HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK A LT 14 REMEo$c
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Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 �_ �'' Fage' of
ON-SITE WASTEWATER INSPECTION REPORT -
YC>( I rJ JI✓
Permit Number: OSP171248 PID Number: 050-491-06
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name:
GENTEMANN FAMILY TRUST
ABSORPTION FIELD
® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
22643 EAGLE RIVER ROAD, E.R., AK 99577
❑ Other
Phone
Number o f Bedrooms
Soil Rating
Total depth from original grade
3
0.8 GPD/SF
11 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2 Ft.
Gravel depth beneath pipe
9 Ft.
Subdivision Block Lot
GLACIER VIEW HEIGHTS A 14 REM
Fill added above original grade
Var. 1.01 Ft.
Gravel length
32 Ft.
Township Range Section
Gravel width
3 Ft.
Beds: Number of Lines
--
Distance between lines
-- Ft.
SEPARATION DISTANCES
To
Septic
Absorption
LiftStation
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
576 Ftz
1
-- Ft.
Well
100'+
100'+
NA
NA
NA
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1000 Gal.
Surface Water
100'+
100'+
NA
NA
Material
Steel
Number of compartments
2
Lot Line
5'+
*1'+
NA
NA
NA
Foundation
5'+
10'+
NA
NA
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
NA
*50'+
NA
NA
Remarks *None known. Waiver OSV171092
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Additional fill added for slope. Tim Ecklund
/ MOA conducted a final grade visit.
Pump make and model
Electrical Inspections performed by
Installer ARM SERVICES
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Drainfield 3034 CO/MT 3034
Inspector ARCTERRA
BENCH MARK (Assumed elevation) 100 ft
Inspection ection 1" 9/11/17 9/11/17
Location and description -TOP OF DECK
2nd
3`d 9/12/17 4h9/13/17
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engin
Conditional Approval:
OF ALS \
`S�' `q's-" '111I
Date
of
4 9TH
0
KENNETH N1. D F S �� 4
71
0_aq /
Approved ���� _;iz Date �
� pRor�ss oN�ti �
i
eer's Stamp
inspection Keport_V-i-il.aoc
AS -BUILT SYSTEM DETAILS/SITE PLAN PERMIT ❑SP171248
GLACIER VIEW HEIGHTS BLOCK A, LOT 14 REM PID# 050-491-06
10 UTILITYESMT BASIS
� S��•56'3 OF-
-112
F
-10
tiT/A'c ,
O�/ A
360, VSF
oFo�
1000
cq�
>,yG ST
C'k&
SSA
27-
SCALES 1' = 30' LSSA 23
m —C=10.0'
Lo,B—C=29.5
99.90 99.50
!A—D=15.5'
OP
gB—D=30.5'
ti
f
yA—E=33.0'
o
n—E=65.0'
�A—F=31.5'
9B—F=63.0'
A
1000 GAL
3A—G=24.5'
SEPTIC
EDB—G=38.0'
TANK
�1—H=23.0'
IB—H=36.5'
94'72 94.5
OF Z4,
* _ TH
I I
KENNETH M. S /
CE -711
1�ti�ww�
`/ i3 ' i
\ \ E 163, 56
�l 0?' \ FSMr \
Oot- \
c
igy�C *((
O 7'
,moo•
SyFo
XA'S
A56
c
C-) Is
) FINAL GRADE
FILTER FABRIC \INSULATM
SEWER ROCK
32' —
PREPARED FOR:
GENTEMANN FAMILY TRUST
22643 EAGLE RIVER ROAD
EAGLE RIVER, AK 99577
FIELD BOOKS
BOUNDARY: N/A
STAKING: N /A
ASSUILT: ,JLS
DWG. FIM-
ACAD ME. FILE
COMPUTED:
DRAWN: BMW
CHECKED: K M D
DATE: 12/l/17
GRID: SWO059
roe NO.: 17184
VARIES
I
T
9'
NO GRK0. VATER
DBSV. 6.22/17
SCALEi NTS
Cl. .rt t(j N
1 0Xn n<nnM7� Hrby n
o�'Pov�� y x LOT 15
z�"' g'Bo7 �H
CD y CD o g. w C1
N I ! y o -4 Y � � �y N3533'47"E 110.82'
a y ° ' n (N35'33'15"E 111.05' R)
n> N . o mss' O • 35.6'cr
En 0
/
91
N
9:
cn
z s C3 °• n y y \
"l
crc_ yob N Y n 24.0'
a
4 Im _
` N O.
