The URL can be used to link to this page

Home My WebLink AboutHIGHLAND TERRACE #2 LT 15Highland Terrace #z Lot 15 #050-312-02 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 9z��7—/ �6�(Aii�DI7� PIDNumber. e954- 3�z-a2 Name: Wastewater System: )ZJ New ❑ Upgrade Beser Addreaa: ABSORPTION FIELD /3�. S 4w.✓ rr do a E� /� .et,.� Phone: X1`7 - Fr35� No. of Bedrooms: S X Deep Trench O Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: / Total Depth from original grade: / 2 GPD/S . Ft � / Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe A.1- AI �2, -" %Crate *-1 3 Ft. Ft. Township: Range: Section: Fill added above original grade:, / Gravel length: 1- 2 FL 40 Ft. WELL f New ❑Upgrade Gravel d": wralz Numberoflines: Distancebetweenlines: • ?/f Ft. % )A Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: 'Ort ✓ 4+It 3 1 ° Ft. I N 2 Ft. 6y0SQ. Ft. I .i M 303 Driller: Date Drilled: Static Water Level: Installer: Date installed: r4 ti 7-.,21 -17 L q Ft. GU% /11C Yield: Pump Set at: Casing Height Above Ground: TANK .T GPM A/ �T" Ft. -R Ft. SEPARATION DISTANCES J)d Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lin Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines 00 Material: Number of Compartments: Well 16s- 13,9 taS Sy-ee/Surfac a Water Water y /do f1W t/amu / LIFT STATION Lot / 38 Size in gallons: Manufacturer: Line Sr 3g' Foundationzn 30 0 "Pump on" level at: ..Pump off' level at: High water alarm at: Curtain Pump Make odel Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: o {✓ Gr/� // Assumed Elevation: 9a -e ENGINEER'S SEAL F 4k� *� Inspections performed by: Dates: 1s 9-/» /se o-�e.e eeaG+aseBeaamsresaeaeeese eee 2nd ®®oasmea ae. se `g Will! �•RBfEtd Department of Health and Human Services approval De P PP �41 sh, ecstss Reviewed and approved by: �' Date: fills� 72-013 (1/91) MOA 25 Permit No. • 5700/7 Page 1 of 1 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: BLOCK2 LOT2 HIGHLAND TERRACE SUB. -0a PID No.: a oS a - -ate LOT 3 SEPTIC I I I I I� I LOT 16 G tl A big 7o2a r3 av3 s�� BLOCK ,2 Lor M M M A •• WELL � M m W L } it LOT ww' w e' 9� BI. pm 15? FRAME I 2 HOUSE - w O O o U $T.p O Z O N } RESERVE ` N89'58'00"E 240.00 74.1 ELEVATI❑NS (NOT TO SCALE) TDP DF�WELLLL CASING ASC) SUNED ELEV = 92.8 H M N ORIGINAL LEVEL = LEVEL AT: O 74.9 m GVT E 58.6 57.9 sw -s nci G tl A big 7o2a r3 av3 s�� DATE SEPTIC +100' <! N44ZF,S- OWNER OF LAND, n IlJtUL O ADDRESS I / 3d 5' LEGAL DESCRIPTION �f PERMIT NUhABER—qqA211MHte of Issue TAX INDENTIFICATION NUMBER,0 Is well located at approved permit location? es ONO Method of Drilling:arr rotary CY cable tool Depth of well: AD , Casing Type, fiV Wall Thickness �.�4 _inhes Diameterr inches, depth 4 feat Liner Type: h)£ -J6 Casing Stickup Above Ground: _._ __ feet Static Water Level (from ground level): �i feet Pumping level: pfe^et after m hrs. pumping gp :? Recover Rate: : qpm Method of Testing Well Intake Opening Type: O Open End en Hole 0 Screened; Start feet Stopped feet Cl Perforations Start 4 j(fept Stopped feet Grout Type: 'waitl �•7 Volume Depth: from__ Poet, to'feet Pump Intake Depth: feet Pump Size hp Brand Name. Well Disinfected Upon Completion? O Yes ❑ No Method of Disinfection: Comments: 7/ail 4;e OP. BORE HOLE DATA DEPTH fj �rtieZ 006ePJGA3 C4.6-" d e0e4 1 rc 3o a.wae e n 13C-al(4- :ra I:• Fp f V'111J-4 P UP"s 13r:400 'L 416y'r Lie I40 �%GbR�cf Gk's APR 10 2000 __- Municipality Ot Anchoraap unian ervices Driller'sName ATTENTION: It is the responsibility of the property owner to submit a copy of the well lag to the proper authority. Municipality of Anchorage: Department of Health & Human Services andlor Department of Fi vironmental Conservation. Matsu Borough: Department of Environmental Conservation. Told trbbbb4btrbb4465ZZ 839 S -113N eMLVV1 N0AI-r1nS Wd LT:SO NOW 00-20-aaV V MUNICIPALITY OF ANCHORAGE p 1cl Department of Health and Human Services 7S On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 1 ' P rk— (907) 343-4744 _Cl l ON-SITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT Initial Permit Number: SW990176 Date Issued: Jul 07. 