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Home My WebLink AboutTALUS WEST #1 BLK 5 LT 15 GREL.._~R ANCHORAGE AREA BOL]'GH Depsrtment of Environmental Quslity 3330 C Street Anchorage, Alaska ggs03 ~NSPECTION REPORT ON-SITE ~EWAGE DISPOSAL SYSTEM LOCATION~.:DU/~O-- G>~(~LEDA' OESCR,PT,ON L ~, 6~ /~l~s DISTANCE · . ~ ~ FROM WELL /~7 ~ / MANUFACTURER MATERIAL~(~ INSIDE LENGTH INSIDE WIDTH NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY/~GALLON$. DISTANCE FROM WELL/~/~-'7~ FOUNDATION NUMBER OF LINES I DISTANCE BETWEEN LINES ABSO.PT,ON AREA DEPTH: TOP OFTILE TO FINISH GRADE TOTAL LENGTH , ~-- _NEA.ESTLOTL'NE_ ~,~_OFL,NES ¢~r TRENCH WIDTH~¢~ IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE y '~ F'~''- (/~OEPTH OF FILTER / // ¢' MATERIAL BENEATH TILE~ ~. ABOVE TILE ~ IN. WELL: T y p'E~,.~ 1~; \~_ ,, CONSTRUCTION ?¢ tf BUILDING ~ ,~-~-NEA R EST NEAREST ~--~/-~[ DEPTH ///--¢"'-~DISTANCE FROM: SEPT'Ck, : EEPAGE / TANK YSTEM_ ~¢~ CESSPOOL OTHER SOURCES APPROVED ~ DISAPPROVED / REMARKS DISTANCES: ~- ~ INSTALLED BY: SEWER LINE DEPT,~I: PIPE MAT[RIAL: 'COT DIAGRAM OF SYSTEM · '. ~,~ q~/~GRei .~R ANCHORAGE AF~ ~o~ J~T4 d J~- ' /sq SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT COMPLETION DATE ANTICIPATED SEEPAGE pIT .DRA]N FIELD NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE FOUNDATION TO SEPTICT.~K./,TA K ~ FOUNDATION TO seepage ~4(J /~2~ · - ' ~llL SEPTIC TANK TO SEEPAG P,,.~.T SEPTIC TANK ~ , SEEPAGE TO NEAREST LOT LINE. WELL tO SePtiC TANK ~ ~ I DRAIN FIELD /~ ~ WATER MAIN tO SEPTIC TANK ~ ~ DRAIN FIELD /~ J DRA[N FIELD /~'] DRAIN FIELD ALSO CONSIDER AREA WELLS. SEPTIC TANK,//'l~/~2 -, SEEPAGE-'I~ DRAIN FIELD TO RIVER. LAKE. STREAM. CAST IRON INTO AND OUT OF SepTIC TANK AND INTO CRIB CROSSIng GAP OF EXCAVATION 5 FEET]NTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON ~IPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. ~.YBTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBed SYSTEM IS IN ACCORDANCe WITH SAID CODe. ~ a~so oer[~y thai ~h~s home w~ll eonta~ a maximum o~ ~ be~lrooms. I understand an upgrade would~be neces~-rv should more bedrooms added. GReATeR ANCHORAGe AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK ~INANCED THROUGH TO BE INSTALLED ~¥ SO,L TEST RESULTS ~ 3~ ~ '~///~;/"~:J~// ~OT£~ 'rH,$ FERMr'r IS No'r VALID WITHOUT BOIL 'rEBz / FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTIC TANK SiZE ./~/'~ ~/~' ~._ ~'~.~~ ~ SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTSFF~~ ~/'~ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE ~ -, DRAIN FIELD SEPTIC TANK TO SEEPAGE ~ WALL SEPTIC TANK ~ ~J ., SEEPAge ~' DRAIN FIELD TO NEAREST LOT L~NE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK ,SEEPAGE ~ , ALSO CONSIDER AREA WELLS. DRAIN ~iELD /0 ') , SEEPAGE PIT TO RIVER, LAKE. STREAM. DIAGRAM OF BYSTEM CAST iRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOil. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2e-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, T also/~, ±~ that ,t-his home 'g111 con~d_~ a ~ of GrEA~Er ANCHORAge Area Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION LOCATION PHONE INSTALLATION OF: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD OTHER FINANCED THROUGH TO BE INSTALLED BY FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. ,E Tl' SI'E IOoo TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ FOUNDATION TO SEEPAGE P]T ~0 SEPTIC TANK TO SEEPAGE Pit WALL DIAGRAM OI~ SYSTEM 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC: TANK AND SEEPAGE PIT FITTED WITH AirtiGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUgh REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF GREATER AN¢ AGE AREA BOROUGH O DINANCE NO. 28'-68 AND THAT THE ABOVE Well Owner ivk',s~:z Pq;rk~c~x~,:ass ...... -..,na~h_, ALASKg 99509 DRILLING LO0 Use of Well )" Location (address of: Size of casing 6" .Depth