HomeMy WebLinkAboutCHRISTOPHER HEIGHTS LT 5Onsite File Christopher Heights Lot 5 #015-233-05 F-_-_-_�_ ._ Municipality of Anchorage On -Site Water and Wastewater Section a (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211353 PID Number: 015-233-05 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 01 Upgrade Name PETER B. & SHARON J. HULMAN ABSORPTION FIELD El Deep Trench EJ Wide Trench El Bed El Mound SiteA Site Address SAMUEL CT ❑ 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 Subdivision Block Lot CHRISTOPHER HEIGHTS 5 Ft. Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption S Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank I Line Ftz Ft. Well 100'+ I 25+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ I i Material Number of compartments Lot Line 10'+ I NA HDPE 2 Foundation 10'+I LIFT STATION Manufacturer Capacity Remarks Tank replacement only. Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield AK Underground, Inc. Drainfield CC/MT S47• ' Inspector Pannone Engineering BENCH MARK (Assumed elevation)100.0 ft Inspection ection v, 6/09/2022 2nd 6/10/2022 Location and description 3.d 4th See Site Plan, Finished Floor Garage ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date 0L t —'mss 9f� r � ... . �"onnotle Septic Syste 'Qveln :�; . CE n1 40 Approved Datb Not .this approval _.. does not include well permit require int . 1 zJoz 133HS '� ' ' , 91966 AV '30V�JOHONV Nd�d �11S £s£ l lzdSO �'�, ON IIM13d �•' sagaIL e'S . so-££z-slo NVm�nH NO�JVHS �R N313d �r� NMVao �..:. . -ON •O'rd 91 S1HOGH 2J3HdO1SPJHo MBIA £ZOZ/£0/ O S 6�sbj.. �....1ay�-- IOZ8-9tLL6U06) XVJ,a3�NlVdOX8081 LX08 O d NOHd SONIMVM 02i003N 31V0 sNOISIA3a ",•.,•, (8809. TO) 311 3AS SN3 3NON lHVd s310N LJL rvI U �(n Lo I/EILilI ww "48 / ol W W 0_ W O CD - o0 0 cn / I 1� 1-' -0 l a _ \ \ \ r-- O_oo I w CN zoz \ ^. o ww W I I o\ ¢U U --r— Q—w I O \� J cncn �o� r _z I- ow /¢ zz I = O� L o il�� I v, \,\ �mQ /ti IN I woo-) NmU/ _ I f I Lc) �\ 9_,,_ . / [if AV o N w I!„'1 [Ol/ ----_—�-�--T �1�-------- - / coOf / 0 If I LOT VACANT NO WELLS OR SEPTICS � o ry LU\L l 11 N �o O r7 It D_ LLl w d r� ~ O Q l;t Q O �O O Q U O �a N ff) 00 oa Zv)0w C)>-o� 0 ~ < v)< ' W U mY cIOOH W— N Z W W W D U Z p H J Q F cn CJ W J Z O Z F- J Q Q J Z U W m z W - Z O J TLj 0 J H 3 H U Z U Q N U J Q F- d Ln Q z 3~ U -_ LJ a W a L's 0 r 3 � m [ifo ZO< Z I Q 0U rr 9� N 00 r7 It m — N U� r� O Ol Ci) Q 0) N ff) 00 N = N O W D U Z p H J Q F cn CJ W J Z O Z F- J Q Q J Z U W m z W - Z O J TLj 0 J H 3 H U Z U Q N U J Q F- d Ln Q z 3~ U -_ LJ a W a L's 0 r 3 � m [ifo ZO< Z I Q 0U rr 9� 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:/Iwww.muni.org/onsite On -Site Wastewater Disposal System Permit Permit dumber: OSP211353 Effective Date: Work Type: SepticTank Upgrade - -J Expiration Date: Tax Code dumber: 01523305000 Site Legal Address: CHRISTOPHER HEIGHTS LT 5 G:2739 Site Mailing Address: 6730 SAMUEL CT, Anchorage Owner: HULMAN PETER B & SHARON J Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy t 0 U. Department 8/30/2021 8/30/2022 Lot Size in Sq Ft: 53771 Total Bedrooms: 3 ❑ 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 Received BN Issued By: Date:�Q Date: S 30 oZOa 1 d MUNICIPALITY OF ANCHORAGE Community Development Department k Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-233-05 Property owner(s) Peter & Sharon Hulman Mailing address 6730 Samuel Ct Anchora, Site address Same e, AK 99516 Legal description (Sub'd., Block & Lot) Christopher He Legal description (Township, Range & Section) Lot Size 53,771 Sq. Ft. Number of Bedrooms 3 Day phone hts L5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Nx all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) X❑ AD U) Septic Tank X❑ Upgrade RX(w/wo (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ 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: Waiver Fees: Date of Payment: g I `� a a a Date of Payment: Receipt Number:_ Q rj 5 �`a Receipt Number: Permit No. ® S P 21 3 5 3 Waiver No. Permit App__- : ._.,:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211353, Rebecca Carroll, 08/30/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211353, Rebecca Carroll, 08/30/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211353, Rebecca Carroll, 08/30/21 HOUSE DETAIL (j Scale: 1 "=30' 2.0' CANT 23.0' DECK 41m DECK 2 STORY 6' PROSY aa RESIDENCE CANT , 4.0' CANT k L. 41.0' 2A' CANT I i Lot 4 Ag 10' C.E.A. EASEMENTS 10' UTILITY, T&E EASEMENT / / 00' PROTECTIVE RADIUS z —26J, g I � O o I SEE HOUSE �- rn DETAIL N P SEPTIC PIPES co,;• MANHOLE' W 20' C.E.A EASEMENT-1'� SEPTIC PIPES SAMUEL CIRCLE CT O i / o o \1 —30' DRAINAGE WELL 1 N !I R-; .