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GREAT LAND ESTATES #1 BLK 2 LT 5
Great Land Estates #1 Block 2 Lot 5 #051-131-09 Municipality of Anchorage e Development Services Department -- % Building Safety Division ,. . On-Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 Page 1 of 2 www.ci.anchorage.ek.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO50250 PID Number. 051.131-09 Nemo Wastewater System: ❑ New ® Upgrade �ddr.ee ABSORPTION FIELD Ptww Na a eed o 070 4 O Deep Tr«.th B &W� Trwv h O Bed D Mand O 0~ LEGAL DESCRIPTION 8� Re" ° 00901 ftom T p 0.45 GPDrFP 8.7 Ft. 8.7 eix La S.Oev,ean Depth b ppe 11«tan fan «q.W pew Gnwl dean f«Medr ppe 2 5 GREATLAND ESTATES 4.414.6 Ft. 4.314.1 Ft TV_WW Rape aeaan FV edwd efpve wg" gr a Cn Length. 15N 1W 10 0.5 Ft. 65169 Ft. Well: [INew ❑ Upgrade Grev«wwt lhl W ofNwe INW« tl«v.�en Mae 5 Ft. 2 +10' Ft Cimsvk~(Pmr«e. A e, cr 7p Depot GWro TOW etrorpim w" Ppe M«en« EXISTING PRIVATE I Ft. Ft 1333 Fe ASTM 3034 OreNr D«e OrYW SutK W«« Lev« ftww OMe YgI«led Ft FLINSTONE ENTERPRISE 8110/2005 .»a Pump"« a"HepntAto Grand TANK GPM Ft. Ft SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption LM Holding uo(iHPMata """' e"Y From Field Station Tank sewer Line ANCHORAGETANK 1250 G« WN +100' — — 4zs M«e.,« STEEL N.b. aCanp«tm«,te 2 a.r.�ew«« +100' — — LIFT STATION Lat8N +10' — — tie No LIFT ur« +5' +10' — .. Perry pn r « um'Pp err w.«« Fand«m In h h Curren Dnn +50' +50' — — Pump "0 a Mod« Ewdnw Hepetfaa pwl r by. . TESTHOLE RE-EXCAVATED TO IS' DURING TIME OF BENCH MARK CONSTRUCTION TO VERIFY NO BEDROCK WITHIN 6' OF CORNS CORNER OF DECK NEAR TANK TRENCH BOTTOM " «" 100 FL Inspections performed by: CHARLES BALZARINI Dates: 1" 819/2005 4. ,A�� 2nd 811012005 ��• �'sf9 Development Services Department Approval hie E Conditional Approval Date: CHRISTOPHER R WOOD u ' CE-10387 ` ' •... CI .......... V, Reviewed and approved by: Date:o (Rev owd) FES,to. crrvc M Permit No. SWO50250 Poge 2 of 2 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT ON—SITE WATER & WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: GREATLAND ESTATES#1 LOT5,BLOCK2 LOT 5 SWING TIES STABLES--- / Q! - DIVERTER O - CLEANOUT -¢ — WELL • — MONITOR TUBE N 8955': HOUSE DECK 300.00' DIVERTER VALVE )3 NEW 1250 GAL' t SEPTIC TANK of F, ° TH OLD SEEPAGE PIT 1 �� NEW 5'X69' NEW 5'X65 t DRAINFIELD DRAINFIEL I OE,D RN F ASSU/ffD ELEVATION � 100' ELEVATIONS (NOT TO SCALE) 0.5' FILL MT -I I MT -2 TANK ; .o 1,250 GAL 4.3' GRA E .•o• ?� 87.2 91.0 86,7-%� 86.7 ORIGINAL GROUND LEVEL AT, 95.4 MT -3 /MT -4 �TH-1 Al 0.8 4.3' 90.8 I.0 o .1' GRAVEI,o° NO .W. ° •• 'OI Jt0- 80.4 86.7-/ BOTTOM OF T. 86.7 050-131-09 0 0 0 0 M SCALE 1'-50' 3 e 0 O iA 0 0 0 1/19/' ENGINEER'S SEAL ;'•. CHRISTOPHER R.\N000 3 '•. CE -10387 r•_0 ©►��®EM STABLES--- / Q! - DIVERTER O - CLEANOUT -¢ — WELL • — MONITOR TUBE N 8955': HOUSE DECK 300.00' DIVERTER VALVE )3 NEW 1250 GAL' t SEPTIC TANK of F, ° TH OLD SEEPAGE PIT 1 �� NEW 5'X69' NEW 5'X65 t DRAINFIELD DRAINFIEL I OE,D RN F ASSU/ffD ELEVATION � 100' ELEVATIONS (NOT TO SCALE) 0.5' FILL MT -I I MT -2 TANK ; .o 1,250 GAL 4.3' GRA E .•o• ?� 87.2 91.0 86,7-%� 86.7 ORIGINAL GROUND LEVEL AT, 95.4 MT -3 /MT -4 �TH-1 Al 0.8 4.3' 90.8 I.0 o .1' GRAVEI,o° NO .W. ° •• 'OI Jt0- 80.4 86.7-/ BOTTOM OF T. 86.7 050-131-09 0 0 0 0 M SCALE 1'-50' 3 e 0 O iA 0 0 0 1/19/' ENGINEER'S SEAL ;'•. CHRISTOPHER R.\N000 3 '•. CE -10387 r•_0 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 995196650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO50250 Legal Description: GREAT LAND ESTATES #1 BLK 2 LT 5 Design Engineer: 0848 Eagle River Engineering Services Owner Name: RANDY 8, CATHERINE STEEN Owner Address: 23622 GREATLAND DRIVE CHUGIAK , AK 99567 - Date Issued: Jul 25, 2005 Expiration Date: Jul 25, 2006 Parcel ID: 051-131-09 Site Address: 023622 GREATLAND DR Lot Size: 90000 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: Q Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by catling (907) 343-7904 ( 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, seated, and heated to prevent freezing. Received Date: Issued By:Date: 7 0 