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Home My WebLink AboutWILLIAMSON #1 BLK 1 LT 16Wi lliamson #1 Lot 1/) I lock ! #015-073-33 _., Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater DiSposal System and/or Well Inspection Report Permit Number: ~,t,o ~ D o'~.~ PID Number: (:~ t Name: Wastewater System: D New ~ Upgrade Address: ~ ~ c~cc~ ABSORPTION FIELD Phone: ~ ~-- ~ JNo. of B~ooms: ~DeepTrench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DES CRI PTI O N Sol, Rati~g~ Total Depth from original grade: ~ GPD/Sq, Ft, Lot: /~ 8~ock:~ ~ ~Subdiv~i°n:~ ~ ~ ~ Depth to pipe~bo~om from~ *~°rigi~al grade: Ft. Gravel depth~,beneath~ pipe Ft. Township: ~ Range: ~ Section: Fill added above original grade: Gravel length: I I ~ ~ Ft. ~ Ft. WELL: ~ New ~ U~ Gravel width:~ Ft. Number of~ lines:~ Distanc~ baleen_ lin~:Ft. ~lassification (Private, A,B,C): ~pth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: ~ GPMJPump Set at: Ft. I Casing HeigM Ab°ye Gr°u~: TANK SEPARATION DISTANCES o s~ptio o Ho~ing ~S.T.aP. TO Septic Absorption Lift Holding 'ublic/Private ~anufacturer: Capacityin gallons: From Tank Field Station Tank Sewer Lines ~ ~C~ ~ Material: Number of Compa~ments: we~ f ~ ~ /~- lZb ~ /~ ~ Sudace Water /~ [~=~ ~ LIFT STATION Lot Size in gallons: ~ Manufacturer: Foundation ~ [ ~ ~. L~ ~ ~ ~ "Pump on" level at: "Pump off' level at: High water alarm at: CudainDrain / ~ ~ ~ ~ ~ ~ Pump Ma~e & Model Electrical Inspections pedormed by: Remark~u ~ ~o ~ cA~ ~O' ~CL BENCH MARK Location and Description: Assumed Elevation; ENGINEER'S SEAL Inspections pedormed by: ~-~A~ Dates: 1st &/,~/~ Department of Health,~ and ~ Human ~, Se~ices ~Date:appr°vaI?- > ~ ~ Reviewed and approved by: ~ /~ -/ 72-013 (Rev. 9/91) MOA 25 WA~TEWATER AB~ORPTIDN SYSTEM LOT 16, BLOCK 1 WILLIAMSDN S/D NOTES, 1) A.WAIVER WAS GRANTED FROM ADEC .... ' DETW~N"'THE CLASS C WELL AND THE PROPOSED CO A ,,'"~ FC la,~.: al,4 T1 1!,8 86,9 T8 ~-.3 33,4 LS ::15,3 35,1 C1/' 25,4 46,3 MT 40,6 37,8 ~2 53,4 40,3 i LOT 15 I~ UNDEVELOPED ND WEULS DR SEpTIC's WITHIN',SDD' DF PROPOSED INSTALLATION. '~. ~ .~250Q '-, ~.T.E,P, TAN~. ~. ~D REPLACEMENT SYSTEM, SEE DESIGN EXIST. 6' CEDER FENCE. CONTRACTOR SHALL REMOVE AND REPLACE TO ORIGINAL CONDITION C,\Work\16-1WILL,DWG · SEPTIC"~y~TiE~h:DN LOT 16, 2) THE EXISTING"iOD. Sg..SEPTIC TANK AND DRAIN- FIELD WILLI~E ABANDONED IN PLACE· 3) RIGHT OF WAY ENC~DAOHMENT PERMITS WERE GRANTED BY ATU, CHUGACH,,~ECTRIC, & ENSTAR. % ::: Exls'i;, Ph vo.~:e Welt LOT 17 Well / S~L'S-'vEgiFIED AT TIME OF INSTALLATION 52 LF OF DEEP TRENCH, 3' WIDE 4,5' EFFECTIVE ND WELLS WITHIN 100~ DF PROPOSED INSTALLATION, EXISTING ~EPTIC SYSTEM ARE GREWATER THAN 80 FEET A~AY FROM THE PROPOSED SYSTEM, DESIGN, Pert Rate, 4 Mira/linch SoIL R~tlng, 1,8 gpd/s~ 3 B,R. 375 SF Required AS-DUILT~ Deep T~ench 4,5' El'Pet%lye, 2-3' Wl~e, 7~ To~[ Depth, 58' Long 468 SF To~ PREPARED FOR~ Mr, Al~nk~ & Heldl Gorl5 5320 Sh~un Circle Anchorage, AK 99516 (907) 346-1557 PANNDNE ENO, SVC P, O, ]]DX 142025 ANCHORAGE, ALASKA 99514 878-8818 DATEI 6-19-98 ~ AS-BUILT SCALE~ 1~=50~ / PERMIT ND. S:W980038 AS- UILT DETAILS WASTEWAT_FR A))~DRPTIDN SYSTEM LOT 16~ BLOCK 1 WILLIAMSDN ~/~ Z C,\Work\IG-1WILL,))WG PREPARED FDR~ Mr, ALANKA & HEIBI DORIS 5320 Sh:un Circle Anchorage, AK 99516 (907) 346-1557 P.I.)). ND. 01[$-073-33 O_ PANNDNE ENG, SVC, P, 0, BOX 142Q~5 ANCHORAGE, ALASKA 995i4 874-0308~ 878-8818 FAX DATE, 6-19-98 NOT TO SCALE AS-BUILT DEPARTMENT OF HEALTH & HUMAN SERVICES SOILS LOG -- PERCOLATION TEST ~ ~ PERFORMED FOR: A LAminA & ~t ~ oO(~ DATE PERFOR~ LEGAL DESCRIPTION: ~/~ ~ ~{~o~{BTownship, Range, Section: SLOPE SITE PLAN ~(FEET) 1 2 3 4 C~L~w~ ~ ~ 7 8 WAS GROUND WATER 10 - ENCOUNTERED? S 11- L IF YES, AT WHAT O DEPTH? p 12 E Deplh to Waler After ,~ . __ 13 Monitoring? Date:. Gross Net Depth to Net 14 Reading Date Time Time Water Drop 17 ~ .... ' ~:10 Io ~'fi~ " " "" ~:~ /o ~ ~ 19 20 PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMeTeR TEST RUN BETWEEN ~ FT AND ~ FT PERFORMED BY: ..~ · ~) z~ ¢,J ~ I CERTIFY THAT THiS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT NUMBER:SW980038 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:POSEY CLIFTON M & ANDREA D OWNER ADDRESS:5320 SHAUN CIR ANCHORAGE, AK 99516 (UPGRADE) PERMIT DATE ISSUED: 3/23/98 EXPIRATION DATE: 3/23/99 PARCEL ID:01507333 LEGAL DESCRIPTION: WILLIAMSON #1 BLK 1 LT 16 LOT SIZE: 13322 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DNHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: MAINTAIN SEPARATION DISTANCES FROM CLASS C WELL ON LOT 17 AS WAIVED BY ADEC.