HomeMy WebLinkAboutLAKE O THE HILLS EAST BLK 2 LT 2Lake O the
Hills East
Block 2
Lot 2
#015-333-13
Municipality of Anchorage Page I of 3
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: - t5wegl 00 1L4 PID Number:
Na IVAILLliP A.00 Kilts 19CYPSLL..
vIS'7A-
Wastewater System: ElNew El Upgrade
G O rAtcFiAL,LE CVWE✓t W114 j0ttunDe AL,
Address:
`iz4 l 11 e>."S-irzes7 �NrrN q C1.T0_3
- ABSORPTION FIELD
Phone:
7.73-T76'1/2q0 -$y$0
No. of Bedrooms:
Lf
A Deep Trench ❑ Shallow Trench ❑ Bed []Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
I 'Z-
Total Depth from original grade:
,•S� •� {�•O•-j
- GPD/Sq. .Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
r
22 EKE O LLL$ Eas-r
//b '"'•C-51 Ft.
Lf • S Ft.
Township:
Range:
Section: ---.
Fill added above original grade:
0.39
Gravel length: 1
56
^ 1." Ft.
Ft.
n
WELL: FXISTI.SGew ❑ Upgra
Gravel width:
Z •5 Ft.
Number of lines:
I
Distance between lines:
--- Ft.
Classification (Private, A,B,C):
rl
To pth:
Cased To:
Total absorption area:
60-7:
Pipe material:
AS -I'M 0.363y F$lo
GLASS A"
Ft.
Ft.
SO. Ft.
Driller:
Date Drilled:
Static Water Level:
Installer:
Date installe
Ft.
G
&711
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
Xseptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer: ./
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
ANG R,�y [.,F f /�h{t�
12-50
Well'
-
�•
251t
Material:
STEEL..Surfac
Number of Compartments:
Z
Zcn{+
Z�+
�ioo{
---
_
—
LIFT STATION
Water
too{+
Lot
+
—
Size in Ions: Manufacturer:
Line
ZS
3
Foundation
---•
"Pump on" level at:
"Pum I at:
High water alarm at:
S'�+
._.
^---•
Curtain
�On1E
Y_Y
fJ
Pump Make el
Electrical Inspections performed by:
Drain
Remarks: tN ReGL57eREb
BENCH MARK
1
Location and Description:
ooOBad it EAST SLpE
iTLplJ
1415' NEL (2E u{qS PN ?,'r I A L,L`f
o� NOJS� �iiREs oL0
Assumed Elevation:
{1154p}Lea cJMEsKE ( OLD SePfIG 'rAnik
100.0
' '%% L
f/)RS PLAGED. T "Z O 'rL1 K trlAV. fLEMOJeb 40
D���
�; ®F A 0
a
%,
was ILSSTRL6Ei� Te
SaLJn r T K— l � � 'r@ 41 A L F14L /n1 Agreik.
A "t t'�' �Ne
Inspections performed by: Dates: is
2nd q ".
•° ;«
-'� 4'
ni 4.
3rd` 5 3
;1A. cern
Department of Health and H man Services approval
.79.53
Reviewed and approved by:Date:°�;"
72-013 (Rev. 9/91) MOA 25
i
!�SW990014 AS -BUILT DRAWING
[=
B C
DBL1 1
18.3
1 28.7 —
DBL2
17.9
29.2 —
ST1
9.4
40.0 —
ST2
8.5
47.5 —
DBL3
10.8
50.5 —
DBL4
11.4
50.5 —
BR
16.9
31.4 —
Col
4
—
2 2
VT _11
24.3
38.9 —
MT2
60.4
25.6
SUMP
30.1
68.7 —
CAUTION: THERE ARE SEVERAL UTILITY
SERVICE LINES OVER THE EXISTING
AND NEW SEPTIC SYSTEMS.
WATER KEY BOX-
SE�R ICE -- --
i
- � \ / SUM
NEW 1
-_4 aEpROOM
HOUSE
Mf K
/
i
/
/
/ C
TH#1
RUN
PARCEL ID NUMBER:
015-333-13
XISTING TRENCH
TO BE USED AS
A RESERVE SITE
(EXACT LOCATION
IS UNKNOWN)
NEW DRAINFIELD
i
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD SUITE 28, ANCHORAGE, AK 99504 0
PHONE: (907) 337-6179/FAX: (907) 338-3246 d`y �S4pp
LEGAL DESCRIPTION: Cl)
LAKE 0' HILLS EAST SUBDIVISION; LOT 2, BLOCK 2,
TYPE OF WORK:
AS -BUILT OF SEPTIC SYSTEM ..... •••
PHILLIP AND KRIS BOYDELL QGayness.
PREPARED FOR: PHONE NUMBER: m -••. -7953 : oG
c/o MICHALLE CULVER W/ PRUDENTIAL VISTA 273-7767/240-8480 �Q91
5/7/99 1 J.L.M. I 1= 30' 1 2 OF 3
P : AS -BUILT DRAWING PARCEL ID NUMBER:
•SW9W9900140014 - 015-333-13
FINPL cwm -100,21
xI 9r2
fcr OF T" fOP Of f"
Af IUf -9431 AfOIJUT-9431
NSW 1250 GALLON
INv ro�el VIC TANK \WufoFvm
AfIOT-93,75 I AfaW-93,56
rim6m
0061% cm M® ® F
98,08-10006
p 96,'}6-9967-� � �
- INWKOF rig
93,10 (AVOW)
wffOM OF fftcH
8Bb0 (AVtf2)
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD SUITE 2B, ANCHORAGE, AK 99504
PHONE (907) 337-6179/FAX: (907) 330-3246
LEGAL DESCRIPTION:
LAKE 0' HILLS EAST SUBDIVISION; LOT 2, BLOCK 2,
TYPE OF WORK:
AS -BUILT OF SEPTIC SYSTEM
PREPARED FOR: PHILLIP AND KRIS BOYDELL PHONE NUMBER:
c/o MICHALLE CULVER W/ PRUDENTIAL VISTA 273-7767/240-8480
DATE: DRAWN BY. SCALE: PAGE:
5/7/99 J.L.M.--�^y 3 OF 3
Of
6N
: .
f A. ar ess. D
ps ' E-7953 ;'`�4-4Qh
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 213 — Anchorage — Alaska 99504
(907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
May 7, 1999
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
MAY 12 1999
Municipality of Anchorage
dept. Health & Human Services
Rei Waiver Request for Lake O' The Hills East Subdivision, Lot 2, Block 2,
To whom it may concern:
The existing 4 bedroom house is served by a community water system and a newly installed septic
system. At the time of construction, the new buyers of the house were adament about saving a
group of trees along the east property line. After the majority of the trench was excavated, the
contractor realized he had miscalculated the effective depth. A field change was made and the
trench was installed as shown on the as -built drawing. We request that you issue a 8 foot waiver
from the new trench to the foundation. The elevation of the distribution line is lower than the
elevation of the footings; in short, any effluent would not be able to migrate towards the footings.
Also, a 2 foot line waiver was requested on the design package. It has been assumed that with the
issuance of the permit that this waiver has been granted.
I am unaware of any adverse impacts with the granting of this waiver. If you have any questions,
please contact me aQ37-6179, or 244-9612. Thank you for your assistance.
.E., M.S.
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
"V LJCY-Ln-
% ca L
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
1
Initial `�"a-� -AOL
61 uC�ct.
Date Issued: Feb 17, 1999
Expiration Date: Feb 17, 2000
Permit Number: SW990014
Legal Description: LAKE O THE HILLS EAST BLK 2 LT 2
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: Phillip & Kris Boydell
Owner Address: 7150 MOUNTAIN LAKE CIR
ANCHORAGE , AK 99516-1866
.Rei - c` ofy-\ u
Parcel ID: 015-333-13 L -1. L__ 5
Site Address: 007150 MOUNTAIN LAKE CIR
Lot Size: 29160 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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:
G'
Date: �_) / / ;9�1
Z' (; - r
Date:
Munlicipality ®f Anchorage
Department of Health and Human Servicesi
825 U' Street
Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor
http:!/www.ci. anchorage. ak. us
February 17, 1999
Jeff Garness, PE
Alaska Water & Wastewater Consultants, Inc.
