HomeMy WebLinkAboutGLEN EAGLE BLK 4 LT 6Glen Engle
Block 4
Lot 6
#050-601-23
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201464 PID Number: 050-601-23
Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade
Name
Melanie Harrop
ABSORPTION FIELD
❑ Deep Trench ❑Wide Trench F1 Bed F-1 Mound
Site Address
23914 The Clearing Dr. Eagle River, AK 99577
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
980-5555
3
EXISTING GPD/SF
JTotal
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Glen Eagle 4 6
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
>100'
>100'
N/A
N/A
>25.
TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Greer 1,000 Gal.
Surface Water
>100'
>1 00'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>10'
> 0'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks Line to tank, tank, and a portion of the line to field
are insulated.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
Northern Excavation
Drainfield Existing CO/MT D3034
Inspector J. Millette
BENCH MARK (Assumed elevation) 100 ft
Inspection 15` 11/13/20
Location and description
ection 2nd
r
Threshold of front door.
3 41n
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
1pF OC NZ�e
Conditional Approval: Date
���P,,.••`'...... •:S
®�®
` 49th
ffi ..... ..... ...,...i.....�
Pv'..... ................ 0..................a�.... ffi
NAICHAEL E. A.NDER50N L—,j
NO. CE -4381 ,•' �"^�"
��`��F '°••.
Septic System
Approved r� �i Date �3 a0�
11/25/20e,,.-°'<`a�
Note: does include
FFG PPOF�SSI�\ill
this approval not well permit requirements.
pit%1%1 �
(Kev uwuuia)
2CO
1"=50'3-BDRM HOMECO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
PERMIT # OSP201464 PID # 050-601-23
GLEN EAGLE, BLOCK 4, LOT 6
A B
FCO 24.1
MH 34.4
SV 35.4
A
B
2CO 35.7
3.8
13.3
17.0
18.8
11/25/20
FEET
0 50 100
50' B.L.M. SECTION LINE EASEMENT
20' UTILITY EASEMENT
10' UTILITY EASEMENT
THE CLEARING DRIVE
EXISTING WELL
EXISTING WELL
EXISTING ABSORPTION SYSTEM
TO REMAIN IN SERVICE.
NEW 1,000 GALLON SEPTIC TANK
w/20" MANWAY
(EXISTING TANK REMOVED AND
DISPOSED OF PER MOA CODE)
MH
SV
FCO
PLAN AS-BUILT
PROFILE AS-BUILT
(NO SCALE)
96.0
91.9
96.7
99.2FCOMH SV11/25/20
1000 GAL
SEPTIC TANK 2CO95.85
PERMIT # OSP201464 PID # 050-601-23
GLEN EAGLE, BLOCK 4, LOT 6
2" INSULATION
0
6
10' UTILITY
EASEMENT
Lot 5
THE CLEARING DRIVE
MANHOLE
SEPTIC \
PIPES
\O
/
r�
m
O
ro�.
w
ROOFTOP DECK
h �W ��
OVERHANG
N
O
\O
O
0
M
\
x
0
z
z
EAST 150.00'
0
p.
-SEPTIC PIPES
3.0'x27.8• CANT
73.9''
0'
i/ �7.4'x1C.C' BALCONY
Lot 6
51,000 S.F.
WEST 150.00'
Unsubdivided
50' B.L.M. SECTION LINE
RESERVATION LINE (PER PLAT)
fX20' UTILITY EASEMENT
PLOT PLAN ___ AS BUILT _X_ SCALE —11 — 40__ GRID _ SW 0160__ Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates inc. (907) 522-6476 Phone ooQo�OO
(907) 522-4625 Fax o�
Professional Land Surveyors kenolangsurvey.com c of A.4N9
jonathan®langsurvey.com SOP •.S 44
I hereby certify that I have surveyed the following described property:
LOT 6, BLOCK 4, GLEN EAGLE SUBDIVISION (PLAT No. 75-56)
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
premises and that there are no roadways, transmission lines or other visible
easements on said property except as Indicated hereon.
Dated this the _—LI— Ph y - -----------, ----_- at Anchorage, Alaska
Da of _________
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
49!H
A,' , KENNETH
.LS -5202. gJOG
Op ... NpGp
4�4ROFfSSIONAL �o
AECC963
10/29/20
MUNICIPALITY OF ANCHORAGE
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. 050-601-23
Property owner(s) Melanie Harrop
Mailing address P.O. Box 770676 Eagle River, AK 99577
Site address 23914 The Clearing Drive Eagle River, AK
Day phone 980-5555
Legal description (Sub'd., Block & Lot) Glen Eagle, Block 4, Lot 6
Legal description (Township, Range & Section)
Lot Size 51,000 Sq. Ft. Number of Bedrooms Three (3)
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
❑x
(w/wo AD U)
Septic Tank
19Upgrade
❑X
El
(D)
Holding Tank
ElRenewal
ElDuplex
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES
A VARIANCE / WAIVER REQUEST FOR:
Distance:
I 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: J#165. 75 couto
Date of Payment: 1(9-2,T-2-0
Receipt Number: OR %SZ. ID
Permit No. 05P20/y6Lj
Permit App__- : :'_, c
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
October 28, 2020
MOA Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Subject: Glen Eagle, Block 4, Lot 6 – 23914 The Clearing Drive
Septic System Design
Dear On-Site Services Engineer:
The septic tank on the subject property has passed its useful life and must be replaced. We are
submitting this application for a permit to construct a new septic tank. The attached site plan
identifies the location of the home and the proposed and existing septic tank sites. No conflicts
exist between this proposed tank location and any other well or septic system, whether on this lot
or adj acent lots.
