HomeMy WebLinkAboutGLACIER VIEW HEIGHTS #4 BLK 2 LT 4Glacier View
'D
Heights #4
Block 2
Lot 4
#050-491-58
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201090 PID Number: 050-491-58
Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑® Upgrade
Name
Zach Meehan
ABSORPTION FIELD
❑ Deep Trench El Wide Trench [I Bed ❑Mound
Site Address
22637 Eagle Glacier Loop
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-360-7995
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Glacier View Heights #4 2 4
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
T14N, R1 W, Section 16
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ftz
Ft.
Well
1001+
100,+
N/A
N/A
N/A
TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer Tank, Inc
Capacity
1250 Gal.
Surface Water
1001+
100'+
I N/A
N/A
Material
Number of compartments
Lot Line
31'
10'+
N/A
N/A
NA
Polyethylene
2
Foundation
17'
10'+
N/A
N/A
LIFT STATION
Manufacturer
N/A
Capacity
N/A Gal.
Remarks 4 inch tank clean out is ABS D2661
4 inch clean outs and monitoring tubes are PVC D3034
Alarm location
N/A
Electrical installed by
N/A
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
Zach Meehan
Drainfield CO/MTD3034
Inspector Zach Meehan
BENCH MARK (Assumed elevation) 585.55 ft
1" 5/30/2020 5/31/2020
Inspect
Location and description
es: 2�a
3b 4h
At SE corner of garage foundation
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
aF At,�R
Conditional Approval: Date
A c�
#- 4V
�!..............
Septic System
+fi# �':v+C RY J. ME�4N.
Approved lift Date Z.D
No. CE83851 , •,�
��k�PROFESSIONP-Qtl�
Note: this approval d s not include well permit requirements.
k Rt7v VJ/VL/ 10!
j 5wm, TIES
/ t\ -E - Iq
k- F 2-4
A- G as'
,- D L4q
a -E 414
G -F `4s�
Q -Cs 4s.s'
tri-iA tdS•S'
r n
qtr!
CAI
v
44
s� � IZSo C-ra�wni �i,ps-c�L
r
SE? -,%L i AMW— imsTRU.OD
1��a�.FoZAit�f7 t�loAl��biztni(n
-ru io -r%t Ll�
T--uSUL C-LZAtl Oa i
In�sTAu-�D IS0 WErN TA��1k
4 "7ZAtr�F1�Ll�
VE i42 :lF-D G9A--A-ree-7V^I1 5 FV dF
$f -e tot i ba wEal TAx1k F
P tA! Flea
.1 4* .*
�*oCfWW d
P4a. t •{
• • a • • • • �
-�3 — 2ozo I
1f�
b
s� � IZSo C-ra�wni �i,ps-c�L
r
SE? -,%L i AMW— imsTRU.OD
1��a�.FoZAit�f7 t�loAl��biztni(n
-ru io -r%t Ll�
T--uSUL C-LZAtl Oa i
In�sTAu-�D IS0 WErN TA��1k
4 "7ZAtr�F1�Ll�
VE i42 :lF-D G9A--A-ree-7V^I1 5 FV dF
$f -e tot i ba wEal TAx1k F
P tA! Flea
.1 4* .*
�*oCfWW d
P4a. t •{
• • a • • • • �
-�3 — 2ozo I
mi
%-.23 -a2iga 0
ASBUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO EIdCROACHM TS EXIST - CE AS
INDICATED. IT IS THE RESPONS13ILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICT)ONS
WHICH DO NOT APPEAR ON "THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SCALE:
DATE:
GRID:
S91ARD & ASSOCIATES LAND SURVEYING 694-082
F --
FS:
7-5—
DRAWN:
OF At
a ... eln?l
0
Duono Mark Seward
L5
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201090
Work Type: SepticTank Upgrade
Tax Code Number: 05049158000
Site Legal Address: GLACIER VIEW HEIGHTS #4 BLK 2 LT 4 G:0059
Site Mailing Address: 22637 EAGLE GLACIER LOOP, Eagle River
Owner: MEEHAN ZACHARY J
Design Engineer:
This permit is for the construction of:
Effective Date:
Expiration Date:
No
t'cnt..,S
u''
o.
Department
Lot Size in Sq Ft:
Total Bedrooms:
5/28/2020
5/28/2021
43621
Disposal Field Q 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
Special Provisions:
Locate the beginning of the field to confirm that the 5' separation between the tank and field is being met.
