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HomeMy WebLinkAboutSUN VALLEY HEIGHTS BLK 1 LT 3Sun Valley Heights Block 1 Lot 3 #017-062-23 ? Municipality of Anchorage Page / of'~' DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION' P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name: Wastewater System: ~ New ~grade Addres':l ~ ¢ / ~ ~¢A[~ ¢/41¢~ ABSORPTION FIELD Phone:,IN°'°f B~ooms: ~ep Trench D Shallow Trench D Bed D Mound D Other Soil Ratin : Total Depth from original grade: Lot: Block: 8ubdiv~ton: Depth to pipe bottom from odgin~l grade: Gravel depth beneath pipe Township: J Range: J Section: / / Fill added above original grade: Gravel length: I WELL; D New ~ Upgrade Gravelwidth: Numberoflines: Driller: / Date Drilled: StaticWaler Level: [nstalle / Cate installed: Yield: GPM IPump Set at: Ft. ICasing Height Ab°voGr°und:Ft. TANK SEPARATION DISTANCES ~t,~ u Holding U S.T.E.P. To Septic Absorption Lilt Holding ~Mb~lo/~dvate Manufacturer: Capacity iR gallons: w~to~ ~¢ ~ ~¢¢¢- LIFT STATION Line I / 7/ ~{ ~ 'Pump off" level at: ~Highwater~larmat: Remarks: BENCH MARK Location a d Description: F~ Inspections performed Department of Heal~l~d Hum rvices approval 72-013 (Rev. 9/91) MOA 25 20.9 36.7~i' SCHED. 4O PVC C6 ~ PLAN ~ :=20' PERF. PVC £L,='86.65 ~ 5' COVER C4 - EL,=88,65 CLEAN-ouT-~ MONITORING TUBE~ ~ /-- GEOTEXTILE SILT ,ER ~M1 C5 \ ~ BOTTo~ OF ROCK / EL,=a~ ~. ~ ~ROPI~ NTS LOT G HLOUf: i SUN VALL(~'y tII~ZGItTS' LINDA '3 PLAN ~ 1"=50' 2900 I~e6't 33rd Ave Ai~chorage, Alas~ca 99507 (99?)273 4361 LOT 3 BLOgT{ 1 6'UN V4LLF, Y HI¢ICH?'~ LINDA LEE I ,S'ep ~ic ,Spa'l Date' 5'ep~ 18, 1994 Permit No. ~ (L~.) ~'~g) 2 ~/' Page ~ of + Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650, Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: 13o & L ~b, q / z~,o'- ~.3!~ ~- : C q: ~7, / / q~, o ' ~ ?z~- 'V f 3-2.7 / ~o. ~ .... -' ~B '~ MUNICIPALITY OF AIqCHOP~AGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ARCHOP~AGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT BU3MBER:SW940281 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:JOHNSON LINDA LEE OWNER ADDRESS:13301 ALPINE DRIVE ANCHORAGE, AK 99516-3132 PARCEL ID:01706223 LEGAL DESCRIPTION: SUN VALLEY HEIGHTS BLK 3 1 LT DATE ISSUED: 8/10/94 EXPIRATION DATE: 8/10/95 LOT SIZE: 44446 (SQ. FT.) NUMJ~ER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 (18AAC?2) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 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 PROVISIONS: THE TOTAL DEPTH OF THE TRENCH MUST NOT EXCEED 12.0 FEET. IT IS RECOMMENDED THAT A DIVERTING VALVE BE INSTALLED SO THAT AT A FUTURE TIME THE SEPTIC TANK EFFLUENT CAN BE SWITCHED FROM ONE ABSORPTION FIELp TO THE OTHER. ISSUED BY: ~ / DATE August 3, 1994 Department of Health and Human Services Anchorage, Alaska Re: Onsite sewer system design for Sun Valley Heights Subdivision Lot 3, Block 1. Dear DHHS, This is a request for an onsite sewer permit for an exJ_sting residence located at the above address. The existing system has been in place about 20 years and has failed. A test pit was excavated near the old system. The soil profile showed a uniform sandy/silty gravel to a depth of 18 feet with a percolation rate of 18 min/inch. The existing tank was exposed and has rusted through and will be replaced. No impacts to the surrounding properties are foreseen. All have onsite systems already and appear to be preforming adequately. This and the surrounding properties are served by a community water system. The required set-backs are easily obtained within the confines of the lot. The topography of the area is gently sloping at about 4% from Alpine Drive to the east. The lot footprint is about 150 feet fronting Alpine Drive by 260 feet deep. Sincerely James M. Wright P.E. o -- Z X Ld 0 0 pr' © Z z 0 Z Ld Z 0 X 61,90' 4 ~) ,-- 20.00' 4 ~) Z Cf) 0 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEOAL DESCR,PT,ON: £~+ a (z, ( 4- 5- 6 9- 13- 14- 15- 16- 17- 18--- 19- 20- Sun (/g l[¢'¥ ~ ~-'tCA~T~ownship, Range, Section: WAS GROUND W~XTER ENCOUNTERED? \..