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MAJESTIC VALLEY ESTATES BLK 4 LT 6
Majestic Valley Estates Block 4 Lot 6 #050-731-33 Municipality of Anchorage Page of Z 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 Permit Number: Sw 9 1.0 1 Z PID Number: Oso -731 -3-:& Name: BILI- .4r-A2Y ��1t.sH � Wastewater System: ❑ New 0 Upgrade Address: 99sr,'i 2,C I art. ABSORPTION FIELD 18 M FGP-1L. 6H1vCiAk A Phone: No. of Bedrooms: ❑ Deep Trench 5rShallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 0r8 Total Depth from original grade: GPD/Sg.Ft. Lot: Block: Subdivision: 6 L4 M VALLEY EST. Depth to pipe bottom from original grade: 111"11 r Gravel depth beneath pipe b S A.NB$T1 G Ft. • Ft. Township: Range: Section: Fill added above original grade: 1 1 Gravel length: 120 ' j - 3 -'? Ft. Ft. WELL: New ❑ Upgrade Gravel width: 5 Number Distance between E IsT/SIG Ft Ft. Classification (Private, A,B,C): Total Depth: o: Total absorption area: Pipe material: ASTM 0-9,c,-3H/ Ft. Ft. Od'0 SO. Ft. tato Driller: ate Drilled: Static Water Level: Installer: 1 Ct,n\ Date installed: Ft.I% _ Yield: Pump Sat at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES yseptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Litt Holding Public/Private Manufa turer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Weir ool 1 t I coo 'F e _ Material: Number of Compartments: Surface Water loot -i' t J o o -F —' -' LIFT STATION LotSize 4" in gallons: Manufacturer: Line J001 10 Foundation ' 36 -� 55 t.1- _. r„ .Pump on" level at: "Pump oft" at: High water alarm at: Curtainl� rro PumpMakeB _ ElectricalInspectionsperformedby: Drain OWN Remarks: ��1�,�c., ��5 1E BENCH MARK Location and Description: 1J91 t9� f� V F� C T(ciSi ASPHAvL.T AT Po1rJT ,r�r, Assumed Elevation: C.RP A 0. T, OR sAN 100.0 Ft EN ,B�AL fI Z -200 PLUa. ,SP4/7ri5n b.fE—p ,1 n at f•.1. �� 3 a `I Inspections performed bys03�gee �eNRoad, 6t7- 4tes: 1st cRr 7Loop on 2nd �- li-�� 5 ROBERT C. COWAN Eagle River, Alaska 99577 3�oA 96 9 Department of Health and Human ervices appva Dater Reviewed and approved by; 72-013 (Rev. 9/91) MOA 25 ST2 DBL Permit No. SW960124 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Lecial Description: LOT 6, BLOCK 4, MAJESTIC VALLEY EST. PID No.: 050-731-33 72-�' A (Rev. 9/91) MOA 25 CO3 C04 78.2 A'S AND 73' LATER 1. &1L'� 1 00, Cj 100 �L,� c �s A PROS. )YELL LOCATION EXISTING 1000 GAL XB� M'P1 col MT2 CO2 PD DBL2 ST2—YFO / Kr MT34 1 .3' _ S �SC INSU ,ATION B 1 Col & = 78 CO2 B 03 & C094 SAND = 75.7' WT= &M2 276. 78.11 1 t' THA C01 Mr's CD MT D `� STH \ GROUND 67.0' B.O. A B C 9.5' — 23' 36' — 45' 42' — 50' 45' — 53' 48 -MT2 — -- � T4 C0a IyR egg CC77T' 56' 63' 56' 63' — NEW TRENCHES r �sy�� ROBERT. r�P��'•yy Cls -8801':r v �A 95' 78' 71 _ — lbQp(�f 106' 92' 106' 92' 72' 70' 72-�' A (Rev. 9/91) MOA 25 CO3 C04 78.2 A'S AND 73' LATER 1. JUN -19-96 WED 15:07 VAN.BOVEN Gas 0993 P.01 SANITARY PUMPERS 20627 Upper Bowery CHUGfAK, ALASKA 99567 (907) 694-2408 CLJSTOIdLRIS ORDEL, NO. NIONE OAT L 14AME i SQA LS N ADORCSS SOLD 07— CASH G.O.D. I CHARGE 1 011 ACCT. : i DESCRIPTION PRICE ... .... .. .. ...... —A ..............o:.....:...... . TAX TGITAL All claims and returned goods Thank Vim! 2140 MUST be accompanied by this bill. PRODUCT 2631 Municipality of Anchorage T DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: -051DATE PERFORMED: LP $16��l.�ti _ LEGAL DESCRIPTION: `— DEPTH (FEET) 1 / 2 -; � V.:> � 0 3".; .S -r r,-1 C�'t" l^,'>F,-•s'f,. t? '1'�A'ri Q�-�� 1JU.'i 4- 5 5 6 7 8 9 Township, Range, Section: SLOPE 10 Depth to Water WAS GROUND WATER 0 ENCOUNTERED? — 11 IF YES, AT WHAT DEPTH? 12 Depth to Water Alter,_ 13 Monitoring? Date: 14 15 16 17 18 19 SITE PLAN S L — -- 0 P E Reading Date Gross Net Time Time Depth to Water Net Drop 0 20 -{ Il__ JI PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT G COMMENTS r"�D t C1 O 7fYL ?92=2L �(215� �F7iGZ)1 �+?%� 0 t PFLR-u1t� 14 6 I S & S ENGINEERING �� L . C PERFORMED BY: I ,. CERTIFY THAT T IS TEST WAS PERFORMED IN Eagle River Loop Road No. 204 / J) ACCORDANCE WITh-AULOSRWr$ftiAlik*iV9M GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) m6 1 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960124 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WALSH WILLIAM D & MARY E OWNER ADDRESS:26138 IMPERIAL DRIVE CHUGIAK, ALASKA 99567 PARCEL ID:05073133 LEGAL DESCRIPTION: MAJESTIC VALLEY ESTATES SLK 4 LT LOT SIZE: 67871 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/14/96 EXPIRATION DATE: 6/14/97 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 PRfOn1VISIONS: )THE SAND USED IN THE FILTER LAYER MUST BE A CLEAN COURSE SAND WITH 4% OR LESS PASSING THE #100 SIEVE AND 2% OR LESS PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED ON THE SAN RECEIVED P ISSUED BY: DATE: C // -1 / c/ c DATE:- 06/N s&S� ,ineenrnq June 5, 1996 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX(907)694-1211 HEALTHAUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 SEWER& WATER MAIN EXTENSIONS REFERENCE: Lot 6, Block 4, Majestic Valley SID Request you issue a permit to upgrade the septic system SEWER&WATER serving the existing three bedroom house on the referenced INSPECTION property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the ENGINEERING STUDIES attached site plan. AND REPORTS At the time of excavation no water was encountered and atfer seven day ground water monitoring, the monitoring tube was found to be dry. WELL INSPECTION & FLOW TEST Attached is -the proposed upgrade design. We do not anticipate any adverse effects on neighboring SITE PLANS wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. ROAD DESIGN Sincerely, SOIL TEST 9 ���,.,/ /!" ✓3L -y Robert C. Cowan, P.E. RCC/gk PERCOLATION TEST Enclosure STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 60' SITE PLAN DES] G v SCALE U7 O -' -pl. (n W W O F m Cf) AD 0 ro y? Cn m O � '- cn 0 ;' lJ LTJ io z w m m m 0 N % O 3 y� cn p h D L7 O 1y-1 b Z / rl o � / ' u' r d H � � a � •`' r UJ C � z L`�iJ LTJ U� C7J — t7) � � 6 / ow tf �.' I l 1Ol mw / w t Lj I y>� �/ o� ny�l � � � I U• oo�� zs-Ni D r mm -� C) ;U W 0 r-d� �UZ N ! I / / o2s,-IL_Sr1� vi�y o,n'^ mMc_ z V' 0 6) y / / h7 Z o' >m -ri.,- �OD-Zj �` O c7� z m SCJ y om v`�rn vx_i," m.P -ice> tz7 t'i z ["ro AZN <wm ^'to Oct �O� 1p\�L Oz �1~il W. m01 DSO 7M1H \`D(US HSC Dr�-In _ n -1- �O� r,Wz Dm (n Vl 7� AM, OOm/ am�O WO y cz A 1 oo IVELL / A n AZ o f rn m kAD7(Ig o z m O O o ow -T7 A Z O 1- N O r J ,sir �, ..✓• (� ••w• r.zv z o' 11 o 0 I'. I mA11-H '.:'d' n. 02 ri 4�iioa , • W IV.T.S. DESIGN DETAIL SCALE Dm nm m� Om 00 Ov Z F-1 :E 0 Dv 0 -CI �m z U) O D _r <r- FD rO N mD vW O r N m N cc (-o D rm JO O O ON D Z F _d m z m M rl -o r- -Dr --i C Om z D -,, Z70 �K l O O v Dm nm m� Om 00 Ov Z F-1 :E 0 Dv 0 -CI �m z U) O D _r <r- FD rO N mD vW O r N m N cc (-o D rm JO O O ON D Z F _d m z N �;Q-0 ODN Z O DSC N � Z _ m OO -C1 l v N m —+ S O m ju rel N I r� Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: T/\W DATE PERFO LEGAL DESCRIPTION: 6 � — `'l I-�'S >7 jownship, Range, Section: € SLOPE SITE PLAN (F EP w O FYt/L�I--I—�f—I- 'ys ROBERT C. COWAN f •.moi CE - 88801 1 1 a Net Drop 2 3 G 4- ZH 6- 67 I 7 N IN 8- . a 9 G t P 10- 11 r0., 12 O f,72.0. I' 13 14- 4151617 16- 16- 17 81920 18- 19- 20 COMMENTS WAS GROUND WATER _ I� ENCOUNTERED? �- S _ IF YES, AT WHAT I L O DEPTH? �I P E Depth to Water All,, Monitoring? �7 .S Dale: Reading Date Gross Time Net Depth to Time Water Net Drop D G-�PIL. ZH Z.