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HomeMy WebLinkAboutSPIELMAN LT 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Heallh Division 825 "L" StreeL Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT "am'A _qp D,ST^NCES C i"V~.~'~.~ i ~'~..'L~.~ 1,~ ~ SEPTIC ABSO,PTION ~r~ TANK FIELD WELL Phone(s) J Pe,mll ~. O~ NO. Of Bedroo~s WELL ~-B~ll J ~0 ~ LOTLINE ~1 ,o,I Township, Range. Section 'Ttz.~/ ~. ~ C~G. ~l l~ / drlveway.'~'"UlkT D,.~,A~ (8howlocalionolwell. seplicsyslem, prope.yhnes, loundaliOn.water bodies, etc., ~ TRENCH ~ED ~ W. DRAIN ~ OTHER g~p:~ :~ p~p: bo::o~ :,o.: *o::l ~.:h :~o~ odgm: gm~ o.gi.:l~m~ ~"- ~ FT J:-- BLG" FT Fill ~dded 8bow odglnsI grade grsvel deplh bene~Jh pipe Gravel length Gravel widlh Number o, lines I Soil rating ~ipe material ~ PRIVATE , ~:' ~ER {Idenlifv~ Ins[aller ~ Date Installed: REMARKS: , ~ ~ J~ - -- ceaifylhatthisi,speaionwaspeH~rm,daccardingtaai, Municipal and Slate guidelines in effect this dale: ' He~llh Depa~menl Approval; ~ 4' :,.." ,~~~ 72-013 (3/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT Permit Number: SW90[_~\~U% Date Issued: Design Engineer: Owner Name: Owner Address~ //~ Parcel ID: ~/~?~-~ Lot Legal: Subdivision:~/z~/f Lot: Section: ~ Township: /~/~/ Range:~Zc~ Lot Size:~-~ (sq.ft. or acres) - Permit Expiration Date: Day Phone:~_~-/~// Max Bedrooms: This Permit: ~F Total Capacity:3 Block: SEPTIC TANK: Minimum septic tank capacity: ~dO gallons. Each septic tank must have at least 2 compartments, insulation is required if depth to top of septic tank(s) is less than 4.0' Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 days of the well's completion. I CERTIFY THAT: 1. I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality 'of Anchorage (MOA) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system, or surface water on this or any adjacent or nearby lot. 3. I understand that this permit is valid for a single family dwelling with a maximum of ~ bedrooms. I also understand that any enlargement will require an additional permit. I understand this permit is issued for the calendar year and e~pires o~ December 31 of the year issued. 5. I wi/I~ notify/DHH$ prior to all inspections by the eng'n er or driller. /(~ner/~sign~e) ~ ~/ ' ISSUED Y: DATE: .... db/ll5 ' Municipa(ity of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502q3650 SOILS LOG -- PERCOLATION TEST 1 2 3 5 6 7 8 9 10 12 13 14 15 I6- 19 2O Township, Range. Section: SLOPE WAS GROUND WATER ENCOUNTERED2 $ IF YES, AT WHAT O DEPTH? E SITE PLAN ' ' Gro% Net DeOth to Readir~j Oa~e T~me T~me Water Drop PERCOLATION PATE -- n TEST RUN 8ETWE6 A~ORO~C6 WITH ALL STA~ AND MUNICIPAL 6UIOELI FF (minute~iru~j PERC HOLE DIAMETER __ ( .~E~::~IF¥ THA.T,~IS,'I'ZT WAS PERFORMED IN ~0~: All Dimensions ~d Locations Must Be Field Verified Prior To Construction SEWE~ SYSTEM'LOCATION PLAN Tho Accuracy Of Location O£ Exisitin9 And Propesed Property Corners, w~ll~, and Septic PRePAReD '"¢) i 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 NAM~q PHONE MAI LING ADDRESS ~' LEGAL DESCRIPTION ' / ' ~ ' / ....... LOCATION NO. OF BEDROOMS Well ~ Absorption area DwelJin PERMJT NO. ~ ~ Manufacturer · Material No. of compartments Liq. capacity in gallons Inside length Width Liquid depth 1~'() ~':"~'L ,IF HOMEMADE: .... ~ ...... ~.. ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer c ....... , · -- ~ - Material Liquid capacity in gallons ~ Well Foundation Nearest Io~ line PERMIT NQ, ~ DISTANCE TO: ~ ~) ' ~ Z ~ No, of lines Length of each line Total leng~ of lines Trench width Distance between'lines ~ I 41 ' ~I ' '~,t inches N ~ ~ Top of tile to finish grade / Material beneath tile ~ ~ j~iV~ ,~ t~~ ~ Total effecti~ absorption area Length Width Dept~ ~ PERMIT NO, ~ ~ Type of crib Crib diameter / ~'rib ~ ~ .~. deptl~ Total effective absorption area m Well ~ DISTANCE TO: ( Building foundation Nearest lot line ~ Class ~ Depth Driller . m~ ~'~ j ~ / ~ ~l~ Distance:~to Iotllioe PERMIT NO, Building foundation Sewer line Septic tank f Absorption area(s) ~ DISTANCE TO: '~(? ...... i ~7 j (~C) OTHER PiPE MATERIALS SOIL TEST RATING . INSTALLER REMARK~ ........ ~ ~t . . · ~q~ ,~ ~, ~, ~..,,... J ~' ~,~ ~ I~ ~l'~J , ./f ,(;~O~,' APPROVED DATE LEGAL I //' J b- r~ ~.~ MIINICIPALITY OF ANCHORAGE Department :{ealth and Environmental ' 825 - Street, Anchorage, AK. g~3cl~ * * * HANDWRITTEN PERMIT * * * Permit ~ C~ WELL AND/~ ON-SITE SEWER PERMIT Applicant: ]~-5C~% ~e~ d~SJ'. Mailing Address: Location: ~+ [ Phone Number: ,~ / - 3 7~"P~' Legal Description:~7~ ~/~(K~ Lot Size: Type of Soil Absorption System Is: Trench: ~ Drainfield: Seepage Bed: Ho ld i~~____ Maximum Number Df Bedrooms: ,~ Soil Rating(sq.ft/brl/ /P~ The Required Size of the Soil Absorption Syste~Is~ DEPTH ? LENGTH --~ GRAVEL DEPTH -'-~' WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(Hat-DWNG) TANK SIZE = /~D~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3/~edrooms. Signer ~ /~ 'Date: ~//~ ,~' '~ . SWP/024(1/81) , ' _/ ~ ~ .. O~part~t O~ ~!ea~th and ~vi~o~m~ta~ Pro~io~ 825 5 ~tre~t, ~cho~age, ~. 99501 ' 264~47~0 ' ~m~ ~_. W~LL AND/OR ON-OIT~ gE~R PERMIT NaxiffiUm N~nbe~ of ~ma' ' ~ ~il Ratg~g(~.ft~} / depth O~ a t.~euch O~ ~it J.S the distance between the surface O~ the the bo~om Of Eh(~ ~cav~tlon(in ~eet). '~e~a is no ~et w~th ~o~ 'Z~ /f)O 0 ~ALLONS ' ~ ~ ~ ~EOUIR~) SEPTIC(H~T~) TANK $I_c = ~ ~s~aLla~Lofl insp~c~io~ of any well~ adjacent. Eo k}',iO properg~ ahd the ~ :' ~ rl~(2) [NgP~CTIONS tR~ RSQUIRED ~ ~ ~ ~il~ be ~ubjoc~ tO p~os~t~u~ion, · a.%~ailabie ko inSu~ ~eopor ins~aLla~Lon. ': ~ ~ ~ P~Rair ~XPIRES D~C~R 3L I 9 8 ~ ' ' * (2) [ ~i].l iastall the sysL~ i~ acoc.~dan~.e ~¢ith S~9/O24(L/OL) ~.~" ' ~;OI LS LOG .UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ,~ PERCOLATION TEST 825 L, Street, Anchorage, Alaska 99501 264-4720 so,Ls Loc- PERCOLAT,ON TEST /o 7- / DATE PERFORMED: - , SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS' ~'~, //~) WAS GROUND WATER S ENCOUNTERED? ,'~-~" ~ L 0 P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water~A T~, Crop I..; ~ ?. ~ :/ 0 Z. / 7.1 ': .Y,:~ :.?, £ ~" :.',.,. ~ ,7 /'/v ~' .': ? ~. :'o ~ , o ~'" · ~?ER~ORMED ~3Y: w/ - )-~" , ,"/ PERCOLATION RATE ~' '''x) ' Im~nute$/inch) TEST RUN BETWEEN ¢i ~ F'f AND / (' , FT CERTIFIED BY: ATE ~ '- ~/ "~'/ 72-008 (6~79) W~A T ER W~E ~, L LOG ANO= DRILLING 3940 "; ll2th St Anchorage, AK 99507 Phone: .