~. SLOPE SITE PLAN I-ffLII.l -4/q II s IF YES, AT WHAT DEPTH? Oeplh Io Wale¢'~fter MonitorinD? ~..,, Gross Net Depth to Net Reading Date Time [h/~,~% Tirne ~A/ii~X Water Drop/~/pt I0 10 ,~ PERCOLATION RATE /~,~'~ (m~nules/mch) PERC HOLE DIAMETER .. ~ TEST RUN BETWEEN ~0 FTAND ~' ~'--FT DOMMENTS PERFORMED BY: ~4'e~'~.- {.~/¢,~/ h [~ I ~(~ ~/?~ r~.-~,~.,,'l CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4185) GREI ER ANCHORAGE AREA BOR Department of Environmental Quality 3330 G Street Anchorage, Alaska gg503 'JGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCAT'ON_ LEG^LDESCR,PT,ON LL ~ ~/ ~.~,_ , SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH ' ~ _ ,_' / NUMBER OF __ MANUFACTURER (~' 6¢g//'~ MATERIAL ~'(~ ~/~c 6¢ COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACIT¢~'' ~-d"~ GALLONS. TILE DRAIN FIELD: FOUNDATION /~'~/ NEAREST LOT LINE /~"~'~'{- DISTANCE FROM WELL / NUMBER OF LINES / __ DISTANCE BETWEEN LINES %~- TRENCH WIDTHJ4P IN. ABSORPTION AREA / ~'g2~/'~ SQ. Fl. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF 'TILE TO FINISH GRADE -~/ MATERIAl_ BENEATH TILE TOTAL LENGTH/~ OF LINES TOTAL EFFECTIVE ABOVE TILE IN. WELL:. · ~ '~. BUILDING NEAREST NEAREST FOUNDATION__ LOT LINE , SEWER LINE DEPTH SEPTIC SEEPAGE ., TANK .... SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED _____REMARKS DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTEM INSTALLED SEWER LINE DEPTI4: PIPE MATERIAL' LOT SLOPE: REMARKS: Form EQ-032 GREATER ANCHORAGE AREA BORC)UGH SEWAGE DISPOSAl.. SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION -- /~/'~'~"¢'~'2~/'/1/~/r ~)/¢~'' ~__ '~ INSTALLATION OF: SEPTIC TANK ..... SEEPAGE PIT ., DRAIN FIELD -- --, OTHER DEPARTMb:NT OF ENVIRONMENTAL QUALITY AUTHORITY WiLL BE SUBJECT ']FO PROSECUTION. SEPTIC TANK ~'~/ , SEEPAGE PIT DRAIN FIELD  EAnlllANKS · CONSULTANTS, lNG. JUNEAU R &'M NO. 462098 Hoe Unlimited 8040 Lake Otis Parkway Anchorage, Alaska 99502 Re: Test Hole and Soil Log Report for Sanitary System Lot 3 Block 1 Sun Valley Heights Subdivision Gentlemen: We are submitting herewith the test boring results and our co~aents ~egardin§ soil conditions encountered at the subject site. This investigation was performed in accordance with your request of 11-12-74, and those procedures outlined in a letter dated September 13, 1971 by Mr.' Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 3 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth of 10,0 feet below ground surface. One sample was recoverer from the bottom of the test hole and the results of this sample are enclosed within. The final log prepared for the test hole has been included in Drawing A-01, Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS JWRlpjm xc: GAAB Test Hole 1 11-13-74 0.0~ (Fill) Organics, w/Soil Organics W/ Some Sand & Gravel 4.07 4.5' Silty Sand, Some Gravel, Trace Clay (SM-ML) 7.0' Silty Sand W/Some Gravel (SM) 10.0' No Water Table NOTE: Test hole excavated with tractor-mounted backhoe. Engineering ~ Geological Consultants Inc. ~NC,O~A~ FAmBA.~S ALASKA , Hoe Unlimited Log of Test Hole Anchorage, Alaska ,/'..:~;~%~ . ., _. . . ,:. .... , ....... ~ Pro e.t kumb~r _~/~ ..... Pm ~ct Name_ ~. ~,., ...... ~ Sam~ed From ~'~~ S~Jrc,. De~ ~;~,~;~;- Location or Suppl~~ . ~ S~mpled By ~,,_~/~ Dry Co¢;;se Agg. ~L"?¢ '__Lb. Dry Fine A~9. __/.~_?~z:_~- L_. btb. ~fci Y,'t. Dry ~ ___ Lb. FR;STURED PARTICLES ~fc! Fracfdred ",V }. SIEVE DRY V/EiGHT % RET. % PASS .... \ ....... I FIN~. ¢,.~ ~,REGAT._ ~P..