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Home My WebLink AboutGLACIER VIEW HEIGHTS #2 BLK E LT 12Glacier View Heights #2 Lot :[2 Block #050-491-47 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~L,',J'~jOO~5~I PID Number: oSoH°t I H7 Name: ~o~ ~ LI~ ~AL~ Wastewater System: B New ~Upgrade Address: ~ ~ e5 ~ ~55~ ~c~ ~. ABSORPTION FIELD / Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION o.~ ~sq.~. ~' _ Lot: ~ ~ Block: E Subdiv~ion:~l~ ~:~.---~ Depth lo pipe bottom from original.grade: Ft. Gravel depth beneath pipe ~ Ft. Township: Range: Section: Fill added above original grade: Gravel length: .... - I,~ Ft. ~ Ft~ WELL: ~Z,ST,~ New ~ Upgrade Gravelwidth: Number of lines: Distance between lines: ~. ~ Ft. ~ Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:/ ~% ~T~ ~0~ Ft. ~0 Ft. ROe SO. Ft. F~O/~5c~ __ Driller: A~L ~LL~ Date Drilled: Static Water Level: Installer:~E~ ~ Date installed: Yield: J Pump Set at: Casing Height Above Ground: 'rAN K ~. ~ GPM, ~/~ Ft. ~'l Ft. SEPARATION DISTANCES ~Septic ~ Holding g S.T.E,P. TO Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: Material: Number Compartments: Well ~O~ ' Ioa [ ~ ~ ¢~ ~ ST~ C Surface /OO~ too t~ ~ ~' ~ LIFT STATION Water Lot * i Size in gallons: Manufaclurer: Line ~ ff ~ ~ ~ ~ ~ ~ ¢ "Pump on" level at: ~ "Pum~ at: High water alarm at: Foundation 0 .... ~0 V~ ~ ~ ~ ~ ~Electrical Inspections performed by: Curtain Drain Remarks: BENCH MARK Location and Description: Assumed Elevation; ~00 ENGINEER'S SEAl. ~- i'"~ i,' j~iver Loop Road No, 204 Inspections performed b~¢mv.~,, r,l~sk. ~9~7 Dates: 1st ~- ~o -fir- d.'.."¢' :./9~?,,,., ~opartment o~ Health Hu vices approval ~ ~¢}',,,~o~ .... c~-ss0~ .'?> Reviewed and approved by ~ Date: 72-013 (Rev 9/91) MOA 25 SW950059 2 2 Permit No, Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LOT 12, BLK E, GLACIER VIEW HTS //2 05049147 Legal Description: PID No.: : C01 C02 ~ /92.9'H ...................................... '" '11 ...... H"~"~" 9 .7.J i GAL 89,2'~ MT 1 GRADE FINAL ............. INS N.T, S ~.o WELL NEW 1250 GAL. SEPTIC TAN] SEPTIC SYSTEM ABANDONED COMPLETELY CO~ 203 C04 NEW S SCALE 1" ~ 40' 72-013 A (1/93) · 77.2Y FCOI 3'i COI~ 88'i 108' C021 93'i 1i3' C03 96':: 1i6' CO4- 97'i 117 C05 li2':: ~31' MTt 107':. 125' C06 92' 107' CO7 121'i 137' MT2 115':. 134' C08 102' 115 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPAR%~ENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PE]~MIT NUMBER:SW950059 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HALL JONATHAN V & OWNER ADDRESS: 0504914700088 DATE ISSUED: 4/26/9[E EXPIRATION DATE: 4/26/96 PARCEL ID:05049147 LEGAL DESCRIPTION: GLACIER VIEW HEIGHTS #2 BLK E LT 12 LOT SIZE: 65331 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALI, CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CILAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL RECEIVED ISSUED BY: ROBERT C. COWAN, RE. ROBERT A. SNAFER, RE. HEAt.TH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER iNSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATrON TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DIS?OSAL SYSTEM DESIGN April 19, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Depar~6nt of Health and H~an Service~ P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 12; Block "E"; Glacier View Subdivision , Request you issue a p~Lt to upgrade the, septic system to serve the Test hol~ were excavated and percolation test~ performed. The, approximate, locatio~ of the test holes are located on the attached site plan. At the. time of excavation no water was encountered in test hole, #I nor in t~st hole, #2. After seven day ground water monitoring, the monitoring tube~ in both test holes w~re found to be, dry. Attached is the proposed upgrade, design. This property has enough area for a future septic upgrade which can be, seen on the, attached site, plan. If you require additional information please conta~ us. Sincerely, / Z//'/' ROBERT C. COWAN, P.E. RCC/gk ENCLOSURES 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ow 3a¥~oarl ,Oq_ = ,,[ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST LEGAL DESCRIPTION: T/.l~ ~ DATE PERFORMED: S.~D/~pp. ~¢ 2._ Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT ~ O DEPTH? p Deplh to'~/a~e(Aller / Reading Date Gross Net Depth to Net Time Time Water Drop :.q,~ lO o ~ I" .' q> /o " I" PERCOLATiONRATd/0 ~ies/,nch, PERCHOLEDiAMETER ¢ (1 TEST RUN BETWEEN"Y-- ~' FTAND 6 FT PERFORMED BY: S & S ENGINEERING I ~ CERTIFY THAT ]'HIS TEST WAS PERFORMED IN 17034 Ea~le Eive~ Loop Road No. 204 ACCORDANCE WlT~bSf~'i~.~,~S~i~/~;~4~L GUIDELINES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: OP.C,~Jt c. fl 2 3 4 7 8 ~3 15 16 17 18 19 20 Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? ~ L IF YES, AT WHAT O DEPTH? p E Depth 10 Weler ^lief ~onitoring7 (~2/:'L l/ Date: I~Z'' Z")- ~Z / SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop · '10 -/o 8'/,~ I~" PERCOLATION RATE ~ (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN ~ F T AND "~ FT COMMENTS I~' - ~Z:~ CERTIFY THAT THIS TEST WAS PERFORMED IN $ & ENGINEERING PERFORMED BY: 17034 Eagle River Loop Road No, 204~ /-~_' ~ ,~ \ .~ ~ ACCORDANCEWIT~a~i~1~,c~iE,,~)S~Jt~,,~L GUIDELINES IN EFFECT ON THIS DATE. DATE: ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN ID(TENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 12; Block "E"; Glacier View Subdivision GENERAL: The scope, of this project in~udes the installation of a 1250 gallon septic tank and a leachfield tAench to serve the four bedroom residence located on the referenced property. The existing septic system is to be, abandoned in place. Construction shall be in accordance with the approved site plan and design drawings, Municipal pe/~mit with any specicl provisions or conditions, and all applicable State and MunicipalWastewater Disposal Regulations. 