HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK C LT 3 REMGlacier View Heights Block C Lot 3 #050-491-33 ) ,~.,/ MUNICIPALITY OF ANCHORAGE .,,.. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION i 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE t [] NEW MAILING ADDRESS LEGAL DESCRIPTION LOGATiON NO' OF BEDROOMS M/Ic ~t~ ~./~'- ~'o~ Ad z PERMIT NO. Absorption area ~ Dwelling ~ ~ ~ ~ Material No. of compartments ~ ~ Manufacturer, ~ ~ Liq. capacity in gallons IF HOME.DE: Inside length Width Liquid depth / OO~ Well Dwelling PERMIT NO. ~O~ DISTANCE TO: ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well ~ Foundation. . ~ ~z ~ DISTANCE TO: /~) ~ ~, Nearest lot line PERMIT NO.~ ~ ~ ~ ~ Z No. of lines / Length of e~c~i~e Total length~ ~°f tines~ Trench width~ ~ inches Dista,ce between__lines ~ ~ ~ Top of tile to finish grade ~/ Material beneath tile / Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib d~ameter DEPT. OF ~ '-- Total effective absorption area ~ ~ ENVi~ONMENTA · ~h~i~f~ation Nearest lot line m Well ~ DISTANCE TO: ,o.~,, fSEP ~ ~,,~ Dis,ance ,o lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~ ~ SOIL TEST RATING / INSTALLER '.-, ~ '~o CE-5325 / APPROV ED DATE LEGAL 72-013 (Rev. 3/78) ~ ZOF 3 P l c~ r-L_ PERM I T NO: DATE: ISE~UED~ 84 "Y74 '5 UPGRADE 05:' / 04 / S 4 CONTACT PHONE: JAMES L. THODE .1.546 EAGLE RIVER IRE)AD EAIDLE RIVER, Al'::: 995T7 2'71-4785 LEGAL DE:SCF~IP: L,.O]' SIZE: LOT LOCAl"ION: SUBDIVIS]:ON: GLACIER VIEW HEIGHTS LOT: :5 SECTION: 16 TOWNSHIF:': 14N RANGE: :[W .5A (SQ,,FT,, OR ACRES) 1546 EAGLE F(IVER ROAD BLOCK: C I c:er'tify that: 1. I am £amiliar t,~J. th the requir'emen±.s f'c)P on-site sewer's .and ~,~].ls~ as sm'L .¢or'i'.h bY {he Munic:[pality of Anchc, rage (MOA) and the State oF Alaska~ 2. I t,~i].], ins'Lall the system in accordance with aZI MOA codes and regu:!.a'LicHqs, and in cc)topi, lance ~,~i'Lh the design cri"Ler. J,a oF 'Lhis per'mi{. 3. I ~i].]. aclhepe to all IdOA and State mC A!as!.::a requirements Eot t. he set back dis'Lances fr'mm any existing .~Ne].l ' ~;aste~-~ater' di IF A I....IF'T STAT]:ON IS !NSTAI..LED IN Al',! ARIEA Ftnumt.,I=r)_.~..,_,,~.,.. BY MOA BU.,L THEN (1) AN ELECTRICAL PERIdIT AND INSPIECTION M(JST BE OBTAINED~ (2) AS-BUZL]'S ,,J.l ....... NOT BE AF'F'ROVED WITHOU]- AN ELECTRICAL ..N.~, ,:...TION REF:'ORT~; AND (~ 't"HE ELECTRICAL WORK IdLIS"F EE' DONE BY A LICENSED tELECTRICIAN,, S I GIxlED AFF',_ICANT'~ ~<~MES L I~-IODE ~GREAi~ER ANCHORAGE AREA BORbCIGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM · ' '~ ' ~ .~ ~ ~'-¥ ~-.i~ ~E SEPTIC TANK: DISTANCE FROM WELL ~ MANUFACTURER INSIDE LENGTH' '/ ~-~// INSIDE WIDTH '~'t_~C_J~_~ MATERIAL LIQUID DEPTH_ NUMBER OF COMPARTMENTS LIQUID CAPACITY ../~L~.~ GALLONS. SEEPAGE ¢,¢~_: NUMBER OF PITS / . DIAMETER LINING MATERIAL BUILDING FOUNDATION__ ADDITIONAL ABSORPTION OR WIDTH ~-~ , CRIB SIZE: DIAMETER NEAREST LOT LINE ? LENGTH 3~ DEPTH / ?