:/l •
� °. � y � N � • o � �
� 12.5' (n � r+
� �an� r N �o Lo No O
> gw m01
� W
a (1)
36.5'
cn
-P nj DECK r r 4.In
d
SCHULL I 10.0'
70' i N
coo�W ss o
ro M m S3533'15"W 176.25' (176.74' )
co0w c
NO 0) cnV
coILOT 1
o��3�LOT 13 BLOCK B
co
,�Z V�
�SN�LiI'AC )Y OF MUNICIPALITY OF ANCHORAGE
On-Site Water& Wastewater Program `- ,S'
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r.
http://www.muni.org/onsite
4"cho0.PGE
On-Site Wastewater Disposal System Permit 41/1/r7 So
Permit Number: OSP171248 Effective Date: 8/31/2017
Work Type: Septic Upgrade Expiration Date: 8/31/2018
Tax Code Number: 05049106000
Site Legal Address: GLACIER VIEW HEIGHTS BLK A LT 14 REM G:0059
Site Mailing Address: 22643 EAGLE RIVER RD, Eagle River
Owner: GENTEMANN 2015 FAMILY TRUST Lot Size in Sq Ft: 21555
Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3
This permit is for the construction of:
0 Disposal Field RI 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: /P. v/,, Date: I tl
Issued By: 1�0,C�C4 (` � Date: 5 3/ 2O/ 7
Municipalityof Anchorage
s"
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV171092 COSA#: Permit#: OSP171248
PID#: 050-491-06
Legal Description: Glacier View Heights Block A Lot 14 REM
Engineer: ArcTerra
Applicant: Gentemann 2015 Family Trust
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the excessive slope has been approved. The approved separation distance is 35.0 feet. In
addition, your request for a waiver of the required horizontal separations from the absorption
field to a property line and to another drainfield have been approved. The approved separation
distances are 1.0 feet and 10.0 feet, respectively. See engineer's narrative and slope profile
drawing for justifications.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
VI The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
n Adjacent properties are not affected by this waiver.
Waiver is Granted: X Waiver is not Granted:
Date: 8I3 Ildo1 '1 Approved by: f&, eecct 64j
Name of Reviewer
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
e
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 050-491-06
Property owner(s) GENTEMANN 2015 FAMILY TRUST.. Day phone 726-3390
Mailing address
PO BOX 770603, EAGLE RIVER, AK 99577
Site address 22643 EAGLE RIVER ROAD, EAGLE RIVER, AK 99577
Legal description (Sub'd., Block& Lot) GLACIER VIEW HEIGHTS BLOCK A, LOT 14 REM
Legal description (Township, Range & Section)
Lot Size 21555 Sq. Ft. Number of Bedrooms -3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field Initial ❑
Single Family (SF) (3.1
(w/wo ADU)
Septic Tank Upgrade Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE 1 WAIVER REQUEST FOR:
Po pasQ flak) ii) PL LXl/JT//i/i C 11 f310 'r Distance:
Jt�m�
>23,
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signatu pr9perty owner or authorized agent)
Permit/Rush Fees: 6(A Waiver Fees: .)15—
Date of Payment: gl3.3J)1 Date of Payment: 023/17
Receipt Number: 05151 b Receipt Number: 081-51-1
Permit No. OSP)'lWaiver No. D5V1`1i02
Permit App_9-1-12.doc
twka:RRA
a ARCTERRA
CONSUL'T'ING, INC
' �1212 E. 51't Aye,Anchorage,AK. 99503
—'*,� Office(907)868-3791, Fax(907) 868-3793
�C,�SNLT I NG. '
August 22, 2017
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Permit With Waivers Glacier View Heights Block A, Lot 14
The owner has requested we proceed forward to obtain a septic permit for the
existing 3-bedroom house. Due to the limited area, from the proposed field we
are requesting waivers to 1' from property line, 10' to the existing crib and 35'+
from slopes in excess of 25%. We do not expect any adverse effects by granting
these waivers since the proposed field slopes along side and away from the
existing crib towards the expansive Eagle River ROW and is 10'+ from the
adjacent property's septic field.
The general slope of this lot is from northeast to southwest at a grade of
approximately 18-20% over the septic area. On August 15, 2017 a testhole was
performed to investigate soils and groundwater. We propose to install one 32-
foot long deep trench. Groundwater was not encountered at excavation or at
monitoring.
