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HomeMy WebLinkAboutHYLEN CREST #1 BLK 2 LT 2Hylen Crest
Block 2
Lot 2
#050-472-83
Municipality of Anchorage
l\\\" Development Services Department
Building Safety DMslGn
On-Site Water and Wastewater Program, 4700 Bragaw St.
u
P.O. Boz 196650 Anchorage. AK 09519-6650 Page I of -1
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO90112 PID Number: 050.472-83
N.n. E TROTTER
Wastewater System: ❑ New ® Upgrade
Jeerw.
UPPER LOWLAND AVENUE EAGLE RIVER. AK
ABSORPTION FIELD
Phw lhl O at eWroona
® Deep Tench O slwww T.MI O eW O Mwrw O Gmar
LEGAL DESCRIPTION
Sal R."
Total Depth epn ".A.l arWe'
0.8 GPOTT
8.0 Fl.
Bbd- Ld suwmw :
Dpm b pM Oo11an Irortt appal pnM
Grovel Jepel De,Nalh pipe
2 2 HYLEN CREST
2.0 R.
6.0 Ft
T~saip R" sacnnn
FJ WOeO ahora enanw pWe
or"L"h
1.0 R.
63 Fl.
Well:GrM
ElNew [:1 Upgrade
vnEVl
Nw aInes Ootann bl.aen 4rle.
2.5 Ft.
1 NIA Ft
Cle..rt, iaw, (Pm"e. A B. C)
70.1 Depth.C.aeG
Total Toah.erpWlt arw
Plp. M.unal:
EXISTING CLASS A
Ft.
Ft
756 Fr
3034 PVC
DMIer
Data Dr.1"
Shea Wolff l 1
kat.11.r
Dau In.uIISJ
Ft
FLINTSTONE CONST.
7116/2009
Y.W
Puny S" at
carp M.gih MD a oro
TANK
GPM
Fl.
FI
SEPARATION DISTANCES
® septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
uaiciprivate
""^""1e1
ry
From
Tank
Field
Station
Tank
Sewer Una
EXISTING
G"
Wall
116'
200+
200+
M.I"W
NWro.racwryvm»m.
surfaceWater
100+
100+
LIFT STATION
30'
14.1
uw aauror
Gal
FouWMwn
5'
10.3'
'P'h°h
o ' """ "
-Pew iep 1 at
Hrph motet alanyl M+
curmn Oram
100+
50+
Pump M... a MW.I
EYamal In.pwa perrormW Ey
Rff�UPGRADE
UPGRADE TO ABSORPTION FIELD, VERIFIED CONDITION OF
BENCH MARK
EXISTING SEPTIC TANK
LFFRRONTONT DOOR, q PORCH
A.sumao Ei at..
100.0 Ft.
Engineer's Stamp
Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1" 711512009
2ne 7116/2009
•�����������
.••�E OF.................. �
"meq
Development Services Department Approval
�,.•'
Conditional Approval Date:
a : 40TH >� •
.......I....�
teven ••R. •Ponnone, a.
Reviewed and approved by Date: -2-Oct#�'d:
�1� '•.,•• '- CE 8149
44%� ����
SWING TIES
CO A B
C1 45.9 50.5
M1 46.6 50.9
C2 63' from C1 11.5 offset from house
I
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SD SD — SD
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13' ELECTRIC &TELEPHONE EASEMENT
60 SD — 6fiD
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w—w—w—w w—w—w—w—w w—w—
NO WELLS WITHIN 200'
- — — — — — — — — — — — —
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NOTES.
P.O. BOXOoo7 ANCHORAGE, E ENG CN 99LL10C
PHONE (907) 272-8218 FAX (907) 272-8211
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RECORD DRAWING
4
HYLEN CREST S/D LOT 2 CLOCK 2
JOSEPH & ISABELLE TROTTER
21027 UPPER LOWLAND DRIVE
EAGLE RIVER, AK 99577
EXISTING
PLAN
125OG SEPTIC TAN
M2.
VERIFIED INTEGRITY
C
14.1
EIIGRADED
SAS
;4B
III
63 Fx3'Wx6'ED. 8'TD
IIEXISTING
SEPTIC AREA
EXISTING
1"T
16,8 II
1
CUWATER
SVC
,,
V3.
C1
1I /
13' ELECTRIC &TELEPHONE EASEMENT
60 SD — 6fiD
�EATT�i-� 1�1'�--�J�,D EnT'TvTAl �j
w—w—w—w w—w—w—w—w w—w—
NO WELLS WITHIN 200'
- — — — — — — — — — — — —
I
15] Tele & Elec Esmt
NOTES.
P.O. BOXOoo7 ANCHORAGE, E ENG CN 99LL10C
PHONE (907) 272-8218 FAX (907) 272-8211
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7/17/09
RECORD DRAWING
sci x=50'
HYLEN CREST S/D LOT 2 CLOCK 2
JOSEPH & ISABELLE TROTTER
21027 UPPER LOWLAND DRIVE
EAGLE RIVER, AK 99577
P.I.D. NO
010472-13
PERMIT NO.
SWxxxxxx
PLAN
SheetF 3
1
2
3
4
5
8
7
8
9
10
11
12
13
14
15
16
17
18
TEST HOLE 1
COMMENTS:
NOTES:
PLAN
Organics.
toDsoE, root
mass
Sands with Sifts
to sandy SILTS
SAND, was
graded Uniform .
soft, easy
digging
Poorly graded
gray GRAVEL
SLOPE
TEST
HOLE
end SAND. 12• WAS GROUND WATER
donikers. soft.
easy digging ENCOUNTERED? NO
IF YES, AT WHAT
DEPTH?
DEPTH TO WATER AFTER
MONITORING? - DRY -
DATE: 7/17199
3
SLOPE
TH 1
PERCOLATION RATE 9.5 (miMnch) PERC HOLE DIAMETER 6 inches
TEST RUN between 5 and 6 FT.
DATE PERFORMED: 719/09
PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
HYLEN CREST S/D LOT 2 CLOCK 2
JOSEPH & ISABELLE TROTTER
21027 UPPER LOWLAND DRIVE
EAGLE RIVER, AK 99577
IN
7�r
��P•'. Scale
�� NTS
CE 8149 .',R� PERMIT
Sheet
�OfESS10�� 2 OF 3
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY
OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN
CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS.
2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS.
3. SCOPE OF WORK: 4—BEDROOM, REUSE EXISTING SEPTIC TANK AFTER CONFIRMING INTEGRITY OF TANK, REUSE
EXISTING SEPTIC FIELD, INSTALL DIVERTER VALVE, INSTALL NEW FIELD.
