HomeMy WebLinkAboutRABBIT CREEK VIEW & HEIGHTS BLK 1V LT 12ARabbit Creek
View Heights
Block i V
Lot 12A
#020-511-19
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OPS181201 PID Number: 020-511-19
Dwelling: ❑® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑ Upgrade
Name:
Marilyn Ballagh Living Trust
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
P.O. Box 113408 Anchorage, AK 99511
❑ Other
Phone
Number of Bedrooms
Soil Rating ITotal
depth from original grade
250-2407
4
1.0 GPD/SF
0.9 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
0.4 Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
Rabbit Creek View & Heights 1V 12A
Fill added above original grade
2.3 Ft.
Gravel length
40 Ft.
Township Range Section
Gravel width
15 Ft.
Beds: Number of Lines
3
Distance between lines
5.0 Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
600 Ft z
Ft.
Well
>100'
>100'
N/A
NSA
>25'
TANK ❑ Septic A S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank/Orenco
Capacity
11500 Gal.
Surface Water
>100'
>100'
N/A
N/A
Material
Number of compartments
Lot Line
>10'
>10'
NIA
N/A
Steel
2
NA
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Orenco - Aux. Pump Basin
Capacity
100 Gal.
Curtain Drain
None
Noted
Remarks
Pump on level at
13 in.
Pump off level at
25 in.
High water alarm at
11 in.
Pump make and model
PF2005
Electrical Inspections performed by
Capstone Electrical
PIPE MATERIAL House to tank D3034 Tank to D1785
drainfield
Installer
A+ Home Services
Drainfield D1785 CO/MT
Inspector J. Millette / B. Schiller
BENCH MARK (Assumed elevation) 100 ft
Inspection 15c 8/21/18 8/22/18
Location and description
2nd
3`° 8/28/18 4t
Garage Slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: Date
��, . • • ' ' , �Q�
k
�� Benjarrt�rLiSchiller
p��j
Approved Date 1$
�.•
CE 12592 •�ti��
• • 10/22/18 , •'�0�
�
PROFESS)iVA L
�Q u �C
�
inspection Keport_V-i-iz.aoc
-RABBIT CREEK V&H BLOCK 1V LOT 1*2A
PERMIT # OPS 181201 PID # 020-511-19
L07rl 111A
NO CONFLICT WITH WELL
ON THIS LOT.
ABSORPTION BED
PN KIN ALTERNATE SITE
ONEBEDROOM MP VAULT (MH2)
GUEST HOUSE
All
MTtTHI LOT 13,
HI
i NO CONFLICT WITH WELL
ON THIS LOT.
ou
THREE BEDRO
1500-GALSTEP TANK
POWER LINES
zi
LL IN WELL HOUSE
LOT 12A
KNI
XN
lii 3, GE
FCO
62.9
86.6
SV
37.0
53.1
2CO
7.0
27.4
MHI
43.7
57.8
MH2
46.4
59,3
POD
397
57.8
MT1
40.5
45.4
53,2
59.2
66.4
53.6
LEGEND
CO'CLEANOUT
2CO'DOUBLE CLEANOUT
FCO-FDUNOAT|ONCLEANOUT
FS-FLOVVGPL|TTERVALVE
MH'MANHOLE
MT-MON|TOR|NGTUBE
SV-GEPT|CVENT
� TH'TEST HOLE
RABBIT CREEK V&H B1V L12A
PERMIT # OPS181201 PID # 020-511-19
J
d
o � 98.7
92.2
71
91.7 1500 GAL
ADVANTEX TANK
86.8
103.7 FINISH GRADE
101.4 ORIGINAL GRADE :2
INSULATION
101.0 DRAINFIELD ROCK 101.0
100.5 SAND 100.5
�-� 40' - I
GROUNDWATER @ 97.4 - 9/18/18
89.3
\
_ _ 4 ill
49
..
- ----.....
�- Benjaml Schiller
CE 12592
.GE PROFILE AS
`1-BUILT r+�iF�Fo ROf SS�NP�+'�'
iG
September 6th, 2018
A Plus Home Services
Attn: Mike Blakeslee
7501 E. 140th Ave,
Anchorage, AK 99516
Dear Mike,
Capstone Electric LLC has completed the electrical portion of work at 15951 Francesca
Dr. Anchorage, AK and certifies that the installation was done in accordance with Local &
National Electrical Codes. Thank you.
Devin Rafeedie
President/Project Manager
I
Sel-vice@capstoneak.com
Office: 907.688.2751 Fax: 907.688.2752
109
PLOT PLAN AS BUILT X SCALE 1" = 60' GRID _ SW 3240 _ Project No. 18-168/A2 _
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, in C.. (907) 522-6476 Phone 000ppp�O
(sol) 522-4625 Fax o 0 F A p�4
Professional Land Surveyors kenOlangsurvey.com o f
jonothan*langsurvey.com G �`' 544
I hereby certify that I have surveyed the following described property: 49TH � O
LOT 12A, BLOCK 1V, RABBIT CREEK VIEW & RABBIT CREEK HEIGHTS O * * O
SUBDIVISION REPLAT (PLAT No. 2004-91) 0'
Anchorage Recording District, Alaska, and that the Improvements situated thereon are Q
within the property lines and do not encroach onto the property adjacent thereto, that KENNETFIN��
no Improvements on the property lying adjacent thereto encroach on the surveyed O �, I o G
premises and that there are no roadways, transmission lines or other visible.•'Q�
easements on sold property except as Indicated hereon. 044-PF�p..�S-520�.•�o O0
Dated this the � � Day of _ I`d D�/'�M 13. e,c�- �� \ at Anchorage, Alaska 400�FESSIONAL \o
�p�ppoo�
It Is the responsibility of the owner to determine the existence of any easements, AECC963
covenants, or restrictions which do not appear on the recorded subdivision plat.
