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HomeMy WebLinkAboutMEADOW RIDGE ESTATES NORTH ADD BLK 6 LT 7AMunicipality of Anchorage : uHN 2 8 2021 On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201166 PID Number: 051-531-31 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JOHN & ELLEN SOMADUROFF ABSORPTION FIELD ❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound Site Address 25045 HOMESTEAD ROAD, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 4 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 2 Ft. Subdivision Block Lot MEADOW RIDGE EST. N ADD 6 7A Fill added above original grade VARIES 0.72 — 0.98 +/- Ft. Gravel length 53 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 378 Ftz 1 Ft. Well 100'+ 100'+ 25'+ TANK ❑ Septic M S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 10'+ 10'+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer GREER / ORENCO Capacity 1250 Gal. Remarks Field insulated. Alarm location GARAGE Electrical installed by DRS ELECTRIC PIPE MATERIAL House to tank 3034. Tank to 3034 drainfield Installer JRS Drainfield 3034 CO/MT 3034 BENCH MARK (Assumed elevation) 100 ft Inspector FWC Inspection V1 7/7/2020 7/8/2020 Location and description 2nd 3'd 7/8/2020 4" 7/27/2020 BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL of �t Conditional Approval: Date e�g.� TH •:9 ��r .. .. .....�.. . %J Curtis Huffman• . (� Septic rovedstem Approved Datevt9/202i.i�! •:� F CE 128991 .• c�`v Note: this approval does include 111OPROFESSION -� k\��`11+ not well permit requirements. (Rev u5/02/18) PID: 051-531-31 PERMIT: OSP201166 LOT 6A �Do W � W A -C=24,9' B -C=11,7' A -D=27,9' B -D=14,9' A -E=37,5' B -E=22.8' A -F=87.4' B -F=70,3' S89 55'20"E 104.85' (105.00' R) LOT 7A BLK 6 1,250 -GALLON HDPE STEP TANK ORIGINAL FIELD DEOMMISSIONED & 6'+ FROM NEW FIELD TH20-1 c LOT 8 O Z 0�DECOMMISSIONED / REMOVED EXISTING S.T. & INSTALLED NEW 1250 -GAL HDPE STEP TANK m A o Qom � P� G GRAVEL Q APPROX. D/W m WATERLINE LOCATION w SCALE, 1' = 30 GRADE MT — FINAL GRADE FILTER FABRIC & INSULATION LOD.25 10 SEWER ROCK SEPTIC SECTION SCALEI NTS MT 103.23 ORIGINAL 102.25 GRADE ORG r GP/SP-sm 7' GM 17 DRY - 6/8/2020 BOH TH2O-1 MEADOW RIDGE EST. NORTH ADD. B6, L7A SUPPORT SERVICES: Adow PREPARED FOR: ��� OF�� JOHN & ELLEN SOMADUROFF 25045 HOMESTEAD ROAD K ° 1cs -.0 * 9TH CHUGIAK, AK 99567 FIRST WATER CONSULTING DATE: 1/20/2021 tis x,f>n SURVEY: JLS 0# 13030 SUES WAY DRAWN: FWCS 020 CE 128991 ,p 1/20/2021 e'� ANCHORAGE, AK 99516 SCALE: 1' = 30 ��ssio�Ay Ar 907-350-9566 firstwaterAK@gmail.com S89°55'20"E 104.85' S75 , (S752s,48 9"E � NOM ES7-�gD RoqD ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: MEADOW RIDGE ESTATES N. ADD. LOT 7A BLOCK b PLAT 79-154 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 should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NO'rES: 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: DATE SCALE: E -µAIL• JULY 27, 2020 1"=30' 20-037 D---- B -Y CHECKED BY GRID NUMBER: BOOK/PACE: JLS NW1462 200164 71j8 , 118.00' (105.00' R) O = FND 5/8" REBAR O = FND 5/8" REBAR w/ ALUMINUM CAP '...49TH... ..., ,r J, HN L. SCHULLER: o LS -10408 N r,. 11�- o °fessionoQ v� ADLAN ,D 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201166 Work Type: Septic Upgrade Tax Code Number: 05153131000 Effective Date Expiration Date Site Legal Address: MEADOW RIDGE ESTATES NORTH ADD BLK 6 LT 7A G:1462 Site Mailing Address: 25045 HOMESTEAD RD, Chugiak Owner: SOMADUROFF JOHN A & ELLEN L Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Q Disposal Field Septic Tank ❑ Holding Tank ❑ Privy 717/ Z'0 � �,,,enr s r De. partin ent 6/18/2020 6/18/2021 Lot Size in Sq Ft: 22324 Total Bedrooms: 3 ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: • Locate the waterline prior to construction and show on the Record Drawing. Des 6e4 -weer'\ Wv&- 'r -k-' � a re.Vised hve*s w l.e , 9 -MC- '111 J ZeLo CO # : (a..A r e- f (CuLz d W i +(-" 12 5 o STEP Iie. Received By: Issued By: Date: Date: �S I' MUNICIPALITY OF ANCHORAGE Development Services Department :` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 051-531-31 Property owner(s) JOHN & ELLEN SOMADUROFF Day phone 9072429329 hApilinn aririrPSS PO BOX 671175, CHUGIAK, AK 99567 Site address 25045 HOMESTEAD ROAD, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) MEADOW RIDGE ESTATES N Legal description (Township, Range & Section) Lot Size 22,324 Sq. Ft. Number of Bedrooms 3 DD B6, L7A APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field F Initial El Single Family (SF) Q (w/wo ADU) Septic Tank fj Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ 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) s' Permit/Rush Fees: 0 L? t -i tito •Z6- Waiver Fees: Date of Payment: Date of Payment: Receipt Number: Receipt Number: Permit No. Waiver No. I GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc COVID-19 2520 DISCOUNT APPLIED 13030 Sues Way, Anchorage, AK 99516 907-350 -9566 / firstwaterAK@gmail.com June 10, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: MEADOW RIDGE ESTATES NORTH ADD BLOCK 6, LOT 7A The property owner has requested we obtain a permit to upgrade the failed septic field of the above referenced lot. We propose to install one pressurized shallow trench as shown on the attached design to serve the existing 3-bedroom residence. The design is based on the recent test hole conducted on June 1, 2020. No groundwater was observed at test hole excavation or monitoring. The slopes are flat at the upgrade site and moderate elsewhere. The lot and area are served by a Class A Public water system. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201166, Deb Wockenfuss, 06/18/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201166, Deb Wockenfuss, 06/18/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201166, Deb Wockenfuss, 06/18/20 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350 -9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: MEADOW RIDGE EST N ADD B6, L7A PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/10/2020 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 GP/SP-sm 5 6 7 8 GM - dense 9 60 min / “ 10 11 12 13 14 15 16 17 BOH 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 6/2/20 10 min 6” 4 10/16” 10 min 6” 4 9/16” 10 min 6” 4 9/16” 10 min 6” 4 8/16” 10 min 6” 4 9/16” 10 min 6” 4 8/16” PERCOLATION RATE 2 (MIN / INCH) TEST RUN BEWTWEEN 3 & 4 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16 TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 6/8/2020 TESTHOLE # 20-1 DATE PERFORMED: 6/1/2020 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: JOHN SOMADUROFF 6/10/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201166, Deb Wockenfuss, 06/18/20 ion MUNICIPA~I.T~ Ue' A~tlU~A~ h and Environmental Prote Fourth Floor West 825 L Street Anchorage, Alaska 9950]_ 279-25].1, x 224, 225 .... : ..... ~ ................ i~i~!-'~F, cTION REPOttT ON-SITE 5EWAOE DISPOSAL SYSTEM S,EPTIC TANK: F~{Ok, WELI._~ .... MANtH'A('IHRE R ........... INSIDE LFNGT}t ............ INSII-JE WI[)TIt~ ' I IQLII[) [-)FPTH ~ .... LIQLJID CAPACITY/_~GALLOhS. / / TOTAL LENGTh_ ~ O~ ~e~] _./ ........ DISI'/~NCE B[1WL[r,] L.I~qLS __ ~ .... TRENCH WIDI t~lN. TOTAL EFFECIIV[ Afl~OliPTiON ,,REA__ ~_ ........... SQ. I ~. t I{~TIt OF EACH LINE DE, PTlt TOI' (Jr IILE. ]O FINIStl (iliAD[ .~-- ....... MA'IE. RIAL [JENEAIIt TILL ~_ ~ ABOVE TILE~ ...... IN. SEEPAGE PIT: DIAMETER ....... OR WtBTtt ....... LENGTH. , DEPTH Log Crib ._Rings Crib Size: DIAMETER ...... DEPTH . DISTANCE FROM: WEI_L ]'OTAL EFFECTIVE BUILDING FOUNDAFION. ., NEAREST LOF LINE ........ AttS()RPT~N AREA (WALL AREA) .......... SQ. FT. Well ~ ~ Class:~ Depth: Well Dist~ To: Lot Line Bldg: Sewer Line: P iDs M~t--~l.~l s: ~_~I~-~'- .... ~ of Bedrooms: ~_~_ ~ ' ...... Installer ~~~t Remarks:. C) P...II --- !~"-' ][ 'T' PERMIT N0. ( 7'?'i. 42 ) RF'PL I C'RNT [)ON ZIMMERMliN JR L. EGFIL. L'7 86 HEII[:,I]L,J RIE:,E. iE EST .= 'r = f E.i'l :( :i::, TRENC:H T"r'PE OF' ':" ' =,L I L. RE:S()RBT I ON '~" '" ........ "'"' ...... I"',R I ~ ff'l ':: ]'] TI F;?.li'l" 11'.,IG ,:: 'ii~;(;:! F:'T,..'E:R ::, = ::t..OEI MI=I::.:: I MI...IM 1',lI. Jl' IE, E=R Cfi: 8E ~..: ::: ]: S = . ..... 'T'HE L. ENGTH P I MENS I ON I S THE LF:1'46TH ( ]:N FEE']") O1::' TH(ii: TR(EhlE:H OR I:::,l:;i:l:::lI 1",IF :f. EL.D. THE ()(!!]::']'H OF' I=1 TRENCH OR F::'IT I.:F: THE: [:,I'.'.:.;TIINCli:: BETHEEN "f'HIE SLJF.:FFIC(ii: O1=' ]"HIE GRCJUND RND THE BOTTOM OF' THE EXCFI',,,'FITION ,::II'.l F:EE'T'). THERE I:i~:; NO SET HIDTH FOF;.'. TRENC:HEL-]. THE GRIIVEL DEPTH I ri.:;., THE MINIMUM [:,EPTH OF GRR'v'EL. 8E'I].,.IEEN THE EiI...rT'F::'F~IL..L. PIPE liND THE BOT"r'OM OF ]'HE EXCIIVFYf'ION ,:: I Iq FLEET). BF:tCKF'IL.L. I I'.,IG OF FIN'? S'¢S"f'EM HITHOUT FI NRL. IN:3PEC'.'f'ION FINI:::, FIF'F:'RO'v'RL. B"r' ]"HI:ii!; [:,EPIIF.".TM(:.]",IT ~,.I ILL. BE: SUBJECT TO F'ROSEC'UT I (3t"'1. MI IqIMUM [)t:::VFI::tNCE DE:THE:EN li HEI._L. lIND lIN"? ON-SITE :SEP.IFK3E I)I.'.:..']F:'OSIII... S'.?STEM IS :'LOO F:EE:T F'OR FI PRI'v'RTE HELL OR ;.:..i'.O~,:3 FEET FCIR FI F:'IJE!H_.IC: 141EI....I ..... :SF:'EC I F' I CI=IT ]: (:IN.'.-.:, liN(:' CONSTRUCT I ON E:' I FIGRF~MS FIRE: lI'v'F1:1: LFIIE',I..E TO I iq:51...ll;;i:lE I:'I;?.(]PER I NS"I'IILLIIT 1 ON F" E: ~." ~'"'11 ][ -I"' "-.." R IL..... ][: [:, F" Ca F4.". ":2" li"'411E::E ,.,., lEE IF:It fr~: IF::' IF~;: ,:::311t"'"~ ][ .".~ii!;; ::E!i;; Il_Il lEE: I CIERTIF'¢ "rklf:lT :[.: I filM FFIMIL..IFIR HITH THE RE6!IJIREMENT'=:i; FOR OI",t-'"SITE: SEI.,JE]:;i::i~.; liN() 1.4EL. I....::::'; Fl:i!; S(i!:'l" F'ORTH B'¢ THE: MUNIC:IPIIL. I]"'¢ C.)F RNCHORRGE. 2: I HIL..L. INSTIIL. I... "[HE S"r'STEM ]:N IIC.'C.:OR[:,FINCE HITH THE COl}E::=]. ]:: I UN[:,ERSTII1'4D THliT ]"FIE ON-SITE SEWER S"?STIEM MFI"r' 'RE(;!I...IIRE E]".II~..III:;::C:iEME]",IT IF TH(E RE!i.:.;I[:,EN(:::E/(~'"": ///// _ "'--- ~IS REME~[)E~~J-~CL..U[:'E I"1~ "f'HlIN }]: E~E[:'F.'.OOM:iii;. z.-....~_ - 'RF"P L~I CFINT [~: April 9, 1977 R & M No. 751138 Mr. Don Zimmerman Box 596 Eagle River, Alaska 99577 RE: Log Two Test Holes for Sanitary System, Lot 7, Block 6 and Lot 4, Block 5, Meadow Ridge Estates Subdivision Eagle River, Alaska Dear Mr. Zimmerman: We are submitting herewith our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of April 6, 1977, and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland of the Muncipality of Anchorage, Department of Environmental Quality. A single test hole was excavated within each lot for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor mounted backhoe and the test holes were extended to a total depth of 16 and 13 feet below ground surface. The final logs of the test holes are presented on Drawing B-03. Groundwater was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. Edward Yarmak, Jr. Geotechnical Engineer EY/pe Lot 7, Block 6 Meadow Ridge Estates TH-1 · MEADOW RIDGE DRIVE · TH-2 Lot 4, Block 5, Meadow Ridge Estates The test hole locations are approximate and have not been located by survey methods. 4-8-77 LOCATION DIAGRAM DON ZIMMERMAN EAGLE RIVER, ALASKA TH- 1 4-7-77 ORGANIC MATERIAL BI.ack SANDY GRAVEL ¥~/SOME SILT (GM) Moist, Medium Dense Red-Brown ~ ~ 3.0' TH-2 4-7-77 0.0' ORGANIC ~b%TERIAL 0.5' SILTY SAND W/TRACE ORGANIC MATERIAL (Roots) (SM) Moist, Medium Dense ~ \ Brown ...... 