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HYLEN CREST #1 BLK 3 LT 2
Hylen Crest Block 3 Lot 2 #050-472-70 10/fel ,2 0 zJ- Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241324 PID Number: 050-472-70 Dwelling: RN Single Family (SF) R with ADU R Duplex (D) El Two Single Family Project: R New RE Upgrade Name Andrew Miller & Sarah Czaika-Miller ABSORPTION FIELD R Deep Trench R Wide Trench R Bed R Mound Site Address 10207 Stewart Drive El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 14 GPD/SFI Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Hylen Crest #1 3 2 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 Ft2 Ft. Well 100'+ 100'+ NA NA 25'+ TANK [l Septic El S.T.E.P. El Holding [I Other Manufacturer Greer (Deep Bury) Capacity 1250 Gal. Surface Water 100'+ 100'+ NA NA Material Number of compartments Lot Line 51+ 10'+ NA NA NA HDPE 2 Foundation 10'+ 10'+ NA NA LIFT STATION Manufacturer Capacity Remarks Tank Replacement Only Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 d Tank to 3034 rainfield Installer - Arm Services Drainfield existing CO/MT3034 inspector Pannone Engineering Services, LLC BENCH MARK (Assumed elevation) 100.0 ft Inspdates:ection 11/07/24 11/07/24 Location and description 2nd 3rd 4th Bottom House Siding (See RD) ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Ak.1 k Conditional Approval: Date fiw CO 49 1H .......... ....... Steven F. 'onnone Septic Syst,6mCE 8149 Approved,-, Date 'Note: thd approval does not include well permit requirern nts. (Rev ublur 6) Ln C)(3-,-.� �alo �m p �Ob m rp v� c o o 0 N <i-0 a �� bZ�rCppC� 0 IQ tib IVo '91U 'Oz-- Oz,��� �O�pC GJ ' �1 A ,"' p r Q y� c W N N M 2 2 ' o co Co ? y W_ cn cn Oaa o m n O y z p 3 W W W W P P W ]CD o ~ Ln r W O Ut -j �{ a Z\ D 4 -ml -1.'0 m,tnmzm m�_ \ \ zn Dm2o�'- �D \ozDCc�om>mo D -'o Z' mz�� pU)()v �U)G7v� \ / '9 \ mr-tOm20ZDv2 ;0mO5v0DO �\ / NK COw• mo,<nZ o o 5 OnrN*i� pp -nom �m r�'1 h A2m>8 mmm r ba ~ �2 O �mOZ02r Cz a 2�L / �Dm03mZmN oo<mncmi�m2 \ O O S m S Z D ZEZ) O m \ my OPO�N � a� .07 0(Znvmv�Dm N11 ��°°nrn>c -lomm ��_� rot OypmnO=ppm cm CLEAN OUT (E) �+ Opx O O dam' -mo 2ooz a >j-00 c> � m ,,"- o mimmmmN v q �g,VCoOm ZNSvn��p= r" 8 N a MAN HOLE N v>_mOOmzm oo �m'vm1vr-2;. azm mODmii Dm zA a� � 2121"-2 \ Fri xm s n22 Nm Atn tD/�70j ZK CLEANOUT ` Zaa \ m- m:',- DOUBLE CLEAN OUT n m rynrji,^j /� 0�m9=�Azm� —Y— DO ` 2 O O00 -", \ >25'm;-NxmN' �� Omwr-,,N<,<vm mmmo�-oZN I O;uaC,yAU) m Z O Z�-<m Om m -n 1 U �m�-SAV) mmo� z— o 'm ^ n y I O rnmm�� N=+-N<o C C)OO�V7D m x c �p�pZ�DCm Z mmm�rrm-r<< m OZ NO� � I r2Z--, *1 .G=m ->m---3 a rT m z,rm� 'Zmo�.8 nvCOD m -<z rn>5-uo m I ��o�ZF mo<cnv 3mNb) (A > m r NOTES: PANNONE PHONE ENG SVC LLC (C.1. 1088) P.O. BOX 1807 PALfv�ER, AK 99645 (907 745-8200 FAX 907 745-8201 OFA(,, p''' cif `!* REVISIONS DATE 12/09/2024 RECORD DRAWING SCALE ANDREW HYLEN CREST #1 83 L2 MILLER & SARAH CZAIKA—MILLER 10207 STEWART DRIVE * :wli •••• •••. "L3even anno*e r?irri70 1" = 50' DRAWN ACP P.I.D. NO 050-472-70 CHECKED SRP SITE PLAN PERMIT RMIT NO. OSP241324 SHEET EAGLE RIVER, AK 1 OF 1 ASPLS MORTGAGE LOCATION SURVEY NOTES: NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE / RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR LOT 12OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY \ BLOCK 2 / / / r EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED r FOR SERVICES IN PREPARATION OF THIS PRODUCT. r - - r ,- \ o�r u LEGEND k�l 6 r r r () RECORD DATA PER PLAT #83-90 1 r r (DELTA=19'21'50") FOUND 1.5" ALUM. CAP CENTERLINE MONUMENT =1110.53' �=C ^^– EDGE OF ASPHALT r r CHORD=N 5T59'55" E r X� (CHORD=111.00') —EDGE OF GRAVEL DRIVEWAY r � n n /r r wv , FENCE LOT 1 © UTILITY PEDESTAL 45.0' � �, BLOCK 3 / Nc� p1 �. i i SEPTIC TANK LID / �g `� `rye • ����5 / Q SEPTIC PIPE `� wa 12'x2s'Imo"" WATER VALVE c� uu SHED �t3` tea. 49.5' o�. 0 DECK TWO STORY F] CONCRETE e� 21.6' RESIDENCE -- 10'x14' 63. co SHED of 30 60 LOT 2 m BLOCK 3 _ 49TH * 1 ,�. SCALE. 1 – 30 FEET ....... .... 1141 ,Ryan G. Johnson; / o •No. 192159 ,r. 12/4/202.4•Amw LOT 1* .� BLOCK? 3LOT \ AS -BUILT OF: BLOCK33 ,�°° \ LOT 2, BLOCK 3 `c \ HYLEN CREST SUBDIVISION \ UNIT NO. L PLAT #83-90 ADDRESS: 10207 STEWART DR, EAGLE RIVER, AK \ LOT 6 LOCATED IN: ANCHORAGE RECORDING DISTRICT BLOCK 3 \ TIMBERLINE SURVEYING AND MAPPING MOA GRID: NW0057 17035 BARONOFF AVE FILE NO.: 24.156 / \ EAGLE RIVER, AK 99577 SCALE: I"= 30 FEET 907-242-5320 DATE: 12/4/2024 ryan@timberlinealaska.com SHEET: 1 of 1 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: OSP241324 Work Type: SepticTank Upgrade Tax Code Number: 05047270000 Site Legal Address: HYLEN CREST #1 BLK 3 LT 2 G:0057 Site Mailing Address: 10207 STEWART DR, Eagle River Owner: MILLER ANDREW C & Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 10/18/2024 10/18/2025 20019 ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 4 Received By: .f 5,a �'' Date: Issued By: �, , Date: �,. ON -SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-472-70 Property owner(s) Andrew Miller & Sarah Czaika-Miller Mailing address 10207 Stewart Drive Eagle River, AK Site address same Day phone Legal description (Sub'd., Block & Lot) Hylen Crest #1 133 L2 Legal description (Township, Range & Section) Lot Size 20,019 -Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (S all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) RX (w/wo ADU) Septic Tank Upgrade RX Duplex ❑ (D) Holding Tank F1 Renewal Multiple Dwellings EJ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: __# 2 Z 5; Date of Payment: -Z Receipt Number: Permit No. 0 � P2- H Waiver Fees: Date of Payment: Receipt Number: Waiver No. Permit App_'-'- : - � Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Mailing: P.O. Box 1807 Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska Subject: Hylen Crest #1 B3 L2 Septic System Upgrade Permit Request This is a design narrative for a permit to install a 1250-gallon septic tank to replace an existing 1250-gallon septic tank to be issued for this property. The existing tank will be decommissioned per moa code. Currently the lot is developed. The proposed replacement will be connected to the existing drain field. This lot and the surrounding lots are served by AWWU water services. There are currently no wells within 200’ of this upgrade. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5’+ from any property line. 5’+ from any deck/stair support. 10’+ from building foundation. 10’+ from any water line. 100’+ from any surface water. 100’+ from any private wells. 200’+ from any public wells. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at (907) 745-8200. Sincerely, Steven R. Pannone, PE, F. ASCE Owner/Civil Engineer 23 September 2024 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241324, Curtis Townsend, 10/18/24 PA N N O N E E N G S V C , L L C ( C . I . 1 0 8 8 ) 2.2. SCOPE OF WORK: INSTALL SYSTEM IN ACCORDANCE WITH THE ATTACHED DESIGN AND SPECIFICATIONS. -- FEET -- FEET Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241324, Curtis Townsend, 10/18/24 PA N N O N E E N G S V C , L L C ( C . I . 1 0 8 8 ) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241324, Curtis Townsend, 10/18/24 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 NAME %%�� �` -{- / K / G f� � I aa V1 PHO/N _E 67,7 —57o (;ANEW ❑ UPGRADE MAI LING ADDRESS _ �, �'o ` G r a I<Ag 7q5 LEGAL DESCRIPTION v . u is l �l LOCATION NO. OF BEDROOMS U y DISTANCE TO: Well !� () - T + Absorption area !� r Dwelling PERMIT NO. $ J 6) 36 ' (� n~. Z N� Manufacturer a 1 AI1Gh0.^ac e. 1'UK Material 5 e.e, No. of compartments Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth Z DISTANCE TO: Well Dwelling PERMIT NO. Oz N Manufacturer Material Liquid capacity in gallons wWell —f = DISTANCE TO: n, ,y (,} j'- Foundation 0 i j Nearest lot line y'� PERMIT N0.P� ^ % U� LL Z No. of lines Length of each line Total length lines Z W of, Trench with Distance between lines — rt ,f.' inches I.. Top of tile to finish gra o Material beneath —tile-- Total effective absorption area e A JV S W Length Width Depth PERMIT NO. f7 a a W Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER V PIPE MATERIALS V/ SOIL TEST RATING 15-0 _� t he r 4) t) eve INSTALLER REMARKS �5 Veri ((J 1%K Iv° qq a eg 4j Qa I �.. 7' )a In L Yhode CE 5035 "'RoresSplo�ay4�(,, jj,, 'V APPROVED DATE LEGAL zi' �c�r`� kik 3 Hj:��n CGhs� 5ctiuiyiol� /2-V IJ tKev. s/76) �U WIA 1 C: I C _T , 1l, m J, ��� ��v A C.,11 P1, n Ci E_-_ DEPARTMENT OF HEALTH AND ENVIRONMENT8/ pR(lTECTION 825 ' STREET/ ANCHORAGE, HK 264~4720 No . ( .... HPPLIC��T KIT CALLHHHM PO BOX 84 CHUGIH� 6;94-'T.02 LOCHTIO� LEGHL LOT 2 BLK ] HYLEN CREST SUB LOT SIZE 999999 SQUARE FEET TYPE OF' SOIL F'JBSO�PTION SYSTEM IS: TRENCH FIHXIMUM NUMBER OF BEDROOMS � 4 SOIL RATING (SQ FT/BR)� 150 THE REQUIRF-_'D SIZE OF THE SOIL ABSORPTION SYSTEM IS: J L !:5 C. C3 FA IL__ L_ C)�� PEP,,MIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE IPISTAL.L.RTIOP-4 INSPECTIONS OF ANY HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. CH �""a A1 *11���� BHCKFIL_fNG OF HNY S.YSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPHRTMUENT WILL BE SUBJE1:T TO PROSECUTION i1INIMU11 DISTHNCE BETWEEN H WELL HND HNY ON—SITE SEWHGE DISPOSHL SYSTEM I.S. J-00 FEET F'OR H PRP, -HTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPPNDING UPM -1 THE TYPE OF PLIBLIC 1.lIEL1... MINIi'|UM [.11STHNCE FROM A PRIVFITE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND TO H SEWER LINE IS 75 FEET. OTHE]:' RE�U�����NTS MA'? HPP�\! SPEC�FICRT1 4S AND CONSTRUCTION C-' HRF HVHILHBLE TO INSURE PROPER INSTHLLHTION ���1 F E-----. �_cE, U11--,. EE 0:-:,' I CE�TIFY THFIT HM FH1,1I1.,fHR I.-JITI.-I ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPRLITY OF HNCHORHGE� 2� I WILL INST�LL THE SYSTEM IN HCCORDHNCE WITH THE CODE� �� � U��ERSTRND THHT TH� O�-SITE SEWER SYST�� M�� REGUIRE �@LAR�0ME�T IF T�E RESIDE�CE IS REMODELED TO INCLUDE MORE THAN 4 BE[IF"O��s. SI6NED� ISSUED -r�,i V4.0 ��������� �� �- -�u:: I_ ������ � THE LENGTH THE DEPTH GROUND HND THERE IS NO DIMENSION OF H TRENCH THE BOTTOM SET WIDTH IS THE LENGTH (IN OR PIT IS THE DISTHNCE OF THE EXCHVHTION POR TRENCHES FEET) OF THE TRENCH OR DRHINFIELD BETWEEN THE SURFHCE OF THE � (IN FEET) � THE �mU GRHVEL THE BOTTOM I.E.; �THE OF THE MI��MUM DEPTH OF EXCHVHTION (IN FEET). �R�Y�� BETWEEN THE OUTFHLL PIPE J L !:5 C. C3 FA IL__ L_ C)�� PEP,,MIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE IPISTAL.L.RTIOP-4 INSPECTIONS OF ANY HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. CH �""a A1 *11���� BHCKFIL_fNG OF HNY S.YSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPHRTMUENT WILL BE SUBJE1:T TO PROSECUTION i1INIMU11 DISTHNCE BETWEEN H WELL HND HNY ON—SITE SEWHGE DISPOSHL SYSTEM I.S. J-00 FEET F'OR H PRP, -HTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPPNDING UPM -1 THE TYPE OF PLIBLIC 1.lIEL1... MINIi'|UM [.11STHNCE FROM A PRIVFITE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND TO H SEWER LINE IS 75 FEET. OTHE]:' RE�U�����NTS MA'? HPP�\! SPEC�FICRT1 4S AND CONSTRUCTION C-' HRF HVHILHBLE TO INSURE PROPER INSTHLLHTION ���1 F E-----. �_cE, U11--,. EE 0:-:,' I CE�TIFY THFIT HM FH1,1I1.,fHR I.