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FIRE LAKE HEIGHTS LT 4
Onsite File Municipality of Anchorage ,. On-Site Water and Wastewater Section • (907) 343-7904P,1 of 2 of ON-SITE WASTEWATER INSPECTION REPORTS"��/� EPORT OSP191201 051-351-26 ®Td Permit Number: PID Number: 2Q�9 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ®❑ Upgrade Name Donna Kenison ABSORPTION FIELD El Deep Trench El Wide Trench ❑Bed E:1 Mound Site Address 18513 Olivia Drive El 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 Fire Lake Heights 4 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 Ft2 Ft. Well 100,+ TANK H Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water 100 1 + Material Number of compartments Lot Line 51+ NA Plastic 2 Foundation 10,+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer Jr's Septic Services Drainfield Co/MT3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 505.0 ft Inspdeation 1"' 6/25/19 6/16/19 Location and description 2' W a 1 kway 3rd 41h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date O F /— ..... , TH •. �. Septic Systems �1%('itt ApprovedC Q Date Note: this approval does not include well permit requirements.�`���' tMev uoruu_10) i p pU _ CD I oIcn D Oz � Co a r9 z ' �36I1pm'O M M p O r x 0 r* 'o Z 'W mE p cn C (n N� -0 m '—ip !moo Z Dp(�71�Z2 O S D r:U OCI m p —1 rn N 0 � C7 -u C o ci o' � II �� 0 > mmC/) (!; D ° ' (A r O Z Z g f-m � O(f1j� Cp m A D r FTI —i p '1 LDZ d � m C7 c m \ �:u cf) ' I � O C \ W C� 11 -� v Dm 1 v m _ > 1 4 � _�— �— A \1 v 10'UEiI Es mt Cp -- > f 00 w DOUBLE p) o h !� ( CLEAN OUT I —. Y \ \ CO a� 1 j v \\ dd 1 I O CLEAN OUT ( \ \ Lo. '-m ` \ Z7 � � D� r� ccrn ro \ z Z \ ( \ 13 (D � m� Z + m -u oyW o ( m o\-uZ7,pV\ ( I- o. \ \ 0 _ _ m r ) \ \ \ "1 CLEAN OUT \ m _ o o cn 00 op momz A \ A \ DOUBLE o T m \ \ \ 00 CLEAN OUTcn M J o \ \ \ D \ \ \ \I M I(� '• ` / l \ NJ 0 ---- -- -- \\ — ----- — V I \ C w tWv O W D m `r,' \ I \ cD Q� W N z w -, /) \ \ I /Z'VV \! L i CD O cn U� ��. \ \ / I NOTES: PANNONE ENG SVC LLC P.O. BOX 1807 PALMER, AK 99645 ������\� �O.......gS\t �G�P•Sit) REVISIONS __. DATE 9/24/2019 RECORD DRAWING PHONE 907) 745-8200 FAX (907) 745-8201 SCALE FIRE LAKE HEIGHTS L4 DONNA KENISON 18513 �* "' .. / /":' 0 �oae•/ CE 8149 �/ /r�+its 1" = 60' P.I.D. NO DRAWN ACP PERMIT NO. SHEEP191201 SITE PLAN EAGLE RIVER, AK o P 2 OF 2 0 Lot 3 S I- C) Q KW BARNES AVENUE - --fid- - - - I 10' UTILITY EASEMENT r---------------------------------- I I 1—i W1 71 W1 QI LOT 4 �i �I O I Septic vent (tfp, 2.0 OH r 1 o ?2nhoie ? e 8° 7s.� 3 co`�O 5Q �� I P 5.7 ti IO --�-q8 u ,y ool SCALE: 1"= 40' ham, or �y ri m Vii•5i 204.95 *LIVIA DRIVE % OF & Aff 6-)• 49th �. ... i. , 00,. izabeth L, Walatka m P so s� • 8036 - LS • Jew afiESS(ahtA�- "�' EASEMENTS OF RECORD, OTHER THAN 112--14 C THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. UNLESS OTHERWISE NOTED Seward, FB 19-5, pg 31-32 BE dwell 8484C 0 0 0 00 Lot 1 A 00 0 Q z AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 4, FIRE LAKE HEIGHTS SUBDIVISION 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 27th day of JUNE 2019. FRED WALATKA & ASSOCIATES, L.L.C. 907-248-1666 Engineers and Surveyors 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: OSP191201 Work Type: SepticTank Upgrade Tax Code Number: 05135126000 Site Legal Address: FIRE LAKE HEIGHTS LT 4 G:0454 Site Mailing Address: 18513 OLIVIA DR, Eagle River Owner: KENISON DONNA M Design Engineer: PANNONE ENGINEERING SERVICES 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 6/17/2019 6/16/2020 36886 ❑ 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 Received By: Issued By: Date: Date: 3 JERA/vS MUNICIPALITY OF ANCH6 RAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-351-26 Property owner(s) Donna Kenison Day phone Mailing address P.O. Box 771357, Eagle River, AK 99577 Site address 18513 Olivia Drive, Eagle River Legal description (Sub'd., Block & Lot) Fire Lake Heights, Lot 4 Legal description (Township, Range & Section) Lot Size 36,886 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR - (Z all that apply) Absorption Field ❑ Septic Tank ❑x Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) ❑X Upgrade (w/wo ADU) ❑X Renewal Duplex (D) El❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 995 Date of Payment: 6-1 aq !!9 Receipt Number: 009;246 Permit No. 05PiR 1201 Permit App_'-'- :• : .,:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191201, Rebecca Carroll, 06/17/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191201, Rebecca Carroll, 06/17/19 by DOC Co. clba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE088-2759 OWNER OF LAND ADDRESS t/ 3 /3 LEGAL DESCRI~ION DATE- Started Ended PERMIT NUMBER ~ OF w,:LL /9o STATIC LEVEL OF WATER F'r. ~ DRAW DOWN FT. GALS. PER HR , KIND OF CASING KIND OF FORMATION: From ~" From ':4 From : From From ,~;~ From. From --~ --~ From From From,/ ~ From From,/, ~ From / ~ From F om / 3 From · Ft. to 'J'- Ft Ft. to ff Ft. · Ft. to /~]' Ft. Ft. to ,) cb Ft. ... Ft. to '-~"-)- Ft Ft. to ~"~ Ft. . Ft. to ~? Ft. __ Ft. to -7;'~ Ft.. · .. Ft. to. -'~ ·~'' Ft. . · . Ft. to ? ,:~7 Ft. ~ ' ~, . From ,",0 -,~ :?,0.:,'491-"/''j From .~ ,--%,.id) ~K,~.d~_ /~ ~gdL~ From From From From : .K'-':.',~:,--~ From__ [!