Loading...
HomeMy WebLinkAboutMAJESTIC VALLEY ESTATES BLK 4 LT 2Majestic Val l Estates Block 4 Lot 2 #050-731-29 mspecnon meparr '1-1-1¢.eoe Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP121301 PID Number: 050-731-29 ❑ New ❑✓ Upgrade Name: Sheryl Elders ABSORPTION FIELD ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed [I Mound Address 25852 Imperial Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 8.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.8 FL Gravel depth beneath pipe 6.2 Ft, Subdivision Block Lot Majestic Valley Estates 4 2 Fill added above original grade 1.2 Ft, Gravel length 45 Ft. Township Range Section Gravel width 3.OFt. Beds: Number of Lines N/A Distance between lines I N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 5581 FTz N/A Ft. Well 104.3 116.6 N/A N/A 73.8 TANK E] Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1000Gal. Surface Water 100+ 100+ N/A N/A Material Number of compartments Lot Line 63.8 64.8 N/A N/ASteel 2 NA Foundation 71.3 124.5 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A N/A Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank Tank to 3034 drainfield 3034 JR's Septic Pumping Dminfeld 3034 CO/MT 3034 Inspector Steven R. Pannone BENCH MARK (Assumed elevation) 10011 Inspectionfs' 10/1/2012 m dates: 2 10/2/2012 Location and description 3'" 10/2/2012 4'" Garage door threshold COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date Steven ESanriorae GE 8149 Approv DateAW --��� mspecnon meparr '1-1-1¢.eoe 44 %N WELL (E). DRAIN FIELD(E) EC2 IN FAILURE. RE -USE AS RESERVE. W\N 10OOg SEPTIC TANK ABANDONED PER CODE —m — T2 NEW 1000g SEPTIC TANK EC1 INSTALL DCO & DV DV 'DCO Z Tl 4u FCO (E) C3 87.1 'p B .104.3 C C1 4s M1 NEW DRAIN FIELD 45LF x 3.0'W x 5.0'ED, 8,0'TD M2 TH-1 t C2 WELL (E) 6.c> z 64.8 k W_ W NOTES: PAMONE ENG SVC, LLCDate RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 ?1.' . OF. 12/3/12 V1. - PHONE (907) 272-8218 FAX (907) 272-8211 Aw. I . _' . f- 00 S"I. TH -50 P.I.D. NO MAJESTIC VALLEY ESTATESS, BLOCK 4, LOT tev 050-731-29 ;.e e� � �.. � a..,! SHERYL ELLERS a IV nnome ;,., PERMIT N0. CE 8149 .- 25852 IMPERIAL DRIVE A7 OSP121301 00 T * .. . \4 �� PLAN EAGLE RIVER, AK 99577 Sheet 1 2 OF 3 A B C FC 30.7 Tl 77.3 765 T2 83.0 82.2 DCO 85.9 84.8 DV 89.4 88.4 EC1 100.3 101.7 EC2 120.0 133.4 C3 89.5 67.5 Cl 126.0 149.5 M1 124.8 148.2 C2 3 6.3 1135.6 155.0 M2 154.8 WELL 43.1 44.3 DRAIN FIELD(E) EC2 IN FAILURE. RE -USE AS RESERVE. W\N 10OOg SEPTIC TANK ABANDONED PER CODE —m — T2 NEW 1000g SEPTIC TANK EC1 INSTALL DCO & DV DV 'DCO Z Tl 4u FCO (E) C3 87.1 'p B .104.3 C C1 4s M1 NEW DRAIN FIELD 45LF x 3.0'W x 5.0'ED, 8,0'TD M2 TH-1 t C2 WELL (E) 6.c> z 64.8 k W_ W NOTES: PAMONE ENG SVC, LLCDate RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 ?1.' . OF. 12/3/12 V1. - PHONE (907) 272-8218 FAX (907) 272-8211 Aw. I . _' . f- 00 S"I. TH -50 P.I.D. NO MAJESTIC VALLEY ESTATESS, BLOCK 4, LOT tev 050-731-29 ;.e e� � �.. � a..,! SHERYL ELLERS a IV nnome ;,., PERMIT N0. CE 8149 .- 25852 IMPERIAL DRIVE A7 OSP121301 00 T * .. . \4 �� PLAN EAGLE RIVER, AK 99577 Sheet 1 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. 2. ALL WORK SHALL WAS ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: INSTALLED 1000g SEPTIC TANK. INSTALLED NEW SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS NOT ENCOUNTERED AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14.0 FEET BELOW EXISTING GRADE. FABRIC DRAIN PIPE I ROCK 6" ABDVE PIPE INV GP/ Iff SWDRAIN ROCK 59.5 4-3.0-1 0 -14.0 V NEW 1000g SEPTIC TANK DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g PERC RATE = 1-5 MPI SOIL RATING: 1.2 GPD/SF AREA RQD: 375 SF SYS. TYPE: DEEP TRENCH 5.0' E.D. MIN LENGTH: 37.5LF USED: 45LF X 3' WIDE, 6.2' E.D., 8.0' TO TOTAL AREA: 558 SF PROFILE SECTION m V R FABRIC Vz IN ROCK B"ABOVE PIPE INV U H DRAIN PIPE R R TRENCH SEE DESIGN LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC NOTES: PAMONE ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MAJESTIC VALLEY ESTATESS, BLOCK 4, LOT SHERYL ELLERS 25852 IMPERIAL DRIVE DESIGN DETAILS EAGLE RIVER, AK 99577 ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT N0, M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL AND VEGETATE -qk 10/18/12 �'�P. •'"9 �' Scale *: 49 NTS ...... .. .... P.I.D. NO 050-731-29 Steven R. annone / PERMIT NO -$,,.CE 8149 OSPI21301 s L 1�1 \\ Sh3eOF 3 Municipality of Anchorage Community Development Department On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 Well Decommissioning Log Legal Address: Subdivision M4-Tc-_setc VALLVY "-r Block I' Lot z T R Section Lot On-site Water & Wastewater Program certified contractor performing the well decommissioning: Name: (%K /0O 6t9 AJ Signature: Company: Well decommissioning date U l I% Method of decommissioning: AMC 15.55.060L1 a. ❑ b. ❑ C. ❑ Location: Use the space below to provide a drawing of the property showing the following items; • North arrow • Decommissioned well, • Other water wells on the property, • Two separate swing-tie distances for each well shown on the drawing, Note: The swing-tie distances shall be measured from either permanent structures or the property corners. -r1d w vc� 7l (z% LI-440 xns I R 72 c A tvb s 14-o w n� ©.t' A s ,%av'a_-e �53�fc i 7A-� 3l4Z w�S �zco.vrM�SS[oNc A z, 6 Ury V, &.)C U) IV 0 F>L-42.rA-t>a s-2s� e.>7 w As u:wommunuy Deveiopmennuevelopment Sewices\Bullding Safety\On Site Water and WastewaterlForms\Client Forms\Well Decommisioning form.doc 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: OSP121301 Tax Code Number: 05073129000 Work Type: Septic Upgrade Permit Effective Dates: October 01, 2012 to October 01, 2013 1-5- / (3 S /o -�2- 1 z l: 010 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: MAJESTIC VALLEY ESTATES Site Legal Address: MAJESTIC VALLEY ESTATES BILK 4 LT 2 G:0363 Owner/Address: ELLERS SHERYL L 25852 IMPERIAL DRIVE EAGLE RIVER AK 995779628 Site Mailing Address: 25852 IMPERIAL DR, Eagle River Lot Size in Sq Ft: 54643 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-731-29 Property owner(s) Sheryl Ellers Mailing address 25852 Imperial Drive, Eagle River, AK 99577 Site address 25852 Imperial Drive Day phone Legal description (Sub'd., Block & Lot) Majestic Valley Estates, Block 4, Lot 2 Legal description (Township, Range & Section) Lot Size 54,643 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field E] Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank ElUpgrade n Duplex (D) ❑ Holding Tank EJRenewal 1:1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. of property owner or authorized agent) Permit/Rush Fees: E 3c) , Waiver Fees: _ Date of Payment: C1 11 bk A Date of Payment: Receipt Number: 615c18Cn Receipt Number: Permit No. 0510Q\ 1 f0\ Waiver No. Permit App_9-1-12.doc Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve0paneneak.com September 12, 2012 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Majestic Valley Estates, Block 4, Lot 2 Septic System Permit Upgrade Request Ladies and Gentlemen: I am writing to request a permit to upgrade the septic system be issued for this property. The proposed systems will serve an existing three (3) bedroom house. Currently the lot is developed. The existing drain field will be re -used as a reserve. The existing 10008 septic tank will be abandoned per code and a new 10008 septic tank will be installed. This lot is served by a private well that is located over 100 feet from this system. The surrounding lots are also served by private wells. There are no wells within 100 feet of this system. 1. Soils. A single test hole was excavated by Pannone Engineering Services in August of 2012, and the ground water monitored for seven days. Groundwater was not encountered in the test hole monitor tube after the seven day monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used for conventional wastewater system. 2. Soil Absorption System Design. a. See Sheet 2 of the design package 3. 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. 4. Topography: The topography slopes approximately from northeast to southwest at approximately 20%- 25% in the area of the proposed drain field. There are no steep slopes in the vicinity of the proposed 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 5. 