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Home My WebLink AboutEKLUTNA HEIGHTS BLK 2 LT 7BMUNICIPALITY OF ANCHORAGE Awe Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 051 -061-69 Certificate of On -Site Systems Approval OSC261058 Expiration Date: 6/15/2026 Legal description EKLUTNA HEIGHTS BLK 2 LT 7B Site address 21635 SETTLERS DR Current property owner(s) HANSEN ERIK L & DEBBIE J _ The On-site system(s) is/are approved for bedrooms X Conditional approval for 3 bedrooms, with the following stipulations: 2 Comments or conditions: Septic system to be completed by June 15 2026. Original Certificate Date: 4/6/2026 ThEEent 6�icate On -Site Systems Approval (COSA) is intended to demonstrate the subject sysis/are in substantial compliance with municipal code. The Municipality of Anchorage, Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Absorption Field Advisory Tank Age Advisory Other Well Flow Advisory Nitrate Advisory Arsenic Advisory MUNICIPALITY OF ANCHORAGE On -Site Water and Wastewater Section CONDITIONAL COSA AGREEMENT COSA NOV— OSC261058 Ellutna Heights 2 7B SUBDIVISION: BLOCK ENEEMM&LOT; The buyer of the above referenced property agrees to complete all the conditions required on the Conditional Certificate of On -Site Systems Approval (CCOSA) issued by the Municipality of Anchorage (MOA) by the referenced date. Failure to do so will result in a daily fine of up to $300 every day after the expiration of the Conditional COSA (see AMC 14,,60,,030). Additional fees will be assessed for inspector's time associate with violations at $145 per hour (minimum one hour). The buyer,, once owner, shall bs. responsible for all violations on the property. Is contents, and acknowledge f am responsi Signature: (BUYER) have carefully read this agreement, understand its ble for compliance with Municipal Law. Buyer Name (Printed): ��.0 6 d b �+et>v %� STATE OF ALASKA )SSW THIRD JUDICIAL DISTRICT Date: 6 The foregoing instru ment was acknowledged before me this 16 day of V►1a*ch .20 2 - LO , Notary Public Sate Of AIN" My Cornmission Expfras DeC b, 2b28 jr NOTARY PUBLIC FOR ALASKA My Commission expires: Page 1 of 1 �-& 101&U COSA Checklist_May2025.docx COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: Eklutna Heights, Block 2, Lot 7B 051-061-69 Conditional COSA, see septic upgrade permit OSP251433 Conditional COSA, see septic upgrade permit OSP251433 COSA Checklist_May2025.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Phone Engineer’s Printed Name Date This is a Conditional COSA. The upgrade septic system will be completed after the property is sold. If the septic system is constructed in accordance with permit OSP251433, no separation distance waivers will be required. 18111 Preston Road, Suite 900 | Dallas, TX 75252 P: (214) 540-0966 | F: 866-205-6119 April 3, 2026 RE: 21635 Settlers Dr, Chugiak, AK 99567 Municipality of Anchorage (MOA) Conditional COSA Money Held in Escrow for Septic System Upgrade To Whom It May Concern, The Owners/Sellers of the subject property have held back $29,775.00 in escrow to allow the Buyer to close and record on the property and the Buyer understands completion of the septic system will be weather permitting but to be completed no later than June 15, 2026 by the Sellers contractor of choosing. Any funds left over from the hold back will be refunded to the Sellers and the Buyer agrees to cooperate with paperwork to be signed in a quick manner to allow for the refund. The money will be held in escrow until such time as a final unconditional Certificate of On-Site Systems Approval is issued by the MOA On-Site Water & Wastewater Program. ______________________________ signature Sincerely, Alyssa Adame VP, Operations and Programs Manager *Bond Department *Renovation and Construction (214) 540-0977 alyssa.adame@primelending.com Docusign Envelope ID: A1B77BF8-BCD6-429E-8C23-E575E6C88332 Addendum or Amendment to the Purchase and Sale Agreement This form authorized for use ONLY by active Real Estate Licensee Subscribers of Alaska Multiple Listing Service, Inc. Form 70718. Revised 03/13. 