Loading...
HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK B LT 7Glacier View Heights Lot 7 Block B #050-501-03 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Pea:mit Number: -~//v'0 00 2 29 PID Number:. (~ ~C0- ~Cdl-O ~' "'~"': Wastewater System: D New ~ Upgrade ~2~5~ ~?tlc p~i~,. ~t~ [;v~r, ~ ABSORPTION FIELD ~76-~ ~ ~D~pTrenc~ ~ShallowTrench ~a~ ~Mound ~Other LEGAL DESCRIPTION ~, ~ ~P~sq. ~. ~. ~' 7 8 ~/~;~r ~iC~ ~e;~s ~-0~ ~. ~.~ ~. WELL: ~z,~,~ New ~ Upgrade ~: ~;~ ~ SEPARATION DISTANCES ~ptlc ~ Holding a S.,aca ~ / ~...' LI~ STATION Remarks: ¢~/~ ~,¢~ ,~¢2/,~¢ BENCH MARK ENGINEEr'S Inspections pedormed by: ~, Dates: 1st ?- ~- ~o ~ Depadment of Health and Human Se~ices approval ~})~% c~ Permit No. SW000229 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, AIDskD 99519-6650 Telephone: 345-4-744 On-Site Westeweter Disposal System end/or Well Inspection Report Legal 0escription: Lot 7~ Block B~ Glacier View H~;s, No,: 050-501-0.~ TEST HOLE · MONITOR TUBE o SEWER CLEAN OUT WELL -- -- - EASEMENT ~ - Deck A C 75' D 100' 16 E 105183 \ \ \ Scale 1"=40' F~iO0,O0 '"'~ R150.O0 -- --\- / / / / wide x 39' Long (TR1) wide x 55' Long CTR2) 8-la-00 ENGINEER'S SEAL ~, ~'.. ~ou~s ,. ,UTE,* .-'~ MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 13, 2000 Expiration Date: Jul 13, 2001 Permit Number: SW000229 Legal Description: GLACIER VIEW HEIGHTS BLK BLT Design Engineer: 0024 Eagle River Engineering Services Owner Name: Henry & Kathy Huntington Owner Address: 22954 Myrtle Dr. Eagle River, AK 99577-9541 Parcel ID: 050-501-03 Site Address: 022954 MYRTLE DR Lot Size: 23618 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of; ~ Disposal Field ~j SepticTank [] Holding Tank ~] Privy [] Private Well Water Storage All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The foltowing special provisions. A DIVERSION VALVE SHALL NOT BE INSTALLED TO KEEP THE EXISTING ABSORPTION BED FOR A RESERVE SITE. THE ORIGINAL BED SHALL BE PERMANENTLY ABANDONED UNLESS A SEPARATION ENCROACHMENT WAIVEF~rAPPROVAL IS OBTAINED FOR THE ON-LOT WATER WELL TO THE ABSORPTION BED. Received By: ~ :~/'l~'"'.~., Date: Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax June 28, 2000 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 7, Block B Glacier View Hts Narrative & Permit Application Dear Mr. Cross: The proposed septic upgrade/well and septic system will have very limited impact on adjacent properties for the following reasons: The surrounding lots are small but have wells and septic systems located so as to allow sufficient room for septic sites. This is an established subdivision and there is no other area on this lot for a septic upgrade. 2. Immediate neighboring septic systems are all +30' distance. Reserve space is adequate, due to absorption capacity and. This is the second system for this lot and a diversion valve will be installed to retain the existing system. 4. Drainage will not be affected and is not a major consideration in our design. If yoU have at~y questions please call our office at 694~54:95.., Sincereiy, Louis Butera, P.E. \2000\00-035~qAR EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 00-035 Calculated By: LB Date: 7/4/00 Legal: Lot 7, BIk B Glacier View Hts Single Family 3 Bedroom Dwelling TEST HOLE Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 450 gallons Percolation rate = 7.3 minutes per inch Wastewater application rate = 0.8 gallons per day persquare foot Required absorption area = 563 square feet Trench width (W) = 5 feet Gravel depth (D) = 1.5 feet Required length = Shallow trench factor * Required absorption area / W Shallow trench factor = ON + 2) / ON + 1 +2 D) Shallow trench factor = 0.78 Total Excavation Depth = 3.5 feet Required length = 88 feet 00-035cal 11:10 AM7/4/O0 // ~ iI / ~. \ ~ \ Septic c.o. IL, Inspect or repoce tonk. ~~5' wide x 49' tong ~ , TEST HOLE .. , t.'