HomeMy WebLinkAboutBARNHILL TR B LT 1Barnhill
Tract B
Lot 1
#011-262-33
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage
I•!`/Development Services Department
` Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SIA/02,0 03 PID Number. 0 11 — —
Nara �Wastewater
611!9UvtC
System: ❑ New ❑ Upgrade
10-75-1 w
ABSORPTION FIELD
Prow Number a$+M1oem,
1
O Dap Trvrn t] Sn,ll.a TrMM DOW O MwM D OIMr
Sod Rnnq
Total Daotn tram wg-ml glade
LEGAL DESCRIPTION
GPDmeF•
Bock Lot Subd.ws :
Degtl a P" WIM from orpabl V Wa
Grawsl &Pot banaam P"
T2 oT- 1 BA1129 14 11-t—
F1.1
N FI
To. P.p R" swq
FA ~ above WWW OWv `
C." Lehgth.
Tl.
FI.
Well: ❑ New ❑ Upgrade
Gr,vMVMhNumbaralms.
A`
Dntame We I"$
FI.
Ft
Cass:6unon (Presale. A. S. C)
Taal Dash
C,sed ld
Tar absomw arae
Poo Matanad
Ft.
R
FI'
D•O.r �\
Data NOW
Slates Walr t."
INlaw � �
Dale Instaflo 1 o f n
Y ap
Pump Sat M.
Ca" me-OM Abaa1 GloU
TANK
GPM
FL
FL
SEPARATION DISTANCES
❑ Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
PubliUPrival
Manidid""
cam",
From
Tank
Field
StationTank
Sewer line
Cal
Mal"
Number of Como,nmenls
Walt
10
10
N
N/o
LIFT STATION
&Oacawaar
p
Lol Lee
D
3o
5.10,
11000 Get.
MarMauura
_
'Pump W. IaM M
-Poop ow levo &I
Wal v,'-/Nd,la'm
Pwlp Mao a mode
Euahral Msf A ms pHlarlt'ad by
4
Conan DrL�
M<,e L�
BENCH MARK
Lorat*lt ama Deswptwn
r
AsaumW E,avbt. n
1�wFl
r�')BL�_i
.a'�h
Or••A`•••. �
16"r
Inspections performed by: 0- s Dates: 1" f R-r-le 2.
« 49 «••••««n
2rA
Department Approval
♦ -------Development
m no
Services
Reviewed and approved by: Date: 1Z f}107Mg0�
R. ❑MI
W
Well ,
To
co
co.-
GO)i=..�
10 D�
CF
` Z v
I:: 49th..._•ii
mmum
25 0 25 50 75 X00- ----Q5,1 Ill Jl No. CE 222
SCALD 1' = 50 FT. �1
WEST IIIMOND BL VIJ lawkwu _•
TOBBEN SPURKLAND P.E. SEPTIC SYSTEM AS BUILT
203 W 15TH. AV£NU£ BARNHILL S/D DA Tr: OCT. 1, 2002
ANCH. AK. 99501 LOT I TRACT B SHEET.1/1 GRID: 2322
907 279-3916 6751 W DIMOND
PERMIT 0 SVO20403 PID # 011-262-33 BAROB012.BV✓G
RightFAX
10731/2002 8:18
PACE 1/1
RightFAX
Inspection Report
Municipality of Anchorage, Building Safety Division
4700 South Bragaw
INSPECTION: VOICE 343-8300 INSPECTION: FAX (907)249-7777 INFO: 343-8211
Name Brick's Electric: Bill Permit 02-9278
Address 6751 W DIMOND BLVD Phone 440-9351
345-2923
Legal LT 1 Inspection Date 11/1/2002
Subdivision BARNHILL
Comments or Directions
Septic System Finished- AM or PM Ok
Inspectlon Retro Electrical Reinspection Y
NO NONCOMPLIANCE OBSERVED
❑ CORRECTIONS ESSENTIAL AS EXPLAINED BELOW
❑ WILL RE-EXAMINE AT NEXT ❑ DO NOT CONCEAL UNTIL REINSPECTION
INSPECTION
COMMENTS: (tor Inspector use only)
Inspector
i
Date: // /` G'
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Oct 10, 2002
Expiration Date: Oct 10, 2003
Permit Number: SW020403 Parcel ID: 011-262-33
Legal Description: BARNHILL TR B LT 1
Design Engineer: 0007 Tobben Spurkland, PE Site Address: 006751 DIMOND BLVD W
Owner Name: Tobben Spurkland Lot Size: 51000 SO. FT.
