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HomeMy WebLinkAboutGLACIER VIEW HEIGHTS #4 BLK 2 LT 3Onsite File Glacier View Heights #4 Block 2 Lot 3 #050-491-57 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201155 PID Number: 050-491-57 Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑® Upgrade Name BALDWIN BRIAN & SHAROLYN ABSORPTION FIELD ❑ D e, nch El Wide Trench ❑Bed El Mound Site Address 22601 Eagle Glacier Loop Eagle River �TEl Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 ti D/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from origina ade Gravel depth beneath pipe Ft. Subdivision Block Lot GLACIER VIEW HEIGHTS #4 2 3 Fill added above original grade Ft, vel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dis ce between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding I Sewer Total absorption area Number of trenches Dist. between enches From Tank Field Tank Line Ft2 Ft. Well >100' NA NA NA NA TANK ®❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1500 Gal. Surface Water >100' NA NAI NA Material Number of compartments Lot Line >10' NA NA NA NA plastic 2 Foundation> 1 O' NA NA NA LIET STATION Manufactu Capacity Remarks 2" insulation placed over inlet line from Gal. driveway to tank Alarm location Electnc H ailed by Installer PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 JRs Septic Drainfield CC/MT 3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspdection 1s' 6/25/2020 7/25/2020 Location and description 2�d 3rd 01 TOP OF LOWER RETAINING WALL ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional Approval: Date All rH I. ........ee •e: . eep000 CurUe L ���Fc; �o.CEIi Septic System Approved Date 5" � .10,24 llflpi�...ESS Note: this approval does not include well permit requirements. kmuv UDIU41 1on NEIGHBORING WELL RADIUS SEPTIC LINE UNDER DRIVEWAY IS BURIED 6' AND PROTECTED BY 2" INSULATION DOUBLE CLEANOUTS NEW 1500 GAL SEPTIC TANK n O DOUBLE CLEANOUTS / I STF/ 100' 0 CO NEIGHBORING SEPTIC MT1 / IS > 10' FROM 2% SLOPE PROPERTY LINE co/B IG CO / \ M T2 .■ 5 BR 1 QQ' EXISTING 52' (32' + 20') BM HOME x 36" x 7.5' EFFECTIVE / O DEPTH TRENCH A e4� \ �e \ NEIGHBORING SEPTIC Q 15 > 10' FROM PROPERTY LINE SCOPE OF WORK `O \ 1. NEW 1,500 GALLON SEPTIC TANK WAS /0 \ / PROVIDED AND TIED INTO EXISTING ABSORPTION SYSTEM. THE TANK WAS ` PROVIDED WITH A MINIMUM 20" 0 MANWAY RISER SERVING THE FIRST COMPARTMENT. 2. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. Septic As Built Drawings Prepared for BRIAN AND SHAROLYN BALDWIN : �P�� OF q��i+�♦♦ 22601 Eagle Glacier Loop Eagle River, Alaska 99577 �?�'° .' 4 H �0 GLACIER VIEW HEIGHTS #4 BLOCK 2 LOT 3 ... OSP201155 ........... ................ EKLUTNA ENGINEERING LLC;.............RTIS"T"...N....E..D......; DATE: 7/28/2020 CURTIS TOWNSEND;+ 19162 MOUNTAIN ROAD DRAWN: CLT N°' C 11 04 ` CHUGIAK, ALASKA 99567 SCALE: 1" = 40' ♦��+ •2', (907) 355-9820 114_ ES ' PID: 050-491-57 SHEET 2 OF 3 iks MARK A B DCO 55'-1 " 28'-5" SI/1 56'-8" 30'-5" S U2 60'- 7" 1 34'-10" DCO 62,-2" 36,-8„ MT1 77'-4" 58'- 6 " MT2 59'-6" 52'-4" 2" INSULATION 94.5 1,500 G PLASTIC TANK It BENCHMARK IS TOP OF LOWER RETAINING WALL, ASSUMED ELFV 100' Septic As 80t Drawings Prepared for t��UR�, BRIAN AND SHAROLYN BALDWIN �.