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OVERLOOK ESTATES BLK 1 LT 4
Overlook Estates Lot 4 Block 1 #068-041-04 tnev vow& i 0) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201278 PID Number: 068-041-04 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name SPIVAK NOAH & RICHARDSON LINDA A70RPTION FIELD ep Trench ❑Wide Trench ❑ Bed '❑ Mound Site Address 6212 Magnaview Dr Eagle River ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 D/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from origina de Gravel depth beneath pipe Ft. Subdivision Block Lot OVERLOOK ESTATES 1 4 Fill added above original grade Ft. G el length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist�btwen lines Ft. SEPARATION DISTANCES ToTotal Septic Absorption Lift Station Holding Sewer absorption area Number of trenches Dist. between tr chis From Tank Field Tank Line Ftz Well > 100' TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1500 Gal. Surface Water > 100 Material Number of compartments Lot Line > 10, NA plastic 2 Foundation 8.9' LEFT STATION Manufactu Capacity Remarks Gal. Alarm location Elec ' nstalled by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer JRs Septic Drainfield 3034 CO/MT 3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspeection 1m 9/29/2020 9/30/2020 Location and description ction 2i,d bottom of stucco point A 3`d 0 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date p.• '� :F9���, .................... •• 1004' Septic System .18..Date . No.0 Approve tn.,. Date 10—Too `�F�F�PROFE55t�N���a�' Note: this approval does not include well permit requirements. tnev vow& i 0) o = �l C:) �� G7 N F— > O ?�K O O� D z U7\) � D z D � ca � G7 00 Z Cn D rn O J cy)z N O N m v Cl) O < ;r, (D �. may0 Boz O N M :37r CO U) ;7 00 0 O A = o O � > c Ol O iz �® C-) ® Cz�p•®� AW ro : O®0 Loz 0 Air nrl N Mm o� S D CD �o 0 m 0 �m �r z C) M U) b /IN --n m lo E)- m = O CO z �o 'I Z .x O� r �m m0 mn o z v Fn OZ C) o v o �m r =i z n m _ cn V O o m \ � ;r\ C) All � m oG) S -u C0 ;oo Oa? D Z m O x --j Lf) c0 r -I z c) m u> v 0 mm n m� n� -i z < O m -F, 0 m 0 x _4- -i ;vx m ZCC) :.; Nt N A --i D mZ m z 05 / cn D rn M m co z O O O .A LO ' ;D mm O -u ;D C) r :j �� zC-> cn m 0 0 F- 1 cn _ 1 O N 0 1 0 D Z C Ln O 11 N N C) 0 j cy)z N O N m v Cl) O < ;r, (D �. may0 Boz O N M :37r CO U) ;7 00 0 O A = o O � > c Ol O iz �® C-) ® Cz�p•®� AW ro : O®0 Loz 0 Air nrl N Mm o� S D CD �o 0 m 0 �m �r z C) M U) b /IN --n m lo E)- m = O CO z �o 'I Z .x O� r �m m0 mn o z v Fn OZ C) o v o �m r =i z n m _ cn V O o m \ � ;r\ C) All � m oG) S -u C0 ;oo Oa? D Z m O x --j Lf) c0 r -I z c) m u> v 0 mm n m� n� -i z < O m -F, 0 m 0 x _4- -i ;vx m ZCC) :.; Nt N A o n -i z Ti m m z �D;�-,� \DZ - z O cn �Cmo U)O < C) oo> O m r zocn u,oM --jC� >Wn/ D W N O O O;oD(n-ID--i<:�E-10 g-- n* m m x m SmrC=z=M>=x00-Xr-m DOr-Dmom�(,)M><K� tnD�o 0C -0 C � <M -D -_C-)o -i�n0mZZ0Mo--io D� zm< mmOOXOCOri- C0-< �- Oom� V9: z � z z- c r O Z O O K Z Z 0 70 0 -+ 0. -iO O >mm� LnZ(Z: > IZcoDDD Z� �`�X ��-Oi=Om�z 0ZD �N �f { cn m �0-iz < - 0 -DUz D mZ rC Dzm�O-q r=� ' _CD zC) 0OMCf),, oz s 0 Cncn0-n-CD;u 0 z Z0mOZmm� Dmor0U) ocooCD<r-co >r -_i �on �z-om-0D�70r-OC DD m DZZzOD=OZOO;r. KmZ Z D r m 00>0-F-9mmxmoDmr,mn x;o->r�SUlzZ �� —i Dtnr O Z-50F'M>zw>> C)> T carr- �zommzz mz C) Ln CD z x-10 < �S Km rcn0� Dcn1'z�D z� z m-Z�o z C� arDm � Mi NO D= 0K:O2 DD U') Mr-�D Om �m �`_ onz o iz m� o0 0 0 0 0 Z Z D M Z m z � 00 x --i _ r=,i mZ m z 05 / cn D CD m O m' O 'i - O z Fri C) LO ' ;D mm �� � -u ;D C) r :j �� zC-> rte` m 0 0 F- 1 cn V Im_D M 0 N D 0 1 0 D Z C Ln fIl- C) j `oX o n -i z Ti m m z �D;�-,� \DZ - z O cn �Cmo U)O < C) oo> O m r zocn u,oM --jC� >Wn/ D W N O O O;oD(n-ID--i<:�E-10 g-- n* m m x m SmrC=z=M>=x00-Xr-m DOr-Dmom�(,)M><K� tnD�o 0C -0 C � <M -D -_C-)o -i�n0mZZ0Mo--io D� zm< mmOOXOCOri- C0-< �- Oom� V9: z � z z- c r O Z O O K Z Z 0 70 0 -+ 0. -iO O >mm� LnZ(Z: > IZcoDDD Z� �`�X ��-Oi=Om�z 0ZD �N �f { cn m �0-iz < - 0 -DUz D mZ rC Dzm�O-q r=� ' _CD zC) 0OMCf),, oz s 0 Cncn0-n-CD;u 0 z Z0mOZmm� Dmor0U) ocooCD<r-co >r -_i �on �z-om-0D�70r-OC DD m DZZzOD=OZOO;r. KmZ Z D r m 00>0-F-9mmxmoDmr,mn x;o->r�SUlzZ �� —i Dtnr O Z-50F'M>zw>> C)> T carr- �zommzz mz C) Ln CD z x-10 < �S Km rcn0� Dcn1'z�D z� z m-Z�o z C� arDm � Mi NO D= 0K:O2 DD U') Mr-�D Om �m �`_ onz o iz m� o0 0 0 0 0 Z Z D M Z m z � 00 x MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://wvvw.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201278 Work Type: SepticTank Upgrade Tax Code Number: 06804104000 Site Legal Address: OVERLOOK ESTATES BLK 1 LT 4 G:0465 Site Mailing Address: 6212 MAGNAVIEW DR, Eagle River Owner: SPIVAK NOAH & RICHARDSON LINDA Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: ' it1 c n t S' a f - c. t.l}artmetit 8/3/2020 8/3/2021 45727 ❑ Disposal Field 10 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B) Issued By - Date: / �� Date: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201278, Rebecca Carroll, 08/03/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201278, Rebecca Carroll, 08/03/20 Municipality of Anchorage Page I of L DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ® Anchorage, Alaska 99519-6650 o Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report 5t,-, 95°L.89 PID Number: 66,8 1 0 uit Permit Number: Name: c1 Wastewater System: IX New ❑ Upgrade Address:VD62 ,y 79 4o4z C—� .9958 ABSORPTION FIELD Phone: 691-41.5-.3-B No. of edrooms: 14 Deep Trench u Shallow Trench D Bed 0 Mound ❑ Other LEGAL DESCRIPTION Soil Rating:i • 2 GPD/ S . Fl. Total Depth fo Vtott �ri na(grade: ill Lot:Block: Subdivision: 4 2 Ovtf21-00.< 657 Depth to pipe bottom from original grade: visi"5, 4.0 6.5 Ft. Gravel depth beneath pipe 8.