¢~,~,:~. t DRY ~t[,, ~l Cv,~RS~ 7}~ ' Lbs. % % · X % , , 'j.1 _Lbs. ,Sg .% X%, , .TOTAL (-.. ~I[V~ . Raf~ Ret.~:5~. --No.4:A '~ ...~at. 'Ret. -rms~ ..'+~p. 4:B ~4_ ~ ~,.~__~_¢~ 80,~~ .02m~' SPECIFIC GRAVITY AND ABSORPTION .O0~,,.m ~ RNE AG~,z. HATc I COARSm AGGREGATE ,¢~,~h, S ....... d L,. r ,~ V/oter, WI Ws~gh~ b Air: Temp.,T in E Gab in ~4 Hours ~' ~ ~' , .... r SoiI~W2 We~ahf in Water WL of Dry SoiI,V~b We~shf H~O Displaced Specific Gravity of Soii~-~E 2 L ~.-. DELETERIOUS MATERIAL J !_A. -ABRASION .~¢mcs ! I I I L t ..... ATTERBERG LIMITS LYQU,D PLASTIC Dish No. Biows Can No. WeiGht Can+V-'~ Soil V','a!oht Con+D~ Soil Wai~h~ of , e..,,, Chh+Dr,/ Soil %'e~hf of Con . ~ ...... of Dry Soil Moisture,% ~ LIQdlD LIMF (LL) PLASTIC LIMIT (PL) PL STI~ INDEX (PI) '-'." C!3ssffi~lion % +10 I % + b" , c, Ass ~-~- ~- .-.,,¢~r .... {'~:.~'4-~,d":?" ', :!~'~Ab,JRATORY TEST WORKSHEET ' '~;{" ';, ':.: i !' ), ',k)i Pro eof Number _~~ Pro eot Name ~ ~:' h::P; ;q:., ',?~Y Sampled From ~-~ ~.~ ' Source .... Depth Dry Coarse Agg, ~. ¢ ~ Lb. SIEVE DRY WEIGHT % RE% Dry Fine Aqg. ._/.~Zz~ ¢:- _ 14b. To,.~,"'"' Wt. Dry F'rosfured Wf. ,;~_,.,~....~,..z~, ,T FIN,..__.._..,.,~ ,~GGREGAT~_~_,C4..~,~,~.~'.~.L._B_S.~.j DR..~.?~I.~C~F..,..T,_.,CO/~, ,b.~..~R~,~A1.~F ~ LBS~ Lbs, % % ' X% -I L~ .% P/o X% . :FOTAL ~]~v~ef. Ref~ ' Pass :t'No,4:~ . ,;_1_ Ret : 'Ret '~~ s~,. ..... .... ' .... ~O~m.m ~f~ SPECIFIC GRAVITY AND ABSORPTION .O05mm ~ 1 T 84 , ~Sb ~q~!~ AGG ?EGATE COARS~ AGGR~A~E ~ F csk We]ghf Saturated W. re.ok ,-,a,~r~ WI Temp,T in F.. \7,, ,,~'x Water Soil~W2 Wt. of Dry Specific Gravity of Soil' - Dct_E3 ~!OJS MATERIAL f~3! 8~ Licflh~ - I . - ~ 200 , Gain in 24. Hours ~ bso.rp~i_on °/o.._~ __ ~ in Water Weiaht H~O Disalaced L.A. 3N isaacs. A'ei~hf After )if terence % Loss '% ~ A DoGRAD ZION __ ATTERBERG LIMITS Dish No. Can No. ~ ,W¢icht Cgo +k'/~ Soil! ,._ V'/¢qh} Ca~ +D.W. Soil Weiqht of Wd';er W~qh~ Oun:bDry Soil ~ht of Can ~h~t _oLD_UL SCI ' Moisture,% LIQUID LIMIT (LL) PLASTIC LIMIT (PL) PLASTIC INDEX (PI } C!assificafion AASHO % +lO %-b % Gruel % Sand % Silt % Fsv CLASS Unified Typ~ of N1aferial . ,_~.'L~_~ Dry Co~rse Agg. .¢,,-G~._~.._Lb, SIEVE Total V;. Dry ~ff Lb. 5" _ ...... FU,*c.D PARTICLES ¢, W.~ .k ': No.4 [~EVE Ret Ret~ Pass NO. 4. GREATEF ANCHORAGE AREA BORr'JGH · '~-',--:"-: h · .' ": "; LABO,xATORY TEST WORKSHEET Dcn~ Sempbd From ~_~ ¢.~,._.~ SCarce . Location of Supply~ ...... Sampled By ~-~r~ ~ ' DRY WEIGh' % RET. % PASS S, ~. R£MA,~KS_ -' '~ 2'00 I Moislure,% Sh~'.e ~, ,~a,.~ LIQUID LIMIT (LL) Sfid<s 8, Ro .... % Loss PLASTIC L~MIT (PL) Cae! ~ '~ ~ PLASTIC INDEX (PI LJ~n,,~ DEGRADATION _~b~ Lumcs C!assificafion Frisb!e AASHO j Unified Total .! % 4-10 I %4- 5" % Grovel Sand . Silt ' % Cia),_ Fsv CLASS Del. j S p, ecs. i V/f Flask Wcter Soil,W2 _ WaiSt m Water_ ~ We':q~t C~ ?fl W(of DW Soil Ws Wefqht H~O Di?ldced J Weight of W~er ., .~ ~ ...... ~ : ~{_~,~ ~ .... , ...... ~- . = S . Gr. Weiqn ~r,4-~[ ~q~ . D~LETER!OUS M~TERIAL L,~.ABRASION ,VJqhf of Can ¥/e~qhf o~ gW .~ P~:l~ ~ ~-..~: ..... -~ L.~ -' _ _:~- ...... ~~' :-"[~'~'--I --~R~TY AN) ABSORPTON ATTER~ERG LIM TS .O0~mm ~ ~ ~ ~ ~ ,- ' ........ ~-~ ........ --~' T~ ~- ' ~ ~~ LtalIC'C PL~S~I~ ~,:Johf c~ FIosx _ N~,~ht Sarura,~ ~ I Dmn r..o, . , ~ ' ~ ¢,'2 *'~ ht Ar r Bow ~,,. F,aok ,re,or WI _ ~n , DLV I ......... Tamo,T in F - Gain in 24 Hours ~ Can No. DRf tc~,~,t:,,t~ CO~RS,- A.:oRE(.AI~ .LBS. J ' . Lbs. ,/o --¥o X 70 , , 'q'OTAL ' j Ret. 'Ret 'Poss.'