4. GROUND WATER WAS NOT ENCOUNTERED IN THE TEST HOLE. NOTIFY THE ENGINEER IMEDIATELY IF GROUND
WATER IS OBSERVED IN THE EXCAVATION LESS THAN 12' BELOW GROUND LEVEL.
UPGRADE FIELD__ ---1' Fill, W/Seeding
TH 1 96.7'
-2 UR
SM
—7
SW
-12
-14
9
97 4' Filter Fabric
Drain rock
2.0' _ above pipe
Inv
I 4" diam. drain pipe.
6.0 yV
J — Drain rock
VM
— 88.3'
1-43.0'
No groundwater
monitored SECTION
9,.3•
VERIFIED CONDITION OF EXISTING TANK M"I =11 '"" a .,:::- Ir - l ep.]•
PROFILE DEEP TRENCH SEE PLANS & SECTION
DESIGN PARAMETERS ABBREVIATIONS
SEPTIC SYSTEM
CU
COPPER
NO. BEDROOM: 4 (600 gpd)
DIP
DUCTILE IRON PIPE
A
TH
gig
s 9
FC
FOUNDATION CLEAN OUT
n1I
11
n n
n n
9,.3•
VERIFIED CONDITION OF EXISTING TANK M"I =11 '"" a .,:::- Ir - l ep.]•
PROFILE DEEP TRENCH SEE PLANS & SECTION
DESIGN PARAMETERS ABBREVIATIONS
SEPTIC SYSTEM
CU
COPPER
NO. BEDROOM: 4 (600 gpd)
DIP
DUCTILE IRON PIPE
TANK SIZE: REUSE EXISTING
TH
TEST HOLE
PERC. RATE: 6-15 MPI
FC
FOUNDATION CLEAN OUT
SOIL RATING: 0.8 gpd/SF
T#
TANK CLEAN OUT NO.
AREA ROD: 750 SF
C/J C#
CLEAN OUT NO.
SYS. TYPE: TRENCH, 6'ED, 8'TD
MONITOR TUBE N0.
MIN LENGTH: 62.5 LF
USE:
R.I.
RIGID INSULATION
63LFx3'WIDE, 6 -ED, 8' TO
DCO
DOUBLE CLEAN OUT
TOTAL AREA: 756 SF
DV
DIVERTER VALVE
FS
FLOW SPLITTER
LEGEND
_w—w— WATER LINE/
WELL RADIUS
_ss — ss — EXIST'G SEPTIC
—�+—es— NEW SEPTIC
--0 CHAINLINK FENCE
NOTES: Date
, lie
7/17/09
P.O. BOX 100217 ANCHORAGE, AK 99510
RECORD DRAWING PHONE (907) 272-8218 FAX (907) 272-8211 *�P9 TH �9*�I Saale
NTS
•• •• ^• P.I.D. NO
HYLEN CREST S/D LOT 2 CLOCK 2 -e3
JOSEPH & ISABELLE TROTTER teven 8149nnone� PERMIT NO.
SWxxxxxx
DESIGN NOTES 210EAG EP RIVER, AK 995771VE I,+111 \ ...... Sheet eet
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 995196650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 10, 2009
Expiration Date: Jul 10, 2010
Permit Number: SWO90112 Parcel ID: 050472-83
Legal Description: HYLEN CREST #1 BLK 2 LT 2
Design Engineer: 0062 PANNONE ENGINEERING SERVI( Site Address: 021027 UPPER LOWLAND AVE
Owner Name: ISABELLE TROTTER Lot Size: 20000 SO. FT.
Owner Address: 21027 UPPER LOWLAND AVENUE Total Bedrooms: 4 Permit Bedrooms: 4
EAGLE RIVER, AK 99577-9513
This permit is for the construction of:
❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907)343-7904( 24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
A. THE ENGINEER SHALL CHECK THE TEST HOLE GROUNDWATER LEVEL THE SAME DAY OF
CONSTRUCTION OF THE SEPTIC FIELD. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE
AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE
SYSTEM WILL STOP PENDING ON-SITE REVIEW AND APPROVAL.
Received By:
Issued By:
mWllDate: —/1/ D 1 .0
e 44jlirz'iDate:l0 (%q
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program , • „
4700 Bragaw Street
P.O. Box 196650
U
(-`
ft
; Anchorage, Alaska 99519-6650
`U �J www.muni.orglonsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION, GC�1�
FOR A SINGLE FAMILY DWELLING
Parcell.D. 050.472.83
Property owner(s) Isabelle Trotter Day phone 2449501
Mailing address21027 Upper Lowland Road Zip Code 99577
Site address 21027 Upper Lowland Road Zip Code 99577
Legal description (Sub'd., Block & Lot) Hytan Crest SID No. 1. Block 2. LOt 2
Legal description (Township, Range & Section)
Lot Size 20.000 Sq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field
Septic Tank
❑
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms
THIS APPLICATION IS AN:
Initial
❑
Upgrade
Renewal
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
Pannone
(Signature of property owner or authorized agent)
PeriURush ees: 530-'_3!j _
Date ent: 7 ZZO C
Receipt Number:0o���
(Rev. 11105)
Waiver Fees:
Date of Payment:
Receipt Number:
Pannone Engineering Services LLC
Steven R. Pannone, P.E., Principal
Licensed & Registered In Alaska and Florida
E-mail: steve(moanenaak.com
July 10, 2009
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, Alaska 99519
Re: Hylan Crest S/D No. 1, Block 2 Lot 2
Septic System Upgrade Permit Request
Ladies and Gentlemen:
I am writing to request an upgrade septic permit be Issued for the above referenced lot. The proposed
system will serve an existing four-bedroom house; the lot is currently developed. The lot is served by a
public water supply system located over 200 feet from this property. The surrounding developed lots
are served by the same public water system; the public wells are located over 200 feet from the
proposed soil absorption system.
1. Soils. A single test hole was excavated in July of 2009. Ground water was not encountered in the
excavation. Bedrock was not encountered in the test hole. Based on the percolation test results and the
overall soils appearance, the soils are suited for the use of a conventional wastewater septic system with
an application rate of 0.8 gpdpsf.
2. Proposed System
a. Percolation Rate:
b. Application Rate:
c. Design Flow:
d. Min. Absorption Area:
e. Total Depth:
f. Effective Depth:
g. Reduction Factor:
h. Width:
I. Minimum Length:
j. Design Length:
k. Effective Absorption Area
I. Septic Tank Size:
9.5 Min Per Inch
0.8 gpd/sf
600 gallons per day
750 sf
8 feet
6 feet
0.00
3 feet
62.5 feet
63 feet
756 sf
1,250 gallon if required
Mailing: P.O. Box 102954, Anchorage, AK 99510-2954
Physical: 11301 Olive Lane, Anchorage, AK 99515
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
3. Surface Water: there is no surface water within 100 feet of the proposed upgrade.
4. Topography: The average topography in the area of the proposed septic system is
approximately 2 percent based on contour information.
