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SEA TURN BLK 1 LT 13
Municipality of Anchorage Development Services Depadment Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci, anchorage.ak.us (907) 134;3.7904 Page lof ~ ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: Address: Phone: Number of Bedmome: LEGAL DESCRIPTION Brock: Lot: Township: $ubdMsion: To le-N Range: Section: Well: [] New_ Classification (Private, A, B, Driller: V GPMI Pump Set at: Yield' [] Upgrade Total Dep~ I Cased to: Ft. I FL Date Drilled: Static Walm' Level: FL Casing Heighl Above Grourxt Ft. FL PID Number: 0 1"1- 1~1- q ~- WastewaterSystem: [] New [~Upgrade ABSORPTION FIELD FI DeepTrenc~ I"1 Shallow Trench I'1 Bed ~ound I'1 Other Soil Rating: 9PO~¢ Depth to pipe bottom from original grade: Fill added above odginal grade: Total Dep~ from ongir~l grade; 1 Gravel width: ~D Total ib$orp~o~l erea: Gravel c~ep~h beneath p,pe: O,T=, F,. Gravel Length; i Numb~ofllnes. I O~stance betweenl,'~es Pipe Material. Date Installed: ~ .-tg lANK InstaTler. SEPARATION DISTANCES [] septic 1"3 Holding [] S.T.E.P. [~ther: From~ Septic Absorption Lift Holding Public/Private ' Manufacturer:. Capacity Tank Field Station Tank Sewer Line '~ [ 0 C."]f C. L ~" I~ GOat. Matenak LIFT STATION I' Well Sudace Water Lot Line Foundation Cudain Drain Rema~s: I1 ti · pump on' level aC I 'PumP off' level at: I v.,~, ~n.I I"~ ~n.I Pump Make & Model I Electrical Inspections peblon'ned by:. BENCH MARK Locabon and De$cnplio~ i?:, o-r'rc ¢/I ~tO~NO Nu'nDer o~..~ompa~men:s' Inspections performed by: Development Se~ices Depa~m~t Approval Reviewed and approved by: ~~ ~. ~~ Date: ~ High water alarm aL [ 00.00Fi' ,... ~ $CALD I' / / ~ai, j 40. TOSBEN SPURKI. ANO 'P.E. ' ~, ~ ~ ' - ' .~ 2o.~ r~ ~Sr~. ,4VE~VUE' ---~LOT 11 BLOCK. 1 SEATURN' [ ANCH, ,dE 9950! [ [ 0,4 VID PREDEGER I · ' l[ 6lOl AZALEA OR~YE SEPTIC 'SYSTEM AS BUILT BITE: 'ld,4Y 24, 20O4 SHEET: 2/3 GRID: 3138 SEAOH3~.BIv'G 0 I 6' MIN 24' MAX PVC DISCHARGE Y_ o ire � FOUNDDATION CLEAN OUT SLOPE FINISHED GRADE AWAY FROM TOP IN ALL DIRECTIONS 0 ')F= c 4' PVC INFLUENT O PPRIMARY CHAMBER O AERATION CHAMBER R, ® CLARIFIER ;n ODISCHARGE CHAMBER /BOTTOM OF TANK BL UEBOARD INSULATION COMPACTED INSTALLATION 1. EXCAVATE A 10' x 10' x 10' DEEP HOLE FOR BIOCYCLE SYSTEM, 2, PLACE A MINIMUM OF 4' SAND OR GRAVEL FOR LEVELING COURSE IN THE BOTTOM OF THE EXCAVATION COMPACT AS REQUIRED, 3. PLACE 4 SHEETS OF 2' x 8' x 2' DIRECT BURIAL RIGID INSULATION ON TOP OF COMPACTED LEVELING COURSE TO PROTECT BOTTOM OF FIBERGLASS TANK, TAKE EXTRA CARE TO ASSURE THAT INSULATION COURSE IS LEVEL IN ALL DIRECTIONS 4. BACKFILL AROUND TANK UP TO INVERT OF 4' INFLUENT AND 1-1/4' EFFLUENT LINES WITH FREE-FLOWING NSF MATERIAL FREE OF LARGE STONES OR BOULDERS 20' C I /— MONITOR TUBE � IS' 1-1/4' SCHEDULE 40 PVC W/ 1/8' HOLES 8 30' 51 A TOP AND BOTTOM MONITOR TUBE i6 SAND/GRAVEL BACKFILL O . AS BUILT eoc�'o�c�n�ezl,g, ti Aza Eon TOBBEN SPURKLAND P.E. LOT 13, BLOCK 1 SEA TURN SEPTIC SYSTEM SHEMATIC 203 W 1. 99501 TH. AVENUE (NCH. AK. DAVID PREDEGER DA TE.- MAY 24, 2004 907 279-3916 6101 AZALEA DRIVE SHEET- 3 3 GRID: 3138 PERMIT #SW030489 PID # 017-121-42 SEA01133OW5 MUNIC/PALITY OF ANCHORA GE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (gO7) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Renewal Date Issued: Nov 21, 2003 Expiration Date: Nov 20, 2004 Permit Number: SW030489 Legal Description: ~.._E~...~._.U.~__B...L_..K_~.-..I_~i.I~..T. ~,13.! Design Engineer: 0007 Tobben Spurkland, PE Owner Name: DAVID PREDEGER Owner Address: 6101 AZALEA DR ANCHORAGE, AK 99516-4332 Parcel ID: 017-121-42 Site Address: 006101 AZALEA DR Lot Size: 49164 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: r~ Disposal Field [] Septic Tank [] Holding Tank [~] Privy [] Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: '// / MunicipalitY of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O ! ? -- /,,~ ) -, /-¢' '2. Permit Number SW C)"342'¢~' Property owner(s) Mailing address (1) Mailing address (2) Day phone Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size ,/.?/- ~' / (o /-'/ / THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Acre~ Zip Code Number of Bedrooms [] Well Only [] [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] I certify that th_e a/bd'~formation/is~rrect. I further certify that this application is being made for a Single Family~~rdance with applicable Municipal Codes. (Signature of prf"~operty owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: Oct°b6r' 29, 2003 Munic 'ity of Anchorage B 1( P.O. I ~ Anchorage, Alaska 99i 3 rrk .Bee. qich, Mayor afetx' I)ivision 0 · 470° Bragaw Street · (907) 3~$-8301 · Fmc (907) 3~$-8200 David Predeger 6101 Azalea Drive Anchorage, AK 995164332 Subject: On-Site Water and/or Wastewater Permit. Permit Number SW020460 Legal Description: cSearlifi:n-Bl6ck 1 Lot 13 Dear Mr. Predeger: An On-Site Water/Wastewater'Permit, number SW020460, issued by this office for a single-family system, xvill expire on November 18, 2003. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as-built inspection report must be sent to this office for review, approval and documentation. This as-built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As-built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee orS100.00 if the renexval application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well permit. If you have any questions, please call this office at 343-7904. Jam~s C~~'~ Manager On-Site Water and Wastewater Program Enc: Copy of permit MUNICIPALITY OF ANCHORA GE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 18, 2002 Expiration Date: Nov 18, 2003 Permit Number: SW020460 Legal Description: SEATURN BLK 1 LT 13 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: DAVID PREDEGER Owner Address: 6101 AZALEA DR ANCHORAGE, AK 99516-4332 Parcel ID: 017-121-42 Total Bedrooms: 4 Site Address: 006101 AZALEA DR Lot Size: 49164 SQ. FT. Permit Bedrooms: 4 This permit is for the construction of: I'~ Disposal Field ~-~ Septic Tank r-~ Holding Tank [] Privy Private Well r--i Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction dudng freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci,anchorage.ak,us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number .SW 0~.~4_.~ Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) ~.,.,~-~- I "~ Legal description (Section, Township & Range) Lot Size.'4 q!/~'~ Aore~ Day phone q qs'l ~, h, lo f A Zip Code Number of Bedrooms THIS THIS APPLICATION IS FOR: Sewer Only E~ Well Only F"] Sewer and Well E~ Water storage sewer Upgrade PROPi=RTY CONTAINS: Hot Tub [~ Jacuzzi' .F-il Swimming Pool BI water softening unit ~_J Therapy Pool 1 certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized Permit Fees: ~ /~-O ~ Waiver Fees: Date of Payment: iii0"7/0 '7.,, Date of Payment: Receipt Number: o~1-'"~ ~.~ .,~, Receipt Number: (Rev. 12;00) ( , 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 13, BLOCK 1 SEA TURN 6101 AZALEA DRIVE Municipality of Anchorage Development Services Department Building Safety Division On Site Water and waste Water Program 4700 South Bragaw Street Anchorage, Alaska 99519-650 November 5, 2002 We are submitting an application for the upgrade of the septic system for this lot. The existing system failed an adequacy inspection and require replacement. This submittal consists &three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the s,eptie system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable test holes are also enclosed. The septic system design is based on the following: Groundwater on October 15 at 4 Ft. Use Standard Bed with BioCycle Soil Rating. From Testhole 08/26/02. 3.5 rain/in = 4 gal per sq.ft/day No. of Bedrooms 4 Required Area: 4 x 150/4 =150 sq.fl. Rock Depth 0.5 feet SYSTEM CONFIGURATION BIOCYCLE STANDARD BED TOTAL LENGTH 20 FT TOTAL WIDTH 10 FT TOTAL DEPTH 1 FT FILTER SAND 1 FT ROCK DEPTH 0. 5 FT INSULATION 2" COVER 2 FT The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoffwill not result from this installation. 6 \ \ I0 5 £L 11 TOBBEN SPURKLAND P.E. 205 PI I5TH. AVENUE ANON. AK. 99501 (907) 279.$9I~ BLOCK1 SEATURN S/D I [ DA~qD PREDEGER GlO1 ~_ALEA DRIVE SEPTIC SYSTEM DESIGN DATE: AUG, 25, 2002 SHEET: I/5 GRID: $158 PERMIT tt SVO2OXXX PID tt 017-121-42 SEAOI131.DWG ~ \ I ~-~ ~--~ "-~ / / ~ '~e~, \. '" ~ ~ ~ ~ ~ / , ~ ,~ --~~'- TOBBEN SPURK~ND P.E. ~0~ ]] ~OC~ ] S~~ ~ SEPTIC SYSTE~ DESIGN 203 F 15TH. AVENUE DAVID PREDE6ER DATE: NOK 5,. 2002 ANCH. AK. 99501 6101 ~ DRIVE SHE~' 2~3 GRID: ~138 007) PER~IT ~ SVO2OXXX RIB ~ 017-121-42 SE~OIIS2.BV6 SLOPE £~N~SHE_~ IN2 FALLA TIBN 4. ~ ~ T~ ~ ~ ~T ~ 4' I~ ~ ~-~4' ~ L~ ~ ~-~ ~ ~ ~/~ ~ILL ~I - - IIY :, . ....:, - - ..- : :... .. ~ ~~_ ~ ; --:~ x / ~.. . .~, , , , .':~~,~.~ .~.* TO~rN SPU~O P.E. ZOr 18, BZOCK I ~ r~R~ s~nc svsr~ 205ANCH. ~AK.15Tfl'99501AVENUE DAVID PREDE~ER DATE: NOK 5, 2002 6101 ~ DRIVE SHE~ 3/J GRID: 3138 (907) 279-39te PerformGd Fcr: Le.:al Descripl;on: 13- 14. 15- 16- 17. Municipality of Anchorage Development Services Depadment Building Safely Division On-Sile Waler and Waslewaler Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchoraqe.ak.us (907) 343-7904 Soils Log - Percolation Test Slope CO,%'MENTS WAS GROUND WATER ENCOUNTERED? ,/,_' L IF YES. AT WHAT DEPTH? ? 0 <~{ ('[-, I-4 t.- D~p,h ,o w~,.r ^.er d::'_. ;,¢ ~ .' :' ,/~;:~,' (ENGINEER,'S SE~.L~ Township. Range. Section: Site Plan Reading Dale Gross Time Net Time De0th lo Water [ Net a,:a ,~ I/.-I- ~, -~z'7-o z PP_ /.z ~,o/~,V_.. [ , lOo ~3> I ~ ~ ~/~. ~ ~?~ __ PERCOLATION RATE ~,~ (~nuter~nc~) PERC HOLE DIAMETER TEST RUN BETWEEN ~:~ FT AND q FT =ERFOR,MED BY; ~ · .