+ No. 4:_~ra~J. A~,B ~~__ LABORATORY TEST REPC. F TEST ON INSITu PROJECT NO. --PROJECT NAME Hoe Unlimited SAMPLED FROM Test Hole 1 SUBMITTED BY Jones SOURCE Lot 3 Block 1 Sun Valley Heights Subdivision LOCATION, Anchorage, Alaska GRAIN SIZE DISTRIBUTION ~4 #16 #sO DEPTH 10.0' DATE SAMPLED 11-12-74 CLASSIFICATION %+ IO % GRAVEL % SAND % SILT % CLAY FSV' PL UNIFIED SM AASHO FAA R~M PROJECT NO.462098 74A' 1611 LAB NO. FIELD NO. DATE REPORTED 11-13-74 DATE RECEIVED 11-12-74 COMPACTION OPTIMUM MOISTURE 14AX, WET DENSITY _ MAX. DRY DENSITY REMARKS DELETERIOUS MATERtAL MINUS ~ 200 MESH SOFT FRAGMENTS COAL M LID. OR LT. WT. PART. CLAY LUMPS STICKS 8 ROOTS FRIADLE PARTICLES SPECIFIC GRAVITY ABSORPTION FINENESS MODULUS SULFATE SOUNDNESS FREEZE - TNAW RATIO STATIC IMMERSION ORGANIC COLOR MOISTURE - PERCENT F~. F_nglneering (3~ologlcal Conaul?anto (;REATER AI'ICIIOI<A(;I AI~i..A UOROU~, Department of [nvironlnenLa] Qua]i[y 3330 "C" Street Anchorage, Alaska 99b03 SOll,S hO(i PI';ItOI,ATI()N TEST l'his form repogts: Soils log % / --P~V~¥-~¥C .............................. Dep th Feet ¥_-~ 2- 3- 4- 5- 6- 7- 8- 10 .... 11 12- 13- 14- Was ground water encountered? ___~_Q ....... if yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net i)rol, Percolation rate minute. ,Proposed installa~l~¥:- ' Se~pa~]e Pit []rain Field I)epCh of h~C . Depth to lho~tom or 04O d Municipality of anchorage I�1 Development Services Department I 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 Parcel I.D. 01-7-0,62-2-S COSA# Qq 02-0y 1. GENERAL INFORMATION Expiration Date: -7 — 9 — f Complete legal description SUN VALLEY HEIGHTS: BLOCK 1, LOT 3 Location (site address) 13301 ALPINE DRIVE • ANCHORAGE. AK • 99516 Current Property owner(s) LAURA HOGAN Day phone 529-9224 Mailing address 13301 ALPINE DRIVE . ANCHORAGE. AK • 99516 - Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well 0 Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ 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 pf 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 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with alt applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Phone 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 analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. 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 the 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. 5. DSD SIGNATURE Approved for 4_ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing Attachments: / COSA Checklist l/ Arsenic Advisory Septic System Advisory Maintenance Agreements 337-6179 f<ef Gar ss: 799 a C•`a` '° ��•0 � �_ eco ON-SITE •.• �� WATER AND WASTEWATER PROGRAM Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: �V . / —lA�� Original Certificate Date: (Ray. 1 tN5) Municipality of Anchorage Development Services Department Building Safety Division `— On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SUN VALLEY HEIGHTS; BLOCK 1, LOT 3 Parcel lD:Q12 06;23 A. WELL DATA COMMUNITY WATER SYSTEM Well type •A• If A. B, or C provide PWSID# 212005 Well Log (YIN) Date completed Sanitary seal (YIN)_ Wires properly protected (YIN Total depth ft. Cased to ft. Casing height (ab round) in. FROM WELL LOG AT I CTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RES =enic: colonies/100 ml. Nitrate mg./L. Other bacteria colonies/100 ml. ug./L. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 8/13/1994 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 4/13/2009 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA -BELOW EXISTING GRADE TO 80TTOM OF SUMP WHICH ONLY EXTENDS 6.9 FEET BELOW INVERT Date installed 8/13/1994 Soil rating .p.d./ or fftdrm) 0_6 System type TRENCH Length 68.5 ft. Width 1.5 ft. Gravel below pipe 8.2 ft. Total depth *10.67 ft. Eff. absorption area 1120 fe Monitoring tube YES Depression over field NO Date of adequacy test 4/28/09 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 20 in. Water added 600 gal, New depth40 in. Elapsed Time: 1 E0 min. Final fluid depth 24 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on' levet at in. "Pump off' levet