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HomeMy WebLinkAboutSPENDLOVE VIEW HEIGHTS BLK 2 LT 6pendlove View Heights Block 2 Lot 6 #021 - 021 - 27 MUNICIPALITY OF ANCHORAGE v O ^f DEPARTMENT OF HEALTH AND HUMAN SERVICES !, �s Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name -- //I lUs//UG 4K DISTANCES _ SEPTIC TANK ABSORPTION FIELD WELL Address 3605 RL. C-- Phonep) Permit No. No. of Bedrooms 9 rWELL ''.28' ©LEGALDESCRIPTIGN COILol Block 2 Subdivision LOUE UiFrA/ Township, Range, Section S� W -3 n L Al AS-BUILT DIAGRAM driveway, water bodies, (Show location of well, etc,) septic system, properly Imes, foundation, TANKS �1 SEPTIC ❑ HOLDING Manulachmer Capacity In gallons Material STEL. No. of Compartments 2- _ TYPE OF SYSTEM Td- RENCH ❑ BED ❑ W. DRAIN ❑ OTHER Dopth to pipe bottom from original grade FT 7 Total depth from original grade /U FT _ Fit added above original grade C� FT Gravel depth beneath pipe 61 FT �' _ _ _.. �a6 Gravellength FT Gravel width Z,7 FT r I)p ' r _50 Total absorption area f� FJO SQ FT Distance between Imes FT / -S 79' Number of lines 1 Soil rating 1 17 6 SQ FT Pipe material PUG Installer vl 9,/1 _ 1 `1� /l/'f/CSI/11j Date Installed WELLS _ VJ PRIVATE ❑ OTHER (Identilv) Classification (A,B G)) Total Depth 2 ?. U FT Cased to 7_'Z 0 FT Installer Date Installed: (n 2. I ' fi� l REMARKS: /= 2ECTZFD 19.20uAIL) 7u111e.I7 Scale: iy_!9�' YS llVb `F !*/f7' Inspections Performed by: CDAT2= r-t/ C3/Tu/Y1A57lG BEF"olcF"/'�-/["A, Date.. B- 22 LGS //8� � / t/�P ��, �^1 �1 1 l4/(',/ AL't_- FfyJ 0 ovS oN certify that this inspection was performed according to all I -- Municipal and Slate guidelines In effect on this date: — 2 P / 20 Health Department Approval: pate: _!- _ a INEJ!FISS A� y".(i ae eonsr ep`�1v¢y 4A y a On f• � � dt � f,- sd ? C C 9 ey tL 6➢0.11 tr -/� /'��013011y J+ c �C >E�^s e.09•,, �,�,, "✓ -- 72-013 (3/85) MUN1CIPALlTY OF ANCHORAGL UeparLment of Health & Human Services B25 L St/`eet, Anchorage, Alaska 99501 343 ON - RITE SEWER & WFLL PERMlT Permit Number: 890066 S J 99()g(ob Date Issued: 05/01/89 Engineer Designed Owner Name: KIM GUGHUULAK Day Phone: Owner Address: 3605 ARCTIC BLVD. 01801 240-4274 ANCHORAE}F, AK 99503 Parcel %d: 021-V21-27 Lot Legal: Subdivisinn: SPENDLOVE VIEW HTSIs Lot: 6 Block: 2 Section: 34 TownshipN WN Range: 2W Lot Size 51164 (sq^ft" o, acres) Max Bedrooms: This PermiL: 3 Total Capacity: 3 SEPTIC TANK: Minimum total sepLic tank capacity: 1,000 gallons. Each septic Lank must have at least 2 compartments, Depth to top of septic tank(s) < 4"0 feet requires insulation over tank(s)., NELl: Log must be submitted to Municipality of Anchorage Department of Health and Human Services within 30 days of well completion,, INSTALL PER ATTACHED APPROVED PLANS. NOTIFY DHHS PRIOR TO EACH INSPECTION BY THIS PERMIT IS ISSUED FOR THE PLANNED THPEE BEDROOM DWELLING ONLY AND EXPIRES ON 12/31/99" I CERTIFY THAT: 1" I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. { will install the system in accordance with all MOA codes and regulations,, and in compliance with the design criteria of this permit" 3" I will adhere to all MOA and State o; Alaska requirements lop the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4" I understand that this permit is valid for a maximum of 3 bedrooms. I also understand that the capacity of the total system is 7 bedrooms and any enlargement will require an additional permit, Signed: L _,^_~~____,,_____ OATE: ' ' (Owner) KIM (9)BMUULAK Issued By: DATE: PERFORMED LEGAL DESCRIPTI DEPTH (FEET) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TES'r & Bx 15&JhLe✓C Ord Township, Range, Section: SLOPE 52�/ Srt�a� �jl/}✓eL `ODrL� /k7r -Ig?- 30 SITE PLAN WAS GROUND WATER �b ENCOUNTERED? S L 0 O P �yq E IF YES, AT WHAT DEPTH? _ Depth 10 Water After D�,/ Monitoring? ii Dale: Reading Data Gross Net Time Time Depth to Water Net Drop r - 1(03-- 13 , ro7 -, 12-3 _ �' .i. -- Ibz) 33 G3$ eoff zy "L 5E .17 EQG cr _Eid !� i2 PERCOLATION RATE L (minulesiinch) PERC HOLE DIAMETER TEST RUBETWEEN FT AND FT PERFORMED BY: AGS — 4' kjll-YJ" I.1L' V- /4, -CERTIFY THA "f HIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL. GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-000 (Rev. 4/85) A rC 5 ALASKA RUIROM PTAL COCITROL SCR US, X. Q Enqineerinq & Enuironmental Studies SPECIFICATIONS FOR A TRENCH TYPE WASTEWATER DISPOSAL SYSTEM LEGAL DESCRIPTION: LOT 6, BLOCK 2, SPENDLOVE VIEW HEIGHTS SUBDIVISION k2 1.0 GENERAL 1.1 The drawings, sheet;: 1 through 4, shall be a part of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 All elevations and depths are advisory, and are to be verified or modified in the field by the engineer or inspecting agency. 1.4 It .is the responsibility of the owner or installer to adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. 7..5 If the installation is not inspected by an AECS engineer, AECS will. not be responsible for the installed system. An engineer at AECS should be consulted prior to construction to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC TANK 2.1 If there is an existing sceptic tank, it may be used if it meets the capacity requirement for the residence and the approval of the MOA. The septic tank shall be a UPC Approved two-compartment tank, constructed of 12 -gauge steel with bitumasti.c coating and set (%i 5� level on undisturbed soil. If the tank is buried at a depth of 4 NJfr�6•� feet or less, it must be insulated with an overlying layer of 2 inch GrmaC,f burial type polystyrene rigid hoard insulation. ' C6�C(f 2.3 The septic tank and trench shall be a rni.ninnun of 100 1.'net from any private well or body of wager, 150 feet from Class C wells, and 200 IJRG/ L j��i feet from Class A or B wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by ADEC or MOA. 2.4 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. 