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HomeMy WebLinkAboutWILLIAMSON BLK 1 LT 5Williamson
Block i
Lot 5
#015-073-10
Municipality of Anchorage °°•
Development Services Department r e
Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
y
P.O. Box 196650 Anchorage, AK 99519-6650 Page / of3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW040223 PID Number: 015-073-10
Name:
Ed Mitchell
Wastewater System: ❑ New 0 Upgrade
Address:
5221 E 98th Ave, Anchorage 99507
ABSORPTION FIELD
Phone: d
Number of Bedrooms: 561-1859 3
❑Deep Trench pp shallow Trench ❑Bed ❑Mound [_]other:
LEGAL DESCRIPTION
Soil Rating:
08
Total original
GPD/F?
8.0 FL
Block: Lot: Subdivision:
1 5 Williamson
Depth to pipe bottom from original grade:
Gravel depth beneath pips:
2.89-4.0 Ft.
4.0 FL
Township: Range: Section:
Fill added above original grade:
Gravel Length:
0.74-2.67 Ft.
57 Ft.
Well: E] New El Upgrade
Gravel width:
Number of lines:
Distance between lines:
5.0 Ft.
1
NA Ft
Total Deplh: Casetl fo:
Total absorption area:
Pipe Material:
Ft. Ft.
570 Fri
ASTM D3034 / F810
Driller: Data Drilled: Static Water Level:
Installer:
Data Installed:
Ft
A+ Home Services
6/29)04
Yald:
Pump Set at:Casing
bove Grountl:
GPM
Ft.
TANK
SEPARATION DISTANCES
O Septic ❑ Holding ❑ S.T,E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
ublic/Private
Manuradurer:
capacity:
From
Tank
Field
Station
Tank
sewer Line
Anchorage Tank
1000 cal.
Well
92
92
NA
NA
55
Material:
steel
Number of Compartments:
2
Surface Water
100+
100+
LIFT STATION
Lot Lina
16
1
NA
Manufacturer:
Gal.
Foundation
35
43
"Pump on'l.vel al
level at:
High water alarm at
in.
1".
in.
Curtain Drain
NA
NA
Pump Make & Model
Electrical Inspections Performed by:
Remarks:
Waiver #WR040043 for 1 ft to lot line. Waiver
BENCH MARK
#WR040042 for 92 ft from well to septic tank and
Location and Description. Top of sonotube at NW side of deck
drainfield. Old tank, drainfield, and contaminated
Assumed Elevation:
FL
99.88
soil removed and buried on site.
Engineer's Stamp
OF
Inspections performed by: Cindy W. Ellis, P. E. Dates: at 6-28-04
* 491 9
'
2ntl 6-29-04
. ............fj.
Development Services Department Approval
•lrfLr.� .....
Reviewed and approved by: Date:CE
c; Ci Y W. Ellis ;mom
-105
(Rev. IY00)
`%�-'•.• 7
'TOp ..........`O�
ESSIOPIA
_.//
moo.
10 ft utility
Easement // MTI /
MT2 /
CO2 /
i
i
I
i
i
/ 100 ft well
/ radius - lot 4
__------__
100 ft well radius -
Lot 5 l
92 ft well
/ �sQ radius
FCO Private Well \x
A
for Duplex
�
Existing
B 3 BR House
i
� I
Well r
� I'I
L�
AS -BUILT
Williamson S/D, Blk 1, Lot 5
Record Drawing for Septic Upgrade
A
B
ST1
37.7
51.0
ST2
43.1
55.7
DCO
44.5
56.3
CO1
40.9
47.2
MT1
39.7
45.5
CO2
73.9
57.7
MT2
74.7
59.0
i
i
/ 100 ft well
/ radius - lot 4
__------__
100 ft well radius -
Lot 5 l
92 ft well
/ �sQ radius
FCO Private Well \x
A
for Duplex
�
Existing
B 3 BR House
i
� I
Well r
� I'I
L�
AS -BUILT
Williamson S/D, Blk 1, Lot 5
Record Drawing for Septic Upgrade
p000000
o �� oF... p�
Edward Mitchel
Watkins Engineering' Inc.
ocO " `•. DO
Parcel ID: 015-07-310
o° �:' 4g TH
. ..�.......
Permit No. SW040223
0.....
D
ODD : ` ° E V10577June LIS / /O
Cindy W. Ellis, P.E. P.O. Box 110443
304
Anchorage, Alaska 1
DO���op000000�����
Scaleinch 30 ft
Phone: (907) 349-1851, Fax: (907) 349-1934
FINAL GRADE
FCO 93,53 - 94.04
NOTE:
RELATIVE DEPTH OF WATER
IN TEST HOLE = 78,83'
TRENCH
N.T.S.
f
AS -BUILT
Williamson S/D, Blk 1, Lot 5
00 o�p
0 mop
OF q4 4p
Record Drawing of Septic Upgrade
d .��. • •...q On
Edward Mitchell
Parcel ID: 015-07-310
Watkins Engineering,Inc.
ao��?
T"
�� . 49_*
Permit No. SW040223
p.p ........ D
Q m CIN Y W. ELLIS
E
d0�°;
Cindy W. Ellis, P.E.
P.O. Box 110443
.• "'os"
June 4
Anchoage, Alaska 99511
��`pp000000d���
Scale30in ch
30 ft
Phoner(907) 349-1851, Fax (907) 349-1934
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
eel'�4ai ) LWD
Date Issued: Jun 25, 2004
Expiration Date: Jun 25, 2005
Permit Number: SW040223 Parcel ID: 015-073-10
L a escnp tan„r TAMSOIrI RIC 1 LT` ,5”
...,,
Design Engineer: 0844 Watkins Engineering, Inc Site Address: 005221 98TH AVE E
Owner Name: Edward Mitchell Lot Size: 11626 SQ. FT.
Owner Address: 5221 E 98th Ave Total Bedrooms: 3 Permit Bedrooms: 3
Anchorage , AK 99507-0000
This permit is for the construction of:
❑✓ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
inust be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: Date:
Issued By: Date: ZT 0
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.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. 015-07-310
Number SW
Property owner(s) Edward Mitchell
Day phone 561-1859
Mailing address (1) 5221 East 98th Ave.
Mailing address (2) Anchorage, AK
Zip Code 99516
Legal description (Lot, Block & Sub'd.) Williamson SID, Block 1, Lot 5
Legal description (Section, Township & Range)
Lot Size 11,626 Acres/Sq.Ft.
Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
❑
Sewer and Well
❑
Water Storage
❑
Sewer Upgrade
r7v
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
A , A . , /I v
(Signature of prqffirty owner or authorized agent)
Z
Permit Fees: Lq&0 41W,09FFees� T�
Date of Payment: 18/01 Date of Payment: &6 0
Receipt Number: �31 a°� Receipt Number:
(Rev. 12100) VV
as
Watkins Engineering, Inc.
P.0 Box 110443, Anchorage, AK 99511
(907)349-1851 cwellis@gci.net
June 18, 2004
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
RE: Williamson SID, Blk 1, Lot 5
Septic System Upgrade
To Whom It May Concern:
Attached please find the application and supporting documentation for upgrading the septic
system for the referenced 3 bedroom house. Waivers are requested for separation between the
well and the drainfield and for the tank and drainfield to the property lines. The existing trench,
installed in 1983, has failed. It is proposed to install a new septic tank and drainfield in the
vicinity of the failed drainfield, due to limited space available.
The proposed design is based upon Test Hole #1, dug May 6, 2004, by Jeffrey A. Garness, P.E.
The proposed absorption field is within a 30 ft radius of the test hole. Test Hole #1 was dug to a
total depth of 14.0 ft, with water at 12.6 ft on May 14. The water level is currently at 12.7 ft. A
soil log is attached. A percolation test was run from 4.0 to 4.5 ft, with a result of 1.6 minutes per
inch. The application rate is reduced to 0.8 gpd/ft2 from the allowed 1.2 gpd/ft2 , because the
perc interval is not on the bottom of the proposed trench, and to be comparable to other perc
rates in the area. The maximum proposed depth is 8.0 ft. Details of the design follow:
Proposed Soil Absorption System:
3 Bedrooms x 150 GPD/BR =
Application rate used:
Required area:
System Type:
Maximum Depth:
Effective Depth:
Reduction Factor:
Length Required:
450 GPD
0.8 gpd/ft2
563 ft2
Shallow trench (5 -wide)
8.0 ft
4.0 ft
0.5
563sq.ft/5ftx0.5= 57ft
The existing drainfield has a total depth of 13.7 ft, which is below the high groundwater level.
Because of this, it will be abandoned. All contaminated sewer rock and native soils will be
removed and properly abandoned. The excavation will be filled with native material and
compacted to a depth of 8 ft.
Watkins Engineering, Inc.; June 18, 2004
Septic Upgrade Permit Application; page 2
There is a 10 ft utility easement along the northwest property line which coincides with the 100 ft
well radius. Therefore, a waiver is requested to place the drainfield at 92 ft from the well.
Waiver #WR010098 was approved on December 5, 2001 to allow the existing drainfield and
tank to be 92 ft from the well. The conditions that existed at the time of that waiver have not
changed, so it is requested that the waiver be issued for the new septic system. A recent water
sample, taken June 3, 2004, showed that the water from the well has not been adversely
affected by the current failed drainfield, with nitrates undetected and no bacteria. The $1150 fee
has been paid. A waiver is also requested for a 1 ft separation to the northeast and southwest
lot lines. I believe that there is little risk to human health or the environment by granting these
waivers. The proposed septic system is located more than 100 ft from the private well serving
the duplex on Lot 4 and from other private wells and surface water.
I am not aware of any adverse effect that this upgrade would have on any adjacent properties'
water and wastewater treatment needs.
Thank you for consideration of this permit application. If you have any questions or need further
information, please call me at 349-1851.
Sincerely yours,
Gi/1
CindY V1 Ellis, P. E.
President
—„� 12
3
s 100 ft eli
ystem
\ � � =4radii s
—septic
Block 1 r
s / \\6
3 B ouse
rwell I
s
s ptic
/ system
Bock 2
3
4A
�FJTCT
Willaimson S/D, Blk 1, Lot 5
Proposed Septic Upgrade - Site Plan
Watkins Engineering, Inc.
�Q, .OF,A..q
s�0
Edward Mitchell
49 TH 711 V
Parcel ID: 015 07-310
�...... 41s
QQCIN
Cindy W. Ellis, P.E.
P.O. Box 110443
0 v `., 10577
June 18, 2004
Anchorage, AK 99511-0443
��«
Scale 1” = 100'
Phone: (907) 349-1851 Fax: (907) 349-1934
a°oG
4p�oo
° ° °°°o6Q
Williamson S/D, Blk 1, Lot 5
Proposed Septic Upgrade
Watkins Engineering, Inc.
_00000O00
o ��.F Atgsi0
Existing 1000 gal
/
steel septic tank
/
p°O;?' 49 THy
to be remove
/
o p ' OI V W ELLIS
00 ` E '0577
CindyW. Ellis, P.E. P.O. Box 110443
June 17, 2004
Anchorage, Alaska 99511-0443
g
Existing drainfiel
Proposed 1000 al
Phone: (907) 349-1851, Fax: (907) 349-1934
to be removed.
steel septic tank.
/Lot Line_WWaiver-Requested_
100 ft well
Proposed Drainfield
radius
5 ft wide, 4 ft effective,
depth, 57 ft long.
92 ft well
Max depth 8 ft
r NSA radius
`� 1
10 ft Utility � �
� So-
\
Easement
TH#1: 5/6/04 / i
Private Well
Jeffrey A. Gayness, P / /
co
for Duplex \\
/ TH
\ \
30 ftTH C /
I
Existing
\ \
Radius MT
3 BE House
I
1 ft Lot Line Wailer
1 I
Requested. I
o° Well
I I
I I
I
I I
Existing sewer rock and contaminated native soil
/
Note: Survey Control
to be removed and properly disposed of. The
to be Provided by
excavation must be filled with native soil and
i
Contractor:
compacted to a depth of 8.0 ft.
i
1) Utility Easement
i
2) Lot 5 Well Radius - 92 ft
i
3) Lot 4 Well Radius - 100
\
4) Southwest Lot Line
Williamson S/D, Blk 1, Lot 5
Proposed Septic Upgrade
Watkins Engineering, Inc.
_00000O00
o ��.F Atgsi0
Edward Mitchell
Parcel ID: 015-07-310
p°O;?' 49 THy
o p ' OI V W ELLIS
00 ` E '0577
CindyW. Ellis, P.E. P.O. Box 110443
June 17, 2004
Anchorage, Alaska 99511-0443
g
opo
Cp . ..
Scale 1 inch = 30 ft
Phone: (907) 349-1851, Fax: (907) 349-1934
4
poo ,;as o ',00G
05202004 14:51 SRGRYR CORP RCCTG 4 6943297 NO.642 D01
+�wiw+niow�■w�en iwe dv . •
GARNESS ENGINEERING GROUP, Ltd. cam; ' QOp
•::.euuaa - ^^-^^se CONSULTANTS& GENERAL CONTRACTORB"r.ww.+o +ar A tr D
........ .. .• •. ...•
� sort 101• 7 • MIND.(0"-X44 • WIIIOIC
SO LOG — PERCOLATION TEST
LEGAL DESCRIPTION: WILLAMSON SUBDIVISION: LOT 5 BLOCK 1 f r A arness: �O
PERFORMED FOR: EDWARD MICHEL!
DATE: 5 6 2004
(eet
ORGANICS TEST HOLE
1
7
a-
9-1
10
11
12 ML
13-
14—
R.O.H.
314B.O.H.
51617 is-
16 -
171
1B
DEPTH TO
GROUNDWATER
DATE
SEEP ® 8.75'
1SOIL
CLASSIFICATIONS
5 14 2004
5 7 2004
1
5:49
GINORG1
1
5:59
10
ML
6"
1
N
GM
CLGC
6"-
Isc
OL
10
0"6"
IIIIIIIIIi
MH
6:09
—
6"
_
//I%CH
Fa
6:19
10
0"
�rY.O,
•
6:19
7
a-
9-1
10
11
12 ML
13-
14—
R.O.H.
314B.O.H.
51617 is-
16 -
171
1B
DEPTH TO
GROUNDWATER
DATE
SEEP ® 8.75'
5/6/2004
2.6'
5 14 2004
5 7 2004
1
5:49
LOT 61 SLOOX 1
WILLU\ ON S/D
SITE PLAN
1 "w 100'
LOT 4, BLDCK i
WILLMYSON S/D
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
'WATER LEVEL
READING
NET DROP
(INCHES)
5 7 2004
1
5:49
6"
5:59
10
0"
6"
5:59
-
6"-
6:09
10
0"6"
6:09
—
6"
Fa
6:19
10
0"
6:19
6:29
10
0"
6'
6:29
—
6"
—
10
5:39
/0
0"
6"
11
6:39
r,-
12
6:49 1
10 1
0'
6"
19 PERCOLATION RATE 1.6 (MIN./INCH) PERC. HOLE DIA. 6 ONCFIES)
TEST RUN BETWEEN 4 T. AND 4.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: X YES ❑ NO
SOILS LOGGED BY: KELLY HEITSTUMAN PERCOLATION TEST PERFORMED BY: NICK HEIT5T19MAN
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PEIRF07MED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
Municipality of Anchora
ep,e11 ,r
,e
e
M
B,
7997 Department
Development Services Department
On -Site Water and Wastewater Proaram
**** VARIANCEIWAIVER REVIEW ****
WR#: 040042 HAM 080435 Permit#:
PID#: 015-073.10
Legal Description: Williamson, Block 1 Lot 5
Engineer: GEG
Your request for an amendment of waiver WRO40042 to include a waiver of the required 100
feet horizontal separation from the septic tank on lot 6 to the private well on lot 5 has been
approved. The approved separation distance is 96.0 feet. This waiver was approved based on
conditions being similar to the 2004 waiver request for the absorption field on lot 6 to the same
well.
This waiver approval applies to the existing septic tank to private well 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.
...............................................................................
Waiver is Granted: X Waiver Is not Granted:
Date: 2/26/2009 Approved by: Deb Wockenfuss
Name of Reviewer
...............................................................................
Rec#:IAIA Amount: _ Date Paid:
**** VARIANCE/WAIVER REVIEW ****
Municipality of Anchorage°
Mark Begich, Mayor ^
a
SAf£TY
Building Safety Division
P.O. Box 196650 • 4700 Bragaw Street
Anchorage, Alaska 99519-6650 • (907) 343-8301• Fax (907) 343-8200
http://�.muni.org
6/25/2004
Cindy Ellis
Watkins Engineering
PO Box 110443
Anchorage, AK 99511
Subject: Waiver Request for Williamson Block 1 Lot 5
Waiver Request #WR040043
Parcel ID #015-073-10
Dear Cindy Ellis:
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
1 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 concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
J oodall
Civil Engineer
On -Site Water & Wastewater Program
WR#,
Date
Lega
Eng -It
Apo i
Waiv
We
Wan
List"
Development a
- Building
On -Site Water ai
P.O.
nchorage, AK" 99519-6650
ncT�oiage.A-us
343-7904
;emit#:
JVF,.
Main of Review
6/25/2004
Municipality of Anchorage
Mark Begich, Mayor
Building Safety Division
P.O. Box 196650 • 4700 Bragaw Street
Anchorage, Alaska 99519-6650 • (907) 343-8301• Fax (907) 343-8200
http://w .muni.org
Cindy Ellis
Watkins Engineering
P.O. Box 110443
Anchorage, AK 99511
Subject: Waiver Request for Williamson S/D Block 1 Lot 5
Waiver Request #WR040042
Parcel ID #015-073-10
Dear Cindy Ellis:
Your request for a waiver of the required 100 feet horizontal separation from the
absorption field and septic tank to private well has been approved. The approved
separation distance is 92.0 feet.
This waiver approval applies to the existing absorption field and septic tank to
private well 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 concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
rGd er
On -Site Water & Wastewater Program
WRM Q
Date Re
Legal'Di
Engiriee
Applica
Waiver']
Criteria:
Waiver
List Coi
On -Site Water
A Aikhmaze
%ed` 611.8104
ALASKA WATER � WASTEWATER
CONSULTANTS, INC.
November 15, 2001,
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650,
Anchorage, Alaska 99519-6650
Ref: Health Authority Approval for Lot 5, Block 1 Williamson Subdivision
As discussed with Jeff Poet at your office, an adequacy test was performed on the three bedroom septic
system for the referenced property on November 13, 2001. The trench has an effective depth of 9 feet with 56
inches of cover (per inspection report; S&S engineering, 1983). There were no standpipes shown on the inspection
report. On the day of our inspection, we found a foundation cleanout, two tank cleanouts, and a monitoring tube at
the end of the field. There was no way to verify the level of the drainpipe in the field and the monitoring tube did
not extend to the bottom of the field. There was 57.25 inches of water in the monitoring tube and the tank was
pumped prior to the test.
At the point that approximately 140 gallons was introduced into the monitoring tube the water level had
risen to a level of 68 inches and began to back up into the tank. This means that the bottom of the lateral at the tank
was at 68 inches above the bottom of the monitoring tube.
After 125 minutes the liquid level had subsided to 63 inches above the bottom of the monitoring tube (a
drop of 5 inches). Water was again introduced and it took 45 gallons to back up into the tank again. This back up
occurred 133 minutes after the water was shut off previously. One can assume that the system absorbed this 45
gallons in the 133 minutes which equates to an absorption rate of 0.34 gallons per minute (487gallons/day).
Another 35 gallons was added to back up the system after 82 minutes of absorption time. This equates to an
absorption rate of 615 gallons per day.
There is no way to confirm the exact level of the distribution line in the field. Assuming that the level of
the drainpipe in the field is not significantly lower than that at the outlet of the tank (which is only 5 feet from the
trench), this system is absorbing enough liquid to conform with the municipality requirements for a three bedroom
house.
If you havey further questions please feel free to contact us at 337-6179. Thank you for your continued
assistance. i
M.S.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
SOIL TEST RATING
INSTALLER
REMARKS - --
i
1834-E
APPROVE D�T LEGAL
72 -013 -(Rev. 3/78)
1
;VJ MUNICIPALITY OF ANCHORAGE ,.
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION --
ENVIRONMENTAL ENGINEERING DIVISION
0
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
ONE
LJNE" -
N EW
O UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
�
Com✓ /'��/art/i7 S tl3'1 p /
LOCATION
NO. OF BEDROOMS _
mini
DISTANCE TO:
Well
/// J
Absorption area/
Dwelling /
�_
PERMIT NO.
- O �O
U Y
F Z
_
f
Manulact urer ./-
Material �/ /
No, of compartments
n Q
W
,/-
; / G C.-/
w F
ILie. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
Well
Dwelling
PERMIT NO.
_1
DITANCE TO:
_ _ __
I����■��F�iGvi��
_10Z
OzF
Manufacturer
Material
Liquid capacity m gallons
p
Well ,(/
Foundation
Nearest lot line /
PERMIT NO. Q
DISTANCE TO:
wJ=
Z W
No. of lines Length of each line
Total length of lines y r Trench w�I th
Inches
Distance bel ween lines
_
~ <M
Top of the to finishgrade //
Material beneath the 9.0
� inches
Total effective absorption area
��
O~
02 ^ &rRoo
�
Length
Width
Depth PERMIT NO.
w
[7—
r
—
Crib depth Total elfrnive absorpuon area
Type of crib
Crib diameter
Well
w:
Building foundation Nearest lot line
DISTANCE TO:
J
Class
Dept
h�
Driller
Distance to lot line
— --
PERMIT NO.
w
Building foo daU
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
_
OTHER
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SOIL TEST RATING
INSTALLER
REMARKS - --
i
1834-E
APPROVE D�T LEGAL
72 -013 -(Rev. 3/78)
mini
I����■��F�iGvi��
wr;L�r Lw -
Lot 5 Blk. 1
Date Drilledi
1-12-84 ''� I ��J
a j
I
Static Vater Level 65 feet Gallons Per Minute 10
I
I
Draw Down NSA feet Total Feet of Casing 146
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j
I
Tvve Material Drilledt
I
I
0 feet to 40 Sand, Gravel
I
40 feet to 140 Sandy Clay. Gravel
i
140 feet to 143 Silty Water
i
I
143 feet to
_146 Grava],, Sand w/avatar
I
to
to
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j
Hefty Drilling
S.R.A. Box 1553 H
Anchorage,Alaska
99507
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01 1_I 04 I ®__ I I. I T wg ®=Y F=r 1=1 ]PA 9== 6 8 " 1 Y 9:3 E=
DEPARTMENT b,, HEALTH AND EPVIREOMENTAL L OTECTION
825 'L' STREET, ANCHORAGE, AK 99501
264-4720
011=1__ 1_ 1=1 VA E=a C3 PA —cow I AF E_ _• E=1 A K K I=" 1=1=° 10 I T
PERMIT NO. d 830270
APPLICANT LE'=LIE WASHINGTON 7125 OLD SEWARD HWY 349-6561
LOCATION
LEGAL LOT 5 BLK i WILLIAMSON _,UB LOT SIZE 99999 SQUARE FEET'
TYPE OF =IFIL ABSORPTION SYSTEM IS: TRENCH
MAXIt'll_M NUMBER OF BEDROOMS = _ =OIL RATING <50 FT/BR)= 125
C THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
inaI="T1-1= "1 70 1_1=VACS IFFA= li K C3 FR FA01K1_ E*E=FOT1-1=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DR:AINFIELD.
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 I_• NO SET WIDTH FOR: TRENCHES.
THE GRAVEL DEPTH I_ THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION ON FEET).
1=_ 1= CA L 1 I FR E= E .1;1=" I' I E= T 1=1 P l :: "5117"K= K CA C3 CA C31=11_ L– 0114 c
PERMIT APPLICANT HAS THE R:ESPON`.IBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RE_zIDENC:ES THAT THE WELL WILL SERVE.
-F&-ACI < > 11'„1 _" F" E_ ®_ i- I C") P'd F1 FQ E= F? E= CA L1 T 1=_ 8= E -a
BACKFILLING OF ANY SYSTEM WITHOUT FINAL IP•SPE_TION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON–SITE SEWAGE DISPOSAL SYSTEM IE
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 H COMMUNITY SEWER: LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY
OF THE WELL COMPLETION.
ETHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
Fz"E"1=' Al I T 1= :=4 F" 11-t 1= OF E_a 1= ®_=1=1 1 ED K FZ 70"1 AL "I ED
I CERTIFY THAT
1: I AN FAMILIAR: WITH THE REQ?UIREMENTS FOR ON–SITE :EWER= AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE=.
_. I UNDERSTAND THAT THE ON–SITE =EWER SYSTEM MAY R:EQUIR:E ENLARGEMENT IF THE
RESIDENCE I S. REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
S
APDL I
ISSUED BY
LESLIE
INGTON
'v'4. 0
S 7125 OLD SEWARD HWY.
'• & ENGINEERS, INC. ANCHORAGE, ALASKA 99503
S 349-6561
ilsl
SUILS106 N--RCMAIMN HSI
1'D It$ Of(MI D I OH
/�.fi�I�m.�iil
GlR55r SI OPI SITZ I'1_AN
10 `
a.
`O
12
O�
14
15
16
o`
,6
20
'�i%.fp 'yI fZtJt�
d�-G f a� 12tuJ
TJ. =z
COMMENTS
PERFORMED OY:�
WAS GROUND WATER
-
ENCOUNTERED?
1
IF VES, AT WHAT
DEPTH'
=l
Gioes
Net
[o
Net
Reading
HL
Time
Time
Wale,
Wale
Oro0
C
G
3f,
3
l'� 4
S
49th
o
T
a
. ti a
�GLc v SO Gk e w 4ll ✓ `
/S
10 `
a.
`O
12
O�
14
15
16
o`
,6
20
'�i%.fp 'yI fZtJt�
d�-G f a� 12tuJ
TJ. =z
COMMENTS
PERFORMED OY:�
WAS GROUND WATER
-
ENCOUNTERED?
1
IF VES, AT WHAT
DEPTH'
1834-F °' Q`V
PERC�&T�� ATE �su�L .I�ninaw:/t,sct.i
I�T.QEP�E TWEEN _T• Q FT ANO �•Q f-!
CERTIFIED 0
=l
Gioes
Net
[o
Net
Reading
Date
Time
Time
Wale,
Wale
Oro0
3f,
49th
o
1834-F °' Q`V
PERC�&T�� ATE �su�L .I�ninaw:/t,sct.i
I�T.QEP�E TWEEN _T• Q FT ANO �•Q f-!
CERTIFIED 0
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 015-073-10 Expiration Date:
1. GENERAL INFORMATION
Complete legal description WILLIAMSON S/D; BLOCK 1 LOT 5
Location (site address) 5221 E. 98TH AVENUE *ANCHORAGE, AK
Currert Property owner(s) GOODDEAL LLC Day phone C/O AGENT
Mailing address 5221 E. 98TH AVENUE *ANCHORAGE, AK
Real Estate Agent HEATHER DAMASSIOTIS W/ KELLER WILLIAIay phone 865-6433
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex J
❑ Multiple r wellings (Single Family and/or Duplex)
3. NUMBER OF BEDPOOMS: 3
4. TYPE OF WATER SUL'oLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
Individual Water Stora e
❑
Individual Holding tank
❑
Community Class__. -Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
�It
Received by ,' - Date: G
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ `t� 2_ pp Waiver Fee $
Date of Payment --Lo Date of Payment
Receipt Number 0L11Ind G Receipt Number
COSA # C o� ( = l Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply dnd/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LID. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachrraents. GEG, LTD_ can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 337-6179
Date t o Z9 z
bedrooms, with the following stipulations:
OF
ON-SITE
WATER AND
WASTEWATER
PROGRAM
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska..
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist (� Nitrate Advisory.
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
By:
(Rev. i W5)
Original Certificate Date: ____ ,if I
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: WILLIAMSON S/D; BLOCK 1, LOT 5 Parcel ID: 015-073-10
A. WELL DATA
Well type *VATE If A, B, or C provide PWSID# NIA
Date completed 1/12/84 Sanitary seal (Y/N) YES
Total depth 146 ft. Cased to 146 ft.
FROM WELL LOG
Date of test 1/12/84
Static water level 65 ft.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
10/24/12
Well production 10 g.p,m, 4.5+ g,p,m,
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate 0,15$mg./L. Collected by: GEG. Ltd.
Arsenic: 5 ug./L. Date of sample: 10/11 /12
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 6/29/04
Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout
_(Y//N,)_YES
' Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 1 O / / 51! d. Pumper A20 ; I &_nCJ t'u mei ng
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 6/29/04 Soil rating (g.p.d./WorCbdrm 0.8 System type SHALLOW TRENCH
Length 57 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth *7.83+ ft. Eff. absorption area 570 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 10/24/12 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 19 in. Water added 575 gal. New depth 27 in.
Elapsed Time: 1130 min. Final fluid depth 23 in. Absorption rate >= 450+ g. p. d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off" ley "11 ir High water alar level at in.
Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAiff station on lot *92 On adjacent lots 100'+
Absorption field on lot *92 On adjacent lots 100'+
Public sewer main
Sewer /septic service line 25'+
Animal containment areas 50'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service
Wells on adjacent lots 100'+
10'+ Surface water 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *1' Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*EXISTING WAIVERS ON FILE WITH MOA.
G. ENGINEER'S CERTIFICATION
I certify that t have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 1017-91a
z
(Rev. 11/05)
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.anchora ge.ak.us
(907)343.7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. D 15 O �J' I D HAA# 1)�; Dty I i
1. GENERAL INFORMATION Expiration Date: 91-1-7 - o &
Complete legal description WILLIAMSON SUBDIVISION: LOT 5. BLOCK 1.
Location (site address or directions) 5221 E. 98th. AVE. • ANCHORAGE, ALASKA 99507
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
PETE STELLING Day phone 522-2665
5221 E. 98th. AVE. • ANCHORAGE. ALASKA 99507
Day phone
TERRY GOSE W/ REMAX Day phone
240-3667
110 W. 38th AVE, SUITE #100 • ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) 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 samples. (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 engineers
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on -situ water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee luture performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate olhow long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benerit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will It confer any legal right whatsoever.
5. DSD SIGNATURE
--LG Approved for 3 bedrooms.
Disapproved.
Phone 337-6179
Date
Conditional aooroval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist =l
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: 11-17 - O b -
(Rev. 17111)
Municipality of Anchorage
Development Services Department
Building Safety Division
Orr -Site Water S Wastewater Program
4700 South Bragaw S►.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: WILLIAMSON SUBDIVISION; LOT 5. BLOCK 1, Parcel ID: Q 15-- O % 3 -10
A. WELL DATA
Well type PRWA7E If A. B, or C provide PWSID# N/A
Date completed 1/12/1984 Sanitary seal (Y/N) YES
Total depth 14 ft, Cased to 146 ft.
FROM WELL LOG
Date of test 1/12/1984
Static water level 65 ft.
Well production 10 g•p-m-
WATER SAMPLE RESULTS:
Coliform _]�>'._ colonies/1100 ml. Nitrate Cl&mg./L.
Well Log (YIN) YES
Wires properly protected (YIN) 'IES
Casing height (above ground) 18+ in.
AT INSPECTION
8/10/2005
99 ft.
5+ g.p.m.
Other bacteria N_colonies/100 ml.
Arsenic: N/A mgJL. Date of sample: 8/10/2005 Collected by: GEG. LtD.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material ANCHORAGE TANK/STEEL Date installed 6/29/2004
Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES
Foundation deanout (YIN) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
Date of pumping 8/10/2005 Pumper McDONALD'S PUMPING
C. ABSORPTION FIELD DATA EMMENZON
Date installed 8/29/2004 Sod rating .p.d. ft'/bdrm) 0_8 System type SHALLOW TRENCH
Length 57 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth --A---ft. Eff. absorption area 570 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 8/10/2005 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 5_5 in. Water added 736 gal. New depth 14_75in.
Elapsed Time: 1y039min. Final fluid depth 8 In. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date
D. LIFT STATION
Data installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAitt station on lot '92'
Absorption field on lot 092'
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent kits 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 100+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '•1' Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 20'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and r `
review of Municipal records that the above systems are in """" .. "" """"""
conformance with MOA HAA guidelines in effect on this date.
.................
A. ess.:
Engineer's Printed Name JEFFREY A. GARNESS g .�
lr6loDate
HAA Fee $ Ll J
Date of Payment
Receipt Number
(Pw. 12101) KIA
Waiver Fee $
Date of Payment
Receipt Number
09-31-05;11:42
SGS ReU
C6entName
Project Namc/N
Client Sompla ID
Matrix
PwSID
S=plc Remarks:
1055096001
Garness Engineering Group. Ltd.
Williamson LS BI
Williamson LS BI
Drink g Water.
0
;907 561 5301 # 2/ 4
All Datesmmes are Alaska Standard Time
Printed Date/iime
08/31/2005 1134
CoticetedDateMme
08/10/2005 1520
Received Datcrrime
03/10/2005 15:45
Technical Director
Stephen GEde
Allowable Prep Analysis
Purometer Results POL Units Mcthod Container 1D Llmlts Date Date Init
Nitrstc-N 0.100 U 0.100 mg/L EPA 353.2 B (o-10) 08/10/05 AZS
Microbiology Laboratory
Total Coliform 390B.NoColi coV100mL SV1209=3 A (h1) 08/10/05 TLF
■�
■ ■ 08-31-05 08:59AN FROM-CTiE ESI, SGS ENV SERVICES 9075615301
■e SGS/CT&E ENVIRONMENTAL SERVICES
---S%
Drinking Water Analysis Report for Total Coliform Bacteria
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE
MUST BE COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM IDs
�fRIVATE WATER SYSTEM
/ Send Results Send Results
W.w5 Cort N.I ryNn�
CpgN/+.
N,a
F
3
v
FA;dd
CA
l.. C.av
Itie
SAMPLE COLLECTION:
ane: J
Mwn W Yw
SAMPLE TYPE:
Routine
Transported
to Lab BY: (Same aS Collector Omer.
TO BE COMPLETED BY LABORATORY
Samnlo Receivino:
Date: e�
Time:
Temp:
Delivery Method:
Received Bv: r.t;" —
Commems,
❑ Sample. over 30 hours old;
Results may be unreliable
7
.................................................................................
Bacterioloolcal Water Analysis Record:
Artatysls Beean: IFJ-f—
Analyst: ?f–
Analytical Melhod:
,—Membrane Filter
❑ MMO-MUG (PIA)
❑ Repeat Sample
T-852 P.01/01 F-958
200 W. POTTER DRIVE
ANCHORAGE, ALASKA 99518
Tel: 007-5132-2343
Fax 907-561-5301
Lab Ref No. _
:1055'I504
0 Send Invoice
❑ Treated Water
DUntroated Water
(refer to lab no. 1
❑ Special Purpose
❑ RUSH SAMPLE
Phone 9:
....................................................
UM04AUG (PIA) RESULTS:
Total Cddwm:
E. Cog'
MEMBRANE FILTER RESULTS:///'''
Direct Count: Coloniev100ml.
Venikation:
iu o.s.n LTe-
BGB
EC
Sent b ADEC:
ANC FBK JtIN
DataMme-
Sent tb ClIon[
Phoned Q Faxed Q
Date/Time:
S e Wien:
Satisfactory
❑ Unsatisfactory
B DateTme; `rr- irit .i.e rv..prpCwnl
Reported
Y' e�C/'O �'
i Core �
Form K FW- 0053 17/17/03
1Wsesinas0lVWK GroupDatalPublc\DOCUMENTIFORMSIapprovecAColi Form 121703.x1S
Municipality of Anchorage
• Development Services Department �a ,
Building Safety Division x
On -Site Water and Wastewater Program `
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING 22,,ee
Parcel I.D. 015-073-10 HAA
^
1. GENERAL INFORMATION Expiration bate: ©�
Complete legal description Williamson S/D, Blk 1, Lot 5
Location (site address or directions) 5221 E 98th Ave., Anchorage, AK 99507
Current Property owner(s) Edward Mitchell
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
5221 E 98th Ave., Anchorage, AK 99507
Day phone 561-1859
Advantage Mortgage Day phone 257-0138
Terry Gose / ReMax Day phone 240-3667
2600 Cordova St., Anchorage, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
[]
Individual On-site
❑✓
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) 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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm Watkins Engineering, Inc. Phone 349-1851
Address P.O. Box 110443, Anchorage, AK 99511-0443
Engineer's Printed Name Cindy W. Ellis Date June so, 2004
ie
5. DSD SIGNATURE At
W. Ellis
�
Approved for 3 bedrooms. iO'••. CE •los»
Disapproved.,`o�..... .........
Conditional approval for bedrooms, with the following st( ,
�r ,.• •, �p ��
qt
`J • ON-SITE 6i
Additional Comments AtAIM AND ' rr
: WASTEWATER
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: &�/.�/ j Original Certificate Date: 7
cpw
(Rev. 01102)
ME
�Wli
r�
.gal. h
_,sor onrae >-_
water alarm level at - in.
5larrn �&drcuit circuit
on
:ptic tank and drainfield to well, and WR040043 for 1 ft to lot lines
field 'inspections-" and- 4?-**
yq,systems are in 49TH
in effect on this date.
Cind W Ellis
CE - 10577
Waiver Fee$
16(4 Date of Payment
Receipt Number
06/29/2004 09:5
T.CFoa .e.�ca Bane
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9072767804
ROBERT E JOHNS JP.
Ora
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NOlLSE
PAGE 02
SUIRVEY CERnFTCATION♦♦������VA�
Prepared by
PMNRLAN
�oPSE..o�
Robert E. Johns, Jr. & ASSOC.
, .'••.•
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Professional Land Surveyors
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842.E 72 AVE
AN ALAS(A 58507
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Lot $F.
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Wum.e w at. Irt aN qe a a J
•♦ ��ritiLn♦•
•
LOT' S , BLOCK 1 ill r r tt
• ILLIA.SO-. SUBDIVISION
♦
❑ LO a R ET SURVEY TYPE
❑ �umm•aa+ As-etuLT
❑
... SYMBOLS
SYMBOLS
F.x.('yTRUCIIS[ w*. -&RT
❑ FLOYKI', '...
a $r REBAR � ASPHALT
RR
As—®ALT ..Loi SmKr... 'RPeagAFRr
o FOUND R®AR A -a-9 WOOD PENCE CONCRETE
PLOT PLANS & LOT SURVEYS
00 ASSUMED azv'NERAL FENCE WO
NOTE-
C IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
ONLY THOSE IMPROVEMENITg ABOVE GROUND AND VISIBLE 4MLL
ONLYN.
TO PINI^SHED GRADE AND UTWTY CONNECTIONS' AND TO DETERMINE
THE EXISTENCE OF ANT EAs6MENlS, COVENANTS
AEN HE
CIC„ ARE SHOWN IN THEIR APPROOXICLCMAIr LOCATION,
OP. RESTRICTONS
R7iICN DO NOT AP qR N TME RECORDED SU DI SON PAT
DNDRIVE3NOw
MAY PREVENT SOME IMPROVEMENTS FROM SIZING SEEN AND LOCATED.
Al.t_ (STAN
UNDER NO CIRCUMm STANCES SHOULD AN AS-BULT BE USFOR CMSTRUCMCN OR,FOR ESTAMUS IM BOUNDARY OR FENCE LINES.
THE SUR VEYDR TAKES RFSP*L%8IUTY FOR THE INITIAL TRANSACTION 04LY AND
ASSUMES FINANCIAL LIABIUT( ONLY MR THE COST OF THE SURVEY.
U6TE0 DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
-SG$-
S Rex 1043088001
'ent Name Watkins Engineering
oject Name/# Williamson S/D L5 BI
:ent Sample ID Williamson S/D L5 B 1
Brix Drinking Water
✓SID 0
ameter
tars Department
Vitrate-N
cr033i0109Y Laboratory
notal Coliform
0-100U
0
All Dates/Times are Alaska Standard Time
Printed DatwTime
06/10/2004 11:59
Collected Date/Time
06/03/2004 15:35
Received Date/Time
06/03/2004 16:00
Technical Director
StepheWC. Ede
PQL _.. Units Method Container M Allowable Prep Analysis
0.100 mg/L EPA 300.0 B (<=10)
col/IOOml SM18922213 A (<=1)
06/04/04 JJB
06/03/04 DKC
Municipality of Anchorage
Development Services Department
Building Safety Division '
On-Sfte Water ✓I< Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-073-10
1. GENERAL INFORMATION Expiration Date:
I
Complete legal description WILLIAMSON SUBDIVISION: LOT 5, BLOCK 1
Location (site address or directions) 5221 E. 98TH AVE
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
TED WELLS Day phone 346-4076
5221 E. 98TH AVE. ANCHORAGE, AK 99507
Day phone .1
ii
F.S.B.O.
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3 `
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL::';,
Individual Well Individual On-site
Individual Water Storage ❑ Individual Holding tank
Community Class Well ❑ Community On-site ❑
Public Water System ❑ Public Sewer ❑
The Municipality of Anchorage Development Services De artment (DSD) Issues Certficates
of Health Authonty
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required fog the transfer,
of title (except between spouses) for properties served by a single family on-site wastewater dispo"I'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 less than 30 days old. (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.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,110.00 at, or prior
to closing for the engineering services provided.
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(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage) tiles and from my investigation and inspection, the
on-site watersuppty and/or wastewater disposal system is(ate) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of Installation.
Name of Firm . ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337=6179
ti i 11
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 .
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date b/
Engineer's Comments: !
In conducting this evaluation, AWWC, Inc. attempted to proWde'a thorough,
conscientious engineering analysts of the system In accordance' with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation p��Q; • • •� �0 I j
distances measured to readily IdentfAable features. The,operatiohal life of all wells and D b 'tom* DO
� 'QvsePtic systems depend on the local soils condlilon, roundwaelevels that may ....:.... .:.
fluctuate duringthe ar, and the water usage of the faint bel served b the system.
YB g ►Y Yp
These conditions are outside the control of the evaluator of the sydem.,Satlsfadory test - • • • • •; • • • Q I
results do not guarantee future performance of the system, nor do they guarantee that a fr• •A. Gayness; -
there are no hidden defects or encroachments. AWWC, Inc. con'therefore not provide Q •. I, -7953 w , :! I '
N`�' !
any warranty or future estimate of how long the system will continue to'meetthe 04te '••. ;.•_•,.•;.•• ay
operational requirements ofthe ADEC or MOA DSD. The content of this report Is for �0�°'Professtoao� „. j
the sole benefit of the owner listed above. Any reliance'upon or;use of this report by any ��OOoo�o
other person or party Is not authorized, nor will ft confer any legal right whatsoever.
5. DSD SIGNATURE
!
Approved for bedrooms.
Disapproved. I
Conditional approval for bedrooms, with'the illowing stipulations:' '
I
I
li I
ii
Attachments:
HAA Checklist 'I 'Manitenance Agreements
Septic System Advisory ! 1Supplimental Engineer's Reort
Well Flow Advisory �I Other
Certificate Date:
BY. 9
' Original ,
11'
I�
(Rev.
,I I
i'
i
j
Municipality of lAnchorage sr
Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: _ WILLIAMSON SUBDIVISION; LOT 5, BLOCK 1 Parcel ID: 015-073-10
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 1/12/84 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES .
Total depth 143 ft. Cased to 146 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 1/12/84 11/13/2001
Static water level 65 ft. 73 ft
Well production 10 g.p.m. 5+ g,p,m,
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 0.50 mg./L. Other bacteria 0 colonies/100 ml.
Date of sample: 11/15/2001 Collected by: AWWC, INC.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material GREER/STEEL Date installed 6/1/83
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) 'YES Depression over tank (Y/N) NO High water alarm (Y/N) _ N/A
Date of pumping 11/13/2001 Pumper NORTHLAND PUMPING
C. ABSORPTION FIELD DATA
Date installed 6/1/83 Soil rating OE/ 50r ft�/bdrm) 125 System type DEEP TRENCH
Length 22 ft. Width 4 ft. Gravel below pipe 9 ft.
Total depth *13.5 ft. Eff. absorption area 700 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 11/13/2001 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 57.25**in. Water added ** gal. New depth ** in.
Elapsed Time: ** min. Final fluid depth ** in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
** SEE ATTACHED LETTER
* PER MOA RECORDS. PIPE IN TRENCH ONLY EXTENDS 9.08 B.G.
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/Ac
"Pump off" in. High water alarm level at yin.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot *92'+
Absorption field on lot *92'+
Public sewer main N/A
*SEE ATTACHED WAIVER
REQUEST LETTER.
On adjacent lots 1001+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line % 10'+ - Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 25'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS SvRy►�
G. ENGI'NEER'S CERTIFICATION `'�� •9s��o
!.certify that I 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 date. , , , , , , , , 0
e r A. ness.
0 �
Engineers Printed Na e JEFFREY A. GARNESS —7953
O�4
Date Z O �4e^ed�°r0 essto�°o��
HAA Fee $ �� Waiver Fee $ —/ 7�• o0
Date of Payment Z Date of Paymen/0•
Receipt Number 13 OZ3 Receipt Number 3a3
(Rev. 12/00) _
Municipality of Anchorage
Development Services Department
• '`1 Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: WR010098 PID#: 015-073.10 HAM HA010625
Date Received: 12105/01
Legal Description: Williamson Block 1 Lot 5
Engineer: Jeffrey A. Garness PE
Alaska Water & Wastewater Consultants, Inc.
Applicant: Ted Wells
Waiver Requested: 92 feet from Well to Septic System
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Permit#:
Points:
Waiver is Granted: l Waiver is not Granted:
List Conditions or Reasons for above: .5�EE 471-6 CLED
Date: By: A9N
Name of Reviewer
Rec#: 13237 Amount: $920.00 Date Paid: 1215/2001
m
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I SCALE: {'' 30' 'i PLOT PLAN: I AS -BUILT: X I GRID: 243-7 I DRAWN BY: MGG I CHECKED BY: I
SQS ENGINEERS, iI NC .
1 HEREBY CERTIFY THAT I HAVE SURVE ED THE FOLLOWU NG DESCRIBED PROPERTY.
LOT 5 . BLK.I W14Lt/*4C5DA1 Z)UND ANCHORAGE RECORDING OISTAICT. AK..
AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THEiPROPERTY LINES
AND DO NOT ENCROACH ON THE PROPERTY_LYING ADJACENT THERETO. THAT NO
IMPROVEMENTS ON 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 THIS 1&i;1 DAY OF ?AN . 1964 ANCHORAGE. ALASKA.
17 IS THE RESPONSIBILITY OF THE OWNER OR 11UILDER. PRIOR TO CONSTRUCTION.
TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH GRAC% AND UT.•I.ITY
CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS
OR RESTRICTIONS WHICH 00 NOT APPEAR ON THE RECOROED SUBDIVISION PLAT..
7125 OLD SEWARD HWY.
ANCHORAGE. ALASKA 99502
01. A4
t�
Ar
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Q.
r.• ..• ..........:.�
f .....`- :..
.•:::...... .
JOHN E. SWANSON •`
1'�j� •.�LS - 3152
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�tt��'!/• • •.. •• • adv
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`dAbs�s�er�+
ALASKA. WATER � WASTEWATER
CONSULTANTS, INC. ■
December 5, 2001
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Waiver Request and Health Authority Approval for Williamson Subdivision; Lot 5, Block 1
The existing 3 bedroom house is served by a private well and septic system. The septic system
consists of a 1000 gallon septic tank and a deep trench type drainfield. During our site visit,
separation distances were measured with a total station and found that the septic tank and
drainfield encroach upon the 100 foot well radius. We request that a 92 feet separation distance
waiver be granted from the well to the septic system on the referenced property. The well that
serves the subject property was drilled on January 12,1984, and the septic system was installed
on june 6,1983. The following items are justification for the waivers:
• The septic system is downhill from the well. If the septic system was to overflow, the
effluent would not travel toward the well head.
• The location of the septic system is in a very visible area so that if any effluent was to
surface, it would be noticed and the problem corrected.
The other path of contamination is subsurface migration wastewater. As can be seen on the
attached well logs, the aquifer is approximately 65 feet deep and there are some confining clay
layers above the aquifer that have served to inhibit the migration of untreated wastewater into the
aquifer. Recent water sample results indicated nitrate levels and coliform bacteria results to be
satisfactory. Based upon the aforementioned facts, it appears that there is minimal risk associated
with the 92 feet separation distance waivers.
We also request that your department issue a Health Authority Approval
If you have any queytions, please contact us at 337-6179. Thank you for your assistance.
�fff}(/��TT P.E., M.S.
Presid
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
LOT 14, BL(
WILLIAMSON
i
LOT 14. BLOCK 1
%
WILLIAMSON S/D LOT 16. BLOCK 1
WILLIAMSON S/D
/ LOT 15. BLOCK 1
WILLIAMSON S/D
/ LOT 13, BLOCK 1
WILLIAMSON S/D
LOT 1, BLOCK 1
WILLIAMSON S/D
LOT 12. BLOCK 1
/ WILLIAMSON S/D i� LOT 2, BLOCK 1
�` � /
/
�tl/ �� N / / LOT 3, BLOCK 1 WILLIAMSON S/D
11 / / WILLIAMSON S/D
LOT 11, BLOCK 1 \���
/ WILLIAMSON S/D / /
/ /LOT 4 BLOCK 1
WILLIAMSON S/D -�—
/ LOT 9A, BLOCK 1/ LOT 2, BLOCK 2
WILLIAMSON S/D �� WILLIAMSON S/D
LOT 3, BLOCK 2
WILLIAMSON S/D
I LOT 6, BLOCK 1
WILLIAMSON S/D—
// LOT 4A, BLOCK 2
�\ WILLIAMSON S/D
i _
LOT 7A. BLOCK 1 /
` WILLIAMSON S/D
t LOT 5. BLOCK 2
WILLIAMSON S/D
'K 2
S/D
LOT 9A, BLOCK 2
WILLIAMSON S/D
L /
LOT 13, BLOCK 2 %
WILLIAMSON S/D /
/LOT 12, BLOCK LOT 11. BLOCK 2
IWILLIAMSON S/D WILLIAMSON S/D
e.
ALASKA. WATER & WASTEWATER
I CONSULTANTS, INC.
PREPARED FOR
TED WELLS
PHONE NUMBER:
346-4076
LEGAL DESCRIPTION:
WILLIAMSON SUBDIVISION, LOT 5, BLOCK 1
TYPE OF WORK:
SITE PLAN FOR WELL WAIVER REQUEST
LOT B. BLOCK 2
WILLIAMSON S/D
DATE:
11/30/2001
DRAWN BY:
K.D.W.
SCALE
1 " = 100'
PAGE NUMBER:
1 OF 2
LOT 6, BLOCK 2
WILLIAMSON S/D
LOT 7. BLOCK 2
WILLIAMSON S/D
/
/
/
EXISTING DRAINFIELD. EXACT PERIMETER /
OF TRENCH IS UNKNOWN. AS -BUILT SURVEY
SHOWS SUMP OUTSIDE UTILITY EASEMENT. /
/
WELL
/ ST195.17'
/ ST2 100.30'
/ SUMP 98.70'
(EDGE TO EDGE)
EXISTING 1000 GALLON MEASURED WITH
SEPTIC TANK TOTAL STATION
S�C� . � '� • 'y•• ' � �
/ I EXISTING
WELL /
\ C/
11/30/2001
0
e` Al DRAWN BY-
AT
Y: vim'` • • ��
1 � rWASTEWATERK.D.W. � •s�oo�
ALASKA. V�ATLR &
CONSULTANTS, INC. SCAM,1" = 30'
6901 DEBARR ROAD, SUITE 28 • ANCHORAGE. AK 99504 • PHONE (907)537-6179 • FAX (907)338-3246 D
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
TED WELLS (907) 346-4076 2 OF 2 ere . Garness.: D
LEGAL. DESCRIPTION: C 7953 eeQQO
WILLIAMSON SUBDIVISION; LOT 5. BLOCK 1 `
0 fc •.,• o,v
TYPE OF WORK: 44OedprofessJ0!! *�
DRAWING FOR WELL WAIVER REQUEST
I co%rlv,,res-
L 14 BL
IL SO S/ LOT 16, BL
WILLIAM S/D
15, BLOCK 1
WI
LOT 3, BLO
1
LIAM
S/D
<v�
LOT 1,
Q
ON S/D
LOT.BLOCK 1
W IASON S
2, B OCK 1
WILLIAMS S/O
L 3, 0 1
ON
LOT 11 LOCK 1
WI SON S/D
4, BL 1
ILLIAM S/D
OT 9A, B CK 1
WILLIAMS N S/D
LOT 2,�QK 2
LLI MSON S/D
LOT 3, BOCK
WILLIAM N S/
6 LOCK 1
J
IL SON S/D
`r
LOT 4A, BLOC
ILLIAMSON S/D
LOT 7A, BLOCK D
C
REST W T MSON S/D
LT 1 LCK2
IL IA N S/
T 9A, BLOC 2
ILLIAMSON S D LOT
BLOCK 2
WILLIA
ON S/D
13, LO
2
LOT 8, BLOCK 2
1 L S
D
t#A D
L T 12, BOCK OT11, OCK 2
LOT 7, BLOCK 2
1 MSO /D WIIZMSON
ILLIAMSON S/D
ATE:
11/30/2001
DRAWN BY.
SCALE:
100'
6 01 BARR AD. I
N R 99 • PHONE (907)337-6179 • F�(907)3-3246
PREP ED FO
R:
PAGE NUMBER:
WE L
346-407
1 0
LEGDESCRIPT
,,<L
WILLIA ON,
LO 5, 1
TYPE OF RK:
TO OGR HIC
DRA A
Municipality of Anchorage
• Department of Health and Human ServiceAlhitl&x
Division of Environmental Services
On -Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650 i '
www.ci.anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel 1. D. ICJ —07�_D' — I �D HAA#
Expiration Date:
GENERAL INFORMATION
Complete legal description
1
Location (site address or directions) G2 a Z I E 2e
Current Property owner(s) Day phone ?�, 4�- — / �, l
Mailing address
Lending agency _
Mailing address
Real Estate Agent_
Mailing Address
Day phone
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by
a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates
are valid for one year for properties served by Class A or B wells or a public water system. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
72025 (Rev. 01 X001'
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval
application show that the on-site water supply and/or wastewater disposal system is safe, functional and
adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-
site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm -) ar,4�� C7la X71 `.f '� Phone
Address C- 4-I.r.
i
Engineer's Printed Name_ Jam? (!�3 g /:7 Date
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
NGIN8 R
i
/v Sffi1!G �ti'�s�
u
bedrooms, with the following stipulations.
Attachments:
HAA Checklist Maintenance Agreements _
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other _
By:-�����, %moo Original Certificate Date
Expiration Date:
75025 (Rev. 01'00)'
Reissue Date:
Ll- /7-0 a
Municipality of Anchorage '�—) RECEIVED
• Department of Health and Human Services
Division of Environmental Services APR 13 2000
On -Site Services Section 825 "L" Street Room 502 A§
P.O. Box 196650 Anchorage, AK 99519-6650 MUNICIPALITY Of ANCHORAGE
www.ci.anchorage.ak.us 11VIRONMENTALSERVICES C!Y
(907) 343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L5 0 I v,( � I I I d /�y 5© a k Parcel I.D.:
A. WELL DATA
Well type �f - v4 e
Date completed
Total depth, _� ft.
If A, B, or C provide PWSID #
Sanitary seal _L
Cased to Jf4 ft
FROM WELL LOG /
Date of test
Static water level ft
Well production n 9 -p.m
WATER SAMPLE RESULTS:
Well Log
Wires properly protected Y
Casing height (above ground) —Y— in.
AT INSPECTION
ft
g.p.m
Coliform ©'
colonies/100 ml
Nitrate,eJ 56ng/I Other bacteria 0 colonies/100 ml
Date of sample:
3 ` 2—W 00
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material �)+e.Q-/
Date installed i _72) Tank size gal Number of Compartments
Cleanouts __�X_Fouunydation cleanout Depression over tank - ) High water alarm
Date of pumping J 7 Pumper.A)of
C. ABSORPTION FIELD DATA
Date installed iL ` i Soil rating (g.p.d./ft2 or ft2/bdrm) i 25P/System type rz%✓IC�
r
Length ft Width `i= ft Gravel below pipe —?--ft
Total depth ft Effective absorption are42 Monitoring tube Depression over field—
Date
ieldDate of adequacy tests—�C Results (Pass/Fail) _ For 75 bedrooms
Fluid depth in absorption field before test S C- in Water added�'al. New depth 2� in.
Elapsed Time: �� min Final fluid depth ,S � in Absorption rate >=5_09-p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) AJ' Pe/" 0V h -<� / _' If yes, give date __
72-026 (Rev. 01/00)'
D. LIFT STATION
Date installed F/4\ -gallons
"Pump on" level at �Jv 'n "Pump off" level at in
Datum Cycles tested
E. SEPARATION DISTANCES
Manhole/Access
High water alarm level at in
Meets alarm & circuit requirements.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot J)U On adjacent lots
r
Absorption field on lot % �O� On adjacent lots > /OCA
Public sewer main Public sewer manhole/cleanout -12V-4
Sewer /septic service line ! Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 41b. Property line fg,Absorption field
Water main XGA Water service line Surface water /�©✓.��
Drainage A&k)e� Wells on adjacent lots //'-�- / C'� 1
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
V
Property line Building foundation / Water main
C.
l \
Water Service line Surface water Driveway, parking/vehicle storage
Curtain drain /U M Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and gs ENI(VE�'6'
review of Municipal records that the above systems are in s
conformance with MOA HAA a;idelines in effect on this date.
Engineer's Printed Name _ l ,_1 al�%��i
1917 4
Date
me=. ...
HAA Fee $ Waiver Fee $
Date of Payment Op� a p l Date of Payment
�
Receipt Number _ cY)Z a 70/ / Receipt Number
72-026 (Rev. 01/00)'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT 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 /
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
/ -., ./- 4 A V f al" i A.. ,rte C_� -I&P- /'s;-,
Location (address or directions)
VI
1�
(b) Applicant Name 9WC,- VIO--r" Laos 'riu Telephone: Home Business
Applicant Address
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agentt�
Address 'QLD 7 Gln r t i Lc S
Telephone
(f) Mail the HAA to the following address:
�OL4
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
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 the legality and status.
4. SEWAGE DISPOSAL
Onsit)community
Public ❑ Community El Holding Tank ❑
Note:l 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)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION,
0
As certified by my seal affixed hereto and as of the validation 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. (%
Name of Firm �t ��L,,t elver-u�r.K � a Telephone P-7 l a
®3ci {
Address E>'S Lt%y l5d �t
Date
e;'` X. - — G� Engineer's Seal
i . 2225-E
29, 1911
DHEP APPR011AL�}�
Approved for (7/GPi%t. bedrooms by
�04
Approved Disapprove Conditional
Terms of Conditional Approval
CAUTION
Date
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 order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
MUNICIPALLY OF ANCHOPAG'c
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION.
0 1985!
Legal Description: L. OT
-0" MIAM (_C�e)m
A. WELL DATA
Well Classification 'ZV_5 If A, B, C, D.E.C. Approved (Y/N) 1i /&
Well Log Present (Y/N) _x_— Date Completed tZ Yield %G a e
Total Depth / 46> Cased to Depth of Grouting IN o L�'( C__
StaticWater Level A rft Pump Set At A0 7- 62� I-(
Casing Height Above Ground O Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot %0-0 ; On Adjoining Lots if ,q
To Nearest Edge of Absorption Field on Lot r/0-0 ; On Adjoining Lots
To Nearest Public Sewer Line NCS N iZ To Nearest Public Sewer
-
Cleanout/Man hole- ©N L= To Nearest Sewer Service Line on Lot � PD
Water Sample Collected by 1 1 ; Datefy/ZIg 5
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
7
Date Installed ry(T` 8 Size ( tl No. of Compartments 6tAC3
Standpipes (Y/N) Air -tight Caps (Y/N) i Foundation Cleanout
/ (Y/N) y
Depression over Tank (Y/N) W Date Last Pumped (a f � h
Pumping/Maintenance Contract on File (Y/N) (41;4c ; for N//k
Holding Tank High -Water Alarm (Y/N) NX! k Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
t
To Water -Supply Well /SC7 To Building Foundation
To Property Line To Disposal Field
To Water Main/Service Line % (� To Stream, Pond, Lake, or Major Drainage
Course d N L
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
Date Installed _ e. /f ,� 3 Length of Field ° r
rr
Width of Field _r Depth of Field 1
Gravel Bed Thickness cj
Square Feet of Absorption Area Standpipes Present(Y/N) ra (=
Depression over Field (Y/N) Date of Last Adequacy Test 1
Results of Last Adequacy Test �Y Y Misr b1 0
Separation Distance from Absorption Field
To Water -Supply Well 1 D-0 To Property Line 10
To Building Foundation To Existing or Abandoned System on
Lot NON On Adjoining Lots ti Sita
To Water Main/Service Line `l ! G� To Cutbank (if present) N i=
To Stream/Pond/Lake/or Major Drainage Course N o14 j-�
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION ` T C)t� �R
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for _
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
— "Pump Off' Level at
— Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked,ve1� fjed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed 4u..LDate 1©ly I�`�
Company �'s� MOA No.i S-�l
Receipt No.
Date of Payment
Amount: $ Engineer's Seal
6...
�Q.n• Nil
2225-E:
Ufa �j* J 26. L911
Page 2 of 2
72-026(11/84)
03 W. 15th AVE "C" SUITE 203
U O �UV-G�U�1�L74'.►l7V D� �o�v �2A CHORAGE, ALASKA 99501
CONSULTING ENGINEER - TELEPHONE: (907) 279-3916
S E P T I C S Y S T E M A D E Q U A C Y T E S T
— — — — — — — — — — — — — — — — — — — — — — — —
LEGAL: LOT 5, BLOCK 1, WILLIAMSON
LOCATION: 5221 E 98TH.
OWNER: BRUCE MATSUTSUYU
RESIDENCE: SINGLE FAMILY, THREE BEDROOMS
WATER SYSTEM: ON SITE WELL
SEPTIC SYSTEM: FROM MUNICIPAL RECORDS:
TANK: GREER STEEL, STEEL, TWO COMP.
1000 GAL.
ABSORPTION SYSTEM: TRENCH
ABSORPTION AREA: 396 SQ.FT.
SOIL RATING: 125
INSTALLATION DATE: JUNE 1983
DATE OF PUMPING: AUGUST 1985
DATE OF TEST: OCTOBER 4, 1985
T,_T-NRRQCEDURE: WATER WAS ADDED TO THE TRENCH AT A CONSTANT
CIF /1 4 RATE OF 7 GALLONS PER MINUTE. THE WATER DEPTH
IN THE TANK AND IN THE SUMP WAS MONITORED.THE
WATER DEPTH IN THE TANK REMAINED CONSTANT AT
*�A 47 INCHES WHILE THE DEPTN IN THE SUMP
g
INCREASED FROM 17.5
LLL INCHES TO 48 INCHES.. A
, 0 7225-E TOTAL OF 450 GALLONS WERE ADDED. AFTER 5
t , MINUTES- THE WATER LEVEL IN THE SUMP HAD
1Ur 2a. 1971 r-�
DROPPED ONE INCH.
. � s
S`kTF,' ` ) OLT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF
THE MUNICIPALITY OF ANCHORAGE.
The operational life of all septic systems depends on the local
soil conditions, groundwater levels that may fluctuate during the
year, and the water usage of the family being served by the
system. These conditions are outside the control of the evaluator
of this septic system. We can therefore not give any estimate of
how long the system will continue to meet the operational requi-
rements of the Municipality and State.
3 W. 15th AVE "C" SUITE 203
40 (5a �PG3G3dG�G1D� polio �20A CHORAGE,ALASKA99501
CONSUt.TING ENGINEER TELEPHONE: (907) 279-3916
R E S I D E N T I A L W E L L I N S P E C T I O N
— — — — — — — — — — — — — — — — — — — — — — — —
LEGAL: LOT 5, BLOCK 1, WILLIAMSON
LOCATION: 5221 E 98TH AVENUE
OWNER: BRUCE MATSUTSUYU
TYPE OF WELL:
C1-1 [e711DfaNXIISIVA
WELL LOG AVAILABLE: YES
INSTALLATION REQUIREMENTS MET: YES
WELL YIELD FROM WELL LOG: 10 GALLONS PER MINUTE
PUMP YIELD: 7 GALLONS PER MINUTE WITH 36 FEET
DRAWDOWN
DATE OF INSPECTION: OCTOBER 4, 1985
TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 7
GALLONS PER MINUTE WHILE THE DRAWDOWN WAS
MONITORED WITH AN ACOUSTIC PROBE. THE WELL
WAS PUMPED TILL THE DRAWDOWN STABILIZED.
STATIC LEVEL WAS FOUND AT 66 FEET BELOW TOP
OF CASING. AFTER 90 MINUTES OF PUMPING AT 7
GALLONS PER MINUTE THE WATER LEVEL WAS AT 102
FEET.
TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON
OCTOBER 2, 1985. TEST WAS NEGATIVE.
TEST RESULT:
THIS WELL MEETS THE REQUIREMENTS OF THE
MUNICIPALITY OF ANCHORAGE.
The Municipal requirement for well flow is
�i ;1:.:.';•y` ".1_
150 gallons of water per bedroom per 24
,ft�s
hours.This well surpasses this requirement.
Y.�
The assessment of the condition of this well
s, 49.1 ✓�
d..�-q���-• ••••
applies only to the conditions as of this
date. The flow rate of the well may change
2225
N -E ;.,.•s
due to subsurface conditions that may not be
j6jN- 25.1971 :r; ,
observed from the surface, and changes in
land use and other factors that may impact
the conditions of the aquifer feeding the
well.
Time
APPLIC_;__,JT FILLS
OUT UPPER HALT,,_ ONLY
Time M�I
Property Ownerc�
U—
Date
e
Date
Date
Inspector
FPI,,,o
1 31/
Mailing Address'
%
Zip Code
Field Notes:
Buyer
,tfyo
Address
>
Zip Code
Lending Institution��11
'CONDITIONS OF APPROVAL
Phone
J /.; A � � �
- -
i %/ / r /
Address
r
Zip Code
Realty Co. & Agent
Phone
Address
Well To Absorption Area
Zip Code
Received
Legal Description
0 — ( ^ F-3
Well to TankB U
Septic Tank Size d d 0
Street Location
Type of Residence
X Single Family
_
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
Individual
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
Community
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
Sewer Disposal
Individual
Year Individual Installed: ' L
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time M�I
' e
Date
Date
Date
Date
Inspector
Inspector
Insp r
Inspector
Field Notes:
,tfyo
>
() APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE 4L_ 7 6
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log
Received
f Z -<
0 — ( ^ F-3
Well to TankB U
Septic Tank Size d d 0
72 0231X821
mac.
�w 15 IoO� Radius
/ �ronrl Well
5 i+e
m-
�.l
N
I
I
r
lo' dTIL. ESIAT-1
j E
it s ENCINEEAE, INC. .
`Y
3U
I
�G✓
X36
m
I HEREBY CERTIFY THAT I HAVE SURV¢E1YEryO��1THE FOLLOWING DESCRIBED PROPERTY,
WI
LOT 5 , BLK.I W14LIAAC)D1.l aiD ANCHORAGE RECORDING DISTRICT. AK.
AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THEiPROPERTY LINES
AND DO NOT ENCROACH ON THE PROPERTY LYING ADJACENT THERETO. THAT NO
IMPROVEMENTS ON 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 THIS I&*'DAY OF TAN , 1984 ANCHORAGE, ALASKA.
IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER• PRIOR TO CONSTRUCTION.
TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH GRACE AND UT'I.ITY
CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS
OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
- .............r..l
JOHN E. SWANSON -
LS - 3152
�pro�essional�a°vim
aad4a0�
�r� r
fir),
JOB NO.:
ZONED
40 O I I
RIA
BOOK
5-155
C.LIF.QT:
STOGFG
SCALE: 1"= 30'
PLOT PLAN:
AS -BUILT: X GRID:
243-7
DRAWN
BY: MGG f
CHECKED BY:
S & 5
ENGINEERS,
INC.
7125 OLD SEWARD HWY.
ANCHORAGE,
ALASKA 99502
I HEREBY CERTIFY THAT I HAVE SURV¢E1YEryO��1THE FOLLOWING DESCRIBED PROPERTY,
WI
LOT 5 , BLK.I W14LIAAC)D1.l aiD ANCHORAGE RECORDING DISTRICT. AK.
AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THEiPROPERTY LINES
AND DO NOT ENCROACH ON THE PROPERTY LYING ADJACENT THERETO. THAT NO
IMPROVEMENTS ON 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 THIS I&*'DAY OF TAN , 1984 ANCHORAGE, ALASKA.
IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER• PRIOR TO CONSTRUCTION.
TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH GRACE AND UT'I.ITY
CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS
OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
- .............r..l
JOHN E. SWANSON -
LS - 3152
�pro�essional�a°vim
aad4a0