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STOLLE BLK 2 LT 4
Stolle Block 2 Lot 4 #020-021-10 Certified Drilling Log DOC CO dba luLLLic,fiN WATER WELLS lee- P.O. Box 670269, Chugiak,AK 99567 688-2759 OWNER OF LAND: Casey Hultquist Bore Hole Data ADDRESS: Depth LEGAL DESCRIPTION Stolle Block 2 Lot 4 From To DATE: 9-14-18 0 2 Casing Stickup PERMIT NUMBER: OSP181313 DATE OF ISSUE: 9-12-18 — 2 4 Overburden TAX IDENTIFICATION NUMBER 02002110000 Is well located at approved permit location: FlYes I INo 4 20 Tight Silty Sand & Gravel Method of Drilling: Flair rotary cable tool 20 36 Broken Bedrock Depth of Well: 400' 36 121 Bedrock Gray Casing Type: Steel Wall thickness .250 inches 121 164 Bedrock Green Hard Diameter: 6 inches, depth 44 feet Liner type 164 302 Bedrock Gray Static Water Level: 120 feet 302 322 Bedrock Gray w/Quartz Recovery Rate 1.5 gpm gph 322 376 Bedrock Gray Method of Testing Air - 376 384 Bedrock Gray w/Fractures .5 GPM Well Intake Opening Type: open end Nopen hole — [1 Screened Start feet Stopped 384 389 Bedrock Gray Ti Perforations Start feet Stopped 389 400 Bedrock Black Broken Grout Type: Bentonite Volume: 50 lbs Depth:from 2 feet,to 42 feet Well Disinfected Upon Completion: Zyes 1 no Method of Disinfection: Chlorine 50 PPM Comments: { WATER QUALITY TESTING Coliform Coi/100mL - Nitrates mg/L Arsenic An u0/L Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. DO6 CO dba IruLLL1cIAN WATER WELLS P.O. Box 670269,Chugiak,AK 99567 688-2759 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW OSP181313 Date of Issue 9-12-18 Parcel Identification Number: 02002110000 Legal Description Property Owner Name &Address Stolle Block 2 Lot 4 Casey Hultquist Pump Installation Date: 10-15-18 Pump Intake Depth Below Top of Well Casing: 390 feet Pump manufacturer's Name: F&W Pump Model: 4F07G10301 Pump Size: 1 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: Mike Anderson Disinfected Upon Completion? ® yes (1 no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Martinson Pump Installers Name: Sullivan Water Wells Attention:The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 4oF �0000- ', 49TH f . ...7 00 D � rl op Thomos H. reye b10sr. LS-7625 J-• /- rOfessiono\ao`- // �D\\oo�oo v' i o_ 6eoC fore \\ i 44 N6 \ � ,b0,� l~, \\ \ \ 0 a`L�0 = o, t p ' , c� II N o `' ___I - - 0 N \ --- o, °- \ o, N�moo. Q ---'. o \\ rc\ o� CD Lot 3 \ o 3p \l%o \3 \ o \ r \ Lot 4 \\ �rn \ � N O '�� \ aExisting House co r rr) z 104.5' SSS' ^� O O hry \ cn 2g2' I \ k / 30' 239.77 S81*45'3O / ' Lot 2 L0 1 Ordered by Legend: - s Hultquist Inc. Set Rebar with Cap O Legal Description: As-Built AL. Monument Found Rebar 0 Lot 4, Block 2, Monument 0 Stolle Subdivision Well G roup Septice . ... ..QS.. Pavement : • •:���: �`- Land Surveying Survey Certification: I hereby certify that a Mortgagee's NM a.i Land Development Consultants Inspection was performed on the described property. Overhang E 'u».�!l Notes: It is the owner's responsibility to determine the f Wood Deck Subdivision Specialists existence of any easements, covenants, or restriction ����// Construction Surveying which are not on the recorded subdivision plot. This Concrete ' :'". asbuilt shall not be used for construction or for "?''' Tom H Dreyer. P.L.S. establishing property lines. 124 E 7th Avenue Anchorage, Alaska 99501 Checked by. AK Scale 1" = 40' Drawn by. AR Grid SW3243 (907) 306-8104 mail@S4AK.com Job 2017-2 Plat 81-42 Field Book: 142-28 Date: 11/28/2018 A 2019-000488-0 A Recording Dist: 301 - Anchorage s 1/7/2019 08:54 AM Pages: 1 of 4 A 1111IIII 11 111111 0 111111 IIIllI III H I III 1102-06A .Grid 3243 EN18034 020-021-10-000 ENCROACHMENT PERMIT This permit is between Chugach Electric Association,Inc.,an Alaska non-profit electric cooperative, (herein "Chugach"), whose address is P. 0. Box 196300, Anchorage, Alaska 99519 and Casey D. Hultquist and Megan M.Hultquist(herein"Permittee"),whose address is 10380 Honey Bear Lane, Anchorage,Alaska 99516. 1. Easement. Chugach is the grantee or user of an easement for the construction and maintenance of electrical facilities,as follows: Dedicated by the plat of the subdivision known as Stolle Subdivision, according to Plat Number 81-42, recorded on the 9th day of March 1981, on file in the office of the District Recorder,Anchorage Recording District,Third Judicial District,Seward Meridian,Alaska, (herein"Easement")which pertains to the following described real property: The East Ten Feet(E 10')of Lot Four(4),Block Two(2),Stolle Subdivision,according to Plat Number 81-42, recorded on the 9th day of March 1981, on file in the office of the District Recorder,Anchorage Recording District,Third Judicial District,Seward Meridian, Alaska. Permittee acknowledges the validity of the Easement. Permittee warrants and represents that Permittee is the owner of the fee simple interest in the land subject to the Easement and the following described real property to which the Easement is adjacent: Lot Four(4),Block Two(2),Stolle Subdivision,according to Plat Number 81-42,recorded on the 9th day of March 1981, on file in the office of the District Recorder, Anchorage Recording District,Third Judicial District, Seward Meridian,Alaska, (herein"Parcel"). Encroachment Permit- Page 1 of 4 eRecorded Document 2. Encroachment.Permittee has constructed or purchased the following improvements on or within the real property subject to said Easement: A well that encroaches approximately Two Feet(2')into the west side of said Easement for a distance of approximately One Foot(1'), (herein "Encroachment"). 