The property and adjacent lots are served by private water. There is no surface
water within 100' of the proposed system and there are no known curtain drains
within 50'. We do not expect there to be any adverse effect on adjacent lots by the
development of this system. If you have any questions, please contact me at 868-
3791 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
4111", _del.&14/
Kenneth M. Duf'
Attachments: On-Site Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Logs/Percolation Tests
20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PEI(907)868-3791 • FAX(907)868-3793
WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN
GLACIER VIEW HEIGHTS BLOCK A LOT 14 REM
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FLAG PROPERTY LINES
• WELL RADII & EASEMENTS
PRIOR TO CONSTRUCTION Scale: l'= 50'
iii
DESIGN DETAILS PAGE 1 OF 2
..
co 3 BDRM X 150 GPD = 450 GPD
r 450 GPD/.8 GPD PER SQ. FT. (9 MIN/IN.)= 563 SQ. FT
O (563 / 2 x (9' GRAVEL) = 32 FT. TRENCH
USE 1 TRENCH - 32' (L) X 2' (W) X 9' (ED)
Total depth of system is 11' max from original grade.
a Total depth of gravel below distribution pipe is 9' ,
▪ NO PUBLIC YELLS WITHIN 200' OF
7, PROPOSED SYSTEM. NOTES:
rn NO PRIVATE WELLS WITHIN 200' OF
3 PRNOOPOSED SEPTICSYSTEM EMSXCEPT AS N200'OTED. 1. INSTALL 1000 GAL TANK & INSULATE TANK IF <4' COVER,
OF
0' PROPOSED YELL SYSTEEXC PT AWITHS NOTED.
2, INSULATE TRENCH WITH 2' HD BURIAL FOAM IF < 3' OF FILL,
MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ.
tz 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK.
4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
0
o.
_� WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC...
4 F Az,\
�� • <Q.6 1 PREPARED FOR; CrTE D
` GENTEMANN FAMILY TRUST �'[� r
o � J' ' ' 22643 EAGLE RIVER ROAD /1(1111
,(4� k-,
g * .4 EAGLE RIVER, AK 99577 \ �IKENNETH1[. i i'�l / FlELD BOOKScoMPUTEtr ; $CE-711: �4� BOUNDARY_N/A DRAwN: BMW zlP '-,`�Alf
1 . 9 3i0 7• �' STANaiC JLS a+Eama: KMD Ga j �lns
a` ,
/ ASBUILT: JLS DATE: 08/22/17 ��''"'`�;”' \
1tli
11:116&.\1:111:11111.-
ESsl+� D . FILE: aau SW0059 ��F�co 4,-. �\-1. cp
E
`_ ACAD FlLE:FILE .ae No.: 17-184 �fR, �K 99577`836
WASTEWATER DISP❑SAL SYSTEM DETAILS
GLACIER VIEW HEIGHTS BLOCK A LOT 14 REM
q.
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4."-7' om 'N
+�d�Y
sr.1rl1P.r, AO FT
r 7�-'w SEPTIC
/....41IN
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ry�� ii ,\ oho �•J `� ��` � �/Sti AD )1 T�/ G' e\ '�� , MT NEW 32'L 9'ED D �.0 TRENCH 0 A5Fc0P60 `SF
`� Co ,roc
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�� CO ` 0, DI V
X
CO DECOMMISSION & REPLACE
EXISTING 1000—GAL S.T
•
7(1'4)
x
:NNN\NNN/ SS'
( SS
Q
FLAG PROPERTY LINES
J
WELL RADII & EASEMENTS
U
PRI❑R TO CONSTRUCTION scale: 1"= 20'
4-.41 �\\ PAGE 2 OF 2
< �F �, 1 PREPARED FOR: hi,RCTER
�' IIIA
GENTEMANN FAMILY TRUST ati �� �,�
/,2 ! 22643 EAGLE RIVER ROAD r" ��� ��
* 9TH 1\ * t EAGLE RIVER, AK 99577
/ • KENNETH M. r i�' S /� FlELD BOOKS cauPuIm a 1
m 4 CE-711:w W� / BOUNDARY:N/A DRAWN: BMW Z LI
f+" �:
' ii,02.07,44,,�• 4': STA1ONG JLS CHECKED: KMD % \
E 1 �� Assuch JLS DATE: 08/22/17 'i'.......,<,,.4,-.
