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HomeMy WebLinkAboutVALLEY VIEW ESTATES #1 BLK 1 LT 6Valley View Estates #1 Block 1 Lot 6 #050-521-63 N N G 0 I ASBUILT-NO CORNFRS SFT Tutc neT� M ti N M m - — — ..uvrtuw cx tiJJVl,1LilLJ I-LUND JUKVhllN6 bbb-4566 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY OF Al 4 !��<<�� //�� ,✓s �,�: �-s �9d/✓ti;-leo, /��ard,�,l DATE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE *'=: 4�f TN zk OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: �/' EASEMENTS, COVENANTS, OR RESTRICTIONS 1y� c-6 t A WHICH DO NOT APPEAR ON THE RECORDED SUBDI- �•• '. Duane Mark Seward VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' �`� ••. LS -6918 • �w.s i^1 ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN�'���.,'� ARY LINES.,���,� Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES - ENVIRONMENTAL SERVICES DIVISION - P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _.~ ~.) ~O~ ~ PID Number: Name: ~---~,~/./ 7--~,~u~: Waslewater System: D New ~Upgrade Address: ~~ ,?~_~ ABSORPTION FIELD Phone: ~ No. of ~drooms: ~q~/~ ~3 ~ Deep Trench ~ShallowTrench ~Bed ~Mound ~Other Soil Rating: Total Depth fro~original grade: LEGAL DESCRIPTION ~.~b~ P,~GPD/Sq. Ft. Lot: Block: Subdivision: ~ '~ Depth to pipe bottom Irom original grade: Gravel depth beneath pipe  Section: Fill added above original grade: Gravel length: WELL: D New ~7 ~ Upgr~/~ ~IP~H ~'~ Ft. ~ I ~/~ Ft. Classification (Private, A,B,C): ~t~' Cased To: Tp a absorption area: Pipe material; Driller: ~ Date Drilled: Slatic Wale, Lev;;:. Instg~ S ~ ~S~O~ Date ins~7~/~ j. vi.~,: ' ,urn, S.~.~: TANK ' SEPARATION DISTANCES D Septic n Holding ~S.T.E.P. TO Septic Absorption Lift Holding ~;;;c/Privat~ Manufacturer: Capacityin gaPons: From Tank Field StMion Tank Sewer Lines ~ Well }~/ /~/ ~5_~ ~/~ ~/~/ Material:~ Number of Compadments: Surface wate~ ~x~ ;~/A ~J~ ~/~ ~ LIFT STATION Lot , I Drain N//~ ~/~ ~//~ PumpMake&Model. r~'~ Electricallnsetionspe.ormedby: Remarks: ~,~,~ ~~ ~ BENCH MARK Inspections performed by: ~ ~ ~ Dates: 1st Reviewed and approved bg~~~~ ~ate: Permit No.SW 930248 Page 2 o! ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O, Box 1.96650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Waslewater Disposal System and/or Well Inspection Report Legal Description: Valley View Estates, Lot 6 Blk 1 PID No.: 050-521-63 STATIDN DETAIL 1-1/4' HDPE PIPE 2' PV~ HANIFDLD !1-1/4' PVC iPRESSURE iLATERALS PVC CLEANDUT (TYP) x 6E' FIELD · ; - MONITOR TUBE + - EASEMENT i SEWER CLEANOUT WELL EXISTING LEACHFIELD PROPOSED LEACHFIELD 72-OI3 A (Wgl) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PAGE 1 OF 1 PERMIT NUMBER:SW930248 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:TEAGUE JEAN L OWNER ADDRESS:1977 BLUE WATER OCEANSIDE, CA 92054 DATE ISSUED: 7/27/93 EXPIRATION DATE: 7/27/94 PARCEL ID:05052163 LEGAL DESCRIPTION: VALLEY VIEW ESTATES #1 BLK LT 6 1 LOT SIZE: 86757 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (t8AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: SEPTIC TANK SHALL BE A MINIMUM OF 1500 GAL. S T A TI 0 N.~~~'1 ~r7'~ ISSUED BY: PLUS A LIFT Louis Butera, P.E. Registered Civil Engineer July 20, 1993 John Smith, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 RECEIVED JUL 2 1 1993 Re: Valley View #1 Lot 6, Block 1 Narrative Mumclpality of Anchorage Dept. Health & Human Services Dear Mr. Smith: We have been requested by our client, Mr. Michael Gershel, to increase the bedroom rating to five bedrooms for this property. This represents a realistic value, considering home occupant loading. As a result, we have included a reserve area calculation in our site plan revision. The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area has large lots allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. Reserve space is adequate, due to large lot size. This is the second field for this lot. 4. Drainage will not be effected and is not a major consideration in our design. Our application requires a waiver of maximum slope aspect to 33%. There is no area on this lot available for upgrade that is below 25 % grade. The slope is vegetated and we are utilizing a wide drainfield,contoured to the slope. The pressure distribution will effectively distribute effluent over a~t~' trench length. We so not anticipate any problems for the variance in slope. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1993\93-030B.NAR P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 · Fax (907) 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM Revised 07/20/93 LEGAL: VALLEY VIEW #1 LOT 6, BLK I GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. SEPTIC TANK 1. ~,~eptic tank is to be removed and replaced in the same location with a ~ 2,000~}llon Orenco Systems lift station/tank with 20-OSI-05 HHF pump. / "~-~-slTfig tank to be properly disposed of. 2. Receipt from licensed electrician to be provided to engineer for wiring of lift station. D_=RA!NFIELD 1. The drain field is to follow the natural land contour to maintain uniform total depth of the drainfield bottom. 2. The bottom of the drainfield shall be level, .plus or minus 1.5". 3. The total depth of the drainfield excavation ~s not to exceed 6.0' at any point. 4. 1/8" holes in pressure lateral to be offset 30° off center from bottom on alternate sides of.p!pe at 19 inch spacing. Holes to be cleaned and deburred. 5. The drainfield gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 4' or equivalent is to be placed over the leach, field. 7. The area over the drainfield is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 6.0' GRAVEL DEPTH = 3.5' DRAINFIELD LENGTH = 102' DRAINFIELD WIDTH = 5' SOIL RATING = 028~D/ft2 BEDROOM CAPACITY = 5 ~TIC TA~th lift station ~ Twenty-four (24) hours notice required for all inspections. \1993\93-030B.SPC E' PVC MANIFOLD VACANT } 5' x 6E' FIELD ~t 7~ . ~ x,6,3 ~ - TEST HOLE ~ ~- PROPOSED NO SURFACE WATER +100' -~-- EASEMENT NO KNOWN CURTAIN DRAINS ~ - SPOT EL~ATION SEPTIC SITE PLAN LEGAL: lOT 6 BLK 1 VALLEY VIEW ffl OWNER: TEACUE CONTRACTOR: N/A ' ~" ...... JOB ~ 93-030~ DATE: 07/20/93~ SCALE 1" = 60' --~~::;,~,,.. -~-" EAGLE RIVER ENGINEER/NC SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (90?) 