HomeMy WebLinkAboutEAGLE CREST #1 TR B LT 25Eagle Crest I
•
A 0
#050-291-26
Municipality of Anchorage
Development Services Department
/
Building Safety Division a
OD-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650 Page of
www.ci.anchorage.ak.us (907) 3437904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW030321
PID Number: 050-291-26
Nam:Wastewater
R=e Marton
System: ® New ElUpgrade
Address:
P.O. Box 113326 Eaale Rtyer
AK. 99577
ABSORPTION FIELD
Phone:
Number of Bedrooms:
..
®ONp Trench ®Shallow Trench 13 Bed 13 Mound t] Other.
LEGAL DESCRIPTION
Soll Rating:
Total Depth from original grade:
1.2 GPD/FP
6.0 Ft.
sloa: Lot: Subdivision:
Depth to pipe bottom from, anginal grade:
Gravel depth beneath pipe:
25 Eagle Crest
#1 Tract 8
3.0 Ft.
3.0 Ft.
Township: Range:
Section:
FIN added above original grade:
Greve] Length:
0.4/4.7 Ft.
44 Ft.
Well: [I New El upgrade
Gravel wkth:
Number of Imes:
Distanos between lines:
5.0 Ft.
1
NA Ft.
ClessMcation (Private. A B. C):
Total Depth:
Cased to:
Total absorption area:
Pipe Material:
Public
Ft.
Ft
375 P!
D3034 & F810
Driller:
Date Drilled:
Static Water Level:
Installer:
Data Installed:
Ft,
Martin Const.
8/20/2003
Mehl:
Pump Set at:
Casing HNght Above Ground:
TANK
PM
FL
Ft
SEPARATION DISTANCES
N Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
Public/Privat
en urer:dapau
:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1000 Get.
Well
100'+
100'+
NA
NA
25'+
Metede:
Steel
Nurnwrot Compartments:
2
Surface water
100'+
100'+
NA
NA
LIFT STATION
Lot Line
5'+
10'+
NA
NA
ae:
an urer
Gat.
Foundation
5'+
1 Q'+
NA
NA
'Pump on" level al:
Pump off vel et.
High water alarm at
In.
In.
In.
Curtain Drain
NA
1 *50'+
1 NA
NA
Pump Make a Model
Electrical Inspections performed by:
Remarks:
tank & field insulated
BENCH MARK
Lomd.a ascription:
Top of telephone box
Assumed Elevation:
100 Ft.
Engineer's Stamp
�a�p'�;� OP log, Is
Inspections by: KND Engineering
Inc.Dates: tat8/20/2003
performed
0 0: 1 age a N„ 00,
2nd
r
•aa aaa a NaaaN
Kenn`"
Development Services
Department Approval
. 'ur
s
Reviewed and approved by:
.0 x Do% ate:
F Za �•=�`�
(Rev. 11/mm)
7�''�-
�1 ROFESSIO P+
a.'u
A -C=12.6'
B -C= 44.5'
A -D=18.3'
B -D= 46.4'
A-E= 27.5'
B-E= 53.1'
A -F= 46.7'
B -F= 26.3'
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW030321
EAGLE CREST #1, TRACT B, LOT 25 PID#050-291-26
WFk
RgOt� I
(F,h�
SECOND STREET
EYBOX
H
ROPOSED S STI M I
W
NG PRIMARY SYSTEM aZa
0 0-F J 1
EXI 000 W
26 TANK
I
h
EXISTING W
HOUSE .