-JITI.-I ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPRLITY OF HNCHORHGE� 2� I WILL INST�LL THE SYSTEM IN HCCORDHNCE WITH THE CODE� �� � U��ERSTRND THHT TH� O�-SITE SEWER SYST�� M�� REGUIRE �@LAR�0ME�T IF T�E RESIDE�CE IS REMODELED TO INCLUDE MORE THAN 4 BE[IF"O��s. SI6NED� ISSUED -r�,i V4.0 9 SOILS LOG = MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: )J- (—�C, I a� (� l-)1 n DATE PERFORMED:_—� LEGAL- DESCRIPTION:: L%t L-7 /Ti ! ! YIevi DEPTH }. cx Na 1 SLOPE SITE PLAN 1 (FEET) ®r. cAvdc- SII I `l Vct Vim` FI 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS lsola'�'�d nov,aovl'f��ut�us 1',- b eTt Q'c'IA i+ •Ft P00i'ly G11'114e j scmd eA o�J �3 roc Irf_+ p OF A4 too* hmes L Thode a w "°e° CE 5035 ; a PERCOLATION RATE- �'�...R>p��EESSIOR��`,�,�i� TEST RUN BETWEEN FT AND n WAS GROUND WATER S ENCOUNTERED? L 0 P IF YES, AT WHAT E DEPTH? 0 Reading ■ Gross Time Net Time Depth to Water e WAS GROUND WATER S ENCOUNTERED? L 0 P IF YES, AT WHAT E DEPTH? 0 Reading Date Gross Time Net Time Depth to Water Net Drop PERFORMED BY: L1C1)A �, T�-7y%�� CERTIFIEDBY: 72-008 (6/79) (minutes/inch) FT DATE: Parcel I.D. 050-472-70 Municipality of On -Site Water and Wast (907) 343-7 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Complete legal description Hylen Crest #1, Block 3, Lot 2 Location (site address) 10207 Stewart Drive Eagle River, AK 99577 Current Property owner(s% Ryan Comer Day phone 405-517-9584 Mailing.address 10207 Stewart Drive Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: R Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class A Well Q Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: VD M / L{/ (// / r/ Date: COSA to be released to the engineer, unless othenai a requested by the engineer. COSA Fee $ S — Date of Payment �l all Receipt Number ocl 6l1 4 COSA# C�SCt(pW 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. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE Date 5/26/2016 sir �z; 49 T -H Via; r System #1 Approved forbedrooms MICHAEL -E. ANDERSON e System #2 Approved for _ bedrooms ®�� s� CE -4381 ��a® Disapproved ®� 9F0°°°°�°X. l�o��� Conditional approval for bedrooms, with the following stipulation. BY v Original Certificate Date: LE _( 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet: '- .. c If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Hylen Crest No. 1, Block 3, Lot 2 A. WELL DATA - No Well on Lot. Well type Community If A, B, or C provide PWSID # 213289 Parcel ID: 050-472-70 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 Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Collected by: Date installed 5/21/1983 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 4-12-16 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 5/21/83 Soil rating (g.p.d./ft2 orfe/bdrm) 150 SFBDRM System type Deep Trench Length 54 ft. Width 2 ft. Gravel below pipe 6 ft. Total depth 9 ft. Eff. absorption area 648 ftZ Monitoring tube Y Depression over field N Date of adequacy5/25/16 Pass 4 test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test 51 in. Water added 810 gal. New depth 70 in. Elapsed Timg; s14,40 min. Final fluid depth 51 in. Absorption rate , 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date "Monitor Tube Was Pumped to Remove Accumulated Gravel. The Depth of Gravel is Now 28" Below the Distribution Line. Fluid Depth Measured from Distribution Line and Subtracted from Gravel Depth Stated in City Files. D. LIFT STATION Date installed Size in gallons_ "Pump on" level at in. "Pump off' level at Datum Cycles tested _ Manhole/Access (Y/N) in. High water alarm level Meets alarm & circuit requirements E. SEPARATION DISTANCES WELL ON LOT TO: - No Well on Lot 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 >51 Absorption field >51 Water main >10 Water service line >10, Surface water >100, Wells on adjacent lots >200' 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 None Known Wells on adjacent lots >200' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 5/26/2016 COSA brown sheet 10-10-12.doc in. Municipality of Anchorage • Development Services Department Building Safety Division 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. 