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RIVER VIEW ESTATES BLK 4 LT 4
171 i t; A( S 1.7 SMrWA � S I Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: X SSP Q 2 PID Number: 050-721-07 ❑ New ❑ Upgrade Name: RONALD & JOYCE DUDLEY ABSORPTION FIELD El Deep Trench El Shallow Trench ❑ Bed ❑Mound Address 6900 WATERFALL DR, EAGLE RIVER AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot RIVERVIEW EST 4 4 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field ( Tank Line FC Ft. well 104.7 I 125.4 ( N/A ( 100+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity I Surface Water 100+ 100+ ( N/A Gal. Material Number of compartments Lot Line 34.5 N/A 2 NA Foundation 41.1 I N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ N/A ANCHORAGE TANK/ORENCO 500 Gal. Remarks LEFT STATION INSTALLED W/O PERMIT BY Pump on level at 40 in. Pump off level at 36 in. High water alarm at 45in. JRs. PES IS DOCUMENTING INSTALLATION @ JRs REQUEST. TANK INSTALLED: 07/22/2013 Pump make and model P2005-1 Electrical Inspections performed by 907 ELECTRIC Installer PIPE MATERIAL House to tank Tank to SCH40 drainrield JRs SEPTIC Drainfield CO/MT Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 1 00f InspectionLocation 3/20/19 dates: 2" and description 3 d 4'" GARAGE FF COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp �G; OF. AC, � Conditional Approval: Date __j 49 TH Steven f�. E�annone n(� t� Approved (���rl Y Date y 9 q E8149 •� PRO �05 aI'j 44 9 19. PP ' f #,29641G „ V ,. ,...�1 — - A B LS 1 52.6 42.1 \ CONNECTED TO \ (E) DIVERTER AyqT� VALVE —M M —M 'I 1 1/4" PVC PI�4� 0?1 M M \ 3BR z7 HOUSE B O (E) 1 WELLE ` A `WELL (E) ( ) \ 3104.7* \ MEASURED IN FIELD 03/22%19 / Z5 L o = O O W O az Q Q mZ O O � WO c j U U D U 12.50 C TANK E \ INSTALLED ICO S DRIVEWAY T STATION LS TO PREVENT TRAFFIC — • . WATERFALL DRIVE PROFILE (NTS) NOTES: PAMONE ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 RIVER VIEW ESTATES, BLOCK 4, LOT 4 RONALD & JOYCE DUDLEY 6900 WATERFALL DIRVE PLAN EAGLE RIVER, AK 99577 49 TH .' Steven R. Pannone CE 8149 Dote 3/27/19 Scale 1"=50- P.I.D. "=50'P.I.D. NO 050-721-07 'ERMIT NO. OSP131078 Sheet 2OF2 4/4/2019 Mail - Customersvc@panengak.com 576093965475630CE1 F-A8B2-4AAO-B77D-B76244ED7742.j peg GO <merodavid@gci.net> —:Pannone Customer Service <Custoiiiersvc@pa.,ierigak.con-,>,- Qll L(TY -b�RIAIWS,;K-A N 5 W� _ ____...---- 0 CI �oln / Op . J �g,,•�" X22. i o,� 555 / 'OIn JPO e o 0 1-00 0 61- K 1N3W3Sb3 kvm>ilvM — (INV ),ii -1 n ,OZ ,LQ' bZ M c ZoZ I Io1P �3 D 1 0- z 9 wv N 1 , e� p L7 W "Y ctl C.7 C� LLC co m R (1; C\2� d H .-. .-i Q Z, -O MAC)M 0 ti. asM ., .. u d HOG W til ��•' E- u 00 % 03HS Qtr "11 w n 1,,�gs'4�a��s�a AMW :jof 1 (70041 Q3yS .l'Zt o� `, A Q%✓ ego JPO e o 0 1-00 0 61- K 1N3W3Sb3 kvm>ilvM — (INV ),ii -1 n ,OZ ,LQ' bZ M c ZoZ I Io1P �3 D 1 0- z 9 wv N 1 , e� p L7 W "Y ctl C.7 C� LLC co m (1; C\2� d H .-. .-i Q Z, -O MAC)M 0 ti. asM ., .. u d HOG z w n 1,,�gs'4�a��s�a AMW :jof 1 ® `, A Q%✓ ego Municipality of Anchorage �J On -Site Water and Wastewater Program • (907) 343-7904 _.. of ON-SITE WASTEWATER INSPECTION REPORT DEC Permit Number: OSP161325 PID Number: 050-721-07 Zd�B Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: RONALD & JOYCE DUDLEY ABSORPTION FIELD ❑ Deep Trench ® Shallow Trench ❑ Bed ❑ Mound Address 6900 WATER FALL DRIVE, EAGLE RIVER, AK ❑ Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 3 1 .2 GPD/SF 5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.4 Ft. Gravel depth beneath pipe 2.6 Ft. Subdivision Block Lot RIVER VIEW ESTATES 4 4 Fill added above original grade Varies 1.6'— 2.1 Ft. Gravel length 50 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 385 Ft2 1 -- Ft. Well -- 100'+ -- NA NA TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer EXISTING Capacity Gal. Surface water -- 100'+ -- NA Material Number of compartments Lot Line -- 10'+ -- NA NA Foundation -- 10'+ -- NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA *50'+ -- NA Remarks *None known. Diverter to existing field. Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank .' Tank to 3034 Installer JRs - Flintstone drainfield Drainfield 3034 CO/MT 3034 Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft Inspeection 1" 6/21/17 (3/21/17 Location and description 2nd ction 3'd 6/28/17 4'h IFF / Garage Slab COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL _Engin .W OF AI � Conditional Approval: Date , j `��' �`q'S"'Ill 1 r KENNETH Di.)li 'F' '� cC 0 7116 i Approved Date eer's Stam Inspection Report_9-1-12.doc AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW100001 RIVER VIEW ESTATES SUBDIVISI❑N LOT 4 BLOCK 4 PID# 015-082-21 U O W � A—C=129,5' Rss-.p F � w N o � R g.z��s� B—C=122,5' 0 o s A—D=131,5'79 gp FINAL GRADE 80,30 U B—D=124.0' �A—E=168,0' FM'M ``° B—E=165,0' o EXISTING N SEPTIC 75.80 75.80 m A—F=166.5' v TANK SEWER ROCK B—F=164.0' I 73,20 OF AZ4, '101* 4�Tx *, _I KENNETH CE -7116 1 r� G�10 / 1 �� \p �FESSIO�� PREPARED FOR: RONALD & JOYCE DUDLEY 6900 WATER FALL DR. EAGLE RIVER, AK 99577 FIELD BOOKS BOUNDARY: SLS STAKING: SLS ASBUILT: SLS DWG. RLE: ACAD RLE FILE 50' COMPUTED: DRAWN: BMW CHECKED: KMD DAME' 11/16/1 GRID: SW0357 JOB No.: 16231 VARIES _L_ T M GR�M vT� ®SRV. 10/20/16 66,20 BOH SCALE, NTS lui m . ................... .. S C HULZ o cc) PROP o 0 Q to Cil 0 CO (D CD CD C co a rIT, • • lui m . ................... .. S C HULZ o cc) PROP o 0 Q to Cil 0 CO (D CD CD C co a rIT, lui m . ................... .. 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: OSP161325 Tax Code Number: 05072107000 Work Type: Septic Upgrade Permit Effective Dates: November 23, 2016 to November 23, 2017 Design Engineer: ARC TERRA CONSULTING INC Subdivision: RIVER VIEW ESTATES Site Legal Address: RIVER VIEW ESTATES BLK 4 LT 4G:0357 Owner/Address: DUDLEY RONALD & JOYCE 6900 WATER FALL DR EAGLE RIVER AK 995770000 Site Mailing Address: 6900 WATERFALL DR, Eagle River Lot Size in Sq Ft: 44160 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field N 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. L cal Provisions: 100' separation between existing well and tank to be confirmed and umented on inspection report. If separation is less than 100', a waiver request will be required r to approval of inspection report. Received By: Date: //` Z /(/ Issued By: ldtYe G U7lL� Date: rl/.? MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-721-07 Property owner(s) y p RONALD & JOYCE DUDLEY Da hone 696-0895 Mailing address 6900 WATERFALL DRIVE, EAGLE RIVER, AK 99577 Site address 6900 WATERFALL DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) RIVER VIEW ESTATES BLOCK 4, LOT 4 S. 44160 S Ft N b f B d 3 Lot Ize q. um er o e rooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Single Family Absorption Field F Initial ❑ (SF) (w/wo ADU) Septic Tank ❑ Upgrade Duplex ❑ (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Code (Signature of property owner or authorized agent) Permit/Rush Fees: OD Date of Payment: 101.2 Receipt Number: 016 0 Permit No. QS/ �6�3o7S� Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. �RcTERRq F s � F ARC 1 1RR�1 CONSUIlPING, INC 212 E. 51 Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 October 24, 2016 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit — River View Estates Block 4, Lot 4 It has been determined that the absorption field of the subject property is saturated. Subsequently, the owner has requested we proceed forward to obtain a septic permit to upgrade the septic system. sm7w NOR11f The general slope of this lot is from east=to west at a grade of approximately 12- 16% over the septic area. On October 13, 2016 a testhole was performed to investigate soils and groundwater. The results of this test are attached for your review. The proposed upgrade will serve the existing 3 -bedroom single-family residence. We propose to install a single 50' shallow trench. Groundwater was not encountered at excavation or at monitoring. The property and adjacent lots are served by private water. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868- 3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. Du Attachments: On -Site Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/ Percolation Test 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 IWELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA RIVER VIEW ESTATES LOT 4 BLK 4 WELL RADII & EASEMENTS PRI❑R TO C❑NSTRUCTI❑N NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. Scale) 1'= 50' DESIGN DETAILS PAGE 1 OF 2 3 BDRM X 150 GPD = 450 GPD 450 GPD/1.2 GPD PER SO. FT. (2 MIN/IN.)= 375 SO. FT (375 / 5 x .64 RF (2.5' GRAVEL) = 48 FT. TRENCH USE 1 TRENCH - 50' (L) X 5' (W) X 2.5' (ED) Total depth of system Is 5' max from orlglnai grade. Total depth of gravel below distribution pipe Is 2.5' NOTES: 1. CONNECT TO EXISTING SERVICE LINE WITH DIVERTER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF ( 3' OF FILL. MIN, 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ. 3. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... PREPARED FOR: RONALD & JOYCE DUDLEY 6900 WATERFALL DRIVE EAGLE RIVER, AK 99577 696-0895 FIELD BOOKS COMPUTED: BOUNDARY -N A DRANK: BMW STAX'NC JLS CHECKED: KMD ASBIBLT: JLS DATE' 10/23/16 DWG. 111E DRID: cu,nxc� ACAD "" FILE doe No.: 16-231 WASTEWATER DISP❑SAL SYSTEM DETAILS RIVER VIEW ESTATES LOT 4 BILK 4 N � a w o � NM � FO^ a a S 88'03'02" E 'O� d) le- cl 31 ft -ft -740k N i ��. of AZ 4, * 49TH� ncl�lrnrn m.�urr a _ / . CE -71 Wq 1Y14e� / 1 ",�Osstall� Idw 41111,011h.--ft:40, LOT 5 ry 124.44' N� Q` �� CO I TH16-1 MZ rO Y X73 c FLAG ELL PRI❑R ro \nNc \ o0 ra W N PROPERTY LrNES I ,RADII & EASE EN S TO C❑NSTRUCTI❑N PREPARED FOR: RONALD 6 JOYCE DUDLEY 6900 WATERFALL DRIVE EAGLE RIVER, AK 99577 696-0895 FIELD BOOKS auaut . BOUNDARY: N A DRANK: STAKING: SLS WELKEU AMUILT: SLS DATE DMC. nL' GRID: ADHD nE: FILE 'IDB N..: SB\ 4' Scale; 1'= 30' PAGE 2 OF 2 WASTEWATER DISP❑SAL SYSTEM DETAILS RIVER VIEW ESTATES LOT 4 BLK 4 OF AZl Ilk * :4 TH fql EE CE -711 1 SS1oX� W LLL I\M 1JiI IX L -"J LI"IL1N 1 J PRI❑R TO C❑NSTRUCTI❑N Scalel 1'= Go' PAGE 2 OF 3 PREPARED F❑RI RONALD & JOYCE DUDLEY 6900 WATERFALL DRIVE EAGLE RIVER, AK 99577 696-0895 FEUD BOOKS cwwlEn: BWNDABY: N A MAW: STAKING: SLS CNECIQD: ASBUILT: SLS DAIS: DNC. 19M MID: ACAD " FILE .IDB No.: o �RCTE RR9 CONSLiL'1'ING, INC; T 212 E. 51" Ave, Anchorage, AK. 99503 Office (907) 868-3791, fax (907) 868-3793 SOILS PERCOLATION TEST Performed for: Ronald & 1, yce Dudley Date Performed: 10/13/2016 Project River View Estates Block 4, Lot 4 TEST HOLE a Depth Org/OI, GM/gp-sp mod dense, trace of silt A B.O.H.—damp / frac. bedrock 19 - HOLE PRESOAKED 20- PRIOR TO TEST ���\ �or' f�L� 1 st7 T KgSKE'I'll M. GFF , T / ?118 1 TF G \ >> H/Ly TH 16-1 SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 10/20/16 Reading Date Gross Time Net Time Depth to Water Net Drop 1 10/13/16 1:00 - 6" - 2 1:10 10 min 14/16" 52/16" 3 * 1:11 - 6" - 4 1:21 10 min 1" 5" 5 * 1:22 6" - 6 1:32 10 min 1 1/16' 4 15/16" 7 * 1:33 - 6" - 8 1:43 10 min 1 1/16" 4 15/16" 9 * 1:44 - 6" - 10 1:54 10 min 1 1/16" 4 15/16" II * IS5 6" - 12 2:05 10 min 1" 5" * Water Added Percolation Rate 2 (min/in) fere Hole Diameter 6" 'fest Run Between 4 feet and 5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. Community Development Department JAWge812M 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT lit Number 13 P J 3 10 7, -ID Number: 050-721-07 ❑ New ❑✓ Upgrad Ronald & Joyce Duc ress 6900 Waterfall Drive of Bedrooms 3 3SORPTION FIELD [:]Deep Trench ❑Shallow Trench ❑ Bed ❑ Mound to pipe invert from original grade lGravel depth beneath pipe EV 5 X. V%g rK ESf, L¢ lFill added above original grade Installer PIPE MATERIAL Housetotank 3034 drainfield 3034 A+ Home Services Drainfield C0/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspection sr Location and description f 7/22/13 d dates: 3'" 4;h Garage FF COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Approval: Date Gravel width Ft. Beds: Number of Lines I I Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area Ft' Number of trenches Dist. between trenches Ft. Well 105.9 N/A 116.3 N/A 45.7 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity I 1250Gal. Surface Water 100+ N/A 100+ N/A NA Material Steel Number of compartments 2 Lot Line 38.0 N/A 51.0 NIA Foundation 25.8 N/A 27.0 NIA LIFT STATIONManufacturer Capacity Gal. Curtain Drain N/A N/A N/A N/A RemarksTank replace only. Pump on level at in. Pump off level atTn h water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank 3034 drainfield 3034 A+ Home Services Drainfield C0/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspection sr Location and description f 7/22/13 d dates: 3'" 4;h Garage FF COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Approval: Date A B DC1 31.9 28.3 T1 39.0 31.2 T2 46.1 36.5 DC2 48.6 39.6 M \ No \ y 4 N �P\ \ N 3BR E _7 HOUSE WELL (E) WELL (E) A 3 \ l� \105.9 COLLAPSED 1250g SEPTIC TANK (E) ABANDON PER CODE \ �a �Gq�FFFq< C oR7�F NEW 12 O SEPTIC TANK INSTALLED DCO BEFORE AND AFTER TANK v DRIVEWAY WATERFALL DRIVE z / ¢oo z o Zug mug m, ug �G 0 (1 ou 0 U pU 1 97.9 G IL IL G 93A-� F NEW 93.2 \ SEPTIC C TANK NOTES:PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211�p ������\\\ - OF l Ikk ? C .........4 � �yf� '0 *: 49TH * f ...... .. ;. .' .. /) Steven 'R.' PannoNe �. CE 8149 $�� + _s fFPEQ' ••••'P`� III \ OFESi`=�•� Date /7/14 RECORD DRAWING score 1 "=50' RIVER VIEW ESTATES, BLOCK 4, LOT 4 RONALD & JOYCE DUDLEY 6900 WATERFALL DIRVE EAGLE RIVER, AK 99577t�I P.I.D. NO 050-721-07 PERMIT N0. OSP131078 PLAN sheet 1 of i On -Site Wastewater Disposal System Permit Permit Number: OSP131078 Tax Code Number: 05072107000 Work Type: Septic Permit Effective Dates: May 08, 2013 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 to May 08, 2014 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: RIVER VIEW ESTATES Site Legal Address: RIVER VIEW ESTATES BILK 4 LT 4 G:0357 Owner/Address: DUDLEY RONALD & JOYCE 6900 WATER FALL DR EAGLE RIVER AK 995770000 Site Mailing Address: 6900 WATERFALL DR, Eagle River This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 44160 Total Bedrooms: 3 N Private Well N Water Storage 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-721-07 Property owner(s) Ronald & Joyce Dudley Day phone Mailing address 6900 Waterfall Drive, Eagle River, AK 99577 Site address 6900 Waterfall Drive Legal description (Sub'd., Block & Lot) River View Estates, Block 4, Lot 4 Legal description (Township, Range & Section) Lot Size 44,160 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade 0 Duplex Duplex (D) El Tank El Renewal El Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorizze�edd� agent) Permit/Rush Fees: SCO I �gQ1BtAa Waiver Fees: Date of Payment: 451 b 1 3 cJ w� Date of Payment: Receipt Number: a:> -Ig CA Receipt Number: Permit No. ose i a N ens Waiver No. Permit App__ :L.:c. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com May 2, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: River View Estates, Block 4, Lot 4 Emergency Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1250 gallon septic tank be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a three-bedroom house and is operating adequately for three bedrooms. The existing 1250 gallon septic tank has collapsed and is exposing raw sewage to the environment. The existing tank will be abandoned per code. The surrounding lots are served by private wells, and there are no wells within 100 feet of the proposed septic tank. This lot is served by a private well that is over 100 feet from the existing drain field and proposed tank. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 4 slopes from southwest to northeast at approximately 15% in the area of the tank replacement. The proposed installation will be located in the central portion of the lot next to the existing septic tank and absorption system. Mailing: P.O. Box 100217, Anchorage, AK 9959.0-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501. Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Mailing: P.D. Box 1.00237, Anchorage, AK 99.510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 \—M M G \ 3BR \ v \ HOUSE WELL (E) WELL (E) 10 3 \ \ X702.3 COLLAPSED1250g SEPTIC TANK (E) ABANDON PER CODE NOTES: ANK REPLACE PLAN 1 PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 RIVER VIEW ESTATES, BLOCK 4, LOT 4 RONALD & JOYCE DUDLEY 6900 WATERFALL DIRVE EAGLE RIVER, AK 99577 �gT�'F9 1250g SEPTIC TANK (P) INSTALL DCO DRIVEWAY WATERFALL DRIVE y�P� Vr HC 4S��1f' /13 Scale ...... .... .. P.I.D. NO ........ ........ 50-721-07 "Steven R. Ponnone PERMIT N0. i P,,,•, CE 8149 ..;5k ncovvvvvv 1 OF 1 / - i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME P NEW S� qq ��11 —5024 /tC q' J Q`j'"LUA �NE ( yO �H �J'i'I d'(-�� ❑UPGRADE MAILING ADDRESS 31 0 1614LAAOLc P -1V LEGAL DESCRIPTION Lt,>T'4 P�LCrK 2w «�tJ 4 f +�I�ie�J LOCATION NO. OF BEDROOMS 1-1 LA/1f /2 �JA_TU�_' ALL_ D)ZWC DISTANCE TO: Well / O Absorption aha I Dwelling / PERMIT NO. U 1 ' _ � Z Manufacturer G n) k� Material No. of compartments W h t -l0 _ t= v' Liq. capacity in gallons IF HOMEMADE: Inside length AIM/v Width�. r 4 Liquid depth q AJ yT DISTANCE TO: Well ; Dwelling PERMIT NO. _j�Z z Q 2'h Manufacturer Material Liquid capacity in gallons O w DISTANCE TO: ryr� Wellt02_1 02_ 1 Foundation Nearest lot In / � �, PERMIT NO. zNo. of lines Length of ea cfz I' / Total length of I' i Trench-id(h %,W'� _ _ t nrte tween lines t Top rile to finish Material beneath rile Total fective absorpti area of grade / U d ltJ Length Width Depth W I Z`*- + A, VD 94f --WW gERMIT NO. W Q h a FLy Type of crib Crib diameter Crib depth oral effective absorption area DISTANCE TO: Well Building foundation Nearest lot line Class Depth riller Distance to lot line PERMIT®jP ���� e J DISTANCE TO: Building foundation or line Septic tank Abstpa°edPs AV I OTHER oo ° ao 000 ®e PIPE MATERIALS ���pn �, �•n^. j [RiY✓-+' 1 d, ® eoo o 00 THOMAS 00 000 °eo "jy 1 SOIL TEST RATING 15-0 Z(Re- e 8-E ° [ ,+ °2?_ ooeaooe .� INSTALLER C ``,, '� I�WOW REMARKS l2)1 :US�LL-> S P[7 ._ lI� L SAI �j�J A) 0 -� C!� '77 Dom/ S IUL) �7, �r� r S OP ANCHOPME MUNICIPALITY —B- 1. 0- HEA ENWRONMENTAL PROTECTION e LIE APPROVED DATE LEGAL 72-013 (Rev. 3/78) ' 11-1 U1 �� �������������� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PR01"ECT10N ' 825 L STREET, ANCHORAGE, Al-, 99501 264.-4720 ID 644_: E3 I -V EE, �EHE 11,4 EE: FZ0 Rc W � ���P1 1 -IF �� PERMIT NO: 84 0 56 3 ENGINEERED DESIGN DATE ISSUED: 07/11/84 /�PPLICANTu, SUZANNE OSMUN ADDRESS: BOX 9431 HIGHLAND RD E"AGLE RIVER, AN: 99577 CONTACT PHONE: 278~3968 LEGAL DESCRIP: SUBDIVISIOW: RIVER VIEW ESTATES LOT: 4 BLOCK: 4 SECTION: 20 TOWNSHIP: 14N RANG�: 1W LOT SIZE: 44i60 (SQ^FT. OR ACRES) certify that: 1" I aW f@0iliar with the r8quip(a0eQts for on�sito sewers and wells as set forth by the Municipality of Anchorage (M0A) and the State of Alaska. 2^ I will inst'-all the in accordance with all M(..)A codes and r8gul.ationF/, and in compliance with the design criteria of this permit. 3" I will adhere to all MOA and State of Alaisl<a for the sgt back: 6istances [rom any existing wellv wastewater disposal.system or, public sewer�o system an this c/r any adjaCent or nearby lot. IF A LIFT STATION IS INSTALLED 11\1 AN AREA COVERED BY MOA CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION 111.)ST BE OBTAINED; (2) AS�BUILTS WILL NOT BE APPROVED WT.THOUT AN ELECTRICAL T.NSPECTION REPORT; nND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICEN8ED El ECTRUMAN" ' SIGNED DATE: �/ � __~_�~ -�-�-*~�r�-7�-- APPLICANT: SUZANN ISSUED BY MIT'.~ / � � MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION n ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NA ME ` �— -^.�)�-�.._.L�___�.—'—.�.-..�. PFIONE � NEW 71UPGRADE MAILING ADDRES c LEGAL DESCRIPTION c� - LOCATION NO. OF BEDROOMS U DISTANCE TO: AI WellAbsorption J area r Dwelling i PERMIT NO.� Y p z W Q -__ Manufacturer ,�— y Material No. of compartments U) Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ®� z DISTANCE TO: Wel �1 /¢i Dwelling PERMIT NO. 02 h Manufacturer Material Liquid capacity in gallons w x DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. IL z Z w aTop No, of lines Length of each line - 3 / of file to finish grade � •4J / Total length of lines eh -width _ __ , _/ , E Ie1Ch9F Material beneath rile J .r K .-._ a inehes Distance between lines / _ ern Total e�ecive adsorption area W Length Width Depth -- PERM T NO. C7 Q F- Ulu Type of cri Crib diameter Crib depth Total effective absorption area -- w N DISTANCE TO: Well Building foundation Nearest lot line Class 041124 Depth Driller Distance to lot line PERMIT NO. w 3 DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER PIPE MATERIALS SOIL TEST RATING -7 (�) e INST LLER REMARKS — CQ_ XS rQ��CC I nn I APPRJ ED DATE LEGAL - - - ' J f3 'o nim ITS..,; ' /iQi --IF ll..�Dl W ��KID �F::-'j C_ -'i Ez- � DEPHRTMENT �, HEHLTH HND ENVIRI'D NMENTHL , JTECTION l� 825 'L/ STREET/ HNCHORHGE/ RK99501 264~472121 � I � 0 !Ehr R... L. Q 14 KJ 010 1 hl -0 3: -T ��1 Ez`. I F :11,-. -T, PERMIT N ( 8]0 508 ) HPPLICHUT' POE REHLTY/JIM RD 99502 LOCHTION LEGHL RIVERVIEW ESTHTES L4B4 LOT SIZE 999999 SQUHRE FEET TYPE OF SOIL HBSORPTION SYSTEM �S� TRENCH MAXIMUM NUMBER ING (SQ FT/BR)= 130 THE REQUIRED SIZE OF THE SOIL 0BSORPTION SYSTEM IS� � �JHL 144���� ��F- ��� � \ ` 4~� THE LENGTH DIMENSIO S THE LENGTH fN FEET/ Of' THE: TRENCH �R DRHINFIELD. ��--^�� THlz I]:lEPTH OF Fi TRF -.NC OR PH' IS THE 1`1 !z;URFHCE OF GROUND AND THE BOTTOU OF THEE�CHVHT IN FEET)- THERE IS t-10 SET`WIDTH FOR TRENCHES� THE GRHVEL DEPTH IS THE MINIMU� DEPTH �F GRHVEL BETWE�N THE OUTFHLL PIPE. HND THE `OTTOM OF THE EXCHVHTION (IN FEET). / ���..... L_ CH�� PERMIT HPP ICH T HHS THE RESPONSlGILlTY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLATION OF MAY HDJHCEAT TO THIS PROPERTY HND THE NUMB�R OF RESIDENCEW THAT THE WELL WILL SERYE. .,:: on 3: 1"1 C'. C --:1F I H:. -:Il VA d I lr�: FEE ��E C g 0 _.. B F.E.- F. BHCKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS DEP�RTM��T WILL BE S, UB -JECT TI -D PROS�CUTION MINIMUM DISTANCE GETWE`EN H WELL HND HNY ON�SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H I.-TITWELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE\ FROM H PRIVHTE WELL TO H PRIVHTE SEWER LINE IS 25 FEET HND TO H COMMUNITY IS 75 FEET. WELL LOGS H QUIRED FIhID MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DAYS OF THE WELL MPLETION, OTHER REQDSIMENTS MY HPPL? SPECIFICATIONS HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION. ��Pell 1- -1— &XV X 1 C. :, -���0 � .—: E I - � I E , F: F :J��� I CERTIFY THHT 1: I HM FHMILIHR WITH THE REQUIREMEHTS FOR ON --SITE SENERS HND WELLS HS SET FORTH BY THE MUNICIPHLlTY OF HNCHORHGE 2�I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES. ]� I UNDERSTHND THAT THE ON—SITE SEWER HRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN 4 BEDROOMS- ^ HPPLICHNT JIM BHXTER (/ ` ISSUED B.DHTE.... ..... s & s AMEN N IR NC SOILS LOG 7125 Old Seward Hwy. Anchorage, Alaska 99502 91 PERCOLATION 349-6561 TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR: f �I{ ��-{7/S� A) :�?ENA-Rl[%�V�ITE PERFORMED LEGAL DESCRIPTION:T— S� Upc SITE PLAN DEPTH-._ --' - -r--- _ -r-. o - (FEET) D bi GANIC SIF r f f "- -- -� I I Ur'r v 5.5' SANby GRAVEL W/ N �o - - - — 2 � /,�.ol TRACE t'o 5or'nE 51e -T SI=R S 1-- --I -I gc E __ 3 o•.J,.oIGO ., 4 �savLf� �s Rry - - — IVE // - -- n//.e'.�,i 6 K pE Mo IST, SUbf<Np/ 6V(. mesio T / Q F -fQ 5 ��%i 0' �� JZ, ! I 1 6 12,0 iANDY` &f6AVEL w/ f. J -;;^� bIt-T, SCA TTtRCD COBS-E5i 00Pl_Y G1;APLL�/ OIST,SVBKND, 8. ��S SDI' E �T/TlFilfi TION 9 10 11 12 13 14 15 WAS GROUND WATEF: ENCOUNTEREW T sr- ➢ T' TF -S T_ I P o� I I i i E I I I i I IF YES, AT WHAT DEPTH? ; - LO LL/1_ri$L/LGrfl' (�_rraFEREN�E mq Date _- G: oss __.