The URL can be used to link to this page

Home My WebLink AboutUS SURVEY 3043 LT 2 OF 22US Survey 3043 Lot 2 of 22 #075 - 092 - 43 G� BL • �-� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s A F ET; Parcel I.D. 075-092-43 Certificate of On -Site Systems Approval Expiration Date: 7-a 6-26?_ Z 1. GENERAL INFORMATION: Complete legal description US SURVEY 3043; LOT 2 OF 22 Location (site address) 153 Juniper Drive *Girdwood 99587 Current Property owner(s) Brendan Flynn Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex .. ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 4 Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer X. WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 1 Waiver Fee $ Date of Payment 0Q.�2 Date of Payment Receipt Number 0 2 9276 Receipt Number COSA # Q S G a. �,(5 8 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: Zf In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and 0000OpQn industry practices. The reported results describe the condition of the system/s on the dates of theQ evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells G ` ' s� �� and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and ' * �7 91 workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and """'-' . . are'ouiside''ihe controi of GEG. Satisfactory test results do not guarantee future performance or the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system�C J f r .y A. -¢ss., can be installed on the property in the event either of the current systems fail to perform adequately in Q 9. �• "E - the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or Qn Pa E party (including subsequent property purchasers) is not authorized, nor will it confer any legal right �r°cess°^ o 6. D5 SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the #AECC884 \1 (DF(/,q Ofi ti0 J= ON-SITE � sAND ti J � WA�iSTE Vv )ATER o � Original Certificate Date: '-/— z. to Z 0 Z Z. The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: US SURVEY 3043; LOT 2 OF 22 Parcel ID: 075-092-43 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1975(7) Total depth *92.7+ ft Cased to UNKNOWN ft ❑ Sanitary seal is functioning correctly JgWires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 418/22 Static water level at beginning of test 87.3 ft. Comments *PER GEG WELL TEST B. TANK DATA Well production at time of test 4.3+ gpm Water storage tank volume N/A gallons Well dysinfected for coliform test? ❑ Yes FBI No Eq Coliform bacteria is Negative Nitrate j3� �ttg/L ❑ Nate less than MRL (ND) Arsenic ug/L M Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 4/8/22 Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (m Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of ective. If not, state depth into effective ❑ Code -required soil er over field ❑ System pres ed (Required if cant for greater than 30 days prior to date of t ons introduced _gallons COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: ?Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate and Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes NSA Community Sewer Manhole/Cleanout > 100' , 50 + ❑ if No ft ❑Yes if No ft Neighboring Tank > 100' R Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NIA ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑✓ Yes if No ft 21 Yes if No ft Community Sewer Main > 75' [:1 Yes if No "50'+ ft Manure/Animal Excreta Storage > 100' P1 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) AW1Nl1 SEWER Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if N ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots- Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Communit ells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If s c tank is under driveway comment below From Abso ion Field on Lot to: Building Foundation > 10' ❑ Yes Property Line > 10' es; Water Main > 10' 171 Yes Water Se ine > 10' -1 Yes pm Water > 100' ❑ Yes enter dista sif less than rec P146- ft If absorption field is under driveway comment below if No ft Wells on Adjacent Lots: if No ft Private Wells > 100' ❑ Yes if No ft if No ft Community Wells > 200' ❑ Yes if No ft if No ft F. ENGINEER'S COMMENTS *ACCEPTABLE PER CODE AT TIME OF INSTAI_I_ G. ENGINEER'S CERTIFICATION / certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 9, 1 V CE79 3 �� T2r. o f e s sionocQ`� #AECC884 4 I sib il to dawminp 'Pn S 0,j .rjv �7. mints, co'^ or not r un SO T any j \� i•�/l or Ito usm, for C, onSITUCI;c-n or f of Icnca lines. e" j _\�'",� �y i Q 0/ 0 ��„ �7 fi \ -mac � � f;' ?