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DEER PARK #1 BLK 2 LT 2
Deer Park #1 Block 2 Lot 2 #051-042-65 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 Onsite Wastewater Disposal System and/or Well Inspection Report Permit Number. SW000066 PID Number. 051-042-65 Name: RICHARD MAXWELL Wastewater System: ❑ New ■ Upgrade Addme22606 OAK KNOLL DRIVE CHUGIAK, AK 99567 ABSORPTION FIELD Phone: (907) 688-5686 No. of Bedrooms: 1 3 9 Deep Trench D Shallow Trench DOW DMound 0Other LEGAL DESCRIPTION =a ` 1.0 TOW Dose, naa 1112 FL aPa/so- P< Lot: Block: Subdivision: "w"b P" bo " F. ar4'ed e� an"4dh W-dh pipe 5.85 2 2 DEER PARK #1 5.15'-6.15' n. <t Township: — Range: Section: — N added eeew eelglnd grvde: anrd w'ptn: 45 0'-0.5' n rL Waed eldlh: Nwnbr d Yne aletonee hebeea arae WELL: ❑ New ❑ Upgrade 2.5 P, 1 — R CkwMlwotion PAwte. ".C): Tatd cowl Ta Told aewrPaoe ane: 527 Pipe mawlot ASTM D-3034/1`810 FL m. R °N" t>do sde wd. L«R GREEN CONSTRUCTION 4/26/00 — 4/27/00 Eyt5nN0 "a " SA w CoWN Hwgnt Nn.e c"04: TANK CPN n rL SEPARATION DISTANCES ■septic 0Holding oS.T.E.P. To Septra Tank Absorption Flsld ft Station Holding Tank Mk/PNwte Seer Unee A HORAGE TANK in 1000 Fmm Mate": Nrna+dw ea welt°: Well too'+ 100'+ — — 25'+ STEEL 2 Surface 100'+ 100'+ - - - LIFT STATION Water Lot— 5'+ 10'+ — — Sze In eo%w. Nen,lech+er: P une en lo.d d: wro en t Hph .dr dorm d: Foundation 5'+ 100+ — — — Curtain ►Nmv Nes. o.drtod Yweeetlone P'^°""e° %: DrainNONE KNOWN BENCH MARK Remarks: L .,d D...W n: BOTTOM OF CANT. ABOVE F.C.O. NEAR POINT 'A" 100.00 rt EMUNEE" °EGL 0oo�40p ;2. vim.: ' • :�Op Inspections performed by AWWC, INC. Dates: 1st 4/26/00 •,.:... ....... 2nd 4/27/00 3rd 5/1/00 : n. ca ss� Department of Health and Human Services approval p 40�,,� ., c 7953 Reviewed and approved by: G!J L e't Date: s' - 0'� ewe ��co ��40po�oo 0\ -015 Re,. 0/91) 110A 25 �NUMBER: PARCEL ID NUMBER: SWO AS—BUILT DRAWING I SW000066 051-042-65 NEW \ I \ EylSn OpM \ 3 H SSE \ INSTALLED FLOW pvy, \ \ DIVERTER (FD) \ \ DBL2 D LI \ ! \ NEW 1000 GALLON \ SEPTIC TANK EXISTING TO BEUSED AS I \\ RESERVE SITE A B \ \ ST1 36.41 46.22 ST2 41.98 49.25 DBL1 44.36 50.78 DBL2 45.86 51.71 FD i 52.43 1 150' CLASS "C" WELL RADIUS D 53.27 CO2 194.57 91.12 MT2 94.65 90.92 \ I \ EylSn OpM \ 3 H SSE \ INSTALLED FLOW pvy, \ \ DIVERTER (FD) \ \ DBL2 D LI \ ! \ NEW 1000 GALLON \ SEPTIC TANK EXISTING TO BEUSED AS I \\ RESERVE SITE A B \ \ ST1 36.41 46.22 ST2 41.98 49.25 DBL1 44.36 50.78 DBL2 45.86 51.71 FD 47.01 52.43 C01 51.09 52.64 MT7 151.24 53.27 CO2 194.57 91.12 MT2 94.65 90.92 \ \ OLD SUMP \\ \\ /'146 Al d.0'.k 5/3/2000 0� OF p� DRAWN BY: n—r— _. ._..-. _ G `.•'• Q AI.ASfiA «'ATER & «'ASTR«'ATER C.J.G. Ste` 1 _ w = 40' CONSULTANTS, INC. 0 ,,...... ... 6901 DFRARR ROAD. "TF 29 • ANCHMAGF, AX 99504 •,NONE (907)777-0179 • FAX 907)516-1246 0 REPARED FOR: PHONE NUMBER: PAGE NUMBER: RICHARD MAXWELL (907) 688-5686 2 OF 3 Q of re A.'Go esS. QO y '• —7953 �• e, ' ��°e,fPE EGAL DESCRIPTION: LOT 2, BLOCK 2, DEER PARK SUBDIVISION #1 •.,, o`o� 4����40000�WP OF AS -BUILT OF SEPTIC SYSTEM UPGRADE PERMrTNUMBER AS -BUILT DRAWING PARCEL ID NUMBER: SWO SW000066 051-042-65 PNH. CRAPE - 9661 j51 5f2 to, or f" I I n - •for OFiMK KN.Ef•9172 / Af0111.Ef-91.92 f I I NSW 1000 CUON 9tLEf ff •91.18 � %Plflc TANK Af N. wr* 9 ALASKA «'ATL'R & WASTEWATER Ste: C.J.G. CONSULTANTS, INC. N.T.S. 6901 DFOARR ROAD. SUTE 2R • ANCHORAGE. M 99304' PHOOF 907)337-0179' FA% 907)336-3266 PREPARED FOR PHONE NUMBER: PAGE NUMBER: RICHARD MAXWELL (907) 688-5686 3 OF 3 LEGAL DESCRIPRON: LOT 2, BLOCK 2, DEER PARK SUBDIVISION #1 TYPE OF WORK: PROFILE AS—BUILT OF SEPTIC SYSTEM UPGRADE `AYERf OF PPE Af CUUf . 90.95 .. ...... ........ A. ass: -7953 • ado ..... cAl MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade .'/lato/no (S 3p/7 W ex ��,4 y/a7AUa@ /.'doPh Date Issued: Apr 17, 2000 Expiration Date: Apr 17, 2001 Permit Number: SW000066 Parcel ID: 051-042-65 Legal Description: DEER PARK # 1 BLK 2 LT 2 Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 022606 OAK KNOLL DR Owner Name: Richard Maxwell Lot Size: 40003 SO. FT. Owner Address: 22606 Oak Knoll Dr. Total Bedrooms: 3 Permit Bedrooms: 3 Chugiak , AK 99567 - This permit is for the construction of: [✓j Disposal Field Q✓ Septic Tank Holding Tank F� Privy ❑ Private Well E] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 34314744 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: 41- / 7 -ov Date: — — ALASKA WATER & WASTEWATER CONSULTANTS. INC. April 6, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade Design for Lot 2, Block 2, Deer Park Subdivision Addn. #1 To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing septic system consists of a 1000 gallon septic tank and a deep trench type drainfield. The existing drainfield is completely surcharged and must be upgraded prior to the sale of the house. A test hole was excavated west/northwest of the existing septic system. The proposed septic system will be designed around the 30 foot radius of this test hole. We are proposing that a new 1000 gallon septic tank and a deep trench type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layers are a GM material to a depth of 5 feet and then transitions to a GM to GM/SM material to a depth of 18.5 to 19 feet (bottom of test hole). No groundwater was encountered during the excavation of the test hole. A percolation test was performed between the depth of 8.5 feet to 9.0 feet which had a percolation rate of 4.21 minute/inch. It is our opinion that due to the overall appearance of the soils, a application rate of 1.0 gallons/day/f12 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 4.21 minutes/inch b. Allowable Application Rate: 1.0 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 f12 f. Total Depth: 12 feet (max.) g. Effective Depth: 6 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 45 feet long k. Effective absorption area = 480 f12 (see note) 6901 Debarr Road, Suite 213 — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246 Note: The trench is proposed to run through the test hole excavation. The 5 feet of the trench area that will run through the test hole location will not count toward the total absorption area. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached design, the a proposed trench is to be installed on a slope of a small hill. The elevation distance between the flat area below the proposed trench and the top of the small hill is approximately 10 to 12 feet; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you h rQe any questions, please contact US at 337-6179. Thank you for your assistance. 1,71 M.S. NOTE: Attached is a site plan drawing, a design drawing, a soils log, and a 7 page construction: specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246 LOT 3, BLOCK 2, I 1 DEER PARK ADDN. 12 I I I LOT B. BLOCK 1, DEER PARK ADON. /2 / I LOT K, BLOCK 2, 1 DEER PARK ADON. 12 / j 1 ZI 1 yl i \� LOT 7. BLOCK 1, yy DEER PARK ADON. 12 1 01 I INLOT BLOCK r5� AREA DEER PARK ADDN. 12 j I I N 1 / IXISTINC \\ 1 3 BEDROOM 1 ♦♦PRE r DESI SEPAL UPGRADE \ / HOUSE I 1 I \i ♦ (SEE DESIGN, PACE 2 OF 2) 1 I 1 I I i LOT S. BEAR PARK S/OIj � ♦♦ �� I � NO ENCROACHMENT CONCEFN ♦♦ ♦♦ \ ! / 1 �♦ ♦ ' ' /� 1 ♦♦♦ �♦ ♦�` / �' LOT 6, BLOCK 1. - DEER PARK ADDN. /2 ♦♦♦♦♦ ESE / / ♦♦♦♦ LOT 1, BLOCK 2. � // DEER PARK ADDN. /2 / WELL ON THIS LOT / IS NOT A CONCERN // 1/•� O� e Clvz •� zp ip N' JO< / / JO< / / � r � 'gyp, / ry��•� 1 DATE: 4/6/20 00 ,•..rte"..::.^., DRAWN BY: ALASKA WATER & WAS TL'AVATER � L.M. —�—�— CONSULTANTS, INC. SCALE' 1 — 100 < •:• * +�, sz4e s�nv •rax oo7uea evol LxseRR Rom. sure to • ANCHORAGE, ax o"504• PHONE ooi e G ` •••,L� PREPARED FOR PHONE NUMBER: RICHARD MAXWELL (907) 688-5686 1 1 OF 2 f r A. Ca ss;' 1% `� •. —7 3 LEGAL. DESCRIP110N: DEER PARK SUBDIVISION ADDITION #1; LOT 2, BLOCK 2,�41e ••• ,• ..q♦f�' y'�w0dProfasslo0°\ TYPE OF WORK SITE PLAN FOR SEPTIC SYSTEM UPGRADE 11 ' \ INSTALL DBL � _ PROPOSED DRAINFIELD UPGRADE SEPROPOSED C TANK 1000 GALLON EXWELL I EXCAVATE A TRENCH THAT TS \ f j 12 FEET DEEP MAXIMUM BY PjI 2.5 FEET WIDE BY +5 FEET %LONG. ADD 6 FEET OF CLEAN, WASHED SEWER DRAINROCK, g \SANG M INSTALL PARALLEL TO CONTOURS 6H U5� FCO co J� ' CO ----LIT Mr \ U -- - -LX'- D +1 o INSTALL FLOW ^ / ONERTER. CMT ENCOUNTERED BURIED STUMPS.— TRASH, ORGANICS, ETC. MIXED / IN THE NATIVE SOILS IN (STING SEPTIC TANK TO \ THIS AREA BE ABANDONED COMPLETLEY EXISTING DRAINFIELD TO BE �O• \ USED AS A RESERVE SETE. NOTE: THE CONTRACTOR SHALL HAVE THE / 150 FOOT CLASS °C° WELL RADIUS FLAGGED / BY A REGISTERED LAND SURVEYOR PRIOR TO ANY CONSTRUCTION. i DATE: ALASKA IVATI?R & WASTr«'ATER s J.L.M. CONSULTANTS, INC. : 1. 0 6001 6E6ARR 8040, SUTE FB • ANCNOR4GE. AX 00504' R101F 001UJ1-0110 - FAX 001)336-3260 30• PREPARED FOR; PHONE NUMBER: PAGE NUMBER: RICHARD MAXWELL (907) 688-5686 2 OF 2 QQ A. Garness.- LEGAL DESCRIPTION: Q —7953 e, DEER PARK SUBDIVISION ADDITION #1; LOT 2, BLOCK 2, O0+/ N TYPE OF WORK:Fessiobo��o� DESIGN OF SEPTIC SYSTEM UPGRADE �Opppppo�� ALASKA WATER & W CONSULTANTS. INC. I SOIL LOG — PERCOLATION TEST I LEGAL DESCRIPTION: DEER PARK SUBDMSION ADDN. fl; LOT 2, BLOCK 2, PERFORMED FOR: RICHARD MAXWELL DATEPERFORMED: 3/29/2000 � f �HIORGANICS TEST HOLE #11 1 O 8 P 10 lid �$JGM/SM 12 13 14- 15- 16- 17- 18- 19— 4 1516171819 H. PERCOLATION RATE 4.21(MIN./INCH) PERC. HOLE DIA. 6" (INCHES) 20 TEST RUN BETWEEN 8.5 FT. AN 9.0 FT. COMMENTS: PERC HOLE PRESOAKED FOR 4+ HOURS P 10R T PERFORMED BY ALAS WATER do WASTEWATER I, CERTIFY THAT THIS WAS PERFOR Erf IN ACCORDANCE WITH ALL STATE rfJry UNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Q.OV DEPTH TO GROUNDWATER DATE DRY 3/29/2000 GW Memmm " •ML DRY r rG 6" GP111111111 2 1:29 \ T r \ ` H 1 11.111!11 CL 1:29 — 6" GCNNN • 1:39 E%ISTINC'4 MIN. .\ \\ SEPTIC SYSTEM, 5 1:40 , 6- SP CH 1:50 10 MIN. 1 yiipi 'ff{/fL1: 'YN� • •y���N�Sc — 6" — 8 8 P 10 lid �$JGM/SM 12 13 14- 15- 16- 17- 18- 19— 4 1516171819 H. PERCOLATION RATE 4.21(MIN./INCH) PERC. HOLE DIA. 6" (INCHES) 20 TEST RUN BETWEEN 8.5 FT. AN 9.0 FT. COMMENTS: PERC HOLE PRESOAKED FOR 4+ HOURS P 10R T PERFORMED BY ALAS WATER do WASTEWATER I, CERTIFY THAT THIS WAS PERFOR Erf IN ACCORDANCE WITH ALL STATE rfJry UNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Q.OV DEPTH TO GROUNDWATER DATE DRY 3/29/2000 DRY 3/30/2000 DRY 4/5/2000 Y 6" SITE PLAN 1—"' I' = 100'.i 1 I PROPOSED 1 SEPTIC 1 UPGRADE � i ExisnNC I 3 BEDROOM HOUSE i 0 J J 0 WATER LEVEL READING I Z 1:19 I Y 6" 1 2 1:29 \ T O \ ` H 1 �� i 3 1:29 — 6" — 4 1:39 E%ISTINC'4 MIN. .\ \\ SEPTIC SYSTEM, 5 1:40 , 6- 6 1:50 10 MIN. 3-5/8" 2-3/8" 7 DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 3/30/00 1 1:19 6" — 2 1:29 10 MIN. 3-1/2" 2-1/2" 3 1:29 — 6" — 4 1:39 10 MIN. 3-1/2" 2-1/2" 5 1:40 — 6- 6 1:50 10 MIN. 3-5/8" 2-3/8" 7 1:50 — 6" — 8 2:00 10 MIN. 3-3/4" 2-1/4" 9 2:00 6- 10 2:10 10 MIN. 3-5/8" 2-3/8" 11 2:11 — 6" — 12 1 2:21 1 10 MIN. 3-5/8" 2-3/8" n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I). ENVIRONMENTAL ENGINEERING DIVISION l 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEIf PHONE R•-.3 )CI NEW IINPGRADE MAILING AD LESS �J LEG L DESCRIPTION '�J''�' a e k Q01 LOCATIONNO. r'rA OF BEDROOMS Dy DISTANCE TO: TkP�n( Absorpnon�rea Dwelling , PT^ pyo l W2Q Manufactur !Liq. Mate No. of mpartments NE c n city in gallons IF HOMEMADE: Inside length Width Liquid tlepth d Y DISTANCE TO: Well Dwelling PERMIT NO. 2�fOz Manufacturer Material Liquid capacity pacitY in gallons W = DISTANCE TO: Well m / Foundation Nearest lot I / PEHMI `, t ,MZ W No, of lines Length � h iye Total length f not Trench inches Distance betwee li s f O Top of the to finish grade Material beneath tileTotal inches elfectivy absorption area �f72) W Length Witlth Depth PERMIT NO. n H W0 Type of crib Crib diameter Crib depth Total effective absorption area H DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. wBuilding DISTANCE TO: foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING 7P 6 a� I ff/n7 / C RE t KS Old '0 APPROVED DATE LEGAL 72-OVJR6. 