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HIGHLAND HILLS #2 BLK 2 LT 7
Hilond Hills Block Lot 7 #050-382-38 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201208 PID Number: 050-382-38 Dwelling: X Single Family (SF) El with ADU 1771 Duplex (D) El Two Single Family Project: FI New NO] Upgrade Name O'NEIL THOMAS & PATRICIA ABSORPTION FIELD 1771 Deep Trench F-I Wide Trench FE11 Bed E] Mound Site Address 5823 Hiland Rd Eagle River El Other Phone Number of Bedrooms Soil Rating depth from original grade 1 3 0.5 GPD/SF JTotal +3.6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade +4.1 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot HIGHLAND HILLS #2 2 7 Fill added above original grade 7.6 Ft. _Gravel Gravel length 45 Ft. Township Range Section width 20 Ft. Beds: Number of Lines 5 Distance between lines 4 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station on Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 900 FI? Ft. Well NA >100' NA NA TANK 0 Septic 0 S.T.E.P. El Holding El Other Manu� f�t Capacity Surface Water NA >100' NA NA Gal, Material Number of compartments Lot Line NA >10 NA NA NA Foundation NA >10' NA NA LIFT STATION Manufacturer acity Remarks 2' of MOA filter sand below septic rock Gal. MASS Type I [A ERS below filter sand, thickness varies Alarm location Electrical installe PIPE MATERIAL House totank Tank to 3034 drainfield Installer homeowner Drainfield 3034 CO/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspdates:ection 1st 7/17/2020 7/22/2020 �d Location and description 2 3`d 7/23/2Qj '4 1h 7/27/206 nail in tree near bed construction ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date - - ;:Fat-- - - TH ......n......... rbsq- T .s Date 7- No. CE11 04 4", Septic System Approved Date PROF Note: this approval does not include well permit requirements. kF\"-v !01 T Lot 8B NEIGHBORING WELL IS > 100' FROM PROPERTY LINE THE SEPTIC TANK IS ON A BENCH LOCATED HIGHER THAN THE PROPOSED SEPTIC FIELD I G v� ABANDONED 58' L x 30" W x 48" TRENCH I A N 1500 GAL STEEL SEPTIC TANK INSTALLED 2017 a FCO UNDER DECK DESIGN PARAMETERS BEDROOM: 3 (450 gpd) SOIL RATING: 300 SF/BR AREA REQUIRED: 900 S.F SYSTEM TYPE: BED 20' X 45' YIELDS 900 SF xW 1 C� to O Tn 0 0 100' NEIGHBORING SEPTI IS > 10' FROM PROPERTY LINE EXTENT OF AREA FLATTENED BY HOMEOWNER TO ACCOMMODATE A GREENHOUSE AND GARDEN 100' 20' L x 45' W x 6" EFFECTIVE DEPTH BED. BM MONITOR TUBES IN TWO CORNERS, AND CLEAN OUTS AT EACH END OF THE PERFORATED PIPES NEIGHBORING SEPTI IS > 10' FROM a FLAT PROPERTY LINE / TOE OF MOUND GAR AGE SCOPE OF WORK 1. BASED ON A PERCOLATION TEST PERFORMED IN JUNE 2020, A 20' x 45' BED WAS CONSTRUCTED. 2. THIS BED IS WIDER THAN 15'. SPECIAL CONSIDERATION WAS GIVEN DURING CONSTRUCTION TO ENSURE THE BOTTOM OF THE BED WAS NOT TRAVELED ON BY EQUIPMENT TO AVOID COMPACTING RECEIVING SOILS. 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. 5eptic As Built Drawings Prepared for PATRICIA AND THOMAS O'NEIL 5823 Hiland Road Eagle River, Alaska 99577 HIGHLAND HILLS UNIT 2 BLOCK 2 LOT 7 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUCIAK, ALASKA 99567 (907) 355-9820 OSP201208 DATE: 7/29/2020 DRAWN: CLT SCALE: 1" = 50' PID: 050-382-38 SHEET 2 OF 3 ONCE VEGETATION WAS CLEARED FOR THIS PROJECT, THE TEST HOLE LOCATION \ WAS MORE ACCURATELY DETERMINED IN RELATION TO THE BED r D r W NEIGHBORING SEPTIC AREA >10' FROM PROPERTY LINE NEIGHBORING X WELL RADIUS r� 0 SCOPE OF WORK 1. BASED ON A PERCOLATION TEST PERFORMED IN JUNE 2020, A 20' x 45' BED WAS CONSTRUCTED. 2. THIS BED IS WIDER THAN 15'. SPECIAL CONSIDERATION WAS GIVEN DURING CONSTRUCTION TO ENSURE THE BOTTOM OF THE BED WAS NOT TRAVELED ON BY EQUIPMENT TO AVOID COMPACTING RECEIVING SOILS. 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. 5eptic As Built Drawings Prepared for PATRICIA AND THOMAS O'NEIL 5823 Hiland Road Eagle River, Alaska 99577 HIGHLAND HILLS UNIT 2 BLOCK 2 LOT 7 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUCIAK, ALASKA 99567 (907) 355-9820 OSP201208 DATE: 7/29/2020 DRAWN: CLT SCALE: 1" = 50' PID: 050-382-38 SHEET 2 OF 3 CONNECT TO EXISTIN( SEPTIC TANK ORI( MARK A B MT1 74'-6" 50'-0" MT2 108'-10" 88'-8" C01 91'-6" 66'-5" CO2 94'-5" 76'-5" )P OF FINISHED GRADE 104.6', TO \INTMN 3' MINIMUM COVER OVER BED. DE SLOPES MINIMUM OF 3:1. THE ?EA HAS BEEN TOPSOILED AND -EDED PE INVERT 101.1' DTTOM OF SEPTIC ROCK 100.6' LAYER OF MOA APPROVED _TER SAND, BOTTOM OF SAND 98.6' .L ORGANIC MATERIAL WAS =MOVED TO EXPOSE 3SORBING SOILS THEN ERS _L WAS IMPORTED. ST HOLE ELEVATION 96.2' ---- ADJUSTED WATER LEVEL 95.5' 27 JUNE 2020 WATER LEVEL 94.5' BOTTOM OF TEST HOLE ELEVATION 92.1' TEST HOLE DUG JUNE 18, 2020 WATER LEVEL MONITORED TILL JUNE 27, 2020 SCOPE OF WORK: 1. PRIOR TO CONSTRUCTION A TEMPORARY BENCHMARK WAS ESTABLISHED. THE BENCHMARK IS A NAIL IN THE SIDE OF A TREE NEAR THE BED CONSTRUCTION SITE. THIS BM WAS USED TO ESTABLISH ELEVATIONS FOR THE PROJECT. ORIGINAL GRADE ELEVATION WAS ESTABLISHED AT THE SITE OF THE TEST HOLE. THIS BENCHMARK WAS NOT DISTURBED THROUGHOUT THE LIFE OF THE PROJECT. 2, ALL SURFACE ORGANIC MATERIAL WAS REMOVED UNDER THE BED AREA, AS WELL AS THE EXTENTS OF THE MOUND OUT TO THE TOE OF MOUND AS SHOWN ON SHEET 2. 3. ENGINEERED RECEIVING SOILS (ERS) WAS IMPORTED TILL THE ELEVATION OF THE BOTTOM OF SEWER ROCK WAS REACHED. ERS WAS MASS TYPE II OR II—A. 4. SEWER ROCK AND PERFORATED PIPE WAS LAID LEVEL. THE BOTTOM OF SEWER ROCK IS 5.1' ABOVE THE WATER ELEVATION AFTER THE CONCLUSION OF THE 7 DAY WATER STUDY. 5. FILL TO A DEPTH OF 3' ABOVE SEWER ROCK WAS PROVIDED. SIDE SLOPES ARE A MINIMUM OF 1:3. TOPSOIL COVER HAS BEEN SPREAD AND GRASS SEEDING WAS DISTRIBUTED TO PROVIDE VEGETATION. Septic As Built Drowings Prepared for PATRICIA AND THOMAS O'NEIL 5823 Hiland Road Eagle River, Alaska 99577 HIGHLAND HILLS UNIT 2 BLOCK 2 LOT 7 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 355-9820 OSP201208 DATE: 7/29/2020 DRAWN: CLT SCALE: 3" = 1' PID: 050-382-38 SHEET 3 OF 3 OF q�� �♦1 49T" ♦10 „ CURTISTOWNSEND.