°"`"'°`^'r00 MUNICIPALITY OF ANCHORAGE• ,,,,,,!
On-Site Water&Wastewater Program No `;.:..5 �
® � PO Box 196650 4700 Elmore Road ` �. .
} Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
" http://www.muni.org/onsite
ArEltal
I)c•partmt lit4NcHOn
On-Site Wastewater Disposal System Permit
Permit Number: OSP181201 Effective Date: 8/3/2018
Work Type: Septic Upgrade Expiration Date: 8/3/2019
Tax Code Number: 02051119000
Site Legal Address: RABBIT CREEK VIEW & HEIGHTS BLK 1V LT 12A G:3240
Site Mailing Address: 15951 FRANCESCA DR, Anchorage
Owner: BALLAGH MARILYN LIVING TRUST Lot Size in Sq Ft: 81631
Design Engineer: FORGE ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
Disposal Field Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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
Received By: h,461-11. 04,/ Date: [/
Issued By: Rdte_Ajt / Date: PAIYl
MUNICIPALITY OF AN !a- .
6� " AGE
Community Development Department _ r ' 3 2018 -IT e: 907-343-7904
Development Services Division a JUS 1 .x: 907 343 7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMI ? i o� 6 8 4
Parcel I.D. 020-511-19
Property owner(s) Marilyn Ballagh Living Trust Day phone
Mailing address P.O. Box 113408 Anchorage, AK 99511
Site address 15951 Francesca Drive Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Rabbit Creek View & Heights, Block 1V, Lot 12A
Legal description (Township, Range & Section)
Lot Size 81,631 Sq. Ft. Number of Bedrooms Four (4)
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field n Initial I I Single Family (SF) n
(w/wo ADU)
Septic Tank Upgrade U Duplex (D)
Holding Tank n Renewal ❑
Multiple Dwellings n
Privy (SF and/or D)
Private Well ❑
Water Storage
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: S $1 v Waiver Fees:
Date of Payment: '7 —1(0 i Date of Payment:
Receipt Number: Receipt Number:
Permit No. OjlnI ZO k Waiver No.
Permit App_ -
��) ' GE
ENGINEERING
PO BOX 240773
ANCHORAGE,AK 99524
522-7773 677-7766(FAX)
July 13, 2018
Municipality of Anchorage
Development Services Dept- On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Rabbit Creek View & Heights, Block 1V,Lot 12A– 15951 Francesca
Septic System Design and Permit Application
Dear On-Site Services Engineer:
The septic system on the subject lot has failed and must be replaced. The attached site plan
identifies the location of the home and the proposed and existing well and septic location. No
conflicts exist between this proposed system and any other well or septic system whether on this
or adjacent lots.
The ground surface on the lot slopes toward the northwest at a grade approximating 5%. There
are no slopes greater than 25% within 50 feet downslope of either the proposed site. Drainage
arrows are shown on the site plan showing the grade and direction of flow. Storm water drainage
will not impact this septic system. The new absorption bed will be constructed parallel to the
slope as much as possible.
The new system will be a minimum of 100' from private wells and surface water and more than
5' away from the septic tank.
Please refer to the attached test hole log and plan and profile sheets for the septic design. If this
design is followed,there will be no adverse impacts to adjacent properties.
Sincerely, .����\\��
Wid.cL–e> 4(2"-°4—^ t.pF q�k 1!,,
•
Michael E. Anderson,PE e* 49 TH %
. Michael E.Anderson
.t11'�J'/ 7
V13/18
PROrESstoW" Aar
RABBIT CREEK V&H B1V L12A
SS LOT 11A I :11
I \ \ \ 10'UTILITY EASEMENTS
NO CONFLICT WITH WELL
\--- \
ON THIS LOT. \\ \II \ \
15'WIDE X 40'LONG 1` ` a I
ABSORPTION BED
I l�e \ \ \ ALTERNATE SITE
ONE BEDROOM PUMP VAULT •
\ \ CLASS C WETLANDS
GUEST HOUSE A4T \ \ BOUNDARY
PLACE FCO MT •...V1, \
IL • "'�T 1 T 2 LOT 13A
tli NIL .... . ..**1 NO CONFLICT WITH WELL
EXISTING •:SORPTION „X •� \ ON THIS LOT.
'\ SYSTE ABANDON IN :, `i- it FOS '' "','' \ \
\ PLAC• LOCATION NOT •-500-GAL FAP �, \ THREE BEDROOM \
KNOWN) AaVANTEXTANK \M� \
W/AX20 POD
/ \
\
Offo \ \
y \ \\ \
// i CO SSION EXISTING �•.,m 20'CEA(CASEMENT
\
8.-TIC T K IN ACCORDANCE I 1 \
WITH MOA CODE. � \
\ I
I Ii
POWER LINES \\ \
\ I III \
1 I /11
�� \\ LL IN WELL HOUSE m
�,� \ / LOT 12A
v MI // �\ \\\
U'0X\N
-�%\ ' - - 1- I \ `\
-- _ I \ \ \
LOT 15A ` \
FonGE
I I \ \
NOTE:
`.,���\xv NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE
9 til PROPOSED SEPTIC SYSTEM LEGEND
�r t•' - .'$9* � CO-CLEANOUT
j*:4g TH :*�� ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2C0-DOUBLE CLEANOUT
.•. .•• .•• --•
PROPERTY ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC FCO-FOUNDATION CLEANOUT
FS-FLOW SPLITTER VALVE
` SYSTEMS.
