HomeMy WebLinkAboutGLACIER VIEW HEIGHTS #2 BLK E LT 5
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:R ANCHORAGE AREA BO'
Department of Environmental C~ualii:y
3330 C Street
Anchorage, Alaska 99503
'-IGH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
NAME Buckles, Mike
MAILING ADDRESS
LOCATION Mile 4 1/2 E.R. Road
LEGAL DESCRIPTION
PHONE
Lot 5, Block E, Glacier View Sub
SEPTIC TANK:
DISTANCE NUMBER OF
FROM WELL MANUFACTURER ~a] l ac~ MATERIAL __ £nncre~e COMPARTMENTS _ 1
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY !00~) GALLONS.
DIAMETER ~JS' OR WIDTH 2~-~
Rings . CRIB SIZE: DIAMETER
SEEPAGE PIT:
NUMBER OF PITS 1 . LENGTH 26, DEPTH
LINING MATERIAL DEPTH 6~ DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDING FOUNDATION NEAREST LOT LINE ABSORPTION AREA (WALL AREA) 576 sq. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE Drilled CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC 1001 SEEPAGE 146'
FOUNDATION LOT LINE SEWER LINE__ TANK .... , SYSTEM
CESSPOOL
, OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
Hanm]ann Construction
PIPE MATERIAL. Cast Iron
LOTSLOPE: Steep to road~
REMARKS:
Steep hillside installation.
Form No. EQ-031
DATE 9/24/73
"One test is worth a thousand opinions"
Performed For ~ t k~ ~ {~)~=.~-.I ~ Date Performed ?-Lt-73
This Form Reports Soils Loo~~ Percolation Test
Oeoth
Feet
Soil Characteristics
4--
9
Was Ground Water Encountered?_~
Yes, At what Denth?
I
IReadinq Date Gross Time Net Time Depth to H20 Net Droo
Percolation Rate
Proposed
Depth of
CoM!~ENTS:
Minute
Installation: SeeoaQe Pit NN~ Drain Field
Inlet Deo{-~-C~o Bottom Of Pit Or Tre~£h
Data Oertified By~~
Test Performed
Date:
Jim' I-~artley
SSar Rout~ Box
Eaqle River, Alaoka
99577
A petg~it :issued by thir., departmm~tt for well and/or on-site
%n th~ ovong you still plan to install the- well and/or
If the well hag bean d~ilL~u, a well ~o9 should ba sent
to this department to document tho instal, lation date.
If you have any c~¢~o~:%ions rer3ardin~; %he abow~ ~a~.ter, p!oasa
do not hesitate to coiTta~t: this off,Ge I~u,ao~i~lt~ly at 264-
4720.
Los
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H'"'::" IF:::" Il:S::" '"lq'" ~-'"'li ....... ::::fl ,. tl;;~f;il L.... EE: ll'"',,~ C:~Tii "lf" IF'"~ .......... ';;;:;:" :;:~i J~'~: II::::::Jl %- t~E~:: il E::, ilEE iF=:" '"'ti' if-ii: .......
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TI~IF= I":,I:;:'P'',, OF I::1 'I'~;~'.E;I",IE:H [;JJ:;]'. F'];'T' ];:E; 'f~;, I"~'~fl'~;:l:::. J::::j:::. Ih.l~::.J:::.F,l IHI::: .:::,l..Jf~.hl-'l_.l::: t
EiI?.OL.IF,II :' =IH[::' THE; E:EIT'T'I;:)J"IOF: "I'HE~: IE',:':',C:f:I'v'~I'Z [.;flq ~ ~,1 F:'EE:. I .:'.
I~'.E; ~ J'l; ~iilE"l" ] ""F' =' :; ":;; ", E: '-' E ;:d;. ~
.... '4F ~F;'FI',,'F ":, := ='"FH ]' ':~; TI'fiE: H :[ !",1 ]; HI..H"I [::~:.iF~,,'Ei... I~:E~;I"I,.IIEIEH "I"F'IE; Ot. IT'F:;'Ft!. i... F:' ]:
J:lJ' ii:;~ '1"1 ~J ' =' '" T"I ........ = ..... "=' = =',' :::: '" :: .... ( ]; 1"4 "~ ~71' ;:'.
O Er E GEO',
.:CHNICAL
Box 90, Davis St,, Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774 SOIL LOG
Soils 8 Foundations
Performed for: Name: ~'~,~
Et DEVEL~-.~MENT CO.
