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HomeMy WebLinkAboutCHARLICE TR D-1Onsite File Charlice Tract D-1 PID# 068-011-10 Formerly Tract D Municipality of Anchorage On -Site Water and Wastewater Program - (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP151252 PID Number: 068-011-00 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: Paul Della Croce ABSORPTION FIELD ❑ Deep Trench ® Shallow Trench ❑ Bed ❑ Mound Address 27141 Roop Road, Eagle River, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-694-9881 4 0.8 GPD/SF 5.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.0 Ft. Gravel depth beneath pipe 3.0 Ft. Subdivision Block Lot Charlice S/D Tr D-1 Fill added above original grade Varies 2.5 to 3.0 Ft. Gravel length 89.8 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist between trenches From Tank Field Tank Line 774 Fe 1 N/A Ft. Well- - 100+ 100'+ 100'+ NA NA TANK -®,Septic ❑ S.T.E.P. []Holding ❑ Other Manufacturer Greer Capacity 1 1500 Gal. Surface water 100'+ 100'+ 100'+ NA Material STEEL Number of compartments 2 Lot Line 5'+ 10'+ 5'+ NA NA Foundation 5'+ 10'+ 51+ NA LIFT STATION Manufacturer N/A Capacity Gal. Curtain Drain NA *50'+ NA NA Remarks *None known. Existing crib & tank Pump on level at in. Pump off level at In. High water alarm at in. Decommissioned in place per code. S.T. and field insulated Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer Owner Install Draintield 3034 CO/MT 3034 Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft Inspection15` 8/8/15 nd 8/10/15 Location and description dates:2 3`d 8/10/15 4" 8/18/15 lDeck @ corner COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF Ai \ Conditional Approval: Date 10, -P KENNETH Mi DUFI ;S / 711U Approved (� Date-... _ 2I Inspection Report_9-1-12.doc AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP151252 CHARLICE SUBDIVISI❑N TRACT D-1 PID# 068-011-00 4f ECOMMISSIONED PER CODE EXISTING 20'X20' CRIB W / 9' ED • 28� GRAPHIC SCALE 0 15 30 y� SCALE:1 "=30' �A-C=42.4' B -C=22,5' A -D=36.1' B -D=31.4' �A-E=109,3' D B -E=128,8' n A -F=91.3' B -F=74,9' L 1 a o� Q '°Co sem D FC .�o �C �B 0 TH15-1 36.20 96.10' ss s as s ss s� 0 as a� J U J J JJ J � = U 0 o- 1500 GAL SEPTIC v TANK i ..OFA1 /*49 TH i 1 - _'_�Co MT F6UEL TANKS NEW 1 00 GAL. STEEL REEK SEPTIC NK FINAL GRADE SEWER ROCK 89.13' PREPARED FOR: PAUL DELLA CR❑CE 27141 R❑❑P ROAD EAGLE RIVER, AK 99577 KENNETFI lM D 5 = / FIELD BOOKS CE-'pll6 �4" r BWNDARY: N A mss` % srAaNc N A • / As"u'LT: SEWAF \ %PESSIOto �dv M. FILE AcAD FILE FILE COMPUTED: DRANK: DATE 09./28/ DMD: SW0465 " "°': 15-165 M �s Z_ C3, SU F9c�F �� rc o1, '�iY ' .8 ULT I N G - 5 l9 1-ItAK.99577-8� ASBUILT SEARD & ASSOCIATES LAND SURVEYING 694-0 I HEREBY CERTIFY THAT I HAVE SURVEYED THE I SCALE, FOLLOWING DESCRIBED PROPERTY: / DATE. INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE TW: EXISTENCE OF ANY GRID: EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES Si .OLU F&, AMY r%A'rh W=Wrlhl Mr I MMM Crir,) r%^Ktc-lrmrtr-ri^m _-A 49TH 41, Duane Mark r q, - Ls -p P.O. 11'0378 lb1:0.330 Dld-Highway hway. (9 0 7�.49`3: '�'8535: ANC*H'64�-bll=,' ALA§ki-.09511 mm"'ll 1� T Location laddidO df: Township,,"MAgpj::,gp own�; :or distance t m ­ba :--maMroad Size of caszng 6;. e, j c s6a-tci + 66t. epth: of "H. 2:5 �X 6 -k dhed Statk: water l0el: -ft. 50,b* land surface. F -b! W, op ed. e§ctibe- screen or porfeii 10 M WdlI pumping ping -test (ininute) 'for hours with . 10 %X of drawdown from static.6 1 r 31* . -W i : 1'. -1 —TO— . —TO— 30-218 w�.th marked Time.1 l V.E 4-1 `rote Date of completion ' then, deeperiec :j WK gip.m gm Depth A , n.ee t -i ground surface: , f al Rr ht oxrmations penexated size of material, color and hardness OPP -L-0—TO-2 -1-8 01b _218 -TO -325 G E 'titbfib!t igb�� black ,:: i§Ppra Trac —ire: tL -TO- wa :s=si, t Zen e_.. ,0 —TO— . —TO— SEWARD ASSOCIATES LAND SURVEYING 694-0829. I HEREBY CERTIFY-THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED ~UBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOIJI~ ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR EM'"TABLISHING BOUND- ARY LINES. DATE~ / / ~RID; DRAWN~ Permit Number: Tax Code Number: Work Type: On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 OSP151252 06801110000 Septic Upgrade Permit Effective Dates: August 06, 2015 to Design Engineer: Subdivision: Site Legal Address: Owner/Address: ARC TERRA CONSULTING INC CHARLICE CHARLICE TR D-1 G:0464 August 05, 2016 DELLA CROCE PAUL & VIRGINIA 27141 ROOP ROAD EAGLE RIVER AK 995777691 Site Mailing Address: 27141 ROOP RD, Eagle River g -8-,r la:° g-lo.../ice Lot Size in Sq Ft: 218904 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 068-011-10 PAUL & VIRGINIA DELLA CROCE Property owner(s) Day phone Mailing address 27141 ROOP ROAD, EAGLE RIVER, AK 99577 Site address 27141 ROOP ROAD, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) CHARLICE TRACT D-1 Legal description (Township, Range & Section) Lot Size 218904 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (® all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage APPLICATION IS AN: Initial Upgrade Renewal rxi TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature ofroperty oer . authorized agent) Permit/Rush Fees: 61:Ci - Date of Payment: '117-'1'ls r Receipt Number: d-rntiL Permit No. 05915 052 Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN CHARLICE SUBDIVISI❑N TRACT D-1 0) 0) N W ro 0 N 0 O Z A� T D-1 aSaaaaON PER CaL COMO rem' as•/om N89'54'10'W 283.18' VACANT FLAG PROPERTY LINES WELL RADII & EASEMENTS PRIOR TO C❑NSTRUCTI❑N DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD 600 GPD/.8 GPD PER SQ. FT. (6 MIN/IN.)= 750 SQ. FT (750 / 5 x .58RF (3' EFFECTIVE DEPTH) = 87 FT. TRENCH USE 1 TRENCH - 87' (L) X 5' (W) X 3' (ED) Total depth of system Is 5' max from original grade. Total depth of gravel below distribution pipe Is 3' NOTES: 1. VERIFY & CONNECT TO 1500 GAL & INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' DF FILL, MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ. 3. CONTRACTOR WILL ENSURE MINIMUM 2X SLOPE INTO SEPTIC TANK. 4 CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... NO SLOPES >25% W/IN 50' OF PROPOSED PRIMARY DR RESERVE FIELDS NO PUBLIC WELLS WITHIN 200' OF 'a PROPOSED SYSTEM g NO PRIVATE WELLS WITHIN 200' OF PISSED SYSTEM EXCEPT AS IIfEA ▪ NO SEPTIC Sm N:NS WITHIN 200' r PRIED VELL EXCEPT AS NOTED. Scale: 1"= 100' PAGE 1 OF 2 PREPARED FOR: PAUL DELLA CROCE 27141 ROOP ROAD EAGLE RIVER, AK 99577 FIELD BOOKS BaINDARY: N /A N/A DMS Da FILE STMe W ASBURT: A COMPUTED: ; BRAWN' BMW/KMD CHECKED: KMD DATE ORO: ABA° Nil' FILE JOB Na: 4a " ""' 7/25/15 ., SW0465 '�F °G t '' 15-058 AK. 99577 gCTER • Ars4X, N. es ff11i7■ nt 11't ' !'l'."r -11 N W 4„,,A LILTING +�yb 0 WASTEWATER DISP❑SAL SYSTEM DETAILS CHARLICE SUBDIVISI❑N TRACT D-1 SHEDS DECOMMISSION PER CODE EXISTING 20'X20' CRIB W / 9' ED CONNE• TO EXISTING 15s'—GAL SEPTIC TAN LOCATE OR AD FOUNDATION CLEANOUT 89°54'10"W 283.18' FLAG PROPERTY LINES WELL RADII & EASEMENTS PRIOR TO C❑NSTRUCTI❑N scale: 1'= 40' PAGE 2 OF 2 PREPARED FOR: PAUL DELLA CRDCE 27141 ROOP ROAD EAGLE RIVER, AK 99577 FIELD BOOKS 9WMDARY' N/A !Math N/A Main DMS 0193. RL& COMPUTED: DRAMt'k BMW/KMD °gq ED' KMD DALE CRID: 07/25/15 SW0465 ACAD ALE FILE a"' 15-058 �ELCTER"4 et ARC TERRA CONSULTING, INC 212 E. 51st Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 SOILS PERCOLATION TEST • Performed for: PAUL DELLA CROCE Date Performed 06/27/2015 Project: CHARLICE TRACT D-1 TEST HOLE # TH 15-1 Depth (Feet) 15- 16- 17- 18- 19- 20- Org/OL GM/gp BLUE SM / CY 11-14' B.O.H. HOLE PRESOAKED PRIOR TO TEST SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO Depth to water after monitoring? 11' What depth? NA Date? 7/6/15 Reading Date Gross Time Net Time Depth of Water Net Drop 1 6/29/15 1:00 - 6" - 2 1:30 30 min 14/16" 5 2/16" 3 * 1:31 - 6" - 4 2:01 30 min 15/16" 5 1/16" 5 * 2:02 - 6" - 6 2:32 30 min 14/16" 5 2/16" 7 8 9 10 11 12 * Water Added Percolation Rate 6 (min/in) Pere Hole Diameter Test Run Between 3 feet and 4 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. birRCTERRq • Rs T�n A� A KENNETH M. is 3 SOILS PERCOLATION TEST 1s � c3i/ ARC ERRA CONSULTING, INC 212 E. 51st Ave, Anchorage, AK. 99503 t �? 