OPESS10 I y ` o�
DWG. FILE GPO SW0059c CoA,�� C �"
t -
`��` ACRD FILE JOB No.: 17-184 FR/ys�TING . 36
FILE R, AK. 99577&
GLACIER VIEW HEIGHTS BLOCK A, LOT 14 REM
SLOPE ASSESSMENT
320'
V
N
C
U
315'
ii i Existing Grade
V L 35' -, 3-8%
o � 18-a!':-------\4
i 310'
0
Na, Existing Grade 25% NYPa• S��pE ai15 o
a 305' a \ ABSOR . FIELD
0 18_20%
0
m
I 300'
\-°'°. s`O?' \ ADD &/❑R MAINTAIN 1'+ FILL ABOVE
= 25% vs HYP❑THE-ICAL 25% SLOPE LINE
s 295' —
I, 43,'3Ci• 37 i
U n
v V
290'
J
ii
cs
U
iz
1 0' 5' 10' 15' 20' 25' 30' 35' 40' 45' 50' 55' 60' 65' 70' 75' 80'
_0
W
o
OF' \Az4 \ SCALE 1'=10'
/ * • * .I ASSESSMENT OF 37' MEETS 35' MINIMUM H❑RIZ❑NTAL SEPARATI❑N REQUIREMENT.
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`\ ARCTERRA ;riS� �t5 M �
F. CONSUL'T'ING, INC / . '9'
'.4 % ' R 212 E. 5151 Ave,Anchorage,AK. 99503 * '�
�‘..c.,,•S „ctelOffice(907)868-3791, Fax(907)868-3793 # #�1��.
. KENNETH M. DUF ,x
SOILS PERCOLATION TEST + `.s. arre4.4cw�
Av
k ; 6.4= i 1.',PPerformed for: Gentemann Family Trust Date Performed:08/15/2017 ,VI&flebF;ssro"
Mk MI6.116:q1111:41P'
Project: GLACIER VW.HTS.BLOCK A,LOT 14 REM TEST HOLE# TH 17-1
Depth
_111%2117, SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
1 Org/OL
d Was Ground water encountered? NO What depth? NA
O Depth to water after monitoring? NO Date? 8/22/17
3
1
0 GM/sm w/some gp/sp cobbles to 2' Reading Date Gross Net Depth to Net
5 a Time Time Water Drop
6 1 8/22/17 1:00 - 6"
2 1:30 30 min 2 12/16" 3 4/16"
c>
8 Q 3 1:31 - 6" -
9 4 2:01 30 min 2 13/16" 3 3/16"
I 0 5 2:02 6"
. d
I I 6 2:32 311 rain 2 12/16" 3 4/16"
12- 7
—
13 8
14 9
I> Ill
I(- • Il
17 12
B.O.H.
I8- ' Water Added
19 Percolation Rate 9 (min/in)Perc Hole Diameter 6"
HOLE PRESOAKED
20- PRIOR TO TEST Test Run Between 4 feet and 5 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State
and Municipal guidelines in effect on this date.
GAAB HD-I
GP~.TER ANCHORAGE AREA BOROI~H
HEALTH DEPARTMENT
327 EA~LE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY / Z~'~)~)
MAILING #d,~/ 77~, ~(~:£C-"~ -~/~'~ PHONE
ADDRESS
GALLONS.
,,~ 7~.~_~/ NUMBER OF
COMPARTMENTS
MATERIAL
~./ i~J~" LiqUID
INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE Pit:
NUMBER OF PITS i OUTSIDE DIAMETER
LINING MATERIAL ~'~'~/~'Z~.~/~ ~r~i/J/~$
NEAREST LOT LINE "~ ~'~ '~
OR WIDTH
DISTANCE FROM WELl.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH /,~i , DEPTH
BUILDING FOUNDATION
sq. ET.
.TILE DRAIN FIELD:
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__
DISTANCE FROM WATER
WELL: TYPE. DEPTH , BUILDING FOUNDATION. · SAMPLE , NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE , SEWER LINE ,TANK , SYSTEM , CESSPOOL , SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
140 U - '
DATE
APPROVED
GAAB-HD-2
GREATEI, ANCHORAGE AREA )ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case N o.~-~-.~//
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
MAILING ADDRESS /~'~ 773 ,PHONENO.
!