Earl Ellis
688-2280
Land Development
NO,~
16
Ground Water Encountered:
Proposed Installat'lon:
Comments: \ -<
Yes No v/ If yes, what depth___~
Seepage Ptt~ Drain Fteld___~
Performed by:__ ~,~,,9%
~j
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel IiD.#
'1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
,.' .'~ ~ h' ~'i' / HAA #
T14N, R1W, Sec.16
River, AK
Bishop
Phyllis Bis~hone~ (home)
Glacier View Heights Lot 5 Block E
Location (address or directions)
NHN Carol Drive, Eagle
(b) Property owner ]lard:5-~n B.
Mailing Address _3%27 E.
(c) Lending Institution
Mailing Address
88th Anchorage, AK 99507
Telephone
Business
(d) Real EstateCompanyandAgent Virqinia Kohlfield/ReMax of Eaqle River
Address 16600 Centerfield Drive #201 Eaqle River, AK
Telephone 694-4200
(e) Mail the HAA to the following address: (or check here FI, if hold for pick up.)
List contact person and day phone number below:
_P_iEk-up by Engineer
2. TYPE OF RESIDENCE
Single-Family l~ Number of bedrooms 3
3, WATER SUPPLY
Individual WelI:E~:
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site I~: Public [] Community [] Holding Tank []
Note: If community well system, must have written confir~atiori from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, 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 Muhicipality 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.
Name of Firm Eagle River Engineering Telephone 694-5195
Address P.O.B. 773294 Eagle River, AK 99577
6. DHHS APPROVAL
Approved for ~
Approved %
bedrooms by-~~// ,.~¢2 Date'
Disapproved _ Conditional
Terms of Conditional Approval
The MunicipalityofAnchorage Department of Health and Human Services(DHHS) issues HealthAuthorityApproval
cerificated based only upon the representations given in paragraphSabovebyan 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 DHHSdo not conduct inspections
or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsibleforerrorsoromissions
in the professional engineer's work.
z2-025 ¢~., ~.,8~)B~ Page 2 of 2
Legal Description: ~";/~¢,'~' //"/~v'
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
ALIIY OF AI3CI-~I~IST. FEBRUARY 1984
ENTAL SERVICES DIVloIO~43.4744
;\PR 2 7 1989
RECEIVED
A. WELL DATA
Well Classification
Well Log Present (Y/N) )/ Date Completed
Total Depth /~,/ /
Cased to ~'4,'~ /
Depth of Groutin9
Static Water Level '~/~'~'"' /".~_) Pump Set At
If A, B, C, D.E.C. Approved (Y/N)
Yield -~,, ~75- ~'~r,~/
/..¢~ ,~,'~,.~
Casing Height Above Ground .70 ¢',4¢,,,,¢ /'~.~.~,,,~, ,,¢/,~ Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot /~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results ~?,,~,-~,
Comments
Depression Around Wellhead (Y/N) ~
· On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
B, SEPTIC/HOLDING TANK DATA
Date Installed ~/73 Size
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N) "~/'~
Holding Tank High-Water Alarm (Y/N)
/~;',~¢ ,.~"~No, of Compartments ~L
Air-tight Caps (Y/N) ,Y Foundation Cleanout (Y/N)
Date Last Pumped _
;for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Building Foundation
To Disposal Field
To Water-Supply Well ~/'~'/2 /
To Property Line /g' /
¢- /
To Water Main/Service Line / g~
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ~.~.2. '
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field ,,2~"
Depth of Field
Gravel Bed Thickness ¢ '
Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well /'-~ I/
To Building Foundation /¢ ¢ /
t. ot
To Water Main/Service Line ~*/¢ /
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line '"'"¢ /
To Existing or Abandoned System on
; On Adjoining Lots "~ /
To Cutback (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed ~~
Company I~,%,1, RIvAr Fnn.!p..?!!~ Ser'!!CeS
P. 0. Box 773294
Date y/.a,?/r~ ~¢_, ~i~,er, AK~9577
MOA No. '~¢/J- 694.-5195
Receipt No.
[:)ate of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
.... .... . ~,.,,.?~.~q~meer s Seal
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
AppLication Date AngL]$1- 1¢,, 1C~RR
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 5 Block E Glacier View Heiqhts Sec. 16, T14N, R1W
Location (address or directions)
NHN Cgrol Dr. Eagle River
(b) Property Owner H.U.D.
Mailing Address 701 "C" St. Box 64
(c) Lending Institution n/a
Mailing Address
Telephone:Home n/a
/~chorage, .zd( 99513-0001
Telephone
B. usiness
271-4665
(d) Real Estate Company and Agent n/a
Address
Telephone
Mail the HAA to the followina address: or: Check here ~, if hold for pick up.