High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES COMMUNITY WATER SYSTEM SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfift station on lot On adjacent Absorption field on lot On Public sewer main Sewer /septic service Public sewer manhole/cleanout Holding tank I areas Manure/animal excrete storage areas _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line .106+ Surface water 100'+ Wells on adjacent tots 100'+ PRIVATE & 200'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line ' III Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PRIVATE & 200'+ PUBLIC F. COMMENTS *NOTE: WATER LINE WAS PROFESSIONALLY LOCATED BY CHUGACH SEWER AND 'DRAIN AND CROSSES SEWER LINE. SEE ATTACHED RECEIPT FROM CHUGACH SEWER AND DRAIN. o6043an.._ G. ENGINEER'S CERTIFICATION Ur I certify that I have determined through Geld Inspections and review of Municipal records that the above systems are in �'"" "" """ ; • • • • • dconformance with MOA COSA guidelines in effect on this a A. Cor s ate. Q...., ... ............ Engineer's Printed Name JEFFREY A. GARNESS Q o 5 s• : k Date tol �o COSA Fee $ % C Date of Payment Receipt Number % 1 �f % (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ON" 06/05/2009 13:21 9072432081 FRED WALATKA & ASSO PAGE 01 �o ,53 W / D, 00 teen 0'5 ° 3 3 V. y WafCv —� Valve I ::1j1 • z 54CO. G ave I: \. . ac ' Q Cglt� ^` `v • N � ; � RARrJ .. � � Service Pole / 253 V nfs I LU �I ¢ 6l 9 ��Itn ` of .I 5� Fri. rl y.$sm.t ...:.... _. _ ..0 P?CK Zoe. $ �' N) l49 _o- - - - - - ip-530'_ - 50 00'30" 5 M . .... Scale: l "=30' Al the r tx, AS -BUILT, ZaCDRNERS SET THIS DATE 1 trereby cartify that I have performed a Mortgogoe's inspection Of r^T : �'_ :- s of the following described'Property' `ot 24 R—�— Le eel c_+% . 0 Fnd Sic " REL -Y `E°' Syn—Va ll ey h'elati is r: as • •'' •.. M o Sei SSB Re6av F s•'• �.' !- Anchorage Recording Precinct. Alaska, and .that the y � - Improvements situated thereon are within the property Y- 0 lines and r'^ O" T do not overlap or encroach on the property lying adjacent thereto, that no improvements on propeny.lying adjacent thereto �•'� �, • ,,' encroach on the premises in question and that there are no f �aF' roadways• transmission lines or other visible easements on said property except as Indicated hereon. Dated at Anchorage, Alaska qq�� ....._... _ ..m.... 2 Cf 115 -.......-day of • Q ----....-'19..C.0 F3ASEMENTS OF RECORD, OTHER THAN THose SHOWN ON THE RECORDED FRED WA KA a ASSOCIATES PLAT ARG NOT SHOWN HEREON. r w (907) 248-1666 Engineers and Surveyors F8 76- C-nJr.-C. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (SOD 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. GENERAL INFORMATION Complete legaldescription Lot 3 Location (site address or directions) Current Property owner(s) Tom Mailing address 13301 Lending agency Mailing address Real Estate Agent Mailing Address t--I /:t 0.3o Expiration Date: Block 1; Sun Valley Hei~_hts Subdivision 13301A19ine Drive Liss Dayphone 748-4192 Alpine Dr. Anchorage, AK 99516 Unlesso~e~ise~queste~ HAA w~behe~byDSD~rp~kup. NUMBER OFBEDROOMS: 4 Day phone Day phone 3. TYPE OFWATER St'" ..... .' ...... :,' .... Individual Well Individual Water St, Community Class ..' Public Water Syste The Municipality of Anch( Approval (HAA) based or engineer registered in the titIe (except between spc supply system. DSD also valid for 90 days from th6' new water sample result: Certificates are valid for/" Municipality of Anchora'? TYPE Of WASTEWATER DISPOSAL: ;ire / ':",ing tank [] ]f ~-site [] //.>-,- "'., [] Certificates of Health Authority an independent professional civil cai are required for the transfer of wastewater disposal and/or water of Health Authcdty Approval are "' ~ ' ~' r 'S C well and may be reissued with ' ?.' ¢, & . ~~ ', .... ne ye~rwithv,lidwstersample,.) ¢ ,.Ils or 8 public w,ter system. The ; / . ~ional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authority Approval Guide!ines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. DSD SIGNATURE L.