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HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 5 LT 3 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221139 PID Number: 050-792-30 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name PAMELA & SAMUEL SNYDER ABSORPTION FIELD - EXISTING ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound ❑ Other Site Address 21290 FALLING WATER DR, E.R., AK 99577 Phone Number o f Bedrooms Soil Rating depth from original grade 3 0.6 GPD/SF JTotal -10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3 Ft. Gravel depth beneath pipe 7 Ft. Subdivision Block Lot RIVER VIEWESTATES 5 3 Fill added above original grade 0.34-0.47 VARIES Ft. Gravel length 54 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area 756 Ft z Number of trenches 1 Dist. between trenches NA Ft. Well 100'+ 100'+ 25'+ TANK N Septic N S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 10'+ 10'+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer GREER Capacity 1500 Gal. Remarks Existing septic system decommissioned. Alarm location FIRST FLOOR Electrical installed by RISING SON Installer DENALI EXCAVATING, LLC PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection dates. Is 9/21/22 2nd 9/23/22 Location and description 3rd 9/23/22 411 9/30/22 TOP OF MH RISER ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date .� • Z-� •�... ..... ' ••••• �� • Curtis Huffman is `. CE 128991 lF . 11/04/22 . • `���s 'SFO • ... , • �,F...m- �k�, '°ROfESS1ti4„,�-� SepticSyste Approved - Date Z 2 202 3 Note: this approval does not include well permit requirements. kr-,uv UUIU4116) PID: 050-792-30 PERMIT: OSP221139 0 10.0, SHED �� G�ARDRAr� i LOT 3 BOK 5 GRAVEL C) D/W <v� O Z DECOMMISSIONED AppROk ' L)�� o q moo`' EXI �10- SEP CSTING SYSTEM &D SYSTEM /7-0" Or SCOpF r O' B D E 1500 -GAL INSTALLED 0' 1OMH MH STEP SEPTIC TANK ` �6 A CO �o O� MT 100' WELL RADIUS 1 �<< GRIST �9 s �R9�ti� 1gg. F =�O IVIT FCO H MH A—C=3.5' so � FINAL GRADE Mas T MT B -C=20,9' ss. / .3o 99.17 FINAL GRADE ORIGINAL 98.83 GRADE A—D=21,0' 94.00 FlLTER FABRIC ' ORG B—D=16,5' 5.83 95.83 93.4 7,500 -GALLON SEWER ROCK A—E=24.9' HDPE STEP 88.83 88.83 77 SM B—E=17.6' A—F=36.4' B—F=33.6' A-13=88.4' SEPTIC SECTION 18 DRY - 8/9/2022 B—G=87,8' SCALEI NTS 82.83 ENG TH 22-1 RIVER VIEWESTATES BLK 5 LT 3 PREPARED FOR: PAMELA & SAMUEL SNYDER 21290 FALLING WATER DR EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK@gmoil.com SUPPORT SERVICES: OF .AZ,` DATE: 11/04/2022 rtis Huffman SURVEY: JLS DRAWN: FWCS X CE 128991 SCALE: 1" = 60 11/04/202?Gar %ftSS100-' AV N62 0� �2'� % LOT 1 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: RIVER VIEW ESTATES SUBD LOT 3 BLOCK 5 PLAT 79-5 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouk any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DAM SCALE: E—MAIL' SEPT 30, 2022 1"=50' schullerftknet 22-073-2 mAm Mr. aEa�n BY GMD NMBM WW AGE: JLS SWO357 220342 O = FND 5/8" REBAR OF 49Tx -./HN L. SCHULLER.: s LS -10408 c ®Lu®fessiono\ LOT 4 "'�l w¢,� S�41 V��l�^ 0 5r' tet. ••..r- ...�` 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax M UR I C: I PALITY OF AM r -110 -RAGE C70-3. ib, vglalw a, Wasb2wubar Frkigrog(ji FID Socc, � SA 4 TIK E#01"5 Road zo-m- s -�j I Pef31—:0-11 -141-719C,�L F -m - Q in` 4Si 18 Wa- 5-tew. ate rDrip osalSystern ipeerrnjit, PamiuMum *C;� -:D-5 -- P. .... . - - JL . -P.221 1 j - WQ-rkTW*,' &--4.PliL-;'Tmjik Upgraje Enter wi i a wD a m a: T,= GO d 0, N um b e rt 13507 923 2 Wi :Nle tewd.Addrosrz R VER VIEW C-SZ.UYL=S lil K 5 LT 3 G;CG5,7 !S02- 61011 -ng AcIdNe-k-'I 2 129j F-ALUNG WAjER DR., Eagle River Owner-, -SWROERSAYASEL AI &. Desigin EngirgioF. T61*1 0ed rio btn s: 3 'Phis po..MiA: 1&,fap tit* emn-Ir1rucAiDn, at'. f! I'd D Sepik- Tank 0 flulding Tam 0 privy 0 pr i, _m�c Wd I tr. a pe'. AllcanNtrianui-an aFjsIj is in, ar-cardanral %riffilb-, ap r!3-vT.,l q = Ewdeui5i-J in lfrizhxagr: rblimic'JaBloo-de ClimplL.rs 1 &!Y -i grol 15.6r- &W 1hp-, 'Slate 3f W;RS�ewmler CAsposal (1 EIAAc72,,1,I .3r,,d Urink-rp.j VW,*qr "Reg.-dalkins (i 121AACPq 'Tha, C:ff-[.0 - -,- , I re-4drun; in;per dius 6. j1p,911he il-dalulicn. —1 hn c-rF.jInm7-r,�j-,qII r, -C De— - Ii3F M. - De ar mnni S P. W.C*e L -p, r r,� p r r* A -15 - 5-5- P'Lfor-d d e n 3 1 i ri mal m n by ixi 1 jr1.1 (., 9 Cq-,� (20- 4- From r: Imo! 15 cm dul-M rr,--i!xing Yomm:npr x'1011 rue, ii,:kie r: u --np if, ;q. ow mmalud and ha, p.,)n u r L rj.