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Home My WebLink AboutSILVER CREST BLK 2 LT 5Silver Crest Block 2 Lot 5 #015-062-36 Onsite File Silver Crest Block 2 LotS #015 - 062 - 36 During tank replacement (05P181 114) , it was determined that drainfield is < 10 ft from foundation . Address at time of COSH (waiver or field replacement) . 3UBM!TTA[ Municipality of Anchorage AUG 13 2018 Page 1 of 3 • Community Development Department On-Site Water&Wastewater Program 4700 Elmore St. •P.O. Box 196650 Anchorage,AK 99519-6650 ttttp://www.muni.org/onsite (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number. OSP181114 PIO Number: 015-062-36 ❑ New IN Upgrade Name: JESSE WHITE ABSORPTION FIELD Address: 0 Deep Trench 0 Shallow Trench 0 Bed 0 Mound 6905 LOVITT CIRCE*ANCHORAGE,AK 99507 0 Other Soil Rating. Total Depth from original grade: Phone: No.of Bedrooms: (907) 617-1579 3GPO/Sq.Ft Ft Depth to pipe invert from original grade: Gravel depth beneath pipe: LEGAL DESCRIPTION Ft. Ft. Subdivision: Block: Lot: Fill added above original grade: Grave gth. SILVER CREST 2 5 ��CA\NG Ft I ownshlp: Range: Section: - Gravel width Beds Number of lines. Distance between lines: Ft. Ft SEPARATION DISTANCESTotal absorption.• Number of trenches: Dist.between benches. To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines So.Ft. Ft Well 100'+ - - 25+ TANK • Septic 0 S.T.E.P. ❑Holding 0 Other Manufacturer Capacity- _CO apacity _ Surface Water 100'+ ` - ANCHORAGE TANK 1000 Gal. Ar Material Number of compartments'. Lot Line 5+ ``y - - N/A STEEL 2 Foundation 10'+ - - LIFT STATION Manufacturer Curtain Drain _ NONE KNOWN Gal "Pump on level at: "Pump off level al'. High water alarm al: Remarks: *OLD SEPTIC TANK DECOMMISSIONED PER UPC PER CONTRACTOR Pump Make 8 Model' Electrical Inspections performed by: PIPE MATERIAL House to tank EXISTING/D3034 Tank to drainfield EXISTING/D3034 Installer A+ HOME SERVICES, LLC. Drainfield EXISTING CO/MT EXISTING/D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft. Inspection Location and DescnptIon: Dates: 1st 7/12/2018 2nd - 3rd - 4th BOTTOM OF FRONT DOOR THRESHOLD ENGINEER'S SEAL Community Development Department Approval � 000��4. 0 OF q pp Conditional approval: Date: (11 ' .. 0 , Li_.!TH lig 7�0 vA VA J- • e •A.••Garness. 0 QOm 1E- 95 - 00 Z 0044 ts• 0Ilo t'gt�op0 A roved: 12)-LeM CA,VX Date: 8/1 `�/1 LICENSE4o0OrOf888�O�. pp #AECC884 0��00 Inspection Report_1-1-12.doc iPERMIT NUMBER: PARCEL ID NUMBER: 1 OSP181114 RECORD DRAWING -, 015-062-36 I / / \ ABBOTT ROAD,/ / \ // 10'Tel&Elec Util Esmt I \ .--- i\ \ 1 / I \ ,/ 1 \ 111 I 100'WELL RADIUS a 11 I 1 II A B C I 1 I I ST1 19.1 20.1 39.1 i I 700•� I ST2 25.0 22.1 39.2 1 Fc( I I DBL1 27.8 22.2 39.0 \ 0/06, I/ DBL2 28.2 22.4 54.5 \ 700. I MT 30.5 24.9 I IV MT I /1 I Rqo06, I / 1 \\ / / I / \ / \ \ // \\ \\ / // \ \` / / \ / i \\ �\\ / i / �/' \\ DETERMINED BY A+HOME SERVICES TO BE i CLEANOUT AT END OF TRENCH;DRAINFIELD \\ APPEARS TO ENCROACH ON THE FOUNDATION AND — A WAIVER WILL NEED TO BE GRANTED PRIOR TO EXISTING 3 COSA APPROVAL BY MOA HOUSE i NEW 1000 GALLON _�� STEEL SEPTIC TANK j: ST1 /�� I NEW HOME INSTALLED BY A+ SERVICES DBLt APPROXIMAT: LOCATION OF EXISTING DRAINFIELD;PER DBL2 M..•• i• CONVERSATION.WITH A+HOME SERVICES,THE DRAINFIELD EXTENDS TO THE NORTH CLEANOUT AND THEREFORE a•} '4. ENCHRO•CHES ON THE EXISTING FOUNDATION APPROXIMATE DRIVEWAY • •` (LOCATION,DRAWN FROM 1978 ' ".• SURVEY IN MOA RECORDS � ,i LOVITT CIRCLE ��/-'' __------ ------------------- --------- / / / SCALE: / 1"=40' ♦IMAMS\ 9 r' Ltd • ''� GARNESS ENGINEERING GROUP, ; liiiMitigallinak FNGINFFRING SALFS CONSULTING `I / IIP • ' ` • 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE,AK 99507'PHONE(907)337-6179'FAX 1907)339-3246•WEBSITE.wmv genessengoeenng • com • • PREPARED FOR: I PHONE NUMBER: PAGE NUMBER: I' ♦ ... � . a 'Y '• arne JESSE WHITE 907-617-1579 2 OF 3 •j�'iJ;: CE-7953 ° � LEGAL DESCRIPTION: DRAWN BY: •.• ••• •6 p 4bc*'� BLOCK 2, LOT 5 D.J.G. 1n Q '•"�'•'••'�•P .4,-- SILVER CREST; w, �'ROFESS\W4 4 TYPE OF WORK: DATE: LICENSE It SEPTIC TANK RECORD DRAWING 8/10/2018 #AECC884 ��* C PERMIT NUMBER: PARCEL ID NUMBER: OSP181114 RECORD DRAWING 015-062-36 • FINAL GRADE=101.45-101.48 TOP OF TANK 1 g2 TOP OF TANK AT INLET=95.33 AT OUTLET=95.29 -1!=:-----: INVERT OF BUNG NEW 1000 GALLON AT INLET=94.69 SEPTIC TANK INVERT OF BUNG AT OUTLET=94.46 V 11 ' 4:PSE, . " ♦. ♦♦♦♦ Alf 4" 4• I. i� •''�♦♦• GARNESS ENGINEERING GROUP, Ltd i : IVO • ENGINEFRING.SALFS O CONSULTING "AP-aE x;.c s --- - 0• 0 3701 E.TUDOR ROAD.SLATE 101•ANCHORAGE.Al)99507•PHONE(907)337 6179•FAX 1907)336J20.TOEBSITE.www.9amnsongn<em9 com '••• • •• ' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •crt:• - -y A. s JESSE WHITE 907-617-1579 3 OF 3 ♦j J,: CE 795 Q � LEGAL DESCRIPTION: DRAWN BY. ♦0 •••.... I(011:.60 -4. SILVER CREST; BLOCK 2, LOT 5 D.J.G. ♦♦♦�0 ... ..". • ,N, �• TYPE OF WORK: DATE: LICENSE tI1PII ;;,.