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SHACKLETON LT 23A-6
Shackleton Lot 23A-6 #016-141-46 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231143 PID Number: 016-141-46 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name PATRICK J MICHELS ABSORPTION FIELD - EXISTING. ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 130 JOAN COURT, ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SHACKLETON 23-A6 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1500 Gal. Surface water 100'+ -- Material EPDXY STEEL Number of compartments 2 Lot Line 10'+ __ NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Tank installed in same location with barricades. Alarm location Electrical installed by Installer NORTHERN EXCAVATION PIPE MATERIAL House to tank 3034 dra nk d 3034 Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1" 8/28/23 2na 9/6/23 da:aro Location and description 4`h GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL �111\ .� 1 of •44. •411 Conditional Approval: Date .� }� A g&P....� *: 49 TH ....�:* .. .... .......:.. Septic t App r r Curtis Huffman �f �`°�is CE 128991 Date •.. ...�r� �� l�c� .X9/6/23 �� F�PROFESSIONp ..+ Note: this approval does not include well permit require ents. k&. PID:016-141-46 PERMIT:OSP231143 FIRST WATER CONSULTING SHACKLETON LOT 23A-6 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 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231143 Work Type: SepticTank Upgrade Tax Code Number: 01614146000 Site Legal Address: SHACKLETON LT 23A-6 G:2630 Site Mailing Address: 130 JOAN CT, Anchorage Owner: MICHELS PATRICK J Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: 11p'CnC Q . DQI)artIII ell t Lot Size in Sq Ft: Total Bedrooms: 7/6/2023 7/5/2024 12615 ❑ 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 J Special Provisions: • The north/south leg of the field is to be located prior to construction in order to ensure that the tank meets the required separation. Show the trench on the Record Drawing. • For the COSA approval, an encroachment permit from MOA ROW will be required. Issued By: Date: Date: 6 2 3 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 016-141-46 Property owner(s) Patrick J Michels Mailing address 130 Joan Court Anchorage, Alaska 99515 Site address 130 Joan Court Anchorage, Alaska 99515 Day phone Legal description (Sub'd., Block & Lot) SHACKLETON LOT 23A-6 Legal description (Township, Range & Section) Lot Size 12,615 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank x❑ Upgrade x pg Duplex (D) El Holding Tank El Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. nature of property owner or authorized agent) Permit/Rush Fees: // 5 Date of Payment: b 2,J 23 Receipt Number: 1 O 3 2 - Permit No. (25 P 2, I 1 c(3 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! June 20, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SHACKLETON LOT 23A-6 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. The existing septic tank is in the driveway and thus we propose to install a 1500-gallon HDPE STEP septic tank per the attached design to serve the existing 3-bedroom residence. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank may be required. The lot and area are served by private and public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231143, Deb Wockenfuss, 07/06/23 FIRST WATER CONSULTING SHACKLETON LOT 23A-6 DESIGN DETAILS: NO PRIVATE WELLS WITHIN 100' OR PUBLIC WELLS WITHIN 200' OF PROPOSED SEPTIC TANK STAKE ALL WELL RADII PROPERTY LINES & EASEMENTS PRIOR TO CONSTRUCTION. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231143, Deb Wockenfuss, 07/06/23 8272P JOAN COURT L N N89052'30"E 90.00 N I 30 � Chain link fence (typ) { 06 Lot 23A-6 Well Conc. ret. wall p I I � : •I9.� -� 26.0 0 !� • �� . W - o deck r a _! C) •1.`. 0 40.0 9.9 r Z �— 1 1/2 Story FrameCO tet' Q f. House `O �-- Lot 23A-5 N ' •'a; _J I 14. ; 66.0 O . . • deck 10.0 = O - t j� ., CO O a,10.4 0 O L�: •! a� 40.0 c� C I I o `� E I I o Z °' _ M o Z U) ; DocuSign Envelope ID: 12F7C043-669C-45D2-AE17-D1967C6CCE03 POST IN A CONSPICUOUS PLACE ALL WORK MUST BE INSPECTED `.ice Field Inspection Request required 2 working days in advance of starting work and 2 working �' days in advance for final inspeciton. Call (907) 343-8206 (voice recorder) for scheduling. Permit is not valid without the call-in and also must include the one -call ticket (utility locate) number. MUNICIPALITY OF ANCHORAGE - RIGHT OF WAY DIVISION 4700 ELMORE ROAD TELEPHONE (907) 343-8240 EMAIL: moarowrequests@muni.org RIGHT OF WAY PERMIT cnr n l)vI)ar[if (2lit R232036 Type: Encrchmnt Status: Issued Grid: SW2630 Date Applied: 09/12/2023 Date Issued: 09/12/2023 Issued By: claudia.pinard Construction Start Date: 09/12/2023 Last Updated: 09/12/2023 Last Updated By: claudia.pinard Permittee: MICHELS PATRICK J Work Order: Utility: Contact Person: Carta Nice (Realtor) 242-2427 Primary Inspector: Charlie Eliassen (907)343-8441 Address/Loc: 130 JOAN CT, Anchorage - @ Lillian Lane. Legal Description: SHACKLETON LT 23A-6 G:2630 Original Work Description: Septic system cleanout pipe encroaches 2' into the 10' Utility Easement. Fee Description Permit Summarized Financial Transactions See reverse for requirements/remarks. Quantity Amount 1 $120.00 Total Fees: $120.00 I have read and understand both sides of this permit. I agree to the terms and conditions; and I certify that all work will comply with federal, state, and municipal codes and regulations and the provisions of this permit. DocuSigned by: 9/13/2023 1 4:04 PDT Signature: —� � j Date: 1BF5E526FB5F486.. DocuSign Envelope ID: 12F7C043-BB9C-45D2-AE17-D1967C6CCE03 Construction Requirements and Notes: 1. This permit has been issued based on the assumption that the information contained in the pals and supporting documentation is correct. Any and all omissions are the responsibility of the permitee. Any change in the scope of work requires a revised or new permit and Traffic Control Plan (TCP). 2. Contractors' acceptance of this permit constitutes acceptance of the Municipality's bonding requirements, and is contractor' representation that contractor has and will comply with those requirements. Unless a specific bond is applied to this permit by written reference, the contractor's performance bond on file with Development Services, Right of Way Enforcement, shall suffice as the required bond. 3. The Permittee shall post a copy of the permit in a conspicuous location at the place to which the permit pertains before any work there is started and shall remove the permit only after the Right of Way Inspector has accepted the work as being in compliance with the permit. 4. The Municipality has the right to inspect and/or reject materials and workmanship not to Municipal standards, to stop work until corrections are made, or to require removal of the facility and to charge time, material and equipment to the Permitee to correct the facility if they fail to comply with the conditions of the permit. 5. Permitee is responsible for locating and protecting all utilities and survey markers in the work vicinity. For utility locates, call Alaska Digline at "811" or (907) 278-3121. 