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GLACIER VIEW HEIGHTS #2 BLK E LT 11
leci¢ View Heights Lot 11 Block E #050-491-46 Municipality of Anchorage Page / of 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/~(~(~c~ ~-~ PID Number: (/~"~) --'/~?/- Name: -¢'J'~-~'~-~ ~/~.,~/~. Wastewater System: ~ New ~pgrade Address: ~/ ~./~ ~ ~ ABSORPTION FIELD Phone: ~~ INo. of~drooms: ~eepTrenoh D Shallow Trench OBed OMound ~Other Total Depth from ori inal grade: LEGAL DESCRIPTION S°ilRatin9: ~ GPD/Sq Ft Gravel depth ben ath pipe Township: J Range: J Section: Fill added above original grade: Gravel length: /r+ Ft. ~'U/¢~ ~ F~. I I WELL:~.~'~/~ New g Upgrade Gravelwidth: Numberoflines: JDistancebe~eeniines: ~ Ft. ~ /~ ~ Ft. ~-M~ /~/ Ft. ~ Ft. ~ SQ. Ft. '~ Date Drifted: Static Water Level: ns aller~/~ ~ Date installed: 8~TlO~ DIST~fi8 ~ptic ~ HolOin~ ~ S.I.E.~. Sudace Water /~*/~ /~¢+~ ~ ~/~ ~ LIFT STATION / ~ ~ / ~ ~ ~ "Pump on" level at: ~" leve[ at: High water alarm at: Foundation Cu~ain ~'~ ~ ~Drain ~ ~' '~ ~/~ '~ ~ IElectrica[Inspecti°nspe~°rmedby: Remarks: ~ ~,F~~ ~,~ BENCH MARK Location and Description: ~¢~ Assumed /~ ~ ~t, Elevation: ~""' ;" h¢.~"l, Inspections pedormed by: ~-~ ~ Dates: 1st ~ ~.T~,.,% .~ 2nd ~ ~ ~-~,,~. ~ .... ~'"~ Department of Health and Human Se~ices approval t~~~-- Reviewed and approved by: ~~ ~' ~ Date: ~'?~ ~ :~ ~;: ' ' 72-013 (Rev. 9/91) MOA 25 \ \ \ \ \ \ \ \ I I :'oN Old ~# NOISIAIOSflS 'SIH M31A ~1313V'19 '3 )0018 '1.[ lOq:u°p'd?osa(] IO~a7 · oN i]'u~Jad V :'ON Old ~# NOISIAI(]Sr~S 'SIH /~31A ~J313VTO '3 ~3078 '[.L 107 :UO!~d!JO$@~ iDEa7 ~ jo 'oN ]!WJ~d :'ON (lid · oN i]'LUJad Douglas T. Kenley, PE 9960 E. Pttffin Dr., Palmer, Alaska 99645 (907) 746-1076 July 29, 2000 Mr. Dan Routh Municipality of Anchorage Health & Human Resources On-site Services Re: Waiver on separation distance from septic leach field to lot line. On Lot 11, Block E, Glacier View Heights Subdivision #2 23062 Glacier View Dr., Eagle River, Alaska 99577 Owner: Stephen Hennig Dear Mr. Routh On behalf of my client, Mr. Stephen Hennig, I am requesting a waiver on a separation distance of less than one foot from septic leach field to the north east property line on the above referenced property. Space was a limiting factor because of the triangular utility easement that occupies so much of the lot, and the 100 foot well radius. There are no adverse effects that will be incurred on the adjacent properties. The lot and adjacent lots are more than 2 acres in size. If there are any questions, or if additional information is required, please feel free to contact me at 746-1073 or 243-5372. Sincerely, De~Ke~176. Encl.: HAA certificate application HAA check list On-site inspection report Asbuilt drawings MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Worksheet WR#: WR000056 PID#: 050-491-46 HA#: HA000347 Date Received: August 3, 2000 Legal Description: Glacier View Heights #2, Lot 11, Block E Engineer: Douglas Kenley, PE 9960 E. Puffin Dr., Palmer, AK 99645 Applicant: Stephen & LouAnn Hennig Waiver Requested: less than one foot lot-line waiver Permit~: Criteria: 1. Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other: Total: Waiver is Granted: List Conditions or Reasons for above: Waiver is net Granted: Date: ~- 7~ O Rec#: 06198 Amount: $'115.00 .......... J~'-m~ Reviewer Date Paid: 8-3-00 Douglas T. Kenley, PE 9960 East Puffin Palmer, AK 99645- August 07, 2000 Subject: Waiver Request for GLACiER VIEW HEIGHTS #2 BLK E LT 11 Waiver # WR000056 Lot Line Request for Parcel ID 050-491-46 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is .5 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Engineering Technician III On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 7 - 2- o ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jun 30, 2000 Expiration Date: Jun 30, 2001 Permit Number: SW000206 Legal Description: GLACIER VIEW HEIGHTS #2 BLK E LT 11 Design Engineer: 0069 Douglas T. Kenley, PE Owner Name: Steve Hennig Owner Address: 321 Kayak Dr. Anchorage, AK 99515-3655 Parcel ID: 050-491-46 Site Address: 023061 GLACIER VIEW DR Lot Size: 106502 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [~ Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at Feast 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE EXISTING SEPTIC TANK SHALL BE ABANDONED IN ACCORDANCE WITH AMC 15.65. Received By~._~,~~ ~w/~.~¢~ Issued By: ¢ Date: ate: Douglas T. Kenley, P.E. 9960 E. Puffin Ddve, Palmer, Alaska 99645 (907) 746-1073 June 22, 2000 Mr. Steve Hennig, Owner Lot 11, Block E Glacier View Heights Subdivision Addition #2 Eagle River, Alaska PERCOLATION TEST RESULTS AND GENERAL SITE INVESTIGATION REPORT ,< CEiVEL JUN 22 2.000 ~,,~JI'q~.!P^LI J¥ OF ANCHORA(~E ,~'~ "-~M~NIAL SERVICES DIVI*' On June 9, 2000, the above-referenced site was inspected in support of this application for approval to upgrade the on-site wastewater disposal system., The inspection consisted of soils percolation tests and an overall conditions survey of the property. The present wastewatar disposal system was previously buried with fill in 1997 when a new driveway was constructed. An attempt was made to locate the crib