� I N IN N t 2 n PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _ _ FT AND 2' o FT S & S ENGINEERING 17034 Eagle River Loop moo PERFORMED BY: IZKV41 2/ XJ' CERTIFY THAT THIS TEST WAS PERFORMED IN / ACCORDANCE WIEIdgIe R� w6 0AAq�:At®SE ?5AL GUIDELINES IN EFFECT" ON THIS DATE. DATE: �' 72-008 (Rev. 4/85) HEALTH AUTHORITY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL. INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN s&S� ,ineeRinq ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 6, Block 4, Majestic Valley S/D June 5, 1996 GENERAL: ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX (907) 694-1211 1. The scope of this project includes the installation of a leachfield trench to serve the three bedroom residence located on the referenced property. The existing trench is to be abandoned completely. The existing 1000 gal septic tank has been excavated and verified the integrity on 5-22-96. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. PTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 .inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 6, Block 4, Majestic Valley S/D June 5, 1996 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before grave]. (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 6, Block 4, Majestic Valley S/D June 5, 1996 5. Backfill over the .final gravel layer must not be less than twenty-four (24) inches. insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel. layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 6, Block 4, Majestic Valley SID June 5, 1996 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 6, Block 4, Majestic Valley SID June 5, 1996 S & S Engineering shall have no liability to the owner_ or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES C A`V'M' moi' TO SEPTIC ABSORPTION Address FROM TANK FIELD WELL Phone(s) Permit No. No. of Bedrooms WELL ` 1 �) } c> I� c�c> I LEGAL DESCRIPTION LOT LINE Lot Block Subdiv,sion �/I L FOUNDATION __'Z2gf I Township, Range, Section �` �� AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etc.) TANKS I I SEPTIC ❑ HOLDING 't Manufacturer Capacity in gallons G - pvo << Material No. of Compartments No. TYPE OF SYSTEM < a ❑TRENCH ❑ BED W. DRAIN ❑ OTHER IE Depth to pipe bottom from Total depth from original grade original grade 2, •) FT 6f15' FT Fill added above original grade Gravel depth beneath pipe C�' FT Z.o FT Gravel length el Gravel width 45� FT FT Ir Total absorption area Distance between lines 61 -2— SQ FT O FT -- 10 o U Number of lines Soil rating Pipe material ---- tL 2— 2'lfJ SQ FT Installer C) 1 Date Installed ._ 2 WELLS � X'PRIVATE ❑ OTHER (Identifv) i Classification (A,B,C) Total Depth Cased to It FT FT I I LA) Installer Date Installed: REMARKS: -EN SEAL Inspections Pertorr ed by: � M + p 0 Pon �1 � �1 •� : o ! Dale m q' 4 6 S Rr S ENGINEERING �' �j 1 �� r : L•S Yr�•> `{$, Y 17034 Eagle River Loop Road No. 204+ IAlar-ka 99577 certify al this inspection was perlormed according to all /` • < >^ Municipal and Stale guidelines In ellect date: ' �_ r� Net, 11 Health Department Approval: _ Date: �' » r'� ':`� +t •"'- erg' 72-013 (3/85) INSTALL PER PERMIT #880219" I CERTIFY THAT: 1" I am Iamiliar with the reqLAirements for on~site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the Siate of Alaska. 2, I will install the system in accordance with all MOA codes and regulationsr and in compliance with the design criteria of this permit. 3. I wil1 adhere to all MOA and State of Alaskrequirements [or the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or neu.Arby lot" �. I unde t i i alid [or a 01 3 bedrooms" I also u oH the total system is 3 bedrooms and any �krladditional permit. Signed: DATE: ���lmqle Issued By: DATE: MUN1ClPALI1Y OF ANCHORAGE Department oHealth & Human Services 825 L Street, Anchorage, Alaska 99501 343-4��4� ON~SITE SEWER PERMIT � ~/�� Permit Number: 890040 `�L�{r���� ���x_�o |�u.� Date Issued: 04/03/89 bngineer Designed Owner Name: CARL D]SOTELL Day Phone: Owner Address: SR BOX 9385 694-5797 EAGLE RIVER�, AK 99577 Parcel Id: 050-731�33 Lot Legal: Subdivision: MAJESTIC VALLEY Lot: 6 Block: 4 Section: 23 Township: 14N Range: 1W I acres) Max Bedrooms: This Permit: 3 Total Capacity: 3 SEPTIC TANK: Minimum ity: 1,000 gallons" Each septic tank must have at least 2 compartments. Dc.�npth to top o" septic tank(s) < 4"0 [eet requires insulation over tall k(s)" INSTALL PER PERMIT #880219" I CERTIFY THAT: 1" I am Iamiliar with the reqLAirements for on~site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the Siate of Alaska. 2, I will install the system in accordance with all MOA codes and regulationsr and in compliance with the design criteria of this permit. 3. I wil1 adhere to all MOA and State of Alaskrequirements [or the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or neu.Arby lot" �. I unde t i i alid [or a 01 3 bedrooms" I also u oH the total system is 3 bedrooms and any �krladditional permit. Signed: DATE: ���lmqle Issued By: DATE: Municipality of Anchorage 4 Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 Carl Diso-tel SR Box 9385 Eagle River, Alaska 99577 Subject: Lot 6 Block 4 Majestic Valley Estates Subdivision Permit #880219, P.I.D. #0-4"0=731-33 CSC A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1988. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the orginal as -built inspection report (three-part form) must be sent to this office for review and approval, and,for documentation. When applying for a new permit, the fees are: $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, lb� /t "/-� Daniel J. Roth Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit MUNICIPALITY OF ANCHORAGE Department o( Health & Human Services 825 L SLrecot, , Anchorage, Alaska 99501 343� , '^/'-~. UN'SlTE SEWER & SEPTIC TANK & WELL PERMIT �,rmit Number: 880219 Uate lssued: 10/06/88 Engineer Dened n�r Name: CARL DISU[EL Day Phone: �JJ',^` 1 S UOX 9385 694^5797 EAGLE RIVER, AK 99577 Lo|. |,�.!. `/��./ision: MAJEGlIC VALLEY EST, Lot: 6 Block: 4 Section: 23 Township: 14N Range: 1W L. C) Si(sq"|t. or acres> Max Aed/`onms: This Permit: 3 lvotal Capacity: 3 1\1 1'.. Minimum Lotal septic I., all capacity: 1�000 gallons. Each septic tank must have at leasL 2 compapit. ments. Depth to top o| septic tank(s) < 4.0 fec� r�`i.� �osulation over tank(s)" WELL: Log muubmiLted to Municipality o[ Anchorage Department of HealLh and Human Services within 30 days of well completion" PER ENGINEERS ATTACHED DESIGN" 1\1O7IFY DHHS PRIOR TO EAC|| lNSPECTION, llfIS PERMIT IS ISSUED FOR THE PLANNFD 3 BDRM, `�iNGLL 18MlLY RESIDENCE ONLY AND EXPIRES 12/31/88" 1, I am [amiliar with the requireNents {or cnite sewers �alld wells as set h by the Municipality o{ Anchorage (MOA) and the State oF Alaska. 2 I wili iraLall the sysLem in accordance with all MOA codes and regulations, .�ompliance with design criteria of this permit, � \ wii\ aJ|:^�' !n �ll MOA and State of� Alaska Pequirements for the s�t back distances from any existinq well� wastewater disposal s L�w s�w�,.