` EASEMENT i S 89'57'52"W 247. Lot 1 Lo 53,771 S.F. Lot 6 20' C.E.A. EASEMENT 10' UTILITY, T&E EASEMENT PLOT PLAN _X_ AS BUILT —__ SCALE 1" = 60' GRID SW 2739 Project No 22-502L 1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax Professional Land Surveyors ken*langsurvey.com o {� QF,fiL��� jonafhan*longsurvey.com '� • '' �s00 I hereby certify that I have surveyed the following described property: LOT 5, CHRISTOPHER HEIGHTS SUBDIVISION (PLAT No. 82-362) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the Day of of Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH KENNET G. G 1 c� IS— 202.••• �J© 40Q OFFSSIONAL AECC963 12,105/2012 03:43 9072430742 AWPS, INC. PAGE 02/.06 Well .Drilling Permit Number; SW__ Date of Issue: Parcel Identification Number._ Legal Description Properp Owner Nppt & Addr Gr -top j, 1-jlr�-� -4- 5 L,,w " "r L Pump Installation Date: Pump Intake Depth Below Top of Well Casiat; 7-c/ feet Pump Manufacturejr!s Name, A y 014 7DO r) Pump Hodel: Pump Size hp xZ, Pitless Adapter Burial Depth: / 0 feet Pitless Adapter Manufacturer's Name; Fida35 liazmlwn IAJ (4 VV01 Dlsivfected Tulpo;j Melhod if Diziinfezfloa. Comments: Pump Installer Mame; /yalee Attention: rhe pump installer shall provide a PS fu I w%,,a-,-T CnT installation log to the DSD within 30 days of pump installation. Nvision oc, a v Street Mark gich Mayor Purpp Installation Log Well .Drilling Permit Number; SW__ Date of Issue: Parcel Identification Number._ Legal Description Properp Owner Nppt & Addr Gr -top j, 1-jlr�-� -4- 5 L,,w " "r L Pump Installation Date: Pump Intake Depth Below Top of Well Casiat; 7-c/ feet Pump Manufacturejr!s Name, A y 014 7DO r) Pump Hodel: Pump Size hp xZ, Pitless Adapter Burial Depth: / 0 feet Pitless Adapter Manufacturer's Name; Fida35 liazmlwn IAJ (4 VV01 Dlsivfected Tulpo;j Melhod if Diziinfezfloa. Comments: Pump Installer Mame; /yalee Attention: rhe pump installer shall provide a PS fu I w%,,a-,-T CnT installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT I,.j~:~IEW [] UPGRADE NAME F~ , 1PHONE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS .-~ Wel' ct- PERM4 O' I! 4 ~ v DISTANCE TO: ] ~ ~'1 ' I- Z Manufacturer. No. of compartments '2- k q. capacity in IF HOMEMADE: Well Dwelling PERMIT NO. DISTANCE TO: Manufacturer Liquid capacity in gallons DISTANCE TO: No. of lines./ Length of eachline~ Top of tile to finish grade ~ ! Length Width Type of crib Crib diameter Well DISTANCE TO: Class Depth Building foundation DISTANCE TO: [ Absorption area ~-t Material Inside length ~ Width Foundation / 7 / Total length of lines,~/4_~ Material Nearest lot line / ¢ ! Trench w dth~ ~inches Material beneath tile ~4 inches Depth Crib depth Building foundation Driller Sewer line ITotal effective absorption Nearest lot line Distance to lot line Septic tank Liquid depth PERMIT NO.r~ ~ I 1~--2- ' ) ~L=~--~-7-T~/~, gq 30L~ Distance between lines L'~ Total effective absorption area PERMIT NO. rea PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS?/ SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol ~ Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Pleaee complete either la, lb or lc.) A.D.L. No. Io.llBorough Subdlvi. sion Lot Block Ib"~l.I I/4qtrs. Section No.I Township N[~] I Range EF-.-~J Meridian '::~ ~"~' '~' '~ ~ ~of~of~of ~IJS~ W~ I '~ Address: ~ .* Street Address and Area of Well Location ~'~;' : ?~ ' 2. WELL LOG Feet Below 4. WELL DEPTH: [final) 5. DATE OF COMPLETION Surface ~.~ ?:~ ff. ~,~ -- ~..~ _ Moteriol Type TOp Bottom ~' ' ~ '~ ~Cable tool ~Rotary ~Driven ~Dug ~ ....... ?' '.' /~,~ 7. USE: ~ Domeetic ~ Public Supply ~ Industry ~:~, ~,:~ ~,~ ::,:., ~:.~:~ // ~; diem. ~, in. to ~ ~ ft. Depth Weight lbs./ft. ..~ . .~, ~ ,-. ~:. ':.~".=~': /..?~ / ~ ~' diam. in. to~ ft. Depth Sfickup ' ft. " '~ :~'~ ~ ''~ ,~':-~'.'~ ~: 9. FINISH OF WELL: Type: ' ~:~ ';"~ -.~.~ '::' Diameter: Slot/Mesh Size: Length: Set between ft. and ff. Backfilling Gravel pack I0. STATIC WATER LEVEL: ';; ~L,,. ft. ~ Above or ~ Below land surface Date Equipment used: ~ '~.~ ~' I1. PUMPING LEVEL below land surface and YIELD / ~.'~' ft. after hrs. pumping.;*..~;· g.p.m. ft. after hrs. pumping ~ I~.GROUTING Well Grouted: ~ Yes ~ No Material: ~ Neat Cement ~ Other: 15. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. 14, RE MAR~.