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HomeMy WebLinkAboutDEER HORN BLK 2 LT 3Deer Horn Block 2 Lot 3 #051-042-82 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221167 PID Number: 051-042-82 Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New A Upgrade Name David & Shellie Barker ABSORPTION FIELD ❑ Deep Trench AWide Trench El Bed El Mound Site Address 21993 Deer Park Dr ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-414-9456 4 1.2 GPD/SF 4.5/4.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.5/2.5 Ft. Gravel depth beneath pipe 2.0/2.0 Ft. Subdivision Block Lot Deer Horn 2 3 Fill added above original grade 0.5/0.5 Ft. Gravel length 35/35 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 500 Ftz 2 6.4 Ft. Well N/A N/A N/A N/A N/A ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water N/A >100' N/A N/A Gal. Material f compartments Lot Line N/A >10' N/A N/A NA Foundation N/A >10' N/A N/A L TATION Manufacturer Capacity Remarks Fields are insulated Gal. Alarm location Electra ailed by Installer PIPE MATERIAL House to tank D3034Tank to D3034 drainfield A.C.E.S. Drainfield D3034 CO/MTD3034 Inspector J Millette BENCH MARK (Assumed elevation) 100 ft Inspdection 1m 6/22/22 6/22/22 Location and description 2nd Bottom of siding 3rd 6/24/22 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date ��'•®F TH i. Septic System r Approved `- 2— % �••. Benjam.� Schiller .� 0 F� CE 12592 c`v Date ( ` r�'`rrF�• ,6/28/22 . •��C�� PROFESSIO0� �� Note: this approval does not include well permit requirements. kmev uoiuu iu/ PERMIT # OSP221167 �� PID # 051-042-82 LOT 4 TH-1984 ® tXISTING TANK & BED • I ,TO REMAIN IN SERVICE �CO2 2 - 35' LONG x 5' WIDE, 2' { % EFFECTIVE DEPTH 22•% CO3— ABSORPTION TRENCHES 1<406 ITS C01 04 LOT 3 MT i T /! TH-A Z16 Cof C056.417.9 4-BDRM HOME i �( ..w.......WATER 1 SERVICE LINE t Z N LOT 2 A B C01 43.3 99.5 FD 44.5 100.6 CO2 44.3 100.6 CO3 44.2 100.2 C04 59.1 100.4 MT1 63.4 99.2 C05 71.8 90.9 C06 71.8 112.3 MT2 75.8 101.9 C07 81.1 102.3 [ N6 -- RANG !tE9®\, Ar 4g TM ; Benja i Schiller CE2592• •��\���4 ��,\��pROFESSI0NP�4 ►'' /� THE SECOND TEST HOLE SHOWN IN THE MUNI !� RECORDS APPEARS TO BE FOR A DIFFERENT LOT N0TZ,. NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE LEGEND PROPOSED SEPTIC SYSTEM CO -CLEANOUT SURROUNDING LOTS ARE SERVED BY A COMMUNITY WATER SYSTEM. 2CO - DOUBLE CLEANOUT NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. FCO - FOUNDATION CLEANC FS - FLOW SPLITTER VALVE 0 40 80 FD - FLOW DIVERTER FEET MT - MONITORING TUBE SV - SEPTIC VENT 1 "=40' TH - TEST HOLE DEER HORN, BLOCK 2 LOT 3 PERMIT # OSP221167 PID # 051-042-82 84.2 WE 87.2 FINISH GRADE 35' 86.7 ORIGINAL GRADE 75.7 GROUNDWATER 5/24/22 74.7 EAST TRENCH 0 �- 2 0 ol�- 1--o 85.0 FINISH GRADE 84.5 ORIGINAL GRADE 20 nn 84.2 82.0 DRAINFIELD ROCK 82.0 80.0 80.0 - 35' 73.5 GROUNDWATER 5/24/22 72.5 WEST TRENCH V,k 49 .. ... ... . ...... .......... .......... �enj . a - chiller PROFILE AS -BUILT CE 12592 hn (NO SCALE) 28, 2022 7ENGINEIRING MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program �o PO Box 196650 4700 Elmore Road _ Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 rY n http://www.muni.org/onsite t�c�partment On -Site Wastewater Disposal System Permit Permit Number: OSP221167 Effective Date: 6/6/2022 Work Type: Septic Upgrade Expiration Date: 6/6/2023 Tax Code Number: 05104282000 Site Legal Address: DEER HORN BLK 2 LT 3 G:1558 Site Mailing Address: 21993 DEER PARK DR, Chugiak Owner: BARKER DAVID M & SHELLIE RENEE Lot Size in Sq Ft: 38939 Design Engineer: FORGE ENGINEERING Total Bedrooms: 4 This permit is for the construction of: Q Disposal Field ❑ 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 Veronica Pope GE 2022.06.06 Received By: 16:38:23 -08'00' Date: Issued By: �'p` �,/z�� Dater 2 UHJCC PALL %//70 F HCH0 G FEE t Community Development Department ` t_ Y Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-042-82 Property owner(s) David Barker/Sheltie Renne Day phone 907-414-9456 Mailing address PO Box 671504, Chugiak, AK 99567 Site address 21993 Deer Park Drive Legal description (Sub'd., Block & Lot) Deer Horn, Block 2 Lot 3 Legal description (Township, Range & Section) Lot Size 38,939 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑ Upgrade ❑X Duplex (D) El Holding Tank El Renewal Multiple Dwellings ❑ 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. �4 (Signature of property owner or authorized agent) Permit/Rush Fees: t 5 % 5 Date of Payment: SA7/Z"Z Receipt Number: D 31 4L1 ,67 V Permit No. OS I°a ( / 6 7 Permit App_'.:-: ,'-..:c: Waiver Fees: Date of Payment: Receipt Number: Waiver No. May 27, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Deer Horn, Block 2 Lot 3 – 21993 Deer Park Drive Septic system design Dear On-Site Services Engineer: The absorption bed at the subject lot has failed, so we are submitting this permit application for the its replacement. The attached site plan identifies the location of the home as well as the new proposed septic location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot slopes toward the west at about 15%. There are no slopes greater than 25% within 50 feet downslope of either the primary or alternate site. Elevations are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trenches will be constructed parallel to the slope as much as possible. This property and surrounding properties are served by a community water system. The new system will be a minimum of 100’ from surface water, and more than 5’ away from the septic tank. The existing bed is located more than 6’ away. Please refer to the attached test hole log, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221167, Rebecca Carroll, 06/06/22 // // Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=40' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE FD - FLOW DIVERTER MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND TH-A DEER HORN, BLOCK 2 LOT 3 FEET 0 40 80 NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM SURROUNDING LOTS ARE SERVED BY A COMMUNITY WATER SYSTEM. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS.DEER PARK CIRCLE6/6/2022 DEER PARK DRIVE15' T&E EASEMENT4-BDRM HOME 275270265260280CO CO CO CO MT MT FS FD 2 - 35' LONG x 5' WIDE, 2' EFFECTIVE DEPTH ABSORPTION TRENCHES MAINTAIN 6' MIN FROM EXISTING BED, & 10 MIN FROM WATERLINE WATER SERVICE LINE ≥6' EXISTING TANK & BED TO REMAIN IN SERVICE TH-1984 THE SECOND TEST HOLE SHOWN IN THE MUNI RECORDS APPEARS TO BE FOR A DIFFERENT LOT Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221167, Rebecca Carroll, 06/06/22 DEER HORN, BLOCK 2 LOT 3 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592R EGISTEREDPROFE S S I O N ALENGINEER6" 2' 2' DESIGN FACTORS:SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 1.46 MIN/IN APPLICATION RATE: 1.2 GPD/SF SHALLOW TRENCH SYSTEM BOTTOM OF TRENCH: 4'- 6" BELOW HIGHEST ORIGINAL GRADE FLOW LINE ELEVATION: 2'- 6" BELOW HIGHEST ORIGINAL GRADE TOP OF TRENCH: 6" ABOVE GRADE 600 GPD / 1.2 GPD/SF /5' WIDE * 0.70 RED FACTOR (2' EFF DEPTH) = 70 LF TRENCH REQUIRED (70 LF SPECIFIED) 5/27/2022 2' 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK GEOTEXTILE FABRIC 5' 2" INSULATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221167, Rebecca Carroll, 06/06/22 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE A DATE READING START TIME NET TIME (minutes) DEPTH to WATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING IF YES @ WHAT DEPTH? 