`�e sysLem on this or any adjacent or nearby lot. 4. I understand that this permii is vaIid [or a maximum of 3 bedrooms. l also understand that the capacity o[ the total s;mtem is 3 hedrooms and any en1arqC's ment will require i additional permit" ',~�_-~_ (Owner) CARL Iss:r� By: DATE: SCALE am m vy m y .� QP4 c� 0 N 'e U) x 0 ...•tom �J" i`37fl E S,'EAL) ,�- � t o Municipality of Anchorage, DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST A. PERFORMED FOR:�DATE PERFORi��",ee LEGAL DESCRI 13- 14- 15- 16 3141516 17 18 19 20 COMMENTS Township, Range, Section: SLOPE '-E"✓S'f�1C� v "' / LTA � 1� WAS GROUND WATER / ENCOUNTERED? I i S IF YES, AT WHAT Q I I„ L ``—+ III vvv 0 DEPTH? P E Depth to Water AfvI 1) t Monitoring? �' Date: SITE Reading Date Gross Time Net Time Depth to Water Net Drop Ll �ip ;- PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND L�5— FT J Bt it b,�v•�.^.^• PERFORMEPM4 eagle River Loop Road No. 2p4— pgI6 Rfiver, Alaska 99577 ACCORDAWfTH ALL STATE AND MUNICIPAL GUID 72-008 (Rev. 4/85) CERTIFY THAT TIS TE T WAS PERFORMED IN FECT ON THIS DATE. DATE: Multiple Listing Service, Inc. © Rev. 6/85 111-e EARNEST MONEY RECEIPT AND AGREEMENT TO PURCHASE This is a legally b/nding contract. Read both page 1 and 2 carefully before signing. Date �r� 1,5" LO Phone o,67 C-041" 14� q SO Phone C)C7 (044` 6797 Listing Office�Gf eo-_.F-".TLYrn Agent _'a1A a. r)�(Ze eA224-- SellingOffice - l� ri�ev b�Pal�U rn0-� Agent :J tjMe,'E, I�. Ilii kx RECEIVEDFROM(Q�Lrf-- SS# cr-)"T- tea" e>'41-17 The sum of Qne,--rh e.SavtA e1 r eA oo%t M�- Dollars ($ DO ) in the form of check for $ 6000,00 , cash for $ , other _. nett: for $ , due no later than to be held in Trust by: as earnest money on and part payment for the real property and improvements situated in the Recording District, State of Alaska, described as: and all fixtures and equipment attached to and a part of the above-described property. DOWN PAYMENT (including earnest money shown above) ..............................$ 1 4LJe O� BUYER shall apply fora loan in the approximate amount of. ................ I ......$ — BUYER shall assume Seller's loan of approximately ....................$ _ - BUYER to execute a Deed of Trust and note in the approximate amount of ................$ payable at $ , or more, per month including % interest per annum for --years payable to TOTAL PURCHASE PRICE .......................................................$ Woo e�O COSTS: The costs designated below shall be paid as indicated by Buyer (B) or Seller (S): ITFM R S ITFM R S ITFM R S ITEM B S Bank Service Fee A JA Doc. Prep. Fee ), Assumption Fee Smoke Detectors p Commitment Fee A Recording Fee y Assump. Transfer Fee P A HOA Transfer Fees X Credit Report Owner Title Ins. X Bank Set -Up Fee AfA Well Flow Test 1A MIP/PMI IU A ALTA Title Ins. A Annual Escrow Fee A,14 VA Funding Fee p Appraisal N A Warehouse Fee A A Escrow Closing Fee / Brokerage Fee Survey Discount Points A Assessments Other Est./Replace Reserves JtJJA I Tax Registration do A Well/Sep. Inspect. Fee A Other Additional Terms and Conditions _rw &, ©F e e 0-ennL6aQd"{_ " kly w6r- 5 GtL'[r eKY�c. �G�e �cr 6242 Lot %I r r CtiA3Y `-a !>,elleJ✓ 1. CLOSING/POSSESSION. This sale shall be closed on or before joy wnhQll, a5 ,19 2_. Possession shall be given to Buyer: ❑ On closing XBefore closing under attached occupancy agreement. 2. FINANCING. Buyer agrees to apply in good faith for any necessary loan or assumption within L?L - days of Seller's acceptance and provide all information, pay all fees and satisfy all conditions required by the lending institution for processing of loan and/or assumption application. Broker has made no representations as to availability of any loans or the Interest rates. In the event Buyer fails to obtain a loan commitment, through no fault of his/her own, within A.)/A days from the date of this Agreement, the earnest money will be refunded, except for direct cost incurred in processing the application. When a commitment is obtained, A)IA additional days are allowed for closing. If purchase is not completed within specified time, earnest money shall be forfeited by Buyer. 3. BROKER INFORMATION. Buyer and Seller authorize any lender to furnish Broker and Agents with closing statements or other information upon request. Buyer and Seller authorize all lenders, escrow agents, and appraisers to furnish to the Listing and/or. Selling Agents on request anyand all information and copiesof documents concerning the status, progress and final disposition of loans, credit, appraisal, closing, conveyance and any other matter related to this sale. 14. DUE ON SALE. If any existing loan contains an acceleration or "due on sale" clause, the lender will demand full payment of the entire loan balance as a result of this transaction. 5. CLOSING DOCUMENTS. Buyer and Seller agreetosign all necessary closing documents anderformtheconditions required by the closing agent and/or any financing institution. Page 1 of 2 3 �--- Buver Seller 13 EXTEr4 JNTO CONTRACT FOR SALE AND � !3CHASE REALTOR° in reference to Contract dated September 15, 1988 between CARL A DISOTEI 1 the Buyer and WADE CHARLES the Seller, it is further AGREED as FOLLOWS: Buyer and Seller agree to extend the above refered contract to purchase and sell Lot 6 Block 4, Majestic Valley Estates. The extension is to commence September 25, 1988 and end by October 15,-1988 or before by closing sale. _ Seller agrees to grant the Buyer access to lot for the purpose of performing the necessary dirt work and clearing for a foundation dig, septic system and to drill a water well before weather rohibits eller agrees to provide clear title to DroDerty Drior to closi Title Search!:to be performed by Stewart Title as soon as possible. Seller agrees to provide resale certificate by October 05, 1988. If Seller cannot provide clear title and a resale certificate to This addendum, upon its execution by both parties, is herewith made an integral part of the aforementioned Contract. September 26, 1988 Date e�ted by uyer T Carl A. Disote]guyer Carl Disotelguyer Date executed by Seller Seller Wade Charles Seller FAR/BAR 004A -87a 11. BROKER. It is mutually agreed by all parties that the Brokers shall not be held liable in any manner whatsoever for damages arising from defaults or acts by or upon the part of either party to this agreement. Buyer acknowledges that the Broker represents only the Seller, and not the Buyer. 12. SQUARE FOOTAGE. Broker makes no representations as to the square footage of the improvements or land. If this is important to the Buyer, the Buyer must independently verify or measure the square footage. 13. CODE SAFETY COMPLIANCE. Broker makes no representations that house or other improvements meet current building code safety or other requirements. Broker shall not be liable for the cost of any work necessary for Building Code requirements. 14. ENTIRE AGREEMENT. This document and the referenced attachments if any consisting of _ pages contain the entire Agreement between the parties. It may not be modified except in writing and signed by the parties. 