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Home My WebLink AboutGLENN VIEW ESTATES LT 10MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (967) 343-7997 httpalwww.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211231 �a Department Effective Date: 6/30/2021 -- ---Work Typ— e -Sep ic—TJpgrade Expiration -Date: -$13012022 --- Tax Code Number: 05152147000 Site Legal Address: GLENN VIEW ESTATES LT 10 G:1360 Site Mailing Address: 23435 GLENN HILL CIR, Chugiak Owner: STEIDING RICHARD P Lot Size in Sq Ft: 55052 Design Engineer: EKLUTNA ENGINEERING, LLC" Total Bedrooms: 1 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Ui C_a_ 'irL �'/ J Date: Date: _------------- Parcel ..____ Parcel I.D. 051-521-47 Property owner(s) STEIDING RICHARD P & WHITMORE LISA M Day phone Mailing address 23435 Glenn Hill Circle Chugiak . AK 99567 Site address 23435 Glenn Hill Circle Chugiak AK 99567 Legal description (Sub'd., Block & Lot) GLENN VIEW ESTATES LT 10 Legal description (Township, Range & Section) Lot Size 55,052 Sq. Ft. Number of Bedrooms 1 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Permit No. D S PP, 1 1-23 i Waiver No. Absorption Field Fx-1 Initial 0 Single Family (SF) 0 (w/ Septic Tank ❑ Upgrade ❑ _6 (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ 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. j (Signature of pMperty owner or authorized ag Permit/Rush Fees: 5 °l Date of Payment: Waiver Fees: Date of Payment: Receipt Number: 0 /310 L Receipt Number: Permit No. D S PP, 1 1-23 i Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211231, Rebecca Carroll, 06/30/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211231, Rebecca Carroll, 06/30/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211231, Rebecca Carroll, 06/30/21 MUNIcIPALITY oF ATcHoRAGEDevelopment Services DepartmentOn-Site Water & Wastewater SectionOwner's signaturePhone: 907-343-7904Fax: 907-343-7997Septic Svstem Owner-installerAqreementThe On-site Water and Wastewater Section (On-site) may issue an approval for a homeownerto perform work on an on-site wastewater disposal system to serve that individual's owner-occupied, single-family or duplex home if the homeowner meets and agrees to the followingrequirements:1. The property owner and excavation equipment operator may perform work on no morethan one owner-installation project in a 12-month period.2. Owner's projected active involvement with the installationI will be performing the instalationmyself3. The name of the excavation equipment operator: Rick Steiding4. I agree that there will be no monetary compensation for installation services rendered.5. The name of the inspecting engineer: Curtis Townsend6. I agree to discuss the following items with the inspecting engineer:a. Permit design criteria and specifications.b. lnspection requirements set forth in AMC 15.65.070.c. Advance notice given to the On-site Water & Wastewater Section for all requiredmunicipal inspections (AMC 1 5.65.070A).7. I agree to have the project-specific On-site Wastewater Disposal System Permit availableat the construction site for the duration of all related work.8. I agree that if the system is an advanced wastewater treatment system (AWWTS), I willobtain additional installation instructions and approval from the equipment distributor.As owner of (legal description\23,1){aL€NN HrcL Ct\ZCL€ CUu11/,4KI agree that the information above is true and accurateOwner's printed name. Rick SteidingDatezlrlru"-/Mailing Address: P. o. Box 196650 * Anchorage, Alaska gg519-6650 " www.muni.org Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-474.4 On-Site Wastewater Disposal System and/or Well Inspection Report N.m~: ~¢¢~¢¢ ~F~c//~ Wastewater System: ~New U Upgrade Address: ~o~ Sq~ ~/m~AK ~~ ABSORPTION FIELD Phone: ~_~ No. of Bedrooms:~ D Deep Trench ~ShallowTrench DBed ~Mound ~Other ~ Total Depth from original