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CHANDELLE ACRES LT 10
-- MUNICIPALITY OF ANCHORAGE · .c21 . ~TMENT OF HEALTH AND HUMAN SER~ :S . Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ - ~ TANK FIELD WELL ~~~/~e~ ~/~o o, ~,oo~~ wE~ /~O ~hone(s) /- ' IPerm~t R~ LEGAL DESCRIPTION Township, Range, ~eCtlon AS-BUILT DIAGRA~ ~Sl~ow Iocabon of well, septic system, property hnes, foundation, R5 t ~ /LDO, ~/~ driveway, waterbodles, etcJ TANKS i Manuv cruder Capacity ~n gallons ~atCr,~l ~/~ / N o. ofCompanments~ T~.~ o~ S~ST~ - ~TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to pipe bottom from Total depth from original grade ong~nai grade /~ ¢ ~' FT FT Fdl added above~ongmal/[ grade ~ Gravel ~dept~ath~e FT Total ab,orpt,oniare, I D,stance betwee, , .... Installer ~ate Installed w~s ~PRIVATE ~ OTHER Ildentifv) Class,f,cat,on (A,B C) ]oral Depth io . ,o Installel Date Installed REMARKS: ~ n e~ ~ Inspect,ohs ~ ~ ~ ~?F"~, ~. ~"~ ~'h ,. ~ ~-~ ~,~ ~.'~ ~ C~Hily that this i~Sp~Cli~ was peH~r~e~ accordi~ to all Hea,,~......e., ~..ro..,: ~~ ' ~I~ ' "'" ~'' " 72-013 (3/85) [)IEF:'AR'FME:Ti"4'f' OF' ,"il::.~-d....1H AIqD t.:.i:NVtFRCII',IME]',IT'AL F:'F;~C)'I"IECT'IOI',I 825 L SI"I:;:EE"f', AI".IC;HC')F~AGE, AK 995C) 1 . 26 4 ..-. 4.7 ,'.:.i'. C, :-::!:::'F:'L t CAI".I l: ::',' D D R E ::3 !S: ANDY ZYWOT' % S&S ENG I NEIER I NG F:AGLE RIVE:~R, AK .... lEGAL DESCR:I:P: SUBDIVISION: CIHAI'4DEi:LLE: ACRES L[)'l': 10 SEc'r']:(:iN: :3 I"OWNSI4IP: lSN RANGE= 1W .OT S:I:ZE: 4:::;5~:~0 (SQ.. F::]', OR ACRES) 'lAX BEDI::4OOMS: I BL. OCK: NA ist. ed belc)w ar'e the optic)r'~s av'ailal:)J.e t.o you J.J"'~ des:i, gnir'ig your' s6..tptic :~:r:i:.t. em. Choose t. he optior'~ t. hal:. best. l'it.s your. sit. e,, :) E: ['" l i"'l I0 F:'IPE BO'T'T'OM (F'"I',) .:, k',.~-.~ V [:.i .... DE:I:::' '1' H (F:]' . i"CJT'f-::L. DEPTH (F:T,) .:~f::':AVI!LI .... W l D'i' H (F: I' . .'~I-',~.,vEL.LE::NG1H (FT.) 5RAVE. I .... V'OLUME: (CU. ¥i}S, ) "" .... ~ I:: (GRLS) ~-~ f.] ... S l "' ~i::):l:l .... Fi'.Fi'l':l:t'4i3 (SQ, F"I. · ~:-~- 'l¢.::hik: MLI.':ST' HAVE:: A'T' LEAST '1"~0 [::OMPARTMENTS .in c:er"L.i, ty t. hat: t. I am i:'amiliar, wi'Lb the r'ecluir'emer"~ts fop on--site sewens and wells as set i(::,r't.h by tine Mur':ic::ipal].t.y of Ri"ichor. age (MOA) and the State of Alaska. 2. I will inst. alt the system in accondance with all MOA codes and r. egulations, and in c:ompliance with t. lne design cr'.itepia of this permit. .S. i will adher'e to alt MOA and Stat. e of Alaska r'equipemer~ts {of t. he set. bat:l< (:Ji~,t~l"~C(:~:- i ]"C}¢[~ any exis't..:~'.ng wen. l, wastewater' d:i. sl:osal system or public ::>ewer'age syste:,m on t. his or' :nd'ny atdja:c:el'it., op near'by 1Qt. "nj., J. u.i'ide~F.:~tar'id t. hat. t.l-i:i.s penmit is va:].d Jc)p a ¢ftaxiNtLtJ]f O~' 1 bedrooms and ai~>,' (:,:,J:.t.a~.(~em<:u'~t. wilt r'eqt..tJ.r'e ar] addit, ic)r~a] per'miL. I: F:: ::.:, t_ :i. in: i S f'AT I 01',1 ]: S :[ i'4S f'AI_L. EED I Iq AN AI::~FZA COVEn:RED B'Y' MOA BU I L..D I I',iG CC)DES, i"I--.[iEI'4 ( 1 ) AH EL..E:C::~.. I:::'~t::;;ld I 1 AND II'qSPE:C'I' 1 ON I"'IUS f BE: C)B'i'A I NED ~ (2) AS-BU I i....l"S ILi...l NL)l E~E: ::::::::::::::::::::::: ~ll"I~C)U'T AN E::I....E~C:TI:?ICF:d .... INSI:::'E::C'i ION RI:::F:'C)RT~ AND (3) THE: ~.~ ................................................. : ......................... ~.:..~.....: ............ 9.... ........... ~_...~ Oy.ter %,0 & E ."'":.'-'Mk, IEERING & DEV[-. "~iMENT CO. Box 90, Davis St., Eagle River. Alaska 99577 694-2774 or 688-2280 )rmed for: Mailing Address: Legal Description: L (~)-'J" / Depth (feet) SOIL LOG Name: ,/'~' 7-~:- ,~__$ Soil Character.lstlc. Earl Ellis 688-2280 5 Wlllr Encountered: Yes~ No /j/ If yes, what depth ~eepage Pit Drain Field Russell Oyster 694-2774 ENG.NEERING & DEVELO, ,dENT CO. ~ ~.:~ Box 90, Davis St., Eagle River, Alaska 99577 .