0$0-472-70 COSA # Q _� L f L 1 ; ;� 3 Expiration Date:3/q/// 1. GENERAL INFORMATION Complete legal description Hylen Crest #s Block 3 Lot i Location (site address) 10207 Stewart Drive, Eagle River Current Property owner(s) Dolan & Adrea Ivey Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Dan Wolf / Keller Williams Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class A Well Community On-site Public Water System Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box ioo217, Anchorage, AK ggS10 Engineer's Printed Name Steven R. Pannone, P.E. Date 11/30/2010 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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 "�� �F �tq ��♦ 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 this All '. `P •.•••••""'•'•••,°•• S �,.•'°• ��� °°°••°•%:' evaluator of system. systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that ' 49TH • there are no hidden defects or encroachments. PES can therefore not provide any warranty for future %•••••+•• •••• • • •••••••••�•••� �____—_0 performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed �� Steve R. nPannone: i �1�% °•.,• above. Any reliance upon or use of this report by any other person or party is not authorized nor will it No. CE 8149 •,44 confer any legal right whatsoever. o•°'� •��h..° 5. DSD SIGNATURE c.•� _Z Approved for ��— bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory ..- 1, 1lAoiLd J NTr- Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: �- (Rev. 11/05) Municipality of Anchorage*A6 •' Development Services Department Building Safety DivisionOn-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Hylen Crest #t Block 3, Lot 2 Parcel ID: -050-&72-70 A. WELL DATA Well type.Ae'16If A, B, or C provide PWSID # Well Log (Y/N) completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total dept ft. Cased to ft. Casing height (above ground) in. OM WELL LOG AT INSPECTION Date of test Static water level ft, ft. Well production p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Oth cteria colonies/100 mL Arsenic: ug/I Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steed Date installed 5 Zt/i983 Tank size 1250 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 7/10/2010 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 5h1/1g8i Soil rating (g.p.d./ff or ftz/bdrm) t5oSF/BR System type Deep Trench Length 54 ft. Width 2 ft. Gravel below pipe 6 ft. Total depth 1Wft. Eff. absorption area 648 ftz Monitoring tube Y Depression over field N Date of adequacy test 11/22/2010 Results (Pass/Fail) Pass For bedrooms Fluid depth in absorption field before test o in. Water added6i3 gal. New deptho in. Elapsed Time: go min. Final fluid depth o in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION "Pump on" level at in Datum E. SEPARATION DISTANCES Size in gallons 'Pump o e Cycles tested. STANCES FROM WELL ON LOT TO: Septic tank/lift station on Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas Manhole/Access (Y/N) _ High water alarm level at Meets alarm & On adjacent lots On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation io+ Property line 10+ Absorption field 5+ Water main 10+ Water service line 25+ Surface water ioo+ Wells on adjacent lots 200+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 75+ Water Service line 25+ Surface water zoo+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 200+ F. COMMENTS Monitorina tube extends 4.6' into field 6' field G. ENGINEER'S CERTIFICATION 7�OF .VX,P.......q....�..._��� SLS•. I certify that / have determined through field inspections and 1 v 4* N � • T" '•• 49— •' review of Municipal records that the above systems are in x ,...,, ,,..;�.., conformance with MOA COSA guidelines in effect on this date. �7' n Steven . 7o 777 Engineer's Printed Name Steven R. Pannone, P.E. �j,�'i�• No. CE 8149 •,:��,�,� Date 11/10/2010 ••j•• .......... .\ .M\p''•�•`��•' �.�ESS lJ_��• COSA Fee $T� Date of Payment Receipt Number ©Z2 g ro (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number in. c+• / 0 `;CR) S WET G' d 6oUS�o ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: Lot 2, Block 3, Hylen Crest Subd. Unit No. 1 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS i WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. i 000 �6 SEWARD & ASSOCIATES LAND SURVEYING 688-4566 SCALE: 1" = 30' -OF At DATE %'t� �'��; 464 8/21/92 '•:�' H* GRIDS r�..... ..... :...•A NW57 000 ..... Duane Mark Seward AF FB: # • LS - 918 AV 31-32�ti Z,' • c�� a► DRAWN. q�As►1W DMS \ Municipality of Anchorage Development Services Department Building Safety Division \ On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.05o'Li72.'70 COSA# 0 0256 Expiration Date: 43 — 9- f o — 10 1. GENERAL INFORMATION Complete legal description Lot 2; Block 3; Hylen Gest Subdivision #1 Location (site address) 10207 Stewart Dr. Eagle River, AIC 99577 Current Property owner(s) Robert Hotzfeld Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone 622-9010 Day phone Cindy l Greattand Realty Day phone 694-9125 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF 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 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 certtfied by my seat 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 s a S Engineering Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer 5. DSD SIGNATURE Approved for Disapproved. bedrooms. Phone 6942979 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: ' z (Rw IIM) -\ Municipality of Anchorage "y • '� Development Services Department ° T i Building Safety Division " --- = On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: `moi 3� / ! YL6�C � � Parcel ID: 0_t'70 - 7 %Z' % b A. WELL DATA(�7nInVti/'71/ r0�KP_ Well type . 