NAME OF APPLICANTI~,//,~. ~-' .~ ~
RESIDENCE ADBRESS f'~/' ~"~'"'f ~J
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCEO THROUGH
PERCOLATION TEST RESU~LTS ANTICIPATED DATE OF COMPLETION
..~o,/ ~- ~'~'' BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~'~'~'~,~ PERMIT TO INSTALL A '~/~ ~' ~ ~'~ a ~, ~'-~
, AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
r~/ ..,SEP~I~T~NKSIZE /o~o~/ TYPE ~'¢( SEEPAGE AREA TYPE
~[ ~ ~ ~,~O~ ~o~, DIAGRAM OF SYSTEM
DISTANCES:
Health Authority
] ce~tJ£¥ t~at ! am £amJ]Ja~ with the ~eq_uJ~emcnts ct'
abo~e described system Js J~ accordance wJt~ said code.
DATE
~, ANCHoRSo~ AREA BOROUGH
CREATER ~ ~ pr
327 EAGLE STREET
ANCHORAGE~ ALASKA 99501
' ' m Re otto a So, Is =og -~ Tes[
Depth '
Feet Soil Characteristics Location Sketch
Reading Date Gross Time Net Time Depth To H20
~r'coia%ion ' ~te: i"> ' ~inute- ....
Proposed InstalLation: Seepage Pit f/ Drain Field
Depth Of lnlet___.~~ Dep~'~o~ O~ Pit Or
Test Performed
Data Certified
by '
A & L DRILLING COMPANY
OWNER OF LAND
ADDRESS /~
LEGAL DESCRIPTION
DATE-Started
PERMIT NUMBER '~/'f/
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694-2588
x] r'UEF/'2' DEPTH OF WELL
~,fdZ~ ~F/[(~ STATIC LEVEL OF WATER FT.
~ /~- ~/.~.IC~ ~lD~ DRAWDOWNFT. /.C
Ended
IND OF ¢:
/ ,2 _?
KIND OF FORMATION:
From ?.~ Ft. to c~) Ft. (o0~_5/~ (~/~,~d From.
From ¢) Ft. to / ,3 Ft, ~'~0 Y ~ffqff~O~ From
From /3 Et. to ~} ~ Ft. ~ · From__
From ~-~} Ft. to%3- Ft ~/~ d~~ ~Ou~From
F~om QA--' Ft. to i° y Ft.2-/g~ ~7~ From
F~om/%)Ft. to / f~ Ft...f~TO~/~ ~ F~om
From ?~-0 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.
6~T~&':~rom __
From
From
From
From
From
From
From
From
From
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft
Ft. to__Ft.
Ft. to Ft.
Ft. to Ft.
__.Ft. to__Ft.
Ft, to__Ft.
Ft. to Ft
Ft. to__Ft
Ft. to Ft
Ft. to__Ft
Ft. to Ft
Ft. to Ft.
Ft. to Ft
MISCL. INFORMATION:
DRILLER'S NAME
1'"1:1.' i'.,t ]: I','ILtI"I [::, :1: :~.;'I"FII'-,E:Ii~: E:E'I"!.,.IIEli!'-'t'-,I I::1 14E:I....I.... F:tt'.,iI:) I::ll".t"r' I:]II",I-:E; ]: TIE SEP.tRGE'-' E:' :t; E F:'C '.:: I:'~L .'.~l r .";TI'El I :t:
:;t. OO FEEIET 'FEd::t F:I I:::'F4:Z',,,'t::tTIE t-,.ll~ii;L.L O1:;~: ;::_':::R F:'f.EET l:'l::lJ:;.': t::1 I:::'I...IEd.... :[ E: I.,.IIEI...i .....
P.iE:L.I... I.J::)C:i:E; FII:;.':E F,:E:i]:!U:[I:;:'.EI::' FIND I"ll...tST ..;,:~' F,;:ETIJF;~:I",IE~;[)'T'(:i THE i:::,EF:'F:ll;4:Ti"IEt"4T I.,.I ]: 'H'"I :[ t",! ::~:[;!:.i l.::,F:l"r':'.:.:;
OF' THIE !4EL.L. '" OMF'I._IE"I"] Ot",t.