-ff 1 No. E 1 904 i • ♦♦iww� Z9l �?: ΔSURVEYOR'S CERTIFICATE MUNICIPALIry OF ANCHORAGE On-Site Water & Wastewater prograrr PO Bor 196650 4700 Etmore RoadAnchorege, Arasl(' 99919-66q0 phone: (907) 94e"7904 Fax: (907) g43-7gs7 http:/1www. runi,org/onsite On-$ite \Alastewater Disposal System permit Permit Number: OSp20120g Work Type: Septic Upgrade Tax Code Number: 0503829S000 site Legal Address; HTGHLAND H|LLS #2 BLK 2 LT z G:0s58 Site hllailing Address: SB23 HILAND RD, Eagle River Owner: O'NEIL THOMAS E & pATRtCtA Design Engineer: HKLUTNA HNGINEERING, LLC- This permit is for the construcfion of: M Disposar Fierd H septic Tank fl Hording Tank E erivy Received By: E Private Wetl fl Water $torage n^1^.udtu. n ^+^.ud(9, Effective Date: Expiration Date: Lot Size ln So Ft: Total Bedrooms: 7t16{2020 7/16/2021 928'19 All construction shall be in accordance with: 4. From October 15 to April 15, a subsurface soil absorp shail be elther: a. Opened and Closed on the same day, or . b Covered, sealed, and heated to prevent freezing special Provisions: since ihe groundwatermonitoring tube is less than 5 ft from the proposed drainfield, it shallbe removed at the time of drainfield construction in ordir to not create " "onorit to-troundwater. please takethis into account when establishing the benchmark. .t , ,: . '-it:: .'7'.: :'' uf z.u, 7 eparnlle n t lssued By: Municipality ®f Anchorage P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 e (907) 343-7904 a Fax (907) 343-7997 http://www.muni.org/Onsite Development'Services Department On -Site Water and Wastewater Section \�\Cllf ^ i/V H Department * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV201040 COSA#: Permit#:OSP201208 PID#: 050-382-38 Legal Description: Highland Hills #2 Block 2 Lot 7 Engineer: Eklutna Engineering Applicant: Thomas & Patricia O'Neil Your request for a waiver of the required Category III Nitrogen -reducing system for an ERS design has been approved. See engineer's waiver request for justifications. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all code requirements be met or another approval from this department. ............................................... ■ ............................. ■ t Waiver is Granted: X Waiver is not Granted: Date: 1 b Approved by: 'Name of Reviewer ......................................'........................................ t **** VARIAN C E/WAIVER REVIEW **** ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-382-38-000 Property owner(s) O'NEIL THOMAS E & PATRICIA Mailing address PO Box 773174 Eagle River AK 99577 Site address 5823 Hiland Rd Eagle River AK Day phone Legal description (Sub'd., Block & Lot) HIGHLAND HILLS #2 BLK 2 LT 7 Legal description (Township, Range & Section) Lot Size 92,819 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field 0 Initial ❑ Single'F SF) 0 Septic Tank ElUpgrade 0 (/wo ADU Duplex (D) ❑ Holding Tank ❑ -� Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Gde,§. ; (Signature of properVowner or authorized agent) Permit/Rush Fees: Date of Payment: 30 2620 Receipt Number: 00 33 &b - Permit No. C S P_ 01009 2, W2, z-, Waiver Fees: 1� 81, 1 5 _ Date of Payment: 7 ZO 20 Receipt Number: 0'7%59 72, Waiver No. 0S V Z0.'( 0 y 0 G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201208, Rebecca Carroll, 07/16/20 Name: Eklutna Engineering Lab ID#: M200392 Mailing Address: 15162 Mountain Rd Date Sampled: 05/12/2020 Chugiak, AK 99657 Time Sampled: 1430 Legal Description: Highland Hills #2 B2 L7 Sampled By: CLT Date Received: 05/13/2020 Sample Site Location: Inside Bathroom Sink Time Received: 1041 Health Guard I Parameter Method Result Unit MRL MCL Date Total Coliforms Colilert (SM 9223B) A --- --- --- 05/14/2020 E. coli Colilert (SM 9223B) A --- --- --- 05/14/2020 Total Nitrate/Nitrite – N TNTplus 835/836 (Hach 10206) 1.84 mg/L 0.200 10.0 05/15/2020 Arsenic Arsenic by ASV EPA 7063 6.565 µg/L 1.000 10 05/13/2020 Method Reporting Limit (MRL): the lowest concentration that can be reported reliably Maximum Contaminant Level (MCL): highest acceptable level in public water systems as set by EPA mg/L: milligrams per liter; 1/1000th of a gram µg/L: micrograms per liter; 1/1,000,000th of a gram Absent (A): none of this type of bacteria was detected Present (P): one or more bacterial cells of this type were detected Results Reported By: _____________________________ Patience Lynch Laboratory Analyst Reviewed By: 9131 E Frontage Rd, Ste 15 Palmer, AK 99645 (907)745-3005 matsutestlab.office@gmail.com Signature: Email: Lynne Hill (May 20, 2020 16:29 AKDT) Lynne Hill matsutestlab.office@gmail.com Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201208, Rebecca Carroll, 07/16/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201208, Rebecca Carroll, 07/16/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201208, Rebecca Carroll, 07/16/20 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Septic System Owner-installer Agreement The On-site Water and Wastewater Section (On-site) may issue an approval for a homeowner to perform work on an on-site wastewater disposal system to serve that individual's owner- occupied, single-family or duplex home if the homeowner meets and agrees to the following requirements: 1. The property owner and excavation equipment operator may perform work on no more than one owner-installation project in a 12-month period. 2. Owner’s projected active involvement with the installation: _______________________________________________________________________ _______________________________________________________________________ 3. The name of the excavation equipment operator: ________________________________ 4. I agree that there will be no monetary compensation for installation services rendered. 5. The name of the inspecting engineer: _________________________________________ 6. I agree to discuss the following items with the inspecting engineer: a. Permit design criteria and specifications. b. Inspection requirements set forth in AMC 15.65.070. c. Advance notice given to the On-site Water & Wastewater Section for all required municipal inspections (AMC 15.65.070A). 