HomeMy WebLinkAboutGLEN EAGLE BLK 4 LT 5Glen Eagle Lot 5 Block 4 #050-601-22 Certified Drilling Log ® DOC CO dba 0@9 0 BILL ac CGLE ULOLIVAN WATER WELLS P.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Henry Huntington ADDRESS: 23834 The Clearing Dr Bore Hole Data Depth From To LEGAL DESCRIPTION Glen Eagle BLK 4 LT 5 DATE: 8-28-19 0 2 Casing Stickup PERMIT NUMBER: OSP191305 DATE OF ISSUE: 7-25-19 TAX IDENTIFICATION NUMBER 05060122000 Is well located at approved permit location: ❑Yes ❑No Method of Drilling: Nair rotary ❑cable tool Depth of Well: 105' Casing Type: Steel Wall thickness.250 inches Diameter: 6 inches, depth 104 feet Liner type Static Water Level: 8 feet Recovery Rate 25 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ® open end ❑open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: 2 4 Overburden 4 18 Silty sand & gravel 18 29 Silty sand with gravel & water 29 48 Tight silty sand & gravel 48 54 Sand & gravel water clean 54 68 Hardpan & Water 68 72 Silty sand & gravel water clean 8gpm 72 80 Tight clay & gravel 80 85 Sandy gravel water 10gpm 85 102 Silt & sand with some gravel water 102 105 Sand & gravel water 25gpm WATER QUALITY TESTING Coflforma COV100ML Nitrates 3. a mg/L Arsenic ND U9/L R ii 19, Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anch Community Development 'Department On -Site Water & Wastewater Program 470OElmore St. 00P.O.Box 196§5OmAnchorage, AK99507-665O�M(9O7)343'79O4 Legal Ad Subdivision Block L 0 t . ___n �6nton Lot ------- On-site Water& Wastewater Program certified contractor performing the well decommissioning: Name Signature Well decommissioning date: 67 /// Method of decommissioning: AMC 15:55.060LI a. F1 b. 7 c. Location: Use the space below to provide a drawing of the property showing the following items; 0 North Arrow Decommissioned well, " Other water wells onthe property, " Two separate swing -tie distances for each well shown inthe drawing, MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.arg/onsite On -Site Water System Permit Permit Number: OSP191305 Work Type: Well Initial Tax Code Number: 05060122000 Site Legal Address: GLEN EAGLE BLK 4 LT 5 G:0160 Site Mailing Address: 23834 THE CLEARING DR, Eagle River Owner: HUNTINGTON HENRY P & Design Engineer: This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: �11C'11j '. t.)ei.�actrn�ne 7/25/2019 7/24/2020 51000 ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. Old well shall remain in service or be decommissioned in accordance with AMC15.55. 2. To close out this permit, please submit the following: a) Well log b) Pump install log c) Water sample results for total coliform, nitrates and arsenic d) Decommissioning log for old well, if not remaining in service. Received By: Issued By: (� July 26, 2 19 Date: Date: 7 a5 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section ` --' Fax: P-0 - 43-7997 s9ro ON-SITE SEPTIC/WELL PERMIT APPLICATION JUL 17 2019 Parcel I.D. 0 CU Property owner(s) � i_ n r-� -r V_,AA �( irnl 1 n.; � n Day phone ZH � - > � uZ 6, 8 L 9 Mailing address ��`��`i I%� (—Aee;rin� hr Site address Legal description (Sub'd., Block & Lot) tC-A A��e: Legal description (Township, Range & Section) Lot Sized r'y D Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (S all that apply) Absorption Field ❑ Initial Single Family (SF) (w/wo ADU) Septic Tank ❑ Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well X Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature�if property owner or authorized agent) Permit/Rush Fees: A 2 5' Date of Payment: V/2" Receipt Number: 10,2 66 Vb Permit No. 05 Ptq 1305 Waiver Fees: Date of Payment: Receipt Number: Waiver No. n.. n......i.....,......a c+..