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HomeMy WebLinkAboutROCKHILL BLK 1 LT 6Rockhill Block Lot 6 #015- 362-14 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201160 PID Number: 015-362-14 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name Ricky and Carolyn Byrd A 0RPTION FIELD ❑ D Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 9400 Maintree Drive ❑ Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 4 PD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from origins ad st, Gravel depth beneath pipe Ft. Subdivision Block Lot ROCKHILL 1 6 Fill added above original gradevel Ft. length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Di nce between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. betwee trenches From Tank Field Tank Line Ftz Ft. Well >100' NA NA I NA TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water >100' NA NA NA Material Number of compartments Lot Line >10 NA NA NA NA plastic 2 Foundation > 10 NA NA NA LI T STATION Manufactu � Capacity Remarks Gal. Alarm location Elie`ctri I installed by PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer Territory North Drainfield CO/MT D3034 Inspector Brandon Jones BENCH MARK (Assumed elevation) 100 ft Inspeection 6/27/2020 1'' 6/26/2020 Location and description ction 2�a 3`d 6/30/2Cb 411 cross bar on NG gas meter ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date '°°°°°"• '.•••� �� 6=•. Septic System -7, Appro ti,.. i� Date—w y��/ Note: this approval does not include well permit requirements. kmuv UOlUL! I O) \ NEIGHBORING SEPTIC THERE ARE NO STEEP SLOPES IS > 10' FROM \WITHIN 50' OF THE PROPOSED / PROPERTY LINE k TANK. 100' NEIGHBORING SEPTIC \IS > 10' FROM PROPERTY LINE 0\ 4 BR / HOME / / B / BM NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE \ c SWING TIES ON PAGE 2 / NEIGHBORING WELL IS > \ / 100' FROM PROPERTY LINE NEW 1250 GAL SEPTIC TANK Cof 8 DOUBLE CLEANOUTS EXISTING 34' x 36" x 60" SCOPE OF WORKFLAT SLOPE � EFFECTIVE DEPTH TRENCH I L ��^ 1. EXISTING SEPTIC TANK WAS REMOVED. — — _ — 2. NEW 1,250 GALLON SEPTIC TANK WAS — -iS MT PLACED AND TIED INTO EXISTING ABSORPTION SYSTEM. THE TANK WAS PROVIDED WITH MINIMUM 20" 0 MANWAY Lot 7—— RISER SERVING THE FIRST COMPARTMENT. - — — — — 3. ALL CONSTRUCTION WAS IN ACCORDANCE NEIGHBORING SEPTIC NEIGHBORING WELL IS > WITH ALL REQUIREMENTS SPECIFIED IN IS - 20' FROM 100' FROM PROPERTY LINE J ANCHORAGE MUNICIPAL CODE CHAPTERS PROPERTY LINE 15.55 AND 15.65. BM IS CROSS BAR ON TOP OF GAS METER, ASSUMED 100' Septic As Built Drowings Prepored for RICKY AND CAROLYN BYRD ®+� OF 9400 Maintree Dr Anchorage, AI ���P� g Alaska 99507 r 49TH �� AF ROCKHILL BLOCK 1 LOT 6 �......•......r T....... ...................� OSP201160 EKLUTNA ENGINEERING LLC �. • RTIS .................. W DATE: 6/30/2020 ��, �. CURTIS TOwNSEND: � 19162 MOUNTAIN ROAD DRAWN: CLT ®0 s •. No. CE 11904 CHUGIAK, ALASKA 99567 %3t SCALE: 1" = 40' ®®�® "�•••••!••...••��,®�®� (907) 355-9820 PID: 015-362-14 SHEET 1 OF 2 LEGEND Q FOUND REBAR LOT 5 i S; SEPTIC VENTWEH PLAT 79-37 CABLE PEDESTAL��� LE ELECTRIC PEDESTAL TELEPHONE L 0 T 4 I PEDESTAL r LEi ELECTRIC TRANSFORMER LIGHT POLE 98.04 _ ASPHALT DRIVEWAY ROCKH/LL 4'ss2� w SUBDI VISION �0y E LOT 6 BLOCK 1 i66Q6, �S PLAT 80-9 LOT 8 % 10' UNDERGROUND T & E EASEMENT NOTES: II N 87'46'36" E 159.22'— — — 1. DIMENSIONS ARE RECORD PER PLAT 80-9. L� -- — — — — — — — — — 2. UTILITIES OTHER THAN THOSE SHOWN MAY EXIST. LOT 7 3. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY DATA SHOWN BE USED TO ESTABLISH ANY FENCE, STRUCTURE OR ANY OTHER IMPROVEMENTS. 4 0 ALL VISIBLE ABOVE GROUND FEATURES OF THE EXISTING SEPTIC SYSTEM WERE LOCATED AT THE TIME OF SURVEY AND ARE SHOWN HEREON. o law; . • l ASBUILT — NO CORNERS SET THIS DATE co •,"� I HEREBY CERTIFY THAT I HAVE PERFORMED Thi A SURVEY OF /�j • �• . �/�~� LOT 6, BLOCK 1, ROCKHILL SUBDIVISION, • • f• • V • • • • . • • • PLAT NO. 80-9, ANCHORAGE RECORDING r Dayna M. Rumfelt ® DISTRICT, ALASKA, �� �`c • • • No. LS Q133322 ��4p•Y AND THAT ET DEPICTED d.1HEREON EXIST AS SHOWN NRCATON TO OF�gs 0NAL� THE PROPERTY LINES. EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON RECORDED PLAT No. 80-9 ARE NOT SHOWN L HEREN UNLESS ONOTE. N D /A\Y E R DATE:6/30/220 FB:20-2 O US SURVEY FEET SURVEY & MAPPING GRID: 2438 DRAWN: DMR 2890 S. BARNYARD CIR., WASILLA, AK 99654 DAYNAO.AVENDERSURVEY.COM (907)301-5177 SCALE: 1" = 50' FILE: 20-021AB Municipality of Anchorage P.O. Box 196650 a 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program x x x x VARIANCE/WAIVER REVIEW x x x x Waiver#: OSV201034 COSA#: Permit#:OSP201160 PID#: 015-362-14 Legal Description: ROCKHILL BLK 1 LT 6 Engineer: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 8.0 feet. This waiver approval applies to the existing absorption field only. Any fixture upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. 