Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
HIGHLAND HILLS #2 BLK 2 LT 3
Highland Hill Block Lot 3 #050-382-34 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 191303 PID Number: 050 382 34 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name NIEMI ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5465 H I LAND RD ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 2 - GPD/SF JTotal - Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade - Ft. Gravel depth beneath pipe - Ft. Subdivision Block Lot HIGHLAND HILLS#2 BLOCK 2 LOT 3 Fill added above original grade _ Ft. Gravel length - Ft. Township Range Section Gravel width - Ft. Beds: Number of Lines - Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line - Ftz - - Ft. Well +100 - _ _ +25 TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Capacity 1250 Gal. Surface Water +100 - - _ Material Number of compartments Lot Line +10 - - - NA Steel 2 Foundation +5' _ ILIFT STATION Manufacturer Capacity Remarks old tank demolished per code - _ Gal. steel tank with advanced polyurethane coating (limited production) Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer MARTIN CONSTRUCTION:.: Drainfield exist CO/MT3034 Inspector CHARLES BALZARINI BENCH MARK (Assumed elevation) 100 ft Inspection 1st 7/25/19 Location and description dates:2 nd deck 3`d 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF Conditional Approval: Date P 49TH •.* r... ......... .., Septic System r) �jj HARLES G BALZARI�I� j r� Fc CE -13854 ••�`� •� Approved Date 9 � o a oa o t -X1. . . • ,� ,tll� °ROFE5S10��C Note: this does approval not include well permit requirements. ate.»t (Kev U5/U2/1 d) 6/30/20 CHARLES G BALZARINI CE-13854 R E G ISTEREDPROFE S S I O N A LENGINEER06/29/20 Carroll, Rebecca M. From: CHARLES Balzarini <cgbalzarini@gmail.com> Sent: Thursday, August 20, 2020 2:42 PM To: Carroll, Rebecca M. Subject: Re: HIGHLAND HILLS #2 BLK 2 LT 3 Hi Becca, He confirmed that access hatches were built into the deck. On Thu, Aug 20, 2020 at 2:31 PM Carroll, Rebecca M.<rebecca.carroll(@anchorageal<.gov> wrote: Charles, Sorry, this one dropped off my radar, but the owner is asking about it. I don't need a revised as -built survey — they often don't survey in the standpipes under a low deck, so showing the manway riser will be good enough. I did forget to ask whether the access hatches were provided in the deck to access the foundation cleanout and tank manway riser/cleanout. Could you please confirm? If you don't recall, I can ask the owner to confirm. Thank you, Becca Carroll Onsite Water and Wastewater Municipality of Anchorage 343-7908 From: CHARLES Balzarini <cgbalzarini(cDgmail.com> Sent: Monday, August 3, 2020 3:32 PM To: Carroll, Rebecca M.<rebecca.carroll(cDanchorageal<.gov> Subject: Re: HIGHLAND HILLS #2 BLK 2 LT 3 Hi Becca, Please see attached, revised inspection documents. I had the house shown incorrectly, so the swing ties have been revised to match the survey. The survey is missing the foundation cleanout and the second tank cleanout, but they're under the deck. Let me know if we need to have them pick those up. I believe there is a COSA that will be submitted for this one soon. Thanks, Charles On Mon, Jul 27, 2020 at 3:05 PM Carroll, Rebecca M. <rebecca.carroll@anchorageal<.gov> wrote: Thanks Charles, I found the correspondence were we approved the install of (9) 1,250 epoxy coated steel tanks. I had forgotten about that! Becca Carroll Onsite Water and Wastewater Municipality of Anchorage 343-7908 From: CHARLES Balzarini <cgbalzarini@gmail.com> Sent: Monday, July 27, 2020 2:37 PM To: Carroll, Rebecca M. <rebecca.carroll@anchorageal<.gov> Subject: Re: HIGHLAND HILLS #2 BLK 2 LT 3 Hi Becca, 2 i Will address your comments. Anchorage tank produced a small number of these tanks, which were approved ( as I understand it). Martin Construction bought most of them and installed them last year. I do have pics of the tank if that would help. On Mon, Jul 27, 2020 at 2:09 PM Carroll, Rebecca M.<rebecca.carroll@anchorageal<.gov> wrote: Charles Balzarini, PE C&M Engineering Services 907 854 5558 www.cmesalaska.com Charles Balzarini, PE C&M Engineering Services 907 854 5558 www.cmesalaska.com Charles Balzarini, PE C&M Engineering Services 907 854 5558 www.cmesalasl<a.com 9 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191303 Work Type: SepticTank Upgrade Tax Code Number: 05038234000 Site Legal Address: HIGHLAND HILLS #2 BLK 2 LT 3 G:0558 Site Mailing Address: 5465 HILAND RD, Eagle River Owner: NIEMI ELLIOT W Design Engineer: C & M Engineering This permit is for the construction of: ❑ Disposal Field RI Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: �LpCtlt C. t, 1.)C.Pa 'tiiient Lot Size in Sq Ft Total Bedrooms: 7/18/2019 7/17/2020 71770 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: J Issued By: _LZ&'4j4 '4j4 p Date: r� / Date: 2 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section - Parcel I.D. 050 - 382 - 34 ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) ELLIOT NEIMI Mailing address Site address 5465 HILAND Phone: 907-343-7904 Fax: 907-343-7997 Day phone 9805719 Legal description (Sub'd., Block & Lot) HIGHLAND HILLS#2 BLOCK 2 LOT 3 Legal description (Township, Range & Section) Lot Size 71,770 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo AD U) Septic Tank ElUpgrade F-1Duplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: A 15_ Date of Payment: 9-1141111 Receipt Number: 6/533b Permit No. 65P/9/a63 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 07/12/2019 RE: Proposed Septic System Modification for Highland Hills#2 Block 2 Lot 3 Dear Reviewer, The above referenced property is currently served by an older septic system. The tank has failed and needs immediate replacement. We are proposing that the existing tank be replaced with a new 1000 gallon (minimum) tank constructed and installed in accordance with MOA requirements. A polyethylene or advanced coated tank is recommended. The tank will have an insulated riser and meet current code requirements. As shown on the plan, the tank will be gre5’ from the house foundation. The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover. The repair shall be performed by a moa certified installer in accordance with MOA requirements. The engineer will inspect the tank before backfilling. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leachfield, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE (07/12/19) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191303, Rebecca Carroll, 07/18/19 CHARLES G BALZARINI CE-13854R EGISTEREDPROFES S IO N ALENGINEER 7/12/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191303, Rebecca Carroll, 07/18/19 Municipality of Anchorage Page / of_ ~' DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION O P._O:.Bo.x 19.6650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 n-~lte wastewater Disposal System and/or Well Inspection Report Permit Number: ...~ ~,'~ ~2~ OPP_..~__._ PID Number: ~~ Waslewaler System: D New 13~'Upgrade ABSORPTION FIELD NO, of Bedr~ O DeepTrench J~ShallowTrench E] Bed D Mound E] Other LEGAL DESCRIPTION WELL: D New Upgrade Grave~ ~ -- / ~/, 5" i Drdler: Ft. ~'~, SO Ft Ft. G,~ F,. TANK SEPARATION DISTANCES '~ Septic E] Holding Well Sudace Water Lot Line Cu~ain Drain Remarks: -//D ' ~J/~ LIFT STATION "Pump On' level .. BENCH MARK Inspections..performed by: ~A"E ~5 Dates: 1st 2nd Department of He~th and, H,~man Sej;vices approval Reviewed and approved bY/~e: 2- Assumed Elevahon: ENGINEER'S SEAL Permit No. SW950002 Page 2 of_ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: HIGHLAND HILLS NO.2 LOT 3 BLOCK 2 PID No.: 05038234 2 2.18.91 ! I I 250.60 SCALE 1"=60' A-C = 90.01 B-C = 79.93 A-D = 99.81 I~-D = 77.71 2/1/95 ~:..-' ~' 49TH~ "...%' li~'...' cE-~7~ ...?:~ .......... .., PAGE 1 OF 1 MUNICIPALITY OF ANCHOR. AGE DEP~ OF HEALTH ~ ~ SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ~CHO~GE, A~ 99519-6650 ON-SITE W~TEWATER DISPOS~ SYSTEM (UPG~E) PE~IT PERMIT NIJ74BER:SW950002 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:LAUVER STEVEN SCOTT & OWNER ADDRESS: HC 85 BOX 9433 EAGLE RIVER, AK. 99577 DATE ISSUED: 1/16/95 EXPIRATION DATE: 1/16/96 PARCEL ID:05038234 LEGAL DESCRIPTION: HIGHLAND HILLS #2 BLK 3 2 LT LOT SIZE: 71700 (SQ. FT.) NIrMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE :. Louis Butera, P.E. Registered Civil Engineer January 12, 1995 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Highland Hills g2, Lot 3 Block 2 Narrative Application Dear Mr. Cross: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage Will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. ~C:~WPWIN60\WPDOCS~ 1995\95-002A.NAR RO. Box 77329.1 · Eagle River, Alas~ 99577 · Telephone (907} 69.1-5195 · Fax {907) 69.1-3297 I I I I I I I ~.50.60 NO KNOWN CURTAIN DRAINS SEPTIC SITE LEGAL: HIGHLAND HILLS PLAN #2, LOT .3 BLK 2 OWNER: LAUVER CONTRACTOR: N A DWG#95TO02 DATE: 01/11/951 SCALE 1" = 60' A EAGLE RIVER ENGINEERING SERVICES P.O. Bom ?'73294 EAGLE RIVER, AK. 99/?? (90'7,) 694-5195 FAX. (90?,) 694-3292' E~ - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT £ ~- PROPOSED LEACHIrlELD .... EASEMENT EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK 99577 (907) 694-5195 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM REPLAC~ I.I~.GAL: LOT 3, BLOCK 2, HIGHLAND HILLS NO. 2, T14N R1W S28 A. G]~NI~RAT. I. The septic plan is for a single family residence only. 2, The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements, 4, Ail soil tests are advisory to the design and are to be verified or modified in the field by the engineer. $. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7, The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. SEPTIC TAN'~ 1. The existing septic tank is to remain in place. 2, Effluent line shall be upgraded by placing cleanouts to current code. 3. Diversion valve, Bull Run or approved equivalent, to be installed to allow leachfield switching. 4, No heavy equipment to be operated over existing tank, soil over existing tank to be undisturbed. C. 1. The drainfield is to follow the natural land contour to maintain uniform total depth of the drainfield bottom. 2. The bottom of the dralnfield excavation shall be level, plus or minus 1.5', 3. The total depth of the drainfield excavation is not to exceed 5' at any point. 4. The perforated leach~pipe is to be laid level over gravel with a tolerance of 0.02'., 5. The drainfield gravel is to be covered with f'dter fabric material. 6, Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leach field. 7, The area over the drainfield is to be l'mish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class *C" well, or 200 feet to any community well. REf~OM!~q:Nq3B!r3 I.I~ACI-na'I~T.n DfMI=N.qTONS: TOTAl. DEPTH: 5' GRAVEL DEPTH -- 2' underpipe, 2*overpipe DRAIN~_T.n LENGTH -- 80' DRAINFIELD WIDTH -- 5' SOIL RATING -- 0.8 GPD/ft2 BEDROOM CAPACITY -- 3 SEPTIC TANK .~ 1,000 gallon existing Twenty-four (24) hours notice required for all inspections. CAWI~VIN~O~WPDOCS~ 1995~95-002.SPC Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage. Alaska 99502-0650 SOILS LOG --- PERCOLATION TEST PERFORMED Pon:_ ~'+~'v~ L~,.,v~,,- DATEPERPORMEO: LEGAL DESCRIPTION: L'~. 1~ · ~ -I~ TownshiD. Range. Section: WAS GROUND WATER Reading Da{e Gross Net Oeoth to Net T;me T;me Wat~ Drop 16 I *' lq'.~ I'00 ~ ~' - 17- % ~ ID'~ q " ~ ~0 ~.~' ~-*~" 18. ~ " t~ :~ 20 PERCO~TION PATE _ ~ ~ - Immut~mc~l PERC HOLE DIAMETER t " TEST RUN BETWEEN ~ FTAND ~ FT COMMENTS t ~--~ ~~ ~ *t~ -- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WiTH ALL STATE AND MUNICIPAL G~IOELINES IN EFFECT ON THIS DAT[ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L' Street. Anchorage. Alaska 99502-0650 SOILS LOG .-- PERCOLATION TEST PERFORMED FOR: ~'~.~ ~' ~L~%..,,~, ~. DATE FERPORMED:~,~,.., ~, LEGAL DESCRIPTION: L ~ ~ ~ Township. Range. Se~ion: 2- 0.-~-~ O.s '1:~.~,o~ t~,~. ~- 5. 9 10 - WAS GROUND WATER ENCOUNTERED? II IF YES, AT WHAT ~ 12 DEPTH? pO 13 ll~l~ m Warn. ,~u E' 14, 15- 16- 17 18' 19- 20- PERCOLATION RATE ~ Immule.