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EAGLE CREST #1 TR A LT 27
Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191394 PID Number: 050-303-24 ❑ New ✓0 Upgrade Name: BETTE MONTGOMERY ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 10261 CREST VIEW LANE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPDiSF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot EAGLE CREST #1 A 27 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station i Holding Sevier Total absorption area Number of trenches Dist. between trenches From Tank Field ( Tank Line Ft' Ft. Well i 103.4 NA N/A N/A 50+ TANK 0 Septic ❑ S.T.E.P. 0 Holding ❑ Other Manufdcturer GREER Capacity 1000Gal. Surface water 100+ NA N/A ` N/A I Material Number of compartments Lot Line I 14.4 NA N/A N/A POLY 2 NA Foundation 5.2* NA N/A N/A LIFT STATION Manufacturer Capacity I Curtain Drain 50+ NA N/A N/A Gal. Remarks *TANK OUTSIDE FOUNDATION PRISM Pump on level at in. Pump off 1pelepelctions h water alarm at in. Pump make and model performed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield NORTHERN EXCAVATION Drainfield C0/MT Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 10011 Inspection 1�' 09/09/19 dates: 2d09/09/19 Location and description 3.d 4m TRIM, NW CORNER HOUSE COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date Q Steven .�. ponnorae y� Approved Mla tDate�- wN—uvii cPv i_ -1-1c.uw cn n D -Do CC) CC) �a ol�:' IK In- -0 M :2 c: c Cc) Cc) (mn :5 n co z 0 - > Dr 0 Ln ;o -0 � 0 o V) 0 n'- c: m 0 � , � 1 0 m 0 lz mm� z >m z ' cf) z ;a C) P z 0 ZP m M m C > z m (A 0 M;0 > 0 Em to /Vt vi F- m F- ell, Lo > z - > > \ W U io o' J c, 125 N) 1 Lp :4 > o r 0 A 0 M > C) 0 F� > (A > mom--I m cn X 0 0 N) n cn m z (A C4 n --1 w N > co C4 0) m z r- co J Cl LD 41 NOTES: PANNONE ENG SVC LLC P.O. -0 OX745-82001 807 PALMER, AK �9645 PHONE (07) FAX (907) 745-8201 REVISIONS Ai REV: 9/16/K19 DATE RECORD DRAWING SCALE EAGLE CREST #1 TRACT A L27 BETTE MONTGOMERY 10261 CREST VIEW LANE EAGLE RIVER, AK 7H .... .. . ....... "sieved A. a n n'o'p- e CE 8149 i I " = 50' P.I.D. NO 050-303-24 DRAWN ACP/JRL SITE PLAN PERMIT NO. OSPI91394 SHEET 2 OF 2 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program pDBox 19O6so 4ro0Elmore Road Anchorage, Alaska 99o19-ssoO pwu 8 -ryn* Fax: (yo7)3«8'/yy7 nop:/x*wn.mvn/,omm^,uc Permit Number: OSp191394 Work Type: SopbrTankUpgrada Tax Code Number: 05030324000 Site Legal Address: EAGLE CREST #1 TR ALT 27 G:0055 Site Mailing Address: i02G1CREST VIEW LN, Eagle River Owner: MONTGOMERY BETTE Design Engineer: PANN0NEENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms 9/5/2019 81412020 [] Disposal Field 2 Septic Tank [] Holding Tank 13 Privy [] Private Well [] Water Storage All construction shall beinaccordance with: i. 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 (18AACD8) 1 The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.G5.Provide notification bycalling (QO7)348-79O4(24/7). 4. From October 15huApril 16, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed nnthe same day, or b. Covered, sealed, and heated to prevent freezing Received By: J 4""1 Issued By: 0- UUCIC'M _.kUy 3 EPL}3/US MUNICIPALITY OF ANCHORAGE sF-" Community Development Department Phone:907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-303-24 Property owner(s) Bette Montgomery Mailing address PO Box 212771 Anchorage, AK 99521 Site address 10261 Crest View Lane Eagle River, AK Day phone Legal description (Sub'd., Block & Lot) Eagle Crest #1 Tract A L27 Legal description (Township, Range & Section) Lot Size 17,820 S q. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X ADU) Septic Tank N Upgrade RX(w/wo Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: OQ o2S . f _t3_15 Waiver Fees: _ Date of Payment: 945115 V 5 jc" Date of Payment: t Number: 0'11 &L7G Recei p d�-lJr� � �'l Receipt Number: Permit No. 11s pl gI&olq Waiver No. Permit App_;•'• .....:c: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191394, Rebecca Carroll, 09/05/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191394, Rebecca Carroll, 09/05/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191394, Rebecca Carroll, 09/05/19 Municipality of Anchorage :,, "., Development Services Department :~ ~: Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page / of / www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name: ' BKB LLC WastewaterSystem: [] New [] Upgrade 10261 Crest View Lane, Eagle River, AK ABSORPTION FIELD Phone: 622_3344 Number of Bedrooms: 3 [] Trench [i~ Shallow Trench [] Bed [] Mound [] Other: LEGAL DESCRiPTiON S°il Ratin'~ Total Depth from odgina, grade: /' GPD/Ft2 Ft. Block: Tract A Lot: 27 Subdivision: Eagle Crest #1 Depth to pipe ~X~om from odginal grade: Gravel depth beneath pipe: / Ft. ~ Ft. Township: Range: Section: Fill added above od'~xnal grade: Gravel Length: -~ Ft. , Ft Well: [] New [] Upgrade Gravel width: ~ Numberoflines: ?istance betweeniines: Ft. ,/1 Ft. Classification (Private. A. B. C): Total Depth: Cased to: Total absorption area: ~,~ Pipe Material: / Private 228 Ft. ~' ~ 2~ Ft. Ft2 Ddller: Date Ddlled: Static Water Level: Installen ~ Date Insta¢ Sullivan Coles Water Wells 4/11/11 206 Ft. Yield: Pump Set at: I Casing Height Above Ground: \ / 5 GPM .2,,"¢Z' Ft.I 3 Ft.~AN SEPARATION [] Septic [] Holding [] S.T.E.P~. / [] Other: DISTANCES ~To Septic Absorption Lift Holding 'ublidPrivate Manufacturer: /~ Capacity: From ~ Tank Field Station Tank Sewer Line/ '~ Gal. Well 100+ ft. 100+ ft. N/A N/A N/A Material: / ~ Number of Compartments: Lot Line 10+ ft. 3.5 ft. N/A N/A Gal. "Pump on" level at: '"Pump off level at: I Hi,water alarm at: Foundation 10+ ft. 10+ ft. N/A N/A in. Curtain Drain NO.. I(~ [o.