The URL can be used to link to this page

Home My WebLink AboutTHOMSON LT 2Thomson Lot 2 #067-041-02 Page 1 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Number: SW000095 PID Number: 067-041-02 Permit "°m°' MIKE LOVETT Wastewater System: • New ■ Upgrade Address: 7100 CLEMONS CIRCLE EAGLE RIVER, AK 99577 ABSORPTION FIELD Phone: (907) 696-4721 No. of Bedrooms: 3 • Deep Trench 0 Shallow Trench 0 Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soli Rating: 0.8 GPD/Sq. Ft. Total Depth from original grade: 10.1-11.9 Ft. Lot: Block: Subdivision: 2 — THOMSON Depth to pipe bottom from original grade: 1.06-2.89 n. Grovel depth beneath pipe: 9.02 Ft. Township:_Range: Section: — FRI added above original grade: 0'-2' FL Grovel length: 35 Ft. WELL: ■ New • Upgrade Gravel width: 2.5 R, Number of lines: 1 Dletance between lines: — n. Claee'Alwllon (Private, A9,C): Total De FL Cased To: FL Total absorption area: 631 so. Ft. Pipe motedal: ASTM D -3034/F810 S(\NG Millen G X\ Dote Drilled: Static Water Level: Fl Installer. TWEED EXCAVATION Date Metalled:v 5/10-12/00 Yield: GPM Pump Set At: Ft. Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES • Septic 0 Holding 0 S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manufacturer. PREMIER PLASTIC Capacity In gallons: 1300 well 100'+ 100'+ — — 25'+ Moledal: PLASTIC Number of compartments: 2 Surface Water 1001+ 100'+ — — — LIFT STATION Lot Line 5'+ 10'+ - - — In gallons: Mon facture° N P Foundation 5'+ 10'+ — — — `Pump on" level aL 'Pump oN` • High water alarm at: Curtain Drain Pump Make : El ctrical Inepecllone performed by: NONE KNOWN Remarks: -1146 1J -est 1r410 0.2 114W BENCH MARK 'T'&eikA vJNs Iti4SULPrrco 01/4)e to LAe.L Location and Description: BOTTOM OF SIDING AT POINT "B" OF CoJLtL. Aeeumed Devotion: 100 F. 0 p to ' ENGINEER'88EAL oo6a` ' 'I ‘IN �F It Sp�O �� 9*0� D Inspections performed by AWWC, INC. Dates: 1st 5/10/00 2nd 5/10/00 3rd 5/12/00 '``I- ODOs •t ��oa fr professiot`..° �4000o�� A ser ss;' •o 7953 \co�p Department of Health and Human Services approval Reviewed and approved by /'. Date: 6- c'O a 72-013 (Rev. 9/91) MOA 25 PERMR NUMBER: SW000095 AS -BUILT DRAWING PARCEL ID NUMBER: 067-041-02 EXISTING DRAINFIELD TO BE USED AS A RESERVE SITE. A B C ST1 26.86 23.91 56.53 ST2 29.5 27.40 58.91 DBL1 31.89 30.35 60.95 DBL2 33.15 31.77 61.98 FD 33.8 32.64 62.64 FCO 15.19 7.01 49.00 C01 113.13 115.81 135.66 MT1 110.43 112.72 132.38 CO2 102.39 98.14 109.01 MT2 101.46 97.73 108.69 a B�R�41 NocF FC SUMP INSTALLED FLOW �D RTER MT1 C01` - - - MT2 'CO2 NEW DRAINFIELD INSTALLED "PREMIER DBL, PLASTIC" 1300 GALLON DBL2 \ SEPTIC TANK N ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE, AK 99504 • PHONE (907)337-6179 • FAX (907)338- PREPARED FOR: PHONE NUMBER: MIKE LOVETT (907) 696-4721 46 DATE: 5/18/00 DRAWN BY: C.J.G. SCALE: 1" = 40' PAGE NUMBER: 2 OF 3 LEGAL DESCRIPTION: THOMSON SUBDIVISION; LOT 2, TYPE OF WORK: AS -BUILT OF SEPTIC SYSTEM UPGRADE `114iiii 9�.• 0'e lre A. Gayness: C 7953 ; •1c c, 'ea profess:0;4 egP 0000�a PERMIT NUMBER: SW000095 AS BUILT DRAWING PARCEL ID NUMBER: 067-041-02 TOP OP TANK — Af INILPf - 93,27 INVPRf OF DUNG Af INI.Pf - 92.56 511 0 FINAL GM -9591-96,13 IN5U.A11ON 512 0 TOP OF TANK Af OUILPI- 9331 i NSW 1300 GALLON 1'remER PLA511C1l 5N9i1C WANK �INVERt OF DUNG Af OMR( - 9235 Mr CO r FINAL GM- 76,72-78,01 i ORIGINAL GR Q 777? - 7999-76,82 13O110M OF 1P.PNCN - 6491 INVERT OF PIPP -73,93 ALASKA WATER & WASTEWATER CONSULTANTS, INC 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE, Al( 99504 • PHONE (907)337-6179 • FAX (907)330-5246 DATE: 5/18/00 DRAWN BY: C.J.G. PREPARED FOR: PHONE NUMBER: MIKE LOVETT (907) 696-4721 SCALE: 1 = 40' PAGE NUMBER: 3 OF 3 LEGAL DESCRIPTION: THOMSON SUBDIVISION; LOT 2, TYPE OF WORK: PROFILE AS—BUILT OF SEPTIC SYSTEM UPGRADE ooF �\ �� 'SOON lit J: fr- A • ess, Q P 'E-79 4•49- .... o 'tf'rofesslo"°oto �kO000��o MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000095 Legal Description: THOMSON LT 2 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Mike Lovett Owner Address: 19444 Ostovia Cir. Eagle River , AK 99577 - This permit is for the construction of: H Disposal Field IA Septic Tank Holding Tank opace/lam-, 57/O/OOG Spm Date Issued: May 09, 2000 Expiration Date: May 09, 2001 Parcel ID: 067-041-02 Site Address: 007100 CLEMENS CIR Lot Size: 48499 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 Privy ❑ Private Well ri Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: e•A 6 -off Y;-73,0 Z Date: 5 _q `L'' 0 Date: - %' 00 Ls ALASKA WATER Fr WASTEWATER April 24, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Sysem Upgrade Design for Thomson Subdivision; Lot 2 To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing drainfield is in need of an upgrade prior to the sale of the house. One test hole was excavated on the property and the septic system upgrade will be designed within the 30 foot radius of this test hole. We are proposing that a 1000 gallon septic tank and a deep trench type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layers are a GM/SM/ML material to a depth of 20 feet (bottom of test hole). No groundwater was encountered during the excavation of the test hole. A percolation test for this test hole was performed between the depth of 7.0 feet to 7.5 feet which had a percolation rate of 4.4 minute/inch. It is our opinion that due to the overall appearance of the soils, a application rate of 0.8 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 4.4 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 563 ft2 f. Total Depth: 12 feet (max.) g. Effective Depth: 9 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 35 feet long lc Effective absorption