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GLACIER VIEW HEIGHTS BLK C LT 5 REM
Glacier' View Heights Block ¢ Lot 5 #050-491 -31 Municipality of Anchorage Development Services Department ~_._- .: Bu,dlng Sa~,ty DMsk~n On~ W~ter & W~s~vMer Progmmo 4700 ~ Br~g~v SL ~.d.a~e.~us (~ ~7~ Poge 1 of On~ Wastewa~r Disposal Sys~m ancot Well Ins~on Repo~ Pe~;t Numbec SW010419 PID Numbec 050-491-~1 Nnme:~O~ PO~ Was~wa~r Sys~m: ~ New I Upqrode 22423 ~G~ R~R RO~ · ~GLE R~R, ~ 99577 ABSORPTION FIELD No. of ~m=: Phonl:(~07) 26~--~0~0 ~ I D~p T~nch ~ Sh=llow Trench ~ ~ ~und LEGAL DESCRIPTION ~.o ~ ~ ~.o-~2.o 5 C G~CIER ~ HEIG~S 1.94-5.94 ~ 6.06 - - - SEE DWG. ~ 42 WELL: D New D Upgrode 2.0 ~ 1 -- / ~ ~ 509 ~.~ D ~054/ F-810 ~ RCP CON.RUCTION 10/16-20/01 To ~p~c ~.~flon m ~l*ng ~ ANCHO~GE T~K 1000 Wetl 100'+ 100'+ -- -- 25'+ 10 GAUGE ~EEL 2 ;u~ce Woter 100'+ 100'+ -- -- -- LI~ STATION N~NE ~emo~s: THE ~I~{NG SEPTIC TANK WAS BENCH MARK COMPL~ELY ABANDONED PER U.P.C. TOP OF GAUGE S~B · THE NO~H~ AND SO~ PROPER~ LINES WERE ~GGED PR{OR TO CON.RUCTION. TRENCH 100.00 IS 1 FOOT FROM LOT LINES. (SEE LOT LINE WA~R ~WR010080). Ins~ons~.by: A~C. INC. Dat.:lst 10/16/2001 'q~;'~ ~.d ~o/~./=oo~ ....... ~'~"'~ " g'/] ..... of Health and Human Sewi~s.approval..~ ,..,; ~ 7,~3......~ Depa~ent R~vlew~ and appmv~ by Date: // /~al (~. 1~] '~ ~: AS BUILT DP, AWING SWO10419 ' 050-49 C01 ~ DEEP BURI~ USED ~ A R~E~ S~E~/ ~~ , ~ / (~.ROX~U~T~ LOttO.) ~~ / ~',. ~. =6~ / ' / /~~'~~ ,~ I ..:, . L'- · A B ~~o~ ~.~ ~o.~ ~ ~,, y ~ ~ 25.19 ~6.54 C04 6~.091 48.19 ~ ~/~/2oo~ ~SI~ ~TER & WASTE~TER ~ GONS~LTANIS, IN~.~ o~cm~, vm[w ,~o,~s su,mws~oN: ~o~ ~. ,~o:x c. ~..:".J. ........ AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE SW010419 050-491-31 99.61-99.79 ~P OF T~ A~ = ~TOP OF T~K AT I~ OF BUNG SEPTIC TANK ~ or BUNG AT ~S~ ~TER & WASTEWATER BOB POE (907) 269-3050 ~ G~ClER VIEW HEIGHTS SUBDIVISION; LOT 5, BLOCK C, *' PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ASBUILT SEWARD & ASSOCIATES LAND I HEREBY CERTIFY -THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY, AND ~AT NO EN~HMENT$ EXIST ~C~ AS INDICA~. IT I$ THE RES~SIBILI~ OF THE ~ ~ D~ER~INE THE ~ISTENCE OF ANY GRID' WHI~ ~ NOT ~AR ~ THE RE~ ~BDI- VISION PLAT. UND~NO CIRCUMSTANCES S~ F~ ~Y DATA H~N BE US~ FOR CONS~U~ION ~FENCE LIN~, OR ~R E~LISHING ~ND' DRA~, ARY LINES. MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (gO7) 343-7004 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 05, 2001 Expiration Date: Oct 05, 2002 Permit Number: SW010419 Parcel ID: 050-491-31 ,Legal Description: GLACIER VIEW HEIGHTS BLK C LT 5 REM Design Engineer: 0041 AK Water & Wastewater Consultan' Site Address: 022423 EAGLE RIVER RD Owner Name: Bob Poe Lot Size: 24568 SQ. FT. Owner Address: 22423 Eagle River Road Total Bedrooms: 3 Permit Bedrooms: 3 Eagle River, AK 99577- This permit is for the construction of: [] Disposal Field [] Septic Tank [] 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 DSD at least 2 hours prior to each inspection, Provide notification by calling (907) 343-7904 ( 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. Received By: Issued By: Date: Date: 10/5/2001 Jeffrey A. Garness, PE Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B Anchorage, Alaska 99504 Subject: Waiver Request for Glacier View Heights Subdivision Block C Lot 5 Waiver Request #WR010080 Parcel ID #050-491-31 Wastewater Disposal System Construction Permit Number SW010419 Dear Mr. Garness: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to propeay line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Civil Engineer On-Site Water & Wastewater Program Municipality of Anchorage Development Services Department Building SafcO/Division On-Site Water and Wastcwater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorasc.~.us (907) 343-7904 Waiver Review Worksheet WRY: 1~/1~010080 PID~:. 950-491-31 Date Received: 09/26/01 Legal Description: Glacier View Helahts Block C Lot 6 Permit~: ~ t,~OI O~l~ Engineer. Jeffrey A. Oamess P.E.. Alaska Water & Wastewater Consultants Inc. 6901 DebafT Rd. Suite 2B AnchoraGe. AK 99604 Applicant' Bob Poe Waiver Requested: I foot from northwest and southwest property lines to dralnfleld Criteria: Geology Points: A. Water Table B. Soil Serption C. Permeability D. Water Table Gradient E. Hodzontai Separation Total: Waiver ia Granted: ~/ Waiver is not Granted: LlstConditionsorReasonaforabove: ~ £E £ZI~II/EE,'~ / $ ~gT[19E'/~ED Z eiTE~ OF Date: /O-f--~)/ By: p~/L/ Name of Reviewer Rec~: 10655 Amount: $1t6.00 Date Paid: 9126/2001 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bmgaw SL P,O. Box 196850 Anchorage, AK 99519-6650 www.ct.anchorage.ak.us {~0~) 343-7~04 Parcel I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 0~0-491-31 Permit Number.~'l'uO'l O4 Iq Property owner(s) Mailing address (1) Mailing address (2) BOB POE 22423 EAGLE RIVER ROAD s EAGLE R~ER. AK. Day phone 269-3050,/223-9701 Zip Code 99~77 Legal description (Lot, Block& Sub'd.) LOT 5, BLOCK C: GLACIER VlEW HEIGHTS SUBDMSION Legal desc~ption (Section, Township & Range) Lot Size ~5-~ ~ Acms/Sq.FL Number of Bedrooms THIS APPUCATION I$ FOR: Sower Only Sewer and Well Sower Upgrade Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub ~]~ Swimming Pool Tbempy Pool [] Jac~ ~'/! DF~ water Soltenlng Unit I certify that the above Information Is correct. I further certify that this application Is being made for a Single Family Dwelling and Is in accordance with applicable Municipal codes. ALASKA WATER &: WASTEWATER CONSULTANTS~ INC. Permit Fees: '~<~1~ 3 ~.