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PARK PLACE #1 BLK 1 LT 2
Onsite File Park Place #1 Block 1 Lot 2 #020-092-67 Den, 16. 20 0:: 12p A;10h0"a0e Vx,:ak (\. FUMP "Del MUNI `3LITOF ANCHORAGE 4. -ine: 90 '-342-790e'-, P! D n -:�i r� m 9 rit Devel(mment Sa.-vi—s cax: zq07-343_71_ 'Aater & 'A'astewatar Sec -ion Pump InstaNation Log vVe.111 Drillinto'. Permit Number: Pamel IdenC.fication Numbbegr: NO- 0?2- Date of Issue: Lc,gal Description 1 Block i Lot l Property Owner N:mie Ivz Address: " .7 Pump Intake Depth Oejow'rop of Wei! casillcgy': Purrip Mands'amum's Norm: Purap Model: Pump Size: Vitle.'is Adapter Bm-ie? feet, Ntte,is Adavur 'Nl.,mufacturWs Nai7,-ae- Pitless iviapter Installer; Well Dk-infected Upon Coulp'l"."lon? F'Y'1•t.-s D No 'N"Iethod (11, DI'An"'ection: Comments. Ptunp lustidler Name: 330 Eest 76t!i Avenue Archorap, AK 99518 Mailing Addvess- Phone: Sui-243-0i4v ?-I ru: 9071-2143-0742 City.- State: — ------ --Zil): Am.-Ition: Tlw munp isista!L!1. Shied! pl,ovio.c a punip lnslmliatirlu log to On-site wit'rin V,> dlys ofpun',j-, 1nstv-11,1fio-o- Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201246 PID Number: 020-092-67 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name DENNIS VALENTINE ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 16851 BETTIJEAN ST, ANCH AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Subdivision Block Lot PARK PLACE 91 BLK 1 LT 2 Ft. Fill added above original grade Ft. Gravel length Township Range Section Ft. Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To! Septic I Absorption Holding Lift Station Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 1100'} t�-I- I ! i 150Manufacturer TANK A Septic ❑ S.T.E.P. [01Holding (3 Other GREER TANK Capacity 1500 Gal. Surface Water 100' j ! ( Material Number of compartments Lot Line 1101+ NA PLASTIC 2 Foundation11 1 Q' -I- LIFT STATION Manufacturer Capacity Remarks TANK DECOM. PER UPC. :Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield MIKE N ANDERSON, P.E. Drainfield CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection 15' 8/3/20 Location and description A1 GARAGE SLAB 3`° 41" ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date �`.' ` �'' ° •' • • ":t� C •49THr,, d .. .. / .r ;•• MICH El N. ANDERSON •-- �" • CE 94 '<� ,. Septic System Approved Date SOU' s;>' • . Z at� •'��' Note: this approval does not include well permit requirements. ��;'4 fESS10� Permit No. OSP201246 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PARK PLACE #1 BLK 1 LT 2 PID No.: 020-092-67 MARK A C01 34 p TC01 35 TCO2 37 6 CO2 39 2 CO3 40 2 I� � I � � 1 i o / B GARAGE -SLAB \ 'CO3 CO TCO2 / 1 DRIVEWAY / \ CO D / 0 /NEW 1500 GALLON PLASTIC TAK EL / A C ARE COVERED / \ OTT LANS ASB ILT / \ SCALE 1"=5/O/' SEPTIC SECTION N.T.S. VAN . .........4. Arc AW AW '.� 49TH MICHAEL N. ANDERSON: L ' No. CE 9469 S°•.�-30-20 •°' 8/14/20201" = 30'BFB BOBBY F. BURNETTSW 3337AS-BUILTASB2020 July 13, 2020 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank permit Legal: PARK PLACE #1 BLK 1 LT 2 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201246, Rebecca Carroll, 07/31/20 1"=40' PROPERTY LINE PROPERTY LINE EXISTING WELL 100' RADIUS WELLEXISTING HOUSE EXISTING SEPTIC SYSTEM -BETTIJEAN STREET-PARK PLACE # 1 BLOCK 1, LOT 2 -CELTIC DRIVE- SCALE: DJR DRAWN: DATE: PARK PLACE #1, BLOCK 1, LOT 2 Anchorage, Alaska DENNIS & ROXANN VALENTINE 7/15/2020 7/15/2020 EXISTING WELL 100' RADIUS WELL R&R TANK W/ NEW 1250 GALLON PLASTIC AND 20" RISER, MAINTAIN 10' FROM FOUNDAITON, DEMO TANK PER UPC EXISTING DRAINAGE FIELD EASE M E N T EASEMENTEASE M E N T DRIV E W A Y PARK PLACE # 1 BLOCK 1, LOT 3A PARK PLACE # 1 BLOCK 1, LOT 4 PARK PLACE # 1 BLOCK 1, LOT 1 PARK PLACE # 1 BLOCK 1, LOT 5 LOMA ESTATES BLOCK 1, LOT 1 LOMA ESTATES BLOCK 3, LOT 1 5%-10% CO DCO Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201246, Rebecca Carroll, 07/31/20 Municipality of Anchorage Page of 3 ` DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 1-96650— Anchorage, Alaska 99519-66504-Te1ephone: 343-474 On -Site Wastewater Disposal System and/or Well Inspection Report PermitNumber* Swq!503161 PID Number: ozo—0--/Z— &I Name: � �ostl�n[N SIA t.