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HomeMy WebLinkAboutT12N R3W SEC 15 LT 140Onsite File T12N R3W Section 15 Lot 140 #015-484-14 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211165 PID Number: 051-581-04 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JOHN & CINDY HITCHCOCK ABSORPTION FIELD -EXISTING E] Deep Trench E:1 Wide Trench E] Bed EJ Mound Site Address TH 4811 E 104 AVENUE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. 140 Township Range Section Gravel width Ft' Beds: Number of Lines Distance between lines Ft. 12N 3W 15 SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' Ft. Well 100'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 5'+ -- NA Foundation 10'+ ILIFT STATION Manufacturer Capacity Gal. Remarks 3BR HOUSE — 4BR SYSTEM. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer PCN drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection151 6/4/21 6/5/21 Location and description ection Zia 3rd 4'" TOP OF BOTTOM OF STEP ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF " Conditional Approval: Date ��Q'�`. • •' g.� TH " " " " " " " • Curtis Huffman Septic System Approy-ej `r Date -25-Z ��•FCE128991 .�.�•'��AiW Note: this approval does not include well tktpROFESSION�4� permit requirements.\\\`11�► (Kev ub/uui u) PID:015-484-14 PERMIT: OSP211165 A—C=67,4' B—C=14.0' A—D=65,2' B—D=14,9' A—E=63,3' B—E=15,8' MT STAKED 100' EXISTING WELL RADIUS FIELD PRIOR TO DECOMMISSIONED EXISTING CONST. S.T. & INSTALLED NEW \ 1250—GAL HDPE SEPTIC TANK WITH NEW DCO. A DCO E CO D MH g C 2,0 ❑H Co NOUS E SEPTIC SECTION s T12N R3W SEC 15 LOT 140 SUPPORT SERVICES: PREPARED FOR: JOHN & CINDY HITCHCOCK 4811 E 104TH AVENUE ANCHORAGE, AK 99516 FIRST WATER CONSULTING DATE: 6/18/21 1SURVEY. WALATKA 3030 SUES WAY DRAWN: FWCS 6/18/21 ANCHORAGE, AK 99516 SCALE: 1" = 20' 907-350-9566 FirstWaterAK@gmail.com U ME d- 0 NTS MUNICIPALITY OF ANCHORAGE D n -site Water & Wastewater Program PO Box 196650 474�10 �]I-!� Anchorage- Naska 99619-8864 Phone. X947} 343-7904 Fax: (947) 3143-7997 ht hvww.munl.pWQmlto On -Site Wastewater Disposal System Permit Permit Nurnber_ OSP211165 Wu6 Type; Sep�cTank Upgrede Tax Cade Number; 01540414000 Site Legal Address, T12N R3VV $EC 15 LT 440 G,253 Site MaIring Address: x1311 E 104TH AVE, Anchoratge Owner_ HITCHCOCK ,JOHN C & CINDY M Design Eng Inner_ FIRST WATER CON$ULTINQ This permit Is for the construction Qf; EITa%otivo Jute; Expirati-on Data, Let Size in Sq Ft: TotoI Bedrooms: 61112021 W1 X2022 32200 © D18pasal Field Q Septic Tank 0 Holding Tark D Privy 0 Private VVell 1:1 Water Storage All con stroc:tlon shall be i n aeaorda n oe with; 1. Tho aftched approval design - 2. ,411 requirements specified in Anchorage Municlpol code Chapiers 15,55 and 15,65 and the State of Alaska Wastewater Disposal Regulations (1 8AAC72) and Dri nking ~Nater Risgul0ons (1 8AAC80) 0. The wastewwater wde raquires inspections during the inslallabori. The engineershalI notify the Develepnwt Services Deparlment per AMC 16,65, Provide notification by calling (!007) 343--7904 (24)7)- 4. From Octobe r 15 to Ap ril 15, a oubsurfooe soll absorplion -system under Construction durin 0 freezing weather shall be either_ a- Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued Ey; 611 f01 Ekat,e= Date; U I B AUTY OF ANCHORAGE 71 Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-484-14 Property owner(s) JOHN & CINDY HITCHCOCK Day phone _ Mailing address 4811 E 104TH AVENUNE, ANCHORAGE, AK 99516 Site address 4811 E 104TH AVENUNE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T1 2N R3W SEC15 LOT 140 Lot Size 32,200 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade El Duplex (D) ❑ Holding Tank ❑ Renewal❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ature of property owner or authorized agent) Permit/Rush Fees: t a 9- 5 Date of Payment: 15—'2 q' V Receipt Number: 5-1 q z72 - Permit No. O S P-2111 b 5 