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Home My WebLink AboutEAGLE RIVER VALLEY RANCHETTES LT 13DEogle Rive Vail Y Ronchettes Lot [3b #050-222-33 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 4 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211303 PID Number: 050-222-33 Dwelling: ❑E Single Family (SF) X with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name CHERIE GARNER-THEOBALD ABSORPTION FIELD ❑■ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 18907 MAN O WAR ROAD, EAGLE RIVER, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 406-1516 5(-4+1) 0.8 GPD/SF SEE DWG. Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG, Ft. Gravel depth beneath pipe 5 Ft. Subdivision Block Lot EAGLE RIVER VALLEY RANCHETTES - 13D Fill added above original grade SEE DWG. Ft. Gravel length 108+ (2 @ 54-1617t. Township Range Section - - Gravel width 2.5 Ft. Beds: Number of Lines Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1080+ Ft2 2 10 Ft. Well PUBLIC PUBLIC - - 25'+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1500 Gal. Surface Water 100+ 100+ _ _ Material Number of compartments Lot Line 5+ 10+ - - NA PLASTIC 2 Foundation 10+ 5+ — _ ATION Manufacturer Capacity Remarks 'TOTAL OF 5 BEDROOMS. HOUSE IS 4-BEDROOMS Gal. AND ADU (SALON) HAS POTENTIAL FOR 1-BEDROOM. Alarm location Electri alled by Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 WHITTERS EXCAVATION Drainfieid D3034 CO/MTD3034 Inspector GEG CONSULTANT, JODY MAUS BENCH MARK (Assumed elevation) 100.00 ft Inspection 151 8/18/21 8/18/21 Location and description 2nd 3'd 8/19/21 41' 8/20/2 TOP OF GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's/Stamp Conditional Approval: 60 0 a 4 0 Date 4 VI IOo.......... ....... ............D ..� ..... ...........� System Q efrey ness,-Septic p _ Appro l Date -—1�Z1 I • •cO �O, p4..c �r95 Note: this approval does not include well permit requirements.0 4a4��Ofess1o��o #AEcc PERMIT NUMBER: PARCEL ID NUMBER: OSP211303 RECORD DRAWING 050-222-33 I I l : I : I I : I NOTE: THE OLD SEPTIC TANK WAS DECOMMISSIONED PER UPC PER THE CONTRACTOR. rEXISTING WATER MAIN IS ON NORTH SIDE OF PROPERTY LINE/FENCE LINE PER ANPiVU PER WHITTER'S EXCAVATION. NEW DRAINFIELDS RESERVE DRAINFIELD INSTALLED FLOW (REQUIRES AW'NTS) --- —1� SPLITTER (FS) -- EXISTING 4 -BEDROOM HOUSE APPROX. LOCATION OF WATER LINE TO SALON FROM HOUSE BASED GEG OBSERVATION OF WATER LINE EXITING HOUSE- a a A' a t X , a I I iI I I IST d Ad, MAN O WAR ROAD EXISTING WATER KEYBOX EXISTING WATER LINE LOCATION PER LOCA 1'E PERFORMED BY ONE STOP SERVICES —INSTALLED DOUBLE DOUBLE - -- -- -------------- ---- •---------- --------- MT4 PLASTIC SEPTIC TANK , �e�� w i i . cl to U N a e d 4 • d, e . 4 H+ EXISTING 4 -BEDROOM HOUSE APPROX. LOCATION OF WATER LINE TO SALON FROM HOUSE BASED GEG OBSERVATION OF WATER LINE EXITING HOUSE- a a A' a t X , a I I iI I I IST d Ad, MAN O WAR ROAD EXISTING WATER KEYBOX EXISTING WATER LINE LOCATION PER LOCA 1'E PERFORMED BY ONE STOP SERVICES -EXISTING DRAINFIELD. ABANDONED IN PLACE FOR POSSIBLE FUTURE USE OF Alt m� o td ........,., ,. _. I`CENVIRONMENTAL ENGINEERS 3701 SITE:ETUDORROAO,SUITE 0ANFORAIAKAPJ07) 337-&17P'WEBS mcnag.cam ,............... PAGE NUMBER: A. GarnessPREPARED FORONE NUMBER: CHERIE GARNER 406-1516 2 OF 4 CE -7p53 _ PROJECT/LEGAL DESCRIPTION: DRAWN BY: ®®�`� �t (G! z� •''��m EAGLE RIVER VALLEY RANCHETTES; LOT 13D J.L.M. A� Cep '••••......••••''•� ®o TYPE OF WORK: DATE:LICENSE 4��ASd�oa®® RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 9/10/2021 -LIC NB&I —INSTALLED DOUBLE DOUBLE CLEANOUTANOUTS (DBL1 t4 DBL2) NEW 1500 -GALLON GREER PLASTIC SEPTIC TANK Ix, M q �e�� w i i . cl to U N a e d 4 • d, e . 4 H+ SCALE: ..a 1" = 30' -EXISTING DRAINFIELD. ABANDONED IN PLACE FOR POSSIBLE FUTURE USE OF Alt m� o td ........,., ,. _. I`CENVIRONMENTAL ENGINEERS 3701 SITE:ETUDORROAO,SUITE 0ANFORAIAKAPJ07) 337-&17P'WEBS mcnag.cam ,............... PAGE NUMBER: A. GarnessPREPARED FORONE NUMBER: CHERIE GARNER 406-1516 2 OF 4 CE -7p53 _ PROJECT/LEGAL DESCRIPTION: DRAWN BY: ®®�`� �t (G! z� •''��m EAGLE RIVER VALLEY RANCHETTES; LOT 13D J.L.M. A� Cep '••••......