9 Office (907) 868-3791, Fax (907) 868-3793 ` * 4-9 TH /^ * / • .)OFAL4t) Performed for: PAUL DELLA CROCE Date Performed 07/18/2015 CHARLICE TRACT D-1 TEST HOLE # TH 15-2 Project: Depth (Feet) BLUE SM / CY 11-14.5' 17 - HOLE PRESOAKED 18 - PRIOR TO TEST 19- 20 - SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO Depth to water after monitoring? 13' What depth? NA Date? 7/25/15 Reading Date Gross Time Net Time Depth of Water Net Drop 1 7/25/15 3:00 - 6.5" - 2 3:30 30 min 1-6/16" 5 2/16" 3 * 3:31 - 6.5" - 4 4:01 30 min 1-15/16" 5 1/16" 5 * 4:02 - 6.5" - 6 4:32 30 min 1-14/16" 5 2/16" 7 8 9 10 11 12 * Water Added Percolation Rate 6 (min/in) Pere Hole Diameter Test Run Between 3 feet and 4 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. 07/29/2015 00:23 19076949881 PAUL DELLA CROCE MUNICIPALITY OF ANCHORAGE PAGE 02/02 Community Development Department \ i, Phone: 907-343-7904 On -Site Water & Wastewater Program Fax: 907-343-7997 Septic System Owner -installer Agreement A real estate property owner (Owner) may install their own septic system. The department may issue an approval for a homeowner to perform work on a conventional (not AVWVTS) on-site wastewater disposal system to serve that individual's owner -occupied, single-family or duplex home if the homeowner satisfies and agrees to the following requirements. The property owner and excavation equipment operator may perform work on no more than one owner installed project in a 12 -month period. As owner of (legal description) Q //V/Zs-JP 62o0 !agree the following items are true and accurate. 1. My experience installing septic systems as follows. >4Or J ccm F / Cc Q 7-, G. /— toMr,.r --S O/FR/ 'Ai 2. The name of the excavation equipment operator is. pa,16 tDn (? A CROC61. 3. There will not be compensation for installation services rendered. 4. I will be actively involved with the septic systemeinstallation at all times. 5. The name of the inspecting engineer is Off >=i 0 0 P-rr) S - A GZ err fag& — +sh Ov r -FUS (-CI vsU�?In,f, 6. I agree to discuss the following items with the inspecting engineer: a. Permit design criteria and specifications. b. Inspection requirements set forth in AMC 15.65.150. c. 2 -hour minimum advance notice given to the On-site Water & Wastewater Program for all required municipal inspections., 7, I agree any changes I make to the items listed above will require a new approval before performing work. 8. I agree to have the project -specific On-site Wastewater Disposal System Permit available at the construction site for the durationtiof all related work. Owner's printed name: 9119-0 L V� «r re-oc& Owner's signature: Septic System Owner Installer Agreement_Fet2015dcc Date: ./e $/ 20 (5--� 11 -VER ANCHORAGE AREA BORO HEALTH DEPARTMENT NO 501 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 MAILING INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME -2----‘)/17 ,d. -X..`!"-/47-7-7--J ADDRESS -� J, // -✓ PHONE-- ' =/% 7.,i//-ruX f ,'V/2 i /c -'C- cam✓ LOCATION Lj1rG-_../-2.- '' iii' LEGAL DESCRIPTION l//`L'FX-1 Piz X/✓1' `'.• Yui• -4j SEPTIC TANK: DISTANCE FROM WELL L' -NUMBER OF MATERIAL c COMPARTMENTSS i'<--- LIQUID CAPACITY -.ViG GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH --? LENGTH- '1<" DEPTH / LINING MATERIAL 2G'% C- Yv 7r /J DISTANCE FROM WELL �L-7/' - BUILDING FOUNDATION NEAREST LOT LINE 4✓1) TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 2t-�/ SQ. FT. TILE DRAIN HELD: - TOTAL LENGTH DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES, TRENCH WIDTH .[S7L EFFECTIVE ABSORPTION AREA 5Q FT LENGTH OF EA -I LINE DEPTH: TOP OF TILE TO FINISH GRADE WELL: cif//yc'it c « ? ' C! DISTANCE FROM -5- WATER TYPE DEPTH L % e- BUILDING FOUNDATION / SAMPLE NEAREST / NEAREST I,„. - _ SEPTIC SEEPAGE -. OTHER LOT LINE XLi - SEWER LINE i 7 TANK -. S LS 7!- SYSTEM •-• )))?-2')' "CESSPOOL/ /%'/� SOURCES= DEPTH OF FILTER MATERIAL BENEATH TILE IN ABOVE TILE DISTANCES: DIAGRAM OF SYSTEM 772777.12)7r/7-7) /H!