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HomeMy WebLinkAboutSAMUELSON LT 1ASamuelson Lot 1 A #051-091-54 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251004 Work Type: Septic Upgrade Tax Code Number: 05109154000 Site Legal Address: SAMUELSON LT 1A G:1357 Site Mailing Address: 21037 SCENIC DR, Chugiak Owner: FEDERAL NATIONAL MORTGAGE ASSO Design Engineer: ALASKA RIM ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: Depart 111e 7t 3/12/2025 3/12/2026 11520 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 3 Received By: L 55 1-f ' 1- k I (,/vi Date: f Issued By:L.Date: ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-091-54 Property owner(s) FEDERAL NATIONAL MORTGAGE ASSOCIATION Day phone Mailing address 5151 CORPORATE DR; TROY, MI 48098 2639 Site address 21037 SCENIC DR Legal description SAMUELSON Lot 1 a Number of Bedrooms 3 Engineering Firm Alaska Rim Engineering Building Permit Number Not Applicable r-1 APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Absorption Field D Initial ❑ Septic Tank El Upgrade EJ Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: #.5q5 Date of Payment: / / ( 0 Permit No. 05 PZ _1_91 COV I Waiver Fees: Date of Payment: Waiver No. Distance: ARE, LLC dba ALASKA RIM ENGINEERING CONSULTING CIVIL ENGINEERS & PLANNERS 1920 Kentucky Derby Dr. Palmer Alaska 99645 Telephone: 907.775.2347 Email: alaskarimengineering.llc@gmail.com Professional Consulting --- Practical Solutions ARE LLC, project # 2024063 January 10, 2025 Municipality of Anchorage, D.S.D., On-Site Water and Wastewater Department 4700 Elmore Road, Anchorage, AK, 99519 Re: Samuelson Lot 1A 21037 Scenic Dr. Parcel ID 051-091-54 Subject: Septic System Replacement/Upgrade Design Narrative and Permit Application Dear Plan Reviewer, The existing septic system was installed in 1987. The System consist of a 1000 gallon concrete tank and 500 gallon steel tank, both to be decommissioned. The owner, a financial institution desires to place the property on the market in 2025. Therefore, the attached following summarizes the proposed plan to replace the septic system. SOILS One test hole was excavated on December 6, 2024. The test hole is located on the drawing with a 30- foot radius centered on the test hole. See the attached soil log for the groundwater monitor results. TOPOGRAPHY The lot slope from the south to the north is basically uniform. There are no topographical issues on the subject parcel. See the attached site plan for the topography. SEPTIC TANK REQUIREMENTS The existing septic tanks will be decommissioned and replaced with an Advantex FAP with pump vault. DRAIN FIELD DESIGN See the attached drawings for the drainfield design. REPLACEMENT SYSTEM This is a replacement system. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251004, Curtis Townsend, 03/12/25 Samuelson Lot 1A Page 2 of 2 21037 Scenic Dr. January 10, 2025 Professional Consulting --- Practical Solutions ARE LLC, project # 2024051 SURFACE WATERS There is no surface water within 100 feet of the proposed system. The site plan indicate the slope and direction of stormwater runoff. (See attached site plan) WELLS & DRINKING WATER There are no water wells within 50 feet of the proposed AWWT system. The property is served by a private well. SURROUNDING PROPERTIES We do not anticipate any adverse effects on the neighboring septic systems, reserve areas or drainage patterns by the installation of the proposed wells and septic system. If you have any question, please call me at 907.775.2347. Thank you for your service. Sincerely, January 10, 2025 Charles A. Leet, P.E. Principal Engineer Attachments: • Permit application • Overall Project Area • Proposed site plan • Field Section • Soil(s) log w/ percolation test data • Asbuilt Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251004, Curtis Townsend, 03/12/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251004, Curtis Townsend, 03/12/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251004, Curtis Townsend, 03/12/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251004, Curtis Townsend, 03/12/25 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this L'5 Day of of20?,S,byand betxvcen herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage MUllicipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate all Advanced Wastewater Treatment System (AWWTS), described as AdvanTex Wastewater Treatment FAP (fully Assembled Package located at (legal description) Samuelson Lot I a 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) IN Throughout the tern of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated Septic effluent in accordance with the equipment's approval for operation in the Municipality. o It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the 111111111fildUrCrs representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of all AWWTS reduces the potential failure of the system, Which could include sewage backup and costly repairs or drainfleld replacement. (rev. 05/18/2018) Page I of 3 r� Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. 0 Owner agrees to grant the Municipality reasonable access to test and inspect tine r\ AWWTS. The Municipality will give at least 24-hour notice. �"�A Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the Construction, maintenance and repair of the Owner's AWWTS. 4� Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Team. The term of this Agreement shall begin oil the elate of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern tine rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/ 18/2018) Page 2 of 3 OWNER: By: f ----(signature) C. N S(print name) t-\ C�- vL" STATE OF hI:ASK-Y V ss. THIRD JUDICIAL DISTRICT Date: I)- � �s 1 @-13 L�t— It I MAY " PARKER ' f Texaj 0 �' -::Notary Pubof Public, State Texas Comm. Expires 09-28-2026 3891 Notary ID 133988915 79 "The foregoill illstrUlnent was acknowledged before me this 26day of 20A' �141')l 0'.-If Pa12-,r-o,1'2 NOTARY JBLIC FOR A-L-M�"- My Commission expires: t> f - 2-9 - MUNICIPALITY: By: signature) Date: C'-V (print name) `Title: Ck (rev. 05/18/2018) Page 3 of 3 LOT 2 PLAT #2000-47 BLM LOT 4 SECTION 8 T15N, R1W, S.M. ED S T (S 89.59'45 E 90.26') I m �o mH o � / m m 57.8' LOT lA LOT 12A z �PP PLAT #91-37 PLAT #96-127 O O O m O 100' z m WELL O RADIUS O � m o N 30' 30' N 24.1' CA LOT 2 J m GARAGE PLAT #67-156 5.2' C"i / 43' TWO STORY 38.9 / m RESIDENCE w A / 4.3' _ w m 29.3' 17.5' ---------------------- 16.0' 10' UTILITY ESMT. LOT 12B mPP PLAT #96-127 (N m 89.53'30" W 90.30') m LOT 8A LOT 7 PLAT #91-37 PLAT #67156 ASPLS MORTGAGE LOCATION SURVEY NOTES: NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. LEGEND () RECORD DATA PER PLAT #91-37 GRAVEL DRIVEWAY EDGE OF ASPHALT FENCE — E E — OVERHEAD UTILITIES P POWER POLE SEPTIC PIPE �w WELL MH SEPTIC TANK LID 0' 20' 40' SCALE: V = 20 FEET (11"x17") �. 0F. A�gsl •:9 I j *•••49TH.... ••* ••Ryan G. Johnson; r�+'•• No. 192159 . 10/15/2024. •S�`a`r AS —BUILT OF: MUNICIPALITY OF ANCHORAGE -- DEI TMENT OF HEALTH AND HUMAN SER% a S Gj Environmental Health Division ©� r ' 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ) Address TO SEPTIC ABSORPTION FROM WELL p TANK FIELD � `�'p Phonels) Permit No. No. of Bedrooms WELL o2L} D 3 LEGAL DESCRIPTION LOT LINE Lot ( Block _ Sub - sion FOUNDATION 7 Township, Range, Section AS -BUILT DIAGRAM (Show location of well, septic system. property lines, foundation, driveway, water bodies, etc.) TANKS IN SEPTIC ❑ HOLDING ' Manulacturer Capacity in gallons 1Go7 u Material l No. of Compartments vf""U I 1 1 1 TYPE OF SYSTEM ❑ TRENCH BED ❑ W. DRAIN ❑ OTHER /h Depth to pipe bottom from Total tlepth from original grade I original grade - ' ( I DU' , FT Z rj FT 1 FIII added above original grade /A" n Gravel depth beneath pipe 'T a Vf ) FT �j, FT 1 Gravel length Gravel width �'7a1 l j �Jll�il�C4�T '�7�� t s (a21 Total absorption area Distance between lines L02 SQ FT FT Number of lines Soil rah, ` P Pipe material !