area = 630 ft2 6901 Debars Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the design, the lot has several slopes that vary in grade and direction. We are proposing that the new drainfield be installed at the base of a slope that exceeds 25%. The lot downhill from the proposed drainfield does not exceed a 25% slope at least 50 feet from the proposed drainfield. The trench is to be installed parallel to the slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179. Thank you for your assistance. NOTE: Attached is a site plan drawing, a design drawing, I soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246 BOB WELLS S/D; LOT 3 BOB WELLS S/0; LOT 4 BOB WELLS S/D; LOT 5 v THOMSON S/D; LOT 4 /_ ` /\ N. / \ / \ / \ \ N. ?PTIC \\ ARE.:0 EXISTING THREE BEDROOM HOUSE THOMSON S/D; LOT 3 EXISTING SEPTIC SYSTEM TH#1 PROPOSED SEPTIC UPGRADE. SEE DESIGN PAGE 2 OF 2 / THOMSON SA LOT 5 THOMSON 5/D; LOT 6 / APTIC REA' 1 THOMSON 5/0; LOT 1 1, CHUGACH STATE PARK ALASKA WATER & WASTEWATER 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE. AK 99504 • PHONE (907)337-6179 • FAX (907)336-3246 PREPARED FOR PHONE NUMBER: MIKE LOVETT (907) 696-4721/274-6166 LEGAL DESCRIPTION: THOMSON SUBDIVISION; LOT 2 TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE DESIGN DATE: 4/27/2000 DRAWN BY: K.D.W. SCALE: 1" = 100' PAGE NUMBER: 1 OF 2 EXISTING DRAINFIELD TO BE USED AS A RESERVE SITE. EXISTING SEPTIC TANK TO BE COMPLETELY ABANDONED r + / / C• MT SUMP PROPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 12 FEET DEEP MAXIMUM, BY 2.5 FEET WIDE, BY 35 FEET LONG. ADD 9 FEET OF CLEAN, WASHED SEWER DRAINROCK. INSTALL TRENCH PARALLEL TO SLOPE CONTOURS. ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD. SUITE 2B • ANCHORAGE. AK 99504 • PHONE (907)337-6179 • FAX (907)338-3246 PREPARED FOR: PHONE NUMBER: MIKE LOVETT (907) 696-4721/6166 LEGAL DESCRIPTION: THOMSON SUBDIVISION; LOT 2 TYPE OF WORK: DESIGN FOR SEPTIC SYSTEM UPGRADE DATE: 4/27/2000 DRAWN BY: K.D.W. SCALE: 1"=40' PAGE NUMBER: 2 OF 2 PROPOSED 1000 GALLON SEPTIC TANK 6�0 D A. mess: P —7953 c00 0,. " •••.....•••'' c o o n sd professlocoo �O�000�e ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 PHONEARR (07) 337 SUITE 9 •B • FAX (907) 39 99504 3246 SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: THOMSON SUBDIVISION; LOT 2 PERFORMED FOR: MIKE LOVETT DATE PERFORMED: 4/18/2000 DEPTH (feet) ORGANICS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 GM/SM/ML TEST HOLE #1 SOIL CLASSIFICATIONS GW GP GM GC SW SP SM SC ORG ML CL OL MH CH OH DEPTH TO GROUNDWATER DATE DRY 4/18/00 DRY 4/25/00 4/20/00 — -- 1 N THOMSON 8/0; LOT 3 SITE PLAN I"=100' CA TI THOMSON S/0; LOT 1 DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 4/20/00 — -- 1 2:58 6" — 2 3:08 10 3" 3" -- 3 3:08 6" — 4 3:18 10 3 1/4" 2 3/4" 5 3:18 -- 6" — — 6 3:28 10 3 1/2" 2 1/2" 7 3:28 6" — — 8 3:38 10 3 1/2" 2 1/2" 9 3:38 —- 10 3:48 10 3 3/4" 2 1/4" 11 3:48 6" — — 12 3:58 10 — 3 3/4" 2 1/4" PERCOLATION RATE 4.4 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 7' FT. AND 7.5' FT. COMMENTS: PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERF ME IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE• W MUNICIPALITY OF ANCHORAGE ®'t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION kJ ENVIRONMENTAL ENGINEERING DIVISION -- 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME g r / / Ct a l� , Man, (&P-7 PHONE Ij�(V �(�. Cf Hd4JEW [a ❑ UPGRADE MAILING ADDRESS) 6'6c 5 aile2EG1 /.Ann. E 4'. 91577 LEGAL DESCRIPTION 601 kvr±, rn scrn Z/ e-p-5kr✓1 LOCATION NO. OF BEDROOMS L3 SEPTIC TANK DISTANCE TO: WellAbsorption 1' /00/2.r area Dwelling _if Material ,57 c. c. Width PERMIT NO. Frp,20 684/ No. of compartments -z- Liquid depth Manufacturer 6eccae. Liq. capacity in gallons IF HOMEMADE: Inside length 6 M J U'Z DISTANCE TO: Well Dwelling PERMIT NO. 2 G b Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD1 TRENCH I DISTANCE TO: Well / /00 Foundation / 3/ Nearest lot line / 1-/(3 PERMIT NO. ,9Q/)&ec/ No. of lies Length of each ne / Total longth of lines '�� Trench width 06 inches Distance between lines Top of tile to finish grade .4.</i _ Material beneath tile 7 / inekes Total effective absorption area ( w Length Width Depth PERMIT N0. NO. ct F w°t Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line ClaDepth (///4W4 Dr'ller Or -C -1 Ois ance to lot line >-a_l/-w -,.n.-x-. , PERM NO. / / tit U6cr69^/ w/ " _ DISTANCE TO: .C6'v-..w Building foundation -,tri Sewer line -rt MO Septic tank /06 d Absorption areals) p OTHER�- PIPE MATERIALS 3334 SOIL TEST RATING //3 - - INSTALLER Ce.r &&c REMARKS 'a \k V d j-0 111. qi Pk. I4 --- - P 11H141-1 nnr.11ttt+l-ti otAse APPROVEDDATE LEGAL 72-013 (Rev. 3/78) q -r I y DOC CO. dim .tta'Eng SUILINAN WATER WERIS P. 0. BOX 272, CFIUGIAK, ALASKA 99567 o TELEPHONE 688-2/59 OWNER OF LAND \I-0 /71--; ryu ,77 r \f' O ADDRESS 16€2 0) 5— e-e-)4/Sell LEGAL DESCRIPTION Lin 1:2, 674(C 77/)'"11 75. ° //—a ded GALS. 7' PER ER . 3.TO e.) DATE • Started EndedGALS. PERMIT NUMBER KIND OE CASING DEPTH DE WELL / a- <9 /1 STATIC STATIC LEVEL OF WATER FT DRAW DOWN FT LIND OF FORMATION: From 6 Ft to r) Ft 0 0/54 .7,2> Off/;''J From .n. to From a Ft. to 7 7 Bt. J/ 4. 7 ji-y „, (.2; : From. Ft. to _Ft,_ Trotn Et to Ft 7 ,e ,,,70,c4 From Ft. to Ft. Frond -.2___Ft. to JO Ft CZ tEr ?:-&;elf ki:::R.:. From Ft. to l't nrom _ail_ Ft. to -12: -.)__FT .c/r) /kJ d -. (:i,.):-.„. From _ _.Ft. to_ Ft From -7.s -S Et. to K.: 2 Ft._ t-1,4•41 0 From Ft. to Ft. Ft om €1:;.? Ft. to ri FtC ...-: 7 i: rom . Ft. to Ft. . _ From EC; `) From/ / 5 Ft to 1/5- Ft. /1/. s, A ji Et to tika Ft .-Slech,•-•149 / Lit. to /d Ft. 6<",t1 I:torn Et to Et " /52 Er...):;?.. Front_ From Ft. to Ft. From _Ft. to From _Ft. to Et. From Ft to Ft ANCHORAGE Ft. , Fr:MuUNLIC_DIFPpticYX:i.