~ I ~ ~ ~ CERTIFY THAT TH~S TEST W,:,S PERFORMED It,,l ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: . ~/"~"~/~ '7_, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephon0 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION ,, I DISTANCE TO: I ~ ~ I Manufacturer Lic. capacity in gallons m J Well ~ Z J P STANCE TO J ~ ~ ~ j No. of hnes J Length of each hne ~~ JTopTopof tile to finish grade J Length :Width ~ ~ J Type of crib Crib diameter - I~ANCE TO: Well ~ iCl~ Depth ~ I ~ISTANCE TO: Building foundation [PHONE [~'E~ &/,~_ /~_~ ~1~ E~ UPGRADE Absorption area Dwelling Material JWidt ] NO, OF BEDROOMS PERMIT NO. No. of compartments Inside length Liquid depth Dwelling PERMIT NO. JMaterial Foundation 1Nearest lot line Total length of lines I Trench width Material beneath tile Liquid capacity in gallons PERMIT NO, Distance between lines Total effective absorption area Depth PERMIT NO. Crib depth Building foundation Total effective absorption area Nearest lot line---- -- Distance to lot lin~ -'J-~ MIT NO, Sept c tank J Absorption area(s) Driller Sewer line OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE LEGAL j APPROVED 72-013 (Rev. 3/78) FIF'F'L. I CRN'T LC~CFIT l ON I_EGFIL E:,EF'FtRTHENT HERLTFI [:IN[:, EN'v' I RONr,IENTF'.I[ .... OTECT I ON 8LT'tE~ "' L. "' :5'FF.:E.'E:T., FINCHOr4:FiGE., FIK. 26,:~.-,I.72C~ D,.RE:tL_ ~, ....If:..qtlb.§ E::, C:nlb.~ ..... '_--.-__-; ~ -'I["E~ RZAI... :[ Fl LOT :]..~: Bt...I<: ::L SEF:ITUF..'I'.,t E;,UE~ '"'lr-_ :51:-:!lJ FIF::E F'EIE'T TVF'E L'iF :5OIL. HE .......F..FII')N '_:.;'T'L-qTEr,1 IE;: [:,RFIINFIE:LE:, HFI::.::IHIJH i'-,II.Ir,'IE:ER OF' E~EI',t~'oor,'I:5 .= '-:l-miL F.':RTING ,'L:'..:' FT,.'"E:R)= .1.,'._ THE: RE.'LT.¢...I]:F;.:EE:, .:,I¢:E OF:' THE ':-:FIIL HE,.::,. BF [ :[ 3N S'T'S'TEf"t ]:% ...... _ FF. EI~_.H -F.' [:,RRINFIELD. THF I.EN.~FH DIHE:FI'::'[.:FI IE; ']'FIE: LENGTH ,::IN FEET> OF THE ' ' .... ~ THE E:,EF'TH CiF' FI TF.:EI",ICH OP:: F'IT :['Z'; THE [:,IS,,TFINCE E~E'THIEEN THE :E;URF'F'iCE 13F' THE 3P 7 _ NJ', Fff',IE:, THE EO"FTOH OF THE E'?::CFI',,,'RT I ON ,:: I N FE:E~--::~_ .... fl"' II.-.-~ E:':: -If" I];~:: E ~'-,,I] C: tf-.-1~ l!,,..~ Z: IE> 'T ~.-~ 3E .".~; /___...rC~ ._ ~.~ ~.'E~ ~Z'o ~ fl~- E' [LEE 'T .. THE .~[.R,E.L £:,E:F'TH ):.S THE H:[I,.,ITr,lljr,1 E:,EF'TH LqF 3RFI',/EI.... E,'~E~Z'F,I-T-,LIE C.JTFFILL F'.f.F'E FIND T'HE BOTTOH OF THE E::.;:Z:FI',,,'F:IT]:ON ,::]:N FEET::,. FI:Ri'lIT F:IPF'L..IF_':F:II'..Ft" I-IFIE; THF_- LE::,F_I'4:,]:E, ILI [? 'TO II'4FF_/RH THIE; [:,EF'F:IR'TI'"EI'.~T E:,l_l[:~:[l'.~13 THE II'.,IE;TFII_.LFIT]:OI'.,I INE;F'EE:TION':5 OF FIN'¢ HELLL--; RD..]'FtCENT TO TH]::5 FR...FE'F.TT RND "['HE.': I'.,IIJHE:EF?. C F F;:EZ :[ [:,EI'.,IC:F:5 THFIT THE I.,.IELL H :[ Et.. '_'-.";EF..:VF.'. RFII'":k'F'ILL..:[NG OF RN'T' .:'r.:,TE. rl H:[THCIIJT FIr.,IFIL. INqF'E'T]JDH FllqE:, iFF[. HL ., THIE; [::,EF'FIF~:TrtEN"F I.,.I ILL E:E ':-.':UE:J'E,:::T 'TO F'F~'_- 'E,E '_' L T :[ ON. HII'.,Ilr,ilUH DISTFINCE BE'FHE:EN R HECL. L. RN[:, RN'T' ON-.'.E;ITE SEHFIGE [:) ]: E;F:'OE;RL. S'T'STEH :I:E; ::[.E,Z~ FE:ET F'Fffe. FI F'F:'.I'v'FITE HELL OF..' :LSC~ TO 2E~O FEET FF.:OH R F'UBLIC HELL. DEF'E;NE:,ING I_fF'ON THE '["¢F'E OF F'LIEC. IL":: I.,.IEI.A_. H]:NIHLIH D]:2;TFINE:E FF'.OH FI PR]:',,,'FITE HE:LL. TO FI PF'.IVRTE SEP.IER LINE ZE; ;.:25 FEE']' FIND TO FI COf"IHUN[T'¢ E;EI.qER L:[NE ]::::'; 75 FEET. HELl._ [_OCii':-.': F:IRE REL::]LIIF'.ED FIND PII_I?_-:T E:E B.:ETI.hlE:I'.,IEE:, TIq THE DEF'FtI:::t"FHENT H]'.THII'..! :L.::E) DF:I'¢E; ElF THE HELL CCIHF'L. ET IOI",I. O'T'HEZF'. F~:EI...':EJIRE:FI['ZN'I"E: Hi::I'T' FtF'F'L'T'. E;PECIF'ICFtTIONE'i FIND CONSTF:L.ICTICIN [:,:[FIGF:'.FIH'.5 R',,,'FI]:LFIBLE TO IiqLqLIF,?.E PF~'.OF'ER INST'FILLFI'FIOr.,I. I C:ERTIF:'T' THFIT :t.: I FIH F::'RFI]:L. IFII:~:: HII'H 'I"H[~ F.:EC!UIREHENTE; F'OF.'. ON-SITE .'.:.;EHER:5 FtND HELLS R]~ :BET FORTH E:'T' THE HLIN:[C:IF'RL]:T'T' OF RNCHOF.'.FIGE. 2: ]: HII_L IN'E, TFd_L 'THE 'Z,'¢E;TEM IN RCCOF.:E:,I--tNCE 14:[TH THE E:OE:,ES. 3:: ]: UNI:>F.B::.:JTFff'~[:, THRT THE ON-SITE E;EP. IE[~:: '::i'T'E]TEH MFt'T' F.'.EC!LIIREE ENLFHRGEHENT IF THL:: RES]:[:,ENCE IE; REHO[::,EI....ED TO :[NCLU[:,E HOF?E THRN 2.": BE[:,F.'.OOHS. [:,EF"FIRTMENT qF HERLTH "L:,TFIEET., RNCHORRGE, T',r'F'E OF '2:OIL RE,:,t EF rIoN ......... ' LOT %IZE ~-O O00 SQI..IFtRE FEET! HR;..',Ir'IUH NLIr,IBER OF E:EDROOMS = 3 SOIL ~:R'I'[NG 'S7. F'r,.-'E:R)= )~- THE RE:C~IJINEC, ciZE OF THE ~OIL..F-IE;SCff;tF'TION _,~:,lEld IS : THE: [_ENGTfi DIMENSION IS THE LENGTH I:It'l FEE'F> OF THE TRENCH OR DRRIHFIEI_D. THE [:,EPTFI OF Ft TRENCH OR PIT IS ~HE [F;~TRHI]:E BE:TF~EEN THE '.SURFRE:E 13F THE GROUHD taN[) THE [?CITTOM OF THE E,.,...R~RT]ON (IN [:Ebb). THERE IS HO 2;ET HIDTH FOR TRENCHES. THE GRB'zEL DEF'TH IS I'HE MINIHLIP1 DEPTH OF' GRFIVEL E, EI'HEEN TliE OLITFBLL PIF'E BND THE E~OTTOId OF' THE EXCRVRTIOII <IN FEET). PERMIT FIF'F'LIC:FINT HAS 'f'HE I~:ESI-':'ONSIBILITY 'TO ]iNFORM -FHi:S; [>EF'RRTMENT INSTiqL. LRTION INSF'E(::TION5 OF ANY HELLS F~L'.,JRC:ENT TO THIS; PF:OPERTY FIHC, NJME',EI~' OF PE':S:IDENC:ES THRT ]'tie HELL HILL E:RCKFILL!NC.i OF tiNY SYSTEM H [:,EF'RF.!TP1EHT H ILL BE '~LI[~:JEF:]' TO F'I~'O':E f'IIHIMLIM DISI'flHCE E:E~TI.,IEEH R HELL RHD Rt'4Y ON-SITE SEHFIGE DI2;POSRL ?t'S'f'EM IS 1CiO FEET F'OR Ft F'RIk,'fiTE HELL OR :LSCt TO 2CiO FEET FROH R F'UE:LIC I,IEL. L. [:,EF'EH[:,ItIG I.)POf~ THE TYF'E OF F'UE:t..iC HEL. L PIIHIf'ILIM [)[STRfqC:E FROM fl F'RIVflTE HELL TO F4 F'RIVR}E 5EHEF: LINE IS 2D FEET TO R C:Of'IMLIf./IT'¢ SEHER L~NE IS 75 FEET. FIEt._L LOGS AF:E REQUIRED RHD I"IUST E',E F4:ETURNED TO THE E:,EF'FIRTt,IENT HI TH~H 3:C~ DRYS. OF 'ftaE FI[ELt. COMF'LET ~ OI'HEF: F:EQI.IIREMENTS MFIY RPF'LY. %F'EC~FICI~TIOf.IS RH[:, CONS'FNLIC:'FION [>IRGRlaMS R'.,,'F~ I LFI[3LE l'O INSURE PROF'ER: I NSTFil_.LFIT I [ CEF:T[F'¢ ]'HFt¥ 1: I RM FRMIL..tRF: 14ITH THE REC!UIREMENT¢ FOR OH-SITE SEHER% RNC, HELLS RE; SET FOF::TI4 E',Y THE MLINIC!F'R(.]:TY CIF RNC:HORRGE. 