1.46 5/12 1 2 3 4 5 6GM (SILTY SANDY GRAVEL) Professional Engineers Stamp: NO DEER HORN, B2 L3 5/12/22 051-042-82 GREG SHEPARD 3:081 2 3 4 5 6 0 0 16 12:33 12:34 12:35 12:36 12:37 1' OB 8:34 Benjamin Schiller CE 12592R EGISTEREDPROFE S S I O N ALENGINEER6/6/2022 PERC TEST LOCATION TECHNICIAN: J. MILLETTE 6 0 16 N/A 11.0' 5/24/22 COMMENTS: 6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING SITE PLAN 6 0 16 USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED BED ROCK 0 0 168:30 6 0 16 6 0 16 0 0 168:35 6 0 16 6 0 16 0 0 168:40 6 0 16 6 0 16 0 0 168:41 6 0 16 6 0 16 0 0 168:45 6 0 16 6 0 16 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221167, Rebecca Carroll, 06/06/22 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141363 PID Number: 051-042-82-000 Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade Name: Christopher Sells ABSORPTION FIELD El Deep Trench ❑Shallow Trench E] Bed ❑ Mound Address 21993 Deer Park Dr. Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907.538.6080 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft.Gravel depth beneath pipe Ft. Subdivision Block Lot Deer Horn, 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 I Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftp Ft. Well Public - - - >100' TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Anchorage Tank 1250 Gal. Surface Water >100' >100' - - Material Number of compartments Lot Line >5' >5' - - Steel 2 NA Foundation >5' >5' _ LIFT STATION Manufacturer Capacity Curtain Drain I NA _ _ _ Gal. Remarks MT's 1 and 2 replaced. Old tank cut Pump on level at in. Pump off level at in. High water alarm at in. open and backfilled. New tank installed along With opposing cleanouts at Inlet and outlet. Pump make and model Electrical Inspections performed by Installer Tank to , PIPE MATERIAL House to tank "Same d a n eld PVC* JR's Septic Pumping Draineeld NA CO/MT Inspector Tyler Perron BENCH MARK (Assumed elevation) 2.645 ft Inspda iones: 1" 09/03/14 09/03/14 Location and description 2w 3"' Orn Wood Beam Retaining Wall off NE house corner. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp o%®a®��eale�y i ACq'S .0F q�g Conditional Approval: Date s 00 i ° rT Charleg Approved OZ11Gt/ t Date �'�= "% •���: ®®g `'�a'r Baa®g Inspection Report_9-1-1 sper LOT 4 MONITORING TUBES OMT2 °MTI IAT 3 4 OPPOSING CLEANOUTS T}2 L ABANDONED TANK, SnTOP CUT, AND FILLED OPPOSING CLEANOUTS ��\/ TH GRAVEL. D B A EXISTING SINGLE FAMILY DWELLING NOTE: 2' INSULATION INSTALLED / OVER SEPTIC TANK LOT 2 SCALE: 1'=50' SWING TIES D C CO 1 21.5 25.5 CO 2 230 27.0 STSP 1 25.1 29.0 STSP 2 32.4 38.4 00 3 34.8 3&8 00 4 35,4 38.4 MT 1 75.5 7&0 MT 2 84.0 87.3 A 10.0 11.5 9 28.5 20.8 NOTE' D & CARE DECK SUPPORTS DBL CLEAN SOIL ABSORPTION SYSTEM BY OTHERS SCALE: NTS Charles A. Leet . CE 10480 . INV. OUT ELEV. 8.21 FG ELEV. 12.84' INV. IN ELEV. 8.36' 1250 GALLON STEEL. SEPTIC TANK (Anchorage Tank & Welding) ALASKA RIM ENGINEERING, INC. 9131 E. FRONTAGE ROAD, SUITE 1 LMER,9645 PH: (907)745— 0222 :AFAX: 9 (907)746-0222 EMAIL: akrim®alaskarim.com : WEB: www.alaskarim.com W0: 14-00669 PAGE: 1 Single Family Septic Tank Replacement DEER HORN, BLOCK 2, LOT 3 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141363 Tax Code Number: 05104282000 Work Type: Septic Upgrade Permit Effective Dates: August 27, 2014 to August 27, 2015 Design Engineer: ALASKA RIM Subdivision: DEER HORN Site Legal Address: DEER HORN BLK 2 LT 3 G:1558 Owner/Address: SELLS CHRISTOPHER L 21993 DEER PARK DRIVE CHUGIAKAK 995675326 Site Mailing Address: 21993 DEER PARK DR, Chugiak This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 38939 Total Bedrooms: 4 N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received I Issued By: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-042-82-000 Property owner(s) Christopher Sells Day phone 907-538-6080 Mailing address 21993 Deer Park Dr. Chugiak, AK 99567 Site address 21993 Deer Park Dr. Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) Deer Horn Block 2 Lot 3 Legal description (Township, Range & Section) Lot Size 39,939 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ERUpgrade ❑X Duplex (D) ❑ Holding Tank El Renewal ❑ Multiple Dwellings ❑ 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 appl ble Municipal Codes. 1 property owner or authorized agent) Permit/Rush Fees: -0Z1 Date of Payment: ? 1q Receipt Number: _H 437 Permit No. l,t� /0_ 1l 2 Permit App_:- : - ::...:c; Waiver Fees: Date of Payment: Receipt Number: Waiver No. — ALASKA RIM ENGINEERING, INC. ENGINEERS—PLANNERS—SURVEYORS 9131 E. Frontage Road Palmer, Alaska 99645 Telephone (907) 745-0222 Fax (907) 746-0222 Online at: www.alaskarim.com August 12, 2014 Jay Crewdson Onsite Water and Wastewater Municipality of Anchorage P.O Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 RE: Deer Horn, Block 2, Lot 3 Subject: Tank Replacement Dear Mr. Crewdson: An adequacy test was performed on August 5, 2014, on the subject lot. During this test it was determined that the 1,250 gallon steel tank was leaking. This narrative is provided to request approval to replace the existing tank and to explain how the replacement will be performed. Water Service This lot is served by the municipal water service. The septic tank is outside of any protective well radius and meet the requirements AMC 15.65.050A Tank Replacement We propose to remove the existing tank after it has been pumped. The tank will be smashed and hauled off site to an appropriate disposal location by the contractor. A new 1,250 gallon steel septic tank will be installed in the same location as the old one. We will verify that the appropriate cover is placed over the tank. Clean Outs We will verify that the foundation clean out exists and that there is an opposing clean out within 10 -feet the new septic tank. If there is not an existing foundation cleanout or opposing clean out they will be installed. Upon completion, we will provide record drawing of the installation. Should you have any questions or comments, please do not hesitate to contact me by telephone or email chuckna,alaskarim. com. t OF ''It Si cerely,t�I ��•.49TN ••..••..•*J#. U I Charles A. Leet, P.E. Principal Engineer <0m . Ch / t �'� •, Ch ries A. Leet ' 'PT • CE1E70480 � MwD nowt BE,. C rw �a a mac w1M.T Nis° 6U' OG'E nmxT euuaxc smeAac 162:17 soc elan.w scNAar Iv.NI awO.w setea b0 ' bm OQ j hp flOs O ! O b if y (� 2 �O 94.3' o UN m qAA' N I LI! o Uj �L. y lO II ' v2 00 00 �i \ RV0.00 UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBIUTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCAUNG. REPRODUCTION MAY CAUSE ERRORS IN SCALE LOT wRvEY SURVEY TYPE SYMBOLS FOUNOAIION AS-BUILT SET REBPJtDRAINAGE ASPHALT ❑ FINAL STRUCTURE AS-BUILT O FOUND REBAR y�9 WOOD FENCE '..L;_x'�.'... CONCRETE ❑ FLOT RIN ... AS- ...LOT SURVEY .. , i0F0ORMMr ® ASSUMED ELEV.-U(--j{-7F METAL FENCE ® WOOD DECK A -M T ... N TREQUITIFICATON AS-BUILT ... N OMMUIS SET PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS. SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTONIS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION •��.����Prepared by PLOT PLAN.••�E CF ,q�+++ Robert E. Johns, Jr. &Assoc. wa+«1WrmW .•�P,.••" `+� Professional Land Surveyors . Ly Iw. Arw r ..Isar a a w Wa.... �� r' • �. 1700 Brink Drive.v w., on w pm n r war ea ,nr ANCHORAGE, ALASKA 99504 an•,N.,. 1 a " Scda: 5, Rx. Lo! S.F.Rec. Plat FBe No. 0' FOUNDATION AS-BUILT •••••' • •• ••• ^�••• V t R. L rano.. r., Il.vay a." Wer I Date Surveyed: 7/21 /14 Drawn by. R�J Checked byR AK IYM WrATn./TlitelN.MYaw • , „� JIV' Nuerrbn m W W W wf M w • ., ...1 ,,. ., �.. 000f•N n•w^•• := . ',• ROBERT E. .JR. ••, ~''° �� [late Drown: 7/21/14 Grid: 1558 W.O. 14-338 FINAL STRUCTURE AS-BUILT �$� •'• .. 