-. ?,-~, .. 694-2774 or 688-2280 Performed for: Name: Legal Description: Depth (feet) 0 -~ cI o 5~-'i <~ 10__ 11 12__ 13__ 14__ 15__ 16 SOIL LOG E~,rl Ellis 688-2280 Tel. N0. ~ ~o°-.~.~ PLOT PLAN PERC. TEST Ground Water Encountered: Yes No // If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Performed by: Date: Parcel I.D. # - 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 1. GENERAL INFORMATION Complete legal description Lbt 10 Chandelle Acres Peters Creek, Alaska Location (site address or directions) 23847 Immelman Circke Chu~iak, Alaska Property owner Mailing address Lending agency Mailing address Agent Address Scott Holderness Day phone" 688-1528 23847 Immelman Circle Chugiak, Alaska 99567 Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 4 NOTE: x Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: x Individual on-site Holding tank Community on-site 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 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 LCMF Limited Phone562-1830 Address 139 E. Enginee~s signature 51st. Avenu~ Anchorage, Alpska 99503 Date DHHS SIGNATURE P'~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date "The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approvat 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. 72-4325(Rev. 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /.-~X'" /~> ~',~,e~__~/__.~ ,~-~'Parcel I.D. A. Well Data Well type Log present (Y/N) Cased to Total depth '~ 95-/ ~t~_~,~.~ Sanitary seal (Y/N) ~r/~°-5 /,~/~;¥dl&)d~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed O~./)o~"~ Driller .g.p.m. Date of test Static water level Well flow Pump level1 z/m ~-.-~o~ Casing height Wires properly protected (Y/N) AT INSPECTION 5-1/,/ FROM WELL LOG NJUNICIPALITY OF ANCHOI~GE ENVIRONMENTAL SERVICES DIVISION "-~,Y 2 6 1994 g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: / Septic/holding tank on lot /'c~ ~ / Absorption field on lot //o Public sewer main ,,t/~,~.- Sewer service line ; On adjacent lots / ! ; On adjacent lots /oo Public sewer manhole/cleanout Petroleum tank /,/',e,~,~. WATER SAMPLE RESULTS: Coliform 4? Date of sample: Nitrate CD. ~,/~' /'~C~/(.. Other bacteria Collected by: ~. /--J,~ ~'~""~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size /,~ ~'"0 Compartments Foundation cleanout (Y/N) )" Depression (Y/N) ~//,~ Alarm tested (Y/N) "7//~-//~/~Z. Pumper ~), 12. '~ ~0/.4~O1~_~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /o~,i On adjacent lots / Foundation / o To property line / ~:'["" Surface water/drainage Absorption field Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed A/,,//~, Size in gallons vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed / ~"{I q/~ Length t4~/~o~ W'~lth Total absorption area c/~ k~o,~-,-.- Date of adequacy test '5//5 Iq ~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) ./.,. Soil rating (GPD/FF) '~?-/'?v/z~- Systemtype Gravel thickness ~J / Total depth Cleanout present (Y/N) ~ Depression over field (Y/N) Results (pass/fail) /o~ ~ s for · f ~. o After test ~'. If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~ ~ / To building foundation /ca On adjacent lots Sudace water On adjacent lots /=5--/ ° Property line /o ~-,/'- To existing or abandoned system on lot ~,. Cutbank ~ o+-uz.. Water main/service line Driveway, parking/vehicle storage area ~,o/ Curtain drain E. ENGINEER'S CERTIFICATION I ce~fy glatl have checked, verified, or conformed to all MOA and HAA guidelines in effe~,c~_~~t~,is inspect'on. Signature Engineer's Name Date Date of Payment ,<5"-- Receipt Number~::~-~? Date of Payment Receipt Number LIMITED ENGINEERING SURVEYING PLANNING PROJECT MANAGEMENT June 22, 1994 Municipality of Anchorage Department of Health & Human Services On-Site Services Post Office Box 196650 925 L Street - Suite 502 Anchorage, Alaska 995019-6650 RECEIVED JUN 2 3 1994 D MtlnJc~palffy ot An ept, Health & Hu,~..c_h,.