~ ,, ~; ',, , ~ ~ ~ ~' ~ 'MONITOR TUBE o SEWER CLaN OUT + WELL NO SURFACE WATER : -- --- ~SEMENT --'- PROPOSEO L~CH FIELD NO KNOWN CURTAIN DRAINS ~- Deck See well end septic Iocotlon plon by A.W.W.S. S E PT I C U P G RA D E P LA N LEGAL: Lot 7, Block B, Gloc;er View Heights Jos~oo-o3s~I D~[: ~-27-ooI sclc[ ~" = 4o'  EAGLE RIVER ENGINEERING SERVICES ¢~ ". ce-6726 ."~ P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 '..'-.. z / / j I ~. `%...'... / / / ~ l l"-~... . '"-~'-.... I LOT 11, BLOCK D ./ x. '-~ ,~ )'-.. '~. '~...~.... / >' ".'".>. ~ B:C~ER w~'~ / ~".< ~'. "-7.'). / ~ / '`%-.~.'"-,. LOT 5, BLOCK B ,/ /' '% ~. '-.~'"~ ,/ \ / '"~. '--.'"~. / / ~'-,. '"- "-\~ \\ / '-. ~ ~ / -q~..~'... LoT B, ?L_LO_C~ B\ I .- "~. ',~ '`%.. // LOT 7, BLOCK A ,/ z/ '"'-'~/.~'~. /~'~LOTS B\~ 9'",~-..SHARED / · /P/~,, ~.~ SEPTIC ~ ! I ."~ '~`% ~-~-. ~,D ~.~ .. / ~ I ~oo' ~' '-"~. "-~ I / "~ --~. -.~_/,..~- ~ L. cV--:~ / ",.~".~ '-. I / i --x_ --. ',.. ~LAC]E~ ViEW I / "/t:".-."../ / ~ ~,. "~ LOT 6, E~kOCN. A / / / /' -,.. -~. ~-... '-.:~.,..' /, ,, / "`% ~. '-.. '/.-_.~_ _- ..- / / --.. . '..... / ~ .... / -.. -.... / -... ~. - '..../ OLAClER ViEW / '`%. ~. ..,~ LOT 5, BLOCK A / 611 ~2o0o '--'- Al ,ASKA WATER & WASTEWATER J.w.u. ~ ?7/// ~m~,o~,~u~.~,.~.o~q~,~o~.mo~E~*o~-~*-~*o~ = 100' ¢ ,. / '~/t'~ PREPAREO FOR PHONE /]UMBER: ~AGE NUMBER: ~'t..~-,~.~ KATHY HUNTINGTON (907) 696-1427 1 OF 1 ~i..~';(Jefr~ A.\Gorn~ss.' GLACIER VIEW HEIGHTS S/D ADDITION #2; LOT 7, BLOCK B ~. '-. .-' Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax LEGAL: SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM Lot 7, Block B, Glacier View Heights Subdivision July 4, 2000 A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multiPfamily wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. B. SEPTIC TANK/LIFT STATION 1. Septic tank and lift station shall be 1000 gallon minimum, MOA approved tank. Existing tank to be inspected or replaced. C. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 3.5' at any point relative to the uphill side. 4. The effluent line within the trench shall be laid level within 0.03'. 5. The trench gravel is to be covered with typar fabric material ....... 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 3.5' GRAVEL DEPTH = 1.5' under pipe, 2" over pipe TRENCH LENGTH = 88' TRENCH WIDTH = 5' SOIL RATING = 0.8 GPD/ft2 BEDROOM CAPACI~ = 3 SEPTIC TANK = 1000 Twenty-four (24) hours notice required for all inspections. \1997\oo-035spec Munletl~llly c! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN P $ 14 - Reading Oete T~me T~me W~' 15- 5o~k I ~-1~-oo~ tz:~o.oo ~Y~" 16- 2 ,, ~2:~0.0o IO' ~%~" I'~" 17- ~ . ~: I~.00 ~ ', ~:~,~o lo' ~" 20 - ~CO~TION RATE ~' ~ {mmul~m~) P~C HOLE TEST RUN BE~E~ ~ ~ AND ~ FY COMMENTS PERFORMED BY: g' ~' ~' 5 [ ~ ,~"~r'- CERTIFY THAT THIS TEST WAS PERFORMED ,N NAME MAILING ADDP((~-7~) ~' ~ ~ ~f~ ~/~ LEGAL DESCRIPTION LOCATION ~ / / /7/~ / M~ )W~II / ¢ ~ Absorption area ~ ~ I Manufacturer ~ ~ ~/[)/]O lDiSTANCE TO: I Well ~/~Dwelhng ~ Manufacturer i 9 ' I .,STA.C. TO Iw"" ~1/ i~o..~t,o. ~ ~ ~ Top of tile to finish grade Materml beneath tde ~ Length t Width / Dept I , ~ Type of crib Crib diameter Crib de~th ~ ~/ / Buildil ~ / DISTANOE TO: ~ ~ Driller ~ Class ~ Building foundation ~ DISTANCE TO: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE OTHER PiPE MATERIALS SOIL TEST RATING INSTAELER REMARKS DATE LEGAL ,J~N EW [] UPGRADE NO. OF BEDROOMS ! Dwelling /¥/~ PERMIT NO. ~'"l i~. Material No. of compartments ,~. Width ~7"~-----"~(~-____ Liquid depth PERMIT NO, Liquid capacity in gallons PERMIT NO, Distance between lines inches Total effective absorption area inches PERMIT NO. ~,~ Material Nearest Iotline Trench width / Tota, e,fectiv~ absorpti~a¢~ Nearest lot line Distance to lot line PERMIT NO, Absorption area(s) Septic tank ~ Departme~. of Health and Environment "Protection ~: ~ 82~-~'L Street, Anchorage, AK.'