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HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK A LT 6 REMg►ari� v�eu� N-�s. S,o 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 PHONE NAME UPGRADE MAILING ADDREScvN '6�� 4K q57 7 LEGAL DESCRIPTION v LOCATION /h NO. OF BEDROOMS Well f Absorption Dwelling PERMIT NO. DISTANCE TO: Uy i Q facturer Materi _ No. of compartments wF rn pacity'igall ns IF HOMEMADE: Inside length Width Liquid depth kLiq. Well Dwelling PERMIT NO. O zSTANCE TO:0 Z Q fac r aterial pacity-in 9af�fl5"-' 2 F- p Well f Foundation , Nearest lot line r PERMIT NO. = DISTANCE TO: .�— w ul LL z No. of lines Length of each I� Total length o, lines Trench widt2h inches Distance Fit eWines r / Z w I'-' — I.. J Top of Tile to finish grade . Material beneath the -; Total effective ab tin area IDO Length Width Depth PERMIT N0. LU QF- Type of cri Cr' iameter rib depth Total effe v absorption area as w Well uildi oundation Barest lot lin w 1STANCE TO: Depth Driller Distance to lot line PERMIT NO. J J W Building foundation Sewer line Septic tank Absorption area(s) , DISTANCE TO: 4— OTHER PIPE MATERIALS 303 SOIL TEST RATING N INSTALLER�y (�t�Y REMARKS i b X� v f 2i APPROVED DATE LEGAL , / TYPE OF' SOIL ABSORPTION SYSTEM IS: TREN,ICH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL_ RATING � SI.—! F`T/E.R ) - :15I,_J THE RECRJ I RED SIZE OF* THE SOIL ABSORPTION 'SYSTEM is: THE LENGTH DIMENSION I'_. THE LENGTH (IN FEET; OF THE 'TRENCH OF-: DRA I NF I E D THE DEPTH OF' A TRENdt_ H OR PIT IS THE DISTANCE BET WEE'N'd THE SURFACE OF THE GROUND AND THE BOT"F'OM OF THE E.:> CAVATIr-INa(IN FEET., THERE IS t+lO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS 'THE MINIMUM DEPT H OF GRAVEL BETWEEN -'HE OUTFALL PIPE AND THE BOTTOM OF THE E.>CAVAT'ION? (IN? FEET), F" E� Cl l._! I F" r.. C_ 9 F -" T TI C_- -F 8--1 Q"A �---_ "-_ : �' _ L If j PERMIT' APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS, OF ANY WELL_, AD-31FIGENdT TO THIS PROF'ERTY AND "THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -- - -__. -F '-, co °-_ r_. _-" .r P-4 r t`' F= A:- 1 CH P -A � F;"E N.._p T " F E -.._E BACKFILLIhIG C �F' AN4',•' SYSTEM WITHOUT FIN#A(... INSPECTION AND APPROVAL BY 'THIS DEPARTMENT WILL BE. SUBJECT TO PROSECUTION. MINIMUM DI:'TANdCE BET14EEN A WELL AND ANY ON—STTE__ SEWAGE DISPOSAL SYSTEM 15 iE= 0 FEET FOR H PRIVATE WELL OR •1.5,121 —TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. M.T.NIMUM DISTANCE' .FROM A PRIVATE WELL "FTC A PRIVATE SEWER LINE IS e:5, FEET AND TO A COMMUNITY SEWER LINE IS 5 FEET. OTHER REQUIREMENTS MAY APPLY. SPEC I F i f•`:AT I ON•d=; AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO I td. ,URE PROPER I CERTIFY THAT 1: I HM FAMILIAR b.! I TH THE: REQU I REMEN•dT'S FOR Ot•,!—S, I TE SEWERS AND WE(...LS: AS SET" FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNdC:EF:'S.T'ANdC: THAT THE ON—SITESEWERSYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IDENC:E I. REMODELED T'C+ INCLUDE MORE 'THAN:! 4 BEDROOMS. APPLICANT HAMANdNd C �Ot4STRt_tC T I CtNd T3v '_T. "•a" 1 L7 r-1 q_11 r-.$ 1 K*--" `A: I I..