HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK D LT 10
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 PHONE T ~w
LEGAL DESCRIPTION
LOCATION NO, OF BEOROOMS
~ PERMIT NO.
I Material · No. of compartments
p. Z Manufacturer ~_ ~ ~~
¢ Liq. capacity in gallons Inside length Width Liquid depth
/00¢ IF HOMEMADE:
~ Well Dwelling PERMIT NO.
DISTANCE TO:
~ ~ ~ Manufacturer ~ Material Liquid capacity in gallons
~ ~ DISTANCE TO: ~¢ ~¢ ~¢r-" 2--3-- ge ~
--~'':~ No. oflines / Length°feac~lin]~/O ¢ Totallength~,)i:,,_¢~. Trenchwidth.~ // inches Distance between lines
~ ~ ~ Top of tile to finish grade Material beneath tile ~/ Total effective absorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
uJ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO~
~ Building foundation Sewer Fine Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PI PE MATER IALS .... ~: :~
INSTALLEB~~ .....
REMARKS
L
~. ,. ~ ~> .
/
~PPROVED DATE LEGAL
by
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588
OWNER OF LAND ~,~1_'6 t~fO ~,~~r_
ADDRESS ~_~ ~o [/ ~/~ ~ STATIC LEVEL OF WATER F'[.
LEGALDESCR1PTION d /~ ~3~ 0 ~*~-~'~ 01~ ~'
DRAW I)OWN FT.
DATE-Started Ended
KIND OF FORMATION:
From
From
From
From 4 '7
From
From [-~'~ Ft. to / 6~ 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,
Ft'om Ft. to Ft,
From Ft. to Ft,
From Ft. to Ft.
From Ft. to_~Ft,
Ft
Ft.
Ft. to ..... Ft.
Ft. to Ft,
Ft. to Ft,
From Ft. to ...... Ft.
From __ ~Ft. to Ft.
Frmn 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
M1SCL. INFORMATION:
Till!ii; L Eii'.,!G'!'H D Z[ i"1[i!:!',I'.i!i; :1: ON :I: :!ii; TI'Iii!:: l...!i!Z!'.,l(:ii'l-!..I ,::
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GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456 I
SEWAGE DISPOSAL SYSTEM M APPLICATION AND PERMIT
PERMIT NO, I
NAME OF APPLICANT
INSTALLATION LOCATION
MAILING ADDRESS PHONE
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
SEEPAGE PIT ., DRAIN FIELD i OTHEr
TO BE INSTALLED BY
NOTE= THIS PERMit IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 hOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE TYPE SEEPAGE AREa SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE P[t WALL
SEPTIC TANK ,SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, ., SEEPAGE PIt
TO RIVER. LAKe. STREAM.
DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTUrbED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING ~NSTALLATION.
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
[)ATE APPLICANT'S SIGNATURE
0SE
Russell Oyster
694 2774
Soils ~' Foundations
Performed for:
Legal Description:
o
GE'~'~ECHNICAI... 8 DEV'
Box 90, Davis SI, [agio River, Alilska 99577
694 27'74 or 6882280
'-*PMENT CO.
SOIL LOG
Mailing Address: ~i?e~.
Z~-F IL' '--'
E~f/ Ellis
698-2280
Land Developrr~n!
15
Ground ~ater Encountered: Yes No
Proposed Installation: Seepage Pit
Comments:
'" If yes, what de, pth
Drain Field
Performed by:
;,%
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
o.~o -- ,¢9/-/~
HAA #
GENERAL INFORMATION
Complete legal description
/
Location (site address or directions)
Property owner ~7'~/~ ~../'~OF' Day phone
Mailing address 22..~07 /~c/r//c: ~, Eoo /C ~F,
Lending agency R~,5'h(L ~5~ F6:~ Day phone
Agent
?l~minq~
Address /~. 0. L~o'~ (~ 7i/0~.
Unless otherwise requested, HAA will be held for pickup;
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1191) Front MOA #21
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 ~ ~'/~/--/'/ ~'/2'7),~/~/.'Z~J'~ Phone ~//~---,/ ' 7'~__~
Engineer's signature ~.~ ~///~.,'/,¢~ZZ.~ '/"
Date
/
DHHS SIGNATURE
Approved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer 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.