6901 De Barr Road, Suite 2B
Anchorage, Alaska 99504
Subject: Waiver Request for Lot 2 Block 2 Lake O'the Hills East Subdivision
Waiver Request #WR990012
Parcel ID #015-333-13
HA990061, SW990014
Dear Mr Garness:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
2.0 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Daniel J. Roth
Civil Engineer
On -Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR#LU _ totL�Q PID# 015-333-13 HA# ���l�lel(31�n 4 Permit #
Date Received: Feb 16, 1999
Legal Description: Lot 2 Block 2 Kake O'the Hills East
Engineer: Jeff Garness, PE, Alaska Water & Wastewater Consultants Inc.
6901 De Barr Road, Suite 2B, Anchorage, Alaska 99504
Applicant: Phillip & Kris Boydell
Waiver Requested: Lot line waiver of 2 foot from the proposed drainfiPld rn
the east property line.
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Points:
Waiver is Granted: ly__ Waiver is NOT Granted:
List Conditions or Reasons for above: SEE EAiG1,VE-PR LUT',EfQ
Of Ju T/FicArioN.
Date: % - /7-9-2 By: 19,4N
Name of Reviewer
Rec #: 04495/0903 Amount: $_115. 00 Date Paid: 2-16-99
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Rd. Suite 2B — Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
February 16, 1999
Municipality of Anchorage
Department of Health & Human Services
P.O. Box 196650
Anchorage, AK 99519-6650
RECEIVED
FES 16 1999
Municipality of Anchorage
Dept. Health & Human Services
REFERENCE: Lake O' The Hills East Subdivision; Lot 2, Block 2,
Conditional Health Authority Approval request
Request you issue a Conditional Health Authority Approval on the referenced
property due to the closing of the house will need to take place prior to February 19,
1999.
On January 18, 1999, the on-site wastewater disposal system located on the referenced
property was tested for purposes of obtaining a Health Authority Approval. The septic
system will not pass an adequacy test and must be upgraded. Attached is the proposed
design for the upgrade. Due to the closing date, we request you issue a Conditional
Health Authority Approval. There is no sign of health hazards such as surfacing effluent,
effluent backing into the house, etc.,. The septic upgrade will be done on or before the
15th of June, 1999.
If you have any questigfis or require additional information, please contact us.
JAG/jlm
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 213 — Anchorage — Alaska 99504
(907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
February 16, 1999
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, Lake O' The Hills East Subdivision
To whom it may concern:
The existing 4 bedroom house is served by a community well and a private Septic system. The
septic system will not pass an adequacy test and must be upgrade prior to the sale of the house.
Comments regarding the proposed design are summarized as- follows:
1. SOILS: A test hole was excavated and a percolation test was performed. The soils below the
organics is a GM material with loam to a depth of 3 feet and than transitions to primarily GM
material to a depth of 6- feet. At 6 feet, the soils than transition to a primarily SM material to a
depth of 17 -feet (bottom of test hole). A percolation test was performed between the depth of 8.0
feet to 8.5 feet and found the percolation rate to be <1 minutes/inch. Due to the high percentage
of sand/silt, the insitu soils should act as a sand filter. A grab sample can be provided if deemed
necessary. No groundwater was encountered at the time of excavation.
2. TRENCH (PRESSURIZED) DESIGN:
a. Percolation Rates: <1 minutes/inch
b. Allowable Application Rate: 1.2 gallons/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 604 gallons per day
e. Minimum Absorption Area: 500 ft2
f Maximum Total Depth: *Base total depth off of 6 feet from bottom of test hole
g. Effective Depth: 6 feet (clean, washed sewer drainrock)
h. Width: 2.5 feet
i. Reduction Factor = N/A
j. Minimum Length: 45 feet
k. Effective absorption area = 540 ft2 (500 ft2 OK)
* The house and existing septic system are on a knoll. The test hole was excavated on the down
hill side of the knoll (see attached topography site plan)_ The beginning of the new trench will
start at the top of the knoll and gradually shallow in depthas it moves towards the test hole. The
bottom of the new trench will be 6 feet above the bottom of the test hole and will not be based
upon the total depth below original grade.
3. SURFACE WATERS: There is a creek south of the proposed upgrade. The 100 foot
setback will be flagged by a registered land surveyor to insure the separation distance will be met.
4. TOPOGRAPHY: As can be seen on the attached topography site plan, there are no slope
concerns.
5. LOT LINE WAIVER REQUEST: We request that a 2 foot lot line waiver be issued for the
proposed drainfield to the east property line. We are unaware of any adverse impact this will have
on the adjacent property to the east.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have, any questions, please contact us at 337-6179. Thank you for your
assistance.
0
NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils log and
a 4 page construction specification letter which are all part of the design package for the
upgrade of this septic system.
J
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L_________________
/ --------------------
LOT 4, BLOCK 2,
LAKE 0' THE HILLS EAST S!
/ sv
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4 EESDTO
4 BEDROOM
l
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MOUNTAIN LAKE CIRCLE -�
ING
TH#1
TRACT C, LAKE 0' THE HILLS EAST
- ------------
i I PROPOSED SEP-
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NOTE: ALL PROPERTIES ALONG MOUNTAIN
LAKE CIRCLE AR SERVED BY A COMMUNITY
WATER SYSTEM AND PRIVATE SEPTICS. THERE
ARE NO WELL ENCROACHMENT CONCERNS.
�------
` �
�, THE
EKE " _ I
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
165.34 6901 DEBARR ROAD SUITE 2B, ANCHORAGE, AK 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
(LEGAL DESCRIPTION:
LOT 2, BLOCK 2, LAKE 0' THE HILLS EAST SUBDIVISION
(TYPE OF WORK: II%J
SITE PLAN FOR SEPTIC UPGRADE
PREPARED FOR: PHONE NUMBER: I
PHILLIP AND KRIS BOYDELL 346-8350
2/16/99
J.L.M. I 1= 100' 1 1 OF 2
LLJ
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eff ey Gayness;
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MOUNTAIN LAKE CIRCLE -�
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TH#1
TRACT C, LAKE 0' THE HILLS EAST
- ------------
i I PROPOSED SEP-
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NOTE: ALL PROPERTIES ALONG MOUNTAIN
LAKE CIRCLE AR SERVED BY A COMMUNITY
WATER SYSTEM AND PRIVATE SEPTICS. THERE
ARE NO WELL ENCROACHMENT CONCERNS.
�------
` �
�, THE
EKE " _ I
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
165.34 6901 DEBARR ROAD SUITE 2B, ANCHORAGE, AK 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
(LEGAL DESCRIPTION:
LOT 2, BLOCK 2, LAKE 0' THE HILLS EAST SUBDIVISION
(TYPE OF WORK: II%J
SITE PLAN FOR SEPTIC UPGRADE
PREPARED FOR: PHONE NUMBER: I
PHILLIP AND KRIS BOYDELL 346-8350
2/16/99
J.L.M. I 1= 100' 1 1 OF 2
LLJ
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E. 115th AVE.
eff ey Gayness;
C 7953
EXISTING SEPTIC TANK,
VERIFY INTEGRIIY�IF OF /
PDDR INTEGRITY ABANDONED KEY BOX _
COMPLETELY AND REPLACE
WITH A NEW 1250 GALLON �
SEPTIC TANK AS SHOWN. f /
� t /
SUMP /
WATER LINE (LOCATED ----a` b� /
PROFESSIONALLY BY
KEN IDHE.) �b
INSTALL
/ EXl5i1N �M
_--- --_4 gEDRO
HOUSE---
NOTES:
1. THE CONTRACTOR SHALL HAVE THE EAST PROPERTY
LINE AND THE 100' CREEK SETBACK FLAGGED BY A
REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION.
2. THE CONTRACTOR SHALL ARRANGE WITH THE UTILITY
COMPANIES AND THE HOMEOWNER FOR ANY TEMPORARY
DISCONNECTION OR RELOCATION OF SERVICE LINES
THAT ARE NEEDED.