4 RN,.1 L y r. n.my..ny a.0 �� fa^ •••'•..,. ..•': has �1 Legal Description: Iw a.e„a•a. �W.a.yarw �+ ,A a�a �. LOT 3 BLOCK 2 .Vwan an aw .e w a,.r a w e rofesaiono` l •• .....w..a. r„ w.. ���,••••••• DEER HORN A\ MUNICIPALITY OF ANCHORAGE 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street. Anchorage, Alaska 99501 Telephone 264-0720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE bPJ%IEW L/P_45S7Zf LD. yti-Z9z OUPGRADE MAILINGAD RESS IIII C�o S 0"S Edi 414 2 / 9 & a' 4S gal 5;,S77 LEGAL DESCRIPTION Go 3 gzle. 7 - LOCATION NO. OF BEDROOMS DISTANCE TO: livelf Absorption area Zc�o .+.. Dwelling u PEM T ffyyOO,, IT (LJCoe- UY 122 Manufacturer n r Ma _ No. No. of compartments W 4 P Kms-- J �+�L. Liq. opacity in gallons L—J C7 IF HOMEMADE: Inside length Width Liquid depth 8O2 DISTANCE TO: Well / Dwelling PERMIT NO. S< Manufacturer Material Liquid capacity in gallons 0 TO: Well Nearest lot Ime PERMIT NO.WDISTANCE jLL=No. of lines VF77tion Length i each line ength of lines Trench width Distance between lines inches 2I.. Top of tile to finish grade at beneath tile Total effective absorption area OI Inches Length/ 3,9 Width Depth . u PERMIT NO. E I Type of crib_ Crib diameter Crib depth Total effective absor tion areV �f W W a DISTANCE TO: Well Buildin f undgti Nearest lot line ?pT� ./- U � /d y J Class) e Or DIt IIeL Distance to lot line PERMIT NO. J ` DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS P vc,, SOIL TEST RATING 0/ /SU 1Jmi rV �f I NSTP�L,LER \�C�. � �.Y 1 jqd R ,� REMARKS 1' I 611-9 fr No. W AP VED DA E LE �Y.;uLE SRO 14 RIVER, ALAS„{ 2.'77 FY is PH. C04-2^79 Vup tnev, 41/211 / 111 t1 n MUN I C I FOAL I TY OF ANCHORAGE �� ,,%� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK '99501 264-4720 ON—SITE SEWER $c WELL_ F�'ERM I T PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX'BEDROOMS: 840689 08/13/84 CHUCK TANNER . S&S ENGINEERING EAGLE RIVER, AK 99577 562-3035 SUBDIVISION: DEERHORN SECTION: 10 TOWNSHIP: 15N 38939 (SQ.FT. OR ACRES) 3 LOT: 3 BLOCK.: 2 RANGE: 1W Listed below are the options available'to you in designing your septic system. Choose the option that best.fits your site. ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROV ED WITHOUT AN ION REPORT; AND (3) THE ELECTRICAL WORM.rfSN717m, RICIAN. SIGNd DATE: APPLICANT: :. r r • TRENCH L'sED W _ DFRA I N DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 3.0 0.5 2.0 TOTAL DEPTH (FT.) 7.0 4.5 6.0 GRAVEL WIDTH (FT.) 2.5 19.0 5.0 GRAVEL LENGTH (FT.) 75.0 36.0 63.0 GRAVEL VOLUME (CU.YDS.) 24.3 25.3 29.1 TANK SIZE (GALS) 1,000.0 ** 1,000.0 ** 1,000.0 ** SOIL RATING (SQ.FT./BR) 150 150 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROV ED WITHOUT AN ION REPORT; AND (3) THE ELECTRICAL WORM.rfSN717m, RICIAN. SIGNd DATE: APPLICANT: :. r r • MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST .V,dSOILS LOG ❑ PERCOLATION TEST PERFORMED FOR:�DATE PERFORMED:- 8 _I 8 LEGAL DESCRIPTION: LO? ��� SLOPE - - 1 ( t 7 I L=M7/-4-i 1 C- 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 iiiii��■■■■ Reading Date Gross Time Net Time Depth to Water Net Drop I VT PERCOLATION RATE d(minutes/inch) TEST RUN BETWEEN FT AND FT 72-006 (6/79) —_ • 4r fw M.•-. & ENGINEERS. INC W f'N 7125 OLD SEWARD HWY. ANCHORAGE, ALASKA 99503 349-6561 SOILS LOG - PERCOLATION TEST I 1 ',.1111.:. 1.0t. a U3 PEIICOLATION reSr PEHrOHMEO FOIl CLLZl1 'e_/ _.- .---/-11A 111'I.IIIUN% MEO / ,20 _ LEGAL OESCHIPTION -CS 773. f_tl�r r f � xul_e�_`ltle SLOPE 1 �� w/ (S�o••tic /G.a..c1 NN� (0.H 2 �GtiO, ,J(OW1 (Y1: 0 J O, •%eo 4 '�•o� � c•000 7 o �o 8 •0p. o. ° °/ o° off 9 ��o t0 e It 12 Is 16 1) IB 19 20 COMMENTS PERFORMED BY 11006 /6/191 %•— fZ• GeCrJCI W/ S.. c T(acc 46 S;11) C. s 1, 5L.�ly A." st GM any T W/� WAS Gnou Ce ENCOUNT IF YES. DEPTH' NOlVGATER r-- L EftED> O / P WHAT E 1 w Reacting Date Gross Time Net Time Depth to Wates Net Drop PERCOLATION RATE Iminulesrinchl TEST'RUN BETWEEN FT AND FT CERTIFIEO BY: DAT ", �O U 5 N MUHMPAUTY OF HCHORAGE 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. 051-042-82 1. GENERAL INFORMATION Expiration Date: - 2 2 t .2 OZ Ll Complete legal description Deer Horn Block 2 Lot 3 Location (site address) 21993 Deer Park Drive Current property owner(s) David Barker & Shellie Renee Day phone Mailing address P.O. BOX 671504, ChUgiak, AK 99567 Real estate agent Greg Shepard Day phone (907) 414-9456 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑■ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System FEI Public Sewer ❑ Waiver request for: Dista Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ L-(4Waiver Fee $ _ Date of Payment (P 3a)) 0� a Date of Payment Receipt Number 0 % 1�1 15 Receipt Number COSA # O -5G 221316 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 6/28/22 6. DSD SIGNATURE System #1 Approved for A bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for of -'`ki1 qs 1 1, ,i * 49 TM_ ............... BenjarryVr Schiller �� �Fc •. • CE 12592AW pROFE SS10N1`� ��AM' _ _y'I%- bedrooms, with the followil y o.pui.L. I `�llllMA I t((((l(rrr By: N.. ��' C� �1 Original Certificate Date: 6 3o- ZO2 -a The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet 1 Legal Description: Deer Horn Block 2 Lot 3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA log is filed with Onsite (or attached) Date Total depth Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments PUBLIC WATER SYSTEM B. TANK DATA Age of tank(s) 7 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 48" n Standpipes/foundation cleanout per record drawing Date of pumping JR's Septic 6/22/22 D. ABSORPTION FIELD DATA Which system tested (date installed) NEW CONSTRUCTICH 0 ALL standpipes present per record drawing Total measured depth from grade 5A ft (max) Measured depth to pipe invert from grade 3.0 ft (min) ❑ N/A — pressurized field limil Monitor tubes go to bottom of effective. If not, state depth into effective 0 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced _gallons Comments/Deficiencies: Insulation placed over both fields COSA Checklist yellow sheet Parcel ID: 051-042-82 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) senic ug/L ❑ Arsenic less than MRL (ND) Coll Date of Sample C. LIFT STATION maintenance completed Age of lift sta years Lift station material Comments: Adequacy test date N/A Results ❑Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic F;J ift Station on Lot > 100' 0 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Ye ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft ding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Yes Animal Contain LO' ❑ Yes if No ft ❑ Yes if No ft Water Main > 10' 0 Yes if No Manure/Animal Excreta Storage > 1 Community Wells > 200' 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' 0 Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' if No Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' M 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' Q 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' Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ✓] Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet OF !L�` 49 TH Y • • r BenjakrvSchiller I F6, •. CE 12592 • �`�.�� $������'0 - --SS10Nt`\� AW 33813 )Iavd 8.3-3(l 30.0 11 o i IN-3n.3.Sye lHOjjA,/(j HjjAj Aao _jS N I S*L I I& xot &0 O z0 ti i IN-3n.3.Sye lHOjjA,/(j HjjAj Aao _jS N I S*L I I& xot 0 CQ I -q 0 Nt E- &0 z0 ti 0 :z .3A -,V �j to x z CO - aC 4 7- 0, 'CO 0 tn : rn PALL - LO :3: C4 LLJ 04 ui PAY < aLL, Lli 0 CQ I -q 0 Nt E- &0 ti :z .3A -,V �j to CO - aC 4 7- 0, (D CD CN tn : rn PALL - LO :3: U P, p r4 w LLJ 04 ui PAY < aLL, Lli v) C; z :D mQ to 0 O 0 13 as a. c r 0 X 0 a_� L E 0 2 L. 0 0) 0 r 0 00 LO 0 4) to to 5 4) s- 0 E a - r .