72-0¢.5 (Rev, 1/91) Back MOA #21
Municipality of Anchorage D[C 0
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division ~ E C ~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description:
A. WELL DATA
Well type
Log present(~N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to /~2L7"
g.p.m.
FROM WELL LOG
7-2d~
O.dO --~?/-/~
Date of test
Static water level
Well production ~),
WATER SAMPLE RESULTS: (~
Coliform [~
Date of sample: [[/~'~/~
B. SEPTIC/HOLDING TANK DATA
Date installed
Foundation cleanout (Y/N)
Date of Pumping /Z/~,/~Z'
I ~
C. ABSORPTION FIELD DATA
Date installed ~ '2~"~:~
· Length --//~) Width
Effective absorption area
7'-Z'~ - 7,-9
Casing height (above ground) -. -
Wires properly protected (Y/N)
AT INSPECTION
¢,:;;z~ i, ~ g.p.~.
Nitrate ~,'7¢:¢ Other bacteria ~¢.~/
' Collected by: '-~. //-//~//), ~//~e
Tanksize /~)L'g~'~ Number of Compartments ,~ Cleanouts (Y/N)
/ Depression (Y/N) /~ High water alarm (Y/N)
Pumper
Soil rating (g.p.d./ft2 or fF/bdrm) /'~'~-~g System type ~),.
..~' ~
P'L~ Total depth
Gravel thickness below pipe
Monitoring Tube present (Y/N) ~ Depression over field (Y/N) _ ..
Date of adequacy test //-Z"7-;)G. Results (Pass/Fail) /OC) O.5' For
Fluid depth in absorption field before test (in.); ~ Immediately after~'~ gal. water added (in.):
Fluid depth 0 (ins) Minutes later: // /~)-~ Absorption rate = ~,~A'- g.p.d.
/~//0 If yes, give date
Peroxide treatment (past 12 months) (Y/N)~/~p
72-026 (Rev. 3/96)*
bedrooms
c~p/~,'ov~i ~'c~ze.~
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at* _ ~1 at*.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
../
Absorption field on lot / ,:3
Public sewer main
Sewer/septic service line /?/)/Of"OZ ,. /,.~0"
Lift station /~,~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~,..~'~/-o C0 Propertyline ~,~"/~/~7~1 ~0
ft' "
Water main/service line /~yz] ~0 Surface wateddrainage /~Z~/)~.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field 14' CO ~ CO
Wells on adjacent lots ~
Property line ,5'5'//~?¢ Mr Building foundation 2 / ";~ (.'(') Water main/service line
Surface water Jl/lY7)~ /~)[i,~-ff~.O~' (/1'~1'~'/,¢; Driveway, parking/vehicle storage area ,.~'~
Curtain drain ./~.z/)(~_ fy/) ffd~D~f'/~f*6]~ ,~" Wells on adjacent lots
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections a~
in conformance with ~40A H/~A guidelines in effect on this date.
Signature
Engineer's Name
are
HAA Fee $ ,~¢ E.¥')
Date of Payment ,/
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEAl_TH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Lot 10; Block D~ Gla~ier View H~qhts
Eagle River, Alaska 99577
Location (site address or directions) Myr~e P~v6, Eaqle Riv~, AK 99577
Property owner .
Mailing address
Lending agency
Mailipg address.
Harry Fluharty
C/0 F.A.A. King Salmon Tower~
Day phone 246-3311
King Salmon, Alaska 99612 _
Day phone
Agent Barbara Crittenden-Jack White ¢o. Day phone
Address 10928 Eagle River Road ¢ Ea~le River, A£~k~
Unless otherwise requested, HAA willbe held forpickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Community well
Public water
NOTE:
XXX
694-5500 _
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
XXX
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
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 w~stewater 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 & $ £NGINEERING ........ .,,.., Phone
l XU,~~, t~a§Je ~,JYelI [.uup ~v~u i,~v, ~v-t
Address ~aqle River, Alaslca 99577
w
Engineer's signature
DHHS SIGNATURE
Approved for '~'_~._~o~_.~_~ bedrooms.
Disapproved.
Conditional approval for
Date '2. _~z~-~5
bedrooms, with the following stipulations:
Additional Comments
By: ,~c.~,,.~ ~..- )~.~ ¢--,~.6~- Date
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.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel I,D.