×ist Pump Make & Model / Electrical Inspections performed by: Remarks: / BENCH MARK Location anTescdption: Assumed : Inspections performed by: Dates: 1st ' :' ': Development Services Department Approval >..~ :.~ ~ ! '4 ~;~ Reviewed and approved by: Date: ] - '' , . ~' [~ ~ ...... l ¢ ~{ / Lot 10 Lot 9 Lot 8 Lot 7 Lot 6 ~ J ~o~-5-- ~ ~ ~ ....... ~- ............ T ............ ~ ............. ~ ............. ,i~-~ ........ ~- ~- - 3rd AVENUE ~SEPT]C~ ~~ AREA,~ Lot 31 Lot 32 132.00' [ Lot 15 \ Lot 50 Lot 49 132.00' 132.00' Lot 47 DOUGLAS T. KENLEY, P.E. c,~,, Engi .... cu~: BKB LLC AS-BUILT Eagle Crest #1 S/D, Tract A, Lot 27 ~O.ESS: 10261 Crest View Lone, Eagle River, I .... 1 OF 2 Lot 48 \ ~ ' ~1 ~ / ~_~.SEP;TIC m i I [ I I ~¢ LC 55 I ~ Lot ~6 ~ Lot 35Amm , I O~ i -- i X~ I 132.00' I I I~ Lot 34 ~x~ ~2.00' t ~1~00' I L__ ~-~--+ & I -k .... ~ I / ~ / 2nd AVENUE xx xx // // ~--~ ~ -~ ~ '1 ~ ......... Lot 15 Lot 14 AREA/ Lot 15 3rd AVENUE / :PTIC / p< / I ' °°'~ \ Lot 28 SWING TIES A B (~) I FCO 23.8' 22.9' (~) ~TCO-1 36.8' 8.5' (~) TCO-2 42.4' 14.5' (~) CO-3 43.3 15.5' (~ SUMP-1 35.8'20.8' (~ SUMP-2 55.1'21.8' I I -k--- -~ --CRES-,C:-V!EW L^~' '1 \ ~ ! -H EPTIC x , u5 Lot 35A 152.00' DOUGLAS T. KENLEY, P.E. ~, ~..., 9806E. NorthstarCircle · Palmer, Alaska99645 · (907)746-1073 c~.-: BKB LLC /II Lot 54 _._~_1 AS-BUILT Eagle Crest #1 S/D, Tract A, Lot 27 ~10261 Crest View Lane, Eagle River, AK I ~ee~ 050-305-24 "'~05/08/111c~'~'DTK I-- ~-~ I~ 1" = ~0' I ..... 10127 ISHEET 2 OF 2 '1- IX // May 10 11 07:02p Sullivan Water Wells 907 688 2759 195 Domestic C.*mmerciai GL~,thenmal Phene glOT--GS&-2759 www. sailiv3mw'~erwL. IJ$.com Well Log Permit Number: OSP 111008 Date of Issue z~lm0. Date Started: 4tlltZoll Date Completed: 4t11~2011 Property Description EAGLE CREST #1 TRACT A Lot 27 Block NONE Property Owner Name & Address: AUDREY MASON EAGLE RIVER, AK 99577 Depth From To 0 2 2 4 4 62 62 84 154 171 171 220 22O ?.28 Borehole Data: Soil Type, Thickness & Water Strata Casing Stk;kup Overbunlen Sand & Gravel Silty Hardpan W/Boulde~ Gray Hardpan W/Clay Gray Clay W/Gravel Gray Silt Sand Gravel De~e Silt Sand Gravel Water Sample Results: Arsenic: ug/l Nitrates mg/l Total Coliform Bacteria colonies/100mL Otho' bacteria: col/1.00mL Parcel Identification Number: Is well located at approved permit location? Section: Town: 05030324000 iXj }¥es i'.....INo Range: Me.od ofl)rilli g lX_'J air rot y F-t cabi too, Casiag type: Wall thickness 0.25 inches Dimneter 6 inches Total: 228 feet Liner type: Diameter inches Depth: feet Casing stick-up above ground: - 2 feet 206 feet Static Water Level(from top of casing) Pumping Level: feet after I hours pumping gTwn Recovery Rate S gpm Method ofTesling: ~r Well Intake Opening Type !XI Open End ! ] Open Hole [. J Screened Start feet Stopped feet I I'eeff°rati°ns Start feet Stopped feet Grout Type: Bentonite d~y g~anular Volume: .~} Pounds Depth 44 Start 0 feet Stopped 44 feet Pump lnlake Depth: feet Pump size: HP brand name I I ' Well disinfeded upon Completion? iX_~ Yes ~ I No Method of disinfection CHLORIHE 50 PPM CoInmelt~'. Well Driller: Cole Sullivan Sullivan Water Wells P.O. Box 671~272 Chu{jiak, AK 99567 (907) 688-2759 Attention: The property owner shall providc this log t'o DSD (onsite) and DNR within 30 days of completion. ARCTIC PumP & WELL INC. Jim :Sullivan PO Box 770197 Eagle River, AK 99577 (907) 688-2510 (907) 258-2510 (907) 745-2510 apw~gci.net Pump Installation Log Well Drilling Permit Number: SW ospl 11008 Parcel Identification Number: 05030324000 Date of Issue: 2-18-11 Legal Description:Eagle Crest #1 Lot: 27 Block: T A Property Owner Name & Address: BKB LLC 18540 Upper Mccrary Rd Pump Installation Date: 4/27/11 Pump Intake Depth Below Top of Well Casing:214 Feet Pump Manufacturer's Name: Pump Model: LBF2-75-S2 Pump Size:3/4 Dempster hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: Baker Pitless Adapter Installer: U/K Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page 1 of l ARCTIC PumP & WELL INC. Jim Sullivan, CPI PO Box 770197 Eagle River, AK 99577 (907) 688-2510 (907) 258-2510 apw@gci.net Decommissioning Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: Legal Description: Eagle Crest # 1 T A Lot:27 Block: Property Owner Name & Address: BKB LLC 18540 Upper Mc Crary Rd ]~o1~ ~ixzor Al( OOq"7"7 Pump Installation Date: 4/27/11 Pump Intake Depth Below Top of Well Casing: Feet Pump Manufacturer's Name: Pump Size: Pump Model: hp Pitless Adapter Burial Depth: Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: feet Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Well permanently decommissioned by procedurel 5.55.060L.c. Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page 1 of 1 On-Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSPl11008 Tax Code Number: 05030324000 Work Type: Well Upgrade Permit Effective Dates: February 18, 2011 to February 18, 2012 Design Engineer: DOUGLAS T KENLEY Subdivision: EAGLE CREST #1 Site Legal Address: EAGLE CREST #1 TR ALT 27 G:0055 Owner/Address: BKB LLC 18540 UPPER MC CRARY RD EAGLE RIVER AK 995777914 Site Mailing Address: 10261 CREST VIEW LN, Eagle River Lot Size in Sq Ft: 17820 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy Y Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The existing well is to be decommissioned by a certified well driller or pump installer. Received By:- MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On-Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 Mayor Dan Sullivan ©57 ill OO~' ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. ¢ .