1999 Expiration Date: Jul 06, 2000 Parcel ID: 050-312-02 Legal Description: HIGHLAND TERRACE #2 LT 15 Design Engineer: 0024 Eagle River Engineering Services Site Address: 010920 CORRIE WAY Owner Name: Charles & Natalie A Neeser Lot Size: 38160 SQ. FT. Owner Address: 11325 Dawn Street #2 Total Bedrooms: 5 Permit Bedrooms: 5 Eagle River , AK 99577 - 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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: J� �C. 7E m Date: 7 7— 1 C Date: 77.Y9 . Y Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax June 30, 1999 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 15, Highland Terrace #2 Narrative & Permit Application Dear Mr. Cross: The proposed septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large and the soil is excellent allowing sufficient room for septic sites. 2. Irmnediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity of the soil in this area. 4. Drainage will not be affected and is not a major consideration in our design. Design calculations for a 5 bedroom dwelling are 750 gallons per day with soil rating of 1.2 and a required absorbtion area of 750/1.2=625 SF required. The trench gravel depth of 8' yields a trench length of 625/16=39 feet. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1997\NESSER-NAR Laois A. MGM C&6736 M LOT 3 NO CONFLICTS - TEST HOLE I SEPTIC Ff++4++ -+-Fw LOT 16 - SEWER CLEAN OUT ¢ - WELL — — - EASEMENT N89'58'00"E - 240.00 I/ I / nl LOT 15 I Ln LOT r O OHSIJ O Ib 16 ¢APPROX Z \ WELL LOCATION I '�� O'�° S89'58'00"W - 240.00 LOT 14 \APPROX NO SURFACE WATER SEPTIC NO KNOWN CURTAIN DRAINS ¢'APPROX WELL LOCATION I SEPTIC +100' APPROX ® - TEST HOLE WELL • - MONITOR TUBE LOCATION 0 - SEWER CLEAN OUT ¢ - WELL — — - EASEMENT - PROPOSED LEACH FIELD - EXISTING LEACH FIELD WELL/SEPTIC SITE PLAN LEGAL: LOT 15, HIGHLAND TERRACE #2 OWNER: CHRIS NESSER CONTRACTOR: N/A JOB# 94-043 1 DATE: 06/29/991 SCALE 1 " = 50' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 OF q�q`s goo * . 49 TH ..........I ............. LOUIS A. BUTERA �^ CE -6736 - J 0 �On�`'Ess1o1+P moo Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lot 15, Highland Terrace #2 6/29/99 A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. C. SEPTIC TANK Septic tank construction shall be a minimum of 1500 gallon steel two compartment tank approved by the Municipality of Anchorage. 2. Septic tank is to be installed level on compacted base material. C. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 11', referencing the ground surface at the uphill side, at any point. 4. The effluent line within the trench shall be laid level within 0.03'. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. Mound if necessary 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL DEPTH= I F GRAVEL DEPTH = 8' under pipe, 2" over pipe TRENCH LENGTH = 39' TRENCH WIDTH = bucket width SOIL RATING = 1.2 GPD/ft2 BEDROOM CAPACITY= 5 SEPTIC TANK = 1500 gallons Twenty-four (24) hours notice required for all inspections. \1999\Nesser-spec AQ j (Municipality of Anchorage DEPARTMENT.&, .«..+• • 1 OF HEALTH & HUMAN SERVICES U 825 "L" Street, Anchorage, Alaska 99502-0650 ®�•�! Louie p,Butera r SOILS LOG — PERCOLATION TEST + CE -6736 : sge ��pROFES A PERFORMED FOR: D'f Ti 5i DATE PERFORMED: - 7-/f LEGAL DESCRIPTION: H,'4,h1,,, T�� =c �� L/S Township, Range, Section SRF: H. SLOPE SITE PLAN N a�y�e" Liw,/ oro Je 1 55 2-0 o 4- 5 5 v 6 10- 14- 12- 13- 01213 O, 14- 15- 16- 17-. 4 15 16 17 18 19 GRcY- yy'KJWN P,- 51.1/ f0ej(' 'r 7 TG. WASGROUNDWATER A/O ENCOUNTERED? fir/ S P-ek,l-f pr' P(�le✓e/ IF YES, AT WHAT L ✓/✓ 'r, 7 -/"tet ar 1,B6S EPTH? E Depth to Water After Monitoring? Ag'3 Dale:—/i-r4' iGr /_-Zn-C9 Reading Soo K Date Gross Time Net Time Depth to Water Net Drop -/r-e /Y!?