°rage '"°" ~ervicee Re: Lot 10, Chandelle Acres Enclosed per your request is (1) the corrected certificate of health authority approval, (2) the results of the total coliform bacteria testing, and (3) the septic pumping receipt on the above subject property. If you have any questions, please feel free to contact me at 562- 1830. Sincerely, LCMF Limited Scott Hattenburg, P.E. Principal SH: lmg Enclosures: 94-036 as stated 139 East 51st Avenue · Anchorage, Alaska 99503-7205 · Phone: (907) 562-1830 · Facsimile: (907) 562-1831 May 23, 1994 Mr. Scott Holderness 23847 Immelman Circle Chugiak, Alaska 99567 ENGINEERING SURVEYING PLANNING PROJECT MANAGEMENT Re: Well and Septic Adequacy Test Lot 10, Chandelle Acres Subdivision Dear Mr. Holderness: On May 14, 1993, I conducted an adequacy test on the above subject property. Well Evaluation At the start of the well flow test, I measured a static water level of 204.4 feet measured from the rim of the casing. We pumped the well for a duration of 4 hours and 20 minutes and the system produced 675 gallons. The static water level at the end of the 4 hr. 20 min. interval was measured at 215.0 feet. Within 40 minutes of the completion of the drawdown tests the well recovered to a static level of 204.6 feet. The well produces the required 600 gallons per day and at 4 hours continuous pumping and is adequate for a 4-bedroom residence. Septic System Adequacy On May 14, 1994, your deep absorption trench was dosed with 675 gallons of potable water. The static liquid level in the monitor tube in the trench was measured at 2.1 feet before the test started and 3.0 feet after the absorption trench was dosed. Twenty-four hours later the liquid level and the absorption field had dropped to 2.5 feet. On May 21, 1994, the absorption trench was tested again. Static level was 2.0 feet before the test and 2.60 feet after the test. The bed was dosed with 625 gallons of water. Twenty-five hours later the bed showed static water level of 2.15 feet. At this time, the bed appears to be absorbing the required 600 gallons per day and is satisfactory. We caution, however, that the trench has an apparent static water level of about 2.0 feet and that there is only 3 feet of freeboard remaining (assuming 5.0' absorption trench depth per the original permit). 139 Easl 51st Average · Ancnoraqe. Alaska 99503-7205 · Phone: (907) 562-1830 · Facsimile:t907) 562-'i83'i Mr. Scott Holderness May 23, 1994 Page 2 The absorption is considered adequate at this time; however, a reduced life should be anticipated. We have no way of estimating what the remaining life will be. Sincerely, LCMF Limited Scott L. Hattenburg, P.E. Principal Attachments: Nitrate and Coliform Water Quality Test Results SH:lmg 94-036 CT&E Ref.# Client Sample: ID Matrix ClientNamc Ordered By Project N~rnc Project# l~'SIl) Commercial Testing & Engineering Co. -. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.2361 - 1 LOT 10 CIIANDEI.,LEACRI~ CHUGLn. K WATER L C MI,' I.IMITED SCOTT L. HATI~'qBUKG I.JA WORKOrSer 78537 Pimtedllale 05123/94 ~., 14:$g Cotls~ted Date 05117/94 (~ ] 9:00 hrs. lter. ei~cdIN~ 05/18/94 C~ 11:1]o hrs. ~ Dirccior Dy: STEPHEN c. EDE $mnple Rcmark,~: R()UTINE SAMI:'I.E COLLECTED H¥: s. HA'rH~NBIrRGAND wr'l'Nt~aEDBY $. HOLDERNESS. QC Parameter R~_~Iu Qt~l UnRs Me$h~ 'Nitratc-N Allowable Ext. Amd Limits Date Date Init 0.49 mg/L EPA 353,1/~[w.0 10 05118/94 CMR * Sec Specitd [rtstt~tioxtu Abovc ** See Sampl~ Remarks Abovc U' = Un~tocted, P~mted vah~ is thc practical qumtification limit. D = Secondary dilution. HA = Uu~vailablc NA = Not/umly zed LT= Less Ihim Gr= G~c~tcrThan 5633 B StreeL Anchorage. AK 99618-1600 -- Tel: {907) 562-2343 Fax (907) 581-6301 _ ENVIRONMENTAL gACILITIES iN ALASKA. COLORADO. FLORIDA. ILLINOIS. ~Mua, RYLAND, NEW JERSEY, OHIO, UTAH. VVEST VIRGItqlA CT&£ R~f.