6. The contractor shall erect signs, barricades and detours in accordance with the U.S. Department of Transportation "Manual on Uniform Traffic Control Devices', Part VI — Traffic Controls for Street and Highway Construction, Maintenance, Utility and Emergency Operations. Failure to do so may result in fines being assessed under Title 14 for work not in conformance with a permit. 7. Changes in the approved road closures or scope of work resulting from emergency circumstances may be allowed during construction. It shall be the responsibility of the contractor to notify the Permit Office, 343-8206, and/or obtain an approved Traffic Control Plan (TCP). It shall be the contractor's responsibility to notify the following agencies: Fire Dispatch 267-4950, Police Dispatch 786-8900, Alaska State Troopers Dispatch 269-5511, People Mover 343-8253 and School Bus 742-1207 or 742-1209. 8. All construction shall be in accordance with the current edition Municipality of Anchorage Standard Specifications (MASS), applicable municipal codes and regulations and the approved drawings and special provisions of this permit. 9. As a condition of this permit all excavations will conform to the standards outlined in OSHA 29CFR, 1926 Subpart P. 10. The Right of Way shall be restored to the same, or better condition, than it was prior to the contractors' work being performed. The work shall be performed diligently and continuously, until completed to the satisfaction of the Municipal Right of Way Inspector. 11. All underground installations within a public place shall be buried at a minimum depth of forty-two inches (42") below the final surface elevation, i.e. bottom of drainage ditches, road shoulder or finished grade. 12. Permanent paving, recycled asphalt pavement (RAP), chip seal, sidewalks and curb and gutter must be replaced within 7 working days after underground work is completed. 13. Winter Condition Requirements (applicable to all Right of Way Permits). a. No trenching and or excavation is allowed within the road prism except for emergency repair of existing utility facilities or by approval of the Director of Development Services. b. Crossing of the road prism shall be by boring technology. c. No frozen material shall be placed in the excavation as fill and/or backfill. A source of non -frozen fill and/or back fill material shall be available. d. All frozen ground within the Right of Way shall be thawed prior to excavation. DocuSign Envelope ID: 12F7C043-BB9C-45D2-AE17-D1967C6CCE03 I/ MUNICIPALITY OF ANCHORAGE Development Services Department V % Right of Way Section 1)clrirtmcnt ENCROACHMENT PERMIT R232036 THIS AGREEMENT, made this 13th day of September 2023, by and between PATRICK J. MICHELS and his heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State of Alaska, hereinafter called the "PERMITTER". WITNESSETH: WHEREAS, PERMITTEE is the owner of the following described real property: SHACKLETON SUBDIVISION, LOT 23A-6, according to the official records thereof, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTER owns and/or maintains the real property more particularly described as follows: The TEN FOOT UTILITY EASEMENT, immediately along to the south boundary of PERMITTEES property as shown on Plat No. 74-86, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTEE has placed a septic system cleanout pipe upon the referenced real property which encroaches 2.0 feet upon the PERMITTER'S 10.0 -foot Utility Easement. NOW, THEREFORE, it is mutually agreed between the parties hereto that: 1. The PERMITTER, acting through the Director of Development Services Department, hereby grants to the PERMITTEE the privilege of allowing septic system cleanout pipe to encroach 2.0 feet upon the PERMITTER'S 10.0 -foot Utility Easement, as shown on "Attachment A," included herewith. 2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless, the Municipality, its officers and employees, from any and all lawsuits, claims or actions brought to any person for or on account of damage to property or injury, disease, illness or death of persons, including all costs and expenses incident thereto, arising wholly or in part from or in connection with the existence of, alterations, maintenance, repair, renewal, reconstruction, operation, use or removal of the encroaching septic system cleanout pipe , as placed upon the PERMITTER'S 10.0 -foot Utility Easement. 3. The PERMITTEE shall not assign or transfer any of the rights granted herein to another individual or company without first notifying and securing the approval of the Director of Development Services Department. DocuSign Envelope ID: 12F7C043-BB9C-45D2-AE17-D1967C6CCE03 4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S real property whatsoever, except only the encroachment rights described herein. The PERMITTER reserves the right to revoke this permit upon twenty (20) days written notice to the PERMITTEE. The PERMITTEE agrees upon such notice of revocation, to move said encroachment(s) from the 10.0 -foot Utility Easement in which it is placed. Should the PERMITTEE refuse or fail to comply with said written notice, the PERMITTER may, without further notice to the PERMITTEE, remove or cause to be removed the encroachment(s), and the PERMITTEE hereby agrees to reimburse the PERMITTER for all costs incidental to the removal thereof. In addition to the mutual promises heretofore made, the PERMITTEE has paid the PERMITTER a one-time permit application fee of $120.00. The PERMITTER hereby waives the annual fee of $315.00. IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day and year first hereinabove written. GRANTEE: GRANTOR: MUNICIPALITY OF ANCHORAGE F7Do, cuSigned by:oa3 'Per k5ig-'Nod hels John Snelson Owner Right of Way Supervisor W Z Q J Z J J J JOAN COURT LO `14 N89052'30"E 90.00 30 1 1 I I O o :�. ; • (D r O O O O O `A 45' Temp Tiirnarnt Ind 1 30 Z —14.0— Lot 23A-6 Well r Conc. ret. wall n 6.0 o 7 deck 0 40.0 9.9 1 1/2 Story Frame House N 66.0 CO , deck 0 Lo 10' Utility Easement 10.0 10.4 10.7 04 Chain link fence (typ) Lot 23A-5 r PIA ~ Wood fence 'A' 8272P 40.0 EI E I 0 T t 2CU Lot 24E 1 �1 (D/ Garage =I U �a \ Di O I hereby certify that I have performed a Mortgagee's inspection in �a V' I /U) `�`�\ OF A�q' accordance with ASPLS Standards of the following described LOT 40.0 < • � ' • j, property: 23A-6, SHACKELTON SUBD. 0 Lo 10' Utility Easement 10.0 10.4 10.7 04 Chain link fence (typ) Lot 23A-5 r PIA ~ Wood fence 'A' 8272P N$9°52'30"E 90.00 RECERTIFIED 8-31-23`� Lot 24E I Lot 24 AS -BUILT NO CORNERS SET THIS DATE \ \ y I hereby certify that I have performed a Mortgagee's inspection in `�`�\ OF A�q' accordance with ASPLS Standards of the following described LOT < • � ' • j, property: 23A-6, SHACKELTON SUBD. = Al, •:sem C� Anchorage Recording Precinct, • 49th '• Alaska, and that the improvements thereon situated are within the property lines and do not overlap the • .. , f• ... ,t. or encroach on property lying J•h < �� adjacent thereto, that no improvements on the property lying /� A • ' / 00�, izabeth L. Walatka . ,o / adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other SCALE: 1 "— 30' ,� sT•• 8036 - LS •• ,� Fp visible easements on said property except as indicated , • 5� oRO ' • •�P�o i FESSIoNA� hereon. Dated at Anchorage, Alaska ` 1 r this 6th day of September, 2004. EASEMENTS OF RECORD, OTHER THAN %,%% THOSE SHOWN ON THE RECORDED f FB 23-2. pg at L� FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON • G n` �_._ FB 23-21 pg 13 BE UNLESS OTHERWISE NOTED. Lantech Engineers and Surveyors 9 yrs 907-248-1666 This drawing is a representation of conditions found at (tie time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. \ /� MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION �` ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME w6vv ❑ UPGRADE MAI LING ADDRESS k (� _ LEGAL DESCRIPTION r� LOCATION NO. OF BEDROOMS Well % Absorption area°' Dwelling PERMIT NO. DISTANCE TO: U Y — F Z LU Manufacturer Material No, of cpartments om rn Liq. cacity in gallons a6 IF HOMEMADE: 1 / s" Inside len �th` %p Width Liquid depth Y DISTANCE TO: Well Dwelling - PERMIT NO. J O'Z O Z Q m—_ Manufacturer Material Liquid capacity in gallons O DISTANCE TO: Well f Found �tio , �—r Nearest lot line / L PERMIT NO. (� w= A_ J LL z No. of lines Length of each line Total length of lines Trench w9h Distance bet en lines Z w/ I--¢ A- inches Top tile to finish Material beneath the otal effective absorption area F of grade �i p � inches Length Width Depth PERMIT NO. w c� Q F Type of crib ib diameter Crib depth Total effective absorption area as Lu W Well - Building foundation Nearest lot line DISTANCE TO: Class pth Driller Distance to lot line PERMIT NO. J Lu DISTANCE TO: uil ing foundation Sewer line Septic tank Absorption area(s) OTHER I PIPE MATERIALS V>NC_ �, 1 7 SOI L TEST RATING I Sb ASV P INSTALLER V 1 f REMARKS i `r'. i. V AV01 by 10 — r r APPROVED DATTE�` LEGAL n1ea_ 72-013 (Rev. 3/78) z / PJ 61 � / ~ � � U,) ^ ������������� �� ���������� "'.jEPARTMENT OF HEALTH AND ENVIRONMENTHL PROTECTION ` 825 L STREET, HNCHORHGE/ HK 99501 '264�4720 K[�� PERMIT NO: 840186 DHTE ISSUED� 04/�]/84 � HPPLICHNT� VICTOR KNOTT /\3\ 68�/4�^ ADDRESS � 8541 E 1�TH � E. � � HNCHORHGE/ HK 99504 '' 'CONTACT PHONE� LE138L DESCRIP LOT SIZE: MHX BEDROOMS SUBDIVISION� SHHC1.,"LTON SECTION: 19TOWNSHIP� 12N 12600 FT. OR HCRES) ] LOT: 2]H~6 ^BLOCK; NA RANGE: ]W LISTED BELOW ARE THE OPTIONS HVHILHBLE TO YOU IN DESIGNING YOUR SEPTIC ' SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. ���� ��� �^���P DEPTH TO PIPE BOTTOM (FT ) 4.0 ` 4� 5 4.0 GRAVEL DEPTH (FT 0 . 0.5 5 TOTHL DEPTH (FT. 7.5 GRHEL WIDTH (FT190 50 GRHVEL iENGTH "F"T.) 45.0 ]60 49.0 GRHVEL VOLUME (CU. YDS. 2 THNK SIZE (GHLS) 1/000.0 ** 1/'000.0 ** 1/000.0 ** SOIL RHTING FT./BR) 150 150 � 150 ` ** T�NK MUST �HVE HTLEHST TWO COMPHRTMENTS I CERTIFY THHT 1MILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND�WELLS HS SET FORTH BY �HE MUNICIPHLITY OF HNCHORHGE (MOH) AND THE STATE OF HLHSKFi 2 I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH ALL_ MOH CODES HND REGULATIONS/ HND IN COMPLIHNCE WITH THE DESIGN Cf."; 1. OF THI� PERMIT ]I WILL HDHERE TO HLL MOH HND STHTE OF HLHSKH �EQUIR�MENTS FOR THE SET BACK �ISTHNCES FROM HNY EXISTING WELL, WHSTEWATER DISPOSHL SYSTEM OR PUBLIC SEWERHGE SYSTEM ON THIS OR HNY HDJHCENT OR NEHRBY LOT. 4 I UNDERSTHND THAT THIS PERMIT IS VHLID FOR H �`IHXIMUM OF ] BEDROOMS AND HNY ENLHRGEMENT WILL EQ RUIRE HN HDDITIONHL PERMIT. � IF H LIFT STATION IS INSTHLLED IN AN AREA COVERED By MOH BUILDING CODES, THEN (1) HN ELECTRICF1L PEIRMIT HND IION MUST BE OBTAINED; (2) HS�BUILT�`. WILL NOT BE APPROVED WITHOUT HN ELECTRICHL INSPECTION REPORT/ AND (]) THE ELECTRICHL WORK MUST BE DONE BY H LICENSED.ELECTRICIHN. SIGNED I JTT 0 DATE: DATE: � SOILS LOGS r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: (lI4 , /1V ! lI o ff DATE PERFORMED: ^ 1/ LEGAL DESCRIPTION: �TC�Y� � 1� 4�� �r-) � 1 Cil A . I SLOPE SITE PLAN I(I s I I Oji_ 411 3- 4 4 7 1 • I , 8-1 9 I s •y . 10 \i', e , WAS GROUND WATER `� S D ENCOUNTERED? I®.( p P 12 4 E ••! �, IF YES, AT WHAT 13 DEPTH? 14- 15- 16- 17- 18- 19 - Reading Date Gross Time Net Time Depth to Water Net Drop 20 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN , FT AND FT COMM PERFORMED BY: y1.. f.� hetes NOR N —LLL I f CERTIFIED BY: 72-008 (6/79) DATE: 49�a2 /21 SOILS LOG MUNICIPALITY OF ANCHORAGE yE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION:- SLOPE SITE PLAN - f 2 3 4 P 5 r '5 6 r A 7 'J 8 v A f 9 0 10- 11 11 i A I' 12 6 / 134,- / 15 t % I 16 / 17 18- 8 19 19- 20 20 COMM L V WA%GO UND WATER S ENTERED? L O P IF YES, AT WHAT — E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: 171A BY: W ST—S3 -3 72-008 (6/79) (minutes/inch) FT AND FT m•�_ • mR �s ', M -W DRILLING, Inc. �. P.O. Box 10-378 G 10300 Old Seward Highwa, (907) 349.8535 ANCHORAGE, ALASKA 99511 DRILLING LOG 84-124 Well Owner VICTOR KNOTT Use of Well Domest c Location (address of: Township, Range, Section, if known; or distance main road Lot 23A6 Block 5 Shackleton ilubd, Size of casing 6, Depth of Hole 9i' feet Cased to 96, 30' feet Static water level 48 ft. (&6,M) (below) land surface. Finish of well (check one) open end (XXX ); Screen ( ); Perforated ( ). Describe screen or perforation None Well pumping test atm --gallons per (Imur) (minute) for 1 hours with of drawdown from static level. Date of completion hin-rch 1, 1; 84 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of.material, color and hardness OTO 2 2 Tn 'i 3 TO 40 40 TO 55 55 TO 90 90 TO 97 —TO— TO— TO— TO- TO— TO- -TO OTOTOTOTOTOTO To TO Casing; stickup Psrown sand Erotism ;sand - wet _ Tro,,m sandy clay wet Waterbearinggravel N Certified C©ntriwt4 Certificate Ne& 614 46 078 3 — CONTRACTOR PERMIT NO: I T- CH F-- F-0 r-4 F I I fz:� ci EE DEPFIRTMENT OFHEHLTH AND ENVIRONMENTAL PROTECTION 825 L STREET/ N HCHORHGE, HK 99501 264-4720 840064 L- P, VE Re V1 I~F - HPPLICHNTVICTOR F), KNOTT ADDRESS: 8541 E. 1'2TH CT. HNCHORHGE/ HK 99504 CONTACT PHONE: 266-1426 LEGAL DESCRIP: SUBDIVISION: SHHCKELTON SECTION: 19 TOWNSHIP: 12N LOT SIZEFT. OR ACRES) LOT: 2I8~6 BLOCK: NH RANGE: ]W I CERTIFY THAT: 1. I HM FAMILIAR WITH THE.REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF HNCHORHGE (MOH) HND THE STHTE OF ALASKA. � 2 I WILL I��STHLL THE SYST�M IN HCCORDHNCE WITH HLL MOH CODES HN� REGUL8TIONS/ HND IN COMPLIHNCE WITH THE DESIGN CRITERIH OF THIS PERMIT., ] I WILL ADHERE TO AL MOH HND STHTE OF HLHSKH REQUIREMENTS FOR THE SET BHCK DISTHNCES FROM 8N1.? EXISTING WELL/ WASTEWATER DISPOSAL SYSTEM OR`PUBLIC ' SEWERAGE SYSTEM ON THIS OR HNY HDJHCENT OR NEARBY LOT. DATE: �� �"..