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Home My WebLink AboutEKLUTNA HEIGHTS #1 BLK 3 LT 22.0 L ()a Anc. k -'L V` S\- 0tDl- 30 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231017 PID Number: 051-061-30 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ®Upgrade Name PHILLIP & SHAYNA GREEN ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound ❑ Other Site Address 24430 CHUGIAK DRIVE, CHUGIAK Phone Number of Bedrooms 3 Soil Rating GPD/SF Total depth from original grade Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot EKLUTNA HEIGHTS #1 3 2 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area Ftz Number of trenches Dist. between trenches Ft. Well 200'+ -- 255'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+-- GREER 1000 Gal. Material Number of compartments Lot Line 10'+ __ NA HDPE 2 Foundation 10'+ __ LIFT STATION Manufacturer Capacity Remarks Tank insulated. Gal. Alarm location Electrical installed by Installer GREEN GENERAL CONTRACTING PIPE MATERIAL House to tank 3034Tankto d a afield 3034 Drainfield CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdection 1" 3/23/2023 2 ,3/23/23 Location and description 3`d 4`h BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: DateTH �.� OF A `��Q"�`. •' ` • r - •.* % •• •• •••• ••••••••••k �� •• . Curtis Huffman f��c�s��C9•.331CE 28021•.�A10' F�pROFESSI l�iON�Amw \ OFESSI � Septic Syste Approved - Date 4 2�z3 Note: this approval does not include well permit requirements. k.- V01U4110) PID:051-061-30 PERMIT:OSP231017 FIRST WATER CONSULTING EKLUTNA HEIGHTS #1 BLK 3 LT 2 W000er Loi CHUGIAK DRIVE L Lot 4 .ot FENCE NOTES: 1) DUE TO SNOW & ICE COVER. — — — SOME SURFACE LEVEL FEATURES ARE APPROXIMATE. 2) THE LOT IS SERVED BY A PUBLIC WATER SYSTEM. PLOT PLAN __— AS BUILT _x_ SCALE 1"_= 50_ GRID _ NW 1461__ Project No.—_--23=106f_A1____ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in Ci . (907) 522-6476 Phone `"� kenOlongsurvey.com �09 � Professional Land Surveyors jonathanolongsurvey.com ��OFAtq\l,, trovisOlongsurvey.com r e, ,S` , I hereby certify that I have surveyed the following described property: LOT 2, BLOCK 3, EKLUTNA HEIGHTS SUBDIVISION — ADDITION No. 1 (PLAT No. P -215A) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the _=_H+ _ Day of --- ��L-------- —= __, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. *' *. 49TH KENNETH .LAN ,' Q. ',Fcf •. 0.1202 ,•'J� A fF9FOp•��1�'�'ND`'�i �i►`R0 ESSIONA��a � State of Alaska AECC963 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 Permit Number: OSP231017 Work Type: SepticTank Upgrade Tax Code Number: 05106130000 Site Legal Address: EKLUTNA HEIGHTS #1 BLK 3 LT 2 G:1461 Site Mailing Address: 24430 CHUGIAK DR, Chugiak Owner: GREEN PHILLIP D & SHAYNA D Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: D C I) al. till C n t 2/23/2023 2/23/2023 2/23/2024 26127 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private 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. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing S (J _ I� Received By: 1 �C— Issued By: _ Cw_� Date: Date: Z- 2 2- 3 MUNICIPALITY OF lie Development Services Department On -Site Water & Wastewater Section ANCHORAGE ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 051-061-30 Property owner(s) PHILLIP & SHAYNA GREEN Day phone Mailing address PO BOX 671754, CHUGIAK, AK 99567 Site address 24430 CHUGIAK DRIVE, CHUGIAK, AK 99567 Phone: 907-343-7904 Fax: 907-343-7997 Legal description (Sub'd., Block & Lot) EKLUTNA HEIGHTS #1 BLOCK 3, LOT 2 Legal description (Township, Range & Section) Lot Size 26,127 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank ElUpgrade 0 Duplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ignature of property owner or authorized agent) Permit/Rush Fees: A `q5 - Date of Payment: ` a2 3 Receipt Number: q O t' oZ 0 Permit No. a�3lU11�1 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! February 17, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: EKLUTNA HEIGHTS #1 BLOCK 3, LOT 2 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. We would recommend a 1500-gallon HDPE tank be installed for functionality and future consideration or flexibility. No impacting groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank may be required. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231017, Curtis Townsend, 02/23/23 FIRST WATER CONSULTING EKLUTNA HEIGHTS #1 BLK 3 LT 2 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231017, Curtis Townsend, 02/23/23 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� '71n PHONE EN( ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATIONf �n / ` k NO. OF BEDR Q. MS 7Z Uy DISTANCE TO: Well Absorption area, ✓ j Dwelling PERMIT NO. a Z LU Manufacturer Material No. of compartmts y Liq.capacity in gallons x, IF HOMEMADE: Inside length Width Liquid depth 6 y Joz DISTANCE TO: Well Dwelling PERMIT NO. ❑ Z x r Q Manufacturer Material Liquid capacity in gallons ❑ w x DISTANCE TO: Well tC_ f, Foundation Nearest lot line PERMIT %�Q J LL Z Zw �—¢ No. of lines Length of each line q Total length of ejs O Trench wi th inches Distance betweenry}, �I�'n Nxt, < F.. ❑ Top of the to finish grade � _ Material beneath the r iaekes Total effective absorption area [f-6 W Length Width Depth PERMIT NO. c� Q F wa Type of crib Crib diameter Crib depth Total effective absorption area ui N DISTANCE TO: Well Building foundation Nearest lot line J J Class L Depth Driller Distance to lot line PERMIT NO. W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE ATER -e K%LS��, /f SOL TEST RATING /3S INSTALLEF REMARKS , i _ APPROV D DATE LEGAL 79-013 (Rev. 3/78) \ 1 ��r-j I v::� I 1:=� " �� DEPARTMENT '-^ HEALTH AND ENVIRONMENTAL r?OTECTION . , 825 /� STRE�T/ ANCHORAGE, AK. �� 1 ) . 264-4720 � ' / IF- F"EF- F-�"rl I~r* PERMIT NO. ( 810097 ) [�^�/� ' � -� PPAN q -L L'L_--LPL6A(Gl'-\ APPLICANT MYERS CONST PQ BX 351 ER -~~-^ 694-96]] '2| LOCATION CHUGIHK C�/,l '~ "' LEGAL LT2 BLK.] EKLMTN�� HTS LOT SIZE 256��'~�,�}UHRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/8R)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �V'k (3F,'F=l"�E=UL E-- FE F:»-~" == !f7m' i{~ �- THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD` THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��U I F-!F:r C.- OH. E= F::> -IF I ::- �n r-4 11� ��T -;7 FE= A- ED 0-7-10 (3 F4 L_ 1 1:3�� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE -r t. �� ___ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY 8N -SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR fl PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INS{/RE PROPER INSTALLATION. F:" FEE F;;! M I -F EF X F=> I FR F="=-. CA FE I::- E"rl E� F-- F;Z" �� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE'-:::. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS SIGNED: - - -__--~--~~AW ...~`~ T� ISSUED ' / ^ copy, WWki -9•e O & E.ENGAEERING & DEVELOI .JIENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Name: e"ff S-' S EAL T yj Tel. No. Mailing Address: /� f /� Legal Description: Z07- a, ✓�Ly i< EZ1dTA1,q A47 • IcJ41 i 4.0,0 Al, Depth (feet) Soil Characteristics 0 1 2 4<1Z4 U'E4- �t O 3 L'Ds/3c �S Tv 6 L OD 4 5 6 7 8 9 10 `PLLOT PLAN %'c, 4� e'96 �c�aSG 12 13 PERC. TEST 14 �7-To�! 7- 15 15 16 Ground Water Encountered: Yes No - If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Performed by: .r 0 z� 10 `PLLOT PLAN %'c, 4� e'96 �c�aSG 12 13 PERC. TEST 14 �7-To�! 7- 15 15 16 Ground Water Encountered: Yes No - If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Performed by: r 0 ft E Ell' !NEER/NG & DEVELOP .'LENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 333-5240 Russell Oyster Earl Ellis 694-2774 333-5240 Civil Engineering Surveying Soils £t Foundations Land Development t --(ice' �G.- � ��-G"G -k � ��". ��U •r—Ai�G1 .�..y--� .