. Michael E.Anderson : / MH-MANHOLE
�#A1'. • 4831-E ����/ 0 50 100 MT-MONITORING TUBE
‘4,,,,,i,". 3D_! 4 r FEET SV-SEPTIC VENT
RROFESSIONas'�
1\tN\``_�� 1"=50' TH-TEST HOLE
RABBIT CREEK VIEW & HEIGHTS SUBDIVISION
BLOCK 1V LOT 12A
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW SHALLOW BED SYSTEM
PERK RATE: 68.6 MIN/IN 1500-GAL FAP ADVANTEX TREATMENT TANK
APPLICATION RATE: 1.0 GPD/SF PUMP VAULT
600 GPD/1.0 GPD/SF/ 15'WIDE =40 LF TRENCH REQUIRED(40 LF SPECIFIED)
BOTTOM OF BED: 2.0' BELOW GRADE
FLOW LINE ELEVATION: 1.5' BELOW GRADE
TOP OF TRENCH: 1'ABOVE GRADE
REVEGETATE MOUND
TO PREVENT EROSION
l ir-
1
�i
1'
OG2" INSULATION &
1' GEOTEXTILE FABRIC
6" :veiNA-147W0MYYMNAINVil
6" I�����i��i �i •�����t•��y�� ��
1'
DRAINFIELD ROCK 1.25" PERFORATED PVC(HOLES DOWN)
10-3/16" DIAMETER HOLES PER LATERAL
MOA APPROVED SAND 4' ON CENTER.
l 2.5' 5' 5' 2.5'
15 1
I 's
GE
TYPICAL BED SECTION
(NO SCALE) Av •
NOTES: i—W
%*• 49TM 1\��*�
1. GRADE AREA OVER TRENCH TO DRAIN AWAY t11 ` C'" "11�/
2. PROVIDE 3'OF COVER OVER TRENCHES AND 4'OVER SEPTIC TANK, OR 2' / Michael E.Anderson :
WITH 2"OF INSULATIONtic�rlF9,�V. 4831-E .•."< "
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER i\1F:PROFESskotk ►
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY ..xxx ��'
VRABBIT CREEK V&H BLOCK 1V LOT 12A
A
4.0
1500 GALLON ADVANTEX TANK
EYE BOLTS EVERY 2' '
i' CABLE W/TURNBUCKLE
TIGHTEN OVER TANK
i
10' L X 2.5'W x 2.5' D
CONCRETE BALLAST a a •
III►►�►III►�1_► ► ►III►�►III►�►IIIH ► ►III III►�►II1�►►IH-1
BOUYANCY CALCULATIONS:
(NEGLECTING WEIGHT OF TANK)
BOUYANCY FORCE ON EMPTY TANK:
1500 GAL CAPACITY x 8.35 LB/GAL= 12500 LBS
WEIGHT OF CONCRETE BALLASTS:
10'x2.5'x2.5'x 150 LB/FT3 x 2 = 18,750 LBS
WEIGHT OF SOIL ABOVE TANK: (6'x10'TANK)
4'x6'x10'x 145 LB/FT3= 34,800 LBS
SAFETY FACTOR: 4.2
fr4
•:4 3. •' '''•.s/•••
SEPTIC TANK BALLAST
-41 jN °;*fit (NO SCALE)
I. 49th
Michael E.Anderson
*r-cp .• No. CE-4381 �• Z`
i(cQ •.v. J-6-'E;.•°•4:,
•/ 1,PROFESSI•��♦♦♦•
��►wwaa�
MUNICIPALITY OF ANCHORAGE -6---Wt `�>j4+
DEVELOPMENT SERVICES DEPARTMENT �0. ".., Il
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 �.1..,�•. ,. ./
SOILS LOG AND PERCOLATION TEST // : MichaelE.Anderson :�if
I�'e 4831-E 91,040
-Ater
DESCRIPTION: RABBIT CREEK V&H BIV LI2A � Itt w ROFES `�
PERFORMED FOR: MARILYN BALLAG H i\������~
Professional Engineers Stamp:
DATE: 06/08/18 PROJECT No.:
PARCEL ID#: 020-511-19 TECHNICIAN: N. SHAFER
HOLE DUG ON 6/4 J. MILLETTE
DEPTH TEST HOLE 1
(feet)
IIIIIIIIIIIII 1108 SLOPE SITE PLAN
2 Oj% PEAT
3 //1///,.
a
4 : • "• :' BLUE SILT/GRAVEL
.•:.•
•,a• : ' MUGM SEE SITE PLAN
6 •..:;
410,.1.;, SILTY GRAVEL
7 : ' MUGM
i
8 i w
9 -<4.'
10 :.t:-:--.;:..r WAS GROUND WATER ENCOUNTERED? YES
S:::. .r.