15. PERIOD EXTENSION. Time is the essence of this contract but either Broker may, with written notice, extend for a period not to exceed '0� days the time for the performance of any act hereunder except the time for the acceptance hereof by Seller. NAME OF SELLING OF E AGENT SIGNATURE DATE (59---t - __ %_ TIME IANe agree to purchase and pay for the above des Agreement is hereby ack owledged. I under irrevocable right fo day rom date returned. BUYE Print names to be on closi g documents: ADDRESS 6R -')$b G' dC fXI- AGENT PHONE Jo c (9`7'1' Z)r 7 properly on the terms and conditions herein stated. Receipt of a copy of this this is a legally binding contract. Said Agent is granted the exclusive and gin an acceptance of this offer failing which earnest money deposit shall be BUYER PHONE: Home Office SELLER ACCEPTANCE. INde accept the foregoing offer and agree to sell and convey the property described on the terms and conditions herein stated. I/We understand this is a legally binding contract. If the sale is not completed, I/We agree to pay for preliminary title report. Seller's Disclosure: Seller certifies that there are no known problems with: the well, if applicable; the foundation or basement walls; the roof; the septic system or sewerage system; the heating or plumbing; drainage in the yard; the fireplace; water in the crawl space; or other except as noted herein. TAX ADVICE. Seller acknowledges he/she has been advised to seek counsel of a tax attorney or Certified Public Accountant for income tax consequences of this transaction. Zp L -T S% COMMISSION. IANe agree to pay forthwith at closing to the above named Broker a commission of $ (•r0C�o for services in this transaction. In the event of a forfeiture of the deposit as above provided, the said deposit shall be paid to or retained by the real estate firm to the extent of the agreed upon commission with residue tothe Seller. I/Wo authorize said real estate firm to pay out of the cash proceeds of sale the expense of furnishing evidence of title, of recording fees, if any, as well as any encumbrances on said premises payable by me/us at/or before closing. I/We acknowledge receipt of a copy of this earnest money receipt bearing my/our signature(s) and that of the Buyer(s) named above. CLOSING AGENT. I/Weherebyappoint I,ourtrueand lawful attorney, tohave prepared onmy/our behalf all legal documents necessary to complete this transaction. DATE _ TIME „LZ. /A-2-77SELLER] " SELLER �i� 3 -��(i Print names as to be on deed: ADDRESS PHONE: Home Office DELIVERY TO BUYER OF COPY OF ACCEPTED OFFER BUYER RECEIPT: The undersigned Buyer(s) acknowledges receipt of a fully signed copy of the foregoing Agreement. DATE _ BUYER 19_ TIME .M. BUYER Page 2 of 2 EARNEST MONEY RECEIPT AND AGREEMENT TO PURCHASE 1 escribed as y s`� %�a 0-U�bs-r WT85S Regarding proporty�V 8. EARNEST MONEY—DISPOSITION. If either Buyer or Seller fails to comply with paragraph 5, above, then the other party may terminate this agreement and, as applicable: Buyer or Seller may forfeit the earnest money and/or proceed in any other legal manner. In the event that the Broker Is unable to determine to his/her satisfaction which party is responsible for failing to perform the Buyer requirementsof the contract, the Broker shall request the parties to execute an agreement for release of earnest money to one or the both Broker need not disburse earnest money until an agreement is signed. Alternatively, Broker may: (a) with otheror parties. Buyer's and Seller's consent, submit the matter to arbitration by the Conflict Resolution Center or other agreed arbitrator; or (b) eller interplead the earnest money with the courts for determination of who Is entitled to the earnest money. The Broker shall be entitled r , to an award, from the earnest money, of reasonable attorney's fees and costs for Interpleading the earnest money. 7. PROPERTY CONDITION. Buyer offers to purchase the property in its present condition, or on terms itemized and made a part of 'IXr�ICinJ this Agreement. Buyer understands that Broker is unable to independently verify the condition of any aspect of Seller's property, Buyer including well and/or sewage system. Any representations about the condition of property are based upon Seller's representa- tions and Seller's attached property information sheet. Both Seller and Buyer hold Broker harmless from representations contained in this Agreement or leading to sale. Seller In the event any improvements on the property are destroyed or materially damaged prior to closing, this contract shall, at Buyer's election, immediately become null and void and earnest money shall be returned to Buyer on demand. 8. TITLE. Seller shall convey title by statutory warranty deed, and will provide proof of marketable title at time of closing by a preliminary commitment to issuetitle insurance. Title shall be clearof encumbrances except conditions_, restrictions, reservations and rights-of-way, easements and covenants of record. 9. PRORATION. Taxes, Interest, insurance and prepaid rents and Home Owner's Association fees, if applicable, will be pro -rated as of the date of closing. Security deposits shall be transferred to Buyer. 10. ASSIGNABILITY.Seller's acceptance of this Agreement is based upon Buyer's apparent ability to qualify forthis purchase within the agreed time and according to the agreed terms. This Agreement is not assignable without the express written consent of Seller. 11. BROKER. It is mutually agreed by all parties that the Brokers shall not be held liable in any manner whatsoever for damages arising from defaults or acts by or upon the part of either party to this agreement. Buyer acknowledges that the Broker represents only the Seller, and not the Buyer. 12. SQUARE FOOTAGE. Broker makes no representations as to the square footage of the improvements or land. If this is important to the Buyer, the Buyer must independently verify or measure the square footage. 13. CODE SAFETY COMPLIANCE. Broker makes no representations that house or other improvements meet current building code safety or other requirements. Broker shall not be liable for the cost of any work necessary for Building Code requirements. 14. ENTIRE AGREEMENT. This document and the referenced attachments if any consisting of _ pages contain the entire Agreement between the parties. It may not be modified except in writing and signed by the parties. 