2.5 Piping shall be fitted with a mechanical watertight calder coupling on the outlet and inlet of the septic tank. Piping shall be 4 -inch solid PVC ASTM D3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot. If the piping is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. 2.6 Cleanouts shall be installed as designated and capped with air -tight 1412 WESL 330 avenue it Anchopane, AIAska 99503 0 (907) 279-5553 rain caps (Jim caps or equi.val.ent), and extended a minimum of 1 foot above ground level 2.7 If a lift station is required it shall be a combination lift station septic tank per Anchorage Tank and Welding, Inc. design. Specifications are attached. 3.0 ABSORPTION AREA 3.1 The gravel for the trench shall be 0.5 to 2.5 inch, screened rock with less than 30a passing #200 sieve residual.. All substitutes must have prior DIIIIS approval. 3.2 The bottom and sides of the excavation shall be raked with the backhoe blade to insure that it has not been compacted during excavation. The bottom elevation shall be level. 3.3 Monitor standpipe(:;) shall be placed as shown in the drawings, and shall be 4 inch rigid PVC ASTM D3034, or cast iron. The section shown with holes may be 0.5 inch holes drilled on 6 -inch centers on opposing sides of the pipe, or a regular section of perforated sewer pope clamped to a solid sect:i.on with either a no hub coupling or a solvent joint. A rubber rain cap (Jim cap or equivalent) shall be installed over the, top of the pipe. 3.4 The distribution pipe shall be perforated 4 inch rigid PVC with a minimum crush strength of 1500 lbs and shall meet the approval of DHHS for use as drai.nfield pipe. All distribution pipes shall be, laid level. 3.5 Trenches may be paralleled, but must have a minimum separation distance between the trenches of 10 feet or 2 times the gravel depth (whichever is greater). 75 feet is the maximum allowed linear length of any trench. 3.0 If the final grade over the trench is less than 4 feet above gravel., insulation is required, using burial type polystyrene rigid board insulation. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil. cover even though insulation .is used. The solid pipe extending from the septic tank to the drainf.ield shall also have 4 feet of cover or an equivalent: layer of insulation to prevent freezing of the line. 3.7 If insulation is not necessary, the gravel shall be covered with a layer of nonwoven Geotextile fabric (such as Mirafai, Pibretex 200 grade, Poly Pi.lter l or equivalent). 4.0 INSPECTIONS 4.1 A minimum of two :inspections are required for the installation of the trench. The first inspection will be of the open excavation to assure that the system is :installed In the proper soil strata, correct depth and meet minimum specified design parameters. 4.2 The second inspection will be after placement of the gravel, monitor standpipe and distribution pipe to verify proper installation and position prior to backfil.l. 4.3 The inspection of the septic tank installation can be :incorporated with any one of the above listed inspections. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite 13 ANCHORAGE, ALASKA 99503 (907) 561-5040 JDB,4.,�-r (. z 1:001CA16"W ✓irW 475 -'-,z- SHEET NO. / OF 9 CALCULATED BY DATE CHECKED BV_ DATE SCALE vrmuc ] mc. ciao,, mR 01411. it L #' 1 ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite a ANCHORAGE, ALASKA 99503 (907) 561-5040 JDBZ,o / 6 XtOM Z' 5&A1bj6✓r OE4J V7r; ji-y PPO Y SHEET NO. OF / CALCULATED BY A• DATE CHECKED BY DATE- ATE_SCALE SCALE- PPO f IDL 101z, Gd.. Mu 01471. ALASKA ENVIRONMENTAL JOBc�T 6 &oee a 5P*1&e✓e bctJ ,03 -t?- CONTROL SERVICES, INC. el 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 SHEET NO. OF — ,/ �ja �' /� -/T-fl / (907) 561-5040 CALCULATED BY DATE CHECKED BV— DATE SCALE A/7.6 I nQtA b � 19 TuaE _tEAtleu7 _ ... /zSv �iAt i��lK X - s��ToAI RoudDidei. T AL4ocJ eek s m/J�i eRje"v4141' 4A!�nJjr SNkCAdC �-, -- BAtxFil,L 3,5 --- Fa/6idpeRIA- FAB9/6 b" �?EZFoZA bis 7 2�BuTiaJ )DE eK Ito FRL m (z, G,Wm. Me¢ 01411 0 U 0 H 0 CD Z m H Z _ O ° H vo D O 00 x r p p m n r H a n OD 0 01 w m n r- Z F mrn m m ID N @ .. (f) N p < Z O W 2: Z r D H M U1 Z M Z M L p p G ]] < H(11 O • D H m-0 m m H77 Fn m n O TM � Or l0 D A Z U) (DO M o N m m m H A H Z N In mI z Z —I m nD z 0 m o m m m 0 rn � m H t f- 0 u r m -I D m D D n r H H r m m D H H _{nn H D D C Z H H C C Z U! z UI O 3 n r ❑ H VI ❑ 0 w m A '0 m m n 1-0 PI DH z (D0 LI7 ❑ C m Cl) --1 m D F 1W -W DRILLING, Inc. 89154 P.O. ®ox 110378 • 10330 Old Seward Highway & (907) 349.8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner Bill Guihlak Use of Well n°meatic Location (address of: Township, Range, Section, if known; or distance main road Lot6, Block 2 Spendlove View Heights, Anchorage — Size of casing 5L Depth of Hole_ 220 feet Cased to 2220 at Static water le -vel- IL5 _ft. (8(94kiYd¢ (below) land surface. Finish of well (check one) open end ( ) Screen ( ); Perforated ( R.. ), Describe screen or perforation Mt 5' Steel Liner Perf'd w/one 4" x 1/4 Torch Slot/ft, Well pumping test at_I,__gallolls pe$ (}iffiW (minute) for_ t hours with 100% , of drawdown from static level:. (2) Liner unperf'd from 0-45' & 200 to 220' Date of completion June 2.1, 1999 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness —2_TO 4 Fill]. MUNICIPALITY OF ANCHORAGE - - - 7 ENVIRONMENTAL PROTECTION; _Topaoii'— ;, r) n 4OQ� 10 _TO 14 grO'_Ip aandv loam i IJP _1_4__TO_ 22 . , `nd "g**t-mravala _AE1) 29 _TO_ 4� _S Alisl €Jxave oc bb1�a �— j —48 TO_ 79 liedrockCrfiq " Mgd xd > ��,_,� ,, zeal 79 TO 4_Grav - Red Nedlualn 84 _TO_ 100 Gra v - medium - silica streaks _100 To 107 -Soft brown gray - water —107 -TO_139 Gray - medium Green a air white streaks _eft etre k ,-172 'TO_ 174 _Brown, soft, water 174 TO_ 220 Grav - white streaks - medium — _— --TO-- ---� nrHfinn4n TTna 01A 0 09or �,� IIIF L tk{' 4. I t December 29, 1973 1780889 Richard Lathrop 900 west Fireweed Lane Anchorage, Alaska 99503 Subject: Lot 6 Block. 