of Hole Township, Range, Section, if .known; or distance main road .... , ,,.33. (3b'6¥~) , Xbelow) lance, ~uxrfaee. Statm Water, level ft. Finish of well (cheek one) Screen ( ); Perforated ( ). Describe screemor perforat~bn Well pumping, test at 10 _gallons per (I~6~it') (mindte) for / ! hours with of drawdown from static level. open end ( '- ); ft. Date of completion Depth in feet from ground surface r ~ _TO 4 0 dO TO. ac~ WELL LOG Give details of formations penetrated, size of material, color and hardness 0 f~ TO ,5,'? TO _TO TO__ TO TO _TO .TO Cmtic~Lc l':o's. 6i4 g 923 TO TO _TO 2 -- STATE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 015-202-35 1. GENERAL INFORMATION Complete legal description Lot 15; Block 5; Talus West Subdivision #1 Location (site address or directions) 4330 Sunstone Circle Anchorage, AK Pr0pe~yowner Ralph & Keni Hopkins Mailing address 4330 Sunstone Circle Dayphone 345-2522 Anchorage, AK 99516 Lending agency Mailin. g address ' Brian Broderick/ Prudential Vista Agent - Ad dress Day phone Day phone 273-7261 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: ×x Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xx If community.wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25 (Rev. 1/91) Front MOA ~21 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 of this Health Authority Approval application 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 f this inspection. Name of Firm ALASKAWA~'ER & WAdi Engineer's signature L.__~//~ I/~//(~/r ~' Alaska Water & Wastewater Consultants, Shall be PAID $ 2-~'~ or prior to, closing for the I~ngi_neerin9 Services Provided. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. Phone rE2B Date bedrooms, with th'e following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates 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. RECEIVED Municipality of Anchorage MAR 0 DEPARTMENT OF HEALTH & HUMAN SERVICES~uNiClPAUT~ O~ Environmental Services Division [NVii~oNMENi-AL SERVIC~'~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type '~--~ ~J G'~'~_ If A, B, or C, attach ADEC letter. ADEC water system number Health Authority Approval Checklist Log present (~1) V~---~ Date completed Total depth G ~'[ Cased to ~ Y '~- Casing height (above ground) Sanitary seal(~/N) \/~-S Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG 10 g.p.m. AT INSPECTION WATER SAMPLE RESULTS: coliform Date of sample: . B. SEPTIC .OLDI.G TA.K DATA Date installed Foundation cleanoUt ~N) Date of Pumping C. ABSORPTION FIELD DATA g.p.m. Nitrate /' ?/¢' /~//-' Other bacteria Collected by: Tank size /~c.r~ Number of Compartments __ Cleanouts(~N)~ Y'~-~ Depression (Y~..~.. High water alarm ~/~ ~/~ Pumper Soil rating (g.p.d./ft~ o~ ~ ~ System type Length /~-~' Wdth .-~" Effective absorption area IO~;~- &~- Monitoring Tube present{~)N(~'~/u~? Depression over field (Y/~) __ Date of adequacy test c,~./l(~/~'~, Results(Pass/Fail) ~V~ For '-[--~.~-~--- Gravel thickness below pipe~.~c~/ ~-~.~' Totaldepth ]~,~' F/E~P ,,V~,~£. Fluid de.~n absorption field before test (in.); r-~.~,, ' Immediately after/0~/~ gal. water added (in.): Fluiddepth (ins) Minutes later: I~ ~,~. Absorption rate = +~ g.p.d. Peroxide treatment (past 12 months) ~ ~ ~ If yes, give date 72-026 (Rev. 3/96)* ~ ~ o~ ~[~[~ bedrooms D. LIFT STATION Date installed _~/'/~ Manhole/Access (Y/N) High water alarm level at*. Absorption field on Public sewer main Size in gallons _ "Pump on" level at* ~- On adjacent lots _ *Datum __ On adjacent lots Cycles tested. E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: / Septic/l'~l~lia~-tank on lot /~ ~ Public sewer manhole/cleanout "Pump off" level at* /00 /oo P Sewer/septic service line d~' ~' 'f' Lift station /'")/'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: ' Ia '> Foundation Property line Absorption field Water main/service line lO '-F .Surface water/drainage /Oc~'7- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Water main/service line Property line Building foundation /~ ~'P /o '.