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CHUGACH PARK ESTATES BLK 3 LT 4
Chugach Park Estntes Block 3 Lot 4 #051-481- 28 panaddy19 30 . ... .r.. .as. :IenoaddV dwelS s,Ja8u1su3 - 1VAONddV 1N3W1?1Vd301NMdO13A3o d11Nnwwoo will asnoq 10 aawoO MN inti b 60Z/9/Z 6 we b60Z/9/Z6 o.Z b60Z/8/Z6a,6 :salep uogduosep pue uogeool uogoadsu! 11006 (uo!lena!a pawnssV) N UVW HON39 saolnjeS 6u1J99u1u3 auouued oloodsul b£0£ 1"100 17£0£ P!agulei0 6uidwnd olldaS s.Hr bfi06 Pleguoeip 17£0£ NuelolesnoH 1V11J31VW 3did Jal!elsuj suolloadsul lapow pue @law 1e wie!e J91am g6!H I le lana! go dwndj le lanaI uo NO11 ,1e009Z` 1 ANV13OVaOHONV l4l0ede0 ja.mloelnuel Ja410 El6u!PIOH El'd'ATS ElolldaS © NNV. 1d V/N l d -A Ob9 sagouail ua@Ageq -4sl0 segouail to jegwnN eaue uogdjosge !eta 1u V/N V/N soul useN eq aouelsl0 sou!110 jagwnN :spa8 g1P.M lanes. 1d O.Ot7 '1d 0 g16u91 laneU0 apeB !eu161,10 anoge peppe 11 1u0.8 1d O'S adld gleeueq gldep an9.10 apeJ6 1eu161.10 w0.11 uanul ad!d of glda 'ld 0£ 6 jSlOdO 6 opei6 lsul6uo wa1 gldap !elol bugelj go Jagl0 ❑ punoW ❑ peg ❑ gouail MollegS ❑ gouaJl daaO (1131d NO11dNO991 s>IJewaa V/N V/N V/N V/N u!ej0 umin0 V/N V/N 9'9£ £'96 uo!lepuno3 VN VIN V/N 6'99 6'9L gull 10-1 VIN V/N +006 +006 jaleM ooeyn8 9'98 VIN V/N 6'£Z6 b'£O6 IDM Dull duel uo!1e1S 8!1 PIDId duel word James 6u!ploH uogdaosgV ogdes O1 b £ salels3 )lied goeongo 101 10018 uo!sinipgnS NOI1dIHOS3a lVEJ31 b swoapa8 to jegwnN auogd EMU(] su!IInS 9t7M6 mjeW apea6dn ❑ MGN ❑ 8Z -68b-690 :jagwnN Old 17696176dSo :jagwnN 11 INOd3H N01103dSNl 1131VM31SVM 311S -NO 1706L -S17£ U06) • 9llsuo/6jo,iunw,MMMp:dllq • 0999-66966 ) 'a6eJogouV 099966 Xog 'O'd • '1S 9aowl3 OOLti weJ6ad jaleMalseM pue aa1eM 91!S -u0 £ 10 6 abed ;uampedea;uewdolanaa Allunuauao0 ebejogouV;o -Ap led town W LEGEND W- WATER LINE/ If WELL RADIUS SS NEW SEPTIC If If If no.0 6 M2 DRAIN FIELD (E) INSTALLED ' NEW DRAI'� �FIELD REUSE AS RESERVE W/ (FUTURE) ADDN OF 1 6LF x 2.5'W x 6.0'ED x 10,0'TD DC2 401F x 2,5'W x 8.0 ED x CITE) T2 Cl f 10009 SEPTIC TANK TI ABANDONED PER CODE -INSTALLED NEW 1250g SEPTIC TANK WITH DCO BEFORE AND AFTER 7 tl, DC1 Oct A BIF If 4 R 14 f HO S E) ZF 103.4 WELL (E) GARAGE I (E) if If NOTES: RECORD DRAWING PAMONE ENG SVC, LLC of P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Fq:� - CHUGACH PARK ESTATES, BLOCK 3, LOT 4 MARK WHITELEY 19246 SULLINS DRIVE PLAN CHUCIAK, AK 99567 . . tle.Ven .R. .0 annone ........ CE 8149 12/10/14 11 P.I.D. NO 051-481-28 PERMIT NO. OSI'l 41514 Sheet 2 OF 3 A B DCI 23.4 14.9 TI 25.1 17.2 T2 j 1.9 24.8 DC2 33.6 26.2 Ci 44.4 36.5 M1 43.8 36.4 C2 71.1 73.8 M2 70.3 73.1 . . tle.Ven .R. .0 annone ........ CE 8149 12/10/14 11 P.I.D. NO 051-481-28 PERMIT NO. OSI'l 41514 Sheet 2 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1 . ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED SPECIAL PROVISIONS. 2. SCOPE OF WORK: INSTALLED SOIL ABSORPTION SYSTEM. DECOMMISSIONED EXISTING SEPTIC TANK AND REPLACED WITH 1250g SEPTIC TANK. 3. GROUNDWATER WAS NOT ENCOUNTERED TO DEPTH OF 19 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 19 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. _ FILTER FABRIC -- 4" 0 DRAIN PIPE TH-I DRAIN ROCK 5" ABOVE PIPE INV OR I 102.2 J __ .5.0 L —972 Sll 8.0 —892 -16.0 6.0 SM/ GP -ls.o 33.2 m m F I- wo z zI o wo z o o z z a � OU OU 1015 101.2 102.2 ulF 3.0 R.I. MIN 1�41ilali -JIF 97.9 97.6 NEW 12509 97.4 _ —97.2 SEPTIC TANK ..-X /CONNECTED SERVICE LINE r r. _ INSIDE OF CRAWL SPACE AND IT �s ABANDONED DEEP SERVICE LINE. —89.2 DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM ABBREVIATIONS DCO DOUBLE CLEAN OUT NO. BEDROOM: 4 (600 gpd) CU COPPER DV DIVERTER VALVE TANK SIZE: 12508 FS FLOW SPLITTER PERC RATE: 0.8 MPI DIP DUCTILE IRON PTFE SOIL RATING: 1 GPD SF TH TEST HOLE BFG BELOW FINISH GRADE / AREA ROD: 600 SF FC FOUNDATION CLEAN OUT OG ORIGINAL GRADE - FG FINISH GRADE SYS. TYPE: DEEP TRENCH 8.0'ED T# TANK CLEAN OUT N0. TS&V TOPSOIL AND VEGETATE - MIN LENGTH: 375 LF - C# CLEAN OUT N0, NIC NOT IN CONTRACT M# MONITOR TUBE NO. USED: R. 1. RIGID INSULATION 40 LFx2.5'Wx8.0' E.D., 13.0' TD _ TOTAL AREA: 640 SF - - - - NOTES: PAMONE ENG SVC, LLC - —'oF a ��� " Date RECORD DRAWING .Lq li+ 12/10/14 P.O. BOX 100217 ANCHORAGE, AK 99510 r S PHONE (907) 272-8218 FAX (907) 272-8211 %g�P ...-7# Scale j*:4 TH *l� NTS ...... .. ... P.I.D. NO CHUGACH PARK ESTATES, BLOCK 3, LOT 4051-481-28 MARK WHITELEY S'te'ven'2' Pannone'] PERMIT NO. ��P CE 8149 �� OSP141514 19246 SULLINS DRIVE _ DESIGN DETAILS CHUGIAK, AK 99567 Sheet ROFESSIO�PV�� 3 OF 3 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 Permit Number: OSP141514 Tax Code Number: 05148128000 Work Type: Septic Upgrade Permit Effective Dates: December 08, 2014 to December 08, 2015 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: CHUGACH PARK ESTATES Site Legal Address: CHUGACH PARK ESTATES BLK 3 LT 4 GA 161 Owner/Address: WHITELEY MARK S 19246 SULLINS DR CHUGIAK AK 995670000 Site Mailing Address: 19246 SULLINS DR, Chugiak This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 54433 Total Bedrooms: 4 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 Issued By MUNICIPALITY OF Community Development Department Development