2022 Alaska Multiple Listing Service, Inc. (AK MLS) All rights reserved. Date____________________MLS #: ____________________1 In reference to the Purchase and Sale Agreement between: 2 ___________________________________________________________________________________, the Buyer(s), and 3 _______________________________________________________________________________, the Seller(s), dated 4 ____________________, covering the real property commonly known as:5 Address: ___________________________________________________________________________________________6 Legal (the Property): __________________________________________________________________________________7 the undersigned Buyer(s) and Seller(s) hereby agree to the following (check only one):8 Addendum – to be used when more space is needed on the Purchase and Sale Agreement 9 Amendment – to be used only when changing an existing Purchase and Sale Agreement 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 To the extent any provision of this Addendum/Amendment is inconsistent with the provisions of the Purchase and 27 Sale Agreement, the terms of this Addendum/Amendment shall control. 28 29 All other Terms and Conditions to remain the same.30 This Addendum/Amendment shall expire unless the party making this Addendum/Amendment is notified of its 31 acceptance no later than ________________________________(date) __________ a.m. p.m. (time). 32 Notification of acceptance of this Amendment/Addendum may be made only by one of the methods specified in the 33 paragraph titled ‘Acceptance/Notice of Acceptance/Delivery’ as contained in Purchase and Sale Agreement.34 35 Date: ____________________________________ Time: ______________________ a.m. p.m.36 Buyer Seller 1: _________________________ 2: ________________________ 3: _______________________37 38 Brokerage Licensee(s) . 39 The undersigned accepts the above Amendment/Addendum40 Upon execution by both parties, this agreement becomes an integral part of the referenced Purchase and Sale Agreement.41 42 Date: ____________________________________ Time: ______________________ a.m. p.m.43 Buyer Seller 1: _________________________ 2: ________________________ 3: _______________________44 45 Brokerage Licensee(s) . 46 25-13865 21635 Settlers Drive Chugiak AK 99567 Eklutna Heights L7B B2 ✘ Hiland Excavation has been paid for septic tank installation and new septic tank has been installed. Weather has prevented the drain field installation to be complete before recording. The Municipality of Anchorage has dictated that 1.5 times the amount of the highest bid is to be held back in escrow. The highest bid of 3 was in the amount of $19,850.00 from Anderson Contracting. Sellers agree to hold back $29,775.00 in escrow to allow the Buyer to close and record on the property and Buyer understands the completion of the septic system will be weather permitting but to be done by June 15, 2026. Any funds left over from the hold back shall be refunded to the Sellers and the Buyer agrees to cooperate with paperwork to be signed in a quick manner to allow for the refund. Sellers and Buyer agree Sellers shall choose which contractor of the 3 will finish the septic system install. Erik Hansen 11/20/2025 3/16/2026 n/a ✘ ✘ Keller Williams Realty AK Group Keller Williams Realty AK Group Jacob Oshesky Debbie Hansen Authentisign ID: D3145B35-8921-F111-9A49-000D3A4FF82ADocusign Envelope ID: 7BEFC160-4DA7-4437-8A55-EA30CD166673 3/16/2026 ALASKA QUALITY SEPTIC 12243 Center Street Eagle River, AK 99577 Client: Erik & Debbie Hansen 21635 Settlers Dr Chugiak, AK 99567 Project Description: Excavate and install three (3) trenches, each approximately 1.5’ effective depth (ED), 40 feet in length, and 5 feet in width. Connect new trench system to existing plumbing. Scope of Work Includes: • Layout and excavation of three trenches • Installation of trench materials as required • Connection to existing plumbing system • Backfill and rough grade Total Project Cost:$18,900.00 Price includes labor, equipment, and materials necessary to complete the work as described above. Any unforeseen conditions or additional work requested will be addressed via change order. Thank you for the opportunity to provide this