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W1zK Zm�=OZO<3: W w < WO wwzOQWOE ww a=mm =D0= WE W J w o U~ of O w zzWwza-mwof 3<-Q-UclwNO}� (DxzF -Zz 0OF-W OO¢wOj¢az0 M K p Z P W � Z O < n - W U W 2 2}= zO = m= w �F mF-030ro /.- O a-) Chugach Park Dr. _--= Arc 113.24' /^ ,d.630.00' E N 89'22'20" E 43AX Sheth ? O Roof OH t v 21.4'^'Lot 9 00 37.2' , N H i . ause; Lot 7 5---- ! R f5�ai� z 4 o :l4a O n I all 0 2`5 50 o US SURVEY N FEET � N O Lo t 8 lB� l�to�tcl�� .� OF. ALgll *� 4$ TH 1 . /Jeremy A Hurst LS 1 �} .' 10' Utility Ease. N 88'46'00" E 208.40' 1F0' • �5�, P _ ESSbNaI��`�..� r 1�� NOTE$ Chugach State Parc -All dimensions shown are grid bearings and ground distances, record boundaries are per Plat No. 72-188. -49th Star has conducted a physical survey of the property and all details shown on this Asbuilt Survey are correct. Under no circumstances should any data hereon be used for construction or the establishment of property lines. -It is the owners responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed. AS BUILT SURVEY LEGEND- 4th Star Surveying � g .r Lot 8, Block 2, ® Clean Out well PO Box 738 Q Septic Tank lid Girdwood, AK 99587-0738 Chugach Park Estates, (907)891-6111 Chuglak, AIS 0 Electric Transformer Jeremy@49th5tar5urveying.com Fence - v " W.O. 2583 -- DATE 9126125 SCALE 1"=50' kmuv UO/UGI lo) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251209 PID Number: 051-481-03 Dwelling: Q Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New n Upgrade Name Lori Hyden ABSORPTION FIELD F] Deep Trench ❑ Wide Trench El Bed El Mound Site Address 19360 Chugach Park Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD)SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Chugach Park Estates 2 8 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ n/a n/a n/a 25'+ TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water 100'+ n/a n/a n/a Material Number of compartments Lot Line 51+ n/a n/a n/a NA HDPE (Deep Bury) 2 Foundation 10'+ n/a n/a n/a LIFT STATION Manufacturer Capacity Remarks Tank replace only Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank existin Tank to g drainfield D3034 Hiland Excavation, LLC Drainfieid existing CO)MTD3034 Inspector Pannone Engineering Services, LLC BENCH MARK (Assumed elevation) 100.3 ft Inspection ection im 8/26/2025 8/26/2025 Location and description 3`d 2�d 4,h MH Lid ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date q>. ....4 ...... X Steven R. Pannone. �� Septic Systerr� Approved Date 0�0� �`s>> .0CE 23/1055. �� '�P�D, ' - . h",'�`- � - Note: this approval does not include well permit requirements. kmuv UO/UGI lo) MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251209 Work Type: SepticTank Upgrade Tax Code Number: 05148103000 Site Legal Address: CHUGACH PARK ESTATES BLK 2 LT 8 G:1161 Site Mailing Address: 19360 CHUGACH PARK DR, Chugiak Owner: HYDEN LORI ANN Design Engineer: This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: parIIII e11t 6/25/2025 6/25/2026 54628 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Recei Issue( Date: 6/25/2025 Date: 6121,912025 3 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section t ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-481-03 Property owner(s) Lori Ann Hyden Mailing address Site address 19360 Chugach Park Drive Legal description Chugach Park Estates Block 2 Lot 8 Number of Bedrooms 3 Engineering Firm Pannone Engineering Services, LLC. Building Permit Number Day phone Not Applicable ❑■ APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Disposal Field ❑ Initial ❑ Septic Tank 0 Upgrade E Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: 05 Date of Payment: 6 IZ#125 Permit No. M2Qog May 2025 Waiver Fees: Date of Payment: Waiver No. Distance: Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Mailing: P.O. Box 1807 Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska Subject: Chugach Park Estates Block 2 lot 8 Septic System Upgrade Permit Request This is a design narrative for a permit to install a 1000-gallon septic tank to replace an existing 1000-gallon septic tank to be issued for this property. The existing tank is 42 years old and is likely perforated and leaking, it will be decommissioned per code. Currently the lot is developed. The proposed replacement will be connected to the existing drain field. This lot and the surrounding lots are served by private wells. There are currently no wells within 100’ of this upgrade. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5’+ from any property line. 5’+ from any deck/stair support. 10’+ from building foundation. 10’+ from any water line. 100’+ from any surface water. 100’+ from any private wells. 200’+ from any public wells. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions, please contact me at (907) 745-8200. Sincerely, Steven R. Pannone, P.E., F. ASCE Owner/Civil Engineer 20 June 2025 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251209, Ben Cogger, 06/25/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251209, Ben Cogger, 06/25/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251209, Ben Cogger, 06/25/25 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 MAILING ADDRESS LEGAL DESCRIPTION / LOCATION DISTANCE TO: ] I Well -1/o Manufacturer ~ [Liq.,capacity in gallons IDISTANCE TO' Iwell I' I Manufacturer I We · I DISTANCE TO: I No. of hnes ~ Length of each Top of tile to finish grade Length Width /Y/ I Type of crib Crib diameter I DISTANCE TO: ]Class .---. Depth DISTANCE TOT' ~ut'ldin~ ~oundation PHONE ,j~N EW [] UPGRADE NO. OF BEDROOMS IAbsorptionarea,lL/Z,~ Dwelling lt..~'"7 I PERMITNO. -- Material.~/~__~ ~ ~- No. of compartments Inside~length Width - Liquid depth ~ PERMIT NO. Dwelling Foundation:.~ ~' '7 Total length of li~nes 3~,- + Material beneath tile Material Nearest lot line, c, ~) ! inches Depth Crib depth Liquid capacity in gallons PERMIT NO. Distance between Total effective absorptio.~,area PERMIT NO. Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE LEGAL _MUNICIPALITY OF ANCHORAGE.- ' Department ~ Health and Environmental ~rotection - 825 ~ Street, Anchorage, AK. ~9501 264-4720 ~---,['--LJ'-J~, * * * HANDWRITTEN PERMIT * * * Permit W~ON-SITE SEWER PERMIT Address: Location: , . Phone Number: Legal Description: ~~ ~~Y~~ Lot Size: Type of Soil\~sorption System Is: Trench: ~. Drainfield: ._ Seepage Bed: Holding Tank: Maximum N~ntber of Bedrooms: ~._ Soil Rating(sq.ft/br) /~ The Required Size of the Soil Absorption System Is: DEPTH 0 WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall Pipe and the bottom of the excavation(in feet). · * REQUIRED SEPTICCI:DD-L-D--I-NG-) TANK SIZE = /dO0 GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this departmeni will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feel for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I wi~nstall the system in (3) I u~der~t~d that the on-site th~ re--ce/~ r~modeled to S igne~ ~~-ica~ accordance with codes. sewer system may require enlargement if include more t~~ed~~ Issued by: Date: SWP/024 (1/81) IC:I;-~LIT~' ~)F R[-~C:P-~E:RGE DEPRRTMENT '~. HERLTH RND ENVIRONMENTRL ..~OTECTION 825 ~L~ STREET., 8NCHORRGE., RK. 99501 264-4720 ~.~ELL PER~I IT PERMIT NO. ( 810098 ) RPPLICRNT LEE ROBBINS LOCRTION PETERS CREEK LEGBL SR BOX ?149 CHUGIRK ~ ~ ~] 688-]:010 L8 B2 CHUGRCH PRRK ESTRTES LOT SIZE _~SOURRE FEET MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS t00 FEET FOR 8 PRIVRTE WELL OR 150 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET 8ND TO 8 COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE 8VRILRBLE TO INSURE PROPER INSTRLLRTION. PEE:r4IT E>~F'IRES [)EC:E~IBER 31. I 981 I CERTIFY THRT 1: I RM FRMILIRR WITH THE RE&-~.UIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN R~RDRNCE WITH THE CODES. 8F'PL I CRNT LEE RCBE:I~ 'v'4. 0 January 4, 1982 Lee Robbins SR Box 7149 Chugiak, AK 99567 Permit ~ 810098 Subject: L8 B2 CHUGACH PARK ESTATES A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, Sewer and Water Program Enclosure: Copy of Permit by DOC Co. {~ba SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 668-2759 OWNER OF LAND ADDRESS ~ ~f LEGAL DESCRIPTION ~' ~'~ PERMIT NUMBER ~O/~/~t ~.d -~ DEPTH OF WELL ~,"'o ~ '7 / 4/~: ~ ~d ~/~' STATIC LEVEL OF WATER FT. DRAW DOWN FT. Ended ~/~/ GA~. PER HR OF CASINO KIND OF FORMATION: From {~ Ft. to I Ft. From ~ Ft. to ~ Ft. From ~ Ft. to Iq Ft. From I ~ Ft. to--Ft. From~ Ft. to Ft. From o~_~' Ft. to~Ft. From. ~o), Ft. to "'] t~' Ft. From '7~' From From ~ 7 From [ r0 -~ From From _ Ft. to ~'7 Ft. Ft. to Ft. Ft. to ti3 ~} Ft. _ Ft. to /~ Ft. 7'16,,~7' ,Ft. to Ft. ~'/-.. ~I'F ~ oa.g' Ft. to ! 