(~' CC2) Recelpt ,umper. I (2---~-~' Waiver Foos: ~ Date of Payment: Receipt Number:. ALASIC WATER & WASTEWATER CONSULTANTS, INC. September 19, 2001 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Septic System Upgrade for Lot 5, Block C; Glacier View Heights Subdivision To whom it may concern: The existing 3 bedroom house is served by a private well and septic system· The septic system consists ora 1250 gallon septic tank and a deep trench type drainfield that is not testable (can't find cleanout pipes under driveway). The homemvner would like the septic system upgraded. A test hole was excavated southwest of the existing septic system in the area of the proposed septic upgrade. The new septic system will be designed around the 30 foot radius of this test hole. We are proposing that a new 1000 gallon septic tank (deep burial) and also a deep trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 1.0 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 3.33 minutes/inch b. Allowable Application Rate: 1.0 gallons/day/ft2 c. NumberofBedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 ft2 f. Total Depth: 13 feet (max.) g. Effective Depth: 6 feet h. Width: 2.5 feet i. Reduction Factor: N/A {~ Minimum Length: 40 feet long · Effective absorption area -- 480 ft2 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached detail drawing, the proposed drainfield is to be installed near the base of a slope that ranges from 50 to 100 percent. The slope downhill from the drainfield ranges from 10 to 35 percent slope. The trench will be installed so that a 25 percent slope from the top of the distribution line will not daylight at any point 50 downhill from the trench. 5. LOT LINE WAIVER REQUEST: We request that a 1 foot lot line waiver from the northwest and the southwest property lines to the proposed drainfield be granted. We are unaware of any adverse effects on the adjacent properties with the granting of this waiver. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Pr~ NOTE: Attached is a site plan drawing, a design drawing, detail drawing, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com t NOTE: THE CONTRACTOR SHALL FIELD VERIFY WELL LOCATION ON LOT 7. BLOCK C. PRIOR TO STAJ~qlNG CONSTRUCTION. [- i I I M.OA. HERn'~G I I ! \ I I I ' ' ~;~.,.~ EXrS'~NG ~ I .... u,~,,~o c~. '~-.~.~L-----~-~-. / .............. ................ 911912001 WATER WASTEWATER ~ , .......... r~ ~l:.-.,r ....... CONSULTANTS, INC. BOB POE 269-5050/225-9701 1 OF 5 O~CIER VI~ HEIGHTS SUBDIVISION; LOT 5, BLOCK C, SITE P~N FOR SEPTIC SYSTEM UPGRADE ~0 NO~: THE CO~CTOR S~ ~ THE NO~HWE~ ~D SO~ ~ PROPE~ UNES F~GGED ~ A REGI~RED ~D SU~OR PRIOR ~S~ WATER & WASTE~TER CON~ULTANT~. lNG. BOB POE (907) 269-3050 2 OF 3 , G~ClER VI~ HEIGHTS SUBDIVISION; LOT 5, BLOCK C. ~E OF ~K: ~Profess~o~ DESIGN OF SEPTIC SYSTEM UPGRADE '~A%~ pROPOSED DRNNFI J.LM. ALASKA WATERcoNsULTANTS, ~ V~ASTEWATER, Nc. PRE. PA,RED FOR: PHONE NUMBER: PAGE NUMBER: BoB POE C.0,> =~.-~0~0 ~0~ OLACIER VIEW HEIGHTS SUBDIVISION; LOT 5, BLOCK C, Pi'P[ OF WORK: DETAIL DRAWING FOR SEPTIC SYSTEM UPGRADE .A~ ~SKA WATER & STEWATER , CONSULTANTS, INC. · ' ............. ISOIL LOG - PERCO~TION TESTJ .............. ~ DESCRI~ON: O~CIER ~ HDO~ SUBDMSION; LOT 5, BL~K C, PERFORMED FOR: BOa ~E DA~ 0/12/2001 HOLE 1 WITH FI~ SH OH ; ~¥.' ' ,O.O~DWATER ~.o~ I~ ~C ~o~-]~1 sP-s~ To GP-GH NET TIHE WATER LEVEL NET DROP 11 DATE RE. lNG CLOCK TIHE (HINGES) RE. lNG (INCHES) 1~ 9J1~/01 1 2:~0 - 6- - 2 ~:00 10 2-1/2' 3-1/2" 13 ~ 5:00 - 6' - 4 ~:10 10 2-3/4' ~-1/4' 14 5 ~:10 - 6" - 6 3:20 10 15 5 5:20 - 6- - 6 ~:50 10 16 5 5:50 - 6" - 17 6 5:40 10 5 5:40 - 6- - 18 6 ~:50 10 19 PERCO~TION ~TE ~.~5 .(HIN./INCH) PERC. H~ DIA. 6~([NCHES) 2 ' TEST R~ BETWEEN 8.5 ~. ~D 9.0 COHHE~S: PERC HO~ W~ PROOFED FOR 4+ HOURS. PERCO~ON ~ PERFORMED PERFORMED BY A~ WA~R & W~I[WATER I, JE~ ~ O~NESS, CE~ ~T ~IS W~/PE~ORMED IN ACCORD~CE W~ ~ ~A~ AND MUNICIP~ GUIDEUNES IN E~LCT ON ~lS DA~: DEPTH TO DATE SROUNDWATER DRY ~/~2/o~ DRY 9/~o/o~ / 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 MAI ~LNG ADDRESS LEGAL DESO~IPTION LOCATION /Well I Absorption ~[ea ~ Z Manufacture~ 1~ _ ~ ~ Ma~ ~ Liq. capac~G gallons [ IF HOMEMADE' [ Ins~e~e~th Width , - Well Dwelling I ~ Manufacturer /V /~ Materia, ~ I Well Foundation IDIsTANcET°: I I ~ ~ ~ No. of lines / Length of each ~e/ t Total length~f ]~e~ Trench ~h~ ~ z ~ I / I ~/ ~ / I ~ ~ inches ~ ~ I Top of t le to fini~ade~ , Material beneath tile ~ ,, / I Length Width Depth ~ ~ ~ Type of crib Orib di~met~// /] Orib depth Total ef e~tive ~bsomti~ ~ Well Building foundation Nearest lot line ~ DISTANOE TO: ~ Glass Depth ~ / ~riller Distance to lot line ~ I ~,/ / , ~ I Building foun~t~n / ~ :ewer line Septic tank ~ I DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RAZZING NSTALLER REMARKS NO. OF BEDR~MS PER 0 No, of co~ments Liquid depth PERMIT No. Liquid capacity in gallons PEDMIT N~ Distance ~e n ines Tot af~ff~C~i,~;~b~d*~r ea -?., ~ -~, ,, ,,~ >o7-'- APPROVED LEGAL 72-013 IRev. 3/78) MUNICIPALITY OF ANCHORAGE , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE MAILING ADDRESS, LEGAL DESCRIPTION ~NEW [] UPGRADE LOCATION Well I Absorption area O_v J DISTANCE TO: J lOO ~-/ J I~jO/ Lq qapacit ingalJons .._.. Ins~delength -- -- I~, t~ ~ DISTANCE TO: Well J~/~j~Dwelhng' ~O~--~ Manufacturer / ~ J We ~ J DISTANCE TO: J J ~ jNo. ofl/nes / ILengthofe~lli~, TotalJen~f~e~ ~ ~ J Top of tile to finish grade Material beneath tile J Length Width · Depth ~ JTypeofcrib Crib diameter ~epth ~ Well Building foundation ~ DISTANCE TO: JClass Depth Driller ~ J Building foundation Sewer line > J DISTANCE TO: OTHER PIPE MATERIALS L TEST RATING INSTALLER Dwelling M a t e r i a~,~ T-~:~. ~- ~. JWidtb Material j Nearest Trench 'dth f NO. OF BEDROOMS No. of colrt~tments PERMIT NO. Liquid capacity in gallons Distance between lines Total effective absorption area Total effective absorption area Nearest lot line Distance to lot line Septic tank REMARKS 'i3EN 0.5 A'ReA I0,0 o~:R / PTi c T-i~ ~ APPROVED ,DATE LEGAL 72-013 (Rev. 3/78) PERHIT NO. ~i""~ L,~ ~"~ ~ [.,EFHRIItE..,! i"_'.~/HEFtLTH AND ENVIR. Fd'.4!"IENTAL FiS. 0TECT~Fih! ,'z]~5 "L"' STRF.]ET., ANCHARFtGE., A.kZ. 99501 2~,'4..-47;20 ':Z 82:0694 APPLICANT LOCATION LEGAL BAF, IB, UCCt BROS. CON. ST. 2]:±2 ROOSEVELT ~4 99503 248--55±i LOT 5 BLOCK C GLACIER VIEW HT. LOT SIZE ]:46F~6 SL--.!UARE FEET TYPE OF SOIL. ABSORPTION SYSTEH IS: TRENCH MRXIMUM NLIHBEF.: OF BEDROOHS = 4 SOIl_ RATING (SQ FT/BR]:,= ±5El THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:,EP"TH== :i~Z~ LE~'-~.STH:: 55 ~3F:!Ftf'k,"EL. [:, E F" -IF H =.: .::_;. 