~'mch) PERC HOLE DIAMETER ~ "' ~, /, TEST RUN BETWEEN ~ FT AND ~ FT COMMENTS ~~~IA~ ~.,.""~* ~,.\1,,.~~ . k'~ /~ ._ ! ~.. ~ -- · / ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH A~ STATE AND MUNICIPAC GUIDELINES IN EFFECT ON THIS DATE DATE ~ ~ ~ ~ NAME ~ MUNICIPALITY OF ANCHORAGE ~--'~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS L GAL DESCR'T 2 LOCATION DISTANCE TO: Man u fac tu ~. ~..~. IF HOMEMADE: DISTANCE TO: Well DISTANCE TO: grade DISTANCE TO: Well f(~ ~.- -- DISTANCE TO: Building foundation OTHER length oflines ath tile Sewer line (' NO. OF BE~NIS PERMIT NO. inch c~ 8bsorption area Septic tank Absorption area(s) lines MUNICIPALITY OF ANCHORAGE -. Department~--! Health and Environmenta3")rotection _ 825 ~ Street, Anchorage, AK. .$501 ,' ,264-4720 · "# ~ HANDWRITTEN PERMIT ~ ~ e Permit #. WELL ANDYNE ON-SITE ~EWER PERMIT G' _ ) _ Location= Phone Number: b~- ~'~/~ ' Legal Description: : ~3 ~ ~~ /~ Lot Size: .- Type of Soil ~sorption System Is: Trench: Drainfield: _ Seepage Bed~ ~ Holding Tank: Max~ N~er of Bedrooms: ~ Soil Rating (sq. ft/br) The Required Size of the Soil ~sorpt%on System DEPTH ~ / ~ LENGTH ~ / GRAVEL DEPTH ~ ~ WIDTH The length d~ension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the m~ depth of gravel between the outfall pipe and the-bottom of the excavation(in feet). 'Pe~it applicant has the responsibility to info~ this department during the ~nstal~ation inspections of any wells adjacent to this property and the n~er [6f residences that. the well will serve. '"' "' "' e e TW0(2) INSPECTIONS ARE REQUIRED ~ ~ ~ Backfi~ ~'"~ ' light,any system without final inspection and approval by this departmeni will be subject.;to prosecution. Min~ distance between a well and any on-site sewage disposal system is 100 feel for a private well or 150 to 200 feet from a public well depending upon the type of public well. Min~ distance from a private well to a private sewer line is 25 feet and to a co.unity sewer line is 75 feet. Well logs are re~ired and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. ' ' ' PERmiT EXPIRES DECE ER 1 9 8 3 ' I certify that: (1) I ~ f~iliar with the requirements for on-site sewers and wells as set for~ by the M~icipalitv of er~( ~ the on s~te sewer system may re~re enlargement if th~l~~~-r;~odeled to include more that 3 bedrooms. Signe~~~~ Issued by: S~/024(~/8~) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST r-i SOILS LOG PERCOLATION TEST LEGAL DESCRIPTION: 3- 4 5 6 7- 8- 9 10 DATE PERFORMED: O-- SLOPE SITE PLAN COP.. q 12- 13- 14- 15 16 17, 18- 2O COMMENTS PERFORMED BY: 72-008 (6/79) WAS GROUND WATER ~NCOUNTERED? _ IF YES. AT WHAT DEPTH? Reading Date Cross Time ND Net Depth to Net Time Water Drop No. 1.457-E Z- OWN£R OF LAND LEGAL DESCRIP'I'ION. :/~ PERMIT NUMBER DRAW DOWN FT. KIND OF CASl~C ~- '~ q/3 ' KIND OF FORMATION~ FI. to Ft .... FI. to Ft. .. Ft. to_ Ft. From, g') FI. tn Il From tlt ' 'FI. to O~ From.~:' ~ Ft. to ~ 7 From : ' Ft. to,. From~ 7 FI.t~ ?.~ From. Ft. to Ft.., From Ft. to Ft. From. ' Ft. to "Ft. From,.. Ft. to, Ft, , From. Ft. to ~FI.' From. FI. to,, Ft. From Fl. to., Ft., From__FL to Ft. From, FI. to ~' ~' Ft.. From Ft. to Ft. From FI. lo Ft. From . FI. lo ' Ft.. From Ft. to Ft., From FI. lo , FI , Front Ft. to Ft. From Ft. to Ft... , From _ FI. to Ft. Fmm_ Ft. to_ Ft. From. Ft. to Ft. From, Ft. to " FI.. From. Ft. to ,, Ft. From Ft to, Ft. From ~FI. to~Ft~ HISCL INFORMATION: DRILLER ,'~ NAME UMCWAUTV OF ANCHDRAD Development Services Department `?�` Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-382-34 Expiration Date: 1. GENERAL INFORMATION Complete legal description HIGHLAND HILLS #2 BLOCK 2, LOT 3 Location (site address) 5465 HILAND ROAD, EAGLE RIVER, AK 99577 Current property owner(s) PAUL & KRISTI GUZMAN Mailing address Real estate agent 5465 HILAND ROAD, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: Received by: 2 (313R SYST) Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ / y±_:_) Date of Payment g Z3,1Z / Receipt Number COSA # 05G Z 1 I H 73 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 8/12/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject toOr A these various and dynamic characteristics and are outside the control of the evaluator of the l well and septic system. Therefore, any estimate of how long a system will function satisfactory ��P• • • • • �) for current or future occupants or guarantee that no unseen encroachments, deficiencies or rg•.. '.9 f¢ discrepancies exist can be given b First Water Consulting & *� 71-11 • . • * J� P 9 Y 9 FWN r 6. DSD SIGNATURE Ir Curtis Huffman System #1 Approved for bedrooms ����`c�s•, CE 128991 �F,�' • .$/12/1 •'F� r System #2 Approved for bedrooms i1i40pROFESSIOHP� Disapproved Conditional approval for bedrooms, with the following stipulat' J\ O E' o WATER lAin Vii, ATER JJ;SERVICEs ridByw. Original Certificate Date: 2� Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: HIGHLAND HILLS #2 BLOCK 2, LOT 3 Parcel ID: 050-382-34 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled 9/13/1983 Well disinfected for coliform test? ❑ Yes ® No Total depth 100 ft ® Coliform bacteria is Negative Cased to 11 ft (INTO BEDROCK) Nitrate 1.02 mg/L ❑ Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND) ® Wires are properly protected NESCasing height (above well pit grade) * 12 in. Collected by NE Date of flow test for COSA 7/16/2020 Static water level at beginning of test Well Plug ft. Date of Sample 8/5/2021 Well production at time of test 4.2 gpm Comments *Well pit with daylight drain ... FWCS tested drain. See MOA record docs B. TANK DATA C. LIFT STATION Age of tank(s) 1 years ❑ Required maintenance completed Tank type/material SEPTIC / STEEL EPDXY Age of lift station _ years Measured operating fluid level in septic tank 49" Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping 8/11/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 1/31/1995 ® ALL standpipes present per record