that was installed in 1974, but was unsuccessful. The site is located on 23061 Glacier View Drive. The inunediate area that has been selected for the replacement wastewater disposal system has an average slope of 2 to 6%. The site is moderately treed with birch, spruce and cottonwood. On-site observation and physical survey show that there are no water wells nor private wastewater disposal systems within a 100' radius of the proposed system. No surface water was observed at the time of the inspection, and it appears that there is no potential for contamination of adjacent water wells or streams from known sources. One test hole was dug to a depth of 17 feet. The hole had a pemolation test preformed to assess the adequacy of subsurface soils to accommodate the replacement on-site wastewater disposal systems. The results of this test is attached to this report. The test site had adequate percolation rate to support the existing three bedroom residence. Subsurface soils were found to be sand and gravel with some silt overlain by 16" of surface organics. The percolation rate for the soil was found to be 12 minutes per inch. The proposed system will have no measurable impact on additional reserve space, surface or subsurface drainage or on drainage from adjacent tots. Attached are proposed design drawings for the replacement system and soils log report. If there should be any questions concerning the percolation rate or charaeteristlcs of the site, please call me at (907) 746-1073 or 243-5372. PE#8176 I STEVE HENNIG I DOUGLAS T. KENLEY, P.E. I lOT 11, RLOOK E, OL^CIER VIEW ~TS #~ SUBD. EAGLE RIVER, ALASKA ( ? STEVE HENNIG LOT 11, BLOCK E, GLACIER VIEW HTS ~2 SUBD, EAGLE RIVER, ALASKA DOUGLAS T. KENLEY, P.E. STEVE HENNIG LOT 11, BLOCK E, GLACIER VlEW HTS 12 SUBD. EAGLE RIVER, ALASKA I DOUGLAS T. KENLEY, P,E. © 0 MR. *STEVE HENNIG LOT 11, BLOCK E. GLACIER VIEW HTS SUBD EAGLE RIVER. ALASKA PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL D~SCRIPTION:~ ~ ~/~' _~j~ c'~,~.~'x~"'z~ Z.~U////~Townsh,p. Range. Sect,on: SLOPE SITE PLAN ENCOUNTEREO? 1 2 3- 4 5 6 7 8 9- 10- I1 s DEPTH? -- ' P E 13 15 16- ]7 ~' ~.'~ // 18 19 20 Oel~lh lo Waler After ,.-/× Moniloriflg? /~'/~- Oale: ........... "' -- & Reading Oale Time Time Waler Orop QGRE~ ANCHORAGE AREA BO,'" 'GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99,503 NAME LOCATION INSPECTION ~fl ~oq'r REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM LEGAL DESCRIPTION L~'I- jj ~/~L¢)(.~ ~.- ~l~l~(.'ii~. SEPTIC TANK: DISTANCE FROM WELt INSIDE LENGTH MANUFACTURER _INSIDE WIDTH MATERIAL <~l-~f~ NUMBER OF COMPARTMENTS LIQUID DEPTH __.LIQUID CAPACITY 1~)00 GALLONS. SEEPAGE PIT: NUMBER OF PITS i . DIAMETER 60~ OR W,DTH IS-' LENGTH iF' DEPTH LINING MATERIAL ~-'~0("~ CRIB SIZE: DIAMETER ,-~-- DEPTH DISTANCE FROM: ~u~.u~ ~o~.T~O~ '~7~', .~*.~ST .OT .~ /~' TOT*. ~T~W ABSORPTION AREA (WALL AREA) .SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION ~¢'1~¢¢~ ~ DEPTH J(~O' DISTANCE FROM: SEPTIC ,~, SEEPAGE TANK (~ SYSTEM NEAREST NEAREST LOT LINE SEWER LINE OTHER SOURCES DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No, EQ~031 DATE V G.A.A.B. [V~-W r)?.il.!2NG, I,¢. P. O. t~ox 4-1224 · 1310C In!,elnational Airport Well Owner (907) 274-4611 ANCHORAGE. AI.ASKA99509 DRII. I,If'!O ...... Use of Well_:_:~ Location (address of: Pown, hq), Range, Section, if kno~vn; or distance main road__~'.'_L. Size of c..smg ~_, Depth of Hole__. -' - ,~ feet Cased to .~ .... feet ,~tatm water ieveL-:''; ...... ft. (aboye) ,. (bel09)) land surface. ,~lnt~h of well t~l~e-,~ one) open c.,d ( Screen ( ); Perforated ( ). Describe screen o~ perforation _L ; · Well pumping test at__~____gallons per (hiSui') of drawdown from static level. ' Date of completmn ,~_-, u~L_J::- ' - (ininute) for_ _~hours with _ '~"] WFLL LOG ); .ft. Depthiu feet from ,. . -', . . , .. , ., · -.. ,,,,,: ground surface ,, ' .- Give detaiIs of formations penetrated, size of material, celor and hardness .......... TO LFL ':-' 3 - CON FP, ACTOR GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4§61 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO, NAME DP INSTALLATION LOCATION INSTALLATION Of: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED 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 FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIt WALL SEEPAGE PIT ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK , SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIBCROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST lEON SIPHON PIPES ON SEPTIC TANK AND SEEPAge PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS RE~/~RDING INSTALLATION. LICENSED DESIGNER 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 SAIG CODE, DATE APPLICANT'S SIGNATURE OEtE Russell Oyster 694-2774 Soils ~ Foundations GEOTECHNICAL F:r DEVELOPMENT Box 90, Davis St,, Eagle River', Alaska 99577 694-2774 or 688-2280 CO. Earl EIIL~ 688 2280 Land Development Perfomed for: SOIL LOG Mailing Address: ~-~'c>~ ~: ~ · Legal Description: 0 1 2 Soil C~h_am__r._a..c_ % e r i s t icj_. 4 6 7 8 9 lO Ground Water Encountered: Yes Proposed Installation: Seepage Pit __ No v//lf yes, wh~t depth.