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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 I I I I I 1 I I I I I INSTALLED DV I & DCO I I \ I I I EXISTING 1" CU I WATER SERVICES -------- SD SD — SD — w— w— w- fTok9 \ 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 = ��pF A�gsl�' /ig�p' '�'9+�� /*• — *� .. ... ..... .. ....... tevenn8149 (" none '• / �) cs•.� 1��' oi�s9 "` � 0ate 7/17/09 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 = ��pF A�gsl�' /ig�p' '�'9+�� /*• — *� .. ... ..... .. ....... tevenn8149 (" none '• / �) cs•.� 1��' oi�s9 "` � 0ate 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 � I I 5 P I I I I I I I •� 4 I I EXISTING 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 - so = so — so — so — so 29.� =90 ur7-w;4E"n"'FfAI�� — — —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 O 0 O 0 N LU O 0 O 0 9 Lot 6 / i N89°59'00"W 100.00 lance LOT 2 10 OH-. III ----m f3.0 OH c 42.0 2 Story Frame }louse YY 0 Y r tot 5 o dk •" • .00H 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 C> O O N LLI O 0 C 0 0 MA 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 C> O O N LLI O 0 C 0 0 MA 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 O O 0 N w 0 O O O 0 iJ Lot 6 2.0 / N 100,00 fence LOT 2 OH Lot 5 42.0 0 2 Story Frame N House Jew o It 'a 6.0 4 0 24.0 26.2— O 0 dk 24.0 °p • .0 OH 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 O O 0 N W 0 O O O 0 LA O M 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 2# Vow HOBS MA 'nay) 9d0-dj -Naorn s,aaaul6ue leuolssaload aul ul suolsslwo Ao sao,ua Aol alglsuodsai IOU sl a6eaoyouy to A}lledlolunW ayl •panssl sl aleollll)ao a aaolaq elep azAleue ao suolloadsw lonpuoo 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 � Np1SS3j0lfdpJ�t� j° 9£LS-37 M oaa.n� 't. toe eat O .6 ...%Otto m sluawwo0 leuoll!ppb aol lenoadde leuoll!puo0 panoiddesia -swooapaq / aol panoaddy �j 3anIVNJIS SHHQ '9 T6/OE/ZT a}e4 ainleu6lss,aaaulbu3 LLS66 XV 'zan?d aTfeg t6ZELL XoS 'O'd ssaappy S6TS-b69 auoud saaTn.zag uTaaauT ug -aanT8 aT eg wal-zldoawzN •uolloadsui slut to alep aql uo loalle ul suollelnbei pue 'saoueulpao '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 (") g.p.m.ro ssi r" < 0r°T'1 @ZY ° (�.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 ,: -- DA74— 8Arm a..+Y 5 e.GPoNi 7 // u t hr T i wr -Oti e. w z:ZZ_ _�"S_N nF LrC e-/FiP/o/ NY l.Z�a 7 1��fsu� `� rbc .vim 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,