THI T IS C
HOUSE
SERVED � (FOUNDATION) (.1
PUBLIC WAS
Io, u LOT 25
SCALE: 1' 50
...... ..9Tx� * �/
FUS
CE 71
1 `\-FE3310N�
PREPARED FOR:
ROYCE MARTIN
P.O. BOX 113326
EAGLE RIVER, AK. 99577
(907) 694-6819
FIELD BOOKS
901MARr. LANG
STAKINQ
ASBULT. LANG
Dolt. FOE:
ACRD ry [. 02037
44'
OOHPIHEU:
°RANµ VBG
Dca'm: KMD
DAT_- 7/27/
aaB: NW 54
" "" 02037
SCALEi NTS 81.5 a
M,ll 1W ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11/FAX (907)696-8111
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.muni.orgionsite
(907)343-7904
ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET
To: KND Engineering
Legal description: Eagle Crest #1. Tract S. Lot 25
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on _
❑ Calculation error in design. _
❑ Additional soils information needed.
❑ Water monitoring results inadequate. _
❑ Discrepancy in information submitted.
❑ Topographic information missing or inadequate. _
❑ Incomplete; missing _
❑ Incomplete; missing _
❑ Additional adequacy test information needed. _
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown.
❑ Proposed system too deep for soils information submitted.
❑ Well log required. _
❑ Omission in narrative. _
❑ Insufficient fill over tank or field._
® Other. Please include AWWU water key box on as -built survey,.,
Name of reviewer. Julie Makela. P. E.
Date: 11/19/2004
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
W
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PLOT PLAN _ ASBUILT _ SCALE I• • 30' GRID NW 04 Project No. t2-119
Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515
907 522-6476 Phone
Registered Land Surveyors 9073 522-4625 Fax ! OF A4
I hereby certify that I haw surveyed the following described property. �`i.• "" ••.NQS
LOT 2s, TRACT % rAi11.E CRW SMIVISION
Anchorage Recordlr�g DisMat, Alaska, and Mud the knprowments situated ;
thereon are within tis properly /nes and do not encroach onto tis4'�..
. ... . 9
edlocerd thereto, That no Inrprvvemerds on TM property Mng adlaaent
encroach em the surveyed premtsce and that there ore no roadvwye, hanamlaron
fines or siker visible sacemerds on sold properly except as Indicated hereon. .. ....... ••• ••• ...
Dated this thee 111" KENNETH LAN
Day ��'^'�'�— , 7sr.43., at Anchorage, Alaska LS -5202
R it The responsibility of to owner to determine The existence at any easernents, ...
eovenards, er restrictions which do not appear on the recorded subdMelon plat. 'FasKslt�
SECOND STREET
C;
M
N 89059100V MOO
LOT 25
11,070 af.
6
C CLEANOUT
zz
-
Qa
Y
K
LOT 26
mm1'
tax400
110.T
E
170
�g
10' UTILITY EASEMENTS--%
ax
ew
50.0'
W
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PLOT PLAN _ ASBUILT _ SCALE I• • 30' GRID NW 04 Project No. t2-119
Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515
907 522-6476 Phone
Registered Land Surveyors 9073 522-4625 Fax ! OF A4
I hereby certify that I haw surveyed the following described property. �`i.• "" ••.NQS
LOT 2s, TRACT % rAi11.E CRW SMIVISION
Anchorage Recordlr�g DisMat, Alaska, and Mud the knprowments situated ;
thereon are within tis properly /nes and do not encroach onto tis4'�..
. ... . 9
edlocerd thereto, That no Inrprvvemerds on TM property Mng adlaaent
encroach em the surveyed premtsce and that there ore no roadvwye, hanamlaron
fines or siker visible sacemerds on sold properly except as Indicated hereon. .. ....... ••• ••• ...