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 wells or septic systems 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 Attachments -Soils Log -Septic System Design 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 "-�WELL RADII' WITHIN 20 FEET OF THE SEPTIC SYSTEM TO BE FLAGGED BY A LICENSED SURVEYOR IVA WELL (E), Ilk Oki, DRAIN FIELD (E) IN FAILURE. RE USE AS RESERVE W_1 OOOg SEPTIC TANK (E) ABANDON PER CODE m — 10009 SEPTIC TANK (P) ill INSTALL DCO & DV _,74J 'z CO FCO (E) &j q�, 4E TH- 1 DRAIN FIELD (P) WELL (E) 40LF x 3,0'W x 5.0 ED, 8.0'TD 101.0 • \ tz \ WELL (E) sa _1A _w I __=,1ry1 W_ IV------ I,- w NOTES: Date PAMONE ENG SVC, LLC OF Akqk1kko 9/28/12 FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 ......... k9? � PHONE (907) 272-8218 FAX (907) 272-8211 .;f Scale ro 4 0 77 Z 50' P.I.D. NO MAJESTIC VALLEY ESTATESS, BLOCK 4, LOT 217, 450-731-29 SHERYL ELLERS teven Pannoe — PERMIT NO. 25852 IMPERIAL DRIVE CE 8149 ...- OSPJ 21301 PLAN EAGLE RIVER, AK 99577 Sheet I— 1 OF 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. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: INSTALL 1000g SEPTIC TANK. INSTALL NEW SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS NOT ENCOUNTERED AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. ER FABRIC O DRAIN PIPE NN ROCK 6' ABOVE PIPE INV 1000g SEPTIC TANK (P) DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 10009 PERC RATE = 1-5 MPI SOIL RATING: 1.2 GPD/SF AREA RQD: 375 SF SYS. TYPE: DEEP TRENCH 5.0' E.D. MIN LENGTH:37.5LF USE: 40LF X 3' WIDE, 5.0' E.D., 8.0' TD TOTAL AREA: 400 SF PROFILE TRENCH SEE DESIGN LEGEND —W— WATER LINE/ WELL RADIUS — SS — NEW SEPTIC ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE r r _._ FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. GP/ 5.0 M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT SIN DIVERTER VALVE FS DRAIN ROCK BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL AND VEGETATE tl 6.0 -14.0 SECTION U O yJO�a1�F �F C 4p 15 Z Z5 nU nO O L n nU no LTER 0 0. FlFABRIC o _ .I�jjl� I IIr IIIj DRA N ROCK 6' ABOVE PIPE INV �I�IIJI� n n 1_ 4e 0 DRAIN PIPE nn 1000g SEPTIC TANK (P) DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 10009 PERC RATE = 1-5 MPI SOIL RATING: 1.2 GPD/SF AREA RQD: 375 SF SYS. TYPE: DEEP TRENCH 5.0' E.D. MIN LENGTH:37.5LF USE: 40LF X 3' WIDE, 5.0' E.D., 8.0' TD TOTAL AREA: 400 SF PROFILE TRENCH SEE DESIGN LEGEND —W— WATER LINE/ WELL RADIUS — SS — NEW SEPTIC ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL AND VEGETATE NOTES:.������\\� PANNON21 ENG SVC, LLC OF q� \� Date FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 9/28/12 PHONE (907) 272-8218 FAX (907) 272-8211 rrg�p' �y+) Scale NTS �.. ... .. ..:.. P.I.D. NO MAJESTIC VALLEY ESTATESS, BLOCK 4, LOT 2- ... / 050-731-29 SHERYL ELLERS Fteven' :'Pannone PERMIT NO. 25852 IMPERIAL DRIVE ��•, CE 8t49� OSP121301 DESIGN DETAILS EAGLE RIVER, AK 99577 '��� ........ Sheet li\� = 2 OF 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 TEST HOLE 1 OR ORGANICS POORLY GP/ GRADED SW GRAVEL/ SAND SOILS LOG - PERCOLATION TEST SITE PLAN SLOPE WAS GROUND WATER BOH ENCOUNTERED? N IF YES. AT WHAT DEPTH? -DRY-• DEPTH TO WATER AFTER MONITORING? -DRY- DATE: 9/5/12 DATE PERFORMED: 8127112 SLOPE TH X READING DATE CLOCK TIME NETTIME WATER LEVEL READING NET DROP 1 8/27/12 4:21 - 4.15 - 2 4:31 10 MIN 6.75 2.60 3 4:31 - 4.15 - 4 4:41 10 MIN 6.49 2.34 5 4:41 - 4.15 - s 4:51 1 10 MIN 1 6.40 2.25 PEROLATION RATE -4.4 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3 Ff AND 4 FT COMMENTS: Test hole excavated by FLINTSTONE ENTERPRISES. 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 ONTHE �DATE OF THIS TEST. NOTES: PAMONE ENG SVC, � x . �OFq�q\ 1 Date IR CONSTRUCTION Tr P.O. BOX 102954 ANCHORAGE, AK 99510 r �.• " ' �•.cS 1 9/28/12 r�P•'� + PHONE (907) 272-8218 FAX (907) 272-8211 icj• y Scale __ /. i:.to Tu st♦i NTS � ... .. .. .. ... � P.I.D. NO MAJESTIC VALLEY ESTATESS, BLOCK 4, LOT 2c0-731-zs t•F�. annoRe SHERYL ELLERS / �teven PERMIT N0. i CE 8149 OSP121301 25852 IMPERIAL DRIVE tf+ SOILS LOG EAGLE RIVER, AK 99577 1�'•� sheet 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 NEW AlL ADE/apLq ❑UPGR --PHOE MAI LING ADDRESS e6y :5 LEGAL DESCRIPTION �J/J /f1% � RCc�cK�� A/4,7_,47 -_S 7- �LLEY e!