:E;i::'IEC: ]: F; l C:FIT :[ CII",IE; t::1t",I[::'..... j t'.,l'.:~;TI;i:l. Jl::"" ( O1".I t;::' 3: l:;ll:~it;;:l:::ll'"t'-'~; FtRE i':I',,,'F:I 3: t....t::IBt....IE: "FO :lB l",l:ii;Lil:~:lE I:::'l:;::l;:)l::'iEli:
]~ i",I:E; Tt:::It....t.. I:::1"1" 3: I:I
..... · .~- It:::. tHi II ..... Ii::" ~" ~::":)! ti'""ii % '.:!E;; :E~,; tl..j
F.> [t-_-~2: if:;'.;.:: ~*-'1! :E '-If" %,,," I1:;::::tl It...... ::E E:, IF:::' u::;:li Ii::;;i;:: i1'"'"11 ~"..,Ii II;:::" ~ "' ................. ~ .. -
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section �� Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-491-06
1. GENERAL INFORMATION
Expiration Date:
Complete legal description Glacier View Heights BA L14 RCI'A
Location (site address) 22643 Eagle River Rd
Current property owner(s) Lisa Gentemann Day phone
Mailing address
Real estate agent FSBO Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
0
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 $ 1412.5-D ff
Date of Payment [Pl& l �Zo ;4./)
Receipt Number (3L4611%
COSA # (35C :301R31
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
COVID-19
25% DISCOUNT APPLIED
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and 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 levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not
guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot
provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole
benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buyers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E.
6. DSDSIGNATURE
/
�/ System #1 Approved for -3 bedrooms
System #2 Approved for bedrooms
Disapproved
{
Phone (907) 745-8200
Date
OF ALgst�
®�P• w to
e
w.-'49
4TH....
Steven R� •Pannorie
CE 8149
kj`D ,R6rESSION}, o� �
Conditional approval for bedrooms, with the following stipulations:
.I►tlltlCtt(((i,,.
r
'I///III.•
By: &VA Ori �
Original Certificate Date: � � �D b
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 BA L14 REM
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 5/31/77
Total depth 162 ft
Cased to 162 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 6/1/2020
Static water level at beginning of test 132.5 ft
Comments
B. TANK DATA
Age of tank(s) 3 years
Tank type/material
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 6/5/20 JR's Septic
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 12/1/17
❑ ALL standpipes present per record drawing
Total measured depth from grade 11.58 ft (max)
Measured depth to pipe invert from grade 2.58 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 050-491-06
Structure served by this system 1
Well production at time of test 3.54 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑ Yes ❑✓ No
❑ Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Pannone Engineering
Date of Sample 6/3/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 6n/2020
Results MV Pass For 3 bedrooms
Fluid depth prior to test 0/0 in
Water added 450 gal
New depth 2/9 in
Elapsed time 50 min
Final fluid depth 0/0 in
Absorption rate '450 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
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'
0 Yes
if No
Community Sewer Manhole/Cleanout > 100'
M✓ Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' Yes
if No ft
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' Q Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
Q Yes
Animal Containment > 50' Yes
if No ft
M Yes
if No
ft
* Waiver on file - OSV171092
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' [�✓ Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' EJ Yes if No 5+ ft Surface Water > 100' Yes if No ft
Property Line > 5
0 Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
P( Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Main > 10'
0 Yes
if No
ft
Community Wells > 200' R) Yes if No ft
Water Service Line > 10'
(n✓ 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'
El Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No 1 *
ft
Wells on Adjacent Lots:
Water Main > 10'
0 Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Service Line > 10'
M Yes
if No
ft
Community Wells > 200' R Yes if No ft
Surface Water > 100'
Q Yes
if No
ft
F. ENGINEER'S COMMENTS
* Waiver on file - OSV171092
G. ENGINEER'S CERTIFICATION
l certify that / 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.
COSA Checklist yellow sheet
piatokuXtURN,
Steven R. Pannone
CE 8149
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
. CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
050-491-06 HAA #
GENERAL INFORMATION
Complete legal description
Glacier View Hieqhts
Lot 14, Block A
Location (site address or directions)
., 22643 Eagle River Road, Eagle River
· Property owner Royce & Sandra Laseter Day phone 694-5195 msg
Mailing add[ess lO:~0.'~ 1~1~= f~v~=z' r,nr~? Rrn~¢]; ~:~gl,= ~v~* AW 9q577
Lending agency N/A' Day phone
Mailing a~ress ' ' : ~
Agent ~'
Address
Les Bailey/Vista'Real Estate Day phone 689-6451
16635 Cente~i~ld Drive, Eagle River, Ak 99577
Unless otherwise'requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
TYPE OF WASTEWATER DISPOSAL:
Individual on-site,~
Holding tank '
Community on-site
Public sewer
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72A325 (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 Eagle River Engineering Services
Address P.O. Box 773294, Eagle River, AK
Engineer's signature ~
Phone
99577
694-5195
Date /.~z- 3 o ~- ? ?