The new septic tank will be placed near the same location as the existing tank. Storm water
drainage will not impact this site.
Wells on this and adj acent lots are shown. The new tank will be a minimum of 100’ from all wells
and surface water, 10’ from the house foundation and more than 5’ away from the absorption
trench. No surface water is within 100’.
Please refer to the attached plan sheet for the septic design. If this design is followed, there will be
no adverse impacts to adj acent properties.
Sincerely,
Michael E. Anderson, P.E.
10/28/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201464, Rebecca Carroll, 10/29/20
2CO
1"=50'3-BDRM HOMENOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
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 4, LOT 6
10/27/20 FEET
0 50 100
50' B.L.M. SECTION LINE EASEMENT
20' UTILITY EASEMENT
10' UTILITY EASEMENT
THE CLEARING DRIVE
EXISTING WELL
EXISTING WELL
DECOMMISSION EXISTING
SEPTIC TANK PER U.P.C.
EXISTING ABSORPTION SYSTEM
TO REMAIN IN SERVICE.
1,000 GALLON SEPTIC
TANK w/20" MANWAY
MH
SV
2CO
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201464, Rebecca Carroll, 10/29/20
y GRED'`' ANCHORAGE AREA BOk.j""i
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME #0—Pil "0/ la/_'rc-rMAILING ADDRESS _'i Ti FT l95r
PHONE
LOCATION LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE / �i NUMBER OF //
FROM WELL MANUFACTURER MATERIAL Fi/�7%�'L COMPARTMENTS__L�
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY Lvo GALLONS.
TILE DRAIN FIELD:
TOTAL LENGTH /
DISTANCE FROM WELL/ FOUNDATION /n t NEAREST LOT LINE �� T OF LINES 139
/
NUMBER OF LINES P DISTANCE BETWEEN LINES 7 1 TRENCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION AREA SSSr ,/ / / /
SQ. FT. LENGTH OF EACH LINE � % `'
I DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE_...(�_IN. ABOVE TILE _2K -IN.
WELL :� ll// 'r
TYPE ll1^�%�+� CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION , LOT LINE , SEWER LINE , TANK , SYSTEM
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED REMARKS _.
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL: C�T` 11Lv ,'
LOT SLOPE: -J
REMARKS:
Form EQ -032
DIAGRAM OF SYSTEM
A
C J^•ti
r 7 ��� •fi
A
S•�� + 1 A'
DATE -2--a-3--75 APPROVED
G.A.A.B. J
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY�`"---IT NO.
3330 "C" STREET ANCHORAGE, ALASKA 99503 _ Z
i TELEPHONE 274-4561 / �v
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
NAME OF APPLICANT
MAILING ADDRESS _Sr 1'7 7-_ ( I � ( /' 4� (`,PHONE
INSTALLATION LOCATION
LEGAL DESCRIPTION c
INSTALLATION OF: SEPTIC TANK � / �-' SEEPA('a.E,PIT DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
(%'s
SOIL TEST RESULTS 0
COMPLETION DATE ANTICIPATED
TO BE INSTALLED BY
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE _/ oOC) TYPE 1 tt Vlke 1
SARVIIII0040kREA SIZE
MINIMUM DISTANCES, REQUIREMENTS
I
FOUNDATION TO SEPTIC TAN�
/K _
FOUNDATION TO Sf[��T, DRAIN FIELD
d`0 /o
SEPTIC TANK TOS T WALL
-
"FI
SEPTIC TANK , SEEPAGE PIT , DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK /DO /00
DRAIN FIELD ___ ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK C11 SEEPAGE PIT �f)„
DRAIN FIELD
SEPTIC TANK. (od, SEEPAGE PIT 00 DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
if 1 r
GRAVEL BACKFILL t � -_ — qj //.cam( -,F- "0 C
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
G.AOR
.A.S.
E N
SE
�'ww ;.u..�QQ b•c l,.J_. � �H,-,�.LY Z--�ic._+� �-�.t.� , J
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREA R ANCHORAGE ARE BC
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DAT C > gpPLICA NT'S SIGNATURE 4� L
TYPE
DIAGRAM OF SYSTEM
13gI °6 d �
a - 4ib
3H ORDINANCE
OCDINANCE NO. 28-68 AND THAT THE ABOVE
Const,tuetion gest 1'ab
"One test is worth a thousand opinions"
0829 TUDOR ROAD, ANCHORAGE, ALASKA 00607 9 TILKPNON[ 333.8472
Performed For /C/g P Date Performed
7�7 7S
Lenal Oescrintion: Lot 6 Block q Subdivision tgLP.t2 4EJ% L F
This Form Renorts Soils Lon PAZ Percolation Test
nenth
Feet Soil Characteristics
1 OASo t
2 -- �, L �� Cr^ v e.(Ij SA iu d(
-f07o (,RAVEL
S�G704
5 —
E-
7 —
7
R —
z
In _
t2 ' yo N
Was Cround Water Encountered?_
If Yes, At what Denth? .7
J`j
0
P
e*�f pf
M
now = W-1149m=MM
FM
Percolation Rate Minute
Prnnosed Installation: Seenane Pit Drain Field
Denth of Inlet Denth To Bottom Pj Pit Or Trench
C n M rA E N T S : M17 . S&P / / C" A ooeg AVA ii IRF73,PAn eA
=7
Test Performed By .77m Mo+ L _ Data Certified By: / G
(907) ^74-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner Brad Dickey Use of Well Dom
Location (address of: Township, Range, Section, if known; or distance main road
{ L6J
Blk 4P -Glen Eagle Subtiiv., Eagle River__
Size of casing 6
_Depth of Hole
6' feet Cased to-- — 65 _ _feet
j Static water level
t3 ft. (xkom)
( law) land surface. Finish of well (check one) open end ( X );
Screen (
); Perforated (
).