~' ;, ~ e~J From ~.,C ~, ,J From ~ Ft. to _. Ft. to ~ '7 Ft. to . . Ft. to . Ft. to · . Ft. .. From Ft From · . . Ft. From · . Ft. /.~.4 '~ ,; ,-" ."~' From __ Ft. 7--,~, ?fr'l From __ '_' ._ z:)~ ~<.~- (D~C Z/''~ From__ From Ft. Ft. Ft. to.. Ft. to Ft. to __ Ft. to Ft. to __ Ft. to __Ft. to Ft. to Ft. to Ft. to Ft. to _Ft, to Ft. to Ft. to_ Ft. to Ft. to Ft. to Ft. Ft Ft. Fl, Ft. Ft. Ft. Fl. Ft. Ft. Ft. Fl Ft Ft Ft. Ft, Ft MISCL. INFOPJ~IATION: RECEIVED MAY 1 1993 Municipahty ot Anchorage Dept. Health & Human Services DRILLER'S NAME . ~ -,.~ PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW920072 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:BOWMAN JOHN D & IRENE OWNER ADDRESS:P.O. BOX 958 EAGLE RIVER, ALASKA 99577 DATE ISSUED: 5/04/92 EXPIRATION DATE: 5/04/93 PARCEL ID:05135126 LEGAL DESCRIPTION: FIRE LAKE HEIGHTS LT 4 LOT SIZE: 36886 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ./_-~-~ * Well and Septic plan only. ~ /, ~/~, ~ ASBUILT NO CORNERS SET. THIS DATE. SEWARD & ~SOCIATES ~ S~ING 688-~566 I HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY, 1"=30' Fire Lake Heights Subd.,Lot 4 DATE, AND ~AT NO EN~HMENTS EXIST ~CE~ AS 9-12-90 ~ND~CA~. ~T ~S THE ~ZS~S~L~W OF THEfP~"49m~ "~% / ~m ~ D~E~,NE TH~ EX,STE~CE OF ~Y ~,D: .;';f ....... %M'T~'~ E~ENTS, COVENANTS, OR RESTRICTIONS ~ ~5~ ~~.~ft~:~ , WHI~ ~ N~T ~EAR ~ THE RE~D~ ~BDI- VISION P~T. UND~ NO CIRCUMSTANCES S~ F~ ¥:~.'... LS,Og~B .."~ " ~ DATA H~. ~ US~ F~ CO.S~U~,O. ~-~9 ,~ ~ ........ ,,~ ~ FENCE LIN~ OR ~R E~LISHING ~ND- DRAWN, A~ LINES. ' DMS 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 PHONE I © NEW q~--X~X-XXX~)~L~X KOEHLER CONSTRUCTION ~"~'~,~---~5',~1] ~OPG.ADE MAILINGADDRESS~°~ ~ ~ ~'~ ~ ~--~ ~-~ j '.~z~ J LEGAL DESCRIPTION ~ ~ I LOCATION NO. OF BEDROOMS ~Well ~ ~ ~l~ Absorption a~a Dwelling ¢ PERMIT NO. ~ Z Manufacturer ~. ~ Materi~ ~ / No. of compart~ts ~ ~ Liq. capacity in gallons Inside length Width Liquid depth / ~ IF HOME.DE: ~ Well Dwelling PERMIT NO. DISTANCE TO: ~z ~ Manufacturer Material Liquid capacity in gallons ~ Well ~ ~ ~1~ Foundation Nearest lot line__ PERMIT~ ~ No. oflines / Lengthofeach~n~ / Totallength oflines Trench width Distancebe[weenlines - ~ / ~ ~ ~ ~/~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area Q ~ / ~ ~"1/ ~ inches ~5~ Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER ~X~. ?~. ~t~'~..., PIPE MATERIALS ftC;,;. SOIL TEST RATING , '.:7; -r 72-013 (Rev. 3/78) MUNI[: F"AL-ITY OF A~[' ~uc~:AI]]E ~ ~ DEPARTMEN. OF HEALTH AND ENVIRONMEN%.- PF~OTECTION 825 L STREET, ANCHORAGE., AK.: 99501 ~ ' PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: 840630 07/27/84 KOEHLER CONST. BOX 958 EAGLE RIVER, AK 688-2681 99577 SUBDIVISION: FIRE LAKE HTS. SECTION: 31 TOWNSHIP: 15N lA (SQ.FT. OR ACRES) LOT: 4 BLOCK]: NA RANGE: 1W DEPTH TO PIPE BOTTOM (FT.) GRAVEL. DEPTH (FT. TOTAL DEPTH (FT. GRAVEl_ WIDTH (FT.) GRAVEL LENG]'H (FT.) GR~VEL VGLUME (CU.YDS.) TANK SIZE (GALS) SOIL RATING (SO.FT./BR) L. isted below are the options available to you in designing your sm. ptic system. Choose the option that best Fits your site. TRENCH BELl W 7.0 6,5 7.0 ~. 0 0 ,, 5 ~ ~ '/ lO. 0 7.0 2.5 2(). 0 5.0'~ ~, ~ ~4.0 ** ..:,8. ) ,~.u ** 1.,250.0 ** 1,250 125 125 125 ** 8RAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1.'I am familiar with the requirements for on-site sewers and wellm as set. Forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations~ and in compliance with the design criteria oF this permit. 3. I will adhere to all MOA and State oF Alaska requirements for the set back distances ~rom any existing well, wastewater ~disposal system or public sewerage system on this or any adjacent or nearby lot. 4, I understand that this permit is valid ~or a maximum o~ 4 bedrooms arid any enlargement will require an additional permit. IF" A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL iPERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT, AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK~E D~JNE BY A LICENSED ELECTRIC:CAN. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST ~_EOA~.DESCR,PT,ON: '/"":'~ /--~''~'~ /"/~'r. Z,,f 4/ ,~- 3-'6 '~. ;-, F, '1 / 5-'~ 8- ~..~ '.. ..., ,.>. ~..~ ¢ 1~_: .¢ 12 .,' .' 1~ .'.- ;' ,.'¢ ¢~ ~ ~ .... , '~. 15- 19 - ~ ',%JUNE 25.197 COMMENTS -~'~,/$ 7~"~"~ ~e.,f-,~ ' ~ SLOPE E IF YES, AT WHAT DEPTH? S~TE PLAN Gross Net Depth to Net Reading Date Time -rime Water Drop PERFORMED BY: ~ ~ ~N RATE TEST RUN BETWEEN '~' FT AND CERTIFIEDBY: '~ ~'~' i FT DATE: 72-008 (6/79) POuCII 6-650 ANGItC)NAGIk Al A;;KA (907) 364-4 I 11 I)EPAIIIMINI ()F I .A[1M AND [:NVliI()NMI N]AI PH()tI'iCIION February 10, 1983 Ann C. Liburd Attorney at Law 810 N Street Anchorage, Alaska 99501 Subject: Carol Creek Water Supply lit was this dopartment's understanding that the subject water supply was appreved en an individual basis as long as proper filtration and chlorination procedtlres were followed. A recent letter from the Department of Environmental Consorvation Sta'te of Alaska, dated August 20, 1982 shows the water syskem disapproved and 'this office has acted accordingly. If there are any further questions, please call this office al: 264-4720. Sincerely, Robert C. Pratt, R.S. Acting Program Manager RC P / 1 j w ® ~� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-351-26 Expiration Date 1. GENERAL INFORMATION: Complete legal description FIRE LAKE HEIGHTS; LOT 4 Location (site address) 18513 OLIVIA DRIVE, EAGLE RIVER, AK 99577 Q9 a0a1 (51 Current Property owner(s) DONNA KENISON Day phone 227-0120 Mailing address Real Estate Agent 18513 OLIVIA DRIVE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ i Waiver/Variance request for: t— �. (:�� (id1 ✓� bistance: ,nsgY�,u,o4 Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5 5 d . Waiver Fee $ Date of Payment y/77 ?'D Z Date of Payment Receipt Number 0$ 2 2 Z6 Receipt Number COSA # 05 C- a � A�, � O Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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: Gayness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: .7 ?� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system ()F 1-i Ot t in accordance with the guidelines and regulations established by the Municipality of Anchorage and (�'`�.,.• t"'' �/ n�l� industry practices. The reported results describe the condition of the system/s on the date/s of the ��.�•' f ;'. v� i� evaluation. Separation distances were measured to readily identifiable features. Hidden defects or 410J/1 r . encroachments may exist that were not idetified during the evaluation. The operational life of all wells .ti i1'jr� % and septic s stems depend upon a varietyof variables, includingbut not limited to, soil conditions, r t .• • • • • • • • • • • groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and ....... i �.:,, ,r : ...:......... are outside the control of GEG. Satisfactory test results do not guarantee future performance of the JPf A. Gar n'ess. system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of (I(, N jl r CFS 7cy3 the well or septic system. GEG makes no representation whether an alternative well or septic system li it°fY� ;• Q��� can be installed on the property in the event either of the currents stems fail to perform adequately in c P P Y Y P q Y t � •;.....•• o the future. The content of this report is for the sole benefit of the person/party that retained GEG to �� e�n1- �� perform the evaluation. Reliance upon the information provided in this report by any other person or �v����J party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for .3 bedrooms \```\�_l`�l\Y OF «��(r/� System #2 Approved for bedrooms �Q� y0 Disapproved �' ON-SITE Conditional approval for bedrooms, with the followinaFstlpulisER AND MAST''EvVATER o D®nrrR AKA By: X��Q��C'_ Original Certificate Date: y 9� i The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10.12.doc Legal Description: COSA Checklist FIRE LAKE HEIGHTS S/D; LOT 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Al Well log is filed with Onsite (or attached) Date drilled 5/92 Total depth 140 ft Cased to 59.5 ft R Sanitary seal is functioning correctly R Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 10/15/20 Parcel ID: 051-351-26 Structure served by this system Well production at time of test 6.7 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes Q No ** ❑Q Coliform bacteria is Negative ** Nitrate 1.07 mg/L ❑ Nitrate less than MRL (ND) * Arsenic ug/L❑ Arsenic less than MRL (ND) Collected by GEG,LTD. Date of Sample *10/15/2020 Static water level at beginning of test 41.1 ft. **4/5/2021 Comments **WATER SAMPLES TAKEN AFTER NEW WHOLE HOUSE FILTRATION SYSTEM. SAMPLE POINT APPROVED BY REBECCA CARROL WITH MOA ONSITE DEPARTMENT. SEE ATTACHED RECEPTS FOR WATER SYSTEM INSTALLATION COMPONENTS B. TANK DATA Age of tank(s) >1.5 years Tank type/material PLASTIC STATION ❑ Requlr aintenance com Age of lift station ye Measured operating fluid level in septic tank *55.5" Lift station material INEStandpipes/foundation cleanout per record drawing Comments Date of pumping 10/27/2020 "TOOK MEASUREMENTS ON TANK THROUGH MANHOLE ACCESS RISER ON 4/23/21. BASED UPON MEASUREMENTS, TANK APPEARS TO BE A 1250 -GALLON GREER TANK (TANK HEIGHT MEASURED AT 66.5"). INSPECTION REPORT SHOWS 1000 -GALLON GREER TANK INSTALLED. D. ABSORPTION FIELD DATA SEEPAGE PIT / DRAINFIELD * Which system tested (date installed) 0 ALL standpipes present per record drawing * Total measured depth from grade ft (max) * Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field * ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Adequacy test date Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test **28 in Water added 816 gal New depth **79 in Elapsed time 1,180 min * **-Jr 1771Code-required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 'SEE ATTACHED ENGINEERING LETTER. "TEST RESULTS FOR SEEPAGE PIT, 1984 DRAINFIELD REMAINED DRY THROUGHOUT TEST. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ✓❑ Yes Septic Tank/Lift Station on Lot > 100' ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' Q Yes if No ft Q Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' El Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10'✓❑ Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 1 + ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No **UNK ft Private Wells > 100' E✓ Yes if No Water Service Line > 10' ❑ Yes if No **UNK ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS "REQUESTING LOT LINE WAIVER (SEE ATTACHED). -PER THE 1984 INSPECTION REPORT, THE COMMUNITY WATER SERVICE LINE CONNECTED TO HOUSE FOR OUTSIDE HOSE BIBBS IS 10'+ FROM SEPTIC SYSTEM. G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet OF A,, � 4 :.. ., lily J �yfr,rel A. Garness; 7953 p� ore • • • . r �. (L(�Q'p aPro fessio�1\;oo #AECC884 ft ft MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Advisory Certificate of On‐Site Systems Approval # OSC211210 Subdivision: Fire Lake Heights, Lot: 4 A water sample taken prior to the installation of the whole house filtration system revealed a nitrate concentration of 71.6 milligrams per liter (mg/L). A sample taken after the filtration system was installed revealed a nitrate concentration of 1.97 mg/L. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. In order to keep the nitrates below the EPA limit, we recommend you monitor the water quality and maintain the filtration system in accordance with the manufacturer’s recommendations. Please see the attached “Nitrate Fact Sheet” for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as “blue baby” disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a medi a with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several “wet chemical” methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive “screening test”, and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. SGS Ref.# 121.1491001 Client Name Garness Engineering Group, Ltd (GEG) Project Name/# Fire Lake Heights, Lot 4 Client Sample ID Fire Lake Heights, Lot 4 Matrix Drinking Water Sample Remarks: Printed Date/Time Collected Date/Time Received Date/Time Technical Director 04/12/2021 15:24 04/05/2021 12:03 04/06/2021 9:12 Stephen C. Ede Allowable Prcp Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Mit Waters Department Total Nitrate/N i trite -N 1.97 0.200 mg/L SM21 4500NO3-F B (<10) 04/09/21 EBH Microbiology Laboratory E. Coli Negative 1 100mL SM21 9223B A 04/06/21 M.A Total Coliform Negative I I OOmL SM21 9223B A 04/06/21 MA IDIJ 2of5 SGS Ref.# 1205741001 Client Name Garness Engineering Group, Ltd (GEG) Project Name/# Fire Lake Heights Lot 4 Client Sample ID Fire Lake Heights Lot 4 Matrix Drinking Water Sample Remarks: LJ Printed Date/Time 10/22/2020 9:24 Collected Date/Time 10/15/2020 14:08 Received Date/Time 10/15/2020 14:59 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 B (<10) 10/19/20 10/19/20 DMM Waters Department Total Nitrate/Nitrite-N 55.4 5.00 nig/L SM21450ONO3-F C (<10) 10/20/20 EWW' Microbiology Laboratory E. Coli Negative I 100ml- SM21 9223B A 10/15/20 A.L Total Coliform Negative I 100niL SM21 9223B A 10/15/20 A.L tip OoJ e, Page 2 of 5 SGS- ---- ------- - SGS Ref.# 1205952001 Client Name Garness Engineering Group, Ltd (GEG) Project Name/# Fire Lake S/Di L4-Kitch Snk Client Sample ID Fire Lake S/Di L4-Kitch Snk Matrix Drinking Water Sample Remarks: Printed Date/Time Collected Date/Time Received Date/Time Technical Director 10/30/2020 9:22 10/27/2020 12:32 10/27/2020 13:35 Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Waters Department Total Nitrate/Nitrite-N 71.6 * 2.00 mg/L SM21 450ONO3-F A (<10) 10/28/20 EWW Page 2 of 5 SGS Ref.# 1206376001 Client Name Sullivan Water Wells Project Name/# 18513 Olivia Dr Eagle River Client Sample ID 18513 Olivia Dr Eagle River Matrix Drinking Water Sample Remarks: ��F:t' �ti FIDE Printed Date/Time 11/25/2020 11:19 Collected Date/Time 11/23/2020 15:30 Received Date/Time 11/23/2020 16:04 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Waters Department Total Nitrate/Nitrite-N 37.8 x 2.00 mg/L SM21 4500NO3-P C (<10) 11/24/20 EWW Page 2 of 6 r�E 1.�' Iti FIDE SGS ReE# 1210064001 Client Name MOA Development Services Department, 0 Project Name/# MOA Client Sample ID 18513 Olivia Matrix Drinking Water Printed Date/Time 01/12/2021 9:32 Collected Date/Time 01/05/2021 13:45 Received Date/Time 01/05/2021 15:20 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Waters Department Total Nitrate/Nitrite-N 79.5 x 2.00 mg/l, SM21450ONO3-P A (<10) 01/11/21 EWW 2of5 I 4 Q co" 1 4 ;or OWA Woo Sk re, 14. 00 co" ONO 3011IInternational Airport. 8d. Anchorage, Alaska B051w (907)583'3770Pb (907)5o3'O50uFax Bill To: KEN|SON.DONNA 18513OLPWADRIVE EAGLE RIVER, AK 99577 Transaction #: 623697 Accourd#: 3010 Page: 1of1 Date: 3/19/2021 //mno: 4:27:41 PM Cashier: 201 Register #: 1 Ship To: NR210(N|TRATES)8ER#4120350 $3.095.00 S250SER#4005956 SYSTEM Rep Item Lookup Code Description Quantity Price KI 16532 PREMIER S35OXPSOFTENER 1 $2.695.00 88V:4005955 RI11705 NR21ODDNITRATE REMOVAL 1 $3.095.00 SYSTEM G/N:4120350 K/71034 NITRATE SELECT MEDIA 1CU 3 $0.00 FT K17938 BRINE TANK ASSY, 18X35 ^ ' 1 $0.00 DISCS SALES DISCOUNT -1 $334.50 Thank you for shopping ALASKA PURE WATER PRODUCTS Please come again! Payment Due.20 days from date of invoice. U���0U��UUU� U8��� UKUU� ��UU�8�KU| K��UU��U �U��UK��U�U�U�0��0UUU�0�VU�K�k0�X��UN0��623697 Sub Total Sales Tax Total K8C/VISA Tendered Coro: XXXXXXXXXXXX8755 Exp: 0124 Au��O6385D Change Due Extended $2,695.00 $3,995.00 $0.00 $0.00 $6,355.50 $0.00 $O'355.5O $O.355�5O HM tiARNESS ENGINEERING GROUP, Ltd u.: ... .. ENGINEERING SALES CONSULTING April 23, 2021 Municipality of Anchorage Development Services On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska 99507 Phone: (907) 343-7904 Ref: COSA Letter for Fire Lake Heights S/D; Lot 