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Home My WebLink AboutGREEN FOREST UNIT 1 LT 3AOnsite File Green Forest Unit 1 Lot 3A PID# 018-011-83 Formerly Green Forest Unit 1 Blk 2 Lots 3 and 4. v O Municipality of Anchorage ."'~ Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page www.ci.anchorage.ak.us (907) 345-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL iNSPECTION REPORT Permit Number: $/~ O ~ O I '7,~- PID Number: .am, t41~c ~c~n~co,,'~ WastewaterSystem: [] New [] Upgrade ~dress't'~'2 0 ..Cnou..,~ l.~e~ Ot't;,~ ABSORPTION FIELD Phone Number of Bedrooms: '~ &~-."-~. ~. ,.~yq ~1~ I-I DeepTrenc~ FI Shallow Trench ~"Bed rl Mound I-I Other. Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION I, ~ Block: Lot: Subdivision: Depth lo pipe bottom from original grade: Gravel depth beneath pipe: Township- Range: Section: Fi!~ added above original grade: Gravel D~ngth: Well: -~/~r [] New [] Upgrade Grav,,,,idth: ~0 Ft. Number of lines:~ Oistancebetweentines:l~ FI. P~pe Material' Class,flcatlon (Private. A. B. C). Total Depth: FI. Cased to: FI. Total absorption area:C~0~''- O Dafter , Date Drilled: ~tatic Water Level; Installer. Date Installed: ¥,e,dG.M I"um" s''at: .,. Ic''ng Ne'¢' ~°¥' G'°"''":~ TANK SEPARATION DISTANCES I~ septic I-1 Holding I-1S.T.E.P. [] Other: Fromm,~ Manufacturee Capacay: TO Septic Absorption Lift Holding Public/Private Tank Field Station Tank Sewer Line ~1'~ ~./'~ O/'~' T~-..x ~ ~' I ~"{~ Ga,. Material: Number of Compartments: ~e, ~ 3,c, , itS' - _ ~,'z.~' E/.-eel Surface Water '~"__~"~'~'__tt.~' '__ -- ~~// S,,: Oal. u.n~ta~,ura~.LIFT STATION Foundation CuC, a,n Dra,n ~"~' ' * ~0 ' "/" ,,,,-- -- / X pump Make & Model Elecb'ica, Inspe~on, performed b~ Remarks' r~o,,~r__.,t, c,,.,.,.r.,--~ ,,- I,,,.,,,,r .,,,. ~:,I.¢ rgo~.,,,,, o/r,d,~ ~ U.,".rt'~..umeoCO,,,,",,eva:.on i~v~l~'. I.O".~R~ ~l~t'r ¢'a~clr ~la¢~'qndcr n~e.o t~'o( Engineer'sStamp Inspections performed by: ~'lct ~q=,~, 7~ ~'...'c Dates: 1st, ~//o/o¥ Development Services Department Approval ,/ --,...-...,.-.-...-,.,.. Reviewed and approved by: ~JA,~ //,] P~- Date: ¢ - / '7- ..~ · :.,>;~, .... ...."~.~ PERMIT NO: SW040175 PID NO: 018-011-83 o ~ SWING TIES: FROM: COR. "A" COR. "B" COR. "C" COR. "D" TO: S.T.C.O. "E" 17' 50.5' S.T.C.O. "F" 11' 58.5' DBLC.O."G" 10' 62' VALVE "H" 10' 63.5' BED C.O. "1" 25' 75.5' BED C.O. "J" 30' 75.5' BED C.O. "K" 33.5' 75' BED C.O. "L" 37.5' 75' BED M.T. "M" 41' 89' BED C.O. "N" 48' 102.5' BED C.O. "O" 51' 103' BED C.O. "P" $4' 102.5' lIED C.O. "Q" 55.5' 102.5' NEW 20' x 30' __ SOIL ABS. BED T.H. #1 LOT 3A, BLOCK 2 GREEN FOREST #1 NEW 1250-GALLON TIC TANK I,F, WELL PAGE 2 OF 3 ORIGINAL SOIL ABS. BED LOT 3A, BLOCK 2, GREEN FOREST SID #1 SEPTIC SYSTEM UPGRADE AS-BUILT PLAN VIEW FLATTOP TECHNICAL SERVICES SCALE: 1" = 30' 14530 ECHO STREET DRAWN BY TFM ANCtIORAGE, ALASKA 99516 JUNE, 2004 PERMIT NO: SW040175 PAGE 3 OF 3 Pld NO: 018-011-83 c.o. (TYP) 2.0' SOIL -- FINAL GRADE ELEV. 85.8' 5' SOIL COVER ! 250-GALLON INV. TANK INV. 92.3' 92.6' BOT. EXC. 81.2' GROUND 20'x30' SOILABS. BED SEWER GRAVEL 4" DIA. F-810 PERF. DIST. PIPE INV. 83.6' (TYP) ISF FILTER SAND TOP ELEV. 83.1' LOT 3A, BLOCK 2, GREEN FOREST SlD #1 SEPTIC SYSTEM UPGRADE AS-BUILT PROFILE VIEW FLATTOP TECHNICAL SERVICES NOT TO SCALE 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 J UN E, 2004 .... : 1203-29A 0-2833 ~.~_~NC~OAUI Ii'lENT AS lLi.:gl~] El,IT · 1[I.~ ~ORE£N£N'I'~ made and entered Into ~his 12th day' of Ala=~a noa-p~o~lb electric] coops=abOVe membership co~pogablon ~cho~age~ Alaska~ he~elaa[~e~ oalZed "Flr~ ~a~y" a~d Cooper and Oania Coope~ o( Anchorage, Alaska~ heretnafte~ called 'docond Party', ~I'I~ESSETI! ~ER~$, First Pa~ty occupies an easement through the center of Lob Three "A" (3A), Block ~o (2), Ocean ~ubdivl~lon, ~choraqe necordlng Dlstrlcb~ ~laska; as shown on the ca,built prepared by Co~Mll~ and Associates and. dated ~bo~r 26~ 1988, and WHEREAS~ Secoltd Party Jtas constructed a gept~o s~stem witl{ drain fleld Which encroac]ms approximately Ten Fae~ (~0 onto the foregoing ~asement a~d a water l~ne which crosses ~; TilE~O~E~ ~or ~nd Jrl consldeFa[[on si m~ual agreements.and o~her good and valuable oonsldera[lon~ FeeeJp~ of ~l~[oh Is hereby acknowledged, t~h-s~ PaFEy, fo~ Partyta enuroao~ent on the acid easemea~ for the purpose · mentloned~ subject to the followlgg conditlon~ 1. Seco~td Party will bold Flrs~ Party harmless f~om liability, for a~y injury or damage ~o any porso~l or ~hloh may r~oul.~ from such ~ncroacl~ent. 2. The said encroar~l~e~t will be without prejudice to First ~arty~s full enJo~enb o~ a~iy and a11 rights it I~y have and to such easement. 3. Any facilities or propor~y of Fl~at Party which are damaged or destroyed aa a r~ault of such encroao~nt will ~'epatred or replaced at no cost to First Party. 4. Second Party wl'll co~ply with all . applloabl~ savory codes and regulatlol~s. relo~a~lo~ or modification of les iacllltles ~o aceo~ato the said e~oroacl~ent will bo paid by Second Party. By Its execution of thl~ Agreement, Second Party agrees, for itself, its ~uoces~ors, a~d assigns, that e~oroao~t upon the aamed easen~Ilt as herelnabove ~n~toned will be sub~ec~ to the foregoing conditions. Ag~ee~nt ~o bo executed by their duly a~bhorlzed and age,ts as o[ the day a2d year first above me~tloned~ CHUgACH ELECTRIC ASSOCIATION~ INC. Gel~eral Manager · Rice.and J~Bia COoper" (Second Party.) ~i~k Cooper ./; ' ~,5RW2/37/8 Cable Television of Alaska, Inc. September 28, 1988 Nr. Rick Cooper 10680 Comodre Drive 'Anchorage, Alaska 99515 Dear Mr. Cooper: Sonic Cable has no objection to the encroachment of a septic tank into a platted 10' utility easement located west of Lot 3, Block 2, GreenForest Subdivision. Acceptance and use of this letter of non-objection by yourself, your heirs, and your assigns, or your successors shall constitute agreement to the following conditions: e Sonic wt11'be held harmless, now and forever, for any damage or injury to any person or property as a result of this encroachment. Any Sonic facility damaged or destroyed as a re6ult of this encroachment will be repaired at no cost to Sonic. Any Costs incurred by sonic for special construction neces- sitated by this encroachment will be borne by the property owner. All applicable safety code regulations will be observed and maintained. This letter of non-objection will in no way preclude Sonic f~om full and enjoyment of its rights within any portion of its ~ight-of-way. Sincer~ly, Joe Miller Risk ~anageme~t Sonic Cable Television attachment JM/sla TOTRL P. 86 JAN-~-l~00 1~: ~ oo ENSTAR Nalural Gas Cemlmny A DIVISION OF SEAGULl. ENERGY CORPORATION 3000 Spenard Road p.o. Box 190288 Anghorsge, Alaska 995194)288 (~) 2T~.