694-329? EAGLE RIVER ENGINEERING SERVICES P.O. Box ?73294 EAGLE RIVER, AK 99577 (907) 694-5195 JOB SHEET NO. CALCULATED BY CHECKEDSY SCALE Valley View #1 Lot 6, Block OF. D^TE 07/20/93 DATE. Louis Butera, P.E. Registered Civil Engineer July 14, 1993 John Smith, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Valley View #1 Lot 6, Block 1 Narrative Dear Mr. Smith: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area has large lots allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to large lot size. This is the second field for this lot. 4. Drainage will not be effected and is not a major consideration in our design. Our application requires a waiver of maximum slope aspect to 33%. There is no area on this lot available for upgrade that is below 25 % grade. The slope is vegetated and we are utilizing a wide drainfield contoured to the slope. The pressure distribution will effectively distribute effluent over a 61' trench length. Wedo not anticipate any problems for the variance in slope. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1993\93-030A.NAR P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 · Fax (907} 694-3297 I ~c~m LIFT STATION > ~ ~ ]/ / ~ 1/4' , ~ ~J/ / HDPE PIPE ~ , ' 9~.~ ~ - TEST HOLE <~ ~ · - MONITOR TUBE '~ ~ " o - SEWER CLEANOUT ~ + - WELL NO SURFACE WATER +100'~ HmH~-- EXISTING LEACHFIELD NO WELLS OR SEPTICS ~200' ~ ,- PROPOSED LEACHFIELD NO KNOWN CURTAIN DRAINS ~ - EASEMEN~ ~ SPOT ELEVATION EPTIC $OTE PLAN OWNER: TEAGUE ,~, ~- · · Ci~" ,~ .: , . CONTRACTOR: NrA ~' ~ JOB ~ 93 0301 DATE: o7/'15/%I SCALE t" = 60' ~=, EAGLE RIVER ENGINEERING SERVICES P.O. Bom 773284 EAGLE RZVZR, AK. 99577 (907) ~94 5195 FAX: (907) ~94-3297 EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER. AK 99577 (907) 694-5195 JoB Valley View ~1 Lot 6, Blk 1 93-030A.CAL SHEETNO. OF CALCULATED BY LB DATE CHECKEDBY DATE SCALE 07/14/93 Single Family Three Bedroom Res,denc 3BR = 450gpd SoilabSorptionrate = 0.8gpd/ft2:: I : I ': i."i !: !"!. 'i i' ~: ~: : Trench absorption:area ~ 450 :-~--; 0:8 '~ 562 Sqmire feeti .i ~.' Drainfield dimensions: : , ! ' i i' ~ ;: ~ ~'" ! :: ":: Width- .~ 5I. Graveldep~h ~= 3.5' . ' : ( : :: ', Length' = 562 * 5 x 0.54 = 61 Pressure lateral holes: 1/8" hole spacing 28 gpm + 0,43 gpm/hole = 65 holes 61' +' 65 = 0.9' ' = '11" hole spacing On center ' \1993\93-030A.CAL SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: VALLEY VIEW #1 LOT 6, BLK 1 Ao GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. SEPTIC TANK 1. Existing septic tank is to be removed and replaced in the same location with a 1,250 gallon Orenco Systems lift station/tank. Existing tank to be properly disposed of. 2. Receipt from licensed electrician to be provided to engineer for wiring of lift station. DRAINFIELD 1. The drainfield is to follow the natural land contour to maintain uniform total depth of the drainfield bottom. 2. The bottom of the drainfield shall be level, plus or tninus 1.5". 3. The total depth of the drainfield excavation is not to exceed 6.0' at any point. 4. 1/8" holes in pressure lateral to be offset 30° off center from bottom on alternate sides of pipe at 11 inch spacing. Holes to be cleaned and deburred. 5. The drainfield gravel is to be covered with typar fabric material. 6. Soil or cmnbination of soil and extruded board insulation to a depth of 4' or equivalent is to be placed over the leachfield. 7. The area over the drainfield is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 6.0' GRAVEL DEPTH = 3.5' DRAINFIELD LENGTH = 61' DRAINFIELD WIDTH = 5' SOIL RATING = 0.8 GPD/ft2 BEDROOM CAPACITY = 3 SEPTIC TANK = 1,250 with lift station Twenty-four (24) hours uotice required for all inspections. \1993\93-030A.SPC Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL PERFORMED FOR; DATE PERFORMED: LEGAL DESCRIPTION: ~,~.~/ ~//~/.4) ~/ ~// Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER IF YES, AT WHAT DEPTH? :',~,~Monitorino? t O '-r Dale: Gross Net Depth to Net Reading Date Time Time Water Drop I 1~;5b,'.¢~ /~ .~..-. ~"-t~l/b'' 5 / ;1~'; ~/5 ,, z/'- (~ /; 7?,, ~§ ,, ¢,-/~l/U' ~,{ /~ 1 2 3 4 5 6 7 8 9 10 11 12- 13 14 15 16 17 18 19 2O PERCOLATION RATE ~"~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~,)~ FT AND z~,..5~ FT PERFORMED BY: --~ /~ ~ '-~ I ~/~'-- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE. DATE: 72-008 {Rev. 4/85) Municipality el Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) PERFORMED FOR: ~'~,F'~x~ ~ 0~ LEGAL DESCRIPTION: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 OATE PE.FO.MED, Township, Range, Seclion: ~/_/?t/ ~'//.~ ,.~d_.. ~-~_~ SLOPE SITE PLAN /~Jc-/~. ~'/ D~)1'// / WAS GROUND WATER ENCOUNTERED' IF YES, AT WHAT DEPTH' Dep(h lo Waler Al(er ,, N Gross Net Depth to Net Reading Date Time Time Water Drop / I ,'1o ;~'~ ~':? "/~. ~. /.',~:q~; ~:? ?/iL,, I /~11~ ~ 9~:0P ~/~/1~ / /,11~ PERCOLATION RATE ~ (minutes/inch} PERC HOLE DIAMETER TEST RUN BETWEEN -2~. FT AND ~ FT COMMENTS PERFORMED BY: l~' ~ ~--~-.~ I ~~"~"-- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL .STATE AND MUNICIPAL GUIDELINES '" EFFECT ON THiS CATE. DATE: 0 9/i~/J9.] 72-008 (Rev. 4/85} Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST tENGINEER'S SEAL) PERFORMED FOR: ~-~ ~-~ ~ ~-" LEGAL DESCRIPTION: G// OATE.ERFOHMEO= Township, Range, Section: ~///t/ ,~'/~,~ ~.%~__. ~-.--...~ SLOPE SITE PLAN Y~ 12 14 ~ '"" ~ 15 16- ~: .... 18- 19- 20- IF YES, AT WHAT DEPTH? Depth Io Water Alter / ,v Monitoring? /0 ~ Gross Net Depth to Net Heading Date Time Time Water Drop ~o,~ 0~/~ ~/~j I ' I;1_~;~o ~'-b 4 I,'35:15 ~? ~/1~ I, P PERCOLATION RATE /~ {minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~:' FT COMMENTS PERFORMED BY: /'~ ~,C:, . I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION Well ] Absorption area Well DISTANCE TO: i~.