Loading...
HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK A LT 5 REMGlacier View He40 ights Block A Lot 5 REM #050-501-13 etvam n MUNICIPALITY OF ANCHORAGE 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 'k�'V\w4 C. PHONE � _ m - NEW ❑ UPGRADE MAILING ADDRESS '19% LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Uy DISTANCE TO: Well �� Absorption area ��1 Dwelling �O PERMIT NO. —r `SoA-I c aZ W < Manufacturer Awc " Material - No, of compartments ti Liq. capacity in gallons � 0 IF HOMEMADE: Inside length 1 � 1 Width Liquid depth CMZ DISTANCE TO: Well Dwelling PERMIT NO. _ H Manufacturer- Material Liquid capacity in gallons in -,W= DISTANCE TO: Well \ Foundation 8Q Nearest lot line -1- \ l7 PERMIT NO. ,f -IBid4-GI6 J LL Z Z w No. of lines I Length of each line J Total length of lines -i Trench width inches Distance between lines f Top of file to finish grade 4` © Material beneath file ! 6 t� inches Total effective at1sorpt'i6 area `��--%�., U) Length Width Depth PERMIT NO. QF• a Wa Type of crib Crib d'a ei Crib depth Total effective absorption area W tw DISTANCE TO: Well Building foundation Nearest lot line JQlass� J ` t Depth Driller Distance to lot line PERMIT NO. -Xo W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIP MATERIALS SOIL TEST RATING �� p A INSTALLER REMARKS AD LJ 4 tl O 3 i` Q` 0 OVED DATE LEGAL r � IL.j r-4 .1! 1= F� L..�.:lf: -y"`� ` uv.:� p DEPORTMENT Or HHEALTHfl'TH AND ENVIRONMENTAL -'1_r"fEU'l Iia SA�t -'925 S'TREE'T': FiNCHORF•IGE, AK. % d : .f - »Y`"� �,'y ..yam } ' r•. F'!1 n" 1� tl . �... Y " ;,1••• FZ," P4 Fi" w.". f''I , P£;RTI T No. r APPLICANT HARRYf'ICiCH.�;'T SR 1;'t�_ X A-1 51i (yliUG I RK i LEGAL. 1.25 f H fiG..FI{:I ER '� I E.1�i gr+1✓lBD L.0T 5.1 -2500xJ_I k" FEET /�} r� !TYPE OF SOIL. FIC,SORBTION SY'�:.'TEM t::: 'TRENCH - �0 4 :OIL.. RATING +. � FT/BR -�. r MF+;f I MLIM ear iMPER OF BEDROOMS , REQUIRED SIZE THE SOIL. iiC kr1F'!1"C"I�iP.} �•r 'fiE:t9 x' THE ,may. tl..,i^:.. �ti.� Il..... P✓:,:_• d ✓"IF RAv B'"'� II7:'iA ..... �W� iii B ' na R..''�".^. &.:.....^ ""P 6`➢ sa'" E,.r ! 1 0 THE LENGTH LyIt9EN.a:tON IS THE LENGTH tIP•a F='EC«:"f) OF `1"Hfs' TR1:NruH C1h;' Dk".1=ilhaF'IE[_.C}, THE DEPTH OF A TRENCH OR PIT 15 THE D I S'I'r tPdt:1:BETWEEN THE: SI.3FiC41=10E OF THE GROUND AND THE;: t3(:a'1IT-It-1 OF THE ?:Fa FEET). THERE 15 NO SET WIDTH FOR TRFNC:H1„.'S. THE. GRAVEs.L. DEPTH I' THE MIt41MUM DEPTH OF GRAVEL, BETWEEN THE OUiFFi}._L PIPE AND THE BOTTOM OF THE E�:C;Fi'+'Eii'1CrP� (IN FF'E�1 T?, } 'f l "�' 2 a.3 F''d I__. E— 0 0�1I t, - `PERMIT APPLICANT HAS THE RE:SPONSIBIL:I:TY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TCS THIS PROPERTY AN[) THE ,NUMBER OF RE51 DENQE S THAI'' `� �-+,.. v.n.... ~� �.11"Q nr..Y �:✓ F. -I ,.^ THE wv tl NELL- WILL ILL . SERVE. E*V . C.NFT IPA. INSPEG-TION �PPI APPROVAL. gR Bti aN 3Y Q{ THIS HIS AAY I__IaG +7F ANY a4""ET WITHOUT ...}I ✓..✓.. rte., v-.. DEPARTMENT WILL SE SUBJECT TO PROS k:C MINIMUM DISTAt'CE. BETWEEN H WM'Ll. AND ANY ON—SITE SEWAG[:. DISPOSAL SYSTEM 1.5 100 FEET FOR A PRIVATE WELL; OR :T 50 TO 200 FEET FROM A F'UBLIC'NELL. DEPENDING UPON TETE: TYPE CI}" F'UE�i.,I�::: !�a!•_:L.L. JIEL.L LOGS ARE REQUIRED AND MUST BE RETURNED 'TO THE: DEPARTMENT NT WITHIN 0 [JAYS OF THE WELL CQMPLETIGta. ';OTHER REQUIREMENTS MAY APPLY. E:PEC.IF"ICATIOW, AND C`ON :TRIIi':t'1i�PJ CkiNC;F'Eit9` FIRE i AVAILABLE TO INS -URE PROPEpp� R I N5,Tfityn.-.LAT ION, �'P-.. �'� �4 � � .nya 11.+u n ;tl �rt �✓ Y tl� �..•i. 'r•.. ntl F^4'" Yn,..x $w^ �a �w� L Y.n.,r �p .e.:K✓ .� xA .a+Q.. 0.