= ,f'1+ct nnj� r✓ • DATE , /"-/' i-' -civ t �.7%✓.!/.�=i' )17.2"7 \rrRovcD i/ ` HEALTH NHORITV ,GREATENCHORAGE AREA libROUGH case No //e)a HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT ( NAME OF APPLICANTAP ..13.2,1L-t-c�- MAILING ADDRESS 6,e --6c N�-`EI PHONE NO 1``x +1 f RESIDENCE ADDRRESIS etr e K.e...-e2, LOCATION OF INSTA LATION a -- 4 t : 764Gtr ebL N---ry El, LEGAL DESCRIPTION A/14 KSI_ w XAi& XX NWW I Sct „t /N. / Y Aiefrtii kA -Nye 1 be ,5'eM;4 d Merit r d it, ni APPLICATION TO INSTALL: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER TO SERVE THE FOLLOWING FACILITY -. (6Q d kocsAil l7oUS e FINANCED THROUGH ("'(m4 Sit -Mi / TO BE INSTALLED BY f)e) )V /.7/1 /1/ e,,v PERCOLATION TEST RESULTS ,;?073—c,///idr/ ANTICIPATED DATE OF COMPLETION g) A8� z° BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED DISTANCES: SEPTIC TANK SIZE TYPE SEEPAGE AREA DIAGRAM OF SYSTEM HEALTH AUTHORITY OR LICENSED DESIGNER TYPE We Cls /S _A 20 Q�S t sroe r' 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. 1010 DATE APPLICANTS SIGNATURE •REATER ANCHORAGE AREA BOROUGH. HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 Performed For '0/n 1qQ„ ffl_e Date Performed Legal Description: Lot Block Subdivision .This Form Reports a: Soils Log Depth Feet Soil Characteristics The Gm wUs ce mN06/ /WI c /ow & 9 confer/. There was re lo h,'9/ 6oc,lder co66le_ Pe661e tent enf. Was Ground Water Encountered? If Yes, At What Depth %1Ji> Reading Date Gross Time CASE 0 % 67,2 1127O : T/ ercolation est Locatio Sketch nfBiuiu fMMEM11 ■EM ■EM MMUS *MIIMM MEM U1 OMNI MOI! f a a,i MIR MNOON a Mir OWN MOW Y ,mer Net Time Depth To H2O Net Drop erco a on .a Proposed Installati .: Depth Of Inlet COMMENTS: �m Test Performed By: inu e Seepage Pit Drain Field Depth To Bottom Of Pit Cr Trench /rx'r // PP/'Gcf� Data Certified By: �%� Dat i r 1 •AGLE RIVER AREA CAA( Aid T °Coke GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "fa" Street, Anchorage,.A ska 99503 274-4561 104 -N 1 Date Received October 27, 1976 Time of Inspection // - $--3{a )LSC. Date of Inspection 1/ -,=.5 -Ya >4ti, /r nye A REQUEST FOR APPROVAL OF of INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: Phone: 2. Property Owner: James W. Lee & John R. Beattie Phone: 694-2161 Mailing Address: Box 882 Eagle River, 99577 3. Legal Description: T14N Rlw Section 25 NWS SE4 NE4 NW' 4. Location: Mile 71/2 Eagle River Road (Tsateciik Road brown w/green trim house) 5. Type of facility to be inspected Single Family 6. Well Data: A. Type Individual B. Depth 215' C. Construction D. Bacterial Analysis No. of bedrooms 7. Sewage Disposal System: On-site system A. Installed 1970 Ll -/q-9/ B. Installer C. Septic Tank: 1. Size Ler() 2. Manufacturer lfou g 41 D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank '4. , Absorption area Nearest lot line , Other contamination /04 , Sewer Lines B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages • • MUNICIPALIT! OP ANCHORAGE MUNICIPALITY OF ANCHORAGE OEpi. OF HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ENyIRONMENtAL PROTECTION a-- - East Tudor Road, Anchorage, Alaska 9950. 276-2221 OCT 27 1976 REQUEST FOR APPROVAL OF RECEIVED INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV 2. Property Owner: ^_1.<9.-5 J l- '/ Ac c -I 2/v/_.) ie, 1c=4. 726._. �Fj ,r. �39s-7'7 r Mailing Address: ��� 4' c-c� 2 /_ iL4' /3 ' )f Day Phone* �' '� /'�� 0 3. Name of Buyer()4cl3�/t //S�isL ' 7� /T' ''7 4'f�(7 y, - t i:i >_4 i.,/,:,:1 c.),1 •) /�` . �= / 5! 'v S ' 7--;...,, cj moi` ✓ S /)xl Mailing Address: `, ri/E3-- /2. /7Zt cC 5, - May Phone: --- 1 g - ,'/6(/ 4. Name of Lending Institution: Mailing Address* Phone: 5. Name of Realtor or Agent' Mailing Address: Phone: 6. Legal Description: /01 q .5/- -"L.