2: [ HILL INSTRLL THE SYSTEM I'N RCCORDRHCE HIT'H THE CODES. ]:: I I.,It4E:,Ei;:STRNC, THRT THE ON-SITE SEI,4ER S'T'S'FEM MRY REQIJIE:E ENLRRGEhlENT IF THEE F:ESIE:,ENE:E IS NEMO[:,ELED TO INCLLIC, E MORE TFIRH :~ DEDROOHS. ERFORMED FOR: EGAL DESCRIPTION: "7~-~'r'- 1 2 3 4 7 8 9 10 11 12 13 14 15- 16- 17 18 19 20 ' SLOPE SITE PLAN ~ ' .... * -- ' )MMENTS Readir,g ate ~_. .?rime ..... '" Time Water Drop PERCOLATION RATE TEST RUN BETWEEN _2-,- _ _ {mir'utes/ir, chi q FT AND .---~' FT RFORMED BY: CERTIFIED BY: DATE: W, 0 ........... 1820~ I~L~V. ~0~ OP HOL~ 71~, o^-r~ St'owe, Silty Bo~.oJ't~ of Hole_ BOX 1869, ST~kR I~OUTE A ANCHORAGE~ ALASKA 9950~ 3~1-4.-7714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF ,~21. O0 DRILLED AT THE RATE OF PER FOOT. PROPERTY OWNER LOCATION OF WELL SITE Bemire CZm~ of ~o~pa,~ z%ZlZ.OW. DRILLER WELL LOG: 0 ..... 79' l? .... 43' Cou~oe g~ue~t wi.U~. 4eu~tx~t .,~m~.~L boulde~o. 95 .... 124' Hc~dpmt. tl cezLer~,e.d 124--153' R w~. ,o~q. 9,~u~t. Two ~U'L': off =~a.~e~'~ ~t 125 ~.o 131 153--154' 15 ~I,'~ w~A 80 fic~t o.fi. wa.t~ ~.tw~OW. of~ 3/4 t~o;~e 3t~m.e~ie. ku~p ~h,ou~ he .&~.o~ed f~ue fe~ of~fi Co4,L off 9.~gg.2_~g.: $21.00 pea. ~L X 154, fee.t: ,,,~34.00 Coa& o.fi £'e. AZ Sca. L: $22.00 WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING, ~3256.00 THANK YOU VERY MUCH. DATE__ BERNIE CLAUS OF RAMPART DRILLING WORKS SERVICE CHARGEOF 1Vi% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. unicipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P,O. Box 196650 Anchorage, Alaska 99519-6650 April 20, 1990 Mr. David Predeger 6101 Azalea Drive Anchorage, Ak 99516 RE: Foundation Setback Variance Lot 13 Block 1Seaturn Subdivision Dear Mr. Predeger: This will confirm the issuance of a waiver to the existing requirement of a 10 foot minimum separation distance between the existing sub- surface disposal field (on the captionad lot) and the proposed location of the foundation of your house addition. As evidenced on the attached sketch, the distance from the end of the existing absorption trench and the proposed foundation will be 7'3". In issuing this waiver, it is clearly understood and agreed upon that the existing septic tank must be moved. The relocation of the septic tank will require a permit from this office which requires that a private sector registered civil engineer submit the proposed relocation supported by a site plan showing the proposed new site and setback distances from the proposed site to all nearby wells and surface water. Attached hereto is a list of approved engineers which could perform this service for you. Very Truly Yours Environmental Engineer, DHHS 907-345-1338 ~lllll~__redeger 6101 Azalea Dr, Anchorage, AK 99516 'MUNICIPA~.II'Y OF ANCHO~A~ ,: .:. ENVIRONMEN1AL ENO NEEJ-{ING DIVISION 0N:sITE SEWAGE DISPOSAL SYSTEM AP~D/OR WELL INSPECTION REPORT UPGRADE ManufltclUm TOi. r ManufaCturer ':~i';.'~ grade (Var lr.N 'PERMITNO. Lmgth al each lino Tohll I~m th of hm,,~ T~mlch w~Jlth "-/0 ....... .. 5' ~'~ Width O~,nlh PERMIT NO, Crib diameter Crib depll~' Tolal altecuw, [)h~orption area ~ y in g~llons PERMIT NO, Tolal elfecliva ab$orplion area Depth Driller D,slanea to lot I,ne PERMIT NO. Sewer line SoDI,c tank Absorplion area(s DATE LEGAL MUNICIPAl. IT" -~ DEPT, -. PLANNERS dRVEYORS 2820 "C" STREET, SUITE NO. 3 .ANCHORAGE, ALASKA 99503 PHONE (907) 272.9231 SURVEY CERTIFICATION: I hereby certily that I have ~urveyad the property showne,',ddescrlbedhere°nand tho: Improvements situated thereon DrO within tile property lines and no encroachments exist OdU'r than noted, -NOTE: It it the contractor's responsibility to check top of Ioundation in relation to finish grade end building setback rCa:lan to lot lines end Easements. [ ~ t. EGAL DESCRIPTION= LEUEND: · 5/8 REBARSET DRN. OY: §/8 REBAR FOUND 2"x 2" HUD & TACK SET EXISTING ELE VS, DATUM ASSUMED GRID: EPLA14 8U Municipality of Anchorage 4 \ On-Site Water and Wastewater Program (907) 343-7904 S a F E T Y Certificate of On-Site Systems Approval Parcel I.D. 017-121-42 Expiration Date: [ �-� ^i 1. GENERAL INFORMATION: Complete legal description SEATURN; BLOCK 1. LOT 13 Location (site address) 6101 Azalea*Anchorage,AK 99516 Current Property owner(s) Jeff Yeaton &Susan Anderson Day phone 909-614-3516 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 5-5D Waiver Fee $ / Date of Payment (et iQ/ 9 Date of Payment Receipt Number (35(0606,67 Receipt Number COSA# QSG(q/�11"9Waiver# 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 bf Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: C/13'f J �oogo.,v04 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system .