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OVERLOOK ESTATES BLK 2 LT 1
Overlook Estates Block 2 Lot i #068-041-07 rj,a <t1u(Y&A�a iC�l .`� ��t,,•�4�Y tasrii L3e3rylCit klaycr Ancnorage VVe;1 & "'u:r,p 6e! �jU !'G4",�U 14'2 OeveloNn'r"t Services beparttin t Duiidin_-q Safety C)ivision : n-SitE Water 4 Wastettrtc''ter Program 4700 Onlore Poad P.C. Box 196550 A,gc.hCrage, AK 395U? 'V("; �.T'gw." ansiPg :K7 343-790{ Pump Installation Log Well Ilrillin; .PCr't➢itt NU1))ber: SA' IarcelTdet;tifjCatli}rj umbe.r:_06-Oyt-07 OVWIook q'S-1u4C4 6z Ll pump Pump Thtoike Depth P -low 'Top off -well C'tsixx�:, ;y'" f. yet Pun'P �Yl.."Iufffetdrer's Name: P111 MP Model: InAr ? S� t �. 11'arap 'Size hp Ntiess Adapter Baru,. Deptft: iv feet ?:Hess Adapter Manufacturer's o%) Witless Adapter histaller: + Well D'sinfected t7pon COMPletion? "Yes L] iYo Method nf Disinfection: Comments: NIn 0 InStader Nj%jne: Date of Issue: Property Owner Name & Address Attention: the Pui:,p i::stalleF shalt prc;ti ide g n.12 , , , �---« _0g rp tae D -SD wizhin 20 days Of pump .insia?3atiaxL Municipality Anchorage•. ct of NIi. Development Services Department Building Safety Division NiMk:1� : On-Site Water and Wastewater Program, 4700 S. Bragaw St. ,/ P.O. Box 196650 Anchorage, AK 99519-6650 Page / www.cl.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 3 kncooie/PID Number: 06-Qqi -07 A of 3 N.m. aY / SLG, a e >c/- Wastewater System: ❑ New 0 Upgrade _ 3qW Li ;nd4 Vista Blvd. Opt COI Tn,n,/Ear.2 S5 7'O ABSORPTIO IE Ph°". rj.23 — 22 0 Number aBedroomsB.alms T / .-r• O Ow Trench O shallow Trwwl a Mound e,( a Other LEGAL DESCRIPTION Sul Rating. cpDFP T«« Does „�° Ft. elotll ^ la f Subdiniataei 1009k EderteS Depth bottom can angina made wamp FI Range- Fa aided Move Griped ped. /-7 FI. Ft. revel L.glhTo.mwp FI. Well: MI New ❑Upgrade Camel -. v Fl. le Number el lines Prance between law.. Ft Cie. acaedn lPmele,'}i. c). Lxt5iin, Wik/41e Total Depen. r C...d to Fi Tour 'Mom m • PPen pi:, atonal Diller Del* Sino Water Level Mover. D«. Installed FL Yield tone Set at c.rrla�l.,ti�n.. Ground GPM FI. TANK SEPARATION DISTANCES t» Septic • Holding • S.T.E.P. 0 Other: To From Septic Tank Absorption Field FFIeld Litt Station Holding Tank 'WIG/Private Line MrMaawr. a t PrnI�J'ri,e, , es C.P.at^y �} /,7W G« Well 135 ` I 55% —_ ISeeover aC •f Fphi M«.n« , l .l l L.� • N""°' a caroanm.nN _! Salop Water ��`-{- LIFT STATION La Lbw / 1I t (..11 ^9' O(/ Sae � G4 MaM•amu - Foundation 38t LHt `-17 Pumps N«« H SPS gaPN.� Mph walr«ren« In Cv1«n pain .— /vone roe toX/ Pwnp Melo Elem.pl al.p.pona wormedby. Remarks t)051-tri, 4a✓lK t045 BENCH MARK // / pAmp't y «q$he , 4 444/141/0re/% loubOn.nd o..orpuon r^ / ItOM ,1 5aii, c, ® t /F/ ail M�( Ep.wn fbinf N FL Stamp ti+zn-era„i .. ' V' tt tt.• If +••y,............... „ C7 .` t.�+�tr, % . t e ” `L • ••I :.. r. _ .•_(r,.�JG I?`; i I .e 1 ROBERT C. COWAN its, 8801 A.� fil , �� C ; .a- 7-1.13.5&6Engineer's 7-1.13.5&6 �X44V%t'ilbCi $ & S ENGINEERING / Inspections performed by: 17034 Eagta Riwr Loop Road, No.D? s: 1M �'D' QS Eagle RI.... M.A. 79577 rd tj`-/0 - °5- Development Services Department Approval and approved by: /{ /. 2 Date: J' /'0 mReviewed ln PERMIT NO SW050014 PAGE 2 OF 3 Municipalityof' Anchora DEPARTMENT OF HEAe HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Te!lephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1, BLOCK 2, OVERLOOK ESTATES P.I.D. No. 068-041-07 O• 4 A IBM SCALE: 1- - 40' Pri"_ .o { ROBERT C. COWAN i j t g1 C C° 8301 1 r 11 h�010z��'~~ PERMIT NO SW050014 PACE 3 of 3 Municipalityof' Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Te!lephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1, BLOCK 2, OVERLOOK ESTATES P.I.D. N0. 