�•;•�'•:•.!.:. IF YES Ca,WHAT DEPTH? 8'
_
~-1 °' DEPTH OF WATER AFTER MONITORING: 6'
11 ;41:.,:i.'"::',.s .: DATE OF MONITORING: 6/11/18
12
GROSS TIME NET TIME DEPTH To N T DRQP
13 DATE READING MINUTES) (MINUTES) WATER (FNCHES
(INCHES)
14 6/08 TEST HOLE PRESOAKED PRIOR TO TESTING:
15 1 15:50 30 4 N" i"
16:20 4 "
16
2 16:22 30 4 g" fg"
17 16:52 4 4"
18 3 16:54 30 4 jeg" "
19 17:24 4 it.
20
PERCOLATION RATE:68.6 (MIN/INCH) PERC.HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 3.0 FT. and 4.0 FT.
COMMENTS:
MUNICIPALITY OF ANCHORAGE �OFA _llkt
DEVELOPMENT SERVICES DEPARTMENT �,�P.•'' ,�
•
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 *• STM
... ..../...jj... ...
SOILS LOG AND PERCOLATION TEST Michael E.Anderson . /
,7'V* 4831-E ••41%
crTF 1 is-1 •'�V r
LEGAL DESCRIPTION: RABBIT CREEK V 8,H B I V L 12A 1Ih,0PROFESS\W-gap-
PERFORMED FOR: MARILYN BALLAGH k‘Nx
DATE: 06/08/18 PROJECT No.: Professional Engineers Stamp:
PARCEL ID#: 020-511-19 TECHNICIAN: N. SHAFER
HOLE DUG ON 6/4 J. MILLETTE
DEPTH TEST HOLE 2
(feet)
1 / 1' OB SLOPE SITE PLAN
2 j PEAT
3 a
4
BLUE SILT/GRAVEL
5 MUGM
SEE SITE PLAN
6 � �
7
8 SILTY GRAVEL
9 '''i" MUGM
1 0 ! !I �. WAS GROUND WATER ENCOUNTERED? YES
IF YES®WHAT DEPTH? 6'
I I DEPTH OF WATER AFTER MONITORING: 5'
DATE OF MONITORING 6/11/18
12
GROSS TIME NET TIME DEPTH TO NET DROP
13 DATE READING (MINUTES) (MINUTES) WATER (INCHES)
(INCHES)
14 TEST HOLE PRESOAKED PRIOR TO TESTING:
15
16
17
18
19
20
PERCOLATION RATE: (MIN/INCH) PERC. HOLE DIA. (INCHES)
TEST RUN BETWEEN: FT. and FT.
COMMENTS: SUBSURFACE SOILS ARE IDENTICAL TO TH1.
Mike Anderson
From: Claudia Roberts[Claudia_Roberts@chugachelectric.com]
Sent: Monday, July 09, 2018 4:47 PM
To: Mike Anderson
Subject: RE: Rabbit Creek View and Heights, Block 1V, Lot 12A
Attachments: Encroachment-Nonobj Request form.pdf
Hi Mike:
That's going to require an Encroachment Permit and Chugach will claim an easement of 20'centered on the OH. It
appears that there is adequate space between the top of the home and the OH wire, but it will required a site visit for
the permit. Attached is the permit application.
L aadia
From: Mike Anderson<andengr@gci.net>
Sent: Monday,July 9,2018 4:16 PM
To: Claudia Roberts<Claudia_Roberts@chugachelectric.com>
Subject: Rabbit Creek View and Heights, Block 1V, Lot 12A
*****EXTERNAL EMAIL******
Hello Claudia- You were a great help on the last project. I now have another in Bear Valley. The overhead electrical
goes right through the property and there is a blanket easement. Can you tell me the CEA position on this. The City will
again require a letter of non objection or a claim of an easement as you did on the last property. Thanks.
Mike
cHuwititpa
Request Form POWERING ALASKA'S FUTURE
ENCROACHMENT PERMIT, EASEMENT RELEASE, LETTER OF NON-OJBECTION
Date: 7/10/2018 Requestor: Forge Engineering
Property Owner(s): Marilyn Ballagh Living Trust - Marilyn Ballagh Trustee
Contact Phone Number(s)Email: 907-441-4000 Mike@Forgecivil.com
Requestor/Owner Address: P.O. Box 113408 Anchorage, AK 99511 (Owner)
Property Address: 15951 Francesca Drive Anchorage, AK 99516
Subdivision Name: Rabbit Creek View & Heights Lot 12A Blocic/Tract 1V
Fees: Encroachment Permit XXX Easement Release/Vacation
(i.e. Shed,deck,structure,septic,well,etc.$280) (General$55,Specific$280)
State Recording Fees Other
(Typically$25—$40) (Conversion to recorded document$75)
Letter of Non-Objection
(i.e. Standard fencing,landscaping$70;no additional recording fees required)
Describe request: New septic system absorption trench will be located beneath
existing overhead power lines as shown on the attached site plan.
Include:
1. Certified as-built or plot plan (for an Encroachment Permit) that clearly shows the encroachment, all
dimensions of the encroachment within the easement area and distance from the property line or easement
line.
