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PARKSIDE BLK 2 LT 1
Parkside Block 2 Lot 1 #050-591-10 uBMITTA Municipality of Anchorage 0UgL 512W On-Site Water and Wastewater Program • (907) 343-7904 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131040 PID Number: 050-591-10 Dwelling: 0 Single Family (SF) M Duplex (D) []Multiple (SF and/or D) Project: ❑ New *Upgrade Name: ERIC JENSEN ABSORPTION FIELD M Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 23429 GLACIER VIEW DR., EAGLE RIVER, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.8 GPD/SF 8.2 Ft LEGAL DESCRIPTION Depth to pipe invert from original grade 2.2 Ft, Gravel depth beneath pipe 6.0 Ft. Subdivision Block Lot PARKSIDE 2 1 Fill added above original grade 1-2 Ft. Gravel length 63 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines NA Distance between lines NA Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 756 Ft2 1 1 - Ft. Well75" 80'* NA NA >25' TANK ■ Septic [IS.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water >100' >100' NA NA Material HDPE Number of compartments 2 Lot Line >5' >10' NA NA NA Foundation >5' >10' NA NA LIFT STATION Manufacturer Capacity -- Gal. Curtain Drain >50' >50' NA NA Pump on level at Pump off level at High water alarm at Remarks *WAIVER OSP131041 in. --- in. -- in. ABANDONED EXISTING SEPTIC TANK PER MOA REQUIREMENTS Pump make and model Electrical Inspections performed by PIPE MATERIAL Housetotank 3034 Tankto3034 dminrield Installer CMM CONSTRUCTION Drainheld F810 CO/MT F81 Inspector ANSON MOXNESS & LARS SPURKLAND BENCH MARK (Assumed elevation) 100 ft Inspection 1�' 7/30113 2"° 8/1/13 Location and description dates: 3" 8/1/13 a 6/28/13 BOTTOM SIDING AT "A" ON SHEET 1/2 COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL E0�J _1 l OF A4 Conditional Approval: Date y g E. SP'JRKLAND.�W ow '+ ADorovedAdl Dale l -`/YOFE�S Insaectian ReDa -1-12.doc \ F D C SW/NGTIES \ ABANDONED £XISIDJG D 18.0 SPDC TANK PER MOA — £ 53.0 87.0 CODE REQUIREMENTS F 52.0 86.0 G 54.0 84.0 '' L INSTMUED 3—BEDROOM SEPTIC SYSTEM H 50.0 81.0 INSTALLED 1150 GALLON SEPTIC TANK 1 54.0 83.0 INSTALLED DIVERTER ✓ 54.0 82.0 TRENCH LENGTH 63 FEET K 52.0 47.0 WIDTH 2.5 FEET L 71.0 49.0 _ EXCAVATION DEPTH 8.2 FEET M 73.0 49.0 ROCK DEPTH 6 FEET �� _ _ GLAC/ER/EW DR/vE I� SWIW(ri1CS INJICATp 'Lo'p P pIsTR�s�� a� FoR TEs'T 14OU; L6L,ArW4> 58c DESIbw 3146CT I oC +{ NOTE: SLOPES EXCEEDING 25% WERE NOT OBSERVED WHHIN 50 FEET DOWN GRADIENT OF THE PROPOSED ABSORPTION FIELD LOCATION. NOTE. THIS IS NOT A SURVEYED PLAT. WELL k SEPTIC LOCATIONS TAKEN FROM ON—SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN AR£ APPROAMMATE 25 0 R5 50 75 100 125 150 SCALE 1' = 50 FT JYUKKtANU 1'.N(iINtEKIn(i I I PARKSIDE BW 2 LT 1 I I SEPTIC SYSTEM ASBUILT 203 W K TH, AVENUE ANON. AK. 99501 ERIC JENSEN DATE AUGUST 28, 2013 (907) 279-3916 23429 GLACIER VIEW DR, ANCHORAGE AK 99577 3'HtL'I: 1fC LWKID+ MbF PERMIT R DSP131040 PID If 050-059-11 PARKSIDEB2LI.SC50-ASABV6 DEEP Trench: 25' Wide 63' Long 9' Max. Depth 6' Sewer Rock NO SCALE Trench Elevation (TyP) C(eanouts Moni to r1s;rs t Barrier BENCH MARK BOTTOM SIDING 0 A' ASSUMED fLEVATiON 100 FEET Installed 1250 Gallon HOPE Septic Tank Foundation Cleanout Run Diverter /Double Clean outs Ground a ter Monitor R RR R 1250 GALLON HDPE SEPTIC TANK ISPURKLAND ENGINEERINGI I PARKSIDE BLK z LT 1 I I SEPTIC SYSTEM SCHEMATIC 203. AK. K. 99501 TH. AVENUE ANON. ERIC JENSEN BA 7F.- AUG 30, 2013 (907) 279-3916 23429 GLACIER VIEV DR EAGLE RIVER 99577 SHEET, 2/2 GRID 0060 PERMIT # DSPI31117 PIB # 050-591-10 PARKSIDEWLI.D3-ASRDV6 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131040 Tax Code Number: 05059110000 Work Type: Septic Upgrade Permit Effective Dates: April 10, 2013 to April 10, 2014 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: PARKSIDE Site Legal Address: PARKSIDE BLK 2 LT 1 G:0060 Owner/Address: JENSEN ERIC M & SHANNON K 23429 GLACIER VIEW DR EAGLE RIVER AK 995779618 Site Mailing Address: 23429 GLACIER VIEW DR, Eagle River Lot Size in Sq Ft: 60204 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The permit includes waiver OSP131041 allowing the drainfield to be: 1) 80 feet minimum from the on property private well, and 2) 20 feet minimum from the 25% or greater slope. Received Issued By n MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I. D. 050' 15q)-10 Property owner(s) ERIC JENSEN Day phone 351 —1704 Mailing address 23429 GLACIER VIEW DRIVE *EAGLE RIVER, AK 99577 Site address 23429 GLACIER VIEW DRIVE *EAGLE RIVER, AK 99577 J✓ Legal description (Sub'd, Block & Lot ) II ,, � ct BLOCK 2, LOT 1 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: ( Pall that apply) Initial ❑ Absorption Field ® Septic Tank Upgrade ❑ ❑ Renewal Holding Tank Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: TYPE OF DEWELLING: Single Family (SF) (w/wo AD U) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) WELL TO DRAINFIELD & SLOPE WAIVER Distance: 80' & 20' 1 certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 550— Waiver Fees: 105b— Date 0 Jb — Date of Payment: H I L{ 113 ()�fa Date of Payment: 4 N I3 Receipt Number: 0:zLm Q Receipt Number: () 5V. 0 4 (Ct Permit No. ©J PI b wO Waiver No. 0a 19 12j1 CSA I (Rev. 01/11) Col SPUMand Eimgonenoping Environmental Consulting and Design SEPTIC SYSTEM DESIGN Park Side Block 2 Lot 1 Municipality of Anchorage June 21, 2013 Development Services Department On Site Water and Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Septic System Installation Permit 23429 Glacier View Dr. Ladies and Gentlemen: We are requesting a revision to the well to septic system separation distance waiver that was granted for the upgrade of the septic system at the above referenced property. The approved waiver is between the onsite well and septic tank and absorption field, reducing the required separation distance to 80 feet. A gas line runs directly over the area that was proposed for the septic tank. Reducing the separation distance by an additional 5 feet for the septic tank will not cause any