2 Spendl.ove Uiew Heights Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, R,S. Sen•i.or Environmental Specialist ISTB/l jw V encs copy of permit Er�1 q _II P��4 �: �::I: � 1 Y..,. �' "T' `-a' Y�! Fr� r-3 Y --i F=Y IC•i RE - DEPARTMENT ��.D DEPARTMENT" OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 Last � �� � 264-4720 Mgt 44 EE E.._. L_ Fl VA E> CA 44 -- 5---- a '-F WE Ems: W WE Fes: i r F? M I _r PERMIT NO. C 780889 ) APPLICANT RICHARD LATHROP 900 W. FIREWEED 344 0420 LOCATION SPENDLOVE DR LEGAL L6 82 SPENDL.OVE VIEW HTS LOT SIZE 50000 SQUARE FEET .TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS .. 4 SOIL RATING CSC.! FT/BR)== 1009 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: Ew w "1" E-1 Wr L . E 1 E e a 1` F 1,e �, =L a_„ F;� H `v* IE=:1. _. L" • O E ° _1,. E -E =: �* THE LENGTH DIMENSION IS THE LENGTH CIN FEET? OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT I5 THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEE:T). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). WEC.-:lLi it F='EEE+ -=% WE F`"`1"' T r..-:-1'""fAF==: ..�. T ;�Ifm:= -1.2!5; ":2 0E-1E_G C4VJ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS: PROPERTY AND THE NUMBER OF RESIDENCIES THAT THE WELL. WILL SERVE. -F140 c :> X " 1=" r_: lcl�'"1- T ca N � 1=1 FR.' WE Ems? Er G31 IL-1 I F`! E� EE> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY OW -SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE: TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE: DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY, SPEC:IF•ICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE: PROPER INSTALLATION. F"E F•' -.'M T iT- ET to W&A it FT WE n5 r> WE ClWEP1&WEFR ng IL AL ii :7' nes I CERTIFY THAT' 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE: ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. � ;�(j �/� (�i�u SIGNED �F .__ __ �D '4 4l APPLIC N'T RXC:WARD LATHROP�L ISSI_Il.D E'sY DA`iE Ark £. . � � / zagQ -� LA SOILS LOG t. MUNICIPALITY OF ANCHORAGU. IN'TAR (MEN 1- OF 1IEALTI-I AND ENVI RONMf:N TAL PROTECTION '-j PI:RCOLAII obi I EST Pouch 6660, Anchoraoo, Ahs'm 5)0502 276 22.21 ;OILS LOG -- PERCOLATION -I EST I -ihf JaiviED f01;'. �._-C �. c�Jo� Lcl ��: G - DATEPFRFORNIED: Ui:r'IUYIS L --O I V� >. ��A � JY�O/b'��•CTL �'�l �ti= �7C��/> SLOPE SIT F PLAN \ N. 7 I lJ j. G r! 1 I IVAS GROUNDVJAI-E14 fiNCOUNTf-RED? IF YES, AT 'A'PIAI DEPTH? S _ D PCHCOI_ATION RATE____ (rninu ms(Inchl IESI RUN 6EE1'WEEN Fl AND ___..____.,__ PI ;-RI )W'T 6Y </'�^'-'l l iCJ� �N`CE.HTIHCD 6Y'v '� __- .— DAIL �T On . >GI 1's � -. HEMICAL & GEOLOGICAL LABORATORIES OFALASKA, INC. 5833 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 5824343 FEDERAL 1'AX ID H 92.0040440 ANALYSIS REPORT BY SAMPLE for Work Order ; 19642 Date Report Printed: FEB 6 90 B 12:05 Client Sample ID:GUSHULAE 3PENDLOVE S/D WELL Client Name MCFADDEN, WAYNE PWSID :UA Client Acct MCFAWC Collected FEB 2 90 A 10:00 his. P.O.* NONE RECEIVED Received FEB 2 90 6 12:30 his. Req t Preserved with :AS REQUIRED Ordered By : WAYNE MCFADDEN Analysis Completed :FEB 5 90 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)MCFADDEN, WAYNE Released By : e,;W_ 2) ..................................................................................................................................... Spacial Instruct: - Chemlab Ref t: 9423 Lab Smpl ID: 1 Matrix; WATER Allowable Parameter Tested Result Units Method Limits -------------------------------------------------------------------------..--------------------------------- NITRATE-N - 2.2 mg/1 EPA 353.2 SO ... . Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED. BY W. MCFADDEN. - - - - - - - - 1 Teats Performed • See SpecialInstructionsAbove DA -Unavailable--- -- --- -- -• HD- Nona Detected '.' Sea Semple Remarks Above NA- Not Analyzed LT -Lase Than, GT -Greater Than 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 Parcell.D. -2 COSA# ()g035a- 1. GENERAL INFORMATION Expiration Date: , ! — 30— f2 2 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency — - ' -Mailing address --- Real Estate Agent Mailing address SPENDLOVE VIEW HTS. BLOCK 2. LOT 6 13456 SPENDLOVE DR. *ANCHORAGE 99516 JENS BECK Day phone 727-5317 13456 SPENDLOVE DR *ANCHORAGE 99516 Day phone LINDSEY BURNETT W/ REMAX Day phone 441-0007 110 W. 38TH SUITE 100 *ANCHORAGE, AK 99503 Unless otherwise requested. COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 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, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 %J Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date $/29f[oq 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 6 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 parry is not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE Approved for —7 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 Engineers Reort Other By: V!