3. The contractor shall be, responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil s¢~Iling. Contractors installing wastewate~ disposal systems m~t be certified by the Municipal Health Dep~tment for system installations. Owners installing their own systems must also receive prior approval from the, Municipal Health Department. SEPTIC TA~K INS]~LLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall in~ude two 4" ~ee~nouts for p~mprng access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpip~ on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page, Two Lot 12; Block "E"; Glacier View Subdivision ~J~ 47_ Septic tanks installed with less than 4' of cover shall be instated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line b~ween the tank and the leachfield there shall be two adjacent cle~nouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cl~anout, in line, shall be to ~ean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: MINIMUM Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inche~ of level. If the sidewalls of the excavation become smeared, they must be raked or s~atched (roughed-up) before gravel (sewer rock) placement. Once, the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inch~ of cover over the pipe. A silt barrier must be installed between the final ~ravel layer and the, native soil backfill. EnSure the silt barrier covers the entire gravel surface before, pla~in~ backfill. Monitor tubes shall be of four (4) inch diamcte~ and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the inve~ of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer m~t not be less than twenty-four (241 inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inche~. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MATERIAL SPECIFICATIONS: I. Any septic tank proposed for installation m~t be constructed by a Municipally approved septic tank manufacturer. Page, Three Lot 12; Block "E"; Glacier View Subdivision 2. The following pipe materials are approved for use in septic system insta~ations in the Municipality of Anchorage: Type of Pipe Per~orated Solid Cast Iron Yes Yes ASTM D3034 (PVC) YeA Y6s ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use, of a type, of pipe other than ~isted above, must be approved by the, inspecting engineer. Insulation shall be, at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inle~ and outlets shall be, fitted with watertight couplings (Ca~de~, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the, native, soil backfill. All leachfield gravel (sewe~ rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the. #200 sieve,. When sand is being used as a filter material, its gradation specifications must conform to current M.0.A. or D.E.C. requirements. INSPECTIONS: Typically the~e will be a minimum of three (3) inspections required during the installation of the, wastewater disposal syst~i. These inspections w~ll occur as follows: The first inspection must be conducted after the, excavation of ditches, pits, trenches, or bed~ and before the installation of any gravel. A septic tank may be, se~ in place, but may not be backfilled before this inspection. The. second inspection must be, conducted after the placement of the, silt barrier, gravel, distribution lines, standpipes, o~anouts, and insulation, but before the placem¢,nt of any other backfill. Page Four Lot 12; Block "E"; Glacier View Subdivision 3~ The final inspection is to occur upon final grading of the property. Often there, will be more, than these 3 inspections required, e~pecially with the. installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thu~, the inspecting enginee~ is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The own~ shall contract with the contractor to perform the work out, ned in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrang¢~,ent existing bctween the contractor and S & S Engineering. S & S Engineerin~ shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the, owner and the M.0.A. S & S ~ngineering shall have no liability to the owner or to others for acts or omissions of the contractor or any othe~ persons p~rforming work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engine~ring's inspecting enginee~ w~ll not be responsible for the construction m~ans, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Tom Fink, Mayor Department of Health and Human Services 825"L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 18, 1994 Alaska USA Federal Credit Union PO Box 196613 Anchorage, Alaska 99519-6613 Subject: Lot 12 Block E Glacier View Heights Subdivision Permit #SW930004, PID #050-491-47 The subject permit, issued January 14, 1993 by this office for a single family well and/or on-site wastewater system, has expired as of January 14, 1994. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. Ail inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Singerely, / / ~/og~am ~anager On-site Services enc: Copy of Permit cc: S & S Engineering PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930004 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:ALASKA USA FEDERAL OWNER ADDRESS:P. O. BOX 196613 ANCHORAGE, ALASKA 99519-6613 PARCEL ID:05049147 LEGAL DESCRIPTION: GLACIER VIEW HEIGHTS #2 BLK E LT 12 LOT SIZE: 65331 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 1/14/93 EXPIRATION DATE: 1/14/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS ].5.