15. PERIOD EXTENSION. Time is the essence of this contract but either Broker may, with written notice, extend for a period not to exceed '0� days the time for the performance of any act hereunder except the time for the acceptance hereof by Seller. NAME OF SELLING OF E AGENT SIGNATURE DATE (59---t - __ %_ TIME IANe agree to purchase and pay for the above des Agreement is hereby ack owledged. I under irrevocable right fo day rom date returned. BUYE Print names to be on closi g documents: ADDRESS 6R -')$b G' dC fXI- AGENT PHONE Jo c (9`7'1' Z)r 7 properly on the terms and conditions herein stated. Receipt of a copy of this this is a legally binding contract. Said Agent is granted the exclusive and gin an acceptance of this offer failing which earnest money deposit shall be BUYER PHONE: Home Office SELLER ACCEPTANCE. INde accept the foregoing offer and agree to sell and convey the property described on the terms and conditions herein stated. I/We understand this is a legally binding contract. If the sale is not completed, I/We agree to pay for preliminary title report. Seller's Disclosure: Seller certifies that there are no known problems with: the well, if applicable; the foundation or basement walls; the roof; the septic system or sewerage system; the heating or plumbing; drainage in the yard; the fireplace; water in the crawl space; or other except as noted herein. TAX ADVICE. Seller acknowledges he/she has been advised to seek counsel of a tax attorney or Certified Public Accountant for income tax consequences of this transaction. Zp L -T S% COMMISSION. IANe agree to pay forthwith at closing to the above named Broker a commission of $ (•r0C�o for services in this transaction. In the event of a forfeiture of the deposit as above provided, the said deposit shall be paid to or retained by the real estate firm to the extent of the agreed upon commission with residue tothe Seller. I/Wo authorize said real estate firm to pay out of the cash proceeds of sale the expense of furnishing evidence of title, of recording fees, if any, as well as any encumbrances on said premises payable by me/us at/or before closing. I/We acknowledge receipt of a copy of this earnest money receipt bearing my/our signature(s) and that of the Buyer(s) named above. CLOSING AGENT. I/Weherebyappoint I,ourtrueand lawful attorney, tohave prepared onmy/our behalf all legal documents necessary to complete this transaction. DATE _ TIME „LZ. /A-2-77SELLER] " SELLER �i� 3 -��(i Print names as to be on deed: ADDRESS PHONE: Home Office DELIVERY TO BUYER OF COPY OF ACCEPTED OFFER BUYER RECEIPT: The undersigned Buyer(s) acknowledges receipt of a fully signed copy of the foregoing Agreement. DATE _ BUYER 19_ TIME .M. BUYER Page 2 of 2 I t, DOC Cn. ana SULLMN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND rQ/S�' /-e �_. `i'J� �?Jc.� :: ••J ADDRESS -- DEPTH 01 \\ELL ,3' G ca ST %11( LI \ EI OF \N \1 FR I I. .-- al •_— - DOVN FT. -- --- - LEGAL DESCRIPTION DATE. -Started ------- - ___�Q �� Ended -_/ ( --_ GALS. PER HR �7 t' n I — PERMIT NUMBER --- -- KIND OF ( \SING-- ��- �- KIND OF FORMATION: From U —Ft. to. c Ft. -.L' J` " j (--`S-rFnnn.--- Ft. to.- From °"Z FLtoFt. �1u1CG'.S✓R:O,..J From-----Ft.to ----- _Ft. Ft, to ~ �`✓ 34d From_-__ Ft. /t7r/i+�liF/t-------.------� From___-�-_ Ft. to--- Ft. From�? J � !� GpA�%.- From— __Ft. .L_Ft. to_.? '' -Ft• 1- t -------.__ - u'---- s' From-�k--Ft.to l.3�Fto��Q�O�/9�� �{��.�-•_ -1.FAS From - Ft. From r34�Ft. to Ft. �i; L;�-`^� �y-/¢ Q 33c✓i� Frum --- Ft. to-- -- Ft._ From_ !D Ft. to 24>0 Ft.�1c©_�S ��3r„1'- -U 4W")Fror'- -- Ft. to-- Ft.. - aa l 4�'„•j 4✓ Frum- ---Ft. From�Pbt�_Ft. to_���.Ft. _11L=-Q.l�'-oc 6C --. C'--.__ / to_____.._.Ft. J R r -- D-61 � From � �f j- -Ft. to-- From— Ft. to- _.. From""--Ft.toJ40._Ft. 4LF41 `. K {Af'�-64(L5,4nf From---Ft.(0- - --- Ft --- � _Ft. to.-S..Ft. 11�L-�F� �r- _ !�t{3<'� From----- F'rom_- _�� _ Ft. tn_ Ft. 6 fi �ilf7 vrom _----- .—-- ft. to FL From ----Ft. to----- Ft.4��� �� 3rr—Fc.! GeC'c=✓ From. ----Ft. `aJ �--Ft. to--- �Q-- - to ----Ft. From From Ft. to 36 __Ft. +4Rrc _-L'�dcLJ ,c r� From -----Ft. to-- --FL- ----- - - ^ rG•Gf'r! From -- to ��'-.�L`•Z''#�� �.____ -Ft. to Ft. - -- - - - From--- __Ft. ------Ft. From to ---Ft.------------- - From-- Ft. to Ft. —---------_ - -- -----Ft. MVNICIPALITY OF ANCHORAGE From.. — Ft. to--Ft-.pfPT;-pFHEALTH-&-- -- - MISCL. INFORMATION: 'J@N 2 3,,989 DRILLER'S NAME 1------------- Municipality of Anchorage • 3 On-Site Water and Wastewater Program c,,' t '_ (907) 343-7904 - • cal IIS R y' S A, C T Y J CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-731-33 _ Expiration Date: ,-ZZ -17 1. GENERAL INFORMATION Complete legal description Majestic Valley Estates Block 4 Lot 6 Location (site address) 26138 Imperial Drive Current Property owner(s) Yoho Day phone 694-4994 Mailing address Same Real Estate Agent Partners Day phone 694-4994 2. TYPE OF DWELLING: r- �� 1u 6 5 7 8 '.-- i)rj ® Single Family (w/wo ADU) - - u a iti ❑ Duplex 111 Multiple Dwellings (Single Family and/or Duplex) a MAY 2 2 2017 to V6 :15 A3. NUMBER OF BEDROOMS: 3 g L 9 ��w 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: 2t------- Date: s/7-07 COSA to be released to the engineer,unless otherwi requested by the engineer. COSA Fee $ g( I.- Pv Date: Date of Payment /Q- ?-//7 Date of Payment Receipt Number a 17110 Receipt Number COSA# QbC/?'f l q 4/ Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date mak$/ 017 �`-oF 4f k,9 aA YCi �� p0G°0.... , 3C •::.-t ;''' e, ..‘-,7 0 6. DSD SIGNATURE " System #1 Approved for 3 bedrooms. g ,; If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: /4A 1 EST/c /AL-[Ey EJT LL3L L 6 Parcel ID: DS073( A. WELL DATA Well type I If A, B, or C provide PWSID# Well Log (Y/N) y Date completed /d/8 r Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth 3 ‘Q ft. Cased to /35ft. Casing height (above ground) /S in. FROM WELL LOG AT INSPECTION Date of test /c//8 ///7/ 7 Static water level / 5 ( ft. /-5? ft. 47/74- Well production i/• 3 g.p.m. '7/ 9 P.m WATER SAMPLE RESULTS: Coliform Q colonies/100 mL Nitrate /VD mg/L Arsenic /Vb ug/L Date of sample: 5/4/7 Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material S /� STFGL Date installed 5/311 i? Tank size //)00 gal. Number of Compartments , Cleanouts (Y/N) y Foundation cleanout(Y/N) 7/ Depression over tank(Y/N) /v/ High water alarm (Y/N) Date of pumping 5/i /7 Pumper ,54J!?p / icb(-1 P J C. ABSORPTION FIELD DATA Date installed 67/en- Soil rating (g.p.d./ft2 or ft2/bdrm) 0• System type enc-li Length 2 I ca /ft. Width ft. Gravel below pipe J. 5 ft. Total depth A(.5 ft. Eff. absorption area 6 00 ft2 Monitoring tube y Depression over field ,t/ Date of adequacy test ',S///// 7 Results (Pass/Fail) P For 1 bedrooms Fluid depth in absorption field before test< •- in. Water added 4-75-0 gal. New depth 3 in. 757 Elapsed Time: r47) min. Final fluid depth Z.s in. Absorption rate >= 5° g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date 71--/e-ca)2. (7 T e.- Z 7—/'e eS D. LIFT STATION N4 ' Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at_ in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot /c2 (*-- On adjacent lots /00' (e- Absorption fAbsorption field on lot /o6(k On adjacent lots / o 'er r Public sewer main /D4 `r Public sewer manhole/cleanout /60 'f' Sewer/septic service line ZS 1. Holding tank / 4o (-e- Animal fAnimal containment areas 50Y- f Manure/animal excrete storage areas /674 'f- SEPTIC/HOLDING TANK ON LOT TO: Building foundation /O rt Property line / ''.7`- Absorption field / 'It- r Water main /4 ''F Water service lire /a (f Surface water / Os T Wells on adjacent lots /&o r4- ABSORPTION FIELD ON LOT TO: Property line /D rt Building foundation_ /D rt Water main / Water Service line /O (f Surface water // )J -f" Driveway, parking/vehicle storage .J off- Curtain drain l2/UK Wells on adjacent lots /690 ("(-- F. iF. COMMENTS 1-060 r Jct- SUaaC 4-, CLL_ C)fes, o rf O Ry- /JGrp rLork S 121-1' r71c-/ \/Lyr /A/JTZ-4i r .4LL fto D12 r To 6)P/7.,_?. I euc1 f ,e 4 04 G. ENGINEER'S CERTIFICATION . 