Services Division QD On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 RUSH ON-SITE SEWER/WELL PERMIT APPLICATION --- RUSH Parcel I.D. 051-481-28 - Property owner(s) Mark Whiteley Day phone p Mailing address 19246 Sullins Drive, Chugiak, AK 99567 UBMATTAI Site address 19246 Sullins Drive DEC 0 1 014 Legal description (Sub'd., Block & Lot) Chugach Park Estates, Block 3, Lot 4 Gretchen Stj ller Legal description (Township, Range & Section) Lot Size 54,433 Sq. Ft. APPLICATION IS FOR: (® all that apply) Absorption Field 0 Septic Tank Q Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 4 APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) ❑X Upgrade Q (w/wo ADU) El F-1Duplex(D) Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: RUSH Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. RUSH property owner or Permit/Rush Fees: 4 g 10 If -16 Waiver Fees: Date of Payment: l �1,%1 1 Itl Date of Payment: Receipt Number: 55-9 ft Receipt Number: Permit No. Q k0lg1uLl Waiver No. Permit App.- :. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com November 25, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Rd. P. fl. Box 196650 Anchorage, Alaska 99519 Subject: Chugach Park Estates, Block 3, Lot 4 Septic System Permit Request Ladies and Gentlemen: I am writing request a permit to construct an upgrade four (4) bedroom septic system on this property. Currently the lot is developed. The existing drain field is in failure and will be re -used as a reserve, with an expansion to accommodate four bedrooms at the time it is re -used. The existing 1000g septic tank will be abandoned per code and will be replaced with a new 1250g septic tank. The surrounding lots are served by private wells that are over 100' from this system. Soils. Pannone Engineering Services performed one test hole on this lot in November of 2014, and groundwater was monitored for seven days. Ground water was not observed to a depth of 19.0 feet below the ground elevation in the test hole monitor tube. It is my opinion, based on the results of the soils tests and overall soils appearance; an application rate of 1 gallons/day/square feet should be used for a conventional wastewater system. 1. Soil Absorption System Design. a. See Sheet 2 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography slopes from east to west at approximately 35% above the field with a slope of approximately 10% across the yard downhill of the upgrade, and getting steeper at 50' below the proposed field. There are no steep slopes within 50' of the drain field. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 4. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 LEGEND , W WATER LINE/ WELL RADIUS / I SS NEW SEPTIC � 2 , 53.7/ ! i sq4Fq�� IIiII / I s � II TH-1 DRAIN FIELD (E) REUSE FIELD P) REUSE AS RESERVE Wi (FUTURE) ADDN 40LF x 2.5'W x 8.0'ED x 13.0'TD ' OF 16 LF x 2.5'W x 6.0'ED x 10.O'TD i 1 I - 1, / i j ( , I i 1 / INSTALL 1250g SEPTIC TANK (P)N 10008 SEPTIC TANK (E) WITHr DCO -� ABANDON PER CODE INSTALL NEW FCO (P) r Z HOUSE % m (E) J 1057 I WELL (E) GARAGE I W i I T� iT.��7: T�Tl I 1 NOTES: PANNONE ENG SVC, LLC--�oFa���tt D,zisi,4 FOR coNsrRucrloN P.O. BOX 100217 ANCHORAGE, AK 99510 r �. qS �� PHONE (907) 272-8218 FAX (907) 272-8211 %g�.. .9 �) Scale • • • ........ P.I.D. NO CHUGACH PARK ESTATES, BLOCK 3, LOT 4 / -051-481-28 MARK WHITELEY e en Ponnone PERMIT N0. P CE 8149 .. ��/� 19246 SULLINS DRIVE f OSP 141514 PLAN CHUGIAK, AK 99567 11pofE5510N-�—`r Sh'etOF 3 "� SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED SPECIAL PROVISIONS. 2. SCOPE OF WORK: INSTALL SOIL ABSORPTION SYSTEM. DECOMMISSION EXISTING SEPTIC TANK AND REPLACE WITH 1250g SEPTIC TANK. 3. GROUNDWATER WAS NOT ENCOUNTERED TO DEPTH OF 19 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 19 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. FILTER FABRIC 4' 0 DRAIN PIPE TH—I DRAIN ROCK o" ABOVE PIPE INV -10 OR SM 8.0 —16.0 6.0 M/ GP — 19.0 D > > m m O U O ZZ w w mO o K p 40U (J U pUw Q n n n nn M U 3.0 MIN 1250g SEPTIC TANK CONNECT TO SERVICE LINE INSIDE OF CRAWL SPACE AND ABANDON DEEP SERVICE LINE. INSTALL NEW FCO. DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM ABBREVIATIONS DCO DOUBLE CLEAN OUT NO. BEDROOM: 4 (600 gpd) CU- COPPER DV DIVERTER VALVE TANK SIZE: DIP DUCTILE IRON PIPE FS FLOW SPLITTER MPI SERC RATE: 0.8 M 0 TH TEST HOLE BFG BELOW FINISH GRADE SOIL RATING: 1 GPD/SF FC FOUNDATION CLEAN OUT OG ORIGINAL GRADE AREA ROD: 600 SF T# TANK CLEAN OUT NO. FG FINISH GRADE SYS. TYPE: DEEP TRENCH 8.0'ED TS&V TOPSOIL AND VEGETATE MIN LENGTH: 37.5 LF C# CLEAN OUT NO. NIC NOT IN CONTRACT M# MONITOR TUBE NO. USE: R. 1. RIGID INSULATION , 40 LFx2.5'Wx8.0' E.D., 13.0' TO TOTAL AREA: 640 SF NOTES: PANNONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 CHUGACH PARK ESTATES, BLOCK 3, LOT MARK WHITELEY 19246 SULLINS DRIVE DESIGN DETAILS CHUGIAK, AK 99567 12/5/14 _ Scale �'�P'• .77 *: 49TH rl� T P.I.D. NO "*. - IV 051-481-28 Steven �'Pannone•� Pic. CE 8149 .'qe-/;01 PERMIT NO. f +`tll`��OFESSIONP0- OSP141514 Sheet 2 OF 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 TEST HOLE OR/ ORGANICS/ OL ORGANIC SILTS SM I SILTY SAND 15 1s 17 SM/ GP 