2.5' SA~[DY GRAVEL ~2Y W/SOME SILT (GM) Moist, Medium Dense 4.0' GRAVEL W/SOME SAND; TRACE SILT (GP) Moist, Medium Dense Brown Many, Cobbles 13.0' SANDY GRAVEL W/TRACE SILT (GW) ~ Moist, Medium Dense $~- Brown, Many Cobbles 16.0'TD Groundwater Table Not Encountered Lot 7, Block 6 Meadow Ridge Estates SANDY GRAVEL W/TRACE SILT (GW) bloist, Medium Dense Bro~.~ Many Cobbles Refusal on Boulder 13.0'TD Groundwater Table Not Encountered Lot 4, Block 5 Meadow Ridge Estates 0~ EY SANITARY SE~'~ER TEST HOLES DON Z I~'~ERMAN EAGLE RIVER, ALASKA ~ ~PROJ. NO 751138 j ?0%_., MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environrnentai 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 7A~ Block 6; Meadow Rid.qe Estates Location (site address or directions) 25045 Homestead Property owner Mailing address Lending agency Mailing address A.H.F.C. #46506 Day phone 520 EAst 34th Avenue, Ancho~ag~ Alaska 99503 Day phone AgentLorZ Crowder JACK WHITE COMPANY Address 10928 Eagle River Road, Ea~le River, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual wetl Community well Xx NOTE: Day phone 694-5500 Alaska 99577 NOTE: 72-025 (Rev 1t91) Front MOA #21 TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site X~ Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. a~,eC] s~uewwoo leUOp,!ppv :suo!~elnd!~s 5u!MOllOJ eq~ q~!M 'SLUOOJpeq 's~uooJpeq Joj leAoJdde leUO!~!puoo 'pe^oJddeslQ ~un±¥NglS euoq8 '9 Legal Description: A. WELL DATA Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. Well ty% If A, B, or C, attach ADEC letter. ADEC water system number ~a~rd~::t'¢¢¢~.~.~-- -- -----~:sD:~;°mP'eted- --- ~asi~g he~;i'i7r Sanitary seal (Y/N) ~ Wires properly protected (Y/N) FROM WELL LOG~'"~ AT INSPECTION Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot g.p.m. Z g.p.m.¢: < , , ; On adjacent lots ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~ --I L~ --~ '7 Cleanouts ~/N) High water alarm (Y/N) Tank size ~ O~ c:~ Compartments ~ Foundation cleanout(~/N) ¥ Depression (Y~ Alarm tested (Y/N) ~D,~cte of pumping 1 [ - ~ ~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot A//OA/~ On adjacent lots 'Z- ~ ~ ~"' Foundation To property line ~,o ~ ~' Absorption field "~ Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA. electrical c~N'"~ SEPARAT~TANCE FROM LIFT STATION TO: JNell on lot On adjacent lots Manufacturer . Manhole/Access (Y/N) __ "Pump on" level at ~----~-~ "Pump off" level at ~ Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~'- l L,,-']'I Length ~' ~ Width Soil rating Ic:*-.-~115¢-- System type "~¢_f=.-~A&.~4 7_' Gravel thickness Total depth 1 '7_ ~ Total absorption area "~¢c~ ~P Depression over field (Y~J~ ~J Results~ail) ~;;2~ Peroxide treatment (past 12 months) (Y~,-~ Cleanouts presentd~N) Date of adequacy test for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water ! Curtain drain E. ENGINEER'S CERTIFICATION On adjacent lots Z-oo ~ *' Property line To existing or abandoned system on lot Cutbank /,/c>,,J',5 Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ & $ ENGINEERING ,~'~?,,~: ,," ,'; ",' '~" ,~, Eagle River, Alaska 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 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 July 2, 1991 WALTER J. HICKEL, GOVERNOR 563-6775 FOR: S & S Engineering PWSID 211431 My review of the records on file in this office reveals that the Dawn Water Company Class A Public Water System, is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, Keven K. Kleweno Lead Engineer 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 7A; Bloc~ 6; Me~.dow RidCe Estate.s; Location (site address or directions) 25045 Hom~tead Property owner Mailing address Lending agency Mailing address. A.H.F.C. # 46306 520 East 34th Avenue. Day phone Anchoraq¢.., Alaska 99503 Day phone Agent Address 1092~ E.,,.g.