- 9: -"Vc 5: .5 c 13 Location' / % ,4=1:1(5-4L---- /,v'f %C' /i CA -1 A % ‘v,[,i% uSc //, 7. Type of Facility to be Inspected: No Bdrms 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 4.3 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation U' / = r /( ,7c1") 72-003(3/76) Page ;2 of two pages - Relit for Approval of Individual •r & Water Facilities Legal Description T14N R1W Section 25 NW4 SE; NE; NW's Comments �� d-*�L /J6y1G✓ �.G t� vel �, Approved Disapproved Approval Valid for one year from date sign Greater Anchorage Area Borough, Department of Environmental Quality Date `%y2f --?4( DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date Performed For ; 1) • ANCHORAGE, ALAY.A 99501 d 74 /VI fr4-4.) 4..) __,.........._.__ Da t e Peri --)!--e.1 4- 3 o - 77 Let.a1 — -- This Form Reports a: Soi.--'7r-Ler; ti),QQ, Perco.tatic,n t est. Depth(..) i 5 /— 0&.1( 477e8T,;e7767,7j;Y-7- Feet E 02: 1 Ch r..e:- i f: t i r.: S I:o•.: at icn.) 1...,....... ,••••......... . 1 ; 1 _.....L...... 9- 6 — Sketch Was Ground ,.atE.:r rt-..7.ountered? If , ••• ;- th AlC9 g f'6) . i • • 1 , .... .,. _„ 1,re ; NeZ T./ TLC ,• . 'flute : Seepage N.1- 1-4 Drain Dot h To :tottom Of Pit Dr /9/k? z_<:=•/* Test Performed Data Certified ---------- 0 -544- Depth To 1-120 Net- Drop iiy L'•y : e-1 / /: -1 44 /9-C Date: '72757T Z2------- ____—_—__..1,____;. -) ; _.... ....._........._._ 197 GAILY DRILLING REPORT ,dIJC0rR 43 ROSA Mt. AOAKTNHOCOA CONTRACTOR - ` 1 k , ` t L ) '1` C L^ ^ L INa ` DATE _ �.. `_..____. / « _ t/ Gj �. �J�WELL -am ..41....f,M.p!•Nyy- fen.A Reotti:c, nee.v«Ecx LEASE cc_ 2.C.--jcv,Ys f, c ,v1-te-sri-.4.-m. NO. RIG NO. DISTRICT F,osir RI ,-e..- COUNTY [STATE 1 _4 I. i s;. 4 . D. P. STRING NO. J SIZE s FROM TO FORMATION ROTARY SPEED WEIGHT ON BIT PUMP PRES. ' NAME HRS. /(// l..r� 7 Y� 6 , ` C d 1 ,q.., 0 LN Li ivd- 40l�G a o V . D0 it a ey s _ ileir z,,, . _. -DM EM _atie RL L SLOPE TEST ACCIDENT:- IGIVENAMEI -_ " AL L t.I �*G, �L - /� I FT. DEG. OFF DR L __ika l_.r c $C u! ii(t 1' IA' BIT AND COREHEAD RECORD MUD RECORD TIME RECORD DRILL STEM RECORD HUN NO. Z WEIGHT DRILLING SIZE D. P. NIZE /� W VISC. CORING SIZE COLL. t,{v WTR. LOSSC. C. OTHER HAKE JTS. D. P. FT. FT. ERIAL NO.---` FILTER CAKE I REPAIRS KELLY DOWN DEPTH IN } 1 PH. I TRIP COLLARS FT. it 1 MTL.. ADDED (REMARKS) 1 HOURS RUN TOTAL FT. REMARKS: (! C II M, t o 9''Z�` Le is rvr (. A�s1J °� �iI1E,L �ie4e,4 7 't'� ii l i:30 " Yc' ''.i t S,rZf� CA d mowed P E IL `Lc to i iv ,p _e +'--LLi D4. 1._ ° o L' .1c116%,cS e 0 t o D-; 'c d o 4.Q 72,1e Left re, $',4 4- CfiSe t'e 3<3. L c'vr_ j Net I) • `Yc e,1S:N;y Andy F nCi. FROM TO FORMATION ROTARY WEIGHT SPEED ON BIT PUMP PRES. NAME HRS SLOPE TEST ACCIDENT: - GIVE NAME) FT. DEG. OFF BIT AND COREHEAD RECORD MLJD RECORD EM 4 - H DRL, TIME RECORD DRILL STEM RECORD RUN NO. .IZE MAKE HERIAL NO. DEPTH IN HOURS RUN WEIGHT 7 REMARKS: VISC. WTR. LOSS•C. C. FILTER CAKE PH. MTL. ADDED (REMARKS) idi-o(-.74 `DRILLING CORING OTHER II REPAIRS TRW SIZE D. P. SIZE COLL 1 JTS. D P. KELLY DOWN COLLARS TOTAL FT. FT. FROM TO FORMATION ROTARY SPEED WEIGHT PUMP ON SIT 1 PRES. NAME I HRS � t DM EM 1 SLOPE TEST ACCIDENT:- (GIVE NAME) FT. DEG OFF RL BIT AND COREHEAD RECORD MUD RECORD "FCORD DRILL STEM RECORD r DAILY DRILLING REPORT ?mall 43 7,7,!.s.',..".1,,.,:f.?.. CONTRACTOR 4_ /4 ".,4_,Aruc.n.ziC!_;'.7),mf C. DATE MA:e c le i— - / TE)..IiMPIWN.II reit. pi "3 c .Z. it ‘ : C. --,tlei et. d . _f_ii:;4-A.,.__ .14' _ LEASE WELL NO. RIG NO. 73 DISTRICT ilii 94. e.. R. v c ii, COUNTY y STATE fi c a irt, D P STRING NO -3 SIZE FROM TO FORMATION ROTARY SPEED WEIGHT ON BIT PUmP PRES. Po s e• NAME HRS. (II' / 4? 5" 112 ;i:l 0 4.1'/e_4! Ve 7_ .s A.Ait • H DM ACCIDENT- : .,..-- (GIVE NAME) 1-1 1!— s' 4. z i.e., w/ A'stin 1- 1---- DEG. OFF 1 DRL BIT AND COREHEAD RECORD MUD RECORD TIME RECORD DRILL STEM RECORD I Run NO. 1 WEIGHT I . DRILLING SIZE D. P. I LIZE SLOPE TEST ACCIDENT: - (GIVE NAME) .--- CORING "1.. SIZE COLL @ FT. MAKE WTR. LOSS•C.C. ---/--La--- -1--A Ikele__d__,.i....__ I OTHER DEG. OFF ihDRL' > t.A d vi....Pc nord/tie 'V /2 V2, BIT AND COREHEAD RECORD MUD RECORD TIME RECORD DRILL STEM RECORD DEPTH IN RUN NO. .7..-• ----1 1 WEIGHT DRILLING 1 SIZE D. P. SIZE COLL. FT SIZE MTL. ADDED ( REMARKS ) VISC. rTOTAL CORING HAKE 14 v 54-cs WTR. LOSS•C.C. OTHER JTS. D. P. FT. SERIAL NO. FILTER CAKE --) REPAIRS KELLY DOWN FT. DEPTH IN ..j - Z 1P I PH. TRIP L COLLARS FT. HOURS RUN 1 MTL. ADDED ( REMARKS ) TOTAL FT. REMARKS . e, 0 a N) Ove,...,.s f gy Pr z_t Seli' ei•Le, 1Y .1 Yes. et: f jj_i_ch 4 dvt. a :4,0 Pm, 4„0 eivt 7 .3 iesA. .y1 64c dev;141 'e4i- 73 ,..L, c9 • ' FORJN , MATOL 'ol / tO 4.