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MAJESTIC VALLEY ESTATES BLK 2 LT 3
I a i MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Page 1 01 -2- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Stg' 0393 PID Number: c--!5 0 -731 o 3 Name: Wastewater System: 11 New ® Upgrade P� Ro13E2"f 7tT6S Address: ABSORPTION FIELD 13(35 O,-D 61. P_ 14 14wY. AK. 9115 Phone: No. of Bedrooms: ❑Deep Trench U' Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: I 2 Total Depth from original I ode: q. GPD/Sq. . Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 3 Z' rAh.)Esi}c JALL81• 55f 2 Ft. Z `� Ft. Township: Range: Section: Fill added above original grade: I Gravel length: NS Ft. Ft. WELL: 0 New ❑ U e Gravel width: 5 Number of lines: Distance between lines: — xlsT,a Ft ) Ft. Classification (Private, A,B,C): Depth: Cased TO: Total absorption area: Pipe material: ASTM - ?P, %,J ATE Ft. Ft. S-79 SQ. Ft. FB I a % scHA. 46 Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. 'Trn1E�0 �Xc. !2'8-�15 Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding IX S.T. E. P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines I v41 0?_AGF Ar1K )%So Material: Number of Compartments: Well, 161r 1721 1011 ZS1* STEEL_Surfac 2 100la — -' LIFT STATION Water f/o 10o1-I- Lot , 1 Size in gallons: Manufacturer: / / ORG SYSTE Line �i ! 3' /250 b-acrt oRA 6.& WAa IG JCo I "Pump on" level at: "Pump off" level at: High water alarm at: Foundation 1 %5 1� I — _ 4211 3z't 4eLj r' Curtainr 20 r S'o ? I Zo — Pump Make & Model oS1 Electrical Inspections performed by: NsAveNLY G, ELcc. COAT. Drain oSNN Wl7s BENCH MARK Remarks: A Location and Description: ToP OF GASM1 ErER , A-r -5-106- OF �OuSE Assumed Elevation: 100 , o ENGIg&k��SEAL OF X91 •�': p 9 AA Inspections performed by:5 & S ENGiNIFERING Dates: 1st 17034 Engle River Loop Road, No. 204 rz- I N-q5- 2nd �• • .f..dY Eagle River, Alaska 99577 l ROBERT C. COWAN `Q 0Gx . Cr - 8801 �t,�F� Department of Heal and Human Services approval ,k5 . Reviewed and approved by: % "T Date: — ZL96 72-013 (Rev. 9/91) MOA 25 Permit No. SW950393 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description LOT 3, BLOCK 2, MAJESTIC VALLEY EST. PID No.: 05073103 ST1 ST2 96.4' 95 95.8' 'RADE FINAL GRA MH �PINAL 116.4' T CO 11EW 90.1' 250 GAL '.T.E.P. 89 9' INSULATION YSTEM / SR 113.6' / / WATER POUND / 7-25-95 N / NEW ABSORPTION TREN H A 8 FCO 1 CTI 705 25' / ST2 38' 23' MH 39' 24' MT. C D / _k _T1 32' 38' i �' MT2 24' 18' / CREEK C� D / NEW 1250 G L i / S. .E.P. SYSTEvI / G6, METER N a fG0 ' n9� o � 2 ST2 . a.ti.. .............1 . Cr} O / � 1 ROBERT C. COWAN • ? O 01 B SCALL 1" = 40' O�.CK CIE - 8801 �`�,a �1��I1'O...... 0\ \ 72-013 A (Fiev.9/91) MOA 25 j WELL PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE 11�q� DEPARTMENT OF HEALTH AND HUMAN SERVICES 1 P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950393 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BATES ROBERT E OWNER ADDRESS:13135 OLD GLENN HIGHWAY EAGLE RIVER, ALASKA 99577 PARCEL ID:05073103 LEGAL DESCRIPTION: MAJESTIC VALLEY ESTATES BLK 2 LT LOT SIZE: 57363 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:11/22/95 EXPIRATION DATE:11/22/96 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE://- 2 2 - 10-57 of I�"'chorage Department of Health and Humar. Services 825 "L" Street Rick Mystrom. P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor November 28, 1995 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 3 Block 2 Majestic Valley Estates Waiver Request #WR950066, PID #050-731-03, SW950393 Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 1 foot to the east property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services DJR/ljm WR# WR950066 Date Received: MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet PID# 050-731-03 HA# November 22, 1995 Permit Legal Description: Lot 3 Block 2 Majestic Valley Subdivision Engineer: Robert C. Cowan, P.E., S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River 99577 Applicant: Robert E. Bates _ Waiver Requested: Lot line waiver of 1 foot east property line Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Date: // 2 2 -!?E By: d/` X/ ✓iG 7-1'/ Name of Reviewer Rec #: C1 �1\�'I'1 / ll 15 Amount: $ \ Date Paid: \ \ - -Aa •,�5 Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for. above: ejss- z mss 2 -AWA- S sew �re R(J611 /ti /T rti(u J 011"/,vA7-//v6, jAeec ,y66Q FCU/Q NO M O/V0 %K/?a' /O SEP/fA/t7rcw FROM %t PoTaA V,9L 90XORP7/0ti a" LGT' ¢ 7-ffk r ti0T /4ePRiG,7416 107 ¢. Date: // 2 2 -!?E By: d/` X/ ✓iG 7-1'/ Name of Reviewer Rec #: C1 �1\�'I'1 / ll 15 Amount: $ \ Date Paid: \ \ - -Aa •,�5 v\ S & S\ ROBERT C. COWAN, P.E. ElIgI& l21}1G ROBERT A. SHAPER, P.E. IA�mvE3E November 20, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED HEALTHAUTHORITY Bg Pqp APPROVALS MUNICIPALITY OF ANCHORAGE 9N 1A f /J Department o6 Health and Human Sen Vices IVtuniCluail�y of Anchorage Attn: Jim Cross Dept. Health & Nurnan Services P.O. Box 196650 SEWER&WATER Anchor.a e AK 99519 MAIN EXTENSIONSg � REFERENCE: Lot 3; Btock 2; Majestic VaUey Subdivision SEWER& WATER INSPECTION Request you i,66ue a permit to upgrade .the 6eptic aystem serving .the three bedroom house on the nebeaeneed pn,open.ty. At6o nequeat you i64ue a 1 p boot pxropety tine wa iveic. ENGINEERING STUDIES A test Note was excavated and a pencotatc.on test pm6ormed in the aaea AND REPORTS o6 the proposed upgrade. The