// z az Original Certificate Date: /Rw I'MI WASTEWATER PROGRAM Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196850 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SPENDLOVE VIEW HTS. BLOCK 2, LOT 6 Parcel ID: 02-1 - 02- 1 - a7 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSIDff N/A Date completed 6/21/1989 Sanitary seal (Y/N) YES Total depth 220 ft. Cased to 220 ft, FROM WELL LOG Date of test 6/21/1989 Static water level 45 ft. Well production 6 g.p.m. WATER SAMPLE RESULTS: Well Log (YM) YES Wires property protected (Y/N) YES Casing height (above ground) 18+ In, AT INSPECTION 8/9/2007 55 ft, 5.37 — 9 -p.m - Coliform ww 1© colonies/100 ml. Nitrate r • R R mg./L. Other bacteria 0 colonies/100 ml. Arsenic: NO ug./L. Date of sample: 8/9/2007 Collected by: GEG Ltd. S. SEPTIC/NOLDING TANK DATA Tank Type/Materiai SEPTIC/STEEL Date installed 8/22-23/1989 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 8/9/2007 Pumper MCDONLD'S PUMPING C. ABSORPTION FIELD DATA Date installed 8/22-23/1989 Soil rating (g.p.d./ft=or(j!EE0 125 System type TRENCH Length 50 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total depth • 10.54 ft. Eff. absorption area 600 ft' Monitoring tube YES Depression over field NO Date of adequacy test 8/9/2007 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test 33.5 in. Water added 634 gal. New depth 47.5 in. Elapsed Time: 229 min. Final fluid depth 37.5 in. Absorption rate >= 450+ g.p,d, Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in galbns Manhole/Access (Y/ "Pump on" level at _in. "Pump off" at�d High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent kits 100'+ On adjacent lots 100'+ 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 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/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. Engineer's Printed Name JEFFREY A. GARNESS Date '812 q 10-4 COSA Fee S / ?) y • CXR Date of Payment act i D % Receipt Number 'D -7 ',�, R (Rev. I lm5) Waiver Fee $ Date of Payment Receipt Number 072764429 RE/MAX PROPERTIES, LOT 7 TILITY EASEMENT ILI EAST 250.00 � o •S,pw- venU LOT 5 O O L6 O N = LOT 6 EAST to N SPENDLOVE DRIVE i r,P�E OF R 4,qo i y' 91 49TH ,tom c , Fred Wafatka No. 3255 -Si Sc41e: = ¢C III1\ orESSl�rr��aoS= EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED Fb 07-5, pg 74-75 PLAT ARE NOT SHOWN HEREON. 12.50 48 p m 08-22-200/ 2/2 8319Q 25 - -, V 'ood d metal ret was A 60.1 O t0� �kea 6 Story Ferre House with daylight basement O z 25 AS -BUILT NO CORNERS SETTHIS DATE I hereby certify that I have performed a Mortgagee's Inspection of the following described property' COT a BLOCK 2. SPENDLOVE VIEW HEIGKTS SUSDMSION Anchorage Recording Precinct Alaska, and that the Improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission fres or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 21st day of AUGUST .2007 FRED WALATKA 6 ASSOCIATES 8 E I Engineers and Surveyors (907-248-1666) i SCS Refq 1074022001 Client Name Gamess Engineering Group, Ltd. Project Nsme/M Spendlove View Ills D2 L6 Client Sample ID Spcndlove View I It% D2 L6 Matrix Drinking Water PWSID 0 Sample Remarks: Pammeler Metals by ICP/MS Collected Datelrime Arsenic Received Date rime Waters Department Technical Director Stephen C. Ede Total Nitmte/Nitrile-N Microbioloov Laboratory Results PQL ND 5.00 4.11 0.100 All Dates rimes are Alaska Standard Time Printed Date/Time 08272007 14:47 Collected Datelrime 08/092007 9:30 Received Date rime 08/092007 14:35 Technical Director Stephen C. Ede Allossabie Prep Analysis Units Method Container ID Limits Date Date Init ug/L EP200.8 (<10) 08/15/07 0824/07 TK mg/L 5X1204500NO3-F D (<10) 08/13/07 JDS Total Coliform 0 coU100mL SM209222D A (<I) 08/09/07 SDP Aug 08 07 08:17p Lindsey Burnett z1�■-7-2007 01:04P FROM: f NORTHLAND PUMPING: SERME. WC. Your Pro'cssiorni Septic Pimping Sm: r.:a 7501 E. 140th Avenue ANCHORAGE, ALASKA 99516 (Gq7) $^.4-7146 FAX (907;. 66S-6770 Leas Beck 13456 Spendlove Drive Anchorage, AX 99516 TIq';F ) Septic Surcharge 19072453487 p.2 70:3396745 P:V1 17643 L 1 8/04 5 hoses Tank located 50' behind house at bottom of hill in brush (hard to pump) THANK YOU 5110.00 4.50 e Municipality of Anchorage O • �-, Development Services Department Building Safety Division •- Onsite Water and Wastewater Program .- 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. oZl -G2- —�% HAA" Expiration Date: f / - - O 2 1. GENERAL INFORMATION Complete legal description LtiT Location (site address or directions) / Current Property owner(s) e l -F i>_L�S �l�(�� ::724'5--1441 Day phone h4'5 --l44 1 Mailing address P0. Rn -4 ((-2-486, A-06.9 • Id k_- q Ys1 Lending agency Day phone Mailing address Real Estate Agent L e:4, e=7 Ll Fr E { 7 Lc Day phone 1-7�3%3 Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by C;< -ss 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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. S S - S g -7 Name of Firm f'7iZ1- T P- F,/t`ri:-3fJ P. t - Phone :3g91-3777 Address �{ -7C �� P W Cti •; 4_ qci- sa.s Engineer's Printed Name Fr. --%}-!T P• G -A7 i Q Date % — - S. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: (Rw 011021 bedrooms, with the OF \;GsP .••..... do-�_ ' ON-SITE • �ci 'Z:Z: WATERAND : R': WASTE'NATER PROGRAM Oty.....•S\\\��� X Maintenance Agreements Supplemental Engineer's Report Other J/ �G.�7 Original Certificate Date: Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 19W50 Anchorage, AK 99519-6650 www.ci.enchorege.ek.us (907)343-7904 0 Y � fHEALTH � ACU�THORITY APPROVAL CHECKLIST Legal Description: VCS p I rJw( Z S Pel-IDIfW Parcel ID:OA-©tel �-7-7 A. WELL DATA Vlani LITS . Well type �IV005 If A, B, or C provide PWSID Well Log (Y/N) l Date completed -L -24-8q Sanitary seal (YIN) Wires property protected (Y/N) Total depthz- R. Cased to 2:! t Casing height (above ground) _1'2> in. FROM WELL LOG AT INSPECTION Date of test 6-24-91 7 -295 -7 -795 -02 - Static water level µ5 ft. 94,5- ft Well production g.p.m. 3 1 g.p.m. (MCOVVV Y) WATER SAMPLE RESULTS: Coliform _C—colonies/100 ml. Nitrate S mg.A. Other bacteria _ 0 colonies/100 ml. Arsenic: _ mg.A. Date of sample: L.L4"oZ Collected by: f3pew-T �kTOl.1 S. SEPTICIHOLDING TANK DATA 86- p Tank Type/Material 9TP-11 WC*II i Lam') Date installed g -ZZ f Tank size 1000 gal. Number of Compartments Cleanouts (Y/N) N.. 11 -- Foundation cleanout (YIN) -*9. Depression over tank (YIN) � High water alarm (YM►�) 0 Date of pumping 7/11 IVZL Pumper ROTC - FOt°7ZU-Z- C. ABSORPTION FIELD DATA 1 Date installed 