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HomeMy WebLinkAboutSCIMITAR #2 BLK 3 LT 19Scimitar #2 Block 3 Lot 19 #051-132-59 MUNICIPALITY OF ANCHORAGE / `� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION �` ENVIRONMENTAL ENGINEERING DIVISION 0* 0* 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE �j NEW ❑UPGRADE MAILING ADDRESS _ jJ LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS DISTANCE TO: Well1 INf' Absorption area ,oDwelling - 't f PERMIT NO. [['�^ R 335 Uy t a z Manufacturer Material , No. of compartments W r G- L (n Liq. vOQ capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 0 Y DISTANCE TO: Well Dwelling PERMIT NO. jaz = z < Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well / j�v Foundation / 9 3 �' Nearest lot line i PERMIT NO. _ _ W y �j .�- w LL Z No, of lines % Length of each lin % Total length of lines Trench width Distance between lines PzW - / p 0.1 ' inches ¢ F Top of tile to finish grade % Material beneath tile Total effective absorption area p inches Q Length Width Depth PERMIT NO. w a f- Type of crib Crib diameter Crib depth Total effective absorption area wa WWell V) Building foundation Nearest lot line DISTANCE TO: _jClass Depth Driller Distance to lot line PERMIT NO. J W 9:DISTANCE Building foundation Sewer line Septic tank Absorption area(s) TO: OTHER PIPE MATERIALS v6 SOIL TEST RATING Q J� �r G p0 �/�� t. '� INSTALLER !z rvs7' , r REMARKS ` OF Y !" if `• Robert A. Shm°e 9 �J •• No. 1457-E G 414 aFfSSIONA\-�P O r P O E DA E LEGAet r� s (IVev. 3/78) THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS: EST 1= K D�P�RTMENT �Rol- HEH�TH HND ENVI�ONMENT� fit PA 10 1- 14: F31 112, EEH', NJ 5-: ���hl- -Tl � � THE WELL TECTION � It���� FEET) OF 825 STREET/HNCHORHGE� HK� 99501 c/ ' 264~4720 THE SURFACE! OF THE GROUND HWD THE W L. A... lot ths PC% lc-�y 1 W FYI 10 EE: Wj EEE FQ �EE,-, M X -1 PERMIT NO� ( 820]]8 ) WIDTH FOR TRENCHES DHYS HPPLICHNT MYERS CONSTRUCTION PO BOX 351 CHUGIHK 6944144 LOCF 4.TIr. ON OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM LEGHL L19 B] SCIMITHR EXCHVHTION (IN FEET). LOT SIZE 42800 SQUHRE FEET TYPE OF SOlL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUPIBER OF BEDROOMS � � SOIL RHTING (SQ FT/BR)� 150 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS: EST 1= K 7- q-1:,— 1L129 SYSTEM IS 5-: ���hl- -Tl � � THE WELL DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFACE! OF THE GROUND HWD THE BOTTOl OF THE EXCHVHTI IN FEET). it: I UNDE T ND THHT THE THERE IS NO SET WIDTH FOR TRENCHES DHYS OF THE NELL COMPLETION. THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM HRE OF THE EXCHVHTION (IN FEET). �=7 ��-- --. !, -iii Ei-t����� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTIO� INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THHT THE WELL WILL SERVE. �_~ -f- 1 - 1 K.0 K2 IT: in 1 IPA Fii, r--:1, (D W :1 K.0 PA "El; 1=1 lot U 1 Fit EE.-, Q BHCKFILLING OF HNY SYSTEM NITHOUT FINAL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT NILL BE SUBJECT TO PROSECUTION MINIMUM DISTHNCE BETWEEN H WELL AND HNY ON-SITE SENHGE DISPOSHL SYSTEM IS 100 FEET FQR H PRIYHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING FOR ON�SITE OPON THE TYPE OF PUBLIC WELL HMD WELLS HS SET FORTH BY THE MUNICIFAL ITY OF HNCHORHGE MINIMUM DISTHNCE F.P.:OM H PRIVATE! WELL TO H PRIVATE SEWE� L. -INE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET. THE CODES it: I UNDE T ND THHT THE WELL LO85 HRE REQUIRED HND MUST BE RETURNED TO THE �EPHRTMENT WITHIN 30 DHYS OF THE NELL COMPLETION. TO MORE THHN ] BEDROOMS. OTHER REQUIREMENTS MHY HPPL4 SPECIFICATIONS AND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTALLATION. 0W.101101 1: W �OW" 1: sQKEH-.l_-E: FEE Q 1107 W9 !S-;� EF.