18 19 BOH SOILS LOG - PERCOLATION TEST SLOPE X TH , � r �S TH_ 1 F F F,z %- 4BR i m n1 H (E) E) SLOPE DATE PERFORMED: 11/18/2014 TH x READING WAS GROUND WATER CLOCK ENCOUNTERED? N WATERTIME LEVEL READING IF YES, AT WHAT 1 DEPTH? -DRY SILTY SAND W/ DEPTH TO WATER AFTER DISPERSED MONITORING? -DRY ORIVER DATE: 11/25/2014 ROCKS ROC 4 MIN DATE PERFORMED: 11/18/2014 TH x READING DATE CLOCK NET TIME WATERTIME LEVEL READING NET DROP 1 11/18/14 3:05 --- 5.26 --- 2 3:09 4 MIN 11.26 6.00 3 3:10 --- 5.26 --- 4 3:15 5 MIN 11.26 6.00 5 3:15 -- 5.26 --- e 3:20 5 MIN 11.26 6.00 PEROLATION RATE 0.8 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 4 FT AND 5 FT COMMENTS: Test hole excavated by A+ HOME SERVICES. Prec hole was presoaked. Test run for at least one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: , LLC PANNONE ENG SVC`� A �\ Date FOR CONSTRUCTION�F P.O. BOX 102954 ANCHORAGE, AK 99510 P(� �gsl')l- 2/5/14 PHONE (907) 272-8218 FAX (907) 272-821Scale �'`\ f 1 /i Co. 9 �j NTS ....... .. .. P.I.D. NO Stv n •R. Gn CHUGACH PARK ESTATES, BLOCK 3, LOT 4 / . .. as1-481-28 e MARK WHITELEY lPE-&MIT N0. � CE 81492 OSP141514 19246 SULLINS DRIVE � �� _ SOILS LOG CHUGIAK, AK 99567 4l\�.oa ...... Sheet heOF 3 US STD. SIEVE SIZE I US STD. SIEVE NUMBER HYDROMETER 3 _ 1-112 3/4 3/8 14 110 120 140 N100 1200 100 � I 80 70 z I � 60 s r m 50 z W 40 30 i 20 I i ' I 10 p i 100 10 1 0.1 0.01 0.001 GRAIN SIZE IN MILLIMETERS GRAVEL SAND - COBBLES SILT or CLAY [6wS[ fIK [WIS[ KOIIXI FIK SYMBOL SAMPLE SOURCE DEPTH (feet) CLASSIFICATION - - - - Silty Sand (SM) Crowther Associates Particle Size Distribution Plate Geotechnical Engineering Services Chugach Pork Estates Block 3 Lot 4 Anchorage, Alaska Job No. 040.002 File No. Pannone CPE B3 L4 Dote November 2014 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/� �pp (��y1�(�CQ ; " PHONE a7(p— 39 y NEW ❑ UPGRADE MAILINGr DRESS LEGAL DESCRIPTION /- 4 /33 100a"('4 &4'� , LOCATI ��✓/ NO. OF BEDROOMS V DISTANCE TO: Well l Qv Abtion area sorp5-1 Dwelling PERMIT NO. .Y a.. ZQ WF Manufacturer Matede Y CrX No. ofz partments y Liq. capacit in gallons ad� IF HOMEMADE: Inside length Width Liquid depth Y 10z DISTANCE TO: Well Dwelling PERMIT NO. O Z < Manufacturer Material Liquid capacity in gallons O w= TO: Well 00 ^� Foun tion "7 Nearest Iq tiner l PERMITNO DISTANCE ! O '7 J LL Z �ZW No. of lines Leng h of each line Total len th of Ijnes Trench widtf�� oZ inches Distance between lines I.. p Top of tile to finish gradeU / ( Material beneath tile / 6 inches Total fe tiv absorption area LU CD Length Width Depth PERMIT NO. a Ir- W° Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PER N)/ NjO. 003/ W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER -4( PIPE MATERIALS C.r . SOIL TEST RATING INSTALLER REMARKS 4 � 3 B r ; I APPROVE9, DATE LEGAL 72-013 (Rev. 3/78) I F=v FA L_ I TV ID F= 11t -•1c 0E DEPARTMENT 0' 'AEALTH AND ENVIRONMENTAL F TECTION 825 "L STREET, ANCHORAGE, AK. 99, 264-4720 WELL_ F=l N Co C-sN-:F. I -re n3 I eWef;?- FzllE:F?_*M I -r PERMIT NO. ( 780371 > /:,b oclK cc to -Ag-79 4,1 APPLICANT CAM ILLE DAVIS P.O. BOX 132 ANCH 99510 2W 42 LOCATION LEGAL L 4 8 3 CHUGACH PARK ESTATES LOT SIZE 54450 SQUARE FEET TYPE OF SOIL ABSORSTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C -AEF'* -T-"- ALO L_F="L_3_r"- -_T;2 01�pF"eL- Oef='-r"- C - THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A 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 0N FEET). F4Z E: L -p U X M E: c> � F= F> -7- X iC -r F4 " K :S X 2!E- dL 0 10 rel 0 " L- L- V-1 ":S 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. --- YWC:) <;2> f=lF;ZE: P;.0FEQUX�'E:C1 - BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL.; OR :150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F::*E:FZMl_T_ =<-'-- :jL"_=.4 71:s I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: __4c --------------- Z_AP�PL_1CA_N_T4;_lL_LE_DAM S - p ISSUED BY --DATE V3. 2 OWNER OF LAND �f ffiaig C��e��t�t�e� i5rilting' by j A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 S DEPTH OF WELL ADDRESS STATIC LEVEL OF WATER FT. w LEGAL DESCRIPTION c�-C K t ' / �cl DRAW DOWN FT. DATE - Started C_4 ' ` ' �' Ended f� — - GALS. PER HR PERMIT NUMBER 7b) 371- KIND OF CASING KIND OF FORMATION: From `- �" Ft. to —,Ft. tJcrc "'5�.'d�' From Ft. to Ft. From Ft. to Ft. Ft. From Ft. to ---Ft. f 'C From 1: -' Ft. to Ft. `From Jr�F'rom From Ft. to Ft. From 0 Ft. to f D Ft. • ~ °`� r I�ucG From Ft. to _Ft.. From `- °� =� Ft. to . 4f % Ft >� From Ft. to Ft. From > Ft. to L"i Ft. S s�t.J{J�s�+'G From Ft. to Ft. From ''' y Ft. to4 Ft. From Ft. to Ft. From Ft. to i E, 0 Ft.�� From From Ft. to Ft. From jc'�(7) Ft. to 6�� Ft. f�j`�(%' i4k4,WV 111i J 4 /30'k -4W41' From Ft. to Ft. From .' Ft. to -.5 00 Ft. Ft. to Ft. From .-)G't' Ft. to 'SQ Ft. f 'C �,�, � `�"�r� `From Jr�F'rom Ft. to Ft. From _ 3 Ft. to )Q Ft. �' {r < C Juc "(j From Ft. to Ft. From ` f' Ft. toA�,d�b __ Ft. /5� 14L > 4-lle j /From Ft. to Ft. From `1—Ft. to ' 1(� Ft. '� � �'� `C J `c'� From Ft. to Ft, From _ .Ft. to i ).) Ft. �S rl% '�1 ' �"' `= From Ft. to Ft. From Ft. to—Ft. E "' From Ft. to Ft. From J ) r' Ft. to `` ' Ft. LS,= K• `'F "'�� From Ft. to Ft, MISCL. INFORMATION: DRILLER'S NAME 0 Et E GEOI _ CHNICAL Et DEVEL(��MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name: 62A1V/L6E PgV15 Tel. No. --,776 `-jZ42- Mailing 42- Mai1ing Address: 13.2 Legal Description: Cy0r,4,=H Depth (feet) Soil Characteristics I 1 A/Z 2 3 4 -:!