HomeMy WebLinkAboutFOX HILL BLK 1 LT 4Fox Hill
Block 1
Lot 4
#051-073-22
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141191 PID Number: 051-073-22
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name:
JAN & MARY ANN NORTHEY ABSORPTION FIELD
Address ❑ Deep Trench ❑ Shallow Trench ® Bed ® Mound
21715 WOODCLIFF DR, CHUGIAK, AK 99567
® Other ADVANTEX
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 2 GPD/SF +1.5 Ft.
IFOX HILL
1 4
SEPARATION DISTANCES
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Well
100+
100'+
100'+
NA
NA
Surface water
100'+
100'+
100'+
NA
Lot Line
5'+
10'+
5'+
NA
NA
Foundation
5'+
10'+
5'+
NA
Curtain Drain
NA
'50'+
NA
NA
Remarks *Non known. Existing system decomm.
per code.
Installer NORTHERN EXCAVATION
Inspector ARGTERRA
Inspeecctiiosn 1" 6/20/14 2 n 6/21/14
ath to pipe invert from original grade Gravel depth beneath pipe
+1.5 Ft. 0.5
added above original grade Gravel length
Var. 4.5+ Ft. 20
20 Ft. 3 7
absorption area Number of trenches Dist. between trench(
400 FP - -
K El Septic ® S.T.E.P. El Holding El Other
acturer Capacity
Anchorage Tank 1500(
at Number of compartments
Steel
STATION
acturer Capacity
Anchorage Tank 1500 c
on level at Pump off level at High water alarm at
Timer Act. 50 ind Timer Act. 29 in.l 52 i
lump make and model Electrical Inspections performed by
30GPM PF3005 Fewer-, u64T44olfncc-„
PIPE MATERIAL House to tank 3034 Tankto 3034
drainfield
Dminfield 3034 CO/MT 3034
BENCH MARK (Assumed elevation) 100 ft
Location and description
64Rh(aE Ftw[L
3" 6/21/14 0
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Approval:
Approved
Date
Date -.2 6 -
OF Aj- �, r
* 9 TH +
KENNETH H.
t 7116 w
a, v
P PG. 5101rp1i i
AS—BUILT
SYSTEM
DETAILS/SITE PLAN
DRAM:
FOX
HILL BLOCK 1, LOT 4
B -D=58.0'
o0
A -E=108.5'
N84°20'20" w 384.83'
iN
B -E=95.0'
�.
qN
A -F=122.0'
4°15'52"W 385.01' R
B -F=1 14.0'
aD9 Nu.:
14-146
® WELL
N
W
T
Dom
f
LOT 4
n
�i
BLK1
ti 26.0•
o n
$0• •(\� J5F'
no
�r�T�G�l�`>G00C'' 20' x 20'
MOUND
TH14-1
T6M lbw
34O'
CO
AX -20 POD &
r\ml
1500 -GAL STEP
A -C=31.8
10
B -C=54.6'
DRAM:
A -D=39.8'
STAKING:
B -D=58.0'
o0
A -E=108.5'
x0y
B -E=95.0'
�.
qN
A -F=122.0'
y¢
B -F=1 14.0'
aD9 Nu.:
PID 051-073-22
PERMIT#+ SW060117
2m
7369. ' R)
16.0' 69.5 a '17 3BpING
NSOV82 E1EPRING
BASIF
f—
a �
TANK
FINAL GRADE
MOA SAND
0 40'
GRAPHICS SCALE
SCALE: 1:40
0.5'
4.0'
1
HOUSE TANK ; 20' 1 SCALE- N'
ABBREVIATIONS I
GROUND WATER(:99,70
�`�\ BOH 95.20
.dew--7—
OF ALS\,
t� TH Y
. Avain n -n of
CE -7116
AdIr
�1'ESSIOTl�'
& SEPTIC - Filed By
BOH = BOTTOM OF TESTHOLE
CO = CLEANOUT
MT = MONITORING TUBE
JAN & MARY ANN NORTHEY
21715 WOODCLIFF DRIVE
CHUGIAK, AK 99567
FIELD BOOKS
cDMRUTm:
BOUNDARY:
DRAM:
8MW
STAKING:
CHECKED:
KMD
AMUILT. JLS
DATE:
6/22/14
DWO. Fly:
MID:
NW1458
ACAD nM
aD9 Nu.:
14-146
\BIk 1 Lot 4\dwa\Septic Resert.dwa
SCALE: NTS PAGE 1
�'1Y '°SULTING . 6
Eq AK. 9951T'�
Page 1 of 2
Poet, Jeff W.
From: Dea Duffus [dea@arcterra.net]
Sent: Thursday, June 26, 2014 1:43 PM
To: Poet, Jeff W.
Cc: bmw.kndeng@ak.net; Tyson
Subject: 21715 Woodcliff / Fox Hill Blk 1 Lot 4
Electrician's letter on installation for your records.
dea
From: Aaron
Sent: Thursday, June 26, 2014 1:31 PM
To: dea@arcterra.net
Subject: Woodcliff
Aaron M. Chambers
Power, Lighting & Control LLC
13841 Savage Drive
Eagle River, AK 99577
plc.chambers@gmail.com
(907) 242-5211
Aaron M. Chambers
Power, Lighting & Control LLC
13841 Savage Drive
Eagle River, AK 99577
plc.chambers@gmail.com
(907) 242-5211
EAD 1831
CON 36389
The power and control for the AdvanTex system has been installed per NEC requirements
for 21715 Woodcliff dr.