grade: LEGAL DESCRIPTION Soil Rating: 1,~ GPD/Sq. Ft. V~r¢ C~ Lot: Block: ~=bdiv~ion' ~ Depth to pipe boltom from original grade: Gravel depth beneath pipe_ Township: ~ Range: Section: Fill added above original grade: Gravel [ength: I WEL~: ~New g Upgrade Gravel width: Number of lines: Distance between lines: Classification P~{¢~(Private' A,B,C): Tota~D~:~__ I Ft. Cased~To: Ft. Total absorption area:~l~ ~ SQ. Ft. Pi~e~j~material: ~ Date~ Static Water Level: Installer: Date installed: Height Above Ground: Yield: Pump Set at: SEPARATION DISTANCES ~Septic D Holding ~ S.T.E.P. TO Septic Absorption Lifl Holding Public/Privat~ Manufactu~r~ ~ ~ Capacity in gall°ns: From Tank Field Statio~ Tank Sewer Lines . Well- lOOt+ jOO,+ -- -- Z5+ Material: ~e~ Number of Compadments: ~ Surface I Water /~0'+ /OD, ~ - /~ ~ LIFT STATION Lot ~ ~ · Manufacturer: Line 1~ /O ~ -- /~ t Size in gallons: Foundation J¢ ~ J O i~ ~- ~ ~ "Pump on" level ~~f" level at: High water alarm at: ~ ' ~ Pummel I ~ctri~l Inspections pedormed by: Drain Remarks: ~O ~ 0~~ ~. BENCH MARK Location and Description: J Assumed Elevation: /~ ~, ENGINEER'S SEAL Inspections pedormed by: ~ND Cn~em¢~ Dates: 1st It~/q~ Department of Healt~and Human~erviqes apIt /7 ¢ %%'00 c~7,,6 Reviewed and approved by: ~~ ~~ Date./2-Z-~ ~,,%. FEeS 72-013 (Rev. 9/91) MOA 25 i AS- T SYSTEM DETAILS?SITE PLAN ~~0' SLOPE EASEMENT PID~OSl-bat ~ LECB ELEC, EASEMENT A D=86,4' ~ o, ~ ~ ~ A-F=49,2' ~aso 5AL ~ 8 ~ d ]~ ~1250 GAL, ~, ~[ SEPTIC X ~9~,7~ / SCALE: N~S FINAL GRADE REX TURNER EAGLE RIVER, AK, 99577 ~ ~ peO~ssiOSbVV~ ARCTIC DEVCO, iNC, __~~ P,O, BOX 3489 (907)696 61ll/Fox (907)696-8111 PALMER, ALASKA 99645 ]ATE:II/I7/96 rev.ta/$/S6 ])RAWINO SCALE: AS NOTED 96051-S1 ~[( ~l 'D BNGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 ........... (90?)696-6rtl/FAX (907)696-81n November 2, 1996 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject~ RECEIVED NOV ~' 1~% Mu ~icipality ol Anch.,ora~e Dept. Health & Human ~erv ces New sewer/well permit - Lot 10, Glenn View Estates Gentlemen: During an inspection on the referenced lot, it was discovered that the contractor choose to use ABS, sch. 40, ASTM 628 solid pipe irt lieu of D3034. Based on a previous approval, on another project by your department, of this pipe and the Saturday installation the corttractor has p~'oceeded forward with the installation utilizing the AB$ pipe. If for some r~a,~on this posses a problem please advise immediately so that the issue can be resolved or corrections made. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ~KOd.mefh M. Duffu. s, P,E. Post-iP Fax Note 7671 ri .d,;~, o7.o..~5. one # NOV- 7--96 THU P. 01 9:5? ADDRESS LEGAL DESCR[PTION_~ DATE - Started PERMIT NUMBER KIND OF FORMATION: From_(") Fl, Io~a~L__ FL, From '~' Fi, to_ q From t I ,.~'.'o /~ From -'~ Fro~. ~ Fromm. Fo From ,~FL From _Ft. Fromm.. FL, From __Fl. From to____Ft,, to rFt, lo ,-Et, to Pt, lo lo , __FL, MISCL, INFORMATION: DEl'TH OF WELL STgTIC LEVEL OF WATER O ~ or~w ~own GALS. per ar __ KIND OF CASING FI, lo____ Fl Ft, to__~Ft. __ Ft. to . Ft. ~_Ft, lO FI. Fl, tO--- FL__ Frum__ FI. lo PI, From __Fl. Io__.__FL From~FI, From__ Fi', Io~__ From ~ Fl. From ~ From From From__ From From.__,Ft- to Ft Ft, lo_~Fl.~__ Fi.,~ Fl, Fl, DRI LLI~R'$ NAM£. -_~..-~ud,~~'~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960240 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:REX TURNER CONSTRUCTION OWNER ADDRESS:P.O. BOX 3489 PALMER, AK. 99645 PARCEL ID:05152126 LEGAL DESCRIPTION: T15N R1W SEC 10 SW COR NW4 (PROPOSED LOT 10, GLENN VIEW) LOT SIZE: 53356 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: DATE ISSUED: 8/08/96 EXPIRATION DATE: 8/08/97 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~ ISSUED BY: KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 July 25, 1996 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 9951%6650 