�14 /cP ��eI4 6 .-51:2 .AND W/ri/ ' 7 '0 F 'a.Q e -z jf�ivo g PACS 1 r-) — 9 12 _^ 13 14 15 16 Ground Water Encountered: Yes No ✓ If yes, what depth Proposed.Installation: Seepage Pit Drain Field_ Comments: Al, 5c,24,& Date: / ITA GS IT CP Parcel I.D. 051-481-28 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION r3 Expiration Date: Complete legal description Chugach Park Estates, Block 3, Lot 4 Location (site address) 19246 Sullins Drive Current Property owner(s) Mark Whiteley Day phone Mailing address 19246 Sullins Drive, Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: Fx1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance Received by: Date: COSA to be released to the ergi eer, unless otherwise requested by the engineer. COSA Fee $ Ad, 50 Date of Payment to VILI Receipt Number 07 35LI46 COSA # Os C!1!/! Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE r r System #1 Approved for �{ bedrooms System #2 Approved for bedrooms Disapproved Date 12/10/2014 ,S�C?FA�gl�t�l • • t Sleveri �. � panriflrie . • • CE -8149 Conditional approval for bedrooms, with the following stipulations: By: ZVG Original Certificate Date: �. The M Ici li � of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet t _, ,. If more than 1 septic system is on the lot: COSA Checklist # L of Structure served by this system I Certificate of On -Site Systems Approval Checklist Legal Description: Chugach Park Estates, Block 3, Lot 4 Parcel ID: 051-481-28 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 1/30/87* Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 600 ft. Cased to 425 ft. Casing height (above ground) 18 in. FROM WELL LOG Date of test 1/30/87 Static water level 250 Well production 0.5 WATER SAMPLE RESULTS AT INSPECTION 12/8/2014 ft. 251 ft. 9.p -m. 1.1 g.p.m. Coliform Neg colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 11/10/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping New C. ABSORPTION FIELD DATA Date installed 12/8/2014 Length 40 ft. Depression over tank (Y/N) N Pumper Collected by: PES Date installed 12/8/2014 Cleanouts (YIN) Y High water alarm (Y/N) N Soil rating (g.p.d./ft2 or ft2/bdrm) 1 gpd/sf System type Deep Trench Width 2.5 ft. Gravel below pipe 8.0 ft. Total depth 13.0 ft. Eff. absorption area 640 fe Monitoring tube Y Depression over field N Date of adequacy test New Results (Pass/Fail) New For 4 bedrooms Fluid depth in absorption field before test O in. Water added -O gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= New g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed N/A "Pump on" level at N/A Datum N/A Size in gallons N/A in. "Pump off' level at N/A — Cycles tested N/A E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 103'4 Absorption field on lot 123.9 Public sewer main 75+ Sewer /septic service line 86.6 Animal containment areas 50+ Manhole/Access (Y/N) N/A s<'= in. High water alarm level at N/A in. Meets alarm & circuit requirements? Nom_ i On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 15.3 Property line 55.1 Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 55.1 Building foundation 35.6 Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage11 0+ F. COMMENTS Well drilled to 400' on 6/25/78 and extended to 600' on 1/30/87. G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 12/10/2014 r...:... S�everi onnone t- CE -8149 ASSUILT M1 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE` FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS DATE ._ INDICATED. IT IS THE RESPONSIBILITY OF THE 9� OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: EASEMENTS, COVENANTS, OR RESTRICTIONS cervi/dam WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTARLISMING BOUND_ ARY LINES. Di2AWNr M N M Zvi r w o 0. •_ Duan. Mark Seward , t Art n Municipality of Anchorage Development Services Department z e Building Safety Division z On -Site Water and Wastewater Program SA ETY 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-481-28 COSA # DIS C 1 w Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot4, Bk 3, Chugach Park Estates Location (site address) 192446 S jl i i n s Dri-ye Dr;-yChu i a , AK 99567 Current Property owner(s) Steve we -1-1.9 Day phone (907)242 0-6979 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 19246 Sullins Drive Chugiak, Alaska 99567__ Day phone Brooke Stiltner @ RE/Max Day phone (907) 244-6742 11525 01d Glenn Hwy Eagle River, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site KI Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pinard Engineering Phone(907) 357-3647 Address PO Box 871347 Wasiiia, Alaska 99687 Engineer's Printed Name Paul E. Pinard, P. E. D 5. DSD SIGNATURE _lef:51 Approved for _ bedrooms. Disapproved: Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory WAI EK AND ; WASTEWATER PROGRAM Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other . By: Original Certificate Date: K (Rev. 11105) Municipality of Anchorage ��°� gk, • Development Services Department R° { Building Safety Division " On -Site Water & Wastewater Program $" `TY 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 4, Bk 3, Chugach Park Est Parcel ID: 051-481-28 A. WELL DATA Well type Pvt If A, B, or C provide PWSID # XA_ Date completed 1/30/87 Sanitary seal (Y/N) Y Total depth 600 ft. Cased to A2-5—ft- FROM 25ft. FROM WELL LOG Date of test 1/30/87 Static water level 250 ft. Well production 0.5 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate ND mg/L Arsenic: ND ug/L date of sample$J3W 11 B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 15 n. AT INSPECTION 9/14/11 253 ft. 2.1 g.p.m. Collected by: P, rd F. gj n _pr; n u Tank Type/Material Septic/Steel Date installed 6/28/78 Tank size 1000 gal. Number, of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YM) NA Date of pumping 7/4/11 Pumper McDonaids Pumping Service C. ABSORPTION FIELD DATA Date installed 6/28/7 Soil rating Jnr ft2/bdrm) 125 System type Trench Length 34- ft. Width 2.6 ft. Gravel below pipe 6 ft. Total depth 10 ft. Eff. absorption area3&,,.-ft2 Monitoring tube Y Depression over field N Date of adequacy test (9/27/r Results (Pass/Fail)PAsR For_3 bedrooms Fluid depth in absorption field before test1_2 in. Water addel,54- gal. New depth_ in. Elapsed Timef445_ min. Final fluid depth 12 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Name- ne vn If yes, give date D. LIFT STATION NA Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pump off" level at in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main NA Sewer /septic service line 251+ Animal containment areas45-�- P, E P On adjacent lots 100' + On adjacent lots 100' + Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100' + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' + Property line 5' + Absorption field 51+. Water main NA Water service line 1 O' + -Surface water 100' + Wells on adjacent lots 100' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 O + Building foundation 101 + Water main NA Water Service line 10' + Surface water 100' + Driveway, parking/vehicle storage 10' +. Curtain drain None Known Wells on adjacent lots 100'+ F. COMMENTS Well drilled 6/25/78 but extended "fraged" by Anchorage Well & Pump G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name _ Paul E. Pinard, P.E. Date 9 /2B/ 11 COSA Fee $ q, G/ O Date of Payment 1 a l GSC 1 cj� Receipt Number 3 (Rev. 4/10) Waiver Fee $ .600' on Pinard 11 %•`w0 19-47 4 f' pq Date of Payment _ Receipt Number __o ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHM?NTS 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 SUBDI— VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONS'rRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND— ARY LINES. SEWARD & ASSOCIATES LAND SURVEYING 694-0829 SCALE: OF Al DATE � p i* _ *$ GRID: jo I Duane k MAr/SewardFB Ls — r` s DRAWN LOCATION: Lot 4, Block 3, Chugach Park Estates DRILLER: Sullivan Water Wells DATE WELL COMPLETED: 1/30/87 WELL DEPTH: 600' STATIC WATER LEVEL (top of casing): 253' PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) WELL FLOW TEST JOB NUMBER: 11-281 DATE OF TEST: 9/14/11 FIELD STAFF: PJ Pinard Time Elapsed Time (Minutes) Static Water Level Flow Rate m Cumulative Gallons Pumped Remarks 6:15 AM i 253' 4.0 --- Start Test — Meter 201160 6:30 15 269' LOCATION: Lot 4, Block 3, Chugach Park Estates DRILLER: Sullivan Water Wells DATE WELL COMPLETED: 1/30/87 WELL DEPTH: 600' STATIC WATER LEVEL (top of casing): 253' PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) WELL FLOW TEST JOB NUMBER: 11-281 DATE OF TEST: 9/14/11 FIELD STAFF: PJ Pinard Time Elapsed Time (Minutes) Static Water Level Flow Rate m Cumulative Gallons Pumped Remarks 6:15 AM ---- 253' 4.0 --- Start Test — Meter 201160 6:30 15 269' 4.0 60 201220 6:45 30 284' 4.0 120 201280 7:00 45 299' 4.0 180 201340 7:15 60 314' 4.0 240 201400 7:30 75 329' 4.0 300 201460 7:45 90 345' 4.0 360 201520 8:00 105 363' 4.0 420 201580 8:15 120 381' 2.0 480 201640 8:30 135 396' - 510 201670 8:45 150 363' - 510 201670 9:00 165 337' - 510 201670 9:15 180 319' 4.0 510 201670 9:30 195 333' 4.0 570 201730 9:45 210 347' 4.0 630 201790 10:00 225 365' 2.0 690 201850 10:15 240 379' - 720 Stop Test 201880 RECOVERY 10:30 AM 15 359' 11:15 60 304 ` 12:00 PM 105 253' All well protection features are adequate. Average Flow Rate: 3.3 gpm Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF PRODUCING 4.0 GPM. THIS TEST DOES NOT CONSTITUTE A WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE. Reviewed by: Paul Pinard d� j Date: 9/23/11 PINARD ENGINEERING P.O. BOX 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) '1 ADEQUACY TEST LOCATION: Lot 4, Block 3, Chugach Park Estates APPLICANT: Steve Wells 19246 Sullins Drive Chugiak, Alaska 99567 SEPTIC TANK TYPEISIZE: Steel/1000 Gallons, per MOA Records ABSORPTION SYSTEM: Deep Trench, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GAUBR = 450 Gallons TEST DATA JOB NUMBER: 11-281 DATE OF TEST: 9127111 FIELD STAFF: PJ Pinard NUMBER OF BEDROOMS: 3 SCUM: 0.0' SLUDGE: 0.0' NEEDS TO BE PUMPED: Yes No XX CURRENTLY IN USE: Yes No XX