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MOUNTAIN VALLEY ESTATES BLK 2 LT 16
ff"U0hb-duv J, (Rev 05/02/18) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904I0EC 0 2019Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181377 PID Number: 05063108 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name Barnard ABSORPTION FIELD Q Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 4901 Hiland Rd ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 229-0154 3 1.2 GPD/SF JTotal 10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4 Ft. Gravel depth beneath pipe 6 Ft. Subdivision Block Lot Mtn Valley Est 2 16 Fill added above original grade 0 Ft. Gravel length 33 Ft. Township Range Section Gravel width 3 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 396 Ftz 1 Ft. Well 100'+ 100'+ na na 25'+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Anchorage Tank 1000 Gal. Surface Water 100 1+ 100'+ na na Material Steel Number of compartments 2 Lot Line 10'+ 10'+ na na NA Foundation 10'+ 10'+ na na LIFT STATION Manufacturer Capacity Remarks Diverter Valve to Old Trench Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank eXlStlng dTank to D3034 rainfield Installer Dean Drainfield D3034 CO/MT D3034 Inspector NorthRim Eng. BENCH MARK (Assumed elevation) 100 ft Inspection 1st 10/23/18 10/24/18 Location and description 2°d Deck 3rd 10/25/119 411 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Eng nee 's Stamp Conditional Approval: Date .0 ��� Septic System Approved pl'w Date U/19 1 �'; `�; •Ra F c a. ,, 4 " °F, �_� '�^• r^ Note: this approval does not include well permit requirements. (Rev 05/02/18) Septic Diverter Valvl New 1000 Gallon Septic Tank w/DCO's Decommissioned Old Septic Tank PER UPC z d O ry 75 C d R" Tl A 64 B 52 T2 65 50 DCO 67 50 DV 68 51 C❑1 102 80 C02/MT 93 64 ,New Trench op car Septic System pP/ c, o T Tj c° CU Simi, j O l d T r e c h e wa Flat Slope 3 Bdrm / 0 Well N R10 / \ e Ease 30' Pe ae 'o Septic System R10 0 Well i / NORTHRIM ,:+�5E,�.'444 MTN VALLEY EST 1" = so' ENGINEERING P `+ steveEng.cOm BLOCK 2 LOT 16 RECORD :..� Po Box 770724 ; Skm � LAYOUT Eagle Rlver, Alaska 99577 +, l'. , 907.694.7028 WASTEWATER UPGRADE `�� z /,7 +' REPLACE SEPTIC SYS Date- 12/4/19 12 of 3 W 1 W N d � Ln l ! i L L QjQj4 W S L.� O ~ U F- i W S U L � Qi d O S +' > i Q 06U � O O 7- (7F - C L d F- W L F- In > 3 U N N -5 O U Z o c —�- o- o 0)n, W W -5 C4 Fi _1 W Ln S z Qj o > O m e 3 z o +' I N Qi W > Ind (U +' > m O L 3 W' J L N W H F- 4 1 C5 +' O pi L c Q U � > Q Q- r M °° O) Q W V M CC) @7 '1.11 N O Q O d U @1 (� W U H +� o c O_ d > O d N W " > W d ®®�y®a�rrtir® W CN _N W ; v 4.4 Ln n O 0 .rcr) N d i N L Ln F- dQj 01 d >O N co c m U U @J - d d -Y d 41� L ; L � O :3i S CT do O O- OW O o UW F- L W d o i L o Qo �r O > 41 � � W O d U i ON O Ua C, o -1 d O W � > W U W N d � l ! i L.� O Ln i OJ W � Qi d @J +' > i Q Q � O_ W -h' In d N -5 > o c —�- aj W W Li _1 W Ln S > O m e W W N l ! O W � Q � N >- o —�- W _1 W Ln > U e o z o > _v W (U U) m w S 3 W' J +' O W H F- 4 1 O c Q Q Q- r W V I- U Q U F- (� W U H W Q /f- � n nr 1__L LD W " W CL ®®�y®a�rrtir® Jo. CN it 6f+� ; v 4.4 n -�Z 0 .rcr) N W U O O N Z W o Q v rn x 0 m c a w STANDARD MORTGAGE SURVEY NOTE: THIS SURVEY IS PREPARED IN ACCORDANCE TO A.S.P.L.S. MORTGAGE LOCATION SURVEY STANDARDS. THIS SURVEY REPRESENTS SURFACE CONDITIONS FOUND AT THE TIME OF LOCATION SURVEY AND DOES NOT CONSTITUTE A BOUNDARY SURVEY. THIS SURVEY IS SUBJECT TO ANY INACCURACIES THAT A BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION SHOWN HEREON SHALL NOT BE USED TO ESTABLISH FENCES, STRUCTURES, OR OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, LIABILITY OF THE PREPARER IS LIMITED TO THE FEES COLLECTED FOR SERVICES IN THE PREPARATION OF THIS PRODUCT. N FENCE -•-.