3176) MUr4I C I FAL I TY OF' F=l FVCF-Fro�iFiGE DEPARTMENT Ot HEALTH AND ENVIRONMENTAL F..JTECTION%, 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 4/U- WELL F:lr4E> Ohl—SITE SE44EFZ F"EF;ZMT68813559�jy. PERMIT N0. C 820956 APPLICANT C&S BUILDING SRI BOX 1020 99567 LOCATION OAK. KNOLL DR LEGAL L2B2 DEER PARK #1 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 200 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>EF'TH= 4 L-aNC,TH= S0 OFZFiVaL- E>F=F='TH= THE LENGTH DIMENSION IS THE LENGTH (IF! 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 CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IF! FEET). FZE[DU I FZEF7 SEF=l'T I C TF:VNK S I ZE= 1.63631+ (3nL-L-ONS; PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO <2> I NSPE63T I OF'+FS FiFZE FZEGlU I FZEF> --- 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. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER. LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS A14D CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='EFZM I T E:XF=' I FZES E>EiGEMF3EFZ 31r 2 482 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLICANT C&S BUILDING ISSUED BY V4. 0 MDfRriRTMENr joF HEAZTH Am Q�-N�i" ArALPRors�crrtom { i 825 'L' STREET, ANWORDX. AK 99Mi '. 264-4729 WELL FitdO 4CIf4—tsx -re= !M—=t—jam P'Jmf2M I T PER i r Na c 828936 7 APPLICANT CAS BUILDING SR[ BM 1929 99,667 559-3Si�'• LocArIOM OAK KNOLL DR LEGAL L2B2 DEER PfM Of. LOT stzc 3t3" smmc Fu OF SOIL ABSORPTtOM S'r'STEM t5: TRfX M +1 MIX[MM INMOM OF B+EDfMtS = 3 SOIL. RATING <50 FT/QP.)- 290 tf THE REMIRED SIZE OF THE SOIL ABSORPTIOM SYSTEM IS: .`; i?�s7rf-t-� � L'Ef.IGT}-!� �e c�fz,Rv�� aEsart-sem s t THE LEmTH DIMENS[ON is THE LEt7GrH cIM FEET-) OF THE TRENCH OR DRAtt4=IELC f 4 THE DEPTH OF A TRENCH OR PIT IS THE DISTANT BETWEEN THE SURFACE OP THc- a:z(xRtD'AND THE BOTTOM OF THC c4cZ YArtOM cIM FEm. t CRE Is M SET WIDTH FOR TRENC HM t + THE owym. mrTH IS THE MIN[MUM DEPTH OF GR#, -A 8ETwEEN THE OUTFALIL PIP£ i AND THE 6Orrm OF THE E>CCRWTIOM <IM F£EM REGlLt xREO SEPT Z +G" TFiri[K �. S Zia 1Q�t3 +GFiL_L_Ca�y k P�r9t-r•-�r�LtcANr Hai ryE ora�tatLCTsr To _INFORri Tots-rr�r-�RIr�+T.-o�ttaG �: } tNsrnLLnrtOM INSPECTIONs CF ANY WELLS ADJACENT To THIS PROPERTY ANO rHC MleER OF RESIDENCES THAT THC WELL WILL 'SERVE "M40 Rf2E [l1 rNt1 OF ANY sY5TEt1 WITHOUT:F[NAL 'INSPECTIOM AND APPROVAL BY THIS �I DEPARTM04T WILL 8E SVBJECr TO PROSECUrrak rMMNIMURM OtSTfv E BErWEEM A WEU- ANO AMY ON-SITE SEWFXX DISPOSAL SYSTEn t5 y s:<,360 FEET!rOR iA PRIVATE WELL OR TSA TO 200 FEET FROM A PUBLIC WEi1_ 6EF646iNG j l tz" THE ; TYPE a-7 PUBLIC Wal- MINIMUM ELLMINIMURM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SO4M LINE 15 25 FEET FM �E TO A 037yt -WIrY SEWER LINE tS 73 J=eer. WELL LOGS ARE REQUIRED AND MUST BE RETURNED To THE DFPARTiewr 14tTHIM 39 CF' THE tMCI t. cot,Pt_ericK OTHER REOIIIREMMr5 MY FPPLY. sP£CEFICRTIOiY MjD 0onsTRt?CTIOM DIRMVtS Am � A"rLABLE to [NsuRE PROPER INsrAL.I.tiriom F 't=FZM Z T 0Ei=EM8Ef2 :r1. 5.-a>8L2 m I CERTIFY THAT ! : I fVf FAMMILIAR WITH THE REGU[REMENTS FOR ori -SITE sEWCF:�S AND WELLS As SET FORTH BY THE i9LR9ICIPAU.rTY OF ANC"OROM 2: r WILL INSTALL THE SYSTEM 1M ROCORDANCE WITH THE COD£5. 3: I UNDCRSTAM THAT THE UM SITE SO4CR SYSTEM MAY RDQUIRC E &SMEM MT IF THE RCSIDERX I5 REPMLLED TO MMUDE MORE THAM 3 SEDRoryra-. APDL cniNr cas 9UILDIim x__-52. -------- DAT£ -_-`-- 1 O & E ENGEERING & DEVELOP .LENT CO. _ Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 SOIL LOG Earl Ellis 688-2280 Performed for: Name: A ED SEVr—A50Al TeI. No.429" 3 59 JAaafitg Address: O et'A )& � Z'4- Legal Description: LoT .2, gLaCs; Z DFE/L- y OP-4� ZS 79 TES Depth (test) Soll Characteristics 0 1 iY1L 5/�T %oi� 50/L 2 3 GP Cog2SE SA.v,�y �.2adFL GogF3cEs g t3auco.=yrs 7-10 4 !z • 85x,6/B. C'. 5 6 PeQc• 7 6'/19 5147-Y 5" A.10 P 6,ZgVE4 6 D EnlJ E 9 10 11 SP G2AUELGy roycjF SOVp 12 13 /3o7'7[a-ir o� /fir 14_ 15 16— Ground Water Encountered: Yes No �If yes, what depth Proposed Installation: Seepage Pit_ Drain Field PLOT PLAN A/o SGgc� PERC.TEST L./{ST /7 .200 ./t /g , 2 L Ay"A'l : * Eorl P. E16. NO. 1745-Ei c� 40FESStOt% Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-042-65 1. GENERAL INFORMATION Complete legal description Deer Park #1 Block 2 Lot 2 Expiration Date: /d .- ,s> « l Location (site address) 22606 Oak Knoll Drive, ChuLiak, AK Current Property owner(s) Lacina Day phone 230-6301 Mailing address same Real Estate Agent Chris Moore, Partners Real Estate Day phone 230-6301 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: ® . Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Received by: Date: /,S- COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 526 Date of Payment 71 2.115 Ci Receipt Number O 514 17- COSA # ©SG S 1,331 Date of Payment Receipt Number Waiver # 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 Certificate of On -Site Systems 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 7/2/2015 6. DSD SIGNATURE ��System #1 Approved for System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms. bedrooms, with the following ° L= 54ove%n'�W��Eng By: 4, Original Certificate Date: /-A `�fJ The Municipal` y of Anchorage Devlopment 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. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet 9442.dw X Nitrate Advisory Arsenic Advisory Other 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:bEC12 '/ 82 L2 Parcel ID: 05/-Dy2-6S A. WELL DATA Well type _,�_ If A, B, or C provide PWSID # Date completed q(?z Sanitary seal (YIN) Total depth -A*—ft. Cased to Otft. 4106 1" FROM WELL LOG Date of test AZA Static water level ,a/A ft. Well production 44.4 g.p.m. Well Log (YIN) AJ Wires properly protected (YIN) Casing height (above ground) /,Ff in. AT INSPECTION 2' /S 5 4- g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 5 S mg/L L! Arsenic AJ D ug/L Date of sample: l6 I S Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material S,'6097Y!'