quote. Authentisign ID: D3145B35-8921-F111-9A49-000D3A4FF82ADocusign Envelope ID: 7BEFC160-4DA7-4437-8A55-EA30CD166673 W e accept cash, checks or cr edit car d payments. Credit car d paym ents will be charged a 3% pr ocessing fee. If you choose to pay by cash or check that 3% will be removed. Page 1 of 2 Anderson Contracting & Environmental Septic, LLC 4601 T IMBER LUX CI R AN C H OR AGE, AK 99516 +19072232305 ac es .inf o907@gm ail.c om ac es 907.c om Es t imat e ADDRESS Erik & Debbie Hansen 21635 Settlers DR Chugiak, AK 99567 ESTIMATE 1263 DATE 03/10/2026 DATE ACTIVITY DESCRIPTION QTY RATE AMOUNT Drain Field Replacement Excavate 3 Trenches 5' wide and 40' long with effective depth 1.5' Trenches will be connected to existing plumbing 1 19,850.00 19,850.00 Exclusions * Contractors not responsible for damage to unmarked or unlocated underground utilities. Any damage will be repaired at owners expense.* ** If an item is not listed above it is not included in this estimate. Unless specifically agreed otherwise, in writing, the property owner shall be responsible for final grading areas depressed from soil settling.** *** Topsoil/Hydroseeding if either topsoil or hydroseeding is desired required it needs to be specifically mentioned in the description of the project above. Otherwise any material, time or subcontractors involved in providing these services will be added to final invoice. ****Price is subject to change per specific engineering design request and permit approval with the MOA. ***** Post installation surveys are submitted to engineer upon completed payment of final invoice. ****** Not responsible for weather damage or delays, for cracks or markings on any finished surface, owners personal property, irrigation, damage to underground storm drains or S.W.P.P 1 0.00 0.00 Authentisign ID: D3145B35-8921-F111-9A49-000D3A4FF82ADocusign Envelope ID: 7BEFC160-4DA7-4437-8A55-EA30CD166673 W e accept cash, checks or cr edit car d payments. Credit car d paym ents will be charged a 3% pr ocessing fee. If you choose to pay by cash or check that 3% will be removed. Page 2 of 2 ******* The most current estimate null and voids any previous estimates. 50% Due before work begins. 50% Due within 15 days of final invoice unless otherwise agreed upon. A fee of 1.5% per day of the remaining balance will be applied to the invoice until payment is made. Legal fees above and beyond $250.00 if invoice is not paid within 30 days of receiving an invoice will be added to unpaid amount. Mail pay m ents t o 4601 Tim berlux C ircle, Anc horage, AK 99516 * C ont ract ors not respons ible for dam age t o unm ark ed or unlocated underground utilit ies . Any damage w ill be repaired at ow ners ex pens e.* ** If an item is not lis t ed abov e it is not inc luded in t his es t im ate. U nles s s pec if ically agreed otherw is e, t he propert y owner s hall be respons ible for f inal grading areas depress ed f rom s oil s et tling.** ***Pric e is s ubjec t t o change per specif ic engineering design reques t and perm it approv al w it h t he M OA.*** 50% D ue before w ork begins. 50% D ue w it hin 15 day s of f inal inv oic e unles s otherw is e agreed upon. If final payment is not receiv ed wit hin 15 days of f inal inv oice. A fee of 1.5% per day of the rem aining balanc e w ill be applied t o t he inv oice unt il pay m ent is m ade. W e ac cept c ash, chec k s or c redit c ard pay m ent s . C redit c ard pay m ent s will be c harged a 3% fee. TOTAL $19,850.00 Acc epted By Acc epted Date Authentisign ID: D3145B35-8921-F111-9A49-000D3A4FF82ADocusign Envelope ID: 7BEFC160-4DA7-4437-8A55-EA30CD166673 Page 1 of 1 Hiland Excavation LLC 10147 C handalar St # B Eagle R iver, AK 995778360 US hilandex cav at ion@gm ail.c om INVOICE BILL TO HANSEN ERIK L & DEBBIE J 21635 SETTLERS DR Chugiak, AK INVOICE 1175 DATE 03/10/2026 TERMS Due on receipt DUE DATE 03/10/2026 DATE ACTIVITY DESCRIPTION QTY RATE AMOUNT Services Install septic system as per engineers design. To Include: -1 Zoeller 173-0001 True flow splitter - Three 1.5'ED x 5'W x 40'L absorption trenches as per design -Waterline Locate -Test hole prior to construction Any vehicles or objects located within the worksite must be removed prior to the commencement of work. If the customer requires assistance with removal, this service can be provided for an additional fee, to be agreed upon in advance. 