� OF A 1 E I LOT 2 �N��°21901 ��P o '9S I 1160 7 d , % .it, ' PP �.49TH -. ' I UTILITIESfGAl J! G Max CCA.... Schillinger� LS -12039 AW N FD PCO .Aw LOT 16 0 ,��������`�� SEPTIC 03 ` v 12/2/2019 ` : I 125.1' Z i G) o R=100' w WELL 110.4' m LOT 5 A7' SHED DECK C° 16.3' G? _ HOUSE DECK r I N z _ I m n � j0r I pp 0 0 o 60 5.9' WELL SHED &SRA\N i � 51.8' l 3.i O RFeg4� I 47.6' LOT 4 1 lN? X165 p31 r`-10' UTILITY EASEMENT LOT 15 AS -BUILT DRAWING OF: 0 25 50 SCALE: 1"=50 FEET DATE: 12/2/2019 LOT 16 BLOCK 2 FILE: 19-134 HILAND PROPERTY ADDRESS: 4901 HILAND RD., EAGLE RIVER, AK 99577 MOUNTAIN VALLEY ESTATES LEGAL DESC: LOT 16 BLOCK 2 MTN. VALLEY EST; PLAT: 73-152, A.R.D. ALL POINTS NORTH LLC, PO BOX 4207. PALMER, AK 99645 TEL: 907-746-4185 i02-3l/8 gr j-1 N' " MUNICIPALITY OF ANCHORAGE MJ .. o o l n On-Site Water&Wastewater Program ti° a.�, PO Box 196650 4700 Elmore Road a t Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,� http://www.muni.org/onsite cpa tirmillitmmlw.nent 4'�C hlORPGO On-Site Wastewater Disposal System Permit Permit Number: OSP181377 Effective Date: 10/19/2018 Work Type: Septic Upgrade Expiration Date: 10/19/2019 Tax Code Number: 05063108000 Site Legal Address: MOUNTAIN VALLEY ESTATES BLK 2 LT 16 G:0658 Site Mailing Address: 4901 HILAND RD, Eagle River Owner: BARNARD BRIAN J & LESLIE L Lot Size in Sq Ft: 46727 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 //i? Received By: Date: Issued By: C90c Date: 10 2 1 g • MUNICIPALITY OF ANCHORAGE Development Services Department L- Phone: 907-343-7904 On-Site Water & Wastewater Section 6 8 9 10 ax: 907-343-7997 , RUMP ON-SITE SEPTIC/WELL PERMIT APPLI lc a TI(CQN 1 6 2018 k ti Parcel I.D. 56- 63 I- o cF (-> 01 6 9 L. ,\C° Property owner(s) Q,4,/\(A rt't Day phone Mailing address Site address $4.41 F Legal description (Sub'd., Block & Lot) zkt 77V VA Lt-e ` 'moo!' 5.2 ,C r< Legal description (Township, Range & Section) Lot Size 44 727 Sq. Ft. Number of Bedrooms .3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) /Fr (w/wo ADU) Septic Tank Upgrade Duplex (D) Holding Tank ❑ Renewal ❑ ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner authorized agent) Permit/Rush Fees: 5(A Waiver Fees: Date of Payment: [n![(a !$ Date of Payment: Receipt Number: 6516$0 Receipt Number: Permit No. OSP/81, Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc \CRT I— I N' ENGINEERING SteveEng.com Steve Eng,PE,PH 907-694-7028 SteveEngPE@gmail.com Date: 10/16/18 Number of Pages: To: MOA On-Site Services Subject: Mountain Valley Estates Block 2 Lot 16 Septic System Upgrade An existing septic system is failing on the subject lot. A soil test reveals silty sand w/gravel soil and no groundwater. The design calls for a new trench and a new septic tank. Most of the subdivision is on private water wells.The terrain slopes northeast at the trench site The system size is a single family at 3 bedrooms. Please review the wastewater system design for the existing 3 bedroom home. I have included design plans & specs, design guidelines, & soil test. If there is need for additional information or clarification please give me a call. Thanks-Steve AIM IF A elbil p Pi ad 7Atr 1.4 9s c s ENGINEERING SteveEng.com Mtn Valley Estates Bloc tit 16 V.4 Ir. . ' 01 • Steven W. cng ; `� SPECIFICATIONS & DESIGN GUIDELINES ' '4; • �t 9Fo � �l61c Wastewater System Sizing: This is an existing 3-bedroom, single family home. This Wgoe developed subdivision. These lots are large with private water wells serving most of the area. No adverse impacts are expected from trench/tank upgrade. No conflicts to the other lots will take place by this septic system construction upgrade. A soil test reveals silty sand w/gravel. An application rate of 1.2 GPD/FT2. Trench Length=375 FT2/6'x 2 = 32' trench, 6' effective. A new 1000 gallon septic tank will be installed; Decommission old tank per UPC.Upgrade sewer service line/foundation cleanout if necessary. Diverter Valve connects old trench. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications(AMC)& State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment,New 1000 gallon septic tank. Install Double Cleanouts. • Decommission old tank per UPC. • 10' minimum between the tank trench,tank to house. 10' to property lines, • 3' of cover or insulation is required for trench; 2" Minimum thickness for insulation can substitute for 1' cover. • Tank& solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall,prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs,ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level,minimum of 4' to groundwater, 6' to bedrock from drain-rock. • Drain rock to be %2 inch to 2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier(filter fabric)to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • The finish grade must be mounded to promote drainage away from trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene(Dow Styrofoam HI/equal) DESIGN NOTE': 1. Connect Exi ting Trench Via Diverter Valve. 2. Sewer Servic; Line minimum 2% slope. 3. Replace Septi Tank/Decommission Old Tank Per UPC. Connect New Tr= ch Via Diverter Valve. 4. Lots Served by P ' ate Wot- Wells. Sep-tic Sys-tem 5. No Conflicts Within ''0'. Mfrk 100' Well Radius. 6. Check Condition Of Se '.ervice Line— Replace If ecessary. 7. Add Double Cleanouts B.•fo ank If No FCO Septic System /4s, top P/ New Trench Septic Test Hole Diverter Valve Jew 1000 Gallon � pe/ >eptic Tank w/DC❑'s )ecorirlission Old +r >eptic Tank 'ER UPC Cu slo. Existing Sept, System 1110- DriVPwa y Flat Slope' R10' 3 Bdrrh / 0 d 0 Well Flat Slope C o Well c R101 1,3 .e -asesn ' Dram' tr\°n 30' Pedes NORTHRIM ;•4� ... MTN VALLEY EST 1' = 50' ENGINEERING SteveEng.comBLOCK 2 LOT 16 DESIGN Po sox 770724 LAYOUT Eagle River, Alaska 99577 10� 1. \/ASTEWATER UPGRADE 907.694.7028 h REPLACE SEPTIC SYS °°10/19/18 12 of 3 • • Foundation Cleanout / Tank Cleanouts I Finamide Opposing Cleanouts Between Septic Tank & Trenches ,e. _ Diverter Valve- "ON" To New Trench 4 Foot Cover or Equal 1000 Gallon 'Anchorage Tank' Mounded Cover To Match Terrain Or Equal Monitor Tube Solid Pipe leanout DESIGN NOTES: I 1. Depth of New Trench is 10'. 2. Septic Tank & Solid Pipe to be Placed on Compacted, MIMI , Stable Soil, Free from Boulders, Filter Fabric 3. Sewer Service Line is Minimum 2/ Slope & 3' Cover. •: _ 4. Water-Tight Couplings, %' :..:.:.:.:.: 5, See Specification Sheet. '_: P=111= = = 1=•' !•!= • 6, All Work To Conform to Municipality of Anchorage (AMC) != 11`•`�=�=11"1� Requirements & Specifications. ! ! . ! .: ::' 7, Maintain 3' Cover Over Trench Or Insulate. = S❑ILS LOG - PERC❑LATI❑N TEST NER1-1-"-R IM Date Performed: 10/5/18 ENGINEERING Performed For: Barnard Legal Description: Mtn Valley Estates Block 2 Lot 16 DEPTH (FEET) T.H. Location: See Attached Test %ji�;� .; ❑r ani c 1 g Boring Location Map Astir 2 - �'',� SP Sand 3 - : .x.r: t._.i.F. 4 - =•`fir Groundwater'? No r '1sJ1 W/ Depth -- 5 - ; `,s ` 6 - .3' i t:-<�°A Gravel Water Depth n`.. 's ..%moi yi 7 - ''.y4 n After Monitoring,None Date: 10/15/18 ; . `:s # Date Gross Time Net Time Depth Net Drop 8 - , i.;=_ :, :x r..ti:iix-.. :. 9 _ ti: ;� _: 1 10/8 0 -- 6" -- { =�'�`` 2 10/8 10 10 min. 2" 4 4=' 3 10/8 10 -- 6" -- 11 - .fY'rZ 10/8 12 - 16 .L 4 20 10 min. 2" 4" :: ;!!: 10/8 20 -- -- ;4.2."--..,;;,..,:- ` a ` ='' 5 6 10/8 30 10 min. 2" 4" 14 - '•�;= .4v,M s"'4'+'::,,S:9 ,f.:: :''4:7:;4 `.° 7 10/8 30 -- 6" -- 15 - Y16 - .. 8 10/8 40 10 min. 2" 4" 9 10/8 40 -- 6" -- 17 - 10 10/8 50 10 min. 2' 4" 18 - ii 10/8 50 -- 6" -- 19 - 12 10/8 60 10 min. 2" 4" 20 - 21 - Percolation Rate 2.5 min/in Perc Hole Diameter 6" Test Run Between 4' & 5' Comments: IJe-A+''C-r'( th t✓C-4 Performed By NorthRim Fng, I CERTIFY THAT THIS TEST WAS Performed in Accordance with All State/Municipal Guidelines in Effect ON THIS DATE. DATE: /61/((/ 6.