—.:......�n..:i.�:..— n..s..a..��_, c:... �n...a.._......� tn.....a.......a.. _�r,._..,...���:....a r....»... n..—...:a n....r....a:,......... Permit No. • _- Page —. of ��' Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.Q. Box 196650 ® Anchorage, Alaska 99519-6650 ! Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: %( GO2 �sr—lokU 4QPcG� n ��z fl n �I i: - IS PID No.: 4)�0Lf0 IZ_-- . 8¢ I 0 n 13 A (Rn: 9: 91) MOA ''S Go 3 r S�ti 2'vI I F �GoL Goa �- Cp5 Gof� r'1Tl � 0 n 13 A (Rn: 9: 91) MOA ''S Go 3 r S�ti 2'vI I F Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~---~/'---~'~-.~'~"~"~ PID Number: ~::)~:::)~(D ~"~..~ ~ {~ ~. ~ ~ ~ ~~ Wastewater System: :J New Li Upgrade ~ ~~ ~~~. ABSORPTION FIELD Ph( ..... [ No ~c]rocm~s. ! Deep Trer~ch [ Shallow ] remch I Bed ~otltld I ] Other LEGAL DESCRIPTION ,o,, Rating ~'~ GPDSq Ft Total Depth f WELL: L ~ New lq Upgrade Gr~w~ W,dth ~ I bt .,.~ ,, ~ TANK SEPARATION DISTANCES ~o.t,~ :~ .o~dm~ Surface w~,~, ~ I~ ~ -- ~ LIFT STATION Remarks:~t~ ~v~ ~ ~~ BENCH MARK Inspec[ 0 rformed by. E. le River, Ala'k' *S77 Department of Health and Human Services approval. 't;~/~ ..... ,ev,ewed ~nd a,,rove~ ~: ~-,~ /~*'* ~ ~ ~a~e: ~/~/* ~ '"'~"-..~----'""-'~' -- PermitNo. ~--~C~'~-'~'~'~d~-~ Page "~ of ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description:'"~L,-"C~--~~-- '~ ) ~ ~'~ PID No.: z~)~:~)L~) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920276 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MCILROY DAVID S & OWNER ADDRESS:1612 EAGLE RIVER ROAD EAGLE RIVER, AK 99577 DATE ISSUED: 9/09/92 EXPIRATION DATE: 9/09/93 PARCEL ID:05060122 LEGAL DESCRIPTION: GLEN EAGLE BLK 4 LT 5 LOT SIZE: 51000 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS UPGRADE SYSTEM MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVED ENGINEER'S DESIGN DATED 9/5/92. THE EXISTING LEACH- FIELD MUST BE PROPERLY ABANDONED. RECEIVED BY: .~. DATE: Septemb~ 8, 1992 ROBERT SHAFFR ROGER SHAF EF~ P O!VIL ENGIN~ (907i 694 HEAL TH AUTHORITY APPROVALS SEWFR & WATER INRPFCTION Municipality of Anchorage DEPARTMENT OF HEA~TH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 5; Block 4; Glen Eagle Subdivision; Request you issue a permit to upgrade the septic system serving the referenced property. The existing system ms inspected and found to be in a state of failure with periodic surfacing. We do not anticipate any adverse affects on n~ighboring properties by the installation of the proposed upgrade. If you hav~ any questions or require additional information for your review, please contact us. Sincerely, ROGER J. SHAFER, P.E. RJS/gm STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER. ALASKA 99577 SCALE SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 {~ ~'~4 ? 8 13 15 ~8 2O Township, Range, Section:'~""~Z~,,I , ~.- \~,/ I '~'~'~' LI:::::::~ SLOPE SITE PLAN WASGROUND WATER ENCOUNTERED? IF YES, ATWHAT ~d DEPTH? Del]thto Waler Atte[,~J / ' Monitoring? -'" l'Z" Date: Gross Net Depth to Net Reading Date Time Time Water Drop ~ ~ '. ~6 ~ 4 ~ ,/~- 4 ~'.4~ _ ~ 4~ '/~~ _ PERC©LA1~ON RAIE __ (minutes, tach) PERG HOLE DIAMEIER 1E51 RUN BEIWEEN __ COMMEN~S '"'"'~I"~ '~ ~,~'~Z~,, ~-'J.~::::~iZ....~ ~_ ~ ~ PERFORMED BY S i S ENGINEERING ~ ¢~3 17034 Eagle River L~p Road ~. ~ ACCO.DA.C~ W., ~S~A~i~.~g~U~.,.~S ~ ~.~C~ O~ ~.