‘ _ Ft. to_ From_ Ft to LLI\114) '1982; Eriv1R01,41v. A.. . ELT RiN From Ft to Ft : Ft. to RE CEFEt. 1 V E Front Ft. to_ From Ft to Ft From_________Ft. to Ft to Ft, From Ft. to Ft. From Ft to Ft MISCL. INFORMATION: From From Ft to Ft DRILLER'S NAME /i:‘.11, -ie --.1 1FAC `�NIE9q,AJD,EL DEPARTMENT HEALTH AND ENVIRDNMENTHL (0TEClIOM 925 1L' STREET, RNCHORHGE, W. 39501 264-4720 C2EsIJOI PERMIT NO. ( 82064 ) ` APPLICANT C&T CONST J. TH0MPSON LOCATION LEGAL 'L2 THOMPSON �� , �-"``" o � ' • 'agiS3 6005 WREN LANE E. R. 99577 694-3029 LOT SIZE 999999 SQU8RL FEEl TYPE OF SOIL ABSORPTION SYSTEM TS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOI/ RATING (SQ FT/8R)-' 195 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ��E8-1111E--...- ��PAT!"-"E=.. �-72 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNWE BETWEEN THE SVRFHCE OF THE GROUND AND THE BOTTOM OF 'HE EXCAVATION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF )HE EXCAVATION (IH FEET). ��IE., �HA.--" R 1: C; rrA pA ��;:!4p7A1 g ��-A� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE IMST9LLHTION INSPFCTIONS OF ANY WFLLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WI}L SERVE. `^-- �"k"AD 1". ��IG-fl II a 1". ErA _ BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEP241TMENT WILL BE SUBJECT TO PR0SECUTIO1 MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 180 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET SRAM R PUBLIC WELL DEPENDING UPON THE TYPE UF PUBLIC NELL MINIMUM DISTANCE FROM q PRIVATE HELL TO H PRIVATE SEWER LlNE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ORE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT NITHIN 30 DAYS OF THE WELL COMPLETION. O|HER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAM S ARE HVRl|HBLE TO INSURE PROPER INSTHLLRTION. I CERTIFY THAT i: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEVERS AND WELLS 8S SET FORTH BY THE MUNICIPALITY OF HNCHORHGE. 2� I WI|"L INSTALL THE SYSIEM IN ACCORDANCE HITH |HE CODES. 3.. l UNDERSTAND THAT THE ON-SITE SEWER: SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDEEACE IS REMDXELED TO INCLUDE MORE THAN ] BEDROOMS � � � ,, ISSUED 6Y ,�~,_`~',~_ 17.'PLICHP1T C&T CONST JTHOMPSON LL/My AmAgi DATE • PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 2644720 LEGAL DESCRIPTION: /��, i•.�• 1 3 6 7 8 9 10 ,11 12 13 .eTH.. T'- ETJ- p.. it 14 15 16 17 18 19 20 hil ('I it iM kjit _ 611 COMMENTS vm. > /1A, So. -A, Cr SOILS LOG — PERCOLATION TEST 1./ LOPE l WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? �lo �> r/ .. 1. t / c, i. SOILS LOG. - PERCOLATION TEST • DATE PERFORMED: 7 Y< (�f s L 0 P E SITE PLAN A,' Reading 1 Date Gross Time Ne TimeWater lvn ,i✓ Depth o Ft Net Drop CI- ci __ . Q. �> /, .JO Za ._. - / 0 /2 i -zit .I // -1 (2 : _r / / ,. / V 2. % a : 0 -2- . 7,0 /0 /1 // „! 0 -th7,('- - .22 - /Z .0 '✓2 -/,./4 Cl Li w /, % -t (d-, C' „ 0 :-s /T ; /'< : yo /0 jfl2C; c/ /?_r 1/ C& JJI-.0 / l(; / Q2 -A jJ_t_j /Z J 2.1%. 0(9 /,� 0 3 IA ,9 /`,._-Th ) -L-/19Ci /,/'r" -Lri20 PERCOLATION RATE d , TEST RUN BETWEEN LAN. PERFORMED BY:,V,4( 1=N1.',i,/?h/ it >G1p Lr J=AY 72-008 (6/79) (minutes/inch) (2' FT AND FT CERTIFIED BY: ATE: NI d- pi CS /11 o U 00 ,-0/ZCe_4_. 2s' SdP2 iwusi-z7;-(24- Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 067-041-02 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address THOMSON LOT 2 COSH# OSG12 GobO Expiration Date: `"T 7100 CLEMONS CIRCLE *EAGLE RVER, AK 99577 ED Sc KENDRA WOLLERT Day phone 622-1268 7100 CLEMONS CIRCLE *EAGLE RVER, AK 99577 Day phone NANCY STAHLY W/ GREATLAND REALTY Day phone 301-4113 Unless otherwise requested COSA will be held by DSD for pickup. 2. NUMBER OF:BEDROOMS: 3 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 Sewer111 • The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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, f 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 Address GARNESS ENGINEERING GROUP, Ltd. 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 & 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 soils 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 will 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 if confer any legal right whatsoever. 5. DSD SIGNATURE 1.7 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date tz1zS /lt bedrooms, with the following stipulations: - rofess�ac 'ODO000�� S( OF M • �, : ON-SITE • 0c; a ; WATER AND W' WASTEWAR PROGRAM ; ,. " 'lf11 f 1' ""1 " Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: / '' 5� 12 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: THOMSON, LOT 2 Parcel ID: 067-041-02 A. WELL DATA Well type PRIVATE If A, 3, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 7/82 Sanitary seal (Y/N) YES Wireserl ro p p y protected (Y/N) YES Total depth 120.7 ft. Cased to 120.7 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 7/82 12/15/11 Static water level 24 ft 36 ft. Well production 25 g.p.m. 7.0 g.p.m. WATER SAMPLE/�RESULTS: Coliform Y' colonies/100 ml. Nitrate t•2-5- mg./L. Collected by: GEG, Ltd. Arsenic: N D ug./L. Date of sample: 12/16/11 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/PLASTIC Date installed 5/12/00 Tank size 1300 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) NA Date of pumping 12/14/11 Pumper JRs PUMPING C. ABSORPTION FIELD DATA I'BELOW EXISTING GRADE 9/30/8611. 195 TRENCH Date installed 5/12/00 Soil rating (g.p.d./ft2orebdrm 0.8 System type TRENCH 44 3 Length 35 ft. Width 2.5 ft Gravel below pipe 9 ft. *9.25 616 Total depth *12.08 ft. Eff. absorption area 631 ft2 Monitoring tube YES Date of adequacy test **12/15/11 Results (Pass/Fail) PASS Fluid depth in absorption field before test 3 in. Water added 930 gal. Elapsed Time: 392 min. Final fluid depth 3 in Depression over field Absorption rate >_ NO For 3 bedrooms New depth 11 in. 