S. Drawing Markings: The Drawings are marked "For MoA Review Only". When written
notification that the review is complete, and that there are no further comments, is received from MoA
On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of the surrounding or existing lots.
There are no wells or septic systems within 100 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Attachments:
Sincerely,
Steven R. Pannone, P. E.
Principal
Mailing: P.O. Box 102954, Anchorage, AK 99510-2954
Physical: 11301 Olive Lane, Anchorage, AK 99515
7/10/09
X
7
01
10
6
NO WELLS WITHIN 0'
2
Q
EXISTING 1" CU ; EXIS NG 125OG SEP'�IC
WATER SERVICES A VERIFY INTEGR`tT1
I 1
4 BR PROPOSED UPGRAD
J
i
HOUS
w0
I
/
3 0
p
ISTING
jPTIC AREA
\
(STING
AREA
i
/
z =
CiH__________
I
j __
__
__
EPTIC
_ _____ _____�
;
O
�—
o
UPPER LOWLAND DRIVE EXISTING 8" DIP
WATER MAI i
vaw
1
0 of
0
I
r ------------t—
II ----
I
EXISTING�j EXISTING
SEPTIC A EA I SEPTIC /
3 1 2
I
EXISTING I I
SEPTIC AFiE I
1
1
III
NOTES: .�������\� Dale
P.AMODNEaIN ANCHORAGE. 99LSL10C k9"
P.O.
Ik)1 7/10/09
ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 ,.= �,'�P 9��/ Scale
... .. .. / P.I.D. NO
HYLAN CREST S/D LOT 2 CLOCK 2/
JOSEPH & ISABELLE TROTTER /(even 'R. ann me /PERMIT NO.
CE 149 swxxx
2102AG EP RE EROAKAND 9957DRIVE (��,Il�' 5nee0Fx5
PLAN
I a
I �
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I 5
P
I
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1 1250G SEPTIC TANK
VERIFY INTEGRITY
1—I
I a BR 10.4
I HOUSE
INSTALL DV III
1 & DCO III 'Wx
PRO OUPGRADE SAS
I III 63LF Wx6'ED, 8'TD
1 \ IIIEXISTING 1" /
2C.5 ~—III T i 1 _ CUWATER SVC /
7
1 EXISTING 1" CU ; /' l�r 10.1
I WATER SERVICESNJ 11�-- — +—-------- -----
--------- � —_= 13'�LECTRIC & TELEPHONE EASEMENT
I I
SD
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—w—w—w—w AI
w—w—w.—w w—w—w—w—w w—w—
UPPER LOWLAND DRIVE
NO WELLS WITHIN 200'
I
-----------------------
r---- 15] Tele & Elec Esrot
ISSUED FOR CONSTRUCTION
PLAN
PANNONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
HYLAN CREST S/D LOT 2 CLOCK 2
JOSEPH & ISABELLE TROTTER
21027 UPPER LOWLAND DRIVE
EAGLE RIVER, AK 99577
V~.e 17/10/09
n rc. rannore j PERMIT NC
CE 8149 _c.,•,Cr�/ SWzxxxxx
`tc=eSheet
PROFLSSC90'
��""�� 2OF5
TEST HOLE 1
SLOPE I sl PUN v
Organ",
1
OR toDsoll, root
I
mess
I
2-
3 3
1
1
a
SMI
sands with sins
I '-• '
to sandy SILTS
I `
6
I 1
I
8
I
7
1
1
SAND, well
1
8
graded uniform.
TEST
HOLE j
9
soft, easy
digging
SW
i
\
10
11
I
12
—o-
Poorly graded
— .—.�-1.--.—.—.—_.—_.—.—.— •—
13
GP gray GRAVEL
and SAND. 12'
donikers. soft,
WAS GROUND WATER SLOPE
14
easy digging
ENCOUNTERED? NO
15
BOH
IF YES, AT WHAT TH 1
18
DEPTH? .1.
DEPTH TO WATER AFTER
MONITORING? - DRY -
18
DATE: 7/10/09
WATER
READING CLOCK NET TIME LEVEL NETDRDP
IME
READING
1 ---
2
a 11:35 -- 5.03 ---
4 11:45 10 6.07 1.04
5 11:45 -- 5.03 ---
e —IT1:55 1 10 1 6.08 1.05
PERCOLATION RATE 9.5 (minAnch) PERC HOLE DIAMETER 6Inches
TEST RUN between 5 and 6 FT.
DATE PERFORMED: 7/9109
COMMENTS: Test hole excavated by Flintstone. Test Hole was presoaked before perc test.Test ran for one hour.
Last three reading recorded.
PERFORMED BY: Steven R.
Pannone, P.E. 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPA�1`Il\L7�GGU�ID7L�IT�NES IN EFFECT ON THE DATE OF THIS TEST.
NOTES:
Pt1ONT ENG SVC, UC
P.O. 80X 102954 ANCHORAGE, AK 99510
.. L s\'
�� '4.,�-1 j
Dot
7/10/09
Scale
ISSUED FOR CONSTRUCTION
PHONE (907) 272-8218 FAX (907) 272-8211
Aw y
• • * /�
"
...
NTS
HYLAN CREST S/D LOT 2 CLOCK 2
P.I.D. NO
050-472_83
JOSEPH & ISABELLE TROTTER
n an
PERMIT N0.
21027 UPPER LOWLAND DRIVE
�teVeCE 8149 ��
PERMIT
SaeoF 5
PLAN
EAGLE RIVER, AK 99577
(�fq?pq`q+p�-'
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY
OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN
CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS.
2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS.
3. SCOPE OF WORK: 4—BEDROOM, REUSE EXISTING SEPTIC TANK AFTER CONFIRMING INTEGRITY OF TANK, REUSE
EXISTING SEPTIC FIELD, INSTALL DNERTER VALVE, INSTALL NEW FIELD.
4. GROUND WATER WAS NOT ENCOUNTERED IN THE TEST HOLE. NOTIFY THE ENGINEER IMEDIATELY IF GROUND
WATER IS OBSERVED IN THE EXCAVATION LESS THAN 12' BELOW GROUND LEVEL.
UPGRADE FIELD__ --1' Fill, W/Seeding
12508
SEPTIC TANK-�. :....•......:.....:.,.