3. THE CONTRACTOR SHALL RESTORE THE SITE TO
ITS ORIGINAL CONDITION, WHICH INCLUDES, BUT
NOT LIMITED TO, TOP--S8Tt11VG AND RESEEDING. THE
CONTRACTOR SHALL A ANGE WITH THE SELLERS AND
THE BUYER OF ANY SP�IFIC LANDSCAPING THAT IS
REQUIRED.
"h
10' UTILITY EASEMENT
---------------
ELECTRIC TELEPHONE
SERVICE LINES
(APPROX. LOCATION)
.—EXISTING TRENCH TO BE
USED AS A RESERVE SITE.
NSTALL CO
NSTALL DBL CO
NSTALL FLOW DIVERTER
--PROPOSED DRAINFIELD UPGRADE.
EXCAVATE 11 FEET DEEP (MAXIMUM)
BY 2 FEET WIDE BY 45 FEET LONG.
ADD 6 FEET OF CLEAN, WASHED
SEWER DRAINROCK
-PROPOSED SITE FOR
SEPTIC TANK UPGRADE.
A 2' LOT LINE WAIVER
/
ALASKA WATER AND WASTEWA'T'ER CONSULTANTS, INC.
6901 DEBARR ROAD SUITE 28, ANCHORAGE, AK 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
LOT 2, BLOCK 2, LAKE 0' THE HILLS EAST SUBDIVISION
TYPE OF WORK:
DESIGN FOR SEPTIC UPGRADE
PREPARED FOR: VHUNL NUmnen:
PHILLIP AND KRIS BOYDELL 346-8350
2/16/99
J.L.M. 1 1= 30' 1 2 OF 2
. ...
of ey Garness.
Om CE 7953
4�Q�pt0fesei0 A,
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MOUNTAIN LAKE CIR
LO 4. e
WE 0 THE
NOTE: AL PROPERTIES ALONG M NTAIN
LAKE CIR LE AR SERV D BY A70NICERNS.
MMUNITY
WATER SY TEM AND RIVATE SCS. THERE
ARE NO VELL ENCR ACHMENT
K WATER AND ASTEWA CO]
165,34 6901 DEBA ROAD SUITE 2B, CHORALE, AK
PHONE: 907) 337-6179/FAX (907) 338-3
LEGAL DESCRIPTION:
2, CK , KE ' HILLS EAST UBDI S
TYPE OF WORK:
SITE PLAN FOR E IC UP DE
IPR�D FOR:PHO E NUM .
BE
PHI IP A KRI BOYDELI 4 �Srl-
FDAV. T DRAWN BY: S LE:
16 99 J. 1 10
INC.
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ALASKA WATER & WASTEWATER CONSULTANTS, INC.
732PHONE (907) 337-6179 ER HTS. C* FAX (907) 389504
3246
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: LAKE 0' THE HILLS EAST S/D; LOT 2, BLOCK 2,
PERFORMED FOR: PHILLIP AND KRIS BOYDELL
DATE PERFORMED: 2/9/99
DEPTH TEST HOLE #1
(feet)
1] --ORGANICS
2
3
4
5
6
7
e
9
10
11
12
13
14
15
16
17
18
ZIMARILY SM
SOME GRAVEL
41"
DEPTH TO DATE
GROUNDWATER
DRY 2/9/99
-;- MOUNTAIN
SOIL
CLASSIFICATIONS
M W/ LOAM
:_'o
SEPTIC
q_`
GW
------------ 77
OR
PROPOSED SEPTIC
GP
ML
GM
CL
I
GC
SITE PLAN 11
OL
21MARILY GM
o0 oQo o
Sw
EXISTNG TH1
4 BEDROOM
"
MH
M TO GM/SM®s
,® ;
SP
CH
J
.�
z
.01
SM
OH
o
SC
ZIMARILY SM
SOME GRAVEL
41"
DEPTH TO DATE
GROUNDWATER
DRY 2/9/99
-;- MOUNTAIN
LAKE CIRCLE
NET DROP
(INCHES)
EXISTING
SEPTIC
SYSTEM r-
------------ 77
PROPOSED SEPTIC
UPGRADE
(SEE DESIGN)'
I
I
SITE PLAN 11
I"= 100'
n
EXISTNG TH1
4 BEDROOM
"
W
HOUSE
J
z
.01
z
�K -
DATE
READING CLOCK NET TIME WATER LEVEL
TIME (MINUTES) READING
NET DROP
(INCHES)
AW-
'Ct GN
ER SES
OEC 5
ZNE o
uw
F� EO
O
19 PERCOLATION RATE
20 TEST RUN BETWEEN
COMMENTS: DUE TO THE HIGH PERCENTAGE OF SANI
PERFOMED BY ALASKA WATER & WASTEWATER I,
THIS WAS PERFORMED IN ACCORDANCE WITH ALL
DATE. DATE:
<1 (MIN./INCH) PERC. HOLE DIA. 6" (INCHES)
8.0 FT. AND .5 FT.
E-MISITkI/lsoiL�1 0 LD ACT AS A SAND FILTER.
/ , CERTIFY THAT I
GUIDELINES IN EFFECT ON THIS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
0* ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
0<NEW
❑ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
• "
r (c H IlLim r= ►QS
LOCATION
NO. OF BEDROOMS
664f k2r A A)�
Well
Absorption area
Dwelling
PERMIT NO.
Uy
DISTANCE TO:
` j
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Manufacturer
Material
No. of compartments
aQ
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ANI
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to
Liq. capacity in gallons
Inside length
IF HOMEMADE:
Width
Liquid depth
z
DISTANCE TO:
Well Dwelling
PERMIT NO.
2 O z Q
H
Manufacturer
Material
Liquid capacity in gallons
O
Well
Foundati n /
Nearest lot ling
e. j
PERMIT NO
w=
DISTANCE TO:
u- z�
No. of lines
Length o e cl7lmef
Total len th of-lines
Trench wi the
j
Distance between lines
Z w
—K
d
inches
w
Top of the to finish grade ,
Material beneath tile`
AV inches
Total effective absorption area
2
OF 92 - �
Length
Width
Depth
PERMIT NO.
w
c�
Qa F-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
wd
W
to
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
R:
Building foundation
Sewer line
Septic tank
Absorption area(s)
I DISTANCE TO:
OTHER
PIPE MATERIALS
1&
S01 L TEST RATI NG
_
INSTALLER
r ;)
G
REMARKS
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D LEGAL C
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721413 (Rev. 3/78)
mur-jic:ir-"L_i-ry ca=
DEPARTMENT 1_\,./HEALTH AND ENVIRONMENTAL i_,,eOTECTION
825 `L-0 STREET, ANCHORAGE, AK. 99501
264-4720
ID N —!E-:. I -r E: :E; F=- W F= � � E= Fe M I -r
PERMIT NO. 820786
APPLICANT BOWEN CONST. 3605 ARCTIC #1571 99502
LOCATION
LEGAL L282 LAKE 0 THE HILLS EAST LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SO FT,,'BR)= 160
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
E.-- F= F=o -IF "= -1 1 D_ I E"1:3 _T_ = c-4- 9:3 F;� n IvP F= L_ E-9 FE F--* -r "- EF.
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F: EEC,! L-1 l FZ F= C -a !F. E: F= -r 31 � -F n r-4 U---: !F. 1 2!E_ -1 2* � 10 f-3 Fl L_ I 3r -.t
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.
--- -rWO < 22 > I N:E; F:o E: C,� -r 10 N:E; n FR E= FR -1E: 0 U I F? F= E-4 — — —
BRCKFILLING 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.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F=o e: F? M I 7F F= X F=" I FR E: �- Ca E: IZ: E= M E� I—E F? 3•- : ::L "C4
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED
APPLICANT
-----------
OWEN CONST.