7. I agree to have the project-specific On-site Wastewater Disposal System Permit available at the construction site for the duration of all related work. 8. I agree that if the system is an advanced wastewater treatment system (AWWTS), I will obtain additional installation instructions and approval from the equipment distributor. As owner of (legal description) ________________________________________________ I agree that the information above is true and accurate. Owner’s printed name: _________________________ Owner’s signature: _________________________ Date: ________________ Complete installation of the septic bed as required by the MOA permit. Thomas O'Neil Curtis Townsend TEO 07/17/20 12:42 PM AKDT dotloop verified TEO 07/17/20 12:42 PM AKDT dotloop verified TEO 07/17/20 12:42 PM AKDT dotloop verified HIGHLAND HILLS #2 BLK 2 LT 7 Thomas O'Neil 07/17/2020dotloop verified 07/17/20 12:42 PM AKDT Thomas E O'Neil dotloop signature verification: dtlp.us/6WZF-xDrm-D3cE 30' i 30' 1 :_ ii r :::?, r=r 4. i:,,. 1 20' I —20' WIDE S 890 39 07" W 202.42' I j SKI TRAIL l EASEMENT 1 10' WI I \ \ I UTILI \ I EASEM I i ` I I \ O LOT 7 SEPTIC h q PIPES X s 0 0 @ ��G �� d) C -*)I cp, O IIm, PP 1,,\ 1jE\ 2Z -50.0�l GAS RAMPMETELE W00(TE��' 24BoGARAGE — 36 3'x28.2� N n I \\ ® I I � I I I � a 1 m I a M II CAR I I I i I O SHE 20 L.�_ 20' WIDE m I i DEPT. OF - ' —ll— I HIGHWAYS - II EASEMENT _ I I I o I I W I I I I I � I I I I � 1 I I I I N 890 34 ' 50 " E 2 30' I 30 I 11 7 Al SURVEYOR'S CERTIFICATE I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY AS DESCRIBED ON THIS EXHIBIT AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT ENCROACH ONTO THE PROPERTY ADJACENT THERETO, THAT NO IMPROVEMENTS ON THE PROPERTY LYING ADJACENT THERETO ENCROACH ON THE SURVEYED PREMISES AND THAT THERE ARE NO ROADWAYS, TRANSMISSION LINES, OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS INDICATED HEREON. DATED THIS THE �� DAY OF AT ANCHORAGE, ALASKA. li i I DE —eJIO I NOTE: DIMENSIONS SHOWN ARE ALASKA II 3/.97' TY ; ; II STATE PLANE COORDINATE SYSTEM, ENT 1 I NAD83, ZONE 4, GRID BEARINGS AND DISTANCES. LOT 7, BLOCK 2 II 'i A II li HIGHLAND HILLS SUBDIVISION (3,I ''I 111 I'I UNIT NO. Ili 1 I °°° 1 I PREPARED BY: li , GRID: tloning �`" Ill ; I 1 I 7'—I, I — ervloss Ino. -_ DRAWN BY: CHECKED BY: 2603 Blueberry Road L. LAMAS L VAUGHAN Anchorage, Alaska 99503 DATE DRAWN: , I 907-569-2000 PHONE , AN -TO I� 1 I 5/1/2020 D SHED X 12' II '; II LEGEND , PRIMARY MON. RECOVERED _---91.7 �� I ; 1 II • REBAR RECOVERED WELL 0 SEPTIC PIPE P -- OVERHEAD POWER LINE CULVERT PORT - ;/; OF 20' WIDE 20 I ,; G3 SKI TRAIL i ' I 'I rr$ ° j *�48- *�I EASEMENT I'; / °°8°°° iiio LINDSEY S. VAUGHAN o o LS -12318 0 AVgJ- ,1 10' WIDE —�IIIO 1 UTILITY 11 i II ��A °�� Aw R01 0FESsIONAL EASEMENT I Aw I I I I I IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. N0. REVISION DESCRIPTION BY I DATE AS -BUILT LOT 7, BLOCK 2 HIGHLAND HILLS SUBDIVISION UNIT NO. 2 PLAT NO. 74-14 - ANCHORAGE RECORDING DISTRICT PREPARED BY: SCALE: GRID: I" = 60' ER SW0558 AA CTLORA1. l-OSITIONING SERVICES mc. DRAWN BY: CHECKED BY: 2603 Blueberry Road L. LAMAS L VAUGHAN Anchorage, Alaska 99503 DATE DRAWN: SURVEY WE 907-569-2000 PHONE 5/29/2020 5/1/2020 907-569-2002 FAX JOB NO: SHEET: S20501 I OF I Municipality of Anchorage 7307 - On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP-171127 PID Number: 050-382-38 Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade Name: Thomas and Patricia O'Neil A ORPTION FIELD ED Dee Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 5823 Hiland Road, Eagle River 99577 Other Phone Number of Bedrooms Soil Rating Total depth from original grade 9076225823 3 D/sF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot Highland Hills 2 2 7 Fill added above original grade Ft. G lel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dis ce between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between nches From Tank Field Tank Line Ft' t. Well 100+ - _ _ _ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Tank 11500 Capacity Gal. Surface Water 100+ - - _ Material Steel Number of compartments 2 Lot Line 5+ - - - NA Foundation 5+ _ - _ L STATION Manufactu Capacity Curtain Drain None Known Gal. RemarksTank Replacement only Pump on level at in. Pump evel at in. High water alarm at in. Pump make and model Electrical Inspectio erformed by PIPE MATERIAL House to tank Tank to D3034 drainfield Installer Territory North Drainfield CO/MT Inspector Luke Randall, P.E. BENCHMARK (Assumed elevation) 100.00 ft Inspection 1't 6/30/17 Location and description 2 Middle Deck Pier Support between points A&B s� 4th COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date OF 44-44 .`� 49TH �••f-• .............................,.... '• Lucas M. Randall Approved Date `!� �0l `' ��• CE 12595 �' s Inspection Report_9-1-12.doc „,;�,°' PERMIT NO: OSP171127 LOT 813 PARCEL ID: 050-382-38 n Q O ry z J r — — — — • — — • — — • — — .— — • — — • — — . _ I PROPERTY LINE NOTE: 1. ALL REQUIRED SEPARATION DISTANCES FOR THE NEW SEPTIC TANK WILL BE FIELD VERIFIED AND ENFORCED AS PER MUNI REQUIRMENTS. DESC A B FCO 8.8' 18.7' COt 27.7' 34.5' Ti 30.5' 37.1' T2 40.5' 46.9' DBL1 42.6'48.8' DBL2 44.0' 50.3' DBL 2 DBL 1 T2 Ti / I , I PROPERTY LINE 1 I I I I I I i I l 1 \ I \ \ I \ i LOT 12 \ FCO NOTE: LOT 7 h �1. POINT A AND B ARE THE OUTSIDE North { \ \ \I CENTER OF THE OVERHANG COLUMN SUPPORTS A EXISTING 3 BEDROOM HOME I 7 1 I \EXISTING GARAGE LOT 13 �! WELL 1 ♦!'