__ TF: nC 9 F"- 6==d r-183 I;".. I _" � � CF W U . DF:F'tl-RTMENdT Ot.. HEALTH AND ENVIRONMENTAL PROTECTION" J�o,)L)fc_��-a ; 25 ' L. � STREET, ANCHORAGE'., AK:.264-4720 ��.J J O nl PERMIT NdC i. :; ;�i1� i; -a_ 6 `: Ol L LY���L21 SSI APPLICANT HAMANN,i CION_:T"R.0 T I OkI PO BO'x, 617 99577 c"94 776 LOCATION LEGAL L 6 B A GLACIER VIEW HEIGHTS LOT SIZE 4 5y.j00 SQUARE FEET TYPE OF' SOIL ABSORPTION SYSTEM IS: TREN,ICH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL_ RATING � SI.—! F`T/E.R ) - :15I,_J THE RECRJ I RED SIZE OF* THE SOIL ABSORPTION 'SYSTEM is: THE LENGTH DIMENSION I'_. THE LENGTH (IN FEET; OF THE 'TRENCH OF-: DRA I NF I E D THE DEPTH OF' A TRENdt_ H OR PIT IS THE DISTANCE BET WEE'N'd THE SURFACE OF THE GROUND AND THE BOT"F'OM OF THE E.:> CAVATIr-INa(IN FEET., THERE IS t+lO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS 'THE MINIMUM DEPT H OF GRAVEL BETWEEN -'HE OUTFALL PIPE AND THE BOTTOM OF THE E.>CAVAT'ION? (IN? FEET), F" E� Cl l._! I F" r.. C_ 9 F -" T TI C_- -F 8--1 Q"A �---_ "-_ : �' _ L If j PERMIT' APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS, OF ANY WELL_, AD-31FIGENdT TO THIS PROF'ERTY AND "THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -- - -__. -F '-, co °-_ r_. _-" .r P-4 r t`' F= A:- 1 CH P -A � F;"E N.._p T " F E -.._E BACKFILLIhIG C �F' AN4',•' SYSTEM WITHOUT FIN#A(... INSPECTION AND APPROVAL BY 'THIS DEPARTMENT WILL BE. SUBJECT TO PROSECUTION. MINIMUM DI:'TANdCE BET14EEN A WELL AND ANY ON—STTE__ SEWAGE DISPOSAL SYSTEM 15 iE= 0 FEET FOR H PRIVATE WELL OR •1.5,121 —TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. M.T.NIMUM DISTANCE' .FROM A PRIVATE WELL "FTC A PRIVATE SEWER LINE IS e:5, FEET AND TO A COMMUNITY SEWER LINE IS 5 FEET. OTHER REQUIREMENTS MAY APPLY. SPEC I F i f•`:AT I ON•d=; AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO I td. ,URE PROPER I CERTIFY THAT 1: I HM FAMILIAR b.! I TH THE: REQU I REMEN•dT'S FOR Ot•,!—S, I TE SEWERS AND WE(...LS: AS SET" FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNdC:EF:'S.T'ANdC: THAT THE ON—SITESEWERSYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IDENC:E I. REMODELED T'C+ INCLUDE MORE 'THAN:! 4 BEDROOMS. APPLICANT HAMANdNd C �Ot4STRt_tC T I CtNd i 'IVIY ll 11 l "L l . v rid. v'rv,l. .vr u Department � Health and Environmental,4Jrotection 825 L Street, Anchorage, AK. 99501 264-4720 # # # HANDWRITTEN PERMIT # # # /OR ON-SITE SEWER PERMIT r� Applicant: fpJ�i����/ t}ata 9� Mailing Address Location: ��.�I/���J Phone Number: lei c� f�` ti e�... Legal Description: (� �� i rY� "''" 'X Lot Size: Type of Soil Absoo ption System Is: Trench: L/ Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH f LENGTH _ GRAVEL DEPTH_ WIDTH The length dimension is the length(in feet) of the trench or drainfield. 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). * * REQUIRED SEPTIC(HOLDING) 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 department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet 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 u 1 # # # 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 3 bedrooms. Signed:oIssued by plic ant Date: SWP/024(1/81) PERFORMED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: 1-6, YJ DEPTH (FEET) 1 `; 2 f U 3 / �-- `7 4- 5 / v 6- 7 7 8 9 10 11 12 13- 14 3 14 �1 J ;- 15 16 I 17 18- 20 8 20 COMMENTS s S Robert A. Mcrferj W. 1457•E R I N ^ SUIL6 LUU ❑ PERCOLATION TEST DATE PERFORMED: 2 CLG—O t+ C -y - /// e--C-j SLOPE - SITE PLAN WAS GROUND WATER S ENCOUNTERED? 