approximate tocati.on 06 the test hole is .located on ,the attached site plan. At the time 06 excavation no water was encountered and a6ter seven day WELL INSPECTION 8 FLOW ground watm mon ito%Cng, water was bound at 9.5 beet. OWTESTEST Attached is the proposed upgrade design. Attached you WiU 6.ind a Nationwide Permit (NWP) issued by the SITE PLANS De axtment o the Arm and an .indiv.iduat water p 6 y quality certi6icati.on 6rom the Ataska Department o6 Environmental Couenvation as required to reroute the existing stream .into its ontig.inat channel. ROADDESIGN We do not anticipate any adverse e66ect6 on neighboring we2?s, septic sytstems on drainage patterns by the installation o6 the proposed septic s ys tem . SOILTEST 16 you require additional in6ormation, please contact us. Sincerely, PERCOLATION TEST �� `-, • �/ ""R",� Robert C. Cowan, P.E. STRUCTURAL& RCC/gk MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 SENT BY:Xerox Telecopier 7020 ;11-21-95 i 5:21PM DEPT. OF ENVIRONMENTAL CONSERVATION DIVISION OF AIR AND WATER QUALITY Major Facilities and Water Permits Section 410 Willoughby Avenue, Suite 105 Juneau, AK 99801-1795 Robert C. Cowan S&S Engineering 17034 North Eagle River Loop Road Eagle River, Alaska 99577 9074555274-4 9076941211:€3 2 November 20, 1 Re: Waiver of 401 Certification, Eagle River NWP 26, COE No. Dear Mr. Cowan: The Department of Environmental Conservation has received the' Engineers' public notice for the referenced project, which serves as yow Water Quality Certification in accordance'with Section 401 of the fedeni referenced project will divert a side channel of a small, unnamed stream with the placement of fill into less than,l acre of wetland, while meeting under Corps of Engineers' Nationwide Permit 26. Water quality certification or waiver is required because the prc authorized under Nationwide Permit 26, and a discharge might result The Department of Environmental Conservation has reviewed the certification of the proposed activity in accordance with Section 401(a). modification to the proposed activity, as well as any similar activity con require certification, Sincerely, / f &tit UO David C. Sturdev 401 Certification cc: Dave C. Casey, Corps of Engineers Bill Lamoreaux, Anchorage/Western.Public Service Area Office, Gay Muhlberg, ADF&d, Anchorage OLS/DCS (DA&WQ/eng1a.r.n26) i TONY KNOWLES, 00VERNC' hone: (907) 465.5276 Fax: (907)465.5274 TTY: (907) 465.5133 Eagle River NWP-26 Certified Mail Receipt Requested T.S. Army Corps of application for State Clean Water Act. The nto the main channel criteria established 1 activity will be the proposed activity. Ltion, and waives ver, any in the future, may Leader 1" = 50' SITE PLAN UPGRADE SCALE x ;:a 4�1cnr.3r>�.ra�nw�Ai7�41 O p�(.n 01 0Ow C Orm 0C���A� .Z7o�OQm-q m�� NII c� Zm mn / 2a: L -OII �II� G7 Z P coGi �a o �,A�f ➢ m W N P m � v t 1 fnT o c" °pts cn � a Gm) \ Ly p ZU) 7- r!fJC7rD m-zl L9 -i A N rri p 0 o� �\ m� r O W r i \ n 7 D rri i ncnN O CA / \- N-IDm� DSC -I ������zni C7 rq pLomm�=zm D Om omo �Nm OV k m �� \ T1 -CN� r- 0 C-) x \ �pogzo c,r D r o. -I r- n z -p ��\ z A a�1-,�Z � CA H o m Z A O �0 --A N D 'C L- -< m co z (D m01 r m -o �r G� Q '�I o co MO `D v cn D A in x mo(n -IU �� IQ Am p� Np T C y � <o fUN f O<OTm �lD Z:V)n (� Z �� vp `\000U4 U4 (A' �CC� - om �DD� OK m A 0 n m e2c�D-WivU) zones zzo Zz N 0 {N �D oom-�D =Z cm zoo C --i C) prim�Mr0I II � N,Zn o O D �O DDDW r- r- >o= 0 uoo0 N D m 2 -Ir -i 2 O� �D-zi Q Z r N�OODm PnWQ� z� a Esc C p QDIiD D>4pocn 3 oC z D (n N r= r Oo O Q n ^tiS\�`''�> > is �i�O► S Z D rn rte, -[ om -K: Q rl r'? �m p O D n o�zA o n aC < c ' , o wm pa L ' NSCALE T. S. PROFILE DETAIL 01 H H :0 m a c) b? v H � �31 o m f- a W W rO rn � O n N ~\ D L cf) I � r I C� D cn ~ I RC1 0 N t� o O -Ti m ��nn x•21 • Y .�.+ \�+ ZO gMKI2 l l� .• sra rn .01 ozzA co z 1 1" = 50' SITE PLAN UPGRADE SCALE O y O t — ^ADD Hr �DLCo m dxb ZTmIG)0AM C+ H 0 Z m =rC7 M M5 �4 co� r m,>, > m y DDm o r C / O m < mz� :o m U� H may I— ANr D G) OH <mZ�m > -< D OH byt-JN iM:E � oNa00 z r z Z D 2 Ozr = 0 cu �\ m0 �— A0 O rqoo _ \ X00 N 2 o / \ O \ d� \ m c— c) M ti \ s`8o \ o \ \ D X, Fri .s _/ r`' CM/) Doub T> cn C _ O6, F9 O / m (_n X / Ln O omZ � O %O rl Z �nG-) NO O Z. f_ X mo (n O Z —I m N fTl T. � D m- -{ z o—I -Op ZD '� "~1111 N,oA A �o �� f1�N= �� x�.�l )r qw< D �O Xp�7 Z Q 1" = 50' SITE PLAN UPGRA01-- SCALE �xu mo�ouiN� (tnU) U zm kTJ ay�0 � N or ("( L\N�C� Oo cry may nOGmvC��c� > p-) rm7 MIS N I I z D D I.rA �HZ ` ZOG° nv cl) Dm 7PpS Va ��I II SGln 7 /v a SIN'RAl .�, y < tIJ (N N m 2 GsmC/) ) �'D o rrmu,�:u m U)/ �-o J D�r D a 0 r O�M p Nm m a \.SII �.00�J'a //- d \O m O --i W r � cu \ v W AS o,s9 ` \ D 0 r� � n o ` ~�� z�O Z0� �n<� Dec cZ LO s�nvNL i-1N D �, ti Seep �/s \ -u mz �'� m > -< 0 X / \ BOO✓�z (N -GI oN \ rc zy� i - n 0 z -0 -�\ z M a� � I V? ow -O O aoOp� mmz co M O O m mO !n O m � C) m m 0 V) O A m -0 'o cn D (n X mu(n �C) p W310 LyMp� �p C 4 (� <o� mv) Z<MmT) OD ZI� �n C7 '-3 -i i� N m W G! (N ul -0 Z m t*� -C .Z7 O G7 P r (n �( `° - K-i O p z z z0n�l z0 -1 V) O p O+?DmD00 o0�=7.z zoNC V)Ul Mz-Z:Z O �O(nnrr00 Z _D vOA �nZOT�D�P0@ V) '00 p0D O O D p V)� pcn ww �1� L D r V) F- r- CO 0 y r o '�.. � s� 79 z ��i_lo�'i D m Q '� x O'er m D C �� W 0 00. �'� r1J o FYI,` � D m :" , i'yFF� '��' N.T.S. PROFILE DETAIL SCALE M _ m u�� �� = O t� cuo n N OD m (n H N � N RUM A (� N rrl r nz� � qq jf Nn Z ti—UA h P ozos n't W ? Ti mmN< i coo on FQ mom ��•••b Z f N= h (ENGINEER'SSEAL) Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ���7G-Zri t✓�S`�S DATE PERFORMELV/'/' 11111 LEGAL DESCRIPTION:����- �-- �ST\L Township, Range, Section: I g�PS SLOPE SITE PLAN FtF�TL 0 a � 1 1 1 1 1 Net Depth to Time Water Net Drop p U d 2 J 3 4- 5 5 \ ItN U 6- 7 U $ U 9 -�D v 10 12 2 - 9S 13 /J / 14 15- 16 17 18- 19- 20- COMMENTS 81920 COMMENTS WAS GROUND WATER ENCOUNTERED? ` S IF YES, AT WHAT a l 0 DEPTH? P E DepthMontt tri Water After Monitoring? (5 gate: -1 ZS -95- OF '4- " CE --88001E IT I i i 1 /-•��1 Reading Date Gross Time Net Depth to Time Water Net Drop p 51/ t" \ ItN PERCOLATION RATE 4 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 FT AND 4 FT PERFORMED BY: S & S ENGINEERING I �CERTIFY THAT THIS TEST WAS PERFORMED IN 1/034 Eagle ver Loop Road No. 204 ACCORDANCE WITH A8a§I9°RIY6*lAWdkhQqMqUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE WATER QUALITY SECTION DATE: August 16, 1995 TO: James Cross, P.E., Program Manager, Onsite/WQ FROM: el,ofarc Little, Supervisor, Water Quality Z SUBJECT: Creek Relocation Lot; Block; Majestic S/D After reviewing the above referenced septic permit, I have the following comments: 1. The relocation of the existing creek from its current channel into the platted drainage easement will require at minimum a U.S. Army Corps of Engineers permit and a Title 16 Fish and Game permit. A flood hazard permit may also be required from the MOA Department of Public Works. The relocation of any stream can be an expensive undertaking and requires a well thought out and constructed design which will keep the stream within its new channel and prevents the creek from returning to its old channel. Careful consideration must also be given to adequately re -vegetating the old channel to prevent erosion and downstream impacts. I would highly recommend hiring an engineering consultant with extensive prior experience in stream restoration and geomorphology to design a new stream channel and to assist in the permitting process. 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 PI/JE/ El NEW NAME — /�� ��� J/- Z' / �/`-30 PGRADE �,J MAILING ADDRESS;--) j/711 LEGAL DESCRIPTION Z_ LOCATION N0. OF BEDROOMS 57 Well Absorption area Dwelling PERNI.IT NO. DI TANCE TO: Uy h Z Manufacturer "�, / / Material No. of compartments IL � rn Liq, rapacity in gallons IF HOMEMADE:: Inside length Width Liquid depth O DISTANCE TO: Well / Dwelling PERMIT NO. 02<M, nufacturer Material Liquid capacity in gallons ///— at Well Foundation�7 f 1 �' Nearest Int lin 7 PER �jT 10. •-7 /s T DISTANCE TO: ��O w _.u z 2 No. of lines / Len th 9f e il ine Total len th of lines Trench width ., 2 �,C 3 P inches Distanc bet en li 2sn w �' — ¢ h / Top of tile to finish grade / ial b/e athytile / Q f // /. Total effe or ton arka iy 0 — �7 nches - Z- l.Sc'C-✓L rrc,l CJ Inches- -1 Length Width Depth PERMIT NO. Lu c� Q M Type of crib Crib d' m ter Crib depth Total effective absorption area a Lu w w rn Well Building foundation Nearest lot line DISTANCE TO: _ Class Depth Distance to lot line PERMIT NO. LU Building foundation Sewer line Septic tank Absorption areas) DISTANCE T0: OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER10 REMARKS �� r - -'Old o CarC-�8 a RobA'Yhr ert fn ,C�PhffHPCV P 41 APPROVFb DATE LEGAL GZ%Gt 72-013 (Rev. 3/78) in 'R ANCHORAGE AREA BORr 'GH r e '' `$ Department of Environmental Quality �""'�°"�• 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME L" �E1�� � //% 0 MAILING ADDRESS A'D ��JJp� ��- PHONE 6YY 3341 LOCATION 9�2�e� �NU LEGAL DESCRIPTION )6 T3 /� �eCk'2- lWt-- %I'�- a,41 -%le�'9/`%/CS SEPTIC TANK: kyokol DISTANCE [r�C, �R1` j� NUMBER OF FROM WELL MANUFACTURER _ �� MATERIAL �' COMPARTMENTS�✓ INSIDE LENGTH INSIDE WIDTH_ LIQUID DEPTH LIQUID CAPACITY4 �QC)Il GALLONS. TILE DRAIN FIELD: pry 041 TOTAL LENGTH/ DISTANCE FROM WELL FOUNDATIONAL/ NEAREST LOT LINE__.-- OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES __ TRENCH WIDTH— IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE__ DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE_. IN. ABOVE TILE `� //ll� IN. WELL: At -T -�N c F4 I k 0 TYPE CONSTRUCTION ------DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST FOUNDATION—,LOT LINE --SEWER LINE CESSPOOL /H SOURCES 74. APPROVED._ - ISAPP VED REMARKS -- DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: z' opv 6 LOT SLOPE: REMARKS: Arll/i Form EQ -032 SEPTIC SEEPAGE TANK , SYSTEM_ DIAGRAM OF SYSTEM r 1 "J DATE -`/,:;'//9e APPROVED G.A.A. B. A'•^'A L.11 1"4 1 X'--- I It 9'=9 Il-. _ I -F r s A F=" Fu VA A= ..: I --A CD & ^ .. fl "11 B i 8-"H. DEPARTMENT HEALTH AND ENVIRONMENTAL "OTE C'T I ON "' _.25 :I.... STREET.. FINIDH�":RAGE: FW"'. 99._.,. A. ko 646, cl :.F 7 -EE, € L-1 F L.1 F= (3 P? F1 C. Ate" � ' P A -"'A 1 ""A"_ PERMIT t+Ila, {; 8006 76 AF'`PI.-.IC:FIt•dT S�'^T�^E:'vE:. ELLI BOe-i 17.1.1- EAGLE RIVER e�r1• w:N�:�1 LOCATION SPRUCE LANE I....EGAL LOT 3 BLK 2 MAJESTIC VALLEY ES LCiT SIZE 43560 Si;!l.!ARE FEET.. TYPE OF SOIL. AE,S'ORP,rIOFd S'r''-TEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = SOIL RATING F'T','E:F' )= 150 THE REQUIRED SIZE OF THE_ SOIL ABSORPTION SYSTEM IS: C- - 4 F�•^ -T - I -I ::-.:: :1- 0 L_ IEW A"-41 a - "= ..1L _L 17A FC F=l %,. lE:- ✓I..._ C:1 Imo. F ='" I &• -A '.