/ to 12, 7//6- S%i' 10 .'., 62 �'/it" %14,. 3 I v to `'2 r76,. 5"Air .. 20 ,. PERCOLATION RATE /• 9 (minutes/inch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN y,f FTAND S'S FT COMMENTS /eect. %/PFivcN J'l'rTic i+-> 3 ,' // Ja /% ST,P 4 Tr+—ti PERFORMED BY: CR r S I—✓ 77�� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE Development Services Department 4 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-312-02-000 Expiration Date: 9/8/2023 Legal description HIGHLAND TERRACE #2 LT 15 Site address 10920 CORRIE WAY Eagle River AK 99577 Current property owner(s) BODOLOSKY JAMES P & JENNIFER X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 6/8/2023 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 ApprovM_June 2022 MUMCPAUTY OF A'�NC HOG AGC Development Services Department P P 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. 05031202000 Complete legal description HIGHLAND TERRACE #2LT 15 Location (site address) 10920 CORRIE WAY Current property owner(s) BODOLOSKY JAMES 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS Day phone 202-4428 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: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 24 - 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 $ ,j S� Waiver Fee $ Date of Payment (,- 3 COSA # 0 �; C, Z -� I ) Yl Date of Payment Waiver # COSA Application—June 2022 COSA Checklist Legal Description: HIGHLAND TERRACE #21-T 15 Parcel ID: 05031202000 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 7121/99 Total depth 320 ft Cased to 42 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 5/19/23 Static water level at beginning of test 26.9 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 49 Date of pumping 8/9/22 ❑ Required maintenance completed, if AWWTS Comments: Steel, 24 yrs D. ABSORPTION FIELD DATA Which system tested (date installed) 8/27/99 ❑■ ALL standpipes present per record drawing Total measured depth from grade 13 ft (max) Measured depth to pipe invert from grade 5 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) If yes, enter date Well production at time of test 4+ gpm Water storage tank volume0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑■ Coliform bacteria is Negative Nitrate 4.44 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L XArsenic less than MRL (ND) Collected by NRirnEng Date 5/19/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/19/23 Results g Pass Fluid depth prior to test 0 Water added 750 gal New fluid depth 7 in Elapsed time 30 min Final fluid depth 0 in in Absorption rate 750 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 96 in Effective depth used 0 in Effective depth remaining 96 in Comments/Deficiencies: Monitor Tube in absorption trench was located and brought up above grade by adding a section of PVC 3034 with cap. COSA Checklist June 2022 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' ❑ Yes Community Sewer Manhole/Cleanout > 100: ■❑yes if No ft ❑■ Yes if No Neighboring Tank > 100' ❑■ Yes if No � ft Private Sewer/Septic, Line > 2 5' M Yes if No Absorption Field on Lot ? 100' ■❑ Yes if No ft Holding Tank? 100' ■❑Yes if No Neighboring Absorption Fields > 100- ❑■ Yes if No _ Water Main > 10' Animal Containment > 50` ■❑ Yes if No ■❑ Yes if No ft ❑■ Yes if No _ Dater Service Line > 10' 0 Yes if No It+lanurelAnimaI Excreta Storage 2 100' If tank or field is under ofiveway Community Sewer Main > 75' ■❑Yes if No ft ❑■ lies if No ❑ WA — Served by Community Well (not an lot) or Public Water From SepticlHolding Tank and Absorption Field(s) on Lot to: (Please enter distances d less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water> 100' ■❑ Yes if No_ Tank to Property Line > 5' ■Q Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑■ Yes if No ft Private Wells ? 