3.� L Depth to Water O P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN FT AND PERFORMED BY: ,,.IS Engineorix CERTIFIED 72-008 (6/79) (minutes/inch) __ FT DATE: °- r �%l"- f by DOC Co. dba - SULLMN WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759 - { OWNER OF LAND �i`.•r...�. ryF DEPTH OF WELL F ADDRESS 3 "J `' r'' `y "J e f- 5-'(; STATIC LEVEL OF WATER FT. ' LEGAL DESCRIPTIO^' �' �' �` ,._'. I > ` c/ f4DRAW DOWN FT. DATE -Started Ended GALS. PER HR PERMIT NUMBER KIND OF CASING / KIND OF FORMATION: MISCL. INFORMATION: DRILLER'S NAME , From Ft. to Ft. From ' ' Ft. to_6 FC .5 From Ft. to Ft. r , oq : From Ft. to Ft. uNICIph, OHORAGE From s`4-5,412"' Ft. to , : Ft. 4 ,4 � 7 t" + From Ft. to T OF H,Fp,LTH - , OTECTION fN�IRO� Ft. fS 4'1;'?r From Ft. to-Ft— o Ft�� From Ft. to O Ft. to !<'fv,-•? Ft. From—Ft. From Ft. to Ft From From ! <t Ft. to , �!'.S . Ft.y� cs �,!!ar J �" - From Ft. to From ! ! . Ft. to 1.J l Ft. ?4 e From Ft. to Ft. From Ft. to - Ft. I_W O 1 From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From -- Ft. to Ft: - From -Ft. to -Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to - Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME ' Ir�U �V 1l.1rHL11 I VI �Ir...i wv-. v.- ` Departments'_. '- Health and Environmental�?rotection 825 Street, Anchorage, AK. 99501 264-4720 # # # HANDWRITTEN PERMIT EL__ F Applicant: 1G Mailing Address: � / : l Location: 44 Gr'Phone Numyb�er. / 0. � �IQC/�� 111_z�l /o/ �2. Legal Description: G -d T � Lot Size: Type of Absorption System Is: Trench: field: See Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Req ' ed Size of the Soil on System Is: DEPTH --f-LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. 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). * * REQUIRED SEPTIC(HOLDING) 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. # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet 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 3 1 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. A.�Signed 1 ��/ Issued by: Applicant 1 Date: � — SWP/024(1/81) �u ��I �� �EF�H�T�1ENT U�� HEHLTHHND ENVIRONMENTHL PROTECTION STREET, HNCHORHGE, HK995c1[ �64-4720 PERMIT NO. ( 810961 ) APPLICANT DAVE RICHARD 9!.D5 MULDOON ROHD #H87 99507 ]]8~]082 LOCHTION MILE 4 1/2 EAGLE RIVER ROHD QT SIZE 22500 SQUHRE FEET LEGAL L 6 B 8 GLACIER VIEW HEIGHTS ` L MINIMUM DISTANCE BETWEEN A WELL AN[) f -,NY ON~`ITE SEW8GE DISPOSHLSY.STEMNISNG 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL o�r� u� OpON THE TYPE OF PUBLIC WELL. TE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND MINIMUM DISTHNCE FROM H PRIYH TO H COMMUNITY SEWER LINE IS 75 FEETTURNED TO THE DEpHRTMENT WITHIN 30 DHYS WELL LOQS ARE REQUIRED HND MUST BE RE OF THE WELL COMPLETION. OHppLy SpECIpICHTIONS HND CONSTRUCTION DIAGRAMS HRE THER REQOIREMENTS MHY � AVAILABLE TO INSURE PROPER INSTALLATION. ������ ������� ��������� -M. I CERTIFY HTHHTHR WITH THE REQUIREMENTS FOR QN�SITE�SEWERS HND WELLS HS 5ET 1 I M� FnI LI FORTH By THE MUNICIPALITY OF HNCHORHGE.NCE WITH THE CODES 2~ I WILL INSTHLL THE SYSTEM IN HCCORD�i . SIGNED:_~�_~�~��~��~~.