0.50 31,650.00 15,825.00 Disclosure **Any Design changes will require a change order** **Landscaping and excess material haul off is not included in this quotation. ** ** A Landscaping contractor will be recommended upon request. ** * Contractors not responsible for damage to unmarked or unlocated underground utilities. Any damage will be repaired at owner's expense. * 1 0.00 0.00 BALANCE DUE $15,825.00 Authentisign ID: D3145B35-8921-F111-9A49-000D3A4FF82ADocusign Envelope ID: 7BEFC160-4DA7-4437-8A55-EA30CD166673 Permit Number:OSP251433 Tax Code Number:05106169000 Work Type:Septic Upgrade Effective Date: Design Engineer: Site Legal Address:EKLUTNA HEIGHTS BLK 2 LT 7B G:1461 Owner:HANSEN ERIK L & DEBBIE J Site Mailing Address:21635 SETTLERS DR, Chugiak Lot Size in Sq Ft:71748 Total Bedrooms:3 This permit is for the construction of: Disposal Field Septic Tank Holding Tank Privy Non-Public Water Well 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. Coodinate with On-Site staff regarding preferred method. 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 12/29/2025 12/29/2026 CREWDSON ENGINEERING, LLC Special Provisions: A test hole is required at the proposed disposal field location during construction to confirm separation to impermeable soil and seasonal high groundwater and to verify the proposed design depth. Construction may proceed at your own risk before completing the 7-day groundwater monitoring. If results require design changes, work must stop until a change order is approved. Submit all test hole results with the inspection report or change order, as applicable. Expiration Date: þ þ ¨¨¨¨ Issued To: Issued By: Date: Date: 12/29/2025 12/29/2025 CREWDSON ENGINEERING, LLC Isatou B Njie MUNICIPALITY OF ANCHORAGE On-Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On-Site Wastewater Disposal System Permit James Jay Crewdson, P.E Email: CELLC.1@outlook.com Cell/Text: (907) 280‐9493 PO Box 671389 ● 18368 Amonson Road ● Chugiak, Alaska 99567 December 24, 2025 Municipality of Anchorage On‐site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99519‐6650 Attention: Curtis Townsend Reference: Eklutna Heights, Block 2, Lot 7B Septic System Upgrade Design Narrative The owner is preparing the subject property to be put on the market for sale in 2026. The existing documented septic system failed a recent COSA inspection and will need to be upgraded. The existing septic tank will be removed in accordance with the code and the existing drainfield will remain in service by means of a diverter valve between it and the proposed drainfield. The proposed drainfield design is based on prior soils tests located both on and off of the subject property. The proposed total drainfield depth is at least 6 above the deepest soils logs found in the nearby area (see attached Eklutna Heights B2 L7B Old Soils Logs). The proposed design requires soils testing prior to construction to verify the design. As such, we are requesting the proposed design be permitted with a condition added to the permit cover sheet requiring soils testing prior to construction to verify the design. The proposed 3‐bedroom septic system is detailed on the design drawing. If constructed as designed, it will; Satisfy all code required separation distances, Not cause any probable adverse impacts to adjacent properties, Not negatively impact existing wells and septic systems on adjacent properties, Not be adversely affected by potential drainage that could flow onto and off of the subject property. Please feel free to contact me for more discussion. Thanks James Jay Crewdson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251433, Isatou Njie, 12/29/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251433, Isatou Njie, 12/29/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251433, Isatou Njie, 12/29/25 Eklutna Heights #1, Block 2, Lot 7B 21635 SeƩlers Dr Local Soils Tests Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251433, Isatou