0 v v v v v v v v v v IN v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v e v v v v v v v v v v v v v v v v v v v I Waiver is Granted: X Waiver is not Granted: Date: 2(1 Approved by: Name of Revie ■■ v v v v v v v v v v v v v v v v v v v is v v v t v v v v v v v v C v e ■.■ ■ v v v v v v v v v v v v v v v v v■ ■ v v v v v v v v v v v v v v v v v **** VARIAN C EMAIVE R REVIEW **** ENSTAR ENSTAR Natural Uas Company A Division of Qg SL .MCOENERGYARAMMU - 30p0 Spenard Road P.4. Box; 19LI288 Anchorigc, AK 99519-0288 (901) 277-5171 12/10/01 Jack White, Prudential 3201 C Street, Suite 200 Re: Letter of Non -objection c/o Olga Grid A2438 Anchorage, Alaska 99507 To whom it may concern: ENSTAR Natural Gas Company has no objection to a septic vent encroachment, into the Main Tree Drive right of way situated on the south property boundary for the subject property know as Lot 6, Block 1, Rock Hill Subdivision. Acceptance and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the property owner. All applicable safety code regulations will be observed and maintained. This letter of non -objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, M. Manuel Lopez, r., Rig tofVAent ENSTAR Natural G _ Cmm�arn� cc: File GaLaska CONIHUNIcaYKAN5. alaskacommunicati ons.com June 22,2020 Ricky & Carolyn Byrd 9400 Main Tree Dr Anchorage, Alaska 99507 Alaska Communications has no objections to the existing septic vent encroaching into the 10' Telecommunications & Electric Easement located along the southern boundary of block 1, lot 6, Rockhill Subdivision, otherwise known as 9400 Main Tree Dr, Anchorage, Alaska as depicted on the drawing provided by Curtis Townsend. Alaska Communications currently utilizes this easement and has no objections to the encroachment Alaska Communications hereby issues this letter with stipulations to allow the encroachments of the above mentioned into the easement- Acceptance, asementAcceptance, (your signature below), and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: 1. Alaska Communications will be held harmless, now and forever, for any damages or injury to any person or property as a result of this encroachment. 2. Any Alaska Communications facility damaged or destroyed as a result of this encroachment will be repaired at no cost to Alaska Communications. 3. Any costs incurred by Alaska Communications for special construction necessitated by this encroachment will be borne by the property owner. 4. All applicable safety code regulations will be observed and maintained. 5. This letter of non -objection will in no way preclude Alaska Communications from full use and enjoyment of its rights within any portion of this easement 6. Alaska Communications is under no obligation to restore any structure damaged as a result of Alaska Communications full use and enjoyment of its rights within any portion of easements or right-of-ways. Please sign both copies, retain one copy for your use and return the other to Alaska Communications. Sincerely, Austin King, Network Engineer Ii, Outside Plant Alaska Communications Outside Plant Engineering, MS#14 600 Telephone Ave. Anchorage, AK 99503 Grid SW2436 OWC DATE: June 29, 2020 Curtis Townsend, PE Eklutna Engineering, LLC. To whom it may concern, Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the existing septic vent encroaching into the T&E easement of Lot 6, Block 1, Rockhill Subdivision, also known as 9400 Main Tree Drive, city grid 2438, GCI WO#20-0006-21. This letter of non-objection in no way precludes GCI Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right-of-way, including unlimited access for servicing its facilities. Also, any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of GCI’s facilities to accommodate any or all the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to me at the address below. Sincerely, ______________________________ Signature ______________________________ Date Markus Kofoid Manager Sr. Field Services Central Region GCI Communication Corp 5151 Fairbanks St. Anchorage, AK 99503 907-868-6168 Office 907-868-8580 Fax DocuSign Envelope ID: 3D26F8AF-6175-41E1-9D45-F0D9F00ABCFC 2001-085096-0 �� Recording Dist: 301 - Anchorage SK I IIIVII1111111lll!IIIIIII@1111IIIIIIIIII111111III'9111111'llll11 ENCROACHMENT PERMIT 1203-14B CC' G-2438 EN01080 015-362-14 This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric cooperative, (herein "Chugach"), whose address is P. O. Box 196300, Anchorage, Alaska 99519- 6300 and John Watsjold (herein "Permittee") whose address is 9400 Main Tree Drove, Anchorage, Alaska 99516. 