3. Permit. Chugach hereby authorizes Permittee to continue the existence of the Encroachment in its existing location subject to the covenants set forth in this permit. 4. Indemnification. Permittee shall indemnify and hold Chugach harmless from any claims for personal injury,property damage or other loss arising in any way from the continuation of the Encroachment. 5. No Expansion or Increase. Permittee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior written consent of Chugach. Chugach has no obligation to provide such consent. 6. No Interest in Real Estate Acquired. Penmittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit,has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any other real property. Without in any way limiting the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes of the common law doctrine of adverse possession. This permit creates no interest in the real property subject to the easement. 7. Modification of Utility Facilities. If the electric utility facilities located within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. If such payment is not made within thirty(30)days of written demand for same, Chugach may terminate this permit in accordance with paragraph 9, below. 8. Covenants Running with the Land. The obligations of the Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the land subject to the Easement and shall benefit the Easement. 9. Termination. Chugach may terminate this permit after the giving of thirty(30)days written notice of such termination if: a. The Encroachment is enlarged, increased or extended within the real property affected by the Easement. Encroachment Permit - Page 2 of 4 1111111 I IIIIIIIII 2 of 4 eRecorded Document 2019-000488-0 b. The Encroachment is damaged by any means to an extent of more than thirty percent (30%) of its replacement cost at the time of destruction. c. Permittee fails to make the payment described in paragraph 7, above. 10. Term. This permit shall,if not sooner terminated by Chugach,expire forty(40)years from the date hereof. 11. Entire Agreement. This written permit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all other prior or contemporaneous agreements,oral or written,between the parties. No modifications,amendments,deletions,additions or alterations of the permit shall be effective unless in writing and signed by all of the parties hereto. CHUGACH ELECTRIC ASSOCIATION,INC. PERMITTEE By: c�-Cti�c'�1��� By:_ r.ZY11* Shelly Schmitt, nior Manager Casey ZHultquist Distribution Engineering Date: 1 I y ( ?oI'1 Date: J ! /9 j By: On Megan . Hultquist Date: i 9 Encroachment Permit- Page 3 of 4 I I IIIIII I 1111 11 ill 3of4 2019-000488-0 eRecorded Document STATE OF ALASKA ) )ss: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this ("+ day of i On _, 2019,by Casey D. Hultquist and Megan M. Hultquist. t• _. •. _. CJAJ2 .. ? O'�' Y: 1---- f-140: Notary Public in and for the State o Alaska p,p: `''`'-P'` My commission expires: rt\c..' 2 ?, 20 l Q STATE OF ALASKA ) )ss: THIRD JUDICIAL DISTRICT ) leohe foregoing instrument was acknowledged before me this _*1 day of GGt ,2019,by 5 //9 Sc�0riff , enior Manager,Distribution Engineering bf Chugach Electric Association,Inc., an Alaska corporation ia1f of the corporation. .0: NOTARY':N �uri �%eCri�//� ( �. o `;PUBLIC%:'�- Not Public %n"and for the State of Alaska *cP4'.. p�. ., My commission expires: 't-0/-Z412 oiI ini Illi\\\\\ AFTER RECORDING RETURN TO: Chugach Electric Association, Inc. P.O.Box 196300 Anchorage,Alaska 99519-6300 Encroachment Permit- Page 4 of 4 III IIII I 11111111 IIII 4of4 eRecorded Document 2019-000488-0 Cska ,_(_,M7,.....4'., i1..11 December 7,2018 Casey&Megan Hultquist 7903 Gate Creek Dr. Anchorage,Alaska 99502 Alaska Communications has no objections to the encroachment of the existing well into the 10'T&E Easement located along the eastern boundary of Lot 4, Block 2, of the Stolle Subdivision, otherwise known 10380 Honey Bear Lane, Anchorage,Alaska as depicted on the drawing submitted. Alaska Communications currently is utilizing this easement and has no objection to the encroachment. Alaska Communications hereby issues this letter with stipulations to allow the encroachments of the above mentioned into the easement. Acceptance,(your signature below),and use of this letter of non-objection by yourself,your heirs,your assigns,or your successors,will constitute agreement to the following stipulations: 1. Alaska Communications will be held harmless,now and forever,for any damages or injury to any person or property as a result of this encroachment. 2. Any Alaska Communications facility damaged or destroyed as a result of this encroachment will be repaired at no cost to Alaska Communications. 