HomeMy WebLinkAboutSPENDLOVE VIEW HEIGHTS #2 BLK 4 LT 2pendlove View
Heights #2
Block 4
Lot 2
#017-401-33
(�\\ Municipality of Anchorage
Department of Health and Human Services
Building Safety Division
• On-She Water and Wastewater Program, 4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL
INSPECTION REPORT
Permit Number: SW 0
PID Number: 17-4 1-33
Name:
iffirlaw Wastewater System: ❑ New ® Upgrade
Address:
AK 99151 A ABSORPTION FIELD
Phone-
Number of Sedmoms:
® Deep Trench ❑ Shagow, Trench C3 Bed Mound p Dyrer:
LEGAL DESCRIPTION Sod Rating: Total Depth hem original Mile:
Block: Lot Subdivision:9.0 Ft
SiDe Depth to pipe bottom from original gmdo: Gravel depth beneath pipe:
Township: Range: Section: Fill added above odgiml g2de: Gravel Length:
1- F.
Well. ❑ New ❑ Upgrade Grave F t.
wdm: Numberoflinea: Distance between Ones:
Clessiflcation (Private, A, B, C): Total D0 3 Ft. 1 0 Ft
Depth: cased to: Total absorption pipo Material:
Exi
FL Ft. 6O FF 034 PVC
Driller: Dab±DrNb4 start, Water Level: Imtaller.
Data InshOled:
Yid:Pump Ft. Beek Contractin 8/ 212004
Set a: Casing HelghtAbove Ground:
GPM F. Ft TANK
SEPARATION DISTANCES
septic p Holding ❑ S.T.E.P. Other:
Septic
P Absorption Lift Holding ublWPrivate
Tank Field Station Tank Sewer Lina
Manufedurer. gpaary:
AnehTank
1000Ga1.
11,0 126,4 75
Steel Numberofccrepamnents:
2
B00+ 100p+
M13
LIFT STATION
8.2
27.$
Sive.
Manufacturer.
Cal.
q
13 28
°Pompon"level at. "Pump or leval at: High water alarm at:
100+
°.
in. In.00+
Pump Make ElecSriealNnpacupnapertormod ty.
Remarks:
T
BENCH MARK
^�
Location and Description:
Hot Tub Deck
Assumed Elovation:
100.0 FL
Engineer's Stamp
� O � � M1,!
••,••':.�
Inspections performed b Pannone Eng. S°'8/1212004
y' � Svc Dates: 1
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Department of Health and Human Services approval
••• •••• -
• •
•Steven
Reviewed and
R. Fonnoner'
approved b?Date:
(Reva q._. 4�J[f.
neo. CE 8219.`
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PERMIT NO: SWO40290
SPEN
/—EXISTG WELL
SWING TIES
CO A 8
T1 15.0 37.4
T2 18.1 36.1
DC 18.6 34.2
DV 19.1 32.6
C1 28.0 42.0
M1 29.3 43.3
1
09
RECORD DRAWING
WASTEWATER DISPOSAL SYSTEM
Lot 2, Block 4 Spendlove View Hts, S/D, No. 2
P.I.D. NO: 017-401-33
DRIVE
v 11 l
� I I
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�EXIST'G WELL
1
1
EX1ST'G D NFIE
IN FAILLI4TO
2 69.1 62.0 /
M2 68.2 61.5 /
E1 23.1 26.2 /
Ez 62.9 50.1
NOTE
1) ALLWORK WAS PERFORMED
IN ACCORDANCE WITH AMC15.66.
2) MATERIALS USED IS IN
ACCORDANCE WITH THOSE SPECIFIED
IN AMC15.65, WASTEWATER DISPOSAL.
3) INSTALLED A DIVERTER VALVE BETWEEN
OLD FIELD.
4 /
/
49TH
10% DOUSE 4
10% (DV)
/ I
EW REPLACEMENTI S`
✓$ _ _ _ 50LFx3'Wx6'ED, 10'TDI
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0 `I
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R.—Pannone: i �•`� "'•`u rWR'
Thom 8. Tracey Ziedow
'EdiB�lr4g \ 8740 Spendbve Drive
,.••°�� Anchorage, AK 99516
......;� � 562-1012
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TANK SIZE: 1,000 gallon
PERC. RATE: 13.3 MPI
SOIL RATING: 0.8 gpd/SF
(188 SFBR)
AREA ROD: 564 SF
SYS. TYPE: DEEP TRENCH, 61EFF
SIZE: 501-174 WIDE, 6'ED, 10' TOTAL DEPTH
PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P, 272-8218 Fax
RECORD
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PERMIT NO:
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No. CE 8149
RECORD DETAILS P.I.D. NO: 017-401-33
WASTEWATER ABSORPTION SYSTEM
Lot 2, Block 4 Spendiove View Hts, S/D, No. 2
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272-8218 PHONE & FAX
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DATE: 8-20-04
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Tom & Tracey 7_ietlow
PANNONE ENG. SVC.,LLC
8740 Spendbve Drive
P. O. BOX 102954
Anchorage, AK 99516
ANCHORAGE, ALASKA 99510
562-1012
272-8218 PHONE & FAX
DATE: 8-20-04
NOT TO SCALE RECORD
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial / Upgrade
Date Issued: Jul 26, 2004
Expiration Date: Jul 26, 2005
Permit Number: SW040290 Parcel ID: 017-401-33
Legal Description: SPEN=VEVT %W'ff5fGFITS` TBLK" "CT;;K'
Design Engineer: 0062 Pannone Engineering Services Site Address: 008740 SPENDLOVE DR
Owner Name: Tom & Tracey Zietlow Lot Size: 48993 SQ. FT.
Owner Address: 8740 SPENDLOVE DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE, AK 99516-3356
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERNNELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017401.33 Permit Number SW
Property owners) Tom & Tracey Zietlow Day phone 562.1012
Mailing address (1) 8740 SQendlove Drive
Mailing address (2) Anchorage. AK Zip Code 99516
Legal description (Lot, Block & Sub'd.) Lot 2. Block 4 Soendiove View Hts, No. 2
Legal description (Section, Township & Range)
Lot Size 1.129 $-9013 AcrestSq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms 3
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub ® Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Waiver Fees:
Date of Payment:
Receipt Number: `'t / CJ/ u ) /Receipt Number.