�P�E•OF q�����♦♦ 22601 Eagle Glacier Loop Eagle River, Alaska 99577�,.�' ••''9!*+ GLACIER VIEW HEIGHTS #4 BLOCK 2 LOT 3 " 49TH • OSP201155................�....................: �_ � ....... .................. EKLUTNA ENGINEERING, LLC .f DATE: 7/28/2020 ��; CURTIS TOWNSEND � w. ROAD IN No. 19162 MOUNTAE 11904 �`� DRAWN: CLT �j�J jCs'i CHUGIAK, ALASKA 99567 SCALE: 1 112" = 1'g•"'`p� (907) 355-9829 PID: 050-491-57 SHEET 3 OF 3 z aza w Ld O J CJ w p m z Y- M Q QD 0_j FG a.s aU �� O o_j _0_ 1.20u 2" INSULATION 94.5 1,500 G PLASTIC TANK It BENCHMARK IS TOP OF LOWER RETAINING WALL, ASSUMED ELFV 100' Septic As 80t Drawings Prepared for t��UR�, BRIAN AND SHAROLYN BALDWIN �.�P�E•OF q�����♦♦ 22601 Eagle Glacier Loop Eagle River, Alaska 99577�,.�' ••''9!*+ GLACIER VIEW HEIGHTS #4 BLOCK 2 LOT 3 " 49TH • OSP201155................�....................: �_ � ....... .................. EKLUTNA ENGINEERING, LLC .f DATE: 7/28/2020 ��; CURTIS TOWNSEND � w. ROAD IN No. 19162 MOUNTAE 11904 �`� DRAWN: CLT �j�J jCs'i CHUGIAK, ALASKA 99567 SCALE: 1 112" = 1'g•"'`p� (907) 355-9829 PID: 050-491-57 SHEET 3 OF 3 G ASBUILT SIEMARD & ASSOCIATES LAND SURVEYING 694-082 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY- Q �� y��v✓� dY_� �' DATE - AND AND THAT NO ENCROACHMENTS EXIST "r:XCEIPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE r * Orr •••.•;• wanaen OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDS EASEMENTS COVENANTS. OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- Duane Merk Seward VISION PLAT. LINDER NO CIRCUMSTANCES SHOULD FS` '� �', L$-5 47r ANY DATA HEREON BE USED FOR CONs'TRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- ' ' 41* ARY LINES. DRAW ' MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone; (907) 343-7944 Fax: (907) 343-7997 http://www.mLini,orglonsite On -Site Wastewater Disposal System Permit �ren_t. Sry r'' R O: lie l>� r tr�� era r Permit Number: OSP201155 Effective Date: 6/912020 Work Type: SepticTank Upgrade Expiration Date: 6/9/2021 Tax Code Number: 05049157000 Site Legal Address: GLACIER VIEW HEIGHTS #4 BLK 2 LT 3 G:0059 Site Mailing Address: 22601 EAGLE GLACIER LOOP, Eagle River Owner: BALDWIN BRIAN T & SHAROLYN H Lot Size in Sq Ft: 43636 Design Engineer: EKLUTNA ENGINEERING, LLC" Total Bedrooms: 5 This permit is for the construction of: ❑ Disposal Field 2 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 (2417). 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: Issued By: y11 Date: ihl Date: 0_�0 MUNICIPALITY OF ANCHORAGE Ar Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section f Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-491-57 Property owner(s) BRIAN & SHAROLYN BALDWIN Day phone 906-250-7172 Mailing address 22601 Eagle Glacier Loop Eagle River AK 99577 Site address 22601 Eagle Glacier Loop Eagle River AK 99577 Legal description (Sub'd., Block & Lot) GLACIER VIEW HEIGHTS #4 Legal description (Township, Range & Section) Lot Size 43,636 Sq. Ft. Number of Bedrooms 5 BLKi2LT 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single FI.K SF) (� 6V1603 ADU) Septic Tank Q Upgrade 0 (D) ❑ Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: ,i Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable 6` 'pal Codes. i (Signature of pkperty owner or authorized aunt) Permit/Rush Fees: Waiver Fees: Date of Payment: (01 [Q l �J�) Date of Payment: Receipt Number: Receipt Number: Permit No. _a';.D:2 t3( !