3. Any costs incurred by Alaska Communications for special construction necessitated by this encroachment will be borne by the property owner. 4. All applicable safety code regulations will be observed and maintained. 5. This letter of non-objection will in no way preclude Alaska Communications from full use and enjoyment of its rights within any portion of this easement 6. Alaska Communications is under no obligation to restore any structure damaged as a result of Alaska Communications full use and enjoyment of its rights within any portion of easements or right-of-ways. Please sign both copies,retain one copy for your use and return the other to Alaska Communications. in w:rely, Larry ' ' ng ring Foreman • - a Communications Outside Plant Engineering, MS#14 600 Telephone Ave. Anchorage,AK 99503 ACCEPTANCE SIGNATURE: DATE: C--7(47-*- / I Z//0/ig Grid RCWC 3243 Mr. Craig Bennett S4 Group 124 E. 7th Avenue Anchorage, AK 99501 Re: Letter of Non-objection, ON BEHALF OF: Casey Hultquist Dear Mr. Bennett: Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the previously constructed well encroaching approximately 2ft into the loft. utility telephone & power easement of Lot 4, Block 2, Stolle Subdivision, also known as 10380 Honey Bear Lane, city grid 3243, GCI WO# 18-0058-70. This letter of non-objection in no way precludes GCI Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right- of-way, including unlimited access for servicing its facilities. Also any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of GCI's facilities to accommodate any or all of the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to me at the address below. Sincerely, C7 Yri-P j Acceptance Date 7//c//f . kus ofoid Manager Outside Plant Design & Data Management GCI Communication Corp 5151 Fairbanks St. Anchorage, AK 99503 4JN��-,PA��r`Op MUNICIPALITY OF ANCHORAGE menr , On-Site Water&Wastewater Program �0 5�, PO Box 196650 4700 Elmore Road s � Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite ° % 1161111 l' I)cpar tincnt On-Site Water System Permit Permit Number: OSP181313 Effective Date: 9/10/2018 Work Type: Well Renewal Expiration Date: 9/10/2019 Tax Code Number: 02002110000 Site Legal Address: STOLLE BLK 2 LT 4 G:3243 Site Mailing Address: 10380 HONEY BEAR LN, Anchorage Owner: HULTQUIST CASEY D & MEGAN M Lot Size in Sq Ft: 48196 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy Q 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 Special Provisions: To close out this permit please submit: 1. Well log 2. Pump install log 3. Water sample results iccejr-- g Received By: I Date: `J l Issued By: l beii^i('4 / • // Date: 7 to t&' Pannone Engineering Services [lc Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com August 22, 2018 Subject: Expired On-Site Water and Wastewater Permit Permit Renewal Request Permit Number: OSP171076 Legal Description: Stolle B2 L4 This is a request to renew the permit for the above mentioned lot. All site conditions remain the same. The construction still will not affect the health, safety, or development of the surrounding lots. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Q SPI'13(3 Igo Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 0‘,4`"ALIr,. , MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program mac" Sr; PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,; http://www.muni.org/onsite I)cparlIncnt 4MCNORPVk On-Site Water System Permit Permit Number: OSP171076 Effective Date: 5/23/2017 Work Type: Well Initial Expiration Date: 5/23/2018 Tax Code Number: 02002110000 Site Legal Address: STOLLE BLK 2 LT 4 G:3243 Site Mailing Address: 10380 HONEY BEAR LN, Anchorage Owner: HULTQUIST CASEY D & MEGAN M Lot Size in Sq Ft: 48196 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy El Private Well ❑ 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 Special Provisions: To close this permit please submit: 1. Well log 2. Pump install log 3. Water sample results Received By --- ( e 'ii. '4111.1( ' r- Date: 5/ 3 / Issued By: 1 L ;.-c( Cc-, Citi+ k_- Date: 5 M20 1 MUNICIPALITY OF ANCHORAGE Community Development Department 3 Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/VVELL PERMIT APPLICATION Parcel I.D. 020-021-10 Property owner(s) Casey & Megan Hultquist Day phone Mailing address 11409 Moon Rise Ridge, Anchorage AK 99516 Site address 10380 Honey Bear Lane Legal description (Sub'd., Block & Lot) Stolle B2 L4 Legal description (Township, Range & Section) Lot Size 48,196 Sq. Ft. Number of Bedrooms'0 q APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑X Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑ Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑Q 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: a is Waiver Fees: Date of Payment: 5/5119- Date of Payment: Receipt Number: o5- Receipt Number: Permit No. t SP17-1U Waiver No. Permit App_.