=,•`=:', OF i C 4� in accordance with the guidelines and regulations established by the Municipality of Anchorage and ' .. �..., industry practices. The reported results describe the condition of the system/s on the date/s of the i V evaluation. Separation distances were measured to readily identifiable features. Hidden defects or — `►� J• encroachments may exist that were not identified during the evaluation. The operational life of all wells � a �.� �a DO and septic systems depend upon a variety of variables, including but not limited to, soil conditions, • groundwater levels (that may fluctuate during the year), quality of construction (materials and f VA workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and jVA are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Vn iv-f'r- A. Gorr)-ss: • system's; therefore, GEG makes no warranty(express or implied) regarding the future performance of V�P, •• _ the well or septic system. GEG makes no representation whether an alternative well or septic system Q4 sf �E .ce � can be installed on the property in the event either of the current systems fail to perform adequately in 0�• P •' �c o the future. The content of this report is for the sole benefit of the person/party that retained GEG to i,Q Pro r es s o&,,z perform the evaluation. Reliance upon the information provided in this report by any other person or �40000� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE YSystem #1 Approved for bedrooms System #2 Approved for bedrooms ��� �,,( OFA O Disapproved d17 � ON-SITE G� Conditional approval for bedrooms, with the following s$ IatiWnATER AND WASTEWATER o 15''%.i 0,4 PROGRAM 1/Il`�YI $))E i��R i c),....f.,..,..7,,,..z,z,- y: +e-4." ___e_ Original Certificate Date: 67— l / The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist 7( Nitrate Advisory Septic System Advisory / Arsenic Advisory Well Flow Advisory Other COSA blue sheer 10-10-12.tloc COSA Checklist Legal Description: SEATURN; BLOCK 1, LOT 13 Parcel ID: 017-121-42 If more than 1 septic system on lot: COSA Checklist# 1 of 1 Structure served by this system 1 A. WELL DATA I Well log is filed with Onsite (or attached) Well production at time of test 6.3+ gpm Date drilled 7/14181 Water storage tank volume N/A gallons Total depth 154 ft Well disinfected for coliform test? ❑Yes J No Cased to 154 ft Q Coliform bacteria is Negative Sanitary seal is functioning correctly Nitrate mg/L 0 Nitrate less than MRL(ND) 0 Wires are properly protected Arsenic ug/L El Arsenic less than MRL(ND) Casing height(above ground) 12+ in. Collected by GEG, LTD Date of flow test for COSA 6/10/19 Date of Sample 5/29/19 Static water level at beginning of test 48.2 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) 15 years 0 Required maintenance completed Tank type/material "°`""`� Age of lift station 15 years Measured operating fluid level in septic tank N/A Lift station material "°`""W 0 Standpipes/foundation cleanout per record drawing Comments: BIOCYCLE Date of pumping SEE BIOCYCLE MAINTENANCE REPORT D. ABSORPTION FIELD DATA Which system tested (date installed) 5/18/04 Adequacy test date 6/10/19 ❑ALL standpipes present per record drawing Results ['Pass For 4 bedrooms Total measured depth from grade "1.9+ ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade ft(min) Water added 1339 gal ❑t N/A—pressurized field New depth 0 in 1 Monitor tubes go to bottom of effective. If not, state Elapsed time 0 min depth into effective Final fluid depth 0 in ❑ Code-required soil cover over field 600+ Absorption rate gpd ❑ System presoaked N/A (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) date of test) N/A If yes, enter date N/A Gallons introduced gallons Comments/Deficiencies:•BED HAS r OF INSULATION PER PAGE 3 2004 INSPECTION REPORT.SEE ATTACHED EMAIL FROM OWNER REGARDING NO FREEZING ISSUES COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' Ej Yes if No ft []Yes if No ft Neighboring Tank> 100' 0 Yes if No ft Private Sewer/Septic Line>25' 0I Yes if No ft Absorption Field on Lot> 100' 0 Yes if No ft Holding Tank> 100' 0 Yes if No ft Neighboring Absorption Fields> 100' Animal Containment> 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage> 100' Community Sewer Main >75' 0 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No *5'+ ft Surface Water> 100' 1 Yes if No ft Property Line> 5' © Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells> 100' 0 Yes if No ft Water Main > 10' ® Yes if No ft Community Wells>200' 0 Yes if No ft Water Service Line > 10' (y)Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' 0 Yes if No . ft Water Service Line> 10' 0 Yes if No ft Community Wells>200' 0 Yes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL .,,,0600-�� G. ENGINEER'S CERTIFICATION o Or t C X4% , �..•.•.• '9.6.4p I certify that 1 have determined through field inspections and review if .:.... ..-.-j---C)0 of Municipal records that the above systems are in conformance with i i `)''>> •.-7 0 MOA COSA guidelines in effect on this date. ... . * 0 o. i.4 o QQ , _jf .