DESIGN PARAMETERS
SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd)
TANK SIZE: REUSE EXISTING
PERC. RATE: 6-15 MPI
SOIL RATING: 0.8 gpd/SF
AREA ROD: 750 SF
SYS. TYPE: TRENCH, CED, 8'TD
MIN LENGTH: 62.5 LF
USE:
63LFx3'WIDE, 6'ED, 8' TD
TOTAL AREA: 756 SF
PROFILE DEEP TRENCH
SEE PLANS & SECTION
ABBREVIATIONS
LEGEND
Filter
Fabric
DIP DUCTILE IRON PIPE
WELL RADIUS
TH1
FC FOUNDATION CLEAN OUT
_ss — n _ EXIST'G SEPTIC
Drain
rock 6"
C# CLEAN OUT NO.
—2OR
M# MONITOR TUBE NO.
2.0'
R.I. RIGID INSULATION
—0 CHAINLINK FENCE
above
pipe inv
DV DIVERTER VALVE
SM
'
�r
4" diam.
Broin pipe.
tiff
VV
—7
v
3
Drain
rock
SW
—12
—14
GP
No groundwater
BOH
monitored
SECTION
LI(7III
I(jIG
I I I I
IrII I'j�II
11 I I
I(1' IjII
11 11
j
n n
/-4' Ua Ped PNS ri
/ F810 HOPE /� ,•,
12508
SEPTIC TANK-�. :....•......:.....:.,.
DESIGN PARAMETERS
SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd)
TANK SIZE: REUSE EXISTING
PERC. RATE: 6-15 MPI
SOIL RATING: 0.8 gpd/SF
AREA ROD: 750 SF
SYS. TYPE: TRENCH, CED, 8'TD
MIN LENGTH: 62.5 LF
USE:
63LFx3'WIDE, 6'ED, 8' TD
TOTAL AREA: 756 SF
NOTES: PAMONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211
HYLAN CREST S/D LOT 2 CLOCK 2
JOSEPH & ISABELLE TROTTER
21027 UPPER LOWLAND DRIVE
DESIGN NOTES EAGLE RIVER, AK 99577
ii
P�� ...... qs, 1+ 7 10 09
,•' �9 Scole
49TH */� NTS
CE 8149,Swxxxxxx
PROIESSW
�r Sheet
A 5OF6
PROFILE DEEP TRENCH
SEE PLANS & SECTION
ABBREVIATIONS
LEGEND
CU COPPER
_w—w— WATER LINE/
DIP DUCTILE IRON PIPE
WELL RADIUS
TH TEST HOLE
FC FOUNDATION CLEAN OUT
_ss — n _ EXIST'G SEPTIC
T# TANK CLEAN OUT NO.
C# CLEAN OUT NO.
—63—u— NEW SEPTIC
M# MONITOR TUBE NO.
R.I. RIGID INSULATION
—0 CHAINLINK FENCE
DCO DOUBLE CLEAN OUT
DV DIVERTER VALVE
FS FLOW SPLITTER
NOTES: PAMONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211
HYLAN CREST S/D LOT 2 CLOCK 2
JOSEPH & ISABELLE TROTTER
21027 UPPER LOWLAND DRIVE
DESIGN NOTES EAGLE RIVER, AK 99577
ii
P�� ...... qs, 1+ 7 10 09
,•' �9 Scole
49TH */� NTS
CE 8149,Swxxxxxx
PROIESSW
�r Sheet
A 5OF6
�\ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME i
/��NE
PHONE
W
/
4 _
❑ UPGRADE
MAIL ADDRESS
J
LEGAL DESCRIPTION I "`•' - ' ''-`' `' -
Vest �
�
LOCATION
NO. OF BE
DROOMS
DISTANCE TO:
Absorption area
2a) . r
Dwelling
P11AT .q .73
y
2UY
Manufacturer �JJ �.C, ("/?fj�?1 _/='-G�i" rt
✓ �{ 'ral j
No. of co parpnents
G
UJQ
s�j
N
Licl c paeii in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
O X
DISTANCE TO:
Well
Dwelling
PERMIT NO.
0 Z Q
2 F°
Manufacturer
Material
Liquid capacity in gallons
=
DISTANCE TO:
Well
Gl. ,6 %.C�:-�-
f
Foundatio
Nearest lot f
PERMIT NO. ^7 _ Z
u z
No. of lines J
Lengtho,ea_ h lipe
Total le gjl gimes
Trench�dth
!'
Distance¢etwe lines
Z w
(
.y �:7
-
cJ C.�' inches
/V
N
Top of tile to fi i
Material beneath
cc
Frade
tile _ / /
Total effegtLve a or f are
4
-
inches
F„J`' �
Length
Width
Depth
PERMIT NO.
w
U
Q I_Type
°' a
of crib
Crib diameter
de tM�
ff
Total effective absorption area
LLl
U)
DISTANCE TO:
Well
Building foundation
Nearest lot line
a
ClriF��r
epth
Driller
Distance to lot line
PERMIT NO. s
LU
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area (s)
OTHER
PIPE MATERIALS
SOIL TEST R NG
5,
INSTALLER
REMARKS
ea'•e �
ar+i'w Y�4i
} ,
At, 6'
N*� f, Y
aE
0
NNCI
ry'cJ ••• Robert R�ICIPALl71 O
ShallorMLUN
`4d
IOPd G;
No. 1467•Q : DEPT. OF t
�
E
77 77-7
-a cay 4r:u , :d ('i7
APPROVED- [} i,l`) a , ,, .7 DATE ALrrl '
rte-3�'il h i'I
ell
72-013 (Rev. 3178)
PERMIf NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
J: I-.'
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �r�
825 L ANCHORAGE, AK 99501
264-4720
840732
08/28/84
C/O S & S ENG'G. CHUCK BARR
SRB 196X /
EAGLE RIVER, K
694^2979
SUBDIVISION: T LOT: 2
SECTION: 8 TOWNSHIP: 14N RANGE: 1W
20000 (SQ'FT. OR ACRES)
4
Listed below are the options
available to you
in designing
system^ Choose the option that
best fits your
site^
..... ~..... ~-..... ^~�~~�_
..... ~��
... .... �..... �
DEPTH TO PIPE BOTTOM(FT")
GRAVEL DEPTH (FT.)
' 4^5
0.5
TOTAL DEPTH <FT")
8.5
4,5
GRAVEL WIDTH (FT.)
| 2"5
20^0
GRAVEL LENGTH (FT")
56.0
38.0
GRAVEL VOLUME (CU.YDS. )
26.0
28.2
TANK SIZE (GALS)
1,250^0 **/'
i,250.0 **
SOIL RATING (SQ.FT./BR)
� 125 /
125
** TANK MUST HAVE AT LEAST
������'�-�'��^����.�
�
TWO S
`�' .... ... .....
....