- :: ,c Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com 4 May 2017 Subject: STOLLE B2 L4 Private Well Permit Request Design Narrative This is a design narrative for a permit to install a replacement well to be issued for this property. The proposed systems will serve a proposed four bedroom (4) bedroom house. Currently the lot is not developed but does have an installed septic. This lot will be served by a private well. The surrounding developed lots are served by private wells. There are no septic systems within 100' of the proposed well. 1. Well Location. a. See Sheet 1 of the design package. 2. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. Mailing: P.U. Box 10021/, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 J \ ii' ''- \ \ 1 ' \ if --rJ** * • MN, - ** * ..---V ---- \ \ "....,,.. ' T / TRUE NOR1N SCALE : 1'. 5:: 1 / i 1 .--- ' j _______________ HOEPR _ . 1VACANT ' . ...--•-•'/. 1 • NIA 1 W �i F.c 1 CP 2 • O* Y C3 4 VACANT `M 13 M \ if 4 \ 1*- SFD FD (P) • INSTALL WELL (P)/.p, / l � ii - 7 l m VACANT \ ..i• / I 4 / r 4 1 1 � w W I N /I 11I NOTES; PANNONE ENG SVC1F Da te FOR CONSTRUCTION , LLC •• P.O. BOX 102954 ANCHORAGE, AK 99510 •• 05/22/11 PHONE (907) 272-8218 FAX (907) 272-8211 •' Scale r•••• ••• P.I.D. NO STOLLE B2 L4 '` --e-0-021-10 CASEY & MEGAN HULTQUIST `" ''t}even A. Pannone PERMIT NO. DRAWN JRL : •. 81491 11409 MOON RISE RIDGE OSP171076 SITE PLAN ANCHORAGE, AK 99516 °•�� Sheet 1 OF 1 I Municipality of Anchorage Development Services Department - Building Safety Division +• On -Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 Page I of 2 www.danchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. W 0 3 C7 Z PID Number. 0 2 0 — O 2/ — IQ Name: Tom i 13 ren da (Cane Wastewater System: ® New ElUpgrade Address: H C o / (Sox 60992, Pala er 9 9 dyso ABSORPTION FIELD Phone: Number of Bedrooms: 2s8-9'+/Y MD,ep Trench O Shasow Trench D Bed D Mond O Other. sw Ratinr,. O• Total Depth from original grade: 9. Z LEGAL DESCRIPTION •+ cpol:e Ft. BI Let Depth he pipe bottom tram o fiia+alg rade. Gravel depth beneath p;pe: I `su�� io I 2 J /r. a Ft. • Ft Township: Range: section: Fill added above original grade: r I • Gravel Length I •7 Ft. Ft. Gravel width Number of finer. Distance bet~ lines: Well: Not in ❑ New ❑ Upgrade 2. S Ft. I — FL Classification (Private, q B, C): Total Depth cased to: Total absorption area: p 2 Pipe Material: D - ?�!+J f y Ft. FL / Fe er -p,1 42 Crlter. Date Drilled: StaticWaterLevet InttaGer. * + Date lnsta..ed:G/6l0 j• FL v Yield:Pump set at Casing Height Move Ow'd TANK GPh1 FL FL SEPARATION DISTANCES RSeptic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding PuC6clPtivat line Maaf'� of A -n cAap lr Tanft caFa�ty Its' Gal. From Tank Field Station Tank Sewer `o tvnMMaterial: Well 7 too' 7180, — ... Lt's If Sf"rR/ Number of Compartments: 2 Surface Water ,> Icae > Jaaa .- .. LIFT STATION Srze: Marutacuer. Lot Lire 60 23 - -' 'Pump ore level at 'Pump off levet at High water alarm et: Fc=n r 7 $ % Iae — — h M. I In. Pump Make b Model Electrical Inspections performed by, Curtain Crain -• — — - Remarks: • :+>, f-rru BENCH MARK 146 e.eet >E: tuel/ naf at- Location and Oesaiptkn: F SPn%ic ins/eNaf:c.w a aF rui-w-cl rnctrkci- ai F !0 f / ��.0 FL Engineers Stamp poae.eaa `� UF•4.6 f ^V ..'•it ``��r '••� Inspections performed by: F(aE/op Tteb Svc Dates: 1stE 15-1e-'_3 0 � , 4911—q 2nd � IR Developmen Services Department Approval OA'THEODORE F. ease <� CE - 3589 ' Reviewed and approved by: Date: o D ry�3R.'•,,•••...••,.�� I PERMIT NO: SW030286 PID NO: 020-021-10 i9k SWING TIES: LOT 4, BLOCK 2 STOLLE SID 61 -FOOT LONG SOILABS.TRENCH- w. 8.1' EFF. GRAVEL 61' PAGE 2 OF 2 � 4W. T.H. FROM: COR. *X' COR. toy,, Ney�-E-- TO: "We S.T. C.O. **A*' 114' 142' S.T. C.O. "B" 108' 137' DBL. or—C C.O.BL. V C.O. O'C" 1061 135' TR. C.O. *'D" 95' 108, T.H. -B-- TR. M.T. O'E" 92.6' 110' "AA" 1250 -GALLON TR. C.0 "Fee 38' 140' SEPTIC TANK TR. M.T. "Gee 37' 1410 2' SOIL COVER 2" RIGID PLAN VIEW SCALE: I" = 30' GROUND of Al, N ele 49TH ........... %THEODORE F. 1400RE lip CE -356 4P' 4' SOIL COVER INV. 11250 -GALLON' SEPTIC TANK CROSS-SECTION NOT TO SCALE INV. INV. 95.6'—� BOTTOM ELEV. 87.5' BOTTOM T.H. #1 ELEVATION 79.2' M.T. DRY 7/8/03 PLAN VIEW SCALE: I" = 30' GROUND of Al, N ele 49TH ........... %THEODORE F. 1400RE lip CE -356 4P' 4' SOIL COVER INV. 11250 -GALLON' SEPTIC TANK CROSS-SECTION NOT TO SCALE INV. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 8/s /C),7 f Sr ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SW030286 Legal Description -"'ISO Block 2 Lot 4 Design Engineer: 0019 Flattop Technical Services Owner Name: Jim & Brenda Kane Owner Address: HC 01 Box 60992 Palmer , AK 99645 - Date Issued: Aug 01, 2003 Expiration Date: Jul 31, 2004 Parcel ID: 020-021-10 Site Address: Unknown Lot Size: 48196 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: 61 if 10-? alm , 0, - Date: 8 / r� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 - ON-SITE-SEWF_RMIELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 5-) __b Z) —10 IO Permit Number SW 030 �L 86 Property owners) T•M � $rcn e& kG A e Day phone Mailing address (1) N c o r l3an 6G99 Z Mailing address (2) Pa At- Zip Code 996YS— Legal description (Lot, Block & Sub'd.) 1,0 f S& /<< .S" I' d 'cription (Section, Township & Range) V)k h�Id Lt,x Lot Size (V Acres/Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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 property owner or authorized agent) Permit Fees: fG o + /air c �S'SO Waiver Fees: Date of Payment: -7/ 28/02 Date of Payment: rrtt Receipt Number: "I Z (� C C Receipt Number: (Rev. 12/00) CIVn & ENVIRONMENTAL ENGLNEERLNG • ENERGY CONSERVA710N & ANALYSIS THEODORE F. MOORE, P.E. PH: (907) 345.1355 July 28, 2003 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: 14530 ECHO ST. ANCHORAGE, ALASKA 99516 The purpose of this letter is to provide the required design narrative in support of our application for a permit to construct wastewater disposal facilities on Lot 4, Block 2, Stolle S/D, located on Honey Bear Lane. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material between 0.5 feet and 3.5 feet are a medium sand with a measured perc rate of less than 1 minute per inch. Below that is a silty gravel, which at the location of the perc test 7 feet below ground level perced at a rate of 2 minutes per inch. While the measured perc rate in the sand appears reasonable, I believe that the perc rate measured in the underlying GM may have been higher than would be typical of the entire stratum. Accordingly, I have designed the portion of the trench that falls within this stratum on a soil application rate of 0.6 gpd/sq. ft. The proposed 4 -bedroom residence has a design wastewater generation of 600 gpd. The proposed design is to excavate a trench down to 9.0 feet with and effective gravel depth of 8.0 feet. The design , length is based on 2.5 feet of sidewall in the SP stratum at 1.2 gpd/sq. ft. and 5.5 feet of sidewall in the GM stratum at 0.6 gpd/sq. ft. Each lineal foot of trench has an absorptive capacity of (2 x 1.2 x 2.5) + (2 x 0.6 x 5.5) = 12.6 gpd. Thus the proposed 60 foot trench with (2 x 60 x 8) = 960 sq. f3. of sidewall area has a design absorption capacity of 756 gallons per day. The topography of the lot in the area of proposed construction slopes down towards the northwest at approximately 14%. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space -surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, e7 e i' `oe^ l Ted Moore, P.E. \ WELL / LOT 10, BLOCK 3 R10 ` ---- / / / / / / \ 24' \ 0. 2 a� �1 1 LOT 2 BLOCK 1 i (VACANT) I I 1 1 1 1 1 1 1 1 1 PROPOSED 60 -FOOT LONG SOIL ABSORPTION TRENCH w. 8.0' GVL. BELOW DIST. PIPE T.H. I #2 SITE FOR SIMILAR REPLACEMENT TRENCH PROPOSED 1250 -GALLON SEPTIC TANK LOT 4, BLOCK 2 STOLLE SID LOT 1, BLOCK 2 (VACANT) CT / /�f'. ?2jL - _d . THEODORE F. MOORE CE . 35891//•a `�2y �N / ••1 •• c` 4 y1" ••..•...•� LOT 3, BLOCK 2 (VACANT) 1T.H. ON #1 `O .�\ \1 88' is - \ EL:1 \ 1 36' _ \ ---- \ 1 ♦ \ 1 \ 1 1 \ 1 1 \ \ 1 PROPOSED WELL SITE \ 1 ' R 100' 1\ '1 hOT 2, BLOCK 2 ' SEPTIC LOT 4, BLOCK 2, STOLLE SID WELL AND SEPTIC SYSTEM SITE PLAN FLATTOP TECIINICAL SERVICES 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 JULY, 2003 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. texia 60 -FOOT LONG TRENCH EXCAVATED TO 9.0 FEET w. 8.5' TOTAL SEWER GVL. 4" DIA. F-810 PERF 4" DIA. D-3034 NON -PERF. 1250 -GALLON SEPTIC 4" DIA. D-3034 FROM PLAN VIEW SCALE: 1" =10' 3 1 r 9 18.5 18 CROSS-SECTION "A - All SCALE: 1" = 5' a "All M.T. .41 ..A" —DOUBLE C.O. J 'i; COCRE F. A700RE•: ♦, "L ` Cr;- 3559 • : i �" CLEANOUT MONITOR TUBE MOUND BACKFILL 2 FEET ORIGINAL GROUND FILTER FABRIC 2" RIGID INSULATION 4" DIA. F-810 PERF. PIPE 1/2" - 2112" SEWER GRAVEL BOTTOM OF EXCAVATION (feet) PL 57 fid' se FLATTOP TECHNICAL SERVICES" i j1 SP Dark gray medium sand 3 i� 4 14530 ECHO ST. t'-, <:'" . ! `•;',+4. (y 6 ANCHORAGE. ALASKA 99516 ��•`:=*��yV •;"p� v TEST HOLE # 1 SOILS LOG — PERCOLATION TEST `••••••••••••••••••••iiz•"' Less silt below 14 feet a LEGAL DESCRIPTION: —Lot t 9 f, ' • T1+LoDC?E F. OCsE'� CE - 35139 • •••'•••.«••• DATE PERFORMED: _JUlyj_2003 . �4 ' PERFORMED FOR: —Jim Kane ;.... ,.. DEPTH SLOPE SITE PLAN (feet) PL e, se "N` 2 < i j1 SP Dark gray medium sand 3 i� 4 5 6 GM/ML Damp Silty Gravel 7 X Particularly silty in top 2 feet Less silt below 14 feet 8 9 NONE eta 5 13 121 06 / T.H #1 \� \_T.H. #2 _ 10% .. . . Date Reading Clock Net Time Time (minutes) Percometer Reading Net Drop (inches) 711 12" Presoak_ Add water 8 -it -art #1 — - Addwater =_2 Add water #3 F=�=1 12:3120 —~23.3/8 12:36:26 5 1.2:37:05 242:05. 12:42:50 12:47:50 5 1 27.1/2 20114 23 3/8 20 5/8 233/8 203/4 31/8 /4 2 5/8 20 PERCOLATION RATE 2 (minutesfinch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN 7.0_ FT AND 7.5_ FT COMMENTS: Despite rapid measured pert rate recommend using .0_gpd/sq. ft_for material below 3.5 feet. PERFORMED BY FLATTOP TECHNICAL SERVICES. I_,/ �c�C ?! j CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7 / 2..5 /G-? FLATTOP TECHNICAL SERVICES 14530 ECHO ST. TEST HOLE 0 27ANCHORAGE, ALASKA 99516 TEST HOLE # 2 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: _Lot 4..BlocU..Stolde-S/D DATE PERFORMED: --July-1.2003 PERFORMED FOR: —im Kane DEPTH SLOPE (feet) 10— Depth Clock Net Time Time (minutes) Percometer Reading 1 to Groundwater Date GM Silty gravel fill material 2 718 3.3/4 31/2_ Pt. ¢ v.<R; 3 ` SP Clean sand I 6 GM Silty gravel B.H. 7- 89 8- 9- 10Depth 11 12- 213 13- 14- 115— Clock Net Time Time (minutes) Percometer Reading Net Drop (inches) to Groundwater Date Nogroundwater 7/1/03_ Monitortubedry 7/8/03 LOi 27 112 23 3/8 19 112. --23-3/8-- 9.314. 