2Sall rating 4r.ptlftzor 1t /bdrm) System type ORW IACW4 {j Length 6 R Width 2 -'57 R Gravel below pipe (0 ft. i Total depth _0 ft. Eff. absorption area GOC) fe Monitoring tube -)b Depression over field )-JO Date of adequacy test 7 —OZ Results (Pass/Fell) R*155 For 3 bedrooms i Fluid depth in absorption field before test _40_ in. Water addedLo gal. New depth 6a in. I Elapsed Time:'=L min. Final fluid depth 52- in. Absorption rate >= 222l g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Ido If yes, give date I 5 --UFT STATION Date installed Cize.iaaallons MaribuierAccess (YM) 'Pump on' level at _ in. el at _ in. 1115 r alarm level at in. Daum / Cycles tested Meets alarm b dreuit requ nttt2__ E. SEPARATION DISTANCES �a SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic tank/lift station on lot lot r On adjacent lots ��3a Absorption field on lot 17.0 / On adjacent lots Public sewer main hJn c Public sewer manhole/cleanout Q& - •6ewerfseptic service fine N SS / Holding tank j SEPARATION DISTANCES FROM SEPTICA49HYIN&TANK ON LOT TO: / Building foundation �J 5 f Property line �r / Absorption field y Water main ► J vwc Water service line tigJr Surface water 1J � Wells on adjacent lots f90 / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �2-9 i r Building foundation � 7& Water main Water Service line "L-90 Surface water Driveway. parkingNehide storage It0 i Curtain drain Nd e Wens on adjacent lots E F. COMMENTS G. ENGINEER'S CERTIFICATION I codify that 1 have determined through field inspections and review of Municipal records that the above systems are in g conformance with MOA HAA guidelines in effect on this date. jEngineer's Printed Name Date 770-0 HAA Fee $ %J Waiver Fee $ ki t P. Fa1pV q CC 9140 Date of Payment ✓ D r 7�3 D 7 Date of Payment Receipt Number 7 tj tD% Receipt Number (Rev. 12/01) JUL-29-02 02:45PM FROM-CTIE ENVIRONIENTAL SRV 9075615301 7-246 P.03/07 F-449 . r� CK� rra�2s ME Environmental Services Inc.zthm SS= Laboratory Division rom�dsrrovrearrrrsd�-as�cvarevrrrsrrrrrrvard�rrr� 200 W. Potter Drive )rslking Water Analysis Report for Total Coliform Bacteria Anchors e. z x318-16os READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: 1907) 681.6301 MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY O PUBLIC WATER SYSTEM I.A. fl I I I I I I Analysis shows this Water SAMPLE to be: x I PRIVATE WATER SYSTEM Satisfactory O Unsatisfactory Sea esatrs seed larotca o Sample over 30 hours old, results may F-�- �t�•y'Li�./ r�� betmrehable w.as 4Ft ' • j'I7 p Sample too long in transit; sample should ow wArer-�'' • 1e t� 4WWr — aQ;b¢ C\': �!: iw :: ald at "Zrt:mLt:tin Al ?Q'� -(� _ to indicate reliable t sults• Please send M 7 9�y new sample via speci :;x7 -7,P de�lllvmy.. it. Date Received 7/'""' Q'U Tlme Recelved . i Z 37 R ,'Sond Results C Serif Ltvolce Analysls Began CO a+.e C,v ` SAMPLE DATE: b® pYear SAMPLE TYPE: O Routine t7 Repeat Sample (for routine sample with lab ref. no. ' ) Special Purpose SIMPLE LOCATION � Comments: lr Ce 21 t O Treated Water' XUntreated Water Analytical Method: Membrane Filter ' a, MMO-MUG • Number of colonieV100 tnl. Result" Analyst 1024635 / /` •. nca Fbks Jun ❑ Fazed Time �v Collected Collected By b'3opn- C Ikur►tot Date: I ITime: Clliiee+nt notified or unsatisfactory results:, Yd+"CY .7. JpYke wItI1 �V zztd Date: BACTERIOLOGICAL WATER ANALYSIS RECORD MM. 0 -MUG Result: Total Collform Membrane Filter. Direct Count Verification: LTB Fecal Coliform Confirmation Final Membrane Filter Results Reported Bys 0.11 pw =11 D Date���i7f DZ_ Time: r- Cali Colonies/loo ml COLIFIRM Coliform/100 ml Time hn A 1, a'r`A"bspa-D .. _-"-----Icy, :A -A rt/•nArete de Surveillance) TNTC -Ter N.a�t Te C.., Oa-aa,.ra.rtmr JUL-29-02 02:45PM FROM -CUE ENVIRONKNTAL SRV ! CUE Environmental Services Inc. C7&E ReLN 1024635001 Cl oat Name Eaton, Brent PaDjact Name/N Spendlove View Hits L6, B2 Cl ant Sample ID Spendlove View Hits L2, 116 M4trix Drinking Water Ordered By PWSID 0 9075615301 T-246 P.02/03 F-449 All DatesMutes are Alaska Standard Time Printed DatsMmc 07/29/2002 14:32 Collected Daterrime 07/242002 19:30 Received Date rime 07/252002 12:37 Technical DireectorrStephe Ede Released BY Sarnpie Remarks: v/)'4 BP 300.0 - Matrix spikes were not valid due to incorrect spikes added. Samples were rerun past hold time, on 7/26/02, to verity concentration. CCV, LCS, MB and duplicate samples recovered within acceptance criteria. No further action taken. r Meter Results L esults PQL Units Me" imits a Prep Analysis 1.4nits Due Date ]nit Vetere napart,-ant N trete-N 3.13 0200 mg/l. FPA 300.0 (<10) 07/23/02 IDT f WeST'• .Z 1140.00 .. �` .-� •p o ' s IY 9TANC PI�� 4f , , • r '1 y '� it - 'R'•' 1 �' + •E.y C9JT a.JD.CPO ' y //6.2.5' �/�S p IW 0 L M r 1, ,> . • • I ,Is zs t D.:q t • '.�� NOTES 1 /� '•• ' • �� •. •• n J MEND C[rr �•h�( 3"z •s - L?z 0 LOT CORNERS OW0. FOUNDATION • % �•-- DRAINACC A94OW3 �, j�\ f 1�' y //6.2.5' �/�S p IW 0 L M r 1, ,> . • • I ,Is zs • '.�� NOTES 1 /� '•• ' • �� •. •• n J L IT SNUL 01 TML RtMOMaISILRT Or TOW 1UI6091 OR ANWAR TO V941VT THAT MHLCIOt LYCRTIOM **OWN IltiTt ALL; aW01V ION! TOVIMYTt AND SOOMt !•' tlliLtry TO Ytat/Y RLI. sLtYATart tITM i te►t0 • • f.•; , • I �':': ;•'„',� TO ALL YTIL 1TM[i�a AAINWKR 1�' _�• 4 S �� '' ,•'• i TMIa FLAT 8t/1btoT8 TML ►aRttL Or ►ROPWITT 8p9111t$ oftow TARt4 �' i • , i• FROM TMC RL90ROtO PLAT DRACRI8Mlt TUT FAMCtL. NATRY044T1 49900040 'r .