� 2 SQ FT Installer Date Installed L WELLS t, P 11 1151E .k L PRIVATE ❑ OTHER (Identify) Classification (A,B,C) Total Depth Cased to FT — — — — — /— Installer AL Date Installed: r I REMARKS: --I - - - - Scale: i�p-ENGINEEFFS SEAL • Inspections Performed by: ,z 11,11, -:: i w Date: �l �(5 g� o„�> nez,,,� �v 0 UD '� xn Rt S & S ENGINEERING cerci y that Ihi inspection was performed according to all17U34 C-11,11910 ;a ����yy c £, Municipal®I�j�ati$gV�r�{ie��(I �ur&t9o�illfiS'dale: `fes. Health Department Approval: Dater '' 72-013 (3/85) d t"e* � �!'. w„•'6"� Municipality of Anchorage K DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: DA DA LEGAL DESCRIPTION: jtT S��r- Township Range Section:�c� �Pl { 1 SLOPE SITE PL f F 6F T) r-TTr� 1 O 2 3 r 4- 5 5 _ 0 6 7 q 8 O h� 10 �'r, _->-or� � ' 'V � WAS GROUND WATER ENCOUNTERED? tJo 11 S IF YES, AT WHAT L O 12 13- 14- 15- 16- 17 314151617 18 19 20 COMMENTS DEPTH? P E Depth to Water Ager Monitoring? Date: u PERCOLATION RATE gD (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND _.�— FT PERFORMED BY: 17034 Eagle River Loop Road No. iv / CERTIFY THA THIS T ST WAS PERFORMED IN Eagle River, as a ACCORDANCE WITH ALL STATE AND MUNICIPAL GUID IN EFFECT ON THIS DATE. DATE: [7 72-008 (Rev. 4/85) W ,` , MUNICIPALITY OF ANCHORAGE Department o� Health & Human Services 825 L et.. I. Anchorage� Alaska 99501 343-4720 Day Phone: 276-5599 Parcel Id: 051�091�41 o e�a : d Y ��o�� SAMUELS8N'�Lot�1 ^U -Blbck: N�A Section: 8 Township: 15N R�nge: 1W Lot Size 1215O (sq.!t. or �cres) iv! Bedrcr�s� This Permit: 3 Total Capacity: 3 SEPFIC TANK: Minimum total se�tic tank capacity: 1�O00 gal�ons. Each septic ta:k �ust �ave ai least 2 compartments. Depth to top o< septic tank(s) < 4.0 �eeL re,iuires i:sulation over tank(s). INSTALL PER ENG�NEERS DESIGN: BED TRIANGLE; 39/ X 35. ABANDON SEPAGE PIT AND SANITIZE AREA. �AND CONPACT BACKFILL. PR�V{DE 2' �F SAND �ATED AT 125 SQFT./BEDROOM BELOW BED. VARIFY THAT A M[NIMUM OF 3'OF NATIVE SOIL EXlSTS BELOW 8ED AREA. NOTIFY DHHS P�IOR TO INSTALLATION AND INSPECTIONS AT 343-4681. A HOL lNG [ANK MU 8E INSTALLED SHOULD THIS SYSTEM FAIL, Z�� ' ^ l CER�IFY THA[: 1. I am [amiliar wiLh the requirements /or on-site sewers and wells as set �orth by the Municipality of Anchorage (MOA) and the State o� Alaska. 2. l wil1 1n*tall the system in accordance wi�h MOA all codes and regulations� and in compliance with the design rmii, 3, I wi1� adhere to all MUA and State Alaska o{ roquirements �or the set back �is�a�ces �rom any existing well, �astewaier disposal system or public sewer�ge system on this or any ad�acent or 1.3 4. I undersLand �hat this is permit valid �or a maximum o� 3 bedrooms, I a]so understand that Lhe capacity of the total system is 3 bedrooms and any enlar�ement will require a: additional permit. 1 1 1- - I I . . - 1% 1 C., ..I. �.3 .1. 11 (3 L) ENCi I 1\11EEID I I\lf 'It 2(JI1. E..' G L- 1 -0: R V R a X41<: n 7 -'EI `Ivl I F )FIFIL Nk iJ -i .... .... .. ... l. -fir, I I: I- -q: 1:: 1-1 1 Ed i I I J. 1,1 .la 1 1 -71C.11 -A-. J::. L 1. 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SEAL) o_y e Municipality of Anchorage's DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ^ gypp,,,, dt��T� r') PERFORMED FOR: /7�� � - �/i.%D/� i�AfN/lEf/If DATE PERFOFiiZo—e n LEGAL DESCRIPTION: 1-1�l41�.l2GS©Al .S/o Township, Range, Section:r/S- A �" '/Vl w' O (� g c 2- 3- 4- 3 4 _ /c u — 5 b 6 7 8- 9- 10 9 10 11 12- 13- 14- 15- 16- 17 21314151617 18- 19- G 819 G uj 9s, 1"I,B2 GM • SLOPE WAS GROUND WATER ENCOUNTERED? / v S IF YES, AT WHAT L DEPTH? OP E Depth to Water After Monitoring? Date: I I PERCOLATION RATE TEST RUN BETWEEN COMMENTS ` v �+G- �� Z2F 2 CfiN p �ivflE BY:'P ERFOR I �— ACCORDANCE WITH % YO34,Eqk�K%aDrhWlAR4a"o FN EFFEC 72-008 (Rev. 4/85) Eagle River, Alaska 99577 (minutes/inch) PERC HOLE DI ETT€ —AN —D FT r C�/F}TTE wl9 ��,� D/f Dr�9 C GcJ/ 7 CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: �/� M ZW'1`RUAL dX8Nj PERMIT TW—, AGREEMENT, made this �l day of 198_, between MUNICIPALITY OF ANCHORAGE, Grantor, and Alaska HonsiNg - Tim Riddles , Grantee, rvliivcb6ETH: The Grantor does hereby grant an Encroach- ment Permit in the following described Public Right -of -Way or Easement Area to Wit: Samuelson Subdivision. Lot 1, located _ within the LZ of Cep+; , a m15N . R1 W, � C'rid NW1357 The encroachment hereby authorizec.'is described as and limited to the following: encroachment of septic sus_tem into BLM road easement as shown on attachment"A', �In consideration for this permit, the Grantee agrees that he will. indemnify and hold harmless the Grantor against any and all claims which may arise or be caused by the construction, alteration or maintenance and existence of the above described encroachment or for any damages whatsoever arising out of the granting of this permit. The Grantor reserves the right to revoke this permit upon twenty (20) days written notice to the Grantee. The Grantee, agrees upon said notice of revocation, to immediately remove said encroachment from the easement, street or public right-of-way. Should the Grantee refuse or fail to comply with said written notice, the Grantor, may without further notice to the Grantee, remove or cause to be removed the encroachment, and the Grantee hereby agrees to reimburse the Grantor for all cost incidental to the removal thereof. The Grantee hereby agrees to pay an annual fee of $50.00 , IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seals the day and year first above written. Grantee: STATE OF ALASKA ss. THIRD JUDICIAL DISTRICT Grantor: ANCHORAGE Municipal Engineer THIS IS TO CERTIFY that on this day of , 198 , before me, theundersigned, a Notary Public in -'and the State of Alaska, duly commissioned and sworn as such, personally appeared J. David Norton, known to me to be the Municipal Engineer for the Municipality of Anchorage, Alaska, who executed the foregoing instriment, and he acknowledged to me that he executed said instrument as the free and voluntary act and deed of said cor- poration for the uses and purposes therein mentioned, and that he was authorized to execute said instrument. WITNESS my hand and official seal on the day and year first above written. NOTARY PUBLIC in and for Alaska My Commission Expires: STATE of ALASKA ) ) ss. THIRD JUDICIAL DISTRICT IN THIS IS TO CERTIFY that on this day of 19--t before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as August 25, 1987 ATANUSKA ELECTRIC ASSOCIATION, INC. ' P.O. BOX 1145 PALMER, ALASKA 99645 S & S Engineering Eagle River, Alaska Matanuska Electric Association, Inc. has no objection to a septic system/leach field encroaching into the utility easement located within Lot 1, Samuelson Subdivision, Section 8, T15N, R1W, S.M., Alaska. This non -objection is conditioned by the stipulation that Matanuska Electric Association, Inc. will be held harmless from any and all damages that may result from the existing and future use of said easement. If you require additional assistance, please contact our office. Sincerely, )CueC_re>. ' l. Rebecca L. Bidasolo Right of Way Agent dai DC4— ALASKA'S FIRST AEC -INCORPORATED 1941 -ENERGIZED 1942 TELEPHONE (907) 745-3231 I` ZMatanuska Telephone