233/8 9718 718 3.3/4 31/2_ 1415 Note: This perc test was conducted at 16 test hole #1 17] 18 19 20 PERCOLATION RATE <1 (minutesrnch) PERC HOLE DIAMETER 6" TEST RUN BETWEEN -2.0— FT AND ---2-5_ FT COMMENTS: west hole dug to confirtn continuity -If sand straturrLencountered intesthole.#1--The.perclestdata ortthis Bheetis -derived .from a second perct.testconducted atiesthole #1 PERFORMED BY FLATTOP TECHNICAL SERVICES. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/ x / 03 �.. ,rr•re •rrrf•� •1••.r•1f ^pCz: F. t:CORE D . �`CL-551-4 �' firi17 :1, SITE PLAN 10%. Date Reading Clock Net Time Time (minutes) Percometer Reading Net Drop (inches) 12" Presoak Add water &start #1 A_ddwater -- #2. dd_water #3 2:52:30 12:5430 2 12:54:55 12:56.55 2 12.57_:22 2:59:2 27 112 23 3/8 19 112. --23-3/8-- 9.314. 233/8 9718 718 3.3/4 31/2_ (Flattop 7echnkdSeMices 14530 Echo Street, Anchorage, ATS 99516 (Phone (907) 345-1355 Lot 4, Block 2, Stolle S/D Honey Bear Lane Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installing a 1250 -gallon septic tank that discharges effluent into a 60 -foot long soil absorption trench containing a total of 8.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The new 1250 -gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed 1 - 4 feet from the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 60 -foot long trench to a depth of 9 feet below ground level. The long axis of the excavation shall parallel an existing contour 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. Sand for leveling or serving as filter material shall comply with Municipal specifications. 3.3 A total of 8.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 8.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 12 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. MUNICIPALITY OF /ANCHORAGE of 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. 020-021-10-000 Expiration Date: Legal description STOLLE BLK 2 LT 4 Site address 10380 HONEY BEAR LN Anchorage AK 99516 Current property owner(s) HULTQUIST CASEY D & MEGAN M 1/23/2024 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: 10/23/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory x Arsenic Advisory Other COSA Approva"une 2022 ' e 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. 020-021-10 Complete legal description STOLLE; BLOCK 2, LOT 4 Location (site address) 10380 Honey Bear Lane *Anchorage Current property owner(s) Casey & Megan Hultquist Day phone 907-830-0802 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 20 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 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. S � COSA Fee $ �Jr0 Waiver Fee $ Date of Payment / �Z�j Date of Payment COSA # _ t�SG 2 3 / Lto 0 Waiver # COSA ApplicaUon June 2022 COSA Checklist Legal Description: STOLLE; BLOCK 2, LOT 4 Parcel ID: 020-021-10 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA X Well log is filed with Onsite (or attached) Date drilled 9/14/18 Total depth 400 ft Cased to 44 ft 0 Sanitary seal is functioning correctly n Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 10/3/23 Static water level at beginning of test 72.4 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 51 Date of pumping ❑ Required maintenance completed, if AWWTS Comments: - D. ABSORPTION FIELD DATA Which system tested (date installed) 8/6/03 0 ALL standpipes present per record drawing Total measured depth from grade 10.8 ft (max) Measured depth to pipe invert from grade 2.5 ft (min) C1 N/A — pressurized field. X Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective EAST MT=2.5' WEST MT=7.75' ❑ Presoaked required if (Required if house vacant or field not us r more than 30 days prior to date of test Gallons introduced gallons date Any rejuvena ' reatment (past 12 months) enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 1.5+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes 0 No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/LD Arsenic less than MRL (ND) Collected by GEG, Ltd. Date 10/3/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station ye Lift station mater' Adequacy test date 10/3/23 Results Q Pass Fluid depth prior to test 32 in Water added 625 gal New fluid depth 40 in Elapsed time 14v min Final fluid depth 36 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 97 in Effective depth used 40 in Effective depth remaining 57 in 0 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' OYes if No ft 110-1 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' no Yes if No ft Holding Tank > 100' QYes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No it Community Wells > 200' Yes if No ft Water Service Line > 10' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS SEE LETTER OF NON -OBJECTION IN MOA RECORDS REGARDING WELL IN ELECTRICAL EASEMENT. APPROXIMATELY T FROM DRAINFIELD TO DRIVEWAY. 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 Gamess Engineering Group, LTD. (GEG) Phone 907-337-61179 Engineer's Printed Name Jeffrey A. Gayness Date full z 1 3 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systemis; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist—June 2022 ��. OF A W ....g.. i .....:.