1. Easement. Chugach is the grantee or user of an easement for the construction and maintenance of electrical facilities, as follows: Described in that certain written instrument recorded on the 12th day of December 1955 at Volume 126, Page 53 of the records of the Anchorage Recording District, Seward Meridian, Alaska, Described in that certain written instrument recorded on the 20th day of April 1982 at Book 722, Page 339 of the records of the Anchorage Recording District, Seward Meridian, Alaska, Dedicated by the plat of the subdivision known as Rockhill Subdivision, according to Plat Number 80-009, recorded on the 13t' day of February 1980, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Easement") which pertains to the following described real property: The South Ten Feet (S 10') of Lot 6, Block 1, Rockhill Subdivision, according to Plat Number 80-009, recorded on the IP day of February 1980, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska. Permittee acknowledges the validity of the Easement. Permittee warrants and represents that Permittee is the owner of the fee simple interest in the land subject to the Easement and the following described real property to which the Easement is adjacent: Encroachment Permit - Page ,1 of 4 Lot 6, Block 1, Rockhill Subdivision, according to Plat Number 80-009, recorded on the 13t` day of February 1980, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Parcel') 2. Encroachment. Permittee proposes to continue the existence of the following improvement(s) on or within the real property subject to said Easement: A septic system vent pipe within the said Easement approximately 8 feet north of the south property line, (herein "Encroachment") 3. ` Permit. Chugach hereby authorizes Permittee to continue the existence of the Encroachment in its proposed location subject to the covenants set forth in this permit. 4. Indemnification. Permittee shall indemnify and hold Chugach harmless from any claims for personal injury, property damage or other loss arising in any way from the continuation of the Encroachment. 5. No Expansion or Increase. Permittee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior written consent of Chugach. Chugach has no obligation to provide such consent. 6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit, has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any other real property. Without in any way limiting .the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes of the common law doctrine of adverse possession. This permit creates no interest in the real property subject to the easement. 7. Modification of Utility Facilities. If the electric utility facilities located within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. If such payment is not made within thirty (30) days of written demand for same, Chugach may terminate this permit in accordance with paragraph 9, below. 8. Covenants Running with the Land. The obligations of the Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the land subject to the Easement and shall benefit the Easement. Encroachment Permit - Page 2 of 4 V I I I III I fN1111111 1I-� o4 2001-085099-0 9. Termination. Chugach may terminate this permit after the giving of thirty (30) days written notice of such termination if - a. The Encroachment is enlarged, increased or extended within the real property affected by the Easement. b. ' The Encroachment is damaged by any means to an extent of more than thirty percent (30%) of its replacement cost at the time of destruction. C. Permittee fails to make the payment described in paragraph 7, above. I 10. Term. This permit shall, if not sooner terminated by Chugach, expire forty (40) years from the date hereof. 11. Entire Agreement. This written permit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all other prior or contemporaneous agreements, oral or written, between the parties. No modifications, amendments, deletions, additions or alterations of the permit shall be effective unless in writing and signed by all of the parties hereto. CHUGACH ELECTRIC ASSOCIATION, INC. By: L hibert, Executive Manager T&D Network Services Date: PERMITTEE By: C� l //John Watsjold Date:_ _ 0 - /�L - D 1 Encroachment Permit - Page 3 of 4 ,- �����II����IIIII�{IIllliilillll 3 of 4 2001-086096-0 STATE OF ALASKA ) ) ss: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this day of 2001, by S 1 C Notary Public i d for the State of Alaska My commission expires: U 6) 'V'j!°�."r' STATE OF ALASKA )' ' �•= `' ; THIRD JUDICIAL DISTRICT ) fz'T= ''1p `_' e foregoing instrument was acknowledged before me this day of 2001, by Lee Thibert, Executive Manager, Transmission and Distribution Network Services of Chugach Electric Association, Inc., an Alaska corporation, on behalf of the corporation. Notary Public in and for the State of Alaskg'�.', 4z �r • _ My commission expires: S7 Is of ._,�. � .. •••'� "'tip AFTER RECORDING RETURN = 0:: Chugach Electric Association, Inc. P.O. Box 196300 Anchorage, Alaska 99519-6300 Encroachment Permit - Page 4 of 4 �iII�IIIIIIVIVIIiN�I � 20-01-086096-0 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:llwww.