Association, Inc. P.O. BOX 1388 PALMER, ALASKA 99645 PHONE (907) 745-3211 age River (907) 694-2101 Wasilla (907) 376-3211 Northern Sights CATV (907) 745-5001 .............................................................................. August 26, 1907 Mr. Tim Riddles Alaska Housing c/o S & S Engineering 17034 Eagle River- Loop Road, Suite 204 Eagle River, Alaska 99577 Dear Mr. Riddles: Thomas R. Minnich General Manager This letter is to inform you that Matanuska Telephone Association, Inc. has no objection to the placement of a septic system, within the indicated utility easement on Lot 19 Samuelson Subdivision, Section B, Township 15 North, Range 1 West, Seward Meridian. Septic is to be deep enough in order that upon burial of existing aerial telecommunications facilities at 24 inches the septic system is not disturbed. An As -Built of the completed septic system is to be provided to Matanuska Telephone Association, Inc. in order that the Association can design, if possible, a route to avoid the septic areas upon burial of .overhead lines. PLEASE NOTE: At no time will Matanuska Telephone Association, Inc. be held accountable now or in the future for damages to the septic system within the indicated utility easement. Please be advised that should Matanuska Telephone Association, Inc. need to upgrade, maintain, or replace buried or aerial cable within the utility easement it will be allowed to do so. Any repairs that may be required to the above septic system due to utility needs will be borne by the property owner of record. This document and the attached As -Built should be recorded. Sincerely, MA NUSKA TELEPH B r-nadette Zim eal Estate a BZ/dlg NONOBJ.SSE /ASSOCIATION, INC. rman Properties Supervisor '.E DRAIN FIELD 7Ak4CE FROM w4ZEX O^ TOTAL LENGTH FDVNDATION _ NEAREST LOT UNE OF VW__S 90WEEN LINES FT. LENGTH OFj,iefVTINE LN. TOTAL EFFECnvE 1*'ID'•' Or TLE TO F"" GRA EE DEPTH OF FCTER MATERIAL EENEATH TILE_'"'- IN. AtOvE TLE CLL:/ DISTANCE FROM ! WATEI Q TH S'�% „&LHLDING FOUNDATION S&PAPLE WEArZST N SEPTGIC / SEEPAGE / ✓r OTHER L� sr-WER LIh1E TAN, ST'STEM.��, CESSPOOL ES DiAGRAJA OF SYSTEM 0 DATE ��+/ ir V4 'x'T. -w 1- �� fsv✓K iANCROLAOL �^"' W501 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM .'�IPNRSADDRESS- v---�'-3�^-- �S ;:JLTIO�N�cY ,O F,L•!�•�°•cy�r•�EG At TAMC: Flo STANCE FkOM WELL /+` MATERIAL 1 L *LlID %XD CAPACITY_ /,a00 GAIlONS. INSIDE LENGTH t! _INSIDE WIDTH �• DEPTH �` } PAGE SYSTEM SEEPAGE PTT XO � WIDTH �D LEW5T`+_ 41 vcm Ee OF PM OUTSIDE DIAMETER OR �""av MATERiA! C �� r DISTANCE FROM WFII �A6 - W¢D+4JG fOV►�AT1�L_—. - ARZSJ LOT LL^LF TOTAL EFFECTIVE AESORPTION AREA twAll AREA) Xi. FT. ; '.E DRAIN FIELD 7Ak4CE FROM w4ZEX O^ TOTAL LENGTH FDVNDATION _ NEAREST LOT UNE OF VW__S 90WEEN LINES FT. LENGTH OFj,iefVTINE LN. TOTAL EFFECnvE 1*'ID'•' Or TLE TO F"" GRA EE DEPTH OF FCTER MATERIAL EENEATH TILE_'"'- IN. AtOvE TLE CLL:/ DISTANCE FROM ! WATEI Q TH S'�% „&LHLDING FOUNDATION S&PAPLE WEArZST N SEPTGIC / SEEPAGE / ✓r OTHER L� sr-WER LIh1E TAN, ST'STEM.��, CESSPOOL ES DiAGRAJA OF SYSTEM 0 DATE ��+/ ir ENCROACHMENT PERMI. THIS AGREEMENT, made this _ 3rd day of September 198, between MUNICIPALITY OF ANCHORAGE, Grantor, and _.A A"KA.HO"VUG FINANCE CORPORATION , Grantee, ITE SgETH: The Grantor does hereby grant an Encroach- ment Permit in the following described Public Right -of -Way or Easement Area to Wit: Samuelson Subdivision Lot 1 located within -the NE 114 of Oar+, a .T15N. R1W. S_M_ Grid NW1357 The encroachment hereby authorized is described as and limited to the following: encroachment of sematic sustem into BLM road easement as shown on attachment 'A " In consideration for this permit, the Grantee agrees that he will indemnify and hold harmless the Grantor against any and all claims which may arise or be caused by the construction, alteration or maintenance and existence of the above described encroachment cr for any damages whatsoever arising out of the granting of this permit. The Grantor reserves the right to revoke this permit upon twenty (20) days written notice to the Grantee. The Grantee, agrees upon said notice of revocation, to immediately remove said encroachment from the easement, street or public right-of-way. Should the Grantee refuse or fail to comply with said written notice, the Grantor, may without further notice to the Grantee, remove or cause to be removed the encroachment, and the Grantee hereby agrees to reimburse the Grantor for all cost incidental to the removal thereof. The Grantee hereby agrees to pay an annual fee of $50.00 IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and 'sea s the day and year first above written. rOfp. ^St, it Grantee: Grantor: ANCHORAGE STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) FOk�iunicipal Engi TS IS TO CERTIFY that on this le X14 day of cI, 198 7 , before me, the undersigned—pa- Notary Pub]Ac in and for the State of Alaska, my commissioned and sworn as such, personally appeared J. David Norton, known to me to be the Municipal lginr for the Municipality of Anchorage, Alaska, who executed the foregoing instrument, and he acknowledged to me that he executed said instrument as the free and voluntary act and deed of said cor- poration for the uses and purposes therein mentioned, and that he was authorized to execute said instrument. WITNESS my hand and official seal on the day and year first above written. NOTARY PUBLIC in and for Alaska My Commission Expires: STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRTCT 1 R16AAr C- COwgN -\ Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program ; r 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0Rl -5Y HAA# 0 4 O C 4 � Expiration Date: 5' q — 0 S' 1. GENERAL INFORMATION . Complete legal description Lot IA Samuelson Subdivision Location (site address or directions) 21037 Scenic Dr. Current Property owner(s) Brian & Nancy Moulton Mailing address . Lending agency Mailing address Real Estate Agent Mailing Address Day phone PO Box 671243 Chugiak, AK 99567 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Day phone Day phone 688-3545 TYPE OF WASTEWATER DISPOSAL: 7® Individual On-site QC ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal andlor water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and,State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S S S Engineering Phone' 694-2979 Address 17034 K. Eagle River Loop Ste. 204 Eagle River, AK 999577 Engineer's Printed Name Robert: C. Cowan Date S. DSD SIGNATURE _( Approved for 3 bedrooms. Disapproved. iERT C. COWAN CE -8801 Conditional approval for bedrooms, with the following stipplations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other ilz. Original Certificate Date: By: c /iA� _ / — (Rev. 01102) Municipality of Anchorage • '� Development Services Department Building Safety Division " On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �, 14 5.,. r*,. S/ � Parcel ID: 0 5-1— 0 % I ^ Sf4 A. WELL DAT Well type�Vi4TE If A, B, or C provide PWSID #= Date completed &L 1170 Sanitary seal 0%) 64> Total depth 5� ft. Cased to 5f ' ft. Date of test Static water level Well production FROM WELL LOG N14 ft. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: mg./I. B. SEPTICIHOLDING TANK DATA Nitrate .100 mg./I. Date of sample: II oq Well Log (YNibl N� Wires properly protected (N) Casing height (above ground) 1 Z + in. AT INSPECTION ( IL o 3T ft. 2.1 g.p.m. Other bacteria colonies/100 ml. Collected by: lOS H11 k-4 k Tank Type/Material SEPTIC 1 C,UUG6TL Date installed `3 / 11 / 70 Tank size 1000 gal. Number of Compartments I Cleanouts&N) VE -5 CI Nslo� Foundation cleanout (YAM,uD Depression over tank f ?40 IrH-i-g�h water alarm (Y/N) ►� W Date of pumping 1 I Orb 6 Pumper ��4iVIT1?