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com May 25, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: T12N R3W SEC 15 LOT 140 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211165, Rebecca Carroll, 06/01/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211165, Rebecca Carroll, 06/01/21 MUNICIPALITY OF ANCNORAGE DEPARTMENT OF HEALTH & ENVlRONMEN'rAL PROTFCTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPF. CTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION ! t / ; ~/ / ' l~ We ! Absorption area I O,STANCETO: I I ~ ~O Ir .u~wmw~u=: Inside length ~m*,C. TO: Im" ~/~ Manufacturer ~' Material Top of tile to finish grad~i/ I I Dwelling Materi~ f~g.¢/ Foundation_~)~ / Nearest lot line /0' 4- Total leng!h of lipes Trench width ~:~/~ ~(~ inches Material beneath tile ~/'/ inches Depth ND. OF BEDROOMS PERMIT NO. No. of compartments Liquid deptb PERMIT NO, Liquid capacity in gallons Distance h eZ~/n es Total effect.~._e ~s.3pti,~ a~ea Leng£h Width PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: c/¢.----~' -%. Depth Driller Distance to lot line AbsorptionPERMIT ND.area(s) / Building foundation Sewer line Septic tank UPGRADE ©THER PIPE MATERIALS SOIL TEST RATING !,:25~ /~//B~ INSTALLER REMARKS 2~EdqOV ED DATE 72-013 (Rev. 3/78) /~" /5~ - .--/~-.,, ' .-//5.4~' - ~'/;~ I DIEF:'AFC'f'MEN'T OF Hf:'!:AL. TH AND ENVIF,:ONMIENTAL F'F~OTECTI(:)Iq 82'.','5 L STREET, ANCH[II::RAE)E, AK 9950 1 ,?,64 '"' q. 720 L.I II ql ...... ~, % '"fl'-' IE '.EL~ lEE: I},~,41 lEE: IF::i: ",.=~:"' , Ib,,lt ILZ',C II--. II ...... IF::':' lEE IF q,". II'""lt ::t]:: "1t" Fr'ERId I T I',10: DATE 8zt()799 09 / :1. 9/E44 AF:'PL I CANT: A):):I)I d., ~ ..... CON'TACT F:'IdOI',!E: T(:)M WESTERI.'IOF ].0400 I:::'ROSPE[;'T DF;L. Ai'4CI"~OF~A['."}E:, Al'::: 995:1. ~: 346...-35::~; :[ LEGAL, :(.)I:.,.,CI .I.I L. OT ~ ..... ,:~ .[ Z. E ,~ MAX BIE DR 00 H ~'3 ',', SUBD I V ]: S :1: ON: I'qA L.O]": :1.40 S E C '1" I 0 N ,~ 15 T 0 W N S 1.41 P: 12 N ,] R A N G fL:: .3 W :7!;2200 (!ilQ. I'=T. DR ACRES) 4 BLOL, I,.: NA L, isFL6;~d I:)(:,~],(:)~,l aJ"(~) 'l:.hl.;.:) c:lp'l'..J, clns available 't..c~ ~iy~t6:~fl,, (]l]~l::)~ the (:)p'~J.C~FI ':,h&~t. b~:.~t {~.'l,,~ DEF:'TH '1"0 F'II:::'E BOTTOM (F'I",,) 1t.,, 0 4.0 4.0 GF~AVEL. DEF:'TH (FT.) '7,, () 0,, 5 3. '5 'I"C)TAL DEPTH (F'T'.) ] 1 ,, 0 4,, 5 7,, 5 GRAVIEI,., W:[ D"rtl (FrT.) 27,, 5 20,, 0 5,, 0 GRAVEL LENGTH (1::"1".) ' 36,, 0 3B. 0 5Zl.. 0 GRAVEl_ VCILUffllE (CU. YDS,, ) 25,, 0 28,, 2 4(),, 0 TANK S ]: ZE (GALS) Z, 250,, 0 '~.-~ ]., 250,, 0 '~">s ~, 250 ,, () St]II.,., RATIIxlG (SQ. FT,, /BR) :[25 125 :[25 'x-'x' 'J"ANK I"lt,.I,~!~'l' HAVE Al" LEAST TWO C[)MPAI:;;'I]'ilENTS ]: I::er'tify that: 1,, I am fam:i.i:i, ar, RJ.'tLH ILI'I~'.~ I'~(::[t.l:i.l"(:~llJf::}l'l'(:,!~ fOP (:;)I]'""!BJ.'[.E) sewel-S and wells as set for'tl-i by 'Line Municipa].:i.'Ly of Anchopage (MOA) arid 'Ll"le State.c:~f' Alaska. I wi].]. :i.~r'H~Ft.a].]. the system in accor'darx:::e ,/~:i.t.h a].l Id[IA cc)des arid r'egulat:i, ons, I will adh~:.me to all MOA and S'La'Le eli' A:l. asl<a r'equ:i.~-ements few' the set back distances fr'c)m any ex:[?,ting ~e].l, wa~FLewater, d:i. sp~:sa], ¢sys'l'.¢:~m oP pub].ic sewe:n*age system [:n 'Lhi~ m* any adjacc~nt c~l' near'by ],cit. I und0~,stand 'Lhat:. '[:h:[s per'mit is va].:i.d fr:H- a max:i, mum of 4 b~dr'c:~c~ms and any entar, gement w:i.]. :l:l:: A I..:IZF:'T STATION I,r3 INS]"AJ._I...ED IN AN AREA COVERIED BY MOA BUIL.DIIqG CODES, THEN (1) AN IEL, IECTF~ICAI.. F'EF~M:[T AND INSPEC]'IOIq MUS]' BE OBTAINED; (2) AS-BUIL.TS N]:I...L NOT BE AF'F:'F~OVED WITHOUT (]lq ELEC'H:~ICAI.... ~I:NSPIEC'T]:ON RIEF:'ORT; AND (:5) THIE IEL. ECTRICAL WORI< MUST BIE D[INE BY A I.ICI~SI~D EI...ECTF~]:CIAN,, AI:::'F:'I..ICAIqT~ TOld ~'rERHOF: ~ I / ........................ I:.,GINEERS - PI_ANNERS ~ SL}RVL 1610 DIMC]NI) DRIVE fi~NCH[)RAGE!, ALAS;~::iA ~1~07 ~ SOILS LOG [] PERCOLATION TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR: SLOPE 1 2 3 4 5 6- 7- 8 9 10 11 WAS GROUND WATER ENCOUNTERED? 