2. In accordance with Chugach Tariff TA252-8,a non-refundable processing fee must be submitted with this
request,as follows:
Encroachment Permit $280
Specific Easement-Vacation $280
Release of General&Reserve Specific Easement $ 55
Release of General Easement $ 55
Letter of Non-Objection $ 70
Conversion to a Recorded Document $ 75
Note: Additional State Recording Fees are charged at cost
Submit Request Form,additional information and non-refundable fees in cash or check only to:
Chugach Electric Association,Inc.,Land Services Department,5601 Electron Drive;
Or mail to P.O.Box 196300,Anchorage,AK 99519-6300. Call 907-762-4781 with questions.
X
Signature of Requestor(If not the owner,include relationship to owner)
Land Services Department Use Only:
DATE AMOUNT PAID$
LS# GRID MAP BOOK PAGE
PLAT# MOA PROPERTY ID#
CLugac El:cir._ rsf::iation, Inc.
5(:;0! f' . E.,:>. rOF• • IC_..; .,..r ,, -.A/c:' '.. , 1 '•7494 Fo ,,,",)-5,.C.)27 • ;CC..j4737.12i
Ver 3/2017 c`r J.:_.. . -':c.c. • F.
A 2018-026964-0
A
Recording Dist: 301 - Anchorage
s 7/20/2018 12:33 PM Pages: 1 of 4
A I�IIIIIIIII�IIINIIIIIIIIIIIIi�I�
I IIIIIIIIIIil�llll
1103-01B
Grid 3240
EN18016
020-511-19-000
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 and Marilyn
Ballagh Living Trust(herein"Permittee"),whose address is P.O. Box 113408,Anchorage,Alaska
99511.
I. 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 5`h day of November 1954,in
Volume 111,Page 156.on file in the office of the District Recorder,Anchorage Recording
District, Third Judicial District, Seward Meridian, Alaska.
Described in that certain written instrument recorded on the 5th day of November 1954,in
Volume 111,Page 157,on file in the office of the District Recorder,Anchorage Recording
District,Third Judicial District, Seward Meridian,Alaska,
(herein "Easement")which pertains to the following described real property:
Twenty Feet(20')wide easement centered on the Chugach powerline crossing Lot Twelve
A(12A),Block One V(1V),Rabbit Creek View and Rabbit Creek Heights Subdivisions
Replat,according to Plat 2004-91,filed on the 10t day of August 2004,on file in the office
of the District Recorder, Anchorage Recording District,Third Judicial 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 Twelve A (12A), Block One V (1V), Rabbit Creek View and Rabbit Creek Heights
Subdivisions Replat,according to Plat 2004-91, filed on the 10`h day of August 2004,on
file in the office of the District Recorder, Anchorage Recording District, Third Judicial
District, Seward Meridian,Alaska,
(herein"Parcel").
Encroachment Permit-Page 1 of 4
eRecorded Document
2. Encroachment.Permittee has constructed or purchased the following improvements
on or within the real property subject to said Easement:
A house and stairway that encroaches within the entire width of said Easement for a
distance of approximately Sixty Feet (60'), a septic system absorption trench that
encroaches within the entire width of said Easement for a distance of approximately
Eighteen Feet(18'),
(herein"Encroachment").
3. Permit. Chugach hereby authorizes Permittee to continue the existence of the
Encroachment in its existing 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.
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:
Encroachment Permit- Page 2 of 4
111111111111111111
2 of 4
eRecorded Document 2018-026964-0
a. The Encroachment is enlarged, increased or extended within the real property
affected by the Easement.
b. The Encroachment is damaged by any means to an extent of more than thirty percent
60%)' of its replacement cost at the time of destruction.
c. Permittee fails to make 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 Agreement. 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.
CHUGACHH ELECTRIC
QASSOCIATION,INC. PERMITTEEE�; /� •
4/-3/1.By: C�,lLn"""\�(1L s�-7By//ei>;GL �/ /// ,
Shell} Schmitt, Senior Manager M rilyn llagh Living Trust
Distribution Engineering M 'lyn A.Ballagh,Trustee `-
Date: 7 j N lap 18 Date: 7 try —Encroachment Permit-Page 3 of 4
I I IIIIII I 111111 IIII
3 of 4
eRecorded Document 2018-026964-0
STATE OF ALASKA )
)ss:
THIR?D JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this /9 day of 7 L-it .
2018,by Marilyn A. Ballagh,Trustee /•�
" "
�P0,s o , c - Lt /
„pc. `¢ am�,,
:0 JULY ''
28 �: - Notary Pu I liefin and for the State of Alaska
m 2021 �•;I My commission expires: 7 — z 5 Zv z t
1.'S�yp�t of A�;*�,,.7S
�,�,r'4fF Y`Pt�Qj,```�
nift
STATE OF ALASKA )
)ss:
THIRD JUDICIAL DISTRICT )
Thefo going instrument was acknowledged before me this i'9day of
2 ,2018,by e-/(y 6e4iiyrr�f ,
Senior Manager,Distribution Engineering of C fugach Electric Association,Inc.,
an Alaska corporation,on behalf of the corporation.
A. Row, / . tie--6:21//fet4. -
p,1i1U11Uf(ipf
A.
4,T '•N Not.--711" blic in and for the State of Alaska
1:34.1�Q' R� My commission expires: 0 I -o i -?O12
UBLICI*~
I/llllll ll
AFTER RECORDING RETURN TO:
Chugach Electric Association,Inc.