ISSUED V4. 0
lry OTEC O
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L-282� 0 i €4 WLS T
36-05 Tip' #i. -37i 9958
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LOT SIZE 91� SQLNM
TIM giSTWI
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solL "TIM <SO
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n4E MINIMUM DEPTH OF GRR� Ge
fm THE
� f i �. f #eta rrle �; MSZ LLITY TO INFORM THIS�: �t��i t
I!s' LAT l INSPECTIONS P24Y [ � Tri THIS T '
IDENCES TMay -,hE WELL WILLOF RF -5
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-yp y �i # t!� Iqr /yt r WITH
TH y��} Qjj i pEMMT'S FOR ON-SITE l ��s
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:€ itsr? i_rw `�'
In # �� :��� ani Tt� � ��r�< EM
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t t, t 3Y '*T�
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MOW, TMH 4 BEDROMS.
sic
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2131415161718192021222324
25
- VI ILLI VI
SOILS LOQ
PROJECT Lake 0' The Hills TEST HOLE NO. 9
CLIENT H.T. Newton ELEV. TOP OF HOLE 840
W. 0.- 0716 DATE February 7, 1981
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
UNWIN • SCHE@EN ■ KORYNTA ■ HUETTL
Lmu�" 2515 A STREET
ANCHORAGE, AK. 99503 276-4245
Organic Material
Moist, Brown, Sandy Gravel, GW
Moist, Brown, Silty Gravelly Sand, SM
Bottom of Hole
No Water Table
0 min/inch
Perculation R+Cepth
Time toWater
12:37 6152"
12:47
12:57 6110-3/411
1:07 713/411
1:17 7'211
1:27 713411
1:37 7'42"
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
UNWIN • SCHE@EN ■ KORYNTA ■ HUETTL
Lmu�" 2515 A STREET
ANCHORAGE, AK. 99503 276-4245
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section -' Fax: 907-343-7997
Parcel I.D. 015-333-13
Certificate of On -Site Systems Approval
Expiration Date: 6/24/2025
Legal description LAKE O TH EH I LLS EAST BLK 2 LT 2
Site address 7150 MOUNTAIN LAKE CIR Anchorage AK
Current property owner(s) WELSH
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
1
By: Original Certificate Date: 8/2/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory X Arsenic Advisory
Other
COSA Approval_June 2022
Development Services DepartmentPhone: 907-343-7904
On -Site Water & Wastewater Section _ Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D.
Complete legal description LAKE O THE HILLS EAST BLOCK 2 LOT 2
Location (site address) 7150 MOUNTAIN LAKE CIRCLE ANCHORAGE AK 99515
Current property owner(s) MARY KAY WELSH Day phone
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ® Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 25 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for: Distance:
Expedited review requested: ❑
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee
Date of Payment ��2`i/ZC/
COSA # 0 5C 211 l 260
Waiver Fee $
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist
Legal Description: LAKE O THE HILLS EAST BLOCK 2 LOT 2 Parcel ID: 015-333-13
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA - PUBLIC WOR CLASS "A" WATER
❑ Well log is filed, with Onsite (or attached) Well production at time of test gpm
Date drilled Total depth ft Water storage tank volume NA gallons
Cased to ft Well disinfected for coliform test? ❑ Yes ® No
❑ Sanitary seal is functioning correctly ❑ Coliform bacteria is Negative
❑ Wires are properly protected Nitrate mg/L ❑ Nitrate less than MRL (ND)
Casing height (above ground) in. Arsenic ug/L ❑ Arsenic less than MRL (ND)
Date of flow test for COSA Collected by
Static water level at beginning of test ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank 50"
Date of pumping 6/24/24
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/3199
® ALL standpipes present per record drawing
Total measured depth from grade 11.4 ft (max)
Measured depth to pipe invert from grade 5_1 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
® Monitor tubes (MT) go to bottom of effective (ED).
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Date
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 6/24124
Results ID Pass
Fluid depth prior to test 11 in
Water added 600 gal
New fluid depth 32 in
Elapsed time 1440 min
Final fluid depth 11 in
Absorption rate 600 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 54 in (MOA 4S ED)
Effective depth used 111 In (Missing ED + Final Fluid Depth)
Effective depth remaining 43 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximate.
COSA Checklist copy.docx
COSA Checklist copy.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No *5 & **8 ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No **3 ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*INSTALLED PER PREVIOUS CODE. **PER EXISTING WAIVER.
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 07/23/2024
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
07/23/24
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT ..411��' 907-343-7904
On -Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite --'�
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC241260
Subdivision: LAKE 0 THE HILLS EAST Block:2, Lot: 2
The septic tank for this property is 25 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more,
not including engineering, surveying, MOA permitting fees or site restoration.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
IR M
MUNICIPALITY
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
3 Q--2oZZ
Parcel I.D. 01533-13 Expiration Date:
1. GENERAL INFORMATION
Complete legal description LAKE 0 THE HILLS EAST 132 L2
Location (site address) 7150 MOUNTAIN LAKE CIRCLE, ANCHORAGE, AK 99516
Current property owner(s) TONIA & VIKTOR BAKLANOVA Day phone
Mailing address 7150 MOUNTAIN LAKE CIRCLE, ANCHORAGE AK 99516
Real estate agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
®
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550
Date of Payment 2 S " 2 Z,
Receipt Number l OE 2-gg
COSA # OCG?,Z 1 16,6
Date:
Waiver Fee $
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 4/27/2022
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q:•' • • • ;1
for current or future occupants or guarantee that no unseen encroachments, deficiencies or rg•' '.9 �}}
discrepancies exist can be given by First Water Consulting & 9 7H
Fwt S /.. ......
6. DSD SIGNATURE• "•"'
Curtis Huffman
System #1 Approved for bedrooms + ��`1 CE 128991 ..•���AW
}� sTF • • .4/712 . • •����
System #2 Approved for bedrooms ilPROFESSIO.00=
Disapproved
Conditional approval for bedrooms, with the following stipulations:
Jri
WA T � TE
2 ASTL=V"ATE
R
oo AM -0-
V1 VI
BY Original Certificate Date:—
The Municipality of Anchorage Development 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 X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other Sievi �-�,..,� �� A6{�iSiO►�/
Legal Description: LAKE 0 THE HILLS EAST BLOCK 2 LOT 2 Parcel ID: 015-333-13
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA – PUBLIC WATER
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth _ft
Cased to _ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) — in.
Date of flow test for COSA
Static water level at beginning of test _ft.
Comments
B. TANK DATA
Age of tank(s) 23 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 50"
0 Standpipes/foundation cleanout per record drawing
Date of pumping 4/20/2022
D. ABSORPTION FIELD DATA
Which system tested (date installed) 4/28/1999
® ALL standpipes present per record drawing
Total measured depth from grade 11.8 ft (max)
Measured depth to pipe invert from grade 7_3 ft (min)
❑ N/A – pressurized field
Structure served by this system _
Well production at time of test _gpm
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate _mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by_
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments
Adequacy test date 4/26/2022
Results 0 Pass For 4 bedrooms
Fluid depth prior to test 14 in
Water added 600 gal
New depth 33 in
® Monitor tubes go to bottom of effective. If not, state Elapsed time <1440 min
depth into effective 4.5' MOA IR
®Code -required soil cover over field
Final fluid depth 14 in
❑ System presoaked Absorption rate 600 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test) If yes, enter date
Gallons introduced gallons FWN
Comments/Deficiencies: , .
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Yes
if No
Neighboring Tank > 100'
❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No
Absorption Field on Lot > 100'
❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No
Neighboring Absorption Fields
> 100'
Animal Containment > 50' ❑ Yes
if No
❑ Yes
if No
ft
_
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
_
❑Yes
if No
ft
❑Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
**5 ft
Surface Water >' 100
_ ®Yes
if No
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
ft
Private Wells >' 100
_ ®Yes
if No
Water Main >.1D'
® Yes
if No
ft
Community Wells > 200' Yes
if No
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment
below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ❑ Yes
Property Line > 10' ❑ Yes
Water Main > 10' ® Yes
Water Service Line > 10' ® Yes
Surface Water > 100' ® Yes
F. ENGINEER'S COMMENTS
if No *8 ft If absorption field is under driveway comment below
if No *3 ft Wells on Adjacent Lots:
if No ft Private Wells > 100' ® Yes if No ft
if No ft Community Wells > 200' ® Yes if No
if No ft
*PER EXISTING WAIVER. **PER MOA PREVIOUS CODE
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
low
Aw
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0 %.--. .........urts Huffman
�� °°Fc •.• CE 128991 •, ���V
`s��c�'•S14/20;2•m
PROFESSIONy 11gb
�I\�`
ft
ft
ft
ft
ft
ft
ft
ft
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC 221166
Subdivision: Lake O The Hills East B2 12
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for
this COSA / property is 23 nears old. A leaking septic tank may be a source of contamination to
the aquifer. Typical replacement costs range from $10,000 to $15,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of a 16 -year-old septic tank.
:Mailing Address P O Box 196650 _Anchorage, Alaska 99519 66
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval 1
Parcel I.D. 015-333-13 Expiration Date: /7
1. GENERAL INFORMATION
Complete legal description LAKE O' THE HILLS EAST BLOCK 2 LOT/2
Location (site address) 7150 MOUNTAIN LAKE CIR., ANCHORAGE, AK 99516
Current Property owner(s) STEVE MCKEEVER Day phone 351-5004
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
E] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual El
Individual Water Storage
❑
Holding Tank ❑
Community Class A Well
El
Community ❑
Public Water System
❑
Public Sewer ❑
WaiverNariance request for: NONE
Distance: ---
by: — V
Date:
Received
COSA to be released to the engineer, unless otherwise requested by the
engineer.
COSA Fee $ 4glo Waiver Fee $
Date of Payment g18�ll�73 Date of Payment
Receipt Number �!%3- Receipt Number
COSA # 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 SPURKLAND ENGINEERING
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SIGNATURE
System #1 Approved for 4 bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 279-3916
Date 9/20/13
e ' 4 TH �!
....., ..':..
i� �•, E. SPURKLAND:
%� ��,•, 11500 '���
Conditional approval for bedrooms, with the following stipulations:
By: ` ��a Original Certificate Date: 0f — 3
Th2�A nicip ty Af oraga Development 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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet <,
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: Lake O the Hills East Blk 2 Lt 2
A. WELL DATA
Well type A If A, B, or C provide PWSID # 213603
Date completed Sanitary seal (Y/N)
Total depth ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate _ mg/L
Arsenic ug/L Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1250 gal. Number of Compartments
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping 10/25/12 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Parcel ID: 015-333-13
Well Log (Y/N)
Wires properly protected (YIN)
Casing height (above ground) in.
AT INSPECTION
ft.
Collected by:
Date installed 4/27-28/99
Cleanouts (YIN) Y
High water alarm (Y/N) NIA
Date installed 4/27-28/95 Soil rating (g.p.d./f:2 or ftz/bdrm) 1'2 System type TRENCH
Length 56 ft. Width 2'5 ft. Gravel below pipe 4.5 ft.
Total depth 7'9-11' ft. Eft. absorption area 504 ftz Monitoring tube Y Depression over field N
Date of adequacy test 4/22/13 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 15 in.
Elapsed Time: 20 min. Final fluid depth 11 in. Absorption rate >= 600 g P d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Size in gallons
"Pump off' level at
Cycles tested
r1l
Manhole/Access (Y/N)
High water alarm level at _
Meets alarm & circuit requirements? --
On
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO
Building foundation 5 Property line 25 Absorption field 51+
Water main 10+ Water service line 10+ Surface water 100'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 3 Building foundation 81*
Water Service line 10+ Surface water 100'
Curtain drain N.O Wells on adjacent lots 200+
F. COMMENTS
*PER EXISTING WAIVER
G. ENGINEER'S CERTIFICATION
l certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKLAND
Date 9/27/13
COSA brown sheet 10-10-12.doc
Water main 10+
Driveway, parking/vehicle storage10+
in.
01
PURKLAND:f{
%r 1500
1 � 1�F�f'ROFESSIONP���
MOUNTAIN LAKE CIRCLE
(LAKE VIEW CIRCLE)
i(1 N
N
,y000 N 89'5848" W
e'er d 38' 21.91'
yp�p �' 70 ELECT.
R' Opp EASEMENT
L'20"
iicei OS
POLE
Ap P 13A OG
Go rl
130.2 ®s ® o
ro
61 2HOUSE 6-U 20.5
0
LOT 3 12,0 a 18. q LOT 1
LOT 2
50' CREEK MAINTENANCE
EASEMENT CENTERED ON
CREEK THREAD
21
W
TRACT C
3
O
h/
EXCLUSION NOTES: It is the owners' responsibUtyto determine
1.1u'. rlvlr
S eY
7F R E A B E L L-
s
the e.istence of any eo .ems, covenants, or e Airi.tions
m
5/8 RB w/CAPD s/D- Re O
which do not appear onthe retarded subdivision plat. NOTE:
325' At MW MONUMENT�
with PRUDENTIAL JACK WHITE
Under no cimstances shld any data hereon be used far
or ou
RUB a TACK o
construction for establishing property lines.
FENCE- _ x
SURVEY
cordl
hos
tth v
OKFHANG-
pphysicvl survey of this property as shown on this
thItthe�a
wOOD DECKS-
Weng and improvLANTECements situated
situated Caere
CONCRETE-
on re within the property line en
pe�ty lines end no encroach-
ASPHALT- (�
menls exist other than noted
O,gpygL_ �
A S—BUILT OF: LEGAL DESCRIPTION:
" s' STANDPIPES- B
WATER AEIL-
LAND & CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS
WEST BENSON BLVD. N 103
ANC
ANCHORAGE, ALASKA 99503
(907) 562-5291
LOT 2, BLOCK 2,
1
LAKE 0 THE HILLS EAST
SUBDIVISION
WORK ORDER NUMBER:
2002 -L -214A
JUNE 5, 2002 Mo1"=40' (fox) 561-6626
-0 sr -2639
CJBaY
D
REC.- 96LI35A
Municipality of Anchorage
Development Services Department eZ.
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING / LI/n
Parcel I.D. 015-333-13 HAA# a Lg)0?
1. GENERAL INFORMATION Expiration Date: G
Complete legal description LAKE
0 THE HILLS FAST
SUBDMSION•
LOT 2 BLOCK
2
Individual On-site
❑
Individual Water Storage
Location (site address or directions)
7150 MOUNTAIN
LAKE CIRCLE
* ANCHORAGE
AK
Community On-site
❑
Public Water System
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
FX & ELEEN O'KEEFE Day phone 346-5570
7150 MOUNTAIN LAKE CIRCLE • ANCHORAGE AK
Day phone
TERESA BELL w/ PRUDENTIAL- J. W. Day phone
240-2248
3201 'C' STREET SUITE 200 • ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank
❑
Community Class 'A' Well
0
Community On-site
❑
Public Water System
❑
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers
work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $925.00 at, or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system fs(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm
ALASKA WATER
& WASTEWATER CONSULTANTS
INC Phone
Address 6901
DEBARR ROAD,
SUITE 28 • ANCHORAGE, AK
99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. 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
_ {� Approved for bedrooms.
Disapproved.
Date
337-6179
lb 3 p2:
•........
tS�O
' e
A. G rn ss:'
"s '•
7953
ro
f.3,0,00-0,
Conditional approval for bedrooms, with the flowing stipulations:
n..
a`�� • ON-SITE
WASTEWATER .
Attachments: p
HAA Checklist Manitenance Agreements �JJ��i'�O • • • S
Septic System Advisory Supplemental Engineers Reort
Well Flow Advisory Other
By:/1. /�4� Ali Original Certificate Date:
(Rm 1✓2101) /"C
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Sita Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.5550
www.ci.anchorege.ak.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LAKE 0 THE HILLS EAST S/D: LAT 2. BLOCK 2 Parcel ID: 015-333-13
A. WELL DATA
well type WE A•
Date completed
ft.
If A. B, or C provide PWSIDit 213603
Cased to ft.
FROM WELL LOG
Date of test
Static water ft•
production 9•p•m-
WATER SAMPLE RESULTS:
Coliform colonies1100 ml.
B. SEPTICfHOLDING TANK DATA
Wires properly protected (YIN)
Casing height (above ground) in.
AT INSPECTION
ft.
g.p.m.
Nitraten
Date of sample: Collected by:
— —colonies/100 ml.