��'M� N•y�e I CERTIFY THA4T :I.: I FTM FAMILIAR: WITH THE: REGTU1REVIEN'T:+ FOPr_lta '�I'1'E: SEWERS AND b1FLL5 A'S SET ' F �7RTH BY THE MUNI(:IPAt...ITY OF ANC.�HORAQE. =f: is WILL. IN -STALL. THE SYSTEM :IN hiCL:Cr1=DANC;E WITH THE C:l'TGEau. i-�ND THAT THE ON—SITE..^ E t4E=.F� SYSTEM MAY REQUIRE E NL.AROE ME:NT IF' THE I +.TeaI�E Fy` r'f RESIDENCE 15 REMODELED TO INCLUDE MORE THAN E?EDROCyMSf Sl GNED APPLICANT HfaRRY t' ACKE,-:Y f ISSUED 'T 1*, k 1' '' i IV SOILS LOG � �, MUNICIPALITY OF ANCHORAGE ❑ PERCOLATION " ry +� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST Pouch 6650, Anchorage, Alaska 99502 276-2221 SOILS LOG - PERCOLATION TEST PERFORMED FOR: fl.-f2RY A kkE DATE PERFORMED: LEGAL DESCRIPTION: )^ ar ' Ol K A �.L�C 1f�%�, ' ' EL., o1 SLOPE SITE PLAN 1 2 3- 456 4- 5- 6 7- 8 9- 1011 10-- 11 12 13- 14- 15- 16- 17 314151617 18 19 PEAT eo 151L -7Y OwAU6- 64zp,Y s�)VDY GyiZa6�7,?%pass" y7 z -) WAS GROUND WATERS ENCOUNTERED? „/�,0 P E IF YES, AT WHAT DEPTH? mil 1-HlaffujFr`l Reading Date Gross Time Net Time Depth to Water Net Drop 20 -goo®��®�®- PERCOLATION RATEA915 / Lir�� Z (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS SL.pP/NPr -M 1N' OHRAY YyWpl yffi :RJUA INEDlum PERFORMED BY: dr+ CERTIFIED BY: DATE: 72-008 (7/76) 41 f1 OuL Lot 5, Blk A. Glacier View Terrace Eagle River, Alaska Driller: Harry A. Mackey Owners: Richard and Ruth Sease Soil 0-3 feet. Sand and gravel mix to 6 feet. Silt and boulders to 41 feet. Sand and gravel to 57, very little water. Boulders, 62 feet gray shale to 74 feet. Gravel 75 feet bedrock 9 feet thru gravel and silt down to 103. Some more water. 20 bales at 100 feet. Drilled down to 118 feet. Pulled casing back to 1091 611. Water 7 gal per min. for 1 hour. Good well. Static level 68 feet. Municipality of Anchorage Development Services Department Building Safety Division = On -Site Water and Wastewater Program 4700 Bragaw Street folr; P.O. Box 196650 ` Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. t750' 561- 13 COSA # (XcbAP­'7 Expiration Date: — /9 _0a 1. GENERAL INFORMATION Qtm Complete legal description Lot 5 Block A Glacier View Hts Location (site address) 23009 Eagle River Road, Eagle River, AK 99577 Current Property owner(s) Don & Ann Brock Day phone 694-5566 Mailing address 23009 Eagle River Road, Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 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 On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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, 1 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. 1 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 Pannone Engineering Services, LLC Phone 272.8218 Address P.O. Box 102954 Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone. P.E. _ Date 615105 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water•�•`� Qf /V 444 levels that may fluctuate during the year, and the water usage of the family being served by the system • `pp • "^ •�� These conditions are outside the control of the evaluator of this system All systems eventually fail and 7 �y satisfactory lest results do not guarantee future performance of the system, nor do they guarantee that C C� 49TH :k j �0 there are no hidden defects or encroachments. PES can therefore not provide any warranty for future ...���.....,..dddd-00 performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed even R. Yunnone above. Any reliance upon or use of this report by any other person or party is not authorized nor will ita9� `� confer any legal right whatsoever. �aE--^��'F'' rS.� • S. DSD SIGNATURE aaaal ----551�•• Approved for __q__ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ON-SITE .