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201160 Work Type: SepticTank Upgrade Tax Code Number: 01536214000 Site Legal Address: ROCKHILL BLK 1 LT 6 G:2438 Site Mailing Address: 9400 MAIN TREE DR, Anchorage Owner: BYRD RICKY L & CAROLYN K Design Engineer: EKLUTNA ENGINEERING, LLC" This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: t„cnr ri ^ Ucpartancnt Lot Size in Sq Ft: Total Bedrooms: 6/17/2020 6117/2021 46660 ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B Issued By: f Y= Date: r Z U ` Date: 1li 4 MUNICIPALITY OF ANCHORAGE 0 Alle Development Services Department '� J� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 015-362-14 Property owner(s) BYRD RICKY & CAROLYN Day phone Mailing address 9400 Maintree Drive Anchorage AK 99507 Site address 9400 Maintree Drive Anchorage AK 99507 Legal description (Sub'd., Block & Lot) ROCKHILL Legal description (Township, Range & Section) Lot Size 46,660 Sq. Ft. Number of Bedrooms 4 BLK 1 LT 6 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single arially (aF) ❑ /wo ADf:J Septic Tank Q Upgrade Q () (D) ❑ Holding Tank ❑ Renewal FJDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above 1or. ation is correct. I further certify that this is in accordance with applicable Municipal Code, G Signature of property owner or authorized .agent) Permit/Rush Fees: 2A5- -- Waiver Fees: Date of Payment: la ll 6 f oZU vZb Date of Payment: Receipt Number: aq(QReceipt Number: Permit No. (3 S %dab! 1100 Waiver No. GADevelopment ServicesOuilding Safetffln Site Water and WastewaterWormsOient ForrnsTermit Application.doc COVID-19 2570 DISCOUNT APPLIED Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201160, Deb Wockenfuss, 06/17/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201160, Deb Wockenfuss, 06/17/20 LEGEND Q FOUND REBAR i LOT 5 / 1 S; SEPTIC VENT PLAT 79-37 cw WELL i / I CABLE PEDESTAL ELECTRIC PEDESTAL / PGF / E LOT 4 \ PEDESTAL F , ELECTRIC/ Nb /E-1 L TRANSFORMER t LIGHT POLE/ / / / / 184• _W 140 /l ASPHALT 6' CHAINLINK FENCE / 4,4' DRIVEWAY N Ss�, �6 LOT 8 6�6� ROCKH/LL SUBDI VISION LOT 6 BLOCK 1 PLAT 80-9 10' UNDERGROUND T & E EASEMENT NOTES: II N 87'46'36" E 159.22'_ 1. DIMENSIONS ARE RECORD PER PLAT 80-9. L� — — — — — — — — — 2. UTILITIES OTHER THAN THOSE SHOWN MAY EXIST. LOT 7 � LO 3. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY DATA SHOWN BE USED TO ESTABLISH ANY FENCE, STRUCTURE OR ANY OTHER IMPROVEMENTS. 4. ALL VISIBLE ABOVE GROUND FEATURES OF THE EXISTING SEPTIC SYSTEM WERE LOCATED AT THE TIME OF SURVEY AND ARE SHOWN HEREON. �G`_��\\\ 0 AIW A�gSlll ASBUILT - NO CORNERS SET THIS DATE wG,'• I HEREBY CERTIFY THAT I HAVE PERFORMED •*Q49T ••* A SURVEY OF • • •,n •Il .ILOT 6, BLOCK 1, ROCKHILL SUBDIVISION, / �15i' V J ..... � PLAT NO. 80-9, ANCHORAGE RECORDING Dayna M. Rumfelt / DISTRICT, ALASKA, �+�`�sl• No�S13322 ..•���/ AND THAT THE IMPROVEMENTS AS DEPICTED ��l``9FpPR'p!l•��QS�,� HEREON EXIST AS SHOWN IN RELATION TO OFESSIoNNOY THE PROPERTY LINES. EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON RECORDED PLAT No. 80-9 ARE NOT SHOWN VDHEREN UNLESS" /A . NN D F � DATE:6/16/2020 THERWIBE 200 -2 SCALE 1 = SURVEY & MAPPING GRID: 2438 DRAWN: DMR US SURVEY FEET 2890 S. BARNYARD CIR., WASILLA, AK 99654 DAYNAGAVENDERSURVEY.COM (907)301-5177 1 SCALE: 1" = 50' 1 FILE: 20-021AB MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILINGADDRESS~w? / ~_~~~ [] UPGRADE LOCATIOI' Wel I DISTANCE TO: ~ /' Man ufacturer~.~l~ ~ Liq. ( Inside length DISTANCE TO: Dwe ng A~soFc~d' ~rea Dwelling / Width NO. O~/E D ROOMS PERM, NO.7106--6 Liqui~epth Foundation, Material IF HOMEMADE: Well PERMIT NO. Manufacturer Liquid capacity in gallons DISTANCE TO: inches We,: /dO / No. of line~l~/ Lengt h_o, fr~j./_/each Iline Top of tile to finish grade Total leng~J;l, of lin§s Material beneat~ tile PERM'T NZ/O ; Length Width Depth Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: i Dista nce~e~e~ Ii nes Total effective absorption area PERMIT NO. OTHER PIP E MAT ER IA~**~_./~ ~.¢ SOl L TEST RATI NG~_~ INSTALLER ~.~~ ~ ¢ REMARKS APPROVED ~ / ~ DATE LEGAL U ,L · ; l.,-I [.~ L L FI I"-,I F'ERMIT NO. ( 810567 ) 825 "L" STREET, RNCHORRGE, RK. 9950:L ;~:64-4720 3:795 W INTER. SET RFFL I_.HNT JOHN WFITSJOLD LOCRTION MRIN TREE [:,RIVE LE 3RL L 6 8"I.L. ROCKH ILL _,~ D LOT S I ~.E b40k~-,,:c'F. ..... I IAI~'F FEET ' '- ']"" '--' "- IS ' TYPE GF SOIL HB:,_F. FTION _,~:,TEM : TREN..H MH,.,IMLIM NLME, EE OF E:EDROOM':; = 4- ..-,LIL RRTING (SQ FT,.'BR,, ........ THE REQUIRED :,I~.E UF THE. :,UIL HtE,:,OR UN . .:, T :, I EM I~. ~ "~ L / [. EF TFI--. 