~: ..::, . ,:~ ' ' 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Wafer Temperature ~o ~ F ~ C This well was dr~l,,led :~n~er my ju[isd[ctio~ and this report is true to the best of my knowledge and belief; Registered Business Name Contract License Number Address: ..; ~ ~.-~ '..:7:~ ~.~,. ~:. ~.? .. ,' ,. ..... . Signed: '~'' ': ;~:r ~/:m : ~ . ... Dote: A uthorl-~ed Representative Form O~-WWR [11/81) Copy Distribution: WHITE-State DGGS, PINK-Driller, CANARY-Customer ~;~ I'11_i1'-4 T I--: T F-.J-~IL T T'T' i--IF /,~.__..~< [:,EF'RRTMENT C ;HEALTH AND ENVIRONMENTAL ~ JTECTION x~-j. / / C( ?!_. ~::---'.s "L '" STREET., RNr:HORAGE., AK. 995F1-I /~-.--/~ ' 2e]4-4720 LdELL FII"-I[:. m"'m~'~,---] I TE SEL-JEm~:-- F'EE~'£-I I T ~F.'.M I T N0. ( :--L'~:0049 ) ~'LICANT LOCATION LEGAL FEJES DEVELOPMENT LSBi CHRISTOPHER HEIGHTS OLD SEWARD HIGHWAY 99502 349-~91 LOT SIZE 999999 SQUARE FEET TYF'E OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= ±50 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:,EF'TH= tt LEI'-,IG TH= 2:3 G F.' R'-.,' E L [)EF'TH= ? THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR F'IT 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). D:EL-(LIIREE) SEPTI Cz TR[~F~[ ~ I ZE= l~3£dp]~ ISI-:ILLCi~_c. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INST~LLRTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE HELL HILL SERVE. TL. Jm] (2) I [-4SPEC:T ICingS R~:E ~:ELqI_II ~:E[:. BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. HINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE NELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERI-1 I T E:=-;:P I ~:ES [:,Em_-:EFIE:EF-: _-~-±.. I CERTIFY THAT ±: 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 THE CODES. ~ I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. S I GNED: l, u. 3..~C~ ..... RPF'LICRNT FEJES DEVELOPMENT ISSi_IED E:Y ~l ( ~ V4. <Permit 9: 821142 January 31, 1983 TO: Permit Applicant Subject: Lot 5 Block 1 Christorpher Heights Subdivision A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. S incerel~ Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 PERMIT NO. ~4LIr-I I C: I t _ ~L I T'¢ I3IF FIFICHu. RFIGE DEPARTMENT OF HEALTH RND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 14ibb AND C,~4--SITE SEbJER PERM IT ( 821t42 ) APPLICANT LOCATION LEGAL FEJES DEVELOPMENT LSB1 CHRISTOPHER HEIGHTS 6917 OLD SEWARD HIWY 99502 ~49-6691 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SD FT?BR)= i50 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:-,EPTH= 11 L El'-.im3 TH = 33 I]RR'v'EL [:,EF'TH= 7' 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). REm_-n. LI I RE[) SEPT I mi: TRI'-IK: S I ZE= 100~3 GRLLCmI'4S 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. TL40 (2) I NSF'ECTImDr4S RRE REQIJ IRED 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 FEET FOR A PRIVATE WELL OR t50 TO 200 FEET FROM 8 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 R COMMUNITY SEWER LINE IS 75 FEET. NELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEI~:I'-I I T E.'-<F' I RES [:,EC:EMBER' 31, :1.982 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 THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. V4. 0 - SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 5 6 7 8 9 10 ~'1 12 13 14 15 16 17 18 19 20 COMMENTS V! S ~,' ,-N...( V'-*:L"~I/,J 3 PERFORMED BY:/(A./I.~- ~ A~.L~,IV ~/: DATE PERFORMED: ~'' -~"} -- S -~'""'~ ( l_of _5- ) SITE PLAN WAS GROUND WATER //~'/o SL. ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN o('(- 1_5-0 FT AND FT CERTiFiED By:~~'''~' ~ 72-008 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251101 Parcel ID 015 -233-05 Expiration Date: Legal description CHRISTOPHER HEIGHTS LT 5 site address 6730 SAMUEL CT Current property owner(s) HULMAN PETER B & SHARON J X The On-site system(s) is/are approved for 3 bedrooms By: 3/14/2026 Conditional approval for bedrooms, with the following stipulations: Comments or conditions: Original Certificate Date: 4/25/2025 This``�rtificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject s�m(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, 6evelopment Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other 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. 