• nTr1 AIATCD Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By; Original Certificate Date: 1/6 (Rw. 11g5) Municipality of Anchorage • Development Services Department Building Safety Division OnSlte Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsits (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: lot 5 Bk A Glacier New Heights Parcel ID:_ Q 15-0 - S'd /.- i 3 A. WELL DATA Web type P Date completed _ d-ff Total depth _11t -ft. Date of test Static water level If A B. or C provide PWSID # _ Well Log (YIN) N Sanitary seal (YM) Y Wires popery protected (YIN) _ Cased tD _JQLR FROM WELL LOG 1275 `75 68 ft. Well production 7 g.p.m. WATER SAMPLE RESULTS: J Coliform — colonies/100 mL Nitrst OA2 inglL Arsenic: &D mgA Date of sample: 612 S. SEPTICIHOLDING TANK DATA Tank Type/Material Anchorage Tank SteN Tank size 1250 gal. Number of Compartments j Casing height (above ground) 12+ in. AT INSPECTION 512512006 96 It. 2.5 g.p.m. Other bacteria 2 L::1_0olonies/100 mL Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) K High water alarm (Y/N) WA Date of pumping 5125@006 Pumper Xs Pumping C. ABSORPTION FIELD DATA Date installed 9=978 Soil rating (g.p.d.W or ft /bdrm) 85 System type Deeo Trench Length 35 ft. Width 1 R Gravel below pipe 6 ft. Total depth 12A ft. Eff. absorption area 4&fe Monitoring tube Y Depression over field y Date of adequacy test 51258006 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 4 in. Elapsed Time: M min. Final fluid depth 4 in. Water added§N gal. New depthjj in. Absorption rate >= M g.p.d. Any rejuvenation heah. ant (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. Datum Size in s 'Pump ofr level Cycles E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankpiR station on lot 125 Absorption field on lot 110+ Public sewer main 100+ Sewer /septic service line 25+ Manhole/Access (Y/N) High water alarm level at alarm & circuit requirements? On adjacent kris 100+ On adjacent lots IW+ Public sewer manhole/cleanout 100+ Holding tank 100+ Animal containment areas 100+ Manureianimal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 10+ Absorption field 10+ Water main 100+ Water service line _25+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ • Water main 100+ Water Service line 25+ Surface water 100+ Driveway, parkinghrehide storage 10+ Curtain drain None Observed Wells on adjacent kits100+_ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 oer* 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. Engineer's Printed Name Steven It Pannone. P.E. .Sze. -en K. ForronR ♦ J, r1CE 8161 r Date C^ �i�C(c�+++"'?)'{�r:•' COSA Fee $ X30 ' db Date of Payment _ 068 4 Receipt Number (Rev. I I=) Waiver Fee $ Date of Payment Receipt Number in. FROM : PANNOhE ENG SVC PHONE NO. : 272 8218 Jun. 12 2026 06:47PM P1 /03. S ' WEL4recp --jN Ate'\ #gy's£Se'a 1~ Tj • I v 1 \�1a`l��iilt■' i% 'C :: s� S a: a m � F =� Baa •.,%•� ' m ' m g s^ i o' 3 e i 8 u P I'• T I j: I O !Qe 0. um a N 124, W �a� m I 0 I �,' /,�q C6-07-06;20;03 ; w-%-7tt-s3 ;907 561 6301 9 2/ d SCS ReEN 1062626001 All Daterrrlmea ate Aloka Standard Tim COcat llama Pwvwc Eng. Sm. Pr(atcd DetcNime 061062006 1521 Project Nameh Lot 7 Elk A Gloeler View Ht3. CollceMd Datdnm 03252006 12;45 CtItat Srmplo 1D Lot S SIR A Glacier View HM Reeelred DoUrrIme 0!•2512006 15:00 Matrix DrinklnRWe= TwfindealDlreeaoe steobeaC.Sdr PWS1D 0 Summa Ranarl:a: AllowNe hep Amlysb Pararcter Results ML Vnkt MmW Cmugw lD LbnN .Deto Dcto Intl Metals by ICY/M9 Amnio ND SAC OWL EMU C (<-10) 0326106 00206 SCL Water* Department witnteN 0373 0.100 MVL EPA 3531 D (oIol 05/23/06 ALR Microbiology Laboratory Total Coli form 0 901/120ML SM2092= A ("D 0525106 TLP A. 0 tA) �1 S'. 