P.O. Box 196300
Anchorage,Alaska 99519-6300
Attn: Land Services Department
Encroachment Permit- Page 4 of 4
I' I 111111111111 II III
4 of 4
eRecorded Document 2018-026964-0
i
_ _ ___ ____ _\---\— ____ _ _ _ . _s N
Ai
\ \ \
R \ 10' UTILITY EASEMENTS
I \ \
Lot 11A ry4tr iA. \
�
k� S \ \
? 10.2'x15.5'I U+
GUEST HOUSE *lbSHED \ i\
O
�i ROOFTOP a
\ � '•e• ( DECK v� Lot 13A
\ \
\ \ \ 9.2'x9.2' PATIO ..s 0-9 ' tea'
SEPTIC PIPES / •'RETAINING _. .l \ SEPTIC \ \
8.0'x12.1' WALL • a PIPE \
\
SHED . ' o Tgp
\ / 0 >- WOODEN i ze?
\ WALKWAY \
1 RADIUS AO. I !os \w/ DAYLIGHT RESIDENCE BSMT.
1 STORY
WELL IN POWER LINES' \ \
4 ` WELL HOUSE
`J /
9y�, \\ '� /Lot t 2A \ ``
81,631 s.f.
Ifl‘P /
n` s.A i. i \ \ \
9 , s \
S to \ \
0:4\
VA \ 63"N
\ i I Lot 15A
\ \
P1.07 PLAN _ AS BUILT x SCALE 1* - 60' GRID SW 3240 Project No. 18-168/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone
(907) 522-4625 Fax -_-.••••••,,,,,v,A h.
Professional Land Surveyors j.nathanaongy� ,cora ,��c-••..------..•qs,'l
I hereby certify that I have surveyed the following described property:
;A-s....' ''
LOT 12A, BLOCK IV, RABBIT CREEK VIEW & RABBIT CREEK HEIGHTS '11(f):: 4911, 7.'!;
• SUBDIVISION REPEAT (PLAT No. 2004-91)
i
Anchorage Recording District. Alaska, and that the Improvements situated thereon are i
within the property lines and do not encroach onto the property adjacent thereto, that •• S
4. 11,ENNETH C. i/
no Improvements on the properly lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on sold property except as Indicated hereon. 5202.•'
Dated this the k' Day ofX'— , '--,C= , at Anchorage. Alaska \Atili"•t gNN
It is the responsibility of the owner to determine the existence of any easements, AECC963
covenants. or restriction which do not appear on the recorded subdivision plat.
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY jOF ANCHORAGE
AND man y h a 1(Q. h rziet
fitaittitin y
0 Mid"
THIS MAINTENANCE AND REPAIR AGREEMENT maddand entered ifito as of this
QV Day of I of 20 hci, by and between /, // , /� j l r tae.,
herein the"OWNER,"and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein,the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS),described as
%d&c'w&K lrefinenf Spin7
located at(legal description).
. I / Z A� OCA //; ') 1Sikas
1,0f 12A Block 1 J
2. Definitions. -i2"c. -1arr1C
Alteration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts,components or pieces not
included in the original construction permit and design.
Certificate of On-Site Systems Approval(COSA). 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 Anchorage
Municipal Code(hereinafter, "AMC") 15.65. These approvals certify that
H. Owner agrees that the AWWTS installation and maintenance requirements as
provided by the AWWTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction, maintenance and repair of the
Owner's AWWTS.
I. Owner agrees to provide and maintain a telephone connection to the AWWTS as
required by the AWWTS approval.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions, nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof,or the right of such party thereafter to enforce each and
every provision hereof.
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended, modified or
changed by a writing, executed by authorized representatives of the parties, with
the same formality that this Maintenance and Repair Agreement was executed
with,and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement, the only authorized representatives of the parties
are: , ✓/��`
a. Owner: i11wi / 'ii
6.7§61),-ThioteeM4fl:
114i:114
: 4
b. Municipalit Director Communi Develo.ment or desi naffed ktg. it /�CS
C. Any attempt to amend, modify,or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWNER:
By /�i � (,,��/;� j� /' signature) Date:(27 '7 /g
icy /14 G -e(print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this Qi day of 3,3
20 IPS , by v\kao..t ANN t31\Luecs tt .
NOTAR PUBLIC FO ALASKA Notary Public
My Commission expires: 01 bl' 2 f CODY O'N EAL
State of Alaska
My Commission Expires Jan. 1, 2021
MUNICIPALITY: r Q (�
By: af./LSN. `}Sl 0 J- (signature) Date: 3 uS 3U, 2 o18
Rdoec is �rro I \ (print name) Title: 4
..-%MUNICIPALITY OF ANCHORAGE/ ....
He~ 'h and Environmental Prote' ton
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
SEPTIC TANK:
DISTANCE
FROM WELL MANUFACTURFR _MATERIAL COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
_ LIQUID DEPTH
LIQUID CAPACITy/d°d GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION
¢ of Lilq_es DISTANCE BETWEEN LINES
ABSORPT:ON AREA -~ O
DEPT~I: TOP OF TILE ]O FINISH GRADE
TOTAL LENGTH f
NEAREST LOT LINE OF LINE
TRENCH WIDTH~'~_~/IN.' TOTAL EFFECTIVE
SQ. FT. LE~GFH OF EACH LINE
DEPTH OF FILTER
MATERIAL DENEATH TILE__~. IN, ABOVE TILE_~.~tt IN.