Describe screen or perforation
None
Well pumping test
at . _1O__gallons per
(�S2k�4�f (minute) for 1 _hours with 100% gfX
fJ of drawdown
11
from static level.
Date of completion_B
July 1975
WELL LOG
Depth in feet from
ground surface
Give details
of formations penetrated, size of material, color and hardness
O TO 50
Small
Silty Gravel: wet. cobbly
50__TO_ 55__
A/A: dry
55 TO, _60___
Water
Gravel:y_ery5andv4-_2_GUM__
60 _ TO_ 65
Water _G
�d Gx_ayelj__ mood saturation
1 — TO
- .- - - ----- ---
TO
Z"
- TO
- -
C;crti(ica1,i s 3
lO
TO-
-- -
TO_
1 —CUSTOMER
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. 050-601-23
1.
1
Phone: 907-343-7904
Certificate of On -Site Systems Approval
Fax: 907-343-7997
Expiration Date: G-5-" 2-1
GEN ERALIN FORMATION
Complete legal description Glen Eagle Sub Block 4 Lot 6
Location (site address) 23914 The Clearing Drive (ER)
Current property owner(s) Melanie Harrop Day phone 980-5555
Mailing address
Real estate agent
P.O. Box 770676, Eagle River, AK 99577
2. TYPE OF DWELLING:
❑N Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Private Septic
F
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550 Waiver Fee $
Date of Payment 2 Date of Payment
Receipt Number C9 ,a cn I Receipt Number
COSA # OSC211069 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
unlclpa ify o Anchorage tiles and trom my investigation and inspection,the on-si e 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
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller P.E.
6. DSD SIGNATURE
System #1 Approved for –3—bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
Phone (907) 522-7773
Date 2/25/21
. pF •:911
TH
*. 49
...
t .......
•chiller j
CE 12592 •����cdMW�/
PROFESSO
with the following stipulations:
KUTY
O1V_ Q o
AT �.
�TFR AM) m
0 pR G / ATFR
JJJJ/f�� IV/
`�
By: -3 �Vl� Original Certificate Date:
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
r
Legal Description: Glen Eagle Sub Block 4 Lot 6 Parcel ID: 050-601-23
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 7/8/1975
Total depth 65 ft
Cased to 65 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 36 in.
Date of flow test for COSA 10/14/20
Static water level at beginning of test 9 ft.
Comments
B. TANK DATA
Age of tank(s) """'o years
Tank type/material SEPTIC/PLASTIC
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping NEW INSTALLATION
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/23/1975
❑ ALL standpipes present per record drawing
Total measured depth from grade 2.1 ft (max)
Measured depth to pipe invert from grade 1.5 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced _gallons
Comments/Deficiencies:
,COSA Checklist yellow sheet
Structure served by this system
Well production at time of test 1.6 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 1.39 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample
02/25/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 10/14/20
Results [D Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 450 gal
New depth 0 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate '450 and
Any rejuvenation treatment (past 12 months)
If yes, enter date
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'
Q✓ Yes
if No
Community Sewer Manhole/Cleanout > 100'
If absorption field is under driveway comment below
❑✓ Yes
if No
ft
[✓ Yes
if No ft
Neighboring Tank > 100'
0✓ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑✓ 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'
Animal Containment > 50' Yes
if No ft
M Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
0✓ Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Q✓ Yes
if No
ft
Surface Water > 100' ®✓ Yes
if No ft
Property Line > 5'
0✓ Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
P/ Yes
if No
ft
Private Wells > 100' ❑✓ Yes
if No ft
Water Main > 10'
Yes
if No
ft
Community Wells > 200'✓0 Yes
if No ft
Water Service Line > 10'
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'
Q✓ Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
✓0 Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
0✓ Yes
if No
ft
Community Wells > 200' 0 Yes if No ft
Surface Water > 100'
✓® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I 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
r�P� of i4C;q���1
49TM •*
Benjamin Schiller
f$ 9 •, CE 12592-02/25/21
ltli'OpROFESSIONP��`'~
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Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-601-23
1. GENERAL INFORMATION
Complete legal description Glen Eagle, Lot 6. Block 4
HAA # ,j? -Q it �j 1
Expiration Date: �? / 9' ` (0 �3
Location (site address or directions) 23914 The Clearing Drive, Eagle River, AK 99577
Current Property owner(s) Hank Compton Day phone 694.3147
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Same as above
Day phone
Lynn Swanson -Prudential Vista Day phone 689-6464
16635 Centerfield Drive, Eagle River, AK 99577
Unless otherwise requested, NAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
2-
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the
transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal
and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health
Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well
and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one
year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or
a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
4. 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 Health Authority 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.