Tank Type/Material STEEL Date installed 4/27-28/1999
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation deanout (YIN) YES Depression over tank (YM) NO High water alarm (YM) N/A
Date of pumping q1&f aQQ l Pumper kna s ftkm ft Sen )i[. -
C. ABSORPTION FIELD DATA
Date installed 41V-28/1999 Soil rating 4.p.d ft%Wrm) 1_2 System type TRENCH
Length 56 ft. Width 2.5 ft. Gravel below pipe 4.5 ft.
Total depth --!I ft. Eff. absorption area 504 fe Monitoring tube YES Depression over field NO
Date of adequacy test 5/20/2002 Results (Pass/Fall) PASS For 4 bedrooms
Fluid depth in absorption field before test 15.5 in. Water added 803 gal. New depth 117.5 in.
Elapsed Time: 398 min. Final fluid depth 16.5 in. Absorption rate >a 600+ 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
'Pump on' level at _in.
High water alarm level at in.
Cycles tested Meets alarm 8 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
line
COMMUNITY WATER
On adjacent
On
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
"3'
Building foundation
8'
Water main 10'+
Water service line
10'+
Surface water
100'+
Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
sw000m
G. ENGINEER'S CERTIFICATION
I certffy that I have determined through field inspections and
review of Munidpal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
w a:
Engineer's Print Name Name JEFFREY A. GARNESS�%., f I 795
Date (�3 / 21� V' ..........
44Ye^edp'ofess�ed �c `
HAA Fee $ _ 3 7
Date of Payment (o • -% — O
Receipt Number 2- 9 4
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH i£ HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
C o ri 0 t -j-1 Only
�ll
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING c� `
Parcel l.D.# 015_333-13 HAA#�`,r�`c�e,.(',�.I
1. GENERAL INFORMATION
"`Complete legal description Lnkt- Q' The Mill-, F'a c:+ r ni- Blk 2
Location (site address or directions) 7190 Moun1-a i n T.,ka Circle
Property owner Phillip X uric; Rr)Wdel 1 Day phone
Mailing address 7150 Mountain Lake Circle
Lending agency
Day phone
Mailing address
Agent Michalle Culver/Prudential Vista Day phone 273-7767
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
4
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 xx
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 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of thjs inspection.
Name of Firm Al
Address
Engineer's signature
Jeffre
Alaska water~ &
Wastewater Consultants, Inc.
Shall be PAID $ 5-3�"
or. prior to, closing for the
Engineers:-;,.: Provided.
er & Wastewatgri Consultq*the 337-6179
d _. Inc.
s P. E.
6. DHHS SIGNATURE
X Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
n
2n
Date s/7/QA
0 AL.e
bedrooms, with the following stipulations:
Date 0-- 1% y%
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 DHI•iS 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.1/91) Back MOAM21
10 111101111111 IIIIII_■IM our
Municipality of Anchorage MAY 07 1999
DEPARTMENT OF HEALTH & HUMAN SERVICES i
Environmental Services Division MUNICIPALITY OFANCH
V RO0NMENTALSERVICES
825 L Street, Room 502 • Anchorage, Alaska 99501 • (90r 943-4744
Health Authority Approval Checklist
Legal Description: LAKe TVk t:;7 TLS Parcel I.D.: 0 fs
L.o 'r Z 12>u04 -1I- Z i
A. WELL DATA
C-, AAI IN Ujk-rEyt- 213603
Well type G�Ass A I� B ar �', attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed
Total depth Cased to Casing height (above ground)
Sanitary seal (Y/N) Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production —9. P.M. —
g -p.m -WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: Collected by:
B. SEPTIC/MetOM TANK DATA
Date installed y 2 1-28 qq Tank size 25o Number of Compartments Z CleanoutsON) "Ycs
,,,A777 QOV 61.E GLEANOVTS
J 21 a To TANK �a
Foundation cleanoutaN) YES Iepression mg KJn High water alarm (Y&1
Date of Pumping E:v-J Pumper
C. ABSORPTION FIELD DATA
Date installed 1-78 91 Soil rating Q&.d./ or#ta/ • Z System type I cE:ac, 4
i
Length 5 I Width Z j� Gravel thickness below pipe 4 s Total depth 9• S " t 1 • S I
Effective absorption area SOci T Monitoring Tube presento/N) YES Depression over field (Yo �a
Date of adequacy test I E'j Results (Pass/Fail)
For 4 bedrooms
Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.):
Fluid depth (ins) Minutes later: Absorption rate = Ig.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)"
D. LIFT STATION
Date i
Manhole/Access (Y/N)
High water alarm
E. SEPARATION DISTANCES
"Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot Zoo 14
Absorption field on lot -zoo ►+
Public sewer main
Sewer /septic
Size in gallons
Gor�,r�l�nl,Y�r
_ On adjacent lots
"Pump off" level at'
u Pc're,a_ SY.S76M
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/Hem TANK ON LOTTO:
1 1-I- t
Foundation 5 Property line 2S— Absorption field
►
Water main/service line I 0 + Surface water/drainage 1001+ Wells on adjacent lots moo li
RQeo Td S6 GREk-rry iN,�n� Io' Acco�o�.�� ro
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: ►_inic- d•-ocA-re5.
► � I
Property line Building founda ion Water main/service line _
%f4U-ASU¢6P a
Surface water 100 (l UKJEY oP, Driveway, parking/vehicle storage area I _r,
1 i
Curtain drain oor3c YIN ovi Wells on adjacent lots Zoo I t
* SES ATTA60 �-_- 0 LTT ►Z
F. ENGINEER'S CERTIFICATION
f certify that I
in conform
Signature
Engineer's M
Date
HAA Fee $_
Date of Payment
Receipt Number
72-026 (Rev. 3/96)`
field inspections and review of Municipal
lefines in effect on this date.
WN -r5 YZ
1014-
W
.J _A pano • o• ••• p•..
.,'
MC °'.•,••.00
;tt��G a�
is '°i}r1FESS10
Waiver Fee $
Date of Payment
Receipt Number
are
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D.# 015-333-13 HAA#
1. GENERAL INFORMATION
Complete -legal description Lake O' The Hills East Subdivision;
Lot 2, Block 2,
Location (site address or directions) 7150 Mountain Lake Circle
Property owner
Phillip & Kris Boydell
Day phone
346-8350
Mailing address
7150 Mountain Lake
Circle
Anchorage,
AK 99516
Lending agency Day phone
Mailing address
Agent Micalle Culver w/ Prudential Vista Day phone 273-7767
Address 4241 B Street Anchorage, AK 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well XX
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 XX
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 (Rev. 1/91) Front MOA e21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compl' nce with all Municipal and State codes,
ordinances, and regulations in effect on the date of t�oinspection.
Name of Firm ALASKA
c -
Address
Engineer's signature
/% f U
Alaska Water & Wastewater Consultants, Inc.
shall be paid $2673.05, at closing, for the
engineering services performed. Invoice
was submitted to Prudential Vista Real
Estate, Michalle Culver.
6. DHHS SIGNATURE
Approved for
bedrooms.
Phone 217-6/75
Date 2 LE
�a�`Op.e
Disapproved.
XXXX Conditional approval for four(4) bedrooms, with the following stipulations:
Money shall be put in escrow in the amount of 1.5 times the high bid of
a minimum of three (3) bids from excavators certified by this office to
construct the proposed wastewater system pursuant to Permit # SW990014
tt Lori Th d to wntn t t tin cLAl l be fapleted
r y
by no later than June 15, 1999.
Additional Comments
4t -
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.
