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TALUS WEST #1 BLK 5 LT 13
Talus' Block 5 Lot 13 #015-202- $$ Municipality of Anchorage Department of Health and Human Services Building Safety Division ~_.~ On-Site Water and Wastewater Program, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SwSW010256 , , PID Number: 015-202-33 Name: Linda R~_nn_qa Wastewater System: [] New [] Upgrade Address: 43t0 St]n_qtt3ne Circle_ 99Stti ABSORPTION FIELD Phone: Number of Bedrooms: 283-8337 4 [] Deep Trench [] Shallow Trench [] Bed [] Mound_ [] Other: Sol! Rating: Total Depth from original grade: LEGAL DESCRIPTION 0.48 GPD/F~ 11.1 ~t. Block: Lot: Subdivision: -~ ~ Depth to llipe bottom from origimll grade: Gravel depth beneath pipe: Township: Range: Section: F~II added above original grade; Gravel Length: 1il Ft. 38~38 ~t. ~ ~ Gravel width: Number of lines: J Distance between lines: Well: New Upgrade 2/2 Ft. 2j 18.3 Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Ft~ F~ 1.368 ~ 3034 PVC ...... Driller: Date Drilled: Static Water Level: Installer: Date Installed: Ft. A+ Home Services 7/30/2001 Yield: [ Pump Set at: Casing Height Above Ground: TAN K GPMI Ft; SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other: To Septic Absorption Lift Holding Public/Privat( Manufacturer: Capacity: ~rom~ Tank Field Station Tank Sewer Line Anch. Tank 1250 ~a,. Material: Number of Compartments: We, 115 109 125 105 Steel 2 Surface Water 100+ 100+ 100+ ~ / LIFT STATION Size: Manufacturer: LotLine 28 10.3 28 250 Ga~. Anch Tank High water alarm at: "Pump on" level at: "Pump off' level at: Curtain Drain 100+ 100+ 100+ l~_~_..j~ ~.,~-D Pump Make & Mede' , Ele~' In'pectiC°ns perf°rmed bY: Remarks: BENCH MARK Drain field split into two field due to running into Location and Description: existing trench. West Garage Man D~or Assumed Elevation: 100.0 Ft. Engineer's Stamp Inspections performed by: Pannone En.q. Svc Dates: ~7/27/2001 2n~o712912OOl Department of Health and Human Services approval (Rev. 11/~9) PERMIT ND, SWOlO25G A S- 3 U I L T P.I.D. ND, 015-202-33 WASTEWATER ABSORPTION SYSTEM NOTE, LOT 13 BLOCK 5 TALUS WEST S/I) 1) ALLWDRK SHALL BE PERFDRNE] . / / ? / ~ , IN J~CCORDANCE WITH AHCZS,S5i i / / ( ./' % 2) ~4ATERIALS USE]] SHALL ~E~ IN ~ / ~ ~ ~ t ACCORDANCE WITH THOSE SPECIF):D~ ? ~ ~ J 4> ~AINTAIN.~'SEPARATIDNX~D ~kL~ / ...... % ~ / ~ EXIST'G ~ /" ~ 'k, ~~ '% / ~ ~ WELL / ',~ 'x / '~ x, "I" ' ............ / EXIST'G ix,~ ~ ~ / , k '- ~ Wb~L x EXIgT'G 4OR ,.: .. ,,: ~ ~ % =~ , .,..~ ..,~ , --, ',. ./' .( .............................. -' ',~ .. % :',. ',. '-......:L :;b~ ...3 ~ NEW 18509 ' ,.X" "L / ~ / TANK - *"~ .......... "'-,. " 9,[ 84' TO TOP NEW SYSTEM". 8 TRENCHE: .~ .... .................. 38L.,-.E.X. 8 x9 EFFT' .... ' Lg ...... .i':;;: ............................... EX!FST'G TANK" DRAINFIEL ...-- .... " .... B ~ 19,6 LS 16,6 31,0 C1 38,4 38.1 M1 19.7 31,4 C2 10,7 33.5 C3 31,1 52,6 M8 38.0 51,7 C4 48,2 55,7 PERC RATE, 45MIN/IN, 4 BR HOUSE-1333 SF RQD TRENCH, 9' EFFT'V 75LF, 3'WIDE, 12' %]], 12500 S.T.E,P, TANK 1350 SF TOTAL 4310 Suns~one Circle Anchorage, AK 99516 PANNDNE ENG, SVC,LLC P, O. BOX 102954 ANCHORAGE, ALASKA 99510 878-8818 Phone & Fax DATE: 7-31-01 AS-BUILT SCALE. 1':50' PERMIT ND' SW01025G NOTEI l) ALLWORK SHALL ~4E PERFORMED LOT IN ACCORDANCE WITH AMC15,65. 8) MATERIALS USED SHALL BE IN ACCORDANCE WITH THOSE SPECIFIED IN AMC15,65o WASTEWATER DISPOSAL, 3) CONNECT PDST TANK LINE TD MID- POINT DF DRAIN FIELD. TYPICAL, 4) MAINTAIN 10' SEPARATION TO ALL LOT L~ES. Z AS-3UILT DETAILS WASTEWATER ABSORPTION SYSTEM 13 BLOCK 5 TALUS WEST S/D IADNV393 &. ~fll ND£IND~ 18.3' U u :~ o. z ! PREPARED FDR~ Ms Llnda Reposa 43:10 Suns~one Circle Anchoraoe, AK 99516 (907) 883-B337 ln0N~3'13 1~N~90 NOII4~INDO~ I?