-- THE LENGTH DIMENSION I'_=; THE LENGTH (IN FEET OF THE TRENCH OR' GRA I NF I ELD, THE DEPTH OF. A TRENC:FI OR PIT IS THE: DISTANCE BETWEEN THE SURFACE: OF THE: GROUND AND THE BOTTOM OF THE E;>;CA'v'ATION (It,I FEET). THERE: IS NO SET WIDTH FOR TRENCHES. THE GRAVEL- DEPTH IS. THE: MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL. PIPE AND THE: BOTTOM OF THE: EXCAVATION (IN FEET::. PERIL I T APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT I::J!-IF: I N i THE I NST'F1I_LFITI Ot•d I NSPEC:TI ONS OF Arlt WELLS ADJACENT TO THIS PF.'OPERT'r' At,II..: THE NUMBER OF RESIDENCES THAT THE WELL. WILL SERVE. •-:r BAC''':KF'ILLING OF ANYS?•r'STEM WITHOUT FINAL INSPECTION AND APPROVAL. BY'1'HI:' DEPARTMENT WILL. BE. SUBJECT TO PROSECUTION. (TION. h1I t,l I t'11,.Ih1 DISTANCE BETWEEN A WELL AND AN',' ON --SITE SEWAGE WAGE DISF'OSAL SYSTEM IS 1.100 FEEET FOR A PRIVATE WELL OF: :150 TO 200 FEET FROM A PUBLIC: WEL_L.. DEPENDING UPON THE: TYPE CSF' PUBLIC 14ELL. 1''11 td I MUM DISTANCE FF='OM A PRI %,'ATE WELL. TO A PRIVATE SEWER LINE 1!:-: 2F'; FEET AND TO A Ctat'1t'1UNI.TY SEWER. LINE IS 75 FEET. CiTHFF:: RE"01.1 I F<:F, ME NTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE To itd:=,I..RE PROPER INSTALLATION. Wim, E. A.." -A I 'T F" TC F P EH r.-. 7'"'1 Fz. E.T- F' :i� _L !D , H: (: I CERTIFY THAT ::I.: I FIM FAMILIAR I.41 TH THE REQUIREMENTS FOR ON-., ITE ' ;EI•'dER,5 AND WELLS AS SET FORTH BIT' THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND D THAT THE ON --SITE SEWER 'S''r'STEN 11AY REE!!_I I F:E ENLARGEMENT NT I F THE RESIDENCE IS REMODELED TO INCLUDE MORE THFitd s BEDR.ClOt'12i; SIGNED( K IGNED(N'F'L'I F_ -F_fL L���?_ ISSUED E.5' _._ DATE:..-�� -� c:�. _ ;r•1.. E:1 _-..� TYPE OF SOIL ABSORBTIOI4d SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS 3 SOIL ' RATING CSG? FT/BR = :150 THE F:EOUIRE:D :SIZE; OF THE SOIL ABSORPTION SYSTEM IS: THE. LENGTH DIMENSION 15 THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT is THE DISTANCE BETWEE 14 ' THE SURFACE:: OF THE. QROUND AND THE:. BOTTOM OFTHEE:r4cAvFrriON CIN FEET). THERE IS NO SET WIDTH FOR 'TRENCHES. 'THE GRAVEL DEPTH 15 THE. MINIME.M DEPTH OF GRAVEL BE;THE;:EN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). T F:# P-4 fix''gip :�L C) R.1 efs CEi F1 L_ LT, 0 r.1 � BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY TH1: DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WEeL.L. AND ANY ON-SITE SEWAGE, DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE;; DEPARTMENT WiTHIN _z -o Goys OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION ,DIAGRAMS ARE AVAILABLE TO INSURE PROPEL: I N S T'ALE._ATI ON. I CERTIFY THAT :E AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FOF:TH BY THE MUNICIPALITY OF ANCHORAGE, 2. I WILL INSTALL THE SYSTEM IN ACCE:1RDANCE WITH THE CODES,. 3: I UNDERSTAND THAT THE ON --SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS, APPLI INT CHARS e RY^POGANY~ DE VELOPM ISSUED BY 1"A LJ V4 1 A._— .f DEPARTMEN'T F'1 9"a L_ 1 ..F OP HEAL -f n4" A -A __ d-'tN'AA 9-1 f Av AND E NVIRO[IMENTAL ' pO]E T 51 0 E. l..IDOR RD , AN HOf.AGE=., Eft`.. -50 14 EEE.._ L_ IF1 to E:a 9:3 PA ---• F�7 I TF---' !S L-1 FEF,-.'' PF- PEE K." Ir -1 I - fi PERMIT NO. 76097 :', APPLICANT CHARLES & GARY POGANY D BOX 6-3 -• F. R, 6-94-23`4 LOCATION SPRUCE E LANE* LEGAL L3 61 MAJESTIC VALLEY EST LOT '.3I ZE_ 5733'6,'];;, S1,!U19F.E FEET TYPE OF SOIL ABSORBTIOI4d SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS 3 SOIL ' RATING CSG? FT/BR = :150 THE F:EOUIRE:D :SIZE; OF THE SOIL ABSORPTION SYSTEM IS: THE. LENGTH DIMENSION 15 THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT is THE DISTANCE BETWEE 14 ' THE SURFACE:: OF THE. QROUND AND THE:. BOTTOM OFTHEE:r4cAvFrriON CIN FEET). THERE IS NO SET WIDTH FOR 'TRENCHES. 'THE GRAVEL DEPTH 15 THE. MINIME.M DEPTH OF GRAVEL BE;THE;:EN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). T F:# P-4 fix''gip :�L C) R.1 efs CEi F1 L_ LT, 0 r.1 � BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY TH1: DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WEeL.L. AND ANY ON-SITE SEWAGE, DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE;; DEPARTMENT WiTHIN _z -o Goys OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION ,DIAGRAMS ARE AVAILABLE TO INSURE PROPEL: I N S T'ALE._ATI ON. I CERTIFY THAT :E AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FOF:TH BY THE MUNICIPALITY OF ANCHORAGE, 2. I WILL INSTALL THE SYSTEM IN ACCE:1RDANCE WITH THE CODES,. 3: I UNDERSTAND THAT THE ON --SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS, APPLI INT CHARS e RY^POGANY~ DE VELOPM ISSUED BY 0 & E GEO . _CHNI CAL Et OEVEL Russell Oyster 694-2774 Soils Et Foundations Perforaled for: Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG MENT CO. Earl Ellis 688-2280 Land Development Name: CHARLES & POGANY DEVELOPMENT Tel. No. 694-2334 n Mailing Address: Box 363 Eagle River, Alaska 99577 Regal Description: Lot 3 Block/9,Majestic Valley Estates pe th feet So ha Acterist�cs 0 A ML - Silt topsoil with roots and organics. 1 GM - Silty Sandy Gravel with roots and organics. A GP -GM - Sandy Gravel with slight amounts of silt. 6 Cobbles -to 18 inches. I 9 GP -GM - Silty Sandy Gravel Greater fraction of finer sands than the material above. !-3 -Bst'tam of Pit 1' I. ...... T. �.- — Water Encountered: Yes No XX 275 sq. ft./BR 225 sq. ft./BR 150 sq. ft./BR 175 sq. ft./BR .�—sr� gip f� ..'60000"a d%? 7 v ��Fle' of � h�. •• `j°' V7� 1... 