• . Garne- 1• 0 9CE-7!0 � • G ��O • oKo '• Q1 • I / COSA Checklist yellow sheet 4 a�'ro`essionoo #AECC884 44��0,p00.6 ✓a v✓ aua.aaa, ua.0 ..✓i✓ Lel© YCLE'�Alaska Anchorage AK 99503 T�,..�:..��.�«�sY;�m-�•••:: Email: crbioak@gmail.com (907) 274-0314 4th Quarter Inspection Report 2018 Homeowner Info Customer Name: Jeff Yeaton and Susie Anderson Tank#: 173 Install Date:May 2004 Address: 6101 Azalea Area Rabbut Creek-Goldenview Initial Inspection: Alarms Tested: Air I✓1 High Water n Battery Tested: Yes n No n N/A (Please make sure alarm is on "normal", not"mute") Does system have a septic tank ? No A Yes (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes A Repaired ❑ Yes [1 Repaired ❑ Strong ❑ Mild None n System Inspection Inlet plumbing in working order? Solids pillow normal? Yes A Replaced U Yes [ Requires Pumping n Are all aerators functioning? Any buildup of solids? Yes g Replaced n Yes ❑ No 74 Clarification return system operating? Any buildup of solids? Yes [I Adjusted n Yes E No I_✓J pH Reading: Dissolved Oxygen PPM Turbidity of discharge (in FTU) (pH of 6-8 is ideal) (2-5 is ideal) (Under 35 FTU is considered compliant.) 7.1 3.2 30.72 Pump float operating? Alarm float functioning? Any buildup of solids? Yes A✓ Replaced n Yes �j Replaced n Yes ❑ No I_✓1 Filter cleaned? Discharge line condition: Yes {71 N/A ❑ Good 11 Replaced I Comments: Has emailing or mailing of form been requested? Yes n No Inspected By: Chris Date: 12-11-2018 (contact office to request...) • `S 72°2./,3 LOT 11 1r72q`- L/ry .pp. ` �psr"Lf'yr N LOT 12 CO 0. 0.) (11 LOT 13 49,164 sq. ft. zti,-.4...) „c})° n rn N. Ct. r'7 LOT 14 3-STORY FRAME 0 SEPTIC HOUSE STANDPIPES ° , SEPTIC V RO 2901 h CO CLEANOUT ,•0• , 544, o 8S..' 1,:): 382. \ 441 ,,,i , / 14GRAVEL , 441 I I' DRIVEWAY I 1 f Q �� HOoUSEuse • O d < ``x....,,,,11111 R� <P'c�. �...q<4Sit h', \ WELL ..♦ • 76 * / i N. '9002. • • Vii- 's Ae •Al(F.1.0 O ,�s�'. BLS-14837 uku ' -� LF\ "' ',r/r����ROFESSIONh`�.�0�_ 0 20' 40' AS-BUILT ' 11111I I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 13,BLOCK 1,SEA TURN SUBDIVISION EASEMENTS OF RECORD,OTHER THAN THOSE SHOWN ON THE ANCHORAGE RECORDING DISTRICT,ALASKA AND THAT RECORDED SUBDIVISION PLAT(79-197)ARE NOT SHOWN HEREON. THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY WITHIN THE PROPERTY LINES AND NO VISIBLE AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT ENCROACHMENTS EXIST EXCEPT AS INDICATED. BOUNDARY SURVEY MAY DISCLOSE. DATED THIS 30th DAY OF MAY.2019,ATANCHORAGE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON ALASKA. BE USED FOR CONSTRUCTION OF FENCES.IMPROVEMENTS,OR FOR ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT, LLC NO CORNERS SET THIS DATE 1 SCALE 1"=40' Land Surveying Services 907.290.8949 --.. WWW FIXPnHFInHT CnM r 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 2A Day of NI ky of 20 )1 , by and between Z 1 ID,IR SFJ (Tbt3 ,herein the"OWNER,"and the Municipality of Anchorage,herein the"MUNICIPALITY", in accordance with Anchorage Municipal 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 an Advanced Wastewater Treatment System(AWWTS), described as 6101 Azalea Drive , Anchorage, AK 99516 located at(legal description) SeaTurn Lot 13, Block 1, Anchorage Recording District 2. Maintenance,Repairs and Alterations. 11(Owner is required to read, understand and initial each section) .4l Throughout the term of this Agreement,the Owner shall enter into a service agreement VVVV 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 4 accordance with the equipment's approval for operation in the Municipality. 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). •1 Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, 4 repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system,which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 41 Owner acknowledges that the Municipality may request records of maintenance and 4 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. Owner agrees to grant the Municipality reasonable access to test and inspect the 41/4 AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new 41 Certificate of On-Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided 4 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. Owner agrees to maintain remote monitoring of the AWWTS as by required the -17k q AWWTS approval. 3. Term. The term of this Agreement shall begin on the date 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 the 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. 05/1 R/2n 1 321 OWNER: By: ,(�.� (signature) Date: q.,24)11 `TESS]C'R (9 ,J (print name) STATE OF ALASKA ) )ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this i9 'day of 20211 by Sessie� S'2, -fall J LOVAtifY wnuurlefrO ie NOTARY 'i BLIC FOR ALASKA �^ww,�. �►� My Commission expires: 3/LP/i 22) N OZ RE \ Y� ,141 gs,�7 tort..0 •4 o' . `� MUNICIPALITY: By: (signature) Date: (� 17 (print name) Title: (rev. 05/18/2018) Page 3 of 3 Municipality of Anchorage Development Services Department Building Safety Division 'on-site Water and Wastewater Program 4700, South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchdrage.ak.us '(907) 343-7904 CERTIFICATE OF,HEALTH AUTHORITY APPROVAL 'FOR A SINGLE FAMI~LY DWELLING Parcel I.D.. GENERAL INFORMATION Complete legal description /-~T' Location (site address or directions) Current Property owner(s), Mailing address Lending agency Mailing address Iio~o Expiration Date: ~ "~"7-I~ L~ Dayphone ~b~---' t..