�: ��--~_____�~~-__�~~~_~_ HPPLICHNT: VICTOR �� KNOTT ISSUED / MUNICIPALITY OF ANCHORAGE Department(' Health and Environmenta' "?rotection 825 L Street, Anchorage, AK. V9501 264-4720 Permit HANDWRITTEN PERMIT # # # ' , WELL A PERMIT �tS Applicant: �%3� 1�%)D Mailing Address: Y/ C Location: G Phone Number: Legal Description: A ShackQ (f -ori Lot Size: Type of Soil Absorption System Is: Trench: ----'- Maximum Number ofDBedrooms; S+P_D)epSoilBRating(sq.ft/bdjng Tank: The Required Size of the Soil Absorption System Is: DEPTH I LENGTH ---GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). # # REQUIRE -SIZE GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ' . * # * TWO(Z) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fef for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bed ooms. Signed: ! Issued by: Q Applicant Date: �a / 9WP/024(1/81) MUNICIPALITY F ANCHORAGE Development Services Department' • Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 016-141-46-000 Legal description SHACKLETON LT 23A-6 Site address 130 JOAN CT Anchorage AK 99515 Current property owner(s) MICHELS PATRICK J Expiration Date: 12/20/2023 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 9/20/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA ApprovaLJune 2022 MUNICIPALITY OF ANCHORAGE o s, :,� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 016-141-46 Complete legal description SHACKLETON LOT 23A-6 Location (site address) 130 JOAN COURT, ANCHORAGE, AK 99515 Current property owner(s) PATRICK J MICHELS Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age _0_ - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $_ S l7 Waiver Fee $ Date of Payment J �'' `L3 Date of Payment COSA # PS C 13 13 V 6 Waiver # COSA Application 2022.doc COSA Checklist copy.docx COSA Checklist Legal Description: SHACKLETON LOT 23A-6 Parcel ID: 016-141-46 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 3/1/1984 Total depth 97 ft Cased to 96.3 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/5/2023 Static water level at beginning of test 38 ft. Well production at time of test 2+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic 6.48 ug/L Arsenic less than MRL (ND) Collected by Date 7/21/2023 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NEW EPOXY STEEL TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/11/1984 ALL standpipes present per record drawing Total measured depth from grade 9.7 ft (max) Measured depth to pipe invert from grade 6.7 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 3’ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 6/5/2023 Results Pass Fluid depth prior to test 1 in Water added 470 gal New fluid depth 2 in Elapsed time <10 min Final fluid depth 1 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 60 in (MOA 5’ ED) Effective depth used 25 in (Missing ED + Final Fluid Depth) Effective depth (ED) remaining 35 in Comments/Deficiencies: Approximate total measured depths from existing grade with ED per elevation measured shots & appears approximately 2’ ED is missing at testing. COSA Checklist copy.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No 5.5 ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS Previous MOA lot line waiver. Per 5/11/1984 inspection report. ST in driveway and is barricaded. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 9/6/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 9/6/23 8272P JOAN COURT LO LO N89052'30"E 90.00 I 30 • Chain link fence (typ) ( I CX5 Lot 23A-6 Well lk% or Conc. ret. wall O i : • •�9.% � 26.0 0 �•� .:• �. . W .; • : • o •; deck �> Z'. % < '� r o 40. 9.9 0 Z 1 1/2 Story Frame �? House `6 Lot 23A - N J ''\ 66.0 I =14. CD 10.0 46deck o t .� :• co 0 • 10.4 CD 40.0 C:) �I I o Z E I a I -C o Z a) > - _� �, z o LU I C > a) Garage o > 45' Temp —) Q8 O �- Wood fence Turnaround �I A -----._0 40.0 10.7 30 LO 10 Utility Easement N 89°52'30"E 90.00 RECERTIFIED 8-31-23 Lot 24E Lot 24 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection .`� �► r in accordance with ASPLS Standards of the following + OF A I described property: LOT 23A-6, SHACKELTON SUBD. '�, Anchorage Recording Precinct, Alaska, and that the ,• C"). 49th .y � g g • improvements situated thereon are within the property lines / • • • , • • • • and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying • • • • • • adjacent thereto encroach on the premises in question and •izabeth L. Walatka , o / that there are no roadways, transmission lines or other "._. ' ��� 8036 - LS • • s visible easements on said property except as indicated SCALE: 1 30 f • • , • �J ! hereon. Fo • . • . • �o ,�, Dated at Anchorage, Alaska �0 NAS- \,P + this 6th da of September, 2004. ssio � Y t � � �� EASEMENTS OF RECORD, OTHER THAN �� FRED WALATKA & ASSOCIATES, L.L.C. THOSE SHOWN ON THE RECORDED FB 23-2 pg 41 L' .a Engineers and Surveyors PLAT ARE NOT SHOWN HEREON _ 13 �1` UNLESS OTHERWISE NOTED. LB t cn ' pg BE 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. 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.muni.orglonsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 016-141-46' 1. GENERAL INFORMATION HAA# .SLI bU49 Expiration Date: 9/100(— Complete 9/I0o(" Complete legal description Lot 23A-6 Shackleton Subdivision Location (site address or directions) John Rd, North to Lillian Lane, right on Joan Court Current Property owners) Victor Knott Mailing address 130 Joan Ct Anchorage, AK 99515 Lending agency Unknown Mailing address Real Estate Agent Mailing Address None Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well El Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone 349-7226 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑s Individual Holding tank ❑ Community On-site ❑ Public Sewer X 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 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 Stale codes, ordinances, and regulations in effect at the time of installation. Name of Firm Theta Environmental & Engineering Phone 242-0755 Address 660 Maney Dr. Wasilla, Alaska 99654 _�%XX%'% Engineers Printed Name Ronald E. Godden y�. ••;tri 5. DSD S)GNATURE Approved for _3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report X— Well Flow Advisory Other By: Original Certificate Date: 0 (Ra.ODOt) Municipality of Anchorage o• \ • Development Services Department Building Safety Division ' On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 23A-6 Shackleton Subdivision Parcel ID: 016-141-46 A. WELL DATA Well type o" f* Date completed "144 Total depth 97' ft. Date of test Static water level If A. B, or C provide PWSID # _ Well Log (YIN) Y Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Cased to 96.3* ft. Casing height (above ground) 30 In. FROM WELL LOG 03/01/84, On File, MOA 48' Well production 5• 9 - p.m - WATER SAMPLE RESULTS: Coliform o colonies/100 ml. Arsenic: ND mg.A. B. SEPTIC/HOLDING TANK DATA AT INSPECTION oa/22/04 79.6 ft. 4.97 Nitrate e.1MND) mg.A. Other bacteria ,,R' I colonies/100 ml. Date of sample: °°tlr°' #45 Collected by: R. Godden Tank Type/Matwial Greer, Steel Tank tie .1.000' i'gal.', Number of Compartments 2 Foundation of�nout (Y/N) Y_:» Depression over tank (Y/N) N Date installed 5/11/84 Cleanouts (Y/N) Y High water alarm (YIN) WA Date of pumping 08/20/04'• Pumper Anchorage Cesspool Pumping/Alaska Pumping C. ABSORPTION FIELD DATA Dale installed 5/11/84' •"41 rating (g.p.d.te or 0bdrm) 150• Length 45» ft. 44, Width 2.5' ft. System type Trench' Gravel below pipe ±E Total depth 10_5' ft.' * Eft. absorption area 450 ftZ Monitoring tube Y Depression over field N ft. Date of adequacy test 8/22/O4 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test dry in. Water added 