The URL can be used to link to this page

Home My WebLink AboutHERITAGE PARK BLK 2 LT 26Heritage Park Block 2 Lot 26 #050-211-54 Al IRully-r A a Inspection Report_1-1-12.doc � Municipality of Anchorage Community Development Department MAA 1 2 p On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:/Avww.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141415 PID Number: 050-211-54 ❑ New ❑✓ Upgrade Name: Gerald & Shelli Tree ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 19435 Citation Road ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. I Gravel depth beneath pipe Ft. Subdivision Block Lot Heritage Park 2 26 Fill added above original grade - Ft. I Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines I Ft. SEPARATION DISTANCES - To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ftp I Ft. Well 200+ N/A N/A N/A N/A TANK 71 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1250Gal. Surface Water 100+ N/A N/A NIA Material Number of compartments Lot Line 31.0 N/A NIA NIA Steel 2 NA Foundation 5.4 N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A N/A Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. - Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tankto 3034 Installer drainfield JR's Septic Pumping Drainfield CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 10011 Inspection - 1ectio3� 9/27/2014 2wLocation and description - Bottom of trim NE corner of house 3" a" COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp A '% Conditional Approval: Date g ql .jw* 49 TM -* A0 Pod �even 'f . 'fannorae'i CE 81 9 Approved % Date �'� w ,AIt i j� gtil��W 'h��' Inspection Report_1-1-12.doc � I \\ i \ o% j �w \ � I � DRAINFIELD(E) COLLAPSED 12508 SEPTIC TANK ABANDONED PER CODE AND INSTALLED NEW 12509 SEPTIC TANK W/ DCO SEPTIC AREA (E) 28 1 o� a o a z zQ OU U 94-7 NEW 12509 SEPTIC TANK PROFILE NOTES: RECORD DRAWING PLAN o„ 27 A B T1 27.6 31.0 T2 20.6 38.4 DCO 20.0 40.6 MT(E) 61.4 24.3 SEPTIC AREA (E) 1 11 1 _ i 1 ,1 a SEPTIC AREA (E) i ,s MT(E) T1 I �/ B II{{I o 4BR 1�•, A } P� i LOT 26 \ SSE (E) 10' UTILITY EASEMENT CITAA9N ROAD-- — PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 HERITAGE PARK, BLOCK 2, LOT 26 GERALD & SHELLI TREE 19435 CITATION ROAD EAGLE RIVER, AK 99577 OP Q \\� Date .Cq lk) 5/7/15 con Scale r/ 1„=50' .... ....P.I.D. NO 050-211-54 Stevenj PERMIT N0. tc,, CE 8149 ..�% OSP141415 �� Sheet 2 OF 2 On -Site Water and/or Wastewater System Permit 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 Permit Number: OSP141415 Tax Code Number: 05021154000 Work Type: SepticTank Upgrade Permit Effective Dates: September 26, 2014 to September 26, 2015 I 1-l4f Jv:ae- Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: HERITAGE PARK Site Legal Address: HERITAGE PARK BLK 2 LT 26 G:0055 Owner/Address: TREE GERALD V & SHELL[ K 19435 CITATION RD EAGLE RIVER AK 995778418 Site Mailing Address: 19435 CITATION RD, Eagle River Lot Size in Sq Ft: 20750 Total Bedrooms: 4 This permit is for the construction of: N 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 Issued By By: Date: aC3 t Date: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-211-54 Property owner(s) Gerald & Shelli Tree Day phone Mailing address 19435 Citation Road, Eagle River, AK 99577 Site address 19435 Citation Road Legal description (Sub'd., Block & Lot) Heritage Park, Block 2, Lot 26 Legal description (Township, Range & Section) Lot Size 20,750 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (N all that apply) Absorption Field ❑ Septic Tank ❑x Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade ❑x `$UbMlfTA� SEP 252014 TYPE OF DWELLING: Single Family (SF) ❑X (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Permit/Rush Fees: ;?1- . Date of Payment: g,5 d Receipt Number: — 6W12) Permit No. 05014 M16 - Permit App_-.;- ;:...:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com September 24, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Heritage Park, Block 2, Lot 26 Emergency Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1250 gallon septic tank be issued for this lot. The proposed system will serve an existing four-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for four bedrooms, and the condition of the drain field will be verified at the time of tank installation. The existing 1250 gallon septic tank has failed, blocking the outlet, putting the house out of service. The existing tank will be abandoned per code. This lot and the surrounding lots are served by AWWU. There are no wells within 200' of this system. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The area around lot 26 generally slopes from north to south with a flat area on this lot surrounding the septic system. The proposed installation will be located in the central portion of the lot, behind the house, and next to the existing septic tank and absorption system. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please -contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 DRAIN FIELD, (E) PES WILL VERIFY CONDITION OF FIELD AT TIME OF TANK REPLACE COLLAPSED 12nOg SEPTIC TANK (E) ABANDON PER CODE AND INSTALL 12508 SEPTIC TANK (P) W/ DCO SEPTIC AREA (E) 28 4BR HOUSE (E) \ SEPTIC AREA (E) 1 Z SEPTIC AREA (E) j . G �o LOT 26 2 10' UTILITY EASEMENT 1 C-ITAT10N ROAD-- NOTES: PANNONE ENG SVC, LLC Date EMERGENCY TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510 J'C�'" '�:451�1 9/24/14 PHONE (907) 272-8218 FAX (907) 272-8211 Scale ..... ... ...... P.I.D. NO HERITAGE PARK, BLOCK 2, LOT 26 a-211-54 GERALD & SHELLI TREE S'te'ven R. Pannope' j PERMIT NO. PF . CE 8149 Z- OSPXXXXXX 19435 CITATION ROAD sr PLAN EAGLE RIVER, AK 99577++11IiF�PROFESSI�NPV� sheet �� "�� 1 OF 1 V A _- 4BR HOUSE (E) \ SEPTIC AREA (E) 1 Z SEPTIC AREA (E) j . G �o LOT 26 2 10' UTILITY EASEMENT 1 C-ITAT10N ROAD-- NOTES: PANNONE ENG SVC, LLC Date EMERGENCY TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510 J'C�'" '�:451�1 9/24/14 PHONE (907) 272-8218 FAX (907) 272-8211 Scale ..... ... ...... P.I.D. NO HERITAGE PARK, BLOCK 2, LOT 26 a-211-54 GERALD & SHELLI TREE S'te'ven R. Pannope' j PERMIT NO. PF . CE 8149 Z- OSPXXXXXX 19435 CITATION ROAD sr PLAN EAGLE RIVER, AK 99577++11IiF�PROFESSI�NPV� sheet �� "�� 1 OF 1 ) MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION f 825 L Street •Anchorage, Alaska 99501 Telephone 264-4720 ENVIRONMENTAL ENGINEERING DIVISION ro*-� ONSITE SEWAGE DISPOSAL SYSTEM ANO/OR WELL INSPECTION REPORT NAME PHONE U<EW y41 ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION �2rc R.? �,�f�b.F PalzK LOCATION NO.OF BEDROOMS O ad DISTANCE TO: al ,C<n Absorption area / Dwelling /C PERMIT NO. o Ef Manufacturer .. E Material L No. of compartments Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth dOZ DISTANCE TO: Well Dwelling PERMIT NO. _? f Manufacturer Material Liquid capacity in gallons W= .W.1 M Z P Z G ¢ H 0 DISTANCE TO: W�II ` / z� Foundation / Nearest lot line 2 ,r� s� Total length of line Trench width Distance Inches Material beneath the // inrf+es PERMIT NO. 67 -ZCY%., between lines Total we absorption area No, of lines LLeength of each I Top of the to finish grade 3 /x W :1 Length Width Depth PER" t NO. o. F Wd Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J C ss �kE D th Driller Distance to lot line PERMIT NO. 3 DISTANCE : Building foundation Sewer line Septic tank Absorption area(s) OTHER N —L PIPE MATERIALS �1,tc n SOIL TEST RATING INSTALLER SE if 7 REMARKS t JILL APPHOV D DATES a LEGAL U Q /CU 13 they. Jrrd61 "" mN I C I RRL I TY OF= nr-40 'hRFiGE DEPARTMENT � HEALTH AND ENVIRONMENTAL .XOTECTION ' 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 Ot-F—S I TE SEWER PERM I T PERMIT NO. C 820788 ) APPLICANT SYDNEY A HEFFNAGLE PO BOX 102 E.R. 99577 LOCATION LEGAL L2682 HERITAGE PARK LOT SIZE 3 694-9746 J 999999 SQUARE FEET ;.TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH ` MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SO FT/BR)= 20�/4-vetm';P) THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: D E P T H= :3-!S L E N G T H= :3:0 G R R VE-= L DEPTH = :1 -:1 - THE 1 THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). R E Q U I R E 1> SEPTIC T R NFC S I Z E— 1 2 5@ G A L L O N 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. --- TWO C 2 ] RRE REGIU 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 A PRIVATE WELL OR 150 TO 200 FEET FROM A 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. F}ERM I T EXF} I RES []EC::EMf= ER 31r 1952 I CERTIFY THAT • 1: 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. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. (FSE ' q l a' STi2R-TA "SIGNED T tj iA (Ole) a3 5 APPLICANT SYDNEW A'HEFFNAGLE ISSUED BY L=') y Ga= g 'Tb = /2 V4. 0 Russell Oyster 694-2774 O & E ENC�;VEERING & DEVELO/. MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Earl Ellis 688-2280 Performed for. Name: 4:S5A 1,2 i0Q.VS7-A0CT/o^/ / 75 Tet. No . -4 9 S' 9 4 O MaIIingAdd ress:-A 0 • �X Q Z� 25/44;/-,6 /� 1,91LEA r 4/,/. .99-r77 Legal Description: -LoT -26. a[.ocK 2 ''M /f, EA/ TAoiE f � Wx .5(/3 - Depth (fest) 0 I•: N Soll Characteristics S/C.To,R sa/L 4�5 �E2G %EsT 6 �! SP-S�f 51c rY (foadt-y 8- 9- 10- 11- 12 910_11-12 13 PLOT PLAN J�o SCRLE PERC.TEST 14 _ S7? LroAeSE 5(V45 �iLAt/EL � irG/r{Sr 3d N 1517 /I/iiv�'� _ .235/$.P 16_ I%� f3orro.0 OF �r �'E OF Al. 'll1 JCQ(••''...•gs 1! Ground Water Encountered: Yes—No—Lf If yes, what depth � y � ° �•:ty�j or '49LH •: kA/ Proposed Installation: Seepage Pit_ Drain Field i"' "n'•••ya�9 •;•/ Earl P. Performed by: ��c�� rrJ, C.LCi� Date: s Z $' 235 = r.080_2a SS; rt=�oS AV 3 ' r 2$-: 375 � - S61(s So' O 0 0 "� -4TH 57-,-wE T PLOT PLAN J�o SCRLE PERC.TEST 14 _ S7? LroAeSE 5(V45 �iLAt/EL � irG/r{Sr 3d N 1517 /I/iiv�'� _ .235/$.P 16_ I%� f3orro.0 OF �r �'E OF Al. 'll1 JCQ(••''...•gs 1! Ground Water Encountered: Yes—No—Lf If yes, what depth � y � ° �•:ty�j or '49LH •: kA/ Proposed Installation: Seepage Pit_ Drain Field i"' "n'•••ya�9 •;•/ Earl P. Performed by: ��c�� rrJ, C.LCi� Date: s Z $' 235 = r.080_2a SS; rt=�oS AV 3 ' r 2$-: 375 � - S61(s 0.0. �- w� o C� r 0.0. �- w� o C� Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 �-Y j b/)7 Anchorage, AK 99519-6650 w (907) 31.3-70 silo F11j* (907)343-7904 f4 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. �if-q— COSA# to 1. GENERAL INFORMATION Expiration Date: I / - - 07 Complete legal description HERITAGE PARK SUBDIVISION: LOT 26, BLOCK 2, Location (site address) 19435 CITATION ROAD " ANCHORAGE. AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent . Mailing address CYNTHIA LIBBY Day phone 622-6654 19435 CITATION ROAD • EAGLE RIVER, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Weil ❑ Community On-site ❑ Public Water System 0 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 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 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 verify that my P investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, $howl thethe onsite water supply and/or wastewater disposal system is (are) safe, functional and adequate for the rturilbrq; bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage riles 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. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 4111104 Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, oo�� p� conscientious engineering analysis of the system In accordance with ADEC and MOA c Q A DSD Guidelines 6 Regulations. The reported results described the performance of the P �\!• ' '9si0Q system under the conditions encountered at the lime of the test, and separation p� Q distances measured to readily Identifiable features. The operational life of all wells and L} D septic systems depend on the local soils condition, groundwaterlevels that may ...t • • • • • • • • • • • • • •° fluctuate during the year, and the water usage of the family being served by the system. t7 These conditions are outside the control of the evaluator of the system. Satisfactory lest • • ....... results do not guarantee future performance of the system, nor do they guarantee that O 9 '. Go east• there are no hidden defects or encroachments. GEG, LTD. can therefore not provide QO°oe CE -7 any warranty or future estimate of how long the system will continue to meet the DQ ^ • i.1' ►, R•b' p4d� operational requirements of the ADEC orMOA DSD. The content of this report is for the sole benefit of the ownerlisted above. Any reliance upon or use of this report by any �0 other person orparty is not authorized, nor will it confer any legal right whatsoever. P��i 0 F C , 5. DSD SIGNATURE J=: • ON-SITE • ••Gi; Approved for bedrooms. `�; WATERAND ;In_ WASTEWATER _ Disapproved. = PROGRAM Conditional approval for bedrooms, with the Blowing stipulations: �i� ••. •• p\\� Attachments: / COSA Checklist C/ Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory / Other By: v ,/� % � Original Certificate Date: 0 6 i )Rev. 11N5) Municipality of Anchorage It Development Services Department �\Building Safety Division 4-9 On-Site Water 6 Wastewater Program 4700 Bragm Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onslts (90n 943.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: HERBAGE PARK SUBDIVISION: LOT 26 BLOCK 2 Parcel ID: 050-211-54 A.LWOHI'type A PUBLIC WATER If A. B, or C provide PWSID# _ Well ted Sanity Wires property protected (YIN) g, Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production i Eg-p-m- Eg-p-m- WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate IL. colonies/100 ml. A Date of sample: Collected by: B. SEPTICIMOLDING TANK DATA STEEL Data installed 9/6/1982 Tank Type/Material 1250 2 geanouts (YIN) YES Tank size gat. Number of Comparfinerds Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A 1/1/2006 Pumper MCDONALDS Pin Date of pumping 1 MPING C. ABSORPTION FIELD DATA Date Installed y .V19e2 Soil rating .p.d ft% rm) 205 System type TRENCH Length 38 ft• Width 3 R. Gravel below pipe 11 R. Total depth •15 ft. Eft. absorption area 620 ft' Monitoring tube YES Depression over field NO Data of adequacy test 4/26/2005 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 56 in. Water added 757 gal. New depth 85 in. Elapsed Tim; 250 min. Final fluid depth 57 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 Mo.) (YM 3 type) NONE KNOWN If yes, give date — 29' OF LIQUID IN MONITORING TUBE ON 10/25/2006. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N1--=I= 'Pump on" level at _in. "Pump om, le High water alarm level at in. Cycles tested Meets alarm & circuit requirements4 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/ldt station on lot Absorption field on lot Public sewer main Sewer /septic service line areas PUBLIC WATER On adjacent lots On adjacent lots manhole/deanout Holding tank Manure/animal excrete storage areas 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'+ Wefts on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main_ N/A Water service line 10'+ Surface water 100'+ Driveway. parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I oert/fy that I have determined through fleld inspections and C-1) : • 4 s review of Municipal records that the above systems are in . •......• • • • • • • • • • • • • • • • • • • =ftmence with MOA COSA guidelines In effect on this date. . Engineer's Printed Name JEFFREY A .Jef A. *vs.:GARNESS s 7953 Data I r /I �a i ��,: ' w • if �!�� 4 '��o`` COSA Fee &'I / / 7):: Date of Payment—LLL LOL Receipt Number Atw (nw. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage . 4t. Development Services Department C' Building Safety Division On -Site Water& Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-211-54 HAA# O5 1. GENERAL INFORMATION Expiration Date:15/ n/ 0ION be Complete legal description HERITAGE PARK SUBDIVISION* LOT 26, BOCK 2 Location (site address or directions) 19435 CfTATION ROAD EAGLE RIVER, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DAVID HEBERT Dayphone (907) 696-5006 19435 CITATION ROAD EAGLE RIVER, AK 99577 Day phone ALLEN JONES w/ JADCO Day phone 823 WEST 53rd AVENUE • ANCHORAGE, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 561-4944 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 0 Public Sewer ❑ The Municipality of Anchorage Development 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 Alaska. 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 professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal axed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Health Authority 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 tiles 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 Finn GARNESS ENGINEERING GROUP, Ltd. 3701 E. TUDOR ROAD. D, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may gucfuate during the year, and the water usage of the family being served by the system. These conditions are outside 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. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefil of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 'q bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with Phone 337-6179 Date 5-1S14;- ,fit fn((�I CHS ng stiputatiep Maintenance Agreements Supplemental Engineer's Report Other By, /�'a , , _ V� \ `�,. �i. Original Certificate Date: 'cnf,_ (Rev 71.01) Municipality of Anchorage ' Development Services Department Building Safety Division On -Sita Water & Wastewater Program 4700 South Bragaw St. P.O. Banc 196650 Anchorage, AK 99519.6650 www.cl. anchorage.akus (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: HERITAGE PARK SUBDMSION& LOT 26, BLOCK 2 Parcel ID: 050-211-54 A. WELL DATA well type Date' completed _XQW-da & Date of test Stats water level Well production PUBLIC WATER If A, B, or C provide PWSID# _ Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: Coliform colonles/100 ml. S. SEPTICfHOLDING TANK DATA ft. g.p.m. Nitrate WUes properly protected (YM) Casing height (above ground) in. AT INSPECTION Date of sample: Collected by: R. g.p.m. — colonies/100 ml. Tank Type/Material SEL Date installed 9/8/1982 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of pumping Pumper 7aYlcL :V PuW1i}ePS C. ABSORPTION FIELD DATA Date installed 9/8/1982 Soil rating 10.p.d ft%drm) 205 Sygiam type TRENCH Length 38 ft. Width 3 ft. Gravel below pipe 11 R. Total depth •15 ft. Eft. absorption area 820 R' Monitoring tube YES Depression over field NO Date of adequacy test 4/28/2005 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth in absorption field before test 56 in. Water added 757 gal. New depth 85 In. Elapsed Time: 250 min. Final fluid depth 57 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed "Pump on' level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at Cycles tasted Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot Absorption field on lot Public sewer main line PUBLIC WATER On adjacent 0 Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation W+ Property line 59+ Absorption Heid 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parkingivehide storage 30'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I carti>)i that I have determined through fieldmspecdons and :t review of Municipal records that the above systems are In conformance with MOA HAA guidelines in effect on this date. ..... ...... ...... '•, ess.� Engineer's Printed Name JEFFREY A GARNESS — 33 i o Date v„r..saod' HAA Fee $ i4 CO Waiver Fee $ _ Date of Paymentr��(.�� )�6 Date of Payment Receipt Number LD:J 4394 =.51'�Iy\ Receipt Number, twv.tvm► 07/18/00 TUE 14:27 FAX 907 562 5485 PRUDENTIAL VISTA REAL E 0002 L *i'mul /'` !' y z -AS-BUILT I hereby eertify'that I have surveyed the tollow•int described. Anebdrate Recording Prednct. Aluka, and that the improve- ments situated thereon are within the property )lees and do not overlap or enrsoseh on the property tytnt adi2cent there- to, that to improvements on property lYinC ad)atent thereto encroach L'nes the premitem Ln oreother.visiblestion and te:scaents there are an Wd property esrept as indicated hereon. Dated •at. Ltte Rlyer. •ALska.. ROBERT -C. JOHNSON :X t^rr4 SCALE: ; • - Re4istcted Land Surveyor Ico. I" c j'p '• . Box 450. Atle'River. Alaska Phone (9075 641-2547 r5 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH &HUMAN SERVICES a Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519.6650 (907)343-3744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 050-211-54 HAA / L��•'�� /� 1. GENERAL INFORMATION Complete legal description HERITAGE PARK SUBDIVISION: LOT 26. RLOCK 2 Location (site address or directions) 19435 CITATION ROAD EAGLE RIVER. AK .. . a0 •: Dav . . 80 :• Lending agency Day phone Mailing address Agent KRIS N N % Day phone I -6G0-- 3 s' '>- 7 S t7 Address 11620 ARBOR STREET. SURE 100, OMAHA, RE 68144-2935 Unless otherwise requested, HAA will behold for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well Public water xxx 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 Ing to the legality and status of system. 72-025 (Rev. 1191) Front MOA 921 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $800.00 at, or prior to, closing for the engineering services provided. 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. ` y Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone (907) 337-6179 I _ i i , I. Engineer's Signature 1 I Date_A!s /W' In conducting this evaluation, AWWC, Inc. attempt to prbvi e a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DHF J Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identiflable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the usage of the family being served by the system. These conditions are outside the control c 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 party is not authorized, nor will It confer any legal right whatsoever. 6. DHHS SIGNATURE Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to 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. 1191) Back MOA 921 Computer Version 1<ECEIVEU Municipality of Anchorage JUL 19 M DEPARTMENT OF HEALTH & HUMAN SERVIGEBvAUTY of nNct+o Environmental Services Division ^.0 SEmICE� 825 "L" Street, Rm 602 Anchorage, Alaska 99501 (907) 343.4744 Health Authority Approval Checklist Legal Description: HERITAGE PARK S/D: LOT 26, BLOCK 2 Parcel I.D.: 050-211-54 A. WELL DATA PUBLIC WATER Well Type if A. B. or C, attach ADEC letter. ADEC water system number Log present (YM) Total depth Date of test Static water level Date completed ;�il�lil71 � e height (above ground) Wires property protected (YM) AT 9— p.m- WATER SAMPLE RESULTS: Collected by: A.W.W.C.. INC. B. SEPTIWHOLDING TANK DATA 9— p.m- Data installed 9/8/82 Tank size 1250 Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (YIN) YES Depression (Y/N) NO High water alarm (YIN) N/A Date of Pumping 6/13/00 Pumper SANITARY PUMPERS C. ABSORPTION FIELD DATA Date Installed 9/8/82 Sop rating (g.p.dJ82 o� 205 System type DEEP TRENCH Length 38' Width (travel thicWress below pipe 11' Total depth 15' Effective absorption area 820 SO. FT. Monitoring Tube present (YM) YES Depression over field (YM) NO Date of adequacy test 6/19/00 Results (Pass/Fap) • PASSED For 4 Bedrooms Fluid depth in absorption field before test (In.). 44" Immediately atter 1119 gal. water added (In.k 69' Fluid depth 26" (Ins) Minutes later. 998 Absorption rate a 600+ Pero)dde treatment (past 12 months) (Y/I4) NONE KNOWN K yes, give data ----- reou cnw. a sr cwmtgwvwwm IIX141-llj14I.11 Data installed Stre in Manhole/Access (Y/N) 'Pump on' leve ' 'Pump ort' level or High water ohm level or 'Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: PUBLIC WATER Septiclhdding tank on lot On adjacent I Absorption Held on lot Public sewer adjacent kala Public sewer manhololdeanout One Lot swoon SEPARATION DISTANCES FROM SEPTICMOLOING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water maln/seMce One 109+ Surface wateddrainage 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 100+ Building foundation 10'+ Water main/seMce line 10'+ Surface water 100'+ Driveway, perkinglvehlde storage area 30'+ Curtain drain NONE KNOWN Wells on a F. ENGINEER'S I cerff& that I with MOAN of Engineers HAA Fee S ACD -00 field Mspecilons and review systems are in conlbrmance m this data. Date of Payment —7— 1q— 6 Q Receipt Number D66577 6z' ) 72-M MW. &W camPAW VWWW Walver Fee $ Date of Payment Receipt Number 07/18/00 TUE 14:27 FAX 907 562 5485 PRUDENTIAL VISTA REAL E Q002 tst. ' ... -AS-BUILT 1 hereby eertifY'that f have surveyed the following described, property: S/oak • Aneborage Rerordint Preclact,'Alaska.and that the Improve- . maa;s situated thereon are within the property Mees and do not overlap or encroach on the property l;vtg od;:cent there- to, that no improvements on property Iyinc adjacent thc.•eto encroaeL on the premises In question and that there are no • roadmays,'transminion L'nes or otber.vtsible *zs :snit ou � �;•t.;�i r sold property except as Indicated hereon. 1 '{•= : ;syt.. �' Dated•at.Eagle RIYer.•Alaska. ' r',• .'F tG.t ?:t ^r. �i tbi:' •� LT •. tyeLL ROBERT C. JOHT5ON • ;7 4001 •;�:c, tT SCALE: Registeled Land Surveyor t:o. 6►.J-LS o ;'4 _ e ':e -: •'-:i .. 1w z ' c • Boz 456. Eagle River. Alaska •'• >�a\t (': Ir•;-'s� • 3 Phone 19071 641-2543 Parcel I.D. # MUNICIPALITY OF ANCHORAGE • � Department of Health &Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING HAA # 14-j�' F- 0 1 0 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) \ q 45 3S eJ (b)Propertyowner �JptAr)(-, '2.Jt712 Telephone: (home) Business Mailing Address 19,5x%' Gt'f6'>'�or� j5j� LS it-l\jA&_L' 4-V ' (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent�pa-�'1d``�� Address Ito to �1-!� Caz4.2 1 — Telephone 1 94 _4y G (e) Mail the HAA to the following address: (or check here Wif hold for pick up.) � 3y P -L - List contact person and day phone number below: 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family-N�- Number of bedrooms 3. WATER SUPPLY Individual Well ❑ Community ❑ Public. Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On -sit 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. 72025(R...7;ee) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the 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. c Name of Firm S & S ENGINEERING Telephone 17034 Eagle River Loop Road No. 404 Address Eagle River, Alaska 99577 Date y 7 ��•►aq.�.5 iat A, '•• i� $'eal t rf A- s"ark. . ta. 147.1 g� 6. DHHS APPROVAL r Approved for bedrooms by Date Approved X Disapproved Conditional Terms of Conditional Approval + . . I., CAUTION ..1 : . 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 forerrors or omissions in the professional engineer's work. 72025(no,. 7188) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) „un of Atd#YECt;SAT - FEBRUARY 1984 ENV1R hfdENTAL SERv1CF-S U:\'1. 343-4744 AY 1, 1989 Legal Description: Lit 2-o ..i - `I A. WELL DATA RECO Y ED Well Classification'— Well lassification- Well Log Present (Y/N) Date Completed Total Depth Cased to Static Water Level Depth of Grouting Casing Height Above Ground Electrical Wiring In Conduit (Y/N) SEPARATION DISTANCES FROM WELL: If A. B. C. D.E.C. ApprovedVN) / Yield Pump Set At . Sanitary Seal on Casing (Y/N) _ Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot %7 ��' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 1-1 ' ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA To Nearest Public Sewer Cleanout/Manhole ; Date Date Installed `)- t3- BySize 125;5> No. of Compartments Standpipes 6%) y Air -tight Caps&%N) —_Foundation Cleanout(CM) )4 Depression over Tank (Y(g Date Last Pumped Pumping/Maintenance Contact on File (Y/N) ;for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well I 'Lr� �.t 7 To Building Foundation To Property Line" lo�-t To Disposal Field tZ t v� To Water Main/Service Line\ To Stream, Pond, Lake or Major Drainage Course Comments 'C_)0r7SPQ1.-A_ 'PJt-WItiA . 72-026(RW. 7/68) From Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ?-�fes- Type of System Design Date Installed '-'Length of Field 3B Width of Field Depth of Field VIV S 1 Gravel Bed Thickness 11 Square Feet of Absortion Area P)310 ` Statndpipes PresenkMN) Depression over Field (Y&? _ Results of Last Adequacy Test Date of Last Adequacy Test - 3 - $`1 - LE E -CL. SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well %�+ To Property Line l o� To Building Foundation �_Z_� To Existing or Abandoned System on Lot r, ; On Adjoining Lots To Water Main/Service Line p, To Cutback (if present) , To Stream, Pond, Lake, or Major Drainage Course t To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION p Date I stalled 1 Size lin,G Qq "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) 'Comments — Dimensions Manhole/Access (Y/N) _ "Pump Off" Level at Vent(Y/N) Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this Inspection. Signed S & S ENGINEERING ,1034 Eagle River 1 oop Road No. 204 Company Eagle River Alaska 99577 Date MOA No. Receipt No. n S ' a z/3Z IVA 7'' Receipt No. Date of Payment 5 V -P7 Waiver Fee: $ — Amount: $ /70 -0(*) Date of Payment - 72 -ON (Rw.7/BB) Beck Page 2 of 2 �..�...... ...rZ 6441 A. shef", • x, He. 1107-1�_cr; Time APPLI, :NT FILLS OUT UPPER HA.. ONLY F,operty Owner )Ie- y . c` r E t / , .` Mailing Address O r V o t1 I /Phone ZIP Code /�9 % Buyer -so h,, a rd y VU -n -A tk'dA Date Address Inspector Zip Code Lending Institution a 5 C ix LA «I Inspector Phone +r. Address , (i • 0 0 0 ZIP Code Realty Co. d Agent Nfi Phone Address 'CONDITIONS OF APPROVAL Zip Code Legal Description ( ) CONDITIONAL APPROVAL' ��f� DATE 'a 'C'1 ',IP�� `—"-""' L a r K Al 1y Street Location 2 . Well To Absorption Area Type of Residence Septic Tank Size ysQ ws -/, Single Family Well to Tank ❑ Multiple Family No. of Bedroom� ❑ Other Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled el%ce June 1975. `�❑ T Community For wells drilled prior to that date, give well depth (attach log If available). ❑ Public Utility Sewer Disposal •.Individual G Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Tema Time Date Date Date Date Inspector Inspector Inspector Inspector e Field Notes: y.MUNICIPALITY OF ANCHORAGE 7- RFOT Y1`.. I,..A 1`_(.TICN 17 1133 RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( U DISAPPROVED ( ) CONDITIONAL APPROVAL' ��f� DATE 'a 'C'1 ',IP�� `—"-""' BY: Q Soils Rating Date Sewer Installed Well To Absorption Area Well Lop Received Septic Tank Size ysQ ws i,- Well to Tank rzm ul n