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HomeMy WebLinkAboutSCHROEDER EAST BLK 6 LT 18`° �So-ora-3v MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 �s ~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/Ofi—Wfttk INSPECTION REPORT PH/O�NE NEW NAME G� J�/ ,S Jl`j— ❑UPGRADE d'""rI C — MAILING ADDRESS 9e" ' � ? :1 c� cl !^�S• i �C/cam* ��%i % 'S � � LEGAL DESCRIPTION ,t / L f /O .C.7 /� �/[ �C- A rU t?clLv _4J t `R��(N 7 fig/LSA° vZ /ir/ r�G LOCATION NO. OF BEDROOMS -71 /: Well Absorption area Dwelling/o PERMIT NO. r DISTANCE TO: �O U '� f Uy Q Manufacturer Material mi / c� No. of com p�a5rtments w r N ~ Liq. caf�acit in gallons Inside length Width Liquid depth a IF HOMEMADE: —� Well Dwelling PERMIT NO. 002 DISTANCE TO: _ O Z Q Manufacturer Material Liquid capacity in gallons _ . b Well Foundation Nearest lot lin�� PERMIT N0. y 9 7 DISTANCE TO: DISTANCE AGO wV w LL 2 Lu No. of lines / Length of each line 6—Y Total length of lines .S—S` Trench width 3 P inches Distance between lines Nom_ ~ q p.. Top of file to finish grade Material beneath tile 7 / Total effective abso ption area 7s3- P _RP Length Width Depth fP--E I T N0. Lu QTotal Q I— Type of crib Crib diameter Crib depth effective absorption area P as w LU Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot linePERMIT NO. J w Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: a,g. OTHER PIPE MATERIALS /RIro et SOILTESTRG INSTALLER REMARKS 1� r F% 4 �. �Nrd •'�' 4+�, "• luiJE ZS, 1971he '^ u APPROVED DATE LEGAL �/ �� ��// b SG O)YeJ•tdNr GfJ�F'���*'1!. -I n.0 II_.. 1,l o, ** GRAVEL LENGTH > 75 FT" REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT, EACH) ** TANK 1%1011 HAVE AT LEAST TWO COMPARTMENTS ��..... ... ... .... ... ... ������.... �..... ����������~�� I certi{y that: 1. I Imiliar with the requirements for on-site sewers and wells as set �orth by the Municipality of Anchorage (MOA> and the State of Alaska. DEPARTMENT I will in�tall the OF HEALTH AND ENVIRONMENTAL PROTECTION regulations, 825 L FV! REET� ANCHORAGE, AK 99501 3" I will adhere to all MOA and 264~4720 requirements for the set back Mohl existing well, wastewater 1:~1-K W FSTAT EE H NVEE FRIP11 X PERMIT NO: 840977 adjacent or nearby 4. DATE ISSUED: 12/14/84 is valid for a maximum u 4 bedrooms awl APPLICANT: JOHN DAIGLEY an additional permit. IF A ADDRESS: BOX 773294 AN AREA COVERED 8Y MOA BUILDING ' CODES� (1) AN ELECTRICAL EAGLE RIVER, INSPECTION MUST Al-': 99577 AS-BUILTS WJLL CONTACT PHONE: 694~5157 INSPECTION / (3) THE ELECTRICAL LEGAL DESCRIP: SUBDIVISION: LICENSED ELECTRICIAN" SCHROEDER EAST ADDN LOT: 18 8LOCK: 6 SECTION: 1 TOWNSHIP: 14N RANGE: 2W LOT SIZE: 20868 (SQ,FT. OR ACRES) LOT LOCATION: PRINCE OF PEACE MAX BEDROOMS: 4 Listed below are the options availabIe to you in designing your septic sysLem. Choose the option that best fits your site, �11WIF:4�������� DEPTH TO PIPE BOTTOM (FT.) 4.0 4,0 4.0 GRAVEL DEPTH (FT.) 7.0 0.5 3.5 TOTAL DEPTH (FT.) 11.0 4`5 7.5 GRAVEL WIDTH <FT.) 2.5 24.0 5.O GRAVEL LENGTH (FT.) 54.0 47.0 81.0 ** GRAVEL VOLUME (OU. Y1353. 37"5 41.8 60.0 TANK SIZE (("iALS) :1. 2!.--i(::) ** 1,250.0 ** 1,250.0 ** SOIL RATING <SQ"FT./BR> 188 188 18B ** GRAVEL LENGTH > 75 FT" REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT, EACH) ** TANK 1%1011 HAVE AT LEAST TWO COMPARTMENTS ��..... ... ... .... ... ... ������.... �..... ����������~�� I certi{y that: 1. I Imiliar with the requirements for on-site sewers and wells as set �orth by the Municipality of Anchorage (MOA> and the State of Alaska. 2. I will in�tall the system in accordance with all MOA codes and regulations, and in compliance with the design criteria o[ this permit. 3" I will adhere to all MOA and State of Alaska requirements for the set back distances �rom any existing well, wastewater disposal system or public sewerage s;stem on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum u 4 bedrooms awl any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED 8Y MOA BUILDING ' CODES� THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WJLL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" SIGNED DATE: � _ -��� APPLICANT: JOHN DAIGLEY ' WSW) BY DATE: / ���.....