� V.. QQ .Je rt "A. Garness. 9. E-77 0 LICENSE 1 dP�ofessionoo #AECC884 4��000Qc' U M UNJUP U T Y OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231400 Subdivision: Stolle Block:2, Lot: 4 907-343-7904 Fax: 343-7997 The septic tank for this property is 20 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. • Municipality of Anc On -Site Water and Wastewater (907)343-7904 Certificate of On -Site Systems Ap Parcel I.D. 020-021-10 1. GENERAL INFORMATION Complete legal description Stolle, Block 2, Lot 4 Location (site address) Honey Bear Dr. - •jua 777 �2 U a JUN t 5 Expiration Date: ` ^ ( ( ^r Current Property owner(s) Sophie J Cavanaugh Trust Day phone Mailing address Real Estate Agent 3085 Pheasant Creek Dr. Apt315 Northbrook, IL 60062 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone WaiverNariance request for: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ (0�50 Waiver Fee $ Date of Payment � it�'1t ('0 Date of Payment Receipt Number oLfl4t Receipt Number COSA# 05LLl�oL;� Waiver# 4 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual I] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ (0�50 Waiver Fee $ Date of Payment � it�'1t ('0 Date of Payment Receipt Number oLfl4t Receipt Number COSA# 05LLl�oL;� 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. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE VSystem #1 Approved for bedrooms System #2 Approved for T� bedrooms Disapproved Phone (907) 272-8218 Date 6/12/2016 Steven�2 an CE -8149r Conditional approval for bedrooms, with the following stipulations: By —._� ^� (��(�D� —lam Original Certificate Date: —17 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 COSH blue sheet r - If more than 1 septic system is on the lot: COSA Checklist # + of Structure served by this system 1 Certificate Y-On-Site, Systems Approval Checklist Legal Description: Stolle, Block'2, Lot ParcelID:020-021-10 A. WELL DATA Well type None If A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (YM)— Wires properly protected{Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of lest Static water level Well production g.p.m. g.p:m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/512003 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (YIN). Y a t Foundation cleanout (Y/N) Depression over tank (Y/N) N High water alarm (Y/14) N JY Date l / �Ot (q Pumper -4.1-r -> )� A of pumping. /ya . B reii G CS C. ABSORPTION FIELD DATA Date installed $16/2Q03 Soil rating (g p:d./ft2"or ftz/bdrm) 0.6GPDLSF System type Deep Trench Length 61 ft. Width 2,5 ft. Gravel below pipe 8.1 ft. J Total depth 1 O.T ft. . Eff. absorption area 982 ft2 Monitoring tube Y Depression over field N Date of adequacy test- New Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test New iri. Water added New gal. New depth NeW in: Elapsed Time: New min. Final fluid depth New in. Absorption rate >_ 600+ ` g;p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No.If yes, give'date D. LIFT STATION Date installed Size in gallons Manhole /Access (YM) "Pump oh"Ievel at in. -`Pump off' level at " in, High water alarm level at in. Datum Cycles tested y Meets alar & circuit -requirements? E. SEPARATION DISTANCES WELL ON LOT TO: : Septic tanktli t station on lot On adjacent lots Absorption field on lot On adjacclAots Public sewer main Public sewer manhole%leanout Sewer /septic service line Holding tank Animal containment areas Manure/animal exp"refe storage areas SEPTIC/HOI;DING TANK ON LOT TO: Building foundation+ Property line 5+ Absorption field5t- Water main 10+ Water service line �:�+ Surface water �+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: - Property line 10+ Building foundation 10+ Water main 10+ Water Service linel p+ Surface water 100+Driveway, p$rkinglvehicle storage 104 Curtain drain 50+ a Wells on adjacent lots 100+ F. COMMENTS N&bUildingS ©n Pro pilhy.*�eptic'sy 6� has never f eel ita-4se: G I;NIGINEER'S CERTIFICATION At 7 ertify -tfiat,l have determined thtough field 1hspeCtfoI ns,.and s review :of' Wriictpal records that th>' above systems are in conformance with MOA COSA guidelines in effect on this date. Engigeees Printed Name Steven P66h6ne ' '•$ '3 n j g � onjno ` 6/12/2016 - ©ate f COSA canary sheo(, .m&l5.doc - - P' ._.� V I VtD�eo iMaV" jj Municipality of Anchorage • -� Development Services Department Building Safety Division _ OnSite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orgtonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O 20 - 0 Z/ - /O COSA # b(PO&4 q Expiration Date: 3 - /!/ -0-7- 1. D7 1. GENERAL INFORMATION Complete legal description kof �. Stc c lc 2, Sfor/e SCb Location (site address) /QW0 Fbrr e , 13 ear Aefn e Current Property owner(s) . i r.n t f3 rrn act bccr n e_ Day phone 2.6'6 - 9119 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address n_17_(30x 60992 kk 996Y15' Non#- Day phone hI Nd -6394 cch Vru ran in/Cina Qrn4i»re Phi. Day phone 26/- 7653 /oy hneAarsr kk 99s�? ��----i7 Urgess otherwise requested. COSA will be held by DSD for pickup. P/eckre CZ(11 Beer/fo �- when 2. NUMBER OF BEDROOMS: — tj Cps/} rcaly {�� /�+cam •y 3. TYPE OF WATER SUPPLY: Wel( not ih TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site 5? 