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **2000 TRENCH TESTED ONLY. 1986 TRENCH WAS DRY AT TIME OF INSPECTION. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off" level Datum E. SEPARATION DISTANCES F. Manhole/Access (Y/N High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Septic tank/lift station on lot Absorption field on lot Public sewer main 100'+ N/A Sewer /septic service line 251+ Animal containment areas 50'+ On adjacent lots On adjacent lots 1001+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas 100'+ 100'+ N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 5'+ Property line N/A Water service line Wells on adjacent lots 100'+ 5'+ Absorption field 51+ 101+ Surface water 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 101+ Curtain drain COMMENTS Building foundation 10'+ Water main N/A Surface water 100'+ NONE KNOWN Wells on adjacent lots 100'+ Driveway, parking/vehicle storage 10'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date i'L/Z-e/// COSA Fee $ LH O Date of Payment Receipt Number (Rev. 11/05) /•9e qi Waiver Fee $ Date of Payment Receipt Number SGS Ref.# Client Name Project Name/t/ Client Sample ID Matrix 1115983001 Gayness Engineering Group, Ltd Thomson L2 Thomson L2 Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 12/28/2011 8:40 12/15/2011 12:30 12/16/2011 12:53 Stephen C. Ede Parameter Results LOQ Units Method Allowable Prep Analysis Container ID Limits Date Date Init Private Individual Analysis Lead Magnesium Manganese Nickel OH Alkalinity PH Selenium Silver Sodium Sulfate Total Dissolved Solids Zinc Arsenic Thallium 0.296 0.200 ug/L EP200.8 C (<15) 12/19/11 12/20/11 SCL 12000 50.0 ug/L EP200.8 C 12/19/11 12/20/11 SCL 1.17 1.00 ug/L EP200.8 C (<50) 12/19/11 12/20/11 SCL ND 2.00 ug/L EP200.8 C (<100) 12/19/11 12/20/11 SCL ND 10.0 mg/L SM202320B D 12/19/11 AYC 7.60 0.100 pH units SM20 4500-H B D (6.5-8.5) 12/19/11 AYC ND 5.00 ug/L EP200.8 C (<50) 12/19/11 12/20/11 SCL ND 1.00 ug/L EP200.8 C (<100) 12/19/11 12/20/11 SCL 7520 500 ug/L EP200.8 C (<250000) 12/19/11 12/20/11 SCL 38.4 0.100 mg/L EPA 300.0 D (<250) 12/17/11 12/17/11 SDP 294 10.0 mg/L SM20 2540C D (<500) 12/19/11 AYC 6.28 5.00 ug/L EP200.8 C (<5000) 12/19/11 12/20/11 SCL ND 5.00 ug/L EP200.8 C (<10) 12/19/11 12/20/11 SCL ND 1.00 ug/L EP200.8 C (<2) 12/19/11 12/20/11 SCL SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1115983001 Gamess Engineering Group, Ltd Thomson L2 Thomson L2 Drinking Water Printed Date/Time Collected Date/Time Received Date/time Technical Director 12/28/2011 8:40 12/15/2011 12:30 12/16/2011 12:53 Stephen C. Ede Sample Remarks: Parameter Results LOQ Units Method Allowable Prep Analysis Container ID Limits Date Date Init Metais by ICP/MS Hardness as CaCO3 Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory Colony Count Fecal Coliform Total Coliform Private Individual Analysis Alkalinity Aluminum Antimony Barium Cadmium Calcium Chloride Chromium CO3 Alkalinity Conductivity Copper Fluoride HCO3 Alkalinity Iron 249 5.00 mg/L SM20 2340B C 1.27 0.100 mg/L SM20 4500NO3-F B 0 0 0 col/100mL SM20 9222B col/100mL SM20 9222B col/100mL SM20 9222E A A A (<200) (<1) (<1) 210 10.0 mg/L SM202320B D ND 20.0 ug/L EP200.8 C ND 1.00 ug/L EP200.8 C (<6) 5.81 3.00 ug/L EP200.8 C (<2000) ND 0.500 ug/L EP200.8 C (<5) 80100 500 ug/L EP200.8 C 8.04 0.100 mg/L EPA 300.0 D (<250) ND 2.00 ug/L EP200.8 C (<100) ND 10.0 mg/L SM20 2320B D 512 1.00 umhos/cm SM20 2510B D 7.42 1.00 ug/L EP200.8 C (<1300) 0.123 0.100 mg/L EPA 300.0 D (<2) 210 10.0 mg/L SM20 2320B D ND 250 ug/L EP200.8 C (<300) 12/19/11 12/20/11 SCL 12/16/11 AYC 12/16/11 DLC 12/16/11 DLC 12/16/11 DLC 12/19/11 12/19/11 12/20/11 12/19/11 12/20/11 12/19/11 12/20/11 12/19/11 12/20/11 12/19/11 12/20/11 12/17/11 12/17/11 12/19/11 12/20/11 12/19/11 12/19/11 12/19/11 12/20/11 12/17/11 12/17/11 12/19/11 12/19/1.1 12/20/11 AYC SCL SCL SCL SCL SCL SDP SCL AYC AYC SCL SDP AYC SCL Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program • 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 3434904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 067- o q !- 0 Z 1. GENERAL INFORMATION Complete legal description 'NOM So*) &O f HAA# OSp)/q Expiration Date: . 7 - / tj - o Z Location (site address or directions) 7/00 r LE:MEWS GSRQ- 9157g - Current Property owner(s)SowAT4AN +ReScCCA- PETERS Day phone 350-20toY Mailing address 7/nn CIS*res erg h 4-Cuz /Z JtP ,#r S ?C7; Lending agency Mailing address Real Estate Agent 57h.1JE 'ct&xlr tc Day phone Mailing Address x kbYM4-rsi L PRoPe271,--r. 6-14-5.1.1-1A Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site [Lj� Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HM) 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 sample results. (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, I 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. 