_ Dateinstalled �%�Zi/ZCoo Tank size laa6 gal. Number of Compartments Z Cleanouts (YIN) _ Foundation cleanout (YIN) V Depression over tank (YIN) -A-1N High water alarm (YIN) Date of pumping � 0 S Pumper ' /�7 S C. ABSORPTION FIELD DATA Date installed Z7 Z110%oil rating (g.p.d./11:2 or ft2/bdrm) /' 61 System type 7-Z0A1CtW Length �76E ft. Width 0, s ft. Gravel below pipe -S ft. Total depth //_ S ft. Eff. absorption area 567 ft2 Monitoring tube �/_ Depression over field Date of adequacy test '7424//S Results (Pass/Fail) P_ ( For 3 bedrooms Fluid depth in absorption field before test 45�' in. Water added s 0 gal. New depth in Elapsed Time: 30 min. Final fluid depth _% in. Absorption rate >= S6 g.p.d Any rejuvenation treatment (past 12 mo.) (YIN & type) Al 0 If yes, give date D. LIFT STATION /4 Date installed "Pump on" level at_ Datum Size in gallons in. "Pump off' level at Cycles tested E. SEPARATION DISTANCES Property line l0 /"` WELL ON LOT TO: S fi Septic tank/lift station on lot /GG /74- tAbsorption Surface water Absorptionfield on lot / GO'* - Public sewer main /G(J rf Sewer /septic service line r Animal containment areas �D SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? in. On adjacent lots fid 't On adjacent lots /G f /y-- Public rPublic sewer manhole/cleanout /60 7` Holding tank /,10,(- Manure/animal excrete storage areas /GGr r10— Building foundation $ •tom Property line l0 /"` Absorption field S fi Water main f0 �� Water service line / Q (fi Surface water /BQ !f Wells on adjacent lots IjQ G r - ABSORPTION FIELD ON LOT TO: Property line /O �7�' Building foundation /D ;4- Water main /a F Water Service line l40 fl('- Surface water /GG ;4- Driveway, parking/vehicle storage 20r +` Curtain drain Al A Wells on adjacent lots e•G i0' G. ENGINEER'S CERTIFICATION ! certify that I have determined through field inspections and review of Municipal records that the above systems are in �P ^., ♦9 conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name —Sl/ 15,t/,' r: -W C Date �2�/5 . EnoPE 6256 `r COSA yellow sheet_2-6-15.doc Municipality of Anchorage • Development Services Department / Building Safety Division / On -Site Water & Wastewater Program 4700 Bragaw Street / w P.O. Box 196650 / Anchorage, AK 99519-6650 y N 11 www.muni.org/onsite (907)343-7904 I CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE'FAMILY DWELLING Parcel I.D. 05104265 COSA# OSC 16 11e 1. GENERAL INFORMATION Expiration Date: (— A " Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DEER PARK #1: BLOCK 2, LOT 2 22606 OAK KNOLL DRIVE •CHUGIAK. AK 99567 KIMBERLY LOMEN Day phone 947-9327 22606 OAK KNOLL DRIVE •CHUGIAK. AK 99567 Day phone ANNE ROBERTS W/ PRUDENTIAL Day phone 689-1810 16635 CENTERFIELD DRIVE *EAGLE RIVER, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 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 Certificate of On -Site Systems 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 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. Phone Address 3701 E. TUDOR ROAD, SURE 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 analysts of the system in accordance with ADEC and MOA DSD Guidelines 6 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 dfe 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 encroachments. 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. 5. DSD SIGNATURE �G Approved for —_ bedrooms. Disapproved. Conditional approval for bedrooms, with the flowing 337-6179 Date 02410 tl c Attachments: `/ COSA Checklist Arsenic Advisoy Septic System Advisory Maintenance Agreements Well Flow Advisory � Supplemental Engineer's Report Nitrate Advisory Other OFA!V� r0 ON-SITE ••��. WATER AND : R'= WASTEWATER : PROGRAM By: Original Certificate Date: �p ' •� c� — l ff (Rw. I L05) Municipality of Anchorage I - I Development Services Department Building Safety Division _ On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: DEER PARK #1; BLOCK 2, LOT 2 Parcel ID: 05104265 A. WELL DATA 'PER CEG, LTD. INSPECTION. **PER AAROW PUMP AND WELL INSPECTION. SEE ATTACHED REPORT Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 1962 Sanitary seal (YIN) YES Total depth "77+ ft. Cased to "40+ ft. FROM WELL LOG Date of test NO WELL LOG Static water level ft. Well production 9.p -m. WATER SAMPLE RESULTS: Well Log (YIN) NO Wires properly protected (YIN) YES Casing height (above ground) 18+ In. AT INSPECTION 6/11/2010 42 ft. 0.79 g.p.m. Coliform Q colonies/100 mi. Nitrate LIQ =mg./L. Other bacteria _0 colonies/100 ml. Arsenic7• 2_qug./L. Date of sample: 6/14/2010 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 4/26-27/2000 Tank size 1000 gal. Number of Compartments 3 Cieanouts (YIN) YES _ Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 6/11/2010 Pumper SANITARY PUMPERS C. ABSORPTION FIELD DATA ow EXISTING GO-AfflE Date installed 4/26-27/2000 Soil rating (g.p.d./it'o /bdr 1.0 System type TRENCH Length 45 ft. Width 2.5 ft.... Gravel below pipe 5.65 ft. Total depth * 11.45+ ft. Eft. absorption area 567 ft' Monitoring tube YES Depression over field NO Date of adequacy test 6/11/2010 Results (Pass/Fail) 'PASS For 3 bedrooms Fluid depth in absorption field before test 12 In. Water added 684 gal. New depth25 in. Elapsed Time: 170 min. Final fluid depth 13.5 In. Absorption rate >= 450+ g_p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date - — D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump off' leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ 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 line 100+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 O'+ 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 G. ENGINEER'S CERTIFICATION o� OF A vo �C�........ S00oo I certify that I have determined through field Inspections andI* .Q review of Municipal records that the above systems are in """"" """ "' conformance with MOA COSA guidelines in effect on this date. t Garn ss' 0 Engineer's Printed Name JEFFREY A. GARNESS ooh J' , CE— 3 h Iz o 40' !f le;' oqA Date y II ��°'P,of°es,000\ad COSA Fee S C1 4 1 Waiver Fee $ i Date of Payment CD fl Date of Payment Receipt Number Receipt Number (Rev. 11/05) st 631126KF;?S MUNICIPALITY OF ANCHORAGE PT.ATnING AUTHORITY FXWLUTION NO. 97-24 ANCHORAGE RECORDING DISTRICT A RESOLUTION APPROVING THE VACATION OF A PORTION OF THE to FOOT tmLxry EASEMENT ALONG THE SOUTH PROPERTY BOUNDARY INTO WHICH AN EXISTING WELL ENCROACHES 1.4 FZE:r AT THE NORTHEAST CORNER OF THE LOT AS REFLECTED ON THE AS -BUILT SURVEY FOR LOT 2. BLOCK 2. DEER PARK SUBDIVISION. DRAWN BY DUANE MARK SEWARD' REGISTERED LAND SU WHEREAS. a petition has been recetved from Kenneth Newland to vacate soutboundary h property a portion of the 10 easement orthamtcornothe lot as Into which anexlstln$ ellcher I4 at the along for lot 2. Block 2, Deer Park Subdivision. Addn. No. 1 reflected on the as-bullt survey tered Land Surveyor. dated July 2. 1997, and drawn by Duane Mark Seward. Regis WHEREAS, legal notice was published and the request was heard by the Platting Authority on September S. 1997, and WHEREAS. the platting Authority found the area being vacated is minimal. and tten letters andjor comments objection W the reqIMAS uested vacation of a portioe affected utilities have n of the utility easement, of non - WHEREAS, the platting Authority found this portion of the utility easement to be of no substantial value to the Munteipality. NOW. THEREFORE. BE rr RESOLVED by the Anchorage Plstting Authority that the vacation of the above described utility easement be approved subject to recording this resolution and a Copy of the as -built survey referenced above at the State District Recorder's Office. PASSED AND APPROVED by the Anchorage Platting Authority this Sth day of September, 1997. Jerry . W Jr. platting Authority Case 5-10144 trm.n m: V,r ga D..lep t t.o. am: eeeo smL..P W rrmresw .wn: r..[•nr os.rn Municipality of Anchorage •r !� • '� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Nater Well Advisory Certificate of On -Site Systems Approval (COSA) # 101101 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 2 of Deer Park #1 subdivision, the well's productivity was determined to be 0.79 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned arc advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 'DL N '�. �•v �� �"L�� t ' ASBUILT SEWARD ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY: yo '� OF A "%% OE�iP.�iYi(P'(�.�OO. HO./ LOTZ .Birt i •(� .......... ' DATE: AND THAT NO ENCROACHMENTS EXIT EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE 4 • M� OWNER TO DETERMINE THE EXISTENCE OF ANY GRID:. ••�..: EASEMENTS, COVENANTS, OR RESTRICTIONS �Ywisso �•• <� N WHICH DO NOT APPEAR ON THE RECORDED SUBDI- o,,... Me,k Sw.,d VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' d 1 •. ts- e� ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN �4rwr. SGS Retq 1102684001 Client Name Garncss Engineering Group, Ltd Project Name/# Dcer Park SID N I L2,B2 Client Sample ID Decr Park SO 91 L2,B2 Matrix Drinking Water Printed Daterrime Collected Date/rime Received Daterrime Technical Director 0612212010 14:04 06/1412010 7:30 06/142010 11:30 Stephen C. Ede Sample Rcmarks: 450ONO3 - Total Nitrate/ Nitrite - MS did not meet QC criteria, biased low. LCS meets QC criteria. Allowable Prep Analysis pwametcr Resuhs LOQ Units Method ContainerlD Limits Datc Date Init Metals by SCP/MS Arsenic 7.94 5.00 ug/L EP200.8 C (<10) 06/14/10 06/16/10 NRB Waters Department Total Nitrate/Nitrite-N ND 0.100 mg/L SM20450ONO3-F B (<10) 06/14/10 AYC Microbiology Laboratory E. Coli Negative I IOOmL SK1209223B A 06/14/10 DLC Total Coliform Negative I IOOml- SN1209223B A 06/14/10 DLC e> 031©OPG3O8 Matanuska Telephone Association, lnc. P.0.90X3550 PMAU1lNABKANOU4$W /HONE10e7174' K,e Ndt� Silo. .........re .....»..»........». NON -OBJECTION TO IASUdENT ENCROACM]IP7T DOCUMENT By this document Matanuska Telephone Amciatlon, Inc. Q -ITA) dedares 69 it has no objection to the placement of the emcrosdument of a'Well within the 10, LTTQZ'TT EASEMENT along the Easterly boundary ofBW CK 2, LOT 2, DELA PARK SUBBMUON NI. ••.••r•••••.•••••rr•••••••••••p•••••rr••r•••••r•r••••r••rr•••r•••••a•••a•r••••rp•r•r Please be advised that MTA through the lsaanoe of this document does not forfeit any of its rights to the use of the utility easement died In the exercise of these rights MTA will, If needed, upgrade. ma 3ink, repair. that and/or replace buried or aerial telaceu mudrations facilities within the easement. Any rep may be reku(red to the encroachment as a result of utility construction will be borne by the property owner of record- This ecordThis document does not authorize the placement of Any additional encroachments within the easement ares. This document is, in no way, an agreement to vacate any portion of the utility eaxment and should not be Interpreted as such. Issued for Matanuska Telephone Association. Inc. this 7th day of July, 1997 by. 6 Real Estate and Properties Supervisor Tics IS To cE3tTwy, that on this 7th day of July, 1997 before me the undersigned.ecky any pGlenublic in And to mer the Sete of Alaska, duly comma sioned and awom as such, personelb SPP�� Sed to me known to be the individual named in and who executed the foregoing instrument and acknowledged to me that he signed and sealed the same u A voluntary act and deed for the uses and Purposes therein mentioned IN WITNESS WIEREOP, I have hereunto set my band and official seal the day and year first above wrhteL 9 Notary Pu tie in and for My eomm1si1C expires: ' 7 _ GRANTORS ADDRESS: Please Retere tot Metanuslm Telephone Association, Inc. Real Estate and Properties Section P. O. Box 3550 Palmer. Alaska 99645 GRANTEES W. Renaeth Nev 22606 Oak Kre0 Chugiak, AK 99 a�-037756 :HCHORACE REC. _[STRICT, !EOUESTED symi'— •'9? JUL 30 Pfd 12 13 1 1 JU1-29-2010 01118H FROM: rte, (,6k&eh .:) a6o 6.k C� h u:5ia k) AK 9 95-7 7 Q p TO:188�6416 /�77;%,/�' !