HomeMy WebLinkAboutGLEN EAGLE BLK 2 LT 4Glen Eagle Block 2 Lot 4 #050-601-12  Municipality of Anchorage Development Services Department ..-'.~"~ ~ .'o · Building SafetyDIvlslon On-Site Water & Wastewater Program. 4700 South Bmgaw SL ,.o. ~ox 1~0 A~,0,. AK ~5~o www.ci.anchorage.ak.us (907) 343-7904 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:. SW0100:~5 PID Number:. 050--601--12 N°me:RAN['Y HARDMAN Wastewater System: [] New [] Upgrede 16600 CENTERFIELD DRIVE * EAGLE RIVER 99577 ABSORPTION FIELD Ph°ne:t'907~ 440--7257 n I~.p Tm,ch n Snd~o,~ l'r, nch l:3 Bed n Mound · WELL: [] New [] Upgrede rL rL EAGLE MOUNTAIN EXC. ,¥17/01 ~ ~ ~ TANK SEPARATION DISTANCES .s.p~= =Holding n $.*.E.p. =Other To s. puc A~,o uo. u~ Hok~.g ~' ANCHORA(:;E TANK *t250 Well 100'+ 100'+ - - 25'+ STEEL 2 s..o=o ~ot., ~oo'+ ~oo'+ - - - LIFT STATION Foundofion 5'+ 10'+ .encore=: BENCH MARK · TANK WAS OVERSIZED TOP OF GARAGE SLAB · OLD TANK WAS ABANDONED PER UPC. ,~. O..F...A/-~ N, Inspections performed by: AWWC. INC. Dates: 1st .¥17/Ol~'~ .' Il, .~ /..' ¥+'(2, ~:.." 4 ~/: ~/~ [' ~'7.' '"~t · ¥.t ..... ..'~-....'....~ ~ ;Jef 'evl, . Gorness: Department of Health and Human Services approval ~I~?o,. '-.. ........... · ~ AS BUILT DRAWING SW010053 - 050-601-12 ~'~ / /-.~.:~:I.'?:~::;~ ST1 63,8 73.1 53'2 70.6 81.4 DBL1 64.0 68.3 DBl'. 63.6 68.6 DBL.3 72,3 83,6 DBL4 73,3 84,7 C01 111,3 121,4 SUMP 128,0 329,5 SUNNY GLEN DRIVE \ ALASKA WATER & WASTEWATER ,~ ,' CONSULTANTS, INC. RANEY HARDMAN 440-7257 1 OF I [ ~'~f~,,. Oamess~ '~' AS-BUILT DRAWING OF SEPTIC TANK UPGRADE AS BUILT DRAWING 5W010033 - 050-601-12 511 / 51'2 Af Il'tiff - 8,~.1.¢ Af Ol.lf!~f o 84.98 INSULATION WAS PLACED OVER PORTION OF TANK WAS LESS THAN 4-' CT SOIL COVER ALASKA WATER & WASTEWATER ~ c.J.o. ] CONSULTANTS, INC. PREPARED FOR: PHONE NUMBER: p.AG~ NUMBE~: RANEY HARDMAN (907) 440-7257 1 OF 1 GLEN EAGLE SUBDIVISION; LOT 4, BLOCK 2, PROFILE AS-BUILT DRAWING OF SEPTIC TANK UPGRADE MUNICIPALITY OF ANCHORAGE Development Se/vices Deparlment On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTE~VATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Mar 16, 2001 Expiration Date: Mar 16, 2002 Permit Number: SW010033 Legal Description:~..GLEN .EAGLE BLK ~-2 LT~;4 ? Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: RANEY HARDMAN Owner Address: 23715 SUNNY GLEN DRIVE EAGLE RIVER, AK 99577- Parcel ID: 050-601-12 Site Address: 023715 SUNNY GLEN DR Lot Size: 52765 SQ. FT. Total Bedrooms: 2 Permit Bedrooms: 2 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: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewafer Program 4700 South Bmgaw SC P.O. Box 19O650 Anchorage, AK 99519-6850 www.cLanchorage.ak.us (9o7) 343-79o4 Parcel I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 050-601-12 Permit Number Pmperty owner(s) Mailing address (1) Mailing address (2) R^NEY HARDMAN Day phone 16600 CENTERFIE'LD DRIVE * EAGLE: RIVER. AK 440-7~57 Zip Code cj~1577 Legal description (Lot, Block & Sub'd,) LOT 4. BLOCK 2: GLEN EAGLE: SUBDMSION Legal desc~pflon (Section, Township & Range) Iq/^ Lot Size. ~. Acres/Sq.FL Number of Bedrooms THIS APPLICATION I$ FOR: Sewer Only Sewer and Well Sewer Upgrade Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Water Softening 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 & WASTE'WATER CONSULTANTSf INC. Permit Fees: -~0 Date of Payment: Receipt Number- Waiver Fees: Date of Payment: Receipt Number. ALASIG WATER & WASTEWATER CONSULTANTS, INC. March 12, 2001 Municipality of Anchorage Developmental Services Department On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Septic Tank Upgrade for Lot 4, Block 2, Glen Eagle Subdivision To whom it may concern: The existing 2 bedroom house is currently served by a private well and septic system. The septic system consists of a 1000 gallon fiberglass septic tank and a shallow trench type drainfield. The homeowner would like to replace the existing fiberglass septic tank with a new 1000 gallon septic tank. The existing drainfield appears to be operating adequately for the residence at this time. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. TOPOGRAPHY: There are no slope concerns. 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. Sincerely,. ~.E., M.S. NOTE: Attached is a site plan drawing, a design drawing., and a 3 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 \ ~ ~. '"~ Lot ~. BLOCK 2: / ~ . 'X X~_LX~{ 7.... , ............... ~- ................... ~%~ ...... ~ ............ ..-- .... --. SUNNY ~LEN )~.IVE.__ ~= ~/ / // % I I ~ . _ ~x ] I "~xx x ,,,.~,/"' ~ ~'''~, ~ ,. ,I ~/12/2001 ...-- OF AI,'~." ~S~ WATER ~ WASTE~TER ~ ~?'4 ~ "~. CONSULTANTS, INC. tl, ~ · ', ~ ' · · ,~ ~ rot e~c .uuo~: p~t .uue~: [~.~ ~ d ..... ~ .... :"' RAN~ HARDMAN 440-7257 1 Or 2 (~ :~ efl'e~ A. Go.ess: ~: GLEN EAGLE SUBDIVISION; LOT 4, BLOCK 2, · -' SITE P~N FOR SEPTIC TANK UPGRADE ~-~ '~ "~ ~'~ II/ SUNNY GLEN DRIVE ,/~/2oo~ ~ O~..At~ ~SI~ ~TER & WASTE~TER ~ , 4 CONSULTA"TS. I"C. , ,~ ~OR: PHO.C ~Ua~[.: ~[ ,U~e~: ,' ~ .. ~ ...... ...}...: .... RANEY HARDMAN 440-7257 2 OF 2 GLEN ~GLE SUBDIVISION; LOT 4, BLOCK 2, DESIGN OF SEPTIC TANK UPGRADE GREA,ER ANCHORAGE AREA BOR~,dGH Department of Environmental Quality 3330 C Street Anchorage, Alaska ggS03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM LOCATION ~7%') ~.~..-,c~,- ~/~/'~:, LEGAL DESCRIPTION [ - SEPTIC TANK: DISTANCE MANUFACTURER MATERIAL INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY /t-~GALLONS. TILE DRAIN FIELD: / TOTAL LENGTH~ ~--~ / NUMBER OF- LINES OISTANCE BETWEEN LIN.B~ ~TRENCH WIDTH IN. ~OTAL EFFECTIVE :~ ...... , ~'~ ~.--~. ~_ ~/ ABSORPTION AREA , ~ ~ .{SQ.~E~GTH OF ~CH.L.INE ~(~~ ........ DEPTIh TOP ~: TI~E TO PINI~H~ADE ~ ~ATERIAL BENEATH TILE ~ _IN. A~OVU TILE T iN. WELL: TYPE ? ~--')-~ ..... CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION__ LO-r LINE ___, SEWER LINE DEPTH SEPTIC SEEPAGE TANK , SYSTEM DISTANCE FROM: CESSPOOL___ , OTHER SOURCES APPROVED DISAPPROVED DISTANCES: SEWER LINE DEPTH: LOT SLOPE: REMARKS: REMARKS DIAGRAM OF SYSTEM / ,, APPROVED Form EQ-032 INSTALLATION OF-: SEPTIC TANK SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED thROUGH SOIL TEST RESULTS / 2 ~'/~7 £ COMPLETION DATE aNTICIPATED MA,L:NG ADDRESS 'C~ /8 IZ~, 19~1 ~:; ~ G g q-?.~ Z~ PHONE DRAIN FIELD TO BE INSTALl-ED BY CC-p~m:T~a~- /~,ux~,oc/ NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST ~.~ 12_1 FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING O1-- ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE // ~[~://~/~ TYPE MINIMUM DISTANC:ES. REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGET~ SEPTIC TaNK tO SEEPAge tO NEAreST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD SEEPAGE AREA SIZE DRAIN FIELD , . DRAIN FIELD '7R.'_ / o~b / SEEPAGE ~ ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK. / r . SEEPAGE PIT'. TO RIVER. LAKE, STREAM. · SE~EPAGE PIT / /~'~) , DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS Of Gr~E~R ANCHORAGE AREA BO):~=~,ORDINANCE NO. 28.68 A, ND THA:?He ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH BAlD CODE. Z~,~,,,~ __~'"~. { dt .... ;:1 F GREATER ANCIIUI<A(],L AP, LA BOROUGI' Department of [nvironmenLal quai,~y 3330 "C" Street Anchorage, Alaska 99b03 8011,8,1,0(; - I"EIIOI,ATION TEST Legal DescripTi-6ni_~'~;-~J~. ~X-~" ~-'~u~~::::~--~'~ Test This form reports, moqls 4og .... ~¥L~ .... Da te Dep ~.h Feet 5- 6- 7- 8- lO- ll ~ Was 9round water encountered? Reading Date If yes. at what depth? .~ ............ Net Drop ~¥~¥?a-~¥o¥ rate mi nute. Drain Fi el d · Proposed ins tal 1 a'~lYn':' -~¥6~ge Pi t ' co,aN'rs: .