5 THE LENGTH [:,IMENSiON IS 'THE LENGTH KIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFFtCE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SE]' HIDTH FOR 'TRENCHES. THE GRAVEL [:,EPTH iS THE MINIF'iUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE E',OTTOM OF 'THE EXE:AVFITiON (tN FEET). PERI"tIT APPLICANT HAS THE RESPONSIBILIT'9 TO INFORH THIS DEPARTMENT DURING 'THE INSTALLATION INSPECTIONS OF ANV WELLS ADJACENT TO THIS PROPERTY AND 'THE NUM. BER OF RESIDENCES THAT ]'HE HELL WILL SERVE. BFIC:KFtLLiNG OF ANV S'gSTEM WITHOIJT FINAL. INSPECTION AN[) APPROVAL B'¢ THIS [:,EPARTMEF,IT WILL BE SLiBJECT TO PROSECUTION. MINIHUM DISTANCE BETHEEN A HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS ±00 FEET FOR FI PRI',,,'A'TE HELL OR ±SE~ TO 200 FEET FROM A PUBLIC I.,.!ELL DEPENDING UPON THE TYPE OF PUBLIC P.tELL i"iINIHLfM DISTANCE FROM FI PRIVATE WELL TO A PRIVATE SEWER LiNE IS ;-25 FEE]' AND TO A COMMUNITV SEHER /_INE IS 75 FEET. WELL LOGS ARE REQUIRED AN[:, MUST BE RETURNED TO THE DEPARTHENT HITHIN _---':~Z~ DAYS OF THE WELL C:OMF'LETiON. OTHER REQUIREMENTS HFI'¢ APPL'9. SPECiFtCFiTIONS FIND CONSTRUCTION [:,IFIGRAMS ARE FtVAILABLE TO INSURE PROPER INSTALLATION. F"EF:~'--~ ][ ]- E::-::F" I: [;..:ESi; [::,EC:EiPq~E:EF-: 3:1.., -'~ S~- ~'___.:2: i C:ER"f'IFV THAT · ].1.: I At'l FAMILIAR HITH THE REQUIREHENTS FOR ON-SITE SEWERS AND HELLS AS SET FORTH B'.r' THE MUNICIPALtT'¢ OF ANCHORAGE. 2: i HILL. Ii'.,tSTRL. L. ]"HE SYSTEM iN ACCORDANCE WITH THE COB, ES. 3:: I UNDERSTFiN[:, THAT THE ON-SiTE SEHEF.: S'SC;TEM MAY REQUIRE ENLARGEHENT IF THE RESIDENCE IS REMO[:,ELEB, TO INCLLtDE HORE THAN 4. BEB, ROOMS. S i ISi'.,IE[:,: ................................. APPLICANT BANDt..ICCI BROS. CONST. .................. ........ S & S %/NGXNEEI%S. 7125 Old Seward Hwy. Ancho/~c]~'i Alaska 99502 ; 349-6561 ' SOILS LOG - PERCOLATION TEST L[OAL D[SCmPT,ON:__~.¢T .~_~L. Od.K C~ .... 0&ACIER SLOPE ENCOUNTERED? ~_(~_ IF YES, AT WHAT DEPTH? ~ - PERCOLATION TEST SITE PLAN J ~ Gross Net )e h Readin9 I Dale J ~. ~. I ' pt ~o Net ___ j .... e ,,me j Wa,~ Orop j PERCO LAI'ION HAFE TEST RUN BETWLEN COMMENTS TEsT __fig_c_6 _D~_%L44~.Z2_6_ I'o___P?o/Tp.~&Lh~ O' ~5~&~ RE.WESt__ 72-008 (6/79) ~D~te Drilled: Static Water Level 16~ feet Gallons Per Minute Draw Down w/^ feet Total Feet of Uasin~ ~_.Ma_terial Drilled: 0 feet to Deeoened well from 225 feet to q6B f~t in bedrock to Tncreased oroduction to .3 %om, to to to to Hefty Drilling S.R.A, Box 1553 H A nchora~ ,Alaska 9950? P.O. Box 10-378 · 10300 Old Seward Highwa' ik~., ,'(907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG ~/ell Owner CECTIO~J% VARY c/o Banducci Brothers Construction Use of Well I)orm~fzic Location (address of: Township, Range, Section, if known; or distance main road Lot 5 Block "C"' Glacier View ~eights Depth in feet from ground surface ........... -~ , ....... 22.~ , fe :-,~.~:~JCased to feet. ...... ~g, ze of casm~ - Deoth..o!.Hole .......... -.~ [Static water level ~ ' ft,': ~ (below) lad surface. F~ish of well (check one) open end '( ~ ); Screen ( ,); Perforated ( ), Describe screen or erforation ~' ~e ~f :~awdo~, ~o~ .~i~.~ !~!~ Date of completion Se~t~er 2~ 1983 WELL LOG ~,~,j~C~pAI l~ ~F ANCHO~GE DEPT, Give details of formations penetrated, size of 0 TO 2 2 TO 7 7 TO 9 9 TO 14 14 TO_ 18 1~ TO. 22 22 .TO. 29 29 .TO 61 61 TO 69 69 .TO. 81 81 .TO 119 119 .TO. 122 122 .TO. 127 127 TO 138 1.38 TO 147 147 225 CasinK s tickum , sfZt7 Silty ~rravel' (d~r~) S~nd and ~ravel silty gravel Boulders, silty Silty hard oan Sandy ~avel Gravel, h~d pan Sandy Fravel (wet) Bedrod:, smmll water seeps in sporadic fractures 3- CONTRACTOR MUNICIPALITY OF ANCHORAGE .. Development Services Department f, p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-491-31-000 Expiration Date: 2/12/2025 Legal description GLACIER VIEW HEIGHTS BLK C LT 5 REM Site address 22423 EAGLE RIVER RD Eagle River AK 99577 Current property owner(s) HENRY KELSEA F & RONALD J X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: The septic tank is under a portion of the driveway. The boulders or some other type of permanent barrier must be left in place to prevent the possibility of damaging the septic tank with the weight of a vehicle. Original Certificate Date: 2/29/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approvdjune 2022 ga i3 `�'*�...�c"-'' 1 P A €3 ii Y 0 t�� �, IN � @s-41 � "a" {,� � "S �' 4.4x' s � � `w: � �i� � to .a, �� Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Application I. GENERAL INFORMATION Parcel I.D. 050-491-31 Complete legal description GLACIER VIEW HEIGHTS; BLOCK C, LOT 5 Location (site address) 22423 EAGLE RIVER ROAD, EAGLE RIVER, AK 99577 Current property owner(s) RONALD AND KELSEA HENRY Day phone 970-- 2. 70' 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC T ANK: © Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 22.3 _ See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSAApplicalion_June 2022 COSA Checklist Legal Description: GLACIER VIEW HEIGHTS; BLOCK C, LOT 5 Parcel ID: 050-491-31 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA 0 Well log is filed with Onsite (or attached) Well production at time of test 3.3 gpm Date drilled *9/21/83 Total depth *368 ft Water storage tank volume N/A gallons Cased to 150.6 ft Well disinfected for coliform test? ❑ Yes ® Nc Sanitary seal is functioning correctly ® Coliform bacteria is Negative Wires are properly protected Nitrate mg/L V Nitrate less than MRL (ND) Casing height (above ground) 12+ in. Arsenic ug/L RArsenic less than MRL (ND) Date of flow test for COSA 2/12/24 Collected by GEG, LTD. Static water level at beginning of test 168.2 ft. Date 2/12/2024 Comments *WELL DEEPE#ED FROM 225' TO 368' ON 7/3/84 mee–pa-IE B. TANK DATA Measured operating fluid level in septic tank 50" ❑ comple Date of pumping 4F—a+ N (s >station ArsRequired maintenance completed, if AWWTS LiComments: C D. ABSORPTION FIELD DATA Which system tested (date installed) 10/20/2001 X ALL standpipes present per record drawing Total measured depth from grade 12.3 ft (max) Measured depth to pipe invert from grade 2.4 ft (min) ❑ N/A – pressurized field. 0 Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) N/A If yes, enter date X1: Adequacy test date 2/12/2024 Results Q Pass Fluid depth prior to test 57.25 in Water added 749 gal New fluid depth 62.75 in Elapsed time 190 min Final fluid depth 57.25 in Absorption rate 450+ gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 72.7 in Effective depth used 57.3 in Effective depth remaining 15.4 in Comments/Deficiencies: TOTAL DPE-TH OF 1984 DRAINFIELD MEASURED TO BE 14.4' (MAX.). THE PIPE INVERT TO GRADE = 8.0' (MIN.) FOR THE 1984 TRENCH. 