- NOR THRIM 4.-- r4.4%4, ENGINEERING ".... M SteveEng. com TN VALLEY ESTATES TH *:49m . *, BLOCK 2 LOT 16 � Po Box 77074 "•"a4, TESTH❑LE LOG Eagle River, Alaska 99577 '•.• -a� p. 907.694.7028 /•/�Jttl J bate; � (/` GE❑TECHNICAL 10/16/18 I1 -- - _._/-C' ?o ___..._...._.��_...._ —_ / iii ' , i / ! f ; . , / I a . c... «..e - ,+ ! 1 11 • {' I `! %I V • .. • sq . - . ... 13 ^1. .:: 3-61.i \.\.............---It-'X 17,f.'1........-,ff.. \;'1 ri w e:' n N W N \ \ . , r 1 i,..1.r.1t • KY I '. • e 0, iNI . -• "L a IN I I O' C�� o�.iiil,L.i.....:'111.:74.......(.2 o' •', 7) •--.4".4.o �r __ .�....... .� _..�. . c'.r.t t JC . •••C.Jona....:1 -- jli 5':0) AS-BUILT I hereby certify that I have/_ surveyedG� the following described property: 7 /t' A v 1 G -z- jj _// 'j Al W y2. .•-.: <- -i s,. 3 3r 7-4/6 AJC P i r.r.i4_-_ ,:___,_.• Anchorage Recording Precinct,Alaska,and that the improve- ments situated thereon are within the property lines and do riot overlap or encroach on the property lying adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there nre no ‘• roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska ! this .' day of 19_ ROBERT C. JOHNSON r---.Y SCALE: Registered Land Surveyor No. 8flo'LS . v. _.,4.6 ' Box 455, Eagle River, Alaska �y { Phone (907) 594-2543 MUNICIPALITY OF ANCI-IORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone .9.64-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT [P. HONE NAME LEGAL DESCRIPTION ,,'ri'r- d,4_llF LOCATION Well DISTANCE TO: I_ Manufacturer ILiq. capacity ia gallons /~. ¢,~ ~ IF HOMEMADE: I Well I " DISTANCE TO: ] NO. of lines ~ ] Leng~~ Top of tile to finish grade _ i Type of crib ~iamete~ IClas~ , . _,Q ~ Depth ~~: Bmldm~ndat~on l Absorptio~,a~a t Dwelling Material Inside length Width NO. OFBEDROOMS PERMIT NO. No, of coEartments Liquid depth Dwelling PERMIT NO. Liquid capacity in gallons I Material F°undati°ra ~/,I Nearest lot line Total length of lines,~, 2.. //~r'~nch width,~.: inches Material beneath tile inches Depth PERMIT NO, Distance between lines Total eff~e4~.rption area PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line LEGAL Sewer line OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS · . DATE APPROVED Septic tank PERMIT NO. Absorption a~ea(s) '1HE!: >'="I':.Y:... D'!"IF;'.'..'j:: :[ ON :IS THE L.Fi~!'.,!(3'IF! ,:'l'l'.! I;::'.~E:T::, OF THE: ]l'J!:;i: J::q~ii:l='T'H OJ=' FI 'TpI::.:'J'I':I.= I"'t:,;: F':"J:T 're "J"H!!.~: D): f.:'i"l:::ff.,!(:E: E:E:TNE~::]'.,! TI.Il: :i;LIJ:~;FF~(::E: 01:::' 'r'F~F (:ifq:(:lUl'-.![) I:t'. r', 'THE: ~/:FFI"'T'~' "1 (~IF "ru.'i:' ' ...... IL [i:':'~I:::I',,,'FIT::::i'.I ,::'j:H F~:,~::"i"). 'T'H?i';'E: :l:::'i; !",!0 ':'i:i~:'l" Iq ]: !:;"T'H F'Oi:;i: 'T'HI:: (il;?l:::rvq~:'-~l..l::,!i'l:..,r..- 'r'=~ 't"H!~: I"!]:i~.,I'I~I','i...H I'::,E;F'TH r:.::' (:iRFVE:'. BE'!"I,.!F.!:'I'.I ]'HIE ~"~1 "I¥::'F I 1:::'];1:;:'i:::' I:::ll',!l::, THE FiI'"I"""t' ': i'1 01::' THE t:~:::.:X:i:F!',,,'FI'i" ii: 0t'.,I ,:: .T. !'-4 I":!i:::E T ). - ' .... 0 CO. & E ENG,,~IEERING & DEVELOi-,vlENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Rus.ell Oyster 894-2774 Performed for: Legal Description: Depth (feet) 0 1__ 4__ 7__ SOIL LOG Mailing Address: //~.y- 2~ ~b ~ / Earl Ellis 688-2280 Soil Characteristics J PLOT PLAN 11__ 12 --__ 13 ' 14__ 15____ PERC. TEST 16__ Ground Water Encountered: Proposed Installation: Comments: Yes No / If yes, what depth Seepage Pit Drain Field 'Performed by: Oate:'~,~',u ~ ~ ~ /~2 (rer.ifieb drilling !,[og by DOC Co. dba SULLI"N WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND 42j-4'�'-j DEPTH OF WELL ADDRESS 70-1 A STATIC LEVEL OF WATER FT. 1014 lc LEGAL DESCRIPTION S '� ,_ /'n q v7;il�•-y 'j Cb AW DOWN FT. DATE. - Started Ended o1 GALS. PER HR PERMIT NUMBER KIND OF FORMATION: From Ft. to Ft. �' �'✓��'� '`1 From Ft. to Ft. i S�•ti� C��/�t�E� From Ft. to Ft. Ft From From Ft. to Ft. Ft. to From Ft. to Ft.