# Client Smupl¢ ID Me~x C;ientNam¢ Ordered By Project Nam~ Pwject~ PWSID Environmental Lab~-rato~ Services LABORATORY ANALYSIS REPORT 94 2361-2 I.OT 10 CIIANI)ELLE ACRIL~I CHUGIAK WATER L C M 1: 1.12vflTED $co'rl' L. HATYENBUR(i UA WO~I~ ~ '/8537 l'~J~l.I)a~ 05123194 ~ 14:57 C~l~:lc4 l:)atc (.~ ~~c 05/~ 8194 ~ 1 ~ ~ Sump le Ra'natks: l'acal Colilbrm ROU'I~U SAIV~LECOLI.ECTED BY: UA. Qc R~ttlt.~ Qual Units #/100ml :.-; ~';":"Allowablc' F. xL Anal M~t~" - :: Limits Date D~ ~d179222D ., . 05/18/94 05119194 Init UA = Unavailable * Sec Special l. tlstru~tiuns Ahoy c ~ ='Not Analyzed ** Sc~ Sample Ikelllarks Above Il = Urtdeteetcd, tt.eport cd vMue is tire p mctiual quantification limit. I:i'= Less 'lhan (.fr =Grcat er I) = Sc~ondaxy 5633 B S{reat. Anchorage, AK 99618-1600 -- Tel: (907) 562.2343 Fax: (907) 561-5301 ' ' ENVIRONMENTAL FACILITIg$ IN ALASKA. COLORAO0. FLORIDA. iLLINOIS, MARYLAND. NEW JERSEY. OHIO. UTAH, WE:~T VIRGINIA 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. # ['~ \ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot [0 Chandelle Acres Peters Creek, Alaska Location (site address or directions) 23847 Immelman Circle Chugiak, Alaska Property owner Mailing address Lending agency Mailing address 2550 Scott Holderness Day phone 562-4958 23847 Tmmelman Circle Chugiak, Alaska 99567 Norwest Mortgage Day phone Denali Street, Suite 1406 Anchorage, Alaska 99503 Agent None, Refinance Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well x Community well Public water NOTE: 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 Public sewer NOTE: x 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 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 LCMF Limited Phone Address 139 E. 51st Avenue An~qra~e, Alaska Engineer's signatu reL---~ -_-_ _~. ' ~ 99503 562-1830 DHHS SIGNATURE /~ . Approved for z:~-- bedrooms. Disapproved. Conditional approval for Date 7/15/92 bedrooms, with the following stipulations: Additional Comments By: / '~/'/~~ /~/--~~ Date 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 1t21 Municipality of Anchorage Department of Health & Human Services .'.. HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /.-~7-/~ CZ~,.~.;..~[c.4z~ Parcel I.D. A. WELL DATA Well type ~:~u', Log present (Y/N) Total depth Sanitary seal (Y/N) ~' If A, B, or C, attach ADEC letter. ADEC water system number Date completed /,.~W~c~-~,,3 Driller Casedto ~ /-'~/Of/-. Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /~' / Absorption field on lot /! ~) g.p.m, g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ~/'~'~" Petroleum tank U~V'./~o~,~ Nitrate Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: 7//~/ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size / ,~ ~"O __ Foundation cleanout (Y/N) )~ Compartments ~ Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~'/~ Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed . Length U~JY-.~O~ Width ~. ~; Gravel thickness Total absorption area /.JA/~,~O Cleanouts present (Y/N) Depression over field (Y/N) ~J /~o c,J~l ! ~ ~ Date of adequacy test Results(pass/fail) /Ic:~..~> ( ~~.~'~] for Peroxide treatment (past 12 months) (Y/N) ~O If yes, give date Soil rating TOtal depth System type ~/,-.~,,~ c/,-.- bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / z~ ~-. On adjacent lots ,/~)5" Property line To existing or abandoned system on lot Cutbank /J//A. water main/service line To building foundation On adjacent lots Surface water Curtain drain Driveway, parking/vehicle storage area /D E. ENGINEER'S CERTIFICATION verified, I certify that I have checked, or conformed to all MOA and HAA guidelines in effect on the daZe..~this inspection. Signature Engineer's Name ~. Date HAA Fee $ //~"~ Date of Payment eoeipt N mber Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY 5033 B STREET ANCHORAGE. ALASKA 99510 TELEPHONE (907) 562-2343 92.343? Sample FAX: (907) 5451.5301 Client Acct JUl 13 92 { 21:30 hzs, Reql : to: L[#IT[0 ................................................................................... ..,~;; .... ~;;0;;;;.,.,; ............ ~aramete~ ~esult~ ~nAts NIT~A?[-N 0.40 ,~i/~ ~?t 35~,2 ReJtatkm: ........................ N0- ~on, Oetmcted "3.e 3am91, ~eMrkm Above (f~S~m~ fv!,e,nber ¢i the $G$ Group ($oc,~t$ Gene,ale de Surveil!ence) OF/ 04, '72 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date Jun~. 7~ 1988 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10; Chand~6 Acres Location (address or directions) NHN Imm~.~man (b) Property Owner Arvid Bf'ornton Telephone: Home 688-5476 Business Mailing Address (c) Lending Institution All,:anco. Bank Telephone Mailing Address Ay~,cho~.a~]&, Alas ka (d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER - Virqinia Kohfi~Zd Address 16600 ¢~.nt~rfi~ld Drive, Suit~. 201~ Ea.ql~ Rlv~r, Alaska 99577 Telephone 694- 4200 (e) Mail the HAA to the followim3 address: or: Check here IX'l, if hold for pick up. List contact person and day phone number below. _'~ & S ENF~INEERINC~/~94-~979 1707;4 Eag~_ ~iu~.)f I nnp Rn~d~ R.~_ ¢04 TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms ordered by Virginia Kohfield WATER SUPPLY Individual Well [~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8,'86~ Front 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 $_~ _~ ~NGINEERING 170~4 Eagle River L~ Road No. 204 Address -· ' - ""~'~' Eagle Rlver~ Date Telephone Approved for z~ ._ bedrooms by Date Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska· The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8/861 Back WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MuHICIP^LITY OF ANCt'IO~HEcKLIsT ' FEBRUARY 1984 ENVI?,oHMEN'fAL SERVICES DIVISION 264-4744 Legal Description: Well Classification Well Log Present (Y/~) Total Depth 0¥--~ Static Water Level Casing Height Above Ground Electrical wiring in Conduit~N) Separation Distances from Well: RECEIVED I 1---~ ~ ~/~. [~:3~,¢'~.~ If A, B, C, D.E.C. Approved (Y/N) ~ Date Completed ~'~ ~ 1-2- \~. ~' ~ Yield Cased to ~.C:>lJ¢~ Depth of Grouting ""--'--- 'Z..~:::>~~ Pump Set At '~ ~'7,.-- Sanitary Seal on Casing~N) y Depression Around Wellhead (Y/~ To Septic/l-~ Tank on Lot ! ~ l"~r~ ' On Adjoining Lots To Nearest Edge of Absorption Fieldl~~f~,_Lot ~ ~:~;;:~1,,~ · On Adjoining Lots To Nearest Public Sewer Line _\lJ~ To Nearest Public Sewer Cleanout./Manhole r'-'//~,,. To Nearest Sewer Service Line on Lot Water Sample Collected by ~-~_ ~ ~;;;~~~, Water Sample Test Results ~'¢"~t ~'~ 1~.¢="~>-~z--~4~'.( ~ Comments [)~L.