11114 ii 1 codify that I have determined through field inspections and . Q Att � .;�� t4 review of Municipal records that the above systems are in 41`.4, - •. f,. •. • ,. $e ,e''';... 7."1T, 8. -ens ;lip conformance with MOA COSA guidelines in effect on this date. ,.{ _ �4 I I) : 1) Engineer's Printed ame (� � �, `�^ 59 Date 5/f (� 7 .59 : t:'.,� i -u�'a` e�41. tr ;f fv 46'1►t;1,:;:. • COSA yellow sheet 2.6.15.doc Municipality of Anchorage Development Services Department Building Safety Division \ _ On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA # MCO ZD 5 Expiration Date: _/0 —/O — to �{ 1. GENERAL INFORMATION Complete legal description Lot 6; Block 4; Majestic Valley Estates Location (site address) 26138 Imperial Dr. Eagle River, AK 99577 Current Property owner(s) Janet Morris Day phone 339-9095 Mailing address 15611 Jensen Cir. Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: �✓ 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S s s Engineering Phone 694-2979 Address 15861 S. Birchwood Loop Chugiak, AK 99567 Engineer's Printed Name R013k2r C. Cuwif'• Date 6 /3c U %tI�"F7 !X 5. DSD SIGNATURE I� Tf i ROBERT - 880 1 G CO1 J�/cif � r . Approved for bedrooms. t G' Disapproved. lli>>i1�'�.. 41 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 7-- ' (7 (Nev 11AS) Municipality of Anchorage o Development Services Department \\\ Building Safety Division ° On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: nT YFiLLt/_ Parcel ID: OSO-731-33 A. WELL DATA )" Well type C►2W/1 iL If A, B, or C provide PWSID # = Well Log Y/) Date completed loba Sanitary seal (�tY J) 5 Wires properly protected&) 1 Eg , r „ Total depth 3� ft. Cased to 13S ft. Casing height (above ground) l$ t in. FROM WELL LOG AT INSPECTION Date of test _ /0 AS 4'? 7 D 61 Static water level�5 �2 ft. �%J ft. Well production 40 J g.p.m. 02 5 g.p.m. WATER SAMPLE RESULTS: Coliform D colonies/100 mL Nitrate AD mg/L Arsenic: ug/L date of sample: SEPTIC/HOLDING TANK DATA Tank Type/Material S EF'r(C //5MI• L-. Number of Compartments a1 Tank size /0�0 gal. Other bacteria 6_ colonies/100 mL Collected by: S4 -S C NF��Ct el�t7(b Date installed S1-3 / $ ' r Cleanouts Yl V ) yr_, ' I Foundation cleano&N) n° Depression over tank (Ye _tje> High water alarm (Y� L Date of pumping >'� a 7 Pumper 73 -rS f'v�titPrrt^4 ___ C. ABSORPTION FIELD DATA Date installed Length aKEb ft. Soil rating (p.d./ft r ft2/bdrm) Width S A System type `%amu/ - 3t gttCcJ Gravel below pipe 0. 5 ft. Total depth y. — ft. EN. absorption area kaftp Monitor�in tube *5 Date of adequacy test 19 AM Result (Pas ail) Depression over field 41) For 3 bedrooms Fluid depth in absorption field before test in. Water added%1 `f al. New depth O in. Elapsed Time:44 min. Final fluid depth D in. Absorption rate >= q5o* g.p.d. Any rejuvenation treatment (past 12 mo.) IV type) �� 0 If yes, give date D. LIFT STATION AD Date installed Size in gallons "Pump on" level at _in. "Pump off" lev t— Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank/lift station on lot M0 1 Absorption field on lot /CO 'w - Public sewer main AJM Sewer /septic service line 06 '4 Animal containment areas s r'/" High water alarm level at Meets alarm & circuit requirements? I On adjacent lots /CXR F r On adjacent lots /C0 Public sewer manhole/cleanout to it Holding tank U r Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Building foundation S rJ- Property line S r� Absorption field r � Water main A) Water service line /0 f Surface water Wells on adjacent lots 1004 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 1 Property line /0 Building foundation /d '< Water main AJ A Water Service line 10 4- Surface water /C�o '/ Driveway, parking/vehicle storage /O r Curtain drain ASC)kT KA2ar W Wells on adjacent lots —CO + F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in r , conformance with MOA COSA guidelines in effect on this date. . _.... / y>; RO E�iTC.'COVIAN ••%C Engineer's Printed Name (�'o o rL�,e r c co w�,� s,, a-;tseat' f.' A ........... 1 Date 6 �3 ° �� (Rev. 11/05) Waiver Fee $ COSA Fee $ Date of Payment 0b Date of Payment Receipt Number 005(,6b Receipt Number (Rev. 11/05) qq WIE 9�j SCS ReLN 1082905001 Client Name S & S Engineering Project Name/a L6 B4 Majestic Valley Est. Client Sample ID L6 114 Majestic Valley Est. Matrix Drinking Nater MSID 0 Sample Remarks: All Dates/Times are Alaska Standard Time Printed DatdFime 07/012008 13:42 Collected Date/Fime 06202008 13:00 Receised Date/Time 06202008 16:35 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results POL Units Mcdtod Container ID Limits Date Date Inn Metals by ICP/MS Arsenic ND 5.00 Waters Department Total Nitratc/Nitritc-N ND 0.100 Microbiology Laborato ug/L EP200.8 C (<I0) 0627/08 06/30/08 NRB mg/L SM20450ONO3-F 13 (<I0) 0627/08 1DZ Total Coliform 0 col/100mL SM209222B A (<1) 0620/08 DLC Fecal Coliform 0 col/100mL SM20922213 A (<I) 0620/08 DLC CeS, 4U (D l,:),-7 /0'-e SCS Ree# 1083068001 Client Name S & S Engineering Project Name/# L6114 Majestic Valley Est Client Sample ID L6114 MajLstic Valley Est \satriv Drinking Water PN'SID 0 Sample Remarks: All Dales/Times are Alaska Standard Time Printed Date/Time 07/012008 10:24 Collected Date/Time 06272008 13:00 Received Date/Time 06272008 15:45 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date ]nit Microbiology Laboratory Colony Count Total Coliform Fecal Coliform 0 col/IOOmL SM20922213 A (<200) 0627/08 DLC 0 col/IOOmL SM209222D A (<I) 0627/08 DLC 0 col/]OOmL SS12092220 A (<I) 0627/08 DLC MUX LT -NO CORNERS SET THIS D...E_ IEREBY CERTIFY.THAT 1 HAVE SURVEYED THE LLOwING DESCRIBED PROPERTY: rsrtfY�•nfia-1 THAT NO ENCROACHMENTS i1CATED. IT IST EXCEPT AS VER TO DETERMINE HTHE EXISTENCE OF ASIBILITY OF NY 'EMENTS, COVENANTS, OR RESTRICTIONS CH DO NOT APPEAR ON THE RECORDED SUBD1- ION PLAT. UNDER NO CIRCUMSTANCES SHOULD 'DATA HEREON BE USED FOR CONSTRUCTION °ENCE LINES, OR FOR ESTABLISHING BOUND_ LINES. --� & 'SCALE. DATE- �/std GRI p F& � 61 a� •o-�s .:ftlLwy% 1, OF A4% ... s_..e LS 46918 si� a !� ` 0*10- J!. �IP HEA OF ANCHORAGE DEPART'.'.EN" OF HEALTH &HUMAN SERVICES Division of Environmental Services dr115 On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING �, o - 73 / Parcel I.D. # ;�3 HAA # F1 1�1,• (��Ii\ 1. GENERAL INFORMATION Complete legal description Lot 6; Block 4; Majestic Valley rs-:)res Location (site address or directions) 26138 Imperial Drive Eagle River, AK Property owner Bill & Mary Walsh Day phone 696-2262 Mailing address 26138 Imperial Drive Chugiak, AK 99567 Lending agency Day phone— Mailing address Agent Eva Loken/ Vista Real Estate Day phone _ Address 16635 Centerfield Drive Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community vaoll Public water 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 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 (Rev. 1/91) Front MOA 021 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. S & S ENGINEERING Name of Firm 17o24 Engle River Loop Road Noz94 Phone C 9 u _ 7 9 Eagle River, Alaska 99577 Address Engineer's signature 6. DHHS SIGNATURE Z Approved for bedrooms. Disapproved. Conditional approval for Additional Comments M Date / , ` / `` � �N Oa., • • �r%t r.i . . . . . . . . . .