+j 11, fr.ee.2inq Sp--.riaM P-m-foslants; 111 f! Id 1� I b b 2 1: ca Im. I lo q n s U r�a U' i, HI Vm,,paralian to,lhc,,I;-;r VRnfJ. 1 3. PM w ci/i(q/z,Z la8Le.'i Br., 161N22 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 05079230000 Property owner(s) PAMELA & SMAUEL SNYDER Day phone Mailing address 21290 FALLING WATER DR, EAGLE RIVER, AK 99577 21290 FALLING WATER DR EAGLE RIVER Site address � , AK 99577 Legal description (Sub's., Block & Lot) RIVER VIEWESTATES BLK 5 LT 3 Legal description (Township, Range & Section) Lot Size 45,592 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank n Upgrade Fx_1 (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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 authorized agent) Permit/Rush Fees: 1 ) 2 cJ Date of Payment: 5// 7/ 20,22 Receipt Number: &o`] 121 Permit No. _ O'S NU 11 _: 9 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Frsr _ `3t C 0 N lz_ Water S U L T I N G .PATER/V,' StEVIATER SUPPORT &PLAUNtUG 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com August 11, 2022 Municipality of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: RIVER VIEW ESTATES B5, L3 The septic tank was previously permitted by MOA, but the owner requested we perform a septic adequacy on the existing septic field. The field did not pass the test and is encroaching the top of slope and therefore will be decommissioned as shown on the design and a new pressurized trench installed. We propose to install a 1500 -gallon HDPE STEP tank and deep trench per the attached design to serve the existing 3 -bedroom residence. The lot and area are served by private wells. There are steeper existing slopes, and no effluent was visually seen or anticipated per the attached design. Also attached is the recently completed test hole and no groundwater was observed. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, i Curtis Huffman, P.E. W d � C ��__GI !IING SERVISfS C� ViSIf Of WRSIEWA7EA �'�� i` SJPAA!IEB Pf ANHINC DESIGN CALCS: 3BR X 150 GPD = 450 GPD 450 GPD/0.86 GPD/SF = 750 SF SAS 750 SF / (2 X 7' ED) = 54 FT. TRENCH USE 1 TRENCH — 54'(L) X 2'(W) X 7'(ED) THERE ARE SLOPES >25% WITHIN 50' TOTAL DEPTH FROM EXISTING GRADE: —10' OF PROPOSED FIELD AS NOTED. 6'ED WOULD BE 63'L VS THE 7'ED NOTES: STAKE PROPERTY LINE & WELL RADII 54 LF 1 1/4N PVC WI' H,,3,/16" H❑L o @ 1,8' SPACING (TYP) APPR❑X, 100' WELL RADII SEPTIC AREA LOT 4 �Y v GRAVEL �v �9 D/W Z� 4 0 1�9 LOT 20 223 t", 41 \ PRIOR TO C❑NSTRUCTI❑N LOT 4 "?A4X ti�u oir c`�"NOmcc �j raa sw Tctias �/ 9L m � � 7c, Icr rm a x-0ar mal rm a sac : w OET:OIE®W D(elNo Mwa WT IAfIW EW ppouff M US£ IIG END !R A.T RLO 1{ �'•S Owe ETA EEL M AnD * Ei1015 Nom y $MATIaI ro 1ET T[1D tr% m W�RNIVa1 FiTt' LWfi � � Troll M vxarosa r s ACE r r o I's'mµ Wr ros>ecr PnwR TN YM R 9 T'nTommaurnro 1 LWN L ❑ T 3 2332 BLK 5 532 / o020 ,moo Go oo,o� LOT 1 LOT 2 APPR❑X, 100' WELL RADIUS APPROX. 100' WELL RA;�IIZS SEPTIC AREA \ 0 NO WELLS WITHIN \ SEPTIC 100' OF PROPOSED / AREA SEPTIC SYSTEM. RIVER VIEWESTATES BLK 5 LT 3 SUPPORT®SERVICES: ®®®® PREPARED FOR: ��`�� OF Aj� 1 PAMELA & SAMUEL SNYDER 21290 FALLING WATER DR —1.1-5 . - �* 9TH EAGLE RIVER, AK 99577 11111! 0 FIRST WATER CONSULTING DATE: 8/10/22 /` tis Huffman / SURVEY. JLS 13030 SUES WAY 1 �n CE 128991 . DRAWN: FWCS v ANCHORAGE, AK 99516 SCALE: 1" = 60' 1 8/10/22' 907-350-9566 FirstWaterAK®gmail.com PAGE: 1 OF 3 ��Pssio�= DESIGN DETAILS: DECOMMISSION OLD SEPTIC SYSTEM AND INSTALL NEW 1500—GAL HDPE STEP TANK. MAINTAIN 10'+ FROM FOUNDATION, 100' TO WELLS, 100' TO SURFACE WATER, 5' TO FIELD & DECK SUPPORTS WITH 4' OF COVER OR INSULATION. INSTALL PER AMC 15.65, 15.55, & MASS ... TANK BEDDING, SEPARATIONS, MATERIALS,..