Owner Address: 6751 West Dimond Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 99501-5128
This permit is for the construction of:
Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (24 hours). ( Not required fora Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: l tl 116 le 7 -
Date:
Date: '9�ll DZ
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program .
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519.6650
www.ci.enchorage.ak.us
(907) 343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parce! I.D. oil- a it a — 33 Permit Number SW020402
Property owner(s) 1-1> Day phone 271- 341 !0
Mailing address (1)
(.tailing address (2)
Zip Code
Legal description (Lot, Block & Sub'd.) I3A�l.I 14 I It.- L
:eca! description (Section. Township & Range)
1-04, Size 5X y QC2_Acres/ q.F Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only Fl water
Only ❑
Sewer and Well ❑ Water Storage L'
Sewer Upgrade
THIS PROPERTY CONTAINS:
Ho: Tub ❑ Jacuzzi
71❑
Water Softening Unit ii
Swimming Pool
Therapy Pool ❑
I ce.^.ify 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.
(S;gnature of property owner or authofzed agent)
Permit Fees: A IA L"- / Waiver Fees:
Dare of Payment: idlL/Ot Date of Payment:
Receipt Number: A b K 7 b Receipt Number:
(Rev. 12.'00)
T.SPUIE '][.,AIM P.E.
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 1 TRACT B BARNHILL S/D
TOBBENSPURKLAND
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
Anchorage, Alaska 99519-6650
Oct. 2, 2002
We are submitting an application for the upgrade of the septic system for this lot. We want to
replace the existing septic tank with a BioCycle unit. The existing concrete crib is still functioning
satisfactory. A waiver for both the existing tank and crib was granted in 1984. The BioCycle unit
will be located more than 100 feet from the well serving this lot and wells serving adjacent lots.
The replacement of this holding tank will not prevent wells and septic systems 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 runoff will not result from this installation.
Well
I
V0 TOWO
:.�a•- To
q �. co
10
t~Y
CF
~ I
' " I C-9`7•• •�
49th.
. _ •..... .0� TOB N SPURKLAND; /t
25 0 c'5 50 75 i00- � I �1:f o. CE -2223 ti -
SCALD 1' = 50 FT.� �1 ......
WEST IIIMDN'o BL V� h''�I....1 '
TOBBEN SPURKLAND P.E. SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE BARNHILL S/D DATE: OCT 1, 2002
ANCH. AK. 99501 LOT 1 TRACT B MEET • 1/1 GRID: 2322
907 279-3916 6751 W DIMOND
P£RNIT # SW020XXX PID # 011-262-33 BAROB012.DVG
Municipality of Anchorage
Development Services Department
• ''� Building Sakry Division
On -Site Water and Wastewater Program `
4700 Bragaw Street a • ..
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.ak.us
(907) 343-7904
PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE
WASTEWATER DISPOSAL SYSTEM
Ip
This agreement, dated 6 Z is made between the Municipality of Anchorage
Development Services Department (DSD) and the property owner(s) of:
This agreement is made for the purpose of maintaining an on-site wastewater disposal system on
the subject property.
The property owners agree to the following:
Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation
statement from a registered professional engineer. This inspection and operation statement shall
verify that the engineer has inspected all effl nt and air pumps, timers, and alarms, and that any
deficiencies have been repaired and that th sy em is functioning as designed.
(Printed Name)
ttudnri,,�
a Puau- �
a
OF
JM 191
(Signature)
(Printed Name)
The Foregoing Instrument was acknowledged before me by
T_uUen 5puayknd onthis *D^'I dayof
nc.{t t2, j- ,200
Wi s my hand d seal n, _ t
Notary Public -nature) �R�
S d l m- SI t�a b44
(Notary's printed name)
My Commission Expires r� ),4 s � I L.
—1
C;
I
o
L.5,
Municipality of Anchorage
-- Development Services Department
Building Safety Division
On -Site Water and Wastewater Program "
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. oil- 90.-33 COSA # 0 7
Expiration Date: .5- g - 0 .�
1. GENERAL INFORMATION _
Complete legal description B/kRN N I l L SIQ i yweJ 0 /��..e4 I
Location (site address) 6751 1&b7144.9,.r X
Current Propertyowner(s) 1041 " vrk_La-t C^ Dayphone :L7fi-39/6
Mailing address '10 77 1,6- /!;-4
Z° 3
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
3
r
TYPE OF WASTEWATER DISPOSAL:
Lid
Individual On-site
['
❑
Individual Holding Tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm S Au a Vc AND € 4 N l E 1--a1 # & Phone .z14-341(0
Address
Engineer's Printed Name Pv�t`(aH Date
r\( q
5. DSD SIGNATURE r` C•.i HE SFURI;IAND
i
Approved forbedrooms. /
2225
Disapproved. t(((�F S1_�'��..