4 4 If //A, B, or C provide PWSID #,21 �i89 Well Log (Y/N) Date completed _ Total depth ft. Date of test Static water level Well production WATER SAMPLE R Coliform - Sanitary seal (Y/N) _ Wires properly pr ed (YIN) Cased to ft. Ca ight (above ground) in. FROM WELL LOG AT INSPECTION ft. U20 mL Nitrate mg/L Ars c: _ ug/L date of sample: B. SEPTICIHOLDING TANK DATA Tank Type/Material '& C 6765 Tank size la:SO gal. Number of Compartments of Other bacteria Collected by: ft. g.p.m. colonies/100 mL Date installed 15/21/5-5 YES ES Foundation cleanoutel)Depression over tank (Y& High water alarm (Y(V Date of pumping Pumper V -TTS K -r9 %�umyIK14 �7r1`� C. ABSORPTION FIELD DATA Date installed S .2/ Soil rating (g.p.d./ft' or ft2lbdr �� System type £P r Length r ft. Widtho(' ft. Gravel below pipe ft. Total depth g•83ft. Eff. ab)orption area MAtoring tube � Depression over field ,m�.�,g Date of adequacy test Result (Pas /Fail) ".' For bedrooms n u Fluid depth in absorption field before test 0 in. Water addedgat. New depth �� in. Elapsed TimecM min. Final fluid depth in. Absorption rate >_ ) g.p.d. Any rejuvenation treatment (past 12 mo.) ((D type) Ny If yes, give date p1CA)iT0cIv& Tvi5E &elwbS ix3T4) t)PPCtZ 310"or" TM E-FfreTIV6MPTti IUD VISil3_& Y£gFcojTnou3 w n4T, D. LIFT STATION N /4 Date installed Size In gallons "Pump on" level at _ in. 'Pump off al- DatumCycles tested E. SEPARATION DISTANCES High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: comn/rfmrry t�—Dwe Septic tank/lift station on lot On adjacent lots Absorption field on lot Public sewer main Sewer /septic service line Animal On adjacent lots Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r r / Building foundation $ '- Property line 5 t Absorption field $ i r i Water main /D t Water service line /O f Surface water Welts on adjacent lots 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I t Property line /D f Building foundation /Q Water main 0 r � Water Service line /0+ Surface water f Driveway, parking/vehicle storage r Curtain drain AX"AX ! V6W4) Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined, review of Municipal records r: conformance with MOA COS gu Engineer's Printed Name Date 812 / S COSA Fee Date of Payment Receipt Number (Rev. 11/05) field inspections and in Waiver Fee $ Date of Payment Receipt Number in'- in. APP -8-2009 11:42 FROM: a0, ta/ 9 61K r V( 3 ,r -0dS: vlEn ,.e 11 ASSUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE" FOLLOWING DESCRIBED PROPERTY, Lot 2, V. ■ 30' Block 3, Hylen Crest Subd. Unit No. 1 DATE, AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 8/21/92 INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY � EASEMENTS, COVENANTS, OR RESTRICTIONS Nw57 WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB ANY DATA HEREON BE USED FOR CONSTRUCTION 31-32 OFFENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN= ARY LINES. ,, _ - _.._ 70:6941211 P.1 his Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. [ 5b- "%- ?0 COSA# Olca3010 1. GENERAL INFORMATION Expiration Date: 7; 16-0:Z Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HYLEN CREST it SUBDIVISION: BLOCK 3. LOT 2 10207 STEWART DRIVE • EAGLE RIVER, AK 99577 MICHAEL do MARY FRAHM Day phone C/O AGENT 10207 STEWART DRIVE • EAGLE RIVER, AK 99577 Day phone 11111111041: s.4 i . Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: •3 *SEPTIC SYSTEM SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class 04• Well 0 Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite 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 Onsite 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 Onsite 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with 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 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. 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 d 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 identifiablo features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate elbow 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 otherperson or party Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for .3— bedrooms. Disapproved. 337-6179 Date 'L"/' Conditional approval for bedrooms, with the flowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory L/ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other By:Original Certificate Date: % — fpn HMI Municipality of Anchorage ' Development Services Department Building Safety Division On. -SRO Water & Wastewater Program 4700 Bragaw Street P.O. BOX 196550 Anchorage, AK 99519-66W www.muni.arg/anstte (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST tel./ Legal Description: HYLEN CREST /1 SUBDMSION& BLOCK 3. LOT 2` Parcel ID: 03'0 V 72.- 7 0 A. WELL DATA COMMUNITY WATER Well type w If A, B. or C provide PWSID# Z1 = Well Log Date completed Sanitary seal rtes PmPer y Protected (YIN) T Cased to ft. Casing height (above ground) in. FROM WELL LOO AT INSPECTION Date of test Static water level ft. ft. Well production 9.p -m. —9 -P.M. WATER SAMPLE RESULTS: Coliform coloniez/100 ml. Nitrate r colordes/100 ml. Arserua Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Data Installed 5/21/1983 Tank size 1250 Cal. Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (Y/N) YES Depresaion over tank (YM) NO High water alarm (YM) N/A Date of pumping 7/7/2006 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 3/21/1983 Sob rating (9.p.dAV41Ert 150 System type DEEP TRENCH Length 54 ft. Width 2 A. Gravel below pipe 6 ft. Total depth *7.ee ft. Eft. absorption area 648 ft' Monitoring tube **YES Depression over field NO Date of adequacy test 7/10/2005 Results (Pass/Fall) PASS For 3 bedrooms Ftuid depth in absorption field before test DRY in. Water added 620 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes. give date — 00MONITERING TUBE ONLY EMENDS APPROX. 3.6' INTO SEWER ROCK. NO PERFORATIONS VISIBLE IN MT. D. UFT STATION Date installed Size in gallons "Pump on" level at _in. "Pump E. SEPARATION DISTANCES water alarm level at �. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lI t station on lot Absorption field on lot Public sewer main Sewer /septic service line areas COMMUNITY WATER On adjacent lots On adjacent lots manhole/cleanout Manure/enknal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 51+ Property line S'+ Absorption Heid 5't Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line to + Building foundation 100+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parkinghrehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS O. 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 MOW COSH guidelines in eflact on this date. Engineer's Printed Name JEFFREY A. GARNESS Date '7b310b COSA Fee S i I ?n Date of Payment `t 'a Receipl Number Waiver Fee $ Date of Payment Receipt Number t N W x R CD V QI 0 s .s M Ire • , • A i i i I•tBUILT�NO CORHlR8 vtT TNIS DArL►• 1 H�RCtY CR7RSFY.T ATD i LAMS SflRPE171iQ N 1 HAYS SU►t&-jTD TNt &CALE'' Mack,; 1N8 OE84ti8Ep PROIrERiYi Lot 2J 1" � 90' �� � :► 0 ���' "f.�• � {. WD:111T 1141.�sst .•Qait :., •��• NO Iio: 1 • • i ' r aRTEt .� • r.J:. • �: A f ►1 r :. • 1 IiGATED' FMa D4ii •j'AL ' ! _w ,fr......••• •";.'t _. *,p• a ro o�rR►i �R>�SPottSiAlUTaf• Ct•T11L?' • ' e/zirsz rk� 'wytP 9 � s�-�� ; �', •1 WHIzi Do HST VM q toHs .,. 7 ,� • ,� ....» y . vislov, PLAY. Urmottto• tRc °' rul'1 DAT71 �{ qi� `i ihi.�Ij�Hi�. #Hau• ?• }� i ►ice► Sao ll q4 ORR /to�i � p7161Cf ( �• 3I.32 i •• [y '' �•1 R� t N W x R CD V QI 0 s .s M Ire • , • A i i i I•tBUILT�NO CORHlR8 vtT TNIS DArL►• 1 H�RCtY CR7RSFY.T ATD i LAMS SflRPE171iQ N 1 HAYS SU►t&-jTD TNt &CALE'' Mack,; 1N8 OE84ti8Ep PROIrERiYi Lot 2J 1" � 90' �� � :► 0 ���' "f.�• � {. WD:111T 1141.�sst .•Qait :., •��• NO Iio: 1 • • i ' r aRTEt .� • r.J:. • �: A f ►1 r :. • 1 IiGATED' FMa D4ii •j'AL ' ! _w ,fr......••• •";.'t _. *,p• a ro o�rR►i �R>�SPottSiAlUTaf• Ct•T11L?' • ' e/zirsz rk� 'wytP 9 � s�-�� ; �', •1 WHIzi Do HST VM q toHs .,. 7 ,� • ,� ....» y . vislov, PLAY. Urmottto• tRc °' rul'1 DAT71 �{ qi� `i ihi.�Ij�Hi�. #Hau• ?• }� i ►ice► Sao ll q4 ORR /to�i � p7161Cf ( �• 3I.32 i •• [y '' MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section 44 P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel LD. # �� .S-� ti -7 3 - o O HAA # _1 L;)C 1'- 1. GENERAL INFORMATION Complete legal description Lot 2; EZoch 3; H 2e.n Cnett Subob'v.LA_jUYt i1 Location (site address or directions) 1(1207 Stewa4t J%«ve. . _ EaQ•?e. Zi.ve.�L. �;K Property owner t4 •ig. Putnam Day phone 696-1274 Mailing address 10207 Steajaii,f 1J%L,;:ve. Eae?e. ;, ve.i. ".,K Lending agency Day phone Mailing address Agent Linda P,annejL/ V,1 Stc `'eaEa `pct e Day phone 6. 9-6464 Address - 16635 Cente!L,1,ie.,9d V)cive Ea.'e -:ve,�. `1K Unless otherwise requested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 4121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERINGPhone cl ^ 7 `i701 17034 Eagle iv r oop oa o. XUq Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for 1 bedrooms. Disapproved. Conditional approval for Additional Comments Date _7//° I r OF ROBERT C. COWAN •Q CE - $LSO I bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 MUNICIPALITY OF ANCHORAGE Health Authority Approval Checklist ENYIRONMENTAL SERVICES DIVISION Legal Description: G -a7- 2- (�G. 06,E � �✓ 9 HYZParcel I.D.: 0 5'o --97a -70JUL 19 1996 �5 - , `C'adxvzszr RECEIVED A. WELL DATA f3 Ll c_ WJ4 er'C, P\(L 7�31/H6 Well type A, If A, B, or C, attach ADEC letter, ADEC water system number /V. /i Log present (Y/N) /U A Date completed _ /v /-� " Total depth /�/ X' Cased to •V- X/ Casing height (above ground) w Sanitary seal (Y/N) _ Wires properly protected (Y/N) iy FROM WELL LOG AT INSPECTION Date of test Static water level /�- �• i✓. f%• Well production y g.p.m. �g.p.m. WATER SAMPLE RESULTS: Coliform /V Nitrate N F�- Other bacteria Date of sample: /!