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Home My WebLink AboutMAJESTIC VALLEY ESTATES BLK 4 LT 1(4 V'k vAtc "05C),w�3�- a,8 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP21 1430 PID Number: 050-731-28 Dwelling: N Single Family (SF) El with ADU El Duplex (D) El Two Single Family Project: El New Z Upgrade Name JEFFREY & EMILY HEBERT ABSORPTION FIELD - EXISTING El Deep Trench El Wide Trench El Bed El Mound Site Address 25844 IMPERIAL DRIVE, EAGLE RIVER 0 Other Phone Number of Bedrooms Soil Rating depth from original grade 1 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. MAJESTIC VALLEY EST. 4 1 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 Ft' Ft. Well 1 00'_F 25'+ TANK Z Septic El S.T.E.P. El Holding El Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ Material HDPE I - Number of compartments 2 Lot Line 51+ 1 NA Foundation 10'+ — - LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by Tank to PIPEMATERIAL Housetotank3034 3034 Installer NORTHERN EXCAVATION drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1 M 10/11/2021 �d 10/11/21 Location and description dates: 2 3rd 4 th ITOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL 0 F .4 Conditional Approval: Date _49 7H .... .... .. ......... 10 Curlis Huffman Septic System Approve�d - Date �691 ZI CE 128991 #0 10/2 0/2 1. . .:q Note: this does include �'PROF�WQAW approval not well permit requirements. _J (Kev ubwwi 6) PID: 050-731-28 PERMIT- OSP211430 Q A NG WALL 313R RESIDENCE -V DECOMMISSIONED EXISTING S.T. & INSTALLED NEW 1000 -GAL HDPE SEPTIC TANK WITH NEW DCO. BM TOP OF MH. STAKED 100' WELL RADIUS .Q' DI DDInD SUMP TO CONST. EXISTING FENCE FIELD L %f -A 54,660 s.f. Irl- A—C=27.7' B—C=23.5' A—D=27.8' B—D=28.0' A—E=33.3' B—E=31.8' FCO M w c D DCO E co 12.6 7.9 Lot 2 SEPTIC ESIVIT. SEP'flC SECTION SCALEi NTS MAJESTIC VALLEY ESTATES 134, Ll PREPARED FOR: JEFF & EMILY HEBERT 25844 IMPERIAL DRIVE EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmoil.com SUPPORT@ SERVICES: OF 'ff k 9T H* 0 (N 0 wj'_4t�� DATE: 10/29/2021 t�"�rtis Huffman AQ.� *4 SURVEY: KGL CE 128991 DRAWN: FWCS 10/29/21 I X SCALE: 1 20' PZSS1014� --w 0 uj 14) 0 c6 C) z Ui Ld 0: Lq to cn Do 04 04 C-4 C� 04 ic 8 0 C, E6 Gi 0 p in m a z >- UJ a: z R V) N uj L 19 4� uj 41:Z� 0 _j -j z VIVID U) c L'i V) OW UJ _j < z V) z 8: z V) z Z. -<j LU V) 0 0 c� m z D LLJ 10 SM ui 1A 00-06 3.6 UZ.00 N 0 C� LU 00 En ,9V9-�Z 3.9t,ZZ.00 N 04 x "to C� U') 4- 0 -j &0 N., 0 z 1-Y, C-47. U') 4 to A 7 r, C-4 . 0) PA 03 V-) P, U PA (M;, 0 c,' -t7 pi 0 LLA lz to z C-4 0 :w 4z TIN < z 0 9) 0 Or 0 - a 0-6 r- 0 < 0 X 00 0 oe .r- 0 CL tm 2 Q* CL IL E D 0 0 0 0 , t 00 0 E M coin . :3 0 C'O -C 0 14 '"D >W, 00) C', ;- — 0 0 40 r- r- 2i >- -E c 00 V) t a a < 0 to t. 1 1 :3 0 -1.- to C-4 C4 wo 0 c a 04 04 0) c 0 to in r- '0 3, 0 '0, wz= 0 r-, 0 COL. 0' 0 Ol E 0 tn c a 0 > —0)0) 0 ro- CL .0 M %-.0 40 :3 E CT (D V) 0 0 L- 0 0 ZOM OE �g CD :2 0 0) MO 0 X 0 CD 0 '00- m r- 0 0 LO r V)m 0 L. 0 0 (D � -0 0 Br V)� c 0 > 0 w a O= V) -6 -6 1--:E :L3 0 0. -< CL F- 0 Om 0 0 00 LLJ (00 w 0,0 :1 0 U� 0 E r 0 C.) -0 0 -J 0 _y (D :.,-j CM 0 < 0 > 0 V) 9D C � :11 X1 0 3 0 M:E �-Z= = t. a 0 > vw), '0 a 0 0 0 a 0 c LLI C) Mau 0 :3 0 m 0.0 k= C- 0) 4D 0 .0 tj C4 c - RE .0 V) 0 :F *6 LLI — 8d 0 LO 0 IS 0 E W 0 0 0 0 _j 0 C"O CL L. tMM2 wo F- r 0 0 0 0 > -C '0 MUNICIEALITY OFANCHORAGE VkCrir„ �• On-S-tte Water & YV2s4ewater Program PO Box 1950 4T4* Elmore Fbwt +' Anchorage, Alaska 9 $1$- {] Phone; (M 34317 1 Fax: ) 3+43-7997 hl.tp;1iwww.muni.orgbmi6e 14-15artrr3vrkr On -Site Wastewater Disposal System Permit Parmit Number, CSP2114�10 Effective Date; 1018,2021 Work Type, SeptloTank Upgrade Expiration Data,. 10IB 022 Tax Code N umber: -060731280170 Situ Legal Add iess: MAJESTIC VALLEY ESTATES OLK 4 LT I G.,0363 Site Mailing Address: 25844 IMPERIAL DR, Eagle RIver owner: HE&r=RT JEFFREY G -& EMILY L Lot Size in Sq Ft- .54660 Design Engineer: FIRST WATER CONSULTINQ Total Bedrooms: 3 This permit is for the construction of: El Disposal Field M Septic Tank 0 Holding Tank ❑ Privy ❑ Private Nell ❑ Waleir Stmge All construction shall h•e in accordance wrth: 1- The allached approved design_ 2- All requirements spefi led in Anchorage Municipal Code Chapters 15-55 and 15-$5 and 11ho Slate of Alaska Wastewater Disposal Regulations {18AAC72} and Drinking Water Regulations. (18AAC80) 3. The wastewater code requires inSpi2dions during the InrtAlIM10r) 7hs engineer shalr notify the aevelapment Se rvi-i�es Deportment per AMC 15-65- Provide notifiia.alran by calk lg (907) 343-7904 (2417). 