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Home My WebLink AboutPREUSS #2 BLK 4 LT 4Pr s #2 Block 4 Lot 4 #050- 571- 45 Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:/Avww.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131161 PID Number: 050-571-45 ❑ New ✓❑ Upgrade Name: Aaron and Samantha Ellison ABSORPTION FIELD 0 Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 10127 Eagle River Lane Eagle River, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 632-9701 3 -8 GPD/SF 11-14 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5-8 Ft. Gravel depth beneath pipe 6.OFt. Subdivision Block Lot Preuss No. 2 4 4 Fill added above original grade 1-3 Ft. Gravel length 55 Ft. Township Range Section Gravel width 5-7Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 660W One Ft. Well >100' >100' NIA N/A >25' TANK ElSeptic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity I 1,000GaI. Surface Water >100' >100' N/A N/A Material Steel Number of compartments Two Lot Line >5' >10' N/A N/A NA Foundation >5' >10' N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain None Noted RemarksFlow Diverter Valve Buried. New Trench Only Pump on level at in. Pump off level at in. High water alarm at in. to be Tested for Future Septic System Certifications. Pump make and model Electrical Inspections performed by Installer PIPEMATERIAL Housetotank D3034 Tank to D3034 drainfeld G & R Excavating Drainfield HDPE CO/MT D3034 Inspector MEA BENCH MARK (Assumed elevation) 100.Oft Inspection ,� dates: 1 6127113 2n° 6/28/2013 Location and description 3" 6/29/2013 a" 6/30/2013 Upper Deck Column Support NE Corner COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin ' F'•••.�•q�,QS��j Conditional Approval: Date AIX, *; 49�a ;* 00 .. ....... y.. N N . . ••.N) �,�• , %MICHAEL E. ANDERSON... : � ♦ CE - 4381 ,�f��f y� 3 -/T.•'�a�® Approved Date Inspection Rep rt_1- -12. oc 'S 0� EAGLE RIVER LANE DM rM I—II ° 3 0 / N 00'08'00"W 120.0' p c o m T J N coa W aJ 10' Utility Ease ent --------------------------- m o F ------- � o c OJ — x yr ® O 3 / X N mN a 3 F � 3 O (n NJ N • n m A n � n n U) cn yam dim F- ® N N O to ��108 -I x N A N o J O N 10' Utility Easement— O 'TI A w Oo a> Oo N a> W D I W z 0 an / �m0 �`imom w mu / r^ ° o_� mrnC3/ V J rn I o H °°aa an W En / / I—II ° 3 0 / d 0 a1 p c o m T J N coa W aJ C N ° o F z � o c OJ — O 3 / N mN a 3 F � O J w TINn—TIK r <COpx O� m I I I I I I I 0 w M -2 o6 0 0 0 Z Dan, O c mo O 1J O O O O c J m O C N 00°08'00"W 120.0' N -a m 3 z 3 0 W A V 0 O m 3 O CD O ;om 0< Qm 0 0. mm3. mm <o 0 D �m0 N 0 0 apo l°mv 0D(D M W m wZ v CD A / 3 N I x cq Om — O 3 / NJ N • n A n D x yam dim F- ® N N O to ��108 -I x r. �G5 J O O o J O N 10' Utility Easement— N 00°08'00"W 120.0' N -a m 3 z 3 0 W A V 0 O m 3 O CD O ;om 0< Qm 0 0. mm3. mm <o 0 D �m0 N 0 0 apo l°mv 0D(D M W m wZ v CD A Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP131161 94.7 U fnI 101.5 99.0 88.7 82.0 Finished .15 101.1 iq _y UU LL 1,500 Gallon Septic Tank p? 10'. II 99.0 101.8 II /, (;eOtpYtile FAhric No Groundwater 6-28-2013 Drainfield Rock 85.0 u 88.7 PROFILE AS -BUILT - No Scale Page 3 of 3 PID No. 050-57145 104.6 � U / 94.7 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 DEPTH (tee[) 1 - 2 3 4 5 6 7 8 9- 10- 11 12- 13- 14- 15- 16- 17- 18- 19 - SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOTS 4, BLOCK 4, PREUSS SUBDIVISION No. 2 PERFORMED FOR: AARON ELLISON DATE: 6/18/2013 PROJECT No.: PARCEL ID#: TECHNICIAN: J. BERKRAM TEST HOLE 2 OB/OG v d SILTY SAND d WITH GRAVEL SM/GM v . DRY I 'dI MEDIUM DENSE d SLOPE - 49th E. ANDERSON SITE PLAN SEE SHE PLAN R S WAS GROUND WATER ENCOUNTERED? NO IF YES @ WHAT DEPTH? DEPTH OF WATER AFTER MONITORING: NONE 2% A DATE OF MONITORING: 6/28/2013 PE DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 6/19 1 2:45 3.25" 2 3:15 30 6.00" 2.75" 3 3:17 3.13" 4 3:47 30 5.63" 2.50" 5 3:49 3.25" 6 4:19 30 5.75" 2.50" PERCOLATION RATE: 12 (MIN/INCH) PERC. HOLE DIA. V (INCHES) TEST RUN BETWEEN: 5 FT. and 6 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 6/21/2013 Permit Number: On -Site Wastewater Disposal System Permit OSP131161 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 Tax Code Number: 05057145000 Work Type: Septic Permit Effective Dates: June 27, 2013 to June 27, 2014 Design Engineer: ANDERSON ENGINEERING Subdivision: PREUSS #2 Site Legal Address: PREUSS #2 BLK 4 LT 4G:0056 Owner/Address: ELLISON AARON L & SAMANTHA 10127 EAGLE RIVER LANE EAGLE RIVER AK 995778460 Site Mailing Address: 10127 EAGLE RIVER LN, Eagle River This permit is forthe construction of: Y Disposal Field N Septic Tank N Holding Tank N Privy 6/a? /�3 a: O -d TOv.' k 6, /Z" /ri W. la Lot Size in Sq Ft: 22620 Total Bedrooms: 3 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. Special Provisions: 7 -Day groundwater monitoring shall be completed to substantiate the permitted drainfield design. If the findings do not substantiate the design, the drainfield shall be constructed per an approved change order based on the new monitoring results. Monitoring results shall be submitted with the final inspection report. Received By Issued By: C01 rtvw Ae dray Jae ( J, MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program r RUSH! ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 050-571-45 Property owner(s) Aaron and Samantha Ellison Day phone Mailing address 10127 Eagle River Lane Eagle River, AK 99577 Site address Same Legal description (Sub'd., Block & Lot) Preuss #2, Block 4, Lot 4 Legal description (Township, Range & Section) Lot Size 22,620 Sq. Ft. Number of Bedrooms Three (3) r RUSH1 45Z-1701 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Q Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ElUpgrade 0 Duplex ❑ (D) Holding Tank ❑ Renewal F-1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 16101tat[ei Permit/Rush Fees: 4 8 (18 . Waiver Fees: Date of Payment: 67M'///,? Date of Payment: Receipt Number: 6g3je?4T Receipt Number: Permit No. LISPOZI&I Waiver No. Permit App_9-1-12.doc Municipality of Anchorage Development Services Division On -Site Water and Wastewater Program fient ,`o S r y r' tib..... epartment **** VARIANCEIWAIVER REVIEW **** Waiver#: OSP131190 COSA#:OSC131302 Permit#:OSPI31161 PID#: 050-571-45 Legal Description: Preuss #2. Block 4. Lot 4 Engineer: Anderson Engineering Applicant: Aaron Ellison Your request for a waiver of the required 10 feet horizontal separation from the proposed absorption field to the existing absorption field has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. .................................................. a ................. ........... Waiver is Granted: X Waiver is not Granted: Date: Approved b P Name of Reviewer ............................................................................... Rec#: Q SSL. Amount: $200.00 Date Paid: 71812013 **** VARIANCEMAIVER REVIEW **** 0 -01 - ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX July 1, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 4, Block 4, Preuss Subdivision No. 2 Absorption Trench to Ground Contours Dear Onsite Services Engineer: The existing septic system on Lot 4, Block 4, Preuss Subdivision No. 2 was poorly constructed and poorly documented. The exact location of the trench is impossible to locate and was not constructed to the configuration of the inspection report completed by the City in 1980. The trench was encountered at two locations although no distribution pipe was ever seen. The new trench was realigned to provide as much separation from the old trench as possible. Unfortunately this meant placing the trench perpendicular to the ground contours for approximately 20'. The absorption area of the trench remains entirely in the percolation zone identified in the design. Placing the trench perpendicular to the ground contours for 20' will have no adverse impact on the soil absorption rates or surrounding properties. We therefore recommend the waiver be granted. Sincerely, Michael E. Anderson, P.E. to MICHAEL E. ANDERSON No. CE -4381 . Coi ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) July 1, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 4, Block 4, Preuss Subdivision No. 2 Absorption Trench to Absorption Trench Dear Onsite Services Engineer: The existing septic system on Lot 4, Block 4, Preuss Subdivision No. 2 was poorly constructed and poorly documented. The exact location of the trench is impossible to locate and was not constructed to the configuration of the inspection report completed by the City in 1980. It appears the trench has approximately 24" of drainfield rock. We will remove the rock and contamination and replace it with a dense silt plug for a minimum distance of 6' from the new absorption trench. This will provide sufficient separation distance to prevent effluent intrusion into the new trench. The existing trench will eventually dry out. It cannot be used on a full time basis in the future to serve the effluent disposal requirements of the house as it is undersized and not as described in the City inspection report. We therefore recommend the waiver be issued to allow 6' separation between the new and the old absorption trench. Sincerely, tylli,J Michael E. Anderson, P.E. fir• 49th _.` MICHAEL E. ANOERSON No. CE -4381 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) June 21. 20133 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 4, Block 4, Preuss Subdivision No. 2 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer The existing absorption trench on the subject lot has failed and must be replaced prior to the issuance of a Certificate of On Site System Approval (COSA). We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the three-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic system. The existing Septic Tank will be uncovered, inspected and verified suitable for continued use. The existing absorption trench will be left intact and tied to the new system with a flow diverter valve. Also identified on the plans are the locations of the existing well on this and adjacent lots and adjacent septic systems. No conflicts exist between the proposed septic system and the wells on this or adjacent lots. Protective radii are shown to the adjacent wells. Ground contours are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole placed on the lot indicated Silty Gravel with Sand (GM/GP) to a depth of 17'. No groundwater was encountered and none has developed during the monitoring period. The percolation rate in the GM soil lense was determined to be 15 minutes per inch. We have designed the new trench with an application rate of .8 gallons per day per square foot. We are proposing to place a 47' long by 3' wide absorption trench with a 6' effective depth. The total depth of the system will be 11' with the distribution line at 5' below the existing surface. A flow diverter valve will be placed to tie the existing trench in for possible future use. The ground surface on the lot slopes to the southwest in the area of the absorption trench. The trench will be placed parallel to the contours of the ground as much as Lot 4, Block 4, Preuss No. 2 June 21, 2013 Page Two possible and in conformance with design criteria. A minimum of 100' will be maintained between all components of the septic system and the proposed well and from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: ]. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, ni.-O-L Ems_, Michael E. Anderson, P.E. Attachments I I r I I I I i I t I\iV \ w r >1 % LLJ, \\ / Q \ LJ \\ 1 � ' 1 1 / \ / \ DAVID AVENUE ••��0 O �i . . .th •? I� %..................... • SITE PLAN • MICHAEL E. -4381ANDERON � •1,'�� No. CSE -438t ' �a SCALE V = 80' �1•,I, .`SS I I' 1 [aq M , I 1 I I 1 / LOT 7, BLOCK/4 1 1 I �w I I I I I LOT 3, BLOCK j4 LOT 8, BLOCK 4 � Included w/Lot 7 I I I y, 1 �L_ I I LOT 9/! BLOCK 4 I e I I I / \ 1 ' I LOT 5, LOCK 4 L0�'\10, BLOCK 4 i / \ I I r I I I I i I t I\iV \ w r >1 % LLJ, \\ / Q \ LJ \\ 1 � ' 1 1 / \ / \ DAVID AVENUE ••��0 O �i . . .th •? I� %..................... • SITE PLAN • MICHAEL E. -4381ANDERON � •1,'�� No. CSE -438t ' �a SCALE V = 80' �1•,I, .`SS I I' 1 [aq M , I 1 I I 1 / LOT 7, BLOCK/4 .rrq�® ��•SI9 ,QST ,��1 � '•' I: '••. 111 �10 ♦ m m. `•., o ''ri EAGLE RIVER N '08'00")l LANE 20.0) OOr�D��< 3St� 0 FnF o m m♦110 0 'x000"' 5 s0 °aam -.z0 , N �� o m Fxl00 f o w, 0 0� o M 0 l J _rl 0 1 Utility Ease e t ------m--------- -------— x ® m x C:: o VJ f H � � —� r- m D r Ln o cu m u a j S O G m O am V V 0 0 z - - z - � 3 z z .00� O O N ' Qx� 'ic o='m 0 - N n x 3 m D� m "o mo sa?am � N D y Ja x m rtF 0 S J <Cn0 M c a a < J — — — — — — — 1 I — — — — — — — 1 0 y 1 3 m 10" tility Eas ment— �a0 M C, z =3 o N 0'08'00' 120.0' IoW Oa o- < < C ry M y rt m 0 0 c D a J N <0 O � C J .r rmvex uonmao m O C TO J LOT 4, BLOCK 4, PREUSS SUBDIVISION NO.2 DESIGN FACTORS: Three Bedroom Home Perc. Rate: 15 Min./Inch Application Rate: .8 GPD/SF SYSTEM REQUIREMENTS: Deep Trench System Verify Existing 1,000 Gallon Septic Tank 6' Drainfield Rock 3 Bedrooms X 150 GPD/.8 GPD/SF (Application Rate) = 562.5 SF Absorption Area 562.5 SF/12 SF/LF = 46.875 LF Trench Length THEREFORE: Construct a 47' Long x 3' Wide x 6' Effective Depth Absorption Trench at the Location Shown. Flow Line Elevation in Trench to be 5' Below Original Ground Surface. Total Depth to be 11' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Maintain 100' Separation from Wells in the Area. Place Diverter Valve to Connect Existing Trench for Future Use. Natural 4'6" Backfill N 05 3' r -i Geotextile Fabric 4" Perforated PVC (Holes Down) Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. C�c Minimum 6' Separation From Bedrock. �....: Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells in the Area. Minimum 100' Separation From Surface Water or Streams. *��, MICHAEL E. ANDERSON ,' MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 DEPTH (feet) 1 - 2 3 4 5 6 7 8- 9 10 - II I 17 18 19 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOTS 4, BLOCK 4, PREUSS SUBDIVISION NO. 2 PERFORMED FOR: AARON ELLISON DATE: 6/18/2013 PROIECTNo.: PARCEL ID#: TECHNICIAN: J. BERKRAM TEST HOLE 1 �T OB/OG d SILTY SAND Q - WITH GRAVEL SM/GM a DRY 4 I MEDIUM DENSE SLOPE N 0 SITE PLAN SEE SITE PLAN sa WAS GROUND WATER ENCOUNTERED? NO IF YES @ WHAT DEPTH? DEPTH OF WATER AFTER MONITORING: O 2% DATE OF MONITORING: P DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 6/19 1 2:40 5.38" 2 3:10 30 7.63" 2.25" 3 3:11 5.63" 4 3:41 30 7.63" 2.00" 5 3:42 5.38" 6 4:12 1 30 7.38" 2.00" PERCOLATION RATE: 15 (MIN/INCH) PERC. HOLE DIA. V (INCHES) TEST RUN BETWEEN: S FT. and 6 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 6/21/2013 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 � NAM / � PHONE V aUl/� � l.G, Z j�/7'j/YI C�I�ii%'�a�� NEVV �UP RADE MAILING ADDRESS LEGALDE CRIPTION LOCATIO NO. OF BEDROOMS C WellN Absorption area Dwelling DISTAE TO: PERM NO. v Y wQ W I— Manufacturer Materi je No, of compartmeyris Liq. capa. ity in gallons N, IF HOMEMADE: Inside length :Width .�L. Li uid q depth 0 Y J DISTANCE TO: Well Dwelling PERMIT NO. 02 FManufacturer Material Liquid capacity in gallons J W DISTANCE TO: Well /(%Q _/_ , Foundation ` Nearest I t Iine/ PERMIT NO.(y�'�y (, C N IS LL Z J2 Lu ~ No. of lines •� Length V(� h `use / °��C Total length of limon s l Trench t - inches Ca Distance b t een lines Q � � Top of tile to finish grade Material beneath the v Total effecti4, a sor tion area ( inches Lu Length Width Depth PERMIT N0. c� a F- wa Lu 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 areas) OTHER PIPE MATERIAL d j V SOIL TEST RATING \ INSTALLER i�Li I REMAINkS 7 a APPROVED DATE LEGAL2T\ L_K / 79_n73 ip.-11 2/7RI ^ DEPARTMENT . ` HEALTH ^' 8-25 'L/ S-TREE 264-4720 �lr-J—= I -T-F= f� F= tl F= FF�q FE< 8 ' � / u PERMIT �( 800284 > �� ^` APPLICANT DONALD ZIMMERMHN JR BOX 596 EAGLE RIVER 'l ^4 LOCATION EAGLE RIVER LANE / �--- LEGHL L484 PRUESS LOT SIZE SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 265 THE REQUIRED SIZE 8F THE SOIL ABSORPTION SYSTEM IS: A J ��8:3 -T H �F- Sl �F-i.o Fl V ��F=� -F H� � \ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET), THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). U I F2 FEE E-- F� -r I C_ -F n�� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -IF W Cl �:=-� > I "��F=o E_ 0 7' 1 C:1 " OH. n F2 E: F-0 F-_��U I F;:,11 FE ra BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY 0N -SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS HND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��1 1- �11. Fico E="_�-. ��F_- F -i! �- I , ��9-3- I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. � SIQNED� O & E ENG—,VEERING & LJr—Box go, Davis St., Eagle River, lasG 99577 694-2774 or 688-2280 Earl Ellis 688-2280 nussell oyster SOIL LOG J_ 7,?,68 694-2774 Tel. No. Performedfor: Name: g e, Mailing Address: y� ox Legal Description: Ldr Depth Soil Characteristics Depfeet) 0 1 ooez,4 2 3 --� 30 , 5��' 6 8 ��n PLOT PLAN 9 `� PERC.TEST 12 e,7i3m 13 Fo L. 14 i4�� °ti('I 4.2 6-L" °` cwt �(P �QtT 15 16 If yes, what depth - Ground Water Encountered: Yes No Drain Field Proposed Installation: Seepage Pit--- Comments: Date. Performed by: d PROS rD CONSTRUCTION WITH VA INSPEC' ,NS (8-1-80) General instructions for submitting requests for determination of reasonable value �1 REQUIRED EXHIBITS V VA Form 26-1805-1 completed by lender (current form) One copy of the Earnest Money Agreement including the following statement: "It is expressly agreed that, notwithstanding any other provisions of this contract, the purchaser shall not incur any penalty by forfeiture of earne.5t money.or otherwise be obligated to complete the purchase of the property described herein, if the contract purchase price or, cost exceeds the reasonable value of the property established by the Veterans Administration. The purchaser shall, however, have the privilege and option of proceeding with the consummation of this contract without regard to the amount of reasonable value established by the VA." Statement from builder A. Number of lots owned in the area �1 B. Number of units proposed C. Number of units now under construction D*Number of units completed but unsold E. The request for appraisal is not made for the purpose of establishing a precedent nor to take advantage of or to evade the intent of provisions which prescribe that five or more units must be submitted and appraised by a committee (� Three complete sets of plans prepared in accordance with VA Pamphlet 26A-3 page 3, c, Floor Plans; d, Heating; page 4, e, Cuing; f, Plumbing; g, Electrical; h, Equipment; i, Exterior Elevations; j. Cross Sections; & page 5, k, Details h Three VA Forms 26-1852 repared in accordance with VA Pamphlet 26A-3 page 5, 3, SPECIFICATI( A. Manufacturers certification in reference to carpet cushion as shown in #21 of VA Form 26-1852. "Carpet cushion (here identify) complies with -HUD OM Bulletin No.. 72 and shall provide satisfactory service." 10 Three Plot Plans prepared in accordance with VA Pamphlet 26A-3 page 2, b, Plot Plan thru page 3, 6 may. Report from soils engineer A. That assures adequate soil stability and drainage B. Statement as to the need for footing drains i t �ic:c; .•r Se4,�_ $,:fstE: 'S '; t'� tic �. Statement from local authorities that public system is not feasible in the area B. Statement from local health aughority that the site is suitable for the proposed system C. Statement from local health authority approving the design of the proposed system / One copy of recorded subdivision plat e,i� One copy of protective covenants A Evidence that local authorities have accepted the streets & utilities for maintenance If Modular or Pre -Manufactured Construction, submit a copy of the HUD -FHA, Structural Engiiicering Bulletin, to show the unit conforms to Minimum Property Requirements D( All requests for appraisals involving a water _su l other than public or individual must be accem anied [;,ythe following: A. Name and details of organization and names of principal owners B. Type and physical specifications of source, including capacity and number of present and potential users r Rncic of rhnrnnr to .o .. ...... l RETURN TO: Division of Geological and Ge, sical Surveys (OGGS). STATE OF ALASKA 3001 Porcupine Drive (Tel epi,._..._. 277-6615) j DEPARTMENT OF NATURAL RESOURCES - Anchorage, Alaska 99501 W A T E R W E L L R E C O R D Drilling Company Name - - LOCATION OF WELL Please complete either la, lb, or Ic. U.S.G.S. Local No. Drilling Permit No. A.D.L. No. la. Borough Subdivision Lot Block 11b. Fraction Section No. I TownshipRange N/S E/W Meridian Ic. Distance and Direction from Road Intersections Street Address and Area of Well Location 3, OWNER OF WELL: Address: -- - 2. WELL LOG Feet Below Surface Material Type Top Bottom 4. WELL DEPTH: (completed) _. ft. Surface Elevation Date of Completion -.- - - " -' - 5. ❑ Cable tool []Rotary ❑ Driven ❑ Dug 1:1Auger ❑ Jetted ❑ Bored -]Other: 6. USE: ❑ Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commercial []Test Well ❑ Other: _`i - ----- - - - 7. CASING: ❑ Threaded ❑ Welded in. to ft. Depth Weight lbs/ft. in. to ft. Depth .. 8. FINISH,OF WELL: Type: Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Fittings: 9. STATIC WATER LEVEL: ft. ❑ Above ❑ 8elow land surface Type of Measurement: 10. PUMPING LEVEL below land surface ft. after hrs. pumping g.p.m. ft. after hrs. pumping g.p.m. 11. _ WELL HEAD COMPLETION: ❑ In Approved Pit ❑Pitless Adapter inches above grade 12. GROUTING: Well Grouted: ❑ Yes []NO Material: []Neat Cement ❑ Other: 13. PUMP: (If available) HP Length of Drop Pipe ft. capacity g.p.m Type: ❑ Submersible ❑ Reciprocating ❑ Jet ❑Other: 14. REMARKS: - 15. WATER WELL CONTRACTOR'S CERTIFICATION: - This well was drilled under my jurisdiction and this report is true to Registered Business Name Address:. the best of my knowledge and belief: Contract License Number Signed: Form 02-WWR r �J �� „/ ® - Au horized Repres tative Copy Distribution: WHITE - State DGGS, Date: .PINK - Driller, CANARY - Customer �i flT v [ S eI ; ( _ A ,_ ,- r' "x _ 14 Anchorage , n A ,. .4 i �, t S?s. I�J 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION September 17, 1980 T0: Whom It May Concern Subject: Lot 4 Block 4 Preuss Subdivision The subject propertylhas an approved on-site sewer system, installed and approved July 23, 1980. Public sewer is not available to the subject property, therefore, not feasible to connect to. The water is provided by a private well because public water is not available to this area. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw APPLIC ,!T FILLS illus lurr N.. - FMa!I!ng wner Loren J. and Maura M. Schroeder. 5112 Eagle River . Lane _ Zip Code dress Pi ver Lynda Maciejewski1400 Birchwood zip Code "' ` He Lending Institution (This is a.. loan as$urp.ption. , - POW* sS"�091i��2 Zip Code Address Realty Co. & Agent Hearthside, Inc Gallery of Homes Zip Code Address AK,- =• -. - -.. Legal Description Lot Li:_, Block 4 ,, - Prues"s 4 2. • - - - ' - Ine Street Location - -- - - - - - Type of Residence LX Single Family , up_ for-1pedrooms) ❑ Multiple Family No. of Bedrooms_ � !�Tp) (Unf in$shed down is s ❑ Other Water Supply ATTACH WELL LOG. A well log is required for all .wells drilled since June 1975. � Individual 1 - For wells drilled prior to that date, give well depth (attach log if available). ❑ Community ❑ Public Utility Sewer Disposal - Year Individual Installed: - XX Individual - - When Connected to Public Utility: ❑ Public Utility ❑ Holding Tank ' EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. NOTE: THE INSPECTION FEE MUST ACCOMPANY Time Time /J -7 Time Time Date Date Date Dale Inspector Field Notes: w ( APPROVED BEDROOMS �1— ( ) DISAPPROVED ( Xj CONDITIONAL APPROVAL' DATE 0 BY: Soils Rating I Date Sewrr i 72029 1910 Inspector Inspector Well To Absorption Area Well to Tank Inspector MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION JUL 2 C 19u3' -CONDITIONS OF APPROVAL wou I no Received - Septic Tank Size C::) �- INSPECTION APPOINTMENTS E R MUNICIPALITY OF ANL IU—L MUNICIPALITY OF ANCHORAGE DEPT. OF I'= °- d. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTWRONMENIAL 1'CTION 825 L Street - Anchorage, Alaska 99501 �t ENVIRONMENTAL SANITATION DIVISION ULIU Telephone 264.4720 11 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEI" I� DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPTY OWNE�rR /I`- �.�a�- �N(5,0ULU/Hta1'— ERTYESIDE�1-E'If di I MAILING AUUrSt Eg�_31NGLE FAMILY ❑ MULTIPLE FAMILY 7. WATER SUPPLY Q INDIVIDUAL* ❑ COMMUNITY ❑ PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM Rg�----INDIVIDUAL/ON-SITE** ❑ PUBLIC UTILITY r C a ❑ One ❑ Four XJ_ Two ❑ Five ❑ Three ❑ Six ❑ Other n * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) NDI G I S' IC N ADORE F4.REALTOR/AC ING AdDRI Eg�_31NGLE FAMILY ❑ MULTIPLE FAMILY 7. WATER SUPPLY Q INDIVIDUAL* ❑ COMMUNITY ❑ PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM Rg�----INDIVIDUAL/ON-SITE** ❑ PUBLIC UTILITY r C a ❑ One ❑ Four XJ_ Two ❑ Five ❑ Three ❑ Six ❑ Other n * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY PE OF RESIDENCE rEyl — �,--! NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER SINGLE FAMILY MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY PERMIT NUMBER ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY ❑ PUBLIC UTILITY DATE DRILLED Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER — ❑INDIVIDUAL/ON -SITE DATE INSTALLED -� ❑PUBLIC UTILITY Connection Verified OSeptic r ❑Holding Tank INSTALLER UUP) Size: v If Tank is homemade SOILS RATING )/ i give dimensions: TYPE OF TANK MANUFACTURER .2P�1 TOTAL ABSORPTION AREA MATERIAL ' 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS — APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED BY 1---Pic,l\rz 73101 72-010 (Rev. 6/79) MUNMPAUTY OF ANCHORAGE :�,``_ 1 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-571-45 Expiration Date: 2 1. GENERAL INFORMATION Complete legal description PREUSS #2 BLOCK 4, LOT 4 Location (site address) 10127 EAGLE RIVER LANE, EAGLE RIVER, AK 99577 Current property owner(s) JARA HAAS Mailing address Real estate agent Day phone 10127 EAGLE RIVER LANE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 5 C Waiver Fee $ Date of Payment S 1 Z� 7//, Date of Payment Receipt Number // %V,", 3 Receipt Number COSA # 0 S C 111 ') 9 0 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 5/26/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to �� these various and dynamic characteristics and are outside the control of the evaluator of the i •� well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: • • .,9 �#A for current or future occupants or guarantee that no unseen encroachments, deficiencies orJ discrepancies exist can be given by First Water Consulting & FWGS . / * • 0 TM . .1 ...•.* r �..