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATttER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. ISSUED BY: SPECIAL PROVISIONS: RECEIVED BY: (' ~I~t. ? December 18, 1992 ROBERTSHAFER PE ROGERSHAFER. PE CIVIL ENGINEERS (907) 694 2979 FAX 694 !211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIt. TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 12; Block "E"; Glacier View H~ights Subdivision We request you issue a permlt to upgrade the septic system s~rving the referenced property. An adequacy t~st was perfomed on the septic system on December I, 1992. The absorption capacity was found to be inadequate. Two test holes were excavated and p~rcolation tests perfo~led. The location of the test hol~s are shown on the attached site plan. we do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincerely, JAMES P. WILLIAMS, Civll Engineer ~R~G?~. ~S ~('HA F ER, p. E~' JPW/tv Attachme~ 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 ,Og = ,,I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG b PERCOLATION TEST PERFORMED FOR: 4/ LEGAL DESCRIPTION: 5 6 7 8 9 10- 11 12 13 14 15 16 17 18- 19.- 20- O/?4~1c3 2 Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? s ~ L IF YES, ATWHAT 0 DEPTH? p Depth Io Water A..~>¢ , Monitorino? ' E Gross Net Depth to Net Reading Date Time Time Water Drop · '10 /o PERCOLATION RATE (~ (m~nutes/mchl PERC FIOLE DIAMErER ~ ~¢ ~EST RUN BETWEEN +_ FTAND k.~ FT COMMENTS I~' ~ ~"'~ CER]IFY THAT THiS TEST WAS PERFORMED IN $ & ENGINEERING PERFORMED BY: 17034 Eagle River Loop Road No. 204~ /,~. ~ ~ \ .~ ~ ACCORDANCE WIT I~;~l~f~l~l~}{~l~.l~,~t_ GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/851 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SFRVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCmPT~ON: '"'~-/'.¢ ~ L F--/~Dr DATE PERFORMED: Township, [Range, Section: 1 2 3 4 5 6 7 8 9 lO 11 12 13 14 15 16 17 18 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ]ll~ ENCOUNTERED? S L IF YES, ATWHAT ~ 0 DEPTH? p Deplh to Water AII[ E Gross Net Depth to Net Reading Date Time Time Water Drop :&5 10 6Y~ /" .' ~2 /0 g " I" PERCOLATION RATE /~ (m~nutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN B _ FT AND (-2__ FT PERFORMED BY: 5 8, $ ENGINEERING ~ ""'"'~ '~.~/"//~ CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 204 ACCORDANCE WITl~a~r~9~,/~s~.~r'~;~}l_ GUIDELINES IN EFFECT/ ON THIS DATE. DATE: oGRE"'"-R ANCHORAGE AREA BO' Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS LEGAL DESCRIPTION~? j/~ J'~t/'C E PHONE SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH b~ MANUFACTURER ~T/::I_~/'( ¢~"~'~l_ -- MATERIAt INSIDE WIDTH LIQUID DEPTH NUMBER OF · COMPARTMENTS __LIQUID CAPACITY /Og)O GALLONS, SEEPAGE PIT: NUMBER OF PITS ! . LINING MATERIAL Lo~, BUILDING FOUNDATION DIAMETER ""/'~ OR WIDTHS/, t-ENGTH'~L, DEPTH ¢' CRIB SIZE: DIAMETER OEPTH ~ ! DISTANCE FROM: WELL , NEAREST LOT LINE . · ABSORPTION AREA (WALl_ AREA) _SQ. FT. ADDITIONAL ABSORPTION WELL: ]'Y PE~)/q-g L.'L,~D CONST RUCTION BUILDING NEAREST FOUNDATION---, LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED ~T/qM'./),~/¢I) DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE__ TANK SYSTEM REMARKS DISTANCES: INSTAl_LED BY: PIPE MATERIAL LOT SLOPE: Form No, EQ*031 DATE__ t2I'7~ APPROV D '-~//~ DIAGRAM OF SYSTEM GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCR,PTION gl~ INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO SE SERVED__ FINANCED THROUGH ~ ::::::::::::::::::::::: FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC 'TANK SIZE /~ TYPE MINIMUM DISTANCES, REQUIREMENT..~ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE Pit SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK _ TO NEAREST LOT LINE. WELL TO SEPTIC TANK _ DRAIN FIELD . SEEPAGE PIT · DRAIN FIELD. · DRAIN FIELD ALSO CONSIDER AREA WELLS· WATER MAIN TO SEPTIC TANK DRAIN FIELD /,ct" SEPTIC TANK, , SEEPAGE PIT . TO RIVER, LAKE. STREAM· --. SEEPAGE PIT DRAIN FIELD CAST IRON rNTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF ~EXCAVATION S FEET iNTO UNDISTURBED SOIL. _4 INCH DJAMETER_~CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGe PIT ~I~T~ED WltPL~R~T_lgHt REMOVABLE caPs GRAVEL BACKF'ILL CONFORM TO BOROUG~E~ULAT[ONS REGARDING INSTALLATION. SEEPAGE AREA SIZE TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAiD CODE, / Russell Oyster 694-2774 Civil Engineering Soils Et Foundations 0 ~t E EIVdlNEERING ~ DEVELOHIv1ENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 333-5240 SOIL LOG Earl El/is 333-5240 Surveying Land Dovelopment Performed for: Legal ~e~th 0 Name: Mailing Address: Description: ~-'~ \ (feet) ~ ~, Tel. No. ~c~A- Z~-t Soil Characteristics 4 5 6 7 8 9 '"~ 10 11 Ground Water Encountered: Yes__ No v// If yes. what depth Proposed Installation: Seepage Pit v/~ Drain Field 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. 050-491-47 1. GENERAL INFORMATION Expiration Date: 2 —1 - 2-02_ Complete legal description GLACIER VIEW HEIGHTS #2 BLOCK E, LOT 12 Location (site address) 23231 GLACIER VIEW DRIVE EAGLE RIVER, AK 99577 Current property owner(s) JEFFREY & DEBORAH HANCOCK Day phone Mailing address Real estate agent 23231 GLACIER VIEW DRIVE EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ l SIS_ Waiver Fee $ Date of Payment 1130)22 Date of Payment Receipt Number -7103`° Receipt Number COSA # 0SG22 ) 555' Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN PE Date 11/28/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the � system and maintenance. The operational life of all well and septic systems are subject to wm these various and dynamic characteristics and are outside the control of the evaluator of the; . well and septic system. Therefore, no estimate of how long a system will function satisfactory o�Q" for current or future occupants or guarantee that no unseen encroachments, deficiencies orlie discrepancies exist can be given by First Water Consulting &49 TH FWCS �® � � . • • • • . •� 6. DSD SIGNATURE . Curtis Huffman X_ System #1 Approved for bedrooms �$��Fcs• CE 12e991 .�\ti' i Te9- p11 /28/22 System #2 Approved for bedrooms $� ROFESSVQ Disapproved Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 12.