068-041-07 ST1 ST2 89.9' FINAL GRADE 2" INSULATION 85.7' NEW 1300 GALLON POLYETHYLENE SEPTIC TANK 85.4' N. T. S. I, I T % ROBERT C. COWAN ? 4 ece CE -8801 f 110.1 ,. ~.5// c/or ` •-• l 111 J�.1:: —Ld'`~~ A B ST1 54.5' 43.0' ST2 58.0' 45.5' DBL1 60.5' 47.0' DBL2 61.5' 47.5' TMT 60.5' 47.5' C01 67.0' 51 .0' 85.4' N. T. S. I, I T % ROBERT C. COWAN ? 4 ece CE -8801 f 110.1 ,. ~.5// c/or ` •-• l 111 J�.1:: —Ld'`~~ MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number. SW050014 Legal Description:fOVERLOOK ESTATES BLK 2 LT 17 Design Engineer: 0003 S & S Engineering Owner Name: KARL SCHAEFFER Owner Address: 6331 MAGNAVIEW DRIVE EAGLE RIVER , AK 99577-9720 Date Issued: Jan 26, 2005 Expiration Date: Jan 26, 2006 Parcel ID: 068-041-07 Site Address: 006331 MAGNAVIEW DR Lot Size: 46490 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued BV. Date./ /or /4, Date: Municipality of Anchorage beVelopment Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. OD p -Oil 1- CYR- Permit Number SW Property owner(s) Kia RL & -% A6EFDay phone 2Z3 - s Zt R..NFf2 • Mailing address kJ) SS Mw64.1A\n`A..i 13R . AIALY-4 Zip Code `1`1S}1 - Site address S P PAS_ Zip Code Legal description (Lot, Block & Sub'd.) Lot i. aVK- Z pvakobk, Eskakts Sib Legal description (Section, Township & Range) a\AP Li Lot Size "IYcres/Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimmirig Pool Therapy Pool [ ( Well Only O - Water Storage q ❑ Jacuzzi ❑ Water Softening Unit 0 0 0 certify that the above Information is correct. I further certify that this application Is being made for a Single Familx Dwelling and Is in accordance with applicable Municipal Codes. S& S ENGINEERING — ` 17034 Eagle River Loop Road, No.204 vv // nick River. Alaska 99577 (Signature of property owner or authorized agent) Permit/Rush Fees: S y 6 0. °.3 Waiver Fees: Date of Payment: 1 / a '1 / 0 S Date of Payment: Receipt Number: 0 CP % s -r dReceipt Number: (Rev. 09/04) �'+M /FILTH PufHOCITY APPROVALS SEWERS WATER SAW EXTEPGIONS SEWER S WATER ASPECTION &S Glneezinq ENGINERugSTIOFS AND REPORTS WEU INSPECTION S RDW TEST SITE PIANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. CML ENGINEERS (907) 6942979 FAX (907) 6941211 January 21, 2005 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 1, Block 2, Overlook Estates Subdivision It is requested that you issue a permit to upgrade a septic system with a replacement septic tank only to serve the existing four bedroom dwelling on the referenced property. Attached is the proposed site plan and documentation required to execute this project. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Z Robert C. Cowan, P.E. RCC/jhm Enclosure 17504 NORTH EAGLE RNER LOOP • SUITE 204 • EAGLE RNER ALASKA99577 k2 PLAN DESIGN 1" = 40' t7. ■ Zab 0 411. frgE kb NI - ID \ - ;@| K ) q £ \ 0 0 0 � 0 k \ § § 2 § 2 _ r • 2i. CC Ae, C N V gineening lox RENIN AUTICR1Y APPROVALS SEWER S WATER WN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION I FLOM TEST SITE PIANS TOAD DESIGN SOI TEST PERCOLATION TEST STR CTUR1AL1 IECNAMCAL INSPECTORS S ON SHE WASTEWATER DEPOSAL SYSTEM DESIGN ROBERT C. COWAN. P.E. ON-SITE WASTEWATER DISPOSAL CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CML ENGINEERS SYSTEM FAX (90 )sa44--1211 REFERENCE: Lot 1, Block 2, Overlook Estates Subdivision January 21, 2005 GENERAL: 1. The scope of this project includes the upgrade of the existing system, with replacement of the 1250 gallon septic tank with a 1300 gallon HDPE septic tank to serve the existing four bedroom residence located on the referenced property. 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. SEPTIC 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. 