Subject: New sewer/well permit NW 1/4, Sec. 10, T15N, R1W (Proposed Lot 10, Glenn View S/D) Gentlemen: On July 18, 1996, we excavated two new testholes for the subject property. There are two previous testholes which were dug during the preliminary plat process, however they were not suitably located for the four bedroom house which is proposed for this lot. The results of these tests and water monitoring are attached. This parcel is currently in the final stages of subdividing. We are designing the system using only area designated in the preliminary plat for Lot 10. No other development has occurred on this parcel of land. We propose to install very shallow 5' wide trenches; the flow will be evenly divided using an approved splitting device. Additional fill will be placed over the system to provide a minimum of 3' of cover when complete. There are no public or private wells within 200' of our proposed system location. There is neither surface water within 100' nor any curtain drain within 50'. We do not expect that there will be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ~I~ Engineering Kenneth M. Dufffts/P.E. attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test SITE P AN WASTEWATER ]3ISPBSAL SYSTEM NW4~ SEC, ]0, T~SN~ PRBP[]SE~ LET ~0, GLENN VIEW ESTATES S/D PROPOSED SLOPE ENENT TELECOM ELEC. EASEMENT VACANT PROPOSED PRIMARY SYSTEM SED RESERVE VACANT LOT 3 GREATLAND ESTATES LOT 4 GREATLAN[} ESTATES DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD 600 GPD/1.2 GPD PER SQ. FI'. - 500 SQ. FT 500/5' X .70 R,F'. <2.0' GRAVEl ) 70 FT. TRENCH Total depth oF system is 3.0' Frm orioina[ 9r~de. NB1-ES: USE SPLITTER TB EVENLY DIVIDE FLBW INTO TWFJ TRENCHES. 2. USE 1250 GALLON SEPTIC TANK. INSULATE TANK IF <4' CI]VFR. 3. INSULATE TRENCHES WITil 2' lid BURIAL F'I]AN.. 4. CL1NI'RACTBR WILL ENSURE MAXIMUM 2Y. SLBPE INTB SEPTIC TANK. 5, ADDITIONAL_ FILL WILL DE ADDED OVER SYSTEM 'FO ACNIEVE HIM, 3' CUVER, PREPARED FE]R: REX 'rURNER ARCTIC DEVCH, ~NC. P,13, BOX 3489 PALMER, ALASKA 99645 KND ENGINEERING ?_0441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 (907)696-6111/Yox (907)696 PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST .%~:~'(~ /¢ ~/Township, Range, Section: 1 2 3 4- 5- 6- 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth Io Waler A~ler/,~ f~oniloring? Gross Net Depth to Net Reading Date Time Time Water Drop ~ ~,:~ / 6 ~/ ~/~ PERCOLATION RATE __ TEST RUN BETWEEN /' ~ (minutes/tach/ PERC HOLE DIAMETER ~ ?/ /' (") FT AND ~-. O F'r *E,EO,MEOB,: ,,/,';~ g-,~.~,,.~ ~ ,4"~ b,. -£~¢_~ _ O~R.,~. Tx^T T~S T~ST WAS ,ER.O ACCORDANCE WITH ALL STA"~E AND MUNI~/AL GUIDELINES IN'EFFECT O" TNIS DATE, DATE: ~..~.~_~ 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ~ ~ /0~ / /~ Township, Range, Section: OEPTH /~/- l SLOPE 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? p E PePthtowaterAlter / f~onitorJng? ~ Date: SITE PLAN A Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE /'~-¢ (m~nutes/tnch) PERC HOLE DIAMETER ~ // TEST .U, .ETWEEN ~'~' ¢ ,T AND ¢/' J ,T ACCORDANCE WITH ALL STATE ANDMUNI~C'ALGUIDELINES~N EFFECT ON THIS DATE, DATE: _ 72-008 (Rev. 4/85) Municipality o{ Anchorage 825 "L" Street Anchora e Al , g , aska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRrPTION: ~N ~/~ ~5 Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SLOPE SITE PLAN J WAS GROUND WATER ENCOUNTERED? ~//~5 S IF YES, AT WHAT L DEPTH? p E Oepll] lo Water After i! - Reading Date ~ross Nar Depth to Net Tim,] Time Water Drop / ~//,//?