-'"' Approved for L./. Disapproved. Conditional approval for NameofFirm S & S Engineering Phone 694-2979 Address 17034 N. EaRle River Loop Ste.204 EaRle River, AK 99577 Engineer's Printed Name ~nh~,-r o_ on~,,~,~ Date ~ ;- ~. ~ w' ';. bedrooms. ,~,o~,? ................. 1, ,,.~ 'h.;J .,::'.:. ;~,'"L~' bedrooms, with the fo~[ow~n~ stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other /"~~ Original Certificate Date: /'7L - / ~ - O '~ (Rev. 01102} Municipality Of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box lg6650 Anchorage, AK g9519-6650 www.cLanchorage.ak, us (907) 343-7904 HEALTH AUTHORITY APPRQ.VAL CHECKLIST Legal Description: LoT' A. WELL DATA Well type C4. n,~ /~ Date completed Total depth, ff Date of test Static water level Well production WATER S/~PM~~ Coliform ,..""colonies/100 mi. Nib'ate mg./I. Ars~ mg./L Date of sample: B. SEPTIC/HOLDING TANK DATA Tanksize t~l.';'O gal. ...['i iNumberofCompadments Foundation cleanout (~1) ¥.¢,~.. Depression over tank (Y/I~ Date of pumplng y/~/0~_. Pumper c. ^esoR noN nE-O OATA," IfA, B, orC provide PWSID# :Xlaoo 5'- . Well Log (Y/N) ,.~--~"- Sanite~y seal (Y/N) Wires prope~cted (Y/N) Cased to . ff Ca..~'/ieight (above ground) FROMVV~,LL,,LOG,, . ~TINSPECTION ft. ..-~'"/ g.p.m, g.p.m. Other bacteria Collected by: irt. colonies/100 mi. Date installed ~'/I 3'/e 'f Cleanouts ~:,~N) ¥~ ,~ High water alarm (Y~ ~ 0 Date installed' ~/I $/W ¥ . Boil rating ~r ~2/bdrm) O. G Length G ~', ~ ff. Width 1- 5" ft. Totaldepth I~ ff Eff. absorption area 113of~ Monltodngtube ¥~$ Date of adequacy test 3/3-0/0 .~ Results ~Fail) /:~ f J Fluid depth in absorption field before test;t/'t~i~. Water added (.do gal. Elapsed Time: &o min. Final fluid depth3/7 in. Absorption rate >= Any rejuvenation t~eatment (past 12 mo.) (YIN & type) ~ ~ .v 4. ~. ~,o,,,~ System type "r,~ ,[,.~ Gravel below pipe ~ · ~, ft. Depression over field ~v o For ~ bedrooms New depth ~' ~ o g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at ~ in. Datum ~ E. SEPARATION DISTANCES Size in gallons .~/~~ (Y/N) 'P.~ in. High water alarm level at Cycles tested Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: ~~ Septic tank/lift station on lot On adja Absorption field on lot ~cent lots Public sewer main ~ Public sewer manhole/cleanout S~e Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ ~' Property line '7 3 Water main / o ~ Water service line I o ~ Wells on adjacent lots ~' c~.~ "*//~j~ '+ / Absorption field 5" -F Surface water ! oo '-~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ '7 Water Service line Io ~c Curtain drain ,v~,.,. ~,~,~,,,, Building foundation I Surface water ! oo '-~ Driveway, parking/vehicle storage Wells on adjacent lots 3-oe -~,/~,~ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name /r~,~,~./~ 7' C. ("~ ~..4~/ Date HAA Fee $. Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number h/ o '5° ~ ~ 's ~ " w EASEMENTS OF RECORD, OTHER THAN THOSE SHO~N ON THE RECORDED PLAT ARE NOT SHOWN HEREON. F'&~'~./? c,,,/,., t,.,? /';'I 4.8 .t ~ ~.--~'_~.~u~ AS-BUILT 1~ CORNERS SET THiS DATE '/ ~-,,-, ~,..-. ~,,-..::.+_,,,~ · .... ~ ~4_Cl'r. ~ -..~.~v~ i h~'eby ce,sit), Ihal I h;we performed a Mo~gagee's InspecS~on ~ · .....~.~ · Anchorage Recorc~lng P~eclnc! At3ska and Ihal Ihe ~- ,..~c",~T.~ ... impm~ements situated Ihe.~ ~'e ~llhln the l~ropeny lines ~~' '~o no~ o~e~fap m e~cto~ch on ~ p~e~ ~ing ad~3cen mete~. '~ thal ~ Imp~vlmenls on propody ~ /~acent Iherelo .. encroach ~ lbo ~emlses in quoslion ara Ihel Ihere are ~ · foa~, transmissi~ lines or other vis~ble easements on laid properly excepl as h,diCaled horn. Dated N Anchorage. Alas~ ~ {9~) ;~8-1~ Engineers .