�_7S,-074.0 LOCATION y/ 11011�eiei,Y l_ DQ/i/E NO. OF BEDROOMS E U Y DISTANCE TO: Well /O� AbsorptionareaDwelling '` ; 7iK PERMIT NO. 17 6/ 6 7 -- LZa Manufacturer �7�Ee Material No. of compartments yN Liq. ca acity in gallons /00e O IF HOMEMADE: Inside length Width — Liquid depth Y DISTANCE TO: Well Dwelling ese PERMIT NO. J Q Z z Fa-, _ Manufacturer Material Liquid capacity in gallons O W DISTANCE TO: Well 115 Foundation Nearest lot line PERMIT NO. y J LL z No, of lines Length of each line ` Total length of Ines Trench width Distance between lines i N, Z cc � / (p inches AIPIAI ,T® ccf. Top of tile to fini.sh grade Material beneath tile Total effective absorption area O 2 'TO 3� 36 n To c� inches S4 FT Length Width Depth PERMIT NO. (7 IL F- U.1 ° Type of crib Crib diameter Crib depth — Total effective absorption area N DISTANCE TO: Well Building foundation _ Nearest lot line J Class Depth Driller Distance to lot line PERMIT N0. J W R: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER - PIPE MATERIALS PrC SOI L TEST RATING /'Vo :�52 . F7-. /e,.4 . - INSTALLER X� REMARKS O ®ee.A;� I oaf; C V ao �j'a+�ou//0 na aoe+e ea/Je owe- � ®' aifs.-•XiG e ewnoe.e +e+e..a ce •+o.o — Earl 1. Ellis U� 'ee �\` NO. 1745-E a0 � e � p�RyO{F�Ee5��S10N�� �`se VAih� A APPRO ED DATE LEGAL .��� / 7 Lor g , 72-013 (Rev. 3/78) M Ly SO Y TO T: 0 N ATU, A 1 47,11, 1 14 f I I 1 .1 Kv t � A 10 K DEPRRTMENT OF 8LTH HND Eit? IRONMHL: N1HL PR TIUN 825 '|.' /|REET/ RNCHORHGE. AK. 9958A. ,/^ ^I,�� U �����- l 11 � ::-:: �pp � hi v 9 -T`I I — TO 75 Nil To I Tom V p EK` ���1 , I - 1 0 "V �. THE (.ENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCU UR DRHIMFlELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE GEIWEEN "I HE SURFHCE OF THE GROUN0 OND THE 8OTTOM OF THE EXCUVHTION (IN FEET) THERE IS NO SET NIDTH FOR TRENCHES THE GRRVEL DEPTU IS THE MINIMUM |)EPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE 8OTTUM OF TH2 EXCRVRTI(-'iN (IN FEEl) 4 0: K 4 �w 1. 1 : 4: Q I&Y Q Y5 top -1 - X 1 7� -1 WISH< ����� S. GO sit ky ����17 ) 04 V �-- PERMlT HPPLICONT HHS THE RESPONSIBILITY TO INFORM THlS DEP0MIENT DURING THE lNSTHLLHTION lNOT CTIWAS UF WAY WELLS HDJHCENT TO THIS PROPERTY HND THE 11 d11M8ER OF RESIDENCES THHT [RE WVLL WILL SERVE �0 4 .3 Q 72 A �������1: gly, I s� va Tv 11 � �. !!��i P.. Y 11:,�!: It BHCKFILLING OF HNY SYSTEM WITHOUT FINAL lNSPECTION HN0 API II.. BY THIS DEPRRTMENT WILL BE SUBJECT TO PRDSECUTION I �O if� Z lot H wl 1 -V TNT K Ill T lot K Vi k > TH Q K TH ppy 17.� ��� ���� 4- , ��� � '�.�~~ '/ / I � M �� r•a I ' C" F' r� L T T' -r' �_� F H P•d �_ i t=i 1 ; �" DEFFRTPIEN'h OF HEALTH AND EFl4'IF:CINNENTAL PROTECTION B25 ,'L' STREET- ANCHORAGE.. W. 9901 26.4-4?20 6,�EEL_L I=HCdGCltJI— ITE-•�L•1�F: F•EtT:r,I I T PERMIT NO, C Gqq ATFL I CANT LOC:AT I ON �C�ii�-�c. �. LEGAL ] ( � �,2�.�L LOT SIZE A' SIDUARE FEET TYPE OF SOIL FIBSORBT I ON SY•_ TEN I S :o'er- t'1A>; I P1Ut'1 NUMBER OF BEDROCIM9 = � SCI I L RATING (SQ FT.-'E:R:? = CA6 THE REQUIRE---[) SIZE OF THE SOIL ABSORPTION SYSTEM I S : C: -EF" -Ir — L-Et-4C:l-IF H= 13t�:F=1 EL_ ClE:F•TF E_ / THE LENGTH DIMENSICIF! IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR FIT. I' THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BCITTOM bF THE Er'CA'ti+AT I ON IPJ FEET?. THERE IS NO SET WIDTH AOR TRENCHES,. THE GRAVEL DEPTH 15 THE= MINIMUM DEPTH OF GRA'v'El_ BETWEEN THE OLITFALL PIPE ANC? THE BOTTOM OF THE LXCAVATION' IN FEET?. �:�r�!u I �:�c=.�F•-t x �� Tr=�r•aa=:: _= x `�_ %� ��roL_L...�_�E•-a_. PERMIT APPLICANT HAS THE KESPONEIBILIT'r' TO INFLRM THIS. DEPARTMENT DURING THE INSTALLATION INSPEC:TION_=+ OF ANY WELLS ADJACENT TO THI_ PROPERTY AND THE NUMBER OF RESIDENCES THAT' THE WELL WILL SEr-,% E. �.-- lJe�i • �, Ira =.FES_ T I �_�Ca =• Ht•E= I<`.E �•!LI I E'EL� -- SACK.FILLING OF ANY -SYSTEM W I THOL IT FINAL I N PEC:T I ON ANC? APPRCIVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PRCISECLITION. M I t•! I MLIM DISTANCE BETWEEN A WELL FIND ANY ON-SITE SEWAGE DIPOSAL SYSTEM I 100 FEET FOR A PRIVATE WELL; CR 150 TO 200 FEET FROM A PUBLIC: WELL DEFENDING UPON THE TYPE OF PUBLIC: WELL, WELL LOG. ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN --,,Cl DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND I_ CIt'!_ TRLIC:T I ON DIAGRAMS FIRE AVAILABLE TO INSURE PROPER IrJSTALLATICIN. >r•E�E�:T°7 I T E: ;F• % F•E' •. C-sE:0Et10=:F0*: I CERTIFY THAT 1: I AM FAMILIAR WITH THE REOU I REMENTS FOR OF!-=.ITESEWER'S AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CCiDES. <: I LINDERS.TAND THAT THE CIN-_ ITE ;EWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCL!_IDE MORE THAN 8 BEDRI:11-ih1s, SIG,NE1) Applican dZ I S,L IED BY C?ATE 5 �- 1=. O' & E GEOT•E._.HNI CAL & DEVELO- AEN T CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 668-2280 Russell Oyster Earl Ellis 6942774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name: � --Tel . No Mailing Address:_c _ Legal Description: Deeth feet X011 Characteris c 0 1 z 3 - 4 a 5 6 7 �- 8 _ 9 9 ,. io,_____ �3 14 �5 16� 1w .Goo 4 e, sw L00 , e0e 4 a oseeso.. �eee!o e°�eec ae °°°e..a aeo °aa°a ua m , Earl P. Ellis .' NO. 1745-C00 •��®� eseee°N��� Ground Waxer Encountered: Yes---- No-,--- If yes® what depth---- '4®haw®SVP 'Q Proposed Installation: Seepage Pit _ DrO n Pipld__ Comments:.—, ------- Performed by:__ Onto: nr�4t)-4- Municipality of .Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 15, 1993 Sheryl L. Ellers HC 83 Box 1739 Eagle River, Alaska 99507-9503 Subject: Lot 2 Block 4 Majestic Falley Estates Subdivision Permit # SW920029, PID #050-731-29 The subject permit, issued March 13, 1992 by this office for a single family well and/or on-site wastewater system, has expired as of March 13, 1993. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $200.00 for an on-site wastewater permit; $75.00 for a well permit and $275.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, JpL,,. th P. E. Program Manager On-site Services enc: Copy of Permit cc: S & S Engineering a MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920029 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:ELLERS SHERYL L OWNER ADDRESS:HC 83 BOX 1739 EAGLE RIVER AK 99577 PARCEL ID:05073129 LEGAL DESCRIPTION: MAJESTIC VALLEY ESTATES BLK 4 LT 2 LOT SIZE: 54643 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 3/13/92 EXPIRATION DATE: 3/13/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER MUST PROVIDE REVISED PLOT PLAN THAT IS PROPERLY SCALED. THE EXISTING WELL MUST BE ABANDONED IN ACCORDANCE WITH DNR REQUIREMENTS UNLESS THE EXISTING WELL IS PLUMBED TO THE NEW WELL AND IT IS MAINTAINED IN SERVICE. RECEIVED BY: DATE: 2 - ISSUED BY: , �QhL.� f -0, m DATE:_" us- ola n Z 2-t-,5, oo ' I ses� s f1��y �' anima -JF rr I TOV? � •1 , w/G14�� or � L� � i S � �� •-i" AS -BUILT I hereby • certify that I have surveyed the following described yrcWrty. o7` Z� BfocltC �f( ,Anchorage Recording ' Precinct,aAl ska, and that the nprovements situated thereon. pre within the property luines and do •not .overlap or encroach -on the'property lying adjacent theretq at no improvements: on -prop erty IYing adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or othar visible'pasements on said property except as indicated hereon. Dated at -Eagle River, Alaska p/ this _dayof.�� 19� A4B T C. JOHNSON' E'L;I-~ SCALE: itegisteeed Land Surveyor No. 880 -LS Box 456, Eagle River, Alaska Phone 694-2543. i "'F7o—R+r c •c n .'1a'q r I ses� s f1��y �' anima -JF rr I TOV? � •1 , w/G14�� or � L� � i S � �� •-i" AS -BUILT I hereby • certify that I have surveyed the following described yrcWrty. o7` Z� BfocltC �f( ,Anchorage Recording ' Precinct,aAl ska, and that the nprovements situated thereon. pre within the property luines and do •not .overlap or encroach -on the'property lying adjacent theretq at no improvements: on -prop erty IYing adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or othar visible'pasements on said property except as indicated hereon. Dated at -Eagle River, Alaska p/ this _dayof.�� 19� A4B T C. JOHNSON' E'L;I-~ SCALE: itegisteeed Land Surveyor No. 880 -LS Box 456, Eagle River, Alaska Phone 694-2543. i CI L �S �n A w �Z 0 � w N 6 / N r o� 0 (��r� mV o`c2� ✓�� `\T 2 1 � J 56 2/w -fii(/. Z2000 /M PC2lAL LDQye DECEIVED MAR 2 5199a Municipalify of Anchorage Dept. Health & Human Services c\'• mQ °ao 3 o °ca '0ns 9 mp M rz ° 2cn -im m "o'a�" "o u 1 m r m n, w o E 3 i � .