~ E::~I Length No. of lines~ of each ~ine Top of tile,to finish grade Length Type of crib DISTANCE TO: DISTANCE TO: Width Crib diameter Well Depth Building foundation Total I~,n~j~hlof lines Material beneath tile t~thdepth Building foundation Driger Sewer line OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS PHONE ,~-N EW ~ _ ~,~,~ [] UPGRADE Dwelling NO, OF BEDROOMS~,.~.. PERMIT NO. Liquid depth PERMIT NO. Material Liquid capacity in gallons Nearest lot line Trench width ~ inches PERMIT NO, Distance bet~/~es Total effective absorl~ ' n area PERMIT NO. Total effective absorption area Nearest lot line Septic tank ' Distance to lot line DATE LEGAL DI::.FAI", ['MLNT OF HEALTH AND IENV:[I?ONMF£NTAI~. F I-,O'fEI., F10N 8.~..~.~ L STREET, ANt, MORAbE~ Ak: 9950:t. 2-]64-4720 F:'ERMIT NG: ,:3,J(.,,~ t. ] DAI'E ISSUED: C8/:[6/85 APPLICAIqT: 80[~ W[][]D C/fi S & S ENG'G ADDRE%S: SF(B 196X ~AGLE RIVER, Al< 99577 CONTAC1 :'HONE: 694-2979 LEGAL DESCRIP: ,~UBDIVI,~3ION: VALLEY VIEW EST. ¢1 LOT: 6 SF':CTION.' 23 ]"OWNSHIP: 14N RANGE: IW LOT SIZE: 86757 (SQ.FT. OR' ACRES) MAX BEDRGGMS = 3 BLOCK L i st ed system. below are the opt~.ons available to you in des:[gnznc,_ your septic Choose the option that. best fits your site. DEPTH TO PIPE BOTTOM (FT.) 4.0 GRAVE[.. DEPTH (FT.) 6.0 3.5 "I'GTAL DEPTH (F"I'.) 1(). 0 7'. 5 GRAVEL WID'f'H (F'T.) 2.5 5.0 GRAVEL LENGTH (F:"T.) 38.0 49~ O, GRAVEL. VOLUME (CU. YDS,) 22,9 36.3 ]'ANK SIZE (GALS) ;,000.0 SOIL RA]"ING (GQ.F]'. /BR) 15G~ 150,. -' .~ 'FANI< MUGT HAVE AT _EAS"I TWO COMPARTMENT,~ [cer. tify that: 1. I am l'amiliaP with the requirements fop c~n-site sewers and wells as set t'or't.l'~ -)y the Municipality of Anchorage (MOA) and the State o~' Alaska, 2, I will install the system in accordance with all MO~ codes and regular, ions, and :in compliance with the design c~itePza o[' this permit. 3. I will. adhere to all MOA and State o{ Alaska PequiPements ¢oP the'set back distances ¢~*om any existing well, wastewater' disposal system er' public sewerage system en this oP any adjacent oP neaPby, lot. 4. I under'stand that this pepmit is valid ¢o~ a maximum' of 3 bednooms and any en].apgement will ~*equipe an additional pePmit. IF A LIF']' STA'TIG~ IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND IN~I='ECTION MUST BE OBTAINED; (F2) AS-BLIILTS WILL. NOT BE APF'ROVED WITHOUT AN EL. ECTRICAL INSPE:CTION RE~'ORT; AND (3) THE EL. ECTIRICAL_~K MUST BE DONE BY ~ LICENSED ELECTRICIAN. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: 1~ ~:~:> ~ LEGAL DESCRIPTION: L~::~- 1 2 3 4 § 7 8 DATE PERFORMED: '~ ~ ~'"~ 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ~1:~ ~ ENCOUNTERED? ~ E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop I COMMENTS SRD 198,~( PH. 694"297~J PERCOLATION RATE J~ //~ (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIE~ 72-008 (6/79) '~ATER_ 9/EL~L~ RECORD . .STATE OF'ALASKA .DEPARTMENT OF NATURAL RE$OURE$ Division of Geolog[c'CI '~ Oeophysicol Surveys White rock 0 80 Shale ~* ~0 i40 ~ ~.~,; ~,,,.~ White rock . . 140 .I 150 Soft hi,ok rock 210 212 ~.,,~,, ~O,h,,: Hard white rock 212 230 ,.c~smG= ~,h...~.d X~w.,d,~ ' ~ Abo;I or ~Oolow lend surface Date 'Id."EMARRS: Produc%i~o of 3 'GPM AA 5385 WATER WELL ADVISORY During a recent Health Authority Approval on-site inspection and test 9f thepota~le water supply well on Lot ~ Block / of //~Z~b~ ~/ ~/ Subdivision, the Well's productivity was determined to be O~ gallons per minute. The minimum well productivity required by this department (AMC 15.55) is 150 gallons per day per bedroom. On this basis, the minimum well flow requirement for a ~' bedroom residence is O--~ gallons per minute. Although the subject well-currently meets the minimum well production requirements, all parties concerned are advised that the production capacity of the well may fluctuate and that water conservation measures may be required during periods of low production capacity. Measures which can be taken to minimize the production well are: 1. .Installation of a storage serve as a reserve source usage. impact of a low tank (300 to 500 gallon) to during times.of maximum water Restriction of noncritical water uses such as, washing cars, lawn and garden watering, etc. Installation of water saving devices on faucets, showers and toilets. 4. Conservative use of laundry facilities and dishwashers. This advisory must be attached to all c. opies of the subject Health Authority Approval. Z_ RZA�js 1 NUP l` U¢11 Y OF ANCHORAGE „r Development Services Department r„. p p ment Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-521-63 1. GENERAL INFORMATION Expiration Date: ® -zo Z_ o Complete legal description VALLEY VIEW ESTATES #1 BLK 1 LT 6 Location (Site address) 25875 Wildflower Cir Eagle River Current property owner(s) Mailing address Real estate agent Gershel Day phone 907.274.9099 PO Box 771772 Eagle River AK 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic E Water Storage Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment q l• `q1 j7 Date of Payment Receipt Number QZ) Receipt Number - C S #— 6.1 r Iq-! —E1oZ- -- 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 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 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE 6. DSD SIGNATURE System #1 Approved for q bedrooms By: System #2 Approved for bedrooms Disapproved Phone 907.355.9820 Date 01 Conditional approval for bedrooms, with the following stipulations: llt(t(((( P�XY OF `�� QN-41i'E WATER AND 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Othe��Gw�Alf t? Legal Description: VALLEY VIEW ESTATES #1 BLK 1 LT 6 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA F Well log is filed with Onsite (or attached) Date drilled 1985 Total depth 230 ft Cased to 30 ft Al Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 8113/19 Static water level at beginning of test 153 ft. Comments B. TANK DATA Age of tank(s) 26 years Tank type/material STEP Steel Measured operating fluid level in septic tank 4 ❑ Standpipes/foundation cleanout per record drawing Date of -pumping Sept 2, 2019 D. ABSORPTION FIELD DATA Parcel ID: 050-521-63 of Structure served by this system Well production at time of test 1.08 gpm Water storage tank volume 165 gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate mg/L no Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 8/13/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station 26 years Lift station material steel Comments: pump cycled on and off Which system tested (date installed) 1993 Adequacy test date 8/13119 Al ALL standpipes present per record drawing Results F7] Pass For 4 bedrooms Total measured depth from grade 6.4 ft (max) Fluid depth prior to test 15 in Measured depth to pipe invert from grade ft (min) Water added 600 gal ❑ N/A — pressurized field New depth 20 in Al Monitor tubes go to bottom of effective. If not, state 1440 depth into effective Elapsed time min 01 Code -required soil cover over field Final fluid depth 15 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: 2' insulation over field + minimum of 32' of cover. Monitor tube in lower field, closest to house was used for readings. 