~1 September 30, 1988 To Whom It Hay Concern: EHSTAR I~atural Gas Company has no objection to the encroachment into the easement on Lot 3 Block 2 Green Forest 5ubdlvision. Si ncerely, Bob Godfroy Distribution Engineer SG/jkk JAN-2~-1900 Mayor ANcIi I ¢i,; W^'I'EI{ a W^STI WA'i'I,m' I 'rlL, rr¥ Eltglneering' & Plan,lng Division 401 W. Inlernalional Airporl Fiend Anchorage. Alaska 99518-1104' September 30, 1988 P. 04 . Owned by the Municipality Ol An'chor~ge RE: Green Fogest Subd., Unit No. 1, Block 2, ~ots 3 and 4 TO Whom It May Concern: ' The Anchorage Water and Wastewater Utility has to objection to the encroachment into the easement on Lot 3 Block 2 Green Forest Subdivision. Sincerely, TZNA R. HAWLEY Engineering Technician l! Engineering & Planning Division Anchorage Water s Wastewate~ Utility JAN-~O-l~00 14:22 September 27, 1988 OV,,,r*I I'y tim Rick & Janis Cooper 10680 Commodore Drive Anchorage, Ak99515 ~heAnchorage Telephone Utility (ATU) has no objection to the encroachment into a platted easement located on the vest property.line o[ Lot ~,.Blk 2, Oreen :Torest Sub., Unit {1, ~ith a soil absorption septic system. as depicted pn the a~built drawing at'~a~hed ~ ~- ' ' no~ a~tached [] . Acceptance and use oE this letter of non-ob~ection by yourself, your heirs, your assigns, or your successors, viii constitute agreement to the [ollovin§ s~ipulations= ATU viZ1 be held harmless, nov and forever, for any damages or injury to any person or property as a resul~ o[ chis encroachment. Any ATU facility damaged or destroyed as a result oE this encroachment will be repaired at no cos~ to ATU. 3. Any costs incurred by ATU £or special construction necessita~ed by this encroachment will be borne by the property owner. ~. All applicable sa£e~y code regulations will be observed and maintained. 5. This letter of non-objection ~ill in no way preclude ATU from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, ANCIIORAGE TELEPIlONE UTILITY Victor P. Slaughter, Supervisor Outside Plan~ Engineering DATE~ MUNICIPALITY OF ANCHORA GE Development Sen/ices 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 Date Issued: Jun 09, 2004 Expiration Date: Jun 09, 2005 Permit Number: SW040175 Legal Description: [~IS.~E_~.~.~_OREST~[INIT~'~I-.ET~"3A"?'.~ Design Engineer: 0019 Flattop Technical Services Owner Name: Alf AAnenson Owner Address: 12530 SNOWBIRD DR ANCHORAGE, AK 99516-2606 Parcel ID: 018-011-83 Site Address: Lot Size: 36851 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: r~ Disposal Field ~-~ Septic Tank [] Holding Tank D Privy r--] Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and 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 ,, 7 Issued By~ Municipality of Anchorage Mark Beglch, Mayor Building Sa. feW Dhqsion P.O. Box 196650 · 4700 Bragaw Street Anchorage, Alaska 99519-6650 ° (907) 343-8301 ° Fax (907) 343-8200 http://xxxxxv.muni.org 4/22/2004 Ted Moore Flat Top Technical Services 14530 Echo Street Anchorage, AK 99516 Subject: Waiver Request for Green Forest #1 Block 2 Lot 3A WaiverRequest #WR040036 Parcel ID #018-011-83 Dear Ted Moore: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concems or questions regarding this waiver, please call our office at 343-7904. Sincerely, oe~Goodall Civil Engineer On-Site Water & Wastewater Program Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastcwater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorag¢.ak.us (907) 343-7904 Waiver Review Worksheet WP#: 040036 PID#: 018-011-83 HA#: Permit: Date Received: 6/9104 Legal Description: Green Forest #1 Block 2 Lot 3A Engineer:. Ted Moore Flat Top Technical Services 14530 Echo St Anch, AK 99516 Applicant: Alf Aanenson Waiver Requested: 5' Lot Linw Waiver Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmBmmmmmmmmmmmmmmmmmmmBmmmmmmmmmmmmmmmmmmmmm~mmmmmmm! Waiver is Granted: Waiver is net Granted: List Conditions or Reasons for above: Name of Reviewer Rec#: 53160 Amount: $175 Date Paid: 61912004. 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 SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLI'NG Parcel I.D. Property owner(s) Mailing.address (1) Permit Number SVV~r-/'O/'~'J''' Day phone "=~:~;~~'~"~' Mailing address (2) Legal description (Lot, Block & Sub'd.) /,, Legal description (Section, Township & Range) Lot Size .,~'f" t ,,q.r' IAcres/Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool ID Well Only [] r'-I Water Storage [] I-"J Jacuzzi [] r'"] Water Softening Unit ['-I ID ' I certify that the above information is correct. I fudher 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: Waiver Fees: Date o[ Payment: Receipt Number: Date of Payment: Receipt Number: (Rev. 12J00) ...... :. ~4~.~ ~JJ l{J?~(~ '~ · .~ ~ ~ ' t ~'~*~ *~~. ~,~'~ ~, ~"" ..