° Ftt. To.vnshi `� 1,1-NJ1‘._/3-' Range: Sect/J��: SZy Fill added above riginal grade: Fl. Gravel length: 41 Ft. WELL: X New ❑ Upgrade Gravel width: 1f' Ft Number of lines: Distance between lines: I I Ne) Ft. Classification (Private. A,B,C): .R\V�s Total Depth: Cased To fO�tFt. Total absorption area: 64.3G SQ.FL Pipe material: Tvc . D3034 Driller: 5tdLI-)V Date ()rifled: • 9-5 Static Water Level: 100 Ft Installer: / - M G-Te•�.lCch.,-v Date installed: I6-IB-dt3 Yield: 3,5-GPM, Pump Set at: . ht71- 5E1 hS OF'. .Ft. _... Casing Height Above Ground: V .... Ft. TANK ... - .r , 'x9=94 SEPARATION DISTANCES r'Iri Septic ❑ Holding D S.T.E.P. To From Septic Tank Absorption Field 011 Station Holding Tank Public/Rrivate Sevier Lines Manufacturer ANctio e Capacity in alons: iso d Well 131 lS t tMaterial: -'-,m STEL Number of Compartments: Z S stere -it-1W ' x-.100 +It9b' LET STATION Lot Line 63' ��-' "'-- Size in gallons: Manufactur lr: /A Foundation I q �_„ "Pump on” level at: "Pum. off' evel at: High water alarm at: Curtain 7 'r-1C J , 00 VCO Pump P.1a1e : ' odel Electrical Inspections performed by: Drain- _ _. ._ ._. _._.._ Remarks: BENCH MARK Location and Description: 51 ,- @ Law i_ vE.. Assumed Elevation: , �U Ft. ENGINEER'S SEAL <S�OFALi:f�Q� f iN by: C,5Y-,5YDates: 1st to 1 ��193 jl4', 4 F Jr Inspections performed 2nd 10)191,” Y Department of Deal - nd Human Services approval' Reviewed and approved by: r Date:. —22 -? 11 HENRY H. WILSON 4 O 1732-E ti4? Ar ®�-,:z.. 72-073 (Rev. 9/91) MOA 25 WASTEWATER ABSORPTION SYSTEM LOT 4 BLOCK 1 OVERLOOK ESTATES SUB AS K,ILT D TAILS A = 14,5 B = 43.5 C = 29.0 D = 23.0 BOTTOM OF TEST HOLE ®��OFAZ,0 0 -7*qa 46,v--' HENRY H. %Y]LSON 1732-E A,, Of 0 to �o n x.,40 �SSIONAWW PERMIT SW930289 PID 06804194 PREPARED EOR1 LOT 4 BLOCK 1 OVERLOOK ESTATES CMM GENERAL CONTRACTORS PO BOX 774042 EAGLE RIVER, AK, 99577 CONSTRUCTING ENGINEERS 9601 BUDDY WERNER DR HCB3 BOX 192A NYRTLE DR ANCHORAGE, AK, 99516 EAGLE RIVER, AK, 99577 346-2000 694-9098 DATE. 2-08-94 NOT TO SCALE DRAWNG IIt 93-S2-0705 AS -BL LT SERV N 36° 49' 58° W 28. oCO cp - a N n q U Q J MAGNEV IEW DRIVE S 51° 49' 57° E 199.66 ® �®®®® OF A44414 49TH Ic /i or4 // HENRY H. WILSON %3082-S 4.44 )4, 0 IONAu l'P ®®®®w I HEREBY CERTIFY THAT A SURVEY OF LOT 4 BLOCK 1 OVERLOOK ESTATES SUB WAS MADE ON NOVEMBER 14 ,1993 ,AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT OVERLAP OR ENCROACH ON THE PROPERTY LYING ADJACENT THERETO, THAT NO IMPROVEMENTS ON THE PROPERTY LYING ADJACENT THERETC ENCROACH ON THE PREMISES IN QUESTION AND THAT THERE ARE NO ROADWAYS. TRANSMISSION LINES. OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS SHOWN HEREON. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEA ON THE RECORDED SUBDIVISION PLAT UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES CONSTRUCTING ENGINEERS HC83 BOX 192A MYRTLE DR EAGLE RIVER, AK, 99577 'Tele. (907) .346-2000 (907)-694-9098 DATE: FEB 5, 1994 SCALE: 1" =60' GRID: SE465 NE 1/4 SEC25 T14N R1W Ogrtift0 thti1ttig taig noccodt a SULLIVAN. WATER WELLS P.O. BOX 070272, CHUG IAK, ALASKA 99681 • TELEPHONE 888.2759 OWNER OF LAND 1t eAJ 0_60 c. . DEpTil OF WELL. ADDRESS ia 6 a zy< 77 4 14 'Z STTIC LEVEL OF WATER FT. JO • t; LEGAL DESCRIPTIONts-r 6( < 0(,)&t)., 3 3 ,•-• DRAW DOWN FT DATE. • StartedEnded 1L 3 . . PERMIT NUMBER • GALS. PER HR KIND.OF CASING • KIND OF FORMA.T1ON: Frorn_ Ft. to___Ft._ reul 4. .4'77'1 <4(...hii Froi�_Ft. to__i _Ft. 0 1.3J From „..Ft. Ft From F t to Ft, Fron1 Xt. to :3 Ft,' -5;4‘,0 4- S. From Ft. to Ft. C4.11 From Ft. to Ft. Frotn__Ft. to _ 'Ft. 4 Frorn42__ Ft. e9 6./...24je-i-j;<- From , Ft to rt , . FlOrd -75.' Ft. to.10_) Ft., N e' '(:)4A.Ji6L From Ft. to Froni./ASIFt. to Li< Ft, C 4 ki___V____. 644 ,..-L;t. '4. /3 t)'.1/7(P4-:463- or rt. to Ft Frmia it i Ft. to1 ,.?0 Ft. S'l '1'6 G4t4--Jr t to F IEZ- C.41.31'F /41 i .4 .-rom t .,---e From_____ _FL to____ ...Ft. ill.)(..41-0,-,-rw .,' ' • . ' From Ft to Froth _LID,,,„Ft. to_t3...[_ Ft. r,,_.„4__Lx_, ;,.....)0 1. C - VVrt n 114 Ft. t„s 64-ii4rife4 Frani _____. Ft, to Ft Fom Ces. ,S7 _Fr. to__.-- rt. r. From /44 1 Ft to 6.C:(Ft. 21,2fr, x.,.e()__47_%c:',,14.... , ., _ Frani Ft to Ft From _ -Ft, to -Ft. - - From _Ft. to Ft From Ft to Ft. ....- RECI—I-VED From From to Ft. From., Ft. to Ft. , Ft to . rt MISCL, INFORMATION: 1 I 4 1, Ft to_ Ft /rl FEB iT1994 Fr"i F1' Ft. rOIT1t to Municipality et Anchoracie- . Ft. Dea.-Frea-VrOiurnan srfon, Pt. to _ (A-) tzO DRILLERSNAME ig.4.44 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PAGE 1 OF 1 C1'UU g- ALL / PERMIT NUMBER:SW930289 DATE ISSUED: 8/11/93 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC. EXPIRATION DATE: 8/11/94 OWNER NAME:CAYWOOD ROBERT C OWNER ADDRESS:P.O. BOX 774042 EAGLE RIVER, AK 99577 PARCEL ID:06804104 LEGAL DESCRIPTION: OVERLOOK ESTATES BLK 1 LT 4 LOT SIZE: 45727 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: � DATE: 9/i� ISSUED BY: ' / / . DATE:a �f/! (AL - kAt 3- \ 1 �1 Li SITE PLAN --WATER AND WASTEWATER ABSORPTION SYSTEM .S� Jo LOT A EAt / \ \ vNocvc..09e0 .