Njie, 12/29/25 Lot 7B, Block 2, Eklutna Heights Subdivision Land Surveying Land Development Consultants Subdivision Specialists Construction Surveying 610 E 5th Avenue Anchorage, Alaska 99501 (907) 306-8104 mail@S4AK.com AKCAN 173042 Group S4 As-Built 0 50' GRAPHIC SCALE 12/15/2025 · Municipality of Anchorage Page I of ~-- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: :~'('~ c~~ O ~'"''/(~ PID Number: ~i -~1 Name: LO~Ai~ [~ ~m~oc~ Wastewater System: ~ New ~'Upgrade Address: ~o ~L~ ~ k~,, k~ ~ ABSORPTION FIELD Phone: ~S--~ ,o. of~drooms:~ ~ Deep Trench ~ShallowTre~ch ~Bed ~Mound DOther LEGAL DESCRIPTION so~ Rating: O. ~ GPD/Sq. Ft. Total Depth fro~o~iginal grade: Lot: ~ ~ Block: ~ ~Subdivbi°n: ~ ~l~ Depth to pipe bo~om~, ~fr°m~ odginal grade: Ft. Gravel depth ~,beneath~ l pipe Ft. Township: Range:~ I Section: Fill added abovel, ~l°rigin~l_ ~grade: Ft. G r~ve]~ ~length:~l~ ,~ ~1 Ft. Number of lines: Distance ~n lines: WELL: EKI~New ~ Upgr~' Gra~e, width: Z.~I Ft. ~ {~' Ft. Classification~ ~(Private'~u~i~A'B'C): ~ ~Ft. Cased To: Ft. Total absorption~oarea: SQ. Ft. Pipe~material: O Driller:~ Date Drilled; Static Water Level: Installer: Date installed: ~ GPM Pump Set at: Ft. Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding )ublic/Pdvate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ C ~ ~GE ~ I 00 Number of Compa~ments: Wel~ ~t~ i~ ~ __ Z~l~ Material:~e~ Sudace Water IOOl.+ iool+ ~ -- _ LIFT STATION Lot ~t Sizein gallons: Manufacturer: Line ~ + I0 I~ Cu~ainDrain ~ ' ~" ~ ~ ~ ~ P~lectrical Inspections pedormed by: Remarks: BENCH MARK ,Location and Description: E N~~AL .... ~,.~,~:~,N~ Dates: 1st Iz-zo-'lG ~ ,~~._~:._ Inspections pedormed by: ~ ~ '; '%' ' ' ~""~'~'"~'/'"~ E~e [~tver, AlaSka 99577 *i,~ CE-8~01 Depa~ment of He approval ',," ..." .... Reviewed and approved by: ~~ ~' / ~ ~ Date: /-2~-~ ~<~,~'-".-~"~-~,<~<.~.~ 72-913 (Rev. 9/91) MOA 25 SW960579 2 2 Permit No. Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 7B, BLOCK 2, EKLUTNA HEIGHTS S/D PIDNo.: 051-061-69 I k B ~ INSTALLED rL W .T~ ST1 1 .0' 15.5' ~/p)' ~ DIVIDER COZ ~_ DDmO~ ST2 2: .0' 1 9.0' ER(;. TEST o.s' s~. 001 2( .0' 30.0' ~%NEW I000 GAL C02 5~ .0' 57.0' SEPtiC TANK MT1 5; .0' 40.0' ~W~ ' ~- . C03 21 .0' 54.0' % . ATH I % ~' .g' ~.g' 3 BDRM ~w~ GtRAOE H ~USE ~w~ WAT R LINE~ (APPE)X, LOC,) 8G~ 1" = 40' ST1 ~INS[ ~TION 6~~ N~W ' 1000 GAL ~4'TAN~SEP~[C ' ~ = ~ ~ ~ = ~' 96 MT2 C03 ~, CO1 "' I1~~-- ~ co~ = 5.a' cos = a~.l' ~T1 = 8!)4' MT2 = 89.2L NC WATER FOUND 83.2' B.O.H. 72-O13 A (Rev. 9/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX.196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960379 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HAMMOCK LORAINE J OWNER ADDRESS:21635 SETTLERS DR CHUGIAK, ALASKA 99567 PAGE 1 OF 1 PARCEL ID:05106169 DATE ISSUED:12/18/96 EXPIRATION DATE:12/18/97 LEGAL DESCRIPTION: EKLUTNA HEIGHTS BLK 2 LT 7B LOT SIZE: 71748 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY: ~'~/ DATE: /~-// ~ /~/~ DAT .: / :Z -- ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. CIVIL ENGINEERS December 2, 1996 (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 7B, Block 2, Eklutna Heights Subdivision Request you issue of a permit to upgrade the septic system serving the three bedroom house on the referenced property. Due to high nitrate levels, the existing well is to be permanently abandoned according to water well ordinance AO N0.96-98(S) (amended and approved S-13-96) and the existing house will be connected to a Community Water System. A test hole was excavated and percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered and after seven day ground water monitoring, the monitoring tube was found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Cowan, RCC/gk PoEo Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 LOT 9A PIONEER STREET ~ ~ ~ ~ ~ 0 ~ ~ ~ ~T~~ ' AS PER OCCUPANT az Z ~ / ~ ~ / / PERFORMED FOR: LEGAL DESCRIPTION'. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST c, ,~,,.,.- 1 2 3 7 8 9- 10- 11 12 13- 14- 15- 16 17, 18- 19- 20- ~jS~'"C'zttv~OCJ~.~'- DATE PERFORMED: I -~m"O ,..~'~ o ~/.~/~,'[~wnship, Range, Section: - ~.