~ ~o~ 2- ~' z/:-~5 1:$5 ~." ~', Z ' /: ~ 0" Z" q . /:~ 0,, ~,, TEST RUM BETWEEN PERCOLATION RATE ~- / (mmutes/,nch) PERC HOLE DIAMETER ~// · FT AND ~ __ FT PERFORMED BY: -- ---- ' -:,/,-~- --~'-~--- ~ CERTIFY THAT THIS TEST WA~ PERFORMED IN ACCOROANCE WITH ALL STATE ANO MUNiCiPAL GUiDELiNES iN EFFECTON TH,S DATE. DATE. 12-008 (Rev Municipality of A~lchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Township, Range, Section: ~/¢~ ~/~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT 0 OEPTFI? p E Oeplh (o Waler Al~er Mmliloring? ~c~ ?,,~/ I I ! I ! ! Reading Date Gross Net Oe~th to Net '~me Time Water Drop I o~,1/~,1c75 I/,'~L~ 3 ' 37 D" PERCOLATION RATE ~ / (m,nules/,nch) PERC HOLE DIAMETER r ~ ~ TEST RUN BETWEEN ~'~ ~ FT AND _ PERFORMED BY: ~ ~ ~ ~ I ~ CERTIFY THAT TPI[S TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATEANO MUNICIPAL GUIOELINES~N EFFECT ON THIS DATE. DATE .... Parcel I.D. # MUNICIPALITY OF ANCHORAGE /,1~1~.~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 1. GENERAL INFORMATION Complete legal description GLEN VIEW ESTATES SUBDIVISION: LOT 10. BLOCK 1, Location (site address or directions) 25455 GLEN HILL CIRCLE CHUGIAK. AK 99567 Property owner Mailing address Lending agency Mailing address ALAN & JANET BECKE'FI- p.O. BOX 671757 CHUGIAK. AK 99567 Day phone (907) 688-6482 Day phone Agent CAROL BENNETI- W/ FORTUNE PROPERTIES Day phone Address 2525 "c" STREET SUITE 100 99505 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: (907) 265-9115 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. 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 ing 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 $1000.00 at, or prior to, closing for the engineering ser~4ces prot4ded. I 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedf7 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 inspe..etion, the on-site water supply and/er wastewater disposal system is in compliance with all Municipal.~nd State codes, ordinances, and regulations in effect on the date of this inspection.~ ,?,/ Name of Firm ALASKA V~ATER &/~AST, F~VATER CONSULTANTS, INC. Phone (907') 337-6179 Address 6901 DEBARR ~OAD/S~I~'E/~B~ANc~HORAGE, ALASKA 99504 / / Engineer's Signature ~, ~J~//j~,,~b~/~ Date_ system in accordance with ADEC and MOS DI'~ItflS 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 sei~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 warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report ie for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or patty is not authorized, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE ~ Approved for L.J- bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~///Z/, ~-~,,,~ //.~/ ~ Date. ~ ' ~-~ o 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/gl) Back MOA #21 Computer Version Legal Description: A. WELL DATA Well Type PRIVATE Log present (Y/N) Total depth 259' Sanitary seal (Y/N) i zCEIVtZD Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERV~(.;~-~;2,, Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Health Authority ApprOval Checklist GLEN VIEW ESTATES S/D; LOT 10, BK 1, ParcelI.D.: If A, B, or C, attach ADEC letter. ADEC water system number YES Date completed Cased to 259' YES 051-521-26 FROM WELL LOG 9/96 Date of test Static water level 145' Well production 30 g.p.m. WATER SAMPLE RESULTS: Coliform ~)' Nitrate Date of sample: 7/26/00 B. SEPTIC/HOLDING TANK DATA Date installed 11/2/96 Tank size Foundation cleanout (Y/N). YES Date of Pumping 7/26/00 C. ABSORPTION FIELD DATA Date installed 11/2/96 Length 72' Width 9/96 Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION 7/26/00 148' 8.8 +/- N/A 2'+ YES /. z/~ ~,.,~ ,//_ Other bacteda - O ' Collected by: A.W.W.C., INC. i250 Number of Compartments 2 Cleanouts (Y/N) Depression (Y/N) NO High water alarm (Y/N) N/A Pumper JR'S PUMPING Soil rating ~or fi2/bdrm) 1.2 System type. TRENCH 7'-8' Gravel thickness below pipe 2' Total depth 5'-6' g.p.m. Effective absorption area 514 SQ. FT. Monitoring Tube present (Y/N) YES Depression over field (Y/N) Date of adequacy test 7/26/00 Results (Pass/Fail) PASSED For 4 Absorption rate = NONE KNOWN If yes, give date YES immediately after 1230 gal. water added (in.): 600+ 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 