878 s gal. New depth dry in. Elapsed Time: 120 min. Final fluid depth dry in. Absorption rate >= 636.5 g"p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) Unknown If yes, give date D. LIFT STATION Date installed WA 'Pump on' level at N/A in. Datum N/A Size in gallons N/A 'Pump off" level at N/A in. Cycles tested N/A E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot 100.0 ft' Absorption field on lot +100 it, Public sewer main N/A Sewer /septic service line + 25 ft' Manhole/Access(Y/N) N/A High water alarm level at N/A in. Meets alar & circuit requirements? N/A On adjacent lots + 100.0 ft - On adjacent lots + 100.o F't Public sewer manhole/cleanout N/A Holding lank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation' 10 Ft* Property line 16 ft' Absorption field 5.5 ft' Water main N/A Water service line + 25 ft' Surface water + 100 ft' Wells on adjacent lots + 100 It SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line + 5.5 ft" Building foundation +10 Ft' Water main NA Water Service line • 25 FC Surface water + 100 ft' Driveway, parkingtvehicle storage 0 It Curtain drain N/A Wells on adjacent tots + 100 ft' F. COMMENTS "Lot line waiver, 8/23/84 • From Installation Inspection Report, 5/11/84 G. ENGINEER'S CERTIFICATION I certify that I have detemlined 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 Ronald E. Godden Date Q 1 (,/a `f HAA Fee $ LJ 30 . CO Waiver Fee $ _ Date of Payment Q IJP JLtJ Date of Payment Receipt Number �� �'i�0�' �j� Receipt Number, (Rev. 12101) and ST. BZ7Z P. JOAN CT, N ' /1/B5'SZ'30"F. 90.00' 30' �— I I• -23A-6- ' It M well V 01* 7 95W. Temp. Airnaroarnd I i X30' f r4 ved � 1 ( 9.9' 26.0 Noose N 66.0' /0.d Y Dick o o Qaro9e e 7 95W. Temp. Airnaroarnd I i X30' f r4 ved � 1 ( 9.9' /At Sly, Frame 4 Noose N 66.0' /0.d Y Dick o o Qaro9e e a a L------ —� .7B9•52'300W 90.00' 41 rc � a 30' EASEMENTS OF RECORD, OTHER THAN 49 THOSE SHOWN ON THE RECORDED LAnicch PLAT ARE NOT SHOWN HEREON. H 23A-5 0 W 2 A"UILT NO CORNERS SET THIS DATE hereby certify that I have performed a Mortgagee's inspection of the following described prope _or Z3A-(o.rty: S//AGf4E70N SUED. Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property tying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated at Anchorage, Alaska this (7 fh day of September 20 04 FRED WALATKA & ASSOCIATES (907) 248-1666 Engineers and Surveyor: I ACS Alaska Communications Systems May 16, 2005 Victor Knott 14114 Rocky Road Anchorage, Alaska 99516 ACS has no objection to the encroachment of the septic leach field and concrete block wall into a platted easement located on Lot 23A-6, Shackelton Subdivision, as depicted on the as - built drawing submitted. Acceptance and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: 1. ACS will be held harmless, now and forever, for any damages or injury to any person or property as a result of this encroachment. 2. Any ACS facility damaged or destroyed as a result of this encroachment will be repaired at no cost to ACS. 3. Any costs incurred by ACS for special construction necessitated by this encroachment will be bome by the property owner. 4. All applicable safety code regulations will be observed and maintained. 5. This letter of non -objection will in no way preclude ACS from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, �4d__21� Greg Sid Foreman Outside Plant Engineering ACCEPTANCE: Grid 2630 DATE: KADIIIM�oM %LEC.oSp.E.gw.WEnYineMLORRESPOwOHnBECTZhwk bn SuDawwian DOC 600 Telephone Avenue Anchorage, Alaska 99503-6091 tel 907.564.1000 www.acsalaska.com cHvGA HOWrRIM6 R/RfRIY IMRr February 2, 2005 Victor Knott 130 Joan Court Anchorage, Alaska 99515 Subject: Encroachment Permit for Existing Septic Pipe Lot 23A-6, Shackleton Subdivision NW%. of Section 19, T12, R3W, S.M., Alaska Grid 2630, EN05002, PID #016-14146 Dear Mr. Knott: Enclosed is the Encroachment Permit for the existing septic system clean out pipe within the easement area on the above referenced property. Please review the Encroachment Permit. If the conditions are agreeable, please sign the document where indicated, have your signature properly notarized and return the document in the enclosed envelope for full execution and recordation. Chugach will record the document. Please submit $35.00 for the Alaska State Recorders' Office recording fees. If you would like a conformed copy of the recorded document, please include an additional $2.00. The check should be made payable to Chugach Electric Association, Inc. A self- addressed, stamped envelope is enclosed for the return of the signed and notarized Encroachment Permit and the check for the recording fees. Enclosed for your information are Chugach's Electrical Facility Clearance Requirements and 97tat it an Easement? handouts and a Locate Call Center card. If you have any questions, do not hesitate to call me at 762-4735. Sincerely, Susan Truskett, SR/WA Right -of -Way Agent III Enclosure ^L _. A rl. .. •....-..•.. 1.. 1203-19B G-2630 EN05002 016-141-46 ENCROACHMENT PERMIT This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric cooperative, (herein "Chugach'), whose address is P. O. Box 196300, Anchorage, Alaska 99519-6300 and Victor Knott (herein "Permittee'), whose address is 130 Joan Court, Anchorage, Alaska 99515. 1. Easement. Chugach is the grantee or user of an easement for the construction and maintenance of electrical facilities, as follows: Described in that certain written instrument recorded on the 16°i day of July 1952 in Volume 76 Page 187, of the records of the Anchorage Recording District, Seward Meridian, Alaska, Dedicated by the plat of the subdivision known as Shackleton Subdivision, according to Plat Number 74-86, recorded on the 16th day of May 1974, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Easement") which pertains to the following described real property: The South Ten Feet (S 10') of Lot 23A-6, Shackleton Subdivision, according to Plat Number 74-86, recorded on the 16th day of May 1974, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska. Permittee acknowledges the validity of the Easement. Permittee warrants and represents that Permittee is the owner of the fee simple interest in the land subject to the Easement and the following described real property to which the Easement is adjacent: Lot 23A-6, Shackleton Subdivision, according to Plat Number 74-86, recorded on the 16th day of May 1974, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Parcel"). Encroachment Permit - Page 1 of 4 2. Encroachment Permittee proposes to continue the existence of the following improvement(s) on or within the real property subject to said Easement: A septic system clean out pipe approximately 2' within said Easement, (herein "Encroacbment"). 