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' FV] Yes Community Sewer Manhole/Cleanout > 100' 7✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' F--/� Yes if No ft Private Sewer/Septic Line > 25' F✓ Yes if No fit Absorption Field on Lot > 100'✓[] Yes if No ft Holding Tank > 100' F/� Yes if No ft Neighboring Absorption Fields > 100' ® Yes if No ft Water Main > 10' Animal Containment > 50' ® Yes if No ft ❑✓ Yes if No ft Yes if No ft Water Service Line > 10' Yes if No Manure/Animal Excreta Storage > 100' if septic tank is under driveway Community Sewer Main > 75' [D Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' FV] Yes if No ft Surface Water > 100' M Yes if No ft Property Line > 5' M Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ft Yes if No ft Community Wells > 200'✓Q Yes if No ft Water Service Line > 10' Yes if No ft if septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells? 100' Yes if No ft Water Service Line > 10' El Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that 1 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. OF !4L,4 e COSA Checklist yellow sheet •• 9 -CCE is IGINEEKS DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org%onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 191442 Subdivision: Valley View #1 Block 1 Lot 6 Starting at 20 years of age the MOA issues Advisory's for steel septic or STEP tanks. The STEP tank for this property is 26 years old. Typical replacement costs range from $8,000 to $14,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 * www muni org MUNICIPAUTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner C c­ 4c7C t Street Address 2- 1 r- P Septic Tank: •Sludge level inches -Pumping: requiredyes no -Pumping complete cK yeno INU&IR" M4, -Pump basket cleanedJno -Effluent filter cleaned G no -Control floats cleaned no -Proper float settings confirmed fies ) no -Operation satisfactorye no Alarm System: -Dedicated electrical alarm q'umw Vf�y�es no -Audible and visual alarm inside dwellin( yves no -Alarm system operatic(satisfactor not satisfactoEy Manhole Riser -Ground water intrusion at riser to tank connection yeK ng) -Ground water intrusion around pipe penetrations ves( no/ -Weep hole function e no -Manhole lid: Functional( ves ) no Insulate es no Properly Secure es no Other -All manufacturer required inspections and maintenance complete no Comments: LEGE MEASURED DATA 12.5' RECORD DATA N 90'00'00" W RECOVERED 5/8" REBAR O PREUSS A VE. (60' ROW) �r r 00 N89°57'14"E 265.00' LOT 6 86,757 Sq.Ft. 100' WELL RADIUS LOT 5 � 3 \ / 6.2'x14.2' o SHED ---'� O Z rr7 1 M N e -j M 32.6'x22.4' THREE STORY HOUSE W/ WALKOUT BASEMENT ..................................................................... C/0 134.3' \ W L LOT 7 WELL 4' 2ND STORY CANT. — — (SEE NOTE 3) N O GP S/Ps 0 C,1�5427' ' PP qLS/Ps 0 11 S71.27� �� 0 41 � � � 10. 4//�'0'0c�4O��iQ NOTES 1. ALL BEARINGS, DISTANCES AND AREAS SHOWN ARE RECORD, UNLESS NOTED OTHERWISE. 2. THIS SURVEY IS PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE SURVEY STANDARDS. 3. WELL OCCUPIES AS MUCH AS 2.6 FEET OF THE 10 FOOT UTILITY EASEMENT. EXCLUSION NOTE: IT IS THE RESPONSIBILTY OF THE OWNERS TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDRY OR FENCE LINES. ASBUILT SURVEY CERTIFICATE: I HEREBY CERTIFY THAT I, OR SOMEONE UNDER MY DIRECT SUPERVISION, HAVE PERFORMED A ASBUILT SURVEY ON THE FOLLOWING DESCRIBED PROPERTY: LOT 6, BLOCK 1, VALLEY VEW ESTATES ADDITION NO. 1 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. 2019 �®®eaasam®®RLOT: 6 BLOCK: 1 y ®® GEOMATICS LLC�`� sudulvisioN: VALLEY VIEW ESTATES 49t = • Po,F s rte iLK w ssssa ::.............. ...........:..r......° ADDITION NO. 1 DATE: ==o:F, No: SECTION 23 TOWNSHIP 14N RANGE iW i l l 1 ou 1905 45 Ter L. Nicodemus , o SEWARD MERIDIAN ?gf SCALE: DRAWN: CHECKED: PLAT NO- 74-19.1 ; MAP _No. _SW_026 1 No.9106-S ;:' �` 3" 60' TENDRA TLN RECORDING DISTRICT ANCHORAGE ..•...•....... QPREPARED FOR: ®4 fSSIONP� ASBUILT SURVEY MICHAEL A. GERSHEL POST IN A CONSPICUOUS PLACE ALL WORK MUST BE INSPECTED 4 { Field Inspection Request required 2 working days in advance of starting work and 2 working G i' days in advance for final inspecilon. Call (007) 343.8206 (voice recorder) for scheduling. Permit is not valid rdihout the call-in and also must include the one -call ticket (utility locale). v. number.IN MUNICIPALITY OF ANCHORAGE - RIGHT OF WAY DIVISION e i)1.1't lIt L Ikt 4700 ELMORE ROAD TELEPHONE (907)'343.8240 FAX.