�a/ PUMP6A?_5 C. ABSORPTION FIELD DATA Date installed 1 9 Soil rating (g.p.d./ft= or /bdrm ): Length 3?'* ft. Width ;0 r X- ft. System type ELCV4MD � Gravel below pipe eD- S ft. Total depth 3 ft. Eff. absorption area 68Aft Monitoring tube SLI Depression over field Date of adequacy test 111(zlekI Resu (Pas ail) For 3 bedrooms Fluid depth in absorption field before test _�9L in. Water added4✓Bgal. New depth_2L in. ,I Elapsed Time: Amin. Final fluid depth)51�in. Absorption rate >= t G0t g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed f n 'Pump on' level at 33 in. Datum '150,Tro r%, E. SEPARATION DISTANCES Size in gallons S60 `Pump ofr level at ;M"'In. Cycles tested .2- SEPARATION 2 SEPARATION DISTANCES FROM WELL ON LOT TO: c r Septic tankilift station on lot 5Q, f OO t Absorption field on lot 100r-{ Public sewer main Niq Sewer /septic service line �6 t+-- Manhole/Access(R)N) i1 r High water alarm level at 3(0 in. Meets alarm 8 circuit requirements? yCg On adjacent lots foo 1 -!•- On adjacent lots f Oa 14 - Public sewer manhole/cleanout t�114 Holding tank q6 I Ok) WT 43 SEPARATION DISTANCES FROM SEPTIC/Hed)fNGTANK ON LOT TO: 1 i / Building foundation ;2Property line 60 Absorption field S 'f Water main K PC Water service line /0 r1— Surface water / rt Wells on adjacent lots (U0 '4— SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: �, wo. Rtr`ar) 1 Property line 5 t Building foundation 104- Water main fJ Water Service line 1014- Surface water (0o rf-- Driveway, parking/vehicle storage 10 Curtain drain Nous uAxxvu Wells on adjacent lots fQQ F. COMMENTS G. ENGINEER'S CERTIFICATION To I I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name P r, A t -t T Co &J,4 i.Cc1 Date IV, HAA Fee 8 _ � 3 0. Date of Payment i-;-/7/dN Receipt Number or, / S 1 (. (Rev. 12101) . Waiver Fee $ Date of Payment Receipt Number *OIBn C. COWAN CE -8801 LL6 FelofZ (-i .,T- V 2S tA 77:'E67- — �vn /tea tAo4 I' w17 Ul INC -r J� `75. a MCAS N v V Ft o p c �' ^ zI s `1 �I< i�it j,(�:' •.aha'%�I rODy y i 14 31 10d P -MIT 8661 12 '4ad e68v 012 106 : 'O! 3ICM 'X6 OIIA3O'S OIIW3ld : WDMi SorroweriClient Moulton Property Address 21037 Scenic Drive city u 1 ak countyMun, of Anchorage K e 99752 Lender National Bank of Alaska L h 1A Ed - Ts•is a . N off a C}lh j.»..r...r414 AS -BUILT v 1 hereby c�+kr surve that have yed the (o g ralb�G p�m�penr: 4or-- ;A. ��17 nLJ�iT- y1-. If S' crt, r1.7L pt. 9. 7-1 —0. R t At ti s,l.,.+ . Anchorage Reoaeding 14ainc1. Aloka, and that the Improve - menus simated lhaean are wkhln the ptoperty lines and do not overlap or encroach on the property ly jn� adjacent lhemo, thin no Improvements on prop�cty ly{ns adJaaru thereto encroach on the premises U oueFrbn and tFat &hem am no roadways, trsnamissJon tares or other vlslbk easements on said property aapt as indimed heron. D4t#d&tK!FJcI4vor, Alaska this al ' day of .-<&*-1 l9 - AO FAT C. JOHNSON - 6: Ld . SCALEwnd . Rog nd LaSomey4f u. SIO -LS Sax 7744%. folk River. Alaska "M ----• - • — Jrhon. r�07) 614•'.-K7 . — - . — - — . '' Fam MFG MCS, • Dfv.•on of ACI Dovolop~o 18001007.7781 FEB—OB-2005 09:59 S&S ENGINEERING 907 694 1211 P.02i02 STATEMENT OF NON -OBJECTION FOR ENCROACHMENT WITHIN UTILITY EASEMENT Matanuska Electric Association, Inc. (MEA) has no objection with the location of a leach field crossing the platted utility easement located In the rorthwesterly corneof the following property; Lot 'A, SAMUELSON SUBDIVISION, Anchorage Recording District, according to Plat #91.37 Section 8, Township L N. Range 1 W, S.M. This non -objection is granted with the full understanding and agreement by all parties having an Interest In the above property that this leach rield encroachment will in no way restrict or limit the current or future ability of MEA to fully enjoy the benefits of the easement for any and all utility purposes that it presently enjoys under the easement. This non -objection is further conditioned by the stipulation that MEA will be held harmless from liability for any and all damages to the encroachment that may result from the existing and future use of said easement by MEA, Its contractors, successors, agents, licensees, or assigns. ATANUSKA ELECTRIC AS OCIATIONINC, BY: _ I, VIT\• e STATE OF ALASKA ... .... (1C IJ General Manager or his Represe tative SS. THIRD JUDICIAL DISTRICT : The foregoing agreement was acknowledged before me this 0-191 day of 20 j2 by r, Notary Public for the State of.)Alaska O \^R My commission expires rmy >tkP�uc. Z BY: BY: STATE OF ALASKA SS. THIRD JUDICIAL DISTRICT The foregoing agreement was acknowledged before me this -? day of �_.20as • u ... .. � • 4M.CJL- nNOTARY Notary Public for the State of Alaska My Commission expires:I o -.2� - e 5 RETgRN TO: MEA, PO 8OX 2929, PALMER, AK 99645 TOTRL P.02 a ..� ,ww, T:��`l7ll� rli'lu l ;t ^°�c•�rrit �c� tr�� •a+'jzirrt.t rit�l,]•� •x,�,� f � �.r�l•�Ifi>ijr;1�"�'lIK�frril��rt i�XrtirR7��]•,� ' •' .. �, r� x•;; ,. _ z ,0• i`f! tA!/I��EA!•)'�,���rri!,�C'��r��y'[�`�',Xj•�!�Jr� :;;,, ,; ' - f C � �✓�c•}r��r1�Y 4`j�t�rrn �.l•��i ll v` 1. •�•�(�l k.N'�•kA�� .� ' ` `�� +-, � • �'�` � * _ i. �ba tfi>•Jrr]�„113�-?::l �jiftl��'�J`��it�T'g `T� ,�°r � .s - •F p ' �k r��"CJftij•�r��F',' ��.��'/�Z,�'��rii>'•Jtr.t��1�.•;A�lcT`a•,[i;� .. s � yt ' � ' r t �a2�����zrlsjr�,u=sa'•��,�r� : �--�- .. � ._� . ° � , . � �,�;:� ; '�� 1�1'•-7tr•�i-��€�11b�•11K�,'�'�r.•1Ff(t•?ir- GC?'#=1rI►!�C•7,lli'•1�1�.j����rl���iS•a'�irt ,i , i L � ..�. .{=' f .�:. � •� 1, ' � r� �Jr'!'�i �P���ijlr.�?�7,�iit,Y��i'GI�?(VFT��'Jih�!L•7j�lt��•k= � r;: , E nArfjJtr,(t t•) , li•A'. • i7♦ _ -Ar- J lz .�a :��zz�-� Y;���C�•71��r�r� ����-������ � �.z�►��c • � ���c , r��l%»rir � �► �*��• ► �,a, MUNICIPALITY OF ANCHORAGE�� • '-e Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES M}t 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER/ AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ®S-1 - O 9 / - 41 HAA # 14-11 q 0 0 -,-76 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Samuethon Subdivision Location (address or directions) 21037 Scenic (b) Property owner Mank L Braunstein Telephone : (home) 688-0985 Business Mailing Address 21037 Scea,ia C jgi k, Ah 99567 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address 18850 Eaq Telephone 694 - Telephone HERITAGE REAL ESTATE ATTN: Nat Jackson Raven Road, Eagte Riven, Ataska 99577 (e) Mail the HAA to the following address: (or check here EXxif hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Road No. 244 Eagle River Alaska 99577 2. TYPE OF RESIDENCE Single -Family ffx 3. WATER SUPPLY Number of bedrooms 3 Individual Well,Q Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-siteZ Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 a ov'(MUNICIPALITY OF ANCHORAGE (MOA) p0k5\011-lealth Authority Approval (HAA) M�N�G�MENjP CHECKLIST FEBRUARY 1984 343-4744 Legal Description: L e2 1 i +M i CJgon� 5 A. WELL DATA �tctly V Well Classification 'Si NG t o F;- lvt It If A, B, C, D.E.C. Approved (Y/N) A&4 Well Log Present (Y/N) _N) Date Completed0��� Iq10 Yield 14. Total Depth_ `� Cased to .. _4 Depth of Grouting — (0 Static Water Level -.2 + Pump Set At U f� Casing Height Above Ground Z q !, Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) G Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL:, To Septic/Holding Tank on Lot �7 S ; On Adjoining Lots / ao To Nearest Edge of Absorption Field on Lot ( 0r-) / ; On Adjoining Lots 100 "+ To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole A To Nearest Sewer Service Line on Lot S f Water Sample Collected by 4T S F�uc�nJcc ✓iN; Date IFa Water Sample Test Results _-ZS v 9 11 'P4C,to vu - 6-A tr s; to 4 A 1 t,2 A Je S Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size (0�&1 No. of Compartments Standpipes (Y/N) —�—Air-tight Caps (Y/N) Foundation Cleanout (Y/N) A) Depression over Tank (Y/N) A/ Date Last Pumped 7- - `1 - D Pumping/Maintenance Contact on File (Y/N) A. IA ; for 1'J11A Holding Tank High -Water Alarm (Y/N) _pij Temporary Holding Tank Permit (Y/N) T SEPARATION DISTANCES FROM SEPTIC/HGH3- C' TANK: To Water -Supply Well ')� 4 8 To Building Foundation To Property Line To Water Main/Service Line �o To Stream, Pond, Lake or Major Drainage Course To Disposal Field f a 7 - Q n " 1 - Comments eiP I(C- / vL)moe �2a��1� 5 ��Sp�,01 VIL) tIyJG /4 t AA P ©fJ Al 6 Z /E m4 DA) 72-026 (Rev. 7/88) Front Page 1 of 2 rid ¢C C's = LRGORATORIES CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET • ANCHORAGE, ALASKA 99518 E TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 Client Sample ID:LI SAMUELSON SID PWSID :UA Collected JUN 25 90 9 17:00 hrs. Received JUN 26 90 9 13:00 hrs. Preserved with :AS REQUIRED ANALYSIS REPORT BY SAMPLE for Work Order # 25096 Date Report Printed: JUL 2 90 9 11:37 Client Name : S & S ENGINEERING Client Acct : SNSENGP P.O.# NONE RECEIVED Req # Ordered By : R. SHAFER Analysis Completed :JUN 27 90 Send Reports to: Laboratory Supervisor :STEPHEN C. ED�r`E 2)S & S ENGINEERING Released By : C --------------------- Special --=------------------------------------------------------------------------------------------------------ ----------------------------------------- -------------------------------------------- Instruct: Chemlab Ref #: 902080 Lab Smpl ID: 3 Matrix: WATER Allowable Parameter Tested Result Units Method Limits ------------------------------------------- - NITRATE -N ND(0.10) m-- 1 EPA $53.2 10 Sample ROUTINE SAMPLE, Remarks: SAMPLE COLLECTED BY RDJ, I Tests Performed See Special Instructions Above UA -Unavailable ND= None Detected X* See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than MUNICIPALITY OF ANCHORAGE 1 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION C) S DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL Nq�7_CLi OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Telephone: Home Business 'Z -1(z;1 SS19 Applicant Address � JE�;k /�,L-f�69i�- `�41SD (c) Applicant is (check one): Lending Institution ❑ ; Owner/buildepll-Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent ����►'� IJP ��r�Y11 Address Telephone (f) *Wrthe HAA to the following address: ' S & S ENGINEERING Eagle River, Alaska 99577 O� 2. TYPE OF RESIDENCE Single-Family;E�_Multi-Family 0 Other Number of Bedrooms IJ 3. WATER SUPPLY Individual Well,'- Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata � / YZ6� Tyrpe of System Design L�b 3j Yam Date Installed eq Length of Field Width of Field f17 iPPr— 4gL) Ln { Depth of Field ��✓b'�'r✓i� t G?a � � U , L, y Gravel Bed Thickness opy&&, ovs- Pl P6�, Square Feet of Absorption Area Depression over Field (YUN" i— Results of Last Adequacy Test Standpipes PresentYON) Date of Last Adequacy Test tJ A Separation Distance from Absorption Field: To Water -Supply Well To Property Line L90� 5/ To Building Foundation To Exist' Ab d d S Lot'' To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course ng or an one ystem on 1 On Adjoining Lots 3� To Cutbank (if present) f 1 1k To Driveway, Parking Area, or Vehicle Storage Area 1. , Comments '��C Qom} �,r c >> f� 1 r (!�X c29�d Lnt t .-� b -i CQ t?2J t—D tG-, -Ism 1 r,-� D. LIFT STATION „ � _ Date Installed Dimensions !ty:J' 1L 1 rt�r Size in Gallons Manhole/Access((9l) "Pump On" Level at �'� "Pump Off" Level at 21� High Water Alarm Level at j7fP Tested for tom'1/` VentON) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes Or N) Comments jtgp'!�p C �1�• ���t-� QJ � 1 -fes ��rnP z� ** Check Permitted Bedroom Rating Against HAA Request ** Icertifythatlhave che ked rified,orconformedtoallMOAandHAAguidelinesineffectonthedateofthisinspection. S & S ENGIN ERiNY�`, J Signed 17024 Es -9W Rilver t cop Road N PM4 Companfaglo River, Alaska 99577 MOA Receipt No. ! o 0/ U 0 o Date of Payment Amount: $ �yU UU Page 2 of 2 72-026 (Rev. 8/86) Back CHEMICAL &GEOLOGICAL LABORATORIES OF ALASKA, INC V '' 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 lAaoR�,oR,Es FEDERAL TAX ID # 92-0040440 .ARALYSIS REPORT BY 3AMPLE Cl lent I'W; . V(XIRI( I. Reg : 2094 (;Iloil t 3,T,pI It): Ll SAMELF l ; GR!4TER ANCHORAGE AREA BOROF"(%,H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME /IiADDRESS-& ewGL / K PH0NE/i�0/l�c� LOCATION .-eetF,;V/C �'/<� / = � ✓'/�z'C� l� �tEGAL DESCRIPTION% SEPTIC TANK: DISTANCE FROM WELL 4/ / MATERIAL C° ;_ r % NUMBER OF COMPARTMENTS / l ��5.��� ��/L�� LIQUID LIQUID CAPACITY OEa�2 GALLONS. INSIDE LENGTH L—' INSIDE WIDTH '" DEPTH_ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH LENGTH _�DEPTH - , LINING MATERIAL �g���%C�i . DISTANCE FROM WELL BUILDING FOUNDATION NEAREST LOT LINE O� _ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)l�J SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTI01f AREA FOUNDATION_. NEAREST LOT LINE ISXANCE BETWEEN LINES FT. LENGTH OF FAetr-rlNE TOTAL LENGTH OF LINES , IN. TOTAL EFFECTIVE DEPTH TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE -IN. ABOVE TILE DISTANCE FROMWATER WELL: TYPES/z�l�l/� DEPTH J� / BUILDING FOUNDATION. �� r SAMPLE `�L '� NEAREST NEAREST SEPTIC /� SEEPAGE f,.-•- OTHER,-- LOT LINE ` SEWER LINE TANK d , SYSTEM T, CESSPOOL SOURCES_ DIAGRAM OF SYSTEM DISTANCES: C =/ems9 DATE APPROVED //�'"�`�•� HEALTH AUTHORITY GAAB-HD-2 GREATEN ANCHORAGE AREA. jR-OUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT L- VG re qq2 6 � S)[ //' MAILING ADDRESS ( i RESIDENCE ADDRESS7rr'1)ic^ &rrclilvlbr/d LOCATION OF INSTALLATION Lin a J2 lf� i LEGAL DESCRIPTION/� APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT V , DRAIN FIELD TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH TO BE INSTALLED BY PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT Case No. C�17&/) ONE NO, vle-VK-�-74-9 e-4 , OTHER THIS IS TO SERVE ASI'Pl'P,17i YY7n LCPERMIT TO INSTALL A 5 e- f/�—V— .AS l AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED E .SEPTIC TANK SIZE � - f, TYPE I22.222JI—SEEPAGE AREA jr TYPE k-V!'6el i' DIAGRAM OF SYSTEM DISTANCES Health Authori I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATAPPLICANTS SIGNATURE SREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT CASE, 321" EAGLE STREET ANCHORAGE, ALASKA 99501 Performed For no, C es?.k &-f}yf�71rjp Date Performed_ 7 �� 20 Legal Descripti n:bdt �Block Subd anion 6Ja✓✓tuc�ls�:t This Form Reports a: Soals Lop, L/ ercolatior. Test r"� Depth reet Soil Char•.cteristics Location Sketch Proposed Depth Of COMMENTS: c) rs ujeA( 30-od<�c b,,(i a.V)P_ur,1 11 011k clo- Encountered? A11) Depth Instal2at' ion,"eeepage Inlet i Test Performed By: 12CX-0 Data Certified By: Date:_ Field Trench •." • MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 254-4720 Application Date W6 I. GENERAL INFORMATION (a) Legal Description (include lot, block, s bdivision, sect on, thip, range) Location (address or directions) r (b) Applicant Nam et° °�� �J �Telephone: Home —�_ Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); _ (d) Lending Institution F-��� Telephone Address (e) Real Estate Company and Agent/— � Address /�� i////C- T I pho� (� C/_ 3- 1� (f) the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well X Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public 0 Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,04) 6. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION a As certified by myseal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. 6. Name Addre Date OF .15 nn aea rI A. 9hetr;°„ a. <P� ae No. ]l'S7•E °°' I`ve. DHEP APPROVAL Approved for my_ bedrooms by 7 L — e ' -°--" f Date Approved _._ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 Y MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1981AUNICIPALITY OF ANCHORAGE 264-4720 DEPT. OF HEALTH & Vi ONM AL PROTECTION Legal Description:/ �f�lolne%8 A% 2 61989 A. WELL DATA RECEIVED Well Classification If A, B, C, D.E.C. Approved((Y N) Well Log Present (Y N) DateeCCom/pleted l9%® Yield Total Depth / Cased tom Depth of Grouting - l%/i-9 Static Water Level Zs Pump Set At Casing Height Above Ground _%� Sanitary Seal on Casin(Y N) Electrical Wiring in Conduio N) Depression Around Wellhead ( /N) / Separation Distances from Well: To Septic/Hebra-Tank on Lot �a� 4- On Adjoining Lots To Nearest Edge of Absorption Field on Lot �.� _ ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer t— Cleanout/Manhole N To Nearest ewer Service Line on Lo �J 711, Water Sample Collected by ,S> �s �� hie /-7 ;Date Water Sample Test Results o i/s ,!c7 T 9 Comments B. SEPTIC/M6 -TANK DATA Date Installe <� Size Z00 ' No. of Compartments < Standpipe (Y/ ) Air -tight Cap (Y N) Foundation Cleanout (Y/N) Depression over Tank (Y N Date Last Pumped Pumping/Maintenance Contract on File (Y/N); for Holding Tank High -Water Alarm (Y/N) J Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/He+dip,-ff-Tank: r To Water -Supply Well �� - (74- To Building Foundation '2j� -/- To Property Line /� To Disposal Field _- 3,0 l To Water Main/Service Line T11 To Stream, Pond, Lake, or Major Drainage Course Comments t Page 1 of 2 72-026(1 1/84) J 5. LEGAL DESCRIPTION MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI(KPT. O( I: ALTH & • 825 L Street - Anchorage, Alaska 99501 ENVIRONMiENTAL ENVIRONMENTAL ENGINEERING DIVISION�PR 9 1979 Telephone 264-4720 6. TYPE OF RESIDENCE pp ��� (� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S&EF�' C ILIILILD3 r DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER, All S, Oe_ v e r/ W r t w, o �` h PHONE MAILING ADDRESS ,34o/ pores A„ cko rct. e, Rk, ?9563 Three ❑ Six PROPERTY RESIDENT (If different from above) - PHONE qA lU, I w,o k ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well 2. BUYER ^p y z Fc( � r S r e vt cli e ss � e - PHONE ,5'�--5,�� MAILING ADDRESS �. INDIVIDUAL/ON-SITE** P5C / SG -43F,2 ❑ PUBLIC UTILITY 3. LENDING INSTITUTION Giber%ci QQhk PHONE las %P76- 1711 MAILING ADDRESS boo 40e`AQ //` A%nJ10 /9k VQLte, 4. REALTOR/AGENT oofill- �ths�� /ef #ovnes � e-tz PHONE / �- Q 76 4 MAILING ADDRESS I - 17o9 ciu� 5� �iio K, 50 5. LEGAL DESCRIPTION 4 o / S. vo e/om � di n STREET LOCATION S G Yl I` C,— 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM �. INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date ❑ PUBLIC UTILITY If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 4 Gallery of Homes ATTN: Bud Retzlaff 1709 So. Bragaw Anchorage, AK 99504 29 June 1979 REF: Lot 1, Samelson Subdivision Wilmoth Property A sewer system adequacy test was performed at the three bedroom residence located on the reference property. The septic tank was pumped on June 26, 1979, and found to have a capacity of 1,000 gallons. The seepage pit was charged with 550 gallons of water. Measurements taken on June 27, 1979, reflecteda loss of approximately 550 gallons or 133 -gallons per bedroom. It can be concluded from the above survey and test that the sewage system serving the residence on the referenced pro rty is adeeuate. BERT A. SHAFE P.E. CF: -Municipality of Anchorage, Dept of Health & Environ Protection -United Bank of Alaska MUNICIPALITY OF ANCKORAGS DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION O -C 51979 December 3, 1979 RECEIVED Municipality of Anchorage Dept. of Health & Environmental protection 825 "L" Street Anchorage, AK 99501 Dear Laura: Attached is the water approval and the letter of opinion on the septic system that we discussed this morning. We are being required by the Veterans AcIninistration to acquire an official Municipal approval on the system. If this is sufficient for your approval please forward a letter to that effect to my attention. If you have need of any other information please feel free to call. Sincerely, MaryLynn Wilkinson Assistant Loan Officer Security National Bank 2525 "C" Street Suite 502 Anchorage, Alaska 99503 (907) 276-6800 4 29 June 1979 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Or.0 5 1979' RECEIVED REF: Lot 1, Samelson Subdivision Wilmoth Property Gallery of Homes ATTN: Bud Retzlaff 1709 So. Bragaw Anchorage, AK 99504 A sewer system adequacy test was performed at the three bedroom residence located on the reference property. The septic tank was pumped on .Tune 26, 1979, and found to have a capacity of 1,000 gallons. The seepage pit was charged with 550 gallons of water. Measurements taken on June 27, 1979, reflected•a loss of approximately 550 gallons or 183 gallons per bedroom. It can be concluded from the above survey and test that the sewage system serving the residence on the referenced pro rty is ad"uate. BERT A. SHAFE P.E. CF: Municipality of Anchorage, Dept of Health F, Environ Protection United Bank of Alaska - ��Tp(NO4A4£A➢Fq .. '�` .. ._ - -, '" ._//y_(�. j..�.I ^ �J///�/�[(''(%�I - -, _"_--. H GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality �s�=o,anNy 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received July 30, 1976 C1� Time of Inspection /,'�3n pm. lA �.1 Date of Inspection - �� "REQUEST FOR APPROVAL OFLe h INDIVIDUAL SEWER a 14ATER FACILITIES FOR 1. Approval requested by: Lomas & Nettleton Company Mailing Address: 4449 Business Park Boulevard Phone: 274-7661 2. Property 'QW e : Jerome Schiller Phone: Mai ing- Address: a/n., pal , ,( 3.,'Legal ;Description: Lot 1 Samuelson Subdivision 4. Location: NHN Scenic Drive 5. Type of facility to be inspected Singel Family No. of bedrooms r 6. Well Data: Individual � A. Type Akl4w B. Depth SlY C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On-site system (home is about 8 yrs. old) A. Installed B. Installer C. Septic Tank: 1. SizeQf f- 19 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages `rer & Water Facilities Pabe 2 of two pages - Re ~ st for Approval of Individual,' ' zegal Description Lot 1 Samuelson Subdivision Comments Approved ry"' Disapproved Date / -2 7 Approval,Va id for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) li) L:. MUNICIPALITY OF ANCHORAGE �= DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO V FHA CONY 2. Property Owneraerome Schiller Mailing Address: Day Phone: - 3. Name of Buyer: Gerald Bunting St. Route B —Box 512 Mailing Address: Palmer, AX c3A645 Day Phone: 754.-4637 4. Name of Lending Institution: The Lomas & Nettleton Company 4449 Business Park Blvd. Mailing Address: Anchorage, AK 99503 Phone: 274-7661 5. Name of Realtor or Agent: Pat Hummel — Selective Realty P.O. Box 1065 Realty: 694— 9524 Mailing Address: Eagle River, AK Phone. Home: 688-3232 91 7 Legal Description: r nt 1 c;amllpl Gon Siihdi vi Gi on LocationNHN Scenic Drive, Chugiak, Alaska Type of Facility to be Inspected 8. Water Supply Type of Supply a] Home No. Bdrms. 