� 6. DSD SIGNATURE Curtis Huffman System #1 Approved for bedrooms r�+�%T . •CE 128991 �l FIFO 4/26/ OlP`F�r System #2 Approved for bedrooms �l ROFESSI Disapproved 1 Conditional approval for bedrooms, with the following stipulakell>.11l(((f�f�� O, `g ON-SIT�v WATER AND m J 2 1 r- PROGRAM JJERVI1 N B Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: PREUSS #2 BLOCK 4 LOT 4 Parcel ID: 050-571-45 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 8/1/1980 Total depth 290 ft Cased to 290 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 5/24/2021 Static water level at beginning of test 52 ft. Well production at time of test 5.6 gpm Comments B. TANK DATA Age of tank(s) 8 years Tank type/material SEPTIC,/ STEEL Measured operating fluid level in septic tank 52" ® Standpipes/foundation cleanout per record drawing Date of pumping 5/24/2021 _ D. ABSORPTION FIELD DATA Which system tested (date installed) 6/30/2013 ® ALL standpipes present per record drawing Total measured depth from grade 15.7 ft (max) Measured depth to pipe invert from grade 10.5 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective 5.2' OF THE 6' ED Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 2.47 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FWD; Collected by - Date of Sample 5/24/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5/24/2021 Results Z Pass For 3 bedrooms Fluid depth prior to test 47 in Water added 450 gal New depth 53 in Elapsed time 1330 min ® Code -required soil cover over field Final fluid depth 46 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date WES Comments/Deficiencies: FIELD OPERATING IN THE TOP'/4 OF THE ED AT DAY OF TEST. . E. 'SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No _ ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that 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. '• �� TH .... ....�:`.. • '. Curtis Huffman �F•• CE 128991 •� �I® P (30/21 �A ROFEWQ �' ft ft ft ft ft ft ft ft • • C.S. t, • -•-� Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 s ITT Certificate of On-Site Systems Approval Parcel I.D. 05057145 Expiration Date: OUtAi 1 1 l a 01 3' 1. GENERAL INFORMATION 4- 4 Complete legal description Preus#2 Block,2 Lot/7 Location (site address) 10127 Eagle River Lane Current Property owner(s) Day phone Mailing address Real Estate Agent Nathan Jabay Day phone X67 8 9 10 77 2. TYPE OF DWELLING: '33 ❑ Single Family (w/wo ADU) a MAY p 8 2018 ❑ Duplex 3 ❑ Multiple Dwellings (Single Family and/or Duplex) 3 0� 6 8 L95�4, 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual CI Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ none WaiverNariance request for: Distance: Aer- Received b : / Date: c71 COSA to be rel-.-_. "7—weer,un ess otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment S/9 ( E) Date of Payment Receipt Number 6 -tf tJ Receipt Number COSA# (151-C t Cat I CIC; 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 C&M Engineering Phone 8545558 Address 30840 prudhoe bay Engineer's Printed Name Charles Balzarini Date 05/07/18 6. DSD SIGNATURE *:- .9TH t :* ¢� System #1 Approved for Y PP S bedrooms System #2 Approved for bedrooms HARCES G BALZARINI Y pp ` -4 CE-13854 •�`�� Disapproved ��lF�••pYS/� - F��.+. Conditional approval for bedrooms, with the following s � '� �$S10��-�` ��• $S\( OF Avvc, ro ON-SITE m • WATER AND WASTEWATFR o PROGRAM • By: (!.(I t^ rctruzhi /42. %�'•�1 Eck/(r�,d Original Certificate Date: t27 11) ,90/ d` 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 blue sheet_:' c If more than 1 septic system is on the lot: COSA Checklist# 1 of1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Preus#2 Block 4 Lot 4 Parcel ID:050-571-45 A. WELL DATA Well type private If A, B, or C provide PWSID# Well Log (YIN) V Date completed 8/1/80 Sanitary seal (Y/N) y Wires properly protected (Y/N)y Total depth 290 ft. Cased to 290 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 8/1/80 4/28/18 Static water level 90 ft. 52 ft. Well production unk g.p.m. +4.3 g.p.m. WATER SAMPLE RESULTS: Coliform neq colonies/100 mL Nitrate 1.26 mg/L Arsenic nd ug/L Date of sample: 5/2/18 Collected by: charles balzarini B. SEPTIC/HOLDING TANK DATA Tank Type/Material septic/steel Date installed 6/27/13 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) yes Foundation cleanout(Y/N) y Depression over tank (Y/N) y High water alarm (Y/N) no Date of pumping 5/CV�01$ Pumper 5A"inTAR%-] Pt/;44 PEK5 C. ABSORPTION FIELD DATA Date installed 6/30/13 Soil rating (g.p.d./ft2 or fta/bdrm) 0.8 System typetrench Length 55 ft. Width 5 ft. Gravel below pipe 6 ft. Total depth 17 ft. Eff. absorption area 660 ft2 Monitoring tube yes Depression over field n Date of adequacy test 4/28/18 Results (Pass/Fail)pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 550 gal. New depth 6 in. Elapsed Time: 120 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) none known If yes, give date n/a D. LIFT STATION Date installed - Size in gallons - Manhole/Access (Y/N) - "Pump on" level at- in. "Pump off' level at- in. High water alarm level at - in. Datum - Cycles tested - Meets alarm&circuit requirements?- E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot +100 On adjacent lots +100 Absorption field on lot +100 On adjacent lots +100 Public sewer main+100 Public sewer manhole/cleanout +100 Sewer/septic service line +25 Holding tank +100 Animal containment areas +100 Manure/animal excrete storage areas +100 SEPTIC/HOLDING TANK ON LOT TO: Building foundation -I- 10- Property line +5 Absorption field +5 Water main +10 Water service line +10 Surface water +100 Wells on adjacent lots+100 ABSORPTION FIELD ON LOT TO: Property line +10 Building foundation +10 Water main +10 Water Service line+10 Surface water +100 Driveway, parking/vehicle storage +10 Curtain drain +50 Wells on adjacent lots +100 F. COMMENTS OF tAL �� G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and Aw'' �Q;`•••• kk • :74,• 4-- 4 review of Municipal records that the above systems are in ••• •' ' 0 conformance with MOA COSA guidelines in effect on this date. » j • » » • rr • ijr • • • • • Engineer's Printed Name Charles Balzarinl ,// Date 05/07/2018 rd • • • • » » _ • . - • » CHARLE G BALZARIP4I - IFg"f CE-13854 s44,•• 4'e 614/(4./•I- � tch..