~��-�^_�~~_� ❑ OILSLOG q -� I 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: JuAn _ Agit� DATE PERFORMED: c� L� i i v w? t._� sc ! LEGAL DESCRIPTION: L f1 it` ICI ylj`L 1-ueaej,,. 5�4�,(y ,(�._,�� j- I�-I SLOPE SITE PLAN 2 3 4 Date Gross Time 5 Depth to Water Net Drop = " 6 ' lgo 51-7 9- 2'. z 10 11 12 13 14- 15 16 17 =/ 18 s 19 V'";',', f 22.25-E: ' Q JUNE Z5, o-/1 20 WAS GROUND WATERS ENCOUNTERED? �� L 0 P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop pe e'.•,I 51-7 2'. z •i -tl-, _ - - PERCOLATION RATE_ _(minutes/inch) TEST RUN BETWEEN FT AND �� FT COMMENTS }e S -f- /oet c, hole . S� .: f -/-,- t- lio/e .D O?u i PERFORMED BY: s k k' -et CERTIFIED BY: DATE: / 72-008 (6/79) =r� / ..... v �!i "Uj ...... ��� �� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET� ANCHORAGE, AK 995O1 264~4720 it ~� PERMIT NO: 850088 DATE ISSUED: 04/05/85 APPLICANT: LYNN PRICE ADDRESS: P O BOX 771228 EAGLE RIVER, AK 99577 ` CONTACT PHONE: 276-1131 LEGAL DESCRIP: SUBDIVISION: SCHROEDER EAST L�T: 18 SLOCK: 6 SECTION: � TOWNS�IP: 14N RANGE: 2W LOT SIZE: 20000 (SQ.FT" OR ACRES) LOT LOCATION: PRlNCE OF PEACE DRIVE I certi�y that: am {amiliar withthe requirements �or on~site szwers and wells as set �orth by the Municipality o� Anchorage (MOA> and the State o� Alaska. 2. I will install the system in accordance with all MOA codes and regulations� and in compliance with the design criteria o� this permit. 3. I will adhere to all MOA and State o{ Alaska requirements [or the se� ba�k distances rro!it any existing well; wastewater disposal system or public sewerage system on this or any adjacent or nearby lo�. APFLI[�ANT: LY�N PRICE ISSUED Oct0bor 124r 1977 V76880 'R I d.chard cram Boy. 10o PAI-ch-OMUer Alaskaa 99510 Sub- ect: Porfilil-. rlxr3iratio, Dear 1,.;.r. Crain A pexialt ismy�(j b Vor on f y t1lir:� Cif; 'Wilt fal: WPM allf 'KIWOr instaIJ ation on Lot .1.3 r ,) ]-I.- expired sincc, t1lic yo.�Jr. � clatc, cycce(lri 0110 OV(Mt YOVa f1tJ 111 plan t',AO WO -11 and/or oll-aitc! aystmaj, a no -w pormit is rocfuir(o. Tli(, soil test Indy be t1s)o(Ito abLain a ciku,.1-0,1AG pon"ite If 010 WO -1-1. has bQ(.,xi dl:illedf a well lou should bc� SoIlL to -tl1.1 - �LCTUJI�tvzAOVA', tO dOCIMU-11t tjjk:' ill.at c ,UvIl'Ition date. X f -e any Cpocr-tiow� regarding the ahow T"lattarp plowit.) you 11C 'r (10 not 110sif.:atct to contac-1- thif; Officc! bq.111060Uatoly at 264-4720. Sincernly, Lf!,q N. Duchholze, P",:" Sanitarian Iwo kj 6 4 0 11 IC; Jl_ F: 111 . ..... 1� d " ir " lf�l TW ���I, ;I F�i:!! 11 F��'_ DEPHRTMENT HEHLTH HND ENYIRONMENTHL OTECTION �'� 2516 E. TUDOR RD. HNCHORHGE/ HK, 99507 276~2221 PERMIT NO ( 76880 ) HPPLIII: HNT HHRD CRHIN BOX 100 279~0691 LOCATION PRINCE OF PERCE DR LEGHL L18 B6 SCHROEDER SUBD EHST HDD LOT SIZE 21780 SQUHRE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS � ] "of IL. IRA HIM (SQ FT290 THE REQUIRED SIZE OF THE SOIL ABSORPTION S INS ���W.H EG; I if" if P� � THE LENGTH DIMENSION IS THE LENGTH (I EET> OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TREN I�THNCE BETWEEN THE SURFHCE OF THE GROUND HND THE BOTT IN FEET) THERE IS NO SET WIDTH FOR TRE THE GRHVEL DEPTH IS OF GRHVEL BETWEEN THE OUTFRLL PIPE HND THE BOTTOM OF ITIE I,A FEET) Roo 10K2 I -:::: F-1 F_ -H.: 11=," IL... 1 If F.,o EITHER H CLHSS I O I I 1,113F AW ROVEI) PLHNT MAY BE INSTHLLED. H CONTINUOUS MHINTE ENT IS REQUIRED. IF H MRINTENRNCE HGREEMENT IS NOT KEP OU MHY BE REQUIRED TO EN|,HRGE THE SUIL HBSORPTIUN SYSTEM HND Y BE Sl 8JECT TO PROSECUTIUN. IF H CLHSS I SYSTEM IS USED THE LENGTH IS 45.0 FEET. IF H CLHSS II SYSTEM IS USED THE LENGTH IS 5 0 FEET. W 11 A01:1 Do 110,111511=51FE113:0- X 11101AF; 0=1 lot EF ��H ...... h v� BHCKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL 8Y THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN H WELL AND HNY ON~SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 200 FEET FOR R PUBLIC WELL SPECIFICHTIONS RND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTICV. WHIM39wUX W :01 Q V CIA 04? CJ 141 Q mvp PER: FTH IF?: ITT Q CA Two PE !0 so I CERTIFY THHT 1� I HM FAll ILIAIR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTHND THHT THE ON~SITE SEWER SYSTEM MAY HEQUIRE ENLRRGEMENT IF THE RESIDE DELED TO INCLUDE MORE THHN ] BEDROOMS SIGNED� ___~~~_ ���PLICHNT RlCHHR". CRHIN 0 Et E GEO .. ;CHNI CAL Ef DEVEL. PMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name:. Tel. No. 7� Mailing Address:,,k6 Legal Description: RektLifeetj Soil Characteristics 0 �e `��.