Name of Firm KND ENGINEERING, Inc. Phone (907) 696-6111
Address 20441 Ptarmigan Blvd., Eagle River, AK 99577
Engineer's Printed Name Kenneth M. Duffus Date 4/28103
Engineer's Comments:
This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the
condition of the well and septic applies only to the
conditions as of the day tested. The flow and absorption
rates may change due to subsurface conditions that
may not be observed from the surface, changes in
land use, local soil characteristics, groundwater levels
that may fluctuate during the year and the water usage
of the family being served by the system. The operational
life of all well and septic systems are subject to these
various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
Approved for _� bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
ENGINEER S
Kennvh'A. Gufi r.
CE 7116
WASTEWA�Et�,
try a.
e
J s
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory
Well Flow Advisory
Supplemental Engineer's Report_
Other
By: 0-� Original Certificate Date: /
(Rev. 01!02)
Municipality of Anchorage , •
Development Services Department
Building Safety Division •
Onsite Water & Wastewater Program ' + •
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Glen Eagle Lot 6. Block 4 Parcel ID: 050.601-23
A. WELL DATA
Well type gfto
Date completed 718/1975
Total depth eft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased to 65R
FROM WELL LOG
3 ft.
WATER SAMPLE RESULTS:
Coliform J—colonies/100 ml.
Arsenic: l49 mgA.
B. SEPTICIHOLDING TANK DATA
g.p.m
Nitrate -41L mg./l.
Date of sample: 3128!03
Tank Type/Material Septic I Plastie Date installed 712311985
Well Log (YM) Y
Wires properly protected (YIN) Y
Casing height (above ground) 3'
AT INSPECTION
4115!03
R.
2.8 9 -p.m -
Other bacteria _-L colonies/100 ml.
Tank size 1000 gal. Number of Compartments 'L Cleanouts (YM) X
Foundation cleanout (Y/N) X -Inside fou dan tion Depression over tank (YM) "_High water alarm (YIN) N
Date of pumping 4115103 Pumper JR's
C. ABSORPTION FIELD DATA
Date installed 7123/1975 Soil rating (g.p.d./ftp or fe/bdrm)1tL System type Shallow TrenchlBed
Length 139 ft. Width 4C R. Gravel below pipe 0.5 ft.
Total depth 4& ft. Eff. absorption area "5.ft2 Monitoring tube 1f•. Depression over field N
Date of adequacy test 4115103 Results (Pass/Fall) Pass For 2_ bedrooms
Fluid depth in absorption field before test L in. Water added_M gal. New depth 2,5 in.
Elapsed Time: M min. Final fluid depth 1 in. Absorption rate , >= 300 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date
D. LIFT STATION
Date installed NA Size in gallons Manhole/Access (Y/N)
"Pump on" level at _ in. "Pump off' level at _ in.High water alarm level at in.
Datum Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer /septic service line 25'+ Holding tank 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line rte'+ Absorption field 5'+
Water main 101+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+
Curtain drain 50'+ Wells on adjacent lots 1001+
F: COMMENTS
of AC
G. ENGINEER'S CERTIFICATION r* f4 1
• •• •• N•N•N• •••N•• • •
I certify that / have determined through field inspections and •t • •••»• •
review of Municipal records that the above systems are in K•
�. w
conformance with MOA HAA guidelines in effect on this date. I/#Fd+,i,�•f� I � � 7116
•vow
�( `cc I
Engineer's Printed Name Kenneth M. DuffusESStoNPyAW
Date 4128103
HAA Fee $375.00 Waiver Fee $ _
Date of Payment Date of Payment
Receipt Number 03yS�bl Receipt Number.
(Rev. 12/01)
KND ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11/FAX (907)696-8111
April 28, 2003
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Glen Eagle Lot 6, Block 4
Gentlemen:
At a pre-test site visit, only two septic standpipes were present (one septic tank cleanout
and one cleanout at the end of the drainfield). On April 12, 2003 prior to testing the
septic system, monitoring tubes were installed in the drainfield. The effluent was found
at the bottom of the effective depth. Subsequently on April 15, 2003, we performed the
septic adequacy and well flow test. The system appears to be functioning properly.
Also during the site investigation, it was discovered that the house has a grinder
pump/basin on the first level and the foundation cleanout is located within the
foundation. The owner stated that he has the septic tank pumped semiannually. Given
the fact that the tank is only a single compartment, we would recommend that the next
property owner continue this maintenance schedule. Once we have received the as -
built survey of the property, we will submit it to you.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
XMD Engineering, Inc.
Kenneth M. Duffus, E.
Attachments: HAA
Water Analysis
4-1C-03; 3:29PM; ;907 5615301 # 2/ 2
ytNORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125
5761 SILVERADO WAY;UNIT N ANCHORAGE, ALASKA 99518 (907) 349-1000 • FAX 349-1016
POUCH 340043 PRUDHOE BAY, ALASKA 99734 (907) 659-2145 • FAX 659-2146
SGS Environmental Services, Inc.