-. NH,- Depth rn Nei Read Time Tune 1 Wates Drop 5- 11:33 53 ?0 PERCOLATION RAT f`. 6__ ___-_-__-_(muiwesimc 10 TEST RUN BETWEEN FT ANn COMMENTs__p���_J_5 _U1-�1_f�"E`7FJ -._yam 15Tv(2[=-v2[iLT_j3/..__ --- PERFORMEnrs7lctt- CERrII lE��f� �; ..✓ ,, r��+u�r. - - .a:.�..0 w.�.=•xaG rn - a- n -.n -s - ✓�-/s .f ..�' 4F+mKa�toKy- wT iGic rr-ate_?.._7V�r8,IGI/4r V_. ;.•.-.r rijy- .,�2_ b i:•:.rJsd...'•.6?b;`fig'-�1;•.+`'-`-•H?'%T.a`ctld"-,i•��'i /SOIL LOG t SOIL LOC'r I PERCOLATION 7125 OLD SEWARD HIGHWAY PERCOLATION T EST z BEDROOMS ANCHORAGE, ALASKA 99502 (907) 349.6561 JOB NUMBER:_ PERFORMED FOR: � <_ OSMUn!_ — - _ _ _ __ DATE PERFORMED: _� _MA_Y��____ LEGAI. DESCRIPTION: L-oTT 3LX 4 �. `-1VEAV (r—w —� SLOPE SITE PLAN O _as ��c-nulcs 0L z 0,5--5.0 --avb wl� SP 2 f'•0. Son,c GFAVCL 17PACE SILT nuasr I PoOkL-j C eApE�j 1 _<,-ATrLz1=D m 3 � COgPL1S � &Ut_ -r �a8�s R�c,wD17� 4 - -1 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Jam, O - �, s WC�1"T3-ICR As r=�� GP PLLE-r� � t � I L.� S FI A �� I Qnf6 UTAYL 00���Q �l 4> q w 0 %ono a ° °Dome ° 00°O JOO SMITH , C WAS GROUND WATER / O ENCOUNTERED? IF YES, AT WHAT DEPTH? S L O P E I X w N C WAS GROUND WATER / O ENCOUNTERED? IF YES, AT WHAT DEPTH? S L O P E Reading Date Gross Net Time Time Depth to Net Water Drop /1 EP 1/ �I DEPTH PERCOLATION RATL— V r (minuteslinch) (FEET) TEST RUN BETWEEN _0� �. FT AND _.O FT COMMENTS PERFORMED BY: _—!'1._d..lw ry (.S.J cL _.__— __ - CERTIFIED BY. - _.__ ___ _- _. DATE: 72 W8 1983; S Gross Time & ENGINEERS, INC. S �/ 7125 OLD SEWARD HIGHWAY ANCHORAGE, ALASKA 99502 (907) 3496561 SOIL LOG PERCOLATION TEST 1 ---"SOIL LOG v t'ERCOLATION TEST 2' - BEDROOMS c I I •' JOB NUMBER:.-F�QS-! ----- PERFORMED FOR: SUz�4-AIA ('/I�(-unl- _- --.----_-_ - _- DATE PERFORMED: LEGAL DESCRIPTION: C-. Gl.- �,� SLOPE SITE PLAN Un. ell z�--k .S. li, Fro cee,� EJ. y y ` t ° 4 5 ��c5e .Sn,. c'•. 6 7 s ., 13 14 15 16 o �-7-0 /crec� /=.osi B�ck�?f /7��C I(A5Ck! Lcss G(JNcal%ereIX BecQrocl: WAS GROUND WATER S ENCOUNTERED? L P E IF YES, AT WHAT DEPTH? -- C -1 r Reading Date Gross Time Net Time Depth to Net Water Drop d r �J k� J &2, / O e )) C -1 r Reading Date Gross Time Net Time Depth to Net Water Drop d r DEPTH PERCOLATION RATE_ — _ �__/_ r�—_. _----__-- (minuteslinch) (FEET) p n TEST RUN BETWEEN —. FT AND _.. �__ - FT COMMENTS P_G-E-O ar_Ll 'PG110.QL PERFORMED BYCERTIFIED BY _ _ _ -. _ DATE: >: noe ase_ 7125 OLD SEWARD HIGHWAY • ANCHORAGE, ALASKA 99502 Home Savings & Owner/Builder Loan Program Attn: Debbie 535 E Street Anchorage,Ak 99501 Re: Lot 4 Block 4 Riverview Estates Owner: William & Suzanne Osmun Dear Debbie: This engineering firm has been retained by the owner/builder of Lot 4, Block 4 Riverview Estates for the purpose of evaluating the septic system currently on the lot. We are familiar with the number of problems that have occured on site over the past six to nine months in reference to the septic systems, but we find that the last system which was installed is at this time usable and appears to be providing waste disposal service to the current occupants. At this time of year it is extremely difficult to construct a new drainfield in that the frost depth is approximately 3Y2 feet in most areas. In addition, opening up the ground at this time and subsequent backfilling could result in a higher degree of susceptibility to frost for the new septic system. The owner has requested our professional services at such time in the spring as it again becomes feasible to do additional soil tests as well as any septic system designs as may be necessary for this lot. The present system appears to be temporarily usable. However, to what extent and for how long a period it remains usable is an unknown. There appears to be some areas within the lot that may be suitable for a new septic system when the spring construction season arrives. At such time as a new system is installed and meets all Municipal requirements we will again contact you and notify you of the conformance of this lot to the Municipal Health Department Guidelines. WASILLA ANCHORAGE SOLDOTNA (907) 376-3770 (907) 349.6561 (907) 262-9534 If you have any questions regarding this lot or the septic system, either existing or proposed, please feel free to call me 349-6561. Sincerely, David A. Stanley Geotechncal Manager DAS:WCH:wel 3A cc: Suzanne Osmun Box 9431 Hiland Road Eagle River, Ak 99577 /,;z 8/.0 J ` L/o13 S6�+r�10 /t aT CAp X.) \ ? _• or16 e L > L ENGINEERS.IMC. p � see; e., ;: ,• :, t .t 4,44 % ?•_;_ e ., 20 ? /7" G%w!s e-ow�ecf-!J \ ,p\ t "11,. 5o14 Put a N s +tl.L ALC 0. WOOOO PR v 2 1P cF iys; ! (J \ N0l)5� _- N NcP ac-cer/,4/ f",t'J�' J°r 3� N a•`P f I� 0 /U Ct• Wer prn.^ ! \ JAj s 8-1 00 2`{ W 246.50 0 w�`r E FZ F L DR —n— a ZCCaT. _3 05 NO.; ars o7 /%%vrt •urc r+rr .r 71 re�a/c%eY a(DOK. rD—IZg JOB NO.: 504-C7 n ,. <:nC co✓¢rarY ..<J.>''/i Gra,�c/ ZONED La,ad fe//%.Per, E/FR. GI_IErJT•: OSMUIJ SCALE: I" - 5p` I PLOT PLAN: AS—BUILT: x GRID: 35-1 DRAWN BY: MG CHECKED BY.V-e 7 IS & S E N C I N E E R S, I N C . 7125 OLD ANCHORAGE, ALASKAW99502 I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY, LOT 4 , BLK. 4—, RIVER VIE'VJ e5TAT>~SANCHORAGE RECORDING DISTRICT, AK., AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT 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 THIS 30+"DAY OF _JAQ. , 1984, ANCHORAGE, ALASKA. IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. Ar B f. 'o e �H ••, i7F M•MT.y••a„.L.e� JOHN E. SWAPSON ; q� POLS -3152 y� t�N�••.• ,. �, 7125 OLD SEWARD HIGHWAY • ANCHORAGE, ALASKA 99502 January 30, 1984 Municipality of Anchorage Department of Health and Environmental Protection 825 "L" Street Anchorage, Ak Attn: Cory Willis Re: Riverview Subdivision Lot 4, Block 4 Conditional Approval for Septic System Gentlemen: At your suggestion we are submitting to you a sketch and a septic systern inspection form for the subject property. These documents and the comments below should provide you with sufficient information to grant a conditional approval for the septic system on the subject property. It is our opinion that the system is adequate for a single bedroom house. 2. The system should be excavated in the spring to verify depths and dimensions. 3. Perc tests should be performed in the spring to verify the soil rating and to fully characterize the depth to bedrock in the area of both beds. 4. The second bed (17' x 181) may have to be abandoned in the spring if shallow bedrock is encountered. Bedrock was encountered at a depth of 5.0' at about 15' east of the systern in a test pit excavated in the fall of 1983. The bedrock surface is thought to dip down to the west, but this needs to be confirmed in the spring. 5. Should the homeowner wish to upgrade the system to more bedrooms in the spring, a new perc test should be run to properly size the systern. WASILLA ANCHORAGE SOLDOTNA (907) 376-3770 (907) 349.6561 (907) 262-9534 Riverview Subdivision Page 2 6. The following items should be addressed in the spring in order for us to certify the system as -built: a. Verify depth of system. b. Complete final grading to establish depth of cover. c. Install any missing standpipes. d. Abandon any part of the system which cannot be brought to MOA standards. In summary, it is our opinion that this is a workable system which will function adequately. Dimensions of the system should be verified, but we feel that the system is in substantial compliance with the regulations. The homeowners have made extraordinary attempts to bring this system into compliance. They have spent thousands of dollars to this end. We realize that the cost of the system is of little consequence to the Municipality, but wish to point out that the Osmuns have made every effort to comply with the requirements. The system would be complete now had circumstances not conspired to prevent it. Should you have any questions regarding this matter, please do not hesitate to call us at 349-6561. We will be happy to meet with you or talk to you at any time in order to expedite the resolution of this matter. Very truly yours, J) - J/�� David A. Stanley Geotechnical Manager DAS:wel 5A Job 83057 J a S ENGINEERS, INC. h�o�rvnA1 'F TF�iPro�t \O� E CTR 40oKJP 1E ZOY.I FOR \ LvIA'� oS ¢pf�Ic an IC I ' 1, 25."1 �.' vl s 1 00 49 ' W 246.50 C~ 57kND?idFS crR r� - Y Boole. : �- 129 JOB NO.: ZONED GLJ EDIT: c�.SMurJ SCALE I" = Fj�' PLOT PLAN: AS—BUILT: GRID: 35-1 DRAWN BY: MG CHECKED BY7125 OLD SEWARD ., S& S ENGINEERS, INC ANCHORAGGE, ALASSKAW99502 I HEREB-'__CERTIFYTHAT I_ HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY, SLOT 4 BLK. 4, F�JVEF_yI�W ESTATF4ANCHORAGE RECORDING DISTRICT, AK., AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT 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 THIS ?G4hDAY OF SEPT. . 