13: L,E~,]TH==-' ,3E_"R%."EL [)EF TH=~ 'THE LENGTH [:, I MENS I ON IS THE LENgtH (IN FEET::, OF THE TRENCH OF: DR~INFIEL[), THE DEPTH OF B TRENCH OR PIT IS THE DISTflNCE BETWEEN THE SURFACE OF THE GROUND ~ND THE BOTTOM OF THE EXCBVBTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRBVEL DEPTH IS THE MINIMUM DEPTH OF GRBYEL BETWEEN THE OUTFBL. L PIPE FIND THE BOTTOM OF THE EXCBMBTION (IN FEET)· RE[:. :.EFT I C: l'l~-~::,{ S I. ZE= 1;~_"5E-~ ...... -- FERMIT HFFLI~HNT HH::, THE RESPONSIBIL. IT"r' TO INFCRM THIS DEPRRTMENT DIJRING THE · '- ...... I '- -' I-I ~ ' I] '" ' ~' tN.:,]HLLHTILN IN:,PEL. TI.N:, GF RNY WELLS RDJRCENT TO THIS FR.FERT'r RND THE NLMBER OF RE:,IE. ENE. E:, THFIT THE WELL WILL SERVE. BFICKFILLII'.,IG OF RNY --,~_TEM F.IITHOUT FINRL INSPEC"I'InI'-,I FIND., FIPPRO',,,'FIL BY THIS DEF'FIRTMENT WILL BE SUBJECT TO PROSEE_TIEN. MINIMUM DISTRNCE BETWEEN Ft WELL RND FINY ON-SITE SEWFIGE DISPOSRL SYSTEM IS ±00 FEET FOR R PRIVFITE WELL OR ~50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET FIND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS; MRY RPPLY. SPECIFICFITIONS RND CONSTRUCTION DIFIGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. F, ERt-1 3[ 'T F.---.F I F~'E_, [)EC:Et,'IE:EF.' Ltl.. I CERTIFY THFIT 1: I RM FRMILtRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS FIS SET· FORTH BY THE MUNICIPALITY OF RNC:HORRGE. r 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 3:: I UNDERSTRND THFIT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF ]"HE RESI[:'ENCE IS REMODELED TO INCLUDE MORE THFIN 4 BEDROOMS. S I GNED: ............................................... ~FFLIL. HN[ JOHN WRTSJOLD MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [~'SOILS LOG [] PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: (0'-- ~"-- ~ J LEGAL DESCRIPTION: ~_ Cb"'[-[.~ ~t~-'~ ~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15- 16- 17 18 19 2O COMMENTS SITE PLAN 72-008 SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) __ FT DATE: MUNICIPALITY OFNCS! Development Services Department:-' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel 1. D. 015-362-14 1 Certificate of On -Site Systems Approval GENERAL INFORMATION Complete legal description Rockhill B1 L6 Location (site address) 9400 Main Tree Dr Current property owner(s) Ricky & Carolyn Byrd Day phone 907.770.6067 Mailing address 9400 Main Tree Dr. Anchorage, AK 99507 Real estate agent Bob Bolding Expiration Date: j©— b Z 0 Zy Anchorage, AK 99507 2. TYPE OF DWELLING: 0 Single Family ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 907.230.0700 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well x❑ Private Septicx❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5X / g 1 a. 5 o 01 Date of Payment Aj'V O Receipt Number 0003 ie COSA # 0 C.20 , 0 I l 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 Eklutna Engineering, LLC. Phone (907) 355-9820 Address 19162 Mountain Rd. Chugiak, AK 99567 Engineer's Printed Name Curtis Townsend Date 5/28/2020 6. DSD SIGNATURE KSystem #1 Approved for q bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms low P4s�-�� g�• gym• d � . Date P�hsr No. PRO ' bedrooms, with the following stipulations: WP,TER AND VVASTLyN%T o1 Original Certificate Date: `2� 6 Z 0 Zy 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 Nitrate Advisory_ Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Rockhill B1 L6 Parcel ID: 015-362-14 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 7/18/81 Total depth 80 ft Cased to 80 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 5/28/20 Static water level at beginning of test 38.8 ft. Comments B. TANK DATA Age of tank(s) `1 years Tank type/material septic plaStiC Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping installed June 2020, OSP201160 D. ABSORPTION FIELD DATA Which system tested (date installed) 918/81 © ALL standpipes present per record drawing Total measured depth from grade 15.8 ft (max) Measured depth to pipe invert from grade 93 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 7.8 gpm Water storage tank volumen/a gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate 9.69 mg/L ❑ Nitrate less than MRL (ND) Arsenic n/d ug/L ❑ Arsenic less than MRL (ND) Collected by Brandon's On -Site Services LLC. Date of Sample 5/28/20 .11 C. LIFT TATION ❑ Required ' tenance completed Age of lift station years Lift station material Comments: \ Adequacy test date 5/28/20 Results Q Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 606 gal New depth 9 in Elapsed time 15 min Final fluid depth 0 in Absorption rate 606+ gpd Any rejuvenation treatment (past 12 months) no If yes, enter date 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' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' ft If absorption field is under driveway comment below Q✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' [Z] Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' F,71 Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' 0 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 if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 8 ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS Requested property line waiver June 2020. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review Of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet all co 1* *Ti 1, s Curtis T se d CE 11 VQ��ja"PROFESSIONA�.�� MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site water and wastewater Section Y Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC 201291 Subdivision: Rockhill, Block: 1, Lot: 6 A water sample revealed a nitrate concentration of 9.69 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 ( ERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 015-362-14 1. GENERAL INFORMATION Completelegaldescdption ROCKHILL SUBDIVISION; LOT 6, BLOCK 1 Location (site address or directions) 940O MAINTREE DRIVE * ANCHORAGE, AK 99516 Cu~Tent Property owner(s) Mailing address Lending agency JOHN WATSJOLO Day phone 227-3832 9400 MAINTREE DRIVE * ANCHORAGE~ AK 99516 Day phone Mailing address Real Estate Agent Mailing address JAY EVENSON w/ PRUDENTIAL VISTA Day phone · 4241 "B" STREET * ANCHORAGE. AK 99505 345-1234 Unlessotherw~emqueste~ HAAw~beheldbyDSD ~rp~k~. 2. NUMBER OFBEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Indiv!dual On-site Indiwdual Holding tank community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certiticates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. i Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1000. O0 at, or pdor I 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(am) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy 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(am) in compliance with all applicable Municipal and State codes, ordinances, and rogulations in effect at the time of installation. Nameof Firm ALASKA WATER & WASTEWAT£R CONSULTANTS. INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Date ,357-6179 Engineer's Comments: In conducting this evaluation, A WWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the perten'nance 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 durng the year, and the water usage of the family being served by the system. These conditions are outside the control of the evatuator 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 encreachments. AW1/VC, Inc. can therefore not provide any warreniy or futura estimate of how long the system will continue to meet the operational requirements of the ADEC ar MOA DSD. The content of this report is for the sole benetit of the owner listed above. Any reliance upon er use of this report by any other peraon or pady is not authorized, nor will it confer any legal rght whatsoever. DSD SIGNATURE ~ Approved for L{.- bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: NOTE: THE WELL FOR THIS PROPERTY MEETS EXISTING STATE AND MUNICIPAL CODES. THERE ARE NITRATES PRESENT. IT IS SUGGESTED THAT PERIODIC TESTING BE PERFORMED TO INSURE THE WELLS CONTINUED SUITABILITY. CURRENT NITRATE CONCENTRATION IS 5.49 mg/L. EPA MAXIMUM CONCENTRATION IS 10.0 mg/L. MORE INFORMATION ON NITRATES IS AVAILABLE FROM THE ON-SITE SERVICES PROGRAM, AT 343-7904. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitanance Agreements Supplemental Engineer's Reort Other Original Certificate Date: / "~- - '.~'"' 0 t L~gal Dascdpfion: A. WELL DATA Well t~pe PRrv^~ Municipality of Anchorage Development Services Department On. Slta Wster & Wastevmm' Program 4700 South Bragsiw 8L P.O. 8ox lge850 Anchorage, AK gg51g-6850 HEALTH AUTHORITY APPROVAL CHECKLIST ROCKHILL SUBDNISION; LOT 6, BLOCK 1 Parcel ID: If A. B. or C provide PWSlD~ N/A Oatacompleted 7/18/1981 Sanltary~eal (Y/N) YES Total depth 80 fL Cased to 80 ft. FROM WELL LOG 7/18/1981 40 Data of test Static water level ft. Well preduction 10+ g.p.m. WATER SAMPLE RESULTS: Coliform ~) colonies/100 mi. Data of sample: 11/20/2001 SEPTIC/HOLDING TANK DATA T;mk Type/Material STEEL Tenkelze 1250 gal. Number of Compartments 2 Foundation deanout (Y/N) YES Depresslofl over tallk (Y/N) NO Date of pumping 11/20/2001 Pumpe[ 015-562-14 we, Log (Y/N). Wlms pmpedy protected (Y/N) Casing heigM (above ground) AT INSPECTION 11/20/2001 ¢0 ft. 4.6 ,g.p.m. Other bactada ~ AWWC~ INC. YES YES 12+ in. . colonies/100 ~. 