~ ~'//Drain Field~ MUNICIPALITY LITY F ANCHORAGE Development Services Department T Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-491-46-000 Expiration Date: 1/2/2025 Legal description GLACIER VIEW HEIGHTS 42 BLK E LT 11 Site address 23061 GLACIER VIEW DR Eagle River AK 99577 Current property owner(s) BUTLER SHARON XThe On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 1/11/2024 Xhis Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approva"une 2022 MUNICIPALITY ORICH Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-491-46 Complete legal description GLACIER VIEW HEIGHTS #2 BLK E LT 11 Location (site address) 23061 GLACIER VIEW DR, EAGLE RIVER Current property owner(s) BUTLER 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑E Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Agela qI - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $_ 5 Date of Payment I -z-D Z COSA # O SCC2 41 C'02 Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 COSA Checklist Legal Description: GLACIER VIEW HEIGHTS #2 BLK E LT 11 Parcel ID: 050491-46 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA X Well log is filed with Onsite (or attached) Date drilled 6/74 Total depth 101 ft Cased to 20 ft MR Sanitary seal is functioning correctly ti❑ Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 5/27/22 Static water level at beginning of test 25 ft. Comments WELL IS LOCATED IN THE MECH RM. B. TANK DATA Measured operating fluid level in septic tank 48_� Date of pumping 1/2/24 ❑ Required maintenance completed, if AVWWS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/20/00 ❑Q ALL standpipes present per record drawing Total measured depth from grade 10/10 ft(max) Measured depth to pipe invert from grade 6.5/6 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Q Monitor tubes go to bottom of effective. If not, state depth into effective _ ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 0 gallons date Any rejuvenation treatment (past 12 months) If yes, enter date COSA Checklist June 2022 Well production at time of test 3+ gpm Water storage tank volume NONE gallons Well disinfected for coliform test? ❑ Yes No X Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 1/2/24 MNA C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5/27/22 Results Q Pass Fluid depth prior to test 0 in Water added 450+ gal New fluid depth 0 in Elapsed time 1140 min Final fluid depth 0 in Absorption rate 450 gpd 111 ml 4 DIPt if-%O&ZI11 61-1di7 X016MI4M Effective depth (per record drawings) 42/48 in Effective depth used 0 in Effective depth remaining 42/48 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Fn Yes if No _ ft ❑0 Yes if No _ ft Neighboring Tank > 100' Yes if No _ ft Private Sewer/Septic Line > 25' Yes if No _ ft Absorption Field on Lot > 100' Yes if No _ ft Holding Tank > 100' Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑� Yes if No _ ft Qi Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑s Yes if No _ ft []i Yes if No _ ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑E Yes if No _ ft Surface Water > 100' Yes if No It Tank to Property Line > 5' ❑ Yes if No 0_5 ft Wells on Adjacent Lots: Field to Property Line > 10' Water Main > 10' Water Service Line > 10' Yes if No _ ft ❑E Yes if No _ ft Z Yes if No _ ft F. ENGINEER'S COMMENTS * SEE MOA LOT LINE WAIVER Private Wells > 100' Community Wells > 200' 0 Yes if No _ It Q Yes if No _ ft If tank or field is under driveway comment below G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Mi:t -e_ " r L e rain �= . Engineer's Printed Name �iwwei COSA Checklist June 2022 Phone 727-8864 Date t ro/a-f xas C. (err �r�'T.a ✓ •k...d.Qjki. • • • • ..d • ' I �• MICHAEL N. AC\DE RSciN•;; •�•f' P' ; f . CC} 4469 pfOf�9F •!�:O/�� ��ryy MUNKI AUTY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site Water and Wastewater Section v` _� Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241002 Subdivision: Glacier View Heights #2 Block:E, Lot: 11 The septic tank for this property is 24 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. MUNICIPALITY OF / y�l i• i Development Services Department On -Site Water & Wastewater Section - Parcel I.D. 050-491-46 ANCHORAGE Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Phone: 907-343-7904 Fax: 907-343-7997 3-ts- 20Z -Z- Complete legal description GLACIER VIEW HEIGHTS #2 BLK E LT 11 Location (site address) 23061 GLACIER VIEW DR, EAGLE RIVER AK Current property owner(s) CAHILL Mailing address Real estate agent SAME 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well E] Private Septic 0 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 $ 50 Date of Payment 5 31 02 Receipt Number 03 .i 3 y 5 COSA# 0,5 G 22 12-4 g Waiver Fee $ Date of Payment Receipt Number 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. l 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name 6. DSD SIGNATURE MIKE N ANDERSON, P.E. System #1 Approved for 3 bedrooms System #2 Approved for , bedrooms Disapproved Conditional approval for bedrooms, Date 5'29-2 .._1- 49TH MICHAEL N. ANDERSON ;'' �tc •• CE -946,9 . •, ,.,, with the following stipulations: By: V"Originai 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other