`�F....... AV . i*�..4�1 *it I { I \ I 00 .......:.... ......... I... { 0,�'� : Luca, M. Randall ; �� 1 595 Aw AV Aw RO ESS 10' T&E EASEMENT ' \ 1 7• I 100' RADIUS FOR WELL DISTANCE 1 l EDGE OF DRIVEWAY DETERMINATION (TYP.) I THOMAS AND PATRICIA O'NEIL SCALE: 1"= 40' AS -BUILT RECORD LOT 7, HIGHLAND HILLS 2, BLK2 SEPTIC TANK REPLACEMENT LMRJ SHEET LMR w MA 1 9/19/17 PERMIT NO: OSPI7112-7 TOP OF TANK AT INLET 012.68 — 2" R1610 INSULATION INVERT OF BUNG AT INLET 62.05 NOTE: 1. ELEVATION BASED ON TBH - PECK PIER = 100.00 PARGEL ID: 050-552-38 FINISHED &RADE Q6. -Io TOP OF TANK AT OUTLET 012.52 __It---- ------------------------------------------- NEN 1500 OALLONINVERT OF BUNG STEEL T/ AT INLET I \_ ql.bq THOMAS AND PATRICIA O'NEIL PREPARED LMR SHEET AS -BUILT RECORD LOT 7, HIGHLAND HILLS 2, BLK 2 REVIEWED MA SEPTIC TANK REPLACEMENT DATE 7/11/17 MUNICIPALITY OF ANCHORAGE �„t On-Site Water& Wastewater Program PQ Box 196650 2.700 Elmore Road ., Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 httpalwww.muni.org/onsite cpartrnent On-Site Wastewater Disposal System Permit Permit Number: OSP171127 Effective Date: 6/19/2017 Work Type: SepticTank Upgrade Expiration Date: 6/19/2018 Tax Code Number: 05038238000 Site Legal Address: HIGHLAND HILLS #2 BLK 2 LT 7 G:0558 Site Mailing Address: 5823 HILAND RD, Eagle River Owner: O'NEIL THOMAS E & PATRICIA Lot Size in Sq Ft: 92819 Design Engineer: Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field E Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: "'e�',(��i (2.'L&'( Date: ►o t 7 MUNICIPALITY OF ANCHORAGE 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. 050-382-38 Property owner(s) Thomas and Patricia O'Neil Day phone 9076225823 Mailing address PO Box 773174, Eagle River AK 99577 Site address 5823 Hiland Road, Eagle River 99577 Legal description (Sub'd., Block & Lot) Lot 7, Block 2, Highland Hills#2 Legal description (Township, Range & Section) Lot Size 92819 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: ( all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: S9/5.190 Waiver Fees: Date of Payment: (0110/0 Date of Payment: Receipt Number: 035378 Receipt Number: Permit No. OSP I Waiver No. Permit App_ • • : .. LOT 8S / I / . - - . - - - - - . - - • - - • - - • - - • — � Ir, / I/ PROPERTYLINE NOTE: 1 r I.ALL REQUIRED SEPARATION DISTANCES 1 / FOR THE NEW SEPTIC TANK HILL BE FIELD 1 r I I VERIFIED AND ENFORCED AS PER MUNI REQUIRMENTS. I PROPERTY LINE I I/11— I\ I I1 GOlMT 1 l . \ • 1 , \ 1 `1 \ 1 , 1 � \ \ 1 n0� � \ , IYEXISTING CLEANOUT 4 START OF 1 \ •• \ ABSORPTION FIELD Q I INSTALL DOUBLE CLEANOUT 1 `♦ Z I \ \ I NEIN 1,500 GALLON TANK ` J \\ \ ; LOT 12 = I \ SEPTIC LINE LOT -1 1 \\ \ i• - - \ FOUNDATION CO 1 — \.-_ \— —_, 1 North r 1444k • N\ I II��OII I // \ EXISTING 3 BEDROOM HOMEI II • A 1 S 1 I // 1 `• l I / \EXISTING GARAGE / �T 15 I l r .� I r • f I HELL 111 *• 4 TH7 * 0 I I I / / 7 \ \ 004 .V¢e: oo .....00 ` ; f,013;4 Lucks M. Randall �� • _.. 11 1 I 10'Ta E EASEMENT /a O AOFES` �-+ I' • IDOT ROH LINE / / • I (20'EASEMENT FROM PROPERTY LINE) , • / 1 i / `• I I r / 1 / 1 I / • 1 — / 1 N — / /..„/\ - 1 • 100'RADIUS FOR NELL DISTANCE '` DETERMINATION(TYPE 1 ---.. EDGE OF DRIVEHAY 1 I \ --.------------ PREPARED LIAR SHEE- THOMAS AND PATRICIA O'NEIL SCALE: 1"=40' REVIE LAR SITE PLAN LOT 7, HIGHLAND HILLS 2, BLK 2 REVIEWED MA SEPTIC TANK REPLACEMENT DATE: 6/6/17 NOTE: I. NEW SEPTIC TANK TO CONFORM WITH ALL REQUIREMENTS WITHIN CHAPTER 15,SECTION 15.65.050 SEPTIC TANKS AS WELL AS DEC STANDARDS. 2. IF SEPTIC TANK 15 NOT INSTALLED AT LEAST 4' BELOW THE EXISTING SURFACE DUE TO EXISTING CONDITION CHALLENGES, INSULATION WILL BE PROVIDED BY THE INSTALLER AS PER MUNI REQUIREMENTS. 3. EXISTING TANK SHALL BE DEMO'D AND DISPOSED PER MUNI REQUIREMENTS. 4. A DOUBLE CLEANOUT WILL BE REQUIRED BETWEEN THE TANK AND THE ABSORPTION FIELD. 4'MIN(SEE •TE 2 I - ASSUMED EXISTING GROUND SURFACE TO EXISTING ABSORPTION FIELD NEW 1500 GALLON STEEL TANK TO HOUSE elSEPTIC SYSTEM PLAN VIEW ft �•QF •ALSk1 o*• 49 TH *-57 r,/ • %9�••• Lucas M. Randall ,5: 1j6� CE 1 595 .•• ``� i - \ -11%,, 4 -;.:`,.,. THOMAS AND PATRICIA O'NEIL PREPARED LMR SHEET LOT 7, HIGHLAND HILLS 2, BLK 2 REVLMR PLAN VIEW REVIEWED MA SEPTIC TANK REPLACEMENT DATE 6/6/17 ! 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 INSPI=CTION REPORT '~AME PHONE LEGAL DESCRIPTION ~/[ ~/17~ ,~/~ . ~CATION NE. OF BEDROOMS Well Absorption area / Dwelling PERMIT NO. ~ Manufacturer ~ Material~/ ~ ~ No. of compartments Liq. capacity in gallons Inside length Width Liquid depth DISTANCE TO: ~ell Dwelring PERMIT NO. Manufacturer Material Liquid capacity in gallons Nearest lot line.~ PERMIT NO. ~ DISTANCE TO: /~¢ ~ ~Z Nc. of lines Length of eaoh line ,/ Totallength~jne, Trench width DistancebetweeoHne, ~. ~ Top of tile to finish grade / Material beneath tile ~ ~ ~inches Total effective~ ~"-oabs°rpti°a Length Width Depth PERMIT NO. ~ Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line ~ Class ~ ~ Depth Driller Distance to lot line PERMITNO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption Crea(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicel Et Geophysicol Surveys Z WELL. LOG Material Type ..... UFCOu-~i~ersy sand, ---- .Slack rock ..... O~e.y .L. uck 7,~r-L-im seams, water ~MUNiC~PAI DEPT ENVIRONt OF HEALTP ~ENTAL PRO' IS. WAI'ER WELL CONTRACTOR'S CERTIFICATION: Section Na. & 'E~qTOlq~ Drilling Permit No. A.D.L. No. $. OWNER OF W~LL: ~lr. earl Disotell Add~o~,: SR Box 9385 Ea~,le River, Ak ,i. WEL.~,EPTH: (Hnol)~ ft. 5. DUE OF_ CSM~LET~~,_ ~- 6. ~Ceblo tool E~Otary C]Driven ~ Dug 7. USE;~ Oomgllic 0 Public Supply [~ industry ~ Irrigoflon ~ Recherge ~ Comm~ricel ~ TO~ Well ~ Othor: CASING: {'~ Threaded '~ werded 9. FINISH OF WELL; Typo: Olomoler: SIot/Maeh Size: Lenglh: Sot between ft. O~d ft 13ack filling G r <r,'e I pock Equipmonl used: II. PUMPING LEVEL below lend surface and YIELD -- ft. alter bro. pumping g.p.m. I~'.GROUTING Well Grouted: [] YOl [] No Malorlol: [] Neet Cement L~ Other: 13. PUMP: (if available) HP Length of Drop Pipe fl. capacity g p.m [] su~. [] do~ [] Con,r.~:o, [] O,~or [4 RE MA~K ~ r~ ~ _.rD ucvzon of 20 G]2H 15. Wafer Tomporalure .... o [] F [] C This well wes drilled under my jurisdiction and Ihis report is true Io the bee! el my knowledge and belief; Ma~nuson Drilling AA 5385 ~.0 Box '770504 Eagle River~ Ak 99577 1984 _ F:'IERkt ]: ']" NO: D~'I"E: I!3SLJlED u rq P F-'I... I CrqN T :', C[] NT ~E',"I" F:'H [:)lxll!!~ ,", DIEF~Iq E; [)1\t ,S 'T' I::~ U [.:' T I Q I',1 SIR t::.f.~(.'.~l...l:: I",. ]. VI::.I"~, Al .... "~ '?,..~77 69z1.'"'c? 11 '7 H I GH LAN D v(pv SIE[:"r' ]: []1,,1: 28 'I"[]NI",ISI.-I I F:'," J.."IN 2. ()¢'.I (!3(;!,, FrT, [.)1:::: ,~'~C;F(E:S) 'T' IF:;¢ lEE I1"*.11 !:)IEF:'"FH 't"C) F::' 3: F:'[~: E',O'I""I"CIt'I (l::r'l'' ,, ) Zl. ,, 0 GFd.'iVIEL. )Z_)E:F:'TH (1::"1".) 4. ,, "I"C)'I'~,L. DIEF::"I"I'I (I::'T ,, ) E! ,, 0 C'Fff:;:hVIEL.. I/'J]:DTI'I (F:"I",,) 2.. (3F;~f. iV[...