~44£~4~ N A M Et Armamd C. S;oielmam ADDRESS: Lot / Block Subdv. J~p~'~/~w~, -- (Off :Bragraw St & 0'Malley Rd) 0 - 18 Pt 18 - 42 Ft 42 - 79 Ft 79 - 102 ~t 102 - 129 Ft 129 - 164 Ft 164 - 171 Ft Sand & G~avel Clay & C~.vel Gravel Brown Clay C~ave 1 Ct~ & Gravel S~nd, G~avel, Wa~er at 8 gpm Well Cased to 171 Pt Static Water Ievel- 150 ~t (Dril~er~ ~'--'-'--'"" Yield G EXCAVATING INC. May 5, 1984 Municipality of Anchorage Dept. of Environmental Health TO WHOM IT MAY CONCERN: I, J.R. Eker, representative of A & B Excavating, certify that the septic system installed in Speilman Subdivision (9-2-83) was done according to Municipality specifications. The trench was backfilled with the required 5' of sewer rock. Perforated ASTM D2729 was used in the leach field. ASTM D3034 pipe was used in place of cast iron leading into and out of the septic tank. The trench was level and building paper was placed over the pipe before backfilling. Sincerely, A & B EXCAVATING J.R. Eker 3305 ARCTIC BLVD. · SUITE 200 · ANCHORAGE "' ALASKA · 99503 · [907] 279-8662 ANCHORAGE, ALASKA 995! 1 Phone 34.4-0993 AMOUNT 99502 1_53244 AMOLJNT 99502 /q L Ct AIMS AND RETURNE~ GOODS MUST 8E ACCOMPAHIEO 8( fills 8 LL .... BY P. O. ~3ox 110777 ANCHORAGE, ALASKA 99511 99502 NT ~53244 DELIVERY St tiP: INVOICE DATE .............. i ................................................. PilICE / DISC. NET PAY 2,7C 2.%.': THIS &/. 0 7 A~OUNT P.O. BOX 499 KENAI, ALASKA 99611 283-?.~21 PHONE: ~:' SOLD: 3103Cl SHIP: TO ~&B EX£A;~A,Ii~G TO fl&E EXCAVA1Z~<G 3305 AEC1ZC ~!.~D 23C5 ARCIiC ~L~D ~200 ~2C0 ~NCI-IER~G~ ~K 9S5C3 ~NC]'t[~RAGE ~K 9~503 CUSTOMER SALESMAN DELIVERY ItCKET INVOICE P./O. NUMBER NUMBER DATE 45 ~6-10~9 3~979 TERMS STOCK DESCRIPTION PRICE DISC. NET NLJMBE R C701]0~ 9C7C1~1~ 9072 Of 04 4"Xl~' PVC PERF EF PIPE 4~XlC~ PVC S~L.]O DF PiFE. I~L£ N'[CS 172 PINT PVC CENE~ GS[ E~25~ 4" 9( ELL IOCO G~L S'fl. S[PTIC YJ~K 40 0 4O 0 I 0 2 0 1 0 6,"11 ,,C t.~ PAYMENT IS ADE WII'HIN OUR RMS, YOU AY EDI'JCT: 14,6C MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, tow. nship, range) Location (address or directions) (b) Property owner ,?~/~'2¢'~¢¢¢~L¢'/' ~/~'~¢¢/'/'/ Telephone: (home)~rf//Business / Mailing Address (c) Lending Institution Mailing Address /(J/~'1~ Telephone /~'2~ (d) Real Estate Company and Agent Address / (e) Mail the HAA to the following address: (or check here~old for pick up.) List contact person and day phone number below: 2. TYPE OF RESID.~N. CE Single-Family [Z' Number of bedrooms 3. WATER SUPPLY Individual Well I]25 Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AscertJfied by my seal affixed hereto and as of the validation date shown below, lverifythat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regu~tions in:ffect on the date of this inspection. NameofFirm ~'O~",~J'-4/Z~J':2~,, '//¢-'~- Telephone ~' 7~'-dr~dP-~,~ Engineer's Seal 6. DHHS APPROVAL Approved for --,~ _bedrooms by Approved _ ~_. Disapproved Terms of Conditional Approval