- ~ ~ '~~~ 'Date B. SEPTIC/I~OL--BING. TANK DATA Date Installed ~" t c~t ~P~' Size ~ "~-~-O No. of Compartments Standpipes~/N) y Depression over Tank (Y~ Air-tight Caps {:~/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) y Foundation Cleanout(:[3~N) /, ate Last Pumped ~ ~ ~ ~;~::)~ 1"5 · for '"------ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/l¢~lm, g-~ank: To Water-Supply Well I (:;~ ~ I To Property Line I 1D ~ To Building Foundation To Disposal Field To Water Main/Service Line Course Comments To Stream, Pond, Lake, or Major Drainage Page1 of 2 72-026 CRev 8/86~ Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata, Date Installed ~'/~ '~[ ~ Width of Field ji~ ~. ,~' Square Feet of Absorption Area Depression over Field (Y(~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well t, ~ tpr- To BuildingLot Foundationl~ To Water Main/Service Line ~')~:::~"~ ~ Type of System Design //~ Length of Field ~ ~ Depth of Field ~ ~ Gravel Bed Thickness ~ ~ ~~ Standpipes Present. N} Date of Last Ad~uacy Test ; On Adjoining Lots To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on To Cutbank (if present) LIFT STATION Dimensions Size in Gallon~~..~ Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for .... ~es 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 ~OA and, HAA guidelines in effect on the date of this inspection. ~ Sig~i7~00~,~ENa~IieN~I~R~N'~Gc.,.t~ P._--?_ .:. 27~ Date ~//,~..~//j~,~ '~: ~ Co~i~l~iy... AiaJka ~57~ . __ MOA No. ~/~0C~''~ ~.2 ~) ~.~ 'i Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (Rev 8186) Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE,FEDERALALASKATAx ID #9951892-0040440TELEPHONE (907') 562-2343 C!~en: Sample !D:LiO. CHANDELLE ACRES Chent Nam~ : S & ~ ENGINEER!NC PWS!D :UA Cizent Acer ' $NSE~GP Col!9cted JUN g g$ ~ ii~%0 Ms. P.O.~ NONE BEC D ?reserved with ;COOL 4 DEG C Ordezed ~y ~ P,~deased By ~, Speciai Ch~miab ~,ef t: L348 Lab SmDl ID: 1 ~atr~x: ~i]owable Paramet~z letted Resuit/Ur~t~ Method Limtt~ NITRATE-N t.I mg/i EPA t53.2 Remarks' Z. AMP.LE COLLEC!ED BY i Tesz:; Performe,~ * See S[,~ciai in~t~uc:aons Abeve DA-Umava~table NJ- ~one I)~tected See Sample ~e~a !.fA,, Ncr kna]yzed Li'-L(~¢~ Than, GT-C~eate:: Tb~n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date t · 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, s, ection, township, range) Location (address. or directions) (b} Applicant Name/~'~ 2y ~a ~'~ Telephone: Home ~'~2 5/- Business 3 Applicant Address / - (c) Applicant is (check one): Lending Institution ~ · Owner/builde[~; Buyer ~ · Other ~ (explain); (d) Lending institution Address (e) Real Estate Company and Agent Address~0[ 77/~q ~ Telephone S & S Dr~jineering TYPE OF. RESIDENCE Single-Family~, Multi-Family [] Number of Bedrooms ~- i Other WATER SUPPLY Individual Well,~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) 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 S & $ E~x~h~,i~ Telephone SRB 196x Address £,,~fe ~Ner, ~J~fca S'~5',~/ Date APR I c i986 Approved for ,t~-~Od./. ¢ bedrooms by Approved /t Disapprovd8 Terms of Conditibnal Approval Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for.errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 MUNICIPALITY OF ANCHORAGL= DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR ] ? 264-4720 Legal Description: ~--~7' ';/~) ~~~V/.~ WELL DATA Total Depth Static Water Level ~-' Casing Height Above Ground Electrical Wi~ing in Conduit ~') Separation Distances from Well: Well Classification "~l~~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present ~'~ Date Completed /vi/~ /~'~.~ ~5 Yield /-..¢'~_ Cased to ~7/D / 7'' Depth of Grouting ""-'- Pump Set At D4, ~ /Z~ ~ Sanitary Seal on Casing~ Depression Around Wellhead.