� ... �� ; ,-, C —�+ 4=�?'��,1✓ V.�.l \^�.�3r'\�'i �l �–J K,�-, � �'1 \ c -'.S 1� / �� �i%.._ 2 3 4 5 8 Y y.t?ch ,til r�} LSP z A 9.� 10F��,_�-.%.('�\__'�\-�-.c),�"3D 11 12 13 14 15 16jZ�i%� Ground Water Encountered: Yes---- No If yes, what depth_._ Proposed Installation: Seepage PitDrain Field Comments:-- c�.�•v���,ti 3' , �' e� �a Performed by: Date:4 -(.� ��� '77 'z'irg"Aa'j�1 I iN - �� ppp / t Al o r j� n ..jr• ��C��G a 3G to ' clpA F r� p NVAN 6 -N- ONA46 rr, FA1. ri! 117 t ' r pROpFcrlo -� APf q IV CE �. �` 7G � ...�,,,�•�..�„ III,,,/ �� - r'�<J ^ r Y 0 � 4/ � � j tl.rv( f f •j� k,.r � r / �/ - .. ire+: �'�e `� `• ///� � 3 L f tea; _ - ' • " j �J SAP -1 COTTEN DIMLLING Co. _ _ '"' /!S' L�'�!c ;•/er, :1laal a 99577 i1 y(`—S h .s 3 s e_.-� .e xl .t f[ . R- �i'•""�_.'�'�...s.__...�. �#+7 i .� ,!.''.. �j. E --,f if�f�.F „. i:i S 'e���li��:.� , 7s � .:.-., :: -.- ...... "'-"_•�.��._._a ��C: A[ R��� DEPHRTMENT HEALTH �ND ENVIRONMENTRL }TECTION 2516 E. TUDOR RD/ HNCHO1:--.!AGIH'/ 171 99507 276~2221 HPPLICANT LOCHTION IyE BOX 100 PRINCE OF PEHCE E. 27g.06g1 LEGAL L18 56 SCHROEDER-`UB (EHST �DD LOT SIZE 21840 SQUHRE FEET MINIMUMTDISTHNCE�BETW�EN H WELL HND HNY ON�SITE SEWHGE DISPOSRL SYSTEM IS J. ,�L.E: EGSr"�E�Rr��YM|E WELL OR �00 FEET F�R H PUBLIC WELL WELL r" HND MUST B� RETU�NED TO THE DEPHRT ENT WITHIN ]0 DHYS SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER F:" Co g,q F�i-. - F -R: 11 Jim:������� I CERTIFY THAT 1RIHHMyFAMILIRRIWITHLTHE RE�UIREME�TS FUR ON�SITE SEWERS AND WELLS RS SET ~ T " ///� .�/w� ��r� ||Y OF HNCHORHGE 2� I WILL I SYST WITH THE CODES SIGNED� nrrI- 1: CMy,I| RICHHRD D. CRHIN ISSUED B MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE: (907) 564-2762 WASTEWAOrER CONNECT PERMIT 95-0106 DATE OF APPLICATION 04/24/95 SCHEDULED COMPLETION DATE 12/31/95 BLOCK/LOT/TRACT BLK 6 I.T 18 x SINGLE FAMILY SUBDIVISIONSCHROEDER EAST [] MUTI-DWELLING No. APTS� COMMERCIAL TAX CODE 5006230 GRID NW 352 AS -BUILT q STREET.ADDRF_SS 12445Z PRINCE OF PEACE DR OWNER WARD JAMES A JR; 6 MARY G PHONE 'GLE,RIVEtA,X °99577=1218 CONTRACTOR [] Repair Existing Servico [] City Tap F] On Property Only [] Hydrant Only [l 50' or Longer ❑ Main Tap - To Property Line Only E] Main Tap & On Property Connect ] Disconnect [j:R&R 17 Main Tap.Only_ ..... . CONNECT SIZE, F INSPECTION'FEE $ 104.00 PERMIT FEE $ 35.00 REIMBURSIBLE NUMBER DEPOSIT $ 0.00 TOTAL $ REMARKS Hook-up to sewer ok per Skip Edinger in Engineering, Assessments, Need Owner's Signature per Skip No City Water Available at this time ... sp ASSESSMENTS [] Main Line Extension ® Have Been Levied x� To Be Levied comments: Owner Staff�� ISSUED BY SAP x0 PAID 0 { E] CHECK#_ INSPECTED BY 139.001 DATE / / PERMITEE (Please Print) James A Ward PHONE 907-552-2805 e� MAIL.ADDRESS 12445 E Prince of Peace Dr Eagle River AK 99577— POST IN A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR Copy # 2 • _ _ _■ Deportment of Public Works MUNICIPALITY OF ANCHORAGE Department of Public Works 3500 E. Tudor Road, Anchorage, Alaska 99507 (907) 786-8240 STRLWr CLOSURE AND/OR RIGH -OF -WAY RESTRICTION POWIT ■ w— — Deparunent of Public Works •�wl�l• REQUESTOR:� TWEED EXCAVATING SUITE 204 DATE:28-APR-95 LOCATION OF INSTALLATION OR CLOSURE: 12445 EAST PRINCE OF PEACE DRIVE OFF SANTA MARIA DRIVE LOT: 18 BLOCK: 6 SUBD: SCHROEDER EAST' DESCRIPTION OF FACILITY AND/OR RELATED NEW CONSTRUCTION: SEWER SERVICE INSTALLATION **CHANGE: 5/3/95 8:00 A.M. TO 5/3/95 1:00 P.M.