\ 4..)1.4... \ \ i \ \ \ 4, HovSt �--- C*\ Uu0E2 cot ssuoc'RoJ HZaifb' S - l A2AMou DZ,vr oR ytwi41- FA tet - RGPtRCtM F1rst"_J N \\ N 45,721 s L-Exs HOUSE worPRn,3tj p�21rnQSbZ DQ1vewAy se P S Jou. m110" l' 30,111 S f- MrA hVA1LlitsLE Fo2 Ais5oRPRoP) SYS rerek 14,cl50 SP SITE PLAN DETAILS PROPOSED WATER AND WASTEWATER ABSORPTION SYSTEM LOT4 BLOCK 1 OVERLOOK ESTATES SUBDIVISION PREPARED FOR: MR. ROBERT CAYWOOD 694-8758 PO 774042 EAGLE RIVER, AK, 99577 SCALE: 1" = 100' DRAWN BY CAL CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 7-23-93 DRAWING N 93-51-07-5 Holm ABSORPTION SYSTEM DESIGN DETAILS --TRENCH GO cD co co to 041Cr1n.AL /PINtfPM> 612OUs $vQCAce 0004..4 TA.w.. rrPAc s. CO MN I3 SCOPE OF PROJECT: New proposed absorption field is designed for a five (5) bedroom system. Lot is to be served by a private well to be drilled as shown on the propoese plan. ABSORPTION AREA CALCULATIONS: Minimum Required: 5 Bedrooms x 150gpd/bedroom = 750 gpd capacity Soils rating, proposed addition, 1.2 gpd/sf (trench design) Minimum sizing: 750 gpd 4 1.2 gpd/sf = 625 sf absorption area Use trench design, with 4' ground cover: 625 sf : (2)(8'D) = 40' minimum trench length IMPACT ON ADJACENT LOTS: There no other private wells within 100' of this proposed absorption system. The proposed absorption system has no adverse impact upon any adjacent lots as shown on attached site diagram. ENGINEER'S SEAL TRENCH DESIGN DETAILS PROPOSED WASTEWATER ABSORPTION SYSTEM LOT 4 BLOCK 1 OVERLOOK ESTATES SUBDIVISION PREPARED FOR: MR. ROBERT CAYWOOD 694-8758 PO 774042 EAGLE RIVER, AK, 99577 NOT TO SCALE DRAWN BY CAL CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WESTER DR 694-9098 ANCHORAGE, AK, 99516 7-23-93 DRAWING # 93-S2-07-5 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 12d wooc' LEGAL DESCRIPTION: 14-6! b,er.itxeV Es+ MO. Jim, 29, 19.5.9 DATE PERFORMED:t- 4-93 Township, Range, Section: SLOPE tA WAS GROUND WATER ENCOUNTERED? IF VES, AT WHAT DEPTH? Depth to Water Alter Monitoring? NO Bate. 5 Z5 TN»' T'IL) SITE PLAN S L O P E 101) 1 ora s Pow L Reading Date Gross Time Ne Time Depth o Water Net Drop O 7_I1-93 C21 O. `F,i — sitAc 1"46" z IiiM% r✓1'1.� I sl i.4 Ir' y 3 ,7....-.4A. Z,,, ,,. P5" t,itae 4 ISmr 9n �n 2SVMI SuS�5% Ir4h>' 6 Zia.,,.: tins .. r`'.- PERCOLATION RATE 3 (minutes/inch) PERC HOLE DIAMETER $ TEST RUN BETWEEN 6 FT AND .L__ FT COMMENTS PERFORMED BY. n$grit-to 9,S I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72.808 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN MUNICIPALITY OF ANCHORAGE ffi� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 068-041-04 1. GENERAL INFORMATION Expiration Date: -7- Z©-21 Complete legal description OVERLOOK ESTATES BLK 1 LT 4 Location (site address) 6212 Magnaview Dr Eagle River Current property owner(s) SPIVAK NOAH & RICHARDSON LINDA Day phone Mailing address 87 Halls Pond Rd. Salem NY 12865 Real estate agent 2. TYPE OF DWELLING: E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or.Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ L/ Z c B J Waiver Fee $ Date of Payment Receipt Number COSA # (SSC Z A�� Date of Payment Receipt Number Waiver # 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Phone 907.406.1058 Date J �� of A�gs�9��� ' �0 ..... ................ .•s• ....... ....... LT Data�� No.CE11 v ����pROfESS1�N�� bedrooms, with the following stipulations: By: �_ (���!/ Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: OVERLOOK ESTATES BLK 1 LT 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1993 Total depth 200 ft Cased to 140 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) ' 12 in. Date of flow test for COSA 720/2020 Static water level at beginning of test 109 ft. Comments B. TANK DATA Age of tank(s) ` 1 years Tank type/material SEPTIC PLASTIC Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping INSTALLED SEPT 2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 1993 ❑ ALL standpipes present per record drawing Total measured depth from grade 14 ft (max) Measured depth to pipe invert from grade 6 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 Parcel ID: 068-041-04 Structure served by this system Well production at time of test 3.4 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 4.13 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 72012020 C. LIFT STATION ❑ Required maintenance co Age of lift station vez Lift stationmaterial Comment Adequacy test date 7/2012020 Results Q✓ Pass For 5 bedrooms Fluid depth prior to test 10 in Water added 750 gal New depth 12 in Elapsed time 60 min Final fluid depth 10 in Absorption rate ' 750 gpd 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' Q Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25'0 Yes if No ft Absorption Field on Lot > 100' F/� Yes if No ft Holding Tank > 100' R Yes if No' ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No ft 0 Yes if No ft 'Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' F� Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 8.9 ft Surface Water > 100' Q Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' FV -1 Yes if No_ Water Main > 10' 0 Yes if No ft Community Wells > 200' F71 Yes if No _ Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' R-1 Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS when old tank was removed, the walls of the hole remained vertical. There was no sloughing. The soil will support the foundation walls, not the new tank. G. ENGINEER'S CERTIFICATION / certify that l 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.1� A ENGINEERS ���. . • • • •••• •• • COSA Checklist yellow sheet ' • ° •' C i»rtis �' o "" No. CE 11904 ��LA` ••�V m ��E�pROFfSS10N�`�� ft ft ft ft 0 =► v m-0 3 f A — O p Q m 0 3 m y m mn �-. °- 3 333 00 0 CD z -i Q' ° m y v 3m 3y0::rm N m y y D m m m m y 'O O O m 3 °' m O m O y I y 7 O tp m � C7 sr v =r ° -co fl o�33mv o— y° 1 m f° m y F m p -.r-< 3.mir -< m mmp °"Oto S0 O txi 00 �.0 Drn� DA3 m .�'< y �'� m 00 I �0 °x -Nim ic�yy Q a3 ° -° 0 0 �l.7 y f m m p M� D 33tn p_p 10 3-a OD m CD CD i(7 n DD"�0 �3 j mfl�s°-to Omay�0Sz 3- ( S3i 3 S.m O <D CD 0 a s I "%H m m Sm m —m .-a3 pm CD X 1 7 0 0 I y o 00 m O O U p Dn I y0mm c 0 Q to m o ro ym A <m3a p Q 3 y -�• 03 0 mem p m D m e m « tp —0 y m m 0 3 CL n o� y -a Q Q-0 _ 0 N z / ch. ' Q > >CA \ \ 03HS ,Z'OLX,Z*g 0 IX ci p0 � � CD 'i cn m CD O III O '., O tp t0 t0 .