1983, ANCHORAGE, ALASKA IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey WATER WELL LOG Revised 08/18/2016 Drilling Started: ____/____/______ Completed: ____/____/_______ Pump Install: ____/____/_______ City/Borough Subdivision Block Lot Property Owner Name & Address Well location: Latitude Longitude Meridian ____________ Township ______ Range _______ Section _______ , _____ 1/4 of _____ 1/4 of _____ 1/4 of _____ 1/4 BOREHOLE DATA: (from ground surface) Suggest T.M. Hanna’s hydrogeologic classification system* https://my.ngwa.org/NC__Product?id=a185000000BYub3AAD Depth From To Drilling method: Air rotary, Cable tool, Other Well use: Public supply, Domestic, Reinjection, Hydrofracking Commercial, Observation/Monitoring, Test/Exploratory, Cooling, Irrigation/Agriculture, Grounding, Recharge/Aquifer Storage, Heating, Geothermal Exploration, Other Fluids used: Depth of hole: __________ ft Casing stickup: ___________ft Casing type: __________ Casing thickness: _________ inches Casing diameter: _________ inches Casing depth: __________ ft Liner type: _________ Depth: _____ ft Diameter: _____inches Note: Well intake opening type: Open end, Open hole, Other Screen type: _________, Screen mesh size: ____________ Screen start: ________ ft, Screen stop:________ ft, Perforated Yes No Perforation description: Perf from: ________ ft, Perf to: _______ft, Perf from: ________ ft, Perf to: ________ ft Gravel packed Yes No Gravel start: ______ ft , Gravel stop:______ ft Note: Static water (from top of casing): _______ ft on____/____/_____ Artesian well Pumping level & yield: ______ feet after _____ hours at _____ gpm Method of testing:__________________________________________ Development method:______________ Duration: ____________ Recovery rate: _________ gpm Grout type: _________________ Volume __________________ Depth: From ___________________ft, To ___________________ft Final pump intake depth: __________ ft Model: _______________ Pump size: _____________ hp Brand name: __________________ Include description or sketch of well location (include road names, buildings, etc.): Was well disinfected upon completion? Yes No Method of disinfection: Was water quality tested? Yes No Water quality parameters tested: Well driller name: .................................................................................. Company name: ................................................................................... Mailing address: .................................................................................... City: __________________________ State: AK Zip: ___________ Phone number: (________) ________- ______ Driller’s signature: Date: ______/______/_________ Anchorage Municipal Code 15.55.060(I) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City within 30 days of well completion. City Permit Number: _____________________________ Date of Issue: _____/____/_________ Parcel Identification Number: ______-_______-________ *Guide for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: https://dnr.alaska.gov/welts/ OR email electronic well logs to dnr.water.reports@alaska.gov North 20 1 PO BOX 110378 4 WAYNE WESTBERG RONALD & JOYCE DUDLEY , AK M-W DRILLING INC 61.2828 001W 0.0 2.0 18.0 4 907 16 67.3 200.0 18.0 2.0 6 n 5 20 1976 -149.4831 n BEDROCK SOFT SHALEY BEDROCK BLACK SILTSTONE ARGILLITE MEDIUM HARD WATER SEEPS IN SPORADIC FRACTURES WITH MOST OF THE WATER PICKED UP FROM 180 DOWN ORGANICS 200 39194 345 4000 EAGLE RIVER RIVER VIEW ESTATES 2 n ANCHORAGE n 99511 416 S 014N 39194 ji I 11 11 ]1:.::. MUNICIPALITY OF ANCHORAGE Development Services Department i { Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 050-721-07 Certificate of On -Site Svstems Approval Expiration Date: Legal description RIVER VIEWESTATES BLK 4 LT 4 Site address 6900 WATERFALL DR Eagle River AK 99577 Current property owner(s) DUDLEY RONALD & JOYCE X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: B Original Certificate Date: _5/3/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-721-07 Complete legal description River View Estates Block 4 Lot 4 Location (site address) 6900 Waterfall Dr. Eagle River, AK Current property owner(s) Ronald & Joyce Dudley Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: �/❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 10 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Well to Tank LVr., L L '1� j �> $� r' --i 6-L p Distance: 97' Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ -15-50 Date of Payment/zs�3 COSA #23 I I Oc8 Waiver Fee $ 1 (gO Date of Payment Waiver # O� 112 3 J OI COSA Application—June 2022 COSA Checklist Legal Description: River View Estates Block 4 Lot 4 Parcel ID: 050-721-07 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 5/20/76 Total depth 202 ft Cased to 67.3 ft 0 Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 4/19/23 Static water level at beginning of test 27 ft Comments B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 10/19/22 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/21/17 ❑ ALL standpipes present per record drawing Total measured depth from grade 6.6 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. P/1 Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies COSA Checklist June 2022 Well production at time of test 6.0 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes © Nc ❑✓ Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L./❑ Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 4/12/23 C. LIFT STATION ✓❑ Required maintenance completed Age of lift station 4 years Lift station material Comments Adequacy test date 4/19/23 Results 0 Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 0 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 31.2 in Effective depth used 0 in Effective depth remaining 31.2 in 0 E. SEPARA190N DISTANCES From Private Well on Lot tri: (Please enter distances if Less than required of iff comf nunity well on lot) Septic Tank/Lift Station on Lot > 100' Cornmurifty Sewer nhole/Cleanout > 100' DjYes tf No 97* ft 10 Yes- if NO ft NeJohboring Tank > GO' 0,/ Yes if No - It Private Sevier/Septic Line > 25' E,/1 Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank> 1 GO' Yes f No fi Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No- ft Cv] Yes if No ft Marluf-JAnimal Excreta Stomge 100' Community Seyder Main > 75' 0/ Yes if No ft I Ye's if No it L '-I N/A - Served by Community Wall (not or, lctj or Public 'Atater From SetrAc1Ho1dlr-@ Tank and Abso-gptRm Field s) ors Lo' Z to: (Please enter dila r%mss if less than required) Building FourrJathns > 10' E,/j Y & s if No ft Surface Water? IGO' 21 Yes if No ft Tank to Property Line > 5' Eil Yes if No ft Wells on Adjacent Lots, FieW to Pmperty, Lire Its' Of Yes if No ft Private Wells > 100' Yes if No Ift VVater in > 10' 0 Yes is ft Gommunfty Wells > 200' Yes if N19 11 Water Service Line > 10' 2 Yes if i4o It If tank or field isz under drii�ee4aycornme-it below F. ENGIN EEWS CONAIMENTS *Waiver recluesLed, G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my sea[ a and as of the validation date shown below, I verffy that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines. indicates that tl'*,;e on-site viate, supply andlor wastewater disposal system appears to cornplj with applicable Municipal and State Wales, ori inances, and regulations in effiect at the brie of installation, unless noted ottiervAse. Name of Firm ArcEer.a Con' ultilig Phone (907)-696-6111 Engineer's Printed NameKen-neM Duffers Date -Ty `ter 1 ER&ecr*s COMMIefit= This ink stir AtiOn WAS COMPleted in Compliance with ADEC and MOA rugulathms. s*%7221tt The 3%_,&mtrje0t of the condition of the well and sLTfic applies only to the corafilions as of the day testexL The flOw and aR rste- MMY ChanW due to subwriarc Conditions that imy anit be o fruet , Se 4,— T 0. 