~3N¥~gD P,I,D, ND' 015-208-33 PANNDNE ENG. SVC,, LLC P. D, BOX 108954 ANCHORAGE, ALASKA 99510 878-8818 PHONE & FAX DATD 7-31-01 NOT TO SCALE AS-BUILT MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 7-3o 12 : . ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jul 23, 2001 Expiration Date: Jul 23, 2002 Permit Number: SW010256 Legal Description: TALUS WEST#1 BLK 5 LT 13 Design Engineer: 0062 Pannone Engineering Services Owner Name: Ms Linda Reposa Owner Address: 4310 Sunstone Cir ANCHORAGE , AK 99516- Parcel ID: 015-202-33 Site Address: 004310 SUNSTONE CIR Lot Size: 17884 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ~] Disposal Field i_;/1 Septic Tank I' Holding Tank ~ Privy [~ Private Well [ii ] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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: Date: Date: 7-2 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci,anchorage, ak. us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-202-33 Permit Number SW 010 Property owner(s) Ms Linde Repose Mailing address (1) 4310 Sunstone Circle Day phone 345.8489 Mailing address (2).Anchorage, AK . .. Legal description (Lot, Block & Sub'd.) Lot 13, Block 5 Talus West S/D Legal description (Section, Township & Range) Lot Size ~ 1 7 I~' Acres/~q.F¢ THIS APPLICATION IS FOR: Sewer Only [] Sewer and Well [] Sewer Upgrade [~ THIS PROPERTY CONTAINS: Hot Tub [] Swimming Pool ~, Therapy Pool E~ Zip Code 99516 Number of Bedrooms 4 Well Only Water Storage [-~ Jacuzzi [] Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: .._,~ .~.-..t.~. Date of Payment:, ,"'7 Receipt Number: ~_~ (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: Pannone Engineering Services, LLC Consulting Engineers (907) 272-8218 P.O. Box 102954 Anchorage, Alaska, 99510 (90T) 272-8218 Fax July 6, 2001 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 995 t9 Subject: Lot 13, Block 5 Talus West Subdivision Septic Upgrade Permit FAILED SYSTEM Gentlemen: My firm was contacted to conduct a Health Authority Investigation of the well and septic system serving this lot for a pending sale. The system was completely inundated with liquid. The fluid levels were approximately thirteen inches above the lateral pipe. I informed the owners that the systems were in failure. The owners requested my firm investigate the possibility of installing a replacement. A single test hole was excavated on June 29,2001o The soils report and a percolation test result is attached. Ground water was monitored for seven days. No groundwater or bedrock was encountered in the test hole. The lot is approximately 0.4 acres in size. Lot 13 slopes to the south at approximately 1 to 2 percent. The proposed installation will be located in the southwestern portion of the lot. The existing fields will be abandoned. The septic tank will be abandoned during the installation. A new 1,250-gallon S oT.E.P, tank will be installed outside the well radius. The proposed location is greater than 100 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, Ste-C~'fi R. Pannone, P.E. Attachments: ~ ...,-.--'"""" PRFIPFISED ~REPLACEMENT SYST ._1 ~..~1 "'- """ -' <: ..................... -¢.,~,-=.x.,,×J x9 EFFT'V / / PERMIT ND, SW01 DE SIGN P,i,D, No~ a5-eoe-33 WASTEWATER A3SORPTION SYSTEM NOTE, LOT 13 BLOCK 5 TALUS WEST S/D 1) ~.LLWORK SHALL tIE PERFBRME] - A[ ]pRDANCE WITH THOSE SPECIFIED; /' ~, .