(Rev. 12100)
A SawlE, in V17)
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Pannone Engineering Services, LLC P.O. Box 102954
Consulting Engineers Anchorage, Alaska, 99510
(907) 272-8218 (907) 272-8218 Fax
July 19, 2004
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 2, Block 4 Spendlove View Hts, No. 2
Septic field Upgrade Permit Request
Gentlemen:
My firm was contacted to design an upgrade to the existing three-bedroom system on the above
referenced lot. During a recent Health Authority Investigation for an upcoming sale, it was
discovered that the existing septic system is in failure. I conducted a single test hole on July 10,
2004. I have attached the soils report and percolation test for your review. No bedrock was
encountered in the test holes. Groundwater was monitored for eight days, and there was six
inches of groundwater after the monitoring period. I will use a depth six feet above this as the
bottom of the trench.
The lot is approximately 1. 129 acres in size and is served by a private well located on the
northeast portion of the lot, on the property line. The issue of the well being on the property line
has been addressed by your department during a Health Authority Investigation for the
neighboring lot. Lot 2 slopes to the south at approximately 8 to 12 percent in the area of the
septic system. The proposed installation will be located in the central portion of the lot. The
existing 1000 -gallon septic tank will be removed and a new 1000 -gallon septic tank will be
installed to serve the house. The existing drain field will be reused. A diverter valve will be
installed between the two fields. Both systems are located greater than 100 feet from the well
serving this lot and surrounding lots. The proposed location is greater than 25 feet from the
water service lines. The other surrounding wells are located greater than 100 feet from the
proposed installation. The proposed installation will not affect the future development of the
surrounding or existing lots. See the attached design.
If you have any questions or concerns, please contact me at 227-3522 or 272-8218.
Sincerely,
Attachments:
PERMIT NO: DESIGN P.I.D. NO: 017-401-33
WASTEWATER DISPOSAL SYSTEM
Lot 2, Block 4 Spendlove View Hts, SM, No. 2
SPENDLOVF- DRIVE
1 ,I I
—EXISTG WELL
2//
y
s/ IXISTG WELL
I
I I
--� , �25% I vf\
EXISTG D FIELD G 3BR
IN FAILU TO BE HOUSE10%
i REUSED
XIST`G TANK /
TH 13. TO B1 ABANDONED /
10% IN PLAC
3 6. 10% 8000 EI0 MW'
F� � 1
NOTE: 1000 EPtTIC TANK
1) ALLWORK SHALL BE PERFORMED 1
IN ACCORDANCE WITH AMC15.65.AL P
2) MATERIALS USED SHALL BE IN DIV R E , VALVE
ACCORDANCE WITH THOSE SPECIFIED ROPOSED REPLACEM Nt SYSTEM
IN AMC15.65, WASTEWATER DISPOSAL. `
3) INSTALL A DIVERTER VALVE BETWEEN N &50LFx3'Wx6'ED, *@TDI /p
OLD FIELD. — — —
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R. Pannone: = Thom & Trac0 zietbw
CE 8149 ,+ w 8740 Spendlove Drive
�OQ•.••'•�' Anchorage, AK 99616
.. .,.aDl. .• 562-1012
TANK SIZE; 1,000 gallon
PERC. RATE: 13.3 MPI
SOIL RATING: 0.8 gpd/SF
(188 SFIBR)
AREA ROD: 564 SF
SYS. TYPE: DEEP TRENCH, VEFF
SIZE: 50LFx3'WIDE, 6'ED,, 70TAL��T 10q
TOTAL AREA 600 SF 47APE
PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P, 272-8218 Fax
DESIGN
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DESIGN DETAILS
P.I.D. NO: 017-401-33
PERMIT NO:
WASTEWATER ABSORPTION SYSTEM
Lot 2, Block 4 Spendiove View Hts, S/D, No. 2
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PREPARED FOR
PANNONE ENG. SVC.,LLC
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No. CE 8149
Tom a Tracependly Dri
P. O. BOX 102954
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8740 Spendbve Drive
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Anchorage, AK 99516
ANCHORAGE, ALASKA 99510
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562-1012
272-8218 PHONE &FAX
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7C4R DESIGN
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SOILS LOO - PERCOLATION TEST
PANNONE ENGINEERING SERVICES
P.O. BOX 102954
ANCHORAGE, AK 99510
(907) 272-8218
PERFORMED FOR: Tom & Tracey Zietlow DATE PERFORMED: 7-10-04
LEGAL DESCRIPTION: Lot 2, Block 4 Spendlove View Hts S/D #2
1
2
3
4
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Test Hole I
OR Organic
Topsoil
GP/Poorly Graded
GM GRAVELS to
I
Silty GRAVELS
SLOPE
TEST HOLE
�'•49TM �.:'y�'1
Steven R. PGn e.4
—
n°.- No. CE 8149 .°
WAS GROUND WATER
Poorly Graded ENCOUNTERED? No
GP/SP GRAVELS WJ
Sand IF YES, AT WHAT
DEPTH? -0-'
BOH
DEPTH TO WATER AFTER
MONITORING? 15.5
DATE: 7-18-04
TEST HOLE
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
7-10-04
12:15
6 118'
12:45
30
3 7 V
2114"
12:46 6 1/2"
13.15
30
41/4'
-- 21W
13:15
6 1/4'
13:45 30 4"
2 114"
PEROLATION RATE 13.3 (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BEWfEEN 7 FT and 8 FT
COMMENTS: Test hole excavated by Beek Excay. Test Hole was presoaked before perc test.
PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
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\ Municipality of Anchorage
• -- Development Services Department *A1
Building Safety Division On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 l
Anchorage, AK 99519-6650
www.munf.org/onsite `
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING o /
Parcel I.D. L%^ COSA# I� 90 Ta R
Expiration Date: -:3 — 3 — 0 Cl
1. GENERAL INFORMATION
Complete legal description Spendlove View Heights #2 Block 4 Lot 2
Location (site address) 8740 Spendlove Drive, Anchorage, AK 99516
Current Property owner(s) GaryW. Soberav Day phone 227-7362
Mailing address 8740 Spendlove Drive, Anchorage, AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSH will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services, LLC Phone 272-8218
Address P.O. Box 102954, Anchorage, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date 12/19/08
Engineers Comments: In conducting an adequacy lest, l attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with h10A DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the system.
Thcsc conditions arc outside the control of the evaluator of this system. All systems eventually fail and
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
confer any legal right whatsoever.