~"7~'~, . ~ . .. . , , ~. . ~'~'~ .. . · . C~ & EN~ON~NT~ ENG~EER~G * ENERGY CONSERVA~ON & ~YS~ ~ODORE F. MOORE, P.E. PH: (907) 345-1355 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 June 3,2004 14530 ECHO ST. ANCHORAGE, ALASKA 99516 Dear Sirs: The purpose of this letter is to provide the required design nan'ative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 3A, Block 2, Green Forest S/D #1. The existing soil absorption bed is currently operating in a surcharged condition. We are also requesting a lot line waiver allowing the absorption bed to be constructed within 5 feet of the north property line common with lot 5. Soils logs, pert test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material betWeen 0.5 and 2.5' below ground level is a slightly silty sand with a measured pert rate of 2 minutes per inch. The underlying material is sandy silt which is permeable based on the absence of groundwater in the test hole as monitored during break-up. The best solution appears to be to construct a soil absorption bed that discharges into the shallow sand stratum. Using the soil application rate of 1.2 gpd/sq.ft specified in the wastewater ordinance, reduced by a factor of 1.5 because the proposed system is a bed, this 3-bedroom residence requires a total absorption area of (3 x 150)/0.8 = 563 square feet. The propOsed 20' by 30' bed design has a total absorption area of 600 square feet. The topography of the lot in the area of proposed construction slopes down towards the west at approximately 5%. As I discussed with Joe Goodall on June 1st, the proposed bed is 20 feet wide because shallow borings indicate the receiving sand stratum becomes thinner to the south of the proposed construction area. In order to promote the longevity of the system I have slightly oversized the bed and underlain it with washed ISF filter sand with an average thickness of over 12 inches. Issuance of the requested 5' lot line waiver will allow placement of the bed so as to optimize utilization of the native sand stratum. Because of the location of the curtain drain on Lot 5 approximately 30-feet north of the bed, this area cannot be used for future replacement systems on Lot 5, so there will be no adverse impacts to granting the waiver. Since the topography slopes down towards the west there will be no conflict between the proposed system and the existing curtain drain. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. I LOT 3 BLOCK 1 .". R 100' WELL.-- LOT 4 BLOCK 1 WELL \ LOT 5 ~ BLOCK 2 SEPTIC AREA ',, ,---5% '~';'. 20'", ! I ! ! I l I l LOT 2 BLOCK 2 100' ABANDON & REPLACE SEPTIC TANK / #1 ', ~.ULL RUN" ..... _,,_ DIV. VALVE ~ - ' RETAIN CONSTRUCT NEW ~, SOIL ABS. BED ,,' ~ 20' x 30' SOIL ABS. BED~ · , 1.0' AVG. ISF FILTER ·, SAND & 0.5' WASHED \ ~ SEWER GRAVEL ·, ·, / , ,'LOT3A, BLOCK2 / ', / \! GREEN FOREST #1 / ' ~ R 100'/ ~ ,'~ WELL / ..,;' \ / -.-3..--¥,, .... ,,...,,,. ,,~.* .,t~,,.% ..,,.-,... ;~ ~ I ~ ':.%, .,' .~.~"/~ ii \ SEPTIC AREA / / / / / / LOT 2 BLOCK 3 SEPTIC AREA LOT 3A, BLOCK 2, GREEN FOREST SlD -7=f' I SEPTIC SYSTEM UPGRADE SITE PLAN FLATTOP TECHNICAL SERVICES I INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 MAY, 2004 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. 20 C.O. J 4" DIA. F-810 CONSTRUCT NEW 20' x 30' SOIL ABS. BED w. 1.0' AVG. ISF FILTER SAND & 0.5' WASHED SEWER GRAVEL UNDER DIST. PIPE INSTALL "BULL DIV. VALVE TO ORIG. ABS. BED 4" DIA. D-3034 PLAN VIEW SCALE: 1" = 10' -- DBL. C.O. FROM FDN. C.O. ABANDON & INSTALL NEW 1250~ALLON SEPTIC TANK CLEANOUT (TYP) / , M, ONITOR TUBE //! /_/ h 2" RIGID INSULATION 1/2 - 2 1/2 WASHED GRAVEL BO~-FOM OF EXCAVATION ~ ~ ISF FILTER SAND (<1% PASSING #200) _.~.~%~.'.,~,.,..,,,.,oo o,-,...,.,,.,,,, ,,,,,, · ,~.~"~--~u, ~ % ,.,n~.,oo-o,-,.,.,,.,,, ,~ -"A" ~.',.'.<'~'-'..;..-.~4 .,,,~,,, o,..,,, ~..,,,_ ?t'?"-.° ,~.'; ~: ~:- ~ q.~ ~ 1"% :. 't,.'~'.. ,-- LOT 3A, BLOCK 2,' GREEN FOREST #l '"'°'"""'"" .... '" .... ¢ SEPTIC SYSTEM UPGRADE ;'~ - - · , PL^~ AND C~OSS-S~CT10N ~.~,/::..~:~,",,, ..*' ~ ,~..' FLATTOP TECHNICAL SERVICES SCALE: AS SHOWN .... ,{: ,,'<' ~. ,--,~r~, ~':~f~." ~45~o ECHO STREET I DRAWN nY: TFM · ,...~. ........ ....~? ANCHORAGE, AK, 99516 ~ JUNE, 2004 TEST HOLE FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~ot 3A._Block2_G~een_EomsLS/_DJ~l DATE PERFORMED: May_21_,_2004 PERFORMED FOR: AIf_Aanensen DEPTH (feet) 1-- 2-- 3-- 4-- 5-- Pt. SP Slightly silty sand ML Sandy silt BoH. 10-- 12-- 13- 154 16- SLOPE Depth to Groundwater Date Nq groundwater 5/21/04 M.T. D_.ry 5)_2_~704 3LO #1 Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) _~5_/21 12'~-Presoak 31 12" resoak 31 AdcJ water & start 3:49 27 #1 3.:-5~ 5 23 4 Add water 3:54:50 27 #2 3.~5§.:50 5 23 1/8 ! 3_7_/8 Add water 4:0_-0:_20 #3 4:0_5:_2.0 5 23.3/16 3 19/1__6 ! PERCOLATION RATE 2 (minutesfinch) PERC HOLE DIAMETER 5" TEST RUN BETWEEN 1.5 FT AND 2.0__ FT COMMENTS: PERFORMED BY FLATTOP TECHNICAL SERVICES. I~.<..,~-~ ',/'/L~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: ~-'c'~1~. ~ Z~'O~/' TEST HOLE FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: __Lot_3A_,_Block_2_Gmen_EomsLS/D_~_l DATE PERFORMED: May_21, 2004 PERFORMED FOR: AIfAanensen DEPTH -- (feet) 1 Pt and fill MUSM Sandy silt SP/SM Somewhat silty sand Variable depth b.g.l. ML/SM Sandy silt Damp, lenses of saturated SP SLOPE Depth to Groundwater Date .__N o_g r_o_u n_dwate r 5_/2_1/_04 Water~ 10.0'. b._g.I. 5/28104 S' I SLOI SITE PLAN #1 17 "'~ 19-- 20~ B.Ho Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) _5/_21 12" Pre_s_oak 27 .... 112 12" resoak 27 112 Ad_d__~t__er & start 3:25:45 23 3/8 #1 3:35:45 10 19 114 4 1/8 Add water 3:36:30 23_316 #2 3.-46.:30__ 10 19_3_/_8 4 Add water 3:47 2333318 #3 3:57 10 19_3/8 4 PERCOLATION RATE 2.5 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 5.0 FT AND 5.5 FT COMMENTS:__Spil__str~t_ifi_cation is very inconsistent. Scattered lenses of SP/SM in ML strata are saturated. PERFORMED BY FLATTOP TECHNICAL SERVICES. I._~,~ ~/J,'?.~,-~-~, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~J~( MUNICIPAMTY OF ANCHORAGE DEPARTMEN'r OF HEALTH AND HUMAN SERVICES Environmental Heallh Division 825 "L" Street, Anchorage, Alaska 99502, TeLephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Addcess Phone(s) Permd No No ol Bedrooms 7JGAL DE,,CRIPTIO" TANKS DISTANCES SEPTIC ABSORPTION WELL TANK FIELD WELL /"7~> I /~,~1 LOT LINE ,~('), 5~' /Z~'1 FOUNDATION /L; i /0/ -,~S-BUII_'r DI^GRAM ~Show location o[ well. septic system, p~operty hnes Ioundabon. SEPTIC [] HOLDING TYPE OF SYSTEM [] "FRENCH .