-:: / '~ ~'"' ;: ? , TANK - '84" TO TOP EXIST'G TANK ]DRAID PERC RATE~ 45MIN/IN' 4 BR HOUSE-ID33 SF RQ]D TRENCH, 9' EFFT'V 75LF, 3'WIDE, 18' T,D, 12509 S.T,E.P, TANK 1350 SF TOTAL PANNDNE ENG, SVC,LLC P, O, BOX 102954 PREPARED FOR, Ms LIDN~ ReposQ 4310 Suns-bone Clr'cle Anchop~§e, AK 99516 (907) 345-8489 ANCHORAGE, ALASKA 99510 272-8218 Phone & Fax DATE, 7-6-01 I DESIGN SCALE, l'=~O' ,, I PERMIT ND' SWO1 NDTE~ 1) ALLWBRK SHALL BE PERFORMED IN ACCORDANCE WITH AMC15,65, 8) MATERIALS USED SHALL BE IN ACCORDANCE WITH THOSE SPECIFIED IN AMC15,65~ WASTEWATER DISPOSAL, 3) CDNNECT POST TANK LINE TO MID- POINT DF DRAIN FIELD, TYPICAL, 4) MAINTAIN 10' SEPARATION TO ALL LDT LINES, DESIGN I ETAILS WASTE~ATER ABSORPTION SYSTEM LOT I3 BLOCK 5 TALUS WEST S/D £~DN~393 S 3E~l aOllNOW IP~]N¥3qO ±~BN¥3q3 £nON¥390 NBII~N~BJ PREPARED FOR: Ms Llmd~ Repos~ 4310 Sunstone Circle Anchorage, AK 99516 (907) 345-8489 P,I,D, ND, 015-808-33 z I,I PANNONE ENG, SVC,, LLC P, O, 3DX 108954 ANCHORAGE, ALASKA 99510 878-8818 PHONE & FAX DATE, I0-7-00 I NOT TO ,SCAL~ AS-BUILT ~lOIL8 LOG- PERCOLATION TEST PANNONE ENGINEERING SERVICES, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 (907) 272-8218 PERFORMED FOR: Ms Linda Reposa DATE PERFORMED: 6-294) 1 LEGAL DESCRIPTION: SM BOH Lot 13 Block 5 Talus West S/D Silty Silt~ W/~ace SUNSTEINE ClR WAS GROUND WATER ENCOUNTERED? No IF YES, AT WHAT DEPTH? DEPTH TO WATER AFTER MONITORING? DATE: 7~6-01 SLOPE HOLE READING DATE GROSS NET DEPTH OF NET TIME TIME WATER DROP 2045 30 5 1/2 5/8 " m15 30 5 3/S ~145 30,, 5 37S ,5/8 PEROLATION RATE 48 (rain/inch) PERC HOLE DIAMETER 6 inches ~ RUN BEWTEEN 7 FT and 8 FT COMMENTS: Test hole excavated by A+ Home ServicesDan Beek. Perc Hole Presoaked. PERFORMED BY: Steven R. Pannone,. P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. 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 NAME MAI LING ADDRESS LEGAL DESCRIPTION PHONE [] NEW LOCATION ~1~S'~,~!::: Q'~-~,~---> ~ ~'~~S~ ~ NO. OF BEDMOOMS I I Well [Absorption area Dwelling PERMIT NO. 0 ~ DISTANCE TO: I l ~ Z I Manufacturer ~ .~ Matefial~ No. of compartments ~ {Liq. capacity in gallons [ - . ............ Inside length ~ Liquid depth PERMIT NO. m~Z&--~ll DISTANCE TO'. []Well ~ 1--1 Dwe ng ~ Manufacturer ¢ IB Material Liquid capacity in gallons o~ = II DISTANCE{~:~ IlWell X Foundation Nearest lot line PERMIT NO. I ' [~ [ Z [ NO' of hnes ~~~ .~ [L~gt~of each h ne ~ ~ x~ __~o~__~ ~~~ ~ ~~ ~o I e~ width Distance between lines ~ ~ _ I inches Top of tile to finish grade ~aterial beneath tile- ' - Total effective absorption area inches I Length Width Depth PERMIT NO. / ~ ~ J Type of crib C~b ~ia~eter Crib depth Total effective absorption area ~ DISTANCE TO: Building foundation Nearest lot line ~ ~Jass ~ ~ Depth Driller Distance to lot line PERMIT NO. ~ 'D~STANCE Building foundation Sewer line Septic tank Absorption area(s) TO: OTHER ~': PIPE MATERIALS SOIL TEST RATING INSTALLER /IAR KS 72-0'~ ( I~v.' 3/78) DATE LEGAL DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ¢, . " 825 "L" STREET,, ANCHORAGE., AK. 99501 264-4720 13N--S I Ti SEWE~: r_IF'GRADE PEEr-1 i T 780946 ) PERMIT NO. PANORAMIC VIEW CAMPER PK APPLICANT LOCATION LEGAL TIBOR & BARBARA BRTHONY 4~i0 SUNSTONE CIRCLE Li~ B5 TALUS WEST #1 LOT SIZE 17000 SQUARE FEET T'¢PE OF SOIL RBSORBTION SYSTEM IS' DRRINFIELD MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= 0 THE REQUIRED SIZE OF THE SOIL ABSORPTION C,,~Tc~_,T~.~,., IS' [:.EF'-I- H= 0 LENGTH= 0 GRAVEL DEF'TH= ~-~ THE LENGTH DIMENSI~4 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>. THE TRE~C:H WIDTH IS L~. ~3~0 FEET THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION 4IN FEET>. REL-3.1J I REC-, SEPT I C TA~4K S I ZE= 1. L---~ r-_--~ £~ GRLL,:-JI'-,IS F'ERMII' APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT [:,URING THE INSTALLATION INSPECTIONS OF RNa' WELLS 8D.$RCENT TO THIS PROPERTY AND THE NUMBER OF RES IDEN.~E_~ THAT THE WELL WILL SERVE. TWCI (2) I f4SPECTIOF~S R[:E REC!I_II [:E[) ,BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL B~ THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. 