SEEPAGE PIT:
Log Crib
Rings
BUILDING FOUNDATION_
DIAMETER __ OR WIDTH ____ EENGTH DEPTH
Crib Size:: DIAMETER___DEPTH___ DISTANCE FROM: WELL
TOTAL EFFECTIVE
, , NEAREST LOT LINE__ ABSORPTION AREA (W~LL AREA)
.SQ. FT.
Well
Class: Depth:
Well Distance To: Lot Line
Bldg: Sewer Line:
Pipe Materials:
~ of BedroomsL ~
Installer: ~
Remarks: B
DATE '" /-- APPROVED
GREATER ANCHORAGE AREA BOrOUgh
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO
3330 "C" STREET ANCHORAGE, ALASKA 99503
~C C TELEPHONE274-,55!
SEWAG;~)ISPOSAL SYSTEM m APPLICATION AND PERMIT
INSTALLATION LOCATION.
INSTALLATION OF: SEPTIC TANK
SEEPAGE PIT_ , DRAIN FIELD _.
. OTHER.
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS /dO
COMPLETION DATE ANTICIPATED
TO BE INSTALLED BY
NOTE.' THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF E~NVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
\
SEPTIC TANK SiZE i~) (~ TYPE SEEPAGE AREA SIZE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK . ~-~ ¢
FOUNDATION TO SEEPAGE PIT _
SEPTic TANK TO
SEPTIC TANK _ · SEEPAGE PIT _
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK _
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, / ~/ ~
· SEEPAGE Pit.
TO RIVER, LAKE. STREAM.
· DRAIN FIELD
SEEPAGE PIT __
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
. DRAIN FIELD // ~ k
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REG~STALLATiON.
_
TYPE
DIAGRAM OF SYSTEM
CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
)ESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
APPLICANT'S SIGNATURE
;;~: ~:ll":J. :t. EtS:J.
'i'HE L.iENf':i-!"H ::' [ "' ~ '.,):E; 't: f' l"] :1: '.':~; THE: L.[i::i'.,IC:F'FH ,:: :l; l'.,i FEET ::, OF' "f'HEi;
T.-.IE DE~:i::'TH CF:' F:i 'T'RE:t'.~C:H CF' I::':[T :!::E; "f'FIE: I::,T'::TFINf:::IE [::[::'T ,IEEH 'T'H[E SI II:~'F:F:i:?E: 0i:::' TFI!E
7 :;, ....!NJ' FIN[) THE: I:j:x:: TT :'ff"l OF:' 'T'HE ~ ,': C: :::t',?F:IT 'J' f'd',i ':; :[ f',l I:::'IEET
'f'Hi/j: "f'F~:E:NE:H b.l :i: [::,TH F'C ~: [::, i:;;: l:::! :il NI::: l EL. DE; ]: :~; E: F'EET.
THE: GI:;;:f::¢,,,'!~:L.. [::,E:F:"TH :i: E; THE: i"'1:1: bi Z MUP't D,[~:F'"i"H QF' (:~iiE:f:~'v'E:L. [?I/~:TI.,~E::F:'f.t THiE OUTFF:II....L. f::' ]: I:::'E
FIN[) THE: BOT-t'OP'I Cfi:' THE [E;>::C:FI',.,'I::~T T -H ,:: :[ N t:'E:[~2f' ).
F:;;~'; ~E:G:~IL..j % ::::::: :E::: :E::::: ::~E;~E::~:::::~'"'#''' '~: ~C ..... i'"'IF:~ li"-,,~ ~.,c" ::F3: % ;;;;~E:~EE ::=:=
4, ....I .... !. t ....... ¢ ~'~ .a QF:' icli",l? .::, .:, ¢::. ' I.,.I :[ THOUT F' :i: btf::lL.. ] NeE F'E~' ': '1" ]' '3H F:!bll2 F:IF'F't:~:O'v'f::IL.
[)[EI::'F~I:;;:TI"IE~:i",iT i,.:[I....L ~',"": :E;I.JEL]'EC:T TO
i"i :i: N" ""' -'
.t.! I,...1t'¢ t:::' S"f'FINCi::' B[~:Tb. IE[Eb! F:i b.I[D...L I:~N/:, Fii",P'd QI"]-':: T"I"E: :E;E:I.'.tF:iGE: t?' }; SF:U3SF~L ' ................
~ · ..... .:, .z , I:.1'1 :i: ~¢~;
:j.!2)t;~l F;;'E:[~2i' i:::'Cd~: R I:::'I:;~::i:VFI'TE: I.,IEL.L. 01:;~: ;:?[;:E I::EI/~71" F'(;}I;~: ?t F'I...IIE',L.]:C t.'.IE:L..I ....
b.iE....L t...f"::{i:!~; I::il:~:[::: I~:EX;¢...IJ:I:;~:E:I?, Fi!",t[)I"'!LI':T E',E:.F;;:IETUF~:i"~iEi;:, "1"~ .... I"HE:
01:::' "l"i '~'~:. b.!ELj... C:Oi"IF'Lt~:T Z OI",L
~;[::'E~;I::;: T F' :f E:f::IT ;i; QI",I~; I:!b![) (?(Z)N:~;TI;i:LI(;}'T ]: CIN [) ;[ I::~(;~[~:f::ll'"l?~; I::I[;~:fE: 7 ""I:::!