~' BED ~] W. DRAIN [] OI'HER Gravel depth beneath pipe ~), /'~ FT .... ,,.,,d,h 2. 0 ! 7 ~'~'~ ~']) $(~ Iq .~ FT WELLS ~] PRIVATE [~ OTHER (Identify) Classlhcahon (A.B Ct , JTota[ D~e-~ J Cased REMARKS: FT ',' ' elines in effect un Ibis dale Munlclpa[ and Slate guId · M U N I C :1: F' ~p~ ~.r. :1] "1" Y 0 I:::' A Iq C I'"1 0 R A G E D~.~par,'l:.ml.:.:!r'rl~. o~:' Health & Human ~ii~ePvic:es ~!~:!'~!;~ L.. S'Lr'.ee't..~, Ar'~chc:)r'.age, Alaska 995()1 A N C H 0 R A[~I'.~.:, AK 9951,5 Day I='hc)r'~e ,", 5 ?, 2.-... 1;:~ S-c.,~,c: t :i. on: ;29 7'o~n sh :i. p: 12N I::,'.ang e '.' ,3W I.,.o'L ,%i?,e 17652 (sq,, ~"t,,,, I:~r'. Max Bedr'ooms: I"h:i.s Per'm SE}]:::'TIC; 'TANK:: MJ.r'~:i. mum 'Lcrl..al sep'L:i.c '('..arlk capac::i.'l:.y," :1.,()()O (:!a:l. Ions,, Each · Lank mLl~!;'l:, have at .I.E, aSt ~?. compai','l'..mer-r'Ls. ]'.)~:ep'N'l 'Lo top ~f' septic tanl.,:(s) · 1',~.:.:,~.:~'1'.. r'equir'es ir't~iuJ, at:J.c)r'l i]w.;;)r' tar'iR (~i),, F:'I:ROVIDI}ii: C,I...EAIq OUT AT IL:,'ACI"J E:X'TRI~i]¥1I"r'Y 01=' ,~;;Ii:.::EI:::'AL:)t:i[ BED., I t',l:iiB]"AI.J.... MOI',t I TOR :1: NG TUBE I N '~I~]':EI'" A['E": BED ,, I::RESE:RVIJ;~D AREA ['.',AL.['.',LJLA]'):[)N EXCL.LIDI~)]'.) AI:RI:~:A ENG:[NI~:ER SHOWED I~{J:NCI::~[)A[',HI~J~:D ON WEI..J... RADIUS F'ROM L(]'T 5, I CEF;'.T :l: I::'Y TI"IA'T'~ J.~ I am ~'ami :1. :i. ar' w:i.'[..h 'l'..he n~.?qt..tir'ements t'c)r', cln..-.si'l'..e sewer's and we~ ls as set f'c:,r'tl'"~ by the I~h..tr'iicipa].:i. ty (:t[' (.'~l"lchc)r'a¢:le (MI)A) ar'id the ~B't'..a't:.e of' h].asl.;:a. ;2,, :[ wi:l.]. :i. nsta].], the sy~it, em in acc:cu"dance ~,~:i. th a:l.l MOA c:cx::les and :3, :1: w:i.].l adher'.~;.~ to) all I~l(::)h anti State of' A].a~ika r'(,.'.)qu:i.r'emen'Ls t'(:H' 'LI]e set I::)a(:::l.,: d :i.s'l:.an(::es f Pc:m) al]~/ ex ist :i.n~l ~?~e]. 1 ~, was'Lewa'[.er, clJ. sposa], system c:)r'. 4,, :1: urldePs'Land that 'Lhis per'.m:i.'l:. :ks valid ~'or. a maximum (::)[ :3 I::~(.):,dr'(::~(:~ms, a 1 so und~r's't:..and 'Lha'l. the (:::a[:)a(:: :k ty c) {' the '~'.(:)'~..~'~ ], ~B'V~i~:.,(.alI) :i ~[!i ::~.~; [:)E,)CiI" art v (a::,r1:1. a r. (.~] ~a mr~,)ri '1: w :i :1 :!r' e:, "::l u :[ r'. (~.) a n a d d i 'L i (:) r'l a ]. p (.'::, r' m :L '['.. ,, ... , .... MUNICIPALITY OF ANCHORA(~D DEPT, OF HEALTH & I:NVIRONMENTAI. PROTECTION 'William S..S.mJtt~ ELEVATIONS BASED UPON ~L)M~-/) DATA. AREA OF LOTE~,r'7~? $.E F/NISH FLOOR E£EVATION . //o, o PREPARED FOR, ~\\~? .. iD ~,u'~ ',. / ~-.~. , L~,'GHND.~ /~ Iron pipped/or tabor It /~ f~ r~ponslbl/lty of ~ ~r or builder, pr/or to construct~n~ fo ~rlfy proposed qrod~ relotlv~ to f/n/shed grad~ and utility connect{ohs and any e~m~ts, ~ve~nfs, ot r~str/cflons which do not ~ppe~r on t~ rocordod ~ubdivision plot, DI?Y/N BY: ~.~c DATE: ~'~.¢½ ~:,~ S~AL E' /:~o SHEET ^'0. / of/ GRID PLOT PLAN PREP,:RED BY CO,,IV,/IN E} ASSOC/ATE'S {000 E. DIMONO BLVO. SdiTE 20,5 AIVCtIORAGE, ALASKA B-eSl5 (907) 522-131l Consulting Ellglneers 1000 E. Dimond Blvd. * Suite 205 * Anchorage, Alaska 99515 · (907) 522-1311 August 3, 1988 Municipal Department of Health and Human Services On-Site Diivision 825 L. Street Anchorage, Alaska 99501 SUBJECT: SEWER PERMIT REQUEST FOR LOT 3A, GREEN FOREST SUBD. Gentlemen: We are requesting the issuance of a permit to construct a septic system on Lot 3, Green Forest Subdivision. This property is currently in the process of a short plat to combine Lots 3 and 4 into a single lot (Lot 3A). Since the owner has possession of both parcels and is currently in the process of filing the plat, we request approval be issued to construct the on-site sewer system. It is the owner's intent to construct his dwelling and well on the existing Lot 4 and the sewer system on the existing Lot This should create no legal problems and we would have no problem with your approval stating that it is for use only to serve Lots 3 and 4 as a combined lot 3A. Should you have any questions information, please ]et us know. Ver~ truly y?rs, C@R~ & ASSp~IATES, INC. · Presid~/ enclos~es or need any additional MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION At J6 ''~ . ~¢. 1 1988 RECEIVED EASEMENT DEDICATION Whereas, Lots 3 and 4, Block 2, Green Forest Subdivision are jointly owned by Rick C. Cooper and Janis L. Cooper in the Anchorage Recording District. Lot 3, Block 2, Green Forest Subdivision is hereby set aside for the purpose of a wastewater disposal area for Lot 4, Block 2, Green Forest Subdivision until such time as City sewers are constructed to serve the area. The owners of Lot 4, Block 2, Green Forest Subdivision shall have rights to utilize all portions of Lot 3, Block 2, Green Forest Subdivision, except other easement areas, fOr wastewater disposal as described above. This document has been executed and agreed to this 4th day of August, 1988, in Anchorage, Alaska. Jan~s Cooper . ANCHORA6E, ALASKA Subscribed and sworn to before me, in my presence, this 4th day of August, 1988, a Notary Public in and for the State of Ala~*ka. - BY RICK C. COOPER AND JANIS L. COOPER My commission expires REOUESlt:U BY ADDRESS ~ . .... o / SEWER SYSTEM LOCATION NORTH LOT k~ 8LOCK % ~t ,¢,-r.o¢,~[ SECTION/TOWNSHIP/RANOE Z?, TIz.,~.. ,ff... Or{AWN OY~ PLAN SUBDIVISION OCTE~INEO 8yusE OF CLOTH TAPE.A~O HOT OY SUflVEYIHO TECHNIQUES.' pREPAREO FOR, & associates,inc. Consulting Engineers ~ ~.~ ,.-"(ENGINEEf~ ~,,~,~,,, CE - 6793 12001 Industry Way · Bldg. B · Suite Eleven * Anchorage, Alaska 99515 * (907) 345-4440 PERFORMED FOR: ~&~ ~ST6N~ ~ ~ DATE PERFORMED: LEGAl_ DESCRIPTION:.