100' ❑■ Yes if No _ Water Main > 10' ■❑ Yes if No ft Community Wells > 200' ❑■ Yes if No _ Dater Service Line > 10' 0 Yes if No ft If tank or field is under ofiveway comment below F. EN INEER"S COMMENTS ft ft It ft ft ft ft G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGIItiEER 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 hater supply andlor wastewater disposal systern appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the tirne of installation, unless noted otherwise. Name of Firm NorthRim Engineering Engineer's Printed Narne Steve Eng CO SA Checklist J L ne 2022 Phone 694-7028 Date �F 'eV Ar Ar ',k : 49 TH * s 0 s�.l.. ; ...Steve Eng . . ' .40 1 ; � CE -6256 6/8,/ I I I I I LOT 3 I I LOT 16 I '00'E 240.00 I L07 to I The location of thelstructure(s) as shown on this rbcord drawing (as -built) co PII 0 wit tle 21, AMC. /—Js—vu V. 1 HEREBY CERTIFY THAT I HAVE CONDUCTED A PW51CAL SURVEY OF THE FOLLOWING OGSCRIBED PROPERTY: LOT 16 . IDCX.IND rZnR= AV31) J$7OAC ADDTrlON AD. 2 HAVE FOUND OR ESTABUSHED ALL OF THE LAT CORNERS AS SHOWN ON THE PLAN AND THAT NO ENCROACHMENTS eXIST EXCEPT A5 INDICATED. R 15 THE RG5PON5151UTY OF THE OWNER OR BUIL.OER. PRIOR TO CONSTRUCTION. TO VERIFY PROP05G0 BUILDING GRADE REATNE TO FINISHED GRADE AND UTILITY CONNECTIONS. AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS. OR RESTRICTIONS WHICH 00 NOT APPEAR ON THE RECORDED EASE 5UBOM51ON PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BG USEO FOR CONSTRUCTION OF FENCE UNGS OR FOR e5TABU5HING BOUNDARY LINES. EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 I .ilr ASBUILT SURVEY LOT 15 HIGHLAND 10421 VFW Drive Eagle River= Alaska 99577 RECORD XXX.XX' TERRACE ADDITION N0. 2 $UBDV. W000 DECKS ® WITHIN THE ANCHORAGE RECORDING 015TRICT SCALE: DATE. Bv; SHEET:I / 1 I CADD File Name: 99.026AB wI •.0 r 30' 3iV 00 BJR n •J-- I Ru. n Oi 7 ... - _ + of ^ o ^ I y St LOT FRAuE O HOUSE IIAM' O �O' O ••t SEPgpplpc OCP - ;• U g b z I Lor is 'e a '00'E 240.00 I L07 to I The location of thelstructure(s) as shown on this rbcord drawing (as -built) co PII 0 wit tle 21, AMC. /—Js—vu V. 1 HEREBY CERTIFY THAT I HAVE CONDUCTED A PW51CAL SURVEY OF THE FOLLOWING OGSCRIBED PROPERTY: LOT 16 . IDCX.IND rZnR= AV31) J$7OAC ADDTrlON AD. 2 HAVE FOUND OR ESTABUSHED ALL OF THE LAT CORNERS AS SHOWN ON THE PLAN AND THAT NO ENCROACHMENTS eXIST EXCEPT A5 INDICATED. R 15 THE RG5PON5151UTY OF THE OWNER OR BUIL.OER. PRIOR TO CONSTRUCTION. TO VERIFY PROP05G0 BUILDING GRADE REATNE TO FINISHED GRADE AND UTILITY CONNECTIONS. AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS. OR RESTRICTIONS WHICH 00 NOT APPEAR ON THE RECORDED EASE 5UBOM51ON PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BG USEO FOR CONSTRUCTION OF FENCE UNGS OR FOR e5TABU5HING BOUNDARY LINES. EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 LEGEND` PowER POLE SEPTIC VENTS ra.) o ASBUILT SURVEY LOT 15 HIGHLAND 10421 VFW Drive Eagle River= Alaska 99577 RECORD XXX.XX' TERRACE ADDITION N0. 2 $UBDV. W000 DECKS ® WITHIN THE ANCHORAGE RECORDING 015TRICT SCALE: DATE. Bv; SHEET:I / 1 FRES Project Number: 99.026 WATER WELL ¢ CADD File Name: 99.026AB r 30' 3iV 00 BJR j 1 M MNMP I UTY OF AHCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231181 Subdivision: Highland Terrace #2 Block: , Lot: 15 907-343-7904 Fax: 343-7997 The septic tank for this property is 24 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 Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-312-02 1. GENERAL INFORMATION N Expiration Date: 61 - .a. - L-15- Complete Jr Complete legal description Highland Terrace #2 Lot 15 Location (site address) 10920 Corrie Way, Eagle River, AK Current Property owner(s) Schulpius Day phone 864-6524 Mailing address same Real Estate Agent Latosha Williams Day phone 864-6524 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by:Date: 2-5 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5216— Date 216—Date of Payment 3/23//5 - Receipt Number m' D-0 �)J� Date of Receipt Number. COSA 9,_ OSC-«i / t7 I 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. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 3/16/2015 6. DSD' SIGNATURE _ tl� System #1 Approved for 17 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following OF :q- 6. - Sievon W. Eno V E""� (S I '2tlons.-,` - By: Original Certificate Date: The Municipality oP chorage Devlopment 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 blue sheet g-1-12.doe If more than 1 septic system is on the lot: . COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: /IOX Q Yr e- Z o'/- If Parcel ID:O SQ - 312- O Z A. WELL DATA Well type P If A. B, or C provide PWSID # Well Log (Y/N) T Date completed 7/2//9_9 Sanitary seal (Y/N)— Y Wires properly protected (Y/N) Total depth Z O ft. Cased to -6�z ft. T Casing height (above ground) Gin. FROM WELL LOG AT INSPECTION Date of test 21Z99 Static water level 2 � ft. Well production S g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform --!Q--colonies/100 mL Nitrate 2 3 mg/L Arsenic N D ug/L Date of sample: 2 /S Collected by: _IV/ . y d�rw, B. SEPTIC/HOLDING TANK DATA Tank Type/Material _ /z- 14nl.3 % FEL. Date installed &/Z7�9. 9 Tank size/ 5 Q (i gal. Number of Compartments 2 Cleanouts (Y/N) Foundation r_.leanout (Y/N) '7# Depression over tank (Whil A/ High water alarm (YiN) A)_ Date of pumping 20 /iS Pumper C. ABSORPTION FIELD DATA Date installed -V'kzoq Soil rating (g.p.d./ft2 or felbdrm) 1. Z System type % rA&4r-/•i Length 416) ft. Width 3's ft. Gravel below pipe d' ft Total depth _/ ? ft. Eff. absorption area *Q -fl Monitoring tube --X Depression over field Al Date of adequacy test 2 Z /S Results (Pass/Fail) For --,6- bedrooms Fluid depth in absorption field before test in. Water added 7 SSD gal. New depth in. Elapsed Time: �?Q min. Final fluid depth O in. Absorption rate >_ %.SQ' g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION A/A Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tankllift station on lot /6 4 'W - Absorption field on lot Public sewer main r Sewer /septic service line Z S rt Animal containment areas S4 Manhole/Access (YIN) _ in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots l BU ,I,- on fiOn adjacent lots /D Q f Public sewer manhole/cleanout /a L Holding tank AM Manurelanimal excrete storage areas d o r SEPTICtHOLDING TANK ON LOT TO: Building foundation -5-4- Property line 16 t Absorption field S Water main /L,) 'f Water service line '-e- Surface water / O'O 5r - Wells on adjacent lots / 60 r ABSORPTION FIELD ON LOT TO: Property line U f Building foundation D `� Water main /4 t` i Water Service line %4 `n Surface water l6d 'f Driveway, parkingivehicle storage Z m Curtain drain !/A,4k Wells on adjacent lots F. COMMENTS G, ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Date 3// ✓`f/ 5 COSA brown sheet_10-10.12.doc OF '41 a Re , Y Sleren W. Eng' L PE .6259 fs u Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite fir''' (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL '`o FOR A SINGLE FAMILY DWELLING s Parcel I.D. -DP- COSA # t )=t n I--)( ) Expiration Date: S3 - 2 - 0 7 1. GENERAL INFORMATION Complete.legal description uF(g`: r4ra TC1ZQAC,4 Z Lor I5� Location (site address) 1 b9 ZO WAR1'E w.41 Current Property owner(s) C NRI' 5 N6 F SLIZ Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Z GZy I-ArA47-` GPR d6io#. Atc 995/5 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: S 3. TYPE OF WATER SUPPLY: Individual On-site Individual Well Individual Holding Tank Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site � u Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Cagle River Engineering Services 18421 VFW Rd., Suits 201 Address Eagle River. AK 99M Phone _ Og- 519 - Engineer's Printed Name C N (ZTSTvPntP_ Q tJcxjN Da 5. DSD SIGNATURE _1z Approved for Jr bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attacnments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev.,IMS) Original Certificate Date: 5-22--07 Municipality of Anchorage V • '� Development Services Department !