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Al e =! Original Certificate Date: ' 3 '" d
(Rw. 77105)
Municipality of Anchorage a
Development Services Department
Building Safety Division `
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: 5 I C> i aAC t `i3. L O i ( Parcel ID: Oil-
A.
il-
A. WELL DATA
Well type
Date completed ILL01
Total depth_�,Zft.
Date of test
Static water level
Well production
If A. B, or C provide PWSID # _
Sanitary seal (Y/N)
Cased to _gf�ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform —,2-5_001onies/100 mL
Arsenic: VQ_ mgA
B. SEPTICIHOLDING TANK DATA
Tank Type/Material 1316 u clf- L IF
ft.
Nitrate O,LU mg/L
Date of sample: 1140
001
Tank size 1Gov gal. Number of Compartments
Well Log (Y/N) N 0
Wires properly protected (Y/N) Y
Casing height (above ground) a H in.
AT INSPECTION
a -Y io ft.
5.0 g.p.m.
Other bacteria _,V coionies/100 mL
Collected by: Lara
Date installed A u a a� 2
Cleanouts (YIN)
Foundation cleanout (Y/N) Depression over tank (Y/N) _bL High water alarm (Y/N)
Date of pumping I : L l 0 '7 Pumper A lt 4m t. S r v i%. to
C. ABSORPTION FIELD DATA
Date Installed U_ Sal rating (g.p.d.1W or ft2/bdrm) Vki "441 System type &,.i-W/e t% /2 r;,b
Length Ut i hw L,&4 ft. Width No l "o unn ft. Gravel below pipe (e 64km ft.
Total depth I !i ft. Eff. absorption area 2.Kt_ft2 Monitoring tube _�_' Depression over field
Date of adequacy test 149 - o Results (Pass/Fail) _P For -3 bedrooms
Fluid depth in absorption field before test J in. Water added gal. New depth+ in.
Elapsed Time: Z-m+ab«, Final fluid depth in. Absorption rate >_ 4150 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Ny If yes, give date LI/
D. LIFT STATION
Date installed L Size in gallons 160.0 Manhole/Access (Y/N)
'Pump on" level at in. 'Pump ofP level at�yiin. High water alarm level at 2 2 in.
Datum -1p d lax It Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ID g
Absorption field on lot rtt>
Public sewer main M/6,
Sewer /septic service line
%D
Animal containment areas 11/R
On adjacent lots > tc-0
On adjacent lots > 10 tp
Public sewer manhole/cleanout N/A
Holding tank r4//}
Manure/animal excrete storage areas i"A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 4.0 Property line a5_ Absorption field .2
Water main 100 t Water service line Ino Surface water
Wells on adjacent lots 1604
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 619 Building foundation _�110 Water main I UU t
Water Service line qo Surface water tq/A. Driveway, parking/vehicle storage
Curtain drain =[.14, Wells on adjacent lots 100 f
F. COMMENTS
G. ENGINEER'S CERTIFICATION
rr+
I certify that I have determined through field inspections and
�•' ��i"
review of Municipal records that the above systems are in
TH
conformance with MOA COSA guidelines in effect on this date.
n
Engineer's Printed Name I e 6 ti tai rn�
:
% �'•T088F UAUI%,0" .
