.LVJ. S 'S
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~(~/~-A E~Z~L~ ~(~'/~). Parcel I.D. ~/~')~::~--~/~-'~-
A. Well D.t.
Well type ~l ¢~ ~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present, N) ~/ Date completed /~/Z~/~ ~ Driller
Total depth ~ ~ / Cased to ~q. ~ ' Casing height
Sanitaw se~) ~ Wires properly protected)
FROM WELL LOG AT INSPECTION
'
Date of test
Static water level
Well flow
. .
Pump levell
SEPARATION DISTANCES FROM WELL TO:
Septic/h~ tank on lot
,
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform
Date of sample: /D/~/~
Nitrate
A./T~ Other bacteria
Collected by: .~ ~ .~ ~Od~
B. SEPTIC/HOEBI~G TANK DATA
Date installed ///- ///-~ Tank size ,/~ ~/z3/-~Compartments
Cleanout~N) ~/ Fou n dation clean ou[/~/N)
High water alarm (Y~ /',--// Alarm~ tested (Y~
Date of pumping /,._l./'/¢~t, Pumper ~ ~-/~l -/'-,~/,..J ]~-
SEPARATION DISTANCES FROM SEPTIC/~TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots
Absorption field
Foundation //"~
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N) ~
DISTANC..~M LIFT STATION TO:
SEPARATION
Well on lot _~ On adjacent lots
D. ABSO~RPTION FIELD DATA
Manufacturer ~
Manhole~)
"Pump on" level at ~ "Pump off" Level at
~ Cycles tested
Sur[ace water
Date installed
Length ~'~-~ / Width
Total absorption area
Date of adequacy test
Water level in absorption field before test /--~/'~
Peroxide treatment (past 12 months) (Y/~? ~-~/
Soil rating (GPD/FF)
/ Gravel thickness
Cleanout presen~iN)
Results (pass/fail)
System type~'/'/'/~z-z- ~
.~ / Total depth
Depression over field (Y/~) /'--//
~ ~:5-'77h--~,/¢ r ~--~ Bedrooms
After test /,-J//~
If yes, give date )'-~//'~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
/
Well on lot /'~- ~
To building foundation ~.~ ~
On adjacent lots ~/~/
On adjacent lots ? ~ ~ Property line
To existing or abandoned system on lot
Cutbank /~ / ~ ~ ~ Water main/service line
Surface water
Curtain drain
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
SignatureEngineer's
Date
HAA Fee $ ~ L~c") , ~FZ'?
Date of Payment //~ - d')/~ ~-~
Rece,ptNumber
Waiver Fee $
Date of Payment
Receipt Number
Chemlab Ref.#
Client Sample ID :LB B3
Mat r ix : WA'i~I{
COMMERCIAI..TESTING & ENGINEERING CO.
ENVIRONMENTAL LABORATORY SERVICES
REPORT of ANALYSIS
: 93.5722-7 5633 8 STREET
ANCHORAGE, AK 99518
GI'~N EAGLE S/D TEL: (907) 562-2343
FAX: (907) 561 5301
Client Name :S & S ENGIN~ING WORK Order :72570
Ordered By :R. SHPe'~R Report Completed :10/29/93
Project Name : Collected :10/25/93 @ 14:50 hrs.
Project# : Received :10/25/93 @ 17:20 hrs.
PWSID :UA Technical Director:S'r~'HEN, C. EDE _
Released By : ~./~
Sample Remarks: ROUTINE SAMPLE COr~C'r~u BY: S.S.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 10/28 LLH
* See Special Instructions Above UA = Unavailable
** See Sample Remarks Above NA = Not Analyzed
U = Undetected, Reported value is the practical quantification limit. LT = Less Than
D = Secondary dilution. GT = Greater Than
~~-~ Member o' the SGS Group (SociCtb GbnCrale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS. OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY. SOUTH CAROLINA
COMMERCIAL TESTING & ENGINEERING CO. AK DIV
CHEMICAL & GEOLOGICAL LABORATORY
TELEPHONE (907) 562-2343
5633 B Street
Anchorage. Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
E~ PUBUC WATER SYSTEM I.D. # F I I I I I I
't~I!VATE WATER SYSTEM
Mailing Address
Mo. Day
SAMPLE TYPE:
Check Sample (for routine sample
with lab ref. no.
~ Special Purpose
Slate Zip Code
Yea r
[] Treated Water
[] Untreated Water
SAMPLE
No. LOCATION
Time
Collected
Collected
By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
'[Z~ Satisfact cry
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received J O/Z~'
/
Time Received / '*720
Analytical Method: Membrane Filter
* No. of colonies/100 mi,
Lab Ref. No.