S-Ifee-k 4a*t 10 Legal Description: GLACIER VIEW HEIGHTS #2 BLK E LT 11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6/74 Total depth 101 ft Cased to 20 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 5/27/22 Static water level at beginning of test 25 ft, Comments WELL IS LOCATED IN THE MECH RM. B. TANK DATA Age of tank(s) 2000 years Tank type/material SEPTICWEE Measured operating fluid level in septic tank 48" ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/27/22 D. ABSORPTION FIELD DATA TESTED EAST TRENCH Which system tested (date installed) 7120100 ❑ ALL standpipes present per record drawing Total measured depth from grade 10/10 ft (max) Measured depth to pipe invert from grade 6.5/6 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 050-491-46 Structure served by this system Well production at time of test 3.0+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.597 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L HE Arsenic less than MRL (ND) Collected by MNA Date of Sample 5127122 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5127122 Results Q Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450+ gal New depth in Elapsed time 1440 min ❑ Code -required soil cover over field Final fluid depth in in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) UK date of test) 0 Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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' 21 Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No ft Neighboring Tank > 100' ✓] Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' �M QQ Yes if No ft Water Main > 10' Animal Containment > 50' Yes if No ft Yes if No It Yes d No ft Water Service Line > 10' Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' Q Yes if No ft n Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 21 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' if No Yes if No ft Private Wells > 100' QQ Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' Yes d No ft 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 0.5 ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' M✓ Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100' [a Yes if No ft F. ENGINEER'S COMMENTS * SEE MOA LOT LINE WAIVER G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet OF f y•. MIA • a Y � of 49TH ; ��•• MICHAEL N. ANDERSON ; /� Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221248 Subdivision: Glacier View Heights #2 Blk E lot 11 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA / property is 22 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 in failure and should be replaced. MaiUng Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org za ,90.09Z M„O1,20.ON LLLC G, It 114G (Din a kI y * to P' Q1 W 0 OON��cd. J J , N � r- E J m4C12 W 7 0 � �7 U .-i O vo 003 Lli "<, 110 9 O m 6 c.04 AMW -�&ji �<J IL �O 0 • V 3 r' z� Go 0 ; ?O 6 /� �® Sic: .'• �e� is Lli o J �— A C S U dj vv a x O � m /�� 1 ••V�,1x, N cCd vii w0 v ?? m N c[ c a o 'er~ a•� o w� (��,Ct>^ 0LO 11 Ol l(i t, y C s �rWphI Q "�vt iC� > N Z V rn C -0 Cl >� b N J O ti+ C, o T � o Cl c9�a° ;ate w O °' / O 'L yy W o a� y �, x kt z; '�� g W5U G: o.-9 >o> p� W a0 m N yE—ca c Z u z �6. tiles_ U°n �E-- O cR Ln .� V > p wc0 �°'c � x N 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 1. GENERAL INFORMATION Complete legal description Location (site address or directions) ~ ~ ~ ~ ~ ~---~'"~¢~ ~/¢ ~-~ ~:~'~' /~/"¢~=~ Property owner Mailing address Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well "/ Community well Public water 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. STATEMENT OF INSPECTION BY ENGINEER As certified by my sea[ 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. [ further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation end 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 Address ~'/ '? ~' Engineer's signature Date ''~' ' I' ~'© bedrooms. 6. DHHS SIGNATURE .......... L/Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisf~ 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. Municipality of Anchorage AUg 0~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) Health Authority Approval Checklist Legal Description: Parcel i.D.: A. WELL DATA Well type Log present (Y/N) Total depth / ~ / Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~--/'~'~2/ Cased to ~ "~'z~"~- Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION FROM WEI~E LOG Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform / '~,"' Date of sample: Nitrate Other bacteria ~ ~ z~ ~/"~/~ Collected by: ,,,~,~--~ ,,~---',z~ ~:~ B. SEPTIC/HOLDING TANK DATA Date installed ~'~ a Foundation cleanout (Y/N) Date of P'umping /'//"~ Tanksize /~'~ Number of Compartments ,~, Cleanouts (Y/N) . )/ Depression (Y/N) ~c/ High water alarm (Y/N) ~/~'~,~' Pumper C. ABSORPTION FIELD DATA Date installed..~ e-/,~ ~ Length ,-~ '~' / ,~',~'/"Width Soil rating (~0r fF/bdrm) ~?- ~' System type Gravel thickness below pipe.~-'~' ~'~, ~'x Total depth ~-, Effective absorption area ,4, ~g~/~/ Monitoring Tube present (Y/N))/' Depression over field (Y/N) ,c/ Date of adequacy test -<~x-s ~:/--/' Results (Pass/Fail) For bedroo.~q..n~ .._....