CE' 25 '
Date 141�4
� \ :�li2iw;;;.e;nnlcL�.►
COSA Fee Z_ 1-/30 Waiver Fee $ _
Date of Payment nZ f�ZO6 Date of Payment
Receipt Number Receipt Number
(Rev. 11/05)
SGS Environmental Services Inc
_ .... ._. ........200 W. Potter Drive
Anchorage, AK 99518
Tel: (907) 562-2343
Fax: (907) 561-5301
SGS Ref. #: 1070340
Client Name: Tobben Spurkland
Project Name:. Barnhill SID, Tract B, L1
Cllent Sample ID: Barnhill SID, Tract B, L1
Matri)c Drinking Water
PWSID
All dates/Umes are Alaska Standard Time
Printed Date/Time: 02/05/07 7:10
Collected Date/Time: 01124/07 9:15
Received Date/Time: 01/25107 10:15
'Technical Director. Stephen Ede
Released
r
Allowable
Prep
Analysis
Parameter
Results
PDL Units
Method
Limits
Date
Date
Init
Bacteria
0.00
9222B
0125107
0125/07
dpt
Nitrate
0.66
0.10 mg1L
EPA 300.0
10.00
0126107
0126107
Jds
Arsenic
ND
5.00 uglL
200.8
10.00
0126107
01/30/07
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Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
Barnhill S/D Tract B Lot 1
Municipality of Anchorage February 7, 2007
Development Services Department
On Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, Alaska 99519
Subject: Depth to Groundwater and Bedrock
Barnhill S/D Tract B Lot 1
Ladies and Gentlemen:
The septic system serving the residence at Barnhill S/D Tract B Lot 1 was constructed in 1968. The
original soil log no longer exists. The house and septic system are located on top of a hill in gravelly
soils. Well logs and soil tests from the surrounding properties do not indicate any bed rock or
impermeable layers to a depth of greater than 100 feet. Shallow ground water is not a concern in this
area of anchorage. This system conforms to the required 6 foot vertical separation between the
bottom of the drain field and bed rock and 4 -foot vertical separation between the bottom of the crib
and seasonal high ground water.
If you have any questions or concerns, please contact me at 279=3916.
Sincerely,
Lars Spurkrand, P.E.
Civil Engineer
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEngllgei.net
02/06/2007 13:39 FAX 9073614848 Realty Executives Alaska Q 001
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNICIPALITY OF ANCHORAGE
AND LA-9_6LY1/Kt=YyUA--r 9-r
THIS MEMORANDUM OF UNDERSTANDING trade and entered into as of this
L Day of of 2kL by and between V &tt W X e_
herein the "OWNER" and the Municipality of Anchorage, herein the
"MUNICIPALITY:' In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AW WTS), described as %� 0 i. LP - located
at 051 W. D i rrt n n& 131 V d Anchorage, Alaska.
2. Defmltions.
A. Attention. Any change to the design or function of an AW WTS that
Includes the installation or removal of any pans, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AW WTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC")15.65.
B. Cerdfknts of On -Site Systems ApprvvaL An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
02/06/2007 13:39 FAX 9073414943 Realty Executives Alaska ® 003
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AW WTS system is in use or operational or until the property is
sold or tide is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
5. Alterations, installation itad Removal of Additional laauinment. Owner agrees
not to make any alterations, removal of parts or additions to the AVAM without a
Construction Permit from the Municipality.
6. Maintenance and Repairs
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AW WTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (Z)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
Hiles and orders for the AW WTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWNTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AW WTS
Operating Permit is: OLp �r
C. Owner acknowledges that the fire sched a for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
02/08/2007 15:40 FAX 9075814845 Realty Executives Alaska ®005
Owner:
Anchorage: Purcbming Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding 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 Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
IIA,
Fftw
MUNICIPALITY:
By:
Title:
Date:
STATE OF ALASKA )
)as.
THIRD JUDICIAL DISTRICT )
The foregoing instr unent was acknowledged before me this,& day of
20M by r -
My Commission expires:
7tJr NOTARY °�y
p G
t s !tous1tom:
Ir�S ''2 J,9�i pp
hoot
aw �Dn E■p�M__.+.
n
S
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRON1MENTAL PrD=ON
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Infcrmatior.
(a) Legalpscripticn (include lct, b}pock,
(address or
(b) Applicants Nam.
Applicants Address
(c) Applicant is (check cne) Lending Institution
Buyer E-::[ ; Other r::j (explain);
(d) Lending
Address
(e) Peal Est
Address
Telephor
2. Type of Fesidence
Single -Family M
Nu.,ber of Bedrooms
3. water Supply
Application. Date
township, range)
Z�
Owner/builcbr E ;
Multi -Family
3
Other (describe)
Individual 14-11 07 Ccnmunity F -::l Public
Note: If camunity well system, m;st have written ccr:firmaticn frau the State
Department cf Envircrrertal Ccrservation attesting to the legality and status.
Is the well adequate for the rumber of bedrooms specified in this HAA x)
4. Sewaoe
Dismosal
Onsite
4�j Public
Community
Holdirg Tank
Is the
wastewater disposal
system adequate fcr
the rumber of bedroom y&N)
(Page 1 of 21
2-15-84
1:
5. Engineering Firm Providing Insoecticrs, Tests, Data and Information
I certify that I have checked, verified, or conformed to all MOA FAA Guidelines in
effect on the date of this inspection.
Signed
Date
Nate of Firm a�CjV U Telephone jam\ —RC1
Address \ZZCs W.33`�
Signed by
Date 3Zrlt
(ENGINEER SEAL)
6.DHEP Approval
Approved fcr�-?_ bedroom,
Apprcved Disapproved
Terms of Corditicral Approval _
ey C. Raid, Jr.
No. 2251 E _:
BY Date-�-gy
Ccnditioral
The Municipality of Anchorage Department of Health and ErvircrJ:ertal Protection does
not guarantee the ccntirued satisfactory performance of the water supply anal/or the
wastewater disposal system. This approval indicates that, as cf the validation tate
shown above, based on the data and information furnished ty an engineer registered in
the State of Alaska, the Later supply and wastewater disposal system is safe and furs
ticnal for the number of bed_-oors and type of structure indicated.
(DREP SEAL)
7. Mail the PAA to the followinc address:
KB2/dS/s
[Page 2 of 21
2-15-=4
MUNICIPALITY OF A. ORAGE t "\
CEPT. OF HEALTH & -�
EW'ROhL�icN7AL P20TECTIOMUNICIPALITY OF ANCfi�RAGE (MDA)
HEALTH ALTHDRITY APPRWAL (HAA)
NAP ;; 'AAd CHECKLIST — FEBRUARY 1984
A. WELL DATA
RECEIVED L I .T&e f -B
Well Classification [c;cTEr If A, B, or C, D.E.C. Approved(Y/N)
Well Log Present (Yy/ Date Completed UrvKntoul�l Yield Uu,)Ko qj
Total Depth lln,«f� Cased to DLpth of (outing
Static Water Leel tlK�\<oWNI Pump Set At__UnIK,oWt\1
Casing Height Above Ground 7, ,r Sanitary Seal on Casing
Electrical Wiring in Conduit Is*) Depression Around Wellhead (Y
Separation Distances from Well:
To Septic/Holding Tank on Lot w 7S'`
t Qn Adjoining Lots �>/a a
To Nearest Edge of Absorption Field on Lot On Adjoining Lots �i00
To Nearest Public Sewer Line /`///1- To Nearest Public Sewer
Cleancut/Manhole 4 'To Nearest Sewer Service Line on Lot f
Water Sample Collected By t:rY f Dateu^����N�
Water Sample Test Results C;,r ,, ci
Camn>nts2j"Fnyr i- ri n /r.� /% (� C) r%s �.�c//' 6: P'i rn7t , {on�f �v,9cf
+�f C.✓1
CZOi(�a�if o{e) �R2E o�S,3y(V�(44w:671ypx�h;5�e'
B. SEPTIC/HOLDING TANK DATA
Date Installed /CI'/•�', Size /C Ir ;<) No. Of Ca{partments /
Standpipes (/N) Air -tight Caps Y ) Foundation Cleanout (Y4)
•c
Depression over Tank (Y/N) Date_ Last Pimped
Pumping/Maintenance Contract on File (Y/N) f.1/-�r i for N//1
Holding Tank High -Water Alarm (Y/N) /J/C Temporary Holding ng Tank permit (Y
Separation Distances fraa'Septic/Holding Tank:
To Water -Supply Fkll -"76" To Building Foundation /C1..s/'
To Property Lire »o To Disposal Field
To Water Main/Service Lire f`m- To Stream, fond. Lake, or Major Drainage
Course N1A'
CCIlltpntS�// L� Sr r� T / sr f .27 c ^, �r�r l.C' >n �j/..�n/i/•4/1FS nc/f? 7r� G l 4� to r
!%lf/!�i/OS'1/f��^I•> f/'n"�?1 CC�f �� ('/1T /•'h�i• /% �� !'!