� Ft. From From Ft. to Ft. From Ft. to Ft. / 6 From Ft. to Ft. A V A00 c /C Ft. From Ft. to Ft. From Ft. to From Ft. to Ft. ISE.cFl(. D From Ft. to From Ft. to Ft. Ft. From From Ft. to Ft. Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: KIND OF CASING From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. E MUNICIPALITY ur From Ft. to r DFVt. C TInN ENVIRJ dP.' - d� From Ft. to Ft. I - -V o 1982 From Ft. to Ft. From Ft. to ISE.cFl(. D From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. DRILLER'S NAME MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water &_ Wastewater Section_ _ _ Fax-_ 907-343-7997 - Parcel I.D. 050-631-08 Certificate of On-Site,Systems Approval Expiration Date: 171 Z ] 2o Z� Legal description MOUNTAIN VALLEY ESTATES BLK 2 LT 16 Site address 4901 HILAND RD Eagle River AK Current property owner(s) MICHALSKI X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 9/21/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory X Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory X Other COSA Approval_June 2022 MUNICIPALITY OF fa4� Development Services Department r T On -Site Water & Wastewater Section ANCHORAGE Phone: 907-343-7904 Fax: -907-343-7997- Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-631-08 Complete legal description Mountain Valley Estates Block 2 Lot 16 Location (site address) 4901 Hlland Road, Eagle River, AK 99577 Current property owner(s) Donna & Jamie Michalski Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 9 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 3yrs - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment q /3/23 Date of Payment COSA # 195 C --2-'Z) 1 Waiver # COSA Application—June 2022 COSA Checklist Legal Description: Mountain Valley Estates Block 2 Lot 16 Parcel ID: 050-631-08 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA. , ❑ Well log is filed with Onsite (or attached) Date drilled 8/82 Total depth 200 ft Cased to 60.5 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 9111/23 Static water level at beginning of test 41.7 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 4811 Date of pumping 6/5/23 ❑ Required maintenance completed, if AWWTS Comments: Sanitary Pumpers D. ABSORPTION FIELD DATA Which system tested (date installed) 10/24/18 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.1 ft (max) Measured depth to pipe invert from grade 4.0 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced N/A gallons NIA date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 0.5 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No OR Coliform bacteria is Negative Nitrate 2.68 mg/L ❑ Nitrate less than MRL (ND) Arsenic 13.1 ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date 8/31/23 C. LIFT STATION 1-11isclijred maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/11/23 Results ❑ Pass Fluid depth prior to test 0 Water added 450 gal New fluid depth 1 in Elapsed time 330 min Final fluid depth 0 in in Absorption rate ' 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 0 in Effective depth remaining 72 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' [E Yes if No ft Field to Property Line > 10' Community Sewer Manhole/Cleanout > 100' Yes if No ft Q Yes if No ft Neighboring Tank. > 100' Yes if No ft _ Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft n Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft ❑ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' R Yes if No ft Tank to Property Line > 5' [E Yes if No ft Field to Property Line > 10' Q Yes