1~. ~7zz
Result*
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS
Membrane Filter: Direct Count
Verification: LSB BGB
Fecal Coliform Confirmation
Final Membrane Filter Results,~
...o,,ed By. /.' A. ~.,/
TNTC = Too Numerous To Count
OB = Other Bacteria
~SSS Memberof,
Date
Time:
RECORD
Coliform/100 mi
Coliform/lO0 mi
PART ONE OF TWO:
REMAINDER TO FOLLOW
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
";.-~ OF ON-SITE SEWER AND WATER FACILITY
* ~ :'~ ~ '," '.L':' ' 264-4720
, . r. ' ' Application Date [ -
1. GENERAL INFORMATION
~ ': ~' ', ; ' Location (address or directions)
· ' ,-
r:, ,".~¢',ff',' (b) :,Applicant Name ~ ~~ Telephone: Home
(a) Legal Description (include lot. block, subdivision, section, township, range)
"";'A~pl,cant Address
(c)
Business Lo~ ~L . ~5~,~
Applicant is (check one) Lending Institution []; Owner/builder []; Buyer []; Other J~ (explain);
(d) Lending Institution~-.,r'~.r"~~"'~ ~,,~-~-~1~ Telephone ~--'~'L.
Address /~, ~\ c.~l.~'~'~--/>-~.~ ~ ,
(e) Real Estate Company and Agent
Address ~ ~
Telephone ~
(f) ~the HAA to the following address:
SRB 196x
TYPE OF RESIDENCE
Single-Family/~-- Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Welll~- Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite~'- Public [] Community [] . Holding Tank []
~,i; Note: If corn munity well system, must have written confirmation from the State Department of Environ mental Conservation
i"~. attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
SPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATU
eto and as of the validation date shown below, I verify that my investigation of t~
Jpply and/or wastewater disposal system is safe, functional and ade
bedrooms and type of structure indicated herein. I further verify that based on the information obtainec
the' Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
posal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
il Address __
'Date
this inspection.
of Firm
S & S Eng|neer|ng
Ea~le ~lver, Alasl~a
Telephone
,/
D HEP APPROVA~L ~/~'')-~'~'~ (~,
Approved for / CJ._~C') bedrooms by,/,~y"~./_.y' ~/~)~d ~, ,~c'~_,~,~Da,e
Approved __ Disapprovdd ConditionaLs/
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
72-025 (11/84) ~,
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO.~l
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST o FEBRUARY 1984
264-4720
Legal Description:
MUNICIPALITY OF ANCHoRAGF.
DEPT. OF HEALTH &
Well Classification --,'/'~.t ~/,.r4.~- ~..
Well Log Present
Total Depth ~¢~ ' Cased to ~.
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
If A, B, C, D.E.C. Approved (Y/N)
Date Completed /'o ~ -".-~-'- ~7/.. Yield
Depth of Grouting ~-~/~'
Pump Set At ~
Sanitary Seal on Casing (~N)
Depression Around Wellhead ~
To Septic/Holding Tank on Lot I o ~ ~ ~'' ; On Adjoining Lots
To Nearest Edge of Absorption Field on L~)t /~oJ'¢- On Adjoining Lots
To Nearest Public Sewer Line A/~._ To Nearest Public Sewer
Cleanout/Manhole ~ To Nearest Sewer Service Line on Lot
Water Sample Collected by -~ { ~ ~-.t4 e. ~¢_.¢~.~.~r~c. ; Date ~- i/"] --~;~ Lc
Water Sample Test Results _c.~?,....~_,,.~ ~,k-¢~
Comments ~:~.'t ,Z ." -r~ b, 'l~, -~P,~,~. ~E_ ~[ "'~-~P ~.~,~',,~-~-~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Stand pi pes ~/.h~
Depression over Tank ,{~)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water M&:,F,/Service Line
Course
Size /~; o ~ No. of Compartments 7_.
Air-tight Caps ~',N')' Foundation Cleanout ~
Date Last Pumped /~- ~'¢~'~ ~.q
A/~.~'- ; for --
Temporary Holding Tank Permit (Y/N)
To Building Foundation /~ ~ *'
To Disposal Field ~-'~' ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72~026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /0 -/~- "7C
Width of Field ~C~ ~
Square Feet of Absorption Area
Depression over Field
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Pr ese nt~T/.N"/
Date of Last Adequacy Test
To Water McJn/Service Line ~-O ~'~'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
To Property Line /@ / ~
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank {if present.)
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all lylOA and HAA guidelines in effect on the date of this inspection.