(-Y~ To Septic/Holding Tank on Lot _ /coo ~ ~- · On Adjoining Lots To Nearest Edge of Absorption Field o.n~ot / ~ ~ ~ ~'''' On Adjoining Lots To Nearest P~bblic Sewer Line ' '-I/,"' To Nearest Public Sewer C:leanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample T, est Results Comments 'Date B. SEPTIC/HOLDING TANK DATA Date Installed ID'/~/- ~ Size /~"c, No. of Compartments 'Z Standpipes ~,)N~ Air-tight Caps (~1~ Foundation Cleanout~/N,y" Depression over Tank ~) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) · for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / To Property Line ~ ' To Water Marl'r/Service Line Temporary Holding Tank Permit (Y/N) Course To Building Foundation ./~ I To Disposal Field ~' / To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~) "/~'-- ~--~ ~"-- Width of Field ~, ~- ' Square Feet of Absorption Area Depression over Field ~'~ Results of Last Adequacy Test Type of System Design .~..~~ Length of Field [/~- Depth of Field ? Gravel Bed Thickness ~'- Standpipes Present~)' Date of Last Adequacy Test /~/'~ Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water M~rTfService Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ,//'~ · On Adjoining Lots To Cutbank (if,~nt) To Existing or Abandoned System on Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions anhole/Access (Y/N) j~// "PumpOff"Levelat ~' '" /A Vent (Y/N) 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. Signed S & S Et~'_ineerin~_ Date ~ ! ¢~ ~ SRB 196x Company F ..... Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) FOLD ~ ~ ROBERT A. SHAFER, P.E. X, VER, AEASKA 99577 -~ .MUNICIPALI~ OF ANCHO~OE DEPT. OF HEALTH & EXCAVATING t CIVIL ENGINEERING WO~ANGED I ADEQUACY TESTS / SOIL TESTS OCT 7 ON SITE INSPECTIONS REPLY From: DATE OF REPLY ROUTING SYMBOL SIGNATURE OF REPLIER ITITLE OF REPLIER RETAINED BY ADDRESSEE MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date . subdivision, section, township, range) (a) Legal Desc~ription (include. lot, block, Location (addre~ss or directions) (b) Applicants Name~ Applicants ~dress (c) Applicant is (check one) Lending Institution Buyer ~--~ ; Other ~--~ (explain); (d) Lending Institution ~ ~ - Telephone - Home ~.~qz~/ Business Owner / tmrti-d~ r Telephone Address (e) Real Estate Co. & Agent Address Telephone 2. Type of Residence Single-Family~ Number of Bedrooms ~. Water Supply- Individual Well~ Multi-Family ~--~ Other (describe) Community~-~ Public~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality .and status. 4. Sewage Disposal Onsite ~ Public ~-~ Community ~-~ Holding Tank ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. En~ineerin~ 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 regula- tions in effect on the date of this inspection. Name of Firm . ... D~P Approval Approved ~ Disapproved Te~s of Conditional Approval Telephone CAUTION THE Mb~ICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH ~D ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL [i~TA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification Well Log Pmesent (Y~ Total Depth ~.H. ~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit d~/N) Separation Distances f~cm Well: To Septic~ Tank on Lot // To Nearest Edge of Absczption Field on Lot To Nearest Public Sewer Line MUNICII~ALITY OF ANCHORAGI~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIOIXJ i JAN 2 1985 If A, B, ar C, D.E.C. Approved(Y/N) Date Ccmplete~/W//~ /~O'~_ Yield 40/{- Depth of Grouting Pump Set At c3, ~, Sanitary Seal on Casing ~N) Depression A~ound Wellhead (Y~ ; On Adjoining Lots ' ; On Adjoining Lots To Nearest Public se~r Cle ancut/Manhole Water Sample Collected By ~ Water Sample Test Results 1'o pK o ,) uo3 To Nearest Se~r service Line on Lot /~ 'i~ B. SEPTIC/~ TANK DATA Date Installed ~-/O '-7~ Size /~ No. of Cc~,~artments Standpipes(~/N) Air-tight Caps ~N) Foundation Cleanout (Y~) ,'z-z.,7 Depression ove~ Tank (Y/~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~ ; for Holding Tank High-Water Alarm (Y/N)~/~ Temporary Holding Tank Permit (Y/N) Separation Distances frcm septic/%~ Tank: To Water-Supply Well // To Property Line /O TO Water MaipJService Line Course To Buildiux] Foundation To Disposal Field /~) To Stream, Pond, Lake, ar Major D~ainage Con~ents [Page 1 of 2] Receipt ~ $o~O?O~-- Date Paid: ! ~ /~-- Amount: ~.dQO 2-15-84 C. ABSORPTION FIELD DATA -- Soils Rating in Absorption Strata Date .Installed ~ -/~- 7~ Width of Field ~ Square Feet of Absc~ption A~ea / ~ 3 ~ Type of System Design .