if No ft Water Main > 10' 0 Yes if No ft Water Service Line > 10' M Yes if No ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' Fs -1 Yes if No ft 0 Yes if No ft If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Forge Engineering Engineer's Printed Name Benjamin Schiller, P.E. COSA Checklist June 2022 Phone (907) 522-7773 Date 9/12/23 low Aw ,• Q Beniachiller CE 12592 • �`4�i �kw, 'low ,f'i�PROFESSIONA.AM' Well Water Advisory Certificate of On -Site Systems Approval # OSC231359 Subdivision: MOUNTAIN VALLEY ESTATES, Block: 2, Lot: 16 This well's productivity was determined to be 0.5 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate and may be insufficient to meet your needs. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. t, Ma�lmg Address P O Box 196650 * Anchprage, Alaska �9519�6650 *www mum org t Arsenic Advisory Certificate of On -Site Systems Approval # OSC231359 Subdivision: MOUNTAIN VALLEY ESTATES, Block: 2, Lot: 16 A water sample revealed an arsenic concentration of 13.1 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. 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 I�'Cft(S MUNICIPALITY OF ANCHORAGE Development Services Department I Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-631-08-000 Expiration Date:i 3— I ( --Z©w 1. GENERAL INFORMATION Complete legal description MOUNTAIN VALLEY ESTATES BLK Location (site address) 4901 Hiland Rd Eagle River 99577 2 LT 16 Current property owner(s) BARNARD BRIAN & LESLIE Day phone 907.229.6490 Mailing address PO Box 771324 Eagle River 99577" Real estate agent Matt Baxter 2. TYPE OF DWELLING: ❑ Single Family(w vol�ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: Day phone 907.227.5412 TYPE OF WASTEWATER DISPOSAL: El Private Septic El ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer i ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Paymentl02 f �l �i9 Date of Payment Receipt Number Receipt Number COSA # (on C16?Iss9 Waiver # Distance: boo 0%a S. 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 inspections 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 Eklutna Engineering, LLC Phone 907.355.9820 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date t _1_10 & 6. DSD SIGNATURE 2 __4 System #1 Approved for 3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms (�rfm LT �•• Date I't It y: 0 No. cE 11 ��l���pROFES5K1Np�'e r bedrooms, with the following stipulations: 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 COSA Checklist blue sheet %., Z OPMENI SoN$1 , z 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 COSA Checklist blue sheet t i ' a Legal Description: MOUNTAIN VALLEY ESTATES BLK 2 LT 16 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA H Well log is filed with Onsite (or attached) Date drilled 1982 Total depth 200 ft Cased to 40 ft ❑ Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) ' 24" in. Date of flow test for COSA 12/9/19 Static water level at beginning of test 43 ft. Comments B. TANK DATA Age of tank(s) 1 years Tank type/material septic steel Measured operating fluid level in septic tank 50" ❑ Standpipes/foundation cleanout per record drawing Date of pumping Sept 2019 D. ABSORPTION FIELD DATA Parcel ID: 050-631-08-000 Structure served by this system _ Well production at time of test 0.63 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ Ne ❑ Coliform bacteria is Negative Nitrate 3.01 mg/L ❑ Nitrate less than MRL (ND) Arsenic 9.657 ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend, PE Date of Sample 1219/19 , C. LIFT STATION ❑ Required maintenance Age of lift station Lift station material Comments: Which system tested (date installed) Oct 2018 Adequacy test date 12/9/19 ❑ ALL standpipes present per record drawing Results 0 Pass For 3 bedrooms Total measured depth from grade 10 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4 ft (min) Water added 0 gal ❑ NCA — pressurized field New depth in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: disposal field installed Oct 2018, < 24 months old. Didn't perform full adequacy test. Measured liquid levet infield at 0". COSA Checklist yellow sheet 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' I2✓ Yes Community Sewer Manhole/Cleanout > 100' [,]✓` Yes if No ft ® Yes if No ft Neighboring Tank > 100' M Yes if No ft Private SewerlSeptic Line > 25'171 Yes if No ft Absorption Field on Lot> 100' 0 Yes if No ft Holding Tank> 100' Q Yes if No ft Neighboring Absorption Fields > 100' f -V1 Yes if No ft Water Main > 10' Animal Containment> 50' P] Yes if No ft M Yes if No fit F/I Yes if No ft Water Service Line > 10' F71 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' 0 Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' I2✓ Yes if No ft Surface Water > 100' M Yes if No ft Property Line > 5' ❑✓ Yes if No fit Wells on Adjacent Lots: Absorption Field > 5' if No Yes if No ft Private Wells > 100' f -V1 Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' F/I Yes if No ft Water Service Line > 10' F71 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' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' [✓ Yes if No It Community Wells > 200' Q Yes if No ft Surface Water > 100' 1771 Yes if No ft F. ENGINEER'S COMMENTS foundation clean out is in crawl space. Accessible from the exterior through a cap in foundation skirting. G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in confor MOA COSA guidelines in effect on this date.{ COSA Checklist yellow sheet IC s ° aaooy.................. see CC�,r�Gs1. Townse ... . No. CE 1964 I.AX ��FloROF�sssa, STANDARD MORTGAGE SURVEY NOTE: THIS SURVEY IS PREPARED IN ACCORDANCE TO A.S.P.L.S. MORTGAGE LOCATION SURVEY STANDARDS. THIS SURVEY REPRESENTS SURFACE CONDITIONS FOUND AT THE TIME OF LOCATION SURVEY AND DOES NOT CONSTITUTE A BOUNDARY SURVEY. THIS SURVEY IS SUBJECT TO ANY INACCURACIES THAT A BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION SHOWN HEREON SHALL NOT BE USED TO ESTABLISH FENCES, STRUCTURES, OR OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, LIABILITY OF THE PREPARER IS LIMITED TO THE FEES COLLECTED FOR SERVICES IN THE PREPARATION OF THIS PRODUCT. N FENCE I LOT 2 N rQ°21,gOlEl ��P� W 0 P0. A`�5�� I X160 Q o ^' . I `r9 PP N ol49 TH'��® UTILITIES i�v, Max A, Schillinger LS-12039 1��Fo X05® i\ /NEW /� LOT 16 0 ���FESSIONP�� SEPTIC D12/19/2019 125.1' z OLD G) SEPTIC N PIPE N piL R=100' N WELL 110.4' `' m LOT 5 I 35.7' SHED DECK CD 16.3' = I HOUSE DECK (" a' ` N Z m pp Qoco m- 0 9 �PgE��Ni o ' WELL SHED 82.0' O 47.6' LOT 4 IN 9 X165 031 �- ---10' UTILITY EASEMENT LOT 15 AS-BUILT DRAWING OF: 0 25 50 SCALE: 1 "=50 FEET LOT 16 BLOCK 2 'h' FILE: 199-134-134 DATE: 2019 HILAND PROPERTY ADDRESS: 4901 HILAND RD., EAGLE RIVER, AK 99577 MOUNTAIN VALLEY ESTATES LEGAL DESC: LOT 16 BLOCK 2 MTN. VALLEY EST: PLAT: 73-152, A.R.D. ALL POINTS NOR'T'H LLC, PO BOX 4207. PALMER, ASC 99645 TEL: 907-746-4185 www.muni.org/onsite Well Water Advisory Certificate of On -Site Systems Approval # OSC191588 Subdivision: Mountain Valley Estates, Block: 2, Lot: 16 This well's productivity was determined to be .63 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVlRONI~,'IENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATFR FACILITY 264=4720 Application Date '~/~__~/ GI=.NERAL INFORMATION (a) Legal D..escription (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name~¢~ ~~ Telephone: Home¢ ~¢" ~ ~ ~ Business~ ¢~¢ (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~ Othor~(explain); (d) Lending ,nstitutio(~~~- ~~~ Telephone _ ..~'-~ (e) Real Estate Company and Agent ~ ~ ~ ~-¢ 7-~- - _ Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family/~ Multi-Family [] Number of Bedrooms ~..