+ C7 0300<nM _0.4-jOD Q (1t Ln I 0`v°i NN° IZ pc I I- 1* 3 Z PQn y'<NV< 4P cp Cntn0 irn O I 33-n-0CD I D S- x O 0 3 3 m C s o O m p 0 tQ m Z 46-1 4p A ° 0 y m `�' OV �� �0 o PA to Its, cr) N � � B I WLA s L 401 Z 101 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street 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 h Parcel I.D. D( g -0 9/-0 1. GENERAL INFORMATION Complete legal description COSH# 070 3 €10-- Expiration Q Expiration Date: OVERLOOK ESTATES SUBDIVISION, LOT 4, BLOCK 1--2-OR 1. Location (site address) 6212 MAGNAVIEW DRIVE • EAGEL RIVER, AK 99577 Current Property owner(s) NOAH SPIVAK (BUYER) Day phone 703-303-7837 Mailing address Lending agency Mailing address Real Estate Agent LORRAINE HALL w/PRUDENTAIL VISTA Day phone 830-3289 Mailing address 16635 CENTERFIELD DR. • EAGLE RIVER, AK 99577 Day phone Unless otherwise requested, COSA 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 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, 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. 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)1n 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. Phone 337-6179 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, W. 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 soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. Those 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 aro no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long tho 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 (Phis report by any other person or party is not authorized, nor will if confer any legal right whatsoever. 5. DSD SIGNATURE Approved for - bedrooms. Disapproved. Conditional approval for Date 9r9 -"kr? oh SS, Q #3 c ro ���DO #3�to Pro/eeatollO.q� Q •`�• ON-SITE • •., `X: WATER AND . m= s. WASTEWATER : bedrooms, with the filowing stipulations: o PROGRAM am`,/_••. • ••�_\ Attachments: COSA Checklist l.,' Septic System Advisory Well Flow Advisory Nitrate Advisory By: (Rev. 11105) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: / 0 ` 67 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.d.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: OVERLOOK ESTATES SUBDIVISION, LOT 4, BLOCK 1, Parcel ID: 06e-6 9/-09 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 8/1993 Sanitary seal (Y/N) YES Total depth 200 it. Cased to 140 ft. Wires property protected (Y/N) YES Casing height (above ground) 12+ in FROM WELL LOG AT INSPECTION Date of test 8/1993 9/17/2007 Static water level 100 ft 102 ft Well production 3.5 g.p.m. 2.7 g.p m. WATER SAMPLE RESULTS: Coliform Q colonies/100 mi. Nitrate '3 (wng./L. Other bacteria 0 colonies/100 ml. Arsenic°,LSiug./L. Date of sample: 9/17/2007 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 10/18-19/1993 Tank size 1500 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 9[24/2007 Pumper C. ABSORPTION FIELD DATA High water alarm (Y/N) JRS PUMPING N/A 7Tx1.,1 1>_11.7il ['iel17171 Date installed 10/18-19/2007 Soil rating ft'/bdrm) 11_2 System type DEEP TRENCH Length 41 ft Width 4 ft Gravel below pipe 8 ft Total depth • ]3.6 ft. Eff. absorption area 656 ft' Monitoring tube YES Depression over field NO Date of adequacy test **9/17/2007 Results (Pass/Fail) PASS For ***4 bedrooms Fluid depth in absorption Held before test E In. Water added 1 9191 gal. New depth E in Elapsed Time• 120 min. Final fluid depth E in Absorption rate >= 600+ g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - **PRE-SOAKED WITH A 1500 GALLONS ON 9/14/2007 ***SYSTEM SIZED FOR 5 BEDROOMS D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in "Pump off' 1= High water alarm level at in Datu i _ Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS Driveway, parking/vehicle storage 10'+ 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 Name JEFFREY A GARNESS Date lull /Da J%EV; Sao COSA Fee $ Date of Payment Receipt Number (Rev. 71/05) 5'3° 1-27-07 CI G2iz Waiver Fee $ Date of Payment Receipt Number SEP -20-0T 15:40 G r nr c C` FROM- r- • 1 R}'Keirs X10 -a q2 3 Daripew •1 R• Z u31sa.'I wi.rL 5 t. N e •&. i.„. $. cnr.c n F a F. ¢ m va 3 kan4� z sit SlJ.`%�{�t'ai Ix O N i 1Y�r VI te- 'Said Mg If P:11$14 tit II nnit n vor°� h8 4x0 a . n a • PIP a - € • L. o S • • 0 i 9 1 o E 40 z 40 . • 4, . a e N N O • T -09T P.002/002 F-455 a 5. N ANALYTICA GROUP Garness Engineering Group, Ltd. Attn: Jody GEG, Ltd. 3701 E Tudor Road, Suite 101 Anchorage, AK 99507 907-337-6179 Fax: 907-338-3246 Client Sample ID: Sampling Location: Overlook Est Lt 4 BIk 1 Client Project: Private Well Testing Sample Matrix: Aqueous COC #: PWSW: Residual Chlorine: Comments: Lab#: A0709240.01A Analytica International, Inc. 4307 Arctic Blvd. Anchorage. AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: Receipt Date: Sample Date: Sample Time: Collected By: 925/2007 9/18/2007 9/17/2007 4:50:00PM SG Flag Definitions: MRL = Method Reporting Limit MCL = Maximum Contaminant Limit 13 = Present also in Method Blank 11= Exceeds Regulatory Limit M = Matrix Interference .1= Estimated Value D = Lost to Dilution •• = RL higher than MCL; target not detected TNC = Too Numerous to Count - result rejected CF = Confluent Growth - result rejected TCNG = Turbid Culture No Growth - rejected Analysis Method Parameter Result Units Flags MRL Prep Prep MCL Method Date Analysis Date Analyst 922213 (Aqueous) - Membrane Bacteria, Other Total Coliform Lab#: A0709240-OIB Filtration MF <MRL CFU/100mL <MRL CFU/I00mL Test was conducted by: Analytica - Anchorage 1.0 9/18/2007 9/18/2007 PL 1.0 1 9/18/2007 9/18/2007 PL Analysis Method Parameter Result Units Flags MRL Prep Prep AICL Method Date Analysis Date Analyst 4500-NO3E (Aqueous) - Nitrate Nitrate as N 4.63 Lab#: A0709240-0IC mg/L Test was conducted by: Analytica -Anchorage 0.50 10 9/18/2007 9/18/2007 