(007),343-8250 RIGHT OF WAY PERMIT R201124 Type: Encrrhmnt Status: Issued Grid: SW026S Dato Applied: 02/19/2020 Date issued: 02/19/2020 Issued By: claudia.pinard Construction Stam Date: Last Updated: 02/20/2020 Last Updated By: claudia.pinard Permidee: LANE FILBERT B & BREGITTES Work Order: Utility: Contact Person: Brent Lane (628) 260-7562 Primary Inspector: Address/Loc: 256%a WILDFLOWER CIR, Eagle River- @ BerryhiiPRoad Legal Description: VALLEY VIEW ESTATES :1 BLK 1 LT 6 G:0263 Original Work Description: 6" Steel well pipe encroaches 2.6' into the 10' Utility Easement &�4:5.4.r1RSI4n Stu®nlltlC Amount Permit. t Si20.00 Total Fees: $120.00 Sao reverse for requirements/romarks I have read and understand both sides of this permit. I agree to the terms and conditions; and I certify that all work will comply with federal, state, avid municipal codes and regulations and the provisions of this permit. Signature: ,i �', 6 Rate: MUNICIPALITY OF ANCHORAGE G ° Development Services Department q, Right of Way SectionLA Department THIS AGREEMENT, made this 20th day of February, 2020, by and between ALBERT B. LANE and BREGITTE S. LANE and their heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State of Alaska, hereinafter called the "PERMITTER". WITNESSETH: WHEREAS, PERMITTEE is the owner of the following described real property: VALLEY VIEW ESTATES #1, BLOCK 1, LOT 6, according to the official records thereof, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTER owns and/or maintains the real property more particularly described as follows: The TEN FOOT RIGHT OF WAY, immediately along the south boundary of PERMITTEES property as shown on Plat No. 74-191, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTEE has placed a well pipe upon the referenced real property which encroaches 2.6 -feet into the PERMITTER'S 10.0 -feet Utility Easement. NOW, THEREFORE, it is mutually agreed between the parties hereto that: 1. The PERMITTER, acting through the Director of Development Services Department, hereby grants to the PERMITTEE the privilege of allowing well pipe to encroach 2.6 -feet into the PERMITTER'S 10.0 -feet Utility Easement, as shown on "Attachment A," included herewith. 2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless, the Municipality, its officers and employees, from any and all lawsuits, claims or actions brought to any person for or on account of damage to property or injury, disease, illness or death of persons, including all costs and expenses incident thereto, arising wholly or in part from or in connection with the existence of, alterations, maintenance, repair, renewal, reconstruction; operation, use or removal of the encroaching well pipe, as placed upon the PERMITTER'S 10.0 - feet Utility Easement. 3. The PERMITTEE shall not assign or transfer any of the rights granted herein to another individual or company without first notifying and securing the approval of the Director of Development Services Department. 4. This Agreement and Permit grants PFRMITTFE no interest in PEnUTTER'S real property whatsoever, except only the encroachment rights described herein. 5. The PERMITTER reserves the right to revoke this permit upon twenty (20.) days written notice to the PERMITTEE. The PERMITTEE agrees upon such notice of revocation, to move said cncroachment(s) from the 10.0 Utility Easement in which it is placed. Should the PERMITTEE refuse or fail to comply with said written notice, the PERMITTER may, without further notice to the PERMITTEE, remove or cause to be removed the encroachment(s), and the PERMITTEE hereby agrees to reimburse the PERMITTER for all costs incidental to the removal thereof. In addition to the mutual promises heretofore made, the PERAMITTEF has paid the P.ERMI.TTER a one-time permit application fee of 5120.00. The PERMITTER hereby waives the annual fee of $315.00. IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day and year first hereinabove written_ GRANTEE: GRANTOR: MUNICIPALITY OF ANCHORAGE JLane ack L. Frost, Jr. Right of Way Supervisor �regitt S. Lane Owner January 13, 2019 Brent Lane 25875 Wildflower Circle Eagle River, AK 99577 Re: Well Encroachment To whom it may concern: ENSTAR Natural Gas Company A DIVISION OF SEMCO ENERGY Engineering Department Right of Way Section 401 E. International Airport Road P. O. Box 190288 Anchorage, Alaska 99519-0288 (907) 277-5551 FAX (907) 334-7798 ENSTAR Natural Gas Company has no objection to the well encroachment within the ten foot (10 FT) wide utility easement adjacent to the south lot line of Lot 6, Block 1, Valley View Estates, Addition No. 1, according to Plat No. 74-191, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. Acceptance and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: • Landowner/Contractor working near ENSTAR gas facilities shall contact the Alaska Digline, Inc., (907) 278-3121 or 811 for line locating two (2) business days prior to any related excavation. This service is free of charge. • ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. • Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. • Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the land owner. • All applicable safety code regulations will be observed and maintained. • This letter of non -objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, Cassie Acres Right of Way & Compliance Technician ENSTAR Natural Gas Company NON -OBJECTION TO EASEMENT ENCROACHMENT DOCUMENT By this document Matanuska Telephone Association, Inc. (MTA) declares that it has no objection to the encroachment of the well in the platted 10' drainage easement of Lot b, Block 1 of Valley View Estates Addition No. 1, Plat Number 74-191, filed in the Anchorage Recording District, State of Alaska. Please be advised that MTA through the issuance of this document does not forfeit any of its rights to the use of the area cited. In the exercise of these rights MTA will, if needed, upgrade, maintain, repair, and/or replace buried or aerial telecommunications facilities within the easement. Any repairs that may be required to the encroachment as a result of utility construction will be bome by the property owner of record. This document does not authorize the placement of any additional encroachments within the easement area. Property owners are required to obtain utility locates before doing any kind of work in the utility easements and will be liable for any damages caused by their construction work in the easements. This document is in no yLay an agreement to vacate any portion of the utility easement and should not be interpreted as such. Issued far tanuska Telephone Association, Inc. this 9�' day of January 2020, by, Robbie Nash, Director, Engineering & Construction THIS IS TO CERTIFY, that on this 9t' day of January, 2020, before me the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared Robbie Nash known to me and to me known to be the individual named in and who executed the foregoing instrument and acknowledged to me that he signed and sealed the same as a voluntary act and deed for the uses and purposes therein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day and year first above written. -`fiz 3� OFMAL S� "ft $PWMW No blic in and for Alaska My commission expires: 'I I I i !'Q a P.O. Box 3550 j Palmer, Alaska 99645 mtasolutions.com 907.761.2510 MATANUSKA ELECTRIC ASSOCIATION, INC. LETTER OF NON -OBJECTION January 9, 2020 Albert and Bregitte Lane 25875 Wildflower Circle Eagle River, AK 99577 Re: Lot 6 Block 1 Valley View Estates #1 Subdivision (Plat 74-191, Anchorage Recording District) Dear Albert and Bregitte Lane: MEA has no objection to the encroachment of a well located 2.6 feet in the utility easement as depicted on the attached as -built survey drawing dated 11118119, subject to the following conditions: 1. The improvement will in no way restrict or limit the current or future ability of MEA to fully enjoy the benefits of the easement for any and all utility purposes that it presently enjoys under the easement. 2. MEA will be held harmless by the landowner from liability for any and all damages or injury to any person or property that may result from the existing and future use of the easement by MEA, its contractors, or assigns. 3. MEA will be held harmless by the landowner for any and all liability arising out of or relating to any use of the easement by others under a Letter of Non -Objection. 4. The landowner will be liable for any damages caused to MEA facilities by the improvement in the easement. 5. The landowner will be responsible for any special construction costs incurred by MEA due to the improvement in the easement. 6. The landowner will assure compliance with all applicable safety codes relating to the improvement in the easement. 7. Use of this letter by the landowner, their successors or assigns will constitute acceptance of these conditions. 8. Alteration of these conditions shall invalidate this letter. 9. This letter is not effective unless it is recorded in the Anchorage Recording District before ownership of the referenced property is changed from the above named landowner. omc;erry, u Manny L p , S Land Service Maria er— STATE OF ALASKA)SS-�� i-9-2ci THIS IS TO CERTIFY that on this 9 day of January, 2020 before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared /� eu'`'ee"&W 1 Manny Lopez Known to me and to me known to be the individual(s) named in and who executed the foregoing instrument and acknowledged to me that he/she/they signed and sealed the same as a voluntary act and deed for the uses and purposes therein mentioned. IN WITNES WHEREOF, I have hereunto set my hand and official seal the day and year first above written SE Not Public in and of Alaska My commission expires -y Return to: MEA, PO Box 2929, Palmer AK 99645 - .kms January 9, 2020 Brent Lane 25875 Wildflower Circle Eagle River, AK 99577 To whom it may concern, Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the existing well encroaching into the utility easement of Lot 6 Block 1, Valley View Estates Addition No. 1, also known as 25875 Wildflower Circle, city grid SW0263, GCI work order 20-0006. This letter of non -objection in no way precludes GCI Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right-of-way, including unlimited access for servicing its facilities. Also, any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of GCI's facilities to accommodate any or all the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to me at the address below. Sincerely, del�oC�­ Signature Date ALEX SLAVENS GCI I OSP DESIGN ENGINEER II Outside Plant Design & Data Management GCI Communication Corp 5151 Fairbanks St. Anchorage, AK 99503 907-929-1034Office 907-868-8580 Fax Municipality of Anchorage • Development Services` Department Building Safety Division On -Site Water and 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 Parcell.D. 050-521-63 HAA# Out NO F Expiration Date: p 1. GENERAL INFORMATION Complete, legal description Lot 6; Block 1; Valley View Estates Addition #1 Location (site address or directions) 25875 Wildflower Cir. Clg5q,:l- Current Property owner(s).' David Cooper Day phone 301-8093 Mailingaddress 19228 Adak Cir. Eagle River, AK 99577 Lending agency Mailing address Real Estate Agent Mailing Address Day phone Dave Otto Day phone 622-0982 Unless otherwise requested, HAA will be held by DSD for pickup. V/13/v, 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date $ �S° f% qe ` ROBERT C. COWAN f �2p 5. DSD SIGNATURE f�c%r :E -i801 A\� ttl Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: WASTEWATER Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By,/ �(�, Original Certificate Date:_S O (Rev. 01/02) ivJLUUIC PUIIry 02 Ancoorage p6C BVi Development Services Department z Building Safety'Diwsion s a f On -Sete WateY &�7llastewater Program a"gaw"S"t _ . , �. ox enc -age, anchorage a us �°`.C-�� 4 P�'X ' ."k � *. w,YSa�i.,q`'xw✓����.5 6*alsrtn"wt� ,� EAgLTH AUTHORi YAPPROVAL CHEC'KL187-` cription i i/0.II /Parcel ID 050 57-) a3 �����+�d� ,� ���✓ j �y� :;.:a€,..., .r;v-�'%,w.'`"'xa''v��'«.5+:++++4w'3'""":`Y'..�.waw.vS,,,.«.....�-.+.vw,,,,.c.....>a,..«�>.:... w�,..,......., Voll e. If A B or C p3rovide P NSib # a Cog` � '3.A `: )ie e 11-1-25 Sanitary sealX81 /N) Wires properly protected(O/N) t,S 1PRE� AA-�'� Cased to 30' ft Casing height (above ground) Ili In S' uction g p m g s, x 9 -P.M. t`✓ s»:�'��'v"�"Y}'�^+nx�.gri"rs'�..zk°�.,�-wY �t"}�J+x»�nst rn4ws Vis" nrY� i��'{„egx�x�``7"`.di°� 's F .._ , 2 colornes/100 ml Nitrated y6 mg./I Other bacteria � colomes/100 ml. M3��3��`F'. u�iul. 1 r �t n r»4z wa r3+:wV1� 4 •a 5 a e o same a /z61� y Collected by n S C—h194 n v,fw K � bye%�m.pp�,'v� ., '✓.++a5:�'^.ShSX-,::J:u':+Y .."C ,J..„ c m n4ti. v'.".. v.. x.b✓',4°;+MI?`P {iT... vi. ..a n!ti a e a P S Date installed 2-6 �W 3 Number of Compartments CleanoutsMN) YOS c eanou N) depression over tank (Yo f)a High water alarm nping Pumper S 35'2'bd,s'',rir.##4::YntA`.m '«.:.;�,xy.51% `*.�,5¢,.mv. e g 26 3 - ^ptl rating g p or ft2/bdrm) 0 System type ft Width S ft Gravel below pipe S ft. v ..,.n.. Z ft Eff absorption area y ft2 Monitoring tube Depression over field ��s��`�"u'� "�i�f5'�'•-»i":w'n�i°Et� "�a.J.�� w�.";�`"` r .�,'<v'.'” � ..2..`n �;� = ewar �"T .,. ..., , quacyfest O Results as Fail} �For 41 bedrooms in abs,brptionfield be ore aster in. Water added gal New depth in. - ne �, � mm Finaf fluid depth � m Absorption rate > �� g p d IatlOn treatment (past lz m0.) l7/I�fV tVOe)� �O i�-P� C\V\/'IWY�. If vac niva ri�4a —.. Z, s�",�.,n,^}? `4`a'3$* iaa'��"Y , ` / ars. •.„ �., Rna in nnllnnc 76 2nfi iblel4cc6§s &Nl off level at `f-5 In High water alarm level at In. tested 7— Meets alarm &circuit requirements? Property line S ' f Absorption field Water service hne �O t� Surface water l00 r DIM'BSORPTION FFIELD ON LOTTO " ` �'� Building foundation Water main Surface water �o Driveway, parking/vehicle storage i :'• � h,r 4, s"`� Y'v u.. ]�'-"i'k'"( •�•A.;W+ „v ai4.fl2i M, xh,l. :.:Yo t 4'.:a.. .. ,.. .. _ v''.w vx .0 '• ?... S I Wells on adjacent lots i0© )f Municipal records that the above systems are in C �r lance with MOA HAA guidelines in effect on this date. I k nosiki o .torr: ✓ <�� Cc 88,01 r s Prmfecl Na >' C " Cat - Waiver Fee $ Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 040381 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 1, Lot 6 of Valley View Estates 4t I subdivision, the well's productivity was determined to be 0.8 gallons per minute. The minimum well productivity required by this Department (AMC —15 5)-for--a-4-bedroom-r-esi ence-is-44 gaflons-per-minutu-Altbough4he _---- subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. 08/04/2004 11:35 9072748408 VANESSA WHITE 2GS.0m' (R) Lo -r 5 r 00 N 3 a V Q O L� T I; 86, S7 5 F (R) GAS '"Er ERS f'tec. meTSR-, e' ' '{� ZNO $TORY_ f>w44 WAtila WELL G"us��a �6 Ia+ct 4. • \ � P O M U. 5. ELF,C, LOT 15 u TH(leE SToffT woo0 a'a<Ims Si NG(.6 KA —I �y RESioGNGE 4,%'G O 4"NG a^pve 0 PAGE 02/02 ♦'vvt .t'r'tlr�, aovc ERSc 1 �r RLE] I" v 40 FT, 0ATE0I ANCHORAGE, ALASKA 1pTo R 2� I MEREBY19 CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY, LOT �BLOCK J VAttEyv E$TAT F 5 aoonl. 3 SU80. NcHo RECORDING PRECIENT, ALASKA, AND THAT THE IMPR VEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LIN S AND DO NOT OVER- LAP OR ENCROACH ON THE PROPERTY LYING DJACENT THERETO, THAT NO IMPROVEMENTS ON PROPERTY LYING A JACENT THERETO EN• CROACM ON THE PREMISES' IN GUESTI,ON AN THAT THERE ARE NO ROADWAY, TRANSMISSION LINES OR OTHER I VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS INDICATED EREON. 1. MAL 0'*4 Municipality of Anchorage • Development Services Department Building Safety Division OnSRe Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-521-63 HAA# IJA D / D 0 /n 1. GENERAL INFORMATION Expiration Date: 3 .S' d Z Complete legal description VALLEY VIEW ESTATES SUBDMSION #1: LOT 6. BLOCK 1. Location (site address or directions) 25875 WILDFLOWER DRIVE • EAGLE RIVER, AK Current Property owners) MICHAEL GERSHEL Day phone 696-2212 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 25875 WILDFLOWER DRIVE * EAGLE RIVER, AK 99577 Day phone AUDREY MASON w/ REMAX PROPERTIES Day phone 16600 CENTERFIELD DRIVE " EAGLE RNER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ■ Individual Water Storage ❑ Community Class Weil ❑ Public Water System ❑ 694-4200 TYPE OF WASTEWATER DISPOSAL: Individual On-site ■ Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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 sample results less than 30 days old. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ ) qC 5 at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(am) 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(am) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD. SUrrE 28 • ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc, attempled to provide a thorough, conscientious engineering analysts of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at Ire fime of the teA and separation distances measured to readily identifiable features. The operational rde of all wells and septic systems depend on the local sols condition, groundwater levels that may fluctuate during the year, and the water usage of the Iamly 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 Mom are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or Mum estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. the content of Mls report Is for Me 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 w81 R confer any legal right whatsoever. 5. DSD SIGNATURE JL� Approved for _ bedrooms. Disapproved. Date Ir 17 01 Conditional approval for bedrooms, with the }Mowing stipuiati4zN': • • • • . ; Attachments: HAA Checklist ✓ Septic System Advisory Well Flow Advisory �— WATER AND PROGRAM Manitenance Agreements Supplemental Engineer's Reort Other By -- Original Certificate Date: ) S" L PUY.1wor Municipality of Anchorage Development Services Department On-site W=W*VW Pmpram 4700 South Bmpaw SL P.O. Box 196850 Arr&MW, AK 995198650 W".d andwrapeAkue (907) 843-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: VALLEY VIEW EST. S/D /1: LOT 6, BLOCK 1. Parcel ID: 050-521-63 A. WELL DATA *CASED TO BEDROCK Well type SATE If a S. or C provide PWSID# N/A Date completed 11/1/85 Sanitary seat (Y/N) YE.S Total depth 230 tL Cased to --N-01 FROM WELL LOG Date of teat 11/1/85 Static water level 75 tL Well production 3 9.p•m. WATER SAMPLE RESULTS: Wen Log (Y" YES Wires properly protected (YIN) YES Casing height (above ground) 12+ In. AT INSPECTION 11/20/2001 162 1t 0.75+/– 9.p•m. Conform 16 colonies100 ml. Nitrate DMSO mgJL. Oftr badsria . colonies1100 ml. Date of sample: 11/21/01 Collected by. AWWC• INC. S. SEPTICIHOLDING TANK DATA Tank7ype/Materlal STEEL Date Installed 8/26/93 Tank eke 2000 gal. Number of Compartments 2 Cleanouis (Y" YES Foundation deanout (YIN) YES Depresslon over tank (YIN) NO High water alarm (Y/N) YES Date of pumping 10/30/01 Pumper JR'S PUMPING C. ABSORPTION FlEL D DATA • LEER TRENCH TESTED ONLY 2 ►tT'S I'd Tarf.