� I CERTIFY THAT 1: I HM FHMILIHR kJIM THE: FOR ON�SITE S�WER� HMD WELLS HS SET FORTH BY THE MUNICIFAL ITY OF HNCHORHGE 2: 1 WILL INSTALL THE SYSTEM IN HCCORDHNCE |QTH THE CODES it: I UNDE T ND THHT THE ON~SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDE�CE/IS/REMODELED TO MORE THHN ] BEDROOMS. SIGNED:~ ISSUED BY CONSTRUCTION SOILS LOG MUNICIPALITY OF ANCHORAGE yf DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: y /1 S ��n/•1Sl 1 DATE PERFORMED: LEGAL DESCRIPTION: %() ✓ /J�/k �G%M� 1 Lcr ) li rrlGi SLOPE SITE PLAN 2 16 a 17 Robert A. Shafer 18 m,� 6� No. 1457.E , R� icy 19- 981 9 +S�fS.cmuni lr� COMMENTS WAS GROUND WATERNO S ENCOUNTERED? D L O P IF YES, AT WHAT E DEPTH? Reading / 3- Net Time Depth to Water Net Drop -4 —4 / rr q• 6 7 lY 8 i �Q 9 ,U tw'1 1 1 0 9 12 0 . 13 v 14 v. i ` U j 15 16 a 17 Robert A. Shafer 18 m,� 6� No. 1457.E , R� icy 19- 981 9 +S�fS.cmuni lr� COMMENTS WAS GROUND WATERNO S ENCOUNTERED? D L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE/ /% (minutes/inch) T-' TEST RUN BETWEEN FT AND „FT PERFORMED BY: -` CERTIFIED 72,008 (6/79) - ! DA .v LOCATION OF WELL (Please complete either to, Ib or Ic.) Ia. BoroLugh Town Subdivision if ion Lof BIocN Ib. I/a gtrs Section NoI- �Anro SCineitan 19 3 ot_of_ot_ - Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. O Ad Street Address and Area of Well Location 2. WELL LOG Feet Below Surface 4. WE Material Type Top Bottom- oulde�d [ an an'a-��Ct G. [ 116 ---7. us ((''itave.� sand 1 {{l� 66 Bo e2 9 6 --a— C -A l�ouMen- 5 diam. IF — liLZ O eird diom. L�—t_. Bia ouUelt 12 9. Flh CM//�C 4-l%D. e VC '�tt_____,_-��-- — TYP SID _ 4 4ode gAaWe 1510 �6l Sal n /F/za�-c/htie 161 10. ST{ y MUNICIPALITY OF It Pui DEPT. OF HEALT &PRO IA -- I'RCTECTION FEB 12. GR( -- Mal r -°-T�t-Y«. GEN -®-- I 13. POP Len Len U Ir, - 14 REM 16. WATER WELL CONTRACTORS CERTIFICATION: - 15_ Wat STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No A U t_ No. ..__.. �._ ship N�11 Range �j Fri --t1 Mori dioAtn OW Street lrVi,•LL ,J Ittl�e�_-_.. lh e/r.� `r'o►ze#iuuction dress: ?_ J_ Viv, 4 LbJj1PT1L (Inial .I 5. @ATE OFCO LETIONO� //v H J OOGG J Cubio tool LAAotary`[]Driven , L--] Dug I Auyer O Jelled ❑ Bored � 0 Other - E. ADa[neeliC L 1 Public Supply ( l l Industry Irrigation L] Recharge ❑ Commerical _ 1 L] Test Well O Others ONG L� The de � Welded may►) '7 -_ in to /"" 11. Depth Wei)Ihi _ 1/_Ibs.1 ft. III to It. Depth Sticup — ft. IISH F WEL�/ N o VpCn Role- Diameter! lomeNrl 1/Mesh Slze- _ Length between ft. and if ' .kfilling _ ,. Grovel po k IT1C WATER ,.EVE L' Above or XXBelow lund surfL�ee Dole Equipment used' ---— — APING L.EVFL below load surface an �0 YIELD ff, offer Ns. Pumps. 9 _ g.p m. r It. after firs. pump{" g -_i g p.m IUTING Well Grouted: U You t ) No erial L,� Neat Cement Otherl AP'. it available) HP gin of Drop Pipe ft, copofrty g. p.m� Subm. [J Jet ❑ Cenir,f.cajl I Fj Other ARKS Bad fed fed ai 24 yPM i This It as aOn1& d/sj_ _y urisdlcllun and this report is True to Inc bu.a art my kunw:u lge nnu ostial, I� M. 15-385 --djsgttsteD XB usi nJLj$/.N We--, C iv" As 99§77 Conlroct l ��:vn .e Number ,I Address: //'' Vv� (J(� JY../1 C/I�n"./_ /[ Jl rt Jh� �- ..�..out,, aSigned �UU 27 /982 Aulhorize l Representatives _---� f Ic+ A2-WWR (11/81) Copy 0rslr,buGan: WHITE'Stare DGGS, PINK Willer. GANAR'. -Customor Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ,P&vr 41zr7zr)4J CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING MON?) Parcell.D. 051-132-59 COSA# MON?) Expiration Date: — QC, t) cl 1. GENERAL INFORMATION Complete legal description SCIMITAR $2. BLOCK 3: LOT 19 Location (site address) 20326 TULWAR DRIVE. CHUGIAK. AK 99567 Current Property owner(s) TRACY & KATHY PERKINS Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 20326 TULWAR DRIVE, CHUGIAK, AK 99567 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems 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. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 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. Name of Firm ArcTerra Engineering & Surveying. Inc. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER. AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 10/31/2008 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 Inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSDSIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: r,udcntnents: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory A Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other BY r Original Certificate Date: tam. nos, Municipality of Anchorage • Development Services Department Building Safety Division ' On-Site Water & Wastewater Program ' • "' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SCIh117AR $1 BLOCK 3: LOT 19 Parcel ID: 051-132-59 A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID # _ Well Log (Y/N) y Date completed 5-20-1982 Sanitary seal (Y/N)Y Wires properly protected (Y/N) y Total depth 185 ft. Cased to 320 ft. Casing height (above ground) 24+ In. FROM WELL LOG AT INSPECTION Date of test 5-20-82 10/22/08 Static water level 145 ft. 114 ft. Well production 2-5 9.p-m. 2.9 9— p.m-WATER SAMPLE RESULTS: Coliform_2colonies/100ml- Nitrate 5.15 mg/L Other bacteria colonies/100 mL Arsenic: _ND_mg4 Date of sample: 10/22/2008 Collected by: ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 06/05/82 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) t[ High water alarm (Y/N) )-pate of pumping 8/14/08 Pumper JR's C. ABSORPTION FIELD DATA A Date installed 5/5/82 Soil rating (g.p.d./fe or ft /bdrm)1i4 System type JiTp-ch Length kft. Width y5 ft. Gravel below pipe -ift. Total depth 2 ft. (Measured 102=1) Eff. absorption area Aafe Monitoring tube Y Depression over field h Date of adequacy test 10/22/08 Results (Pass/Fail) Pass For -_bedrooms Fluid depth in absorption field before test Q in. Water addedJOL gal. New depth 26.4 In. Elapsed Time: 149.4 min. Final fluid depth _k In. Absorption rate >= 450+g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) lLlf yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) `Pump ono level at—in. •Pump off" level at—in. High water alarm level at_in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 251+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 1001+ Holding tank 1001+ Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property tine 10'+ Building foundation ]0'+ Water main 101+ Water Service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots loo'+' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and C`"" "•' • •• review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this M. •r date. �I ti`CC Engineer's Printed Name KENNETH M. DUFFUS It �9;�p90FES510tiP�ra` Date 10/31/2008 COSA Fee $430.00, p Date of Payment Receipt Number O Ll5 1 (� (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • Development Services Department Building Safety Division On -Site water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 080383 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 19 of Scimitar #2 subdivision. This inspection revealed a nitrate concentration of 5.15 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS RcEN 1085791001 Client Name ArcTerra Engineering and Surveying Project Name/H Scimitar #2 B3,L19 Client Sample ID Scimitar k2 B3,Ll9 Matrix Drinking Water PKSID 0 Sample Remarks: Printed Datdrime Collected Date/Time Received Date/Time Technical Director 10/3012008 16:00 10/2212008 15:30 10/22/2008 16:25 Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10129108 10/30/08 NRB Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory Colony Count Total Coliform Fecal Coliform 5.15 0.100 mg(L SM204500NO3-r B (<10) 10124/08 1DZ 0 coU100mL SM209222B A (<200) 10122/08 DLC 0 coVIOOmL SM209222B A (<I) 10/22/08 DLC 0 col/IOOmL SM209222B A (<I) 10/22/08 DLC LOT 2 10. + .t _� ^O EXISTING 9• HOUSE ?'0 o iso DECK OVER GARAGE (TYP) GRAVEL D/W LOT 18 ANCHORAGE RECORDING DISTRICT ASBUILT OF: SCIMITAR SUBDIVISION UNIT NO.2 LOT 19 BLK 3 PLAT 74-190 SURVEY CERTIFICATION: 1, John L. Schuller, have conducteda physical survey of this property as shown on this drawing and that the improvements situated thereon are within the property lines and no enchroachmcnts exist other that noted. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any casements, covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. OCT 22. 2008 1 1'-40' 08—OHZ Aw BY: 0iECKED BY G NUNBFa: BOpI AW JLS NW1261 0804/01 WELL LOT 19 • \ SEPTIC VENTS (TYP) O Op 4�9• / LOT 20 / / LOT 37 .:�0FALX% ?' 49 �. /. .... JOHN L SCHULLER; '. IS -10408 �10, e •. p �� LEGEND FND REDAR 0 ALL RECORD INFORMATION IS PER PLAT (74-190) ti Q� ER��/ f T � R, AK 99577.8"6 72-025 (Rev. 1/81) Front MOA e21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 6 9 y -3L9 71 17034 Eagle River Loop Road No. 204 Address Qule River. Alaslra 49577 Engineer's signature Date / n/ x G I q Additional Comments t�` B'Y: •1 Date -/ - The Municipality of ;A6chorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certifica6s 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist � c Legal Description: L9T lot(3L� 3 SLIy✓ �Ti'vo Slny Parcel LD.: Q Z n A. WELL DATA rVI p ^ O Well type If A. B. or C, attach ADEC letter. ADEC Water system number rn Log present OI) Date completed S 2-O -g -2- 4-Q © :r - Total Total depth 1(b5 Cased to Casing height (above ground) 12a , Sanitary seal QN) \/ Wires properly protected (Y N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform C7 FROM WELL LOG 1a5� Z -S Nitrate 3 AT INSPECTION -zs-9 S9 - P.M . 3.10 Other bacteria fl Date of sample: ,o - \ oi 9 Collected by: S & S ENGINEERING 17034 Eagle River Loop RoacllNo. 104 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed (P-5-5'2- -7 Tanksize 1,orit> Number of Compartments 7--Cleanouts I Foundation cleanout SIN) _ Depression (YIQ �A High water alarm (Y/N) Date of Pumping 1S Pumper C. ABSORPTION FIELD DATA Date installed (+�` 8 y Soil rating (g.p.d./ft` or ft2/bdrm) I �g2.System type Length ''lo Width Gravel thickness below pipe 1o( Total depth 1�` Effective absorption area 40 Monitoring Tube presen —V-_ Depression over field (YdP Date of adequacy test Result as il)r!3`-�S For 3 bedrooms Fluid depth in absorption field before test (in.): _—< Immediately after,00 gal. water added (in.): 12 h Fluid depth '/2 (ins.) Minutes later: b Absorption rate =SO 4 g.p.d. Peroxide treatment (past 12 months) (Yo AA- 14J 0D If yes, give date �� D. LIFT STATION Date installed Manhole/Access (YIN) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: off' level at* Septic/holding tank on lot 1 by k ; On adjacent lots 1bC�> Absorption field on lot 1 o a k ; On adjacent lots 1 OD � k Public sewer [Hain ~SIA Public sewer manhole/cleanout , ID Sewer /septic service line 2S t Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation �o, Property line 25 t +- Absorption field Water main/service line 1 0 Surface water/drainage 1 0h t Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation r Water main/service line 1 a 4 - Surface water too t Driveway, parking/vehicle storage area 5o t Curtain drain 1, Wells on adjacent lots I t�-o t+ Property line -Z-5- F. -S F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review ofrbfunicipal records that the above systenr.s are in conformance with N OA -1AA guidelines effect on this date. �.. �E•,F'!a�'ghll Signature ��� e �S.�yl /� Engineer's Name /C <)!3 k., i C rr� i✓a9 ✓ng�{}��rffw ±, Date /o/a-c. /qS— HAA Fee $ e?W - 6Z Waiver Fee $ Date of Payment l0�—c�� Receipt Numbcr 6400 ( X 7 ff Rev. 8/95 OSS: haa.wk.doc Date of Payment Receipt Number ? w. ROBERT C. COWAN CE -8801 ..rry ...• . Fr:vFiSaV'j ME Environmental Services Inc, 'ztlL Laboratory Qivision CT&E Ref.