5. DSD SIGNATURE
_j,t::f Approved for _.,!5- bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: vv !/ f Original Certificate Date: 102. —2 3 � d c9
(Rev. I1N5)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Spendlove View Heights No 2 Block 4 Lot 2 Parcel ID: 017.401.33
A. WELL DATA
Well type P If A, B, or C provide PWSID k _ Well Log (Y/N) N
Date completed _ Sanitary seal (Y/N) I Wires properly protected (Y/N) Y
Total depth 118 ft. Cased to 40+ ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 1214 008
Static water level ft. 29 ft.
Well production 9.p -m. 2.2 g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate 3.03 mg/L Other bacteria 0 colonies/100 mL
Arsenic: NQ ug/I Date of sample: 12102008 Collected by: Michael Wehr
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Anchorage Tank Steel Date installed 811212004
Tank size 1000 gal. Number of Compartments I Cleanouts (Y/N) v
Foundation cleanout (Y/N) y Depression over tank (Y/N) p High water alarm (Y/N) nla
Date of pumping 1212112008 Pumper A Plus Home Services
C. ABSORPTION FIELD DATA
Date installed11218 2004 Soil rating (g.p.d./ft2 or f?1bdrm) 9-8— System type deep trench
Length 60 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 9 ft. Eff. absorption area 600f? Monitoring tube Y Depression over field N
Date of adequacy test 121412008 Results (Pass/Fail) PASS For 2 bedrooms
Fluid depth in absorption field before test 4 in. Water added450 gal. New depth9 in.
Elapsed Time: 60 min. Final fluid depth 4 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at_ in.
Datum
Size in gallons
"Pump off"level at —In.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 111
Absorption field on lot 126
Public sewer main 100+
Sewer /septic service line 100+
Animal containment areas 75+
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 13 Property line 66.2 Absorption field 10+
Water main 100+ Water service line 30+ Surface water 100+
Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 27.8 Building foundation 28 Water main 100+
Water Service line 50+ Surface water 100+ Driveway, parking/vehicle storage 20+
Curtain drain Non Observed Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and,.""f. qoi»
review of Municipal records that the above systems are in ;. »,•._ ,..,.
conformance with MOA COSA guidelines in effect on this date.
�.. »;.
0 ,Steven R. Ponnonej
Engineer's Printed Name Steven R. Pannone. P.E. ��� R r<
Date 1211912006 e� ,,..........�,�,_�.
COSA Fee $ 3Q
Date of Payment 12,14101,62V
Receipt Number 07122a
(Rev. 11/05)
Waiver Fee S
Date of Payment
Receipt Number
TO
4,111
wqfE�Jl
SCS RcE#
1086524001
Client Name
Pannone Eng. Srv.
Project Name/M
Spcndlovc View k2 B41-2
Client Sample ID
Spendlovc View (12 841.2
Matrix
Drinking Water
P\N'SID
0
Sampic Remarks
Parameter
Results
PQL
(<10)
12/10/08 12/16/08
NRB
Metals by SCP/MS
S%1204300NO3-F
B
Arsenic
ND
5.00
Waters Department
Total NitratcMnritc-N
3.03
0.100
Printed Date/Time
Collected Daterrime
Receired Date/rime
Technical Director
12/182008 13:06
12/042008 12:28
12/042008 13:00
Stephen C. Ede
Allowable Prep Analysis
Units Method Container ID Limits Date Date
u8/L
EP200.8
C
(<10)
12/10/08 12/16/08
NRB
mgt,
S%1204300NO3-F
B
(<IO)
12/ON8
!DZ
Microbiology Laboratory
Colony Count 0 col/IOOml- SX120 9222B
Total Coliform 0 col/IOOml. Sh1209222B
Fecal Coliform 0 col/IOOml- S%1209222B
A (<200)
A (<I)
A (<1)
12/04/08 DLC
12/04/08 DLC
12/04/08 DLC
A/YL
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GRH „d ANCHORAGE AREA BOR,,JGH
Department of Environmental Quality
`,.
�— 3330 C Street
Anchorage, Alaska 99503
y'ry� INSPECTION REPORT CSN -SI'T'E SEWAGE DISPOSAL SYSTEM
NAMEV. iN//96&C _ MAILING ADDRESS PHONE
LOCATION
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCEA[f, NUMBER OF
FROM WEL I-/ —
— MANUFACTURER' -A' -r -MATERIAL` -ZS.1 _—COMPARTMENTS \
INSIDE LENGTH INSIDE WIDTH.-.. _ — LIQUID DEPTH - _-- LIQUID CAPACITY140-- GALLONS.
TILE DRAIN FIELD:
,�/ o / f TOTAL_ LENGTH
DISTANCE FROM WELL/L—&/ FOUNDATION _A�/� _N/fE/ARRjEEST LOT LINELe')2�_/--OF LINES
NUMBER OF LINES—1— DISTANCE BETWEEN LINES L�"/__/__TRENCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION AREA —� SQ. FT. LENGTH OF EACH LINE --- -
DEPTH OF FILTER r
DEPTH: TOP OF TILE TO FINISH GRADE _MATERIAL BENEATH TILE SC_6TJ ABOVE TILE
WELL: NJ ! N
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED ._
DISTANCES
CONST RUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
INSTALLED BY^Wak
r r
SEWER LINE DEPTH:— --
PIPE MATERIAL:
LOT SLOPE: �VeVPll'
REMARKS
Form EQ -032
NEAREST SEPTIC
SEWER LINE— , TANK -
REMARKS
DIAGI
DEPTH — DISTANCE FROM:
SEEPAGE
SYSTEM_
M OF SYS-DEWL,
DATE! ' _ APPROVE
G.A.A.B.
06-1220(o) Rev. 1973 AL : OLr ARTMENT OF HEALTH AND SOCIAL ilCES
DIVISION OF PUBLIC HEALTH Lab Na'
INDIVIDUAL AND SEMI-PUBLIC
DATE BACTERIOLOGICAL WATER ANALYSIS -
INDIVIDUAL ❑
NAME —
ADDRESS -
CITY
ADDRESS
OF SOURCE
SEMI-PUBLIC ❑ CHLORINE RESIDUAL PPM —
REPORT RESULTS TO - -
ZIP CODE
OFFICE
Analysis shows this Water SAMPLE to be:
❑ -Satisfactory
❑ Unsatisfactory
❑ Questionable
❑ Sample too long in transit; sample should not be over 48
hours old at examination to indicate reliable results. Please
send new sample.
❑ Bottle broken in transit, please send new sample.
