HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 3 LT 1Great Land
Estates #3
Block 3
Lot 1
#051-133-37
> GREA cR ANCHORAGE AREA BORuuj'H
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION
REPORT ON-SITE SEWAGE
DISPOSAL SYSTEM
NEAREST
etJJu ?
NAMEQ.l
/�
LOCATION e-� "vv 7-1-1
MAILING ADDRESS �� /">/
LEGAL DESCRIPTION
�� / 2uP-/i ,PHONE
cc
SEPTIC TANK:
DISTANCE �' NUMBER OF
FROM WELL MANUFACTURER �'- MATERIAL COMPARTMENTS
i
INSIDE LE/WTI� INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS.
SEEPAGE Pr'r— '
NUMBER OF P�. DIAMETER OR WIDTH" �,� LENGTH nDE�PPTIf
LINING MATERIAL CRIB SIZE: DIAMETER—DEPTH �� l DISC TANC/E FROM: WELL
/ TOTAL EFFECTIVE //
BUILDING FOUNDATION NEAREST LOT LINE . ABSORPTION AREA (WALL AREA) IK, F SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE -✓ AL` )
/ CONSTRUCTION
BUILDING
NEAREST
FOUNDATION
LOT LINE
CESSPOOL
OTHER SOURCES_
APPROVED
DISAPPROVED
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:_
NEAREST
SEWER LINE
REMARKS
DEPTH
SEPTIC
TANK_
DIAGRAM OF SYSTEM
CI C '
e�
DISTANCE FROM:
SEEPAGE
SYSTEM
DATE r APPROVED
�
, rM U ir-A 1 a 1 /��9--1 'T' %-" C.9 F-- ���It, � ;z F-1 IF::]'.
DEPARTMENT Lx HEALTH HND ENYIRONMENTHL F_^JTECTION
2510 E TUDOR RC\/ HNCHORHGE, HK. 99507
276~2221
���I_.. L_ ��A V_,-1 CH 1`- -1 "T" FE." KEE: 1 1 E,7-�
ERMIT NO. ( 76448
�PLICHNT KE ST RT BX 1175 CHUG IHK 688-281]
}CATION QUICK WHY
:-:G8L L1 B] GREAT LHND ESTATES LOT SIZE 90000 SQUARE FEET �
/^YPE OF SOIL HBSORBTION SYSTEM IS: PIT
MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT/BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
_p— C L_ EE P -J ���I-A= �
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF EHCH SIDE FOR H SEEPAGE PIT.
THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BE
THE SURFACE OF THE
GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
HND THE BOTTOM OF THE EXCAVATION (IN FEET).
'R K- ������� _V" P-4 ����= ���� �������
8HCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION'HNC FF�PROYHL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROS ECUT I Ot-k
MINIMUM DISTANCE BETWEEN H WELL HND ANY ON-SITE SEWAGE DISPOSHL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPHRTMENT WITHIN DMIS
OF THE WELL COMPLETION.
SPECIFICAT IONS HND CONSTRUCTION DIHGRHMS ARE AVAILABLE TO INSURE PROPER
INSTHLLHTION.
��r 1
�� ���I ��
� �� ��� ���� ��C� �����
I CERTIFY THAT
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS AND WELLS AS SET
FORTH BY THE FIR
OF ANCHORAGE.
2� I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]� I U SE SYSTEM MAY REQ8IRE ENLHRGEMENT IF THE
RESIDEN
SIGNED�—~~____�_____�_�~~�.�~__�_���~~__�~~��~�'
y
APPLICANT HARRY H. MHC4%,91TI '
�
/�.6���
. L I0)21tzuetlon gest ZaLt
.r
"One test is worth a thousand npinions"
2204 Cleveland Anchorage, Alaska 99503
Performed For Harry"Mackey Date Performed 6/25/76
Legal r)escrintion: Lot 1 Bloc4: 3. Subdivision Great Land Estates
This Form Renorts Soils Lociyes Percolation Test_
tenth
Feet Soil Characteristics
2 Topsoil
4—
6 — Coarse Sandy Gravels
8 — (GP - GW)
-
0-12-
14
14
Bottom of Test Hole
16 —
20—
Was Ground Water Encountered? No
If Yes, At what Depth?