* m o O Oa. p y ... " A r ��a r o ! N / Q N 7C All fbN r mD o e u O A w H o a I^ t 1' f7 D W v v 3 n ®mD a c° w o 'n 0-0 -4 a Vv 14 M L1 :p .p "O O O � O y DI 40 a o0_-0;3� ''N N O D .r. a 7 7 _'. 0 f0 Z) ora r\ CL C o � -s n N N � ull (der#ifirdbN iin� DOC C,,. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND DI.PTH OF t\LLL _ ��,� /` /, L , ADDRESS t 14C Sl \[I( LL\ FL OF \\ \fFR FI_ LEGAL DESCRIPTION ; o r �,_14- c )R %\N DOWN FT. - --- DATE • Started Ended C_ � GALS. PER HR /5 C'i PERMIT NUMBER –=1 J GI GL) 1 KIND OF CASING Ei 4 C 0 KIND OF FORMATION: From Ft. to Ft. 77/ << From. Ft. to Ft. From_>�_Ft.to� Ft.EnJ From Ft. to Ft. FromFt. toiFt. �c•� From Ft. to Ft. From�_Ft. to i i �-i� z / C(i'?°Cf�rom -fl -T --Ft. /< Ft. to Ft. From 9 5 Ft. toFt.� -- From Ft. to Ft From s Ft. to 131 Ft. / c i i t�i•,10_t_6C4,,�,_From Ft. to Ft. From-/ 3q Ft. to171 Ft. ,5 4 644_jc.c_ _ ? From F1. to Ft. From Ft. to Ft. LG1�T�� Froin -Ft. to__Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From---.--- Ft. to Ft. From Ft. to Ft. _ From_ Ft. to Ft. From_ Ft. to t. Froin Ft. to Ft. From Ft. to Ft.— From Ft. to Ft. From Ft. to Ft. From Ft. to--Ft.---- oFt.From FromFt. to Ft. From_ Ft. to_Ft. _ From Ft. to Ft. From Ft. to_ ,!�` MISCL.INFORMATION: i 1993 �AY Munlapal ly vtuman ServIce$ & H Dept. Health DRILLER'S NAME ., -� C_.4 '� �y. �Q V 3NJ .r c Q Y to J6s Q Y M aco U i s s i i i i s i : i s i C Ni i C: rn sj i i Ci �s:t i i KS i i W O F Z i •� Cd O w G o• p i r5. O 5 i O O O C O O O O • U O O a O a oa W ce a a ee r ce • a z r+ ce i e W • j 3 j .Yi : i L cl cl iE cr •s rfj i �• K cl E c! N ti„' i i i e i C 11: �i hi ct cii •. r,; i IS OF F F tO^ F F l0 10. OF OF F E L; N; j4 C-� K —"'•• i i i i E i Z ci pa: • i C•i F. --i Ci Ci •• i < � ZCS Ia`"' � r9 C C Lu cd O w La z o w : 7._< i S: 0: � O O O O O z G O rn jn �ii W ji, O O O O O O O w k WL6 w w L6 L• w L6 w L6 iJ C = .. c 1�- z GIV, O < r % EC i C) CY) T V/ VJ titi M c") Mc ti I— mCD � W c M ♦ ^ O LL V a_ d Q O i U z LL r_ IJ � � U a) � C/) U L Z (n U) U co m 06 U) c � Q O > Cn DO WA Lf� N O N N ill co C O cu 0- x X LU 0 O O CY) N CY) ti 0 LO 0 w a) U N F- 0) 0) Y m J Y (m� Q L W I— U W w J � Q � Q U U) D W Lo co o Ln N Q � U � N `) a M J Cn J N O O 0 a) ..O 0 a) O Q Q m a) m T cn E a) U c O a) X c O Q cn c 0 O a) cn O O 0 a) A ,;I- CN O (N O V - a) M M. v O 0 O d Q. CL 0 a O 3 C E ~ ~ ca d ♦�♦ U L d O O p C N 0 C _a. rL �`+ > c_ p = o Q > Q N C o Q U Q Ep C ._. N (n o — a) cv c a) U)° O }' 3 c a) a. .N z Q E N 0 p .Q p Q Q cL N N0 E d X c i � N >% Cl) c 4Z-0 N >% -0 a) Z o 70 fn N E 'a O Q C O C LZ O o Q d O U) > 4- O QL O U IL a Q N 0 R L) N O v_) Q Q Q` ++ Z O Y a) E R O c R O 2 0 0 0 U= N uR1 U U) o rn � 07 Nt d' C? C? r -- r- 0 0 O7 O7 W o LL V A a To i U a _ LL a - � U E Cf) V � L Q � U L /an) 0s C/) ) L E Q O a) cn 00 O co U Q Q Q O Q U) E U) N cp 0 O N 4- m U U Z O 0-) N M O o Z o J Q � LU a) Z 2 LU m 0 a_ TMI N J Nt Y J Q m w w ~ W � J W Q } W w ck� J > Q U w 0- w 2 - w2 Q N LO 00 C LO o N U N U a) _0 ca 0) a) a) 0 0 n. o O 0 U a) C: 0 Q ca 0 U) w J J LU C+ a) LL aa)) W a) LL a O C/) a) CO 0 0 0 m U O O () d O N 0 _� 0) N 'O — U) N 3 a) O a) Q. ACV L) � c C L o V E _ 2! U -C N E c� U o U)G C/) El�. () N U) C -0 O a) E EO Ll Q UO) 0) d U ❑ ❑ rn N c O — Y LLC: > M a) ❑ N a U m O ❑ _0) Z m -a a) '� o ❑■ m w > O ❑■ ❑ U �. ) c. O C. m ( J ❑ ❑ O co L m � o '^ N O U) a) V J ++ s E OO El Elu) a +� o El ¢ ❑ w J d ❑ a L - n a) �, +� Q w N U CO a) d � O a�) cin n > 1� L LL LL LsQL r a.a) w w a) L a w m O I-- H cn Q Q > a) Q M m > > W m Z, a) LL aa)) W a) LL a O C/) a) CO 0 0 0 m COSA Checklist Legal Description: MAJESTIC VALLEY ESTATES B4, L2 Parcel ID: 050-731-29 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA N Well log is filed with Onsite (or attached) Date drilled 3/1992 Total depth 173 ft Cased to 173 ft Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 9-16-24 Static water level at beginning of test 134 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 48 Date of pumping 8/28/24 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 10/2/12 0 ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 3.8 ft (min) ❑ N/A —pressurized field. ❑ Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Well production at time of test 3+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes Q No 9 Coliform bacteria is Negative Nitrate 0.755 mg/L ❑ Nitrate less than MRL (ND) Arsenic Collected by Date 9-11-24 _ ug/L 0 Arsenic less than MRL (ND) PANNONE ENGINEERING C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 9/16/24 Results QPass Fluid depth prior to test 2 in Water added 450 gal New fluid depth 2 in Elapsed time 1440 min Final fluid depth 2 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 74 in Effective depth used 2 in Effective depth remaining 72 in Comments/Deficiencies: PROPERTY HAS TWO FIELDS, 2012 FIELD WAS TESTED, SYSTEM ACTIVE COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Q Yes if No _ ft Neighboring Tank > 100' g Yes if No _ It Absorption Field on Lot > 100' 0 Yes if No ft Community Sewer Manhole/Cleanout > 100' FK Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Holding Tank > 100' [j]Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No _ ft FmJ Yes if No _ ft Manure/Animal Excreta Storage �> 100' Community Sewer Main > 75' Q Yes if No _ ft Lj.I Yes if No _ ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑m Yes if No _ ft Surface Water > 100' Q Yes if No _ ft Tank to Property Line > 5' ❑i Yes if No _ ft Wells on Adjacent Lots: Field to Property Line > 10' Q Yes if No _ ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No _ ft Water Service Line > 10' '❑ Yes if No ft F. ENGINEER'S COMMENTS Community Wells > 200' 9 Yes if No _ ft If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm t�L ide AAc- sw Phone 727-8864 Engineer's Printed Name Date .'�LQ�• • 'i .' y a • %...: ... .... ' n MICHAEL N. ANDER50N v Its f, C94 9 y +� ,g4, , COSA Checklist—June 2022 MAJES T I C V A L L E Y ESTAT E S SUBD I V I S I O N BLOC K 4 IMP E R I A L D R I V E Taylor L. Dosch No. 189892 R E GISTEREDPROFESSIO N A L L A N D S U R VEYOR V U 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ��.. (Z� — i3�--a-�.t N-� vt � t' Cz.Je-� •-- I ew P �--, c>�-- "" i6`II � o� L -`C` (b) Applicant Name _t-Af� Oc-I _ Telephone: Home Business — Applicant Address 'moo \Z. (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderta; Buyer ❑ ; Other ❑ (explain); —� (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAAgoa gb" l(o�wing_a�dRdIre�ssG B 6 9 1�1� -WVtE-�' � --- 2. TYPE OF RESIDENCE Single -Family g 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 (1 ;84 ENGINEERING FIRM PROVIDIN.., INSPECTIONS, TESTS, FILE SEARCH, DA 1A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this I-fealtt- 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 & S ENGINEERING Telephone _ Address SR B 196X pato --- EAGLE RIVER, AK 99577 —�Ul —.3 __ 6. DHEP APPROVAL��� � G l Approved for , �0bedrooms by �� Date z Approved..a� 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) MUNICIPALITY OF ANCHORAGE (MOA) 4 ht,��&Pc2N HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 11(�� D�e�Ycfc�iN 1 Legal Description: L_ ` A. WELL DATA Well ClassificatisQ'` S `� If A, B, C, D.E.C. Approved (Y/N) Well Log PresentON) Date Completed L" -?-1 --1-1 Yield CsrQM'I- � Total Depth k4ta' Cased to 14b Depth of Grouting Static Water Level 7-05 Pump Set Aty t` --- Casing Height Above Ground _ Electrical Wiring in Conduitd3YN) Separation Distances from Well: H Sanitary Seal on Casing CN) Depression Around Wellhead (Y/O = To Septic/HeklIftg-Tank on Lot 103 I ; On Adjoining Lots 1't` To Nearest Edge of Absorption Field onot A 15 ; On Adjoining Lots l A - To Nearest Public Sewer Line P To Nearest Public Sewer Cleanout/Manhole F' To Nearest Sewer Service Line on Lot 25 Water Sample Collected by Date '7-2-5- S10 �.._ Water Sample Test Results SA -r v sola t•�ca ate, Comments B. SEPTI C/Id0t6fIMTANK DATA Date Installed t" I - Ti Size 1 »1� No. of Compartments Standpipesp/N) Air -tight Caps CP/N) Foundation Cleanout/ 1) Depression over Tank (YQ a Date Last Pumped Pumping/Maintenance Contract on File (Y/N) fN ; for Holding Tank High -Water Alarm (Y/N) a �" Temporary Holding Tank