5'6/50.07 �,Pc-c l T _ O a t 6/0 '77 V MM U-9 J o00M �l Iv v Y ASW L/,VLA S. 5r VZ6'o5"E• L4 -, Ci � r;1r mm ,EACG F o� z � • a g gw tl a� - o 8i�EE fn 0 Op as N O \` X r ^� � moi• p I) � O •• ; ~ � �' O /��• • • ,':O • •7�� 5 1= ' 0- �'ii o o bya 77 Afl.� \ = V 1�. w w : S' �a + a o ♦f+�ref'�— i 0 \ �\ y +• _ s j•.�' e s Q C Municipality of Anchorage Development Services Department =�.�� •� Building Safety Division,ram blk, Onsite Water and Wastewater Program 4700 South Bragaw St. • P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Steve Pannone Legal description: Glacier View Heights REM Block A Lot 5 The attached paperwork has been reviewed and Is being returned for the following reasons: ❑ Original signature or stamp missing on ❑ Calculation error in design. _ ❑ Additional soils information needed. _ ❑ Water monitoring results Inadequate. ® Discrepancy in information submitted. Survey scales less than 100 feet well to tank ❑ Topographic Information missing or inadequate. ❑ Incomplete; missing ❑ Incomplete; missing — ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. ,_ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. _ ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. ❑ Omission in narrative. _ ❑ Insufficient fill over tank or field._ ❑ Other. Name of reviewer: Poet Date: 6-15-06 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK I MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services CIPALITYOFANCHORAGE On -Site Services Section ENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 OCT 01 1997 CERTIFICATE OF HEALTH AUTHORITY RECEIVED � "� ^ D APPROVAL FOR l• A SINGLE FAMILY DWELLING y Parcel I.D. # HAA #�� 1. GENERAL INFORMATION Complete legal description Lot 5; Block A; Glacier View Heights V Location (site address or directions) 23009 Eagle River Rd Eagle River, AK property -owner ' X Eric & Barbara Beck Day phone 696-6978 Mailing. `address, 23009 Eagle River;Rd. Eagle River, AK 99577 ending agency Day phone ., L Mailing address Agent Kat i Olmstead Remax of Eagle RivEDay phone 694-4200 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 v 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) 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 S & S ENGINEERING Phone17034 Edgle Rivem Loop Road No. 204 Address Eagle River, Alaska 99577 9 /. 1 �0 Engineer's signature 6. DHHS SIGNATURE X Approved for -4 bedrooms. Disapproved. Conditional approval for Additional Comments By: WTln Date 113 C7 / g bedrooms, with the following stipulations: Date /i� —14 —Z7 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 orderto 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 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIC5&NICJpALIiy0FANCmc) Environmental Services Division ENVtRONMEMgLSERVICESD! 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 story OCT 01 1997 Health Authority Approval Checklist VIE.) RECEIVED Legal Description: Y"�r r,- BLo IC �q Parcel I.D.: A. WELL DATA Well type iPgol VA -,'E- If A, B, or C, attach ADEC letter. ADEC water system number pXLI-Yuw OV -0' aA-:.k saw Log present (Y& 0L Date completed Ale" Total depth i It Cased to i ��� Casing height (above ground) I [ + Sanitary sealY/) i✓ .'