adverse impacts. The justifications listed in the original permit also would pertain to the revised waiver distance. In addition, a Greer poly tank will be installed. Plastic tanks do not corrode, and are less likely to leak over their life span, than steel tanks. We would like to modify the waiver to allow the septic tank to be placed as close as 75 feet from the well to avoid the gas line. Waiver Request: Well to Septic Tank 75 feet. If you have any questions or concerns, please contact me at 279-3916. Sincerely, �S Lars Spurkland, P.E. Civil Engineer 203 West 151h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net Municipality of Anchorage Development Services Division On -Site Water and Wastewater Program menc `� mfn N **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP131041 COSA#: Permit#:OSP131040 PID#: 050-591-10 Legal Description: Parkside, Block 2. Lot 1 Engineer: Garness Engineering Group Applicant: Eric Jensen v rAl g�9 Jc 1�wnk Your request for a waiver of the required 100 feet horizontal separatio th tion field to the private well has been approved. The approved separation dist a is�@=feet. +mss PerCO1 Your request for a waiver of the required 50 feet horizontal separatii the a so n field to 25% or greater slope has been approved. The approved separarion distance is 0.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: ` U 13 Approved Name of Reviewer ............................................................................... Rec#: 050699 Amount: $1,050.00 Date Paid: 4/412013 **** VARIANCE/WAIVER REVIEW **** March 28, 2013 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic System Upgrade for Parkside; Lot 1, Block 2, To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgraded. We are proposing to install a new 1250 gallon septic tank and a deep trench type drainfield. Attached are a site plan and a design drawing showing the proposed septic system. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns. 4. WELL WAIVERS FOR SUBJECT PROPERTY: Due to site constraints, we are requesting an 80 foot waiver from the well on the subject property to the proposed septic tank & drainfield. Comments supporting the waiver requests are listed below: • The well and septic system are on opposite sides of the house. If effluent were to surface, it would be unable to travel back towards the well head. • We are only asking for a 20% variance. • Recent water samples results indicated no bacteria present and nitrate levels to be 0.721 mg/L. In short, the water quality is within MOA, state, and EPA requirements. • The topography of the lot is laid out in such a way that if the proposed septic tank or drainfield were to overflow, the effluent would travel down the slopes in the complete opposite direction of the well head. 5. SLOPE WAIVER: We are requesting a 20' waiver be granted from the drainfield to the cutbank. As can be seen on the attached drawing, at a 25% slope (starting 2.5 feet above the drainfield) the potential point of daylighting is greater than 50' horizontally from the drainfield. • The proposed drainfield will have a greater separation distance from the cutbank than the existing drainfield. • As stated above, at a 25% slope (starting 2.5 feet above the drainfield the potential point of day lighting is greater than 50' horizontally from the drainfield. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com In short there is minimal risk associated with the grating of these waivers. See attached cross section drawing. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any 911stions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com \ \ \ \ PARKSIDE; BLOCK 2, LOT 6 PARKSIDE; BLOCK 2, LOT 7 < \ PARKSIDE; BLOCK 2, LOT 2i y TH"1 / lip A'I i 3tID:rliSn�]FiZI�[iO RKSIDE; BLOCK 1, LOT 2 PREPARED FOR: ERIC JENSEN LEGAL DESCRIPTION: PARKSIDE; BLOCK OF WORK: SITE PLAN LOT 1 Li \\ PARKSIDE; BLOCK 1, LOT 4 0 REA PHONE NUMBER:I PAGE NUMBER: 351-1704 1 OF I �REA II►C3 I PARKSIDE; BLOCK 1, LOT 3 i 3/19/13 NUMBER OF BEDROOMS: 3 GALLONS PER DAY (GPD): 450 GPD PERCOLATION RATE/S: 14.11 MIN/INCH PROPOSED APPLICATION RATE: 0.8 MINIMUM GRAINFIELD SQ.FT.: 563 SQ. FT MAXIMUM DEPTH: 9 FEET WIDTH: 2.5 FEET LENGTH: 62.5 FEET EFFECTIVE: 6 FEET ACTUAL SQ.FT.: 750 SQ. FEET / EXISTING 3 BEDROOM HOUSE / INSTALL C/O PRIOR TO TANK INLET / NSTALL DBL c/o's NOTE: CONTRACTOR MAY NEED TO PICK UP SEWER SERVICE LINE NEAR HOUSE TO GET GRADE TO PROPOSED SEPTIC TANK. IT IS ALSO RECOMMENDED TO INSULATE THE DRAINFIELD. T ST2 / \ DRAINFIELD M_ \ 0 �i /EXISTING 1000 GALLON T S€PTIC-TANK TO BE l � EXISTING L "DECOMMISSICNEQZ PER UPC �}� DRAINFIELD TO BE USED AS RESERVE SITE. — �_ VZE V Dri axe GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3201 E. NOOK FWD. SURE 101 • . HOFWE. M 99507 • PHONE (907)33)-6179 • FM (901)3]8-1216 • 6£DSRE: •,ngame,x�pin«Rn9.can PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ERIC JENSEN 351-1704 2 OF 4 LEGAL DESCRIPTION: DRAWN BY: PARKSIDE; BLOCK 2, LOT 1 1 PNB OF WORK: SEPTIC GN 3/28/13 / / \ Ltd. HAS A 7 PAGE SP I KATION LETTER THAT PERTAINS TO THIS DESIGN. / TO OBTAIN A COPY OF THE LETTER / CONTACT DEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND / / PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND / CONDITIONS OUTLINE ofil 9. / NOTE: THE CONTRACTOR SHALL HAVE THE WEST EASEMENT, AND ALL WELL �,�W` / RADII FLAGGED BY ALL REGISTERED LAND SURVEYOR RADIO! PRIOR TO CONSTRUCTION. / / EXISTING 3 BEDROOM HOUSE / INSTALL C/O PRIOR TO TANK INLET / NSTALL DBL c/o's NOTE: CONTRACTOR MAY NEED TO PICK UP SEWER SERVICE LINE NEAR HOUSE TO GET GRADE TO PROPOSED SEPTIC TANK. IT IS ALSO RECOMMENDED TO INSULATE THE DRAINFIELD. T ST2 / \ DRAINFIELD M_ \ 0 �i /EXISTING 1000 GALLON T S€PTIC-TANK TO BE l � EXISTING L "DECOMMISSICNEQZ PER UPC �}� DRAINFIELD TO BE USED AS RESERVE SITE. — �_ VZE V Dri axe GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3201 E. NOOK FWD. SURE 101 • . HOFWE. M 99507 • PHONE (907)33)-6179 • FM (901)3]8-1216 • 6£DSRE: •,ngame,x�pin«Rn9.can PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ERIC