Legal Description:
A. WELL DATA
Well type ?¢-~\l ~'~'~ If A, B, or C, attach ADEC letter.
Log present ~)'N)
Total depth
Sanitary seal ~_~/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
Date c.o.~plete.d,~_'~,¢''j-'~ ~ :7.~.____ Driller
Casedto \ L-~"~ ~ '~ Casing height
Wires properly protected~C¥~N)
AT INSPECTION
~.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
ADEC water system number
z
; On adjacent lots
~F¢¢,,~¢-~; On adjacent lots
Public sewer manhole/cleanout ~/ ~
Petroleum tank .~.~ ~ -V
WATER SAMPLE RESULTS:
Coliform (~
~o ~ Nitrate
Date of sample:
B. SFPTIC/HOLDIN6 TANK DATA
Date installed (-¢
Cleanouts~N)
High water alarm (Y~_~
Date of pumping
Collected by:
Other bacteria _ F-~ c,
$ & S ENGINEERING
Eagle River, Alaska 99577
Tank size ~'~'b b Compartments %
Foundation cleanout (Y~ r'~ Depression (.Y~i) ~
/~ Alarm tested (Y/N) ~
.~. ~ \ ,~ ~ c~ -~ Pumper '~¢-~. ~¢¢-~$ ¢'~ a L.
SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)on lot \ c~ ~ On adjacentlots
To propertyline \ ~ ' ''~ Absorption field
Surface water/drainage
Foundation
Water main/service line / C~
72-026 (Rev 7/91)Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at
High water alarm level ~-.---~'~- Cycles tested
Meets MOA electri~__
Sw,E~ANCE FROM LIFT STATI~ll on lot On adjacOe~t 7o~;
off" level at
Surface water
D. ABSORPTION FIELD DATA
Date installed Lc - ~
Length "~ E)~ Width
Total absorption area
Depression over field (Y~)
Soil rating
Gravel thickness
Cleanouts present(~N)
Date of adequacy test
System type
Total depth
Result.~:i~fa~) ~..~'~S ___ .,~ f .
Peroxide treatment (past 12 months) (Y~ ~ If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot \ O.~'~
To building foundation
On adjacent lots ~"~
Surface water
Curtain drain
~'A?---¢~ o ¢.,r~'X:) n a dj ac e n t I ct s \ D~ Property line
To existing or abandoned system on lot
Cutbank '~ c~ t 'P
~ Water main/service line
Driveway, parking/vehicle storage area
bedrooms
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect o~date of this inspection.
Engineers Name
HAA Fee $ -/
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE ~ '~'.ii ,-
Department of Health & Human Services ..
' . DIVISION OF ENVIRON MENTAL SERVICES
. , - : - -. .... 343-4744 '?.~,~i ~¢"~"" ' - .. ~ ~ i~'::."~:.'~ .'. '.-
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL_OR.
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~ - . ~ · :2 .'--
Parcel r.D. # [-""3 -z'~ ~ L.[ O~ ~ ~ ~ \ .... HAAi~. ~'-~ ~L:~°~ ~
1. GENERAL INFORMATION (Must be completed prior.to submittal) -
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lot 4i Block B; Gla~ier View Hei,~hts Subdivision
Location (address or directions)
NHN Myrtl6 Driv6
(b) Property owner Walter & Jud~ Johnson ' :Telephone : (home)
Business
Mailing Address .-
(c) Lending Institution Telephe ne
Mailing Address
(d)
(e)
Real Estate Company and Agent RE/MAX
Nicolays en
Telephone_ ' 694L4200 ;' ''-'
ENGINEERING
OF EAGLE RIVER
. .~._.:... _
Mail the HAA to the following address: (or check ~ere.)~, if hold for pick up.)
