HomeMy WebLinkAboutSUNNY VALLEY LT 27 / ~-/ 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 ,~t'% ~'~ ~ ~---~ PHONE
MA~U~6A~S~ ~ ~. ~ / ~
~ IF HOmE.DE: Inside length Width ~ ,,. Liquldde~b
~ inches
~ ~/O~ /~6~ /~ Dr ler Distance to Jot Jine PERMITNO.
OTHERI ~
SO~L~S~RAT~N~. ~ ~_j '~
APPROVED ~ ~ ~Q~'~D~,"~.., ..~; '~ LE~' L --' ~ -'
SULLIVAN WATER WELLS
P. O. SOX 272, CHUGIAK, ALASKA 99567 · TELEPHOI~E 688-2759
OWNER OF LAND
ADDRESS '~
LEGAL DESCRIPTION
DATE - Started ~
PERMIT NUMBER
DEPTH OF WELL /' ';/dS~
STATIC LEVEL OF WATER FT.
DRAW DO~/N FT.
GALS. PER HR ,'~ -~ '-"
KIND OF CASING - (::~-~ (: /...
KIND OF FORMATION:
From_ () Ft. to 'i Ft.
From · Ft. to ~, I Ft.
From ,- , Ft. to .'~ , Ft._ o/,~. 7 .... .
From Ft. to Ft.
From .~((" Ft. to ~,~5' Ft.
From Ft. to Ft.
From. /".. iV Ft. to c:~ '~ Ft.
From Ft, to Ft.
From Ft. to Ft.
From rfTM :''Ft. to r!<~ ~ ~ Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft
From Ft. to Ft.
From__.Ft. to__Ft.
From Ft. to Ft.
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MISCL. INFORMATION:
DRILLER'S NAME
D,-FARTMEN] OF HEAL ]'H APlD ENVIRONMEPlTAL F'Fi.'OTECTION
LM,_ L STI'~EET. ANCt-'tORAGIF~ AK 9950
~ 4 47~.1_,
F'ERMI~
DATE ISSUED:
840873 EI~G I NEERED DESIGN
10 / 127/84
ll,,,~q IE E_ L_
APPLICANT: C/O S & S ENG'G. D A ANDERSON
ADDRESS: SRB 126X
EAGLE RIVER, Al.{ 99577
CONTACT PHONE: 6~74-29'79
LEGAL
I_.OT SIZE:
SUBDIVISII]N: SIJNNY VALLEY LOT: 2'7
SECTION: 16 TOWNSHIP: 14N RANGE:.
~.935A (SQ.--.T. OR ACRES)
BLObl.. PlA
I
IF A I_IFT ST~'I'IOPl IS
THEN (1) AN ELEC]~
I, gILL NOT BE
ELECTR I(3AL
cer. ti fy that:
I am lamiliap with the peouzrements for, on-site seweps and .wells as se~
~oPth by the Muni. cipality o~' Anchorage (MOA) and the Stat~ of Alaska.
I will instal] the syetem in accoPdance with all MOA codes'and re~uiai'-[ons
and in compliance with the design cri'Leria of ti]is permit, ' ......
I will adhepe to alt MOA arid State of AIaska pequi e. mE. nL= for' the set back
distances f'r'om any e ~st~. ~eI]., waste~ai, er. disposal ..y;~t=,n or' public
sewerage /sys'Eem on this or an.y ad:jac:~n'L of nearby lot.
:~I..I_ED IN AN AREA [,O/E.I-¢E.D BY MOA BUILDING CODFS~
:MIT AND INSF'ECTION MUST BE OB't"AIIxtED; (2) AS-BUILTS
AN F .' ' " ' ~ o :,p: ', ' ~ ' '
-I-ECTRICAI .... N~,I-CT10~, REF'ORT; AND (3) THE
SIGNED
APPE'ICAN]'
IoSUED BY
D A APlDERSON
DATE:
DATE:
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTIViENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
Y
5
10-
11
12
13.
14
15
16,
17-
18
19,
20-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
No.
[] SOILS LOG
J~ PERCOLATION
TEST
Reading Date Gross Net Depth to
Time Time Water
'Z ', 3o ,6-"
'3 ,.,~¢ ; Ia
PERCOLATION RATE
(minutes/inch)
TESTRU~.ETWEE. . / FT~%~ET
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNICIPALITY OF ANCHORAGE
AND
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
Day of �D be r
of 20 , by and between r"-g�Ck_La_ ` -Xpy-
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AWWTS), described as %� located
at o klmL. '� , Anchorage, Alaska.
2. Definitions.
A. Alteration. Any change to the design or function of an AWWTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AWWTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included in
the original design which would allow the AWWTS to continue to
perform as designed.
E. Permit (Construction) An On -Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AWWTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On -Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
3. Fee. Owner shall pay to Municipality an annual fee of _ Zr=�)
($_ .00), payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
AWWTS.
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AWWTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
5. Alterations, Installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AWWTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is: Ojjn(,�r_
C. Owner acknowledges that the fine schedule for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AWWTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AWWTS.
7. Nonwaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
8. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Owner:
Anchorage: Purchasing Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
OWNER:
By: fQ 0 L�
Date: � j
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
MUNICIPALITY:
By:
Title:
Date:
ss.
The foregoing instrument was acknowledged before me this `5�lay of 0&ober
20 UU 3, by (0 �'Y)Z.ro, G . 01 on i the () (A )np—r
NOTARY PUBLIC FOR AZol
KA Notary Public
My Commission expires: 3 3 ORING SHELBIE M
State of Alaska
My commission Expires Apr. 13, 2013
UNICIPALITY OF ANCHORAGE [
DEPARTMEN'~ OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) I'egal Description (include lot, block, subdivision, section, township range)
'Location (address or directions)
'J:)'.P-. ,~,..~T':~.~,_~ Telephone: Home ¢~-~q Business
(b) Applicant Name ~: ,
Applicant Address ~. ~ ~ ~, ~. ~, ~ ~ ~, ~,
(c) Applicant iS (check one}: Lending Institution ~; Owner/builder~ Buyer ~; Other ~ (explain);
(d) Lending Institution. ~¢/~ ~'~ Telephone
Address
(e) Real Estate Company and Agent
Address
T.e~ephone
(f) '~' he~'~AA to the following addr~.~__~: __
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms '~
WATER SUPPLY
Individual Well []
Other
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL '~
Onsite ~ ~ublic [] Community [] Holding Tank []
Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDIN~ISPECTIONS, TESTS, FILE SEARCH, DA,-..~AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, J verity that my investigation4of thi~'~learth
Authority Approval shows that the on-site water supply an d/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 Municiparity of Anchorage flies and from my investigation and inspection, the on-site Water supply and/or
wastewater disposal system is in compliance with afl Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm ',~ ~-',
Address
Date
Approved for _ %.~ - bedrooms by ate
Approve(] {..~'~ Disapproved _ - Conditionalt~_Z
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection {DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in oi:der to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data betorea certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO~'~
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
FNVJRONI.A~NT,:,L p~c,ii.c 7~ON
Well Classification ~'~z~2~--~ f
~ ~ A, B, C, D.E.C. Approved (Y/N)
Total Depth ~ Cased to //~'O D,,,,~, ~, ~ .. ~
Static Water Level __ ~z -- - ~'H ~' P~u~l~t A~ ~ ~
Casing Height Above Ground
Electrical Wiring in Condui(~/N}
Separation Distances from Well:
To Septic/~ Tank on Lot
Sanitary Seal on Casin.~N)
Depression Around Wellhead (y,~
-; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot _JO,P (~- ; On Adjoining Lots
To Nearest Public Sewer Line _. ~/f'~' To Nearest Public Sewer
Cleanout/Manhole _ ~/,cJi.__ - To Nea,rest Sewer Service Line on Lot
Water Sample Collected by ~ ) ~ ~--¢-,~/./'~/.v/./~ ;Date ~--~
Water Sample Test Results __ .~ /¢) ~Z'/ ~' ~,."~ ~;
Comments ~4?4-('/'.~-,C /OR~/~-O~-~~ ~b-~
B. SEPTIC/HOLDING TANK DATA
Date installed /¢-'~'Z-~LSize ~:¢)(2~O ~
-- - No. of Compartments
;'.ndpipe~N, /'~ ~'~fl..~gh' CapCN) Foundation CJeanou¢'~)
epression over Tank (YYN)I ~ ..~ ~'
~ - - ~ , . - Date Last Pumped W~~~
Pump,rig/Maintenance Contract on File (Y/N/ ~/~ . /~ ~O~~ ~
Holding Tank High-Water Alarm (Y/N) ~ /~ ~ Temporary Holding Tank Perm t (Y/N) ~
Separation Distances from Septic~/;~ Tank:
To Water-Supply Well _
_
To Property Line /0 /-/-'
TO Water'S/Service Line ~ ~/'
Course
. To Building Foundation ~ !
To Disposal Field -/~:) /
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72 026(11/84)
Soils Rating in Absorption
Date Installed Length of Field
Width of Field Depth of Field 2
Gravel Beo Thickness
Square Feet of Absorption Areaf 16�4 %ndpipes Presenc(Y)N)
Depression over Field (Y/9 A,, Date of Last Adequacy Test
Results of Last Adequacy Test A
Separation Distance from Absorption Field:
/
ToWater-Supply Well e
ToBuilding Foundation �~
Lot
On
ToE�udngmA�ndom�S�emon
� � '� � ����
ToWater +Aa�q/Sewice Line To Cu1bunk (if present)
To Stream/Pond/Lake/or Major Drainage Course
L.
To Driveway, Parking Area, or Vehicle Storage Area V -f
Date Installed
Size in Gzd|ona
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhu|e/Aocaaa(Y/N)
"Pump Off" Level at
** Check Permitted Bedroom Rating Against HAA Request **
Vont (Y/N)
Pumping Cycles -during Adequacy Test. Meets MOA
|certify that neffect onthe date of this inspection.
Signed Date
Company 1j", MOA No. 0
Receipt No.
Date of Payment
AmounL$
Page 2 of 2
72-026 (11/84)