� Building Safety Division , • ` , r On -Site Water &Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Arg q ,4Nt> 1 t%'Q AZLE ie Z I -or 15— Parcel ID: O 1; O -31 O a.. A. WELL DATA Well type ATG Date completed _7Z11 Jcl ° Total depth 320 ft. If A, B, or C provide PWSID # Sanitary seal &N) Cased to 14 Z ft. FROM WELL LOG Date of test 7/21191 Static water level 7- ft. Well production 5 9•p -m• Well Log GN) W'5 Wires properly protected &N) -5 Casing height (above ground) -S rp_in. AT INSPECTION S /u /Zook 23 ft. +2 g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate C, 4_ mg/L Other bacteria _PL colonies/100 mL Arsenic: —0— ug/L date of sample: _�& `D(Yeo P Collected by: L 4 4W3 i(344ZA rvr B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTI r'��EY- Date installed 4 / Z %/ 9 5 Tank size 15 oD gal. Number of Compartments 2- Cleanouts &N) }/t'S Foundation cleanout 1G' N) � Depression over tank (Y& NO High water alarm (YAG N CD Date of pumping S19 /zcpo7 Pumper C. ABSORPTION FIELD DATA Date installed 01127 q% Soil rating (g.p.d./ft' cr ft%drrtt) i Z System type TRC NGN Length 4 17 ft. Width 3.5' ft. Gravel below pipe I ft. Total depth 1 3 ft. Eff, absorption area L1& Monitoring tube Depression over field ND Date of adequacy test / ?oo Results Pas ail) Ph S S For S bedrooms Fluid depth in absorption field before test in. Water added�Ogal * New depth 0 in. Elapsed Time: /0 min. Final fluid depth b in. Absorption rate >= 7S0 g p•d• Any rejuvenation treatment (past 12 mo.) (YIN & type) ko If yes, give date Aft'¢ D. LIFT STATION Date installed Size in gallons 'Pump on' level at _in. 'Pi o Datum Cycles tested. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic lank/lift station on lot t Ir90 Absorption field on lot f Ivo t Public sewer main it- 1co I r Sewer /septic service line '1 V5 Animal containment areas �- /oo r (YIN) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots +100, On adjacent lots t 10o r Public sewer manhole/cleanout 1,100, Holding tank +75 - Animal 7S Manurelanimal excrete storage areas I1010 r SEPARATION DISTANCES FROM SEPTIC/I 181=9ING TANK ON LOT TO: Building foundation f 5 Property line f 5� Absorption field t S Water main 41,0 ' Water service line +to Surface water 'r Its. r Wells on adjacent lots +luy t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line f'10 Building foundation r Io Water main +/0 Water Service line + to r Surface water + loo r Driveway, parking/vehide storage GO Curtain drain f" Yb r Wells on adjacent lots '/' loo t F. COMMENTS M. G. ENGINEER'S CERTIFICATION t certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Date COSA Fee $ 7W /71 — Date of Payment 5 / Receipt Number. td (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 05-21-07;14:30 ; SGS Ref. #: 1072018 Client Name: Eagle River Engineering Services Project Name: Highland Terrace #2. L15 Client Sample ID: Highland Terrace #2, L15 Matrix Drinking Water ;907 561 5301 # 1/ 1 SGS Environmental Services Inc 200 W. Potter Drive Anchorage, AK 99518 Tei: (907) 562-2343 Fax: (907) 561-5301 All dates/Umes are Alaska Standard Time Printed DateMme: 05/21107 14:30 Collected Date/rime: 05108107 10:30 Received Datelllme: 05/08107 12:50 Technical Director Stephen E>ia Allowable Prep Analysis Parameter Results PDL Units Method Limits Date Dale iNt Bacteria 0.00 9222E 05/08/07 05/08107 dpt Nitrate 5.60 0.10 mglL EPA 300.0 16.00 05/09/07 05/09/07 Jds Arsenic ND 6.00 ug/L 200.8 10.00 05/17/07 05/18/07 tk Municipality of Anchorage ,.