DHHS SIGNATURE
'Approved for --~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments'
' '~:.The MU~:iciPlality of A'n'~hSrage Department of Health and Human Services (DHHS) issbes Health Authority
Approval C?tificates;based only upon the representations given in paragraph 5 above by an independent
p¢ofessional engi~;~' registered in the State of Alaska. The DH HS 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 ~1
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
Health Authority Approval Checklist
Well type ,~r,v~* f-~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) /V Date completed
Total depth /~'~- ' Cased to / ~'.?. ¢
Sanitary seal (WN) ~/
Date of test
Static water level
FROM WELL LOG
.3-- .7/-- 77
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
/-~- lq
Well production
/"7/~ g.p.m.
g.p.m.
WATER SAMPLE RESULTS:
Coliform ,~
Date of sample: J D.. -/~'
Nitrate ~)// ///"/~"~//_--- Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 5-//'7~ Tanksize /,~,¢',~ Number of Compartments / Cleanouts (Y/N) ~
Foundation cieanout (Y/N) ,Y' Depression (Y/N) ~ . High water alarm (Y/N)
Date of Pumping /~'/,~/~-~ Pumper
. C. ABSORpTIoN FIELD DATA
Date installed 5-- '-/~ 7~
Length /z--// Width
Soil rating (g.p.d./fF ~ 75~' ~',~,~ System
type
Gravel thickness below pipe ~' / Total depth
Effective absorption area ~'-z~ 5/ Monitoring Tube present (Y/N) Y Depression over field (Y/N) AJ
Date of adequacy test ~' /'~--/~ ' 7 4 Results (Pass/Fail) /o~,¢j. For -~ bedrooms
Fluid depth in absorption field before test (in.); ~//Immediately after.~'¥o gal. water added (in.): /~ ?//
Fluid depth ~' ? (ins) Minutes later: /5-z~ Absorption rate = '/'¥,-~'~ g.p.d.
Peroxide treatment (past 12 months) (Y/N) /,,///,~r-
If yes, give date
72-026 (Rev. 3/96)*
Date installed
Manhole/Access (Y/N)
Size in gallons
"Pump on" level at*
"Pump off" level at*
High water alarm level at*
*Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /Oo,/~/'
Absorption field on lot
Public sewer main t¢
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation '-'(' / Property line ,2. ¢' / Absorption field
Water main/service line 'P/z)/ Surface water/drainage -Y-/,~o / Wells on adjacent lots
fO /
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
//
Property line Building foundation ~',0 ¢
Surface water 'F/~¢ /
Curtain drain ¢V/¢/-
F. ENGINEER'S CERTIFICATION
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots Y/d,¢ /
I certify that I have determined thru field inspections and review
in conformance with MOA HAA guidelines in effect on this date.
Signature
Date
~ar~
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
("%~ _ ~.~C,~ \ _ ~ NAA # ,.~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdiv'ision, section, township, range)
Lot 14; Block "A"; Glacier View 'Hei,qhts'
Location (address or directions)
Mile 4.4 Eagle River Road
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
John McBride
8C 83, Box 1545~
Telephone:(home) 694-3899
Eagle River. Alaska 99577
Telephone
Business
376-7979
(d) Real Estate Company and Agent
Address
Telephone
(e)
Mail the HAA to the following address: (or check here rq, if hold for pick up.)
List contact person and day phone number below:
17034 Eagle River Loop Road No 204
2. TYPE OF RESIDENCE
Single-Family[D Number of bedrooms 3
3. WATER SUPPLY
Individual Well [~
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
. Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5~ ENGINEERING FIRM PROVIDING h.dPECTIONS, TESTS, FILE SEARCH, DAiA AND INFORMATION .
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage fifes 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 Telephone
S & S ENGINEERING
Address 17034 Eaclle River Loop Road No. 9o4
Eagle River, Alaska 99577 ......~//. ,/~?(..~
Date
6. DHHS APPROVAL ~.,/ ~
/ '-,
Approved for ~ bedrooms b~_ .~:~"~'~'/'~'¢ .~/~<~~'~'~
Approved ~'~' Disapproved Conditional
Terms of Conditional Approval /%5~/4J/~
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 DHHSdo 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. 7/8a} Sack Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
· Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: /-.-o'~
t'ec
A. WELL DATA
We, c ass f cation .