--/ Fluid depth in absorption field before test (in.); Immed~ ~d (in.): Fluid depth~ Absorption rate = .g.p.d. P. erexide-T~reatment (pas 12t months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (WN) High water alarm level at* C~.~lesle~t~8~-~-'---'~ E. SEPARATION DISTANCES Size in gallons "Pump on" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /,~,¢'A~, On adiacent lots /"¢<~ Absorption field on lot ,, ,,~-,z--~z On adjacent lots ,' o.-~ Public sewer main ,,c/~'/¢ Public sewer manhole/cleanout Sewer/septic service line -~'-¢-'/"~'~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ?'.5~' Property line /~,z:/ Absorption field ~- Water main/service line ,Zc~'~,~//Surtace water/drainage /z¢~ ¢-,~ Wells on adjacent lots ,/~' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ '~ Building foundation ,~ ~ / Water main/service line ~"~ Surface water /~¢ o '/'~/. Driveway, parking/vehicle storage area. ~/~' Curtain drain _/J.',¢~ ,¢,~¢)'~ z~ ~-" '~' ,'~ Wells on adjacent lots /,¢~ ENGINEER'S CERTIFICATION ·' , certify that l have determined thru field inspections and review of Municipal recor~J. ~F~_~ ims are in conforma~c~,e with MOAiHAA cuidelines in effect on this date. .;,~'~.~..."¥~' ~ '~.~, Signature [~ ~ ~~ Engineer's Name ~¢,¢]'7-~ Y-' ~/ ' ~. ~ ~ · Waiver Fee $ ///%~'/)7~ Date of Payment __ ~ ~ '~ ~-D-TJ Receipt Number ? / ?~ F~ 7~.~ ___ HAAFee $. ~'~ ~ Date of Payment_ Receipt Number 72-026 (Rev. 3/96)* 07-25-50 15:52 FEOkt'CTE ENVII~ONMEHTAL ,~K CT&E EnvironmentalServiceslnc, 5515501 T-015 P.02/03 F-560 CT&E R~f.v Client Nam~ Project Namum Client Sample ID Matrix Ordered By PWSID 1004008001 Douglas Kcnlcy P.E. Ll 1, Block E, Glacier View HIs LI 1~ Block E, Glacier Vmw Hfs Drinking Wmer Sample l~marks: Results PQL Client POn Printed Date/Time 07/26/2000 12:55 Collected Date/Time 07/21/2000 16:15 Received Da .rjr,Time 07/21/2000 t7:t0 Technical Director Stephen C. Ede ,.Released By ~ Unim Method Allowable prep Analysis hmks Date D~ae Init 0.838 0.500 mg/L EPA 300.0 10max 07/21/00 SCL MicroDxolo~ Li~lo o r nco ~"%r Total Coliform 16 O1~, No Coil col/100mL SM18 9222B 07/21/00 ff)T ,VIUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTFCTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Cate June 2 ~ 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 11, Block E, Glacier View Heights T14N R1W Sec.16 Location (address or directions) Myrtle Drive (b) Applicant Name St;even Hennig Telephone: Home 694-3253 Business 271-2511 Applicant Address SR 1551 Myrtle Drive, Eagle River, Al<: 99577 (c) Applicant is (check one): Lending Institution [] ; Owner/builder [] ; Buyer [] ; Other [] (explain); (d) Lending Institution Alaska Pacific Ban]( Telephone Address 101 W. Benson, Anchora_ge~, AK (e) Real Estate Company and Agent N/A Address 562-6100 Telephone (f) Mail the HAA to the following address: pickup b,y e~;ineer TYPE OF RESIDENCE Sin~le-Famiiy [] Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [] Community [] Public [] ~ Note: If community well system, must have written conlirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation lrom the State Department of Environmental Consewation attesting to the legality and status. Page 1 of 2 72 u2r,¢~,841 ENGINEERING FIRM PROVIDh,G INSPECTIONS, TESTS, FILE SEARCH, DAi'A 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 fudher verify that based on the information obtained from the Municipality of Aacl~orage 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. *with wavier of we]_l to septic tank separation by MOA, Name of Firm Telephone Address EAGLE RIVER ENGINEERING SERVICES EAGLE RIVER, AK 99577 P, 0.~0X~7~3294 694-5195 DHEP APPROVAL Ap.rove for _'**' ¢ ' Pbedrooms by ¢¢' Approved ~ Disapproved ~ 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 prolessional engineer's work, Page 2 u; 2 72 025 (11i84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ,//~° ;''~ // ~/~ ~, ~..- ~-~ ~ ~-, I~L~NiCIPALITY OF ANCHORAG!~ DEPT, OF HEALTH & ENVIP, ONMENTAL pROTECTION o 2,1988' R £EbVED WELL DATA Well Classification /¢~.~ ! c,'.4 F-L2 If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) "Y Date Completed ~'/? '--,' Yield Total Depth /o/ ' Cased to ~ o '~,~t~:~,. Depth of Grouting /"/ Static Water Level ~'- ¢, 7 '/Sc/o,-*, /oiD ~,-~.r,.,.~.~ Pump Set At ¢4' 6~ Casing Height Above Ground "~ / Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ¢ 3: / ; Or~ Adjbining Lots To Nearest Edge of Absorption Field on Lot /o¢ ' ; On Adjoining Lots To Nearest Public Sewer Line /~/ /¢1 To Nearest Public Sewer Cleanout/Manhole _ ~ ,.//¢ To Nearest Sewer Service Line on Lot Water Sample Collected by /~5/~ ,¢~ "~'~ £'"' ¥ '~;' e ¢ ~,¥~ ; Date ~,~/':~ Water Sample Test Results '~';~ '~-~; ~/-o Comments B. SEPTIC/HOLDING TANK DATA Date Installed _ /-)' Standpipes (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 / Size /~"""'¢ ¢~-'/' No. of Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) ~" Date Last Pumped -S-/ ; for ,-'~//.4~ _ Temporary Holding Tank Permit (Y/N) 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 /2'7 ~ Width of Field ? ~'/ Square Feet of Absorption Area Depression over Field (Y/N) A/' Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ! Po" To Building Foundation Lot ,/~ //~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design _Fe¢.