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED TIME COLLECTED
- Sample Collected from ❑ Kitchen Tap ❑ Bathroom Tap E] Basement Tap
❑ Other (List) --- Well - ❑ Dug ❑ Driven ❑ Drilled ❑ Bored
SOURCE: ❑ Spring ❑ Cistern ❑ Other—_
DugWell or Cistern Construction: - -
Walls-❑ Wood ❑ Concrete ❑ Metal ❑ Tile Brick or.
Tap - ❑ Wood ❑ Concrete ❑ Metal ❑ Open Top ❑ Concrete
LOCATION:
❑ In Basement ❑ Basement Offset ❑Under House - - -
❑ln Yard ❑ Other . - -
Building Sewer Septic
DISTANCE TO: or Other Drainage Pipe— Feet. Tank—feet.
Tile - Seepage Cess -
Field Feet. Pit — Feet. Pool — Feet. Privy ---Feet
Other Possible
Sources of Contamination —--
MATERIAL: Building Sewer- ❑ Cast Iron ❑ Wood ❑ Tile ❑ Fibre ❑ Asbestos -
Cement
❑ Plastic Joint Material - Type .
GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No
When? — -
Diameter of Well — Depth Feet.
Well Casing -
Material Diameter Depth
Length of Water Depth -
Drop Pipe — From Bottom — Feet.
Offset in In Utility
PUMP LOCATION: ❑ In Well ❑ Basement ❑ In Basement ❑ Room -
On Top
❑ Of Well ❑ Other — ---
PURPOSE OF EXAMINATION: Illness Suspected? ❑ Yes ❑ No
New Source of Supply? ❑ Yes ❑ No Repairs to System? ❑ Yes ❑.No Signature _—'—
06-1220 ;b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973 1
11 1
READ INSTRUCTIONS Date Received Time Received _ P Lab. No. --
REVERSE SIDE
Lactose Broth
IOcc locc
loco IOcc
lice
1.Occ 1.Occ
24 Hours
48 Hours --
- -
-
- -
Brilliant Green
-
24 Hours
48 Hours
EMB
BEFORE Lactose Broth, 24 hrs.
Coliform Density —
MF Results
COLLECTING SAMPLE
Reported by
This analysis indicates Coliform Organisms to be:
48
AGAR
Gram's stain
(Most probable No. per 100cc)
a.m.
Date- —P.M.
Absent
Present
Municipality of Anchorage 9�
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017-401-33 HAA# Q L�D �{
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot 2 Block 4 Saendlove View Heights #2
Location (site address or directions) 8740 Spendlove Drive, Anchorage, AK 99516
Current Property owner(s) Thomas D & Theresa M Zietlow Day phone 345-1507
Mailing address 6201 Petrified Tree Circle, Anchorage, AK 99507
Lending agency
Mailing address
Day phone
Real Estate Agent Rick Jarvis Day phone 244-3590
Mailing Address
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
3
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may reissued with
new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A
or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
(Rev.11/99)
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 Health Authority Approval Guidelines for 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Eng. Svc. Phone 272-8218
Address P.O. Box 102954, Anch, AK 99510 /
Engineer's Printed Name Steven R. Pannone, P.E. Date 01,2S lcq
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious
engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The
reported results describe the performance of the system under the conditions encountered at the time of
the test, and separation distances measured to readily identifiable features. The operational life of all
wells and septic systems depend on the local soil condition, ground water levels that may fluctuate
during the year, and the water usage of the family being served by the system. These conditions are
outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results
do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects
or encroachments. PES can therefore not provide any warranty for future performance nor give any
estimate of how long the system will continue to meet the operational requirements of the ADEC or
MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon
or use of this report by any other person or party is not authorized nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
t� Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
v1 ic�nnar A maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: EJ�,� � Iy.,
Expiration Date:
(Rev. IMM)
Original Certificate Date: C 1-14, - d 1/ -
Reissue
Reissue Date:
rv,
V-`4
m° M
SPENDLOVE DRIVE
0
M O
M
S 89'57'52" E 1 R1 nn'
IN
ORDERED sv:
TOM & TRACY ZIETLOW
EXCLUSION NOTES: It Is the owners' responsibility to determine
the existence of any easements, covenants, or restrictions
LEGEND: SET FND
5/8'RB W/CAPS 5/8' RB O
which do not appear on the recorded subdivision plat. NOTE:
Under no circumstances should any data hereon be used for
3,25' ALMON.Q}MONUMENT
construction or for establishing property lines.
HUB g TACK Ij
SURVEY CERTIFICATION: SLANA has conducted a
SCE— —x— x —
OVERHANG—
SLANA SURVEYS INC.
physical Vu with of this property nt shown on this
drawing and that the Improvements there
are within the
WOOD DECKS—
CONCRETE—
property ed. and no encroach—
no enc
m
manta exist other than noted.
ASPHALT—
A S— E9 U I LT OF: LEGAL DESCRIPTION:
SEPTIC STANDPIPE��
LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS
440 WEST BENSON BLVD. # 103
(fax) 561-6626
WATER WELL -
ANCHORAGE, ALASKA 99503
WORK ORDER NUMBER:
(907) 562-6103
LOT 2, BLOCK 4,
04SL120
_
AU 20' 2004
scAtc
'•=4°'
PIAT NUYeER
76-
SPENDLOVE VIEW HEIGHTS 42
WiAwN 6Y:
Mn
CHEDIaD
t.
ailD°.
NUYeE1C
2841
e001(, RFCFRT
SGS R4#
1045264001
Ad Data/Times are Alaska Standard Time
Client Name
Pannone Bus. Sm.
PrintedDatoTime 0623/2004 13:39
Pro/ectName/N
L2, B4, Spendlove View 42
CallededDateMme 09/18/2004 12:05
Chert Sample ID
L2, ove #2
Received Data/I'ima 06/18/2004
Metria
kin ; Water
Drdnking Wates
TeeMalal Dlree.
MID
0
Released
SenVIc Remarks,
Paamter Rma0s PQL Units Method Container ID AllowaW Prep A=IS
UnitsDete Dae !nit
Waters Department
NitnowN 2.35 0.100 MWL EPA 300.0 B N-10) 08/19/04 JJB
microbiology Labosatoay
Total Coliform 6 OB, No Coll
MU100mL SM209222B A (<-1) 08/18/04 DKC
SGSfCT&E ENVIRONMENTAL SERVICES
Drinking Water Analysis Report for Total Coliform Bacteria
READ INSTRUCTIONS ON RBVMW SIDE WMAN COUSCTINa SMILl
MUST BE COMPLETED BY WATER SUPPLIER .
rl PUBRX WATER SYSTEM [DO — — — __, _
9Md etvoka
SAMPLE COLLECTION:
j1��yY��
M wfis . Lil_�
Ma Day Tar
20D W. POTTER DRIVE
ANCHORAGE, ALASKA 99618
Tek 907-562-2343
Fax: 907 -6S1 -5X1
Led Rmf 1 .