4. From Cctabar 16 tc April 1$, a Subsurface soil absorption system under construction during freezing weaU er shall be either. 0. Opened and Closed on Me some da}, or b. Covered, sealed, and heated tD prevent freezing 10/08f2021 Received By, Date; Issued By: 1 Date- or- H a=10 G [E Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section '-- Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-731-28 Property owner(s) JEFFREY & EMILY HEBERT Day phone. Mailing address 25844 IMPERIAL DRIVE, EAGLE RIVER, AK 99577 Site address 25844 IMPERIAL DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) MAJESTIC VALLEY EST. B4, L1 Legal description (Township, Range & Section) Lot Size 54660 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade X (D) ❑ Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: 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: -02-2-5- Date 022.5Date of Payment: ID�GAZI Receipt Number: 91r081 Permit No. 0.5192 I 1 L{3O Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com October 4, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: MAJESTIC VALLEY EST. BLOCK 4, LOT 1 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211430, Deb Wockenfuss, 10/08/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211430, Deb Wockenfuss, 10/08/21 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 1 /�/�� A4_1 Q_e,� `e- If�ct-G t��,LLi PHONE ��- .�.i� -[p NEW ❑UPGRADE MAILINGAD,DDRESS LEGAL DE71PTION LOCATION f NO. OF BEDROOMS t3 U Y DISTANCE TO: Well r Absorption area Dwelling, , PERMIT�W F- Z LU Manufacturer v� Materi I No, o�,com artments �L P N Liq. cap a y insgallons 7ali'9 � IF HOMEMADE: Inside length -. Width -- — Liquid depth -__ O Y Jaz DISTAN T� Well �-l' Dwelling RERIMIT NO. = Z ��„ Ma acturer Liquid achy in gallons w2 DISTANCE TO: Well �� Foundatio f o Nearest lot line , �, / &) PERMIT NO I, �_ .wu u- z H z No. of lines �/� �- Length of each line Total length of lines Trench width inches Distance etween lines C.� o r Top of tile to finish grade '� r Material beneath tile t�T ynehes Total ffective a so ption area �% ua Length Width Depth PERB16f-T NO. _ a a Uj Type of crib -ef-Z diameter nb depth Tota -affie iv absorption area NWell DISfANCE T0: Building ferrnd ion Nearest lot line - J CI S9 / � Gv Depth Driller Distance to lot line PERMIT NO. Lu DISTANCE TO: Building foundation Sewer line Septic tank/ �>� Absorption areals�i y - OTHER PIPE MATERIALS 3 -% SOIL TEST RATING .� 4-1-o O INSTALLER / -) i REMARKS Ae 7 APPROVED f c DATE// LEGAL Y l /J ' 4 a /� -3 /Z-Uis Inwv. 3(/b) V MUNICIPALITY OF ANCHORAGE '`' Department -)f Health and Environments Protection `;V;' "% 825 u Street, Anchorage, AK. 99501 264-4720 ! S� dh * * * HANDWRITTEN PERMIT Permit # �ND/OR ON-SITE SEWER PERMIT Applicant: �� 0 Mailing Address: .Location: ,! Phone Number: r e/ Legal Description: L�7�k ��0 oi� Size: Type of Soil Absorption System Is: 14 Trench: i/ Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: 73 Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH (2— LENGTH GRAVEL DEPTH C6 WIDTH ::;,The length dimension is the length(in feet) of the trench or drainfield. The 'ae'pth 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 SEPTIC(HOLDING) TANK SIZE _ _ L 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(Z) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection and approval by this departmen will be subject to prosecution. Minimum distance between a well,and any on-site sewage disposal system is 100 fee 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 3 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 will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence ys remodeled to include more that 3 bed om Signed: \ Issued by: Appliclant ��tt Date: SWP/024(1/81) 0 Ef E OEOT. .oHNICAL Ff OEVELC MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 668-2280 Russell Oyster Earl F-i/is 694-2774 SOIL LOG 688-22.80 Soils 6 Foundations Land Development Performed for: Name: iel. No.- Mailing Address:�e� Legal Description: nth Lf e e tj Soil Character ,t c. 0 1 2 3 LI 5� 6 7 8 9 ..� .�goo �a . 1 Iq �...°.a.•°.°a•°.°goo........... 15 neF ••eu�p°..........••..n•.•.�.0 1/i i/�� Earl P. Ellis t tv� 16 e•• • NO. 1745-E '• (`Cw PRO Ground Water Encountered: YesNo If yes, what .depth r ,. Proposed Installation: Seepage Pit e Drain Hold Comments:_-_,«. Perfgrtiiod by:_ Data: Dritting ,[ng by DOC Co. Ooa SULLIVAN WATER WELLS P.O. BOX 2272, CHUGIAK, ALASKA 89567 • TELEPHONE 688.2759 OWNER OF LAND e-9414, e t Y DEPTH OF WELL 3 G r ADDRESS I0^ (-7/ 45 STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION L I i?