& MOA PERMITTED DESIGN. HI 100' OF PROP ED IC SYSTEM. RIFY 1199', WELLS AT 'up OF NEW FIELD IS 35'-50' FROM TOP OF SLOPE & NO DECOMMISSION EXISl1NG FIELD SkOp- EFFLUENT DAY LIGHTING WAS PRESENT PER STAKE ORIGINAL FIELD WITHIN 10' OF SLOPE. VEGETATION, USE MOA SAND OR SILT PLUG 14' pR� ETC... WILL NOT BE DISTURBED BELOW, NO SEPARATION TO NEW FIELD J TO DAY LIGHTING IS ANTICIPATED & DUE TO SOILS R CONST, ANY POTENTIAL EFFLUENT WILL RISE TO THE REC& T PROPOSED FIELD SURFACE FIRST. APPROX. WELL RF RIVER VIEWESTATES BLK 5 LT 3 SUPPORT@SERVICES:Adr, OF AZ ®® PREPARED FOR: �w�� `Q� PAMELA & SAMUEL SNYDER _ 0 11-1 " '�f ' 21290 FALLING WATER DR "4* 9 TII EAGLE RIVER, AK 99577 FIRST WATER CONSULTINGDATE: 8/10/2022 A rtis Huffman / SURVEY: JLS 1 f�, CE 128991 �� 13030 SUES WAY DRAWN: FWCS ' 8/10/2022 ear ANCHORAGE, AK 99516 SCALE: 1" = 30' 907-350-9566 FirstWaterAK@gmoil.com PAGE: 2 OF 3 ®®®`®® C,p � PROPOSED ABS❑RPTI❑N TRENCH & SLOPE RIVER VIEW ESTATES BLOCK 5, LOT 3 I- 35' -{ NATIVE SOIL I SURVEY: RETAIN TOPSOIL AND VEGETATION - EXISTING FLAT LAWN MIT DRAWN: E 5' Y 25� SL OP . SCALE: R'UN GD IMAGIMAR —7'ED G PAGE: ��ZS�1N -10' FROM GRADE E � S�OQ6 QF' ao�• S�,O Gey. 1 50' NO APPARENT EFFLUENT DAY LIGHTING WITHIN 50' OF PROPOSED FIELD 90' MOA STATES PER ONLINE CONTOURS THAT SLOPE MAY BE GREATER THAN 40% & UP TO 80% SLOPE. THIS HYPOTHETICAL 80% SLOPE LINE SHOWS POTENTIAL EFFLUENT SHOULD NOT DAYLIGHT & WOULD BE APPROXIMATELY 501+ TO THE PROPOSED LEACH FIELD. THERE ARE NO SLOPES GREATER THAN 80% WITHIN 501+ OF THE PROPOSED FIELD. NO VISUAL OBSERVATIONS OF ANY DAY LIGHTING FROM EXISTING 1983 SEPTIC FIELD. RIVER VIEW ESTATES BLK 5 LT 3 PREPARED FOR: PAMELA & SAMUEL SNYDER 21290 FALLING WATER DR EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmail.com SUPPORT,SERVICE C M DATE: 8/10/2022 SURVEY: JLS DRAWN: FWCS SCALE: 1" = 20' PAGE: 3 OF 3 OF AZ 'k,Of � *�9 TH * rtis Huffman 11 U1 1%P2022ts® \ �FESSIOTiAi' F rst Water -'- CONSULTING SuPPani&PLA N N 1 0 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAKagmail.com SOILS LOG - PERCOLATION TEST LEGAL : RIVERVIEW EST. B5, L3 DEPTH Net Drop FEET OG SOILS ................ ............... " 6" ORG/OL 1 15/16" 2 3 4 5 6 SM 7 8 9 10 11 12 13 14 15 16 BOH 17 19 20 Of Al �l *: 4s TM....':* . .. .... ........ ' Curtis Huffman �� �'�c •. CE 128991 ��is�F�•.,8/11/2 •��n PROFESSO' PERFORMED FOR: SAM SNYDER TESTHOLE # 22-1 DATE PERFORMED: 8/1/22 GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: NA - DRY DATE: 8/9/2022 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION Reading Date Gross Net Depth to Time Time Water Net Drop 8/9/22 30 min 6" 16/16" " 6" 15/16" " 6" 15/16" PERCOLATION RATE 23 (MIN / INCH) TEST RUN BEWTWEEN 4 & 5 FT PERC HOLE DIAMETER 6" PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16 TH PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 8/11/2022 Z'S IN N411 LOT 4 A� No. �' 0.11 �� 7 0' SHED 0, oo (�ool 0000,00 0. 600, LOT 2 0 001, 00 41, LOT 1 'Z z ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: RIVER VIEW ESTATES SUBD FND 5/8" REBAR LOT 3 BLOCK 5 PLAT 79-5 su)? SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a •AW 0 F 4 0 physical survey of this property as shown on this drawing and that the A W_ 'S, 11P improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should 0.0 �.. 49TH any information on this drawing be used for construction of fences, A? .... ...................... . ..... structures, improvements, or for establishing boundary lines. n n �1 % P EXCLUSION NOTES: It is the owners responsibility to determine ?A -)0 ...... ........ ............. N L. SCHULLE . R• '0 the existence of any easements, covenants, or restrictions which �P- `•* il- LS-10408 qJ do not appear on the recorded subdivision plat. 1831 Talkeetna Street WORK ORDER NUMBER: DATE: SCALE.,, E-MAIL, -T Anchorage, Alaska 99508 JULY 11, 2022 1 =50' schuller0ok.net kk�)C�' DRAWN BY. CHECKED BY � GRID NUMBER: 96M -/PAGE: \'O�\ A8W (907) 227-1455 office 22-073 1 1 JLS 1 SW0357 220251 S io n (3\ 4•00, 1 (907) 274-4992 fax NAME 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 ~?~z,,¢'~/ I ~-~'P ¢'~' [] UPGRADE MAI LING ADDRESS ~-'-",v' LEGAL DESCRIPTION LOCATION _ / , ~:~ NO, OF BEDROOMS~_~ t~ z~/vz7~ ~P*c · /,-"1/p. D STANCE TO Manufacturer /-~ ,~ . ~.. ]Liq. capacity in gallo~s DISTANCE TO' I ..... ~en ~ , DISTANCE TO:I No. of lines / ~ Length of eacl] li)~e mop of tile to ~nish grade - Absorption area /L'¥ Dwelling 7 / PERMITJNO. Material :~ '~'z'~ No. of compartments Inside length Width Liquid depth ID~elling PERMIT NO. Liquid capacity in gallons Foundation.~ · PERMIT NO .... Distance between lines Total length¢~ps Material beneath tile IMaterial Nearest lot line,:~.