~'/~J~ Length of Field ~[ Depth of Field / ~- ravel Bed Thickness ~ ~! Standpipes P~esent ~/N) Depression over Field (Y~ Date of Last Adequacy Test Results of Last Adequacy Test ~fT~4~P~ . ! Separation Distance f~cm A~sGrption Field: To Water-Supply Well /~'~'- ' To P~operty Line /~ To Building Foundation /~9 ~ To Existing ~r Abandoned System cn Lot ~3/~[ ; On Adjoining Lots ~O /~- To Water Main/Service Line /3/~ To Cutbank(if ~esent) To Stream/Pond/Lake/c~ Majo= Drainage Course ,4YA To Driveway, Parking Area, c~ Vehicle Stc~age A~ea ~-O ;~ Cca%Tents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA on the date of this inspecticn. Con, any ._ KB1/d5/s [Page 2 of 2] Date MOA No. 2-15-84 MUNICIPALITY OF ANCHORAGE . MUNICIPALITY C;: ANCH©RAGE_ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION ~:~'~ ~ ~ :: ';~'~ Telephone 264-4720 REQUEST FOR ~PPROVAL OF INDIVIDUAL WATER AND SE~~L~ DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proce~ed. Please allow ten (10) days for processing. PROPERTY/~RESIDENT~r{If different ~ from~¢~.~ above}. ~.~ ~PHONE PHONE MAILING ADDRESS ~ / MAILING ADDRESS ~ -r_/ ~ ~ // 4. REALTOR/AGENT~/J f PHONE MAI LING A DDR ES~ ~ 5. LEGAL, DESCRIPTION v 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS r~ [] One [] Four SINGLE FAMILY Two [] Five [] MULTIPLE FAMILY Three [] Six 7. WATER SUPPLY . I NDIVIDUAL* COMMUNITY [] PUBLIC UTI LITY [] Other 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For wells drilled ~p~rior to thatr date, give well depth (attach log if available.) ~;~2~'~,~ ~ **If individual/on-site, give installation date ~///¢ ('-'~/7~ ~)x{.,/' If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. · THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSP ECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE [] PUBLIC UTI LITY Connection Verified [--ISeptic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] OTHER Septic/Holding Tank IAbsorption Area ISewer Line INearest Lot Line 5. COMMENTS ~]~APP ROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must a,q~qpany certificate) [~"~DISAPPROV ED LEGAL DESCRIPTION 72-010 (Rev. 3/78) (907~ '2(~ ~ 4111 May 24, 1979 Blue Max Development Corporation 125 West Fireweed Lane Anchorage, Alaska 99503 Subject: Lot 10 Chandelle Acres Subdivision Approval of the on-site sewer and water facilities can not be granted at this time. An inspection of the property on May 24, 1979 revealed the well is in a pit, the sewer system does not have a septic tank and the leaching pit is pumped on a regular basis. Therefore, before an approval will be granted, the following must be completed: (1) Raise the well casing twelve(12) inches above ground level. (2) Obtain a soils test, so that this department may issue a permit for a new sewer system. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: Spokane Mortgage 3201 C Street - Suite 250 99503 R.T. Ohrt, Associated Brokers 125 West Fireweed Lane 99503 Russell Oyster 694-2774 0 & E ENG,,qEERING & DEVELO, "I~ox 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG " E~I Ellis Performed for: Legal Description: Depth (feet) 0 1 2 3__ 4 5 6__ 7__ 8__ 9__ 10__ 11__ 12__ 13__ 14__ 15__ 16 Soil Characteristics Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: x PERC. TEST ~.~ '~. ~., ~ t+_~Z ...... -.-'~ I~~~' '~'q" :,:? :.:::/ :' No '" If yes, wh~t depth Drain Fiold .:~ ~ L ~ . Performed by: