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SUNNY VALLEY LT 21A
Sunny Volley Lot 21A #050-354-31 Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSPl11291 05035431000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: October 13, 2011 to October 12, 2012 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SUNNY VALLEY Del.artment Site Legal Address: SUNNY VALLEY LT 21A G:0057 Owner/Address: JOHNSON TERRANCE W JR 9436 W LAKE DRIVE EAGLE RIVER AK 995779515 Site Mailing Address: 9436 WEST LAKE DR, Eagle River Lot Size in Sq Ft: 50493 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On-Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0~0", ~'/--/- :~1 Property owner(s) 1~-~4t,4.,/¢.~' "~._1,/,,¢.(,~,,,¢' Day phone Mailing address ~ ~ ~K~tv~ ~ ~ 4!( ~7 Site address E~ ~T ~ ~X~F~ Legal description (Sub'd., Block & Lot) ~O~y ~~ , ~ ~ Legal description (Township, Range & Section) Lot Size ~, ~ Sq. Ft. Number of Bedrooms ~ ~ THIS APPLICATION IS FOR: THIS APPLICATION IS AN: ([] all that apply) Absorption Field '~ Initial [] Septic Tank [~ Upgrade ~ Holding Tank [] Renewal [] Privy [] Private Well [] Water Storage [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for?~Sinrlle Family Dwelling and is in accordance with applicable Municipal Codes. ~ o~e r' ~-'¢ ~t~t ~--~ ~ Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 ) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve .~.. panengak.com October 10, 2011 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Sunny Valley, Lot 21A Septic System Permit Upgrade Request Ladies and Gentlemen: I am writing to request a permit to construct an upgraded septic system be issued for this property. The proposed system will serve an existing four-bedroom house. Currently the lot is developed. The lot is served by a private well. The existing 1000g septic tank will be decommissioned per code and a 1500g S.T.E.P. tank will be installed. The existing drain field was designed for a three-bedroom house and is in failure. It shall be re-used as a four-bedroom reserve at a later date based on Cat III. A new drain field will be installed southwest of the existing field and will be sized to handle a four-bedroom waste stream. The surrounding developed lots are served by private wells. The private wells are located over 100 feet from the proposed soil absorption system. 1. Soils. One test hole was excavated by ArcTerra Consulting Inc. in April of 2011. See the soil log attached. Ground water was monitored for seven days. Ground water was monitored to a depth of sixt feet (6') below ground level in May. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 0.8 gallons/day/square feet should be used, using a conventional wastewater treatment system. Soil Absorption System Design. a. See Sheet 2 of the design package 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and the existing drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The average topography in the area of the proposed septic system is approximately 15 percent based on the survey information in the area of the septic system. There are no steep slopes within the vicinity of the proposed drain field. !'qlailh~g: P~O. Box i002I?~ Anchorage~ AK 995!0--0217 ~ ~' ~ ·A<99503 Physica: 6S. 5 East 82n'~ Ave Cu~t:e B6, Ancnoraae~. Telephone: (90?} 272-,8228 FAX: (907} 272-825~ Page 2 of 2 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, **73¢.: ......... ~.....~~~,U.: ......... ~.....J ~,~/.~..o Steven R. Pannone ,~ ,~ ~'-... CE am ,-",-~ Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Ma:iling: P~O~ Box t00217.~ Anchorase~ AK 9951,0--02t.7 Physical: 615 f.:.;ast 82.~x~ Ave, Suite B6, AncBoi-age, AK 99503 Telephone: (907) 272-8218 FAX; {907) 272--8211 FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 ~" ~~{~ Sco~e .... ~ P.LD. NO SUNNY VALLEY, LOT 21A TERRANCE JOHNSON PLAN EAGLE RIVER, AK 99577 ,i~s(C~ Sheet SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE A~-i-ACHED SPECIFICATIONS, .3. SCOPE OF WORK: INSTALL NEW SOIL ABSORPTION SYSTEM AND 1500g S.T.E.P. TANK. 4. AN APPARENT WATER TABLE WAS OBSERVED AT A DEPTH OF [5.0 FEET AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN [5 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 1 MAXF--~ ~-- 6 TOPSOIL & VEGETATE \ //-FILTER FABRIC 4.0 P5.0 '' 10.0 ~l 5.0~-~---10.0 · 5.0--"] ---~ G~OUNDWATER ~-GRAVEL BEDDING GM © 60' / / % ~-1~4"~I PERF PIPE - . 5_2_2011 .... ~~8 HOLES @ 24 O.C. GROUNDWATER -12 - @ -10.5' 9/25/2011 ~-DRAIN ROCK SECTION ~ ~ ~ 1 DLuZ 4: zO Oz ~ 0 ~ -- VVlDE TRENCH SEE DESIGN (TYP 3LA) 1500 g S.T.E.P. TANK (P) PROFILE DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM LEG E N D NO. BEDROOM: 4 (600 gpd) --W-- WATER LINE/ ABBREVIATIONS TANK SIZE: 1500g S.T.E.P. WELL RADIUS CU COPPER PERC RATE = 6-15 MPI DIP DUCTILE IRON PIPE SOIL RATING: 0.8 GPD/SF -- SS -- NEW SEPTIC TH TEST HOLE AREA RQD: 750 SF FC FOUNDATION CLEAN OUT SYS. TYPE: WIDE TRENCH 0.5' E.D. T# TANK CLEAN OUT NO. MIN LENGTH: 150 LF C# CLEAN OUT NO. USE: M# MONITOR TUBE NO. (SEA) 50 LF X 5' WIDE, 0.5' E.D., R.I. RIGID INSULATION 2' TD DCO DOUBLE CLEAN OUT TOTAL AREA: 750 SF DV DIVERTER VALVE FS FLOW SPLITTER NOT S: ?ANNONF_. BNG PHONE ( 07) 272- 2 272- 2 SUNNY VALLEY, LOT 21A ~~'~ P.I.D. NO dO~SO~ 9436 W LAKE DRIVE DETAILS EAGLE RIVER, AK 99577 Performed for: Project: Depth (Feet) 1- 2- 4- 5- 6- 7- 8- 9- 10- 11- 12-__ 13- 14- 15- 16- 17- 18- 19- 20- CONSULTING~ INC 212 E. 51 ~t Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 SOILS PERCOLATION TEST Terrance Johnson ~,, ~v,,......... ~,q - Date Performed: 4/4/2011 Sunny Valley Lot 2lA TEST HOLE # TH 11-1. ORG/OL SEE ATTACHED SITE PLAN FOR HOLE LOCATION GM w/ occ. boulders 2' & gp pockets seeps B.O.H. HOLE PRESOAKED PRIOR TO TESTING Was Ground water encountered? YES What depth? 