&S Waiver No. GADevelopment ServiceslBuilding SafetylOn Site Water and Wastewater\Forms\Client FormsTermit Application.doc COVID- ] 9 I 257o DISCOUNT APP► mr- Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201155, Rebecca Carroll, 06/09/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201155, Rebecca Carroll, 06/09/20 a ti ASBUILT I HEP.EBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY= ,Gi��Z AND THAT NO ENCROACHMENTS EXIST EXCE�T AS INDICATED. IT IS THE RESPONS!SILITY OF THE OWNER TO DETERMINE THE E:Cis*rENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SMOULD ANY DATA HEREON BE USED FOR CONs'rRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SUWARD & ASSOCIATES LAND SURVEYING 694- SCALE:���o �` ��.a�►�a�� DATE; �� • pA � �5:4 491—H GRID= ,sem s5' �.. ........,--•....•...� • Duane Mark Seward F'S° MUNICIPALITY OF ANCHORAGE DE, TMENT OF HEALTH AND HUMAN SERB e5 O1 Environmental Health Division l� I 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 A, -I- ON -SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES ��- `yam " TO Address SEPTIC ABSORPTION /�� FROM TANK FIELD Phone 151 ' Permll No. Nio. of Bedrooms WELL f F­T,�11iv _ DESCRIPTION LOT LINE — 1/e' //osBlock Subdlvlslon Range. Section ..�..."'. ". ...."' ""•"••J IrIPC Iltall Vllell InffiaIIG Daie Installed WELLS tN PRIVATE, j -JN 61atI IA. B.Ct ❑ OTHER (Identifv) Total Depth Cased to FTJ 3 3/FT. Date Installed REMARKS: .r. -f c.1 Lir . 'e- e s"Lv /NS zs /c, fr' c/ 7_1_75,11/ foir�. /! J_C--f Pc'✓rr„ J / �r-f-r.. ?e,.:<, f'rum cCt'd r�.v ✓'vs�.. .d-1 _S dc.,a /1?r .-r-r S- ��//✓/S-7 :>j �.. /-C. /..F �./k. WELL FOUNDATION �s / y� 7/J AS -BUILT DIAGRAM (Show location of wet., septic systemproperty lines, foundation, driveway. wafer bodies, etc.l J✓, rS n E G Inspections Performed by. _ [aglC Riyor [n4ineer�_�rvices _ T(� P. 0. Box 773294 Date Eagle River, AK 99577 694-5195 7 — certify that (his inspection was perionned according to all Municipal and State guidelines in ellect on [his date: Health Department Approval: Date.. 1-07 72-013 131851 .T I H3 IV 4 ry a- TANKS L SEPTIC ❑ HOLDING iVlamll{aC(W er Capacity In gallons Material No. of Compartments - -- TYPES OF SYSTEM r>/1 TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to Alpe bol tom Irom dotal depth Irom oris i I grace original grade FT _ Gravel tlepih ben ealh pipe / lI FT FII atldetl above original gratle --6-raw-ii / F7 -- _ FT lengnl-_-________— Gravel wldllt FT FT Total absorption area I Distance between lines 7 fSoSQ FT /� FT ..�..."'. ". ...."' ""•"••J IrIPC Iltall Vllell InffiaIIG Daie Installed WELLS tN PRIVATE, j -JN 61atI IA. B.Ct ❑ OTHER (Identifv) Total Depth Cased to FTJ 3 3/FT. Date Installed REMARKS: .r. -f c.1 Lir . 'e- e s"Lv /NS zs /c, fr' c/ 7_1_75,11/ foir�. /! J_C--f Pc'✓rr„ J / �r-f-r.. ?e,.:<, f'rum cCt'd r�.v ✓'vs�.. .d-1 _S dc.,a /1?r .