Al Analysis Method Parameter Result Units Flags MRL Prep Prep Analysis Date Analyst MCL Method Date 200.8/200.8 (Aqueous) - Family Well Water 1 Arsenic 0.686 ug/L Reported by: Krissy Plctt, Laboratory Project Manager Test was conducted by: Analytica - Thornton 0.15 10 200.8 9/21/2007 9/21/2007 KS Page 1 of 1 10-27-07 Page 1 of 1 Sonja Garness From: Jim Sullivan [apw@gci.net] Sent: Thursday, September 27, 2007 11:07 AM To: Sonja Garness Subject: Magnavue 6212.doc 10-27-07 Garness Engineering RE 6212 Magnaview On 9-25-07 We installed A MOA seal and conduit At this property Thank you Jim Sullivan No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.13.32/1033 - Release Date: 9/27/2007 11:06 AM 9/27/2007 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 RE ISSUE Parcel I.D. 068-041-04 1. GENERAL INFORMATION HAA# 030/83— Expiration 30133—Expiration Date: //-025-- Complete /-02-S— Complete legal description OVERLOOK ESTATES SUBDIVISION; LOT 4, BLOCK 1 Location (site address or directions) 6212 MAGNAVIEW DRIVE * EAGLE RIVER, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DANIEL SZEKELY Day phone 729-3188 6212 MAGNAVIEW DRIVE * EAGLE RIVER, AK 99577 Day phone Day phone 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 (I -IAA) 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 vatid 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. Note: Alaska Water and Wastewater Consultants, inc. shall be paid $ at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certifie b� seal affixed hereto and as of the validation date shown below, t verifYI y investigation, based on procedures outlined in the Health Authority Approval Guidelines foriip lication, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functions ar equate for the number of bedrooms and type of structure indicated herein. I further verify that based on 1h information obtained from the Municipality of Anchorage files and from my investigation and inspectio , 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 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, AKWWC, Inc. 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 aro no hidden defects or encroachments. AKWWC, Inc. can therofore 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 it confer any legal right whatsoever. Date 5. DSD SIGNATURE Approved for T bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: (Rev. 1201) 6/2 /°44-1--• Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date' n , �--> — 0 I'BEl•GW EXISTING ogADU r' 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: OVERLOOK ESTATES SPD; LOT 4, BLOCK 1 Parcel ID: 068-041-04 A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES Date completed . 8/1993 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth. 200 ft. Cased to 140 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/1993 5/112003 Static water level 100 ft, 101 ft, Well production 3.5 g p.m 2.5+ g.p.m. WATER SAMPLE RESULTS: Conform . . colonies/100 mi. Nitrate 4.11 mg./L. Other bacteria colonies/100 ml. 8,(21003 Arsenic: N/A mg./l.. Date of sample: 9/2112003 Collected by: AMC. INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 10/18-19/1993 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (WN) N/A Date of pumping 8/22/2003 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 10/18-19/1593 Soil rating • .p.d ' • r ftibdrm) 1.22 System type DEEP TRENCH Length 41 ft Width 4 ft. Gravel below pipe 8 ft. Total depth •13.6 ft. Eff. absorption area 656 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 5/1/2003 Results (Pass/Fail) PASS For, "4 bedrooms Fluid depth in absorption field before test 0 in Water added 600 gal. New depth 0 in Elapsed Time: 0 min. Final fluid depth 0 in Absorption rate >= 600+ g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date *SYSTEM SIZED SIZED FOR 5 BEDROOMS DRAINFlEL D DRY ON 8/21/2003 D. LIFT STATION Date installed Size in gallons Manhole/A "Pump on" level at in. "Pump off = - - in High water alarm level at in Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/deanout Sewer /septic service line 25'+ Holding tank N/A NJA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Welts on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 O'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 10'+ Curtain drain NONE KNOWN F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent lots 100'+ 1 certify that I 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 Na e Date 8/yy%rZ JEFFREY A. GARNESS HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 12/01) AS -BUILT SURVEY N36'49'58'W 28. • MAGNEVIEV DRIVE S 51. 49' 57' E 199.66 HENRY 11. WILSON 0002-9 %. VSSIUNALV‘ i 1 HEREDY CERTIFY THAT A SURVEY OF L07' 4 .BLOCK 1 OVERLOOK ESTATES SUB IIAS MADE ON NOVEMBER 14 ,1993 ,AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT OVERLAP OR ENCROACH ON TJIE PROPERTY LYING ADJACENT THERETO. THAT NO IMPROVEMENTS ON TIIE PROPERTY LYING ADJACENT THBRETC ENCROACH ON THE PREMISES IN QUESTION AND THAT THERE ARE NO ROADWAYS. TRANSMISSION LINES. OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS SHOWN HEREON. it IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS WHICH DO NOT APPEA ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON DE USED FOR CONSTRUCTION OR FOR ESTADUSHING BOUNDARY OR FENCE LINES CONSTRUCTING ENGINEERS HCO3 BOX 192A MYRTLE DR EAGLE RIVER, AIC. 99577 ?Tele. (907) .346-2000 (907)-694-9098 DATE: FEB 5, 1994 SCALE: 1" =G0' GRID: SE465 NE 1/4 SEC25 TI4N RIW Municipality of Anchorage Development Services Department Building Safety Division •On -Site Water & Wastewater Program 4700 South Bragaw SL _ P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 068-041-04 1. ' GENERAL INFORMATION Complete legal description HAA# j'1 Fi 03, 3 6.10 /g 6" Expiration Date: 6 -.0 3 OVERLOOK ESTATES SUBDMSION; LOT 4. BLOCK 1 Location (site address or directions) Current Property owners) Mailing address Lending agency Mailing address Real Estate Agent Mailing address 6212 MAGNAVIEW DRIVE ' EAGLE RIVER, ' AK DANIEL SZEKELY Day phone 729-3188 6212 MAGNAVIEW DRIVE * EAGLE RIVER, AK 99577 Day phone Day phone 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. Note: Alaska Water and Wastewater Consu!tants, Inc. shall be paid $ at, or prior . to closing for the engineering services provided. 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 bedrooins and type of structure indicated herein. 1 further verify that based oil the : information obtained from the Municipality of Anchorage files and from my investigation and inspection, .the on-site watersupply and/or wastewater disposal system is(are) in compliance with all applicablelMunicipal and State codes, ordinances, and regulations In effect at the time of installation. .. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901DEBARK ROAD, SUITE 28 * ANCHORAGE, AK 99504 Enineer's Printed Name JEFFREY A GARNESS, P,E• Engineer's Comments: • • In conducting this evaluation, AKWWC, Inc. 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 cenditions encountered at the time of the test, and separstion 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 AKWWC, Inc. can therefore not provide • any'warrahty oi' 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 solo benefit of the owner listed above. Any reliance upon of use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE V Approved for 1+ bedrooms. ' Disapproved. By: Conditional approval for bedrooms, with the Mowing stipulations: ttt(ttUttf rift • : ON-SITE • O Lam: WATER AND °'= Attachments: HAA Checklist Septic System Advisory Well Flow Advisory dt WASTEWATER • pfmGRAM • Manitenance Agreements J�JJ�J//�� IENT•� S•E`1\,O\ ?)/11)1))11' Supplemental Engineer's Reort Other (Rev. 12n1) Original Certificate Date: Q 0 3 T Municipality of Anchorage Development Services Department Building Safety Division On.Site Water & Wastewater Program 4700 South Bragaw $t. P.Q. Box -196650 Anchorage. AK 99519-6650 www:d.anchorage.ak.us (907) 3434904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: OVERLOOK EST. S/0; LOT 4. BLOCK 1 Parcel ID; 068-041-04 A. WELL DATA. well type .PRNATE 1f A. B. or C provide PWSID# N A Well Log (YIN) YES Date completed 8/1993 Sanitary seat(Y/N) YES Wires properly protected (YIN) YES Totatdepth 200. ft. Cased to 140 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/1993. 5/1 /2003 Static water level 100 ft. 101.. ft, Well production 3.5 gprn 2.5+ g.p.m. WATER SAMPLE RESULTS: CdlifomT J251 colonies/100 ml. Nitrate: ar. Lmg./L. Other bacteria : Colonies/100 ml. Arsenic . N/A mg./L. Date of sample: 5/2/2003 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 10/18-19/1993 Tank stze1 0 .gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation deanout (WN) YES Depression over tank (YiN) , N0 Date of pumping e 7/5/2002 High water alarm (Y/N) N/A Pumper, JR'S PUMPING C. ABSORPTION FIELD .DATA Date instal'l'ed. 10/18-19/1993 Soil rating r ft/bdr m) Length 41. ft: Width 4 ft: System type DEEP TRENCH Gravel' below pipe 8 ft. Total depth*13.6Tft. Eff absorption area 656 ft' Monitoring tube YES Depression over field NO Date of adequacy test 5/1 /2003. Results (Pass/Fail) PASS For •4 bedrooms Fluid depth in absorption. fieldbefore test ,,0 in. Water added600gal. New depth , 0 in. Elapsed Time; a min. Final fluid depth 0 in. Absorption rate >= 600+ g.p. . Any rejuvenation treatment (past 12 mo.) (YM &. type) NONE KNOWN If yes, give date *SYSTEM SIZED FOR 5 BEDROOMS D. LIFT STATION Date installed Size in gallons Manhole/A "Pump on" level at in. "Pump off' - - - n High water alarm level at in Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1000+ Absorption field on lot 100'+ On adjacent lots On adjacent lots 1000+ 100'+ Public sewer main N/A Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 59+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 100+ Water main N/A Water service line 10'+ Surface water 1000+ Driveway, parkinglvehide storage 10'+ Curtain drain F. COMMENTS NONE KNOWN G. ENGINEER'S CERTIFICATION Wells on adjacent lots 1000+ I certify that i 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 Printpd me Date 5Ig03 HAA Fee $ 375. "' JEFFREY A. GARNESS Date of Payment 5 17. 03 Receipt Number .349'79 Mev. 12/01) Waiver Fee $ Date of Payment Receipt Number 05-06-03 04:55P11 FROM-CTAE ENVIRONMENTAL SRV Mgr SGS Ref.# Client Name Protect Name/ii Client Sample ID Matrix 1032425001 AK Water & Wastewater Consultants Inc. Overlook Estates L4 B I Overlook Estates L4 B1 Drinking Water 9075615301 T-435 P.02/03 F-268 All Dates/Times are Alaska Standard Time Printed Date/time Collected Date/Time Received Date/time Technical Director Relax 05/06/2003 14:44 05/02/2003 15:15 05/02/2003 15:30 Stephe C. Ede Sample Remarks: Parameter Results PQL Units Method Allowable Limits Prep Date Analysis Date Init Waters Department Nitrate -N Microbiology Laboratory Total Coliform 4.11 0.100 mg/L EPA 300.0 2 OD w/o Coli (<=10) col/100mL SM18922213 (<=1) 05/02/03 IS 05/02/03 SKW AS -BUILT .SURVEY N 36' 49' 58' W 28. MAGNEVIEV DRIVE S 51. 