~ / DEPTH ~ DISTANCE FROM: WELL ~/~'.2 F/-T' ~"7'F~ 1. TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'~SQ. FT. WELL: TYPE J~"~¢ ' CONSTRUCTION BUILDING NEAREST FOUNDATION __ LOT LINE DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM CESSPOOL APPROVED DISTANCES: OTHER SOURCES DISAPPROVED REMARKS PIPE MATERIAL:__ LOT SLOPE: REMARKS: .,/ DATE APPROVED G.~ A.B. eriifiei Drilling A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ADDRESS LEGAL DESCRIPTION /~o?' DATE-Started ~i':/~ / / PERMIT NUMBER '~ ~ ~ 70 DEPTH OF WELL ':~ ~LO / STATIC LEVEL OF WATER FT. / r' R^w DOWN GA~. PER HR ~<1-o / ~ KIND OF CASING ~ KIND OF FORMATION: From r' Ft. to -~" Ft.._~]~'YO ~' ~'/'~tgcu~'/ From--Ft. to.~Ft. From ."q' Ft. to /,j~ Ft. ~//:9 From~Ft. t~Ft, From /.~ Et. to ~'~ Ft. ~{~ ~oczg * ~Oo~Od~JFrom Et. to Et From -?'), . Et. to /.,~L]~ Ft. ~/) ~ /~oo~/~.f From~Ft. to Ft From .':~ "?' /Ft. to /J>O Ft. [~O ~oc~- ,~o~/O From~Ft. to Ft. From_ /~'O Et. to /c?,~ Ft. {~l~oC~ ~o~ From~Ft. to Ft. From / ~'[~) Ft. to ~7 ~' '.)- Ft. /~'d~o << ~-°~lO From Ft. to.~Ft From · ) ':;& Ft. to ~fl~3 7 Ft. ~5~/?oc< ,~o/~,5~ ~/~d~'~ro Ft. to.~ft. From Ft. to_ Ft. From Ft. to.~Ft. Fromm. Ft. to Ft. From . c.E Ft. to.~Ft ~ ~c~O~ -,?~.~ O.Fro~Ft. to Ft. From~Ft. to~Ft ~'~?~ o~ r,~,- ¢~o%C,,~ From_~.Ft. to~Ft ~q/gO~.~ ~romc_~ m. to.~.Ft. From_~.Ft. to Et .SE? ~°m?9'b' Ft. to.~.Ft Fromm. Ft. to~Ft f t ~ 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: ! . / ,q~, ), & ')"~:., ?'7,7,- DRILLER'S NAME Drilling by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ~ d/.~. 't' ~'r'D ~ DEPTH OF WELLL ~ ~ / ~TIC LEVEL OF WATER FT. / ADDRESS IPT~ION ~ --~-~ LEGALDESC ~or.~ ~4~ C ~~W~ - ~ */'VT PERMIT NUMBER ~g _~O KIND OF CASING ~ ~O~ ,-% KIND OF FORMATION: From O .Ft. to From ,~" Ft. to From ].~" _Et. to From -74 Et. From 13~ r. Ft. to From [o°~) Ft. to_ /ct' ,2 Frmn [q.~ Ft. to From c) 3okFt. to 937Ft. 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. _ Ft. ,.~}~J T ~'.~14o'~/ From -- Ft._ ~/~ From_ . Ft. ~ ~oc < ~oclO Fronl _Ft. ~doC~ ~o~d~ From Ft. ~d~o c~ ~OClO From ~o~,~ ~/¢~,o~'a~ ~t. ~o From Ft. to Ft. to__Ft. Ft. to __Ft. Ft. to _ Ft. Ft. to ____ Ft._ Ft. to . Ft_ __ Ft. to Ft. Ft. to Ft. Ft. Ft. Ft. Ft _ Ft Ft Ft Ft. From Ft. to__Ft. From Ft. to__Ft MISCL. INFORMATION: o ~z C.¢q5 DRILLER'S NAME · NF!LI...AE:E I:IR I r'l~. Et::ii])LE I,;~: i ';,'E~;.: Ri:, L. 2 E',E: GLFIC:IIEF.': 'v'IEH FIGT~; ."..:: 6:2:,:!. E LCd" H6i::-::iHi...iFi NLtHbE:I;?. OF I~:EI)RO01',]~; :: -~: THE F'E' ~i_ ]: Id:Ell::, :'E; I ;?~E: OF THE :~501L.. FIE 'BOF."F'T '[ ': N .::, T .: ¥ E~ I I E;: 'YHE LEi'.~6'TH D, ZI'IEN'_'3ION IE:; THE LENGTH (tN FEET::, OF' ]"HE TRENCH OR [.',F.:FIINFiELt). THE [;,EF'TH OF FI TF::ENCH OR PIT :t:'_=, .]"HE [::,:I:5TRNCE E:E:THEEN 'I"HE :E;t...II'4~FFICE OF' THE L~iFi:OUN[;:, l.:~i'4E:, THE BO"I"TOH OF TNE E::..':C:FI'v'Frf'ION ,.'.'IN FEE']"). THi:EF;:E: ]:2; 1'.40 '.'SE.]" H II'::,TH Fo'OR' TRENCHE~;. Ti..fi::[ (31;~:I:Y,,,'EL [:,EP'TH I:5 THE Id :[ N J: I'"iUI',I DEI-::'TH OF GRFI'v'EL BE.]"t.4EEN THE OUTFRL. L. PIPE RND THE E;OTTOH Of:' '['HE E:dCR',,,'FtTZON ,:i IN FEETi:,. E:,~:i 'L:K'F' )1L.L I N6i 0t::' Rl'.4't' E;'.?