[K 4 IN'9 I "cr 7 is DRAW DOWN FT DATE • Started Ended GALS. PER HR 1-5-00 PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From n Ft. to Ft. 0y4f � 6✓ �o F.J From Ft. to Ft. From _cL Ft. tojL« FL , CL M E 6ror-IC4 From Ft. to Ft. From FL to.!�:_Ft. From Ft. to Ft. From f7 Ft. to_�2EFt. /+li K&6/ .J T LL IJ J f e<f FT From ' Ft. to Ft From %' Ft. toLeFt. s4, O �r- <t r ✓!=c ,From Ft. to Ft ~ From % • Ft. toZ2_ _FL C e-'9 From Ft. to Ft. From/ FL to_L-2�Ft. From Ft. to Ft. From Ft. to Ft. ? uJ<re:k From Ft. to Ft. From FL From Ft. to FL From Ft. to Ft. From Ft. to Ft. From Ft. From Ft. to Ft. From Ft. to Ft. T:.From -Ft.-to Ft. From Ft. to Ft. From ; Ft: to Ft. From Ft. From Ft. From Ft. to Ft. From Ft. to Ft. blISCL. INFORMATION: From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft I DRILLERS NAME s 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 Parcel I.D. 050-731-28 1. GENERAL INFORMATION Expiration Date:. Complete legal description MAJESTIC VALLEY ESTATES BLOCK 4, LOT 1 Location (site address) 25844 IMPERIAL DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) JEFFREY & EMILY HEBERT Mailing address Real estate agent Day phone 25844 IMPERIAL DRIVE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) F� Duplex F-1 Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic Water Storage E] Holding Tank Community Well E] Community El Public Water System 11 Public Sewer El Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5 50 Waiver Fee $ Date of Payment 10 Date of Payment q� Receipt Number (9 J'Z Receipt Number COSA# 05C2 I I (,o;?g Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my sea] affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/1512021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to .46 these various and dynamic characteristics and are outside the control of the evaluator of the fo - .4 1 well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or TH discrepancies exist can be given by First Water Consulting & F E ?I.- .. . .... ......... 6. DSD SIGNATURE _- . . 11 . Curtis Huffman CE 128991 bedrooms t< System #1 Approved for e� .10/15121 System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: 0� r)P A. Q_ ON-SITE 114D WATER AN WASE V'ATER PROGF\AM By: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: MAJESTIC VALLEY ESTATES BLOCK 4, LOT 1 Parcel ID: 050-731-28 If more than 1 septic system on lot: COSA Checklist # —of — Structure served by this system _ A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 6/10/1983 Total depth 136 ft Cased to 40+ - ft (UNKNOWN /ASSUMED) Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/30/2021 Static water level at beginning of test 124 ft. Comments B. TANK DATA Age of tank(s) NA – NEW TANK years Tank type/material SEPTIC I HDPE Measured operating fluid level in septic tank NA H Stand pipes/fo u nd ation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Which system tested (date installed) 6/22/1983 0 ALL standpipes present per record drawing Total measured depth from grade 8.7 ft (max) Measured depth to pipe invert from grade *3.2 ft (min) El N/A – pressurized field Well production at time of test 4.2 gpm Water storage tank volume NA gallons Well disinfected for coliform test? El Yes No 0 Coliform bacteria is Negative Nitrate 1.05 mg/L Nitrate less than MRL (ND) Arsenic _ ug/L Arsenic less than MRL (ND) Collected by WES Date of Sample 10/8/2021 C. LIFT STATION El Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/30/2021 Results R Pass For 3 bedrooms Fluid depth prior to test 32 in Water added 530 gal New depth 47 in El Monitor tubes go to bottom of effective. If not, state depth into effective 5.5' OF THE 8' ED Elapsed time 1330 min Z Code -required soil cover over field Final fluid depth 32 in E:1 System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced qallons Comments/Deficiencies: *SUMP INVERT. FWC5 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft 0 Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' Z Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Z Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Yes if No ft 0 Yes if No ft ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Manure/Animal Excreta Storage > 100' Yes Community Sewer Main > 75' Z Yes if No ft N Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water> 100' Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' 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' El Yes if No *0 ft Wells on Adja cent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS *DRAIN FIELD CROSSES PROPERTY LINE WITH EXISTING EASEMENT. G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. TH . ......... .. .. .. . ......... CurIis Huffman CE128991 AiV' 3 0/29/? 