11.5' Depth to water after monitoring? 6' Date? 5/2/11 Reading Date Gross Net Depth to Net Time Time Water Drop 1 4/12/11 1:00 6" 2 1:30 30min 25/16" 3 ll/1G' 3 * 1:31 6" 4 2:01 30 min 2 5/16" 3 11/16" 5 * 2:02 6" 6 2:32 30 min 2 4/16" 3 12/16" 7 8 9 10 11 12 · Water Added Percolation Rate 8 (min/in) Perc Hole Diameter 6" Test Run Between 2.5 feet and 3.5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTIO~ LOCATION ~o~ [ I ~ ~ ~ NO, OF BEDIMS ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~OZ /, /' · -- ~ Material Liquid ca.city in ~llons Top of tile ~ finish gra~ Material beneath tile ~ inches OTHER ' "" ~. r~ ~ M / 'r~ ~4 ~ c .~ ~ V '~1~ · lb ,~-~ ,---- ON--SITE SELqER PERMIT APPLICANT ~COTT NYER PO BOX 1~-1411 ANCH ~9511 LOCATION LEGAL L~I SUNN~ VALLEY 5/D MUr~ I C I,~"AL I Ty OF DEPARTMENT . HEALTH AND ENVIRONMENTAL'..<OTECT~ON 825 'L' STREET, ANCHORAGE, AK. 99501 TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFI ELD LOT SIZE 2?6-6756 SQUARE FEET MRXIMUM NUMBER OF BEDROOMS = ~ SOIL RATING <SQ FT/BR)= 160 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH: 4 LENGTH: 96 GRRVEL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TAFt, CH WIDTH I~ -~- ~0 FEET. THE QRRVEL DEPTH IS THE MINIMUM DEPTH Of GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REQU ! RED SEPT I C TRhlK S I 2E: ~-OOO GRLLOr~S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ------ T~O < 2 ~ INSPECT I Otis RRE REQU I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXP I RES DECEMBER 2:L.- 1982 I CERTIFY THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. 'PEm:OR~:O FO,, [")~Vo_ ~'t~n~.S~` MUNICIPALITY OF ANCtIORAGE DEPARI'MENT OF HEALTH AND ENVIRONMENTAL PROTECTION SOILS LOG - PERCOLATION TEST LEGAL DESCRIFTION: I 10- I1 12 ; 13 14 15 16 17, 18- SOILS LOG PERCOLATION TFST .eLOP£ (L,-','. ~elTE PLAN I Z )O, WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT e ifie Drillittg- og by DOC Co, dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 ADDRESS ~o t?,~ tjx- I~1/ ~'~ ~711 STATICLEVELOFWATERFT. LEGALD~CRI~ION Z o~ ~ ~ ~o~ OATE- Sta,ed tl/,/p~ Ended PERMIT NUMBER KIND OF CASING KIND OF FORMATION: '2// From 0 Fi. to CQ Ft O~/~O~x~ From Fi. to Ft From '-) Ft. to L~''~ Ft. ~0 ~ ~f~From Ft. to.~.Ft. From ~ Ft. to Ft. ~ ~ From Ft. to Ft.* From ~ Ft. to ~ Ft. ~ From Ft. to Ft, r~m '~ Ft. to~.~ rt. ~"~ ~C~;< ~ From Ft. to Ft. From Fi. to ~t. d~ From Ft. to Ft. From ~ Ft. to ~ Ft..~d~ff~ From Ft. to.~_Ft. From ,~ Ft. to./~ ~Ft. ~g~ ~ From Ft. to Ft. From /~Ft. to /3~ Ft, /~<o~ ~ e~ F~m Ft. to~_Ft. From t.~ Ft. to tT~-Ft.. ~tO/~ ~O From Fi. to Ft. From/.~~ Ft. to /~ Ft. ~dO .~'~ From~Ft. to Ft From Ft. to Ft. ~ ~ ~ ' From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to From Ft. 1o Ft. From ~_Ft. to Ft. From Ft. to Ft.. From Ft. to.~Ft. From Ft. to Ft. From Ft. to MISCL. INFORMATION: DRILLER'S NAME "- // '. ~ Parcel I.D. 050-354-31 Municipahty of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION: Complete legal description SUNNY VALLEY; LOT 21A Expiration Date: � - l - 2 d Z. Z Location (site address) 9436 WEST LAKE DRIVEL EAGLE RIVER, AK 99577 Current Property owner(s) TERRANCE JOHNSON Day phone 726-3051 Mailing address 9436 WEST LAKE DRIVE EAGLE RIVER, AK 99577 Real Estate Agent GARY BECKER W/ KELLER WILLIAMS Day phone 313-7966 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex - ❑. Multiple Dwellings (:Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual N Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_5 50 r3�, Date of Payment 2.. -C(- 26 z2 Receipt Number 02-gAP 6 COSA # Q5 C 22103 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # �v �a 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: _Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: l' z In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system 4 in accordance with the guidelines and regulations established by the Municipality of Anchorage and y\�:•.I, industry practices. The reported results describe the condition of the system/s on the date/s of the O� •• evaluation. Separation distances were measured to readily Identifiable features. Hidden defects or �1G� 0� encroachments may exist that were not identified during the evaluation. The operational life of all wells K' Fi �O and septic systems depend upon a variety of variables, including but not limited to, soil conditions, (� • . • • • • • • • • • • • • • • • • • • • • . G groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systemis. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the fri-e A. G rness. system/s; therefore, GEG makes no warranty (express or implied). regarding the future performance of CE - the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to 'A\ Cp,.o ,e5�_ono perform the evaluation. Reliance upon the information provided in this report by any other person or �����O party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for _y__ bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the ON-SIric ° in VIATEQ ° RAM 1))))))111 By: v... /vim Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: SUNNY VALLEY; LOT 21A If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA M Well log is filed with Onsite (or attached) Date drilled 11/8/82 Total depth 137.5 ft Cased to UNK ft 0■ Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 1/13/22 Static water level at beginning of test 46.1 ft Comments Parcel ID: 050-354-31 Structure served by this system 1 Well production at time of test 5.8+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes RN No 0 Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by GEG,LTD. Date