-.I... L.JiZI\I[.iTH (F::"T,) F:~"? ,, 0 [:~I:::~VliF. L.. VE)L..Ut¥Ili!:: (CU ,, Yi)S ,, ) 2~!; ,, 'l"~l',ll< !3]: ZIE (GIM...!3) 1 ~, (X)(),, C) .~..~ SOIl... I::~¢FI*ING (~3[i),, F:I". /BR) :LfSC) '>~'¢,' TrqNl< i'ILI!iFI'' I'-I~.~VIE AT L. IEAF::;T '1"1,4[:) COI,IF'ART'MEixI'T'S II,,..~ .... :11], iF::;;::. ~::::'ll % II"ql ::~ ,, '5 7.5 ~:~ ,, 0 4?. 0 1, .. 0()(). 0 .~..~. 15 () For,'Lh by Ch[~ kluniEil:~a].i.Ly of' ¢~nc:hor'age (Iq[]f./) and 'Lbs:, Si:.a'Le PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS 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 SLOPE SITE PLAN o. 2225-E JUNE,,'% 197! A O.O.NDWATER ENCOUNTERED? IF YES, ATWHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PEt:f~OLA~PION RATE /~(~¢' ~d~/r~ (minute~/hrch) TEST RUN BETWEEN FT AND FT CERTIFIED BY: i~ DATE: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE 0 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-382-38 Legal description Highland Hills #2 Block 2 Lot 7 Site address 5823 Hiland Rd, Eagle River Current property owner(s) Richardson Expiration Date: 1-18-2023 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: p By: L. i Original Certificate Date:/ 2ZZ This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUHMPA U7Y OGSHC HO R „ OCA Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-382-38 Complete legal description HIGHLAND HILLS #2 BLOCK 2, LOT 7 Location (site address) 5823 HILAND ROAD, EAGLE RIVER, AK 99577 Current property owner(s) ALEC D. RICHARDSON Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 5 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 55z Waiver Fee $ Date of Payment lo I& lea COSA # OSS i L1q 3 c� 9- 5)3U_i L/ Date of Payment Waiver # COSA Application 2022.doc Legal Description: HIGHLAND HILLS #2 BLOCK 2 LOT 7 Parcel ID: 050-382-38 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 1984 Total depth 86 ft Cased to 29 ft (INTO BEDROCK) ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 9/20/2022 Static water level at beginning of test 15 ft. Well production at time of test 6.2 gpm Comments B. TANK DATA Measured operating fluid level in septic tank 50" Date of pumping 9/28/2022 i ❑ Required maintenance completed, if AWWTS Comments: 2017 SEPTIC TANK INSTALLED D. ABSORPTION FIELD DATA Which system tested (date installed) 7/2020 ® ALL standpipes present per record drawing Total measured depth from grade 4 ft (max) Measured depth to pipe invert from grade 3_6 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ® Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 2.22 mg/L ❑ Nitrate less than MRL (ND) Arsenic 9.02 ug/L ❑ Arsenic less than MRL (ND) Collected by F wrs Date 9/20/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/20/22 Results E Pass Fluid depth prior to test 0 in (DRY) Water added 530 gal New fluid depth 0 in Elapsed time <5 min Final fluid depth 0. in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in Comments/Deficiencies: 2020 SEPTIC FIELD INSTALLED. NO KNOWN FROST ISSUES. COSA Checklist 2022.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Tank to Property Line > 5' ® Yes if No ft Field to Property Line > 10' ® Yes if No ft Water Main > 10' ® Yes if No ft Water Service Line > 10' ® Yes if No ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' ® Yes if No Community Wells > 200' ® Yes if No If tank or field is under driveway comment below ft ft ft ft ft ft ft ft G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/07122 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & fWGS COSA Checklist 2022.docx ,�'°!Lq� li /AW'1& *: 49 TM ....•:* �j• '. - Curtis Huffman (� �'�'•• CE 128991 �%fl'A- . 10/07/22, •F���•� l�lFOPROFESWO U!)Vi MUNICIPALITY OF ANCHORAGE Development Services Department- Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-382-38 1. GENERAL INFORMATION Expiration Date: ©j sa , a Cu) C Complete legal description HIGHLAND HILLS #2 B LK 2 LT 7 Location (site address) 5823 Hiland Rd Eagle River AK Current property owner(s) O'NEIL THOMAS E & PATRICIA Day phone Mailing address Real estate agent PO Box 773174 Eagle River AK 99577 2. TYPE OF DWELLING: 0 Single Family ( w AD ❑ 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 0 Private Septic 0 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 $ 2-10 (_0 U 10 Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # ()5G20/3'0_L 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 Phone 907.355.9820 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date�<- -''ZCI _a 7H 6. DSD SIGNATURE"""""::: E ate` . System #1 Approved for bedrooms : oa 2 iy No. CE 11984. a System #2 Approved for bedrooms ���assioNa� Disapproved Conditional approval for bedrooms, with the following stipulations: OFq�,tlri,� WATER AND WASTEEVt'ATER ...i .inn.-. r•- ♦ e By:���✓ l�'�i�,Q�� Original inal Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: HIGHLAND HILLS 92 BLK 2 LT 7 If more than 1 septic system on lot. COSA Checklist # of A. WELL DATA ■❑ Well log is filed with Onsite (or attached) Date drilled 1984 Total depth 86 ft Cased to 29 ft lA❑ Sanitary seal is functioning correctly ■❑ Wires are properly protected Casing height (above ground) +12 in. Date of flow test for COSA 5"21202° Static water level at beginning of test 19.5 ft. Comments bedrock starts at 28' depth in well casing B. TANK DATA Age of tank(s) 3 years Tank type/material septic Steel Measured operating fluid level in septic tank 50" ■❑ Standpipes/foundation cleanout per record drawing Date of pumping 10 Jul 2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/2020 ❑■ ALL standpipes present per record drawing Total measured depth from grade 4.0 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) ❑ NIA — pressurized field ❑Q Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comm ents/Deficiencles: new bed installed July 2020 COSA Checklist yellow sheet Parcel ID: 050-382-38 Structure served by this system Well production at time of test 5.4 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes 0 No 0 Coliform bacteria is Negative Nitrate 1.84 mg/L ❑ Nitrate less than MRL (ND) Arsenic 6.565 ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 511212°20 C. LIFT STATION ❑ Required maintenance compl Age of lift station y Lift station materia Comment Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) 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' EJ Yes Community Sewer Manhole/Cleanout > 100' ❑Q Yes if No ft 0 Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' ❑Q Yes if No Absorption Field on Lot? 100' ❑Q Yes if No ft Holding Tank? 100' Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment? 50' Yes if No ❑Q Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main? 75' ❑Q Yes if No ft Z Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑Q Yes if No ft Surface Water > 100' Property Line > 5' ❑Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ft ft ft ft ft Q Yes if No ft 0 Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10'[]✓ Yes if No ft if septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' EJ Yes if No ft If absorption field is under driveway comment below Property Line a 10' ❑Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100'Q❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conform,, MOA COSA guidelines in effect on this date. �pF k,Ak � COSA Checklist yellow sheet ENGINEER`S STAMP *:'49 aL *. .... .. ........... . �Alp I •' Rata .C pROFES M,— ENGINEER`S STAMP Municipality of Anchorage Development Services Dej3aHment Building Safely Division On-Sile Waler and Waslewa~er Program 4700 South Bragaw St, P,O, Box 196650 Anchorage, AK 995t9-6050 www.cl.anchorage,ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D. 050-382-38 1, GENERAL'INFORMATION C~mplele, legal descripUon Ln r 7; Location (site address or directions) 5823 Hilafld ' Road ~bn:entPropertyowne~'({)' Tom & Judy CraiR Expiration Dale: Rln~ ?' ~41nnd Rilln ~? Day phone Mailing address Lending agency Day phone Mailing address Real Estale Agent Kathy Geraci / Greatland Day phone 694-9125 Mailing Address 11/,11 ~31d ~lPnn g'vy F~,l~, g~vor, A~( qq577 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Wa[er Slorage Community Class ~ Public Waler System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding lank Communily On-site Public Sewer The Municipality of Anchorage Development Services Departmenl (DSD) Issues Certil~cates of Health Authorily Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In Ihe State of Alaska. CerUficales of Health Authority Approval are required for the Iransfer of lille (excepl between spouses) for propedies served by a single family on-site wastewa[er disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Cedificeles of Health Authorily Approval are valid for 90 days from Ihe date el' issue for propedies served by a private or Class C well and may be reissued with new waler sample results less Ihan 30 days old. (Cedi[icales may be reissued for a period of up Io one year wilh valid water samples.) Cerlific~[es 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 o~' Ihe validation date shown below, I verify that my Investigation, based on procedures outlined In Ihe Health Authority ^ppmval Guidelines for this application, shows that the on-site water supply and/or wastewaler disposal system Is(are) safe, functional and adequale for the number of bedrooms and type of struclure Indicated herein. I furUter verify fha{ based on the Information obtained I'rom 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 o[ installation.. NameofFirm S & S En~ineer~n_~ AddresslT034 N. Ea~le River Loop Ste. Engineer's Printed Name Robert C. Cowan DSD SIGNATURE ~ Approved for 3 Disapproved. Conditional approval for Phone 694-2979 204 EaRle River, AK 99577 Dale ~ [ 5/0 7. bedrooms. ,~ ~.~ ...... .' ~- ~ bedrooms, with the following slipulations: Additional Comments Altachments: HAA Checklist Septic Sys{em Advisory Well Flow Advisory X Maintenance Agreements SUpplemental Engineer's Report Other Original Cediricate Date: Municipality of Anchorage ~ Development Services Department ~ '° Building ,Safety DIv~ion ' ° On-Site Water & Wastewate~ Program ~ 4700 Sou~ Sragaw St, P,O. Box 196650 Anchorage, AK 99519-6850 www.ci.anchorage,ak.us (9O7) 3437904 HEAL:H AUTHORITY. ~PROVAL CHECKLIST Well type ~ If A, S, or C provide P~ID # '"" Datecompleted?~*/4~ Sonltanjseal(Y/N)~V~ To,*, d,p,~ ~,',. c~ fo ~'~ .. FROM WELL LO(} Date of test Static water level Log (Y/N) Wires properly protected (Y/N) Casing hetght (above ground) AT INSPECTION Well production ~ g.p.m. ~' } g.p.m. WATER SAMPLE RESULTS: Coliform ~) colonies/lO0 rnl. Nitrate ~.~/mg./1. Other bacteria / colonies/100 mL c~*~: ~t ~; e. SEPTIC/I'iO.I.DIN~.TANK DATA Tank Type/M~teriai '~{~}o'rr¢., / Tank size ~ gal. Number of Comparlments Foundation cieanout (Y/N) ~ Depression over tank (Y/N) ". Date of pumping ~//~2"/0'~: Pumper C. ABSORPTION FIELD DATA Date instelled Cleanouts (Y/N) "~ High water alarm (Y/N) Date i~stalted~ Soil rating (g.p.dJftz or ft=fodrm)/~) System type '~(~--~,J~, Length ~5'~ ~ f~ w.~th '~ ft. (~revel below pipe 4 ft. Total depth ~ ft. Eft. absorption area '¢~ Monitoring tube Fluid depth in absorption--/field before test 0 in. Wate~ added~gaL Elapsed Time: ~ min. Final fluid depth ~*in. Absorption rate >= '~'~ g.p.d. Any rejuvenation treathlant (past 12 mo.) (Y/N & type) /%/If yes, give date Depression over field ~ For. ~ bedrooms D. LIFT STATION Date installed 'Pump on" level at/ in. / Datum E. SEPARATION DISTANCES Size in gallons "Pump olr levol at .. Cycles tested Manhole/Access (Y/N) · in. High water alarm level at in. Meets alarm & circuit mqalmments? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankal,~on on lot Absorption field on lot Public sewer main S/,~septic sewice line On adjacent lots . /C~ %' On adjacent lots ~/~ /' ~ Public sewer manhole/ctsanout /V///¢~' Holding tank /V'//]-- SEPARATION DISTANCES FROM SEPTIC/H~J~I~"G TANK ON LOT TO: Building foundation ~ ~'/- Property line ~'._.