Any questions please call me. Thanks ,
6/26/2014
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP141191
Tax Code Number: 05107322000
Work Type: Septic Upgrade
Permit Effective Dates: June 19, 2014 to June 19, 2015
Design Engineer: ARC TERRA CONSULTING INC
Subdivision: FOX HILL
Site Legal Address: FOX HILL BILK 1 LT 4 G:1458
Owner/Address: NORTHEY JAN R & MARY ANN
PO BOX 671684 CHUGIAK AK 995671684
Site Mailing Address: 21715 WOODCLIFF DR, Chugiak Lot Size in Sq Ft: 45171
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
IL
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: PRIOR TO FINAL INSPECTION REPORT APPROVAL: The original permit
documents shall be submitted.
Receivi
Issued
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage Alaska 99519-6650 9 (907) 343-7904 • Fax (907) 343-7997
hup://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Proaram
went s,
�o F
r`
llepartment
**** VARIANCEIWAIVER REVIEW ****
Waiver#: OSP141192 COSA#: Permit#:OSPI41191
PID#: 051-073-22
Legal Description: Fox Hili, Block 1. Lot 4
Engineer: ArcTerra
Applicant: Jan & Mary Ann Northev
Your request for a waiver of the required 15 foot maximum absorption field bed has been
approved. The approved width is 20 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
................................................•.............................1
Waiver is Granted: X Waiver is not Granted:
Date: Approved by:
Name of Reviewer
...............................................................................
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
ANCHORAGE
t � `` e Phone: 907-343-7904
i r Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATIONfIUBIWITT P
Parcel I. D.
051-073-22 JUN j zoic
Property owner(s) JAN & MARYANN NORTHEY Day phone
Mailing address PO BOX 671684, CHUGIAK, AK 99567
Site address 21715 WOODCLIFF DRIVE, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) FOX HILL BLOCK 1, LOT 4
Legal description (Township, Range & Section)
Lot Size 45171 Sq. Ft. Number of Bedrooms
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
Initial ❑
Single Family (SF)
❑
Septic Tank
Upgrade 't
(w/wo ADU)
Duplex
[kj
(D)
Holding Tank
ElRenewal
ElMultiple
Dwellings
❑
Privy
❑
- y A (SF and/or D)
Private Well
❑
Water Storage
❑
JUN 1 3
2014
THIS APPLICATION INCLUDES A VARIANCE / WAIVER
REQUEST FOR:
BED WIDTH TO 20'
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
owner or authorized agent)
Permit/Rush Fees:—!5 (oq Waiver Fees: els (2��Si1
Date of Payment: (o lo5 /I y Date of Payment: (O �13I1 y
Receipt Number: ()515(0�7 Receipt Number: OS5�6S�7
Permit No. OS-PIy J�.q1 Waiver No. C)Selq 11042-
Permit
1042
Permit App_9-1-12.doc
Julie 12, 2014
Aw-Tlb.,i-zR,v
CONSULTLN(�, INC
2122..5i'Aclv,Atichorape,AK,9()503
Office 01)7)36S -,3 -?91. Fax (907) 86R-3'93
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Sobje& Upgrade Sewer Permit — Fox Hill Block 1, Lot 4
It has been determined that the absorption field of the -subject property is
saturated. Subsequently, the owner has requested we proceed forward to obtain
a septic permit to upgrade the septicsystern that serves the 3 -bedroom house.
The general slope of this lot is from the north to south at a grade of
approximately 0-3% over the septic area. June 7, 21014 a testhole was performed
to investigate soils; and groundwater. The results of this test are attached for
your review. We propose to install a 5" pressurized mound with an Advantox
option and reduced length of 20'. Groundwater was encountered at 7 during
5
excavation and at 3at monitoring.
Due to required design and subject lors characteristics, we are requesting a
waiver to increase the width of the proposed absorption bed from the standard
15' wide to 20' wide with laterals 7' apart. The, contractor will not use heavy
equipment over the absorption bed during construction.
The property and adjacent lots are served by private water. There is no surface
water within 100' of the Proposed .system and there are no known curtain drains
within 5(Y. We do not expect there to be any adverse effect on adjacent lots by the
development of this system. If you have any questions, please contact me at 868-
3791 / FAX 868-3793,
Respectfully submitted,
ArcTerra Consulting, Inc.
Attachments: On -Site Sewer Application
Wastewater Absorption System Details; /Site Plan
Soils Log/ Percolation Test
2M1 PTARMIGAN BLVD - EAGLE RIVER, AK 99577-8736 - pfl (9M $6&3791 - FAX (907) 868-3793
ELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLA
FOX HILL BLOCK 1, LOT 4
FLAG
WELL-
PRIOR
ELLPRIOR
PROPE'RT'y LIS
RADII1 8 11 %
RA-'��Scm�
M
TN LLJINS I I'<uL1 I ILIIN Scale: 1'= "00,
DESIGN DETAILS PAGE I OF 5
CONTRACTOR WILL TAKE 3 BDRM X 150 GPD = 450 GPD
SPECIAL CARE & WILL NOT 450 GPD/0.4 GPD PER SQ. FT, (15 MIN/IN)= 1,125 SO. FT
OPERATE HEAVY EQUIPMENT (1125 / 20 = 7 FT. BED
USE I BED 57' (L) X 20' (W) X 0,5' (ED)
OVER THE BED Total depth of system is 1,5' above original grade.
AS PUBLIC WELLS Will" aW Or Total depth of gravel below distribution pipe is 0L5'
PROPOSED SYSTCK Excavate 2.5' below existing grade & instatt 4'
W PAWAIC WELLS VETItl" ?W OF PEA approved sand to 1,5' above existing grade.
P110,03cp SYSIC14 EXCEPT AS WIED
10 SEPTIC SYSTEM VITTM OF
PROI'MIED WELL EXCEPT AS ARITEZ NOTES= I. INSTALL 3250 GAL STEP & INSULATE TANK :F <4' COVER,
2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF FILL,
OF A1,4 14
0 1 �e-
�9 TH
jok'..........
j
K9NN M. 1A F S
MIN. 2' FILL 'WITH INSULATION, 73' COVER NO !NSUL REQ.