Permit (Y/N) — Separation Distances from SeptiofHetdhTg Tank: I To Water -Supply Well 03 To Property Line — To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) 101 t� `S A To Building Foundation To Disposal Field S( To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata a Type of System Design Date Installed Lr 1 - "7 `i Length of Field �0 1 , Width of Field o Depth of Field Si I Gravel Be.0 Thickness �J y27Standpipes Present Square Feet of Absorption Area(VN) I .Y.Sti Depression over Field (Y/dgp / Date of Last Adequacy Test Results of Last Adequacy Test — 3 Fail— Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line D To Stream/Pond/Lake/or Major Drainage Course To Property Line 11 p To Existing or Abandoned System on On Adjoining Lots3b To Cutbank (if present) A rJ L To Driveway, Parking Area, or Vehicle Storage Area z Comments Qk� ����iTrr�6V��`� D. LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test, Meets MOA I certify that) I�ayec! ai �Ked�RlN�or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed en J tfe J EtV IIV Date JUL 3 0 1986 12 1 70A Company7MOA No. RIVER, AIK 97951- Receipt No. '4 Date of Payment�3� �(�" e: e' ne$ Or Amount: $ Page 2 of 2 72-026 (11/84) ,fin`_O j 14 5. LEGAL DESCRIPTION DATE RECEIVED l� INSPECTION APPOINTMENTS TIME E C_ y e -'<- -,C6. TIME NUMBEROF,B�ED OOMS TIME ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six DATE DATE C4-� r DATE COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) INSPECTOR INSPECTOR INSPECTOR NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF ANCHORAGEF�t DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECHdKONMENTAL KOTECTION 825 L Street - Anchorage, Alaska 99501 MAY 3 '1981 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 R E C E. !_ V E D_ 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. PROPERTYOWNER �.� PHONE MAI LING ADDRE55 PROPERTY RESIDENT (If iff rent from above) PHONE 2. BUYER PHONE 7 MAILING ADDRESS J 3. LENDING INSTITUTION PHONE MAI N DDRESS 4. REALTOR/AGENT PHOIyE MAILINGADDRESS e,tJ%i?!�St` / irc.�-<-�. f!/Cd�as--i%3c�'F ,+'it� l .��_IC _ 5. LEGAL DESCRIPTION •/ -//y7 f-�.� STREET LOCAT ON E C_ y e -'<- -,C6. 6.TYPE OF RE IDENCE NUMBEROF,B�ED OOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ 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** ,72 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED j INSTALLER ❑Septic Tank or ❑Holding Tank Size: % Q(0U If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER /� �� TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS LLY APPROVED FOR —y. BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE ( r BY r 72010 (Rev. 6/79) MUNICIPALITY OF MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTMWGR67131MENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • 'JUL 16 1979 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 RECEIVED ECEIVED 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. PR PERTYOWNER PHONE ❑ One ❑ Four ❑ Other MAILING ADDRESS ❑ MULTIPLE FAMILY PROFFRTY RESIDENT (If different m above) PHONE l INDIVIDUAL* 2. BUYER PHONE since June 1975. I -or wells drilled prior to that date, give well ❑ PUBLIC UTILITY MAILING ADDRESS 3. LENDING INSTITUTION PHONE �1 INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date 'required MAI LING ADDRESS If system is over two (2) years old an adequ cy est is 4.REALTOR/A NT PHONE by this Department. MAILING ADDRESS 5. LEGAL DESCRIPTION .may- a A&r STREET LOCATION 6. TYPE 0,VRESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two CI Five ❑ MULTIPLE FAMILY Jul Three ❑ Six 7. WATER SUPPLY l INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. I -or wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM �1 INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date 'required If system is over two (2) years old an adequ cy est is ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3176) THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL — DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS , ^ LT APPROVED FOR -2 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany c ficate) 6�-DISAPPROVED DATE BY (Title) CC LEGAL DESCRIPTION 72-010 (Rev. 3/78)