�~_-~�-~_ APPLICANT DAVE RICHARD (D ~o\ V4� 0 ISSUED BY___-~~_~�_-�__~�~�_�~_~�~~~__~ Municipality of Anchorage E • Development Services Department i Building Safety Division -'- -- ' On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL. FOR A SINGLE FAMILY DWELLING !� ,,pp 1 aS U✓ Parcel I.D. 050-501-14 _ HAA# O 3 031 Expiration Date: f - q=0 •- 1. GENERAL INFORMATION. Complete, .legal description Lot Block A; Glacier 114ewQi1Zhts 411hrji37.jsion Location (site addressordirections) 22953 Eagle River Rd. Current. Property owner(s) Patty I Day phone _ 273-7261 Mailing address Lending agency Mailing address Real Estate Agent Day phone Brian Broderick Day phone 273-7261 Mailing -Address Prudential R F. 4711 R cr Annr.,�gim, AK 99503 Unless otherwise requested, NAA willbe held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site , El Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name 5. DSD SIGNATURE V Approved for Disapproved. Robert C. Cowan L- bedrooms. Date 10/ a -9% 0 3 ROBERT C. COWANeO CE -8801 A Conditional approval for bedrooms, with the following stipulations: J = ON-SITE '• m Additional Comments `�: WAT.RIPAhim WASTEWATERPROGRAM ; Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date:_ Z © — 2-9 — 03 (Rev. 01/02) OCT -28-2003 19:56 IU 4V V. S&S ENGINEERING uu...�. SGS Rd-# 1036975001 Client Name S & S EagWeering Project NQraW LG, S " A" Glacier View Hts Client Sample 1D L6, B "A' Glacier View its Matrix DritWng Water Sample Remarks_ 907 694 1211 P.01i01 All DateslTiomes are Alaska Standard Time Printed DaWTime 1012812003 17:11 Collected DateJT me 10/2312003 14:00 Received Date/time 10/23/2003 16:37 Technical Director Stegben C. Ede Messed ¢y /I) I) / 1211,L n a 1v, Allowable Prep Analysis ParMMet• Ctuafif'w Results PQt. Units Method CunlainerM umits p�� Ditte fait waters Depatrtmeut Nitrate -N 0.100 u 0.100 mS/L EPA 300.0 B ( 10) 10/24/03 JJa Microbiology Laboratcsy Total Wiform � w]/lOomL SM1992223 A (<-1) 10/23/03 DKC TOTAL P.01 Municipality of Anchorage • Development Services Department '�`' r Building Safety Division On -Site Water and Wastewater Program =�! 4700 South Bragaw St. y �.. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 _ CERTIFICATE OF HEALTH AiJTHORiTY/HFI;KOVAL FOR A bINGLE FAMILY DWELLING Parcel I.D. O S- a - 5-0 l - 11 HAA #-_ *.) _3 1�, — Expiration Date: 0 - 1. GENERAL INFORMATION r' Complete legal description Lot 6: Block A: Glacier View Heights S/D Location (site address or directions) 22953 Eagle River RD., Eagle River, AK 99577 Cbrrent Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Patty Godfrey Dayphone 273-7261 Day phone Brian Broderick Dayphone-726j_ Mailing Address Prudential Real Estate, 4241 B St., Anchorage, AK Unless otherwise requested, HAA will be held by DSD for pickup.'Va 995 03 // 7 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY:, Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site B Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. ":c of f"i,^;; S & S Engineering rnone 694-2979 Address 17034 N. Eagle River LP RD, Eagle River, AK 99577 Engineer's !Tinted Name Robert C. Cowan Date __2A/o 3_� ZZ -.!