1046264
9-1111119.
O Smd RoulN be41ndtmaa.
SAMPLE TYPE:
O Routine 0 Treated Water
Tim; 12 40 _ AN am: ❑ Roiliest $ampleUntreated Water
Locaaom ga
rear to lob no.
eolleown ` te-- .si ectal Purpose-
Trampolbd r(�,, oP
to Lab av: varve as collector Other
BE COMPLETED BY LABORATORY
41}mple Racelvine:
Date:,
Delivery Method:
Received By:�—
Cam"Mm
0 Samtae overabhours ext [j RUSH SAMPLE
Re41uts meg be ur"Ho e
❑ 411 Hour Waken PhfNw :
5-7or R41mou n Fax #:
�................ a u..............O...............................0u...............urs.. a..................: 1........ a...
SaMoriglogical water Analvala Record:
Analvale Sse41nl i �l l9tT .
Ansiytieal Method:
Membrane Filter
MMO•MUG (PiA)
MM"VO VIA) REaVLTS:
701411 CNroml:
MEMBRANE FILTER RESULTS:
DLl"t Colmt (� o'j C01=8 /teOmL
v.~lon:
r.uio.wM., LIS:
f BGe:
r...wwpm l a
8"tto pDEC:
ANC FBK JUN
D41l41mme:
Sent to giant
Phoned 0 Faxed Q
Datarri"
Apow wah:
® Satisfactory
Cj unsatisfactory
TNTC •Too Marttaua. Count
warted By: `b , (AyhT Date/Time: Siz"3�g*l �@(i
819nnluro I—.6'."—_� 09 .ONvaaabN
V
Ferni0pW-0083 t&fll03
ttpotre9publVo4^OCUMENTtFORM51MiarolColi Form 121703.z1e
Municipality of Anchorage
p.g 3
Mark Begich, Mayor �,�31tA3iFy�
Development Services Departmentt
P.O. Box 196650. 4700 Bragaw Street DEPARTMENT
Anchorage, Alaska 99519-6650
(907) 343-8101 Office (907) 343-8125 Fax
http://www.muni.org
September 1, 2004
Thomas and Theresa Zietlow
6201 Petrified Tree Circle
Anchorage, AK 99507
RE: Encroachment: Existing Well
Block 4, Lot 2, Spendlove View Heights #2 Subdivision, Grid 2841
Dear Mr. and Mrs. Zietlow:
The Right of Way Division has reviewed a request for a letter of non -objection to an existing well, which
encroaches 9 feet into the 10 -foot Utility Easement on the eastside of the lot. On the as -built survey
dated August 20, 2004, submitted with the request, the petitioner has shown the well.
Right of Way Section issues this letter of non -objection with stipulations, and by using it the petitioner is
agreeing to the following:
1. Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or
injury to any person as a result of the encroachments.
2. All applicable codes and regulations will be observed and maintained within the easement.
3. This letter of non -objection will in no way preclude MOA from full use and enjoyment of its rights
within any portion of the easement.
4. Additional and extraordinary costs incurred during any future required construction, repair or
reconstruction of MOA improvements to accommodate any or all of the encroachments shall be paid
by the property owner.
5. Obtain letters of non -objection from the following utilities:
®Anchorage Water & Wastewater Utility
NChugach Electric Association, Inc.
QMatanuska Electric Association, Inc.
QMunicipal Light and Power
OEyecom (Girdwood cable TV)
NAlaska Communications Systems
QMatanuska Telephone Association
NEnstar Natural Gas Company
NGCI Cable of Alaska
All letters of non -objection should be retained in your permanent files. Should you have any questions,
please call me at 343-8033.
Sincerely,
Jack L. Frost, Jr.
Right of Way Supervisor
Aug 27 2004 12:08PM ENSTAR Engineering 907-562-0053 P.1
8/27/2004
Thomas and Theresa Zietlow, Re: Ler
6201 Petrified Tree Circle Grid; 24:
Anchorage, Alaska 99507
To whom it may concern: E
ENSTAR Natural Gas Company has no objection t`a we
easement situated on Lot 2, Block 4, Spendlove Vie�nr He
Acceptance and use of this letter of non-objectit n by
assigns, or your successors, will constitute agreement to
ENSTAR will be held harmless, now and forever 1
any person or property as a result of this encroach
Any ENSTAR facility damaged or destroyed,as a
will be repaired at no cost to ENSTAR. t
Any costs incurred by ENSTAR for special bonsti
encroachment will be borne by the property owner.
All applicable safety code regulations will be
This letter of non -objection will in no way pr
enjoyment of its rights within any portion of it
Sinceely,
M. an
Jr-
M.
f-
ENST N yural as pane
cc: File
ENSTAR Natural
Gas Company
En9FleerYno Deparrdnent
401 E. International Airport Road
P. O. Box 190288
Anchorage, Alaska 99519-0288
(907) 3347743
FAX (907) 58243053
of Non -objection
encroachment into a utility
hts #2 Subdivision,
yourself, your heirs, your
►e following stipulations:
r any damages or injury to
of this encroachment
necessitated by this
and maintained.
ENSTAR from full use and
08/27/2004 14:10 FAX 907 343 8214 BUILDING SAFETY
Municipality of Anchorage
Anchorage Water & Wastewater Utilitv
Engineering Division
btip://www.awwa.biz
Mayor Mark Begich 3000 Arctic Boulevard- Anchorage, Alaska 99503.3898 • Fax (907) 562-0824
August 27, 2004
Thomas & Theresa Zietlow
6201 Petrified Tree circle
Anchorage, AK 99507
Re: Spendlove View Heights View #2
8740 Spendlove Drive (Grid 2841)
Encroachment of an Existing Well into Utility Easement
Dear Property Owner:
The Anchorage Water & Wastewater Utility received your request August 25,
2004 for a letter addressing AWWU's position regarding the well encroaching into
the 10 -foot utility easement, located-omthe east,.property line of the referenced
parcel. An as -built plot plan, -dated Septeniber 21';1,991 was submitted with the
request.
AWWU has no facilities within°•Gnd 2841 he ;a7ea Js'butside of the AWWU
water service area ;boundary and Is ;included in the 'flillside Wastewater
Management Plan (designs'ted for lerge lbt developrnent a d'?onsite services).