49' 57' C 199.66 F �4 rzi . /7. • • HENRY H. WILSON )11 3082-S • Al \SSI0FENA ' V� 1 HEREBY CERTIFY THAT A SURVEY OF LOT 4 BLOCK 1 OVERLOOK ESTATES SUB WAS MADE ON NOVEMBER 14 ,1993 ,AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT OVERLAPOR ENCROACH ON THE PROPERTY LYING ADJACENT THERETO. THAT NO IMPROVEMENTS ON THE PROPERTY LYING ADJACENT THERETC ENCROACH ON THE PREMISES IN QUESTION AND THAT THERE ARE N0 ROADWAYS. TRANSMISSION LINES. OR OTIIER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS SHOWN HEREON. IT IS THS RESPONSIBILITY OF TIIE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS WHICH DO NOT APPEA 011 THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY 0R PENCE LINES CONSTRUCTING ENGINEERS HC83 BOX 192A MYRTLE DR EAGLE RIVER. AK, 99577 7Tele. (907) .346-2000 (907)-694-9098 DATE: FEB 5, 1994 SCALE: f....„60. GRID: SE465 NE 1/4 SEC25 T14N R1W !�J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# Z5n-o`-fi- £`/ HAA #! I� ! ?Oboe 1. GENERAL INFORMATION Complete legal description 1 -of 4 S /4 / O dCr60d/r E ty r�cl Location (site address or directions) /174c/1/4 ver,-✓ �iive �G� /e geflvcr Property owner Miysvc Terr /%%are Day phone 6Y6- 7666 Mailing address Poe 77a g- / /=,,5 /4 ,opei.r- ?Ss 77 Lending agency Day phone Mailing address Agent Pra ele.✓hr<.l rJ/r /- /Pc,/ /5"? f4 it Day phone 687-- 66/ Address i'Ay- le tivCr- /Q-1( i 55'77 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water X NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer k NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Eagle River Engineering Services 6 '-s , s - Name of FirmP.O. Bua 273294, Eagle River, AK 99911-3294 Phone Address Engineer's signature 6. DHHS SIGNATURE x Approved for 3- bedrooms. Disapproved. Date 42- as - 59 Conditional approval for bedrooms, with the following stipulations: Additional Comments Date l 2 -29 -77 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does th is as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is .not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA M21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIOS� Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (9d7 (343<471W39 Health Authority Approval Checklist „vMacv;„ , K ,,_;;; o s c> Legal Description: �f- 4' e% /7 / CYe,C42* /i » Parcel I D.: �i(s - v `d/ - owy A. WELL DATA Well type P47/ ///PZ4 If A, B, or C, attach ADEC letter. ADEC water system number /✓ /-4 Log present (Y/N) Y Date completed b�9 Total depth clot' Cased to /+/e2' Casing height (above ground) 2 Sanitary seal (WN) r Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION Date of test A? /-�- Static water level /Da / /to 1 Well production 22, t g.p.m. 6 a g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate h ©in9 Other bacteria Date of sample: /2 --to i S Collected by: E,e s B. SEPTIC/HOLDING TANK DATA Date installed /oh3 Tank size /5"4v , irdNumber of Compartments ' Cleanouts (Y/N) y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) /u �A Date of Pumping /o%7 r Pumper S� S t»ei,"S C. ABSORPTION FIELD DATA Date installed ✓49/5 Soil rating (g.p.d./ft, o, eibd«n) 7 System type % /rive../// Length L// / Width /f Gravel thickness below pipe S" 1 Total depth "� Effective absorption area 6/c6 Monitoring Tube present (YM) Y Depression over field (Y/N) x) Date of adequacy test 1;27" a i9 Results (Pass/Fail) P For 3 bedrooms Fluid depth in absorption field before test (in.); 6 - " Immediately afterb6iL gal. water added (in.): 9 %s" Fluid depth 8 34, fr (ins) Minutes later: /1) Absorption rate = "` &oa g.p.d. Peroxide treatment (past 12 months) (Y/N) NSA If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1.3-a/ On adjacent lots ric)t ` Absorption field on lot /-5" I I On adjacent lots t//v' Public sewer main y,D Public sewer manhole/cleanout 7' / ' Sewer /septic service line + .mss Lift station t ioo SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 6 ` Property line 'tie ` Absorption field 7 Water main/service line 'No / Surface water/drainage /laid` Wells on adjacent lots */e)// SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /-m Building foundation 1 7 / Water main/service line f/c' Surface water Curtain drain /V /it Driveway, parking/vehicle storage area Wells on adjacent lots ;'-i&&" F. ENGINEER'S CERTIFICATION 7-,0' I certify that I have determined thru field inspections and review of Municipal records thesaporf` in conformance with MOA HAA guidelines in effect on this date. Signature J�� Engineer's Name Date l-2— )--`�9 HAA Fee $ Date of Payment Receipt Number J 2-;) oil 72-026 (Rev. 3/96)* 5 (l' (_ ��l Lit) .) stems are tie �6e'ct=ana�U«s .,dobe ae tq�fr .V. /lidera e %: 5736 c Waiver Fee $ Date of Payment Receipt Number 12-22-89 15:26 FROM -CTE ENVIRONMENTAL 5615301 CT&E Ref # Client Name: Project Name Client Sample ID Matrix PWSID CT&E Environmental Services Inc. Laboratory Division 998803001 Eagle River Engineering Svc n/a L4 B4 Overlook Est Drinking Water n/a 200 W. Potter Drive Anchorage, AK 99518 Ter (907) 562-2343 Fax: (907) 561-5301 Client POW Printed Date/rime Collected Date/time Received Date/rime Technical Director Released By T-730 P.02/03 F-037 n/a 12/22/99 15.15 12/20/99 08:15 12/20/99 09.20 Stephen Ede Sample Remarks: Parameter Total Coliform (ME) Nitrate Results POL units Allowaple Method Limits Prep Date 0 col/100 ml SM922213 5 00 0.5 mg/t_ EPA 300 10.0 Analysis Date Mit 12/20/99 KAP 12/20/99 SCI_ 12-28-1999 10:12AM FROM E.R. Engineering CTJE halal Client Name Proleci Name/77 Client Sample Ill Matrix Ordered By PWStD CT&E Environmental Services fnc. eosoosooseeeennfl 9%203001 Eagle River Engicee ing Loi 4 ]31k 4 overlook Es Lor 4 1111. 4 Overlook Ear Drml;in(s Www 0 Svcs. TO 3434786 P.02 Cti4ot PON Prilited Date/rime Collected Date Tire Rec'ei'ved Date/Ti1rc 'technical Director Released B oof ]2/23 "1999 16724 12/20 1999 a; 15 12/200999 9;20 8tegalit n Ede Sample ltcmark9: Parameter Results Pal. units Martinet AL lrwaple Prep Lima to Dale anatys is Dace tDic WATERS DEPT nitrate -pi MICRO LAB lora t Cot from 4.99 0.5oo noir EPA 300.0 col/700m. arida 42826 cele, 12/20 199912120/1999 50L la/ea/199c CAP TOTAIL P.02 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D # 068-041-01-A HAA# 1 -\ Pet IA0tilloS 1. GENERAL INFORMATION Complete legal description Lot 4, Block 1, Overlook Estates Location (site address or directions) Magneview Drive, Eagle River Property owner Robert Caywood Day phone 257-7086 Mailing addressP. 