-- " 2 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 nn Well Flow Advisory Other 01 Legal Description: GLACIER VIEW HEIGHTS #2 BLOCK E LOT 12 Parcel ID: 050-491-47 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Well production at time of test 4.4+ gpm Date drilled 7/14/1997 Water storage tank volume NA gallons Total depth 201 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 40+ ft (ASSUMED PER MOA DOCS...) ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 0.216 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Date of flow test for COSA 4/14/2022 Collected by WE Static water level at beginning of test 0 ft. Date of Sample 4/6/2022 & 11/18/22 (Nitrates/Coli) Comments SULLIVAN INSTALLED NEW SANITARY SEAL. SWL AT GRADE & DROPPED 20' DURING TEST. B. TANK DATA Age of tank(s) 27 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 48" ® Standpipes/foundation cleanout per record drawing Date of pumping 4/13/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/10/1995 ® ALL standpipes present per record drawing Total measured depth from grade 10.3 / 9.4 ft (max) Measured depth to pipe invert from grade 4.8 / 3.7 ft (min) ❑ N/A — pressurized field C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material .ice Adequacy test date 4/14/22 Results E Pass For 4 bedrooms Fluid depth prior to test 0 / 0 in Water added 500 / 500 gal (N / S) New depth 21 / 18 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1400 min depth into effective IR SHOWS 61ED — SHOTS 5.51+ Final fluid depth 0 10 in ® Code -required soil cover over field Absorption rate 600+ gpd ❑ System presoaked Any rejuvenation treatment (past 12 months) N (Required if vacant for greater than 30 days prior to date of test) If yes, enter date Gallons introduced gallons FWGS Comments/Deficiencies: MEASUREMENTS AT GRADE & SHOTS. PER 2015 COSA & MOA IR DOCS. :. 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' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment : 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® 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 ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No. Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® 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 _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No _ ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION, I.h"'��' I certify that I have determined through field inspections and review �,��Q •�`.�� of Municipal records that the above systems are in conformance �, g •;� �� with MOA COSA guidelines in effect on this date./� • 17•i . , • `':� /.... ........... • :• • Curtis Huffman � 'g, CE 1/28/22 99 • • "��``�� Ii' ft www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221555 Subdivision: Glacier View Heights #2 Block E Lot 12 Starting at 20 years of age the MOA issues AdvisorV's for steel septic tanks. The septic tank for this COSA / property is 27 Vears old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. MUNICIPALITY 0 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. 050-491-47 1. GENERAL INFORMATION Expiration Date: -7r 2J -7-02-2- Complete 0ZZ Complete legal description GLACIER VIEW HEIGHTS #2 BLOCK E, LOT 12 Location (site address) 23231 GLACIER VIEW DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) TREVOR & SHAUNA TOMLINSON Day phone Mailing address Real estate agent 23231 GLACIER VIEW DRIVE, EAGLE RIVER AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -5 50 Waiver Fee $ Date of Payment ¢y /W -z-z-Date of Payment Receipt Number ODD 20L- Receipt Number COSA # 05 C2,2- 1 1 .5--j Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 4/18/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the _tom\\\\\\ system and maintenance. The operational life of all well and septic systems are subject to `+i ��1�� these various and dynamic characteristics and are outside the control of the evaluator of the �' •�(i l well and septic system. Therefore, any estimate of how long a system will function satisfactory ��P• • • • for current or future occupants or guarantee that no unseen encroachments, deficiencies or A g•'• discrepancies exist can be given by First Water Consulting & F�![ S . / *• 9 TH 6. DSD SIGNATURE"�":'- • • Curtis 'Huff"Huan' System #1 Approved for bedrooms ��`�%r, CE 128991 .•�49AW Fq'•.4/18/�2•'F� r System #2 Approved for bedrooms ,1,\ ESS0 � Disapproved Conditional approval for bedrooms, with the following stipulations: OF' i WATER AN m 1 WAST" V'ATER Z^ J JJ O 1 1V7SERV1�� \\ Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other IC Legal Description: GLACIER VIEW HEIGHTS #2 BLOCK E LOT 12 Parcel ID: 050-491-47 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Well production at time of test 4.4+ gpm Date drilled 7/14/1997 Water storage tank volume NA gallons Total depth 201 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 40+ ft (ASSUMED PER MOA DOCS...) ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 0.416 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 18+ in. FWC" Date of flow test for COSA 4/14/2022 Collected by Static water level at beginning of test 0 ft. Date of Sample 4/6/2022 Comments SULLIVAN INSTALLED NEW SANITARY SEAL. SWL AT GRADE & DROPPED 20' DURING TEST. B. TANK DATA Age of tank(s) 27 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 48" ® Standpipes/foundation cleanout per record drawing Date of pumping 4/13/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/10/1995 ® ALL standpipes present per record drawing Total measured depth from grade 10.3 / 9.4 ft (max) Measured depth to pipe invert from grade 4.8 / 3.7 ft (min) ❑ N/A — pressurized field C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 4/14/22 Results M Pass For 4 bedrooms Fluid depth prior to test 0 / 0 in Water added 500 / 500 gal (N / S) New