~-~-~~~ ..... - .... : .................. "One test is worth a thousand opinions" 2204 Clevland Road Anchorage, Alaska 99503 277-0231 No. Proj¢cl~ Pi~ INTERMEDIATE FINE Well Owner M-W DRILLING, INC. DRILLING LOG 0o?; .Use of Well ',:: ', Location (address of: Township, Range, Section, if known; or distance main road Size of casing_'i" Static water level Screen ( Depth of Hole ft. (~b~irb) Perforated ( ',,4; feet Cased to i ',:~ i feet (below) land surface. Finish of well (check one) ). Describe screen or perforation. Well pumping test at__). © gallons per of drawdown from static level. open end (minute) for I hours with WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness :ft. .TO. _TO. .TO. .TO. .TO TO. TO .TO. .TO. .TO. .TO. [' 1] V' ( 2 -- STATE 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # L"~C'7~, --/r~,('-,\ - \ ~ 1. GENERAL INFORMATION Complete legal description HAA # Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ ''~ TYPE OF WATER SUPPLY: Individual well ~ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fronl MOA~21 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 of this Health Authority Approval application shows that the on-site water supply and/orwastewaterdisposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. Ifurtherverifythat based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ~.~¥icl E. Dayton P.E. Name of Firm ~1o Dona]ar St. Phone ~:;'~,~,'~ak, Alaska 99~67 DHHS SIGNATURE ~ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 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 DHHS 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 engineeds work. 72~J25 (Rev. 1/91) Back MOAtf21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. A, WELL DATA Well type F// "' ~/AI'f~' Log present (Y/N) ~/ Total depth z/.~'4 Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed /¢Z.~/~? Driller Cased to /.-,~-'~ ,/ Casing height " Wires properly protected (Y/N) ADEC water system number FROM WELL LOG AT INSPECTION Date of test Static water level Well flow I0 g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: 10.5 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: ~ m Nitrate .... ~ Other bacteria /.~,.¢ ~.~, { - Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) 'Y High water alarm (Y/N) __ Date of pumping Tank size I o O ~ Compartments _ Foundation cleanout (Y/N) Y' Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line ¢-~o On adjacent lots ~ co .+ Foundation Absorption field ¢&°? Water main/service line_ '~ Surface water/drainage 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 "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed /O/?/ 7C Length ~--5" Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating Gr~vel.:, thickness System type Cleanouts present (Y/N) Date of adequacy test for ~ If yes, give date Total depth ,/7/¢:¢ ! '! bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I~ To building foundation On adjacent lots I ~ Surface water Curtain drain On adjacent lots i o~ 4- Property line To existing or abandoned system on lot Cutbank A~o ~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date HAA Fee $ / David R. Dayton P.E. 20210 Donalar St. ak, Alaska 99563' Date of Payment / '~ ?~ .~ Receipt Number _~)~. ,Z-;/. Waiver Fee: $ Date of Payment Receipt Number D. R. DAYTON, P.E., R.L.S. ~xx~)~T~xm~ Chugiak, Alaska 99587 20210 Donalar XXXXXXXXXXX (907) ~8~L~Yx 696-2417 January 8, 1993 ADEQUACY TEST Legal Description: Lot 4, Block 2, Glen Eagle Subdivision Date of Test: January 7, 1993 Septic Tank: 1000 gallon, Sunset Plastic Tank Absorbtion System: 4' wide x 8' deep x 25' long trench Soils Rating: 125 sq. ft. per bedroom Design Flow: 3 bedroom - 450 gallons per day (DHHS Records) (DHHS Records) (DHHS Records) (DHHS Records) Test: 762 gallons of water were injected into the absorbtion trench in a 2 hour period. There was no rise in the water level in the monitor tube. Results: The system accepted more than 150% of the daily design flow with no rise in the liquid level. Conclusion: The absorbtion system is currently functioning adequately for a 3 bedroom home. D. R, DAYTON, P.E,, R.L.S. ~xx~~l:~ Chugiak, Alaska 99567 20210 Donalar (907) 696-2417 January 8, 1993 WELL FLOW TEST Legal Description: Lot 4, Block 2, Glen Eagle Subdivision Date of test: January 7, 1993 Well Depth: 154 ft. Static Water Level: 70.3 ft. Test: The well was pumped for 4 hours at a rate of 6.1 gallons per minute. This resulted in a drawdown of 12.9 ft. Results: The well is currently producing adequately to serve a 3 bedroom home. .