- a Si i 144 ' .' '1 I. 4 V" •.e. . Z-- y ROARYED WEIT GH SPTEON BIT PUMP PRES. PUMP PRES. _ NAME HRS. , / -A. 4 is- "& 4 ea 4 e 01/ , -e Pe 1: fele. DI 1,_e ct c_A41,. NJ es ‘. 6. za ,4 a ... -...... Po s e• 144 htiti..4l fi Pfei 3341 0 .14e y- Pz ) ' 14 :il. I H SLOPE TEST ACCIDENT- : .,..-- (GIVE NAME) 1-1 @ FT. ACCIDENT - (GIVE NAME) , 1- 1---- DEG. OFF 1 DRL BIT AND COREHEAD RECORD MUD RECORD TIME RECORD DRILL STEM RECORD I Run NO. 1 WEIGHT I . DRILLING SIZE D. P. I LIZE VISC. I .--- CORING SIZE COLL MAKE WTR. LOSS•C.C. I OTHER JTS. 0 P. KELLY DOWN FT. FT EERIAL NO. FILTER CAKE .-- [ REPAIRS DEPTH IN PH. TRIP A COLLARS FT HOURS RUN 1 MTL. ADDED ( REMARKS ) rTOTAL FT. REMARKS: FROM TO FORMATION ROTARY WEIGHT SPEED ON BIT PUMP PRES. NAME HRS DM EM H SLOPE TEST ACCIDENT - (GIVE NAME) , H @ FT. E, DEG OFF _ __-_ MUNICIPALITY OF ANCHORAGE 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 # -'Cl (39N — Lt l®+ HAA # niRcn --1,1-i 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Tnact D; Chan.e.ice Subdiv.iz ion Location (address or directions) Mite 71 Eagie Riven Road, Eagte Rivet, A.ea,SFia (b) Property owner John $ea Telephone : (home) 694-9111 Business Mailing Address P.O. Box 770882, Eag.ee Riven, Ala ka 99577 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here 6, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 EagPe Rivet Loop Road, Sca.te 204 Eagle Riven., Aea4ka 99577 2. TYPE OF RESIDENCE Single -Family I Number of bedrooms 5 3. WATER SUPPLY Individual Well CC Community 0 Public 0 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 [ Public 0 Community 0 Holding Tank 0 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 Address Date 5 & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Telephone f4/g 6. DHHS APPROVAL / Approved for L �� 0- bedrooms by Date ?— a 6- iy Approved X Disapproved Conditional Terms of Conditional Approval CAUTION 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 A. WELL DATA Well Classification t rbc Well Log Present (Y/N) Date Completed S"5 " U Yield (44 apt 59 Total Depth a 151 Cased to 3 3 Depth of Grouting Static Water Level / O 1 - MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) ''CHECKLIST - FEBRUARY 1984 343-4744 Legal Description �r orc_f C ! , h A/ ✓<fcc If A, B, C, D.E.C. Approved (Y/N) Casing Height Above Ground "7->O , t Pump Set At U.( Sanitary Seal on Casing (Y/N) 4 Electrical Wiring in Conduit (Y/N) r Depression Around Wellhead (Y/N) tJ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot (110 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Al/A (So' ; On Adjoining Lots / t ; On Adjoining Lots / CO / t To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ( 0' f Water Sample Collected by 6 4 S 511 m)C.C.fiNc3 ; Date f4" 6 qt 8 Water Sample Test Results .1(i17-16-, f c(orct — 4/,,,c, -W';‘,9- 4- Nr tko0-� , 3 Comments B. SEPTIC/HOLDING TANK DATA Date Installed "'" op Size (�©0 No. of Compartments Ul • Standpipes (Y/N) Y Air -tight Caps (Y/N) I Foundation Cleanout (Y/N) N Depression over Tank (Y/N) I\) Date Last Pumped S-8 Pumping/Maintenance Contact on File (Y/N) / IVA ; for Holding Tank High -Water Alarm (Y/N) Pt//ti Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well j / 0 To Property Line i jL7 t To Water Main/Service Line 1 /C -t- To Building Foundation To Disposal Field Ai/h, To Stream, Pond, Lake or Major Drainage Course Comments j)7 �� ' tDv \ ve.d 61 -SA MtPiI y Bwhper 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata UK Type of System Design 02.1 Date Installed '"-, 16-10 Length of Field 0K - Width of Field UK Depth of Field Gravel Bed Thickness U (K 4/ Square Feet of Absortion Area UI( Statndpipes Present (Y/N) i Depression over Field (Y/N) k) Date of Last Adequacy Test /1/ Sept 3q. Results of Last Adequacy Test At( S V� Gfiof y 5 jedfoo w`^ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well