~ Su~e~,s 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. # _(~ I~- ~ O ~'~ - ~--"~ HAA # _~'\ ~'~7_2-~-~ 1. GENERAL INFORMA'rlON Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address t.~,s. L,,,.J'~A, ~'-og/,J~,'.q _ Day phone t%~c,( fi, C~!~ ~'b~,u~- ~ (~A)clt.~z~,.~, AY-- Day phone Agent Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF: WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Publid water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site __~- _ Holding tank Community on-site Public sewer 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 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that r:ny 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--'"P'. A~',¢~,,~¢- ~¢,, ~¥~ Phone Address ~;~,~,~,~Y-- l~'-z,~z~ / ~,~c~z~ : A F--.. Engineer's signature- ~ _ Date ,~ DHHS SIGNATURE Approved for ,~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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. IVlunicipality of Anchorage R E C E 9EPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services DivisJor 825"L" Street Room 502 · Anchorage, Alaska 99501e Municipality of Anchorage Dept, Health &.Human Servloet~ Health Authority Approval Checklist Parcel I,D.: _(~ IT ~ o ~% - "~- "~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Smdtary seal (Y,q',l) FROM WELL LOG g.p.m Casing height (above ground) Wires properly protected (YFN) AT INSPECTION Nitrate Other bacteria Collected by: IT,So · Depression (y/Iq) _ Pumper _t2a c,~ T/& ~,.q~ Number of Companmeats "z_ Cleanouts (Y/N) ~ c:, High water alarm (Y/N) ~ (/~, Soil rattng (g.p.d./ft2 or fl~/bdrm) ~3. ~, System type _ 'b "7- ,5 Gravel thicku~ess below pipe _ ~', Z- Total depth Date of test Static water level Well prodaction WATER SAMPLE RESULTS: Coliform Date of sample: II. SEPTIC/HOLDING TANK DATA Date installed ~ -t~o - 't q Tank size Foundation cleanout (Y/N) __ Date of Pumping C. ABSORPTION FIELD DATA Date installed ~ -1'3-ct Length G c~ .-/r Width Effective absorpuon area // Date of adequacy test ~__.-/g Monitoring Tube present(Y/N) Results (Pass,ail) _<~,.~ Fhfid depth in absorption field before test (in.); Z" Immediately after ~-- gal, water added (iii.): Fhdd depth _ (ins.) Minutes later: Absorption rate -- g.p.d Peroxide treatment (past 12 months) (Y/N) Ir'yes. give date Depression over field (Y/N) r'~__ _ For rd bedrooms D. LI~T STATION Date installed [ Size in gailons Manhole/Access (yfiXl) ~' F%///pu~ _/ E. SEPARATION DISTANCES "Pump oft" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: 4//t~ Oo~4otv~-rff ct)~.Cc.- Septic/holding tank on lot .; On adjacent lots ~ent lots Absorption field on lot Public sewer main ~ Public sewer manhole/cleanout ~e Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '~ ~ Property line 7~ ~ Absorption field Water main/service line .~On~ Surface water/drainage /00 ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain ! ~'o Property Line Driveway, parking/vehicle storage area Wells on adjacent lois F. ENGINEER'S CERTHqCATION I certify that I have determined thru field inspections and review o in confornmnce with MOA ff~M guidelines in effect on this date. Engineer's Name Date -~-t' ~ - HAA Fee $ ~ C~, CtD Date of Payment Receipt Number Rev. 8/95 eSS: haa.wk.doc Waiver Fee $ Date of Payment <ff~7 '' Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMI=NTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING (~)'"h,O~ ~ ti;Z} \ - ~ HAA # .~ ~-'~°t~"~ ",,& ~L.