Signec~ & S Engineering Date /
SP~B 196x
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
MOA N°~- OO _~
( III"~II('..tL & GEOLOGI('.41. I.-IBOR.,ITORIIL~'
TELEPHONE (9071 562 2343 5~3:~ B Streel
Anchorat- A!aska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
P u,,,o WATER S YSTE, ,.O.,
PRIVATE WATER SYSTEM
Name
Phone No
Mailing Address
City State Z,p C,~de
Mo. [3ay Year
SAMPLE DATE:
SAMPLE TYPE:
,/~/~ Routine
Check Sample (for routine sample
with lab ret. no.
ii Special Purpose
Treated Water
Untrealed Water
SAMPLE
NO. LOCATION
I
I
I
Time Collected
Collected ~_
J .
J
J
J
TO BE COMPLETED BY LABORATORY
?alysis shows this Water SAMPLE to be:
~ Satisfactory
I~ Unsatisfactory
i } Sample too long in transit: sample should
not be over 30 hours old at examination
to indisalereliable results Please send
new sample via special delivery mail.
.ate . ceived /-/?- 26 _
Time Received /~_(7//i9 __
Analytical Method: Membrane Filter
' No. of colonies/100 mi.
Lab Ret. No.Rnsult*Analyst
I/.'3~""~ I 1~ ~,q._
J I1] _
J II] _
I II]
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLI..ECTING SAMPLE
Membrane Filter: Direct Count
Verification: LTB BGB
Final t,% mbrane Filler Results O
R~.porti'd By "~ ~ {~ "'~'~- Date
Time:
TNTC = Too Numberous To Count
OB : Other Bacteria
C oilfo~ m/100ml
Coiitomdl00ml
1--/¢'- 2' 6
APPLIC
Property Owner
Hr. & Mrs. Ken Boyd
Mailing Address P.O. BOZ 2380. Anch.. Ak.; 99510
Buyer Mr. & Mrs. Lar[y Vend1
Address 317 Pri~tlof Loop
Lending InstituHon
Ak. Pacific Mortgage Co. ,, Attn. Terri Dubell
Address P.~t. Box 420 (101 West Benson Blvd_); aneh
Realty Co. & Agent Coldwell Banker Jack White Co.
Address 3201 C St., Anch.. Ak.,, 99503
Legal DescriptionLt 8, Blk 3, (~l~trl F..agle Sub
street Location rb.~ Cl~l'l[ll~ ])~'~[V~
Type of Residence
~ Single Family
~ Multiple Family No. of Bedrooms 2
[i Other
NT FILLS OUT UPPER HAl ONLY
Zip Code
Zip Code
zip Code 99510
Frank Willis/ k C.Dale Murphy
Zip Code
Phone
Phone
276-3110
Phone
277-1553
Water Supply
1~ Individual ATTACH WELL LOG. A we~l Icg is required for all wells drilled since June 1975.
Community For wells drilled prior to that date, give well depth (attach Icg if available).
! } Public Utility
Sewer Disposal
I
ndividual
Public Utility
[7 Holding Tank
Year IndivkJual Installed: _
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN RE INITIATED
Time Time Time Time
Date Date Date Date
- !
Inspector Inspector Inspector Inspector
Field N°tes: ,~r '0' ~"
MAY 0 9 1983
(
( ) DISAP~OVED
( ) CONDITIONAL APPROVAL'
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tank Septic T~k Size
EXCAVATION
ROBERT A. SHAFER
WORK
May 15, 1983
CIVIL ENGINEER
694.2979
Coldwell Bankers
Jack White Realty
3201C Street
Anchorage, Alaska
99503
Reference: Lot 8: Block 3: Glen Eagle Subdivision
A sewer system adequacy test was performed on the system located
on the referenced property, as you requested. The septic tank was
pumped and verified to have a c~4~ity of~0 gallons. The
absorption trench was tested by a continuous flow of water over a
period of 48 hours without any adverse effect on the system.
It can be concluded from this test that the waste water disposal
system serving the ~wo bedroom residence located on this property
is c~nlu~9_~nG%i~nin~ adequately. However, the system cannot
be guaranteed against subsequent failures.
If we may be of fur~,,~er service, please do not hesitate to contact us.
cc: Hunicipality of Anchorage
Department of Health and Environmental Protection
¢,RR lqr~Y F^61F FIIVFR, Al ASKA
MU.lC,P^L,TY OF ANC.OR^G~... D?'._?S
826 L ~t~ - Anehera~, Alaka
MAR 2 8 't979
ENVIRON~NTAL ENGINEERING DIVISION
· R E C E i V E D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTION~: Complete ~11 pa~l on p~e 1. Ingo~la r~a will n~ a prE. Please allow ten (10) days for pr~essing.