0. Box 774042: Eagle River, Alaska 99577 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Pov, 1/01) Front MOA 021 1.t1Vow !me !mu um) 9Zo-u won! %Jaeul6ua leuolssaload aql ul suo!ssiwo JO Sloaaa ao; alglsuodsei lou sl e6eaogouy ;o Allledlolunyl eq1 •panssl sl ateoippeo a aao;aq step azAleue JO suoilOedsu! lonpuoo IOU opSHHOto seeAoldw3 •stuewaalnbaa ems {we leaapa; wino Ames owepao ul suoRnjRsul6uipuelalagt pue sewoq siesegoand of Asapnoo a se slut scop SHHa eq1 •eNseIV ele1S eql ul p0a81s0aa aaaul6ue leuolssa;oad tuapuedepul ue Aq anoge g gdea6wed ul uanl6 suoquwesaadaa eq; uodn Apo peseq saleol;llaa0 lenoaddy Awoglny 4lleeH sanss! (SHHa) seo!MaS uewnH pue 4lleeH;o wewuedea e6eaoyouy;o Aluedlolunw aql NOI LflVO /�/Sf/1 alea sluewwo0 IBUORlppV :suollelndlis 6ulnnollo; aUl glIM 'swooapeq ar v',OSSUOlid� ®4 �ei��• ° ,6'ill no I ° • V ,t90 �e ffrt Qt:r .1oo *v., '` �4,d a® °c1/4,0 is p° euo°.°°.&Sr v 7111 AO eIrc". 13/6f L. °lea •A8 401 lenoadde IeuolllpuoO •panoaddesR3 •swooapeq � ao; panoaddy X 3dn1VNOIS SHHa •9 LLS66 'XV 6SEZ-669 euoud aanmu6ls s,aaaul6u3 sseippy 'IOATU 9Tbeg 'WITH uebtunegd T 6170 5u. zaau;bu;j Qplx Wald ;o OWEN •uolloedsul sly; 10 am ail uo loam w suolleln6aa pue 'saoueulpao 'sepoo awls pue ledlolunW Ile to* eoueydwoo ul sl we sAs lesodslp aaleMalseM Jo/pue Aiddns aaleM ails-uo aql 'uolloadsul pue uolle6llsanul Aw woa; pue salt; e6eaogouy;o Allledlolunw eql woa; paulelgo uollewao;ul aql uo paseq le4lA;laanaaylan; I u eioq paleolpul aanlonals;o edAj pue swooapeq;o aagwnu 844 401 e;enbepe pue Ieuolloun;'a;es sl wejsAs Iesodslp aaleMals2M ao/pue Aiddns aal9M ails-uo 9114 le4l smogs uopeolldde lenoaddy Allaogln`d 41180H slgl;o uolle6llsanul Aw leU1 Await 1 'Molaq uMoys amp uoRep!len 041;o se PUB oleJeu pail;;e leas Aw Aq pewpeo sy b133NION3 A9 NOI103dSNI dO 1N3W31V.LS •S Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 4 Blk 1, Overlook Parcel I.D. 068-041-94 A. Well Data Estates Well type Ind. If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 3/93 Driller Sullivan Total depth 200' Cased to 1 4 0 ' Casing height 24" Sanitary seal (Y/N) Y Wires properly protected (Y/N) v FROM WELL LOG Date of test 8/93 Static water level 100 ' Well flow 3.5 g.p.m. Pump levels unk AT INSPECTION g.p.m. n O Z_ y N0 o On 0 To v e ea n ccs ° �l co 1 SEPARATION DISTANCES FROM WELL TO: 9. Septic/holding tank on lot 132' ; On adjacent lots +100 ' Absorption field on lot .1 51 ' • On adjacent lots +100' Public sewer main lA Public sewer manhole/cleanout NA Sewer service line +100' Petroleum tank +100' WATER SAMPLE RESULTS: Coliform 0 - 4/9 Nitrate 2.24 5/25/94 Other bacteria $ 614 bi- Dale of sample: Collected by: CAL B. SEPTIC/HOLDING TANK DATA Date installed 10/93 Tank size 1500 gal Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N f lq A Alarm tested (Y/N) NA Date of pumping :[!: fifew. , t r•.r Pumper SEPARATION::QISTANQES F ,,0M SEPTIC/HOLDING TANK TO: Well(s) on lot 132' On adjacent lots +100' Foundation 6' To property line 63' Absorption field 7' Water main/service line +50' Surface water/drainage +100 ' 72.026(3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at ' ump off' Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) SEPARATION CE FROM LIFT STATION TO: ell on lot D. ABSORPTION FIELD DATA Date installed 10/93 On adjacent lots Surface water Length 41' Width 4' Soil rating (GPD/Ft2) 1.2 System type Trench Gravel thickness 8' Total de thvaries 12.0 to p 14.5' Total absorption area 656 Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test New Results (pass/fail) - for Bedrooms Water level in absorption field before test - After test - Peroxide treatment (past 12 months) (Y/N) - If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 151' On adjacent lots *100' Property line 37' To building foundation 17' To existing or abandoned system on lot NA On adjacent lots +100' Cutbank +100' Water main/service line +50' Surface water Curtain drain +100' Driveway, parking/vehicle storage area +50' +100' E. ENGINEER'S CERTIFICATION I certifr that I have checked, verified, or conformed to all MOA and HAA guidelines in efffse , owi this inspection. S°OGGMG°p "q DD ��, *(49Ya ` � ° 9 0 0 so "too,' y�y,. G p6pwua°°Q (/ a 3 : e •p 591 [�eeke°O `� Signature - n t20,• te- - Engineer's Name KND Engi er inq, Ken Duffus, P.E. Date �so rvn�Pir Kano. MST& 934 � % t� HAA Fee $ OD teib Date of Payment -20 __ 751- Receipt c Receipt Number / C� (57/ ) 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number SINCE 1908 CT&E Ref.# Client Sample ID Matrix Client Name Ordered By Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 942517-1 L4 BLK1 OVERLOOK S/D WATER BLS & ASSOCIATES, INC CHUCK LANDERS UA WORK Order Printed Date Collected Date Received Date 78800 06/02/94 05/25/94 05/25/94 @ 14:29 @08:00 @ 13:00 Technical Director STEPHEN C. EDE Released By: hrs. hrs. hrs. Sample Remarks: ROUTINE SAMPLE COLLECTED BY: CAL. Parameter QC Results Qual Units Allowable Ext. Method Lunits Date Anal Date Init Nitrate -N 2.24 mg/L EPA 353.2/300.0 10 05/27/94 CMR F-71210-16794 * See Special Instructions Above ** See Sample Remarks Above U = Undetected, Reported value is the practical quantification limit. D = Secondary dilution, UA = Unavailable NA=Not Analyzed LT= Less Than GT= Greater Than 5633 B Street, Anchorage, Al( 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