�NT'tnit�' Wastewater System:. © New i Kpgrade ENN1S �a— Address: ABSORPTION FIELD Phone: No. of Bedrooms: �� ❑ Deep Trench t�nallow Trench ❑Bed O Mound 1:1 Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grafi : GPD/Sq. Ft. Lot: Block: Subdivision: l \ -PAP-e- Depth to pipe bottom from originalgrade: Gravel depth beneath pipe PLAN 9 Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: — Ft. /3 Ft_ WELL: �rjA ew 0 Upgrade Gravel width: � Number of lines: Dista�� tween lines: Ft Classification (Private. A,B.C): Total Depth: Cased To: Total absorption area: Pipe material:,.—f5/71;.t 4-3P3^111_ Ft. Ft. SQ. Ft. — V& Driller: Date Drilled: Static Water Level: Installer: Date stalled: Ft. 1.d11� Yield:Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES optic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding PubticiPrivate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines % 11'L$15 Well i �0 / n / A1114— Ma�ri�l Number of Compartments: /�, Surface y ' >/o d / //� r LIFT STATION ivy Water /o o Lot Size in gallons: Manufacturer: Line Foundation f� / � / ¢.3 N � � �-- "Pump on" level at: "Pump off' level High water alarm at: Curtain / �--- �.� r— Pump Make Mo ectrical Inspections performed by: Drain Remarks: resf /,4A_ 2 x/ag ey_a--*✓jxk-&/ A BENCH MARK Location and Description: o.ti � 1 c1T.. A4"; Npoit"41 4NQ Assumed Elevation: /e c rw �� }� pg�� //..� �/ '� �/�� AI-paagez m ENGINEER'S SEAL � ' cn WS.S. I�2"1 Inspections performed by�'� Dates: 1st • `T / 2nd '2/--7-' 2y s 2Q _., ... a.a. oorrsooaoenoyc as `,s - 0e artment of Health and H man Services approval Reviewed and approved by: YZe�1i2tJ Con 72-013 (Rev. 9/97) MOA 25 rt _ b�,�S1 0.�( �,Q/y� _j Per. mit No. Page ~ of ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: -I Permit No..5'(~) ~"~[,~7 Page ~ of -~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report PID No.: December 20, 1995 Municipality of Anchorage Department of Health & Human Services 825 "L" Street Anchorage, AK 99502 Suject: L2, B1 Park Place Subd. Addn. No.1 Septic System Design Encroachment Request Dear Mr. Roth: We are requesting a separation distance waiver from 50' to 30'; · absorption field to roadway embankment, due to the feasibility and constructi~ili~y of ~e~Upgrade Design Plan.~ We feel that the effluent discharge into the type of soil (GM) is of the type that will not allow an effluent lateral absorption to exceed 15'. The soil found on this lot is GM in .both test holes performed. The current Upgrade Permit design has 7.5' shown for the total depth. This simply will not work due to the existing discharge elevation from the home. The total depth must be increased to 9.5' for the west trench and 13.5. for the east trench, see site plan. The test hole performed by AECS was to the depth of 15'. The one we observed yesterday went to the depth We request that if we observe another testhole to the of 16' , depth ~f 19.5..or 20 to be associated with the east trench, can we pro- ceed with the installation of this plan, or is a waiting period required??? Sincerely, Alan Haraia for Michael E. Anderson, p. E. SITE PLAN SCALE 1" = 30' SHEET NO. CALCULATE0 BY CHECKED BY ~3~' OF DATE. SHEETNO. OF CALCULATED BY. DATE CHECKED BY DATE SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~ ~1, ~K ~ ~Township, Range, Section: 8 9 10 11 12 13 14 . 15 16 17 18 19 20 COMMENTS '%~'- ~"/ WAS GROUND WATER ENCOUNTERED? $ L IF YES, AT WHAT O DEPTH? p E Depth to Water Alter M0nit~dng? - Dai.. Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT ACCoRDANcE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: / Z./~/~ 72-008 (Rev. 4/85) MEMORANDUM FROM: Mike Anderson, P.E. fyI t. A_ Municipality of Anchorage Dept. Health & Human Services SUBJECT: Lot 2, Block 1, Park Place Subdivision Septic System As -Built Certification Attached is the certified as -built for the septic system constructed on Lot 2, Block 1, Park Place Subdivision along with comments from the original review by Jim Williams of your staff. I will address each of his comments in the order received. 1. A soils log is submitted which shows soil strata to 6' below the system.. 2. A cross section which shows the west trench relative to the toe of slope along Bettijean Street is attached. Also attached is a letter to Dan Roth of your staff requesting a variance to the separation distance between the absorption field and roadway embankment. The original letter, which should be in your files, was approved by Mr. Roth before the system was constructed. 3. All depressions over the septic area have been filled in and all jim caps are in place. 4. The attached drawing `shows the distance from the well to the north and the septic tank. The distance between the well and the septic tank cleanout is 100.5'. It is true that a portion of the tank is within the 100' radius, but both the inlet and outlet of the tank are at least 100' from the well. The tank was placed at the same location as the old tank, but was moved out of the 100' radius of the well on the lot. The excavator was somewhat imprecise in the placement of the tank and thought the entire tank was outside the 100' radii of both wells. This is the only location for the tank in which the flow diverter valve will work to both the old trench and the new absorption trench. We respectfully request that a waiver between the tank and the well to the north not be required in this instance. 5. The new absorption trenches were originally designed to be entered in the center. Because of the distance separating the two absorption trenches it is easiest to enter at the north end. My technician, Alan Harala, discussed this with you in December of 1995, as I was out of town. He received verbal authorization to enter the trenches at the north end and not as shown on the design. The system is constructed with a flow divider and both trenches receive equal amounts of effluent. We are confident the trenches will work in the configuration constructed and are hopeful the as -built can now be certified and further action is unnecessary. 75.15 c~'c~o SCALE "S4'S4~'~ lO0:OO_~, ADDITION NO. I PARK PLACE SUBDIVISION MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. POX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PERMIT NUMBER:SW950387 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:VALENTINE DENNIS M & ROXANN O OWNER ADDRESS:16851 BETTIJEAN ST ANCHORAGE, ALASKA 99516 PAGE 1 OF 1 I ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT DATE ISSUED:il/13/95 EXPIRATION DATE:il/13/96 PARCEL ID:02009267 LEGAL DESCRIPTION: PARK PLACE #1 BLK 1 LT 2 LOT SIZE: 41558 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 PHE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: AT THE TIME OF CONSTRUCTION ENGINEER SHALL CONSTRUCT A NEW SEPTIC TANK A MINIMUM OF 100 FEET FROM THE WATER WELL ON THE PROPERTY. RECEIVED BY: ~' ~ ~ ~ DATE: ISSUED BY: ' DATE: //--/~ ~ October 27, 1995 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 2, Block 1, Park Place Subdivision, Addn. No. 1 Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The absorption trench on the subject lot has failed and must be replaced. We hereby request a permit to upgrade the system in accordance with the attached design. A testhole placed on the lot revealed a medium graded gravel with a percolation rate of 46 minutes per inch. We are proposing to place a wide drainfield with 4' of drainage rock beneath the laterals. A total of 134' of trench will be required. A splitter valve will be installed at the intersection of the two trenches. The topography of the lot slopes from north to south from 1% to 