~' >':U' i} ?Om-er ,?~ 0.~ :.' CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX:(907) 561-5301 ANALYSIS RESULTS for INVOICE i 62130 Chemlab Ref.~ 93.0077 Sample ~ 1 Matrix: WATER Client Sample ID PWSID Collected Received Preserved with L4 B2 GLEN EAGLE SUB UA 01/06/93 @ 15:00 hrs. 01/07/93 0 13:00 hrs. Client Name :DAVID DAYTON, P.E. Client Acot :DAVIDDA BPO# : Rsq~ : Ordered By : PO~ :NONE RECEIVED Analysis Completed : 01/08/93 Send Reports to: Laboratory Supervisor :~EPNEN C. EDE 1)DAVID DAYTON, P.E. Parameter Results Units Method Allowable Limits NITRATE-N ND(O.iO) r~/1 EPA 353.2/300.0 RECEIVED JAN 1 9 1993 Munl01pality of Anchorage Dept. Health & Human Services Sample ROUTINE SABLE COLLECTED BY: D.R.D. Remarks: 1 Tssts Performed ' See Special Instructions Above UA~Unavallable ND- None Detected '* See Sample Remarks Above Nh- Not Analyzed LT=Less Than, GT-Greater Than Member of the SGS Group <SociOtO Gbn~rale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPA[Pt-ECIENT OF HEALTH ANi) ENVIRONMENTAl_ PrtoTECT~ON DIVISION OF ENVIRONMENTAL HEALT~I CERTIFICATE OF INSPECTION FOFI NEALTH AEJTHOHITY APPROVAL OF ON-SIrE SEWER AND WATEI-~ FACILITY 264-4720 Application Date. fZ'_"/_t~ '1"__ B ~ -_- ...... 1. GENERAl,. INFORmATiON (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ..... ................................. (b) Applicant Name ~/~ Z~/ ~¢~ Telephone: Home ~¢~%~ Business Applicant Address .... ~.:. ..... ~ ~, ~ ......... ~ ~ ~.~ (c) Applicant ~s (check one): Lending Institution [_~]; Owner/)u der P~(; Buyer ~; Other ~ (explain); (d) (e) Address Rea! Estate Company and Agent ........ , ............ ~_:-.~= ...... : /~ ............. Address ......... .~% /~, _ ....................... Tc,ephon (f) Mail the I tAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi.-Family [] Other Number' of Bedrooms ...... ~ .............. WATER SUPPLY Individual Well~ Community [] PublicD Note: If community well system, must have ..... w~ itten confirmatien from the Stale Dei')artmer~t, of E qvirol~menlal. ()onservatJoR attesting to the legality and status. SEWAGE DISPOSAt. Onsite~l~ Pul)lic El Community E1 Holding Tank El Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attestin.q to the legality and status. ENGINEERING FIRM PROVI[.)ING INSPECTIONS, 1ES'I'S, FILE SEARCH, DATA AN[,) INFORIVlATION As certified by my seal affixed hereto and as of the validatiol~ date shown below, I verify that r-ny 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 informatiol~ 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ..... Address Date Telephone DHEP APPROVAL /'. 't ! / ''~ / ,' -' Approved for / ~'"¢<:'; ~.'/__ bedrooms by _~-'_2.___ ............... "_ ........[)ate Approved ___~ ........... Disapproved ............... Conditional Terms of Conditional Approval I;AUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representat!ons 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 MU, NIc PALITY OF ANCHORAGE DEPT. OF HEALTH & FNVIRONMENI'AL PROTECTION ,:UL 2 5' RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST ~ FEBRUARY 1984 264-4720 Legal Description: ),-. o'T' '~' Well Classification Well Log Present Total Depth ~¢~"~'~ _ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in CondUit~,.N) Separation Distances from Well: To Septic/Holding 'Tank on Lot __~C5 ~."