3 Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation House is 8 yrs old 72-003(3/76) 0 Individual (on_sita X ,N lora selective Reality BOX 09577 am a U"Mi" ew, Sem Systat4 Aerviag e uub-joct proporty must Imp� rate abp= 1 000 gallons of U6011 water via1poocamper must be lamagpiat to the 31ts and arrougemputs for an sector made � tOX-0 4"Sllr"n1 16 t -b, it there Arm fr ollso plouse Oontact t US offim276-222.,, *xtftnaiOn 2864 Sincerelyt Les Al Buchholz Sanitarian Lkrua tr � r -. �jy i. �'i ✓(; I'r � .. _ �'%�S �/r' �' cid/-�.�� ......A i.N .. �-� d/f_C/J_U,� ,l�"r�'G�__..lJ"d��lOdV 5... DLC93�.�•. ---QJ a I N�i ---7-•-----...__ r�..._.________._:__ �a- . t.. µr4, .,,��. — ------------- � t - ----- 4 _ !..._yr-.Tp..��- • _ C,4/VVmTpo _._Tv A/v1.) il 4 t'1"c MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY Or ANCHORAGE CHECKLIST- FEBRUARY 1984 ENVIRONWNTAL HrViC�5 DIVISION 264-4744 IIAJ �7 Legal Description: A. WELL DATA -I Well Classification If A, B, C, D.E.C. Approved (Y/N) /P Well Log Present (YQDate Completed Yield 0.5 GnPf`1 Total Depth 54 1 Cased to t Depth of Grouting 1 JX— Static Water Level )Z Pump Set At t� Casing Height Above Ground �4" Sanitary Seal on Casing (VN) Electrical Wiring in Conduit O/N) Depression Around Wellhead (YkQ Separation Distances from Well: ( To Septic/Haldttij Tank on Lot Ste ; On Adjoining Lots I To Nearest Edge of Absorption Field o Lot 6>c;> I ; On Adjoining Lots 1 �� To Nearest Public Sewer Line P To Nearest Public Sewer Cleanout/Manhole p To Nearest Sewer Service Line on Lot Water Sample Collected by / I NLI r�5t ;Date Water Sample Test Results Comments B. SEPTICG TANK DATA Date Installed Size 1 rOK2Y2 No. of Compartments ` . StandpipesCVN) Air -tight Caps(DN) Foundation Cleanout (Y/dV Depression over Tank (Yo Date Last Pumped IS —�y Pumping/Maintenance Contract on File (Y/N) K ;.for Holding Tank High -Water Alarm (Y/N) 4 'N Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/LW,4d44Q Tank: �' To Water -Supply Well To Property Line I To Building Foundation I<, To Disposal Field To Water Main/Service Line I e2 1"— To Stream, Pond, Lake, or Major Drainage Course Comments S C is �i l..i --I'- f_� c�:?�t (-s 46 A T- csy- Page 1 of 2 72-026 (Rev. 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata `J -AQ" -Type of System Design Date Installed r _76 Length of Field 39 /QrAAJgu14Iy Width of Field AN a ulctr Depth of Field G leuwtPa Gravel Bed Thickness io r v Nd eu- C - oVeV —O�iDe Square Feet of Absortion Area to SZ 40Statndpipes Present (Y/N) Depression over Field (Y/N) Results of Last Adequacy Test Date of Last Adequacy Test �_n - -z - F Z) SEPARATION DISTANCE FROM ABSORPTION FIELD: i To Water -Supply Well (CC) � To Property Line 1 To Building Foundation O To Existing or Abandoned System on Lot®i ; On Adjoining Lots To Water Main/Service Line / o �f To Cutback (if present) AJ/6- To Stream, Pond, Lake, or Major Drainage Course T To Driveway, Parking Area, or Vehicle Storage Area o' 'f" Comments D. LIFT STATION Date Installed — / 7 S � Dimensions 4 // Z N,A Size in Gallons �5 19, Manhole/Access (WN) "Pump On" Level at "Pump Off' Level at S rr High Water Alarm Level at Vent (Y/N) �1 Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) N Comments Awca- 5T-A-nc)rJ "'Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 5 5 ENGINEERING �' � b� Signed 1 -7e -3q Fggio River loop Road No. 2Q4 °••••••• °�aS' Eagl® River, Alaska 99572ineA t• •°U p Company V Date J 4V • - > MOA NoG"� b .``.--.ff.•.. Shw1 ...°�.C; �1T � IIbfI.H/�I A.�yS/I� . �. • V� . �^• Mem 1441 Receipt No. �A Date of Payment Amount: $ L70, Receipt No.'_ Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 �R0FE'S 5i��Pa� 5. ENGINEERING FIRMA PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone S & S ENGINEERi Address 17034 Eagle River Loop Road No. 2 - Eagle River, Alaska Date 6. DHHS APPROVAL Approved for bedrooms by Approved _tee Disapproved Terms of Conditional Approval � 11\ eqM• •�q ��l ��y 4 AO KeYY OOgsOq qpb egeg5q•qY ineers §e S 8. i....• ¢�v..�.Y f.OMM d - too. t457.r; Conditional Date -' -�,r �r/� (�Ht3<- 1 rfs�, f3�}'. .:z ,xa$' v�NE'. 4� �'y'i¢�; •. r � �F. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back 'age 2 of 2 (Pell L) SZO-dL Z to Z abed ->AoM s,Aoeul6ua puoissaload ay} u! suolss!wo Ao sAoaaa aol alq!suodsai jou sl e6eAoyouy to j!Ied!o!unlnl ayl -panssi sl a}eo!lpoo a aaolaq elep azo leue ao suoi}oadsui lonpuoo jou op d31-10 10 saaAoldw3 sluawaiinbai a}els pue leaapal ujuVoo Als!les o} aapao ui suoiln}i}sui 6u.pue, aiay} pue sawoy to siaseyoand o} /saunoo a se sly} saop d3H0 ayl 'e�ISeIV 10 a}e}S ay} ul paaalsi6aa aaau!6ua leuolssaload }uapuadapw ue Aq anoge g ydeifted ui uani6 suoi}e}uasaidaa ay} uodn Alalos paseq sa}eoillUao Ienoaddy l!aoy}ny y11eaH sanss! (d3H0) uol}oa}oad leluawu0a1nu3 pue y 0 }�eal-I to }uaw}jedaa6eaoyouy to j!ILdiounW ayl rig : -V s AWNS y�edie e�cae�•• �!r N011fly0 Ienoaddy puoilipu00 to swaal �euoi}lpuo0 panoaddes10 panaddy a}e0 '/ A s w o o i p a q (,) 1 aol panoaddy , (` lVAOaddV d3HO '9 a}e0 ssaippy LL566 a]jsel`d'aan!� a16e3 L� auoydele NZ 'ON PON eo doo'7.10' a al wild to aweN ONIS33Ni9NAISAL sly} to alep ay} uo loolle u! suol}eInbai pue'sooueu!pao'sapoo a}e1S pue ledioiunlN Ile y}!nn aoumIdwoo ui si wa}sAs lesodsip aalerna}sem ao/pue (lddns aalem al!s-uo ay} 'uoiloadsui pue uo!}e6i}sanul AW woal pue saI!1 a6eaoyouy to A1!ledioiuny4 ay} woal pau!elgo uoilewlolui ay} uo paseq ley} Aliaan aaylrinl I uia.aay pa}eolpui ain}oni}s to ad j pue swoojpaq to jagwnu ay} jol a}enbape pue leuoilounl'ales s! wals (s lesodsip aalemalsem io/pue Aiddnsialum a}!s-uo ay} 112141 smOLIs lenoaddy Aluoylny y11eaH s!y110 u0i}e6!}s0nu! (w leyl!}iaan I'nnolaq uanoys a}ep uoi}ep!Ien ay} to se pue olaaay pax!lle peas (w Aq paippoo sy NOIIVWHOdNI ONb ylyO `HO!ly3S 3lld `S1S31 `SNO1103dSNl !DNIOIAOEId W!!13 JNId33NI0N3 '9 72-010 (Rev. 3/78) I OFFICIAL USE ONLY ER -L D D ER TE RECEIVED NUMBER OF BEDROOMS ❑ THREE ❑ FIVE ❑ FOUR ❑ SIX 3 RER IROOMS must accompany certificate) ne ❑ OTHER THIS SIDE FOI INSPECTION APPOINTMENTS TIME TIME DATE DATE - INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ ONE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY ❑ TWC - PERMIT NUMB 2. WATER SUPPLY ❑ INDIVIDUAL DEPTH OF WE ❑ COMMUNITY DATE DRI LLE ❑ PUBLIC UTILITY Connection Verified.LOG RECEIVE 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMI ❑ INDIVIDUAL/ON -SITE DATE INSTAL ❑PUBLIC UTILITY Connection Verified INSTALLER ❑Sep is Takik or ❑ Holding Tank Size: 6U If Tank is homemade SOILS RATIN give dimensions: TYPE OF TANK 'MANUFACTL TOTAL ABSORPTION AREA MATERIAL -Septic/Holding 4. DISTANCES WELLTO: Absorption Area to nearest Lot Line 5. COMMENTS J APPROVED FOR BE[ ❑ CONDITIONAL APPROVAL (lette tom' DISAPPROVED �^ E ' "ice —._ BY (Title) .IVAL r DESCRIPTION 72-010 (Rev. 3/78) I OFFICIAL USE ONLY ER -L D D ER TE RECEIVED NUMBER OF BEDROOMS ❑ THREE ❑ FIVE ❑ FOUR ❑ SIX 3 RER IROOMS must accompany certificate) ne ❑ OTHER C. ABSORPTION FIELD DATA f� Sal _Soils Rating in Absorption Strata Type of System Design � e � Date Installed 9 7-1 Length of Field f 2O De d Depth of Field g �� Width of Field p r Gravel Bed Thickness Square Feet of Absorption Area Standpipes Presen (Y/ Depression over Field (Y N) /V Date of Last Adequacy Test � s Results of Last Adequacy Test �� �� S�/i C z`�rr— %/ Separation Distance from Absorption Field: To Water -Supply Well /00 / f To Building Foundation f—z r Lot A.1 To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course — To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons To Property Line le" To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) Dimensions Manhole/Access (Y/N) "Pump On" Level at ump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for