/PIM R06eftS AAROW PUMP & WER SERVICE, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 348-9355 - Fox (907) 333.8978 Eagle River: (907) 622.9335 CUSTOMER P.1 MUCE NP 08701- JOB armr a o oG k "61L "1 aR-2-1 4V9 9 L,4TT.v' Amt4 204rorY-s -1 I�vj%CE o�TE WEUDEPTI ewt PlORM PUMP DEPTH Q N 171 QUANTITY QUANTITY DESCRIPTION PRICE AMOUNT 0. / �! O LABOR HOURS RATE AMOUNT TOTAL MATERIAL TOTAL LABOR WORK ORDERED BY DATE COMP. TOTAL LABOR PAY THIS AMOUNT Thank You SIGNATURE (I Hereby Atf.rowledge the Sedsla dry Completlon of the Above Described Work and agree Ihat x above work Is not pekl W In 90 days I agree to allow Aarow Pump 8 Wed Service, LLC. the right 10 remov0 unpaid for eWlpmonl end charge for labor already pertormod 6 labor to remove unpald for egtipmont) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. u1S MUNICIPALITY OF ANCHORAGE • 'pyr"' DEPARTMENT OF HEALTH & HUMAN SERVICES 1411 Division of Environmental Services Onsite Services Section P.O. Box 196650 Anchorage, Alaska 99519.6650 (907) 3434744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 051-042-65 HAA # 4r I C_ CO t 2a 1. GENERAL INFORMATION Complete legal description LOT 2. FLOCK 2. DEER PARK SURDNISION fit Location (site address or directions) 22606 OAK KNOLL DRIVE Lending agency Mailing address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxx 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: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1191) Fmnt MOA 921 Computer version Note. Alaska Water and Wastewater Consultants, Inc. shall be paid $1250.00 at, or prior to, closing for the engineering services provided. 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 andlor wastewater disposal system is in compliance with all Municipal and Sta codes, ordinances, and regulations in effect on the date of this inspection. 7 Name of Firm Engineer's Phone (907) 337-6179 Date -5726 In conducting this evaluation, AWWC, Inc. adelrrJt prcvidee'r6orough, conscientious engineering analysis of the system in accordance with ADEC and MOA DHHS idelines & 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 identirrable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water oo�opp usage of the family being served by the system. These conditions are outside the control of o OF A Cep . the evaluator of the system. Satisfactory test results do not guarantee future performance o •. •••• of the system, nor do they guarantee that there are no hidden defects or encroachments. v� , AVV=, Inc. can therefore not provide any warranty for future estimate of how long the p system will continue to meet the operational requirements of the ADEC or MOA DHHS. 0 ��„•'•„ 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 tight whatsoever. Je,re .Cornes 6. DHHS SIGNATURE -7953 e OK ' e —!C Approved for 3 bedrooms 4p�ooO QQ Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments M Date S' //-0 0 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. 1191) Back MOA #21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES l Environmental Services Division — 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-3744 Health Authority Approval Checklist LogalDescription: LOT 2 BLOCK 2. DEER PARK S/D #1 Parcell.D.: 051-042-65 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) NO Date completed 1982 Total depth 106't Cased to 40'+ Casing height (above ground) 18"+ Sanitary seal (YIN) YES Wires properly protected (Y/N) YES FROM WELL LOGS Date of test Static water level .t1; Well production g.p.m. AT INSPECTION 4/27/00 0.501 g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate 0.1611 mg/L Other bacteria 0 Date of sample: 5/1/2000 Collected by: A.W.w.C., INC. B. SEPTIC/HOLDING TANK DATA Date installod 2/26-27/00 Tank size 1000 Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression (YIN) NO High water alarm (Y/N) N/A Date of Pumping NEW Pumper — C. ABSORPTION FIELD DATA Date Installed 4/26-27/00 Soil rating (g.p.dJft2 or ft21bdrrm) 1.0 SO' System type TRENCH Length 45' Width 2.5' Gravel thickness below pipe 5.85' Total depth 11.4'-12.1' Effective absorption area 567 SO. Fr. Monitoring Tube present (YIN) YES Depression over field (Y/N) NO Date of adequacy test NEW Results (Pass/Fail) — For 3 Bedrooms Fluid depth in absorption field before test (in.); Fluid depth — (ins) Minutes later. Peroxide treatment (past 12 months) (YIN) 72-026 (Rev. 3Aer computer version Immediately after — gal, water added (in.): Absorption rate = — If yes, give date D. LIFT STATION Date installed Size Manhole/Access (Y/N) High water alarm level at* -"Pump off" level at* 'Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septiclholding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ LIR station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 109+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 100+ Building foundation 10'+ Water main/service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage area 10'+ Curtain drain F. ENGINEER'S I certify that I of Municipal with MOA H Signature V Engineer's HAA Fee Date of Payment Receipt Number 72-026 (Rev. 3198p Computer Version NONE KNOWN Id Inspections and review stems are In conformance this date. Wells on adjacent lots 100'+ Waiver Fee $ Date of Payment Receipt Number MUNICIPALANCHORAGE O DEPARTMENT HEALTHEALTH8 HUMAN SERVICES of 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 l.D.# C1'S1-CHQ-1c4) HAA# 1�nc11i'`2kLL'� 1. GENERAL INFORMATION Complete legal description Lot 2; Block 2: Deer Park Subdivision #1 Location (site address or directions) 22606 Oak Knoll Drive Chugiak, AK Property owner Kenneth Newland Day phone 688-3427 �;-Mailing address .22606 Oak Knoll Drive Chugiak, AK 99577 Lending agency '" Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX 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: Individual on-site XXX 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. 72-025)11w.1N1) 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 S & S ENGINEERING G q y _ ary 17034 Eagle rver Loop oa o. Phone Address Eagle River, Alaska 99577 , Engineers signature 6. DHHS SIGNATURE ./ Approved for bedrooms. Disapproved. Conditional approval for Additional By: Date 61 y E OF ROBERT C. COWAN CE -8901 bedrooms, with the following stipulations: U���� Date 1 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 orderto 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. 