~" To Nearest Edge of Absorption Field on Lot "'-'"'¥~¢-..~,N{ CAr-["C--- If A, B, C, D.E.C. Approved (Y/N) Date Completed ~,O- ~,~- ¢'1 t,, Yield [~=;~, ~, ~ Depth of Grouting Pump Set At __ Sanitary Seal on Casing (~' Depression Around Wellhead ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line 1~ 1/~" To Nearest Public Sewer Cleanout/Manhole l~r- To Nearest Sewer Service Line on Lot Water Sample Collected by ,~)f¢-~ ~-..'t,4.~&l'~,tt~(~ ;Date __ '17~ Water Sample Test Results __ ~,~.,4,.--r'c,5~'~..~..-r~'~ ~ B. SEPTIC/HOLDING TANK DATA To Water-Supply Well ___ To Property Line To Water Main/Service Line Course Date Installed 1~0- ~ Stand pi pes ~V,N') Depression over Tank ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: ;for ~'/~ Temporary Holding Tank Permit (Y/N) /~//¢¢ Size ~ o~c:~ ''~ No. of Compartments ~Air-tight Caps ~/~) ""__ Foundation Cleanout Date Last Pumped · To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed t, O - ~ - Width of Field "¢ Square Feet of Absorption Area Depression over Field (.-Y',~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /v'/4' To Water Main/Service Line I'7--~''' ~ I~¢*' Type of System Design Length of Field Depth of Field Gravel Bed Thickness t'~ .5~)C.~ ~i¢'~, ./// Standpipes Present(~A'~) Date of Last Adequacy Test 1~go/ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~ZO" To Existing or Abandoned System on ; On Adjoining Lots /OO t To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at /~// Vent (Y/N) ~ Pumping Cycles during Adequacy Test, Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. o.." ~'.' '~' ' -~ .., ~GINEtr.~IN¢4 .5- S~=ned ~ ~ ;.,.; ~.o~, Date _ Com~ahV~,,~l ~ ~IVER, Receipt No. ' ................ Date of Payment Amount: $ ~,Ob Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAO--E GREATER ANCHORAGE ARE/, BOROUGH DEPT. OF HEALTH & Department of Environmental Qual i'ky ENVIRONMENTAL PROTECTION 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 OEO 2 0 976 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES RECEIVED Type of Inspection: CMRO VA FHA CONV xx Property Owner: Brad Dlckey Mailing Address: Name of Buyer: Eagle River, Alaska Robert R. & Maryann S. Leedy D_ay Phone 694-9239 Mai 1 ing Address: c/eTop~er Inn Name of Lending Institution: 4554 Homer Dr. Day Phone Anchorage, Alaska Alaska National Bank 265-4894 Mailing Address: Pouch 7-010 Anchorage, Alaska Name of Realtor or Agent: N/A Phone 277-5511 Ext. 31 99510 Phone Mailing Address: 6. Legal Description: Lot 4, Block 2, Glen Eagle Snbdivision Location: Contact Brad Dickey for directions 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well ? 9. Sewage Disposal'System Type .of S~stem: Public Utility If Individual, date of installation Single Family Res. No. Bdrms. ? xx ? Individual (on-site) Unknown GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received December 20, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES ~/ ' FOR Cony. 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: Alaska National Bank Pouch 7010 Brad Dickey Pho~le: 277-5511 x 21 Phone: 694-9239 3. Legal Description: Lot 4 Block 2 Glen Eagle 4. Location: 5. Type of facility to be inspected Single Family 6. Well Data: A. Type Individual C. Construction 7. Sewage Disposal S~stem: A. Installed C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area No. of bedrooms B. Depth D. Bacterial Analysis On-site system B. Installer 2. Manufacturer 2. Material E. Disposal Field: Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line Total length of lines , Absorption area , Other contamination , Sewer Lines , Absorption area EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Req t for Approval of Individual ~ r & Water Facilities Legal Description Lot 4 Block 2 Glen Eagle Comments Approved \ ~/~(x. Disapproved Date///~//~2~-' Approval~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)