7orface,cliangus inland use, local -wit loeb that may thictuateduring (fit ye2r 4r"� X ��7 A And the crater utwgv of thieraluiLv wrvvd by the svuenlI lit sifter jdanal life of all swell ind icptic At* -_;y!itC11t% ArV!mbjCCt its these Varivul and dynanxic charactcriqOic, And are Outside the control tet tete en Auntorp arthe well And wittic wNim. Therrfort.Anircrra can ool give anv estiniatc,)f hoi,* IA"- a SNs;rnj will function satisfaLtory for curr=t or ftinre occupant, or can ArcTerm guamtee that no unseen den' -,F, encro2chunisits, denitles or dtWrepanch's exist COSA Gtia-kist_june 20M ARCTERRA CONSULTING, INC 20441 Ptarmigan Blvd. Eagle River, AK 99577 Office (907) 696-6111, Fax (907) 868-3793 May 1, 2023 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Tank to Well Separation Waiver– RIVER VIEW ESTATE BLK 4 LOT 4 In the process of obtaining a COSA for the sale of this property we have verified the as- built separation distance between the tank and well to be 97 feet. During your review, the distance from the well to the 1984 leachfield has also been questioned. We are requesting waivers be issued for the well to tank and leachfield distance of 97 feet each. The water samples on 4/21/23 show nitrates as non-detectable. The septic tank was installed in 7/22/2013 and the inspection report noted the distance between the well and tank as 105.9 but no surveyor’s as-built is noted in the MOA record file. The record inspection report for the 1984 leachfield states it is 11 feet wide and as the 2019 as-built survey shows the standpipe in that field to be 102.5 feet from the well, we are requesting an additional waiver be issued for the well to leachfield of 97 feet (11’/2 = 5.5’ to edge of trench from total distance of 102.5’). The existing topography of the site slopes northeast away from the well to the septic tank and further to the leachfield. An as-built survey was completed on 6/28/2017 as part of the leachfield upgrade but the waiver was not addressed at that time as no changes were made to the tank location. We do not expect there to be any adverse effects to the existing well or this septic system operations in the existing location. If you have any questions, please contact me at 696- 6111/FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. Duffus, P.E. Attachments: SGS Laboratory Analysis Report Schuller As-built t- Municipality of Anchorage _ I�epm•t,ncnt P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231016 COSA#: OSC231108 PID#: 050-721-07 Legal Description: River View Estates Block 4 Lot 4 Engineer: Ken Duffus, PE Applicant: Ken Duffus, PE Your request for a waiver of the required 100' horizontal separation from the septic field to well has been approved. The approved separation distance is 97'. Your request for a waiver of the required 100' horizontal separation from the septic tank to well has been approved. The approved separation distance is 97'. This waiver approval applies to the existing septic features 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 nonobjection 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 Gran _ 1 Date: 3 Z 3 Approved by: Name of Reviewer **** VARIANCE/WAIVER REVIEW **** '?y � MUNICIPALITY OF ANCHORAGE '0Gn • DEPARTMENT OF HEALTH & HUMAN SERVICES.�y �G �aTc� Division of Environmental Services "/" G, -y" O On -Site Services Section ;k P.O. Box 196650 Anchorage, Alaska 99519-6650 0 343-4744 /G Lo oy° �' G) CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING O �2 Parcel I.D. # 5_0D ' �7-2-1 -P7 HAA # ji ` A 9 4- 1. GENERAL INFORMATION Complete legal description Lot 4, Bloch 4 • Rivenview Ea.ta.t" Location (site address or directions) Waten6aU D)Live Property owner uRon and Cathy Webb 7 Day phone 696-1796 Mailing address Lending agency HC 85 Box 9441 Eagle Rivm AK 99577 Day phone Mailing address Agent Linda Banners/ REMAX OF EAGLE- RIVER Day phone 696-1796 Address 16600 Centen6ietd D)tive Unless otherwise requested, HAA will beh Id for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Riven, AK 99577 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 dat_of4Ns inspection. Name of Firm 5 & 5 mqGjNPERING Phone 17034 Eagle River Loop Address Engineer's signature Date_J //(/9 L,4 Y"p q y� "7 �1A o yr � sY. �'��► `" �.� o �� •!\ V. a00beV..4Y ppN6"IY� Y .� .. A. Sfwfa, i r r N,6. 1457.E : d A ap o 6. DHHSSIGNATURE / Approved for _� bedrooms. M_ Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments NUTIr The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-0250 .1/91) Back MOA N21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my, investigation of this Health Authority Approval application shows that the on-site water, supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from .my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & 5 ENGINEERI Phone 17034 Eagle It r Loop Roadft.204_ Address jivre' leska 995 Engineer's signature DateCo S /ti 04/U�!�E-d Ta d F Los NEED TO 13. //J.r7A Cfi�6, 74A 1/07 F,i?o U/.o�ZJ To Pl1l s • �/21 oA� .y xv y y sqy x it t Y " 4ilo /Cn6iC M),YOdJ.a vtl 0tl� pn.G eu ..er ar ;et, 6.. DHHS SIGNATUREo4W A. S11.;et. Approved .for bedrooms. ,; Ha. �as7.P a.. Disapproved.�aac�rQ�4 —� Conditional approval for bedrooms, with the following stipulations: �ON�Y S�//fLL Bre �L/�CFD IN 410?i6w rc fo�+PLETE TKE .g(joy,� STvt%Et7 WoRK oN ELLE AriFLk'AiER 2IJAOJ.9L SYSTEM THIS LoT- I.vol?,' TD bF Oif,01 E 7W0 b? N LATER ]771,1.y TU /L/974 Additional Comments Date-? - 2 2 - 24 The,Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Beck MOA 421 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: "T 4 6 (�AJ f�� \ f,'. Parcel I.D. A. Well Data Well type �(`��l rKt �� If A, B, or C, attach ADEC letter. ADEC water system number. Log present ON) Date completed Driller Total depth 202 Cased to 12�P�. Casing height Sanitary seal((Y 1) `/ Wires properly protected ON) Date of test FROM WELL LOG - _ - 20 --7 t Static water level �o Well flow 9 -p -m Pump levellyl�' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main b l7 AT INSPECTION �t "1.1 9 -p.m ; On adjacent lots � � Z ; On adjacent lots Public sewer manhole/cleanout Sewer service line S< l Petroleum tank 2S 1 WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: 3 — —'l lk B. SEPTIC/HOLDING TANK DATA Date installed '8 " l ' 164 Tank size � ZSR Compartments Cleanouts VN) Foundation cleanout Depression YQ AI t t d Y A, \J > , I D Other bacteria LIDS & S ENGINEERING r: Collected by: 17034 _.le .,ives, he -op Eagle Rivor, Alaska 99577 High water alarm (Y� arm es e Date of pumping ��� Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I \ On adjacent lots 1 0 0 \ Foundation t To property line \ o Absorption field j 2Lz� Water main/service line 1 �� Surface water/drainage 1":::> (_�> 72-026(3/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DICE FROM LIFT STATION TO: on lot On adjacent lots D. ABSORPTION FIELD DATA Manhole/Access (Y/N) " o off" Level at tested Surface water Date installed � — 1 — 2� 4 Soil rating (GPD/Ft2) I Sv fL