12%. It also slopes from west to east at a rate of 0% to 12%. No groundwater was found in the testhole to depths of over 12'. The existing septic tank will be exposed and checked for any leaks or other distress. If the tank is found to be leaking it will be replaced with a new tank placed outside the well radius. No other conflicts exists with other wells in the area. If the absorption trench is placed in the location shown the following statements can be made: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. ,Lot 2, Block 1, Park Place Sub., Addn. No. 1 October 27, 1995 Page Two The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments AREA MAP SCALE 1" = 100' SHEET NO. OF. CALCUL4T~D 8'~ DATE C~"C~ED BYI ' DATE SCALE / ~ ~-' /'~a i ' : " ":~::' * ' ......... ~ ............... -- LOT 2, BLOCK 1, PARK PLACE SUBDI¥1$1ON ' ............ .... ADDITION NO. 1 ...... SITE PLAN SCALE 1" = 30' SHEET NO. OF CALCULATED BY DATE CHECKED BY, DATE SCALE LOT 2, BLOCK 1, PARK PLACE SUBDIVISION NO. I DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Perc. Rate: 46 Min./In. Application Rate: .45 GPD/SF Reduction Factor: .5 Shallow Trench System 1,250 Gallon Tank (Existing) 4' Gravel Beneath Dist. Pipe 4 Bdrms. X 150 GPD ! .45 GPD/SF = 1,334 SF of Absorption Area 1,334 SF ! 5 LF X .5 (Red. Factor) = 134 LF Total Absorption Trench Therefore: Construct a Shallow Wide Absorption Trench System With Two Laterals Each 67' in Length. Distribution Pipe Placed at 3.5' Below Ground Surface. Verify the integrity of the existing septic tank and resuse if acceptable. S' '--.O" I TYPICAL WIDE TRENCH SYSTEM (NO SCALE) NOTE: 1. Bottom of Trench to be 4' Above Groundwater. 2. Grade Area Over Trench to Drain Municipality o! Anchorage 825 "L" Street, Anchorage, Alaska 99502-0650 DEPARTMENT OF HEALTH & HUMAN SERVICES SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: L~i ~1i ~ ~ ~/~ Township, Range, Section: 6 7 8 9, 10- 11 12 13- 14- 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT O ~ '""' "'"' DEPTH? ~ ,.: _z~ ~' -- Monitoring? /Vo,~~r' Dale: /! Reading Date Gross Net Depth to Net Time Time Water mw Drop 7..~/~' ~ $,/~ ,el ~,'~,~ /~ ~ .~ PERCOLATION RATE ~/"~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN "A"- FT AND '~ FT 72-008 (Rev. 4/85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: Lot 2, Block 1, Park Place Sub., Addn. No. I GENERAL: 1. The scope of this project includes the verification of the integrity of the existing 1,250 gallon septic tank and the construction of a wide absorption trench with 4' of drainfield rock beneath the distribution pipe. A total length of 134 L.F. of trench is required with 2 laterals. A diversion valve will be installed at the intersection of the two trenches. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION/REPAIR The existing septic tank shall be exposed and checked for leaks on all surfaces. If leakage is detected a new septic tank must be installed. Lot 2, Block 1, Park Place Sub., Addn. No. 1 October 27, 1995 Page Two 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Septic tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts shall be installed between the tank and the drainfield. The first cleanout shall be located on undisturbed soil not more than 10' from the tank. The first cleanout shall be to clean toward the drainfield. The second cleanout shall be to clean toward the tank. 7. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. Lot 2, Block 1, Park Place Sub., Addn. No. 1 October 27, 1995 Page Three 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Lot 2, Block 1, Park Place Sub., Addn. No. 1 October 27, 1995 Page Four 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 seive. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. 'i, ..... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ~NEW MAILING ADD~ESS LEGAL DESCriPTiON LOCATION ~ ~Z Manufacturer ~,~ Ma~ ~ No. of corem,hts. ~ Liq. capacity in gallons inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material ~--~ Liquid capacity in gallons No. of lines I Length of;~oach~ line Total~en~th.