of Sample 1/14/22 B. TANK DATA C. LIFT STATION Age of tank(s) <11 years n Required maintenance completed Tank type/material STEEL Age of lift station X11 years N)eas_ured operating fluid level in septic tank *36.75"/36.5" Lift station material STEEL d Standpipes/foundation cleanout per _ cord drawing Comments: "Maintenance and repair performed Date of pumping 1/13/2022 6 I z Z � ' on 1/9/2022. *TANK LIQUID DEPTH IN ST1/ST2 ON 2/7/2022. TANK COVER OVER TANK IS.18.5" TO 25.75" PER 2/7/2022 FIELD MEASUREMENTS. NO FREEZING ISSUES PER OWNER (SEE ATTACHED STATEMENT) D. ABSORPTION FIELD DATA SHALLOW DRAINFIELDS (X3) Which system tested (date installed) 10/20/11 R ALL standpipes present per record drawing Total measured depth from grade *4.4 ft (max) Measured depth to pipe invert from grade ft (min) 9 N/A — pressurized field * ❑ Monitor tubes go to bottom of effective. If not, state depth into effective * Code -required soil cover over field Adequacy test date 1/13/22 Results I Pass For 4 bedrooms Fluid depth prior to test **0 10 in Water added **390 / 310 gal New depth **4.75 / 4.75 in Elapsed time **272 / 220 min Final fluid depth **1.5 / 4.25 in ElSystem presoaked Absorption rate *'*Soo gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: 'THIS IS FOR THE UPPER DRAINFIELD. THE MIDDLE DRAINFIELD HAS A TOTAL DEPTH OF 3.6-3.8' DEPTH BELOW GRADE AND THE LOWER DRAINFIELD HAS A TOTAL DEPTH OF 1.6-1.9' OF COVER BELOW GRADE. MONITORING TUBES IN THE LOWERE DRAINFIELD DO NOT APPEAR TO EXTEND TO BOTTOM SINCE NO VISIBLE PERFORATION COULD BE SEEN THE LOWER (SOUTH) DRAINFIELD APPEARS TO BE SURCHARGED AND SHY ON COVER. SEE OWNER STATEMENT ABOUT NO FREEZING ISSUES **UPPER (NORTH) DRAINFIELD / MIDDLE DRAINFIELD -BASED UPON THE RECOVERY READINGS THE UPPER (NORTH) DRAINFIELD IS CAPABLE ABSORBING THE 600+ GPD AND THE MIDDLE DRAINFIELD HAD A CALCULATED ABSORPTION RATE OF 214 GPD. MIDDLE TRENCH APPROACHING THE END OF ITS USEFUL LIFE. NOTE: GEG 1/13/2022 DRAINFIELD ELEVATIONS TAKEN DURING TEST DO NOT MATCH THE DRAINFIED ELEVATIONS SHOWN ON THE RECORD DRAWINGS. C:QSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑ Yes Septic Tank/Lift Station on Lot > 100' ft Surface Water > 100' Community Sewer Manhole/Cleanout > 100' E] Yes if No ft [] Yes if No ft Neighboring Tank > 100' F-1 Yes if No ft Private Sewer/Septic Line > 25'F71 Yes if No ft Absorption Field on Lot > 100' E] Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ft 0 Yes if No ft [✓ Yes if No ft Water Service Line > 10' (l Yes Manure/Animal Excreta Storage > 100' ft Community Sewer Main > 75' 0 Yes if No ft [] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' S Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Q Yes _._if N4 ft Community Wells > 200' [✓ Yes if No ft Water Service Line > 10' (l 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' v Yes:. if. No ft If absorption field is under driveway comment below Property Line > 10' R 'Yes if No ft Wells on. Adjacent. Lots: Water Main > 10' Q Yes . if No ft Private Wells '> 100' - Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' B Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS *MET SPEARATION AT TIME OF INSTALL. CENTER OF ST1 TO CENTER OF DECK SUPPORT (SONOTUBE) IS 5.2'. DECK SUPPORT NOT OVER STEP TANK. **THERE IS A STREAM SOUTHWEST OF THE SEPTIC SYSTEM. ACCORDING TO 2011 PANNONE RECORD DRAWING, STREAM 100'+. NOT ABLE TO PHYSICALLY VERIFY DUE TO SNOW COVER. MOA WETLAND & STREAM MAPPING ATTACHED WHICH SHOWS THE STREAM (AND/OR WETLANDS) 100'+ FROM DRAINFIELDS. G. ENGINEER'S CERTIFICATION I certify that / 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 #AECC884 11 MUNICIPALITY OF ANCHORAGE Development Services Department 4 p p �� =� �' Phone: 997-343-7904 On -Site Water & VV a to as��ti.�.tei � , Seaton Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner Sheena- `50 nson Street Address -3436 we_ ri WIp. ter, _ Septic Tank: Sludge level 3 inches Lift station: -Pumping: required Y es no .Pumping completed es no Pump basket cleanedes no Effluent filter cleaned es no Control floats cleaned es no -Proper float settings confirmed e no Operation satisfactory. yes no Alarm SVstern: Dedicated electrical alarm circuit {yes no Audible and visual alarm inside dwelling Des no -Alarm system operation satisfactoi not satisfactorti Manhole Riser -Ground water intrusion at riser to tank connection yg§ no Ground water intrusion around pipe penetrations yes no Weep hole functional e no -Manhole lid: Functional es no Insulated es no Properly Securedes no Other -All manufacturer required inspections and maintenance completed yes no Comments: Qualified Maintenance Provider: Technician ,t qY\. Company Signature C_ Date of maintenance-116�Z- Date 1 2&0-6a Lang & Associates, Inco Professional Land Surveyors 1 7 ouu Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone (907) 522-4625 Fax ken@langsurvey.com o OF jonothanQlangsurvey.com ��'�`� �Lqs�� I hereby certify that I have surveyed the following described property: LOT 21A, SUNNY VALLEY SUBDIVISION (PLAT No. 82-400) Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a representation of the conditions that were found on the dote the survey was performed. This survey does not constitute a boundary survey and is subject to any Inaccuracies that a subsequent boundary survey may disclose. The information contained hereon shall not be used to establish any fence, structure, or other improvements. Dated this the _ �Day of1_r=_ l..CJI- — � of Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49LH* .................. 