~. ) Trench w~i d.i[ ~ -~'-~ nc ~es inches Total effective absgr~tion area Length Type of crib DISTANCE TO: Class Width Crib diameter Well Depth Depth Crib depth Building foundation Driller PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Building foundation Sewer line Septic tank DISTANCE TO: PERMIT NO. Absorpt o~ ~'rea(s) OTHER PIPE MATERIALS -P Pd. SOIL TEST RATING INSTALLER REMARKS DOC Co, dba P.O. BOX 272, CHUGIAK, ALASKA 99567 ,~ TELl:PHONE 688-2759 OWNER OF LAND __~LI~ g ~ 'F 0 ~ DEPTtt OF WELL ) ~, ~),o~ ADDRESS _? O ~O~ [ qt ~ ~o ~ STATIC LEVEl. OF WATER FT. LEGALD~CRI~IO~ ~ ~ ~10~ Ot~'m ~S~ __ D. W OOWN PERMIT NUMBER OF CAS N,; _ d O KIND OF FORMATION: From_--d2.---Ft. to,--/g_Ft. , ~'~-~--- ~-1~¢~'~/~-'z- From Ft. to~Ft, From .... Fl. to ..........Ft.~/ C, ~ F From Ft. to~Ft From_.~ e~ Ft. to~ __Ft.~_~~ O<, m~ From Ft. to ..... FL Frame'Ft. tod g~Ft.~a~& ~ ~ From From_~] ~Ft. to.~ Ft.., ~g_Oc.~., __~OK~'~O From Ft, to___~Ft FreesoFt. to ..... Ft,_ ~ ~'& _~ ~g~' From ..... Ft. ~o ..... Ft From .... Ft. to .... Ft fl ~-)Y~--~ From .... Fi, to ~ Ft. From ,~Ft. to___Ft. Fromm. Ft. to ...... Ft From Ft. to___Ft From____Ft. to ...... Ft From Ft. Io _Ft, From___.Ft. to ...... Ft From__ _Ft. to_~____Ft, From__ Ft. to__ Ft From Ft. to .... Ft, From .... Ft. to ..... Ft From Ft. to ___Fi. From .... Ft. to ..... Ft. From Ft. to .Fi ..... From ...... Ft. to___ __Fi From Ft. to .... Ft ....... From ....... Ft. to____ _Ft MISCL, INFORMATION: /~ 7~2 ,~u')ject: LOt 3w Block b, .~ivervJew Estates On-site As-built: Dear ~Sir: This de[)artmei~t canm)t accept the submitted ou-,.qite as-built until further informaticm is provided. The .~oils test's total del)th was 13 feet al]d th~;reforc; the per,~it allows the botton'~ o~ the (~rainf~ie,].d to !)e no ~aore than 9 feet below (jr¢)u~d level. Th~, total depth on the as-bi.lilt is t0 feet; so information neec[G to be provided by tho (;ngineer certif, yi~g thah there was no ground water 4 feet bo, low tho bottom of the installed trench depth. soon as this infort;~ation }]as been proviCie(i we can aCCODt the a~-builts. ]]~: you have any questions t}lease contact your ~. ' Sinc(~rely~ Cory t~iliis, t<o'? Acting Sewer & Water i~ re(.) ram i',lanage r c C ~ iir. Richard i.o i~oys(m P00. Box 10-4020 A~]chorago, &K 995].0 F'EFd"lt T I'.,10. RF'F:'I_ I CFINT L. O F: R T I 0 N L. EF~F~L · .)'OHN 3F:" _- ':: '~ L.::.E,.. F,.I EF.. .[FZI.~ E.::,TP FE::, LOT :SIZE 9'9:~'~'~'9'"".: ..... '" FIRE'" ' FEET 'I"'¢F'E ElF ~;OIL HE,--,-F.FTION '5'f~TE£'I :[S: TF..EN..FI I'"lF~;:'::II"llJl"l NI_II'IE:EF.: OF BEDF.:OOHS = 3: :5OIL F.:RTINI3 ,::~;6! FT/BR)= :L453 THE: F.:EI.7.!UIF.':E[:, :SIZE 13F THE SOIL FtEr.:=,L-IF.:F'TIOI'.~ '5'T'iS'TEI'"I I~;: THE LF:NGTH DIHENSION I2: THE LENGTH (Ih,I FEET) OF THE TREhtCH OR I-":'RFIINFIEL[:,. ]"HE DEF'TFI OF Ft TF. tEhlCH OF.': PIT IS THE [:'ISTFtNCE BE'FNEEN THE 2:]LIRFFICE OF THE GF.:OLIN[:, FIN[:' '['FILE DOTTOH OF' THE E',:'::CFI',,,'RTION '::IN FEET::,. THEF-:E I'.E:"; NO SET I.,.II[:,TH FOR TRENCHES. THE GF.':FI',,,'EL DEPTH iS THE HINIh'IIJH [:'EF'TH OF GF.'.FI',,,'EL E:ETNEEN 'FFIE OUTFFtLL F']:PE FIN[:, '['HE BOTTOH OF THE E',:'::CFt',,,'FtTION '::IN FEET). F'EF.:I"'IZT FIF'F'LICFINT HFI2; THE F-E.:-,F_hlz, IE,[LIT~ 'TI-I INFFIF.:H "rH'r5 [:iEF'flF~:TfflENT [:,I.JF.:ING THE ]:NL:.iTFILLFiTZON ZN'_SF'ECTZON2; OF FIN"r' NELLS FID..:rFICENT TO THIS F'ROF'EF.'.T'¢ RND TFIE NUHBER OF F.:EE,'r £:,ENCE:.5 THRT THE I.,.IELL N ILL. 'E, ER',,¢E. E,I-_.I..F1LL. ING OF RN'¢ 2;'~.':E;TEI',I 1.4ITHOLIT FINRL. I~I_FEL. 1 IuN RNE:, F~F'F'F."-',/FiL. E:'T' I FI.T.:, E:'EF'RF:THENT 1.4ILL BE 2:LIB.'rEi::"F TO F'F.:OSEI::UTI3N HINIlqLll,1 C,I'_:.;TI~i'.,tE:E BETI.,.IEEN FI NELL RN[:, FIN'¢ I]IN-SITE SENRGE C, ISPOSFIL S'T'STEH I'.E; :I..E~E~ FEET Fi'If4: FI F'F.:I',,,'RTE !-,.IELL OF.: :L5C1 TO 2C~C~ FEE7' FF.:OH R PUBLIC NELL. [:,EPENDING UF'ON THE T'¢PE OF' F'LIBLIC !-4ELL. HIN:[HUI,1 E.',I:5'I"RNCE FF..'OH R PF..'I',,,'R1-E NELL 7'0 R PF.:Z',,,'FITE b~;EP.IEF.: LII'.,IE Z~i; 25 FEEl" RN[::, "t"O FI COHHI. JN.'[T'¢ '.:.;EI.4ER I_INE ~'_:; 75 FEET. L,.IELL LOGS FIRE RE(..:!LIZ.F.:E[:, FIND HUST E:E RETLIRI'4EB, TO THE DEPFIRTHENT 14ZTHIN ~:¢ E:,Ft'.,.'2.:, OF' THE 14ELL. COHPLETION. OTI--IEI:~:: RE6!UIREI',IENT'.Z, HR'.r' RF'F'L"r'. SPECIFICR]'IONS RNE:' E:OI"~:.z.,"FRLIC'TZON DIRGRRi'"IS FIF:'.E FI',/FtlLRBLE TO INSURE F'ROF'EF.': INSTRLLFITION. I CEF.:T I F"r' "FHRT :1.: I FtH FFd"'I~L~RR NZTH THE RELT.!UZREHENTS FOF.'