• :. Development Services Department ° Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 070150 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on , Lot 15 of Highland Terrace #2 subdivision. This inspection revealed a nitrate concentration of 5.60 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. I I I I I LOT 3 I I LOT 16 I '00'E 240.00 I L07 to I The location of thelstructure(s) as shown on this rbcord drawing (as -built) co PII 0 wit tle 21, AMC. /—Js—vu V. 1 HEREBY CERTIFY THAT I HAVE CONDUCTED A PW51CAL SURVEY OF THE FOLLOWING OGSCRIBED PROPERTY: LOT 16 . IDCX.IND rZnR= AV31) J$7OAC ADDTrlON AD. 2 HAVE FOUND OR ESTABUSHED ALL OF THE LAT CORNERS AS SHOWN ON THE PLAN AND THAT NO ENCROACHMENTS eXIST EXCEPT A5 INDICATED. R 15 THE RG5PON5151UTY OF THE OWNER OR BUIL.OER. PRIOR TO CONSTRUCTION. TO VERIFY PROP05G0 BUILDING GRADE REATNE TO FINISHED GRADE AND UTILITY CONNECTIONS. AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS. OR RESTRICTIONS WHICH 00 NOT APPEAR ON THE RECORDED EASE 5UBOM51ON PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BG USEO FOR CONSTRUCTION OF FENCE UNGS OR FOR e5TABU5HING BOUNDARY LINES. EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 I .ilr ASBUILT SURVEY LOT 15 HIGHLAND 10421 VFW Drive Eagle River= Alaska 99577 RECORD XXX.XX' TERRACE ADDITION N0. 2 $UBDV. W000 DECKS ® WITHIN THE ANCHORAGE RECORDING 015TRICT SCALE: DATE. Bv; SHEET:I / 1 I CADD File Name: 99.026AB wI •.0 r 30' 3iV 00 BJR n •J-- I Ru. n Oi 7 ... - _ + of ^ o ^ I y St LOT FRAuE O HOUSE IIAM' O �O' O ••t SEPgpplpc OCP - ;• U g b z I Lor is 'e a '00'E 240.00 I L07 to I The location of thelstructure(s) as shown on this rbcord drawing (as -built) co PII 0 wit tle 21, AMC. /—Js—vu V. 1 HEREBY CERTIFY THAT I HAVE CONDUCTED A PW51CAL SURVEY OF THE FOLLOWING OGSCRIBED PROPERTY: LOT 16 . IDCX.IND rZnR= AV31) J$7OAC ADDTrlON AD. 2 HAVE FOUND OR ESTABUSHED ALL OF THE LAT CORNERS AS SHOWN ON THE PLAN AND THAT NO ENCROACHMENTS eXIST EXCEPT A5 INDICATED. R 15 THE RG5PON5151UTY OF THE OWNER OR BUIL.OER. PRIOR TO CONSTRUCTION. TO VERIFY PROP05G0 BUILDING GRADE REATNE TO FINISHED GRADE AND UTILITY CONNECTIONS. AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS. OR RESTRICTIONS WHICH 00 NOT APPEAR ON THE RECORDED EASE 5UBOM51ON PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BG USEO FOR CONSTRUCTION OF FENCE UNGS OR FOR e5TABU5HING BOUNDARY LINES. EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 LEGEND` PowER POLE SEPTIC VENTS ra.) o ASBUILT SURVEY LOT 15 HIGHLAND 10421 VFW Drive Eagle River= Alaska 99577 RECORD XXX.XX' TERRACE ADDITION N0. 2 $UBDV. W000 DECKS ® WITHIN THE ANCHORAGE RECORDING 015TRICT SCALE: DATE. Bv; SHEET:I / 1 FRES Project Number: 99.026 WATER WELL ¢ CADD File Name: 99.026AB r 30' 3iV 00 BJR j 1 MUNICIPALITY OF ANCHORAGE P • DEPARTMENT OF HEALTH R 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 Parcel I.D. %' = — HAA # i� 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Day phone Mailing address Si_z Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water x NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site x Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(R.V. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION 6Y 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 investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm te iaadk Kiger Engghleeliti�` Seear, Phone ' r�p OX E J .h, ragle XlVer, AR�"5�7�•.d"S67' ` Address Engineer's signature Date 6. DHHS SIGNATURE M Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 8.21 mg maximum concentration is IU.0 mg .