��• SEPTIC SYSTEM PROFILE 8/9/2018 #AECC884 ��t„,. '"a� MUNICIPALITY OF ANCHORAGE ent On-Site Water&Wastewater Program �o rn SP '� '� PO Box 196650 4700 Elmore Road 4 �, Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 °v n X45 �'s httpa/www.muni.org/onsite44'( co -___� Department On-Site Wastewater Disposal System Permit Permit Number: OSP181114 Effective Date: 5/31/2018 Work Type: SepticTank Upgrade Expiration Date: 5/31/2019 Tax Code Number: 01506236000 Site Legal Address: SILVER CREST BLK 2 LT 5 G:2439 Site Mailing Address: 6905 LOVITT CIR, Anchorage Owner: WHITE JESSE W & Lot Size in Sq Ft: 45708 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing oh 6 Received By: -�'��` Date: Issued By: ^``e,Cy, Date: 5/31/(6 Svc)6 1 8 9 70 77 J A; MUNICIPALITY OF ANCHORAMAY 30 2018 3 1-4 i Community Development Department Phone: 907-' 39C) Development Services Fax: 907- 343-79• On-Site Water & Wastewater Program Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 015-062-36 Property owner(s) JESSE WHITE Day phone 907-617-1579 Mailing address 6905 LOVITT CIRCLE*ANCHORAGE.AK 99507 Site address 6905 LOVITT CIRCLE *ANCHORAGE,AK 99507 Legal description (Sub'd, Block& Lot) SILVER CREST; BLOCK 2, LOT 5 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial Lf Single Family(SF) Absorption Field [ I (w/wo ADU) Septic Tank ® Upgrade Duplex (D) [ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy [ I (SF and/or D) Private Well I I Water Storage I 1 THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 915 Waiver Fees: Date of Payment: 5731114 Date of Payment: Receipt Number: a a/'116) Receipt Number: Permit No. O3 Pi' Waiver No. (Rev.01/11) Air t- , Quanics GARNESS ENGINEERING GROUPLtd 7.•c�[ment Sy tcr> ENGINEERING SALES CONSULTING +�=- Dea�er May 25, 2018 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Silver Crest; Block 2, Lot 5 To whom it may concern: The existing 3-bedroom house is served by a private well and septic system. The existing steel septic tank (installed in 1977) is in a state of failure and needs to be upgraded. We are proposing to decommission the existing tank and replace it with a new 1,000-gallon steel tank. The contractor is to have all pertinent well radii and easements flagged prior to construction and are to maintain a 10'+ separation to all building foundations and/or deck piles. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. i erely, / - -r- A . carne '.E., M.S. Presse 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com \� /� / \ ABBOTT ROAD \\ \\ i 10' Tel & Elec Util Esmt i `\ % / %/ I `\ Il \ 100'WELL RADIUS 11 I I 1 700, I I I 11.F// i/Il 1 700 I i` \\\ �F<<quo I / 1 \ KGs / / \\ `\ / \ \ / / \ \ / / ‘ \ / \ / NOTE:THE CONTRACTOR SHALL HAVE THE \\ / 100'WELL RADIUS FLAGGED BY A \` � REGISTERED LAND SURVEYOR PRIOR TO \\ CONFIRM FUNCTIONALITY OF EXISTING / CONSTRUCTION. \ FCO;IF NON-FUNCTIONAL REPLACE / \ � - .� \ EXISTING SEPTIC TANK TO BE DECOMMISSIONED —�— \ BY FILLING WITH CONCRETE ---- GEG,Ltd.HAS A8 PAGE SPECIFICATION \ EXISTG .I�/ LETTER THAT PERTAINS TO THIS DESIGN.TO / HOUS IN• REMOVE EXISTING POST OBTAIN A COPY OF THE LETTER CONTACT TANK CLEANOUT ..-- GEG.BY PROCEEDING FORWARD WITH THIS 10'+ — " INSTALLATION,THE ENGINEER,WELL DRILLER, — CONTRACTOR AND PROPERTY OWNER AGREE / THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE tCOVERED PORCH TERMS AND CONDITIONS OUTLINED. INSTALL NEW C/O AND MT AT NORTH END OF TRENCH PROPOSED 1000 GALLON STEEL SEPTIC TANK; INSTALL DOUBLE CLEANOUTS AFTER TANK APPROXIMATE LOCATION OF TANK BASED UPON MOA RECORDS AND CLEANOUT LOCATION ASSUMED LOCATION OF TRENCH PER SUMP LOCATION AND MOA RECORDS LOVITT CIRCLE , )/ S ALE: / / ,,,,1 ♦ ♦. i •• GARNESS ENGINEERING GROU ' *�1 *..- P, Lt ; i .... CIVIL&ENVIRONMENTAL ENGINEERS -.:_ 0 • 3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE.AK 99507'PHONE(907)337-6179'FAX(907)338-3246'WEBSITE'www.9amessengmeenng.com • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 mess icy/ JESSE WHITE 907-617-1579 2 OF 2 ��iJ,' v.= PROJECT/LEGAL DESCRIPTION: DRAWN BY: v SILVER CREST; BLOCK 2, LOT 5 D.J.G. ��''+�2 �•�. �-� TYPE OF WORK: DATE: LICENSE , �1 4• SEPTIC TANK DESIGN UPGRADE 5/25/2018 #AECC884 , �� `lUNICIPALITY OF ANCHORAGE Pt�y�y Ilea, ..i and Environmental Protec 'on Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 Q INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM _ NAME „Q�in1�N_D—tl(lrl'1 L4TQ A±_ MAILING ADDRESS _�4o� J0.l1Q ITE -Q- PHONE 34'4--74$6 LOCATION 1Q.V \1T Qkk CLE LEGAL DESCRIPTION 5 `' ?` S1WEQ �RCST Sy6 OW. SEPTIC TANK: DISTANCE Prop' (\ NUMBER OF FROM WCLL -�aClI /� MANUFACTURER-lj_1Y`E Qr MATERIAL _ -.�y_. COIAPARTMENTS INSIDE LENGTH oh INSIDE WIDTFI-/IA_ LIQUID DEPTH NjL7_ LIQUID CAPACITY GALLONS. TILE DRAIN FIELD: ,p % C % TOTAL LENGTH DISTANCE r ROM WELL _ FOUNDATION_1S2__NEIAnREST LOT UNE -L-5. OF LINE 3A- # of Lines V)CME- DISTANCE BETWEEN LINES 11t�TRE�N, 1CHI FWIDTHIsz_ IN. TOTAL EFFECTIVE ABSORPT ION AREA SQ. FT. LENGTH OF EACH LINE � DEPTH Of FILTER UC P111: TUP Of TILE TO FINISH GRACEa- MATERIAL BENEATH TILE -B4- IN. ABOVE TILE IN. SEEPAGE PIT: DIAMETER _OR WIDTH_, LENGTH_, DEPTH Log Crib _Rings_ Crib Size: DIAKILTER_DEPTIi_DISTANCE FROM: WELL TOTAL EFFECTIVE UUILDING FOUNDAI ION_, NEAREST LOT LINE APSORPTION AREA (WALL AREA) SQ, FT. Q�oP. \u0. ----------- -- ------------- nll ;ass: Depth: :11 Distance To: Lot Line _ Ldg: Sewer Line: Zpe Materials: of Bedrooms: 3 Istaller: HAMILTLRJ t1S- :marks: \oo I II I tt- ! i 411 ✓ LfnnC 44- T, f -1_ _ i - DnTE ea �.1i nrrRov[D�Q� ��1Lel 1.11 i rti1 T - T F7- T T k.,• rJ F F=1 rJ l-- I-1 ca v-9 Li F Sc -c-- a'•Ln n-" DEPARTMENT Oc _ HEALTH AND ENVIRONMENTAL I jTE;CTION11 =26')1 825 'L' STREET, ANCHORAGE, RK. 99501. /('tvu2 20"4-4720 WF_.I_L Hh11f'�' t_trJ—F~ I TE F=L-A Ef? F„EFS't•1 I T lot 0;),N PERMIT NO. C' x71023 APPLICANT ',PAYMOND HAFIIL.SOFJ 9400 JUPITER 344+7485 LrlrATION LOVITT. CIRCLE LEGAL L5 B2 SILVER,CREST SUBDIVISION LOT SI7F 45708 SQUARE FEET TYPE OF SOIL. ABSORDTION SYSTEM IS:, TRENCH.. c� \ t MAXIFIUM NUMBER OF BEDROOMS = 4 SOIL RATING CSO FT/BR)= 100 I THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: GF=PTF-1= �.4a 1_Eh-.IGTH= E'er+ UF�F��,{f=L GF=F'TH= r �• `;� , THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DP,AINFIELD. THF DEPTH OF A TRENCH OR PIT 75 THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). r:EG!IJ I Ft:[=fes CPT I 9-- - I ZZE= 125a=� r� �1LLC�tJ F•F=iI1FC1=tGF_ P'Lt=irJT OF'T I C1rJ A PACKAGE PLANT MAY BE INSTALLED AT THE PERFIITTEE'S OPTION SUBJECT TO THE FOLLOWI14G CONDITIONS: 1. EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2. A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION. ---------------------------------------'- --- TWrJ i 2 7 I t+ISF'Et T I Or11 F7=1r�F-_ F�'F IJ I r_Z 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 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=•EF=t t'1 I T EXP I F:: FEE S~ FJECEt•1CF=1<' n�:1r 1'-=A'r ? I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS ODELED 7NCLUDE MORE THAN4 BEDROOMS.SIGNED : - '<� ee-ZZ�7sz-'r=-- -------------- APPLICANT RAYMOND HAMILTON ISSUED 8✓.__S_`--DATE-L_�_a�__� V3. 0 L'prjT�, 11frctb�� w;ttz-w 3l� j Cad'Lcel - . . ` 3.Q DOM ti Fr +gip '70 0 �{ CICO � 7-77 iiit 1 1 i�t It 1 "„, — PCRE7ic k lv" --0 u C-17_' C l PC. l tS . (7M -W DRILLING, INC. (7' V -1-T. c- 4) C:.i'� '°r n:.F �Tcr:�: DRILLING LOG 1. �. / 111- t / {� Rap liamilton L6c I. Well Owner Use of Welt •-j Location (address of: Township, Range, Section, if known; or distance main road Lot_5 Block 2 Silvercrest Subdivisionl Anchorar-e Size of casing nepth of Hole 121 feet Cased to 120.9 feet Static water level 35 ft. (bbove) (below) land surface. Finish of well (check one) open end ( Xx ); Screen ( ); Perforated ( ). Describe screen or perforation NIA Well pumping test at 20 gallons per (hour)' (minute) for -1 --hours with 1007_ zxt, of drawdown from static level. Date of completion 12/8/77 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO 2 2—To 3 3 rn 13 18 TO 39 _L9—TO—E—) 60 TO G5 tis TO 75 75 TO a5 ;-5m--a-n- Tp90-2ZTO -22—TO-2-1,9- 1.1R118TOIL 118 O_1Z1_ TO TO Casinfi ctickup Orttanics Loose r.rave'_ Sandv gravel Siltv r.ravel Wet sandy f-rauel Siltv travel: clavev Silty aravP). iGu'.'i<nh� �:ric fill 1c �/'�• 2 — STATE 61 8 9 10 77 •f Municipality of Anchora ,.; FEB 1 2, 2018 On-Site Water and Wastewater Program /La (907) 343-7904 CulliETY a 6 8 L Certificate of On-Site Systems Approval Parcel I.D. 015-062-36 Expiration Date: J —1 1. GENERAL INFORMATION: Complete legal description Silver Crest; Block 2, Lot 5 Location (site address) 6905 Lovitt Circle*Anchorage,AK 99507 Current Property owner(s) LeeAnn Taylor Day phone 223-6673 Mailing address Real Estate Agent Mary Cox Day phone 440-9820 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage 0 Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer 0 WaiverNariance request for: Distance: Received by: Date: 141191/A COSA to be release. to the engi - r,unless otherwise requested by the engineer. COSA Fee $ JD Waiver Fee $ Date of Payment aZ.1l/S Date of Payment Receipt Number 3 SU (Ci 6) Receipt Number COSA# O C,1 qI0 q?` Waiver# • 5. STATEMENT•OF-INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 1 /?aa/i t In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system o��\�0 in accordance with the guidelines and regulations established by the Municipality of Anchorage and o / �1 industry practices. The reported results describe the condition of the system/s on the date/s of the '• . OF �< .. evaluation. Separation distances were measured to readily identifiable features. Hidden defects or �� •.�O encroachments may exist that were not identified during the evaluation. The operational life of all wells /.,y • 9 / /\ %%7*V0 and septic systems depend upon a variety of variables, including but not limited to, soil conditions, g groundwater levels (that may fluctuate during the year), quality of construction (materials and fDA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and Q... . / .. are outside the control of GEG. Satisfactory test results do not guarantee future performance of the / system/s;therefore, GEG makes no warranty(express or implied) regarding the future performance of QOM ;J:f :; A. Hess• the well or septic system. GEG makes no representation whether an alternative well or septic system O,is • CE .7, i3t1 ,;O� can be installed on the property in the event either of the current systems fail to perform adequately in O fe �I �f /. �oo� the future. The content of this report is for the sole benefit of the person/party that retained GEG to �Ii4Po'p' 6 'o perform the evaluation. Reliance upon the information provided in this report by any other person or 0 r° 0 pQ party (including subsequent property purchasers) is not authorized, nor will it confer any legal right \\,., �� o 0 whatsoever. OF#A o84 6. DSD SIGNATURE <2*' 1�-� System #1 Approved for---3bedrooms j ON-S)TE System #2 Approved for bedrooms WATER AND Disapproved =o WAS o' -',12..„ pROGRAM . Conditional approval for r bedrooms, with the following sti ul ��O 1. c e t c_��.I t SW /ears �NTSE \ tituke-uiQ .e,fr et a c -c1c,---h ;s z0 ,L, eu> _ _ ,A,, / � By: Original Certificate Date: 2-- l6^l) The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: Z____. COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Silver Crest; Block 2, Lot 5 Parcel ID: 015-062-36 A. WELL DATA Log A Well type Private If A, B, or C provide PWSID# N/A (YIN) Yes Date completed 12/8/1977 Sanitary seal (YIN) Yes Wires properly protected (Y/N) Yes Total depth 121 ft. Cased to 120.9 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 12/8/1977 11/28/2017 Static water level 35 ft. 56.4 ft. Well production 20 g.p.m. 4.5+ g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 ml. Nitrate ND mg./L. Collected by: GEO. Ltd. Arsenic: ND ug./L. Date of sample: 11/21/2017 & 11/28/2017 B. SEPTIC/HOLDING TANK DATA *40+ year old steel septic tank is at the end of its useful life. Tank Type/Material Septic/Steel Date installed *12/1/1977 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Yes Foundation cleanout(YIN) Depression De ression over tank(YIN) No High water alarm (Y/N) N/A Date of pumping 1/30/18 Pumper A+ Home Services C. ABSORPTION FIELD DATA *Below Existing Grade 0 Sumpl Date installed 12/1/1977 Soil rating (g.p. d./ft2o ft2/bdr ) 100 System type Deep Trench Length 34 ft. Width 3 ft. Gravel below pipe **7 ft. 476 ft Yes Depression over field No Total depth *9.4+ ft. Eff. absorption area 2 Monitoring tube**Yes Date of adequacy test 11/28/2017 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 746 gal. New depth ***9 in. Elapsed Time: ****0 min. Final fluid depth ***9 in. Absorption rate>= 450+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) None Known If yes, give date — **Sump only extends approximatley 3.58 feet below invert of lateral. ***2.83 feet below invert of lateral. ****The first 102 gallons introduced caused a rise of 9 inches in the sump. The liquid depth did not rise throughout the rest of the test. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off'level at '4, wa er alarm level at in. e- " Cycles tested Meets alarm &circuit requirements? 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 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation *5' Property line 5'+ Absorption field 5' Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 1C+ Surface water 100'+ Driveway, parking/vehicle storage **0' Curtain drain None Known Wells on adjacent lots 100'+ F. COMMENTS *Assumed based upon field location of post—tank cleanout and 12/1/77 inspection report which shows 5' seperation from septic tank to post tank cleanout (see attached photographs). **Trench runs parallel to driveway. �oo�ON,\ G. ENGINEERS CERTIFICATION o OF .i %% 11 np i certify that l have determined through field inspections and / 1' s�7; review of Municipal records that the above systems are in �/* 4'% 00 conformance with MOA COSA guidelines in effect on this I Av date. 0.... Av Engineer's Printed Name JEFFREY A. GARNESS l0 9' ' r`�l_ Garne •.s;':.,,o' Q Date 1/3///g v • ••1 ' t3< <.B��Ao� '1,(.,\*jDrofessiovIoo. DOOO��o #AECC884 (Rev. 11/05) e .^�IU ti i Municipality of Anchor ff nuc2 8 ?015 On -Site Water and Wastewater Progra �6 (907)343-7904 ZZ 8 L g Certificate of On -Site Systems Approval Parcel I.D. 015-062-36 Expiration Date: % t)--' q —/.r 1. GENERAL INFORMATION Complete legal description SILVERCREST; BLOCK 2, LOT 5 Location (site address) 6905 LOVITT CIRCLE `ANCHORAGE, AK Current Property owner(s) LESLIE STEPHENS Day phone 306-6273 Mailing address Real Estate Agent 6905 LOVITT CIRCLE "ANCHORAGE, AK KAY ENGLAND Day phone 440-9022 2. TYPE OF DWELLING: FX] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: 7 /4 Date: IL- r_.ngA tn he released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 831 Ji5 Date of Payment Receipt Number Cj(4 Receipt Number COSA # (14VII51 LIl $ Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Garness Engineering Group, Ltd. Phone (907) 337-6179 Address 3701 E. Tudor Rd., Suite 101, Anchorage AK, 99507-3246 Engineer's Printed Name Jeffrey A. Garness Date J02 6 jji;- In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance withthe guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the dates of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent properly purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report 6. DSD SIGNATURE ✓System #1 Approved for bedrooms 3Z The upon System 42 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the following Certificate Date: ,(t(( OF ON-SITE WATER AND WASTEWATER PROGRAM of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet 9-JAZd0c Nitrate Advisory Arsenic Advisory Other Allo - If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SILVERCREST: BLOCK 2, LOT, 5 A. WELL DATA Well type PRIVATE if A, B, or C provide PWSID# N/A Date completed 12/8/1977 Sanitary seal (Y/N) YES Total depth 121 ft. Cased to 120.9 ft. FROM WELL LOG Date of test 12/8/1977 Static water level 35 ft, Well production 20 — 9 -p.m - WATER SAMPLE RESULTS: Coliform ® colonies/100 ml. Arsenic: Nitrate NIQ mg./L. Date of sample: 7/6/2015 Parcel ID: 015-062-36 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 24 in. AT INSPECTION 7/3/2015 74 ft. 3.8+ g.p.m. Collected by: GEG. Ltd. B. SEPTICIHOLDING TANK DATA STEEL SEPTIC TANK IS APPROACHING THE END OF ITS USEFUL LIFE Tank Type/Material SEPTIC/STEEL Date installed 12/1/1977 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 6/30/15 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRAD Date installed 12/1/1977 Soil rating (g.p.d./Wo /bdrm 100 System type TRENCH Length 34 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth *10.4+ ft. Eff. absorption area 476 ft' Monitoring tube **YES Depression over field NO Date of adequacy test 7/3/2015 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 687 gal. New depth *!*_27m. Elapsed Time: 10 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — *SUMP ONLY EXTENDS 55" BELOW LATERAL. ***28" BELOW LATERAL. D. LIFT STATION Date installed Size in gallons ManhoWAcoess (YM "Pump on" level at in. "Pump ofr level at i . High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Sewer iseptic service line 25'+ Public sewer manholetcleanout 1 100'+ Holding tank _ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field LINK Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parkingivehicle storage *0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *TRENCH RUNS PARALLEL TO DRIVEWAY. G. ENGINEER'S CERTIFICATION I certify that I have determined through Held inspections and review of Municlpal records 'that the above systems are in oonfornorm with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 91 24k - (Rev. 11105) w Municipality of Anchorage Development Services Department Building Safety Division -- Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. DIS -Dtoa -3l COSA# Ur, 0553 1. GENERAL INFORMATION Expiration Date: 02— /,6—' 0 % Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SILVER CREST S/D• LOT 5 BLOCK 2 6905 LOVITT CIRCLE • ANCHORAGE. AK 99507 HAROLD LEYDA Day phone 346-3128 6905 LOVITr CIRCLE • ANCHORAGE. AK 99507 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: . Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ 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 On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lest, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole 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. 5. DSD SIGNATURE _Jeff Approved for bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory 337-6179 Date - 6 II t3 I ob bedrooms, with the fllowing stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other ••0000•.. . , wVRXM 0.00.••' By�a �r Original Certificate Date: Nr ilm% Municipality of Anchorage ' Development Services Department Building Safety Division OnSfte Water & Wastewater Program 4700 Bregaw Street P.O. BOX 196650 Anchorage, AK 995196650 www.muni.orglaroits (907) 9437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SILVER CREST S/D: LOT 5, BLOCK 2 Parcel ID: 6 15-- Q6;7 -"34P A. WELL DATA Well type PRIVATE N A. B, or C provide PWSID# N/A Date completed 12/1977 Sanitary seal (YIN) YES Total depth 123 ft. Cased to 120.9 ft. FROM WELL LOG Date of test 12/1977 Static water level 35 ft. Web production 20 g.p.m. WATER SAMPLE RESULTS: Coilfonn 0 colonies/100ml. Nitrate-U,ILmgJL. Well Log (YIN) YES Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/14/2006 55 ft. 6.82 g.p.m. Other bacteria 0_colonies/100 mi. Arsenic:-RD-ugJL. Date of sample: 8/14/2006 Cogected by: GEG Ltd. S. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Data installed 12/1/1977 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 7/31/2006 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed /2/1/1977 Soil rating (g.p.d./ftV� 100 System type DEEP TRENCH Length 34 ft. Width 3 A. Gravel below pipe 7 ft. Total depth •10.4 ft. Eff. absorption area 476 fe Monitoring tube YES Depression over field NO Date of adequacy test 8/14/2006 Results (Pass/Fail) PASS For **4 bedrooms Fluid depth in absorption field before test 0 in. Water added 1001 gal. New depth E In. Elapsed Time: 3 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date - •MONITORINO TUBE DOES NOT EXTEND TO BOTTOM OF GRAVEL •' SYSTEM IS APPROVED FOR 3 BEDROOMS. BUT IS SIZED FOR 4 BEDROOMS. Municipality of Anchorage ueveiopmeni services Depariment Building Safety Division Onsite Water 8 Wastewater Program 4700 Brapayt$tr_eet__ __....... P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SILVER CREST S/D; LOT 5, BLOCK 2 Parcel ID: A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 12/1977 Sanitary seal (Y/N) YES Total depth 123 ft. . Cased to 120.9 ft, FROM WELL LOG Date of lest 12/1977 Static water level 35 ft. Well production 20 g.p.m. WATER SAMPLE RESULTS: Coliform Q_ colonies/100 ml. Arsenic: -.jb_ugJL. B. SEPTIC/HOLDING TANK DATA Nitrate-N&mgJL. Well Log (Y/N) YES Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/14/2006 55 ft, 6.82 g.p.m. Other bacteria 0 colonies/100 ml. Date of sample: 8/14/2006 Collected by. GEG Ltd. Tank Type/Material SEPTIC/STEEL Date installed 12/l/1977 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/31/2006 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA PBELOW EXISTING GRADE Date Installed 12/1/1e77 Soil rating (g.p.d.lft'ort't d 100 System type DEEP TRENCH Length 34 ft. Width 3 A. Gravel below pipe 7 ft. Total depth 'to.4 ft. Eff. absorption area 476 ft' Monitoring tube YES Depression over field NO Date of adequacy test 6/14/2006 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in. Water added 1001 gal. Elapsed Time: 3 min. Final fluid depth E in. Absorption rate >= For •'4 bedrooms New depth E In. 600+ g•p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — *MONITORING TUBE DOES NOT EXTEND TO BOTTOM OF GRAVEL •• SYSTEM IS APPROVED FOR 3 BEDROOMS, BUT IS S I •S� cf-Fr-fe( i4e. I,r MrAffr M'rt SIZED FOR 4 BEDROOMS. 71;re D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) _ "Pump on" level at _in. "Pump ofr I igh water alar level at Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot 100'+ On adjacent lots 100'+ Absorption field on lot too '+ On adjacent kits 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage '0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS ' TRENCH RUNS PARALLEL TO DRIVEWAY G. ENGINEER'S CERTIFICATION. �J!-Ir 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 A .... ..... date. ..... ' .Camrn s:• Engineer's Printed Name JEFFREY A. GARNESS A E-7 ` Date fell 806 � efe • �.i!.1R�o6•.i ^e�Pro/."eb�d COSA Fee Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number f7£7BOTT �OAO /0" TELE. EtEG,.2/ZG�J� E/%SE.NF�/T L07- ,f N COT S /''"0 GOT 6 LU n trl t o O ` � ,rF �r`'6 ,,,p�•7r V' ^. yyaG p ►`��: �F�. �. . r. ;'m X49 F.P. '1 h � k9/ /�: �jEwC2 � •�'•, l} V3.wr f oer h N N ii Z04/TT C/CCL E Y'c L h 1s the al Ble aIIStr Or !•ri:der, r.0 r:nA,ruellcn. to 7ertf, re!etlre to 11n- l•::rd gra•:.• rr•. a:. is 000nes Nene and ex..der.ee of UU' trme- mr•s evra:.•un. rr r 4wlCNeCJ vhioh doyi avl-v>r W. Nit teaocdN4 Fudsri BUIL. RECE TIFICATtO..r' to G 06 IHrJ,IIL ►.Yids tt�l.IIi/ a: t.vrrr.r •ri_ Reekb e0o of: fi7 1 C,/4/. &, Qe,ezor: Arno 7 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH 8 HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OVID OF ON-SITE SEWER AND WATER FACILITY 264.4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) 1.0750E3X,2 S/Lt/E2G2.a^SI SEC_/y 7 /RN,)3le/ Location (address or directions) 4,90j; LD ✓�T T G/ CLC (b) Property Owner A- &;Z2/LL LYNcN Telephone: Home Business Mailing Address (c) Lending Institution —G f Arr— 041007-4416•E Telephone Mailing Address (d) Real Estate Company and Agent ut2l7-AFl6 11064TS ENrE2S oN Address 207 r�i . No ¢TN6¢N A/GHrS Telephone A 7! — /33 3 (e) Mail the HAA to the following address: or: Check here Er if hold for pick up. List contact person and day phone number below. %. S P�r2ttakntn 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite] Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 77-075 (Rr SWI Flc a 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 insAettion— _ _ n Name of Firm Address Date _ _ Telephone All J DHHS APPROVAL Approved for bedrooms by Approved�^� Disapproved Conditional _ Terms of Conditional Approval Ca71llf enl Engineer's Seal Datef �� -- ' _P'7 7� The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 77-025 (Aft 8161 Bnk n ►M��EEUppNIICIPALITY OF ANCHORAGE (MOA) KNICIPAL11Y OF AFiCH6R1�i�AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH 3 CneCKLIST - FEBRUARY 1884 ENVIRONMENTAL PROTECTION 264-4720 IFEB 2 6 037 A. WELL DATA RECEIVED Well Classification Q S If A. B. C, PE.C. Approved (Y/N) WA Well Log Present (Y/N) - Date Completed 'N/77 Yield- �� Total Depth 10-x/ Cased to 1-21 Depth of Grouting NCAIL Static Water Level 6a Pump Set At R a7 : o w1 3rl y Casing Height Above Ground � Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ; On Adjoining Lots i / 0'0 To Nearest Edge of Absorption Field on Lot O % ; On Adjoining Lots % l V Ci To Nearest Public Sewer Line NOAIF To Nearest Public Sewer Cleanout/Manhole IVOLI er To Nearest Sewer Service Line on Lot Water Sample Collected by r -S ; Date ''71A /4- 7 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 'Y,,177 77 Size aJ D No. of Compartments 7 ' y Standpipes (Y/N) DNC Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) _L Date Last Pumped Pumping/Maintenance Contract on File (Y/N) NSA., ; for Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) W40 Separation Distances from Septic/Holding Tank To Water -Supply Well 107 To Building Foundation To Property Line i /0 To Disposal Field To Water Main/Service Line % !D To Stream, Pond, Lake, or Major Drainage Course ly 0 E Comments Page 1 of 2 72-026(11/64) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 10-0 Type of System Design %�ECff Date Installed 121117 7 Length of Field 3 y Width of Field -.Sc) Depth o1 Field Gravel Bed Thickness / Square Feet of Absorption Area b % Standpipes Present (Y/N) J Depression over Field (Y/N) Date of Last Adequacy Test /S 1 -a Results of Last Adequacy Test �`e S S tem f v ✓�gf�✓ee N+ s Separation Distance from Absorption Field: i To Water -Supply Well 107 To Property Line To Building Foundation o To Existing or Abandoned System on ,Lot No 11VI= ; On Adjoining Lots O To Water Main/Service Line - >10 To Cutbank (it present) AM ME To Stream/Pond/Lake/or Major Drainage Course N041 To Driveway, Parking Area, or Vehicle Storage Area Comments *C�ti7Z 0 47r1.127A7 D. LIFT STATION Date Installed — Size in Gallons — "Pump On" Level at Not�c' High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Check Permitted Bedroom Rating Against HAA Request •' Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Icertify that Ih_ vechecked,venied con ormed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date �lII��7 Company MOA No. Receipt No. - CY-3 3i Date of Payment a - acc• - 01 Amount: $ \ DO, co Page 2 of 2 72-026 (11,84) =`OF /,1 ltj ,-,Q` '! * Engineer's Seal �. •• •22 2 ;J.E.. .; ►'1 r.. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 , Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Cg90S L.oVLT•T' c tI?6LLL (b) Applicant NameB—JA ILV L' N / Telephone: Home 3NI6^3S s 9s j Business 10-14-37 Applicant Address L 9 o s I P -C (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder(; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution W'.4411 s;44e- Telephone Address (e) Real Estal Address Telephone 'L7& - / 3 33 Mail the HAA to the following address: 2. TYPE OF RESIDENCE ct Single-family ❑ MUlti-Family ❑ Other . Number of Bedrooms 3 3. WATER SUPPLY ' Individual Well Community 13 Public 13 Note: If comrrfunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community 13Holding Tank 13Note Ifcommunitywell system, must have written confirmationfromtheState DeparlmentofEnvironmental Conservation attesting to the legality and status. 72-025Pue�l' Pagel of 2 ('N 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 9 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 sale, 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. _ _ z ..'ITisw�vrs"ing"arcl Address V nco y [.W- f';) rr7 Date *•�+9L1 1 d r+ Engineer's Seal 2225-E 25, 1911 DHEP APPR AL CV_) Approved for bedrooms by #, to Approved Disapprove Conditional 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 professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions In order to satisfy certain federal and state requirements. Employees of DHEP do not conduct Inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025(11/94) n MUNICIPALITY OFLVtM OditlTY OF ANCHORAGE (MOA) DEPT, OF L t►T{�pqApp�U�THORITY APPROVAL (HAA) ENVIRONME(VTAL HEeKLIST - FEBRUARY 1884 M AY 2 2 Nffi 284-4720 al Description: RECEIVED L1a A. WELL DATA Well Classification 2 Es If A, B, C,, /D.E.C. Approved (Y/N) � KA Well Log Present (Y/N) � Date Completed 1 7=�77 Yield ALO 7? &'r1 Total Depth / AI Cased to Depth of Grouting NE Static Water Level 5 a Pump Set At $0 rro I.! Casing Height Above Ground Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) )!f Depression Around Wellhead (Y/N) N Separation Distances from Well To Septic/Holding Tank on Lot 10 -7 ; On Adjoining Lots >1 To Nearest Edge of Absorption Field on Lot 10 7 ; On Adjoining Lots 7104 To Nearest Public Sewer Line NOME- To Nearest Public Sewer Cleanout/Manhole N D -N-9— To Nearest Sewer Service Line on Lot - i r 0 Water Sample Collected by T -s _ ; Date A�ZA! 6 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 'i977 Size /$24;0 No. of Compartments Standpipes (Y/N) E Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) y Depression over Tank (Y/N) ,ly Date Last Pumped —1%1116 Pumping/Maintenance Contract on File (Y/N) IyA' ; for Y/A Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) WDA Separation Distances from Septic/Holding Tank: To Water -Supply Well 7 To Building Foundation To Property Line — 0 To Disposal Field To Water Main/Service Line ? !lp To Stream, Pond, Lake, or Major Drainage Course N 0A(Z Comments Page 1 of 2 72-026(11/64) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata t}O Type of System Design Date Installed /'vi�77 Length of Field '34� Width of Field 3p Depth of Field Gravel Bed Thickness Square Feet of Absorption Area q& 9 Standpipes Present (Y/N) Depression over Field (Y/N) !%� Date of Last Adequacy Test SGL/fd b Results of Last Adequacy Test �49C 6!Y& '?-WAes :3eee✓ed-rs._* Separation Distance from Absorption Field: To Water -Supply Well _ 10-7 To Property Line To Building Foundation e4 -IS To Existing or Abandoned System on Lot IYO_((C ; On Adjoining Lots 7 < da To Water Main/Service Line To Cutbank (if present) NOR! C To Stream/Pond/Lake/or Major Drainage Course MON P�= To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at — Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) 'Pump Off' Level at '• Check Permitted Bedroom Rating Against HAA Request '• Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA IcertifythatIhavechecked,verified, conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed _ Date - *!�V2% Company MOA No. Receipt No. 8:;k 4 -Ctkt 1�fqr- Date of Payment —' Y� Amount: $ L S -00 - Page 2 of 2 72-026 (11,84) ` ` ��tNLx �� CSF. At It :.4 9 M•. a2225 -E :a suv: 2s. 1911, N Engineer's Seal 203 CJ 4 �i�ILAJVD9 POE O r 20A CHORAGE.ALASAI 99501 CONSLILTING ENGINEER TELEPHONE: (907) 279-3916 S E P T I C S Y S T E M A D E Q U A C Y T E S T — — — — — — — — — — — — — — — — — — — — — — — — LEGAL: LOT 5, BK. 2, SILVERCREST LOCATION: 6905 LOVITT CIRCLE �d OWNER: MERRILL LYNCH RELOCATION CCI.' " T RESIDENCE: SINGLE FAMILY, THREE BEDROOMS'.. )� C 1 ' WATER SYSTEM: ON SITE WELL �(k SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1250 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 469 SQ. FT. SOIL RATING: 100 INSTALLATION DATE: DECEMBER 1977 DATE OF PUMPING: MAY 21, 1986. ROTA ROOTER DATE OF TEST: MAY 21, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 6 FEET OF COVER. LIQUID WAS VERY THICK. TOTAL DEPTH 47 INCHES. BOTH CLEANOUT AND SUMP OF TRENCH WERE DRY. SUMP WAS 13 FEET DEEP WITH TOP OF PIPE FLUSH WITH GROUND. CLEAN OUT WAS FIVE FEET EP WITH 12 ABOVE GROUND. TRENCH IS NEXT TO AND POSSIBLY UNDER DRIVE WAY. .,mow.- erer ysts.. 530 GALLONS OF WATER WAS ADDED TO THE SYSTEM. 50 GALLONS INTO THE TANK. 100 GALLONS INTO THE SUMP AND THE REST INTO THE CLEAN OUT. THW WATER LEVEL IN THE TANK DID NOT CHANGE. NO WATER SHOWED UP IN THE SUMP. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. THIS RESIDENCE HAS BEEN VACANT SINCE MAY OF 1986. SYSTEM WAS NOT TESTED AT THIS TIME. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. W, 15th AVE "C" SUITE 203 c n tnn��(� nl% Ipo�o �20A3 ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER `(`3 Lj(�!f TELEPHONE: 19071 2 79-3 91 6 R E S I D E N T I A L W E L L I N S P E C T I O N LEGAL: LOT 5, BLOCK 2, SILVERSREST LOCATION: 6905 LOVITT CIRCLE OWNER: MERRILL LYNCH RELOCATION CO. TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: PUMP YIELD: DATE OF INSPECTION: DATE OF TEST: 0 l��..,1 �.. ... 'r 11: 20 GALLONS PER MINUTE 7 GALLONS PER MINUTE MAY 21, 1986, FEBRUARY 25, 1987 MAY 21, 1986 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 7 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 53 FEET BELOW TOP OF CASING. AFTER 80 MINUTES OF PUMPING THE WATER LEVEL WAS AT 64 FEET. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON MAY FEBRUARY 26, 1987. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. This residence has been vacant since May of 1986. No testing of well flow was done at this time. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. APPLIC--%IT FILLS OUT UPPER HALE ONLY Property Owner 1I/ Phone Date Date Mailing Addrlss Zip Code d Buyer 1iL�� Address G "Zip Coda Inspector Lending Institutlon d One /J — D' Address 'A,/ Zip Code �p�o Realty Co. d Agent_ ,r�L `7 ,/ •1/ -r•I +" i� Phone/- ('3 ) APPROVED BEDROOMS —zz ( ) DISAPPROVED Address A , Zip Code ( ) CONDITIONAL APPROVAL' Legal Description �f�i. ir DATE L ,'ZQI -Q X, Street Location vw�j BY: Type of Residence Soils Rating Single Family ;W Well To Absorption Area Well Log Received , z' ;❑`Multiple Family No. of Bedrooms_ GL -1-1 ❑ Other Water Supply Individual ATTACH WELL LOG. A well " Is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give wett depth (attach log If avallable). ❑ Public Utility Sewer Disposal 'FLAndlvidual Year Individual Installed: 4 r� 0 Public Utility When Connected to PublicU11141 0 Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector . Inspector fInspector Field Notes: ,gInspector 1 ('3 ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE L ,'ZQI -Q X, BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received , z' Septic Tank Size �„Z SQ GL -1-1 Well to Tank STANLEY BRUST & ASSOCIATES Engineers - Planners - Surrepors 1317 East 74th Avenue Anchorage, Alaska 99507 (907) 349-6577 �IEPTIC SYSTEM ADEQUACY REPORT JOB NO. DATE OF REPORT DATE OF TEST 6/ 5V i ��/`LY vrLf/ LEGAL DESCRIPTION : LOT , BLOCK, SUBDIVISION OR SECTION T—N, R_N', S.M. , ALASKA PERFORMED FOR: REOUESTED BY: MUNICIPALITY OF ANCHORAGE ENVI& ,:^R :1 :A. ! :0 F ; - •J - ��T�J V .7 SJsL yy y F HONE NO. PkiONE NO —� / _ -RECEIVED • TYPE OF SYSTEM 09 SEPTIC TANK. - SIZE ��GALLONS 0 CRIB OR SEEPAGE PIT Ea-� LEACH FIELD NUMBER OF BEDROOMS SEPTIC TANK WAS PUMPED O YES E3"NO ��f 'j��/-eel �' "- a/'7 SrPr1 NOTES 6 OBSERVATIONS: Str1>'1c /c Z/ ". S„l,s-q )[ ^ TEST PERFORMED BY:�1- -7 _ RLPORT FRLPAkEO BY: _�!-✓t�-- APPFOVED BY: _ i n STANLEY BRUST & ASSOCIATES. Engineers - Planners - Surveyors Legal Description .fie i No of Bedrooms 3 Adequacy Test Log r,. Project No. MUNICIPALITY OF ANCHORAGE r -T f � ENVI9 r! -I ..-A . ' ,U F .::, .4 2 9 1962 Ji l✓tr ofreJ7— p F S Date Time Level Remarks septic tank FIT f v 40-4 Stanley Kubik c/p tiarion K. Lamnman C-21 Heritage Homes 207 E. Northern Lights Anchorage, N" 99503 Subject: I.ot 5 Mock 2 .Tune 18, 1962 Silver Crest Subdivision Approval for the individual sewer and water facilities cannot banted until the following items have been completed: •/The water analysis report needs to be submitted to this office from the Chem Lab, 5633 R Street, for our review. • The septic tank pumped with a receipt submitted to this department. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt Associate Environmental Specialist nrl43/p/EH Enclosure MUNICIPALITY OF ANCHORAGE r DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION., ENVIRONMENTAL ENGINEERING DIVISION % 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720 CERTIFICATE OF INSPECTION SEWER AND WATER FACILITIES 1. PROPERTY OWNER MAILING ADDRESS < G' t: c,r �, `./--yam. C, � � ✓� / :• �.. / /C. 2. LEGAL D7ESCRI PTION ' ( 3. TYPE DWELLING SINGLE FAMILY RESIDENCE O OTHER (Describe) 0 MULTIPLE FAMILY RESIDENCE 4. WATER SUPPLY INDIVIDUAL "O COMMUNITY/PUBLIC S. SEWAGE DISPOSAL `Z, INDIVIDUAL/ON-SITE O PUBLIC UTILITY O HOLDING TANK (Maintenance Required) APPROVED FOR _V BEDROOMS 0 CONDITIONAL APPROVAL (See Attached) O DISAPPROVED DATE BY (TITLE)/ ,/.<Ar„y ^'I ry Sf-�r,../•�-;� /i!/y A,, 4'1 72o14 Ono ) /