Conditional Date The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsibleforerrorsoromissions in the professional engineer's work. 72-025 (Rev 7/88) Back Page 2 of 2 A. WELL DATA Well Classification Well Log Present (Y/N) (~ MUNICIPALITY OF ANCHORAGE (MOA) IClPALITY ©l=Jg'A6J'I©RAGE - - N__e~!m Aulrm. r~y Approval (HAA) N~ENTA~ S~~ FEBRUARY 1984 343-4744 JUN 2 8 1990 Legal Description: ~~ ~ , f,A, B, C, D.E.C. Approved (Y/N) ~ Date. Completed /¢t~~¢'';'''''" Yield ~ Total Depth ~ / Cased to ~ Depth of Grouting Static Water Level //,'~.~ Casing Height Above Ground ~ ~- Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line /k..J///~_ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot .~' 10(~I Water Sample Collected by ~-O)((r'~ ¢¢~] ~ ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA~ D¢~_,ln~e¢ ~/~/~.~¢~S'~z¢~''~/' /~2¢).(.~ No. of Compartments ~ StandPipes (Y/N) ~ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) /~ Date Last Pumped ~////¢~ Pumping/Maintenance Contact on File (Y/N) ~ ;for /~ Holding Tank High-Water Alarm (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) ~/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line /~"//_/20 / To Building Foundation '.7~ /---/~4:) / To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field /'~ Type of System Design Length of Field ~ Depth of Field /'~/1 Gravel Bed Thickness ~' Statndpipes Present (Y/N) Date of Last Adequacy Test Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: / To Water-Supply Well To Property Line To Building Foundation ~7 ! To Existing or Abandoned System on Lot '~ -~-~ [ ; On Adjoining Lots To Water Main/Service Line '~ /E20 / To Cutback (if present) /',J/.,~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area .~ ~d":> f Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at "// Tested for Meets MOA Electrical Co/des~N) Comments ~tETAccess (Y/N) _ .--'~ "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check PermUted I certify that yb, e,v, inspection.//////¢/ Signed ///~/~ Company MOA No. Bedroom/Rating Against HAA Request** checke/d.~/¢rified, or conformed to all MOA and Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ;t on the date of this ineer's Seal CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ? .0, i! fi[';',~2 · LOCATIO;I OF U~LI~ (Legal Desc:ipLion)' ~/ELL DEPTH: ~_~ FT. CASING:_ ID.RTE IDRILLIIIfi CO!-IPLETEO:__ .STATIC SIATER LEVEL (Top of Casing): FY DR[LLER: FT Clock Tine , E'lapsed [~me Since pumping'SCar~ed/ Stooped, lain. Dept. h to lO 2O 50 SS .lZo (z hours}l ].80 (3 hours 240 (4 hours RECOVERY 5 15 I Pump ~ ng Race, ~PH Rena?ks Orav~down/ Recovery November 14, 1984 State of Alaska Department of Land and Water Resources 3601 "C" Street Pouch 7-005 Anchorage, AK 99511 Gentlemen: ADL 214851 In September 1983 I furnished you with a copy of my water well log to incorporate into the captioned permit file. Since your receipt of that information, I have subsequently deepened my water well an additional 58 feet. This work was accomplished by Hefty Drilling Company in June 1984. The attached water well logs reflect my well as originally being drilled to 171 feet, then deepened 58 feet to a total depth of 229 feet. Would you please place this information into the captioned water well file - ADL 214851. Very truly yours, 11330 Bragaw Street Anchorage, AK 99516 Enclosure W"A T E R W.