�C,P �'J 1 r Pc - c •r ef-/J/ et1 c� e rtes^/ �ltcac-,V(t W 4� c •� t5al o e),— C:7-t) ).=J r 4, d4 r f ClQTS1E' rOVS14cr 3`/®/41 f CSC=AGE_ r✓��f��'�? i LS s - i' '�%e�► a '0�'uw rw A ' -V L e/ �Lr Pc'.y N `ells' Z J J j y �FESD ��,�4WI December 29, 1978 Smiley's Realty Box 1086 Eagle River, Alaska 99577 subject: #780160 Lot 3 Block 3 Eklutna Heights Subdivision #780158 Lot 1 Block 3 Eklutna heights subdivision #780159 Lot 2 Block 3 Eklutna Heights subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation Hate. if there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist LIB/1 jw encs copy of permit ~ lot FEE Kit R -A l �-.IE -T- VA 141 Igo EEL 3: :11 FEE= ��CER � ��I � I P.."ll�� MINIMUM DISTHNCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM � PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MHY HPPLYSPECIFICHTIONS AND CONSTRUCTION DIHGRHMS HRE HVFIT LHBLE TO INSURE PROPER INSTHLLHTION �FEE M Q IE:: ...� I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR OYSITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2: I WILL INSTALL. THE SYSTEM IN HCCORDHNCE WITH THE CODES 3� I UNDERSTHND THHT THE ON�SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS R�MODELED TO INCLUDE MORE THHN ] BEDROOMS. SIGNED� ISSUEDBY..... ... .... ..... _~_��_=�_��_~—� MUNICIPALITY OF ANCHORAGE o Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-061-30 Certificate of On -Site Systems Approval Expiration Date: V4'zo Z Z( Legal description EKLUTNA HEIGHTS #1 BLK 3 LT 2 Site address 24430 Chugiak Dr Current property owner(s) Shayna and Doug Green X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: By: Original Certificate Date. 4/5/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services 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 work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE o Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-061-30 Complete legal description EKLUTNA HEIGHTS #1 BLOCK 3 LOT 2 Location (site address) 24430 CHUGIAK DRIVE, CHUGIAK, AK 99567 Current property owner(s) PHILLIP & SHAYNA GREEN Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ® Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 0 - See advisory if steel older than 20 years. NEW TANK 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 26-0 Date of Payment 3 3 2 COSA # 05c 231072 Waiver Fee $ Date of Payment Waiver # COSA Application—July 2022 copy.doc COSA Checklist 2022.docx COSA Checklist Legal Description: EKLUTNA HEIGHTS #1 BLOCK 3, LOT 2 Parcel ID: 051-061-30 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC / CLASS “A” WATER 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 NA 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 NA Date of pumping NEW HDPE TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/5/1981 ALL standpipes present per record drawing Total measured depth from grade 11.3 ft (max) Measured depth to pipe invert from grade 7.9* 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 3.2’ ED IR IS 5’ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 2/17/23 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 2/18/2023 Results Pass Fluid depth prior to test <1 in Water added 640 gal New fluid depth 3 in Elapsed time 15 min Final fluid depth <1 in (DRY NEXT DAY / MOIST) Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 60 in Effective depth used 22 in (1.8’ ED MISSING) Effective depth remaining 38 in Comments/Deficiencies: *Approximate sump invert. Shots show 1.8’ or approximately 22” (ED) of effective sewer rock depth missing / not measurable of the 5’ ED. Total measured depth of MT & CO from existing grade. COSA Checklist 2022.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/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 Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 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 > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private 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 Public water service line was staked and enters crawl space approximately shown on inspection report drawing. 