List contact person and day phone number below:
17034 Eagle River Loop Road
Eagle River, Alaska 99577,,
2. TYPE OF RESIDENCE
Single-Family I~ Number of bedrooms
3. WATER SUPPLY
Individual Well [~ Community [] Public []
· .Note: f corr!mu~ity well system, must,ha? written confirmation from the State Department of Environmental
Conservation"att6sting to th: I(~aiity and'~'{~'tbs:*;:" .:v....:.", :,-:;.-:,,:;?b-?,~ . ~.....~
: On-site B~( Public [] Community []'. . ' Holding Tank []
' Note: If corem'unity well sy~t~m~ rn~si ha~e wri:tt'en c'8:~¥i'rmA{ig:~ ~om'~l~ Statel Dep~'r~r~en~ gf Environmenta!
Conservation attesting to the legailty and status. .. . . ..
72-025 (Rev. 7/88) Page -1 of 2 '
~ Jo ~ ~6~d
RECEIVED
A. WELL DATA
Well Classification
Well Log Present ~ /V/ Date Completed
Total Depth L'//(' Cased to ~f'E) / ¢' DePth of Grouting
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit t(~N) r~/
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
;..,~,., cHEc~KLIST- FEBRUARY 1984
~ ,:'-,-,:, u;v~si~N 343-4744
Legal Description:
If A, B, C, D.E.C. Approved
Yield :~, ~ ~/~/¢/
Pump Set At
Sanitary Seal on Casing ¢-Y~, N)
Depression Around Wellhead
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot
To Nearest Public sewer Line
To Nearest Sewer Service Line on Eot
Water Sample Collected by ~4.. ~.~ ~Lc~r..~._~r~,~ ;Date ~-~''q~,
Water Sample Test Results
Comments ~ ~ ~L.~.
B. SEPTIC/HOLDING TANK DATA
Date Installed \~-'"> t ~cl ~ Size
Standpipes ~/N) y
Depression over Tank (Y/~
Pumping/Maintenance Con!act on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~
~ o~ No. of Compartments
Air-tight Caps (¢~'N) "1/ Foundation Cleanout~N)
~-~ Date Last Pumped
~/,0¢ ;for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To WaterrSupply Well \ u:, ,::,.
To Property Line \c'~'~
To Water Main/Service Line \ o~r
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation
To Disposal Field
Comments
72-028 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~Z- ~-~ - ~
Width of Field
Type of System Design
Length of Field
Depth of Field ~
Gravel Bed Thickness C~ ,% ~
Statndpipes Present (~/N)
/,../,Date/A._ of Last Adequacy Test
Square Feet of Absortion Area
Depression over Field (Y~)
Results of Last Adequacy Test
SEPARATION DIS-I:ANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Property Line '~' ~
To Building Foundation
Lot ~ /
To Water Main/Service Line to ' o''-
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~ %~,s'~4-t "~so ~-r~_.-~
/o ~'~ To Existing or Abandoned System on
; On Adjoining Lots ~u, ~ '~
To Cutback (if present) '~"~ ~'5'
D. LIFT STATION
D~d Dimensions
Size in Gallo~%'~-. Manhole/Access (Y/N)
"Pump On" Level~,~ "Pump Off" Level at
High Water Alarm Level at ~ Vent (Y/N)
Tested for ~ Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N) ~
Comments ~
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to ail MOA and HAA gu~dehnes m effo.¢~:o~}~a,te,.of th~s
inspection.
Date
Receipt No. ~L[~D/L[q l~ Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order $ 31234
Date Report Printed: JAN 14 91 @ 11:18
Client Sample ID:L4 B"B" GLACIER VIEW HTS
PWSID :UA
Collected JAN 7 91 @ 13:00 h~s.
Received JAN S 91 @ 15:08 hrs.
Preserved with :AS REQUIRED
Client Name
Client Acct
BPO $
Req ~
Ordered By
S & S ENGINEERING
SNSENGP
PO # NONE RECEIVED
R SHAFER
Analysis Completed :JAN 9 91 Send Reports to:
1)S & S ENGINEERING
Laboratory Supe?isgr.L~HEN C. EDE
Released By :~~.. ~ 2)
Chemlab Ref #: 910073 Lab Smpl ID: 3 Natrix: WATER
Allowable
Pazameter Teeted Result Units Nethod Limits
...............................................................................................................
NITRATE-N 0.76 mg/1 EPA 353.2 lO
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
CHEMICAL & GEOLOGICAL LABORATORIES OF I, ILASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
~] PUBLIC WATER SYSTEM I.D.# I I I I I r I
PRIVATE WATER SYSTEM
Name Phone No,
$ & S ENGINEERING
Mailing AddreSs034 Eagle River Loop R~ No, 2~u~
Eaflle River, Alaska9957~.