17034 NORTH EAGLE FINER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 Page 2 Lot 1, Block 2, Overtook Estates 310 January 21, 2005 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 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. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal 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, Femco, 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. Page 3 Lot 1, Block 2, Overlook Estates SID January 21, 2005 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with Tess 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, which ever requirement applies. 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 owners 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. 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 -2..1 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 Cr, (At 6ct, Ie>/ PHONE 37(, --$-UG J [NEW ❑UPGRADE MAILING ADDRESS 'IO . eoX g 70-24-G./ //Vqs //G , - 9i6S-7 7 LEGAL DESCRIPTION L t- 1 ,rs/v a D vefeLoa 5sTA77,-r T iv w le / w Se e a S LOCATION h 51e ,fr vfii L' //ej NO. NO. OF BEDROOMS 4" U 1 wQ (A 1_ DISTANCE TO: Well ).25 / %ice/:_v:e L Absorption area /4 ' Dwelling/ `moo PERMIT NO. S.5`0ay/ Manufacturer G" CCr r A/8-4--- Material Sfee- / No. of `D._ compartments a Liq. capacity in gallons / 02 SU IF HOMEMADE: Inside length _ Width Liquid depth.. a Z FManufacturer DISTANCE TO: Well Dwelling PERMIT NO. Material Liquid capacity in gallons TILE DRAINI=IELD TRENCH DISTANCE TO: Well Mgr 135--/ /yrrt • Foundation / D Nearest lot line ._ /7i PERMIT NO.G O S U a4-/ l No. of lines / Length of each linecCo r yTotal length of linesU ,, Trench width Distance between lines /VA Top of tile to finish grade L/ Material beneath tileTotal 7 inch - effective absorption area $ 6o p W C7 toType a y Length Width Depth PERMIT NO. of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well - Building foundation Nearest lot line J J W Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption weals) OTHER PIPE MATERIALS ApprevcI et/C., SOIL TEST RATING I a. 5 9'/ad„-, INSTALLER L��" �.I S Ci)CtGl2%�Ct_) G. W, ,6'4/ Vey i c -n. `K 0,eI1 REMARKS �/ /� e r +-� ; /L L p, y4 e. -Err[ � L/ .e-eer/rflu/h-, 1-/tr.e... `b� by4,44' l-,,,-2-.„/ fr; c 14r�4 4'ZEC « a T r �a� /a s -o Gk //co 1-4d, ki 9 /`.0 !1 27 `bkAI \..rayr� IY la f�. \ APPROVED DATE LEGAL Lo/`/ 6/0 4-- a av,e=,e‘.OC, N els . 72-013 (Rev. 3/78) PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: T q:1!: -1'1( DEPARTMENT OF HtiALTHAND• ENVIRONMENTAL PROTECTION R25 L STREET.. ANCHORAGE, AK 99501 264-4720 f 1 ~ I .. icr..WEE � I -F 850241 05/�0/85 CONTACT PHONE: LEGAL DESCRIP: LOT SIZE� MAX S-DROOMS: G.W.• BAILEY P.O, BOX 8/0/44 WASILLA, AK 99687 376-5067 SUBDIVISION: OVERLOOK EST. • SECTION: 25 • TOWNSHIP: 14N 47500 (SQ.FT. OR ACRESl Listed below are the options avaj system. Choose the option that - - - - - " DEPTH TO PIPE BOTTOM (FT.) GRAVEL DEPTH (FT.) TOTAL DEPTH (FT.) GRAV�L WIDTH (FT.) GRAVE! LFN8TH GRAVE| VOLUME (CU.YDS,) TANK SIZE (GALS) SOIL RATING (SQ,FT,/BR) LO 1. RANGE: to you in�es IDs your site. - 4,0 7,0 • 11.0 2.5 27,0` 18,8 1„000,0 ** 125 ** TANK MUST HAVE AT LEAST TM�~COWARTMENTS 4,0 0.5 4,5 1/.0 34.0 21.5 1,000"0 ** • 125 '1,000.0 ** 125 I certify that: 1. I am familiar with the requirements for un -sit sewers and wells as set forth by the Municipality'of Anchorage (MOA) and the Sta.te of Alaska. 2, I will install the system in accorda�co with all MOA ,And rryulaiions and in compliance with the design criteria of this permit. ` 3. I will adhere tb all MOA and State QC Alaska requirements for the set back distances from any existing well, wastewater. dispbsal system or' public on this or any adjacent or nearby lot sewerage system. 