�. ROBERT C. COWAN ` <•,- �_� C'yJl` CE. 8801 bedrooms, with the following stipulations: Date _� — 2/ - 9>s 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 theirlending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 421 Municipality of Anchorage �^ DEPARTMENT OF HEALTH & HUMAN SERVICE C E I V G Environmental Services Division it 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 244996 Municipality of Anchorage Health Authority Approval Checklisg)ept. Health & Human Services Legal Description: Lor 6 gLoC-1(9 MA3Frnc 4LUlf Parcel I.D.:_ oda —73► - 33 EsrA7e5 S/D A. WELL DATA Well type PAI jA-r a If A, B, or C, attach ADEC letter. ADEC water system number Log present (T/N) Date completed 10/68 Total depth 360 Cased to 135.5 Casing height (above ground) 17- , Sanitary seal (DN) _ Y Wires properly protected &N) Y FROM WELL LOG AT INSPECTION Date of test _ I C>/ g 8 >o -! o- ti G Static water level 151 1601 Well production g.p.m. 'Y. O 9 -P.M. WATER SAMPLE RESULTS: Coliform R3 Nitrate O. /oo Other bacteria !� Date of sample: 13 -O)6 Collected by: S C. ,d a Eu „J C_ B. SEPTIC/HOLDING TANK DATA Date installed 5 - 3I -B9 Tank size I Number of Compartments _Z Cleanouts (ON) "Y Foundation cleanout &N) y Depression (YAO) tQ High water alarm (Y/C Date of Pumping 6 Pumper C. ABSORPTION FIELD DATA Date installed 6 -la-g(� Soil rating (g.p.d./ftz orf?/bdrm) o.a Gro _ System type TrcedC'N Length Izo' z ® co, Width 5 Gravel thickness below pipe D -S ' _Total depth I Effective absorption area bc) o Monitoring Tube present YON) Y Depression over field (Y6) ►J Date of adequacy test._A �- Results (Pass/Fail) _ For _ bedrooms Fluid depth in absorption field before test (in.); Immediately after- gal. water added (in.): Fluid depth (ins) Minutes later: j Absorption rate = g.p.d. Peroxide treatment (past 12 months) If yes, give date _ /A 72-026 72-026 (Rev, 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level Csted E. SEPARATION DISTANCES Size i on" level at' "Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / oo' 4- On adjacent lots Absorption field on lot /0014 "Pump off" level at" 1 o014 On adjacent lots /0014 Public 001 -1 - Public sewer main rJ �A Public sewer manhole/cleanout ``I! A Sewer /septic service line Z51 F Lift station N / A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 35� Property line 100' t Absorption field Water main/service line t 0th Surface water/drainage roo'+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line to 1 Building foundation SS i Water main/service line Surface water I oc, 4- Driveway, parking/vehicle storage area Curtain drain N A Wells on adjacent lots I do!+ F. ENGINEER'S CERTIFICATION 8514 Z614 1 certify that l have determined thru field inspections and review of Municipal record atikSm: in conformance with HAA�uide ' es in effect on this date, // i Signature Engineer's Name Ir�d/3 i `(�c��7.✓ ,,».... .... ... ....5,,,. aD ROBERT C. COWAN ? Date CE-si3ol HAA Fee $ 260 e el�) Date of PaymentC /XOZC? , Receipt Number / t(lo ( l /�% 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number are zit'lL - CT&E Environmental Services Inc. La J O ia i o ry Division>.9�-.�rAsvOO�svv�v.�e-.rO,9.d!-®.3'�.�0•v9sd,.�srvsrswB.9,CP.vi 1�1Pc «lv51.s. �0 CCI170 RE -4D LtSTRL"CTIO.AS O.N'RE:•cRS'ESIDE 3EFOPE COL r CTlyG S 0!FL .K 99513_ ; _05 t/ ,. .=37j 35= =3 ,907;.. I n tr NFL:5 T 3? CONLPt p _ — PUBLIC WATER SYSTEM I.D. PP.I`ATEW.-STERSY"STEYI i � J'drtd n_Sl1u '] StnG Ir. vp;C c�ennt. vmo<r I i 1 - Stmt Resals --- / 'r - S. �t?LEDAT.:�0�U�I 3 . 1�qi4I Month Da}' Year 5A. P L E= 1 TE: 19 Routine ❑ Treated Water Repeat Sample (for routine sample ❑ Entreated Water with lab ref. no. ) Special Purpose Time Collected SA:IPLE LOCATION Collected By -Llotgy/ MASC$TIC- VAL1 10:'{5"tw\. QpI O 3E C0V?L-i cD 3Y `,00R 11. Kt Sa -0 carr oid, res_ics a .'.i... i....,1_ „etV 59,^^,le ': i3 57eC12'; aellVei! mzll. Date Receked Time Received 3 / Analysis Bean Anaklical Method: MMM ->IL G ` ` i•7ef Ji cJ!?i,lei:ifl] t;:I. Lab Ref. \o. Result' An' st ao0 J � Jar.t to A.D.c.C. nca Fbki .Jun ❑ r Fax<d '1 Client notified of unsa(is,actor. results: 17 °hoard spo:<e wish Faxed BACTERIOLOGICAL WATERANALYSIS RECORD >t?10-MUG Result: Total Coliform Membrane Filter: Direct Count Verification: LTB Fecal Coliform Confirmation BGB E. Coli Coloniesiloo ml COLIFIRM r. ICS ran b iuC..un: Final Membrane Filter Res uI Reported B.N 4 t/''�� 1 Date6 Time Cor..,.ens: _ ColCiform%100 ml hrs OH - Oru<r /(uu<riu �'\ SGS ''Member of ..? SGS Groh (SOCio.i Genzira;e Ce St.rveill C:._.-G��11A.-_v�;DA '!,� .0-q,�• _ 05/16/96 14:26 CTBE ESI ANCHORAGE � 9076941211 NO.291 D02 GT&E Environmental Services Inc. 'n LLaboratory Division RI/ Laboratory Analysis Report CT&E Ref.tf 961636.961636001 Collected Date 05/07/96 Client Sample ED L6 134 Majestic Valley 101 Matrix Drinking Water Technical Director: Stephen C. Ede PWSID 0 Released I3y•5— Sample Reni�rks: — -- Parameter Results QQ PQL Units Method Allowable Prep Analysis [nit _ Qual Limits Date Date Ni trate-Il 0.100 U 0.100 mg/L EPA 353.2 e p 05/08/96 EMB Total Coliform col/100m1 SM18 9Z228 (DW) 05/07/96 TAV 20 05 W/0 C041 U Undetected LT Less than GT - Greater than D Secondary Dilution ! - Below the calibration ra I 200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562.2343 Fax- (907) 561.5301 3180 Peger Road, Fairbanks, AK 99709.5471 — Tel. (907) 474-8656 Fax; (907) 474.9685 ENVIRONMENYAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI, NEW JERSEY, OHIO, 'NEST VIRGINIA MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services a DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # L�"=ter) ' _` \ _ _; n - HAA # 0 C\S-5 (— � I-iz�1' 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LUT G. B.Lach 4, MAJESTIC VALLEY Location (address or directions) Tmmkia2 Dki.v (b) Property owner f ARI *DTC0)T)=1 I Telephone : (home) Business Mailing Address P G Box 770210 Eagte Riveh., Alaska 99577-0210 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here INXif hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family E�X 3. WATER SUPPLY Individual WeIIXXX Number of bedrooms 3 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site qX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 Z jo Z abed rVe (981L 'nea) SM -U •ylaom s,aaaul6ue leuolssajoid ayj ul suoissiwo ao saoaaa aol alglsuodsaa jou si a6eaogouy jo AjlledlolunW ayj •panssi si ajeoi pliao a aaolaq ejep azAleue ao suoljoadsui Ion puoo jou op SHHC jo saa (oIdw3 •sjuawaainbaa ajejs pue leaapal uiejaao Alsijes of iapio ui suoijnipsul 6ulpual alayj pue sawoy jo siaseyoind of Aselinoo a se slyj saop SHO ayj 'e>MV to ajejs ayj ul paaajsl6aa aaaul6ue leuolssajoid juapuadapui ue �(q anoge g ydea6eaed ui Uan16 suoljejuasaadaa ayj uodn Aluo paseq pajeolllaao lenoaddy (jlaoyjny'41POH sanssi (SHHQ) saoinaaS uewnH pue yjleaH jo juawjaeda4 a6eaoyouy jo Alliediolunw ayj cr �ty,S:;Si,yif: n W PC)i1l19Vi.� �.! vYnp�; r.aeov .a na c,y �uolind� -; lenoaddy leuolj!puo0 jo swiej leuo!j!pu00 panoiddeslaV panoaddy ajeQ q_(q swooapaoj panoaddy r'I`d OHddV SHHO '9 f Sl.na1 � L. OIL(] LLS66 v1sglt!'aanla e16e3 ssaappy M� sou door �aKIM 81Bea � bbEOLI wal auoydalaj DN12133W"21"S d joawe N .. 