~ of lines Trench wid~hO~ inchos Distance betmeen.~ lines O ~ ~ Top of tile to finish grade ~._ ~t¢~ Material beneath tile ~ ~ inches Total effective Length Width Depth PERMIT NO. ( ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL ~/?BI ]]OX ]~(~9~ ~TAR ~OUTE A -~NCHORAGE. ALASKA 99502 $1X INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 295 ~ '- .. 7' ¢.~-~ .o DRILLED at THE raTE OF .i"~9.,I~ 00 PER FOOT. PROPERTY OWNER LOCATION OF WELL SITE DRILLER WELL LOG: 0 ....... 2.3' COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CheCK PaYabLE TO RamParT DRILLING WORKS FOr THE SUM OF ?7~g~ THANK YOU VERY MUCH. DATE BERNIE C A~L~S OF RAMPART DRILLING WORKS :t~.e. 'b. ct.~ 192,! SERVICE CHARGE OF 1~% PER MONTH WILL BE ASSESSED ON PAST DUEACOOUNT~. [EFHRTMENF ~, ,HERLTH RND EN'¢IRONMENTBL~, ~OTECTION ' * ,--,...', L STREET., RNE:HORRGE., PK. ~ ~.b4 4~ ~0 F'ERMIT NO. r 8'2~0065 ) BF'PLICBNT - - - - .. Z._Z4' LOCBTION OFF GOLDEN VIEW DR. LEGBL L 2 B 1 F'BRK FLN_.E F'EF-:[-I ][ T · -~,r --.~.r 4~, LOT SIZE 50000 SE.!URF.:E FEET TYF'E OF SOIL MB_,UF..FTION SYSTEM IS: [:,RRINFiEL[:, MRY-.'IMUM NLI1BER OF EE[:,F.'O-Mq 4 SOIL RRTING ,:$E.~ FT,-"E:R)= 'lt._ THE F.:EQLIIRE[:, SIZE OF THE SOIL RBSORPTION SYSTEM IS: [:.EF"TH= 7 LE~-~.3TH= 7~-;. .3F-:R%-"EL [)EF"TH=: 3:. 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD, THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THE TF:E~-~E:H ~.~ Z [:.TH Z :5 5. EI~Z~Z~ FEET. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OLITFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). F-: E,;., ~J I F-: El:."_---. F P T. X C: TR~,~ ~-::~ '---5 :[ ZE = -~ 25£~ F'ERMIT RPF'LiC:RNT HRS THE REz, F_Nz, IE, ILIT? TO INFORM THIS DEPRRTMENT DLIF.:ING THE IN'--;TRLLRTION INSPECTIONS OF RN'.,-' WELLS RDJRCEI'.,IT TO THIS F'ROF'EF.:T'-r' RND THE NLME:ER OF RESI[:'ENZ:ES THRT THE WELL WILL SERVE. BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPRO'..,'RL BY THIS DEF'RRTMENT WILL BE --,UBJEL. T TO F'F.'n'=,EF:IITII-iN. MINIMLIM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS ±00 FEET FOR R PRIV8TE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM 8 PRIVRTE WELL. TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS PRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS PRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. I CERTIFY THRT l: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. SIGNED: ........... RF'F'LICRNT ~.¢~R","L PRLMER i S,=;ijEF:, ,, '~, -. ',,,'4. 0 h~'~4r~,i i,~ r~IqF~NCi~ ~-,'~. ~' ' . .-,~,'~ .... ~b.,~ i_.""' ~:, FS~T , ,r- _,,.,, h'~_~ I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: I 2 3 4 5 6 7 8 9 sHE SLOPE SITE PLAN / i' / / 10 11 12 13 14 15 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: WAS GROUND WATER S ENCOUNTERED? /'~ O L E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time £~,~ r~') Water Drop i i'~O ~ ~'.~- . q5 ,1~~ L5 r- ~1 ~oo 10 'q~ .i ~ PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: - "'-~'" '"(minutes/inch] FT AND ~ FT ! 72-oo8 Certificate of On -Site Systems Approval Parcel I.D, 020-092-67 1. GENERAL INFORMATION Expiration Date: ie �00 Complete legal description PARK PLACE #1 BLK I LT 2 Location (site address) 16851 BETTIJEAN ST, ANCH AK Current property owner(s) VALENTINE FAMILY TRUST Day phone Mailing address SAME Real estate agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) EJ Duplex 1-1 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic Z Water Storage El Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5,%C-,), ID -1c, Waiver Fee $ Date of Payment I / I I 12020 Date of Payment Receipt Number 00HLA Receipt Number COSA # OSC� 01 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 8-31-20 S. DSD SIGNATURE ✓ System #1 Approved for 4 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, r ^v'• ♦ MICHAEL N. ANDCRZiCN00 CE 94 P FESSl4ti���"` with the following stipulatlo. ,�r•'�'` J \N nob By: QA 6Ad� Original q g nal Cerilflcate Date: X�d,2d The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: PARK PLACE #1 BLK 1 LT 2 Parcel ID: 020-092-67 If more than 1 septic system on lot: COSA Checklist # of _ Structure served by this system A. WELL DATA n Well log is filed with Onsite (or attached) Date drilled 512/83 Total depth 255 ft Cased to 255 ft 0 Sanitary seal is functioning correctly no Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 9/4/20 Static water level at beginning of test 42.4 ft Comments B. TANK DATA Age of tank(s) 2020 years Tank type/material Measured operating fluid level in septic tank NEW Standpipes/foundation cleanout per record drawing Date of pumping * new plastic septic tank installed D. ABSORPTION FIELD DATA Which system tested (date installed) 12/29,95 ❑X ALL standpipes present per record drawing Total measured depth from grade 12.2 ft (max) Measured depth to pipe invert from grade 8.2' ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective _ ❑ Code -required soil cover over field Well production at time of test I.2+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes V No ❑ Coliform bacteria is Negative Nitrate mg/L a Nitrate less than MRL (ND) Arsenic Collected by - ug/L X Arsenic less than MRL (ND) MNA Date of Sample 8/24/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 8/24/20 Results [D Pass For 4 bedrooms Fluid depth prior to test 16 in Water added 600+ gal New depth 28 in Elapsed time 1440 min Final fluid depth 17 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test)If yes, enter date 0 Gallons introduced gallons Comments/Deficiencies:. grass has grown up so the measurement is slightly higher than the asbuilt COSA Checklist yellow sheet 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' Q Yes Community Sewer Manhole/Cleanout > 100' ❑Q Yes if No _ ft M Yes if No _ ft Neighboring Tank > 100' ❑✓ Yes if No _ ft Private Sewer/Septic Line > 25' 21 Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No_ ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' ❑✓ Yes if No _ ft Water Main > 10'Q❑ Animal Containment > 50' ❑✓ Yes if No ft ❑Q Yes if No _ ft 0✓ Yes if No _ ft Water Service Line > 10' ❑Q Yes if No_ Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' Q Yes f No _ ft MQ Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No _ ft Surface Water > 100' QQ Yes if No ft Property Line > 5' Yes Yes if No _ ft Wells on Adjacent Lots: Absorption Field > 5' if No Yes if No _ ft Private Wells > 100' ❑✓ Yes if No _ ft Water Main > 10'Q❑ Yes if No —ft Community Wells > 200' 0✓ Yes if No _ ft Water Service Line > 10' ❑Q 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' Q✓ 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' ❑Q Yes if No _ ft Water Service Line > 10' ❑✓ Yes if No —ft Community Wells > 200' ❑Q Yes if No _ ft Surface Water > 100'✓Q Yes if No _ ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 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. COSA Checklist yellow sheet f C�:•:a''t��%, 49Z_i `0 e �t f^ CE 4 f' i��lfoPRQF SSlO���``—� 2020-036965-0 L Recording Dist: 301 - Anchorage S 8/18/2020 01:17 PM Pages: 1 of 4 • IIIIIIIIIIIIIIIIIIIIIII 1103-05D Grid 3337 EN20014 020-092-67-000 This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric cooperative, (herein "Chugach"), whose address is P. O. Box 196300, Anchorage, Alaska 99519 and 2017 Valentine Family Trust, Dennis M. Valentine and Roxanne O. Valentine Co -Trustees (herein "Permittee"), whose address is 16851 Bettijean Street, Anchorage, Alaska 99516. 1. Easement. Chugach is the grantee or user of an easement for the construction and maintenance of electrical facilities, as follows: Dedicated by the plat of the subdivision known as Park Place Subdivision, Addition No. 1, according to Plat Number 82-244, recorded on the 201h day of August 1982, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska, (herein "Easement") which pertains to the following described real property: The Northeasterly Ten Feet (NE 10') of Lot Two (2), Block One (1), Park Place Subdivision, Addition No. 1, according to Plat Number 82-244, recorded on the 20th day of August 1982, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska. Permittee acknowledges the validity of the Easement. Permittee warrants and represents that Permittee is the owner of the fee simple interest in the land subject to the Easement and the following described real property to which the Easement is adjacent: Lot Two (2), Block One (1), Park Place Subdivision, Addition No. 1, according to Plat Number 82-244, recorded on the 20th day of August 1982, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska, (herein "Parcel") 2. Encroachment. Permittee has constructed or purchased the following improvements on or within the real property subject to said Easement: Encroachment Permit - Page 1 of 4 eRecorded Document A well that encroaches approximately Three Feet (3') into the northeasterly side of said Easement along the northeasterly property line, for a distance of approximately One Foot (I'), (herein "Encroachment") 3. Permit. Chugach hereby authorizes Permittee to continue the existence of the Encroachment in its existing location subject to the covenants set forth in this permit. 4. Indemnification. Permittee shall indemnify and hold Chugach harmless from any claims for personal injury, property damage or other loss arising in any way from the continuation of the Encroachment. 5. No Expansion or Increase. Permittee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior written consent of Chugach. Chugach has no obligation to provide such consent. 6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit, has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any other real property. Without in any way limiting the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes of the common law doctrine of adverse possession. This permit creates no interest in the real property subject to the easement. 7. Modification of Utility Facilities. If the electric utility facilities located within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. If such payment is not made within thirty (30) days of written demand for same, Chugach may terminate this permit in accordance with paragraph 9, below. 8. Covenants Running with the Land. The obligations of the Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the land subject to the Easement and shall benefit the Easement. 9. Termination. Chugach may terminate this permit after the giving of thirty (30) days written notice of such termination if: a. The Encroachment is enlarged, increased or extended within the real property affected by the Easement b. The Encroachment is damaged by any means to an extent of more than thirty percent (30%) of its replacement cost at the time of destruction. Encroachment Permit - Page 2 of 4 2of4 eRecorded Document 2020-036965-0 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 ASSOCIATION, INC. By: , Shelly Schmitt, enior Manager Date: al I g '-)0ov eRecorded Document PERMITTEE By: Y Dennis M. Valentine, Co -Trustee 2017 Valentine Family Trust ��Mm By: rC -L- (9 Roxann O. Valentine, Co -Trustee 2017 Valentine Family Trust Date: Encroachment Permit - Page 3 of 4 3of4 2020-036965-0 STATE OF ALASKA ) ) ss: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this /�Wday of - 2020, by Dennis M. Valentine and Roxann O. Valentine. STATE OF ALASKA ss: THIRD JUDICIAL DISTRICT r11Le��_ r Mary Ptb 'c in and for the State of Alaska My commission expires: The fo • going i strument was acknowledged before me this day of , 2020, by , (/ Senior Manager, Distribution Engineering&f Chugach Electric Association, Inc., an Alaska corporation, on behalf of the