depth 21 / 18 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1400 min depth into effective IR SHOWS WED — SHOTS 5.51+ Final fluid depth 0 / 0 in ® Code -required soil cover over field Absorption rate 600+ gpd ❑ System presoaked Any rejuvenation treatment (past 12 months) N (Required if vacant for greater than 30 days prior to date of test) If yes, enter date Gallons introduced gallons NES Comments/Deficiencies: MEASUREMENTS AT GRADE & SHOTS. PER 2015 COSA & MOA IR DOCS. := 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' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® 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' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main >..10' Yes_ if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® 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 _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION ,�•�r li l certify that I have determined through field inspections and review ��,�Q`.: •' •' •:i�[�� of Municipal records that the above systems are in conformance g ' •:'� �� with MOA COSA guidelines in effect on this date. J : e • TH rj • Curtis Huffman rr� �'c�c,•.. CE 128991 .•��.,� '0 ROfESS100`��"�r ft ft ft ft ft ft ft ft Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221153 Subdivision: Glacier View Heights Block E lot 12 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA 1 property i§-27 -years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank. rt Mailing Address P O Box 196650 *-Anchorage, Alaska 99519 6650 *www muni org Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 Parcel I.D. GENERAL INFORMATION Complete legal description Location (site address or directions) Current Property owner(s) ~"~ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: Day phone ~:~¢2~ _ ~-¢,¢~,~ Mailing address Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:-')~/'~- NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on propedies served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 fRev 01,00V 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 adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. .,.1~, ............ NG 17034 Eagle Rivc. r L~op ~oad No. 204 Name of Firm ~agle River, ~,~,sl..~ 99577 Address : ~ Engineer's Printed Name -?1~,~.~¢ Phone Date DHHS SIGNATURE ,c~,*r c. COWA.~ ,' .~- .,. /,"'" Approved for bedrooms ......... ,.,-,. %~ ~ ~,, %.,., .- Disapproved. ~. ~,,~,..,,.~ .~. ~.~. Conditional approval for __ bedrooms, with the following stipulations. 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 iRev 01 001' CEIV D 825 L SIroot, Room 502 · ^nchoraOe, Alaska @~501 · (@07) 343-4744 Health Authority Approval Checklist Legal Description: ~-/Z/' 6'~'///' A. WELL DATA Well type /~/P"/¢-1'--~' Log present (~N) Total depth ~ / / If A. B, or C, attach ADEC letter. ADEC water system number Date completed ~/~/~ Cased to ~/¢ Casing height (above ground) Wires properly protected ~) Date of test Static water level Well production FROM WELL LOG AT INSPECTION WATER SAMPLE RESULTS: Coliform O Date of sample: ~_~///~//~-~ Nitrate Collected by: Other bacteria S & $ ENGINEERING 17034 Ea_~le River Loop Road Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed z~-/jO/'¢gTa, nk size /Z ~>~'~ Number of Compartments ~- Cleanout(~)N) FoUndatiOn cleanoul(~/_//N) ~/~$ Depres~sion (Y~ High Water alarm (Y/N) ,/~//~L Date of Pumping ,~;//'/~q Pumper kJ~T'~'% C. ABSORPTION FIELD DATA Date installed ~'/JO/¢~' Soi[rating~orft2/bdrm) O~,'~ Systemtype D~/.~.~-"~--~/~i.-(-- Length ~.~ Width ~" ~.¢ Gravel thickness below pipe ~-2 Total depth Effect,veabsorption area ¢~) ~:~ Monitoring TubepresenON)~¢'~Depressionoverfield(Y~ Date of adequacy test ¢/¢/~ Results(Pass/Fail, ~.,z~,.~ For ,~/~-~- bedrooms Fluid depth in absorption field before test (in.); -'~ Imme'~i~tiely afte~7~aL water added (in.): Fluid depth ~ (ins) Minutes later: ¢~) Absorption rate= '7/---~'~ g.p.d. Peroxide treatment (past 12 months)(Y/N)//~/I//¢ ,~-,J/~lf yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons "Pump 0 n" I...~~ ~~'Eatum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ,/~) Absorption field on lot Public sewer main /'t/ On adjacent lots / On adjacent lots /'~ ,O C-'- Public sewer manhole/cleanout N/,~- Lift station /K,,///~r-/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ t ~ Property line Absorption field / / Water main/service line /(.-/~- Surface water/drainage /~-/¢-- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ! Property line //O/'~/- Building foundation //'(~1~ Surface water Curtain drain Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots //~O /~/ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records ~n conformance w th MOA H~A gu del nes n effect on th s date Date 6 /,q/o~ *~%.,... CE-8801 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Lot 12; Block "E"- GLACIER VIEW HEIGHTS , Location (site address or directions) NHN C~rol Drive, Eagle River Mile 4.2 Eagle River Road off Myrtle Drive Property owner .... Mailing address Lending agency Mailing address A]ask~ r~RA E-(7.H./Pro[lerty Mngmnt..Day phone 786-2709 P.O. Box 196613, Anchoraqe¢ AK 99519-6613 Day phone Agent Address Day phone /Jim Levra Unless otherwise requested, HAA will be held for pickup. OF BEDROOMS: ,~ NUMBER TYPE OF WA'rER SUPPLY: Individual well XX 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. _ x× 72-025 (Rev. l191) Fronl MOA~21 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 tl~is Health Authority Approval application shows that the on-site water supply and/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type ofstructureindicated 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. _~ & S ENGINEERING Phone Name of Firm 17024 Eagle .......... ' *' .... Eagle River, Alaska 9~2577 Address Engineer's signature 6. DHHS SIGNATURE Approved for _ bedrooms. Disapproved. ~ Conditional approval for /~/7~'~-(4 bedrooms, with the following stipulations: z~(..~.t.~,~l,~,_ .?L~.,-- ~~ ~-~- ~-~' ~ .L, ~ ' /1 ~ -. Additional Comments By: 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 profesmonal eng'neer's work. 72A)25 (Rev 1/91) Back MOA Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~::~r \3.- ~¢_¢~._ ~_~_.~¢..~¢¢ %(,~v&~.l~arcel I.D. ~ &~¢ A. WELL DATA Well type ?¢.tk//'~¢.~ Log present~/N) ~ Total depth ~-o \ Sanitary seal (Y~ IfA, B, orC, attach ADEC letter. ADEC water system number Date of test Static water level / '~ Well flow Pump level Date completed ~ ~ ~ ¢'~'~' Driller Cased to ~ ~ ~ 4- Casing height Wires properly protected (Y~'i~) FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ -~ g.p.m. AT INSPECTION Absorption field on lot Public sewer main ,~Sewer service line '2~~' ~''~ WATER SAMPLE RESULTS: Coliform ~) ~"°""/~°~. Nitrate .Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed '~ Cleanouts ~/N) High water alarm Date of pumping ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria _ ~ b~,,.~ ~__ S & S ENGINEERING t"zo~'rk'~gtr~'~l~ o, 204 Eagle River, Alaska 99577 Tank size \C>~ Compartments Foundation cleanout~/N) "~ Depression ('~ P Alarm tested (Y/N) ¢'~/~ ~) \/--- Pumper k.) ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ,~ "~ To property line \o .~urface water/drainage 72-026 (Rev. 7/91) Front On adjacent lots \o~.~ Absorption field \C~ ~ k ~" Foundation Water main/service line (o~ C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical c~ SEPA~ANCE F.OM LIPT S"jlATION TO~ ~/.eh~n lot On adjacent lots Manufacturer Manhole/Access (Y/N) ~ "Pump on" level at ~off" level at ~ycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length '~- t Total absorption area Depression over field (Y~./~ Results(pas~,,~ g::~;'~-. ~ for Peroxide treatment (past 12 months) (Y~ Soil rating _ / 'Z-~' ~1¢;~_. System type _~'-~---~/,-¢-~¢-- L~T-' Gravel thickness Lo~ Total depth ~,\~ Cleanouts present'N) _ \,/ Date of adequacy test I '7~ ~ "Z.- ~,~.~ ~ l,~, bedrooms If yes, give date ~l/k SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ~ "~ On adjacent lots \ co ~.4-- Property line \ To building foundation \ c::'\ ~ To existing or abandoned system on lot On adjacent lots ~¢~ \ ~ Cutbank ~//k Water main/service line Surface water ~ c)~ t~- Driveway, parking/vehicle storage area I ~'urtain drain ~l,~,.. ~-~'~"('/----'~1~ "'1-~-¢, ~ 0'~.'¢.~¢~.~. E, ENGINEER'S CERTIFICATION I certify that ! have checked, verified, or conformed to all MOA and HAA guidelines in effe ~ date of this inspection. Signature Engineer's Name Date ~ & ~ ENGINEERING 17034 Eagle Rlve~' hoop Road No. 204 ~a(jte River, Alaska ~9577 HAA Fee $ f 7 Date of Payment Receipt Number 72 026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number .?~.~.~x:,.~.~...,~.~,, OG ,OF DRILLING by A t, L DRILLING COMPANY ~ ~"'~ ~~ ~ Ir/- ~ ~',-.~ ............................... ~--,~..-.., ................... ,,,,~ o~ ,,,, ...... ~..~/ ....................... ,' ADDRESS ........................... .~ ......................... ~ ...... '"=L S,T, ~X P......X.. .~.~_.Z K~ ~' ~.. i STATIO LE,,EL oF w~.R ~. ./.~ .......................... ............................... lx ....... : ....................... ,RAW Dov,~, FT .... /',~. ~ 'DATE--STARTED ~ 7 ..~-...._~_~._.,,:.,. ............ ,.~ ........................... "A~'--ENDED ....... '/":/'"'~____~--~----2-..q.. ............... KIND OF FORMATION,. ............................................. FROM ........................ FT. TO ........................ FT ............................... FROM...,i-.c~,, .......... ~r. TO...,/...,~.. ............ FT..~......~...#.I.[...~-- ~'ROM ........................ ~. tO ........................ ~ .............................. ~o .............. ~. ~o_. ~ / ~ ~ ~,~z~o~ ~ ,.o ....................... ~ ..... ~o~....~...l ........ ~. ~o... . ~. ~- ~ g~ ~ ~ ~o~ ............................ ' .................... ~. TO ............... ,~o~,',,E..~.....~. ~o / p ? ,~ p~ ~.~. ~,. ' .............................. -, ....................... r .......... ~-~.---~~ ~0~ ........................ ~. ~0 ,~o~...x.~..e ...... ~. ~o../t.~_ = ~, ~K ~,~o~ ,~ ....................................................... ............................ ' ........................ ~0 ........................ ~ .............. ~...~...~....~...:..r~.~.~. ~Q~ ........................ ~. ,to ........................ ~ ............................... .................... ........................ ............................... DRILLER'S NAME . ...~:.. ...... ~ CHEMICAL & GEOLOGICAL L4BORATORY 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 $ 61234 Chemlab Ref.~ 92.6638 Sample ~ 1 Matrix: WATER Client Sample ID PWSID Collected Received Preserved with L12 BLK E GLACIER VIEW HTS Client Name :S & S ENGINEERING UA Client hcct :SNSENGP 12/01/92 0 18:30 h~s. BPO# : 12/02/92 0 15:20 hrs. Req# : Ordered By :R. SNAFER POS :NONE RECEIVED Analysis Completed : 12/03/92 Laboratory Supervisor : STEPHEN C, ED~ Released By : ~ L~, ~ Send Reports to: l)S & S ENGINEERING Paramet ez Results Units Method Allowable Limits NITRATE-N ~ mS/1 EPA 353.2/300.0 10 Sample ROUTINE SAMPLE COLLECTED BY: S.S, Remarks: I Test8 Performed ' See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-Greater Than Member of the SGS Group <Soci~tO G~n~rale de Surveillance) CHEMICAL & GEOLOGICAL A'DIVISION OF COMMERCIAL TESTING & TELEPHONE (907) 562-2343 Drinking Water Analysis Report for Total Coliform TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D. # [] PRIVATE WATER SYSTEM ITO BE Mailing Address $ & $ ENGINEERING Phcxle NO. 17034 Eagle ~ver Loep Eegle Ri~, ~aska C~y Mo, Day SAMPLE TYPE: ~ [] Routine ~ E] Check Sample (for routine sample' ' with lab ref. no. ) E] Special Purpose State Zip Code Year [] Treated Water [] Untreated Water SAMPLE Time No. LOCATION Collected 51 I Collected By 4BORATORY iGINEERING CO. i633 B Street trage, Alaska 99518 ;acteria COMPLETED BY LABORATORY Analysis /~Satisf n Unsat [] Samp not b( to ind new: Date Ftc .