~S DA~ 72-008 (Rev 4~85) F T ANb __ FI CERIlFY ]HAl THIS ]EST WAS PERFORMED IN DA, E ~'- ! MUNICIPALITY OF ANCHORAGE i,'~"I~ ~, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION  ENVIRONMENTAL ENGINEERING DIVISION '~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 - ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE MAILING ADDRESS LEGAL DESCRIPTION ' ~ J / LOCATION NO. OF BEDROOMS Well Absorption area Dwelling ~ PERMIT NO. IO0 ' Iq 9 ~ ~ Manufacturer ~ ~ ~ Material~z~ ~ N°' of compartments ~_  Liq. capacity in gallons Inside length Width Liquid depth [ j~ ~ IF HOMEMADE: ~ ~ -- ~ Manufacturer /~ Mater~al Liquid capacily in gallons ~ DISTANCE TO: ~ ~ ~ To~ ~f tile to finish grade Material beneath til~ Total effective absorption area Type ~f crib Crib diamete~ Crib depth Total effective absorpti ...... ~ 0 ~ ~ - Well ~ DISTANCE TO: /j ~ /~ Building foundatZo~ -- Nearest lot line /~ ~ DISTANCE TO: OTHER SOIL TEST RATING REMARKS ~.~ ~ N APP~OyED// /y/~ t / DATE LEGAL O & ~ (Rev. 3/78) Permit Applicant: Location: Legal Description: L0P ~ E/h~Z Type of Soil Absorption System Is: Trench: _ Drainfield: ~ _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms ~___ Soil Rating(sq.ft/br)-~--/~/~) :S The Requiredi~e of the Soil Absorption System Is: DEPTH '~~7~! LENGTH /~?~ / GRAVEL DEPTH __~~ WIDTH The length dimension is the length(in feet) of the-~rencn or ~tainfield. MUNICIPALITY OF ANCHORAGE Department ,f Health and Environment~ Protection 825 Street Anchorage AK. 9950 264-4720 F ~-( * * * HANDWRITTEN PERMIT * * * -'- WELL AND/~]~: ON-SITE SEWER PERMIT ' / Phone Number: e9-- 6-~/¥ f/~,,'~ LOt Size: -- The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). I ,5C * * · * REQUIRED SEPTIC(He~,~,~) TANK SIZE = GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this departmen' will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee' for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 S B * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that ~bedrooms · ~T/ ~'.'-"~/~l(~l~ ---'~,_ /j, ~., ,~L~ Signe~: ~ ~K~ ~'~'(z~.~i;l~/~/~ Issued by: ' ~ , (- Appli~n~ ' ' /'' ~ , Date: M DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, A~aska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION I EST SLOPE ,/ 10 11 12 13 14 15 16 17 18 19 .., 2O COMMENTS 72-008 (6/79) WAS GROUND WATER ENCOUNTERED? () P IF YES, AT WHAT ( DEPTH? ' I Gross Ne Reading Date Time Tirr y " ,5 ~ ~ / PERCOLATION HATE :5f (minums/mch) TEST RO..ETWEEN '-5''-- ~' 0 0 0 0 0 0 0 0 0 0 0 0 ,-] ~] ~ ,-.] .] ,-] ~ ~ ~ ~ ~ -.] 0 0 0 0 0 0 0 0 0 0 0 0 m Parcel I.D. # MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (9O7) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 050-601-22 1. GENERAL INFORMATION Complete legal description GLEN EAGLE SUBDIVISION: LOT 5. BLOCK 4 Location (site address or directions) 25854 CLEARING DRIVE Property owner Mailing address Lending agency Mailing address JANE KELLY Day phone c./o DECKLE BROCIES @ DYNAMIC PROPERTIES Day phone (907~ 261-7600 Agent DECKLE BROCIES @ DYNAMIC PROPERTIES Day phone Address .~111 O STREET. Ste. 100, ANCHORAGE, AK 99505 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xx Community well Public water NOTE: If community well system, provide wdtten confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xx Holding Tank, Community on-site Public sewer NOTE: If community wastewater system, provide wdtten confirmation from State ADEC lng to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $~jlll~ at, ] or prior to, closing for the engineering services provided. J 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. ~ 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone (907~ 337-6179 Address 6901 DEBARR ROAD, SUITE 2B ANCHORAGE, ALASKA 99504 Engineer's Signature Date In conducting this evaluation, At444,'C, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DHHS Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being sen/ed by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranO/ for futura estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or parry is not authorized, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE Y Approved for ~ bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments Date ~ ,/'7- E) ~ 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. 