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 Eagle River Engineering Services 10421 vi -vv Fid., SUM 2111 Address Fag(e PNer, AK 9Q577 Engineer's Printed Name cMl2TstoPtte2 R- 000.6 Date H//9/2450s Phone 69LI-5796-- 5. DSD SIGNATURE V Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ••. yo t a _ ON-SITE n t•-- • WATER AND 1 WASTEWATER PROGRAM • ` ?ri:. NT St`•�O Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory (Rev 01/02) Maintenance Agreements Supplemental Engineer's Report Other (42 Pfr-e-71— Original Certificate Date: L-1--19-05 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 7/40 not SoA.) 1-6 7 Z A. WELL DATA Well type PR.ZVJ4TG If A, 8, or C provide PWSID # - Date completed 7$Z. Sanitary seal (Y/M) YA S Total depth /2D.7 ft. Cased to / ZQ-7ft. FROM WELL LOG 7/sz Date of test Static water level Z. y ft. Parcel ib:0 7-Oyf-n2_ Well Log ON) Yes Wires properly protected (Y/f1 yes Casing height (above ground) 2', in. AT INSPECTION • /O5 - 3o ft. Well production ZS g.p.m. '/• 7 g.p.m. WATER SAMPLE RESULTS: T Coliform colonies/100 ml. Nitrate/. i%` mg./l. Other bacteria 0. colonies/100 ml. / Arsenic: mg./I. Date of sample: 1/ - 8 - o 5' Collected by: -Tenho zVA %%Aov B. SEPTIC/HOLDING TANK DATA Tank Type/Material P1-41 jr. L Date installed 5 //2/00 Tank size '1 3o 0 gal. Number of Compartments 2 Cleanouts (Y/N) YE 5 Foundation cleanout (Y/N) vets Depression over tank (Y/N) MO High water alarm (Y/N) A/D Date of pumping 1112ZA,51 Pumper I'R r 5 C. ABSORPTION FIELD DATA Date installed tz Soil rating (g.p.d./ft2 or -ft?/ n) System type TREAdGN Length 3 .5 ft. Width Z. S ft. Gravel below pipe 9 ft. Total depth 12 ft. Eff. absorption area (,31 ft2 Monitoring tube V/E5 Depression over field 40 Date of adequacy test y�/ / /Or Results (Pass/Feiy 945 5 For 3 bedrooms Fluid depth in absorption field before test ZD, in. Water added PiOgal. New depth ZA in. Elapsed Time: 70 min. Final fluid depth ZD in. Absorption rate >= 6//O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Md If yes, give date — D. LIFT STATION Date installed °Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pugtp off lit%q,aff in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT Septic tank/litt-etetien on lot 1100 Absorption field on lot 't' /DO Public sewer main t 100 Sewer /septic service line `D 7 1 TO: Manhole/A High water alarm level at Meets alarm & circuit requirements? in. On adjacent lots 't' 100 On adjacent Tots 1' 10 0 Public sewer manhole/cleanout t 106 Holding tank t 100 SEPARATION DISTANCES FROM SEPTIC/I IOWI fS TANK ON LOT TO: Building foundation 1 20 r Property line 1-50 r Water service line '1' 15 Water main 4- 2 S Absorption field Surface water Wells on adjacent lots +106 1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line t SOr Building foundation * 10 Water main Water Service line + /00 r Surface water tion Wells on adjacent lots *100 r Curtain drain t' CO r poste Wow*/ F. COMMENTS * sec S &S hc if D G. ENGINEER'S CERTIFICATION t- 5 r t/00r a'loor Driveway, parking/vehicle storage +5.0 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name OiRi oP�F_ie R. 4%60% Date yl/`dbs 4 r., A Pr , UJ+ rr RWOOo CE:1D38w .................. HAA Fee $ loos - eb Date of Payment Receipt Number (Rev. 12/01) c4li slos- trct,542ti 01 Waiver Fee $ Date of Payment Receipt Number 4-18-05:11:13AM; sG$- 007 5815301 0 2/ 2 Nitrate analysis for sample collected at: Clemons Cir #7100 L2 Collected on 4/08/05 and received at SGS on 4/08/05 and assigned sample number 1051833-001. The total nitrate/nitrite result is 1.46 mg/L, below the regulatory limit of 10 mg/L. A written report of this result will be mailed later this week. The final nitrate analysis could not be conducted with the 48-hour holding time from collection indicated in the EPA -approved method, so a preservative was added to the sample to prevent the possibility of biological degradation of any nitrate amounts present. Addition of the preservative does mean that the final result does represent a total nitrate/nitrite concentration value. Nitrite is typically not present in groundwater or drinking water samples, but if it is present, the contribution to the reported value is usually small. If you have any questions, feel free to contact us at 907.562-2343. Sincerely, Lif Bryan!. Project Manager Sp a kc. st;i ;t Covv. c r - 19 -or cut f/ ),-yas,. a_* S yrs 44,1 tab ulU n o± G/an t h I /et e- red, int 4/ h oh J'�•�t�� 0 V a S ra Id u Lo ve, Orycn a Sr tire/ retic i i S (c )t0 s. a., WA A r 6'ccAv1C 7t%tiy- "nc It gvi t 71-kty to ol a rill pre cit.,' 11 in 0,v/ c 1, e k 0h &c_ te ell. 5 /4 s sc.-- - vvo,,KS Le f .t_ A. t u.,sc s Wo✓Y. 6ryat. / IhCI ittAlalek 0�" av�y reeb/en, C. rc, • s{ •e j .7t" A it cif s �c cc vvarte,, I. eft w.y/L 57L L- J 4-18-05:11:24AM: SGS/CTE ENVIRONMENTAL SERVICES • Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPUER p PUBLIC WATER SYSTEM IW • PRIVATE WATER SYSTEM • 0 Sand Resat ' Send Imola :607 8818301 w 1/ 1 200 W. POTTER DRIVE ' ANCHORAGE, ALASKA96518 Tel: 907-562-2343 Fax: 907-561-5301 • Lab R•r t . [.%.10.5181��IIyyII3I13�ann-81 1. SAMPLE COLLECTION: . r..r..d.. .w•.}.aw re.. r•wi.w.�.. time: 8. o M••M aq . Ttme: Location: PM WNW on8 CI-EM6tO CIR Co1NNor. TAW Transported' to Lab By: ❑ Same as collector ••07/ Other. SAMPLE TYPE: , litoutIne Repeat Sample 2 • (refer to lab no. eirdsert 0 Special Purpose • • O.Treatsd Water .:1:1 Untreated Water. earidleanw O BE COMPLETED BY LABORATORY Sample Reeeivk)g; • ' Date: l{ •-b/'�5 :Time: • / 33 Temp: Delivery Method: Received By: 5'L . Contrives: rwd wen ❑ Sane* OW as boas aid; . Results may be unrslsbla 0 RUSH SAMPLE Phone #: • Fax #: aacterloloalcal Water Analysis Record: • • MMO-MUG (PIA) RESULTS: Analysis Bryan: �//r% /3-72.r Total Wife= Analyst E Coil": / Analytical Method: • Membrana Filter MMO-MUG (PIA) MEMBRANE FILTER RESULTS: °tract Count O Colonist/100S Venni:Mkn: •wart. jjLTB: /r I awl Cala t EC' Date/Tine: Jf-// if }A,. as •ow•r Meow% Sant b *DEC: ANC FBK JUN DateMmt Sent to Client Phoned Q Faxed DateMme • Spoxe wRb; -Satisfactory 0 Unsatisfactcy TNTC • Toe M..r•e• 1• Cor tpeialpud5c1DOCUMENTIFORMS1M4Coll Form.xts Form # FW- 0053 10/24/03 - . a... memo - • 1.46 R V R a-Ndta ,,.. 6q4 -S19& ).N.i. Egg- szoil . r."Ib �2t VFW a SI -i -e 20 I • . SAMPLE COLLECTION: . r..r..d.. .w•.