=� �' � � � oc Doc 4. *-A 9TI- LTICeoP 6. 6$e THOMAS H. DREY>�o C, Geral Randall Jr. LS - 7625 140 4053-S 0 w, 'OFEssin P-1, IT IS THE CONTRACTOR'S RESPONSIBILITY LEGEND: TO CHECK TOP OF FOUNDATION IN RELA- - 5/8 REBAR RECOVERED TION TO FINISH GRADE AND BUILDING 0 518 R EBAR SET THIS SET BACKS IN RELATION TO LOT LINES ENC31NEERS - PLANNERS• SURVEYORS AND EASEMENTS. SURVEY 0 2'Q" HUB & TACK SET 440 WEST BENSONLEGAL DESCRIPTION: 0 EXISTING ELEVATIONS ANCHORAGE, ALASKA 99503 562-5291 DATUM ASSUMEDSCALE: oF: for 2Z or Lle>S 304-3 91 1� hoiv - Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904U4NEWE T Y CERTIFICATE OF ON --SITE SYSTEMS APPROVAL Parcel I.D. 075-092-43 Expiration Date: �.o2�'2-02-/ 1. GENERAL INFORMATION Complete Iegal description US Survey 3043 Lot 2 of 22 Location (site address) 153 Juniper Drive, Girdwood, AK Current Property owner(s) Charles Petrie & Olivia Wall Day phone Mailing address. 153 Juniper Drive, Girdwood, AK Real Estate Agent. ` Day phone 2. TYPE OF DWELLING:. ® Single Family (w/wo ADU) ❑ Duplex. ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF.WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual ❑ Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community. Class Well ❑ Public Sewer Public Water System ❑ WaiverNariance request for: _ Distance: Received by: Date: COSA to be released.to the erfgineer, unless otherwise requested by the engineer. COSA Fee. $ 0� a v 1 Waiver Fee $. Date of Payment 1.0 a 7/,? M. Date of Payment Receipt Number Q' 5. 01 7 o2 G Receipt Number COSA # 3 Ca (0 1 5 1 �J Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and.as of the validation date shown below, I verify that my investigation, basedon procedures outlined in .the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply, and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances; and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name. KENNETH M. DUFFUS Date Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the... evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future ��► �\ occupants or can ArcTerra guarantee that no unseen ,r OF ALS encroachments, deficiencies or discrepancies exist. /��v A0TTT 11 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. KENNETH US APr r• F'C:Sslor ` •� Conditional. approval for bedrooms, with the following stipulations: ,tllil.11(((( Wb`MJ02id �131VAA 31SdM 31lS-NO .cam Original Certificate Date: 0 �%�Z 020 The Municipality of Anchorage Development -Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 6 by.an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet-10-10-12.doc X Nitrate Advisory Arsenic Advisory Other Legal Description: US Survey 3043 Lot 2 of 22 Parcel ID: 075-092-43 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1975* Total depth 135* ft Cased to 40+* ft Sanitary seas is functioning correctly Wires are properly protected Casing height (aboveground) 30 in. Date of flow test for COSA 10/8/20 Static water level.at beginning of test 85 ft. Comments *: Per previous CASA K DATA Age of to years Tank type/material Measured operating fluid leve tic ❑ Standpipes/foundation cleanout per Date of pumping tank BSORPTION FIELD DATA Which s tested (date installed) ❑ ALL standpipes ent per record drawing Total measured depth from ft (max) Measured depth to pipe invert from gr ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies:. . COSA Checklist yellow sheet Well production at time of test 4.2} gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes _ Nc Coliform bacteria is Negative Nitrate 0.213 mg/L ElNitrate less than MRL (ND) Arsenic ug/L Arsenic less than, MRL (ND) Collected by Areterra Consulting Date of Sample 10/8/20 LIFT STATION ❑ Req maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Fina depth in Absorption ra gpd Any rejuvenation treatrn ast 12 months) _ If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer. Manhole/Cleanout > 100' ❑ Yes if No NA ft ❑ Yes if No 50+" ft Neighboring Tank > 100' ®.Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ❑ Yes if,No NA ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes. if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No 50+x ft ® Yes if No ft Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foun.da r _ ❑ :Yes if No ft Surface Water > 100' ❑Yes if No ft Property Line > 5' ❑ e ft Wells on Adjacent Lots:, Absorption Field >5' ❑ Yes if No ft rivate Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community 00' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway corn ow bsorption Field on Lot to: (Please enter distances if less than required) Building Founda _ ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10'' No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No Private Wells >'00'❑ Yes if No ft Water Service Line > 10' El Yes if No ft Comr ell�>200' ❑ Yes if No ft Surface Water > 100' F-1Yesif No ft F. ENGINEER'S COMMENTS Y: Acceptable per code at time of installation G. ENGINEER'S CERTIFICATION I certify that I have determined .through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines iri effect on this date. COSA Checklist yellow sheet Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 075-092-43 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent Expiration Date: 6 - 18-/r U.S.S. 3043; LOT 2 OF 22 153 JUNIPER DRIVE, GIRDWOOD, AK, 99587 STEPHEN & GALUSHA GRAJEWSKI Day phone C/O AGENT 153 JUNIPER DRIVE, GIRDWOOD, AK, 99587 SAM DANIELS W/ GLACIER CITY REALTY 2. TYPE OF DWELLING: ▪ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System W aiverNariance request for: N/A 4 Day phone 227-4626 TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer • Distance: - Received by: i COSA to be released to the engineer, unless otherwise requested by the engineer. Date: W/ S COSA Fee $ 5 — Date of Payment 31u1,/i6 Receipt Number oa0335G COSA # DSC–Wag Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection; the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: in conducting this evaluation, GEG provided an engineering evaluation of the well andiorseptic system in accordance with the guidelines and regulations established by the MunicipalityofAnchorage and industry practices. The reported results describe the condition of the systemls on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of constmction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do nol guarantee future performance of the systemis; therefore. GEG makes no warranty (express or 'Winged) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either ofthe current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. 6. DSD SIGNATURE System #1 Approved for 4 System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms. Phone 337-6179 Date • vac • • ■ _ 7Ctfey A. .mess �: • o '��y,/ 'E-7 53 i • D 4. • �n �.11jpF,S; \Q\�,t i OF bedrooms, with the following stipulations: lit -rf o j, `.# ON-SITE �; WATER AND ' y o WASTEWATER oz_ �� PROGRAM �� SERJ\C -\ By: The Municipals y or<Ftnchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Original Certificate Date: -0 / g _IJy 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 10/12112) Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: U.S.S. 3043; LOT 2 OF 22 Parcel ID: 075-092-43 TER M.O.A. RECORDS. MAX WATER LEVEL WAS 95 FEET DURING GEG FLOW TEST. A. WELL DATA **ASSUMED BASED UPON SURROUNDING WELL LOGS. SEE ATTACHED. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed -1975 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth *135 ft. Cased to **40+ ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 2/26/2015 Static water level JNPJP\�Pg�E ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. NitrateQ• 1 9 �mg./L. Collected by GEG, Ltd. Arsenic: /',0 ug./L. Date of sample 2/26/2015 B. SEPTICIHOLDING TANK DATA Tank Type/Material Tank size gal. Number of Compartments Foundation cleanout (Y/N) Depression over tank (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2orft2/bdr System type Length ft Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption - -a ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absor• '.n field before test in. Water