4 .m.q. .anm ♦.. uee. .r ,R; rail P. Ellis t w, NO. 7745-[ eo , 1h Ror-Fssio�-4j` If yes, what depth oposed Installation: Seepage Pit.. Drain Field, lowwients: Pit measured approximately 3' x 10' in plan area. All sides of pit logged the same, ",;;,' or ni ad by: Date: 6 Oct. 1975 4 tr v.,rrttf rb Brining mug by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 s TELEPHONE 694-2588 OWNER OF LAND f�i: a :_,�' 3 % iC;6.' P of _ DEPTH OF WELL ADDRESS STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION ct / _s' 1; '-` c'fIiAW DOWN FT. <' DATE - Started fff = % _ Ended / _ GALS. PER HR ' ' _- r` PERMIT NUMBER KIND OF CASING f 4�' ` KIND OF FORMATION: From Ft. to =-� From Ft. to Ft. t From Ft. to Ft. i� j_ Froin Ft. to_ Ft. From )Ft. to %� !� .. Ft t r ;%1 F G>l." a !:> + Fromm Ft. to Ft. From Ft. to i '-,> Ft r, - _ / i' fi'0 (� From Ft. to_ _Ft. From ?rr Ft. tok 3 Ft. /��; ( t�' „`� `1�'�, From Ft. to Ft. From Ft. to t£� Ft-{rf /K�r r-;r'}',l t4) From Ft. to Ft. From i 4' 1 J r Ft. to '- � Ft. __..r, 72 f ;��F'r" / f •� �� PromFt. to _Ft. From Ft. to '-�qFt. From Ft. to Ft. From ' Ft. to r I z Ft. .''i..'%ice From Ft. to Ft. From Ft. to 3 ' " Ft: •>> °1 : ' From Ft. to_ Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Froin Ft. to_ _Ft. From Ft. to Ft. From Ft. to Ft. FromFt. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Fromm Ft. to Ft. Front Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME I Municipality of Anchorage _ 0 s Development Services Department . Building Safety Division `^�`• = �`' _ On-Site Water and Wastewater Program z T 4700 South Bragaw St. -.r. :r.:� •.,,< P.O. Box 196650 Anchorage, AK 99519-6650.:,:•:',.J www.ci.anchorage.ak.us ,.._ _.•. ` .,.:; u;.; , (907)343-7904 j. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 05p —'Z-M COS - ... '-_ ....._- HAA # • .' _ Expiration Date: 7 — a D 3 1. GENERAL INFORMATION Complete legal description L0 i 3 .540-11 E463 r~S i 1 L VA-LL>=.-! es7-Arl Location (site address ordirections) 6411-7 wilt SviN4Dr- .i Current Property' ownei(§) V6. 11 i ovwtu Zi u.P Mailing address`. . 1/ 1�/�'� A"!& Lending agency"'' Mailing address Day phone ' '3 yb Z•' Day phone - Real Estate Agent Day phone Mailing Address - Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: / Individual Well 03/ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: . Individual On-site Individual Holding tank ❑ Community On-site ❑ ' Public Sewer ❑ .. The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 -by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public :eater 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, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm I obbeiA 912u y*-P.1a►.I-0�' 1 - t Phone _02-79-39/b Address ?, L/// 3 Engineer's Printed Name _ _ e- &,I sa V taL I.Lofo Date _ LIJB w 3 5. DSD SIGNATURE i7Q c' Te be .c.or4tmd ; i/Abedrooms. o�� F9 °° °°r��40 pproved for �' °•° Disapproved. ` /8��® moo'+ Conditional approval for-- - -'-" " bedrooms; with'the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: O 3 (Rev. 01/02) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program " "' 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L oT S. . BK 2. 14A �L=sr I Sr- VAL—LR'l i~ z T . Parcel ID: 0 50"731 03 A. WELL DATA Well type FZ Date completed Total depth 3_2Q_ft If A, B, or C provide PWSID # N%A Sanitary seal (Y/N) Cased to ,$,L,_fL Well Log (Y/N) Z Wires property protected (YM) Casing height (above ground) 12 th in. FROM) WELL LOG AT INSPECTION Date of test 5!G / y 4 4 e l c>-3, Static water level A e2 ft Well productiony g.p.m g.p.m. WATER SAMPLE RESULTS: Coliforr colonies/100 ml Nitrate mg./l. Other bacteria colonles/100 ml. Arsenic. mg./I. Date of sample: ANo.S Collected by: =�ao�v V B. SEPTIC/NOLDING TANK DATA Tank Type/Material L Date installed 12-'-8 —45 Tank size IAgo gal. Number of Compartments i Cleanouts (YM) Y L Foundation cleanout (YM) Depression over tank (YM) t-4_ High water alarm (YM) Date of pumping / 0 2 Pumper S0. "a C. ABSORPTION FIELD DATA, Date installed [%-S— Soil rating (g.p.d.fie or«tftdrm) I. 2 System type 5 — W. )de- AeLength Length4 8 R Width ft Gravel below pipe 5 fL Total depth 4 fz R Eff. absorption area 3 7 S ftp Monitoring tube �_ Depression over field r` _ Date of adequacy test o3 Results (PassiFail) _ For bedrooms Fluid depth in absorption � gal New depths in. p rption field before test �+-7 in. Water added-- Elapsed Time: 1a min. Final fluid depth U Lin. Absorption rate >= JVD g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) )y„ If yes, give date t� D. LIFT STATION Date installed I :.' 8 — 9 5 Size in gallons I oL w0 Manhole(Access (YIN) Y "Pump on' level at 3 in. 'Pump ofr level at IL in. High water alarm level at 3 in. Datum Zo-4 wit, p� Cycles tested I'D Meets alarm & circuit requirements?_ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 101 -� On adjacent lots 7 I coo Absorption field on lot 15c) t On adjacent lots 7 I 0-0 Public sewer main 1`4/A Public sewer manhole/cleanout tq/A Sewer /septic service line I ao Holding tank hY A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1 'o Property line +t field_ ? © t Water main NIAr Water service line AS Surface water 1 4yo Wells on adjacent lots �t 10,0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line I Building foundation 9; G Water main 14/A Water Service line 00 Surface water 1 o_t3 Driveway, parking/vehide storage SO f Curtain drain S n Wells on adjacent lots > I vt3 F. COMMENTS �J G. ENGINEER'S CERTIFICATION i I car* that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date, y Engineer's Printed Name JtiGd.AhN 1) Date 14-8-0-3 HAA Fee $ 375 Waiver Fee $ Date of PaymentJY-z1,0_,3 Date of Payment Receipt Number 31 '+ Receipt Number (Rev. 12101) I\ 04/24/03 TIIU 00:48 FAI 8808410 YISTA REAL ESTATE ER ©00: OF ASBUILT-NO CORNERS SCT THIS DATE. Sgt b i HEREBY CERTIFY THAT 1 HAVE SJRVEYED THE SC U7i yc FOLLOWING DESCRIBED PP.OPERTY, - r r AND THAT NO EM�tOwCFINENTS EXIST CEPT AS DA Et INDICATED. IT IS THE gESPONSIBILITY OF THE OWNER TO DETERNLNE THE EXISTENCE 07. ANY GRID: EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR 0144 THE RECORDED WSD1- rr✓3�.' VISION FLAT. UNDER NO CIRCUMSTANCES SHOULD FB' I ANY DATA HEREON BE USED FOR CONSTRIICTTON V FENCE LINES, CR FOR ESTABLISHING BOUND- ARY LINES. DRAWN - • lkik a*.' S c� o w « i MUNICIPALITY OF ANCHORAGE ° DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 OFRTIFICATE OF FIt_ALTI-' :' 1JTFIC::ITY APPROVAL FOR A SINGLE FAMILY IJVdcLLING Parcel LID. # 05-6- 7.3/- 63 _ MAA# 40\00CILA 1. GENERAL INFORMATION Complete legal description Loi 3; Block 2_Majestic Valley Estates Location (site address or directions) NHN Spruce Lane EagJ.e River, AK Property owner address Ri.m Ruona C/O Vista Real estate ___ Day phone M ilin 4241 "B" Street .anchorage, AK 99503 a g - Lending agency — Mailing address Agent Tem Alexan&_r/ Vista Real Estate Address — Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OFBEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water Day phone Day phone 273-7277 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYKE OF WASTEWATER DISPOSAL: Individual on-site _:XXX Holding tank — Community on-site : Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC WJosting to the legality and status or° system. 72-025 (Rev. 1/91) Front MOA N21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from) the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING 17034 Eagle River Loop Road ago. 204Phone _ G q `� ��cl 7 ell Address Eagle River, Alaska 99577 Engineer's signature i Date 3 , a- S' / `t 7 i� ROBERT C.(ONAN f 6. DHHS SIGNATURE �t ` �J Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date ¢ _17— / 7 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificat,"'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 acourtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/81) Back MOA W21 D. LIFT STATION Date installed 12 -114 -99 Size in gallons 1250 Manhole/Access (DN) YES "Pump on" level at" YZ 1 "Pump off' level at" High water alarm llevel at" Ll if 'Datum 607TOM OF TAtl 1C Cycles tested t�/R LESS -r P}&rl 2PAPS) E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: / epis holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots 1001+, On adjacent lots f oa 1+ Public sewer manhole/cleanout � JA Lift station I m1 + SEPARATION DISTANCES FRO SEPTI HOLDING TANK ON LOT TO: Foundation 511- Property line )6' 4- Absorption field 1 01 t Water main/service line 1011- Surface water/drainage loot+ Wells on adjacent lots _ 1 oo'f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line _%_ t Building foundation 1014 Water main/service line Surface water /00 + Curtain drain 501+ * UJA1vED 11-28-9S (wgSoo6r�) F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area Wells on adjacent lots i certify that l have determined thru field inspections and review of Municipal in conformance with MOA H guide!;es in effect on this date. Signature ,, ,,, 77; Engineer's Name C • C 0tcl Date 7 HAA Fee $_! '_61 Date of Payment 3 Z2- 6 L77 Receipt Number 72-026 (Rev. 3/96)" Waiver Fee $ Date of Payment Receipt Number 1011- 301 -f" 1001-I- .�cor�KtFl aligns are r� r . /9 A •k EE"%%��//,p .ROBERT C. cOWAN f 1� J�ip� •,� CE - 8501 ? Af •,�N MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICIiS DIVISION Municipality of Anchorage MAR 26 DEPARTMENT OF HEALTH & HUMAN SERVICES ���� Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 •.(907) 343-4744 Health Authority Approval Checklist Legal Description: Lo -r 3, IbLoci< 2 t MAJEs-nc Parcel I.D.: 050 -'7 3 1 -03 J ALL6`( ESrATeS A. WELL DATA Well type eRO A•r-E If A, B, or C, attach ADEC letter. ADEC water system number Log present ON) Total depth Sanitary seal (ON) Date of test Static water level Well production YES Date completed i I N 20 Cased to 8-7 FROM WELL LOG i Zoo S WATER SAMPLE RESULTS: C/ I /a-/ Casing height (above ground) Wires properly protected (VN) `IES AT INSPECTION 8 - V7 2061 9. P.M. 5.7 g.p.m. Coliform d Nitrate b. /23 Other bacteria Date of sample: 3 - 15 - 97 Collected by: S & S ENGINEERING I /U34 age River B. SEPTI HOLDING TANK DATA Eagle River, Alaska 99577 Date installed 12 -ly - 95 Tank size 1250 Number of Compartments 2 Cleanouts (FaN) Yes Foundation cleanout (Y/N) Ycs Depression (YO do High water alarm ON) yes Date of Pumping )-30-9-7 Pumper NfAejrJG C. ABSORPTION FIELD DATA Date installed a - 9S Soil ratingp.d./ orf?/bdrm) !