1984 TRENCH WAS DRY BEFORE AND DURING TEST. COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑i Yes if No ft ❑m Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' g Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft ❑i Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft ❑■ Yes if No It ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *51+ ft Surface Water > 100' n Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' ❑■ Yes if No ft ❑ Yes if No **0 ft Q Yes if No ft R Yes if No ft Wells on Adjacent Lots: Private Wells > 100' FMI Yes if No Community Wells > 200' M Yes if No If tank or field is under driveway comment below ft ft F. ENGINEER'S COMMENTS *MET SEPARATION DISTANCE AT TIME OF INSTALL **A 1' LOT LINE WAIVER GRANTED TO DRAINFIELDS (WAIVER# WR010080) SEPTIC TANK AND PART OF 1984 DRAINFIELD UNDER PAVED DRIVEWAY. SMALL BOULDERS HAVE BEEN PLACED OVER SEPTIC TANK AREA AS QUASI REAR VEHICULAR TRAFFIC/PARKING OVER TANK - SEE ATTACHED PHOTO. f -tam a F, jL -ib G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Engineer's Printed Name Jeffrey A. Garness Phone 907-337-6179 Date 2-12.3,2-¢ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations 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 systems. 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 attemative 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. COSA Checklist June 2022 A. Ga CE -7 �G LICENSELVP rafessio 3\ �.eocsaa ��li��o�`j' ARM Septic Services, LLC ARM Septic Services, LLC 17933 Old Glenn Highway Chugiak, AK 99567 (907) 688-9433 ARMServicesAK@outlook.com www.ARMServicesAK.com Invoice BILL TO Kelsea Henry 22423 Eagle River Rd Eagle River, AK 99577 INVOICE #DATE TOTAL DUE DUE DATE TERMS ENCLOSED 3786 02/26/2024 $0.00 02/26/2024 Due on receipt ACTIVITY QTY RATE AMOUNT Septic Tank Pumping:Septic Tank Pumping1000 gallon Septic tank pumping/cleaning including fuel surcharge To be completed May 31 2024 1 310.00 310.00 PAYMENT 310.00 BALANCE DUE $0.00 .r N 00 40 Lot 6 POB (See Note 2) STOO54 VO Lot 7 a X27 48 e mint LOT 5 f Conc. ret. wall 37,p .0 2 Story Fe 2.0 OH House: .6 a deck uQ� 6'� `�- Rock wall o1, F 76St (�,5� 76, Std fic - J Well o /r Wood fence (typ) 8509S \?b \ �O % �r on 'c? Or• NOTES: 1. Bearings and curve data are record per Plat No 70-151, unless noted. Distances on the Westerly and Easterly lot lines are per ROW Acquisition Plat No. 81-226. The Southerly lot line and right of way distances are computed. 2. The point of beginning for this survey is the NW corner of Lot 5, Block C, monumented by a I" rebar. The basis of bearings is computed at S15°03'56"E per Plat No, 81-226 between the NW and SE corners of said Lot 5. The computed distance is 212.67 feet and the measured distance is 212.93 feet. 3. There are discrepancies in the right-of-way distances per Plat No. 81-226 and the lot does (� Q not achieve mathematical closure. 4. Alaska Department of Transportation and \� 1% !� U° �c1�� Public Facilities Survey Report dated 1-29-14 found that the existing ROW lines matched Q each other within approximately 0.2' along the 0 common corridor. 5. Asphalt location is approximate due to snow \ and ice. Revised 2-21-24 (See Note 4) AS -BUILT NO CORNERS SET THIS DATE `N\\\ I hereby certify that I have performed a Mortgagee's inspection ,' in accordance with ASPLS Standards of the following �� OF . A(q described property: REM LOT 5, BLOCK C AW .6, I, GLACIER VIEW HEIGHTS ADDITION • 9th • • 9 Anchorage Recording Precinct, Alaska, and that the >% * . •. * 04 improvements situated thereon are within the property lines 00 and do not overlap or encroach on the property lying 00 • 1� adjacent thereto, that no improvements on the property lying �o • % adjacent thereto encroach on the premises in question and ,/, �, . izabeth L. Walatko . Q / that there are no roadways, transmission lines or other �,% • 8036 — LS • • •J � visible easements on said property except as indicated '% • • • • a 5 MW hereon. '°R0 ' ' • ' x� 4W Dated at Anchorage, Alaska SCA RECORD, OTHER THAN OD, '' \ \ this 13th day of February , 2024. EASEMENTS OF _ THOSE SHOWN ON THE RECORDED% t� FRED WALATKA & ASSOCIATES. L.L.C. PLAT ARE NOT SHOWN HEREON G �Z �BE Engineers and Surveyors UNLESS OTHERWISE NOTED. FB 23-4, pg 40-41 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered. the liability extent of the preparer is limited to the amount of flees collected for services in preparation of this product. 0 o. - 5 STOO54 VO Lot 7 a X27 48 e mint LOT 5 f Conc. ret. wall 37,p .0 2 Story Fe 2.0 OH House: .6 a deck uQ� 6'� `�- Rock wall o1, F 76St (�,5� 76, Std fic - J Well o /r Wood fence (typ) 8509S \?b \ �O % �r on 'c? Or• NOTES: 1. Bearings and curve data are record per Plat No 70-151, unless noted. Distances on the Westerly and Easterly lot lines are per ROW Acquisition Plat No. 81-226. The Southerly lot line and right of way distances are computed. 2. The point of beginning for this survey is the NW corner of Lot 5, Block C, monumented by a I" rebar. The basis of bearings is computed at S15°03'56"E per Plat No, 81-226 between the NW and SE corners of said Lot 5. The computed distance is 212.67 feet and the measured distance is 212.93 feet. 3. There are discrepancies in the right-of-way distances per Plat No. 81-226 and the lot does (� Q not achieve mathematical closure. 4. Alaska Department of Transportation and \� 1% !� U° �c1�� Public Facilities Survey Report dated 1-29-14 found that the existing ROW lines matched Q each other within approximately 0.2' along the 0 common corridor. 