~N ~T ~ Township, Range, Section: ~, ~, WAS GROUND WATER ENCOUNTERED? N C~ s L DEPTH?IF YES, AT WHAT ~..j/j~,f !, I]~pth Io Waler Alter hlonitorin¢ SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19~ 20~ / / Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER __ __ FTAND __.FT COMMENTS P R ORMEO : A, ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECi' ON THIS DATE. DATE: 72-008 (Rev. 4/85) THAT THIS TEST WAS PERFORMED IN & associates,inc, k%~ ~o~ PERFORMED FOR: AC~ ~Y~T~ [~ DATE PERFORMED: LEGAL DESCRIPTION:~ ~~ ~. Township, Range, Section: ~, ~, SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT 0 DEPTH? P E §eplh Io Water Aller ~aniloring? Oale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (m~nules/inch] PERC HOLE DIAMETER COMMENTS PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: TEST RUN BETWEEN FT AND FT · ~ I CERTIFY THAT THIS TEST WAS PERFORMED 72-008 (Rev, 4/85) & ~ssociales, inc. Consulting Engineers 12001 Industry Way · Bldg. B · Suite Eleven ,, Anchorage, Alaska 99515 · (907) 345-4440 PEREOR ED EOR: AC G'AG LEGAL DESCRIPTION:~~ ~"--O'~-..~'~""' ,._,~,h,.~T°wnship, Range, Section: "~, IA, ALCVS~¢, 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE SITE PLAN \L.T WAS GROUND WATER ENCOUNTERED? ~ ~ /' S DEPTH? p E Depth lo Waler Afler ~0nit0ring? ~?--~"'~ Dale: '-~,/~ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ TEST RUN BETWEEN __ · (minules/inch) PERC HOLE DIAMETER __ . FT AND FT COMMENTS /. ACCORDANCE WITH ALL STA'fE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~..~/4 72-008 (Re;.. 4/85) Par ~:::~,:1. I d ;: 0 l.~:il.--C) 1. :1...- 15 f'c:,r"N'i by Ll'le.:, I'lu.n.i.c::i.l:)a.liL¥ oi ar'id J.r'~ i:::ch"npi:i, al / c: (.:...; ~.,,~J.t,l"i 'Lhe:, d(..i~fs:i.l{li~ c:l'J.'L(.:~,r':i. 41 (::)f 'l:.h:i.~ pepmil' · :S,,i ~a~:i.:l.J. a(::ll'm~r'ize I:.o a.I] FIE)(.1 And ~:! .i-;I ,,m:::~.)~i~ f rmm ~an's,' ~.~x J.~st. J.m::J ,,,~e)t 1 ~, ~,,,ua~M'..~:~wa't.~:.z,r, d :i.~M:~o~a:l. ~y~'l:.{{,:,m or' pLfl::) 1 :i.c a 1 !2;o Lu'l(::h.7;~ r'. ~i'(~. f~ll(.:l 't. hal.. !'. h e~ c: alU) ac: i '!'. y o ~ I... h t:.~ 'L o'L a ] ~y~!i'l'. (:.:m'~ J. fi~i :2; b e:'X'r:l I" c)c)m~!!i ar'i d ,'::tl'J y EH"i ]. ,'::t P ~J 6;:'fh~:~'FI 4. W i .I. I I' (~, (:l~.~ :i. r' (x~ '"' 'X~ ¢' '"" '~ ~ ~ ........................................ WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys // Drilling Permit No. LOCATION OF WELL (Please complete e[the'r lo, lb or lc.} A.O.L. No. lc OISTANCE AND DIRECTION FROM ROAD NTER ECT NS 3. OWNER OF WELL: 5. DATE OF COMPLETION " IO. STATIC WATER LEVEL: ~ ff. , OCT ~ ~gS~ Leng,h of Drop Pipe 1,. c~poci,y __g.p.m. T his~~~~~ / 'we" was d riliede~/¢ ~ ~ ~ a~er/~ r is~.{cli .... this rep or, is true to t~f~ m y~/~knowiedge~ and belief; .I t I I I I I I I I I I~- Certificate of On -Site Systems Approval Parcel 1. D. 018-011-83 Legal description GREEN FOREST UNIT 1 LT 3A Site address 12521 SILVER SPRUCE DR Expiration Date: 6/19/2025 Current property owner(s) MATSON FAMILY TRUSTMATSON DAVID E X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: By: t -- bedrooms, with the following stipulations: Original Certificate Date: 9/17/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Ulu COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA ApprovaIjune 2022 MUNICIPALITY_ -OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel l.D. 018-011=83 Complete legal description GREEN FOREST UNIT 1; LOT 3A Location (site address) 12530 SNOWBIRD DRIVE, ANCHORAGE, AK Current property owner(s) DAVE MATSON Day phone 907-250-7965 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY:* Private Well F] Private Well serving 2 dwelling units Fl Private Well serving 3+ dwelling units ❑ Community Well or Public R Water Storage 4. TYPE OF WASTEWATER DISPOSAL: # Private Septic [] Private Septic serving 2 dwelling units ❑ Holding Tank Fj Community Septic or Public Sewer 5. SEPTIC TANK: FR Steel F1 Plastic [I Concrete ❑ Fiberglass Age 20 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: 0 AWW7S � Bed r_1 Deep Trench ❑ Wide Trench F-1 Seepage Pit Waiver request for: Expedited review requested: [_J Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment L ZoZ, y Date of Payment COSA # 05C� 2 123 G Waiver # COSA Application—June 2022 COSA Checklist Legal Description: GREEN FOREST UNIT 1; LOT 3A Parcel ID: 018-011-83 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 9/29/1988 Total depth 161 ft Cased to 161 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/18/2024 Static water level at beginning of test 42.8 ft. Comments B. TANK DATA Measured operating fluid level in septic tank "48.5" Date of pumping ---:T / I I !' f ❑ Required maintenance completed, if AWWTS Comments: *IN STI / 47" IN ST2 D. ABSORPTION FIELD DATA Which system tested (date installed) 6/15/2004 ❑■ ALL standpipes present per record drawing Total measured depth from grade 3.4 ft (max) Measured depth to pipe invert from grade 2.4 ft (min) ❑ N/A — pressurized field. ❑■ Per record drawings, field is insulated. 0 Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Well production at time of test 9.9+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes 0 No 0 Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic 5.41 ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date 6/19/2024 T STATION ❑ Require t Age of lift station Lift station matdfiaool com Adequacy test date 6/18/2024 Results M Pass Fluid depth prior to test 0 in Water added 828 gal New fluid depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 Effective depth remaining m 6 in L� - I/?-q2� L( Comments/Deficiencies: DIVERTER VALVE APPEARED TO BE DIRECTING FLOW TO THE-2924.DRAINFIELD. DID NOT EVALUATE 1988 DRAINFIELD, BUT DID NOTE THAT THE MT IN THE 1988 BED APPEARED DRY. COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑■ Yes if No ft ❑� Yes if No ft Neighboring Tank > 100' ❑■ Yes if No ft Private Sewer/Septic Line > 25' ■❑ Yes if No ft Absorption Field on Lot > 100' ❑u Yes if No ft Holding Tank > 100' ❑■ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' [E Yes if No ft ❑■ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑■ Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water ICS`'F- T` F:"_0'41�sJ .S T1S1..