3. CONTRACTOR VILL ENSURE MINIMUM 27. SLOPE INTO SEPTIC TANK,
4, CONTRACTOR 'VILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC
PREPARED FOR:
JAN & MARY ANN NORTHEY
21715 WOODCLIFF DRIVE „o min
CHUGIAK, AK 99567
FIELD 800K5
80UNQARX
1 9,
R,
STAXW- STAKING YMD
ASIURT, sa�s
Rao, Tte SAO, NW1458
ACAO "C" FILE
"0" A"' 14-146
WASTEWATER DISPOSAL SYSTEM DETAILS
FOX HILL BLOCK 1, LOT 4
I
LDt7JT 4
BLIP
r'
INSTALL NEW MOU.
7
Ti
G :-
¢ M T
n CC)
O
In
J11)
FLAT
ECOMMISSION EXISTING DED
SEPTIC TANK PER CODE
NO SLOPES >10%
`-` WITHIN 100` OF
PROPOSED MOUND
SW CANT K FC.
FP CANT 0 4'7.p•
a •�(%j ��it�yG,
53.7` 720•C13^"
OPTIONAL ADVANTEX DESIGN
3 BDRM X ISD GPD = 450 GPD
450 GPD/2 GPO PER SO, FT. (15 MIN/IN.)= 225 SO, FT
QZ5 f 20 « 11.25 FT. DED
USE I BED - 20' (L) x 24' (W) X 0.5' (ED)
Total depth or system is 1.5' above original grade.
Total depth o€ grave} below distribution Pipe is 0.5' .
Excavate 2.5' beta. existing grade & install 4'
MCA approved sand to I.5' above existing grade.
OF A.4
V
INSTALL NEW
1250 STEP
ALL DESIGN SPECS REMAIN THE SAME EXCEPT
LENGTH IS REDUCED TO 20' & AN AX -20 POD
WITH D[SHCHARGE BASIN IS INSTALLED IF
THE ADVANTEX UPGRADE OPTION IS USED.
PREPARED FOR
JAN & MARY ANN NORTHEY
2171.5 WOODCLIFF DRIVE
CHUGIAK, AK 99557
awrr a
4 � eaxwaxe
r'^. f7 „J'"A� J
stunwz TAI
3z olisv # Rswar L5
Ow¢ ftt
CVYP[„EIX
I;. BM W
a+v D; XMD
las 5132/1
Dia NW145E
"w; 34-345
Scale 1'= 30'
PAGE 2 OF 5
qY b
A Q
C P
n t
a �
R`✓ ULFING
£� ax 99577x
WASTEWATER ABSORPTTON SYSTEM DESIGN T)ETAILS
FOX HILL BLOCK 1, LOT 4
2 FINISHED GRADE (ADD UNCLASSIFIED FILL) i.
v 4' TOPSOIL IS SEEDED / VEGETATED
FILTER FABRIC AND INSU
SE
EwER ROCK
MIN. 4D' SAND FILTER FOR SEPARATION
G
a 2
1250 AL
0 �4' - r
S, I �E'p - 57" BED KLM GRAX
L*l SW.
5' SEPARATION TO GROUNDWATER REQUIRED
GROUND WALRA! 3.5'. EXCAVATE 2.5' FROM
CONTRACTOR WILL TAKE ORIGINAL GRADE & INSTALL 4' MOA APPROVED
SPECIAL CARE & WILL NOT OPERATE HEAVY EQUIPMENT SAND TO 1,5'+ FROM ORIGINAL GRADE,
OVER THE BED
3' (typ) 3' (typ)--\ CAP ENDS OF PIPE ---\ M,T,
HOLES
51 Lr 1 1/4' PVC W/3/16
@ 51' SPACING (TYR)
3 1/4' PVC FROM TANK TO rmLD
LT 1751 F
8 L
1 114' PVC FOR rPANjFCMtD 5 :1" :SPA
3' -7
vt
.0 M F
001
M, F,
Lj 06
57'
PRESSURIZED DISTRIBUTION SYSTEM HOLE SPACING DESIGN
RESIDUAL HEAD
a, HOLE SIZE = 3,l5- = 1,30 GAIL. PER HOLE @ 30 PSI
4' SOLID 1 30 GALS (PUMP DELIVEkYVI_W GALS,IWLE = 30 HOLES
_MGM -HME- 4. 153 LF LATEiZAL130 HOLES = 5X SPACING PER HOLE
A"'%oa 5, ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS,
r.*� oF A PAGE 3 OF 5
Alr PREPARED FOR;
JAN & MARY ANN NURTHEY �,wcT�,� k
21715 VOEII)CLIFP DRIVE / -1 0.-1
CHUGIAK, AK 99567
KEN
REED 0"S
W
OU A BMW
0 gp
STAKI!N, KMO
mane JLS
ssioll .mr JLS 6 12 14
'2 a ""' sf'.�
NW1458
HLe 14 �NU
_146
WASTEWATER SYSTEM HOLDING TANK DIE. -AILS
FOX HILL BLOCK 1, LOT 4
CONCRETE
WEIGHT USE
15 cubic
(3000 Los'
v
1250- 5AL
STEP
CONCRETE ANCHORING CALCULATION
V-
WMASSOME WATER TABLE IS AT GROUND SURFACE
WATER DJSPLACEIk Pi It 3,17'-E x jii` = 316 CUFT,
WEIGHT OF WATER DlSPLACEIL C3t6 CU,F`LX62A LBF/CU.FT,> z +19719 LBP
Fe =-19716 LBF (SOUYANT FORCE)
WEIGHT OF TAW 11250 GAL). -1061 LRF
4 = -1061 LBF (WEIGHT OF TANK)
WEIGHT OF SOIL ABOVE TANK, 1110 L8F/CUFT.>6,33' - 10' 9 4'= -15841) LBF
F5= -15840 LBF (WEIGHT OF SOIL)
NET FORCE = (-15840 - 1061 , 19718) LBFa -2817 LBF
SCALE NTS