. ON-SZTE E;EI.,.IEF.:':;, FINE:' NELL. S FI'_:, 2;ET F'OF.:TH B"r' THE I"ILINZCIPFIL..~T"/ OF FINCFIORFtGE. 2: T I.,.I:[LL. ZN5I"FILL 'TFtE :5'~"$TEI'"I IN F~E:COF-:E:'RNCE 1.4:[TH TFIE CODE'::;. 2:: :[ UNE:'EF.':"STF~NE:, 'FHRT THE ON-L:;TTE %ENER 'E,'¢STEH HFIh" 'F.:ELqU~F'.E ENLRF.:GEI"IENT :I.'F TFIE: F::E'-SZE:'ENCE Z E; F.:EHFIEi,,ELEE:, TO INCLLIDE I"IOF.:E TFIFIN 3 'T hiE: L. EiI'.,IG"FH E)ZJ: HEN'.!!; ]; O1",! :1: :ii; 'rl'Hti{ f...E!:F4CkTH C :[ N F:'E:[i:'f' ::' OF:' "FI'~E 'T'I:;Ui~::?"IC;:!I CI!:~: [;:'F;;:t:~, ]: NF:' ;l: EEL. C:'. 'i'HIE B'E?'J"H O!':: F::l '!14:l]i);i'"iCH O1:;:: I;::'];T );:5 'f'l"lE D];:B'f'FINE:IE E"i~;'!"HEEN 'T'HE ~;I.,I!q:FF~E:E~ OF THE tZ~!:'itOl_IN[;:' F:I!'"![;:' "FHE E"O'T'FEq"'I E'F THE E[NCI:I","~:IT]:EII'"i C :IN 'T'HEE?RE; ;i: ~i; NO CE;E"F I"! ]: [::''f'H F:'O?. 'T'HE; GF;i:?I'V'EI.... !;}EI='T'I'I ;[:5 'TI'IE I'"lZ[l",l:!:l"!l...li'"l DEF:'T'H OF C~RI=I'v%L.. EE:EI"NEEN THE F::!I'"E:' THE~ E~"O'T"f'Eq"I OF' T!'"IE~: E',:':;E:F!'V'I:::I'T ;[ ON C Z l"! F;'EE'T F:'Ii:Zt;;:!"! :[ '1' I:::!i::'PL. ii: CF:IN'!' HI=II!!; 'T'H!E ,r;;:[.::iBF:'EIN:i:~; ;[ E ]: L. '[ 'T"¢ 'FO [ l"!i:::' :i' I.?h'l 'T'!'"J 'IZ :!:.:; [::'E:F'F:Ii:;i:'i"f'"IE!;N T' .' .il::' ;1_' ?'.JC!i 'T'HE ];N:iii;'T!:::!L.!...F:!q'ZON J;Nri!;f::'I::!%:TiZCd",!'J:i; Eft= '4 Hr:: f: r;, i" I:: iq:EiE; ;[ i;;:,E!;i'.,IE:E:iL; 'TH!:::!'T TI..IF.:~ h!t=.:l .... O&E ENG,NEERING & DEVELO, Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Oyster 694=2774 Performed for: Legal Description: SOIL LOG Mailing Address: -.~.~: ~.-~'- MENT CO, EaH Eifi- 688-228u [)epth (feet) Soil Characlerlstlcs 11 13 14__ 15__ PLOT PLAN PERC. TEST 16__ Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No_ ~ If yes, what depth Drain Field__~''~ 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 3; Block 5; River View Estates Subdivision Location (site address or directions) Property owner Mailing address Karen Patno Day phone Lending agency Mailing address Day phone Agent Address Sharon Minsch - RE/MAX OF EAGLE RIVER Day phone 694-4200 16600 Centerfield Drive, Suite 201, Eagle River, Alaska 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 '"" TYPE OF WATER SUPPLY: Individual well xxx Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF'WASTEWATER DISPOSAL: NOTE: xxx Individual on-site Holding tank Community on-site Public sewer 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 date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING ] 7034 Eagle River Loop Roa~ NO, _2..0~_'. Eagle River, Alaska 9957'/ Phone Date DHHS SIGNATURE //~' Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: By: Additional Comments 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. 72425 (Rev. 1/91) Back MOA ~21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~o-( ~u.( ~ Rlu~-01~ ~s?~'.~7~ ! Parcel I.D. A. WELL DATA Well type '~¢~u~-q. 6~ Log present ~_.~N) Total depth Sanitary seal (~YN) If A, B, or C, attach ADEC letter. Date completed ADEC water system number Casedto ~b ~c~ (¢.~2C8'' Casing height Wires properly protected (~0'N) . ~/~' Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION I (¢k~ g.p.m. ~ '~ (AK 5~-'+ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line ; On adjacent lots /¢0 ¢~- ;On adjacent lots /GO/f- Public sewer manhole/cleanout /d/A Petroleum tank WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: (.~,,~cj r~./A~ Other bacteria Collected by: B. SEPTIC/ ' Date installed Cleanouts (~N) High water alarm Date of pumping Tank size Foundation cleanout Compartments ~- Depression (Y/~_~ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s) on lot !GO ~- On adjacent lots To property line l0 4- Absorption field Surface water/drainage t~ or4~ /0© ~- Foundation I% ' Water main/service line 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C, LIFT STATION / Date installed /L'//~r- Manufacturer Size in gallons / ~-.. Manhole/Access {Y/N) . Vent (Y/N) __ - _ Pump on'"'~ved at ' s/"~"Pump off" level at High water alarm level ""~'"% ~s ,--""~Cycles tested Meets MOA electrical codes (Y/N) ,.---'"'"'~ ~..~ SEPARATION DIS~FT STATION TO: Well on lot Do ABSORPTION FIELD DATA Date installed ct [I.