1191) Back MOA fl21 Computer Version RECEIVED Municipality of Anchorage DEPARTMENT Of HEALTH & HUMAN SERVICES Environmental Services Division _._ MUNICIPALITY 0['/~. 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4~i~ONMENTAL Health Authority Approval Checklist Legal Description: GLEN EAGLE SUBDIVISION; LOT 5, BLOCK 4 Parcel I.D.: A. WELL DATA Well Type PRIVATE Log present (Y/N) Total depth 61' Sanitary seal (Y/N) If A, B, or c, attabh ADEC letter. ADEC water system number Y Date completed 5-28-8,3 Cased to 61.5' YES FROM WELL LOG 5-28-8,3 20' Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION 4-10-2000 N/A 2'+ YES 050-601-22 2,3' 4 g.p.m. 4.7 g.p.m. ,-~' ~ ~ Other bacteria ~ (~ Collected by: A.W.W.C., INC. Nitrate Date of test Static water level Well production 1250 Number of Compartments 2 Cleanouts (y/N). Depression (Y/N) NO High water alarm (y/N) ' N/A Pumper JR's PUMPING Soil rating~r ft2/bdrm) 0.4 ,38' Gravel thickness below pipe Monitoring Tube present (Y/N) YES Depression overfield (Y/N) Results (Pass/Fail) PASS For 4 YES WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed 10-,3-92 Tank size Foundation cleanout (Y/N) YES Date of Pumping 4-10-2000 C. ABSORPTION FIELD DATA Date installed 10-,3-92 Length 40' Width Effective absorption area 1520 sq. ft. Date of adequacy test 4-10-2000 0 Immediately after 728 15 Absorption rate = NONE KNOWN If yes, give date System type MOUNDED BED 0.5' Total depth ,3.5' NO gal. water added (in.): __ 600+ GPD Fluid depth in absorption field before test (in.); Fluid depth 0 (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Computer Version Bedrooms D. LIFT STATION ~ Date installed Manhole/Access (Y/N) ~eVel at* "Pump off' level at* High wa~ *Datum ~C. yetes'"t-e st e d SepticJholding tank on lot Absorption field on lot Public sewer main Sewer/septic service line E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ 100'-F N/A 25'+ On adjacent lots 100% On adjacent lots 100'+ Public sewer manhola/cleanout N/A Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10'+ Surface water/drainage. 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: 10% Building foundation 10'+ 100'+ NONE KNOWN Absorption field 5'+ Wells on adjacent lots 100'+ Property line Surface water_ Curtain drain Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots 10'+ 10'+ lOO'+ F. ENGINEER'S CERTIF I certify that I of Municipal ~ecor~s with MOA H~A guld~/~ Signature ~ Engineer's Name Date .~//~ .~/09 eld inspections and review systems are in conformance ~n this date. JEFFREY A, GARNESS HAA Fee $ ,.~(~-O r (')~ Date of Payment Receipt Number ~-~ Zrc~ ~'~)) 72-026 (Rev, 3/98) ComputerVersfon Waiver Fee $ Date of Payment Receipt Number 04-25-00 16:16 FROM-CTE ENVIRONMENTAL ~t~.~ CT&E Environmental Services In~. 5615301 T-51B P.OZ/03 F-BOO CT&E Ret'.