~'""'~' Property owner(s) ..,¢,.~,¢,-~ ,,¢'-.,..,',.-,¢ ('.,¢','~'~.-'--": 4'~:~ Day phone ~,.~ Mailing address ,-'/~-~ ~ z¢..,~ ¢;,~x.~ ,~/,/,~,¢ ¢~, ~-"-,;¢~-~,~-' J.~'-,,~ Site address ,,,~ ~x / ¢r/¢',¢...,~, z~l,,,¢,.-'~ _.~' ,¢,,,./¢¢! "'~" '-" '''¢ Legal description (Sub'd., Block & Lot) ,¢,¢~ ~ ~.*~"~<-¢-¢~" ~.., ¢'~;,¢',¢',¢-~¢'?~ Legal description (Township, Range & Section) Lot Size /.~/¢-/~¢'"' Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: ([~ all that apply) Absorption Field [] Initial [] Septic Tank [] Upgrade Holding Tank [] Renewal [] Privy [] Private Well [] Water Storage [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of pro~)erty oCr(er or authorized agent) RushFees: Date of Payment: Receipt Number: O'jS--~/~.~ Permit No. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 1/11) Lot 10 Lot 9 Lot 8 Lot 7 Lot 6 / ~ 3rd AVENUE Lot 50 132.00' Lot 49 \ / 2nd AVENUE \ \ / Lot 48 152.00' Lot 47 ' 132.00' 32.00' DOUGLAS T. KENLEY, P.E. Civil EncJi .... I AS-BUILT cue.~: BKB LLC 1 OF2 Eagle Crest #1 S/D, Tract A, Lot 27 ~°0~:10261 Crest View Lane, Eagle River, AK l~°"u""~:050-505-24 I~'"u"B~ ~:°2/~/~1 ...... °~ I ..... ~ I~: ~'= ~°°'1 ........ ~°~ I~E~T Lot 15 Lot 14 3rd AVENUE (]] FCO ® l'CO-1 @ TCO-2 ® co-3 @ MT-1 ® C0-4- -~o AR EA~// Lot 15 -CRES¥-V!EW U~,N g -(Priv~e)--- \ X- Lot 28 132.00' Lot 33A DOUGLAS T. KENLEY, P.E. cu~, BKB LLC Eagle Crest //1 S/D, Tract A, Lot 27 Civil Engineer Lot 27~l -H -- -- :// Ml /1 / // ~ / // // ~-// /~ ~ /~--$ B.R. // SINGLE FAMILY RESIDENCE / TANK A / : ¢ ..... '~%:> _ _ _ I i I ARE*~ -- _ Lot 34 ~ . ~DRESS:10261 Crest View Lane, Eagle River, AK I P'D"uu"~":050-505-24 AS-BUILT ~T n,m ema ~ ,~,o=~ ~ THIRD STREET -~.~.~ 10' UTILI~ ESMT. ~ N89° 50' 00"W 132.00' LOT ~ TH~ $UR~YOR TAKE~ R~PONSIBIU~ FOR ~ INI~AL TR~AC~ON ONLY ~D AS~ME$ FIN~OAL U~IU~ ONLY FOR ~ COST OF ~E ~R~Y. U~O DISTANCES PREV~L O~ SCAUNG. R~RODUC~ON MAY CAU~ ~RORS IN ~ ~T~.~ SURVEY TYPE SYMBOLS ~ R~ ~O~R/ A~--~9~LT 0 FOUND R~AR ~ WOOD ~CE ~ CON~E~ ~SUM~ METAL WOOD DECK PLOT PLANS ~ LOT SURVEY5 NOT~; IT IS ~E RESPON~81UTY OF TM~ BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPRO~ CONS~UC~ON, TO ~RI~ PROPOSED ~UI~ING GRADE' R~A~VE SHO~. FiNCh, ~S, TO ~NISHED GRADE AND U~UTY CONNECTIONS ~O TO D~MINE FTC.. ~E SHO~ IN ~R A~PROXIMA~ LOCA~ON, ONLY, SNOW ~E [XIS~NCE QF ANY EA~M~, COV~AN~ OR RESTRIC~ON$ MAY PRE~NT SOME :MPROVEMENT5 ~OM BEING 5E~N AND LOCATED. ~ICH O0 NOT APPEAR ON ~E RECORDED SUBDiViSiON P~T- ALL DI$TANCES ARE RECORD UNLESS O~ERWISE NOTED. SURVEY CERTIFICATION ~~ Prepored by ~: OF ~/'t%, Robert E. Johns, Jr. & Assoc. PLOT P~ ~ ~ .... ,,,,.. ~ ' '--~ ~' ~'~ ' "' ~'~__~_~ ~.;' '--~'4 Professional~2 ~.Landl2 A~. Surveyors m~ a* m~ a~ ~~~ Re~ Lot S.F. Rec. Plat F~e No. ~, ~d a~ ~ ~ h~ ~. ~ ROBE~O~, O~ ¢ '-"~ "~ ~ 4121-S ~'... 12/21/10 ~""'NW0055 1368 ,,- ~' - -'" '-'"" ~*~J. ~' ............. _~o* ~* EAGLE CREST ~x~-~--~ ~,-.- -,,,~*** . T~CT A LOT 27 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ Top of tile to t~sh ~d~ --.'~ ¢ ' M'~ri~nea''li~.7~ ~'Y' ' ~ ~ ¢¢inch, Total eff~ti~O Length Width ~epth PERMIT ~ DISTANCE " DISTANCE TO: ~ OTHER PIPE MATERIALS REMARKS a t 72-013/~ :ev. 3/78) I ............. I-1U I"-,i I C I F'RL I T"r" OF FII'-,ICHORRGE DEPARTHENT OF HEALTH AND EflVIRONr,IENTAL PROTECTION 825 L. STREET, ANCHORAGE, AK ~501 2~4-4720 Cl~'-~--$'-. 1' TE $1~I~IER )'-% IqELL PEI~P1 1' T PERMIT rio: B48137 DATE I_._%1JED. 04785/'84 APPLICAHT: ADDRESS: CONTACT PHONE: C?O S & S ENG'G. SRB ±96X EAGLE RIVER, Ri( 694-2~79 SCOTT EXCAVATING ~9577 LEGAL DESCRIF': LOT SIZE: r.lR:,.'. E. EDF:OOMS: SUBDIVISION: EAGLE CREST SECTION: ? TOHNSHIP: i7820 (SQ. FT.'OR ACRES) LOT: 27 BLOCK: R.AHGE: ~-W TRACT A LISTED BELOH ARE THE OPTIONS AVAILABLE.TO YOU IN DESIGNING YOUR SEPTIC S'¢STEI'I. CHOOSE THE OF'TIOfJ THAT BEST FITS YOUR SITE. BEE:'' DEPTH TO PIF'E BOTTOH (FT.) 2.0 *~: GRAVEL DEPTH (FT.) 9.5 TOTAL DEPTH (FT.> 3.5 GRAVEL HIDTH '(FT. > ~?.0 GRAVEL LENGTH (FT.> ~4.0 GRAVEL VOLUME (CU. YDS.) 2&.4 TRt~K SIZE (GALS) ~,000.0 ~* SOIL'RATING (SQ. FT./BR) - 125 DEPTH TO PIPE BOTTOH < ;3. 5 FT. REQUIRES INSULATION DEPTH TO ~IPE BOTTOM.( 4.0 FT. MA"r' REQUIRE A LIFT STATION TR[~K MUST HAVE AT LEAST TWO COHPRRTMENTS I CERTIFY THAT: ~ ±. I RI1 FAMILIAR NITH THE REQUIREHEHTS FOR Of.I-SITE SEWERS AND WELLS AS SET FORTH BY THE HUNICiPALITY OF ANCHORAGE (I'IOR)¢RND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEH IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THI~ PERMIT. ~. I WILL ADHERE TO ALL l,lOR AND STATE OF RLRSKR REQUIREMENTS FOR THE SET BACK [.,IDTRNCES FROH RtlV EXISTING WELL, WRSTEWRTER DISPOSAL S9STEM OR PUBLIC. SEHERRGE SYSTEM OH THIS OR ANY ADJACENT OR NERRB9 LOT. 4. I UNDERSTAND THAT THIS PERHIT IS'VALID FOR R MAXIMUM OF ~ BEDROOMS AND RMV Et~LRRGEr'IEHT WILL REQUIRE RN RDDITIOHRL PERHIT. '' IF R THEN WILL ELECTRICAL WORK MUST BE DONE BY R LICENSED ELECTRICIAN. RPPLICR~T: C?O S~.~ S EIJG'G. SCOTT E,"(C~[/.,;ATING v/ ISSUED B"r' _~ _~_ DATE: LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BLIILDING CODES, C~> AN ELECTRICAL PERMIT AND I/JSPECTION MUST BE OBTRINED~ (2) AS-BUILTS NOT BE APPROVED WITHOUT. AN ELECTRICAL INSPECTION REPORT; AND (~) THE SOILS LO~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264~,720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: J~ ~'~ .