� � i:.:• r �T/J SKY 6. DSD SIGNATURE -1 It RMUT C. COWAN t CE-soot Approved for _ �' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Y `J VIV-JIIC -�: Additional Comments WATER AN ; m= WASTEWATER . PROC RAM, J . r+� Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: we Original Certificate Date:_' 0 ✓ (Rev. 01102) Municipality of Anchorage .,,a ' Development Services Department Budding Safety Division On -Si ,fttd► & Wastewater Program `" "' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907}343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: yr 6; de !) _K Al, at .+!5& i- V! &-k_ J Parcel ID:0 SV 'So A. WELL DATA k16( Gs "-T-5 Well type Date completed q h Total depth �ft. If A, B, or C provide PWSID # Well Log (Y/N) _ L Sanitary seal (YIN) Wires property protected (YM) _ Cased to ,410 *'ft- height (above ground) ��in. FROM WELL LOG Date of test _!? /'61_ Static water level 110 ft. Well production f Z O.P.M. WATER SAMPLE RESULTS: AT INSPECTION /3 le > 3 1057 ft. — 403 9 -p.m. Coliform colonies/100 mi. Nitrate 0-* 1 mg./I. Other bacteria a colonies/100 ml. Arsenic: r mg.11. Date of sample: ��03 &C011ected by: ,54 15- B. B. SEPTICIHOLDING TANK DATA Tank Type/Niaterial G e _ Date installed — © 1 Tanksize 1-94 gal. Number of Compartments Cleanouts(YM)__� Foundation cleanout (YIN) De —scion over tank (YM) � High water alarm (Y/N) IN jc/f 4 ' Date of pumping 2 Pumper C. ABSORPTION FIELD DATA Date installedQ _ Soil rating (g.p.d./ftz or fefbdrm) System type _ _ G Lengti :4,A,.. ft. Width 3 ft. Gravel below pipe ^ft. Total depth _L.�_ ft. Eff. absorption area "fe Monitoring tube Depression over field Date of adequacy test 3 03 ��Results (Pass/Fall) PA S ,S For 4 bedrooms Fluid depth In absorption field before test ,/ Water addedAwgal. New depth s. Elapsed Time: Ino min. Final fluid depth 54 in. Absorption rate >_ 4490 _g-p.d. Any rejuvenation treatment (past 12 mo.) (YIN R type) 4Z _ If yes, give date _^ D. UFT STATION Date installed /V A- "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off level at_ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankHif�i IKon on lot l ©O t i - Absorption field on lot 1 r1n / Public sewer main N ,4 S r /septic service line Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots %c© 4 - On adjacent lots t (0 0 /'f` Public sewer manhole/cleanout _ N Holding tank N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: �f Building foundation `7 d- Property line �- Absorption field 5 + Water main Water service line /O /•-- Surface water too Wells on adjacent lots t 00 tr SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ► I Property line _ (O 4- Building foundation _ f 0 'a- Water main Water Service line 4- Surface water _� OD ► 4- Driveway, parking/vehicle storage Curtain drain a Wells on adjacent lots 14PC �+ F. COMMENTS G. ENGINEER'S CERTIFICATION in. I certify that I have determined through field inspections and review of Municipal records that the above systems are in ""• •' " »" » ••'^ •^• conformance with MOA HAA guidelines in effect on this date. 