# Client Name Project Name/~ Client Sample ID Matrix Ordered By PWSID 1001672001 AK Water & Wastcwater Consultants ~c. Glen Eagle Lot 5 Bk 4 Glen Eagle Lot 5 Bk 4 Drinking WaIer Client PO~ Printed Date/Time 04/25~2000 13:55 Colleeled Dale/Tima 04/19/2-000 10:30 Received Da[e/Time fl4/20/2000 11 25 Technical Director Stephen C. Ede Sample Kemad~s: WATERS DEPT AttOual~.e Prq~ AnaLysis mej/L EpA 300.0 (<10) 04/20/00 SCL MICRO LAB TotaL cotiforn D4/ZO/O0 JDT 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 5; bloc~ 4; Glen Eagle Subdivision Location (site address or directions) The Clearing Property owner Mailing address Lending agency Mailing address David S. & Kar~n E. Mc Ilroy Day phone 694-5312 Wk: 265-6170 1612 Eaqle River Road, Eagl~ River, AR. 99577 Day phone Agent Re M_,,.,'. of EagC_e ~_iver Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well 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 NOTE: XX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72 025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/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. NameofFirm ~ ~ ~--~(r",J~~g/~' Phone ~:~-~2-~'/~ Address Engineer's signature Date DHHS SIGNATURE Y Approved for bedrooms. Disapproved. Conditional approval for 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 lendin9 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. 72~325 (Rev 1/91) Back MOA ¢21  Municipality of Anchorage ~i~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~/--- ~f ~ ~ ~ Parcel I.D. ~ ~'~ ~ (~ I'~--"~--- WELL DATA Well type'~¢ Log presenO/N Total depth Sanitary seal (Y~) If A, B, or C, attach ADEC letter. Date completed Cased to ADEC water system number 5- ~:~' ~"~'~ Driller--~7/ Casing height t ~."4- Wires properly protected/N) "--(// FROM WELL LOG Date of test / Static water level ~'~-'~ Well flow "~ '~ Pump level AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / Absorption field on lot [~ Public sewer main f'JorJ ~. Sewer service line \ ~ ' ~r Petroleum tank j,.JCpt-l~ IZ~,.J~2u..)i--~l - WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ~ ~ I/-'t -~7-~ '~.~ ¢v~./.~ . Other bacteria Collected by: ~ ~ ~ 4~1'~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts ~"~1) High water alarm (YN~) Date of pumping Tank size I '~ ~'-~;:~ ~-!4c:' ~ Compartments Fou halation cleanout~)"~ Depression (Y~ Alarm tested (Y/N) ~/h ~~- Pumper ~ ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I'~-~/ On adjacent lots I ~ ~'~ Foundation ¢:~ To property line 1 ~'~ I , Absorption field /~--'~ Water main/service line Surface water/drainage ,/~ ' ~ 72-026 (Rev 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION D/LS~CE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length ~r-O / Width :~M~:)l Total absorption area l ,~.~:~ ¢~ Depression over field (Y~.~ ~ Results (pass/fail) L.~ ~ t...[ '~'-7/~ ~ f'~ Soil rating O.~f_ ~I2p/~_..¢¢.._ Gravel thickness D,~-~~ Total depth Cleanouts present(~N) % Date of adequacy test ~--)/~ , for ~ · System type ~"~4:2'¢ t.-I ~ , Peroxide treatment (past 12 months) (Y~__~_ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~¢::~ ~.) i On adjacent lots To building foundation ~%1"~ I On adjacent lots Surface water 1(~_.) ! Curtain drain Ifyes, givedate ~/--~' Property line l~-~ / To existing or abandoned system on lot J O¢~- Cutbank ¢...10~ Water main/service line J~) /'4~ Driveway, parking/vehicle storage area ;::~ I bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. EFG E IN q,~*..~ 17334 Eagle River L~p Road No.~ . , ' HAA Fee $ /'~C) i ~ Waiver Fee: $ Date of Payment / ~ ~ ~,/~ ~ ~-~ Date of Payment Receipt Number ~'-/~//.-~'(//-/.,~//~'~ Receipt Number ~[T~AT~ ~ I 8 r~/1 ~PA 35~.~ ~P~BG~ Membo,~ el t~e SOS Oro~p ($OClet~ O~nOrelO de $urvell'ance) 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 264-4720 Application Date Nay 1, 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5; Block 4; Glen Eagle Subdivision _ Location (address or directions) (b) Applicant Name Dave McIlroy Telephone: Home 694-5312 Business 263-4872 Applicant Address 1612 Eaqle River Road, Eaql~e_ River, Alaska 99577 _ (c) Applicant is (check one): Lending Institution[]; Owner/builder[]; Buyer[]; Other[] (explain); _ (d) Lending Institution Alaska Mutual ~'elephone Address E~.g ].