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HomeMy WebLinkAboutSUNNY VALLEY LT 14 REMMunicipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191363 PID Number: 050-354-15 ❑ New ❑✓ Upgrade Name: BRENDA JOHNSON & NICOLE JOHNSTON ABSORPTION FIELD ❑ Deep Trench [I Shallow Trench El Bed El Mound Address 9451 West Lake Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Sunny Valley 14 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft' Ft. Well 108.2 NA N/A N/A N/A TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 15000al. Surface water 100+ NA N/A N/A Material Steel Number of compartments 2 Lot Line 50.4 NA N/A N/A NA Foundation 15.7 NA N/A FN/A LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A N/A Gal. RemarksTank replace only. Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to drainfiefd 3034 Installer DEAN CONSTRUCTION Drainfield C0/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 1001`1 Inspecttiones 1� 9/10/2019 Location and description 2nd House F.F. 3m 4u, COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date ...:. Steven f�. f�anriorae d C 8149 �s ,1W Date E55AWIApperov Inspection Heport_1-1-12.doc o�U)00—,-.m 00 s N n p _> I �C �_ V7 D N '� z -0 vN -c>1c"15 � 0 Yn (Ilm zNm-;lz O.. D rnT OJ m (� �OOl Ir OPX A m I N U.O -i>i74 -C ! ����Z�Oo;D ! -0 T!7.. Ernm0Lo O i-r*m� UDo0 O -1 5 .. J n ::o - m m I I m e . o m 0 � D o n D zm2po z g� � a'VD O z m rn m D C O D g r O� z 0 N A � M D Lc) rrl Z v m Em n r i m Ste. / m f�� '1 -0 z 0 O / \✓<t A ~,Tm r V �� \ w W / j < "0 Do o o mz rno rn \ rn % / a Dm o i N -P � m A O MANHOLE -- �y z m no'D --I o ! Y ` `S,` \ N n O Z�ADO r Z I M nip O m D CLEAN OUT �� 0 Cc) 1 N m o� N �O� / O LQ ND M z S nrn �Z J; Z m m O N n m r r / ry N -� D l V N m \ S i U / M -P � U � CO CO 0) .� \„ W NOTES: PANNONE ENG SVCLLC P.O. BOX 1807 PALMER, AK'99645�....a„ PHONE 907) 745-8200 FAX 907) 745-8201 P•' 0tf- REVISIONS AlE 09/13/19 RECORD DRAWING SCALE F49 7H 1" = 50' SUNNY VALLEY L14 REM P.I.D. NO 050-354-15 BRENDA JOHNSON & NICOLE JOHNSTON PO BOX 772764 EAGLE RIVER, AK 99577 SITE: 9451 WEST LAKE DRIVE E ..--even annone CE 8149 Q •' DRAWN ACP/JRL SITE PLAN PERMIT NO. OSP191363 SHEEZTOE 2 EAGLE RIVER, MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program RO Box '96650 4700 Elmore Road Anchorage, Alaska 99519-6650 Pt,,,,,: (907) 343.7904 Fax: (907) 343-7997 Permit Number: OSP191363 Work Type: SepticTank Upgrade Tax Code Number: 05035415000 Site Legal Address: SUNNY VALLEY LT 14 REM G:0057 Site Mailing Address: 9451 WEST LAKE DR, Eagle River Owner: JOHNSON BRENDA H 50% & Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: MM, Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: MOM _11 nQpilrunclit 8/19/2019 811812020 55704 El Disposal Field 10 Septic Tank El Holding Tank 1_71 Privy El Private Well El Water Storage All construction shall 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 (1 8AAC72) and Drinking Water Regulations (I 8AAC80) 1 The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65- Provide notification by calling (907) 343-7904 (2417). 4, From October 15 to April 15, a subsurface soil absorption system Linder construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Date - 3 EAAMS Rust MUNICIPALITY OF ANCHOIRACE Community Development Department =Y, Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-354-15 Property owner(s) Brenda Johnson & Nicole Johnston Mailing address PO Box 772764 Eagle River, AK 99577 Site address 9451 West Lake Dr. Eagle River, AK Day phone Legal description (Sub'd., Block & Lot) Sunny Valley L14 REM Legal description (Township, Range & Section) Lot Size 55,704 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Mu.Itiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 106() Waiver Fees: Date of Payment: S /!g `/g Date of Payment: Receipt Number: j1 q06) Receipt Number: Permit No. 05 I- n l q l ��O Waiver No. Permit App_; .....:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191363, Rebecca Carroll, 08/19/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191363, Rebecca Carroll, 08/19/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191363, Rebecca