drawing Total measured depth from grade 5_3 ft (max) Measured depth to pipe invert from grade 2.7 ft (min) ❑ N/A — pressurized field Adequacy test date 7/16/2020 Results M Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 500 gal New depth 6 in ® Monitor tubes go to bottom of effective. If not, state depth into effective *SEE COMMENTS Elapsed time 1400 min ® Code -required soil cover over field (INSULATED TOO) Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons FRES MT appears to extend 0.5-1' below ED per observations and MOA record docs E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No *5 Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5 ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MOA APPROVED 5'— SEE MOA IR RECORD DOCS. G. ENGINEER'S CERTIFICATION02 ��N�k I certify that I have determined through field inspections and reviewof Municipal records that the above systems are in conformance edj •� with MOA COSA guidelines in effect on this date. j * : •� TH . • ..':* Curtis Huffman / ����'Fc�•.. CE 128991 •.•����� Y 4 U M C W EJ U U T Y F Development Services Department On -Site Water & Wastewater Section Parcel I.D. 050-382-34 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: Z© Z o Complete legal description HIGHLAND HILLS #2 BLOCK 2, LOT 3 Location (site address) 5465 HILAND ROAD, EAGLE RIVER, AK 99577 Current property owner(s) ELLIOT W. NIEMI Day phone Mailing address Real estate agent 5465 HILAND ROAD, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System 2 (3BR SYST) Day phone TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ q Date of Payment S/r,2C.9-o Receipt Number -7 181 Lf 2 COSA # 0 S C 201 y y 1 Waiver Fee $ Date of Payment Receipt Number 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 8117/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to OF �te� �`l1 these various and dynamic characteristics and are outside the control of the evaluator of the •�(� well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: • • • for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & rWCS . * . 49 TH .....•:* �. .� 6. DSD SIGNATURE Curtis Huffman System #1 Approved for bedrooms CE 128991 *\ low FIFO .$/17/zOPO� System #2 Approved for bedrooms `�1 PROFESSION Disapproved Conditional approval for bedrooms, with the following stipulations: :Rev FWLS ON-SITE o�y R o W E : AND m J�o PROG&AM )111o\l - Original Certificate Date:"�2� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: HIGHLAND HILLS #2 BLOCK 2 LOT 3 Parcel ID: 050-382-34 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled 9/13/1983 Well disinfected for coliform test? ❑ Yes ® No Total depth 100 ft ® Coliform bacteria is Negative Cased to 11 ft (INTO BEDROCK) Nitrate 1.53 mg/L ❑ Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND) ® Wires are properly protected FW'�: Casing height (above well pit grade)` 12 in. Collected by Wr's Date of flow test for COSA 7/16/2020 Static water level at beginning of test Well Plug ft. Date of Sample 8/17/2020 Well production at time of test 4.2 gpm Comments *MOA approved well pit with daylight drain ... See MOA record docs. B. TANK DATA Age of tank(s) 1 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 7/16/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 1/31/1995 ® ALL standpipes present per record drawing Total measured depth from grade 5.3 ft (max) C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 7/16/2020 Results N Pass For 3 bedrooms Fluid depth prior to test 0 in Measured depth to pipe invert from grade 2.7 ft (min) Water added 500 gal ❑ N/A — pressurized field New depth 6 in ® Monitor tubes go to bottom of effective. If not, state depth into effective *SEE COMMENTS Elapsed time 1400 min ® Code -required soil cover over field (INSULATED Too) { Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Fw}cs Comments/Deficiencies: MT appears to extend 0.5-1' below ED per observations and MOA record docs.° i , E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S 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. OF At _49 TH .. ....... d� .. .. .... .......... Curtis Huffman gam, CE 128991 'oPROFESS 4NA�ti�� ft ft ft ft ft ft ft ft 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.rnuni.org/onsite (907) 343-7904 (~ERTIFICATE OF ON-SITE SYSTEHS APPROVAL FOR A SINGLE FAHILY DWELLING 1. GENERAL INFORMATION COSA.0 cIO Expiration Date: (¢.- Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HIGHLAND HILLS SUBDIVISION #2; LOT 3~ BLOCK 5465 HILAND ROAD * EAGLE RIVER, AK 99577 JOHN TYSON Day phone 5465 HILANO ROAD · EAGLE RIVER, AK 99577 Day phone ,351-1696 RANEY HARDUAN w,/ REMAX PROPERTIES Day phone 440-7257 16600 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577 Un/ess otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 2 SEPTIC SYSTEM SIZED FOR ,3 BEDROOMS 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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. Address .3701 E. TUDOR ROAD. SUITE 105 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone .3.37-6179 Date q'Z~-/O c~ 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 & 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 fluctuata 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 tho system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal tfght whatsoever. 5. DSD SIGNATURE ^pprove ,or Disapproved. Conditional approval for ..... bedr~ms, ~ ON-SITE WATERAND : bedr ms, with the alowing stipulations: ?.. PROG M ..... Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Sb'eet P.O. Box 195550 Anchorage, AK 99519-6650 www.muni.org/onslte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEHS ,A, PPROVAL CHECKLIST Legal Description: HIGHLAND HILLS ~2; LOT .3~ BLOCK 2~ Parcel ID: 4~)~"4: A. WELL DATA *CASED TO BEDROCK Well type P~VA'r~: If A, B, or C provide PWSID# N/A Date completed 9,/13/1983 Sanitary seal (y/N).YES Totaldepth; 100 ft. Casedto ,11 ft. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ ,in, Date oftest. FROM WELL LOG 9/13/1983 AT INSPECTION 2/6/2009 Static water level 25 .ft. 44 .ft. Well production 10 wATER SAMPLE RESULTS: Coliform ~:) colonies/100 mi. Arsenic: I'J..~::> ug.lL, SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL g.p.m. Nitrate I~-'-~ mg./L. Date of sample: 2/9/2009 Tanksize 1000 gal. Number of Com)artments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 2/13/2009 Pumpe~'. 8.0 .g.p.m. Other bacteria (/~ colonies/100 mi. Collected by: GE(;, Ltd. Date installed 1 O/198,3 Cleanouts (Y/N) YES High water alarm (WN) . N/A JR'S PUMPING Co ~I~EI~OW EXISTING GRADEI Width: ; ~5/20 ft. ABSORPTION FIELD DATA 1/~o-3Mt995 Date installed 10,/t5/1983 Length ,6'1'?~/41 ft. 582/ , Total depth . ,,5.7,/3.8 ft. Eft. absorption area 820 ft' Monitoring tube YES Date of adequacy test **2/6/2009 Results (Pass/Fail) PASS Fluid depth in absorption field before test DRY in. Water added 15,30ga1. Elapsed Time: 120 min. Finalfluid depth 4 in. Any rejuvenation treatment (past 12 mo.) (YIN & type) **TESTED 1995 TRENCH System type TRENCH/BED Gravel below pipe 2/0.5 ft. Depression over field. NO For 3 bedrooms 10 in. g,p.d. New depth Absorption rate >= 450+ NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) ~ "Pump on" level at ~rm level at__ Da Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'-{- On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas. 50'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N,/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line * 10'+ Building foundation. 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacentlots. 100'+ F, COMMENTS Absorption field 5'+ Surface wateF 100'+ Water main N,/A Driveway, parking/vehicle storage 10'+ *EXACT LOCATION OF BED UNKNOWN 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 COSA Fee ~; ~ ~ 0 ~ Date of Payment 3J 51 Receipt Number (Rev. 11~5) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewaler Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.munl.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAHILY DWELLING RUSH 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: /~/-. - ~ ..~'-'- O~ HIGHLAND HILLS SUBDIVISION; LOT 3~ BLOCK 2~ 5465 HILAND ROAD * EAGLE R~VER, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MARK JOLIN Day phone 5465 HILAND ROAD * EAGLE* RIVER, AK 99577 301-6101 Dayphone KATHI OLMSTEAD w/ REMAX PROPE*RTIFS Dayphone 694-4200 16600 CENTERFIELD DRIVE * EAGLE* RIVER, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 SEPTIC SYSTEM SIZED FOR ,3 BEDROOMS 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 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 pdvate or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my . rocedures outlined in the C. edificate of On-Site Systems Approval Guidelines for this application, inve,.stigation b. ase. d on p .......... ~l ~v.~tem is (are) safe, functional and adequate "~ .... ~v~'ater su i anD/or wastewa[er ~pu .... · ...... . - ~or the num~.r c~.~uu,~ [, information obtained from the Municipal ty 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 CARNESS ENGINEERING CROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANcHoRAGE, AK 99507 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Phone 537-6179 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thon:~gh, conscientious engineering analysis of the system in eccordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described tho performance of the system under the conditions encounter~:f at tho time of the test, end separation distances measured to readily identifiable features. The qoerational 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 evaluater of the system. Satisfactory test results do not guarantee futura perfon'nance of the system, nor do they guarantee that there ere no hidden defects er encroachments. GEG, LTD. can therefore not provide any warranty er future estimate of how long the system will continue to meet the operational rsquirements of the ADEC er MOA DSD. The content of this report is for the scle benefit of tho owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal ~ight whatsoever. Jr,5 L ': ;f ess.: 5. DSD SIGNATURE J Approved for ~ bedrooms. Attachments: COSA Checklist Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: : Arsenic Advisory ~.~; Maintenance Agreements Supplemental Engineer's Reort Other '. Or{ginal Certificate Date: Septic System Advisory Well Flow Advisory Nitrate Advisory Legal Dssatptlo~: A. WELL DATA Municipality of Anchorage Development Services Department Bum~llng Safely Division Or,Site Water & Wastewatsr Program 470o ~ragaw Sumet P.O. Box 19665O Anchorage, AK 99519-6650 www.munl.oeg/m,.slte (~07) 343-n)04 CERTIFICATE OF 0N-SITE SYSTEPIS ~,PPROVAL CHECKLIST HIGHLAND HILLS SU~DMSION; LOT `l, BLOCK 2~ *CASED TO BEDROCK Well type PRNAT[ If A, B, or C provide PWSID# . N/A Date cempleted ~ Sanitary seal (Y/N) ..YES Totaldepth 100 ft. Casedto '11 lt. FROM WELL LOG 9/13/lg83 25 Date of test Static water level Well production 10 WATER SAMPLE RESULTS: Coliform /~ colonies/100 mi. A~senic: ~J_~ ug./L. B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Wires properly protected (Y/N), Casing height (above ground). AT INSPECTION 25 ff. 6.5 g.p.m. YES 12+ Nib'ate J,~',,~ mg./l.. Otherbecterle I Date of sample: 8/25/2006 Collected by: ABSORPTION FIELD OATA ~ 1/30.-.11/I gg5 Date instafled 10/*'1~[lg83 Soil raUng (~r(~)~ System type. TRENCH/BED Length 91.5/41 ft. Width. 5/20 ft. Gravel below pipe 2/0.5 ft. 582/ Total depth .5.7/3.e ft. Eft. absoq)Uon area 820 ft= Monitoring tube Y~ Depression over field NO Date of adequacy test 9/12/2006 Results (paSS/Faji)' PASS For 3 bedrooms Fluid depth in absotpUon field before test D. RY in. Water added 790 {~al.. New depth .*'1.lin. Elapsed Time: 1288 min. Final fluid depth DRY in. ' ~)sorpfi~n rate >= 450+ g.p.d. Any rejuvenation Ireatment (past 12 mo.) (Y/N & type) .. NONE KNOWN If yea, give date - "'MONITORING *I1JBE INSTN.LED BY HOMEOWNER, t2.5 INCHES TOO DEEP. BED PRE-SOAKED WITH 1254. GALLONS OF WATER ON 9/11/2006. TRENCH SURCHARGED Tank Type/Material STEEL Tank size 1000 gal Number of Compartments 2 FoundaUon deanout (y/N) YES Depression over tank (Y/N)..NO Date of pumping. 