• 2 System type Ter.1cH � I Length 0i Width 5 Gravel thickness below pipe 2.5 Total depth 6 • S' Effective absorption area 375 Monitoring Tube present (PN)`i_S Depression over field (Y/M IJo LE%s THBfJ Date of adequacy test N Z 6A esults (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = '— Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 050-731-03 HAA # f?A.9505� 1. GENERAL INFORMATION Complete legal description Lot 3; 61.2oc`; 2; 1.aje.,5ttic Vat2e.y Eb�t-ate.a Location (site address or directions) NUN Sp,,cuce. Lane Property owner Rcbe'tLt E. 6ate.a Day phone 09/1-3905 Mailing address C/0 Les Ge .sten/ Von ."cKe.nzie Re.aC E4ta'e. 13135 UYd Gtennfho . Eagtie. Riven, AK Lending agency Day phone Mailing address _ Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: VVIV Individual well ^^/\ Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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. S & S ENGINEERING Name of Firm Phone C--2 - `� 7 Eagle rver Loop oa o. 204 Address Eagle River, Alaska 99577 Engineer's signature REQUEST YOU RELEASE THE CONDITIONAL HEALTH AUTHORITY APPROVAL, HAS BEEN CObfPLETED AND A REVISED AS BUILT/Ii`1SPECTION`REPORT ,I� 6. DHHS SIGNATURE X Approved for _�_ bedrooms. Disapproved. Conditional approval for Additional Comments By: 111Th Date 2 //e /17 ALL REQUIRED WORK F. M .....: _..........._... .......... . Sf ROBERT C. COWAN CE • 8201 i ��• bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rv. 1/91) BaCk MOA M21 MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0, S7 0 - -7 31 - t' 3 1. 2. 3. 4. GENERAL INFORMATION HAA # V� LL Cl! SYS.--- Complete legal description Lot 3• BEock 2; bSaTezt%c VaUe.0 E.6tatez Location (site address or directions) _ NHN Snn.uce. Lane. _ Property owner Robe.nt E. Ba.te.a Day phone 694-3905 Mailing address C/U Lea Ge,ia.Een Don McKenzie Reap F,,tatc 13135 0 d ' e.nn Hwy. Eagte, Riven., AK 99577 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water XXX ENV O NA;FNrA OFANC.HU SERVICES DI SION 1995 REC�IVEL) NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(8w.1/91) Front MOA #21 5. STATEMENT OF INSPr-CTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 & S ENGINEERING Phone G �i - `i -7 [l 17034 Eagle River Loop Road NO. 204 Address Engineer's signature ! Y/l /1 ( S r? E U„ z -To tie C (1i�1_riILi) 6. DHHS SIGNATURE Approved for bedrooms. Date Disapproved. Conditional approval for 3 bedrooms, with the following stipulations: M water into stream maintenance easement a minimum of 100 feet away :E, -„m the P.R;A, •.,_st,,w terr system serviijg tneire„Teen 'Chis property. Engineer shall furnish this office with a revised as-btrsciliju.plishe l'�:'omments AdditioXathan June 15, 1996. Money in escrow shall not be released until this office has issued final sy: -L-' ��- `i LLLCL Date / — 4 - 9(� The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Sack MOA e21 D. LIFT STATION Date installed 12-%,k -`tS Size in gallons ! 5-0 &A1 Manhole/Access (I) Yi;-�-S "Pump on" level at*_ Lia "Pump off' level at* 3a High water alarm level at* `tai *Datum SoTrow. or- Cycles rCycles tested 3 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Se tte holding tank on lot loo`' : On adjacent lots Absorption field on lot 1 PD iA : On adjacent lots 101-) � k Public sewer main Public sewer manhole/cleanout _ rq^ Sewer /septic service line ZS t k Lift station S r7 os r SEPARATION DISTANCES FROM SEPTI HOLDING TANK ON LOT TO: Building foundation S0— Property line to `A-- Absorption field t o ` Water main/service line No to Surface water/drainage tom Wells on adjacent lots o �� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation tD 1� Water main/service line N0 k Surface water �F '1 o t a Driveway, parking/vehicle storage area --'20 � Curtain drain 0` Wells on adjacent lots_ lib `� _ Property line \44/� 1 SFi-f-- car 4iz-o A,,NRq >� �n�.� � tl-y� �s ('w r 9 s ocv F. ENGINEER'S CERTIFICATION I cerci/y that have determined thru field inspections and review of Municipal record-tbFb '�jems are in conformance with All HIbl g delines in effect on this date, s,�Q, ,.••• """ ••. 4S`eeaT� Signature �L N °. , tot �a.rn. . � vro. .nonv.un o;lt Engineer's Name IC d134C.4i C _ 0 e✓�In/ ;j„ ee s.............u�i f+t T �9 ROBERT . COWAN i �? ;q Date l a 6 l q15— lf�c��.� CCE -�+ 8801 . ``, v'y HAA Fee $ Waiver Fee $ Date of Payment d / /5 Date of Payment Receipt Number � ' , �_ iP l��) Receipt Number Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OP ANCHOMi Uuk Municipality of Anchorage ENVIRONMENTAL SERVICES DIVIS DEPARTMENT OF HEALTH & HUMAN SERVICES ,.- . Environmental Services Division I � �' 26 1995 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 RECEIVED Health Authority Approval Checklist Legal Description: Lof 3, �2 MQt&S-rl1_VAc«-/ Cs -r, Parcel I.D.: 0150,73103 A. WELL DATA Well type `peg VASE If A, B. or C, attach ADEC letter. ADEC water system number Log present (VN) VLs5 Date completed 5 --7" i (a Tb yao r_ I,/I/87) r r r / Total depth li20 Cased to C65 Casing height (above ground) 1o? 4 - Sanitary seal q)N) �� Wires properly protected(I) Y6<- FROM ds FROM WELL LOG AT INSPECTION Date of test 5-7- "7 (p (ro/l/$7, g -1'7 -qSStatic water level i 0 e� 2.00� 1 d 1, Well production e. D. in. S. -7 O n ,,, WATER SAMPLE RESULTS Coliform Nitrate rnz Other bacteria Date of sample: Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. S�PSI IOLDING TANK DATA Eagle River, Alaska 99577 Date installed 12-1LA.cj55_ Tank size IaSD Number of Compartments 2 Cleanouts( ISI) t/iF5 Foundation cleanout ON) V L -S Depression (Y/& (Jo High water alarm (DN) Vt-' S Date of Pumping tib' TeA'�"'ez Pumper C. ABSORPTION FIELD DATA Date installed Iti4-W Soil ratit19 (g.p.d./ ` r 112/bdrm) • a System type 5HALt-OW TP&WeN Length �{� r Width 1 Gravel thickness below pipe Total depth ,57, S Effective absorption area W90 Monitoring Tube present((DN)� Depression over field (Y/Of /\/o Date of adequacy test LrlA Sys c" Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (iii.); Fluid