73-75 (Fw 1/91) Bart MOA a71 MUNICIPALITY Of ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage �IUN 25 1997 DEPARTMENT OF HEALTH & HUMAN SERVICE Environmental Services Division /��`, ' 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90745-47Y E D Health Authority Approval Checklist Legal Description: Lo r .2 /JL c 2 L*A=E C.Ps4f_ d Parcel I.D.: U S't - c WL A. WELL DATA n Well type ' 91%10 i£ If A, B, or C, attach ADEC letter. ADEC water system number i✓ Q Log present Date completed Total depth / o f, ; Cased to �� r f Casing height (above ground) Sanitary seal ('16N) Wires property protected N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: g.p.m. 37' r %x g.p.m. Coliform i% Nitrate odd Other bacteria O Date of sample: L�-11- 7 7 Collected by: B. SEPTICIHOLDING TANK DATA Date Installed ` 9 Jy7� Tank size lcl'9 C' Number of Compartments 7— Cleanout ) Foundation. cleanoy6N) Depression (1 J High water a 6}' term (YM) DateotPumpmg S 'iPumper J� �'`J/✓t/'i,JS y C. ABSORPTION FIELD DATA T` Date installed'e g (g•p• Soil rating d./ftZ or ftZ/bdrm) moo � System type Length �D � Width r 3 Gravel thickness below pipe Total depth' 9,.Z9, Effective absorption areaL70O Monitoring Tube presen&/N) Depression over field (A) Date of adequacy test b'l&-79 Result (Pass1Faiq For 3 bedrooms Fluid depth in labsorption field before test (in.); f Immediately after -� )gal.water added (in.): 9 Fluid depth (ins) Minutes later: Absorption rate mp.d. Peroxide treatment (past 12 months) W Z11 ✓C, /�'t� `j �If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at' off" level at` SEPARATION DISTANCES FROM WELL ON LOT TO: i4 . Septic/holding tank on lot I c o On adjacent lots yoo'4. Absorption field on lot 1�o r On adjacent lots Public sewer main �I A Public sewer manhole/cleanout 0 -I :T - Sewer Sewer/septic service line 2� Lift station �' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: rf rf 1 Foundation 5 Property line S 1 Absorption field 3 Water main/service line /O �f Surface water/drainage O� D r Wells on adjacent lots �f`4- Ctrs G� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10 Building foundation 10 Water main/service line Surface water I Driveway, parking/vehicle storage area C>14- �oau i� Curtain drain (�n� Welts on adjacent lots F. ENGINEER'S CERTIFICATION��„_' I certify that I have determined thru field inspections and review of Municipal re In conformance with /MOA�jA�Aguidelin sin effect on this date. Signature Engineer's Name R4)4h4 % c • C8w fr Date C lx s- l9 7 j -d HAA Fee Date of Payment Receipt Number 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number I y` ROBERT G MVAN CE -6801 are n e- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH b HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES n CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date /87 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Descrip 'on (include lot, block, Location (address or directions) (b) Property Owner Telephone: Home Mailing Address (c) Lending Institution� Telephone Mailing A (� (d) Real Estat Address Telephoni Business (e) Mail the HAA to the followina address: or: Check hereif hold for pick up. List contact person and day phone number below. k. Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well K 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 Onsite Ki Public ❑ Community ❑ Holding Tank ❑ Note: 11 community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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Aw leyl AluaA I'molaq umo14s alep uopep!leA 014110 se pue olajay pax!;le leas Aw Aq pa!l!Uao sy NOI1VWtl03Nl CNV V1V0'HOtlV3S 3113'S1S31'SNOI103dSNl ONIOIAOHd WH13 ONitl33NION3 'S MUNKJPAUIY OF ANCHORAGE ENVlRONNDENTJVyNWIFS5L j ri),� ANCHORAGE (MOA) HEALTH AUTH�jRITY APPROVAL (HAA) JUN11 KLIST- FEBRUARY 1984 284-4744 RECEIVED Legal Description: L,.- 1 /3Lk z 7 �a2e -# Art- 4 A. WELL DATA Well Classification 5• ` If A, B. C, D.E.C. Approved (Y/N) �r/A Well Log Present (Y6) -Date Completed 22*ee4- /Tei- Yield - D. 0, &P-^ Total Depth T7/�p Cased to `�� 1.'r Depth of Grouting Static Water Level 3�. Pump Set At L"�• & Casing Height Above Ground ;� t Sanitary Seal on Casing (!!?N) Electrical Wiring in Conduit/N) Separation Distances from Well Depression Around Wellhead (Y.f>Sq To Septic/Holding Tank on Lot / 13 ; On Adjoining Lots %ue. To Nearest Edge of Absorption Field on Lot 2 i t ; On Adjoining Lots To Nearest Public Sewer Line #"/A To Nearest Public Sewer Cleanout/Manhole . A To Nearest Sewer Service,Line on Lot Z S F Water Sample Collected by S r /- L/I- AZ "-� fwcc ; Date & - r Water Sample Test Results A V'7 f,I/ ALiZN�)!f Fve Comments Oe -L 7l"s7 %RS-z�-rrr} (► ryNl), B. SEPTIC/HOLDING TANK DATA Date Installed 'll -i"15 -0-r- Size /�&t> No. of Compartments Z Standpipes&fN) Air -tight Cap 6(N) Foundation Cleanout6N) Depression over Tank (Y& Date Last Pumped 4 L -Z -n q Pumping/Maintenance Contract on File (Y/N) A11A ; for ✓J1A Holding Tank High -Water Alarm (Y/N) K'Z 4 Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 113 To Building Foundation /N To Property Line /O To Disposal Field To Water Main/Service Line To Stream, Pond, Lake; or Major Drainage Course fH Comments le kt� S/_1$i-0z.z Pagel of 2 72.W61P,w P P61 Fmm C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata L `i' Type of System Design Date Installed Length of Field leo Width of Field 36� Depth of Field 9, Gravel Bed Thickness S� Square Feet of Absorption Area L'�b Standpipes Present 6l1N) Depression over Field (YA Date of Last Adequacy Test Results of Last Adequacy Test S A? r F?A1 r %,t V r—.. 