4. Iunderstand that this permit is valid for a maximum of 3 bedrvcm,-, any enla�gement will require an a^[ditium,Al p�rmit, IF A LIFT STA:lON IS INST4! LED IN AN Ry MCA 2UILnP..,!G COD=, THEN (1) AN.ELECTRICA! PERMIT AND INSPECTION MUST BE OBTA7NFD uS..... 9UILTE WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPFrr7nN Pr:pORT: AMD ELECTRICAL WORK MUST BE DONE nY - | IEENSED ELERICIAN. ~^ ^ SIGNED APP|ICANT: S.W. ISSUED BY • DATE: PERFORMED FOR: -- LEGAL DESCRIPTION: 2- 3- 4- 5- 7 8- 9- 10- 11 - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST In //ey aSG e -/-1‘w 2,0 / LS'Jccy .1 c Ue-L. SLOPE tRG-ANePS7it_ 5v-Aie 4 th-F.-ed' (C- e -6- ) 13- 15 16- 17- 18- 19- 20 - obo Oo00 Louis A. Bubas . oray..agx•, ••,,> �pBOF1l!ESSi-'`;. a DATE PERFORMED: WAS GROUND WATER in o S ENCOUNTERED? , V L 0 P E IF YES, AT WHAT DEPTH? SOILS LOG ❑ PERCOLATION TEST ,SV? die S•- tS /1-4 %J 7 /HIV ae / Lt.; Sec- S' SITE PLAN Pro? In T H. 77 %'O Reading Date Gross Time Net Time Depth to Water Net Drop reffee-bor-T-:8N RATE � (minutes/inch) d� L TEST RUN BETWEEN FT AND COMMENTS I/`ecc e>>r„e„�J 77e�.ei. S>.,r-5:->, /J4Gf'l•iu-e FT PERFORMED BY: 72-008 (6/79) CERTIFIED BY: 4 , DATE: J4-4$7,//frT LOCATION OF WELL `Ia,l Borough Anch Ic. I DISTANCE (Please complete :either la, Ib ar Ic.) Subdivision Overlook Lot Block; 2 'WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys °rifling Permit No. A.D.L. No. Ib. 1/.girt. S.ellon No. .—of.—.of —of AND DIRECTION FROM ROAD I11 'TERSECTIONS Slreot Add,.es and Area of Welt Loaatt n Township NO Range ED s ;.... W❑ Meridian., , S. OWNER OF WELL.: Mr. Karl Schaeffer adds.:e: Anchorage, Ak. 263-4328 2. WELL LOG Material Type Feel Belo Surface Top Bottom 4. WELL 22 (final) 5 5. PATE OF CQMpLET1As Harrl pan Boulder small boulders 52 0 21 51 20 51 52 95 Gravel_And wRter Shale Fracture 95 97 120 97 120 130 6.. 0 Cable fool ❑ Auger 7. USE: iomeNia O Irrigation D Test Well 1:5tXolary Driven 0 Dug Jetted O Bored ❑ Other: Public Supply ❑ Industry O Recharge 0 Commerical ❑ other: Skala 130 225 (, UN1GPA ITY Of ^NCHORAOE DE T. Of SEWN & ENVIRO1,IMEP)TAL DROTECTIOM 8 CASING: ® Threaded ., .. Welded diem. 6 In. to 97 ft. Depth Weight 11_ lb./ ft. diem. In. 10 • ft. Depth Stickup ft. 9. FINISH OF WELL: Type: Diameter Slot/Mesh Slze: Length: Set between fl. and ft. Boakfllling ()retire! peck 10. STATIC WATER LEVEL: 60 ft 6 0 Above or Below land surface Equipment used: 719 ii. Dal. UG22,19B RECEIVED II . PUMPING LEVEL bolaw land surface and YIELD ft. after hrs. pumping g.p.m. ft. alter hr.. pumping g.p.m. 12.GROUTINO Well Grouted: 0 Yes 0 No Material: O Neat Cement n Other: 13. PUMP: (If available) HP Length of Drop Pip. ft. Capacity g.p.m. Subm. ® Jet ® Centriflcal ❑ Other 16. WATER WELL CONTRACTORS CERTIFICATION: 14. REMARKS: Production of 1 GPM 15. Wator Temperature 0 This well was drilled under my )urlsdiet on and this report le True to tho best of my knowledge and belief; Magnuson Drilling AA 5385 Registered t evil ered Business Noma Address: P.O. Box 770501 EagleRiver, Ak. r i signed orm 02- WWR (11/81) Cop Distribution: WHITE -State 0665, PINK -Driller, CANARY -Customer Co^r§sS). pante Number Author! ed Repre.entatly. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 068-041-07 HAA# OSoo413 Expiration Date: 8- /a- --©.S 1. GENERAL INFORMATION Complete legal description Lot 1; Block 2; Overlook Estates Location (site address or directions) 6331 Magnaviev Dr., Eagle River Current Property owner(s) Karl Srhneffer Day phone 223-8260 3980 W. Linda Vista Blvd. Apt. 11201, Tucson, AZ 85742 Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date SV/A0/05- ALL /A0/or !i('L Co.veft T....S O,c h{AA Re•p,tov:A HAVE y3E4t. Fvs.t F.LLKv (SGnTic Ftmelt_APPit.ovnc /J R.r ami fr¢O, 5. DSD SIGNATURE l/ Approved for 14" bedrooms. Disapproved. Conditional approval for o,v 1,4 '61,-2:t ROBERT C COWAN j� j 11f� CE -8801 ri\ i te•`` bedrooms, with the following stipulations: Additional Comments ON -SR - WATER AND m" WAbTEWATER • PROGRA4,4 • = • s •. • ••p•( Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory By:S,a A (Rev 01/02) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 3 /2 - 0.5- Legal Description: A. WELL DATA Well typerat `�tW1Th Date completed 02,0 Total depth "S I ft. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST 1 -CT 1; Berg. 2 ; n tryljcoolc ESTATESParcel lb: 01:525-13L1(-0 If A, B. or C provide PWSID # — Well LogOIN) Y"65 Sanitary seal CN) .jL j Wires properlyprotecterer/N) 'S65 Cased to 99 111. Casing height (above ground) 124 in. AT INSPECTION FROM WELL LOG Date of test &/2o /65 Static water level r ft. Well production 4a g.p.m. WATER SAMPLE RESULTS: (Ilrr/or ) Coliform 0 colonies/100 ml. Nitrate 0. 113 mg /I. " Arsenic: mg./I. Date of sample: 5/4/05 B. SEPTIC/HOLDING TANK DATA Tank Type/Material S"EPTtc. /14 -tire Tank size MO gal. Number of Compartments 2 Foundation cleanout t) 45 Depression over tank crop Date of pumping Pt(L) 1-1 44014, Pumper C. ABSORPTION FIELD DATA Date installed l fcS Soil rating (g.p.d./ft2 0 /bdr Length ' ft. Width 3 1 Total depth 111 ft. Eff. absorption area 474 ft' 1 /x/06 Fluid depth in absorption field before test f 2" n`Itt>" rr Elapsed Time: t . min. Final fluid depth 2 in. Date of adequacy test Results r 1110 r ft 200 g. m. Other bacteria 0 colonies/100 mi. Collected by: $4 S E/041 /oFfefZ.1 A-76 Date installed 5'/1, /05 Cleanouts69N) .Y65 Ax) High water alarm (Y6) $© N t9 System type Me-A--le-4/ Gravel below pipe % / ft. Monitoring tube 'S Depression over field AJC) r ail) PASS For 114 bedrooms Water added-03gal. New depth 31Snin. Absorption rate >= IetC i' g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Ntct 10.3).#2X&A) If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on' level at _ in. 'P at _ in. Datum . Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ICc71 t Absorption field on lot ICO 'I Public sewer main IJ a Sewer /septic service line as I+ e/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots /OO' 4 - in. I On adjacent lots /00 4 Public sewer manhole/cleanout N Holding tank IJW SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 614- Property lineSI+- Water main h'W 1 Water service line 10 '� 1 Wells on adjacent lots I00 "I" SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line Ib 14 Surface water 106 1+ Curtain drain PM* f to -TVA) Wells on adjacent lots I tt)14. F. COMMENTS n '4600 GAt LOPS or Gc�k1'�— (eh G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. l� Engineer's Printed Name 4)a b 4 Building foundation IDI 4- €.t C CODA,' Date Cl/V/ Cl Absorptionfield 5' 14-- Surface water 1t:0 14 Water main N Driveway, parking/vehicle storage 2t RosaYC. COWAN in - 1);,:, j% CE -8601 r.^ �/ 1 14 t`•.^ .1 HAA Fee $ ij30,'°t- I/.i.o0 Date of Payment a/s ler 4 .)-/ s. A'r Receipt Number 06305 de 063S-0 (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number N. .�\ SorR.d,✓7 't tt.. era rY •1- TVP.•gt YW•i 1 (C^ .