-~ , SLOPE SITE PLAN WAS GROUND WATER ~ l~) ENCOUNTERED? DEPTH? ~. pO E Depth to Water Alter Monitoring? --'"'-- Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN "~ COMMENTS ~0 .~13) TlO~ ,,CZ.. P~,'~¢~, ~L,4 7/~' 7'~ $' 7- (minutes/inch) PERC HOLE DIAMETER __ FT AND (.~ FT / 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: Uq 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15- 16 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~ '~ ~ [~T..ownship, Range, Section: SLOPE WAS GROUND WATER . [~ ENCOUNTERED? L DEPTH?IF YES, AT WHAT ,A' pO E SITE PLAN Deplh tO Water,~.r), I MonitorinD? ~ Dale: Gross Net Depth to Net Reading Date Time Time Water Drop ~1 " ~ '1'~ 1," PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER ~ TEST RUN BETWEEN ~'~ FT AND ~ '~ FT COMMENTS PERFORMED BY: .~A.~.~ ~..I.m.' .... ] .._..~ D...I kl. et~l I/----- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE W~I~L~ff~I~PAL GUIDELiNES IN EFFECT ON THIS DATE, DATE: / ~ /~ q ~ 72-008 (Rev. 4/85) G£;-'~TER ANCHORAGE AREA BOROI)~H D~.,RRTMEBIT OF ENVIRONMENTAL QUAL / 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ADDRESS //~'~ LOCATION ,/~//':~/~ ~U/~ ~'~=: ~'-'~Z~z~' ~=~LEGAL DESCRIPTION ~'~ '7// SEPTIC TANK: DISTANCE FROM WELl LIQUID CAPACITY MATERIAl ,,,~'''/~= Z:-z/~ NUMBER OF ~ COMPARTMENTS ~2Z~(.l//(~'~-j'~=~ /~ ~('~/ //' //'¢'{{']/J'/'/~J~'- LIQUID GALLONS. INSIDE LENOTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: , DEPTH ' NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH , LENGTH NEAREST LOT LINT TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) TILE DRAIN FIELD: ~ , F- NDATION NEAREST LOT LINE DISTANCE FROM WELL O~ , NUMBER OF LINES // DISTANCE BETWEEN~ TRENCH WIDTH DEPTH: TOP OF TILE TO FINISH GRADE DEPIH OF RIAL-B,EI~EATH-IIEE~ TOTAL LENGTH , OF LINES / I~TOIAL EFFECIIVE IN. ABOVE TILE -- DISTANCE FROM / WATER j~.,/~/~/~:- , NEAREST WELL: [ypEz~.~/J/ DEPTH , BUILDING FOUNDATION._ ,~2~)'- SAMPLE NEARES1 ~ SEPTIC / SEEPAGE . ,' OTHER LOT LINE (~>-~'//.. -' ~'~ ~'~ SEWER LINE TANK ))~'-~ . SYSTEM ./'~6 . CESSPOOl -~ . SOURCES DISTANCES: _~<,,' ~ -/~/ B AGRAM OF SYSTEM APPROVED ' G~.A.B. GREATER ANCHORAGE AREA BONOUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCh 6-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279~8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION Of: SEPTIC TANK ~ SEEPAGE P1T.~ ., DRAIN ~IELD OTHER FINAL INSPEC:TION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJEC:T TO pI~OSECUTION. DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK .,SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN fIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK SEEPAGE PIT TO RIVER, LAKE, STREAM. DRAIN FIELD DRAIN FIELD · SEEPAGE PIT , ALSO CONSIDER AREA WELLS. , SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING (~AP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTight REMOVABLE CAPS. .//v - ~ HE.~,L/Th aUthOhITY ~/ I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICA"T'SS'G"AT"RE .(~ ' 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 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ]'.ot 7]3; Block 2; Eklutna Be'iqht~ LocatiOn (site address or directions) 21635 Settlers Drive Chuqiak, AK Property owner Mailing address LOrraine Hammock 8660 Williwa Avenue Anchorage, Day phone AK 338-1811 Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. ~. . TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer 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 m 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 in. dicated 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 wastawater 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 S & S ENGINEERING 17034 Eagle River I. oop Road NO. 2~ Address Ea~lle River, ~Ala,ska 99577 Engineer's signature ~,~Z_ Phone Date / /~; / ~ 7 DHHS SIGNATURE 'X Approved for ~,D Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Co'des. There are nitrates present. It is ~,,~d f'hnt ,,:J .nartnd~c testin~ be performed to insure the Wells continued suitability. Nitrate concentration is 5.1 mg/1. EPA · ~;.~--..~ ........ -~^. ~ Inn ~g/] --. : . ? ' .