umping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. iiif2. Date L Signed X*3: —/2 S�,Vb dv q � Compap MOA No. o� Xh ( /y p� o: Receipt No:- Date of Payment Date a� p Amount: $ s Robert A. Shafer �. No. 1457•E e' 40 .40 Page 2 of 2 �dO��ARDFESS��N�m®� 72-026 (11/84) - _ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1981AUNICIPALITY OF ANCHORAGE 264-4720 DEPT. OF HEALTH & NVI ONMMAL PROTECTION, Legal Description: )alHlVe /S0 0l 2 61989 A. WELL DATA RECEIVE® Well Classification ��U�l If A, B, C, D.E.C. Approved (Y N) IV RECEIVED Well Log Present (Y N) Date Completed Yield Total Depth 57 Cased to Depth of Grouting Static Water Level 2-S Pump Set At 4-( Casing Height Above Ground Sanitary Seal on Casin (Y N) Electrical Wiring in Condui (Y N)^ /N) Depression Around Wellhead ( /V Q Separation Distances from Well: To Septic/t-leldi=-Tank on Lot r4- ; On Adjoining Lotscuot 4. Ld�NG, To Nearest Edge of Absorption Field on Lot; On Adjoining Lots To Nearest Public Sewer Line I To Nearest Public Sewer J Cleanout/Manhole ~ To Nearest ewer Service Line on Lo r Water Sample Collected by �> S/��� ��; Date Water Sample Test Results Comments B. SEPTIC/TANK DATA Date InstalleL 70 Size �� No. of Compartments F Standpipe(Y/ ) Air -tight Cap GN) Foundation Cleanout (Y//N) Depression over Tank (YNJ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) _; fo Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/h4e+di+4g-Tank: r To Water -Supply Well To Building Foundation To Property Line `© ¢ To Disposal Field r To Water Main/Service Line l0 Course �b AJ Comments Page 1 of 2 72-026(11/84) To Stream, Pond, Lake, or Major Drainage !rr 1 1-% I MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIMPT. Of 1' -ALTs & 825 L Street - Anchorage, Alaska 99501 ENVIROMnIENTAL i ....- ACTION s _ ENVIRONMENTAL ENGINEERING DIVISION APR 9 !� Telephone 264.4720 6. TYPE OF RESIDENCE pp �^����[ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SH�1�FI.HAC11L D3 i DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ,. XV1lo- S, lieVer WI1 YnoTh ❑ Two ❑ Five PHONE �7b-3 if MAILING ADDRESS 3�)o1 bo�-l`5 R95©3 7. WATER SUPPLY PROPERTY RESIDENT (if different from above) r_?5 INDIVIDUAL* PHONE 13 1r ,W 0't )'L since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTI LITY 2. BUYER Je SS 1'e- Fd -nn'l S Te -ov - PHONE MAILING ADDRESS **If individual/on-site, give installation date Psc t &x3ya If system is over two (2) years old an adequacy test is required 3. LENDING INSTITUTION a�I'I"kJ ep>1 k by this Department. PHONE MAILING ADDRESS boo 0eAg1i A��to e /9k 4. REALTOR/AGtENT -60ath- j NN5 'm Q /e I, rues et .550ci PHONE 7 - 76 MAILING ADDRESS 170V Qrct4 cLw Si` Ay,ckowa�_Z e/qK R9.5041 5. LEG/AL DESCRIPTION /.. 0t I '5el STREET LOCATION �ELA)l �chw �SQ dr 91 scc - ,A Ala,44 od toup o400 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY r_?5 INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) 4 r� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �S I DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�C t OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 4q — )1 _07 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) l1 So, �„ i � �' � 1 , C;2� T Location (address or directions) (b) Applicant NameTelephone: Home Business 2�(o SSG1�t Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/buildep�Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Prn'F'-C=�;4 '� 7 { Fnlwi —_ Telephone (f) 't Wrthe HAA to the following address: S & S ENGINEERING 17034 Sagiv RW" Loop Koad 0. Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family�Multi-Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well,' Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-02e (11/84) MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ®�/ - O 9 / - y-/ HAA # 14-0- q 0 0 �Z7U 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Samue23on Subdiv"iz.ion Location (address or directions) 21037 Scenic (b) Property owner MaLck L Bkaun3"te n Telephone: (home) 688-0985 Business Mailing Address 21037 Scenic C /-giak, Ak 99567 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Telephone HERITAGE REAL ESTATE ATTN: Hat Jach,5on Address 18850 Eagte R"ive7 Road, Ea to R"iveh, Ata6ka 99577 Telephone 694- (e) Mail the HAA to the following address: (or check here EXxif hold for pick up.) List contact person and day phone number below: S & S ENGiNEERINr 17034 Eagle River Loop Road No 2g4 Eagle River" Alaska 99a77 2. TYPE OF RESIDENCE Single -Family [fX Number of bedrooms 3 3. WATER SUPPLY Individual Well Kk Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-siteXX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 pM(MUNICIPALITY OF ANCHORAGE (MOA) p\\lxsk0NieaIth Authority Approval (HAA) MoNx4A CHECKLIST FEBRUARY 1984 EN�1RpNM�NlA 343-4744 _ Legal Description: L m f 1 A. WELL DATA Well Classification NG IP F9, nn) It, If A, B, C, D.E.C. Approved (Y/N) —e1IA Well Log Present (Y/N) _Date Completed PE& q10 Yield Total Depth-�1L_ Cased to 6-4 Depth of Grouting Static Water Level '2 -4- Pump Set At U Casing Height Above Ground z-41 f Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) a Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot �-7 6 On Adjoining Lots To Nearest Edge of Absorption Field on Lot � Qco / ; On Adjoining Lots � oo "+ To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole N A To Nearest Sewer Service Line on Lot Water Sample Collected by S ! 1S Fw�c nlc-c ✓ rN 9 ; Date � Water Sample Test Results F9 t-sy+Ztg ✓c, — 8i8 �� 4 A.), tg ih s Comments B. SEPTIC/HOLDING TANK DATA Date Installed/�y/r o Size (QOOqlg.I No. of Compartments Standpipes (Y/N) —T—Air-tight Caps (Y/N) T—Foundation Cleanout (Y/N) nJ Depression over Tank (Y/N) A/ Date Last Pumped Pumping/Maintenance Contact on File (Y/N) /J ; for ! � Holding Tank High -Water Alarm (Y/N) ii1 Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/H9HW4G TANK: f To Water -Supply Well 4 � 8 To Building Foundation a To Property Line To Water Main/Service Line /0 To Disposal Field 1--/ n / t To Stream, Pond, Lake or Major Drainage Course 100 "`r 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA z 6L Soils Rating in Absorption Strata 12 � pe of System Design CZL�i>� t Date Installed �'1� '87 Length of Field �� f T��(,�=L� Width of Field 12-.75 ffyiP---- Zlo L-A-� Depth of Field �L�b� t , P!fR21/r-1 I I,, Gravel Bed Thickness �` JIJV LA, 4 PI PL Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test L00'7— Standpipes Present (9N) Date of Last Adequacy Test � e Separation Distance from Absorption Field: 1 To Water -Supply Well To Property Line To Building Foundation 1p0 To Existing or Abandoned System on Lot �"� YJ Get f3 ; On Adjoining Lots )� To Water Main/Service Line 5� j --k— To Cutbank (if present) P 1 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments '� 6f Dyfj�'-o�) ami r ^ c i�fl f d13�•� C2J C_.. I , r --o L -,C—, is �.�` T1 1 r3 D. LIFT STATION 4-1►0121tj � -+ L -or --Yl Date Installed � 71 —,!51 Dimensions kT-1�1 ' � 5-vs- Size - -Size in Gallons Manhole/Access(�1) �!46�6 "Pump On" Level at "Pump Off' Level at 2 High Water Alarm Level at �fP , Vent ON) Tested for ri � Pumping Cycles during Adequacy Test. Meets MOA Electrical Codesd9N) Commentst- ** Check Permitted Bedroom Rating Against HAA Request ** I certify that S & S ENG e -',e Nv�rilied, or conformed to all MOA an`dd HAA guidelines in effect on the date of this inspection. C.. Signed 17004 & Diver 1 nen Rand Uwj3 Y/ Companf agla River, Alaska 99577 �j MOA No. C3 T00 '3 Receipt No. lO 0 Ci O Date of Payment Amount: $ Page 2 of 2 72-026 (Rev. 8/86) Back