~ --~ RECEIVED BY: ~k_f~~.~t~2[~ DATE: Steven R. Pannone, P.E. Consulting Engineer (907) 272-8218 P.O. Box 142025 Anchorage, Alaska, 99514 (907)272-8218 Fax March 3, 1998 Mmficipality of Anchorage Dept. of Health & Hmnan Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 16, Block 1 Williamson Subdivision Septic Upgrade Permit Gentlemen: My finn was contacted to investigate the septic system serving this lot for an upcoming sale. The existing trench system was tested to determine its adequacy for a three bedroom house. The system was found to be in faihim. A single test hole was excavated on February 16, 1998 for a system upgrade. The soils report and a percolation test result is attached. Ground water was encountered at 13 feet below the surface. After seven days of monitoring, the ground water stabilized at 13 feet below the surface. 1 subtracted three feet from this depth to compensate for the spring rise in the grotmd water. No bedrock was encountered in the test hole. An additional soils test will be conducted during the installation of the system to verify the soils at the eastern edge of the trench. The lot is approximately 0.33 acres in size. Lot 16 slopes to the northwest at a rate of approximately 8 to 13 percent. The proposed installation will be located on the southern portion of the tot. The septic tank will be verified dining the installation. Itwillbereusediffoundcompetentandreplacediffotmdleaking- Double clean-outs will be installed down stream from the tank. The proposed system would be 60 feet log. Lot 15, located west of Lot 16, is nndeveloped at this tinge and installing this system will not adversely affect fi~ture development of lot 15 or sun'mmding lots. The proposed location is greater than 100 feet away fi.om the existing well serving this properly and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. A request has been submitted to ADEC to approve a lesser separation distance from the Class C well on Lot 17. The existing septic system on Lot 17 is in failure. My Firm was contacted to develop the replacement system design. The proposed installation will not affect the fi~ture development of the surrmmding or existing lots. See the attached design. Please contact me at 272-8218 or 227-3522 if you have any.questioj~s about the proposed installation. Sincerely, Attachments: C:\WORK\I 6-1 will.001 .wpd PERMIT NB, LOT i5 IS UNDEVELnpED NO WELLS OR sEPTI~,'S WITHIN:200' OF PROP~SEt) PROPDSEB ',1250g '", PROPOSED REPLAcEmENT SYSTEM, SEE DESIGN DESIGN WASTEWATER ABSORPTION SYSTEM LOT 16, BLOCK 1 WILLIAMSDN NOTES, ........ D A~WAIVER IS BEING REQUESTE~ FROM ADEC ~-'" ~ETW~EN",THE CLASS C WELL AN~ THE PRDPDSE~ ..... ' ..,," ~) THE EXISTING'~i'O:DD~ SEPTIC TANK AND DRAIN- ,... ,,, FIELD WILLBE ABAN~B~E~. IN PLACE, ~/~ Exist, Class ~'/ / ~ SEE NOTE EXIST, 6' CEDER FENCE, ~ CONTRACTOR SHALL \. REMOVE AND REPLACE TD ORIGINAL CONDITION C,\Work\16-1WILL,DWO NO WELLS WITHIN lO0' OF PROPOSED INSTALLATION, EXISTING SEPTIC SYSTEM ARE GREWATER THAN 30 FEET AWAY FROM THE PROPOSED SYSTEM. SOILS WILL BE AT TIME DF INSTALLATION DESIGN, Perc Ra~ce, 15 MIn/lnch Soil R~tlng~ 0,8 gpd/s? 3 B,R, 536 SF Required Deep Trench 4,5' EFFective, 8-3' Wide, 7~ To~;~l Dep~;h, 60' Long 540 SF To~[ PREPARED FUR: Mr, CLIFF Posey 5320 Sh~un Circle Anchorage, AK 99516 (907) 265-1544 PANNDNE ENG, SVC P, D, BOX 142025 ANCHORAGE, ALASKA 272-8218 99514 iIIATE, 2-a3-Da I DESIGN ISCALE~ 1'=50' PERMIT NO, DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM LDT 16, BLDCK 1 ~ILLIAM~DN P,I,]), NO, 015-073-33 z ;~\Work\16-1WILL,I]~/G ~REPARED FOR, Mr, Cli?? Posey 5380 Sh~un Circle Anchorage, AK 99516 (907) 265-1544 w PANNONE ENG, SVC, P, O, ~OX 142025 ANCHORAGE, ALASKA 99514 874-0308, 878-8818 FAX ~ATEI 8-B3-98 NOT TO SCALE DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PER~OR~ED FO~: ~ ~ ~ ~ ~ ~A~E P~O~E~~ LEGAL DESCRIPTION: L/~ ~ ~ ( ~ ~[(~ ~o~ Township, Range, Section: 1 2 3 4. 6- 7 8 9 10 11 12 13 14- 15- 16- 17- 18- 19- 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? s IF YES, AT WHAT DEPTH? Depth to Walet After MonitorinD? / ~ Date: Reading Date Gross Net Depth ~.~ Net Time Time Water Drop ~ ~ ~. ~ ~1~ ~1~ PERCOLATION RATE ~' (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~-- FT AND ~ FT PERFORMED BY: ~' '~'~'~/L~t)~.) ~ - ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'~//~--~--/¢~ ~ 72*008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~-~--LI~:)'-C T~ ~-~_.;~'~ DATE LEGAL DESCRIPTION: L~-~- t'-P.