Well Log Present (Y/N) t~ Date CompletecJ
If A, B, C, D.E.C. Approved (Y/N) ~
' _~--2'[- ~ Yield ~. 2- ~z~
Total Depth
Static Water Level ! ~
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public SeWer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
Cased to/--/o'/- Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
[ oO -/ ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TANK DATA
Date Installed ~-/-/-~Z) Size
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
I CPO(0,-. ~JNo. of Compartments
£
Air'tight Caps (Y/N) c1 Foundation Cleanout (Y/N)
/~ Date Last Pumped --J/'~.~d¢
/~/~ , 'for /0 ,
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK:
To Water-Supply Well
To Property Line . .
To Water Main/Service Line
To Building Foundati'on
To Disposal Field
/
To Stream, Pond, Lake or Major Drainage Course { d::)¢_~ -/-
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata / _~y_~ ~/~E;) Type of System Design
Date Installed ~-~ -- '-CC) Length of Field //_.~
Width of Field / ~ / Depth of Field / ~
Gravel Bed Thickness
Square Feet of Absortion Area ~YO/'¢ ~ Statndpipes Present (Y/N)
Depression over Field (Y/N) &) Date of Last Adequacy Test
Results of Last Adequacy Test ff~Cq'ILI~:~qC"u[-OFc~ ~ ~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
( Co -/- To Property Line
To Water-Supply Well
To Building Foundation ,2. ~
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Existing or Abandoned System on
; On Adjoining Lots .'~O '/'
( O '/' To Cutback (if present) &)
Comments
D. LIFT STATION
Date Installed ~,
Size in Gallons '~
"Pump On" Level at '~
High Water Alarm Level at ^ ~ ~A
Tested for
Meets MOA Electrical Codes (Y/N) ~,
Comments %
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that have checked, verified, or conformed to all MOA and HAA guidelines in
inspection.
Signed ~ & S F. NGINEERING
17034 Eagle River Loop Roacl No. 204
Company - . · "--J-- ~'~'~
Date
MOA No.
Receipt No.
Date of Payment
Amount: $
/
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
#1: Time 10:30 a.m.
Date
Insp Pratt
i¥1UNIL. IK'ALI I ¥ UI- F%I~L. MUMAbt
DEPARTMEN~'/ OF HEALTH AND ENVlRONMEN]~A~'PROTECTION
825 L Street, Anchorage. Alaska 99501
264-4720
Date Received: April 11, 1978
4-13-78 Thurs
#2: Time ;/~:~%~) ~3: Time
Date L/-I~-~(~ I~PJ Date
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request:
Mailing Address: Pouch 7-025 99510
2. Property Owner: William J. Nef
Mailing Address: Post office Box 336 99577
National Bank of Alaska % Sherrie Stevens
Phone: 276-113~
Phone: 694-9379
3. Legal Description: Lot 14 Block A Glacier View Heights Subdivision
4: Single Family Residence: (x) Number of Bedrooms: Three
Multiple Family Residence: ( ) Number of Bedrooms:
Well System:
Permit #
Construction
Individual well (x) Community/Public System ( )
Depth of Well 162' Well Log on File ( )
Bacterial Analysis
e
Sewage Disposal System: On-site System (x)
Permit ~ Installed 1970
Septic Tank Size
Absorption Area
7. Distances:
Public Utility ( )
Installer ~/~
Manufacturer ~~
Soils Rate ~ Material ~
Well to Septic Tank 1~(>[ to Absorption Area
to Sewer Line
Nearest Lot line
Absorption Area
-= MUNICIPALITY OF ANCHORAGE=~-~
Department of Health and Environmental Protection
~ 825 L Street, ~chorage, Alaska 9950~
Mail
in g
Address: ~
Name of Buyer: /()?~;~_~_~ ~~z~
Mailing Address: ~ Phone:
o
Lending Institution:
Mailing Address:
Realtor/Agent:
Se
o
Mailing Address: Phone
Legal De sc,riPtion: ' /f--/ . _/)~.~f~_ ~ ~' ~- × ~f~ ~-w~.
Street Location: C~/6k'm--..~-~z/(/~ ~/'~W /~_/w.~ .
Single Family Residence: (~Number of Bedrooms: .~
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply:. * Individual Well ~-~f~"Public/Community System
If Individual Well, well depth /~-
If Community System, name of system
8. Sewage Disposal System: *~3n-site System ~ Public System
If On-site System, date of installation: / ~
( )
( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
Pa.g,e ~ 9wo ~
Dep~rtment of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 14 Block A Glacier View Heights Subdivision
Comments:
Affadavit Attached: ( )
Approved:
Disapproved:
Letter Attached: )
Date:
Date:
Department Worksheet: