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Home My WebLink AboutVALLEY VIEW TERRACE BLK 3 LT 1Valley View Terrace Lot 1 Block 3 #050-352-10 M ,,t--`7'73 5'q EASEMENT FOR VALUE RECEIVED, MICHAEL D. NORMAN and SHARON K. NORMAN, do hereby grant an easement and right-of-way over the following described property, to -mit: An easement of the south 55 feet for use as a gravel drive- way and an area used for a septic system on the following described parcel of property, said areas being more particu- larly set forth in Exhibit "A" (As -Built Survey), attached hereto and incorporated by reference: Lot One (1), Block Three (3), VALLEY VIEW TERRACE SUBDIVISION according to the official plat thereof, filed under Plat Number P-574, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. The easement and right-of-way over and across said area of land is for opera1. - tion and &dintenance of a driveway over, along and across said property described above for ingress and egress to the following described parcel of property, and for operation, repair and maintenance of a septic system on the above described property. Said ingress and egress will not be limited to any cause, and will be for the exclusive use and benefit of the following described parcel of property, to -wit: i Lot Two (2), Block Three (3), VALLEY VIEW TERRACE SUBDIVISION, according to the official plat thereof, filed under Plat Number P-574, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. j The septic system located upon Lot 1 above described shall be for t sole and exclusive use of Lot 2 above described and said septic system shall be maintained by and for the use of Lot 2 until such time as an approved replacement septic system and/or access to community sewer shall be placed on Lot 2. The driveway located upon Lot 1 above described shall be for the use of Lot 2 until such time as a replacement driveway shall be placed on Lot 2. The maintenance of said driveway and septic system shall be done in a reasonable manner and no unnecessary waste shall occur. All costs of re- pair and maintenance to be borne by the owner(s) of Lot 2. This esement and right -of -may shall run with said properties and be binding upon the undersigned, and their heirs and assigns and shall inure to any person, firm or corporation who shell hereafter acquire title to said properties. DATED this � day of Y�)fc�-2 , a983. KICHAEL D. NDRMA SHARON K. NORMAN STATE OF ALASKA ) C. ss. THIRD JUDICIAL DISTRICT The foregoing instrument was acknowledged before me this;o 0- day of ��1 ra,,,L�r 1983, by MIICC�H,AEL D. NORMAN and SHARON K. NO . 'Fbtary Public in and forACask My commission expires: &--5� STATE OF ALASKA E TARY PUBLIC JEA14NE NIEE MAR 22 '96 11:43AM TRANS ALASKA TITLE ANCH P.2i3 PAM 0102 vASTrtr'N•1' roR Coon Attn vAtttpat.r• CO•tcTDERATTON, the re=elpt and 6uffi- cien-y whereof are hereby a-knovledged and con4-estrd W.?.W. CONSTRt1CT70N, T*fC., Grantor hereby quit:>}aiRt and Conveys to SHAV,0H X, "rNnnTCKS and NTC11AE1, A. RnT'nl C'lf, their respective eu^aessors, helr'a or assigns, r'fAntces, the following das=rihed property: An easement for the nonex^lissive ute of Lot T, Block 3 valley view Terrace cubdivlaion a-cotding to the official plat thereof r r5-14, Anchorage RCcorfllnq District, third audicinl time as , Statro �fdAreska for ia:ementse for septicasystem and/ormaviceas tontil Va time as an app P community or muni:ipal' sever Shall be plAced upon or made available to Raid i.ot 2. Any and all maintenance, repair and/or upkeep of said septic ,System shall be in a reasonable manner and no unne:essary waste, dpmaae or injury to the easement shall occur. The cost of any push nnlntenan:e, repair and/or upkeep shall he borne by and at the sale cost and expense of the ownerlsi of said Lot 7. ppcCRTPTTnN Yrom a point beginning 45 feet Northeasterly from the Eouthwestcrly most point on the houndary between Lot' 1 and 2, Alo:k 3. Valley View Terrace SubdiviSlOh, plat ps 74, Anchoraee pezording District, ThirA ludi:Jal District, State of Alaska proceed 75' Northeasterly alonq said boundary theme proceed along a line perpendiculAr to said boundary in a florthwestcrly dirw:tlon for a distance 0' A0 feet, thence proceed South- westerly alone a line parallel to said boundary for a dis- tan-e of ?S feet thence in a Sout►icnaterly direction along a line perpendicular to tale! boundary bacV. to the point or beginninq. $TRS i�N7 Tr.NF^4rr1T Lot 1, Rlo_k 3, irailey View Terrace SvhOivision according to the official slat thereof r5 74, Anchorage Re:ordinq District, Third judicial District, State of Alaska. This is an casement appurtenant running with the land in favor o` the dominant estate. nATUD- November ,�_ . )QP.< W.J.W. C014s"rpUCTION, INC. Niiliam I. Walker President RETURN TOt RAth.1$R F-4AN'C1At SE"M d7' 7 1 J""'E S PARI: BLDG G A"CH.AX 9)503 ATIN, MAR 22.'96 11.43AM TRANS ALASKA TITLE ANCH 7 0103 1184 STATF. OF ALASKA Z as THIRD .-111nTCIhr- bISTRIC? 1 '•" da of November. n TRTR TS TO CFRTIfY that on the Y 1904, before mt, the undernigntA, a Notary— Pru li= in aetSonailY State of Alaska, duly commissioned and sworn as su=h• p appeared WT1.LT>tN J. WAt.KRR to me known to be the president o`_ N.•T.a CONSTRUCTION, TNC., a corporation, and known to r.•e to be the person who executed•the within instrument on behalf of the to me that the sane COordtlon herein named, and aokhowledgeA tp was signed as A fret at and deed of the saidcorporation for the uses and purpose$ therein stated and pursuant to its Bylaws or a resolution of its Board of bireators. WITNESS my hand and notarial seal the day and year la$t above written. i rte:; ., f%,,.-� �• "tar17u c n an tor.. a ••• +:1 State of Alaska - Coc:rmiealone txpires:' 1 S �• RmTM TCt :757 , ,_1 :'S P.... , s.)G C 1�T714-,J- -pa732a ?taw 5 1218 Y�'6`1 REQUE51ED 81 1ODRESS P. 3/3 J G 7 40' DRAINAGE Lot 2EASEMENT Lot 3 —Z N 907.6-00-E 2.53,44' 1.7'x21.1' CANT 1 STORY RESIDENCE 4-2s, wl FULL BASEMENT WE 16.2x27.3' DECK Lot 1 2.5'x5.5' CANT 28,749 q.f. SEPTIC PIPES Lot 3 GRAVELSEPTIC /FOR r DRIVEWAY W CANT "'T 2 4W'. CANT .,6,5"' BALCONY io, CLEAF EASEMENT UP C�- , . 0/'/ "15' ELECTRIC EASEMENT Lot 2 55' SEPTIC EASEMENT (BK. 1014, PG, 685) PLOT PLAN AS BUILT JL 'SCALE _4L,-59_ GRID sw 0,16D Project No; 18-2aw1 1.1500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Assoclafes, inc. .(967) 522-6476 Phone (907) 612-4625' fax X§_�P At'' Professional Land Surveyom ken0longsurvey.com C)F " ,Nll 1 lonothon0lonasurvev.com I hereby certify,that I have surveyed the following described propertyi LOT 1, 000 3,'VALLEY' VltW TERRACE SUBDIVISION (PLAT No. P-674) Anchorage- Recording Distrl6t, Alaska, and that the Improvements situated thereon are within the property '-J.ln*9:'deist do not tnerbach onto the property adjacent thereto, that no Improvements on. the - property lying adjo'cint thiirifd enorbadh on the surveyed promises and that. there, are no roadways, transmission lines or other visible easements on sold property except as indicated hereon. Dated this the — 'Z10 bay. of 70t"b . , at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. 491U KEN LAN 0 NAME :,~_.~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVlRONM£NTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE RESS [] UPGRADE LEGAL DESCRIPTION D,ST^NCE TO: We,, i Abso,pt,o. ar,a (5_ Dwelling Liq.~c/~t~n--gallons IF HOMEMADE Inside~ength . W dth ~ DISTANCE TO: IWel, Manufacturer / ~ NO. OF BEDROOMS No. of compartments.--.., Material Well ~ ] ~/~ Foundation - ~./f~_ Nearest lot Iir~__~O(~- DISTANCE TO: ~J No. of,ine,/ I Length ?.~.~? Tot al ,e.¢~l~,f )i nes Trench wi~l~?]~, i rich es Top of tile to finish grade ! Material beneath tile " '7'Z~ inches Length Depth Type of crib Crib diameter Building foundation Well DISTANCE TO: Building Liquid depth DISTANCE TO: PERMIT NO. Liquid capacity in gallons effective s r tio a PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Sewer line Septic tank OTHER INSTALLER REMARKS APPROVED DATE 72-013 (Rev. 3/78) STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ GeopnyslcolSurveys ~.~ .:. w ~.~ .-,3-'/41''-i'1''':'/'='" ' T°'l~lhlPNn '' ' v~ ....... , . '--of',,--,~--' .' ~D~.' wD { ' ~ ~"~ '"-- Subm ' ~" ~'nfr f c~' "0 Other ' : , ~, 0 . 0 0 . .':'-:::.~ : l~ ' . 16. WATER WELL CONTRACT~R'~ CER~IFICATIONt 15. Water TemPerature o : ~ F: L:: ~ C ormOZ'WWR (11/81) Copy Olslrlbutlon: WHITE'~toIe O6OS, PINK-Or~]IIr,,'C~H~R~"'GusIomlr c ~_.~UNICIPALITY Of ANCHORAGE · . Department! f Health and Environmenta~rotection 825 ~J Street, Anchorage, AK. ~9501 264-4720 ~'~ ~ ~ ~ HANDWRITTEN PERMIT ~ ~ ~ Permit WELL AND/OR ON-SITE SEWER PERMIT ~ Applicant, ~,/O~ ~~/'~ Mailing Address: ~ ~ Location: ~ .~/~¢ ~ Phone Nu~er: Legal Description. : ~ / ~ ~8/~ ~~ Lot Size: Type of Soil ~sorption System Is: / Trench: ~ Drainfield: Seepage Bed: Holding Tank: Max~ N~ber of Bedrooms: ~ soil Rating(sq.ft/br) /~~, ..... The Required Size of the Soil ~sorption System Is: ' GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of .the excavation(in feet). There is no set width for trenches. The gravel depth is the min~ depth of gravel between the outfall pipe and om ~ ~ REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any welts adjacent to this property and the nu~er of residences that the well will serve. ~ ~ ~ TWO(2) INSPECTIONS ARE REQUIRED ~ ~ ~ Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Einlm~ distance from a private well to a private sewer line is 25 feet and to a co--unity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and cohstruction diagrams are available to insure proper installation. ~ ~ ~ PERMIT EXPIRES DECEMBER 31, i 9 8 3 ' ' I certify that: (1) I ~ f~iliar with the requirements for on-site sewers and wells as set forth by the Municipality of ~chorage. (2) I w11~sta11 the s~tem in accordance with codes. th~re~ ~emod~ed to include more that 3 b~ooms. --~p~icant ~ /~ ~ ~ / Date: / SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, A{aska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~ SOILS LOG [] PERCOLATION TEST .ERrORMED FOR: 'g''-'- LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 DATE PERFORMED: LOPE 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS SITE PLAN WASGROUNDWATER ~ ENCOUNTERED? ~ ~ O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE AI~//(~ (minutes/inch) TEST RUN BETWEEN FT AND -- FT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [~' SOILS LOG [] PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: 1 2 4 5 9 SLOPE SITE PLAN 10 11 12 13 I'~C~ow ~ ~L/5 14 15 16 17 18 19 20- COMMENTS ~ ' PB, WAS GROUND WATER ~/~ ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Cross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) ? TEST RUN BETWEEN . FT AND FT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ./~) ~r~'(~j _ ~ ~'~. --/~_~ HAA# {"[~~[Of'O ~'~) ~'- 1. GENERAL INFORMATION Lot 1, Block 3, Valley' View Terrace Complete'legal description Location (site address or directions) 23431 Upper Terrace Property owner Paul Davis Day phone 696-7664 Ma ngaddress 23431 Upper Terrace, Eagle River, AK 99577 Lendin'g agency U~ilin. g address Day phone Agent Address ' ;Day phone Unless otherwise reque~t~, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. XXX TY~E OF WA~TEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72q)25(Rev. 1/91) Front MOA~21 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 of .this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature $ & S ENGINEERING 17034 Eagle River Loop Road No. 204 EagJe River~ flla~.~.~ e. gE77~ Phone DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with thee following stipulations: Additional Comments Date / 2. - 2 2 - ~'~ The Municipality of Anchorage Department of'Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to pumhasers of homes and their lending institutions-in order to satisfy certain federal and state requirements. Em ployees of DH HS 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. RECEIVED Municipality of Anchorage NOV 3 0 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90~-~'4 Health Authority Approval Checklist Legal Description: ~.-d'T' // ~g~g:'~ .~; ]/~Z..~/~/~J' Parcel I.D.: A. WELL DATA Well type P,~--! Log present (Y/N) L~/'~.., Total depth Sanitary seal ~/N) Cased to If A, B, or C, attach ADEC letter. ADEC water system number Date completed FROM WELL LOG Date of test Static water level Well production Casing height (above ground) Wires properly protected ~)N) AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform G Date of sample: ]//~- ~ / ~/ B. SEPTIC/HOLDING TANK DATA Nitrate ?. G '7 Other bacteria Collected by: ~ ~ .~ ~-~'/c~-/Ar'E~;-'~?-J,'V/-~-' Tanksize /~ ~ Number of Compartments __ Date installed Foundation cleanout~')N) c~,~, Depression (Y~ /t,/~ High water alarm (Y/N) Date of Pumping /[//&~/~'~S. Pumper C, ABSORPTION FIELD DATA Date installed ~/I~~' Length ;~z/ Width Effective absorption area .~ Date of adequacy test / Fluid depth in absorption field before test (in.); "~ Immediately after~'/'~gal, water added (in.): Fluid depth ~ (ins) Minutes later: .~C.3 Absorption rate = Peroxide treatment (past 12 months) (Y/N) /~'~]zl~'~/~'//~/A/ If yes, give date ~- Cleanouts. ~"~N) 4/* Soil rating (g.p.d./fF or fF/bdrm) /~ Gravel thickness below pipe Monitoring Tube present(~/N) /7~-~ Depression over field (Y~) Results (Pass/Fail) /,~55 For /,~"~-~'~ bedrooms System type ~--~:,-V~ Total depth /~- 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* / Cycles tested / Size in gallons "Pump on" level at* *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ,/O(~ -'/ Absorption field on lot ('~ / '¢ On adjacent lots On adjacent lots Public sewer main Sewer/septic service line .Z'~- /'¢- Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ;~,- ¢',¢- Property line ,-~- "zz- Absorption field : Water main/service line ~?:.~ ¢ Surface water/drainage /¢(2 /.¢- Wells on adjacent lots / Public sewer manhole/cleanout / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation F. ENGINEER'S CERTIFICATION I cert'fy that I have determined thru field inspections and review of Municipal recor~'tl~'a~'ih~ ~b&~,s"~,stems are in conformance with MOA HAA guidelines in effect on this date. Water main/service line ~_,~ Driveway, parking/vehicle storage area ~::)~ / Wells on adjacent lots [00 /'/- HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number '12-03'$g 14:19 FROM'CTE ENVIRON~NTAL 5615301 T'338 P,02/03 F-476 ~CT&E Environmemal Seru;ces Inc. CT&E Ref. ff Client Name Project Nme/// Client Sample ED Matrix Ordered By pWSED Sample Remarks: 996~72001 $ & S ~g~neering Valley, View Terrace go;t Blk3 Va/ley View Terrace Loft Blk3 Drimdng Water 0 Client PO// Printed Date/Time 12/02/99 11:16 Collected Date/Time 11/29/99 15:20 Reeeived Date/Time 11/30/~9 10:30 Teehnienl Director: ~ephen C. £de Rele~ed B~~ ~ Prep ANaLySiS 0 cot/100mL $.18 9222B 1.67 0.500 ~ng/L EPA ]00.O 11/30/99 UP 10 max 11/30/09 11/$0/99 SCL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-352-10 HAA# HA920061 1. GENERAL INFORMATION Complete legal description Lot 1 Block 3 Valley View Terrace Subdivision Location (site address or directions) Terrace Drive Property owner Mailing address Bill Welch Day phone _694-8115/344-1717 PO Box 770329, .Eagle River, Alaska 99577 Lending agency Mailing address_ Agent _ City Mortgage % Julie North Day phone 121 West Fireweed Lane, Anchoraqe, Alaska 99503 Day phone Address -- -- Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Three (3) TYPE OF WATER SUPPLY: NOTE: XXXX individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72~)25 (Rev. 1/91) Front MOA #21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, i furtherverify 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 Address Engineer's signature DHHS SIGNATURE ~'~- Approved for Disapproved. $ & $ ENGINEERING Eagle River, Alaska 99577 Phone bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of 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. I/91) Back MOA~I {~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-~'~"\ ~'~,~_'Z~ ~[~'L.-t.~'~%/ ~,J~-~Parcel I.D. A. WELL DATA Welltype ~dL~//Nt'~:~-~ IfA, B, orC, attach ADEC letter. ADEC water system number presen~:~/N) Log Total depth ~C) ~ Cased to ~/--- .~' ~ Casing height Sanitary seal~YN) ~' ~ Wires properly protected FROM WELL LOG AT INSPECTION Date of test ~_~. ~:)"L~ Static water level 'Z.~~ '2.~ Well flow ~¢ .~:) g.p.m. ~'"~ ~ Pump level ~- SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~C)~' t4-- ; On adjacent lots Absorption field on lot ~c~o ; On adjacent lots Public sewer main '~'lp¢- Public sewer manhole/cleanout Sewer service line '~-'~ ~ ~ Petroleum tank ~..~.. WATER SAMPLE RESULTS: Coliform ~:)/"'~ ~'~/~°° '~ o--~ ~ Nitrate Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed Cleanouts t~N) y High water alarm (Y4~ Date of pumping Collected by: Other bacteria S & S ENGINEERING !?03~. £=g!_, ~!~,~ [~? I~oad No. 204 Eagle River, Alaska 99577 Tank size [.ooo &~ Compartments Foundation cleanout (~/N) ~ '~ Depression (Y/~) /"[ Alarm tested (Y/N) ~'~/ ~ Pumper ~"'. ¢- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ~ ~'~ On adjacent lots ~ C~C> t.~Foundation ~ 'Y To propertyline ~ t'~ Absorption field \~ Water main/service line )~t'~ Surface water/drainage ~, C>c:> ~ '~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at High water alarm level j~s tested Meets MOA electric~ ANCE FROM LIFT STATION TO: On adjacent lots _ Surface water D. ABSORPTION FIELD DATA Date installed '~ - / - 'i5~-~ Soil rating \?~' ~/¢'¢-.- System type "~'¢Z.¢.~(~ Length ,.-z~.?~) .Width .-z~=,~ [ Gravel thickness U, ~ Total depth Total absorption area "¥'-1~ ~ Cleanouts presen~N) Depression over field (Y/~__~ /~ Date of adequacy test ~ Results ~)fail) ~.~ for '1"'¢J ¢-¢_~-.. (_"~, bedrooms Peroxide treatment (past 12 months) (Y/~) I,J.~lJF,_. I/I,..