___~ Absorption field ~" Water main /~//~(" Water sen~ce line /(9 ~'- Surface water / Wells on adjacent lots /'O0 Property line Water Sewice line Curtain drain SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation [O /'/'' Water main /U'//~- Surface water /4~/.e' Driveway, park~hide storage Wells on adjacent lots //0/~ ~ F. COMMENTS I certify that I have determined through field ~n~pectlons and /o HAA Fee $ Date of Payment Receipt Number (Rev. 12~oo) 0 25-o&-f- ~ Waiver Fee $ Date of Payment Receipt Number Parcel I.D. # 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 1. GENERAL INFORMATION Complete legal description Lot 7; Block 2~ Highland Hllls #2 Location (site address or directions) Property owner' Pam6Za Page Mailing address P.O. Bo;c 771843 Hiland Road Eaqle Rive% AK Eagle River, Day phone AK 99577 694-6685 Lending agency Mailing address Agent Eva Loken / REMA× PROPERTIES Address 16600 Cer~:erfigld Drive Su.,L~e 201 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ~ TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: Day phone Day phone 694-4200 Eagle River, AK 99577 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 'rYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide wriften confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Ftonl MOA ¢lgl 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation datE; shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves~i~gation 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 Phone ~;~ ~'¢~ ~ ~ 7 ~' Address Engineer's signature DHHS SIGNATURE /~ Approved for ~/¢-~-~ ~,? bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or anatyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~)25 (Rev. 1/91) Back MOA#21 Legal Description: A, Well Data Municipality cf Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Well type ~7¢._~q ~-¥_ .If A, B, or C, attach ADEC letter, ADEC water system number Log present ~7N) ..~ Date completed d'l ~'~ ~ ~'~ Driller ~-"~A~ ~O~ ~,..~ Total depth % Lc' Cased to "2--~1 ' ~-~, ¢--. Casing height ~/-~ Sanitary seal ¢~/N) ',./ Wires properly protected (~/N) b/ AT INSPECTION Date of test Static water level Well flow Pump level1 FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \~:> ~ Absorption field on lot , \ ~ ~ \ .b- Public sewer main ~ l Z:~ Sewer service line '~/.--~ \~ g.p,m. MUNICIPALITY OF AN(;H~.)RAGE ENVIRONMENTAl- SERVICES DIVISION Rt!CEIVED ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: "7 -- ?.. ~z~ . oi :~ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed \ Cleanouts t~'N) High water alarm Date of pumping Other bacteria S & S ENGINEERING ]~'u;~,~ [~agie River L~p ~oa6 Eagle River, Alaska 99577 Tank size ~, ~ ~ O Compartments Fou ndation cleanout (~)q) k/ Depression (Y('~ Alarm tested (Y/h~) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \, ©c> ~ ¥ On adjacent lots \ ~ ~ k .b Foundation To property line \ ~o I & Absorption field. / / i Water main/service line Surface water/drainage ~, ~ o 72-026 (3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons. Vent (Y/N). "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DIS~ STATION TO: ~ On adjacent lots Manufacturer Manhole/Access (Y/N) .~]8~ tested Su dace water D. ABSORPTION FIELD DATA Date installed l ~ ~z~ Length ~ ~ ~ Width Total absorption area /J¢(~ ~'~, ,Cleanout present ~N) Date of adequacy test '~ -- '?.--'1 ---~% Results~;ffail) Soil rating (GPD/FF) /~o ~l~-- System type '~o'" Gravel thickness 4 t Total depth k~/ Depression over field (Y~ ~',~-~ % for ~ Bedrooms Water level in absorption field before test -1~ ~)"~ After test Peroxide treatment (past 12 months) (Y~.)~ ~ t'z'~°v'/~ if yes, give date SEPARATION DISTANCE' FROM ABSORPTION FIELD TO: Well on lot V ©o To building foundation On adjacent lots ~,~ Surface water Curtain drain On adjacent lots ! D~ ~ ~ Property line ) To existing or abandoned system on lot Cutbank ~/~, Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION have checked, I certify that l ~ Signature ~~, ~N? Engineer's .... ' Loop [~ad No. 204 99,577 / Date /~t'te Fqv~;r' Ai~'d'a ~//2-' ~//~'~''~ or conformed to all MOA and HAA guidelines in ~ff..,e..c, ~; HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # t'-'%~ - ")_~ ,. _~L - ~O-~b ,°_~ NAA# l-/~--'~ ~ ~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner _'~l Mailing Address (c) Lending Institution /~ ///4 Mailing Address _,/~J (d) Real Estate Company and Agent Address Telephone /~ (e) Telephone: (home) Telephone Business Mail the HAA to the following address: (or check here I'q, if hold for pick up.) List contact person and day phone number below: _ ]/ TYPE OF RESIDENCE ily'l~ Single-Faro Number of bedrooms WATER SUPPLY Individual Well~ Community [] Public [] Note:If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site,~ Public [3 Community E] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of thevalidationdateshown below, Iverifythat my investigation of th is Health Authority Approvat shows that the on-site water supply and/or wastewater d'isposal 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 F rm Telephone Z- / Address J~C'C' ~ ~,~c,~,-/ ~_Oc,.G ~,'~ ~.~. ~'.~/)~ Date Z//~///~¢ Engineer's Seal 6. DHHS APPROVAL ' Approved for -,'~ bedrooms by Approved ~(~ Disapproved Terms of Conditional Approval Date Conditional The MunicipalityofAnchorageDepartmentof Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5abovebyan independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: L~ A. WELL DATA Well Classification '~]¢~///~c'TL(L Well Log Present (Y/N) Y' Date Completed Total Depth ~/,~ ~ Cased to~'¢] ' -~- Static Water Level '::Ct:- ~ ' Casing Height Above Ground ~ ~ Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ] l(~ ' To Nearest Edge of Absorption Field on Lot If A, B, C, D.E.C. Approved (Y/N) Depth of Grouting ~k~ Pump Set At ~(',-~ ' Sanitary Seal on Casing (Y/N) ~Y/ Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ /~(~ ; On Adjoining Lots '~'/Z(? ~ To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~-~r- (~]~, ,~,Z¢.~ J~, ]~[ To Nearest Public Sewer Cleanout/Manhole ;Date ~ /i(; /~ '~, B. SEPTIC/HOLDING TANK DATA Date Installed (]/,,¢f"zf Size I ' Standpipes (Y/N) ~' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /(~('-2~-).~(No. of Compartments )/' Foundation Cleanout (Y/N) ¥/' Date Last Pumped ;for ~i Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well //C')t To Property Line -:~.