BLOCK: 2
your septic
. ..... .....������
4"0
3"5
7.5
5.0
54.0
40"0
1,250.0 **
125
I certi[y that:
1. I am f,amiliar 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 [or 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 undersLand that this permit is valid for a maximum of 4 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODESj,
THEN (1) AN ELEC IT AND INSPECTION MUST BE OBTAINED; <2) ASBUILTS
WILL NO T AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRIC L R MUE BY A LICENSED ELECTRICIAN^
SIGNED DATE:
TO'"
_____~_~__```__-�
APPLICAN1�' O S & S ENG/G" CHUCK BARR
, `
ISSUED BY DATE: 0/
�. .....---~~-~~�~~~~~~�~~��^�^~~^��~�~��~
�
6'
�^/�'
PERFORMED FOR:
LEGAL DESCRIPTION:
DEPTH
(FEET)
2
3
4
U�
5
F .
6
7
7
8
9
1
10 d
c
11 `
12
13
C
14-
15
4 15
16'
17
18-
19-
20
819 20
COMMENTS
J SOILS
LOG
MUNICIPALITY OF ANCHORAGE W C) y
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
DATE PERFORMED:
G2Az�Sr)
45-C)
C/)Z- /G 7 Sig
SLOPE
l
WAS GROUND WATER
f S
ENCOUNTERED?
,Q
J�` L
Depth to
Water
/ O
P
IF YES, AT WHAT
/z L E
DEPTH?
/
SITE PLAN
c
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
.o/
'rn"4.4T' A PERCOLATION RATE
k��'�l(►VE.»�'��'`�+ TEST RUN BETWEEN
•+ H
PERFORMED BY: ;=rt4tl.v
72-008 (6/79)
L;10111r;:' ' INt3
tBU-TU ^^ yy
_CERTIFIED
/T (minutes/inch)
FT AND FT
DATE:
Parcel I.D. 050-472-83
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description
t�
A -,Al
} APR , H15
Expiration Date: L - 17
Hylen Crest #1, Block 2, Lot 2
Location (site address) 21027 Upper Lowland Ave
Current Property owner(s) Timothy & Megan Rlebe Day phone
Mailing address
Real Estate Agent
PO Box 770091 Eagle River, AK 99577
2. TYPE OF DWELLING:
[K] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
EXI
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
U
Public Sewer
❑
Waiver/Variance request for:.
Received by:e�--' 4-0,— 0 4 / Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Saz Waiver Fee $ _
Date of Payment U f V S Date of Payment
Receipt Number ®otaqiL� Receipt Number
COSA # ©SCWaiver#
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 fime of installation.
In conducting an adequacy lest, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the central of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 04/10/2015
6. DSD SIGNATURE i
System #1 Approved for bedrooms Stevan ?'.' ♦5a are: '
CE 8149 rf
System #2 Approved for bedrooms
Disapproved{OFtS51`
Conditional approval for bedrooms, with the following stipulations:
By:�� / r Original Certificate Date:
Th ni ' it 6f orage Development Services Division (DSD) issues Certiflcates 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 I a
If more than 1 septic system is on the lot:
COSA Checklist # + of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Hylen Crest #1, Block 2, Lot 2Parcel ID: 050-472-83
A. WELL D%CrA
Well type Public If A, B, or C provide PWSID # AVMU Well Log (Y19) -
Date completed Sanitary seal (YIN) — Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic(Steel Date installed 09/20/1984
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N{� High water alarm (Y/N) N - -
Date of pumping T �3 �� (�7 Pumper cT�2 S Ytn.vi
C. ABSORPTION FIELD DATA
Date installed 07/16/2009 Soil rating (g.p.d./ftz or ftz/6drm) 0.8 g.p.d./sf System type Deep Trench
Length 63 ft. Width 2.5 ft. Gravel below pipe 6 ft. .
Total depth 9.6 ft. Eff. absorption area 756 fiz . Monitoring tube Y Depression over field N
Date of adequacy test 04/09/2015 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 10 in. Water added -649 gal. New depth �2 in.
Elapsed Time: 220 min. Final fluid depth 10 in: Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at
in. High water alarm level at in.
Datum Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
On adjacent lots
Absorption field on lot
On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer /septic service line
Holding tank
Animal containment areas
Manure/animal excrete storage areas,
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 10+ .
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMEN//TT�S %1
G. ENGINEER'S CERTIFICATION
I certify that l have determined through held inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date 04/10/2015 -
COSA canary sheet_2.6-16.doc'
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 110+
Municipality of Anchorage
*S
4700
Development Services DepartmentBuilding Safety DivisionaOn-Site Water and Wastewater Program 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. 050 472 63 COSA # Q S C I D� I
Expiration Date: Z/^
1. GENERAL INFORMATION
Complete legal description Hylen Crest #i BIk2 Lt 2
Location (site address) 21.027 Upper Lowland Ave. Eagle River Ak. 4Q577
Current Property owner(s) Benjamin & Jennifer Douglas Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
21027 Upper Lowland Ave., Eagle River, Ak 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community Class Well ❑
Public Water System
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (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 7ooii7,Anchorage, AKggrio
Engineer's Printed Name Steven R. Pannone P.E. Date 1 2,c 9F1 u�
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features. �+
The operational life of all wells and septic systems depend on the local soil condition, ground water ���� • �F A( V4Ot
levels that may fluctuate during the year, and the water usage of the family being served b the s stem. •"'
Y g Y g Y g Y Y ���P,.�• +1�
These conditions are outside the control of the evaluator of this system. All systems eventually fail and
satisfactory [est results do not guarantee future performance of the system, nor do they guarantee that 49
p( •• :.'� �j
there are no bidden defects or encroachments. PES can therefore not provide any warranty for future �•••••.. •• ^•• ••• •• ......••r•••••�
performance not give any estimate of how long the system will continue to meet the operational ........ I ... ..... ....... ...... tt-, i
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed /� ;Steven R. Pannone i{u i
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it ��cl,p �• N o. CE 8149••.`
confer any legal right whatsoever. ++ ......
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
By:tf > Original Certificate Date: 9-3
�'f 2—
(Rev. 11105t
Municipality of Anchorage o k s
' 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: Hylen Crest #i Blk 2 LT z Parcel ID: oro -472.8;
A. WELL DATA
Well type Public
Date completed
Total depth ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (Y/N)_
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESUL
Coliform
ft.
g.Pm-
mL Nitrate mg/L
Well Log (YIN)
Wires properly protected (Y/N)
Casing height (abovend) in.
AT
ft.
ug/I Date of sample: Collected by:
SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel Date installed g/20ha84,
Tank size 12SO gal.