System type TS� 6-t") 4t>) Length (9C�t Width 1 1 Gravel thickness D • S Total depth 3 •� Total absorption area Cleanout presentON) N) �Z _Depression over field (Y® ,-( Date of adequacy test t(' Result as ail) ?A --!5S for 3 Bedrooms Water level in absorption field before test C) N After test b N Peroxide treatment (past 12 months) (YO N o� 6- IZ-r( o l-,(Lj If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot L <D'Z k To building foundation On adiacent Int. On adjacent lots 1 e Property line To stin or abandoned s stem o I t g y no r 1� Water main/service line Surface water 3 Driveway, parking/vehicle storage area Curtain drain 4 r, - E. E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to Signature 5 & 5 ENGINEERIN 17,034 Eagle Rive o oa ( No. 204 Engineer's Name Date HAA Fee $ 6 Date of Payment i7 Receipt Number 72-026 (3/93)` Back and HAA guidelines in effect on the Waiver Fee $ inspection. Date of Payment Receipt Number �p- ROBERT SHAFER, P.E. ROGER SHAFER, P.E. Auud 11 1994 CIVIL ENGINEERS g , (907)694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Depan.tment o6 Heat,th and Human SeJ vices P.O. Box 196650 Anchorage, AK 99519 MAIN EXTENSIONS REFERENCE: Lot 4; Btock 4; R.iven.v.Lew Estates A Cond.itiona2 Health Authoni.ty Appnovai waa ,i33ued on Manch 22, 1994 SEWER&WATER Uon .the ne6enenced pn.open-ty. Att wonh. nequ,ined Uon. .the Cond-iti,ona2. INSPECTION H.A.A. has been compteted. Reque3t you issue a F.inat Heatth Autho)L%ty Appuva2 at th,%3 time. ENGINEERING STUDIES I[11 you have any questc.on/s o)t kequine any additional in6owati.on, AND REPORTS ptea6e contact us. S,incen WELL INSPECTION & FLOW TEST OB A. S AFER, P.E. SITE PLANS SIGI ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL_ INSPECTIONS ONSITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # HAA # VA qc� cc-D"o 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Wager Fall Drive (b) Property owner AHFC Telephone : (home) Business Mailing Address #52343 G 11rY (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone JACK WHITE Co./ Lori Crowder 10928 Eagle River Rd., Eagle River, Ak. 99577 694-5500 (e) Mail the HAA to the following address: (or check here A if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family � 3. WATER SUPPLY Number of bedrooms 3 Individual Well E� Community ❑ Public ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Q Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING 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 129-Z97 9 "s & S ENGINEERIN Address 17034 Eagle River Loop Road No. 204 Eagle River, Date ©F . • A• •�11R117e � r '• YNa. 1457-9 .' V 6. DHHS APPROVAL Approved for 3 bedrooms by Date le y _'MZ Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) ® Health Authority Approval (HAA) j CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: L",- �i �•x Q A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present4�Y7N) _ Date Completed Total DeptK Cased to 1L2 Depth of Grouting Pump Set At (3V� Static Water Level Casing Height Above Ground -;5" Yield lj:�_> . o Sanitary Seal on Casing -\PN) Electrical Wiring in Conduite'N) Depression Around Wellhead (YN)� SEPARATION DISTANCES FROM WELL: / I To Septic/Holding Tank on Lot k, ; On Adjoining Lots (. CDC) To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots I To Nearest Public Sewer Liners To Nearest Public Sewer Cleanout/Manhole rJ 1 Z To Nearest Sewer Service Line on Lot �1 Water Sample Collected by � k l II ,CLIr=� ; Date Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date InstalledP�-1-4k' Size_J 5o No. of Compartments Standpipes �Y N) Air -tight CapsY N) Foundation CleanoutN) Depression over Tank (Y/Np r__1 Date Last Pumped Pumping/Maintenance Contact on File (Y/N), ollt� ; for F /1 Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well ( Qom) To Building Foundation To Property Line 1r--) -4— To Disposal Field �_Z_o To Water Main/Service Line 1 e To Stream, Pond, Lake or Major Drainage Course �a Comments �J"�S ������� ��'J i�l�� r In 72-026 (Rev. 7/88) From Page 1 of 2 C. ABSORPTION FIELD DATA // 101 Soils Rating in Absorption Strata 1'J��f Type of System Design 1ytt=fib Date Installed Length of Field �'fl Width of Field Depth of Field Gravel Bed Thickness aS Square Feet of Absortion Area YO X Statndpipes Present (YN) Depression over Field (YOR 1, Date of Last Adequacy Test 8 Results of Last Adequacy Test�— SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well ` off( To Property Line o'er To Building Foundation I To Exisying or Abandoned System on Lot -0' ; On Adjoining Lots To Water Main/Service Line To Cutback (if present) I-4 r� To Stream, Pond, Lake, or Major Drainage Course \ , To Driveway, Parking Area, or Vehicle Storage Area V > >C �— comments ,f"d ff D. LIFT STATION 7' Date Installed Dimensions Size in Ga Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pu C cles 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 ,; & S ENGINEERING 17034 Eagle River LOOP KOad No. 204 Companyagl� k'vlaska 99577 Date MOA No. C!� " Cx_;1 Receipt No. Date of Payment--( Amount: $ Receipt No Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 35 • ,�v ,,.y.. µ ' `y _ ineer �a 0 ° ..« bhp•=�• �,u , e Sr eeaae �ae�`�6�. F 0�E����.�a MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date May 9, 1988 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4; Mock 4; Rivet View Subdivi6-i,on oat 4" Location (address or directions) Wateh Fat_ D,tt i,ve (b) Property Owner AHFC Telephone: Home Business Mailing Address 052343 (c) Lending Institution Fi)tst Nationat Bank o{t AnchokUAphone Mailing Address (d) Real Estate Company and Agent JACK WHITE COMPANY/Loki Crowden Address 10928 iZiven. Road, Eagke Rivet, Ayaska 99577 Telephone 694-5500 (e) Mail the HAA to the following address: or: Check here 0, if hold for pick up. List contact person and day phone number below. S 9 S ENGINEERING/694-2979 17034 Eagte Riven, Loop Road Su,,Lte 704 Eapte R.iveh A&,ska 99577 on.den.ed by Lori Cnowdm 2. TYPE OF RESIDENCE Single-FamilyU Number of Bedrooms 3. WATER SUPPLY 3 Individual Well M 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 n 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 (Rev 81861 Front 5. ENGINEERING FIRM PROVIDING 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. / �y Name of Firm S & S ENGINEERING Telephone'Zq�9 17034 Eagle River Loop Road No. 204 e2 Address ^°- -_ •' - -a-- .,,.r.,.. Date N 6. DHHS APPROVAL 4 J - _ (/�a ``fit Date Approved for f? bedrooms by Approved ✓ Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8i861 Back cN0-N s�o . OF MUNICIPALITY OF ANCHORAGE (MOA) r� y HEALTH AUTHORITY APPROVAL (HAA) �ZP\ CHECKLIST - FEBRUARY 1984 tig 264-4744 Legal Descri tion: f" A. WELL DATA Well Classification ! h3�P1 J i f�e9�� �- If A, B. C, D.E.C. Approved (Y/N) Well Log Present CI) � Date Completed '5 - _9�-:�l G, Yield ��� 6� Total Depth gjO'Z, Cased to �Z-�17 Depth of Grouting j Static Water Level Pump Set At \� u Casing Height Above Ground ��"U Sanitary Seal on CasingQSGN Electrical Wiring in ConduitV9N) V Depression Around Wellhead (YE1S6y Separation Distances from Well: To Septic/Se4i-Rq Tank on Lot e C3 On Adjoining Lots 1 FCD To Nearest Edge of Absorption Field on L t Lr7'l_ ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer ) Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by AFI + t�;6 Date r� -1I dt� Water Sample Test Results Comments ,l✓���>>v� -T<7� �f'a2tX� z -�a B. SEPTICIR"OCt)tfFJGG TANK DATA Date Installed f�) -Jt '"" A Size 1 0 No. of Compartments Standpipes &)N) — Air -tight Caps�%�N) —Foundation Cleanout Depression over Tank (Y( 1� Date Last PumpeB Pumping/Maintenance Contract on File (Y/N) H, for Holding Tank High -Water Alarm (Y/N) r� Temporary Holding Tank Permit (Y/N) A Separation Distances from Septic/H&k4ag_Tank: To Water -Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field 2-L', I To Stream, Pond, Lake, or Major Drainage Comments . 