Received By:
tel/ Issued By:
Date:
Date:
3
5/28/2020
MUNICIPALITY OF ANCHORAGE
Development Services Department : t' Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICIWELL PERMIT APPLICATION
Parcel I.D. 050-491-58
Property owner(s) Zachary & Ryli Meehan Day phone
Mailing address 22637 Eagle Glacier Loop, Eagle River, AK 99577
Site address SAME
Legal description (Sub'd., Block & Lot) Glacier View Heights #4 Blk 2 Lt 4
Legal description (Township, Range & Section)
Lot Size 43,621 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) 0
(w/wo ADU)
Septic Tank
0
Upgrade
Duplex
ElHolding
(D)
Tank
F-1Renewal
ElMultiple
Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES
A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: A,25'1141 -TS Waiver Fees:
Date of Payment: q 186laoa6 Date of Payment:
Receipt Number: 0 951A Receipt Number:
Permit No. — d,5P:26IOQb Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
SEPTIC TANK REPLACMENT• NARRATIVE
Address:22637 Eagle Glacier Loop, Eagle River, AK 99577
Legal: Glacier View Heights #4, Block 2, Lot 4
After recently having the existing tank pumped, it was observed that the outlet baffle has been dislodged and is laying in
the bottom of the tank. The tank sidewalls are likely corroded at the liquid to air transition, as there appeared to be some
gravel in the tank during pumping. In order to protect and maintain the life of the existing drain field the tank should be
replaced as soon as possible. The existing house is 3 bedrooms.
The scope of this project is to remove and replace the existing 1,000 steel septic tank with a new 1,250 -gallon HDPE
septic tank. The new tank will be installed in the existing excavation. The existing tank is a minimum of 100' from all wells
in the area and 100' from any surface water in the area.
The well on lot 4 block 2 is 164.5 ft away from the center of the existing and proposed new septic tank location. The well
on lot 4 block 3 is 127 ft from the center of the existing and proposed new septic tank locations.
The distances from the existing septic tank, as well as the proposed new tank, to the onsite well and neighboring onsite
wells within 200 ft are as follows:
• Lot 4, Block 2, Glacier View Heights #4 —164 ft from the center of tank & 128 ft from the closest portion of the
existing drain field.
• Lot 4, Block 3, Glacier View Heights #4 —127 ft from the center of tank & 113 ft from the closest portion of the
existing drain field.
• Lot 3, Block 2, Glacier View Heights #4 —151 ft from the end of the leach field.
• Lots 3 & 5, Block 2, Glacier View Heights #4 — 200 + feet to existing and proposed septic tank.
Records maps show a stream has been mapped on the property. There is currently no active stream on this property.
Recent septic and well inspections on record within the last 10 years also indicate a stream was not present. Assumptions
could be made that any previous drainage or stream was altered years ago from Eagle River Road improvements.
There are no expected impacts to the surrounding properties, wells, wastewater systems, and drainage.
All elevations will be referenced from MOA Monument E-32
O
A
COAW
* 49TB
Off .. ..
p °> ZAC J. M EHAN ;
�No. C E83851 0�
%�f OFESS101' .
Glacier View Heights, Block 2, Lot 4 Narrative 1 of 1
SEPTIC TANK REPLACMENT • SPECIFICATIONS AND GENERAL NOTES
Address:22637 Eagle Glacier Loop, Eagle River, AK 99577
Legal: Glacier View Heights, Block 2, Lot 4
GENERAL
1. The existing tank is a minimum of 100' from all wells in the area and 100' from any surface water in the area.
Construction shall be in accordance with Municipal Permit with any special provisions or conditions and all
applicable State and Municipal Wastewater Regulations.
3. Underground locates will be completed at least 2 days prior to excavation. Locate tickets are considered active
for 14 days after the initial locate has been completed.
4. MOA Monument E-32 will be used for elevations and grade of the inlets and outlets, as well as the original and
final grades.
SEPTIC TANK INSTALLATION
1. A new 1,250 -gallon HDPE septic tank will be procured from Greer Tank, Inc.
2. Construction shall include one 4" cleanout and one insulated manhole access riser.
3. The septic tank shall be sufficiently bedded with MOA sand to prevent settling or shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above the final grade.
5. The tank will have a minimum of 2" of direct burial insulation.
6. Two cleanouts will be installed between the tank and the drain field. This will replace the existing single cleanout
between the tank and drain field.
7. Final grading over the tank shall be such that a positive slope exists away from the septic tank.
MATERIAL SPECIFICATIONS
1. Septic tanks must be constructed by a Municipality of Anchorage approved septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage.
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E.
(perforated but not solid) and ASTM D2662 or A.B.S. (perforated or solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal).
INSPECTIONS
Municipal Ordinance requires a minimum of two inspections. However, a registered professional engineer in the
State of Alaska will be present during the entire installation process.
Glacier View Heights, Block 2, Lot 4 General Notes & Specifications 1 of 2
Upon completion of the septic tank installation, an as -built will be provided to the Municipality of Anchorage tank,
inlet, and outlet elevations. The as -built will show pertinent field survey data and notes.
Point of contact:
Zach Meehan, PE
907-360-7995
zachmeehan@hotmail.com
Glacier View Heights, Block 2, Lot 4 General Notes & Specifications 2 of 2
0A
4,4
.
5AW
491"
.. .. ......
