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HomeMy WebLinkAboutROLLING HILLS VIEW ESTATES BLK 4 LT 4Rolling Hills View Estates Lot 4 Block 4 P-624. t+ #050-322-12 Municipality of Anchorage Page —of--Z,- f--Z,—DEPARTMENT DEPARTMENTOF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:--1SL.lg20Iq' PID Number: d���221Z Name: Wastewater System: ❑ New -;4Jpgrade Ajdr'a' l.t ABSORPTION FIELD Phone:( _CI�. IQM �G No. of edrooms: �eep Trench ❑ Shallow Trench O Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 4/f� .T„1iPD/S FI. from original s: Lot: Block:� Ss i n: s 1 _ tL�Lj Depth Io pipe bottom from original gra: h beneath pipe i0 Ft. Ft. Township: Range: Section: Fill added above original grade: / h: Ft Ft. Lines: WELL: ❑ New ❑ Upgrade Graveldept w19 �� I Dsuncese warlineaFt FI Cl I cation (Private, A,B,C): Total Depth: Cased To: Total absorption area: ';�SO lzF2510 k XZ Ft. Ft. Ft. Driller. Date Drilled: Static Water Level: Installer: Date installed G1 Ft. L yield:Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑Holding OS.T.E.P. To Septic Absorption Lift Holding ublic/PnvMs ranufacturer.pacity In gallons: From Tank Field Station Tank Lin Satyrc Well 101�5r.J�s �—J Material: Number of Com artmants: Water 1004-100'-+- —' LIFT STATION Lot Line 10 Sizeingallons: Manufacturer. Foundation e5o I ZL// �g r "Pump on" level at: D off' level at: High water alarm at: Curtain Q , 1 Ta Pump Make ooel Electrical Inspections performed by: Drain Remarks: o io BENCH MARK Location and Description: (ice Assumed Elevation: 1 ENGfjpQ 9�11 OF ACas ease. i5 .•' _ 4r1 �j S 8 S ENGINEERING ojr, 9I1i t 17034 Eagle River Loop Road. No. �teS: 1S Inspections performed by. «.«• .....�... Eagle Rlvar, Alaska "Sri 2nd as a ��, R R SHAPER Department of Heajth and Human Services approval . '.e. No. 8215 �'F••. .e•''���n e�fei: Reviewed byb�lg —2592 FES510�VA t+�?0FESS0 and approved Date: 72-013 (1191) MOA 25 Permlt No. hiAJ eZD l-1-1 Page _0— of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 * Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report t'oL-l;l 04 4 1 v 1�.w fit: _ Legal Description: :!Z2_S VlJf 4p PID No.:�— cel G74 a v r'tf l 3 � L8 t1 � 5 rlo tj4� U r' ,� w� vaholl,s • rj l a A zatis ,ri49Iri*. •� ,�% Vi •'.•,N• •i • , ER l,QfiPi � I Com" II' ii s% a No. 821.5 F 111100 tA MT�j A � /�1 cot Co�3 GDS Go(o COQ Ig7f 1 h1 A 72-0 ZN5 Q,�" '�� � 1� :�r l�% t l o L/�� l�l� I 17 A (7/Yt) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920171 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:CLARY EVERETT J & OWNER ADDRESS:18942 UPPER SKYLINE DR EAGLE RIVER, AK 99577 PARCEL ID:05032212 LEGAL DESCRIPTION: ROLLING HILLS VIEW ESTATES BLK 4 LT 4 LOT SIZE: 46609 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: kjrm Iq -al-79- DATE a9-7a DATE ISSUED: 7/06/92 EXPIRATION DATE: 7/06/93 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: THE SEPTIC SYSTEM MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVED ENGINEER'S DESJGNDATED 6/26/92. % / G/ DATE • C 6 z__ RECEIVED BY: U-) June 27, 1991 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 6942979 FAX 694.1211 HEALTH AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 SEWER&WATER MAIN EXTENSIONS REFERENCE: Rolling Hills View Estates Subdivision, Block 4, Lot 4 SEWER 6 WATER INSPECTION Request you issue a permit to upgrade the septic system serving the above referenced property. ENGINEERING STUDIES An adequacy test was performed on the existing system and the AND REPORTS absorption capacity of the system was found to be adequate for a one bedroom house. A test hole was excavated and a percolation test performed in WELL INSPECTION the area of thero osed upgrade. The round water monitoring &PLOW TEST tube within the hole has been checked and found to be dry. Attached is an upgrade design which shows the location of the proposed trench. SITE PLANS We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. If you have any questions or require additional information ROAD DESIGN for your review, please contact us. Sincerely, SOILTEST V ROGER J Si)AFER, P.E. PERCOLATION TEST RJS/LSU/lsu STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESION 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 40' rJ o~mk� rn V4 C4 IV 7 P fi 0 o�N o wAm m oyo " ,', rn 'b oit �m „ Z 0 ��� uaw Zt m „Uo40) n 14 14 o n O \C UPGRADE r O r O I W N • 4;0,4 4.'•j��Z l 4' 11'1 N O � r s m r � y O 10 r n y y m so m O A � � r 0 N • 4;0,4 4.'•j��Z l 4' PERFC LEGAI 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 —J}vJJ TEST RUN BETWEEN FT AND LFT COMMENTZ/�2,�, PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River LoaRoad No. y ACCORDANCE WITH ��L�T�R.Iu�IIGUIDELIN N EFFECT ON T IS DATE. DATE: 72-M (Rev. 4,85) Y \I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION `� ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [INEW �" �j � �7 % •�'OPGRADE MAILING ADDRES 2 LEGAL DESCRIPTION, C LOCATION r _ ` �71-•J NO. 0�EOROOMS DISTANCE TO: Well Absorption area Dwelling PERMIT NO. D �Y WQ Manufacturer St Material No. of compartments N ~ Lq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth damZ DISTANCE TO: Well Dwelling - - PERMIT NO. S? H Manulactu Ma int li ui ny in gallons m= DISTANCE TO: We -t -(0O , Foundation t zoo Nearest lot line p/ PERMIT NO. .IC)IS,76 .w.l LL= F- No. of lines n e Length of each e t Total length ofline� , d CT Trench wl5lth '/' winches Distance bet wePq li W`. op of it finis grade 7 Material beneath tile Total effective a so t'Rn area r0I3- � � U w Length VI Depth PERMIT NO. t, n h wd Type of crib Crib diameter Crib depth Total effective absorption area n DISTANCE TO: Well Building foundation Nearest lot line J ss Depth Driller Distance to lot line PERMIT NO. J w i TO: Building foundation Sewer line Septic tank Absorption area(s)DISTANCE OTHER PIPE MATERIALS - 303C4 s- 'C SOIL TEST RATING I NSTAL lEji,_ REMARKS C 4eS7' On oa'b P/7' for- I T -v IL'X tms1 to C�(uS'7i n o 7- 7 En2vcn-r.s UDc hof drrns. W +4) PPHOVED DATE LEGAL 72-013 113/78) M LJ r4 I C I MY L- I T •r G7 F= P r-4 C F -1'-"R F=l G r --- DEPARTMENT DEPARTMENT L. HEALTH AND ENVIRONMENTAL t._OTECTION • .