List contact person and day phone number below.
Engineer 694-5195
(e)
TYPE OF RESIDENCE
Single-Family []
Number of Bedrooms
WATER SUPPLY
Individual Well [~ Community [] Public []
Note: If community well system, must have written cot,::
attesting to the legality and status.
'~n from the State Department of Environmental Conservation
SEWAGE DISPOSAL
Onsite I~1 Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 fRev 81861 Fronl
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm j?.,ag'le River Engineer±rig' Se~'-v'±ce$ Telephone 907/694-5195
Address P.O. BOx 773294 Eagle River, AK 99577
Date
DHHS APPROVAL ~_..~ ~
Approved ~ Disapproved Conditional
Terms of Conditional Approval
cAuTiON
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
engineer's work.
Page 2 of 2 72~025 fRev 8/861 Back
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description: .~ ~/' -~ ,'~/'~ ~
Well Classification /'CK'/~',,'~ ~-,,E' If A, B, C, D.E.C, Approved (Y/N) '""/,~
Well Log Present (Y/N) )/ Date Completed 6/~ ,~/2' ~' _ Yield
Total Depth / &-¢' ' Cased to ~'~°/ Depth of Grouting
Static Water Level _'~ ~'f;-o,.-, ""3~ Pump Set At ,,3'o
Casing Height Above Ground 3 ¢ ~' .~&o¢,¢ ~.*¢e~-.,',,,." F'~'anitary Seal on Casing (Y/N)
Electrical W~rmg m Condu~t (Y/N) ,A) (,Z,~.,,~¢¢ ,,, ,¢ ¢[~epression Around W~l~lhead (Y/N)
Separation Distances from Welh $~/-/'$ ~/$~%t.,~ /~ ¢'E/'¢~ ~'
To Septic/Holding Tank on Lot "/¢242 /
To Nearest Edge of Absorption Field on Lot /3¢ ¢
To Nearest Public Sewer Line _
~. 25- ¢/,~.~
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
~'/~ To Nearest Sewer Service Line on Lot
/.E",v_), 2, e e ~ ; Date 7/,..~
B. SEPTIC/HOLDING TANK DATA
Date Installed ,2/73 Size
Standpipes (Y/N) Y Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well */~ /
To Property Line /¢ /
To Water Main/Service Line /~"~ /
Course '~//~
No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped ~/¢¢
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~¢' /
To Disposal Field .!~ /¢ /
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test ~'~
Separation Distance from Absorption Field:
To Water-Supply Well / :3 ¢/ /
To Building Foundation ~¢',O~' /
Lot
To Water Main/Service Line ¢'/o
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
//~/'~"~' Type of System Design
Length of Field ~; /
Depth of Field /¢2
Gravel Bed Thickness ~'"
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line ¢'/~ z
To Existing or Abandoned System on
; On Adjoining Lots ¢' ~ /
To Cutbank (if present) /"/j~
LIFT STATION /¢/~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify tha~checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Si ned ~J~ Date
P. 0. Box 7722_.94,__
Eagle River, Al( 99577
694-5195
MOA No.
-Tcr 7
Company /
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CE,UtllFICAIE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SI rE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 5 Block F, Glacier View ~ Subdivision #2
Location (address or directions)
Applicant Name Chris A]_e×ander Telephone: Home 694-2797 Business
Applicant Address SRi-B Box 1562 Easle River, Alaska 995
Applicant is (check one): Lending Institution []; Owner/builder [~;~3uyer []; Other [] (explain);
(b)
(c)
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Re/Max - Lorraine Minor
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family E~x Multi-Family []
Number of Bedrooms three(3)
Other
WATER SUPPLY
Individual Wel~E]~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite E~xxPublic [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to tile legality and status.
Page 1 of 2 72025(11/,84)
ENGINEERING FIRM PROVID[ . INSPECTIONS, TESTS, FILE SEARCH, D. \ 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 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,
Name of Firm Telephone
Address
Date
Approved for three(3) bedroo
Approved cccccc Disapproved Conditiona%.
Terms of Conditional Approval
Corrected the number of bedrooms from two to three bedroom program.
CAUTION
The Muncipality of Anchorage DepaMment 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 tl~eir lending
institutions in order to satisfy certain federal and state requiremenls. Employees ol DHEP do nol conduct inspections
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for error's or omissions in
professional engineer's work.
