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SKYLINE VIEW BLK 2 LT 11
Skyline View Block Z Lot 11 #051-192-16 Municipality of Anchorage Development Services Department % Building Safety Division • • r - ' Onsite Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW030103 PID Number: 051.192-16 Name` GEORGE E. GARRISON Wastewater System: ❑ New ❑ Upgrade Address: PO BOX 670894. CHUGIAK. AK 99567 ABSORPTION FIELD Phone: Number of Bedrooms: O Deep Trench O Shallow Trench 17 Bed 0 Moura Other LEGAL DESCRIPTION Soil Rating: Total Dept" from' ' al grade: GPD/Ft� Ff. Blick: Lot: Subdivision: Depth to pipe bottom from original grade: Grovel to beneath pipe: 2 11 SKYLINE VIEW FI. Ft. Township: Range: Section: Fru added above original grade:Gravel Length: Ft. Ft. Well: ❑New [Ell Up rad Gravel width: ` Number of Ines: Distance between lines: Ft. Ft. Classification (Private, A, B. C): Total Depth: Cased to: Total absorption a Pipe Material: Private Ft. FL Fe Driller: / �J Dale Droled: Static Water Level: Instal Date Installed. iT FL Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. FL SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. -Vanu To Septic Absorption Lift Holding PublicfPdvat acturer. panty: From Tank Field Station Tank Sewer Line Anchorage Tank 1250 Gal. well 100' 100'+ NA NA 25'+ Material: Steel Number of Compartments: 1 2 Surface Water 100'+ 100'+ NA NA LIFT STATION Lot Line 51+ 10'+ NA NA V ue. nu ac urer. tK Gat 5'+ 10'+ NA NA Pump on level at. ump o Hign water alarm at. Foundation In In. NA *501+ NA NA Pump Make Electrical Inspections performed by: Curtain Drain Remarks:BENCH 'noneaknown. Old tank abandoned per code. New 1250 gal. tank MARK placed north of old tank location • added Insulation over tank. lana escriplon: Cement slab at bottom of steps ume,l UaVaIJOA. 100 FL Engineer s Stamp .r.OF 44 • ill Inspections performed by: KND Engineering. Inc. Dates: tat 4129!2003 %Tr ;r 9L 2"d 5/22103 /e• •.•a. •«.«. as .:... Developmen ervices Department Approval .0.0.000•a ..;. « Kenneth M. Du s ? �� �� s��'6000 CE 7t s Reviewed and approved by: Date: 30 of 0 , Jet (Rev. 1:100) 9lC to _ ,,,\\0.F S ►1��P� AS -BUILT SYSTEM DETAILS/SITE PLAN SKYLINE VIEW BLOCK 2, LOT 11 >EPTI SEPTIC K N D vc 9 A—C=14.9' B—C=28.3' A—D=22.9' B—D=33.2' 101 WELL 0 N x 149AATI� 1250 GAL � SEPTIC TANK 1 tt I N ORIGINAL GRADE FX?M fAMC 11 ESTI 00 PREPARED FOR: GEORGE GARRISON 19373 STARFLOWER CIRCLE CHUGIAK, AK 99567 FlELD BOOKS COMPUTED: BOUNDARY: - DRAWN: VBG sTAIQNc _ CHEDOD KMD AMULT. - DAM- 6/10/0 Dvr_ ME, DRro. NW1159 AcAD FLE: 03038.DWG JOB N": 03038 Permit SW -030103 PID# -051-192-16 II SEPTIC SEPTIC SEPTIC S SCALE: NTS 1 L"ll LW ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 J g TVs Ior- ( T► (vim MUNICIPALITY OF ANCHORAGE / Development Services Department l 2 / / G 3 On -Site Water 8 Wastewater Program 4700 South Bragaw Street ! r ,/ O} P.O. Box 196650, Anchorage, AK 99519-6650 (L' y (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Apr 29, 2003 Expiration Date: Apr 28, 2004 Permit Number: SW030103 Parcel ID: 051-192-16 Legal Description: UYLINE VIEW BLK 2 LT I V Design Engineer. 0070 KND Engineering Site Address: 019373 STARFLOWER CIR Owner Name: gectzlc 6nwt,soN Lot Size: 13942 SO. FT. Owner Address: P.O. Box 670571 Total Bedrooms: 3 Permit Bedrooms: 3 Eagle River , AK 99577 - This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (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, sealed, and heated to prevent freezing. Received Issued By: Date: V2,7 03 By: 22 Date: 2 ko___ Municipality of Anchorage .'' Development Services Department' Building Safety Division tl= On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D 051-192-16 Permit Number SW 030 103 Property owner(s) George & Kristin Garrison Dayphone RBB -8095 Mailing address (1) 19373 Starflower Circle, Chugialk, AK 99567 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'da Skyline View, Lot 11, Block 2 Legal description (Section, Township & Range) Lot Size 13942 Acres/Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade�rj,k/4� ,fED ff THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. of property owner or authorized agent) Permit Fees: y�%d Waiver Fees: Date of Payment: T�D3 Date of Payment: Receipt Number: D 3 5 -?2- Receipt Number: (Rev. 12/00) KNDD ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11/FAX (907)696-8111 April 29, 2003 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Tank Upgrade — Skyline View, Lot 11, Block 2 Gentlemen: The owner has requested we proceed forward to obtain a septic permit on the subject lot to replace the existing septic tank. The existing septic tank has been identified to be in failure and will be properly abandoned. We propose to install a 1,000 -gallon septic tank. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, I€�i�ID Engineering, Inc. Kenneth M. DuffusVP. Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN SKYLINE VIEW BLOCK 2, LOT 11 SHERM STREET wEu •� e 7: 6 5 4 s SEPTIC sEPnc n� SEPTIC W -- -- SEPTIC 118.00 — ti*s sEPn 12 0 N °° o•. s o 1. SEPTIC o ' .... SEPnc vcu N yap .... HELL e •� 9 g..... 19 g s c WAMLL m e SEPTIC () .... 150.00 150.00 VACANT O VACAN3 € VA 1A8NT 8 W g s s II 8 i wi O � O � o o � ` DESIGN DETAILS 1. ABANDON EXISTING TANK 2. INSTALL 1000 GALLON SEPTIC TANK 3. CONNECT TO EXISTING SYSTEM 4. INSULATE TANK IF LESS THAN 4- OF COVER O\\ PREPARED FOR: Ar...................S' i Af GEORGE GARRISON 'y �` 19373 STARFLOWER CIRCLE * •` ,9 —.i * CHLIGIAK, AK 99567 ......................... ...... ............ I ..... ED: / FIELD BOOKS CouruT • u. s :: CE awmAnr: _ DRAYM:JSG • tiQ � sTAa"c: _ t"EaED: KIAD 1 ......................... ASemT. _ DATE 29 MA `%PESS10,0-N, Aw Dwo. nom: DRi¢ NW115' AmFnE' 03038.DWG '106 "°'` 03038 Scale: 1"= 100' EM PAGE 1 OF 2 JS�1b�!!LJ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 I WASTEWATER DISPOSAL SYSTEM DETAILS SKYLINE VIEW BLOCK 2, LOT 11 CV SEPTIC PROPOSED NEW 1000 GAL. TANK MT CO �C; All O cl� OC r-� C 100' SEPTIC 0.0 ..................... WELL �' 1 \ C I c 12J m PREPARED FOR: GEORGE GARRISON 19373 STARFLOWER CIRCLE CHUGIAK, AK 99567 FIELD BOOKS BOUNDARY: STRONG: ASBUILT; Dw- rux_- ACRD FILE: 03038 tompuTm. DRAWW: JSG CHECKED: KIVID DAM 29 M CRV. NW11I5 JOB Nm: 03038 T - Scale: 1"= 30' PAGE 2 OF 2 M -Al LUJ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 .............. :..i . . .............................. (907)696-6111/FAX (907)696-8111 � b} DOC Co. Ciba SULLIVAN WATER FELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND jqk&,SX it /-aJ `1L hJ ( DEPTH OF WELL STATIC LEVEL OF WATER FT. ADDRESS LEGAL DESCRIPTION—4- n 1 12� k._ r/ 1,%)t L)1 OuIDRAW DOWN FT. DATE -Started Ended �{ 0 GALS. PER HR 30 KIND OF CASING _ t' _=� 7 'o PERMIT NUMBER KIND OF FORMATION: From Ft. tom. From Ft. tom -- — F Ft Aerl J: G From._ 7 !�-Ft. to Ft.—:jY_/.?1"i'c�aC ='n k Fromi Ft. to .. Ft.- From L Ft. to F ' e S,=F1 r1.S From Ft. �.) _ From t. to - r Jc' tiJr r i Ft. to t. From L_ Ft. to _LFtyl ,v(� ! —,-� - L. SFrom F _ t. town Ft lTi 'UA' " r l -.``I { From ..��.%�` From _`l 1 Ft. to Ft. N --- — From L z Ft. to From�- 7(-" �J v Ft. From_-�—Ft. Ft. to ---Ft. From Ft. to /��� FtAe ✓,_ From Ft. (�.. P1 `i 1-4 Ft. to ,.J ,q Q 1/ From h 1,/ FromFt. to1�1--Ft.._L-- Ft. to o �: Ft. �TI From—Ft. �-•�� Ft. to ----Ft. C"�,i3iict C From �Si—Ft. to !t� Ft. From_ Ft. to_ Ft. From Ft. to Ft. From Ft. to—Ft. From _Ft. to Ft• \' From Ft. to Ft. From _Ft. to Ft. From Pt. to Ft From --Ft. to From Ft. to__ ---RAR-+ —1 91 n �! / r T rQ �� n) t-4JZ C',� ;,�<�From— Fi. to--lliitlRi( Ip�itt 0f �cNCIT@r itrJ----- From /" % d Ft. to� Ft. — th & Human Services ept. M t Ft.(,,1 D From Ft. to• From_-- Fj to —__— / From Ft. to --Ft From Ft. to—Ft., MISCL. INFORMATION: DRILLERS NAME C�' t1firb Briffilt ifwg b) DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 , TELEPHONE 688-2759 OWNER OF LAND ZJL df �,� a-( A./O U,r_e ,V C. -'l DEPTH OF NN ELL S–() �) ADDRESS STATIC LEVEL OF WATER 1;T. LEGAL DESCRIPTION DRAW DOWN FT. DATE - Started Ended GALS. PER FIR PERMIT NUMBER KIND OF FORMATION: KIND OF CASING 2 c� ,,j From 1) —Ft. to 's V Ft. A From. Ft, to Ft. From ."..� % Ft. to�Ft. HIL6) = J From, Ft. to Ft. From Ft. to c)� Ft.• From —Ft. to Ft. From Ft. to Ft. t: - ,i From. Ft. lo_ Ft From—Ft. to Ft. From Ft. to Ft From SO, Ft. to_ift_Ft. t J -i From Ft. to_ Ft. From _jaL� Ft. to Ft. � 4 From_ Ft. to Ft. From _Ft. to_Ft.'^ / From Ft, to _Ft. From Ft. to Ft. -5– P17' From Ft. to Ft. FromAj% Ft. to Ft. T h-4-1 4- `From —Ft. to _Ft. From Ft. to Ft. From to Ft. . RECEIVET —Ft. From --Ft. to Ft. From Ft. to_ Ft. From Ft. to Ft. From Ft. to—Ft. MAR 11 1991 From Ft. to Ft. From —Ft. toMu It 10i �12 C Zept.!H!eaplfh 8, Human Services From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From—Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME MUNICIPALITY DF ANCHORAG� Department of Health & Human Services 825 L Street, Anchorage� Alaska 99501 343~ UN�SITE WELL PERMl[ Permii Number: 900149 Upgrade �Q Date lssued: 06/13/90 Owner Name: A"H.F"C. Day Phone: Owner Address: 520 [AST THIRTYFOURTH AVE. 561-19OO ANCHORAGE, AK 99503 Parcel Id: ����-192~1� Lot Lega]: Subdivision: �KYLINE VIEN Lot: �1 8lock: 2 SecLioo: 16 lnwnship: 15N RaRge: lW Lot Szze 13942 (sq,ft, or acres> Max 8edrooms: lhis Permit: 3 Total Capac:1. 3 WELL: Log musi be submitted to Municipality of Anchorage Department of Heaith and Human Servzces within 30 days of well completion, 1NS[ALL PB� ENGINEERS Al[ACHED PLANS, NO CROSS CONECTlON W]LL BF PERMITED BElWEEN WELLS. . THIS PERMll I5 1�5U��U �Uh |Mf. F,%x/��/mu �� lNGLE FAMILY DWELLING ONLY ANU EXPI|�ES ON 1^ I am �amiliar with Lhe requirements �nr on~site sewers and we1ls as set forth by the Munzcipality of Anchorage (MOA> and the State o� Alaska, 2. l will install the system in accordance with all MOA codes and regulations; and in compliance with the design criteria o[ this permit. 3. I will adhere to a1) MOA and State o� Alaska requirements |or the set back distances from any existing we1l, wastewater disposal system or public sewerage system 1 his or any adjacent or nearby 1ot^ 4" I understand that this permedrooms. l a1so understand that the capacity o[ the total sys1em is 3 bedrooms and any enlil1 i dditi 1 permit` Cign.