added _gal. New depth in. Elapsed Tmin. Final fluid depth in. Absorption rate >= g.p.d. rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date 88 ft. 4.7+ g.p.m. Data installed Cleanouts (Y/N) High water alarm 12+ in. AWWU SEWER D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at • wa er alarm level at in Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main *501+ Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots On adjacent lots 1001+ Public sewer manhole/cleanout *501+ Holding tank 75'+ Manure/animal excrete storage areas 1001+ 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Properly line Absorption field Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIE e . ' OT TO: Property line B ' • •undation Water main Water service line Surface water Driveway, parking/vehicl: storage AWWU SEWER n drain Wells on adjacent lots F. COMMENTS `ACCEPTABLE PER CODE Ar TIME OF INSTALLATION. G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed New JEFFREY A. GARNESS Date sA& /li (Rev. 10/12112) ,.•'E OF • 1 • • e J. f -, A. -s 2 �1� A E-797 LOCATION OF WELL (Please complete either la, Ib or Ic.) STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8 Geophysical Surveys Drilling Permit No, A.D.L. No. 71Borough Subdivision Us 3043 Lot ' 131 Block • Ib. '/4 qtr. _of—of —of— Section No. Township No s❑ Range E❑ w❑ Meridian Ice DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS • Jeremy and Aleyeaka R.d. Street Address and Area of Well Location 5. OWNER OF WELL" Address:. Lourie Goat. Y. WELL LOB Feet Baow Burton • 4. WELL DEPTH: (final) ft. 5. DATE OF COMPLETION _4__ - 1T_ - __EL M aterlal Type - Top Bolcom t45 s ti ekup , - - 0.. - 2 '6. • ■ Cable tool. ti Rotary ❑Driven ■ Dug organic 2 7 • Auger ❑Jotted 0 Bored • Other: gravely ropy . 7 -I2 T.USE: ❑ Domestic Es Public Supply 0 Industry silty gravel , . 1.2 33 ❑ Irrigation 0 Reoharg. 0 Commerical sandy silty 33 52.. • ❑ Test well ■ Other: gravel silty sand wet . 52 58 " 8 CASING: ❑ Threaded ® welded 58 • 66 diam. '6 in. to 13` ft. Depth Weight 17 Ibs./ft water Sana and gravel clay 66- - -118 diem. in. to ft. Depth Stickup 2 It. gravelly ail ( sandy gravel • 118 134 • 9' FINISH. OF WELL: water Sand and gravel 134 • 142 Type.. sereened Diameter: 6" •resin ' 145 Slot/Mesh Size: 60 Length: 6s Ail ty rl nl Suter ." . 142 set b.iwe.n 136 n. and 142 n. • Wockfflling no Gravel pock no - 10. STATIC WATER LEVER 67 n. 4 17 /$7 _ " 0 Above or ® Below land surface Date 1451 - Equipment used: sounder' II . PUMPING LEVEL below land eUrfao. and YIELD 8,5 fl. after 2 pumping 45 e.P.m. _ _hrs. - - - ft. after pumping g.p.m. _hrs. I2.GROUTINo W.II Grouted: ,Yes 0 No Material: Neat Cement ❑ Other: j® 15. PUMP: (7r available) HP 2hp 20 Length of Drop Pipe ft. capacity g.D.m. 0 Subm. ❑ Jet ❑ Gentrified! ❑ Other 14,REMARKS: 't /0 �/ c' 01SwrPRI C2 Sera..` 16. WATER WELL CONTRACTORS CERTIFICATION: - - 15. Water ❑ F 0 O ,Temperature _a This well was drilled under my jurisdiction and thisreportIs true to the best of my knowledge and belief; terprises AA 91'n8 • Re piatered Basion+ams Contract License Number Addrees: P 00- Bax 1.1:0496 - anchorage, Ak 99511 slgnea: zaDa.: 4-17-87 rind R Auth rleed RR reeenlatlsenlatl ve Form 02- WWR. (11/81) Copy Distribution: WHITE -State DCIS, PINK -Driller, CANARY -Customer LOCATION OF WELL (Please complete •Ither la, Ib or lc.) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling P•rmlt No. A.D.L. No. EtBorough Subdivision Lot /3F Block Ib. —of_of_ot— 1/4gtrs. Section No. Township NO s❑ Range ED w❑ Meridian Ic. DISTANCE ND DIRECTI N (FROM ROAD INTERSECTIONS /" ti Street Address and Area of 11/111 Locotlon 3. OWNER OF WELL: ��rJ��/' (A� Address: i✓t/'fJ r --•f /V 1�T-' 75-1 /gip "% g� 2. WELL LOG Feet Below Surface 4. WE/LLD.E7} TH: (fleet) S. DATE OF CJAPLETf0/3 ff. Z_ ��jj - Material Type Top Bottom / Attrellic 0 6. ❑Cable fool �gotary ❑Driven ❑Dug C� �/ ,Z V Auger• Jetted ❑ Bored • duher y //9,7. USE:Dome Ule Et Public Supply ❑ industry /,Q/ 2 }ea ❑ Irrigation ❑ Recharge ❑Commerical '�r/j2i��V7 ;t-4.1elli/4A-- 0 Test Well 0 Other: rf� '• / '• Y/ a. CA$INS: ❑ Thhread d Nr Welded ///jJJ �//l/ j� / diem. (211 in. to 4 y ft. Depth Weight /.42 lbs./ft. / ,c7 diem. in. to ft. Depth Stickup ft. /////JJJJJ�--a�� .. J{J{;,..