,
ZACC� ••
J. MEEHAN ; i
No. CE83951
III
T
low
A Nr
�'{
.�P .
s5 y�
v ¢'
• • 4918
•��
�l A Y J. MEEHAN .' v°
s� No. CE83951e`�Aw
'°ROFESSO"'
���;ZZ
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Septic System Owner-installer Agreement
The On-site Water and Wastewater Section (On-site) may issue an approval for a homeowner
to perform work on an on-site wastewater disposal system to serve that individual's owner-
occupied, single-family or duplex home if the homeowner meets and agrees to the following
requirements:
1.The property owner and excavation equipment operator may perform work on no more
than one owner-installation project in a 12-month period.
2.Owner’s projected active involvement with the installation:
_______________________________________________________________________
_______________________________________________________________________
3.The name of the excavation equipment operator: ________________________________
4.I agree that there will be no monetary compensation for installation services rendered.
5.The name of the inspecting engineer: _________________________________________
6.I agree to discuss the following items with the inspecting engineer:
a.Permit design criteria and specifications.
b.Inspection requirements set forth in AMC 15.65.070.
c. Advance notice given to the On-site Water & Wastewater Section for all required
municipal inspections (AMC 15.65.070A).
7.I agree to have the project-specific On-site Wastewater Disposal System Permit available
at the construction site for the duration of all related work.
8.I agree that if the system is an advanced wastewater treatment system (AWWTS), I will
obtain additional installation instructions and approval from the equipment distributor.
As owner of (legal description) ________________________________________________
I agree that the information above is true and accurate.
Owner’s printed name: _________________________
Owner’s signature: _________________________ Date: ________________
Lot 4, Block 2, Glacier View Heights #4
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/GP W-€L-L-tNSPf-C-TtOITREPORT-
NAME
PHONE
EW
y-C_�/
r 11-j�� of '�
I eev l
6qi/ .1i76
❑UPGRADE
MAILING ADDRESS, x /e
LEGAL DESCRIPTION i
J
Lif X/ �!/� �G (J ! e C / -G.� L'/ L �/ /,fs /t / I L//•V le Lam./ X&
LOCATION
NO. OF BEDROOMS
c� x
Well Absorption area
DISTANCE T0: `p e� } / S /
Dwelling
� i
PERMIT NO.
r yU
b- Z
Manufacturer
Mater
No. of compartments
wF
"; �nc4. TLF/✓/te
/
Liq. capacity in gallons Inside length
IF HOMEMADE:
Width
Liquid depth
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Oil
Manufacturer
Material
Liquid capacity in gallons
2
DISTANCE TO:
Well e
/Op
Foundation ®
-pol-
Nearest lot line
of
PERMIT NO.
�f•,[0�3£r�
ZNo.
of lines
Length of each line [
Total length of lines /
Trench width
Distance be een lines
SD
3� inches
rY z
y
Top of tile to finish grade Q' /
Material beneath tile /
Total effective absorption area fj
E+
CJS inches(.-E7-"�'
Length
Width
Depth
PERMIT NO.
Lu
QType
of crib
Crib diameter
Crib depth
Total effective absorption area
a
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class �,F ��
Depth
DrillerJ,y/// of
Distance to lot line
PERMIT NO. O
u
DISTANCE TO:
Building foundation
Sewer line
Septic tar E)u
Absorption area(
OTHER
�u Zi
PIPE MATERIALS
L/,c- �
SOIL TEST�RATJ NG
INSTALLER
—
REMARKS
J
iyKr S._4
/Pfz c:
p
31
bj
,e•
49al � � �;it v
d.... ... .......
�1 T. �n� i S_,
o. 2225-E
e"
JUNL 'n, 1971
.
0N.41���
APPROVED DATE LEGAL
y G/"4/ . 'lLf 6 -Al eL,w
PERMIT NO:
DATE ISSUED
APPLICANT
ADDRESS:
CONTA,:T PHONE
LEGAL, DESC:RIP
LOT SIZE:
MA.:; BEDROOMS
DEPARTI''1EN 1' OF HEALTH AND E hIV I RONMENTAL PreOTECT I O N
8251 STREET., ANCHORAGE., FII:' 9,5 J.
264-4720
U_ 14 E� F-2 o19� 14 E—_ L. L_ F- U_ F_: r-1 l —r840-381 (�03,6
-
HAMMAN CONSTRUCTION
BOX, 6f'.
EAGLE: RIVER, Af:: 99577
694-2-1.776
SUBDIVISION: GLAICER VIEW HTS. LOT: 4 E. -'LOCK:
SECTION: 16. TOWNSHIP: 14N RANGE: 1bd
1A (SQ, FT. OR ACRES)
LISTED BELOW ARE THE OPTIONS— AVAILABLE TO YOU I N DESIGNING YOUR SEPTIC:
SYSTEM. CHOOSE THE OPTION THAT BEST FIT -H-3 YOUR SITE.
i Er-a0M
DEPTH TO PIPE BOTTOM (FT.) c. 0
GRAVEL_ DEPTH (FT. ) 5. 0
TOTAL DEPTH (FT. ) 13. 0
GRAVEL WIDTH rFT. ) 2.