I S d ' t To Property Line To Building Foundation 4 ' To Existing or Abandoned System on Lot fi ; On Adjoining Lots 30/t // To Water Main/Service Line (D ,'� To Cutback (if present) NIIA To Stream, Pond, Lake, or Major Drainage Course Rl/lA To Driveway, Parking Area, or Vehicle Storage Area ,s--0, ' t Comments 0 t D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at N Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. Signed Company Date MOA No. S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 995 2e, /63 s gds t e 414(4'0e�s� �fUi Receipt No. 62 / V27 /b2/? Receipt No Date of Payment 9-2/- g/ Waiver Fee: $ Amount: $ 2 7c) • GO Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGt 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 r7'"2 2 - SS 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 1 Lot-, la -C> (b) Applicant Name k'— 3 i n e,Telephone: Home (014-111 1 Business 4- Z► b I Applicant Address '1U f 2— �� �'`t A44 - 9 SI1 (c) Applicant' is (check one): Lending Institution 0 ; Owner/builder; Buyer ❑ ; Other 0 (explain); (d) Lending Institution ATelephone Address (e) Real Estate Company and Agent _Tb •ts. Address C . �.s s�..�-�,Jc,� ) �.c✓tr—�,�.�1c t� Telephone (f) HAA to the following address: S £.r. EnSVKIF7R1NG SRI3 1CBX 1 1VER ALASKA . ssn PK. 604-2979 2. TYPE OF RESIDENCE Single -Family Multi -Family 0 Other Number of Bedrooms 3. WATER SUPPLY Individual WeIIdg- Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservatio attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservatio attesting to the legality and status. 72-025 (11/84 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 t Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and ad for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtal 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 Address Date Telephone 6. DHEP APPROV Approved for. Approved Lit) e- edroo Disapprove Terms of Conditional Approval 7/rAd- ,07 `P t/ c :"..,„:":,0;.:...AF,...3,.stwss:f..0.,:r• •e 1457 .....74.3.410 t Y0 4°.,.••p�.`.+� 4.. De_ 13 - g� Date """ Conditional 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 264-4720 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION o51985 RECEIVED Legal Description. -1-'--V > A. WELL DATA Well Classification `' If A, B, C, D.E.C. Approved (Y/N) N As' Well Log PresenttaN) Date Completed -S — '10 Yield �+ t Total Depth Z C S Cased to Depth of Grouting Static Water Level 1 .ac:)' Pump Set At 004 Casing Height Above Ground tea" Sanitary Seal on CasingON) Electrical Wiring in ConduitP/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 11C:31 ; On Adjoining Lots 4=.-c -4- r To Nearest Edge of Absorption Field on Lot \t ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole To Nearest Public Sewer To Nearest Sewer Service Line on Lot l a I+ Water Sample Collected by S ; Date 1 - Z3' Water Sample Test Results Comments B. SEPTIC/HAL-DWG TANK DATA Date Installed .ter 011,0 Size No. of Compartments Li t 1A Standpipesd,N) Air -tight CapserON) Foundation Cleanout (Ye Depression over Tank (Y6? Date Last Pumped 1-23 _`gam Pumping/Maintenance Contract on File (Y/N) .n• /A ; for / Holding Tank High -Water Alarm (Y/N) N 1 A Temporary Holding Tank Permit (Y/N) a r a1 Separation Distances from Septic,44-lefd°►g-Tank: To Water -Supply Well I l, b 1 `--" To Building Foundation '32 I To Property Line t O 4' To Disposal Field 4 To Water Main/Service Line 1. t } To Stream, Pond, Lake, or Major Drainage Course Comments o TZ(.._ — S�4 ---pr-<.—k. - FS -)t c -'c- 1)+.) Ivl.-� 174-....)a- 1 't i- Vbi-i , ,-r-c7 N -p. A. c.art-,A4:_ ort., j or is Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA I--- . Soils Rating in Absorption Strata 0%14 • Type of System Design 4-3Z-1 15 Date Installed Length of Field U ‘ IL, Width of Field 1.)