1 - * \k�A- -dab, PROFESSOW A:LV3e(r • Municipality of Anchorage t3 9-, '� . �6 `.% On-Site Water and Wastewater Program (907) 343-7904 ETE APR 18 2u . Certificate of On-Site Systems Approval I¢ ti Parcel I.D. 050-731-28 Expiration Date: te' ' •tl df 1. GENERAL INFORMATION Complete legal description Majestic Valley Estates, Block 4, Lot 1 Location (site address) 25844 Imperial Drive Current Property owner(s) Stephen & Judy Reep Day phone Mailing address 25844 Imperial Drive, Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual Individual Water Storage El Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: ,I / _ , Received b �� .�/A.`_ _ _ Date: 4 a/ f COSA to be released to the engineer otherwise requested by the eer. COSA Fee $ Waiver Fee $ Date of Payment (04/t?' Date of Payment Receipt Number Cfg5 Receipt Number COSA# cSCI9 (t3'1 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastew • tem is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of inst In conducting an adequacy e. ; I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 4/18/2017 i C'7;g9 Tc V !1 6. DSD SIGNATURE System #1 Approved for bedroomsSleveri 1i. ann e: If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description Majestic Valley Estates, Block 4, Lot 1 Parcel ID 050-731-28 A. WELL DATA Well type Private If A. B. or C provide PWSID# Well Log (YIN) Y Date completed 6/10/1983 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 136 ft Cased to 40+ ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 6/10/1983 4/7/2017 Static water level 115 ft130 ft Well production 25 g.p.m 6.0+ g.p.m. WATER SAMPLE RESULTS. Coliform Neg colonies/100 mL Nitrate 1 .18 mg/L Arsenic ND ug/L Date of sample: 4/7/2017 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/ Steel Date installed 6/22/1983 Tank size 1 '000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 4/6/2017 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 6/22/1983 Soil rating (g.p.d./ft2 or ft2/bdrm) 240 sf/br System type Deep Trench Length 56 ft Width 3 ft. Gravel below pipe 8.0 ft. Total depth 11 .0 ft. Eff absorption area 896 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/7/2017 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 19 in. Water added 480 gal. New depth 31 in. Elapsed Time 140 min. Final fluid depth 19 in. Absorption rate >= 450+ g p d No Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes. give date D. LIFT STATION Date installed N/A Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 0* Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS * Drain field crosses the lot line. An easement exists to accommodate this. G. ENGINEER'S CERTIFICATION OF AL, 1 certify that I have determined through field inspections and /�'g'<� 1; •• ::y��#J review of Municipal records that the above systems are in A yk• % , *y # conformance with MOA COSA guidelines in effect on this date. •••• ••0r.•� •• Engineer's Printed Name Steven Pannone :Seven W. Pannone Date 4/18/2017 0 c9.. CE-8149 0,� I�, OFE55y*.4-' COSA canary sheet_2-6-15.doc Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-731-28 HAA# 0 � Qq 2 U 1. GENERAL INFORMATION Expiration Date: / j - a S-- C) 3 E;l &a Us Complete legal description MAJESTIC VALLEY'LOT 1, BLOCK 4 Location (site address or directions) 25844 IMPERIAL DR.* EAGLE RIVER, AK* 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address GAVIN & CONNIE RUES Day phone 694-6205 25844 IMPERIAL DR.* EAGLE RIVER, AK* 99577 Day phone BROOKE STILTNER W/ REMAX ER. Day phone 16600 CENTERFIELD DR.* EAGLE RIVER, AK* 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 694-4200 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As cerfifred by my seal aihxed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: in conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE !� Approved for _3 bedrooms. Disapproved. 337-6179 Date '' f (z 0.3 Conditional approval for bedrooms, with the filowing stipulations: WASTEWATER Attachments: �n•., ,•'•��` HAA Checklist Agreements JJ/JOyFy��iSPic System Advisory Supplemental Reort Well Flow Advisory Other By<��/� Cf /. %J Original Certificate Date: 8 - '15- 0:3 (Rev. 12107) Municipality of Anchorage Development Services Department Building Safety Division On-SRe Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.onchorage.ak.