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HomeMy WebLinkAboutMANOR LT 2Manor Lot 2 #050-671-44 MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW ❑UPGRADE MAILING ADDRESSr _ LEGAL DESCRIPTION 1--.2 L LOCATION NO. OF BEDROOMS �.-c��r�IJJL of` �Sv�/lL.�s•—rtc�n� p%L• � /itisSPl2�f7c>r� Ca2-, a Well Absorption -t /arga Dwelling �DISTANCE TO: Uy PERMIT NO. 8 F_. Z a Manufacturer UI Scl J Material 5 ��-- No. of compartments UJ - - nI< w Liq. capacity in gallons I C�CC�L IF HOMEMADE:-- Inside length Width Liquid depth DISTANCE TO: Well t Dwelling 0 PERMIT NO. IN Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well Founclatkzn Nearest lot line PERMIT NO. _J ". No. of lines Length ofa""ch Iyne Total length pf limps Trench width Distance between lines J 7, /A ° . ru inches e h _ Top of the to finish gra i 'f Material beneath tile� Total effective absorptin area `? — (06 inches � z_0 Length Width Depth PERMIT NO. u) ct Type of crib Crib diameter /I Crib depth Total effective absorption area I- w N Well Building foundation Nearest lot line DISTANCE TO: �_jCla L Depth G,r DrillarA ) Distance to lot line PERMIT NO. a i S `� S T` LU DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER------- h PIPE MATERIALS SOIL TEST RATING � CP INSTALnL, R I REMARKS y %120L -f I, S' ISU — n cwt s1:.f. �c, sem' _ ' �. P - ` -- f n ♦ l \ "y'Y 4. vf44:n OC YC, .).:. cAA(a.f '1� _ a rnv YYa •••c �_ •. �.,_,fi �' s � — �, a APPgOVEDDATE LEGAL F. J "ivy /2&f3 (Rev. 3/78) , ������I 11`-� Ph L.. 1 7""ir 10 F�" ������FR'. V DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ^ 825 L STREET, ANCHORAGE' Al,': 99501 264-4720 PEAMIT NO.- DATE O:DATE I6S1JED: APPLICANT: ADDRESS: CONTACT PHONE: 840591 07/18/84 KATHY --- DROWN 1210 G GT. ANCHORAGE, 561-5434 YHTES AK 99501 LEGAL DESP: CRISUBDIVISION: MANOR SECTION: 6 TOWNSHIP: 14N LOT SIZE: 32273 (SQ.FT" OR ACRES) MAX BEDROOMS: 3 Listed below are the options available to system. Choose the option that best fits �~P1111 F:1;K=A� DEPTH TO PIPE BOTTOM (FT.) GRAVEL DEPTH <FT,> TOTAL DEPTH (FT.) GRAVEL WIDTH (FT") GRAVEL LENGTH (FT,) GRAVEL VOLUME (CU"YDS. ) TANK SIZE (GALS) SOIL RATING (SQ.FT.IDR) ** TANK MUST HAVE AT LEAST I certify that: 8.0 2.5 52.0 21.6 1,000"0 ** 137 ' LOT: 2 ' ^ RANGE: 1W you in designing Your site, Ui:E-Z'rD 5"5 ^0� 0.5 6.0 ! 17"0 34.0 21.4 1�000,0 �* 125 BLOCK: NA your septic 4"0 3"5 7"5 5.0 49"0 24"5 1,000.0 ** 150 MENTG ���1- - .- -������������~���� 1" I am familiar with the requirements for on-site sewers and wells asset forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the 5ystem in accordance with all MOA andes and Pegulat.ions, and in �omplicnc� with the design criteria of this j_-)er0i�° 3" I will a�here tn all MOA anc SUt-ofAlaska rgcuirmeDt5 for the set. back distaOces from any existing well, wastewater disposal systefl) or public sewerage system (-in this or any adj|aceOt or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE E` ECTRICA E BY A LN ELECTRICIAN" SIGNED DATE:/�7 � ���,� �� ~_............. ^^~-��~~~~�~�~~~ APPLICANT KATH RO�N YATES � ISSUED BY DATE -,r .RiiNm f: ENGINEERS, INC. 7125 OLD SEWARD HWY. ANCHORAGE, ALASKA 99503 3-19-6561 Su11_ S ,.c7c; P[ HC01 A I MN 11 S1 ✓ ii I'll, p1' r•I lrl �t rl nrltrN HH -H / /�QI 1 A `f�/✓I �E^ !rnli_ r6lur][tnal ll I'1 ltl rll<MI I1 1 f)11 `) 1Y J 1 Lt�,AI UC JC.11I1'TION 'iI TI- 1'l AN 9 �J'� o, LA do 0 GI w IS 16 I7 IB 19 20 COMMENTS F x,31 ° oaoo�3t�� Fl ^�Qoca oAoa aoo uo0o an 'o^ William C. Hagmaier e 6266 �V y WAS GROUND WATER ENCOUNTERED' IF YES. AT WHAT DEPTH' Reading I Dale No S L O P __— E Gross Timc ENW®WMMMO: [}p r r 0-1-5 ORCAOICS •PAP � I m" , z . . OO" 0-6.0 ^E lODt5H BROW/✓ GkgvFiLY SAND w/ TRA<E SII -T, SL -1r11 1 I i 11 ,}., ••;� rt'10157• $V eKNO, P%J�1•Cn NE srvE, OT 7 v Poor, L.Y GR/•.Dt ;; ^Y%!P59 LY �reNE r -{ to 4 "Nl) 5M A CL <-- IZ o a L T 0 6 6 =— bo'e''o �,0-72,0' GeaY15N Bkov�n7 - m off' GRY 54n)p w/TRhcE Sr�T 5L((; HTIY M 5 T) SUB1?NC, i p °60. NON -Cola E51VE, POWo L_Y GeAOEZ> m CO(3T3(.ES I'ovuDE E'S C 2.5 9 �J'� o, LA do 0 GI w IS 16 I7 IB 19 20 COMMENTS F x,31 ° oaoo�3t�� Fl ^�Qoca oAoa aoo uo0o an 'o^ William C. Hagmaier e 6266 �V y WAS GROUND WATER ENCOUNTERED' IF YES. AT WHAT DEPTH' Reading I Dale No S L O P __— E Gross Timc ENW®WMMMO: •PAP � I m" , : . . OT IZ L T 9 �J'� o, LA do 0 GI w IS 16 I7 IB 19 20 COMMENTS F x,31 ° oaoo�3t�� Fl ^�Qoca oAoa aoo uo0o an 'o^ William C. Hagmaier e 6266 �V y WAS GROUND WATER ENCOUNTERED' IF YES. AT WHAT DEPTH' Reading I Dale No S L O P __— E Gross Timc ENW®WMMMO: •PAP � m" , : . . NetI Depth w Time Water __ __- _— .}____ .-.. _.. __ PERCOLATION RATE \/I ✓ U A.- L .__-__IrninulctA nchl TEST RUN BETWEEN 3 1• s ANO --' _ I -T PERFORMED BY: �Jf,/ /�([/Y `�+� -Jl;e^ TIFIEOBY -- DATE Net Drop Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 050-671-44 COSA# Npoa14 __- 1. GENERAL INFORMATION Complete legal description Expiration Date: !I_ 2-06 Lot 2; Manor Subdivision Location (site address) 18842 Inspiration Cir. Eagle River, AK Current Propertyowner(s) Fred Belz Day phone 622-3733 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address . Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Ea Individual On-site 0 ❑ Individual Holding Tank ❑ Q Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite 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 Onsite 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 S b S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Ra 8t'LT Ow4,.� Date 6 1 06 5. DSD SIGNATURE ROBERT C. COWAN CE -8801 t/ Approved for _� bedrooms. �t r'f •., Disapproved. tttl>z��»�►' Conditional approval for bedrooms, with the following stipulations: Attacllmems: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By:LL �y/ Az O'� Original Certificate Date: G/ y!/, rl (Rev. 11)05) Municipality of Anchorage .• • Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LA'T a2 r �AA?D2 S/� Parcel ID:_ OSO -t7-71yq A. WELL DATA Well - C� If A, B, or C provide PWSID p i2 363 t7 Well Log (Y/N) Date completed _ Sanitary seal (Y/N) _ Wires properly Prot ec ) Total depth ft. Cased to ft. Casin t (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well prod g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform D * colonies/100 mL Nitrate Iios l mg/L Other bacteria Q* colonies/100 mL Arsenic: 0 mgA Date of sample:jtvfo Collected by: S4-S f7"1e()0CC Zuu * QEfliMlPCt © 6 Z ob B. SEPTICAiOLDING TANK DATA Tank Type/Material Sr-Prlc (g fZrf.L Date installed io f l 31 as Tank size _ICM gal. Number of Compartments Cleanouts (%) _ \165 Foundation cleanoul(VIN) Y6S Depression over tank (Y/&) L" High water alarm (Y/6 CC) Date of pumping Z S G Pumper 7\_P(5 PO M P/J7i. OF C. ABSORPTION FIELD DATA Date installed to h3 S Soil rating (g.p.d.tft2 o 1bdrm 13 System type T�*X-&-Cg 1 Length �s� ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth CL•1 ft. Eff. absorption area 1ft2 Monitoring tube as Depression over field )U6 Date of adequacy test 3 t'Xc Results (�g Faiq 73;55 For 9, bedrooms Fluid depth in absorption field before test �� r! Pl p � �, in. Water added 3L gal. New depth in. Elapsed Time: L min. Final fluid depth 52 