3. Permit. Chugach hereby authorizes Permittee to continue the existence of the Encroachment in its proposed location subject to the covenants set forth in this permit 4. Indemnification Permittee shall indemnify and hold Chugach harmless from any claims for personal injury, property damage or other loss arising in any way from the continuation of the Encroachment 5. No Expansion or Increase. Permittee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior written consent of Chugach. Chugach has no obligation to provide such consent 6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit, has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any other real property. Without in any way limiting the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes of the common law doctrine of adverse possession This permit creates no interest in the real property subject to the easement 7. Modification of Utility Facilities. If the electric utility facilities located within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment If such payment is not made within thirty (30) days of written demand for same, Chugach may terminate this permit in accordance with paragraph 9, below. 8. Covenants Running with the Land. The obligations of the Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the land subject to the Easement and shall benefit the Easement. 9. Termination. Chugach may terminate this permit after the giving of thirty (30) days written notice of such termination if: a. The Encroachment is enlarged, increased or extended within the real property affected by the Easement Encroachment Permit - Page 2 of 4 b. The Encroachment is damaged by any means to an extent of more than thirty percent (301/o) of its replacement cost at the time of destruction. C. Permittee fails to snake the payment described in paragraph 7, above. 10. Term. This permit shall, if not sooner terminated by Chugach, expire forty (40) years from the date hereof. 11. Entire Acreement. This written permit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all other prior or contemporaneous agreements, oral or written, between the parties. No modifications, amendments, deletions, additions or alterations of the permit shall be effective unless in writing and signed by all of the parties hereto. CHUGACH ELECTRIC ASSOCIATION, INC. aff_1 ulltl1 Z�4��By: By: n Edward M. Jenkin, P.E., Director Victor Knott i Engineering Services Division Date: a,3 /OS Date: c2 A /O Encroachment Permit - Page 3 of 4 STATE OF ALASKA ) ) ss: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this ,?& day of rlla r 2004, by i L10 Y /67 o "— (PRINT NAMES OF PERMITTEE/S) STATE OF ALASKA THIRD JUDICIAL DISTRICT ) ss: Notary Public in and for the State of Alaska My commission expires:: 2 /J !) Z0J-1 The foregoing instrument was acknowledged before me this,3Y-4—day of hry 2005, by Edward M. Jenkin, P.E., Director, Engineering Services Division of C ugach Electric As�tion, Inc., an Alaska corporation, on behalf of the corporation. Da viW JP. l3itt vn A'- ,r�;0'tay t.;;yf.-, PUBt-iG AFTER RECORDING RETURN TO: Chugach Electric Association, Inc. P.O. Bog 196300 Anchorage, Alaska 99519-6300 Notary Public in and for the State of Alaska My commission expires. Encroachment Permit - Page 4 of 4 r IJ 2/7/2005 Mr. Victor Knott 14114 Rocky Rd. Anchorage, Alaska 99516 To whom it may concern: ENSTAR Natural Gas company A OMSK)N S /ACO ENERGY Engines ng Gepartment 401 E. International Airport Road P. O. Box 190288 Anchorage, Alaska 99519-0288 (907) 3347743 FAX(907)562-0053 Re: Letter of Non -objection Grid: 2630 ENSTAR Natural Gas Company has no objection to a leach field cleanout encroachment located Two Feet (2ft) into the Ten Feet (10 ft) Utility easement located on the southern boundary of lot 23A-6, Shackleton Subdivision. Acceptance and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the property owner. All applicable safety code regulations will be observed and maintained. This letter of non -objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion of its right-of-way. ANCHORAGE WATER & WASTEWATER UTILITY "A New Standard of Excellence" Owned by fhe Municipality of Anchorage Victor Knott 130 Joan Court Anchorage, Alaska 99515 Engineering Division Anchorage � 3000 Arctic Boulevard All -America City Anchorage, Alaska 99503-3898 fax 907.562.0824 http://www.awwu.biz 2002 Mark Begich, Mayor February 7, 2005 Re: Shackelton, Lot 23A-6 (Grid 2630) Encroachment into Easement Dear Property Owner: The Anchorage Water & Wastewater Utility received your request for a letter addressing AWWU's position regarding the existing septic system clean out that encroaches into a utility easement located on the south 10' of the referenced lot. An as -built drawing with septic pipe location was submitted with the request. AWWU water and sanitary sewer mains are not available to the referenced lot. AWWU is not using the utility easement and has no objection to the encroachment. If you have any questions, please call me at 343-8009 or the AWWU Planning Section at 564-2739. Sincerely, Hallie Stewart Engineering Technician Voted Best Tasting Water in America - 1998 U.S. Conference of Mayon April 20, 2005 Victor Knott 130 Joan Ct. Anchorage, Alaska 99515 Dear Victor Knott, Subject to your agreement to indemnify the company as set forth below, GCI Cable Inc. of Alaska has no objection to the leach field cleanout encroaching into the R.O.W 10' utility easement on the East property line of Lot 23,A-6, Block N/A Woodland Park subdivision. Known as (130 Joan Ct.), in city grid 2631. This letter of non -objection in no way precludes GCI Cable from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right-of- way, including unlimited access for servicing its facilities. Also any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of GCI's facilities to accommodate any or all of the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Cable harmless, now and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to myself at the address below. Sincerely, / r1 L Acceptance Rob Hansen VQ OSP Design I Mte Municipality of e P.0. Ik)x ISNA 0 - Anchorage, Alnskll SY9519.66.91) - Telephone (0)7) 313.R.M - Fa% (fN)7) 313-fCIM) 4700 Rmpw til rest - Anchonlge, Alaska 191.1-07 Nim,n...111.org Mayor Mark Bcgich Iltdlding Safcty Division May 11, 2005 Ron Godden, P.E. Theta Environmental Engineering 23254 Northwoods Dr Chugiak, AK 99567 Subject: Waiver Request for Shackleton Lot 23A-6 Waiver Request WR#: 050026 Parcel ID # 016-141-16 IIA/Permit # Dear Ron Godden, P.E.: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to private well has been approved. The approved separation distance is 97.0 feet. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, c Goodall Civil Engineer On -Site Water R Wastewater Program Community, Securhy, Proshe/ity ti Municipality of Anchorage Development Services Department • v Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#:050O26 PID#:016-141-16 HA/Permit# IIAO40479 Date Received: May 11, 2005 Legal Description: Shackleton Lot 23A-6 Engineer. Ron Godden, P.E. Theta Environmental Engineering 23254 Northwoods Dr Chugiak, AK 99567 Applicant: Victor Knott Waiver Requested: 97' horizontal separation from well to septic tank Criteria: Geology Points: A. Water Table 5.87 B. Soil Sorption 1.94 C. Permeability 1.55 D. Water Table Gradient 4.50 E. Horizontal Separation 2.88 Total: I I 16.741 Waiver is Granted: X Waiver is not Granted. List Conditions or Reasons for above: Date: 5111105 By: Joe Goodall Name of Reviewer 14.9m..0 .... women .... ..a ... ........ a.............. Rec#: 67476 Amount: $M Date Paid: 51111200 State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District Office Engineers dated January 3,1985) Waiver Request for: Shackleton Lot 23A-6 Parcel I D#: 016-141-16 Waiver Request Number WR#: 050026 Waiver Requested: 971 horizontal separation from well to septic tank Engineer: Ron sodden, P.E. IIA040479 Septic Tank Data The existing septic tank was installed in 1984. This septic tank has encroached the on -lot well for approximately 20 years. The water sample results submitted 8/22/04 showed 0 coliform, .1 nitrates, and 0 other bacteria, all within Anchorage Municipal Code 15.55. Well Data The well was completed March 1, 1984. The depth of the well is 97 feet and cased to 96.30'. The Static water level is 79.6 feet and a flow rate of 4.97 gpm at inspection from Theta Environmental Engineering. The well log shows there is approximately 44 feet of brown sand below the septic system and then 35 feet of brown and sandy clay. Based off Theta Engineering statement the water table appears to be below the low permeability soils which would put the water table around 90 feet. State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District office Engineers dated January 3, 1985) Waiver Request for. Shackleton Lot 23A-6 Parcel I D#: 016-141-16 Waiver Request Number WR#: 050026 Waiver Requested: 97• horizontal separation from well to septic tank Engineer. Ron Godden, P.E. IIA040479 Water Table Points 1074 Depth of well: 90 5.87 Depth of septic system: 11 1 79 1.5 Distance from the bottom Point Silt 3.5 of the system to the highest Value Clay 6 water table In feet 0 0 8 1 17 2 24 3 30 4 40 5 85 6 100 7 290 8 1000 9 10 • Straight line Interpolation Is permitted between any two values Soil Sorbtion Points .,. 1.94 Soil Type I Point Value Clean Gravel 0 Fractured Rock 1 Course Clean Sand 1.5 Sand w/ Small Amt of Clay 2.5 Silt 3.5 Clay and Sand Equal 4.5 Clay 6 911.5 +r 7912.5 +( 9 0 +r 9 0 +1 9, °+ POO 0+ [Tog—) 9 1 0 + (79 1 0 0.8 + 1.1 + 0 0 + 0 + 0 *Use the predominant soil type but values can be averaged for a mixture + 0 + 0 Permeability Soil Type Polnt Vatue Clay(will channel) 0 Silt and Sandy Clay 2 Clayey Sand 3 Fine Sand 1.5 Sandy Gravel 1 Fractured Rock 0.9 Course Sand (30 grit) 0.4 Clean Gravel 0 Points 1674 1.55 r749 1 .4 + 735 9 ) 3 +f 79, 1 + [ 9, 1 +r 91 1 ♦r 91 1 $0) +r 911 0.22 + 1.33 + 0.00 + 0.00 0.00 + 0.00 + 0.00 + 0.00 *Use the predominant soil type but values can be averaged for a mixture Gradient 4.5 -60% 0 Separation -30% 0.3 -20% 0.7 slopes toward well -10% 1.2 1 -5% 2 100 0% 2.93- flat 5% 4.5 300 10% 6 slopes away from well 60% 7 *If the gradient is unknown, assume the worst case Horizontal 0 Horizontal Point Separation Value In Feet 0 0 25 0.7 50 1 75 2 100 3 150 5 200 6 300 7 Points 1474 4.50 Points 1674 2.88 *Linear Interpolation between two point value Is acceptable. Horizontally means straight line distance to the well not the contaminate travel distance to water table which may be greater. Conclusion: Grant Waiver Total Points: 16.741 GE2Theta Environmental & Engineering 660 Maney Drive Wasilla, Alaska 99654 March 18, 2005 On -Site Services Program Dept of Health & Human Services Municipality of Anchorage P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 23A-6 Shackleton Subdivision, 109 Joan Court, Waiver Request, Separation Distance, Well — Septic Tank. This is a waiver request for the separation distance between the well and the septic tank on the subject lot from 100 ft to 97 ft. The property is located in an older subdivision, with a mix of undocumented and documented water systems and wastewater disposal systems. Some documentation is quite limited because it appears that property ownership does not often change. Further, public water is nearby, but not accessible to the subject property. The existing well and disposal system was installed 3/1/84 and 5/11/84 respectively. A MOA Health Authority Approval Certificate was issued sometime after 8/27/84. The Wastewater disposal system inspection report, dated 5/11/84 indicates the separation between the septic tank and the well was 100 ft. The owner ordered a new Approval Certificate for a property transfer. Both the well and soils absorption field past testing and a request for the Certificate was submitted, 9/16/04. However, it appears the separation distance between the well casing and the first compartment septic tank cleanout is 99 feet. This means it is very likely separation distance from the nearest portion of the septic tank to the well is less than 100 feet. Anchorage Municipal Code and the Alaska Department of Environmental Conservation Regulations requires that no portion of the septic tank or soils absorption field be less than 100 feet from the well. Both the Code and Regulations provide a waiver option, if a lesser separation distance can meet the intent of the regulation and protect public health. This is a submittal for such a waiver. The following areas are discussed: 1. Geological. Subject Lot: Soils test logs show the surface has approximately 1 foot of organics with 2 ft of silty sand, with sand to the bottom of the hole at 14 ft. No ground water was 3/18/2005 KnottL23-A6M0AWaiverV1.doc observed. The well log shows similar soils with the sand extending to 55 ft. Brown sandy claw was encountered to 90 ft and water bearing gravel to 97 ft. Adjacent lots: 23A-5 shows similar soils in the soils log. The well log showed brown sandy clad from 55 feet and indicated the sandy clan extended to 104 feet before water bearing gravel was encountered. 24 E does not have a well log, but has a soils log of sorts. It indicates there is sand to 12 feet. W66t, E1/2 Lot 24 has a soils log that indicates silt at the surface to 6.5 ft, sand from 7 to 10 ft, and silt to 19 ft with no water encountered. It is on public water. Lot 24 does not have soil logs or a well log. Lot 23A-2 does not have a well log or soils data. Lot 23A-1 is undeveloped. Lots 23A — 3 and 23A-4 have public water. Based upon the above, it appears the following conditions exists: It appears that a water table is not encountered until at least 50 feet below grade in the vicinity. The water table appears to be associated with medium to low permeability soils and is not connected to the water table used for drinking water for the wells. It also appears that while the soils permeability below the soils absorption is high, the bottom of the systems may be as much as 40 feet above soils with lower permeability, and as much as 80 ft above the water table used for drinking water. It appears the water table gradient is to the south and away from the well on the subject lot. It appears there are no other wells less than 100 feet from the subject lots absorption system. It appears the horizontal separation between the well and septic tank on the subject lot is approximately 97 ft. It further appears that it is highly unlikely that contamination from the septic tank could reach the well. 3/162006 KnottL23-MMOAW aiverVI .doc 2. Special Considerations. The well and septic tank on the subject lot has the dwelling between them. The natural terrain slopes away from the well to the septic tank, and the ground surface at the septic tank is approximately 5 ft lower than the ground surface at the well. 3. Other. This is a 3% waiver from the 100 ft separation. The well has a structural barrier between it and the septic tank. Only the occupants of the dwelling are at risk in the unlikely event that contamination could ever reach the well from the septic tank. Based upon the data and drawings attached, it appears a waiver of the separation distance between the well and any portion of the septic tank will satisfy the intent of the coded and regulations and protect public health. I recommend the waiver be granted. If there are any questions, please feel free to contact me at (907) 242-0755. Enclosures: Vicinity Map Lot 23A-5 Data Lot 24 Data Lot 24E Data E1/2, W 66' Lot 24 Data. Lot 23A-2 Lot 23A-3 Lot 23A-4 3/1=005 KnottL23-A6MOAW aiveNt.doc OF FIN : {� GODDEN `3. -. ,.