9/8/ 981 Data installed Clearmuts (Y/N) YES High water alarm (Y/N) N/A ISAACS PUMPING New deplh Absom~on rata >= 600+ NONE KNOWN If yes, give date ABSOI~OTION FIELD DATA I*~ 0NI.Y EXTENDS ABOUT $0" BELOW INVERT.I Data installed 9/e/lgel ~ rating (g.p.d./It~or~'~'n~ 85 System type DEEP TRENCH Lenglh 54 fL Width 5 ,fL Gravel below pipe Total depth 14.9 fL Eft. el:~Ol~on ama ,,%40 tt~ Monltaring lube *YES Data of edequacy test 11/20/2001 Results (Pass/Fell) PASS Fluid deplh in absorption field before test 0 in. Water added 698. gal. Elapsed Time: 0 min, Final fiuld depth 0 in. Any rejuvenation treatment (peet 12 mo.) (Y/N & type) fL Dapmsaion overfleld. NO For 4 bedrooms 0 in. g.p.d, D. UFT STATION Date installed Size In gallons .... ~, _ M~ 'Pump on' level at in. 'Pump off' n, High water alarm level at ~ in. ~ Cycles tested Meets alarm & circuit requirements?. Fe Septic tank/lilt station on lot .aJ3~fion field on lot. Public sewer main Sewer/septic seneca line SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100' 100'+ N/^ 25'+ SEPARATION DISTANCES FROM SEPTICfl'"IOLDINO TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water sauce line, 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELO ON LOT TO: Properly line 10'+ Water sendce line 10'+ Curtain drain NONE KNOWN COMMENI~ . Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ On adjacent lots lOO'+ On adjacent lots 100'+ Public sewer manhote/deanout Holding tank N/A N/A Absorp~on field. 5'+ Surface water. 100'+ Water main N On'veway, pa~ng/vehlclestorage 10'+ G. ENGINEER'S CER'nFICATiON I cerZ~ that I have detenninnd through field inspec~/on~ and mv~ew of Municipal taco.s that the a~x)ve a~em~ am In conformance wff. h MOA HAA guidelines in effect on this date. Engineer's Printed Name Date I I /Z~,/D t JEFFREY A. GARNESS Dat. of Pa er l t- Receipt Number (:~)150 Waiver Fee $ Date of Payment Receipt Number. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 6; Block I; RockhilISubdivZsion Location (site address or directions) 9400 Main Tr¢~ Driv~ Property owner John E. & Kathl~n M. Wat~jold Mailing address 9400 Main Tr~ Driv~ Anchorage. Lending agency Alaska Hom~ Mortga,q~ B~rnad~tt¢ Mailing address 36th Av~nu~ Anchora9~, 'Addr(~ss Day ohone 346-1134 - wk:762-7685 AlaSka 99516 · Day phone 563-3033 Alask~ 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 'q TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 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 sluewwoo leuoB!PPV :suop, Blnd!~s §U!MOIIOt eq~ ql!M 's~uooJpeq 'SLUOOJpeq ..~ Jo,[ le^oJddB leUOB!puoo 'peAoJddBs!a g~lnJ.VNIDIS SH Ha '9 euoqd ZZS66 e~lSel¥ 'Je~la OlBe~] 'ON paoli dool ~eH~l elBe~l I~£0ZL gNI~I~INIgN~1 $ ~' S e~n3~u6!s s,Jeeu!l~u~] sseJppv ~uJ!:l ~o eLUBN · uop, oedsu! s{q~ ~o eTep eql uo loe~je u! suoB~ln6eJ pub 'seouBu!pJo 'sepoo el~),S pub IBd!o!UnlAI lib q~!M eOUB!IdLUoO U! S! LUelS~S IBSOdS!p ~ele~elSBM ~o/puB ~lddns JelBM el!s-uo eqi 'uoBoedsu! pub uop, B6Bse^u! ~by byo~ pub Sel!J e6BJoqouv LUO~,[ peu!B1qo uoBBLuJo~u! eql uo peseq 1BLI1/{jpe^~eq~n~ I 'u!e~eLI peTBo!pu! eJnlon~ls Jo ed,{i pub sbyooJpeq ,[o Jeq~unu eq1 Jo,[ elBnbepe pub IBUOp, ounj 'e~es s! ,-els~s IBsods!p JelBMe~SBM Jo/pue ~lddns JeIBM ei!s-uo eql ~,Bq~ SMOqS uoBBo!IddB IB^o~ddv ~ipoqlnv q~lBeH s!ql ,to uo!1e6!Tse^u! /{bY ~,BLp, ~JIJE)A I 'MOleq UMOqS elep uoBePlle^ eq~, jo se pue o3eJeq pexlJJB lees ~uJ Aq pe!j!~Jeo sv t:I:I:INIIDN:I Ag NOI.LO::IdSNI -lO /N':IIN:I.LV.I.$ 'g (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ ~:> ~L-~-- . \ Parcel I.D. A. WELL DATA Well type~-~l~V~A'~c~ If A, B, or C, attach ADEC letter. ADEC water system number Log presenl::~N) Total depth Sanitary sea~N) Date completed "~ -- ~ ~ --~ ~, Driller Cased to '~:~c>r Casing height Wires properly protectedC~N) "/ FROM yELL LOG Date of test "~ /SI Static water level 4~t~==' ~ Well flow ~ ~ -Jr- Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ~, '~ Sewer service line ~-~ -k g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank t--.~ ~ ~_ WATER SAMPLE RESULTS: Coliform '~ Nitrate Date of sam pie: ,~f..~gf' ~' ~ Other bacteria ~ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed <:2[ Cleanouts~:~N) High water alarm (Y/N) Date of pumping Tank size \ '~..~'~S:) Compartments Foundation cleanout {5~;ZN) y Depression .Alarm tested (Y/N) -- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot [ ~::;>~ On adjacent lots To property line ~c=- [ +' Absorption field Surface water/drainage Foundation Water main/se rvice line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed <c~ _ Length "¢~¢~ Width Total absorption area Depression over field (Y/~ Result~>/fail) Peroxide treatment (past 12 months) (Y~ / Soil rating ~ '¢"~-'~'~2 System type Gravel thickness '~ ' Total depth Cleanouts presentCCi~'N) Date of adequacy test for ~ bedrooms If yes, give date To building foundation On adjacent lots '~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot t, ¢:-¢:~ ~ On adjacent lots \ ~ ~ .Propertyline To~xisting or abandoned system on lot Cutbank ~/'~- Water main/service line Surface water Curtain drain Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Lh~clate of this inspection. S & S ENGINEERING ~'~'~, 'r~.,~,**'*'~*,,~,"~-e~ ~, 17034 Eagle Riv~ L~p Road No. 2~ ~ ~ .