Foundation cleanout (Y/N) Y
Number of Compartments 2
Depression over tank (Y/N) N
Date of pumping 8h4/202.2 Pumper JR Pumpers
C. ABSORPTION FIELD DATA
Cleanouts (Y/N)
High water alarm (Y/N) N/A
Date installed 7/i6/2ooq Soil rating (g.p.d./ft2 or ft2/bdrm) o.8 System type Deep Trench
Length 6:t ft. Width 2.r ft. Gravel below pipe 6 ft.
Total depth 8 ft. Eff. absorption area 796 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8/3.4/2012 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 42 in. Water added600 gal. New depthrz in.
Elapsed Time: Zoo min. Final fluid depth 42 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
"Pump on" level at in.
Size in gallons
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ioo+
Absorption field on lot loo+
Public sewer main 7g+
Sewer /septic service line zs+
Animal containment areas ioo+
Manhole/Access (Y/N)
level at
Meets alarm & circuit requirements?
On adjacent lots ioo+
On adjacent lots %oo+
Public sewer manhole/cleanout ioo+
Holding tank ioo+
Manure/animal excrete storage areas ioo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation c+ Property line ;+ Absorption field 4+
Water main io+ Water service line io+ Surface water ioo+
Wells on adjacent lots ioo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line io+ Building foundation io+ Water main ao+
Water Service line io+ Surface water ioo+ Driveway, parking/vehicle storage io+
Curtain drain So+ Wells on adjacent lots ioo+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
t certify that t have determined through field inspections and c ,,' 49TH
review of Municipal records that the above systems are in h
conformance with MOA COSA guidelines in effect on this date. r
........... ... .....
R.
Engineer's Printed Name Steven R. Pannone, P.E. I� Steven No. CE 8149 ei
1� C149s•��
••4.•.I••��
Date / ��1,� ♦•f�_ . �';T:Y';rr1t�••.
COSA Fee $ - 00
Date of PaymentgItt61Fz
Receipt Number &f ko w6y,
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
in.
NON -OBJECTION TO EASEMENT ENCROACHMENT DOCUMENT
By this document Matanuska Telephone Association, Inc. (MTA) declares that it has no objection to the
encroachment of a portion of a septic system within the 15' Electric & Telephone easement located along
the south boundary of Lot 2, Block 2, Hylen Crest Subdivision Unit 1, Anchorage Recording District, Third
Judicial District, State of Alaska, situated in Section 8, Township 14 North, Range 1 West, S.M., 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 borne 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 asreement to vacate any portion of the utility easement and should not be
interpreted as such.
Issued for Matanuska Telephone Association, Inc. this 23rd day of August, 2012, by,
r
y9 Real Estate & Properties Supervisor
THIS IS TO CERTIFY, that on this 23rd day of August, 2012, before me the undersigned, a Notary Public in and
for the State of Alaska, duly commissioned and sworn as such, personally appeared Bonnie Bailey 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.
/12 1�
Notary ublic ' I and for
My commission expires:
GRANTOR:
Matanuska Telephone Association Inc.
PO Box 3550
Palmer Alaska 99645-3550
800.746.9510
907.761.2510
907.761 .2646 (fax)
www.mtasolutions.com
Local
Long Distance
Wireless
Business Solutions
Internet
Directory
DTV
MATANUSKA ELECTRIC ASSOCIATION, INC.
LETTER OF NON -OBJECTION
August 28, 2012
Benjamin S. Douglas and Jennifer H. Douglas
21027 Upper Lowland Avenue
Eagle River, AK 99577
Re: Block 2, Lot 2, Hylen Crest Unit No. 1 Subdivision (Plat 83-90, Anchorage Recording District)
Dear Benjamin and Jennifer:
MEA has no objection to the encroachment of a Septic System located in the utility easement as depicted
on the attached as -built survey 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 28 day of August, 2012 before me, the undersigned, a Notary Public in
and for the State of Alaska, duly commissioned and sworn as such, personally appeared
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. a,`e�y�„Frrt,gfp`
�>"rr,
IN WITNESS WHEREOF, I have hereunto set my hand and off' alasea1, e.day: ail year first above written
SEAL n
Notary Public in and of Alaska My commission expi$es
Return to: MEA, PO Box 2929, Palmer, AK 99645
:,L�.%X
Lot l
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9
Lot 6 /
i
N89°59'00"W 100.00
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LOT 2
10 OH-. III ----m f3.0 OH
c 42.0
2 Story Frame
}louse
YY
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tot 5
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UPPER LOWLAND AVENUE
r r
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. RCJ,
FS 09-4, P9 WS?
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Lot 3
8342H
SCALE: 1 "= 30'
OF Atq`r�l'
*-'49TH*
-TH liJ � tl
•, Fred VJala:ka
�}F N3, 3255,S
— AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's Inspec4on
of the following described properly, LOT 2 BLOCK 2.
Q HYLEN CREST SUBDIVISION, UNIT No. 1
r>
BE
Anchorage Recording Precinct Alaska, and Chet the
Improvements situated thereon are within the property tines
and do not overlap or encroach on the property lying
adjacent thereto, that no Improvements on the property tying
adjacent thereto encroach on the premises In question and
that them are no roadways, transmission Enos or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this IBM dayof JULY .2009
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
(907.246-1666)
a
l5' Elec. & Tefe.
Easement
N89°59'00"W 100.00
0
tns
UPPER LOWLAND AVENUE
r r
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. RCJ,
FS 09-4, P9 WS?
O
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Lot 3
8342H
SCALE: 1 "= 30'
OF Atq`r�l'
*-'49TH*
-TH liJ � tl
•, Fred VJala:ka
�}F N3, 3255,S
— AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's Inspec4on
of the following described properly, LOT 2 BLOCK 2.
Q HYLEN CREST SUBDIVISION, UNIT No. 1
r>
BE
Anchorage Recording Precinct Alaska, and Chet the
Improvements situated thereon are within the property tines
and do not overlap or encroach on the property lying
adjacent thereto, that no Improvements on the property tying
adjacent thereto encroach on the premises In question and
that them are no roadways, transmission Enos or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this IBM dayof JULY .2009
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
(907.246-1666)
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/onsfte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050.472-83
1. GENERAL INFORMATION
Rosy ,
COSA s 09 0 2.3 ,2
Expiration Date: %- 02.1 — I a
Complete legal description HYLEN CREST BLK 2 LT 2
Location (site address) 21027 UPPER LOWLAND AVENEUE EAGLE RIVER AK 99577
Current Property owner(s) ISABELLE TROTTER Day phone 244-9501
Mailing address 21027 UPPER LOWLAND AVENEUE EAGLE RIVER, AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSH will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class A Well
®
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based,bn the information
-Irom the Municipality of Anchorage files and from my investigation and inspection, the on-site water
obt�
I o
` /or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
\i ces, and regulations in effect at the time of installation. �} a
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 7/17/09
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 that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PCS can therefore not provide any warranty for future
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
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
center any legal right whatsoever.