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 3/31/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 3/31/2023 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. `" "` P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-061-30 HAA # D3� Expiration Date: - / 6. - r7 1. GENERAL INFORMATION Complete legal description Eklutna Heights ##1, Block 3., Lot 2 Location (site address or directions) 24430 Chugiak Dr., Ch gia , AK 99567 Current Property owner(s) Duke Fravel Day phone 1522-2466 Mailing address PO Box 85, Chugiak, AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of i KND ► ► ►Inc• • 1 696-6111 ••• 1 u•.• • • ; •• Engineer's Printed Name Kenneth M. Duffus Date 1 T/11 /200 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes In land use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other N yo� t,.•• ON-SITE : �: :--WATfR�tND ' m= WASTEWATER PROGRAM = J �l�lllJlll11111��`` By: �1%�/ Original Certificate Date:��o :O 3 Municipality of Anchorage �K •,,,. a +, Development Services Department`'' Building Safety Division On -Site Water & Wastewater Program _. ... 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST i Legal Des;cription;�KLUTNA HEIGHTS #1- BLOCK 3, LOT 2 Parcel ID:_0 51 - 0 61 -3 0 li A. WELL DATA Well type Public If A. B, or C provide PWSID # 213750 Well Log (Y/N) Date completed Sanitary seal (Y/N.).__ Wires properly protected (Y/NL. j Total depth ft. Cased to —fit• Casing height ;(above ground) _ FROM WELL LOG AT INSPECTION i Date of test i Static water level � ft' ft. Well production g.p,m i g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg./I. Other bacteria _ colonies/100 ml. Arsenic: mg,/I. Date of sample: Collected by: j B. 'SEPTIC/HOLDING TANK DATA Tank Type/Material septic/steal (Anch, Tank) Date installed _5/5/1981 --- Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N),Y { Foundation cleanout (Y/N) Y_Depression over tank (Y/N) LHigh water alarm (Y/N) ,N Date of ! pumping 12A II /03 Pumper Sanitary i C.' ABSORPTION FIELD DATA Date installed 5/5/1981 Soil rating (g.p.d./fe or ftp/bdrm) 105 System type Trench Length 42 ift. Width 3 ft. Gravel below pipe _5 ft. Total depth 10 ft. Eff. absorption area 420 ftp Monitoring tube Y Depression over field N i 1 Date of adequacy test 12/11 /03 Results (Pass/Fail) Pass For 3 bedrooms i i { Fluid depth in absorption field before test -0 C sludaelin. Water added --M gal. New depth 14 in. ;Elapsed Time: 25 min. Final fluid depth_0 in. Absorption rate' >= "450+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date i D. LIFT STATION Date installed NA Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in.High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank 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 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10' + Water main 10'+ Water Service line 10'+ Surface water 10 0'+ Driveway, parking/vehicle storage 20'+ --- Curtain 0'+ Curtain drain 50'+ Wells on adjacent lots 200'+ F. COMMENTS ��V OF A4 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and O -P"4' 116064"' ""' ' review of Municipal records that the above systems are in 6•.4.44 conformance with MOA HAA guidelines in effect on this date. I s, •;Kenrem J 60'•66,.._ CE'71t6 Rsi Engineer's Printed Name Kenneth M. _Duffus �,��Fq'•4: �` •' ��':`• 9 0 FQ 444Yf\PV I� PR0FESS'��y."' Date 12/11/03 HAA Fee $375.00 Waiver Fee $ Date of Payment 12/12/03 Receipt Number 17 (Rev. 12101) Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services Mu On -Site Services Section EnrytRp ENT OFANc,4 P.O. Box 196650 Anchorage, Alaska 99519-6650 SERVICES01VISION 343-4744 NOV z ; 1996 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLI N G Parcell.D.