� Wires properly protected(?V) FROM WELL LOG Date of test i 9 j - f Static water level i �7 Well production 9•p•m- WATER SAMPLE RESULTS: Coliform C AT INSPECTION 01 ©,i - sA jj Nitrated Other bacteria Date of sample: q1_ ` a Collected by: SEPTIC/HOLDING TANK DATA g.p.m. !t �^ S & S ENGINEERING 1 G,('NW4 17034 €afire River Loop Roa$No. 204 Eagle River, Alaska 99577 Date installed %Z Tank size 150 Number of Compartments iL Cleanouts &N) Foundation cleanout&I), u Depression (Y4I JJC) High water alarm (Y/N) !v Date of Pumping ?L hL 77 Pumper :Z-�� C. ABSORPTION FIELD DATA Date installed "A Soil rating (g.p.d./ft2orft2/bdrm) J IPS System type ��IiJCi} /n pipe�— Total depth Length '_Width �� Gravel thickness below f Effective absorption area 4-A `%" Monitoring Tube present &Y N)Ap-- Depression over field (Yo Date of adequacy test Resultsass Fail) "� For 50 Z bedrooms n Fluid depth in absorption field before test (in.); 1)9 ( Immediately after 610 gal. water added (in.): vZ I Fluid depth 'Q-'1 (ins) Minutes later: 7)C) Absorption rate = Me) g.p.d. Peroxide treatment (past 12 months) (Y/N) Vote{ KNoz}>J If yes, give date 72-026 (Rev. 3/96)` D. TIFTSTATION Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot _ 100,+ On adjacent lots Absorption field on lot _ thoe4 On adjacent lots 160 Public sewer main Public sewer manhole/cleanout f d0 +t Sewer /septic service line Z S Lift station 100 1 + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation S Property line 5 �� Absorption field Water main/service line 10 � Surface water/drainage I hea r � Wells on adjacent lots I ry r1 I fi SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line in � 4- Building foundation CO 1 )_ Water main/service line to,i Surface water 100 1 _ Driveway, parking/vehicle storage area 614 Curtain drainlJtLlN - K W WN Wells on adjacent lots 1004 F. ENGINEER'S CERTIFICATION .^� OF I certify that I have determined thru field inspections and review of Municipal rec�I t(� rmgi m: in conformance with MOA H A elin in effect on this date. C9 �"%AV -� Signature * r th Engineer's Name / .2 i �. C6 11/4N • .... A ROBERT C. COWAN 1:7 CE - 8801 ?� Date i/�o Ifl7 HAA Fee $ d60 - Date of Payment _ Z()/M2;;Z_- Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number are 7&E Ref.R ,lient Name Yoject Name/R Ment Sample ID Qatrix )rdered By IWSIID CT&E Environmental Services Inc. �rsiar�aii 975841001 S & S Engineering L5, BA Glacier View Hts L5, 13A Glacier View Hts Drinking Water 0 Client POR Printed Date/Time 09/29/97 12:09 Collected Date/Time 09/26/97 15:30 Received Date/Time 09/26/97 08:25 Technical Director: Stephen C. Ede Released By Allowable Prep Analysis 'arameter Results POL Units Method LiMits Date Date tnit itrate-N 0.592 0.100 MQ/L EPA 300.0 10 max 09/26/97 GCP otal Coliform 0.00 col/100mL smia 92220 09/26/97 TMl1 TOTPL P.02 CT&E Environmental Services Inc. CT&E Ref.# 975841001 Client Name S & S Engineering Project Name/!t 15, BA Glacier 'View lits Client Sample ID L5, BA Glacier View Hts Matrix Drinking Water Ordered By PWSED 0 Corrected report for Nitrate. Client POH Printed Date/Time 10/06/97 13:53 Collected Date/Time 09/26/97 15:30 Received Date/Time 09/26/97 08:25 Technical Director: Stephen C. Ede Released By Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Nitrate -N 0.134 Total Coliform 0.00 0.100 mg/L EPA 300.0 10 max 09/26/97 GCA 001/100ML SM18 92228 09/26/97 114W TOTAL P.03 MUNICIPALITY OF ANCHORAGE�� • T DEPARTMENT OF HEALTH & HUMAN SERVICES M Division of Environmental Servicesjj 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. # n6c)- - I 'I HAA # � 1. GENERAL INFORMATION Complete legal description Lot 5; Block A; Glacier View Heights Subdivision Location (site address or directions) Mile 4 6 Eagle River Road, Eag1P RivPrg Alaska Property owner Richard and Ruth Sease Day phone 694-4082 