-, C." 0 al w 't> < 02 Z 1 1 Cl C-4 m® 04 N 0) c om b 0' L- 2 a c a E:6 in o a -'00 0.0 0= 0 CL 0 0 0 a CD al 4) 0 2 - 0. 0 (D o mm 0"o CL L- E W c &- D0102am 2. *c 't > -- 4, 01 -t) W V) co 0 0 t 0 o c CE -x 0 �ODM c III 0 E- 0 " E 0 c 0 > 0 a =0 oll 'a 0 ui =z= 0 0 �L- 00- 0 0 0 C IV 0 M i < C.) %-- 0:6 o V),o ta N'. 0 CL *0 a a 0 mo+3m - 00 E-Lli (D CO - E -0 =) a o>.0 x 0 " c L. 0 pa °5 17) A V) 0 0-�o 4) l p tz 0 0 <'O 0 r x 0 LU Of > x .Z'u o a C3 C L. a O:E = 3: it LLJ ui M V) >W -p 0 CL 0 r- 0 W,;; M En to = w - 0 0 p a a O= C 0 — WI- 0 c 0 V) < a M= C:E 0- >.= Cl) O= O a C-4 c 0 :E - o >�u 0 aro- 0:2 3:0 V) V) 0 0 0 0 0 :E -Mj Wo Qi E -or- ro- 0 am LO z :5 0)4— 0 CD (D >0W 0 LU CL C— 0 , tM o M , 0 c E0 0.0 — 0c Z 1-- 0 0 c E -E E E Cl1 Q. CL 1 1 c - o L- a a < 3c 0-0 0 0 Q • Municipality of Anchorage E` On -Site Water and Wastewater Program = (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-042-82-000 1. GENERAL INFORMATION Complete legal description Location (site address) Deer Horn B2 L3 21993 Deer Park Dr. Expiration Date: Current Property owner(s) Chad & Sharon Severson Day phone 854-7931 Mailing address, P.O. Box 671805 Chugiak, AK 99567 Real Estate Agent, Cody Fenton, Centry 21 Day phone 830-4572 2. TYPE OF DWELLING: 0 Single Family (w/wo ADLI) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Release to Cody Fenton COSA Fee Date of Payment Receipt Number COSA# 0,5C ).611 i'_� Date: 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 Alaska Rim Engineering, Inc. Phone (907) 745-0222 Address 9131 E. Frontage Rd. Palmer, AK 99645 Engineer's Printed Name Norman K. Gutcher Date OF A 0- 6. DSD SIGNATURE System #1 Approved for bedrooms a eBsGso�te/; ° Norman K. Gutcher e System #2 Approved for bedrooms �� sT CE -4919 Disapproved Conditional approval for bedrooms, with the following stipulations: BY: \, `✓V& Lf— 1Z-(�o Original Certificate Date: q_q_j The Municipality of Anchorage Developme ervicon (DVS 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—f . c If more than 1 septic system is on the lot: COSA Checklist # _of Structure served by this system Certificate of ®n -Site Systems Approval Checklist Legal Description: Deet' Horn B2 L3 Parcel ID: 051-042-82-000 A. WELL DATA Well type Public If A. B, or C provide PWSID # 213001 Well Log (YIN) Date completed Sanitary seal (YIN) Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test N/A N/A Static water level N/A ft. N/A ft. Well production N/Ag p m N/A 9 -P.M. WATER SAMPLE RESULTS: Coliform N/A colonies/100 mL Nitrate N/A mg/L Arsenic N/A ug/L Date of sample: N/A Collected by: N/A B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/28/14 Tank size 1 250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping NC�1 3 I ) UJ Pumper WA J J�\,s lit f k� C. ABSORPTION FIELD DATA Date installed 8114/84 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System type Absorption Bed Length ft. Width 3t 2 ft. Gravel below pipe 0.5 ft, Total depth 5.9 ft. Eff. absorption area 912 ft2 Monitoring tube Y Depression over field N Date of adequacy test 3/10/1.6 Results (Pass/Fail) P For 4 bedrooms Fluid depth in absorption field before test 1 in. Water added 620.2 gal. New depth 8/5.5 in. Elapsed Time: 1390 min. Final fluid depth 0/0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed N/A "Pump on" level at N/A in Datum N/A Size in gallons N/A "Pump off"level at N/A Cycles tested N/A E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main N/A Sewer /septic service line N/A Animal containment areas N/A SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) N/A in. High water alarm level at N/A in. Meets alarm & circuit requirements? N/A On adjacent lots N/A On adjacent lots N/A Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas N/A Building foundation >51 Property line >5' Water main > Water service line > 10, 10' Wells on adjacent lots >200' ABSORPTION FIELD ON LOT TO: Property line > Building foundation >10, Water Service line Surface water > 100 Curtain drain Wells on adjacent lots >200 F. COMMENTS G. ENGINEER'S CERTIFICATION l 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 Norman K. Gutcher Date —:�/r 4 —/ COSA canarysheet_2-&15.doc Absorption field >5 Surface water > 100' Water main >10 Driveway, parking/vehicle storage O OF ®G3 0• a-' °° .ray � , � e � PPff:acc°naae °nc°°°c°° °ojo PPPPJJffff yy// Y e DOoe�be�Z°Ld:•J°° ° �1 p: Norman K. Guichor CE -49194 19 LOT 4 BLOCK20 N,5.0o 00"E 162• 4" PLASTIC ® RISER (TYP.) G I� v P"AQD 4 ^C,4 I CANT co °i I (TYP-) w ,r RECOVERED 2" AL -CAP (TYP.) DECK w/ STEPS (TYP.) I o zI LOT 3 4.1' ::::N 1 DECK .:i£ 38,939 S.F. WATER :ASPHALT KEY I RIVEWAYx .:::;c;::s:::- a / EPS���N� �cl NAT. GAS -U.G. T&E SHED 17 ui 0 N 0 ui 0 N 3 co LOT 2 0 Z FENCE /— (TYP.) 2.6' 11.7• 'UTILITY POLE w/GUY ANCHOR Rg2{�jx&C) o OOr� 9° P �\ ?OOp �Eg i (C)=CALCULATED DATA x42' D (M)=MEASURED DATA PER ohu OVERHE DA TA UTILITIES LAT U.G =UNDERGROUND T&E=TELECOMMUNICATION & ELECTRIC NAT.=NATURAL FND.=FOUNDATION (TYP.)=TYPICAL 1" — 50• NOTES: 1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY SUBSTANTIALLY COMPLIES WITH ASPLS MORTGAGE STANDARDS. 5. TIES TO PARTIALLY MONUMENTED OR UNMONUMENTED PROPERTY LINES ARE t1 FT. 6. THIS SURVEY PERFORMED FOR SHARON SEVERSON. IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRITTEN CONSENT OF ALASKA RIM ENGINEERING, INC. IS A VIOLATION OF FEDERAL COPYRIGHT LAW. 7. THIS LOT SERVED BY A COMMUNITY WATER SYSTEM. EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ............... eobert•J. Farmer •°o 10615-5 �•. s °•9 �OFESSIONA,- vAa AS—BU IG [EMAP LALASKA RIM ENGINEERING, INC. 9131 E. FRONTAGE RD, PALMER, ALASKA 99645 IL (907)745-0222 : FAX: (907)746-0222 : akrim®alaskarim.com : WEB: www.alaskarim.com WO: 1600173 FB: 16-01 PAGE: 1 of 1 GRID MAP: NW1558 Engineers: Planners: Surveyors I SCALE: 1" = 50' 1 FILE: 1 600173A I HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED UNDER MY DIRECTION ON THE FOLLOWING DESCRIBED PROPERTY: DEER HORN SUBDIVISION, BLOCK 2, LOT 3, PLAT No. 84-179, PALMER RECORDING DISTRICT, PALMER, ALASKA. SURVEYED ON THE 11th OF MARCH, 2016. ©2016 Gmail - Letter of Non -Objection M Gmail Letter of Non -Objection Smith, Larry L. <Larry. S mith@acsalaska.com> To: "CodyFenton84@gmaii.com" <CodyFenton84@g mail. com> Mr. Fenton, Page 1 of 2 Cody Fenton <codyfenton84@gmaii.com> Mon, Apr 25, 2016 at 12:10 PM I received a request for a Letter of Non -Objection for 21993 Deer Park Drive. AC does not service this area. Please contact MTA for this letter as this is within the MTA service area. Thanks, Larry Smith Network Engineering Foreman Alaska Communications 600 Telephone Avenue, MS#14 Anchorage, Alaska 99503 Ismith@acsalaska.com Phone: (907) 564-1812 Cell: {907} 244-01779 www.acsalaska.com cid:mageO©1.gif 61CcC 4D5.CFFE7100 ---- L O__.:_..__._.o------ L_:_L_.. 0.-......-1 ANG/'1M� April 21, 2016 Chad and Sharon Severson 21993 Deer Park Drive Chugiak, Alaska 99567 Dear Chad & Sharon Severson; Subject to your agreement to indemnify the company as set forth below, GO Commmnication Corp has no objection to the monitoring tube encroaching into the telecommunications & electric easement at the west property line of Lot 2, Block 3, Deer horn, also known as 21993 Deer Park Drive, city grid NW 1558. This letter of non -objection in no way precludes GO Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right-of-way, including unlimited access I'm servicing its facilities. Also any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of GCl's facilities to accommodate any or all of the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now and forever, for any damage, costs, expense (including reasonable auomey's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to me at the address below. 