~ %,~ ¢ Length of Field / -%" Depth of Field ,7 o / Gravel Bed Thickness ~' / Standpipes Present (Y/N) __~ Date of Last Adequacy Test ~'~,./~° ,/'¢- ~ To Property Line /~ / To Existing or Abandoned System on ; On Adjoining Lots 3o To Cutbank (if present) ,,¢" /~1 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav_.~e checked, verified, or conformed to all MOA and HAA guidelines in effect o? the date of this inspection? Signed --,-'~'~'"~~ :- Date MOA No. Company Receipt No. '~._?~.~ Date of Payment Amount: $ (~ ~.~" ~ Page 2 of 2 72-026 (11/84} Engineer's Seal /VlunicipalitYo Anchorage P.O. [BOA i96650 ANCHORAGE, ALASKA 995'19-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES June 16, 1986 Lou Butera, P.E. Eagle River Engineering Services P.O. Box 773294 Eagle River, Alaska 99577 Subject: Lot 1! Block E Glacier View Heithts Subdivision Waiver Request, WR86-070 Dear Mr. Butera: Your request for a waiver of the 100 foot separation required between a well and septic tank has been granted for the subject lot. This distance was waived to 63 feet. This waiver is valid for the existing three bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw EAGLE RIVER ENGINELR NG SERVICES / Eagle River, Alaska 99577 / Telephone (907) 694-5195 / June 2, 1986 Mr. Steve Morris Civil Engineer, On-site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 REF: Lot 11, Block E, Glacier View Heights Dear Mr. Morris: On behalf of my client, Mr. Steven Henning, I am submitting -the information necessary for your determination of a wavier of separation distance, well to septic tank, to 63~ i'or the above referenced lot. The septic system absorbtion rate has been tested and found adequate for a 3 bedroom use. The leachfield was installed in 1974 by Berg Underground and was inspected and approved by the Municipality at that time, as per the inspection report enclosed. A later' request for final approval shows the well to septic tank distance as '65' Our field measurements confirm the tank inlet to be at 63' from the well. The enclosed well log shows that the well draws from a bedrock confined aquifer at a depth of 66-101'~i~JrThe casing is continuous to 20 ' where it is seated into bedrock. The surface 'topography is such that any seepage would be directed away from the well ].ocation toward a 30% slope 'to the south. The subsurface soil is a GW-GP 'type with a perc. rating of 100. A water sample fer coliform bacteria was satisfactory. The well is located inside 'the house and[ has a concrete slab foundation poured around 'the casing which would act to protect the aquifer. The lot is very steep and the well is located as far north as possible due to 'terrain. The area in question has a low population density. If there are any questions or if additional information is required please feel free to contact me at 694-5195. Sincerely, Lou Butera, P.E. Encl: HAA application soil log inspection report ~_, well log I DA:rE ~'~ El V E D ,! : . . iNSPECTiON APPOINTMENTS .~TI M E TIME , TIME INSPECTOR INSPECTOR INSPECTOh MUNICIPALITY OF ANCHORAGE DEPT. OF HEAL'III & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEO~()NMENTAL PRO'[ECTION 825 L Street - Anchorage, Alaska 99501 9 19 1 ENVl RONMENTAL 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 processin9. 1, PROPERTY OWNER PFIONE PROPER~Y~RESIDEN'r (If different from above) PFIONE MAILING ADDRESS 3. LE~NG~NSTITUTION / . ~) ] ~ ....... ~ / ~_~ .~ I PFIONE MAILING ADDRESS 4. ,~TOR/~GEN~/, ,~ , PHONE MAILING ADDRESS . ~ ~ ~ 5. I. EGA~.L.z~ES~ RI PTION .... STREET~7~CATION/) ' ' j¢~ 6, TYPE OF~ESIDENCE /~ SINGLE FAMILY [] MULTIPLE FAMILY [] One [] Four [] [] Two [] Five ~] Three [] Six Other 7. WATER SUPPLY I NDIVIDUAL* COMMUNITY [] PUBLIC UTILITY 'ATTACH WELL LOG. A well Io9 is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Io9 if available.) 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY :' YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RI.:QUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS I~LSINGLE FAMILY [] ONE ~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [~. INDIVIDUAL DEPTH OF WELL E3 COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED ~..~. 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~DIVIDUAL/ON -SITE DATE INSTALLED .U.L,C Connection Verified _ ~ INSTALLER ~Septic Tank or ~HoldingTank Size: /z) ~ M If Tank is homemade SOILS RATING give dimensions: TYPE OF *ANK,:~, ~::( /? MANUFACTURER TOTAL ABSORPTION AREA MATERIAL ~ 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line ~ Nearest Lot Line WELL TO: /~ ~ Absorption Area to nearest Lot Line 5. COMMENTS ~,;~ .