Dated this thee 111" KENNETH LAN
Day ��'^'�'�— , 7sr.43., at Anchorage, Alaska LS -5202
R it The responsibility of to owner to determine The existence at any easernents, ...
eovenards, er restrictions which do not appear on the recorded subdMelon plat. 'FasKslt�
AS -BUILT
SYSTEM
DETAILS/SITE
PLAN Permit SW030321
EAGLE
CREST #1,
TRACT B, LOT 25
PID#050-291-26
AD
D \ SECOND STREET
10'
A -C=12.6'
B -C= 44.5'
A -D=18.3'
jf'P�!'
iw
41
LOT 25
i'
ii
B -D= 46.4'
4�
A-E= 27.5'
B-E= 531'
A 1000 GAL
A-F=46.T
SEPTIC
905
905
B -F= 26,3'
TANK
SEWER
ROCK
9TH �I
.K... ..S ,...4
71
\ FESSlo*" ./
44'
PREPARED FOR:
ROYCE MARTIN
P.D. BOX 113326
EAGLE RIVER, AK, 99577
(907) 694-6819
FLED BOOKS CCwu
0" LANG DQ
STAKMM CHECKED: KMD
ALT LANG DAM 7 7 0
DWG FLE DPoD: NW 54
A' ` 02037.DWG """ 02037
SCALE: NTS g1.5 a
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8738
July 19, 2004
Municipahty of Anchorage
Mark Begich, Mayor
Building Safety Division
P.O. Box 196650 • 4700 Bragaw Street
Anchorage, Alaska 99519-6650 • (907) 343-8301• Fax (907) 343-8200
http://w .mmi.org
Royce Martin
P.O. Box 113326
Eagle River, AK 99577
Subject: On -Site Water and/or Wastewater Permit.
Permit Number: SW030321
Legal Description: l ajle Crest* I-Tr-9tB`"Gt
Dear Mr. Martin:
An On -Site Water/Wastewater Permit, number SW030321, issued by this office for a single-family
system, will expire on August 19, 2004 This permit was valid for 365 calendar days.
If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit.
If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to
this office for review, approval and documentation. This as -built inspection report must be signed by
the licensed Professional Engineer who inspected the installation of the system. As -built inspection
reports are required to be submitted within 30 days of the completion of the system.
If no system was installed under this permit, and you are still planning to install a well or wastewater
disposal system, a new permit must be obtained from this office. A new permit for a second year may
be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of
the original permit.
When applying for anew permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well
permit.
If you have any questions, please call this office at 343-7904.
Sincerely,
Daniel Roth
Program Manager
On -Site Water and Wastewater Program
Enc: Copy of permit
r
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water d Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519.6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SW030321
Legal Description: EAGLE CREST #1 TR B LT 25
Date Issued: Aug 20, 2003
Expiration Date: Aug 19, 2004
Parcel ID: 050-291-26
Design Engineer: 0070 KND Engineering Site Address: 019128 SECOND ST
Owner Name: Royce Martin Lot Size: 11070 SO! FT.
Owner Address: PO Box 113326 Total Bedrooms: 3 Permit Bedrooms: 3
Eagle River , AK 99577 -
This permit is for the construction of: ,
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By:
Date: ZZ t13
Date: t9
Municipality of Anchorage
Development Services Department'' a
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
(907)343-7904
y- ON-SITE SEWER/WELL_PF_RMIT-APPLICATION-
FOR A SINGLE FAMILY DWELLING
) j� ' 030321
Parcel I.D. �V —�� Permit Number SW
Property owner(s)IWk-A Day phone
Mailing address (1) o
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) &CkIn`o Ica S% ( arc-- B L .S
Legal description (Section, Township & Range)
Lot Size 1 1 ° [) 1'Cj Acres/Sq.Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only ® Well Only
❑
Sewer and Well ❑ Water Storage
❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi
❑
Swimming Pool ❑ Water Softening Unit
❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is
being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: %> 1 bt�) V_ aN_AAVbv'faiver Fees:
Date of Payment: ` t CCV75 Date of Payment
Receipt Number: �Z S Cc Receipt Number:
(Rev. 12100)
RENEW 814/2003
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragew Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Aug 14, 2002
Expiration Date: Aug 14, 2003
Permit Number: SW020294 Parcel ID: 050-291-26
Legal Description: EAGLE CREST #1 TR B LT 25
Design Engineer: 0070 KND Engineering Site Address: 019128 SECOND ST
Owner Name: Royce Martin Lot Size: 11070 SQ. FT.