~--~ Other WATER SUPPLY Individual Well [~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attestin9 to the legality and statue. SEWAGE DISPOSAL Onsite ¢~ Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-0~5(11 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, I=ILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that rny investigation of this Health Authority Approval 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 flies 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 n effect on the date of this inspection. Name of Firm Address Date Telephone Approved for ~"~ be Approved Terms of Conditional Approval Conditional. ' CAUTION Tile Muncipality of Anchorage Department of Health and Environmental Protection (DFtEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a ceMificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 ol 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARy 1984 MUNICIPALITY OF ANCHORAGE: DEPI'. OF HEALTH & J~NVIRONMENTAL PROTECTIOn' I I,;,,'",';" [2 0 I985 264-4720 Descript,o~ WELL DATA Well Classification -"'"~f¢~-~- ~ ve¢~-[=~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present~/,N~' Date Completed _ 8 - 8"'~' Yield Total Depth c,~-00 ' Cased to Static Water Level "~5'''¢ Casing Height Above Ground Electrical Wiring in Conduit~/J~¢ Depth of Grouting Pump Set At Sanitary Seal on Casing Depression Around Wellhead Separation Distances from Well: To Septic/Holding Tank on Lot /00 ! To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /"//¢'~"/ Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots /OO ~ ¢'' ; On Adjoining Lots To Nearest Public Sewer Nearest Sewer Service Line on Lot ~ ~/~ ; Date ~'-/~ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~ Air-tight Caps~,~ Depression over Tank.4-~t~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) "&"///¢'~ ~ "c~ '~- ~Size ./O¢ O No. of Compartments '"~ Foundation Cleanout 4-Y~ Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line /~ To Water Main/Service Line To Building Foundation To Disposal Field Course To Stream, Pond, Lake. or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field ,~,,,~... Depth of Field .._/ Gravel Bed Thickness ~ Standpipes Present ~'~ Date of Last Adequacy Test / Square Feet of Absorption Area Depression over Field (~Vl~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To E~or Abandoned System on ; On Adjoining Lots ~ To Cutban~ (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~'/~ Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that,!,,h, ave checked verified or conformed to all MOA and HAA guidelines in effect on the date of this inspection. /.,4 '~.~ ~ ,~,,,~ . ' ' ~ . Signed : ~,~ ~i~?"[~L"~ Date ~//7/~ ~- Company PH ....... .- 1~9~7~' MOA No ~ ~ ~ J Receipt No. ~'~ ~S%O Dateof Payment ~'~'%~ Amount: $ ~ Page 2 of 2 72-026 Date Inspector Comments Conditional Approval Date inspector [)ate Sewer Installed Soils Rating Permit No.~ ~d2~A)"< (~. Well To Absorption Area Welt to 'rank. '-~-- / d I~UNICIPALITY OF ANCHORAGE i~NVIR' ;; ~t,', ;i',, > .... ~;, Z',. TION C C [ 2 b; Septic Tank Size / CF© O Holding Tank Size Well Log Received O,~3. APPLICANT FILLS OUT LOWER HALF ONLY PropertyOwner 7~, ~)10 ~' ¢- /' 'fl. ~._;/.r'-'~( // Ph,one MailingAddres, ~': ~'~,/--. ~' Realty Co. &Agent Address ~ 0 Legal Description / Typ~f Residence ~ Single Family ~ Multiple Family [] Other Wat~, Supply /El Individual FJ Community [] Public Utilit.~ S ewa,~l e Disposal /[~ Individual [] Public Utility [] Holding Tank No. of Bedrooms_ Phone ? ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log If available.) Year Individual Installed _ ~:;~ When Connected to Public Utility; ~'"' ..... ~' INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.