5. Asphalt location is approximate due to snow \ and ice. Revised 2-21-24 (See Note 4) AS -BUILT NO CORNERS SET THIS DATE `N\\\ I hereby certify that I have performed a Mortgagee's inspection ,' in accordance with ASPLS Standards of the following �� OF . A(q described property: REM LOT 5, BLOCK C AW .6, I, GLACIER VIEW HEIGHTS ADDITION • 9th • • 9 Anchorage Recording Precinct, Alaska, and that the >% * . •. * 04 improvements situated thereon are within the property lines 00 and do not overlap or encroach on the property lying 00 • 1� adjacent thereto, that no improvements on the property lying �o • % adjacent thereto encroach on the premises in question and ,/, �, . izabeth L. Walatko . Q / that there are no roadways, transmission lines or other �,% • 8036 — LS • • •J � visible easements on said property except as indicated '% • • • • a 5 MW hereon. '°R0 ' ' • ' x� 4W Dated at Anchorage, Alaska SCA RECORD, OTHER THAN OD, '' \ \ this 13th day of February , 2024. EASEMENTS OF _ THOSE SHOWN ON THE RECORDED% t� FRED WALATKA & ASSOCIATES. L.L.C. PLAT ARE NOT SHOWN HEREON G �Z �BE Engineers and Surveyors UNLESS OTHERWISE NOTED. FB 23-4, pg 40-41 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered. the liability extent of the preparer is limited to the amount of flees collected for services in preparation of this product. M UHUPU7V OF , HC HO COLS DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241043 Subdivision: Glacier View Heights Block:C, Lot: 5 REM 907-343-7904 Fax: 343-7997 The septic tank for this property is 22 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-491-31 1. GENERAL INFORMATION Expiration Date: g- 65�, ^ Z Complete legal description Glacier View Heights, Block C, Lot 5 Location (site address) 22423 Eagle River Road Eagle River, AK Current property owner(s) Lisa & Tracy Adams Day phone (907) 229-0498 Mailing address Real estate agent 22423 Eagle River Road, Eagle River, AK 99577 Chantelle Smith 2. TYPE OF DWELLING: Fmil Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone (318) 464-2782 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Septic Tank under paved surface. Waiver of request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ `1 �� 5 I �" 1 Waiver Fee $ 1015 C'v 11 Date of Payment Date of Payment Receipt Number O-7 122 Receipt Number COSA # Q S C a o 1 bAI Waiver # 0 S V'Zd 109 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 12/28/20 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: — (O' �- 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Glacer View Heights, Block C, Lot 5 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9/21/83 Total depth 368 ft Cased to 150.6 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) >18 in. Date of flow test for COSA 12/7/20 Static water level at beginning of test 155 ft Comments B. TANK DATA Age of tank(s) 19 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 8/31/20 - JR's Pumping D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 10/20/01 HE ALL standpipes present per record drawing Total measured depth from grade 10.9 ft (max) Measured depth to pipe invert from grade 5*0 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5.9 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 050-491-31 Structure served by this system Well production at time of test 3.7 gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 12/2/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Septic System is Gravity Flow Adequacy test date 12/7/20 Results ❑✓ Pass For Fluid depth prior to test _ Water added 505 gal New depth 61 in Elapsed time 1440 min Final fluid depth 47 in 3 bedrooms 52 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' Q Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No Neighboring Tank > 100' Fv Yes if No ft Private Sewer/Septic Line > 25' 17771 Yes if No Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No FV71 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Fv� Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ft ft ft ft ft Q Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 21 Yes if No ft Private Wells > 100' 0 Yes if No. Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No. Water Service Line > 10' M 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' ❑ Yes if No 1 * ft Wells on Adjacent Lots: Water Main > 10'✓0 Yes if No ft Private Wells > 100' Q✓ Yes if No Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS Septic tank is located under paved area out of the driveway. *See Lot Line Waiver No. WR010080. G. ENGINEER'S CERTIFICATION )F ��<� 1 certify that I have determined through field inspections and review ��`F;.>•'`"�������*� �''v%���0 of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 4.9 th 00! ....... ............y�.a,.�.:f.... ................. I .......... ................. T. -;o'� MICHAEL E. ANDERSON G� �� •. No. Cc -4381 , D 12/29/20 ,.••'° COSA Checklist yellow sheet ft ft ft ft December 29, 2020 M.O.A. Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: Glacier View Heights, Block C, Lot 5 — 22423 Eagle River Road Septic Tank Under Pavement Dear On -Site Services Engineer: The septic tank on the subject lot was placed in 2001. The southern end of the tank was placed under the paved driveway. Since that time the driveway has been expanded and now covers the entire septic tank. The septic tank was fabricated from I0 -gauge steel and specifically designed for deep burial and heavy loads. The septic vents are encased in traffic rated steel sleeves with covers. The top of the tank is located at 8' below the surface. The backfill material atop the tank is free draining sand and gravel. No groundwater or surface water is noted anywhere in the area. The septic tank has been operating at this location for nearly 20 years. The tank has not been known to freeze during that time. We request a waiver to Municipal Code to allow the septic tank to remain at its current location. Its fabrication for deep burial and its history of performance indicate the tank will continue to function as designed. Sincerely, Michael E. Anderson, P.E. Municipality of Anchorage Development Services Departm. nt Bullding Safety Divlston On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anc~horage, AK 99519-6650 www.cl.anchorage.ak.us (907) ~43-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Pa=ll.D. 050-491-31 HAA~ .