Carroll, 08/19/19  , ~' MUNICIPALITY OF ANCFIORAGE · DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONNIENI'AI_ ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-47~0 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR wELL INSPECTION REPORT ~ UPGRADE LOCATION NO, OF BEDROOMS ~ DISTANCE TO: ~ Manufacturer ~g~ Materi~ ~ No. ofc~artments Liq. cabin, lions IF HOMEMADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: i Well Dwelling PERMITNO, O ~ ~ Manufacturer Material Liquid capacity in gallons ~ DISTANCE TO: Well /~O f Foundation ~ ~ Nearest lot line Leng each Ii e TotaI length of lines Trench wi~ -- inchesinChes Total effect~tlon area --~" Mat erial'~n ;~h tile -- ~ ~ ~ Top of tile tO finish grade ~ Length Widd¢ Depth ~ PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest ~ot line ~ DISTANCE TO: ~ Class Depth. Driller Distance to lot line PERMI% NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER REMARKS . APPROVED % DAT~ LEGAL 72-013 (Rev. 3/78) PERMIT NO. RPPLICRNT LOCRTION LEGRL [.EFHRTM_NT u HERLTH RND ENVIR:OWMENTRL r'~OTECTION .:. -. '='~'-' L._/.,TREET., RNCH RRGE., BK. 9S.=..~i ~ a_~ -=,ITE SEL4E~: F'ERfdZT ~-I~- " olk12.,:,l 5 HRMRNN CONST. PO BOX 617 ERGLE RIVER 694-2776 LINK i~ c' ' ~.~_,68 'ME, IIRRE FEET LOT ~ SLINNY VRLLEY _,UE, LOT _-sIZE ='~- _ .... 'TYPE OF SOIL. FIBSORPTION SYSTEM IS: TRENCH MRXIMUM NUMBER OF' BEDROOMS = 4 SOIL RBTING (SQ FTZBR)= 125 THE REQUIRED :SIZE OF THE ':;OIL BBSORPTION SYSTEM IS: THE LENGTH DIMENS'ION IS THE LENGTH (IN FEET]:, OF THE TREN_.H' ' P OR DRRINFIE~[:,". THE DEPTH OF ~ TRENCH OR PIT IS THE DISTRNCE BETHEEN THE BURFRCE OF THE GROUND BND THE BOTTOM OF THE EXCFWRTION (IN FEET). THER:E I=, NO _,ET WIDTH FFIR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRR',,,'E[ E, ETHEEN THE OIjTFFILL F_FE RND THE BOTTOM OF THE EXCRVRTION (IN PEET). PERMIT RFPLI_.RNT HR_, THE ~.E_,PLN=IBILI]~ TO INFORM THIS DEPRRTMENT [:,.BINS THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERT9 BND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. BBCKFIL. LING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTFINCE BETWEEN R WELL BND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS t00 FEET FOR R PRIVBTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET BND TO R COMMUNITY SEWER LINE IS '?5 FEET. OTHER REQUIREMENTS MRY BPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER IN~TRLLRTION. F'EF-L'~'-~ Z 'T E::-~P I] ~:;-:E'--~]. [)EC:E[~'IE:EF-: 3:J_., 1DE:J_ I 1: FORTH B'=' THE MUNICIPBLITV OF RNCHORRGE. 2: I WILL INSTFtLL THE SYSTEM IN BCCORDBNCE WITH TWE CODES. 3:: I UNDERSTBND THRT THE ON-SITE SEWER SYSTEM MR'¢ REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. :,IbNE[ .... ~'PL I I]:RN'F P~MRNN CONST. I_,_,UE[. B~ ~ BRTE V4. 8 CERTIFY THRT I RM FRMILIRR WITH THE REQUIREMENTS FOR! ON-SITE SEWERS AND WELLS RS SET MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST /~ SOILS LOG [] PERCOLATION TEST LEGAL DESCRIPTION: 2 3- 5- 6- 7- 9- SLOI SITE PLAN 10- 11 13- 14- 15- 16- 17 18 19- 20- Robert A. No. WAS GROUND WATER /~__.'~'¢' SL ENCOUNTERED? 0 P DEPTH?IFYES'ATWHAT /~/ E Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: -/ 72-008 (6/79) PERMIT NO. E:.EPARTblENTL,~.¢ HEALTH AND EN?IRONMENTRL¼~.OTECTION 825 ~L' STREET~ RNCHORRGE, AK. ~50t ) APPLICANT LOCATION LEGAL CHAMBERS CONST. MILE 4 EAGLE RIVER ROAD LOT t4 SUNNV VRLLEV SUB SRA BOX 447-A LOT SIZE 688-9224 56000 SQUARE FEET MINIMUM DISTANCE BETWEEN B WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS ±00 FEET FOR A PRIVATE WELL OR ±50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE 12; 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED 'TO THE DEPARTMENT WITHIN 30 DRVS OF THE WELL COMPLETION. EITHER REQ IIREMENT~ MA9 APPL9. :,PEuIFIL. HTI_N:, AND CuN:TRUuTIuN [:,IAGRBMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEF-:ffl I T E)-(F' I RE__"B- [:~EL-:E~-'~BER 3:1.. 1981. I CERTIF9 THAT i: I BM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH 89 THE MUNICIPRLIT9 OF ANCHORAGE. 2: I WILL INSTALL THE SVSTEM IN ACCORDANCE WITH THE CODES. SIGNED: ........................................ APPLICANT CHAMBERS CONST. V4. 