}.aw re.. r•wi.w.�.. time: 8. o M••M aq . Ttme: Location: PM WNW on8 CI-EM6tO CIR Co1NNor. TAW Transported' to Lab By: ❑ Same as collector ••07/ Other. SAMPLE TYPE: , litoutIne Repeat Sample 2 • (refer to lab no. eirdsert 0 Special Purpose • • O.Treatsd Water .:1:1 Untreated Water. earidleanw O BE COMPLETED BY LABORATORY Sample Reeeivk)g; • ' Date: l{ •-b/'�5 :Time: • / 33 Temp: Delivery Method: Received By: 5'L . Contrives: rwd wen ❑ Sane* OW as boas aid; . Results may be unrslsbla 0 RUSH SAMPLE Phone #: • Fax #: aacterloloalcal Water Analysis Record: • • MMO-MUG (PIA) RESULTS: Analysis Bryan: �//r% /3-72.r Total Wife= Analyst E Coil": / Analytical Method: • Membrana Filter MMO-MUG (PIA) MEMBRANE FILTER RESULTS: °tract Count O Colonist/100S Venni:Mkn: •wart. jjLTB: /r I awl Cala t EC' Date/Tine: Jf-// if }A,. as •ow•r Meow% Sant b *DEC: ANC FBK JUN DateMmt Sent to Client Phoned Q Faxed DateMme • Spoxe wRb; -Satisfactory 0 Unsatisfactcy TNTC • Toe M..r•e• 1• Cor tpeialpud5c1DOCUMENTIFORMS1M4Coll Form.xts Form # FW- 0053 10/24/03 04/13/2005 07:33 9073449821 JR' Pumping PO Box 773415 Eagle River, AK 99577 (907) 694-6454, IBNIInp Informatlon Jonathan & Rebecca Parana 7100 Clemons Circle Eagle River, AK 99577 (907) 690.3175 'Job SIM Infomratlon Jonathan 7100 Clemons Circle Eagle River, AK 99577 (007)996-3175 PAGE 01 Service Agreement Number: 012836 Order Date: 22 -Apr -2004 Sella Date: 25 -Apr -20D4 12:00 am TedmMdan: Reggie Job Type Repeat Map Grid: 134- - Jab Description: 1250g P.O. Number: Teens: Net30 Salesrep: Nikde Map Book: J Croat Smote: Eagle River Road Job Com menta: New - no previous records on file, new tank Tax Percent: 0 Service Type Price Each Se* Servs under 2k 8115.00 Addilknel Location Comments: Diagram: Wood vertical stained hamears on House/Brown w/Red Trim PIpn behind house & garage Beck In run hoses trough dog pen JRS SEPTIC oty 1 Ca & Pumped Tank x 2 Men Tax No No en Extension Actual 8115.00 Gallons Planned: 1250 Gallons Actual: Hose Length: 2 Double Tank: I J Pump System: ❑ Belles Inlet: 0 Baffles Outlet NonTaxable Total Estimated Charges: 511500 Actual Charges: Insets Total $0.00 fax Total 50.00 Grand Total 5115 00 Customer agrees to the terms and conditions printed on tha bade. THIS IS A BINDING AGREEMENT. Slgnature and Title of Customer Representative Dote Accepted by as Pumping Dare Acopted For your added convenience we accept American Express, Dlcover, Vise and Master Card payments over Wm phare. 4a.. Mt nava snxumtx w01 be turned over to collections. 525.00 For NSF Checks Returned. Pe ,J • n 1. •`Q1 .� Duane Nsr% Seward •• .� SZ t •. LS -6918 • . a titt,,u'`I^7Q - arm, Ywy/.;;/� . AS.BUILT'N0 corn ere set this date I hereby certify that 1 have performed a Mortagee'i In spection of the following described property Thomson Subd.a Lot 2 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN CN THE RECCRDED PLAT ARE NOT.SHCWN HEREON. The information hereon is for the use of lending institutions shoiaing the 'relationship of exih'ting structures and platted easements and lot lines.. It is not to be used for positioning additional structures or fencelines. • • Mchorage Recording Precinct, Alaska, and that the Improve ments situated thereon are within the property lines and d 'not -overlap or'entzoach on the property lying adjacent there to, that no Improvements on property lying adjacent thereb encroach on the premises in question and that there are n roadways, transmission lines or other visible easements of said property except as Indicated hereon. Dated at Anchorage, Alaska this 17 , August E8 ay or 6-4566 1G 88 SEWARD,& ASSOCIATES LAND SURVEYING 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 Parcell.D.# �Ir:�� t� L\V fHAA# CH1-1 i -or: 1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2; Thomson Subdivision Location (address or directions) NHN Clemons (b) Property owner Marty & Sue Angel Mailing Address Telephone : (home) 694-3984 Business 1797 Eagle River Road, HC83, Eagle River, Alaska 99577 (c) Lending Institution Seattle Mortgage Telephone Mailing Address (d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER - Eva Loken Address ]6600 Centerfield Drive, Suite 201, Eagle River, Alaska Q977 Telephone 694-4200 (e) Mail the HAA to the following address: (or check here ®, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family ❑ Number of bedrooms 3. WATER SUPPLY Individual WellfSc 2 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. 4. SEWAGE DISPOSAL On-site ER Public 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 {Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 17034 Eagle River Loop Road No. 204 naaie tier, Ata5;ga S & S cNta1N) L'Lc1IM 7 Date Telephone /�JG �/5, 11/fr -Keavii A. $kaict t1u. 1443:4, ., .. 6. DHHS APPROVAL Approved for Z bedrooms by i014Ni Stet rn+ Date 11 /16/96 Approved X Disapproved Conditional Terms of Conditional Approval iu.astoGut�-1 t>(spos4c. sysr <s Aatave Gc92 Z SEDR-cowls 0tirvy 5o6.; .-( Ha -5 //As o,v(,.