Page 2 of 2
72-025 (1 I/8,1)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEC'rlON
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 5; Block E; Glacier View Estates I12
March 19, 1986
Location (address or directions)
(b)
Applicant Name Chris Alexander Telephone: Home 694-2797 Business
Applicant Address SR1-B Box 1562, Eagle River, Alaska 99577
(c) Applicant is (check one): Lending Institution [] ; Owner/builder [] ; Buyer [] ; Other [] (explain);
(d) Lending Institution Telephone
Address
(e)
Real Estate Company and Agent
Address Eagle River, Alaska
Telephone
Re/Max - Lorraine Minor
(f)
~dthe HAA to the following address:
S ~q__Engine¢~i ng
SRB~9/~X
Eagle River, Alaska
99577
2. TYPE OF RESIDENCE
Single-Family ~ Multi-Family [] Other~
3. 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 IX'l 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 cedified by my seal affixed hereto and as of tile validalion date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal syslem is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verily that based on the intormation obtained
from the Mur~icipality of Anchorage files and from my investigation and iespectio~, the on-site water supply, and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordif~ances, and regulations in effect on
the date of this inspection.
Name of Firm --5-& ¢ E~'.'.'jb~ef'ir~ Telephone
Address
Approved /% Disapprov6Zd
Conditional'
Terms of Conditional Approval
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 (1 ~/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO~l
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST ~ FEBRUARY 1984
MUNICIPALITY OF ^I,~C,-J;%~ .~
DEPI'. OF HI~ALh ;..
ENVIRONMENTAL PRO. ~,~
MAR 2 6 1986
Well Classification --~fc~-L Ji,'&-~l-f~_.. If A, B, C, D.E.C. Approved (Y/N)
Well Log Present.,¢¢'~) Date Completed "1 c[ ,'-j ~O Yield
Total Depth '"'\~7-~t Cased
Static Water Level 7~
Casing Height Above Ground
Electrical Wiring in Conduit.(.,~
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot \C~o ~ ~-
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Depth of Grouting ~
Pump Set At
Sanitary Seal on Casing
Depression Around Wellhead
; On Adjoining Lots
; On Adjoining Lots
/
~[¢~" To Nearest Public Sewer
~ To Nearest Sewer Service Line on Lot
Ic.~ ~ <L~ ~-~ f'~ ~f'~-~ ri"4 (-~ ;Date %~ ~-:~ ~=' ~
Comment¢ W¢~-4~
SEPTIC/HOLDING TANK DATA
Date Installed '~ -7~¼-~'% Size
Standpipes ~/J~¢)~' Air-tight Caps
Depression over Tank ~
Pumping/Maintenance Contract on File (Y/N)
HoJding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water-Ma'ffl/Service Line
No. of Compartments
Foundation Cleanout~.N)'
Date Last Pumped
~.4 ) ,,~__ ; for
Temporary Holding Tank Permit (Y/N)
Course
To Building Foundation ~' ~
To Disposal Field %~'~ ~ ~
To Stream. Pond. Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~'~ ~'Z.,3.~ ?"~,'~-'~
Width of Field
Square Feet of Absorption Area
Depression over Field
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~
To Building Foundation
Lot
To Water--Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field Z,,(.a
Depth of Field
Gravel Bed Thickness
Standpipes Present ~N)
Date of Last Adequacy Test
To Property Line ~,O ~ ~
To Existing or Abandoned System on
; On Adjoining Lots ~ ~' ~
To Cutbank (if present),
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
Manhole/Access (Y/N)
~,~ "Pump Off" Level at
__ Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
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.
,~ & 5 F-,r~i~?~¢~'},~_ Date
Signed &~G
Company
Receipt No.
Date of Payment
Amount: $
MOA No~,,
Page 2 of 2
72-026 (11/84)
DATE RECEIVED
I NSPECTI ON APPel NTM ENTS. ~'~--~
DATE DATE DATE
ENVIReR~ENTAL ~O'rEcrION
MUNICIPALITY OF ANCHORAGE
I," r~E. pA~q..T.~I.I~NT OF HEALTH & ENVIRONMENTAL PROTECTION
oLJL ,') :[ ]~J~[~ 825 L Street-Anchorage, Alaska9950,
[~ F F/~ I \/~I~,~'IRONMENTAL SANITATION DIVISION ~; '
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER I PHONE
Alan ~_aul & Niki Alpert McCurryI 694-9729
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
CArol Drive
2, BUYER PHONE
John C. & Judith Mo Alexander 694-2797
MAILING ADDRESS
..PO Box 6804, Anchoraqe, ALaska 99502
3. LENDING INSTITUTION PHONE
Alaska Mutual Savings, Lori Cate 274-5722
MAILING ADDRESS
PO BOX 8-9093, Anchorage, Alaska 99508
4. REALTOR/AGENT I PHONE
TOTEM REALTY - Jeanne Webster (Hm, 333-76~1)I 272-0571
MAI LING ADDRESS
724 Eas% 15th Avenue Anchorage, Alaska 99501
5. LEGAL DESCRIPTION
Lot 5, Block "E", Glacier View Heights#2
STREET LOCATI ON
Carol Drive off Myrtle DRive approx. 3½ miles up Eagle River Road.