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MAJESTIC VALLEY ESTATES S/D; LOT 1. BLOCK 4 Parcel ID: 050-731-28 A. WELL DATA Well type PRIVATE 'D 9 If A, B. or C provide PWSID# N/A Date completed (p Sanitary seal (YM) YES Total depth 1-36 ft. Cased to 40+ ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: N/A mgA. B. SEPTIC/HOLDING TANK DATA Well Log (WN) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 7/29/2003 127 ft. 4.4 g.p.m. Nitrate 1.11 mgJL. f 003 Date of sample: 7% 0 2003 Tank Type/Material STEEL Tank size 1000 gal. Number of Compartments 6 Foundation cleanout (Y/N) YES Depression over tank (YIN) O Date of pumping 8/8/2003 Pumper C. ABSORPTION FIELD DATA Other bacteria 0 colonies/100 ml. Collected by: AKWWC. INC. Date installed 6/22/1983 Cleanouts (Y/N) YES High water alarm (Y/N) NLA JR'S PUMPING Date installed 6/22/1983 Soil rating p.d r ftjbdrm) 240 System type SHALLOW TRENCH Length _56 _ fL Width 3 ft. Gravel below pipe 8 ft. Total depth 11 fL Elf. absorption area 896 ft' Monitoring tube **YES Depression over field NO Date of adequacy test 7/2912003 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test 675" in. Water added 662 gal. New depth 76—Vin. Elapsed Time: 1111 min. Final fluid depth 66.50 In. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date – •* MT EXTENDS APPROXIMATELY 92' BELOW INVERT D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line e0'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line e0'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkingivehicle storage Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS s recuru'r G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and * Y� review of Municipal records that the above systems are in """.... ' ..• ""' conformance with MOA HAA guidelines in effect on this date. J Go sa. Engineer's Printed Name JEFFREY A. GARNESS e� 79 Date/pro Q��ed......•��o fessb►` HAA Fee $ s Waiver Fee $ Date of Payment/20 i0 Date of Payment Receipt Number !0�-T Receipt Number (Rev. lyo1) Sent By: Alaska Water and Wastewater Con; 907 338 3246; Aug -22-03 9:52AM; 07/23/2003 17:17 6944988 BROOKE .y 0 Page 2/2 PAGE 02 ASSUILT-iHO CORNERS SET THIS DATE. 1 HEREBY CERTIFY THAT 1 HAVE SURVEYED THE SC" FOLLOW'" DESCRIBEO PROPERTY, 1•,40 HaJe3tic Valley Estates Subd.,14t 1 Ilk. 4 AND THAT NO ENCRQ ZWENTS EX13T E7i6EPT AS DATb 1-14-90 INDICATED. IT IS THE RESPONSIBILITY 0/ THE OWNER TO OETERMINE THE EXISTENCE OF ANY ORIO, FAS E]iENTa, COVCHANTS, OR Rt3YttIFTIONS SV 363 WHICH 00 NOT APPEAR ON THE RECOR= SUB01- V1310H KAT. VNOER NO CIRCUMSTANC93 RHM I.D F6 ANY DATA HEREON K USED FOR CONiTRUCTION 10-49 Of PENCE LINES, OR FOR E3TAURMHO BOUND- ART u04, N� D!6 .y 0 Page 2/2 PAGE 02 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 HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 050-731-28 HAA # �_\ (-' L1 1. GENERAL INFORMATION Complete legal description Nhjestic Valley Estates Lot 1, Block 4 Location (site address or directions) NHN Imperial Drive, Eagle River Property owner Mailing address Consuela werbelow Day phone 696-7877 River, AK 99577 3 Box 1701 Lending agency _NorwPGt / r.PR1P/Brady Day phone 272-6594 Mailing address P.O. Box 142347, Anchorage, AK 99514 Agent Lori Crouse / Vista Real Estate Day phone 689-6464 Address 16635 C'PntPrfiPld nrivtzR'-Qle River AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 n 0 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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294 Eagle River AK 99577 Engineer's signature ��'� Date yam" -�•:'m .,, .. s.. • �'�` "� ' n° SY fA V. 6. DHHS SIGNATURE 1 — Approved for bedrooms. b}p Disapproved. Conditional approval for bedrooms, with the following stipulations: 4 Additional Comments Date 4 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.1i91) Back MOA#21 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage OCT 0 7 1996 DEPARTMENT OF HEALTH & HUMAN SERVICES ® r ®1 Environmental Services Division !` 11 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: ff/}JParcel I.D.: 050`731—Z-cY— Go%/ BLGCk- �f A. WELL DATA Well type f �wlfTG If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) %S Date completed Total depth Cased to 132'Casing height (above ground) Sanitary seal (Y/N) yG S Wires properly protected (Y/N) yC—S FROM WELL LOG Date of test _0& ZY3 / Static water level Well production 2 g.p.m. WATER SAMPLE RESULTS: Coliform w AT INSPECTION (P -g-P.M. Nitrate /' �z Other bacteria Date of sample: D 9,s�' `/l9(�o Collected by: C /Z F, .S B. SEPTIC/H@tDING TANK DATA 000 Date installed Tank size DO Number of Compartments Z Cleanouts (Y/N)—,y S Foundation cleanout (Y/N) ytirs Depression (Y/N) NO High water alarm (Y/N) Date of Pumping 0(A /3 9(a Pumper cT C. ABSORPTION FIELD DATA Date installed 0611813 Soil rating ( ftLw ft2/bdrm) %d'y System type 7/e CA161-/ Length GLP Width 31 Gravel thickness below pipe IF _Total depth Effective absorption area 99U 1 Monitoring Tube present (Y/N) yi575 Depression over field (Y/N) Date of adequacy test 09104'hResults (Pass/Fail) 1a11 S i For _ bedrooms Fluid depth in absorption field before test (in.); 5-7. 