2 h uoljoadsul slyj jo ajep ayj uo joalle ul suoljeln6aa pue 'seoueulpio 'sapoo ajejs pue ledlolunW lle yj!m eouelidwoo ul sl wajsAs lesodslp aaiumamm Jo/pue Alddns aajum ajls-uo ayj 'uoljoadsul pue u01je611sanul Aw woal pue sallj 96eaoyouy jo AjlledlolunN ayj woaj paulejgo uoljewaolul ayj uo paseq jeyj Ajuan aayjinj l •ulaaay pajeolpul ainjonajs jo ad�(j pue swooapaq jo aagwnu ayj aoj ajenbape pue leuoljounj 'ales Si wajs/�s lesodslp aajeMajseM ao/pue Alddns aajum aj!s-uo ayj jeyj smogs lenoaddy (jlaoyjny yjleaH slyj jo u011e611sanul Aw jeyj Ajuan l 'Molaq uMoys ajep uoljepllen ayj jo se pue ojaaay pax!lje leaslw (q paljljaao sy N0jj.VMd0dNI (INV VJ.Va'HDHV3S 3-11d'S1S31'SNO1103dSNl JNICIIA08d W81d ONI833NION3 '9 '- OQ PG�S�OC, *71� MUNICIPALITY OF ANCHORAGE (MOA) �OHealth Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 j � 343-4744 l Legal Description: A. WELL DATA Well Classification l 1'SC�1J}p"�— If A, B, C, D.E.C. Approved (Y/N) Well Log Present&N) Date Completed Ia,lVe Yield 2'p GPIA r Total Depth'2J410 C:ased to IXA Depth of Grouting Static Water Level l Pump Set At u Casing Height Above Ground Sanitary Seal on Casing43>/N) Electrical Wiring in Conduito'. U Depression Around Wellhead (Yd -4)> r4 SEPARATION DISTANCES FROM WELL: r I To Septic/Holding Tank on Lot On Adjoining Lots E� To Nearest Edge of Absorption Field on Lot V t �I -i,.- ; On Adjoining Lots l i To Nearest Public Sewer Line A To Nearest Public Sewer Cleanout/Manhole P I To Nearest Sewer Service Line on Lot 25 Water Sample Collected by � �? '� ) Date Water Sample Test Results 156!� rj° Comments B. SEPTIC/HOLDING TANK DATA Date Installed '05t Size l axe No. of Compartments Standpipeso/N) Y Air -tight Caps$9N) _ Y _ Foundation CleanoutC PN) y Depression over Tank (Yk1 [ate Last Pumped Pumping/Maintenance Contact on File (Y/N) ; for N Holding Tank High -Water Alarm (Y/N) N A Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well c>' To Building Foundation To Property Lines ''t' To Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ZZs le- -- Type of System Design 1!t� Date Installed 15 —tel — Length of Field I + Width of Field Depth of Field �i e✓ Gravel Bed Thickness Square Feet of Absortion Area \\ lo�l 2 Statndpipes Present4!ON) Depression over Field (Yd i Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well \ k ptk To Property Line To Building Foundation — Lot To Water Main/Service Line To Existing or Abandoned System on On Adjoining Lots 'fit To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course k op I+ To Driveway, Parking Area, or Vehicle Storage Area 95�bt� Comments D. LIFT STATION Date Installed Size inons "Pump On" Level a High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) '"Check Permitted Bedroom Rating Against HAA Request's "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect c a,t41% to of this inspection. �"yI Signed 8. S ONGINEIERING ti'vl: Company 17034 Eagle River LOOP Road No. 204 hag[O KIVOr , Date MOA No. �' ���Q_S Receipt No. /�1 �S Date of Payment 7 !-3 Amount: $ / 0` r>( - Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 •1. 1.a..9 $p' L1a ( A. ShaF«' c� p (�?61) `"� l J n GaP ^e•,u pub !�~S ' i� a.Y• °° CHEMICAL � GEOLOGICAL LABOIZATORIE�S Off' AI�A,SI�A, I1VC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE 19071 5622313 FEDERAL TAX ID # 920040440 LA60RATO RHES ANALYSTS REPORT BY SAMPLE for Work Oidor B IM053 Date Roport Printed: JUL 10 89 C 21:01. Client Semelo 11):L6 B4 MAJESTIC VALLEY RISID :UA Collected JUL 6 89 ,3 i4: 30 lits. Roceived JUL 7 89 C 10:30 hrs. Pr.cserved with :AS REQUIRED Analysis Completed :JUL 7 89 Laboratory Supervisor.:ST'EPHEN C. ED" Relo-ased By Special Instruct; Chovlab Ref_ 11: 6144 Lab Smpl ID: 1. Matrix: SOTL3 Client Name S G S ENGR Client Accc SNSENGI' P.O.4 NONE RECEIVED Roy 4 Ordeted By Send Repoxts to: 1)S D S ENO?, 2) Al louc,blo Parameter Rosult/Unite Method Limits NITRATE -N ND(0.10) mg/1 EPA 353.2 10 Sample SAWLE COLAEMED BY RP Remarks: L Tests Performed Sec SPOVal Instruction:: Above UA-Unav?ilablO ND- None Detected See Sample Remarks Above NA- Not Aro.lyzed Lhasa Than, R-Gicatei Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. i TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 v "'°"•°"'°' Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.# PRIVATE WATER SYSTEM Ana is shows this Water SAMPLE to be: Satisfactory Name Phone No. Unsatisfactory r 6- , %=�_ ❑ Sample too long in transit; sample should 6 not be over 30 hours old at examination Mailing Address _ to indicate reliable results. Please send new sample via special delivery mail. City State Zip Code SAMPLE DATE: f i l / 1 L4 Mo. Day Year SAMPLE TYPE: (radfRoutine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By II // 2 3 4 5 READ INSTRUCTIONS BEFORE Date Received rl- 7- 8 9 Time Received Gv 3,-) Analytical Method: Membrane Filter ' No. of colonies/100 ml. Lab Ref. No. Result' Analyst 6144 m I m m BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LT N BGB Coliform/100mi COLLECTING SAMPLE Final Membrane Filter Results Collform/10Dmi Reported By ate_".S Time: a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria PART t OF 2 REMAINDER TO FOLLOW CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. Aw TELEPHONE (907) 562.2343 5633 B Street Anchorage, Alaska 99518 v ^'•' Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUI3LIC WATER SYSTEM I.D.f► Ana is shows this Water SAMPLE to be: PRIVATE WATER SYSTEM Satisfactory Un Name Phone No. satisfactory ��.�� ;}}- ❑ Sample too long in transit; sample should 7 - not be over 30 hours old at examination Mailing Address to indicate reliable results. Please send s-77 new sample via special delivery mail. City State Zip Code SAMPLE DATE: � f �-YI LSI Wfl Mo. Day Year SAMPLE TYPE: Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE 2-2-0.? Time Collected NO. LOCATION Collected By 1T Lab Ref. No. Result* Analyst 6144 -c�p 2 m U m 3 m —_j m 4 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Date Received 2-2-0.? Time Received Go 3 e) Analytical Method: Membrane Filter * No. of colonies/100 ml. Lab Ref. No. Result* Analyst 6144 -c�p ED_ m U m II m —_j m BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filler: Direct Count Verification: LTB N BGB Collform/100ml Final Membrane Filter Results Coliform/looml Reported Byii—1 ate=�1 Time: a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria PART t OF 2 REMAINDER TO FOLLOW Vi -IT -w-t (firb'Drill Ing !-L11!J I„ DOC Co, oba SULLMN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 - TELEPHONE 688-2759 OWNER OFLAND g0g.5o 7 e .V.S rA j—, 'cj - DFI'Di 01; 1NELL -7 ADDRESS . ....... ST N I R LFVIA. 01: W:\fLR LIZ 1: 1. LEGAL DESCRIPTION - to- F(,Ya-J.-�&. --- 4 %+ Froni . . - FL 1 o-.-- DATE -Started Ended GALS. PER HR 2% PERMIT NUMBER Ft. to. ---Ft. KI'N'D OF CASIM. FronjY:L. F I. KIND OF FORMATION: Frorn U Ft. to. Ft. Froin.-- 1: 1. 1 F I. From Ft. to Ft. Front 1: 1. 1 FI. From—Ft. t o�Ft. HIM'd,1017IJ e013441 -T From Ft. to Ft. From—ql—Ft. to Ft. From- ---FI. to ---Ft From-S�Ft. (o-0-S'FI.-4"Z6W64.") From. FI. From /-fllrFt. to -7/0 Ft. 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