4~) Ft. d_/. ~ }* From / ~'0 Ft. toi & ! Ft. From [/~ I Ft. to ~._/_~__~Ft. From Ft. to Ft. From~Ft. to I~'~ Ft. From i~¢~ Ft. to [ VO Ft. From Ft. to Ft. From__Ft. to.___Ft From__Ft. to_ _Ft__ From .... Ft. to Ft From Ft. to Ft From Ft. to Ft From Ft. to Ft From Ft. to Ft. From__Ft. to Ft From Ft. to__Ft. From Ft. to Ft. From . Ft. to Ft From Ft. to Ft. From__Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN P IF YES, AT WHAT DEPTH? Gross Net Depth to Net ! ~-'~:':Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN . 'FT_ .,~/~ ~ FT 72-008 (6/79) 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING Eagle River, Alaska 99577 Phone Date 3 //q/~, DHHS SIGNATURE ~' Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251439 Parcel ID 051 -481-03 Expiration Date: 05/29/2026 Legal description CHUGACH PARK ESTATES BLK 2 LT 8 Site address 19360 CHUGACH PARK DR Current property owner(s) HYDEN LORI ANN X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: (No comments By. Original Certificate Date: 9/30/2025 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Sectio ...... .... Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-481-03 Complete legal description Chugach Park Estates Block 2 Lot 8 Location (site address) 19360 Chugach Park Drive Current property owner(s) Lori Ann Hyden Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well serving # dwelling units F-1 Other Non-public well as regulated by MOA El Water Storage F-1 Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: � Private Septic F-1 Private Septic serving 2 dwelling units F Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel [] Plastic Fj Concrete ❑ Fiberglass Age <1 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: 0 AWWTS F-1 Bed FE -1 Deep Trench E] Wide Trench F-1 Seepage Pit Waiver request for: Expedited review requested: n Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee Waiver Fee $ Date of Payment Date of Payment COSA # 0S( A0 V Waiver # COSA Application—Apr2025, doe COSA Checklist Legal Description: Chugach Park Estates Block 2 Lot 8 Parcel ID: 051-481-03 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA F Well log is filed with Onsite (or attached) Date drilled 04/06/1981 Total depth 189 ft Cased to *Unk. ft 0 Sanitary seal is functioning correctly F Wires are properly protected Casing height (above ground) 18 in. Well production at time of test 1.9 gpm Water storage tank volume none gallons Well disinfected for coliform test? ❑ Yes n No ❑ Coliform bacteria is Negative Nitrate mg/L 0 Nitrate less than MRL (ND) Arsenic 1.943 ug/L ❑ Arsenic less than MRL (ND) Date of flow test for COSA 05/29/2025 Collected by PES Static water level at beginning of test 153.9 ft. Date 05/29/2025 Comments *Cased to 189 per previous COSA by Robert C. Cowan, P.E. B. TANK DATA Measured operating fluid level in septic tank New Date of pumping New ❑ Required maintenance completed, if AWWTS Comments: New Tank D. DISPOSAL FIELD DATA Which system tested (date installed) 05/1983 (J ALL standpipes present per record drawing Total measured depth from grade 8.0 ft (max) Measured depth to pipe invert from grade 4.2 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective *3.8' ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) no If yes, enter date C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 05/29/2025 Results r,—/I, Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 7.5 in Elapsed time 240 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 60 in Effective depth used *14.4 in Effective depth remaining 45.6 in Comments/Deficiencies: *Effective depth remaining conservatively assumes unobservable effective depth due to monitor tube depth; is used. COSA Checklist_May2025.