7s` Immediately after9/D gal. water added (in.): 80,9 le Fluid depth 6 3 (ins) Minutes later: 3 /S ,. , , Absorption rate = f v g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at' _ Cycles E. SEPARATION DISTANCES "Pum `Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/hekftng tank on lot Absorption field on lot /oo /oo ' Size in gallons On adjacent lots On adjacent lots "Pump off" level at' t�<o� Public sewer main /611A Public sewer manhole/cleanout NIA £,ewer /septic service line FC, i Lift station /\I 1A SEPARATION DISTANCES FROM SEPTIC/H6! +NG TANK ON LOT TO: Foundation '? y Property line a Absorption field 3 r Water main/service line tip, Surface water/drainage 0001 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: f9 �'rt56me� Property line cR°!sem 4�� '~ Building foundation S° Water main/service line Surface water f / /00 Driveway, parking/vehicle storage area Curtain drain /VOLAE 1 t l PAP-C/VZ Wells on adjacent lots F. ENGINEER'S CERTIFICATION l certify that t have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. ------------ Signature s�1 Engineer's Name Date X09 G HAA Fee $ 0 t5-0 r Date of PaymentoZ Receipt Number ,�g�- -// (2S 3 72-026 (Rev. 3/96)' Waiver Fee $ trop ,ss ' Date of Payment Receipt Number as �: Fr •r'i r.:b^-.,. .Ysv i 10/09/96 TUE 16:71 FAX 6696499 VISTA REAL ESTATE EA [A 002 EASEWNT ACT"EMENT �=D OC1` `141996 Municipality of P.nChOrage Dept. Health & l iuman Services W11CIINIS the septic trench constructed to provide swage 4tsposal for Lot 1, Block 40 Majestic valley .Estates Subdivision extends onto Lot 2, Block 4, Majestic Valley Estates Subdivision anti, Whereas the owncrs of the subject parcels wish to enter into a:o agreement to allow the continued use Of Uid septic system trench, tf e. pattiews agree as fo{Iows; An gAWmqd located an lot 2, block 4, Majestic Valley Estates Subdivision per description below containing 1145.92 square fel t more. or less is hereby created for se ie y t rench use by the owner of Lot 1, Block 4 Majestic Valley Estates Subdivision and is more particulnfly described as follows: (SEE na'recx131) OfflIBITs A s 0) Beginning at the southern common corner of said Lot 2 (aid Lot t proceed N33 2314gI1W 82.00 feet along the , roperty line to the TRLM- POINT O BEGI1NN1I'dG- thence S71 33V0' 00"lE, 38.57 feet to an angle point; thence NO2 27491W, 63.63 to the cotumon property lire and an arrgle point; thence S33 23'44"W, 6149 feet along the common property line to the TRUE POINT Or, DE:GINNJNG AND POW OF (ENDING ofthis easeltrent. Whereas it is understood that the protection ofpartics is paramount, the parties agr" as follows: 1. The easementshall be granted to the owner of I,ot 1, Block 4, Majestic Valley Estates Subdivision and their heirs and successors, sale or transfer of ownership by the owner(s) of either lot shall include transfer of ownership of this agreement, 2. It is expressly understood that this easement agreement shalt only be. valid as long as the existing septic system trench is operating in accordaocc with Municipality of Anchorage standards. Should the system vease to operate this easement agreement shall immetliateky becoute null and void and any new system or expansion shall be constructed solely within Lot 1 block 4,1!riajestic Valley Subdivision. 3. It is agreed that the owner of lot I Block 4, Majestic Valley Estates Subdivision shall hold the owner of lot 2 block 4. Majestic valley Estates Subdivision banrless fret» damage or penalty as follows: 11. sewage spills or overflow b. costs in connection with any form of violation of law regarding septic system operation. c. conflicts with or damage to wells, ground water or other parts of the envirowncnt.,, created solely by the septic system trenCI . d, Any cost arising out of inspection, repair or danwge of the septic systan trench page one of two T14, if strumenl Is bn-'W recwdud t:y Tr�ll;ltloskry 77110 IMUT011ca AprncY. hlc., us cn r,: Cn:n/nr aalian r -MY. If hay nal Ircon cxnmlr,:l c., 1,, IF 011Y. Gn Ills IIID rI 11 . 1.