3.......... KEN ETH. tANG o .LS -520. yaps �Q�ROFfSS10NA1- AECC963 Y M u i ilSbiity :6f .hi:h'6i- ige 'Development Services Depa ment · Bui~ing Safe~ D~bion O~& Water & Wast~ater P~mm 47~ ~ B~aw SL P.O. ~x 1 ~ ~ch~ge. ~ ~51 ~ ~.d.ahc~.ak.us · (~7) ~7~ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 050-354-~1' ~ I ~ 1. GENERAL INFORMATION Expiraiion Date: ._.~r'-_ ,~.,/./J - O Complete legal description SUNNY VALLEY SUBDMSION; LOT 21A, Location (site address or directions) 9436 WEST LAKE DRIVE * EAGLE RIVER, AK. 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOSEPH CN3ANISS Day phone (907) 694-0638 9436 ~ LAKE DRIVE * EAGLE RNERt AK. 99577 Day phone Dayphone Unless otherwise requested, HAA 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 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage De;velopment Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered in the State of AJaska. Certificates of Health Authority 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 HAAs upon request to homeowners, Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (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 professlonal 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 vedfy that my Investiga~on, based on procedures outlined in the Health Aufhotfty Approval Guidelines for this application, shows that the on-site water supply and/or wastewaler disposal system is(are) safe, funcb'onal and adequate forthe number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Munidpalily of Anchorage files and from my investigation and Inspecb'on, the on-site water supply and/or wastewatsr disposal system is(are) in compliance with all applicable Munidpal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm GARNESS ENGINEERING CROUP, Ltd. Address 3701 E. TUDOR ROAD, surrE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Phone 337-6179 Date . . . Engineer's Comments: In conducting this evaluaUon, GEGo Ltd. attempted to pmvfde a thorough, conscientious engineering analysis of the system in acco(dance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the ¢~nditions encountered at the Urne of the test, and coperat~n distances measured to readily Identifiable features. The eperat~nat life of all wefts end septic systems depend on the local coils condition, groundwater levels that may fluctuate during the year, end the water usage of the family being sewed by the system. These conditions ere outside the contn~l of the evaluat~ of the system. Satisfac'fc~y test results do not guarantee future performance of the system, nor de they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not pmvfde any warranty or future estimate of how long the system will centinue to meet the operational requirements of the ADEC er MOA DSD. The content of this report Is f~' the sole benefit of the owner listed above. Any reliance upo~ or use of this rep<~t by any other person o~ party ls not authorized, nor will It confer any legal right whatcoev~. 5. DSD SIGNATURE ~ Approved for .~ bedrooms. Disapproved. Conditional approval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the following stipulations: ON-SiTE '" ........ Maintenance Agreements ~,,/?ram-r ~-~,~.., Supplemental Engineer's Report Other Original Certificate Date: ~ - ~..-/"tt - ~) ~ Legal Description: A. WELL DATA Municipality of Anchorage Development Sentices Department Bulkllng Safety Division On.Site Water & Wastewater Program 4700 ,~ Bmgaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage~ak.us (~07) 343.~04 HEALTH AUTHORITY APPROVAL CHECKLIST SUNNY V~lry SUBDMSION; LOT 21A~ Well type ~mVA1~ ff A, B, or C provide PIN~ID~ N/A Datecompletnd 11/8/1982 Sanltaryseal (Y/N) YES Total deplh 137~5 lt. Cased k) 40+ ft. FROM WELL LOG Date of test 11/8/1982 Static water kwel 43 Well production 25 WATER 8AMPLE RESULTS: Collfo~n ~ colonies/lO0 nd. Amen~ N/A mgJL. SEPTIC/HOLDING TANK DATA Tank Type/Material g.p.m. Nitrate Date of sample: 1/28/2005 Tank size 1000, gal. Number of Compartmenta Foundation cteanout (Y/N) Date of pumpUlg 8/2004 AB$ORPllON FIELD DATA Date installed Lengm 68 ft. 2 Depression over tank (Y/N) NO Pumper ,Soil rating (g.p.d./ft~0g(~,..~.~) 160 Width 5 ft. Parcel ID: 050-354'-11E ~ I well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 1/27/2005 45 ft. 4.17 g.p.m. 18 in. Total dept~ N..~ ft. Eft. al~orptlon area 486 ft= Monltedng ~uhe Date~fedequacytast 1/27/2005 Resufts(Pas~Fall) PASS Fluiddep~abemptionrmldhefomtest 19 in. Wateradded 4g3gal. Elapsed Time: !036 min. Final fluid depb~ 19 k't. Abempfion rote >- 450+ Any rojuvenatlon ~'ealmant (past 12 mo.) (Y/N & type) NONE KNOWN ff yss, give date **$UMP AREA ONLY HAS 22 INCHES OF COVER, THE RE)ANNDER OF TRENCH APPEARS TO HAVE 2+ re.t.~ OF COVER. AND IS INSULATED PER 1982 INSPF..CllON REPORT. ***UQUID ~ 6.5 INCHES BELOW INVERT OF OISTRIBUTION MNE. System type TRENCH Gravel below pipe 2 ft. Depression over field NO For 3 bedrooms New deplhe#24.SIn. g.p.d. Date Instelled 10/16/lg82 Cdeanoute (Y/N) YES H~h water alan~ (Y/N) N/A AROUND,THE CLOCK Other bacteria ~ colonlesJlO0 mi. Collected by: OEG~ LtD. D. UFT STATION Date ~s:iled Size in gailees ~ =on level et in. ~ tested . M ::he:: r;= :: :trements ? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septlo tenk/IR steUon on lot 100'+ AJ~3rption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public ~ewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'-~- Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pmpariy line 10'+ Building foundation t0'+ Water main N/A Water service line 10'+ Sudace water 100'+ Driveway, parking/vehicle storage Curtain drain NONE KNOWN Walls on adjacent lots I00'+ 5'+ F. COMMENTS O. ENGINEER'S CERTIFICATION / certify that I have determined through field inspec~ona end m~4ew of Municipal mcor~s that the ebove systems ere in conformance with MOA HAA guidelines in effect on this date. Engineer~ Printed Name Date 'z-'/z-7 -/~. ~' JEFFREY A. GARNESS Waiver Fee $ Date of Payment Receipt Number 01/30/2005 12:23 9072767804 ROEERT E J01-HS JR PAGE 01 . . ~ ~ ~R~Y ~ I PLOT P~NS k LOT ~R~ NO~ Prepared ~ ~.~c~=~=~ ~~ Robe~ E. Johns, r. ~ Assoc. ~~~, .~>~~ , Professional Land Surve~rs . . ~,, ~ ~0,' .~.~- .~...~ . ,,~ ~ 1~29-05 ~~, '~~ ~<~:- .::... .-~-n-os ~ ~ ~'~s-~ --~.~J' LOT 21-A, SUNNY VALLEY SUBDIVZSZON Parcel I.D. #. MUNICIPALRY OF ANCHORAGE ~Ll~[ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site So.ices Section P.O, Box 196650 Anchorage, AJaska 99519-6650 (g0?) ~4:~4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 050-354-31 1. GENERAL INFORMATION Complete legal description SUNNY VALLE"Y SUBOMSION: LOT 21A. LocaUon (site address or direcUons) 9,*36 WESTLAKE DRIVE FAOLF RIVER_ AK 99577-9515 Property owner LOUIS NATHANSON Mailing address 9436 WESTLAt(E DRIVE Lending agency. Mailing address Day phone.-~ FAGL~ RIVER. AK 99577-9515 Day phone Agent Day phone Address Un/ess 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 wrftten confirmation from State ADEC attest- lng 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 wrftten confin'nation from State ADEC lng to the legality and status of system. 72-025 (Rev, 1/91 ) Front MOA ~21 Computer Version orOe: Alaska. Water. and Wastewater Consultants, Inc.. shall be paid $400.00 at, flor to, closing mr the enginee#ng services providea. 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 heroin. 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 tn compliance with all Municip.~ and State cedes, ordinances, and regulations In effect on the date of this inspection. Name of Firm ALASKA WA71 Address 6901 DI~BARR R~AI Engineer's Signature I . v In cendu~'ng this e~aluation, AWWC, In~ system In accordance with ADEC and M( ~/A.~Z"~A' R CONSULTANTS, INC. Phone (907) 337-6179 rI~21~/AN¢ -tOP, AGE. ALASKA ~9§04 / / - HS Guidelines & R~ula~ons. ~e ~ ~sul~ des~ ~e performance of the system under the conditions encountered at the time of the test, and separation d/stances measured to readily Identifiable features. The operational life of all walls and septic systems depend on the local soils condition, ground water levels that may fluctuate dudng the year, and the water usage of the family being sen/ed by the system. These conditions are outs/de the control of ,~'=~ the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or parly is not authorized, nor will it confer any legal #ght whatsoever. 6. DHHS SIGNATURE / Approved for "~ bedrooms Disapproved Conditional approval for. bedrooms, with the fo,owing stipulations: Additional Comments Date~ The Municipality of Anchoroge 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 rogistercd 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 ) Bac,~ MOA ~! Computer Version Municipality of Anchorage ' ~ C E ! V E./.~ DEPARTMENT OF HEALTH & HUMAN SERVICES ~ Envtronment~Se~'~co~O~'~en OCT 1 0 20~ WELL DATA Well Type PRNATE Leg ~ent (y~) Total depth 1 Health Authority Approval Checklist 056-;~5¢-:~1 SUNNY VAI try SUBDiViSiONi LOT 21A Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number y~s Date completed Cased to 40% FROM WELL LOG Date of test 11/8/82 8teffo water level Well p~xluction ~,~ WATER 8AMPLE RESULTS: Colifoml 0 Nitrate Date of eample: 9/28/00 D. SEPTIC/HOLDING TANK DATA Date Installed 10/16/82 Tank size FouedaUon deanout (Y/N) 1 ~/8/82 AT INSPECTION 8/25/2000 lB"+ g.p.m. 3.5 g.p.m. 0.50 mg/L .Other bacteria.' 0 Collected b~. A.W.W.C., INC. 1000 NumberofCompartmente ;~ Cteanoute(Y/N) YES Dapr~islell (Y/N) NO High water alarm (Y/N) N/A Date of Pumping 8/25/2000 Pumper Je'S PUMPING C. ABSORPTION FIELD DATA * SEE An'ACHED DATA Date Installed 1 O/16/82 8oll rating (g.p.d.flt2 or fl2Jlxlrm) Leng~ ss' Width ~' 160 System ~ TRENCH Gravel thlcimess below pipe g' Total depth 4.5' Elfecltveal~erea 486 Sq. FT. MonltoringTubepmsent(Y/N) YES Dapmssinnoverfleld(Y/N) NO Date of adequacy test 8/25/2000 Results (Pass/Fall) PA~$ For. 3 Bedrooms Fluid depth In al~on field before test (in.);. F'Md depth 7" (ins) Minutes leter. Perax~e tmalment (past 12 moflifm) (Y/N) 0" Immedtetelyaffer 54~ gal. wateredded(in.)~__ N3sorptlon mte - NONI~ KNOWN If yes, ONe date -' F... SEPARATION DISTANCES SEPARATION 01STANCES FROM WELL ON LOT T~, Septic/t~dlng lank on lot Abso;ption field on lot Public sewer main Sewer/septic service line 100'+ On edjacent lots 100'+ 100'+ On adjacent Iota 100'+ N/A Public sewer manhole/cleanout N/A 25'+ Mit ml]on N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water maln/senace fine 10'+ Surface waterldralnage 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Pmpe~ Uno 1 o'+ Building foundation Suttsce water 1 oo'+ Curlaln drain NONE KNOWN Wefts on adjacent lots 100'+ 10'+ Water maln/sendce line 10'+ Driveway, paddng/vehlcle storage ama 10'+ Wells on adjacent lots. 100'+ Oala of Payment /0-./(~· ~ WaKer Fee $, Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 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 3,-/~ '*-/-,~' 70 Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3 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. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ~' Holding tank " .. ,- Community on-site Public sewer 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 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 furthervedfy 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 Address Engineer's signature S & S ENGINEERING Eagle River, Alaska 99577 Phone Date ~'/'7/~ DHHS SIGNATURE *t~' Approved for --~ Disapproved. Coqditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificate~ based only upon the representations given in paragraph 5 above by an independent professional eng!neer 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 respoesible for errors or omissions in the professional engineer's work. ROBERT C. COWAN, P.E. ROBERTA. SHAFER, EE. TEST August 7, 1996 CML ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: RECEIVED AUG 8 Municipality ot Anchorage Dept. Health & Human Services Lot 21 Sunny Valley Subdivision Dear ~Lr, Cross, This is in reference to a HAA, with a septic system advisory, issued by your department on July 17, 1996. In our letter of July 12, 1996, we stated that it is possible that the distribution line may have been laid down slope. On August 5, 1996, Dean Construction excavated both ends of the trench to establish elevation. During this construction we found the distribution pipe at the end of the field was 0.6 ft lower than the distribution pipe at the beginning of the field. The pipe, in approximately the last 30 ft. of the trench, was raised to the correct elevation. 10 yards of sewer rock and new insulation was placed over the pipe to correct this system. Now, instead of 17 inches of water in what appeared to be an 18 inch effective depth, this system had 17 inches of water in what we have documented/corrected a 24 inch effective depth, indicating the system is only 71% saturation. Request you please re-issue a BAA for this property without a septic system advisory. If we may be of further service please contact us. Sincerely, 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-354-$! HAA# ['"~'~C'~'c~L~ C~,--,'.-,'.-,'.-,'.-~c~"L'I 1. GENERAL INFORMATION Complete legal description Locatior{ isit~ ~ddre.ss or,directions) 'Property owner Mailing address ~.ending agency 9456 t'Jez~. Lake E4~.,~e River, AK Day phone . $49'54'70 River~ AK 99577 Day phone Mailing address 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. 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 & $ ENGINEERING 17034 Eagle River Lo~p Road No. 204 Address ~,ele River. Alaska 99577 . Engineer's signature ~/J · ~"~.,~'~------ bedrooms. DHHS SIGNATURE ?::~ Approved for Phone ~' 9 '7 - 3- e 'T ~7 Disapproved. Conditional approval for 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 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. MUNICIPALITY OF ANCHORAGE M E M 0 R A N D U M SEPTIC SYSTEM ADVISORY Prior to a recent adequacy test on the septic system for this lot, /~ inches of standing water was observed in the absorption field. This indicates that approximately ~ % of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject }Iealth Authority Approval. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street. Room 502 · Anchorage, Alaska 99501· (907) 343-4744 A. WELL DATA Lo, pmseat~) Total depth Saaiuuy Health Authority Approval Checklist JUL 15 1996 IfA, B. or C, auach ADEC I~Ier. ADEC water system number Date completed Cased to ~/a I ~ FROM WELL LOG I1- ~-/'z~ Il- Casing heigh~ (abovc ground) Wires properly ptmec~cl AT INSPE~ON Date of I~1 5tali¢ water level Well pmdUCUoa WATER SAMPLE RESULTS: g.pm. Cotifo~m Date of q~mple: IL ~]lO~O TAJqK DATA Date installed /~]~.. Tank size . Date of P~mping C.' ABSORIq'ION k'TKi.II DATA Niuate O. I Othe~ bac~ria O Collected by.: /0~:)~ NumberofCompaflments ~ ¢leanoms~/N) )/ Soil rat~ (g.p.d./t~ or l~axlnm Effective absorplion ~a ~/~,,~-~f-~. Monilming Tube prescnt~%l) y DepreS~oe over fldd (YR~ ~,/ pat= of ~. ~=~ 7-//- ~ ~, P.=u~) ~ Fo~ ~ ~ Fl~d~~fionfidd~o~(~.): /~v l~~.w~ (in.): /~,~ Fi~ 17,~ (i~.)~u~ la~: /~0 ~onr~ ~ ~ = g.p.d. Fcroxidc treatmcm (l:mSl 12 months) (Y~ .'~',,~. ;~,,-~l,~,~fye~, pre date ~'~//~ D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pmn~ff' level al* SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~---'ff~oiding lank on Io~ I~0~* ~' ; On adjaccm lots Al~ovption field on lot ~ C)C:> : On ad'Jac~t lots I~blic ~cwcr main ~{p Public sc~vcr manlmle,/clcanom Sewer/~'puc s~ce line ..~' * ~' Lift s~mon SEPARATION DISTANCES FRO~OLDING TANK ON LOT TO: Building foundation '1~'1~' Propen)' line lo ~4. Abso~ion fie. Id ~.t4' Water maJn/setvice line Io I'P Surfacewater/dmln~ge /o~ 14' Wells on adjac~t lots /~O 14- SEPARATION DISTANCE FROM AI~ORFflON FIELD ON LOT TO: Building foundation /o ~ '~ Water mni~/setwice line I 0 I '~' Sur~._~ water Ioo I '/" Dill'way, parking/vehicle storage a~a Cuflain drain ~'//~ Wells on adjacent lots ]oO ~ ~' I~.' line /o ENGINEER'S CERTIFICATION I ceni~, that I have determined thru field inspec~ons and review o/MuniciPal in conJbrmance ~vith MOA ~.L~ guidelines in effect on Otis date. $ , Waiv~ Fe~ S Dat~ of Payment ~___-~_ipt Numbe~ nic' ouly ipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 ROBERT C. COWAN, RE. ROBERT A. SHAFEF~ RE. C~IL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 21A Sunny Valley Subdivision Dear Mr. Cross, On June 14, 1996, S & S Engineering was contacted by the owner, Eric Beene, to perform the necessary work to obtain a Health Authority Approval (HAA) for the referenced property. Shortly after this date we performed a site visit to determine the liquid levels in~he_leachfield. At this time the-level-was-meaSured-at-17 inches, Whidh iF. only.l-inch-~q~/o ~low the bottom of the distribution line. The septic tank was pumped on July 1, 1996, by J.R. Pumping. Approx'~_ately 4.5 hours after the septic tank was pumped the ~q~i~_level'-'in-the-monitoringiTtube-was 'meaSured~at i6~5 ~inches. * ' - On July 8, we were notified by the owner that the liquid levels were at 14 inches. On July 11, we again arrived at the property to perform an adequacy test on the septic system. The data for this test is as follows: TIME GALLONS MONITORING TUBE 10: 13 0 13 INCHES ----____-. 10:28 80 13 " ............... 10:43 180 14 ," ...... 10:58 270 14 ............. 11:13 360 15.5" ....... 11:28 450 16 "---~ ,, ....... :~, ,/;.. 11:43 540 17 ..... 11:58 630 18 , .... HOSE REMOVED FROM SYSTEM FOR APPROXIMATELY 17 MINUTES 12: 15 0 UNKNOWN . 12:34 740 18 . ........... 1:oo 900 19.5 - 3:00 --- 17.5" .... LEVELS IN THE SEPTIC TANK DID NOT CHANGE DURING THIS TEST 17034 NORTH EAGLE RNER LOOP · sUFrE 204 · EAGLE RP/E F~ ALASKA 99577 Page 2 July 12, 1996 Lot 21A Sunny Valley With 17 inches of water, in what appears to be an 18 inch effective depth, this system would be considered 94% saturated and would typically receive an advisory by your department. We feel this advisory should not be placed on the HAA for the followlng reasons: 1. During an adequacy test performed by S & S Engineering on March 5, 1990, we found the liquid level at the start of the test to be 17 inches. The water level was 23 inches at the time we stopped adding water to the system. The water being added did not back into the septic tank. 2. During an adequacy test performed by Robert E. Gilfilian in September 24, 1993, it was reported that the water level in the absorption field before the test was at 17 inches and at the end of the test was 22 inches. 3. It is also possible the 2 feet of f~r~¢T,,~ .~6~r~.~R this system%v~ ~ ~o ~-'.~m~ ~ ~ ..... of sewer rock around and over the pipe and the distribution line was installed into the required 2 feet of sewer rock. 4. It is also my experience that at the time this system was installed, the practice of laying the distribution line down slope was not uncommon. A consistent drop in liquid levels, after the pumping of the septic tank, indicates this system is not in ground water. If we may be of further service please contact us. Sincerely, · Shafer Engineering Technician Professional Engineer ATTACHMENT DETAIL PROFIL£ 24. MONITOR] TUBE 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-35~,-'31 - ~r~ - ~ t_~ HAA # ~ 1. GENERAL INFORMATION Complete legal description Lot 21A Sunny Valley Subdivision Location (site address or directions) ' 9~,36 West I_aRe Drive Property owner Mailing address Barbar~ Bovle Day phone 696-3448 Lending agency Mailin~ address P.H.H. Hcrr~ Equi tY Day phone~- 1855 C..atev~y Blvd.~ Suite 950~ Concord! CA 94520 Agent Kathy Olmstead Address Jack: W3ite Ccn'pany, EaRle River, Alask:a Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 'w TYPE OF WATER SUPPLY: Day phone 694-5500 NOTE: Individual well X Community well Public water ~' · If..comm. unity..we!l..system, pro~/ide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: X Individual on-site Holding tank Community on-site 'Public sewer NOTE: If community wastewater system, l~rovide written confirmation from State ADEC attesting to the legality and status of system. 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 nomber 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 Gi I f i I ian Engineerin~ Inc. Phone 376-3005 or 277-2021 Address 255 E. Firewe~;l,~Lan,e~ Suite I02.~ A~choraget AK 99503 Engineer's signature R~R'R~.~G i i f/~, r-~~ Date 9/25/93 · ...-, DHHS SIGNATURE ~ Approvod. [or 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 DH HS 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 2IA~ Sunny Va l lay ,Sub. PamelI.D. 050-354-3! A. Well Data Well type Pr'ivat e Log present (Y/N) Y Total depth /37' Y Sanitary seal (Y/N) .If A, B, or C, attach ADEC letter. ADEC water system number. Date completed 11/8/82 Driller Sullivan Water' Wel Is Cased to 40' + Casing height 30" .Wires propedy protected (Y/N) Y Date of test Static water level Well flow 1500 ,qpm Pump level1 Unknov~ FROM WELL LOG ATINSPECTION 11/8/82 9/24/93 43' 43~ 1" g.p.m. ,,,C', ~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 100 + Absorption field on lot t 00 + Public sewer main NA Sewer service line 25 + Unknown ; On adjacent lots 100 + .; On adjacent lots 100 + ,Public sewer manhole/cleanout NA · Petroleum tank 25 + WATER SAMPLE RESULTS: co,form Date of sample: 9/24/93 B. SEPTIC/HOLDING ;rANK DATA Date installed 10 '" Cleanouts (Y/N) Y High water.,alarm (y/N) Date of pumping. Nitrate (~- ~ ,///~/// Other bacteria .Collected by: K. Sheet s Tank size t 000 ,cia I Iens Compartments ;~ .Foundation cleanout (Y/N) Y .Depression (Y/N) NA Alarm tested (Y/N) NA Pumper N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 100 + ,On adjacent lots 100 + ,Foundation 10 + To property line 10 + Absorption field 10 + Water main/service line ! 0 + Surface water/drainage 100 + CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size In gallons Vent (Y/N) High water alarm level 'Pump on' level at Manufacturer Manhole/Access (Y/N) 'Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots' Surface water, D. ABSORPTION FIELD DATA Date installed Length 68 ' Total absorption area 10/t6/82 .Width /~85.7 Date of adequacy test 9/24/93 Water level in absorption field before test I 7" Peroxide treatment (past 12 months) (Y/N) N SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 100 + To building foundation 20 + On adjacent lots 30 + Cutbank__ Surface water 100 + Soil rating (GPD/FF) 160 s.f./ER 60" .Gravel thickness 2/*" - .Cleanout present (Y/N) Y Results (pass/fail) Pass ~ .-~_# After test ~'~ ~.f yes, give date .On adjacent lots 100 + ,System type 5hal Iow trench Totaldepth 4' w/insulation Depression over field (Y/N) N for 3 Bedrooms Property line 10 + .To existing or abandoned system on lot NA NA ,Water maln/service line 10 + Driveway, parking/vehicle storage area 20 + Curtain drain NA Eo ENGINEER'S CERTIFICATION Engin~fs Name Date HAA Fee $ Date of Payment Receipt Number 72-(~6 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number Gilfilian Engineering, Inc. 1800 E. Parks Hwy., Suite D-100 Wasilla, Alaska 99654 WELL FLOW TEST DATA SHEET From: Well Log. ® Probing Measurements X ADEC Records Well Depth: 137' 5" ® Static Level: 43' 1" X Physical / Sanitary Features: Sanitary Seal ~/' / Cap ~ Casing Above Ground Surface:. 30" Pump Wire in Conduit ~ Surface Drainage Away from Well: Good ~ Poor. Well Pump Specs: Water Supply Line: Size: Type: Drop Pipe: Size: Type: Depth to Pitless Adapter: Storage / Pressure Tanks: · Time Time Interval Pumping Cumm. Static Comments Minutes Rate {gpm} Gal. Level 1010 -- 5.5 -- 43' 1" Water level measurement 1030 20 5.5 110 53' 0" taken while pump was 1045 15 5.2 188 53' 2" running. 1120 35 5.5 390.5 54' 7" 1200 40 5.5 600.5 52' O" 1230 30 5.5 765.5 54' 7" 1300 30 5.5 930.5 51' 5" 1330 30 5.5 1095.5 54' 10" 1410 40 5.5 1315.5 54' 7" Minutes Average -- Gallons /,sl 240 TOTALS 5.5 1315.5 11 ' 9" Time Time Interval Static /,r Comments Minutes. Level 1420 10 45' 9" LOCATION: Lot 21A Sunny Valley Subdivision CLIENT: P.H.H. Home Equity PROJECT NO: 93114 DATE: 9/24193 BY: Kent Sheets WELLFLOW.GEI MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SERVER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D,# (~) ° ~-I--.-~ HAA# ~1=~ [L-~cl C~-~c'''j I 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 21A .~u.m~z./ [l~u~.~.F S~zbd~.v.l.s,l. on Location (address or directions) 943& ~t ~k~ Driv~ (b) Property owner .T~t. ry ,~ Romoru~ Grove, Telephone : (home) 694-4519 Business Mailing Address 9456 ~'~Z~t L~zk~ Dr~.u~.t E~zql~ R~.u~rt Ak~ 99577 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent RE/MAX OF EAGLE RIi/ER ATTN: [/~.~q~.~. [ Address 16600 CCJ~.~.rf,i.~.~.d Dr./.u~ #~01 Eaq~ RZv¢~, Ak, 99577 Telephone ~94-4~0~l (e) Mail the HAA to the following address: (or check here,l~ if hold for pick up.) List contact person and day phone number below: $ & $ ENGINEERING 1703~r La, op ~ead Ho. 204 Eagle River, Alaska ~$77 2. TYPE OF RESIDENCE Single-FamilyZ:Z Number of bedrooms 3. WATER SUPPLY Individual Well [33~. Community [3 Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [3( Public [] Community r-I Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. Page I of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION- AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of thls Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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 .... ;~:~c.~]G Telephone ~ c,?~".'-'Z--¢"/? ~ 1~ :;34 ~=gle River Loop Road No. 204 Address ,, , ~la.,,;=, e9.~77 Date 6. DHHS APPROVAL ,- . Approved for~,bedrooms by Date Approved ~ Disapproved Conditional Terms of Conditionai~'pproval/ ~~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7;~5 (~o,,. 7/88) e,,¢~ Page 2 of 2 /'~'~,'.nY cM ,U..I~,I~A~LJTY OF ANCHORAGE (MOA) "! ; ' ~ CHECKLIST - FEBRUARY 1984 343-4744 ~ Legal Description: '~ '~'~'"" ,~---,./ A. WELL DATA WellClassification ~_~'),~J~ ~': (~'"'A/~"~ :i~A,B,/~,D.E.C. Approvod(Y/N) Well Log Prese~((y/N), ,, Jl--Date/COmpleted. ,-- ' ' .I I'--~" ~ '"~' / Yield ~'A... Total Depth_/~.~--~. Cased to ,/~/O 't' Depth of Grouting - Static Water Level ' ~Z1/ ' Casing Height Above Ground Electrical Wiring In Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest S~wer Service Line On Lot Water Sample Collected by Water Sample Test Results Comments. Pump S~t At ~) Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots I OO "t- I C.'.X2 't ; On Adjoining Lots ! ~O '+ To Nearest Public Sewer Cleanout/Manhole /J//~ Date Installed ~:~/.~;L.~-_Size ! r')~O No. of Compartments Standpipes (Y/N) I,~ Air-tight Caps (Y/N) Depression over Tank (Y/N) /~ · Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well · To Property Line ' I O ~ 'f' '/'~ To Water Main/Service Line. ! ~ I"~ ~ To Stream, Pond, Lake or Major Drainage Course Comments .--~ ,~, "t"iC-~ ~, f,,~ ,~ ~ ~ ~ Foundation Cleanout (Y/N) Date Last Pumped. ,,~ - ~ :,or Temporary H~lding Tank Permit (Y/N) To Building Foundation TO Disposal Field. "'"' Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I ~0 ~://~ ~'~' Date Installed I 0 - I (,~ -- ~ ~. Width of Field. Square Feet*of Absortion*Area Depression over Field (Y/N) Results of Last Adequacy Test Date of Last Adequacy Test Length of Field ~_,~ Depth of Field Gravel Bed Thickness ,~./.1 Statndpipes Present(Y/N) ,~_~.._~ SEPA'.RATION DJSTA. NCE FROM ABSORPTION FIEL~D: To Water-Supply Well ! ~O z.f. -- To Building Foundation Lot "[',)/1~ To Water Main/Service Line To Property Line ! To Existing or Abandoned System on ; On Adjoining Lots ' ~ 0 ~"~' TO Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION ~ . Date Installed " Dimensions Size in Gallons ' ~ ' ' r Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at TH;gs~edW:~r Alarm Level at t~//x ~ Vent(Y/N) '~,,,,,~' Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** f ' · . .,..F~ ~..,., I certi y that I have checked, verified, or conformed to all MOA and HAA guidelines in eff_e~.te of inspection. , · . ~ · Signed ~,~ m~I~INFE.ING Corn"an,, 17~-~gle River L~p Road No. 2~ ~'~/~/~ Date - '.--'~ ,, ReceiptNo."' ~/~0 /~ *'.,', ReceiptNo ' ' · ,' · of Payment /9- Waiver F..: $ Amount: $ Z~-~ Date of Payment 7~ m-. ~)e,ck Page 2 of 2 '%, APPLI"'~,NT FILLS OUT UPPER HA'~; ONLY Add~ess Zip ~e Phone Address ~ ~ ~ Zip ~e Legal Descdpt~. ~ ~1~ ~U~[~¢~~' Sewer Disposal Iq ~ Time Time Time Time / ~,,[ d Date Dale Date Date Inspector Inspector Insp~tor Insp~t~ -N. lpALh .... ' ~,-,~c&~ - ./~ RECEIVED , { ) APPROVED ~DROOMS ~ 'CONDITIONS OF APPRO~. Soils R.aling Date ~wer Install~ Well To ~sorptlon Area / O O ~ Wetl L~ R~elved