Time Flow Rate Volume Cumulative Volume Septic Tank Septic Tank Soil Absorption System Comments pM (GPM) (LALs) (GALS) Liquid Level A Level Monitor Tube 1" p SAS Level Monitor Tube 3' 0 SAS Level 2:35 5.3 - - 4.0' - 1.0' - Start: Flow -Meter 221720 2:50 5.3 80 80 4.1' 0.1' 1.4' 0.4' 221800 3:05 5.3 80 160 4.1' 0.0' 1.9' 0.5' 221880 3:20 5.3 80 240 4.1' 0.0' 2.3' 0.4' 221960 3:35 5.3 80 320 4.1' 0.0' 2.7' 0.4' 222040 3:50 3.3 80 400 4.1' 0.0' 3.0' 0.3' 221120 4:05 - 50 450 4.1' 0.0' 3.3' 0.3' Stop Flow 221170 F�.T;Z6r91N4:i 1 Date "rime ST MT SAS MT 9128 3:30 PM 4.07-0.1' 1.07-2.3' 'ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMWNTS: System appears to be operating satisfactorily. Since the system had not been in use for a while, the SAS was soaked for a couple of days prior to this test. The level in the SAS rose 2.3' during the test but a recovery measurement, taken slightly less than 24 hours after stopping the flow, showed satisfactory absorption with a return to the starting level. Reviewed by: Paul Pinard Date: 9128111 MUNICIPALITY OF ANCHORAGE K 7i0 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION l rr DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date Septembe,% 17, 1987 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4: Stock 3; Chugach Pa,%k Estates Location (address or directions) (b) Applicant Name Ratph 8g,%ke Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ®; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution (!0_n;thtLA t Telephone Address (e) Real Estate Company and Agent HERITAGE RFAI ESTATE/ Suzaaae Coop Address 1 R;;0 Faqip_ 2juea Rd , Faa?o R.Cyen, UaSka 99577 Telephone 694-4994 (f) Mail the HAA to the following address: 1 S & S ENGINEERING a 17034 Eagle River Loop Road No. 204 Magle River, A 03 2. TYPE OF RESIDENCE t Single-FamilygR Multi -Family ❑ Number of Bedrooms 3 Other 3. WATER SUPPLY Individual Well V 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 72-025 (11/84) 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 S & 5 ENUINhhKING Telephone Address 17034. Fagle River Loon Road No. 204 Date Eagle River, Alaska 99577 6. DHEP APPROVAL Approved for—bedrooms by Approved Disapproved Conditional — Terms of Conditional Approval 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) G<, MUNICIPALITY OF ANCHORAGE (MOE.l X01 ��S�G� HEALTH AUTHORITY APPROVAL (HAA) PrL �5�\ CHECKLIST - FEBRUARY 1984 O� �`L 264-4720 Legal Description: �'� 4- RaLet'— 3 A. WELL DTA% Well Classification S • - If A, B ..roved (Y/N) gtrp Well Log Present ly Date Completed 81 Yield i• 4 (Mfr ► Total Depth toOtD Cased to �23 Depth of Grouting Static Water Level .7 AXI 01 uPump Set At X21 II Casing Height Above Ground is Sanitary Seal on Casing ON) — Electrical Wiring in Conduit¢/N) Separation Distances from Well: Depression Around Wellhead (YAIP To Septic/a-lekiitig Tank on Lot 1. d;'q 1-f ; On Adjoining Lots — To Nearest Edge of Absorption Field o Lot co �+ ; On Adjoining Lots To Nearest Public Sewer Line )A' To Nearest Public Sewer Cleanout/Manhole p To Nearest Sewer Service Line on Lot Water Sample Collected by l 1�1 r�Gr ; Date �t Water Sample Test Results -�y Comments B. SEPTIC/HOLDING TANK DATA c9J_> t -4 - PO -PO 141 J Date Installed (Q— S Size k 629RQ No. of Compartments -• Standpipes P/N) Air -tight CapsON) Foundation Cleanout (Y/Q Depression over Tank (YO aP Date Last Pumped 1q _g1 Pumping/Maintenance Contract on File (Y/N) ;for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Hotftg Tank: 1 To Water -Supply Well ( ct::> �'i' To Building Foundation t � To Property Line 0 + To Disposal Field To Water Main/Service Line �� To Stream, Pond, Lake, or Major Drainage Course CIO ) Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 12-4 * JVYL- Type of System Design �t'-�- o 1 Date Installed � '" -2,0 -18 Length of Field 34 Width of Field '27Z„ Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present -CPN) Depression over Field (Y0 Results of Last Adequacy Test Date of Last Adequacy Test fie_ -1 -.?-, 12.0 _ Separation Distance from Absorption Field: To Water -Supply Well � C,0 I f' ) To Property Line To Building Foundation 1-1 Lot ; On Adjoining Lots To Existing or Abandoned System on r To Water Main/Service Line 1 0 To Cutbank (if present) d. To Stream/Pond/Lake/or Major Drainage Course I� I � To Driveway, Parking Area, or Vehicle Storage Area O Comments D. LIFT STATION 1 Date Installed � Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA 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 ENGINEERING Date � "2�j ':PJ CompaA 7034 Eagle Rlvw Loop Road NoAgA No. %-T'-Q Eagle River, Alaska 99571 49 O U/ O Receipt No. Lbo Date of Payment U O 4 c ddf •r.•aya>NN1+6ga�i: A 8 �� Cry ipfiP Amount: $ En 9 4• •h t+.dfi Pet g�H� pAbod A. Shakoe 14874 11000000.,066 Page 2 of 2 ! �IipROFEWW'�a~e�° 72-026 (11/84) if*f - - fwg rtt��e DOC Co. tlba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND _-_ .-- ------ _ DEPTH OF WFLL ADDRESS STATIC LEVEL OF WATER FT. b LEGAL DESCRIPTION_` _ j__j&e _ fie -4.0 7 -DRAW DOWN FT. DATE. - Started _ — Ended/ r� _ �-_-�--�___-- GALS. PER HR PERMIT NUMBER KIND OF FORMATION: From__ -Ft. to44,0 Ft.