-I;iln I ,,., -, 10/08/96 TUE 18:22 FAX 6896499 VISTA REAL ESTATE ER Drn?98t4PC346t,I This agmetaont has tout simed and enWTod into this '/ dday of 19% hr the Anchorage Recording Distric( Third! Judicial distrust at anchorage, Alaska. consuelo C.Werbelow C,wner Lot 11Block 4, Majostic valley Estates Fagle River, Alaska: She Ellers 1�heryl, 1,I Zlo-rs Ovmer Lot 2, Block 4 Majestic Malley Estates Fagtc River, Ala*a AT ANCHORAGE , .r•1i.,7'#.SKA. . r This is to certify that on the �i !day of LiZ4V 1916, personally appeared before me, the nvdersieAud it Notary Public in and for this State of Alaska, known to tic to mr to be; the persons) tnatnecl is -wd who executed tht foregoing docurnent and they ackatowledgod to nw, that they were authorizod to cxccute tum- forgoing heforgoing d ot;=ont. WI'T'NESS MY HAND AND NOTARY SEAL the day acid ywx fust herein above written. NOTARY PUBLIC IN ANI? FOR ALASKA 4 �'WL A.dletsit® Arty Comtrtissian Expires: a .� , 0 o_ STATE OF, ALASKA) THIRD .RJDI(,IAT-. DISTRICT ) This is to c€n4 that on this A of (Qt - ir-J 1996, before men. Notary Public, in and for rA (103 the State of Alaska, __.. hexyl L.r Ellex s personally appeared before nne, the Undersigned, a notary Public in and for the State of Alaska, known to be to he the person(s) named in astd who executed the foregoing document aW they acknowledged to me that they were authorized to execute the foregoing document_ WITNESS MY HAND AND NOTOR-Y SEAL the day and year first hereinaf)er written. - ._ m...........,". cpea a�rr _....., _ .. ntta•r.ac A�u�utitart a NOTARY PUBLIC IN AND FOR ALASKA � c��e�A��at� My Cammissiori'exf,ire:,�`j`'A Page two r5f two two RECORDING RETURN TO,. VISTA REAL ESTATE 16635 GENTERFIELD DRIVE EAGLE RIVER, AK 99577 ATTN: LAURIE CROUSE 10/08/96 TUE 16:22 FAsi 6896499 ITISTA REAL ESTATE ER EXHIBIT A oro?9R4PCIs75SJ n larx� within Lot 2,13Lock 4,MdjEtstio Va7_1.e1r ' sb, the P"at O -f which was Wed as Plat 77-27 In the Aridur-�age F"=aAmq i7aMriM Maz ka. "te spa t . M tadnPs 1145.92 e fM,, MMV or less. an (wi tui at tka� mmthex" CrAmn mrflfw of !itaJc1 got 2 MW Wt 1 kror*W [33°23'44"T;, 82.00 feet alow the pzoWrty 1.im to t1le n=, POMT OF BWMMM8 thenM 071030'40'IE, 38.57 iep-t tO an ale }xatnto ¢1>wn�a 833"2`l' 4411% 63.63 to tho ':ce(meys p3oI :tX ]-i nq ark an angle point, thence O33°,+3'49"61, 69.49 T 1. along 41r CptT[tM711 PMP9'ty laxle Lo the TRtUE P()INq, �EGX Qat AMPa7Ct C1r 1 iVG MAS easftmt. SCE. 19 9 9!16 (hh irairurnenr is (,vino reetrrdsd 6V (ranfAla:.1:p Titln InWroix: Agoncy, In¢„Us hn ❑ctnninieda;: �;� onh, B hp; nr.l Login exa"dnzd n; ro its nliacy Ii S+"V• on the tldu of IF, 9sio to hn: okY. 17j 004 lU/US/9d TUE 16:22 FAX 6890499 VISTA REAL ESTATE ER FXHI IT B i 1 AW)HORAGE IWO, OIST ICT rofflukWOR W +96 [lCT 8 nM 9 Ufa � s� l a 005 APS u g 3 J y J tl. 9 UL S;tr U. 1Y -i it e n m � �`� ., ��. � �� rte• rill 5 .z APJ :Zyl;/vewg Ke--i�s- P /A a 1}`Jij m � �`� ., ��. � �� rte• rill 5 .z APJ :Zyl;/vewg Ke--i�s- Parcel I.D. # MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 06-0 - 7;3/ - ';t_ P HAA# 'za /Q�a�� 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Robent Connad Telephone: (home) Business Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Re/Max o4 Eaate Riven ATTN: Sharon Minsch Address 16600 Centen4.ie.2d DiLive Suite 201 EagZe Riven, Ak. 99577 Telephone (e) Mail the HAA to the following address: (or check here NXif hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-FamilyU 3. WATER SUPPLY Individual Weld l S & S ENGINEERING 17044 E-gle Rover 1 oop Rom] No. 204 Eagle River, Alaska 99577 Number of bedrooms 3 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status.' 4. SEWAGE DISPOSAL On-site,Q Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 Z ;o Z abed h008 (88/L 'A98) 9Z0-ZL '>laoM s,aaauibuo leuoissa;oid agl ui suoisslwo ao saoaaaao; apsuodsaa lou sl abeaogouy;o AjiledioiunN agl'ponssi si aleol;iliao a wo;aq elep azAleue ao suolloedsui lonpuoo lou op SHHO;o saeAoldw3 -sluewaiinbai alels pue jeaape; uleliao Alsiles of aapio ul suollnlplsui buipual magi pue sawog ;o siasegoind o; Asolinoo a se sigl saop SHH4 agl Te sexy ;o ale}S ay} ui paaalsibaa aaauibua peuoissa;ad luapuadapui ue Aq anoge g ydeiBuied ul uaAlb suolleluasaidaa agl uodn Aluo paseq paleoilpoo Ienoaddy (liaoglny glleaH sonssl (SHHa) saolAaaS uewnH pue glleaH to Iuawlaedaa abeaogouy;o lliledioiunN agl NOIlfiVO jeu0111PU00 _ / "" ale 4 � , J� d K, ....... „. eta, ��' � '°° � �r• < 6 auogdalal .� .� ?'