~ { ~L~(~-i/~4~.~O ~ Township, Range, Section: SLOPE SITE PLAN DEPTH 2 3 4 7 8 9 10 - 13- 14- 15 16 17 18 19 20- COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Depth to Water Alter iYlonitoring? Date: Reading Date Cross Net Depthl~_ ~ Net Time Time Water Drop PERCOLATION RATE '~ (minutes/inch) PERC HOLE DIAMETER TEST RUN EETWEEN ~' ET AND '~ FT PERFORMED BY: '~O(~(:~/t~ j"~. t.~-, I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/'~'~/~ t'~ 72-008 (Rev. 4/85) PERMIT NO, DESIGN WASTEWATER A~SORPTION SYSTEM LOT 18, BLOCK 1 WILLIAMSON NOTES, t)..,A ~/AIVER I~ ~EING REQUE~TE~ FROM A~EC · ' ~ETW~N ~HE GLASS C WELL AN~ THE " ,~EPTIC"'~Y~M~:DN LOT 16, .,,~' 8) THE EXISTING '~009 SEPTIC TANK AN~ DRAIN- ,'' ,'"' FIEL~ WILLaE AaAN~W~D ~N PLACE. ~:. : LOT 16 LOT i~ IS UNI~EVELOPED NO ~ELLS OR SEPTIC'~ WITHIN 8.00' OF p~OPO~E~ INSTALLATION.:: ::'. ,::,, PROPO~ED'.~85OQ ', S.T.E.P. TANK ~-~'. PROPOSED RE~ SYSTEN. SEE DESIGN EXIST. G' CEDER FENCE. CONTRACTOR SHALL REMOVE AND REPLACE TO ORIGINAL CONDITION C.\Work\16-1WILL.D~/G SEE ND NO WELLS WITHIN 100' OF PROPOSED INSTALLATION. EXISTING SEPTIC SYSTEM ARE GREWATER THAN 30 FEET A~AY FROM THE PROPOSED SYSTEM, P,I,9, NO, 015-073-33 / SOILS ~ILL BE AT TIME OF INSTALLATION PREPARED FOR' Mr. CU?? Posey 5320 Sh:un Clrcte Anchorage, AK 99516 (907) 265-1544 DESIGN~ Pert RinSe, 15 MIn/Inch SLit Rmtlng, 0,8 gpd/s? 3 B,R, 536 SF Required Deep Trench 4,5' E??ectlve, 8-3' ~lde, 7' Tot~[ 3epth~ 6~~ LoMQ 540 SF To~t PANNDNE ENG, SVC P, 0, BOX 142025 ANCHDRAGE~ ALASKA 278-8818 99514 ~ATE, 8-83-98 I DESIGN ;CALEI 1'=50' ,qHFO CONSTRUOTION DEPT F,qX NO, 9073381679 P, 02/04 ..... ..~: ...... . ,; ?. .... TONY KNOWLES, GOVERNOR DEPT. OF ENV~RONMF~NTAL CONSERVATION DIVISION OF IgN¥IRONMENTAL HEALTH DRINKING 'WATER and WASTEWATER PROGRAM 555 CORDOVA sTREET ANCHORAGE, AK 99501 http://wWw,state, a}Cus/dec/homeJhtm March 18, 1998 Telephone: (907) 269-7519 Fax: (907) 269-7650 Mr. Steven R. Pan0olae, P.E. P.O. Box 142025 1 Anchorage, Ak 99514 Re: Lot 17, B16ck 1 Williamson Subdivision ADEC # 9~21-WW-068-146 Dear Mr. PannonS: I h~ve 'reviewed y6ur waiver request and modifications for the wastewater system for the above property. Attached you will find an Approval to Cons~uct.form for th~s s~te. The Certification ito Construct constitutes written approval required by A.S. 46_03.720(a) for wastewater- The :.,Certificate to Operate for the trench system will be issued when lhe Department has approved the app!icant's, mxgineering as-built plans. . Inspection and sign-off of as-built plans shall be performed by a professional engineer regislercd in the State of Alaska. Arrangements for this inspection work are the responsibility of the devch~pcr. If construction o~' operation have ~ot begun within two years after issuance of plan approval, l l~c approval is voidi and plans must be submitted to the Depm~ment for review and approval Any future expansion of the subject projec( will require additional approval from this office. A H future corresponklenee should include the above project number. Enclosed, you v~ill also find fee Invoice #203637; please submit your payment with the white remittance copyito thc above address. Enclosures: Asl Stated · Respectfully, N~:23-98 NON 07147 fiHFO OONSTRUOTION DEPT Ffi× NO, 9073381679 ~ STA'~ OF ALASKA ~p~T~ OF ~iRo~NT~ CONSERVATION ~ONSTRUCTiON ~ OPE~TION CER~ICA~E ~ . FOR ~STIC WASTEWATER DISPOS~ 'SYS~MS A, APpROVAl, ~1'O CONsTR~CT '..: · plus for the construe'ion or modification o P, 04/04 dome~tiq was~ewat.~r disposal , ~l~k~' submi~ ~ ~ ~ 15 ~C 72,210 have b~n mvi~ ~d · : · "" ;[] 'ool~ififionally.ap~rove'd (s~ altacl~d c~s). : . ' ' ''" '' ' ' " /:, If ~fion ~ not s~ ~h ~o ye~ of~e appmV~ ~m, ~is ca~ific~ is void ~d new p{~ ~d sp~ifications, mua A?pmvod by - ¢ ',/~/~.Z~ff,~'~, ' .'~'%'"' ' c. rrbe ,,AppROvAL TO OP~'ATE" s~tiou mag be compl~teA and signed by the Department before this system is ma& availabl* for u~e. i domesfi~ w~t~ater disposal syst~xt was completai TM col~mction of thc ~__ __ -- on _ _ (da~). The system is hereby granted intethll approval to operale for 90 days following the completion dat~. I~--- ' !. ' ' ' ' .... '-'-- ~,---,'~,~* has i:e~ftrmed that the domestic _ '.., ~ _.~a dmwirl,,~ !submltt~d to the D~artment, er an . AS.oullg/r~tu ,,~ r~y,, . ' ......... waSt6'water disposal syste~m was c, omstru~;t~n m suostanttat ~xm~,a,~, rr . ..,. ~inai approval ~ oper~: : Dis~batio~:. DATE 3000 Spenard Road p.O, Box lgo28B Anchorage, AiaS~,~, 99519-0288 May 18, 1998 Steven R. Pannone, P.E. P.O. Box 142025 Anchorage, Alaska 99514 Dear Mr. Pannone, Enstar Natural Gas Company has no objection to the proposed septic system that will encroach into the utility easement on Lot 16 Block 1 of williamson subdivision. This easement is not needed by ,,ENSTAR". If you have any questions please Call me at 264-3743. Right of Way Agent FROM : Ar~ohovage Coppo~a~ Suit~ PHONE ND, : 9~? 2?4 J401 Jul, 30 !998 OG:44PI~ P2 ENCROACHMENT PERMIT 1203-15A G.2437 EN98019 This permit is betwecn Clmgaeh Electro Association, Inc., :m Alask~ non-profit electric c, oopetativ¢, (herein "Chugach'), whose a~ess is P. O. Box 196300, Anchorage, Alml~ 99519-6300 and Aisin and I-Ie~dl Goris of Anchorage (herein "Perrni~ec"), whose address is P.O, Box 233245, Anchorage, Alask~ 99523, 1. Eamme~. Chugach is the ~ntee or user of an e~ement for the constxuct~on and mamtenence of electrical facflmes as follows, Domrlbed in th~ certain va'itten instrument recorded on ~he 27th day of Aug., 1952, Jn Book 78, P~ge 52, o~ file in Ole office o£ the District Recorde~, Anchorage Recording District, Sewo.,xt Meridian, grate of Dedicated by the pkt of the subdivision k~own as Williamson Subdiv/sion A&fition No. 1, ~ccording to Plat Number 70-192, rccorded on the 27~ day of ~ruly, 1970, on file L~ the office of thc District Recorder, Anchorage Recording District, Sewaxd Meridian, AJ~.ska, (herein "~.~m~nt') which p~rtain~ to the following described real [~roperty: The Southe~t Fifteen (SE 15') of Lot Sixteen (16), Block One Willi~m~son Subdivision A~ifion No. t, 70-192, on ~ ~ the office &the Dis~ot ~ordg, ~horage R~ording D~ict, S~d Mefidi~ ~a. pc~sn~tt~¢ acknowledges the validity of the Easement. Permittec warrants and represents thaZ Peraut~ ~$ the owner of the fe~ sanple Interest tn thc land subject to the B~ement and the following described real property to which the Essem~nt ~s a~jacent. lot Sixteen (16), Block One (1), Williamson guMtvtston Addition No. I, t~¢cox~ling to Plat Number ?04 92, on filo irt the office of the District Recorder, Anchoragv Recording DisMcI, Seward Meridian, Alaska, (herein "PerceP). Encroachment P~mlt - P~go ! of 4 improv~mcms on or within the real pro!~rty subject to the Easement: A wastewater absorption system tha~ encroad~,'s approximately Seven Feet (7') into the F,~gmen~ for a distance of approxitr~ely Forty-fiv~ Feel (4~'), 4. ~. pcrmittt~ shaU indemnify and hold Chugach harmless from any claims for p~rsonal injury, property dmuage or o'~h~r loss arising h,. any way from the construction or continuation of thc Enoroa~llment. 5. Ex 'n a . PermRtee shall not in an), way expand or increase the cxt~nt to which the Encroachment o~oupies lny of the real property encumbered by the I~.sement without the prior written consent of ChugaCh. Chugach has no obligation to provide at, ch =onsent. 6. No L-~,.-reSt in Real Esi~,ta Acouired. Permittce hereby ~owiedges ~ E~ro~ ~d ~y ~di~o~ ~e~o, gv~n if in v~ola~on of~is ~t. has ~d s~ not ~ tl~ ~e giv~ ~ to ~y ~ter~s~ or ~mte ~ ~e ~eal prope~ subj~ to ~e ~eRt or ~y oth~ r~ ~. Wi~out ~ ~y way H~9.g the foregoing, Po~Re~ ~Owi~ges ~t the Enrichment is not adv~ to any i~rest of Chug~h ~ i~ ~ntin~tion h emirely wi~ th~ ~rmission of Chugach for p~ose~ of ~ ~n law do~ of adverse ~sgssion. T~s p~t,~egzs no inmrest ia the r~ pxo~y subjecl to ~g ~emont. 7. Modification o£Utili~v Faciliti~, Iff ihs ¢l¢~tri~ utili~' facilities lo~ated within the F,a,s6~ne~ll are upl~adcd, added to, replaced or t'~,~onst~cted, P~rmi~t~e shall pay thai portion of Ch~ggh's total costs for such modification which is reasonably attribulabl¢ to a~commotinling or pr~sgrving the En~roa&ment, If such payment is mad~ within thirty (30) days of wrll'ten demand for earle, Chugaeh may ter~irmte this permit in ~cordance with paragraph 9, b~low. g. COVenants Runain~ with the Land, The obligations of the Permit'tee arising from ';his permit shall be covenants running with tho land which shall burden the Parcel and the Permittee's interest in t~ land subjeot to ~e l'~'asement and shall benelit the Easement. Terrcit~natton. Ch,,~ach may terminate this permit after the giving of' thirty (30) days w~iRen noti~ of sl~ch termination if: Encroachment Permit - P~ge 2 of 4 ~ ~M [ ~¢horae~ Corporat~ $ui~$ PHON~ NO, : ~07 274 340~ Jul, 20 1998 06:45PH P4 The Encroachment is enlaged, increased or extended within the real property affected by the Easement, b, The Encroachment is damaged by any means to an extent of'more tha~ thirty percent (300A) of'i~s replacement cost at the time of destruction, c. Permlttee fails to m~e the payment described in par~ph 7, almve, 10, T_eltl!. This permit shall, if not sooner terminated by Ch~gaeb. expire £orty (40) years from tl~ date hereof. 