7Q��,t��f7/ Sincerely,/J Acceptance Date David D Blehm OSP Design Manager GCI Communication Corp 5151 Fairbanks St, Anchorage, AK 99503 907-868-6769 Office 907-868-8580 Fax M1 NON -OBJECTION TO EASEMENT ENCROACHMENT DOCUMENT By this document Matanuska Telephone Association, Inc. (MTA) declares that it has no objection to the encroachment of an existing septic system in the utility easement of Lot 3, Block 2, Deer Hom Subdivision, Plat Number 84-179, Anchorage Recording District, State of Alaska. Please be advised that MTA through the issuance of this document does not forfeit any of its rights to the use of the area cited. In the exercise of these rights MTA will, if needed, upgrade, maintain, repair, and/or replace buried or aerial telecommunications facilities within the easement. Any repairs that may be required to the encroachment as a result of utility construction will be bome by the property owner of record. This document does not authorize the placement of any additional encroachments within the easement area. Property owners are required to obtain utility locates before doing any kind of work in the utility easements and will be liable for any damages caused by their construction work in the easements. This document is in no way, an agreement to vacate any portion of the utility easement and should not be interpreted as such. Issued for Matanuska Telephone Association, Inc. this 21st day of April, 2016, by, �,ie& OSP Engineering & Construction Manager THIS IS TO CERTIFY, that on this 21 st day of April, 2016, before me the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared Robbie Nash known to me and to me known to be the individual named in and who executed the foregoing instrument and acknowledged to me that he signed and sealed the same as a voluntary act and deed for the uses and purposes therein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day and year first above written. J Notary PubRc n and fq�Alaska My commission expires: 11-20-2018 Matanuska Telephone Association Inc. PO Box 3550' Palmer Alaska 9964?": 3550 800.746.9510 907.761=2510 'i6-761-!646(fax) w .mtasolutions.com Local Long Distance Wireless Business Solutions Internet Directory DTV MATANUSKA ELECTRIC ASSOCIATION, INC. LETTER OF NON -OBJECTION April 21, 2016 Chad J. Severson and Sharon S. Severson P.O. Box 671805 Chugiak, AK 99567 Re: Lot 3, Block 2, Deer Horn Subdivision (Plat 84-179, Anchorage Recording District) Dear Chad J. Severson and Sharon S. Severson: MEA has no objection to the encroachment of a septic system located in the utility easement as depicted on the attached as -built surrey drawing, subject to the following conditions: 1. The improvement will in no way restrict or limit the current or future ability of MEA to fully enjoy the benefits of the easement for any and all utility purposes that it presently enjoys under the easement. 2. MEA will be held harmless by the landowner from liability for any and all damages or injury to any person or property that may result from the existing and future use of the easement by MEA, its contractors, or assigns. 3. MEA will be held harmless by the landowner for any and all liability arising'out of or relating to any use of the easement by others under a Letter of Non -Objection. 4. The landowner will be liable for any damages caused to MEA facilities by the improvement in the easement. 5. The landowner will be responsible for any special construction costs incurred by MEA due to the improvement in the easement. 6. The landowner will assure compliance with all applicable safety codes relating to the improvement in the easement. 7. Use of this letter by the landowner, their successors or assigns will constitute acceptance of these conditions. 8. Alteration of these conditions shall invalidate this letter. 9. This letter is not effective unless it is recorded in the Anchorage Recording District before ownership of the referenced property is changed from the above named landowner. Sincerely, Keith Quintavell Right -of -Way Administrator STATE OF ALASKA)SS- THIS IS TO CERTIFY that on this 22 day of April , 2016 before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared Keith Quintavell Known to me and to me known to be the individual(s) named in and who executed the foregoing instrument and acknowledged to me that he/she/they signed and sealed the same as a voluntary act and deed for the uses and purposes therein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day „and year first above written SEAL BLOCK 0 \\ NTS Do E te' � 1 4wv wl q 3 WATER KEY 25' 61 �r n I CANT n r (TYP•) � I s rI LOT 3 38,939 S.F. DECK r II AEpS (TYP') ui � 3 cli W/ o () g LOT 2 �o Z AT. GAS FENCE v �(TYP•) 4" PLASTIC ® RISER (TYP.) �4 G O . � pG 26� / I pOry 4wv wl q 3 WATER KEY 25' 61 �r n I CANT n r (TYP•) � I s rI LOT 3 38,939 S.F. DECK r II AEpS (TYP') ui � 3 cli W/ o () g LOT 2 �o Z AT. GAS FENCE U.G. T&E �(TYP•) SHED 2 6' a.' — NAY:i::.UTILITY POLE : `0--::... w/GUY ANCHOR i.• R6�C� w0, _ pA� LEGEND: � 56 'yi R i (C)=CALCULATED DATA 0 (M)=MEASURED DATA (R)=RECORD DATA PER PLAT ohu=OVERHEAD UTILITIES U.G.=UNDERGROUND / T&E=TELECOMMUNICATION & V ELECTRIC NAT.=NATURAL FND.=FOUNDATION (TYP.)=TYPICAL NOTES: 1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY do IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY SUBSTANTIALLY COMPLIES WITH ASPLS MORTGAGE STANDARDS. 5. TIES TO PARTIALLY MONUMENTED OR UNMONUMENTED PROPERTY LINES ARE ±1 Fr. 6. THIS SURVEY PERFORMED FOR SHARON SEVERSON, R SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRITTEN CONSENT OF ALASKA RIM ENGINEERING, INC. IS A VIOLATION OF FEDERAL COPYRIGHT LAW. 7. THIS LOT SERVED BY A COMMUNITY WATER SYSTEM. EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS. OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. AS -BUT 9 '49TH ;ir RE ALASKA RIM ENGINEERING, INC. 9131 E. FRONTAGE RD. PALMER, ALASKA 99645 PH: (907)745-0222 : FAX: (907)746-0222 EMAIL: akrim®alaskarim.com : WEB: www.alaskarim.cor W0: 1600173 FS: 16-01 PAGE: 1 of 1 GRID MAP: NW1558 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 r , Certificate of On -Site Systems Approval Parcel I.D. 051-042-82-000 Expiration Date: - 61 1. GENERAL INFORMATION Complete legal description Deer Horn Block 2 Lot 3 Location (site address) 21993 Deer Park Drive Current Property owner(s) Christopher L. Sells Day phone 907-538-6080 Mailing address 21993 Deer Park Dr. Chugiak, AK 99967 Real Estate Agent Heather Damassiotis 2. TYPE OF DWELLING: E] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 _ Day phone 907-830-6540 ptt'olov' K, raUC� 2 �2�14 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual i1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System i] Public Sewer WaiverNariance request Received by. Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 526 Waiver Fee $ Date of Payment L/ C �ajD1$yyJ Date of Payment Receipt Number 11i 6 6) . Receipt Number COSA#_ 05ctg11453 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 Alaska Rim Engineering, Inc. Address 9131 E Frontage Rd. Palmer, AK 99645 Engineer's Printed Name Norman K. Gutcher 6. DSD SIGNATURE __j,Z System #1 Approved for L� bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Phone 907-745-0222 DA%8/28/8/28/14 OF A4 %%W Norman K. Gutcher ; CE .4919 mPRQFESSlO���m bedrooms, with the following stipulations: By: ® Le . Original Certificate Date: The nici 'i�of� nchorage 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 N/A Septic System Advisory ,�_ Arsenic Advisory N/A Well Flow Advisory N/A Other COSAUuesheet r , 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: Deer Horn Block 2 Lot 3 A. WELL DATA Well type Public Total depth Date of test Static water level Well production WATER SAMPLE Coliform Parcel ID: 051-042-82-000 If A, B, or C provide PWSID # 213001 Well Log (YIN) Sanitary seal (YIN) _ Wires properly protected (Y/N' Cased to ft. Casing height LOG AT 00 mL Nitrate ug/L Date of sample: ft. ft. g. p. m. g.p.m. mg/L Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1259 gal. Number of Compartments 2 Foundation cleanout (YIN) Xy Depression over tank (YIN) N Date of pumping N/A Pumper New Tank C. ABSORPTION FIELD DATA Date installed 8/14/84 Length 38 ft. Date installed 8/28/14 Cleanouts (YIN) Y High water alarm (YIN) N/A in. Soil rating (g.p.d./ftZ or ftz/bdrm) 150 ft'/bdrm System type Absorption Bed Width 24 ft Gravel below pipe .5 Total depth 5.9 ft. Eff. absorption area 912 if 8/05/14 Monitoring tube Y Depression over field N Date of adequacy test Results (Pass/Fail) ft. For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 669.3 gal. New depth 4 in Elapsed Time: 15 min. Final fluid depth 0 in. Absorption rate >=.600+ g p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes. give date N/A Date installed "Pump on" level at in. Cycles tested E. SEPARATION DISTANCES N LOTTO: Septic tank/lift To Absorption field on lot Public sewer main Sewer /septic service ' _ .&W ontainment areas level at Meets alarm & circuit On adjacent lots On manhole/cleanout Holding tank \ Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: , Building foundation >51 Property line >5 Water main >10' Water service line >10' Wells on adjacent lots >200' ABSORPTION FIELD ON LOT TO: Property line 0 Building foundation >10 Water Service line >10' Surface water >100' Curtain drain None known Wells on adjacent lots >200' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Norman K. GutCher Date 8/28/14 COSA brown sheet 10-10-12.doc Absorption field >5' Surface water >100' Water main >10' , Driveway, parking/vehicle storage in. cnpm Z0,1m sen mWT ead(c srmAa( UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTA13USHING BOUNDARY OR FENCE UNES, THE SURVEYOR TAKES RESPONSIBIUTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURWY SURVEY TYPE SYMBOLS ❑ FOUNDATION AS -BUILT C1FINM, STRUCTURE AS -BUILT SET REBAR y DRAINAGE ASPHALT M X METAL FENCE WOOD DECK I o FOUND REBAR g__"''°®'"" F-1 PLOT PLAN ... AS -BUILT ... IAT 5RE... TOPOGRAPHY pO n ASSUMED ELEV. -)E-.g_e WOOD FENCE ® A$ -BUILT ... NO CQRNDiS Ei OCR CERTFlCATdN AS -BUILT CONCRETE AS -BUILT ... NOCORNERSSET PLOT PLANS & LOT SURVEYS IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. IURVEY CERTIFICATION I PLAN on o ar w ens wN a mY I "J� • Robert E. Johns, Jr. & No- Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 4 Scale: 1„ C 50, FOUNDATION AS -BUILT r •••?'• •• ••• •^ '•w• orarn by RE3 Chocked bSMK Date Drawn: 7/21/14 Pam on M -Fr I�YW of M1 W.D. 14-338 1 ranNl{fl m 0. kl eN eql A M. anewaa ew emmau.r m wsa, I,+..,' = ••••,•,,, �, •• ROBERT E. •, JR. w tw aH m b .bt Wr . AS �,'3s '•,• 4 S FlNAL STRUCTURE -BUILT 'B I. R. E MI..Y.. 1w,0Y 41R(y eat 1 —1 of Bow M'M^M m ArdA< ur MaM a q4 bt wa Yw1 sv W •'. '•,•. •••••• ♦f♦+a . /F�•• sir,.l°n. u,a eivm°un a f— bw s+< ne wumrN.,Y+b aW WM. of ssknot_ �\ Lo / ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN, FENCES, WELLS. SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED, ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 1 Scale: 1„ C 50, Rec. Lot S.F. Rec. Plat rile No. °°" Surveyed- 7/21/14 orarn by RE3 Chocked bSMK Date Drawn: 7/21/14 Grid: 1558 W.D. 14-338 1 Legal Description LOT 3 BLOCK 2 DEER HORN Municipality of Anchorage *AE Development Services DepartmentBuilding Safety DivisionOn-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. 051-042-82 COSA #�'%� L -5-5 Expiration Date: _ 1-7 1. GENERAL INFORMATION Complete legal description DEER HORN BLOCK 2, LOT 3 Location (site address) 21993 DEER PARK DRIVE CHUGIAK AK 99567 Current Property owner(s) BRIAN ROCERS & AMANDA RICHMOND Day phone Mailing address 107805 E 297 PR SE, KENNEWICK, WA 99338 Lending agency » Mailing address Day phone Real_EstateAgent_____----LES_BAILE-Y---&ASSOC_ ______ --_--__------Da hone__ ------_-- __ Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS 4,. 4 a 3. TYPE OF WATR.SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water St©rage.. ❑ Individual Holding Tank ❑ Community Class Well' ❑ Community On-site Public Water System ® Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 ARCTERRA CONSULTING INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 11/30/11 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The now and absorption rates may change due to subsurface conditions. that may not be observed from the surtace - changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and thd water usage of the family being served by the system. The operational fife of all well and septic systems and subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen -S := encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for _ H bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the following stipulations: �cY OF . J ON-SITE • �i WATER AND WASTEWATER = cglio� 'N rvTs Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other BY: Original Certificate Date: I / (Rev. 11/05) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: DEER HORN BLOCK 2, LOT 3 Parcel ID: 051-042-82 A. WELL DATA Well type PUBLIC If A, B, or C provide PWSID # Date completed Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level ft. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION Well production g,p,m. WATER SAMPLE RESULTS: Coliform colonies/100mL Nitrate mg/L Other bacteria Arsenic: mg/I Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA ft. colonies/100 mL Tank Type/Material fttic/Steel Date installed 1984 Tank size 1250 gala 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 1130 1 Pumper JRs C. ABSORPTION FIELD DATA Date..installed jj 4 984 .Soil rating (g.p.d./ft2 or ft fbdrm)150 System type BED Length 38ft. Width 24 ft. Gravel below pipe 0_5 ft. Total depth 5_3 ft. Eff. absorption area`912 ft2 Monitoring tube Y Depression over field N Date of adequacy test 11/09/2011 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 730 gal. New depth 2.5 in. Elapsed Time: 15 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots ' Public sewer main. Public sewer manhole/cleanout Sewer /septic serviceOne Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 51+ Water main 101+ Water service One 101+ Surface water 1001+ Wells on adjacent lot ` 2001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One 101+ Building foundation 101+ Water main 10'+ Water Service line 101+ Surface water 100'+ Driveway, parking/vehicle storage 101+ Curtain drain 50'+ (None Known) Well on adjacent lots 2o0'+ F. COMMENTS Vacant system surchareed with 2000 gallons nnor to test_ G. ENGINEER'S CERTIFICATION I cert' that I have determined through field inspections and certify ... review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date.