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HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK A LT 11 REM GAAB-H~)- i GR,'~,TER ANCHORAGE AREA BOROU'"~H HEALTH DEPARTMENT 327 . ..~LE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~'"-,'~'"/~/ "c~'"~"~'/' LOCATION -'~-;~-~ SEPTIC TANK: ADDRESS LEGAL DESCRIPTIO DISTANCE FROM WELL 7'~' / NUMBER OF MATERIAL ~/'~'"~,~'~¢-'~7~'~'~-~ COMPARTMENTS LIQUID CAPACITY /~-'~ ~:~ '~) GALLONS. INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH ./~-~ / LENGTH r~.~ / · : DEPTH J DISTANCE FROM WEE[ //'~ _ , BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) _"~,,~'~"'~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL ~ DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH ,FOUNDATION , NEAREST LOT LINE xlCEBETWEEN LINES ~CHWIDTH ~ ' ~VE / DEPTH OF FILTER MATERIAL BENEATH TIL~i IN. ABOVE TILE WELL: TYPE ,,~'~-~ , DEPTH / NEAREST LOT LINE ~ 3 , SEWER LINE ~'~ DISTANCE FROM ~ WATER · , BUILDING FOUNDATION. ' SAMPLE /"~) , NEAREST SEPTIC J SEEPAGE .~ ,~ OTHER .. ,TANK ~'~/ SYSTEM .//~/~" ,CESSPOOL ~, , SOURCES DISTANCES: DIAGRAM OF SYSTEM Parcel I.D. 050-491-03 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Expiration Date: GLACIER VIEW HEIGHTS BLK A LT 11 REM Location (site address) 22757 Eagle River Rd Current property owner(s) CLARK Day phone 317-4433 Mailing address Real estate agent Jessica Day phone 317-4433 7897p7 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) t ❑ Duplex OCT T 8 2019 D ❑ Multiple Dwellings (Single Family and/or Duplex) �� 3 3. NUMBER OF BEDROOMS: 3 �!` 0z 6 8 L 9'' 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Z Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ESO • 00 Date of Payment 10(2,09 Receipt Number 0q?0�20 COSA # QS Glc, t56_1 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 10/23/19 ry By: Original Certificate Date: I © 3 r 7 lev K N t�o" The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet 6. DSD SIGNATURE t System #1 Approved for bedrooms System #2 Approved for bedrooms ,,,:,. =-yPE Disapproved°,,✓��23�y��`' Conditional approval for F�p'OFESS�UN��� bedrooms, with the following stiptalatior SFE S9. h(N6 r r , .W'P� r<'R p� �Co p,El\if ry By: Original Certificate Date: I © 3 r 7 lev K N t�o" The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: GLACIER VIEW HEIGHTS BLK A LT 11 REM Parcel ID: 050-491-03 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with .Onsite (or attached) Date drilled 1970 Total depth unk ft Cased to 40+* ft ❑ Sanitary seal is functioning correctly OR Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 10/7/19 Static water level at beginning of test 125.8 ft. Comments * From MOA file B. TANK DATA Age of tank(s) 1970 years Tank type/material Concrete Measured operating fluid level in septic tank Al Standpipes/foundation cleano t per record drawing Date of pumping V 2 D. ABSORPTION FIELD DATA 1970 Well production at time of test 6+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.9 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by NRimEng Date of Sample 10/7/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 1970 Adequacy test date 10/7/19 ❑ ALL standpipes present per record drawing Results Q✓ Pass For 3 bedrooms Total measured depth from grade 10 ft (max) Fluid depth prior to test 6 in Measured depth to pipe invert from grade NA ft (min) Water added 450 gal ❑ N/A —.pressurized field New depth 15 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 60 min depth into effective FEWCode-requiredsoil cover over field Final fluid depth 10 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 73 Yes Community Sewer Manhole/Cleanout > 100' []Yes if No ft M Yes if No Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line > 25' F-1 Yes if No Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' 0✓ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No �✓ Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M✓ Yes if No ft 0✓ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0✓ Yes if No ft Surface Water > 100' ft ft ft ft ft 0✓ Yes if No ft Property Line > 5' 0✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' M Yes if No ft Private Wells > 100' ✓v Yes if No _ Water Main > 10' 0✓ Yes if No ft Community Wells > 200' [D Yes if No. Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10'✓0 , ani Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' f, Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS fil ft ft ft , ani G. ENGINEER'S CERTIFICATION I certify that 1 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. f, t3 A "V FRo- r COSA Checklist yellow sheet a cr fil ft ft ft D' rES LAND SURVMNG 694-082q - ..rj Duan'6Mvk wwd I LV' s 5s rx -a ASBUILT SWARD & rES LAND SURVMNG 694-082q - ..rj Duan'6Mvk wwd I LV' s 5s rx -a ~' - ..... "":~"'""~": ~:' "--~'~" - "~:" "='" '~'D VISION OF ENV RONMENTAL HEALTH 'r' ' .... ::...~ '.....:~ : r ['--' 'L~:--:~ :':' ~ERTIFI~ATE 0F INSPECTI0~'~OR HE~TH AUTHORIT~ APPROVAL.; _~ :: ,. ' 1. GENERAL INFORMATION (a) OE ON-SITE SEWER AND WATER FACILITY 7 264-4720 ~::'-~ Application Date Legal Description (include lot, block, subdivision, section, townsh p, range), Lot Z1 Block A Glacier View T14N R~W Sec. ~6 June 75; lq86 Location (address or directions) (b). Apphcam Name Neil Wilkins Telephone: Home 694-5798 Business ?65-2645 ApplicamAddress S.R. lB BOX 1559 Eagle River, Alaska 99577 (c) Applicant ~s (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lendinglnstitution !8t Nat'l Bank of Anchor.Telephone Address P,O. Box 770548 Eagle River, Alaska (e) Real Estate Company and Agent N/A (f) 694-20~3 99577 Address Telephone Mail the HAA to the following address: Pic. k~]? by en['~neer 2.: TYPE OF RESIDENCE Single-Family [] Multi-Family Number of Bedrooms 3. WATER SUPPLY Other Individual Well [] Community [] Public [] ' Note: If community well system, must have written confirmation from the State Department of Environmental Conservati'on 'attesting to the legality ane status. 4, SEWAGE DISPOSAL . Onsite [] Public [] . Community [] Holding Tank [] Note: If commumty well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. . 72-025 (~ 1/84) Page I of 2 :'~'~:'.15j:",:ENGINEERING FIRM PROVIDING,NSPECTIONSi~,TESTS~'iFIEE:SEARCH ~D'A~-~AND IN~RMATION~::~!~'!~;i~i,;ii~i.~i~:i¢?~;*~'-'- As certified by my seal affixed hereto and as of the validation.dateshown below, I verify that my im, estigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. *Septic tank located under driveway. Name of Firm Telephone Address EAGLE RIVER ENGINEERING SERVICES Date ~'///'~//¢~ EAGLE RIVE~,AK 99577 / P. 0. ~0X 77320{ 6~4-5195 Approved for ~'ff-/¢-~---,~' bedrooms Approved L~ D isapprover~d ' ' '-'~ Co nditi~ Terms of Conditional Approval CA U TI O N The Muncipality of Anchorage Department of Health and Environmental Protection (DHEp) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOAT'/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal D. escription: ,].o ~ // uc~'l. OF HEALTH & ..... ENVIRONMENTAL PROTECTION WELL DATA Well Classification P~/u),~T'C If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) /V' Date Completed / P ?o Yield Total Depth ~4~"~ Cased to ~O Depth of Grouting Az Static Water Level ,//? //.Cb/o ¢-, ~/, ~ ¢' ¢~¢, ~' Pump Set At ~'*' ~'~' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Casing Height Above Ground +/~ Electrical Wiring in Conduit (Y/N) .,Y Separation Distances from Welh...~' 7'\' / To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot ~-/~¢ / To Nearest Public Sewer Line ,V,,/.~ Cleanout/Manhole Water Sample Collected by /:-Q~_~, ~' /'~'/~ Water Sample Test Results ; On Adjoining Lots /¢c ; On Adjoining Lots ¥/¢~ ' To Nearest Public Sewer To Nearest Sewer Service Line on Lot I~,,¢~$;,,.'e.~r,~.j ;Date Comments B. SEPTIC/HOLDING TANK DATA /?70 Date Installed Standpipes (Y/N)%x ~' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well 7 -~ ' To Property Line ~/~ / To Water Main/Service Line ~/~ / Course Size /¢'"¢~ ~¢~ I No. of Compartments / Foundation Cleanout (Y/N) .4/ Date Last Pumped ~' -/~ ; for '4'/~'4 Temporary Holding Tank Permit (Y/N) To Building Foundation ,/'-'<-- / To Disposal Field ~-o ? To Stream, Pond, Lake, or Major Drainage 72-026(.11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ?¢ 7o Width of Field /~ / / .5'-o Square Feet of Absorption Area /-/ Depression over Field (Y/N) /L) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~'~ / To Building Foundation ~'*,.5- / Lot To Water Main/Service Line "'/~ / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ¢~' ¢'~ ' Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line '~'-/0 To Existing or Abandoned System on ; On Adjoining Lots "/'--Y'~ / To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed -:-'-'-'-'-'-'-'-'-~'~--- Date ,7/~,~/'~''~/ Company ,~'7',/'~,/~-, ..C, MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84)