~ To Water Main/Service Line /(])(_.2 ¢ To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field ..~'~ Comments 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Abso(ption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) ~. Results of Last Adequacy Test ¢~/¢;.~.¢m Type of System Des'gn '%~CH Length of Field ~ ~ Depth of Field ~ ~ Gravel Bed Thickness ~' f ~ % Statndpipes Present (Y/N) ~ Date of Last Adequacy Test ~//o,/~'~ / SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /~?-S~ / To Property Line . ~ r.~ To Building Foundation ~'¢,~-~ To Existing or Abandoned System on Lot /~,,/~>'~ 'On Adjoining Lots ~./(~)(? t To Water Main/Service Line /OO ~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Packing Area, or Vehicle Storage Area To Cutback (if present) D. LIFT STATION /~ Date Installed ~, )'t~ Size in Gallons ~ "Pump On" Level at ~ High Water Alarm Level at ~ Tested for '%% ~l;e:r~eMnOtsA Electrical Codes (Y/N)'~ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and inspection. Signed Company Date MOA No. Receipt No Date of Payment Amount: $ 72-026 (Rev. 7188) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 effect on the date of this Engineer's Seal & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 11670 Date Report Printed: FEE 13 89 @ 15:15 Client Sample ID:I,7, SS, IlIGHLAND HTS PWSID :UA Collected FEB l0 89 @ 15:00 hrs. Received FEB 10 89 @ 16:30 hrs, Preserved with :AS REQUIRED Client Name : CORWIN & ASSOC Client Acct : CORWINP P,O.$ NONE REC'D geq ~ Ordered By : J. KRESS Analysis Completed :FEB 13 89 Send Reports to: Laboratory SuperTTj~PHEN C. EDE Released By : ~'.,(~%ta~-' ~___--. 1)CORWIN & ASSOC Special Instruct: Chemlab Roi ~: 4221 Lab Smpl ID: i Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 1.9 ~/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY J. KRESS. I Tests Performed ' See Special Instructions Above UA=Unavailable ND~ None Detected '* See Sample Remarks Above NA= Not Analyzed LT-Less Than, GT=Greater Than bPJNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION J~PPLICATION FOR HE~TH AUTHORITY A~PROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision,__section, township, rare;e) Location (address or directions) -~.,..,, ,~',, -' ~,~_. Telephone - Home Business Applicants Name.. Applicants Address ~, / .....~ ._~ , (c) Appliqant .is (check~ one) Lending Institution Buyer ~--~ ; Other ~--~ (explain); / Address ,;C~ , ,~.: ;~' .~ '~ r- (e) Real Estate Co. & Agaric ~/~ ~--~ ; Owner/builder.S'; Telephone ,~3 J? / /~v D / Address (f) Telephone Mail the HAA to the following address: 2. Type of Residence Number of Bedroome ~ 3. Water Supply Individual Well ~ Community ~--~ Public ~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. S,ewa~e Disposal Onsite ~ Public ~-~ Community C~ Holding Tank ~-] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] Engineering Firm Providin~. Inspections~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, ] 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 theft, 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 regula- tions in effect on the date of this inspection. Name of Firm Address ~ O pHEP Approval Approved for~bedrooms Approved__~__ Disapproved Terms of Conditional Approval CAUTION T"HE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~;~.ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESS--f~-~ ENGINEER REGISTER~iD 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 REQUIRE~ MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANA3~YZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN T~ PROFESSIONAL ENGINEER'S WORK. RR4/eJ/Di8 [Page 2 of 2] (DHEP SEAL) 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 !984 WELL DATA Legal Description: Z~'~ 7 //~/~ Well Classification /~/~, ~ ~e If A, B, or C, D.E.C. Approved(Y/N) Well Log P~esent (Y/N) // Date Completed ~/~/ Yield Total Depth ¢~E / / Cased to 2'~ '. ~e~¢~/~ Depth of Grouting Static Water Level '.~.% / Pump Set At ~'6- ~ Casing Height Above Ground ~_z/ ~ Sanitary Seal on Casing (.y/N)..fi/ Electrical Wiring in Conduit (Y/N) ~/ Depression A~ound Wellhead (Y/N) ~/ Separation Distances f~om Well: To Septic/Holding Tank on Lot /~3 ~- ; On Adjoining Lots. /~3 ~ To Nearest Edge of Absorption Field on Lot /~¢- ; On Adjoining Lots To Nearest Public Se~a~ Line /Z/~9~t_ To Nearest Public Sewer Cleanout/Manhole /Z/~¢_ To Nearest Sewer Service Line on Lot Water Sample Collected By ~/-¢.-T/.ve~¢-,- ; Date Water Sample Test Pesults -~"~7~z& ~¢-~-¥ t_~~ Conmgnts B. SEPTIC/HOLDING TANK DATA Date Installed .~.//~<¢ Size /~ ~/ No. of Cc~pa~tments ~)~ Standpipes (Y/N) .~Y/ Air-tight Caps (Y/N) . ~. Foundation Cleanout (Y/N) ~ .y Depression over Tank (Y/N) /~/ Date Last Pumped ,'¢/~¢~/ Pumping/Maintenance Contract on File (Y/N) ~ ; for __~- Holding Tank High-Water Alarm (Y/N).////~ . ~mporary Holding Tank Permit (Y/N)~/¢//~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To P~operty Line _z/D To Water Main/Service Line C o ur se To Building Foundation ~-~2/ To Disposal Field II / To Stream, Pond, Lake, o~ Major Drainage Coim~nts Receipt ~ Date Paid: Amount: /4%~ -oe- [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/~ ~ Width of Field ~> ~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ~6~ ~ Depth of Field ~ z Gravel Bed Thickness g/z ~ Standpipes Present .iY/N) Date of Last Adequacy Test /L//_J-~ Separation Distance from Absorpticn Field: To Water-Supply Well / W~ / To Property Line /zP / To Building Foundation /~2~ To Existing or Abandoned System on Lot /J/P~ ; On Adjoining Lots z~/~n~_ ~w- To Water Main/Service Line /~P f- To Cutbank(if present) ~_~F To Stream/Pond/Lake/or Major Drainage Course /L/~-~ To Driveway, Parking Area, or Vehicle Storage Area /~ r Comments LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Di.wensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I oertify that I have checked, verified, or ccnforn~d to ali. MOA HAA Guidelines in effect on the date of this ins~ionF A/~ Signed Date / Company ~ ~ ~ ~/~r A ~ 7~?~. MOA No. KB1/d5/s 2-15-84