-r-r S- ��//✓/S-7 :>j �.. /-C. /..F �./k. WELL FOUNDATION �s / y� 7/J AS -BUILT DIAGRAM (Show location of wet., septic systemproperty lines, foundation, driveway. wafer bodies, etc.l J✓, rS n E G Inspections Performed by. _ [aglC Riyor [n4ineer�_�rvices _ T(� P. 0. Box 773294 Date Eagle River, AK 99577 694-5195 7 — certify that (his inspection was perionned according to all Municipal and State guidelines in ellect on [his date: Health Department Approval: Date.. 1-07 72-013 131851 .T I H3 IV 4 ry a- X SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 7c PERCOLATION TEST 625 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST as QureflA pgj? l /7 PERFORMED FOR: Cf//7a ler �r rr DATE PERFORMED: a % LEGAL DESCRIPTION: LOf / -2 G/G��G, /i•er✓1 /rec,A SLOPE SITE PLAN 1 7 4 - 8 9 ! Q t 10 Tbers ! / (G M) S.R W -11y 6- -u V�--- ( $fjmC .�/lJl"f' >,. J --/O r�0 G4rJte I�JGK UW1�Or.n -1-v dep J7, o¢' Ter f t,.,le 16 ;' OF 144.411 ©s �. � •e•••e •a. _ry� e a• •••• 18- TW , 4c 19 •.:i. Re•...............�.4sv d �n Louis A. Butera ® c ' CE -6736 Q8 F0•'•••••oo"'•APV ® PERCOLATION RATE 7i 6 -(minutes/inch) � pROFESSI��.�"' d/?OFES \ TEST RUN BETWEEN _ FT AND -%F— FT COMMENTS !'=r,� N WAS GROUND WATER /V C7 L ENCOUNTERED? 0 mar+i iv r•tc( P IF YES, AT WHAT 6A Re DEPTH? �2*-87 PEI? loN 6w7ERA Reading Date Gross Time Net Time Depth to Water Net Drop SlJRL( /&7 Eagle River Engineering es ServicP- 0- BUA 113Z94 CERTIFIED BY7 PERFORMED BY::_� oma_ DATE: Eagle River, AK 99577 694-5195 72-008 (6/79) LOT 2 v w� tiV &5 ru �" T i i L&Niit!/ � Q'4: 6 � OPoSE�RIVE PR 07 WELL _AND SEPTIC SITE PLAN LEGAL: LOT 3, BLOCK 2, GLACIER VIEW HTS OWNER: SCOTT PEPPERS CONTRACTOR: CHARLES BARR�CONTRACTING EAGLE RIVER ENGINEERING SERVICES PO BX 773294 EAGLE RIVER, AK, 99577 694-5195 100' �9� LOT 4 WELL / WELL EASEMENT EXISTING LEACH FIELD NEW LEACH F"IFLD — 140 -CLEANOUT SCALE, 1' = 40' .%PEOTFICAT]iONS FOR ON,,,'SITE SL::PT]:C SYS1'EM LEGAl_: tiNA, VI:! l)[: 'iH :: / !!' wr r.. air a wriu p /.ung by DOC Co. o5a SULLIVAN WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 6862759 OWNER OF LAND(2�/a..r BFRS ep-%jr' DEPTH OF WELL 3yZ ADDRESS ,-'r2 at, oZ%FoZ 6 14,k STATIC LEVEL OF WATER Fr. 6 L 3 A—GLfl `r E2 u/F- d'JDRAW DOWN FT. LEGAL DESCRIPTION L?«C Fl. to Ft DATE • Started �` Ended /519 GALS. PER HR 2,600 From Ft. to Ft. LIQ Front—Ft. to PEMIrr NUMBER KIND OF CASING — is KIND OF FORMATION: Fromm—Ft. to d Ft. b`t t'C 4,j E4r7:--j From Ft. From c� Ft. t.--:L6—Ft. %2-j O 6QA./cG Ce -4 I'From Fl. to Ft. From Ft. to FL M I Kec-d From Ft. to Ft. From -<t Ft. to--7-7—Ft. 'dAeel0�9� From Fl. to Ft �c.— FromFL togdg Ft. S/L % C-4'17' £ From Ft. to Ft From Ft. to Ft. LIQ Front—Ft. to Ft. I From WA Ft. to /-; Ft. ,�f..111 6 �C�'��'� � From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft __ From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Fl. 