depth — (ins.) Minutes later: Immediately after —gal. water added (in.): Absorption rate = g.p.it. Peroxide treatment (past 12 months) (YIN) _ If yes, give date HEALTH AUTHORITY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN S&Sl 7ineexinG December 17, 1995 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 3; Block 2; Majestic Valley Estates ROBERT C. COWAN, P.E. ROBERTA. SHAFER, PE. CIVIL ENGINEERS (907)694-2979 FAX (907) 694-1211 Request you issue a Conditional Health Authority Approval on the referenced property due to cold Weather conditions and depth of frost. The stream is to be rerouted to its original channel. Work to be completed no later than 15 June 1996. If you require additional information please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577 G 2 (g� � � L ➢ c9 N -j� 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINT ENTS 77C, \ (L (�7__ TIME TIME TIME it `- DATE DATE DATE ❑ One ❑ Four ❑ Other SINGLE FAMILY ` INSPECTOR - - INSPECTOR INSPECTOOPr,,, &&,_..INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF H ALTll & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P: D i ECTION • ENVIRONMENTAL SANITATION DIVISION NOV 10 11980 Telephone 264.4720 LL REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERI I�IM D DI RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER�PHOONE C ,/ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MAILING ADDRESS / PROP RT ESI DENT (If different from above) PHUNF 2. BUYER � ONE MAILING ADDRESS v - 3. LENDING INSTITUTION PHONE r 1!�_ S919 - -zit/� MAILING ADDRESS n 4. REALTOR/AGENT PHONE MAI LING ADDRES -- 'k ff)l 911 w C Ilk, 5. LEGAL DESCRIPTION -- - L -C7S 77C, \ (L (�7__ STREET LOCATION -` CATION 6. 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 that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** A -RD YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. -010 (Rev. 6/79) f�-t/ i, / b M 72010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 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: )POO If Tank is homemade give dimensions: SOILS RATING �( TYPE OF TANK MANUFACTURER { TOTAL ABSORPTION AREA MATERIAL P^ 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ILYAPPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must mpany certificate) ❑ DISAPPROVED DATE BY M 72010 (Rev. 6/79) ��,llljf�jl; ~ DAVID A. SLENKAMP ROBERT A. SHAF-ER % r MECHANICAL ENGINEER CIVIL ENGINEER 6940055 6940979 E November 21, 1980 MUNICIPALITY OF ANCI-IORAOC DEPT. OF WA L N I & ENVIRONMENTAL P; �rECTION Steve Ellis PRA 2 1 now) Box 1711 Eagle River i';iad Eagle River, Alaska "9577 RECEIVED Dear Mr. Ellis, Reference: Lot 3; Bleck 2; Majestic Valley Subdivision A sewer system adequacy test wns performed on the 16th thru the 19th of November, 1950 on the system located on the referenced property. The septic tank was pumped and verified to have a cnpacity of 1000 gallons. The absorption trench was tested by a continuous flow of water over a period of 72 hours. It was concluded, as n result of this test that the absorption trench was only capable of accepting approximotely 300 gallons of water without backing up into the septic system. The septic tank is adequate for three bedrooms, however the absorption trench is only adequate for two bedrooms. In accordance with our telephone conversation of November 20, I have made arrangemerts to have the system upgraded to accommodate one additional bedroom. If we may be of further assistance, please do not hesitate to cell. Sincerely, RODERT A. SHAPER, P.E. RAS/ss cc: Municipality of U chornre Department of Health and EnviornmentrIl Protection Totem Roa.lty ATTENTION: Linda Gra _suer Alaska Pacific Dank ATTENTION: Ronnie SR6 196X EAGLE RIVER, ALASKA GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received July 13, 1976 Time of Inspection A'�(Q Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1 . Approval requested by: Alaska Mutual. Savings Bank % Chris Anderson Mailing Address: - Phone: 2. Property Owner: Charles & Pogany Dev elopment Phone: 688-2390 Mailing Address: Box 323 Eagle River 99577 3. Legal Description: Lot 3 Block 2 Majestic Valley 4. Location: Spruce Lane, off of Eagle River 5. Type of facility to be inspected Singel Family No. of bedrooms 3 6. Well Data: Individual A. Type _ B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On-site system A. Installed 1976 B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page l of two pages Page 2 of two pages - Req. st for Approval of Individual S�...ar & Water Facilities Legal Description Comments Lot 3 Block 2 Majestic Valley Approved proved _ _ Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality 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 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMF 2. Property Owner: _z_ 1 `• Mailing Address: 0 3 3 rH 5. R 7 91 91 23 VA . FHA CONV'�:L v Day Phone: Name of Buyer: rOS '-(A I )(-`y-> Mailing Address: Q- c_ Day Phone: Name of Lendinglnstitution: ::A\Ag4(a MU�-d0.-1 Mailing Address: Fn eI've V- Phone: Name of Realtor or Agent: (� Mailing Address:-" �q Phone:/ Legal Description: �-©} Sir— cL L Location: cl.4 \3e" H, 1) Type of Facility to be Inspected: S�No. Bdrms. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served 1 If Individual, depth of well Sewage Disposal System \q Type of System: Public Utility l _Individual (on-site) If Individual, date of installation 72-003(3176)