- ~'APPROVED FO~CB BEDROOMS ~CONDITIONAL APPROVAL (letter must accompany certificate) ~ DISAPPROVED ~ 72-010 (Rev. 6/79) October 13, 1981 Deirdre Earle % Barb Warthen Dynamic Realty 501 West Northern Lights Boulevard Anchorage, Alaska 99503 Subject: Lot 11 Bloc]< E G]_acier View [{eights Subdivision I~2 Approval for the individual sewer and water facilitigs cannot be granted until the following items have bedn completed: / ,/ (3) The water analysis report needs 'to be submitted to this office from the Chem Lab, 5633 B Street, for our review. Expos~ the well for our inspection to determine proper construction, also to insure minimum distance requirements are met between 'the well and sewer system. The standpipes to the septic tank and th~eac:h-~ng 'are~-~r~'' need to be located and possibly raised abo[7~'~rb~n~7-~eevel for our inspection. The sep-bic tank pumped with a receipt submitted 'to this office for our review. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A 1isLing of private firms performing 'the test is enclosed. This report needs to be submitted to this office for our review. If there are any further questions, please call thJ_s office at 264-4720. Sincerely, James S. Roberts Associate Environmental Specialist DAT-E'R ECEiV ED INSPECTION APPOINTMENTS TIM[' TIME 'rIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR ~,I, UNICIPAI.ITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF Ik.:d.'rH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'I~RONMENTAL P~OFECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION JUL 9 1980 Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAClLI'FIE8 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. ROP RTY OWNE R/ PHONE ~AI kl~ ~RESS different from able) / PROPERTY ~ESIDENT (If PHONE PHON~ MAILING ADdreSS 3. LENDING INST~TION ~ ,/ ~J, PHONE 4. REALTOR/AGENT 5. LEGAI~ DESCRIPTION STREET LOCATION ' ~ ,- [~ 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 (attacll log if available.) 8. SEWAGE DISPOSAL SYSTEM I~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY /¢?7 YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE: THE INSPECTION FEE IVIUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY Lj 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SlX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL 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 []Septic Tank or []Holding Tank Size: /(L']¢} O If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER '~OTAL ABSORPTION AREA MATERIAL ~-¢ Q ~'0¢'~'~ (?3./.z_~l..._ ~. DISTANCES Septic/Holding Tank Absorption ~rea sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENT8 I~-~APPROV ED FOR S BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DAVIDA. SLENKAMP ROBERTA. SHAFER MECHANICAL ENGINEER 694-9055 July 23~ 1980 Totem Realty ATTENTION.' A~tdry I'~son F~,~le River, Alaska 99577 Dear 1,~rs. ~,~son~ Reference: Lot 11; Block E; Ol. czerv.Let,t Subdivision CIVIL ENGINEER 694-2979 MuNICIPAUTY OF ANCHORAG~- DEPI', C)F 1-12/:',LTiJ & ENviRONMEN1 AL 'c i:'O ~'EC~ION JL L g ,! 980 A'b you~~ request~ a sewer system adequacy test ¥~ss performed on "the system located on the referenced property. The seotic pumped and verified to hnve a capacit~,~ of 1000 gallons. The seepage pit ~,ras charged Yrith appro×i~stely 1000 gallons of wa'tar and after a period of 24 hours -the entire araount of smter Yzhich had been added had percolated out of -the seepa~e pit. It can be (;oncluded from 'the above test that 'the septic tank and seepnr~e pit is currently functioning adequately for 'the ~hree bed- room house on this property. If ¥~e may be of further sssistnnoe, !)'lease do not hesitate to ca].l. OO~ ]'~un~oiDa]_i~ of &nchora.e Department o~ He~l'bh s~d Enviornmentsl Protec't~on Amfac Mortgage SRB 196X EAGLE RIVER, ALASKA J~%!y 11, 1980 Eo !layo Gabriel % Au0.rey To'tern Realty }?. O. Dox 9].1 :~.~a~le River~ Alaska 99577 Subject: Lot 11, Bloc]~ E, Glacier View t~'eiqhts ~}~, Approval for your individual sewer and ',,,later fa~i!ities can not be granted u~til the foll~ing item~ have been c crop 1 e t ed: (1) '£he septic tank pumped with a re~:eJ., .. . .}~t, submitted to this office. (2) ~n a,~equacy test be performe~ on the ~.xisting leachin~,~ area. ~his test will d~termine if the syste!,~ is adeq~late according to National ~tandards. A listing of prlw~te f~rms p~rfor,~'~ing the tes~ is eaclosed. ~i'his report need~ to be submittof[ to this d~partment for our review. water analysis rep~t be ~elivered 'to t!~is office _~f~:om Chum Lab, 5633 B Street,, for our reviews. (4) Lo(~.ate. and expose the standpipe to the septic' 'tank for our ins,,'~octlon. This is to insure the min:l.raum distance requirements are ]net between your ~ell and sewer s'ystem~ Please no~.,i~y this department for a re-inspection when the. noted descrepancies have been coffee;to,.1. If there are any ~urther q,a, estion~, please contact this office at 264~4720. Sincerely, ~bert C. Pratt, R.S. Associate Specialist RCP/kas ~fac ~iortgage C~p~atJ.on 401 N. NorthernLLights Blve., Suite 212 99503 MUNICIPALITY OF ANCHORAGE. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIREOTIONS~ Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. ' PHONE 2. BUYER -- ~ - , / ., ~' / PHONE MAILING ADDRESS :~: ~' , Z' X*~ 3~END~NG INSTITUTION t , ' ~ -- n / MAILING ADDRESS ~)~ ) ~-~] .~ __ ~ , 4. REALTOR/AGenT ~ ~- , . f ~ PHONE 6, TYPE OF RESIDENCE / ~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY £.. NUMSE. oF SEDHOOMS - [] One [] Four [] Other [] Three [] Six -ATTACH WELL LOG. A well log is required for a wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available.) 