~ Surface water (O ~ '~ Driveway, parking/vehicle storage area Curtain drain _ ~6/'~EZ ~' TM Wells on adjacent lots F. ENGINEER'S CERTIFICATION , certify that, hav. e.detert~i~e inspeectiffOe,ntSoannldhirse;i;~ of Municipal are HAA Fee $_ ~ Date of Payment Race,ptNumbar 72-026 (Rev. 3/96)* Waiver Fee $ \, \ ~,,_~1~._ Date of Payment. ~-~ Receipt Number d--~LL~\ ~- \~3~-~"~ Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us AK Water & Wastewater Consultants, Inc. ATTN: Jeffrey Garness, PE 6901 De Barr Road, Suite 2B Anchorage, AK 99504-0000 March 31, 1999 Subject: Waiver Request forTALUS WEST #1 BLK 5 LT 15 Waiver # WR990017 Lot Line Request for Parcel ID 015-202-35 Dear Engineer: Your request for a waiver of the required I0 feet horizontal separation of the on-site wastewater disposal system to the lot iine has been approved. The approved separation distance is 5 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, ·Mears Civil Engineer I On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Wa'iver Review Worksheet WR#~\0~q~h~ PID~ 015-202-35 HA# HA990084 Permit # Date Received: March 5, 1999 Legal Description: Lot 15 Block 5 Timberlux #i Engineer: Jeff Garness, PE, Alaska Water & Wastewater Consultants. Ina. 6901 De Barr road, Suite 2B, Anchorage, Alaska 99504 Applicant: Ralph & Keni Hopkins Waiver Requested: Lot line waiver of 5 feet from the absorption field tn east property line Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: Points: 3. Other: Waiver is Granted: ,~ Waiver is NOT Granted: List Conditions or Reasons for above: Date: Name of Reviewer Amount: Date Paid: ~-~- ~] Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B - Anchorage - Alaska 99504 Phone (907) 337-6179 - Fax (907) 338-3246 March 4, 1999 Municipality of Anchorage Department of Health & Human Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Lot Line Waiver for Lot 15; Block 5; Talus West Subdivision To whom it may concern: Request you issue a property line waiver on the subject property for the separation distance between the leachfield and the east property line at five (5) feet. We do not anticipate any adverse effects by issuance of this waiver (please see attached asbuilt survey). We are in the process of obtaining letters of non-objection from the utility companies. We will submit them as soon as they are issued. If you have any questio.~/please Pre~idl~nt [/ JAG/gd contact us at337-6179, or 244-9612. e,¢? /----___ ', /// ~ ,,~' ~S--Z~.~. / I / ~ ~ ~ ~ ~/ /~I~ / tI / It tI _E~L D~CRI~ON: TALUS W~ST SUBDIVISION; LOT 15, BLOCK 5, ~?Ag~ ~ '"~ ~LPH AND KENI HOPKINS 345-2522/564-5545 TELECOMMUNICATIONS 600 Telephone Avenue ® Anchorage, Alaska ,, 99503-6091 ,, 907 564-1000 March 10, 1999 Jeffrey A. Garness Alaska Water & Wastewater Consultants, Inc. 6901 DeBarr Road, Suite 2B Anchorage, AK. 99504 ATU Telecommunications has no objection to the encroachment of the existing septic system drain field into a platted easement located on Lot 15, Block 5, Talus West Subdivision #1, as depicted on the as- built drawing submitted. Acceptance and use of this letter of non-objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: ATU will be held harmless, now and forever, for any damages or injury to any person or property as a result of this encroachment. Any ATU facility damaged or destroyed as a result of this encroachment will be repaired at no cost to ATU. 3. Any costs incurred by ATU for special construction necessitated by this encroachment will be borne by the property owner. 4. Ail applicable safety code regulations will be observed and maintained. This letter of non-objection will in no way preclude ATU from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, eering DATE: NO, : " ' Rv ~niag ~w~ you ~tm ENSTAR Natural Gas Company . 