JENSEN 351-1704 2 OF 4 LEGAL DESCRIPTION: DRAWN BY: PARKSIDE; BLOCK 2, LOT 1 1 PNB OF WORK: SEPTIC GN 3/28/13 9 FEET f 2.5 FEET -j 6 FEET FEET SCALE: 1 " = 10' GARNESS ENGINEERING GROUP, Ltd. .._= CONSULTANTS 8. GENERAL CONTRACTORS 3701 E. NOOF ROAD, SUITE 101 - PNCHORA M 99507 - PHONE (907)337-6179 • FM (907)338—M46 • REOSRE: wwx.gameuengineenng.ca{ PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ERIC JENSEN 351-1704 3 OF #. L' LEGAL DESCRIPTION: DRAWN BY: PARKSIDE; BLOCK 2, LOT 1 PNB TYPE OF WORK: DATE: CROSS SECTION DRAWING - WAIVER REQUEST 3/28/13 FEET ].4 t> C PARKSIDE; BLOCK 2, LOT 6 PARKSIDE; BLOCK 2, LOT 7 \--------------- / I �4 9q \ 7 / RETIIC -___ PARKSIDE; BLOCK 2, LOT 2/ Y I / op�o� / PARKSIDE; BLOCK 1, LOT 2 / / SCALE: U \ PARKSIDE; BLOCK 1, LOT 4 \�X (�SEPTIC // (�SEPTIC AREAD // / ARS / I PARKSIDE; BLOCK 1, LOT 3 I1 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS.... -;x E. TUDOR RM. SURE 101 • ANCW E. O1( 99507 • PHONE PREPARED FOR: ERIC JENSEN LEGAL DESCRIPTION: PARKSIDE; BLOCK 2, LOT 1 • FM NE NUMBER: PAGE NUMBER 351-1704 1 4 OF 4 : OF WORK: SITE PLAN TOPO— 5' CONTOURS ME 3/19/13 OF v GARNESS ENGINEERING GROUP, Ltd. .... _.. ......... :-. CONSULTANTS S GENERAL CONTRACTORS . — .. ,..: SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: PARKSIDE; BLOCK 2, LOT 1 PERFORMED FOR: ERIC JENSEN D� DEPT ORGANICS (feet) TEST HOLE # 1 1 19� PERCOLATION RATE 14.11 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.0 FT. AND 6.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ANDREW GRAY COMMENTS: PERCOLATION RESULTS ARE WITHIN 1/16TH OF AN INCH PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P RFO MED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 3128 SOIL CLASSIFICATIONS 2 GW ORG GP ML GM CL AA 4 GC OL 0000 o SW o a o 0 MH 5 '�•' ' SP .•.. CH SM ' OH 6 SC SEE ATTACHED SITE PLAN 7 DEPTH TO DATE GM GROUNDWATER 8 DRY 3/19/13 DRY 3/25/13 9 DRY 3/28/13 SC 10 1„ = 100' DATE READING CLOCK NET TIME WATER LEVEL NET DROP i t TIME (MINUTES) READING (INCHES) 12 3/25/13 1 4:33 — 6.00" — 2 5:03 30 3 13/16" 2 3/16" 13 3 5:03 — 6.00" — 4 5:33 30 3 7/8" 2 1/8" 14 5 5:33 — 6.00" — 6 6:03 30 3 7/8" 2 1/8" 15 16 B.O.H. 17 18 19� PERCOLATION RATE 14.11 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.0 FT. AND 6.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ANDREW GRAY COMMENTS: PERCOLATION RESULTS ARE WITHIN 1/16TH OF AN INCH PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P RFO MED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 3128 SGS. SGS Ref.# Client Name Project Name/# Client Sample ID Matrix Sample Remarks: 1131145001 Gamess Engineering Group, Ltd Parkside Ll B2 Parkside Ll B2 Eric Jensen Drinking Water Printed Date/Time Collected DatefTime Received Date/Time Technical Director 04/03/2013 15:08 03/29/2013 8:30 03/29/2013 14:39 Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Ina Waters Department Total Nitrate/Nitrite-N 0.721 0.100 mg/L SM21 4500NO3-F B (<10) 04/02/13 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM21 9223B A 03/29/13 ACF Total Coliform Negative 1 100mL SM21 9223B A 03/29/13 ACF Page 2 of 4 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 y` �� t01 Ll �`� I S1 �� Permit Number: �1-*"--�PID Number: Nam : �( ` L J Wastewater System: ❑ New Upgrade Address: 1�+ ABSORPTION FIELD Phone: n 4 ` 2 No. of 1115ooms: eep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: 1P Total Depth from original�gr�de: fJ GPD/S . Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Ft. t Ft. Township: Range: Section: Fill added above original grade:t C Gravel length: � Ft. mss-, ,/ Ft. WELL: El New 1:1 Upgrade ' Gravel-dvl:;' �1 � Number of lines: 1 Distange eenlines: I'�1P Ft. Ft. CI 'fication Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipmaterial: EEId Ft. I Ft. c� �/ I ) SQ. Ft L O� Driller: Date Drilled: Static Water Level: Inst Date i stallgs-dam: Ft. � ✓ 1 � Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private M nu cturer: /� Capacity in gallons: " From Tank Field Station Tank Sewer Lines 1�— L�'Q Well 1 Ot ^I w Q„t / / t Maa 5: t Number of Compartments: LIFT STATION WateSurfacr \mak ��`K Lot k 1Size \O k in gallons: rer: Line \0 Foundation t A l / / "Pump on" level at: "Pump off' level at: water alarm at: Curtain I/ Pump Make & Model Electrical Inspections performed by: Drain BENCH MARK Remarks: Location nd Description: Assumed Elevation: p 010 Ft EN ,ra4N,Ei{&SEAL s� r;`•; yr "',. _.. i1 _SCC Inspections performed by: S & S ENGINEERING Dates: 1st____ 17034 Eagle River Loop Road No. 9QA Eagle River, Alaska 99577 `nd t b N Department of He=and Services approvals Reviewed and approved by:!_Date: i= 7-91 72-013 (1/91) MOA 25 10 Permit No. "► t d►gelr Page 2' of 2 - Municipality Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID No.: Opo 0I t 1 d �I Pc I yr C*Vj►Te, mss. P�'�-►� • Gv 1,\ MT Gti3 lv�l Jae> tiW /el7I LVA, I NIT toa � ...coq' q33/ F�1►,ia►. �i� GeL Gv> Co Cv i ?3 N17' coo 1 scSEp►" � st Oct ° �y4 M TS� o�r�,�T�'�-'il-`Jol-ai. 72-013 A (2101) MOA 25 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:SW910194 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:LUKJAN ANTHONY RAY OWNER ADDRESS:BOX 1548 MYRTLE DRIVE EAGLE RIVER, ALASKA 99577 PARCEL ID:05059110 LEGAL DESCRIPTION: PARKSIDE BLK 2 LT 1 LOT SIZE: 60204 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 7/15/91 EXPIRATION DATE: 7/15/92 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE:. Jr DATE: lS� ROBERT SHAFER, P.E. ROGERSHAFER vp� r CIVIL ENGINEERS (907) 694.2979 - FAX 694-1211 f4 GLf RIVER, PSP Duey 8, 1991 Sy,P HEALTH AUTHORITY APPROVALS Munici.patity o6 Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 8251 L Stkeet SEWER&WATER P.O. Box 196650 MAIN EXTENSIONS Anchorage, Ataska 99519-6650 REFERENCE: Lot l; Btock 2; Parh6.ide Subdivision; SEWER WATER Request you i,6sue a permit to upgrade the septic system serving the INSPECTION re6ereneed property. An adequacy .tat waa per6ormed on .the existing .6y.6 tem on May 29, 1991. We bound .the