~ :: '. Th~ Uunici~ll~ of ~nchomge Dep~ment of Health ~nd Human Se~ice~ (DHHS) I~ues Health Authori~ ApproVal. ~... C~ifi~t~"b~S~,,,. only upon the mpre~en~tions g ven n p~mgmph 5 ~bove by ~n nde~ndent prof~mnal engin~r reglster~ In the State of Alaska. The DHHS does this ~ ~ cou~esyto purch~m of hom~ ~nd their lending In~titutlon~ in order to ~tls~ ceftin f~eml ~nd ~Mte r~ulmmen~. Employ~ of DHHS do not conduct tn~pe~ion~ or ~n~l~e d~t~ before a oe~ifi~te i~ i~uM. The Uunicipali~ of Anchorage is not r~ponsible for errom or Omi~ion8 in the pr°fe~ional engin~ wo~. 72-(~6(Rev, 1/91) Back MOAiY21 D. LIFT STATION Date installed Size in gallons ~ Manhole/Access (Y/N) "Pump~'Pump off" level at* High water alarm level at*..._~'~'/*Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main S~ Lift station SEPARATION DISTANCES FRO~OLDING TANK ON LOT TO: I FoUndation ~ Property line . ~ol..,+ Absorption field Water main/service line I o I.f..Surface water/drainage ! co14' Wells on adjacent lots On adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line - I O Building foundation I o I-I' Water main/service line Surface water . I o ~ ! -f-~ Driveway. parking/vehicle storage area Curtain drain I~ /~ ,, Wells on adjacent lots I 6'o R ENGINEER'S CERTIFICATION *..~ I certify that I have determined thru field inspections and review of Municipal records ,n conformance w~O~_ HAA g~el~ ln_ effect on thls date. Signature Engineer's Name ~z~,e~ ' ~". Date Waiver Fee $ Date of Payn~ent Receipt Number HAA Fee $ t7~z~' ~) Date of Payment C)//C)'7/~'~ Receipt Number '~ ~-4 7 72-026 (Rev. 3/96)* EXCAVATION ROBERT A. SHAFER WORK CIVIL ENGINEER 694-2979 March 26, 1983 James Christian 4101Wispen Circle ~A Anchorage, Alaska 99503 Dear Mr. christian, MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMFNTAL PROTECTION APR lg83 RECEIVED Reference: Lot 7B: Block 2: Eklutna Heights Subdivision A sewer system adequacy test was performed on the system located on the referenced property, as you requested. The septic tank had been v~ to have a capacity of 1.~LS~ gallons during a previous adequacy test performed by this office. At the time of this test the septic tank was empty and did not require pumping. The seepage pit was tested by charging the system with approximately~_SQQ gallons of water and after a period of 24 hours all the water which had been added to the crib had percolated out. It can be concluded from this test that the waste water disposal system serving the four bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failures. The standpipe in the seepage pit needs to h~ ~w~nd~ until it extends above the surrounding soil. It should also be noted that a water sample was taken from the hose bib on the back of the house and an analysis performed by Chemical and Geological Laboratories of Alaska. The results of this test indicated that the water sample was satisfactory. If we may be of further service, please do not hesitate to contact US. Si (....-ff'/RO~E, RT A. SHAFJZR, P.E. sZss 'cc: Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA ' O~ ~.. ~ RECEIVED ' ' ,NSPECTIONAPPOINTMENTS' T~ TiMi=' TIME DATE DATE DATE INSPECTOR MUNICIPALITY OF ANCHORAGE ,MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTEC:TtOI'~ t~I [~i~) ENVIRONMENTAL SANITATION DIVISION FEll P, 4 1981 .~ Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER . -~o~c~(c~ .;c/~t~/cL(/ P.O.E P.~IP.".qT'. n.o~u=~ I ~1~ olrterent trom abovel PHONE 2. ~'-u'~ ~.;~ ~ PHONE MAILING ADDR ES/~ M/~LI NG ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS LLEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~UMBER OF~EDROOMS ' ~ One ~ Four ~ Other ~ SINGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY ~1 PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ,..v. ,,, ~ .. THIS SIDE FOR. OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX · : PERMIT NUMBER 2. WATER SUPPLY [--I ~INDIVIDUAL : .~ . . .