AWWU issues this letter with stip6lit+ssr{s to atlowthe existing well to remain in its
current location and byusing It propeity owher&,are agreeing to the following:
1. AWWU will be held harmless now ,and fprever, #or any_damages or injury to
any person as a result ofthe encrbe18etit
2. All applicable codesand, regulatlons,yvlil be observed'and maintained within
the right-of-way;
3. This letter will in no way preclude AVWU frorn4611 use and enjoyment of its
rights within any portion of the rightof-way; and,
4. Additional and extraordinary costs incurred during any future required
construction, repair or reconstruction of AWWU facilities to accommodate the
encroachment shall be paid by the property owner.
Should you have any questions, please call me at 343-8009 or the AWWU
Planning Section at 564-2739.
Sincerely,
�f �t .
�
Sandra D. Notestine
Engineering Technician
Community, Security, Prosperity
G:\Enginearing\Planning\PlanningVHMSlenaoachment$ Enc-SpendlrneView-B4L2.doc
U002
Aug 29 04 06:18p
August 29, 2004
Thomas &/or Theresa Zietlow
6201 Petrified Tree Circle
Anchorage, Alaska 99507
To Whom It May Concern:
p.2
Subject to your agreement to indemnify the company as set forth below, GCI Cable Inc.
of Alaska has no objection to the well encroaching into the 10' utility easement on the
east property line of Lot 2, Block 4, Spendlove View Heights Subdivision #2. Known as
8740 Spendlove Drive in Anchorage city grid 2841.
This letter of non -objection in no way precludes GCI Cable 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 GCI's facilities to accommodate any or all of the encroachments shall
be paid by the property owner.
By signing below, you agree to indemnify and hold GCI Cable 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 by signing and returning this letter to myself at the
address below.
Sincerely,
Rebecn ee ' _
OSP Project Manager
RM
Date
5151 Fairbanks Street • Anchorage, Alaska 99503 • 907 / 868-5600
08/31/2004 07:45 561-8356 ATU OSP ENGINEERING PAGE 01
ACS
Alaska Communiemlons Systema
September 1, 2004
Thomas & Theresa Zietlow
6201 Petrified Tree Circle
.Anchorage, Alaska 99507
ACS has no abjection to the encroachment of the well
into a platted easement located on Lot 2, Block 4, Spendlove View
Heights 02, as depicted on the as -built drawing submitted.
Acceptance and use or this letter of non -objection by yourself, your
heirs, your assigns, or your successors, will constitute agreement to
the following stipulations:
1•
ACS will be held harmless, now
and forever, for any
damages or injury to any person or
property as a result of
this encroachment.
2.
Any ACS facility damaged or destroyed as a result of this
encroachment will be repaired at no
cost to ACS.
3.
Any costs incurred by AC9. for
special construction
necessitated by this encroachment
will be borne by the
Property owner.
4.
All applicable safety code regulations will be observed
and maintained.
5.
This letter of non -objection will
in no way preclude ACS
from full use and enjoyment of
its rights within any
portion of its right-of-way.
Sincerely,
Greg *aid,�
Outside Plant Engineering
ACCEPTANCE:
AC&P 4476
GS \ 1 e \ lAEMk*ef\COmeW\NOfxgec\
DATE:
600 Telephone Avenue Anchorage, Alaska 99503.6091 tel 907.664.1000 wwwac"larka.com
D. LIFT STATION >.
Size gallons a Access
Date installed
q
"Pump on" level at _ in'"Pum _ in High water alarm level at �n A
D Cycles tested Meets alarm & eircuitt,�requlrements? N u
_ M
w "w
E. SEPARATION DISTANT A,W.. a m as ., ;• .,: . -,
SEPARATION DISTANCES FROMLNnOT O
op
Septic tank/lift station on lot 111 On adjacent lots 1'00+
Absorption field on lot .
1264 On,adjacent lots 100+
-12
Public sewer main 100+ Public sewer manhole/cleanout 100+
Sewer /septic service line 75+ Holding tank 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO,.
Building foundation 13 Property line 68.2 Absorption field 10+ ry
Water main100+ Water serylceline 30+ Surface water 100+ 4 wy
w� ttMI
Drainage 10;278
Wells on adjacent lots 100+
SEPARATIOAIJBuildm foundProperty line gWater Servic50+" Surface water' 100+ ` Driveway, parking/vehicle storage 20+
w
Curtain drain Norj.Cp ved Wells on adjacent lots 100+
F. COMMENTS
NGI
G• l Eertrf NihatRl have determned fhrou h field ms ections an .. •
d i TH1♦I
review of Munrapal records that the above systems are 1n r
conformance with MOA HAA gmde6nes m effect on this date ` '
_. ,,. �.., .. .:.,......_ .,. _., :.�j atevR Ponroe. 70
ff
Engineer's Printed Name` Steven RPannone. P E. ♦1�'s Nom
Date (23(ov ♦♦♦Nit
Ess .•'
HAA Fee 7,5Waiver Fee $
Date of Paymentl —z� U_ Date of Payment _
Receipt Number ✓ 7 6 7 Receipt Number
(Rev. 11/99)
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Vtew
Legal Description: L - �' lig Ici-44"Z _Parcel I.D. _
A. Well Data
Well type J-ZAU/ATI�E_ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) t�,21 Date completed t-,l1a Driller N /A
Total depth V t�:J KN W N Cased to V N t, til 1-1 Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N) Y�
FROM WELL LOG AT INSPECTION M i
Date of test tiJ L ((7, -yr 1 '
ryll C 5 U Cn
Static water level N�/� 2-4 P -r-
Well flow r�
��lk g.p.m. g.p.m. l� h
Pump levell 1 t� At'P�r IOC) (='"f . c
Orr
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot I I On adjacent lots D cs
i
Absorption field on lot I ; On adjacent lots 5 /
Public sewer main N Public sewer manhole/cleanout lel )Al
Sewer service line Petroleum tank y�l IJA
WATER SAMPLE RESULTS:
Coliform
Nitrate
Z , (0 5
Other bacteria
Date of sample:
I I �-`��
Collected by:
Rtz..011T E�4701_1
B. SEPTIC/HOLDING TANK DATA
Date installed 19 A7C0 Tank size l000 c'-tAl-- Compartments
Cleanouts (Y/N) yFloundation cleanout (Y/N) �( Depression (Y/N)
High water alarm (Y/N) `_NII Alarm tested (Y/N) LJ -1A
Date of pumping I C) -3f -" `)`i Pumper [ 5AAC-`a 1�UMC't►�Ci
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I 11:5 On adjacent lots •-tFoundation
To property line Absorption field �.� I Water main/service line
Surface water/drainage (,1 ZA1
72.026(3193)• Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
On adjacent lots
D. ABSORPTION FIELD DATA
Manhole/Access
"Pump off" Level at
Cycles tested
Surface water
Date installed i 9'�-O Soil rating (GPD/Ft2) I ':;zD System type
Length -2 Width U I�kc.K�OWL J Gravel thickness
Total depth (Z
Total absorption area 6f-) 'I F'sF Cleanout present (Y/N) Y Depression over field (Y/N) N
Date of adequacy test I 0 •- -!a `,� l-� Results (pass/fail) f A IS = for 5 Bedrooms
MLA
Water level in absorption field before test "� ! r3 r Z ` , 5" b exp After test 10 (� /B DeLnr m u-4
Peroxide treatment (past 12 months) (Y/N) Iv 0 If yes, give date �Q 1 Z 6
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot _ On adjacent lots I 0 r i— Property line r-,
i
To building foundation U To existing or abandoned system on lot
On adjacent lots
Cutbank N Jt1 Water main/service line
Surface water N / Driveway, parking/vehicle storage area
Curtain drain N14 1A X i=a.4O,'-\ S'O2.rA-1,;
E. ENGINEER'S CERTIFICATION
NO
,,D WA47'C-Tt-
I certify that ! have checked, verified, or conformed to all MOA and NAA guidelines in affect oh'the °date of this inspection.
b
/ r
/y
Signature "(�
,, �1
Engineer's Name Z!J�l/�
1u-l� �fr�b --IU�
/ o
Ul
Date //! 3 /9
HAA Fee $ h6_r�C_ly_�-
Date of PaymentZ/
Receipt Number Z17f C 7 �7 �0
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
Commercial Testing & Engineering Co.
Environmental Laboratory Services 1-
LABORATORY ANALYSIS REPORT
CT&E Ref.# 94.5623-1
Client Sample ID L2 BLK4 SPENDLOVE VIEW HTS
Matrix WATER
Client Name EATON, BRENT WORK Order 10610
Ordered By Printed Date 11/07/94 @ 10:47 hrs.
Project Name Collected Date 11/02/94 @ 11:50 hrs.
Project# Received Date 11/02/94 0 17:00 hrs.
PWSID UA
Technical Director STEPHEN C. EDE
Released By.
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: BRENT EATON. WITNESSED BY T.Z.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
----------------------__-----_----------__------_----_----------'
Nitrate -N 2.65 mg/L EPA 353.2/300.0 10 11/04/94 CMR
* See Special Instructions Above UA = Unavailable
** See Sample Remarks Above NA = Not Analyzed
-:U = Undetected, Reported value is the practical quantification limit. LT = Less Than
-D = Secondary dilution. GT = Greater Than
5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax_ (907) 661-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
Commercial Testing & Engineering Co.
-'ztiL Environmental Laboratory Services r/srrr�/s/.r�r...Ir//�•����'•��-+'�'�®��'d-+�'"'�
5633 3 Strut
Anchorage, AK 9951 8-1 600
Drinking Water Analysis Report for Total Coliform Bacteria Tel: (907) 562-2313
Fax: (907) 561-5301
RFAD LVSTRGCTIONS ON REVERSE SIDE BEFORE COLLECTING S�LVPLE
viUS T BE CONPLE ED BY WATER SUPPLEER
❑ PUBLIC WATER SYSTEM I.D.
K PRIVATE WATER SYSTEM
❑ Sencn��pRe-��-nu��`,=sTT
C S�dlrtvoice
Collected
l
'::aZ
D —
\'�
1�
AK 9S -D
cc
C:y
Sac t-? Cxc
❑ Send Results ❑ SendlnvoLe
Canoes Sv>w Co-a::.ane
C,,y Sn:e -?C.e
SAMIPLE DATE: L1! 1
Month
SA�vL?LE TYPE:
%� Routine
❑ Repeat Sample (for routine sample
"ith lab ref. no. )
❑ Special Purpose
SAMPLE LOCATION I
Day Year
❑ Treated Water
Untreated Water
Time
Collected
Collected
By
TO BE CO vTT FTED B I ABUIKAI UK I
vsis shows this Water S.A-�vLDLE to be:
ref Satisfactory
Cl Unsatisfactory
❑ Samote over 30 hours old, results ma}'
be unreliable
❑ Samole too long in transit; sample should
not be over =S hours old at examination
to iridicaie reliable resn!LS. Please Send
neve' sample Via suecial delivery mail.
Date Received tt B 2 --
Time
Time Received t �-�
Analysis Began
Analytical Method: Vfembrane Filter
❑ vL�fO-u i G
Number of color�es/? 00 _.d.
Lab Ref. No Result* Analr'st;
94.5 23 O
Sent to A.D.E.C. Anc Fbks Jun ❑
Faxed
Date: \11j
q% Time:
Client notified of unsatisfactory results:
❑ ❑
Phoned Spoke with Faxed
Date: Time:
BACTERIOLOGICAL, WATER ANALYSIS RECORD
Iv1MO-MUG Result: Total Coliform
Membrane Filter: Direct Count
Verification: LTB BGB
Fecal Coliform Confirmation
Final Nfembrane Filter Resu is
Reported By ^ h �- Date ' Wpp
Comrnerits:
E Coli
0 Colonies/100 ml
COLIFIRNI T,v rc- roo.nwmoav: ro cove
Time
OB -thho Beam.
Cots orm/100 ml
l6 hrs
PAT ONE OF
v Member of the SGS Group (Societe Generale de Surveillance)
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND. NFW JERSEY, OHIO, UTAH, WEST VIRGINIA
ENCROACHMENT PERMIT
1203-25A
G-2841
EN04050
017-401-33
This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric
cooperative, (herein "Chugach"), whose address is P. 0. Box 196300, Anchorage, Alaska 99519 and
Thomas D. and Theresa M. Zietlow, (herein "Permittee"), whose address is 6201 Petrified Tree
Circle, Anchorage, AK 99507.