systems' absorption capacity .inadequate 6or .the 3 bedroom ENGINEERING STUDIES u-6idenee toca-ted on .the ro ert 1� p y. AND REPORTS The property .is tocated on a re2ati.ve2y steep h.iP-bide. The proposed septic .trench is to be toeated on a 4tattened area below .the house. The na.tu t ground sur6aee on .the uphitt and downh tt slide 6o .the WELOWTESCTIDN &FLOW TEST o However, due to the -t�cench hQfJ a b.2o pe U6 Qpprox�c.mate2y 50� to 600. U YL dense vegetation and onganzc soil layer there ,is tittle chance o6 e65u2en-t dayt i ting down .the steep grade. Due to .the targe tot sizes .in .the area we do not anticipate any adverse SITE PLANS e64ect6 on the neighboring propmtiez by the .instattation o6 .the proposed septic system. or require addition, in6oation 6or youk 16 you have any questionsnrm ROAD DESIGN review, pt contact us. Since y, SOILTEST B A. SHAFER, P.E. PERCOLATION /gm TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 1 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 N , SCALE e Municipality of Anchorage' DEPARTMENT OF HEALTH & HUMAN SERVICES'; ,•4V1 ,, ,,n•. F e, 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TESTA. y_;;w. PERFORMED FOR: �J�Tdr� DATE PERFOf(ME&"•'7`4 f7�?!; 1 LEGAL DESCRIPTION: 2 � �7t�� Township, Range, Section: .i PT,K SLOPE SITE PLAN 10 (� a, WAS GROUND WATER ' �l �( ENCOUNTERED? - S 11 _� L �� pr IF YES, AT WHAT O 1,ll� DEPTH? E 2 Depth to Water After 13 Monitoring? L — Date: 15 /g vY 16 C::>- ik- 17 18 19 Reading Date Gross Net Time Time Depth to Water Net Drop L 1 �v (per' C�� .--•' 2, 3 s .moo -7 2 �`•5b ,� t " t a '7 t lA ry d o 4 t z 3 4- 6 6 7- 8 9 10 (� a, WAS GROUND WATER ' �l �( ENCOUNTERED? - S 11 _� L �� pr IF YES, AT WHAT O 1,ll� DEPTH? E 2 Depth to Water After 13 Monitoring? L — Date: 15 /g vY 16 C::>- ik- 17 18 19 Reading Date Gross Net Time Time Depth to Water Net Drop L � �o�to�jt rJ:2.7 �� (per' C�� .--•' 2, 3 s .moo -7 �`•5b ,� t " t a '7 t lA ry d o 4 t z 20 h Iui PERCOLATION RATE 'I(minutes/iin�Jch) PERC HOLE DIAMETER TEST RUN BETWEEN N AND - FT COMMENTS E,�t: -c ��,.iii: ". _ - PERFORMED BY: �• �.lAska �3�5]� *SEFFECT CERTIFY THAT THIS TEST WAS PERFORMED IN �.ac�4e t ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI ON THIS DATE. DATE: 72-008 (Rev. 4/85) v1U LV 11.1 Yt1L1lx Ur tiLV ..nvn.c-�L Heal. and Environmental Protec I)n Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 1 --- INSPECTION RE13ORT ON-SITE SEWAGE DISPOSAL SYSTEM ----- �U/ Ci �__ [� � NAME MAILING - —MAILING ADDRESS IRhESNE{� LOCATION .f_YL `` LEGAL DESCRIPTION _ ��' ^� /• �f',� E SEPTIC TANK: DISTANCE /J % r NUMBER OF FROM WELLL_�® __ MANUFACTURER U,Se —MATERIAL _ C MPARTMENTS_ INSIDE LENGTH__ `— —INSIDE WIDTH— • ----LIQUID DEPTH LIQUID CAPACITIO � GALLONS. TOTAL LENGTH DISTANCE FROM WELL ��� / FOUNDATION— NEAREST LOT LINE_ �C� OF LINE �5 # of Lines _� DISTANCE BETWEEN LINES - r=/J//A�—TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPT;0114 AREA _—�� SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE 10 FINISH GRADE MATERIAL BENEATH TILE —14�4d-'ABOVE TILE IN. SEEPAGE PIT: DIAMETER OR WIDTH_—, LENGTH_, DEPTH Log Crib _Rings_ Crib Size: DIAMETER__—DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION _—. , NEAREST LOT LINE-- . ABSORPTION AREA (WALL AREA) Well Class: W 'Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: # of Bedrooms: Installer: _) Remarks: ,S FP. DATE v LD A I i �,�;— 1A - I I i—r— — —-a I -- DATE v DEP8RTMENT ' HLML|M j. /n- �v/c�..^,n STREET/ ANCHORAGE/ HK. 9S^'�11 �mu ��� ����� ������ J� PERMIT NO. u/� , HPPLICHNT M K JHCOBS HNVIK CIRCLE BOX 619 E. R, 694~9940 LOCHT�~ - ION D ��� LOT 5IZE 60204 SQUHRE FEET LEGAL L.J. B2 PHRKSIDE SUBD TYPE OF SOIL HBSORBTION SYSTEM IS� TRENCH MHXlHUM �UMBER OF BEDROQMS � ] SOIL RHTING (SQ FT/BR)� 195 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCEOF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET) THERE IS NO SET WIDTH FQR TRENCHES. ` THE GRHVEL DEPTH'IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFF�L PIPE HND THE BOTTOM OF THE EXCHYHTION (IN FEET). ����-��= ���� �F������ �������H � A _7-� F- F7-- P������� BACKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT T8 PROSECUTION. MINIMUM DISTHNCE BETWEEN H WELL HND ANY ON~SITE SEI GE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WE�L SPECIFICHTIONS HND CONSTRUCTION DI8GRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLFTION. �cn F_ � � � ���N' I CERTIFY THHT / 1� I HM FH�ILIHR WITH THE REQUIREMENTS FOR ON --SITE SEWERS HND WELLS AS:; SET FORTH BY THE MUNICIPALITY OF ANCHORAGE., 2 I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES ]' I UNDER THHT THE ON~SITE SEWER SYSTEM MAY REQUIREENLHRGEMENT IF THE R�5IDENCE IS REMODELED TO INCLUDE MQRE THAN ] BEDROOMS. ~�y SIGNED ^ ._ �1L-��� HPPLICHNT I5SUED BY__LAla��� K JHCOBS ,~, ' ~ — . .... .......��^ ,�~----- 77 m ` 0 Er E GEOT,JCHNI CAL Er DEVELC_1MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name: Tel . No. ?�J S � Mailing Address:3Qx QA to� Legal Description: \ %_e 1��, .cs��t '2�,kA�- Depth (feet) 0 2 3 4 5 Ces r3 ti"v"' 1 o 6 7 8 9, 10 11 12 13 _,==,,j4 15 16 Soil Characteristics �� ccs � 1,�-.�►J ��� - � b� .,ti -s Ct' 7'a �r, Ground.Water Encountered: Yes y_-- No — If yes, what depth Proposed Installation: Seepage Pit Drain Field a Comments: Performed by: v� *�,,,� ,./ Date:' t� �� I '16 0 � SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 265 feet f+ DRILLED AT THE RATE OF $21000 PER FOOT. f) D iLi (YLd 4 I PROPERTY OWNER Mr. Terry Truetle 7 rj LOCATION OF WELL SITE—Tt-.o Wk. Sub- �G�_ ✓/ t'• �I, % DRILLER WELL LOG: 0--261 Gravel and small boulders. 26-1800 Bedrock. A sedimentary rock. 180-2000 A granular rock showing some signs of water. Not a usable yield. 200-2401 Sedimentary rock. 240-255' Granular material showing under two GPM. A fairly good minumum yield. 255-265' Porous material producing more water. Three to four GPM. Total yield of a possible steady flow of six GPM. 100 feet of water standing. should be installed 10 feet off bottom. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF THANK YOU VERY MUCH. $5565.00 BER CLAUS OF RAMPART DRILLING WORKS DATE March 31st�7Z__ SERVICE CHARGE OF I Y2% PER MONTH WILL BE ASSESSED ON PA DUE ACCOUNTS. I !� • Municipality of Anchorage On -Site Water and Wastewater Program < ~` (907)343-7904 sa Err Certificate of On -Site Systems. Approval Parcel I.D. 050-591-10 Expiration Date: 115- 1. 51. GENERAL INFORMATION Complete legal description Parkside, Block 2, Lot 1 Location (site address) 23429 Glacier View Dr. Current Property owner(s) Eric & Shannon Jensen Day phone Mailing address 23429 Glacier View Dr. Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: (] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 7 Individual E Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request 4. Received by: COSA to be released to the unless otherwise requested by the engineer. COSA Fee $ Date of Payment (c5l) 5' O Receipt Number 051 bq id, COSA# n5C161?5I Date: " f u IS Waiver Fee $ _ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system.. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 9951-0 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE Vf System #1 Approved for 3 bedrooms System #2 Approved for. . bedrooms Disapproved Date 6/3/2015 l�..v WN Seven nnone t. '. CE -8149 .-@ Conditional approval for bedrooms, with the following stipulations: my: f�y Original. Certificate Date: The Municipality of Anchor Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only. upon the representations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. - ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet t .., .. ff more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Parkside, Block 2, Lot 1 Parcel ID: 050-591-1-0 A. WELL DATA Well typPrivate If A, B, or C provide PWSID # 3I3t�t9't7 Date completed 3/,$1/1977 Sanitary seal (Y/N) Y Total depth 265 ft. Cased to 265 ft FROM WELL LOG Date of test 3/31/1977 Static water level 165 Well production 0 WATER SAMPLE RESULTS ft. Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) 12+ in. AT INSPECTION 5/27/2015 159 ft g.p.m. _5.1 Coliform Neg colonies/100 mL Nitrate 0.637 mg/L Arsenic ND ug/L Date of sample: 5/21/2015 Collected by: B. SEPTIC/HOLDING TANK DATA PES g.p.m. Tank Type/Material _ Septic/Steel Date installed 8/2/2013 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping -MM i'u�__.umper" "Rs �('M'eln � z01 P % C. ABSORPTION FIELD DATA Date installed 8/1/2013 Soil rating (g.p.d./ftZ or f?/bdrm) 0.8 GPD/SF System type Deep Trench Length 63 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total depth 91 ft. Eff. absorption area 756 ftZ Monitoring tube Y Depression over field N Date of adequacy test New Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test New in. Water added New gal. New depth New M. Elapsed Time: New min. Final fluid depth New in. Absorption rate >= 450+ g.pA. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date _ D. LIFT STATION 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 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION l certiry that ! have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 6/3/2015 COSA canary sheet 2-6-15.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ F 0 o� SCALE 1" = 30' J 30' \ 0' 15' 30' 60' 41 LOT 2 IClean Out T2 Vent \ 28>R�56 Typical (9) I Valve MT Vent Wood Porch I Typical (4) & Steps 6$ Well 1 3R ® \Se I 1� 1\' C1 o 0'��4Q4G��pJ p 6.2' G. ^�pOQk�J�L LS Satellite Dish Typical (2) ood Porc n & Steps LU r o Izo C' r, Wood Service Pole & Anch, aQs�he9t� n / 2P9IQ LOT 1 / BLOCK 2 ye / �o J .s. Note: All Distances Measured To Wood Trim I / /PARKSIDE � an accurate survey of the following described SION (73-39) was made on June 12, 2015 and that the improvements 3 situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no Improvements on the 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. Easements other than those shown on the / record plat may not appear on this drawing. Anchorage Alaska, this 15th day of June 2015. PREPARED FOR: PANNONE ENGINEERING AS -BUILT OWN_ JSP DATE 6/15/2015 GRID SW 060 FILE NO. F.B. 2015 JOB N0. 1525 PG. 19 1545 KARABELN/KOFF SURVEYING rsn»sem MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 0 ro - 5�- 011 70 Parcel I.D. # HAA # CZ 1. GENERAL INFORMATION Lot 1; Btock-'-2-'j' -PaAk,6,8d-(t-,-'Sctbrdivision Complete legal description 14, A directions) 23429 GtacieA View DAive Locatiodfs"hie";' WreAs or — Kr lb� "I Merty� wner�,alet de. t :Mail nil ].t8dress. 2342 iagency.) .-' AK Day phone 696-8143 (h) View Drive Eagle XiveA, AK 99577 r, Day phone 72-025 (Rev. 1191) Front MOA 821 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 bedroorns and type of structure indicated herein. I f u rther verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the onsite water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING _ Phone `� )L'q Z Z� 17034 age KIVer LOOP RGad No. Address Eagle River, Alaska 99577 Engineer's signature Date -�'41O F " y ROBERT C. COWAN % CE -8801 `Additional Comments r By:' Dated=L� �;The Municipal ity4kk nchorage"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 protesslorral engineer registered in the State of Alaska. The DHHt3 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 i:,sued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (ROV. 1/91) Back MOA N21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES • '� Environmental services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: T 2 PDcrg-ELS t DC S� _ Parcel I.D.: A. WELL DATA Well type` (t-« If A, B. or C. attach ADEC letter. ADEC water system number Log present (ON) Total depth ?.. Sanitary seal f�N) Date of test Static water level Well production '-tA Date completed 5 Cased to i (SFot oc_t,4 Casing height (above ground) ll �z— Wires properly protectedC�IN) — FROM WELL LOG WATER SAMPLE RESULTS: Coliform D Date of sample: Nitrate 0 -t3 -,1S AT INSPECTION 0 O — w m Lu Z �? 