~/¢o'¢ Length L/& / Width Total absorption area On adjacent lots Depression over field (Y/r~ Results f(~/fail) Peroxide treatment (past 12 months) (Y/{~) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot J0©/~ On adjacent lots To building foundation On adjacent lots _~0 ~ ~- Surface water Curtain drain ~,~.m,,~ Soil rating /L/¢ ~',c:/~/1' System type Gravel thickness ~¢-" Total depth Cleanouts present {~0'N) Date of adequacy test for --~ /~AJO~ If yes, give date _ Property line_ ~O' ~- To existing or abandoned system on lot Cutbank ~ o~_ Water main/service line. Driveway, parking/vehicle storage area __ bedrooms E. ENGINEER'S CERTIFICATION 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 7034 Eagle River Loop Signature Engineer's Name Date HAA Fee $ / Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3... Block 5; Riv~rvi¢~ Estates Subdivision Location (address or directions) Drive. (b) Property owner Mailing Address Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) RealEstateCompanyandAgent RE/MAX OF EAGLE RIVER - Eua Loken Address 16600 Ce,nterfi~Ed Drive~ Ea~l~ River, Alaska 99577 Telephone 694-4200 (e) Mailthe HAAtothefollowing address:(orcheckhere ~,ifholdforpick up.) Listcontactperson and day phone numberbelow: S & S ENGINEERING/694-2979 17034 Ea¢le River Loop Road, S~Lte 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Familyz~ Number of bedrooms __ 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] 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. 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all MunicipaJ and State codes, ordinances, and regulations in effect on the date of this inspection. ' Name of Firm - ~, ,- ~*,~-~,',Ir-'FRING Telephone 17034 Eagle River Loop Road No. 204 Address Date 6. DHH$ APPROVAL Approved for ¢/ Approved /~ Terms of Conditional Approval bedrooms Disapproved Conditional Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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. TheMunicipalityofAnchorageisnot responsibleforerrorsoromissions in the professional engineer's work. 72-025 IRev. 7/88) Back Page 2 of 2 ~ MUNICIPALITY OF ANCHORAGE (MOA) (~.~[~/ Health Authority Approval (HAA) MUNiCll)~., , CHECKLIST- FEBRUARY 1984 · ~NVIRONMENTA~-$~-R¥ ~,~ ,'5 :_~i'~ ~l, ~i~ 343-4744 A. WELL DATA Legal Description: MAR 2 2 L990 · RECEIV[.' Well Classification ~,M~IG ~ ~i ~ Well Log Present (Y/N) ~__ Date Completed ~ ~ J Total Depth [ ~5 Casedto_32 ~ Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) A///~ Yield z-?/, _7~ ~/ORN~ 1 Static Water Level % "~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) /I Pump Set At L) Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) U SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / OO To Nearest Edge of Absorption Field on Lot /'~ _; On Adjoining Lots / O -~ ; On Adjoining Lots / O0 To Nearest Public Sewer Line __/'J/¢~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot /t)/~ / Water Sample Collected by ~.~ .~ ~_.~jlO~.~l'ld~ ;Date .~ '-/~- ~'0 Water Sample Test Results ~K~I?-%-FC~'?o('c( ~ ~'~-,~CLff~-~¢'~ Comments B, SEPTIC/HOLDING TANK DATA Date Installed o?-/%--?~Size Standpipes (Y/N) c1 Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: OOL~¢I~' I NO. of Compartments / Air-tight Caps (Y/N) Foundation Cleanout (Y/N) ~ Date Last Pumped ~ ~ .~ --~0 ~kJ/l,~ ;for ~ / Temporary Holding Tank Permit (Y/N) ¢*)/~ To Building Foundation To Disposal Field To Water-Supply Well [ l,O f To Property Line [ O P To Water Main/Service Line / 0 ' t~ To Stream, Pond, Lake or Maior Drainage Course 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness /;~ ~ ~- ~ Statndpipes Present (Y/N) /k.) .~- Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot SEPARATION DISTANCE FROM ABSORPTION FIELD: [ OO ~ To Property Line ~O/¢- To Existing or Abandoned System on To Water Main/Service Line / rD t To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ; On Adjoining Lots .~,O To Cutback (if present) ~0 Comments D. LIFT STATION Date Installed %%',,,,,.., Size in Gallons "Pump On" Level at '%, High Water Alarm Level at ~) ~d/q Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines inspection. Signed $ & ~ ENGINEEEING , Date ~~ ** MOANo. ~ ~~-~ / Receipt No. ,~/"'~ ~--/~ Date of Payment ,,¢.~%~ ~- ,~: Amount: $ / ~.¢'2~ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 in effe6t.~J'Lthe date of. this 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 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property oWner' /,¢~/~Z'~-'~ Telephone: Home Business Mailing A'ddress ' ,,.~/~c.-'~'.~ -.~.~¢~.'..-.~ ..,'~.~',...~.~,..--~,.-~'" /./~Z.,¢, ('..,.J- /'~w~,~'Jo.,'~ (c) Lending Institution Telephone ~-~/~ ~' ~ °¢'~" Mailing .Address (d) Re¢,i Estate CompanY/an'd Agent J~./~ '-'"~"~"/~ ~'~'~... AdOS---res (e) Mail the HAA t(~ the fo[Iowina address: or: Check here,,~, if hold for pick up. List contact person and day phone number below. ' ' TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Well~ Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite")~ Public [] Community [] Holding Tank [] Note:/ '~lf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 IRev 8/861 Front 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 Address - Date DHHS APPROVAL Approved for/'"/'A""~¢~'¢~) bedrooms by ,/'(~'"'¢'"' '~' "~~ Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Depadment 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 Jending 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 fRev 8/86) Back ,~0'~-~ ~×O~'~MUNICIPALITY OF ANCHORAGE (MOA) ~.X4Gx~ . r~ p ~59 HEALTH AUTHORITY APPROVAL (HAA) ~x~~ ~ CHECKLIST - FEBRUARY 1984 ~ Legal Descri P~fk~ ~ WELL DATA Well Classification ~/~ If A, B, C, D~fi.C. ApprovoO (Y/~) Well Log Present (Y/N) ~ Date Completed -~*-~P - ff~ Yield Total Depth /~ Cased to ~> ~¢-~ Depth of Grouting Static Water Level ~/'~ ~¢~ ¢'~-, Pump Set At Casing Height Above Ground /~ ~/ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~¢z2 ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ ~ 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 ~/~ ; Date ~ Water Sample Test Results ~¢ ~~ O,/Z ~' B. SEPTIC/HOLDING TANK DATA Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ,/~o To Property Line ~ / To Water Main/Service Line ~-d- Comments ..;. ,.. · Size .,'~"~ No. of Compartments ~- Air-tight Caps (Y/N) ~/¢" Foundation Cleanout (Y/N) __,t/// Date Last Pumped J' ~" ~7 ;for -- Temporary Holding Tank Permit (Y/N) --~ To Building Foundation To Disposal Field //~"~ / To Stream, Pond, Lake, or Major Drainage Pc-ge 1 of 2 r 72 026 (Rev 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/'>~/'¢% o¢'~ Width of Field ~'~ '" Square Feet of Absorption Area Depression over Field (Y/N) . Results of Last Adequacy Test / Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line ~'~"~-~- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field ~¢'~ ~z/-~c'//~t.~ Gravel Bed Thickness ."'~,~ Standpipes Present (Y/N) /.v'- Date of Last Adequacy Test ~'~ To Property Line /"~ To Existing or Abandoned System on ; On Adjoining Lots ~,o' ~ To Cutbank (if present) Comments LIFT STATION ~///~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify.t~hat~/~.:~k-~d, or conformed to all MO/A and/HAA guidelines in effect on the date of this inspection. Signed ~.~//~--~.~ Date ~,.-/~'~...¢'//~¢'~ Company ~,~¢¢,,n ~.~//". MOA No. ~"~"- ¢¢'.~---¢.~o~, Receipt No. ./() Date of Payment Amount: $ Page 2 of 2 72 026 fRev 8/861 Sack M~.~ICIPALITY Of' ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF IREALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ]tEALTH AUTHORITY APPROVAL CERTIFICAI~ 1, General Information Application Date J----c~---~- (a) Legal Descriptio~B (include lot, block, subdivision~ section, township, range) Location (address or directions) Applicants Address/~O Z~O/-~ _/_~P/~ (c) Applicant is (check one) Lending Znstitution Buyer ~ ; O~her ~--~ (explain); _.'i'__eaephone__~.Home / / Business (d) Lending Institution Address Telephone (e) Real Estate Co. & Agent Address .0 (f) Telephone T~e of Residence Single-Family~ Multi~Family~ Number of Bedrooms__~ Other (describe) Water ~ 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. e~ ,, IIl?/ /, On, it~- ~ Public ~ Community ~ Holding T~ank ~ Note: If community well system, mus~ have wrJ..t~t, en confirmation from the State Department of Enviro~ental Conse~ation attesting' to the legality and status. [Page 1 of 2] 5o En~ineerin$ Firm Providing Inspections, TeStSL~ile Search, Da~ and Information As certified by my seal affixed hereto and as of the validation date shown below, verify that my investigation of. this Health Authority Approval shows that the on-site water supply ~/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 AnchoraEe files and from my iuv~eti~ation an~ inspection, the om-site water supply and/or wastewater disposal system is im compliance with Eull Municipal and State codes, ordinances, and regula- tious in effect on the date of this inspection. Name of _ _ _ ~k__ .......... Telephone ' ' Address Date ,~ / ~ / ~L ~.~ ~, ~ ~. '~- - Approved ~ '% ~,~' Disapproved Co~ition~ Terms of Conditional Approval THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~PRALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~qZ. ALTH AUTHORITY APPROVA~ CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN P2dlAGRA~H 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA° THE r)HEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANAJ~YZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS LN THE PROFESSIONAL ENGINEER'S WORK. RR4/eJ/D18 [Pa~e 2 of 2] 7-19-84 'MOA' MUNICIPALI1Y OF ANCHORAGE MUNICIPALITY OF ANCHORAGE [ ) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECi'IOI',[ CHECKLIST - FEBRUARY 1984 MAY 2 Legal Description: /-...,~ Z~'..~,,.. ,,~,~)'/~-~f'~.' ALL,IV WELL DATA Well Classification/¢~ ~ /t.~,~/)/-t2 If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y~//N) E).ate'(~et~td ~'//'-~/~ 3 Yield Total Depth _L~ ,:~'"' / Cased to ' -~ pth of Grouting Static Water Level ~;~" ! Pump Set At Casing Height Above Ground *~O~'~' Sanitary Seal on Casing(~)4) Electrical Wiring in Conduit~N) Depression Around Wellhead (Y/¢ Separation Distances from Well: To Septic/l~ank on Lot ./O~ ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /z~? cf- ; On Adjoining Lots To Nearest Public Sewer Line /*'1 //¢ To Nearest Public Sewer Cleanout/Manhole ~ //t-- To Nearest Sewer Service Line on Lot Water Sample Collected by-~'t '-~ ~/-'~///,¢ ~'~/'//~/~ ;Date Water Sample Test Results __-.~,'~ _"7" /~' ~,.¢~,,r~¢_. Comments -,'"-2' '~ B. SEPTIC/~TANK DATA Date Installed Stand pipe.~q'/' Depression over Tank (Y/(Ny Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/~Tank: To Water-Supply Well To Property Line Size //~0~) No. of Compartments Air-tight Caps~)~ Foundation Cleanou (~) Date Last Pumped / /%J /¢~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water Main/Service Line Course To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~¢j~/..,.~ l/ Square Feet of Absorption Area Depression over Field (Y~),) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well f ~¢~'.~ "''~ To Building Foundation Lot ~ O ~.J To Water Main/Service Line /O To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments _ ,/~/~,2~.._/ / Type of System Design Length of Field ~ ~ Depth of Field /0 Gravel Bed Thickness Standpipes Present (~) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ,¢~ To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions -Manhole/Access (Y/N) /,,,t////~._ "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA 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. Date ~') ,~/,2, ~ ~'-' MOA No. _~,~-oO :3 Signed Company, Date of Payment Amount: $ Page 2 of 2 72-026 (11t84) APPLI¢ "NT FILLS OUT UPPER HAl ONLY Phone Property Owner ~[ ~ : / ' ~ ~ : .,(C ,~. Mail',ngAddress Z / / ~ / /--/ /'/ /i// ~"~/¢. '-~'/ /,~l/? ZipCode d_i.. (~ Zip Code Address Phone Lending Institution / '; 't- /.~.j/j /' ! . /,/ /,i / Address ~2 ~ //, '] ~ Zip Code '--: Phone Realty Co. & Agent ,~;' Y : }"' /-~ ~ ~i Zip Code Address ,../I. (... I ~.. '~," '/'/7 ?'-¥ i Legal Description / r'.~ '[ ~ ~:.Z-/ o ~ ~'l :~ ,. 1:: ,.? ~. /; .../' ;:~ /? t;/9 ~ (. Street Location d ,:>(-i.-:/~: ~, iz &"/~ "--f' z "?(( '/- ' Type of Residence ~' Single Family ~ Multiple Family No. of Bedrooms__ ~ Other Water Supply ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ~ individual [] Community For wells drilled prier to that date, give well depth (attach log ii available}. [: Public Utility Sewer Disposal Year Individual Installed:__ ~ ~ ~] Individual When Connected to Public UtiLity: [] Pnblic Utility ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Date Date InspeCtor Insp6ctor Time Date Inspector Inspector "~) APPROVED BEDROOMS ~ ) DISAPPROVED ) CONDITIONAL APPROVAL' 'CONDITIONS OF APPROVAL APR 0 51983 "Muntclpality of Anchorage" "Dept. of Health & Envirnnmental Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size