Owner Address: PO Box 113326 Total Bedrooms: 3 Permit Bedrooms: 3
Eagle River, AK 99577 -
This permit Is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: �'f d
Date:CJ 14 OZ
Municipality of Anchorage
Development Services Department
4
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
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D 050-291-26 Permit Number SW020294
Property owner(s) Royce Martin Dayphone 694-6619
Mailing address (1) PO Box 113326 Eagle River, AK 99577
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub d )_)Eagle Crest #1 Tract B, Lot 25
Legal description (Section, Township & Range)
Lot Size 11,070 Acre q.F Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.'
of property owner or authorized agent)
Permit Fees: Vdo Waiver Fees: _
Date of Payment:V_2/OZ Date of Payment:
Receipt Number: h 'L 3(# 11 Receipt Number:
(Rev. 12100)
K V D ENGINEERING, INC.
20441 PTARMIGAN BLVD.
/FAX (907)696-8111
July 31, 2002
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New sewer permit — Eagle Crest #1 Tract B, Lot 25
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit on the subject
lot. On June 13, 2002 one testhole for the proposed system was performed. The results
of this test are attached. The general slope of this lot is from south to north at a grade of
approximately 0-5%.
We have designed our system utilizing the existing testhole that was excavated for the
3 -bedroom house, which is proposed for this lot. The lot will be served by public water.
We propose to install one 5' wide shallow trench. Water was not encountered during
the excavation or during monitoring.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
IKHD Engineering
enneth M. Duffus, P.
Attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA
EAGLE CREST #1, TRACT B, LOT 25
B
27
26
22
1 3
2
K
D
lar a i■
TRAC B
3
RMr
WAM
--------------..IREC,
4
3
27
26
R
SfRYED
MYrIR w•
v
I
EaM
lar a i■
TRAC B
3
all
36
4
No PUBLIC YELLS WITM eW IF
PRUPUSED SYSTEK
MU PRIVATE WELLS WITM ear a
PRWMU SYSTEM E)WXPT AS WTM
M SEPTIC SYSTEMS WITIQM ear If
PMPUSED WELL EXCEPT AS WTEIL
DESIGN DETAILS
3 BDRM X 150 GPD = 450 GPD
450 GPD/1.2 GPD PER SQ. FT. (2 MIN/IN.)= 375 SQ. FT
(375/5'(W)) X .58(RF) (3.0' GRAVEL) = 43.5 FT. TRENCH
USE 1 TRENCH - 44 (L) X 5' (W) X 3.0'(D)
Total depth of system is 6.0' from original grade.
Total depth of gravel below distribution pipe is 3.0' .
NOTES,
1. USE A 1000 GALLON SEPTIC TANK, INSULATE IF <4' OF COVER,
2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM,
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
MIN. 3' COVER IF REQUIRED,
5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS.
6. CONTRACTOR WILL HAVE THE EXISTING WELLS ON THE SURROUNDING
PROPERTIES STAKED BY A SURVEYOR, TO ENSURE SEPERATION.
PREPARED FORS
ROYCE MARTIN
P.O. BOX 113326
EAGLE RIVER, AK. 99577
(907) 694-6819
FIELD BOOKS I cw vnE
e0 DAR"LANG
STA0 a
, wr.
