HomeMy WebLinkAboutNORTH SLOPE #2 BLK 5 LT 16North lope
Block 5
Lot 16
#050 � 581 � 20
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 9 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: PIDNumber:
Home: V 6D 1`1 E L
Wastewater System: 0 New J9 Upgrade
Address: N Z 1, *2 1!, ,
- '- - Z' 6% 1- P
ABSORPTION FIELD
I ii N i, �
Phone:
No. of Bed
jorns:
13DeepTrench )KShallowTrench 08ed OlMound 00ther
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
1 2— GPD1Sq Ft
9. If
Lot: Block: Subdivision:
I & 5 W
Depth to pipe bottom Jim original grade!
Gravel depth beneath Tipe
13
1,10cal -,>Lom
5. S Fl,
1 5" Ft.
Towns!�'P�e,l
Range:
Section:
Fill added abo ginal grade:
Gravel leng%j_
see . T.2
1 Ft
I Ft.
WELL: 0 New 0 Upgrade r)ftfr, it
Gravel depth:
13,6
Number *1 lines:
I
I oursqm,`�kr "It.
Fit
Classification (Private. A,B,C):
FLIJ VbT r-
Total Depth:
Cased T*:
Total absorption area:
Plea material;
-3034
Ft.
Ft.
SO FIA
A�5-Trl /r-alo
Driller:
Date Drilled:
Static Water Lemel:
Installer.
Dat '�'arracf'
Ftm
ar A I — 6111f`51
Yield:
I Pomp Safe':
I
Casing Height Above Ground
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
PrSeptic 0 Holding 0 S.T.E.P.
To
Septic
Absorption
LI"
Holding
Public/PrIvole
Manufacturer:
Capacity In gallons:
From
Tank
Field
Station
Tank
Sinver Lines
Well
135'
V
Material:
Number of Compartments:
Surface
Water
111A
LIFT STATION il/N
Lot
Size in gallons:
Manufacturer:
Line
'515-
1
Foundation
3F
.5-a
"Pump on" level at:
"Pump off- level at:
High water alarm at:
Curtain
/J/+ I—
Pump Make & Model
I
Electrical Inspections perlonned by:
Drain
Remarks: 7,*�/r ove,x;-;i
BENCH MARK
Location and Description:
or'
Assumed Elevation:
Ft
ENGINEER'S SEAL
% if
Inspections performed by: Dates: ist I
1� a.
2nd 7,90T"�
1 1,
Louls 't
Department of Healt d Huma rvices ap...
proval
4 a.
Reviewed and approved by;= Zevic
Date:
72-013 (1/01) MOA 25
Permit No. 7 Page ap _�2
of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 9 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Description:
AII
Ld
'�E
0
DRIVEVAY
EL��
I�IIR OUSE
GARAcC
-----------------
TOP OF SLOPE BREAK—/
PID No.:
EAST
300.40'
30,
SEA SONAL I
SHED I)Rt�..AGI I
EASEMENT
55.3'
91 CZ3
41' LEACH TRENCH
1250 GAL SEPTIC TANK
EAST
ELEVATIONS
-96.9'
FINISHED
GRADE LEVEL
5.3'
!TANK
93.10" \-92.05, FIELD
72-013 A "I) MOA 25
EtmfX36AS OEAL
NO0
ATER ... ...........
TABLE
Poo..
_7Q
Louis A !w*
10, UTILITY EASEMENT
SCALE, I' - 60'
0
- TEST HOLE
- MONITOR TUBE
0
- SEWER CLEANOUT
WELL . .1 -
PROPOSED LEACHFIELD
EASEMENT
Top or EASI DECK
ASSUMED CLEV 100J001
EtmfX36AS OEAL
NO0
ATER ... ...........
TABLE
Poo..
_7Q
Louis A !w*
PAGE I OF I
MUNICIPALITY OF ANCHORAGE ts PAI
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 -L- STREET, ROOM 502 la -199-9/
ANCHORAGE, ALASKA 99519-6650 8U 4tA_Z>�
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910167 DATE ISSUED: 6/25/91
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 6/25/92
OWNER NAME:KOMEL EDWARDS S &
OWNER ADDRESS:SRA 2326
EAGLE RIVER, AK 99577
PARCEL ID:05058120
LEGAL DESCRIPTION: NORTH SLOPE #2 BLK 5 LT 16
LOT SIZE: 49686 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY
ISSUED BY:
DATE: e5p��IZ_5
/9'/
DATE: 61,751-IF1
-117
Louis Butera, P.E.
Registered Civil Engineer
June 19, 1991
John Smith, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Lot 16, Block 5, North Slope #2
Narrative
Dear Mr. Smith,
The proposed sepfic upgrade will have very limited impact on adjacent properties for the
following reasons:
1. The area has large lots allowing sufficient room for septic sites.
2. Immediate neighboring lots have septic systems and wells in place with adequate
reserve area.
3. Reserve space is adequate, due to soil absorption capacity. Soils are very
adequate, ground water is not a problem. The exisfing system has not failed; the
owner simply wants to eliminate the log crib system.
4. Drainage will not be effected by the septic system installation. There is a
drainage easement shown on the plat, however, the drainage is limited to a 2-5
week breakup period. There was no surface water at time of inspection.
We are requesfing 40' setback for extreme South edge of the drainifield to the change in slope.
The minor variance will not cause any danger of effluent surfacing due to depth of the
leachfield.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
P.O. Box 77329 1 - Eagle River, Alaska 99577 - Telephone (907.) 69 1.5195 - Fax (907) 69.1-3297
-'Ur DRIVEVAY
rd IJITLV$
L i
Ld WELL G4RAG,
u
3 DR kousc
Of
a <
0 ID
z
0
-----------------
P SLOPE BREAK—/
100,
WEL
(APPROX LOCATION)
NO KNOWN CURTAIN DRAINS
SEPTIC
LOCATION APPROX)
EAST
300.40
?E0ASON'ArL
DRAINAGE I
SHED EASEMENT
1000 GAL TANK 00,
(TO BE REMOVED
TMO
0 T"'D
PROPOSED 41'
ABIIIBIIIIN TRENCH
PROPOSED 1200 GAL
TANK
16'xl6' CRIB
(ABANDONED IN PLACE)
— — — — — — — — — —
10' UTILITY EASEMENT
LOCO GAL TANK
16'XI6,
CRIB
0 —
TEST HOLE
—
MONITOR TUBE
0 —
SEWER CLEANOUT
—
WELL
PROPOSED LEACHFIELD
— —
EASEMENT
SEPTIC SITE PLAN
LEGAL: LOT 16, BLOCK 5, NORTH SLOPE #2 or At
4;%'k" 11 %p 40
OWNER: KOMEL a
v i
CONTRACTOR: VA
JOB # 91-0711 DATE: 06/18/911 SCALE l' 60
EACLE RIVER ENCINEERINC SERVICES
'—� � A. F�lora
C E.6736
P.O. Box 773294
A EACLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 16, BLOCK 5, NORTI1 SLOPE #2
A. GENERAL
1. The septic plan is for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
and State Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified or modified in the
field by the contractor to meet Municipality of Anchorage, Department of
Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
B. DRAINFIELD
1. The drainfield is to follow the natural land contour to maintain uniform total depth
of the drainfield bottom.
2. The bottom of the drainfield shall be level, plus or minus 1.5".
3. The total depth of the drainfield excavation is not to exceed 11' at any point.
4. The sewer line is to replace the existing sewer line that leads to the existing pit.
5. The drainfield gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 4' or
equivalent is to be placed over the leachrield.
7. The area over the drainfield is to be finish graded to prevent ponding of surface
water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 9.5' GRAVEL DEPTH = 3.5' DRAINFIELD LENGTH = 41'
DRAINFIELD WIDTH = 5' SOIL RATING = 1.2 GPD/ft2 BEDROOM CAPACITY = 3
SEPTIC TANK SIZE = 1,250 gallons (oversize)
Twenty-four (24) hours notice required for all Inspections.
NOTE: Abandon existing tank and pit by pump, crush and fill.
n SOILS LOG
MUNICIPALITY OF ANCHORAGE
~i % Fa PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: r::� r w/wIto k-� Ir -1 rst— DATEPERFORMED: 15-1.4 stitl-al
LEGAL DESCRIPTION: Lo -r- lej 5, dee-rq 64-orr Z T(4
Tor -60,lk- tZI 4e,�VIS.L- SLOPE SITE PLAN
2
3 - �j
4-
6-
7 - r-3
8-
9-
10-
.. 0
11-
12-
13 -
14 -
15-
16-
17 -
201 i
COMMENTS
OF A
................... ..
lovi, A. Butcr(3 4�
CE -6736
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
6114
4114
6: st�
to flij
to
6 1 -4
5:4&
16 111A
1 %1
/I C-
3
611-4
oa
to t1ill
2 li*c
-4
6114
6: IS
to I I wk
9 1!r/1,4 11
PERCOLATION RATE 1..4 (minutes)
TEST RUN BETWEEN 'A FT AND FT
PERFORMED BY: CERTIFIED BY: DATE: 16101fZ
72-008 (6/79)
EAGLE RIVER Joe
SHEET NO. OF
ENGINEERING SERVICES
P. 0. Box 773294 DATE�
EAGLE RIVER. ALASKA 99577 CALCULATED By—
Phone 694-5195 CHECKED BY J�� DAIE—���/
�wt/pavft � � 04"
O�& E GEOTECHNI CAL & DEVELOPMENT CO.
Russell Oyster
UN 2774
Soils Et Foundations
Box 90, Davis St., Eagle River. Alaska 99577
694-2774 or 688-2280
SOTL LOG
Earl Ellis
688-2280
Land Development
Performed for: Name:— e�i Tel. No. 1r)4 --e-7-A
Mailing Address: 7-%7 D �Ar-v-)r- f\1V;-77
Legal Description: Y -&,r \L- 7��-\e- J--�
Depth (feet)
Soil Characteristics
I0,.%av
2
3
4
5
7
8 C.4.^WL 'S
A
10
11
e.
12 lu"t i�
Ground Water EncoAlered: es No— If yess what depth
Proposed Installation: Seepage Pit Drain Field
Comments: \7"V mtb"'y 1z "L\
Performed by: Date: I Mv,
:. I - , .7
- . J,
--M;WIDR1LL1NG,:Inc..-...
-:h
2811 Dawso
P. 0. Box 4-1728 n
f
C 607-�279 -1i41
one) open end
ANCHORAGE, ALASKA 99509
T.
Screen Perf
'DRILLING
A';
LOG
e
-.,,,,r�','WeU:Dum`oIn2 test at gallons i3er -(hour) i (minuto,f or ------hours w
-77
w -
�7
'Y
L Well Owiii
:. I - , .7
- . J,
--M;WIDR1LL1NG,:Inc..-...
-:h
2811 Dawso
P. 0. Box 4-1728 n
f
C 607-�279 -1i41
one) open end
ANCHORAGE, ALASKA 99509
Screen Perf
'DRILLING
A';
LOG
e
-.,,,,r�','WeU:Dum`oIn2 test at gallons i3er -(hour) i (minuto,f or ------hours w
-77
w -
�7
'Y
I
(iddress cf:�,Townshlp, Range, Section, if knov n; or istance main ad
Resubdivided
-A
161 Bl k 5, North Slope Su��
'4,Size of caslng.L �epth ofmole:-'-*`-'�-��- eet Cased to. �-eet
-:h
...
f
Static water eve t (Aov�)-, (below) land surface. Finish of well (check
one) open end
Screen Perf
;;cribe ; 4oratinn
A';
"I D screen o ..
e
-.,,,,r�','WeU:Dum`oIn2 test at gallons i3er -(hour) i (minuto,f or ------hours w
-77
w -
T
Pepth
4:kroun(
diawdo�vn*l from� static level. --
V4 f,4V':,.
completion
WELL
n feet from
surface -,'Giv 6tall�o'f foimationi
; I. o e
rr
Z
LOG
4's,iie 'o' -f m`a't'er`ia'l",'co'1or and hardness.
-4 . . . . .
-:h
f
TO
A';
e
I
-77
w -
TO
"V.
0
TO
A';
. ......
I
-77
w -
TO
I
-A
....
.
.
TO
.0
0
st
-n
—TO
—TO
ntract,
=1z
1� �7
municipality of Anchorage
Development Services Department
Building Safety Division
on -Site Water and Wastewater Program S. C I V
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEms APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-581-20 COSA# nq_C'_LLq��2—
Expiration Date: 3 — / 6
1. GENERAL INFORMATION
Complete legal description
North Slope #2, Block 5, Lot 16
4019 Kogru Place
Location (site address)
Current Property owner(s) W. Ranier Day phone
4019 Kogru Place
Mailing address
Lending agency Day phone
229-1637
Mailing address Pete Farris 229-1637
Real Estate Agent Day phone
Dynamic Proper -ties
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
3
2. NUMBER OF BEDROOMS: —
3. TYPE OF WATER SUPPLY:
D
Individual Well
El
Individual Water Storage
El
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
individual On-site
D
individual Holding Tank
El
Community On-site
Public Sewer
- The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers 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 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 NorthRim Engineering Phone 694-7028
Address P -n Rox 7707P4
Engineers Printed Name Steve Eng Date 12/9/09
S. DSD SIGNATURE
_Ief� Approved for bedrooms.
Disapproved.
Conditional approval for _ bedrooms, Vith the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
7 7".:
PROGRAM
MINIM
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: A� J IL/
Original Certificate Date: la- &—o
(Rac I IMS)
Municipality of Anchorage
Development Services Department
S
Building Safety Division
On -Site Water & wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEms APPROVAL CHECKLIST
Legal Description: North Slope #2, B 5, L 16 Parcel ID: 050-581-20
A. WELL DATA'
Well type P If A. B, or C provide PWSID # Well Log (YIN) N
Date completed _1921 Sanitary seat (Y/N) Y Wires property protected (Y/N) Y
Total depth _JaaLft. Cased to Casing height (above ground) 30' n.
FROM WELL LOG AT INSPECTION
Date of test
Static water level Aq.1 4 ft. ft.
Well production 9 -P.M. 9-P m.
WATER SAMPLE RESULTS:
Coliform ____D—colonies/100 mL Nitrate 1 P mg/L Other bacteria 0 colonies/100 mL
Arsenic: 0 .2 _Zg7L dateofsample: 11/19/09 Collected by: NRirn Eng,
B. SEPTICIHOLDING TANK DATA
Tank TypefMaterlal Anr-hnrapp Tank (steel) Date installed ugn/gi
Tank size I P5 gal. Number of Compartme nts P Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping IP/11/09 Pumper Sonitckry Pumper-;
C. ABSORPTION FIELD DATA
Date installed
6/3 /)boil rating (g.p.d./fe
or ft2lbdrm)
__ L2
Length 41
ft. Width
5
ft.
System type
Trench
Gravel below pipe 3.5
Total depth 9 ft. Eff. absorption area 3 7 9ft2 Monitoring tube Y Depression over field N
Date of adequacy test 11/19/09 Results (Pass/Fail) POLSS For _3 bedrooms
Fluid depth in absorption field before test 0 In. Wateradded 95gat. New dept415 _in.
Elapsed Time: 2". Final fluid depth 0 In. Absorption rate >= �50+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) ' unk
if yes, give date
D. LIFT STATION
Date installed N/A
oPumponolevelat N/Ain.
Datum N/A
Size in gallons
N/A
Manhole/Access (Y/N)
NIA
OPump off* level at
N/An.
High water alarm level at
N/A in.
Cycles tested
N/A
Meets alarm & circuit requirements?
N/A
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100' + On adjacent lots 100, +
Absorption field on lot 100' + On adjacent lots 100, +
Public sewer main NA Public sewer manhole/cleanout NA
Sewer /septic service line 25' + Holding tank NA
Animal containment areas . 100' + Manurelanimal excrete storage areas inn, +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10' + Property line 10 + Absorption field 51 +
Water main �IA Water service line Surface water Ion, -
Wells on adjacent lots inn, +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10,+ Building foundation to,+ Water main NA
Water Service line 10' + Surface water 100' + Driveway, parking/vehicle storage 50' +
Curtain drain NA Wells on adjacent lots 100' +
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I 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.
Engineer's Printed Name Steve Eng % ,
Date 11/12/09
wk.,
COSA Fee $ 0 Waiver Fee $
Date of Pa, V m e n I --Log—:
Date of Payment
Receipt Number .560 C� Receipt Number
(Rev. 11/05)
z
a .
jw�
114 1
X1 P4
'If
N
Ilk
......... .
ASBUILT-NO CORNERS SET THIS DATEP
SOCIA=S LRND SMVrinW 6110-00.
I 149REBY CERTIFY sTHAT I HAVE SURVEYED THE
SCALE,
ok.;ro , .
, t- OF At %%k
FOLLOWINS DESCRIBED P90PERTY'
cf= *
I
DATE,
6
EN C E,F'r' X
N'
AND THAT U
INDI CATED. IT IS THE pESPONSIBILITY OF THIZ
0 WNER TO DETERMINE THE MSMCE OF ANY
rp
GRID3
or v 'r 4 &1
if
LkSWEM, COYENANTS, OR RESTRI=ONS
WHICH Do NCT.APPEAR ON THE RE=ED SUBDI-
@.,Owr All 61
VISION PLAT. UNDER NO CIRCUMST&NM S lHok"
Fb
AM DATA HEREON BE USED FOR CONSTRIJ71`16N
FOR ISTABLISHINg I)OUND`-
OFFENCE LINESI ON
DRAWN,
i
ARY LINK3,
ALYTICA
GROUP
SP-Analytica, Inc. -Anchorage
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Northrim Eng
Report Date:
12/8/2009
Attn: Steve Eng
Receipt Date:
11/19/2009
17237 Bear Paw Circle
Sample Date:
11/1912009
Eagle River, AK 99577
Sample Time:
I 0:00:00AM
907-694-7028
Collected BY:
SE
Fax: 907-694-7026
Client Sample ID:
4019 Kogru
Sampling Location:
4019 Kogru
Client Project:
Real Estate Package
Sample Matrix:
Aqueous
COC #:
PWS4:
Residual Chlorine:
Comments:
Lab#: A0911218-01 A
Flag Definitions:
MRL = Method Reporting Limit
MCI. = Maximum Contaminant Limit
B = Present also in Method Blank
H = Exceeds Regulatory Limit
M = Matrix Interference
I= Estimated Value
D Lost to Dilution
** RL higher than MCL. target not detected
TNC = Too Numerous to Count - result rejected
CIF = Conflucnt Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MIRL MCL Method Date Date Analyst
9222B (Aqueous) - TCbyMcmbFilt.-Enumerat Test was conducted by: Analytica - Anchorare
Bacteria, Other <MRL CFU/IOOmL 1.0
Total Coliform <MRL CFU/100ml. 1.0
Lab,#: A0911218-OIB
11/19/200911/19/200(CW
I I / I 9/200911/19/2009CW
Analysis Method Prep Prep Analysis
Parameter ' Result Units Flags l%IRL MCL Method Date Date Analvst
45(X)-NO3E
Nitrate+Nitrite pres
Nitrate -Nitrite as Nitrogen 1.26 mg/L 0.50
Lab#: A0911218 -OIC
Test was conducted by. Analytica - Anchorage
10 12nnOO9 12/2/2009 JQ
Analysis Method Prep Prep Analysis
- Parameter Result Units Flags AIRL MCL Method Date Date Analyst
�i-olzW-S (Aqueous) - ramny weii water I Test was conducted by: Analyfica - Thornton
Arsenic 0.277 ug/L 0.15 10 200.8 12/1/2009 12/112009 GY
Page 3 of 3
6 lyp(_rs (Ijorlt>
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 9951 M650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. - 6 To - 5 r6 1- 7-0 HAA # 1)506_�2
1. GENERAL INFORMATION Expiration Date: �?rgr- (-a
Complete legal description Al`oIZT#f 5topg 4Z- I_e97- /4 15 k- 5—
Location (site address or directions) �c) I *t it 0 4 gy, PL�
Current Property owner(s) TA #0 +- M 6j? y R.CSL Day phone I r
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
D__."
Individual Water Storage
Individual Holding tank
.0
Community Class - Well
Community On-site
El
Public Water System
Public Sewer
El
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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineers 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 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 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 Eagle River Engineering Services Phone
4 0421 VFW Rd., Sulte 201
Address Eaqle River, AK 995n
Engineer's Printed Name e-#1?P5?yP&ye P, yj-oob Date 1010i-L05r-
5. DSD SIGNATURE
_Z Approved for" '2) bedrooms.
Disapproved.
CHWOPHER P. WOOD
% . CF -103117
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
*.-. 01 — ..
oN.SITE
WATER ANU e
PPOGRAM -:*d
Maintenance Agreements
Supplemental Engineer's Report
Other
By: A I.& N Ok SL� Original Certificate Date:
�0 I /
(Re, 01102)
Municipality of Anchorage
Development Services Department
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
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Na I?rH S La PE' * 2. /-aT- 14 9 L_pr�k S Parcel IIJ: 05'O -S91-10
A. WELL DATA
Well type CR&bgig' If A. B, or C provide PWSID # Well Log (Y/(9 dvo
Date completed 1 CI7 1 Sanitary seal k9N) _k5 Wires properly protected 6)N) 1&75
Total depth -L31 --ft. caw to LLLO—ft. Casing height (above ground) '3 0 in.
FROM WELL LOG AT INSPECTION
Date of test 4 OVIC 9 IZA 42 5E
Static water level A &&C - ft. � 7- ft.
Well production LWX 9 P.M. g P.M.
WATER SAMPLE RESULTS:
Coliform .. (2_colonies/1 00 ml. Nitrate .3.72 mg./I. Other bacteria colonies/100 ml.
Arsenic: I mg.A. Date of sample: ?ZZ9J?4wr Collectedby: C#4,eLAd
B. SEPTICIHOLD" TANK DATA
Tenk-T7M/Material T_45�_ Date installed '6 /)a/c# /
Tank size I -L Co gal. Number of Compartments Cleanouts Y67-5
Foundation cleanout C)N) Yjt-
.1 . Depression over tank (Y/10 *V4D High water alarm (YO 'y Q
Dateofpumping WMAS_- Pumper S4-yL741Y PLj PyPL-ie 3'
C. ABSORPTION FIELD DATA
Date installed glloAl Soil rating (g.p,d ./ft2 OF 112ghFIrffl ) /_Z System type 31,41LOw 'rJ2W4U4-
Length ft. Width — 9 ft. Gravel below pipe 'S. 3'- ft.
Total depth ft, Eff. absorption area _I&ft2 Monitoring tube YjL_� Depression over field - At, 0
Date of adequacy test C7A/'05[::: Results (Pass/Feil) 10*5 For '3 bedrooms
Fluid depth in absorption field before test 4f in. Water added 11SV gal. New clepthZg' in.
Elapsed Time: 1"Ornin. Final fluid depth in. Absorption rate >= q J:Q g.p-d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) &4APIC- - If yes. give date jV14
D. LIFT STATION
Date installed Size in gallons Coe ;�f Manhole/Access (YIN)
OPump on" level at_ in. Pump fr level in. High water alarm level at
Datum CJC*s tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/144talieiit on lot + /00
Absorption field on lot I- IuQ f
Public sewer main
Sewer /septic service line +2 5::
On adjacent lots
On adjacent lots I- /&PC
Public sewer manholelcleanout �-Aftj
-Holding tank --- /00 1
SEPARATION DISTANCES FROM SEPTIC/! 10691N TANK ON LOT TO:
Building foundation I- Property line ", Absorption field 5'
Water main I— t43 Water service line '11- Surface water +-(oo
Wells on adjacent lots -+ Ifte) , �
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 11- 10 ' Building foundation +*10 Water main 1-10
Water Service line 4- 10 r Surface water tlay'f-- Driveway, parking/vehicle storage * 1110
Curtain drain . 4- Wells on adjacent lots +1 CPO
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.'
Engineer's Printed Name C#W5[Wh-rIt I?- Uwb
Date ks-/a r -
HAA Fee $ LJ �)
Date of Payment 24 /v . k.kr
Receipt Number 4q �1`5�
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
M,Klh
in.
10-04-05;16:16
SGS
SCS Ref.#
Client Name
Project Namelif
Client SamPlV To
Matrix
Samplc Rcmarks:
1056142001
Eagle River Enginccring
North Slope 2 L16 B5
North Slope 2 L16 B5
Drinking Water
;907 561 5301 # 2/ 7
All Datc&lTimes are Alaska Standard Time
Printed DntcMme
10/03/2005 16:34
Collected Distefrime
091IM005 1435
Received Date/Time
09/1612005 16:22
Tccbnlczl Dlrmor
Skohen C- Ede
Allowable Prep Analysis
ponuncter Results POL Units Method Contmincr 10 Limitt Date Date fait
Nitrutc-N 3.72 0.100 mg/l. EPA 333.2 A 09/16105 AZS
Nitritc-N 0.100 U 0.100 mjVL EPA 353.2 A 09/16105 AZS
Metals Dtipartnuant
Hardness as CaCO3
Privasts Individual Analvissis
Aluminum
Antimony
Arsenic
Barium
Cadmium
Calcium
Chromium
copper
from
Lead
Magnesium
Monpnese
Phosphorus
Chloride
Fluoride
Potmium
Selenium
Sodium
Silicon
silver
Tballiurn
Sulfate
113 5.00 mg/l, SM20 2340B A 09/27105 09129105 SCL
20.0 U
20.0
ug/L
EP200.8
A
09127/05 09/29/05
SCL
1.00 U
1.00
ug/L
EP200.9
A
(<-6)
09/27105 09f29105
SCL
5.00 U
5.00
ug/L
EP200.3
A
(<-50)
09127/05 09f2910S
SCL
6.04
3.00
ug/L
EP200.9
A
(<-20DO)
09/27105 OM9105
SCL
O.SGO U
0.500
tig L
EP200.8
A
(<-5)
09J27/03 09J79105
SCL
30500
Soo
uiVL
EP200.8
A
09/27105 09/29/OS
SCL
1.00 U
1.00
UgIL
EP200.9
A
(-C-100)
09/27/05 09/29105
SCL
31.0
1.00
ugfL
EP200.3
A
(<-1300)
09127/05 09/29/05
SCL
250 U
250
ug/L
EP200.8
A
(<-300)
09/27105 09/29/05
SCL
0.415
0.200
ug/L
EP200.9
A
(<-15)
09127/05 09/29105
SCL
9030
50.0
ug/L
EP200.8
A
OV27105 09/29/05
SCL
3.10
1.00
ur/L
EP200.9
A
(<-50)
OV27/05 09/29105
SCL
200 U
200
ug/L
EP200.8
A
09/27105 090105
SCL
6.16
0.100
mg/L
EPA 300.0
A
(<-250)
09/16105
JEM
0.1001.1
0.100
mjVL
EPA 300.0
A
(<-2)
09/16103
JEM
500 U
500
ug/L
EP200.3
A
09/27/OS 09/29/05
SCL
5.00 U
5.00
ug/L
EP200.8
A
(<-50)
09/27/05 09129105
SCL
4380
500
uWL
EP200.8
A
(-C-250000) 09127/03 09/29tO5
SCL
4560
200
uz/L
EP200.8
A
09/27/05 09/29/05
SCL
1.00 U
1.00
US/L
E7200.9
A
f -c-100)
09/27/05 09/29105
SCL
1.00 U
1.00
ug/L
Enou
A
(<-2)
09/27/05 09/29/05
SCL
9.67
0.100
mjVL
EPA 300.0
A
(<-230)
09/16105
JEM
10-04-05;16:16
-Sa$-
;907 561 5301 0 V 7
SCS Ref.9
1056142001
An Datc-srrimcs are Alalka Standard Time
aientr4nme
Eaglc River Engineering
Printed DatcfTimc
10103t2OOS 16:34
Project Name/#
North Slope 2 Ll 6 B5
Collected DatedTime
09/16/2005 14:35
Clientsample][13
North Slope 2 L16 BS
Received Datefrime
09/1612005 16:22
Matrix
Drinking Water
Technical Director
Stephen C. Ede
Allmable Prep Analysis
hramcicr RMItA FQL Unit% Metbod Containar W Limits Date Date Init
Private Individual Analvsis
Zinc
Total Dissolved Solids
Nickel
HCO3 Alkalinity
CO3 Alkalinity
OH Alkalinity
Conductivity
pH
Alkalinity
Total Coliform
7.08
5.00
ug/l.
EP200.3
A
(<-5000)
09/27105 09/29105
SCL
129
10.0
mi/l.
SM20 2540C
A
(<-500)
09/20105
ISC
2.00 U
2.00
ag/l.
EP200.8
A
(<-100)
09/27/05 09/29/05
SCL
104
10.0
mg/l.
SM20 2320B
A
09/29JOS
CRH
10.0 U
10.0
mg/L
SM20 2320B
A
09/29ID5
CRM
lO.OU
10.0
mgfl.
SM20 2320B
A
09129ID5
CRH
240
1.00
unihos/cm
SM20 25 1 OB
A
09116105
ISC
7.20
0.100
pH units
EPA 150.1
A
KS -8.5)
09/16/05
ISC
104
10.0
mg/L
SM20 2320B
A
09/29105
CRH
108. No Coll
col/100ml.
SM20 9222B
A
(<-I)
09/16ms
DFT
zve;v �Oto�
Parcel I.D. #
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
050-581-20
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
North Slope #2 Lot 16, B1.k 5
Location (site address or directions)
NM Kogru Place, Eagle River
7
Property owner Jmes & Brenda schaf f — Day phone 696-2748
Mailing address 14c Ell nox 7176 F.Agle River. AK 99577
Lending a . gency Premier Mortgage/ Sue GaUeon— Day phone 563-7736
Mailing address 3000 A Street, Suite 102, Anchorage, AK 99503
Agent ' NA Day phone
AAeiracc
Unless otherwise requested, HAA will be held for pickup.
2.: NUMBER OFBEDROOMS: -3
..3..�-_TYPE OF -WATER SUPPLY:
Individual well
Community well
C�
<<11'
L
04
r,
Public water
NOTE: If community well system, provide written confirmation
from State ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
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.
n-025(RwA191) FWt UOA*21
5. STATEMENT OF INSPECTION BY ENGINEER
Ascertified by my seal affixed hereto and as of the validation date shown below, lverifythatmy
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the Information obtained from
the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water
supply and/or wastewater disposal system Is In compliance with all Municipal and State codes,
ordinances, and regulations In effect on the date of this Inspection.
Name of Firm Eagle River Eng:Lneer:Lng Services Phone
694-5195
Address P.O. Box 773294, Eagle River, Ak 99577
Engineer's signature - Date I.L - .2 7 -:Fr
-Of A
AW %
.. ... ..............
L,,i, A. WOO
CE -47-26
X A�
6. DHHS SIGNATURE
.Approved for, bedrooms.
�Pisapproved.
Conditional approval for
Additional Comments
bedrooms, with.the following .'stipulations:
Date Z — 'Z—Z�
Thie 'Municipality of'�ncbbrage Department of Health and Human Services (DHHS) Issues Health Authority
Apprqvaf_Certifli��t�s 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 thi�l r lending Institutions In order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct Inspections or analyze da�a before a certificate Is Issued. The Municipality of Anchorage Is not
responsible for errors or omissions In the professional engineer's work.
MMM�-Vll) 5� MOA021
WMICIPAWY OF AW-W-AALA
Municipality of Anchorage 'ICES DIVISM
DEPARTMENT OF HEALTH & HUMAN Mftff
Environmental Services Division rl.r. , 95
825"L" Street, Room 502 0 Anchorage. Alaska 995010 (90t) ;��iA419 a
Health Authority Approval Checklist
RECEIVED
Legal Description: NAM A Z- Parcel I.D.: 57 -Z(
fl Q
A. WELL DATA T A0 se�&
Well type At YA*12� If A. B. or C. attach ADEC letter. ADEC water system number
,reom /5,f-/
Log present (Y" AID Date completed 1911 gaml
Total depth 131 " �WAOIWCascd to t4pa' ge asing height (above ground)
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Wires properly protected (Y/N) yrs
AT INSPECTION
/2- zg, -91—
.94/ 1
g -p -m- 5�.v &P-m-
Colifiann Nitrate 0- '75 M(g/Z— Other bacteria
Date of sample: Collected bv: , mes
B. SEPTICA110tSM TANK DATA
Dam installed 1991 Tank sim 1;'549 Number of Compartments _!�- Clements (Y/N)-&6
Foundation c1caitout (Y/N) VCS Depression (YIN) _d4L_ High water alarm (Y/N) AIIA
Date of P%unpmg..Z,05A5 Pumper 'JA
C. ABSORMON FMLD DATA
Date install zw/ Sad rating (g,pA./ft' ) 1,7- System type Me=
Length —AL—Width 5 1 Gravel thickness below pipe -3% 5 ' Total depth do, F *'
Effwuve absorption area 399 I;t Monitoring Tube promt(Y/N) YCIS Depression ova field (Y/N) A/0
Dineofadapawytest jj%-X&-1F Results (Pass/Fail) PA-'xS For -3 bedrooms
Fluid depth in absorption field before lea (in.X -1 1 � Intinediately after�4% gal. water added (in.): 13 IS -
Fluid depth 1- � (ins.) Minutes later: Ito Absorption rate - _
Peromde treatzmat (past 12 months) (Y/N) _ d # If yes, give date
-f- Vr.
D. LIFT STATION �,// q
Date installed
Manhole/Access (YfN)
High water alarm level at*
Cycles
E. SEPARATION DISTANCES
Size in gallons
*Datum
SF-PARA77ON DISTANCES FROM WELL ON LOT TO:
SepticUl,Unll tank on lot
al* **Pump off'levei ;u*
On adjacent lots
Absorption field on lot On adjacent Ion A /Po ,
Public sewer main Public sewer manhole/cleatiout
Swmer4septic senice line f -7 f- � Lih station
SEPARATION DISTANCES FROM SEPTICIMMMM TANK ON LOT TO:
Budding foundation 5s, Property line Absorption field
Waw�maia/service line t1V urface wateddrainage Wells on adjacent lots
SEPARA77ON DISTANCE FROM ABSORP71ON FEFILD ON LOT TO:
Budding foundation Wow Mowservice line
Surface water Drivepm, paricing/vehicle storage area
Curtain drain Wells on adjacent lots Propert� line 55
F. ENGINEERIS CERTIFICATION
HAA Fee S
Dam of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee 5
Dale of Pityment
Receipt Number
I certifv that I hatw determined thru field inspections and review q(Municspal recw&e tkat �6 a"r are
in conformance with A40.4 M -M guidelines in effect on this date.
Signature
.............
Engincer'sName I-OVIS AilrfWA ?44�
Date r
6
4 S,
ik
HAA Fee S
Dam of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee 5
Dale of Pityment
Receipt Number
12/27/95 17; 33 C1111ERCIAL TESTING � 907 694 3297
ACY&F En-Aronmantal Services Inc-
k
cr&Z RAf.#
9s.S514-3
matrix
VJkTBR
Client sample
ID L16 ELxs NaTH sLCPZ 62
Client. we"
EkGLV RIVER EMzrEu%VG
OrtWrcd Vy
LOU
Project Nasw
12/20195 Kw
Proj*atq
DW31D
IUA
SAIVIS ]Remark-$
Parameter
-------------
Vitrate-V
COLLEC= SYS t. -B.
cc
Reau2t$ Qual
---------------------------
0.1s
WORX Order
20283
Printed Date
23127/9S a 17:12 lira.
Collected Date
12/18/95 a 11;4S him.
Ite,,J"d Date
12129/SS 0 14$00 bra.
T,cb,ical Director MPH= C- =2
R116affied RY
4c� f&�—
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CA unaveitabl
Bee Special Instructions ikb� NA Not An-l":d
Sea r,,Vle R*rarke Abo1re LT Lose 'Man
Vnd*tected, Reported lralUs is the practital "atificatlon limit. cir"tar Than
0. onn dry dilution-
Allowable
Ext.
Anal
Units method
Limits
Date
Date Tait
----------------------------------------------------------------------
" A EPA 300.0 ION
to
12/20/95
12/20195 Kw
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CA unaveitabl
Bee Special Instructions ikb� NA Not An-l":d
Sea r,,Vle R*rarke Abo1re LT Lose 'Man
Vnd*tected, Reported lralUs is the practital "atificatlon limit. cir"tar Than
0. onn dry dilution-
MUNICIPALITY OF ANCHORAGE A91
DEPARTMENT OF HEALTH& HUMAN SERVICES dom
Division of Environmental Services an
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # �50-581-20 HAA#
GENERAL INFORMATION
Complete legal description
North Slope #2 Lot 16, Block 5
Location (site address or directions)
NHN Kogru, Eagle River
Property owner Troy 6, Julie Buse' - Day phone 696-2873
Mailing address P -Q- Sox 772291. Fgale River. AK 99577
Lending agency Alaska USA / Kathy - Day phone 694-5390
Mailingaddress P.O. Box 196613, Anchorage, AK 99519-6613
Agent
Address
N/A
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well X
Community well
Public water
Day phone
�1 -5 L_-�
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 X
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.
724M (A.. 1191) F�l MOA 621
STATEMENT OF INSPECTION BY ENGINEER
Ascertified bymysealaffixed heretoandasof the validation date shown below, Iverifythatmy
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system Is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my invest�qation 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 Eagle River Engineering Services Phone 694-5195
Address P.O. Box 773294, Eagle River, AK 99577
Engineer's signature Date —;'2'
me Sys #-v� reit-C..( .7 -A 4r - 9 7 .
6. DHHS SIGNATURE
_Z�_Approved for -4 bedrooms.
M
Disapproved.
Conditional approval for
Additional Comments
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. Employeesof DHHSdonot
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.
r24=(P�.INI) BWA MOA621
Municipality of Anchorage AiRk
aim&
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: fl001Y' !�LoAc �07- —Parcel I.D. 050- 5k/-7-0
A. Well Data 5
Well type P,9 / VATf- If A, B, or C, attach ADEC letter. ADEC water system number A11A
.040W 11291
Log present (Y/N) A/V —Date completed 1771 jeffPaT -Driller _ ON14o'4010N
Total depth / 3 7-' 12 ePO rZf45 b Cased to ;�- LID 10 geNQ�4 Casing height -3 / :3 1'
Sanitary sea] (YIN) — y —Wires property protected (Y/N)
Date of test
Static water level
Well flow
Pump levell
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
C-
Z
1? 9. b,
rn
e.-)
'5 - �L —9 -P.M.
rn
e -n
2
M
0
Septietholding tank on lot 1-1-D I ; On adjacent lots -17/06
Absorption field on lot 13SI On adjacent lots -�t /00
Public sewer main A4 14 Public sewer manhole/cleanout AI)A
Sewer service line NIA Petroleum tank
WATER SAMPLE RESULTS:
Coliform —Nitrate 40 9 �51ee�, Other bacteria
Date of sample: Collected by: rN I'mcc
B. SEPTICIHOLDING TANK DATA
Date Installed IF91 ___Tank size / 2 50 —Compartments 21
Cleanouts (Y/N) y Foundation cleanout (Y/N) y Depression (Y/N) AID
High water alarm (Y/N) IV14 Alarm tested (Y/N) 111A
Date of pumping 0 7/ v /gy Pumper -J-p- 6
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 17�0 ' -On adjacent lots -f100 ' _Foundation '59 '
To property line 5 S'l Absorption field Io I -Water main/service line �/,/o
Surface water/drainage
72-M(=)*F=t CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed —Manufacturer
Size In gallons Manhole/Access (Y/N) —
Vent (Y/N) oPump on" level at OPump off" Level at
High water alarm level 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 9/ Soil rating (GPD/Ft) 4?_ 6PAP/,c7- System type 7_R�W C A/
Length 41 Width :5 -Gravel thickness _-Jotal depth
Total absorption area 3?9 1A Cleanout present (Y/N) Y Depression over field (YIN)
Date of adequacy test 03 ?3 Results (pass/fail) PASS for _R Bedrooms
water level In absorption field before test /o. r After test
la
Peroxide treatment (past 12 months) (YIN) HIA If yes, give date 14 J.4
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /35 —on adjacent lots 11/00, Property line
To building foundation To existing or abandoned system on lot
On adjacent lots -t- 30 Cutbank— 5.0/ Water main/service line
Surface water NIA Driveway, parking/vehicfe storage area
Curtain drain 8/1-1
E. ENGINEERS CERTIFICATION
SS
I cerfity Mat I have checked. verified. or confor7ned to all MOA and HA4 guidelines in effect on Me date of this inspection.
C'
'ZI T!4
Signature
Engineers Name Z-Oo/s
Date 7 .2 a
HAA Fee$
Waiver Fee $
Date of Payment 7_-_ d 6- -2X Date of Payment
Receipt Number /_,� 6 r6_7 7 0 ) — Receipt Number.
n-026 (3W)- Back
07/22/94 11:09 ME EWIPUR04TFL LAD SERUICES - 90? 694 3297 M.735 M2
Commercial Testing & Engirmering Co.
Environmental Laborotori Services
LABORATORY ANALYSIS REPORT
CUE W.1 N.36654
Cliffltswwlell) FOKnI SLOPE 02 LOT 16 MX 5
Mabrfx WAM
I
CITemblame EAULY. RIVER ENGINTERING WORK Chdw $0593
Or&red By Prh%tedDdc 07/22/94 @09;37 bra.
"n -Mum CullectetlMe 07120/94 (j4Q9;35 hrs
pmjectl RorAvalliate 07/20/94 @11:10 Ium
MID UA
TedmimlDircdor STTTITENC.ME
—Sm—rp1cR=wka: RO(riINT..iAMPLECOLLECIFDBY:LM.
Allowabk ExL Amf
parainder Rw�(s QuI 1hiti Iddiod 1kolt* Datc Date Irdt
-Wlt—r.ft- —N 1.06 M91L EPA 353.2M.0 10 MOM CMR
Sv Spocial Inomctions Above UA-May"Ie
q=,qwvpIeRm=k&Ab,)vo NA-14�tAnaljred
U - VoMmted. IkrpoTf ed vultz is the pm -tical Tbutificadon 11rdit. LT-loviThan
or- 01"iffumn
D-44toruky6litiGn.
Z;
-!1.
:-1 5633 8 Streei. Anchorage. AK 99518.1 $00 — let: 19071562-2343 Fax: (907) 661-6301
U.
EWSONMENTALFACILITIES IN ALASM COLORADO, FLORIOA. ILLINOIS. MARYLAND. NEW JERS". OHIO. UTAII,Wt"MAGINIA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 050-581-20 %
1. GENERAL INFORMATION
Complete legal description North Slope 112, Lot 16, Block 5
T14N RIE Section 32
Location (site address or directions)
NHN Kogru Place
Property owner Edward S. Kcmel Day phone 694-3051
Mailing address SRA Box 2326 Eagle River Road, Eagle River, AK 99577
Lending agency NIA Day phone
Mailing address
Agent Verna Danielson/Heritage Real Estatepay phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well X
Community well
Public water
694-4994
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 X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(R.AMI) F�l MOA#21
5. STATEMENT OF INSPECTION BY ENGINEER
Ascertified by my seal affixed hereto and as of the validation date shown below, I verifythatmy
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 I urther verify that based on the inf ormation 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 Eagle River Engineering Services Phone
Address P.O. Box 773294, Eagle River, AK 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for —3 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
694-5195
Date 03/30/93
Lcu:% A. tu!vra
CE -1,736
bedrooms, with the following stipulations:
By: -30(-64 SVIAM4 Date
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 intheStateof Alaska.The DHHS does this as a courtesy to purchasers of homes
andtheirlending Institutions in order to satisfy certain federal and state requirements. Employeesof DHHSdonot
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(ROV.1/91) 8�k MOAN21
Municipality of Anchorage
Department of Health & Human Services
sm
HEALTH AUTHORITY APPROVAL CHECKLIST LILLMal
Legal Description: North 131ape #2, Lnt 16, 131k 5 - Parcel I.D. 050-581-20
A. WELL DATA
Well type )57;4AF If A, B, orC, attach ADEC letter. ADEC water system number " -//IQ
Log present (Y/N) A)
Date completed If 7-2� 0'— k,' w5-ODriller
Totaldepth 13a" 1,12-100-4 Cased to 1-42' Casing height I
Sanitary seat (Y/N) y Wires properly protected (Y/N) Z
FROM WELL LOG
Date of test IVIA
Static water level
Well flow 9 -p -m.
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
AT INSPECTION
-r /,0/ ,
; On adjacent lots
Lq miCONITY (IF AW140RAGE
SERVIU-S DIVISION
,ETIkONWNTAL�
e "
e �-,Ar efta'.;J
Absorption field on lot /-?S. / . : On adjacent lots 0 1
Public sewer main 1�1/q — Public sewer manhole/cleanout
: �AR 3 1 1993
9 -P.M.
RECEIVED
,-).4
Public sewer servide line ov ;N — Petroleum tank 4/,o I
WATER SAMPLE RESULTS:
Coliform Nitrate 3 rn$, IL Other bacteria -9�=
Date of sample: ow,45193 — Collected by:
B. SEPTIC/HOLDING TANK DATA
Date Installed 17 7/ —Tank size 1-115 0 511 Compartments - _Z
Cleanouts (Y/N) /�' Foundation cleanout (Y/N) 1$1 Depression (Y/N) "J
High water alarm (Y/N) 10-/_ —Alarm tested (Y/N)
Date of pumping
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot )47 —On adjacent lots z"I'JI Foundation
s-� 1 11
To property line —Absorption I ield /10 Water main/service line
Surface water/drainage � 14
72-M (R". W) F�t MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed
Size In gallons
Vent (Y/N) —"Pump
High water alarm level
Meets MOA
Well on lot
(Y/N)
Manufacturer
,,�Manhole/Access (Y/N)
at "Pump off" level at
Cycles tested
DISTANCE FROM LIFT STATION TO:
D. ABSORPTION FIELD DATA
On adjacent lots
Surface water
Pate Installed,, Soil rating '�'��/-,-�System type el
L -. ein gt h '! 1. Width 5- Gravelthickness 11f Total depth
Total iibsbrption"area 3;75 Cleanouts present (Y/N)
Depression over field (Y/N) - Date of adequacy test /5-Y
Results (pass/fail) rX for 3 bedrooms
Peroxide treatment (past 12 months) (Y/N) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /-75-, On adjacent lots -Propertyline
To building foundation
To existing or abandoned system on lot K,1,1 ' —
C_
On adjacent lots Cutbank - 40e Water main/service line
Surface water Driveway, parking/vehicle storage area z2o
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that / have checked, verified, or conformed to all MOA and HAA guidelines In effect on the date of this inspection.
Signature
Engineer's Name
Date �Fz
HAA Fee $ 170 4�� -
Date of Payment - -51 -F-'l
ReceiptNumber
72-M JR.. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
I MAR 30 193 09:05 HOPTHERI TESTING, WCHORAGE
P.
NORTHERN TESTING [ABORATORIES, IV ,
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA "701 t907) 456-3116 6 tv�x 3 125
2" FAIRBANKS STREET ANCHORAGE, ALASKA 9MW (D07) 277���
Eagle River Engineering
P.O. Box 773294
Eagle River AK 99517
Attns Louis Butera
our Lab 1:
Location/Projecti
Your Sample XDs
sample Matrixt
Comments:
Lab
Number Method
A122a42
N. slope 12 16/5
water
Parameter
A122842 EPA 353.3 Nitratc-N
At L,4
Roo
MA #16d By; Su;an .. T1 tp6cai
�siob Su er or
Report Datef 03/
Date Arrivedt 03
Date Sampled: 03
Time Sampledt 16
collected By: - SG
* Definitions *
a - Below Regulatory
M - Above Regulatory
E - Estimated Value
M - Matrix Interiere
0 - Lost to Dilution
MDL w Method Detiicti
Units Result * MDL
---------------------------
Mg/1
0.2 :
93
93
on Limit
ba:0 Date
s;xred Analyzed
---------------
03/26/93
5. LEGAL DESCRIPTION
DATE RECEIVED
INSPECTION APPOINTMENTS
7 1 NVE_
TIME
TIME
DATE
DATE
DAii;
INSPECTUF—t-
INSPECTOR
INSPECTOR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE r -"T- OF H!!ALTH e,
DEPARTMENT OF HEALTH & ENVIRONMENTAL PR*F4AW_tQN,."NjAL PROTECTION
825 L Street - Anchorage, Alaska 99501
DEC
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 . RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL
WATER AND SEWER FACILTTIES
DIRECTIONS: Complete all parts fni page 1. Incomplete requents will not be processad. Please allow ten (101 days for processing.
1. PROPERTYOWNER _F�RIO_NE
8. SEWAGE DISPOSAL SYSTEM
2FPW.4
:5& INDIVIDUAL/ON-SITE**
MAILING ADDRESS
— )714 1;7.6-zg� 4�—�l 1�
PROPERTY RESIDENT (if different fiom above)
HONE
2. BUYER
PHONE
MAILING ADDRESS
TINSTRUTION
3. LENOFNG
PHONE
AI.An"
MAILING ADDRESS
4. REALTORIAGENT
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
Z67 /6 kor_rp
STREET LOCATION
f
6. TYPE OF RESIDENCE
NUMBER OFBEOROOMS
'X SINGLE FAMILY
C3 One 0 Four 0 Other
0 Two 0 Five
0 MULTIPLE FAMILY
J9 Three 0 Six
7. WATER SUPPLY 01
10 INDIVIDUAL*/? ZZ /-3A
-ATTACH WELL LOG. A well log is required for all wells drilled
0 COMMUNITY
since June 1975. For wells drilled prior to that date, give well
13 PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
:5& INDIVIDUAL/ON-SITE**
—,1275 YEAR ON-SITE SYSTEM WAS INSTALLED.
0 PUBLICUTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72 010 (Rev. 61791
ME
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
0 SINGLEFAMILY
0 MULTIPLEFAMILY
NUMBER OF BEDROOMS
0 ONE 0 THREE 0 FIVE [3 OTHER
0 TWO 0 FOUR 0 six
2. WATER SUPPLY
0 INDIVIDUAL
0 COMMUNITY
0 PUBLICUTILITY
Connection Verified
PERMITNUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
OINDIVIDUAL/ON -SITE
C]PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER
OSepticTankor EDHoldingTank
Size:- If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES WELLTO:
SepticiHold,ng Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
R�IAPPROVED FOR BEDROOMS
0 CONDITIONAL APPROVAL (letter must accompany certificate)
13 DISAPPROVED
DATE
By _e4
1 1)
72 010 (Rev. 6179)
- ___ lu,-
A
E'dward 1-'.omel
SRA 2326
Eagle River, Alaska
Dear Mr. Yomel,
r%� *
(0"1\ IN
EXCAVATION ROBERT A. SHAFER
WORK CIVILENGINEER
694-2979
teptember 27, 19,814IC:-ALITY Cr ANC�!--RAG'
L)� �� '. � 1 1.
ENVIRC.'-
'S� F; 2 9 1 ��l
99577 REC E IV ED
Reference: Lot 16; Block 5; North Slope Subdivision #2
A sewer system adequacy test was performed on the system located
on the referenced property as you requestcd.00�T *c tank was
Niifgg�j
2�Q verified to have 5i, ggity of 10 s. The seepage
p.it4gga.s-�IEC!Srllargecf-w—it-ii--a�1000 aT Is oL iresn water and after a period
of 24 hours all the water which had been added had percolated out
of the crib.
It can be concluded from this test that the waste water disposal
system serving the three bedroom residence located on this property
is currently functioning adequately. Fowever, the system cannot
be guaranteed against subsequent failures.
Tf we may be of further assistance, please do not hesitate to call.
Sincerely,
P
�Vr E.
cc: Alas1ra Bank of Commerce
Eagle River Branch
municipality of Anchorage
Department of Health and Environmental rrotection
SAO 196X EAGLE RIVER, ALASKA
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-
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received October 14, 1976
Time of Inspection 3,'M'pM
Date of Inspection In .4f)- f)lt) / j )a.
'/61j
REQUEST FOR APPROVAL OF C
INDIVIDUAL SEWER & WATER FACILITIES
FOR ffLo4
AHFC
1. Approval
requested
by:
Lomas and Nettleton
% Bill Long
Mailing
Address:
4449
Business Park Boulevard
Phone: 274-7661
2. Property Owner: Lowell Pollard (out of state) Phone:
Mailing Address: % Post Office Box 249 99577
3. Legal Description: Lot 16 Block 5 North Slope Subdivision #2
4. Location: Kogru Place
5. Type of facility to be inspected Single Family No. of bedrooms 3
6. Well Data: Individual
A. Type
C. Construction
7. Sewage Disposal System
A. Installed 1975
C. Septic Tank: 1. Size
B. Depth
D. Bacterial Analysis
On-site system
B. Installer
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
8. Distances:
2. Manufacturer
2. Material
1329
A. Well to: Septic tank , Absorption area Sewer Lines %
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Page I of two pages
Page 2 of two pages - Rec. ,t for Approval of Individual S"'�r & Water Facilities
I A
Legal Description Lot 16 Block 5 North Slope Subdivision #2
Comments
sapproved
Date
Approval UAlid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
Da te
iMunicipality of Anchorage
:Environmental Protection MUNICIPALITY OF ANCHOfAGj:.
DEPT. OF HEALTH & .
:2516 Tudor Road ENVIRONMENTAL PROMC710"
�'Anchorage, AK 99507
OCT 14 1976
REQUEST FOR APPROVAL -OF
INDIVIDUAL SEYER VIATEP FACILITIES R
ECEIVED''.
IV
Type of Inspection: -Ci'-IRO VA AHFC FHA cot,
2. Property Owner: Lowell Pollard (out of State)
C/o il. U. Jjox W.49
Nailing Address: Eagle RiV6r# AK 99577 Day phone 694-9555
3. flame of Buyer: Edward S..Komel
4001 Old Seward Hy #7
Fai I i . ng Address: Anchorage - Ax. Day Phone 278-3582
4. Nlane as' Lending Institution: Lomas and Nettleton
.4449 Business Park Blvd. ATTN: Bill LoTig
Nailing Address: Anchorage; AK 99503 Phone 274-766i
5. Name of'Realtor or.Agent: ..Myrna.johnston (A:REAP 'Inc.', Realtors)*-:
P. 0.
Flailing'�ddress: Eagrle River,*AZ'.99577 Phone 694-9555-
0
6 Legal Description�. -North'Slope Subdi�ision*�ddn#2, .'Blk 5, Lot 1,6
Location: Kogru Place (Turn left off Eagle -River Road -at Mile .10,
Turn left at first road't6 left, home is trown ranch with ar rt.in-. I
front on XKXX right hand side. .(Home --is vacant, agent ha �ckepoand can.
accompank)).'
'�inglei-ramflv fio. BdY��15 3
.7. Type of Facility.to be inspected:.
S. -Water Supply.
Type bf Sapply Pul5lic Utility Individual )ex*
I f' Individuil's' "number of diiellfng.s. pre's'eittly S'e�ved
If Individual, depth.of we 11 132 Feet
�ewage Disposal -'System
Type of Syst'em: - Public Utility fndivi�ual (on-site) xx
_If -Individual, date� of installation 1975
NOTE: Prior inspection was accomplished for another transaction which
fell through. Bank requires a re -inspection. Prior inspection was
done on 5-10-76
0
h� % L
tic 5 11)
it e tie
t'o I I
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
11C11 -4561
3330 Str t, Anchorage, Alaska 99503 274
fYYL-)a' Date Received April 30, 1976
0- Time of Inspection PIV,
Date of Inspection
REQUEST FOR APPROVAL OF
0 71NDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Area Realtors Inc. % Myrna E. Johnston
Mailing Address: Box 249, Eagle Ri%;er 99577 Phone: 694-9555
2. Property Owner: Lowell Pollard
Mailing Address: Out Of State
Phone:
3. Legal Description: Lot 16 Block 5 North Slope Subdivision 02
4. Location: Kogru Place
5. Type of facility to be inspected Single Family No. of bedrooms 3
6. Well Data: Individual — serving one
A. Type
C. Construction
7. Sewage Disposal System:
A. Installed 1975
B. Depth
D. Bacterial Analysis
Onsite syttem
B. Installer
C.
Septic Tank:
1.
Size
D.
Seepage Pit:
1.
Absorption Area
E. Disposal Field: Total length of lines
8. Distances:
2. Manufacturer
2. Material
110,
I
A. Well to: Septic tank Absorption area Sewer Lines
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1174) Page I of two pages
age 2 of two pages - Re( st for Approval of Individual �r & Water Facilities
Legal Description
Comments
Lot 16 Block 5 North Slope Subdivision #2
Disapproved
Date
Approval,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74
Da te
4-28-76
eoml�k
'GREATER ANCHORAGE ARLt, BOROUGH 1111-11111CIPALITlY OF ANCHORAGe
DEPARTMENT OF HEALTH 8,
Department of Environmental QUality_Et4V NTAL PROTECTION
3330 "C" St., Anchorage, Alaska 99503 2/4-141M
APR 3 0 1976
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER 9 WATER FACILITIES -RECEIVED
1. Type of Ins pection: CNRO VA FHA CONV
2. Property Owner: Mrs and Mr Lowell Pollard
Plailing Address: OUt of State Day Phone
3. Name of Buyer: N/A
Hailing Addres s: Day Phone
4.. Name of Lending Institution: N/A
Mailing Address: Phone
5. Name of Realtor or Agent: - Myrna E. Johnston
AREA, Inc., Realtors
Mailing'Address: Box 249, Eagle River, AK Phone 694-9555
99577
6. Legal Description:' North Slope Subdivision No. 2, Blk 5, loot 1:6
Location: Kogru Place (Turn left off Eagle River Road at Mile 10, -
Turn left at first road to
nt�eft' r ar ryiaght, hoame_is brown
Ranch with carpart -in fra TraiT:dr bj3:rk:dt0in xd cfent can
accompany.
7. Type of Facility to be inspect'ed:. Single Family No. Bdr�MS. 3
B. Water Supply
Type of Supply: Public Utility Individual XX
If Individual, 'number of dvielli'ngs. preseintly se�ved 1
If Individual, depth of vial l 110 Feet
9. Seviage Disposal -System
Type.ofs System: . Public Utility Individual (on-site.) XX
_If Individual date of installation 1975
Tenants are in process of vacating - Call Agent (Myrna Johnston)
694-9555 for Inspection. I