11. ~. This written permit con~tiimes the entire agreement between the p~rties with re~pe~t to the subjgt mat~ hereof and supersedes all other prior or ~ontemporar~ous agreementS, oral or written, between the parties. No moditlea~ions, amendments, deletions, additions or alterations of the per. it shall be effective unless in writing and signed by all of the l~rtles hereto, CHUGAClt ELECTRIC A88OCIATION, INC, By: Title: Eugene N. Bjomsta~ General Manager Date: By: PERMITTEE Alain Oori~ Heidi (~ofie STATE OF ALASKA ) ) ss: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this/'7 day of ~'~i ...... ,1998, by /a, la_~',e. C-.~,~,'-~ ,, , My commission expires A/OW W; 2-~b 1 ~n~roachme~t permit - Page 3 or'4 ) MUNICIPALITY GE ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PRoTECTIoN ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME :~nFONE LEGAL DESCRIPTION ' ~ ~ D~STANCE ~0,, L ~ Dwe~m~9 P~RMIT~O, Manufacturer Material -- No. of compartments Liq, capacity in gallons Inside length Width ~ L~quid depth j~ ~ IF HOMEMADE; ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ ~ ~ Manufacturer --~- [ Material Liquid capacity in gallons ~ DISTANCE TO: Well Foundation / ~r~lo line PERMIT NO, ~ ~ No, of lines Length of each line Total length of lines Trench width Distance between lines ~ Top of tile to finish grade ~~ _~/ ~.~/ inches Material beneath tile Total ~ffective absorption area Lengtb Width Depth PERMIT NO, ~ ~ Typ~of crib Crib dian]eter Crib depth Total effective absorption a~e~ w ~ DISTANCE TO: Well Building foundation Nearest lot line ~ ;lass Depth Driller Distance to lot line PERMIT ~O. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~QIL TEST RATING ..... INSTALLER ~EMARKS 72-013 (Rev, 3/78) SHEET NO. _.OF_ ................ ' ......... --; ..................... CALg BY DATE .... CHKD BY___ _DATE_ _ · . ....... ''' -;;;; ;,~e~r~ ~ ._: . . ~ . . . . . . . . : . . . . ..... : ........ ~ .............. ~,~.~' ' . . ~... · · · . · . ~ · · · ' ' . : i':i i i i: i ii /"!'"~a;"/<"i'":'":'"i"i'"i'"i"':'":"':'"":'"!'"!'"!'"i"::: :i ": '~. i~i,:~.:,,,;o,.,'~'7::, l ii [:'EPFIR'T'HENT ( HE']=ILTFI I::tND ENVIRONMEI",FI'FIL. , ')TL=.'CTICLI'.,I 8;:~!5 "'L' '-:3'FRE[ET., F¢.,ICI'IC1F.'.FIEiE., FII<. n2, P.,It --.. "=:T=.: ::E "IF IF.'~E ~'S~ E.E I1.,,.~ EiE IF;~: F" E: F;'?.' P"'~ ]E '1r' ',:"8i052 ) FFL1 ...I.~ I' LOC I::{'1' I ]i",l TOi't HOR[:,EN ~,,111 OFf:' I_ :].E; [F~ .1. I.,.ItLL..[FIi'tS;CIF,I 5;[:, -FFIE LENGTH I}II¥1EN:L:;ICfi'.4 IE; THE LENGTH (IN FEE'T) OF' THE '['FIE [),EP]"FI O1:= FI TRENCH OR PI'l" IS THE DJ:$TF:INCE BETHEEN ]'HE SUI:?.FFIC[~: OF' GROUND I=IN[:' THE E:OTTOM OF TFIE EXC:FI',/FIT ]: ON '::IN F:'EET). THERE IS; NO SET HII}TH I::OR TREi'4CHES. ]"HE GRI';tVEL I}I'.:]:::'TFI :[:!!; 'TtiE I"lliqlMUi't [)EF']'H OF GRF'I',,,'EI_.. BETHEEN THE OUTF'IaL[. FIND TFiE BOT TOM OF Tt'IE E',:.:',CI':I'v'FrT' I Cd'.,l ( I N FEET ). I' PERM Z T RPPL. :[ C:FIN'F HFr:'; THE REE.;F'ONS 18 i L Z T'¢ TO Z NFr_)RM TH I .'F:; IDI:EF'FIR-f'i','iENT DLIF;: I NG -I'HE I I'.,IE;I'FILLRTIOi',I ]:NSF'ECTION% OF:' RN~r' I.,.IF!~LLS RDJRCEN'F TO THIS PROF'EF.'.']"'.r' I'::11",11:;:, THE NLIMBE:I:~:: OF RE$I[)ENC:E% THFIT THE HELL.. HIL.L SER',,,'E. I'dlNIMUM DISI'f:INCE E:ET!.,.IEEN I=1 lqEL..I... FIND Ri'.,I'¢ ON-':SITE SEI.,.IFtGE [)IS;POS';RL 5;"r'S;;TE:M IS :[.00 F:'EET F:OR I'-t PRI',,,'IaTE 14EL.L...~ OR :1. C%) TO :C'00 FEET FROM FI F'USLIC HELl.. DEPEND IIqCJ I...IPOIq TliE 'F'T'I='E OF F:'I..I[:~:[..IC HELl OTHER RE[.:P.J I REME'.NT'_"T, MFPr' FII:::'F'L"r'. '.SPEC I F I CFIT I ON'."