RMa nE
Am "L'02037
"No' 02037
Scale 1'= 100'
PAGE 1 OF 2
ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
WASTEWATER DISP❑SAL SYSTEM DETAILS
EAGLE CREST #1, TRACT B, LOT 25
SECOND STREET
10'
E
44'
PROPOSED 3
BDRM HOUSE
12.0'
ooo
KIT
Ln
61 o
PREPARED FOR,
ROYCE MARTIN
P.O. BOX 113326
EAGLE RIVER, AK, 99577
(907) 694-6619
fle.O BOOKS cauFuhu
eouFaAnr. LANG MAW vBG
lrr� Ommm KMD
Auwr. DAte 31
M FM aaQ NW 54
AOM"02037.DWG '108"" 02037
1 *1
IN
0
ScaLet 1'= 20'
PAGE 2 OF 2
IEH UDENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8738
JKV D ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
�t
CE 7116
SOILS PERCOLATION TEST
Performed for: Royce Martin Date Performed: 6/13/02
Project. Eagle Crest #1 Tract B, Lot 25 TEST HOLE # 02-1
Depth
(Feet) SEE ATTACHED SITE PLAN
ORG/Loam —brown, moist FOR HOLE LOCATION
1
13-
GM- med dense, gray/brown
dry, w/ boulders to 1'
B.O.H.
14
Date
Gross
Time
Net
Time
15-
Net
Drop
t
6/13/02
16-
-
6"
-
17-
1:10
10 min
18-
h;
3
"
19 -
HOLE PRESOAKED
20- PRIOR TO TEST
Was Ground water encountered? NO What depth? NA
Depth to water after monitoring? DRY Date? 6/20/02
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
6/13/02
1:00
-
6"
-
2
1:10
10 min
9/16"
5 7/16"
3
"
1:11
6"
-
4
121
10 min
12/16"
54/16"
5
"
1:22
6"
6
1:32
10 min
13/16"
53/16-
7
•
1:33
6"
-
8
1:43
10 min
1"
5-
9
•
1:44
6"
10
1:54
10 min
15/16"
51/16-
11
"
1:55
6"
-
12
2:05
10 min
V,
5"
•
Water
Added
Percolation Rate 2.0 (min/in) Perc Hole Diameter 6„
Test Run Between 2.5 feet and 3.5 feet
L Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
Municipality of Anchorage -
On-Site Water and Wastewater Program ( LIN 67 70 .
(907) 343-7904 ` E T Y
In. 4431
CN h
Certificate of On-Site Systems Approval a s s L
Parcel I.D. 050-291-26 Expiration Date: -
1. GENERAL INFORMATION
Complete legal description Eagle Crest #1 Tract B Lot 25
Location (site address) 10150 Crest View Lane
Current Property owner(s) Palmer, Howard & Jackson, Karen Day phone
Mailing address 10150 Crest View Lane Eagle River, AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
O Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System Public Sewer ❑
WaiverNariance request for: Distance:
/- !� ,",
d
Received b _ /) / J� ► 4/ 1 Date: l.� �o�!
1
COSA to be released to the engineer,unless otherwise requested the engineer.
COSA Fee $ 5 A P. Waiver Fee $
Date of Payment (€11-11? Date of Payment
Receipt Number 052+1X7 Receipt Number
COSA# e6 -!W 2-2a- 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,J attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regylatiotts.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.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 6/6/2017
Alew OF
‘kk
AMP, A� s��
h
yl
AIWTO NO.' Y TI
•* f
6. DSD SIGNATURE ' ' • .421, -
System #1 Approved for bedrooms .Steven R. '+niton
- "- /
System #2 Approved for bedrooms � c9� CE-8149 ��
Disapproved 11 FROFESSIONP—4
Conditional approval for bedrooms, with the following stipulations:
•
ON-SITE,
WATER AND
VVASTEWATFP, :
PROGRAM &
C'-t-,\i\V N"
y: Vim- ` Original Certificate Date: ( ,— /2 1 7
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 Adviso''ry
Well Flow Advisory Other '�c
COSA blue sheet c •
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Eagle Crest #1 Tract B Lot 25 Parcel ID: 050-291-26
A. WELL DATA
Well type Public If A, B, or C provide PWSID# Well Log (YIN)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g p.m g.p m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample. Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8/20/2003
Tank size 1 000 gal Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N
Date of pumping 6/3/2017 Pumper JR's Pumping
C. ABSORPTION FIELD DATA
Date installed
8/20/2003 Soil rating (g.p.d./ftz or ftz/bdrm) 1.2 GPD/SF System type Shallow Trench
Length 44 ft. Width 5 ft. Gravel below pipe 3 ft.