# 05"f—pG/—�v HAA# 1. GENERAL INFORMATION Complete legal description 4�' 2 ��-'rti�� ,<.irs s.� ✓.r!.s�o cJ Location (site address or directions) Property owner $ — Day phone Mailing address - 25 Lending agency �.��°F'r_'„°sc�/ ploer. Day phone �9O7).2Sb'-7.S3�/ Mailing address r26 00 vGy.4Gr ST• 9�✓�ti'o9c�� 94.9 Agent ✓Ay"O>' XG 00-r Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: -:If N 3. TYPE OF WATER SUPPLY: Individual well Community well V' Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer i 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. 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 Phone�g�;� Address q01 Engineer's signature I 1�Si�~^ Date i t" 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments 0 bedrooms, with the following stipulations: CAUTION Date /,2 —1— i� 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 e21 6411-1" Municipality of Anchorage R°NMFtiTq`A DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division *Oil 825 L Street, Room 502 •Anchorage, Alaska 99501 • (907)4744;',9 '9' y�s�oh Health Authority Approval Checklist✓�jF Legal Description: 65le4vres4 /.�rr l� Parcel I.D.: A. WELL DATA Well type 'W� lvEutf A, B, or@ attach ADEC letter. ADEC water system number ,i n?176 Log present (Y/N) Date completed Total depth Cased to Casing height (above ground Sanitary seal (Y/N) Wires pr:S-PECTION erly pro(Y/N) FROM WELL LOG j Date of test �/ Static water level Well production g.p.m. g.p.m. WATER SARESULTS: oliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed .I_Ay >f B/ Tank size A*'Op "Z- Number of Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/N) i Depression (Y/N) A) High water alarm (Y/N) I9 Date of Pumping ' ;�r Dai— ?4 Pumper C. ABSORPTION FIELD DATA Date installed �`tif.9>' B Soil rating (g.p.d./ft2 or ft2/bdrm) O 5 #21 wSystem type 70k"moi Length Width Gravel thickness below pipe .0_,4�4 Total depth /off Effective absorption area ZMonitoring Tube present (Y/N) >/ Depression over field (Y/N) A2 �Z 't/ee/4 Date of adequacy test f� '�O� g Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); " Immediately after CG/ gal. water added (in.): �f u�d�v s Fluid depth (ins) Minutes later: Absorption rate g.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* /,/,o me If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* o "level at* High water alarm level at* , *Datuf , ested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot On adjacent lots-- . A __..._ . Public sewer main -- Pu lic sewer manhole/cleanout Sewer ptic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation �� ` Property line .z.3`f �` Absorption field 7 �f Water main/service line Z -f-'' /Surface water/drainage P r c,�uEd ells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: _00 - Property line ! Building foundation Water main/service line Surface water �o,v6 mrs62�Ev Driveway, parking/vehicle storage area •fo ' -� Curtain drain A4A. ar Wells on adjacent lots 10,4ve' F. ENGINEER'S CERTIFICATION 7171a I certify that I have determined thru field inspections and review of Municipal recon` tot atib�'de ems are in conformance with MOA HAA guidelines in effect on this date. • aq Signature I• _ ' Engineer's Name GoF�« :� f �� °;..'�/. • • • ¢N- `' Date l l ! 5 .9 Le HAA Fee $ jet) G4_) Date of Payment 4�&� Waiver Fee $ Date of Payment Receipt NumberI5' 1 Receipt Number 72-026 (Rev. 3/96)* Douglas T. Kenley, PE 9960 E. PujyM Dr. Palmer, Alaska 99645 (907) 746-1073 November 21, 1996 Mr. James Williams Municipality of Anchorage Health & Human Services On-site Services Re: Request for a conditional HAA approval for Lot 2, Block 3, Eklutna Heights Subdivision, 24430 Chugiak Dr. Chugiak, Alaska. Dear Mr. Williams: We hereby request a conditional HAA approval for the above referenced property, The on-site septic system was tested and approved by us on November 14, 1996 with one exception. Two stand pipes were found to be broken just below grade. One standpipe was at the septic tank and the other was at the trench clean out. As requested by your Department I certify the following facts and conditions related to the existing septic system: 1. There will be no imminent health hazard created or prolonged by granting the conditional health approval while this condition exists. 