3 2/4t. Separation Distance from Absorption Field: To Water -Supply Well f Z'7 To Property Line lt>r^` To Building Foundation 1 'c' To Existing or Abandoned System on Lot ; On Adjoining Lots � 14 To Water Main/Service Line �� r% To Cutbank (if present) r/�A To Stream/Pond/Lake/or Major Drainage Course WIA To Driveway, Parking Area, or Vehicle Storage Area /.;, e D. LIFT STATION Date Installed Dimensions — Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Pumping Cycles during Adequacy Test Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S&S ENGINEERING Date Compan]%g Eagle River Loop Road Nom No .7_00 3 EEagle River, Alagko 99577 Receipt No. � — e,-,? e-9 0O/ Date of Payment , Amount: $ /Od Page 2 of 2 72-026 IR" 8'MI Back 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 May9 ,1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 1,ot 2, Block 2, Deer Park #1 T15N R1W Sec.4 Location (address or directions) Oak 'Knoll Drive (b) Applicant Name Cathy Cartwright Telephone: Home 688-9882 Business N/A Applicant Address Box 67-0316, Chugiak, AK 99567 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderET; Buyer ❑ ; Other ❑ (explain); , (d) Lending Institution N/A Telephone Address (e) Real Estate Company and Agent N/A Address Telephone (f) Mail the HAA to the following address: pickup by applicant please call 2. TYPE OF RESIDENCE Single -Family El Multi -Family❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well 13 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 Onsite 0" Public ❑ Community ❑ Holding Tank ❑ Note: if communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72.025 p1,841 5. ENGINEERING FIRM PROVIDIN. INSPECTIONS, TESTS, FILE SEARCH, D..A AND 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, 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.* well located 71' from leachfield may not be properly Name of Firm EAGLE RIVER ENGINEERING SERVICES Telephone abandoned. Address Date 694-5195 6. DHEP APPROVAL OF ,1 ••�,•iH ... ..........' Engineer's Seal tout A. Butara CE -6796 Approved for bedrooms by Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in 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 7I-020 (1 1104) ?01�1 ?0_�' MUNICIPALITY OF ANCHORAGE (MOM/ MUNICIPALITY OF ANCHOtULTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH 8 CHECKLIST -FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 MAY 12.1986 Legal Description: ° ' -/s �h -2 6L -e r A. WELL DATA RECEIVED i?/? / v�7 TE If A. B. C, D.E.C. A 9 Well Classification � Approved (YIN) Well Log Present (YIN) 2V Date Completed /9 '*'-Z Yield 1-2 Ts.r h -c( Total Depth - & s ' Cased to S'40 7. Depth of Grouting 2 VA Static Water Level 33/ r3T, Pump Set At-� i. Casing Height Above Ground Sanitary Seat on Casing (YIN) IV Electrical Wiring in Conduit (YIN) y Depression Around Wellhead (YIN) N Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots /0S r To Nearest Edge of Absorption Field on Lot .17 ; On Adjoining Lots /G s To Nearest Public Sewer Line �V /A To Nearest Public Sewer Cleanout/Manhole A' IA To Nearest Sewer Service Line on Lot Water Sample Collected by Date .3-13- A'4: Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed /5 5 � Size /"""' -j4/ No. of Compartments"Z Standpipes (YIN) y Air -tight Caps (YIN) y Foundation Cleanout (YIN) Depression over Tank (YIN) Nr Date Last Pumped 5 zS-5 Pumping/Maintenance Contract on File (YIN) Al 1.4 ; for — Holding Tank High -Water Alarm (YIN) /�/ 14 Temporary Holding Tank Permit (YIN) 11'114 Separation Distances from Septic/Holding Tank: To Water -Supply Well // 3 ' To Building Foundation /S/, To Property Line 701 /,7 ' To Disposal Field H J ' To Water Main/Service Line '�� To Stream, Pond, Lake, or Major Drainage Course W /A Comments Pagel of 2 72-026(11,84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata oCJ 46Z%?T Type of System Design L rsNc.( Date Installed L 5 Length of Field E Width of Field 3 Depth of Field y Gravel Bed Thickness S Square Feet of Absorption Area 4<c;" 46 Standpipes Present(Y/N) X Depression over Field (Y/N) All Date of Last Adequacy Test �Z Clw-e Results of Last Adequacy Test S' ;e - .J `y Abs .rf.rx '004 /C 7£ 3 ec•r use_ Separation Distance from Absorption Field To Water -Supply Well / °" 7 To Property Line ''/o I / To Building Foundation 70 To Existing or Abandoned System on Lot 4 ; On Adjoining Lots ' 3o To Water Main/Service Line ren To Cutbank (if present) 11-114 To Stream/Pond/Lake/or Major Drainage Course - AY Al To Driveway, Parking Area, or Vehicle Storage Area do = Comments Gael/ /• .. . . d a �G 'L-cK 6y ry oA 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 Check Permitted Bedroom Rating Against HAA Request .. Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Icertify thatlhavec eeked,vrified.orconformed toall MOA and HAA guidelines ineffect onthe date ofthis inspection. Signed Date ' Company MOA No. Receipt No. Date of Payment Amount: $ Z,5. Qn �.';�. r'.-7 S j Engineer'sSeat s •"Y' . I1 yI •..,GO .........HH �1 Page 2 of 2 , Louis A. Bu lerq t .`fin �A CU716 72-026 111,84) �� � pn^CFESSt�NS �IIP6 ��- JG���ouse �'v vs APPLle- �NT FILLS OUT UPPER HA, ONLY Property Owner . C a S COdl3 vL Ke - (O AJ - Phone Maillny Address C Zip Code L A6-1 53 Buyer GP--dj� o- K-4-i/iy (�A�eTwRtSIiT Address q if 2 2/_ '- Zip Code 99 Lending Institution Rill rro 41A $Auk Cr I)lASkA Phone Address ZIP Coda 6,— 3 Realty Co. d Agent7ERR GtJA N y%y T,-teA, A'4Atry /NG. r 9 Phone Address Zip Code e%! G Fy -9y9f ,Legal Description 3 2 DE E,E PAA 657id/es Street Location_ Inspector P.,C,4` Type of Residence Inspector (� 1 vR Single Family Z Inspect d O Multiple Family No. of Bedroom Inspecto(r� ❑ Other . Water Supply K Individual 91an(16LoATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community nc, L.Lu 4n O nt For wells trilled prior to that date. give well depth (attach log It available). ❑ Public UtilityC•• W ..lL.V 1 _I .. � P.- ice, Sewer Disposal nC Y: Individual Q r�.��'/Nu7 Year Individual Installed: i 9R,2. r� �r ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank l`��' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. �V J 1932 Time Time Time \ J Date Date Date Date Inspector P.,C,4` Inspector (� 1 Inspect d Inspecto(r� . t� a -L k Field Notes: W ..lL.V 1 _I .. � P.- ice, MUNICIPALITY OF ANCHORAGE l`��' �V J 1932 ��v,- l�.(Y-�i It vGr'p�'� ZA wr�Ar 1. VED.�g z MS 'CONDITIO OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE A' -1/-9-3 BY: Soils Ratlnp Date Sewer Installed Well To Absorption Area Well Log Received I Septic Tank SIZe QOci G — Q 1 Well to Tank I Ito 12 Wa (WI