~a Riv.~.~- Roc,.~, ?.g.6.~. Riv5% A~. 99577 Unless otherwise requested, HAA will be held for pickup. 3 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Day phone NOTE: Individual well Community well Xx. Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XX 4. TYPE OF WASTEWATER DISPOSAL: NOTE: 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 STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 s ..... ;:..,.~ ,~¢,!~(; Engineer's signatur~a¢e River, Alasba 9~57~ Phone Date o..s S G.^TUR ~' Approved for ~'/'¢~--(..5?bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 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. 72-025 (Rev, 1/91) Back MOA #21 Legal Description: ~-~/~ A. WELL DATA Well type /~ Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. ADEC water system number Driller Casing height If A, B, or C, attach ADEC letter. Date completed Cased to Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level g.p.m, g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~ ~ [ ~'-"/'~ Cleanouts (~/N) y High water alarm (Y/N) Date of pumping Tank size ~ ~ Foundation cleanout (2~N) Compartments Depression (Y/.~ Alarm tested (Y/N) ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~o/v/'¢-- On adjacent lots /~:~,~ I.~ To propertyline I o~J' Absorption field ~' Surface water/drainage I ~;'! ~F Foundation Water main/service line 72-026 (Rev. 3/9'1) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~ Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed ~-~- ~ ~' On adjacent lots Soil rating Manufacturer Manhole/Access (Y/N) · "Pump off" level at Cycles tested Surface water System type Length "~/~ Width Total absorption area Depression over field (Y~J~ Results (pass/fail) '~ Peroxide treatment (past 12 months) Gravel thickness Cleanouts present (:.~N) Date of adequacy test for ~ Total depth ~ ?-- / bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots '~C~ Surface water ,/~C:~ Curtain drain f On adjacent lots Property line To existing or abandoned system on lot /~/c~/~dd~ Water main/service Ii ne Driveway, parking/vehicle storage area Cutbank E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on ~17034 Eagle [~iver Loop ~oad No, 204 Engineer's Name Ea~qle River, Alaska O te HAA Fee $ Date of Payment Receipt Number 72*026 (Rev, 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number WALTER J. HIOKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 July 2, 1991 563-6775 FOR: S & S Engineering PWSID 211431 My review of the records on file in this office reveals that the Dawn Water Company Class A Public Water System, is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, Keven K. Kleweno Lead Engineer 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 7A; BLOCK 6~ MEADOW RIDGE ESTATES ~q~h ~~ Location (address or directions) NHN Homestead (b) Property owner Mailing Address (c) Lending Institution Mailing Address. A.H.F.C.#4~315 520 East 34th AVenue Telephone:(home) Anchorage, Ak. 99577 Telephone Business (d) Real Estate Company and Agent JACK WHITE COMPANY ATTN: Kathi Olmstead Address 10928 Eagle River Road, Eagle River, Ak. 99577 Telephone 694-5500 (e) Mail the HAA to the foJlowing address: (or cheok heretiC, if hold for piok up.) . List cont. act person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Road Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family E~(X 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 J~ 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 8 lo 8 eBed DEPT. OF ENVIRONMENTAL CONSERVATION / ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 October 24, 1989 STEVE COWPER, GOVERNOR 563-6775 Mr. RoGer J. Shafer S & S EnGineerinG 17034 EaGle River Loop, Suite 204 EaGle River, AK 99577 PWSID: #211431 According to the records on file in this office, the Dawn Water System is in compliance with the State of Alaska Drinking Water ReGulations. Sincerely, ~r~m~ Fi Officer VEC:bas ~ MUNIOIPA,L, ITY OF ANCHORAGE (MOA) ~ [~¢~-~'-~'.'. '~ .,Hea [h~&~l,thority Approval (HAA) ~_~,1/~ -C~i~CKLIST - FEBRUARY 1984 343-4744 ':! ,~ Legal Description: ~ "~ Date Completed Depth of Grouting A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments '~L,~,~, ~, ~), '~- IfA, B, C, D.E.C. Approved~N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~ - ~ ~,-"(7 Size ~ No. of Compartments Stand pipes(CZ~/N) '~( Air-tight Caps ~[~/N) Depression over Tank (Y/~Cj~ ~-[ Pumping/Maintenance Contact on File (Y/N) Holding Tank High.Water Alarm (Y/N) Foundation Clea no ut~Y:;~l) ;te Last Pumped II - ~ ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Building Foundation To Disposal Field To Water-Supply Well , ~'~¢ To property Line To Water Main/Service Line To stream, Pond, Lake or Major Drainage Course 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ! ~ '¢'/f-~'~-~ Type of System Design Length of Field ~ ~ Depth of Field \~ Gravel Bed Thickness ~ ~ Square Feet of Absortion Area "~'~? Statndpipes Present~?N) Depression over Field (Y/~]~ ~ Date of Last Adequacy Test Results of Last Adequacy Test '~(-~' ~ -"- ~ ~ , SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well "~.4¢ 1,4~ To Property Line \ ~"'~ To Existing or Abandoned System on 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 ; On Adjoining Lots \ ~ ~4--" To Cutback (if present) Comments lled Dimensions Manhole/Access (Y/N) ~ "Pump Off" Level at High Water Alarm Level at~'~"~ ~ Vent (Y/N) Tested for ~ Meets MOA Electrical Codes (Y/N) Comments 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 in effect on the date of this inspection. Signed Company Date MOA No. S & S ENGINEERING 17034 Eagle River Loop Road No, 204 .., ........... Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 APPLIC NT FILLS OUT UPPER HAl ONLY PrOperty OWner ~, \ (Z, Iq I-1l'4 O Y~I'~ (b F E ~E~ ~ Phone Lending Institution ~{_~ [-~:~:c~< ~ [~ ~ ~ )) L ~ ~ ~ Phone ) ~" ._ Phone Type of Residence  Single Family Multiple Family No. of Bedrooms ~ Q Other Water Supply ~ Individual ATTACH WELL LOG. A w~l Icg Is required for all wells drilled since June 1975. ~Community For wells drilled prior to that date, give well depth (attach Icg if available}, ~ Public Utility Sewer Disposal /) Individual Year Individual Installed: / c:[ /2 ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: DF~T C'~: ENVIR)i~;,:~,,A- .C;.2L~tON RECEIVED ( ~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ~ ~ CONOmON*L DATE ~ ~ --~ ~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received / /~[¢ ' ~ ~ Well to Tank Septic T~k Size January 31~ 19f]3 ]:ii. chard ,~:lc Per re n P.O. }~ox 413 Chugiak, Aa 99567 '" ' ~ ~ Mo. ado~Ollidge L,,t. ~,lorth Add. ~uoject: Lot 7A Approval for the individual sewer and water facilities cannot be granted until the followinq items havo. been completed: Tho r;(~ptic tank pumped ~ith a receipt submitted to this departm(?nt. An adequacy test no. ed,,.; to be performed on the existing leaching area. This test will determine ii! the ~,;ystem is ade<iuate accordinq to National Standard,~. A listin~l of f~rivate firms porforming the test is enclosed. '?his rgport needs to ho submitted to this offico for' our reviev~. Please notify this Depart]a~nt for a reii~s¥)ection when the noted discrepancies have been corrected. If there are any further cluestions, please call thi?~ office at 264-4720. Sincerely, Enclosure Jim Roberts Associate Environmental Specialist January 31~ 1983 Alaska P, lutual I)ank P.O. Box 1.068 i;;a~:!le River, Ali< 99577 ,,ubqe~' ~' ' ,c..t: Lot 7A. Block 6 ~;Ieadoq Ridqe. "~' · )~ the individual sewer and water i]acitit~es cannot the ,.ollowln.~ items have r~een completed: until .... ' ~L~. till, tlc tank putal[)ed with a receipt submitted n t. An adequacy test nee,:]s to be performed on the existing leacl~ing area. 5?his test will determine if the system adequate accordinq to Hational Standards. A listing of private firms ~:mrforming the tent is enclosed. ?his repoz-t needs to be ~.mi~itted to this office for our review. ]?lease notify this Department for a reinspection whe. n the ~otQd di~cre"~anci(m have been corrected If there are any further questions~ please call this office at 264-4720. ,% incere ].y, Jim Roberts Associate Environmental ;;~pecia].ist EXCAVATION ROBERT A. SHAFER WORK CIVIL ENGINEER 694-2979 January 27, 1983 Totem Realty ATT ~iT I©N: ~ancy ?oore P.O. Box Eaqle ~iver, .hlaska 99577 MUNiCipALITY OF ANCHORAGE DFD.r C!' :': ~} '. ~ FNVIF. );.L' :I, ,^ - .~ ,..lION Dear ~.[s. >'oore, Reference: Lot 7A~ Block 6: ~ ea2owr[dge Estates North A sewe~ adequacy test was performed on the system located on the referenced property as you requeste~. The septic tank was pumped and verified to have a capacity of 1000 gallons. The absorption trench was tested by a continuous flow of water over a period of ~4 hours without any adverse effect on the system. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However the system cannot be guaranteed against subsequent failures. If we may be of further service, please do no~ hesitate to call. Since~ell~, /, ~ 'ROBERT A.~S[tAFE.~, P. E. "~s/ss cc: Municipality of Anchorage Department of Health and Environmental Protection #1: Time Date Insp MUNICIPALITY OF ANCHORAGF DEPARTME~,. OF HEALTH AND ENVIRONMEN,..~ PROTECTION 825 L Street, Anchorage, Alaska 99501 ~ ~ ~79-2511, ext. 224 or 225 Date Received: August 31, 1977 9:30 a.m. ~2: Time #3: Time 9-6-77 Tuesday Date Date Kennedy Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: United Bank Alaska Mailing Address: 645 G Street 99501 Phone: 278-9526 688-9024 2. Property Owner: Donn G. Zimmerman, Jr. Mailing Address: Box 596 Eagle River 99577 Phone: 3. Legal Description: Lot 7 Block 6 Meadow Ridge Subdivision 4: Single Family Residence: ( Multiple Family Residence: Number of Bedrooms: Three Number of Bedrooms: o Well System: Permit % Construction Individual well ( ) Community/Public System (x~ Depth of Well Well Log on File ( ) Bacterial Analysis e Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (x~ Public Utility ( ) Installed 1977 Installer Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line MUNICIPALITY OF ANCHORAGE //- ,_~_~ Department of Health and Environmental Protection /~~<i' 825 L Street, Anchorage, Alaska 99501 i[k~R~,~~) 279-2511, ext. 224, 225 ..... ~~,7 ~ of Individual Sewer and Water Facilities '" ...... ~equest for Approva± 1. Property Owner: /~,,4 ~l ~ ~ :,.-.a ~ ..' ,...~-~.~', ~ Mailing Address: ~/~ ,~--/~ ~l~ ~[,%E~, Ak Phone: Name of Buyer: Mailing Address: Phone: 3. Lending Institution Mailing Address: Phone: 4. Realtor/Agent: ',~A ~>~0'" Mailing Address: Phone: 5. Legal Description: ~T 7 ~/~ ~ ~F~6~J ~;~[c~ ~% ,Street Location: I4D~,{ ~{~g ~A. 6. Single Family Residence: Multiple Family Residence: 7. Water Supply: *Individual Well ( ) If Individual Well, well depth If Community System, name of system 8. Sewage Disposal System: On-site System If On-site System, date of installation: *NOTE: (,~ Number of Bedrooms: ( ) Number of Bedrooms: Public/Con. unity System Public System ( ) A well log is required on ALL wells drilled since 6/75. 3/77 P~ge Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 7 Block 6 Meadow Ridge Estates Subdivision Comments: Affadavit Attached: ( ) Letter Attached: ( ) Date: Date: Department Worksheet: DEPARTM 825 ~1: Time ~ Date l'- IL~-~ /~Krr~ MUNICIPALITY OF ANCHORA~ r OF HEALTH AND ENVIRONMEi ~L PROTECTION L Street, Anchorage. Alaska 99501 264-4720 Date Received: January 12, 1978 #2: Time ~3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Security/Pacific Mortgage Corporation Mailing Address: 1011 East Tudor Road, Suite 190 Phone: 276-1933 2. Property Owner: Don/Laurel C. Zimmerman Mailing Address: Box 596 Eagle River 99577 Phone: 688~9024 3. Legal Description: Lot 7 Block 6 Meadow Ridge Estates Subdivision 4: Se Single Family Residence: (x) Multiple Family Residence: ( ) Well System: Permit # Construction Individual well (4 Depth of Well Number of Bedrooms: Four Number of Bedrooms: Community/Public System ~ Well Log on File ( ) Bacterial Analysis e Sewage Disposal System: On-site System (x) Public Utility ( ) Permit ~ '~1~,~ Installed i~7~ Installe~ Septic Tank Size I.l(~-'~ ~c~/~5. Manufacturer ~p~ ~ Absorption Area ~q~' Soils Rate I/'")/-'). Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 7 Block 6 Meadow Ridge Estates Subdivision Comments: Affadavit Attached: Approved :~ ~ ~-~ ~~ Disapproved:~/ ~~'~I~ Department Worksheet Letter Attached: ( ) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 12-8-77 1. Type of Inspection: CMRO VA 2. Property Owner: ZIMMERMAN, Don Jr. & Laurel C. FHA XX CONV Mailing Address: Box 596~ Ealcje River, Alaksa DayPhone: Name of Buyer: DANIEL L. ARTS 688-9024 Mailing Address: 4843 Loretta Lane, Anch, Ak Day Phone: 659-9912 //33 4. Name of Lending lnstitution: SECURITY PACIFIC MORTGAGE CORPORATION Mailing Address:1011 East Tudor Road Suite 190 Phone: 276-1933 5. Nameof Realtor or Agent: Edna D. Wilson, Marston Real Estate Mailing Address: 2804 Northrn Lght Blvd. Anch, Ak Phone:. 276-2804 6. Legal Description:Lot 7, Blk 6, MEADOW RIDGE ESTATES Location: NHN Homestead Road, Eagle River, Alaska 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: single ~amily No. Bdrms. 4 Public Utility. ,Individual XX If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) XX Please note: before we can start processing the paperwork there is a $25.00 fee that must accompany each request. The fee schedule went into effect May, 1977. If there are any questio~I£11~ALllV <.~/i~ .,. please contact me at 264-4720 Laura Harrison [~m. ~I:~-,,.1~I,~ 72-003(3/76) #1: Time Date Insp D E PARTM 825 MUNICIPALITY OF ANC~ORAr- OF HEALTH AND ENVIRONMEI, AL PROTECTION L Street, Anchorage. Alaska 99~1 ~~/./ 264-4720 ~ ]'/c~-~ - Date Received: #2: Time 93: Time Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Security Pacific Mortgage Corporation Mailing Address: 1011 East Tudor Road, Suite 190 Phone: 276-1933 2. Property Owner: Don/Laurel C. Zimmerman Phone: 688~9024 Mailing Address: Box 596 Eagle River 99577 3. Legal Description: Lot 7 Block 6 Meadow Ridge Estates Subdivision 4: Single Family Residence: ( Multiple Family Residence: Number of Bedrooms: Four Number of Bedrooms: Well System: Permit # Construction Individual well ( ) Community/Public System ( ~ Depth of Well Well Log on File ( ) Bacterial Analysis Sewage Disposal System: Permit ~ 77142 Septic Tank Size Absorption Area On-site System ~ ) Public Utility ( ) Installed 1977 Installe~ 1,000 gallons Manufacturer Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 7 Block 6 Meadow Ridge Estates Subd/vision Comments: Approval request states a four(4) bedroom, residence however, the sewer was installed as a three(3} bedroom residence rating. Affadavit Attached: ( ) Approved ~_..~~~_~ DisapproveS: ~ ~ ~%~~_ Department Worksheet: Letter Attached: ( ) Date: January 16r. 1978