015-233-05 Complete legal description CHRISTOPHER HEIGHTS LOT 5 Location (site address) 6730 SAMUEL COURT ANCHORAGE, ALASKA 99516 Current property owner(s) PETER & SHARON HULMAN — Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: Z Private Well n Private Well serving 2 dwelling units F-1 Private Well serving 3+ dwelling units E] Community Well or Public R Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic R Private Septic serving 2 dwelling units El Holding Tank R Community Septic or Public Sewer 5. SEPTIC TANK: Fj Steel Z Plastic F Concrete F Fiberglass Age 3 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: E] AWWTS F-1 Bed Z Deep Trench [:] Wide Trench R Seepage Pit Waiver request for: Expedited review requested: 0 Distance: 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 $ Date of Payment COSA # of Waiver Fee (z , Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: CHRISTOPHER HEIGHTS LOT 5 Parcel ID: 015-233-05 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 3/30/83 Total depth 120 ft Cased to 115 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 46 in. Date of flow test for COSA 3/21/2025 Static water level at beginning of test 38 ft. Well production at time of test 5+ gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.235 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 3/14/25 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 3/21/25 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) 4/1/1983 ALL standpipes present per record drawing Total measured depth from existing grade 12.8 ft (max) Measured depth to pipe invert from grade 5.8 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 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 3/21/2025 Results Pass Fluid depth prior to test 12 in Water added 500 gal New fluid depth 15 in Elapsed time 30 min Final fluid depth 12 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 84 in (MOA 84” ED) Effective depth used 12 in (Final Fluid Depth) Effective depth (ED) remaining 72 in Comments/Deficiencies: Total current depths from existing grade. New monitoring tube was installed prior to test to the proper effective depth. COSA Checklist.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 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 A small portion of the field is on the edge of the driveway & no known frost or freezing issues with 5.8’ of cover. 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 03/24/2025 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 & 03/24/25 2025-010398-0 L Recording Dist: 301 - Anchorage S 4/23/2025 12:06 PM Pages: 1 of 6 • IIIIIIIIIIIIIIIIIIIIIIII EN25007, SW1837, 015-233-05-000 CHUGACH ELECTRIC ASSOCIATION, INC. ANCHORAGE, ALASKA RIGHT-OF-WAY EASEMENT RERECORDING OF RIGHT-OF-WAY ENCROACHMENT RECORDED 4/23/2025 AT 2025-010387-0 TO CORRECT LEGAL DESCRIPTION THIS COVER SHEET HAS BEEN ADDED TO THIS DOCUMENT TO PROVIDE SPACE FOR RECORDING DATA. THIS COVER SHEET APPEARS AS THE FIRST PAGE OF THE DOCUMENT IN THE OFFICIAL PUBLIC RECORD. DO NOT DETACH AFTER RECORDING RETURN TO: Chugach Electric Association, Inc. Land Services Department P.O. Box 196300 Anchorage, Alaska 99519-6300 eRecorded Document 1203-23D 1837 EN25007 015-233-05-000 FOR RECORDING IN THE ANCHORAGE RECORDING DISTRICT AFTER RECORDING MAIL TO: CHUGACH ELECTRIC ASSOCIATION, INC. ATTN: LAND SERVICES DEPARTMENT PO BOX 196300 ANCHORAGE, ALASKA 99519-6300 ENCROACHMENT PERMIT This Encroachment Permit ("Permit") is entered into this 22nd day of April 2025, by and between Chugach Electric Association, Inc. ("Chugach") and State of Alaska, Department of Environmental Conservation ("Permittee") (collectively the "Parties"). WHEREAS, 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 15th day of February 1983 at Book 850, Page 0003, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska, Dedicated by the plat of the subdivision known as Christopher Heights, according to Plat Number 82-362, recorded on the 27th day of October 1982, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (the "Easement"); WHEREAS, the Easement pertains to the following described real property: Lot 5, Christopher Heights Subdivision according to the official plat thereof, filed under Plat Number 82-362, Records of the Anchorage Recording District, Third Judicial District, State of Alaska; (the "Parcel"). WHEREAS, Permittee has constructed the following improvements on or within the real property subject to said Easement: A drain field that encroaches approximately Seven Feet (7 Feet into said Easement for a distance of approximately Twenty-five (25 feet, within said Easement(s) on said Parcel; (the "Encroachment"); 2of6 eRecorded Document 301-2025-010398-0 WHEREAS, the Parties desire by this Permit to authorize Permittee to continue the existence of the Encroachment in its existing location subject to