1. PROPERTY OWNER PHONE
MAILING ADDRESS ~
PROPERTY RESIDENT (If different'from Ebon) ~ PHONE
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION ~ i I I PHONE
MAILING ADDRESS
4. REALTOR/AGENT ' I PHONE
MAILING
B. LEGAL DESCRIPTION
LoT 8. B~.o~- ~
STREET LOCATION
S. TYPE OF RESIDENCE
~" SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
~ Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
a. SEWAGE DISPOSAL S¥~¥~.M
INDIVIDUAL/ON-SITE**
[] 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.) 'q/'~ ~ _../~
If individual/on-site, give installation date '/! .
......... .-- I[L
· ~m-- ....... : ~ · . "7 I
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
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 UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
r--]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tan~or [] Holding Tank
Size: 7~:~) ~¢~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding Tank ]Absorption Area ISewer Line I Nearest Lot Line
Absorption Area to nearest Lot Line
5.
COMMENTS
{~"~ APPROV ED FOR '"-~ BEDROOMS
[~--"~CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
Hay 15, 1979
Gregory P. Bogus
1591 Eagle River Road
Eagle River, Alaska 99577
Subject: Lot 8 Block 3 Glen Eagle Subdivision
Approval for your individual sewer and water facilities
will not be greanted until the following items have been
completed:
(1) The top of the well casing is sea]ed with a sanitary
seal so that it is water tight.
(2) Expose the standpipe to the leaching area for our
inspection.
Notify this department for a re-insp~ction when descrepancies
have been corrected. If ther~ are any further questions,
please contact this office at 204-4720.
Sincerely,
Robert C. Pratt, N.S.
Associate Specialist
RCP/ljw
cc: First Federal Savings and bean
305 West 5th Avenue 99501.
AF,;(:!~( ,l~/',(;F, Al ASKA 99502
(!!,1i~ ' '
.~,. ,Illl
March 30, 1979
Gregory P. Bogus
159] Eagle River Road
Eagle River, Alaska
99577
Subject: Lot 8 Block S Glen Eagle Subdivision
Approval for your indivJdual sewer and water facilities
will not be granted until the folloiwng items have been
completed:
(1) The top of the well casing is sealed with a sanitary
seal so that it is water tight.
(2) A four(4) inch cast iron cleanout be installed to the
septic tank or leaching area.
Notify this department for a re-inspection when descrepancies
have been corrected. If there are any further questions,
please contact this office at 264-4720.
Sincc ~ly,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: First Federal Savings and Loan
305 West 5th Avenue 99501
Bryan Elsner
207 East Northern Lights Boulevard
99503
~,~X MUNICIPALITY OF ANCHORAGr
: \.' D~iARLI'MENT ~. HEALTH AND ENVIRONMENTAL . AOTE£T'ION ~,
~l_~J.~ / x Date Received: March 30, 1977
2nd Inspection: Time
Date
Inspector
].st Inspection: Time ~'~,'~ P;7~
Date ~ -~-77 ~
Inspector ~, ~f ~/~ ~
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska National Bank of the North
Mailing Address: Pouch 7-010 99510 Phone: 278-4581/273
2. Property Owner: Brad Dickey Phone: 694-9239
Mailing Address; Star Route A Box 1613 99577
3. Legal Description: Lot 8 Block 3 Glen Eagle Subdivision
4. Single Family Residence: (x) Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
J
Well Data: Type Individual
Con s truct ion
Depth Well Log Filed ( )
Bacterial Analysis
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site system (x) Public Utility
Installed /~ ~/~ ~'~ ~nstaller
~ ~ ~ Manufacturer
Soils Rate Material
( )
Distances: Well to Septic Tank
~o Sewer Lines Nearest Lot Line
Absorption Area to Nearest Lot Line
to Absorption Area
Contact
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Stre~t, Anchoraqc, Alaska 99501
279-2511, exh. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
II ~ /0~
Type of nSl')ection:
VA FHA _CONV XX
Property Ownel:. BRAD DiCKEY/builder
Mailing Address: SRA Box 161.3, Eagle River, Ak. Day Phone: 694-9239
Name of Buyer: GREGORY P. & CHRISTINE G. BOGUS
Mailing Addless: E. Lakeridge Dr. Box 66, Eagle
River, Ak.
Name of Lending Institution: Alaska National Bank
Day Phone: 272-8411
Mailing Address:_P°uch 7-010, Anch- Ak. 99510 Phone: 278-4581 ext273
5. Name of Realtor or Agent: N/A
Mailing Address: Phone:
Legal Description: Lot 8, Blk 3, Glen Eagle Subdivisimn
Location: NHN Sunny Glen, Eagle River, Alaska 99577
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility
i~onlf tndividu~al, date, of i.~llation hie Oldwyn
Alaska National Bank
No. Bdrms.
Individual
Individual (on-site)
003(3/7G)
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 8 Block 3 Glen Eagle Subdivision
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
Approved , Date: ~ ~ ~ ~ ·
Disapproved: Date:
Department Worksheet: