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HomeMy WebLinkAboutEKLUND #1 BLK 2 LT 6,kN C)60 -S31-11 \ Municipality of Anchorage Development Services Department E Building Safety Division Onsite Water 8 Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 Onsite Wastewater Disposal System and/or Well Inspection Report Permit Number. SW090104 PID Number. 050-531-11 Name: GREG & COLLEEN HILDEBRANDT Wastewater System: ❑ New ■ Upgrade Address: 4441 PANTHER DR • EAGLE RIVER, AK a 99577 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 696-5677 4 ClDeep Trench ■Shollow Trench OBed OHound 0Dther LEGAL DESCRIPTION Sas Rotkw 0.8 T*tW a.pth Imn edgW4 grow: 2 TO TOP OF SAND cPone. rt rL Block: Lot: Subdivision: DWh a pp• sonar hwn Orkl M Wad: Gra..I e.pth sww*th r+ao: 2 6 EKLUND #1 SEE DWG. n 0.50/0.51 rL To.nship: Range: Section: rir eee.e seer• el*'4 erase rrww Wvm — — — SEE DWG. rL 150 (2 O 75) re WELL: ❑ New ❑ Upgrade Gar.I .iM 5 NanWr W Sn..: 2 ahtarc• a«..w, sa..: 15 R R Cb,wrwoten Prhal.. A.S.0 : T•l•I a•..e ":(�,1 Total olwapa.n era: 750 P" rn.t«id: D 3034/ F-810 \v\"" n so. r ors.r: �/ oat. DKkd: 51 store Mar l..w: srtae•r: TWEED EXCAVATION W. s,•tal.e: 7/8-9/2009 s< yNw: Pwap WAL "06'""N.tphl AD.w rwwaa TANK ap„ FLrL SEPARATION DISTANCES ■Septic E3 Holding ClS.T.E.P. 0Others io Septic Tank Absorption Field Lift Station Holding Tank bsc/PrMeb 5•.« un.. Nonufa tom'' PREMIER PLASTICS aoa ity In gdbrw: 1300 rrom Wall too'+ too'+ — — 25'+ NaL.rLw: H.D.P.E. thin,e.r a Caravartrn.nb: 2 Surface water 100'+ 100'+ - - - LIFT STATION Lot Line 5'+ 10'+ — — — Su. M gMac Y•rwlacivnr: Foundation 5'+ 10'+ — — — en M.•I et: en oL: Wph .at« okr at P,•p II.•• a•ctrteal trrp.cuorw p.narm.e ey: Curtain Drain NONE KNOWN Remarks: OLD SEPTIC TANK WAS COMPLETELY BENCH MARK Locaeon aM p..criphore ABANDONED PER UPC BOTTOM OF SIDING ON NORTHEAST CONER OF SHED A>.ren.A EM.•twro 116.82 n, Inspections Performed by: GEG, Ltd. Dates: 1st 7/8/2009 ENGINEE"SA 0000 2nd 7/9/2009 3rd 7/9/2009 Development Services Department Approval 0 4 ': 9 Conditional approval: Date: •• ••• •• .... QQ e a Gar ss P . ` E —7 . p a��4p0 P I2•? D15 cpo \ (/-c7 Reviewed and approved by: Date: �ofesslo'n (R... 4/06) PERMITNUMBER: - ASBUILT DRAWING PARCEL ID NUMBER: 050-531-11 SW090104 SWO A B MT 63.71 49.99 PANTHER DRIVE �T ST1 65.89 52.51 / ST2 66.32 54.21 �0D DBL1 66.59 55.43 :: • ' • ' "'' '` DBL2 66.71 56.81 _ _ _ FS 97.13 90.38 -.._ -.._ C01 72.92 78.26 EXISTING 4 BEDROOM MT1 73.31 78.86 1 HOUSE I. BLOCK U 2, LND OT 7 CO2 136.96 129.47 MT2 136.5611 . 4 I / CO3 84.22 95.17 I MT3 83.20 93.45 C04 136.77 133.54 I MT4 138.26 135.20 / EKLUND 11, OL0CIS �LOT S / rSE.PTIC / ARS�D / SMALL PORTION OF DRAJNFIELD! ARE LOCATED OUTSIDE OF THE 30 FOOT RADIUS OF TESTHOLE /1, SOILS WERE VISUALLY INSPECTED BY JEFF POET DURING INSTALLATION. MTI —NEW 1300 CALLON PREMIER PLASTIC TANK THJI GARNLSS ENGINL•'ERING GROUP, Ltd. CONSULTANTS 3 GENERAL CONTRACTOR�•••••• •• 1101 L TOM•AWA A 101 AMUCA/fl, AK 00901 OIgIS (W)001 -AIT • M[ ("7j,1] m" ADAK2 w,.p y.an PREPARED FOR: PHONE NUMBER: PAGE NUMBER: GREGORY HILDEBRANDT 696-5677 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: Qa �- •• EKLUND #1, BLOCK 2, LOT 6 K.D.M. 0�4s TYPE OF WORK: DATE' O� PROPOSED SEPTIC SYSTEM UPGRADE 7/21/2009 RAv. 01105) 6vov ,u \ PERMIT NUMBER: ASPARCEL DRAWING PARCEL ID NUMBER: SW090104 050-531-11 FINAL GRADE - MT 114.28-114.30 2' INSULATION IOP OF TANK TOP OF TANK / AT OUTLET - 111.27 AT INLET - 111.271 i I "I INLET INVERT OF BUNG-/ AT INLET - 110.41 FILTER NEW 1300 GALLON "PREMIER PLASTICS" SEPTIC TANK SOUTH TRENCH r-nNAl GRADE . FILTER 98.80-99.21 NSU ORIGINAL GRADE AT ... .... rHIGHEST POINT - 98.73 TOP OF SM . 100.54 OUTLET 9N4Rf OF BUNG AT OUTLET . 110.18 NORTH TRENCH -- -- FFUL1L GRADE 104.33-1x.49 BOTTOM TRENCH . IOP 9 SAND 94.75 BOTTOM OF TRENCH - 93.75 REIATNE ELEVATION OF BOTTOM OF TEST HOLE - 94.38 (NO NE ELEVATION OF BOTTOM OF TEST HOLE - 88.75 (NO WATER% GARNESS ENGINEERING GROUP, Ltd. + - ,-r-,., CONSULTANTS NS GENERAL CONTRACTORS 3"1 L T1OOA I . MAR 101 AIK1MNiF. AR Nl07 INKY( 007)W-111711 • FM (M»ll!-NN * ' w�.p pir,ysin PREPARED FOR: PHONE NUMBER: PACE NUMBER: GREGORY HILDEBRANDT 696-5677 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: EKLUND #1, BLOCK 2, LOT 6 K.D.M. TYPE OF WORK: OATS: PROFILE AS -BUILT OF NEW SEPTIC SYSTEM 7/23/200 c 01)05) MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water B Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade 7-9-cte & /1:3v Date Issued: Jul 06, 2009 Expiration Date: Jul 06, 2010 Permit Number: SW090104 Parcel ID: 050-531-11 Legal Description: EKLUND #1 BLK 2 LT 6 Design Engineer: 0855 GARNESS ENGINEERING GROUF Site Address: 004441 PANTHER DR Owner Name: GREGORY & COLLEEN HILDEBRANDT Lot Size: 29900 SQ. FT. Owner Address: 4441 PANTHER DR Total Bedrooms: 4 Permit Bedrooms: 4 EAGLE RIVER, AK 99577 - This permit is for the construction of: ❑Q Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Received By: Issued By: Date: a 91 Date: Municipality of Anchorage • --\ Development Services Department Building Safety Division On -Site Water 8 Wastewater Program ' 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. ()_570_5S I - 11 Property owner(s) GREGORY & COLLEEN HILDEBRANDT Day phone 696-5677 Mailing address 4441 PANTHER DRIVE *EAGLE RVER. AK Site address Legal description (Sub'd, Block & Lot ) EKLUND #1* BLOCK 2. LOT 6 Zip Code 99577 Legal description (Township, Section & Range) NIA Lot Size 2010 q00 Sq.Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. 1 further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit/Rush Fees: S 3o Waiver Date of Payment: �I / Receipt Number: (Rev. 11/05) Date of Payment: Receipt Number: GARNESS ENGINEERING GROUP, Ltd. . CONSULTANTS & GENERAL CONTRACTORS,- - �-, June 16, 2009 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Street Anchorage, Ak 99507 (907)343-7904 Ref: Proposed Septic System Upgrade for Eklund #I; Block 2, Lot 6, To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system is failed and needs to be replaced. We are proposing to install a new 1250 gallon septic tank and a 5 -wide trench type drainficld. Two test holes were excavated on the property. The drainficld will be designed around the 30 foot radii of the test holes. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing fordrainficid specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography below the drainficld is a 15-20+/- percent slope running approximately northeast to southwest. In short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any qucitions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. NOTE: Attached is a sire plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507.1259 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: www.gamcssenginecring.com EKLUND /1, BLOCK 5, LOT 2 T14N, RIE, SECTION 32, SW4, NE4 L EKLUND /1, BLOCK 5. LOT 1 \gC AREA`.� \ \Q \ / v \ I 1 /PAN 1 1 EKL � I \\ 1 \\ \ 1 jam, \` 1 BLOCK U 2. �T 5 EKLUND j1, \ BLOCK 4, LOT 9 \ \ \ EKLUND /1. BLOCK 4. LOT 8 CSW /qEPjlC ARtD �1\ �1 \ 0\1 \ \\ 3\1 \ \ \ 3% \ 1 EKLUND /1, \ 1 BLOCK 4, LOT 7 \ IER DRIVE\\ \� -- --t----------- --7- - I EXISTING 4 BEDROOM HOUSE I I EKLUND 01, BLOCK 2, LOT 7 I C�� I I I I I NQRDx \ \EKLUND #I. \ BLOCK 2, LOT 3 / GARNGSS ENGINEERING GROUP, Ltd. _ ----•p•-- CONSULTANTS 6 GENERAL CONTRACTORS �^ 1101 E TDM M . MIR 101 . MDKMML M M 7 FM ] 32" • e ' ew. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: GREGORY HILDEBRANDT 696-5677 1 OF 1 LEGAL DESCRIPTION: DRAWN BY: EKLUND #1. BLOCK 2. LOT 6 K.D.M. TYPE OF WORK: SITE PLAN (Rev. 01/05) KIRK LOT 1 SOF o°0�� 9 '•:9 Eby mess. CE -7 53 ; Qa b In� Ofw" g / EKLUND /1, \ BLOCK 2. LOT 4 os 0\00 L 1 I ` NQRDx \ \EKLUND #I. \ BLOCK 2, LOT 3 / GARNGSS ENGINEERING GROUP, Ltd. _ ----•p•-- CONSULTANTS 6 GENERAL CONTRACTORS �^ 1101 E TDM M . MIR 101 . MDKMML M M 7 FM ] 32" • e ' ew. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: GREGORY HILDEBRANDT 696-5677 1 OF 1 LEGAL DESCRIPTION: DRAWN BY: EKLUND #1. BLOCK 2. LOT 6 K.D.M. TYPE OF WORK: SITE PLAN (Rev. 01/05) KIRK LOT 1 SOF o°0�� 9 '•:9 Eby mess. CE -7 53 ; Qa b In� Ofw" NUMBER OF BEDROOMS: 4 GALLONS PER DAY (CPD): 600 PERCOLATION RATE/S: 8.57 PROPOSED APPLICATION RATE: 0.8 MINIMUM DRAINFIELD SO.FT.: 750 MAXIMUM DEPTH: J FEET WIDTH: 5 FEET LENGTH: 150 (2 O 75) M.O.A APPROVED SAND FILTER: 1 FOOT EFFECTIVE: 0.50 FEET REDUCTION FACTOR: N/A ACTUAL SO.FT.: 750 LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT CEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION. THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND NOTE: THE CONTRACTOR SHALL HAVE THE SOUTH do WEST LOT LINES, AND ALL WELL RADII FLAGGED BY A REGISTERED LAND SURVEYOf PRIOR TO CONSTRUCTION. EKLUND /1, BLOCy2. LOT 5 �PTIC AR� 04' off' `- PANTHER DRIVE r— EXISTING 4 BEDROOM HOUSE EXISTING FCO EXISTING 1250 CALLON SEPTIC TANK IS TO BE COMPLETELY ABANDONED PER UPC / EKLUND J11. BLOCK 2, LOT 7 — PROPOSED 1250 GALLON SEPTIC TANK INSTALL DOUBLE \ CLEANOUT S INSTALL FLOW SPLITTER EXISTING DRAINFIELD IS \ \ \ TO BE COMPLETELY \ \ ABANDONED 4fHj/ \ \ ok PROPOSED y/ DRAINFlELD SCALE: 4 �? / ^ �A GARNL•_'SS ENGINEERING GROUP, Ltd. - -- - -• CONSULTANTS d GENERAL CONTRACTORS.-��--••---mom- >w� c n n A w 101 • MCHORQL r w l . w • Nu poMa " PREPARED FOR: PHONE NUMBER: PACE NUMBER: GREGORY HILDEBRANDT 696-5677 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: EKLUND #1. BLOCK 2, LOT 6 K.D.M. TYPE OF WORK: DATE: PROPOSED SEPTIC SYSTEM UPGRADE 6/30/2009 v ( ey•.�•���ness* •�• C 953 �aPG GARNESS ENGINEERING GROUP, Ltd. +- ,• CONSULTANTS & GENERAL CONTRACTORS—, 7701 L T MoD, sure 101 • M,6,oRAU. AK NW7 . waw; (WW7- In • FA s07U" • WU"m SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: EKLUND 11: BLOCK z , LUr o PERFORMED FOR: GREGORY k COLLEEN HILDEBRANDT DATE DEPTH ORGANICS (feet) =="=c TEST HOLE 1 1 2 3 ------------ L------------ � -- ---- r 6/10/09 1 3:10 — 6" GM TO SM—LARGE 4 / E%ISMNG N COBBLES & 1 4 SEDR00 I 7 ' ' rZA BOULDERS. 5 MUIR• 7 � SOIL IS DENSER 5 4:10 EKLUND /1, 6' WITH DEPTH 6 4:40 30 r��1L•i .'PMC 7—IMBEDROCK B.O.1I. 9 10 11 12 13 14 15 16- 17 18 DEPTH TO DATE GROUNDWATER DRY 6/9/09 p 6/16 /0-7 ------------ L------------ � -- ---- r 6/10/09 1 3:10 — 6" — 1 / E%ISMNG N 3.5 1 4 SEDR00 I 7 ' ' rZA f 4 MUIR• 7 � 3.5 5 4:10 EKLUND /1, 6' — BLOCK 2, LOT 4:40 30 r��1L•i .'PMC THQ2 • :. Y/V�. • r-- WACANTD DEPTH TO DATE GROUNDWATER DRY 6/9/09 p 6/16 /0-7 DATE READING ------------ L------------ � -- ---- r 6/10/09 1 3:10 — 6" — 1 / E%ISMNG N 3.5 1 4 SEDR00 I 7 HOUSE f 4 4:10 7 � 3.5 5 4:10 EKLUND /1, 6' — BLOCK 2, LOT 4:40 30 2.5 .'PMC THQ2 • :. �� r-- WACANTD i DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 6/10/09 1 3:10 — 6" — 2 3:40 30 2.5 3.5 3 3:40 — 6' — 4 4:10 30 2.5 3.5 5 4:10 — 6' — 6 4:40 30 2.5 3.5 19 I I PERCOLATION RATE 8.57 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 1.5 FT. AND 2.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: KYLE MAUS PERCOLATION TEST PERFORMED BY: KYLE MAUS PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: OF GARNESS ENGINEERING GROUP, Ltd. 0 • •- -•- •-- -- CONSULTANTS d GENERAL CONTRACTORS �••�-.•—=4----��•• d4 O ...... ... .. ....... .......... V01 c corn. w¢ 101 • w¢Hawu. A "W7 • nwc(WrWi179 • rwt: w -uw • ncesnE: w•.•••w••`w.o•m SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: EKLUND 1; BLOCK 2 , LOT 6 J 11 e' ess: PERFORMED FOR: GREGORY & COLLEEN HILDEBRANDT DATE: 6/9/09 ' CE -7953 `BOG e. '1•�I'.crf'' o°'o (feet) ORGANICSTEST HOLE 2 4°�400osslof o 1 SOIL CLASSIFICATIONS �\ 1 GW _= ORGi .1- 1- ----------- ------------ 3 GP ML 1 N �t GM CL t GM TO SM -LARGE GC OL � I % 4 BEDROO 4 COBBLES k I -�- HOUSE BOULDERS. °° O ' SW MH 5 SOIL IS DENSER °: �'° : SP CH - WITH DEPTH SM ' i OH -- BLOCKUND 2. Loi 6 SC Csepnc TH#2 • ` 7 DEPTH TO DATE �� THJjt ` rACAHT—,7 GROUNDWATER 'BEDROCK DRY 6/9/09 9 —3•iOT- to— tt 12 13 14 15 16 17 18 PERCOLATION RATE 7.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 19 TEST RUN BETWEEN 1.5 FT. AND 2.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES C-]NO SOILS LOGGED BY: KYLE MAUS PERCOLATION TEST PERFORMED BY: KYLE MAUS COMMENTS: PERFORMED BY CEG, Ltd. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P RFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 1 O rt DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 6/30 09 1 3:50 - 6" - 2 4:20 30 2" 4" 3 4:20 - 6" - 4 4:50 30 2" 4" 5 4:50 - 6" - 6 5:20 30 2" 4" 72-013 (Rev. 3178) V 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 NEW OTH eg 'Ross C T — ❑UPGRADE MAILING ADDRESS RP BQx l2,LX Kill ALA6KA V62:7: LEGAL DESCRIPTION E:KLVND .b, 1.07- .0T %8 K 4 W ba 3 S.M. LOCATION NO. OF BEDROOMS � 1 ^T F AI 7E 1 v UY DISTANCE TO: Well ea Absorption area 5•°5- Dwelling PEWIT N NS QManufacturer &REw Meter No. ofmpartmentsa y Liq, ca acit in gallons �� IF HOMEMADE: Inside length Width Liquid depth .f' Y DISTANCE T0: Well Dwelling PERMIT NO. J C7Z _ < Manufacturer Material Liquid capacity in gallons ❑ w= DISTANCE TO:35(06 Well�� Foundation 6 Nearest lot ling / P IT NO., J LL Z Z w -OC No. of lines { / Length f e cq line Total I ngth of lines Trench widtYy inches Distance between lines Top finish Material beneath tile Total effective absorp ' area F. of tile to grade �+ ❑ 315 $'a3E° WAIr „J0® Inches Length Width Depth PERMIT NO. w aF- Type of crib Crib diameter 'b a Total effective absorption area Lu FL WWell in Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer Vev fT Septic tank Absorption area(s) OTHER I f4 N H R pRilve PIPE MATERIALS ?&Rr-ORA'T�D j S61L I'D WC, 544 D SOIL TEST RATINGIt C? T Ak lvr= WL IN r'VA5TfiVC'1ej> INSTALLER TMLEY5 BAC _CdQ0Wgk0W)A16-_*"1r_S REMARKS INSPECTORS MOA-4 S nZ& bV5I1JLAT-1i;W j A VfAPIng EIAMtYEkk wit QI PC-A• -eD OVEi; 5 CTA-NIC O `IiI w 5 rl T k / tORo ®F A 2� a Gi u'� W- - PXV'Prkc. /Ars' AT FoovaAmAil oA, SePTIC 30111 1 R A —(, i 9$ a APPROVED DA-F# Jn-as. �A(��� ~' ®�0 910 no®�e® �~q����A l /.. 1" ICJ 72-013 (Rev. 3178) V � 1 ' DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND f� oQ 9V '6-; ADDRESS O /3nYL_—_/0c 34 LEGALDESCR[PTION DATE -Started 31/yi/d'S' ---Ended DEPTH OF WELL /3 y_ TC ST A Il( LEVEL OF WAI'LR FT. .__SJ- DttA1ti' G,1LS. PER HR I PERMIT NUMBER .._-. __ _ ._. ,... KIND 01- (1SIN(; KIND OF FORMATION: From Ft. .to-l—Ft.1J l4,1 4-4;F ---.--.._. From._ ' .Ft. to----. Ft. - --.-. From -_Ft. to OL Ft. 41'47-77' S/1�+ 0 __ iF'Q oa Front. Ft. to._ _,__Ft. -.- From Ft. to Ft. CLA/ M t A094Q From Ft. to__.__ Ft.,-. From_/_ __Ft. to TO .Ft._ �d'Q_%)/�•v.-._. _ ucQctf From._.__._._ Ft. to ---- --- -- Ft.-._ From__S5 Q Ft. to. 6S._Ft. , From hS Ft. to �g Ft. <r4t----- -- --- From__ ­ Ft. to-_--- Ft. From _ _�_Ft. toFt. Si9.ND _ G R.J.;. t--- <�t r From ---____-- Ft. to_-_[�-- Ft. _.-_.-_�_..._ . _...._. From__._t..._-.Ft. to-Ft.l From)..--_-Ft.w--.t!`►,JIi.'�_I to.gP..... Ft._. 1 ,CCo /w�. Nj9ifQPAnJ From____. -I t to 1I ._,...Ft. ��: S_ �gr�/q _-L_._.... From -SQ --Ft. to --(71. __Ft.:_..�i/3i9 Fron)---Ft hr..._ /�' J86-Fti 4 �j From___-.__Ft.to-._ Ft._�r LEGAL ^ H -11.1 INT 1 1:1 it: W to Q 1: A - V U 1=7 d2w 14U 1:1 Of El lot out Eli JEE�:� LOT SIZE: 29900 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Listed ' below are the options 825 L STREET, ANCHORAGE, AK 99501 "Y FT KAM CT NO pvJ V:::t, JE: rr'dll 264~4720 TO PIPE BOTTOM (FT°> 4"0 , 4.0 4.0 GRAVEL �All ���"1 - K Es M W Ez lot hit Wj M UAI 11 A[ 11 PERMIT NO: 860048 2"5 22.0 5^0 GRAVEL 60^0 41"0 DATE ISSUED: 02/14/86 W. 33^5 48"2 TANKSIZE (GALS) 1»250°0 ** 1!,250"0 ** 1,250.0 APPLICANT: SOIL BR[��HER ROSS CONST" ** 7ANK MUST HAVE AT ...... LEAST TWO COMPARTMENTS ..... _-~~-_..... ..... ..... -~_~__~.... ..... ..... ADDRESS: I certi[y P.O. BOX 1234 1" I am familiar, with the requirements i'or on-site sewers and wel1iii; as set EAGLE RIVER� AK 99577 of Alaska. 2" I will install the CONTACT PHONE: 68B~3385 and in compliance with the design criteria of this permit. 3" I will adhere to all LEGAL DESCRIP: SUBDIVISION: EKLUND LOT: 6 BLOCK: 2 SECTION: 32 TOWNSHIFT. 14N RANGE: 1E LOT SIZE: 29900 (SQ"FT. ClR ACRES> MAX 8EDROOMS: 4 Listed ' below are the options available U5 VOLA in designing your septic system. Choose the option that best 1;its your site^ "Y FT KAM CT NO pvJ V:::t, JE: rr'dll DEPTH TO PIPE BOTTOM (FT°> 4"0 , 4.0 4.0 GRAVEL DEPTH (FT") 5.0 O^5 3.5 TOTAL DEPTH WT.)` 9"0 4"5 7^5 GRAVEL WIDTH (FT.) 2"5 22.0 5^0 GRAVEL LENGTH (FT"> 60^0 41"0 65.0 GRAVEL VOLUME (CU. YDS. W. 33^5 48"2 TANKSIZE (GALS) 1»250°0 ** 1!,250"0 ** 1,250.0 ** SOIL RATING (SQ,FT./BR) 150 150 150 ** 7ANK MUST HAVE AT ...... LEAST TWO COMPARTMENTS ..... _-~~-_..... ..... ..... -~_~__~.... ..... ..... .... ..... ..... I certi[y that: 1" I am familiar, with the requirements i'or on-site sewers and wel1iii; as set forth by the Municipality o0 (MOA) and the State of Alaska. 2" I will install the system in accordance with all MOA codes and regulations; and in compliance with the design criteria of this permit. 3" I will adhere to all MOA and State o' Alaska requirements �or the set back distances from any well1, wastewater disposal system or public sewerage system on this or any adjacent or, nearby lot, 4" I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED 1)"0, f DENALI ENGINEERS & SURVFMORS SOIL LOG � P. G.' Bdk 873'447 �� PERCOLATION WASILLA, ,AK 99687 SOIL LOG 777 TEST 371f'-9505 376'-3770 PERCOLATION TEST BEDROOMS j���,�., �,�-. "� / _ JOB NUMBER: l 4 0 PERFORMED FOR. FRO t—f aR S 11'1255 �-�/�5 T DATE PERFORMED: S / LEGAL DESCRIPTION. E%(L UN D 5 y B ✓ LOT % FJ K A I T 14rl SLOPE w j WAS GROUND WATER �'! ENCOUNTERED? �—_-- �, r • r 13 TD — 14 i 15 16- OF 44 17 y� ®® +'1 a p^' movvaaaTr//aieVp�oq 18 u R�o�o 19 e A. Noft 20 �9�G®®•®•v®®®®•o •��C 4k� fiOFESSO IF YES, AT WHAT DEPTH? Reading Date I Gross Time SITE PLAN E Net Time I DWatero I Drop DEPTH PERCOLATION RATE 1 5 U � �- (minutes/inch) (FEET) I O.O FT TEST RUN BETWEEN � FT AND COMMENTS I` EGGO MY✓I GMD �S� / PERFORMED BY: 16(. fA4,'`Q CERTIFIED BY: DATE: ORGANIC- MAT' �OL> 1 d,., C7 . N S H TAN (o"—f3 3roW 2 �'�o GRAVELLY 5hNp) TRACE SILT � �',y; SCATTE RED Co B13L E S/ Gvt.,v 3 30-35% 5V-'8RA/jp+vkA1D/ PO4PLY GR�4pr✓?I Si.(C+NTLY MOIST TO DRY, C0'3ALE5 -e4l' VE+,Y Sr.rGHT ST ZATiFICATron/ 5� Sp 6 r 1,' � r0 t ,! 7 , O O'r✓ 8 , sof 10 r,' r `O, to w j WAS GROUND WATER �'! ENCOUNTERED? �—_-- �, r • r 13 TD — 14 i 15 16- OF 44 17 y� ®® +'1 a p^' movvaaaTr//aieVp�oq 18 u R�o�o 19 e A. Noft 20 �9�G®®•®•v®®®®•o •��C 4k� fiOFESSO IF YES, AT WHAT DEPTH? Reading Date I Gross Time SITE PLAN E Net Time I DWatero I Drop DEPTH PERCOLATION RATE 1 5 U � �- (minutes/inch) (FEET) I O.O FT TEST RUN BETWEEN � FT AND COMMENTS I` EGGO MY✓I GMD �S� / PERFORMED BY: 16(. fA4,'`Q CERTIFIED BY: DATE: P.C. BOX 6650 J y 4NCHORAGE, ALASKA 99502-0650 i_? i. (907) 264-4111 TO. NY HNOWLFS. u AY OR DEPARTMENT OF HEALTH & HUMAN SERVICES January 10, 1986 TO: Permit Applicant Subject: Permit # 850035 Lot 6 Block 2 Eklund Subdivision A permit issued by this Department for an individual well and/or on—site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on—site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on—site sewer system the original as—built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, St -o -.ti A40_4 et Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit II M EI !L. I! !!' !I ..Lr }l^_.. Il: :xa• it `ti ;t__.. lC.._.I(...,,,tt"" JC::ti 1F : 1 u P.,11 !f::: II8 iC.3 ll 4;: X- ii }4 "E"R AND F'R(31"[:_C:'1"7:C) 1\1 {E325 L. '.",]"F?F.I-:'1" ANCI-ff:)FtACaE Ai-:,' r;t;'5C)!. 261-1.72('s IC::(! P,11 :L': :l ..:... (EE :: W M SM I)::::: y:::, , A&: !I.mJ IE-. !L_._. IL- I'""' N::1 : iF:; F;:11"„ "tl .11. ""If... HERMIT Nth 850035 7. (..,i.. ,..1 t .'y 15 :I: �?:::)Ll E"I:)u C}...r :i. r... f(.),-t AF'1:AL..:I: f_:F`rl\ T I3F=tiC7"1')-IF ='I" S RIMS C:;tllNfi T',: C t....0". RIVE.-RI, �.I- 9957 C::CII\I..I.T`rC::T 1x:1..:1€:]1\11- ^ 6g:;fE...338 L...I]EC.3AL_. DIE`)t E,IF'a tr! E3DLV1:S1C)N:: kI) tlI\ID L...(I(.. SEMT10NIP ! tai+!MSi I I I'"' u VIN RANGEn m- I. 0T LA CO„'T:I:CIN:! F::Y-)1rTYI-..li:1R r.?F,IVEHi: MAX BEDI::Z010111E�:� -11- I. 1. l.L.A. a rl 1 F [5? I. C.1 W a r i:'7 t. L.r r:a 7 r.:41 } 'i r:..J •t.. ,.t.t::. !,: your J - ' :.1t:Ftt::a ? .. ;_} YOU ].!l .a". ::t_ll" 'r1=. }'(:.a.. , .:... l :. I::. -Y is .1. s. a. ,. .r .... a 7..4- t t "i. P1 t - >4';i'(. E?f!1 :: i..',l"k Ut.F::m e? '(:.l"k Y? t)p'L. :1. t:)I"i 't. 1-i .::. t, La esf5't_ f '+ t to your site., ""IF' IF,.:: 11 401 B__,.11 i( !l ,fl : , 8.."i1 H''„ti. N ^ ;I -Il_ 17"•,.11 )DET-11.1 "I"C) )`'7:1:::'Lc A:(:IT-11311 :FIT„) 3.0 •'•s• 4.() , :. , _.. GRAVEI. DEPTH {F"T'.: z 5.i_} ..:::: a ..I..C)..Ci'•dl__ DEii:l^,,..1..x..1 (F-...". El. 17.'.'i l?t vE.:1.^. t"JI:T..)Tl...l (F;.)..„) 2,•5 5.0 t"! C';Fi VEI_. L"E11\ICi••"t-I (F:IT., 60. C} 65. t"i C•:iRAb``l=L._ VC]i._.t.JME= (COU. YDS::) 250. 6 ^18.:22 (l'.7 i`•1I.^....) 1. R250. 0 1.a 25Y,, ciCaIL F'i'(1'T'S1\IC3 ( C>'!::'I":'"(':.':E:iR) 150) x S)1:=.F, T'H 1-0 1=' I: F`' I:30T'T011 :: 5 i--r. F E G! Ll I: FZE"13 :I: I\IE-, )L_ YT I: (31\I 41 r.:)Lc:r-'l..H .-1-(::) PIPE BOT-11"1311 <:: 4.0 FIT. licit' REQUIRE At L...1F:"T 13TF••i"I-:13NI *41 ..F'61P'•il<: 1"]GIST HAVE AT I-..G'As"r "F'tx!C:) .1. 1 iam lafil 7. I. iter vVi. i:. 31 '! (rt+ 1' EMY U ire:}nen li't:. i:i { r?' t:7!'1 tti a.'t. ei 's,e PJe F,s i.-anti Vdt :1.1't :liCi 4eS(?{ !' I t h`I : -' -r 't . " r� ... ., e v 0 A) .. 7 .I. .:y ...y S:_ .t. .^ .. -. off v � _ .... f•!';}("I'_.'k I::}W' t:..'. ei" � t.Iii .L v. i�c:. a: .7. {'_FI C.}S i-.fi!„-)tC]k"r.Y C) (il !1^2r and t_E,+... .d i.. mt t.. ca �.)i r1 .1. :al �a l; is :: : .I. In! . I. I. :: i7 <.::'!:. <r:Y i. I. 'k. !"t e s y'::i'€:.. e? f!'1 a. I"1 4`+! :L 't:, h :..4 .+. s. i l ..., A . i :: d:1 Gl e ii :e4 i k to .a i"1 d in comp I. L is i i = 1 4v' 7. 't'.. I"1 t l"i e d e =5 f. g F i f':: i ` 7. 't'_ iii? 1" :il of .. 7 _t..h ..y .. a1 'j.... ! f:`d. y t_, S' t.. :.:..y.-,:•,: .t_a t' } .i r (.}I" 't..I"1 t'.? i?i?�irF aY.. -_aw I. IN 7. I. a. ci ...l�.:-r?i'e:•. t_t..F >•}.: 1. Mt".iM1 r.:. P'1 C._,.a :.. t::i't:. t:. _ri ):..}.I. t3^sl<:%% ,'. c::. :.�1 1. i` fii4". ('k't'..ii± ' J. tri' :.:i . 7 v .. ..: k •_7 t" ..... t;^ / {}"1'!111 itC?br ��:•.; ( I"kC"l 4`Jti:<Ia. lti,-:tFu:.�'::deii't'_[rri" {:ia.t(::}i.F'c:>tit:1. ..(i;F(Yt 4i}^ cm--i I.i"? S Or any :'i:l i:a..)tiai15=?Pi'('_� on, ti*i:•?a-ir1::}V I.+.::F't:.:: ` .)t.•":.. '..` , ':i.+ :}. 'ic> vatlid :L. i"� i C:F Y` _. iP:T:Y S` :i. fYi 1..4 Y}'k C7 i 'i� I_. %?ti C't::F f'YYY}4"i ::Y t'k t:i �• :, ]: t-a; t_i :�: r �s k. tit 17 � i 1' .. t (.. ! Y .1.::a I :} rm r n: �.t , r.:. ...� ., , y. t.y ... ..) ., t"" •a L H. '! " :-t ...: i : :::Y r i.l .i .t y ..y '1 .I .f. • .. .:�F e5F P' iPk .. i' i I:F` A L...I:I":'T STATI:DN IS I:l\lti;'Tir"11....I....EED 11\I AN i F:il_:f-1 COWEH'TZED BY 1'4C.:)( Ti-IEN (1) TIN L :l....E:"C: !_R I CI L.. F IE-R("1 -1- AND 111,13PEC; I" I: [M MlJIl --;]E)Ei1 (2) ,`• -,! T,l1 T!_..'T's IWI1:1.._1... 1\I01. BE:: AF:1::-,RCVE.D !.'JITHC:)L.l"l AN 1H.".1.E=C'I"F't:I:COAL. I:bl(ePELC::TICIN Fih:)'C11Fi'T',, i=1P,D (75) THE l:1.E'.C`-R1C`.(§l_ IrJ :�::: t°l!l:'1 Fri= I:)C:)I•l1: \' A I_.ME:::1�•SED Pa....E�C.'_I.RICO:1111\(. *:rT C:3I\Il:':.t.7 S:){1`1 .. � a. Jpf .r ... t.d E.. � 0 a ' V A P",I-'I....I: CA I ; BRO 11.11"::E-t;:_ RDE-3E; CO01\15"I"" ISSUED 13Y DATIE -- --..... _......... ..... ..............y,s� ._............. n MUNICIPALITY OF ANCHORAGE LI DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: /Li.eri iN �S/�/l�y.S l`,O/j S re6le4T/L)d ee.[ DATE PERFORM/ED: f> n 3 LEGAL DESCRIPTION: �GJOT �/V�� a7T �KG0AJ,6 J�IJB, �.fl�GF let,y`g i/A'14Gt T sl naF SITE PLAN 2 a 4 3 *; 4 , ' SP� PaOec Y f 2,O�j EC1 �SAHf�S, /j-0 6 %Icy Pe SITU 7 Date Gross Net Depth to Time Time Water Net Drop ■E■■■■■■■■ 8 y IR■■EME■■■N 9 i At79O VMS OWN r. � Ye 10 iffEve MEN °eo ° C 0 eases ee �e ee d Q� ow nce C. Lo er 1 Q 11 ✓ rV A6<,7 TOM Of:;'6C4 12 13 14 15 16 17 18 19 WAS GROUND WATER A'/( ENCOUNTERED? c>, IF YES, AT WHAT DEPTH? ■■■■■■■■■■ Date Gross Net Depth to Time Time Water Net Drop ■E■■■■■■■■ ®® iS% IR■■EME■■■N At79O VMS OWN iffEve MEN °eo ° C 0 eases ee �e ee d Q� ow nce C. Lo er 1 Q I■liIN ■I■■■■■■■■E NONE, Il��:yy-i■■ ■■■■ a°eeeeo�� M■�'..�\■■■■ �■ ■■■■MEN 7■ Reading Date Gross Net Depth to Time Time Water Net Drop ®® iS% nw~ OF AC At79O °0C �0e8e 8 Os 0o0e� °eo ° C 0 eases ee �e ee d Q� ow nce C. Lo er 1 Q p e ® 00 e AV tl���CoO s. etv a°eeeeo�� 20 I� "���. 't. PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTSA6,:51541Af416,N" Y7.1AXZ X4 - 7 ZZ: /S66t UcLa—OC' r E AJ J E% �Qil/t:D � SfE U"E4c�?.�) r'ElraeJ �/1 �LIR'FirlC,� // PERFORMED BY:��p"'E'J irlKr�� 1(',.Cl�/%/u/Ei _CERTIFIED BY: 7C�, IJl1G;��Fr�. DATE: C� 6t �3vao� 72-008 (6/79) W i. • 7 r te\` Municipality of Anchorag a 5 6 8 9 v 1p (7-' B v71 (7-'i- I On-Site Water and Wastewater Program RIM -1/4%.1k--..-4, (907) 343-7904 a Arra O8 20,E t . 111." Certificate of On-Site Systems Ap•A l`al h Parcel I.D.050-531-11 Expiration Date. Ali ^ l 1 1. GENERAL INFORMATION: Complete legal description EKLUND#1; BLOCK 2, LOT 6 Location (site address) _/.14/ `L.I. l to 4/-,,r (_)%‘.,� pv 431 e ie' 'v; A K ciis 1 Current Property owner(s) Colleen Hildebrandt Day phone 854-9632 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 4 I LIE Waiver Fee $ Date of Payment i{I$(1'1 Date of Payment Receipt Number 076q56 Receipt Number /� COSA# U 5Cf`z (l O/ Waiver# 0ar°I Y� l r 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: Gamess 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: ' I ,l e) In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and a000Op� industry practices. The reported results describe the condition of the system/s on the date/s of the a OF A l`Op4 evaluation. Separation distances were measured to readily identifiable features. Hidden defects or , � ."Y. t encroachments may exist that were not identified during the evaluation. The operational life of all wells47 and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 4�'" , 0 groundwater levels (that may fluctuate during the year), quality of construction (materials and j* .. 4• TH ,i,\ %..Y*00 workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and ,i D are outside the control of GEG. Satisfactory test results do not guarantee future performance of the i O system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of ii• Q the well or septic system. GEG makes no representation whether an alternative well or septic system 0 '..j. fri • Game Q can be installed on the property in the event either of the current systems fail to perform adequately in 0 ig • the future. The content of this report is for the sole benefit of the person/party that retained GEG to VA s CE �' c OO perform the evaluation. Reliance upon the information provided in this report by any other person or Q� o '•i.4 0•�'• 0)\4=-1 party (including subsequent property purchasers) is not authorized, nor will it confer any legal right 0� ea F o whatsoever. �� p�ofess�ooa � .0p1 -' ��#AetG884 6. DSJa SIGNATURE IC System #1 Approved for C( bedrooms System #2 Approved for bedrooms J`\ "' ►.,,�` Disapproved Conditional S` ON-SITEG� a approval for bedrooms, with the following s pule ti�R AND •. v WASTEWATER oz PROGRAM T cp\i\c' 0 IIP By: �1 ' Original Certificate Date: L ( Z --(? The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist 7( Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 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: EKLUND#1; BLOCK 2, LOT 6 Parcel ID: 050-531-11 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 3/12/85 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 134 ft. Cased to 134 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 3/12/85 4/11/2018 Static water level 55 ft. 59.3 ft. Well production 12 g.p.m. 5.2+ g.p.m. WATER SAMPLE RESULTS: Coliform!v)E Cr- colonies/100 ml. Nitratee')-c 1 g./L. Collected by: GEG, Ltd. Arsenic: N +) ug./L. Date of sample: 3/29/2019 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/H.D.P.E Date installed 7/8-9/2009 Tank size 1300 gal. Number of Compartments 2 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 9/29/2018 Pumper SANITARY PUMPERS C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE SOUTH/NORTH Date installed 7/8-9/2009 Soil rating 1p.d./fP'Or ft2/bdrm) 0.8 System type SHALLOW TRENCH Length 150(2 @ 75) ft. Width 5/5 ft. Gravel below pipe 0.50/0.51 ft. Total depth *2.6+ ft. Eff. absorption area 750 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/11/18 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0/0 in. Water added548/577 gal. New depth 0/2 in. Elapsed Time: 0/55 min. Final fluid depth 0/0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - *INSULATED PER 2009 INSPECTION REPORT; ON 3/28/2019 ALL CLEANOUT AND MTS WERE DRY D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at '• '• a er alarm level at in. _ . •• 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 117+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *MET CODE AT TIME OF INSTALL \'I- "- P t `' - P1-1-77A -I E'''T G. ENGINEER'S CERTIFICATION 4,40-K P.•••' . '•l.. �iv. I certify that I have determined through field inspections and • • �' e;).• review of Municipal records that the above systems are in * i conformance with MOA COSA guidelines in effect on this % �^ •I ' date. f rey AGorniss/43: Engineer's Printe Name JEFFREY A.GARNESS O. 1> ....... •CyE�79 3 .../c � Date • 1 41 • LICENSE♦,, IRI o `S`su 4. #AECC8B4 (Rev.10/12/12) • • SQ uE 8 •F Municipality of Anchorage P On-Site Water and Wastewater Program d • t i " (907) 343-7904 SAFETY Certificate of On-Site Systems Approval Parcel I.D. 050-531-11 Expiration Date: g7-7-1 1. GENERAL INFORMATION: Complete legal description EKLUND#1; BLOCK 2, LOT 6 Location (site address) 4441 Panther Drive*Eagle River 99577 Current Property owner(s) Colleen Hildebrandt Day phone 854-9632 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by• Date: 5-7'F/(8 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment s/ / l�? Date of Payment Receipt Number ottq Receipt Number COSA# O S C 15+ 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: if Igo), B o'' ' OF I, In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o� O F A 440 in accordance with the guidelines and regulations established by the Municipality of Anchorage and •.• .•.•• industry practices. The reported results describe the condition of the system/s on the date/s of the p P� • I d • v 9� evaluation. Separation distances were measured to readily identifiable features. Hidden defects or f' ' -*(�I) encroachments may exist that were not identified during the evaluation. The operational life of all wells �" . 4 • T. �/� and septic systems depend upon a variety of variables, including but not limited to, soil conditions, / Q groundwater levels (that may fluctuate during the year), quality of construction (materials and 4 Q workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and I•.. - • .d ... are outside the control of GEG. Satisfactory test results do not guarantee future performance of the / of e A. . ss,• system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of OQ 9 '. C —7053 BOO the well or septic system. GEG makes no representation whether an alternative well or septic system V 7 (PO can be installed on the property in the event either of the current systems fail to perform adequately in Q� •e 3`�I • �� the future. The content of this report is for the sole benefit of the person/party that retained GEG to p o �ed rofessOnaa perform the evaluation. Reliance upon the information provided in this report by any other person or "OOOoo�1 party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE /C System #1 Approved for bedrooms System #2 Approved for _ bedrooms .\-0 OF AJ - Disapproved QP Conditional approval for bedrooms, with the followi •\st• gl i�)iTE �,. WAjE�` Np z o WAg-[EWATER o •� pROGRAM n4'4�Arr c.�c�t�C'. ae13-7--- ---:_s__ (. Original Certificate Date: -----" 7- 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: COSA Checklist 7 -- 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: EKLUND#1;BLOCK 2,LOT 6 Parcel ID: 050-531-11 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 3/12/85 Sanitary seal (Y/N) ___ Wires properly protected (Y/N) YES Total depth 134 ft. Cased to_(ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 3/12/85 4/11/2018 _ r Static water level 1 5 S ft• 59.3 ft. Well production 12 g.p.m. 5.2+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate O.`1- mg./L. Collected by: GEG, Ltd. Arsenic: NO ug./L. Date of sample: 4/11/2018 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/H.D.P.E Date installed 7/8-9/2009 Tank size 1300 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout(Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A ut Date of pumping I , t / 1 Pumper s C. ABSORPTION FIELD DATA I*BELOW EXISTING GRADE SOUTH/NORTH Date installed 7/8-9/2009 Soil rating •.p.d./'i or ft2/bdrm) 0.8 System type SHALLOW TRENCH Length 150(2 @ 75) ft. Width 5/5 ft. Gravel below pipe 0.50/0.51 ft. Total depth *2.6+ ft. Eff. absorption area 750 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/11/18 Results (Pass/Fail) PASS For 4 bedrooms 548/577 Fluid depth in absorption field before test 0/0 in. Water added gal. New depth 0/2 in. Elapsed Time: 0/55 min. Final fluid depth 0/0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date - *INSULATED PER 2009 INSPECTION REPORT D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on"level at in. "Pump off'level at wa er alarm level at in. 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 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS "MET CODE AT TIME OF INSTALL vocimaik E OF 4• G. ENGINEER'S CERTIFICATION `P�•............. ' .••♦ certify that I have determined through field inspections and 49 i'k ••'* to review of Municipal records that the above systems are in •• conformance with MOA COSA guidelines in effect on this ••• date. A�' J•ff >, A ess 4/= Engineer's Printed Nam JEFFREY A.GARNESS �j�'J`,e. •• E-7 �•�� 41... Date q130 8 v.. pESSWP•� LICENSE 1 ""AV** #AECC884 (Rev.10/12/12) • — —PANTHER DRIVE — — 30' eke• S 89°51'30' E — — — --- 130.00' r� — _ •Fd 1/2' ' utility Esnt 10' Graved Dr1vt Rhr _ _1 — 17.6' Electric Esnt IIS' ` I / __L `P14 Bk 1243 i----555' IL Pg 0454 30' / Bk 1276 'r • I Gravel k ' 4.5'x5' • A.R.D. Deck m Stairs a 4, • FrarHe o �, Fuel House . oN,Tank o- r Pipes OO \ - '`4 KU r I 8'x10' M Stairs t ° Cu 6' o o • Chain Link Fence / b b O • 7 3.5'x6' 1).4. O Stairs Deck O • M 14' (U 3.3'x8'j t Stairs 14 Q rr up b vof 5 . • t 5 LOT 6 w . • m w CD CD CO . M co O • O a 0 CDO 1.3..t.Pe,ce ® O Z orr'0 • . • . Z LEGEND • • F ,!2' S 89°51'30° E 130,00' Fd ® Well Pipe CD Septic Pipe o Sewer Clean Out �`"""��11 =`�P�-.DF A/ 'II. ,1,i = *: 49i /\ ...*.,,, I hereby certify that 1 have surveyed the following described 9. .. / property:Lot 6, Block 2,Eklund Subd Addition# 1,Plat ; � '. Afithony P. Boneto:& No.71-115,Anchorage Recording District,and that no encroachments �/ c �� s '•• LS-10393 • exist except as indicated hereon. This As-built will only show the / . P -- it t17'0•o.LV 5./17•' . easements that appear on the recorded subdivision Plat No.71-115,and those r as recorded by Book and Page in the Anchorage Recording District; t I l tt. SS IcN0- .,: under no circumstances should this data hereon be used for the construction or establishing of boundary or fence lines. 0 20 40Eklund Subd.Addition ASBUILT SURVEY APB Land Surveying SCALE IN FEET Lot 6 Block 2 Gregory R&Colleen M Hildebrandt 4441 Panther Drive 12204 East Prince of Peace Drive 1"=40' As Depicted on: Plat No.71-115 Eagle River.Alaska 99577 Eagle River,Alaska 99577 Anchorage Recording District GRID: SE0702 (907)227-1361 rHR CHECKED Surveyed:May 5,2017 CRAFTED:R : MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # nen - h S3 1 1 HAA# WonQ(1i1aR 1. GENERAL INFORMATION// 11Complete legal description /,, /, Location (site address or directions) rl*o� Property owner la?, ') 'r 4�C'c--,US Day phone Mailing addresscl 2- y _5� i Y�9,vD 2 78 r.�od -Z S-�f3a 2 Lending agency P14P Day hone ®d opc 51c99 Mailing address Agent�G/'¢ o%cam �i- Day phone 6%foo Address �b600 - ,z�«t,� Da Zo/ 676L2L14r% 9957% Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: a- 3. TYPE OF WATER SUPPLY: Individual well Community well Public water pie -*54 -- 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 Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5°a3�9 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm_'' ` ') ��y� ag Phone 0� ¢l Address 4 C 7 6 ��,/�I ZCv �fkcU �r�/< A t_A-*,,=,a 99st � Engineer's signature ,! Y ! Date 6. DHHS:SIGNATURE _L— Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: -, ©tom 's M ice-} Date 4 1 192., 111Th 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. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ^ �T Parcel I.D. r�Lu�o Svc A. WELL DATA Well type EyeI0111'1 If A, B, or C, attach ADEC letter. ADEC water system )65>numbers Log present (Y/N) �> Date completed ��� Driller J4t"l ✓ �� i Total depth 13�41 Cased to f Casing height Sanitary seal (Y/N) yds Wires properly protected (Y/N)-`� m FROM WELL LOG AT INSPECTION z z `- n Date of test �� — ?�/o�9Z n c z Static water level C� m o < D Well flow % g.p.m. 9•P rpT7 ,`%`,' Cn_ Pump level I 7, ® < > O SEPARATION DISTANCES FROM WELL TO: z Septic/hefding-ta rk on lot 113 ; On adjacent lots A0 `" Absorption field on lot / i% ; On adjacent lots Public sewer main Public sewer manhole/cleanout Public sewer service line Petroleum tank' WATER SAMPLE RESULTS: Coliform Nitrate '�° Other bacteria Date of sample: Collected by: B. SEPTIC/MEll:BINS TANK DATA Date installed /��gJ Tank size `Z 's-0 Compartments Cleanouts (Y/N) (YL Foundation cleanout (Y/N) e-g��f Depression (Y/N) High water alarm (Y/N) �� Alarm tested (Y/N) :A ✓, Date of pumping SEPARATION DISTANCES FROM SEPTIC/kms TANK TO: Well(s) on lot i On adjacent lots Foundation 5`-lv To property line ---Absorption field 4442 Water main/service line Surface water/drainage 7z-026(R"•3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Manufacturer — Manhole/Access (Y/N) "Pump on" level at "Pump off' level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water Date installed �/ /Ss� Soil rating �� �0 System type Length 6 O Width 2 Sr Gravel thickness 5,01 Total depth St Total absorption area (Poo � Cleanouts present (Y/N) y Depression over field (Y/N) Date of adequacy test �B�r3 Z Results (pass/fail) rS for �' bedrooms Peroxide treatment (past 12 months) (Y/N) e6� If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot // On adjacent lots 106 7`- Property line //le t To building foundation ('T To existing or abandoned system on lot /VONT On adjacent lots Cutbank A/,)-.I;a Water main/service line Surface water IVo>✓6 Driveway, parking/vehicle storage area /540 Curtain drain {yoAf0 E. ENGINEER'S CERTIFICATION ,U6Ner I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature o••' .� Engineer's Name � � ' • � "� .. ' .� Date e David R. Dayton NO. 2205-E HAA Fee $ 1 7r7 °6YZ) Date of Payment 7 /a Receipt Number '23 Z Sz C__PoCO 72-026 (Rev, 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number D. R. DAYTON, P.E., R.L.S. HC 78 Box 1026 Chugiak, Alaska 99567 (907) '40 696-2417 July 9, 1992 ADEQUACY TEST Legal Description; Lot 6, Block 2, Eklund Subdivision Date Performed: July S, 1992 Septic Tank: 1250 gallon, 2 compartment, steel tank (DHHS Records) Absorbtion System: 60' x 5' effective depth trench (DHHS Records) Soils Rating: 150 sq. ft. per bedroom (DHHS Records) Daily Design Flow: 4 BR x 150 gallons/day/BR = 600 GPD Test: As the house has been vacant, the system was pre-soaked with 600 gallons of water. After 5h hours soak time, 905 gallons of water were injected into the absorbtion system in a 2 hour period. Results: The system accepted 1'h times the dailt design flow with a 1.5' rise in the monitor tube liquid level. The absorbtion rata was then monitored for 70 minutes. Conclusion: The plot of water absorbed versus time shows the system is currently functioning adequately for a 4 bedroom home. a 17034 Eagle River Loop Road ROBERT A. SHAFER Eagle River, Alaska 99577 CIVIL ENGINEER ** WELL FLOW TEST DATA SHEET ** 694-2979 PRO`JEEC`''1 S A• W ti -t -I -S TE. a� — r t -W � ,tA)E iNATE OF TEST: - Jam' )b '92 LOCATION OF WELL (Legal Description): L p -r uysue- 2 G�-,L_L o AD S�o WELLDEPTH: 17 Lo' FT. CASING:_ 1S4' FT. SCREEN: DATE DRILLING COMPLETED: '7' DRILLER: S J L %✓ 1 V c n •� STATIC WATER LEVEL (Top of Casing): 615 FT. DATE: s;' l D —qv CLOCK TIME ELAPSED TIME SINCE PUMPING DI STOPPEDD,, MIN. MIN. DEPTH TO WATER, FT. DRAWDOWNI RECOVERY PUMPING RATE, OPM REMARKS 12: ATO 0 lj �j (SWI) 0 0 Start 1 5 Lo ��� I Li"FiD S3 r' V rK S�ZF } F'vuv't(RI..i1„. 10 15 k: c> 20 25 30 35 22 40- 45 50 55 60 (1 hour) 90 120 (2 hours) -��' 'L'1' ?j 150 180 (3 hours) 213 747 240 (4 hours) gb' Zi' 573 , RECOVERY t 0 0 5 10 15 20 25 30 y5 — �........_ Comments: Flow is not Guaranteed Subsequent Variations Can OcOur. MUNICIPALITY OF ANCHORAGE k DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION t, DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date /"Z Y10/'O' 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) /oma e,(_ork. 7., g5]KL tinlA Location (address or directions) // 72ti�ort Owy 1-0 Ka ✓u �Zn�� �aH ,Qr- Zoo one 2v' elp2 _1i ce (b) Applicant Name DDR �� Telephone: Home Business X00 ` 385 Applicant Address 7 (p&'L t (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder K; Buyer ❑ ; Other ❑ (explain); - (d) Lending Institution 14K Telephone Address (e) Real Estate Company and Agent' Address Telephone (f) Mail the HAA to the following address: SFiB 196x Earle Dives, Alaska 99577 2. TYPE OF RESIDENCE Single-FamilyMulti-Family ❑ Other Number of Bedrooms r 3. WATER SUPPLY Individual Wel14 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. 72-025 (11/84) Page 1 of 2 5. ENGIMEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigatioii 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address S & S Engineering Date Alaska 99577 6. DHEP APPROVAL (Y) Approved for j4UC__ bedrooms b Approved -X-- Disapproved Terms of Conditional Approval Telephone Condition 11 cJhep CAUTION e Raba�1 A. 5hafms , 10.57-F Date 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 (11/84) MUNICIPALITY OF ANCHORAGE. DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION FEB 1 x;1986 A. WELL DATARECEIVED MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ��y- 6 F�du/vL Jib Well Classification �2IVg If A, B, C, D.E.C. Approved (Y/N) d Well Log Present (f j Date Completed 8� Yield 0, Total Depth z !/ Cased to yD r r Depth of Grouting uk Static Water Level 127•! Pump Set At Casing Height Above Ground !Z �r Sanitary Seal on Casing Electrical Wiring in Conduit6K Depression Around Wellhead KO Separation Distances from Well: To Septic/Holding Tank on Lot !�� i� ; On Adjoining Lots /DO To Nearest Edge of Absorption Field on Lot !do J, ; On Adjoining Lots !Db it To Nearest Public Sewer Line To Nearest Public Sewer r - Clean out/Man hole 'u To Nearest Sewer Service Line on Lot 3� Water Sample Collected by�j�����' ;Date Water Sample Test Results �7 Comments'<I-e_w Z, Z'9" s— w2rt/ �iv B. SEPTIC/HOLDING TANK DATA Z' Date Installed r G"g,N_ Size �TS"o No. of Compartments Z Stand pipes4qLNj' Air -tight Capsomr Foundation Cleanout6 l T Depression over Tank,F& Date Last Pumped Pumping/Maintenance Contract on File (Y/N) �Z4' ..—;for ~� X! Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: r To Water -Supply Well leaf To Building Foundation y% To Property Line /D ri- To Disposal Field s� r •- To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments c/t /Fii-.�- �/!s /S ad ,eon CN //1/ lksc ge 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Sb j32 Type of System Design �— Date Installed S GABS Length of Field (2a' CJ It Width of Field — Square Feet of Absorption Area Depression over Field elw) — Results of Last Adequacy Test Depth of Field Z Gravel Bed Thickness booStandpipes Present 0/w Date of Last Adequacy Test N/. Separation Distance from Absorption Field: To Water -Supply Well fapt To Property Line / To Building Foundation !2�:5 Lot To Water Main/Service Line 114 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments — D. LIFT STATION Date Installed _ Size in Gallons ; On Adjoining Lots If— To Existin or Abandoned System on I To Cutbank (if present) ^1 p� T 0 r4 - Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (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 and HAA guidelines in effect on the date of this inspection. S & 5 Engineering Signed x Date ZKr'%6 Companfagle River. Aladm225Zr MOA No. '8-r� 3 Receipt No. No Date of Payment Amount: $ LQ��LD� Page 2 of 2 72-026 (11/84( �� dF A.~ 4th IMF� i eA .09.509• 0*99*9t�a^ If PPP . .Oe alo ai. g1 'x. Mb+r1 A. Shuler �._ Me, 1457-6