in. Absorption rate >= ��+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Yo type) J_.)o If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump otr level at SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankA on lot t" Go 1 t r Absorption field on lot Public sewer main VIA Sewer /septic service line 961+ r Animal containment areas 60f- Manhole/Access (Y/N) water alarm level at Meets alarm 8 circuit requirements? t On adjacent lots I CO 'f r On adjacent lots / SO {- Public sewer manhole/cleanout IU Holding tank N! Manure/animal excrete storage areas (60 If - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 r t Property line _5 Ia Absorption field S 1+ Water main 0/4 Water service line 10 1+ Surface water I b01.1 - Wells on adiaoent kris SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation )O (4- Water main 10 R in. r Water Service line 10 r 4- Surface water I Ab r=- Driveway, parking/vehide storage Curtain drain rJ605' 49-Z VU Wells on adjacent kris —Ln V, GO / -1 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 COSAA guidelines in effect onnthis date. Engineer's Printed Name _ R &-cT e • t•- Or. t, Date 6 �/ /0(. COSA Fee $ `f Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Eq. }; ROBERT C.-COWAN /C TTa f flit � j f••.......�;,*`L Municipality of Anchorage Development Services Department Building Safety Division ' On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Septic System Advisory Health Authority Approval # 060214 During a recent adequacy test on the septic system for Block , Lot 2 of Manor subdivision, 53 inches of standing water was observed in the absorption field. This indicates that approximately 89% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Health Authority Approval. SCS Reto Client Name Project Name/M Client Sample ID Matrix Sample Remarks: 1062574001 S & S Engineering Lot 2 Manor SD Lot 2 Manor SD Drinking Water All Dates/Times are Alaska Standard Time Printed Date/time 05/312006 16:38 Collected Date/time 0522/2006 13:48 Received Date/time 05232006 10:54 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Microbiology Laboratory Total Coliform 0 col/100m]. SM2092226 A ("l) 0523/06 DSII SCS ReEN 1062240001 Client Name S s@ S Engineering Project Name/N Lot 2 Manor SD Client Sample ID Lot 2 Manor SD Matrix Drinking N'atcr P\PSID Sample Remarks All Dales/Times are Alaska Standard Time Printed Dale/Time 05/122006 16.54 Collected Date/Time 05/042006 16:40 Received Date/Time 05/052006 10:04 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results POL Units Mcthod Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 Waters Department Nitmic-N 4.51 0.100 mg/L EPA 353.2 Microbiology Laboratory Total Coliform 59 OD, No Coli C (<-10) 05/08/06 05/11/06 SCL D (<-10) col/IOOm. SN12092220 A (<-I) 05/05/06 ALR 05/05/06 TLF .syr 01, i .Pei��l7,r-s�C�i'�J4v//zo% (s/��%.r,el�•�r�?-i,niF� .PEv�FO scram .ri�9i�'e'• 9�/r/'�� 'l ASBUILT-NO CORNERS SET THIS DATE. RMARn X Ac I HEREBY CERTIFY -THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: �f•9�vo•P •rv.6.' LoT z AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED, IT IS'THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SCALE= DATE: GRID: .taw zss� FB: d.?- oz DRAWNs OF•A�TNN1/ #, Dusa. MGX S.wud �• ) }� ¢•'•• 1S-6918 �+ Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.ancho rage. ak. us 4`5 0A (907)343-7904 �P+ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.�- .�r)_C ° - 7/— '4 yf HAA # 0 Expiration Date: 3-, C 1. GENERAL INFORMATION Complete legal description Lot 2; Manor Subdivision Location (site address or directions) 18842 Inspiration Current Property owner(s) Mark q 1 verman Day phone 6a6 -4'i? l Mailing address Lending agency Day phone Mailing address Rea! Estate Agent Kathy Olmstead Day phone 59,-- 0� Mailing Address Remax / Eagle River Unless otherwise requested, HAA will be held by DSD for pickup. l�� �Zr,._. 1 04A31a z 2. NUMBER OF BEDROOMS:_ 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individua! On-site Individual Water Storage ❑ individual Holding tank ❑ Community Class JD Well 0 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 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 engineers 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 S & S Engineering Address 17034 N. Eagle River Loop Engineers Printed Name S, CSD SIGNATURE Robert C. Cowan L"� Approved for ;?_ bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Ey: 5�,-� I (Rev. 01102) Phone 594-2979 Ste. 204 Eagle River, AK'99577 Date /'31a.7/0 z - r � �r. hJ tj•;o 1 %03ERT C. COWAN f Cr -3"001 `�:,w �� 0'x e` • f� A bedrooms, with the following stipulations: ,t,d 'tj'�. c, ,p �AIATER AND WASTEWATER ; PRGGPAM X Maintenance Agreements Supplemental Engineer's Report Other 1 Original Certificate Date: / a — _�?., 7? - C -2 - 12-23-02 10:37 FROM-CT&E ENVIRONMENTAL SRU AdhkCT&E Environmental Services Inc. s srrrra►rrrrrrirrirIVM CT&E Ref. #: 1028543001 Client Name: S & S Engineering Project Name: Lot 2 Manor SID Client Sample ID: Lot 2 Manor SID Matrix: Drinking Water PWSID n/a Sample Remarks: Parameter Nitrate Total Coliform (MF) U. Results PQL Units 4.26 0.200 mg/L 0 Cal/100 ml 9075615301 T-262 P.02/02 F-067 Client PO#: n/a Printed Date/Time: 12/23/02 10:15 Collected Date/Tlme: 12/19/02 15:00 Received Date/Time: 12/20/02 7:50 Technical Director: Stephe e Releasedl�7r Allowable Prep Analysis Method Limits Date Date Init EPA 300 10.0 12/20/02 PW SM9222B 12/20/02 KAP 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050 671 44 HAA # %1'G_� I b 1. GENERAL INFORMATION Complete legal description Lot 2, 4001ft Manor Subdivision Location (site address or directions) 18842 Inspiration Circle Eagle River AK Property owner Michael & Patricia Strunk Day phone 696 3492 Mailing address 18842 Inspiration Circle Eagle River AK Lending agency Mailing address Agent cindy Wilson/Jack white Address old Glen Highway, Eagle River, AK Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well xxxxxx Public water Day phone Day phone 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 xxxxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Anderson Engineering Phone 563-7155 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. M ( �FIZt✓c bedrooms. Conditional approval for Additional Comments Date 9/26/96 bedrooms, with the following stipulations: 4l1TIC 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 - Back MOA W21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: ��� r �(Op!� M,4Aj op,, ParcelI.D.:_ A. WELL DATA Well type C"S S C If A, B. or C. attach ADEC letter. ADEC water system number Z13le 5-7 Log present (YM) Total depth Sanitary seal (YM) Date of test _ Static water level _ Well production WATER SAMPLE RESULTS Date completed Cased to FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) MUNICIPALITY CHORAre AT INSpFMy8RNMENTAL SERVICES DIVISION SEP 10 1996 RECEIVED g.p.m•—g.p.m. Coliform 0 Nitrate /I, % 3 Date of sample: —1/5^/9 Collected by: B. SEPTIC/HOLDING TANK DATA Other bacteria C) (!;;j &8e,27— Date 8e,2 l — Date installed `' Tank size /, D © 0 Number of Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) _� Depression (YIN) IJ High water alarm (Y/N) Date of Pumping _ 9/5 Pumper T.R. um @ ln1(1 C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d.M2 or ft2/bdrm) 1-37 Fr System type _7'R c- !C44 Length ' Width 349 u Gravel thickness below pipe S _ Total depth Effective absorption area Fr, Monitoring Tube present(YIN) �_( Depression over field (Y/N) Date of adequacy test _ ( Results (Pass/Fail) 7A 6.5 For _ bedrooms l� Fluid depth ins absorption fief in.); `Jt Immediately after IO gal. water added (in.): °� 5- j 1J �Y < a� Q Fluid depth _^(ins.) Z ter:s"o Absorption rate = i g.p.d. Peroxide treatment (past 17(YIN) If yes, give date D. LIFT STATION Date installed Manhole/Access (YIN) High water alarm level at* Cycles tested AIC)4 E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /90 P ; On adjacent lots "Pump off' level at* P Absorption field on lot ? 16-6 ; On adjacent lots Public sewer main A4/ Ll: j Public sewer manhole/cleanout Sewer /septic service line i -7 WOO I Lift station ^JdA1 a SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ( Building foundation 37 Property line f S -t (.Cs f Absorption field 715 Water main/service line ? 50 t Surface water/drainage % %00 � Wells on adjacent lots >/00 t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation > 410, Water main/service line 7S�r`7 1 Surface water// 7 /b0 r Driveway, parking/vehicle storage area ' Curtain drain /VDNC` I)SSlatUeJ Wells on adjacent lots yf06 t Property line ?fS F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that. the above. "systems are in conformancetiwith MOA HAA guidelines �in effect on this date. Signature Engineer's Name A4ICjI/a_c' 6- A^jD &725c1j � ole g Seal Here Date HAA Fee $ _U Y 610 Date of Payment 911()1196- //, Receipt Number - / S �0_+ Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number 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 ,,��n Parcel I.D. # 090 Of HAA # 1. GENERAL INFORMATION Complete legal description �0,61/;n Lo f' Location (site address or directions) nlpirll{'rf A_ le. _ EV i, A-li. I Property owner Mr ahad l t S(i7 //- fl Day phone a —_ Mailing address IM41 . T aWiiiLl,-11 l ) rd -(e. F_ec le-� IVar , A Lending agency Day phone Mailing address AgentjAag 6�IEtrr jl1lt'v �i 160 t? Day phone Address (JI(.{ 0V n ULU%, V Q My a t II 1'_ Unless otherwise requested, HAA will be held for pickup. MUNICIPALITY OF ANCHORAGE 2. NUMBER OF BEDROOMS: �2– ENVIRONMENTAL SERVICES DIVISION 3. TYPE OF WATER SUPPLY: SEP 10 1996 Individual well RECEIVED unin� ty 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 (Ftev. 1/91) Front MOA M21 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 Anderson Engineering Phone 563 7155 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's signature E, Date 9/7/96 6. DHHS SIGNATURE Approved for TWO a) bedrooms. M Disapproved. Conditional approval for Additional Comments V 1✓ bedrooms, with the following stipulations: Date � 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 c Municipality of Anchorage , Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST hs Legal Description: �L �' t �%/�t1� `�� Parcel I.D. A. WELL DATA Well type Log present(Y/N)_ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number Z, 3 � Date completed Casedto FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line Driller Casing height Wires properly protected (Y/N) $9120 AT INSPECTION ; On adjacent lots i'l,' —; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform �- Nitrate MS Other bacteria Date of sample: 2 �-�2i Collected by: D. SEPTIC/HOLDING TANK DATA Date installed - >- f-�15 Tank size 10-6� Compartments -2-` Cleanouts�(rM) -\� Foundation cleanouWM) Depression (Y/6))� High water alarm (Y/N) Date of pumping Alarm tested (Y/N) Pumper M1 )P41 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ( 1 Well(s) on lot "- On adjacent lots>>� Foundation To property line Absorption field lv Surface water/drainage Eel 1 (D I Water r- main/service line 1 � 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed (157' V;�- Length 4L Width On adjacent lots 2 ic� 1 "Pump off' level at Cycles tested Surface water _ Soil rating Z� System type I Gravel thickness Total absorption area �� - Cleanouts present) Depression over field (Y, try Date of adoquacy test Total depth Results ss78ail) �� �'�, 1`f� / for Peroxide treatment (Past 12 months) (Yf� r` H `�-rA IIf yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: 1 � Well on lot l C5 C> On adjacent lots 1�- Property line_ To building foundation f� To existing or abandoned system on lot On adjacent lots �J�t� Cutbank tj Al- Water main/service line- » o(A- Surface water \ ��� 1 Driveway, parking/vehicle storage area�t Curtain drain �� U �, -2- E. E. ENGINEER'S CERTIFICATION bedrooms 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. a P, S ENGINEERING Signature 17034 F?agle River Loop Road No. 204 Eaglo River, Alaska 91577 Engineer's Name Date L, HAA Fee $ Date of Payment C! Receipt Number °2 72-026 (Rev. 3/91) Back MOA 21 ,2 �i/1���ii b i., � .:� fry. yl• �`j/rrj�s+Qua ,7 Waiver Fee: $ — Date of Payment Receipt Number 09/10/96 15:05 CT&E ESI ANCHORAGE -r 5635389 NO.081 D03 ZtL ME Environmental Services Inc. Laboratory Division ,ll 200 W. Potter Drive Anchorage, AK 99618-1606 Tal: (907) 502-2343 Fax;{907)561-5301 CT&E Ref,# 964343001 Client PO# Client Name SC Technical Printed Date/Time 09/10/96 09:14 Project Name/# L2 Manor S/D Collected Date/Time 09/05/96 12:55 Client Sample 1D L2 Manor S/D Received Date/Time 09/05/96 14:50 Matrix Drinking Water Technical Director: Stephen C. Erle Ordered By 4.13 1.00 W/L EPA 353.2 PWS1D 213637 Released By Stunple Remarks Lo m of N to Member of the SGS Group (Soci616 Gbn6reie de Survoillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA Allowable Prop Analysis Parometer Reeutta PQL unity Method Limits Date Date [hit Nitrita•N 0.100u 0.100 Mg/l. EPA 353.2 09/06/96 EEC Nitrate -N 4.13 1.00 W/L EPA 353.2 09/09/96 ESC Total Coliform 0 0 col/100mL EM18 92220 09/05/96 TAV Lo m of N to Member of the SGS Group (Soci616 Gbn6reie de Survoillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE • 'R DEPARTMENT OF HEALTH & HUMAN SERVICES M} R Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I. D.# 0!�n-In—)1-'A1 -\ HAA #_ i� "1aU 1. GENERAL INFORMATION Complete legal description Lot 2; Manors Subdivision Location (site address or directions) 18842 In4pination C.ikete Property owner Aiu ie H"zetquist Day phone 696-1699 Mailing address 18842 Insp.iha;,%on C.ikcte Eagte Riven A.ea4ka 99577 Lending agency Mailing address. Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 -� 3. TYPE OF WATER SUPPLY: Individual well Community well XX Public water _ NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system, 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site _XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91( Front MOA 1121 5. L 0 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 17034 Eagle River Loop Road No, 204 Address EQ •I -a ^i••sr AlaSka 99 77 Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments bedrooms. It ITIr,, Date (o- 1— 9 2- i'2...215 �pC�O �a�••ae �u�oee�y� AQ�s ROFESSIO�l'„�� bedrooms, with the following stipulations: Date l 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 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. LABORATORY 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 fw 111,10W.'r'. , 'J4.04), Cix'! WA'U 1-I MwFrlab �tef..' 92.2li 307 r.�wqpl.f' k I I Mr�' (J.jolit Sarnp7.o lU -",2 IfUIW ",/F) 13 03V !AY 26 92 � 09:5(l hu 1 14AY 26 92 1 1.1;45 lirg r f .!,s r"): y 0 11 with M') REOUBU) '11'hy )"t 92 TUIIIII11 iTf, Rel. o"Igod gy Pot :11011,1: REU1UM I - L � 11 u 1 t : 1 1 j 11 j T S 14 t I i o I1 f T. AJUF - 11 10 (MEON s 13 s Member of the SGS Group (Soci6t6 G6n6rale de Surveillance) ]. is Fa Torted See i."J j1) t '. tic! 1. N) ny', 1ji'v 1 op, :0 (ab, C, None 0ctoried Sea 'I'millAu RLI; tda Alluv; illi= Not "Iwllyv.ndj Th"n (MEON s 13 s Member of the SGS Group (Soci6t6 G6n6rale de Surveillance) G r rj WALTER J. HICKEL, GOVERNOR l J1 � rr 1 DEPT. OF ENVIRONMENTAL CONSERVATION %! ANCHORAGE DISTRICT OFFICE ` 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 FOR: S & S Engineering October 1, 1991 PWSID 213637 My review of the records on file in this office reveals that the Manor Subdivision Class "C" Public Water System, is in compliance with the provisions of 18 AAC 80.200, State of Alaska Drinking Water Regulations, Sincerely, 4 1"N Byron Roys Environmental Engineer r L t ,., ii MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION DIVISION OF ENVIRONMENTAL HEALTH %J CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL -•" tlt<(` .fes \\ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date -- 1, GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) _ _ _� �V a `� � 2. � L � ►�J � /� o� ru ES � /2 � �-�c�i�1 � l i2 — - (b) Applicant Name Telephone: Home __ Business` a Sy -3 4 -1 - Applicant Address L2lsa_ % �sGG4. C�p 6? -0 / - (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other El (explain); r (d) Lending Institution ���� SLIP /l.J�r� cam_ Telephone Address C. % -- — (e) Real Estate Company and Agent Address --__—_— Telephone _— HO /-,n. (f) nil -the HAA to the following address: 2. 'TYPE OF RESIDENCE Single-Family)X Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well ❑ Community ❑ Publicr C Z,A-SS' A - DG (� %3�or&0 C/ e D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Int Public 0 Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 n-025 (11,84) 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 investigatio: n Of a t°c� isf# Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional anthk J for the number of bedrooms and type of structure indicated herein. I further verify that based on the information from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply an J ur - wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect orj the date of this inspection. _'one Name of Firm —Ygn196 Sp �7y _Telephone Address Date —-- — ---- 7Lr, s%i:%-re v?, -i e:57o l'a AJ 040 � � A/4. 19 d //3/cg `i` Yo.soc noep� /It)° yI oer's p � je (: �.��`I t •L6Q �70V `P• CCON• V4r.) It OOU gQ�n}?mbari A. $f,arar ," ifi��fi �,'oo {do. t A$7•ft ," sir o b, t• 6. DHEP APPROVAL Approved for ----bedrooms by — Date --�A— Approved _ Disapprove -- 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 DFIEP 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 ;' ,. '- . ....c�.uJ.�...5 q!! -if.. Y�Mr«J.9 ioe,-.Tw..rJ..��. E�+i.�.- m���:..-'-. 1'!f1_ r1_._... _�L r... _. .. w w t'�-. JNICIPALITY OF ANCHORAGE lj HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST — FEBRUARY 1984 A. WELL DATA Legal D scription: L Z P//e7'4 U)l 12 Well Classification If A, B, or C, D.E.C. Approve Well Log Present (Y/N) Date Conpleted Yield__ Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (YIN) Separation Distances from Well: To Septic/Holding Tank on Lot /�5`o f On Adjoining LotsTo Nearest Edge of Absorption Field on Lotf3�t ; On Adjoining Lots 1,5_0 — To Nearest Public Sewer Line To Nearest Public Seer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By Date — Water Sample Test Results Camrents�%� C 6L G (/ /2 U i� j G L_ I f G i cl 1 L — -- - -D /5-0 F. 13. SEPTIC/HOLDING TANK DATA Date Installed Size Q Q 0 No. of Compartments 7 Standpipes (Y ) Air -tight Caps (Y Foundation Cleanout (Y ) Depression over Tank (K ) Date LastPµmped /✓ 6A J -- Pumping/Maintenance Contract on File (Y )�/ /� for — Holding Tank High -Water Alarm (Y/N) W %1 Temporary Holding Tank Permit (Y/NJ ki-- Separation Distances from Septic/Efq1d!rxj Tank: To Water -Supply Yb ll To Building Foundation_ Z/O _ To Property Line To Disposal Field To Water Main/Service Line 16,�(p To Stream, Pond, Lake, or Major Drainage Course iCI D 0 6= Comments Receipt '# Date Paid: Amount: [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata It Type of System Design �Lh,c_z Date Installed Length of Field �4 2 - Width Width of Field Depth of Field IFI, Gravel Bed Thickness -6 O G� Square Feet of Absorption Area 17Z ZO Standpipes Present (Y ) Depression over Field (Y ) Date of Last Adequacy Teste Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well `.S -O -,4- To Property Line G� To Building Foundation ,5U fi To Existing or Abandoned System on Lot 30 J On Adjoining Lots / To Water-Mai;rVService Line c� f To Cutbank(if present) ` To Stream/Pond/Lake/or Major, Drainage Course /x.10 r1G� To Driveway, Parking Area, or Vehicle Storage Area C:� Comments r-' Yrz- D. LIFT STATION Date Installed Dimensions Size in Gallons Ma ole/Access (YIN) "Pump On" Level at f" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping C les during Adequacy Test. Meets MAA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date Company SR a9G} "IN= MOA No. �S 0 3 Pay, �w� 0719 v KB1/d5/s (Page 2 of 21 2-15-84 ANCHORAGE/WESTERN DISTRICT OFFICE_ 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE : &, /'� PwS I.D.r# To Whom it May Concern: BILL 5HF.FFIFLO, (GOVERNOR Telephone: (.907) Address: 2742533 According ,to records on file in this office the�?�v�r �tT✓e'�'/_ �_ Water System is in compliance -with the State Drinking Water Regulations Sincerely, CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of_— ubIic waters stem located in_- Alaska, submitted in accordance with 18 AAC 80.100 ------_have been reviewed and are 0 approved. J conditionally approved (see attached conditions), j t;r` �JC•t Ht Jp'i'\ �✓ � t/ter r I:-( BY TITLE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Changa (contract order no, or descriptive reference) Approved by Date The "APPROVAL_ TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE r, s The construction of the_ j! 1.. ) �' _ __,� �_�:__ _ ._. _public water system was completed on The system is hereby granted interim approval to operate for 90 days following the completion date. DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY i 'L u" ln— H POL, i 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 2.64-4111 TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840591 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 2 Manor Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, e WIT Keith E. Bandt, Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057