72-M (Rev. 1/91) Back MOA N21
...e f. I V P- U
Municipality of Anchorage FEB 161999 }
DEPARTMENT OF HEALTH & HUMAN SERVIQE&IPALIrY OFANcHc)m
Environmental Services Division ENVIRONMENTALSERVICEs DIV _�
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: LAttG o 'Tilt= #iLie -F6=r Parcel I.D.:
A. WELL DATA
Well type 6&j*es "A" If A, B, or C, attach ADEC letter. ADEC water system number ) 663%
Log
Total depth
Sanitary
Date completed
FROM WELL LOG
height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
Date of test
Static water level
a
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Nitrate
Collected by:
Other bacteria
Date installed 2� Tank size UZ �0 Number of Compartments '7—_ Cleanouts (21N)�`�
Foundation cleanout (Y)@1 IQQ Depression (Y& fJ High water alarm (Y& flies
Date of Pumping Pumper A+�mye �epzu+ct�s
C. ABSORPTION FIELD DATA
Date installed'Zb 7- Soil rating o ff2 System type I P - N[ #i
t �
Lengths Width �' Gravel thickness below pipe Total depth J7 -S' _ j Z•v
Effective absorption area i 06;6 O Monitoring Tube present &N) z.s Depression over field (Y& (Jr,
Date of adequacy test I I 9 i Results (Pass ai 1 - For41
bedrooms
�1QfR LoiJ �i U:f$IL CGP
Fluid depth in absorption field before test (in.); czar Immediately afters gal. water added (in.): o iaAli
��,;;I<<�
Fluid depthg j44Lcq (ins) Minutes later: i Z Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Yf% tLlu-� kt-kt :.J?S If yes, give date
72-026 (Rev. 3/96)'
D. LIFT STATION
Date installed
Manhole/Access
High water alarm level at`
E. SEPARATION DISTANCES
on"
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer /septic
Z061 -N
a i+
SEPARATION
+
Size in gallons
"Pump off" level at'
�nI�MUNtT� �c�►�
On adjacent lots
On adjac
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
! � I
Foundation f Property line f
PAbsorption field
Water main/service line le °+ Surface water/drainage i00 4- Wells on adjacent lots (off
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
' fbz ! i
Property line Building foundation to Water main/service line �G
Surface water io& + Driveway, parking/vehicle storage area
Curtain drain
F. ENGINEER'S CERTIFI
l certify that
in conformd
Signature
Wells on adjacent lots
inspections and review of Municipal record
?s in effect on this date.
A
4-
01 .4 V
pa are
Engineer'sNarfie° l "% ��? Gdrncu ; � j
�•e 7953 : V.
�� G
DateF9F
HAA Fee $�,
Date of Payment
Receipt Number
72-026 (Rev. 3/96)'
Waiver Fee $
Date of Payment 11)b 1, -)Ie-)
Receipt Number L9`�
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # o ) S — 3 3 3 — 3 HAA #
1. GENERAL INFORMATION
Complete legal description Lot 2, Block 2s Lake 0' The H 2?z E"t Subdivision
Location (site address or directions) 7150 Mountain Lake C.ikcte
Anchonage, AK
Property owner Max 9 Dawn Medema Day phone 346-2717
Mailing address 7150 Mountain Lake Ci&ete. Anchonage, AK 99516
Lending agency Day phone
Mailing address
Agent
A _1A ........ -
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well XXX
Public water
Day phone
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 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
5 & S ENGINEERING
Name of Firm Phone 6 '7 y - 3L 9 7
Address
Eagle River, ea Alaska 99577 204
Engineer's signature
Date 3/ a c /-7 6
OF
P+ ROBERT C. COWAN r• C
�E - 880
6. DHHS SIGNATURE ,t,
��,'ti, 1/
Approved for ��� bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By:,
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.
72-025 (Rev. 1/91) Beck MOA 021
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
MUNICIPALITY til' AN
ENVIRONMENTAL SERVICES DIVISION
Health Authority Approval Checklist
N zt 12 2
Legal Description: 1,0 T- a 13 LK a LA ice, a ' T// 4- H«<1Parcel I.D.: C) I S- - -3 3`71$ � E I F V D
A. WELL DATA
Well type e tq sJ
Log present (Y/N) _
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE
Coliform
A If A, B, or C, attach ADEC letter. ADEC water system number a 13 G 0 3
Date completed
Cased to
FROM WELL LOG
Nitrate
g.p.m.
_ Casin=height(abo ouni
Wires pr/N)
AT INSPECTION
Other bacteria
Dd`e of sample: Collected by:
B. SEPTI OLDING TANK DATA
Date installed e6 d o Tank size / ° Number of Compartments _Z
g.p.m.
Cleanouts O/N) YEJ`
Foundation cleanout (9/l) Y 6 S Depression (YI " 0 High water alarm (Y/0 -` D
Date of Pumping 3 / ?-o 1 61 G Pumper 114- #6 M /g- S -R V i c e J`
C. ABSORPTION FIELD DATA
Date installed � / r -O / $ Z
i
Length S (4 Width _
Soil rating (g.p.d./& or t2/b
r
3 Gravel thickness below pipe
60 System type T 4'5,-
G N
G / Total depth 1% /
Effective absorption area .? 0 8 Monitoring Tube present(Y/M Depression over field (Y/N)
Date of adequacy test 3 / / 9 1 g ` Results (Pass/Fail) P/f 5 J For y bedrooms
Fluid depth in absorption field before test (in.); S ° Immediately after gal. water added (in.): 0
Fluid depth 4 N (ins.) Minutes later: 11 Absorption rate = G o o 't g.p.d.
Peroxide treatment (past 12 months) (Y/N) P4 ^'E- "^'O w A'j If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (Y/1)
High water alarm level at*
Cycles
E. SEPARATION DISTANCES
Size in gallons
"Pump on"
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO: N / 4
Septic/holding tank on lot
Absorption field on lot
Public sewer main
service line
"Pump off' level at*
On ad'a -lots"_
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FRO SEPTIC OLDING TANK ON LOT TO:
i r
Building foundation S`• -/- Property line ) 0 ' Absorption
Water main/service line /0 t Surface water/drainage /00 f Wells on adjacent lots
M Aq
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation /0 Property Line Water main/service line / 0
Surface water /06
o6 r 4
Driveway, parking/vehicle storage area
Curtain drain Nk N o wr.1 Wells on adjacent lots /' /y
F. ENGINEER'S CERTIFICATION -- 5tl- W ipQ 100 r3 of 103 qt,
I certify that I have determined thru freld inspections and review of Municipal records thaar&jVfiUFsAtt, ire
in conformance tiv4NIOAHAA guide!' es in effect on this date. a��C � "' • ., S,�l�
Signature
Engineer's Name r g al'.
t�# `•� ROSERT C. COWAN �i 4-i
Date 3 /� o �% (o Ie , -, % CE - 3801
HAA Fee $
Date of Payment ✓� r%�
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services M`
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. #
1. GENERAL INFORMATION
Complete legal description Lai 2 f3 (C'cL 2 Luke a' Ther lfr«s C-asf
Location (site address or directions) 71SW M&t Afu'1n HaITP Ci`(`
Property owner
Trm k`
Francer Pei<ru1
Day phone
3N6- 26'7
Mailingaddress
-71-TO
rye«^keA't^ L.cake
Circle Anc(7o!2
e +k 9915_E6
Lending agency
Day phone
Mailing address
Agent Be Max PrOP—J�"'ej — TccC� r3/atr Day phone 27G- 276/
Address 2600CorcFova� Sf. �4nc46r'e, e 146- 99So3
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: K
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:
Individual on-site ✓
Holding tank
Community on-site
Public sewer
NOTE: if community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on' -site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm _F(afhop Tec -An ica( Sa�v'rce- Phone
Address iH630 r -c-110 Ak 995l
Engineer's signature � � Date P 1,5-191
A-01 t4
C� -:1:,71 •,y`i
51 y
,•
6. DH SIGNATURE
Approved for bedrooms.
Disapproved.
HE
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 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. 1/91) Beck MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 2 /2 Lake G' The H-rlls EuJt Parcel LD
A. WELL DATA
Well type A If A, B, or C, attach ADEC letter. ADEC water system number
Log present(Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
Date completed
Cased to
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot —
Public sewer main
Public sewer service line
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
Driller
Casing height
Wires properly protected (Y/N) —
9.p -m.