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100' P-1 Yes if No Sewer Manhole/Cleanout > 100' Surface Water > 100' Z Yes if No ft [Z] Yes if No ft Neighboring Tank > 100' F✓ Yes if No ft Sewer Service/Septic Line > 25'❑✓ Yes if No ft Disposal Field on Lot > 100' Q✓ Yes if No ft Holding Tank > 100' Q✓ Yes if No ft Neighboring Disposal Fields > 100' ft Community Wells > 200' Animal Containment > 50'✓0 Yes if No ft Q✓ Yes if No ft Manure/Animal Excreta Storage > 100' Sewer Line/Main > 100' R✓ Yes if No ft M✓ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10' P-1 Yes if No ft Surface Water > 100' Z Yes if No ft Field to Foundation > 10' 0 Yes if No ft Wells on Adjacent Lots.- ots:Tank Tankto Property Line > 5' r7l Yes if No ft Wells > 100' Yes if No ft Field to Property Line > 10' EYes if No ft Community Wells > 200' Q Yes if No ft Water Main/Service Line > 10' (Y✓ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC & MOA 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 years, and the water usage of the people 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 if the system, nor do they guarantee that there are no hidden defects of encroachments. Therefore, we cannot provide any warranty of future performance, nor can we estimate the 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. Engineer's Printed Name Steven R. Pannone COSA Checklist_May2025.docx Phone (907)745-8200 Date 9/26/25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEAl'TH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~'"~\ - L\ c~.~ _ {,- '~ GENERAL INFORMATION Complete legal description Lot 8; Block 2; Chugach Park Estates Location (site address or directions) 19320 Chugach Park Chugiak, AK 99567 Property owner Mailing address Lending agency Mailing address Lori H~de.n Day phone P.O. Box 671022 Chuqiak~ AK 99567 261-3681 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well XX× Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: X^X If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 MUNICIPAl. Ii I *or Al ~NVIRONMt~NTAL ~ERVIC~:$ DtYi~tON Health Authority Approval Checklist Legal Dcscriptiou: A. WELL DATA Well type Log present {~q) Total depth Sanitary. seal Date of test Static water level Well production [~v-- 7_. ~t:OM.t~rt.~~ }P&4--$-Parcel I.D.: FROM WELL LOG If A. B. or C, attach ADEC letter. ADEC water system number Date completed t_[ _ ~, ~ ~ Jr Cased to I Del J Casing height (above ground) Wires properly protected Oq) AT INSPECTION 15'2_.' 4,O g.p.m. Z,q WATER SAMPLE RESULTS: Coliform Date of sample: B. ~OLDING TANK DATA Nitrate O, I o Other bacteria /__) Collected by: S & S ENGINEERING i7~4 Eagie River Loop ~[oad No. 204 Eagle River, Alaska 99577 Date installed 4"--~ 3 Tank size /* 0 o Number of Compartments 2_ Cleanouts (.~ZN) ~ Foundation cleanout {~lqq) ~/ Depression (YFI~ ~J High water alarm (Y/N) ~/¢ Date of Pumping Z-14 ~q {, Pumper -~7.~~ /~Otv//'t,Ottt ABSORPTION FIELD DATA Date installed e~9 Soil rating (g.p.d./fi2 or fl2/bdrm) 12-5'n~/~g.- System type '7'~/Lff~ 4-/'4 Length ~ & ' Width ,,2,6'- ~ Gravel thickness below pipe 6'- ~ Total depth ~ t Effective absorption area ~l O fz:,et~, Monitoring Tube presentOq) 5t Depression over field (Y~j) Date of adequacy test "~' /'ff'~'f 6. Results ~fFail) ~,a~'5 For ~ bedrooms Fluid depth in absorption field before test (in.); t9 Immediately aftert/(7o gal. water added (m): t/~/ Fluid depth ~ (ins.) Minutes later: ~ Absorption rate = ~,3~ 4- g.p.d. Peroxide treatment (past 12 months) (Y~]~ ~/~d~. I~tJ~l~)lfyes, give date D. LIFI' STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* High water alarm level at* ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line · On adjacent lots [C>e~ t4r ' On adjacent lots ~/~ Public sewer manhole/cleanout ,Z.%~ t $~ Lift station [ C> e> ~' 4-- SEPARATION DISTANCES FROM~~OLDING TANK ON LOT TO: Building foundation I O ~ Jr Property line I o I * Absorption field Water main/service line /o ~ ~ Surface water/drainage /00 t ~ Wells on adjacent lots /oo tO- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation I ID x Jr Water main/service line ~ c~ ~ '~ Surface water ~ o O ~ Driveway, parking/vehicle storage area '2~ I Jr Curtain drain ~ I~ Wells on adjacent lots l'~0 ktr Property line [ 15 F. ENGINEER'S CERTIFICATION I certify that I have determ/ned thrufield inspections and review of Municipal record~.