7 —gP.m o p, 4 � Other bacteria O n Uu j s Collected by: 's B. SF SEpTIC/HOLDING TANK DATA 1 Tank size 1 �o Number of Compartments Z Cleanouts Y�T)_ Date installed 1 '� 1_-�1 E1 Foundation cleanout9 ) Depression _ — (Y,� r% High water alarm (Y/N) Date of Pumping 2 23 Pumper C. ABSORPTION FIELD DATA S stem t e c l-� Date installed -] - 5 1-q 1 Soil rating (g.p.d./ftor ft-/bdrm) D. �o Y � � Total depth �D i -'j Gravel thickness below pipe �v. Length /i_ '� Width. Effective absorption area 9 � Monitoring Tube present(S)/M_Depression over field (YO Date of adequacy test {o , d & - S S Results as ail) �°A55 For 3 bedrooms Fluid depth in absorption field before test (in.); s"7 " g.p.d Immediately afterB00 gal. water added 7B D Absorption rate =_—g p d Fluid depth 1,0'2 ft (ins.) Minutes later: 3 t /fL J�u� �If Peroxide treatment (past 12 months) moJ`�O d'6 yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level tested E. SEPARATION DISTANCES Size in gallons "Pump on" level _—gip *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Scptic/holding tank on lot io o t - On adjacent lots Absorption field on lot _ I b r� 0 - Public sewer main Sewer /septic service line 2S 1 �- at* On adjacent lots I 07d 14 - Water + Public sewer manhole/cleanout �p Lift station A //k SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation %per 41 Property line 1 t A — o Absorption field S ' Water main/service line l o tSurfacloo"' e water/drainage Wells on adjacent lots_ � by k'b SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation t r Water main/service line t + Surface water l/b p t Driveway, parking/vehicle storage area Sa r �- Curtain drain i�ja'4)W� ells on adjacent lots /00 Property line / d t + F. ENGINEER'S CERTIFICATION I certify that I have determined Jthru field inspections and review ofMunicipal records in eonfol'maace m.th IV W /� f gni elides ' effect on this date. Signature o//// Engineer's Name /04 61 e'e ' - Date /0 11D,-01 195 - HAA Fee Waiver Fee $ Date of Payment Date of Payment Receipt Number _ 3 3 q 7 Receipt Number Rev. 8/95 OSS: haa.wk.doc r�1� OF A ROBERT C. COWAN CE -8801 . t•' are Lending agency Homeauity #2025-38879 Day phone Mailing address AgentJack White Co -Barbara Littenden Day phone 694-5500 Address 10928 Saute R.ivon Rd E�aq'e. Rive.,, A2a.6ka 99577 Unless_ otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX _.. —...-Community_ well, 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: - 241 VOW MUS MA'ney) SZO-ZL -i joM s, aauibua leuoissajoid ayl ui suoissiwo jo saoaaa jol algisuodsai IOU sl a6saogouy p /lllsdioiunyq ayl -panssi sl elsogp90 a aaoleq elsp azAleus .lo suolloadsui lonpuoo IOU op SHH4 {o saeAoldw3 •sluawailnbai alels pus leaapal ulelaao Alslles olaapio ui suopnlllsul bulpual aiayl pue sawoy to sieseyoand of AsalJnoo a ss slgl saop SHHO eq j'u� sely to elelS ayl ui pejelsibei aaeul6ue leuoissaload _ luepuadepul us Aq anoge g ydeibeied ul u9A16 suoileluesaidaa ayl uodn /luo paseq saleollipeo lenoaddy- i41joylny ylleaH sonss! (SHH4) seowaS uewnH pus ylleaH to luawpedad 96eaoyouy to /4!ledloiunyq ayl 7W elea :AS :suoplelndpls buiMollol ayl yl!M 'swooapaq 0 9li60 '•J`� ( •o o •oo r•oo• a i1.a.ro i oVi i_ i• s o• e o o•• __ aol leAoadde IsuolllpuoQ , .panoaddeslp -swooapaq — aol panoaddy" E- 3linIVNJIS SHHa '9 l b-1 alea einleu6ps s, eoup6u3 LL96G e?iseltl'.1aAIN a16eq 'ON peon dool.lamll alOe3 4£OLL ssaappy 9N12133N1�"I� c V c —� �✓Z J .P auoyd w.lL� to aweN •uolloadsup slyl to alep ayl uo loega up suo!lelnBei pue `seoueuipio 'sepoo alelS pUe led!o!unW Ile yl!m eoueildwoo ui sl welds lesodspp aalemelsem ao/pue Alddns aaleM ails-uo ayl `uolloadsul pue u011e61ls9nul AW woal pue S9111 96eaoyouy to /l!ledpoiunN oql wo.11 peupelgo uollewiolul ayl uo paseq leyl A4!aaA aaylJnl 1 •uiejeq paleoppup einlonals to aN4 pub _ swooapaq to aagwnu ayl aol alenbape pue leuoploun}'alas sp welsAs lesodspp aalumalsam ao/pue Alddns .Ialem alps-uo ayl leyl smogs uopleoildde lenoaddy AliaoLylny ylleaH spyl to u011e511sanuI Aw.leyl i(l!J9A 1 'molaq umoys elep uoplepppsA ayl to se pue olaJay paxllle peas Aw /q pailp eo sy E133NION3 AS N01103dSN1 d0 LN3W31` .LS 'S e Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: \ aL,04AL L Pd�t�s,�'� s� Parcel LD A. WELL DATA 1 Well type ?e,%yuy — If A, B, or C, attach ADEC letter. ADEC water system number µlx Log present/N) Date completed 3'1'11 Driller Total depth 2 V S t Cased t- I I'l-rD Casing height 12 N Sanitary seal ON) Date of test Static water level Well flow Pump level FROM WELL LOG "l '-"J\ --I-] Wires properly protected ON) 9 -p.m AT INSPECTION 5;-- 2.9 -9 /aV1dNICiPALIT( OF ANCHORAGE 44 ' EWIRONMENTAL SERVICES DIVISION Au -1 1991 g.p.m. �x RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1 C�?C> On adjacent lots toe " Absorption field on lot I \oma Public sewer main Public sewer service line "a On adjacent lots \d�� Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: c o�� Coliform d b°L• Nitrate 0'S7 �• / �"'Other bacteria o�E S- 23 �`� 1 Collected b Date of sample: y' S& 5 ENGINEERING 4 Eagle River Loop Road No. 2 04 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed :--j5`-1 � Tank size 11 (<;;ZC:40 Compartments 2- Cleanouts MN) Foundation cleanout:(-7YN) �4 Depression (Y94P � High water alarm (Y/N) . Alarm tested. (Y/,N) Date of pumping N1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r I t Well(s) on lot e�l� On adjacent lots C>� Foundation �n � l To property line t t Absorption field S Water main/service line ) "j l Surface water/drainage I C�' k 72-026(Rev_3/Bt)Front MOA 21 CONTINUED ON BACK PAGE Z e::h Date installed Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water Date installed �3 -�) t—n9411D/ Soil rating 0. 