City State
Mo. Day Year
Zip Code
SAMPLE TYPE:
~/~Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
.) [] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
3 I
4 I
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~Satisfactory
[] Unsa[tisfactory
[] Saml~le too long in transit; sample should
not b~e over 30 hours old at examination
to indicate reliable resalts. Please send
new sample via special delivery mail.
Date Rebeived ~J
Time Re~:eived / 5 ~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result* Analyst
Iwt.r~¥~t-~ l I-I-6]~A..
I II-~
I I~'
I I~
I I
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TNTC =
Membrane Filter. Direct Count
Verification: LTB
Too Numberous To Count
.BGB
Coliform/100 mi
Coliformrl00 mi
OB = Other Bacteria
MUNICIPALITY OF ANCHORAGE
DEPARTf~ENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR FIEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ;_~- ~"~,.-' '~','¢"J" S ....
GENERAL INFOR~AI'ION
(a)
(b)
(c)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
App';cant N:~e~¢ ~~ Telephone: Home ~ ¢~' ¢~ ~ * Business ,A~. ~ "¢I ~-~"-
Applicant
Address
Applicant is (check one): Lending Institution ~; Owner~d~]~; Buyer ~; Other ~ (explain); .... ~ ......
(d) Lending Institution/C~r~<_-cc;-z-~-~--Z?-Z~ · Telephone 5-~. /_:
Address ......... (~?L~- '~-~"t.~"~-~'" /- ~:~--'- ~:~--~' ----
(e) Real Estate Company and Agent ~ _~~:--- :~---~-,:
Address ~ ~-
(f) ~,e HAA to the following address:
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well ~-J/ Community [] Public
Note: If community well system, must have written confirmation from the State Department of Environrnental Conservation
attesting to the legality and status.
4, SEWAGE DISPOSAL
Onsite l~" 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.
Page 1 of 2 72-025 (H/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this I-.{eaRh
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for tile number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
fi'om 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 ____f~.z~S.~..9~]~1~j Telephone
Address SP, D
Date
DH~PAPPROVAL [ "'~ ~ . ~
Approved __-~__ ............... Disapproveo _ Conditional
Terms of Conditional Approval
CAUTION
The Muncipdity 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 DFtEP 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
MUNICIPALITY OF ANCHORAGE (MOL/
HEALTH AUTHORITY APPROVAL (HAA)
MUNiCIPALiTY OF ANC~,~[LIST - FEBRUARY 1984
DSPT. OF HEALTH & 264-4720
WELL DATA
Well Classification
ENVIRONMENTAl- PROTECTION
gE(: 2 6 1985
RECEIVED
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present(~¢~4)
Total Depth [{'~f2.-'~ ~J ~
Static Water Level
Casing Height Above Ground
Electrical Wiring in ConduitS/N)
Separation Distances from Well:
Date Completed
_ Cased to ILc'Z- ~ q ~
"'j'~ ~ - '"7 ~ Yield
Depth of Grouting '"~
Pu m p Set At t_), ((..,
Sanitary Seal on Casing4~/N)
Depression Around Wellhead (Y/~
To Septic/14e~ Tank on Lot / ¢>~,- ; On Adjoining Lots
To Nearest Edge of AbsorptionField o~ Lot \ c::~z;::'~ '~ ; On Adjoining Lots
To Nearest Public Sewer Line ,/~//~ To Nearest Public Sewer
Cleanout/Manhole ~/~ To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ~ ~[.~1~ ; Date
Water Sample Test Results ~ ~~
Comments ~ ~. ~l~ ~ ~~
B. SEPTIC/I,I~L-'Btf~H~ TANK DATA
Date Installed
Standpipesd~N) Air-tight Caps4¢~)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from SepticCHoMin§ Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Lo - '~.~t,--~ ~(~'~ size I L~c~c:::~ No. of Compartments
Foundation Cleanout (Y~)
t~//~ate Last Pumped
; for t~
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/I~.