9/20/2006 Pumper Date installed, 10/1983 Cleanouts (Y/N) _ YES High water alarm (Y/N) N/A JR'$ PUMPING colonies/100 mi. GEG, Ltd. D. LIFT STATION Date installed . Size in gallons ~ Manh~ -Pump on' ,evol at in. ~ter olarm ~vel a.t __ .in. ~ Cycles taste~ Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Septic tsnkailt station on lot Absorption field on lot Public sewer main Sewer/septic senaco line Animal containment areas 100'+ N/^ 25'+ 50'+ 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'+ Welts on adjacent lots 100'+ On adlacem lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Holding tank N/A Menura/animal excrete storage areas 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *UNKNOWN Building foundation 10'+ Water main N/A Water sewice line 10'+ Su~aCe water. 100'+ . Driveway, perking/vehicle storage Curtain drain NONE KNOWN Wells on adjacent lots 100'+ 10'+ . F. COMMENT~ *EXACT LOCATION OF BED UNKNOWN G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal racords that the above systems am in conformence with MOA COSA guidelines in effec~ on tide date. Engineers pdnted Name JEFFREY A. GARNESS Date °117~ /° ' ANY DATA H~REON I~E USED FOR CONSTRUCTION' O~' FENCE LINF.~ OR FOR ESTABLISHING BOOND- ARY LINES, ' HEREB~ C~RT'~ 'THAT' "AVESU~VEYED FOLLOWING DESCRIBED PROPERTy~ ~ENTS, ~V OF ANY WH~ DO NOT ~NA~s, OR ~TRICTIONS / / ,I ASBUILT.,-NO CORNERs SET T T'r' ~'-~'-c////////'~-- z.-..~.-~.~- HERE~¥ CERTIfy .THAT I HAVE SURVEYED TH~ FOLLOWING DESCRIBED PROPERTY, INDIOA~. IT tS THE EES~NS~alLI~ OF THE ~.. ~ ..../ WHI~ DO NO ~TRICTIONs .~ -/7-- .~...:.;.~ VISION P~T. UND~ N0 CIRCUMSTANCES S~ F~ ~Y DATA H~N ~E US~ FOE CONS~u~IO~ ARy LINES. Municipality of Anchorage Development Services Department Building Safely Division On-Site Water & 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 ParcelI.D.. 050-382-34 1. GENERAL INFORMATION Expiration Date: /0 .- Complete legal description _ LOT 3, BLOCK 2, HIGHLAND HILLS SUBDIVISION ~2 Location (site address or directions) 5465 HILAND ROAD * EAGLE RIVER, AK 99577 Current Properly owner(s) Mailing address Lending agency Mailing address BRUCE IGLEHART Dayphone 694-021,3 5465 H1LAND ROAD * EAGLE RIVER~ AK 99577 Day phone. Real Estate Agent Mailing address Day phone. 2. NUMBER OF BEDROOMS: Unless otherwise requested, HAA will be held by DSD for pickup. 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 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 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 Apprcval sre 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 ncr responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prfor I to closing for the engineerfng services provided. 4, STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto end as of the validation date shown below, I vetffy that my investigation, based on procedures outlined in the Health Authorfty 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 strocture indicated herein' i further verffy that based on the information obtained from the Municipality of Anchorage fi/es and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with ali applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SuI'rE 2B * ANCHORAGE, AK 99504.. Engineer's Printed Name JEI-FREY A. CARNESS. P.E. Phone 337-6179 Date Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provfde a thorough. conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The repoded results desctfbed 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 dudng 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 perfon~ance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE ~ Approved for ~ i3edrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: = ~ WAS'I'EWA'i'ER: Manffenance Agreements "~))))',l))) ~)))ll~ Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department BuDding 8afsty OIvlmon On-Site Water & Westewater Program 4700 ~oulh 8ragaw GL P.O. Box lg6650 Anchorage, AK 89519.6650 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT ,1~ BLOCK % HIGHLAND H!"~ ~2 Parcel ID: A. WELL DATA *CA$1~ TO BEDROCK Welltype PRIVA~ ffA, B, orCprovidePWSID# N/A Well Log (Y/N) YES Date completed 09/13/83 Sanlteryseal(Y/N)..YES Wlmspmpedypmtected(Y/N) YES Totaldept~l ,100 It. Cas~lto '11 It. FROM WELL LOG Date of test 09/13/83 Static water level 25 Well predu~ion 10 WATER SAMPLE RESULTS: It* g.p.m. 050-382-34 Ca$1ngbaigM ~bovegmund). 12+ ~. ATINSPEC~ON 6/28/02 _ 28 It. 9.5+ g.p.m. Coliform 0 colonles/100 mL A~enic: N/a, mg./L. B. $ EPTIC/HOLDING TANK DATA Tank Type/Materiel STEEL Nitrate ~,32 mgJL. Other bacteria 0 colonies/100 mi. Date of ~unple: ~ Collected by: AKWWC, INC. Date Inst~ed, lo/8~ Cleanouts (Y/N). YES High water alarm (Y/N), N/A dR'S PUMPING Tankslze $000 .gal Number of Compartmente . .2 FoundaUon deanout (Y/N) YES Depression over lank (Y/N) ..NO Date of pumping 06/18/02 Pumper. C. ABSORPTION FIELD DATA 'l'lr~e.u TRENCH ONLY. MEASUREMENT ARE IN BOTH TRENCH MI"S ,/30:... 3t/95 i~~ ~.68~ TRENCH/ Date Installecl ~ Soil rating ~ System type BED - It. Vddth 5/20 It. Gravel below pipe 2/8 IN. ft. 582/ ~ Total deplh ~.7/~o it. Eft. absoq~flon area 820 It Monitoring tuba ,YES Depression over fieid NO For 2 bedrooms New deptM~.6~in. 450+ g.p.d. Date of adequacy test 6/28/02 Results (Pass/Fall) *PASS Fluid depth in absorption field before test .9/12in. Water added 698 gal. Elapsed Time: ...TO0 min. Final ftuid depthl.2/151n. Absoq~on rate >-. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date.. D. UFT STATION .... ~ Date installed , Sizetn galio~ls ~ . ~. -pump on' level at ~ High .ter alarm level a.t ._,-. .m. ~ Cycles tsstecl Meets alarm & cimuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ At)soq3flon field on lot 100'+ Off adjacent Iota Public sewer main N/A Public ~ewer manholdcleenout N/A Sewer Isepflc ~en~ce line 25'+ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5°+ . Property line 5'+ Al:~orpflon 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 sewice line 10'+ , Sudace water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ .Driveway, parldng/vel~icle storage 10'+ F. COMMENTS *LOCA~ON OF BED UNKNOWN. NO PIPES IN BED G. ENGINEER'S CERTIFICATION I certify ~at I have deten'nlned through field inspec{fons e. nd conformance with MOA HAA guidelines m e#ect on mia · Engineer's Printed Name JEFFREY A, GN~NESS Date (Rev. 12J01) Waiver Fee $ Date of Payment Receipt Number JU~-20-02 T.I(U 09:I8 ~ PI{OVIDEI~OE X RAY FAX I, lO. 2814885 I / I P. 03 ,) ASBUILT-NO CORNERS SET THIS DATE. ~"~J"~'" CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY~ L INDIOA~. IT IS THE RES~SIBILI~ OF THE [~EMENTS, COVENANTS~ OR ~STRICTIONS ~ .~ '~ ~ .... ~'~ eHIm ~ NOT ~EAR ~ THE RE~ ~DI- /ISION P~T. UND~ NO ClRCUMST~CES S~ ~Y DATA H~N BE US~ FOR CONS~U~ION }F FENCE LIN~ OR mR E~LISHING ~D- tRY LINES. MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services Parcel I.D. .... On-Site Servtces Section 'P.O. Box 196650 Anchorage. Alaska 99519-6650 .... 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # 1. GENERAL INFORMATION Complete legal description Highland Hills ~2 Lot 3, Block 2 ' Location (site address or directions) NHN H~nd Road, Eagle River Property owner Mailing address Lending agency Mailing address Agent Steven & Patricia Lauver N/A Address Day phone 99577 Day phone 694-5195 msq Pat Halverson/Prudential Relocation ay phone (713) 781-5100 2500 City West Blvd., Suite 400, Houston TX 77042 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community.we!l.system, provide written confirmation from State ADEC attest- lng to the legality and status of system~ ' '' TYPE OF WASTEWATER DISPOSAL: Individual on-site .Hol~in_ g. !a;n..k..;" Community on-site . Public sewer X · NOTE: , ,:..,, ~,,-,' ~ ~1 ~,~:' '~ ~": '~ .'~ ~',~7 ~ - If communi~ Wast~water s~tem; ~rovide ~ri~en confirmation f~m State ADEC attesting to the lega an a system STATEMENT OF INSPECTION BY ENGINEER ..... '-* As certified by my seal affixed hereto and as of the validation date show~ 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 inves.t~ation- 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. Eagle' ~i.ve~ ]~g~'~ee~i~cj Serv±ces Phone. 694-5i95 Address P,O, Box 7'/3294. Eaq].e Rive[-. /~.k 99577 ~~'"~'~---*-~"~-~- Date ~ ;- K- ?5' Engineer's signature DHHS SIGNATURE --~ Approved for ~ bedrooms. Disapproved. . ' Conditional approval for bedrooms, with the following stipulations: Additional Comments . .B,y~ ' Date 2 -/&::) - · ~.-... , ~, , .,~. o L ~'he 1~4iic!p, ality o[.~h~=ge De.merit of Hialth and Human Se.ic. (DHHS) i~ues Health A~ofl~ :.,~proval CeAifi~tes;ba~ only upon ~e mp~n~tions given In paragraph 5 above by an Inde~ndent prof~ional e~ste~ in the S~te of Al~ka. The DHHS d~ th~s as a cou~ to pumh~m of homes andthe fiend ng~n~itutm~ norderto~tis~ce~ nf~em ands~te~u mmen~.Emp oy~of DHHSdonot conduM Ins~ons or anal~e da~ ~fom a ceAifi~te is I~u~. ~e Municipali~ of Anchomge Is not m~nsible for effom ~r omi~lon~ In ~e pmf~ional engin~fs wo~. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: H/¢~/l,.~/v,9 !//I-~ 5 # ~. A. Well Oata Parcel I.D. Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number, Date completed. .Cased to FROM WELL LOG Date of test 0~//1~/,~'~ Static water level ~.~ / Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic~ tank on lot / / ~" Absorption field on lot / ~0 / Public sewer main ~,.//~ Sewer service line ~/~ / WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: /- 3 ~ - ~ B. SEPTIC/HOL-BING TANK DATA Date Installed ./~/,~ ~, Tank size ~<]//$/J' 3 Driller ////A,'7'~' /:~E;/3.C~/-Casing height Wires properly prote~ed ~) AT INSPECTION g.p.m. (~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank. //n Collected by: Other bacteria Compartments Cleanouts (y/N) ~/~ High water alarm (y/N). Date of pumping Foundation cleanout (y/N) y~ Depression (Y/N) /'~/~ Alarm tested (Y/N) / ~'/~'~/~ Pumper SEPARATION DISTANCES FROM SEPTIC/N~LD:NG TANK TO: Well(s) on lot //~; On adjacent lots To property line ,, ~/(~ ~ Absorption field Surface water/drainage Foundation Water maflVservice line 5./ ~2-ms (3~3). Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) 'Pump on' level at High water alarm level Meets MOA electrical codes (Y/N) J SEPARATION DIS~TATION TO: Well o_..~_~ On adjacent lots D. ABSORPTION FIELD DATA Date installed (~/./3//<2 ~ Soil rating (GPD/FF) Manufacturer Manhole/Acce~ ~/'/ ......'""-'Pump off" Level at ...-."'~cles tested Sudace water Length 21.§' Total absorption area Date of adequacy test ,/V/~ ' Water level in absorption field ~efora test Peroxide treatment (past 12 months) (Y/N) Q~ ~?~,/,ff 7,.-. System type Width ~ ' Gravel thickness ~. I Total depth .5--,~',D.. ~ Cleanoat present (Y/N) }/~-5 Depression over field (Y/N) Results (pas~ail) ,,~5 <~ for ~ Bedrooms /~////;~ After test /'///'~ ,/V//? If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~D To building foundation On adjacent lots Sudace water Curtain drain On adjacent lots ./- /~0/ Property line To existing or abandoned system on lot -/' ~,(~ ~ Cutbank //~//~ Water n1~service line '~'/~ / Driveway, parking/vehicle storage area '/~'~0 ~ /S/ Eo ENGINEER'S CERTIFICATION ,e, c2 .. ~., ,'..-.. % ',~ ~ Date ~ ~-~ ' ~ ~p- ~,, HAA Fee $ ,.~Z30 Date of Payment ,~_ ;7- ~,"'""' Receipt Number ~'~ ~?'