Mailing address P.O. Box 771003, Eagle River, Alaska 99577 Lending agency Mailing add Day phone Agent Jean Locke/DON MCKENZIE REAL ESTATE Day phone 69479035 Address 13135 Old Glenn Highway, Suite 100, Eagle River, Alaska 99577 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: 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 XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 921 u 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 17034 Eagle River Loop Road No. 204 Address Eagle Rimer Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. Date (-r-" ke_e�Z bedrooms, with the following stipulations: 11ITir 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 921 v Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �T S 6>1 A` �1(,pr� r F 2' Parcel I.D. A. WELL DATA Well type P��`�.n�ti: If A, B, or C, attach ADEC letter. ADEC water system number Log present N) Date completed � Q?g Driller �y Total depth �� Cased to l 09 1 b Casing height Z t + Sanitary seal (9/N) Wires properly protected (ON) �0 m Date of test Static water level Well flow Pump level FROM WELL LOG 1975 U? IR L),/- SEPARATION )I` SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I °b1* ; On adjacent lots lob 1 + Absorption field on lot J I �y11- ; On adjacent lots Public sewer main I�C� Public sewer manhole/cleanout Sewer service line Z� 1� Petroleum tank WATER SAMPLE RESULTS: M Coliform C� aocs1tD0vv- , Nitratey'Z1 9 Otherbacteria Date of sample: �0 _ 5✓ r1 ZCollected by: S `` S l bile lG �4r1 (, B. SEPTIC/HOLDING TANK DATA Date installed 'i-- 2 Z '?8 Tank size I ZED Compartments Z Cleanouts (9/N) 4—/ Foundation cleanout (�N) \�J Depression (Yo High water alarm (Y& Alarm tested (Y/N) 'Ja Date of pumping G ' `%Z Pumper_ 4Sf/06 u c SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot !� On adjacent lots 1Foundation 401 To property line D 14- Absorption field �a 1 Water main/service line I o 1 h Surface water/drainage I ot> 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE 2 c AT INSPECTION 'j -l2 -a►► — rM _ c C` rTI m ^ � a 9.p -m. 3.4 ® r `9n 0. 11t1 ® o� z ; On adjacent lots lob 1 + Absorption field on lot J I �y11- ; On adjacent lots Public sewer main I�C� Public sewer manhole/cleanout Sewer service line Z� 1� Petroleum tank WATER SAMPLE RESULTS: M Coliform C� aocs1tD0vv- , Nitratey'Z1 9 Otherbacteria Date of sample: �0 _ 5✓ r1 ZCollected by: S `` S l bile lG �4r1 (, B. SEPTIC/HOLDING TANK DATA Date installed 'i-- 2 Z '?8 Tank size I ZED Compartments Z Cleanouts (9/N) 4—/ Foundation cleanout (�N) \�J Depression (Yo High water alarm (Y& Alarm tested (Y/N) 'Ja Date of pumping G ' `%Z Pumper_ 4Sf/06 u c SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot !� On adjacent lots 1Foundation 401 To property line D 14- Absorption field �a 1 Water main/service line I o 1 h Surface water/drainage I ot> 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes Manufacturer Manhole/Access (Y/N) SEPAR)��DISTANCE FROM LIFT STATION TO: II on lot D. ABSORPTION FIELD DATA Date installed Length �s< On adjacent lots Width 3(° n `Pump off" level at Cycles tested Surface water _ Soil rating 13"5 41A5 "p- System type TSL 1Gr< Gravel thickness l° Total depth i o Total absorption area qZo 0 Cleanouts present/N) Depression over field (Y10 W Date of adequacy test — Results( as _ail) j�/�r�s for r -6.o Peroxide treatment (past 12 months) (YO idD,�E (,i4,3 JJ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Wo, 41 On adjacent lots 1 C>-,5 1 -�- Property line_ r >— To building foundation 7o To existing or abandoned system on lot r On adjacent lots 3o /Cutbank A Water main/service line. Surface water 1bL-> ) t, Driveway, parking/vehicle storage area — Curtain drain 1 11k E. ENGINEER'S CERTIFICATION -12 - q/ bedrooms r/f Iat� "J/4 I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. .v c;�F�•�1f��i F IJ d Signature 17034 Eagle Rivor Loop Road No. 204 Engineer's Name e « e, :u� „•a s age (ver, ase 7 c Date fj o- 1ZUi.t_J..,is,rr:a cc; 1,10. 