Total depth 7.6 ft. Eff. absorption area 375 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 5/25/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 12 in. Water added 450 gal. New depth 18 in.
Elapsed Time. 1440 min. Final fluid depth 12 in. Absorption rate >= 450+ g.p.d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm& circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
Survey on file. .
G. ENGINEER'S CERTIFICATION -40-.44
OF ,
I certify that I have determined through field inspections and 4
review of Municipal records that the above systems are in * i % '.*T04
conformance with MOA COSA guidelines in effect on this date. %, _•• •`� • •el • •• ••
9 Steven Pannone ` • 0
Engineer's Printed Name :� everi V. Pnririorie:
6/6/2017 6 CE-8149 4,1
Date IN..
sc
COSA canary sheet_2-6-15.doc
Parcel I.D. 050-291-26
Municipality of Anchorage
On -Site Water and Wastewater Program cry
(907)343-7904 s,=try
Certificate of On -Site Systems Approval
Expiration Date: - .3 -1 %
1. GENERAL INFORMATION 9 25
Complete legal description Eagle Crest #1, Tr;K, Lot
Location (site address) 10150 Crest View Ln.
Current Property owner(s) Charles & Twila Templeton
Mailing address
Real Estate Agent
Day phone
10150 Crest View Ln. Eagle River, AK 99577
2. TYPE OF DWELLING:
F71 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual F-1
Individual Water Storage
❑
Holding Tank ❑
Community Class ,nfell
Public Water System
❑
n
Community F-1
Public Sewer ❑
WaiverNariance request for:
Distance:
Received by.•
Date:
COSA to be released to the engineer, unless otherwise requested by the
engineer.
COSA Fee $ 5Z6" Waiver Fee $ _
Date of Payment 3141 S Date of Payment
Receipt Number 6 $ OG q G Receipt Number
COSH# OSC(5l6%5 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 -ofOn-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.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 3/3/2015
6. DSD SIGNATURE * '48 ?H
System #1 Approved for bedrooms S}even . Pan
System #2 Approved for bedrooms �� '• CE -8148
Disapproved �% %RPfESS�..►•`
Conditional approval for bedrooms, with the following stipulations:
By: ( ' Lam` Original Certificate Date: 3 -_
The unicipali o 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 blue sheet E
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Eagle Crest #1, Tr- o
.Legal Description: Ltx Parcel ID: 050-291-26
A. WELL DATA
Well type Public If A, B, or C provide PWSID # AWWU Well Log (Y/N)
Date completed Sanitary seal (Y/N)
Total depth ft. Cased to Ift.
FROM WELL LOG
Date of test
Wires properly protected (YIN)
Casing height (above ground) in.
AT INSPECTION
Static water level ft. ft. -
Well production 9 -P.M., g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic - ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8/20/2003
Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 4? 01 S Pumper PLL n=AQ i -
C. ABSORPTION FIELD DATA
Date installed $/2012003 Soil rating (g.p.d./ft2 or fta/bdrm) 1.2 GPD/SF System type Shallow Trench
Length 44 ft. Width 5 ft. Gravel below pipe 3 ft
Total depth 7.6 ft. Eff. absorption area 375 fe Monitoring tube Y Depression over field N
Date of adequacy test 3/3/2015 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 2 in. Water added 488 gal. New depth 4 in.
Elapsed Time: 90 min. Final fluid depth 2 in. Absorption rate >=450+ g.p.d.
No
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed _
"Pump on" level at
Datum
Size in gallons _
in. "Pump off' level at
Cycles tested _
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Manhole/Access (Y/N) _
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+ -
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
As-RL,ZU p, r�
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 Steven R. Pannone
Date 3/3/2015
COSA brown sheet 10-10-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 110+
de i annone
S;•. CE -8149 _-k-
in.