5. DSD SIGNATURE
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
Maintenance Agreements
Supplemental Engineer's Report
Other
By c_e�_ Original Certificate Date: Z 2, '10
p,w,,,n51
Municipality of Anchorage e
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: HYLEN CREST BLK 2 LT 2 Parcel ID: 050472.83
A. WELL DATA
Well type A -
Date completed _
Total depth ft.
Date of test
Static water level
If A, B, or C provide PWSID # AWWU
Sanitary seat (Y/N) _
Cased to ft.
FROM WELL LOG
Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic: — ugA Date of sample:
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N)
Wires properly'protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
ft.
g.p.m.
Other bacteria colonies/100 mL
Collected by:
Tank Type/Material STEEL Date Installed 912011984
Tank size X250 gal. Number of Compartments 2 Cleanouts (YM) Y
Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 711612009 Pumper JR PUMPING
C. ABSORPTION FIELD DATA
Date installed 71116=09 Soil rating (g.p.d./te orft2/bdrm) Q 8 System type DEEPTRENCH
Length 63 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth § ft. Eff. absorption area 118 ft? Monitoring tube Y Depression over field N
Date of adequacy test 7110009 Results (Pass/Fail) SASS For 4 bedrooms
Fluid depth in absorption field before test NEIN 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.) (YM & type) If yes, give date
D. LIFT STATION
Date Installed
"Pump on" level at _ In.
Datum
Size in gallons
"Pump off"level at _ in.
Cycles tested
Manhole/Access (YIN)
High water alarm level at
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NIA On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5' Property line 30' Absorption field 17'
Water main 75' Water service line 43' Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 14' Building foundation 10' Water main 45'
Water Service line 58' Surface water 10'+ Driveway, parking/vehicle storage 30'
Curtain drain 50'+ Wells on adjacent lots 200'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field Inspections and `,� ei
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. 0. Al Steven none� =
No. CE 81x9
Date 711712009 ee ''
COSA Fee $ + / O Krn 4
Date of Payment
Receipt Number
(Rev. 11105)
Waiver Fee $ _
Date of Payment
Receipt Number,
In.
Lot 1
O
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Lot 6
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fence
LOT 2
OH
Lot 5
42.0
0
2 Story Frame
N
House
Jew
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6.0
4
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24.0
26.2—
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15' Elec. 8 Tele.
Easement
N89059'00"W 100.00
O
co
_UPPER LOWLAND AVENUE_
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. RCJ•
FB 094, pg 56-57
O
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0
N
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0
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BE
8342H
Lot 3 SCALE: 1"= 30'
— AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's Inspection
of the following described property: LOT 2 BLOCK 2.
H_YI EN CREST SUBDIVISION UNIT No. 1
Anchorage Recording Precinct, Alaska, and that the
Improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no Improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage. Alaska
this 18th day of JULY .2009
FRED WALATKA 8 ASSOCIATES
Engineers and Surveyors
(907.248-1666)
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services AGIAJD3�
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744 1661 1 Q 3;0
CERTIFICATE OF HEALTH AUTHORITY NOISIAIa 33JIAd3SlV1N3wNOWN3
APPROVAL FOR A SINGLE FAMILY DWELLINGI 3ov8oHCNv J0,ullvd0INnw
Parcel I.D. # 12�G'' y�2—!d_5 HAA
1. GENERAL INFORMATION
Complete legal description Lot 2 Blk 2 Hylen Crest
Location (site address or directions) 21027 Upper Lowland Avenue
Property owner Joseph Trotter Day phone 694-7210
Mailing address 21027 Upper Lowland Eagle River AK 99577
Lending agency First National Bank of AnchOMfthone 694-2103
Mailing address F.agl p Rimer
Agent N�/A Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well X
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Fronl MOA 421
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IOU op SHHQ to saafoldw3 -sluawaalnbei alels pue leaapal ulejjao i4slles olaapao ul suollnlllsul bulpual a!aul pue
sawou to siasepind of Asalinoo a se sl4l scop SHHQ a41'e)lsely to alelS aul u paaalsl6aa aaaul6ue leuolssaloid
luapuadepul ue Aq anoge 9 gdea6eaed ul uan16 suolleluasaidaa aul uodn Aluo paseq saleo!}llaa0 lenoaddV
Al!aoglnV ulleaH sanss! (SHHQ) saolnaaS uewnH pue 4lleaH to luawliedaa a6eaogouV to Al!ledlolunn ayl
V _ —7 alea
mollelndlls bulnnollol eql ul!m 'swooapaq
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'sapoo alels pue ledlo!unW Ile ul!M eouelldwoo ul sl walsAs lesodslp aalennalsem Jo/pue Alddns
aalenn ells-uo aul 'uolloadsul pue uolIeBllsanul Aw woll pue sell; 96eaououy to Al!ledlolunn aul
woal paulelgo uollewaolul aul uo paseq leul Al!aan aaulanl I •ulaaau paleolpul ainlonals to adAl pue
swooapaq to aagwnu aul aol alenbape pue leuollounl 'ales sl walsAs lesodslp aalemalsem Ao/pue
Alddns aaleM ells-uo aul legl smogs uolleolldde leno.iddy Al!aoulnV ulleaH s!ul to u01le611sanul
Aw leul Al!aan I 'Molaq unnous alep uollep!len aul to se pue olaaau pax!lle leas Aw Aq pa!liliao sy
d33NIJN3 AS N01103dSN1 d0 LN31N3.LV1S 'S
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ��`9/F' �par el LD
A. WELL DATA
Well type A If A, B, or C, attach ADEC letter. ADEC water system number
Log present(Y/N)
Total depth
Sanitary seal (Y/N)
FR
Date of test
Static water level
Well flow
Pump level
Date completed
Cased to
WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Public sewer service line
WATER SAMPLE RESULTS:
�'LO e" �
.2C,
Coliform Nitrate
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Driller
Casing height
Wires properly protected (Y/N)
g.p.m.
AT INSPECTION
.0RK
=•r,
ma
;02_
9
V
raw
Pw
0
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g.p.m.ro
ssi
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<
0r°T'1
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(�.ce
C�
On adjacent lots ;2
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
Date installed % !� h 4/_ Tank size
Compartments =
Cleanouts (Y/N) IL Foundation cleanout (Y/N) ` _ Depression (Y/N)
High water alarm (Y/N) /V/1 Alarm tested (Y/N)
/
Date of pumping ��,�ii d!l f
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Wel I(s) on lot "'
To property line
t« '
Surface water/drainage & /,
On adjacent lots
y a.� r
Foundation �i
Absorption field sV Water main/service line Y /,) /
72-026(Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION AIM
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off' level at
Cycles tested
Surface water .