` ., Engineer's Printed Name KENNETH M. DUFFUS Date 11/30/11 ' : :.J COSA Fee $490.00 Waiver Fee $ Date of Payment LJ /Z -Z- �/ Date of Payment Receipt Number D 25 ---7:;,OD Receipt Number (Rev. 11 /05) 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 -BK:Ea r Wein3et CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D._D51-042-132 COSA# h(d)A-4a- Expiration Date: 6 — 2 - Z 1. GENERAL INFORMATION Current Property owner(s) DFNNIS RASH _IR- Day phone 632-5593 Mailing address Lending agency' . - Day phone Mailing address Real Estate Agent Day phone Mailing Address 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 A Well Public Water System 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. TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding Tank ® Community On-site ❑ Public Sewer n 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. ..1 Engineer's Printed Name KENNETH M- DUFFIIS Date 6/23/06 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes Inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for 4" bedrooms. Disapproved. 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 PROGRAM By:, Original Certificate Date: (t«. tvos) i Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program ' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: DEER HORN BLOCK fY LOT ' : 3 Parcel ID: 051-042-82 A. WELL DATA Well type CLASS 'A' If A. B, or C provide PWSID it 213001 Well Log (YIN) Date completed Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: rLi Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION Coliform colonies/100mL Nitrate mg/L Other bacteria /Trr"I mgA Date of sample: Collected by., S. SEPTIWHOLDING TANK DATA ft. colonies/100 mL Tank Type/Material Septic/STEEL Date installed 8/14/1984 Tank size 1250 gal. Number of Compartments 2 Cieanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N_ Date of pumping le�gl2ee� s Pumper IRs C. ABSORPTION FIELD DATA Date Installed 8/14/1984 Soil rating (g.p.d./Rzorfe/bdrm) 150 System type BED Length -a ft. Width -?Aft. Gravel below pipe 0.5 ft. Total depth 3,1 ft. Eff. absorption area 912 ftp Monitoring tube Y Depression over field N Date of adequacy test 6/23/06 Fluid depth in absorption field before test 0 in. Elapsed Time: .a min. Final fluid depth.Q in. Results (Pass/Fail) PASS For A bedrooms Water added 630 gal. New depth -Z jn. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date----- D. LIFT STATION Date installed_ Size in gallons Manhole/Aocess (Y/N) `Pump on" level at in. 'Pump off" level at—in. High water alarm level at—in. Datum Cycles tested Meets alarm & circuit requiremenlsZ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manureianimal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 10 0' + Wells on adjacent lob 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10 ' + Water Service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 1 0'+ Curtain drain 50'+ Wells on adjacent lob 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 4r*, ^ ••r ''•;'i w' 1 certify that I have determined through field inspections and4 1 ��.review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date.. _ _ e . Engineer's Printed Name KENNETH M. DUFFUS Date 6/23/06 COSA Fee Waiver Fee $ Date of Payment lY Date of Payment Receipt Number, 8 sb 3 Receipt Number (Rev. 11M5) Municipality of Anchorage Development Services Department .W Building Safety Divis:cn .. 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///' Parcel I.D. �.S I— bf�c�— $a HAA# 1. GENERAL INFORMATION Expiration Date: Z _ z 0/ Complete legal description DEER HORN SUBDMSION• LOT 3, BLOCK 2, Location (site address or directions) 21993 DEER PARK DRIVE * CHUGIAK, AK 99567 Current Property owner(s) VALERIE WOSK Day phone 688-2243 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 21993 DEER PARK DRIVE • CHUGIAK, AK _99567 Day phone AUDREY hIASON w/ RElAAX PROPERTIES Dayphone 694-4200 16600 CENTERFIELD DRIVE " EAGLE RIVER, AK 99577 Unless otherwise requested, HAA 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ S j L)' at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal atExed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Health AuthorityApproval Guidelines for this application, shows that the onsite water supply and/or wastewater disposal system is(am) 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 tilos and from my investigation and Inspection, the onsite water supply and/or wastewater disposal system is(am) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address , 6901 DEBARR ROAD, SURE 2B • ANCHORAGE, AK 99504 Engineers Printed Name JEFFREY A. CARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. 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 underthe conditions encountered at the time of the test and separation distances measured to readily Identifiable features. The operational ride of all wells and septic systems depend on the local lolls 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 fest results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provido 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 Por 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 R confer any legal right whatsoever. 5. DSD SIGNATURE .X_ Approved for 4- bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist mac_ Septic System Advisory Well Flow Advisory 337-6179 Date It Lo of bedrooms, with the fiVMng stipulations: Manitenance Agreements Supplemental Engineers Reort Other OGRgAri N By:�ll SLA /. Original Certificate Date: (Rw. 12C0) Municipality of Anchorage Development Services Department Buts ft Safety msion O"b Wdw& Wastewater Program 4700 south erapew SL P.O. Box 198850 Anchorage, AK 99519 850 W ww.d.anehorageakus (907)943-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Lem DaWpnom DEER HORN SUBDIVISION: LOT 3. BLOCK 2. Peroel ID. A. WELL DATA wen type W K A. B, or C provide PWSIDl kl—=1 Dain completed sanimry seal Cased to t FROM WELL LOCI Date of test Smtcmamr level t wen production —a—pm WATER SAMPLE RESULTS. Conform – oolontesM00 ml. Nitrate – mgA. Dam of sample: S. SEPTICh1OLDING TANK DATA wen :u 7,1 Casing hel& (above ground) in. AT INSPECTION Offer bacteds – cotonies/1C10 ml. Tank TyWMemriai STEEL Data installed 8/14/84 - Tank atm 1250 gal. Number of Compartments 2 Cleanoum (YIN) YES Foundatim deanout (Y/N) YES Depression over tank (Y" NO Mph water alarm (YIN) N/A Data of pumping 11/9/2001 Pumper JWS PUMPING C.- ABSORPTION FIELD DATA Date kfafaned 8/14/1984 SO ramp (9.p dm'or(1�0150 Sygm type BED Length 38 tL Width 24 t Gravel below ape 0.5 t Total depth —1.