-- More inf^rmation occ citrates is ava 4ab'e from the 9n s'te Sery:ees "-sg�am, Date %— / I/ - U o NUTION ' II -J 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ]2-0M (Bea 151) Back MOA s l Municipality of Anchorage APR 0 ' 2000 DEPARTMENT OF HEALTH & HUMAN SERVICESMu,Niur,; ;v U, ANCH Environmental Services Division w,rF 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Lo7 /5- / e Terr,e,-"'`„LParcelI.D.: 3) a-0 A. WELL DATA Well type d, If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) /V Date completed '7- Q1 - P51 Total depth 3 -- o Cased to Casing height (above ground) a Sanitary seal (Y/N) Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION Date of test Static water level Well production '2,5ir 5 - WATER WATER SAMPLE RESULTS: g.p.m. Coliform Jef Nitrate X6%? t Other bacteria Date of sample: '�V - 3- O Collected by: 15;v2 we -e, B. SEPTIC/HOLDING TANK DATA Date installed Tank size /Sov--, Number of Compartments -'Z Cleanouts (Y"--2L- Foundation Y"2 Foundation cleanout (Y/M /1' Depression (YN r ✓ High water alarm (Y/N) o�" lq Date of Pumping /YefV Pumper -;7V 14 C. ABSORPTION FIELD DATA Date installed S'%27li'� Soil rating (g.p.d./ft2 or ft2/bdrm) A 2 System type %PA Length 44O / Width 3, j Gravel thickness below pipe P' Total depth ✓1 Effective absorption areaVV4 44 Monitoring Tube present(YN Y Depression over field (Y/N) TJ Date of adequacy test N % Results (Pass/Fail) — For bedrooms Fluid depth in absorption field before test (in.); - Fluid depth — (ins.) Minutes later:= Immediately after_ g -- la .water added (in.): Absorption rate = Peroxide treatment (past 12 months) (Y/1) If yes, give date D. LIFT STATION Date installed ss (Y/N) alarm level at* ,.Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* "Pump off' level at* _ *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot t /�� ; On adjacent lots Absorption field on lot f ! 3 ; On adjacent lots Public sewer main Nix Public server manhole/cleanout ig Sewer /septic service line % y Lift station f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line t3 Absorption field (� Water main/service line t/d' Surface water/drainage /' Wells on adjacent lots y- /uo ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 3o / Property Line 3 S- Water main/service line Surface water _ h to v Driveway, parking/vehicle storage area d /o Curtain drain N / Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that 1 have determined thru field inspections and review of Municipal record§"k�h_ ab5wt sy tepis are a in conformance with MOA HAA guidelines in effect on this date. „_.6V� Si nature— Pv 1re3 ? eg',z o, Engineer's Name Z-;, ,✓ ,fry ^Fxw—.rgtrte' 9'=1° touish.L'utOil a Date i��r/Dy . t�, G 7 6 HAA Fee $ J hZ) / PO Waiver Fee $ _ Date of Payment � / 7/,./bt > Date of Payment Receipt Number �� S g li'L1 �?/ Receipt Number Rev. 8/95 OSS: haa.wk.doc 04-12-00 11:01 FROM -CTE ENVIRONMENTAL LCT&E Environmental Services Inc. �6r ►ririr.�sirii.►iri�rr� 5615301 T-219 P.02/03 F-364 CT&E ReE# 1001414001 Eagle River Engineering Client POt: Printed Date/Time 04/06/2000 22:59 Client Name Project Name/it LE l5 Bk 2 Highland Terrace Collected Date/Time 04/03/2000 0:00 Client Sample 1D Lt 15 Bk 2 Highland Terrace Received Date/Time 04/032000 14:35 Matrix Prinking Water Technical Direct r Stephen C. $de Ordered BY Released PWSID 0 Sample Remarks AL-Loual)Le Prep AnaLrsis Parameter ResuLts PVL Units Method Limi is Date Date Init MATERS DEPT Nitrare-N 8.21 0.500 m6/L EPA 300.0 (<10) 04/03/00 SCL MICRO LAB Torat coliform 0 COL/100mL. 5918 92226 04/03/00 KAP Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax www.eagleriverengineering.com July 12, 2000 Jeff Poet Onsite Services Re: Lot 15 Highland Terrace #2 Dear Jeff, We have inspected the well wire installation at the above referenced lot and it now meets the requirements of the MOA code for Health Approval. You currently have this blue form on your desk waiting this verification and it should be able to be released at this time. Should you have any questions, please contact me at 694-5195. Sincerely, Louis Butera, P.E. \1998\99-026-Itr