~ ~ ,. ~ ~. Signature =..~. m ....~,..~ oo=~ ~ ~ ~,~,,, ~ = ~ HAA Fee $ [ 7~' ~ ~' Waiver Fee: $ Date of Payment ~ I ~ ' ! ~ Date of Payment Receipt Number ~~7~ ~eceipt ~umbor MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) ~ or ~ ~,'odP / ~o~'nH/~$ _~/z~, 7'1~ ~ ~ ~ ~ ~-~ Location (address or directions) ' (b)', Applicant Name ~O~ ~elephone: Home ~¢¢-~0 Business ~: Applicant ~dSress ' ' ~ ~00 ~¢/~¢ ~ (c) · Applicant is (check,one): Lending institution ~; Owner/builder ; Buyer ~; Other D (explain); .... "' ~/~ Telephone . .... ;, (d) Lending Institution ~: Address (e) Real Estate company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms + Other WATER SUPPLY Individual Well J~ Community [] Public [] Note: If community well system, must have written conf rmation from the State Department.of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,J~ PublicE]. Communityl-I ,Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 dh-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 /~ Address [z~)O ~'/' ~'~ i~/ /¢Y~¢1 Date ~/~'~ Telephone ApProved for ~--'c~, ~ be~i~m~tvYet~,'"/---vvl~~,~' /~ate ?~rmOsV~tcord~itionalApprova,' pp ~-~onditio~a~} 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. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ? MUNICIPALITY OF ANCHOP. AGE. DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION ?LgS WELL DATA Well Classification Well Log Present (Y/N) Total Depth ~ t Static Water Level Casing Height Above Ground 42° ~(O 7/~z Electrical Wiring in Conduit (Y/N) /v ,,~"~/V/~ ~ If A, B, C, D.E.C. Approved (Y/N) Y Date Completed '~"//'¢¢/'¢¢' / Yield Cased to ~4:~ ~ Depth of Grouting .~¢(~, /O //'¢4 Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Y I00 ' ~ Separation Distances from Well: To SepticlH, o',di~,g Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /,4 Cleanout/Manhole ; On Adjoining Lots //~O f ¢ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) /V' Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /V/~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course ,/~'/./~ Size /Z_~O~ Air-tight Caps (Y/N) No. of Compartments O '.Y' Foundation Cleanout (Y/N) Date Last Pumped /V/,4 ;for /V/,,.~ Temporary Holding Tank Permit (Y/N) ///,¢~ To Building Foundation .¢/O / To Disposal Field /~ ~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'/,~ / Width of Field -~' Square Feet of Absorption Area --~'~ Depression over Field (Y/N) /~ Results of Last Adequacy Test ¢- / Type of System Design ~:~"P Length of Field ---~¢ Depth of Field ~:) Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test / Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Property Line /'~ ~ '¢' To Existing or Abandoned System on ; On Adjoining Lots ~) /"<:~:~ / To Cutbank (if present) ~'~" ~ To Driveway, Parking Area, or Vehicle Storage Area / / / / / D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Man hole/~N'"~ ~~~,./",~mmp Off" Level at Vent (Y/N) Tested for Electrical Codes (Y/~ .~'~'~ Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 7 Company /,/~'~-~'~',~/ /kfE', MOA No. Receipt No. -"~--~ ~' ! S %/ Date of Payment ~:~ Amount: $ Page 2 of 2 72-026 (11/84) ALASKA ENVIRONMENTAL CONTROL SERVIf~'~, INC. 1200 West 33rd Avenu=. Suite B ANCHORAGE ALASKA 99503 (907) 56:1-5040 JOB CALCULATED BY ~- ~/'~:~'~;> -~ DATE CHECKED BY- 3ATE SCALE IP~ZO / OF HEALTH & 0 ? 1986 D i D,g, TE RECEIVED , INSPECTION APPOINTMENTS ¢, ~ ~ DATE DATE ~ DATE MUNICIPALITY OF ANCHORAGE IPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~EPT' OF HEAL~I~ & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL p[~oTECTiON ENVIRONMENTAL SANITATION DIVISION SEP Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing. 1. PROPER~Y OWN~ ..... PHONE PROPERTY R~siD~NT (If different from above) t PHONE '2. BUYER ~ PHONE MAI LING ADDRESS 3. LENDIN~STITUTION ~, PHONE 4. REALTOR/AGENT PHON~ 5. LEGAL.DESCRIPTION ;TREET LOCATION 6. TYPE OF ~ESIDEI~CI~ ' ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [~ Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY ' INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~J INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) ~l [ ~ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG'RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY (::~---(~ { Connection Verified iNSTALLER ' []Sept;ic Tank. or [] Holding Tank Size:~-3 If Tank is homemade SOILS RATIN(~ give dimensions: TYPE OF TANK MANUFACTURER ~ ~ ~, _ ~ TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line I t WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~APPROVED FOR' ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must acco~any certificate) [] DISAPPROVED DATE BY ~~