89 oed z HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ _ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 54578 Chemlab Ref.# 92.2625 Sample # 1 Matrix: WATER Client Sample ID IS BA GLACIER VIEW HTS. S/D PWSID UA Collected JUN 8 92 @ 10:15 hrs. Received JUN 0 92 @ 15:10 hrs. Preserved with AS REQUIRED Analysis Completed JUN 10 92 Laboratory Sup es x EPHEN C. ED� Released By Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO# PO# :NONE RECEIVED Req# Ordered By :R. SHAFER Send Reports to: 1)S & S ENGINEERING 2) ........................................ ...................................... Parameter . ..........Results Units Method Allowable Limits ------- NITRATE -N 0.27 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: ...................................................................... 1 Tests Performed See Special Instructions Above UA -Unavailable ND. None Detected See Sample Remarks Above NA- Not Analyzed LT=Less Than, GT -Greater Than %iSGS Member of the SGS Group (Societe G6n6rale de Surveillance) a Parcel I.D. # MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES �k i Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-665Q 343-4744 . CERTIFICATE OF HEALTH AUTHORITYi. APPROVAL FOR A SINGLE FAMILY DWELLING QED—bo/—/�� HAA# 14—It �o0 1. GENERAL INFORMATION Complete legal description Lot 5; Black "A"; G2acLeA View He,i,gkts Subdivision; Location (site address or directions) Mite 4.6 Eagte Riven Road Property owner R.ickajtd W. 9 Ruth A. Se.ase Day phone Mailing address P. 0. Bax 771033 Eag.te R.LveA, Atasiza 99577 Lending agency Day phone Mailing address AgentLanhcyLude e E R A fta4essiokiat Day phone Address 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 694-4082 278-2776 NOTE: 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 XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 4� 5. "STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that Tny 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 furtherverify 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 a �asi;a�I Phone 6 fT' 29?1 17034 Eagle: River Loop Road No. 204 Address e ag Rivet, - I; Engineer's signature Date 6. DHHS SIGNATURE Approved for �� bedrooms. Disapproved. Conditional approval for Additional Comments 0 +moo av®� a p yp ` • aye aL' Deas as e.au.eaae ..>............. :off �, Cobert A. She 0V < r F c r 1457 s .0f bedrooms, with the following stipulations: Date -�—a3'Ct 1 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 orderto 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 46 Legal Description: 6A Parcel LD -4% a -A -r-. sla A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number A Log present �N) Date completed 19 ? t3 Driller H kx-a4 A. t1 a&ILef Total depth 11 Cased to 1 0 Loµ Casing height 12-1 Sanitary seal ON) Date of test Static water level Well flow Pump level FROM WELL LOG Lr -(-76 U�b t SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 100 } Wires properly protected (WN) Absorption field on lot 1 C> 1D Y ; On adjacent lots Public sewer main ala Public sewer service line WATER SAMPLE RESULTS: Public sewer manhole/cleanout 00 \A - 4L }4 L Petroleum tank 25't Coliform O Nitrate t 30 Other bacteria