••••''•� ®o TYPE OF WORK: DATE:LICENSE 4��ASd�oa®® RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 9/10/2021 -LIC NB&I IPERMIT NUMBER: PARCEL ID NUMBER: OSP211303 RECORD DRAWING 050-222-33 1 FINAL GRADE TOP OF MANHOLE 100.99 (MHl) = 101.22-\ 'ION TOR 3 @ 2 OF # t -i 0 "ARNESS EN"INEERING Aw OF : 4 GROUP, Ltd/ .......... jo CIVIL &ENVIRONMENTAL ENGINEERS �.,, jo HONE (007) 337.6i7g * WEBE17E: 3701 E TUDOR nn¢cem...... ROAO. SUITE 101 'ANCHORACE,AUSKA'.1 PHONE PREPARED FOR: NE NUMBER: PAGE NUMBER: A. Gar ss Zo CHERIE GARNER 406-1516 3OF4 v CE -7953 Aw PROJECTILFGAL DESCRIPTION: DRAWN BY: It* EAGLE RIVER VALLEY RANCHETTES; LOT 13D J.L.M. 4 TYPE OF WORK: DATE: LICENSE a RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 9110/2021 #AECC884 III YA PERMIT NUNIBER:p RECORD ID NUMBER: RE OSP211303 CORD DRAW1NG 050-222-33 NORTH TRENCH SOUTH TRENCH RIC ., ROUP,Ltd .._ ClVI & ENVIRONMENTAL ENGINEERS,...._.:/� 1 •, m 3701 E TUDOR ROAD. £UITE 101 ' ANCHORAGE, ALASKA' PHONE (907) 337-n'179' LVESSITE: wru.garncsc.cngm_e.mg.ccm l .......... .. ,...... ¢ PREPARED FOR: PHONE NUMBER: PAGE NUMBER; f '1J� re G mess LV ffi CHERIE GARNER 406-1516 4 OF 4 O#G� CE -7953 •` �AV S' PROJECT/LEGAL DESCRIPTION: DRAWN BY: #4 ��•�' c,AV EAGLE RIVER VALLEY RANCHETTES; LOT 13D J.L.M. LICENSE LF •`'••�....1.••• TYPE OF WORK:: DATE: RROFESS\Cl ® � RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 9/1012021 i ICENSEi MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 198658 4/nnElmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 On -Site Wastewater Disposal System Permit Permit Number: OSP211303 Work Type: Septic Upgrade Effective Date: Expiration Date Tax Code Number: 05022233000 Site Legal Address: EAGLE RIVER VALLEY RANCHETTES LT 13D G:0054 Site Mailing Address: 18907 MAN 0 WAR RD, Eagle River Owner: GARNER-THEOBALDCHER|ER Design Engineer: GARNESSENGINEERING GROUP LTD This permit iafor the construction of: R1 Disposal Field 2 Septic Tank 1771 Holding Tank F1 Privy 7/28/2021 7/2Q%l022 Lot Size inSqFt: 17855 Total Bedrooms: 5 0 Private Well 11 Water Storage Ail construction shall beinaccordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.6S.Provide notification bycalling (DO7)343-79U4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: o Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Received By: Issued By: !A1 Date "ViTUNICIPAPL-ITY OF ANCHORAGE ...... :v'.�-.x-t"-� Development Services Department `� - Phone. 907-343-7904 On -Site l later & Wastewater Section Far.: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-222-33 Property owner(s) CHERIE GARNER Day phone 406-1516 Mailinq address 18907 MAN 0 WAR ROAD, EAGLE RIVER, AK 99577 Site address 18907 MAN 0 WAR ROAD, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) EAGLE RIVER VALLEY RANCHETTES; LOT 13D Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: (® all that apply) Absorption Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN Initial ❑ Upgrade 0 Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) 0 (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner14 authoriz Permit/Rush Fees: - Waiver Fees: Date of Payment: 7a3 fid-? 1 Date of Payment: Receipt Number: N 39 76- Receipt Number: Permit No. 0.f;%0ZI I'30� Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211303, Rebecca Carroll, 07/29/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211303, Rebecca Carroll, 07/29/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211303, Rebecca Carroll, 07/29/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211303, Rebecca Carroll, 07/29/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211303, Rebecca Carroll, 07/29/21 Lot 13A Lot 13B S89°59'15"E 133.00 10' Utility Easement ---------------------- Qm rn Wood fence (typ) O LO 6.7 1.3 OH deck Lot 13C M !- 53.5 0 161,tt 22 • OFA 8 SCALE: V= 30' 13D N 2.8 OH 14.0 cco 19.: 10.2 2 Story Frarne House CO - 23.6 jCD 6 O O Septic vent (typ) N89059'15"W 133.00 MAN O WAR ROAD OF AW '' `� • 49th1010 i Kiam lizaYe'hIatka :R ,® �'PA, • 8036 - LS • .W p.. 4' Q7i`ftsS10NAt AMW 16.0 Salon 0 O N Lot 12E Chain link fence O O L6 M r W Lot 12A O t1� 0 0 O O M 0 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 13D EAGLE RIVER VALLEY RANCHETTES Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 20th day of APRIL 2021. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON Engineers and Surveyors UNLESS OTHERWISE NOTED. FB 21-1, pg 59-60 BE 1 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION :825 L Street- Anchorage. Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE I .j~NEW LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~ Z Me~uf~turer Material No, of compartments ~ Liq. capacity in gallons Inside lengt~ Width Liquid depth i O ~O IF HOME.DE: ~O~ DISTANCE TO: Wet, ~ ~,,ing PERMIT NO. ' · Length of each llne ~; ~ TOp of rite Io finish grade ~ I Uaterial beneath bee ~ ~ inches ~ ~ Type of crib Crib diameter Crib de Toter ef f~ti~ absorption area m Well Building fo~atlon Nearest lot line ~ DISTANCE TO: ~ DISTANCE TO: OTHER PIPE MATERIALS F jIG SOIL TEST "ATING ~3 INSTALLER / PERMIT, NO. ( r'lU~ I C T PI:IL_ T T~' I_~F IcI~C:HOR~lFJE DEPFIF;jTfi1E['.]T,~,,C HEALTH RND EIqVIROr.iI'.IENTRL/'~ROTECTIOr. I "'" ' '¥.~5 ' ' STREET, FINCHORFIGE.. FlK. S 'O~. 2~4-472C~ Obi----~. I TE _~,EI,leR PeF:P1 1 T E:20~46 ) FIPPLICFINT LOCRT I 0N LEGAL HOHER P01,1ER C0NSTRUCTI0 PO E:OX ~47 E. R. 995?? LIZD E. R. VALLEY F:RNCHETTES. LOT SIZE 999999 SQUARE FEET TYPE Of SOIL FIBS. ORPTION SYSTEM IS: TRENCH MR×If'IUM NUMBER 0f BEDROOMS = -~ SOIL RFITING (S0 FT?BR)= THE REOUIRED SI~E OF THE SOIL FIBSOP. PTION SYSTEM IS: 27??. DEF'TH= :L2 le~-~GTH= F~2 GRR'¥'EL DEPTH= THE LENGTH DIMENSION IS THE LEHGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH Of Fl TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SURFRCE OF THE GROUND AND THE BOTTOM OF THE EXCRVRTION (Ir.l FEET). THERE IS NO SET HIDTH FOR TRENCHES. THE GRFlVEL DEPTH IS THE MINIHUM DEPTH OF GRFtVEL BETHEEN THE OUTFFILL PIPE FiND THE BOTTOM OF THE EXCFIVRTION (IN FEET). F:eC~.lJ ! F:ED SEPt T C PERMIT FIPPLICFINT HAS THE RESPONSIBILITY TO INFORM THIS DEPFIRTMENT DURING THE INSTRLLFITION INSPECTIONS OF ANY HELLS RDJRCENT TO THIS PROPERTY FIND THE HUMBER OF RESIDENCES THAT THE HELL ;.fILL SERVE. TI-lO ( 2 ) I I'-.ISPECT I ¢~ !'-,I S RF:E REC!IJ I F:ED "e..RCKFILLING OF FlNY SYSTEM HITHOUT FINAL INSPECTION FiND APPROVFlL BY THIS DEPFlRTMENT HILL E:E SUBJECT TO PROSECUTION. H'INIHUM DISTFlNCE ~ETHEEN Ft HELL FiND FlNY ON-SITE SENRGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVFlTE HELL OR 150 TO 200 FEET FROM R F'Ue. LIC HELL DEPENDING UPON THE TYPE OF PUE:LIC t,IELL. MINIMUM DISTFINCE FROM R PRIVATE HELL TO FI PRIVFtTE SEHER LIHE IS 25 FEET AND TO Ft COMHUNITY SEHER LINE IS ?5 FEET. OTHER REOUIREMENTS I'IRY FlPPLY. SPECIFICATIONS RND CONSTRUCTION DIFIGRRMS FiRE FIVRILFIBLE TO INSURE PROPER INSTALLATION. PEF:fd T T E."-::F' T F:E$ DECEldBEF: _-~'~ ~. ~82 I CERTIFY THAT. i: I FlM FRHILIFIR H/TH THE REO. UIREHENTS FOR ON-S. ITE SENERS FiND NELLS. FlS SET FORTH BY THE HUNICIPFILITY OF FINCHORFIGE. 2: I HILL INSTALL THE SYSTEH IIq FICCORDFINCE HITH THE CODES. ~: I UNDER-C. TRND THAT THE ON-SITE SEWER SYSTEM HAY REQUIRE ENLFIRmGEMENT IF THE RESI[,ENCE I~, REMODELED TO INCLU[:.E HORE THAN ~ BEDROOMS. .............. APPLICANT MOHER POHER CONSTRUCTION V4. 0 ~ ~ D SO~LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION J~ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST 10'" 13- 14- 15- 16- 17- Ibbert Ne. 19- 20- COMMENTS PERFORMED 72-008 (6/79) SLOPE SITE PLAN WAS GROUND WATER SL ENCOUNTERED? J~/Q pO E IF YES, AT WHAT DEPTH? L~ Gross Net Depth to Net Reading Date Time Time Water Drop I ~/.~/.~z 7:/oe 6 ~" z ,, ?.'vDr ~,.,~ q" %" S ,, 9:,.~ ~o ,,.,:,, "/~," ~'/~'" v ,, e:oo ~o~;~ "/'~/~z." ,1~" PERCOLATION RATE <~'/ Iminutel/inch| TEST RUN BETWEEN ZTt ~/~'. ET AND ~' /~/Z , ET /?/z,,// ' CERTI,I,, B~ ~/~~ DATE: I2 '/. • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 050-222-33 Expiration Date: 1. GENERAL INFORMATION: Complete legal description EAGLE RIVER VALLEY RANCHETTES; LOT 13D Location (site address) 18907 MAN 0 WAR ROAD EAGLE RIVER AK 99577 Current Property owner(s) CHERIE GARNER-THEOBALD Day phone 406-1516 Mailing -address Real Estate Agent 18907 MAN 0 WAR ROAD, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ WaiverNariance request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ R eD Waiver Fee $ Date of Payment ►� (�Z I Date of Payment Receipt Number 005_716r Receipt Number COSA # 05c. z 1 15 9 ( 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: _Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 9 (../Z 1 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE -- System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the Y OF((� �,,/,#AECC884 ON-SITE WATER AND WAST f=i/'VER z � in 9 stlu at o 4 1. Fit/r .1� "�- Original Certificate Date: C /� 21 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10-12.doc