‘14-• Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 0 04.E Standpipes PresentQ �/ J) Depression over Field mop Date of Last Adequacy Test � ZS Results of Last Adequacy Test Separation Distance from Absorption Field: To Water Supply Well 15b' To Property Line 1,1=2,1 ! To Existing or Abandoned System on Lot t-3IAA ; On Adjoining Lots3,'f" To Building Foundation u/A To Water Main/Service Line L a '4 To Cutbank_(if present) n9 /Jp, To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments s.. Ere --3 D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at r l "Pump Off" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA aryl HAA guidelines in effect on the date of this inspection. Signed f"rQfiJ��;3i` i SPf3 1 Company L �;3 p Y r t L GC -2' Receipt No 6,E; 31 D.9 Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) ci-c�-ssS Date MOA No. L/ 3 KCllRAWFOW (01f ANC;HUKAUl- ti.. OF HEALTH & t�Rzli�Itw E4 AE PROTECTION �-- SOILS LOG 63 MUNICIPALITY OF ANCHORAGE % ®AmeDEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST EIVED825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR:___�1-Ft--� DATE PERFORMED: 4;A - ZI LEGAL DESCRIPTION: -ESEPT# SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Robert A. Shafer No. 1457-E ." €a FQ .......... WAS GROUND WATER S ENCOUNTERED?�_ L 0 P IF YES, AT WHAT E DEPTH? ■■■■■■■■M■ Date Gross Time Net Time Depth to Water Net Drop ■■■■■■■■E■ ■■■■■■■■",■ ■■■■■■■■IN■ ■EMEEMMINNE ■■■ EEME■■■ ■■■■■■■■■■ ■■■■■EMR0■ MMEMMOMENE .MEM&■■■■■ C12■■■■■■■■ MWE■■.■■■■ Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS 1-h`� '�a'C'-�'ta�. licl' ��o//S (Z 1-/ I�jt� \/� •T-�tt-�^t A -t Z, . s trg s PERFORMED BY: CERTIFIED BY: DATE: 72-008 (6/79) LLDLJL.P las q -k j rakos -7- „-7-) 1) • MI INICIPALITY OF ANCHORAGE MUNICIPALITY DEPT. — DEPARTMENT OF HEALTH & ENVIRONMENTAL PRoTECTiaN,.JIRONrJ,ENTAL • 825 L Street -Anchorage, Alaska 99501 - 1'r ENVIRONMENTAL ENGINEERING DIVISION JUL "�� �' Telephone 264-4720 -OF ANCHORAGE Ci ii::.'`LTH & Fi.OTECTION _ 1 1 1979 RR REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEgcI�YEP DIRECTIONS: Complete all parts on pane 1. Incomplete requests wiii not be processed. Pease allo.v ten 110'. cans for processing. -{ 1. PROPERTY OWNER PHONE BEATTIE,_ Johii_R._ Jane L. I 694-2161_ _ ,_Mary MAILING ADDRESS P.O. Box 882, Eagle River, Alaska 99577 fngl-/- 9/Il Aon INDIVIDUAL;'ON-SITE'S If system is over two (2) years cid an adequacy test is required O PUBLIC UTILITY by this Depar'ment. PRG'PERT` P. LSIDFNT (If d,fferr: ; frorr above' PHONE Same 2. BU'1,ER PHONE Same MAILING ADDRESS 3. LENDING INSTITUTION First Federal Savings $ Loan Association PHONE 274-6565 MAILING ADDRESS P.O. Box 4-2200, Anchorage, Alaska 99509 Attn: Laurie 4. REALTOR/AGENT N/A PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION :_ h,nLi-cj- Tract D, Chart$ -Subdivision STREET LOCATION Mi 71/2 Eagle River Road Eagle River, Alaska 99577 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One - Four El Other X SINGLE FAMILY Two ® Five _' MULTIPLE FAMILY L-1 Three U Six 7. WATER SUPPLY IC INDIVIDUAL' *ATTACH WELL LOG. A well fog is required for all wells drilled i_COMMUNITY since June 1975. For wells drilled prior to that date, give well _' PUBLIC UTILITY depth (attach log if available.) 225 Feet 8. SEWAGE DISPOSAL SYSTEM **If individual/on-site, give installation date Aug. 1970 ' INDIVIDUAL;'ON-SITE'S If system is over two (2) years cid an adequacy test is required O PUBLIC UTILITY by this Depar'ment. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Riteit cc's ( CI 6 THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE IDATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE EI SINGLE FAMILY `' MULTIPLE FAMILY NUMBER OF BEDROOMS 7 ONE iJ THREE TWO J FOUR El FIVE D OTHER ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY E PUBLIC UTILITY Connection Verified PERM' !vl h1BER DEPTH OF WELL - DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM _'INDIVIDUAL:ON -SITE EPUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED —INSTALLER E7Scptic Ta'?k or 11. 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 Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS Srr APPROVED FOR BEDROOMS certificate) CI CONDITIONAL APPROVAL (!eTter must accompany ED DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 : Re. 3178'