��l��-��- "- «-& -^-a f �a 0 �// L Y'. 9 FINISH OF WELL% ,Ar' // TYPO: Diameter, cal Slot •sh Stn: Length: Set between ft. and ft. Backfilling Gravel pooh I i 10. STATIC WATER LEVEL: y'L/re. ft. 7/3, ///''' ((land Dat• ❑ Above or eBelar ,urfoq• Equipment used: rii(CrLas.v�.((�( 11 . PUM_PII 6 LEVEL below lend surface and YIELD 5-7 ft. after / bre. pumping wA0 e.o.m. ft. otter hrs. pumping q.p.m. _ 12.GROUTING WII Grouted: 0 Ye• lam'' No Material: ❑Neat Cement ❑ Other: 13. PUMP: (If available) HP Length of Drop Pled ft. capacity. b�Mk�m Subm. nitkt ❑ Centrificol O Other 14. REMARKS: 16, WATER WELL CONTRACTOR'S CERTIFICATION: t:'. 15. Water 4i 'pasture's_o.i f"TF (I'd - .( This 6 r as d• iu,e tl'untl y jur' inn id this report Is true to the peat of �knowledge and belief; ContractLicense Number 'brAddressSigned: 2?%7jr'21 Dole: iAuthorizedzed Taenfative ,. Form 02- WWR (11/81) Copy Oistribution: WHITE- State DGGS, PINK- Driller, CANARY -Crate '0N 10001 StSf1 P.U. IOX 11037a a. 10330 Ula tlewara mignway (907) 349-8535 ANCHORAGE,. ALASKA 99511. DRILLING LOG Well Owner Bill Hume Use of Well Domes tic Location (address ofs Township, oRange, Section, if known; or distance main road ti5aS 14306.1 T.nt 29 Airawwred 10" 121 Size of casing Depth of Hole Static water level 74 5 ft. (a i Screen ( ); Perforated ( Describe screen or perforatic Well pumping test at 30 g: of drawdown from static Date of completion Septem Cased to 120.65 feet low) land surface., Finish of well (check one) open end ( ) ; (minute) for a 'hours with 6 35 ft 10" CSG pulled back 3' & pressure grouted w/neat cement. 6" CSG dry grouted w/1 sack Enviro- plug while drilling below th 10'. WELL LOG Depth infeet from ground surface 0 TO 2 2 TO 4 TO 10 10 TO 32 ') TO 35 5.3 TO Er ') 55 TO 5� TO 9 45 103 TO 10" TO 121 TO TO TO TO TO df,formations penetrated, size of material, color and hardness d 4at4ttp Gravel Fain}.';-ve, Water Gravel;. tntermittent-clean sand lenses, NWWA Cert'fied't ontL4'- P io. 312 & 973 2 —STATE 00 O_ 0 _ o 36'1: S ft �l g 3 Q O 0 33 2 33 z@`¢ Grid Number SE4913 E ' °2 93 Vic. jF9[s, • B Wastewater Collection System S 9 On \Y i5 L i 43 4T^ 6 f2 f Oto De 09 i OP A z 0 0< 9 0ek d 33 02 0 Q O 2 (tap Q F mUV e<U_ 9 v; a s `� oV a Z7Via0WaC>0 NOZO90, O CVVV(9V2£uF7>33 F Z cc 0 _ o Legal: SE 1/4 Sec18 T1ON R2E _ ._., Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 075-092-43 1. GENERAL. INFORMATION Complete legal description USS 3043 LOT 2 OF 22 HAA# 1-)4f)aa--4- 9--os Expiration Date: Location (site address or directions) JUNIPER STREET • GIRDWOOD, AK. 99587 Current Property owners) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BARBARA GIMLIN c/o SAM DANIEL w/ NEXT HOME Day phone (541) REAL ESTATE 756-8441 Day phone SAM DANIEL w/ NEXT HOME REAL ESTATE Day phone 783-1910 1015 EAST 6TH AVENUE • ANCHORAGE, AK. 99507 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System • TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local sous condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system wilt continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for `7- bedrooms. Disapproved. Conditional approval for Phone 337-6179 Date 11 /2 Z/py bedrooms, with the following stipulations``lk‘IIt0Ff ANA V• : ON-SITE rn- WATER AND • WASTEWATER PROGRAM •• Attachments: HAA Checklist Septic System Advisory Well Flow Advisory !/ Maintenance Agreements dl�C/JNT//j� lyj`jjl ,\\\ Supplemental Engineer's Report Other By: J2#y7 1? (Rev. 17/01) Original Certificate Date: 6 .2 0..6 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196850 Anchorage, AK 99519-6850 www.d.anchorage.ak.ua (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: USS 3043 LOT 2 OF 22 Parcel ID: 075-092-43 A. WELL DATA *PER MOA HAA FILE RECORD. Well type PRNATE If A, B, or C provide PWSID# N A Date completed 1975 Sanitary seal (Y/N) YES Total depth 935 ft. Cased to 40+ ft FROM WELL LOG Date of test Static water level ft. Well production `e , g p m WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate 0.111% mgJL. Arsenic: N/A mg /L 8. SEPTIC/HOLDING TANK DMA Tank Type/Material Well Log (Y/N) NO Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 8/8/2005 87 ft. Date of sample. 6/6/2005 Tank size gal. Foundation deanout (YIN) Number of Compartments 8.3 g.p.m. YES 12+ In. Other bacteria colonies/100 mi. Collected by GEG, UO. PUBLIC SEWER Date installed umping C. ABSORPTION FIELD DMA Date installed Length ft Width ft. Total depth ft. Eft. absorption area_ Date of adequacy test Re Fluid depth in absorption field • - t In. Elapsed _ min. Final fluid depth _ in outs (WN) over tank (Y/N) _ High water alarm (Y/N) Pumper Soil rating (g.p.dJfebr fttbdrm)_ ft2 Monitorin ass/Fail) — Water added PUBLIC SEWER System type Gravel rejuvenation treatment (past 12 mo.) (Y/N & type) gall. Absorption rate >= g.p.d. If yes, give date Pe ft. Depression over field For bedrooms New depth _in. D. UFT STATION Date installed We in gallons Manhole/ "Pump on' level at in "Pump • n High water alarm level at in Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL. ON LOT TO: *AS REQUIRED PRIOR TO 1983 Septic tankAift station on lot N/A Absorption field on lot N/A Public sewer main *50'+ Sewer /septic service line 25'+ On adjacent lots On adjacent lots 100'+ 100'+ Public sewer manhole/cleanout Holding tank *50'+ N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line Absorption fie W : Surface water PUBLIC SEWER Water main cent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water service line Su n F. COMMENTS G. ENGINEER'S CERTIFICATION Driveway, parkinglvehicle storage Wells on adjacent lots I certify that I have determined through field inspedlons and review of Municipal records that the above systems we In conformance with MOA HAA guidelines in efled on this date. Engineer's Printed Name JEFFREY A GARNESS (o(z7-4 5 - Date HAA Fee $ Waiver Fee $ Date of Payment (0";r) -OG �Date of Payment Receipt Number / (►pV.M Receipt Number (Ray. 12/01) 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 # 0-12)—C\9 --1-1 HAA# k�ligl�f>1�SS 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2; Za"'ishisie.e,: oic Lot 22; USS 3043 Location (address ordirections) NUN Juwi.pen. V'uLve (b) Property owner Lanny & Man,%anne Dani.e2a Telephone : (home) 783-2740 Business 783-2222 Mailing Address P.0.Box 532 G.Lndwood, AQadka 99587 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent JACK WHITE COMPANY ATTN: Jack Vandenbwtg Address 3201 C Street Si, fie #100 dnchonage, A$266z 945 3 Telephone 563-5500 (e) Mail the HAA to the following address: (or check here C, ',)4f hold for pick up.) List contact person and day phone number below: 5 & S ENGINEERING 17034 Earyle gt„Pr 1 nap Rand No 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family XX Number of bedrooms 4 3. WATER SUPPLY Individual Well XX Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site 0 Public IBX Community 0 Holding Tank 0 'te: If community well system, must have written confirmation from the State Department of Environmental servation attesting to the legailty and status. 1) 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 S & S ENGINEERING Address 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date 6. DHHS APPROVAL, Approved for bedrooms b Approved Disapproved Terms of Conditional Approval x./04-2 Conditional 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. 7188) Back Page 2 of 2 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) MUNICIPA rR ST\'FEBRUARY 1984 ENVIRONMENTAL SERVICES aStI3 417,44 I Legal Description rr 2Z - APR 1 61990 EC JIVED Well Classification ) r 91 1] ' ' t_- If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/ 1 Date Completed V\1G b Yield 6- Agri Total Depth °1/41. ---}Cased to Depth of Grouting l 4 1 - c Static Water Level Pump Set At • V ---c‘ 2— ' is" CasingHeight Above Ground Electrical Wiring in Conduit (VN) Y SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot il i& ; On Adjoining Lots /A' To Nearest Edge of Absorption Field on Lot I-1 A*, ; On Adjoining Lots ( To Nearest Public Sewer Line 16 -4- To Nearest Public Sewer Cleanout/Manhole ,Ot) } 1 To Nearest Sewer Service Line on Lot 2-5 'iWater Sample Collected by Sk 4t,- Y�--1.r- , Date Water Sample Test Results Comments Sanitary Seal on Casing (1JN) '1 Depression Around Wellhead (Y,EN) B. SEPTIC/HOLDING TANK DATA Date .stalled Size No of Compartments Standpipes Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank Date Last Pumped Pumping/Maintenance Contact on Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TA To Water -Supply Well - To Building Foun To Property Line To Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course ` Comments r,Jt-� 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soil. Rating in Absorption Strata Type of System Design Date Ins : led Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area Statndpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Prop- Line To Building Foundation To ing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments JI�\G-\?6"1— D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & 5 ENGINEERING 17034 Eagle River Loop Roact Na 204 Cagle IL' las 2577 Company Date y0 MOA No. 0 Receipt No. 9/KO Y,//O r/ Date of Payment Amount. $ 72-026 (Rev. 7/86) Back _/(7 /70 00 oA •... *e. a+qo .. Robert A. Shoicr No. 1457-E • Receipt No S «/> °•• Waiver Fee $ Date of Payment Page 2of2 crriscris A:ronin coa �1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 i ( 1 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days fo processing. 1. PROPERTYOWNER Roger J/Edith Davis PHONE 783-4551 MAILING ADDRESS Girdwood Hardware 99587 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER Larry K/Marianne L. Daniels PHONE 783-6000 MAILING ADDRESS Post Office Box 532 99587 3. LENDING INSTITUTION Spokane Mortgage Company PHONE 277-0543 MAILING ADDRESS 3201 C Street 99503 4. REALTOR/AGENT Jack Vanden Berg % Jack White Company PHONE 277-1553 MAILING ADDRESS 3201 C Street 99503 5. LEGAL DES ION Lot 2 k 22 U.S. Survey 3043 Girdwood STREET LOCATION Mile 1.2 Alyeska Highway 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS NI One NI Four NI Other 129C SINGLE FAMILY ❑ Two N Five • MULTIPLE FAMILY &3cxThree ■ Six 7. WATER SUPPLY )x INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled IN COMMUNITY since June 1975. For wells drilled prior to that date, give well ■ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM **If individual/on-site, give installation date ?MX INDIVIDUAL/ON-SITE** If system is over two (2) years old an adequacy test is required ■ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) See note on attached white sheet, system is being connected to the public sewer. THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS • IN ONE ■ THREE ■ FIVE ■ OTHER SINGLE FAMILY O FOUR IN MULTIPLE FAMILY IN TWO IN SIX 2. WATER SUPPLY PERMIT NUMBER DEPTHOFWELL • INDIVIDUAL • COMMUNITY DATE DRILLED • PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ■ INDIVIDUAL/ON -SITE PERMIT NUMBER DATE INSTALLED OPUBLIC UTILITY Connection Verified INSTALLER • Septic Tank or • Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line - Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS �_-. . V,aa�ww�. Ls 1 L. Came& 6d �.t,-G-12 1 jggli .-'n.. '1 /Cf it BEDROOMS certificate) ■• APPROVED FOR I,kl' CONDITIONAL APPROVAL (letter must accompany O DISAPPROVED DATE /CI—. d4-.-7 ? BY (Title) Z C ..42,&— LEGAL DESCRIPTION 72-010 (Rev. 3/78) 0L1TS l DE 4, 30/nen, f Tp 7- „,6---„w7g PRA 77- GREATER ANCHORAGE AREA BOROUGH_. Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV AHFC X 2. Property Owner: Roger J. & Edith Davis Mailing Address: Girdwood Hardware 99587 3. Name of Buyer: Day Phone 783-4551 Larry K. & Marianne L. Daniels Mailing Address: PO Box 532, Girdwood 9958Bay Phone 783-6000 4. Name of Lending Institution: Spokane Mortgage Co. Mailing Address: 3201 C St., Anchorage 03 Phone 277-0543 5. Name of Realtor or Agent: Jack Vanden Berg Jack White Co. Mailing Address: 3201 C St., Anchorage 03 Phone 277-1553 6. Legal Description: Lot 2 of 22, U.S. Survey 3043 Girdwood Location: Mile 1.2 Alyeska Highway 7. Type of Facility to be inspected: 3 No. Bdrms. Water Supply Type of Supply: Public Utility Individual xx If Individual, number of dwellings presently served If Individual, depth of well 135 ft. 9. Sewage Disposal System Check of sewer system not required by bank as public sewer will be available within two weeks Type of System: Public Utility Individual (on-site) xx If Individual, date of installation 1975 one EQ -037 (1/74)