Legal Description: EAGLE RIVER VALLEY RANCHETTES; LOT 13D Parcel ID: 050-222-33 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 ELL DATA PUBLIC WATE� ❑ Well to ' ' ed with Onsite (or attached) Well production at time of test gpm Date drilled Water storage tank vol gallons Total depth ft Well disinfec r coliform test? ❑ Yes ❑ No Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test forCO Static water le beginning of test ft. B. TANK DATA Age of tank(s) NEW years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA DUAL DEEP TRENCH Which system tested (date installed) 8/18-20/21 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.8 ft (max) Measured depth to pipe invert from grade 3.87 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet orm bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) ug/L ❑ Arsenic less than MRL (ND) Collected by EG,LTD. Date of Sample _ IFT STATION ❑ Requir aintenance com Age of lift s>material ye �: Lift station Comments Adequacy test date NEW Results F,/ Pass For 5 bedrooms Fluid depth prior to test NEW in Water added NEW gal New depth NEW in Elapsed time NEW min Final fluid depth NEW in Absorption rate 750+ gpd Any rejuvenation treatment (past 12 months) N/A If yes, enter date E. SEPARATION DISTANCES PUBLIC WATER rivate Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift S a Lot > 100' Community Sewer Manh 101' nowt > 100' Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No _ ft Absorption Field on Lot > 100' ❑ Yes if No� Neighboring Absorption Field. — ' H Yes if No ft Sewer Main > 75' ❑ Yes if No ft e Sewer/Septic Line > 25' ❑ Yes if No ft Tank > 100' ❑ Yes if No ft Animal Cont` nm`e _ ' ❑ Yes if No ft Manure/Animal Excreta Storage > �..,� ❑ Yes if o _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than requited) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: ✓❑ Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' M Yes if No ft Water Main > 10' M Yes if No ft Community Wells > 200' M Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' F71 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' U✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION oma' OF I certify that I have determined through field inspections and review , is/r QQ of Municipal records that the above systems are in conformance with p MOA COSH guidelines in effect on this date. .. T g .:......q ... ........... .. COSA Checklist yellow sheet ss�;�-e- - 9, CE -79 G d��a pro f essio�o�o #AECC884 Lot 13A Lot 13B ( 8495K S89059'15"E 133.00 Lot 12E — �� - -• - ;- - .:____-�;•--tet---- 10' Utility Easement ------------------------- Septic vent (typ) ° Lot 13D Chain link fence ° ° ° ° Wood fence (typ) ° O O_- Manhole, � deck ff� Lot 13C c 6.7 1.3 OH l Co r-53.5 N f 2.8 OH LL! Lot 12A �n 14.0 CO iO C) o N 10.2 19.3— 16.0 to toO � 2 Salon Story Frame House o n 0 OCo Co N O O-14.3 �. U3 O Z 5.0 14.5 c,,' 20.6 u7 23.6 { N 19.0 ui ° r Asphalt a tD ¢ d - C) Septic vent (typ) N89°59'1YW 133.00 c0 O MAN O WAR ROAD RECERTIFIED` 9-02-21 ev( AS -BUILT NO CORNERS SET THIS DATE OF I hereby certify that I have performed a Mortgagee's inspection �Q~, • • .� in accordance with ASPLS Standards of the following rdescribed property: LOT 13D ,� �•'•• 49th • 011'00 EAGLE RIVER VALLEY RANCHETTES oil /`° • �' 'Q /oo Anchorage Recording Precinct, Alaska, and that the ® -L improvements situated thereon are within the property lines 00 and do not overlap or encroach on the property lying o0 �,lizobeth L. 4Jalatka . adjacent thereto, that no improvements on the property lying �! ��a� • • 8036 — LS • • �� adjacent thereto encroach on the premises in question and �� Fa • , o� •� that there are no roadways, transmission lines or other SCALE: 1 30' pR0FFSS1oNA�•��+- visible easements on said property except as indicated �,��®®�� hereon. Dated at Anchorage, Alaska - 7- �� this 20th day of APRIL 2021. THOSE SHOWNN ON THE RECORDED EASEMENTS RECORD, OTHER THAN FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON FS 21-6, pg 10 Engineers and Surveyors UNLESS OTHERWISE NOTED. FB 21-1, pg 59-60 BE 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. Municipality of Anchorage Development Services Department Building Safety DMsion On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 w,,wv.ci.an cl~ora ge.a k.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O~O -,2..;.~.~-- 3'.7 1. Expiration Date: 7- ~-cO 3 GENERAL INFORMATION Complete legal description Location (site address or directions) Current Property owner(s) Mailing address Dayphone ..~5"?- ~-?.1'! Lending agency Day phone Mailing address RealEs~te Agent Day phone Mailing Address Unless othenvise requested, HAA will be held by DSD for pickup. ' 2. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] D Individual Holding tank D Community On-site - [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of ~aska. 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. Cedificates 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 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 ail applicable Municipal and State codes, ordinances, and regulations in effect aLthe ti.me of installation. Eagle River En meen- Se wlces NameofFirm P.O. Box. 273294, E~[e~Jv~,AK qq577.32(~. Phone ~"~'-.-f'/~J" Address Engineer's Printed Name DSD SIGNATURE ~" Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: - ,?~, ON-:511P- : ~,~: WATI::R AND : rn:: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agre. ements Supplemental Engineer's Report Other Original Certificate Date: '7- ~- Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewatar Program 4700 South Bragaw St. P.O. Box 196650 Anch~age, AK 99519-6650 wwv.ci,anchorege.ak.us (907) 343.7904 HEALTH AUTHORITY ,' :)PROVAL CHECKLIST Legal Description: ~l~,le., P~;I/'~,IF V, II .y Ihn ¢ : 131:) ~J te If A, B, or C provide PWSID # __ d __ Sanitary seal (Y/N) ft. Cased to ~ft. FROM WELL LOG . Well production ~ g.p.m. WATER SAMPLE RESULTS: ~ Date of sample: Co, ed by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ,~/.-~¢ I Tank size Je~o gal. Number of Compa~lments -.~ Parcel ID: 0,-C0- 322" 3,3 Co Well Log (Y/N), Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION Other bacteria tn. Date installed /9~ Cleanouts (Y/N) Foundation cleanout (Y/N) ~ ~,~,D~ression over tank (Y/N) /~ High water alarm (Y/N) Date of pumping q-I - o l Pumpar 'J~ 5 ABSORPTION FIELD DATA ~.73 Date installed ~ Soil rating (g.p.d./ft~ or ~/bdrm) .,.~LT..~;~/i.(,k System type Tre_#C,J~ Length ~,,~ · ft. Width ~ 0 ~/ ft. Gravel below pipe Total depth ~.3,75' ft. Eft. absorption area 013, ~ Monitoring tube ¥¢,~ Depression over field Date of adequacy test ~ Results (Pass/Fail) Fluid depth in absorption field before test'~l~n~.. ~Water added ~11~'3~r"~Cgal. Elapsed Time: ~ t(~r min. Final fluid depth ~'~' in. Absorption rate >= Any rejuvenation treatment {pest 12 mo.) (YiN & type) For ~ bedrooms New depth ~.~ in. Y- ~'.~o g.p.d. If yes, give date. '"---' g.p.m. colonies/100 mi. D, L~ STATION Data.lied _ 'Pump on~l at in. Datum '~ E. SEPARATION DISTANCES Size in gallons __ 'Pump off' level at Cycles tested in. Manhole/Access (Y/N) High water alarm level at Meets alaml & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: 'Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: O~ adjacent lots On adjacent lots Public sewer manhele/cleanout Holding tank Absorption field Surface water f Water main -I' I ~ I Driveway, parking/vehicle storage Building foundation ~ ~' ~ Water main .k lO ~ Wells on adjacant lots t'~00~ Property line ~ Water Service line Curtain drain ~V/A F. COMMENTS Property line ~' Il) ~ Water service line. {' tO ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation .j- I$ ~ Surface water 1~ 100 ~ Wells on adjacent lots ..I, tO0 ~ in. HAA Fee $ .'~'7~'~'. ~ Waiver Fee $ Date of Payment ~ Date of Payment Receipt Number ;~ ~O~ .~ Receipt Number (Rev. 12/00) , rev~w of Municipal records that the a~ve systs~ am in con~rmance w~h MOA H~ gu~efines in eff~t ~ this date. MUNICIPALITY OF ANCHORAGE Building Safety Division MEMORANDUM DATE: July 9, 2002 TO: Property Owner FROM: Jeff Poet Engineering Technician III SUB J: Wastewater Disposal System Advisory The wastewater disposal system serving this property must absorb 450 gallons of fluid per day to be considered adequate for this property. The adequacy test performed on this system on June 26, 2002 indicated an absorption rate of approximately 470 gallons per day. Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax TEST DATE: LEGAL: LOCATION: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: SEPTIC ADEQUACY TEST REPORT 6/26/02 Eagle River Valley Ranchettes, Lot 13D Eagle River Single Family, 3 Bedrooms Public Water System From (Municipal) Records Tank: 1,000 Gallons Absorption System: Trench Type INSTALLATION DATE: 1982 INSTALLED ABSORPTION AREA: 992 Square Feet ORIGINAL SOIL RATING: 37 min/inch (From Original Soil Log) TEST PROCEDURE SEPTIC: The leachfield was charged with water from the on-site well at an average rate of 9.6 GPM for a total of 1,250 gallons. The septic tank and leachfield liquid levels were monitored referencing a measurement below the top of the standpipe. During the test, water was added through the after tank cleanout tube and the leachfield water level was monitored as water was added and then absorbed into the surrounding soil. The water level in the septic tank did not rise after the addition of 1,250 gallons of water showing that the leachfield had accepted the entire amount. A total rise in liquid level in the leachfield was recorded as 29". Measurements were taken of the leachfield level, at l0 minute intervals for the first hour and after 19.25 hours with a satisfactory return in liquid level. The monitoring indicates the septic system will accept the required 150 gallons per day of effluent, per bedroom, which is the required absorption rate for Municipal approval. \2002\02-023SF. PTICONLYAD£Q TEST R£Pr. DOC P^O£ I of 2 TEST RESULTS The septic system soil absorption rate meets the requirements of the Municipality of Anchorage for a 3 bedroom single family residence as of the day the system was tested. Assessment of existing subsurface conditions by the inspecting engineer is limited to information obtained from the available monitoring tubes and Municipal record search. We do not guarantee the validity or quality of subsurface tests and inspections performed by the original inspecting engineer or authority. This report is limited to absorption rate testing and surface separation measurements as currently required by the Municipality of Anchorage. The septic tank was not inspected for structural integrity. The operational life and the matter of compliance with State and Municipal codes, for all water and septic systems depends on the local soil conditions, groundwater levels that may not be observed from the surface without additional testing, water usage of the homes being served by the system, and the detail of required testing procedure. Septic systems expire with use and future environmental concerns may require more extensive testing, which could render the leachfield unusable. This is true ofall septic systems. There is no guarantee that septic system tested will meet the requirements for approval in the future. The test data and investigation of existing conditions is provided to our client for submittal to the Municipality Health Department for their reviexv and approval. Any concerns with this test report should be discussed with the testing engineer. If it is requested we will submit the report directly to the Municipality. ~.2002\02-023S£PTICONLYADEQ TEST REFT.DOC PAGE 2 of 2 Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax July 8, 2002 JeffPoet On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 13D, EAGLE RIVER VALLEY RANCHETTES tlealth Approval Dear Mr. Poet: We are providing this letter as additional explanation of the adequacy test results data provided to you dated 6-27. We monitor the water added to the trench every 50 gallons as it goes into the trench in order to more accurately determine the recovery value. The recovery from a level of 93 inches to a level of 85 inches corresponds to a gallon amount of 375 gallons rather than a strait line relationship from the 64" to the 93" levels divided by the total gallons. The results are just passing grade but they are passing. We also monitored short term recovery over 142 and 71 minute time periods after adding water with better values. The calculations we used to determine the 24 hour value are attached. Ifyou have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. EAGLE RI~*"'~ ENGINEERING ~.~tVICES P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 8HEE? NO ' CALCULATED BY ~'~'~ OA?E CHECKED BY DATE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage. Alaska '99519-6650; 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~ - ~;~- ~-)73 1. GENERAL INFORMATION Complete legal description Lot ISD; .,E,~ql~ Riue,~ Va..~c~/ Ranchett~ Location (site address or directions) Property owner Mailing address Lending agency Mailing address 18907~an Day phone Day phone rag~ ~,,~, AK 99577 Agent Caro~ Gr~.~n~/ REM/U( EAGLE R%FER Day phone Address 16600 Cen~crfl&~d D.'[iue Eagle I~.u~t, AK 99577 694-4200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: w XXX If community well system, provide written Confirmation from State ADEC attest- ing to the legality and status of system. . 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. ' STATEMENT OF INSPECTION BY ENGINEER ' AS ce'rtified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system Is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of inspection. Name of Firm o .~J~h.? Phone ~,~" ~-~'~ q Addre~ ~ E~g~ _ Date Engineer's signature DHHS SIGNATURE F Approved for '~ . Disapproved. Conditional approval for bedrooms, bedrooms, with the following stipulation§: 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~o1" \"5~;) ~ ¢-,,,t~,~. \lf,<~-¢~rcel LD, If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding; tank on !ot ~,~ t ~ Absorption field on lot ~ =' ~ ~' Public sewer main Sewer service line .g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout .Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: .Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date Installed o~ .. ti-- ~,/...- Cleanouts (.3~N) ~ High water alarm (Y~ ~ Date of pumping __ .- .Tank size I-'-~ o o Compartments 'Z..- Foundation cleanout ~/N) ~/ Depressio._~) Alarm tested (Y/N) ' i-t=~-'cl~ Pumper * ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: / Well(s} on lot ~.~o i P On adjacent lots t/..- To property line i ¢, i ~- Absorption field /0 /oo tV," Surface water/drainage Foundation .Water main/service line CONTINUED ON BACK PAGE 72-O26 (3/93)' Front C. LIFT STATION Date Installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) 'Pump on' level at '~ _ High water alarm level ~ed ' ' - Meets MOA electrical codes (Y/N) ~ SE~LIFT STATION TO: W~I on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~, - ~.\. 'D ~ Soil rating (GPD/FF) 2-'7'~ /15g..' System type "~lZ-~ c~ Length Lp'~'~. Width "~ ~'' Gravel thickness ~ ~ Total depth 17.) TOtal abs0rption~ ~rea ,c~ ,~ .?... ~.Cleanout present~) '~' Depressio~ over field, (Y~'i '-~ Date of adequacy test ~-' ~x-~*' Results(~'fail) ".,'F:'A-'55 for -;~ ~, Bedrooms Water level in al~sorption field before test ~ (~ After test ~ ;37" r perPxide treatment (past12 months) ('~.r /./o,,.JE.. /~,,Ja~J Ifyes, givedate SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot '*~o t ~' On adjacent lots ,.--~1~ Property line To building foundation !~ To existing or abandoned system on lot On adjacent lots ~c> ~ 4- Cutbank ~/~r Water main/service line Surface water /o ~, ~ +' Driveway, parking/vehicle storage area Curtain drain "'J ~ EL ENGINEER'S CERTIFICATION this inspection. / /. Sionatur^ S & S ENGINEERING,~/ Date /// ' '/ ' / I,/ HAA Fee $ ~ Date of Payment Receipt Number Waiver Fee $ Da~ of Payment Receipt Number. 72-026 (3/93)' Back 4 Parcel I.D. If MuHtClP^Lt~¥ CF Department of Health & Human Services ENVt~.ONMr-HI'"t- DIVISION OF ENVIRONMENTAL SERVICES ..-,.,r.-;.~ ~. 7 lCq(~ 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 15 D; Ectg~. RZu~ V~.f..e~/ Ranch~t.~6 - Location (address or directions) 18907 ~.lan 0' 0](z,'t Road (b) Property owner E~e~o~:g:/'~_u~ ~ A~JeJ~. Telephone: (home)694-55~& · Mailing Address ~8907 Uan 0' ~/a~. Roctr/, Ect~t.e RZu~., Ak. 99517 Business. ~7~'-7581 No~h~nd Ido~t~ga~ Corpo~zUtJ. Orrelephone (c) Lending Institution Mailing Address E~]~.~. ~/.u~t~ A.t.~6~:t · (d) Real Estate Company and Agent TARGET~ /NC. REALTOTCS Address 17034 Ec[,qt.e RZuer Loop Roc[c~ E~,gt.~ FJ.v~., ,Lt.a.6ka. 99517 Telephone 69#-~$$~ (e) Mail the HAA to the following address: (or check hereY~, if hold for pick up.) List contact person and day phone number below: ATTN: CaroiFn G~n~ S & S ENGINEERING 17034 Eacde River Loop Road No. 2~1, Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family E~x- Number of bedrooms $ ,,4 3. WATER SUPPLY Individual Well r'l Community ~( Public [3 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,~ Public r'l Community I-1 Holding Tank I'1 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 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date 5 & -% L'~'!G!ta~ERtNG 17034 Eagle River Loop Road No. 204 E.a~1,~ River~ Alaska 99577 Telephone 6. DHHS APPROVAL Approved for Approved Disapproved Conditional Terms of Conditional Approval 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 institutio ns in order to satisfy certain federal and state requirements. Employees of DH HS 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 (MOA) ~'~ · -(,*~__~ Health Authority Approval (HAA) '* \~.'~1;;,~/ , CHECKLIST - FEBRUARY 1984 M~LI~Y OF ANC. HO;{AGE 343-4744 ENVIRONMENTAL SERVICES DIVISION . Legal Description: [~-~i" J"z~C:) ! 7 1990 · A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground - Electrical Wiring In Conduit (WN) ECEIVED ' Date C0ml~leted .DePth of Grouting if A, B, C, D.E.C. Approved ~N) y Yield Pump Set At Sanitary Seal on Casing (Y/N) '" Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~'~J~\~ ; On Adjoining Lots · , On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA' Date Installed ~Size ~.~[3c3 No. of Compartments Standpipes ~N) y Air-tight Caps ~N) Depression over Tank (Y~ ~ Pumping/Maintenance Contact o~ File (Y/N) Holding Tank High-Water Alarm (Y/N) I,[ ~.. y Foundation Cleanout(~YN) '~ Date Last Pumped ~ .,o~ _o~ ~ I.-t ~ ~. ; for ~ Temporary Holding Tank Permit (Y/N) 1,4~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Property Line [~:' ~"~" To Water Matin/Service Line \ C> \ 4- To Stream, Pond, Lake 'or Major Drainage Course Comments '[;;:~,~.-~E,..t:, "~,~, To Building Foundation '~"1 ¥' To Disposal Field Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~:~ L ~ t,_. <~ 'Z-.- Width of Field Square Feet of Absortion Area Depression over Field (Y/~ Re'suits of Last Adequacy Test ~"'~:'5 "~//~._ TyPe of System Design' -~'""~=.u,,3~' Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present ~N) y Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot ~1~"' To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course ..To Driveway, Parking Area, or Vehicle Storage Area Comments ' To I~roperty Line ) c:, To Existing or Abandoned System on ; On Adjoining Lots "~o To Cutback (if present) D. LIFT STATION Date Installed Dimensions Size~ · Manhole/Access (Y/N) .' ~ : ~ ~ .' "Pump On".Level at ~ " -n ~ '" ' - ' . ~ Pum,. Off Levelat - ~ High Water Alarm Level at ~ ~ ~ ~ Tested for ~ ~ _..~Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/~L)~"'"~ ~ . Comments_..............__ ~ . ~'~ ~ **Check Permitte8 Bedroor;n Rating Against HAA Requ?s.t~* I certify that I have checked, verified, or conformed to 'all MOA a'nd HAA g~idelines in effect On inspection. ' , Signed S & S ENGINEERING 17034 Eagle I~lver L~p ~.~a~ No. 204 Company --E=g!-- F.'.,~", -~l.ssca 99~577 Date ~2~'~ MOA No. ~ /~=~' ~ Receipt No. 3 ~'~c~ I Dateof Payment (~'J/fT' ~) Amount: $ /'"'] 0~'~--'' 72-026 (Rev. 7~88) Back on_t_h..e~tate of this .,. Receipt No. - Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANC~{ORAGE, ALASKA 99503 August 15, 1990 STEVE COWPER, GOVERNOR 563-6775 FOR: S & S Engineering Attn:Rodney Jones PWSID: ~210875 According to the records on file in this office, the Norfolk Utilities Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VEC:pf APPLY \NTFiLLS OUT UPPER HA' : ONLY Phone Propert~ Owner Orville Mowrer MalllngAddross P.OoEox 647 Eagle River ~Jc. Z~pCode 99577 ;88--3273 , Buyer Steven& Allison Erickson Addrees P.O.Box 5-504 Fort Richardson Ak. 99963 Z~pCode 99503- 688-3002 Phone Lending lneU~tl~lPgSC Eagle River 'Branch 694-2021 ~ Zip Code Address '~' ...... Phone eeeltyCo.&Agen! Red Carpet Great Ires& ;' 694-9125 Kathy Geradi Z~pC, ode 99577 f t,g.,Oesc,lp,~. :Lot '13 D Eagle P/v~er Ranchettes s,~t Leca,mJust off Eagle River R~. ion Man-o-War Type of Residence ]~ Single Family i'1 Multiple Family NO. of Bedrooms 3 " ri Other Water Supply ATt'ACH WELL LOG. A well log Is required for all wells drilled eince June 1975. ~ Individual ,, For wells ~'llled prior to thM date. give well depth (attach log if available). Community :~Publlc Utility ~lndividual Year Individual Installed~'% ~9 ' t · When Concocted to Public~tlllty: r-1 Public Utility ri Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RECXJEST BEFORE PROCESSING. CAN BE INITIATED. Time Time Time Time oa,e Ba~ % Date Inspector Inspector Inspector Inspector /dUNTCIPALITY OF AN~O~GE AUG :3 0 1982 RECEIVED (~ ) APPROVED ~DR~MS 'CONDITIONS OF APPROVAL ( ) DISAP~OVED ( ) CONDIT~NAL APPROVAL' DATE ~~ Soils Rating