401 E. International Airport Rd. P O BOX 190288 ' Anch0r~ge, Alaska 99519~0288 · ,'Engineering Dept. Fax (907) 563-4085 March 4, 1999 Anchorage Water & Wastewater Consultants, Inc. Mr. Jeffrey A. Garness, P.E.,M.S. President 6901 Debarr Road, Suite 2B Anchorage, Alaska. 99504 Dear Mr. Garness: ENSTAR Natural Gas Company has no objection to the vacation of the 10 foot utility easement or the sewer septic system that encroaches into the 10 foot utility easement on Lot 15 Block 5 of Talus West Subdivision. This easement isnot needed by "ENSTAR". If y~ have any questions please call me at 264-3743. T)an Westervelt Right of Way Agent 1203-22C G-2736 EN99007 ENCROACHMENT PERMIT This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric cooperative, (herein "Chugach"), whose address is P. O. Box 196300, Anchorage, Alaska 99519-6300 and Ralph and Keni Hopkins, (herein "Permittee") whose address is 4330 Sunstone Circle, Anchorage, Alaska 99516. 1. Easement. Chugaeh 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 27th day of August 1952, at Book 78, Page 51, of the records of the Anchorage Recording District, Seward Meridian, Alaska, Dedicated by the plat of the subdivision known as Talus West Addition No. 1, according to Plat Nmnber 72-248, recorded November 9, 1972, on file in the office of the Dislrict Recorder, Anchorage Recording District,' Seward Meridian, Alaska, (herein "Easement") which pertains to the following described real property: The Southeasterly Ten Feet (SE'ly 10') of Lot 15, Block 5, Talus West Subdivision Addition No. 1, according to Plat Number 72-248, recorded November 9, 1972, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska. Permittee acknowledges the validity of the Easement. Permittee warrants and represents that i ' Permittee is the owner of the fee s.mple interest in the land subject to the Easement and ~e following described real property to which the Easement is adjacent: Lot 15, Block 5, Talus West Subdivision Addition No. 1, according to Plat Number 72-248, recorded November 9, 1972, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Parcel"). Encroachment Permit - Page I of 4 2. ', ~ncroachment. ?ermit~ee proposes to continue the existence o£the followin~ improvement(s) on or within the real property subject to said Easement: A septic system pipe approximately 1 foot within said Easement, and a septic system drain field approximately 3 feet within said Easement for a distance of approximately 42 feet, (herein "Encroachment"). 3. Permit. Chugach hereby authorizes Permittee to continue the existence of the Encroachment in its proposed location subject to the covenants set forth in this permit. 4. Indemnification. Permittee shall indenmify and hold Chugach harmless from any claims for personal injury, property damage or other loss arising in any way from the continuation of the Encroachment. 5. No Expansion or Increase. Permitlee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior Written consent of Chugach. Chugach has no obligation to provide such consent. 6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit, has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any ethel' real property. Without in any way limiting the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes of the common law doctrine of adverse possession. This permit creates no interest in the real property subject to the easement. 7. Modification of Utility Facilities. If the electric utility facilities located within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. If such payment is not made within thirty (30) days of written demand for same, Chugach may terminate this permit in accordance with paragraph 9, below. 8. _Covenants Running with the Land. The obligations of the Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the land subject to the Easement and shall benefit the Easement. 