200 W. Potter Drive
Anchorage, AK 99518
Attn: Rhonda Strucher
Phone: (907) 562-2343
Fax: (907) 561-5301
NTL Lab#: A306211
Client Sample ID: 1031662001
Client Project.
Location: Lotti, Blk4 Glen Eagle
Sample Matrix: Water
COC #: 31672
Comments:
Report Date: 04/08/03
Date Arrived: 04/03/03
Date Sampled: 03/28/03
Time Sampled: 16:10
Collected By:
Flag Definitions
MRL = Method Reporting Limit
MCL = Maximum Contaminant Level
B = Presentin Blank
H = Exceeds Regulatory Limit
M = Matrix interference
J = Estimated Value
D = Lost to Dilution
U = Less Than Reporting Limit
Analysis Method Prep Prep Analysis
Parameter Result Units Flag MRL MCL Method Date Date
SM 4500 NO3E
Total Nitrites/Nitrates-N 4.39 mg/L 1.25 04/07/03
Reported By: Wendy Mitchell
Anchorage Laboratory Manager
8 THE CLEARING DRIVE
N 90000'00'E 150.00'
LOT 5
10' UTLIiY EASEMENT
LOT 7
I
—20UTLTTY EASEMENT
L _
PLOT PLAN _ ASBUILT X SCALE I" - 40' GRID SW 160 Project No. _
Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515
Registered Land Surveyors (907) 522-4625 Phone
I hereby certify that I have surveyed. the following described properly:
LOT 6, BLOCK 4, GLEN EAGLE SUBDIVISION (PLAT 75-76)
Anchorage Recording District, Alaska, and that the improvements situated
thereon are within the property lines and do not encroach onto the property it 49B
adjacent thereto, that no improvements on the property lying adjacent thereto
encroach on the surveyed promises and that there are no roadways, transmission v
lines or other visible easements on said property except as Indicated hereon. "' •' •...
c� KENNETH . L G
Dated this the 21" Day of hid 203_ at Anchorage, Alaska '•.. LS -5202
It is the responsibility of the owner to determine the existence of any easements, p
covenants, or restrictions which do not appear on the recorded subdivision plat. .........RIWIL
03-114
MUNICIPALITY OF ANCHORAGE '`5/,,) G 12 .
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY H86-1288
264-4744
Application Date
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 6 Block 4 Glen Eaqle Subdivision (T14N R1W Section 15)
Location (address or directions)
(b) Property Owner Hank Compton
Mailing Address SR Box 1594
Telephone: Home 694-3147 Business
(c) Lending Institution Columbia Mortgage Telephone 563-1133
Mailing Address 471 West 36 Avenue, Anchorage, Alaska 99503
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address or: Check here ❑, if hold for pick up
List contact person and day phone number below.
2. TYPE OF RESIDENCE
Single -Family ®x
Number of Bedrooms two (2 )
3. WATER SUPPLY
Individual Well a Community ❑ Public ❑
Note, If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite aX Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 R'W rwrl
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
0
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 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
Address
Date
Telephone
Engineer's Seal
This property is disapproved due to the non-compliance of the
Conditional Approval dated December 3, 1986.
DHHS APPROVAL
XW&AMXXXXXXXXU&6M8Xby ADate
XAMN,XXXXXXX;'XXXXXXDisapproved XXXXXXXXX Conditional
Terms of Conditional Approval
CAUTION
September 17, 1987
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
Page 2 of 2 72 n25 (a,�� 8 -ea) aa(k
h
A`
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
ROBERT A.SHAFER
CIVIL ENGINEER
694-2979
Ju.ey 13, 1987
MUNICIPALITY OF ANCHOc .F
DEPT. OF HEALTH 8
ENVIRONMENTAL PROTECII.
MunicLpaei-ty ob Anchonage
Department ob HeaPth and Human Setviees>iU� 1 ' 1`a��
825 L Street R E C EI V E D
Anchonage, A2asha 99501
ATTENTION: Oobby Robinson
REFERENCE: Lot 6; Beock 4; Geen Eagee Subdivision
Deat Robby,
This eettet is in 4e6ponse to the Municipaeity ob Anchonage boteow up
on a eonditi.onat Heaeth Authority Approval issued in November, 1986
on the tebereneed property and our discussion concerning a telephone
convetsati.on which you had with Mr. Hank Compton, owner ob the rebe.teneed
property.
At .the time we tequested a conditional Healt;� Nu,th,or.ity App4ovr,"_ on
the re6e4eneed property we explained to Mt. Compton that he would be
tequited to bollow up in the 6pring on the terms ouiti-ned in the conditional
apptoval.
We tacked to Mr. Compton on three 6epatate occasions this spring about
the need to complete the work necessary bot binal app4oval. Our biu t
discussion, I be.ieve, was in May when Mr. Compton 4equested we delay
the wokk until some time in June when they teturned Brom vacation.
Out second discussion was abten the MOA hollow up teeephonic notice
in June that the te4ms ob the eonditi-onae approval had expired.
In both ob these conversations Mt. Compton was compeete2y coope4ative
and made atrangement6 to have the wokk done the boPeowing week, however,
our th,itd conversation did not bane so well.