~ ,EGA, DESCR,PT,ON: 2 ~ f~ WAS GROUND WATER ENCOUNTERED? PERCOLATION TEST DATE PERFORMED::~~;~ SLOPE f ;TE PLAN ~J ( P E DEPTH?IFYES'ATWHAT 1 2 3 4- 5- 6 7 8 10 11 13- 14 15 16 18- 19- 20- COMMENTS PERFORMED BY: Gross Net Depth to Net Reading Date Time Time Water Drop 72-008 (6/79) g'd ,o z~7 t'~ t'~ [] SO~LS LO~ MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Aleskl 99501 264-4720 SOILS LOG - PERCOLATION TEST LEGAL...C.,'.,O": I~rac t ~ Z ~7 ' ~ b ~e~/ ~ 8- 9 10 11 12 14- 15- 16- 17- 18- 19- 20 COMMENTS WAS GROUND WATER ~D ~_ ENCOUNTERED? pO E Iqo. 1457.E Gross Net Depth to Net Reading Date Time Time Water Drop ~. AI , I PERCOLATION RATE ~/~ (minutes/inch) 's'e,¢° e?7 T- ·.Z' CHUGIAK, ALASKA 688-3199 ~k;RILLING CO. ~d~ WE SERVE ALL ALASKA POST OFFICE BOX 42 - CHUGIAKo ALASKA 99567 KODIAK, ALASKA 486-4826 · OWNER OF LANDI~Rcan..}IcClmuCl..J~ .......................................... ADDRESS ..S..~.;....~..'....~....n...°.5....7.~.!O....E ~.9.~.T.si.~.~.~ ................. WELL - SITE .....,L...Z.7....T~ ~,..~..Eo, i;.l.e...~.r.e.~.'~...$.ub.,~ ........ DATE - STARTED ....................... .5..-..),..-..{~..4 .............................................. DATE- ENDED .............................5...~..2..T..8...4.. .............................................. DEPTH OF WELL ......... 2AOf.t ........... : .................................................. STATIC LEVEL OF WATER PT ...... ..6..O...'......i...n.....h...o...1...e.....e...s...t..,. .............. % 100% est. DRA¥ DOWN FT ........................................................................................ 180 est. GALS. PER fIR ........................................................................................... 6" Sch 40-240' KIND OF CASING ...................................................................................... KIND OF FORMATION: FROM .......... O ......... FROM .......... .3. ......... FRO~,! .......... .~.. ......... FRml .......... .3..2. ....... FROM .......... ~..9.. ...... ERO. .......... ....... ERO. .......... .... FROM .......... 1.1.9. .... FROM ......... ..2...0...1. .... FROM ......... 22fl .... FROS! ...................... FI{O,",! ...................... PT. TO ........... ~ ........ FT..Ov~:~ur~ten ...... FT. TO .......... ..6.. ........ FT...~..~.~...d.....~......O..C _a..¥..e..1 FT. TO ........... .3...2........ FT...~..?:.?..¥.....~......S..9 ~ .d..... FT. TO ........... .~.9 ...... FT...f;_q..b. ~.. ,~..e.....~.~ .Q ~'! .e.. FT. TO ........... .8...4. ...... FT...S...a...n...d.....&......G...r...a..v...e..l FT. TO ........... J,.1.~... Fr..D.~,M.~....C.~,.~I~. ......... rt. TO ........... ~.~... FT..?..~.~.d..?..~. .............. FT. TO ........... 2.Q.L. Fr..San.~...&..G~a.v.e.1 FT. TO ........... ~..2...8.... FT...~...J:~.?.....~...a...~...d. ......... FT. TO ........... 2.4 Q... Fr. FT. TO ...................... FT FROM ....................... FT. TO ....................... FT .................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT, TO ........................ Fl' ................................. FROM ....................... FT. TO .............. [ ......... FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ......... :.~ ......... .uff/~CleAL~f OF DErL ~'f '~'C-~i'*&'"' FROM ....................... FT. TO ....................... EII~ .RD..N...~..~ ,1~'...Al:...?.?..t .t ~ !.~.~ N FROM ......... FT. TO ............. FT...{.~r~Y--..~..6..,'~8~.- FRO.',! ....................... FT. TO ....................... FT. .. 'R'E'C'E'IV'E'D FROM ....................... Fl'. TO ........................ FT ................................. MISCL. INFORMATION: Pump should be set at 225' no warranties or no warranty implied. Dennis [~illiams DRIII FR'~ 'N $',IF. R444 MUNICIPALITY F ANCHORAGE Development Services Department p p Phone:907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-303-24 1. GENERAL INFORMATION Expiration Date:) 2--),q-- Complete -- ),' r c 7 Complete legal description Eagle Crest #1 Tr A L27 Location (site address) 10261 Crest View Lane Current property owner(s) Bette Montgomery Day phone Mailing address PO Box 212771, Anchorage, AK 99521 Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic FD 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 $ 100 Waiver Fee $ Date of Payment 9 if 3119 Receipt Number 0376-6 6 COSA # A67C19l143? Date of Payment Receipt Number 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for 1� bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date 9/13/19 Conditional approval for bedrooms, with the following stipulations: �``lnbl (((((f����Ii, l&,,, i. NQ0 m^ Ij�1i1!1i11���'� ' f Original Certificate Date: `z 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 Other Legal Description: Eagle Crest #1 Tr A L27 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Q Well log is filed with Onsite (or attached) Date drilled 4111111 Total depth 228 ft Cased to 228 ft H Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 827119 Static water level at beginning of test 211.9 ft. Comments B. TANK DATA Age of tank(s) New years Tank type/material Poly Measured operating fluid level in septic tank n/a ❑- Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA Which system tested (date installed) 7/17184 © ALL standpipes present per record drawing Total measured depth from grade 9.5 ft (max) Measured depth to pipe invert from grade 4.0 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Al Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 050-303-24 Structure served by this system Well production at time of test 4.59 gpm Water storage tank volume gallons Well disinfected for coliform test?