2. There is no obvious code violation. 3. There will be no adverse effect as a result of granting the conditional approval. 4. Compliance will be met by June 1, 1997. Moneys have been set aside for completion of the above work. Thank you for your consideration of the conditional approval. Sincerely, Douglas T. Kenley, PE CE #8176 Douglas T. Kenley Civil Engineer State of Alaska C.E. 8176 Legal Description Applicant Date of Test System Data SEPTIC SYSTEM ADEQUACY TEST ',ref E- .�f,%��-✓s' Tank Volume rOa d 6' -le - Number of Bedrooms Absorption System Absorption required (1.5 dally flow) [TIME VOL.TEST ..(gpm) • DATA DIFF. LEVEL COMMENTS ---------- System Passed System Failed Comments . �+Jvr�f�✓��a .=a.— e4, f,vv; c� g r; c s� B�c�t� ct✓/�e ; •�� LftJY.>:'c�.t7UPG'� Lt%^ifY�.� i.r-� 'TilJ2J.r�- /ems VST f.[J� i c.��i.J� rU l.'_O � dYv�.z.-A✓✓� �[Jt� �tl./,>>'l�-F= .lifO�/IEsG �/�,/�Y" C�f✓O o..t` !'-�C.t/'Cfl .��1�' Lia%. Ts> G't+<'++�.✓ O:f �'' Ga: �s,�f[tC�u'rY iL/6�'G+',./!it/O 17i4i.�JfnJ L�r.vEs� i t s x Douglas T. Kenley Civil Engineer State of Alaska C.E. 8176 SEPTIC SYSTEM ADEQUACY TEST Legal Description /- 0r z 0;4- 0 Z.�/ 1�,,-A.41 �� : �lv 9/J e,/uL,,a,rc: 17.Yr. C:.ue"IIVAO . Applicant C Si:`srs Date of Test qv4(, System Data Tank Volume Absorption System Number of Bedrooms 9 Absorption required (1.5 dally flow) System Passed V/ System Failed Comments �rnr�v�9p Tse'. qo<<s.a�, <��= , tr�ou<>c'v� .•ate o�F " EO 1 - - - r I i.3G�� .,i •• � t � VOL.TIME g.(gpm) •COMMENTS TEST DATA LEVEL ---------- ---------- ---------- ---------- System Passed V/ System Failed Comments �rnr�v�9p Tse'. qo<<s.a�, <��= , tr�ou<>c'v� .•ate o�F " EO 1 - - - r I i.3G�� .,i •• � t � =r"�L9 4;r ' P°� f ,iL lu • ... O 1 eAr 1 I I� • ih f • �4"�1�1 liii � ♦ � 1 • , i m ri I c , • f f � f , �."�1,1! ,� f��/y (Y}•,W }� /� �j ,/fly � , r�` 4r ! 0��L.i � C1i Q{ i.•. FW�Y�WY.�WYr t �Mq ttahHtAp 21 113' pA^rit. BWAfth IL ALA oommmw 1 MY 02"TIPF-Y THAT ! HA S SUNY Yip iii ^�� .• IW11i0 DOOMEW • PRI ItTTO +$N nd Hei2ltta 8ubd..Adt MA, ] .T nl- 7. atia• RA-ire. w i�G. irfd - & . MUNICIPALITY OF ANCHORAGE • 4 Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 1 -?)(-) HAA # L Lk4-a 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LUT 2: BLOCK 3; EKLUTNA HEIGHTS ;df Location (address or directions) NHN Chu:aiak (b) Property owner A.H.F.C.#26478 Telephone: (home) Business Mailing Address 520 Eabt 34th Avenue, Anchanage, Ak.. 99503 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent JACK WHITE COMPANY ATTN • Kath i- Otmztead Address 10928 Eaate Riven. Road, Eaq.Pe R.ivea, Ab 99577 Telephone 694-5500 (e) Mail the HAA to the following address: (or check here AK if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 170-14 Eagle Rhter_L**p Road No- 4304 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family &� Number of bedrooms —3- 3. WATER SUPPLY Individual Well ❑ CommunityX Public [J;; Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site GFX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING 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 investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection.. Name of Firm Telephone Address _ 17034 Eagle River Loop Road No. 204 Date s�a�aV% l r. t! 1� •eeoe '-'� ep A FAcAr�• ,1�. 1466.4 e �e`=7 e•�uw r.eVe r Cd'1�#��t'S 6. DHHS APPROVAL % Approved for bedrooms by ate l / Approved 7�.