+u+• Date Installed 8/26/93 Sop rating.p.d fftdnn) 0_e System type TRENCH Length 102 (I, Wldlh 5 JL Gravel below pipe -1.5% Total depth 6.27 R Etfabsorption ansa 944 Its Monitoring tube YES Depression over Held NO Date of adequacy test 10/31 /0110/ 01t0 Resuits (Pass/Fall) *PASS For 4 bedr kms Fluld depth In absorption field before test 11.5 In. 22.5/ Water added 2000981, New depth 38 ln. Elapsed Time: 1240 min. Final tluld depth 21 In. Absorption rate --- 600+ g,p d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN if yes, give date D. LIFT STATION Dete Installed 8/26/1996 Size in gallons 2000 Manhola/Access (YIN) YES 'Pump on' level at 41 n. 'Pump ofr level at--L7jn. High water alar level at 45 rn, Datum 00110M OF TANK Cycles tasted -. 3 Meets alar & droult requlr ements2_lE5__ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfillt station on lot 100'+ Absorption field on lot 100'+ Publlc sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer menholeideanout N/A Sewer /septic service One 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property One 5'+ Absorption field 5'+ Water main N/A Water service One 10`+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT M. Property Ina 10,+ Building foundation t 0'+ Water mato N/A Water service One 10'+ Surrace water 100`+ Driveway, parldrilyWhide storage 101+ Curtain draln NONE KNOWN Wens on adjacent tots 100'+ w-iel.d :1_-i; iii G. ENGINEER'S CERTIFICATION r certifythat! have determined through tied Inspectsystems an; and review of Mun(dpal7ecords that the above systems ere In conformance with MOA HAA guide0nes In effed on this date. Engineer's Prl N me JEFFREY A GARNESS% Cg -78 Date tryJo! D 4, •....... HAA t=ees a °'O . 00 Date of Payment Receipt Number 013 o aq Sm.12MO) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage a .M• Development Services Department. Building Safety Division ...,. On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 010606 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 1, Lot 6 of Valley View Estates #1 subdivision, the well's productivity was determined to be 0.75 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.42 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. Parcel I.D. # 1, 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 050-521-63 HAA # ~%~ ,~-~ GENERAL INFORMATION Complete legal descriptio~c~{~ Valley View~, Lot 6, Block 1 Location (site address or directions) NHN Birch Lane, Eagle River Property owner Jean Teague Day phone 696-2212 (mscj) Mailing address 1977 Blue Water Lane, Oceanside, CA 92054 Lending agency Lynn LaPerrier, City Mortgage, Day phone Mailing address p.o_ P~× 928]0. Anchorage. A~ 99509-2810 Agent N/A Day phone Address 277-0700 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: ~' ' individual well Community well Public water Unless otherwise requested, HAA will he held for pickup. 5 X NOTE: TYPE OF WASTEWATER DISPOSAL: Individual 'on-site NOTE: If community well system, Provide written confirmation from State ADEC attest- ing to the legality and status of system. x Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 / /' S U LULUOO muomppv :suo!~elnd!~s I~U!MOIIOJ eq~ Hi!M 'SLUOOJpeq 'SLUOOJpeq JOj le^oJdde leuog!puoo 'p@^oJdd~s!Q ]ot po^o]dd¥ ~ ~urlJ.'dNglS SHHO '9 LLG66 ~ ,.~AT~I aybUO~ "~6E££L xc~ 'O'c~ Ss@Jpp¥ G6I§-T~69 aUOqcJ SaOT~uaS 6UT=aaUT6UA ~aAT~J aySg:~ LUJ!-I JO eUJ~N 'uo!loedsu! s!q~, jo elep 9ql uo ~oojjo u! suo!lBlnSeJ pue 's@ou~u!pJo 'sepoo a1~lS pu~ I~d!o!un~ lie ql!M eoUe!ldu]oo u! s! tuels,~s lesods!p jm, eMelSeM Ao/pue ~lddns JBJI~M 9J!g-UO aq~ 'uo!loedsu! pub uo!~Sp, se^u! XLu tuoJJ pub SCl! tuojl peu!e, lqo UO!I~LUAOJU! eql UO peseq ~8ql X~peA~eqpnj I 'u!e.leq pe:~Bo!pu! @Jn),onA~s jo edX~ pu~ stuoo]paq ~o Jaqtunu oq~ Jo~ ejenb@p~ pu~ leUO!lounj 'ejBs s! LUelSXS lesods!p ~O~eMe~SeM Jo/pu~ ,qddns Jel~M eI!S-UO aq~ l~q~ SMOqS uo!~eo!ldde I~^oJddv ,~lpoqlnv I:I:I~INIgN3 AB NOI.I.O:IdSNI -t0 J.N:31N:I/V'.L$ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: J//TL.L.E~"/ ~/~IM -~/ J.0/'~ ~CJ¢-/ Parcel I.D. A. WELL DATA Well type }~.H/,~'~. Log present (Y/N) ydS; Total depth ~ ~,~ i Sanitary seal (Y/N) ?/ If A, B, or C, attach ADEC letter. Date completed Cased to ,'~ ~ ~ FROM WELL LOG Date of test Jl/~1 Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/hold!rig tank on lot Absorption field on lot Public sewer main , -,.,,o sewer service line ADEC water system number /~//.4 // /Y,~ Driller. ~g/V¢$D/'/ Oasing height Wires properly protected (Y/N) g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform .~ Nitrate Date of sample: /L~ /lOli. L. &OA/,c/~--/~Other bacteria / Collected by: B. SEPTIC/I-IOL~BtNG TANK DATA Date installed ,') ~/~-Z::~/~ Tank size Cleanouts ~ · ~,~ Foundation cleanout (Y/N) High water; (Y/N) ,A//.~ Date of pun ting .A//.~ ~ Compartments ~ /'/"/~'~' Depression (Y/N) /t/p Alarm tested (Y/N) ISTANCES FROM SEPTIC/', IOL~,----'hXIG TANK TO: Well(s) c) acent lots W ~/(~/ To property line Absorption field 4' ] O0 ! Surface water/drainage ¢'/00 I Foundation ~"~ ' Water,mci,q/service line 7~ / 0 I 72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at /q/qb/'/ Manufacturer Manhole/Access (Y/N) )/~ /¢,/'~ ~ ~" "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: / Well on lot __ /'~'~ On adjacent lots · Surface water D. ABSORPTION FIELD DATA Date installed 0 g/Z(/,,/~ 3 Length [0'/// Width Total absorption area Depression over field (Y/N) Results (pass/fail) /.-,~ Soil rating Gravel thickness -~. System type Total depth ''~ ~.~ / Peroxide treatment (past 12 months) (Y/N) /"/,/'~ Cleanouts present (Y/N) Date of adequacy test /V//~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot To building foundation On adjacent lots 7~ .,~D_/ Surface water Curtain drain _ On adjacent lots ~/DD ' Property line ¢- ovO' To existing or abandoned system on lot Gutbank ~,'~ Water me!n/service line Driveway, parking/vehicle storage area A PP,4 ~£/v 7' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signature _~ Engineer's Name HAA Fee $ ~O0 Date of Payment ~.~'~/7~' Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21