]: i",]:5 T R L. i... R T :[ 0 N. "
Department of [nvironmental ?'~!1i ty
3330 "(." Street
Anchorage, Alaska 99503
SOILS LOG - PEROLATION TEST
Performed for_~_~C ~L~/~~lla~ ,
m~s rom reports: Soils qog__ ~ ' peFcb)a{T~n' test
Feet
/12 -
13-
Was ground Water encountered?
Date Pe rfo nne~/~-I/,~ ~
_Y_.~_~_____ If yes, at what de~th? &' Oet 4 10, ,qll
Reading Date Gross Time Net Time Depth to Watep Net Drop
Z
'Proposed installat-T6-nT--$~page Pit
Percolation rate minute. - ....
brain Field
Depth of Inlet . · D~pt~--t-o--b-o~t~-6~--~)it or trench
COMMENTS: ~ 0-~--'1'~-~'-.V~aO$+ , *.At ~~g ~.
........................... ~-~-~ ........ '-'~r .... ~a~-F-;g~-~t°m.-+-...
>., CVO~b,i
MUNICIPALITY OF ANCHORAGE ENVhq~t..~:,:' .,, ~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION CTION
825 L Street - Anchorage, Alaska 99501
Telephone 264-4720iX~rb ~ ~ 'VL0'
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing.
PHONE
PROPERTY RESI~ENT (If different from above) ~ ' ' PHONE
2, BUYER PHONE
MAI LING ADDRESS
3'. 'LENDIN~I~STITUTIO~ ~ PHONE
I
~AILING ADDRESS
4, REALTOR/AGENT ] PHONE
I
~AILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ [] One [] Four
SINGLE
FAMILY
[] Two [] Five
[] MULTIPLE FAMILY [~;]"/Three [] Six
[] Other
7. WATER SUPPLY E~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. Awetl log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[~//I N DIVI DUAL/ON-SITE**
[] PUBLIC UTILITY
If ~nd~wdual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY -
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
, PERMIT NUMBER
2, WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] IN DI VI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
t
Absorption Area to nearest Lot Line
5. COMMENTS
~/~'APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title)'~~
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
MUMUPAUTY OF
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. 020-511-19
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: /� 0 I 1
Complete legal description Rabbit Creek View & Heights, Block 1V, Lot 12A
Location (site address) 15951 Francesca Drive, Anchorage, AK
Current property owner(s) Marilyn Ballagh Living Trust Day phone 250-2407
Mailing address P.O. Box 113408, Anchorage, AK 99511
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
El
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ ?- Waiver Fee $
II
Date of Payment �4 A0119 Date of Payment
Receipt Number 6'35-117 1115-7 Receipt Number
COSA # Q SC l 9 195-0 Waiver #
o� PaA ��3�a�� kcev-- 01 4y �
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 6/18/19
6. DSD SIGNATURE SIGNATURE
�J System #1 Approved for 4
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms
bedrooms, with the following stipulations:
By: Original Certificate Date: I t oh
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Rabbit Creek View & Heights Block 1V Lot 12A
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled Unknown
Total depth ft
Cased to ft
Al Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12 in.
Date of flow test for COSA 6/4/19
Parcel ID: 020-511-19
Structure served by this system
Well production at time of test 0.6** gpm
Water storage tank volume 300 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate .288 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 5/21/19
Static water level at beginning of test 0* ft.
Comments No well log. System on timer with holding tanks -flow rate tested by Anchorage Well and Pump.
B. TANK DATA
Age of tank(s) New years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping New Construction
D. ABSORPTION FIELD DATA Bed/Mound
Which system tested (date installed) 8/21/18
BE ALL standpipes present per record drawing
Total measured depth from grade 3.2 ft (max)
Measured depth to pipe invert from grade 2.7 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
C. LIFT STATION
❑ Required maintenance completed
Age of lift station New years
Lift station material Steel
Comments: New Construction
Adequacy test date New Construction
Results EJPass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Fv7l
Yes
Community Sewer Manhole/Cleanout > 100'
F, Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' 0✓ Yes
if No
ft
Private Sewer/Septic Line > 25' P/ Yes
if No ft
Absorption Field on Lot > 100' M✓ Yes
if No
ft
Holding Tank > 100' 7 Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' ❑✓ Yes
if No ft
77 Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ✓/ Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ®✓ Yes if No ft
Property Line > 5'
Fv7l
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
0
Yes
if No
ft
Private Wells > 100' FV7l Yes if No ft
Water Main > 10'
Q
Yes
if No
ft
Community Wells > 200' F71 Yes if No ft
Water Service Line > 10'
[D
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 121 Yes if No ft If absorption field is under driveway comment below
Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots:
Water Main > 10' ✓I1 Yes if No ft Private Wells > 100' ®✓ Yes if No
Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' 0✓ Yes if No
Surface Water > 100'✓0 Yes if No ft
F. ENGINEER'S COMMENTS
Septic system constructed in August of 2018.
`Well is listed in Municipal records as artesian.
**Flow test completed by computing drawdown in well.
G. ENGINEER'S CERTIFICATION
�F
....
..°.. q
I certify that 1 have determined through field inspections and review `�;.•°°` °'•.;
of Municipal records that the above systems are in conformance with °° «° y
MOA COSA guidelines in effect on this date. ;°°° 9th °•m
MICHAEL E. ANDERSON <
No, CE -4381 e8«
,� °`"•. 06/18/19 ,.••° �, �
COSA Checklist yellow sheet°......
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ft