the conditions and covenants set forth in this Permit; NOW THEREFORE, in consideration of the mutual covenants, terms, and conditions set forth herein, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Permit. Chugach hereby grants to Permittee, and Permittee hereby accepts, a permit to maintain the existing Encroachment in the Easement for the Permit Period (as defined in Section 3). Permittee is not authorized to and shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement. The Parties do not intend to create a lease or other interest in real property for Permittee through this Permit, and the Parties only intend to create a permit that is revocable at will by either Chugach or Permittee as provided herein. 2. Acknowledgement of Easement and Non -Adversity. 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 5, Christopher Heights Subdivision according to the official plat thereof, filed under Plat Number 82-362, Records of the Anchorage Recording District, Third Judicial District, State of Alaska, (the "Parcel"). Permittee hereby acknowledges and agrees 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. 3. Permit Period. The "Permit Period" for the Encroachment shall commence on the date hereof, and subject to sooner termination as hereafter provided, shall expire on 04/22/2065. Notwithstanding the foregoing, this Permit may be terminated by Chugach at any time during the Permit Period as provided in Section 7. 4. Indemnification. Permittee shall indemnify, defend, save, and hold harmless Chugach and its officers, directors, members, partners, employees, agents, affiliates, successors, and permitted assigns against all claims made or judicial or administrative actions filed which allege that o Chugach is liable to the claimant by reason of: rn M O (a) any injury to or death of any person, or damage to or loss of property, or any - o other thing occurring on or about any part of the Encroachment, or in any manner growing out of, M 0 resulting from or connected with the use, condition or occupancy of the Encroachment if caused by — N any negligent or wrongful act or omission of the Permittee or its agents, partners, contractors, = o employees, permitted assigns, licensees, sublessees, invitees, or any other person or entity for whose conduct the Permittee is legally responsible; Encroachment Pen -nit - Page 2 of 5 eRecorded Document eRecorded Document 2of5 301-2025-010387-0 (b) violation by the Permittee of any contract or agreement to which the Permittee is a party in each case affecting any part of the Encroachment or the occupancy or use thereof by the Permittee; and (c) violation of or failure to observe or perform any condition, provision or obligation of or under this Permit on the Permittee's part to be observed or performed hereunder. The indemnity obligations outlined herein shall survive any cancellation, expiration, or termination, for any reason, of this Permit. 5. 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 Section 7(c). 6. 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. 7. 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; (b) The Encroachment is damaged by any means to an extent of more than thirty percent (30%) of its replacement cost at the time of destruction; (c) Permittee fails to make the payment described in Section 5; or (d) The Encroachment is determined by Chugach to inhibit or prevent necessary use of the Easement for electric utility purposes in such a manner that the Encroachment can no longer be accommodated or preserved. Upon expiration or any termination of this Permit, Permittee shall promptly remove the Encroachment and restore the real property subject to the Easement to its original condition. If Permittee fails to do so within thirty (30) days after termination, Chugach may do so at Permittee's expense. 8. Notices. Any notice, demand, request, or other communication under this Permit _ 9 shall be in writing and shall be addressed to the Parties at the addresses set forth below. Each party M may amend its address for notices from time to time upon written notice to the other party in — (0 o accordance herewith. Communications may be delivered and shall be deemed to have been given by — o L0 the delivering party and received by the receiving party: (i) when delivered by hand; (ii) one day N after deposit with a nationally recognized overnight courier or delivery service if sent priority CD overnight delivery; (iii) on the date sent by electronic mail (with confirmation of