% 1. GENERA[. INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3; Block I; Sun Valley Subdivision Location (address or directions) Mile 6.2 Hiland Road (b) Property owner Mailing Address (c) Lending Institution Mailing Address Biscus & Kornbrath HC 85 Box 98~2 Telephone:(home) Rive~ Alaska 99577 Telephone Business (d) Real Estate Company and Agent Re/Ma~ o~ Eagle River ATT~/: Eva Loken Address_ 16600 Centerfield Drive Suite ¢201 Eagle River, Ak. 99577 Telephone 694-4200 (e) Mail the HAA to the following address: (or check here ~if hold for pick up.) List contact:person and day phone number below: S & S ENGINEERING 170-34-Eagt~ Ri,w,~ [.,.,up Ru~d Eagle River, Alaska 99577.. 2. TYPE OF RESIDENCE ~ingle-Famiiy E~X Number of bedrooms 3 ~ 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site E~X Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 5, ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Address Telephone Date 6. DHHS APPROVAL Approved for ',~ bedrooms by Approved _ ~. Disapproved _ Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph § 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 7/88)88ck Page 2 of 2 ,. M~o~,CIPALI'I'Y OF ANCHORAGE (MOA) ~,~xs~ ~Health Authority Approval (NAA) " CHECKLIST - FEBRUARY 1984 ~ ~ 343-4744 A. WELL DATA C(~x~- Well Log Present (Y/N) ~ _ Date Completed ~"~- ~ ~ '- Yield Total Depth ~ ~ Oased to Depth of Groutin~ Static Water Level _ I z.f Casing Height Above Ground Electrical Wiring in Conduit (Y/N) _ t1 SEPARATION DISTANCES FROM WELL: To Septic/PNC,41J~cj Tank on Lot f O ?- To Nearest Edge of Absorption Field on Lot //¢; - Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ( CO ; On Adjoining Lots I cO To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot ~'O ! -- Water Sample Collected by ~ ,~c _~ ~.~/,j? i/'J ~ ¢~t,J~ Water Sample Test Results ,~ R ~/"l ~' fP~ ¢---{t'-o r ~ ~ Comments ~/iq __ TO Nearest Public Sewer Cleanout/Manhole /',1//41 ;Date ~ - 10-':t0 - B. SFPTIC/HOLDING TANK DATA Date Installed -~-~O-.8~Size I000 Standpipes (Y/N) ~ _Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) No, of Compartments ~ Foundation Cleanout (Y/N) _ ~ Date Last Pumped ~ ( ~ -- '~ O '~ A,I/~ ;for /'J/~ Temporary Holding Tank Permit (Y/N) /d/P', SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~ ~. ~l'f'c, _ To Building Foundation To Disposal Field Po o d '* <.e. po J 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _2.2 ~-¢,/~[~ Date Installed .~'"- 7~o - ~ ~-' Width of Field ~:'~, ' Type of System Design Length of Field -~- Depth of Field ! C' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Gravel Bed Thickness '7~. (¢ ~ ¢ '~ Statndpipes Present (Y/N) /',,) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / ! ~ ' ~- To Building Foundation .~- Lot ~/~ To Water Main/Service Line I O 'Y To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line / To Existing or Abandoned System on ; On Adjoining Lots ~'-~ To Cutback (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelin?,.dg,.effect on the date of..t,h.i..s... inspection. ,,. Signed $ & $ 2N6tN~,,,~!G Company 17034 Eagle River Loop Road No. Eagle Rlver~ Alaska,99577/.~ Date ¢¢r~/ Receipt No Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPOR~ BY SAMPLE for Work ORder t 26322 Date Report Pzlnted: AUG i6 90 @ 09:55 Client Sample ID:L$ Bi SOH VALLEY S/D PWSID :UA Collected AUG lO 90 ~ 13:00 hrs. Received AUG 10 90 @ i7:00 hrs. Preserved with :AN REQUIRED Cliemt Name : S & S P.O.{ HONE RECEIVED Req { Ordered By : R. SHAFER Analysis Completed :AUG 15 90 Laboratory Supsrvlso} ~P~HEN C. EDE Released By : ~ C. ~d/~..--'- Send Ropoxts to: l]S ~ S ENGINEERING 2) Spedal Instruct: Che~ab Roi {: 902977 Lab Smpl ID: I ~trix: Allowable Pa~ametez Tested Result Units ~ethod Limlt~ NITRATE-N 0.22~ rng/1 EPA 353.2 Sample ROUYINE SAMPLE. Ronasks: SAMPLE COLLECTED BY RD3. I tests Performed ' Soo Special Instructions Above UA-Unavailable ND- Reno Detected "Nee Sample Remarks Above HA- Sot Analyzed LT,,Less ~hen, 6~-$~oater Than