0 © © Fir by SULLIVAN WATER WBLLS P. O. BOX 272, CHUGIAK. ALASKA 99567 e TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER Ended Fol-c~/0t~/ - DEPTH OF WELL /' / STATIC LEVEL OF WATER FT. .' DRAW DOWN FT. "' GALS. PER HR , / - c:~ ~ KIND OF CASING ': KIND OF FORMATION: From__ Ft. tn ' - ...Ft. From ,Ft. to ";"; ', Ft.__ From -Ft. to___ Ft, From Fl, t0_ _Ft. From__Ft. to Ft. From , rI' Fi. to. c -_Fl. From From Ft. to_ Ft. Ft. to .Fl, From_ Ft. to Ft. .'; From Ft. to_ Ft From__Ft. to. ' , FL_ ' From _Ft. to Fl. ' From , - Ft. to :'~ Ft. : · · _ From ~ - '.__Ft. to. ; From · ',r-~_Ft. to '-' ~_..Ft.__" From /~q Ft. toZ~'t~'~""~Ft. From__ Ft. to Ft. From Ft.t~ Ft. From _Ft. to Ft. From Ft. to Ft. From Ft. to _Ft. From Ft. to__Ft. From Ft. to ,Ft._ -- - From- - Ft, to~.-, Ft._ From__ ,Ft. to. Ft From Ft, to Ft. From _Ft. to __Ft. From. . ,Ft. to_ Ft. From_ Ft. to Ft. MISCLINFORMATION: From ~ Ft. to Ft.__ · From Ft. to__Ft.__ Fr~m.,. Ft. to Ft.' From Ft. to ~]~c~._~1~ 05 ~c~D~ ~ DEPT. C~F HEALTH & From ".Ft. to ......... ,~-AL P8©TECTION ,: AU$7 1981 RECEIVED DRILLER'S NAME .. t MUNICIPALITY OF ANCHORAGE Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section s Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-354-15 1. GENERAL INFORMATION Complete legal description Sunny Valley L14 REM Expiration Date: 12 _1 ` Location (site address) 9451 West Lake Drive Current property owner(s) Brenda Johnson & Nicole Johnston Day phone Mailing address PO Box 772764 Eagle River, AK 99577 I Real estate agent Day phone 2. TYPE OF DWELLING: E] Single Family (w/wo ADU) ❑ Duplex ❑ - Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic E Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: . Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ b$d Waiver Fee $ Date of Payment 03119 Date of Payment Receipt Number 66'V t*Z6 Receipt Number COSA # 6501 a 1q3)? Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE Phone (907) 745-8200 Date NI OF A1_ sy�� System #1 Approved for bedrooms vre Sfe�/en ,R f'oiiricroe ; �.•. CE 8149 e o System #2 Approved for bedrooms $��cl�, . Disapproved Conditional approval for bedrooms, with the following stipulations: \IN( OF If, WATER AND t WASTEIFWATER i PROGRAM s •- Original Certificate Date: q-1 q —(q r ^ The Municipality of Anchorage 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 engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Sunny Valley L14 REM If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA Fil Well log is filed with Onsite (or attached) Date drilled 4121/81 Total depth 202 ft Cased to uk ft MR Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 8/8/19 Static water level at beginning of test 88.2 Comments B. TANK DATA Age of tank(s) New years Tank type/material ft. Measured operating fluid level in septic tank W Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Trench Parcel ID: Structure served by this system 1 050-354-15 Well production at time of test 3.08 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes N Ill Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L H Arsenic less than MRL (ND) Collected by Pannone Engineering Services Date of Sample 73OMI9 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 611778' Adequacy test date 8/8/19 Al ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 7.75 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 3.75 ft (min) Water added 600 gal F-1N/A- pressurized field 20 New depth in 1 Monitor tubes go to bottom of effective. If not, state 120 depth into effective 28"' Elapsed time min © Code -required soil cover over field Final fluid depth 0 in ® System presoaked Absorption rate >600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies:.. South Drain field monitor tube extends 28" into drain rock, North drain field monitor tube goes to the bottom of effective. COSA Checklist yellow sheet n/a E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' F� Yes Community Sewer Manhole/Cleanout > 100' [✓ Yes if No ft []✓ Yes if No ft Neighboring Tank > 100' M✓ Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' M✓ Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' Q Yes if No ft 0 Yes if No ft Yes if No ft Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' Yes if No ft P11 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F� Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5'✓1 Yes Yes if No ft Wells on Adjacent Lots: ✓0 Absorption Field > 5' F71 Yes if No ft Private Wells > 100'✓� Yes if No ft Water Main > 10' El Yes if No ft Community Wells > 200'✓� Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' F/ Yes if No ft Surface Water > 100'✓[] Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. a, ?