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 Spendlove View Heights Subdivision
Addition No. 2, according to Plat Number 76-43, recorded on the 27th day of February
1976, on file in the office of the District Recorder, Anchorage Recording District, Seward
Meridian, Alaska,
Described in that certain written instrument recorded on the 9th day of September 1958, in
Easement Book 4, Page 123, on file in the office of the District Recorder, Anchorage
Recording District, Seward Meridian, Alaska,
Described in that certain written instrument recorded on the 20th day of January 1953, in
Volume 84, Page 299, on file in the office of the District Recorder, Anchorage Recording
District, Seward Meridian, Alaska,
(herein "Easement") which pertains to the following described real property:
The East Ten Feet (E 10') of Lot Two (2), Block Four (4), Spendlove View Heights
Subdivision Addition No. 2, according to Plat Number 76-43, recorded on the 27th day of
February 1976, 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
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:
Page 1 of 4
Lot Two (2), Block Four (4), Spendlove View Heights Subdivision Addition No. 2,
according to Plat Number 76-43, recorded on the 27th day of February 1976, on file in the
office of the District Recorder, Anchorage Recording 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:
A water well that encroaches approximately One Foot (1') into the East One Foot (E 1')
of said Easement for a distance of approximately One Foot (1'), a warning sign is to be
installed by the Permittee, adjacent to the well to warn of the danger of working near the
overhead electric lines in the area, Chugach will supply the warning sticker,
(herein "Encroachment").
3. Permit. Chugach hereby authorizes Permittee to continue the existence of the
Encroachment in its 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. If
the shed is removed from the Easement it shall not be relocated into the Easement in the same
location.
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.
Encroachment Permit - Page 2 of 4
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.
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:
Edward M. TY m, P.E., Director,
Engineering Services Division
PERMITTEE
By: �c ,
Thom4s D. Z' tlow
Date:
By:
Theresa M. Zietlo
Date: `l I l ki
STATE OF ALASKA )
) ss:
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this I `tet day of
CjBaeiewbW 2004, by-1T+owasa £�"j-Cerera M. 2:1ef(ow
PRINT PERNHTTEES(S) NAME(S)
1
���''I��f�i3O�F sA�'•' "e��
STATE OF ALASKA
ss:
THIRD JUDICIAL DISTRICT
i /% 4---_
otary Public in and for the State of Alaska
My commission expires: Z /1 V f o V
+ e foregoing instrument was acknowledged before me this 16t day of
UC Pbn �GY 2004, by
Director, Engineering Services Division of Chugach Electric Association, Inc., an
Alaska corporation, on behalf of the corporation.
Notary Public bin and for the State of Alaska
��tttt�tt/?rr�� My commission expires:
4" 1.
k �
AFTER RECORDING RETURN TO:
Chugach Electric Association, Inc.
P.O. Box 196300
Anchorage, Alaska 99519-6300
Encroachment Permit - Page 4 of 4
After Recording Return to:
DeUsio Moran Geraghty & Zobel, P.C.
943 W. 6th Avenue
Anchorage, AK 99501
DEED GRANTING EASEMENT AND EASEMENT AGREEMENT
We, Robert D. Sutherland and Nicole S. McCullough, of 8800 Spendlove Drive,
Anchorage, Alaska 99516-3358 ("Grantors"), are the owners of certain real property described as
follows:
Lot 1, Block 5, Spendlove View Heights, Subdivision #3, according to Plat No.
830224, Anchorage Recording District, Third Judicial District, State of Alaska.
In consideration of One Dollar ($1.00), the receipt and sufficiency of which is hereby
acknowledged, hereby grant, bargain and convey to Thomas D. Zietlow and Theresa M. Zietlow of
8740 Spendlove Drive, Anchorage, Alaska 99516-3358 the right of ingress to and egress from the
real property described above for the purpose of maintaining, repairing and keeping in good order
the water well system located on the following described real property:
Lot 2, Block 4, Spendlove View Heights, Subdivision #2, according to Plat No.
760043, Anchorage Recording District, Third Judicial District, State of Alaska.
The easement granted by this deed is for the benefit of the Lot 2, Block 4 property, as
described in the preceding paragraph. The easement described in this instrument is to and shall
run with the land, and shall be for the benefit and use of Robert D. Sutherland and Nicole S.
McCullough, their heirs, successors and assigns, and to the benefit and use of Thomas D. Zietlow
and Theresa M. Zietlow, their heirs, successors and assigns.
The parties mutually agree mutually agree to indemnify, defend and hold harmless each
other for any liabilities and costs arising out of their respective negligence or intentional acts, by
themselves, their agents, successors or assigns.
This deed and easement agreement constitutes the entire agreement between the parties.
There are no prior or contemporaneous oral or written agreements between the parties.
Dated: ;-00
88018
By: ---1f cc,�M�
Robert D. Sutherland
Page 1 of 3
STATE OF ALASKA )
) ss
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY that on this \% day of 2004, personally appeared
before me Robert D. Sutherland, to me known to be the individual described in and who
executed the within Instrument and acknowledged that he executed the same as his free and
voluntary act and deed, for the uses and purposes therein mentioned.
Dated:
GIVEN UNDER MY HAND and official seal the day and year last above written.
STATE OF ALASKA
State of p
i expires:
LIR S4
Nicole S. McCullough
13,
) ss
THIRD JUDICIAL DISTRICT ) c5o ( bv-kK
THIS IS TO CERTIFY that on this 1St day of-4eeust-2004, personally appeared
before me Nicole S. McCullough, to me known to be the individual described in and who
executed the within Instrument and acknowledged that she executed the same as her free and
voluntary act and deed, for the uses and purposes therein mentioned.
GIVEN UNDER
Dated: %-a1.®
STATE OF ALASKA
seal the day and year last above written.
011 nn %
Not Public, State of Alaska
c mission expires: my Commission Expires
Marcf� 13;
By:
Thomas D. Zietl w
) ss
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY that on this lj�
before me to Thomas D. Zietlow, to me known
executed the within Instrument and acknowledged
voluntary act and deed, for the uses and purposes 1
88018
GIVEN UNDER MY HAND and official seal
day of004, personally appeared
to be tANilal
described in and who
that he executed the same as his free and
herein mentioned.
year last abgye written.
MyAommission expires:
Page 2 of 3
Dated: f I o By: ot•'" I
Theresa M. Zietlow
STATE OF ALASKA
) ss
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY that on this day o2004, personally appeared
before me to Theresa M. Zietlow, to me known to be the individual described in and who
executed the within Instrument and acknowledged that she executed the same as her free and
voluntary act and deed, for the uses and purposes therp"entioned.
GIVEN UNDER MY HAND and official seal tho day
cii�SI3
My
last above written.
expires:
Page 3 of 3