�—Disapproved// Conditional Terms of Conditional Approval (,,--�OAJc7 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) OCHECKLI,StT- FEBRUARY 1984 ni MAt 'NI'IM-4744 Legal Description: kot ;Z A loc t< :;� ' � JUL) �i�i 6E1(Z., j h fis A. WELL DATA VZ C �F Well Classificationr_{(09 !SS A If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Date Completed Electrical Wiring in Conduit (Y/N) Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date Water Sample Test Results Comments 'S 14 Zf�L AOAe- d C!4rD/bUA� B. SEPTIC/HOLDING TANK DATA .f Date Installed S_ 81_Size 1 000 No. of Compartments �e_ Standpipes (Y/N) K Air -tight Caps (Y/N) K Foundation Cleanout (Y/N) Depression over Tank (Y/N) 1J Date Last Pumped Pumping/Maintenance Contact on File (Y/N) �� ; for Holding Tank High -Water Alarm (Y/N) A) -Temporary Holding Tank Permit (Y/N)— SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: r i To Water -Supply Well 00 t To Building Foundation � To Property Line To Disposal Field To Water Main/Service Line lo t To Stream, Pond, Lake or Major Drainage Course t5 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata j Type of System Design w_ C JC Date Installed Length of Field Width of Field Depth of Field / Gravel Bed Thickness Square Feet of Absortion Area Statndpipes Present (Y/N) Depression over Field (Y/N) /J Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 02 too t To Property Line / O To Building Foundation ;2 To Existing or Abandoned System on Lot _ /J /69 ; On Adjoining Lots 3 0 f i n) To Water Main/Service Line / C) t To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course NIA To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) '"Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines inspection. S & S ENGINEERING Signed -_ 17034 Edule Row i Loop Ran No. tuq Company ._ Eagle River, Alaska 99577 Date /�/ y i MOA No. _ n, e o G U� 3 Receipt No. n Date of Payment Amount: $ _ 70 Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 date o'f this A (, SMA A. thele«' w '. Na. 14bi� :bra Seal STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 October 24, 1989 Mr. Roger J. Shafer S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, AK 99577 563-6775 PWSID: #211431 According to the records on file in this office, the Dawn Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, z/2 � t el Vera E. Craig Environmental Fiel Officer VEC:bas NEW CONSTRUCTION '1. 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS Subdivision STREET LOCATION TIME TIME TIME NUMBER OF,BEDROOMS L DATE DATE DATE Q Three ❑ Six 7. WATER SUPPLY INSPECTOR INSPECTOR INSPECTO xct MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI"PT or I ,-:,e,Li; 1 & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL i'iili -CTION • ENVIRONMENTAL SANITATION DIVISION Jul_ 1981 Telephone 264-4720 ® INDIVIDUAL/ON-SITE** REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE EPCf6jW46 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. PHONE PAUL V., & ARLEEN E. MYERS 694-2980 MAILING ADDRESS P.O. Box 351, Chugiak, AK PROPERTY RESIDENT (If different from above) PHONE Chugiak Drive, Peters Creek, AK None 2. BUYER PHONE JOHN F. CATLIN 271-4356 MAILING ADDRESS U.S. Geological Survey, 800 "A Street, Anchorage, AK 99501 3. LENDING INSTITUTION PHONE United Bank of Alaska (Linda Moss) 276-1911 X 279 MAILING ADDRESS G Street` Anchorage, AK 4. REALTOR/AGENT PHONE Jim — MAILING ADDRESS Box 911, Eagle River, AK 99577 5. LEGAL DESCRIPTION Lot 2 Block 3. Ek u na Heights Subdivision STREET LOCATION NHN Chugiak Drive 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ED One ❑ Four ED Other ® SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Q Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975. For wells drilled prior to that date, give well .� PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ® INDIVIDUAL/ON-SITE** 1981 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Ne brest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS LAY A PROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE / 43 BY 72-010 (Rev. 6/79)