¢ 3i� r T �z a M_; its MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date �'I IUGB`a (a) Legal Description (include lot, block, subdivision, section, township) range) L -r '�3 a - (o C,V !z S/rneKL lou 'K- b Location (address or directions) (b) Applicants Name V.'tC-rue Kwu'iT Telephone - Home337-0,tb Business�lr�-/4 Lb Applicants Address FS /1 4ff 12 T" car- 4k �- (c) Applicant is (check one) Lending Institution Owner/builder n ; Buyer E:j ; Other 7__� (explain); - M2 PON sc l,n f-trrr- (d) Lending Institution F i FFo 6.imK or- A(zvsk.4 Telephone 37 1-�oSl�s- Address 'Z13 W Kgr_11,c-(tk; L.i6Nr-s 9, -VD 4ivc6,ta&e ,4L. WEo3 (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 1�14r.;P Gta,z 4 f o /dc -cam 2. Type of Residence Single -Family Number of Bedrooms 3. Water Supply Multi -Family Other (describe 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 tate State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. W - - e 1..'• la.s t -,v r-. Engineering Firm 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 regula- tions in effect on the date of this inspection. Name of Firm /SEC. Telephone ")-61r 56 /G Address I LOCI W '3o AVC Date !9-7 ,.l 0 c 6 `/ DHEPDHEP Approval Approved for Approved (ENGINEER SEAL) bedrooms Disapproved Terms of Conditional Approval , By CAUTION K- �f4s-0 3 � �0 Date Conditional THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4Je3jn1S (Page 2 of 21 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 C— Z O �84 A. WELL DATA Legal Description: �tz%�141 SIla raCl� L Well Classification Pvtroet k If A, B, or Cr D.E.C. Approved(Y/N) NfA- Well Log Present 61N) Date Completed J M4K /q8 q Yield 6 - TotalTotal 4 Depth De I Cased to 86.30 Depth of Grouting P �i P g Static Water Level LA R� Pump Set At Casing Height Above Ground a,r), Sanitary Seal on Casing /N) Electrical Wiring in Conduit (Y-*) Depression Around Wellhead (Y _ Separation Distances from 4b11: To Septic/Holding Tank on Lot On Adjoining Lots &T /Oy To Nearest Edge of Absorption Field on Lot 4� On Adjoining Lots G i ! (*F f To Nearest Public Sewer Line ty To Nearest Public Sewer Cleancut/Manhole A) /(}- Th Nearest Sewer Service Line on Lot A//+ - Water Sample Collected By Go'aDeni Date 17 ZJuh 8 q Water Sample Test Results 5 4 ++ 5 4 Comments*(=rom ch -s%' t`e z„specf,%% i4pi , 5-11-a y B. SEPTIC/HOLDING TANK DATA Date Installed S- 11 - S `/ Size /000 No. of Ccupartments ZZ Standpipes (i) N) %4.e5 Air -tight Caps (Y ) 'J1p3 Foundation Clear-cut Depression over Tank (Y Date Last Pumped A/A - Pumping/Maintenance Contract on File (YIN)AIA— ; for Holding Tank High -Water Alarm (Y/N)q/q- Temporary Holding Tank Permit (YIN) Separation Distances from Septic/Holding Tank: To Water -Supply Vb11 To Building Foundation 3_b ,ter./, i To Property Line f (o --To Disposal Field f,S Sj (G To Water Main/Service. Line &)(A, To Stream, Pond, Lake, or Major Drainage Course. f# 100 { Comments [Page 1 of 21 2-15-84 C. AYMRPTION FIELD DATA Soils Rating in Absorption Strata 1!5'0 dZ IS J� Type of System Design - ec! Nr -k 1 Date Installed 5 11 Length of Field _ S Width of Field 2, �" �7 Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present ) yZS a -pression over Field (Y,(�}] NO Date of Last Adequacy Test k.14 Results of Last Adequacy Test �J A)QW systew� Separation Distance- from Absorption Field: To Water -Supply Wbll /00 j To Property Line /D/ To Building Foundation (/V 3 To Existing or Abandoned System on Lot 4 1�- ; On Adjoining Lots r>3y/ To Water Main/:iervice Line N (4- To Cutbank(if present) N 14 - To Stream/Pond/Lake/cr Major Drainage Course%��¢v/UO-f To Driveway, Parking Area, or Vehicle Storage Area C.4gae,6 3$' Comments Fro on.�'{e i�31lra�+!S PL0^A r-11-24 D. LIFT STATION Date InstalledA- Dimensions Size in Gallons Manhole/Access (YM) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at . -- Vent (YM) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(YM) ' Commnts ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conforired to all MOA HAA Guidelines in effect on the date of s inspection. Signed � Date ?S- Jun I`E ,q '��,.Q e.;;;.c� t9� Company MOA No. � S`'° KB1/d5/s [Page 2 of 21 -n eau°e. oy C. Reid, Jr. ,• ,W No. 2251.6x'17XV 2-15-84 ALASKA �i iOIROURTAL COnTROL SCI oUS, InC. 6ngineerinq & Enuironmental Studies August 23, 1984 Keith Bandt Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99503 Subject: Shackelton Subdivision, Lot 23A-6 - Absorption Field to Lot Line Separation Waiver Dear Keith, On behalf of Mr. Victor Knott, owner of Lot 23A-6, Shackelton Subdivision we request a waiver of lot line to absorption field separation to 5.5 feet. Justification for this waiver is as follows: a. The on-site disposal system inspection report, as -built, dated May 11, 1984 shows the subject separation to 'oe 10 feet. However, installation occurred during the sane time the power and telephone lines are being buried. They used a small bulldozer which moved and covered the :rebar markers. The exact location of the lot line has not readily apparent during the inspection and a mistake was made when the measurements were made. When the HAA checklist; was accom- plished, all measurements were redone. However, the lack of a waiver was overlooked. b. The area in question is along the south lot line. It is a utility easement for electric, telephone, and sewer when installed. The gas line runs along the north lot line. The absorption system does not encroach to the east or west and the lot to the South is vacca_nt. C. Mr. Knott has already agreed to hookup to the public sewer when available. Based upon the justification provided above, our opinion is the waiver will have little or no impact on the environment. Nor, will the waiver cause any problem to any nearby property owner. If you have any questions, please feel free to contact crn at 561-5040 for further information. AppF �� YOOsa�DO pag„�v7'i4. R is id,`b7.", Phd, P. E. R Lei y C. Reid, Jr. J(n,°osY 'No 2251•c F gFr z.;_'',i'`''- _:;=1200 fest 33rd Auenue. Suite B • Anchoraqe Sincerely den Rnvironmenial Engineer Alaska 99503 9(907) 561-5040