- .' ��J Jenoiddy leuoilipuoO;o swaal panoaddesla �. panoaddy tq swooapaq T ao; panoaddy eilselV `aaAW alseg N peOU d00-1 aan;tl •.1` ONI'SSaNl'ON3 5'8 S IVAOFJddV SHHd '9 alea ssaippy waid;o aweN ,uoiloadsui sig; ;o alep agl uo loa;;a ui suollelnbaa pue 'saoueuipio 'sapoo alels pue ledloiunw ale glint eoueildwob ul si walsAs lesodsip aalerv,alseM ao/pue Alddns aaleM alis-uo agl 'uolloadsui PUL, uollebllsanui Xw woa; pue sail; abeaogouy ;o L(llledioiunw agl woa; pauielgo uoilewaolul agl uo paseq legl L(;uaA aaglan; I -uiejeq paleoipui ainlonals;o adll pue swooapaq;o aagwnu agl ao; alenbape pue leuolloun; 'a;es sl wels/,s lesodslp aaleMalseM ao/pue Alddns aaleM ails-uo agl legl SMOgs lenoaddy Allaoglny glleaH slgl;o uoilebllsanui Aw legl A;uaA l'Molaq uMogs alep uoilepileA aql;o se pue olaaag pail;;e leas Aw !,q pailpeo sy NOI.LVW»OdNI ONV V.LVQ'HOFJV3S 311:1 `S.LS31'SNO11O3dSNl JNIQIAOdd Wold ONId33NIJN3 'S MUNICIPALITY OF ANCHORAGE (MOA) fi� • Health Authority Approval (HAA)�r t CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: /—Ota_) BOG K I MAIC A. WELL DATA Well Classificationm( I U If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) I— Date Completed (O - f z - Total Depth I '�1a Cased to v t Depth of Grouting Pump Set At U +{ Static Water Level Yield _f_ ( r_'Z-a3-` CJ Casing Height Above Ground I ;2 1- Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ( Ci0 'r Depression Around Wellhead (Y/N) l On Adjoining Lots /00 r � To Nearest Edge of Absorption Field on Lot On Adjoining Lots I O 0 1 To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole 'o (%t To Nearest Sewer Service Line on Lot 5;2 5 + Water Sample Collected by I N (!E1, c- it I N � ; Date l ,Z -�2 (1 Jl Water Sample Test Results w I l S�rAC,`��ry- ,�AC.it� J'i W.t- + N i l k(A Comments B. SEPTIC/HOLDING TANK DATA Date Installed —Size /000 No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) _� Foundation Cleanout (Y/N) Depression over Tank (Y/N) /J Date Last Pumped If Pumping/Maintenance Contact on File (Y/N) hi/6 ; for `- Holding Tank High -Water Alarm (Y/N) _�N)ILA Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: I To Water -Supply Well ( of To Building Foundation 3 r To Property Line To Disposal Field 3 2 - To To Water Main/Service Line ! l7 i To Stream, Pond, Lake or Major Drainage( Course ((fid t n Comments 6(Tt C �W Nk Or�yN�7�C Cr 4� ) (� s ��55 t7�p� y�✓vna�n/r� 72-026 (Rev. 7788) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �4 /� Type of System Design Date Installed x -22—e"5 Length of Field Width of Field _2, (7 Depth of Field Gravel Bed Thickness rJ Square Feet of Absortion Area C(b Statndpipes Present (Y/N) Depression over Field (Y/N) n1 Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well / Old To Property Line To Building Foundation Jac To Existing or Abandoned System on Lot A I ; On Adjoining Lots '1 (30 � + / To Water Main/Service Line J D i To Cutback (if present) A)f/} To Stream, Pond, Lake, or Major Drainage Course 100 /+ To Driveway, Parking Area, or Vehicle Storage Area '? D 9 Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. N.,,•�. a 1.-J Signed 5 & 5 EMGiNEEIUNU Company �y yq Ragle jai jer Loop Road No. 204 Date Eagle River, Alaska 99577 jam/ MOA No. Receipt No. pC/�� Date of Payment Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 APPLIC VT FILLS OUT UPPER HAL ONLY Time ✓ne Property Owner /l, 1 _7 1l ` `�C, / IY�� r, 'A' JJ C.-7 �' r-) Pho Mailing Address �(,' 'j !� __ �l �• r Zip �.� Z/ Buyer Date Address �. �c .,.J(/ = %h ---_.-/-~ ��/`i- Zip Code (�U '• Date Lending Institutionn _- /W 0 110L Phone Address>S Cj - ._F r,� �� ( Zip Code �f/j� (/' �� - %_) / Realty Co. & Agent /lr "1 Phone Address�_ /1 C -'.� Zip Code �-�' l.)C� Legal DescriptionI^ Street Location m�.- Type of Residence /1�,�{�/,�/�/� Field Notes: IVC) 1, / v 1.. X Single Family-, / Imo./ ❑ Multiple Family No. of Bedrooms ! oo ' ❑ Other eric. Water Supply +� $ ` - Individual " ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ,X ❑ Community For wells drilled prior to that date, give well depth (attach log if available).. ❑ Public Utility 'CONDITIONS OF APPROVAL v ( ) DISAPPROVED {{j'U Sewer Disposal // �_ �• ( ) CONDITIONAL APPROVAL' ?U, Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: . ❑ Holding Tank Soils Rating Date Seo-liedWell NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ' S --- Time Time Time G Time 1 Date Date Date i, Date Inspector Inspector Inspector CEJ Inspector /1�,�{�/,�/�/� Field Notes: IVC) 1, / v 1.. / �'WI�' / Imo./ ^.- ! oo ' JUN N ?,� 1983 eric. +� $ ` - " j' f ;:�-5) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL v ( ) DISAPPROVED {{j'U ( ) CONDITIONAL APPROVAL' DATE] 2--(o— .... Soils Rating Date Seo-liedWell To Absorption Area ' S --- Well Log Received hd=----- -_-� Well to Tank Septic Tank Size 72029131821/�,,,.>e.l.-� ci l ~• �'