transmission) if sent during normal business hours of the recipient and if also transmitted by one of the other means permitted hereunder; or (iv) on the third day after the date mailed by certified or registered mail (in 11111111111111 11111111111111 Encroachment Permit - Page 3 of 5 3 of 5 eRecorded Document eRecorded Document 301-2025-010387-0 each case, return receipt requested and postage prepaid). The rejection or other refusal to accept or the inability to deliver because of a changed address of which no notice was given shall be deemed to be receipt of the communication sent. If to Chugach: Chugach Electric Association, Inc. Attn: Land Services Department P.O. Box 196300 Anchorage, AK 99519-6300 If to Permittee: Peter B. Hulman and Sharon J. Hulman 6730 Samuel Court Anchorage, AK 99516 10. Governing Law. This Permit shall be governed by and construed in accordance with the laws of the State of Alaska, notwithstanding any conflicts of laws principles. 11. Waiver. No waiver by either party of any failure to comply with this Permit shall be deemed a waiver of any other or subsequent failure to so comply. 12. Entire Agreement. This 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. 13. Assignment. This Permit and the rights of Permittee hereunder may not be assigned by Permittee without Chugach's prior written consent. Date: `t Date: q, , La; 1),7, 0 � Date: 6 1221 Zo2-5 5of6 301-2025-010398-0 eRecorded Document eRecorded Document CHU CH LECT C ASSO I TION, INC. By: Name: Cynthia Coughlin Title: Manager, Land Services PERMIT E By: Peter B. Hulman PERMITTEE By: ✓ a'^ ' Sharon J. Hulman III I IIII'I I IIIIII I II III Encroachment Permit - Page 4 of 5 4of5 Ki1y MIMS1y 11X1:101] STATE OF ALASKA ss. THIRD JUDICIAL DISTRICT The foregoing instrument was acknowledged before me this duday of A PEI, 2025, by Cynthia Coughlin, the Manager, Land Services of Chugach Electric Association, Inc., an Alaska nonprofit electric cooperative corporation, on behalf of the corporation. r TE OF' ALASKA OTARY PUBLIC eanna R. Kilburn My Commission Expires %°l. o'LO. STATE OF ALASKA ss. THIRD JUDICIAL DISTRICT t J e Notary Public in and for Alaska My Commission Expires: �-7 The foregoing instrument was acknowledged before me this ay of kpj t--. , 2025, by Peter B. Hulman. STATE OF ALASKA NOTARY PUBLIC Deanna R. Kilburn My commission Expires 1,94-0-7 STATE OF ALASKA ss. THIRD JUDICIAL DISTRICT Notary Public in and for Alaska My Commission Expires: The foregoing instrument was acknowledged before me this __�qay of A&cj L - 2025, by Sharon J. Hulman. S7NOTARY SKA LICrnMs �•9• A�a� 6of6 301-2025-010398-0 eRecorded Document eRecorded Document �J,644� ?=KtV�L' Notary Public in and for Alaska My Commission Expires: J U t Encroachment Permit - Page 5 of 5 5of5 301-2025-010387-0 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INspEcTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Telephone · (home) ~ YJ-- ,'~J~,~Business Telephone Mailing Address (d) Real Estate Company and Agent '-.).~--- ~/~ ,/-~-- ~ Address Telephone' (e) Mail the HAA to the following address: (or check here~ if hold for pick up.) List contact person and day phone number below: TYPE OF RESIDENCE Single-Family,~i~ Number of bedrooms WATER SUPPLY Individual WellJ~' Community [] Public [] Note: If community, well system, must have written confirmation from the Stat(; Department of Environmental ' Conservation attesting to th'legality and status.' ' ' · 4. SEWAGE DISPOSAL On-site,[~ Public [] Community ID Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 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 th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of struCture indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date Telephone 6. DHHS APPROVAL Approved for ~' bedrooms by Appro~,ed ' Disapproved Terms of Conditional APproval Date Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 (MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) UNiCH~ALI~E~L, Ir~TA~ L:FE a R UARY 1984 ENVIRONMENTAL SERVICES DI~O~44 Legal Description: ~,~ APR 9 1990 Well Classification Well Log Present.N) Date Completed Total Depth ,,/Z'O Cased to ,//_~'"- Depth.of ~routing Static Water Level -,~',.~/ Casing Height Above Ground Electrical Wiring in Conduit ~N) SEPARATION DISTANCES FROM WELL: / To Septic/Holding Tank on Lot /.,¢ Y' If A. B, C, D.E.C. Approved (Y/N) '~J/'"'~ Yield _-~-J'- ~t ?