NMI
V�
Readinq Date Gross Time Net Time Depth to H2O Net Dron'
i—
Percolation Rate Minute
Proposed Installation: Seenaae Pit Drain Field _
Depth of Inlet Depth To Bottom Of Pit Or Trench
rnMMENTS: 85 Square Feet drainage area required per bedroom.
No ground water or bedrock encountered.
Test Performed By
Data Certified By: CONSTRUCTION TEST
nate: 6/28/76 LAB
LOG
Lot 1, Blk. 3, Great Land Estates
Builder: Harry A. Mackey
Driller: Harry A. Mackey
Owners: Joseph and Arlene Mc Coven.
)-3 ft. - Topsoil
3-30 ft. - Gravel, sand, clay with large boulders
30-37 ft. - Gravel, sand and clay
37-43 ft. - Mostly clay
+3-48.6 ft. - Gravel with water
+9-71.6 ft. - Clay with boulders
71.6 ft. - Large boulder
71.6- 83 ft. - Gray clay and some hard pan
33-100 ft. - Gravel
100-104 ft. - Large boulder
105-106 ft. - Sand with Itttle water
106-194 ft. - Bedrock
this well at 49 ft.
thitfwell again at 71.6 ft.
duction: 2 + gal per min.
tic Level: 90 ft.
ed to: 106 ft.
-0 1 jo�-i09
MUNICIPALITY OF ANCHC
RNVIRO Pt OF HEALTH &
NMENTAL PRorr,
OCT 2 91976
RECEIVED
LOT SIZE (check one)
EIA)
Under % Acre
L1 13)
Y:-1 Acre
MCI
1 - 5 Acres
❑D1
Over 5 Acres
ANCHORAGE, ALASKA MLS
Residential
Rev, 4/79
95,000.001 3,18180
Addr:: uick Wa
Bmu BIns Yr. U Lot Size Zoning
3 2 1976 2.14 a RI
B 1 2 Tot Sq. Ft. 2 4 8 0
I Liv, Rm. 1st FI s 2nd Fl
Din. GarageArport
Kitch. NN
x i pdrnw ( 1 FrnlCe f ] Pid
UTILITIES
OA) Public Water
P9B) Well
❑C) Public Sewer
® D) Septic Tank
❑ E) Elec
-Up—DateTerms
6117 80
Assum/Ref.
Rec. Veh. Parking ryes
Dist.100
Style axes 7 6 7 .4 6
p/Ent Assorts none
Heat
it/HW
Ballst. 53,300 apprx
Pmt.48 7.5 9
Poss.
-lose
Bal 2nd.
Pmt.
[']Ov/R
Bnk -AK State
Util. area [,I Gas [ xl Bsmt.
[x] Refrig
Rec. Veh. Parking ryes
_
1 Fara Rm. [ ) Wtr. (X] Patio
[x] Crpt.
Grid 1260
11 ' Bath [X)MII [ ) Comp._
[x] Drap
Ei. Ghu is
1' ' orkrm [ 1SWr [XjDspsl.
[x]View
Jr.. Gruening
1 den (X]Septic l ) Fence
[x] DishW
HiChuiak
Owner Joe � Arlene McCown
1ph 688-3294
Legal Greatland Estates #3
Blk 3 Lot 1
Lovely immac split entry
home built by H Mackey.
Blown foundation heavily
insulated. Heat econ.
Tastefully decorated home. No 4WD. Gas nearb . Xtr
ighboPit
Acreage wooded in covenanted nerh
LA : uxiel Bowman Toshow
LB/CLO 694-354
In .AREARiver
No.2010 Ph 694-955
The BLUE NUMBER is the MAXIMUM NUMBER of characters, including spaces, whether
using pica or elite typewriter. Any copy beyond the maximum number of characters de-
noted by the blue numbers will not appear on the listing. _
.n""
Owner, by signature below, requests that this listing not be placed
with the Multiple Listing Service.
Owner:
Sign Yes J No,[ I Exchang no
Possession Date _.a f t e r C1 0 s In g_ Owner. -- — --
Reason for Selling moving
Owner hereby em Ploys AREA—__Inc
hereinafterr erred t s 'A nt " s le aid ex u ve t t sei tha ce ain real property described as
G`reai�an EsTafeg3 ion Y __-- -
An_hO r a g e _ Recording Dis ict. Slate of Alaska• for the price of $ _9 �i 0-0 D_ — on the terms of
$cash, cash, balance payable:
as per agreement ---- --
and to accept a deposit to bind a prospective buyer.
Owner's morchantiblo title shall be secured by a policy of Idle insurance, issued by a responsible company, to be furnished and paid
for by Ownor. Owner agrees to obtain a preliminary commiimem [of tide insurance within __—_-- days after execution of this agreemeen.
Intorost, taxes• rents, insurance ar]d_assessmmit will be prorated to the dale, yOf cllosiing. o -June--] This agency shall continue irr( Zly for the full period beginning Itax c h_16—� ")U to midnight _.L1tne--] .
13_&0. Owner agrees to pay Ag. -l1percent of the selling price as compnsahr the properly is sold on transferred by
i
I
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 SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910217
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:ALASKA HOUSING FINANCE CORP
OWNER ADDRESS:20066 QUICK WAY
ANCHORAGE, AK 99510-1020
PARCEL ID:05113337
LEGAL DESCRIPTION: GREAT LAND ESTATES #3 BLK
LT 1
LOT SIZE: 93218 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 0
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
9
PAGE 1 OF 1
DATE ISSUED: 7/26/91
EXPIRATION DATE: 7/26/92
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
L6[(i DATE:cl
ISSUED BY: JOHN. SVL4fTf+ DATE: '� �ZS/°l-
NW1260
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by
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SULLIVAN. WATER WELLS
P•O.BOX 570272,CHUGIAK,ALASKA 995019 TELEPHONE 688.2759
OWNER OF LANDAe. AlojTio
ADDRESS
LEGAL DESCRIP?TION4v1 / tK 3 ajr6
DATE - Started Ended!
PERMIT NUMBER_
DEPTH OF WELL 3n) y �.+
STATIC LEVC1.017 WATER FT.
DRAW DOWN FT
GALS. PER HR ___ %J
KIND OF CASING --(9-1440 y
KIND OF FORMATION:
Fro m-a—Ft, t Ft,-tG�'J10
From4L—Ft, to -4 --Ft.-. _t�c�rQ /SJ�dc�
From_Ft. to.&_Ft. .�i� ,O b�l¢�ItLJ�
From
From
From __
Ft. to----- Ft.
Fr. to Ft. .
Ft. to Ft.
Ft.�3t h _ _____ From 171, to Ft.
From Ft. to o-7 —D
From, ..., Ft, to__L_�,� + `Ft. f f G 1 `i % 4n4�,J' From Ft. to—Ft—
o _FtFromFt. to Ft.� C.P,B� 1��5 From Ft. to Ft.
From—Ft.
From Ft. to__Ft.��' -' _ lJ_AslFr Frori Ft, to Ft.
00
FromFt. to a _rt +�� S �L 4r=(.t From Ft. ro_Ft.
From Ft. to Fr.✓i��___.__ From Ft. to-- Ft.
1
From !t- Ft. to -AID -_Ft. Ajo t From Ft. to Ft.
From Ft. to- Ft. A.a4�4;4- From_ _ --Ft-to-Ft.
From 4+� _ �' — � From;lj 71
L�O Ft, to Ft. � � /Q_s� � �^� From__Ft. tn_____—Ft.
From Ft, to �f' rom__Ft. to- Ft.
From IkS—_Ft, t Ft,.� From Ft, to Ft.
From i90 Ft. .to„2be Ft. "A��/�fia=„�f From__. _ Ft. to.__, -- -Ft._..
From
Fromm
MISCL. INFORMATION:
146'F, O—Ott`.
From Ft. to Ft.
From _Ft. to—,--- Ft
DECEIVED
FEB 18 1992
Municipality of Anchorage
Dept. Health & Human Services
DRILLER'S NAME �___
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 051-133-37 Expiration Date: (E
1. GENERAL INFORMATION
Complete legal description GREAT LAND ESTATES #3 BLK 3 LOT 1
Location (site address) 20066 QUICK WAY, CHUGIAK, AK 99567
Current Property owner(s) PAUL JACKSON Day phone
Mailing address
Real Estate Agent DIANE SHEARER Day phone 854-0077
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
Fx1
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
U
Public Sewer
❑
Waiver/Variance request for: NONE Distance: ---
Received by:
COSA to be released to the engineer, unless othemise requested by the engineer.
Date:
COSA Fee $ 1�j0�i Waiver Fee $
Date of Payment 4i I 0 Date of Payment
Receipt Number 0 Receipt Number
COSA# cL b )i'4O(.P Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm SPURKLAND ENGINEERING
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SI NATURE
System #1 Approved for L3 bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 279-3916
Date 8/5/-t�
K
iS E. SPURKLAND 4 Q
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date: C, - !
Th u al' nchorage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 5 c
If more than 1 septic system is on the lot:
COSA Checklist # of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
3 1
Legal Description: GREAT LAND ESTATES #3 BLKkLOT,�_ Parcel ID: 051-133-37
A. WELL DATA
Well type PRI If A, B, or C provide PWSID #
Date completed 2/16/92 Sanitary seal (YIN) Y
Total depth 300 ft. Cased to 146 ft
FROM WELL LOG
Date of test 2/1/92
Static water level 125
Well production 1_25
WATER SAMPLE RESULTS
ft.
Well Log (YIN) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >12 in.
AT INSPECTION
7/24/13
135
ft.
g.p.m.
2.73 g.p.m.
Coliform NEG Monies/100 mL Nitrate 3'1 mg/L
Arsenic ND ug/L Date of sample: 7124113
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/ FIBERGLASS
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (YIN) Y
Date of pumping 7/24/13
C. ABSORPTION FIELD DATA
Collected by: ANSON MOXNESS
Date installed 9/13/76
Cleanouts (YIN) Y
Depression over tank (YIN) N High water alarm (YIN) N
Pumper JRs PUMPING SERVICE
Date installed 9113/76** Soil rating (g.p.d./fe or ftZ/bdrm) 85 System type CRIB
Length 14 ft. Width 74 ft. Gravel below pipe 6 ft.
Total depth 8 ft. Eff. absorption area 336 f 2 Monitoring tube Y Depression over field N
Date of adequacy test 7/24/13 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 12'5 in. Water added 600 gal. New depth 19 in.
Elapsed Time: 15 min. Final fluid depth 16'5 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) _ If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons —
"Pump off" level at _
Cycles tested
Septic tank/lift station on lot 100'
Absorption Feld on lot >100,
Public sewer main NA
Sewer /septic service line >25
Animal containment areas >50
SEPTIC/HOLDING TANK ON LOT TO
in.
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >100,
On adjacent lots >100
Public sewer manhole/cleanout NA
Holding tank NA
Manure/animal excrete storage areas >100'
Building foundation >5 Property line >5
Water main NA Water service line >10'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10 Building foundation >10'
Water Service line >10 Surface water >10Y(N.O.)
>50'(N.O.) >100,
Curtain drain Wells on adjacent lots
F. COMMENTS
*CLEANOUT INSIDE HOUSE. ** CRIB REPAIRED IN 2001
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKLAND
Date 8/8/19
COSA brown sheet -1 0-10-1 2.doc
Absorption field >5
Surface water >100'(N.0)
Water main NA
Driveway, parking/vehicle storage10
6401 ---I1-\`
`a�E o� A�gil�I
in.
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
HAA # iQ9 `�I)1
Parcel I.D. #
1. GENERAL INFORMATION
Complete legal description Lot 1; Block 3; Greatland Estates Subdivision
20066 Quickway
Location (site address or directions)
Property owner
HFC u20354 Day phone
Mailing address
WA #100427
Lending agency
Day phone
Mailing address 694-4200
Agent Sharon Minsch - RE/MAX OF EAGLE RIVER Day phone
Address 16600 Centerfield Drive, Suite 204, Ea le River, Alaska 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
XXX
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:
XXX
Individual on-site
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.
79_n95 (Rev. 1/911 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 Phone
I EER G
Address 17034 Eagle River Loop Road No 204
Eagle River, Alaska 99577,
Engineer's signature
6. 1375 SIGNATURE
XApproved for �'�'� �> bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date 7�- 15-12
OF 4dr
oa
� a^
I i✓� s' �p .r 5
+ � Y
r,...
ER J.
No. I
lico"JWESSXO��
bedrooms, with the following stipulations:
By: ��� Date ;Z - -0 - 67
47717
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 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 H21
Municipality of Anchorage
Department of Health & Human Services _
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
3 Parcel I.D. 'D,�51 //33
te5���
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present(WN) Date completed -7711
Driller GRAu-A✓�
� I U
Total depth —Casedto Casing height X2'4
Sanitary seal �/N)
Date of test
Static water level
Well flow
Pump level
Wires properly protected &Y7N)
FROM WELL LOG
-7 �I
12S I
1. 2e �; g.p.m
0Y_
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
12 -20 -'AI
V�
2%, g.p.m.
2,J 2
Septic/holding tank on lot ��� ; On adjacent lots i
Absorption field on lotC>t�
1 IA �I� ; On adjacent lots �I
n..u:..................... l.Imonhnln/nlannnii4 - O
Sewer service line A_etroleum toc�k tJ L.-;>tJ�
f�C�N)WATER SAMPLE SAMPLE RESULTS: z`%''► •w� l �'u S' 1�'�`' �� ��y'Iv1/Li7•
Coliform Nitrate 12, ISIS Other bacteria
`/ t�
Date of sample: _ 2 Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 9- \3--I (a Tank sizes Compartments
Z
Cleanouts6)N)%-4F undation cleanout(/N) Depression (Y&
High water alarm (Y/ N) �� Alarm tested (Y/N)
Date of pumping L) Pumpers 1
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot �t r On adjacent lots j cik Foundation-
To
oundation To property line 4- Absorption field Water main/service line
1
Surface water/draie � k
� t o egpw nag(iViot-61- (STING vj&L
72-026 (Rev. 7/91) Front �lr�' `C'�'��7 `� , 12k �''`/� (f, pc _ C> 7 c"eft_IAZ�CONTINUED. 9,N BACK PA�
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
"Pump off' level at
Cycles tested
Surface water _
D. ABSORPTION FIELD DATA
Date installed-- Soil rating �5 � System type
� I
Length � Width �� Gravel thickness �� Total depth
Total absorption area Cleanouts presentdT/N)
Depression over field (Y/N�
Date of adequacy test 1�5 r2�-
Results (pass/fail) yl�� for
Peroxide treatment (past 12 rnonths) (Y(!* If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot On adjacent lots Property line 1
t <J
To building foundation �� "� To existing or abandoned system on lot
On adjacent lots 1/ I_�Cutbank Water main/service line- 11 �
Surface waterPP ��I _- Driveway, parking/vehicle storage area _I
Curtain drain _u, fVt� 1t•I)DW V / e>I
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
S A S ENGINEERING
Signature 17034 EaUIe Ri_ v�p Road
Eagle River, Alaska 9967/ f °'
Engineer's Name
Date
vv
J
HAA Fee $ 4`l0��
Date of Payment
Receipt Number z l S`�,
Waiver Fee: $
Date of Payment
Receipt Number
9L'J?-r_��l-cbCi
ULL J BHB8 c. •'-iJ
MAP SKETCH AND PHOTOGRAPH ADDENDUM
BorrowerIClient_
'Er�tperty Address— -- -- -- ---� -- -- - - — --- alp Code -
County Stato
Lender
LAYOUT SKETCH
0
Lay VIEW AVE.
• _ I zoaao � I_. �.
20625 W ; 13•}3 _ ..
_._20320_
202A
KAREN
TI
nL—
KAHER AVE, - Ij— " — _ ._ __� � WEN
21714 21734
IM '201x5 I Fi
20102 .`.cAI Fuss A401 20:;9 .10N n ,2^!. ! ,YJ' t I —5
r ' 201i6 I20113
:IC
T
�{ I L I /jya � /)➢ i / ,J/
2ooz5 ' 2Go24 m \ + 20}14
I2163fi 21717 4 2162V 2I'n62;639
TARIKA AVE. ' 1` - _
24r4
4567 1
/7M
149
i VrCHWOLF. TEN.
__4—_—__------"`-�
BIHCKWOOD L:GP 7RAILEiI -
000RT
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i
I � ' N. Bi19cHivGGp I
Zs_
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_et�_
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s
I
9d gyp.-%-�'• c�
ASBUILT-NO CORNERS SET THIS DATE.
1; Jo
ter. 87
]ARD & ASSOC:
I HEREBY CERTIFY THAT I HAVE SURVEY "D THE
SCALE,
FOLLOWING DESCRIBED PROPERTY:
1"=§0°
Creat Land Estates,Un t Na.. 3,Lat Z B]k. 3
AND THAT NO ENCROACHMENTS EXIST 666E "T AS
DATE,
INDICATED. IT IS THE RESPONSIBILITY OF THE
2-12-92
OWNER.TO DETERMINE'THt EXISTENCE OF ANY
GRID,
EASEMENTS, COVENANT$, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
NW 1260 -
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
FB&
ANY DATA HEREON BE USED FOR CONSTRUCTION
22-39
OFFENCE LINE$, OR FOR ES•TASLISHING SOUND-
ARY LINES.
DRAWN:
DMS
R,5V 18
OF Ata
Jar 49'Lli
06
........
w Dvpno•Mprk Seward
�°q', c5 -bars .`A
CHEMICAL cit GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99519 TELEPHONE (907) 562.2343 FAX: (907) 561-5301
k'c6r:ySI3 R:SL TS 3or INVOiCY 1 51022
92.053n are
.Pie: I c Hatrix: Wt,TEF.
Client game :S u S U,'. E3iN'u
L',I7kn- Jt&D.6 Iu :.- B3 ,;7�A?.A3I5 ESTATZS client Acet :SHSEHGP
i `Ii• Q;. BF01 t Poi :NONE RECEIVED
VE; I-, %r5
Oc (: ,'4S .
Cciiected Regi
Rece3re3 FEB 11 P .::.5 h vrne:ed By
Freso-^ed with AS RELUInu' I
Send Ri"rts to:
Antivs3s Completed 113 & S E"r3IHEER1Hu
L6DUTat'{Tt• SupeIvisor? STE'rii:ELS�eleitcd Dy
..�
...........................................
...... ..............................
..............................,..........................`........�`r�Le.............Method Aliow6bl.o Limits
eaui s --
C.-.maf AT --------
- __
^. i5 rtFfl E°A 153.2 1
4
I
F -. >) x t F ".:
t• - _. I ' _ Y 1 1. K
u
t
A0DlI#E SIriYLE C4LLECTtb BSt ll J S
g�p.e
Reaarke�.
u.aw.ogw.w...wu..r
.......e........w.a .................u.w..
............................... ...Darr.......................................
QA -line aileble
'See Special Instructions Abore
F Teets Performed.
" Sample Rsaarke Above
e Sample
WD- None Detected
GT -Lasa Than, GT -Greater Than
HA- Not Analyzed
SGS Group (SociAtB GAnbrale de Surveillance)-';,
y„� �.
Member o! the
17034 Eagle River Loop Road
Eagle River, Alaska 99577
C
ROBERTA.SHAFER
CIVIL ENGINEER
694-2979
PROJECT:�L{ t L� f " Z� DATE OF TEST:
LOCATION OF WELL (Legal Description):
r �
WELL DEPTH: FT. CASING: 1 FT. SCREEN:
DATE DRILLING COMPLETED: DRILLER:
STATIC WATER LEVEL (Top of Casing): ` FT. DATE:
CLOCK
TIME
ELAPSED TIME SINCE
PUMPING STARTED/WATER,
STOPPED, MIN.
DEPTH TO DRAWDOWN/
FT. RECOVERY
PUMPING
RATE, GPM
REMARKS
2; ap
0
1
k"24 (SWI) 0
0
Start r1E
1
5
10
k-3 (
- -- -
12.: 1 S
15
Gi
q"�)
20
25
21 n
30
35
40
45
lam. O
1 L'-Sa
50
Z� o
55
L
3�
60(1 hour)
90
13
120 (2 hours)
2' ry10
150
Z
S
180 (3 hours)
O
210
212
%•
q- ; PN:�>
240 (4 hours)
RECOVERY
t 0
0
5
10
15
20
25
—
30
35
_ --
Comments: Plow isnot Guaranteed
Subsequent Variations
2. , l Can Occur.
5. LEGAL DESCRIPTION /-1±3B
f�-
DATE RECEIVED
Y INSPECTION APPOINTME S
e-,
TIME
TIME II -
�JA A- - L:!b
TIME
DATE
DA E
LD /is
DATE
INSPECTOR
NSPECT R
INSPEC�R
Three O Six �eJ
7. WATER S,IJPPLY
INDIVIDUAL*
*ATTACH WELL LOG. A well log is required for all wells drilled
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PR TECaIgp OF HEALTH &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL r)OTECTION'
•
ENVIRONMENTAL SANITATION DIVISION`ijIN 7g�o
Telephone 264.4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND Cf IEI@ES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY - OWNER
PHONE '
MAILING ADDRESS
PROPERTY RCSIDENT (If different from above) PHONE
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
2. BUYER
&I'_0 k'elacCC'�q- cc)G
PHONE
MAILING ADDRESS
c�(ot Y �U NUS
3. LENPING INSTITUTION
PHONE
MAILING ADDRESS/
4. REALTOR/AGENT
o i & ( 0 t0'4'T ky —�/� c C/3 GIS -4 4v 1=
PHONE
MAILING
5. LEGAL DESCRIPTION /-1±3B
f�-
1
±' BLt_
C>�A'
STREET LOCATION
U 1 C
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
ED One O Four Othert.f�.
fV SINGLE FAMILY
O Two O Five ht/6)v
O MULTIPLE FAMILY
Three O Six �eJ
7. WATER S,IJPPLY
INDIVIDUAL*
*ATTACH WELL LOG. A well log is required for all wells drilled
O COMMUNITY
since June 1975. For wells drilled prior to that date, give well
ED PUBLIC UTILITY
depth (attach log if available.)
B. SEWAGE DISPOSAL SYSTEM
���'' SYSTEM WAS INSTALLED.
7
INDIVIDUAL/ON-SITE**
— YEAR ON-SITE
0 PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑
❑ TWO ❑
THREE ❑ FIVE ❑ OTHER
FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: 1000 If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL / t
W
4. DISTANCES WELL T0:
Tank
Absorption
Area
77�eSeptic/Holding
Sewer Line
Absorption Area to nearest Lot Line
5. COMMENTS
F�
r
r�A
APPROVED FOR 3 BEDROOMS
❑ CONDITIONAL APPROVAL (letter must acc ny certificate)
Fr] -DISAPPROVED
DATE n•' % n 6
BYj� �^_ I /��