9. Termination. Chugach may terminate this permit after the giving of thirty (30) days written notice of such termination iff Encroachment Permit - Page 2 of 4 a. Tt~e Encroachment is enlarged, increased or extended within the real property aft~cted 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 paragraph 7, above. 10. Term. This permit shall, if not sooner terminated by Chugach, expire forty (40) years from the date hereof. 11. Entire Agreement. This written permit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all other prior or contemporaneous agreements, oral or written, between the parties. No modifications, amendments, deletions, additions or alterations of the permit shall be effective unless in writing and signed by all of the parties hereto. CHUGACH ELECTRIC ASSOCIATIO , IN i~.~t~eE[Ig."¢~e N. Bjornstad ,' ~,,\ G,~.-.fa[;Manager Lat · .~ ~r r ~ Date: Keni Hopkins Date: ,-~- 70~' q'q STATE OF ALASKA ) ) SS: THIRD JUDICIAL DISTRICT ) T,~o~regoinjg i~nstrument was acknowledged before me this .... ~(7/'~4'~ day of '0 ItOt4'~ , 1999, by k&'e 'Th;bet4; -/4i~ fl~.;~.~ General Manager 'of Chugach Electric Association, Inc., an Alaska corporation, on behalf of the corporation. Notary Public in and for th~ State of Alaska My commission expires Encroachment Permit ~ Page 3 of 4 ,' kTATE OF ~LASKA ) ) SS: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this c2-'0~ day of l&~(a_h[ ,1999, by ~qLPH /-, J~/>P'g-lN% tg~bc r/o~'~ Chugach Elecgric Association, Inc. P.O. Box 196300 Anchorage, Alaska 99519~6300 020401 ANCHORAGE RECORDING DISTRICT 1999HR25 AHIO: h6 REQUESTED BY Encroachment Permit - Page 4 of 4 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description ~_o'r' 15 Property owner Mailing address Lending agency Mailing address Agent N¢~ ~- Address Location (site address or directions) &t 3%o ANc H O~A ~ E Box ~1~1 ; ANc~o?AGE~ SuN STo/,.I ~ CIRCLE Day phone 562.- Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site ¢ Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 of this Health Authority Approval application 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 F/-ATTOP TEC¢ Address IqS.~o ECI~o ~'T' Engineer's signature '~~ Approved for _2 __ Disapproved. Conditional approval for DHHS SIGNATURE Phone CJ JJj~ J JJJ JJ J JJJJ J JJl JJ JlJ~ · THEODORE F, bedrooms. Date bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates 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~)25(Re¥ 1/91) 8ack MOA~21 Municipality of Anchorage Department Of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescriptJon: I-OT I,E... BL~ ,Er T/IZ.U'5 ~VE£T ParcelI.D. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Y Date completed Jo/~,/15' Driller M- Iv' Cased to ~' Casing height JO" Wires properly protected (Y/N) Y Date of test Static water level FROM WELL. LOG .. Well flow Pump level g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot '~ to O Public sewer main ~ AT INSPECTION Sewer service line .. · MUNICIPALITY OF ANCHO?,AGE t:JqVi~,ONMEN~AL SEf~ViCES DIVISION g.p.m. .RECEIVED ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Ho~'E ¢r, SE¢~/£~ WATER SAMPLE RESULTS: Coliform ~ cc,/ /'(uo ~ Date of sample: /~ /? /9 2. B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) ¥ Nitrate _ I, ,~ ,'~/.¢' , Other bacteria Collected by:_ High water alarm (Y/N) . Date of pumping _ ~ / .?o / ? ~ Pumper_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I0,.~' To propertyline ~' I0 Surface water/drainage Tank size 12,~O C~ ~,/.. Compartments Foundation cleanout (Y/N) ~ DePression (Y/N) Alarm tested (Y/N). N,~ · N Foundation !,N ~',~oM ¢.0, On adjacent lots Absorption field. 