4 To whom it may concern: Jeffr�eyA,.C,e(rness .'Q. CE-7953AW l®` R�FESSIONa,`o' We are requesting a COSA for the referenced property. The testing and configuration of the water and sewer system is not standard, and the following is an explanation of the systems for your refence: WATER SYSTEM: On 10/15/2020 we performed an adequacy test on the well for the referenced property. According to the owner, all interior plumbing is connected to the well on property and the outside hose faucets are connected to the Carroll Creek Water System. We connected directly to the hose bibb off the pressure tank for the well test. Water samples were taken on 10/15/20 from the well, but high nitrates (55.4 /1g/L) were encountered. An additional test on 10/27/20 indicated a nitrate level of 71.6 /tg/L. A whole house water filtration system has been installed recently (see attached receipts) and new water samples for nitrate and bacteria were pulled on 4/5/2021 and taken to the lab for testing. SEWER SYSTEM: On 10/15/2020, we performed a septic adequacy test. Per the 1984 inspection report, the existing drainfield consists of a seepage pit (1972?) and a shallow 5 -wide drainfield which has 36 inches of effective depth. The septic tank was upgraded on 6/25/2019. Prior to testing, we checked the liquid level in the seepage pit and 5 -wide drainfield. The seepage pit had 28 inches of liquid depth and the 5 -wide drainfield was found to be dry. We did note that the sump at the end of the 5 -wide drainfield only extended 8" below the invert of the distribution line. The bottom of the seepage pit was 172 inches below grade and the invert of the 4" line from the tank into the seepage pit was 49 inches below grade A total of 816 gallons was added to the seepage pit which caused the liquid level to rise to 79 inches. At no point was water observed flowing into the 1984 5 -wide drainfield while adding water to the seepage pit. The recovery of the seepage pit was monitored 1,180 minutes after water had stopped being introduced and 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Website: www.gamessengineering.com Page 2 of 2 the liquid depth was found to be at 36 inches. Based upon this information, the seepage pit absorbed 450+ gallons and passed the adequacy test for a 3 -bedroom residence. We did also note the septic tank was slightly shy on cover; however, based upon a statement from the owner, there has been no issues with freezing (see attached email statement). LOT LINE WAlVdE *EQUEST: The existing drainfield is in a 10 -foot utility easement and sump .pears,to be approximately 5.5 feet from the west lot line. This would make the ed- o s drainfield approximately 3 feet from the lot line. We are requesting a 1 -foot lot line waiver be granted from the west lot line to the drainfield. Letters of non- objection have been issued for the drainfield being in the utility easement and are on file with your department _' If you have any questions, please contact us at 337-6179. Thank you for your assistance. , re A. Garness, P. E., M.S. ent 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Website: www.gamessengineering.com Municipali 4 P.O. Box 196650 0 4700 Elmore Road Anchorage. Alaska 99519-6650 a (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Serices Degaftment On -Site Water and Wastewater Section �c c 1 s ' l�c1); nIenr xX7: / XXK�C Waiver#: OSV211025 COSA#:OSC211210 Permit#: PID#: 051-351-26 Legal Description: Fire Lake Heights Lot 4 Engineer: Garness Engineering Group Applicant: Donna Kenison Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 feet. See engineer's waiver request for justifications. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................................................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: I l o� �o Approved by: __ Wnu "o T � Name of Reviewer Jody (Maus From: Donna Kenison <jeneric@mtaonline.net> Sent: Friday, October 30, 2020 3:24 PM To: Jody Maus Cc: Iiz@anchorageaIaskareaIestate.com Subject: COSA Hi, Per your request, of a statement from me, I have not had any freezing issues with my septic tank. Donna Kenison Sent from my Wad 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 051-351-26 HAA # ~ ~ GENERAL INFORMATION Complete legal description Fire Lake Heights Lot 4 Location (site address or directions) NHN Olivia Drive, Eagle River Property owner John Bowman Mailing address p.o. R~× 670958, Eagle River. AK Lending agency Alaska USA/Kathy Steinborne Day phone Mailing address P.O. Box 196613, Anchorage, AK 99519 Agent R~M~× of Eagle River/Kath_v Olmstead Day phone Address l~e600 r,,~+,~,-~,~,~ n~,,,~ ~,,~+~ ')nl ~ p~,,:,- ak' Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: Day phone 696-2681 99577 694-5390 694-4200 99577 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: 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 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 FirmEagle River Engineering Services Phone 694-5195 Address P.o. Box 773294, Eagle River, AK Engineer's signature DHHS SIGNATURE ~_ Approved for Disapproved. 99577 bedrooms. Conditional approval for 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-O25 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ?//z£ /.,~V,~ PI~I&HT5 L~?