PREPARED FOR:
JAN & MARY ANN NORTHEY
21715 WOODCLIFF OJUVC
CHUGIAK, AK 09567
FIELD BOOKS I ean+�
LBS GF CONC. N
mmmm
?t?,CTE
STAKING KIM
Alw FAA NANA,�R
ficna
M- FILE 14-146
9
U-1
-D
z
W
iJ
CONCRETE
WEIGHT USE
15 cubic
(3000 Los'
v
1250- 5AL
STEP
CONCRETE ANCHORING CALCULATION
V-
WMASSOME WATER TABLE IS AT GROUND SURFACE
WATER DJSPLACEIk Pi It 3,17'-E x jii` = 316 CUFT,
WEIGHT OF WATER DlSPLACEIL C3t6 CU,F`LX62A LBF/CU.FT,> z +19719 LBP
Fe =-19716 LBF (SOUYANT FORCE)
WEIGHT OF TAW 11250 GAL). -1061 LRF
4 = -1061 LBF (WEIGHT OF TANK)
WEIGHT OF SOIL ABOVE TANK, 1110 L8F/CUFT.>6,33' - 10' 9 4'= -15841) LBF
F5= -15840 LBF (WEIGHT OF SOIL)
NET FORCE = (-15840 - 1061 , 19718) LBFa -2817 LBF
SCALE NTS
PREPARED FOR:
JAN & MARY ANN NORTHEY
21715 WOODCLIFF OJUVC
CHUGIAK, AK 09567
FIELD BOOKS I ean+�
LBS GF CONC. N
mmmm
?t?,CTE
STAKING KIM
Alw FAA NANA,�R
ficna
M- FILE 14-146
9
Adv-nT-x Treatment System
AX 20 Series - Mode to
Wet Rise,/Lid
miet
I -
1eq
package "'
Fu_ R,se,/Od
arae FiRmle
TANK FOR A3 Br)R.,4 RESIDEN(T
1 INM3LAII-,TANK,t-Wi�Ffgiil.OWAt)VANI'PXVAI)S IUAI-LUWM-`ArFRA-NSI+X
3 NO AIR LUERFQUI"-D.
PREPARED POR:
FIELD BOQKS
eaRw""r UQYNDARY
&Tx STARING
_VBG
�' SCHULLgR
om ME,
Am FILE
ngol A
0
End View
cturn b"
Fibote
D-0,
wq
Scale: NTS
PAGT-�SOF j "
or N OF A/
t AXRcTL-RRA
CONSULTYNC., IN�C 'of
212 E. 51 ' Ave, Anchorage, A K. 99503
Office (907) 868-3791, Fax (907) 868-3793
42A
SOILS PERCOLATION TEST
�11t AO
Performed for:J;rt. &, AlAry Northey
Date Performed: 6/5/14 jo�,
Projem—FO — ------ HOLE T1114.1
DepLb
(Fect) SEE ATTACHED SITE PLAN
I _W ORG/01, FOR HOLE LOCATION
9-
to-
It-
12-
13-
14-
15-
19-
GM/SM
rm"
]BOLE PRESOAKED
20- PRIOR TO TESTING
Was Ground water encountered? YES what depth? 7'
Depth to water after monitoring? 3.5' Date? 6/12/14
Reading
Date
, in � �
I J'ame ss
I
Net
'time
Depth to
Water
Net
OP
1
6/6114
1:00
6"
130
30 min
315/161
2 lrb-
3
131
6"
4
2:01
30min
315!16"
21/16'
2:02
6"
2:32
30 Fine
411'16"
2 0116"
7
9
to
1i
12
*
Water
Added
Percolation Rate 15 (mien) Pers Hole Diameter— 6:_
Test Run Between ----L— feet and 2 feet
L Kenneth M. Duffus, certify that this test was performed in accordance with all State
and Municipal guidelines in effect on this date,
MUNICIPALITY OF ANCHORAGE
(® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
�( ENVIRONMENTAL ENGINEERING DIVISION
82.5 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME +
PHONE[/
PKEW�
El UPGRADE
MAI LING &BpfiESS
LEGAL DES RIPTION
Hy 4-
LOCATION
SW
NO. OF BEDROOMS
�
DISTANCE TO:
sorption arear
hLx..c��
Dwelling IVIV
PERMIT
Manufacturer Ci
M��
No. of compartments
F Z
o. Q
UJ l..
V)
Liq. capa,cc�ity in gallons
IF HOMEMADE:
Inside length
Width
•----�.-�
Liquid deptJ�e_,_�.
C� '
DISTANCE T0:
Well
welling
PERMIT NO.
006
z
Manufacturer
Material
Liquid capacity in gallons
DISTANCE TO:
Well
F undation
Nearest lot line
PERMIT NO.
w S
_ LL z
No. of lines
Length of each line
tal length of lines
Trench width
Distance between lines
¢
inches
¢ I—
_
Top of the to finish grade
Material beneath tile
Total effective absorption area
D
inches
Length �[ t j Width ,) /
Ue e G,c/
PE IJ NJ,2.
<[
W"
G, 5,� 4r
Rry-,
Typ of cr/ _ Crib cliZineter
Crib d81t'~•
/(,�
Total effective absorption area
w
N
DISTANCE TO: Wel
Building fou n
Nearest lot line
J
Class Depth
Driller
Distance to lot line
PERMIT NO.