-3~6 Day phone e Real Estate Agent Mailing Address · Unless othen/vise requested, HAA will be held by DSD forpickup. NUMBER OF BEDROOMS: ~ Day phone 3.. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage. Community Class, Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer [] [] [] The Municipality of'Anchorage Development Services Department (DSD) Issues Certificates of 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 and/or 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 iserved 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. STATEMENT OF INSPECTION BY. ENGINEER ..... ~ ' ' As certified by my seal affixed hereio and as of the validation 'date shown' ~elow,' 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 furtherverify 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 ,-i..-O,~,~N ~ ~p~i.~V..t,,A,~'~ ,i' I~tE- .. ~Phone.:,~."lq..-SqlE., ~ ~o:~ .... Address 2.0, 3. Engineer's Printed Name DSD SIGNATURE ~ APproved for L.~ -Disapproved. Conditional' approval for bedrooms. ~ :~ bedrooms, with the following stipulations: Additional comments By: Attachments: HA.& Checklist X Septic System Advisory Well Flow Advisory (Rev. 01~2) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Legal Descnption: A. WELL DATA'i. II - type!~'~l~~_ i, ' Well 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. ,;,,. . Lo'T' :t"~, I'~ iZ. I ~1-~- ~'~"X)12't'~ Parcel?D: , [ O t7- t;:ZI- O'z. . IfA, B, or C provide PWSID # Date cOm'pl6ted ~/;"/~'/ " Sanitary seal (Y/N) Tot . d"Pti q"- : ' Cased to .ft. ' : I~ i~:,, .- FROM WELLLOG : · Date of iesi Static w!'te~r I~vel Well producbon 7¥ WATER SA'M~LE RESULTS: ' coliform · ti . colonies/100 Arsenic:. ~.. ' mg./L SEPTICIHOEDING TANK DATA ft. Nitrate- ~ D mgJI. Date of sample: Well Log (y/N) ' ~/ Wires properly protected (Y/Iq) Casing height {a~b~ve ground} AT ~lqSPECT~Oh i~ ~ ~ ft. 5, ~ ! g.p.m. Other bacteria [: Collected byi .: !- '; i Y ,. t'J- in. _~ colonies/100 mi. TankType/Material , ~ lO lank siZ~' r/~,O~ gal. Number of Compartments Foundat,on cleanout (Y/N) ~ Depression over tank (Y/Ni Dateof,pump~ng 'J~/~ r~/)u.,"&~7 Pumper ABSORPTION FIELD DATA Date instal ea ~ Soil rating (g.p.d./ft Date installed i: ,_~--/~ .-~ Cleanouts {'¢/~) High water ala]m, i (y/N) y Elapsed ,Time: v' min. : Final flu, id depth /,'/in. Any reju%,enation treatment ipast 12 mo.)'(Y/N & type) Syste iY'pe Gravelibelow pip~ . O, .',','5~ ft. Length ][ [ i!o~'O ft.I ' Width { I : ~ ft' ; .ge~ression over field ~. Total depth' .~ J' ft.. Eft. absorption ,,~'ft~ Monitoring tube,.~ 'ti i:;~ "" I'~/f2._ ' ~ '. Results(pass/Fail) ~ ~-.-'.-~ ~ For ~ bedroOms Date of ad6qbacy test Fluid d;~ht i'~ absorption field before test~' ~in'. . . W~ter added ~gal.'~ i .... New depth ~in. Absorption r~te.~>= ' / g.p.d, .l:f ye~s, give date. De LIFT STATION Date ins[ailed ..~/~/~..-/~, "Pump on" level at ~.,~7,- in. Datum E. SEPARATION DISTANCES Size in gallons "Pump Off' level .,~, in. Cycles tested SEPARATION DISTANCES 'FROM wELL ON LOT TO:' Septic tank/lift station on 10t t o o . · ~ ,. Manhole~Access (Y/N) ~ "~ High water alarm level at · ~'~'"" Meets alarm & circuit requirements? Abs0~:Ption field SurfaCe ~at'er Water main , 4',3 /',~: :: Drivewa~', parking/vehicle Sto~,rag'e or~' adjacent lois On adjacent lots Public sewer manh01e/cleanout "Holding tank ~ Absorption field on lot Public sewer main Sewer/septic Service line sEpARATION DISTANCES FROM SEPTIC/HOLDING TANK .ON LOT TOi . Building foundation I t ' r Property line Water main l~'q/A~' - ' '.' · Water service line 'D.- ~ '~. Wells on adjacent lots '10-~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ,~D Building foundation Water Service line -~- ..R" ..~ Surface water ' r,-.'t Wells' on adjacent lots Curt'air~ drain F. COMMENTS in. HAA Fee $ Date of Payment Receipt Number, (Rev. 12/01) -.I '/,//.5 · ' I ce,ify 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 Date 'M~" ;~ · Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6050 www. ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORI'I'Y APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D., O I'~,,- Expiration Date: ~ .- /.4'-0 54 GENERAL INFORMATION Complete legal description J... 0-i' L~cation (site address or directions) 'J~A,t/ID ~-l:::)l~/;,tq Dayphone. I~1~ ! A'L~ Current Property owner(s) Mailing address Day phone Lending agency ~ H G LA N (~ - Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community Class ~. Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (H/LA) 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 and/or 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 e 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 th~s application, shcws 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, tile on-site water supply and/or wastawater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Address . ~?-0 ~ 15 ~ ~ ?'~ % Engineer's Printed Name .. "~ J~J~' ~ ~j~ u~ E !,~ ,~ ~'~ Phone. ~."7.. ~ Date DSD SIGNATURE Approved for bedrooms. Disapproved. XX ' Conditional approval for 4. bedrooms, with the followirig stipulations:~ · Money,.in ~the omount.,n, f 1.~ times the hi:q? bid of.a minJmum of three bids from npproved ' ..... · contractors siial113e put ,n escrow to construct (z new wbstewater msposal system purs.uant -'to'permd number owuou-tS~JWl'a'L~re~JT-~Wor~Lry m~row--Cn~ll hot be relex~sed unt~ Tins 'ff .... ~ ....'f' '1 .......I.--C-om'fm~ s: Il b - -' ~ ~-" ...... ' ......... 15 2~...,4 · "--'0 Ic~'hns. IVert irio-approvcl oll -~d ~.~.UmF~cu.u~u~r .,u~,au.r., ; ... Additional Comments Attachments: HAA Checklist Septic System Adviso. ry .... Well Flow Advisory Maintenance Agreements Supplemental· Engineer's Report Other Odginal Certificate Datg: / ~- ' / ~ "O..,~ (Rev. 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: L¢~" Parcel ID: 0l'7- A. WELL DATA Well t~pe Date completed '//~//6: I Total depth I ~ t--I ft. IfA, B, orC provide PWSID # Sanitary seal (Y/N) Cased to I,~ ft. Date of test Static water level Well production FROM WELL LOG - ' 'Ty I '~ g.p.m. WATER SAMPLE RESULTS: Coliform . colonies/lO0 mL Arsenic: t,/ mg./L Nitrate '.NP rhg./I. Date of sample: SEPTIC/HOLDING TANK DATA Tank Type/Material ~_~ Tanksize I~'~ gal. Number of Compartments Foundation cleanout (Y/N) Date Of pump ng ' I"q//,,c~ Log (Y/N) "/ Well Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 'z'/.//e ~, 5"- I' ft. ,~".. ~-~: g.p.m. in. Other bacteria i ,~' colonies/100 mi. Collected by: Date installed ~/~//z./~; / Cleanouts (Y/N) y High water alarm (Y/N) 1", I Ce Length 7D Total depth,J.~' ft. Date of adequacy test ABSORPTION FIELD DATA Date installed ~'//2//~ I Soil rating (g.p.d.ift2 or ff2/bdrm) /7~'"' ff. Width ~ ,;~ ft. Eft. absorption area ~-,-,~5/7 ft2Monitoring tube . Fluid depth in absorption field before test in. water added Elapsed Time: min. Final fluid depth in. Any rejuvenation treatment (past 12 mo.) ~/N & ~pe) gal. Absorption rate >= System type I~..c~,~ ~ Gravel b~low pipe ~,~. 3" ft. "/' Depression over field For .,~ bedrooms New depth in. g.p.d. If yes, give date ; ' ~ /Acce~ss (Y!N) in. ~ High water alarm level at .~/';__ Meets alarm &.~rcuit requirements? JI acent lots D LIFT STATION . i I Date installed II Size'in gallons i Datum ~ ',, i: ~cies tested E. SEPARATION DISTANCES '; i~, :i ! ' SEPARATION DISTANCES FROM WELL ON LOT TO: ', ~ Absorption field on lot t0o ' On ad On aa Public sewer'main ', .... Public sewer manhole/cleanout Sewer/septic service line !J,~o ,Holdi g SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I Absorption field Surface water ' Building foundation J~I!t ))i P~6perby line 7 ' Water main I"'~/A 'ii ,a Wellson adjacentlots ')' I Ii!!ij.! :' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT.TO: in, Waiver F.,lee $ j HAA Fee $ Date of Payment i Receipt Number ?(Rev. i2/01) i, i Property line I p 1~ Bui ding foundation I,~ ': Water main ~ Surface water '~ Driveway, parking/v~hicle storage .! Wes on adja6~nt lots '~' ,/.,.o., , Curtain drain JF COMMENTS I' ' =; " ,G. ENGINEER S CERTIFICATION J Il ~. ; ' : : . I~e'. 'i .}, I' Icertifvthatlhavedeterminedthrough~eldinspectionsano .', ' ~:~t'¢~,c;!'L: i . ~ , , ., .i,. . . . ~.~ i ~ ~:~.~ ..... .,~""~ reviewofMunicipalrecordsthattheabovesystemsarem .', ~!o~ ,,',.~., ~ ''i conformancewithMOAHAAgb/deJin,'~s'ineffectonthisdate.,.,, ,' " ~? DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIMF/~ DATE DATE DATE ~.,.z ,/I INSPECTOR INSPECTOR I N S P EC~/(~R~'-j' DEPT. ~UNIOIPALITY OF ANOHORAGE FNVIRONM[Nh , ~,. ,i. CI'ION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEO'TION ' 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND 8EWER FACILITIES DIRECTIONS: Complete all parts on page 1, Incomplete requ~ts will not b~ processed. Please allow ten (10[days for processing. 1. PROPE RT~NE" PROPERTY RESIDENT (If different from above) ' PHONE 2, BUYER PHONE MAILING ADDRESS 4. REALTOR/AGENT ~ I PHONE I MAILING ADORE88 5, LEGAL DESCRIPTION ~/~ / //,-~ 8TFIEET LOCATION 6, TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY 7. WATER SUPPLY I NDIVIDUAL* COMMUNITY [] PUBLIC UTILITY N UMBER OF~BEDROOMS D One r-] Four [] Other E] Two I-] ~:ive ¢[~* Three [] Six * ATTACH WELL LOG, A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** /?Op'/ / [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ SINGLE FAMILY [] ONE J~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX PERMIT NUMBER 2, WATER SUPPLY /[~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ~ INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: / ~ L, c~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS .// ., PPROVEDFOR $ BEDROOMS [] CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79)