� k1. PROFESSO'--4: 14:V VieV`- ` COSA canary sheet_2-6-15.doc • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 ,#', Certificate of On -Site Systems Approval ) Parcel I.D. 050-571-45 Expiration Date: 1. GENERAL INFORMATION Complete legal description Preuss ; i. 2, Block 4, Lot 4 Location (site address) 10127 Eagle River Lane Eagle River, AK 99577 Current Property owner(s) Aaron & Samantha Ellison Day phone 632-9071 Mailing address 10127 Eagle River Lane Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual F Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariancerequest for: by'Oa �teIr !Or If V11AJ4T 11 �e 'VL11,A)r,S A"d Distance: Received by: "� �� Date:` t COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ lA420A 0(--S Date of Payment 1 l?�113 (y Yn Receipt Number COSA H 05(-% 3o� Waiver Fee $ QCY) Date of Payment Receipt Number V,:�— Waiver u oS P131 W 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 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 522-7773 Date 7/3/2013 By: Original Certificate Date: Ther mcipar of cho 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 forerrors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet ., c °. ° ° 49TH 6. DSD SIGNATURE _Az� System #1 Approved for bedrooms ............. _ ..... d MICHA�r E DERSON System #2 Approved for (A,., bedrooms ®0 sl< CE -4381 ; Disapproved ®® F9Fp'•-3-f�°°�a ��PROFESS1�Ha®® Conditional approval for bedrooms, with the following stipuhmV.. +® By: Original Certificate Date: Ther mcipar of cho 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 forerrors or omissions in the professional engineer's work. 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: Preuss No. 2, Block 4, Lot 4 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 8/1 /80 Sanitary seal (Y/N) Y Total depth 290 ft. Cased to 290 ft. FROM WELL LOG Date of test 8/1/80 Static Water level 90 ft. Well production Unreadable g p m WATER SAMPLE RESULTS: Coliform 0 colonies/1 D0 mL Nitrate '625 mg/L Arsenic N/D ug/L Date of sample: 5/16/13 B. SEPTICIHOLDING TANK DATA "Inside House Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Foundation cleanout(Y/N) Y Depression over tank (Y/N) N Date of pumping New Const. Pumper C. ABSORPTION FIELD DATA Parcel ID: 050-571-45 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >18 in. AT INSPECTION 5/29/13 43 ft. 4.0 g.p.m. Collected by: Pinard Engrg. Date installed 6/27/13 Cleanouts (Y/N) Y High water alarm (Y/N) _ N Date installed 6/27-30/13 Soil rating (g.p.d./ft2 or ft2/bdrm) '8 GPD/SF System type Deep Trench Length 55 ft. Width 5-7 ft. Gravel below pipe 6 ft. Total depth 12-17 ft. Eff. absorption area 660 ft2 Monitoring tube Y Depression over field N Date of adequacy test New Const. Results (Pass/Fail) For_ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum Size in gallons _ "Pump off level at Cycles tested _ Manhole/Access(Y/N) in. High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot > 100' On adjacent lots > 100' Absorption field on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main >10 Water service line >10 Wells on adjacent lots >100, ABSORPTION FIELD ON LOT TO: Property line 10, Building foundation >1 0 , Water Service line >10'Surface water >100 Curtain drain None Noted Wells on adjacent lots >100' 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 Michael E. Anderson, P.E. Date 7/3/2013 COSA brown sheet 10-10-12.doc Absorption field >5' Surface water >100' Water main N/A , Driveway, parking/vehiclestorage in. A, MICHAEL E. ANDERSON A CE - 4381 11 pRprEssoo �® 111\`a%V%�* EAGLE RIVER UNE _ � — — \ / } S N00$e02& 2$00 `m ®� &' ,c A« G__G \k\)k\))/( § }: } �( \§7;E!! { � �2 s•\� Co k \ \ CA\ 0 q+R E ---T ,c A« G__G \k\)k\))/( § ,!!!a)) �( \§7;E!! { ©� I 0 \ /) 2$+}§(/ 0 - �\ 03 ® t ƒ ° ak(\£\! )m! . _ \ \ k = i q+R E ---T ,c A« G__G -- ©� I 0 \ /) 03 ® t ƒ _ r = i / 23�� \ o Z } \ » }I m I ® » . 6 0 \ E pa / o \ / \ , � s co » �� ® 2 - — — — ,& Utility as—nteme Nm°0e0o& 120.00 4 5 0 OD � k Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program s A E T 4700 Bragaw Street P.O. Box 196650 a Anchorage, AK 99519-6650 ; www.muni.org/onsited�/ � (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-571-45 COSA # J I Expiration Date: 3 1. GENERAL INFORMATION Complete legal description PRUESS #2 BLK 4 LT 4 Location (site address) 10127 EAGLE RIVER LN Current Property owner(s) ERIC & LYNDA LINDBOE Day phone 206-669-4425 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. BOX 770211 Day phone Mary Cox / Remax Day phone 257-0165 Unloll!s oi�drwise requested, COSA will be held by DSD for pickup. 2 NUMBER OF `B,EROOMS: 3. , TYPE 01= WAITED SUPPLY: 1rdivjduaell , 'Individual Wate Storage Com,nhuh ty..Class Well Public Water System 3 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 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 102954, Anchorage AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 12/17/2010 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 levels OF ��1 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 this .. . �P.•S �. C,.• •••••;�y of system. All systems eventually fail and test do �� satisfactory results not guarantee future performance of the system, nor do they guarantee that ;'° rH there are no hidden defects or encroachments. PES can therefore not provide any warranty for future •• ••• •• • •••• ••••• ••i•••••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 j�';Steven ••R. Pannone;�, i above. Any reliance upon or use of this report by any other person or party is not authorized nor will it �1 3 °•.,•• No. CE 8149 ,,•1 =i confer any legal right whatsoever. 