~0~,,.{ If yes, give date ¢1/,- ___ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot / of':) To building foundation On adjacent lots Surface water Curtain drain ~ IA- On adjacent lots I'o,~ \ '~ _ Property line ~ I '~ To existing or abandoned system on lot Cutbank ~/A-- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, orconformed to all MOA and HAA guidelines in effe¢ te of this inspection, S & S ENGINEERING Signature 17034 Eaole River Loop Road N~ Eagle River, Alaska ~95~. Engineer's Name Date '"" HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number ~-~ 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 /'/--//~ "~--' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township,.~ Location (address or directions) Applicant Name ~;[( ~L*Q~ Telephone: Home Applicant Address ~ '~¢~ ~ (b) Business ~[-~ (c) Applicant is (check one): Lending Institution []; Owner/builde¢~ Buyer []; Other [] (explain); (d) Lending Institution Address ~ bt ¢,t_z.~ ~ ~,- G ~ (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms ~ Other 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. SEWAGE DISPOSAL Onsite/[~'- 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 (I $~84) Page t of 2 '5. ENGINEERING FIRM PROVIDIN~'=,NSPECTIONS, TESTS, FILE SEARCH, DA'I~"~ND INFORMATION 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, functionar 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 ~ ~, . 8~ ~ ~ ~ Telephone Address ~'~, // -/ DHEPAPPROV~ ~ .(, .~'~ Approved [~d · Disapproveld~ Conditiona~ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority ApprovaJ 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 h.omes 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 72-025 01/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 WELL DATA WeiJ Classification Well Log Present ~,~N,) Date Completed ~1.,~ Total Depth ./~-'O · Cased to Static water Level ~___..~ ,r Casing Height Above Ground Electrical Wiring in Conduit ~1~ Depth of Grouting "- Pump Set At ,//"//~' Sanitary Seal oh Casing~ Depression Around Wellhead Separation Distances from Well: ' To Septic/Holding Tank on Lot ,,/OB "~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ..,/~4) '~ ~' ; On Adjoining Lots To Nearest Public Sewer Line ,~'/'/~-F To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed /~,~ Jt ~ Stand pipes~N)'- Air-tight Capsd~N') Depression over Tank.(~/~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~t~ ! ,4- To Property Line ' /Z) To Water Main/Service Line Course Comments Size ~/~(--') O No. of Compartments Foundation Cleanou~/l~) Date Last Pumped :for Temporary Holding Tank Permit (Y/N) To Building Foundation /~ I ¢- . To Disposal Field /~-'~" ~ ~ ~ ~ _ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 ~ ABS'ORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field ~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well Type of System Design Length of Field t~ ~ Depth of Field 1/¢'~ Gravel Bed Thickness ~ Standpipes Present~AN~ Date of Last Adequacy Test To Property Line To Building Foundation Lot ,,,4¢/,~.. . ; On Adjoining Lots To Water Main/Service Line ,,,,'L/'/~ct.- ":FO t~)To Cutbank (if present)_ To Stream/Pond/Lake/or Major Drainage Course TO Driveway, Parking Area, or Vehicle Storage Area Comments To Existing or Abandoned System on ,/~ /'~' D. LIFT STATION 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, verified, or conformed to all MOA.~nd HA¢, guidelines in effect on the date of this inspection. Signed ~ Date Company, ~~ MOA No Date of Payment ¢ -I b- ~o ~ t Page 2 of 2 72-026 (11/84)