GRAVEL LENGTH (FT. 415. 0
GRAVEL VOLUME (0U. YDS. 22, _C1
TANK: SIZE ( GALS) 1.-000. 0
_=i;IIL RATING r'Sf.q. FT. /BR) 150
TANK' MUST HAVE AT LEAST TbaO COMPARTMENTS
I CERTIFY THAT:
1. I Aril FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEI•dERS AND WELLS AS SET
FORTH BY THE MUNI C:IPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASE:FI.
w. I WILL INSTALL THE SYSTEM IN A GOF,DANC:E E'•f I TH ALL 110A iA C.'ODES AND REGULATIONS.,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
_. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY Ei<i 15TI NG WELL.: WASTEWATER DISPOSAL SYS TEN OR PUBLIC
SEWERAGE SYSTEM ON THIS OR. ANY FID _ A ENT OR, NEARBY LOT.
4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A h1Ar:,IMUN OF 3 BEEDROOM=. AND
ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
IF A LIFT ;NATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODE S:
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS--BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL IN F''ECTION REPORT.; AND r:''::' THE
ELECTRICAL WORK: MIST BE GONE BY A LICENSED ELECTRICIAN.
SIGNED DATE:
APPLICANT: HANNA. CDNSTRUC:TION
SOILS LOGS
i
_ MUNICIPALITY OF ANCHORAGE
11
0 ai`' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: //4 ✓�7 1 J, G, s-, �c%��S f r`^c f/d�-� DATE PERFORMED: /hci o,
LEGAL DESCRIPTION:
__...,� SLOPE SITE PLAN
(FEET)
1-
2-
3-
4
5-
6
7-
8
9-
10
11 -
12-
13
14
15-
o u tv �gu ocst;N
6- //
O2 6/+NI L
L A y_crt
WAS GROUND WATER _ S
ENCOUNTERED? ,�,� L
S� �d 6"we( D _
,Some 7-'nE-S J SD IF YES, AT WHAT E �- V
S \ DEPTH?
16
17 •e �o tJ»
18-
19
8 �;?.� •• �'.�
20- N 2225-E;
71
COMMENTS_ r----��
Reading
Date
Gross
Time
Net
Time
Depth to
Water
'rill
lomm-111
IMMINMENIN
MEN
i
mini
001101INNS■
i■
WAS GROUND WATER _ S
ENCOUNTERED? ,�,� L
S� �d 6"we( D _
,Some 7-'nE-S J SD IF YES, AT WHAT E �- V
S \ DEPTH?
16
17 •e �o tJ»
18-
19
8 �;?.� •• �'.�
20- N 2225-E;
71
COMMENTS_ r----��
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
0,S'2c,( / `�'
PERCOt-PCI' 6N RATE S�lrr•, (mrauxeslincli)_
V,3,, I
TEST RUN BETWEEN FT AND I— — FT
f
PERFORMED BY:CERTIFIED BY:
72-008 (6/79)
DATE: y
J
r
3
0e, /7
Chex :ifirb 'Briltiny lkxg
by
DOC Co. dba
SULLMN WATER WELLS
P.O. BOX 272, CHUGIAK, ALASKA 99567 o TELEPHONE 688-2759
OWNER OF LAND % ' /'I'/► ^t (I f�F /f S c'cv.+) S
DEPTH OF WELL
ADDRESS •S 4' / 7 F_17� c t{ U c l f9 f', STATIC LEVEL OF WATER FT.
LEGAL DESCRIPTION (�� = G� Cry ry /� °a C%L "VRAW DOWN FT.
DATF, •Started
�` Ended GALS. PER HR 13 r) b 0
PERMIT NUMBER
KIND OF FORMATION:
KIND OF CASING c)
FromFt. to Ft. t" eL 4 r~I FII e ` t Froin—Ft. to FL
From t'u Ft. to_J -7 Ft. .S r/%'� �ti i, eF /'I t F� �4 `?/J From Ft. to Ft,
From Ft. to --��// Ft.
From— Ft. to LS —Ft._
From Ft. to Ft. 4T n d a d
From7(i_Ft. to l._rr .Ft J/< 1 e_4 4, i f
From Ft. to Ft.
From i _Ft. to / J ,A Ft. J "V"O/,) < </I i7_'C
From Ft. to Ft. l(_).1. 1"i', .?
From Ft. to Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
Ft,
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
MISCL. INFORMATION:
From
Ft. to
Ft.
From
Ft. to
Ft,
From
Ft. to
Ft.
From
Ft. to
Ft.
From
_Ft. to
Ft.
Froin
-Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
Prom
Ft. to
Ft.
From
Ft. to
_Ft.
From
Ft. to
Ft.
From Ft. tp, _ . t C Ft.
7v.
FC2ctr, s; Ft " :j .Ft.
Fr4ntY" Ft. to Ft.
From 'to Ft.