When we showed up the day bebote the wokk was to be pe46otmed to go
oven the job site with the exeavatot Mt. Compton insisted that he was
not going to have his yard torn up with backhoes, dozens, etc. and that
he did not beee that he shoued have to do anything with the system even
though at this point in time I pointed out to him what appeared to be
sewage sutbaei.ng at the end ob his d4ain4ietd. He stated he eoued repair
this by hand digging. Du4ing this discussion M4. Compton was somewhat
hostile towand6 the idea ob having his system repaired, thetebore, I
tetminated our ctient teeationship and suggested he. contact another
engineer.
SRB 196X EAGLE RIVER, ALASKA 99577
page two
Lot 6; Beock 4; Geen Eagee Subdivi6ion
Juey 13, 1987
Having been un6uccebb4u.e i
bun.then action nee_d6 to be
Riven, Aeaska 99577.
S.incene.ey)
`-RUB A. SHAFER, P.E.
RA /66
compkefii.ng the wokk nequ.i.ned bon a bine HAA,
directed ,to Mn. Compton, SR Box 1594, Eagee
q k7
TH LkEP )-0 T,+Y kr-NAAbAr //' 0 7 Ate° r/E
rNFORMEQ /1F
F "r PE � TS /Y)
Al4
.(1OuT THE f3 -� OF SEPT, w� CALL
L/1E
914cN T/-lFN
F/��Ay -7AuEurt
OWNER /rR,CUMPToa
N oAwn H/NED
l COQ SCFIAFfR
S pohf T Nc FIRED uPbAHpE HAPs7ATEa rjlAT THi
AA. H E SAID /r u su P p 0A1F_
►�. TIFF
L �
�0 BUTS LoON THE
T14AE�' p,.ACF '4Nd /gEPERfO^rFFoR
rEsf wjj.L AF U, lcc wA�Tr
ApE4'uRCY TN o� f/ ubasT.
r EK v F TH f �,l C
R E S ulrf. � \ l f MuR%bAbf C°.
PRF_i/OF_.yi °
TA �3y1/3? cou puTEK/i 6y4,S�9s
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVALt
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Descrption (include lot, block, subdivision, section,
t'
Location (address or directions)
(b) Applicant Name r� Telephone: Home y—�� Business
Applicant Address S
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution Telephone
Address k-7
(e) Real Estate Company and Agent
Address
telephone
(f) M}aWthe HAA to the
<� 4 ('
ng address:
2. TYPE OF RESIDENCE
Single-FamilyA Multi -Family ❑ Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite] Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 71-01'' (" "d)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 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 & 5 ENGINEERING Telephone
Address SR B 196X
Date _ EAGLE RIVER, AK 99577 / 6
CO/(JO/?ioN,qe_ .9�tJp2vvG-� Re' ,ic/.eEO,
501e- 7-,er,T7
AF;r" /• W-IVOs 72) 3F' r= Sc�duEO
TO Cd,J x�e uV/y/o-ale , uivrC •r 7ZJ et—'
A/e G. T /S jLlN !98 6
6. DHEP APPROVAL
Approved for 2 bedrooms by. `` ` ` `� --Date /
Approved — Disapproved _ Conditional
Terms of Conditional Approval r S 7// 7ErJ HBU dE
/fi
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)
M, NnrwnL;iY OF ANCH iLMPALITY OF ANCHORAGE (MO^)
::F HEALTMEALTH AUTHORITY APPROVAL (HAA)
EN 1TAL PROTEMIthECKLIST -FEBRUARY 1984
264-4720
1 19861.
Legal sDesc,�i�tion:
A. WELL DATA L L E E
Well Classification I'iPlUaC It A, B, C, D.E.C. Approve�iV)
Well Log PresentY N) Date Completed 8 V�IG l97J' Yield�'XiPec+S �• S f/J/rr•
Total Depth G S Cased to ./ 5 r Depth of Grouting u K
Static Water Level .7 Pump Set At u
Casing Height Above Ground --j
Electrical Wiring in Conduit t(Y N)
91 _/
Sanitary Seal on Casing Y/ ) —
Depression Around Wellhead (YO
Separation Distances from Well:
r
To Septic/HeI44iT`Tank on Lot /OQ On Adjoining Lots l00
To Nearest Edge of Absorption Field on Lot ADD On Adjoining Lots
To Nearest Public Sewer Line IJ 14 To Nearest Public Sewer r
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by S •,� S �'s2v�N�t/�ia l Date !!A�/�� 6
Water Sample Test Results _ s<3 T�S�'/9 G Tv i
Comments /t-/ 0
B. SEPTIC/H10-TANK DATA
Date Installed y7� 2 3 Size /dg:� 0 No. of Compartments
Standpipes®/N) Air -tight Cap (Y N) Foundation Cleanout (Y/Vi
Depression over Tank (Y/9 Date Last Pumped
Pumping/Maintenance Contract on File (Y& '^J14 for r—
Holding Tank High -Water Alarm (Y//IV)� Aitq Temporary Holding Tank Permit (YON /y
Separation Distances from Septic/ �+lopPRtTTank:
To Water -Supply Well l00 To Building Foundation /0
r�
To Property Line ZD To Disposal Field
r
To Water Main/Service Line l0 To Stream, Pond, Lake, or Major Drainage
Course iCJ o NE
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
7i
Soils Rating in Absorption Strata Type of System Design Dka2 /9/N F/ ec O
Date Installed t2.3 /7 /
Length of Field /.�9
Width of Field Depth of Field � 1
Gravel Bed Thickness
Square Feet of Absorption Area SSf Standpipes Present (YN
Depression over Field(YO Date of Last Adequacy Test
Results of Last Adequacy Test re9_VrYS 47 A c 710e0'Y 4170,e/.F 1 '
Separation Distance from Absorption Field:
To Water -Supply Well !DD f
To Building Foundation /o
Lot OAJ v nrE
To Water Main/Service Line *J
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line /0
To Existing or Abandoned System on
On Adjoining Lots -_em 00L
To Cutbank (if present) N
o Are
) I
N,Esv SoiG ;r&ro, 7 r7wle l?aBEsrGfLcD-
LIFT STATION
Date Installed
Dimensions
Size in Gallons
Manhole/Access (Y/N)
"Pump On" Level atTltl�"Pump
Off' Level at
High Water Alarm Level at
V I LAI Vent (Y/N)
Tested for
Pumping Cycles
during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
It
Comments
" Check Permitted Bedroom Rating Against HAA Request "
I certify that�v���,v��ifiE1J, or
conformed to all M A and HAA guidelines in
effect on the date of this inspection.