62 � System type G(� , t i Length — (4 4 3 Width 3 Gravel thickness _r� Total depth L q IPJ Total absorption area t Cleanouts present6�/N) C Depression over field (YZ4 p Date of adequacy test Result as fail) for 3 bedrooms Peroxide treatment (past 12 months) (04> If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot nom' On adjacent lots 4 -_Property line �1 To building foundation On adjacent lots 1 To existing or abandoned system on lot Cutbank 2or Water main/service line - Surface water p=moi I Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that f have checked, verified, or conformed to all MOA and HAA guidelines in effect 00.111e,aata —This inspection. S & S ENGINEERING Signature 17034 EaVIe I,vcr Loop Read No. 204 , Eagle River, Alaska 99s77 Engineer's Name r� P J t Date HAA Fee $ Waiver Fee: $ _ Date of Payment s v / Date of Payment Receipt Number �� `� �f o B3 Receipt Number 72-026 (Rev. 3/91) Back MOA 21 - ' MUNICIPALITY OF ANCHORAGE J DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH 0 U(.4) , i e� t CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 1 OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date C v 6 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L / 13 2 aqe b Sl 47 r-- Location =Location (address or directions) (b) Applicant Nam Telephone: Home Business (� �✓—�lG Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; OthqP12zI, (explain); (d) Lending Institution Telephone Address l // (e) Real Estate Company and Agent �7�2/ Zl9 Grp' �bovGS — u 2 r n G C� Address 7 Telephone (f) Mail the HAA to the following address: -S A 5 ENCnIMERINI EAGLE RIVER, ANC 99577 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 43 3. WATER SUPPLY Individual Well;) Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDIk&INSPECTIONS, TESTS, FILE SEARCH, DAeA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Telephone � � `f' �'� 7 9 SR B 196X Address Date 6 6. DHEP APPROVAL Approved for M�L bedrooms by' pare �1 Approved Disapprove Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALT THORITY APPROVAL (HAA) OF A ECKLIST - FEBRUARY 1984 WFIJ 01. t1EPRO`tr,1100 264-4720 ENV 0wtol L Legal Description: Lc; + 5�_? 12 roNiV If A, B, C, D.E.C. Approved (Y/N) N%l� Well Log Present 6" N) Date Completed j " 31 ` -1 _t Yield Total Depth 2- r Cased to �/G � -f- Depth of Grouting Static Water Level 1 Li I Pump Set At Casing Height Above Ground — Electrical Wiring in Conduit (9-,N) Separation Distances from Well: Sanitary Seal on Casing ON) Depression Around Wellhead (Y IN b f'iw _. To Septic/fig Tank on Lot 1 0C) ; On Adjoining Lots ��djr 4 To Nearest Edge of Absorption Field on Lot I c�� + ; On Adjoining Lots 4 - To Nearest Public Sewer Line )"/ To Nearest Public Sewer Cleanout/Manhole N� To Nearest Sewer Service Line on Lot-� Water Sample Collected by nt0671k0i:�rO� tJbl ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 9e,'3/ -3y Size /tx00 ONL No. of Compartments Standpipes ()�N) Depression over Tank (Yt Air -tight Caps [YEN) N d - Foundation Cleanout (Y(l9 Date Last Pumped )O Pumping/Maintenance Contract on File (Y/N) / ; for Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) N116 Separation Distances from Septic/F-Tank: To Water -Supply Well 11 To Property Line To Water Main/Service Line Course N /A Comments Pagel of 2 72-026(11/84) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ! Type of System Design Date Installed "� �j `�� Length of Field/ Width of Field Depth of Field Gravel Bed Thickness I Z Square Feet of Absorption Area w0c, "A Standpipes Present ON) Depression over Field (YO Date of Last Adequacy Test Results of Last Adequacy Test S A t $ Ir"b`too[' y Separation Distance from Absorption Field: To Water -Supply Well lDoi`(' To Property Line /L� I To Building Foundation To Existing or Abandoned System on Lot n ; On Adjoining Lots To Water Main/Service Line To Cutbank (if present) �f To Stream/Pond/Lake/or Major Drainage Course 'J / ►) 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 17 "Pump Off' Level ai High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING Signe cl� ,� 6% Date �% or CompSSU MOA No. �� 3 C�[ 4 U 0 I— O C1 ��— ta Receipt No. .��"� l)�' fid, t 8 car, �Cy`�e<' Date of Payment / Z � 01`4 af' Amount: $ �, v .C?9k}�ealete Page 2 of 2 72-026 (11/84) P°4 n, I / MUNICIPALITY OF ANCHORAGE --/ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1 `'2,0-0—S 1. GENERAL INFORMATION . (a) egal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Gvr5 ;6W& `— Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Otherdg�(explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent (-,�'�� t`-- ^"�� 1SU?st� >d� �C�•. - Address Telephone (f) MSI the HAA to the following address: a 2. TYPE OF RESIDENCE Single -Family F5 Multi -Family ❑ Number of Bedrooms Other 3. WATER SUPPLY Individual Well V Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite-- Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROMDIN' INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address Date 6. DHEP APPROVAL. a Approved for .' bedrooms b ��•�"` Date Approved --4-- -- Disap ved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOMUNICIPALIT/ OF ANCHODEPTR40E HEALTH AUTHORITY APPROVAL (HA�VIRONM NTALEPROTECTION CHECKLIST - FEBRUARY 1984 264-4720 NO v 2 n � Legal Description: �— ��L s �VC t1 A. WELL DATA S C� If A, B, C, D.E.C. A Well Classification roved PP ( Y/N tq4 ) Well Log Present (VV) Date Completed -✓ -3S - 71 Yield Lo 6,FA + Total Depth '2 -LOS 1 Cased to Depth of Grouting Static Water Level 1 `'I3 Pump Set At t__5+iL Casing Height Above Ground — Electrical Wiring in Conduit/N) Separation Distances from Well N Sanitary Seal on Casing 4?M) Depression Around Wellhead (Y4Lp To SepticLEleldiM Tank on Lot 1 LS: I ; On Adjoining Lots \ �� To Nearest Edge of Absorption Field oLot ���� ; On Adjoining Lots <<-��I'� To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ZS I+ Water Sample Collected by S �L^�\��� �"- ; Date Water Sample Test Results Comments fn35:r_�v.