J
��
W
Building foundation
DISTANCE TO:
Sewer lin
Septic tank
Absorption areas)
OTHER
PIPE MATERIA
�rG
SOILTESTRATING
1fJ
z Z �r
INSTALLER ���' CQA15:r,
5� /�f2�-ftp
t
T
REMARKS
leiCo
p' ..®
m
off No. 1.187-9 •••:
•
T`
IIFn�'�QFESSI���
APPROVED rf D TE LEGAL'---
� � n t t. i r•
a
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL. INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
Juty 20, 1986
Municipa ity ob Anchonage
Depa4tment ob Health and Human Senvi ces
825 L St4eet
Anchonage, A2asha 99501
ATTENTION: Susan Oswatt
REFERENCE: Lot 4; Bloch, 1; FoxhiU Subdivision
ROBERT A.SHAFER
CIVIL ENGINEER
694-2979
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
JUL u , li .
RECEIVED
An on -bite wastewater disposat system was .instalted on the nebenenced
pnopekty under. penm.it #840101 on August 3, 1984. l pecti.ons were pe).bo)tmed
and ane documented on an inspection nepont on bite in owt obb.iee. This
nepoit-t has not been submitted bon neeond due to non-payment ob bees
associated with the work.
MUNICIPALITY OF ANC1iORAGH
DEPT. OF HEALTH &
. SAFER, P.E. ENVIRONMENTAL PROTECTION
lss
MUL 211986
RECEIVED
SRB 196X EAGLE RIVER, ALASKA 99577
�
MUNICIPHLITY OF HNCHORHGE
DEPHRTMENT OF HEHLTH HND ENVIRONMENTAL PROTECTION
825 L STREET/ HNCHORHGE, AK 99501
264-4720
C1140 --lb; X "TEE: 23 EH: WE Q F? A 1-11 IL_ _F
PERMIT @O� 840101
DRTE ISISUFD:
HPPLICHNT� C/O S & S ENG'GSCHUCHM0N CONSTR
HDDRESS� SRB 196X
EHGLE RIVER, HK 99577
�ONTHCT PHONE� 694-2979
LEGHL DESCRIP: SOBDIV
SECTIONTOWNSHIP: 15N RHNGEW
LOT SIZE� 45570 (SQFTOR HCRE�) '
LOT I OCHTIONWOODCLIFF
MHX BEDROOMS� ]
LI�TE� BELOW HRE THE OPTI0NS
HVHILHBLE TO YOU IN SEPTIC
SYSTEM.
CHOOSE THE OPTION
THHT BEST FITS YOUR SITE.
-F VA IC.-, 1-9 ����I F. -4. F'�:: Fil -1: 11"A
DEPTH
TO PIPE
4.5 40
GRHVEL
DEPTH
0.5 I5
TOTHL
8.0 0 7/5
CARMEL
WIDTH 001
24.0^
3RHV�L
LENGTH (FT� )
��8�0 ** 47�0 0 **
GRHVEL
VOLUMF�'i (CU.
41.7 688
TRNK
S�ZE (GHLS)
1,000. 0 ** 1/1;-� ** 1/000. 0 **
SOIL
RATING (Ell FT.AN)
2G7 250 287
**
GRHVEL 1 1 } 75
FT
REQUIRES I" IULTIPLE RUNS (NOT EXCEEDING 75 FT. EHCH)
**
THNK MUST HAVE HT LEAST
TWO COMPARTMENTS"
... .... ..... ��..... �..... ...
I CERTIFY
1,
THHT�
I HM FHMILIHR WITH
THE
REQUIREMENTS FOR ON-SITE SEWERS HND WELLS HS �ET
FORTH BY THE MUNICIPHLITY
OF ONCHORHGE (MOH) HND THE STATE OF HLHSKH
2.
I WILL INSTFjLL THE
IN WITH FILL MOH CODES HND R�GULHTIO�S,
AND IN COMPLIHNM WITH
THE CRITERIH OF THIS PERMIT.
]
I WILL HDHERE TO Al
L MOH
HND STRTE OF Hl FOR THE SET �HCK
DISTHNCFROM HNY
EXISTING
WELL, WHSTEWHTER DISPOSAL C.IR PUBLIC
SEWE�HGE SYSTEM ON
THIS
OR HNY HDJHCENT OR N�HRBY LOT
4
I UNDERSTHND THHT THIS
PERMIT IS VHLID FORH MHXIMUM OF ] BEDROOMS HND
RNY ENLHRGEMENT WILL
REQUIRE
AN ADDITIONAL PERMIT.
IF H
LIFT STRTION IS lNSTTILLED
IN HN HRER COVERED BY MOH BUILDING CODES/
THEN
(1> AN ELECTRICAL PERMIT
AND INMCTION MUST BE. OBTHIMED/ (2) HS�BUILTS;
WILL
I'lOT BE F1PPI �'.:OVED 14 1TH01.
iT HN ELECTRICAL IPECTION REPORT/ AND (:3) THE
ELECTRICHL
WORK MUST BE
DONE
BY 8 LICENSED ELECTRICIHN
Y
(J
P(Pj('1 I (')
iqG' i, 1>,,-'1 I l i
DEPARTMcN 1OF HEALTH AND ENVIRONMENTAL PRO 'Fc:C T ION
Permit dl: 840101
Janucf %1, 1985
TO: p, i mi t Applicant
SUBJECT: Lot 4 Block ]_ Foxhill Subdivision
A oei m i I i-ssued by this Department for an indi°.Tidual well
and/<,I F~site sewer_ system has expired as of December 31,
1984 .