__1�- From From""> t', Ft. to 0 Ft.� i5 From From . � 12L.__ Ft. to ?Ft. _ ttl f' ' rurn _ k:. From ---Ft. to_-.___ Ft. ��! r " �� r s From ?' v t' ,,, +y7 w KIND OF CASING S :rg' Ft. to ---Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. From— = _Ft.From Ft. to Ft From Ft. to—_ Ft.^---__—_-- - -_-_ _— - Froin __— Ft. to__ _ _ Ft From_ -_Ft. to_—l---Ft_ -__-- From__-- Ft. to-- Ft. From Ft. to ---.__—.FL—__--_—___—__-- From Ft. to Ft. From From From From From From From From From. Ft. to-_---Ft._----__-- Ft. Ft. to ------Ft. Ft. to-- ____ Ft Ft. to --___Ft, Ft. to Ft. Ft. to Ft. Ft. toFt. Ft. to -------.Ft. M/ISCL.}INFORMATION: �j ry �y r,,ltd l�'.4. z) /"-, rL d+ B'..`. z.,,J S:.% a%w� / IP i _.r ,- •:� Y r i �; ...r .,-.. t."'., y+ 4 " i•,J �j Fes" N.% � f_' i '. #t`� 4: 1� From —Ft. to Ft From. Ft. to Ft From _.—Ft. to— Ft. MUNICIPALITY to DEIN[ OF HEALTH & ENVIRONMENTAL From— Ft. to Ft. From ----Ft. to � EP 2 51987 From ------Ft. to --Ii. CFIII From__ -__—_Ft. to. _--_Ft. ___-----_--- From _-F't.—___- 6,0 rte/ DRILLER'S NAME 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 May 27, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4; Mock 3; Chugach Paitk E3tates Location (address or directions) (b) Applicant Name Cindy Lewi,6 Telephone: Home 688-2025 Business Applicant Address SR Box 4238 Gteattand, Chugiak, Ataska 99567 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 6 ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Menn..itt Lynch Telephone Address Anchorage (e) Real Estate Company and Agent Henitage HomeAlDate P,%ice Address SR Box 126, Eagle Riven A.f?aska 99577 _ Telephone 694-4994 (f) Mail the HAA to the following address: S 9 S Engineenting SRB 196X Eagle RiveA, A.2aska 99577 okdened by Daae Pkice 2. TYPE OF RESIDENCE Single -Family P Multi -Family ❑ Other Number of Bedrooms 3. 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. 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 72-025 (11/94) 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 inSp"(ENGINEERING Name of Firm SR B 196X Telephone Address EAGLE RIVED, LaK 99577 Date _ JUN 4 1986 6. DHEP APPROVAL Approved forZl��__Iedrooms Approved_ Disappr, Terms of Conditional Approval Conditional C�J1T-T!� 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) MUNICIPALITY OF AMIXIS AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTEC699264-4720 i i l 1.l r; c Legal Description: 'Z y/5 3 A. WELL DATA R E c E i Y E Well Classification �5.aC � If A, B, C, D.E.C. Approved (Y/N) �- Well Log Present&4- Date Completed b — %8 Yield 4 3 z G�/►�1 Total Depth e-1600 Cased to &a Depth of Grouting Static Water Level Z Sd -, Pump Set At Casing Height Above Ground 12, Sanitary Seal on Casing Jto,Ylw Electrical Wiring in Conduit Depression Around Wellhead kyo Separation Distances from Well: To Septic/Holding Tank on Lot % Op I ; On Adjoining Lots To Nearest Edge of Absorption Field on Loi AY0 f ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer �a Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by .S S��/4. �'Date Water Sample Test Results 'me_ Ie Comments B. SEPTIC/HOLDING TANK DATA Date Installed — Stand pi pes &*Y '!�P-?8 Depression over Tankr('Y( Size 60 0 No. of Compartments Z — Air -tight Caps 41 Foundation Cleanout (No 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 from Septic/Holding Tank: To Water -Supply Well l0 d To Building Foundation �f To Property Line To Disposal Field S To Water -64A' /Service Line Course Comments Page 1 of 2 72-026(11/84) 3n i to - To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z S f82 Type of System Design Date Installed �o'" %� Length of Field Width of Field 3Z ti Depth of Field % d 2 I Gravel Bed Thickness Square Feet of Absorption Area 6t Standpipes Presents C0 / Depression over Field4*4a Date of Last Adequacy Test / Z'"lc7 X87 Results of Last Adequacy Test S-hf7: ' 4=Ae_,7-a le- V Separation Distance from Absorption Field: To Water -Supply Well Ab d To Property Line To Building Foundation '77 To Existing or Abandoned System on Lot ; On Adjoining Lots 30 i4-- To Water Matn/Service Line 3� / To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area �d Comments — D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) "PVmp Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA 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 ENGINEERING Date .SUN d 1986 SR IS 196X Company MOA No. 3 EAGLER1 U-12 A1(995//I Receipt No. 3?or.,Z� Date of Payment—�"-� Amount: $ LIS Q CSO Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal De cri tion (include lot lock,°su ivis on, ecti , township, range) Location (address or directions) '1/,rL (b) Applicants Name ,(� eCI� 0�� Telephone — Home Business Applicants Address G ��u/ e mef �/%fP �r�✓ (c) Applicant is (check one) Lending Institution ; Owner/builder'; Buyer = ; Other [::I(explain); (d) Lending Institution N Telephone Address j \ (e) Real Estate Co. & Agent Address /fes/.Ae l-�, we s Telephone (f) 1 the HAA to the following address: J/S �keel%nv' 2. Type of Residence Single --Family Multi—Family Other (describe) Number of Bedrooms 113 3. Water Supply e�? fj' Individual Well Community E= Public M 