(,3 COSA Checklist yellow sheet F OF ,q-� O ASBUILT 1 HEREBY CERTIFY THAT I HAVE SURVEYEL" THE S);t1ARD ASSOCIATES L��D SURVEYING FOLLOWING DESCRIBED PROPERTY: �U�!.r✓,� y�-�%n-.••'� U � moi /� AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONS!DILITY OF THE OWNER TO DETERMINE THE EXiS'iENCE OF ANY EASEMENTS, COVENANTS.. OR RESTRICTIONS WHICH DO NOT APPEAR Oli THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD HEREON-'VqY DATA BE ® FOR OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LIMES. oCAL.E: DATE. GRID- .'✓ii-jf 01F 'A zX ��Duone Mr.;1: LS -5 8 e'.=ia, is APPLICANT FILLS OUT UPPER HA[.~ ONLY Property Owner /,~ / C/~/J/~' L~ -~" Mailing Address Zip Code :? 2 Buyer ~4/I ~Z'g~/v g?~ Z//~ / ~/qA4 ~f ff ~ ~ -- ~ ~ z~p Cod. ~ . Phone Address Zip Code LegalDescription ~(~T /~/ 5~ V~Z~ c~ ~ Type of Resi~nce ~ Single Family ~ Multiple Family NO. of Bedroo~. ~ Other WAter Supply ~ Individual A~ACH WELL LOG. A wall Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility ~ individual Year Individual Installed: / ~/ ~ / ~ Public Utility When Connected to Public Utility: ~ Holding TAnk NOTE: THE iNSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ~(~ C'~ ' - o AUG 2 6 1983 "Municipal~ty of Anch~rag? "Dept. of Hca~th ( ~APPROVED BEDROO~ "CONDITIONS OF Ap~e]0g~l ( ) DISAPPROVED Soils Rating Date ~wer Installed Well TO Absorption Area Well Log Received /~ ~/~/ Well to Tank Septic T~k Size 72-023(3182} EXCAVATION ROBERT A. SHAFER WORK August 23, 1983 CIVIL ENGINEER 694-2979 Muldoon Realty 822 Muldoon Road Anchorage, Alaska 99504 ATTENTION: Toby Reference: Lot 14: Sun Valley Subdivision IAs you requested the well located on the referenced was inspected. The well was found to be adequately sealed, all wiring was in conduit in accordance with the current code and the ground around-~ the casing sloped away from the well. At the time of inspection a water sample was taken and submitted to Chemical and Geological Laboratories of Alaska for analysis for total Coliform bacteria. The results of this test were satisfactory and a copy of the report has been provided to the Municipality. If we may be of f~rth~r service, please do not hesitate to contact US. I /ss CC: Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA ~" '1 D~..~JR ECEIVED INSPECTION APPOt NTM~NT,S, ' ~ DATE DATE] DATE INSPECTOR INSPECTOR INSPECTOR[~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. ©J: REALTH & 825 L Street - Anchorage, Alaska 99501 ENVJR©NMENTAL PR©TECTIOH ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 AU~ ? 1981 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER F~(J~I~J~I~ E D 31RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAI El NG AD DR ESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION ~TR LET LOCATION ~''c'3~'~'~ 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY NUMBER OF BEDROOMS [] One [] Four [] Other__ [] Two [] Five ~ Three [] Six * ATTACH WELL LOG. A well Icg is requ red for all wells dril!ed since June 1975. For wells drilled ~ri0r to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM I~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. 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 NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED [~JPUBLIC UTILITY ~, --~"( Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: I ~&'~'~ . If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/HoldingTank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line B, COMMENTS [~]-~PPROV ED FOR ,~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BTC~ 72-O10 (Rev, 6/79)