6. TYPE OF RESIDENCE NUMSER OF,,BEDROOMS
~] SINGLE FAMILY E~] One [] Four
[] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7, WATER SUPPLY
[] INDIVIDUAL~
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells dritled prior to that date, give well
depth (attach Icg if available.)
8, SEWAGE DISPOSAL SYSTEM
[] INDIVI DUAL/ON-SITE~
[] PUBLIC UTILITY
1974
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
; PERMIT NUMBER
2, WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
E~Septic Tank or []Holding Tank
'~'~t ~;iT Tank is homemade SOILS RATING
Size: I ¢ "-"
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Are~ ISewer Line Nearest Lot Line
WE L L TO: I CPO
1
Absorption Area to nearest Lot Line
5. COMMENTS
[~J-~ APPROVED FOR ~'~ BEDROOMS
[~ CONDITIONAL APPROVAL (letter must a,~c~mpany certificate)
E~]~'~ DISAPPROVED /,~/~.//
DAVID A. SLENKAMP
MECHANICAL ENGINEER
694-9055
August 22, 1980
ROBERTA. SHAFER
CIVIL ENGINEER
694-2979
Allan and Niki M. cCurz~y
c/o Totem Realty
ATTE~.~TION: Jeannie Webster
724 F~,st 15th Avenue
Ahchorage, Alaska 99501
Dear ]';r. and ?'~'rs ' ~
?,~cvurry~
Reference: Lot 5; Block E; Glacier View I{eights /~2
A sewer system adequscy test was performed on the system located
on the referenced property as requested by Jeannie Webster of Totem
Realty. The septic tank v~s punped and verified to bare a capacity
of 1000 gallons. The seepage pit was charged Yrith appro×;_mately
1000 gall. ohs of Ymter and after a pariod of 24 hours a!l the water
which had been added had percolated out of the seepage pit.
It can be concluded from this test that the sm.~ge system (septic
tank and seepage pit) is currently functioning sdequ,stely for the three
bedroom home.
If we may be of further assistance, please do not hesitate to call.
Sincerg~y,
~/,'
cc. ],;~cipa~i~ ct Ancho~aKe
Department of Health and Envlor~ental Protection
Alaska ?,~tual Savings Bank
TPE ~FION. Laurie Cate
SRB 196X EAGLE RIVER, ALASKA
INSPECTION APPOINTMENTS ~
DATE / / /--~,, DATE ,,~ DATE*
INSP~TOR/¢~ INSP~TOR . '' INSPECT~
~ Telephone 264-4720
DIREOTION8~ Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing.
1, PROPERTY OWNER ~ ~ ¢ PHONE
PROPERTY RESIDENT (If different from above) PHONE
MAILING ADbRESS ~
3. L~NDI~GINSTITUTIO~ -- z ~ I~ PHONE
MAILING ADDRESS ' .~' ' - '
~ '
MAIL~ADDRESS _) ~/ .~., ~ a,
5. LEG~J_ DESCRIPTION ~ ./)
STREET LOCATIOI~ '
6. TYPE OF RESIDENCE
~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
~ Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
~.. INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG, A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS __
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL -~EPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTILITY
Connection Verified__ LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ~ '~-'-') -~
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank ~L~o/v-~,-,**---~",~-
Size: l ~_.)O(~ If Tank is homemade SOILS RATING
give dimensions: 1 ¢'~ o
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line
WELL TO:
I
I
Absorption Area to nearest Lot Line
5. COMMENTS
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
PLEASE REPLY TO: MAIN OFFICE
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
PNVIRONMENTAL PROTECTION
OCT 3 1 lg19
RECEIVED
Addendt:m to puzchase agreement for Lot 5, Block h', Addition ~2 of
Glacier Vie',,' SLd)division, Eacle River, Rlaska
Buyer al:d selle;- aaree to eaua!ly sha:n ~.:z ...... s of lmmicip'al approval
of se~.~.eyg~cm and well.
,,, ,.
. .., ~X
Seller
Datd,?
,"~ (L