•,•,• „•• 1 • PINS TO 01 AMR TM 04LTMt OR TON 89494098 FLAT ant ROT 111oso OM •. • TMN FLAT. TVgypRIs WTIFICILJION V4057 At" Ototwv TMaT 1 NaVC tUlvtvt0 TMC PROTT 19/CRI1tD 08 TOM PLAT ARO Tot OTtOCRT8 11TWT4$ T094990 Alt 2 OCAT90 Mor$ Or TRIS nAT. ID tM18 17 *AV or �••/ ,I1 ON TH11 PLAY M LOT $9 N4nTOT7oMt 1 BTRVCTV144 a$8 19 Ytt4 raw HS 8urL-r Lor 6 ,Bz OCK -2. SPE/YlJL 0 YE" Y/EW 11Z'A6h'rS BESSE EPPS Ek POTTS 2220 E. DOW AVE. 349•!1431 ANCHORAGE, ALASKA 99507 344.1352 GRANS" all -ow /CAL!' /0�$p' O.O 014 "mONL1T1 f DA74141-17-97I►1t. 19.1 1 1- 17.90 MUNICIPALITY OF ANCHORAGE • DEPARTMENT 01= HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 995'19-6650 343-4744 CERTIFICATE: OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # Da I - Oat -- a -j HAA # _L�a_LJ_aSS r'; 1. GENERAL INFORMATION Complete legal description �T �'� 5p�1,1b ��� \A0,J (-�-r5. 5tJ3i plUl`�l� Location (site address or directions) 12✓ ��� SiIDI�cE Property owner Mailing address Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water _ Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE: OF WASTEWATER DISPOSAL.: Individual on-site _ Holding tank _ Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA R21 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 Address Engineer's signature 6. DHHS SIGNATURE _1Z Approved for TNi?F bedrooms. Disapproved. Conditional approval for Additional Comments 0 Phone 2zR-3777 Date 8 `�_ 9 bedrooms, with the following stipulations: Date 13 /3-11 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-M(Sw.1/81) Back MOAp21 ,i.. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES AUG u b C*D Environmental Services Division c 825 L Street, Roorn 502 a Anchorage, Alaska 99501 ° (907) 341- *LITY OF ANCHORAGE "N IR NMENTALSERVICESDIVISION Health Authority Approval Checklist Legal Description: `;FOdPW✓E Vl`w E!-rS . Parcel I.D.: A. WELL DATA Well type 1( It�l(lDUI�L _ If A, B, or C, attach ADEC letter. ADEC water system number 'I`ILA Log present (Y/N) +✓S _ Date completed 6P - .Z-1 -e Total depth Cased to _ �� Casing height (above ground) _u Sanitary -- seal (Y/N) GS — Wires properly protected (Y/N),CS FROM WELL LOG AT INSPECTION Date of test1-Q,q Static water level — 45/ 144E Well production co g.p.m. I Rt cc2"Y 1 g,p,m. WATER SAMPLE RESULTS: Coliform _—� Nitrate 3• / Other bacteria Date of sampler Q �_tA3_l-Lcn _ Collected by: _ B. SEPTIC/HOLDING TANK DATA Date installed g =9 _2 Tank sire A �? Number of Compartments = Cleanouts (Y/N)_ � Foundation cleanout (Y/N) Depression (Y/N) _J�D_ High water alarm (Y/N) Date of Pumping -7-I4-V_ Pumper _`�?DTO-F_C�F�R_ C. ABSORPTION FIELD DATA Date installed 0 - 7i2 - !t__ Soil rating •(g p.d t or ft2/bdrm) `� System type P. _FTZ(�160 Length . 5 Width _2 • 5 / _ Gravel thickness below pipe _ 6? _ Total depth _ P Effective absorption area Monitoring Tube present (Y/N)�kk_ Depression over field (Y/N) _fJ� Date of adequacy test -_��_ Results (Pass/Fail) _ t�l�SS _ For -3 -+- _b oms if Fftk P. u Fluid depth in absorption field before test (in.); 100,75 5 Immediately afterS�gal. water added (in.): 03 T'RMkT D. F. if TV-vm T.z).P, Fluid depth _E7, 2 (ins) Minutes later:_ D _ Absorption rate Peroxide; treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) I A "Pump on" level at* -" A "Pump off' level at* hf � High water alarm level at*/ N A *Datum Cycles tested A E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots 1 Absorption field on lot 2 On adjacent lots Public sewer main Sewer /septic service line /\-, 15C), Public sewer manhole/cleanout Lift station t A (A W SEPARATION DISTANCES FROM SEPTIC/HeL-I d TANK ON LOTTO: / r r Foundation GJ5 Property line 1512�- Absorption field 5 f 7 I Water main/service line Surface water/drainage fi/4t— Wells on adjacent lots 50 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line °� Building foundation 7& Water-main/service line I Surface water Driveway, parking/vehicle storage area 110 Curtain drain NIA, Wells on adjacent lots F. ENGINEER'S CERTIFICATION i certify that I bave deterrpi.ne h u field inspections and review of Municipal in conforma rth M i alines in effect on this date. Signature Engineer's Name't U Date HAA Fee $ 5m- 0, Date of Payment 0' q f ! f l Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ? 15o t 49 BRENT P EATCN ;'4Q CE -3726 are AUG -06-90 10:32 FROM -CTE ENVIRONMENTAL 6616301 T-613 P.02/03 f-342 1 • OUS Environmental Services Inc. ar.�rw�revw�►uiwoiru�nro.�� CT&E 1104 993491001 Client PW Client Name Eaton, Brent Printed rmtefvme 07/25/99 1530 "eet Name/# L 6 B 2 Speadlove View HTs Collected DatwTiate 07/19/99 1105 Client Sample ID Well Water Received VatelTYme 07/19/99 1330 Matrix Drinking Water Tecbm ical Director. epden C. Ede Ordered By PWSID 0 Released >$y u �Q Sample Remarks: �— EP300 Nirrate: McTbod blank was delectable For nitrate (0.651mg/L). Sample value m8y be bia4 high Alla.able Prep Anelyuis PArAmeT� err RRSMITO KL Oni�rs HMO Limi to Dove aare� lnit Mfrrate-H 7.95 0.500 1@/L EPA 300.0 10 sax 07/19/99 07/19/99 SCL ToraL Coliform 63 Da/LOOK, rw coli sH19 9aaaa 07/20/99 CCP AIIG-06-00 11:44 FROM -CTE ENVIRONMENTAL AI� CTEIE Environmental Se laboratory Division r+,uy®r�r�: 6616301 T-621 P.01/01 F-363 1-'71 IiZ4e1 w I ripl/A•K -SIM ^ Ta: From: 0 ea Ojiuit [ ,nem co,Pom rax I� RWfq: Pllg Nola EMan' Drinking Water Analysis Report for Total C;olltorrn tiactena ar RL•'AD IASTP VC'71O.NS ON REVERSE SIDE BEFORE COLLEC'TINGSAMI'4E Fax �- T'O 0E COMPL.FTED BY LABO RA TORP (.AAijalystS SImwS this Waief SAMPLE w be Gln $et15tACt0Ty p 1 Unsan�factary 0 Sample Qvcr 30 hours old, resulq may be unreliable ❑ Sample too long In Transit; Sarnp{e should not be over 48 hours old at C)IMMnatton to indicate reliabic results. Please send new sample via special delivery }nail Dave Received S-5-11 -. — Ti -!a -.— Time Received j AnalYiis Begalt V. nn Joel ,Q -,Quo 562-2343 n PUBLIC WATER SYSTEM I31. N 1a- PRIVATE WATER SYSTFM ❑ Sen4 Resum ❑ Send Invoice SAMPLE DATE, ME Month SAMPLE TYPE' Q Rouillte ❑ Repeat Sample (for routine sample with lab ref. no. Special Purpose SAMPLE LOCATION —J�`Z'arwaiu+a [0� I z �1 Day Year ❑ Treated Water Untreated Water 'Gime Collected Collleecte�<d By 11 �� ///���- pl"m Fml Analytical Method: MMO-M4Filter Number ofeolontes/100 TrII. - Result' Analyst 99�EH33 ►O/ Cil -2- :h Fbka dun Cl Faced !)air. ._ Tune Client notified of unaadsfactory results: p— — C]Phoned Spoke eith Fnxea Pate Taste: BA(7FRIOLOGICAL WATER ANALYSIS RECORD MMO-MUG; Result: Total Coliform E. Coli Membrane Filter: Direct Count — (':? - --- Colonlml00 ml Vanficarion: LTB „ _ BGB ,COLIFlAM� Fecal Coliform Confirmation -- Final Membraac Filter Resutis------- RepottedBycar- ��= Pate_ Time Com,ncnls: Coli-fo'rrvToa ml �� W - hes TNTC-Tev A.."., Ta "-n, 08 -seer, 8v.err,v _ii'iBliiFw7 Mamoer 011 ilia SOS Group lSocuh0i Gonerale4e Survedlancel ENviAONMENI"AI. FACILITIES IN ALASKA CALIFORNIA. FLORIDA, IGI-MOIS, MARYIANP. MI0RIt3AN. MISSOURI, NEw sERSEY, 04n0. wE3T vIRGINIA Roro- RrROUBLEE 0 000tRO SEWER -[TRAIN SERVICE R 'NO AWAY 00 O,N11 THE 0 ,1/y® N2100125 R O. Box 112688 ANCHORAGE, AK 99511 (907) 345-2513 Phone 345.8284 Fax Job Address 3156 Sn�fr DATE TERMS -15 DAYS CUSTOMER ORDER J-- ROTO -ROOTER SERVICE CALL HRS. @ STEAM THAWING HRS. @ 7sa;, , QGi .1o, OVERTIME CHARGE HRS. @ Job Address 3156 Sn�fr DATE TERMS -15 DAYS CUSTOMER ORDER J-- ROTO -ROOTER SERVICE CALL HRS. @ STEAM THAWING HRS. @ TRIP CHARGE HRS. J @ QQ , QGi .1o, OVERTIME CHARGE HRS. @ ADDITIONAL LABOR CHARGE HRS. @ PLUMBING HRS. - @ PUMPING SERVICE (GAL.) HRS. @ )00,U DD i Do ' HYDRO -JET SERVICE _ HRS. @ 'D4C6MFoRA-1NBPE13FI6N-_,�v ..,-�5}} 0_ iQr� MATERIALS Z '�/y\C tet" D 'co PLEASE PAY FROM THIS IN OICE TOTAL N i) q,06 TOTAL FOOTAGE CLEANED OR THAWED BLADES USED PROBABLE CAUSE OF STOPPAGE I!'� LINE CLEANED ❑ JOB NOT GUARANTEED FOR FOLLOWING REASON WORK ACCEPTED BY� 7 ❑ See additional job information form attached. To PoowHxr Call NEUS CUST6M`printing Servke TOLLEPEEFBBU8 6127NE0.5.fro., Petnboro yn, NH 0.3e:8. Ret Ni G3MA239 MUNICIPALITY OF ANCHORAGE • C� 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. # -oar --a-) — HAA # _'0 Q'� aL5� 1. GENERAL INFORMATION Complete legal description gL S oFA•t b Lo ua Il 1 r w dE y r` S 3o T�?M 2kn1 Location (site address or directions)S_ TEw * C i Rc Le o 1�E P- _-- DFAr Mn0K[ Property owner —Day phone 3`15 - 7 S to Mailing address Lending agency Mailing address Agent — Address. -- Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank - Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rov.1/91) Front MOAN21 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 ofFirm ANb07s'hj E-NLi,Jrm,jC Phone .3.?7—f 655 Address PO. 30x ZVD77-Y /�ANem. 1jjLggTz Engineer's signature � �-c CE(�t,_d�Date `� Z A 9U 6. DHHS SIGNATURE X Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments M 'Cis a 1. Michael E. Anderson n_ 4381-E JFE''S\0\`��, bedrooms, with the following stipulations: t Date 6-�; �1 1— 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 (flee. 1/91) Back MOA 021 Municipality of Anchorage Department of Health & Human Services M HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Z. G & 2 �2LAin41211E UiF_w Parcel I.D. _ b )- / -. O A. WELL DATA Well type PR/V,9 T E If A. B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Date completed ?�8�� Driller—/" -IA/_—_ Total depth_ z2D _Cased to Zzo Casing height /3v// —_ Sanitary seal(Y/N) Date of test Static water level Well flow Pump level Wires properly protected (Y/N) FROM WELL LOG / y5 g.p.m. Kt SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot _—/D/, AT INSPECTION n, 3-31-92- — o z 7 D 9,prmi t' 00 nETE2 Wll 1.LED a` < > 7- rri Y+y c[> m N ti 0 O rnm On adjacent lots _. /DO 74 5 o _ Absorption field on lot _ /Zo ; On adjacent lots /oo /E--_ Public sewer main _ In Lfs Public sewer manhole/cleanout 112iLE5: Public sewer service line _— fn/G s Petroleum tank s /DO' t WATER SAMPLE RESULTS: Coliform SAr( sFn �-7 6 P_� y Nitrate _ q, o — Other bacteria -e- Date of sample: 3 - 3 I - 2 z ---_ Collected by: _FA`E bvQE &i -- B. SEPTIC/HOLDING TANK DATA Date installed --a Z -R? Tank size /Ono —Compartments — Cleanouts (Y/N) _ Foundation cleanout (Y/N) __y_—_ Depression (Y/N) High water alarm (Y/N) —�E Alarm tested (Y/N) A4 Dateof pumping 4_ "''"�'� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /CJ/ —On adjacent lots /ClE f --Foundation 5-5 --_ To property line --Absorption field_ _Water main/service line Surface water/drainage NOM C_ /N A�E�J - /oo'+ 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE LIFT STATION Dateinstatted� Size in gallons \ Vent(Y/N) High water alarm level "Pump Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots "Pump off" level at tested Surface water D. ABSORPTION FIELD DATA Of Date installed 8 -Z 3 - 42 Soil rating 12 S System type D, 7"e Emcd Length so/ Width Z • S/ Gravel thickness 6 Total depth N Total absorption area (D O (p Cleanouts present (Y/N) Depression over field (Y/N) N Date of adequacy test 3 Results (pass/fail) PA SS for 3 bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 120' On adjacent lots /ooIi-- Property line 2B To building foundation To existing or abandoned system on lot OQkaE O W L07' On adjacent lots /001+ Cutbank so / Water main/service line 17 0 / Surface water IJoN e M 62-raA Driveway, parking/vehicle storage area / /O / Curtain drain KMM E ) u A KEA E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ _Z70 0 Waiver Fee: $ Date of Payment GJ °L Date of Payment Receipt Number Receipt Number 12-026 (Ray. 3/91) Back MOA 21 �0 I Signature '" yrr%� r1� °"R`C�>—� - ;'"y to ••�,� ^ � � ALI i e. ato `oee loeeea�a°c veccoa Engineer's Name /''I 14,*al� LoaSUr� w - o Mich An ael e Date �� C, •ne 4361 HAA Fee $ _Z70 0 Waiver Fee: $ Date of Payment GJ °L Date of Payment Receipt Number Receipt Number 12-026 (Ray. 3/91) Back MOA 21 INVOICE a0yVlbT00Z?a SEEWERANDI DRAIN 'Wcoa# ja '7"a&4 CLEANING SERVICE vaaw tke V"ti ew„ P.O. BOX 112688 PHONE345.2513 ANCHORAGE, ALASKA 99511.2688 L /--t j�� I F l'2rs ( �" > > , J Job Address _ DATE SALESMPN TERMS -"DAYS CNSTOMERORDER# ROTO -ROOTER SERVICE CALL HRS. @ — STEAMTHAWING — HRS. @ TRIPCHARGEE HRS. @ OVERTIME CHARGE HRS. @ — ADDITIONALLABORCHARGE HRS. @ PUMPINGSERVICE � �"' (GAL.) HRS. .1 @ HYDRO -JET SERVICE HRS.. @ - MATERIALS of Mena PAVPPOMTHIS INVOICE TOTAL TOTAL FOOTAGE CLEANED OR THAWED BLADESUSED RRnaeRi r MUSE OF STOPPAGE LINECLEANED ----- ❑ JOB NOT GUARANTEOR-FOL OdG REA ONS—A.