1 2. -Watermain/serviceline. ~ ~o 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) _ High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION i31STANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed _ ~/2 Length ~ ;~ ~ _Width ~ ' Total absorption area Depression over field (Y/N) _ H Results (pass/fail) ~/~ $S Peroxide treatment (past 12 months) (Y/N) Soil rating ~0 ~'/~l)~h System type_ Gravel thickness Cleanouts present (Y/N) Y Date of adequacy test ~/'//~ 2 . for KN'OL,/N If yes, give date N, /~ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ~ To building foundation _ I'~ On adjacent lots- ~ f Onadjacentlots '-~/eO Propertyline [0 To existing or abandoned system on lot It.,4. Cutbank iq,/~ - Water main/service line '7 ,50 Surface water Curtain drain Driveway, parking/vehicle storage area 0 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, ....... HAA Fee $--/Y~) ~'~ Date of Payment ,/~)'~/~' ~'~ Receipt Number ~ (///~ ~' Waiver Fee: $ Date of Payment Receipt Number GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ~['~5q-~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWERFOR & WATER FACILITIES Cony. Date Received October 18, 1976 Time of Inspection t~.'~ ~Oi Date of Inspection. /ZD-~/~-7/n 1. Approval requested by: Alaska Pacific Bank % Rosie Parks Phone: 276-3110 Phone: Mailing Address: Post Office Box 420 2. Property Owner: Mose Pendergrass Mailing Address: Star Route A Box 1585-B 3. Legal Description: Lot 15 Block 5 Talus West Subdivision ~/, 4. Location: wilderness Lane Type of facility to be inspected Well Data: A. Type Individual Single Family No. of bedrooms 3 , Absorption area Other contamination , Absorption area , Sewer Lines , B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On-site system /~9,~/~ P~z>~- A. Installed /~ B. Installer C. Septic Tank: 1. Size /.~). 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 oi~ two pages - Re[ st for Approval of Individual Y er & Water Facilities ,Legal'Description Lot 15 Block 5 Talus West Comments Approved ~/~ (~,~/~Disapproved Date Approval :,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-O34 (1/74) 06-1220(a) Rev, 1973 DATE ALA~ i)EPARTUENT OF HEALTH AND SOCIAL SE ;ES ' DIVISION OF PUBLIC HEALTH Lob No. INDIVIDUAL AND SErVII.PUBLIC BACTERIOLOGICAL WATER ANALYSIS OEE C iNDIVIDUAL SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO CITY ZIP CODE ADDRESS OF SOURCE Analysis shows this Water SAMPLE to be: [], ~atisfactory [] Unsatisfactory [] Questionable [] Sample too long ~n transit; sample should not be over 48 hours old at exam~nallon to indicate reliable results. Please [] Bottle broken ~n transff, please send new sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATER IS AN JNDIVIDUAL SUPPLY SAMPLE COLLECTED BY DATE COLLECTED ~ ~ ~ ' TIME COLLECTED x ~ . Well -- [] Dug [] Driven [] Drilled [] Bored SOURCE; J~] Spring [] Cistern J~ Other____ Dug Well or Cistern Construction: Diameter of Well Depth Feet. Well Casing Material Diameter _ Depth Length of Water Depth Drop Pipe From Bottom Feet. Offset Jn In Utility : PUMP LOCATION: I~] In Well [] Basement [] In Basement ~] Room On Top [] Of Well [] Other PURPOSE OF EXAMINATION: Illness Suspected? READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE [] Yes [] No Repairs to System? [] Yes ~] No Signature __ 0B.1220 Cb) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. ]973 Laclose Broth 10cc 10cc 10cc 10c¢ 10¢c 1.0cc 1.0¢e 24 Hours 48 Hours Brilliant Green 24 Hours --48 Hour~ Reporled by Absent Present This analysis indicates Coliform Organisms to be::' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 69504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 1 8 1976 RECEIVED 1. Type of Inspection: CMRO Mose Pendergrass 2. Property Owner:. VA .FHA CONV xxx .Mailing Address: S~A. Box 1585-B Anchorage 9950/ Name of Buyer: Robert Baker Day Phone: 349 4207 Mailing AdfJres_sj · new to area c/o ~zsa & Game (State) Raspberry Rd 4. Name of Lending Institution: Alaska Pacific Bank Mailing Address: P O Box 420 5. Name of Realtor or Agent: Jack White Realty Mailing Address: C Street Callais Center I 6. Legal Description: Lot 15 Blk 5 Talus West S/D Location: Off Huffman Rd on Wilderness T,anm Day Phone: Phone: 276 3110 Larry Mauldln Phone: 277 1553 7. Type of Facility to be Inspected: ~in~lp family 8. Water Supply Type of Supply: Public Utilitv If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility. If Individual, date of installation No. Bdrms. 