( a 6��-c jvvts 4a As DCc ;odu By /Q//6/cw Reda- E -4 RS A-pp/Lads/lc. , CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATk< V Well Classification SiN)9lP t v4 nn i MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: L-ot 2 (h Oit&Sn&J f-) ) Well Log Present (Y/N) 11 Date Completed 7/A 2 Total Depth (2f10" Cased to 17o,Btr Depth of Grouting Static Water Level 2- 7' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) If A, B, C, D.E.C. Approved (Y/N) Yield (0.1-7 nn (to -2q -q0) Pump Set At UlC I Z r r t Sanitary Seal on Casing (Y/N) ti Depression Around Wellhead (Y/N) P3 SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ( 00 I • On Adjoining Lots / 00 1 - To Nearest Edge of Absorption Field on Lot ( 00 1 ; On Adjoining Lots ( 00 /y' To Nearest Public Sewer Line / ___ To Nearest Public Sewer Cleanout/Manhole t -)A i To Nearest Sewer Service Line on Lot 2 S f Water Sample Collected by _1t� Skil i..1Neert N7 ; Date / 0 - (9 - 5/ a Water Sample Test Results �✓� l s fAG l o✓ u — R a_Ci r n A) t t Comments B. SEPTIC/HOLDING TANK DATA Date Installed 11-30'8?Size / 0oo94 No of Compartments a Standpipes (Y/N) Air -tight Caps (Y/N) t1 Foundation Cleanout (Y/N) A/ Depression over Tank (Y/N) Date Last Pumped (0 - 2 (o - 50 Pumping/Maintenance Contact on File (Y/N) for A)lIA Holding Tank High -Water Alarm (Y/N) A)lIA Temporary Holding Tank Permit (Y/N) tJ/G4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well / 00 To Building Foundation I / To Property Line To Water Main/Service Line 10 I0' 1 To Disposal Field / 2 - To Stream, Pond, Lake or Major Drainage Course / 00 f Comments •Sepftc- POmpe.d �(( �iR S C -C poo( PonAip(t) 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 3 Depth of Field / 1 Type of System Design — 3 O- P 7 Length of Field 4 q lee&ck Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Gravel Bed Thickness to ( F4 Statndpipes Present (Y/N) -7- / Date of Last Adequacy Test (o -24-to SAti s f,Ac,togry - Aedroc M SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well / 00 /'f To Property Line ( 0 / t To Building Foundation s ( To Existing or Abandoned System on Lot n)/(A ; On Adjoining Lots - 0 t To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ( (Do t To Driveway, Parking Area, or Vehicle Storage Area 1 30 i --5I Comments S tem niJ1 � Ade G u(/k IC•' for l )o ( Z) bec U'ooM s 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 effegt-or'th , to of this' inspection. 1E .n. Signed c 5 LIN fri =. Nls Company '17034 Eagle River Loop Ctoad No 904 ilcileo River, Alaskil 99577 o Date MOA No. (% c/o - LgS e-)_ Receipt No. 02 a 3 / (3 J 4 7 ) Receipt No Date of Payment //-/— 9 0 Waiver Fee. $ Amount. $ / 70 00 Date of Payment 72-028 (Rea. Ma/ Back Page 2 of 2 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 # '-,o 7O4//-6 HAA# VA SR (c6 I 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2 Thom4on SubdivLe-Lon Location (address or directions) C2emon6 Cinete. (b) Property owner AIIFC 066029 Telephone : (home) Business Mailing Address 520 Eat 34th, Anehonage, Atadhaa 99503 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER - Eva Lohen 16600 Centenftietd !kin, Suite 201, Eau/Le Riven, A2aeha 99577 Address Telephone 694-4200 (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eag2e Riven Loop Road. Sa.Lte 204 Eagte Riven. Ata41za 99577 2. TYPE OF RESIDENCE Single -Family CX Number of bedrooms 3 Ondened by Eva Loben 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. 4. SEWAGE DISPOSAL On-sitetX Public ❑ Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION . As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. c Name of Firm 5 & 5lNGIWEr^IS•!G Address 170341_'a,io i;iv::r koad No. 204 Eagle krver, 1414141.,,:a7i Date Telephone 6. DHHS APPROVAL Approved for 3 bedrooms by Approved Disapproved /(A2[161/ Conditional Date 1(2OPiiztS Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA ;MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) 'ti CHECKLIST - FEBRUARY 1984 343-4744 Legal Description. th.4 fp) Well Classification Well Log Present ail—N) Total Depth l2o'elf Cased Static Water Level I4 21 4\QJ1xt. Date Completed to 0-0 1 Depth of Grouting 27 r Pump Set At lifer Casing Height Above Ground IZ N -t' Sanitary Seal on Casing 9N) y 1IkOt•1' Cr -1 If A, B, C, D.E.C. Approved (Y/N) Yield 4;(40 610H H' Electrical Wiring in Conduit 0/N) Depression Around Wellhead (W SEPARATION DISTANCES FROM WELL: r To Septic/Holding Tank on Lot \ 00 • On Adjoining Lots ( 00 1H` To Nearest Edge of Absorption Fieldto Lot \ 40 4- • On Adjoining Lots To Nearest Public Sewer Line /f< To Nearest Public Sewer Cleanout/Manhole I To Nearest Sewer Service Line on Lot %moi k \on -k N,4 Water Sample Collected by ' 7 t6 ; Date 1\ — eQ'g Water Sample Test Results J 4fltt.t-191t--1/41 _ f t ce j (Jl 1 Q— Comments 0e1-47 6.-0,5 j -w/(ip S-tk,- 88 B. SEPTIC/HOLDING TANK DATA Date Installed 9-41.7431-- Size \ 4290 No of Compartments 2 Standpipes (QiN) Y Air -tight Caps n) Depression over Tank (Yap //Date Last Pumped 6- 1'I - sg Pumping/Maintenance Contact on File (Y/N) //// - ; for Holdigg Tank High -Water Alarm (Y/N) I(fk Temporary Holding Tank Permit (Y/N) (4,A Foundation Cleanout (Yea) N - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: \001 .=4- ToWater-Supply Well To Property Line To Water Main/Service Line To Building Foundation To Disposal Field \o'd- \f \ 2/ To Stream, Pond, Lake or Major Drainage Course \ iocit 4 -- Comments Comments PJB -\P1 1-36, 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1<1/P,n-- Date Installed e1 --3O St Length of Field Zgy9 Width of Field ryJ Depth of Field Type of System Design 1 Square Feet of Absortion Area Depression over Field (Y. Results of Last Adequacy Test Gravel Bed Thickness Rpo Statndpipes Present ON) >J Date of Last Adequacy Test — SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well \ 0t 1 —Vto- 0-z 1-50--, To Property Line To Building Foundation 1 To Existing or Abandoned System on Lot /A ; On Adjoining Lots /27€7 I'-- \ To Water Main/Service Line \ o j -k To Cutback (if present) 1"/A- ( To Stream, Pond, Lake, or Major Drainage Course 100-(' To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in a Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at - t Y/N) Tested for Pumping y - _ 'ne Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments /pc Dimensions **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.,�,atti�1.ih"TMT.. , inspection. .o•°' a ° �� ' � Signed Company Date /7 -2 fr 8 MOA No. l^ /'6.