� B. SEPTIC/FZL-BtNGTANK DATA Date Installedg— 3 t' 77 SizeI ,z—�_- No. of Compartments 2- Standpipeso/N) Air -tight Caps C%) Foundation Cleanout (Y$91 Depression over Tank (Y&P Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N Separation Distances from Septic/Fdelding-Tank: To Water -Supply Well k aa1 To Building Foundation To Property Line To Water Main/Service Line VL*-,:::, I + Course "s 1A Comments Page 1 of 2 72-026(11/84) To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design ��P ✓4 Date Installed ° - —_J-7 Length of Field Width of Field u Depth of Field Gravel Bed Thickness Square Feet of Absorption Area to to 0-0 Standpipes Present fVN) Depression over Field (Yo Date of Last Adequacy Test i Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well c�£� 1� To Property Line o I To Building Foundation Lot To Water Main/Service Line \ o la' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed On Adjoining Lots To Existing or Abandoned System on S G, -v (� _ To Cutbank (if present) IIA S1 Dimensions Size in Gallons anhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA 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 N" Date - Company' , - �'� -�� Eft; K40A No. Receipt No. I �D�°z,. r i, Date of Payment s Y I I � b. ,r�,, � `' PO ,101 Amount: $ Page 2 of 2 72-026 (11/84) j .> oY"l i�:Y t.;. AT'�'`�iECEIVED /y�„) f” APPOINTMENTS' ! U I TIME TIME IME A'tOn q m — Q-f TINSPECTION - ( Afl DATE DATE - DATE WELL -LOG. A well log is required for all wells drilled INSPECTOR INSPECTOR INSPECTO ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF H°ALTH 0: DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRON,"CNTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ll���}}{{ iFvr fY AK • _ I L: v` ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED CEI E REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incompleterequests will not he processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER DKSOt/ rt PH (9�-97Yp� MAILING ADDRESS ow 995'77 PROPERTY RESIDENT (If different from above) Dl_ �iC'/Y �/�4� �t'lt/YZ• PHONE . PHONE 2. BUYER .CA��P�iU 99 (J�,6T G�tl�t/rUG� MAILING ADORE e O • /sox (O�r 7 3. LENDING INSTITUTION PHONE e om� MAILING ADDRESS - 4. REALTOR/AGENT eaV /T x�/orn�� Sum G,�wo �✓ PHONE �9 s/97f/ MAILING ADDRESS � Iz D �P/Y�X 1914SiC4 99577 5. LEGAL DESCRIPTION } 1,d7-1 � " G/E� STREET LOCATION Ike- 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other J SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY l Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* *ATTACH WELL -LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - -77 YEAR ON-SITE SYSTEM WAS INSTALLED. INDIVIDUAL/ON-SITE** ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) j l \S( -G�� `— L -r U _J �.(/�-��-{�� C V 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 7 1. TYPE OF RESIDENCE ,1;2' —, SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE � THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY X INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED _ LOG RECEIVED ' 3. SEWAGE DISPOSAL SYSTEM P!IINDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED — INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTUREttFj TOTAL ABSORPTION AREA MATERIAL — 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line -- 5. COMMENTS r – z APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must c ompany certificate) CI—DISAPPROVED DATE f BY 72-010 (Rev. 6/79) EXCAVATION Century 21, Heritage Homes ATTEI\TION: Sue Gallion SR Box 126 Eagle River Road Eagle River, Alaska 99577 Dear Ms. Gallion, WORK May 21, 1983 Reference: Lot l-, Block 2; Parkside Subdivision ROBERT A.SHAFER CIVIL ENGINEER 694-2979 A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The absorption trench was tested by a continuous flow of water over a period of 48 hours without any adverseeffecton the system. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failure. If we may be of f rther service, please do not hesitate to contact us. Sincer R P. E. 4S/Wss cc: Municipality of Anchorage Department of Health and Environmental Protection SRB196X EAGLE RIVER, ALASKA ` (MUNICIPALITY OF ANCHORAGE �_/' ;Department of Health and Environmental Prot,Pct�idn, 825 L Street, Anchorage, Alaska 9950'1' Q51I 279-2511, ext. 224, 225 - - equest for Approval of Individual Sewer and Water Facilities Property Owner: T iMailing Address:,L: hone �! '9q d Name of Buyer: Mailing Address: Phone: :Lending Institution: - Mailing Address: Phone: Realtor/Agent:p� Mailing Address: Phone: Legal Description:��� Street Location: i Single Family Residence: (Dy Number of Bedrooms: ;Multiple Family Residence:' ( ) Number of'Bedrooms: Water Supply: *Individual Well ( Public/Community System (') If Individual Well, well deptha112 r If Community System, name'of system -�'' 8. Sewage Disposal System: On-site System 'If On-site System, date of installation: (p<) Public System ( ) i *NOTE: A well log is required on ALL wells drilled since 6/75, `\ !'1U1111t' iL1 17 U�"' IAN.MUN'Wi"- r (x) Public 3EPAR] ��IE�i 1` Or HEAL f}! AND Eii'J I kON(�F i�. T z?0TEC` 10 Installed IV— 825 L Street, Anchorage, Alaska X9501 � 632 279-2311, ext. 224 or �`] f Q®Q a .`anuiacturei_ Date Received.- August 24, 1977 8S Soils Rate ------------ Rate _-----�� Tine 10:00 a.m. i=2. Time u.3. Time Date= 8-26-77 Friday Date Date Insp Willis Insp Insp REQUEST FOR APPROVAL OF INDIVIDU .T, SEWER tNvD WATER FACILITIES ]_. Lending Institution Request.: Mailing M .ress: --hone: M.K. Jacobs Property O: -aver: M.K. 694-9940 Mailing Address- 619 Anvik Circle 99577 3. Legal Description: Lot 1 Block 2 Parkside Subdivision 4: Single Family Residence: (x) Number of Bedrooms: Two lultlple Far ily Residence: ( ) Zitiisb1, O: �i�C1YUG'tT',S: 5. well, System- individual. Wei -1 (x) Coi-LLt unity!Publi.c System ( ) Permit #, Depth of Wel.]. 250' Well Lc)a on File �() Construction utd� 2acterial Analysis Sewage Disposal Systema Clrr-.sit-e System (x) Public Utility ( ) Permit-, 4 Installed IV— Insi". i_1er � 632 Septic Tank Size f Q®Q a .`anuiacturei_ Absorption Area — 8S Soils Rate ------------ Rate _-----�� Lata _ � 7 .'.1- -i a l _40ewt, D.i.st Hees . 1e a.1 i;o Sr+pt _c "Tank t;) Sewer Line to Nearest Lot Dine Nearest 1,ot 1:in to Absorption Area Absorption Area. 1 Page, SW7 department of Health and Environmental Y.rotnct.i_a:n Request. for Approval. of Individual Sewer and C>.ater Facilities Legal. Description: �Lot_1 Block 2 Parkside Subdivision C 0 RWCc :it 3 : AffadaviI Attached: t' } Letter Att-ached: ( )