-825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 0r410I TE L EWER Ur= (3MRpE r=' =FRM I T PERMIT NO. C 810575 > APPLICANT FRANK BRUSH PO BOX 249 99577 688-3472 LOCATION MC CURRY LEGAL L 4 S $.P.OLLING HILLS VIEW EST LOT SIZE 43560 SQUARE FEET Q JQZW40 TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER. OF BEDROOMS = 3 SOIL RATING <50 FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: OEPTF-i= ILID ILEtd13-r"= 2S G;FZFlk- EL DEPTH= 4 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). REG7L_l I F;ZEE> SEPTIC TFit-4F< '= I LE= 1QI+0 GFiLLOt�FS 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. --- TWC C 2 ? I rJS~PECT I G]RIS nFt E FSEG!U I FREF3« --- 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. FPEFZ M I T EXP I FRES E>EG3EMBEFR =1s I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS 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 RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLICANT FRANK. BRUSH ZSAC1. AND WELLS AS SET ENLARGEMENT IF THE ISSUED BY ------------------------------ DATE_5.9_"l_1__JDJ-- V4.0 ('JNICIPALITY OF ANCHORAGE �'' /D" 30 Department of Health and Environmental vrotection ' ►/Lu6 Lo- 1 Q-91 825 L Street, Anchorage, AK. 99501 A�� 5 264-4720 r� * * * HANDWRITTEN PERMIT WEtt-R ON-SITE SEWER PERMIT-UQGYCcL-- r— Applicant,-5 ',rj1T,'%NL' /J/A-,SN Mailing Address: /O& Location: ///: C Ge, Legal Description: Phone Number: loXf- 3 LI % �' � Lot Size: 'f 35G� Type of Soil Absorption System Is: v Trench: ✓ Drainfield: , Seepage Bed: Holding Maximum Number of Bedrooms: 3 Soil Rating(sq.ft/br) _ Tank: / ZS The Required Size of the Soil Absorption System Is: DEPTH / LENGTH 12elC_ . GRAVEL DEPTH_ WIDTH The length dimension is the length(in 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(in 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 (in feet) . ,ar-- * * REQUIRED SEPTIC(HOLDING) TANK SIZE _©d GALLONS 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(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this departmen will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee 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. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1 * * * 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 codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that �3 bedrooms. Signed: 1 )/ 1'i_., �/ Issued by: �-�--- : 4it� r �� Applic6nt / Date: 6^/ 7l�.� SWP/024(1/81) n n ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE ❑ PERCOLATION �� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST t,` 825 L. Street, Anchorage, Alaska 99501 2644720 1/� SOILS LOG — PERCOLATION TEST � /^b PERFORMED FOR: `/ v yc- P ��r 4 �r / / 7 /��� �""Dk PERFORMED: • ��uN v I LEGAL DESCR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 oeC-AA/e c ry,-c�os,/ 4- _Roo)e Ly ylnJl C ?vG�/Si AJ,9 2S /WASGROUNDWA9�� ENC UNTERED7 TER A IkN o 1G1o/f, IF YES, AT WHAT DEPTH? SLOPE SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: S Ft S Engine -r! V CERTIFIED BY: 72-008 (6/79) =o n Al hinieipalit.y of Anchorage M Department of Health and Human Services LR_ 825 "L" Street Rick htys;•om, Mayor 5 p•O• Box 196650 Anchorage, Alaska 99519.6650 ht:p:•, wv.wx. .ancncrage. a<.us 343-4744 March.16, 1998 Robert C. Cowan, P.E. S S S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 4 Block 4 Rolling Hills View Estates Waiver Request #WR980005, PID #050-322-12 Dear Mr. Cowan: Your request for waiver(s) of the required 100 foot horizontal separation of an on-site wastewater disposal system to a private well has been approved. The approved separation distance(s) are an absorption field on Lot 4 to the private well on Lot 3 of 97 feet. This waiver approval applies to the existing on-site wastewater disposal system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, A;;,//. v� Daniel J. Roth Civil Engineer On-site Services Program ljm:#6 r � MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR980005 PID# 050-322-12 HA# n/a Permit # Date Received: February 13, 1998 Legal Description: Lot 4 Block 4 Rolling Hills View Estates Engineer: S & S Engineering, 17034 North Eagle River Loon Road Suite 204 Eagle River, Alaska 99577 Applicant: same as above Waiver Requested: Waiver requested for absorption trench on lot 4 to a yriS . well on lot 3 of 97 feet. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: // WAlvER REQu EST fore Lor VER REQUEST vumilER WR9B000T r,C W>lIVEfQ R"w"sr FoR r" DELL oA/ Lor j TO THE AOSORPrfew F/EtD a.V Lor 4t OF 97 FEEL; or,c H/Sr0/PY- THE SuoTECT /I0SORPTI10V FIELD L,As ODvSTRuCTEO IA, TuLY 31 /?72. Tut sve7F-Cr M•ELL WIPS txISr,A•6, WHEA/ r"E j#Vf"/ptW f,ELD L NS CCA/IrRacrEp rut AOSORPT/oA, FIELD IS comfrRwcrEp /N // SIiA,nY SKr m*rERIRt w,rH A PERCOt/ar/O.v KMTE Or 32 H/,VNreS/I,vCN. ri-11.1 TYPE of sou Is VEfeY EFFECTIVE Ar rkFAr,•G SEpr,e rA.V/C EFFLuE,vr IAi vE,tY SHoRr PlorAAee (.:: 2-44 rHE /}BSORPTiov FIELD /N fl u ESrVAl IS O.V T,lf S/l�+E /4r/Rox,w ,sT CoNteNrf /fS rf(f_ WELL /A, QuE1T,O.v. r<If 4t yERt Y/w•L OEDRe[K Hau,EvER A"ENRS r0 SLOP& FROM BEA,t'ArH 7wil ADSeRPrlcw F,EtO VOv,/,WHro rvl-A)(vJ THE WELL Ar /s R*rr Or LESS m.,F.v MOKE )'REDaH141ANT SLO/E of TME /6D?0c/t Is P£Itp�rOiraLA/P To rHt► LIME 0Er►.EE,1 rhlE /iBfORiTjp.V f/ELp /}n•0 wELL /v QL,Efj,•.V. WELL V*rA• - rHE 4.ELL /,v OUtfrNA, lS 46J' FlEr VEEP, i9fPOVC/r IA, EACpurrbR6p /}r /s F[£r: Tka fe/t EA/CO9u7f3REO 4PErr.E6V O i /S' Fttr /S 12 Alt,kre//weN GM rYP£ Solt, The Srgr/c 4.m le levet IS 2S f_E7- rkUs ImvIcxmv& r"AT No w r6K IS K/�L• rNE j-f6LL Vr THE ClhSlA'6 SCOROCK /.VTERF jCE, U,"rDR /s I C)W.PTap 70 a,VrtR 71eE wFLL. wr G2 ):r— 7/ sr ? 70Fr FR»crkKeFf wA}TER s/°kpteS /4.4plc/sre pt/pT A/a COLlI�ORM 9AcrER/A ARE !'R ES£n,T WITRATE? OA, /O/P7 ?.49 yet. A VEiPY ,✓rsREtti�+L, NOT[ O., T/r/S L.PLL /f rHgr rPE (w TNfS f. EtL 4.f;RE 'f; .f If OA -1 /Q/90 /A-.vicN 'IA,& rw*r N/rMg7E (fYELf blAv! Ae7&wLY DA'II/6D. TILE A,1771,rrE LEVELS /►LojrE,fR TO /f VACv6X0"A-'P L EVEL f FOu,✓y /N THE' AREA. 0 S. OF /P. D. E. G. S. D. W. G. foR S. G. /Y. 0.. PO/a r3 Iu)q ER T9LTLE B E v R 00? IJ" ' 7 GM 32...../,.. 4.s ��=I PERNE IL I t ��cg S t►niE Rf AIliv[ .'. (,v14Tf12 rl4BLF GRIfI��F�r —3 7o co..s6pvKrlvE I 2 y_.ear 2 z. o 2.9 *A,19 r0r4L /7.7 1 COR/C49f10 v wHb.l. rHC po/tirl ARE2.3 FROM HtEr,,A,I. rA4 /L potArf )ev 4K IK6O ro @vLlty ".f M•AlvcR.. FNtTot'1 `11 riseuff Elo ON ONEW)" / of 2 or rH�J "uvr Tusr'Py r"E ,RgwTlw� of rkly wAWFJ?. w R 48 0&0r OSo - 322 - /2 ENVIRONMENTAL SERVICES DIVISION February 4, 1998 FEB 131998 RECEIVED MUNICIPALITY OF ANCHORAGE Attn: Dan Roth Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 4; Block 4; Rolling Hills View Estates SID Dear Mr. Roth, Request you grant a waiver for the horizontal separation distance between the septic leachfield on Lot 4 and well on Lot 3 at 97 feet. The mitigation factors involved which support the issuance of the %aivers arc as follows. 1. The vertical distance from the bottom of the Icachficid to the water table is 60' ++ 2. The soil in the arca is predominantly silty sand and gravel with small amounts of clay over the bedrock. This soil type is in the middle range of the soil sorption factors. 3. The referenced property has bedrock starting at about 15 feet below the surfaces. 4. The well to Icachficld has a 60%water table gradient sloping away from the water source. Since the well and Ieachfield are on approximately the same contour line while the natural slope of the arca is 25%+ , the gradient is said to be sloping away from the water source. 5. The -well to leachficld has a horizontal separation distance of 97 feet. The above information is provided to insure a formal waiver is in place, per your letter dated January 7, 1998 to Mr. & Mrs. Johnson (property owners Lot 4; Block 4; Rolling Hills View Estates). It is my opinion that issuing this ti -jiver will not impact the eater quality of the well on Lot 3. ormation, please contact me. 1 / «' SITE PLAN WAIVER REQUEST . Mq M_ «2■® !|m 22 �! mo ink 220§;| 0 M. aE cos 1:1,e (§§� a§ ta | | o ® _ M o iA , K *� § m ` E � K® ( C4 � . C4 c 4 )� R # § • §\ K q / M cn , o ƒP �•! ■ ,. : §dr _._.�...-...,.._..........�..--.....�1.-•--�--..:..,.:...: ,4,11 - _� ._ .1 1. n • INSPECTION APPOINTMENTS DATE RECE VED J (\IZ , t7 , TIME TIME TIME Li NUMBER OF,BEDROOMS bQ SINGLE FAMILY ❑ One ❑ Four ❑ Other I : 30 ❑ Two ❑ Five ❑ MULTIPLE FAMILY D' Three ❑ Six >ti DATE ®' INDIVIDUAL' DATE DATE since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) _ �— ��—g� 4a=\ Qt INSPECTOR 0 INDIVIDUAL/ON-SITE" INSPECTOR INSPECTOR NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPQTY, m-XicWRAGE , MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL KOTECTION DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION �\ • 1 525 L Street • Anchorage, Alaska 99501 MAY 15 1981 ENVIRONMENTALTelephone 264.4720N DIVISION RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAILING ADDRESS Pa 77 PROPERTY RESIDENT (It different from ab vel PHONE 2. BUYER PHONE MAILING ADDRESS C� ex"l i « Z711,exo I<k r74S7 3. LENDING INSTITUTION PHONE a o MAILING ADDRESS C 4. REAOR/AGENT PHONE MAILINGA DRESS 5. LEGAL DESCRIPTION iA; Y STREET LOCATION �. 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS bQ SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY D' Three ❑ Six 7. WATER SUPPLY ®' INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - 0 INDIVIDUAL/ON-SITE" x'4776 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. W^= 1 V L'7- 1 � 0 a« . THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS JA [13 APPROVED FOR , BEDROOMS ❑ CONDITIONAL APPROVAL (letter must ac co %1YDISAPPROVE\ r \ pa y certificate) DATE Y Bt/ w \. v 72010 (Rev. 6/79) ."' A n DAVID A. SLENKAMP ROBERT A. SHAFER MECHANICAL ENGINEER CIVIL ENGINEER 694.9055 - 694-2979 June 1, 1981 MUNICIPALITY OF ANCHORAGE DEP'. OF HEAL'.' 3 ENVIRONMENIAL P:.:. ; :CTION ,Ml 1'6 1981 Area Realty ATTENTION: Joyce Porte RECEIVED P.O. Box 249 Eagle River, Alaska 99577 Dear Mrs. Porte, Reference: Lot 4; Block '2; Rolling Hills View Estates A sewage system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The seepage pit was full of water and approximately 1000 gallons was removed. The crib was then recharged with 1000 gallons of fresh water and after a period of 24 hours approximately 231 gallons had percolated out of the crib. It can be concluded from this test that the septic tank is adequate for the three bedroom residence located on this property. However, I regret to inform you that the seepage pit is only adequate for approximately 1;; bedrooms. It will be necessary for you to have the absorption area upgraded. In accordance with the Municipality's request, the measurement from the well to the existing seepage pit was determined to be approximately 102 feet. If we may be of further assistance, please do not hesitate to call. Sincerely, E. cc: Alaska Pacific Bank Municipality of Anchorage Department of Health and Environmental Protection SRS 196% EAGLE RIVER, ALASKA t'0 C/w 1 L�,,Ie-lr n R&M ENG EERING & GEOLOGICkL. CONSULTANTS 229 EAST 51st. AVE. — P.O. BOX 6037 — ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 TELEX 090-35419 Civil Engineers Geo%gists Land Surveyors JAMES W. ROONEY. P. E. RALPH R. MIGLIACCIO MALCOLM A. MENZIES, P.E., L.S. Engineering Geologist JAMES H. WELLMAN, P.E. June 29, 1973 Mr. Charles Miller P. O. Box 554 Eagle River, AK 99577 R & M Project No. 36631 Re: Test Hole and Soil Log Report for Sanitary System Lot 4, Block 4, Rolling Hill View Estates Dear Mr. Miller: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of June 28, 1973, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environ- mental Quality. A single test hole was put down within the Lot 4 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 12 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. However, a minor water seep was encountered at 12.0. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & 1.1 ENGINEEERRING & GEOLOGICAL CONSULTANTS �s d f!':� R JJWR: ph +'rc: GAAB ANCHORAGE FAIRBANKS JUNEAU T.H.-I 6-28-73 rN ORGANIC MATERIAL (PEAT) / SILT, SOME SAND Q 0-0 6Q O .06 GRAVELLY SAND 0.0. TRACE SILT (SP) aao o�. o. SILT, TRACE SAND (ML) �d Qp0- O�O QD .o 0.0 SILTY SANDY GRAVEL (GM �o C. d� o b0. Q;Oti d '• • / SILT, TRACE SAND (ML) •00 b poo SILTY SANDY GRAVEL (GM) a,P OA 0.5, In 5.0' 5.5' IO.d 10.5! 12.6 T.D. Note% Test hole excavated with tractor mounted backhoe. Minor water seep at 12.0' Engineering b1 Geological Consultants Charles Miller Property LOG OF TEST HOLE ANCHORAGE IA,NKANK! ALASKA JUNEAU Anchorage Alaska DATE 6-29-73 SCALE I" a 2' DWN BY G.A.W. CHKO BY W.E.D. PROD. No. 36631 Iowa NO. A-01 \ l Joh o, a S. o S,�i-{ro.c�s.anlLlc� S•� WJcobbl....- S'i��y S*wpy M: Q wta M: Municipality rr�" �. 825 "L" STREET l v E F� ANCHORAGE, ALASKA 99501 ©`(907) 264-4111 '\ nchorage GEORGE M. SULLIVAN. MAYOR DCPARTNii NT Of WALTR AND ENVIRONMENTAL PROTECTION May 20, 1981 Frank/Pauline Brosh Post Office Box 43 Eagle River, Alaska 99577 Subject: Lot 4 Block 4 Rolling Hills View Estates Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: � (1) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) Expose the leaching area so that we can determine the distance between it and the well. If the leaching area is 100 feet from the well, the following will need to be completed: (a) Install a cleanout to the leaching area. (b) Adequacy test - if the adequacy test fails, an upgrade will be necessary. Prior to the upgrade a soils test will need to be obtained so that a permit for the upgrade can be issued. If the leaching area is less than 100 feet from the well, `the following will need to be completed: (a) A soils test will need to be performed. (b) Obtain a permit from this office so that the system can be upgraded. . (3) Expose the septic tank manhole to verify its existance. (4) If there is a septic tank, it needs to be pumped and verified for size. This will need to be verified by a registered engineer. •Frank/Pauline Brosh • May 20, 1981 Page Two (5) If there is not a septic tank, one will need to be installed. A permit needs to be issued prior to installing the tank. If there are any further questions, please call this office at 264•-4720. Sincerely, t Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska Bank of Com•nerce Post Office Box 1185 99577 Joyce Porte 8 Area Inc. Realtors Post Office Box 249 99577 Parcel I.D. Municipality of Anchorage Development Services Department ; Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF -ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 050-322-12 1. GENERAL INFORMATION COSA# 060Q,(6�5 Expiration Date: — 3— pro Complete legal description Lot 4, Block 4, Rolling Hills Yew Estates Location (site address) 18945 Upper McCrary Road Eagle River. AK 99577 Current Property owner(s) Allen G. Rohde Day phone 360-8597 Mailing address 13135 Old Glenn Highway #207 Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Thm (3) 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 ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 OnSIte Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-ske wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite Systems Approval Guidelines for this application, shows that the on-sfte water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage. AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE �� Approved for 3 bedrooms. Disapproved. Date 6/22/2006 �••�� v� ssssa• _5r .4 �.. 49th s_ Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other 13y: Original Certificate Date: G - .2- -3 - O m... r,MM Municipality of Anchorage Development Services Department On -SRO Building Nffiera Waste Program •,' •' Dmslon 4700 BrsgaW Sheet P.O. BOX 198650 Anchorage, AK 99519-WSO www.m mi.orymults (907) 943-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal oeaClptlpn: Lot 4. Block 4, Rolling HBa View Estates Parcel I17. 050.372-12 A. WELL DATA Wee type Private B A, 8, or C provide PWSID h _ Date completed :1975 Sanitary seal (YIN) Y TOW depth >230 it Cased to e!m fL FROM WELL LOG Date of test Static water i vel R Well production g.p.m. WATER SAMPLE RESULTS: Coliform j coloniesM00mL Nitrate /•S/ mg1L Arsenic: XLJO MO Dated sample: 6/1 1106 S. SEPTICIHOLDING TANK DATA Wee Log (Y" Now Wires mqmNy protected (Y" Y Casing height (above ground) —a--in- AT 0in.AT INSPECTION 6/17/06 21.0 R 2.5 g.p.m Other bacteria O colonies/100 mL Collected by. A.Harsla Tank TypelMaterfal Seo6dSteei Date MUded 7192 Tank stl:e I AW gal. Number of Compartments 2 Cleanouts (YRS Y Foundation cleanout (YIf4) Y Depression overtank (Y" N High water alarm (YIN) N Date of pumping 101,2 e 0 S' Pumper J ft Pumping C. ABSORPTION FIELDDATA Data iestellad 1981/1992 SW rating (g.p.dje of fi=Ibdnn) •45 GPDISF System type Deep Trench Length 116 fL Width 3 R Gravel below pipe 415 R Total depth 9 14 R ER. absorption area 984 fe Moollorfng tube Y Depreaslon over field N Dated adequacy test 6/18106 Results (PasslFae) Paan For 8 bedrooms Fluid depth in absorption field before test 0 in. Water added 1,018 gal New depth 0 tn. Elapsed Tine: 0 min. Final fluid depth --L—in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 3 type) N If yea, give date O. UFT STATION Date installed Size in gallons Manhole/Access (Y" 'Pump an' level at _ in. 'Pump or level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm 6 Bradt rmo*emerda? E. SEPARATION OISTAN¢ES SEPARATION DISTANCES FROM-WELL ON LOT TO: Septic tankAi t stadon an lot )1100' On adjacent lots >11W Absorption field an lot >100' On adjacent lets 97. Public sewer main N/A Public sewer manhole/deanout N/A Sewer /aepde service Ina >25' Holding tank N/A Animal containment areas Nam ManureAmilmal excrete storage areas None SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation >S Property Una W Absorption Aeld >1C Water main N/A Water service line )110 Surface water >100' Weds an adjacent lets )1100` SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10 Budding foundation >10' Water main WA Water Service line >10' Surface water >100' Day. peftVAAhtds storage 2' Curtain drain None Noted Wells an adjacent lets 97" F. COMMENTS: Wavier to 9T leaned Between Absorption Trench and Neighboring Well. First Absorption Trench Constructed In 1981. Second and Third Trendy Added In 1992. Wag FiyNnfraetrrred to Increase Production to Current Rate. .d►�pK G. ENGINEER'S CERTIFICATION I catty that I have determined through field inspections aril review of Munkdpel nxwds that the above systems are in coMormanae wAh MOA COSH guidelines io effect an tins date. Engineer's Printed Name Michael E. Anderson, P.E. Date 6/22/2008 COSA Fee S_ Date of Payment Receipt Number, (Rev. 7 Vas) J7 'A/ Waiver Fee S Date of Payment Receipt Number ,r'6/ ASBUILT-NO CORNER; THIS DATE K NI I HEREBY CERTIFY •THA I HAVE SURVEYED THE SCALEt I FOLLOWING DESCRIBED PROPERTY= Lot 4, 1" - 30' + OF At %P4 Block 4 Rolling " Hills View Estates Subd. DATE, • AND TF?AT NO ENCROACH ENTS EXIST EXCEPT AS g/21/92 �P• TH • •s9 INDICATED. IT IS THE ESPONSIBILITY OF THE i *D OWNER TO DETERMINE T E EXISTENCE OF i- ANY GRID- EASE RID -z OWNER � EASEMENTS, COVENANT , OR RESTRICTIONS EW254 / •. ,,t WHICH DO NOT APPEAR THE RECORDED SUBDI- o..". Merk Aw. d VISION PLAT. U=ND CIRCUMSTANCES ISHOULD FB: 1 �•. I.S-6919 ANY DATA HEREON BE US FOR CONSTRUCTION 31-42 �r��y •.., �• ' �+� OF FENCE LINES, OR FDA ESTABLISHING BOUND- DRAWN' 14`��ip/��� +.. ARY LINES. DMS ��►��� I A SCS ReLM 1062993001 Mot Name Anderson Engineering Project Name/M L4 Dik 4 Rolling Hills View E Client Sample ID From outdoor water spigot hfatria Drinking Water All Dalcarlimes are Alaska Standard Time Printed DaleMme 061202006 14:17 Collected Date/Time 06/112006 1631 Received Daterfime 06/12/2006 16:45 Technical Director Stephen C. F.de Sample Remarks: Allowable Prep Amlysis Paramctcr Results PQI. Units Mcdnd Container ID Limits Date Date but Metals by ICP/M3 Arsenic Waters Department Nltmtl N Microbiolca Laboratory Total Colirorm 1.51 0 5.00 ug/L EP200.8 0.100 mg/L EPA 353.2 C (<10) 06/13/06 06/16106 SCL D (<10) coU100ml. SM209222D A (<i) 06/12/06 ALR 06/12/06 TLF r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES V • j Division of Environmental Services _ On -Site Services Section P.O. Box 196650 Anchorage, Alaska 995196650 (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel l.D.# 050-322-12 HAA# 1. GENERAL INFORMATION Complete legal; description Log-ztl�n Ute address o . r direction . s) 18945 1 UPPFR " McCRARY ROAD EAGtF . RtVER. , AK 99577 Property owner REBECCA EDMOMDSON Day phone bas—ssse Mailing address c/o Ai ROMASZEAS 1 16600 G NTERFIELD DR EAGLE RIVER. AK 99577 Lending agency Day phone Mailing address Agent At ROMAS7EWSKI w/ REMAX OF E.R. Day phonea24-4200 Address'cenn'rcrrronnn DRIVE EAGLE RIVER AK 99577 Unless otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC Ing to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,100.00 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 Ins ction, the on-site water supply and/or wastewater disposal system is in compliance with all I niclp nd State codes, ordinances, and regulations in effect on the date of this inspection. n A Name of Firm Phone (907) 337-6179 Engineer's Signature Date 11/1 /4 in conducting this evaluation, AK%V, Inc at ted to provide a thorough, conscientious engineering aa�sls of the system in accordance with ADEC and M A S 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 Identifiable features. The operational life of all wells and septic systems depend on the local solls condition, ground water levels that may fluctuate during the year, and the water o0��04 usage of the family being served by the system. These conditions are outside the control of o0 the evaluator of the system. Satisfactory test results do not guarantee future performance o `� 0 F 9 C 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. f A. ess. 6. DHHS SIGNATURE X_ Approved for .3 bedrooms By: 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 #21 Computer Version Municipality of Anchorage RECEIVED DEPARTMENT OF HEALTH & HUMAN SERVIES Environmental Services Division FLP 1 2 2000 a825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 EN�nMUNICIPALITY OF ANCHORAGE Health Authority Approval Check sstRONMENTAL.RQWCES OMSION Legal Descriptiorf OLLING HILLS VIEW ESTATES; LOT 4, BLOCK 4Farcel I.D.: 050-322-12 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (YIN) NO Date completed PRIOR TO 1975 BEILILVED TO BE Total depth 232'+ Cased to CASED TD BEDROCK Casing height (above ground) 180+ Sanitary seal (YM) YES Wires properly protected (YM) *YES "WELL HEAD IS INSIDE A INSULATED BOX WHICH APPEARS TO BE WATER PROOF. THE WATER SERVICE E AND THE WIRING COMES OUT THE TOP OF THE WELL HEAD AND GOES DIRECTLY INTO FROM WELL LOG AT INSPECTIQ . Date of test Static water level Well production WATER SAMPLE Coliform Date of sample: " 9/7/2000 Collected by: A.W.W.C., INC. B. SEPTICIHOLDING TANK DATA Date installed 7/31/92 Tank size 1000 Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression (YIN) NO High water alarm (YIN) N/A Date of Pumping 9/31/2060 Pumper JR's PUMPING C. ABSORPTION FIELD DATA (1) — 1981 TRENCH 1 — 8/81 (2) — 1992 TRENCH Date Installed 2 — 76//1 1 92 Soil rating .p.d or it2/bdrn) 0.45 System type TRENCHES 1 28' 1 3' 1 5' Length 2 - 88' Width 2 - 3' Gravel thickness below pipe 2 - 4' To I depth 9' - 14' t —280 SO.FT. Effective absorption area (2)-704 So.FT. Monitoring Tube present (YIN) YES Depressi er Id (YIN) NO Date ofadequacy test 9/1/2000 Results(Pass/Fail) PASS For Bedrooms 1 -0" (l)-79.3 (1)-0 Fluid depth in absorption field before test (in.); 2 -0" immediately after (2)-359 gal. water added On.): -20 1)-0" (1)-0 Fluid depth (2)-14.5* Ons) Minutes later. f2%-195 Absorption rate = 450+ Peroxide treatment (past 12 months) (YIN) NONE KNOWN If yes, give date 72-m (Rev. "or computer Venloi D. LIFT STATION . , Data installed— Manhole/Access High water alarm level aY 'Pump aft' level aY *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septldholding tank on lot 100'+ On adjacent Iota 100'+ Absorption field an lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/deanout N/A Sewer/septic service One LIR station SEPARATION DISTANCES FROM SEP71C/HOLDING TANK ON LOT TO: Foundation 5'+ Property One 5'+ Absorption Aeid 5'+ Water malrdservice Ane 10'+ Surface waterldrainage 100'+ Wens on adjacent kris 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: 'WR980005 — DOUBLE CHECKED WITH TOTAL STATION Property One 10'+ Building foundation 10'+ Water main/service Ane 10'+ Surface water 100'+ Driveway, parldngfthiale storage area 10'+ Curtain drain NONE KNOWN Wells on adjacent lots '97' F. ENGINEER'S CERTIA I car* that I d ru lle/d Msped/ons and review ofMun/dpa/ s systems are M conformance with MOA ou 1 s on this date. Engineer's Name I rU JEFFREY A. HAA Feet .,51pn . U a Date of Payment �- i z Receipt Number h L,52)[ 72-M (Raw- Sar campuar vam, Waiver Fee $ Date of Payment Receipt Number e 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 l.D.# 0-4r,—'Q-12 HAA# IA1)gQt>L1014 1. GENERAL INFORMATION Complete legal description LLot4 • Btock 4; RotEi.ng H�Cd View E Location (site address or directions) 18945OUppen McC, any Property owner EvexeU Cta)ty Day phone 694-1802 Mailing address 1894JEUppeA SkWne. Dative Eagte R.ive4, Ah. 99577 Lending agency Mailing address Agent Caaot.ine Steano-Thom" 13135 Otd Gtenn H Address Day phone DON McKENZIE REAL EST��Fy phone ihwau #100 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water 694-9035 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site _ Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-0251Rw.1/91) Fm l MOA621 lU row %W9 46A A&U) SMZZ •>IJom s Jaau!6ua leuo!ssa;ad e4l u! suoiss!wo Jo sJoJJa Jol elq!suodsaJ IOU sl e6eJogouV ;o �4!jedio!unW eq1 panssl sl eleoil!1Jao a eJo;aq elep azAleue Jo suo!loadsui lonpuoo IOU op SHHO;osaaAoldw3 sluawannbaialelsput,leJapa;u!elJaoAlsilesoliapJou!suoilnl!lsu!6ulpualJ!aglpue sawoq;o sJase4oJnd of AselJnoo a se s!41 saop SHHO a41 •eNselV;o elels aq1 u! paJalsi6aJ Jaau!6ua leuoissa;ad luapuadepu! ue Aq anoge g gdw6eJed ul uaA!6 suo!ieluasaJdaJ eq1 uodn Aluo paseq saleo!;!3Ja0 leAoiddV Al!JoglnV g3leaH sanssl (SHH(l) saOlMas uewnH pue glleaH;o luawlJedaO e6eJo4ouV;o Al!ledio!unyy 941 NOI111VJ zp SL ale° :suo!lelnd!is 6u!mollo; egi 4l!m 'swooJpaq R' sluawwo0 leuoll!PPb Jo; lenoidde leuoll!puo0 •panoiddes!° •swooJpaq Jo; panoiddV 3unIVN°JIS SHHO T amleu6!s s Jaau!6u3 tZ566-849RIV, AIN a!6c.l ssaJPPV M'ON pecH dool JOAla e16e3 4£Ot:l auogd '� �- wJld;o eweN •uo!loadsui s141 ;o alep egl uo loalle ut suo!leln6aJ pue'saoueu!pJo 'sopoo ele;S pue ledlolunyy lle 4l!m eouelldwoo ul st walsAs lesodslp Jalemelsem Jo/pue Alddns Jalem ells-uo egi 'uo!loodsut pus uo!ie6!isanu! Aw woJ; pue sal!; e6eJogouV;o Al!!edlolunlry a4l woJ; pau!eigo uo!iewJo;ut e43 uo paseq legs A)!J9nJagvn;1 *Malay paleOlpui emlonJis;o adA; pus swocupaq;o Jagwnu egl Jo; elenbape pue leuol;oun;'a;es si walsAs lesodslp Jalemalsem JO/pue Alddns Jalsm el!s-uo egi le4i smogs uo!leo!ldde lenoJddV A4uo4inV U11eaH slgi 10 uo!le6!isanu1 Aw ie43 y!Jan l'molaq umogs elep uo!lep!!eA agi;o se pue olaJag pax!;;e leas Aw Aq pa!jgiao sy U33NION3 AS N01103dSNl d0 1N3W31V1S 'S Municipality of Anchorage AAL Department of Health & Human Services IN HEALTH A THORITY APPROVAL CHECKLIST 'L01�1�1vJG11 tilfj \/f,&VA Legal Description: fi!a 1 L t T 4 Parcel I.D. 020 Z A. WELL DATA Weft typ-P ��If A, B, or C, attach ADEC letter. ADEC water system number Log present (/N) t` I J� Date completed 6 Driller Total depth 23q 1 4- Cased to 4014- Casing height Sanitary sea (Y N) Wires properly protecte (Y N) Y WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: AT INSPECTION n -"1 4PFt• p 52 g.p.m. gM G 1 N N O in G) � m r t z Septic/holding tank on lot _lOf� ; On adjacent lots Absorption field on lot On adjacent lots Public sewer main tJ U .-1 C-,7 Public sewer manhole/cleanout 100'+ t�lor�l� r Sewer service tine 1 O t' Petroleum tank 00 r-1 , ILv�lo�r�l WATER SAMPLE RESULTS: Coliform Nitrate tJ-C7 C O. 10 /tether bacteria 0 Date of sample: �%Ih �q?� Collected byd by: B. SEPTIC/HOLDING TANK DATA Date installed -1I3t 10-2- Tank size -Compartments ?� Cleanout (Y N) Foundation cleanout (Y ) Depression (Ya _ High water alarm (Y& Alarm tested (YIN) IJ f&' Date of pumping 1•. L . Pumper yJ u, —f".P r-) IL SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot ID�r Onadjacentlots )���"r Foundation --812/ r Topropertyline Absorptionfield Water main/service line Surface water/drainage ' AM �•4- 72--026 )Rev. 7191) From CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N)' High water alarm level .,.Pump on" level at Meets MOA electrical codes SEPARATION Well on lot _ D. ABSORPTION FIELD DATA Manufacturer Manhole/Access LIFT STATION TO: On adjacent lots "Pump off' level at Cycles tested Surface water _ Date Installed R 131 �'►7 Soil rating o 4`� :'fySystem type 17425_0�'ry-.Jo_�4 Length Width Gravelthickness 1 A Total/depth 11 - Total 1 -Total absorption area Cleanouts presen (Y ) Depression over field (Y& Date of adequacy test �A Results (pass/fail) for E-2 bedrooms Peroxide treatment (pas) 12 months) (Y& '" If yes, give date )` JA' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 100 /On adjacent lots I 1-t- -Pro 40r r i To building foundation To existing or abandoned system on lot 1 tr On adjacent lots Cutbank—NIWatermain/service line 1h 4— !� Surface wa r Ib0 Driveway, parking/vehicle storage area d/ Curtain drain E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING p�(t-_ —. %.Q Signature 17034 Eagle River Loop Road No. 204so co •.•• •'•,r�i�) Eagle River, Alaska 99577 — Jr MM .% Engineer's Name Date r 8' Z HAA Fee $ /7/) , eD Date of Payment -- 5r— t• Z — 9 Z Receipt Number —O•,3 94Z ra64 .:Q 72-029 (R«. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number ROGER No. WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. 11,427-0424- During A9z049¢ During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot 4 Block #_ of Ryal&b N/«1 VIE w Subdivision, the well's productivity was determined to be •68 gallons per minute. The minimum well productivity required by this department (AMC 15.55) for a __?_ bedroom residence is _.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of noncritical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. Lo T �IG F—o L %.t < y Lc.S Y 4 of CST. S- 9 Z— �.! `l : 53 ` 1J: p� I�tS� 13'l� 10•� __ VS *7 y'S 7 — ^-r i g*- P,JrAO-- _ -- --- ----�— — Z'-0 "' -- — � _17.77 I tNFERING 17034 Eagle River Loop Road No. 204 a aRiver,-Alaska-0SST7 • 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 Parcel I.D. N HAA ff 0 Pigr-'Lt Inn 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3; Block 4; Ro Location (address or directions) 19221 Upper Mc Cnaay HiU-6 View Estates Subdivision (b) Property owner Steve Lingle Telephone: (home)688-0622 Business Mailing Address HC 90 Box 5086 Chugiak. AtaAka 99567 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here ❑x)f hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eapi Rive= llap Re rLNo- JQ4 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family CYX 3. WATER SUPPLY Number of bedrooms-3— Individual Well Otx 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-site QtX 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. 72-025 lw". r/em Page 1 of 2 Z 10 Z 86ed Note teen •Mu) SMEL *XjoM s jaaul6ua leuo!ssajad ayj ul suo!sslwo jo sjaja jol alq!suodsa lou si 96ejoyouy jo Aj!led!a!unw a41 •panssl sl ales!plin a aojaq elep ezAleue io suopoadsul lonpuoo lou op SHHO jo saakoldw3 •sluawannbaj aiels PUB Imp; Malin Als!ies oliapio ul suo!inl!isu! 6ulpual j!ayl pue sawoy jo siase4and of Asaunoo a se slyl saop SHHO 941 •vXsely jo alelS 041 u! Pajalsl6aj iaauifte leuolssajad luapuadapul ue Aq 9Aoge 94dei5eied ul uaA16 suopuluasaidai 94l uodn Aluo paseq paleoljua0 lenaddyAl!joglny ylleaH sanss! (SHHO) saolAIaS uewnH pue ylleaH jo luawliedao 96eioyouy jo Appololunw a41 Nounvo .T/bw wnwTxPw Vd3 •T/bw S•S ST uotgeaquaouoo panuiquoo s,TTaM aqq eansui oq pewao3aod aq pagsobbns sT qI sapo0'TPdi0zunw puP ajPgS butgsixa sgaaw dgaadoad sitjq ..y 0 -OT si u0t4Pa4ua0u03 ag Pa:Ipy . *AgTTTQP'gTns bui4s94 oipoiaad gPgq •quasaad sagPagtu ale a03 TTaM aqj- :agoN lenaddy leuo!l!Puoo jo swia1 leu011!Pu0O panwddes!o Panaddy eleo�,(gswoapaqJojpanaddy 'IVAOHddy SHHO '9 Jq oleo i aE66�isely'�a�ib ai e3 "VON peolj dool aaeja o16e3 i'£0L1 ssaiPPV 9Nim;1MIOW S 7 S euoydalal wjlj jo eweN •uolloadsul slyl jo slap eql uo loalja u! suopeln6ai pue'saoueulpio'sapoo elelS PUB,ledlo!uninl ile 4l!M eoueildwoo ul S1 Ovals; s lesods!p jaleMalseM jo/pue Alddns jaim 9l!s-uo eyj 'uo!joadsui pue u0!ie611sanul Aw waj PUB, sal!j e6ejoyouy jo Al!led!o!unlnl sqj waj pau!elgo uo!lewjojul ey1 uo paseq leyl /4!JaA ia4lin} 1 •ulaay paleolpul einloniis jo adAl Pue swoapaq 10 jagwnu eyl joj ejenbape pue leuollounj 'ales sl waists Iesods!p jaieMalseM jo/pue Alddns jalm aps-uo a41 le4l smogs lenaddy Al!joylnV ylleaH 514110 u0pe61jsanui Aw leyj AjuaA I'Molaq uM04s alep uo!leP!IeA 84110 se pue olaia4 paxljle leas Aw Aq pailgiao sy N011VWH0dN1 ONV V1V0'HOHV3S 3-1lq'S1S31'SN01103dSNl JNIOIA02ld WHIj ONIH33NION3 'S oa4d "x MUNICIPALITY OF ANCHORAGE (MOA) P`'aso� Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 ao�'o 2c1 Q Legal Description: Lo-( 3aInc-!c A. WELL Well Classification 'Si 1 f lP FA M; 1ti If A. B. C. D.E.C. Approved (Y/N) -LIlfl— Well Log Present (Y/N) __J1_ Date Completed Yield Total Depth_E3��Cased to .65 ' Depth of Grouting Static Water Level i 6 � 3 � 1 Pump Set At U �� Casing Height Above Ground 3 O„ Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) 4 Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Ino' 4 ; On Adjoining Lots 100 To Nearest Edge of Absorption Field on Lot 1 Oo } ; On Adjoining Lots 100,4 To Nearest Public Sewer Line �J JA To Nearest Public Sewer Cleanout/Manhole 4A To Nearest Sewer Service Line on Lot z S - f Water Sample Collected by _-� 4�S E n/a r iJ ecd I N 4 ; Date I V -1 E) �! Q Water Sample Test Results SA !' S'_A C_f0 ru — 66a t' ,C j A 4- Comments B. SEPTIC/HOLDING TANK DATA Date Installed (A-1- i3S' Size f 009No. of Compartments Standpipes (Y/N) u _Air -tight Caps (Y/N) 4_Foundation Cleanout (Y/N)— Depression over Tank (Y/N) x) Date Last Pumped f O' 2 6 - 9'D Pumping/Maintenance Contact on File (Y/N) 1,3Irk ; for ��✓� Holding Tank High -Water Alarm (Y/N) _Temporary Holding Tank Permit (Y/N)1� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: r To Water -Supply Well To Building Foundation 3 To Property Line ! + To Disposal Field 13 To Water Main/Service Line l n f To Stream, Pond, Lake or Major Drainage Course A.) / Yj Comments 'SeofL POAAPe i 104 �I�s C'�SS 10001 %vnAdrN� 72-M (R.. 7/88) RMI Page 1 of 2 c. Ansvnr I1UN rltLu DATA Soils Rating in Absorption StrataL00 0 Type of System Design Date Installed (p - I - 5 Length of Field 3 `� Width of FieldO '� Depth of Field Gravel Bed Thickness Sy Square Feet of Absortion Area 0 6 Statndpipes Present (Y/N) y ' Depression over Field (Y/N) Date of Last Adequacy Test ( O - / A - I D Results of Last Adequacy Test aTr-1,7Ac.7orj --Z, 6&_,dy'noM SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well I Ob . f To Property Line LO f To Building Foundation f3 To Existing or Abandoned System on Lot N16 ; On Adjoining Lots r To Water Main/Service Lino Cutback (if present) u !4 To Stream, Pond, Lake, or Major Drainage Course N/A To Driveway, Parking Area, or Vehicle Storage Area !.;-o Comments D. LIFT STATION Date Installed' Size in Gallons.' "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) - Pumping 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 Inspection. Signed a d 5 ENGINEERING age (veroopRoad No, 2()4Company Cagl„Rtvnr ela.4.995n Date MOA No. - e Receipt No. OS 2-2308 ..L,3{ 7 ) Date of Payment o� Amount: $ Z 76 Receipt No. - Waiver Fee: $ Date of Payment 72-076 (Rw. 7/66( Back Page 2 of 2 (ifecY•b-jq)p(er;l td' this 6j i �T •�9 ,.• .waaa....i..a sti.f. `e`, Ift �. "�. rMUNICIPALITY OF ANCHORAGE n DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) �� f / y moi'.-•CZ-:��,(L:�� �/�r Location (address or directions) (b) Applicant Name p� t1 Telephone: Home Business 74" _Kra 3 Applicant Address Jul S ? CLQ • r! frG�' 7 (c) Applicant is (check one): Lending Institution ❑ ;$wnerlbuilder0 ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address following address: -oz-9 7 2. TYPE OF RESIDENCE Single -Family T Multi -Family 13 Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well ;d Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite X Public ❑ Community ❑ Holding Tank ❑ Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72025 (11,84) Page 1 of 2 n n 5. ENGINEERING FIRM PROVIDING ..4SPECTIONS, TESTS, FILE SEARCH, OAT.. AND INFORMATION 1 As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this Inspection. Name of Firm Address _ Date Telephone IN �• _. t ,~��/�}yam rig. 14314 S�'!,^A ••�4 M�N••,'H 4b, •�, F+n '� 'r, 6. DHEP APPROV �j Approved for be by 0ate Approved Disapproved Conditions Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent prdfessional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Page 2 of 2 22.025 (11,04) ..-Rrw.�w+,.I,FFFR V R4•.00RSVG - OM 41F riK#4 a n MWOM4411110K LDRCMH MUNICIPALITY OF ANCHORAGE (MOA) rg0V O 5 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST -FEBRUARY 1984 RECEIVED 264-4720 Legal Description: t� �' a`'K • y A. WELL DATA Well Classification S &�It A, B, C, D.E.C. Approved (Y/N) Well Log Present ON) Date Completed to - 114 -BtS Yield Total Depth Cased to r Depth of Grouting Static Water Level la+�r Pump Set At V •� M Casing Height Above Ground Esc Sanitary Seal on CasingOP/N) Electrical Wiring in ConduitC%N) Separation Distances from Well Depression Around Wellhead (Y p To Septic/Haldlhg Tank on Lot ).=;L_-� I-V ; On Adjoining Lots r To Nearest Edge of Absorption Field o Lot t Gwc> 14, ; On Adjoining Lots To Nearest Public Sewer Line a To Nearest Public Sewer Cleanout/Manhole a To Nearest Sewer Service Line on Lot 25 f+ Water Sample Collected by S �JG Imo" �� ; Date 1 3 0 - 'O5 Water Sample Test Results SAT«--� r Comments B. SEPTIC/+K)L 1G TANK DATA Date Installed tv' 1 - 65 Size 1 (.00 No. of Compartments Z Standpipes ON) Air -tight CapsdVN) Foundation Cleanout (VN) Depression over Tank (Y.11q Date Last Pumped rzlcc_ � Pumping/Maintenance Contract on File (Y/N) N /& ; for N►J Holding Tank High -Water Alarm (Y/N) /x Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/NeldengTank: To Water -Supply Well 1 cs)c7 f + To Property Line I It To Water Main/Service Qne7 t r 4 Course Comments Page 1 of 2 72-026111,811 To Building Foundation r To Disposal Field 8 To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata t Type of System Design 'r12a�C to Date Installed - to \ — 100 Length of Field '3'"* Width of Field 4'o'^ Depth of Field -- t3 N Gravel Bed Thickness 5� Square Feet of Absorption Area s Standpipes PresentfQN) Depression over Field (Y(p Date Last Adequacy Test i V .J Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well t. oo 14 - To Building Foundatiop Lot r� A To Water Main/Service Line L e I k To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed 1 ' To Property Line 10 A To Existing or Abandoned System on On Adjoining Lots 30 1, A Tq Cutbank (if present) ay OEM a Dimensions Size in Gallons,Whole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at 9LVent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments Check Permitted Bedroom Rating Against HAA Request •' I certify that I have checked, verified, or conformed to all MOA anSHAA guidelines in effect on the date of this inspection Signed 6 A F EVG44 Date Company„k i r— SRC I=« MOA No.S OF Receipt No. AH, t�4 "fie, r��E Date of Payment ���S�FSS °P^ Amount: $ 10 Hw6on �. Shof�. % ' rtJ. 1457 i11t Page 2 of 2 •4< •^.....-�'.�`; ' 72-026 J 11, Bad