Date of sample: Collected by: — V'� VJ ki B. SEPTIC/HOLDING TANK DATA Date installed 9-11-16 Tank size � (:-> Compartments 2 Cleanouts ON) — Foundation cleanout aN) High water alarm (Y& Alarm tested (Y/N) Date of pumping 7. (C)1-9 I 7:P— - L -r -a ss Poo c, Depression (YC IJIa SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ~IoLS t L 9b' Well(s) on lot 1� On adjacent lots Foundation To property line 10 1 Absorption field Surface water/drainage 1 d o 1 V Water main/service line Int 72-026(Rev.391) Front MOA 21 CONTINUED ON BACK PAGE m Z AT INSPECTION c 7 lZ-91 rn C m n r- L X12' P7"I ~ g.p.m. 3 9.p -mm M. llll �= O' Z On adjacent lots 1 too 1Y Absorption field on lot 1 C> 1D Y ; On adjacent lots Public sewer main ala Public sewer service line WATER SAMPLE RESULTS: Public sewer manhole/cleanout 00 \A - 4L }4 L Petroleum tank 25't Coliform O Nitrate t 30 Other bacteria Date of sample: Collected by: — V'� VJ ki B. SEPTIC/HOLDING TANK DATA Date installed 9-11-16 Tank size � (:-> Compartments 2 Cleanouts ON) — Foundation cleanout aN) High water alarm (Y& Alarm tested (Y/N) Date of pumping 7. (C)1-9 I 7:P— - L -r -a ss Poo c, Depression (YC IJIa SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ~IoLS t L 9b' Well(s) on lot 1� On adjacent lots Foundation To property line 10 1 Absorption field Surface water/drainage 1 d o 1 V Water main/service line Int 72-026(Rev.391) Front MOA 21 CONTINUED ON BACK PAGE cmd Lao Ket. 1 171YZ16 WORkorder :36044 Client Acct :SNSENGP Collected :JUL 8 91 @ 18:10 hrs. Received :JUL 9 91 @ 18:15 hrs. Promised :JUL 11 91 Analysis Completed 7- 10- 9/ Laboratory Supe visor :STEPHEN C. EDE Released By rtisi5(' 7'rttc�L, Client Sample ID:LS HA GLACIER VIEW HTS client !lane t5 -�9 �I�tl� w Ordered By R. SHAPER Preserved with :AS REQUIRED PWSID :UA Matrix: WATER Sample SAMPLE COLLECTED BY: RAY. Remarks� 'iChemiab Extraction Analysis Analyst (Sample# Test -Parameter Method Units Result Date Date Signature 11 80153 -NITRATE -N- - - - - - - -EPA 353.2 - - - mg/l - - - 0.3o I_nd of Sample# 11 Lab Instructions on WORKorder# 36044 I Tests for this Sample. MUNICIPALITY OF ANCHORAGFppF, NICIPALITY OF ANCHORAGE' 8� DEPARTMENT OF HEALTH 8, ENVIRONMENTAL'P OTMTICW HEALTH 825 L Street - Anchorage, Alaska 9950' NVIRONNI=NTA E^`-" _CT10N ,�% • V ENVIRONMENTAL ENGINEERING DIVISIONt,,Iov 1 1978 gce Telephone 264-4720 // REQUEST FOR APPROVAL OF INDIVIDUAL WATER ANRfiWF lILdTIE DIRECTIONS: Complete all parts on page 1. Incomplete requests will 'not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER - PHONE MAI LING ADDRESS .;T " n .S , Y�`�� ��x #ti`7S RVo `7 r PROPERTY RESIDENT (If different from above) PHONE 2. BUYER� > /` IC:r> PHONE MAILING ADDRESS 3. LENDING INSTITUTION1 e]es PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGALDESCRIPTION �1 ��SJ iT IL �J STREET LOCATION 6. TYPE OFR SIDENCE NUMBER OF BEDROOMS ❑ One ❑ Four E:1 Other SINGLE FAMILY Two ❑ Five EJ MULTIPLE FAMILY �❑ Ld Three ❑ Six 7. WATER SUPPLY E� 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 E� INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) �,O, d � 4-��A yrs G �� ¢ (mew) wire 040,1( igreoa 6 i THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 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 E:1 PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: ) 3.-`a Ij If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank - Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 6` APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE // // 1 1 r' (, r `� (DESCRIPTION BY (Tit f � G v/ \ f(IBLN' LEGAL 72-010 (Rev. 3/78)