~/~C'0/~)5~"~'7/ 1. GENERAL INFORMATION Expiration Date: ~ "/,~' ~ ;~_ Complete legal descflpflon GLACIER VIEW HEIGHTS SUBDMSION; LOT 5, BLOCK C, Location(sitaeddressordirecflons) 22425 EAGLE RIVER ROAD * EAGLE RIVERr AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BOB POE Day phone 269-3050 22425 EAGLE RIVER ROA0 * EAGLE RIVER~ AK 99577 JEANNE IdEE w/ RESIDENTIAL MORCTACE Dayphone 694-8817 11452 BUSINESS BLVD. * EAGLE RIVER, AK 99577 Day phone Unless otherwise requested, HAA wi#be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well ~ Individual Water Storage Community Class Well E~] Public Water System LJ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional cml engineer registered in the State of Naska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewatar disposal and/or water supply system. DSD also Issues HAAs upon request to homeewnem. Certificates of Health Authority Approval ara valid for 90 days from the date of Issue for properties served by a pdvata or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Munidpailty cf Anchorage Is not responsible for ermre er omissions In the professional engineer's work. Note: A/aska Water and Wastewater Consultants, Inc. shall be paid $762.50 et, or pdor I to dosing for the engineering sen¥ces provided. I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto end es of the validation date shown below, I varify that my InvasEgaEon, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewster disposal system Is(are) safe, functional and adequate for the number of bedrooms and b/pe of sbt~cfure lndicated herein. I further vadfy that basad on the information obtained from the Munidpality of Anchorege files and from my investigation and inspection, the on-site water supply and/or wsstewater 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 Fin'n ALASKA WATER &: WASTEWATER CONSULTANTS. INC. ~ddress 6901 DEBARR ROAD. SUffE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Phone 337-6179 Date Englneefs Comments: In conducting this eva/ua~'on, A WWC, Inc. ettempted to pmvfde e themugh, consdenffous eng/nsedng analysis of ~he system in eccordance with ADEC and MOA DSD Gu/del!nee & Regulations. The reported results described the performance of the system under the conditions encountered et the ~me of the test, end separa~on di~ances msesumd to mad#y IdenEflable faature& The opemEona! #te of ail walls end septic systems depend on the local soils ¢ondiffon, groundwater level~ that may fluctuate dudng the year, end the water usage of the family being sen, ed by the system. These ¢~ldltfons ere outside the control of ~he evaluator of the system. Satts~acfo~ tosf msulls do not guarantee fufure peffon'nance of the system, nor do they guarantee that them em no hidden defects or encroachments. AWWC. Inc. can therefore not provfde any wan'anty orfufure estimate of how long the system will con!!hUe to meet the opera#onal mqulmment~ of the ADEC or MOA DSD. The content of this repo~t ls for the sole benefit of the ovmer #sted ebove. Any re!lance upon or use of this report by eny other per~n or parb/ is not euthorlzed, nor wfil lt conter any legai dght whatseever. 5. DSD SIGNATURE ~/"~ Approved for ~ bedrooms. Disapproved. Conditional approval for __ bedrooms, with the fllowlng stipulations: ~'. ON-SITE ';-~ ~ ~: WATER AND Attachments: I-[AA Checldist Septic System Advisory Well Row Advisory ~ : WASTEWATER .: : ..... Supplemental Engineer's Rsort Other Orlgln~l Certificate Date: //- /~-'"" O ! Municipality of Anchorage Development Services Department Building S~'~tl ~ On.Site Water & Wastewater F~ 4700 ~3ulh Oragaw ~"t. A. t/ELL DATA Well type ~VA~ HEALTH AUTHORITY APPROVAL CHECKLIST GLACIER VIEW HEIGHTS S/Di LOT 5~ BLOCK C~ Parcel ID: ~VF[{ D~J~ENED FROM 225' TO 568' ON 7/3/84 If A, B, or C provMe PWSlD~ N/A Well Log (Y/N) 050-491-31 Foundation duanout (YIN) Y~S Date of pumping NEW C. ABSORPTION FIELD DATA Date In~sl~d lO/1~-2O/Ol Length 42, lt. B. SEPllC/HOLDING TANK DATA Tank Type/Material STEEL TankMze 100o gal. Number of Compadments 2 Total deplh ~1-e~ ft. Eft. abeoq~on ama 509 It' Monltering tube YES Date of adequacy test NEW Results (Pass/Fall) PASS Fluid depl~ In abso~tion Ileld before test - In. Water added - gal. Elapsed Time: - min. Final fluid deplh - In. Absorption rate Any mNvenallon treatment (past t2 mo.) (Y/N & type) NONE KNOWN Da[~'~sinn over ~ (Y/N) NO Pumper. PBELOW FINN. ORADEI Soil rating ~ ~redm) 1.o Width 2.0 lt. AWWC, INC. Date Instelled 10/16-20/01 Cteanonte (Y~N) YES High water alarm (y/N) N/A System type TRENCH Gravel below pipe 6.06 lt. Dapmsslon over field NO For 3 bedrooms Newdeplh - In. - g.pzl. ffyes, give date - FROM WIEU. LOG AT INSPECTION Oate of test 9/21/8`3 9/20/01 Stel[o water level 13,3 .fL 177 fL Well product]on `3 g.p.m. `3.3 g.p.m. WATER SAMPLE RESULTS: Datecompletecl .9/21/8`3 SaIIlIat, yMaI(Y/N)YES Wll~Sptopedylxotected(Y/N) Totaldepth `368 fL Casedto 150.6 fL Caslnghelght(abeveEronnd) t Urln. D. UFT 8'rATION Date Installed Size In gallons ~ 'Pump on' level et In. 'Pum n. High water elann level et In. ~ Cycles tested Meets alam~ & drcuit requirements? SEPARATION DISTANCES SEPARATION DISTANCES FROM ~ ON LOT TO: ~ept~c tenkJlllt ~telten on lot 100'+ Absorpfion field on lot. 100'+ Public ~war main N/A Sewer/sepfic serif, ce llne 25'+ On adjacent lots lOO'+ On adjacent Iote 100'+ Public sewer rnanhuie/deenout Holding tank N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundaUon 5'+ Property llne 5'+ Al:eorption field. Water main N/A Water sen'Ice line. lO'+ Surface vmter. Wells on adjacent lots 1 oo'+ 5'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION fiELD ON LOT TO: Property line .1'+ Water service line 1 o'+ Curteln drain NONE KNOWN COMMENT8 Bulidlng foundation 10'+ Surface water 100'+ Wells on adjacent Iota 100'+ G. ENGINEER'S CERTIFICATION I cerffy that I have determined through field ~e end revtew of Municipal records that the ebove systems em In conformance with MOA HAlt guidelines In effect on this date. Englnes~Pdn~ad~lame JEFFREY A. GARNESS II Oate ~.~oj oate of Paymsnt RecelptNumber 0~'~ ~.~r~ *WNVER ~WR010080 Water maln N/A Ddveway, patffing/Vehlcle ~orage ~' 1'+ i~e.,,d Waiver Fee $ Date of Payment Receipt Number. 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 Ahchorage, AK 99519-6650 .:,! : ,,: wWW:ci.anchorage.ak. Us : - . "' '.'(907) 343-4744: : '.' ;':: : CERT F CATE OF HEA,,L,~'H AU,THORf,,T?A~PROVAL FOR A S INGLE FAMILY, DWELLING: Parcbl I.D~)~"~) ,~.,L/~ / ~- ,'~ ( HAA# ~'~ II ,,, '-;,? ¢: -.