✓❑ Yes ❑ Nc 0 Coliform bacteria is Negative Nitrate 2.31 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L N Arsenic less than MRL (ND) Collected by PES Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 8127/19 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 410 in Water added 600 gal New depth 1810 in Elapsed time 120 min Final fluid depth 4/0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) wknown If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ✓❑ Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft Q Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No Absorption Field on Lot > 100' ❑✓ Yes if No ft . Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ✓l Yes if No ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ❑ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ft ft ft ft ft ❑✓ Yes if No ft Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' Yes if No Water Main > 10' F71 Yes if No ft Community Wells > 200' ✓❑ Yes if No Water Service Line > 10' 0 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' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' es f if No � ft- Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' ❑ Yes if No Water Service Line > 10' 0 Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 9/13/19 COSA Checklist yellow sheet OF A� �k �x,P• • � l , . . Steven 1b�or,nene* CE 1? I AG << � iat %: ;® ft ft ft ft ASBUILT CLIMAnn ituv-v DuAvrlllNb 0y4-UbZLJ ----------- I HEREBY CERTIFY 7 T HAT I HAVE SURVEYED THE SCALE: I t FOLLOWING DESCRIBED PROPERTY: 1710 I Duane Mtrk Seward DATE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXis*rENCE OF ANY GRID: EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD F,9: ANY DATA HEREON BE USED FOR CONs'rRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. rDRA'W_N: Duane Mtrk Seward Parcel I.D. 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. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION /o COSA # ¢_~: Expiration Date: Complete legal description Eagle Crest #1 S/D, Tract A, Lot 27 LoCation (site address) 10261 Crest View Lane, Eagle River, AK Current Property owner(s) BKB LLC Mailing address 11525 Old Glenn Hwy., Eagle River, AK 9§577 Lending agency Mailing address Day phone 622-3344 Real Estate Agent ReMax of Eagle' River (Audrey Mason) Mailing Address ~'.~, Unless otherwise reque~'~od, COSA will be held by DSD £or pickup. NUMBER OF BEDRoOMs: 3 Day phone 11525 Old Glenn Hwy., Eagle River, AK 99577 Day phone 622-3344 TYPE OF WATER SuppLy: Individual. Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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 Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Douglas T. Kenley, P.E. Phone (907) 746-1073 Address 9806 E. Northstar Circle, Palmer Alaska 99645 Engineer's Printed Name Douglas T. Kenley Date ~'-'/- ~' ~ f ~7~ . -- ., bedrooms, with the following stipulations: DSD SIGNATURE ~ Approved for B Disapproved. Conditional approval for bedrooms. Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: .v~O"(-'/~-/--- Original Certificate Date: (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Eagle Crest ~ S/D, Tract A, Lot 27 Parcel ID: 050-303-24 Well type private Date completed 4,/11/11 Total depth 228 .ft. Date of test IfA, B, or C provide PWSID #.. , Cased to ~ ft. FROM VVELL LOG 4/11/11 Well Log (WN) Y Wires properly protected (Y/N) .. Casing height (above ground) AT INSPECTION Y in. Static water level 206 Well production 5 WATER SAMPLE RESULTS: Coliform Ne~lative Colonies/100 mL Arsenic: ND mg/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size 1000 gal. Foundation cleanout (Y/N) Y Date of pumping 12/27/2010 C. ABSORPTION FIELD DATA g.p.m. Nitrate .. ,0.8 mg/L Date of sample: 5/1/ll g.p.m. Othei~ bacteria Negative Colonies/100 mL Collected by.:.~ F. Kenley N Septic/Steel Dat,e..!0stalled ' 7 /17/84 Number of Compartments 2 Cleanouts (Y/N) Y Depression over tank (Y/N) , .N High water alarm (Y/N) N/A Pumper JR's Pumping Date installed 7/17/84 Soil rating (g.p.d./ft~ or ft~/bdrm) 287 System type, Trench Length 40 + 46 = 86 ft. Width 2.5 ft. Gravel below pipe 5 Total depth 9.5 ft. Eft. absorption area ..,.869, ft2 Monitoring tube . Y Depression over field, , Date of adequacy test 12/23/2010 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 7-3/8 ,in. Water added, 620 gal. New depth Elapsed Time: 72 min. Final fluid depth 31-3/4 in. Absorption rate >= 450 Any rejuvenation treatment (pest 12 mo.) (Y/N & type) ,, , N If yes, give date 38-1/4 in. g.p.d. D. LIFT STATION Date installed "Pump on" level at . . Datum in. E. SEPARATION DISTANCES Size in gallons "Pump off" level at. Cycles tested in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ ft. Absorption field on lot lO0+ It. Public sewer main N/A. Sewer/septic service line. ~ ft. :::Z. ~ / Animal containment areas 50+ ft. On adjacent lots 100+ ft. On adjacent lots 100+ ft. Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100+ ft. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 35 ft. Property line 10+ ft. Absorption field. Water main.' 25+ ft. VVater service line 10+ ft. Surface water Wells on adjacent lots' lOO+ft. 10+ff. 100+ ff. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *3.5 ft. Building foundation 40 ft. Water main 25+ ff. Water Service line 10+ ff. Curtain drain .onek.o~m~e~. Surface water lO0+ ft. Wells on adjacent lots 1o0+ ff. Driveway, parking/vehicle storage 5+ ft. F. COMMENTS: *A lot line waiver is on flip at the MOA. G. ENGINEER'S CEI~TIFiCATION I certify that I' have:"deter~flined through field inSPections and r~view of Municipal 'records that the above systems aro in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Douglas T. Kenley Date ~. l 0o ~. COSA Fee '~) Date of Payment / _.)