12 13 14 15 16 17 18 19- 20- IF YES, AT WHAT DEPTH? SITE PLAN Reading Date Time Time ~..~,.~i../.~ C' ' "~'~ rep --- ,.>" v, ,~ ' PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) FT PERFORME[~ BY: ~/'~' ~/~' ¢~' ~-~&/~: CERTIFIED BY: ~'. /~'t~'~ 72-008 {6/79) O ,q o o q~ Development Services Department On -Site Water & Wastewater Section Parcel I.D. 015-484-14 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description T12N R3W SEC 15 LOT 140 Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: q '2-,S--- Zf Location (site address) 4811 E 104TH AVENUE, ANCHORAGE, AK 99516 Current property owner(s) JOHN & CINDY HTICHCOCK Mailing address Real estate agent Day phone 4811 E 104TH AVENUE. ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 1 20 21 Date of Payment Receipt Number Receipt Number COSA #05.,C- 21 I "D- S Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/15/2021 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 P'(� • • ' well and septic system. Therefore, any estimate of how long a system will function satisfactory /�g�•.' • • �,9 ��� for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS ' *• 4 TMr ...•.* 6. DSD SIGNATURE rr CE 128991 Curtis Huffman �� �'F�• .•�`�/� System #1 Approved for bedrooms ����srF�F.,�/15/�9 •`���� System #2 Approved for bedrooms 1`,\ PROFESSIOi� Disapproved Conditional approval for bedrooms, with the following stipulations: i B r Original Certificate Date: — S Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Qll� W1 y OF X11/, otv-sl :53 =m �� 0 1`ER � c� W ,.: A D m� ,m PRGGA'A4 ER c=am i B r Original Certificate Date: — S Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other a Legal Description: T12N R3W SEC 15 LOT 140 Parcel ID: 015-484-14 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 1/18/1985 Total depth 298 ft Cased to 298 ft (PER MOA REC. DOCS) ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 5/13/2021 Static water level at beginning of test 239 ft. Well production at time of test 5 gpm Comments B. TANK DATA Age of tank(s) NA — NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NA ® Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Which system tested (date installed) 9/28/1984 ® ALL standpipes present per record drawing Total measured depth from grade 14.6 ft (max) Measured depth to pipe invert from grade *5.4 ft (min) ❑ N/A — pressurized field ® Monitor tubes no to bottom of effective If not state Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 1.33 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by Date of Sample 5/13/2021— Comments /13/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5/13/2021 Results ® Pass For 4 bedrooms Fluid depth prior to test 61 in Water added 800 gal New depth 81 in depth into effective Elapsed time 1400 min ® Code -required soil cover over field Final fluid depth 56 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: *DCO TOTAL DEPTH AT_TEST _- ELEVATION SHOTS SHOWED 9.35' DIFFERENCE DCO/MT FIELD OPERATING IN THE TOP 1/3 OF THE TED. NES E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I 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. �---w- -% g.• TH ' • , Curtis Huffman ' ?'<'��, •. CE 128991 •• i`�i bil8/2a . •�4P A pROFESS1aN�' -W ft ft ft ft ft ft ft ft 50.00 �a SLM Lot 115 EAST 164.93 (R) 114.93 BLM Lot 140 Septic vent (typ) N O N O e 00 O 55 3 Manhole M 2oo26 2.0 OH -L Houserame Co d 24 3 1 deck 1 0 Well 0 a 1 3 w l � � N 0 > Oc E2 L _ 114.87 C7 X410WED (R) Record per BLM survey dated 1-27-1955 (R1) Record per Plat No. 2004-144 00 000 00 LID N O O co co O O O 0 50' BLM Road Reservation o O LO Lf') E. 104th Avenue EAST 164.87 (R) LO I` d' N O 0 0 0 Z z Ret. wall BLM Lot 141A i SCALE: V= 50'1 Aftr of • A�qs �� AM . f- ®�• 49th ••� 00 s 00 10 �, •. lizabeth L. Walatka o ,m �saF • 8036 - LS • • J�_t'A-V pROFESSI ONAX-•� P®® Vw' ®®® RECERTIFIED 6-08-21JWz5C) RECERTIFIED 5-14-21 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 140. SECTION 15, T12N, R3W, Seward Meridian, AK Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 30th day of AUGUST , 1996. EASEMENTS OF RECORD, OTHER THAN FB 21-4, pg 23 FRED WALATKA &ASSOCIATES, L.L.C. THOSE SHOWN ON THE RECORDED FB 21-4, 9-10 PLAT ARE NOT SHOWN HEREON pg Engineers and Surveyors BE 907-248-1666 UNLESS OTHERWISE NOTED. FB 96-2, pg 30 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PRGTECTION DIVISION OF ENVIRONMENTAL HEALTH CFRTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or direclions) Applicant Name JE~E¢~ fi~/~Telephone:Home ~/~ Business Applicant Address ___~ ~pplicant is (cheek one): kondin~ Institution ~: Ownor/builder ~: Buyor ~: Othor [] (oxplam); (d) Lending Institution _ (e) Real Estate Company and Agent ,/~//4~r Address t4////~ ' Telephone (1) Mail the HAA to the following address; Telephone TYPE OF RESIDENCE Single-Family,J~ Multi-Family [-I Number of Bedrooms Other 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. 4. SEWAGE DISPOSAL Onsite~[~ Public [] Community [] Holding Tarlk [] Note: If community well system, must have written confirmation lrem the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) [ENGINEERING FIRM PROVtDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA~A 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 ef 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 Telephone DHEP APPROVAL Approved for ~£ , , Approved ~ ,~ bedrooms by. ate /2 ' Disapproved Conditional 'Terms of Conditional Approval CAUTION 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 tile 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 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 ?2-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: _ WELL DATA Casing Height Above Ground Electrical Wiring in Conduit ~N) Separation Distances from Well: Well Classification TO/~/~,/~ ~'.~ If A, B, C, D.E.C. ~Approved (Y/N) ~ Well Log Present ~.) Date Completed ~/~/~- Yield Total D~ptb i ~'Zg' __ Cased to ~~ Depth of Grouting ~fi Static Water Level ~ ~ ~ / Pump Set At ----~/~ ~/ Sanitary Seal on Casing ~N) Depression Around Wellhead (Y~ To Septic/Holding 'rank on Lot ~O~ z ; Oil Adjoining Lots /~(') /7~' To Nearest Edge of Absorption Field on Lot _~_ / ' ; On Adjoining Lots /~") To Nearest Public Sewer Line , fV//~ _ To Nearest Public Sewer Cleanout/Manhole ___ .~/1/'/,J~. '__ To Nearest sewer Service Line on Lot Standpipes ~N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank kligh-Water Alarm (WN) _ Separation Distances from Septic/Holding Tank: To Water-Supply Well t 0~ / To Property Line ]~ To Water Main/Service Line _ Course . /00 . Size __] ~.~-t~ _ No. of Compartments Air-tight Caps &ND __ Foundation Cleanout Date Last Pumped ' /~//~ por ~ry Holding Tank Permit (Y/N) / To Building Foundation ~."~ TO [Disposal Field ~ / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-0260 ~/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/2~/~ ~/ Width of Field Type of System Design Length of Field Depth of Field /// Gravel Bed Thickness 7 Standpipes Present Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: I10' To Water-Supply Well To Building Foundation Lot To Water Main/Service Line /V'//¢~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ,/~/.~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions .,,. Manhole/Access (Y/N) ~ Pumping Cycles during Adequacy Test. Meets MOA Receipt No. Date of Payment Amount: $ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have,.chc4;ked, ye~ified,,,,or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed q ///~'/f'~/~Ctc~//X~-~ Date J~?~//{/.~,~ ' ' ' ' Company ~~ f~ MOANo. ~-0 2/ Page 2 of 2 ~¢~... ~E- 225~.~ ~ CONTROL SERVIC' ', INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 OF DATE / / /