# 95.4711-1 Laboratory Analysis Report Matrix (PATER Client Sample ID L 19 B3 SCIMITAR 42 Client Name 8 & 8 ENGINE$RING WORK Order 19022 Ordered By Printed Date 10/25/95 w SSi32 hra, Project Name Collected Date 10/19/93 0 13:10 hra. Project# Received Date 10/20/95 @ 14:00 hrs. PWSID UA Technical Director STEPHEN C. EDE Released By ��— Sample Remarks: SAMPLE COLLECTED By: DAVID. QC Allowable Ext, Arial Parameter Results Gual Unite Method Limits Date Date Init Nitrate -N 3.9 D mg/L EPA 353.2 '^- -- 10. - 10/24/95 CMR I .,-----s-w-o_o___Qe____'"____"------------- ___---.__"--------------e_ ----- ______"___"`_____---` n. x See Special Instructions Above VA + Unavailable r* see Sample Remarks Above NA M NdC Analyzed d". Undetected, Reporcad value is the practical quantification limit. LT Lsss Than kaa Secondary dilution. OT Greater Than .a 200 W. Poher Drive, Anchorage, AK 99618.1605 — Tel: (907) 562-2343 Fax: (907) 561=5307 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA. ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY. OHIO, WEST VIR(JINIA z00 ZSL*ON TT2TG69LO6 F SNIlS31 IIJIOb3141403 bS:ST 961SE101 MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES y� T 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 l.D.# 0�1-1 Lq-�cn HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Lot 19; Btock 3; Sc,imitaA Subdi.vi4ion #2 203#6 Tutwan Djr i.ve Property owner H.U.D. #111-033774-203 Day phone Mailing address 605 Wept 4th Avenue Anchorage, Ata3ha 99501 Lending agency Day phone Mailing address Agent SANDY HALMSTAD A34oc,i-ated BAoke&z Day phone 563-3333 Address 640 Welt 36th. Avenue Suite One Anehoaage, Atka 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 �+ 3. TYPE OF WATER 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. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone Address 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 577 Engineer's signature Date 6.HS SIGNATURE Approved for bedrooms. Z Disapproved. Conditional approval for Additional Comments OF AL •j V j .R J. No. t OOFESSt�NP.® bedrooms, with the following stipulations: 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 orderto satisfy certain federal and state requirements. Employeesof 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. 72-025 (Rev. 1/91) Back MOA 421 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT 101 EVIL 3 Cie-, el p�� L Parcel LD A. WELL DATA Well type ?2NVP-� If A, B, or C, attach ADEC letter. ADEC water system number ts' Log present &N) 4 Date completed `62— Driller Total depth N$s Casedto 1-Z-0' Casing height t 4 - Sanitary Sanitary seal O/N) Wires properly protected O/N) FROM WELL LOG AT INSPECTION M Date of test v x, c oz z M zr Static water level ft, Well flow Z -�' g.p.m. 3•� g.12�n. co m O z Pump level y V� co ^' o 0 SEPARATION, DISTANCES FROM WELL TO: yG) � nn Septic/holding tank on lot ��' � ; On adjacent lots Absorption field on lot \00 ; On adjacent lots 1�} a4l '14A Public sewer main Public sewer manhole/cleanout Sewer service line ZS t Petroleum tank 2 S WATER SAMPLE RESULTS: Coliform n l t� eal Nitrate 2 rtiy�� Other bacteria tiZ) £ Date of sample: q-24 -9 L— Collected by: S & S ENGINEERING 17034 Eagle Rive; Loop mead No 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed -5' e)? ---Tank size loo(D Compartments Z Cleanouts &N) Foundation cleanout (E)N) Depression (Y6p High water alarm (Y.® k� Alarm tested (Y/N) "I /A Date of pumping - 71} _`l 1 Pumper Cr_SS PD a L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1060- On adjacent lots look,- Foundation %0 To property line 2 S %4- Absorptionfield 5.1 Water main/service line lot Surface water/drainage 100 t 4- 72-026 72-026 (Rev.7/st) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) ump off"level at Cycles tested Meets MOA electrical codes SEPARATION TANCE FROM LIFT STATION TO: lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed 5 - by Soil rating \ 50 `�) I> - System type -1- X S_t46- l Length -4 1 Width 37- (( Gravel thickness t.0 Total depth \D Total absorption