corporation. G AFTER RECORDING RETURN TO: Chugach Electric Association, Inc. P.O. Box 196300 Anchorage, Alaska 99519-6300 �e Notary Public in and for the State of Alaska My commission expires: (?1 -01 -'?2 Encroachment Permit - Page 4 of 4 4of4 eRecorded Document 2020-036965-0 ENSTAR Natural Gas Company September 16, 2020 2017 Valentine Family Trust Dennis M. Valentine & Roxanne O. Valentine 16851 Bettijean Street Anchorage, AK 99516 ENSTAR Natural Gas Company A DIVISION OF SEMCO ENERGY Engineering Department, Right of Way Section 401 E. International Airport Road P. O. Box 190288 Anchorage, Alaska 99519-0288 (907) 277-5551 FAX (907) 334-7798 Subject: Letter of Non -Objection- well Lot 2, Block 1, Park Place Subdivision Addition No. 1 To whom it may concern: ENSTAR Natural Gas Company has no objection to the existing well encroachment within the ten foot (10 FT) wide Tele. & Elec. Easement, coincident and parallel to the east lot line of Lot 2, Block 1, Park Place Subdivision Addition No. 1, according to Plat No. 82-244, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. 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: • Landowner/Contractor working near ENSTAR gas facilities shall contact the Alaska Digline, Inc., (907) 278-3121 or 811 for line locating two (2) business days prior to any related excavation. This service is free of charge. • ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. • Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. • Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the land owner. • All applicable safety code regulations will be observed and maintained. • This letter of non -objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, Cassie Acres Right of Way & Compliance Technician ENSTAR Natural Gas Company DocuSign Envelope ID D0035CH9-DADC-43B8-B8F69FDO17F8149A 'GCI September 10, 2020 Dennis M Valentine & Roxanne O. Valentine 16851 Bettijean Street Anchorage, AK 99516 To whom it may concern. Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the existing well encroaching into the utility easement of Lot 2, Block 1 Park Place Subdivision 41, also known as 16851 Bettijean Street, city grid 3337, GCI WO#20-0006-35. This letter of non -objection in no way precludes GCI Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right-of-way, including unlimited access for servicing its facilities. Also, any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of GC I's facilities to accommodate any or all the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance try signing and returning this letter to me at the address below Sincerely, DocuSipned by [[`, �rr K `---- 10444 181 I 17141(. Markus Kofoid Sion llr 1), it t) Manager Sr. Field Searvicos Contral Region GCI Communication Corp 5151 Fairbanks St. Anchorage, AK 99503 007-868-6168 Off ic.:e 907-868-8580 Fax , ", APPLIC FILLS OUT UPPER HAL .ONLY Buyer Address '~ ~ ~ Zip Code Lending Institution FID ~')~' (7-t.%)( l?[~c S!~ ~2, ~,) ~ j c ~A ~) Phone Address Zip Code ~. 7 Z Realty Co. & Age~ Phone Address Zip Code Legal Description ~ ~ ~ ) [2/1~ /P~.~'~ .~/ Street Locati~ 1 ~:;'1 I~L' i-l//v~,~ ~ I r ~ ~.~ Type of Residence ~e Family [] Multiple Family [] Other No. of Bedrooms. Water Supply ~l'~ivid ual [] Community [] Public Utility ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior lo that date, give well depth (attach Icg if available). Sewer~,Grsposal ~[~ Individual [] Public Utility [] Holding Tank Year Individual Installed: / ''~ ~ When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date /~. ~//.,~. (~. Inspector Inspector Inspector Inspector Field Notes: /.f¢-~.,~ MuNtCIPALFP( OF ANCHO~GE DEPT. OF H~ALTH & ~NvIRONM~NTAL PROTECTION (~ APPROVED BEDROOMS *GONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL~ Soils Rating Date ~wer installed Well To Absorption Area ~ / Well Log Received /~_ / '7 ~ ~ ~ 3 --~2 WelltoTank / ~ / Septic r~k Size /~ S'0 72-023 [3182)