Permit:
a -e
issued on a
calendar year basis
by auti,.o.r_ity
of ''•1Fii
j, ,pal
Ordinance.
A new permit must
be obtained from
this I ,
I.,t, tinent
for any
well and/or on-site
sewer system not
inst l I
l by
e expiration date.
tit e.
yrlil I..�ve drilled the well, a well log eels to be sent
t0 {=)i ;)�'partillent for documentation of thG lnstallatl O:�
and L„ lose the permit.
If a I,i date engineer inspected the installation of the
on_siI ,ewer system, the original as -built inspection report
and tli, yellow copy must be sent to this office for review
and ri;l al, and for documentation.
If tl, ( are any further questions, please call this office
at 2(A 4720.
Sinccr, 17,
Keith I; . Bandt,S!ipervisor
Envir(ff mental Engineering Program
KEB/l )'T/
one. copy of Permit
MMP/0 11 /
LEGAL DESCRIPTION: Z Z7 A! /
SLOPE
1 Q
p.
2 �a
3 U
4 4 `t
5
L
t
6 U
7 V
8
l
9 b
10
v ( %
L ' L WA ROUND WATER S
11 / w 7 /C�7 % ENCO NTERED? L
} I� O
12 �!��' `•�! y ".._../ _._._- IF YES, AT WHAT / E
13 DEPTH? u
ry.
4 L c
19
20 L
COMMENTS
PERFORMED
72-008 (6/79)
`!-iP Clfm 1-7
w I t: LAN
,Reading
`-
❑ SOILS SLOG
MUNICIPALITY OF ANCHORAGE
Net
Time
ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
PERCOLATION
825 L. Street, Anchorage, Alaska 99501 264-4720
TEST
a
'-" SOILS LOG — PERCOLATION TEST
PERFORMED FOR: �L'tC // lye?, �i --"`�""-r -� DATE PERFORMED:
`> /17 F /
LEGAL DESCRIPTION: Z Z7 A! /
SLOPE
1 Q
p.
2 �a
3 U
4 4 `t
5
L
t
6 U
7 V
8
l
9 b
10
v ( %
L ' L WA ROUND WATER S
11 / w 7 /C�7 % ENCO NTERED? L
} I� O
12 �!��' `•�! y ".._../ _._._- IF YES, AT WHAT / E
13 DEPTH? u
ry.
4 L c
19
20 L
COMMENTS
PERFORMED
72-008 (6/79)
`!-iP Clfm 1-7
w I t: LAN
,Reading
`-
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
01 1
l77
L
Y
l
/0
PERCOLATION RATE_^C-7 ` _(minutes/inch) /1(
L
TEST RUN BETWEEN ��� FT AND m.e. FT
CERTIFIED
DATE _
DOC Co. dba
SULLMN WATER WELLS
P.O. 80272, CHUGIAK, ALASKA 99567 s TELEPHONE 688-2759
OWNER OF LAND_ -
ADDRESS
LEGAL DESCRIPTION &JC I r X N1-
DATF, - Started Ended Y 1�q
PERMIT NUMBER
KIND OF FORMATION:
DEPTH OF WELL
STATIC LEVEL OF WATER FT.—_ --
DRAW DOWN FT.
GALS. PER HR bS:q —
KIND OF CASING
From Ft. to Ft.
From ---
Ft. to—Ft.
Ft. to
From _�7_Ft'. to_j3Ft._sS_el"r,d G e''f`it
From --Ft.
to
Ft.
From 1 5 Ft. t0._7S_Ft. H1g0<d10.4.0 —
From_
-Ft. to
_—Ft.
From75' Ft. to- 101 Ft. — (f <#AqY = �� �E�-
From_ _.—Ft.
to-_
Ft,
Fromm D / Ft. to—/ /a Ft. S'`�"3� E1R�4JF= L AL T
Froin -----Fl.
to ----Ft.
From
Ft. to Ft. /ll t 2��'!% —_
From--.---..
Ft. to
Ft. .. ---
From(/ a-
Ft. toFt. �0 G Q-14 `'
From
to
Ft. —
-FL
From
Ft. Ft. LJq—)
From
_Ft. to
Ft. .--
to
From__Ft.
From
Ft. to___-----
to Ft. _
From__—___Ft.
to Ft.
From_Ft.
From ---Ft.
Ft.
From
Ft. to_
Ft. -----
to
From_
Ft. to Ft.
From_
Ft. to—
—Ft. -
From
Ft. to Ft.
Froin
Ft. to—Ft.—
o
Ft.From
From—Ft.
Ft. to _Ft.
From
Ft. to—_
Ft.
OF ANC ��
From
Ft. to —Ft.
From_
Ft. to_rt.S.EP.T.
2�UNICIPALIV
OF HEALTH &
A, ALPTI-C-TiOtd—
ENVIRON
F
Ft
From Ft. to Ft. From t. to ---
From —Ft. to_— Ft.—__��T 2
From—Ft. to Ft. (�
MISCL. INFORMATION: E� � b W I
DRILLER'S NAME------
• Municipality of Anchorage `
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I. D.051-073-22 Expiration Date: �4 — �z 6.- P
1. GENERAL INFORMATION
Complete legal description FOX HILL BLOCK 1, LOT 4
Location (site address) 21715 WOODCLIFF DRIVE, CHUGIAK, AK 99567
Current Property owner(s) JAN & MARY ANN NORTHEY Day phone
Mailing address PO BOX 671684, CHUGIAK, AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
• i
Duplex
❑ Multiple Dwellings (Single Family and/o `&L
3. NUMBER OF BEDROOMS: 3
JUN 2 3 2014
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community {slats Well
Public Water System
WaiverNariance request for:
Received by
�<<y Date:
COSA to be released to the engineer, unless 966ry✓ise requested by the engineer.