1�� C�i'� Page 1 of 2 72-026 IRov 8,W Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1 7 / (���— Type of System Design C L9 V-3 Date Installed Length of Field La t r Width of Field —�'�� �'`Depth of Field 1�72 lu o'1 :� t�"``v i b{ Gravel Bed Thickness 1 y Square Fe�t of Absorption Area / � � Standpipes Present C�yN) Depression over Field (Yd yJ Date of Last Adequacy Test Results of Last Adequacy Test C� Ic�G�t 'C�� 1 7? F�Cl— Separation Distance from Absorption Field: 1 To Water -Supply Well b" To Building Foundation 1 t Lot To Water Main/Service Line C-) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION J Date stalled / Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Property Line On Adjoining Lots C--, 1 4 - To Exist' g or Abandoned System on To Cutbank (if present) Dimensions Manhole/Access (Y/N) "Pump Off" Level at to t (Y/N) Pumping C�ycl ** Check Permitted Bedroom Rating Against HAA Request ** I,-)ot--)[G Adequacy Test. Meets MOA 1 certify that I have checked, verified, or conformed to all MOAand HAA guidelines in effect on the date of this inspection. Signed & S ENGINEERING C/ 1 ngc. 2�f�te Z 3 O CompdbAle River, Alaska 99537 MOA No. (!fFl— 00,3 hk Receipt No.—/ Date of Payment q 'Ay,Mxs °°?,*y` C+ O N"• ::,Y�r: Amount: $ % 2 �'tv d c3 S (4 Page 2 of 2 72-026 (Rev 8/861 esck �'1 b%Oext A. 9hA4_, SS °• •' �i7', 4` MMCIPALITY OF ANCHORAGE. DIVISION OF ENVIRON14ENTAL HEALTH DEPARTMENT OF HEALT11 AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ..I_�AIJ.C_-�� (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) s`' 4 tx"/..,5`76 n (b) Applicants Name ,�1J<�dNnL(= (f cja2Af__ Telephone Home Business m7. Applicants Address_ �.� C%L 'u%. -` .� 6!c_'r-PC t -A/< 9e7S7-f (c) Applicant is (check one) lending Institution [- ; Owner/builder ; Buyer Other (explain); (d) Lending Institution `s Tele one 4 W Address (e) Ileal Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2.. Type of Residence Single -Family F,77_� Multi -Family Number. of Bedrooms 7 3. Water Super Individual Well IR1 Community Other (describe Pu"b"lic L 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 52< Public Community I,= Holding Tank ELI 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 21 5. Engineering Firm Providing_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 oil -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 onsite water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm �sl iAlr / r1�.. , /K2 r" _ Telephonee��� Address�P�- Date _� (ENGINEER SEAL) 6. DHEP Approval Approved for bedrooms By Approved - Disapproved L`J ,,gym°16&00° (C✓)'. 101 o0e N ° ) rI &oe0/n/l 000 eaeu 0 4 ���016610 o°e 0o�- &� n^^AS R. SMI"fH ` 160 11° Conditional. CAUTION 'THE 14UNICIPALITY OI' ANCHORAGE DEPARTMENT OF IIEALTH AND ENVIRONMEN'T'AL (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THF, ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER IN THE STATE OF ALASKA. THE DHEP DOES TIAs AS A COURTESY TO PURCHASERS OF THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA CERTIFICATE IS ISSUED. THE; MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE OR 014ISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/DI8 PROTECTION REPRESENT - REGISTERED HOMES AND REQUIRE -- BEFORE A FOR ERRORS [Page 2 of 2 ] 7-n19-•84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AUG 3 1984 RECEIVED Legal Description: Lt -)r4- a-brk 4 Well Classification If A, B, or C, D.E.C. Approved(Y/N) NI -i - Well Log Present (Y/N) �(��_ Date Completed 2.6 mF}-q ,7 G Yield 4 C P/J_ Total Depth 2bZ Cased to Z2.3' Depth of Grouting N/'F Static Water Level -40 Pump Set At Casing Height Above Ground 205' Sanitary Seal on Casing (YLN) Electrical Wiring in Conduit (Y/N) 1(F S Depression Around Wellhead (Y/N)/.ILD Separation Distances from Well: To Septic/Holding Tank on Lot �p(�� ; On Adjoining Lots > ►off To Nearest Edge of Absorption Field on Lot_ 1Qp/ _ ; On Adjoining Lots >)fIn To Nearest Public Sewer Line ,S'� d ( To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot/U��� Water Sample Collected By M Date I Aue,_, 654 Water Sample Test Results ,�ATr5EAc_-g) T Comments B. SEPTIC/HOLDING TANK DATA Date Installed / gel � Size )2_6-C) K;+I, No. of Compartments Z_ Standpipes (Y/N) Ye S Air -tight Caps (Y/N) ycfg Foundation Cleanout (Y/N)YE: S Depression over Tank (Y/N) NO Date Last Pumped /Vt_-W` 5 V_5T&-20_ Pum/Uping/Maintenanoe Contract on File (Y/N) A ; for _ /1A Holding Tank High -Water Alarm (Y/N) /Q' 1A Temporary Holding Tank Permit (Y }/U Separation Distances from Septic/Holding Tank: To Water -Supply We 11 In U _ _- _ _ To Building Foundation To Property Line 2-0 / _- To Disposal Field j To Water Main/Service Line A] 14 To Stream, Pord, Lake, or Major Drainage Course A) /A Comments o 0 ,4p-6 -:;,, ?'? / 6 l (Page 1 of 21 2m15p$4 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /,5_0d/,6,< Type of System Design Date Installed Length of Field 6Q Width of Field jj Depth of Field Z- S SAA)6 A40uAv1�> G avel Bed Thickness 6" Square Feet of Absorption Area Standpipes Present (YM) YES Depression over Field (YM)f1(j Date of Last Adequacy Test /U IA Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Property Line 38 To Building Foundation GJ To Existing or Abandoned System on Lot )`7C) ; On Adjoining Lots > IC)O To Water Main/Service Line A) A To Cutbank(if present) S To Stream/Pond/take/or Major Drainage Course Al 1 4 To Driveway, Parking Area, or Vehicle Storage Area > /Pp Comments D. LIFT STATION 1UpT ,4P1O1-1C,446LC Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Continents Dimensions Manhole/Access (YM) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Gu Qies in effect on the date of this inspection. tOF A4N® 1�����Wa.ee000000 P_�f ®®® Signe Date U ( mac/ 67 Company _?,t JAJ 1AJG MOA No. ,S U0 -f d KB1 /d5/s (Page 2 of 21 MAS R. SMITH 2248-E t$3 AY 2-15-84 - APPLIC 'IT FIEFS OUT UPPED HX ONLY Pro /erty Owner (�1: t �,t-_ .`. " Phone Date .�<-`-:..(r Date { Mailing Address l f ./ i�-=fi- Zi Code p Buyer Inspector (� Field Notes:-- = Address P Zip Code Lending Institution a-, �.,„-,.. ..�- ��e- �.`%l�L 1 t�--� �” 4� !��52ane Pb ( )APPROVED BEDROOMS CONDITION OF APPROVAL 6Gb.°' ( )DISAPPROVED ` L _ (,� _ ,_—�'� -x_-.f- _ 04 -C ck% l�w� .42A Address rv.- `iia Zip Code - Realty Co. & AgentPhone Address Q" c7 Zip Code Legal Description Soils Rating Street Location ). � c� i • -(- ({1), r�}c r / ={ { l -� Ic' -,,: i' _ f , i r - }F type of Residence [`-,Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. log if available). Community For wells drilled prior to that date, give well depth (attach ❑ Public Utility Sewer Disposal ,X -.Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: — ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date { Inspector Inspector Inspector Inspector (� Field Notes:-- = QJ)C Q�g-o>z —{-cis-� �(� L_ • c� . '� �--f�' � ..1y� ( )APPROVED BEDROOMS CONDITION OF APPROVAL 6Gb.°' ( )DISAPPROVED ` L _ (,� _ ,_—�'� -x_-.f- _ GA -C ck% l�w� .42A ( }) CONDITIONAL. APPROVAL' /�y� DATE'S .. BY: Lam" l,�Jj �,�•„L'� �- / 1 -J.L/v.�.C1�� - -` C CJ � � Q" c7 Soils Rating Date Sewer Installd Well To Absorption Area tv d 7 Web og Received`-"� Well to Tank Septic Tank Size ]2023 (31tl2� 'q .0.25'0 kQ^ I'ot rt' (ilu""k ",, idv(ar APOVOV'l 1. 1 oj,-, th('� j. no i- viou"t L .;-wo.r -I nd -ljitLof I�j"C.ilit-iot� C..".11(10%1)(I . r p:; In -Lmi unt. i 1, t I Io v("'J-Wkd ll(i i !--�u I iA'.; 12137 C: bcje ri cooploted � 0 dow" t, o 1 1 1 1, - I .. r pit or-ound t1w woll. c; iii I m asci,, i..() D" ittl if It p",r viou-.; p o soi 1. 'o ],It i I--.' rf vi t 11 wo-I I c a '.; J- cl o I: O11 i" il)(Al clet-mout. nood f� t - o I)o i. 1'1':i t-. a J lo (A to tho Spection IJlloll thc� r: rill Oi�lcrilparlcit2i; liilvc.'. .111: t}ir-,to are aw/ Cory I'd Act, ifili Prow.'-if!l I IS, C16 L-14- ' V\ C) 4 <7 r, i r - vO r - ) (.._1 (jC r - ) (.._1