/•- Collected by: E3. SEPTIC/HOLDING TANK DATA Date installed _2 �_ k' Tank size IeSy Number of Compartments Cleanouts ON)X/ S Foundation cleanout ON) %'S Depression (Y/N' Alc High water alarm (Y/,q y� Date of Pumping 7 �i"-�G Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 o76dr i S��_ System typed Length _� `� Width; Gravel thickness below pipe G Total depth Effective absorption area ' 1� Monitoring Tube present CYAI) 2 -S Depression over field (Y/� NG Date of adequacy test _ %-��'�G Results (,Fail) _ / For i bedrooms Fluid depth in absorption field before test (in.); % Immediately after e7lgal. water added (in.): _ Fluid depth (ins) Minutes later: Absorption rate = 900 f g.p.d. Peroxide treatment (past 12 months) If yes, give date�- 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Size in gallons N Manhole/Access (Y/N) ,N - "Pump on" level at* /tl•A, "Pump off' level at* High water alarm level at* /t/- *Datum Cycles tested /Z - /1 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /V ' 4' Absorption field on lot Public sewer main On adjacent lots On adjacent lots Public sewer manhole/cleanout /V- /�' Sewer/septic service line /V-A Lift station /• SEPARATION DISTANCES FROI�/ZfOLDINGTANK ON LOTTO: /v_ A. Foundation S '4 Property line �>' Absorption fie Water main/service line /O h Surface water/drainage Wells on adjacent lots 200/4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line lt�,,,� Building foundation /0//- Water main/service line ro Surface water Driveway, parking/vehicle storage area Curtain drain TQC �x Wells on adjacent lots F. ENGINEER'S CERTIFICATION l certify that I have determined thru field inspections and review of Municipal records th 10,Ve PVF p N, ............ . w in conformance with M A HA.gguidelin in effect on this date. Signature Ag Engineer's Name Rk 6,6 1,14, 7- CO w / ' / ! - ` ROBERT C. COWAN Date I/b CE - 8801 HAA Fee $ :�` C)O Date of Payment � /C.%!(/ -- �% Receipt Number 26 6 / c ° c 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number are MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # . AL- L�1-Qn ri 'I. GENERAL INFORMATION Complete legal description HAA# W0� '`lQ C) Lot 2; $tock 3; Hyten Cnea.t Subdivision i.on # 1 Location (site address or directions) 10207 Stewart 'Dkive Property owner John 9 Manu Sue Mize Day phone Mailing address 10207 S.tewant D)Li.ve Eagte RiveA, Alaska 99577 Lending agency Day phone Mailing address Agent Viicgini.a Koh4ietd RE MAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Ce to,,4,Q d D)Live. Eaqte Riven, A&,Ska 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 '\? 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 421 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone 5 & S EWNEERING Address 7M4 F:+gle River Loop Road fj0 904 Eagle River; Alaska 99577 Engireer's signature Date _ 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments OF At 97 r CO I?** iia yy ���ew T ti E�1A•�!®0• i.�i..i __N J. 5VAFER No. 8215 -'oo. H•iao� ?ROFESS1aNP�,�,`,' bedrooms, with the following stipulations: 111TIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Bev. 1/91) Back MOA k21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 44 Legal Description: ��2 �3 6 v1�1,E S �� Esr'� 6 Parcel I.D. A. WELL DATA Well type DIf A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N)_ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Date completed Cased to FROM WELL LOG Driller Casing height Wires properly protected (Y/N) _ AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot %C) 0 ; On adjacent lots Absorption field on lot lob \ -� ; On adjacent lots Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria I ,,, o w z C) g� p'> n Lu tJ� z o s? z N1 B. SEPTIC/HOLDING TANK DATA Date installed Tank size o Compartments 7- _ Cleanouts O/N) Foundation cleanout &N) Depression (IY/& _ High water alarm (Y tJ Alarm tested (Y/N) Date of pumping 4?-,�>- \ 2,7-tti Pumper. _��� ►�oM� ����(f��� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: `� 12 Well(s) on lot ��`� On adjacent lots � Foundation 1 _ kA- To property Iine� Absorptionfield-� Water main/service line l�1 Surface water/drainage I p6 t �- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes — Manufacturer Manhole/Access (Y/N) uM-p off" level at Cycles tested SEPARATIQ.N-DISTANCE FROM LIFT STATION TO: on lot On adjacent lots D. ABSORPTION FIELD DATA Surface water Date installed 5_21 , 61S Soil rating Iia 4 /F -f . System type Length 54k Width *Z- Gravel thickness Lok Total depth � bt Total absorption area IV 8 Cleanouts presentoYN) \11 Depression over field (Y& ++ Date of adequacy test B- 18-9L Results as GAi1) Pp<5-`> for �r_iN y1,-- (1�� bedrooms Peroxide treatment (past 12 months) (Y& /,i Da If yes, give date '`J/4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: �� Well on lot Dov k On adjacent lots r`/',Property line � t To building foundation On adjacent lots 3o tk Surface water k C>C> t k Curtain drain 'L't1,6, 130 1 E. ENGINEER'S CERTIFICATION Cutbank To existing or abandoned system on lot _I& '�/a Water main/service line LC> 4 - Driveway, parking/vehicle storage area t certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Signature S & S ENGINEERING a , Eagle River Loop Road No. Engineer's Name Eagle Rive, Alaska 99577 Date HAA Fee $�- Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ .— Date of Payment Receipt Number _7S (+- date of this inspection. (4-91H gE e •fit eeeq®aeeavnv aaeeedeo e a Sad c.v o ann �e y•� fl .11. , HAFEft 115 MUNICIPALITY OF ANCHORAGE S V DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�� OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Descrip ion (include lot, block, subdivision, section, township, range) o�� �� � Location (address or directions) (b) Property Owner (c) Telephone: Home Mailing Address Lending Institution l ��'f��—-- Telephone Mailing Address (d) Real Estate Company Address �Q 01 Business Telephone 6 9 e_ Z/nj , - v Mail the HAA to the followina address: or: Check here if hold for pick up. List contact person and day phone number below. 5 & S ENGINEERING a1 11 O. 04 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family ❑ Number of Bedrooms 3. WATER SUPPLY Individual Well ❑ Community ❑ Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-026 Mew 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone 6r c v c T:M :INEERING Addre Date n i eal . ..t ,�... ♦.,nen � (, yA.)�J%WR W DHHS APPROVAL �q� _ " Approved for ^� C¢ bedrooms by �' _ — Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 79-02s rape asst Back B. SEPTIC/l4GU5tNG TANK DATA Date Installed d5 -L1-03 Size !l2G✓b No. of Compartments 2- Standpipese/N) Air -tight Caps/N) Foundation Cleanout�C N) Depression over Tank (Y/0 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for N Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) A Separation Distances from Septic/Hatding Tank: To Water -Supply Well -Z'c' r-')` To Building Foundation I To Property Line '> -- To Disposal Field — To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/64) To Stream, Pond, Lake, or Major Drainage ,p v5 MUNICIPALITY OF ANCHORAGE (MO. l ERS CEo�, 15 *iEALTH AUTHORITY APPROVAL (HAA) SO MVN�cgp'\-\"(f P CHECKLIST - FEBRUARY 1984 �Nv\�CNMEN 264-4720 Legal Descripti— LZ A. WELL DATA Well Classification If A, B, C, D.E.C. Approvek#TN) Well Log Present (Y/N) Date Completed — Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At — Casing Height Above Ground — Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: r To Septic/I:teldf9'g Tank on Lot 2l::►a 4- ; On Adjoining Lots To Nearest Edge of Absorption Field I on Lot ��� '� ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/l4GU5tNG TANK DATA Date Installed d5 -L1-03 Size !l2G✓b No. of Compartments 2- Standpipese/N) Air -tight Caps/N) Foundation Cleanout�C N) Depression over Tank (Y/0 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for N Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) A Separation Distances from Septic/Hatding Tank: To Water -Supply Well -Z'c' r-')` To Building Foundation I To Property Line '> -- To Disposal Field — To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/64) To Stream, Pond, Lake, or Major Drainage ,p v5 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata \,5o O/Ala * Type of System Design Date Installed 15-111 ��� Length of Field 15+ f Width of Field 2t Depth of Field I n Gravel Bed Thickness a Square Feet of Absorption Area g Standpipes Presentp/N) Depression over Field (Y69 Results of Last Adequacy Test Date of Last Adequacy Test 7..1 — 6Y1 Vii) . Separation Distance from Absorption Field: To Water -Supply Well '4- To Property Line To Building Foundation Lot ; On Adjoining Lots To Existing or Abandoned System on 3o r4— To Water Main/Service Line \ c:> I+ To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course 1 00 1+ To Driveway, Parking Area, or Vehicle Storage Area IS Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for 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 M 2 A and AA guidelines in effect on the date of this inspection. Signed Date Z 8 CompaW34 Eagle River Loop Road ND MA No. Eagle River, Alaska 99577 Receipt No. /O o/ Od/� Q'�iee,.eN• •,;��� Date of Payment 7Z 3, Amount: $ / 00 �... ret°s•Seah9 .. i S +ov.�a e�ae•...Q. H Pvbert A. Shehr n , t* NQ. 11.1:37-E ;n Page 2 of 2 72-026 (11/84) STEVE CUWPER, GOVERNOR 0 or a s a DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 "C" STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 DATE: PWSID #: To Whom It May Concern: 563-6775 According to the records on file in this office, the C v,- e- n� Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Ronald S. Klein Environmental Field Officer Time A►PPLIC `NT FILLS OUT UPPER HASP 'ONLY Property Owner Phone Mailing Address -' .,5,-. i,' ;Ic7,-! Zip Code Buyer Date Address Zip Code Lending Institution ��ll. i>{ rc. • �_; f, } �. Phone Inspector Inspector Address/L Zip Code Realty Co. & Agent ( t_ r.)`�� "t)S: :� r�, .['_rrp�'. �i �."-.1:'-a/.,l;..,g Phone Address �1r-„-� �(� '. � S -._ : - � � .... .. c-�. Zi Code L-C,V\ 6) - / Legal Description� \ t-- ' Street Location Type of Residence DEPT. OF HFALTH C, 'p -tingle Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply RECEIVED ❑ Individual 'CONDITIONS OF APPROVAL ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. "Community For wells drilled prior to that date, give well depth (attach log if available). O Public Utility Sewer Disposal jl^'Tndividual Year Individual Installed: S t L ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ..�_ Date Date Date Date.�+� 2 Inspector Inspector Inspector Inspector L-C,V\ 6) - / Field Notes: MUNICIPALITY OF ANCH GE DEPT. OF HFALTH C, ENVIRONMENTAL PROTECTION RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' _ DATE BY: Soils Raling Date Sewer( Well To Absorption Area Well Log Received-�.----- �Installed 5/n Well to Tank Septic Tank Size 72023 13182)