-~ Parcel I.D. O~ /~ ,~'~/~,~' A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 / ~ O ' Cased to If A, B, or C, attach ADEC letter. ADEC water system number Y£.5 Date completed O 5/~ ~. Driller ~'~ · Casing height Y~:S Wires properly protected (Y/N) FROM WELL LOG 15.0 g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/l~aJ~l~g tank on lot /0 ~ ' Absorption field on lot / ~'O ' Public sewer main ,,~//~ Sewer service line ./._~ ~,- t ~; u L. z. / Y,~/~l ; On adjacent lots 7 ; On adjacent lots ~'/~¢ Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform '~ Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/H~-'W;Q TANK DATA Date installed O~/o° ~ Cleanouts (Y/N) I//~ .~ High water alarm (Y/N) Date of pumping Tank size /Z- ~O Compartments Foundation cleanout (Y/N) )/~5 Depression (Y/N) ,A/J// Alarm tested (Y/N) ,/"///~ 0~ / 0l-/ ~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /0 .~ On adjacent lots To property line ~"~ ' Absorption field Surface water/drainage /'/j,~ + J Foundation Water rr~m/service line /5 ' 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) water alarm level High Meets MOA electrical co~~ SEPARATION D~.~,NCE FROM LIFT STATION TO: p. Jet~ On adjacent lots D. ABSORPTION FIELD DATA Date installed 0 ~'/~'~ Length ~ j../. I Width Total absorption area Date of adequacy test D~'/0 ~/~/~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Manufacturer / "Pump on" level at J "Pump off" Level at Cycles tested Soil rating (GPD/FF) /7~ 5 ~'//~/~. Gravel thickness ,-~ / Cleanout present (Y/N) Results (pass/fail) Surface water System type ~/E~t/~/FlE~b Total depth ,~ ~/Z55 Depression over field (Y/N) P/~5 -~ for .~ Bedrooms After test /-~ ''~ If yes, give date /~//.4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /3D ' To building foundation On adjacent lots ./- ~,~ / Surface water Curtain drain On adjacent lots -.~//_20 ~ Property line To existing or abandoned system on lot Cutbank /V/~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on~,C~_ ~is inspection. ~lg~sture ~ Engineer s Name Date ¢/V/~ Date of Payment 0¢-- ~-7~ ace .ymen Receipt Number ~ 0~ Receipt Number POST IN A CONSPICUOUS PLACE ALL WORK MUST BE INSPECTED G p Qb R 1t regt d�&ed 2.wortdV days n advance of starting wwk and 2 Na ftV Perm(t is not vM ft C" & also Cag ��iu Include f o recoco number. (ufbflyk�cate) folm a��: �'"e read and understand both sales of this 4e n"M pemeii, t agree Eu ttee tames and nWns, neunldpai nd � and the provisions (this perntit Mares: and 1 WRY tteatab workwtp implyvrkte WW4 state. Signature: Date: Ment MUNICIPALITY OF ANCHORAGE Art Development Services Department Right of Way Section ENCROACHMENT PERMIT R THIS AGREEMENT, made this 14th day of October, 2020, by and between DONNA M. KENISON and her heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State of Alaska, hereinafter called the "PERMITTER". WITNESSETH: WHEREAS, PERMITTEE is the owner of the following described real property: FIRE LAKE HEIGHTS SUBDIVISION, LOT 4, according to the official records thereof, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTER owns and/or maintains the real property more particularly described as follows: The TEN FOOT UTILITY EASEMENT, immediately along the west boundary of PERMITTEES property as shown on Plat No. 72-0089, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTEE has placed a leach field and a monitoring tube upon the referenced real property which encroaches 4.5 -foot upon the PERMITTER'S 10.0 -foot Utility Easement. NOW, THEREFORE, it is mutually agreed between the parties hereto that: 1. The PERMITTER, acting through the Director of Development Services Department, hereby grants to the PERMITTEE the privilege of allowing a leach field and monitoring tube to encroach 4.5 -foot upon the PERMITTER'S 10.0 - foot Utility Easement, as shown on "Attachment A," included herewith. 2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless, the Municipality, its officers and employees, from any and all lawsuits, claims or actions brought to any person for or on account of damage to property or injury, disease, illness or death of persons, including all costs and expenses incident thereto, arising wholly or in part from or in connection with the existence of, alterations, maintenance, repair, renewal, reconstruction, operation, use or removal of the encroaching leach field and monitoring tube, as placed upon the PERMITTER'S 10.0 -foot Utility Easement. 3. The PERMITTEE shall not assign or transfer any of the rights granted herein to another individual or company without first notifying and securing the approval of the Director of Development Services Department. 4. This Agreement and Permit grants PERMITTEE no interest in PERMTTTER'S real property whatsoever, except only the encroachment rights, described herein. 