~E L L L 0 G iNC .... DRILLING 3940 E ll2th St Anchorage, AK 99507 ~none: 544£5455 NAME: ADIP~SS: Armand C. MDielmam lot I Block (off Bra~raw St & 0'Malley .Ed) O- tSFt 18 - 42 Ft 42 - 79 Ft 79 - 102 Ft 102 - 129 Ft 129 - 164 Ft 164 - 171 Ft Sand & Gravel Clay & Gravel Gravel Brown Clay Gravel Ci~ & Gravel Sand, Gravel, l~a~r at 8 glxn Well Cased to 171 Ft Static Water L~vel - 150 Ft Yield % 8 .gpm MUNICIPALITY OF ANCHOP, AGI~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION gUN 8 1990 RECEIVED Date Drilled: 6-! -S~ Bobby Ross Static Water Level feet Gallons Per Minute 25 Draw Down N/A feet Total Feet of Oasing 5.5 Ty. oe Material Drilled: 0 feet 56 foot to 56 1.3ot clav tO 5B Clom~] ormvo.1 v;/xemter to hoononod ~ee!l to 58 feet, from original well to to to Hefty Drilling S.R.A. Box 1553 H Anchorage, Alaska 99507 MUNICIPALITY OF ANCHORAGE DIVISION OF E~,~IRONMENTAL HEAifI~I DEI2A~YI'MENT OF 1~,~ AND EN~IR~MENT~L P'R~ECTION APPLICATION t~R H~'JJ]i ~4~{ORITY APPROVAL CERTIFICkffE 1. (~mz~al Infomnation Application Date 5-11-8 4 legal [~9sc~iption (include lot, block, subdivision, section, t~nship, range) (a) (b) Location (add~ess ot~ directions) 11330 g raqjDJ._.~_~.~.~., Anchor aq~z Applicants N~me Armand ~ielman Applicants Address Ak. 99516 (Cross street O'Malle¥.[ rib lephone 3 4 5 - 0 7 7 8 SRA Box ].024G Anchorage, Ak.. 99515 (e) Applica~sq~is (check OhS)Lending '.institution L~--~.~ ~r~uil~r~; ~ E'd~ ~ ~hO~ LqH (explain), (d) lending Institution t.~rst Natn 1 Bank of Anch. 5%19pho~ 265-6300 Ad. ess Main Br~ - Realty Dept. (e) ~a]. Estate COo & Agent Address N/A Three Othe].~ (O~scribe) Note: If c.~rm'~nity well system, n~]st have va, itten confL~mation frc~ the State Depa~tn~nt of Envirorm~ntal Conservation attesting to the legality ~%d status. Is the ~911 adequate fo~, the number of bedrcx~ns s[7~;cified in this HAA (Y/N) Yes Ohsite ~ Public Ii~---[ Co~anity .~'[ Holding Tank L--~ Is the wastewater disposal system adequate for' the number of bedrooms (_Y/N)____.~. ,___ [Page 1 of 2] 2-15-84 ~ certify that i haw d~cke(i~ ~erified, o~ ccnforn~d to all ~A ~ ~i~lir~s in effect on tho date of this it']spection~ Signe~ .......................................................................... Date Nacre of Firm .......................................................... ~tlo~ Address Signed by ORIGINAL STAMP ON FILE WITH CONDITIONAL APPROVAL OF MAY 7, 1984 :~ ~///..,)~ ~/ ( ENGINEER SEAL) ~lhe Municipality of Ancho!?age [>~parb'rent of Health and Enviromrental l~,otection dces not guarantee the continued satisfactory [~rfo~m~ancm of the water supply and/or the was~water dis~sal system~ This approval indicates that, as of the validation ~te sh~,m ahoy, ~d on t["'~ c~ta and infol~tion ft~nished ~ ~l e~i~er ~egistered in the State of ~aska, tJ~e v~ter supply mid wastewater disposal system is safe and fun~= tional roi, the