— WORK ACCEPTED BY CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 52331 Chemlab RofA 92.1262 Sample # 1 Matrix: WATER Client Sample ID L6 B2 SPENDLOVE VIEW PWSID UA Collected 6 his. Received MAR 31 92 0 14:30 hxs. Preserved with : AS REQUIRED Analysis Completed : APR 1 92 Laboratory Supe iso S PHEN C. EDE Released By C� ......................... Parameter ------------------------- NITRATE-N ........................ Results ---------------------- 4.0 Client Name :MCFADDEN, WAYNE Client Acct :MCFAWCS BPO# POI :NONE RECEIVED Req# Ordered By :WAYNE MCFADDEN Send Reports to: 1)MCFADDEN. WAYNE 2) ..................................................................... Units Method Allowable Limits --------------------------------------------------------------------- mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: UA, NO TAG FOR 'THIS SAMPLE.. Remarks: ................... 1 ............................... Tests Performed See ........................... ..................... ............... Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than Q)I GS Member of the SGS Group (Soc16t6 G9n6rale do Surveillance) 6. LEGAL DESCRIPTION DATE RECEIVED _— INSPECTION APPOINTMENTS STREET LOCATION TIME TIME TIME 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS DATE DATE DATE INSPECTOR / INSPECTOR INSPECTOR MUNICIPALITY ANCHORAGE MUNICIPALITYA oPA & V RONMEN' APRTECTION DEPARTMENT OFHEArTHN O OF HEALTH & Alaska 99501 FNVIRON/v1pNTAL 825 LStreet -Anchorage, pPOiECilO A depth (attach log if available.) ENVIRONMENTAL SANITATION DIVISION JUIN c 0 Mal Telephone 264-4720 ((�� � REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FARIE-111114 VEE DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER l rik"IC. i 2 �V "��L91� PHONE —;I-- MAILING ADDRESS ``2) 1 rr move) PHONE PROPERTY RESIDENT (If different from — -------- 2. BUYER PHONE MAILING ADDRESS — 3. LENDING INSTITUTION PHONE MA L NG ADDRESS 4. REALTOR/AG /� 1/ �Lr -- ken, FH—ONE---- MAILINGADDRESS 6. LEGAL DESCRIPTION STREET LOCATION - ('c� rlie U)'C�cj ----- 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One lB� Four ❑ Other__ 11,�SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY Ep' 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.) _ 8. SEWAGE DISPOSAL SYSTEM — — 79' INDIVIDUAL/ON-SITE** `�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) /� /�Al�l�,l Oar��,,,� E 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 DATEINSTALLED 73 INSTALLER ❑Septic Tank or ❑ Holding Tank Size: PLSO If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER Jj TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS A ^ ❑ APPROVED FOR BEDROOMS 11 CONDITIONAL APPROVAL (letter must accompany certificate) dl,_DISAPPROVED DATE �% -3 --1 BY N�- "o 72-010 (Rev. 6/79) v -8l The S7 R1 E1 needs to be submitted to I.,Y ANCHORAGE, ALASKA 99501 office from the Chem Lab, 5633 B Street, for (901) 264-4111 our review. 1�13r- 4.•`i 1 -'11 �;e , !1� [ �/ / GCORGi t,9. Stitt IVAN, MAYOH fl � DCPAHIG.IEN: 01 HLAtIt( AND ENVII70NMENfAL PH018C1101J July 27, 1981 Patricia N. Brooks Star Route A Box 383 Anchorage, Alaska 99507 Subject: Lot 8 Block 2 Spendlove View Hei-ghts Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this office for our review. (3) An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing ofof private firms performing the test is enclosed. This report needs to be submitted to this department for our review. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska Mutual Savings Bank Post Office Box 11.20 99510 Larry Eaton Polar Realty 1101 East 76th Avenue, Suite B 99502 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR I . Approval requested by: y72 Mailing Address: _rte Phone: 2. Property Owner: `i Sfjii� �1`/�f�oU�=Phone: Mailing Address: 3. Legal Description: Z07- 4. 4. Location : __/��/"�� /����odi / ft <r ✓ ///f 7� ��/.�iii� ��r�� �id/GG 5. Type of facility to be inspected yf'/fJ/G�No. of bedrooms 6. Well Data: A. Type ,� 29%�B. DepthC. Construction D. Bacterial Analysis 7. Sewage Disposal System: A. Installed //-7 B. Installer �/ �.�v�o11�// � �✓_ C. Septic Tank D. Seepage Pit E. Disposal Field 8. Distances: 1 . Size 2. Manufacturer 1. Absorption Area Material���✓ Total length of lines A. Well to: Septic tank %�, Absorption area /40 Sewer Lines /! Nearest lot lineOther contamination ��ir/�C�i����• B. Foundation to septic tank /� , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Rey„est for Approval of Individual '3cwer & Water Facilities Legal Description Comments Approved Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date February 26, 1374 Robert. Underwood o n. Rom 921 `anchorage, Alaska 90507 SUI?,l[f:T: SpanSewer and water View Hei�thi;st�•c3-hedronrt rvino toinvlc familA Mock y dwelling Dear Nr, Underwood: On February ?r,, 1'?7n this department: inspectOd the sewer and water On Fa uar at the 74 this location. The sever system cnnsistinq of a 125, Mallon s>optir, tank and sWa�e pit is approved by this dnssart Ill(9nt anti lncaLC'I an adequate distanCC away from the t•!oll. The 101' well is of approved construction. A ,ample of eater was obtained (Torn the Well for testing. +;!r :i11 not, have the "Sul" this test until March1, 1974.> do not anticipate any Urobloms with tho water. Slnccroly, C.S. McKechnie, R.s., E":nvirommnptal control Officer csm/ko