- DEPTH OF WELL [] COMI~UNITY ' ..: DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. sEwAG~E DI~OSAL 8Y6T, EM PERMIT NUMBER [] iNDIVIDUAL/ON -SITE DATE INSTALLED [] PUBLIC UTI LITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size:, If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Absorption Area to, nearest Lot Line 5. C(~MMENTS I~APPRoVED FOR ~EDROOM$ ' [] CONDITIONAL APPROVAL (letter mu~"~cco~npan2rE6~ificate) 72-010 (Rev. 6/79) Fobruat:y 27, "~ Rona]d Sc:hu].dt: 3301 Gl. cnn Don Anchor:aqe~ A]a~:dca 99501 Subject: Lo{: 7B B](cx 2 Eklutna NeighLs Subdivi ~ion Approval for your J. ndividual sewor and wat:e.]: fac~l]_Ll-. cannot be granted until the [ollowing :items have been 2' completed: ~~(]) The war. er analysis report: needs {:o be del [,./ered [:o "~.',~' this office from l:he Chem Lab, 5633 B .~...~.ec.L, / O~lr review. (2) LocaLe and expose f-he well for our inspection lhz, is Lo det:ormine proper cons[:.r~lo[:J, oI1, al. so W(.. min:imum distance roqllJ.r(llR(lrlils are llletl bel. tw(~en Locat:e an~ expose t:hc st:andpipes t.o l:]lc ~(:w..]. for our j. nspecl:.:ion. Please nok.ify t:his del)arLmenh :flor a reinsp(:ction when the noted descrepancies have been correct/.ed~ ~f there are any further questions pt=a .... call this office at 264-4720 Sincerely, ReP / ]. j w c e: A].aska PacJ fic Narlk Mort:gage Ix>an Deparl:menb Post Office Box 420 995].() DAVID A. SLENKAMP ROBERT A, SHAFER MECHANICAL ENGINEER 694-9055 February 1, 1981 CIVIL ENGINEER 694-2979 MUNICiPADTY Of: ,.~,NCHORAGE. DEPT. (ct: i: ~ ~ c~ ENVIRONiv'~ ,i: , ,:CT/ON James Christian SRB 70 Pioneer Street Chugiak, Alaska 9956? Dear Mr. Christian, Reference:' Lot 7B; Block 2; ~lutna }{eights Subdivision RECEIVED A sewer system adequacy test was performed on the system located on the referenced property as you requested. The seotic tank was pumped and verified to have s capacity of approxilm~tely 1250 gallons. The seepage pit was charged with 1000 gallons of fresh water and after a period oD 2~ hours all the ~mter added to the crib had percolated out. It can be concluded from this test that the sewage system located on the referenced property is currently functioning adequately for the four bedroom residence. If we may be of further assistance, please do not hesitate to call. Sincerely, ,// ? / / ,¥ t 4~ '~' ~- ~_C.~' ' / ~ Z - ~RDBERT A. ~FER, ~,,~S/s s ,, cc: ~nioipali%y of Anoho~a~e Depar%men~ of Heal%h and Envio~nmen%al Pro%cc}ion &lasks Pacific B~nk ATTENTION: Betty High Ronald Schuldt SRB 196X EAGLE RIVER, ALASKA EAGLE RIVER AREA GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality "C" Street, Anchorage, Alaska 99503 274-456i Date Received March 7, 1977 Time of Inspection Date of Inspection 3-9 ~ / REQUEST FOR APPROVAL OF ~-Ke~n INDIVIDUAL SEWER & WATER FACILITIES ' - ' FOR ):t0 a.m. 7 Wednesday 4. 5. 6. 1. Approval requested by: First National Bank of Anchorage Mailing Address: Post office Box 720 Phone: 276-6300 2. Property Owner: Ronald J, Schuldt Phone: 688-2569 Mailing Address: DQ~ .20 Pioneer Street, Chugiak 99567 Legal Description: Lot 7B Block 2 Eklutna Heights e Location: See map Type of facility to be inspected Sinqle Family Well Data: A. Type Individual C. Construction Sewage Disposal System: On-site system A. Installed B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line e No. of bedrooms 3 B. Depth 80' D. Bacterial Analysis 2. Manufacturer , Absorption area , Other contamination 2. Material , Sewer Lines ..., , Absorption area EQ-034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES I~NVFC, ONMr~H h \L L4AR 7 - 1. Type of Inspection: CMRO VA FHA CONV 2. Property Ow.er: Mailing Address:-~0 3. Name of Buyer: Mailing Address: Day Phone: Name of Lending Institution: F~'7- /'-/~'-)' [ 0 ~ ~ ~' ~r ~l< Mailing Address: ~/~r-! ~J (~/~/c~¢ ~ Phone:_ 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: ~- O 1- Location: Phone: .r 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Public Utility No. Bdrms. 3' ,Individual If Individual, number of dwellings presently served If Individual, depth of well ~-0 ~ Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76) Pag~ 2-of two pages - R .~st for Approval of Individual ~egal Description Lot 7B Block 2 Eklutna Heiqhts er & Water Facilities Comments Approved~. ~A~o~ Disapproved Date ~--~ I ~,77 Approvals}al id for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a l~rue and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)