=lved Time Fie elved hews this Water SAMPLE to be: ~ory sfactory e too long in transit; sample should over 30 hours old at examination ;ate reliable results. Please send ~mple via special delivery mail. Analytical Method: Membrane Filter No, of colonies/100 mi, Lab Ref. No. Result* I Analyst * ;~ = ¢"' I~-._~, '~..~ ~0-'''''/ BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count Coliform/100 mi BEFORE Verification: LSB Fecal Coliform Confirmation BGB COLLECTING SAMPLE TNTC = Too NUl OB = Otl3er Bac Final Membrane Fl~e~..S' Coliform/100 mi Reported By //'~ ~ Date Time: /~0~ a.m. PART ONE OF TWO REMAINDER TO FOLLOW 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 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 12; Bl~c~ E; Gla~¢r Vi~ Heig~s Location' (site. a~ress or directions) Carol Drive ' .Prop~(t~ owner, r'' '~-, '~On ~ L~nda H~ /f;'.Mailingadd[essr.'* HC 85 8cz . Lending agency.- "¢ Mailing address Agent Eva LokEn/ REMAX OF EAGLE RIVER Address Day phone Ea,qle, Riv~r~ AK 99577 16600 Ce, nte/£fie~d Drive Eagle, Rive~, 694-4255 Day phone Day phone 694-4200 AK 99577 '. ~ ...!~._:_ .UnJ_ess_othe .rwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 .... , _. 3 ...... TYPE OF WATER SUPPLY:.::~"~" .,!:.: ~;.~ . ........ ..... ' Individual well" ..... xxx ,Community well Public water NOTE: If community well system, provide written confirmation:.from State A,,,DEC attest. ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL:. , (,,,,,%,~%.L.',.~,_. XXX -' <.'~ ?,,.- ndivdualon-site . -:., ...:. -;.,~.:., · .' "'~.;~ . -., ::'. . L,..:..-...: ./4:: : Holding tank .... '.':' ;. ' -", Community on-site · . ' ' "' Publicsew~r "'.; '.. ". . ' 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 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/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 invest, i_gation 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 S & S ENGINEERING Phone ~ ~/~ ~ ~'-°/7~ 11034 EagJe River Loop Road No, 204 Address Eagle Rlv~, Al~ka, 99577 ~ ,/ DHHS SIGNATURE Approved for / Disapproved. - - Conditional approval for bedrooms, with the following stipulations: /"?' 9 Additional Comments ," (,,,.} .? ', . ' .' ;:~ '; ~,,iq\',-,' 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 ~lata before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-4325 (Rev, 1/91) BeCk IVK~A e21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ,. ,, Legal Description: LOT I~ .~-~,. 1~ , ~Lc~..~e~,V~ ~'Parcel I.D. A. Well Data Well type ~vA-~ Log present,N) y~-~ Total depth ~o( ' Sanitary seal ¢~',J) "/~-<~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed '7-H ~ -7'-I Driller Cased to c~°' Casing height t~" Wires properly protected ~¢4) g.p.m. Date of test Static water level Well flow Pump level1 FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Io-7 ' Absorption field on lot. ~o~ Public sewer main Sewer service line AT INSPECTION ; On adjacent Jots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: ~ -' 1 5 -~ ':5 ,// Nitrate o.! ~ Other bacteria ~'--/ 7-~ J~ Collected by: ~-o+% B. SEPTIC/HOLDING TANK DATA Date installed 5 - I0 - ct 5 Cleanouts'(~N) 'y~, High Water alarm (Y~)! Date of pumping hJ/A Tank size l~%o ~,~.. Compartments Foundation cleanout ~N) ~ Depression (Y/~ Alarm tested (Y,~ c*~c,O o~ ¥%T-~,4, Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot i o '~ To property line ~q Surface water/drainage On adjacent lots Absorption field Foundation s~q Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE F~O..~~'~''~ _~WC.e~'~'~ On adjacent lots Manufacturer Manhole/Access (Y/N) ~~¢..~~"Pump off" Surface water D. ABSORPTION FIELD DATA Date installed ~- - l o - of ~- Soil rating (GPD/Ft Length ~ ~ ' Width ;~.S ' Gravel thickness Total absorption area ~00 FL ~ Cleanout present~) '7 Date of adequacy test ~ ~j~_.,o svs-r~-.~ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/~ ~o - t~.~ System type ~)~E:p Total depth Depression over field (Y/(~ /',4'o for Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot loD t To building foundation On adjacent lots Surface water Curtain drain On adjacent lots Property line Cutbank To existing or abandoned system on lot too Water main/service line Driveway, parking/vehicle storage area i I o 14- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72~026 (3/93)~ Back Waiver Fee $ Date of Payment Receipt Number 05×17×95 0?:50 COMMERCIAL TESTING ~ 90?6941211 N0.479 Q02 CT&E Environmental Services Inc. Laboratory Division 9s. 680- Laboratory Analysis Report WATER L12 BLK E UI~CIER VIEW HTS ordered By ~, COWAN ProJec~ Name ProJe~t~ PWBID UA WORK Order 14691 P~tnt~d Date 05/17/95 $ 08~25 h~o. Collsct,d Dat~ 05/15/95 Received Date 0~/~/95 Te~hn~ca~ Dlrecto~ STEPH~N C. ~DE Sample R~marks: SAMPLE COLLECTED BY: DAVE, OC Allowable Ex~. Anal Parameter Results Qua% un,ts Method bimi~e Date Date Init Nitrate-H 0.~9 m~/b EPA 353,2 10. 