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 Fl. From Ft. to Ft. From Ft. MISCL. INFORMATION: From Ft. DRILLER'S NAME -4' 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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. Name of Firm S 8 S Engineering Phone 694.2979 Address 15861 S. Birchwood Loop Chugiak, AK 99567 Engineer's Printed Name RO /fidX i C Co ,,f Date SbL �o y G 9,7 R03ERT C. COV✓AN 6. DSD SIGNATURE Approved for bedrooms. +t F''" Disapproved. tt Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By:(�' • '��� Original Certificate Date:7 ' ' 0 8 �j (Rev 7X05) Municipality of Anchorage Development Services Department Building Safety Division �- -' On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROV L CHECKLIST Legal Description: Lor 3, taLKJ e?;_(7LliC '# Parcel ID:05-O-y 1-5- 7 A. WELL DDATAA Well type"-IV4'17E . Date completed &1L Total depth I32_ft. Date of test Static water level Well production eIf A, B, or C provide PWSID # = i 1gC7q Sanitary seal I) 1 Cased to 13X ft. FROM WELL LOG Q1 r 6 S ft. S0 g.p.m. WATER SAMPLE RESULTS: Coliform U colonies/100 mL Nitrate N D mglL Arsenic: N A uglL date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material S�P� tC S Tank size/SZ gal. Number of Compartments Well Lo Y/ ) *S Wires properly protectede// 1) Casing height (above ground) n. AT INS[E TION I n0 �o' 1 g.p.m. ar-LI.')*(.O 8y f,^,*'k./kV."At,c- Other bacteria O colonies/100 mL Collectedby: S'� S LNWNdkR..G Date installed 1 8 T Cleanoutt2�) -'jrs Foundation cleanou (t l�l I) �5 Depression over lank (1T>b� High water alarm ZDVAIZA r Date of pumping IO l o Pumper 7K S �Rmri!Jk1 z C. ABSORPTION F ELD DATA Date installed It 6�Soil rating (g.p.d./ft2 0ft2/)drm System type.—I QEAYIrI r / Length �_ ft. Width 3 ft. Gravel below pipe -7 - r Total depth IeZ ft. Eff. absorption area 760 tt, Monitonn tube ES Depression over field o Date of adequacy test 1 I I 6 Result (Pass ail�ffgq For 5 bedrooms " p Fluid depth in absorption field before test � In. Water added gal. New depth M in. n Elapsed Time: IX min. Final fluid depth In. Absorption rate >= '-7 6�) ,t, g.p.d. Any rejuvenation treatment (past 12 mo.) (Y& type) 0 If yes, give date D. LIFT STATION tI /6 Date installed Size in gallons 'Pump on' level at_ in. evr Datum _ Cycles tested _ E. SEPARATION DISTANCES at _ in. High water alarm level at SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank/lift station on lot / Absorption field on lot Public sewer main Sewer /septic service line Oqs r / r Animal containment areas � Meets alar & circuit requirements? On adjacent lots 1004 r On adjacent lots /co -f Public sewer manhole/cleano t N Holding tank A) / Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: /�, 1 r �-r I Building foundation a8 , Property line 12-t Absorption field 7 / I Water main N Water service line /d -f Surface water /LSD ?I' / Wells on adjacent lots /Clo >< SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 Building foundation 4 7 1 Water main I I r `Water Service line /Q F Surface water /004 Driveway, parking/vehicle storage / f Curtain drain IlaDM WDOQ)QVells on adjacent lots _Lc)o 4- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I 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. Engineer's Printed Name Pa 6 T C CowR,,l Date 5— fa 3 /a 8 COSA Fee $ Date of Payment 5 1,2 Receipt Number 41056 