•-•Q h er 4 _� 6 . ir \ <, `)t# 4 5.1i` t r ��. \ SEa. t /C. 360, oo 4 n0• Kt44Ise/ flit :..e r -4 -Or -7 ,C AS -BUILT N 1 hereby certify that 1 have surveyed the following described property• �—C7 I f/cc-# Z Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this %2t1 day ofi.r, 19 e r ROKERT C. JOHNSON vec SCALE: Registered Land Surveyor No. '80 -LS 1" -2" Cj C Box 77-0456, Eagle River, Alaska 99577 Phone (907) 6942543 rt060Get C.Cp4d4_. Municipality of Anchorage Development Services Department • Building Safety Division On -Site Water and Wastewater Program • 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. [7 Cog—Oil—o7 1. GENERAL INFORMATION Complete legal description )-0 7 / 13 L0 c. K al 0•421-00K 12 S r4- re s Location (site address or directions) 3 3 / Plea N4 v r 4 W D?, £4c-(. t Rl vibe Current Property owner(s)KARL S CNAEFFeR Day phone 0-7,3-51&o RLve., fin llae f, y-ocso.✓ 42 HAA# 050(X13 Expiration Date: S'- / O — O Mailing address 1rS'7Y Z Lending agency Day phone Mailing address 3' SO v. La/unit visr4 Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by /93D for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: • Individual Well Individual Water Storage Community Class Well Public Water System JEJ 1 Li TYPE OF WASTEWATER DISPOSAL: Individual On-site $( Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or 8 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S &S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone 6 R y - a-9 79 Eagle River, Alaska 99577 Address Engineer's Printed Name RC 0 8 kit7-C . Caw4,✓ Date a /7 AGS CCNOIrlOgyAL /HFA laol-Willtr¢O D'-' To LI£AK1tiG. ts9P,1,li ,o ''.L OF !�G� pit Sit.orr c 7-4s x (vw4i4 ostout-4). TN (4 . / t NO 4t nt*(•VT FKt ... . y>94 H14* -1N W4 XAAA, No o�t0 v‘.,...1rL c.c....ac.e A✓4 rO ��,�;:11:,191- a..,•'`;••11 AovgRfd 1£�Fgcr /bY TNd C.RAn.r1r4 0� 7H1S ✓ `PG p....... . �.. " 6 cuworr,or4i APPQuvgL. RtPcAc4,.1d .7 S,t.or,t r MINK TC Rt !N5TALI-(Q /,3',I Tv, -4 / r, Ain r. I).'% ROCERTC COWAN %c- 6. DSD SIGNATURE ' `t' C: •8301 r`.v . 4 Approved for bedrooms. h "".... .*‘111.:1r,"::7,7-:11%%':-.9". Disapproved. 'c` -:...-- By X Conditional approval for it : bedrooms, with the following stipulations: 1.5 times the high hid frnm 2 Terrified ingtau era shall be placed in escrow. Work to be performed pursuant to permit No. 050014. Money in escrow shall not be•'••ln--- released until this office has given final approval. The work shall be completed nn Inter than 6/Isms_ Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory • X Maintenance Agreements Supplemental Engineer's Report Other (8...01102) Original Certificate Date: 2- — /0 ' �� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo , / 8 Li( al o Witte o re ($ 7474.] Parcel ID: 06 5' -° Y/ -a 7 A. WELL DATA Well type it r v+rt If A, B, or C provide PWSID # = WeII Logi:9N) V ( I Date completed (/)a /Y- Sanitary seal()/N) YE J Wires properly protected/N) • Ye£ -5 Total depth; ar ft. Cased tog 7 ft. Casing height (above ground) 1a_+ in. FROM WELL LOG AT INSPECTION Date of test C /T o / 71.5- /Rd /c r - //.2, /v,r Static water level G 0 ft. / q 0 ft. Well production /.0 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0. 113 mg./l. Other bacteria 0 colonies/100 ml. Arsenic: — mg./I. Date of sample: //l/3 , «�//e osr 4 Collected by: S & S ENGINEERING 57034 Eagla Rlwr Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Tank Type/Material S 4,P r r c� S T IL 2 L Date installed 6/$' S` Tank size I a r0 gal. Number of Compartments a Cleanouts 61N)yE S Foundation cleanout (3/N) Ye SS Depression over tank (Y0 N 0 High water alarm (Y6) 4v 0 Date of pumping 'u - Pumper C. ABSORPTION FIELD DATA Date installed G I'n Soil rating (g.p.d./ft2 o/ft2/berm) la- S System type t'2 itt- c -N c- A 4 Length 0 ft. Width '3 ft. Gravel below pipe % ft. Total depth 1( ft. Eff. absorption area rco ft2 Monitoring tubeYE—SS Depression over field Al D Date of adequacy test 1 /a o / OS- Results sail) PA 4 5 Fluid depth in absorption field before test l I I� J in.s."4 { Water added Srial. 