'v a D �,1 r C . Co w A.✓ ter cCOWAN,a• Engineers Printed Name �; CE - "01 Date -718163 f,i HAA Fee $_ 3 7 S' � v Date of Payment 7//q/0 3 Receipt Number 0,3 8 A o 9 (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number 6— 5-03: 2:48PM: A SGS Rert1 1033070001 Client Name S & S Engineering Project Name/N Glavier View Hts L6 B A Client Sample ID Glacier View Hts L6 B A Matrix Drinking Water :907 5515301 # B— 2 All Datesfl'imes are Alaska Standard Time Printed DatelTime 06/03/2003 15:10 Collected DateMme 0529/2003 12:00 Received Datefrime 05/302003 16:00 Technical Director _ i Stephen C. FAN Sample Remarks: L Units Method Limits Prep DateAnalysis Parameter Results P Q Limits Datc Date ]nit Waters Department Nitrate -N 0.100 U 0.100 mg/l. EPA 300.0 (<=10) 05/30/03 JS Microbiology Laboratory Total Coliform TNTC OB col/100mL SM18 9222B (<_]) 05/30/03 KAP ,Jure 30 03 09:30a /V( -w ^f 6130103 Brian Broderick 907-273-7362 0 a a ti .ASBUILT SEWARD h I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE, FOLLOWING DESCRIBED PROPERTY' ., ///E,•✓�F/1�"e%df'�. DATE AND THAT NO ENCROACHMENTi'EXIST'E(CEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID, EASEMENTS, COVENANTS, OR RESTRICTIONS fw is9 WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB'• ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN, ARY LINES. p�arf Awl P•Z V i APPLIC NT FILLS OUT UPPER HAI ONLY Phone Property Owner Zip Code �7JE- Mailing Address ;... Buyer _ I , i ,:`J -• �� - Zip Code -' Address i_i, - _ - .' �- Phone _ Lending Institution !J i ry �_ Zip Code . Address ,� - ` `� - Phone Realty Co. & Agent Zip Code Address �_,i i r •'-� r .l ! _ ! %' Legal Description... - II :.�. /i r=;-� „__ - f/ • :- rc. Street Location-- . TYPe of Residence G� Single Family ' y Cj Multiple Family No. of Bedrooms ❑ Other Water Supply ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. _. ❑. Individual For wells drilled prior to that date, give well depth (attach log if available). ` 0- .Community ❑ ',Public Utility Sewerdisposal - Year Individual Installed: l Individual -�" <--- When Connected to Public Ut Hty: - ❑ Public Utility _ ❑ Holding Tank BEFORE PROCESSING CAN BE INITIATED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST time _ , Time D Date Date Date Inspector Inspector Inspector Approval Pyo ` , iZ Permit No. Septic Tank Size Date Sewer Installed l ,-_�— Holding Tank Size Soils Rating Well To Absorption Areae Well Log Received Well to Tank `�— APPLICANT FILLS OUT LOWER HALF ONLY. Phone Property Owner Mailing Address Buyer Address / -- Phone Lending Institution � �n � Address i�/L "'�� /��Ciff Phone Realty Co. & Agen Address Legal Description Z Street Location If Type f ence y Single Family No. of Bedrooms ❑ Multiple Family ❑ Other Wate S ATTACH WELL LOG. A well log is required for all wells drilled since June Individual 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Community available. ❑ Public tilit Sew g posal Year Individual Installed: �, Individual When Connected to Publicic Utilit�� ❑ Public Utility ❑ Holdin Tank .�nre. ruc i"PFCTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. -