_ - -~ ? -// ~) Receipt Number (~) -~-5 -? 2(~1~'/ (Rev, 11/05) Waiver Fee $ Date of Payment Receipt Number azv. ~L~V. ..,~,.,,,~.~ ~.,.~ THIRD STREET S89° 56' 00"E 132.00' t ~o~ /~ HOUSE LOT 28 ~ 4 0 ,o O LOT 26 O '~-- O ~' 20.0 '~-- O O y WELL Z ACCESS DRIVEWAYS10' UTI LITY ESMT.AccEss DRIVEWAYS N89° 56' 00"W 132.00' LOT 34 UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. USTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MaY CAUSE ERRORS IN SCALE. [] LOT SURVEY SURVEY TYPE SYMBOLS [][] FOU.OA"O".S-B.,LT..ALS~UC,~.E.S_BU,LT · SETREBAR ~::~ ;.~DRA,NAGE ~ ASP.ALT [] PLOT PLAN . . . AS-BUILT... LOT SURVEY, , . TOPOGRAPHY O FOUND REBAR ^ ~ ^ WOOD FENCE ~ CONCRETE [] AS-BUILT . . NO CORNERS SET [~ RECERllFICAllON AS-BUILT , . NO CORNERS SET G ASSUMED ELEV. X X X METAL FENCE ~ WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS F'ROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION ~,.,~,~,~_11~1..' Prepared by P'OTPLA. ,,~ Ur 4/ Robert E. Johns, Jr. & Assoc. ' ""~,'"""", th°""o- ,'",-'~', '""ye,"" ~' V'".;..'"' '"'". Professional Land Surveyors "°" ~'~ ~ "-~"' "" °' ~' ....... " 05/11/11 REJ L dlme~l ~d Infecmot~n ~ ~bo~n hece~/~ HN'"3 ~o~ oth,~-,,,I.,.. '" o ~ Date Drawn: ..' .,. 05/11/11 Grid:Nw0055 w.o. 1368 I, Ral~tt E. John~. ~r.. hereby c~'tl~y ~ot I ~ ~?' hove p~'formed ~n As-guilt ,urvey of the /. 'oo,, ,,* ~ c.j '.,~,4' Legal Description: ,tructure. thl, lot end that all the '~t~" ,,,, ,, .... '.",'; EAGLE CREST #1 .o. oth.... "..~*" TRACT A LOT 27 SGS Ref.# 1111633001 Client Name Douglas Kenley P.E. Printed Date/Time 05/10/2011 13:28 Project Name/# Eagle Crest #1 S/D Collected Date/Time 05/01/2011 16:15 Client Sample 1D Tract A, Lot 37 Hose Bib Received Date/Time 05/02/2011 11:52 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container lD Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/03/11 05/09/11 NRB Waters Department TotalNitrate/Nitrite-N 0.857 0.100 mg/L SM20 4500NO3-F B (<10) 05/04/11 AYC Microbiology Laboratory E. Coli Negative I 100mL SM20 9223B A 05/02/11 DLC Total Coliform Negative 1 100mL SM20 9223B A 05/02/11 DLC DouOas T. Kenley 9806 E. Northstar Circle. Palmer. Alaska 99645 (907) 746-1073 Legal: Eagle Crest #1 S/D, Tract A, Lot 27 Commems: A lot line waiver is requested for the leach field CO to 3.5' of the property line. This will have no adverse effect on adjacent properties. Douglas T. Kenley Douglas T. Kenley P.E. 8176 9806 E Northstar Circle, Palmer, Alaska 99645 (907) 746-1076 WELL AND SEPTIC ADEQUACY TEST Legal: Ea~lle Crest#1 S/D, Tract A, Lot27 Address: Applicant: 10261 Crest View Lane (private), Eagle River, AK BKB LLC. Date of Test: 23-Dec-10 Work Order #: Phone #: 622-3344 10127 System Data: Tank Volume (gallons): 1,000 Number of Bedrooms: 3 Absorption System: Absorption Required (150 gal X #bedrooms) Deep Trench 450 Depth of well (ft.): 240 Static Water Level (ft.): 24 Depth of Casing (ft.): Height of Casing (inches above ground): 240 35 Time Net Time Meter Incremental Total Flow Well Delta Well Monitor #1 Comments (min.) Reading Volume (gal.) (gpm) Level Level (ft.) Tube Level (gal.) (gal.) (ft.) (in.) 11:35 --- 10647 ..... 24.0 -- 7-3/4 12:04 28 10697 50 50 1.8 24.0 0.0 12:14 10 10711 14 64 1.4 24,8 0.8 7-5/8 12:24 10 10724 13 77 1.3 12:39 15 10741 17 94 1.1 12:44 6 10757 16 110 2.7 25.3 1,3 8-5~8 12:57 13 10792 35 145 2.7 10-3/4 13:17 20 10853 61 206 3.1 24.0 0.0 16-9/16 13:37 20 10922 69 275 3.5 29.2 5.2 18 13:57 20 10990 68 343 3.4 29.1 5.1 14-1/2 14:27 20 11093 103 446 5.2 27.1 3.1 20 14:57 27 11195 102 548 3.8 27.2 3.2 31-1/4 15:32 35 11311 116 664 3.3 28.2 4.2 38-1/4 15:43 11 11350 39 703 3.5 38-5/16 *Comment 15:57 14 11396 46 749 3.3 27.1 3.1 16:30 37 11547 151 900 4.1 16:44 24.2 0.2 **Comment 16:55 31-34 System Passed X System Failed~: ?.2~ ~. ':'::'~ Additional Comments: The well produced a total of 823 qallons in 246 minutes or a total production of 3.3 GPM. ' complete recovery in just 14 minutes. *The spetic system passed absorbin~ the system in 72 minutes. ',~. MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division May 12, 2011 Mayor Dan Sullivan Right of Way Section Phone: 907-343-8240 Fax: 907-343-8250 BKB LLC Audrey Mason 18540 Upper McCrary Road Eagle River, AK 99577 Encroachment: Septic leach line in 10' Utility Easement Eagle Crest #1 Subdivision, Tract A, Lot 27, Grid NW0055, 10261 Crestview Lane The Right of Way Division has reviewed a request for a letter of non-objection to an existing septic leach line, which encroaches 5.0' into the 10' Utility Easement. On the drawing prepared by Douglas T. Kenley, P.E., dated May 8, 2011, submitted with the request, the petitioner has shown the leach field. This letter of non-objection is issued with stipulations, and by using it the petitioner is agreeing to the following: 1. Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or injury to any person as a result of the encroachments. 2. All applicable codes and regulations will be observed and maintained within the easement. 3. This letter of non-objection will in no way preclude MOA from full use and enjoyment of its rights within any portion of the easement. 4. Additional and extraordinary costs incurred during any future required construction, repair or reconstruction of MOA improvements to accommodate any or ail of the encroachments shall be paid by the property owner. 