~; FIN[::, C:Oi'.,I::];1]:?.I_IC'T' :( ON [:, ! I::'ll::i[;?.l:::lM::i; FIRE: 19v'FI I I-..RBL. E TO INSURE F'ROF'IER I I'.,I'.STFfl_LFFr I ON. I CEf;?.'I"IF"r' THFFr I;:.'E'.2;IDENC:IE Z'=]; REMODE=LE:D TO INCL.U[':,E i'dORE 'rHFIN ]: E',E[)ROOMS;. November 22, 1978 R&M No. 851158 Mr. Tom Worton P.O. Box 4-1953 Anchorage, Alaska 99509 Subject: Soil Investigation for Sanitary Sewer System, Williamson Subdivision, Anchorage, Alaska Dear Mr. Worton: Lot 16, Block 1, At your request of November 22, 1978, we conducted a subsurface soils inves- tigation at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with those procedures required by the Municipality of Anchorage Department of Health and Environmental Protection. This investigation, which was accomplished on November 22, 1978, consisted of a test hole excavated to a depth of 20 feet below the existing ground sur- face. The test hole was sited according to your instructions and its loca- tion is shown in attached Drawing A-O1. Excavation was accomplished with a backhoe. All material excavated was continuously monitored by an experienced engineering geologist. The topography at the excavation site is generally gently-sloping to the north. At the time of the investigation the site had original vegetation consisting of mixed spruce and birch. The top of the test hole was located at original ground surface. The soils encountered in the excavation are shown in the test hole log in Drawing A-01. This log displays specific conditions encountered at the test location. However~ subsurface conditions may vary in other parts of the lot without any apparent surficial evidence of tile change. Groundwater was not encountered. Bedrock was not encountered. At the time the hole was exca- vated seasonal frost was not present and permafrost was not encountered. Based on the visual classification of the soil and the requirements set forth by the Muncipality of Anchorage~ a percolation test was not necessary withiu the test hole on the subject lot. November 22, 1978 Mr. Tom Worton Page -2- We appreciated this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if wa can be of addi- tional service. Very truly yours, R&M CONSULTANTS, INC. Ernest R. Rahaim Staff Geologist pGar or3Y. ~c ~i~ahnage r GS/kah/12-F BORING NUMBER Date Completed: SOIL DESCRIPTION MOSS AND ORGANICS 25' SANDY GRAVEL reddish brown, slightly moist 5.0~ SANDY W/TRACE SILT gray, slightly moist, fine to medium sand, cross bedded SANDY GRAVEL W/TRACE SILT scattered cobbles, gray, slightly moist, medium to coarse sand SILT ght gray, slightly moist20.0' LOCATION SKETCH No Scole NOTE: OISTANCES SHOWN ARE APPROXIMATE AND HAVE NOT BEEN MEASUREO BY SURVEYING METHODS. EXPLANATION BEDR~)CK ~TYPI~AL SOILS LOG I A.H,-AFT£;CBORING .~SAMPLER TYPE SYMBOLS L ..... _SOIL SYMBOLS DWN, CKO, SM LTANT5, INC. t. SCALE ) ~.~ ....... ;OIL,, LOG LOT 1~, BLOCK 1 WZLLIAMSON SUBDIVISION ANCHORAGE, ALASKA L°wG."o. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OI5"' - ~7~' -'~-~ 1. GENERAL INFORMATION Complete legal description ~.~,~ /.o~, Location (site address or directions) HAA# I-//4 ood:~ /¢".f Expiration Date: Current Property owner(s) ¢,~'u~; f~,c~'¢U ~,~, ~ .4/¢,,4-~ ~-~,~',./' Day phone Mailing address d-3?_O ~,~,~,.~ ~--cl¢,. /'¢-~4o¢',~,¢.~., .4-~ Lending agency ~znk Day phone Mailing address Real Estate Agent c~-,.,'z~/ ~¢x+~., ~'~.,¢'/~,~ Day phone Mailing Address ~_5'zC "~" :t..~ ~c,,¢/-~ ~'oo, A-,~4o,--ov¢~/ Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Cedificates 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. 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. NameofFirm F[,~f.-/c,,p ~"~-¢A~¢~' ~'~',-'~-,_/ Phone Engineer's Printed Name Date ,¢~,z~ ¢, ¢/- 1~, ~.o00 DHHS SIGNATURE ~ Approved for '~ bedrooms. Disapproved. Conditional approval for ENGINEER'S ~~ .., ..~' * ''~ .... ~',. STAMP bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Oate: / - ~ ¢ - ~D I Original Certificate Date: / O - .2. L/ _ oo Reissue Date: Legal Description: /.~,'/- A. WELL DATA Well type Date compieted Total depth ~> ~-~$ ft Municipality of Anchorage RECEIVED Department of Health and Human Services OCT ~ ~ 2000 Division of Environmental Services On-Site Services Section 825 "L" Street Rooq~El~nic~palit ...... P.O. Box 196650 Anchorage, AK 99519-66~ ~ealth & Hum~ ~.ci.anchorage.ak.us ' (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Date of test Static water level ft Well production g.p.m WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi Date of sample: I¢' B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed ~'/Iz/ Cleanouts '-r' Foundation cleanout Date of pumping. /~' / C, ABSORPTION FIELD DATA Parcel I.D.: If A, B, or C provide PWSID Cf __ Well Log /V Sanitary seal 7' Wires properly protected Casedto >?_3'_3 ft Casing height (above ground) ~'~ in. FROM WELL LOG AT INSPECTION ~ I~-~/c.,o ~ ~1 ft > ,~,,, ~ g.p.m Nitrate ~'¢*,¢- mg/I Other bacteria ~ colonies/100 mi Collected by: F/cx/-,/-~/.) ")~c.¢, ._~'c, c.. / .¢/-~ f Tanksize I ~¢'~ gal Number of Compartments 'r' Depression over tank N High water alarm Pumper Rc, /c, R o,=, Date installed 4¢ ? ! z/~2~ Soil rating (g.p.d./ft2 or ft2/bdrm) ~z~zSystem type Length ..5' Z. ft Width ;3 ft Gravel below pipe ¥.,5" ft Total depth ¢ ¢fi Effective absorption area'/o",~ ft* Monitoring tube Date of adequacy test ;3 / 2-,8/0~ Results (Pass/Fail) Fluid depth in absorption field before test ~ in Elapsed Time: ! ~ min Final fluid depth Any rejuvenation treatment (p~st 12 mo.) (Y/N & type). 72-026 (Rev. 01/00)* "T'," (',"c ,4 __ Depression over field A/ For bedrooms Water added ,~,.¢...3 gal. New depth ,o in. O in Absorption rate >= ,-/,~-~, g.p.d. /4 If yes, give date /,/. ~, D. LIFT STATION Date installed ~'/I~./¢~ Size in gallons ~:',', "Pump on" level at ,¢ z in "Pump off" level at :Z ~ .in Datum F5~,/-,,6~, ~/~//' Cycles tested Manhole/Access ~ High water alarm level at ~ ,-(~ in Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot / / Absorption field on lot On adjacent lots On adjacent lots Public sewer main ~,, ~-. Sewer/septic service line Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 6' ' Property line I~,' ' Water main ;> ~' Water service line ¢" /, Drainage > /~.,~, ' Wells on adjacent lots Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I1' Water Service line '~ Curtain drain t4o,~- Building foundation Surface water '~. ¢ o~, Wells on adjacent lots Water main 't:- 2-.~-' Driveway, parking/vehicle storage ~, ~(,zo' ~" F. COMMENTS G. ENGINEER'S CERTIFICATION I 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. Engineer's Printed Name '"7"-'4¢~,~--.,/~,,-~ r. /~o,~,.~, Date ~:;~c~%,~.,,,~- /¢, ¢-o~.~, ~ ¥.: ~; ;'ENGINEER St '.: · HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01t00)* 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 GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent fil o~¢-: Address Day phone ~ y~'-/~-5- 7 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ..~ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ~ Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~325(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 / H Engineer's signature bedrooms. DHHS SIGNATURE [~ Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 DH HS 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 I~efore 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 APE 18 2000// DEPARTMENT OF HEALTH & HUMAN SERVICES UN[CIPALIT¥ OF ANCHW Environmental Services Division ,fMIPr~NMENTAL SERVICF~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth ~> ,7.. Sanitary seal (Y/N) Health Authority Approval Checklist ifA, B. or C, attach ADEC letter. ADEC water system number Date completed I? ? ~ Cased to ~ ~. ~ 3 Casing height (above ground) ~' Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION g.p.m. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ,"2 ¢o ! / /oO ~./__. Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~'//-z./? ~ Tank size Foundation cleanout (Y/N) Date of Pumping ~"/2.7/ C. ABSORPTION FIELD DATA Date installed ~' / Length 5' ~-' Width "~ 5'. ~ g.p.m. ~. ~'g'~' ~'~,~/-~ Other bacteria /V'o~¢ Collected by: ~'/~/-~y, 7~/~;~-~,/' ~'~,~,~ ! ~ Number of Compartments ~- Cleanouts (Y/N).__ Depression (Y/N) /'/ High water alarm (Y/N) Pumper /~ ,/~ ~'4,~ Soil rating (g.p.d./~ or ft~/bdrm) ~ System type -T',"~,~ ~) Gravel thickness below pipe '7'.,~-' Totaldepth I0~"(~, ,'~,~,. Effective absorption area ¥~,~ ¢' Monitoring Tube present (Y/N) 'r' Depression over field (Y/N) Date of adequacy test ,.~/' ~-~'/~.~' Results (Pass/Fail) ?~.c./ For ~ bedrooms Fluid depth in absorption field before test (in.); ~ Immediately after~5'3 gal. water added (in.): Fluid depth ~ (ins) Minutes later: /'zc' Absorption rate = '~' ~' 5-~ g.p.d. Peroxide treatment (past 12 months) (Y/N) /~/~? ~. ~,~ ~u,~ If yes, give date. ~. ,4 72-026 (Rev. 3/96)* D. LIFT STATION Date installed ~'/1~-/9~ Manhole/Access (Y/N) ~' High water alarm level at* .~ ~/~- Size in gallons .~,~,~r~/ ¢,~ I~-Z'¢¢{ "Pump on" level at* ¥ ?-" "Pump off" level at* '3,3 // *Datum ~,,t-,9,,~, ,~.,¢' ~/,~lh Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot. Absorption field on lot Public sewer main h/. ,4. lit? I On adjacentlots -~ Io~. ' On adjacent lots ~ ,/oO ' Public sewer manhole/cleanout Lift station I I ~ ' Sewer/septic service line _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ ~ Property line 15' Absorption field .5-' '~ Water main/servme I ne .