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 21 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 regula- tions in effect on the date of this inspection. Name of Firm Address r` c Date 6. DHEP Appioyall Approved for,bedrooms Approved Terms of Conditional Approval �v-gyp � �e• s.0l. fr��j�� }7 0. Telephone Date Disapproved Conditional _ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND 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 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 DEC 13 1PAII A. WELL DATA Le a Des =3 ipt�n: fiff Well Classification If A, B, or C, D.E.C. Approved(Y/N) Well Log Present( /;i Date Carpleted5 Yield 0.3 2 Total Depth (' Cased to ���� of Grouting Static Water Level U Pump Set At Casing Height Above Ground / 2 �� Sanitary Seal on Casing(Y ) Electrical Wiring in Conduit (/1) Depression Around Wellhead Separation Distances frau Well: To Septic/K*14ivx1 Tank on Lot On Adjoining Lots Gy/voe U To Nearest Edge of Absorption Field onLot On Adjoining Lots U AJb // r (> To Nearest Public Sewer Line � G n To Nearest Public Sewer Cleanout/Manhole ' /U To Nearest Sewer Service line on Lot o _ � 'R I IESFilt�r Date / 2 /0 Water Sample Collect�:d. 2SRB y ; } r�y7 Water Sample Test Results PK 604-2�� %� S- � -r-u A-1 Comments e<l& 6l /-o r- -7-1c 1(4 6-1 GLeV /D jlp 363 ` A;aWW S /2eCc) rY! Gee j/t!S �/a�'T hP��✓ ���� B. SEPTI DATA LATA Date Insta1%) /76 d(» _ Size �No. of Compartments 2- _ Standpipes Air -tight Caps (Y Foundation Cleanout (k& Depression over Tank ( Date Last Pumped Pumping/Maintenance Contract on File ( /YL- for Holding Tank High -Water Alarm ( Temporary Holding Tank Permit Separation Distances fran Septic/Holding Tank: To Water -Supply Well 00 To Building Foundation To Property Line CO . To Disposal Field 5-1 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course If 0 ".J Comments /-1-0 pi F Receipt # SS" 5 -- Date Paid: _ �3 Amount: (Page 1of2j 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 112 Type of System Design h--voc 4 Date .Installed 7 Y Length of Field 3 Width of Field 3z t' Depth of Field /C7 r� Gravel Bed Thickness 70 Square Feet of Absorption Area Standpipes Present (Y ) Depression over Field (?: Date of Last Adequacy Test /2 Results of Last Adequacy Zest 5) C Trams Separation Distance from Absorption Field: To Water -Supply Well /U, To Property Line 16 74- To Building Foundation _ - To Existing cr Abandoned System Cn Lot /Uy AJC ; On Adjoining Lots GC Ar _0 I U To Water Service Line �?O /- To Cutbank(if present) AJ -D "i To Stream/Pond/Lake/cr Major Drainage Course SII A To Driveway, Parking Area/, cr Vehicle Stcrage Area S'y A Continents co 4 Cl � �'ha 5,� D/2 9 /J ,F( —,—G _0 A -lei 7 Y//Y,r r /0 F D. LIFT STATION Date Installed Dimensions Size in Gallons ;Man4h/Access A (Y/N) "Pump On" Level at Level at High Water Alarm Level at Vent (YM) Tested for Pumping Cycles during Adequacy Test. Meets MDA Electrical Codes(YM) Continents ** Check Permitted Bedroan Rating Against HAA Request ** I certify that I have checked, verified, cr conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed EIVQiW!`E#IN Date n ..e ,ar.v,�-r la.. p •� T Company ' ��:,1. tIIVVER, ALASO, w MOA No. r C pt a ra e' •• KBl /d5/s ...., `° ay!•4MlW lR Re rt A. Shafer ♦i ,_�� (Page 2 of 21 2-15-84 0 V�4kp 7 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS STREET LOCATION TIME - TIME TIME 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS DATE ^ DATE G7j DATE — ® Three ❑ Six 7. WATER SUPPLY FNSPE 0 INSP TOR INSPECTOR ❑ COMMUNITY since June 1975. For wells drilled prior to t ate, give well MUNICIPALITY OF ANCHORAGE depth (attach log if available.) DEPT. OF HEALTH MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 0* OCT 2 9 1979 ENVIRONMENTAL SANITATION DIVISION (" Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Ralph Blanchard and Camille Davis 1277-2522 MAILING ADDRESS c/o Penney & Jensen Real Estate on Benson Blvd, at New Seward Hwy, Anchorage, AK PROPERTY RESIDENT (If different from above) PHONE none n/a 2. BUYER PHONE Home Federal Savings & Loan Association 272-1451 MAILING ADDRESS 535 D Street, Anchorage,, AK 99501 3. LENDING INSTITUTION PHONE Home Federal Savings & Loan Association 1272-1451 MAILING ADDRESS 535 D Street, Anchorage AK 99501 4. REALTOR/AGENT PHONE Penney & Jensen Real Estate 1277-2522 MAILING ADDRESS Benson Blvd. at New Seward Hwy, Anchorage, AK 5. LEGAL DESCRIPTION Lot 4, Block 3, Chugach Park Estates Subdivision STREET LOCATION NHN Sullins Drive, Peters Creek, AK 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other ® SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ® 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 t ate, give well E:1 PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ® INDIVIDUAL/ON-SITE** 1978 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) // rZ / ��} 4 72-010 ( Rev. 6/79) 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ 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: 0601 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption. Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accom any certificate) ❑ DISAPPROVED DATE / BY 72-010 ( Rev. 6/79)