~;.]"Er,1 I.,] I THOUT F t NFIL I N:..:.;F'EE:T I ON FINE:, RF'F'F.:EI',,,'FIL E:'¢ TH I ~; DEF'FIP::'I'NEN'F H I L.L DE 'B JE:.'fEE T 'T'O F'~:O:_:;EE:LIT I ON. PiiNIr,IIJH [:,IS]"F:INCE E:ET!.4EEN R .NELL RI'.,tD RN"r' ON--SITE 2~;EWRGE DIS;POS;RL :;LO~:.~ FEET F'OR R F'i~:I'v'RTE .NELL OR 200 FEEl" FOR FI PUBL]:C' HELL. kii!::LL LOG':2, FIRE RE~:.:!UIRE:[:' FINi::, i"ll.j~.:iT BE RE.]"UF'.I.4ED .]"O THE DEPRRTHENT !4ZTHIN GF 'i'HE t,.tE':L.t.. COHPLE.]"ION. ~;F'EC: I F :[ CRT]: ON'.5 Fli",ID f_":ONSTRUC:T l ON [::' I RGR. FIi'"IS RF.:E FI'v'FI I LRBLE TO :il NE;IJRET PROF:'EI;'. J: NE;TI::IL LR'f' .~10i",l. :t. CEi::::t" t F""r' TFIFIT J..: i F~t"I F'FIHZL.]:FIF'..NI'T'H '£HE RE6!UIREtHEI'.4TS FOR ON-SITE SE:HERE; RI'.,tt]:, NE:LL':_:; R:5 '.E:;E'T F'OF:]H E:'-r' THE NIJNICIF'FILIT~'r' OF FINC'NORRGE. ;2: t HiLL :[i'.,IS.]'r:'ILL..]"NE "E,"r"E, TEH IN FICCORDRNCE HI.]"H THE CODEE;. 3:: ~ iJN[::,ERE;.]'FII.4[::, ']'HFIT THE ON-SITE SEI.4EI;.": L:.;"d£':;TEH HFI"¢ RE6!UIF.':E ENLFIRGEHE:NT ti::' THE F:E:5 ]: L:,ENCE 12; REI,'IO[:,ELED TO I NC:LU[:,E HORE THRN 2 E:EDROOH'-:~;. ::.:; i GNE:D: ._ ;~.~ ............ ~ ............................. ,,. o Depa ~nt of Health and Enviromment, SOILS LOG ~P~ ~ ~ TEST ~rotection Performed for Legal Description 0 4 6 I0 Wallace Arima Date Performed Lot 3[ Block C, Glacier View Heights 6/30/76 (See back for test hole location) Red-brown, sandy silt (ML) Perc rate = 275 ft.2/bdrm. Red-brown, gravelly sand (SW) with some silt and cobbl-es to 12 inches. Perc rate = 125 ft.2/bdrm. Gravel content variable from -1.5 to -16 feet. 14 16 TD = 16 feet No water table encountered. AVERAGE PERC RATE FROM SOILS LOG = 139 ft.2/bdrm. Date mi nu he ---' NO--_RTHWEST EXPLORAmTo~J ~xr~ LOT 3 75' 20' Corner 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 OSC241494 Parcel ID 050 -491-33 Expiration Date: Legal description GLACIER VIEW HEIGHTS BLK C LT 3 REM Site address 22419 GLACIER VIEW DR Current property owner(s) HUMPHREY MICHAEL C & ARIANNA M X The On-site system(s) is/are approved for 3 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or conditions: Original Certificate Date: 12/9/2024 Thi Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject stem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF F ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section k� Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-491-33 Complete legal description Glacier View Heights Block C Lot 3 Location (site address) 22419 Glacier View Dr. Eagle River, AK Current property owner(s) Michael & Arianna Humphrey Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: © Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 47 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed © Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment I i Z Date of Payment I I COSA # Waiver # COSA Application—June 2022 Glacier View Heights Block C Lot 3 050-491-33 8/5/76 240 159’6” 18 10/3/23 166 3.4 Arcterra Consulting NA 49” * 10’ trench addition in 9/6/84 7/14/76* 9 6 3 10/3/23 22 450 35 1200 22 450+ 72 58** 14** ** Field is operating at 80% capacity. 11/21/24 X 1.84 X 11/18/24 Standpipe on West end of the trench was located during site inspection. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. Arcterra Consulting Kenneth Duffus (907)-696-6111 83*** *** Waiver granted 9/7/84 by State of Alaska D.E.C. ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: GLACIER VIEW HEIGHTS SUBDIVISION LOT 3 BLOCK C PLAT 70-151 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoulc any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER, DATE: SCALE; E—MAIL OCT 17, 2023 1 =30' schullerOak.net 23-109 DRAWN BY, ICHECKED BY: 1$1D NUMBER: BOOK AGE: JLS SWO059 230329 "ANN, low OF AW A� 104� 49TAH .70 .......... ......... j RA • CO,J HN L. SCHULLER.- 0 o LS-10408�o ell 'aw Mw fessiono Adw `6\\1 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax 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 1. GENERAL INFORMATION Complete legal description Lo,f: 3; Block "C".= ~LACIER VIEW HEIC~HTS Location (site address or directions) NHN Ced~a Way, Eagle River Property owner Mailing address H.U.D. Day phone Lending agency Mailing address Day phone 563-3333 Agent ASSOCIATED BROKERS Day phone Address 640 West 36th Avenue, Anchora.qe, Alaska 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: $ "~ TYPE OF WATER SUPPLY: Individual well ~(~,~ Community well Public water ~ NOTE: 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 ~x Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s & S ENGINEERING Phone 170~;4 Eagle Kiver Loop P,o~d i'Jo. ~O~i, Address Eagle Rivet', Alaska 99577 Engineer's signature DHHS SIGNATURE Approved for .'.~.,~¢~._~bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHH$) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH H$ does this as a cou r~esy to purchasers of homes and their lending institutions in order to satisfycer~ain federal and state requirements. Employees of DHH$ do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~.¢,-z~ ~::~_.,"~," ~.~,~,.~.~_,~ ~l~,rcel I.D. A. WELL DATA Well type ~-~[2-.t ~ Log present ~/N) Total depth ~.~-c~ ' Sanitary seal If A, B, or C, attach ADEC letter. Date completed ,,~c~/.~ ~- ~-~ L~, Driller Casedto /~"L~ L,. Casing height Wires properly protected Q/N) ADEC water system number ' ~ FROM WELL LOG Date of test ~ - 5-'~ ? L.~ Static water level ! ~'-~ ' Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main AT INSPECTION service line WATER SAMPLE RESULTS: Date of sample: ~-Z -~ (), '~ f7z' ~ ~ :, . g.p.m. 3, ~- g.p.~'l I ....) ~ ") ; On adjacent lots [~ ~ m ; On adjacent lots ~ oot ~ Public sewer manhole/cleanout ~A Petroleum tank ~ ~+ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~.'~'"J ~ Cleanouts~)/N) ~ High water alarm (Y~ Tank size Foundation cleanout (Y~) Other bacteria Date of pumping S & S ENGINEERING 17034 Eagle River Leep Read Ne. 204 Eagle River, Alaska 995~2 Compartments Depression (yfl~) [/ Alarm tested (Y/N) Pumper ~'--~., SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~'~ ~'~ Onadjacentlots \~c~ ~'¢- To property line \ c~ Absorption field ~-'~ ~ Surface water/drainage \ 6>~ 26 (Rev. 7/91) F Foundation Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA ~_ SEPAR~.TA-ON DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (~ "Pump on" level at ~'Pump off" level at ~ Cycles tested Surface water D. ABSORPTION FIELD DATA , Date installed \ ~"1L,' Length '~:~ ' Widt~h Total abso~ptipn area Depression over field (Y~ Results~fail) Peroxide treatment (past 12 months) ('~ Soil rating \~ Gravel thickness Cleanouts present(~)'N) Date of adequacy test for -'("~ ~¢-_..E.~ ~¢ ~ If yes, give date System type Total depth \'7--~ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ To building foundation On adjacent lots "~ t~- Surface water Curtain drain E. ENGINEER'S CERTIFICATION On adjacent lots Property line Cutbank To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA g Signature Engineer's Name Date 17034, Eagle, River Loop Road No, 204 HAA Fee $ ~'") Date of Payment Receipt Number 72-026 (Rev 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 'snle~s pue ~l!le6al eq~ o~ 8u!~seHe UO!~BAJeSUOO I8$USLUUOJ!AU~ ~O ~uewHgd@(] ele~S @4~ woJ~ UO!IBLUJ!~UOO Ue~pM eAeq lsnw 'wels~s II@M X~!unwwoo Il :a~ON [] NUe.L 5u!plOH [] ~!untutuoo [] o!lqn8 [] ei!suo 'TVSOdSIQ =IOVM3S UO!~eAJSSUOO le~UetUUOqAU3 ~O lUSUJ]Jede(~ @~elS 841 u~oJJ uo!]euJJ!¢uoo U811[JM @Ae4 ~snku 'tue~s~s Ile/~ X~!untutuoo ~1 :alON [] o!lqnd [] X$!untuLuoo [] II@M lenp!A!pUl X-lcldnS ~a.L¥~ 'g ~ SWOOJpS~ ~O JSqWnN [] XliWe3-!llnV~ [] Xl!We~-elSU!S '=ION3OIS3bl dO :::IDA/ 'g zsetrF, bu8 Aq dn ~3~ :ssaJppe 6U!MOlIOIaH~OlVVH eq~l!e~ ~66~-~69 auoqdele± O) LLCj66 >1~ ';~@AT8 aTb~a p~o~ :ZaaT~I aTSe2 0§§ST ssa]ppv TOOD eutrezn$ :u:~:~ sat~OH abe:~T:ZaH ~ua6v pue XuedwoO 8]els3 le@~ (8} sseJppv auoqdalej. ~/u uo!ln~!~SUl 6u!pu@~ (p) :(U!eld×a) [] J@qlO: [] JeXn8: [] Jepl!nq/Jeu~o: [] uo!)nHlsul fiu!pueq :(auo ~oeqo) s! ~ueo!lddv (o) LOS§ -E0§66 ~ 'abe~o~o~ ~ 'aqS 'a~ ~9g '~ 0~9 ~a~o~8 pa~TOOS~ o/o sse~ppv lueollddv gggg-g9g sseulsn8 ~/u eWoH:euoqdele~ 'G'~'H eweNlUeO!lddV (q) aAT.zQ aT~;U~A (suo!loaJ!p Jo sse~ppe) uo!leooq LVlT'd 'N~T,T, '9T uoT3,oaS: s3~qJSTeH ~OTA ~zaTaeTD 'D 5[ooT~ 'g (@fiu~ 'diLISU~Ol 'uo!loes 'uois!^!pqns '51oolq '~Ol aPnlou!) uop, dposeQ I~fie-1 (~) NOI/~ClNHO4NI 886I 'E Z~e[4 el~O uo!leo!lddV 0~Zt~-t~98 X/191OVJ W3/VN~ GNV W3M3S 3_LIS-NO JO F~/' (~ -- O~ ~-~ qVAOUddV X±IUOH±nV H±qV]H btO=t NOI±OadSNI :10 HLqY]H 9VJ. N=IINNOI::tlAN3 40 NOISIAIQ NOI.LO=I/O~d -I¥/N~I~NOalAN~ QN¥ H.Lg~f:~H .dO 'L 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 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. Name of Firm Eaqle River Enqineerinq Svcs. Telephone 694-5195 Address P.O. Box 773294 Eaqle River, AK 99577 Date Engineer's Seal Louis A. ~u~era DHEP APPROVAL Approved for 3 Approved ~<' Disapproved Terms of Conditional Approval Conditional CAUTION 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 ,~,_..~, 7~-025 [11/84) ENVMIC~i~PAL/TY OF A,,_ ~'" MUNICIPALITY OF ANCHORAGE (MO~r~ HEAL . -." ~, ~ ~KL,ST- FEBRUARY 1984 ' ~ m DEPT. OF HEAL~ & 264 47on ,~ ]~RON~mT~L ~O~C~O~ ' '~ --~ ~~~ ,,~yn amnm Legal Description: RECEIVED We,, ,f. Well Log Present (Y/N) Y Date Completed _~ ~/~/~ Yield Total Depth ~ ~ ~ /~o / Cased to Depth of Grouting Static Water Level /~ ' ~/,-,~' ~ Casing Height Above Ground '//-'/ Electrical Wiring in Conduit (Y/N) Y Separation Distances from Well:~ To Septic/Holding Tank on Lot ~...~....../ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~/'~' Cleanout/Manhole Water Sample Collected by Water Sample Test Results Pump Set At .2. ~..¢'" - ~.$~' Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) ~ Comments ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~¢ ~.~4~' / ,~'~Z¢~,'''''~'~''' ;Date 1LJI ~l ~ j, B. SEPTIC/HOLDING TANK DATA Date Installed /~' Size ,/~¢ ~,~/- No. of Compartments Standpipes (Y/N) Y Air-tight Caps (Y/N) ,Y Foundation Cleanout Depression over Tank (Y/N) ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /M/~ · for Holding Tank High-Water Alarm (Y/N) '~v'//~ Temporary Holding Tank Permit Separation Distances~tic/Holding Tank: To Water-Suppl W~ell Ct ~/~"~ To Property Line -~' · To Water Main/Service Line _~-4/ '" Course ~___./4~ To Building Foundation c~-~ / To Disposal Field "~/'¢' / To Stream, Pond, Lake, or Major Drainage Page 1 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/N) Results of Last Adequacy Test ~'~ ~',x: ~ ,:/',,,~. Separation Distance from Absorption Field: .,* To Water-Supply Well To Building Foundation "~¢/ Lot 7~//c- To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area. or Vehicle Storage Area · '~,,~,,'~ 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 ¢' ,.~ / To Cutbank (if present) Comments 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 Oft" 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 J/'~~:~- Date ,~Z/,.~'¢/ Company z~-A. ,,,'g,,,~ /~.,,,..,¢,--. MOA No. ,..?'~"' Receipt No. / .,2-~__~..~/ Date of Payment Amount: $ Page 2 of 2 72-026 (I 1/84) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL H~ALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION bZPPLICA_T!ON FOR ~---%LT~ A~iw-ORIT-f 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) /.~? :'7, , /J)a~-k ~ . ~1~ V,'~ ~S~Z,T'~ _..~.~T,'o~ 1~ ,, ?-i~V., k I Ix~ (b) Location (address or directions)~ Applicants Name Telephone - Home Business Applicants Address /~ ~e~y/~ /~l'~¢v ~J, ~ef//~ Al~er/,~K (c) Applicant is (check one) Lending Institution ~ ; ~er/builder ~ ; Buyer ~ ; Other ~ (explain); (d) Lending Institution / ~/~.~~ g- Telephone J-~ (e) Real Estate Co. & Agent ~ ~lac,'~.~ Telephone (f) Mail the HAA to the following address: 2. Typg of Residence Single-Family~--~ Number of Bedrooms 3. W~ter Supply Individual Well~ Multi-F~mily ~ Other (describe) Community~ Public~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite ~ Pub].ic ~--] 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] 5. 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 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 wastewa'ter disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm ~.4~dz_~l~ '~/~,~/~.~I/¢ f~l~l./_.--~_~/<~ Telepho,ne ~ ~/~ - ' ' ' (ENGI~ER SEAL> ~~ ]~ ~5,'.~<o t-:o c~'~:~-.~777 DttEP Approval ~n,., ~5)~''% "' ''~' """7'~'")%' ' ~ ~ r~ '~.~'<%:i('" .:'"" '~" Approved for (~) bedrooms By ~ C(~:.i::~;'.