nur~r of ~'o~ ~d t~ of s~uct~e indicated~ ( ~l>;P SEAL) 7° Mail the HAA to the following address: '_~. ~Ok. ,...w/.l'~ - < 7 Y~5'~' KB2/dS/s [Page 2 of 2] 2-15-84 TECTOfllC$ INCORPORATED Armand Spielman 12660 Schooner Drive Anchorage, Alaska 99516 5/].1/84 RE: Lot 1 Spielman Subd. Dear Mr. Spielman, I made a final inspection on 1 Spielman Subd. and found that the final grading around the well c~§i~.q-to~e-~-Lisfactory. The casing is 12" above ground with PVC conduit protectinq well wires. Should there be any questions,/~lease call me ~ 349-2526. / s i n~-'~.~ Thom Fischer Engineering · Civil · Structural o Mechanical · Electrical · Surveying PO BOX 4-2265 ANCHORAGE ALASKA 99509 ° 1207 EAST 74TH AVE. (907)-349-2526 MDN!CIPA!.ITY OF ~NCHORAGE 1)IVISIC4~ OF I%~VIRONMENTAL D~PA~['i~'i~f OF H~LTfl ~D F~VIR~MENT~ PR~ECTION APPLICKrI~,I ~R HEALI~I ~PHORITY APPROVAL CERTIFICATE 1. C~e,~ral Information ~plication Date ~./2 (a) [~ga]. ~s~'iption (include lot, block, subdivision, ~ction, t~ship, range) . Location (add~,ess o~' d~rections) ':~,~: ic:(,:~}q~ ,~ ~ (b) Applicants Na~ ...... ~bd ~']J~(:]i~_._~i~~ ~-:k~l:~{~ ........... '~ !e~c~ ~ '~i'J~ - ~ /// . - r.z ~ P -'--, , (e) Peal Estaue Co. & Agent Address Te lephoes 2. ~ of i~sidence Single-Family [7 Num~er of ~dr~r~ 3. Water Su~j~y. Individual Well OtJ~er (de scribe) Co~m~unity L~-~ .Rlblic L-ii! Note: I:{! c.~unity %e].l system, must have written confirn+ation frem the State ~par~'~nt of ~viron~ntat Conservation attesting to tb~ legality ~d status. Is the '~.~1]. adequate for the n~r of hedr~ s~cified in this ~ Is the wastewater dis[}Dsal system adequate f~r tfile r~r of P~dr~ (Y/N) [Page 1 of 2] 2-15-84 ~n~g. ineeringi Firm Pr~ "'' .~' ~ ............. I ce~z~i~y that I ha~e c~eked, v~ied~ o~' ~nfo~ed ~o all ~gA HA~ Gu~l(r~ effect on the d~te ~f' ~s inspection, Appro%~d '~ 1~ dr c©I~ By ~_/~. ~,~L~z .... .~ Date Approved C~ Disapproval [-m Conditionally[ ~e Municiga'lity o~ ~eHo~a~ ~pa~,~%~t o~ ~alth and Enviror~ntal Pcotection not guarantee the continued satisfacto~zy U~t~o~n~ of tt~ ~ate~, supply and/~ the wastewateE d~s~sal ~ystem. ~is apEroval indicates that, as ;~ th~ validation ~te sh~,m ~, ~d on ~ data aud informatio~ fuunished ~.~ an e~i~er the State of ~.aska, ~e water supply and wastewater disposal system is sate ~,.d _.~ tional for the ~er of ~'~ a~d t7~ of s~uctu~e indicated. ( Pm]EP 7, Mail the HAA to the follcming address: KB2/d5/s [Page 2 of 2] 2-15-84 aJ Be MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 WELL DATA Well Classification ~% ~hlt? Well Log P~esent (Y/N) ~(i/~ Total Depth 17 i Cased to Static Water Level /~--O' If A, B, C, '----- Date Completed /~,/~ ~ Yield i7/ Depth of Grouting ~ Pump Set At J~5~e- ~7~) / Casing Height Above Ground ~ %~ ~=~m~Atj Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y~) ~ ~ ~' ~p~ession ~ound ~l~ead (Y~) Sep~ation Distan~s f~ ~11: To ~ptic~olding Ta~ on ~t [ ~ ~ To ~arest Edge of-~'~sorption Field on Lot To Newest Public ~ Line Clean~t~anhole , ~/~ To ~est ~= ~rvi~ Li~ on ~t / Wate~ Sample Collected By ~~ ~; ~te ~/ Wate~ S~!e Test Pesults SE~IC/HOLDING T~ ~TA ; On Adjoining Lots ,I CY.