-3–A EN. absorption area 912 ft' Monitorirfg tube YES Depreaelon over ffeld NO Date Of adequacy test 10/28/01 Raub (Pass/Fan) PASS For 4 bedrooms FhAd depth in absorption field before teat 1 in. Water added 774 gal. New depth 6 In. Elapsed Time: 180 m1n. Final Auld depth 1 in. Absorption rate a. 500+ g.p d. Any rejuvenation treatment (past 12 mo.) (YIN 6 type) NONE KNOWN If yea. gWe date – D. UFT STATION Date installed Size In 960" •Pump oM level at---Jn. E. SEPARATION DISTANCES High water alarm level at In. Cycles mated Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankMft station on lot Absorption field on lot Public sewer main COMMUNITY WATER SYSTEM On adjacent Ca Public sewer manholatcleanout Holding SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 50+ Property One 5'+ Absorption field 5'+ Water main 10'+ Water service u0—* 10'+ Surface water 100'+ Wells on adjacent lots 200'+ *PER INSPECTION REPORT 40 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: SEE ATTACHED bet ONE W*M!R tr--T'i�- Property One •10' Building foundatlnn t o'+ Water main 10'+ Water service Ong ` 10'+ Surface water 100'+ DOveway. parld*Whide storage 10'+ Curtain drain NONE KNOWN Walls on adjacent lots 200'+ F. COMMENTS *PER PREVIOUS INSPECTION REPORT ** See Amt's ,Ar=D A.J—B.atL r- Owb- 0. ENGINEER'S CERTIFICATION r cerg& that I have deternifned through Ile/d brspectrons and K1.1.Q tri review of U~ records that The above systems are In ....... conformance with MOA HAA guidelines In effect on this date. A. Englneer'a Printed Name JEFFREY A. GARNESS —7953 1 • Data �••p-• +....._w� b� HAA Fee S 3010 • 0'O Date of Payment / / – Receipt Number O/oi 796P OW -000 Waiver Fee $ Date of Payment Receipt Number ALASKA WATER & WASTEWATER CONSULTANTS, INC. November 12, 2001 Municipality of Anchorage Department of Development Services On -Site Water & Wastewater Program 4700 South Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Lot Line and Standpipe Concerns for the Septic System on Lot 3, Block 2, Deer Horn Subdivision. To whom it may concern: The subject lot has a 4 bedroom house on it which is served by a Class "A" water system and a private septic system. The septic system consists of a 1250 gallon septic tank and a bed type drainfield. According to the inspection report, there were two monitoring tubes installed in the drainfield. During our site visits, only one monitoring tube could be found. The current homeowner, Valerie Wosk, is the original owner of the property who had the house built in 1984. According to Ms. Wosk, she has never seen two standpipes for the drainfield. Ms.Wosk has personally done extensive landscaping in the area over the drainfield and is very familiar with the area. Attached is the most current as -built survey. The monitoring tube shown on the as - built survey is 10 feet from any lot line; but we are unable to physically verify that the drainfield is 10 feet from any lot line or if it is in the utility easement located along the west property line. According to the inspection report, the drainfield is 10 feet from all lot lines - If you have any questions, please contact us at 337-6179. >A "'Cr e 'n4a-r- —T -'+F 1St 1iv�0� 6901 Debarr Road, Suite 2.13 • Anchorage, Alaska 99504 Ph: (907) 337-6179 0 Fax: (907) 338-3246 • Website: akwwc.com Sent By: RE/MAX OF EAGLE RIVER, INC.; 9076960214; NOV-8-01 11:58AM; Page 2/2 M ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY AND THAT NO ENCR&ZlQENTS 'EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS,COVENANTS,'OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNdER NO CIRCUMSTANCES .SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. /ayo OF At P r. 9g •� Du.n. AYr� }wird ;' it DRAWN, Sent By: RE/MAX OF EAGLE RIVER, INC.; 9078960214; Oct -20.01 12:18AM; Page 2/2 .nF�ecr AOR r Yr rte. oK' v; x N SCALE /0•4p• Cz o �Ga 00 ...r. •• 15 •po,op �„ . • �� RJc*1 ,` ybS EASEMENTS OF RECORD, OTHER THAN 9 E THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON... -ASSUI T, THE INFORMATION HEREON IS FOR THE USE OF • �LENOING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES ANO PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADOITIONAI. STRUCTURES OR FENCrEUNES. . No corners set K,FGrRTIFY 9,C'.,/0wW50t/ ASaUrLT DATCD 0-/S•40r4 I AVOW daMy that 1 have surveyed the ronowklg described property. Lot 3 Bloat 2 DEER HORN SOSO. Anchorage recording district Alaska. and that the Improvements situated ther000 are within the property lines and do not overlap or wcroach on to property lying adjacent thereto, tut no Improvements on property lying adlecent thereto encroach on the premises In question and that there are no roadways. transmission lines or other visible easements on said property except ea Induted Mason. Anhorspe, Atasks a AUG. 200/ I1h� 6A/D NW1558 Book pg f,« W r`, MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMNTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date11-3 1,9 Ite (a) Legal Description (include lot, block, subdivision, section, township, range) / 4 rr .7 r% � � I- I . Location (address or directions) T/S SCJ A<� (b) Applicants Applicants Address IJ V Telephone - Home Business (c) Applicant is (check one) Lending Institution Q ; Owner/builder Buyer E::l ; Other [-::I (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. d Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family M Multi -Family Other (describe) Number of Bedrooms 3. Water Suool - 11nef1-lu"V✓J $ Cl4ry iQ Individual Well Q 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 z Public _ Community Q Holding Tank Q 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 21 l'�N 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 regula- tions in effect on the date of this inspection. Name of Firm Ir Da 6. DHEP Approval Approved for bedrooms =17 (ENGINEER SEAL) Approved �_ Disapproved 1 Terms of Conditional Approval CAUTION Telephone THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRON`LrNTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATION'S GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DREP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 r A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) 14 Well Classification If A, B, or C, Well Log Present (Y/N) Date Colpleted Total Depth Cased to Static Water Level Pump Set At CHECKLIST — FEBRUARY 1984 MUNICIPALITY OF ANCH^�A'%F. DEPT. OF HEALTH t ENVIRONMENTAL PROTK �v SEP 1 3V811 RECEIVED Legal Description: 3 B Z c72 Ab D.E.C. Approved(Y/N) Yield Depth of Grouting Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (YM) Depression Around Wellhead (Y/N) Separation Distances from Wall: To Septic/Holdirg Tank on Lot 260 On Adjoining Lots To Nearest Edge of Absorption Field on Lot280 7 Cr Adjoining Lots To Nearest Public Sewer Lire To Nearest Public Sewer learout/Marhole To Nearest Sewer Service Line on Lot 'Watple er;_SanCollected By Date Watei Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Instal / B Sine12-5-0 No. of Conpartments 2 Stardpipes (Y w Air -tight Caps (Y Foundation Cleanou (Y ) Depression over Tank ) Date Last Pumped /lJ e LcJ Pumpirg/Maintenanoe Contract on File (Y )/v 4 ; for ►� Holding Tank High -Water Alarm (Y/N)� r+ Temporary Holding Tank Permit (Y/N) AJ � Separation Distances from Septic/Holding Tank: To Water -Supply Well ZD 0 -/- To Building Foundation 22 To Property Line /49 To Disposal Field 4445- To LsTo Water Mair,/Service Line�,.�� 77� To Stream, Pond, Lake, cr Major Drainage Course / Comrents Receipt $ Date Paid: Amount: [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata .SCS Q Type of System Design Date Installed �� / q 4c Length of Field �B 1 Width of Field 2 C{ Depth of Field ravel Bed Thickness _ Square Feet of Absorption ea q�2 Standpipes Present Depression over Field (X Date of Last Adequacy Test Results of Last Adequacy I+est N e Separation Distance from Absorption Field: if i t, 'W e c4J To Water -Supply Well Z yL To Property Line / D To Building Foundation SO To Existing okra Abandoned System a: Lot /i Z/a- ; On Adjoining Lots Jd / To Water 4tair/Serviee Lire ,FO / To Cutbark(if present) !✓ � ✓} To Stream/Pond/Lake/or Major Drainage Course P `{4 To Driveway, Parking Area, or Vehicle Storage Area Z 0 cons, nts D. LIFT STATION Date Installed Dimersiors Size in Gallons Manhole/Access (YM) "Pump Or." Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets hDA Electrical Codes Ccmmnts *.* Check Permitted Bedrocm Rating Agairst HAA Request ** I certify thve checked, verified, or conformed to all MOA HAA Guidelines in effect on the da of icn. I _ Signe Date Company, S 8 £ elsimsm Nn MOA No. X a(f RIVER. AUS:C1 Zs77 KB1/d5/ PN. (Page 2 of 21 w ,4 Mmrrm A. 51%.hrto. 1157.2 2-15-84