3 Individual (on-site) Individual w¥~ .... APPLIC NT FILLS OUT UPPER HAl ONLY Property ~Jwner .^ ~?~7/~'~ Address /~ ~ ~ k~ ,-- /~ ~ , ~ ,; Zip Code~-~/ Legar De~ription ' ' ~- ~ ~ MuqipleFamilYother No. of Bedroo~ -- ~~ ~~~_~ ~"~~ .~ Wate~ Supply lndividual A~ACH WELL LOG. A w~l log is required for aH wells drilled since June 1~975. Community ~ For wells driged prior to that date, give well depth (attach ~og ~f available). ~ Public Utility lndividual Year IndMdual Installed: P~blic Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time ,~ime~ ~ Date Date Date Date Inspector Inspector Inspector Inspector ()APPROVED BEDROOMS ~~ 'C0NDIT~ONS OF APPROVAL (~1CO~D~T~O~ALaPP~OVAL' con~ac~ w~h a copx submit[ed to t2~s off~ce OATE Peb~V ~, ~983 for OU~ f~[es on the 8et aeration unit ~n the By:~~~ on-site sewer system. Soils Rating Date ~wer Installed WOH To ~sorption Area Well Log Received Concrete PrOducts of Wasilla, Inc. HOME & COMM, ERCIAL SEWAGE TREATMENT PLANTS BOX 149 - WASILLA, AK. 99687 ~ PHONE 376-5919 JET Home Plant Service~Policy This Agreement entitles:'~Owner ~,~ Street Address 3- to the following se~ice for / year(s) from the date ~acceptance. Upon receipt of th~s s~gned ~greement an~ $. /~ ~ , ~Concrete Products agrees to perfor~ t~e foUowing serv~ce~ during the term of t~e agreement: ~u Concrete Products will inspect the J~ pbnt at the 0bore oddres~ twice a ~eer. These inspections u_,o_s 7-' PLANT SERVICE · Removal of aeration unit, inspection, adjustment, cleaning of aerator's shaft, field service of aeration unit, if.needed, and re-installation. · Inspection, cleaning, and adjustment, if necessary of surface skimmer and/or tube setter. · Examination of final effluent for color and odor, if there is access at time of inspection. · Check of discharge point and wet weather overflow for blockage (if applicable). · Inspection and adjustment of control panel setting and overload protection, if there is access at time of inspection. · Insj~ection for sludge accumulation with arrangements for removal when build-up warrants removal. ~ Concrete Products further agrees to the following: EMERGENCY SERVICE · There will be no charge for emergency service calls. · There will be no service or labor charges for removal or re-installation of aerator, if required. · If improper operation cannot be corrected at time of service, homeowner will be notified immediately and given estimated date of correction. · If improper operation cannot be corrected at time of service, the Department of Environmental Quality, GAAB, will also be notified. · If necessary, the entire mechanical unit or any parts will be replaced according to the manufacturer's warranty program. Freight charges to the factory or to an unauthorized -repair station and aerator repair charges are not covered under this agreement. Owner's Signature (.~'~' 1 Concrete Products Date ALASKA r:UIROllmdlTAL COFITROL Il'lC. ~n§in~erin~ $ ~nuipOllm~nlal ~ludi~s JANUARY 20 1983 1ST NATIONAL BANK/ATTN JULIE P.O. BOX 3128 ANCHORAGE AK 99501 SELLER - ROBERT BAKER BUYER-WILLIAM & WATSON SUBDIVISION-TALUS WEST #1 BLOCK-5 LOT-15 R£CEIV D ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 1320 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE C~JPACITY OF THE SYSTEM IS 1350 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 6/2/82 . SEPTIC TANK ADEQUACY THIS HOUSE HAS A PACKAGE PLANT IN LIEU OF A SEPTIC TANK. ]200 ~.Ucsl 33rd Auelme, $1[it~ [~ $ Anchor,~% Al,~ska 99503 · (907) 276q36]