-i, '~ Expffation Date: j .1./ GENER~.~NFORMATION ' '" E~t~o~'(;it'~"a~d~8~s or directions) 2Z~Z~ ~¢~ ~ ~/ '.. ~ Current op y ( ) ~/ , : -* ........ iii dress ~¢~ , Lending agency Day phone M~iling address Real Estate Agent_ Day phone Ma ng Address Unless othe~ise requested, H~ will be held by DHHS for pickup. HAA p~cked up oy: 2; ' NU~BEfl OF B EDflOOMS: ~ 3. TYPE OF wATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: IndMdual Well ....... ~' - ' ' ' Individual Omsite Individual Water Storage ~ - Individual Holding Tank - .. Community Class Well ~ . . Community On-site PuBlic Water System ~ ' Public Sewer ...... ~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the Cepresentations given in paragraph 5 byan ir~dependent professional Civil eng neer registered in the State of Alaska. Certificates of Health Authority Approval are required for, th~'transfer of title (except between spouses) on properties served, by'a s?gle f~t~!!y 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 ~0 days eld. 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. 7.2-025 (Rev. 0~/00)* 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verity 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/or wastewater disposal system is safe, functional and adequa!e 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 Address Eagle River. AlasEa 9g~77 Engineer's Printed Name /'Or 0 ~ ,~-/~.7'-- (~. $&$ENGINEERING ' : 'Phone 17654 E~9;u ~;ver L~op Roa~i No. 20'~ bedrooms. ,, ;' ~ · · '~' , . ,.',' '~,~L '! ~ bedrooms, with the following stipulations. 6.' :'DHHS sIGNATURE '[~- Appr, oved for "~ Disapproved. Conditional approval for ' · ' 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: 75-025 (Rev. 01/00)* Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERV{~/~[. ~-I Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501. Health Authority Ap~p~oval Checl~li~b,~r~L s~v,i ~'~ ~,',~.,,~" Legal Description: ~[ ~/' ~ ~]' ~~ Parcel I.D.: A. WELL DATA ~~ ~ Well type ,/r~/ Log present (Y/N) Total depth Sanitary seaJ~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to /~"-~/-'~/~ Casing height (above ground) Wires properly protected~,l) FROM WELL LOG AT INSPECTION Date of test '/?/~.~/,~ '~ ~-'/~' ~'/~/"'~ Static water level //~ ~ /~' Well production ~ ~ g.p.m. ~ ~ g.p.m. WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Dateinstalled '~/~---'¢//(¢~ Tanksize Foundation cleanout~,l) ,/A(,~ I O~ Depression .ate of ~), ~,¢--~ / Other bacteria Co,coted by: Number of Compartments ~ Cleanouts~'N) ¢~,~ ;¢~/~) High water alarm (Y/N) .,/'v//,,'~ / FIELD DATA . C. %%t%%nRstPa~ieOdN ¢/~'¢,/44~"~ Soil rating (g.p.d./fF or~ ,/~-~-~~ ¢ System type_ / / /. / / Length ,/~/ Width '~ Gravelthickness below pipe ~ Total depth Effective absorption area '~ ~'-~'~ Monitoring Tube present~)~ Depressio,~n, over field (Y/~)/V~ Date of adequacy test ~.~/~,//~/ Results(Pass/Fail)_ ,~'~ _For /~"'~- bedrooms Fluid depth in absorption[/field before test (in.); ~ ImmediatelY after~-~C~ga[, water added (in.): //~- Fluid depth //// (ins) Minutes later: ~ Absorption rate = ._/z-,¢~-'~ .g.p.d. Peroxide treatment (past 12 months) (Y~)/'~'E? If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested /' E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum "Pump off" level at* Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /~0 'J On adjacent lots //~rS) /'4 /~ O /,',~ On adjacent lots /%//"~ Public sewer manhole/cleanout ./k//.,~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~- /'¢- Property line ~-" ,~ Absorption field ~- Water main/service line /~¢ Surface water/drainage /'dT~ /~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~) ?- Building foundation Surface water /~0 r~ / Water main/service line ,--/ Driveway, parking/vehicle storage area ~ /cz- Wells on adjacent lots ~-¢'~ Curtain drain AIO I F. ENGINEER'S CERTIFICATION ~ cert~fy that ~ have determined thr~ tie~d inspect~ns and re~ie~ ~f M~nicipa~ rec~rds tha~t~ ~(~(~7sj~ nA are in conformance with MO& H~uideli~s in effect on this date. engneersName I~oD~¢c~ ~- UO~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # ~r-I ~o~ \ ~q,-~-3 GENERAL INFORMATION Complete legal description hot 5; Block C; Glacier View Heights Subdivision - i. . Locati0[~.(siteadd[ess or directions) e Property oWner Mailing address RELOCATION RESOURCES, INC. Day phone Lending agency Mailing address Day phone Agent Elaine Girvan/AREA COLDWEL5 BANKERS Day phone Address 4105 Tudor Center DL~ive, Anchoraqe~ Alaska Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 561-2488 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding 'tank Community on-site Public sewer xxx NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~025 (Rev. 1/91) Front MOA #21 As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained from the Municipality of Anchorage files and from m,j investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S =-.HG!NF~=I~G 7034 Eagle Ri,vet Loop Road No? 2_04 Name of Firm Address Engineer's signature bedrooms. DHHS SIGNATURE Approved for ~- ~'~) Disapproved. Conditional approval for Phone Date ~- gl - ¢ I ..bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The OHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of OHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91} Back MOA ~1 Legal Description: A, WELL DATA Well type "~-~-4 ~ Log presen ~[¢'(~-~) Total depth '~ L~ Sanitary seal,_(~l) Date of test Static water level Well flow Pump level Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ~1~.~_¢- Parcel I.D. ~) ~-O If A, B, or C, attach ADEC letter. Date completed "7- -z>, ~ Driller Cased to {~'C). L~ ' Casing height Wires properly protected ~/N) FROM WELL LOG . % g.p.m. ADEC water system number ~'~'/~, MUNICIPALITY OF ANCHORAGE AT INSPECTIO~/IRONMENTAL SERVICES DIVISION ,~-'?..L,-~, SEP 2,~ 1991 ~1~' C.EIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer serVice line '¢'~ ~ ¥ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate B. SEPTIC/HOLDING TANK DATA Date installed ~ - ~-~1 - ~5~ Collected by: Tank size Other bacteria 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 9~$77 Compartments Cleanouts~N) \I Foundation cleanout ~/N) \J Depression (Y~ . High water alarm (Y(~ /~J 'Alarm tested (Y/N) ~'J/A Date of pumping °l-"J---~"~t Pumper "~"..