//,~/,~ o To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Pump Set At gO ~ Sanitary Seal on Casing~}N) Depression Around Wellhead (Y~. · On Adjoining Lots /aC ; On Adjoining Lots ,,~/~e To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ___~./,,d,,,,~. ;Date ,.~ Water Sample Test Results ~ z ~,-'~ ." ~) /tJ,"/~/~ ~': B. SEPTIC/HOLDING TANK DATA Date Installed ~/'/~//~'$ Size Standpipes ~N) Depression over Tank (Y/(~ /~Oo No. of Compartments ~' Air-tight Caps~N) Foundation Cleanout ~)N) Date Last Pumped ~f//~//~ ~ Pumping/Maintenance Contact on File (Y/N) ,~J'.//,z)- ; for /J,/',,~' Holdin~ -~.~a~.k',¥1ig~ate~.Alarm (Y/N) /L)//',,~.- Temporary Holding Tank Permit (Y/N) SEPe~.IO~N_~,~O~TAN~ROM SEPTIC/HOLDING TANK: To~W,~ter-Sul~y ~Ve~¢'t '~;,,l~Y To Building Foundation /,7 TO Property Line ~/'~, To Disposal Field To ~t~in~Se~e ~ ~ ~ ~ To Strea~; Po~d. L~ ~t Major Drainage Course ~/o o Comments -- ' ' ' 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Type of System Design Length of Field .~" ! Depth of Field Gravel Bed Thickness Statndpipes Present ~N) Date of Last Adequacy Test Depression over Field (Y/~ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ,/ To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area · To Property Line /Y / To Existing or Abandoned System on ;On Adjoining Lots _.~ /oo ! To Cutback (if present) · $- Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at . "Pummel at i~ . ~ ,,~~ent (Y/N) High Water Alarm Level at /v"~ Pumping Cycles during Adequacy Test. Tested for Meets MOA Electrical ~odo~W~''~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back ~ ,,L%[~t,~tze~date of this ~.,.. . ~ ~ Seal Receipt NO. Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL ~ALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~- ~ ~ ~b~ (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~ ~e ~'~S Telephone - Home Applicants Address ~ ~OX 7-o ~c~m~ ~ ~ ~qS'o7 (c) Applicant is (check one) Lending Institution ~--~ ; Owner/builder ~ ; Buyer ~--~ ; Other ~-~ (explain); (d) Lending Institution ./~'/~¥ Telephone Business % ~-- Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 2 {~ I~,, 2. Type of Residence Single-Family.~. Number of Bedrooms Multi-Family ~--~ Other (describe) RECEIVED Water Supply Individual Well Community ~-~ Public~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 4. Sewage Disposal,, ~ ~ "'! '''? ~ :,' Note: If community well system, mUs~ nave W~itten confirmation from the State Department of Environmental Conservat.i6~ ;attest.lng to the legality and status. e En~ineerin~ Firm Providin~ 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. Telephone %-~] - 5-0 ~d~ Name of Firm Address Date DHEP Approval~ Approved for /~r.,,.~ Approved Terms of Conditional Approval CAUTION 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~ iS~L,') / RR4/ej/D18 Il, ! ~, 1, i~ [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (H AA) CHECKLIST - FEBRUARY 1984 Legal Description: Date Ccmpleted Well Classification PuT Well Log P=esent ~N) Ye ~ Total Depth ~ ~o ' Cased Static Water Level Casing Height Above Ground Electrical Wiring in Conduit ~/N) Separation Distances frcm Well: To Septic/Holding Tank on Lot If A, B, (r C, D.E.C. Approved(Y/N) ~ 3 -$o -~ ~ Yield Depth of Grouting ~- Pump Set At Sanitary Seal on Casing ~/N) Depression A~ound Wellhead (Y~ ; On Adjoining Lots ~/OO To Nearest Edge of Absorption Field on Lot*,W~' ; On Adjoining Lots~r,o~ To Nearest Public Se~r Line m~- To Nearest Public Sewer Cleancut/Manhole ~ To Nearest Sewe~ Service Line on LOt Wate~ Sample Collected By F- c~o9~ ; Date Wate~ Sample Test Results .~u~-,~F_~ / B. SEPTIC/HOLDING TANK DATA Date Installed ~ - I - E 5 Size /O oo ~u ! No. cf Ccmpartments Standpipes ~/N) q~b Ai=-tight Caps ~N) ~e~ Foundation Cleanout ~/N)W~3 Depression ove~ Tank (Y~}~O Date Last Pumped ~ ~-~-~ Pumping/Maintenance Contract on File (Y/N)~ ; for Holding Tank High-Ware= Alarm (Y/N) ~'+ Temporary Holding Tank Permit (Y/N) Separation Distances f~cm Septic/Holding Tank: To Water-Supply We 11 ~-' 1% To Property Line ~' To Water MaiDJService Line Course ~ ~oo To Building Foundation To Disposal Field To Stream, Pond, Lake, c~ Major D=ainage [Page 1 of 2] Receipt % Date Paid Amount: 2-15-84 c~g 6,~--I (H~.~i~L~c'-.-P"ec~ ABSORPTION FIELD E~TA Soils Rating in Absorption Strata Date .Installed cf -- ( - ~ 5 Width of Field ~ ! 5"o Square Feet of Absorption A~ea Depression over Field (Y~_D ~0 Results of Last Adequac7 Test m % SepaEation Distance f~cm A~sc~pti(~. Field: To Water-Supply We 11 ~- / g I I To P~operty Line Date of Last Adequacy Test Type of System Design Length of Field ~ ~- Depth of Field ~.