~ ; On Adjoining Lots J CY.~ TO Nearest Public Sewer Date Installed ~/.~/~'~ Size jc3c~c_~ ~6~_ No. of Cc~%)a~tments Standpipes (Y~) y~ Air-tight Caps (Y~) ~q Foundation Cleanout (Y~) ~pression over Ta~ (Y~) ~o ~te ~st P~d '--- ~ ...... P~ing~aintenan~ Con~a~ on File (Y~) ~/~ ; fo~ ~ .... Holding Ta~ High-Wate~ Ala~ (Y~) ~/~ Te~rary Holdi~ Tank Permit (Y~) ~p~ation Distan~s ~ ~ptic~olding Tank: To. Water-Supply ~11 [~ / To ~ilding Foundation ~o / To ~o~rty Li~ ~c~,~t~ To Dis~sal Field ~ O / To Water Main/Se~vi~ Li~ To S~e~, Pond, ~e, ~ ~jor ~aina~ [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Abso~tion Strata Width of Field ~_~ Type of System Design Length of Field .. Depth of Field Gravel Bed Thickness Square Feet of Absorption A~ea ~/q9 ~ Standpipes P~esent (Y/19) ~---~ ~p~ession over Field (Y~) ~ ~te of ~st A~a~ Test Results of ~st Ade~a~ ~st ~ Separation Distan~ ~ ~sorption Field: To ~te~-Supply ~11 ~ { ~ ~ To ~o~rty ni~ o~.~ To Building Foundation ~O ~ To Existing or ~ando~d System Lot ~/~ ; ~ Adjoining ~ts ~o Wate~ Main/~vi~ Line ..... ~ To ~t~(if ~e~nt) ~/~ ~ .............. TO St~e~ond~ke/or Majo~ ~aina~ C~se TO ~iveway, Pa~kin9 ~ea, ~ Vehicle Sto~a~ ~ea Counts D. LIFT STATION Date Installed Size in Gallons "Pump ~n" Level at High Water Alarm Level at .... Tested for Electrical Co~nents Dimans ions Manhole /A.c_~c~.Ss~-.(-¥'/N) Vent (Y/~I) Pumping Cycles du~ing Adequacy Test. M~ets MOA ** Check Permitted Bedroom Rating Against HAA Request ** ' I certify that I have~e~he..cked, varified, o~ conformed to all ~OA HAA C~lidP_Li 9s in effect on the date °f~this/i~pecti:cn' [-- ~(~_-~ U['-' ~ 1~' ~m. , 'i , Signed ._ 2-15-84 TEMPORARY EASEMENT KNOW ALL MEN BY THESE PRESENTS: That the undersigned, JANE LONGACRE, formerly JANE WILHOUR, of 1539 West Fourteenth Street, Anchorage, Alaska 99501, hereinafter called "Grantor~' for the good and valuable consideration of ONE DOLLAR ($1.00) in hand paid by ARMAND C. SPIELMAN, of ~ ~¢~..~ ~' , Anchorage, Alaska 995~, hereinafter called "Grantee", the receipt whereof is hereby acknowledged, does hereby grant and convey unto said Grantee, his successors and assigns, 'that certain grant of easement for and with the right to operate, maintain and repair a septic system consisting of one (1) outfall pipeline, metal septic tank, vent pipes and leaching lines, as presently installed which partially encroaches upon, under and across the following described land owned by the Grantor in the Municipality of Anchorage, State of Alaska, to wit: A triangular parcel of land situated within Tract B-6 of the SIEFKER SUBDIVf~ION TWO, in the northeast quarter of Section 21, T12N, R3W, Seward Meridian, descrbed as follows: Beginning at a 5/8 inch iron pipe which designates the southeast corner of Lot 1, SPIELMAN SUBDIVI- SION, the plat of which is filed in the Anchorage Recorder's Office, on February 24, 1982, as Plat 82-38 of Municipal Records, thence due west along the south line of said Lot 1 approxi- mately 111.5 feet to the true point of beginning. Thence south 40° west 33.0 feet, thence due west 2.5 feet parallel with the said south line of Lot 1; thence north 24° west 30.8 feet to a point on the south line of said Lot 1; thence due east 31.5 feet along said south line of Lot 1, more or less, to the true point of beginning. The location of these facilities as hereinabove described are all shown upon the survey plat market Exhibit A, attached hereto and made a part hereof. It is the intent of the Grantor to grant the hereinabove rights to Grantee for only such period of time until the Municipality of Anchorage establishes a trunk line sewer system to accommodate this property. Grantee's use of said easement will cease at the time the Municipality establishes said trunk line and Grantee will be thereby obligated to connect the outfa!! to the trunk line sewer system and thereafter remove the septic system from Grantor's land. When Grantee's connection to the Municipal- ity's trunk line sewer system is completed, the easement granted hereunder shall be null and void. Notwithstanding the above, if Grantee has not connected to the Municipality's trunk line sewer system within five (5) years from the date hereof, the easement granted hereunder shall be null and void unless Grantee obtains Grantor's prior written permission to continue said easement. -1- Grantee, at Grantee's sole cost and expense, further covenants and agrees to restore Grantor's property to the same condition said property was in prior to Grantee's septic system being installed and to hold Grantor harmless from any cost or liability of said restoration. This easement shall be binding upon the heirs, executors, administrators and assigns of the parties hereto and embodies the entire agreement between the Grantor and Grantee. IN WITNESS WHEREOF, Grantor and Grantee have executed this instrument this ./~/' day of March, 1984. GRANTOR: J~N~ly JANE WILHOUR GRANTEE: A MA D C. Sp U N STATE OF ALASKA ) ) SS. THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on this ~ day of March, 1984, before me, the undersigned, a Notary Public in and for the State of Alaska, personally appeared JANE LONGACRE, formerly JANE WILHOUR, known to me and to me known to be the individual named in and who executed the foregoing document and she acknow- ledged to me that she executed the foregoing document as her free and voluntary act and deed for the uses and purposes therein set forth. WITNESS my hand and notarial seal the d~y..an~-;~ear'. first here inabove written. ~/~d~ ~k Notary Public in and My Commission ..... ../ ,. STATE OF ALASKA ) SS. THIRD JUDICIAL DISTRICT ) 'THIS iS TO CERTIFY that on this .~'~r/ day of March, 1984, before me, the undersigned, a Notary Public in and for the State of Alaska, personally appeared ARMAND C. SPIELMAN, known to me and to me known to be the individual named in and who executed the foregoing document and he acknowledged to me that he executed the foregoing document as his free and voluntary act and deed for the uses and purposes therein set forth. -2- WITNESS my hand and notarial seal the day and year first hereinabove written. Notary Public in" and' for Alaska /%;-' , --' ..".> ' -3-