~D'~e,'' ~- ~ '- 2~ Approved ~ Disapproved __ ~ondition~ __ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 A~ND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2} 7-19-84 ae WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALT~ BiYlIRORITY APPROVAL CHECKLIST - FEBRUARY 1984 k,.,~, 'iUNiCIPALITY OF~ ANCHO,'RA(~: DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION :SEP_. 1_8 1984 RECEIVED Legal Description: ~- ~ If A, B, C~ C, D.E.C. Approved(Y/N) Well Log P~esent (Y/N) ~ Date Cca,~let.ed Total Depth ~ .7 '7 '~/- Cased to /.5-c/~ of" Static Water Level /D-~~ ~T Pump Set At Casing Height Above Ground ~ ~'~¢J~e5 Electrical Wiring in Conduit (Y/N) ~ Separation Distances f~cm Well: To Septic/Holding Tank on Lot ~'~ -'~7- TO Nearest Edge of Absorption Field on Lot Depth of Grouting Sanitary Seal on Casing (Y~) Y ~ession ~ound ~l~ead (Y~) ; On Adjoining Lots /~ ~ -~7- ; On Adjoining Lots To Nearest Public Sewe~ Line / Ap?a,~, L~ ~,'1~-~ TO Neantest Public Sewer Cleancut/Manhole App/~K~ ['{ ~()~ To Nearest Sewer Service Line cn Lot Wate~ Sample Collected By Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed '~-/~/-~' Size /~'00 $o/ No. of C~t~artments Standpipes (Y/N) ~ Ai~-tight Caps (Y/N) ~ Foundation C!eanout (Y/N) Depression over Tank (Y/N) /~ Date Last Pumped ...,~ ._ ~, _ Pumping/Maintenance Contract on File (Y/N) ~/ ; for . Holding Tank High-Wate~ Alarm (Y/N) 7~ .... Temporaz~; Holding Tank Permit (Y/N) Separation Distances fztc~ septic/Hold,ing Tank: To Water-Supply Well '~ 3 ~7~ ~L~ To P~operty Line 3~ J~T' TO ~ter Main/Se~vi~ Li~ ~0 ~T Comments To Building Foundation ~ {7~ To Disposal Field ~.~-.Ta~- To Stream, Pond, Lake, o]z Major Drainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD ~ATA Soils Rating in Absorption Strata /~CJ Date Installed '?-1~-76 ~J q-~-~ Width of Field .~'~C) ~/ Square Feet of Absorption A~ea Depression over Field (Y/N) Results of Last Adequacy Test .~?Z/~/~ Type of System Design Length of Field 3 ~ ~'~- Depth of Field / ~ '~I Gravel Bed Thickness ~ .~2.~ .f2?z Standpipes P~esent (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foun~tion Lot ~/~ ; To Wate~ ~in/~vi~ Line ~ ~ To ~t~(if p~e~nt) ~.~ To St~e~ond~ke/~ ~jo~ ~aina~ C~se To ~iveway, Pa~king ~ea, ~ Vehicle St~a~ ~ea ~.~-~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Wate~ Ala~-mLevel at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Co~nents ** Check Permitted Bedroom Rating Against HAA ~quest I certify that I have checked, verified, or conformed to all MOA on the date of this inspection. Company ~~ ('~' ~,'.,.e.4~_,,.-.~ MOA NO. KB1/dL/s [Page 2 of 2] 2-15-84 r DEPT. OFENVlRONMENT/kLCONSERVAT~ON SOUTHCENTRAL REGIOI~L OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 September 7, 1984 Mr. James L. Thode, P.E. 1546 Eagle River Road Eagle River, Alaska 99577 Dear Mr. Thode: Subject: Horizontal Private Well to Septic Tank Separation Waiver Glacier View Heights, Lot 3, Block C (8521-WA-028) The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the private ~well and septic tank to 83 ft. provided that the pipe connections to the septic tank have coulder coupling or their equivalent. erely, Environmental Engineer BEE/rosin