5. The PERMITTER reserves the right to revoke this pont twenty (20) days written notice to the PERMITTEE. The PERMITTEE a u upon such notice "revocation, to move said encroachment(s) from the 10.0 oo ity Easement in which it is placed Should the PERMITTEE refuse or fail to comply with said written notice, the PERMITTER may, without further notice to the PERMITTEE„ remove or cause to be removed the encroachment(s), and the PERMITTEE hereby agrees to reimburse the PERMITTER for all costs incidental to the removal thereof. In addition to the mutual promises heretofore made, the PERMITTEEhaspaid the PERMITTER a one-time permit application fee of $120.00. The PERMrITER hereby waives the annual fee of $315.00. IN WITNESS WHEREOF, the partie and year first hereinabove written. s hereto have hereunto set their hands and seal the day • GRANTEE: GRANTOR: MUNICIPALITY OF ANCHORAGE Donna M. Kenison Owner hackL. Frost; Jr. 'Right of WaY Supervisor 8484C SCALE: 1"= 40' �eNZt\ fi t OF • qL�,� � ,r,P. � S „' F. 49th •�' tt d izabeth L. Walotka . p ,A 8036 — LS • Jew. O • 5 r 'o ti �afssiotw.•'r�� EASEMENTS OF RECORD, OTHER THAN k \ �tt�4� THOSE SHOWN ON THE RECORDED 7-z-- l q PLAT ARE NOT SHOWN HEREON. UNLESS OTHERWISE NOTED Seward, FB 195, pg 31-32 BE AS -BUILT NO CORNERS SET THIS DATE I hereby cerdry that I have performed a Mortgagee's inspection of the following described property LOT 4 FIRE LAKE HEIGHTS SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property Anes and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the properly lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements an said property except as Indicated hereon. Dated at Anchorage, Alaska this 27th day of JUNE 2o1q. FRED WALATKA & ASSOCIATES, L.L.C. 907-248-1666 Engineers and Surveyors BARNES AVENUE 0 M O M _ — S89056'E 204.89 10' UTILITY EASEMENT F��S_jf LOT 4 JIO O PI =)I O O Lot 3 r0 I OOH SepOe vmt (h/p GMara : • L C:) c0 _;g: Lot 1A C) I 0 h0 O O Z I I opo • • t'y` s``� .�'`'� ami 0 Z •'...'0 5.7 ... eo b ti 4 .• �S I 1� j((�jR L wag cmc i� r vi :.�tom' i! OWeq r- S89°561E 204.95 OLIVIA DRIVE ti SCALE: 1"= 40' �eNZt\ fi t OF • qL�,� � ,r,P. � S „' F. 49th •�' tt d izabeth L. Walotka . p ,A 8036 — LS • Jew. O • 5 r 'o ti �afssiotw.•'r�� EASEMENTS OF RECORD, OTHER THAN k \ �tt�4� THOSE SHOWN ON THE RECORDED 7-z-- l q PLAT ARE NOT SHOWN HEREON. UNLESS OTHERWISE NOTED Seward, FB 195, pg 31-32 BE AS -BUILT NO CORNERS SET THIS DATE I hereby cerdry that I have performed a Mortgagee's inspection of the following described property LOT 4 FIRE LAKE HEIGHTS SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property Anes and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the properly lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements an said property except as Indicated hereon. Dated at Anchorage, Alaska this 27th day of JUNE 2o1q. FRED WALATKA & ASSOCIATES, L.L.C. 907-248-1666 Engineers and Surveyors G l e - J ( 3so- a8'! i 410.2i' ' } o �a {Lcn� - I - s w1 WE 4 w 0) A R N! e O 08-- - WZo' o�$ 1jI 1IfI = O a' 204.9xFr - L V 1 A d 204.98 IWm �W<; to �7 11 a p�p��ffim1. Si J I I o, y II 208.03' I 1 > 8 80^86 E 1 tjj to - p �=g(sM�'�W<�$.� v e - J 0J (68-ZL) ( 3so- a8'! i 410.2i' ' L o g {Lcn� - w w 0) 3. O on WZo' - -o = O a' A V E N jU E (EX1.9TI14a1 - _ d (n F lyl — w IWm �W<; to �7 Y > 31 a p�p��ffim1. Si < w o, y _j y tjj to - �=g(sM�'�W<�$.� � wi Pa 4s 7 1 V E I.L 0J (68-ZL) ( 3so- a8'! i 410.2i' ' L { u ?. Gu .. w =yyF � O Uotl°W. F a. zeSh v ¢ 3 Fpz u ¢�a �mSi• ��y a ' � �o eL0-0 R A ORIVe _J 1 W� 2 d •V �gmo « f IWm �W<; to �7 ( 3so- a8'! i 410.2i' ' U% y m<a0 .. LE iT i0a. 11��1 »iYLg N M ' Z—l------- 1-50l $ ' � �o eL0-0 R A ORIVe _J 1 W� 2 d •V �gmo « f IWm �W<; to �7 a p�p��ffim1. Si rev 8� y y�'• c�Mlamm .. tl ml M ' Z—l------- ;� N«;ates-. ati.. $ ' � �o eL0-0 R A ORIVe _J _z o;c'3'.>i dj m= z "� 3 Qw O p�p��ffim1. Si O O y ' {40.7214 �=g(sM�'�W<�$.� c�Mlamm ml o"5'a Ito e;=e JR, « 5 3p 3 z I Qlaga�J4 Ut O p t4� j O a ' {40.7214 �=g(sM�'�W<�$.� 4s S gj C- - - -1414 0 w ;3ki' m4 a Z i MATANUSKA ELECTRIC ASSOCIATION, INC October 14, 2020 LETTER OF NON -OBJECTION Donna Kenison PO Box 771357 Eagle River, AK 99577 Re: Lot 4 Fire Lake Heights Subdivision (Plat 72-89, Anchorage Recording District) Dear Ms. Kenison: MEA has no objection to the encroachment of a septic system drainfield situated in an undeveloped utility easement as depicted on the attached survey drawing dated 7/2/19, 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, i Mann L ez, Land Ser y s a e STATE OF ALASKA)SS- THIS IS TO CERTIFY that on this 14 day of October, 2020 before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared Manny Lopez Known to me and to me known to be the Individual(s) named in and who executed the foregoing instrument and acknowledged to me that he/she/they signed and sealed the same as a voluntary act and deed for the uses and purposes therein mentioned. IN WITNEW WHEREOF, I have hereunto set my hand and official seal the day and -M bove written Notary Public inand of laska My commission expires Z N Return to: MEA, PO box 2929, Palmer, AK 99645 cry•. pt=auc 'r Dom ign Envelope ID: 636546A3-CFE24FA1-BC6D-0D3CO3F95ABE JL 71GCI October 13, 2020 Donna Kenison 18513 Olivia Dr Eagle River, AK 99577 To whom it may concern Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the septic system drainfield encroaching into the utility easement of Fire Lake Heights Subdivision Lot 4, also known as 18513 Olivia Drive, city grid NW0454, GCI wo#20-0006-41. This letter of non -objection in no way precludes GCI Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right-of-way, including unlimited access for servicing its