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.ok.us. (907)343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 6 51 - 1 3 / - v q Permit Number SW Property owner(s) 17-4Nt�Y 4- L 7'h'E121'Wr 57BI)s) Day phone 041-4070 4070 Mailing address (1) 23 627 41126ATI_A bR, Mailing address (2) �W Gtl*kUAK -4 r 19 rO Zip Code q 156 7 Legal description (Lot, Block & Sub'd.) CtitfkTi.4A ex L S" 13 Z Legal description (Section, Township & Range) Lot Size �( acre 1Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above Information is correct. I further certify that this application Is being made for a Single Family OvAling andA in accprdance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: zyw •G )) Date of Payment: o0aq OS Receipt Number: 7i 329 44 (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: Eagle River Engineering Services Christopher PL Wood, P.E. 10421 VFW RD. Suite 20'(907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax July 20, 2005 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Greatland Estates #1 Lot 5 Blk 2 Narrative & Permit Application Dear Mr. Roth: Eagle River Engineering Services (ERES) was contracted to design a septic system upgrade at the above referenced property. The homeowner wishes to upgrade their septic system, due to recent problems with backing up, and the age of their septic tank. A test hole and soils percolation test has yielded a percolation rate of 37 minutes per inch, and no water table. The soil type appears adequate to support a replacement 4 bedroom leachfield. The existing seepage pit will be kept on line with use of a diverter valve. The proposed 4 bedroom septic system upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, so there is room for wells, septic systems and alternate sites. 2. Immediate neighboring septic systems are all +20' distance, and no private (or community) wells within 100' of the proposed septic system. 4. Drainage will not be affected and is not a major consideration in our design. Installation of this 4 bedroom septic upgrade will not adversely affect the wells or septic systems or reserve areas on adjacent lots. If you have any questions please call our office at 694-5195. Sincerely, EAG WE =7VICES Christopher R. Wood, P.E. Principal \2003\05.043SEPTICNARRATI VE Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW Rd. Suite 201 Eagle River, AK 99577 (907) 694-5195 tel (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Great Land Estates N1 Lot 5 Block 2 July 14,2005 A. GENERAL 1. The septic upgrade plan is for a 4 bedroom single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavations shall be filled and monitor tube removed. B. SEPTIC TANK 1. The sewer piping from the house shall be 4" PVC 3034 laid at 2% grade maximum — 1% minimum and insulated with 2" of burial foam if shallower than 3 ft., with 2 ft. minimum. 2. Septic Tank shall be a minimum of 1,250 gallon tank of MOA approved construction, insulated, or place with 4' of soil cover, min. 3. SEPTIC TANK MUST BE RATED FOR DEEPER THAN 6' BURIAL! C. DRAINFIELD 1. The drainfield is to be placed as shown on the site plan. Contractor shall take extreme care ensure that 10'separtation distance is maintained between trenches, from the lot line, and from the house foundation. It is recommended that a licensed surveyor be utilized to locate all immediately adjacent lot lines and easements, and well radii. 2. The bottom of the drainfield excavation shall be level, plus or minus 1.5", prior to placing gravel. 3. The total depth of the drainfield excavation shall not exceed 8 ft. at any point in relation to natural ground surface. 4. The drainfield gravel shall be covered with typar fabric material. 5. Soil or a combination of soil and extruded board insulation to at depth of 3' or equivalent is to be placed over thelcachfield. 6. The area over the drainfield is to be finish graded or mounded to prevent ponding of surface water runoff. 7. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. \\Eros\docs\W PDOCS\2005\05.043.4brdrainficld- spec.doc Eagle River Engineering Services Christopher R. Wood, P.E. RECOMMENDED LEACIIFIELD DIMENSIONS: TOTAL DEPTH = 8' GRAVEL DEPTH = 4' under pipe, 2" over pipe (4.5' total) DRAINFIELD LENGTH = 133' SOIL RATING= 0.45 GPD/R2 SEPTIC TANK= 1250 gallons min. DRAINFIELDWIDTII= 5' BEDROOM CAPACITY= 4 total Twenty-four (24) hours notice required for all inspections. \\Eros\docs\WPDOCS\2005\05-0434brdrainricld- spec.doc EAGLE RIVER ENGINEERING SERVICES 10421 VFW RD Suite 201 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 05-043 Calculated By. CW Date: 7/20/2005 Legal: Great Land Estates #1 Lot 5 Blk 2 TEST HOLE 1 Single Family 4 Bedroom Dwelling Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 gallons Percolation rate = 37 minutes per inch Wastewater application rate = 0.45 gallons per day per square foot Required absorption area = 1333 square feet Trench width (W) = 5 feet Gravel depth (D) = 4 feet Required length = Shallow trench factor • Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor = 0.50 f Total Excavation Depth = 6.5 feet XJol 70 JDAJtLr[1 Required length = 133 feet 05.043 4brdrainfieldCalc 11:12 AM7/20/2005 NEIGHBORING u ��UP°' GREATLAND DRIVE - 100' RADIUS 0pQ i a I ��/ N 89'55'36" 00 00' E LOT 5 / WKE LL 1p0 dfr-� 1 ~I w �R�T2 HOUSE V) \ Ay': Lu I \ DECK ~I � REPLACE EXISTING TANK WITH NEW 1250 TANK GAL SEPTIC WELL+200' FROM SEPTIC 3 I SjABLES--� 0 O 0 0 Z II - I EASEMENT N 89'55'36" E - PROPOSED LEACH FIELD - IEXISTING LEACH FIELD DRNEWAY SEPTIC +30' 1 NEW 5'X67' 1 DRAINFIELDS 10 UTILITY --EASEMENT • - MONITOR TUBE JUL o - SEWER CLEAN 0 INSTALL J / EXISTIN(;/SEEPF PIT TO REMAIN .L RADIUS + - WELL / ® - TEST HOLE 1. NO KNOWN CURTAIN DRAINS I WELL/SEPTIC SITE PLAN LEGAL: GREATLAND ESTATES, LOT5, BLOCK2 OWNER: RANDY AND CATHERINE STEEN CONTRACTOR: UNKNOWN JOB 05-043 1 DATE: 07/22/05 SCALE 1"= 50' A' EACLE RIVER ENGINEERING SERVICES P.O. Box 773294 EACLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3295 .PSE O. AC LOT P ._........1-.- IRISTOPHER R. WOOD. , CE -10387 I`; ": ��� Performed For. PC, AA Legal Description: - ffaf Depth Feet 1 Gifu FILL 1 13- 14- 15- 16- 17 - 20-u COMMENTS Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196850 Anchorage, AK 99519650 www.d. anchorage. ok.us (907)143-7904 Soils Log - Percolation Test G^aCOherine Data 540cn Date Performed:b/3/o$--- kl E5 {rt es �o I a P I^yr a Township, Range, Section: T1 5 1IZ 14/1 S (T. 1y 4: 15 0 5'g- 8 "- GM )'To Y 1 5/1N0 �(2g06L) clRhY WAS GROUND WATER er�� ENCOUNTERED? IU(J 8 IFVES,ATW1ATDEPTH7 L Depth to Webr After o Monl ooing?yo"JE PE Date: 6122105- IT 122 OIT (I H rlan Reading Data Gross Time Net Tine Depth to Water Net Drop 6/3/05 4: 15 0 5'g- 8 "- - 0- 6/3/05 6/3/05 L♦;LIS 30 5"10 -fib'. I -r, Lt bl3los 5' ai 3c, 5"9- N j"' 5 b/3105 5; a4 0 S's -.0 bl3los 5:5y 30 5,q -,—e TI. C, L f92 f"""`^""^ •`^' , , rLKt; MULE DIAMETER 6 TEST RUN DOWEEN =FT AND 7 FT PERFORMED BY: C ti 4 r I eS & I -z G r;'%. I CERTIFY THAT THIS TEST W a PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPA GUIDELINES IN EFFECT ON THIS DATE. DATE: GRE ^"ER ANCHORAGE AREA BOI UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME`-_k'�'I�'I l)''11Iy MAILING ADDRESS / l PHONE LOCATION LEGAL DESCRIPTION SEPTIC TANK:/J�Ffp�%{ '�'vlt w' -A S �l_f`ac) j�u,llclJr%c1� DISTANCE l/ r' `�1p,c NUMBER OF FROM WELL MANUFACTURER "'' I I`- MATERIAL ` C L - COMPARTMENTS 1. INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH, LENGTH—, DEPTH �i C,(; t ' `) I. /' / LINING MATERIAL CRIB SIZE: DIAMETER E DEPTH `.� DISTANCE FROM: WELL a TOTAL EFFECTIVE BUILDING FOUNDATION ( NEAREST LOT LINE ABSORPTION AREA (WALL AREA) �(' V SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHERSOURCES DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM- APPROVED- YSTEM_ APPROVED DISAPPROVED REMA DISTANCES: INSTALLED BY: /1?l;jlC-iC1v PIPE MATERIAL: i LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM r' KA -W DRILLING, Inc. P. J. Box 4-1224 • 1310C International Airport Road l (907) 274.4611 /` ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner JoseAh Roseman Use of Well Dom Location (address of: Township, Range, Section, if known; or distance main road L51 B2_ Great Land Subdiv, Size of casing 