SignedSR n 796y eKK 1IVVGG
Date
CompanAAGII C DIVeer AK 9957
i MOA No. JV6Oa 3
� � •"..••-• "'�sj���
�C�C� 1 — �> l3
•*�. 4i
# 4•; '.,.
Receipt No.
Date of Payment
Amount: $
14614 'e'
Page 2 of 2
72-026 (n,ea)
5. LEGAL DESCRIPTIO
DA rE RECEIVED
INSPECTION APPOINTMENTS
NUMBER OF BEDROOMS
TrME
❑ One ❑ Four ❑ Other
TIME
TIME
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
L A`
DATE
ATTACH WELL LOG. A well log is required for all wells drilled
DATE
DATE
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
^
l
INDIVIDUAL/ON-SITE""c
r
g YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
I o
INSPECTOR
INSPECTOR
INSPECTOR
MUNI ANCHORAGE
L
MUNICIPALITY OF ANCHORAGE ENVIRUNivrili.-. :.,_ LCTioN
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501 1 l (�
ENVIRONMENTAL N DIVISION
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPER YOWNER
l
d
PHONERR.
MAILA DRS
159 AI
PROPERTY RESID T (If different fro above)
PHONE
2. BUYER
PHONE
MING ADDRESS
3. L 1 G ST TU 10
PHONE
MA N DES
6
4. REALTOR/AGENT
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTIO
S EE OCAT[
010
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
f. SINGLE FAMILY
❑ One ❑ Four ❑ Other
W Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
F�g INDIVIDUAL'
ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE""c
r
g YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
NN
/ loll){'',��� 7''1�: • rw� ,j R'
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
ED PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank r ❑ Holding Tank
Size: MW If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL T0:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
L�]--APPROVED FOR 2 BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY
—n,n,o_.. c".I
MunicipaTity C)
A
Gfhl':',f H1 MI (IJi ()I IH,, i_I II., NP I I,rV'II 'i 1',"'i 1I'F+U11 ( II':!1
September 25, 1981
Henry A./Lora L. Compton
Star Route Box 1594
Eagle River, Alaska 99577
Subject: Lot 6 Block 4 Glen Eagle Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(1) The water analysis report needs to be submitted to
this office from the Chem Lab, 5633 B Street, for -
our review.
(2) The septic tank pumped with a receipt submitted to
this office for our review.
If there are any further questions, please call Ihis uEfic(�
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/lw
cc: Alaska National Bank of Alaska
3301 C Street, Calais II
99503
—.; MUNICIPALITY OF ANCHORAGE
DEPARTME' OF HEALTH AND ENVIRONMEN' PROTECTION
825 L Street, Anchorage, Alas,a 99501
279-2511, ext. 224 or 225
Date Received: May 4, 1977
#1: Time 2:00 p.m. #2: Time #3: Time
Date 5-3-77 Tues Date Date
Insp Kennedy Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Alaska National Bank of the North
Mailing Address: Pouch 7-010 99510 Phone: 278-4581/273
2. Property Owner: Brendan/Patricia Boil
Mailing Address:
Phone:
3. Legal Description: Lot 6 Block 4 Glen Eagle Subdivision
4: Single Family Residence: (xk
Multiple Family Residence: ( )
Number of Bedrooms:
Number of Bedrooms:
2
5. Well System: Individual Well (x) Community/Public System ( )
Permit # Depth of Well 65' Well Log on File ( )
Construction Bacterial Analysis
6. Sewage Disposal System: On-site System (x�: Public Utility ( )
Permit # Installed 1976 Installer
Septic Tank Size Manufacturer
Absorption Area Soils Rate Material
7. Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
Sin�le
7. Type of Facility to he Inspected:_-_—_Dwpllino -- __--No. Bdrms.__2
8. Water Supply
Type of Supply: Public Utility Individual R
If Individual, number of dwellings presently served If Individual, depth of well -- apDrox. 65 ft
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site)_ % ___
If Individual, date of installation _ July 11)76
IF ANY QUESTIONS PLEASE CONTACT PAM- 278-4581 ext. 273
72 003(3/761
tv.JNICIPALITY OF AW&
MUNICIPALITY OF ANCHORAGE
uFrt v -,, iH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
EFIVI,,;i rC _� N
1 32 L 6tiecfi, Anchoraqu, Alaska 9'1501
279-2511, ext. 2.24, 225
'IAI 1
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
p EC L f V � / c D
L
K
1. Type of Inspection: VA-__-_-_FHA___CONV
-_--
Brendan Boily b Patricia Boily
2. Property Owner.-- - -- - - -- ---- -- - - -
- ----- -- - -