~e (e) Real Estate Company and Agent none/refinancin~ ............. Address Telephone (f) ~C~he HAA to the following address: S & S Engineering SRB 196X Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family[] Multi-Family[] Number of Bedrooms 4 Other WATER SUPPLY Individual Well [~ Community [] Public [] Note: If community well system, must have written confirmation from the State Departmenl 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 72 025(11/~4) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA'TA 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 turttler verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply arrd/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~,~..N[~,INrr. EP~NG Address .~R B 196X Date EAGLE RIVER, AK 99577 HAY II 1986 Approved for ~"~'~ bedrooms by .~'~.~,. Approved .... ,,,~__ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given ~n 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 o25 WELL DATA MUNICIPALITY OF ANCHORAGE (MO*,/ MUNICIpAUTY OF ~H AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTION. 264-4720 MAY ! 9 1986 Legal Description: ,Z.. ~' Z~ z.// RECEIVED Well Classification Well Log Present~,J~)' Total Depth ~,~/ i Static Water Level Casing Height Above Ground Electrical Wiring in Conduit ~/1~, Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed ~'-- Z; ,~ - ~ ~ Yield Cased to Depth of Grouting Pump Set At ,,~'-~' / Sanitary Seal on Casing~ Depression Around Wellhead't'~-~' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /Co / ~' ; On Adjoining Lots To Nearest Public Sewer Line /'"//,4-'! To Nearest Public Sewer Cleanout/Manhole w To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Stand pipes~F' 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 Wate~-M:!.'T/Service Line Size/~I~'''~:2 No. of Compartments Air-tight Ca ps~/~ Foundation Date Last Pumped "~'///~'- · for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field //~=~ / Course To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 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 Type of System Design ,Z'~ Length of Field ,~' / Depth of Field ~ x Gravel Bed Thickness // / Standpipes Presen~/Jq~' Date of Last Adequacy Test ,~'-~ ~'~'~:~ ~' To Water-line/Service Line ..~'D ¢ /- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~.~ To Cutbank (if present) '~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) ~Z// "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING Sig r~et¢ B,~ ]~6X Date _M. AY c°~i[.~.E ~iVEk, AK ~577 MOA No. Receipt NO. Date of Payment ~,- ~'~ Amount: $ ~:~%- Page 2 of 2 72-026 (11/84) Mailing Address APPLIC'NT FILLS OUT UPPER HA[' ")NLY Zip Code Phone Buyer Address Zip Code Lending Institution . Address Realty Co. & Agent Address Zip Code Zip Code Legal Description Type of Residence F~v Single Family "f~' Mulliple Family No. of Bedrooms I Olher Water~}. IndividualSUpply '[ '1 Community I~ Public Utility Sewer Disposal Phone Phone ATTACH WELL LOG A well Io9 m required for all wells drilled since June 1975 For wells drilled prior to that date, give well depth (attach log if available) g,J Individual Year Individual Installed /'~' '[ Public Utility When Connected to Public Utiiity: I I Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED Time Time Date Inspeclor Inspector Date Inspector Field Notes T~me Time k~% ' Date Date ~). -~' (. ~ ~ MUNICIPALITY OF ANCHORAGE RECEIVED 'C. ONDITIONS OF APPROVAl APPROVED BEDROOMS DISAPPROVED CONDITIONAL APPROVAL' Soils Rating , . ? ~m" * ) , Well to Tank / C; C, Septie~ank Siz~ I > ': > '