~, ~ Surface water/drainage "~ f~'¢ ' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Il' Building foundation ?,o ~ ~ Water main/service line ? ~-J~_' Surface water ~> ~, Driveway, parking/vehicle storage area_ Cu~aindrain ~ ,~ Wells on adjacent lots~ I~' ~ c(~ '~"~1/ ENGINEER'SCERTIFICATION ~ ~', ~ ~ ~ ~ ~ ~ ~ I cedi~ that l have determined thru field inspections a~d review of Municipal records that. th~ ~l~s are in confo~ance with MOA H~ guidelines in effect on this dam. Signature ~ ~ ~ Engineer's Name Date Dpv,! 17., HAA Fee $ /~'~ ~ ate of Payment Receipt Number ~-~75"( ~ ~) Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SE:'RVICES Division of Environrnental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343~4744 CERTIFICATE OF HF-ALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. It _~ I ¢') - [")~ ~ -- .%% HAA # ~-~ ~"~°L~)LI GENERAL INFORMATION Complete legal description Location (site address or directions) ,5-..7 &:2 _~A~ ~r~/¢ Propertyowner .A rc /~ Jr oc ~-J'¢ ,~ :~ .4-¢c.ho~,~' ~_ Dayphone Mailingaddress '8 ~5 ('~,rcCr.,~,,~ ~1~. / ,A-^cAo,"c:~,~ Lending agency (.Xn/'~ Day phone Mailing address Agent P~/'i~' ~-~:~, - Address ~0~ ¢o~o~ ~/.,, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: 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. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank _ Community on-site Public sewer If community wastewater system, provide wdtten confirmation from State ADEC attesting to the legality and status of system. 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 verifythat based on the information obtained from the Municipality of Anchorage files and from my inves~i_gation and inspection, tile 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 ~/a/./,:~ ?~'cAn'~c~f ._~e~'~"~c-,'/ Phone Address 1 4.¢~ 0 /~'o4o _('/,~ /}-n C ho,,'~., /)~ Engineer's signature '~~ ~, ~ DHHS SIGNATURE ~__ Approved for Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 2~L~¢_.~.~ (~ ~,z.~c,-¢~¢_.;C' ._ Date ~- p- - ~ .7, 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. 724)25(Rov.~/91) Bock MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADI--C water system number fV Date completed I~ 7,¢' Driller ~ Total depth '.> 8 3o ' Cased to Sanitary seal (Y/N) Y FROM WELL LOG ;> 8..~0' Casing height Wires properly protected (Y/N) [)ate of test Static water level Well flow g.p.m. Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot i! ~" ¢r~ ¢,o, Absorption field on lot f ?-'~' ¢~ c.o, Public sewer main /V,/L Sewer service line ~ ~$" WATER SAMPLE RESULTS: Coliform 0 cot /too ~.~ Nitrate_ Date of sample: ,¢ / ~'o / ¢_~ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~ t ? 78 Tank size AT INSPECTION F., .,MUNIcIPALiT,,, ~ r~VlI~ONMgN~ ' UF ANCHo IA!. $£RVIc~ ._ ~AG~ "~ UlVl$10N g.p.m¢ 0 REC ,'IVED ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Other bacteria F/oF/o? '/-~ c A Compartments Cleanouts (Y/N) Y' Foundation cleanout (Y/N) h' Depression (Y/N) High water alarm (Y/N) /,~. ,+. Alarm tested (Y/N) Date of pumping ~/~'¢'/?~? Pumper ~-".r~ ~¢_,r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I I ~' ' On adjacent lots i '88 ¢ To property line -~ ~o' Absorption field ¢' ' Foundation $" Water main/service line Surface water/drainage 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION N, ~, Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed '~ Length 3' '7' Width Total absorption area 5-o"o r~ ' Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at CycLes tested Sudace water Soil rating (GPD/FF) I,O System type Gravel thickness 7 ' Total depth I ? ' Cleanout present (Y/N) 'd Depression over field (Y/N) Results (pass/fail) ?o.u for flc,,~ 6 Aftertest ~a" ,,~ n 0,~¢ ~',~ c.~.,.~ oF .If yes, give date ,",/, ,~. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / '~.¢' To building foundation On adjacent lots ~> ? c,' Sudace water ;> (oo ' Cudain drain E. ENGINEER'S CERTIFICATION N Bedrooms On adjacent lots ! 3'¢' ;F¢,~, c .c~. Property line > Jo ' To existing or abandoned system on lot h',//-. Cutbank N, .4. Water main/service line ;> ~5~' Driveway, parking/vehicle storage area .> .~-o ' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~'-~ ~ ~ r' ~'~ "~ Engineers Name ~,&¢~0¢~' /~. ~o~e Date %C~ ~ ~ /~¢~ ,~.: .?~o~o~ ~. ,'.~oo~s - ".. CE- 3589 HAA Fee $ Date of Payment Receipt Number 72-026 {3/93)' Back Date of Payment Receipt Number