Mailing Address: __. _____ ____- __Day Phone:_--
3. Name of Buyer: Henry A. h Lora L. COmnton
- - _-
c/o 610 McKav Bldg, Anch. Ak. Da
Mailing Address:_ -_ _— y Phone:
276-3656
4. Name of Lending Institution: _ Alaska National Bank of the North
Pouch 7-010 278-45'91 ext. 273
Mailing Address: _--__ --___- -------Phone: _ ___--
N/A
5. Name of Realtor or Agent:
Mailing Address:-- -- _ -N/A - ------ _-- Phone:_ N/A----
6. Legal Description:_ __Lot 6, -Block 4, Glen Fagle S/T)
Location: -_The Cleaning, Eagle Rdver
Sin�le
7. Type of Facility to he Inspected:_-_—_Dwpllino -- __--No. Bdrms.__2
8. Water Supply
Type of Supply: Public Utility Individual R
If Individual, number of dwellings presently served If Individual, depth of well -- apDrox. 65 ft
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site)_ % ___
If Individual, date of installation _ July 11)76
IF ANY QUESTIONS PLEASE CONTACT PAM- 278-4581 ext. 273
72 003(3/761
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 6 Block 4 Glen Eagle Subdivision
Comments:
Affadavit Attached: ( )
Approved:
Department Worksheet:
Letter Attached: ( )
Date: 5 — / 7 %
Date:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received April 13. 1976
�j� f'C� ��� Time of Inspection
rac c�K Frites.
EX- Date of Inspection k/_
Ak �rw9 / REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
1. Approval requested by: Alaska National Bank of the North
Mailing Address: Pouch 7-010, 99510 Phone: 277-5511 x 31
2. Property Owner: Brad W. Dickey Phone: 694-9239
Mailing Address: Star Route Box 194, Eagle River
3. Legal Description: Lot 6 Block 4 Glen Eagle Subdivision
4. Location: NHN The Clearing Drive
5. Type of facility to be inspected Single Family No. of bedrooms 1
6. Well Data: Individual - serving one L
A. Type 42,9///rD B. Depth %l '
C. Construction S 7-44) 1 D. Bacterial Analysis
7. Sewage Disposal System: On—site system
A. Installed /7 -S /75 B. Installer
C. Septic Tank: 1. Size O 2. Manufacturer Sc &sell
D. Seepage Pit: 1. Absorption Area 2. Material I,P� ✓'e
E. Disposal Field: Total length of lines% 7
8. Distances:
r �
A. Well to: Septic tank //10 Absorption area d"o Sewer Lines
Nearest lot line , Other contamination
B. Foundation to septic tank Absorption area SS S
C. Absorption area to nearest lot line /p t
EQ -034 (1/74)
Page 1 of two pages
MUM( -WAW 11 i � ,t..,. ' " .:-A"_.l
MUNICIPALITY OF ANCHORAGE FNv!R.�r-lr,tir i<�.I?N
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage., Alaska 99503 — 274-4561 1
REQUEST FOR APPROVAL OF R L C L I V E U
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA CONV XX
2. Property Owner: Brad W. Dickey
Mailing Address: SRA Box 194, Eagle River, Alaska Day Phone 694-9239
3. Name of Buyer: Brendan M. and Patricia A. Boily
Mailing Address: General Delivery, Eagle River, Ak. Day Phone NHP
4. Name of Lending Institution: Alaska National Bank
Mailing Address: Pouch 7-010, Anchorage, Alaska Phone 277-5511 ext.31
5. Name of Realtor or Agent: n/a
Mailing Address: Phone
6. Legal Description: Lot 6, Block 4, Glen Eagle Subdivision
• • !�4
@74N UFFM• • U
Eagle River, Alaska
7. Type of Facility to be inspected: single family No. Bdrms. 1
8. Water Supply
Type of Supply: Public Utility
Individual
If Individual, number of dwellings presently served one (1)
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
EQ -037 (1/74)
Individual (on-site) XX
Page 2 of two pages - Rec t for Approval of Individual S r & Water Facilities
Legal Description
Comments
Approved
Lot 6 Block 4 Glen Eagle Subdivision
Disapproved
Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true ano
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
Date
lanK
ofthe north MET HOPO111 AN Of I ICI POUCH NO.7 pl'l AN( "O"C1 ,!N_ASK A 99610 ('1011 J/J hS11
April 12, 1976
Municipality of Anchorage
Department of Environmental Quality
3330 "C" Street
Anchorage, Alaska 99503
Gentlemen:
Re: Lot 6, Block 4, Glen Eagle Subdivision
Please find attached the Request for Approval of Individual Sewer and
Water Facilities. If at all possible, I need to have a rush on this
request. Please give me a call as soon as this is ccmpleted, at
277-5511, ext. 31.
Thank you.
Sincerely,
Ann LaRose
Real Estate Loan Interviewer
Mortgage Loan Department