~&~b'b~~e in conformance witO 5~,~ ~ guidel~s in effect on this date. Signature ¢~ d. : Engineer's Name /~ ~ z5 ~,t ~ ~ . k o ~,q ~ ...................................................................................................... >:~.k~ HAA Fee $ ~eOO ~ ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 8; Block 2: Chugach Park Estates Subdivision Location (site address or directions) Corner of Chugach Road and Platzek Prope~y owner ~ori Hyden Day phone 688-4959 Mailing address P.O. Box 671022, Chugiak, Alaska 99567 Lending agency Mailing address Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3 NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ~'~Y Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ft21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm 17034 Ea§ltl ~i~J' kldep Read Ne... ~ Phone Eagle Ri~ar~ AlaSka ~E]~F~'~ Address Engineer's signature DHHS SIGNATURE Approved for 5 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The D HHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~Y21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ ~ ~¢..~Z..- /--t-~.Sf.~--~.-~ Parcel I.D. A. WELL DATA Well type Log present ~J~N) Totaldepth Sanitary seal (~(N) If A, B, or C, attach ADEC letter. Date completed Cased to \ ~ Date of test Static water level Well flow Pump level FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ADEC water system number ~ - L.~ -~t Driller Casing height Wires properly protected ~.~N) AT INSPECTION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~:;> c~ '"'t, o o .~ --0-,/ Nitrate Date of sample: ~' Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~'" ~'~ Cleanouts ~YN) ',~ High water alarm (Y~ Date of pumping Other bacteria t~ ~ ~ ¢--- S & S ENGINI;;L:IaI~ ~!~_. 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Tank size ~, c>c, c~ Compartments Foundation cleanout (~N) ~ Depression (Y~:) ~ Alarm tested (Y/N) ~ .-'7..- --~ '7~ Pumper ;;:~_~-_ ~E.--~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ o~ ~ On adjacent lots \~O To property line ~c>t'¥'' Absorption field Surface water/drainage \ L~ Foundation Water main/service line 72-026 (Rev. 7/91)Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at ' ~mp off" level at High water alarm level J ~ Cycles tested Meets MOA el~__ SEPARA~.~.J~ISTANCE FROM LIFT STATION TO: w'ell on lot On adjacent lots · Surface water D. ABSORPTION FIELD DATA Date installed ~'~-- Length '~'~ ~'~ Width Total absorption area Depression over field (Y~ Result~fail) Peroxide treatment (past 12 months) (y~..~l Soil rating \'Z.-~' Gravel thickness Cleanouts presentd[~YN) Date of adequacy test for ~=~ ~ ~ If yes, give date System type Total depth bed rooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ c:~ ~'" On adjacent lots \ o o ~'' Property line To building foundation ~..o ~" To existing or abandoned system on lot On adjacent lots Surface water Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ //70 ," ~ Waiver Fee:, Date of Payment / ~ --?/-- ~7 ~ Date of Payment Receipt Number Z_~/Z-~:~/'[') (~--//_?/'~) Receipt Number 72-026 (Rev. 3/91) Back MOA 21 APPLIC '-NT FILLS OUT UPPER HA[-'ONLY Property Owner j~zf ,,d/i~,':-: 7'~/.~ j..~i -? ./i ' /~.~c: I~J/¥ z./22> Phone Mailing ,~,ddress / ~. ~.~, ~ Address ~:'0 . Lending Institution / ~ /~ :, ~ /L,'~ ~ .... Y ' ' ' Phone Address ::,~ 2~,/' (;~ ~j~ ~L~-/-~ ~~f~ ~ zip Code Phone Realty Co. & A~nt Address Zip Code Legal Descript~n ~ Street Locati~ Type of Resi~nce ~Single Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~divid~l A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~n~,v~u.~ ~e~r ~n~v~ua~ D Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ( J~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED Soils Rating Date Sewer Installed Well To Absorption Area / O--~-~-" Well Log Received / .% ~'- 1:;~' ~-'-' :~ O ' <~ ,.~ Well to Tank //' ~) '/- Septic Tank Size 72-023 (3182) ~'