Date installed �`�F`/ Soil rating Z,251 System type Tel -&-i e,/-
Length 63 Width 36' ".1 Gravel thickness V, J Total depth ey,s" /
Total absorption area e�?') //Z5 Cleanouts present (Y/N)
Depression over field (Y/N)
Date of adequacy test 4 �425,:Z
Results (pass/fail) _/5?2- _ for .�? -- bedrooms
Peroxide treatment (past 12 months) (Y/N) ",1,14 If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot a On adjacent lots
r�OG) r
Property line t A2 :
i
To building foundation -�L To existing or abandoned system on lot NI4
On adjacent lots 7-34) Cutbank /V1<3 Water main/service line -`'e)
Surface water
Curtain drain IV14
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area Bio
1 certify that i have checked, verified, or conformed to all MOA and HAA guidelines in effect on, the, date of this inspection.
F `�tt 11 •.
- rl
,9 S
Signature
�--
Engineer's Name
Date / L oYl
pct
HAA Fee $ t 7 Waiver Fee: $
Date of Payment ( Date of Payment
�� T6 Receipt Number
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Eagle River Engineering Services
119.40 Business Blvd, Suite #205
P.O. Box 773294 694-5195
Eagle River, A. 99577 Fax 694-3297
Legal: t e ,Y �e� c 7,-
Owner; ,Y rre Date:
Type of test;
❑ Well Flow Test V Septic Test Only ❑ Well & Septic Test ❑ Other;
L... -.- Al
Time
Meter
Reading
Monitor
Level
Well
Level
Tank
Level
GPM
PSI
Remarks
,:
--
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8Arm
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17
L
WALTER J. NICKEL, GOVERNOR
ILJI (hU1111JJJ ILJI I rL�' U� ILJ( (J/ Il I n\ i1
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE 563-6775
3601 "C" STREET, SUITE 322
ANCHORAGE, ALASKA 99503
FOR: Eagle River Engineering
November 19, 1991
PWSID # 213289
My review of the records on file in this office reveals that the Hylen Crest Subdivision
Class "A" Public Water System, is in compliance with the routine coliform bacteria samples
requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC
80.200.
Sincerely,
Byron Roys
Environmental Engineer
BR/cf
`j11� printed on recycled paper b y C.Q.
« MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Des iiption (include lot, block, subdivision, seJcti n, township, ra ge)
Location (address or directions) 0/ 7-- T /Q_)
(b) Applicant Name �_.�yTelephone: I-lome
Applicant Address `;'—U Fly r�_ f ,�_,.f;>r
(c) Applicant is (check one): L- ending Institution
Business
Ider d, Buyer E] ; Other © (explain);
(d) Lending Institution r2 _ �:�� << :�z telephone
Address
(e) Real Estate Company and Agent
Address
(f).J:'MhiTthe HAA to the following address.
2. TYPE OF RESIDENCE
Single -Family Multi -Family Ea Other
i
Number of Bedrooms
3. WATER SUPPLY
Individual Well ® Community l
Public
Note: If community well system,/must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL.
Onsite Public ❑ Community n Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-02504,8d)
5. ENGINEERING FIRM PROVIDING ,..SPECT IONS, TESTS, FILE SEAnCH, DAT�..oND INFORMATION
G.
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
forthe number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm—
Address -- —_--=
Date
DHEP APPROVAL � VD'a
PA yA roed for )�.✓.__b dr,oms b'te
Approved ------ DisapproveG/. _--___ Conditional —_—.
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Cnvironmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State o` Alaska- The DHEP does this as a courtesy to purchasers of horses and their lending
institutions in order to satisfy certa!n federal and state requirements. Employees of DI IEP do not conduct inspections or
analyze data before a certificate "sued, The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (1 LC41
A.
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
„.yr 24,E
RECEN-0
WELL DATA
Well Classification
MUNICIPALITY OF ANCHORAGE (MOAr
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: j--67-I'r Z • Z
If A, B, C, D.E.C. ApprovedrgN)
Well Log Present (Y/N) Date Completed
Total Depth Cased to Depth of Grouting
Static Water Level Pump Set At
Yield
Casing Height Above Ground _ Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
Depression Around Wellhead (Y/N)
To Septic/+Ie4 Tank on Lot -7 C>I + ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ;?� *� ; On Adjoining Lots —
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
Water Sample Test Results
Comments 45g� < V lkgnr
B. SEPTIC/Hi6lBf #G TANK DATA
Date Installed �0' 0+ Size leo No. of Compartments
Standpipes (DN)
Air -tight Caps&'N)
Z
Foundation Cleanout (DN)
Depression over Tank (Y/&? Date Last Pumped ►� ,
a
Pumping/Maintenance Contract on File (Y/N) ; for
a
Holding Tank High -Water Alarm (Y/N) r' A Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Refdwq Tank:
To Water -Supply Well Zc-, 0 ( To Building Foundation
To Property Line o To Disposal Field
To Water Main/Service Line
Course
To Stream, Pond, Lake, or Major Drainage
Commentsy .t
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata (�� ��� Type of System Design
Date Installed Length of Field �� T
Width of Field 30 Depth of Field �1 0
Gravel Bed Thickness �� N
Square Feet of Absorption Area Slo% `P Standpipes Present (27N)
Depression over Field (YAP—
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well
r-' /A
Date of Last Adequacy Test N- 7
To Property Line
0
To Building Foundation Zt To Existing or Abandoned System on
3
Lot 4 ; On Adjoining Lots 3�
To Water Main/Service Line 01 k To Ctbank (if present)
a
To Stream/Pond/Lake/or Major Drainage Course
1
To Driveway, Parking Area, or Vehicle Storage Area
Comments K_"�crf'S
D. LIFT STATION
Date Installed
Size in Gallons
Dimensions
Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed 8 a 10 EJGINE` RINQ Date e6-,
011
Company'' ' E ?;lVr;1, P,i Ac iE2 R ;77 MOA No.
Receipt No.
Date of Payment
Amoun$
t
Vffobert A. Shafer 1
ao No. 1457.E
Page 2 of 2
72-026 (11/84)
(I
�iMp � � I AIA,
( \ BILL SHEFFIELD, GOVERNOR
REIT. OF ENVIRONMENTAL CONSERVATION Telephone: (907)
Address:
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303 274-2533
ANCHORAGE, ALASKA 99501
DATE:�����
PWS I.O.#ciL�eJr _
To Whom it May Concern:
According to records on file in this office the
J� 11 Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
I " J, A, &A,