[Z. ~__$%?,,c~, Well(s) on lot To propertY line Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ~C:C>~'~ On adjacent lots ~0~ ,~+ Absorption field __ ~ Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electri~ ::?~ANCE FROM L' FT STATI. vvefi~on lot O n adjacOe~t 7o~; Manufacturer Manhole/Access (Y/N) "Pump on" level at .--~--~T~u mp off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~ - 7--~ ~ Length ~l,C~ Width Total absorption area ~O~,~z-,. ~,~ Depression over field (Y.~.~ Res u Its._f~[~'f a i I) Peroxide treatment (past 12 months) (V,~ Soil rating ~O ~/~¢-. Gravel thickness ~;~,O~ Cleanouts present (~N) Date of adequacy test for ~'o 0 ¢-- ('dr") If yes, give date System type 'T'¢.-¢~ Total depth. bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ~O~~' To building foundation On adjacent lots '%0 ~'~ Surface water \OO ~4- Curtain drain ~//~ E. ENGINEEB S.CERT FICATION . · On adjacent lots ~ ~oo ~ Property line To existing or abandoned system on lot Cutbank ~1 ~'- Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in ef~ $ & S ENGINEERING 17034 Ea.qle Ri,vet Loop Road Eagle River, Alaska ~9577 Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number of this inspection. 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 GENERAL INFORMATION (a) Application Date 2/11/86 Legal Description (include lot, block, subdivision, section, township, range) Lot 5 BI C Glacier View Hts. Location (address or directions) Mile ~,.2 Eagle River Road (b) Applicant Name E: C_.n~h~tt C. nr~nn Telephone: Home 69[1-7g06 Business 561-5201 Applicant Address 200 W. 3~,th Ave. Suite 950, Anchorage, Alaska 99503 (c) Applicant is (check one)~. Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 200 W. 3Zlth Ave., Suite 950, Anchorage, Alaska 99503 TYPE OF RESIDENCE Single-Family I'~ Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [] Community [] Public [] ,'~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 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. 72-025 (11/84) ENGINEERING FIRM PROVIDI[ 'NSPECTIONS, TESTS, FILE SEARCH, D! ~ AND INFORMATION As certified by my seal affixed hereto and.as ~! the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance wi,!h all M. unicipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Whitewater Engr. Constr. Telephone 345-7008 Address 11600 Cange Rd., Anchorage, Alaska 99516 Date 2/11/86 Engineer's Seal 6. DHEP APPROVAL Approved for ~"~-~-~.) bedrooms by '" - ~ Disapproved ~~sVoef Conditi I Approval ona Date Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) J¸ j 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 Application Date 5/-~/~ GENERAL INFORMATION (a) Legal Description (include lot, block, st~bdivision, section, township, range) Location (address or directions) (b) Applicant Name ~-' O_.vC~r~.-f- ~'¢YC,7-~c-..~elephone: Home Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builde'r"~, Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e} Real Estate Company and Agent Address Telephone (f):~)the HAA to the following address: TYPE OF RESIDENCE Single-Famil~:) Multi-Family [] Number of Bedrooms "~ Other WATER SUPPLY Individual Well'~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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. Page 1 of 2 72-025 (11/84) ,[ ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Engineer's Seal Approved for '~.~¢-~ bedroomsby ,~,~ ~?--~-¢-¢-<~,¢~--~ Approved DisapPr0v'c~ ' ..,.~% -~ Conditional Terms of Conditional Approval Date ~-~/' -/l/(~'(~' / CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) MEALTH AUR~ORITY APPROVAL (KAA) CHECKLIST - FEBRUARY 1984 DEPT 0~ . ~ . · r I'IEALTH r~NVIRONMENTAL PROTE&CTioN RECEIVED Well Classification ~{%~% Well Lcg P~esent (Y/N) TotalD~pth ~ ~(c~f~ z ~d to Static Water ~1 Casing ~ight ~ Gr~nd Elec~i~l Wiring in ~nduit (Y~) ~p~ation Distance ~ ~11: To ~ptic~olding ~a~ ~ ~t If A, B, c~ C, D.EoC. Approved(Y/N) Date Completed 7/-%/~4- Yield ~__~_~ Pump Set At Depth of G~outing Dap~ession Around WelLhead (Y/N) ; On Adjoining Lots I ~0/,,~.. TO Nearest Edge of Absorption Field on Lot ~-- ; On Adjoining Lots_jc~Dt.~- To Nearest Public Sewer Line ~ ~. To ~arest Public Sewez Cleano]t/Manhole ~.~ ~ To Nearest Sewe~ Service Line on Lot __~_~ Water Sample Collected By ~'-T~4~ ~ct~- ; Date ~/~ watezr Sample Test l~esults CQ,~ents B. SEPTIC/HOLDING TANK DATA Date Installed 7/g-~ Size I~.~,D NO. of Cc~partments ~ Standpipes (Y/N) ~.~-~ A~-tight Caps (Y/N) ~'~ ~...F~oundation Cleanout (Y/N) ~ salon ovelz Tank (Y/N) ~ D~ate Last Puntz~~~z Dep~e ...... ~ ./ ,,..~ ,Pumping/Maintenance Contract on File (Y/N)~-~I~7 ; fo~J~c Holding Tank High-Wate~ Alarm (Y/N) ~/~r . Tempo~az-f Holding Tank Permit (Y/N) ~ Separation Distances f~cm Septic/Holding Tank: To Water-Supply Well To P~operty Line To ~ter ~i~Vi~ To Building Foundatic~~ _~ ..~ TO Disposal Field ~' TO St~eam~ Pond, Lake, c~z Major Drainage Co~,~nts [Page 1 of 2] 2~15~84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '-7/?~'~ /~ Width of Field ~ ~ Square Feet of Absorption Amea ~>~ Type of System : Length of Field · .D~.pth of Field Gravel Bed Thidkness Standpipes P~esent Depression over Field. (Y/N) ~ao Date of Last Adequacy Test Results of Last Adequacy Test %'~ i ~¥ Separation Distance from Absorption Field: / To Water-Supply Well ' ~2~ ~'U~ To P~oper'ty Line I ~ To Building Foundation ~ 4 ~ '-{~' To Existing or Abandoned System cn Lot ~4/~r ; On Adjoining Lots ~Z2~.~{~. To Water Main/~ ~ ~r--~ To Cutbamk(if present) To Stream/Pond/Lake/or Majo= D~ainage Course To Driveway, Parkin~ A~ea, or Vehicle Storage Area Con~nts D. LIFT STATION Date Installed Size in Gallons "P~ttp On" Level at High Wate~ Alarm/L~vel at Tested fo~ Electrica~/~odes (Y/N) 4 Cor~rents/ / PumDing Dimsnsions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Meets MOA ** Check Permitted Bed~oc~ Rating Against HAA Request I certify that I have checked, verified, or confc~m~d to all MOA HAA Guidelines in effect Sic~ed f~' ~ ~='~ I~,_-- Date Company t~,,~-,,'~'~'~- ~n%, (~-~:DL. MOA NO. KB1/dS/s ~-/a~ ~b [Page 2 of 2] ~ ~ ~, ~HOM A. FISCHER ~ 2-15-84