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Home My WebLink AboutRIVER VIEW ESTATES BLK 4 LT 1River View Estates Block 4 Lot 1 #050-721-10 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES /' O Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON—SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES y/ U�r TO Address SEPTIC ABSORPTION FROMGWELL TANK FIELD —eq Phones) Permit No. No. of Bedrooms WELL 563- 3333Feaoal 3 LEGAL DESCRIPTION LOT LINE �� 6o I 6Q i Lot Block Subdlvisign - J y /1 e vcr r/, r 24),Cs FOUNDATION"3v / X 5 0' 3J' Township, Range, Section T AS -BUILT DIAGRAM (Show locatwn of well, septic system, property lines, foundation, driveway, water bodies, etc.) TANKS Dd SEPTIC ❑ HOLDING Manufacturer Capacity in gallons 1-5 X /s,S t/ N XCSYJ',O -i Material No. of Compartments C_i � z• c ,� ,�> TYPE OF SYSTEM ❑ TRENCH ❑ BED W. DRAIN ❑ OTHER I,4p5 r4de- Depth to pipe bottom from Total depth from original grade original grade / FT /Jr S FT Fill added above original grade Gravel depth beneath pipe oZ FT '3,5' FT Gravel length Gravel width 33 FT S FT Total absorption area Distance between lines 3 O,S" 80 FT / S FT Number oflines Soil rating Pipe material / / 3,z� SOFT Asim 3v3 Installer Dale Installed /7e4 ✓ G✓rlr hp, -;l //—/3 /F81p WELLS ® PRIVATE �ki1r ❑ OTHER Odentitvi Classification (A,B,C) I Total Depth I Cased to FTI FT I Installer I Date Installed: I REMARKS: f " r 1t k _. trp5r46Le of -.'� /X/r 7b L�XvJ/7% ,12q0/,4 Fie%/. O.Q rr/3uri4/ F4 (,y riot �i�✓�, L �eG� oni Garr-�er.� 4..,01 AFf-ei T4wK. / jop A rvd — rr,-^e4 Inspections Performed by: Eagle River Engineering Services P. 0. Box 773294 °a1e Eagis River, AK 99577 y/rsJ&9 6945195 I certify That This inspection was performed according to all Municipal and State guidelines in effect an [his date: !� i3/�� Wealth Department Approval: ..VL / ' 4 ��— Dale: G— 72-013 (3/85) l4y�i IF vz Je9'v� r v C o 0 AnoS€ os,,¢c:,po GGdoaoou cc e A t{R.e Louis ^,;otSo;era a _r tr-, qV NO WELLS /ELL. AND SEPTIC SITE PLAN EGAL+ LOT 1, BLK 4, RIVERVIEW ESTATES OT 2 RIGHT DF WAY EXISTING LEACH FIELD ��+�+- NEW t_EACH FIELD µ CLEANOUT SCALE, V = 60' WNER: H,U,D, ONTRACTOR:N/A -- AGLE RIVER ENGINEERING SERVICES O BX 773294 ` AGLE RIVER, AK. 99577 L »� 94-5195 �,;.� SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR:�! G✓%� / %� DATE PERFORMED: LEGAL DESCRIPTION:_ .2D /y / �� y „ �y�/�y�L- "� -ST dT SLOPE SITE PLAN 1 _ 0 2 _ 3 0 4 0 5 v U. 6 7 8 / J 9 0 10 11 IT, D/j6Q7✓/c 13 Wim' 14 g o0o0L v occos�, ucanc:- 15 o-, r% snovun naa uu ue....... 16 -� �?? `i `- � o Louis A. 3otern J , CE -o)36 a 17 oce oo aoeF r�, p W 18- 19 8 19 20 COMMENTS WAS GROUND WATER S ENCOUNTERED? A� L o S O IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop Sou H 7 -7 /fie PERCOLATION RATE ei- / (minutes/inch) TEST RUN BETWEEN y FT AND S FT S- GJ, Dry f, e1w i. L10'wd-r So, / S'tratce i Z= e'i' Ire Ne! Eagle River Engineering Services PERFORMED BY: 2 9 tax 773294 CERTIFIED BY: Eagle River, AK 99577 694-5195 72-008 (6/79) DATE: /9�.G SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 1, BLOCK Q, RIVERVIEW ESTATES A. GENERAL 1. The well and Septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification- - All materials and workmanship shall meet the Anchorage Department of Health and State Department Of Environmental Conservation require- ments . J.- All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. F1ll excavation, and depths are advisory and are to be verified or nlod:ified in the field by the contractor to meet. Municipality of Anchoracle, Department of Environmental Conservation requirements. E. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. -Tile excavation is to be exactly in the area Shown on the Site plan, any deviation requires engineer approval. 0. It. is always recommended that a surveyor- locate the nearest lot line Position and the location of any easements. B_ DRAINFIELD The dr.infield Is to follow the natural land contour to maintain urufor[if total] depth of ths: trench bottom. Tof the dra;nFlc:Id shal] be! le\,el, plums or minute 1.5 I l i s-)LLjI (ter)th c,f the dralnl-geld excavat) or; is not to exceed _1.S at -i u r) 1, _ The sevi(-,r line is to be connected int;o the existing leach line to al] effluent overflow t the up,_iraded leachfield. Thr_- dre in-rield yr ✓el is to be oovered wit!I typar or fabric material UI" i:Orllt?1nH t.Ion 0 x,011 and eXtruded board inSul-atlon to a depth f 4 or eciuivr crit as f.o be placed over the drainfield. TIu e_,.; 0vcr the dr r1nf I lei I to be ftn _=.h k_zradcd to prevent. pondlrig of t c,;:= w�ltunof - 11:, and Ie, chfleld must not bc, closer than 100 c irtv tj an -1 prlvwell. l50" to any Clasp. "G` wr�..11. or 200 feet to fly (t nlnunl I v w l RECOMMENDED LEACHFIELD DIMENSIONS �? J. .� r 3 IJI .L-1L_EIJUIrI-> _� Ukrall'i LELl in,lDlli - _ - s..