** DATES OF WORK: 5/2/95 8:00 A.M. TO 5/2/95 1:00 P.M. TYPE* OF STREET CLOSURE OR TRAFFIC R -O -W RESTRICTION(S): PARTIAL CLOSURE '1141FULL CLOSURE - MUST PROVIDE EMERGENCY AND LOCAL ACCESS** REQUIRED DETOURS AND SAFETY DEVICES IN ACCORDANCE WITH U.S.DEPARTMENT OF TRANSPORTATION "UNIFORM TRAFFIC CONTROL DEVICES." TWEED EXCAVATING **WARNING LITES OF ALASKA** REMARKS: The undersigned agrees to erect signs, barricades and detours as 8ti1)ulnted accordance with U.S. Department of Transportation "Uniform, Traffic Control Devices." It is further agreed ,that if above detours, signs and barricades are not, erected as specified, the Municipality of Anchorage may correct sante and collect the cost thereof from the requestor . NAME OF PERSON IN CHARGE: BOB SCHAFER TELEPHONE: 694-2979 COMPANY: TWEED EXCAVATING ADDRESS: 17034 EAGLE RIVER LOOP ROAD X (SIGNATURE OF APPLICANT) TRAFFIC ENGINEER BY: R -O -W PERMIT//: 95-0203-00 STREET CLOSURE NOTIFICATION: ANCHORAGE FIRE/POLICE DEPAR'T'MENT SCHOOL BUS PEOPLE MOVER PUBLIC INFORMATION OFFICE -Jf 80-006 (1 10/86) 1 f/ ■ Deparunentof Public Works MUNICIPALITY OF ANCHORAGE Department of Public Works 3500 F. Tudor Road, Anchorage, Alaska 99507 (907) 786-8240 - POST IN CONSPICUOUS PLACE - . Tram r. , Ix7AX7 YIQ 'i' Dt,M4FT Nn! Department of Public Works 95-0203-00 ISSUE DATE: 28 -APR -95 GRID: NW 252 PAV NT BREAK?—N TYPE OF WORK SEWER SERVICE INSTALLATION LOCATION OR ADDRESS 12445 EAST PRINCE OF PEACE DRIVE OFF SANTA MARIA DRIVE LOT 1-8 BLOCK: 6 SUBD: SCHROEDER EAST — _-- — PERMITTEE: TWEED EXCAVATING SUITE 204 ADDRESS: 17034 EAGLE RIVER LOOP ROAD, EAGLE RIVER, AK 99577 CONTRACTOR: TWEED EXCAVATING ADDRESS: PHONE: 694-2979 CONSTRUCTION START DATE: 2 -MAY -95 WARRANTY PERIOD: APPROVED DRAWING ATTACHED? N BOND OR LICENSE NO. ON FILE? Y PROJECT -NO: N/A AS BUILT REQUIRED? Y FILE -NO: N/A CC -NO: N/A ---- -- -- ---- FIELD INSPECTION AND NOTICE REQUIRED 48 HOURS IN ADVANCE COMPLETED INSPECTED BY: DATE: (.Paving and/or sealcoat removed From streets and alleys during construction must be patched immediately with temporary cold mix if permanent patch cannot be made. Permanent paving, sidewalk and curb/gutter must be replaced within 7 working days after underground work is completed. 2.Construction shall be to standard specification. 3.Prior to construction (24 hr. notice) and final inspection call St. Mitint. 786-8206 REMARKS: WINTERTIME SPECIAL CONSTRUCTION REQUIREMENTS ATTACHED. TYPE OF FEE AMOUNT SERVICE $ 100.00 ------ __-SEWER --- - - ----- —-- CLOSURE $ 100.0 _ROAD INSPECTION FEE _ -------- - _ REFUNDABLE PAVING DEPOSIT: _ $ 1500.00 TOTAL FEES & DEPOSITS: $ 2020.00 DEPOSITS RETURNED ( ) $ — METHOD OF PAYMENT: CASH RECEIVED: $ 0.00 CHECKS: #1: 1893 AMT: $ 520.00 #2: 328393 AMT: $ 1500.00 CHARGE BACK: UTILITY CO: NO: `FEES RECEIVED BY: CL DATE: 28 -APR -95 I HAVE READ THE ABOVE APPLICATION AND KNOW THE CONTENTS THEREOF, THE SAME IS TRUE AND CORRECT. I FURTHER, AGREE THE ABOVE WORK WILL BE DONE IN ACCORDANCE WITH ALL STATE AND MUNICIPAL LAWS AND ORDINANCES. X Signature of Permittee or Agent (i II Su-uzu t1Anv.L/0/) U-, LU - / I 1 1. 1- .. ., cm \�° w . i v �cJ Lu LL, ca p ® r LL � � C r CC X E � z i o � v J C z H C/a y ra z � � C MUNICIPALITY OF ANCHORAGE 0* DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section 44 P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. #(` 1. GENERAL INFORMATION HAA #_ r; A LE�4,(—,I(c Complete legal description Lot 18; B.2ock 6 • Sehnoe.de.n East Subdivi,5ion Location (site address or directions) 12445 E. 'Lince. o� Peace. Eagke, Riven Property owner )i1n 9 Many Wand Day phone 696-5623 Mailing address 12445 E. P ,iripo c,4Peaee. _ EAg2e. Riven, AK 99577 Lending agency Mailing address_ Agent Tom _Ste,tg !eman/ DYNAMIC PROPERTIES Day phone Day phone Address 3111 "C" Sne.et Suit 100 Anchonaae AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 261-7600 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank — Community on-site Public sewer�— NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSF __:TION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm — S & S ENGINEERING Phone _ 6 °y 17034 Eagle River loop Road No. 204 Address Engineer's signature 6. DHHS SIGNATURE / _ Approved for ? bedrooms. Disapproved. Conditional approval for Additional Comments By: 11ITIC Date r / y / q S— 7!7 I ! 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 courtesyto 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. 7M25 (Rev. 1191) Back MOA x21 Municipality of Anchorage AraL IRFM Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: !�fj-Parlcel I.D. A. Well Data Well type AiIf A, B, or C, attach ADEC letter. ADEC water system number Log present ®N) — �Date completed 1 Driller Total depth I GS ' Cased to Ly Casing height ] 10 Sanitary seal �N) Wires properly protected (VN) �./ m FROM WELL LOG AT INSPECTION Date of test j o -� to �_- Z— %S ' s p Z K v — Static water level m r Well flow 0 , S g.p.m. _ /,/ g.p.m. '" v Pump levellyl� ��i n C n 7 c SEPARATION DISTANCES FROM WELL TO: N n p Z Septic/holding tank on lot 1-1// ; On adjacent lots _ I ov _ f Absorption field on lot �; On adjacent lots _ /oo Public sewer main /DD Public sewer manhole/cleanout /Dei Sewer service line c?S f Petroleum tank :W5- / 74 WATER SAMPLE RESULTS: Coliform D Nitrate 01/s Other bacteria U Date of sample: 3-d 9 - 9-s- Collected by: S S E,/ , �.✓r�,e „`/ S B. SEPTIC/HOLDING TANK DATA vJ?-«_ SF -- -q S' Date installed Cleanouts (Y/N) Tank size Foundation cleanout (Y/N) High water alarm (Y/N) Alarm tested Date of pumping SEPARATION DISTANCES FROM S Well(s) on lot adjacent lots To property Imo/ Absorption field Surface water/drainage TANK TO: Compartments Depression ndation Water main/service line 72-026(3M)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) ,Pump on" level at ,,Pump off" Level at High water alarm level -- Cycles tested _— Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed On adjacent lots Length Width Total absorption area Date of adequacy test — Water level in absorption field before test Peroxide treatment (past 12 months) V41 SEPARATION DISTANCE Well on lot_ To building fou On adjacent jo drain E. ENGINEER'S CERTIFICATION water Soil rating (GPD/Ft2) System type Grckness Total depth leanout pre Depression over field (Y/N) _R� Its (pass/fail) for Bedrooms ABSORPTION FIELD TO: After test -- yes, give date On adjacent lots Property line To existing or abandoned system on lot Cutbank —Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on,,!he e of this inspection. OF ACt�s Signature I N: /6 t l�c�/3 rL/t C COw.4r✓"r' ¢ .. Engineer's Nam880 1 e - ROBERT C, COW Date HAA Fee $ �� �� r> Waiver Fee $ Date of Payment �� Date of Payment Receipt Number L7,S Receipt Number CT&E Environmental Services Inc. Laboratory Division L b t A l S CT&E Ref.# 95.1145-1 a ora ory na yss eport Matrix WATER Client Sample ID L18 BLK6 SCHROEDER EST S/D Client Name S & S ENGINEERING WORK Order 13519 Allowable Ext. Anal Ordered By R.J.S. Printed Date 03/31/95 @ 16:46 hrs. Project Name Collected Date 03/28/95 @ 14:00 hrs. Project# Received Date 03/29/95 @ 10:30 hrs. PPISID UA Technical Director STEPHEN C. EDE Released BK' -' Sample Remarks: SAMPLE COLLECTED BY: RAY QC Allowable Ext. Anal Parameter Results Qual -------------------------------------------------------------------------------------------------------------------- Units Method Limits Date Date Init Nitrate-N 0.13 mg/L EPA 353.2 10. 03/29/95 OAA * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U= Undetected, Reported value is the practical quantification limit. LT = Less Than D= Secondary dilution. GT = Greater Than 200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY. OHIO. WEST VIRGINIA 05/12/95 16:03 COMMERCIAL TESTING - 9076941211 NO.457 D02 J L ME Environmental Services Inc. z Division �y CT&E Ref.ft 95.1845-1 Laboratory Analysis Report Matrix NATER Client Sample ID L18 136 SCHROEDER EAST SID Client Name S & S ENGINEERING WORK Order 14615 Ordered By BOB COWENS Printed Date 05/12/95 ® 16:51 hre. Project Name Collected Date 05/10/95 9 14:10 hre. Project# Received Date 05/11/95 9 10:45 hra. PNSID UA Technical Director STEPHEN C, tDE Released By wif-- Sample Remarks; SAMPLE COLLECTED BY: RAY. �— QC Allowable Ext. Anal Parameter Results Qual Unita Method Limits Date Date Init ---------------------- ----------------------- Nitrate•N 0.10 U Ing/l, RFA 353.2 10. 05/12/95^ CMR See Special Instructions Above '{ UA-6Unaveilablr_s y'^ See sample Remarks Above NA Not Analyzed ,V;s Undetectod, Reported, value is the practical quafltification litnit. LT - Less Than 15 - Secondary dilution- GT ^ Creator T11a11 200 W. potter Drive, Anohorege, AK 99518-1605 — Tel: (907) 5622343 Fax: (907) 561.5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI NEW JERSEY, OHIO, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES -i 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. # _L!��Cz_f C:L 7r HAA # 1. GENERAL INFORMATION Complete legal description Lot it; Brock 6; Schitoeden East Subdivizion Location (site address or directions) 12445 East Pn,%nce oA Peace Property owner Lynn Pntice Day phone 696-2229 Mailing address 12445 East P)Lince oU Peace Eagle Raven, Ata6ka 99577 Lending agency Day phone Mailing address Agent Cindy Wilson/DUN MC KENZTE REAL ESTATE Day phond994-9035 Address 13135 U.2d Glenn Highway Eagle Riven, A2a6ka 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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 021 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 5 & s PNGINEERING Phone —1 agle River Loop Road No. 204 Address Zacile IFiva., Alaska 99577 Date Engineer's signature _ 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments M_ T,. �.% `a i ��y d�4 L•hJOtl0 i00�f�.1�AY"i 1 H4�Y AtlYtlaB .AY Y i RCGE J. 5 AF'r_R o'u i .J9 go". ho O '1 a�F�'ROFESSI���� bedrooms, with the following stipulations: Date /0—/—?2 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. 1/91l Back MOA x21 Municipality of Anchorage Department of Health & Human Services+ HEALTH AUTHORITY APPROVAL CHECKLIST f1S Legal Description: Lof Q 1�1—K Sc R-nFhp �R- Parcel I.D. A. WELL DATA Well type ak JA56 -_ If A, B, or C, attach ADEC letter. ADEC water system number Log present ON)y Date completed —�0 - I LP _ Driller 15 c, Total depth i cb5 Cased to ) lbw Casing height_ 12- Sanitary 2Sanitary seal Wires properly protected�Y4N) y Date of test Static water level FROM WELL LOG Z45' a Well flow C2 P5 9 -p.m Pump level Uk4__ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 100 On adjacent lots — JLC—)D �L Absorption field on lot \ 0 n ; On adjacent lots Public sewer main 4 1' __ Public sewer manhole/cleanout% Sewer service line ZS Petroleum tank WATER SAMPLE RESULTS: Loll I, Coliform _� Bpd w � Nitrate . C;)' A �� I� Other bacteria Date of sample: (� -`j 1� Collected b S S ENGINEERING y: � f�3d �roglc Rl+rerr eeq Rcfacl No Eagle River, Alaska 99577 S. SEPTIC/HOLDING TANK DATA Date installed 19 18 1q, Tank size I d �a0�'L Compartments '2— Cleanouts6'y�"/N) �� _ Foundation cleanout &N) Depression (Y6Q /J High water alarm (Y/6) 'J Alarm tested (Y/N) J4 Date of pumping 13 , 9 Z _ _ Pumper_ �: C�SS�a o L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10Q / f On adjacent lots /00'-1- To 0D'i- To property line /C) / Absorption field S Surface water/drainage I r7b \ �­ Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE ATINSPECTION _ fy) fT1 19 rn m M o 6n iii � m On adjacent lots — JLC—)D �L Absorption field on lot \ 0 n ; On adjacent lots Public sewer main 4 1' __ Public sewer manhole/cleanout% Sewer service line ZS Petroleum tank WATER SAMPLE RESULTS: Loll I, Coliform _� Bpd w � Nitrate . C;)' A �� I� Other bacteria Date of sample: (� -`j 1� Collected b S S ENGINEERING y: � f�3d �roglc Rl+rerr eeq Rcfacl No Eagle River, Alaska 99577 S. SEPTIC/HOLDING TANK DATA Date installed 19 18 1q, Tank size I d �a0�'L Compartments '2— Cleanouts6'y�"/N) �� _ Foundation cleanout &N) Depression (Y6Q /J High water alarm (Y/6) 'J Alarm tested (Y/N) J4 Date of pumping 13 , 9 Z _ _ Pumper_ �: C�SS�a o L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10Q / f On adjacent lots /00'-1- To 0D'i- To property line /C) / Absorption field S Surface water/drainage I r7b \ �­ Foundation Water main/service line 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 Manufacturer Manhole/Access (Y/N) mp off' level at Cycles tested SEPARATIQ E� ANCE: FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed I°L_" Soil rating —fib System type -r�R r /3 Ld Length 45 �- Width N Gravel thickness —Total depth <<� Total absorption area %8 S� Cleanouts present &,N) J Depression over field (Yo tl Date of adequacy test 7- I0 = i 7 - Results ss ail) 5_� for {�dJ� C�� bedrooms Peroxide treatment (Past 12 months) (Y& /``W A6, If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots loo \ Property line Well on lot )ot> To building foundation On adjacent lots Surface water \0�> k Curtain drainr"' 116, E. ENGINEER'S CERTIFICATION i;�- _Cutbank To existing or abandoned system on lot _Water main/serviceline�L Driveway, parking/vehicle storage area I• C> k V a -- I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. �� }� d+E' y1300% a t s r!V(il{Vk:ERINC ra ,,� a° t ' A 17M-4 Epcile {fver iLoop Road No. 204 Signature "q '.a lver Alaska 99577 1 Engineer's Name --; k °"A/I P. a Date HAA Fee $ -2 )_ `"i2 Date of Payment --Q I 4 - Z )- - Receipt Number `6 (91J Waiver Fee: $ Date of Payment Receipt Number (to ;r-11 J. �prQF9L;0a�fi" CHEMICAL & GEOLOGICAL LABORATORY t,. A EAVISION OF COMMERCIAL TESTING & F.NGINEERIN(I CO. 6633 G STNECT ANQF10RAVIE, ALASKA 9fW$ TELEPHONE (909) 562.2343 FAX- (9^7) 501.5301 uwiurtanr _� ANAI'I613 RISULTS for INVOICE 4 58406 Charalab Re1.4 9.4984 Sareple 1 11 Matrix: NATER Client Sample ID Lld B6 SCHROEDBR EAST S/U PW31D UA Collected SBP .19 92 t 16:05 Iv:s. R9coived : SEP 15 92 1 14:30 his. Preserved with AS REQUIRED Analysis Completed : SRP 16 92 Laboratory Supervtsor "Jp m C. EDE Released By f�a ✓�r„ Client Nom :S 8 5 ENGINEERING Client loot :3115ENOP Hot R9gt ; Arderad By :R. SHARER Sand Rsports tv: 1)3 R 3 ENGINEERING 2) P01 :BOAR RECRIVBD ...............................,..,............. ..................... ,.......n.,............. .,...................................... Parameter Results Unite Method Allowable Limits •-------..-- NITRATE-N 0 17 rW'/1 EPA 353.2 10 Snnple ROUTINE SARLB COLLECTED BT: RAY. Rai n%ks : ..n.e.r.•.+.:....-............. I ........ na................o..n.....n........nn.a.e...........—.........wwru..n...........tY\YIIIL .nnf Y��1. R11 1 Tette Perforned $ee GpaCzal Inetructivns Above UA -Unavailable ND- None Detected °' See Sample RenaL)te Aboye NA• Not Analyzed LT -Lase Than, GT•Crsater Then �f*%SGB M9iT)bnr of the SOS GrnUC (,SoclW 000ele da Surveillanco) 1�.�3 Mia 4s �1pv� 'q'q ("q�A S & S ENGINEERING 17034 Eagle River Loop Road No, 204 Eagle River, Alaska 99577 1 D -`I 2- �(� 1�.�3 Mia 4s �1pv� 'q'q ("q�A S & S ENGINEERING 17034 Eagle River Loop Road No, 204 Eagle River, Alaska 99577 A MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 2134-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) % ///v to L? 4V Jec / Si.=A�• oect er $'a 40410, –Gst �✓c�/� Location (address or directions) (b) Applicant Name h<,' rim —Telephone: Home ��G/`sf'��c� Business —_�— - Applicant Address 1001-- (c) Applicant is (check one): Lending Institution El ; Owner/builder; Buyer ®; Other E7 (explain); _ - ---- — (d) Lending Institution �,s✓tc`c__ `(- —Telephone � — Address v✓1t �%� J" (e) Real Estate Company and Agent — Address _ ---------- Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family'w Multi -Family El Other -- -- Number of Bedrooms 3. WATER SUPPLY Individual Well X,Community 0 Public El 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 Onsitex Public 0 Community L7 Holding Tank C7 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. i2 urs k 1 nal Page 1 of 2 A' A „e FILE SEARCH, DATA AND INFORMATION , 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, investigation of this ficalih As certified by my seal affixed hereto and as of the validation date shown below, I verify that safe, Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequato investigation and inspection, the on-site water supply and/or 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 9 wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Eagle River Engineering Services — ___-- P. 0. ©ox 77329_4 _ _ Telephone ---- Name of Firm __-- °agln River, AIC 99577 — _— Address_-.- Date� tl:_, �/� ` ,e , ,, nj Engineer's Seal e _i rp 6730 1� 6. DhiEP APPROVAL -- C/ Date Approved for bedrooms by T r Approved Disapproved Conditional —�— Terms of Conditional Approval CAUTION r Iu above by E dent professional The Muncipality of Anchorage Departindependent of Health and Environmental inmPpro'ection (DHE issues Health Authority the representations g Parafl �j purchasers of homes and their lending Approval certificates based solely upon engineer registered in the State of Alaska. The DHEP does this as a courtesy to p ns or institutions in order to satisfy certainiis federal and tate requirements, Municipality of Anchorage is not responsible ble for errors oromissionsomissions in the analyze data before a certificate professional engineer's work. IYIV IYIIA rl1L111 W1 MINnVRHUL' DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) �t ar3� HEALTH AUTHORITY APPROVAL (HAA) APR J 5 CHECKLIST - FEBRUARY 1984 o G> 264-4720 Kf DE A roecQe r Legal Description: r la N lt! '�L A. WELL DATA roved (Y/N) - N f If A, B, C D.E.C. App „•`� r l lJ � A 5- �rP� Well Classification 9� T � 9%� _Yield ----- Date Completed �� Well Log Present (Y/N) ,�S_ z Depth of Grouting l fis Cased to -- ,, /- i;,c(tcc.rc4,f Total Depth —�,_ pump Set At Static Water Level— a—o ! y Sanitary Seal on Casing (Y/N) AlCasing Height Above Ground _ Depression Around Wellhead (Y/N) — Electrical Wiring in Conduit (Y/N) Separation Distances from Well: on Adjoining Lots /�O-- To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot/o-- °---- on Adjoining Lots To Nearest Public Sewer Line _ // c �""" To Nearest Public Sewer S ,IL To Nearest Sewer Service Line on Lot _ Cleanout/Manhole .- Water Sample Collected by Water Sample Test Results =--t Comments ; Date —',3 /a S -S' ree.cue, . c5— ��,' DC7 B. SEPTIC/HOLDING TANK DATA t Vvl�� 1 a S o No. of Compartments _---- Date Installed /g---- — Size Foundation Cleanout (Y/N) ---------- Standpipes (Y/N) _—� Air tight Caps (Y/N) - y -- y _ Date Last Pumped -2�`�`�' Depression over Tank (Y/N) N (� Pumping/Maintenance Contract on File (Y/N)A Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well Y..t To Property Line !=— To Water Main/Service Line /v fi Course Comments page 1 of 2 for ' Temporary Holding Tank Permit (Y/N) i To Building Foundation To Disposal Field — To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design DYNr, c Date Installed /9 8 y Length of Field ss - Width SWidth of Field 6 Depth of Field _ // Gravel Bed Thickness 7 , Square Feet of Absorption Area O Standpipes Present (Y/N) - Depression over Field (Y/N) — Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 0 / To Property Line To Building Foundation a u To Existing or Abandoned System on Lot Nd"__ ; On Adjoining Lots 3e � To Water Main/Service Line /C-11 yL To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIF'r STATION Date Installed Size in Gallons - "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Cutbank (if present) __Va %c f — Dimensions Manhole/Access (Y/N) — _ "Pump Off' Level at — Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav hecke, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed_ �Date3 5- , � Company Fc�54- lei"er=s•MOA No. � 5" J 7-- 3- Receipt No. � r•°ABOT°O °Y°•E� k Date of Payment 4 r/I_17e5 � ��••e ,��: o�� �Q et) 0 AWr °®� Engineer's Seal �5 ® Amount: $ rS1. 3 R 0! alone°°°Coop•.• Page 2 of 2 72-026 (11/84) s(n LOUIS A. UUf01'G �q• Cr -6736 n _ty AYTTAIM: At Craig p, 0. cx 112.01- -, r i ; a 9, 577 M6gCIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 001-16 1979 RECEIVED j/ A:0r, s/ cc: �Y of knc hwa e of P U th ..lid F^t 0p, Cj0 7Cn I'J sfi3 193X r-^,GLE FIV[ -n, AU-zSrA �r rd (9U, n1. Ct rQs ii �in L,; of l� ri-„all,.nc i n d a d fc n,,.d to ae 3 r s t: � With 109 r�,"O off' fresh er' The ` ii3 It � � s ried � t�.'�-,,n l i _od nl 24 Lss c Sure �e"S I a p, r'u i” _�. .. i,,, approxIMMY 75 .,;lions. of t- u.y, '.,`;L it unn e t of c,-'1 d Mt i,:. ,�"lI s X' As 3 r sl)l ; of We a to serve the 2 bedroom r" dei ce. a?ecuate further assistance WPM do not s he;_ '"tee ;,^, c;! 1. I£ we c•..n be of j/ A:0r, s/ cc: �Y of knc hwa e of P U th ..lid F^t 0p, Cj0 7Cn I'J sfi3 193X r-^,GLE FIV[ -n, AU-zSrA