~'99501 '~' 264-4720 * * * HANDWRITTEN PERMIT * * * Permi~ ~ ~ , ~H~LL AND/OR ON-SITE SEWER PERMIT -~/, ~ Location: ~'~ ~/%J~-~ Phone Number: Legal Description: ~ ~ C~33 :~/~/~'~~ o~t Size: Type of Soil Absorption System Is: %/ Trench: Drainfield: Seepage Bed:/~ Holding Tank 'Maximum Number of Bedrooms: Soil Rating(sq.ft/br) /~---~ DEPTH The Required Size of the Soil Absorption System Is: ' LENGTH GRAVEL DEPTH / The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~~ GALLONS * * Permit applicant has the responsibility to inform this department during the' installation inspections of any wells adjacent to this property and the~number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this departmeni will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee~ for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I w~l~ in~s~all t~system in accordance with c~des. ] (3) I~nd~r.~/~ t~//the on-site sewer system may require enlargement if ~e ~~////~/~~~modeled to include more th~^//~3~bedr°lms'/ ~ S i gne~ / xl/~/////'~/~,,~///~/' Issued by: ~~ >~,~"~. ~<~/~-~ SWP/024 (1/81) /~ SOl LS LOG MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street. Anchorage. A~aska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE;' SITE PLAN 6 7 8 10 11 2 3 4 5 WAS GROUND WATER ENCOUNTERED? 12 13 14 15 16 17 18 19¸ /x. [ i-' f) / Gross Net Depth to Net Reading Date Time Time Water Drop 20 PERCOLATION RATE (m.~tes/inch) / PERFORMED B~:~{~~ ~1~t~. A~-~t8~'~' ~'~"' CERTIFIED B~I~b~/// DATE:/' ~2-oo~ ~/~ 0 v : < ,m ¢., 0 · ¢; C: DATE II)~DR~LLE~G CO. CHUGIAK, ALASKA 99567 PHotON E 688-3j199 NAME ~!~ CI~ LEGAL DESCRIPTION LEGAL OWNERS BANK OR LENDING INSTITUTIONS CURRENTLY HOLDING DEEO OF TRUST HOME PHONE WORK PHONE No. _ 367" DESCRIPTION OF WORK WELL NUMBER DEPTH PUMP MAKE HP SE~'ING COMMENTS SERIAL NUMBER MODEL I MATERIALS All charges shall be paid in full within ten days unless other arrangements are made prior to work. The customer sha/I pay interest at the rate of two (2) percent per month on any amount not paid within ten days. Failure to pay may result in a lien against the property. THIS IS A RIGHT TO LiEN SAiD PROPERTY DESCRIBED ABOVE WORKMAN DATE CUSTOMER SIGNATURE OUT MATERIALS OTHER CHARGES PAY THIS AMOUNT Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.oi.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROV,~L FOR A FAB i ?:'DwELI Parcel I.D. O~O Expiration Date: 1. Mailing address ~ ~ Lending agency ~ /~ Day phone GENERAL INFORMATION Complete legal description ~ Location (site address or directions) = Mailing address Real Estate Agent )D _w ,-., ~,¢. ,L-- /~,--.,,~¢,,-z',~_..r Day phone Mailing Address ~')// ( ~r~.~-~- -~'~¢,-'-/.~ /~'.~ Unless otherwise requested; HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: {~ Individual On-site ~, [] individual Holding Tank [] [] Community On-site [] [] Public Sewer ,, [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 01/00)* 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 Health Authority Approval Guidelines for the Health Authority Approval application show that the on-site water supply and ¢~-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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Eagle River Engineering Servlce. Phone P,O. Box 773294~ Eagle ]R/ver~ AK Address Engineer's Printed Name {._f~c(.i ~ ./-q . -;~ ~-~ v-~ Date / ] / '7/~ z~ DHHS SIGNATURE ~" Approved for ~.