NO Bedrooms D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" leve~'-Ievel at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line 100% 100'+ N/A 25'+ On adjacent lots__ 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT 'TO: Foundation 5'+ Property line 5% Absorption field 5'+ Water main/service line 10'+ Surface wateddrainage 100% Wells on adjacent lots 100% SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main/service line 10% Surface water 100'+ Driveway, parking/vehicle storage area 10% Curtain drain NONE KNOWN F. ENGINEER'S CERTIFI/I: I certify that I/h~ dot~r of Municipa~ recor with MOA l~ gL ~eJ~nj Signature ~ Engineer's Name~ ' Date ~ field inspections and review ~,/e~( ~ systems are in conformance ~.j/f eff~ on this date. [ dEaF REY--A:OARNESS Wells on adjacent lots 100% .......... HM Fee $ ,3 Data of Payment Receipt Number 72-026 (Rev. 3/96)* Computer Version Waiver Fee $ Date of Payment Receipt Number 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.# ~::)~/- ~'~-/--2~ HAA# 1, GENERAL INFORMATION Complete legal description /-.~,Jr Location (site address or directions) Property owner' Mailing address Lending agency Mailing address Day phone 7/'/~' - (cO(DO Day phone Agent 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: X 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: X 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. Name of Firm I~ID Engineerirlg Phone (~?& -L/Il F arm n vd. Address ~agle River, AK Engineer's signature //~. ~~ Date ///~/~ Approved for ¢ Disapproved. Conditional approval for bedrooms. DHHS SIGNATURE bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and State requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA~/21 I~NVIRONMENYAL ~,ER. VICE8 DIVISION Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA ' Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist L, oJr lb ~l~n VI'du..) _~:..%1L Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date of test Static water level _ Well production WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed II/I/~ Foundation cleanout (Y/N) Date of Pumping Date completed Cased to ~, ~2~' ¢ Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION _ q/q4 '",,,. g.p.m. g.p.m. Nitrate 4~), ~ I ~ Other bacteria COllected by: /(N~ E~r~,.~ I¢1C~ ¢'1'.~¢ Tank size /~,.5~ Number of Compartments ~2~ Cleanouts (Y/N) . '~/ Depression (Y/N) High water alarm (Y/N) ~ Pumper C. ABSORPTION FIELD DATA Date installed Length ~,~., ~ Width Effective absorption area Soil rating (g.p.d./fF ~ I. '~, System type 7~'~4~ Gravel thickness below pipe ~.,' '~ Total depth ~rl~l~p ~MonitoringTubepresent(Y/N) ¥ , Depression over field (Y/N) Date of ~// Results (Pass/Fail)/z/. adequacy test Fluid depth in absorpti~eld before test (in.); /~mediately after Fluid depth / (ins) Minutes later: / Absorption rate = Peroxide tr~ment (past 12 months)(Y/N)// 72-026 (Rev. 3/96)* For / __ gal. water~ded (in.): __ g.p.d. If yes, give da ,.tO/ / bedrooms LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons / ump on" level at* / '~'Pump" off" level at* *Datum E. SEPARATION DISTANCES F. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station /V/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ! O ~ +' Water main/service line Propertyline 1 0 4- Absorption field J 0 4- Surface water/drainage I00 -4- Wells on adjacent lets [00 -~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ~ O ~ 4- Building foundation I O ~ ~r Water main/s,er~ice line Surface water /~)O~ 4- Driveway, parking/vehicle storage area ,/ Curtain drain '~ ~-~:)~ 4. Wells on adjacent lots ENGINEER'S CERTIFICATION I certi~thatlhave determined thrufield inspections andreviewof Monicipalroco~,~ in conformance wire MOA HAA guidelines in effect on this date. Signature Engineer's Name ~n~'~ ~. ~,~ /--- HAA Fee $_ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number