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number A 3 ROBt4T C,{OWAN f� a -8301 Y in. I I 7,7 n n C7 `-'7 1 c: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 n Application Date I 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) TOT 3, ER VIEW HETGHTS,j T14N R1W Section 6 _ Location (address or directions) EAGT,E GT,ACTER T,OOP, EAGLE R RTVBR (b) Applicant Name C. BARB CONTRACTING Telephone: Home NA Business 6914-2767 Applicant Address P.O. BOX 770541, EAGLE RIVER, AK 999577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other U (explain); EXCAVATOR/ CONTRACTOR (d) Lending Institution NA Telephone NA Address NA (e) Real Estate Company and Agent NA Address NA Telephone NA (f) Mail the HAA to the following address: HOT D FOR PTCK[TP BY EAGLE RIVER ENGIN ;RRTNG SERVICES 2. TYPE OF RESIDENCE Single-FamilyCS Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well XX 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 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. 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WELL DATA Well Classification v�"'k If A, B, C, D.E.C. Approved (Y/N) _" Well Log Present (Y/N) Date Completed y6' �� — Yield j ouu �H �GPm �-� s,�t y�.� � Total Depth x.33 Cased to / 33 Depth of Grouting `` Static Water Level Pump Set At^ t Casing Height Above Ground — a Sanitary Seal on Casing (Y/N) 4` Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot/Ov On Adjoining Lots fC°� To Nearest Edge of Absorption Field on Lot On Adjoining Lots Cia To Nearest Public Sewer Line �� To Nearest Public Sewer Cleanout/Manhole _ "��{ To Nearest Sewer Service Line on Lo Y�Z 5 Water Sample Collected by — tri?" f ;Date y��s`� ��<�� ���� J%.itci� Water Sample Test Results C" �' �^ — �� " AID 0 4• "w Comments B. SEPTIC/HOLDING TANK DATA Date Installec!4 AA 4y 7 Size /SoD 5 n f No. of Compartments Standpipes (Y/N) y Air -tight Caps (Y/N) % Foundation Cleanout (Y/N) =� Depression over Tank (Y/N) Date Last Pumped lUkfw Pumping/Maintenance Contract on File (Y/N) _ ; for N� Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well lou To Building Foundation To Property Line To Disposal Field To Water Main/Service Line �!Q Course t/e�dr Comments Page 1 of 2 1.1 11 .1111.A1 R'y i To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /,;, Width of Field �U Type of System Design Length of Field S Depth of Field l� Gravel Bed Thickness v Square Feet of Absorption Area /o Standpipes Present (Y/N) Depression over Field (Y/N) i -f Date of Last Adequacy Test ✓'� C� �J�" Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 7`00 To Property Line To Building Foundation - 47 To Existing or Abandoned System on Lot /��� ; On Adjoining Lots t3, To Water Main/Service Line fiy To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /a / Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off' Level at s✓c�,+rc Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hate ch cked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date % 7 Company '�L S'MOA No. _` 5 - Receipt No. o;:? _0 0 1 00,:;2-r Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) �-1— k' v c o Engiheer's Seal a �T10,iSS10.