`""°°°°°`x'^� -J P. L -� _ L f �:nc r, 1L. .1 CYE^q L1a LC I'OI 1 uearoC,111 �l'1r e' � o'• a ***NOTE: ULD 1RENCH IS 10 EL TIED Ihd. CLEANOUT IS 10 BE PLACED BEFORE AND AFTER TANK AND ON TANK. LINE FROM HOUSE TO TANK MUST BE SNAKED_ REPLACE LINE IF BROKEN (INDICATE REPLACEMENT OF LINE AS SEPARATE AMOUNT ON BI[r)_ INSULATION OVER TRENCH AND LINES IS REQUIRED. ,Pe.rmit 4: 32077"1 January 31, 1.983 TO: Permit Applicant Subject: Lot 1 Block 4 River View Lstates Subdivision A permit issued by this department for an individual well and/or_ on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well. log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as--builts for our files and documentation. If there are any further questions, please cal]_ ti,.i_s office at 264-1720. Sincerely Robert C. Pratt, R.S. Acting Program Manager Sewer and water Program RCP/ljw enc: Copy of Permit SwP/0 57 PI1__J 1`4.1.fl�'L I—F-nL--L « " �-" " ""�=^" ^~~^`~ -_-- I ``'O-'- DEPARTMENT pr HEALTH AND ENVIRONMENTAL �7OTECTION V 825 / STREET/ ANCHORAGE/ AK. 9L j1 264-4720 1.4 1= L_ L_ F1 r_4 EN �lr_-1 F:::, FZ ��I -r PERMIT NO. ( 820777 ) APPLICANT JOHN L GROSS PO BOX 1161 E.R. 99577 694-9138 LOCATION LOT SIZE 999999 SQUARE FEET LEGAL LIB4 RIVERVIEW EST TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ::LC:-# �1=-�401_H� ::::�!5 U.-E'F`r"� IS THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FR! E:_: 0 NJ I F.' E_ I::- f3 I=- F=)m I- I I::- -F " N K _�-- I = r-__ -1 kil 0 0 �" I L- (D P-4 �=` PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. 744�� > �� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO 0 PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F-� M I _T_ E� E=� I CERTIFY THAT :1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]` I UNDERSTAND THAT THE ON~ -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. WED:L A� 7�- - -__-~- - - ---- - - - - (APPLICANT JOHN L GROSS (� .� ' ISSUED BY SET IF THE V4L 0 MUNICIPALITY OF ANCHORAGE �My� Pe—pr7 Lj CP DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ® ENVIRONMENTAL ENGINEERING DIVISION F� / "T 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720�� ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Y .� PHONE ❑UPGRADE MAILING ADDRESSg�f- (Xa LEGADESCRIPTIOpN L ///7 / ,✓ LOCATION �21 d(5- NO. OF BEDROOMS Uy DISTANCE TO: Well J ! Absorption area/ / Dwel ing ,J�DC,m „ C / - PERMITNO &16t Ll 9 Material No, of compartments H Z Manufacturer /1 a Q —� wF v' Liq. rapacity in gallons IF HOMEMADE: Inside length Width Liquid depth a a Y DISTANCE TO: Well Dwelling PERMIT NO. O Z Q Manufacturer Material Liquid capacity in gallons p w y DISTANCE T0: Well l ©+� F.o4indation tNn ., [t�G+ Nearest lot line f ��:�J L% PERMIT NO. J u. Z No. of lines Length of each line Total le y h,of lines Trenc idth inches Distance between lines Z w r a H Top of ti to finish grade/ / Matena beneath rile /� 6p inches Total effective bsorption area % / � /—/�-�L�� — Length Width Depth PERMIT NO. w 0 Q I- Type of crib Crib diameter Crib depth Total effective absorption area P a w w w Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J w Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PI MATERIA SOIL TEST RATING INSTA LER R RKS � /�/Y` l'f" /,J�� nfL•:"L] V �t/ LS r]� i�J6- �1 �-- IS© rt (Gasl �`/•� - CKJ11Y7 lJ1e` I'�l�L/ L,65_A)&r'9r-) Y 1rM APPROVED DATE �e16 �� LEGAL �� r✓�,��zr� s�f� l u� �/ �� / 70 niI[Dn Z1791 d-` R @° A 1 C::1C F ° 9`":V I_. 1: "IF `r' C# A — 019 P -°d w_ V-1 Y _w [ a ° �_l 1--i HEALTH F1t'D Et. -k IF?:NIIENTFiL ow rEC:TII:*4 C�25 `L.' :ETRE ET: hiNC:HI:Ir:AGE: FiK. 1::19,_.o1 264-4720 w_ yw d"•„y ..._._ °� ;, I 'Y Er- =� t: ` 1 ^. N h. - Fzi” F.- kms.. t �? 1'°`B Y Y` F'E:fa''1I:`f r•ll:�, r: _;��iii'a:.a.� � ;� AF'F"1._t:CAhIT .3I11 h•'IF44WLL-, _804 WILSC.'IN WAY :94 U:IC::ATICIN F.P.IEft'v'IE:1.4 [::)E::. LF C NII._ LOT 1 EILF-: RIVER,IE[.J ESTATES LUT 12E �cl�'4Wa!�IF•_i I!UA E FEET I -IF: I:I :C E_ ABSCIF:F'`r i I:Ir•a SYSTEt l I S : TRE61CH t IFi,<; I I''II_Ih1 11U11E,ER OF BE:['.,,R iC)1,elS •"- 3 ..'CI I L F:f I`r I r`JCi w I! F'T, 'EF::7 TFIE F:EI !I._1I F•::EC: SIZE E: CIF THE SOIL ABSW[°'F'T I CIN '!,Y'STEI'l I S : .3 3' 2 4 C -I' _ ° IF.;:■ k= F" 7" :.:��; �„ L_ tl-�: &"••S Y_. � Y"' �.�.A �.:�. WFS,. Vila ("i f�-"° tl =� " o°" k= fl._ ��:� IE; ��•° -b"_ 9•-E �� „�.. THE LEN131"FI C.iIr'IE 1'-JSICIt•1 IS THE LF;.rd13n-I (IN FEET) OF THE •TREr'aIWH OFF'. C>F:ADIFIELD. `"HE ClE :f"'•1"E•1 t_II.. A TRE N F1 OR P I `I` 15 THE DISTANCE BETWEEN THE SURFACE OF THE GF`'(',*JU C, FIND THE: BOTTOM OF THE E ;ID HVFIT 101'•4 -" I N FE:E'r THEF".E: IS k1O SEF b.II[;'fH FOR TRENCHES. THE (IF.FIVEL DEPTH IS THE: [I.T.N1111..II''1 DEPTH OF GF:H'v'EE.. BETWEEN THE OUTFALL F'IF'E Fil'•,ID THE E.017CIrI CIF THE r,>;C:FiVATION Ira FEET). fl : w'g 9__u 1E [I, :° @ :: �W w p.�„...:IL Y�= `Y-il r .� { _ A w _... f'fE:f:C'Il:l fIF'F'L..IC:FII'dl” Fins 'rHE TO INFOW-1 THIS DEPARTMENT DURING '1"FIE 1: I'd'W; 1 I :IL..1._Fi"r I Cera INS F'E'C:T I CTed',; CIF ANN.' WELL'S FIC;. f)C:ENT TO THIS. F'F::CIF'EF:T'r, Ahic. THE I'dI_IME,E:F' C F7 RESIDENCES THAT THE F•IEL.L WILL SERVE. d.,. K- 0 w; ; I, C-- -T.1 0 P -A • V�� Fw-� rte° EE F.° F—:-- AA BAC'KFI:I..I._If-I i CSF' Pied',' S'•r''STE[l wI1'HCiI "r FINAL Ir1,_:3FECTIOt•,I AND HF'WF<i:lVAL BY THI:='. DEF'1'iF`1"[lEI'fr I•d I u_ EIE; :I IF�UE C T TO PROSECUTION. M I r,I I MUll C) I STFIr• i -M BE:TF•IE E.r•d A IdELL AND ANY CIN -SITE SEWAGE DISPOSAL SY STEI''1 I -S :11`it i FEET FOR A F'F: D FITS: WELL OF." TO 200 FEEL" FROM N PUBLIC FdELL DE. PF—.'h1D T NC1, I_IF'ON TFIE: T'1 PE_ OF PUBLIC WELL. I'IIr,IIi''1LItl D1: ;TANC:E FROM Fi F'M:I', 9TE WELL. TO A PRIVATE _=EWER LINE? IS 25 FEET At -.1D I,0 A I:C'Il,llf1Uh1IT%' SEWER LINE IS, '5 FEET. UTHE"f : F::EG?LJ:f. F :Ef1E:1',ITS MAY AF'F'L'•r'. SPECIFICATIONS MID IW CTed:. T F:I_IC:1"ION D I t113E~•:I=iNS ARE Fi',N1ILFIEcLE: To INSUFM F'F.'OPER INSTALLATION. K=" lr 6w- E: -.a:--'■ A-' +I : C-1 I C:EP,,,r I FY ri-vi"f ::L : I All FF�IM I L I FiR WITH THE I? EG"W I REME::t••1`S F C'IR ON --S I `r E. SEI•,dER.--; At -ID WELL:::, AS SET FC-IRTF-1 E' -r' T+ -1E_ 11UPI DD I F'FIL.. I TY OF Fir•dC HOIRAGE. :Et•d'STFILL THE =Y ST'EWt'I IN FIC:C:I:IF;DFIr•CE WITH THE: C:CIDE3. I LIr+IC: Er ::. rl-lydc� TFIA,r `r1AE Ot,l- E_S I TE'4� SEWE F'. c 4''sTEM MAY F:'EC!l.I I F:E. EI',IL.FIt :13E t lEtd`I' 1: F THEFZE'.:;IDE NC:E' I': RE:N IDELEC:, TCI INCLUDE MORE THAN 3 BEDROOMS. ""' L. "A, . _! I t'1 1 A � M5 �y r� I W,',!_IEr; B1,`..,_ _.Jz a� , ____DATE._.Q..��✓L� ,�, C., ® & E ENG- NEERING & DEVEL O, i ENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Ltussell Oyster 6942774 Performed for: N SOIL LOG !a- --cl f,417 4,04 ,-" `? Mailing Address: Legal Description: Depth (feet) Soil Characteristics 0 Ab 3 4 (Zp rJ�c_ eU -1-4� 6 Earl Lille 688-228o Tel. No.'2 -7 ?" - 2- 4/4/ 179'03 12 13 14 15 16 PLOT PLAN AbO, At, i Ail /0,r PERC. TFSY - - -- Ground Water Encountered: Yes " No If `yes, what depth Proposed Installation: Seepage Pit Drain Field �! Comments: Performed by: � �'` s' � � �� Date: a I''I I N *.( l''II..II''I DISTANCE B TWEENJ A WELL FIND ANY OPI--S I TE SE:WAi3E SYSTEM IS :LOC'i FE:E:T FOR A PRIVATE WELL. is R :L50 '(O w:4: 0 FEET FROM A PUBLIC WELI... DEF•'E N E', E'G l..IF'C�Nd THE: T', -'PE OF PUBLIC b.IE:L.L. I''17:I'•d11''ILIN'1 I!:G:w'I"AN,ICE: FROM A F'F:IVATE WELL TCi A 1='F:I'v'ATE SM.IEF:: LINE IS 25 FEET AND TO A ( Cil''ll''IUNdITY ';EWEF',' LINE IS 7`5 FEET. WELL LOCIG ARE F.'E:MYERED ANCd t'U_i'ST BE. F:E`FUF:tdEE:, TO THE DEPARTMENT 14ITH.I.Nd 3:0 Cif"Ti'S CIF. `I"HE WELL COMPLETION. "RUCTION Od GT3FAI1W ARE" OTHEF: REQUIREMENTS I''1A',•' FIFFL.FCNS TO INSURE f-'F,OPER I Nd TALLFIT ]:Or•,I. 1`-',, KE :1 w 1' 1"'1 :1 _�... E-• _; N " 'T lf�=° IE : ,, { "N FE a = � . {''I I � � I C G F. T I F'•r' "I'VIA'f 1.: I F9h1 FAM I I._ I F9t WITH THE F:EOU I F:EN9Er•d` S FOR CIN—SITE SEWEF:`. AtdC: WELLS.; A SET 'I"HE: r'll_ N I C I Ff L. I rr, OF AN C:HOR (IGE. I WILL. INd'STAL.L. Ti*' _-i'r"STEt'1 IN Fig: COF-'.Dj-IN CE WITH THE CODES. FIf"'f' t ANTh�td GiF.'.Oss V4. 0 7`0 0 Y' 1 Y 'Y 1"-4 -11- tl F ° Y=Y tl_:n E— CE::f='FIF:1"I''1Ehdl" .•r HEALTH AND EN-P)IRON MENdTAL rROTECTIONd 82-r_i 'L' STREET, ANC:f•dOf=ACiE., AK. 9950:1 i '6 4_472 0 F'E::F N'IJ. NO. :; 800z� Af='1='L.I t ANT JOHN i*FCr. S E,O,X' :9.161 E. R. 1. ON P' I'0 ER ', I EW DR. I._FD:AL. I_ :1. Bk:: 4 RIVER 'MEW EST. LOT SIZE ri 'c_1, -,W, SQUARE FEET I''I I N *.( l''II..II''I DISTANCE B TWEENJ A WELL FIND ANY OPI--S I TE SE:WAi3E SYSTEM IS :LOC'i FE:E:T FOR A PRIVATE WELL. is R :L50 '(O w:4: 0 FEET FROM A PUBLIC WELI... DEF•'E N E', E'G l..IF'C�Nd THE: T', -'PE OF PUBLIC b.IE:L.L. I''17:I'•d11''ILIN'1 I!:G:w'I"AN,ICE: FROM A F'F:IVATE WELL TCi A 1='F:I'v'ATE SM.IEF:: LINE IS 25 FEET AND TO A ( Cil''ll''IUNdITY ';EWEF',' LINE IS 7`5 FEET. WELL LOCIG ARE F.'E:MYERED ANCd t'U_i'ST BE. F:E`FUF:tdEE:, TO THE DEPARTMENT 14ITH.I.Nd 3:0 Cif"Ti'S CIF. `I"HE WELL COMPLETION. "RUCTION Od GT3FAI1W ARE" OTHEF: REQUIREMENTS I''1A',•' FIFFL.FCNS TO INSURE f-'F,OPER I Nd TALLFIT ]:Or•,I. 1`-',, KE :1 w 1' 1"'1 :1 _�... E-• _; N " 'T lf�=° IE : ,, { "N FE a = � . {''I I � � I C G F. T I F'•r' "I'VIA'f 1.: I F9h1 FAM I I._ I F9t WITH THE F:EOU I F:EN9Er•d` S FOR CIN—SITE SEWEF:`. AtdC: WELLS.; A SET 'I"HE: r'll_ N I C I Ff L. I rr, OF AN C:HOR (IGE. I WILL. INd'STAL.L. Ti*' _-i'r"STEt'1 IN Fig: COF-'.Dj-IN CE WITH THE CODES. FIf"'f' t ANTh�td GiF.'.Oss V4. 0 Jolln Gross, Dox 1161 c1C}1.C: rdverj Alanlra 119577 fSubj (,-'ct . porndlf.. 1j pormil-, is'silocl 'by tlii,3, ,:or well. aivl/or on—;:U�O- S I 'L BI _ A ck River view Estates e"'Yer (ml Lot, . fl I �-- suDdivislon han, wcpired� since th,kr;,111-10 NTO . t . i �!l i. - - J. t1w 'r j 'All tPlan to instal- well !,-,ower wisbnifti, a liew permit is The Ori( lunztl, J 1)(A], tort taav br: to) Obtaill cl o-urrnrit pnrfA-�, a wo-.)J. 1('jg r;hou:W be sent etnpartmonv, to Y�j ym hF.-nye any clam.,tialusq recrarclingi the albovn matter, plc,arw, con-Ulut. thi-H ol:'fice iiiynm�dial--ely at, 20-11-4790. oinc "--nior Municipality of Anc On -Site Water and Wastewater (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS 1 8 9 70 17 -- Y SEP J 0 201' lit ILI Parcel I.D. OSo — 72 tL 1 O Expiration Date: 1? —17-1 1. GENERAL INFORMATION Complete legal description River View Estates Block 4 Lot 1 Location (site address) 21220 River View Drive, Eagle River, AK Current Property owner(s) Foshaug, Joseph Day phone 865-6566 Mailing address same Real Estate Agent, Matt Dimmick Day phone 865-6566 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Received by:Date: 7 /f COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 62-(0 Date of Payment Receipt Number 61..5_5'5� Date: Date of Receipt Number COSA # DSAS 1 $DO Waiver # 5. STATEMENT O ION 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 NorthRim Engineering Phone -694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 7 4 6. DSD SIGNATURE ' System #1 Approved for _ bedrooms. ,,,,. Vv. System #2 Approved for bedrooms. �F rid., tt na �Fa Y�l7�lf•1�,� Disapproved. p qvi: Si.::.ty Conditional approval for bedrooms, with the following. stipulations: By: Original Certificate Date: 7 /� The Municipality of Anchorage Devlopment 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAblueshee[ 9-0-02Aoc If more than 1 septic systemis on the lot: COSA Checklist # of Structure ?served b'y this system Certificate of On -Site Systems Approval Checklist Legal Description: Urz �/E�1.rJ �T�6J' BL/ [. ! Parcel ID:OSO 72! JO A. WELL DATA Well type J_ If A, B, or C provide PWS ID # Well Log (Y/N) Date completed 7 7/90 Sanitary seal (YIN) ( � Wires properly protected (YIN) Total depth 88 ft. Cased to —1—eft.. Casing height (above ground) min. Date of test. Static water level Well production FROM. WELL LOG 7/7/ot-6 46� ft. 0. 51- g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate 2. P 7 mg/L Arsenic A10 ug/L Date of sample; it B. SEPTICIHOLDING TANK DATA AT INSPECTION Z /5 � ft. g.p.m. Collected by: Tank Type/Material _SEATTFr L Date installed T��d Tank size /006 gal.. Number of Compartments 2 Cleanouts (YIN) Foundation cleanout (YIN) Depression over tank (Y//N) Al High water alarm (YIN) A/ Date of pumping Pumper 3?21t+ C. ABSORPTION FIELD DATA Date installed 1'3 • V Soil rating (g.p.d.tft2 or ft2/bdrm) / 3 c System type Leith, 4!/ ft. rt Width 3 S ft. Gravel below pipe S 3 S ft. T a(c{2pth 1.ft. EfF' orption area /0 JASftZ Monitoring tube _ °* Depression over field -4/ Date of adequacy test �'f' �S Results (Pass/Fail) P For bedrooms Fluid depth in absorption field,before test ' _ in. Water added e--/50 gal. New depth?? in. Elapsed Time: 3 19 min. Final fluid depth 0_ in. Absorption rate >= 50 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 141 If yes, give date D. LIFT STATION VA Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot %b110 W On adjacent lots /1J0 r Absorption field on lot 9 6 On adjacent lots Zaa �f- Public sewer main A4 Public sewer manholelcleanout f 0 O Sewer /septic lineZ S `l Holding tank �4CJ00 �f Animal containment areas �(� rf Manure/animal excrete storage areas l CJG �t SEPTIC/HOLDING TANK ON LOT TO: r Building foundation -f Property line / d -- Absorption field J� F r Water main r!} Water service line / O �"f Surface water r 0Cl f Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation /o '+` Water main /Q �-f- Water Service line /0 r� Surface water Ia0 rr. Driveway, parking/vehicle storage CJ Kfi' Curtain drain 6 Wells on adjacent lots o F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review, of Municipal records that the above systems are in - conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name SD�;t/F 4AJ E Date COSA yellow sheet_2-6-15.doc 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.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-721-10 COSA #®Sn, / a/ /�/� Expiration Date: 6 __ zj„ 1. GENERAL INFORMATION Complete legal description River View Estates Block 4 Lot 1 Location (site address) 21220 River View Drive, River View Drive, Eagle River AK 99577River AK 99577 Current Property owner(s) Brown Jennifer & Allan Day phone 244-1930 Mailing address same Lending agency Mailing address Real Estate Agent Mailing Address Day phone Cindy Wilson Day phone 244-1930 RE/MAX of Eagle River Unless otherwise requested, COSA will be held by DSD for pickup. 2, NUMBER OF BEDROOMS: 3 -__3.. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are 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 On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724 Eagle River Engineer's Printed Name Steve Eng Date 7/30/2012 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of I evaluator of the well and septic system. 5. DSD SIGNATURE Z Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other WATER By. Original Certificate Date: e3 - l (Rev. 11105) 61 Municipality of Anchorage o p E • 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: River View Estates, Block 4 Lot 1 Parcel ID: 050-721-10 A. WELL DATA- Public Water Well type P If A, B, or C provide PWSID # _ Well Log (YIN) Y Date completed 7/7/80 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth 88 ft. Cased to 88 ft. FROM WELL LOG Date of test 7/7/80 Static water level 6 ft. Well production 0.5+ g.p.m. WATER SAMPLE RESULTS: Coliform Pass colonies/100ml- Nitrate 0.61 mg/L Casing height (above ground) 12 in. AT INSPECTION 7127112 ft. Arsenic: 0.44 ug/I Date of sample: 7/17/12 Collected by: nr B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 80 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping Z_/_?b Z Pumper Z s C. ABSORPTION FIELD DATA Date installed 80188 Soil rating (g.p.d./1t2 or ft2/bdrm)138 System type trench Length 41/33 ft. Width 315 ft. Gravel below pipe 3.5 ft. Total depth 817 ft. Eff. absorption area 410/305 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7127112 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 3 in. Water added 450 gal. New depth 15 in. Elapsed Time: 60 min. Final fluid depth 3 in. Absorption rate > 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) unknown If yes, give date = D. LIFT STATION Date installed na Size in gallons na Manhole/Access (Y/N) na "Pump on" level at na in. "Pump off' level at na in. High water alarm level at na in. Datum na Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 96' " Absorption field on lot 96' * Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50'+ Meets alarm & circuit requirements? na On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout NA Holding tank na Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 10' Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main na Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain n/a Wells on adjacent lots 100'+ F. COMMENTS Waiver G. ENGINEER'S CERTIFICATION �F.lR t 4 %%li @ °•• b I certify that 1 have determined through field inspections anda°.ft review of Municipal records that the above systems are in ® . 4`3 conformance with MOA COSA guidelines in effect on this date. 0•" Engineer's Printed Name Steve End gt®„$AgPE 56 Date 7/30/2012®4�sr''�• "73a��a "` COSA Fee $490.00 Date of Payment -4131119, l /� Receipt Number G 15350 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number f Municipality of Anchorage • "` Development Services Department Building Safety Division On -Site Water & Wastewater Program W 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING qjftParcel I.D. 050-721-10 HAA# 7717 -t7 1. GENERAL INFORMATION Expiration Date: z - '-� - C% 3 Complete legal description RIVERVIEW ESTATES SUBDIVISION: LOT 1, BLOCK 4, Location (site address or directions) 6700 WATERFALL DRIVE ' EAGLE RIVER, AK 99577 Current Property owner(s) STEVEN CRISWELL Day phone 694-3087 Mailing address 6700 WATERFALL DRIVE • EAGLE RIVER, AK 99577 Lending agency Day phone Mailing address Real Estate Agent EVA LOKEN w/ PRUDENTIAL VISTA Day phone 689-6476 Mailing address 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site a Individual Water Storage ❑ Individual Holding lank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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 samples. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. 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. /further venfy that based on the information obtained from the Municipality of Anchorage riles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE, AK 99504 a Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 10 /17�/c Engineer's Comments: In conducting this evaluation, AKWWC. Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines E Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any otherperson or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for ? bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory '4 IR". 12 M1) bedrooms, with the fllowing stipulations: Manitenance Agreements OF.4 y0�� ON-SITE :��= WATER AND Rt= WASTFWATc:R PROGRAM Supplemental Engineer's Reort JJ'l� Vile, Other Original Certificate Date: / ll – 4�" C :2— I 9 i I Municipality of Anchorage • Development Services Department Building Safety Division OnSke Water & Wastewater Program 4700 South Bragaw SL P.O. Box 198850 Anchorage, AK 995196850 www.d.anchorsge.sk.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: RIVERVIEW ESTATES S/D; LOT 1, BLOCK 4, Parcel ID: 050-721-10 A. WELL DATA Well type PRIVATE Date completed 7/7/80 Total depth 88 ft. If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Sanitary seal (YIN) YES Wires properly protected (YIN) YES Cased to --LB—ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test 7/7/80 Static water level 6 ft. AT INSPECTION 7/1/02 23 ft. Well production 0.5+ g,p,m, 6.3+ g,p,m, WATER SAMPLE RESULTS: Coliform 0 oolonies/100 ml. Nitrate 0.549 mgJL. Other bacteria 0 colonies/100 ml. Arsenic: 0.002 mg./L. Date of sample: 8/7/2002 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA *FOUNDATION CLEANOUT IN CRAWLSPACE Tank Type/Material STEEL Date Installed 8/5/80 Tank size 1000 gal. Number of Compartments 3 Cleanouts (Y/N) YES Foundation cleanout (YIN) *YES Depression over tank (YM) NO High water alarm (YM) N/A Date of pumping 9/25/2002 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA **TESTED 1980 TRENCH Date installed 1080/1e88 Soil rating (g.p.dJft'ort� 138 System type TRENCH Length 41 1980/33 1988 ft. Width 30/5 ft. Gravel below pipe 5/3.5 ft. Total depth 6/7.25 ft. Eff. absorption area 410/a0s fe Monitoring tube YES Depression over field NO Date of adequacy test 8/6/02 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY in. Water added"s13gal. New depth 34 in. Elapsed Time: 970 min. Final fluid depth 3 in. Absorption rate >= 450+ g.p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date – Y i i D. LIFT STATION Date installed Size in gallons Manhole/Accp— (Y/IJ) "Pump on" level at _in. "Pump ofr IF --I of _in. High water alar level at in. Datum - Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: *SEE ATTACHED WAIVER PACKAGE Septic tankAlft station on lot •96' On adjacent lots 100'+ Absorption field on lot '96' On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ 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 HAA guidelines in effect on this date. Engineer's Print Na Data lD�2A-�Q.. JEFFREY A. GARNESS HAA Fee $ F7% 5 . CC 4s4 , Date of Payment 10/25/02• Receipt Number 27391 (Rev. 12/01) Walver Fee $ 1001). eo 5-4 Date of Payment 10 25I0 -a - Receipt Number ,i41�g AUG -16-02 10:19A11 FROM -CUE ENVIROMENTAL SRV G CUE Environmental Services Inc. L CT&E ReLO 1024944001 Client Name AK Water & Wastewater Consultants Inc. Project Nattte/N Riverview Est SID Ll: Blk4 Client Sample ID Riverview Est SID Ll: Blk 4 Matrts Drinking Water Ordered By PWSID 0 Sample Remarks 9015615301 T-935 P.02/03 F-269 All Datex/fimes are Alaska Standard Time PrintedDatelfime 08/14/2002 16:27 CollectedDate/flme 08/07/2002 8:32 Received Date/Pirne 08/0712002 12:50 Technical Director Stephen C. Ede Released Ry � W tv.A" Allowabte Prep Analysis Parameter Maki PQL Unix Method Limits Date Date Init Metals Department Arsenic 0.00200 U 0.00200 mg/L EPA 200.9 (<0.05) 09/12/02 IMP Waters Department Nitrate -N 0.549 0.200 mF/L EPA 300.0 (<10) ORM/02 PLW Microbiology Laboratory Total Coliform 0 coV100mL SM18922213 (<1) 08/07/02 SBH Sep 24 02 06:13p ASSUILT Eva Loken 907 689 6476 iYB9'cl OL''!l� /6'7- 00 - SEWARD & ASSOCIATES LAND SURVEYING 694-0829 r I I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: ,�e'��'"�qo, i I11 FOLLOWING DESCRIBED PROPERTY: .o/l�Cr'{��/F37AlE/flvr/df; S� DATE OF A(�s`` AND THAT NO F.NCROACNMEIrTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE i��z i .� ' 4-- GV 1 OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDol "';%�""...j� J I EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APP2AR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: 9�/z ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN' ARY LINES. GYM- m -A i. --,d • gT A '• LS -6913 .' Pr Anchorage >Iunicinaliiy of iclioi-age ! & n - f All -America City Bttilding Safety M ision I'r George P. Il"acreh. 31(n or 2002 11/12/2002 Jeffrey A. Gamess, PE Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B Anchorage, Alaska 99504 Subject: Waiver Request for Riverview Estates Block 4 Lot 1 Waiver Request #WR020082 Parcel ID #050-721-10 Health Authority Approval Number I-IA020546 Dear Mr. Gamess: Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to private well has been approved. The approved separation distance is 96.0 feet. This waiver approval applies to the existing absorption field and septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely,A / 9 Y? Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program 1'.O. D)x 196650 • Anchorage, Alashn tM819-6650 • Telephone: (907) 343-8301 • Vim: (907) 343-8200 4700 South Bragnw Strecl • Anchoragc, Alaska 99.507 h tq,://�w�e.cl.nnrhora�e.nk.us Municipality of Anchorage Development ServicesDepartment � Building Safetyty Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 1%650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: WR020082 PID#:050-721-10 HA#:AH 020646 Permit#: Dade Received: 10126102 Legal Description: Riverview Estates Block 4 Lot 1 Engineer. Jeff Garness. PE Plaska Water & Wastewater Consultants. Inc. Applicant: Steven Criswell Waiver Requested: 66 feet from well to septic tank and absorotion field Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: X Waiver is not Granted: List Conditions or Reasons for above: SFE 61MA 4 ED Date: / //i2/02 By: PAAI Name of Reviewer ........................................................................ was ... I Rec#: 27381 Amount: $1.000.00 Date Paid: 1012612002 wAI✓ErQ RE QK E S T r -em fit vEIQ vmv ESrnn:r BL.Ock f LOT / WAIVED REQu.Esr NUM0EK WRo2a082 WR/VER xE�EST Fo,r U/✓-La7' SUPT/� rlvN/� r0 f.�MYTEi(' WELL. o< 9GFE�T -' l9SOIQPi/ON f/el-V V,tM - rHE A6S0RPTiow l`/EtD /m qu6S77oN wqf laNST/puc imp IA/ /¢ubksr /480, W W rME- SOIL) rlte ABfmiortom FIFLP APO 7W&I ( Lv#..f lOA.-frm W W W W �S8 /SlQy471.G SFT Ito 4�Bcv. T/l�sEQ��r�r ru A p�`RtaLAr-ivr� �N _,.. R6rE of Ttox So/i. /e/trev RS 4 &m is Baa ... 600P FOR l'kC rXV#4rMEAI7 OF SEWric T/tovk 9FALus.vr THE SCR T/c �� TI4AIk ALfO E�+C/rOACHS ��' /t.AT-FR c'-�1-L 9to FB/:r f%w/9Y. TKE t,-i+rex wstl /" QLP 5rran/ t�/4.r eomx Ae&�crt vlAl JuIY I9�0. TWE lvrsLt / f 88 fCer voejo uA Arex& 1i cAocOuw.reoe&Ao Rr fj¢ ofels #d AtE,¢Oai tAYORt Of `HltteopAAN / *KE E✓CVCW74PRKP Osrk.eev GRC"AlAO suKPr+ce *dly ri-if .4,q"jpefR Elvraw.r,c�¢csv Ar- 84 Fell-. THF. 5-7A7'i w/3rER Lf-jEt Is *r 27 feET: OEtt Lo6.f FKoM TIlz s x"&A•+oAW-� AREA f-AlQ/(#mss PeoRock ScoPEs (,J9E.t7iY FRO" T74C E -NE pm-V- >v*RD TO Tt)-: W - Sw. TuE- WELL ! SEPTI c gelOMIC rO of OP 7HE- SAhu,E !cO!"e GCwJ'OKK OPME BF_OKocle, itiE meow 4r /0 kIbHF_R Ai GRoy 0 ry 893M - Frr'r►' fuAe/jneE SLaPe cvvrourv. 71we' SAVjP-cr wprl5R wUtt, /S kP AlX'- f/2aK pot SET/e S Y,$ FW^ ,1 /O c /w ELG•vl7rloiv, WA7.0 SA'MPt6f IAVtc<}rP-1 NU Qog.-cTF-K/A } N!rRArmS 6.S49PVA This SePARAnew Hff Ex►srxp Fe 0 v E A 22 YFR)es. r`` I 5. of A. 0. E. C. 5. D. W. G. {Or S. C. R. 0. PATER TAKE PI POW 74 0, % =X=.74i-rO fS 34 C W W SOIL SoJQQTicA/ coo 4(27)4 zi+ / -NO N N N NNN �� PERwfABJc irr /27) l C76 /i�J.O+(7 /(VOO 6vArFR TnjgLE 6JfJ4o1E.v7- ASSUME CON•S6pvArIVF- AS 81"O'Ck 4PPFAAU To FIVSS Ab�vEArJf TKs ;�iiASaJ4Ptiav FJeLO .4,vp b•EtLArwf sauE 4xpcJevr,•, Atsu•�� -.S�o KOJPfZON7-J4L SEPARArIvAo s CONCL u JJ e" GIQpvr 1w 41VEJ? Pawrs S. 8 4.2 1.4 2.0 2.8 /7.2 %Z Ak ALASKA WATER WASTEWATER CONSULTANTS, INC. September 20, 2002 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request and Health Authority Approval for Riverview Subdivision; Lot 1, Block 4, The existing 3 bedroom house is served by a private well and septic system. We request you grant a 96 feet separation distance waiver from the well to the septic tank; and a 96 feet separation distance waiver from the well to the drainfield on the referenced property. The well that serves the subject property was drilled on July 7, 1980, and the septic system was installed on August 5, 1980 The following items are justification for the waivers: • The lot is sloping down from the well to the septic. The grade at the well head is 10 + feet in higher in elevation than the septic system. If the septic system was to overflow, the effluent would not travel towards the well head. • The location of the septic system is in a very visible area so that if any effluent was to surface, it would be noticed and the problem corrected. The other path of contamination is subsurface migration wastewater should the tank begin to leak. As can be seen on the attached well logs, the aquifer is relatively deep with approximately 63 feet of various hardpan layers which serve to inhibit the migration of the wastewater. Recent water sample results indicated nitrate levels to be 0.549 mg1L and coliform and bacteria results to be 0. Based upon the aforementioned facts, it appears that there is minimal risk associated with the 96 feet separation distance waivers. o u hive uestions, please contact us at 337-6179. Thank you for your assistance. Sinc2re y, ivy'A.(mess, P.E., M.S. Pr idcn� 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com i i I I I I I I I I I I I I I I I I I I -------- ------ I I I I I I I I / 31 �i N Ir �I /I Il I I I I i I � 1 I EXISTING DRNNFIELDS FASTING SEPTIC TANK CARPORT \ ALASKA «'ATER & `VASTEWATER CONSULTANTS, INC. 6901 DFRARR ROAD. SUITE dR • ANC.ORAGF. AK 99506 • RNONF (901)331-0179 • FAX (907)316-3766 PREPARED FOR: PHONE NUMBER: STEVEN CRISWELL 694-3087 LEGAL DESCRIPTION: RIVERVIEW ESTATES SUBDIVISION; LOT 1, BLOCK 4, TYPE OF WORK: SITE PLAN FOR WAIVER PACKAGE 9/19/2002 DRAWN BY: C.J.G. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION l� DIVISION OF ENVIRONMENTAL HEALTH I Q CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVALi� l OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application DatezL'3/�& 1, GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 1 BLOCK 4 RIVERVIEW ESTATES SECTION 20 T14W R1W Location (address or directions) (b) Applicant Name H.U.D. Telephone: Home n/a Business 563-3333 Applicant Address C/o ASSOCIATED BROKERS 640 W. 36th AVE. ANCHORAGE AK 99503-5807 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other 0 (explain); - U.S. DEPT. OF HOUSING & URBAN DEVELOPMENT (d) Lending Institution Address Telephone (e) Real Estate Company and Agent CALDWF L BANKER - SAPm BOYD Address 4105 TUDOR CENTRE DRIVE. ANCHORACF AK 99508 Telephone (f) Mail the HAA to the following address: PICK UP BY ENGINEER 2. TYPE OF RESIDENCE Single -Family ® Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well 51 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of E=nvironmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 10 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (17,84) Page 1 of 2 5. ENGINEERING FIRM PROVIDINt ISPECTIONS, TESTS, FILE SEARCH, DA. 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 EAGLE RIVER ENGINEERTING SERVICES Telephone 694-5195 Address P.O. BOX 773294 EAGLE RIVER AK 99577 Date yzlwelp l 0� tm 4,m:ts y aa �'a 0 �ngineer's Seal ooaaaoo u.�� (� 4 9 4 ......... s• A ®C o Louis A. Butera .° Y d iP%,o cc -6736 �.�SFD )C ooO=eo aaeo°'��GCd 0TESStOy�,`'' 6. DHEP APPROVAL Approved for bedrooms by �/� 2 Date L Approved _._ Disapproved Conditional Terms of Conditional Approval dhe� CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CF W.V1 ,,j§,TORFtf2SRUARY 1984 MUNICIPA0 � $ ENVIP'ONMv tEN ALSCRVICE� Legal Description: 13 lriw Ser- A. er A. WELL DATA I` I'E.0 Well Classification �/`T/��F If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed 71710 Yield 45- 6 -,"— Total -," Total Depth 88 l-' , /&3 Cased to y °m °+ Depth of Grouting Static Water Level /d•c15%�� i� �r�^S Pump Set Atef�e�1'2 Casing Height Above Ground /G` Electrical Wiring in Conduit (Y/N) y Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots 11 /V To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole_ j"�F To Nearest Sewer Service Line on Lot Water Sample Collected by %-NSi^ ; Date 40 Water Sample Test Results �o /, rCur.. = O ca.. J- /+/ * fc = Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size ayG/ No. of Compartments Standpipes (Y/N) y Air -tight Caps (Y/N) % Foundation Cleanout (Y/N) A/ Depression over Tank (Y/N) N Date Last Pumped Ak"'/.2, /j'F'S� J -Rs Pumping/Maintenance Contract on File (Y/N) ;for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) N� — Separation Distances from Septic/Holding Tank: To Water -Supply Well /Uo' To Property Line i To Water Main/Service Line Course 71-/ao Comments Pagel of 2 72-026(11/84) To Building Foundation _30 i To Disposal Field 3 To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata % 3� �� Type of System Design Date Installed Length of Field 33 u�yrtidQ Width of Field 3��s� Depth of Field 5 - Gravel Gravel Bed Thickness Square Feet of Absorption Area r Standpipes Present (Y/N) ILI Depression over Field (Y/N) Results of Last Adequacy Test N Date of Last Adequacy Test 6ee / ®risiuti/ TreNr.� r -Yeo( aY' /die ��04c.h�� d2i3rp y,��,-�� Separation Distance from Absorption Field: To Water -Supply Well `SOD To Property Line 'lo To Building Foundation -Sa To Existing or Abandoned System on Lot 15 ; On Adjoining Lots To Water Main/Service Line '`'� To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course "I f" '� To Driveway, Parking Area, or Vehicle Storage Area ?20 '� Comments 'ex�rt,:s ��spS.ucLe D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed _��- Date Company MOA No. S✓ ��6J� Eagle River Engineering Sarvicos P. 0. Box 773294 Q (7 Receipt No. P. le River AK 99 5195 7 Date of Payment 694-��) Amount: $ __ �% - d n " oo; ` �? Engineer's Seal Page 2 of 2 72-026 (11/84) (�OO•J4 �'.:'VJur.� OCOSr G'C'rn 1 ^. •c4 GeO0CJC op oU[l l'*oe coo ao Goo- V Ci -6736 o ,' N1" 1 J0o °(, - MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTI-1 & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) I; ri i 0 6 1985' CHECKLIST - FEBRUARY 1984 284-4720 Legal Description: A. WELL DATA Well Classification If A, B, C,, D.E.C. Approved (Y --- Well Log Present Date Completed 7�7�8 d Yield f a f - Total Depth 8040t �— Cased to Depth of Grouting Static Water Level` Pump Set At er (- Casing Height Above Ground _ Z3 Sanitary Seal on Casing M - Electrical Wiring in Conduit aml Depression Around Wellhead t7 Separation Distances from Well: To Septic/Holding Tank on Lot 3 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot / b S ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole __1Y 44 To Nearest Sewer Service Line on Lot Water Sample Collected by�f 4Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 9 6d Size �� No. of Compartments Stand pipes&'�N)- Air -tight Cape Foundation Cleanout j" 6 Depression over TankDate Last Pumped `�`- :�� Pumping/Maintenance Contract on File (Y/N) — Ale for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) --%4714-- Separation Distances from Septic/Holding Tank: �0 1 7 - To To Water -Supply Well ,�L� 7 To Building Foundation To Property Line �� To Disposal Field To Water Main/Service Line ��A-I - To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I4 O 012- �] Type of System Design Date Installed V - S- 8 Length of Field Width of Field *� Depth of Field Square Feet of Absorption Area Depression over Field Gravel Bed Thickness rs L! ,/d Standpipes PresenaY/#)- Date of Last Adequacy Test S-- _8 S— Results of Last Adequacy Test LFI-O-"ro 2L/ Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation �D f To Property Line To Existing or Abandoned System on Lot A.Z ; On Adjoining Lots /�,�i� To Water Main/Service Line zzk To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /l To Driveway, Parking Area, or Vehicle Storage Area. - Comments D. LIFT STATION Date Installed - Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Maghole/Access (Y/N) — [Pump Off' Level at Vent(Y/N) g Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed t 3 �1CfIfi1�Hil,' c Date Compaq,rz RVER, ALASKA 2i`"r57r MOA No. 00 3 Receipt No. J �c4SZC�ct Date of Payment F-) --(r) -`( 5 Amount: $ L) `; O_Q Page 2 of 2 72-026 (M84) OF A4 ,tine •• 6• a +• •°O <�°° * LY'r iWbotl A. 5hafor �+••n No 1497-� �� 6Y°4U •tl• Air nYGV 5. LEGAL DESCRIPTION DH rE RECEIVED INSPECTION APPOINTMENTS / TIME TIME TIME 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS DATE DATE DATE ED ---Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six INSPECTOR INSPECTOR INSPE TOR WELL LOG. A well log is required for all wells drilled "'\ 'c'LL since June 1975. For wells drilled prior to that date, give well ,rMUNICIPALITY OF ANCHORAGE ' 1 MUNICIPALITY OF ANCHORAGE nrpT OF I P°i-Ta ^- ENVI, -. !i 6E6ARTMEFN7'OFIHEALTH & ENVIRONMENTAL PROTECTI 825 L Street -Anchorage, Alaska 99501 0 1%"P j ENVIRONMENTAL SANITATION DIVISION "`J 719852 RECEIVED Telephone 264-4720 rr� �� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWL��AL�LIII°IAD DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 16c_ rrL _.- 2. BUYER r %?.Q PHONE MAILING ADDRESS C)c%Y C/CJo D 5c C.E�i., �t 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT - PHONE C"-%-(/_�i Z'N ill i— 1{-r-'=✓�!'G`L°� .L MAILING ADDRESS 5. LEGAL DESCRIPTION / STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS El"SINGLE ❑ One ❑ Four Cl Other FAMILY ED ---Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ID'INDIVIDUAL-ATTACH WELL LOG. A well log is required for all wells drilled El COMMUNITY �1 COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM LIT-- INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72010 (Rev. 6/79) kD 0 Lo L� V) 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: I 06t'_',, If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS . t1- APPROVED FOR 3 BEDRO`O/MS y_1CJ) ❑ CONDITIONAL APPROVAL (letter must accompany certifi te) LJ---DISAPPROVED DATE BY 72-010 (Rev. 6/79) Tj -vi ('111r) I 1,-Ja or 0`1(1i c't I, uloi� to Hlv�rCa1 1 e�F'ji-la arr1.11 vloll')I—icm 111-t I)c tll( L COrl";JAit i o 1.-v r�,, 'L f 1 r"por L n Vc) 1�n mlb.IiLtod U) i 01,11' .-0 V 1, OV., c o llho O)ol-.1 J 'Wo, o n, 2 C, . ; i TYLE: 1'-' 1.'1,, A �;pccin L i.,, INSPECTION APPOI INSPECIUN R MUNICIPALITY OF ANCHORAGE ICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION • ENVIRONMENTAL SANITATION DIVISION OCT7 1980 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWREE VEE® DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE 1. PROPERTYOWNER MAILING ADDRESS /f PROPERTY RESIDENT (If different from ahove) 2. UYLK _0 9 U / v �- C- 6?le= MAI LING ADDRE86 ILING AD s /�'' REALTOF MAILING ADDRESS 5. LEGAL DESCRIPTI G Ask 21� SINGLE FAMILY ❑ MULTIPLE FAMILY 7. WATER SUPPLY ® INDIVIDUAL* ❑ COMMUNITY ❑ PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM Lel INDIVIDUAL/ON-SITE** ❑ PUBLIC UTILITY /i!�a/C�T E ❑ One ❑ Four ❑ Other ❑ Two ❑ Five 0' Three ❑ Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 094� 1i AA ! JO i�di THIS SIDE FOR OFFICIAL USE ONLY rYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY PERMIT NUMBER ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY ❑ PUBLIC UTILITY DATE DRILLED Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY DATE INSTALLED Connection Verified ❑Septic Tank or ❑ Holding Tank INSTALLER SizeIf Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS 6-5 ❑ OTHER rption Area ISevder LineNearest Lot Line APPROVED FOR 3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED 72-010 (Rev. 6/79) 825 .,L., STRE_:ET ANCHORAGE, ALASKA 99501 (907) 2.644111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT" OF HEALTH AND f_NVIRONMENTAL PRO'rE.CTION October 10, 1.980 John L. Gross Post Office Box 1161 Eagle River, Alaska 99577 Subject: Lot 1 Block 4 River View Estates Subdivision Approval for your individual sewer and water facilities cannot be granted until the following items have been (completed: �n (1) A well log submitted to this department for our \ review. (2.) The water analysis report be delivered to this ,(,L - department from Chem Lab, 5633 B Street, for our review. If there are any further questions, please call this department at 2.64--4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska National Bank of: the North 3201 C Street r Calais 11 99503