COSA Fee $ �lp�',� I(o�,f0 •�Ov
Date of Payment
Receipt Number
COSA # cS5C-)q 12775
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
TYPE OF WASTEWATER DISPOSAL:
®
Individual
❑
Holding Tank
❑
❑
Community
❑
❑
Public Sewer
❑
Received by
�<<y Date:
COSA to be released to the engineer, unless 966ry✓ise requested by the engineer.
COSA Fee $ �lp�',� I(o�,f0 •�Ov
Date of Payment
Receipt Number
COSA # cS5C-)q 12775
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 6/23/14
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. 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,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist. Ar w
r
6. DSD SIGNATURE
0
The
System #1 Approved for bedrooms. �, n ' ; ;{6 D F
%System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Original Certificate
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 engineers work.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbWesh et 10.10-12.do
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: FOX HILL BLOCK 1, LOT 4 Parcel ID: 051.073.22
A. WELL DATA
Well type PRVT
If A, B, or C provide PWSID #
Date completed 811984
Sanitary seal (Y/N) Y
Total depth 120 ft.
Cased to 120 ft.
FROM WELL LOG
Date of test
8/1984
Static water level
87 ft.
Well production
25 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 2.06 mg/L
Arsenic: ND ug/L Date of sample: 512812014
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC / STEEL
Tank size 1500 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping NA -NEW TANK Pumper
C. ABSORPTION FIELD DATA
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 12+ in.
AT INSPECTION
512812014
ft.
g.p.m.
Collected by: ARCTERRA
Date installed 6121/2014
Cleanouts (Y/N) Y
High water alarm (Y/N) Y
Date installed 6/2112014 Soil rating (g.p.d./ft2 or ft2/bdrm) 2.0 System type BED
Length 20 ft. Width 20 ft. Gravel below pipe 0.5 ft.
Total depth 2.5+ ft. Eff. absorption area 400 ft Monitoring tube Y Depression over field N
Date of adequacy test NA- NEW SYSTEM Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: —min. Final fluid depth _ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed 6121114 Size in gallons 1500 Manhole/Access (Y/N) Y
"Pump on" level at Timer Activated (50") in. "Pump off' level at Timer Activated (29") in. High water alarm level at 52 in.
Datum BOTTOM OF TANK Cycles tested 2 Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 75'+
Sewer /septic service line 25'+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO:
On adjacent lots 100'+
On adjacent lots 1004
Public sewer manhole/cleanout 1004
Holding tank 100'+
Manure/animal excrete storage areas 100'+
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 1004
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water, 100'+ Driveway, parking/vehicle storage 104
Curtain drain 50'+(NONEKNOWN) Wells on adjacent lots 1004
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that t have determined through field inspections and
review of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date. OF ALA
Engineer's Printed Name KENNETH M. DUFFUS
/++f
Date 6123/14 d TH
COSA brown sheet 10-10-12.doc
P KEY DU /
16 /
z
LOT 5
BLK 1
LOT 2
0
M
0
M
ANCHORAGE RECORDING DISTRICT
M �
0
00 a o
M 00
M
N 00'10' 43"W
00°12'02"W
LOT 4
6
LOT 3
BLK 1 � \
Lo C�
• rrZ
\
\_SEPTIc `-' iY
VENT Q
(tYP) LLJ
0•]
0 o LOT 3
N BLK 1 \
11)
w
_ Q
r- On
MHS O \
Ci
M
Z
VAULT •
BW CANT -�
•
FP CANT � 44'G.
exsn
z?aHOUSF� _
SHED
WELL GRAVEL
® D/W
15' T&E EASEMENT /
ASBUILT OF:
FOX HILL SUBDIVISION
LOT 4 BLOCK 1 PLAT 83-555
SURVEY CERTIFICATION: I, John L. Schuller, have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated thereon are within the property lines and no
enchroachments exist other that noted.
EXCLUSION NOTES: It is the owners responsibility to determine the
existence of any easements, covenants, or restrictions which do not
appear on the recorded subdivision plat. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
WORK ORDER NUMBER: DATE SCAR:: JE -MAIL:
JUNE 22, 2014 1"=40'
14 — 0 2 2 DRAWN BY: CHECKED WTI DRID NUMBER:BOOK AGE:
JLS NW1458 140164
L=164.69' 165.04 /
R=320.00 /
WOODCLI FF DRI VE /
O• = FND 5/8" REBAR
tOFA-N\
49TH �y i
•i�t . L. SCHUUER, oH'-NLS-10408 i
AW
111
%0 fes sionol
yo AD LAIVb��L�
w
�D
Uo t7'� 0
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE
AND. CArVD) e, 6
Pvy �t"\A X
o i 123 )!y
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
Day of June of 20 14 .. by and between
, 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
Advantex
located at (legal description).
Fox Hill Blk 1, Lot 4, 21715 Woodcliff Dr. Chugiak, AK
2. Definitions
Alteration. Any change to the design or function of an AW WTS 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'j 15,65. These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from perforating as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AW WTS that were included
in the original design which would allow the AW WTS to continue to
perform as designed.
Permit. An On -Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AW WTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AW WTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations Installation and Removal of Additional Equipment. Prior
to performing any alterations to an AW WTS, the owner agrees to obtain an On-
site Wastewater Disposal Permit from the Municipality in accordance with AMC
15.65.
5. Maintenance and Repairs.
A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
service and maintenance provider angroved by the municinaUly and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement; and any renewals thereof, at the owner's sole expense, to pay
for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement
costs, and (5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules
and orders for the AW WTS.