��j " /� — �'� LIIp From Septic/Holding Tank and,,Absorption Field(s) on Lot to: (Please enter distances If less than required) 1 Building Foundations > 10' S Yes if No *5+ ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No **5+ ft Private Wells > 100' ❑■ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' g Yes if No ft Water Service Line > 10' Q Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS f- IA tJ4 L. 'MET CODE AT TIME OF INSTALL., **LOT LINE WAIVER GRANTED (WR040036). BASED UPON SCALING SEPTIC STANDPIPES OFF AS -BUILT SURVEY, TS AT NORTH END OF DRAINFIELD ARE 5+ FEET FROM NORTH LOT LINE. THE 1988 DRAINFIELD WAS GRANTED LETTERS OF NON -OBJECTION FROM UTILITY COMPANIES FOR BEING IN UTILITY EASEMENT. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regardin the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist—June 2022 / 114-- . 7/2�/Z5� c_ o� OF q J...- .... 1..... {... •-- f e Gar ss_ O � OO CE1-7 53 •- �� p4 p�{ 2 `� 0 LICENSE 4� �ofess�000 #AECC884 MUNICIPALITY F ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT � � '�`� 507-343-7904 0n-Site w��ater and iastewatr Satin _., I-ax: 343-797 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241236 Subdivision: Green Forest Unit 1 Block: , Lot: 3A The septic tank for this property is 20 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more, not including engineering, surveying, MOA permitting fees or site restoration. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Lot 6 Lot 5 Nnalor easement "9.A5 SCALE: V= 50' 12-b r__A iain link fence (lyp) 0 1�0 06 0 o N C� 6pp Ci 7z .0 Greenhouse Wire fence----/ A/ Gazebo 7 V oo 0 oV,Y Lot 2 SSA 56• , Ret. wall LOT 3A0F Ali AW .0 Aw Y * Shed 00*•49th t * 4 a..i aes xi 4 . i 4'. � `-Elizabeth L. Walatka oo Well• 0 8036 - LS Q- 41 AW 4N& 1>69 sloNA- RECERTIFIED 6-G4-24 A 4, AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 3A, GREEN FOREST SUBDIVISION UNIT I Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this — 1 st —day of JUNE '2004. EASEMENTS OF RECORD, OTHER THAN - FRED WALATKA & ASSOCIATES, L.L.C. THOSE SHOWN ON THE RECORDED FB 24-1, pg 46-47 Engineers and Surveyors PLAT ARE NOT SHOWN HEREON BE 907-248-1666 UNLESS OTHERWISE NOTED. JKD This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence, structure or other improvements unless otherwise noted. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence Is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. Lot 5 Nnalor easement "9.A5 SCALE: V= 50' 12-b r__A iain link fence (lyp) 0 1�0 06 0 o N C� 6pp Ci 7z .0 Greenhouse Wire fence----/ A/ Gazebo 7 V oo 0 oV,Y Lot 2 SSA 56• , Ret. wall LOT 3A0F Ali AW .0 Aw Y * Shed 00*•49th t * 4 a..i aes xi 4 . i 4'. � `-Elizabeth L. Walatka oo Well• 0 8036 - LS Q- 41 AW 4N& 1>69 sloNA- RECERTIFIED 6-G4-24 A 4, AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 3A, GREEN FOREST SUBDIVISION UNIT I Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this — 1 st —day of JUNE '2004. EASEMENTS OF RECORD, OTHER THAN - FRED WALATKA & ASSOCIATES, L.L.C. THOSE SHOWN ON THE RECORDED FB 24-1, pg 46-47 Engineers and Surveyors PLAT ARE NOT SHOWN HEREON BE 907-248-1666 UNLESS OTHERWISE NOTED. JKD This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence, structure or other improvements unless otherwise noted. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence Is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. Authentisign im 52700584-15)6-EF11-991A-002248299C60 MUNICIPALITY OF ANCHORAGE Development Services Department Right of Way Section ENCROACHMENT PERMIT R241833 THIS AGREEMENT, made this 16th day of August, 2024, by and between MATSON FAMILY TRUST and their heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State of Alaska, hereinafter called the "PERMITTER". WITNESSETH: WHEREAS, PERMITTEE is the owner of the following described real property: GREEN FOREST SUBDIVISION, UNIT 1, according to the official records thereof, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTER owns and/or maintains the real property more particularly described as follows: The TWENTY FOOT UTILITY EASEMENT, into the northeast of PERMITTEES property as shown on Plat No. 88-105, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTEE has placed a septic tank system upon the referenced real property which encroaches 5.0 feet to 11.0 feet upon the PERMITTER'S 20.0 -foot Utility Easement. NOW, THEREFORE, it is mutually agreed between the parties hereto that: 1. The PERMITTER, acting through the Director of Development Services Department, hereby grants to the PERMITTEE the privilege of allowing septic tank system to encroach 5.0 feet to 11.0 feet upon the PERMITTER'S 20.0 -foot Utility Easement, as shown on "Attachment A," included herewith. 2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless, the Municipality, its officers and employees, from any and all lawsuits, claims or actions brought to any person for or on account of damage to property or injury, disease, illness or death of persons, including all costs and expenses incident thereto, arising wholly or in part from or in connection with the existence of, alterations, maintenance, repair, renewal, reconstruction, operation, use or removal of the encroaching septic tank system, as placed upon the PERMITTER'S 20.0 -foot Utility Easement. 3. The PERMITTEE shall not assign or transfer any of the rights granted herein to another individual or company without first notifying and securing the approval of the Director of Development Services Department. Authentisign IO 62MCB04-1576-EFit-991A-0=4829OC60 4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S real property whatsoever, except only the encroachment rights described herein. 