05/15/95 CMR See Special Instructions A~;ove UA = Unavailable See 8ample Remarks Above NA - Not .Analyzed Undetected, Reported valus ie the prac%iual ~antif[cation limit, LT = L~ee Thail Secondary dilution. GT = Greater Than 200 W. Potter Drive, Anchorage. AK 99518-1~05 -- Tel: (907) 562-2343 Fax: (907) 581.5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI, NEW JgRSEY, 0HI0, WEST VIRGINIA NU, 4~i ~Ud ztK CT &E Environmen tn ISa tv ices Inc. Laboratory Division Drinking Water AnaLysis Report for Total Coliform Bacteria 20o w. Anchorage, AK 9951 READ IIYSTRUCTION$ ON REVERSE SIDE BEFORE CO£££CTZNG S.4MP£E Tel: (907) 562.2343 Fax: {907) 561.5301 MUST BE COMPLETED PUBLIC WATER SYSTISM I.D. # PR,rATE WATER SYSTEM )8[.. Send Results ~3 ~?end h~voice [3 ,Yenfl Invoice SAMPLE DATE: Month SAMPLE TYPE: ~ l Routine o Repeat Sample (for routine sample with lab tel no. ) O Special Purpose SA~4PLE LOCATION Day Year Treated Water Untreated Water Time Collected Collected By TO {~, dom PL~3TED bY LABORATORY Analxsis shows this Water SAMPLE to be: ~,/"~'SatisthOtor7 Unsatisfactory Sample over 30 hours old, results may be Unrcliuble Sample tau long in transit; sample should not be over 48 ]tours old at examiltation to indlcatc reliable taBu[ts. Please send new sample via special ~div¢ry mail. Time Received O ~ff.~- Analysis Began Analytical Method: '1~ Membrane Filter Q MMO-MUG Number ot colonies/100 mi. Lab Ref. No. Result* Almlyst S~6t Io A.D.E.C. ~t;tch Fbl(~ Jun Client notified 0runsntisfoctory rebaits: Spoku Mth Time: BACTERIOLOGICAL WATER ANALYSIS RECORI) MMO-MLtG Result: Total Coliform Membrane Filter: Direct C(~unt (~ Verification: LTB BOB Fecal Coliform Confirmation Final M0mbrano Filler Results (~ . E, Colonies/10]} mi COL, IFIRM C01iform/100 mi Time ~ hrs I,"axed Fnxed TNTC = T~O Numerous Tu £'uant 011 - (fiber Ilacterlo ~l~~ Member of ~he 8GS Group ($oei6~6 G~nGrale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA, ~LORIOA. ILLINOIS, MARYLAND. MICHIGAN. MI$SOUBh NEW JERSEY. OH[O, WEST VIRGINIA Eagle River Area GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 '~C" Street, Anchorage, Alaska 99503 274-4561 Date Received 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: Spokane Mortgage Company 3201 C Street, Suite 250 Phone: 277-0543 Gary E. Lee Phone: 279-1441 (w) 694-2293 (h) Star Route Box 193-P Eagle River 99577 3. Legal Description: 4. Location: ~.~r_ol Drive 5. Type of facility to be inspected 6. Well Data: Lot_ 12 Block E Glacier View Heights Single Family No. of bedrooms 3 A. Type C. Construction 7. Sewage Disposal System: A. Installed 1974 C. Septic Tank: D. Seepage Pit: E. Disposal Field: 8. Distances: Individual B. Depth D. Bacterial Analysis On-site system 201' l. Size 1. Absorption Area Total length of lines B. Installer 2. Manufacturer 2. Material A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Other contamination , Absorption area , Sewer Lines C. Absorption area to nearest lot line EQ-O34 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION FE. 8 'r 1977 RECEIVED MUNICIPALITY' OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY- Sewer and Water Sectlon 825 "L" Street, Fourth Floor, Anchorage, Ak. 99503 279-2511 Ext. 229 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES I. Type of Inspection: CMRO VA FHA CONY 2. Property Owner: Gary E. Lee (work) (home) Mailing Address: Star Route Box 193P: EaBle RJvmr Day Phone 279-1441 or 694-2293 3. Name of Buyer: same - refinance Mailing Address: same 4. Name of Lending Institution: Spokane Mortgage Co. Mailing Address: 3201 "C" Street~ Sulte 250 Day Phone s~m~ Phone 277-05'43 5. Name of Realtor or Agent: Mailing Address: __ none Phone ...... 6. Legal Description: Location: _ Lot 12, Block E, Glacier View Heishts Addition Carol Drive, Eagle River 7. Type of Facility to be inspected: single family residence No. Bdrms. 3 Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served 201 feet If Individual, depth of well individual One XXX Sewage Disposal System Type of System: If Individual, date of installation Public Utility Individual (on-site) x×x June, 1974 MUNICIPALHY OF ANCI-toRAGt! ~NVIRONMEH [^.L Page 2 of two pages - Re, st for Approval of Individual F ~r & Water Facilities Legal Description Lot 12 Block E Glacier View Hei,ghts Comments Approved Disapproved Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of EnVironmental Quality DIAGRAM OF SYSTEM 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) 06~1220~a) Rev. 1973 DATE ALA~ DEPARTMENT OF HEALTH AND SOCIAL SE: 'ES DIVISION OF PUBLIC HEALTH Lab Iqo. INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL 'WATER ANALYSIS omcE INDIVIDUAL NAME ADDRESS CITY ADDRESS OF SOURCE SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO ZIP CODE --' COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY - DATE COLLECTED TiME COLLECTED Well- ~ Dug [] Driven [] Drilled [] Bored SOURCE: [] earing ~ Cistern [] Other Dug Well or Cistern Construction: WalJs--[~ Wood [] Concrete [] Metal [] Tile Brick or Top -- [] Wood ~ Concrete [] Mela [] Open Top _1~ Concrele LOCATION: [] In Basement [] Basemenl Offse~ [] Under House []in Yard [] Olher Building Sewer Septic DISTANCE TO: or Olher DroJnage Pioe Feet. Tank .Feel, Tile Seepage Cess- Field- Feet, Pit. Feet. Pool Feet, Privy__ __Feet. Other PossibJe MATERIAL: Building Sewer- [] Cast iron [] Woad [] Tile [] Fibre [] Asbestos [] Plastic JoJnl Material - Type GENERAL: Does Water Become Muddy or Discolored? [] Yes [] No When? Diameter of Well Depth Feel. Well Casing Material Diameter Depth Lenglh of Waler Deplh From Botlom _ Feel. Drop Pipe Offset in In Utility PIJMP LOCATION: [] In Well [] Basement [] In Basement [] Room On Top [] Of Well [] Other PURPOSE OF EXAMINATION: Illness Suspected? [] Yes New Source of Supply? [] Yes [] No Repairs to Syslem? READ INSTRUCTIONS Analysis shows thls Waler SAMPLE to be: [] Satisfaclory E UnsaHsfactory [] Questionable [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. [] Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS ON REVERSE SIDE BEFORE COLLECTING SAMPLE 06.1220 (b) Rev. 1973 Dale Received Laclose Broth 24 Hours 48 Hours BHIlianl Green 24 Hours 48 Hours EMB Lactose Broth, 24 hrs. Coliform Density MF Results [] No [] Yes [] No Signalure BACTERIOLOGICAL WATER ANALYSIS RECORD : ' / - ' ~ ~'ime Received ~ / pm Lab. No. AGAR AB hrs. Groin's stain Reporled by TBis analysi~ indicates Coliform O;ganJsms to be: Absent (Mosl probable No. per 100cc)