Municipality of Anchorage
• Development Services Department
Y
Building Safety Division � t
On -Site Water and 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. 050291-26 COSA # C (a` 10 1
Expiration Date:
1. GENERAL INFORMATIQN
Complete legal description Lot 25, Tract B, Eagle Crest aunweidii
, 10150 crest view Lane Eagle River, AK 99577
Location (site address)
CurrentPropertyowner(s) road andYoko Koss
Malliflg address 10150 Crest View Lane Eagle River, AK 99577
Lending agency
Mailing address,
Real Estate Agent
Mailing Address
Unless'otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Three (3)
3. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑✓
Day phone 654-3430
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑✓
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 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 sample results. (Certfcates 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 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, P.E.
5. DSD SIGNATURE
Approved for —S
Disapproved.
Conditional approval for
bedrooms.
Phone 522-7773
Date 2127/2012
bedrooms, with the following stipulations:
till nlvv- 2.,;
� • .illi �l�TQ'f AILTI"ew �
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report.
)ther
(Rev. 11M)
Original Certificate Date:
Municipality of Anchorage
• �� Development Services Department
1 Building Safety Division _
--- ' On -Site Water & Wastewater Program
4700 Bragaw Street,
P.O. Box 196650
Anchorage, AK 99519-6650
wvvw.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 25, Tract B. Eagle crest Subdivision No. 1 Parcel ID: 050-291-26
A. WELL DATA
Well type_ If A, B, or C provide PWSID # _ Well Log (Y/N)
Date completed _ Sanitary seal (Y/N) _ Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL
Arsenic: _ mg/I Date of sample: _ Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8/20/2003
Tank size 1,000 gal. Number of Compartments Two Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 2/17/2012 Pumper JR's Pumping
C. ABSORPTION FIELD DATA
Date installed 8/2012003 Soil rating (g.p.d./ftz or ftp/bdrm)1.2 GPD/SF System type 5' wide Trench
Length 44 ft. Width 5 ft. Gravel below pipe 3 ft.
Total depth 7-10 ft. Eff. absorption area 375 ftz Monitoring tube Y Depression over field N
Date of adequacy test 2/2112012 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g,p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N)
"Pump on" level at in.
"Pump off' level at _
in. High water alarm level at in,
Datum
Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
On adjacent lots
Absorption field on lot
On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer /septic service line
Holding tank
Animal containment 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 N/A
Water service line
>19 Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
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 Noted
Wells on adjacent lots
>100'
F. COMMENTS: Lot is served by AW WU water system.
4
G. ENGINEER'S CERTIFICATION .low�P� ' '.•••,'594®
0
I certify that t have determined through field inspections and ATH i r�
review of Municipal records that the above systems are in /' '• lr-•A ........0
conformance with MOA COSA guidelines in effect on this date. O•••• .. 00
0,
0, ;Benj in 1 Schiller r
Engineer's Printed Name Benjamin Schiller, P.E. �e°• C 2592 tea
Date 2127/2012 �t� 9F •� ,9!+,..•' c�<'"'
�I :pROFFSStONPo�•'
COSA Fee $ Lt h�
Date of Payment owl aq 6 p
Receipt Number 03Tt3CQ
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number,
$,ear 6r/Es�I
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
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-291-26 HAA # t A(N oLl
Expiration Date: Lal lla L['G
1. GENERAL INFORMATION
Complete legal description Faale Crest #1, Tract R Let 25
Location (site address or directions) .JblED C,CM-V \l��s+> Lo c�a✓
Current Property owner(s) Royce Martin Day phone 694-6819
Mailing address POB 773326. Eagle River, AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBEROFBEDROOMS:
$
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 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 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.