DRILLER'S NAME
GE BV
00
Municipality of Anchorage z�K �no
On -Site Water and Wastewater Program r r
(907) 343-7904 '~
5 A FET Y
Certificate of On -Site Systems. Approval;
Parcel I.D. 050-491-58 Expiration Date: %2 2-3 ~ z�
1. GENERAL INFORMATION:
Complete legal description GLACIER VIEW HEIGHTS #4; BLOCK 2 LOT 4
Location (site address) 22637 Eagle Glacier Loop *Anchorage 99577
Current Property owner(s) Zachary Meehan Day phone 360-7995
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® 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:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee Waiver Fee $
Date of Payment T iA I Date of Payment
Receipt Number 0/6'3 6 G Receipt Number
COSA # ®S �- 11 �J�o $ Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 I
Engineer's Printed Name: Jeffrey A. Garness Date: C, !I t f-2.,
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulation's established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may Fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE ?
_ K System #1 Approved for 3 bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the
T
�.. .....\-....... ......
I •J r A. ess.*
CE 795
o f esslo�°oo
#AECC884
li�t,tttccrrrrrrr
ITY OFq�i�/�
g Ohl -SITE �y
FF
m
1 T �9
a i�
v ATER
m PRO, _nn < n
- yr
n
.\
By_Original Certificate Date:
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
11
Legal Description: GLACIER VIEW HEIGHTS #4; BLOCK 2, LOT 4 Parcel ID: 050491-58
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 4/1984
Total depth 131 ft
Cased to UNKNOWN ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 7/18/20
Static water level at beginning of test 73.4 ft.
Comments
B. TANK DATA
Age of tank(S) NEW years
Tank type/material SEPTI PL"
Measured operating fluid level in septic tank 61"
❑ Standpipes/foundation cleanout per record drawing
Date of pumping NEW OnJ'{'c
D. ABSORPTION FIELD DATA DEEP TRENCH
Which system tested (date installed) 9/12J84
❑ ALL standpipes present per record drawing
Total measured depth from grade 9.66 ft (max)
Measured depth to pipe invert from grade 4.5 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Well production at time of test 7.8+ gpm
Water storage tank volume N/A gallons
Well di cted for coliform test? ❑ Yes ❑ No
Coliform bacteria is Nega ive
Nitrate mg/L ENitrate less than MRL (ND)
Arsenic ug/L (ja_Ar es nic less than MRL (ND)
Collected by
Date of Sample I f I- If
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: NIA
Adequacy test date 7/18/20
Results Q✓ Pass For 3 bedrooms
Fluid depth prior to test 45 in
Water added 709 gal
New depth 56 in
Elapsed time 120 min
❑ Code -required soil cover over field Final fluid depth 50 in
❑ System presoaked Absorption rate 450+ and
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE
date of test) N/A
Gallons introduced N/A gallons If yes, enter date
Comments/Deficiencies:_ �j '1 L 1 �s uyo -l.4 ' UFi p o ,.s
COSA Checklist yellow sheet
0
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'
F�' Yes
if No
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
r-71 Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No ft
Absorption Field on Lot > 100' n Yes
if No
ft
Holding Tank > 100' R Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' n Yes
if No ft
Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' C] 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'
F�' Yes
if No
ft
Surface Water > 100'
Q Yes if No ft
Property Line > 5'
I] Yes
if No
ft
Wells on Adjacent Lots:
Wells on Adjacent Lots.-
ots:Water
Absorption Field > 5'
Iv Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
0 Yes
if No
ft
Community Wells > 200'
0 Yes if No ft
Water Service Line > 10'
[l 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'
[)
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Cj
Yes
if No
ft
Wells on Adjacent Lots.-
ots:Water
WaterMain > 10'
Fv1
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Service Line > 10'
P/1
Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS u;N>
STREAM SHOWN IN MOA WETLAND MAPPING 19 NOT PRESENT DURING
TIME OF INSPECTION
G. ENGINEER'S CERTIFICATION
l certify that l 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
#AECCBB4
Municipality of Anchorage ase
On -Site Water & Wastewater Program
0* (907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-491-58 Expiration Date: ��-
1. GENERAL INFORMATION 0
Complete legal description GLACIER VIEW 4 BLOCK 2, LOT 4
la.r'i21"
Location (site address) 22637 EAGLE RVER LOOP
Current Property owner(s) OWEN & AMBER STRONG Day phone 351-4368
Mailing address 22637 EAGLE RIVER LOOP
Real Estate Agent OWEN STRONG Day phone
2. TYPE OF DWELLING:
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:
Individual Well
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for. n/O A Distance:=
Received by:. Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ CJ 24 — I
Date of Payment
Receipt Number fs�i4 �J�y1
COSA# 0SCl5ILIS�O
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
9
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
Address
GARNESS ENGINEERING GROUP, Ltd.
3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK, 99507
Engineer's Printed Name
Engineers Comments:
JEFFREY A. GARNESS, P.E.
Phone 337-6179
Date 6 ! 2 -014 -
M
C 1 -
M
Original Certificate Date: 2 u 27 -
The 9d6?c1p91ity efA� ge Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenat ` ns 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 1011012)
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: GLACIER VIEW HEIGHTS #4; BLOCK 2, LOT 4 Parcel ID: 050-491-58
A. WELL DATA *ASSUMED BASED UPON SURROUNDING WELL LOGS
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 4/1984 Sanitary seal (Y/N) YES
Total depth 131 ft. Cased to *40 ft.
FROM WELL LOG
Date of test 4/1984
Static water.level 72 ft.
Well production 50 —g -p.m.
WATER SAMPLE RESULTS:
Coliform ND colonies/100 ml.
Arsenic: 0 ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate ND mg./L.
Well Log (YIN) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
Date of sample: 8/3/2015
Tank Type/Material SEPTIC/STEEL
AT INSPECTION
8/3/2015
74 ft.
5.0+ g.p.m.
Collected by: GEG. Ltd.
Date installed 9/12/1984
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Date of pumping 11/3/2014 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE AT SUM
Date installed
9/12/1954
Soil rating (g.p.d./fi br /bdrm
150
System type
TRENCH
Length
50 ft.
Width 2.5
ft.
Gravel below pipe
5
ft.
Total depth *9.9+ ft. Eff. absorption area 500 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 7/30/2015 Results (Pass/Fail) PASS Forbedrooms
Fluid depth in absorption field before test 50 in. Water added 620 gal. New depth 60.5 in.
Elapsed Time: 180 min. Final fluid depth 52 in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at in. "Pump off'
E. SEPARATION DISTANCES
water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on tot 100'+ On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N/A"
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas "'# F l00'+ ti
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service
Wells on adjacent lots 100'.
10'+ Surface water *100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water *100,+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*SEE ATTACHED DOCUMENT FROM MOA WETLANDS MAP. IT INDICATES THERE IS A STREAM
THROUGH THIS LOT. GEG TECHNICIAN ROB CAMPBELL WALKED THE ENTIRE LOT AND FOUND NO
STREAM.
G. ENGINEER'S CERTIFICATION
N
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 JEFFREY A. GARNESS
DateB)�tg
(Rev. 11/05)
u�1
7
M
J
�
u�1
II9
v
II9
FA
W / �
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATEOFOF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-491-58 Expiration Date:
1. GENERAL INFORMATION
Complete legal description GLACIER VIEW HTS #4• BLOCK 2 LOT 4
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
22637 EAGLE GLACIER LOOP *EAGLE RIVER, AK 99577
JO WOOD Day phone 694-3369
22637 EAGLE GLACIER LOOP *EAGLE RIVER, AK 99577
OWEN STRONG W/ PRUDENTIAL Day phone
2. TYPE OF DWELLING:
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:
Individual Well
0
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by:.. ; jt Dater 3r
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 7 oao
Date of Payment
Receipt Number.
COSA# 0_ L 3/093
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply andlor 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 1
Engineer's Comments
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
p6`J�p
conscientious engineering analysis o/ the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
o
A..
bedrooms:
�O�ri��
system under the conditions encountered at the time of the test, and separation
n
ON-SITE gym=
_ �...
q`4p0o
distances measured to readilyidentifiable features. The operational fife ofall wells and
septic systems depend on the local sods condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
QoP,.
Q , •'
777
A,�
pA {�pkjk'
These conditions are outside the control of the evaluator of the system. satisfactory test
ltll�a7. `
,
i Z_,
results do not guarantee future performance of the system, nor do they guarantee that
D
then= are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
......... ......
... .
operational requirements of the ADEC or MCA DSD The content of this reportis for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
a......�
Qp A
A. rn ess
CE— 95�
r
other person orparty is not authorized, nor will it confer any legal right whatsoever.
VO s
On.'`P_'X1�2�I13
, as
6. DSD SIGNATURE
V
-
System #1 Approved for
bedrooms.
System #2 Approved for
bedrooms:
�O�ri��
Disapproved.
n
ON-SITE gym=
Conditional approval for
bedrooms, with the following qp tioWATER AND
fl WASTEWATER oz^
pA {�pkjk'
ltll�a7. `
,
i Z_,
Original Certificate Date:
FOr If t r
The unicipality or Anchorage Develop, eat Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
IR— 1unsl
✓� Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: GLACIER VIEW HTS #4; BLOCK 2, LOT 4 Parcel ID: 050-491-58
A. WELL DATA *ASSUMED BASED UPON SURROUNDING WELL LOGS
Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (Y/N) YES
Date completed 4/84 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 131 ft.
Date of test
Static water level
Well production
Cased to *40+ ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
50
ft.
Casing height (above ground) 12+ in.
AT INSPECTION
2/25/13
g.p.m. 2.64+ g.p.m.
Coliform 0 colonies/100 ml. Nitrate ND mg./L.
Arsenic: ND ug./L. Date of sample: 11/8/2013
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Collected by: GEG. Ltd.
Date installed 9/12/84
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 2/27/2013 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 9/12/84 Soil rating (g.p.d./Wor �/bdrm 150
Length 50 ft. Width 2.5 ft.
System type
TRENCH
Gravel below pipe 5 ft.
Total depth *10 ft. Eff. absorption area 500 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 2/25/13 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 52 in. Water added 660 gal. New depth 62 in.
Elapsed Time: 120 min. Final fluid depth 54 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off' level High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots
Public sewer manhole/cleanout
0P111117
100'+
Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 3'
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
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 JEFFREY A. GARNESS
Date it IT 5-J1;
(Rev. 11105)
4P?........