AT INSPECTION
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
_ ; On adjacent lots
; On adjacent lots _
Public sewer manhole/cleanout
Petroleum tank
Collected by:
Other bacteria
NOV 0 5 1991
B. SEPTIC/HOLDING TANK DATA
Date installed B I2 0 16 2 Tank size 1210 P -d" pwer Compartments 2
Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N
High water alarm (Y/N) Nr A. Alarm tested (Y/N) N1*1
Date of pumping 9 / 17 /91 by Raly RGo k-er
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot NIA. On adjacent lots > 20L Foundation
8'
To property line to I Absorption field G Water main/service line > 10
Surface water/drainage > foG'
72-026 (Rev. 3/91)Front MOA 21 - CONTINUED ON BACK PAGE
C. LIFT STATION N.A.
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off' level at
Cycles tested _
Surface water _
Date installed 8 ( 20 / 8 2 Soil rating 160 a' /3eerrn System type 7 -re?) c 4
Length 59Width 3' Gravel thickness 6 Total depth
Total absorption area 708 a' Cleanouts present (Y/N) � rt. 7-)
Depression over field (Y/N) N Date of adequacy test 11 /`f /91
Results (pass/fail) Puss for y bedrooms
Peroxide treatment (past 12 months) (Y/N) N If yes, give date _N, A-•
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot N. A. On adjacent lots > 200' Property line—IC (� sy.
To building foundation 16 To existing or abandoned system on lot N.A.
On adjacent lots -5 30' Cutbank N A. Water main/service line. ;> to '
Surface water > (00 ' Driveway, parking/vehicle storage area -a2 ' front /n -
Curtain drain N.A. No lo> 11ne aucilvel" neecleie s,�re e''
9@l9ccr0rh0n olviunro cua_-, ✓e�rr/rof c¢No(
E. ENGINEER'S CERTIFICATION ez/ f -,me dr' liaskr//ufra�
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature �i/�- r r� �. C r.. .�
Engineer's Name %heorfCr �� �• /"taco rC " ' s
.J aeceauoa eo,a°ese
ti
Jl ,
Date 1) /5 191 �;;_,°°-. aoa a �"•
o .W
HAA Fee $ /b Waiver Fee: $
Date of Payment // 5--w Date of Payment
Receipt Number --LO " &30 Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Q WALTER J. NICKEL, GOVERNOR
nA
U U
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE 563-6775
3601 "C" STREET, SUITE 322
ANCHORAGE, ALASKA 99503
FOR: Flattop Technical Services
November 5, 1991
PWSID # 213603
My review of the records on file in this office reveals that the Lake -O -The Hills East
Subdivision Class "A" Public Water System, is in compliance with the routine coliform
bacteria samples requirements listed in Table C, and with the inorganic sampling listed in
Table B of 18 AAC 80.200. This compliance is conditional on the initiation of sampling for
the radioactive contaminants listed in Table B of 18 AAC 80.200.
Sincerely,
Byron Roys
Environmental Engineer
BR/cf
Municipality of Anchorage
K
Department of Health and Human Services dr1h5
825 "L" Street
Tom Fink,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
November 13, 1991
Ted Moore, P. E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Waiver Request for Lot 2 Block 2 Lake O'the Hills S/D
Waiver Request #WR910053, PID #015-333-13, HA910525
Dear Mr. Moore:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 6 feet.
This approval applies to the existing septic system lot line
-- separation only. Any future upgrade to the septic system- _wil L_.__
require all separations be met or another approval from this
department.
Sincerely, Concur:
/ Robert W. Robinson ohn Smit P.E.
Civil Engineer Program Manager
On-site Services On-site Services
ljw#7
CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 November 6, 1991 ANCHORAGE, ALASKA 99516
Robbie Robinson
M.O.A. DHHS
P.O. Box 196650
Anchorage, AK 99519
Dear Mr. Robinson:
8001n. GS uGwntj
9C)Uj0 ou JaCI
LCR 9 AON
03
IJD d
Per your request, I am submitting additional information regarding the location of the septic system on
Lot 2, Block 2, Lake O'The Hills East with respect to the lot line.
According to the "as -built" inspection report submitted in 1982, the soil absorption trench is 6 feet
from the nearest lot line. I am enclosing a copy of an "as -built" survey of this lot, the original of which
unfortunately does not show the location of the cleanouts. On this "as -built" I have plotted the locations of
each of the cleanouts based on swing ties from building corners, and have sketched in a hypothetical
configuration of the system with the longer trench leg 6 feet from the property line as reported on the
inspection report. The monitor tube, as plotted, scales to bell feet from the lot line, and I suspect it is
located near to the intersection of the two legs of the trench.
Based on surface evidence, there is no reason to doubt the veracity of the information recorded on the
as -built inspection report. No septic system standpipes were observed on the adjoining lot to the east
within 30 feet of the subject septic system. It does not appear to me that the presence of the septic system
as constructed will have any adverse impact on the ability to upgrade the system on the adjoining lot at
such time as that may be required. Therefore, we are requesting you to approve the location of the system
as presently installed.
Please feel free to give me a call if you have any questions.
cc: Jack Blair, ReMax Properties
Sincerely,
Ted Moore, P.E.
4%
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LAkc VEW CiRc
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SCALE! ' - _,: PLOT PLAN: AS -BUILT: X GRID: DRAWN BY: ?L CHECKED BY.•
S Q S ENGINEERS, INC. 7125 LD ANCHORSEHWY,.
ALASKA
I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY,
L07 2,. ( 1aKC, f ' TELE, I�I���' °rl.if,3G ANCHORAGE RECORDING DISTRICT, AK., �C1
ANO THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES .i IQ
ANP OONOT ENCROACH ON THE PROPERTY LY.XNG ADJACENT THERETO, THAT NO
r'a�•.•'''�`•'�•.� S,f. �)
IMPAOVEMENTS ON PROPERTY LYING ADJACENT THERETO ENCROACH ON THE PREMISES ,Ay�'•4.
IN QUESTION AND THAT THERE ARE NO ROADWAYS,TRANSMISSION LINES OR OTHER
VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS INDICATEDHEREON. / 149L�3.-•• •�+•!•'••
DATED THIS 1ln DAY OF NOV, ig5Z, ANCHORAGE, ALASKA. � � '`" ""`•'1�'a
IT IS .THE RESPONSI8ILI7Y OF THE OWNER OR BUIIDEA. PRIOR TO CONSTRUCTION,l 'rl •'• ,�•p' �i
TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH GRADE AND UTILITY te�Faplp�fSd10NA�,do
CONNECTIONS AND 70 08YCFIMINE THE EXISTENCE; OF ANY EASEMENTS, COVENANTS �
ILII AAr.1I.1f171A•,I• 1,11'1 M111 AAi1,17. •/, r,l�•I1 .�•I Tllr Arltitil�••I+,• e•, .e„•Mi,YNYI.I !y,- •.I 1����4
AR,(
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SCALE! ' - _,: PLOT PLAN: AS -BUILT: X GRID: DRAWN BY: ?L CHECKED BY.•
S Q S ENGINEERS, INC. 7125 LD ANCHORSEHWY,.
ALASKA
I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY,
L07 2,. ( 1aKC, f ' TELE, I�I���' °rl.if,3G ANCHORAGE RECORDING DISTRICT, AK., �C1
ANO THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES .i IQ
ANP OONOT ENCROACH ON THE PROPERTY LY.XNG ADJACENT THERETO, THAT NO
r'a�•.•'''�`•'�•.� S,f. �)
IMPAOVEMENTS ON PROPERTY LYING ADJACENT THERETO ENCROACH ON THE PREMISES ,Ay�'•4.
IN QUESTION AND THAT THERE ARE NO ROADWAYS,TRANSMISSION LINES OR OTHER
VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS INDICATEDHEREON. / 149L�3.-•• •�+•!•'••
DATED THIS 1ln DAY OF NOV, ig5Z, ANCHORAGE, ALASKA. � � '`" ""`•'1�'a
IT IS .THE RESPONSI8ILI7Y OF THE OWNER OR BUIIDEA. PRIOR TO CONSTRUCTION,l 'rl •'• ,�•p' �i
TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH GRADE AND UTILITY te�Faplp�fSd10NA�,do
CONNECTIONS AND 70 08YCFIMINE THE EXISTENCE; OF ANY EASEMENTS, COVENANTS �
ILII AAr.1I.1f171A•,I• 1,11'1 M111 AAi1,17. •/, r,l�•I1 .�•I Tllr Arltitil�••I+,• e•, .e„•Mi,YNYI.I !y,- •.I 1����4