Name of Firm ,.O(907) SAR-611 in
Engineer's Printed Name Kenneth M. Duffus Date 11 /15/ 004
Engineer's Comments:
This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the
condition of the well and septic applies only to the
conditions as of the day tested. The flow and absorption
rates may change due to subsurface conditions that
may not be observed from the surface, changes in
land use, local soil characteristics, groundwater levels
that may fluctuate during the year and the water usage
of the family being served by the system. The operational
life of all well and septic systems are subject to these
various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
Approved for '_'23
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
bedrooms.
bedrooms, with the
X Maintenance Agreements
Supplemental Engineer's Report
Other
ByA . Com -U -V" or Q Original Certificate Date:IcaITdA
Municipality of Anchorage br
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program ' • "
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage,ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description;Eagle Crest #1. Tract B. Lot 25 Parcel ID: 050-291-26
A WELL DATA
Well type Public If A, B, or C provide PWSID #_ Well Log (Y/N)
Date completed Sanitary seal (Y/NL— Wires properlyprotected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground)
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production
g.p.m
WATER SAMPLE RESULTS:
Coliform _colonies/100 mi. Nitrate _mg./l:
g.p.m.
Other bacteria _colonies/100 mL
Arsenic: mg./I. Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material septic/steel (Anch. Tanks Date installed 8/20/03
Tank size 1000 gal. Number of Compartments Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y_Pepression over tank (Y/N),N_High water alarm (Y/N) N
Date of pumping *NA New Tank Pumper
C. ABSORPTION FIELD DATA
Date installed 8/20/03 Soil rating (g.p.d./feorft2/bdrm) 1.2 ..System type Trench
Length 44 ft. Width _5_ft. Gravel below pipe 3 ft.
Total depth 6 ft. Eff. absorption area 375 ft2 Monitoring tube Y Depression over field N
Date of adequacy test SIA - New System Results (Pass/Fail) For' bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth ln. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date__-_-
"Pump on" level at in. "Pump off' level at_ in.High water alarm level at in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Meets alar & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5 ' + Absorption field 5 ' +
Water main 10'+ Water service line 10'+ Surface water 10 0'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 10 0'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+ Wells on adjacent lots 10 0'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
fY 9 p •.... .......... ..... :..
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. �' 1 •�+ „ „
T •' =kenWtrhy1 Q
/ �• '•wo
Engineer's Printed Name Kenneth M. Duffus �� m ti.• -,,fi �``�
Date 11/15/04
i �9F� 90pESS1oN ��� I
HAA Fee $57,50
Date of Payment nll6 0`j
Receipt Number tfo)?�
(Rev. 12(01)
Waiver Fee $
Date of Payment
Receipt Number
o SECOND STREET
M
wf,Twr •
LOT 26
b.or Ngo
iO, UTILITY
,1.4
LOT 25
11,070 a.t.
Z STOW(
vva�o r'e.we rmP�+e
179'
9'
50.0'
------
889'9WOE 82.00'
I
PLOT PLAN _ ASBUILT X SCALE I" - W GRID NW54
Project No. 02-119
Lang & Associates inc11500 Daryl Avenue, Anchorage, Alaska 99515
Registered Land Surveyors (907) 522-6476 Phone
Re 9 Y 907)) 522-4625 Fax
OFAt
I herby oarlify Nat 1 haw surwyad tM toilowing daorlbed propsriy:
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LOT 25. TRACT B, ICAM E clmsT mm msloN
Anchorage Recording DisMd, Alaska and That tM knprowments Mooted
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lhenon are within Na properly Inn and do not encroach onto the property
adlaard Ihord% that no knprovements on the properly lying adlaaeM Mireto
encroach on the surveyed promises and that then are no roadways, i anemiaton
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Ilea or other visible easements on sold property except as indicated Mrson.%
Dated this TM Z-)* Day of at Anchorage. Alaska
KENNETH L
LS -5202
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N le the resof Na owner to determine Nu existence at may
covenants, or dons which do the
not appear on recorded subdMsieson plat.
KINK•