5. Maintain letters of non-objection from the following utilities: [] Anchorage Water & Wastewater Utility [] Chugach Electric Association, Inc. [] Matanuska Electric Association, Inc. [] Municipal Light & Power [] Eyecom (Girdwood Cable TV) [] Alaska Communications Systems [] Matanuska Telephone Association [] Enstar Natural Gas Company [] GCI Cable of Alaska [] No letters required All letters of non-objection should 'be retained in your permanent files. 343-8240. If you have any questions, please call me at Sincerely, Right of Way Supervisor Concur ~roperty O er(s) Municipality of Anchorage P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997 .http://www.muni.orq/Onsite Development Services Department On-Site Water and Wastewater Pro.qram **** VARIANCE/WAIVER REVIEW **** WR#: 101289 HA#: 101353 Permit~: PID#: 050-303-24 Legal Description: Ea.qle Crest #1 Tract A Lot 27 Engineer: Applicant: BKB LLC Your request for a waiver of the required l 0 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 3.5 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: 5/13/2011 Approved by: (~~ Rec#: 05528C Amount: $200.00 Date Paid: 10-28-10 **** VARIANCE/WAIVER REVIEW **** Douglas T. Kenley, P.E. 9806 E. Northstar Circle, Palmer, Alaska 99645 (907) 746-1073 May 20, 2011 Municipality of Anchorage On-Site Services 4700 South Bragaw Anchorage, Alaska Re: BKB LLC, Owner Eagle Crest #1 S/D, Tract A, Lot 27 10261 Crest View Lane (Private) Eagle River, Alaska REQUEST FOR COSA FROM CONDITIONAL A Conditional COSA was previously obtained in anticipation of a buyer for the house on the above- described property. The Conditional COSA was for septic and well. An adequacy test was performed on 12/23/10, at which time not all of the pipes could be located and one of the pipes was clogged and full of dirt. The owner decided to wait until spring to locate the missing pipes. Also, the water sample tested by SGS was found to have 18.4mg/L nitrates. Jim Sullivan of Sullivan Wells lowered a camera into the well and found a hole 33 feet down in the well casing, which necessitated the drilling of a new well on 4/11/11. The old well has been abandoned per code. Attached is paperwork for the requested COSA. Dean Construction repaired the clogged sump-2 pipe and J.R. Pumping ran a camera down the length of each trench and determined that the 40' long trench extended 5 ' into the utility easement, which is also their road. We have letters of non- objection to accompany this request. If you have any questions, please call me at (907) 746-1073 or 243-5372. Sincerely, Douglas T. Kenley, P.E. PE #8176 MUNICIPALITY OF ANCHORAGE DEPARTMEI~T OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date /~/,/~ '~/~ ~ 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) .... ~ Locat on (address or d rect ons) ~ ~ . ~ 'i* ' ' . . . ~.. ,~7.., ...,,.~. ?,. >, . ~... ... ~..~ . .. . · (b)' Al~'l~lican{ Ua~e ~'~'/~',~1 ~ / Telephone: Home~~4Z'''~'~''f Business . Applicant AddreSS.,:_ ," i . , . ' . ' ' ' ' ' .; Owner/builder/~ Buyer I=1; Other I-I (explain); (c) ~ Apphcant Is (check one);~endmg Institution [] ~ (d):.'L~hd~in~lnstit~tio~l;.~/~?~,~-z~ ~/4~'7'Z~;~~/ Telephone · ~ ~. ~ ,~. Address -' ~' .... "" ' .... ' (e) Real Estate ComPany and Agent Address Telephone (f) Mail the HAA to the following address: ' . $ & S ENGINEERING -~ ': $RB 196X '-' ' ' ; EAI~LERIVER AK TYPE OF RESIDENCE Single-Family ~ Multi-Family Numbe~'0f Bedrooms' ~ ;' ~ Other · '.. .' attesting tO the legality'and status. . ~:.~ ~, ,/. ,. ~ ~. ~ , .' .- 4.'SEWAGE DISPOSAL..' -. . · ~ .'. Onsi[e~ Public [] Community FI Holding Tank [] Here: ff community'well system, must have written confirmation ~rom the State Department of Envlronmenta~ Conservstion etteSt ng to the le~lit~ and statu~. . . ~; , . ,..~, ~2 Pagelof2,,;?:~:; .:;,,-.i '- ! - ' WATER SUPPLY . . Individual Well,[~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation ' ENGINEERING FIRM PROVID~"~ INSPECTIONS TESTS FILE SEARCH ['"'"~'A AND INFORMATION ' · t : . ', AS certified by my seal affixed hereto and as of the va dat on date shown be ow, verify that my nvest gat on of th s Heat } . .' ,: 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 I * ~:. "' ;~* '; fr6m the Municipality Of Anchorage files and from my investigation and Inspection. the on-site water supply and/or t ...... : wast~waim, disposal s~.stem is in Compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm .-~SJ~S-E~GJ~EF. JJJNG Telephone i "" Addressr *' ' SR B 196X j i~ ... ii.i~ ~': ;~::,~ D~i~' ;: :/;:':':[: ;' ·; EAGLE RIVER, AK 99577 JUL 2- :. ~', . 6..'DHEPAPPROVAL -":.* · ' i . ~.* . Approved for .~/._/~bedrooms · :'~Pl~OVed: '.~.~.~' ' Disapproved Conditional t "' . T~[ms ~ ~ondit, ion~l Appr, oval ~. J .... , '-'~ '-~,,~ .~' . ,. , · .,,~ ~ ,?, ~ ~' :: , . .... · , · ....~ r'. "~ :~';' '" " ~ " CAUTION ' ' ' The Uuncipalily of Anchorage Depa~ment of Health and Environmental Protection (DHEP) Issues Health Authority Approval ce~ilicates based iol~ly upon the representations given In paragraph 5 above by an independent professional engineer registered in lhe 81ate of Alaska. The DHEP does lhis as a coudesy to purchasers ol homes and Iheir lending institutions In order to satisfy ce~ain lederal and state requirements. Employees of DHEP do not conduct inspections or ' ~ analyze data before a ce~ilicate Is Issued. The Municipality of Anchorage Is not responsible tot erro~ or omissions in lhe : . ~. professional engineers wot .~.. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 ~,~'JNICIPALIT'f OF ANCHOP. AO~ DEPT. OF HEALI~I & .Ei"~/I~ONA~NTAI. PROTECTION JUL Legal Description: WELL DATA Well Classification Well Log Present ((~N) Total Dep, th Static Water Level · Casing Height Above Ground Electrical Wiring in Conduitd~N) Separation Distances from Well: To Se'ptic/blok~h'r0"Tank on Lot To NeArest Edge of Absorption Field on ~.ot To Nearest Public Sewer Line /~/Jt/ Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments Cased to If A, B, C, D.E.C. Approved (Y/N) Date Completed 5'-"L.- ~5-/ Yield Depth of Grouting Pump Set At O [/-. Sanitary Seal on Cesing~N) Depression Around Wellhead (Y.~ /~Z> / ; On Adjo!~ing Lots /o~ /~ /~;~ ; On Adjoining Lots /z~ C~ To Nearest Public ~wer TO Nearer ~wer ~ice Line on Lot ~ /+ ~/~ ;Date ~'~ ~ B. SEPTIC/I~ TANK DATA Date Installed Standpipes ~N) Air-tight Caps (~7N) Depression over Tank (Y/..~ Pumping/Maintenance Contract on File (Y/N) ~/~ Holding Tank High-Water Alarm (Y/N) separation Distances from septic/l,4eldi~,~g Tank: Size / Oo O NO. of Compa~ments ~ Foundation Cleanout ~N) ~jDate Last Pum~ 7-~-~ ~ ; for ~ Tempora~ Holding Tank Permit (Y/N) To Water-Supply Well .,,/~)~ / To Property Line ! ~ To Water Main/ser¥ice Line Course A/A To Building Foundation ~--~'"' To Disposal Field ~ ' To Stream, Pond, Lake. or Major Drainage Comments Page 1 of 2 72-026(1 t/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '7-/'~ Width of Field Square Feet of Absorption Area Depression over Field (Y/~) Results of Last Adequacy Test '~- ~'7 ~,~/~,"Z. Type of System Design Length of Field "~ ~ ~ Depth of Field Gravel Bed Thickness ~- '/''''' ~ o '~:'~-" Standpipes Present ,~/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /0/,0 To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /04~ / To Property Line /~"' ' To Existing or Abandoned System on ; On Adjoining Lots '"~z~ / 1 ~ /~ To Cutbank (ii present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA "Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOAend HAAguidelines in effect on lhe date of this inspection Signed S & S ENGINEERING Date JUt. ~ 8 19~' Company~R B }96X MOA No.'f~J'''- O o ..~ EAGLE RIV~_R, AK 99577 Receipt No. qo~3 Date of Payment Amount: $ (a ~' ~'.~ Page 2 of 2 MUNICIPAM'I~' OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 App,ie tion Date GENERAL INFORMATION (a) Legal Description (include lot. block, subdivision, section, township, range) Location (address or directions) (b) Apphcant Name D/~--~-~.~(~'t ~1 [~1~, L~telephone: Home g~"~'~J~'- Business Applicant Address (C) Applicant is (check one): Lending Institution 1-'1; Ownl~r/builder,,~'; Buyer D; Other I'-I (explain); Id) Lending Institution Address /~-- (e) Real Estate Company and Agent Address /~,- "~ Telephone (l) --fv",",",",",'~Tthe HAA to the following address: TYPE OF RESIDENCE Singlo-Family~. Multi-Family FI Number of Bedrooms , ~ Other WATER SUPPLY Indwidual Wel,~, Community Fl Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legalily and status. 4. SEWAGE DISPOSAL Onsite~ Public [] Community I-I Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legalily and status. Page I of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ° ~ ..~ ~._~ AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address ~RI3 Date Telephone Approved for ~L~-.,~ bedrooms b .~.'L/~,~.~"~Date Approved .~_ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) 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 certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 DEPT. Of h~,'~-.., ~' ENVIROt',,g','~NTAL PROTECIION APR 16 Well Classification ~ If A, B, C, D.E.C. Approved~/N) Well Log Present ~).,~) Date Compleled .-~" "~' '~'~" Yield ~'~--~'~'~'J ~-,r ~,~(/[ Total Depth .~/'~3 ~ Cased to ~'/'~ · P' Static Water Level ~ ' Casing Height Above Ground /¢,,~ "~ Electrical Wiring in Conduit {~kL) Separation Distances from Well: Deplh of Grouting Pump Set At ~'~.~'~'~'- ' Sanitary Seal on Casing~.~l,) Depression Around Wellhead To Septic/Holding Tank on Lot /'~"~ / ~ ; On Adjoining Lots To Nearest Edge of Absorptio~ Fiel(~ or~ Lot ./oO · '"' ; On Adjoining Lots ,,",~ To Nearest Public Sewer Line~ ~'~,"/,0.- To Nearest Public Sewer CleanouVManhole /~'.~"~"'- To Nearest Sewer Service Line on Lot ~V'~.- Water Sample Collected by . "~'("~ ~"~'"$/~'~"~"~/'~' ;Date Water SamPle Test Results ~ ~ ~, ~'fl.~,Tt~ (2 ~' Comments B. SEPTIC/HOLDING TANK DATA Datelnstalled ~./~'~/~/" Size_~O0 No. of Compartments Standpipes {~'N,) Air-tight Caps ~,,N) Foundation Cleanout ~ Depression over Tank.~) Date Last Pumped ,,~""~,,""' Pumping/Maintenance Contract on File (Y/N)-- _,~ ; for v~-,/,~ Holding Tank High-Water Alarm (Y/N) ~'? Temporary Holding Tank Permit (Y/N) ~'~.~' Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Comments · /43d ! To Building Foundation ,,,,,1~/' /~, /a-- 'To Disposal Field ~ ! .~.?,.-/,,~;j_ /O (7~- TO Stream, Pond, Lake or Major Drainage Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field ~" Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /4:;)0 ' To Building Foundation ~'O · Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~-- Standpipes Presenl~/N) Date of Last Adequacy Test To Property Line /~) · F To Existing or Abandoned System on '~/~'~'~'~'~'~'~'~'~'~' . ; On Adjoining Lots Lot TO Water Main/Service Line p./'//~q--- ~0 'iL-) To Cutbank (if pre~e, n,) To Stream/Pond/Lake/or Major Drainage Course \ To Driveway. Parking Area. or Vehicle Storage Area ~ · 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) /i "Pump Off" Level at · ~ / Vent (Y/N) //?t//¥//~c.- Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or confor mod to all ~O~./A/a,/fd HA~..qy.~.!?~'in effect on Ihe date of this inspection. Signed ~ Date [~/~..'/ Compa y ......... Receipt No. Date of Payment Amount: $ Page 2 of 2