�d: DATE: --''~ (Owner) A.H F C ^ lssued By: DATE: LEGAL itp� DRAWN Z;5 W DATE SHT. 1 I 7-S W v j� - ► H a jerk 3�0 - 1 1_,--� i-2- Ma. a..ufi •• . No. 14574 f: ' O�1 pzOFESS'Q���� CKD. 10 C !S DATE SHT. 1 I 7-S W v j� - ► H a jerk 3�0 - 1 1_,--� i-2- Ma. a..ufi •• . No. 14574 f: ' O�1 pzOFESS'Q���� Tprtt*ftpb l3rilting TEug by DOC Ca. abo SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA $8567 • TELEPHONE M-2759 OWNER OF LAND +�� i, hb ��- , DE11TH OF WUL t2 i2 ADDRESS LEGAL DESCRIPTION—Z O! DATE • Started Ended - PERMIT NUMBER STATIC LEVEL OF WATER FT DRAW DOWN FT. -- GALS, PER Hft KIND OF CASING z- sl i KIND OF FORMATION' From 0 _Ft. to O�Ft, From—Ft. � `ST�cr�'Q From Ft. to_- Ft. From- Ft. tv % f" Ft. d s � 474tog r _ From._.•._.,�Ft. to_F't. __ --- -- - --- IId From _.f1L.._Ft. to2�1:t. +3 d 6&X4 { Coh dl.4Wrom Ft. to Ft. ____ From_Ft. to Ft. xe �" pt �F Frottt Ft. to - Ft - CC1PALt'N �p.1.� ,t�1 From Ft. to %.? Ft, ��r .��t�!d �AUEtFrom...___ --rt. M�--BR�-- ��I4xr From-L IT Ft. to 1A Ft. Sid i Y .S/}rJ6 _ From - Ft. toE� __._ Ft. 0 p r- � From«� _Ft. to �! Ft, ��r4Tr % /} J0. Fromm 1 Ft, to � 4` FromlAd'—Ft. to _ Ci? t 4 4-S From_Ft. __ P __Ft. to From Ft, to j�7 Ft,_ From,--- Ft. to Ft. _ From Ft. to Ft. _—_T_— From -Ft, to—__,_..Ft. — From Ft, to_ Ft.—. _ _s --- From—Ft.. to --Ft. - - ---- From —Ft. to— Ft, From --Ft. to—Ft.—__ - From ---Ft. From Ft. to Ft. _ Fmm ... Ft. to FL From Ft, to—Ft- o - ---Ft- - -- From—Ft. to..,.._,,.,,._...Ft._ From—Ft. From _ _—Ft. Ft_ to_Ft. From Ft. to Ft,� From _Ft. _... ,. Ft. to_Ft. , From Ft, to.Ft INFORMATION; t?def S,h.. rt C.Af 2�cls i rr+lC� rti t �� DRILLERS NAME / lY �•� }I_q/41THM 'inHmTC7Tt.lAq) r, Rh.!CT. PC, An WHf MUNICIPALITY OF ANCHORAGE DepartmenL o� Health & Human Services 825 L Street; Hnchorage/ Alaska 99501 343-4720 ON�SITE W�LL PERMIT Date Issued: 07/20/89 Engineer Designed Dwner Name: AHFC AHFC Day Phone: Owner Address: 520 E, 347H 694~2979 ANCHDRAGE� AK 99503 Parcel [d: 051-192�16 Lot Legal: Subdivision: SKYLINE VIEW Lot0 11 Section: 16 Township: 15N Range: 01W Lot Size 13942 (sqr acres) Max Bedrooms: This Permit: 0 Total Capacity: 3 WELL: Log must be submitted to Municipality o[ Anchorage Department of Health and Human Services within 30 days of well completion" THlS PERMIT IS 8EING ISSUED FOR THE PURPOSE OF DRILLING A NEW WELL ON THE SUBJECT LOT. [HE EXISTING WELL WHICH SERVES THE SUBJECT LOT IS L0CATED ON ADJACENT LOT 12" AFTER [HE NEW WELL lS BROICA H| INTO SERVICE; THE EXISTING WELL ON LOT 12 MUST BE A8ANDONEU IN ACCORDANCE WITH ADEC REGULATIONS OR A LETTER OF NON�OBJECTION FDR THE WELL TO REMAIN IN S�RVICE FROM THE LOT 12 PO [ CERTIFY �HAT: 1. I am �amar with the requirements [or on-site sewers and wells as set �orth by the Municipality o� Anchorage (MOA) and the State of Alaska. will install the system in accordance with a1l MOA codes and regulations, and in compliance with the design criteria o[ �his permit. 3. l will adhere to all MOA and State of Alaska requiremenLs �or the set back distances�rom any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby .1. c) 4. I understand that 1. 11 s valid [or a maximum of O bedrooms. I also understand that the capacity o[ the total system is 3 bedrooms and any enlargemenL will require an additional permit. SigneCh.2n 0_ ~ (Owner) AHFC 7 A Il Issued By: DATE: ~... ..... �r�-�����~^^����w�-�~��~~~_._~~~^^~~ LEGAL lei �� �l/�4 l/� V, e a�c�� ry pd .e r 1 �i� DRAWN ' CKD. DATE 8 _ SHT.�Si°O,.eo��,� f 2 y�..i ............... .w +77Ai eq`'<f RI VE R. PV PSPa4 �('V O'O'wo o�aM�'� 5ys—r�-� I_—or 11 1 Q ; ��✓e ►fit �r 6 i w� GRED-,. R ANCHORAGE AREA BOF AGN Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME !A' ,44e/ er S 7�MAILING ADDRESS. P, ©' SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER _ INSIDE WIDTH - MATERIAL - LIQUID DEPTH E -(6(1s1 --- =1 NUMBER OF __COMPARTMENTS LIQUID CAPACITY GALLONS. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL --FOUNDATION _NEAREST LOT LINE.___ OF LINES NUMBER OF LINES — DISTANCE BETWEEN LINES — TRENCH WIDTH— IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE . MATERIAL BENEATH TILE_ WELL: TYPE _—CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION LOT LINE _ SEWER LINE CESSPOOL APPROVED DISTANCES: OTHER SOURCES — DISAPPROVED INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL:— — LOT SLOPE: REMARKS: _Q Form EQ -032 SEPTIC TANK- REMARKS _IN. ABOVE TILE IN. DEPTH — DISTANCE FROM: SEEPAGE SYSTEM DIAGRAM OF SYSTEM 0 r %�7 DATE/ / APPROV E 3 VOOM G.A.A.B. THE REQUIRED SIZE GF THE SSIL HBS0APllON SYSTEM IS: liI I:i, 11 :�� I ~1 4 ;i : 6.ii 11 . . F 641 G! - 1'�� wvyhqv NO U 1" h~�w� Z 10 Ch W:I: �;d: A 3. 4 4US"00 h ±� W 0 1-����ii 1i l I 11;;:,� ic:�� ii ��: � i, ��.x ii, ii : j I I� BHCKFILLING OF HNY �YSTEM WITHOUT FINAL INSPECTION GNl') HPPROYRL BY THIS DE�HRTMENT WILL BE ��UBJ�CT TU PROSECUTION. l CERTIFY THHT 1HM FHMILlPAR WITH THE REQUIREMFNTS FOR UN—SITE SEWERS HND WELLS HS SET FORTH BY THE HUNICTPHLITY OF HNCHORHGE. 2� I WlLL IFAS THL} THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTRND THHT THE GN -SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT lF THE FOS IDENCE IS REMODELED TO INCLUDE MORE THHN ] 8EDRO0MS GRF. --R ANCHORAGE AREA BG. UGH 0rfI1I DEPARTMENT OF ENVIRONMENTAL QUALITY i°�(IJ I I IIS\ ° 3330 "C" STREET ANCHORAGE, ALASKA 99503 nIIIIJJJJ LLLJJJ��<� f TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM ® APPLICATION AND PERMIT NAME OF APPLICANT -V/iV / f/ 1.14 Xo- o MAILING ADDRESS 731y PERMIT NO. j INSTALLATION LOCATION 7�'r{))ll+�-�/�� sT� LEGAL DESCRIPTION !! �l9 / �l /`S Ik ��.7�/��r- �' • ��� "��3 INSTALLATION OF: SEPTIC TANK G� SEEPAGE PIT , DRAIN FIELD , OTHER 7el44/- , TYPE AND SIZE OF FACILITY TO BE SERVED e- =J 9 ' so __4 FINANCED THROUGH p(�� !�( TO BE INSTALLED BY _//�}})))) ��_:xA_� solL TEST RESULTS o'f— NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST 43 COMPLETION DATE ANTICIPATED 9 - FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE Age'? '' TYPE [[j �-ed "f'i t' �� SEEPAGE AREA SIZE �lJ� �(T- �J TYPE —Lh- MINIMUM DISTANCES, REQUIREMENTS e— I FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ' J DRAIN FIELD A0 SEPTIC TANK TO SEEPAGE PIT WALL. SEPTIC TANK. SEEPAGE PIT DRAIN FIELD J TO NEAREST LOT LINE. WELL TO SEPTIC TANK) ✓n' SEEPAGE PIT DRAIN FIELD (�(,! / ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC nTANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK, ` I SEEPAGE PIT--[/LLr _. DRAIN FIELEY B TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, G.A.n.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM i I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-66 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. , DATE APPLICANT'S SIGNATURE EQ -016(3-75) _^O E GEE i'ECHNI CAL & ®EVEL-]PMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis' 694-2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: PdAme:_�� ��c�L.� , r,�5 TO . No. Mailing Address: 5. � at �5� Legal Description: ���- \ \�•� 2_ _�\cy\ Doth fejt So 1 Oh cra Lerlstics 0 1 _ a 3� 11 5� 6 7 ..� B.�. 9 , 12 13 1Z VN (P, 'p, / Ground dater Encountered: Yes No� If yes' what depth Proposed Installation: Seepage Pit Orcin Hold Comments: . �' 1KN `ZA Vn "Vs �1 \ J ��J,\ .Performed by: _ ;��� .� Dater � cS • Municipality of Anchorage`„ On -Site Water and Wastewater Program 2' (907) 343-7904 s A, {* CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-192-16 Expiration Date: i _ c3 ^1 7 1. GENERAL INFORMATION Complete legal description SKYLINE VIEW BLOCK 2 LOT 11 Location (site address) 19373 STARFLOWER Cl AK 99567 Current Property owner(s) ANNA L. WIGGINS Day phone Mailing address Real Estate Agent 19373 STARFLOWER CIRCLE, CHUGIAK, AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class —Well ElCommunity ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless COSA Fee $ 5 P14 Date of Payment ► I gal g Receipt Number U Ro3(00 COSA# 55U710oa- Date: by the engineer. Waiver Fee $ Date of Payment Receipt Number. Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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 ARCTERRA CONSULTING. INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 01/10/2017 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen OF A r� \ encroachments, deficiencies or discrepancies exist. Ar�� L,9 *149 TH 6. DSD SIGNATURE 0- System #1 Approved for bedrooms. �, "' ; e System #2 Approved for bedrooms. 1PT�%ea AV' '�tEssto`�� i Disapproved. 0�_v Conditional approval for bedrooms, with the following stipulations: By: �`^^ �f� l� Original Certificate Date: I— 17J 7 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA W. sh .t_10.10.12Am If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SKYLINE VIEW BLOCK 2 LOT 11 Parcel ID: 051.192.16 A. WELL DATA Well type PRVT If A. B, or C provide PWSID # _ Well Logs (Y/N) Y Date completed 611990 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 360 & 500 ft. Cased to 218 & 229 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 611990 12.29.2016 Static water level 209 & NA ft. 218 & 180 ft. Well production 0.5 & 0.22 g.p.m. 0.44 & 0.16 g.p.m. WATER SAMPLE RESULTS: Coliform OxI colonies/100 mL Nitrate 1.e2 mg/L eoww. to Arsenic: Nn ug/L Date of sample: 12129116 & Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 4/29/2003 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 12.29.16 Pumper JRs ""` ' ""v °. C. ABSORPTION FIELD DATA Date installed 512011977 Soil rating (g.p.d./ft2 o ftZ/bdr 85 . ' System type DEEP TRENCH Length 26 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 8.2 ft. Eff. absorption area 260 ft2 Monitoring tube Y Depression over field N Date of adequacy test 12.29.2016 Results (Pass/Fail) . PASS For 3 bedrooms Fluid depth iri•absorption field before test 0 in. Water added 600 gal. New depth 0 in.. r Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450+g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N 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 Manhole/Access (Y/N) "Pump off"Ievel at in. High water alarm level at Cycles tested Meets alarm & circuit requirements? Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots 92' (MOA#WR980052) On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 1004 110 Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ ,,..: ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) 'Wells on adjacent lots 100'+ F. COMMENTS 3*4 Ute bw err IL 4PP*44 7p Rd dECo~4. 