~ Gravel Bed Thickness 7 I Standpipes P~esent (~/N) TO Building Foundation / Lot ~ ; On Adjoining Lots To Wate~ Main/Service Line ~- To Cutbank( if p~esent) To St~eam/Pond/Lake/c~ Majo~ Drainage Course To Driveway, Pa~king A~ea, cE Vehicle StcEage A~ea ¥ ~- ' To Existing cE' Abandoned System cn 'D~..LIFT STATION Size in Gallons ~'~_ "Pump On" ievel at High Wate~ Alarm Level at Tested' for Electrical Codes (Y/N) Dimensions Manhole/~ceess (Y/N) ~ I . "Pump Off" Level at ~ ~ ~ Vent (Y/N) Pumping Cycles du~~~cy Test. Meets' MOA Cc~ments ** Check Permitted Bed~oa~ Rating A~ainst HAA Request I certify that I have checked, verified, c~. conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed ~ ~-~ Date j~..~ ..' Company ~6¢~ MOA No. ... [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE DMSION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ~NVI~ PROTECTI~ APPLICATION FOR HEALTH AUTHO~ APPROVAL CERTIFICATE 1. General Information Application Date / ' (a) Legal_ Desc~iDti~ ( include lot..block, ~$ubdivision, se.ctiqn~,~township, ranc3e Loc~ion (ad~ess ~ directions) , / (¢) ~plicant is (¢~e~k one) .[ending Institution ~--~ ~ Ow~ ilder,~ -~ Buyer ~ ; Othe~ ~ (explain); (d) Lending Institution Telephone Address (e) B~al Estate Co. & Agent /~' /~ '~/~ Ad,ess ,.. ~ 2. Type of Besidence Single-Family.~ Number of Bedrc~ms 3. Water Supply Individual Well Multi-Family ~--~ Other (describe) Community ~-~ Public ~--~ Note: If ¢~,~.~nity ~11 system, must have w~itten confirmation f~c~ the State Department of Environmental Conservation attesting to the legality and status. 'Is the ~11 adequate for the number of bedrccms specified in this HAA[~/N) 4. Sewage Disposal Onsite ~ Public ~--~ Community ~--~ Holding Tank ~-~ Is the wastewater disposal system adequate fc~ the rumber of bedrocms ~) [Page 1 of 2] 2-15-84 5. Engineerinq Firm Providing Inspections, Tests, Data and Information I certify that I have checked, verified, c~ conformed to all M9~l HAA Guidelines .i effect on the ~d~e of this inspection. Signed by Date ( ENGINEER SEAL) Conditional ~-~ Terms of Conditional Approval .The Municipality cf Anchorage Department of Health and Environmental Protection not guar_antee the continued satisfactory performance of the water supply a~d/or wastewate~ disposal system. _This approval indicates that, as of the validation shc~n above, based on the data and infQrmation furnished by an engineer registe~e the State of Alaska, the wate~ supply and w~stewater disposal system is safe and tional for t~he rnmber of ~3droc~s and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 ao MUNICIPALITY OF N~DRAGE (MOA) R~ALTH AUTHO~TY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification MUNIQPAUTY OF ANCHOEAGE . DEPT. OF HEALTH & ~ENVIRONMENTAL P~OTEC~O~ .' MAR 2 1 RECEIVED Well Log P~esent ~) Total Depth /~ Cased to Static Water Leal ~! Pump Set At Casing Height Above G~ound ~ °2' Sanitary Seal on Casing A~ound Wellhead j, If A, B, cz C, D.E.C. ~ ~p[~ov~d(Y/N) Yield ; On Adjoining Lots /~d ~ Separation Distanoss f~cm Well-. To Se pt ic/H~~ Tank on Lot /~ / To Nearest ~dge of ~bso~ption Field on Lot To Nearest Public Sewer Line /%7/~ To Nearest Public Se~ Water samPie Collected By ~,~ , Date ' ~///5/~.~ s. SEPTIC/HOLDING TANK D~TA Date Installed ~/,//_./;~_~ .. Size / ~/9 ~) NO. Cf Cce%>a~tm~nts Standpims _~N) ai~ti~t ~ ~) F~ti~ C~an~t ~i~inte~n~ ~a~, ~ Fi~ (Y~) N/~ ; f~ Holdi~ T~ mgh~te~ m~ (Y~) ~/~ . ~~ ~ldim T~ ~ation Distils ~. ~pt~Ta~: To ~te~Suppl~ ~11 /dd/+ To ~ildi~ F~n~ti~ /~ [Page 1 of 2] 2-15-84 Soils Ratir~ in AbscFptic~ Strata Date Installed Width of Field Square Feet of Absorption A~ea Depression over Field Results of Last /~equacy Length of Field Depth of Field Grail Bed Thickness ' D~te of Last Adsquacy Test ~/~ Separation Distanc~ f=(~ Absc~ption Field.- To Water-Supply Wall /~ ,~)'.+- To Property Line To Building Foundation. gl~-/ ~ To Existing · Lot ~ ~/~ ; On Adjoining Lots To Water Main/Se=vice Line ~/~ .... To Cutbank(if p~esent) To ~i~way, Packing Aeea, ce Vehicle Stceage Area Ccm'l~nts o. n:~FT ST~ON--~0~Je-- Date Installed Size in Gallc~s "Pump On" Leal at ,, High Water Alarm Leal at Tested fo~ Electrical Codes(y/N) Comments Manhole/Ac~ss (,Y/N) ~ Off" Leal at vent: mm~ing cycles du=ing Adequacy Test. ** Check Permitted Bed~ocm Rating Against HAA Bequest ** · I 'certif9 that I hav~ check, d, ~rified, ce oonfcemsd to all ~ HAA Guidelines in effec'~: on t~ date of this inspection. " KSl/d5/s [Pa~e 2 of 2]