-03 S & S ENGINEERING 17034 Eagle River Loop Road No. 204 C.eyle Rivers Alaska 99577 Receipt No. Date of Payment Amount. $ 72-026 (Rev. 7/88) Back - -2a td /7c 00 Receipt No Waiver Fee. $ Date of Payment Page 2 of 2 A. ihste J+ ee NSA )d47.)`, e O(�tCO'OyyOe* O8Oc004`'a�Cri �-6'I B J tt eti: MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE. General Information i' ; (a) Legal. Descri,ption (include lot, locic, subdivision, section, township, range) 2- 'I C-3 / S' c tom/ Location (address or directions Jed 141 (b) Applicants NamecJ)2(/( G(/✓l// MIA Telephone – Home Business /t Address / w Applicants (c) Applicant is (check one) Lending Institution Buyer [ ; Other f _II (explain); (d) Lending Address Institution 11 ; Owner/builder Telephone JJ r (e) Real Estate Co. & Agent C._./(2C/( Address ( t �' e /51-- Telephone SGL Telephone F= (:)//:] �)` ) •Mail the HAA to the following address: 2. Type of Residence Single --Family =k Multi -Family r G -Number of Bedtooms -1 3. Water Supply Individual well. `-1, Community [ [ Public Other (describe) Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public [—T Community IT Holding Tank E� Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] V!a' WNfrvSlriPJYF�i'.:A 5. Engineering Firm Providina 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 regula- tions in effect on the date of this inspection. Name of Firm Address Date/6// ->/ • (ENGINEER SEAL) 6. DHEP Approval Approved for /C-e'ie_1 bedrooms Approved g_-- Disapproved Terms of Conditional Approval Telephone r� U' No 1457-E iiia `gy'''m Ley _ " ..1.6')(C4 DAYt.Fq'satcl.` {!.{xxI A. $Iwiet Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-- AT.IONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D1.8 [Page 2 of 2] 7-19-84 A. WELL DATA Well Classificati Well Log Presen(Y '* Total Depth / / MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Static Water Level MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONW&NTAL PROTECTION[ OCT 1 1 1980 REEVED If A, B, or C, D.E.C. Approved(Y/N) Date Completed 7 Z Yiel•� c Cased to /20 f Depth of Grouting Pump Set At LC Z lr -F Sanitary Seal on Casing Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Wb11: To Septic/ -Tank on Lo To Nearest Edge of Absorption Field on Lo Lot /O ; On Adjoining Lots /420 (7(-- Lot/00 (Y Depression Around Wbllhead To Nearest Public Sewer Line %) FP ; On Adjoining Lots /00 171 - To f To Nearest Public Sewer Cleanout/Manhole /1/ Gy2- To Nearest Sewer Service Line on Lot Water Sample' Collected By S e�SCLIgkee/�14,; Date /10/0G/2s4 Water Sample Test Results </ Comments /O >L B. SEPTIC/H N-TANKDATA Date Instal 77.303 Z Size /90D Standpipes Depression ver Tank '/i Date Last P d --ri —f3 Pumping/Maintenance Contract on Fileld (Y , for Al /1'1 Holding Tank High -Water Alarm (YfNef A Temporary Holding Tank Permit (Y/14 /f Separation Distances from Septic/Holding Tank: To Water -Supply Fb 11 /O / To Building Air -tight Caps No. of Compartments Z Foundation Cleanou To Property Line h To Water Main/Service Line Course Comments Foundation // To Disposal Field /Z r To Stream, Pond, Lake, or Major Drainage Al 0 r -I rk [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7730 2 Width of Field 3 6 " Square Feet of Absorption area Depression over Field (.Y 9) Results of Last Adequacy Test G/6 47/r Type of System Design r6Llc Length of Field 4/ 41/ Depth of Field // Gravel Bed Thickness Standpipes Present Date of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well /i9 0 71-- To Property Line To Building Foundation Lot /v/ /, ; On Adjoining Lots /V / /79 4/ / 0 /- /7 3 / " To Existing or Abandoned System cn To Water Ma»/Service Line /Z7 To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area c_41) t Comrtents t 0 N• q D. LIFT STATION ** Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Di nsions Mdnho Electrical Codes(Y/N) Comments cess (Y/N) Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, on the date of this inspection. Signed tiMOWFAMO H4 ;O Companyi At A= KB1/d5/s [Page 2 of 2] or conformed to all MOA RAA Guidelines in effect .47T Of 141- 4.11 th `V ° .. VR•4t I. 1 O •7 �Lpy of 19 it c:,i> �T i}g Date/0 MOA No. u Febarl A. ShaMr °•No. 1457•E •• c : 15 .4 •+ <z °%`` rimevE. U,�a 2-15-84 Time a Date Date Date Inspector Inspector Inspector P caclA milmriunLlry r /,NCII Comments ,_,F22 RAG' Conditional Approval DEPT. OF I'7'1r I P. ENV IRONM?.: A_ I.;O,°C.TION f uV 9 1982 P -n, RECEIVED Date Sewer Installed "7_ % Permit No. Septic Tank Size 1 O 0 G Holding Tank Size Solis Rating Well To Absorption Area Well to Tank / a Well Log Received . ]4.A. C pJ✓ �� V APPLICANT FILLS OUT LOWER HALF ONLY PropertyOwner C F, T Construction Mailing Address 2530 Teklanika Drive, Eagle River, AK Phone 694-3029 Buyer Doug Albertson 2221 Muldoon 11318, Anchorage, AK 99504 Address Lending Institution F:LrSt Nat. hank of Anchorave Address P.O. Box 4-2090, Anchorage, AK 99509 Phone 265-3812 Realty Co. & Agent Commonwealth AREA, Inc. Address P.O. Box 249, Eagle River, AK 99577 Phone 694-9555 Legal Description Lot 2 Thomson Subd. Street Location NNW Clemens Circle Typepf Residence n Single Family o Multiple Family No, ❑ Other 2 0 of Bedrooms WaterjSupply (-.• rT Individual ATTACH WELL LOG. -A well log is required for all wells drilled since June ❑ Community 1975. For wells 'drilled prior to that date, give well depth (attach log if o Public Utility available.) Sewage Dlsposai CT Individual Year Individual 0 Public Utility When Connected ❑ Holding Tank 1982 Installed• to Public Utility NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.