area 4a o Cleanouts present &/N) Depression over field (Y&N (� Date of adequacy test Results as_fail) 6#SS for -Ca (-$) bedrooms Peroxide treatment (past 12 months) (Y& If yes, give date �a SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot u>01�_ On adjacent lots 1 Property line 7-51 -1- To S11- To building foundation 22�1 To existing or abandoned system on lot l ". On adjacent lots CJD t Cutbank ', 1 p" Water main/service line ko Surface water \ ob \L Driveway,3-c � parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. y�IJR k?fa'b e�eooWear,°bo "A41� S «S ENGINEERING t e e. Signature I/031' Eaule. Rive, Loop no:jcjNe 204 j3%nt ro � °� ;1 river, Alaska 99577 n � lI4S �� s Engineer's Name ee�w c 9,m ,( 9e tdepGn, 'c rs aee°000s yp� Date i� %O, ®°soeoo9UG `l5 � p D� HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ — Date of Payment Receipt Number A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. b653 B aTREFT ANC;H F1..AGE, ALAOM 90518 TELEPHONE- (907) 662-2343 FAX: (007) 561',.5381 Client Sample iD L19 33 SCIMITAR 12 MID UA Collected APR 24 92 4 09 3O hrA. Recelvad APR 24 92 1 14:40 hre. Preserved with AS REQUIRED Annlysie compkated APB 27 92 Laboratory Supervisor STEPHEN C. SCS Releaaed By :Alw� c, t/x ANALYSIS RESULTS tcc INVOICE t 53195 Chenlab Re:,# 92,1740 Sample t 1 Matrix: WATER ('llant Name :,S & 9 EHGINSUM Mot Acct ;SNSENGF BPC# , Req# : Ordered By :R. SHA?" Send Reyo[ts to: 1)S & S EiULMRINC 2) Pot -NONE 1112TVID ..............................................._........,...............--,......,.,.....,..,--.....---.............................. Paramater Reaulte Unita Method Allowable Lucite ----------- ------ NITRATE-F 2.3 mg/I EPA 353,2 10 Semple ROUTINE SAM4LE COLIECTFD BY' P.kY Remarks: ......... .................s........... ...... ♦.......... _1 ......... ... -............. Y. ............... lap .... .......... •............ 1 Taste Performed Sae 8pectal Inetruetione Above UA-Unavailablo ND- None Detected Sea Sample Remarks Abova NA- Not Analyzed LT -Lean Than, GT -Greeter That f�N M6ft}GBr r,.f rhe SOS G'Oup (SOQWCf 0606fale de Sutvaillance) r' MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES y 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 Parcell.D.# C)61 -13Q -AS is HAA# 0Rot 10�-t+-(`1 1.-- GENERAL INFORMATION Complete legal description l n,t 19; SPnnh 3; So m,itns i116dilliAon #9 Location .(site address or directions) Property owner NIJn #111-033774-761 Day phone Mailing address Lending agency Day phone Mailing address Agent 1=4anciva ctieU.jASC00IA1E12 BROKERS Day phone 463-3353 Address 640 taut 36th Avenue, Suite One, -Anchorage, Ataska 9'9503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE'OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. - 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(89Y.1/91) Front MOA M21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm g & s ENGINEERING Phone 9 17034 Eagle R'wer Loop Road No. 204 AddressAlaska q Engineer's signature Date l X27' 1 6. DHHS SIGNATURE Approved for -3 bedrooms. Disapproved. Conditional approval for , J4 Additional Comments By: ...�.•�• .ld *:49TH '•.� �...0... . ..... , • RODE .8HA �R, P.E • �•• 08215 • V lililk ®iFESS �4W bedrooms, with the following stipulations: Date —7— The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is. issued. The Municipality of Anchorage is not responsible for errors, or omissions in the professional engineer's work. 72-025 (Rev. 1/91 ) Back MOA N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1--aT No - 3 Ste"'' i oeiL -4 Z Parcel LD A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log presentQYN) \11 Datecompleted Driller MNL0*30sc>' Total depth i 815 1 Cased to t 2fl k Casing height 12" Sanitary seal ®/N) Date of test Static water level Well flow Pump level Wires properly protected 61N) FROM WELL LOG 2-- S g.p.m. UK— SEPARATION DISTANCES FROM WELL TO: MUNICIPALITY OF ANCHORAGE AT INSPECTIOfeVIRONMENTAL SERVICES DIVISION SEP 27 1991 RECEIVED 3.� g.p.m. U V__ Septic/holding tank on lot IC>C> ; On adjacent lots tcD � } Absorption field on lot I t�?�} ; On adjacent lots 100 , t Public sewer main �Ja Public sewer manhole/cleanout 11A Sewer service line 'L� Petroleum tank ZS WATER SAMPLE RESULTS: Coliform O 4 �`Ln ^>3 Nitrate 3 195 "k Other bacteria t%lpA<E Date of sample: 01 - 1 a—`I I Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed (o -S '82 Tank size toob Compartments 2 Cleanouts O/N) Foundation cleanout O/N) V Depression (YO High water alarm (Y/(R) /f Alarm tested (Y/N) 1J�A4 Date of pumping 1-14-91 Pumper SSP 00 C - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot l o cv On adjacent lots w o z Foundation 10 To property line r 2 S t Absorption field I S Water main/service line vo Surface water/drainage 1 ot> 14- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Pump on" level at Meets MOA electrical codes (Y — Manufacturer Manhole/Access (Y/N) 11 mp off' level at Cycles tested SEPARATIONJDI3TANCE FROM LIFT STATION TO: lot On adjacent lots D. ABSORPTION FIELD DATA Surface water Date installed - 5 - t32 Soil rating I Sod'/6P System type '712 -"L -kA Length qc> Width 32i1 Gravel thickness U Total depth l of Total absorption area +a>04 Cleanouts present'/N) V Depression over field (Y/6) Date of adequacy test I - j a .a) j Results%fail) b6b for bedrooms Peroxide treatment (past 12 months) (Y& 144o �,W If yes, give date 'd SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wel l on lot I on i J- On adjacent lots loo Property line '2 , } To building foundation To existing or abandoned system on lot - On adjacent lots �5 b Cutbank `,I/' Water main/service line I,01 Surface water 10 Driveway, parking/vehicle storage area 30 Curtain drain �ID� E. ENGINEERS= CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on thg4atte of this inspection. At W Signature 5 AS ENGINEERING y�� •• �9 rE� rt ° ocv 17034 Engle River Loop Road No. 204 •°t°• eOV °• ♦ i0°.e� Engineer's Name rag i6yor Alaska 99577 Date 2�- I �� •, ROG RJ.Bb CER P.E. !� I' 9621 ,ow HAA Fee $ /?o ' 0 Date of Payment f Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WOR%order# 38467 Date Report Printed: SEP 23 91 @ 08:33 Client Sample ID:L19 B3 SCIMITAR#'A PWSID :UA Collected SEP 18 91 @ 17:00 hrs. Received SEP 19 91 @ 14:45 hrs. Preserved with :AS REQUIRED Analysis Completed :SEP 20 91 Laboratory Super is r •ST PHEN C. EDE Released By G_ .................................. Chemlab Ref #: 914941 Lab Smpl ID: 1 Parameter Tested -------------------------------------- NITRATE-N Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO # PO # NONE RECEIVED Req # Ordered By :ROGER SHAFER Send Reports to: 1)S & S ENGINEERING 2) Matrix: WATER Result Units Method ----------------------------------- 3.5 mg/l EPA 353.2 Allowable Limits ------------- 10 .................. 1 ..................................... Tests Performed See _......................................... _............ Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA= Not Analyzed LT -Less Than, GT -Greater Than `S'%C^S Member of the SGS Group (Societe G4n6rale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION 2. Application Date �_ Z a—, 8 6 (a) Legal Description (include lot, block, subdivision, section, township, range) -__ „A z, ,, z �� . _ _ , �. SIS Location laddress or directions) 1 % 2 -, OFA (b) Applicant Name -,' IIN'�t I Telephone: Home Business Z-r7Z-S 7� y Applicant Address ryoMB SArV� n44S T,0,6 >, V�,� Cl tan - (c) Applicant is (check one): Lending Institution OT" Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution `���� �� ����-� Telephone Address a-r1_N I bla �t" 4 (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: SRB 196x Eagle River, Alaska 99577 TYPE OF RESIDENCE Single -Family Multi -Family ❑ Number of Bedrooms 3. WATER SUPPLY Other Individual Well V— Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite- Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025)11j84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S E»gineering Telephone SRB 196x Address s a !� 6 Date 14 8 6. DHEP APPROVAL Approved for bedrooms by Approved Disapprov6 Terms of Conditional Approval Conditional dihep CAUTION 4 bF 41 V aaa aeD VV .n p al . R. a . � .1 a te..n.f9Nl'1 4R'. w3. *n The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) UCYI. Ur MALIN do MUNICIPALITY OF ANCHORAGE (Mdx) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) APRCHECKLIST - FEBRUARY 1984qwv 2 1906 264-4720 Legal Description: - y- z g U flY E D Sc/M.r-rAx -3/y A. WELL DATA Well Classification �& %V If A, B, C, D.E.C. Approved (Y/N) IA - Well Log Present OGNT Date Completed S__ Zo - B2- Yield y� a�L/�✓�� Total Depth /to -3 5 Cased to Depth of Grouting Static Water Level %�%�� Pump Set At /i1 X/ Casing Height Above Ground /Z Sanitary Seal on Casing/.N) Electrical Wiring in Conduit V -/.N) Depression Around Wellhead,(Yf.)jP) Separation Distances from Well: To Septic/Holding Tank on Lot to On Adjoining Lots To_Nearest Edge of Absorption Field on �ot 10tz:' tr ; On Adjoining Lots To Nearest Public Sewer Line P- To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results S P� is�rAD rte / Comments B. SEPTIC/HOLDING TANK DATA OQ%r Date Installed €�Z Size ZA a No. of Compartments Standpipes' Air -tight Caps 6�N1 Foundation Cleanout — Depression over Tank ky& Date Last Pumped —3- z-7'8AJI Pumping/Maintenance Contract on File (Y/NI "` for Holding Tank High -Water Alarm (Y/N)/Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /y a ` To Building Foundation /0 1 I +- To Property Line To Disposal Field To WaterA4akWService Line 3° , Y To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) Time Time �e f Dpte Date Date Inspector V Inspector il Inspector Comments 1A �CA'j &Q/ W Conditional Approval () Approved Bedrooms ( ) 9i1a �prc«ed ( ) Conc41ion il Approval Date Sewer Installed Permit No. Septic Tank Size /Oo Q -5-,_._ g1� Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank j U Z lX O APPLICANT FILLS OUT LOWER HALF ONLY Property Owner M� 0x7ST`ijCTTC7r 1W. Mailing Address PO Box 351, Chugiak, AK 99567 C16979633 Buyer J. Alan & iii nda K. Phillips Address PO Box 164, Eagle River, AK 99577 Lending Institution First national Bank of Anchora a Phone Address Mile 14 Old Glenn I ry. Eagle River , ]F� 99577 694--2103 Realty Co. & Agent TC)tj t REaltyr ITiC. Phone PO Fox 911r Eagle Riverr AK 99577 694-9994 Address Legal Description Lot 19r Block 31 SC7m1ST97TVISion � Street �gbation NHN Tul%qar Drive, Peters Creek Type of Residence yF3 Single Family ❑ Multiple Family No. of Bedrooms O Other Water Supply Individual ATTA WELL LOG. A well log is required for all wells drilled since June Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available.)— - Sewage Disposal kJ Individual Year Individual Installed: T 982 ❑ Public Utility When Connected to Public Utility: O Holding Tank u1nTC• TIJC INcoeeTlnN CFF M11CT ACCr1MPANV FAr3I4 IRFAIIFRT RFFnRF PR0rFRRIKIr CAN RF INITIATon r l A`. 1. ?�� n i, OC PG`s CH 6-650 / ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 C1NY I<^10:NLFS. YO F, DUPAR T MFiNT OF HEALTH AND ENVIROMM.F NII AL PROI-ECIION Alvin & Thelma Weaver March 3, 1982 P.O. Box 976 Wasilla AK 99687 Subject Lot 13 Block 3 Scimitar Sub. Addition #2 To whom it man concern: The sewer system on the subject property was inspected and approved in October of 1981. A water analysis was drawn on March 2, 1982 and the results show it to be free of coliform bacteria. This letter does not constitute a full health authority approval from this department. If there are any further questions. please call this office at 264-4720. . Sincerely c� , Robert C. Pratt Associate Environmental Specialist P b k