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
"'~'4~ ~:~ Standpipes Present d;~;~N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well \ ¢c:~ 1 ..~
To Building Foundatio
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
TO Cutbank (if present)
Comments
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 S & $ Enghmei.|t~, Date
Company ?¢'-'~', ~;w~r, Alaska ~ MOA No.
Receipt No. ~
Date of Payment
Amount: $ ~%-~
Page 2 of 2
72-026 (11/84)
APPLIC' FILLS OUT UPPER HAL'- ONLY
Addres~ Zip Gode
Street Locat[~ /'1} / i ~j
Type of Resi~nce
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~'individual /:: ~ ~ j/ A~ACH WELL LOG. A Well Icg is required for all wells drilled since June 1975.
. ~ Community ~ ~ /A} ~.:/ For wells drilled prior to that date, give well depth (attach Icg if available).
'~ Public Utility
Sewer Disposal
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time
Date Date Date~_
Inspector Inspector Inspector
Field Notes: f~C) ~'~ZC-,D~''C~ O ~,'~, ~
~ ' ~0 ~-~ L~' ~.0~
Inspector
"Municipality cf Anchorage"
"Dept. of Healtt~ &
E:nvironmnnl~l Protection"
(3) APPROVED BEDROOMS ) DISAPPROVED
) CONDITIONAL APPROVAL'
DATE /"~ [''~'
*CONDITIONS OF APPROVAL
Soils Rating Date Sewer Installed
~ (.. · ','i~ ~ '~'~ ·
72-023 (3/82)
Well To Absorption Area
Well to Tankt"'7 L[.
Well Log Received
Septic Tank Size
EXCAVATION
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
WORK
July 31,
1983
Re/Max Realty
ATTENTION: Darlene Nicolaysen
P.O. Box 848
Eagle River, Alaska 99577
Dear Darlene,
Reference: Lot 4:
Block B;-Glacierview Heights Subdivision
A sewer system adequacy test was performed on the system located
on the referenced property, as you requested. The septic tank
was pumped and verified to have a capacity of 1000 gallons. The
seepage pit was charged with 800 gallons of fresh water and
after a period of 24 hours all the water had percolated out.
It can be concluded f~om this test'that the waste water disposal
system serving the three bedroom residence located on this
property is currently functioning'adequately. However, the system
cannot be guaranteed against subsequent failure.
If we may be of further service,
US.
/ ?Rg]Mg'R.T A. SH~/TER, P.E.
cc: Municipality of Anchorage
Department of Health and Environmental Protection
please do not hesitate to contact
SRB 196X EAGLE RIVER, ALASKA
~oo~
X
SE~ER ~ENF
~L¥£S~t 'l¥~qH V~L$IA
~'~ ggfl ,LO6 X~aI OI::gT A[O]~ /,6/OT/gO ~;{:
--, r ,' DA'r,~ RECEIVED
INSPECTION APPOINTMENTS "-- .~~,
TIME TIME TIME
/.'~(~, m
DATE DATE DATE
3-11' ~:~3 ~'~ ~.s,
· ,,~.,'-m^~ ~F ANCHORAGE
' DEPT. OF
MUNICIPALITY OF ANCHORAGE~v RONMEN~, ,- --%
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOn"
825 L Street- Anchorage, Alaska 99501 ~AR ~ 0
- ENVIRONMENTAL SANITATION DIVISION
RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS= Complete all parts or) page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
I. PHONE
~AILING AOD~E~ ~ / /
PROPERTY RESIDENT ~t different fr~m ~bov~) / " / ' PHONE
'
y' LEGAL DESCRIPTION
Ih.
I STREE~ LOCA_TI~J~ - "/ ~
~SINGLE FAMILY
~ MULTIPkE FAMILY
/
NUMBER OF~BEDRQOMS
[] One E-I Four
[~/Two [] Five
[] Three [] Six
[] Other
7, WATER SUPPLY
[~ 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 UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[~ INDIVIDUAL/ON-SITE** ,/~ ~ ~' YEAR ON-SITE SYSTEM wAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79}
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE E~ OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
E~JSeptic Tank or []Holding Tank ~)~ ~___..~~,
Size: ]~)l~) If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER ~..~ .
TOTAL ABSORPTION AR EA MATERIAL
4. DISTANCES Septic/Holding Tank Abs~orption Area Sewer Line I Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
~/ APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY