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SEIDLER LT 4
Seidler Lot 4 #050-131-i1 Legal Description s�I "jl/ eV Pump Installation Date: g 113 1► 3 Pump Intake Depth Below Top of Well Casing::: 1O&eet Pump Manufacturer's /Name{: qlu Y5 Pump Modem: 55,101 1 a t� L Pump Size t hp Pitless Adapter Burial Depth: \ Z feet Pitless Adapter Manufacturer's Name: Pitless Adapter installer: Well Disinfected Upon Completion?Kyes 171No Method ofDisialcedon: Comments: Pump Installer Name: 5u 111 v'd n u4w wi e?o &x G70d�g / h.� a q 7 Attention: The pump installer shall provide a pump mstallatton log to the DSD within 30 days of pump installation. Development Services Department Building Safety Division ®n -Site Water & Wastewater Program -_ 4700 Elmore Road P.O. Box 196650 Mark Begkh Anchorage, AK 99507 Mayor WWW.muni.org/0 nsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: _ Parcel Identification Number: Legal Description s�I "jl/ eV Pump Installation Date: g 113 1► 3 Pump Intake Depth Below Top of Well Casing::: 1O&eet Pump Manufacturer's /Name{: qlu Y5 Pump Modem: 55,101 1 a t� L Pump Size t hp Pitless Adapter Burial Depth: \ Z feet Pitless Adapter Manufacturer's Name: Pitless Adapter installer: Well Disinfected Upon Completion?Kyes 171No Method ofDisialcedon: Comments: Pump Installer Name: 5u 111 v'd n u4w wi e?o &x G70d�g / h.� a q 7 Attention: The pump installer shall provide a pump mstallatton log to the DSD within 30 days of pump installation. Municipality of Anchorage s -� Development Services Department i y; Building Safety Division ;� '�, On-Site Water 8 Wastewater Program, 4700 Bragaw St. \ P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SWO80151 PID Number: 050-131-11 NOTeOJANIS &SAMUEL GUY Wastewater System: ❑ New ■ Upgrade Address: 11928 BIRCH HILLS DR 'EAGLE RIVER, AK 99577 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 694-6458 2 Cl Deep Trench ■Shallow Trench ClBed Oklound OOtner LEGAL DESCRIPTION Sol Nova: 10 TdtM Depth beth erkirwl ewaee: 10 MAX In. G"/s4. rL Black: Lot: Subdivision: Depth b pp. boa" bath ewlpinel orode: Grawel depth bene th plot. — 4 SEIDLER 5.79 FL 4.21 re Township: Range: Section: — — — h odab owwo orklnol greet: G`a'el wgac 38 SEE DWG. rL n. Gre.el width: Nomnbe, a snow: DYlonce We. w.: WELL: ❑ New ❑ Upgrade 5 FL 1 — In. Ciomfcalrn PA*ote Ae.G : Total Doth: Cove To- ) Total abeoq; n ow.a: 380 pipe ^hates: D 3034/ F-810 rL SO. Ft. 1,wi~ We krtaMd: GREY'S CONSTRUCTION 8/6-7/08 OwYMr: �\N� Yled: stela wale, t.ewel: X�S In TAN K Ylele; pe np set Aa re..mp Npht AeOw. GIW M: GPN R n SEPARATION DISTANCES ■septic OHolding OS.T.E.P. OOther To Septic Absorption Lift Holding ubk/PrNale uOO1I ANCHORAGE TANK tapeta �b 1000 From Tank Field Station Tank sewer Lkre 100'+ 100'+ — — 25'+ 11o1erfel: STEEL llrnCew of rnmnpowun.^Is: 2 Well Surface water 100'+ 100'+ — — — LIFT STATION Ste In selwr: YaMe.lwe,: Lot Line 5'+ 10'+ — — — on, Wet of umnp Off' level o1: e e, ole,m al: Foundation 5'+ 10'+ — — — Pwap Dews Vkel Ynpedtkm pewlam.mw bra Curtain Drain NONE KNOWN BENCH MARK Remarks: OLD TANK WAS ABANDONED PER THE UPC. Lecauon e,M Desedplion BOTTOM OF SIDING ® POINT C Aewwwrd P.welrm. 100.00 rt ENGINEERS SEAL Inspections performed by: GEG, Ltd. Dates: 1st 8/6/08 booa000p 2nd 8/7/08 OF• S�0 3rd 8/7/08 v Do Q� Development Services Department Approval'?: 9 H y* �QQ Conditional approval: Date: 0 Q Je r A. am ss:• Q E-79 e0 �Ij04�e .• g �r (� U.gc�oo Reviewed and approved by: ate:DO°°Profeseton°oma �0400000� (R.- 4/0e) PERMITNUMBER: SW080151 SWO \\` — AS—BUILT DRAWING PARCEL ID NUMBER: 050-131-11 EXISTING / •\�/ / A B /��/ \ ST1 37.49 25.08 C07�1MT2 ST2 40.72 28.45 \ \ C5T2 CO 42.31 29.94 LOT 2. BLOCK 1 MTI 01 EXISTING J / DBL1 45.75 33.02 / DBL2 46.62 33.83 \\ 1 I / 100' WELL RADIUS \ / I FD 52.47 38.12 / / 1 C01 50.98 45.91 I MT1 49.50 42.53 / I CO2 70.68 29.06 / / 100' WELL RADIUS I I / / MT2 67.20 26.03 = I 0 SEIDLER #I. LOT 1. BLOCK 1 GARNLSS ENGINEERING GROUP, I.td. p;?` - - -,. - CONSULTANTS E GENERAL CONTRACTORS^-�^•^•^-^��• ' a 3»1 c neon ROOD.101 • wc+cur[. we wwr . nw[ po�Wr-•i» • F" (ao>')u Wff • gsne ....�......y.�.wo�. O PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JANIS GUY 694-6458 2 OF 3 E—� O�P�• LEGAL DESCRIPTION: DRAWN BY: O s SEIDLER #1. LOT 4. BLOCK 1 K.D.M. 13 oo,TYPE OF WORK: GATE: 4o��OC ASBUILT DRAWING 8/11/08 (Rev. 0105) 0 \\` EXISTING / 2 BEDROOM / HOUSE C07�1MT2 ST1 / \ \ C5T2 DBL 1 di 2 MTI 01 EXISTING J / DRAINFlELD / NEW DRAINFIELD l / GARNLSS ENGINEERING GROUP, I.td. p;?` - - -,. - CONSULTANTS E GENERAL CONTRACTORS^-�^•^•^-^��• ' a 3»1 c neon ROOD.101 • wc+cur[. we wwr . nw[ po�Wr-•i» • F" (ao>')u Wff • gsne ....�......y.�.wo�. O PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JANIS GUY 694-6458 2 OF 3 E—� O�P�• LEGAL DESCRIPTION: DRAWN BY: O s SEIDLER #1. LOT 4. BLOCK 1 K.D.M. 13 oo,TYPE OF WORK: GATE: 4o��OC ASBUILT DRAWING 8/11/08 (Rev. 0105) 0 PERMIT NUMBER: SW080151 TOP OF TANK AT INLET = 93.68 INVERT OF BUNG AT INLET = 93.10 AS -BUILT DRAWING °050 131-11R INSULATION[ FINAL GRADE = 96.27+ INSULATION ST1 ST2 /TOP OF TANK AT OUTLET = 93.72 NEW 1000 GALLON SEPTIC TANK -INVERT OF BUNG AT OUTLET = 92.91 GRADE = 88.09+ 1 FILTER FABRIC ORIGINAL GRADE = 89.52 INVERT OF PIPE = 83.73 RELATIVE ELEVATION OF BOTTOM OF TEST HOLE= 73.52(DRY) GARNESS ENGINEERING GROUP, Ltd. - -• CONSULTANTS 3 GENERAL CONTRACTORS —• �.... "' "......•• =1 L NOOK M.D. Ml R[ 101 • MIOOALL MR N 7 PREPARED FOR: PHONE NUMBER: T PAGE NUMBER: •• •••• .••••.... CE -7 533 .. JANIS GUY 694-6458 3 OF 3 00� e';J t A. G .. :i LEGAL DESCRIPTION: DRAWN BY: SEIDLER #1, LOT 4. BLOCK 1 K.D.M.pr f �0� �.��! .�•�'' cAo TYPE OF WORK: DA7E6�11�08 404�40�sesto PROFILE DRAWING )Rev. 0105) Aug 14 08 09:21a Sullivan Water Wells 907 688 2759 p.1 Catitieb 4Dn'tting Kog by Dec m. dM SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 -TELEPHONE 688-2759 OWNER OF LAND: Sd ? x ► . " h u y BORE HOLE DEPTH ADDRESS: LEGAL DESCRIPTION: SC I a/. 64 At'7—!q DATE: f��o PERMIT NUMBER: n7O /29 Dateof Issue -a6 -p� TAX IDENTIFICATION NUMBER: j25-Q_-J'k_- // Iswell located at approved permit location? 61�< :J No Method of Drill'ng: air rotary O cable tool Depth of well: 400 Casing Type' Wall Thickness ' a5a inches /r Diameter inches, depth feet Liner Type: �aHfE Casing Stickup Above Ground: a' feet Static Water Level: 1.30 feet Recover Rate: _/ b0x* 14-6Pw Method of Testing:Lnr=mof DSS &,'_ gy4,e., e,4c' Well Intake Opening Type: O open end en hole :1 Screened; Start feet Stopped feet Z) Perforations Start feet topped J� a'e eNio GroutTypc: /3c.tT� Volume Depth: from feet, to 4 0 feet Well Disinfected Upon Completion? f7-765 J No Method of Disinfection: C:Flcat... X feet Comments: �r[.Jb r 7 t -KJ to Sit. —.-e 6XWJxL 1_'49_4 .0G uc: R Fy 136.04ae.C A%xl< tidill t3g&0C:'C K4'lrs --� Driller'sName ATTENTION: It Is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. ARCTIC PUMP & WELL INC. Jim Sullivan, CPI PO Box 770197 Eagle River, AK 99577 °Niw� e.e (907) 688-2510 (907)258-2510 (907)745-2510 arw n gdnct Pump Installation Log Well Drilling Permit Number: SW070129 Parcel Identification Number: 050-131-11 Date of Issue: 6-26-08 Legal Description:Seidler Property Owner Name & Address: LotA 11928 Birch Hills Drive Block: Eagle River AK 99577 Pump Installation Date: 8-14-07 Pump Intake Depth Below Top of Well Casing:388 Feet Pump Manufacturer's Name: Dempster Pump Mode1:L-75 Pump Size: 11/2 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name:S50 Pitless Adapter Installer: Arctic Pump & Well, Inc. Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page I of I MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade g_G- o k @ -S'vo 9'7-oB 6) 1/'Oz) Date Issued: Jul 31, 2008 Expiration Date: Jul 31, 2009 Permit Number: SWO80151 Parcel ID: 050-131-11 Legal Description: SEIDLER LT 4 Design Engineer: 0855 GARNESS ENGINEERING GROUP Site Address: 011928 BIRCH HILLS DR Owner Name: SAMUEL & JANIS GUY Lot Size: 46029 SO. FT. Owner Address: 11928 BIRCH HILLS DRIVE Total Bedrooms: 2 Permit Bedrooms: 2 EAGLE RIVER. AK 99577 - This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued Date: Date: d� 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 ON-SITE SEPTICIWELL PERMIT APPLICATION phone FOR A SINGLE FAMILY DWELLING Parcel I.D. 1 Property ms's a yr^�li e Mailing address 5—Al-ell u-; I I Zip Code qq 51 1 Site address S 6-+M e Zip Code Legal description (Sub'd, Block & Lot) S �Oi L - Legal description (Township, Section & Range) Lot Size U14Sq. Ft. THIS APPLICATION IS FOR (®all that apply) Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well Water Storage ❑ Number of Bedrooms ZX' THIS APPLICATION IS AN: Initial ❑ Upgrade ❑ Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature oC property owner of au' Permit/Rush Fees: Date of Payment: oD Waiver Fees: Date of Payment: Receipt Number. 1(,4600 Receipt Number: (Rev. 11/05) K*U(:.?AIHY C* EMON ANTAL UR J+.cttatr� �.( I hervW. certify that I have wrveyed the to'lowmg described ympert7. 1—arm EIQ4�S_ to-.... t .A AS -BUILT act. Alasia, ag that the oa are wiebtn tbo proper" •encroach on the propecU tonm n the prnP no roadways, trarsmissior otr on Bald proper!, ezcepl u tomessea mem. Dated at Jade River. Alaska of ;9�e6 MEL ROB=RT C. JOHNSON `�Q9' SCALL r Iieit!" Land Surveyor No. MO -L: '� GRE, i ER ANCHORAGE AREA BOk,dGH olwx ��� Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT CIN -SITE SEWAGE DISPOSAL. SYSTEM NAME ' Q ��' �[�%CU�/�S _ MAILING ADDRESS r0C, f9�' // 2FY - n r✓C%/i PHONE/�v�� LOCATION (��✓/L'S yU /v E' f�y� � 0V/f4LEGAL DESCRIPTION'"'r J��� sh). �9}ie /o SEPTIC TANK: DISTANCE NUMBER OF FROM WELLMANUFACTURER S%GNSG % MATERIAL _/der f 'S COMPARTMENTS_ + _ INSIDE LENGTH_ _ INSIDE WIDTH__ LIQUID DEPTH _LIQUID CAPACITY_ 42-0 GALLONS. _71QervC H T tit/¢ l� ;2•vv wirli /v Fr'�r1 yr Ltiu U e & SEEPAGE f ft . / NUMBER OF Pi�r_�. DIAMETER D /. OR WIDTH_, LENGTH_, DEPTH ! LINING MATERIAL CRIB SIZE: DIAMETER_DEPTH DISTANCE FROM: WELL %,)- -2- _. TOTAL EFFECTIVE BUILDING FOUNDATIONAL, NEAREST LOT LINE G� ABSORPTION AREA (WALL AREA) -4-06 .SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE 1UW/ C__CONSTRUCTION 11INI�If/Ey DEPTH �Ga DISTANCE FROM: BUILDING ✓ NEAREST / Z 76 NEAREST SEPTIC7 / SEEPAGE r ��7 FOUNDATION � LOT LINE SEWER LINE___, TANK. SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED __ REMARKS DISTANCES: _a—M-C INSTALLED BY: �C� �zG�<l✓�+"� PIPE MATERIAL: "3 Tkoto co i nj fo e r F119c , LOT SLOPE: REMARKS:00 Form No. EQ -031 'Tf(; IVCffgy1C"V W�rIY14 /61 &,4A0¢ L . DATE DIAGRAM OF SYSTEM I ?e,P0�01-�5 gc` 1 C'LeR�+oa.T• APPROVED G.A.A.B. IV at xyi Ie as 6/ik GREA. .R ANCHORAGE: AREA BOF. !GH,i- DEPARTMENT OF ENVIRONMENTAL QUALITY 1 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 �0+keo uw�'J SEWAGE DISPOSAL SYSTE - APPLICATION AND PERMIT NAME OF APPLICANT t���— V�-MAIL/,J,�NG ADDRESS — INSTALLATION LOCATION aQ LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANKAG�yr DRAIN FIELC TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH Of I_ / TO BE INSTALLED BY SOIL TEST RESULTS 75s NOTEI THIS PERMIT IS COMPLETION DATE ANTICIPATED — (c2Y `f-c�7 q q PHONE _ a� OTHER VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL. QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE loco TYPE SEEPAGE AREA SIZE 6 / r0--- �T6E MINIMUM DISTANCES, REQUIREMENTS_ � FOUNDATION TO SEPTIC TANK •['-l" FOUNDATION TO SEEPAGE PIT DRAIN FIELD —. SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK �^ SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. f WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD "~ ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK, �- SEEPAGE PIT DRAIN FIELD TO RIVER. LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. IG.A.A.B. / OR ENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANC DESCRIBED SYSTE IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE �G FORM NO. EQ -016 DIAGRAM OF SYSTEM ORDINANCE NO. 28-66 AND THAT THE ABOVE 0 Et E GEOTECHNICAL & DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Soils 9 Foundations SOIL LOG Earl Ellis 688-2280 Land Development Performed for: Name: 14:5 5 e)C iqT,C- D f L01e-D eS Tel. No. 67 l5- e ,:?79/- Mailing Address: bar //G/ ; �f �c� Riac:12 ; , /<,. Legal Description: R.T z/ > i5a4,ds�42. �5a&ai i/IS le)Al Depth feet Soil Characteristics 0 1 2 J i&.— /e,,P/� 3 5 6 7 P a 9 90'r 10 12 Aq -- Ground Water Encountered: Yes_ No If yeso what depth Proposed Installation: Seepage Pit t-�- Drain Field Comments: 014NED NOW BY: Ronald L. and Ann M. Otte - SR 237 - Ea, -le River, Alaska 99577 LOG OF DRILLING by A & L DRILLING COMPANY OWNER OF LAND ....... LC......... ................... DEPTH OF WELL...... -P... .......... ............... ................. i ADDRESS .......... ......................................... .............. _ ............................ - STATIC LEVEL OF WATER FT. ..... ........ WELLSITE... .......................................................... -----_------------- ----------- -- DRAW DOWN £T. ................................................................ DATE—STARTED ....... ?/.. -ji e17 r ......................................... ...... GALS. PER HR. ............/ .C. -)......C -P............................ . ................... DATE—ENDED ....... 1. !r ... 11117.�r .................................................. KIND OF CASING ...... .................................. KIND OF FORMATION: FROM ........ 4? ............ FT. TO......- !j .......... FROM.....2 2'.'r .... FT. TO. - .. ....... y ........... K'1441 'e"'o FROM.... - ) ...............FT. TO.... FROM............. --•------..FT. TO ................ ....... FT ............... ............... FROM .... ..........FT. TO..J..t ............ <'FRM-... O_ ...... . XO ... FT. TO.2�.'-_e.-3 ...... FT_.. 1?Z AV, ack FROM ... 1.!r_ ........ FT. TO../.CI* ............. FROM... 2:1.3 ...... FT. TO..... FT.. A/ 'If ............... FROM. -I FT. TO ... ........... FT....t FROM ........................FT. TO------. FT .............................. FROM.j.�7..t9 ............ FT. TO ..... /1'7� ..... FT ...... ae4evrnic, FROM..�� ... 17 ..... _25�z ...... FT. TO ....... ...... FT...../ ................ ....... FROM ... ildj ......... FT. TO ..... fs.'�) ...... g cj rw Ram ----_--_-_--------- FT. TO ........................FT............................... FROM..I.S.1 ......... FT. TO... -----/.4 . ...... FROM ........................FT. TO ........................ FT ............................... MISCL. INFORMATION: 77c,7-44 cils"tj c DRILLER'S NAME J'F/ .... .................... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930041 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:OTTE RONALD L &. OWNER ADDRESS:11928 L DEVILS DR EAGLE RIVER, AK 99577 PARCEL ID:05013111 LEGAL DESCRIPTION: SEIDLER LT 4 LOT SIZE: 46029 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ]ISSUED: 3/30/93 EXPIRATION DATE: 3/30/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PR RECEIVED B ISSUED BY: OVISIO S: 2 Y : �l/(✓Lf✓ (/fk� DATE: o� MUNICI?AIRY nF NrHORAue ENMONMENTAt SERV 'S UIVISION `F? :1, 0 1993 RECEIVED C. D ba a.X. .1i GUY 'P s �tfy . AS -BUILT ( I hereby- certify that I have surveyed the following t ��'� plot �© described property; Lg r 4. Anehorag6 Reeordiag Precinct, Alaska, and that the improvemehts aituatild tiieteon ace within the property Brice and do not overlap 'or encroach on the property lying adjacent.theretoi that no improvements on prop- erty l& ad*cxht'thflgreto eacrbach on the premises in question and that there' are no roadways, transmission lines or other vWkle easements on said property except as indicated hereon. Dated at Eagle River, Alaska thisLZ !` -day. oL �'' � t�_ — ��—_ I9'A ROBERT C. JOHNSON SCALE: Registered Land Surveyor No. 880 -LS V ; 4.0 PPE hone X 468 Eagle River, Alaska 84.2549 Tprtifirb Britting +ung by DOC Co. dba SULLMN WATER WELLS P.O. BOX 870272, CHUGIAK, ALASKA 99587 • TELEPHONE 988.2759 OWNER OF LAND ,K p`J0 7-7-F ADDRESS Ili d cP L AQ -6 (JI L,S• V)4 t' A, LEGAL DESCRIPTION JLQ' DATE • Started_ Ended PERMIT NUMBER KIND OF FORMATION: �y F _n Ft toA-Ft CAV,, s-1GICJf From DEPTH OF WELL _ 46a STATIC LEVEL OF WATER FT. JAI -- DRAW AI" DRAW DOWN FT. _ GALS. PER HR -/J KIND OF CASING 6 Y-4 0 Ft to Ft romFrom C;k_Ft. to -!I--- Ft. 00iEZ 11946,..) From Ft. to --Ft. From" Ft. to ---71-* Ft. �t A r Y 644 JPL Ft. to _ Ft. From�Ft. to�Ft. JL;I`W,14 9.4 _ OnS7 y From 445rom- Ft. to ---Ft _ From ! ZJ!b Ft. to &/ FL ACaZb f-r� From _._-Ft. to -Ft - From X5 Ft. to !a2► Ft. /SAf llaC � -tom From_ Ft. to_ - Ft. �- From_idj Ft. to-lzl dff0x&� G�rE� From Ft. to--- Ft. From44(r-Ft. to -&r -Ft, lR dd-W it 6&.eA From Ft. to- Ft. -- From--Ft. to Ft ! 2 „, 46o4rg S From Ft. to Ft. - -- From/L"�' Ft. to -Ft. SAW1 r e 3t44'ot� From -Ft, to --Ft.- -LL* II �� Froml�Ft. to �� Ft. QAJI*C �AgU &f9:^,From�Ft. to_ -Ft.�_ .r From AR to QLFt. From Ft. to Ft.fA.rZFrom Ft. to_ Ft.,._w.�.__ From Ft. to ff.^'dAfaCeA- Fr -J From Ft. to._ Ft. From.,3:C:�-'Ft. to int._����/t From Ft. to _Ft,_ -10,1k From Ft. to Ft. From Ft. to Ft. From ` Ft. to_ ,Ft- MISCL. INFORMATION: ap' S7r1 T67^" 6/1 citye0j(D mun'iciO"'y of nap gety ces 0e9t, Health &Hum DRILLER'S NAME Tatifirb +drilling +ung 6y DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE6BB•2759 OWNER OF LA`'ND_��ct.) oT/ 5. ADDRESS )W? ? J? S xdA ' LEGAL DESCRIPTION LU i �} S£f,64tF/'4 DATE • Started Ended PERMIT NUMBER KIND OF FORMATION: From—D— Ft. tops --Ft.- E XI 144 W f -LLL From,J,YD_Ft. to ,3/a Ft. II4"19.4`gaef4 From : a Ft. to 33-4 Ft _A360AOG CC• � 4lka From Ft. to Ft.�C/ From230 From-+�Q—Ft. to—ja5 Ft_4C..,40& S "C 6M9-,e'f From_ Ft. to Ft. ©1d i 2 From4 ,T? ti Ft: to�Qt%Ft. From Ft. From --Ft. to Ft. DEPTH OF WELL STATIC LEVEL OF WATER FT. — DRAW DOWN. FT. — GALS. PER HR KIND OF CASING _t1 From Ft. to ---Ft. -- From Ft. to ---Ft. From Ft. to_—_ Ft. - From Ft. to_ Ftp From ------Ft. to_—_Ft— tFromFt. From-Ft. to---Ft.--- o_--Ft.From From—Ft. Ft. to---Ft._� From Ft. to---Ft.— From Ft. to_ Ft. From —Ft. to - -_Ft. -- —Ft. From- Ft. to_ --Ft. --- From Ft. LO— From—Ft. o From Ft. to Ft. From Ft. t0^. —Ft. - From Ft. to _Ft: _— From --Ft. From Ft. to Ft. From—Ft. Ft. to Ft. From Ft. to Ft._ From Ft. to ---Ft. — From Ft. to Ft. From Ft. to ---Ft. — From Ft. to Ft. From Ff. to - Ft- — MISCL. INFORMATION: DRILLERS NAM E1" • Municipality of Anchorage u ts£ Onsite Water and Wastewater Program o . (907) 343-7904. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I,D. O SO -13 /- ! / Expiration Date: q 1. GENERAL INFORMATION Complete legal description 5e(d It'c Location (site address) Current Property owner(s) /�i ffz r.4 ^- Day phone 0 -.64. *0 y Mailing address Sc we: Real Estate Agent rn. o.s Day phone 2.TYPE OF DWELLING: Single Family (w/wo ADU) Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ' ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Publie.Sewer ❑ Received by: Date: _ .COSA to be released to the engineer, unless otherwise requested by the engineer. - - COSA Fee $ `��� Waiver Fee $ Date of Payment �� ��� a- Date of Payment Receipt Number 005 Receipt Number COSA# VSA -12l, Waiver# S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown' below, I verify that my investigation, :.based on procedures outlined `in the. Certificate of Onsite Systems Approval Guidelines for. this application; shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the,number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system ls(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm LV orPhone (6? Address 'P 0- ;3.,a -7-7 43 7 a c/ Engineer's Printed Name 7�w— tom, Date / ,!:�2 711Z gy Original Certificate Date: �3 Theale al y chorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska, The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSH blue sheet_9-1-12.do 6:DSD SIGNATURE p e°e rise SI V System #1 Approved for bedrooms.' a. °} • System #2 Approved for bedrooms. FE 6`56 e, Lt271/.apt >� Disapproved. Conditional approval for bedrooms, with the following stipuladonsr gy Original Certificate Date: �3 Theale al y chorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska, The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSH blue sheet_9-1-12.do If more than 1 septic system is on the lot: COSA Checklist # _of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: S e., d 12v- f. f i Parcel ID: A. WELL DATA Well type _/1P_ If A, B, or C provide PWSID # Date completed 6 z7 07 Total depth 6�0_ft. Date of test Static water level Well production Sanitary seal (Y/N) Cased to LL ft. FROM WELL LOG 2 _7La 7 /3o ft. WATER SAMPLE RESULTS: 126 g.p.m. Coliform colonies/100 mL Nitrate _3.y3 mg/L Arsenic 6,V ug/L Date of sample: / 2 // / Z B. SEPTIC/HOLDING TANK DATA Tank Type/Material��� , S Well Log (Y/N) Wires properly protected (Y/N) T Casing height (above ground),�_in. AT INSPECTION 2/!/2 a. Y✓4Z g.p.m. Collected by: AIA , Date installed d Tank size 4a� gal. Number of Compartments 2 Cleanouts (Y/N) `1 Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm (Y/N) Date of pumping MA/z/ -2 Pumper C. ABSORPTION FIELD DATA Date installed Vz Soil rating (g.p.d./fte or ftZ/bdrm) System type Ys. Length 3 ft. Width S ft. Gravel below pipe 15� -A_ ft. Total depth _L ft. Eff. absorption area 3 80 fie Monitoring tube _,r Depression over field /✓ Date of adequacy test Z2hrzt Z Results (Pass/Fail) _� ( For Z bedrooms Fluid depth in absorption field before test in. Water added. 300 gal. New depth © in. Elapsed Time: _30 min. Final fluid depth 0 in. Absorption rate >='— 3 CO r— g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes,. give date D. LIFT STATION /la Date installed "Pump on" level a in. Datum Size in gallons "Pump off el at in. Cycles t6sted Manhole/Access /N) High water rm level at in. Meets nn & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: r / Septic tank/lift station on lot Ida t On adjacent lots Absorption field on lot /Qa ¢ On adjacent lots Public sewer main AfaL Public sewer manhole/cleanout .t%A i Sewer/septic service line Z S Holding tank /a. Animal containment areas 5 r¢ Manure/animal excrete storage areas �f SEPTIC/HOLDING TANK ON LOT TO: i Building foundation s "r Property line /D 'r- Absorption field S t Water main nG Water service line O it Surface water lGG 'a Wells on adjacent lots 6O SIF ABSORPTION FIELD ON LOT TO: Property line �O r Building foundation � Water main i✓Q Water Service line 4 Surface water l0� �� Driveway, parkingivehicle storage Curtain drain VAP- Wells on adjacent lots 40� F. COMMENTS T-0 Z7 G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Date ?/1 ?Z/ COSA brown sheet_10-10-12.doc Municipality of Anchorage s p a , Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 121582 During a recent COSA on-site inspection and test of the potable water supply well on Block , Lot 4 of Seidler subdivision, the well's productivity was determined to be 0.44 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 2 -bedroom residence is 0.21 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING G Parcel I.D. � r7� - 131 11 COSA# 016A+ 1. GENERAL INFORMATION Expiration Date: -11 - CO20 - 08 Complete legal description SEIDLER LOT 4 Location (site address) Current Propertyowner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address 11928 BIRCH HILL DRIVE *EAGLE RIVER AK 99577 JAN GUY Day phone 694-6458 11928 BIRCH HILL DRIVE *EAGLE RIVER AK 99577 Day phone CONNIE HAYWORTH W/COLDWELL BANKER Day phone 265-9166 10928 EAGLE RIVER ROAD *EAGLE RIVER AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 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 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 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 verity that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site watersupply 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 riles and from my investigation and inspection, the on-site watersupply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP. Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering anaWs of the system in accordance with ADEC and MOA DSD Guidelines B Regulations. The reported results described Me performance of the system under Me conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational file of all wells and septic systems depend on the local soils condition, groundwaterlevels 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. GEG, LTD. 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 Me sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DS'D SIGNATURE _SApproved for -42— bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other By: IY•v IIM I V\Q� •'•• '•. �O • ON-SITE WATER AND •; WASTEWATER PROGRAM Original Certificate Date: 8 —,- tQ _-0 8 01 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SEIDLER LOT 4 Parcel ID:Q��3� ter• / A. WELL DATA Well type PRNATE If A. B, or C provide PWSID# N/A Date completed 6/27/07 Sanitary seal (Y/N) YES Total depth 400 ft. Cased to 44 ft. FROM WELL LOG Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION Date of test 6/27/07 Static water level 130 ft, _��� ft• Well production 0.26 g.p.m. 9•P•m• WATER SAMPLE RESULTS: Coliform1_ 0 colonies/100 ml. Nitrate 0.107 mg./L. Other bacteria 0_colonies/100 ml. Arsenic: 5 51ug./L. Date of sample: 7/2/08 Collected by: GEG Ltd. B. SEPT ICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (YIN) YES Depression over tank (Y/N) NO Date of pumping NEW C. ABSORPTION FIELD DATA Pumper_ Date installed 8/6-7/08 Cleanouts (YIN) YES High water alarm (Y/N) N/A Date installed 8/6-7/08 Soil rating (g.p.d./ft'o /bdr 10 System type TRENCH Length 38 ft. Width 5 ft. Gravel below pipe 4.21 ft. •8.57 -NO Total depth 11.58 ft. Eff. absorption area 380 ft' Monitoring tube YES Depression over field Date of adequacy test NEW Results (Pass/Fail) PASS For 2 bedrooms Fluid depth in absorption field before test = in. Water added =gal. New depth =in. Elapsed Time: = min. Final fluid depth= in. Absorption late >= 300+ g.p•d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 50+ Absorption field 5'+ Water main N/A Water service line 101+ 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/vehicle 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 COSA guidelines in effect on this date. Engineers Printed Nae JEFFREY A. GARNESS Date 811110$ COSA Fee S of 3 V • of Date of Payment 'W114Lg Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval # 080277 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 4 of Seidler subdivision, the well's productivity was determined to be 0.26 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 2 -bedroom residence is 0.21 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. i t -13-2008 10:33 FROM: 6940830 TO:3383246 P.1 �: 1 30, • ASBUIIT-NO CORNERS SET THIS DATE. i 8 �2 I SEWARD S ASSOCIATES LAND SURVEYING 688-4566 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY, SCALE, FOLLOWING DESCRIBED DATEr ' �',f �♦ rEiO,EP sr�6t� lcr f AND THAT NO ENCROACHMENTS EXIST EXCEPT AS �P,. r- clp,p r �:* INDICATED. IT IS THE RESPONSIBILITY OF THE - ' 49' OWNER TO DETERMINE THE EXISTENCE OF ANY GRID; % EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- SHOULD FB° �� �` ., LS 18 �o VISION PLAT. UNDER NO CIRCUMSTANCES c 'A �♦�� OF FENCE L NES,JOR FOR ESTABLIISHI.NG BOUND- DRAWN' A I ARY LINES. ,p_^1f _;Ia Cr..w. t - s t"k .8.@ ge M..MJy' MaAC?A,mrrf I- A :P* AS -BUILT �P I hereby- oe:tib' that I Leve surveyed the following ' /� `Qq. described proDatT, 1 S�'eDty► pt 1 1n/ �z S E 1'�-k— Anclors[� R Lu Prcdnet. Xh" and amt, the jmpapv<m mu tLartan art vrttbm t2w propat7 linea andd0 lot overly or wx=aoh on the proPerU IyJM adjacent thsvvto; mat Do jmon arty Iyjn% adja�t thattc on the premiues to gyeatfon and that:ers�ara�ao roadways, trarsmissior I1ma or otberviaWM aaeementa on said property ercept as buBcated betsvt Dated at Sadie Rlter, Alma ROB>aCt C. JOHNSON SCALIL / IteQtstaed Land Surveyor No. 880.L£ MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # HAA # 0 Qc\ G �G 1. GENERAL INFORMATION Complete legal description Lot 4; Seidtex Subdivision Location (site address or directions) 11928 Lowen De.vit6 End Eag2e Riven, AK 99577 Property owner Ron 9 Ann -S L -k Day phone _(h) 694-4200 Mailing address 11928 Lowen Devit6 End, Eag2e, Riven, AK (w) 276-7401 Ann - Lending agency Day phone Mailing address Agent Canotine Ghi:e_,en/REMAX EAGLE RIVER Day phone 694-4200 ext. 235 Address_16600, n tek( e.2d Vic ve 0201 Eag2e, Riven, AK Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: / •34'1-` 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site _ Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA n21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 & S ENGINWIN6 Phone _ 17034 Eagle River Loop Road No. 204 Address Eagle River Ahska 90572 Engineer's signature — _ Date'2Z"� _ 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments 0 bedrooms. 411TIr', bedrooms, with the following stipulations: ✓ls"04 Date '�/ 7 c The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA H21 WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. 171A� �CJ,GGY� During a recent Health Authority Approval on - s to inspection and test o� the potable water supply well on Lot Block — of 1-1.) �Lc,�' Subdivision, the well's productivity was determined to be O, 3 gallons per minute. The minimum well productivity required by this department (AMC 15.55) is 150 gallons per day per bedroom. On this basis, the minimum well flow requirement for a _5 bedroom residence is O,3/-2� gallons per minute. Although the subject well currently meets the minimum well production requirements, all parties concerned are advised that the production capacity of the well may fluctuate and that water conservation measures may be required during periods of low production capacity. Measures which can be taken to minimize the impact of a low production well are: 1. Installation of a storage tank (300 to 500 gallon) to serve as a reserve source during times of maximum water usage. 2. Restriction of noncritical water uses such as, washing cars, lawn and garden watering, etc. 3. Installation of water saving devices on faucets, showers and toilets. 4. Conservative use of laundry facilities and dishwashers. This advisory must be attached to all copies of the subject Health Authority Approval. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1� 4 SID — Parcel LD A. WELL DATA Well type V -1Q k5!Cry_ If A, B, or C, attach ADEC letter. ADEC water system number _ Ik Log present &N)Date completed -�3 — Driller �>JV`-` J //�� Total depth_��t Cased to 'Lo\ S U ��• Casing height- Sanitary eight Sanitary seal (DN) J Wires properly protected Y&N) Date of test Static water level Well flow FROM WELL LOG A< -q3 \5 . o G' PPM Pump level �C•*i1.t� f>W�•�•�o t� \�'1S �5 �tSa�-�P� SFA SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ')o AT INSPECTION U 7 31n3 o z ' x ID On adjacent lots _ o o m —T Absorption field on lot \\ \ e a \ ;On adjacent lots \02\ Public sewer main N1 Public sewer manhole/cleanout\A Sewer service line ZS Petroleum tank WATER SAMPLE RESULTS: Coliform h Clovvl MoD rt Q Nitrate C>A L) ^`� � • Other bacteria yt _,� - c�� S &S ENGINEERING 17034 Date of sample: Collected by:Eagle River Loop Road No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed S - 1'5- Tank size \ D' o o Compartments CleanoutsY�N) _—�— Foundation cleanout 69N) _ I( ,_ DepressioMY/0) High water alarm (Y)�}N' Alarm tested (Y/N) 4 Date of pumping Pumper _rn-_ t�L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ `_� a k On adjacent lots— ba Foundation To property line \ t> \-1 Absorption field Surface water/drainage \ o o l -i- ate Water main/service line \ O \•k — 72-026 (Rev. 7191) 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 — Manufacturer Manhole/Access (Y/N) " mp off" level at Cycles tested SEPARATION-BTSTANCE FROM LIFT STATION TO: II on lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed Soil rating 1�'b� I�r_ System type _KLSL,� � ak Length Width Gravel thickness o{ Total depth (�{ Total absorption area � Cleanouts present/N) Depression over field (Ya y' Date of adequacy test 2 -Lo Results ass fail) for T��� (-3� bedrooms Peroxide treatment (past 12 months) (Y/6) �4(L_ If yes, give date S`A a -h r Lt Dc 'L �i iL pcP P tva 1 D '� SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot a On adjacent lots }' k Property line o To building foundation Zo { To existing or abandoned system on lot Onadjacent lots Cutbank 'J /k Water main/serviceline Surface water �j� ©' h Driveway, parking/vehicle storage area tea' Curtain drain E. ENGINEER'S CERTIFICATION t certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspi?ction. 5 i, 5 ENt31NEERINta y, F eq 4ri Eagle Rlvor Loop Road No. 204 Signature 17034 O Eagle River, Alaska Engineer's Name ,Pee Date .''• ;.: n'_)�. E;t; ., IAf=ICY{ l J O 9J HAA Fee $ Z 7 0 `2 Waiver Fee: $ Date of Payment I-/- " 7-.P- _9� 3 Date of Payment Receipt Number �U!%-7- 6 7 S-/7 Receipt Number 72-026 (Rev. 3/91) Back MOA 21 WELL FLOW TEST DATA HEALTH AUTHORITY CLIENTS Go�O�Y�- Cei R-1E�i'r.R� DATE OF TEST: APPROVALS F LOCATION OF WELL (Legal Description) : 4 ��F 1L7T WELL DEPTH s L%Op ' CASING DEPTH -20 - Cj TESTED BY i SEWER &WATER DATE DRILLING COMPLETED: 14--93 DRILLER: MAIN EXTENSIONS TEST DATA: SEWER& WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P E ROGER SHAFER. P E CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 CLACK TIME DEPTH TO WATER DRAWDOWN PUMPING RATB(GPM) REMARKS ?5 3�"�` J i n5 1 -- t,��,i L> - L' T �> S Q) % 3 -3' 4 MISC. DATA: CASING HEIGHTS Z SANITARY SEAL?i WIRES IN CONDUIT?: GRADING O.K.?: BACTERIA & NITRATE S PLEB COLLECTED: 97_ u RESULTS: WELL CURRENTLY PRODUCES -�� GPM WITH A --DRAWDOWN FWW RATE NOT GUARANTEED—SUBSEQUENT VARIATIONS CAN OCCURI i i f'- / l "1 D�L4 r,. -b W g- 6--& U ll rz� Vj -T- 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 HEALTH AUTHORITY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS '::ELL INSPECTION A ROW TEST 5'TE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P E ROGER SHAFER, P CIVIL ENGINEERS WELL RECOVERY TEST DATA (907)6942979 FAX 694-121 >"CLIFNT: WELL LOCATION (legal)TEST DATE: DATE: y - Ilo,�l°� TESTED BY: WELL DEPTH: 001 WELL DRILLER: CASING DEPTH: 20`2, DATE DRILLED: TEST PROCEDURE: 1) Draw water down to pump. 2) Shut pump off 15-60 min. -record time -record meter reading 3) Turn pump on. Drawdown. 4) Shut pump off. -record time -record meter reading 5) Calculate gal./min. recovery. A- )S-93 TEST DATA: START TIME: u•_gap, MISC. DATA:. Casing Height: 12�� Sanitary Seal?: _— Wires in Conduit? - Grading O.K.?:_ Pump Depth:_4 3 Samples Taken?: Date: Ll -lb -`13 STATIC WATER LEVEL:_A_2,:,.2? TRIAL PUMP TIME GAL. /� 1 OFF 0 ; D C) `-- ON sem- OFF -Z- 2 OFF OFF Q ; 6 0 2 0 �►P ON 9 p OFF 3 OFF p c.;> :- ON OFF -- 4 OFF P l� 1 �'.30 ON 5 OFF ON RESULTS: WELL CURRENTLY PRODUCES: 2C> 61 FA FLOW RATE NOT GUARANTEED- SUBSEQUENT VARIATIONS CAN OCCUR! 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Time APPLK .NT FILLS OUT UPPER Hid. ONLY Properly Owner Phone _ Mailing Address Zip Code Buyer Date Address Zip Code Lending Institution Date Phone Address Zip Code Inspector Realty Co. & Agent Inspector Phone Address Zip Code APPROVED BEDROOMS jt Legal Description _y' Street Location " Type of Residence Single Family 1. ' ❑ Multiple Family edrooms- No. of Bedrooms-- Other Other Water Supply BY: V Individual Soils Rating ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community rWell,bsorption Area For wells drilled prior to that dale, give well depth (attach log if available). ❑ Public Utility _ Sewer Disposal Septic Tank Size Individual Year Individual Installed: Public Utility When Connected to Public Utility: . ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: APPROVED BEDROOMS jt 'CONDITIONS OF APPROVAL ( DISAPPROVED ( ) CONDITIONAL APPRO AL' DATE .r. BY: Soils Rating Date Sewer Installed rWell,bsorption Area Well Log Receivednk Septic Tank Size 72023 (3182) 5. LEGAL DESCRIPTION DATE: RECEIVED INSPECTION APPOINTMENTS Subdivision TIME TIME TIME DATE DATE DATE. INSPECTOR INSPECTOR IN MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HFALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 pp 14 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days. for processing. 1. PROPERTY OWNER - Ronald L. and Ann M. Otte PHONE 276-7401 (work) MAILING ADDRESS _ —. 5O5 ome SR 237.- Eagle River, Alaska 99577 PROPERTY RESIDENT (If different from above) PHONE same 2. BUYER - PHONE Same as Property Owner MAILING ADDRESS 3. LENDING INSTITUTION PHONE Alaska Bank of Commerce (Attention: Ms. Michelle Young) 276-7200 MAILING ADDRESS Pouch 7012 - Anchorage, Alaska 99510 4. REALTOR/AGENT PHONE n/a MAILING ADDRESS 5. LEGAL DESCRIPTION • Blocs 1 Lot 4 Seidler Subdivision STREET LOCATION Devils End Drive — Eagle River 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other fix SINGLE FAMILY Ric Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY )X INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTI LITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM _ X}M] INDIVIDUAL/ON-SITE** 1975 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 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: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ) l c( 1 ❑ APPROVED FOR BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) LJ' DISAPPROVED DATE % BY 72-010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGE �f l - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 River,.Alaska REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. - 1. PROPERTY OWNER ❑ One ❑ Four - -. ❑ Other PHONE MTs Ronald.L & Ann M. Otte - , 276-7401/5949 _ MAILING ADDRESS _ SR 237-, Eagle River, Alaska 99577 WELL LOG. A well log is required for all wells drilled PROPERTY RESIDENT (If different from above) - PHONE 2. 6UYER B. SEWAGE DISPOSAL SYSTEM _PHO— satfle -asowner -- **If individual/on-site, give installation date`:' 1975` MAILING ADDRESS - ❑ PUBLIC UTILITY _=LENDING NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. INSTITUTION ---' PHONES-�--�- Lst Federal Savings &Loan Assoc 274=6565X506- - MAILING ADDRESS - P.O.-Box 4-2200, 4-2200, Anchorage, Ak''99509 4. REALTOR/AGENT _...__...�.—�� PHOfVE MAILING ADDRESS 5. LEGAL DESCRIPTION �...._ ._...m._,.......�a."......_s_.._.'.._�e.,.'..a.._... _-.'.""'....'_"'.'., Lot 4, SEIDLER SUBDIVISION STREET LOCATION NHN Devils End Road,.Eag1e River,.Alaska 6. TYPE OF RESIDENCE F NUMBER OF BEDROOMS Ek SINGLE FAMILY ❑ One ❑ Four - -. ❑ Other KR Two ❑ Five ❑ - MULTIPLE FAMILY ❑ Three : ❑ Six _._.,_._d�.._.,.. 7. WATER SUPPLY -_—......_.,....__�_�o.........._. �M INDIVIDUAL*,ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM )0. INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date`:' 1975` If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. —THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS j TIME TIME _ TIME DATE DATE DATE - INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER Of BEDROOMS ❑ SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX — - PERMIT NUMBER - -p-� 2. WATER SUPPLY -. ❑ . . INDIVIDUAL. DEPTH OF WELL q ❑ COMMUNITY - DATE DRILLED -- ❑ PUBLIC UTILITY .Connection Verified LOG RECEIVED _. A-- S~ SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑IINDIVIDUAL/ON -SITE. DATE INSTALLED OPUBLIC UTILITY Connection Verified INSTALLER - ❑Septiclankor F-1 Holding Tank..,, tt���;.rr. _ Size:OCAD If Tank is homemade SOILS RATING - give dimensions: ---- TYPE OF TANK MANUFACTURER - TOTAL ABSORPTION AREA - MATERIAL •i. DISTANCES 'JELL TO: Septic/Holding Tank Absorption Area Sewer Lina Nearest Lot Line Absorption Area to nearest Lot Line - 5. COMMENTS Ft" APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DA -FE - BY (Title) - to �j LEGAL DESCRIPTION A ` ------ _. 72-0 i 0 Mev. 3/78) A Ni", Ronald Otto SHP 237 DW710 luvUry Alaska 99577 ]bar b". Otte) DAVID A. SLENKANIP MECHANICAL ENGINEER 6940055 soptonbpr ��) P 11_9�_-") Reference: Lot /'; Seidler 'SuIxtivi""l-on ROBERT A. SHAFER CIVIL ENGINEER 6940979 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION SEP Pi 4 1980 RECEIVED At Lho rmucst W Carol Shnrrod, HMO >60-& WKs nod Loan, nn nlinnuncy tn�-t was performed an the sontic syskm so -vin- gour two bedroom home locrtod on the rKirencad prnporty. Tho Peptic tab- l.,��s pu�mnd --ind verified to have n c2nn&Ly of 1000 p-Pors, The absorption trench was charged will my"ximitely 4?6 -allons or witor b%, continuous flow over n u -plod o? 21 tours, An water We] in the sumn nL the and oV the trench vrs monitored with no mensurabl- over [-,lie A hour period, It enn be concluded from the above test QW, srrvr+ 'e -;"'vs'tnm 1,,; currontly functioninr adequately. If U0 pay be o' further nsainkneo, pin -so do nQ hanyt-W to C01. it I I n r' 7�I y ThnicipKiLy K Anchornyo SpnKmant W He-Ith and EnviornmW& Protnotion P00 Wern! SovinF2 and Conn AT07TION: Serol Sherrod 11 SRB 196X EAGLE RIVER, ALASKA i i 7c i�3 1-0 — v aoeN am