1� .•°'� ��;�a 5. DSD SIGNATURE �.•'. �3 V Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory _ PROGRAM Maintenance Agreements Supplemental Engineer's Report Other __111 %0 -- Mm) By: Original Certificate Date: ^;j_ Ud :inspec ons and ,� ° syster�as are in ;.` 91�-8�8Ct' 4n thrs aFa�e. ,�_ 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. 050-571-45 COSA # Expiration Date: 1. GENERAL INFORMATION Complete legal description PRUESS #2 BLK 4 LT 4 Location (site address) 10127 EAGLE RIVER LN Current Property owner(s) ERIC & LYNDA LINDBOE Day phone 206-669-4425 Mailing address P.O. BOX 770211 Lending agency Day phone Mailing address Real Estate Agent Iy nn IG.i'I( O�( /kMQX Day phone' Mailing Address vgJ —01&�5 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BE�bROOMS: 3 3. TYPE OF WATER,$UPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date e0o2-? 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 �� 0� 4�� levels that may fluctuate during the year, and the water usage of the family being served by the system. � ��qS��1� These conditions are outside the control of the evaluator of this system. All systems eventually fail and 1� satisfactory test results do not guarantee future performance of the system, nor do they guarantee that AAr? 4 g rH •••�°:: �0 there are no hidden defects or encroachments. PES can therefore not provide any warranty for future 00 .......... •••• 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 '.Steven R. Pannone; i above. Any reliance upon or use of this report by any other person or party is not authorized nor will it �I��J No. CE 8149 confer any legal right whatsoever. ��j�•., °F'AW 5. DSD SIGNATURE V Approved for -3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory X WASTEWATER a • • PRC.,rRAM Jj��JN)iv } Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date:_ --Z' 3-/0 Municipality of Anchorage *Ar, Development Services DepartmentBuilding Safety DivisionOn-Site Water & Wastewater Program 4700 Bragaw Street P.O. -Box 1-96650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: PRUESS #2 BLK 4 LT 4 . Parcel ID: 050-571-45 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 8/1/1980 Sanitary seal (Y/N) Wires properly protected (Y/N) Y Total depth 290 ft. Cased to 290 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 8/1/1980 7/27/2010 Static water level 90 ft. 53 ft. Well production Unreadable g.p.m. 6.5+ g.p.m. WATER SAMPLE RESULTS: Coliform . colonies/100 mL Nitrate o7, mg/L Other bacteria colonies/100 mL Arsenic: mg/I Date of sample: 7/27/10 Collected by: DAN MORAN B. SEPTIC/HOLDING TANK QATA Tank Type/Material Greer Steel Tank size 19,00 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date installed 7/23/1980 Cleanouts (Y/N) Y High water alarm (Y/N) N Date of pumping 7/20/2010 Pumper JRs PUMPING C. ABSORPTION FIELD DATA Date installed 7/23/198b Soil rating (g.p.d./ftz or fe/bdrm) 190 System type DEEP TRENCH Length 56+31 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 11 ft. Eff. absorption area 870 fl? Monitoring tube Y Depression over field N Date of adequacy test 7/27/2010 bedrooms Fluid depth in absorption field before test 24 in. Results (Pass/Fail) PASS For 3 Water added450 gal. New depth36 in. Elapsed Time: 120 min. Final fluid depth 24 in. Absorption rate >= 454 g.p.d. . Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date. D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 100+ Sewer /septic service line 25+ Animal containment areas 100+ Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+: Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 10+ Absorption field 5 Water main 100+ Water service line 25+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 100+ Water Service line 25+ Surface water 100+ Driveway, parking/vehicle storage 20+ Curtain drain None Known Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone, P.E. Date Y®D ?2G% COSA Fee $ / q a Waiver Fee $ Date of Payment / �n / -0 Receipt Number % J 2— (Rev. 11/05) Date of Payment Receipt Number V 4F C i� ,.• 49 TH •; ..n. ........a... .......................... • . � %Steven R. Pannone/ �� '• No. CE 8149 ♦n14111. ESS�� in. 7t' 5 i AS -BUILT I hereby certify that I have sun eyed the following property: A:whoi;ige Recording Precinct. Ma!' -a• and that the i ..uprov,-nicnts situated thercon :.re within the •-prcpertv linvs oijd 6) not ovz!rljo. or cnCL02r"rj on I'm property :hereto, th:t no im-,rovenict I its on prop- (--:IY lvi:-.iZ adjacent '.!-�ereto e-croach cn the pre:r.ises 1.1 j u. -;ton and th-m tlie-.c are :-,o •Lrancni.srion 1.!ILS or rth-r vi-ible easements on said property except as inl::-atiA Itrcun. C2',C(l it F_-i,;le H!vcr, Alaska ih:s of PGH 11T C. JOHNSON, :4-.e SCA LE: Pir.i;:erc-J L --.d S-_ir-;evcr No. S30 -LS Uom 4S6, E7.p.le P:vcr. -Uaska 43 7.- t i AS -BUILT I hereby certify that I have sun eyed the following property: A:whoi;ige Recording Precinct. Ma!' -a• and that the i ..uprov,-nicnts situated thercon :.re within the •-prcpertv linvs oijd 6) not ovz!rljo. or cnCL02r"rj on I'm property :hereto, th:t no im-,rovenict I its on prop- (--:IY lvi:-.iZ adjacent '.!-�ereto e-croach cn the pre:r.ises 1.1 j u. -;ton and th-m tlie-.c are :-,o •Lrancni.srion 1.!ILS or rth-r vi-ible easements on said property except as inl::-atiA Itrcun. C2',C(l it F_-i,;le H!vcr, Alaska ih:s of PGH 11T C. JOHNSON, :4-.e SCA LE: Pir.i;:erc-J L --.d S-_ir-;evcr No. S30 -LS Uom 4S6, E7.p.le P:vcr. -Uaska