facilities. Also, any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of GCI's facilities to accommodate any or all the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to me at the address below. Coosrvned bySignature om" "°�"` 14E+287,FU4,C_. Date Markus Kofold Manager Sr. Field Services Central Region GCI Communication Corp 5151 Fairbanks St. Anchorage, AK 99503 907-868-6168 Office 907-868-8580 Fax 'yam n•••vy. Anchorage Water & Wastewater Utility i Engineering Division Mayor Board Chair Ethan Berkowitz Aaron D. Dotson October 13, 2020 Donna M. Kenison P.O. Box 771357 Eagle River, AK 99577 Re: FIRE LAKE HEIGHTS LT 4, Grid (NW0454) Request for Letter of Non -objection to Encroachment (Tax ID# 051-351-26) The Anchorage Water and Wastewater Utility received a request from your Representative Garness Engineering on October 13, 2020, regarding an existing septic drain field encroaching into the Utility Easement along the west property line of FIRE LAKE HEIGHTS LT 4. AWWU is currently not using this Utility Easement and has no objection to the encroachment. AWWU hereby issues this letter with stipulations to allow the encroachment of the existing septic drain field within the Utility Easement, the property owner(s) agrees to the following: 1. AWWU will be held harmless, now, and forever, for any damages or injury to any person as a result of the encroachment; 2. The property owner(s) shall call for utility locates before excavation in the easement; 3. The property owner(s) will drive piles 10 feet deeper than the sewer main; 4. All applicable codes and regulations will be observed and maintained within the easement; 5. This leiter will in no way preclude AWWU from full use and enjoyment of its rights within any portion of the easement; 6. The property owner(s) shall pay any additional and/or extraordinary costs incurred to accommodate the encroachment during any future required construction or reconstruction of AWWU facilities; 7. AWWU's non -objection does not imply other approvals that may be required for this encroachment; and, 8. AWWU does not provide a position for any other parcel or utility impacted by the encroachment. Should you have any questions, please call the AWWU Planning Section at 564-2739. SiPaul ly, I er VC Engineering Technician III Anchorage Water & Wastewater Utility 6@ Clearly 3000 Arctic Boulevard • Anchorage, Alaska 99503 Phone 907-5642774 • Fax 907-562.0824 • mvw.awwubix �`✓�� EMSTAR Natural Gas Company September 30, 2020 Donna Kenison 18513 Olivia Drive Eagle River, AK 99577 Subject: Letter of Non -Objection- septic Lot 4, Fire Lake Heights To whom it may concern: ENSTAR Natural Gas Company A DIVISION OF SEMCO ENERGY Engineering Department, Right of Way Section 401 E. International Airport Road P. O. Box 190288 Anchorage, Alaska 99519-0288 (907) 277-5551 FAX (907) 334.7798 ENSTAR Natural Gas Company has no objection to the existing septic trench within the ten foot (10 FT) wide Utility Easement, coincident and parallel to the west lot line of Lot 4, Fire Lake Heights Subdivision, according to Plat No. 72-89, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. Acceptance and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: • Landowner/Contractor working near ENSTAR gas facilities shall contact the Alaska Digline, Inc., (907) 278-3121 or 811 for line locating two (2) business days prior to any related excavation. This service is free of charge. • ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. • Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. • Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the land owner. • All applicable safety code regulations will be observed and maintained. • This letter of non -objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, Cassie Acres Right of Way & Compliance Technician ENSTAR Natural Gas Company NON -OBJECTION TO EASEMENT ENCROACHMENT DOCUMENT By this document Matanuska Telephone Association, Inc. (MTA) declares that it has no objection to the existing encroachment of the septic system drain field within the utility easement located at Lot 4 of Fire Lake Heights Subdivision, filed as Plat No. 72-89 in the Anchorage Recording District. Please be advised that MTA through the issuance of this document does not forfeit any of its rights to the use of the area cited In the exercise of these rights MTA will, if needed, upgrade, maintain, repair, and/or replace buried or aerial telecommunications facilities within the easement. Any repairs that may be required to the encroachment as a result of utility construction will be bome by the property owner of record. This document does not authorize the placement of any additional encroachments within the easement area. Property owners are required to obtain utility locates before doing any kind of work in the utility easements and will be liable for any damages caused by their construction work in the easements. This document is in no tvav�n arreement to vacare ny portion of the utility__ easement and should not be in reted s irh Issued for Matanuska Telephone Association, Inc. this 14th day of October, 2020 by, Jessica Burnett, Real Estate & Properties Supervisor Matanuska Telephone, Association, Inc. P0. Box 3550 , Palnter,Alaska 99645 ml.isol,ilions.curn 907.761.2510