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. i OF L*4' Engineer's Printed Name . -KENNETH M. DUFFUS Date 01110/2017. #' +1 9 TH COSA canary sheet_2-6-15.doc _ • -�- - - P KENNETH M. D 'F :.1 / C 711 tok Vim/ P�FF.SHIOt`a\.� Municipality of Anchorage Development Services Department =. a_ .... Building Safety Division < s <; On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC171002 g a recc,,t COSA on-site inspection and test of the potable water y well on 13lock 2, Lot 11 of Sky Line View subdivision, the well's 7;;tivity was determined to be .6 Combined gallons per minute. The ,num well ;Iroductivity required by this Department (AMC 15.55) for a room res,;dcncc is .31 gallons per minute. Although the subject well 7tly exec ",is this minimum requirement, all parties concerned are 'd that 0' • production capacity of the well may fluctuate. Restriction -n-critic,d water uses such as washing cars and watering lawns and I:Is may be required. advisory r. Lust be attached to all copies of the subject Certificate of On- �ystems A;-proval. 180.00' S890 59' OTE PXP•04L &MtYXL CPNtA f1F'..IASAAI])) 2.1.9 Delmar ma' PllANP 21BAIX 9pC 0ADNL g1BAIX 10' UTI ESMT C.O.s — — — — — — — — — — — — — — — — — — V OT to VEfyt tv . t0a WELL RADIUShh O L*1 y 10 z p-�' �4 �' •CQ• ON S R'O. Og. o. a. ti V M (� Q 12 b WELL O L=35,82 OI STARFLOWEf'' CIRCLE Qo UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBIUTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LotSURVEY SURVEY TYPE SYMBOLS FWNDATION AS-BUILT SET REBARt—I ASPHALT DRAINAGE ElMAL STRUCTURE AS-BuiLr 0 FOUND REBAR 8--8-...8. .WOOD FENCE rA '�" CONCRETE ❑ PLOT PUN ... As-wiLi ...LOT wROEr ... TOP00tWHY 00 ASSUMED ELEV. ,t-=,r},- METAL FENCE ® W000 DECK AS-9UM1i.. NO N T RF RFl ARON AS-BUILT. 0 CORNERS PLOT PLANS & LOT SURVEYS NOTE: ITIS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION,. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN: FENCES. WELLS. SEPTIC CLEANOUTS. SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS. AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY. EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE. RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATIONPrepared eayaarq++ ++® by Robert E. Johns, Jr. & Assoc. PLOT PLAN ... q� ""•••;Q `+ L�..e,m,PnL�.I•<-P.,..dl,..-,.� a•` 4 F ors Professional Land Surveyors Y um. b„m > «maan.a a •r w br m,,.. m. a. ewt mT. Lye � 1700 Brink Driw. ANCHORAGE, ALASKA 99504 or aww.eL .w mne.. a'ao.,wm..xe.. NT . 49th_., �'•¢e Scole: Rea. Lot S.F. Rec. PIaf Fite No. FOUNDATION AS BUILT '0 1„ _ �O, I. Ad»t c A+na +. n.+cr uury awI I I,eM Wwtll!'M tl, Y-Bull �vmY w Pn % j; e^'$"•„+"� "F P . " O Dote Sur"yd: " 01/05/17 DroMn b '", REJ Checked by� w.n=em m,Pm w ww Bwt m a., s ... .......: ....1m J K aMn.Im. a,e ntme•Bm m nw.,,.n.. t�'. ; ROBERT E. JOHNS, JR. r i� P Grid: W.0 �••- t eP �® Date Drawn: 01/05/17 NW1159 17-02 STRUCTURE q •A eP'' '• .L1 S •: ed Legal Description:LOT FINAL AS-BUILT W. mt me n•1 m m. 11 BLOCK 2 .w•w. •, —d +o'aTogessionol on00�4® +® ®e0 SKYLINE VIEW Municipality of Anchorage Development Services Department ;0/ .. '"at Building Safety Division On -Site Water and 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 Parcel I.D. 051-192-16 cosA# Expiration Date: /V 2 3-09- 1. OR1. GENERAL INFORMATION Complete legal description SKYLINEVIEWBLOCK 2 LOT 11 Location (site address) 19373 STARFLOWER CIRCLE CHUQIAK AK 99567 Current Property owner(s) LYNNE SCHLU—NIPF Day phone Mailing address 12110 BUSINESS BLVD STE 6 EAGLE RIVER AK 99577 Lending agency Day phone Mailing address Real Estate Agent BONNIE KINE Day phone 244-7176 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site 0 Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 ewarequerd for the transfer of title (except between spouses) for properties served by a single-family on 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. •STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. ' Name of Firm ArcTerra Engineering &Surveying Inc Phone _868-3792 Address 20441 PTARMIGAN BLVD EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M DUFFUS Date 07/15/2008 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regu!ations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are out ide the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a �j OF ,Q4 system will function satisfactory for current or future z ,••••""'••.;45 1 occupants or can ArcTerra guarantee that no unseen '•.? +1 encroachments, deficiencies or discrepancies exist. j *=49L 5. DSD SIGNATURE Approved for —3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: WATER AND M= PROGRAM Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Report Nitrate Advisory Other By: Lei Original Certificate Date::Z--23-0,9 ca.. tua51 J Municipality of Anchorage Development Services Department ;t' !►': 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 CHECKLIST Legal Description: SL. LINE VIEW BLOCK 2. LOT Il A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID # _ Date completed 611990 Sanitary seal (Y/N)Y Total depth '+sQ& sou ft. Cased to 11a & 229 ft. FROM WELL LOG Date of test _ 611990 Static water level 209 & NA ft. Well production 0.5 & 0.22 g.p•m- Parcel ID: 051-192-16 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) min. AT INSPECTION _214A.221— ft. 0.66 combined 9.p.m• WATER SAMPLE RESULTS: Coliform © colonies/100mL Nitrate 0.97mg/L Other bacteria 0 colonies/100 mL Arsenic: �/ _mg/l Date of sample: %-/-&'b Collected by: ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Ssntic/Steel Date installed 04/29/2003 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YFoundation cleanout (Y/N) Y Depression over tank (YIN) LY High water alarm (YIN) N_Date of pumping 7111/08 Pumper Saanitury C. ABSORPTION FIELD DATA Date installed 5/20/1977 Soil rating (g.p.d.W or ftr/bdrm) 61 System type Trench Length eft. Width _a ft. Gravel below pipe 5 -ft. Total depth T,6 ft. (measured) Eff. absorption area Z ft? Monitoring tube Y Depression over field PL Date of adequacy test 7fj1/oe Results (Pass/Fail) PASS For bedrooms Fluid depth in absorption field before test 0 in. Water added-fi4Q_ gat. New depth 0 in. Elapsed Time: o min. Final fluid depth 0 in. Absorption rate > c +g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) glf yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N)___ 'Pump on" level at_in. 'Pump off" level at_in. High water alarm level at_in. Datum Cycles tested Meets alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 92'+(MOA tWR980052) Absorption field on lot _100'+ On adjacent lots _100'+ Public sewer main 751+ Public sewer manhole/cleanout _loo'+ Sewer /septic service line _ 25'+ Holding tank moo'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line _51++ Absorption field 5'+ Water main 1o'+ Water service line l0'+ Surface water -oa'+ Welts on adjacent lots loo'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line _ lo'+ Building foundation —11±—Water main _ 10'+ Water Service line 1g'+ Surface water moo'+ Driveway, parking/vehicle storage _ITI_ Curtain drain 50'+(None Known) Wells on adjacent lots _10T F. COMMENTS G. ENGINEER'S CERTIFICATION�,�p�;:••"""• .�s•vt I certify that I have determined through field inspections and s *?49LN review of Municipal records that the above systems are in C`c' •�•'• •••••• �•• conformance with MOA COSA guidelines in effect on this r "a date. t Mw•M•uw••••w OO.. K.nri�th'M. t46w W Engineer's Printed Name _KENNETH M. DIJFFUS� It�9�.•�'��.mg���v� Date 07!15/2008 ��``FESSIIM" COSA Fee $430.00 Waiver Fee $ Date of Payment__�ar�o� Date of Payment Receipt Number X10 Receipt Number (Rev. 11105) Municipality of Anchorage • ed!.: to Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 ww w.ci.anchorage.ak.us (907) 343-7904 Nater Well Advisory Health Authority Approval # 080235 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 2, Lot 11 of Skyline View subdivision, the well's productivity was determined to be 0.66 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. Municipality of Anchorage --�1 - Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 L tj CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY LIWELLING Parcel I.D. QS I I `7Z b HAA # D 3 Q 61 4 Expiration Date: 3 04 1. GENERAL INFORMATION Complete legal description SKY _r^AIr= a/2'1= t.J 152— Location 52Location (site address or directions) 19 73 C T A P FL,0 W 6 t2 c Ru,(;7 Current Property owner(s) r4C026)E IcS-Ts=A) GhRRrsuOay phone C44-eA09s- Mailing address Lending agency . Mailing address Real Estate Agent .-Mailing Address Day phone Day phone -&nless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: _ 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certifcates 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and.type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm. C-AGLL PTjf9 ECIGie1l E TNG riwne_ 6 -S19s Address 1o4—z_( V r�,) (Z,(p S u '+e 201 1 Engineer's Printed Name P. �,)rpoh Date II /12 5. DSD SIGNATURE XApproved for 3 bedrooms. Disapproved. d Y�� Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory . Well Flow Advisory X— Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 2 17,103 Rev. 01102) Municipality of Anchorage =0 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: 'S1CV/,i_AM5 � W i3 7 L I I Parcel ID: n S/ 1 92 / 6 A. WELL DATA Well type Ri JAiC If A, B, or C provide PWSID # Date completed _6440 Sanitary seal (Y/ ) Total depth 34D ft. f00(+_ Cased to 7-14ft. Z 2� r FROM WELL LOG Date of test /275/46 �/90 Static water level Z XJ /'4 ft. Well production O- S O.ZZ g.p.m WATER SAMPLE RESULTS: - Coliform --O_Icol� /100 ml. Nitrate O•?U 1 mgA. Arsenic: _ mg./I. Date of sample: -4 v/p3 B. SSE HOLDING TANK DATA Tank Type/Material Tank size 1 ZSn gal. Number of Compartments 2 Foundation cleanout (9/N) Y Depression over tank (Ye %J Date of pumping 11/13/01 Pumper 1 lz � 5 C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftz oftZ/bdrm) Length ZG ft. Width 3 ft. Well Log(Y/.N) y Wires properly protected (WN) Casing height (above ground) ZZ in. AT INSPECTION 1) /. 12 ID 3 21 3 ZZZ ft. 0.3 / rawt B_Auehg.p.m. Other bacteria d /c/ '01 100 ml. Collectedby: e 412ZS WrNnh Date installed 7 /ZC/lh Cleanouts @N)y High water alarm (Y/N) k//A System type Ti D# -A)0+ Gravel below pipe _S ft. Total depth /O ft. Eff. absorption area Z(At2 Monitoring tube Y Depression over field n lI Date of adequacy test 7103 Results (Pass/Fail) PA 55 For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added gal. New depth 0 in. Elapsed Time: 2q nmin. Final fluid depth5 0 in. Absorption rate >= 'f 0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y Q& type) A) If yes, give date D. LIFT N Date installed\ "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off"level at_ in. Cycles tested Manhole/Access(Y/N) High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank lift station on lot hgo On adjacent lots c7rZ' Absorption fieldr on lot / Do f v On adjacent lots � 0 Public sewer main /<%c) Public sewer manhole/cleanout Zoo, Sewer/service line ZS Holding tank fJon1E tc,,,)n1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' -f- Water Water main to r '- W ells on adjacent lots / C90 t- Property line S t Absorption field Sr t Water service line /Of 7 Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line { Building foundation /L) t Water main loo f Water Service line /Or'I-" Surface water zoo � Driveway, parking/vehicle storage Curtain drain SO t a)oNE K twvWells on adjacent lots /rTl tt F. COMMENTS D v, G. ENGINEER'S CERTIFICATION G 4LGt FtP2 13 ort} . l certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name _C H RSS-10Pt+ Z P W oot> Date _ I� HAA Fee $ Waiver Fee $ Date of Payment —)-�, N o3 Receipt Number (Rev. 12/01) Date of Payment Receipt Number CE:10387 41.'00[) in. Parcel I.D. 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.cl.anchorage.sk.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-192-16 GENERAL INFORMATION Expiration Date: Completelegal description Lot.11, Block 2, Skyline View S/D .. Location (site address ordirectioris) 19373 Starflower Circle Current Property 6vner(s) MA rrd - j/ j f Fe _144 t a& Day phone ro88-SZ -_y Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site EXI Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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 welts 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 seat affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l 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. 5 & 5 ENGINEERING Name of Firm 17834 E49 River 1 ann Resd No. 204 Phone Goll ->-'l 9 Address Eagle River, Alaska 99577 Engineer's Printed Name 'Robert C. Cowan Date a -/a-7/ C 5. DSD SIGNATURE IZ Approved for bedrooms. Disapproved. ON-SITE , WATER AND : :WASTEWATER PROGRAM ' .N/6 • .... • • SGV \� 14, y�4 RCSERi d COWAN cr :� CE -9601 ittltl�`�, Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: 3 — .2— O f (Rw-12M) Municipality of Anchorage ' Development Services Department Building Safety Division ` On-Sfte Water E 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: Lori r' 4 ;5eYL1NE V!L- l Sj' ParoelID:05/^/?Z-/L A. WELL DATA Well type QAvA?z— K A, B, or C provide PWSID # Well Log (YM) Date completed G /9O Sanitary seai�yN) &s Wlres property Protected &N) y�15 Total depth o- ft. Cased to -42;i ft. Casing height (above ground) 14 In. FROM WELL LOG AT INSPECTION Date of test L `!O 2 f t: O / Static water level Zo g L IN ft. Z ZO �� 4G5 ` ft. Well production��IPN 13GPI� g.paw O. / g.p.m. WATER SAMPLE RESULTS: 04 ZS Coliform 44Lcolonies/100 ml. Nitrate B 62!rmg.A. Other bacteria A/40— colonies/100 ml. Date of sample: O / Collected by: 15 1 5 G -->,(G (n/EEA I N 6- B. SEPTIC/HOLDING TANK DATA Tank Type/Material /� IG UN1G Tank size /Q gal. Number of Compartments Z Foundation cleanout 6/N)�-S Depression over tank (Yo Date of pumping Date installed -7 `/ Cleano4t9IN) 63 High water alarm (YIN) Pumper SA+,( I Tr+ Y C. ABSORPTION FIELD DATA Date Installed Soil rating (g•p•d./ft2 or 1 d rr )8_6 System type /0-6n(C14 Length ZL ft. Width 3 ft. Gravel below pipe 4_ ft. Total depth ,3, 57 ft. Eff. absorption area 1&6 ft2 Monitoring tube( -f Depression over field A/D Date of adequacy test 2 Z =J Results (Pass/Fail) PRSS For 3— bedrooms Fluid depth in absorption Heid before test _AL in. Water added4l&al. New depth_IL-1n. Elapsed Time: -0- min. Final fluid depth Absorption rate >= } 4fo g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) /✓eNF AKA1,*W1V ff yes, give date D. UFT STATION Date installed Size in gallons `Pump on" level ataIn. Datum E. SEPARATION DISTANCES Manhole/Access (YIN) 'Pump off" level at _ in. High water alar level at In. Cycles tested Meets alarm 8 circuit requirements? 00 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAron lot Absorption field on lot d Public sewer main N �� Sewer /septic service line On adjacent lots 9 r On adjacent lots l c-0 )#- Public sewer manhole/deanout Holding tank N Z'4 SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation �+ Property line 5 1 Absorption field 5 �t r�+ Water main N R Water service line Surface water /00 Wells on adjacent lots 00 r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / O �+ Building foundation /0 ,� Water main i Water Service line 104- Surface water / O O r� Driveway, parking/vehicle storage /0 Curtain drain NoNt 4iVfw Wells on adjacent lots 00Z,, F. COMMENTS 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 NAA guidelines In effect on this date. Engineer's Printed Name /r a8 &,g r C 0 W,#^� Date ;L/al /01 HAA Fee $ �W • W Date of Payment LD -:f -J Receipt Number /25M 611 (Rev. 12110) Waiver Fee $ Date of Payment Receipt Number iQtQE'j�R`s - `Jr� S P6601ANr f %r MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO.��o �5 During a recent Health Authority Approval on-site in=_cect'_cn and test of the potable water supply well on Lot Block ,2_ of5ikV,411V-VJEDt1Subdivision, the well's productivity was determined to be 9. 2 gallons per minute. The minimum well productivity required by this Department (A.MC 15.55) for a �_ bedroom residence is 0. '31 gallons per minutle. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of ncn-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. 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. # — I °I H ' HAA # 1. GENERAL INFORMATION Complete legal description Lot 11, Block 21 Skyline View SIS Location (site address or directions) 19373 Starflower Circle, Eagle River, AK 99577 Property owner Cancello Day phone 688-6522/276-1655 Mailing address Lending agency Northland Mortgage Day phone 274-5150 Mailing address 2605 Denali St., Suite 100, Anchorage, AK 99503 Q„pnt Lynn Burns/Rainbow Realty Dav phone -522-5966 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 N 3. TYPE OF WATER SUPPLY: Individual well XXX 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 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 a -a 7 9 I 7u34 E-5UWRtvw-LvvIr Road No. 20 4 Address Eagle River,.Alaska 99577 Engineer's signatureDate I y VJr>IH� 6. DHHS SIGNATURE , /„.... ..if, •��, �� ror i .ROBERT C. COWAN Approved for 3_ bedrooms. + �s .�� CE - asoi e�z �.... .r Disapproved.'.;�`� Conditional approval for bedrooms, with the following stipulations: Additional Comments > By: — Date ff-21 8 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-M (Ray. 1/91) Back MOA #21 o Municipality of Anchorage AUG 19 1998� DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNI CIPALIFY OF ANCHORAG i L V 825 L Street, Room 502 • Anchorage, Alaska 99501 • (J"1494W'CFS DIVISI Health Authority Approval Checklist Legal Doscription: X07" 11 6"L K ') S h Y L"vi- i- 'V' "v Parcel LD A. WELL DATA Well type N Riy A T _ If A, B, or C, attach ADEC letter. ADEC water system number Log present &)N) Date completed C A0 o Total depth '3'6o r Cased to 40 Sanitary seal &N) Date of test Static water level Well production P_S FROM WELL LOG Gl�o Cl _ () 'S_ g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate Casing height (above ground) Wires properly protected (ON) %'E AT INSPECTION ��ll lay 016s- 0 6s' 0 g 0 9 Other bacteria _ 0 r Date of sample: .,J , ;Z `) S Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed l' �, -) 1'-' 7 Tank size / ° ° 0 Number of Compartments Cleanouts &N) �/f j Foundation cleanout &N) yDepression (Y/6) 1v o Date of Pumping `t Pumper C. ABSORPTION FIELD DATA High water alarm (Y/6) /`r D Date installed -7 -7 / '7 7 Soil rating (g.p.d./ftz or z/bdrm . _ System type r/ Length o Width -3 Gravel thickness below pipe r Total depth i b r Effective absorption area J(10 !-r 2 Monitoring Tube present ON) Y4 t Depression over field (Yo N J Date of adequacy test `d �!I / `t V Results as /Fail) _ P*Ss For _ bedrooms r i• Fluid depth in absorption field before test (in.); 0 Immediately aftery0o gal. water added (in.): 0 Fluid depth w('. (ins) Minutes later: N 4 Absorption rate = SSG V g.p.d. Peroxide treatment (past 12 months) (Y/N) NON r kNywr' If yes, give date — 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES "Pump on" *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /0014 -- Absorption 0014 --Absorption field on lot / 0 0 .-1-- Public sewer main A/ Sewer /septic service line -JS- Size in gallons "Pump off" level at* On adjacent lots q (6-/61VI l r2r a 0i r/m On adjacent lots _ / 00 Y Public sewer manhole/cleanout s\J /,o Lift station P,� / rt SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1 Foundation Property line 57 -f` Absorption Water main/service line -/01-Surface water/drainage )o 0 1�_ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation I 01 -�- 0 � Water main/service line Surface water 1 Driveway, parking/vehicle storage area _ Curtain drain PJ (i N K tC N o w N10 Wells on adjacent lots _ /00 -1 F. ENGINEER'S CERTIFICATION l certify that / have determined thru field inspections and review of Municipal rec9p in conformance with MOA HAA gui elines in effect on this date. A"^ ,4r `7 Signature Engineer's Name Co w 4 Date �sl/Frg5 HAA Fee $ 300,00 Date of Payment �/� (T,lq- Receipt Number VY -027 l q Y 3 6 % 72-026 (Rev. 3/96)* R06ERT-:C. COWANf �Q c CE -8801 are (Vaiver Fee $ 5^- C) C? Date of Payment Receipt Number JUL-31-O8 13:00 FR06KU EPIVIROMME11TAL C.vE Environmental Sarvicai:ie i CT&113 Ref,N Client Name .project Name/N Client Sample ID Mml ix Ordered By PWSW Parameter iotat Coliform Nitrdze•N n LL 983855003 S & S Engineering NIA Lt 11 Hlk2 Skyline View Drinking Water 17 501'5301 T-012 P 03/10 F-015 Client PON Printed Date/Time 07/31/98 12:20 Collected Date/Time 07/22198 16:45 Received Date/Titre 07123/98 16:00 Tecbtdral Mrector: Stephen C. Ede Released By Allowable Prep Anatysis Results PQL units Methvcl Limits Odle pete ]nit 0 col/100nL $1418 92229 07723/98 RMV 0.909 0.100 M.9/L EPA 300.0 10 Max 07726/98 07/26/98 G[P Municipality of Anchorage 1�1j Department of Health and Human Services 825 "L" Street Rick Mystron,, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor http://www.ci.anchorage. ak. us 343-4744 August 28, 1998 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 11 Block 2 Skyline View Subdivision Waiver Request #WR980052, PID #051-192-16, HA980239 Dear Mr. Cowan: Your request for waiver(s) of the required 100 foot horizontal separation of an on-site wastewater disposal system to a private well has been approved. The approved separation distance(s) are the well serving the subject property and the septic tank serving Lot 10 Block 2 of 92 feet. This waiver approval applies to the existing on-site wastewater disposal system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-site Services Program ljm: #6 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet1 [�7 c WR#j A>D`19;rl`)4� PID# •-mss-192-16 HA# Lje� ,(- ~Permit # Date Received: August 19, 1998 Legal Description: Lot 11 Block 2 Skyline View Subdivision _ Engineer: Robert C. Cowan, P.E., S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577 Applicant: Cancello Waiver Requested: Waiver request between the well serving the subject property_ and the septic tank serving Lot 10 Block 2 of 92 feet. Criteria: 1. Geology: A. Water Table B Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special. Conditions: Waiver is Granted: x_ List Conditions or Reasons for Rec #: 04027/4436 Amount: $ 625 Points: WAIvFR REQuEsr FDR dor // BLIP 2 SkYt/NE 1/lew Sub Wfirvriq /?EQursr NkMBFo? wt?g8oOS2 W RIvEIq RFQucur xpR ml Lar WELL ra Ne/GKwoK'f 11 Or/o) fEPTic r1#Ivle. 5EPrrc 0/¢7,n — SkjDTFcr sFvr•c TifNR oN Lor /v 194k 2 +rets eoNSTRucrl<p /N J'utr /117�. rT is R G/eEcR S rec, ritm4. FHE raowe As [ oo4rgp OOwe. 6N*p/RN 7" hh� FgoM 79 -*f_ wFLL tm qua s r, o4., O^/ ^N e000q cr-t to re 2 % st op&, It ALSO MOO IS LOON-reog ON TNe Daws/ flop- Of TMiE HYvI9tgI+Llc 6/P/1D/46y% df "r& FC-0 THE CJ � ly > S E R vl" 1* 4 w GLI /N � ' k F f rl DN. Ci Ci Ci NCi CJ ((�,)4 r9X IwEid. IN quffSrroa w+r•J nRlltav /^v JwA/f 1990. r/48 IvsL/. IwA43 gf /4. )QESKLr OPS P4 Eft IIr/0,& WELL SEIQvrNb Lor // Of le 2 Iv*:r EleiA ,6p IN r,xcpu3 OF lo,%.yl f Nlrn#4res, ''''rt4if /s NOT le,vCoA,tMO/v POR 7-/t/f **REp IAI''rME SH 4L I.0 LNEffl {v66Ls (� y0/, SO!Lx CO^/.f/S7 OF PR/wti19Rrli w17AvE f wlrA4 sAN/) /1-7* rwx srnj4r.4 wwcu /s Lp/*pao wiry &I rlfArt r. ME New $,07ow-er ajw-cl /s Co^.tr?weret7 360 roer OirEP wrrry tiu,tar?okf L#YP-K Rs of CLQ} Y f 6LVNw NE 9a ' 6 ✓ k l Ivo PO N Sr CoIN/e/Nl , TILE MI-r6R FC&R+NG AfAAIfi�R PRPIA 7 -Ale sN�cloar�le HlGk NIrR#rF_ S. "eft P, ,vlrjtj+rE LeL)F IN rltE^wFLcf !ti TkIS �PRa.� I�,pE Na�v-DETfCTOLrF R Low (x I I~y/f) m N N k• F^ 1 14 IIJ L4 !4 L4 LI P. x wow ©00 CA ,p>e qq 7 t5 caro Nc4ra (010 ©, paitirs 2 /d " OF EP - g ":Front rlfmi Pc prf l 90 is X=.57�`'7. SOP"- faesrloov / i,a)( NO(O - as Uve) a 323 PERMfr4B�c + rf 2a$ w�rFn rl�r�c�' Gni 11FAII CGN SSR vK} YI ✓►= Q % 2 .9 2.7 (ON CC rt S i o,y �V o9- l VE, J-< NDepartment ROBERT C.COWAN,P.E. inq ROBERTA. SHAFER, P.E. CIVIL ENGINEERS Au ust 18, 1998g REC FAX (907) 694-1211 Municipality of Anchorage AU(G 20 199B of Health and Human Services HEALTHAUTHORITY P.O. Bos 196650 APPROVALS Anchorage, AK 99519 sept. Health & Human Services REFERENCE: Lot 11; Block 2; Skyline View SEWER&WATER Request you issue a Health Authority Approval on the referenced property and grant a waiver for MAIN EXTENSIONS the horizontal separation distance between the well seting the referenced property and the septic tank servicing Lot 10, Block 2 at 92 feet. The mitigation factors involved which support the issuance of the waivers are as follows: INSPECTIONiTER 1. The horizontal separation distance from the well to the septic tank is 87 feet. 13% of the required separation distance is requested to be waived. 2. The samples taken from the well located or the referenced property indicated 0.909 mg/L of ENGINEERING STUDIES nitrate and 0 colonies per 100 ml. of bacteria. ANDREPORTS 3. The referenced lot is on a 0% to 5% slope away from the well head towards the septic tank. This would prevent an), surfacing effluent from reaching the well head. WELL NSPECTION 4. From the well log on the referenced propertN. y we can see that the well depth is 360 feet. The &FLOW TEST static water level was reported to be 209 feet. The distance between the tank and the water table is approximately 200 feet. 5. The soils on the well log for the referenced lot indicate sand and gravel with layers of silt, clay SITE PLANS or hardpan between the ground surface and the aquifer. These confining layers would prevent any effluent from contaminating the aquifer. 6. The worst case hydraulic gradient is 0% (see attached surrounding well logs). ROAD DESIGN 7. A septic tank is not normally releasing contamination and therefore would not be expected to allow septic effluent to reach the wells. SOILTEST The granting of this separation distance waiver would not have an adverse impact of the surrounding properties. If you require additional information, please contact us. PERCOLATION TEST Sincerely, Qf STRUCTURAL& Robert C. Cowan, P.E. MECHANICAL INSPECTIONS RCC/skh Enclosure ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 LEGAL: LOT 11, BLOCK 2, SKYLINE VIEW S D d � DRAWN 81': ECKED BY: R.D.P. r R.C.C. DATE: SHEET: 08-17-98 1 OF L .M•ar,•e • i � � ;S .✓•' `, •' �a 1 p�9 ROBERT C. COWAN •4a�C��°f.- �'i CE -8801 ` ���9f+`•• •?` 17034 EAGLE RIVER LOOP ROAD EAGLE RIVER. ALASKA 99577 •••� • 'r �%'ROFESS�O�4 PHONE# (907)694-2979 FAX' (907)694-1211 EXISTING TRENCH LOT 10 LOT 11 � `'Tic aRE� C 1_39, EXISTING 1000 GAL. SEPTIC TANK N 1�0 New LOT 20 RA a dlU�, WEAL EXISTING 1000 GAL. EL i 100 SEPTIC TANK w N 100' WELL RADIUS -EXISTING TRENCH WELLS OT 9 STARFLOWER V CIRCLE LOT 19 o WELL 100, , — WALL Ln w RAZj1Us II U) - LOT 13 LOT 18 LOT 8 I UNDEVELOPED I MUNICIPALITY OF ANCHORAGE�� • DEPARTMENT OF HEALTH & HUMAN SERVICES M}� 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. # �\ - 1. GENERAL INFORMATION HAA# OL'] I C62 ) Complete legal description Lot 11; i32ock 2: Sku2.ine, View Subdivision Location (site address or directions) 19373 Stan.{yoowlen., Eagle, Riven, A2a6ka Property owner AHFC #71774 Day phone Mailing address WA #99983 Lending agency Mailing address Day phone Agent l o/c.i^Caawden/ 7AU/ COIJTTF COMPAUV Day phone 694-5500 Address 10923 Eag °e. Rive/c Rd. , EagEe, Riven, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 � 3. TYPE OF WATER SUPPLY: Individual well 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 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 M21 A 6. By: 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 r Phone Address 17034 Eagle River Loop Road No, g_Q4 Eagle River, AlaSka Engineer's signature DHHS SIGNATURE Approved for Disapproved. bedrooms. Date _t�— 8 _ej_ `7,I• R • ,'4�7 C • T1" 1 �• ';�K 0 •• R01 J.3F FER, P.E. t. 5 J7 •• °.0�'so �a Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L -o -T ll L+LtG 2 S�Vt ,�E Js@,,0�o parcel I.D. r /yZ '16 A. WELL DATA Well type n W Wr, _ If A, B, or C, attach ADEC letter. ADEC water system number '�4. Log present t N)_ _ Date completed Le '` D _ Driller !�!OuL-\\IkA c4t:SZ Total depth !2LPO' ii 4 - ix_->' Cased to lj � V_ . X11A2 1 Casing height 12 �t + Sanitary seal ON) Date of test Static water level Well flow Pump level Wires properly protected&N) FROM WELL LOG Lam- 90 2oq' S SEPARATION DISTANCES FROM WELL TO: AT INSPECTION 1O - `,1 :n MUNICIPAUTY OF ANCHORAGE ENVI(2ONMENTAL SERVICES DIVISION 52.D 4: Iq.D P100e 2.1991 �C13 _CEIV Septic/holding tank on lot I (�1 �- ; On adjacent lots 1rpo1 v Absorption field on lot Public sewer main Sewer service line rJ \Or,>,k ; On adjacent lots \ r ->D k A - Public sewer manhole/cleanout tk Petroleum tank 4 IA - WATER SAMPLE RESULTS: �t V, q,w East �1�a C�� tom, •�..�.. Coliform D D. Nitrate �k`t M Other bacteria fro n) S Date of sample: ( D 3 1 -`11 Collected by: S A S ENGINEERING 17034 Engle River Loop Roa No. S. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed -7 21 -11 Tank size _ L� cL-_-�- Compartments 2 Cleanouts 6)/N) V Foundation cleanout/N) _T_ Depression (YM) /j High water alarm (Yt� tJ Alarm tested (Y/N) "1/.h J Date of pumping � 1 - �.► -$n _ Pumper -9 %ESS�o� � 10QS� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot 10C) On adjacent lots \ori �� Foundation_ To property line \P tJ- Absorption field Z5 t Water main/service line Surface water/drainage t0=> kk 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 Meets MOA electrical codes "Pump on" level at Manufacturer Manhole/Access (Y/N) SEPARATIO TANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots p off" level at - Cycles tested Surface water Date installed 'j 2-1 1 Soil rating `ate System type `rR-le't3 L. ( �( Length Zt"° Width 3 Gravel thickness Total depth 1 L) � Total absorption area o Cleanouts present y Depression over field (Y& Date of adequacy test -lc 1- m - Q's Results Lg fail) PSS for �� P��-�� bedrooms eroxide treatment (past 12 months) (Yor\1 o�1 � iZdb "1 / If yes, give date 7v -a � 6_zr V d.2Pc7,1T 1,..1c jF jrsr»-16, EPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ oo On adjacent lots t do (-✓ Property fine _ to t To building1 x foundation To existing or abandoned system on lot t3) On adjacent lots '>d Cutbank _ �J, Water main/service line 1o1 d Surface water C> Driveway, parking/vehicle storage area Q t �- Curtain drain 1`IL, E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effectorate to of this inspection. �� - "k S & S ENGINEERING Signature 170 77 34 Eagle River Loop Road No, 204 ,•`(+I Eagle River, Alaska 995 ° Engineer's Name �• • ° • ° ° ° ° ° • ° ° ° °� ,,QQ /� m°e foo e0-a0°Y•11p se Date , 1� — b 11 o RO R J. 3 AFER, P.E. a ,� S ° HAA Fee $ / Waiver Fees It Date of Payment Receipt Number' T 72-026 (Rev. 3/91) Back MOA 21 Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES &;*dAmAA;1W4 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF: ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel 1. D. # --51 -\CA a ILO HAA # 1A1Y� 1C_;n--I 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 11: Mock 2: Skatine View Subdi.visiOn; Location (address or directions) NHN Cotumbinde (b) Property owner A. H. F. C. #71714 Telephone: (home) Business 561-1900 Mailing Address 520 Eab.t 34th Avenue, Anehanage, A.E?aska 99503 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent JACK WHITE COMPANY ATTN: Lon.i. Chuwden Address 10928 Eagte R.ivejt Road, Eagke Riven, Ah, 99577 Telephone (e) Mail the HAA to the following address: (or check here g% if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING '17034 Eagle River Loop Road No. 204 yagle River, Alaska 99577. 2. TYPE OF RESIDENCE Single -Family [KX Number of bedrooms 3 3. WATER SUPPLY Individual WellXX Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site C$X Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Z5;-79 Address y3" pryer Loop road No. 204 Rim kla ' a 99577 Date A�) / 6. DHHS APPROVAL //%% Approved fort—bedrooms by —��/ Date l� Approved X —Disapproved Conditional Terms of Conditional Approval CAUTION' j The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 7/88) Back Page 2 of 2 vtl girteer's Seal; a' 6. DHHS APPROVAL //%% Approved fort—bedrooms by —��/ Date l� Approved X —Disapproved Conditional Terms of Conditional Approval CAUTION' j The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 7/88) Back Page 2 of 2 J MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) A CHECKLIST - FEBRUARY 1984 343-4744 �n Legal Description: �--1� A. WELL DATA a Well Classificatior If A, B, C, D.E.C. Approved (Y/N) A Well Log Presentp) Date Completed Yield 4-v 4- Ptd Total Depth Cased to Depth of Grouting Static Water Level I, I " ( '2-c2 Pump Set At Casing Height Above Ground �2_K ) Sanitary Seal on Casing 4 Electrical Wiring in Conduit VN) v Depression Around Wellhead (YKI ) SEPARATION DISTANCES FROM WELL: I To Septic/Holding Tank on Lot 1 GZ� : - ; On Adjoining Lots �._b?�;2 1 -1- To Nearest Edge of Absorption Field o Lot �1 -k- ; On Adjoining Lots < < I A - To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole N t To Nearest Sewer Service Line on Lot ZS Water Sample Collected by ;Date Water Sample Test Results Comments /�U-��7 'moo �f✓I ��w�a�r� F�/�Gt) �� �('I� � , B. SEPTIC/HOLDING TANK DATA Date Installed 7-_-,22'77_Size I �� No. of Compartments Standpipes O N)___Air-tight Caps ON) FoundatiCleanout�M) Depression over Tank (Y,Nq rlI ate Last Pumped 1 ~ZI 89 Pumping/Maintenance Contact on File (Y/N for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: � I To Water -Supply Well \ �' To Building Foundation Zo r To Property Line \ — To Disposal Field To Water Main/Service Line 1 �l To Stream, Pond,` `Lake or Major Drainage Course t 1 Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION�PIELD DATA Soils Rating. h Absorption Strata �S<' Type of System Design Date Installed –Zr–>' –7 7 Length of Field Zlo Width of`Fiel Depth of Field I d ice: ti Gravel Bed Thickness 5 5igi)are F t of rtion Area Z�Q� Statndpipes Present (WN) 40e )ress on�wield (Y/ /'J Date of Last Adequacy Test Results of LAdequacy Test a-- SEPARATION L SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well �Ool'� To Property Line bf To BuildingFoundation 3�( I � To Existing or Abandoned System on Lot — A G ; On Adjoining Lots 30 ).t To Water Main/Service Line � � � To Cutback (if present) r� D To Stream, Pond, Lake, or Major Drainage Course i )fi To Driveway, Parking Area, or Vehicle Storage Area �7 o CommentsoP'�Zi��f D. LIFT STATION Dat7inGallons ed Size "Pup Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) '*Check Permitted Bedroom Rating Against HAA Request*" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. inspection. oat I have checked, verified, or conformed to all MOA and HAA guidelines in effect on,th date,gf this at. �cNC Signed 17034 P -401c' 12iver Fag�Rv s ka - Company *! Date ee S6al MOA No. e7 S Receipt No. n 3 •55 �_3 Receipt No. Date of Payment // : C� Amount: $ /70 Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 i t1[i tj\lel Manch 6, 1991 ROBERT SHAFER, P.E. anr_ca QUA Von CIVIL ENGINEERS (907) 694.2979 FAX 694.1211 HEALTH AUTHORITY APPROVALS Mb. Loki Crowden JACK WHITE COMPANY 10928 Eagle River Road Eagte Riven, A.Casha 99577 SEWER &WATER MAIN EXTENSIONS REFERENCE: Lot 11; Btoeh 2; Skytine View Subdi.v.i6ion; NHN Cotumb.ine StAeet AHFC #71774 W.A.1184246 SEWER& WATER Dealt ✓ear Lonti, At your 4eque6-t we have pen6ormed 6tow -tuting on ,the we226 seuing .the Ae6eneneed pnope.rty. ENGINEERING STUDIES AND REPORTS Az you may know, .the nit4a.te contaminated we -U which uaed .to aeLve -thin propeAty has been abandoned below grade per welt pvlm it 0900149. On Manch i, 1991 we per6onmed weft 6tow testing on the east wett. Th.C6 WELL INSPECTION weee was dniY..Led .in June, 1990 .to a depth o6 500 6-t. We measured the &FLOW TEST btatc.c wateA kevet at 202' be.Cow the -top o6 .the wett casting. A meter W" connected near .the we22 head and the 6tow .turned on 6utP. The wateA ievek was d)tawn down to .the pump at 493 6t. At .that point .the SITE PLANS 6tow wa6 -tuAne.d o66 and the wett a lowed to ReeoveA 6or approxima-te2y 30 minutes. The 6tow was ,then -turned on and the water teve2 drawn down to .the pump white .the quantity o6 water metered. TW procedure was 60ttowed seven (7) time6 with eons.i6.tent Reautt6. Flom this .tat we bound the wet .to cuArentCy produce approx-ima-teCy 13 gaPtom peA hour (GPH) ROAD DESIGN which coineidu with the dtWeu estimate when the wett was okig.ina ty dkitted. The 6-torae e capacity Within thio wet ea6�.ng i6 400 gaPCou. SOIL TEST On MaAeh 3, 1991 we peR6ormed wett 6tow testing on .the west we.tt. Thi6 wett wa6 a.Lso dLitted .in June 1990 to a depth o6 360 6t. We measured .the 6tatie water Levet at 119' beeow .the -top a6 the ca6ing. A meteA wa6 connected and the 6tow -tuLned on 6uU. The water tevet wa,6 dRawn down PERCOLATION TEST .to .the pump at 3541. The Game Recovery Late pLocedune6 were 60ttowed a6 w.i-th. .the ea6t wett. From .this -test we bound .th.i.6 weit .to produce approximatety 52 GPH which .iz more than the dnitteA'6 e6.timate o6 30 GPH when .the weU wa6 dotted. The storage capacity within -thy, wet ca6ing i6 330 ga tons. STRUCTURALS MECHANICAL It 6houtd be aehnowted ed .that the continued production o6 n& then weft. INSPECTIONS can be guaranteed, 6ub6equent var.iation6 can oceuL. ONSITE WASTEWATER DISPOSAL SYSTEM FSIGN 1 17034 EAG I.F RIVER LOOP, SIIITF 204 FAr,I r Pivrp A, A �� Page Two Lot 11; BCock 2; Skyti,ne View Subdivision; AHFC 671774 Manch 6, 1991 The two we Z6 combined ane eurren-tty capable 06 buppty.Lng 65 gaUona per hours. / 603 . -. With .the 730 gattons 06 6torage within .the weft ea6.inp, the entire water �� 4yztem .c.6 curen-tty capable o6 6upptying approximately 4 gattou pen minute oven a 4 hover, peni.od. Th.i,6 i.6 .in exeezz 06 Mun.icCpaC requ,irement6 bon a 3 bedroom house. 16 we may 4y --,,o6 6ur-the4 aerv.ice, pteaee contact ua. ety, ROB RT A. SHAVER, P.E. R/gm cc: MUNICIPALITY OF ANCHORAGE- "Departnen-t 06 Hea2.th 9 Human Serv.icea. MUNICIPALITY OF ANCHORAGE • _ Department of Health & Human Services r}� DIVISION OF ENVIRONMENTAL SERVICES —� 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # C'6} —) I -Q - � lL— HAA # 0 V'-)9 1 \ l n 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 11; Block 2; Skyline View Location (address or directions) (b) Property owner A. H. F. C. Telephone: (home) Business Mailing Address 4171774 520 E. 34th Anchorage Alaska (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Jack White Co. / Kathy Olmstead Address 10928 Eagle River Road, Eagle River, Alaska 99577 Telephone 694-5500 (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road No. 204 age Kiver, Alaska . 2. TYPE OF RESIDENCE Single -Family 3. WATER SUPPLY Individual Well EX Number of bedrooms 3 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site 12 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 TA ENGINEERING FIRM PROVIDING INSPECTIOSaTdat os date FILESEARCH, beloww,II vei•ANDify INFORMATION on of this As certified by my seal affixed hereto and as of theI and/or wastewater disposal system is safe, 'l Health Authority Approval shows that the on-site water supply e of structure indicated herein. I further verify that functional .and adequate for the number of bedrooms an Yp investigation and based on the information obtained from d/o he Municipality system s inzcompliance with all Municipal and inspection, the on water supply nd regulations in effect on the date of this inspection. State codes, ordinances, a�ll 2�7 Telephone 7 I, Name of Firm 5 & S ENGINEERING Address 17034 Eagle River Loa Eagle River, Alaska 99577 O Date kiAn�a11.. do No. 1457•k�s %5b PROFES-.vow 6. DHHS APPROVAL Date / ` / 7, Vie, A'Prov bedrooms bYI L/�-�� Disapproved Conditional Approved 1 �. /-r, i Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval purchasers of registered in the St homes and their lending cerificated based on ofof AlaskapThe DHHS sdoes nthis s as arcou aph 5esbyoto py an independent professional engineer and state o not conduct ctions institutions in order to a ce tyficate)is issuedl. The Municipal ty of Atnchorage is notfree pons ble for errors or omissions or analyze data before in the professional engineer's work. page 2 of 2 72-025 (Rev. 7/88) Back MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES ON MAR 2 719w-) RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) fi� CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: �T �\ 'eJL-Y- 'S" L-1 1-36 V l 1� Well Classification Well Log Present (Y/9) I" Date Completed I Total Depth L) , .Cased to "AG, Depth of Grouting If A, B, C, D.E.C. Approved (Y/N)� Yield �� c- '? n Static Water Level '1--J� Pump Set At \ c�kI Casing Height Above Ground �L_ -IrSanitary Seal on Casingc(*N) Electrical Wiring in ConduitViON) SEPARATION DISTANCES FROM WELL: Depression Around Wellhead (Y/M To Septic/Holding Tank on Lot a� ; On Adjoining Lots \ CAZ:�' Vr To Nearest Edge of Absorption Field o Lot ;On ; On Adjoining Lots Uo�i To Nearest Public Sewer Line p To Nearest Public Sewer Cleanout/Manhole i To Nearest Sewer Service Line on Lots Water Sample Collected by c� f- I r �I ; Date Water Sample Test Resultst��--- Comments B. SEPTIC/HOLDING TANK DATA Date InstalledSize No of Compartments 21 Standpipes /N) 4_—Air-tight Caps q1N) 4 Foundation Cleanout ((?/N) Depression over Tank (yjq) _ r� Date Last Pumped Pumping/Maintenance Contact on File (Y/N) �' ; for Holding Tank High -Water Alarm (Y/N) —_ice—Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 1 `J�( To Building Foundation I To Property Line I o I To Disposal Field S t To Water Main/Service Line 1 0 lq- To Stream, Pond, Lake or Major Drainage Course ICA Comments �� C�����a� Q 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 7/611' Type of Systern Design _17:52ti— (A Date Installed Length of Field 2b� Width of Field �� Depth of Field 1 I Gravel Bed Thickness 11�> Square Feet of Absortion Area -2,1" Statndpipes Present �VN) `P Depression over Field (Y/N _ Date of Last Adequacy Test Results of Last Adequacy Test SV SEPARATION DISTANCE FROM ABSORPTION FIELD To Water -Supply Well �� I To Property Line `o I To Building Foundratign� To Existing or Abandoned System on Lot ; On Adjoining Lots .;� ( To Water Main/Service Line � o -1- To Cutback (if present) 1� To Stream, Pond, Lake, or Major Drainage Course \ S;Z�I4 r� To Driveway, Parking Area, or Vehicle Storage Area�-- Comments D. LIFT STATION /P Date Installed I Siz allons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) `"Check Permitted Bedroom Rating Against HAA Request`* "Pump Off" Level at Vent(Y/N) umping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date, -of this inspection. .�4�� 9� Signed e F S ENGINEERING �p A1'l,q� ' ~ �L V vo�a�Yo �eoa.. Company 17034 Eagl© River Loop Road No. 204 Eagle River, Alaska 9577 Date 2-- Z( .-T�1� MOA No. C r - 40 — bo Receipt No. r-">(�� Date of Payment %- Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 3'aI Municipality of Anchorage Department of Health anO I luman Services Ul�li� Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Ancliorage, Alaska 99519-6650 March 29, 1990 Robert Shafer S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Subject: Lot 11, Block 2, Skyline View S/D Dear Bob, As noted in my previous letter, the department is unable to grant a Health Authority Approval since the subject property does not conform to approval guidelines. Information you previously submitted verifies that the sewer system is properly designed for a three bedroom single family dwelling. An adequacy test performed January 19, 1989, was satisfactory for a three bedroom dwelling also. The system is in compliance with applicable municipal and state laws and regulations. The well meets all separation distance criteria and is properly constructed. The water sample tested negative for bacteria. However, the nitrate tests results showed varying nitrate levels ranging from 6.4 to 11.4 mg/1. Since the maximum allowable nitrate level is 10.0 mg/l, we were unable to approve this well as a water source. Any potential buyer should be made aware of the nitrate levels, and should also understand that this department will not be able to provide a future Health Authority Approval as long as the well water exceeds the maximum of 10 mg/l nitrate. Please call me if you have further questions. Sincerely, Susan Oswalt On -Site Services /289 cc: John Smith, P.E., Manager, On -Site Services Municipality ®f Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650. March 28, 1990 Mr. Robert Shafer S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Subject: Skyline View, Blk 2, Lot 11 Dear Bob, A The written policy governing issuance of Health Authority Approvals states that when the nitrate level is over 10 mg/1., a Certificate will not be issued. That is in keeping with both State DEC and EPA standards. The levels noted in this well ranged from 6.4 mg/l to 11.4 mg/1. Samples collected in the immediate area also show a number of wells in regular use with nitrate levels in excess of 10 mg/1. As a result, we are unable to approve this Health Authority request. It is our understanding that field investigation has shown that water is entering the casing at approximately the 90' level. The well log however, does not indicate where the water bearing strata are. We understand also that the pitless is not leaking and that there are no shallow perforations of the casing. We suggest that some consideration be given to the potential of lining and/or grouting this well. We will be glad to discuss this possibility further. Sincerely, Susan Oswalt On -Site Services /285 Attach: HAA form cc: John Smith "Vt#\ ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS A A (907) 694-2979 Manch 26, 1990 FAX 694-1211 MUNICIPALITY OF ANCHORAGE eQC�E ENVIRONMENTAL SERVICES DIVISION P SSP RIV E R, AV MAR 2 71990 HEALTH AUTHORITY APPROVALS Munt.c,%pat.iiy ob Anchorage R E C E I V E D DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street SEWER &WATER P.O. Box 196650 MAIN EXTENSIONS Anchorage, Ata6ka 99519-6650 REFERENCE: Lot 11; Btock 2; Skytine View Subdivision SEWER &WATER This tetter .Cs to serve as a disctosure ob the water 6ampt.ing data we INSPECTION have received to be used in reviewing the attached reque6t bon Heatth Author.Lty Approvat on the rebereneed property. On January 19, 1989 water 6amptes were -taken Brom the weU 6e4v,ing the ENGINEERING STUDIES rebereneed property. The nitrate resuet was 8.2 mg/t. The water was AND REPORTS re6ampted on January 26, 1989. The nitrate resutt6 were 6.4 mg/t. Abter that time it was discovered the weft serving tis property w" toeated 1u6t abb the property tine on Lot 12. A new weU was dv.Ued WELL INSPECTION on the rebereneed property .to a depth ob 237 b.t. but no water was &FLOW TEST encountered.. An easement wa6 then granted by Lot 12 attow,ing Lot 11 access .to, and use obi the wW. On January 8, 1990, the or.ig.inat weU was tested again baz, nit4ate6. SITE PLANS The resutts were 11.4 mg/t. On January 12, 1990 .the water Brom .the weU pump was attowed to run bar approx-imatety 1 hour and another sampte was -taken. This nitrate %esutt was 10.5 mg/t. ROAD DESIGN Since the property had been vacant bolt a tong period ob time and the weU was unused, we were eurtou6 to see what the nitrate tevets woutd be .ib the weU were u6ed on a regutar basis. SOIL TEST On March 15, 1990 we 6tarted the water running again and ,took another sampte. Th i6 resutt was 10. 2 mg/t. Abter allowing the water to nun bolt 2 days we 6ampted again on March 17, 1990. This 4e6utt wa6 7.7 mg/t. The water was allowed to continue running and on March 18, 1990 another sampte wa6 taken. This resutt was 7.8 mg/t. PERCOLATION TEST From this data cottected we beet that as tong as the weU remain/ active, the base nitrate Levet i6 around 7.8 mg/t. Since this ,i6 betow .the allowabte t-im.i.t ob 10 mg/t, we beet a Heatth Ce4ti6.icate could be v66ued with the ztiputation that aU potenti.at buyer6 ane noti6ied ob STRUCTURAL& MECHANICAL the nitrate 6ampt.Lng history and with the recommendation that nit ate INSPECTIONS sampt.ing be continued pertiodicatty. ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot 11; Btoek 2; Skytine View Subdivision Manch 26, 1990 Ataska Howling Finance Company, the cuAAent owneAa og ,the pnopeAty, have agreed .to instaU a LeveA.6e osmosi6 -type ob tkeatment bystem under. the kitchen h.ink. This type 06 unit w.itt kid the wateA o6 high n tta-tm 44om the kitchen Sink tap. TheneUoAe, the Hitchen tap could be deh.ignated ae the dA.inh ing wateA .tap. A nevmse ohmosis -tAeatment system .range enough to ,5enve the whole home ti3 cost pAoh,ib.itive. 16 you have any queati.ou oA comments, ptease contact aa. Sin )RT A. SHAFER, P. F. gm r • WATERWELLEASEMENT � p�� �/� THIS AGREEMENT made this 2541.day of August, 1989,'' by andlbetween DAVID M. BUSH and KAY F. BUSH, hereinafter referred to as the grantor, and ALASKA HOUSING FINANCE CORPORATION, hereinafter referred to as the grantee. WHEREAS, the grantor is the owner in fee simple of the following described realty: Lot Twelve, Block Two (2), SKYLINE VIEW SUBDIVISION, according to the official plat thereof, filed under Plat Number P-508, Records of the Anchorage Recording District, Third Judicial District, State of Alaska, hereinafter Lot 12; and WHEREAS, the grantee is the owner in fee simple of another and adjoining parcel of land described below: Lot Eleven (11), Block Two (2), SKYLINE VIEW SUBDIVISION, according to the official plat thereof, Records of the Anchorage Recording District, Third Judicial District, State of Alaska; and WHEREAS, the grantee is desirous of enjoying the use of a certain portion of the grantor's land for the sole purpose of using and maintaining a private water well, and WHEREAS, the grantor has agreed, in consideration of $2,500.00 (Twenty Five Hundred Dollars and No Cents) and other good and valuable consideration, the receipt of which by grantor is hereby acknowledged, to grant to the grantee an easement solely for said defined purposes and for no other, Now this GRANT witnesseth that in return for said specified consideration paid by the grantee to the grantor, the grantor hereby grants unto the grantee, his heirs and assigns, full and free right and authority to use the following described portion of grantor's land solely for purposes before mentioned. A Twenty (20) foot by Thirty (30) foot easement appurtenant on Lot 12 more particularly described as follows: Commence at Lot Corner common to Lots 11 and 12 of said Block Two, SKYLINE VIEW SUBDIVISION, said corner lying on the right-of-way line of Columbine Street. Run thence along the line common to said Lots 11 and 12, North 45 degrees 06 minutes East, a distance of 13.00 feet to the true point of beginning. Continue thence North 45 degrees 06 minutes East along said line a distance of 30.00 feet; thence South 44 degrees 54 minutes East a distance of 20.00 feet; thence South 45 degrees 06 minutes West a distance of 30.00 feet; thence North 44 degrees 54 minutes West a distance of 20.00 feet to the true point of beginning. Containing 600 square feet, as shown on Exhibit A, attached hereto and made a part hereof, dated 1/21/89 by William D. Fleming, Registered Land Surveyor; 4 o Ke -i3 JHrA 03 '90 15:49 9076941251 JHCK WHITE/ER P.3 IT IS FURTHER COVENANTED and agreed by the parties hereto, for themselves, their heirs, executors, administrators, personal representatives and assigns, that should the well, pump, or water lines at any time while in, use be in need of maintenance, repair or replacement in the same location, the same shall be maintained, repaired, rebuilt or redrilled at the sole expense of the grantee, their heirs, executors, administrators, personal representatives, or assigns; and the grantor assumes no liability other than due diligence in protecting the improvements within the easement from harm and hereby covenant that they will continuously keep said well and rights of access granted herein unencumbered so as to allow Grantee free use and access to the water well during the term of this agreement. Grantee may from time to time, remove brush, shrubbery, soil; and/or excavate to repair or install water lines; in the course of maintaining or improving the existing well. Grantee receives free use of easement and agrees to restore the easement area to substantially the save conditions which exist at the time any work commences with the understanding no trees exist or will be placed within the easement area. Alaska Housing Finance Corporation retains a beneficial interest in the grantor's above-described lands by virtue of a certain, deed of trust and promissory note to secure the purchase price of said land. Accordingly, the said Alaska Housing Finance Corporation by virtue of its equitable interest in the grantor's land above described joins in this grant and agrees to be bound by its terms. Any dispute or disagreement arising under or in any way concerning this instrument shall be submitted for resolution to the process of binding arbitration in accordance with the Alaska Statutes made and provided for said arbitration. The jurisdiction of the Arbitrator shall commence 60 days from the onset of the dispute and shall operate to toll all applicable Statutes of Limitation. IN WITNESS WHEREOF the grantor, grantee and Beneficiary-Promissee (and co -grantor), as equitable title holder, have hereunto set their hands the day yearfirst above written. 9.L4� ALASKA HOUSING FINANCE CORPORATION DAVID N. BUSH, Grantor By Its: Property Disposition Officer N►/ �, �.� N Water Well Easement (Bush) NOLA CEDERGREEN Page 2 of 4 THIRD JUDICIAL DISTRICT ) ss. STATE OF ALASKA ) THIS IS TO CERTIFY that on this day of August, 1989, before the undersigned, a Notary public in and for the State of Alaska, duly commissioned and sworn, personally appeared DAVID K. BUSH, to me known to be the person described in and who executed the above and foregoing Water Well Easement, and acknowledged to me that he signed and sealed the same freely and voluntarily for the uses and purposes therein mentioned. WITNESS my hand and official seal the day and year in this certificate first above written. Notary Public in and for Al & MY commission expires: S �p THIRD JUDICIAL DISTRICT ) ) ss. STATE OF ALASKA ) THIS IS TO CERTIFY that on this o day of August, 1989, before the undersigned, a Notary public in and for the State of Alaska, duly commissioned and sworn, personally appeared KAY F. BUSK, to me known to be the person described in and who executed the above and foregoing Water Well Easement, and acknowledged to me that she signed and sealed the same freely and voluntarily for the uses and purposes therein mentioned. .'WITNESS my hand and official seal the day and year in this certificate first above written. Notary public in and for Ala ka My commission expires: S Water Well Easement (Bush) Page 3 of 4 THIRD JUDICIAL DISTRICT ) ) ss. STATE OF ALASKA ) THIS IS TO CERTIFY that on this age day of t, 1989, before the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn, personally appeared NOIR Chi, to me known to be the person described in and who executed the above and foregoing Water Well Easement, and acknowledged to me that she signed and sealed the same freely and voluntarily for the uses and purposes therein mentioned. WITNESS my hand and official seal the day and year in this certificate first above.written. i .fes No • lic inand r Alaska m9� My commission expires: $—t5 4 a Water well Easement (Bush) Page 4 of 4 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACII.11 Y 264-4720 Application Date_ -- 1. GENERAL INFORMATION (a) I_PyAI Description (include lot, block, subdivisionection, township,, range) Locati,qn (address or directions) (b) Applicant Name &_��7Business Horne . '�� Applicant Address _ /� . >j7 l-21 (L (c) Applicant is (check one): Lending Institution Cl ; Owner/builder 0 (/Buyer Cl ; Other (explain); %J I '. . (d) Lending Institution Z l ^• tet • �d�'�, F$tAphone Address ,-fy_�s°' -AtE'a (e) Real Estate Company and Agent 'cq Address Telephone (f) Mail the HAA to the following address: �Y ii* i•l {•,.�i,11 t1i I�1.{ili4f. 2, TYPE_ OF RESIDENCE Single -Family lr, Multi -Family ® Other Number of Bedrooms ._ .5�1 3. WATER SUPPLY Individual Well o Community O Public Ca Note: If community well system, must have written confirmation frorn the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Pf Public ❑ Community Cl Holding Tank El 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 /2-025(11,811 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION � As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firrn Address Date r. - Telephone Or �r \ er 4 F�tgi -Sew ,.,. t497•w ee, aeee ns _9�0�, •e . �� ca �� X41. �.. ' � ..If-i:.Jr•'! �, r o 1 ' l G. ©HEP APPROVAL bedrooms b ��4 � i 1 (,'j E.:t e �� r:-_ .�, Approved for rs Y y=4 ljate— A �— Approved _ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA)ENVIRONMENTAL PROTECTION CHECKLIST 264 FEBRUARY 1984 MAY 2 2 19E3n Legal Description:��\ A. WELL DATA Well Classification Si F' If A, B, C, D.E.C. Approved (Y/N) �/, Well Log Present (Y(M Date Completed -els �� 7-5-1 5Yield 1 5 Ce; el 7 y Total Depth Cased/to '40 14 Depth of Grouting _ Static Water Level 00 Pump Set At �' !�• Casing Height Above Ground — Sanitary Seal on Casing YEN) Electrical Wiring in Conduit(')N) Separation Distances from Well: Depression Around Wellhead (Y(_ To Septic/LIWdi€ag Tank on Lot /06 / _ ; On Adjoining Lots /&-,rJ ,� To Nearest Edge of Absorption Field on Lot /�U / ; On Adjoining Lots /ou To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole A' To Nearest Sewer Service Line on Lot �- Water Sample Collected by ' C-�'r4 �� 1� Date Water Sample Test Results Comments P7200uLt5 /.\-1 rxGe%�;s cor , 5- c1964 B. SEPTIC/HTANK DATA Date Installed ? - 1-"7 '77 _ Size 006 No. of Compartments N Standpipes�CDN) Air -tight Caps PN) _ Foundation Cleanout (YOW Depression over Tank (Yal Date Last Pumped /O -- r'v - 49T- d -j Pumping/Maintenance Contract on File (Y/N) _ ; for /0 /, - Holding Tank High -Water Alarm (Y/N) _ Temporary Holding Tank Permit (Y/N) A Separation Distances from Septic/ UoLd4H_-Tank: To Water -Supply Well - ��� / To Building Foundation To Property Line To Water Main/Service Li Course Comments Page 1 of 2 72-026(11/84) To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata '� //'3 Type of System Design'�ti J Date Installed r% 'L-) '7 % Length of Field �3"Z• 7 Width of Field[ > 1 t Depth of Field ti / It Gravel Bed Thickness 4 - Square Feet of Absorption Area ^` Z�'_ Standpipes PresentN) Depression over Field (Y_16)) Date of Last Adequacy Test 6 Results of Last Adequacy Test —_ �/a rl F� e- DV tj Separation Distance from Absorption Field: To Water -Supply Well U To Property Line _ ) u f+ f�f To Building Foundatio To Existing or Abandoned System on Lot `'ffi ; On Adjoining Lots '1;1 > =1 To Water Main/Service Line iF� ' TP Cutbank (if present) `~' /la To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons _ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) 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 Date 7�7, /i.,- 0 .'tis F 4✓1lit -t. _ f Company , 5 11 11 11000 _ MOA No. �J�yv ? �i117=rn S vA� k k,ra Receipt No. i jl, aJt f3 3��$`x °1 Date of Payment S ` � � �' S� ® 'a PP ' A &% Amount:$ _SIS .OU U.r j %s;� raA®n �j 9nOnP� Page 2 of 2 72-026 (11/84) e9 p �� G.olhsrtuhn Rn• Wer iP,*•e No. 145%-e L'AanbL Time APPLK - NT POLLS OUT UPPER HALL ONLY Property-0vrner �) p ,., i ' ' 1 -7 4 .� Phone �. . Date Date Date Mailing Address V. if) , I:�o� ' 1 �� Vi C ( f• rG � Zip Code 4.0 Buyer , Address `� (;,• 'i IV �illd (") i+l�lir ) j - !}.-- i�ld e /"� Zip Code(l,([ LendingInstitution '` - I/1T{� F �at41'at�r} � y � ,. �7 r t �(-�,� Phone cc Inspector Address .f, ,-^i_-^--•�--;� 4 � Zip Code ( (�_) 0.1 Realty Co. &Agent !`,.1,•.n..�, �`w Q-<� "Nc_ }� P -ti 1 rur.;, Phone Address , to 0 C, �� uc(a v- ('.a ta.f.`'1. I t� rl i.�i . I Zip Code �ll�• J r''(a �; 1"r1�, Legal Description t,..?1'1 (il hiie[_ly ,�, V ,4�.) `'�tk)• OF ANCHORAGE i•. (q M0 { Ire j 1 � \ Street Location ��, Ii'�i{�-•w@ `; �'r• IO .Y\ 4!t .�' Type of Residence Lo A,Single Family ❑ Multiple Family No. of Bedrooms' ❑ Other ( DISAPPROVED Water Supply ( ) CONDITIONAL APPROVAL - A Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community\� -. 1'`_� _ For wells drilled prior to that date, give well depth (attach log if available). El Public Utility Soils`Ralin Date Sewer Installed -?-27,--7 1 —1 Sewer Disposal lCi •' Individual Year Individual Installed: Public Utility When Connected to Public Utility: ❑ Holding Tank Septic Tank Size /p -p NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time C-57— Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ko ypAUNICIPALITY OF ANCHORAGE i•. (q M0 { Ire j 1 � \ DEPT. OF f1°i!_T;i „� Lo QQ «lam � �C -t � ( APPROVED BEDROOMS' 'CONDITIONS OF APPROVAL l) ( DISAPPROVED ( ) CONDITIONAL APPROVAL - DATE 12 a Soils`Ralin Date Sewer Installed -?-27,--7 1 Well To Absorption Area iC� O' Well Log Received .`� Well to Tank 10 O Septic Tank Size /p -p 72023 (3182 5. LEGAL DE �� it DATE RECEIVED STREET LOCATION INSPECTION APPOINTMENTS NUMBER OF,BEDROOMS I -INGLE FAMILY TIME' TIME - TIME ❑ MULTIPLE FAMILY -` Three ❑ Six 7. WATER SUPPLY * INDIVIDUAL* DATE DATE DATE ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DIS-POSALSYSTEM I - et<INDIVIDUAL/ON-SITE** INSPECTOR INSPECTOR INSI'ECTO t, MUNICjp'ALITy QF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIbWl ,1,7,!, ;,, 825 L Street -Anchorage, Alaska 99501 • C: fUN ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FA lIK, 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 M�AI ADD SS RO_PERTY RESIDENT (If different from above) PHONE ,LI/ -- 57Z Z � /__ �� /- _ 2. BUYER -R �") r i� ��i PHONE MA LING ADDRESS / 3, LENDING INSTITUTION PHONE MAI I G ADDRESS - q6 ff �L.�(� 4. REALTOR/AGENT PHONE MAILIr,fGA RESS 5. LEGAL DE �� it STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS I -INGLE FAMILY ❑ One ❑ Four ❑ Other _ ❑ Two ❑ Five ❑ MULTIPLE FAMILY -` Three ❑ Six 7. WATER SUPPLY * INDIVIDUAL* ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DIS-POSALSYSTEM I - et<INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 1---7�=' 'rc,(I Gtl.��f� 1,a6s41 Aol�e-