8, sr.'WAGE DISPOSAL SYSTEM ~ INDIVIDUALION-SITE~* [] PUBLIC UTILITY **lf udividual/on.site, give installation date //'~ ~ ~ If system s over two (2) years old an adequacy test is reeuired by this Depardnent, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY ,, DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME --~-ATE DATE DATE T~SPECTOR INSPECTOR INSPECTOR -~IRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE E~] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAl. SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified. INSTALLER ' [~8eptic Taqk or []Holding Tank !;ize: !~)(~) If Tank is homemade SOILS RATING give dimensions: -TYPE OF TANK MANUFACTURER -TOTAL ABSORPTION AREA MATERIAL -4, DISTANCESwELL 'TO: Septic/Holding TankI IAbs°rpti°n Area Sewer ~Lin[I N'earest Lot Line -Absorption Area to nearest Lot Line -5, COMMENTS ~ APPROVED FOR _~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev, 3/7B) 1. Approval requested by: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 - ,¢.,~,~. c(~-7~, Date Received Time of Inspection ~¢,~0 '~,9 Date of Inspection ~ .. ~ .~ INDIVIDUAL SEWER & WATER FACILITIES FOR Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: Phone: Phone: -~.~- g.-Io % 4. Location: ~O/-/z)~ ~/)~/~ /~3~_4 //~,X/ ~9't. 8/9,.~/)~ ~0/~,9/~ 5. Type of facility to be inspected_ d~) No. of bedrooms 6. Well Data: A. Type J, ~/~z)~J,m C. Construction -5~?~4~{~,. ./l~) 7. Sewage Disposal System:- B. Depth I~/ ' D. Bacterial Analysis C. Septic Tank: 1, Size /~.00~ 2. Manufacturer ~t,'~ D. Seepage Pit: 1. Absorption Area ~0 2. Material E. Disposal Field: Total length of lines ~(~/~}~¢ ~.9/ ) e Distances: A. Well to: Septic tank ~:~', Absorption area 2~" , Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank _ ~ , Absorption area C. Absorption area to nearest lot line LQ-034 (1174) Page 1 of two pages 'GREATER ANCHORAGE AR~,", BOROUGH . ,~,~" Department of Environmental Quality 2320 "C" St., Anchorage, Alaska 99503 - 274..4561 r~))Y~\~k ~ SEWER & WATER FACILITIES '~r¢~~'/ INDIVIDUAL 1. Type of Inspection: 2. Property Owner: Mailing Address: 2. Name of Buyer: CMRO VA FHA zx~ell R, 6 o~rol J. Bebcut C~eral Delive~f, ,Eaqle. [Liver D a.z P h o n e ... sa~e a~s CONV XXX~ Omaer/Builde r, Mailing Address: Phone Name of Lending Institution: . -. ~. Mailing Address: ~1o ~. No~he~T2~zt~Blvd. Phone 279=7637 ~-. ,-~, _ 5. Name of Realtor or Agent: Mailing. Address: Phone 6. L e g a 1 D e s c r i p t i 0 n: Lot 11. Block E, Glacier View S~R)divisicn L o c a t i o n: Off Eagle River Road on Carol I)rive res±den~. 7. Type of Facility to be inspected: Si~q].e f~Z¥. No. Bdrms. 2 8. Water Supply Type of Supply: Public Utility Individual xx~ If Individual, number of dwellings presently served ~f Individual, depth of well 9. Sewage Disposal. System Type ,o'f S~stem: Public Utility If Individual, date of i.nstallation Individual (on-site) page 2 of two pages - R~ Legal Description ~V~ l! st for Approval of Individual ~er & Water Facilities Comments Approved ' roved Date /- 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) 4.t Sabj~t~ ~t 1.t ~O. oc:k ~g ~2.a(xier Vi~w ~ub,'livi~ic~n Sanitarium 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 4. Location: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received February 2, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAk OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. Alaska Statebank 310 East Northern Lights Blvd. Phone: 279-7637 x 36 Lowell R & Carol J. Bebout Phone: 694--2708 General Delivery, Eagle River Alaska 99577 Lot 11 Block E Glacier View Subdivision Off Eagle River Road on Carol Drive No. of bedrooms ' 2 Type of facility to be inspected Single Family Well Data: Individual A. Type B. Depth //~/ / C. ConstruCt ion's.. ~/v~/~/~>. D. Bacterial Analysi~~ Sewage Disposal System: on-site system. A. Installed ////-~-- 7~ B. Installer_ C. Septic Tank: 1. Size Zmm 2. Manufacturer ~/~' D. Seepage Pit: 1. Absorption Area ~0 2. Material E. Disposal Field: Total length of lines ~'~:~/~:-~m_ Distances: A. Well to: Septic tank ~ ~ , Absorption area Nearest lot line ~ ~ , Other contamination B. Foundation 'to septic tank , Absorption area C. Absorption area to nearest lot line , Sewer Lines _, EQ.-034 (1/74) Page 1 of two pages Januarv 26, 1976 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner: Mailing Address: 3. Name of Buyer: Mailing Address: 4. Name of Lending Institution: Mailing Address: __ 5, Name of Realtor or Agent: Mailing Address: CMRO VA FHA BEBOU£, Lowell R. & Carol J. CONV ~ C~meral Deliverv, Eaqle River Day Phone 694-2708 Day Phone Alaska St~tebar~ 310 E. Northern Lichts Blvd. Phone &NC 99503 N/A 279-7637 (Valerie) e:~[:. 36 Phone 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Sinqle family residence No. Bdrms. 2 Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) EQ-037 (1/74) Page 2 of two pages - R( ..st for Approval of Individual ,er & Water Facilities Legal gescription Lot 11 Block E Glacier View Subdivision Comments Approved ~/~ Disapproved Date ~- Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)