-
rriFic,�S
[Page l of 21
2-15-64 :,
C. ABSORPTICN FIELD DNTA
Soils Rating in Absorption Strata /�*rA;?,I'.l,yi Type of System Design C'p.'r(,7
Date Installed /`,{`,)F) Length of Field //47/nr,t. Ll
Width of Field ; /. �,.,,,1 *1 Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area //.n 1v4 Standpipes Present,(Y�'N)
Depression over Field (Y6) Date of Last Adequacy Test 3/ /fry
Results of Last Adequacy Test X415-0
Separation Distance from Absorption Field:
To Water -Supply Well -ti F�f3 * To Property Line 7i0`
To Building Foundation .?/S ` To Existing or Abandoned System on
tot NIR-- 1 On Adjoining Lots NJA
To Water Main/Service Line 'VIA To Cutbalk(if present) ''/A
To Stream/Pond/take/cr Major Drainage Course_ PIA -
To Driveway, Parking Area, or Vehicle Storage Area w 3`
Comm nts///ftiCi.etmf' 5 r,)�F%r m
iYISAQr/IS.nc.,,�c• /n r.k//(?,,,Drivv,f
D. LIFT STATION
Late Installed N�r� Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at Vent (YM)
Tested for Pumping Cycles doing Adequacy Test. Meets M3A
Electrical Codes(Y/N)
Caments
*' Check Permitted Bedrow "Rating Against HAA Inquest
I certify that I have checked, verified, or confcrm. d to all MOA HAA Guidelines
on the date
of this inspection.
Signed o/.��s. c.y Date �3/2�
CoaQany MOA No. -{1.2 )..
KEI/d5/s so
...
Q.ggOc oyl /9G s'Mdz� e -�i c�i ` -' t . ••...... y
, � Com:,, �-.•, �" o� �. f' � i '
(Page 2 of 2)
OY C. Reid, J,,
No. 2251E _
in effect
2-15-84
RLRSKr fMUIROfl MTRL COIITROL �,D, UICCS, inn.
Enginecring 6 Enuironmental Studies
MARCH 5 1984
DANIEL A MOORE JR
600 W 76TH SUITE 737
ANCHORAGE AK 99503
SELLER — JACK WHITE BUYER —
SUBDIVISION — BARNHILL BLOCK — TRACT B LOT — 1
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY
THE SURGE CAPACITY OF THE SYSTEM IS 675 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON MAY 6 1983 .
FLOW TEST ON WELL
THE WELL FLOW RATE WAS 5.3 GPM FOR 3 HOURS.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
1200 West 33rd Aucnue. Swte 6 9 Anchoroge. Alaska 99503 •(901) 561-5040
+ v
RLRSKr fMUIROfl MTRL COIITROL �,D, UICCS, inn.
Enginecring 6 Enuironmental Studies
MARCH 5 1984
DANIEL A MOORE JR
600 W 76TH SUITE 737
ANCHORAGE AK 99503
SELLER — JACK WHITE BUYER —
SUBDIVISION — BARNHILL BLOCK — TRACT B LOT — 1
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY
THE SURGE CAPACITY OF THE SYSTEM IS 675 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON MAY 6 1983 .
FLOW TEST ON WELL
THE WELL FLOW RATE WAS 5.3 GPM FOR 3 HOURS.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
1200 West 33rd Aucnue. Swte 6 9 Anchoroge. Alaska 99503 •(901) 561-5040
�, O,..xDl•ryor•
CHEMICAL & GbJLOGICAL LABORATORIES OF ALASKA, INC.
_ TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER (-1 p
5633 B Street ''
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM: C) See h on back
I.D. NO.
Water System Name Pho" No.
i2o o
Medina Address I
City
State
SAMPLE DATE: ® ® PRO
Mo. Day Year
Zip Code
SAMPLE TYPE:
C/Roullne
• Chock Sample (for routine sample.
with lab ref. no. 1 O Treated Water
O Special Purpose nlreated Water
SAMPLE Time Collected
N0. LOCATION i Time
By
L� .c14 7 -an I _ la 39
2 R4 11r
%6 ...
4
5 L
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
Katisfactory
❑ Unsatisfactory
❑ Sample too long In transit; sample should
not be over 30 hours old at examination to
Indicate reliable results. Please send new
sample via special delivery mail.
Date Received
Time Received
Analytical Method:
Q Fermentation Tube
S} !Membrane Filter
Lab Ref. No. Result' Analyst
Q7
ED
I m
I m
•rA of .,100 M. No at 0041. paoo.n.
or 1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Prr. 1987
READ INSTRUCTIONS membrane Fitter. Direct Count Coilform/looml
Verification: LTB )
BCB
BEFORE
Final Membrane Fitter Results col-lflo miloomt
Reported By --~ i I"11 Date
.i,
Time: 4- i 1 a.m.
ING SAMPLEP.m.
TNTC= Too Numerous To Count
. I
tION,
Anchorage Drilling Co:
2650 East 681h Avo.
Anchorage, Alas'.ca 941-702
Date - 192-0
To
1 f Address ._, GCS 7 e?Ai ,kl f i
cily
2s<�
Redif rm I
8s 882 STATEMENT