( Waiver Fee $ Date of Payment Receipt Number, 72-026 (3~93)' Back MUNICIPALITY OFANCHORAGE f~"~ DEPARTMENT OF HEALTH AND EI~VIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH C~ERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION Application Date 10/21/85 LegalDescription(includelot. block, subdivision, section, township, range) Lot ~ Block 2, HiKhland Hills #2 T14N R1W Sec. Location (address or directions) Hiland Road 28 (b) Applicant Name Chuck La~"com Telephone: Home 69h-6762 Business _ 863-7101 App)icantAddress ..SR-94';J~. Hiland Road, Ea~zle R'tvez', Ak 99.577 (c) Applicant is (check one): Lending Institution I-I; Owner/builder ~; Buyer r-i; Other I-I (explain); (d) Lending Institution N/A Telephone Address (e) Real Estate Companyand Agent ERA Gold'oannep - ]V[e~odv Wood Address 1~;77 "C" Street Anchorage AK 00501 Telephone 272-~;581 (I) Mail the HAA Io the following address: TYPE OF RESIDENCE Single-Fami;y~ Multi-Family r-I Number of Bedrooms. ~ Other WATER SUPPLY Individual Well E'3 Community [] Public [] Note: Il community well system, must have written conlirmation from the State Department of Environmental Cor~ser~ation attesting to the legality and status. SEWAGE DISPOSAL Onsite]~ ~ublic[] Community[] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 'S. EN. GINEERING FIRM PROVIDII~_ iNSPECT ONS, TESTS, FILE SEARCH, DA o ~ AND INFORMATION As certif ed by my seal affixed hereto and as of lhe validahon date shown below, I verdy that my mveshgation of th~$ Heait~l Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and acleq uate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information ObtaineQ 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 ~.AGIE RIVER ENGINEERING $[RVl~',F.~-elephone Address EAGLE RIVER, AK 99577 P, O:-~OY~ 7732~4 Date /,~'./'-.g,~"/'~ $ 694-51~ Approved ,~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval ce~ificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and stale requirements. Employees of DHEP do not conduct inspections cr analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 2~_~ ~720 Legal Description: ~UNIF'IPA/h'Y OF ANC-Ho.RAG,3 DEPT. OF HEALTH & Well Classification _~::'~'~ I c~.4.7"~ If A. B. C. D.F-C. Approved (Y/N) '""~",'~") Well Log Present (Y/N) y Date Completed ~"//'~/~ ~ Yield /c, Total Depth ~7 · Cased to //" ~;~'-/'~-"~ Depth of Grouting Static Water Level ~ .5'-" Pump Set At ~7.., Casing Height Above Ground _~ · Electrical Wiring in Conduit (Y/N) .~'" Separation Distances from Well: To Septic/Holding Tank on Lot //*.~ · To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line __ ,,,Z.~'J~ Cleanout/Manhole _ ~.~..,',,,.~ Water Sample Collected by /~'~j.- Water Sample Test Results ,~"~ Comments Sanitary Seal on Casing (Y/N) _ .~ Depression Around Wellhead (Y/N) ,~ ; On Adjoining Lots /o,o '/' ; On Adjoining Lots _ /~,'o "~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot _'-"'J'"~" ¢=""~"'~"~; Date B. SEPTIC/HOLDING TANK DATA Date Installed _ Standpipes (Y/N) Depression over Tank (Y/N) . Pumping/Maintenance Contract on File (Y/N) _. ~ ],4 Holding Tank High-Water Alarm (Y/N) . ~ /,~*- S~paration Distances from Septic/Holding Tank: To Water-Supply Well //5" · To Property Line /~ To Water Main/Service Line /~' Course ~ Size /'"'~'~' No. of Compartments Ai'r-tight Caps (Y/N). "~ ' Foundation Cleanout (Y/N) Date L. ast Pumped . ; for ~-- Temporary Holding Tank Permit (Y/N) __ To Building Foundation ,5-' / To Disposal Field ,~"" / To Stream, Pond. Lake, or Major Drainage Comments Page I of 2 72-026(31z84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / ~ !/'~ '~ Width of Field '~' ~ ~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test -~'~ Separation Distance from Absorption Field: To Water-Supply Well /43 o '+ TO Building Foundation Lot To Water Main/Service Line /'~' To Stream/Pond/Lake/or Major Drainage Course "#~"~"~-' 'To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~ ! Depth of Field ~ ! Gravel Bed Thickness ~ '" . Standpipes Present (Y/N) Date of Last Adequacy Test _ To Property Line '"/~ ' To Existing or Abandoned System on ; On Adjoining Lots ~' '~ TO Cutbank (if present) Comments LIFT STATION Date Installed Size in Gallons · 'Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments *' Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed J~~--~"'" Date Company ~ ~,¢. MOA No. ,,5-7" -..z~' Receipt No. ~::~'/~ n V Date of Payment Amount: Page 2 of 2 Engineer's Seal ~APP.'LIC~NT FILLS OUT UPPER HAL"~ONLY P,op~r,y ow,., CCC Construction ~P~,,,-~: M.~.og^dUr~. PO. BOX 6h? Ea~le River, ~aska zm~ 99~77 ~688-3~3 euy., Chiles B~d & ~izabeth Ann L~com III AU~res$~55 F ~ea Ft. ~ch~dson, Alaska zm~e 99~5 A~,.. -Eagle ~ver,Br~ch, Eagle ~ver ~aska z~p~e99577 688-~2~ AUU,e. Eagle ~ver, ~aska 99~77 z,~e 694-36~6 Single Family Other Water Supply ~ Individual O Community r'l Public Utility Sewer Disposal ] I ndividual Public Utility 0 Holding Tank For wells ~llled prior to that date. give well depth (attach fog If available). ATTACH V~LL LOG. A well log la ~equlred for all wells drlled elnce June 1975. Year ,.d~v~ua, ,.static: 1983 When Corrected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time //~ '"--' Date Date Oate Date Inspector Inspector Inspector Inspector Field Notes: ^/-- ~..~ -. J~IUNICIPALITY OF ANCHORAGE '~~' ~ ~ C~ ~ ~ OCT ~9 RECEIVED (~ ) APPROVED ~EDROO~S *CONDITIONS O¢ APPROVAL ( ) DISAP~OVED ( ) CONDI~NAL APPROVAL* ~tis Rntlng Date ~wer Instalt~ Well To ~sorplion Area Wetl Log Recel~ ADEQUACY TEST WATER AND SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SITE PLANS ROAD DESIGN SOILTEST ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK ROBERTA. SHAFER November 30, 1983 CIVIL ENGINEER 694-2979 Municipality of Anchorage Department of Health and Environmental Protection 825 L. Street Anchorage, Alaska 99501 MUNICIPALITY OF ANCHORAGE ~'EPT. OF DEC RECE! ED. REFERENCE: Lot 3: Block 2; Highland subdivision ~2 At the request of CCC Construction the well on the referenced property was inspected. The well casing was e_~ped with adequate ~anitary seal and all wires had been ~lac-m ~ .......... an _ ground arouse we}l u~szn~-~d~y ,~np~wav from the well. At the same time that this inspection was p~-~rformed, a water sample was taken from the hose bib on the side of the house and submitted to Chemical and Geological Laboratories of Alaska for a coliform bacterial analysis. The results of th~s t~st were satisfactory.. -- If ~-~a~ be of further service, please do not hesitate to call. Si6cer~ / AFER. cc: CCC Construction SRB 196X EAGLE RIVER, ALASKA 99577