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 Onsite 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 Onsite 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. NameofFirm F/ctb6mom Tcthnic 1 Phone 3`r'S-�355 Address /1VS30 F-cho 4faelyon did h,7c6., 9¢.SlC Engineer's Printed Name -PiaooZOrr F. /—taa"15 Date f'1eznab lo- ZaoC' a o f3�=ge� 4 h fr 4S)T=) 5. DSD SIGNATURE .(VAACl &: _ 7, 77U., ,• 4� nKODpRE F. MOORE'� Approved for bedrooms. y, •.. ca • 3 89 Disapproved. �C.. Conditional approval for bedrooms, with the following stipulations:• • c : "� Approval is for septic system only. Attacnments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other BY (%,-+� All /0111- Original Certificate Date: 3-14-o6 (R" 11105) Municipality of Anchorage Development Services Department _ Building Safety Division ' Onsite 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: t O f y� 914104 Z S%0 Ile S /D Parcel ID: O 2G - o Z✓ - id A WELL DATA— (.lett not in Well type — Date completed — Total depth ft. Date of test Static water level Well production if A. B, or C provide PWSID # Sanitary seal (YM) Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: ft. 9.p -m. Coliform odonies/100 mL Nitrate mg/L Arsenic: mgA Date of sample: B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Wires property protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. on 100 mL Tank Type/Material S w ftic. 1.0 -eel Date installed Tank sig _ gal. Number of Compartments 2 Clearouts (Y/N) Foundation deanout (Y/N) X. Depression over tank (Y/N) A/ High water alarm (YM) Al. .4. Date of pumping N•A. - Ala Hale Pumper Al. A. C. ABSORPTION FIELD DATA Date Installed b /6/Soil rating (g.p.d.e or ft2thdrm) 0.6 System type Tree cA Length 6 / ft. Width 2•.f' ft. Gravel below pipe &. / ft. Total depth Z ft. Eff. absorption area �ft2 Monitoring tube Y_ Depression over field N Date of adequacy test V-4. -_UResults (Pass/Fafl) P O&C- For I— bedrooms Fluid depth In absorption field before test O in. Elapsed Time: — min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) Water added 0 gal. New depth --C.? in. In. Absorption rate >= 60n g.p.d. N If yes, give date 0. 4, D. UFT STATION None Date installed "Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off level at _ in. Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requiremenls? SEPARATION DISTANCES FROM WELL ON LOT TO: Ul a /1 n a,' r � Septic tank/lift station on lot Absorption field on lot Public sewer main On adjacent lots On adjacent lots Public sewer manhole/clearmm in. Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Budding foundation Nai4 in Property line � GO ' Absorption field 26 ' Water main N. A. Water service line No F rn Surface water > 1601 Wells on adjacent lots > 14o r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Propertyline x 23' Building foundation Net in Water main M..�. Water Service line Ne f i, Surface water. 7 tGa ' Driveway, parkingNehicle Storage Curtain drain N • A. Wells on adjacent lots Zoo F. COMMENTS _jamrt/C E (.a+ef/ n!u>< sec /� % nese, cDi,ne.• nr f \ir F A G. ENGINEER'S CERTIFICATION �,, ,. ���,,,,�� .,•� I certify that 1 have determined through field lnspectlwrs and ''� '•.i ," : L°1 review of Municipal records that the above systems are In *. 49TH ;"5• t' r .......................... conformance with MOA COSH guidelines /n effect on this date. ? •� V. Engineer's Printed Name Theri3 rz+ F. rroo. to C[ 3F. 594 ae - Date f`&C<,-C4 /O� ZAO ',:.'•. p ' COSA Fee $ T .Sd t -P l 73 Aarb Date of Payment a 14 n � Receipt Number 7 � l0 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 48.196.31 SQ.FT. OF AREA 'lel e 1 gEAg� . 6 A ` \ \w \ / N CI o \ 3 l7 \ N\ Cn 1 \ \ 2 C2 \ \\ o. 1 Cw TABLE Date 3-14-06 rCURVE DRADIU LLNCTIi C1 9090'00' 20.00' 1 31.42' C2 31'Dr15-1 330.00' 1 179.24' % � r J MAPNC Orli£: / f Inch - 60 feet 2 FOR: Dynamic Properties Date 3-14-06 scareLegal 1" = 60. uesenptlon Lot 4 81ock 2 LanMark gN.0e.tetar a S..7tar. me. 9370 Vanguard Drive. suit. 207prow¢ �ncbC a) 562 45Alas050 �7 Grid 3243 wa-Dour 2600263 STOLLE SUDDMSION by dhb Field Book 221 I hereby certify that the property described hereon has been surveyed by me. or at my direction. and that the improvements situated thereon are within the property Imes and do not overlap or encroach on the property lying adjacent thereto unless otherwise shown. That no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways. transmission lines or other easements on said property except as shown. It is the responsibility of the owner or builder. prior to construction. to verity proposed building grade relative to finish grade and utility connections and to determine the existence of any easements. covenants. or restrictions which do not appear on the recorded subdivision plat Listed distances prevail over scaling. Reproduction may cause distortion. •� °F.A *: 49 :* I....w.: .... ti o w : CHARLES E. FORGES e` Try'. LS -7326 � vdp ••• '� pots i