C. Upon request by the Municipality, the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained
by the system vendor, the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an
AW WTS may be assessed in accordance with AMC 14.60 for improper
discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance, repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AW WTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
H. Owner agrees that the AW WTS installation and maintenance requirements as
provided by the AW WTS vendor/installer and approved by the Municipality
are the governing guidelines for the construction, maintenance and repair of the
Owner's AWWTS.
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 terns and
conditions of this agreement, the only authorized representatives of the parties
are:
a. Owner: _
b. Municipality: Director Community Development or designated authority
C. Any attempt to amend, modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
g, 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. Severabilfty. 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.
(WNER:
'By: Coy jtt tom) tVj6WIWj�-- (signature) Date:.
(print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing
instrument was acknowledged before me this Z day of Juw C 20 by
Xe �U4'
NOTARY PUBLIC FOR ALASKA
My Commission expires:. p3- 2 $- ZZp -
MIJNiCIPALITY:
By. (signature) Date: _
(print name) Title: -
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-472_U
Application DateSeptember 26, 1986
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 4: Block It Foxhill Subdivision
Location (address or directions)
(b) Applicant Name Bruce Phau Telephone: Home — _ Business 786-6364
Applicant Address __United Bank of Alaska
(c) Applicant is (check onej: Lending Institution 12 ; Owner/builder 0 ; Buyer 0 ; Other 11 (explain); .
(d) Lending Institution __U.=t2 Bavj,_�ska------ Telephone __7-86.x6.364
Address 440 East••. 36th Avenue, Anchorage, Alaska 99503
(e) Real Estate Company and Agent
Address
Telephone
(f) fie HAA to the following address:
-- igIe-RA v�� a-- 9957- - - -
2. TYPE OF RESIDENCE
Single Family W Multi-F,arylit " Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well [R Community D Public
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite N Public ❑ Community C3 Holding Tank
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 72-025 (11/84)
5. ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DA i.1 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 regulations in effect on
the date of this inspection.
Name of Firm S & S FNG7 � f$1NG Telephone 6 5;1f6
Address SR B 1966 — --
Date EAGLE RIVER, AK 99577
6. DHEP APPROVAL
Approved for ``bedrooms by
Approved ___ _ Disappro/A
Terms of Conditional Approval
Conditio
CAUTION
Y,, ¢
ca 1 ep-
uport A. sh>n3c7 4V
14.57-a r° v
A9 Eo�o ao ED TJ�0 g
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations 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 hornes and their lending
institutions in order to satisfy certain federal and state requirements. 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.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
A. WELL DATA
Well Classification _ oe I Z-11 Z A
Well Log Present(Y/ ) Date Complel
l2n
GMIKW MkNTAL PROTECTION
GCT 1310
RECEIVED
Legal
Description:
If A, B, C, D.E.C. Approved (Y/N)
d _ b' — Yield -W K
Total Depth % I Cased to Depth of Grouting
Static Water Level 9-7 r Pump Set At
Casing Height Above Ground 22 Sanitary Seal on Casin
Electrical Wiring in Condui (Y/ ) Depression Around We
Separation Distances from Well:
To Septic/HIItgi Tank on Lot —CDU
r_1C
9(Y/ )
Ihead (Y10-
;-
; On Adjoining Lots
/-A
r
To Nearest Edge of Absorption Field on Lot 7:24- _ ; On Adjoining Lots
To Nearest Public Sewer Line lull -4- To Nearest Public Sewer r
Cleanout/Manhole /To Nearest Sewer Service Line on Lot
Water Sample Collected by ��y`�1��/� Date
Water Sample Test Results
Comments Fi -04.1'
B. SEPTIC/lid TANK DATA
Date InstalledSize f 6'>4�0 No. of Compartments —
Standpipes(Y N) Air -tight Caps (Y/ ) Foundation Cleanou (Y N)
Depression over Tank (Y N) Date Last PumpedE-Zj �N��
/ eu i ,.
Pumping/Maintenance Contract on File (Y/N) d`� �� ; for
Holding Tank High -Water Alarm (Y/N) N7 , Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic>tFTTank:
To Water -Supply Well — / "� F
To Property Line — /0
To Water Mft/Service Line
Course 1'f w �_J
Comments
Page 1 of 2
72-026(11/84)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed '213
Width of Field
5
Type of System Design aqq ,
ength of Field � i
Depth of Field �5_
Gravel Bed Thickness 6 H _-
Square Feet of Absorption Area //Z 8 % Standpipes Present (Y N)
Depression over Field (Y8 N) Date of Last Adequacy Test l C2
Results of Last Adequacy Test SA-rl I.[;RCPt y pa, s ai
Separation Distance from Absorption Field
To Water -Supply Well ZDD �L To Property Line /0 f
/
To Building Foundation 25- To Existing or Abandoned System on
LotAe.? ; On Adjoining Lots
To Water =MService Line To Cutbank (if present) a AJ �=
To Stream/Pond/Lake/or Major Drainage Course /1/ o /✓
r
To Driveway, Parking Area, or Vehicle Storage Area ,_SOf
Comments W , -/--
D.
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at Z 7A "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
Pumping Cycles during Adequacy Test. Meets MOA
I certify the I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
& SMtylCdlrERINC Date /� — /3- 8 6
Signed
Company MOA No.ULC KIVIcK, AK Y9577
Receipt No. -5980/ OD -2. y
�4�yn
�i
Date of Payment
Amount: $P
•Y� v Cc Ps gyioa°r,.SP • L�}
n
n �*° ..P..a oo. •Pe *°r�r .P
9.bm0 A. Shafer +r.
t1� i�°mP t•1a, 1f.57•E Pi ��wa�
Page 2 of 2f;��°'PPY .•°`�•�L°a*
a��lc4I pR01 "004
72-026 (11/84) -