5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days written notice to the PERMITTEE. The PERMITTEE agrees upon such notice of revocation, to move said encroachment(s) from the 20.0 -foot Utility Easement in which it is placed. Should the PERMITTEE refuse or fail to comply with said written notice, the PERMITTER may, without further notice to the PERMITTEE, remove or cause to be removed the encroachment(s), and the PERMITTEE hereby agrees to reimburse the PERMITTER for all costs incidental to the removal thereof. In addition to the mutual promises heretofore made, the PERMITTEE has paid the PERMITTER a one-time permit application fee of $120.00. The PERMITTER hereby waives the annual fee of S315.00. IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day and year first hereinabove written. GRANTEE: Deceased Margaret Katherine Matson Owner Dave lvlAtfoh 09/17/24 David E Matson Owner GRANTOR: MUNICIPALITY OF ANCHORAGE John Snelson Right of Way Supervisor ~ Municipality of Anchorage ({,~,~ Development Services Department ~,~,~=~'~ :~,],] ~ ' ' Building safety Division ~' ' ' On-Site ,Water and Wastewater Program - ' ' ' : '4700 South Bragaw St. ~ a ~ ~ ' ~.ci.anchorage.ak.us ' - ' CERTIFICATE OF HEALTH AUTHORI~ A~PROV~ ~ "' FOR A SINGLE FAMILY DWelLING ..... Parcel I.D; 0~ '~1'- ~3 H~ : Expiration Date: 1. GENERAL INFORMATION Complete legal description /.,o Location (site address or directions) Current prpperty owner(s) · Mailing address I Lending agency .~ ~- Mailing address Day phone Day phone Real Estate Agent ~',l,e~.~l~ Mailing Address ~;/1! "C." Unless otherwise requested, HAA will be held by DSD for pickup. 2. 'NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: ~ Individual On-site [] r-i Individual Holding tank [--I [] 'Community On-site [] [] Public Sewer [] The Municipality of An;:horage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations'given in paragraph 4 by an indepen, dent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. 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 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. 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 application, shows that the on- site water supply and/or wastewater disposal system is(ar~) safe, functional and adequate for the number of bedroom's 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. Engineer's Printed'Name ~eo~e DSD SIGNATURE ~ App.rov,ed for ~ Disapproved. Conditional approval for .bedrooms. bedrooms, with the following Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: X Maintenance Agreements Supplemental Engineer's RepOrt .Other Original Certificate Date: (Rev. 01/02) Municipality of Anchorage Development Services Department. Building Safety Division On-Site Water.& Wastewater Program ~ 4700 South Bragaw St. ,' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 !!! ti! HEALTH AUTHORITY APPROV^L CHECKLIST .' -]: .]Welltype ..~ If~, B, orC providePWSlD ~ -- , Well L~(~/N) :' '~ Date ~t~/~ ~ ~.'.Sanita~ seal~(WN) .~ :Wires ~roperly~p tected (Y/N) : ~::Tota~ ~ft. , Cased to. I~ t . ff ,Casing height (ab~ ve ground) - ' 'vvell production ~. ; 'g.p.m. . .. ~ g.p.m. ;WATER SAMPLE RESULTS~ ' ;~.. ~ ; ~.: ' ~~ : ' " ~ ni~ '< { ~/0~ te acter,a colonies/100ml. ~, ~ Colifor ,,~ 'colonies/lOOml. Nitrate 0.' ~mg./I..,4; 0 h r b ' ' ; .... - : -- mg./I. : Date o~s~ie~:~ Collected b? :. B. SEPTIC/HOLDING TANK DA~A ~ : ~,~. . TankTyPe/Material: ~~ / ~(~ :- ,~., ' Date.installed ;~ ~LIe ~o~ ': Tank size t 2~0: gal.'.' , [Number of:Compa~nts ~ Cleanouts (Y, -:'- :Foundat0ncl~an0ut(Y/N) r DepresSion bver tank (YIN) ~':~ Highwateral.~r~:(y/N) ~.~. C.' ABSORPTION FIELD DATA [- ~ ?,' ..... .. ;: . .. ,, D. LIFT STATION Date installed "PumPon" level at.__ Size in gallons "Pump off" level at~ Datum Cycles tested SEPARATION DISTANCES , · SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. Se~tib taflk/lift *' ' stabon on lot Absorption field on lot Public sewer ma~n Sewer/s&l~tic service line '~, 2,d'/. ..- ' * "On adjaC'e~i'lots'.:.'~, "l O¢5 " On adjacent lots ~ pUblic sewer manhole/cleanout "','HOlding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~"' ~, ; Building foundation ~' ' ',', Property line Water main ~/.4. '.; "'" :: .-' ", '. Wa{er service line ~" ~ ' Wells on adjacent lots~ ,~O'Z, i,. - ,SEPARATION DISTANCE FROM'A'BSoRPTION FIELD ON LOT TO: Property line ~' ' Building foundation Water Service line, ;>;' I~ * ', Surface water ~, :Cudain d~:~in ",~ ~,-'~" ', Wells on adjacent' lots', F., COMMENTS ENGINEER'S CEkTIFICATION I certify tl~at:l"'have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this dbt~.r Engineer's Printed Name -'r'~ Date. ~-'~..4'**~_. ?I~'~ ~_c:;)O ~/' :.:. ~ ' ' Absorption field ~ ~l.i' ; Surfa~water, ~. toO~ i, Driveway, parking/vehicle stor~ige ~"~' 'Y.~ ' HAA F~e'*$ ' '-' .,3'.~ Date of Payment Receipt Number _ (Rev. 12/01) ,. ~ pY"Y'~ : ::... ~ ': -WaN, er Fee $ Date of Payme~nt Receipt Number J 8Z C7X MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # t'~\& - C'1\ \ -~,~ HAA # ~ Gl ~°~ ('bL~'-~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent d'--'~ c ~' /XZA~/~, Address 3 ~0 [ '~ " Telephone Telephone: (home) 3' YJ,-- gZ6'E Business ~%Y Telephone (e) Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3, WATER SUPPLY Individual Well [] 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 legality and status. 72-025 (Rev. 7/88) Page 1 of 2 . 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverifythatmyinvestigationofthis 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 Munioipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date D ~c Telephone Engineer's Seal 6. DHHS APPROVAL Approved for ,,~ Approved' -'~ · __Disapproved Conditional /2-/¢ -87 Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations givenin paragraph 5 above by an independent professional engineer registered in the State of Alaska. 'l'he DHHS does this as a courtesy to purchasers of homes and their lending institutions in ordertosatisfycertain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELl. DATA Well Classification _ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: /.o¢' .~,~,, Well Log Present (Y/N) Total Depth ! ('/ .Cased to I Static Water Level ,~'/' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: 'I'o Septic/Holding Tank on Lot I ~5' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line --~ ~oo To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Date Completed /¢/87 Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) If A, B, C, D.E.C. A~p_roved (Y/N) N, Yield ,y¢'~ ?-~," {Ov?- ItC' ~ To Nearest Public Sewer Cleanout/Manhole ~' v e.~ ;Date ; On Adjoining Lots ~ <oo ' c.c. ; On Adjoining Lots ~ ~'oo · SEPTIC/HOLDING 'rANK DA'rA Date Installed ~? 2'~'/'6g] Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) N,A. Holding Tank Fligh-Water Alarm (Y/N) hi, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well 15'~" ~',~/~ c.c. To Property Line ¥~' ~.¢r a./- To Water Main/Service Line ~ ro To Stream, Pond, Lake or Major Drainage Course Comments N.c,e'4 ,~o'- ./~, nor- ~ cc,¢~1 ! ~"~'¢¢'~ ¢' NO1 of Compartments Air-tight Caps (Y/N) N Foundation Cleanout (Y/N) Date Last Pumped N,,'~. (.occ~/¢, ; for Al,//. Temporary Holding Tank Permit (Y/N) /V, To Building Foundation To Disposal Field I1' 72-026 (Rev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata lb-dj Date Installed ¢; / ~d" / ~,¢ Width of Field ¢¢' ' Square Feet of Absortion Area -7 Depression over Field (Y/N) /"/ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /1¢" ;,-,~,'~ ~',~' To Building Foundation Lot N,,4.. /Z~:,(r-,~ Type of System Design Length of Field 2' 7: ~,- ' Depth of Field £' Gravel Bed Thickness o,,5- ' Statndpipes Present (Y/N) Date of Last Adequacy Test u /-.~¢ /~ To Property Line 3'o ' To Existing or Abandoned System on ; On Adjoining Lots ~' -?~' ' To Water Main/Service Line ~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutback (if present) >,/, [3. LIFT STATION N, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guid~l~,'~u effect on the date of this inspection. Signed ~~ ~.~ ............ , .........1...'~nglneer s heal Date P~c Receipt No. MOA No. ~9 - ~..,4' ~. Receipt No. ¢¢ ( "'%---~ -')~ Date of Payment ,,//c-~ Amount: $ 72-026 (Rev. 7/88) BBck Waiver Fee: $ Date of Payment Page 2 of 2 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 :\ ~ - &:.\ \ ' ~Od~¢~"~ NAA # t;_~ ~ o~.-~,~ L'L; !~:, 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner 1~' :~0:~: Telephone: (home) Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here Iq, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms ~ 3. WATER SUPPLY Individual Well~' 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 ID Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5, ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of thevalidation date shown below, I verify that 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 regulations in effect on the date of this inspection. Date ~¢¢~ 6. DHHS APPROVAL Approved for Y Approved ~'~ _ bedrooms by Disapproved Conditional Terms of Conditional Approval Engineer's Seal 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 byan independent professional engineer registered in the State of Alaska. The DHFIS does this as a courtesy to purchasers of homes and their lending institutions inordertosatisfycertain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88)Back Page 2 of 2 A. WELL DATA Well Classification (/~ MUNICIPALITY OF ANCHORAGE (MOA) Heal,tb~Authority Approval (HAA) OF ANC ,~,~L~l~¥ [~/lZ~I~Jlr~ST - FEBRUARY 1984 F.N~N-~Ai. S~.~,VIC~-S PlV~ 343-4744 MAR 1989 RF_C VF-D Legal Description: If A, B, C, D.E.C. Approved (Y/N) Yield Well Log Present (Y/N) ~" Total Depth /('~ / ~ Cased to / ~., / ~ Static Water Level ..5~ ~ Casing Height Above Ground_ ¢~-. ~ Electrical Wiring in Conduit (Y/N) Date Completed d///? ,¢/~,~ Depth of Grouting ~k,!~ ~ Pump Set At / -.-%'~ -5~ Sanitary Seal on Casing (Y/N) y Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /7~_2 / ; On Adjoining Lots /'~:~) To Nearest Edge of Absorption Field on Lot //;¢,-~ / ; On Adjoining Lots ,.~/~72 / To Nearest Public Sewer Line //~-'///::)r' To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~/~2~':'..~ / , · Water Sample Collected by ~-,'£--4~-t~v/ ,/~'¢.ZJ£ ~--f' , Date _,- Water Sample Test Results .~)~,-FI Comments &iLEL~) ~/Z£LL. ~.~/C:--~z./": <:¢/¥?/~ B. SEPTIC/HOLDING TANK DATA Date Installed ""~/~'~/'_~Size /~ ~'<:::;2 No. of Compartments Standpipes(Y/N) V ___Air-tight Caps(Y/N) Depression over Tank (Y/N) / Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /¢--'"//~'- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well //7~--) i To Property Line '~ / To Water Main/Service Line '~/~2 / To Stream, Pond, Lake or Major Drainage Course Foundation Cleanout (Y/N) Date Last Pumped '/("'/~f-,// /!,_,]//'3~_ ; for A//~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field /~-) / 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 ~-~D Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field _ ,,~ ~,, Depth of Field_ Gravel Bed Thickness ~2, Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well //¢:2~ ,_~' / To Building Foundation /O ? ~ Lot /L'///~r' ;On Adjoining Lots To Water Main/Service Line ~/~'2 ? To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway. Parking Area, or Vehicle Storage Area ,~ ~-O To Property Line ?~:?' ~ / To Existing or Abandoned System on Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Comments Dimensions Manhole/Access (Y/N) / k./~- ~ Vent (Y/N) ~/'~ Pumping Cycles during Adequacy Test. **Check Permitt~e/¢ Bedroom FCtting Against HAA Request** I certify that I/f~;~e ~checked/~ver~ied, or conformed to all MOA and ~AA% inspection. Signed , ate MOA No. Receipt No. ~-'~ Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 effect on the date of this Engineer's Seal