1 ., Elapsed Time: G a min. Final fluid depth 1 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) "°""r K N O 4.41 For 3 bedrooms New depth 3 fin. Li ro g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons Manhole 'Pump on' level at _ in. 'Pum! • . _ _ in High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot / 0 0 14- On adjacent lots On adjacent lots / 0 0 -t Public sewer manhole/cleanout N/4 Sewer /septic service line iiS 14- Holding tank I>1 1A Absorption field on lot / a 04 -- Public sewer main N /A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S #* Property line S t Absorption field A ' ( r o 'Pt A to-.fcif o) Water main N i AWater service line 1 0 I{ Surface water / 00 Co-- Wells on adjacent lots 1 0 01 "/' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / 0 'f' Building foundation /0 'f• Water main 1V /t Water Service line / 0 14 Surface water / 0 0 t'1` Driveway, parking/vehicle storage Curtain drain Mb"( Knrcw,✓ Welts on adjacent lots / 00 f F. COMMENTS 4c-7be FA,rroNS olc t,"4-7-4 et Sra4A-41E• G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name RD /SitA r C • CO Date a- /-7 /O 5— -14- aG S2f i i c T4NK Lt41<S - Con, 4. HAA Fee $ +f 3 O o ,/.:I &5 (,"41 4</a r Fee $ `l a/g/o r ,f Date of Payment Receipt Number (Rev. 12/01) 0 6 3 r Date of Payment Receipt Number 02-04-05 11:12AM FROM-CTSE ESI, SCS ENV SERVICES 9075615301 T-901 P.01/01 F-329 SOS/CTd&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ IKSTRUCTIONa ON REVERIE Sala BEFORE COLLSCTINO SAMPLE MUST BE COMPLETED NY WATER SUPPLIER Q PUBLIC WATER SYSTEM IPS AVICATI WATER SYSTEM 0 a.na Raub ❑ WE MKS. boast t Yob* mallee av ca. SAMPLE COLLECTION: 0 Sana Maas 200 W. POTTER DRIVE ANCHORAGE. ALASKA 99Ste Tet 907-562-2343 Fax: 907-561-5301 W MN.. 1050531' iA *IIIIIIMII1�II'll11 . II i3 sena Amb. "Sr beim NIMIIC11111,1•11, MTN haul Willa Fm.. waft Mier Leese. _ SAMPLE TYPE: r. a earn. r wars NIS%7 `L� p Os* (/7i� (lJ201-. kr.a, t yQ�r C')l'L! Y1! Ther. I {: 1 S 7 VIM' PM onnwI — Lector: Lie T .- Tnnsprre mtab Pr: I7 Routine ' Ro "peat Sample (refer to tab no Coltman Special Purpose TO BE COMPLETED BY LABORATORY Semple Recelvinot Date: [ •211.65 Tine: / 2244 Temp Delivery Method: C. Received By: JZS- Pmw Nan. Comments: D Scums ova it hen. tat R.wals may b ulreaWN ❑ H Maur Wyss Me tLOeNa ❑ Tmted Water ❑ Untreated Water 0 RUSH SAMPLE Peon it Fax It pacteriolonkel Water Analysts Retort MMO4410 WN RpfLTS: Analysts Bogor (/% 114D Toile Callum Analyst eT2 E Cat Analytical Meth W: MEMBRANE FILTER RESULTS: Dual Count �• C onkM100m1 M Membrane Filter vnBa.am: MMO•MUG (PIA) TOM Dews {LTD: BOB ® Sa istattory /aa.eer { EC• 0 Unsatisfactory IS.nt M ADEC: ANC NIX JUN J WOE Cent Phoned [] - Faxed D Downms- Spoke wilt Reported By: Ioru.ei. ll,.16 DatelTime: 'if Z`04 /BBD .- . -....� a........w.r....••n.e C...... 111,17411 vis 0 Tait • Ta@ne,er*Cage a.oew,Nada Forme FW 0053 12l17A9 01-20-05 02:23PM FROM-CTUE ESI, SGS ENV SERVICES SGS SCS Refit Client Name Project Name/p Client Sample ID Matrix Sample Remarks: 1050311001 S & S Engineering Overlook Estates Lot 1, Bk 2 Overlook Estates Lot 1, Bk 2 Drinking Water 9075615301 7-654 P.02/06 F-099 Alt Dates/Times are Alaska Standard Time Printed Date/time Collected Date/Time Received Date/Time Technical Director Released B 01/20/2005 13:19 01/172005 14:00 01/172005 14:00 Stephen C. Ede Parameter Resew PQL Waters Department Nitrate•N Microbiology Laboratory Allowable Prep Anatysis Unin Method Containa ID Limits Date pow Init 0.113 0.100 mg/I. EPA 300.0 R E vinatat a Total Coliform -t99B; No Coli 13 (<-10) 01/18/05 XM coV100mL SM209222B A (<-1) 01/17/05 DPT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ONSITE SEWER ANO WATER FACILITY 264-4720 Application Date c9—/6' —ga GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, sedtion, township, range) L.--c=-r- . 2- c k, Location (address or directions) L/� t c ✓ht YG:� • (b) Applicant Name lN44-17L =rte Telephone: Home te'Cfe ` -7-Gt r " Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer 0 ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) (ttheHAA to the following address: BREI "acev n6 n- „v1LL' RIVER, ALASKA vert PH. r, -1179 2. TYPE OF RESIDENCE Single -Family% Multi -Family 0 Other Number of Bedrooms 4 3. WATER SUPPLY Individual Well kg Community 0 Public 0 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 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11184) Page 1 of 2 5. ENGINEERING FIRM PROVIDIN(:� ,JSPECTIONS, TESTS, FILE SEARCH, DAt_.-AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation • As Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and ad& for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtai�q from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply andior 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 v L" i Telephone E. R'VEI-1; 'tLi„;C= 35 Address P:+ : 2 9 Date - S. DHEP APPROVAL Approved for tf bedrooms by Approved Disapproved Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-(.2; x,11 -G4) ovPGE A. WELLA Well Classification .-/' MUNICIPALITY OF ANCHORAGE (MO)` HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description- )� sr� If A, B, C, D.E.C. Approved (Y/N) '"t/a Well Log Present ON) Date Completed °-/ -acs- Total Depth 2 -7 -5 - Static Static Water Level Cased to (oo Depth of Grouting Pump Set At tJ /�- Yield Casing Height Above Ground 34, " Sanitary Seal on Casing CVN) Electrical Wiring in ConduitO/N) Depression Around Wellhead (Y Separation Distances from Well: To Septic/Neldi rg Tank on Lot /Z J ; On Adjoining Lots / 36 ; On Adjoining Lots 145'0 14- /-cv'd' To Nearest Edge of Absorption Field on Lot /x r -s To Nearest Public Sewer Line Cleanout/Manhole µ/Q Water Sample Collected by Water Sample Test Results Comments T S To Nearest Public Sewer To Nearest Sewer Service Line on Lot 5 #. ,/,-16/,..7664---/,-, 4 ; Date Z6" 8 1 -f -151/45-- AJ A SOD 6'44. HDLI.-/rvG -77.4"-I14. (.c% 7741 ,u B. SEPTIC/WILDWG TANK DATA Date Installed 1 -0/92,C - Standpipes %N) Size 1 2- No. of Compartments Air -tight CapsON) Foundation CleanoutorPhl) t.--' Depression over Tank (Y/ / Date Last Pumped t- Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Hold riy Tank: L c7 I To Water -Supply Well To Property Line To Water Main/Service Line Course Comments ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ice_ t c> To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I7 --S 1P -A-' Type of System Design TI ��- Date Installed ' O, c1 Length of Field 1. Width of FieldDepth of Field I N Gravel Bed Thickness' Square Feet of Absorption Area St2c-° Standpipes Present 'N) Depression over Field (YL99) Date of Last Adequacy Test 1.--- .J Results of Last Adequacy Test `.).-_) jA Separation Distance from Absorption Field: To Water -Supply Well t - To Property Line 1 r7 1"t' To Building Foundation / ''.-4' To Existing or Abandoned System on Lot /A • On Adjoining Lots "'r'1 -k' tki /A n I .� To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course 0 4 To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at ) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S A P r:IGIivL=ig-?INN Date SRO 106X Company ,- .^,t t RIVER, ALASKA ' $aT'MOA No c)6. 3 PI1. 694-297.1 Receipt No. "l z1 Lo Date of Payment ql 2-7 Amount: $ j ,UC Page 2 of 2 72-026 (11/84) Reborl A. Shofar : uW P. n No. 1457-E 4.1. ' ' *. o' �gis.