CE -7RZ3//
Municipality of Anchorage
On -Site Water &Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I. D. 050-491-58 Expiration Date:
1. GENERAL INFORMATION
Complete legal description GLACIER VIEW HTS #4; BLOCK 2, LOT 4
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
22637 EAGLE GLACIER LOOP *EAGLE RIVER. AK 99577
JO WOOD Day phone
694-3369
22637 EAGLE GLACIER LOOP *EAGLE RIVER, AK 99577
OWEN STRONG W/ PRUDENTIAL Day phone
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:
Individual Well
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by: Date: 31z V
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ �`L �' Waiver Fee $
Date of Payment�Date of Payment
Receipt Number �%� �J.3Q Receipt Number
COSA #v� �'� %�'J� Waiver #
6. 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for _-:3 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 337-6179
Date t
bedrooms, with the following stipulations:
=M84
e� A`F�a%ness:
7CQ/ 7,9 3 �Oylj
ON-SITE
WATER AND
WASTEWATER
PROGRAM
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory 9 Other i ('
By: 1 0� Original Certificate Date: 3 - 1 t —)3
,
If more than 7 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: GLACIER VIEW HTS #4; BLOCK 2, LOT 4 Parcel ID: 050-491-58
A. WELL DATA
*PER SURROUNDING WELL LOGS
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 4/84 Sanitary seal (Y/N) YES
Total depth 131 ft. Cased to *40+ ft.
FROM WELL LOG
Date of test 4/84
Static water level 72 ft.
Well production 50 g.p.m.
WATER SAMPLE RESULTS
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
2/25/13
73 ft.
2.64+ —9 P.M.
Coliform /. ,0 colonies/100 ml. Nitrate n mg./L.
v
Arsenic: l Q ug./L. Date of sample: 2,/25/13
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 3
Collected by: td.
Date installed 9/12/84
Cleanouts (Y/N)
YES
Foundation cleanout (Y/N) YES Depression over tank
(Y//N) NO High water alarm (Y/N) N/A
Date of pumping 3 Pumper �� r �..rvL✓JinU�
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 9/12/84 Soil rating (g.p.d./ft2or Ibdrm 150 System type TRENCH
Length 50 ft. Width 2.5 ft. Gravel below pipe 5 ft.
Total depth *10 ft. Eff. absorption area 500 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 2/25/13 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 52 in. Water added 660 gal. New depth 62 in.
Elapsed Time: 120 min. Final fluid depth 54 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off'
Cycles
E. SEPARATION DISTANCES
Manhole/Access
water alarm level at
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
r
Septic tankAift station on lot loo + On adjacent lots 100'+
Absorption field on lot i Vo I# On adjacent lots 100'+
Public sewer main N/A Public sewer manholetcleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line ✓C" l * Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101,+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 3'
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
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 JEFFREY A. GARNESS
Date
(Rev. 11/05)
s/. v:
f _
It
KIZ
AS -BUILT
I hereby certify that I�have s eyed the following described
Pmpert}t: ` ` .
6-4 e' 14 .
Anchorage Recording Precutct, Alaska, and that the improve-
_ - - - ments situated -thereon are within the property Tinier and do not
overlap or encroach on the. property lying adjacent thereto, that
no improvements on property I ad7''aeent thereto encroach
on the premises in question and that tl ere are no roadways,
transmission lines or other visible easements on said property
t - - except as indicated hereon. -
, Bated- at Eagle River, Alaska - - - -
ayof 19_
ROBERT C. JOFINSON
SCALE: r Registered Land Surveyor No -LS
1" _ , Box 77-0456, Eagle River, Alaska 495577
Phone (9M 694-2543
tLUNI.CIPALITY or ANCHORAGE
DIVISION Or ENVIRONM MAL HLALTH
DCPAR'T2 ENT OF' HEALTH AND E,,NVIRON".1ENTAL PROTECTION
APPLICATION FOR B ALTH Ai)THOl"tiTY APPROVAL CCRTIFICA.T):
1. General Information
Application Data
(a) Legal Descript/ioln (include, lot, block,, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name ('/+, ,-t _'..,� - Telephone - home �w ^�BusinessVFu
Applicants PP Address f;G'l,
(c) Applicant is (check one) Lending :Institution E -j ; Owner/builder
Buyer 1- ; Other 1�mj (explain);
(d) Lending Institution ) 1: Te.l.tp.hone
Address
(e) Real Estate Co. & Agent
Address
'telephone
(f) Mail the HAA to the following address:
2. Type of. Residence
Single -Family,
Number of Bedrooms
3. Water Supply.
Individual Well.
Multi -Family
Community 1
Other: (describe
Public [---:I
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 I Community E-1 Holding 'rank^�
Note: If community well system, must have vTritt:en confirmation from the State
Department of Environmental Conservation at:test:ing to the legality and status.
[Page 1 of 2]
5. Engineering Firm Providing Inspections, Tosts, Tile Searches Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, [:
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 regula-
tions in ef.fec_t on the date of this inspection.
Name of Firm ] ,/, /, >. %i �� „ ,( / Telephone
Address o f / { r /r..r A l c
Date
At
;5
(ENGINEER SEAL)
h. DHEP Approval
Approved for �.k;_r bedrooms
Approved Disapproved
Terms of CondY.ti.onal Approval_ _
J
Conditional`
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTnMENT OF HEALTH AND ENVIR=-SENTAL PRO-!.'7CTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UI'ON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 AB0VE BY AN INDEPENDENT PROFESSIONAI, ENGINEER REGISTERED
IN TIEE STATE OF ALASKA. THE DHEP DOES THIS AS A, COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AID STATE REgUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE YOR ERROI:S
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
RR4/ej/D18
[Page 2 of 21
(DHEP SEAL)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
B. SEPTIC/HOLDING TANK DNrA
Date Installed - Size No. of Compartments
Standpipes (Y ) % Air -tight Caps (Y/N) Foundation Cleanout (Y/N) y
Depression over Tank (Y—/N)�/ / Date Last Pumped fie'_ Uc.j
Pumping/Maintenance Contract on File (Y/N) for
Holding Tank High -Water Alarm (Y/N) N1 Temporary Holding Tank Permit (Y/N) !L
Separation Distances from Septic/Holding Tank:
To Water -Supply Wbll To Building Foundation 6- /
To Property Line _ /0 To Disposal Field
To Water Main/Service Line /v To Stream, Pond, Lake, or Major Drainage
Course
Comments s�
[Page 1 of 21
`�`i�l
2-15-84 r-)
Legal Description:
A. WELL DATA
cue %/i t c!� //; SWell
Classification %��✓c ��
If A, B, or C. D.E.C. Approved(Y/N)
Wel]. Log Present (Y/N)
Date Conpleted glee-! Yield ' oc�GG2ly
Total Depth / 3 1 ( Cased to
� ��..4- P ,� Depth of Grouting A,1 /q
Static Water Level 7 a
Pump Set At Z„u 4 -
Casing Height Above Ground
Sanitary Seal on Casing (X�
Electrical Wiring in Conduit (Y/N) y Depression Around Vbllhead (Y/N) .N
Separation Distances from Well:
To Septic/Holding Tank on Lot /y u I On Adjoining Lots /o-) j -
To Nearest Edge of Absorption Field
on Lot /ay ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole yG�
To Nearest Sewer Service Line on Lot /oo
Water Sample Collected By Gns ^men-
; Date ;/ tee' sy
Water Sample Test Results S c f fr7
e
ComBnts
B. SEPTIC/HOLDING TANK DNrA
Date Installed - Size No. of Compartments
Standpipes (Y ) % Air -tight Caps (Y/N) Foundation Cleanout (Y/N) y
Depression over Tank (Y—/N)�/ / Date Last Pumped fie'_ Uc.j
Pumping/Maintenance Contract on File (Y/N) for
Holding Tank High -Water Alarm (Y/N) N1 Temporary Holding Tank Permit (Y/N) !L
Separation Distances from Septic/Holding Tank:
To Water -Supply Wbll To Building Foundation 6- /
To Property Line _ /0 To Disposal Field
To Water Main/Service Line /v To Stream, Pond, Lake, or Major Drainage
Course
Comments s�
[Page 1 of 21
`�`i�l
2-15-84 r-)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /3�0 LA Type of System Design 7 -re c -
Date Installed 5VIL11LL-� Length of Field o
Width of Field 73v Depth of Field / 3
Gravel Bed Thickness 1
Square Feet of Absorption Area 415:-e ` Standpipes Present (YIN)
Depression over Field (Y/N) /✓ Date of Last Adequacy Test AA?
Results of Last Adequacy Test /t -le c-,�
Separation Distance from Absorption Field:
To Water -Supply Yb11 /cfe-) � To Property Line
i
/5r
To Building Foundation 'a a ; To Existing or Abandoned System on
Lot I/A^e- ; On Adjoining Lots s, -t'-
To
t`To Water Main/Service Line /C) To Cutbank(if present)
To Stream/Pond/Lake/or Major Drainage Course -�v_
%V_, P,P ,J p
To Driveway, Parking Area, or Vehicle Storage Area S I."L,Ver .4_f,
Comments eoc f o5 k f't/4' 7- .. /Z, Cf Ze
D. LIFT STATION
Date Installed
Size in Gallons
"Plaixp On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(YM)
Comments
Dig ensions
Manhole/Access (YM)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MCA
** Check
Permitted Bedroom Rating Against HAA Request %*
I certify
that I have checked, verified, or conformed to all
NPJA.HAA Guidelines in effect
on the date of this
inspection.
Signed
/d�6e 5�,�
k/�,w�� Date
Tvhbe,_
MOA No. k y- °��
A
y
Company
�`ENGPnlfiicr-
SL • t'.
ne•'t}STFI
F±. �• No. 22-25-6;
.�•r"��•, JUNE 25, 1371 •;•.`;:;:
y
(Page 2 of 21
L•...,