6 Depth of Hole 191 eet Cased to 178 feet Static water level 138 ft. ( (below) land surface. Finish of well (check one) open end ( x ) ; Screen ( ); Perforated ( ). Describe screen or perforation_ None Well pumping test at 9 gallons per (l�e'�ige (minute) for 1 hd�iit�llcslPlt �F�°OI@ of drawdown from static level. DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Date of completion 23 April 1975 'JUN 2 51987 WELL LOG w _ Depth in feet from ground surface Give details of formations penetrated, size of material, color and ardness O TO 1 Surface Organics 1 TO 11 Silty Gravel: cobbly 11TO 25 Harr}pans till, undiffer6ntiated, cobbly 25 mn 28 Boulder _ 28 TO 55 Cobbly Hardpan Till 55 TO 57 57 en 60 60 TO 74 74_Tp 76 76 TO 78 78 TO Al _ 81 TO 125 125 TO 150 _ 150 TO 175 $75 TO 188 188 --- Boulder Cobble Gravel L - r Graver Turd an __-coY.)bly — Cobble Gravel _ �✓ vV Gravelly Hardaan Boulder Gravelly Hardpan. tilklaceous, cobbly m _ncid ravel wPaPPS_a lit le Water Water Sand & Gravel Bedrock 1—CUSTOMER 0 Et E GEOTECHNICAL Et DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-27l 688-2280 Land Development Soils & Foundations SOIL LOG Performed for: Name: J 0sc FA/ k6Scti14Al Tel. No. Mailing Address: Legal Description: X07 f, 1-34 /(:f, Z, G/ze-47- 1-1�NO Depth (feet) Soil Characteristics 0 2 3 4 5 l v �' _ VEG r s f �l .��c,r, SA-i1lD. %I OZ.Si 7 8 9 10 11 5 �/,9A VtGL y �/�E 5�rvt� iZs12 r 13 UI07-rOn? eF /ye GC f� Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit v�' Drain Field Comments: A16 13, cs e � iC cDa- C P���vv c��TC2 e5 X/�CGT� A VV /¢ r O /- /0/7- j30 7-7-0 i✓/ ff Russell Oyster 694-2774 Civil Engineering Soils & Foundations r� 0 & E EivGI NEERING & DEVELOr-10ENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 333-5240 SOIL LOG Earl Ellis 333-5240 Surveying Land Development Performed for: Name: ��'�C�� ����� Tel. No. Mailing Address: Vvy, Legal Description: Depth (feet) Soil Characteristics JI 2---0 oiw\- \-?�% 4�m 3 4 5 6 �W ��► 7 s 9 10 12 'Ccs 1 Z " Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pity Drain Field Comments: N. %3 Performed by: �x.2 �� " � Date: `ZA \Ck-13 - HN - o , o MUNICIPALITY OF ANCHORAGE R�\CES • DEPARTMENT OF HEALTH & HUMAN SERVICEVVNG Division of Environmental Services ENS\RO On -Site Services Section _ P.O. Box 196650 Anchorage, Alaska 99519-6650a 343-4744 e, CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # C% > I - l 3 ) C 1 HAA # �=, P,` �. �7' 1. GENERAL INFORMATION Complete legal description Lot 5; Block 2; Greatland Estates #1 Location (site address or directions) 23622 GReatland Circle Chugiak, AIC Property owner Roger and Hope Powell Day phone Mailing address C/O Remax of Eagle River 16600 Centerfield Dr. Eagle River, AK Lending agency Mailing address Day phone Agent Bob Wambolt/Remax of Eagle River Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 XXX 694-4200 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 XXX Holding tank Community on-site Public sewer 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 furtherverify 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 S & S ENGINEERING Phone '< ` `' `� -7 Fi 17034 Eagle River Loop Road o. 204 Address Ragle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments Date c/ aLi/ i( .c. i tr � { �''•/ (.. , £. fav 7a�_ I� ` 3ROBERT C. COWAN CE -8801 J ry /Y bedrooms. --=-' bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Rack MOA 10 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES MUNICiPALRYOFA Environmental Services Division ENVIRONMENTAL SERV N 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-46f 2 `' 1596 Health Authority Approval Checklist RECEIVED Legal Description: Lor 51 Bi_oc,K 2 GREA-rL_Artc Parcel 1. D.: C S` / /3 A. WELL DATA Well type PR i VATe If A, B, or C, attach ADEC letter. ADEC water system number Log present ON) ye5 Date completed 41 - 2 3 -7 5 I Total depth 111 Cased to 1-76 Casing height (above ground) "- Sanitary seal ON) Yes Wires properly protected (DN) SES FROM WELL LOG AT INSPECTION Date of test i{ - 23 -7 S /0 - Z7 -c7(, Static water level 1 38 1 33 Well production • O g.p.m. S o 9•P•m• WATER SAMPLE RESULTS: Coliform O Nitrate I • b a Other bacteria Date of sample: lady' / ci Collected by: C, B. SEPTIC/HOLDING TANK DATA Date installed 5-13-75 Tank size 17-S0 Number of Compartments 2, Cleanouts (DN) YEs Foundation cleanout ON) Yr;S Depression (YQ !J� High water alarm (Y/Q >Jo Date of Pumping 1 d � 71 i< ct L Pumper U_ z v� � 4 � ' i A( C. ABSORPTION FIELD DATA Date installed 5 -13- -1 Soil rating (Sjk.W ort2/bdrm 1 Zs' System type SEEPACac torr Length 21 Width ZI Gravel thickness below pipe 6 Total depth 16 Effective absorption area $0Y'A Monitoring Tube present (Y?N) YES Depression over field (YAC Ne Date of adequacy test to -22-9G Results r!5 PA,ss For `� bedrooms q Fluid depth in absorption field before test (in.); 5�u Immediately afterbod gal. water added (in.): 7z Fluid depth 5q 1, (ins) Minutes later: )L 3 Absorption rate = U 0 g.p.d. Peroxide treatment (past 12 months) (Y� tJ oKE Kdoyjr✓ If yes, give date 72-026 (Rev. 3/96)"' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level E. SEPARATION DISTANCES "Pum "Datum SEPARATION DISTANCES FROM WELL ON LOT TO: [Se tic holding tank on lot 10014 Absorption field on lot I o o t + Size in gallons On adjacent lots On adjacent lots "Pump off" level at" loo 1-i looI-t Public sewer main tJ /A- Public sewer manhole/cleanout IJ! %A Sewer /septic service line a51+ Lift station ^t 1 t} SEPARATION DISTANCES FROM SEPTIC HOLDING TANK ON LOTTO: Foundation 3S1 Property line 1 o 1-F Absorption field 1 Water main/service line 101-{- Surface water/drainage too I + Wells on adjacent lots too 1`I SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: � Property line 161+ Building foundation 6 2 Water main/service line Surface water 100,+ Driveway, parking/vehicle storage area Curtain drain F. ENGINEER'S CERTIFICATION Wells on adjacent lots !oo 1 + I certify that I have determined thru field inspections and review of Municipal in conformance with M A HAA guidelines in effect on this date. Signature Z/ - Engineer's NameGC Dr,S� qtr C , CC,) �Y,1 Date HAA Fee $ Date of Payment a��!L , pp/ Receipt Number ercP 72-026 (Rev. 3/96)" Waiver Fee $ Date of Payment Receipt Number Q I o 1 4 —75 14 - RV-1I?Ri C COW.AJ c o- are 10/22/96 CT&E 4ef.# Client NQ me Project i4ame/# Client Semple ID Matrix r Order4l3y PWSID::: 16:58 CT&E ESI ANCHORAGE - 9076941211 ME Environmental Services Inc. Laboratory Division i�iii��►.►�►,i/� Laboratory Analysis Report 965524001 S 8c S Eugineeriu$ Lot 5 Blk 2 Greatlatld Pst. #1 Lot 5 )3* 2 Greaamd Est. #1 Drin1diT Water 51 NO.986 D03 Client PQ# Printed Oate/Time 10/22/96 16:11 Collected Date/Time 10/10/96 15;30 Received Date/Time 10/11/96 09:45 Technical Director: Stephen C, Ede Released By C � Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date snit f Nitrate -.N 1.60 0.100 mg/L SM18 4500-1403F 10 max 10/11/96 RAM Total Co.liform D 0 col/100ml. SM18 92228 10/1Z/96 TMW 0_ 200 W, Potter Drive, Anchorage, AK 99518.1605 — TeL {907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax: (907) 474.9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES R 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. # C-) } — 1 '�) 1 - (l9 HAA # 0 f�q 1. GENERAL INFORMATION Complete legal description Lot 5; 13.2ock 2; G4eat2and Ehtatez #1; Location (site address or directions) 23622 Gneattand Citcte Property owner Dir.. Milton 9 Kathy LandeAs Day phone Mailing address mizzou&4 Lending agency Day phone Mailing address Agent Suzanne CooX RE/MAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Centet�ietd Vti.ve Eaaxe Riven Aft. 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 y 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water 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 XX Holding tank Community on-site Public sewer 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. Name of Firm Phone & S ENGINEERING Address 17034 Eagle River Loop Road Ne 304 Eagle River, Alaska 99577 Engineer's signature Date 2'�7.�2_ 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for 11A01% _ Additional Comments bedrooms. w — OF .44 q �Ya••g0••gq••O T-�fJ� t�••1iq ••q •a° •N •i• ioH�q , w • �o _v lccka. FER ?,, �No. 5 15 °709646 (�0 1�S/� H�FC5S1�1�V� bedrooms, with the following stipulations: aurlr The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 021 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lt>T Parcel I.D. A. WELL DATA Well type P% C If A, B, or C, attach ADEC letter. ADEC water system number -A) A, Log present&N) Date completed Driller Total depth tot t t Cased to \1 a � Casing height 12�t 1 Sanitary seal ON) V Wires properly protected (WN) FROM WELL LOG AT INSPECTION Date of test z z 3 Static water level 1 �� i 13 t if'I7 i F) z Well flow C> g.p.m. i�.0 + n g -pr t m O Pump level n z M cn N y 2 O SEPARATION DISTANCES FROM WELL TO: a Septic/holding tank on lot oc�>� ; On adjacent lots l oa rn z lbfl�� Absorption field on lot i1nn\ ; On adjacent lots Public sewer main �I4 Public sewer manhole/cleanout t ix k4 - Sewer service line WATER SAMPLE RESULTS Petroleum tank + Coliform c ov(�tDD„ti� Nitrate VA CJ Other bacteria tAoQE, Date of sample: ' 2`�' i 2 Collected by: S & S ENGINEERING 17034 Engle rver Coop Road No 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed Tank size 12'0 Compartments Z- Cleanoutso/N) Foundation cleanout (VN) _ Depression (Y/Aj P— High water alarm (Yb Alarm tested (Y/N) Date of pumping � --4p Pumper Ci,Wra>OL, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wel I(s) on lot °p ,,, On adjacent lots t� Foundation 355, To property line t D k a Absorption field 1 7 I Water main/service line 1_n Surface water/drainage l ab tk 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y, SEPARATI on lot Manufacturer Manhole/Access (Y/N) ump off' level at Cycles tested FROM LIFT STATION TO: D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed 45'x'5-1*z�' Soil rating 17-S I6� System type St;f ?ate -L PST Length Z 1 t Width 2.1 Gravel thicknessTotal depth 1St Total absorption area 65D!q Cleanouts present(6YN) Depression over field (Y& Date of adequacy test 1-29 `12 Results as ail) for erw V_ (4) bedrooms Peroxide treatment (past 12 months) (Y& 144 "4 (s, lent C, %,J 'L If yes, give date °! SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot __ 1yc> % �– On adjacent lots 1 bot Property line l b t .v To building foundation l>�z l— To existing or abandoned system on lot I 't" On adjacent lots Cutbank '`5 a, Water main/service line. Surface water l>Driveway, parking/vehicle storage area Curtain drain tl\ E. ENGINEER'S CERTIFICATION 44 t A__ 16 t- 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect „oq�e date of this inspection. i)�57. S 8, S ENGINEERING /sn��'a 9q'` r� ' _ Signature 17034 Eagle River Loop Road NO 204 �:aql River, Alaska 9997/ Engineer's Name Date 7;)-G12 HAA Fee $ 2 Waiver Fee: $ Date of Payment ✓ Date of Payment Receipt Number o2� L s Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. _ 5633 B STREE7 ANCHORAGE, A'IASKA 99518 7ELEPHONE (907) 562.2343 FAX: (907) 561.5301 ANALY:-'IS ?ESULTS for INVOICE i 50710 Chemlarr Ref.f 92.0369 Sarepie t 3 Matrix: WATER. Client Sample ID : LS B"e GREATLANT) 13T. 11 PNSID UA Collected : JAN 29 92 t 16:00 hrs. Received SAN 30 92 f 14:40 hrs Preserved with AS nQUIRED Analysis Completed JAN 31 92 Laboratozy Supsrvisor STIFIris C. EOE Released By ,�y Client Name :3 at 3 ENGINEERING Client Acct :3N3ENGP BPOt Regt Ordered By :P..J.3. Send Reports to: 1)S 8 3 ENGINEERING 21 POt cNONE RECEIVED Y ..................... ......I.............1.....Y.• .................. ..........»...,........._. _.....................suUn-Ite..........- Method Allowable Limits parameter Resullttss EPA M5.7 10 NITRATE -N Semple B.OIITINE 3ANT?'E COLLECIED BY: P,AY - Renarks: ...................... ............................Sae Special Ingtn.ctlrns Above OA-Gnavailable I Tests Performed ND. Nona Detected Sea Semple ftenazke shove NA- Not Analyze - 2 LT -Lego Than, lT»Grel:er Than SGS Nenbe• of the SGS Group (Soci616 G&Orele de Surveillance) MUNICIPALITY OF ANCHORAGE NoISI G C NRR. DEPARTMENT OF HEALTH & HUMAN SERVICES /IQE331 DIVISION OF ENVIRONMENTAL SERVICES 3DVa CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPR( OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date _ 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) 3 Location (address or directions) Property Owner ` / 624 w""d Telephone: Home ��� a�� Business Mailing Address ''� / ������ (c) Lending Institution EE (e) Mailing Address _ Real Estate Comp, Address Telephone Mail the HAA to the followino address: or: Check here if hold for pick up. List contact person and day phone number below. #/ 17634 Eagle River Loop Road No. 204 Eagle River, Alaska 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms _ 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If communitywell system, must havewritten confirmation from the State Departmentof Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front 4300 (9919 nae) S&O -OL Z to Z abed "Njom s,Jaauibua leuo!ssaload aql ui suo!ss!wo ao sioaaa ao} alq!suodsai lou s! abeaogouV }o (l!led!o!unlN a41 panssi si aleo!lgaao e aaolaq elep az (leue Ao suoiloadsui lonpuoo lou op SHHO to saaAoldw3 sluawaa!nba.i alels pue leaapal uppoo Als!les of aapio u! suo!ln1psui 6u!pual A!agl pue sawoq to saasegoand olAsapnoo e se s!glsaop SHHO agl'eNsely to @leis aql ul paaals!6aa aaau!buo leuo!ssa;o.id luopuadapu! ue Aq anoge 9 ydei6wed ul uaAlb suoileluasa.idaa agl uodn Aluo paseq saleo!l!ljao lenoaddV AllaoglnV glleaH sonss! (SHHO) saolAaaS uewnH pue glleaH to luawueda0 obeaogouV to (l!ledio!unyq aql NOI1f1VO leuo!l!puo0 G b L1j 2 — auogdelal leAoiddV Isuo!l!puo0 to swial pano.iddes!O panoaddV ,(q swooapaq aol panoaddy IVAOHddV SHHO '9 aps0 ssaappV VNIH33NION3 S'8 S Wald to aweN •uo!loadsui s!gl to alep aql uo loalla ui suo!leln6aa pue'saousu!pio 'sapoo alelS pus !ed!oiunW Ile ql!M aoue!ldwoo ui si welsAs lesods!p aaleMalseM ao/pue (lddns aaleM ails-uo agl 'uo!loadsui pue u01le61lsanu1 AW woal pus saI!l a6eaogouy ;o (l!led!o!unw aql woal pou!elgo uollewaolui aql uo paseq legl /;laaA aaglanl I •u!aaaq paleo!pui eAnlonals to ad/l pue swooapaq to aagwnu aql aol alenbapepue leuo!lounl'aless!walsAslesods!pAelentalsennao/puellddnsAelemalis-uoaglleglsrAogslenoiddV (luoglnV glleaH SM to uo!le61199nu! AW legl AllaaA I 'Molaq uMogs alsp uo!lep!!eA agl to se pus olaJaq paxllle leas tw !q pallpuao SV NOIIVWFlOdNI (INV V1V0'HOUV3S 3l1d'S1S31'SN01103dSNl ONIOIAOIdd WHij ONId33NION3 9 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MtjNIDIEPT.I OFOH ALTNH &RAGE CHECKLIST- FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 Legal Description: Ln S IjUN 2 ?, 1987 A. WELL DATA RECEIVED >J Q Well Classification S.I% If A, B, C, D.E.C. Approved (Y/N) Well Log Present ®/N) Date Completed A -Z'? -'�- Yield r _ Total Depth 19 ( Cased to (^i Depth of Grouting Static Water Level I Z5� Pump Set At L) (L Casing Height Above Ground — Electrical Wiring in Conduitd:PN) L4 Sanitary Seal on Casing (DN) Depression Around Wellhead (YCV Separation Distances from Well: To Septic/Hotding Tank on Lot I C>0 I ;On Adjoining Lots ( ft i To Nearest Edge of Absorption Field oq Lot �+ On Adjoining Lots lfl� To Nearest Public Sewer Line A To Nearest Public Sewer r Cleanout/Man hole --h To Nearest Sewer Service Line on Lot // ZS + Water Sample Collected by % ���('1�� "�G ; Date �- �L-8� Water Sample Test Results Comments W w � �W� Ti�Lt, yJ LL -L' 1-b &ec'C__Ss c�r S,z 6k EM . a(JE=YZ Lt t -4-R__ 5 B. SEPTIC/HOLOMG TANK DATA Date Installed S- (3 y_1 S Size i'I-4SD No. of Compartments Standpipes (/N) Air -tight Caps (62q) Foundation Cleanout 69N) Depression over Tank (YQ Date Last Pumped ten. _ (S -g7 Pumping/Maintenance Contract on File (Y/N) a ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/kleidiflg Tank: To Water -Supply Well Loo I+ To Building Foundation '27S r To Property Line ( a I k To Disposal Field t To Water Main/Service Line ( b A— To Stream, Pond, Lake, or Major Drainage Course I— U I -+YJ Comments Z)IS���I� �JP'(P1 rs�r 5►�'�'I ' 022 Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption p Strata �2� � �� Type of System Design Date Installed Length of Field 21 J Width of Field 2 Depth of Field U Gravel Bed Thickness Square Feet of Absorption Area Ski Standpipes Present ON) Depression over Field (Y/9) Date of Last Adequacy Test 57 Results of Last Adequacy Test ��(S� " !+ ?,(I -- Separation Distance from Absorption Field: To Water -Supply Well 1 oto 1 To Building Foundation Vz_I Lot To Water Main/Service Line I o I't' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed To Property Line to To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) IJa��Y 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 Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed G Date Z S7 Compah7y034 Ea Loop Riad Na. 1�1f3A No. S/7— cx� 3 h .r Ol c � �� `}y +`��.-i ° v0 nv qua 1pI Eagle River, Alaska 99377 _ Receipt No. GO sy r i 7 ° t Date of Payment `� D4 7 ]'•, •/en..OSCP�In �. Amount: $ 'NX, 1•G(3T=`r1 ar�4tp Page 2 of 2 72-026 (11/84) S °o CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 °IES ANALYSIS REPORT 5Y SANPL E VERBA Ci )erit Nil# rE-Kari ;eG #: i'i iient S-mrji Ill: L5 BU 2 GREATLANDESTATES#1 izr-ple UeC'd 'UN I'- Ordered By t ED O,,-, t, AMUi?I=:SS #1 r ;j viYGIfV!SEE iliNG LOOP :;6), #2(:u EMA01, ' a:i-iEk, :Al' c<,51 5peciai instruct: Cnemtiab fvef #: 66558 Lar? Smpi ID: 4 Matrix: (dater i A i l ow:da i e Paraneter Tested Result/Units liethod ts iii Tt ATE -N 0, 20 mg/ 1 camr,ie lternarks: 1 `Pests Performed i� See Special Instruct ionsAbove ND= bone Detected l See San, ele Remarks Above NA= Not Aral yzed L'i=Less Than, GT=Greater Than 011erlt ACCOUnt : b!%I`.ii;iv r Date 1kport Printea: ,i0N 16 bi 110 16: ; Re 1 eased i?v i:I! ,hC - . REPOPT.S ADUEyj % Cnemtiab fvef #: 66558 Lar? Smpi ID: 4 Matrix: (dater i A i l ow:da i e Paraneter Tested Result/Units liethod ts iii Tt ATE -N 0, 20 mg/ 1 camr,ie lternarks: 1 `Pests Performed i� See Special Instruct ionsAbove ND= bone Detected l See San, ele Remarks Above NA= Not Aral yzed L'i=Less Than, GT=Greater Than GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality n f Yr'li _I n �A x�`CS1 �Sv� 3330 "C" Street, Anchorage, Alaska 99503 274-4561 AD/Pf0 JAiI !AY • / `J Mpa VI Date Received December 23, 1975 Time of Inspection q, �naalL Date of Inspection I �� REQUEST FOR APPROVAL OF pe INDIVIDUAL SEWER & WATER FACILITIES FOR CONV. 1. Approval requested by: First National Bank of Anchorage % Paula Cranmer Mailing Address: Post Office Box 720 Phone: 279-4481 x 288 2. Property Owner: Joseph Roseman Phone: 688-2511 Mailing Address: Box 232, Chugiak, Alaska 99567 3. Legal Description: Lot 5 Block 2 Great Land Estates 4. Location: 5. Type of facility to be inspected Single Family No. of bedrooms 4 6. Well Data: Individual A. Type B. Depth 186 C. Construction D. Bacterial Analysis 7. Sewage Disposal System: A. Installed B. B. Installer,9.�//L %ate. 4 Ar - C. Septic Tank: 1. Size 2. Manufacturer AOeeE? s'%Ga,[ D. Seepage Pit: 1. Absorption Area �%2. Material E. Disposal Field: Total length of lines 8. Distances: A'. Well to: Septic tank Absorption area Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line F0-034 (1/74) Paoe 1 of twn nanes MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 — 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION! DEC 2 31975 RECEIVED 1. Type of Inspection: CMRO Lot VA FHA CONV XXX Block 2. Property Owner: JOSEPH ROSEMAN Land Estates Mailing Address: Box 232 Chugiak, Alaska Day Phone 688-2511 3. Name of Buyer: Same as Above River Alaska Mailing Address: Day Phone 4. Name of Lending Institution: First National Bank of Anchorage (Paula Cranmer--Ext. 288) Mailing Address: P. 0. Box 720 Phone 279-4481 5. Name of Realtor or Agent: n/a Mailing Address: Phone 6. Legal Description: Lot 5 Block 2 Great Land Estates Location: Eagle River Alaska (Great Land Circle) 7. Type of Facility to be inspected: Single Family Residence No. Bdrms. 4 8. Water Supply Type of Supply: Public Utility Individual XXx If Individual, number of dwellings presently served ONE If Individual, depth of well 186 Feet 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation EQ -037 (1/74) Page 2 of two pages - RE :st for Approval of Individual ier & Water Facilities Legal Description Lot 5 Block 2 Great Land Estates c Comments Approved �,�� Disapproved %!— Date �G• Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. f // Date Z— SIGNED EO -034 (1/74)