~ bedrooms. Disapproved. Conditional approval for bedrooms, with the followir Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: // Reissue Date: 72-025 (Rev. 01/00)' RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIC~V 0 9 2000 Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99-~31MJJ~-~P/SL~0~G~; "ENVIRONMENTAL SERVICES DIVISION Health Authority Approval Checklist LegalDescription: L~-7 ~¢//-r~' ¢/.,,,.'.-/,/4-~/'//'.( ,~.,(~/~ ParcelI.D.: ¢--)¢-O -_4-¢t-a3 IfA, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~' Date completed Total depth / N~) / Cased to /'Y,~" Casing height (above ground) Sanitary Seal (Y/H) 'Y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test ~'- ~ - ~ '~ //- '~ ~ - '~ o Static water level '~'~ /~,,2 ..~ / Well production &"- g.p.m. A. WELL DATA Well type /~'~'/ g.p.m. WATER SAMPLE RESULTS: Coliform '~ Date of sample: //- o 6 - Nitrate ~. ~- ~-5/~- Other bacteria Collected by: B. SEPTIC/HOLDING TAN K DATA Date installed ~dao Tank size Foundation cleanout (Y/N) _ ~ Date of Pumping ~ x~'~ ~.'~'-~/.JPumper /¢2~J0 Number of Compartments D.. Cleanouts (Y/N) . Depression (Y/N) /~J High water alarm (Y/N) Y C. ABSORPTION FIELD DATA Date installed Length ~ ~ / Width Effective absorption area /--/5-~ $~-' Monitoring Tube present (y/N) Date of adequacy test ~/ve~' ~-~,~ Results (Pass/Fail) Fluid depth in absorption field before test (in.); Fluid depth. ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Soilrating (g.p.d./ft or ....drm) D,~' Systemtype .5``/ GraVel thickness below pipe /, 5- ~ Total depth -~" Immediately after--' Absorption rate = If yes, give date Depression over field (Y/N) __ For ~ gal. water added (in.): .g.p.d. ,,~ bedrooms 72-026 (Rev. 3/96)* High w~J.-~larm level at* Cyd~es tested Size in gallons "Pump on" level at* *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station ,,,J SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~72-' Property line /~' Water main/service line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / Surface water Curtain drain F. ENGINEER'S CERTIFICATION Absorption field .."z¢,¢" Wells on adjacent lots ¢'/'~" Water main/service line Driveway, parking/vehicle storage area /-/-~ Wells on adjacent lots ~-/~,~" I certify that I have determined thru field inspections and review in conformance with MOA HAA guidelines in effect on this date. Signature ar~ Engineer's Name ,~¢*~ ..~' ,~,/,¢~¢~ Date /// '7/~ o HAA Fee $ Date of Payment //~/~/~-~ ' 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number '1t-08-00 IT:12 FRO~CTE ENVi~ON~HTAL 5615301 1-44~ ~.uwu~ CT&E Environmental Services Inc. Laboratory Division 200 W. Petter t3rive Anchorage, AK 99518 Tel: (907) 582-2343 Fax: (907} 561-§301 CT&E Ref. #: 1007027007 Client PO~: n/a Client Name: Eagle River Engirteering Servic~es Printed Date/Time: t 1/08/0D 18:45 Froject Name: nla Collected Date/Tim*~-: 11/D6100 08:33 Client Sample ID: Lot 07 Btk B Glacier View Hts Received Date/Time: 11/06'00 14:00 Matrix; Ddnki~§ Water Techtlicat Director: Stephen Eda PWSID Wa Released Sample Remarks: Allewable Prep Analysis Parameter Results PQL Unite Method Limbs Date Date Init Total Coliferm (MF) 0 ~IIIQ0 mi SMBA22B 111~61~ ~P Nitrate 0,$ U 0.5 m9~ EPA ~0 10,P 11/o6f~ SCL MUNICIP~,LITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 7; Block "B"; ;' _ Glacier View Heights S~bd~vision Location (address or directions) 1559 Myrtle (b) Property owner _Beth A. Schwob & Lee Brei Telephone: (home)694-6741 Business Mailing Address 1559 Myrtle Drive Ea~le River, Alaska 99577 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent _~ELLER.~ REAL E_~TATE Address 207 E~t Northern Lights Blvd., Suite #I I$ Anchorage, Ak. 99503 Telephone (e) Mail the HAA to the following address: (or check here ~[3(. if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 E*gl~, ~iv~_~- Loop Road Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family~C Number of bedrooms 3. WATER SUPPLY Individual Well ~c Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72 025 (Rev. 7/88) 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, Iverifythatmyinvestigation 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 wastewate¢ 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 Address Date 17034 Eagle River Loop Road No. .-_.~A ~;,,,,~. Alaska 95'577 Telephone Approved for ~.~ bedrooms by Approved ~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdonotconductinspections or analyze data before a certificate is issued. The MunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72 025 (Rev. 7/88) 8ack Page 2 of 2 A. WELL DAT~~¢ Well Log Present (Y/N) ~ Date Completed MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Total Depth . . Static.Water Level I .2_/ ' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) If A, B, C, D.E.C. Approved (Y/N) ~-- ~ - ~ Yield Cased to .~/0 -/- Depth of Grouting -- Pump Set At i~ " SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / I O' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line M/~1 To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots, / ~/~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~ ~'~) Size ! ~2~©4,¢rl No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: Foundation Cleanout (Y/N) Date Last Pumped ~-- ~.2. ~ - ~ ~ :for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed (o - '~ -- ~ Width of Field t ~-./ Square Feet of Absortion Area /---/~ (o ~ Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test ~_~¢t ']~.~¢~-~orc1 -- .:~ /~¢_~¢'oo SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot t,,.)/~ 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 Statndpipes Present (Y/N) To Property Line ~--~ © ' 'P- To Existing or Abandoned System on ; On Adjoining Lots __ L~© /~ To Cutback (if present) ~/¢~ / Oo '"'h Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ 72~026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. Client ~am~le ID:L7 E'B' GLACIER VIEW UTS PW$ID :U~ Collected MAY 21 90 @ 17:00 h~s. Received MAY 22 90 @ 13:30 ?reserved with :AS NEQUIRED 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE fox Work Order $ 21908 Date Report Printed: MAY 25 90 @ 11:07 Client Name ; S ~ S ENGR ,, Client Acct: $NSENGP P.O.$ NONE RECEIVED Req $ Ordezed By : R. SHAPER Analysis Completed :MAY 23 90 Send Reports to: Laboratory Supe~vio~o~_S__~EPNgN C. EDE 1)S ~ S EN§R ~peoial Instruct: Chemlab Ref $: 901477 Lab Smpl ID: 1 Matrix: WATER Allowable parameter Tested Result Units Method Limits NITRATE-N ND(O.1D) ~g/1 EPA 353.2 ' 10 Sample SAMPLE COLLECTED BY R.J.S. Remarks: ROUTINE SAMPLE. 1 Tests Pexfoxmed * See Special Ir~truct[ons Above UA=Unavailable ND- Nons Deteoted "Sea Sample Remarks Above MA- Not Analyzed LT~Lees Than, GT=Greater Than APPLIC'NT FILLS OUT UPPER HAl '~' ONLY Property Owner LOg'y-~,.'3 20¥~T'r~O''' t ~,~,~. ~0~ (I-(~'k~'- Phone Buyer · Zip Code Address - Address ~ '~,~_,~7~h ~ ~ C, Q.~¥-e C'~ ! Zip Code Address Zip Code Street Location Type of Residence ~/Single Family [] Mulfiplo Family No. of Bedrooms ~'~- ~.~ [] Other Water Supply ,~lndividual A'CrACH WELL LOG, A well log is required for all wells drilled since June 1975. ,U Community For we s drilled prior to that date, give well depth (attach log if available)· P [] Public Utility Year Individual Installed: [] ~uhlie Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector inspector Inspector Inspector ( ~PPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE Soils Rating 72-023 (3182) ~4 ~