'MINIMUM DISTANCE BETWEEN R WELL 8ND ANY ON-SITE SEWAGE DISPOSAL S~STEM IS i00 FEET FOR A PRIVATE WELL~ OR &50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. 'OTHER REQUIREMENTS MA~ APPLY. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERbl I T E."-..' P I RES DEC:E~IBER _~l.. iL='-7"--- E: I CERTIFY THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERST8ND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. SIGNED' n~[~- T~'~ '~R~ARA BATHONY ISSUED B' ,DATE___ V~.2 GRE/ R ANCHORAGE AREA BORi GH Department of Environmental Quality 3330 C Street Anchorage, Alaska gg§03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK,: DISTANCE FROM WELL INSIDE LENGTH INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY ~' GALLONS. TILE DRAIN FIELD: / DISTANCE FROM WELL /~'~"~ FOUNDATION ~-~/ / NUMBER OF LINES / DISTANCE BETWEEN LINES ABSORPTION AREA /'~"~(:~ /~ SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE ~;/ DEPTH OF FILTER · ~/ TOTAL LENGTH _NEAREST LOT LINE___Z'D OF LINES MATERIAL BENEATH TILE /~2... IN. ABOVE TILE ~ ~/' IN. WELL: CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION__ LOT LINE ___ SEWER LINE__ TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED __ DISAPPROVED DISTANCES: INSTALLED BY: ~-//'~VA-,~'~ SEWER LINE DEPTH: LOT SLOPE: REMARKS: REMARKS DIAGRAM OF SYSTEM / G.A.A.B. Form EQ-032 Ir ANCHORAge Area DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 IGH PERMIT NO. SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION MAILING ADDRESS LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS 0~5/~ COMPLETION DATe ANTICIPATED NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING Of A,NY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPe _ type ...: .~/.',.~-,. ' ../-. . .- /,~ . ! - .~. j./.,,...,',,,... .~. , /~, ., ,.:~_; .... --: MINIM'UM DISTANCEs. REQUIREMENTs ........ r DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE 4;~T SEPTIC TANK TO SEEPAGE~LT~ WALL · DRAIN FIELD SEPTIC TANK ~ SEEPAGE TO NEAREST LOT LINE. WELL TO SEPTIC TANK Drain FIELD DRAIN Field S EePAG E~t~ / ~ ALSO CONSIDEr AREA WELLS. WATER MAIN TO SEPTIC TANK /'~ / SEEPAGE Pit /~:~ / DRAIN FIELD // ~7 / SEPTIC TANK, ~/ / , SEEPAGE~PI~ /~ / , DRAIN FIELD / ~ / TO RIVER. LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND into CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBed SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIt FITTED WITH AIRTight REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. .) OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS Of GREATER ANCHORAGE AREA BOROUGH O~.RDINANCE NO 28-68 AND THAT THE ABOVE DESCRIBed SYSTEM IS IN ACCORDANCE WITH SAID COde. T c:~.c:~O C~ ~t~c~C ~S ~ ~ ~~ ~ ~ O~ - ...." FORM NO. EQ-01 6 DRILLING, INC. DRILLING LOG Well Owner ~ ~, .... ~ ,~ !..i,~:~;:; Use of Well r :~ Location (address of: Township, Range, Section, if known; or distance main road Size of casing -~ .Depth of Hole 7 ~ feet Cased to 70.. ,q feet Static water level "~ ft. (/~5b"~8) (below) land surface. Finish of wel~ (cheek one) Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at ~;,9 gallons per (h~)ur) (minute) for ~ hours with of drawdown from static level. open end ( Date of completion ~,~ a~_% 7f~ WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness .TO TO 7O .TO_ TO~ TO~ TO _TO _TO. TO TO TO TO TO ); ft, NV, tWA Certified Contractor ........ ~,r^'o fll~l & 9~3 2 = STATE Well Owner '5~ '~ M-W DRILLING, Inc. P. OJBox4-1224 · 1310C International Airport Road (907) 274-461l ANCHORAGE, ALASKA 99509 DRILLING LOG Use of Well D-~.~ Location (address of: Township, Range, Section, if known; or distance main road I% ~3~ Blk 5 '['3.'.'['us /'/~n~ SubClVo Size of easing 6" Depth of Hole 50 feet Static wafer level ,:':~ ft. (.h%~('~) (below) land surface. Screen ( ); Perforated ( ), Describe screen or perforation Well pumping test at 6 gallons per (tfdti¥)~ (minute) for 3. of drawdown from static level. Date of completion ?,~, Julv 1975 Cased to !~O feet Finish of well (check one) open end ( hours with WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 _TO -3 O~:~anJ. cs '~ _TO 2.':~ ~il'ky ~r,~v~J ::~;~ TO_ 44 Cobbles A4 TO 46 _ Sil~y grave3. TO _TO N~A Ce~fified Cont~a~6~ .TO TO _TO ); ft. 2 -- STATE CERTIFICATE FOR A SINGLE Parcel I.D. 015-202-,33 1. GENERAL INFORMATION Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.ora/onsite (907) 343-7904 OF ON-SITE SYSTEMS APPRO /AL FAHILY DWELLING Expiration Date: ~ ~ ~-~'- 1/ Complete legal description TALUS WEST S/D #1; BLOCK 5, LOT 13 Location (site address) 4-310 SUNSTONE CIRCLE * ANCHORAGE, AK * 99516 Current Property owner(s) SCOTt WESTOVER Day phone 229-9699 Mailing address 4,310 SUNSTONE CIRCLE * ANCHORAGE, AK * 99516 Lending agency Day phone Mailing address Real Estate Agent ~;~' ?~i'~M~ii[ng address ~lnless otherwise requested, COSA will be held by DSD for pickup. · NUMBE'ROF BEDROOMS: 3 Day phone TYP, E OF WATER SUPPLY: Individual Well · Individual Water Storage [] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: individual On-site · individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER o As certified by my seal affixed hereto and as of the validation date shown belov~4 I vedfy that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows t,hat t,5e on-site water supply and/or wastewater disposal s~,~tem is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify t,~at based on t,Se infon~ation obtained from the Municipafity of Anchorage files and from rny investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 557-6179 Address ,5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA hSD Guidelines & Regulations The reposed 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 dunbg the year, and the water usage of the family being se~ed by the system. These conditions are outsNe the control of the evaluator of the system. Satisfacto~ test results do not guarantee future pefformance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, L Th. 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 repo~ is for the sole benefit of the owner listed above Any reliance upon or use of this repo~ by any other person or pa~y is not authorized, nor wifl it confer any legal right whatsoever, hSD SIGNATURE ~ Approveafor ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Cneud~st Septic System Advisory Well Flow Advisory IN]ILl ~L~ ~UvI~O~ y (Rev. 1 II05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: TALUS WEST S/D #1; BLOCK 5, LOT 15 Parcel ID: 015-202-33 WELL DATA *DRILLED 7/24/1975. DEEPENED 8/20/1975. BOTH LO(;S PRESENT. Well type PRIVATE IfA, B, or,C provide PWSID# N/A Well Log (Y/N) *YES Date completed '7/24/1975 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth '71 ft. Cased to *70.8 ft. Casing height (above ground) ] F in. Date of test FROM WELL LOG '8/20/1975 AT INSPECTION 4/27/2011 Static water level *40 .ft. 22 ft. Well production 0.5 WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 mi. Arsenic: ND ug./L. g.p.m. 8.5 g.p.m. Nitrate 3.34 mg./L. Collected by: GE(;, Ltd. Date of sample: 4/28/2011 SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P./STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 10/25/2010 Pumper. Date installed 7/27-29/2001 Cleanouts (Y/N) YES High water alarm (Y/N) YES A+ HOME SERVICES ABSORPTION FIELD DATA Date installed 7/27.29/01 (_2_ 0 38) Length 76 TOTAl' .ff. [*BELOW EXISTING GRADEI Soil rating ~or ft2/bdrm) 0.48 System type DUAL TRENCH Width 2/2 ft. Gravel below pipe 9/9 ft. Any rejuvenation treatment (past 12 mo.) (Y/N & type) **TESTED SOUTH TRENCH ONLY. NORTH TRENCH HAD Depression over field NO For ,3 bedrooms New depth 97 in. in. Absorption rate >= 450+ g.p.d. NONE KNOWN If yes, give date - 55" OF STANDIN(; WASTEWATER '12.3+/ Total depth 12.o+ ft. Eft. absorption area 1,368 ft2 Monitoring tube YES Date of adequacy test *'4/27/2011 Results (Pass/Fail) PASS Fluid depth in absorption field before test. 46 in. Water added 1420gal. Elapsed Time: 1288 min. Final fluid depth 77 D. LIFT STATION Date installed "Pump on" level at E. in. SEPARATION DISTANCES · Size in gallons "Pump off' levet~. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas. 50'+ 100'+ Manhole/Access ~ ~ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property'line 5'+ Water main N/A Water service line. 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field 5'+ Surface water. 100'+ Property line Water service line Curtain drain NONE COMMENTS *SEE A'I-~ACHED '5'+ 10'+ KNOWN Building foundation 1 O' Surface water 100'+ Wells on adjacent lots. 100'+ Water main N/A Driveway, parking/vehicle storage WAIVER LE-I-rER AND LETTERS OF NON-OBJECTION. .in. 10'+ 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 M°A COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date '~'/Z~'//~/ COSA Fee $ ~/ Date of Payment Receipt Number (Rev. 11/05) ',, Waiver Fee $ ~) "" Date of Payment Receipt N u m ber.~_~ ~~~- Municipality of Anchorage P.O. Box 196650 · 4700 Elmore Road Anchorage, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997 ...h. ttp:l/www.m u ni.or.qlOnsite Development Services Department On-Site Water and Wastewater Proqram **** VARIANCE/WAIVER REVIEW **** WR#: 111077 HA#: 111171 Permit-g: PID#: 015-202-33 Legal Description: Talus West #1 Block 5 Lot 13 Engineer: Garness Engineering Group Applicant: Scott Westover 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 5.0 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. Waiver is Granted: X Waiver is not Granted: Date: 5/26/2011 Approved by: · .............................................~;,~'~.~';;;';;'.=..............., Rec.;g: 073452 Amount: $200.00 Date Paid: 5124/11 **** VARIANCE/WAIVER REVIEW **** GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS May 16, 2011 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Talus West Subdivision #1; Block 5, lot 13; Waiver Request; Mr. Poet, The subject property is served by a private well and septic system consisting of a S.T.E.P. tank and two drainfields. During the course of our inspection, the south drainfield was found to encroach into the 10' utility easement. We request you waive the distance between the lot line and drainfield to 5'+. Attached is an as-built survey and letters of non-objection from the relevant utility companies. We are unaware of any adverse impact these waivers would have on adjacent wells or septic systems. If you have any ~ly, h Ii Presi >lease contact us at 337-6179. 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com SUNSTONE N89 56' C[RC L~ J 30" ~E. 53.30 \ \ \ \ \ \ \ \ \ /- ./ ./ A THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURESAND pLATTED LOT LINES OR EASEMBNTS AND IS NOT TO BE USED FCR POSITIONING ADDITIONAL STRUCTURES OR FENCELtNES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.(UNLESS INDICATED) NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES AS-BUiLT SURVEY ( NO CORNERS SET THIS DATE ) I-= 30' I HEREBY CERTIFY THAT I HAVE PERFOFIMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY, LOT 1:3, BLOCK 5, TALUS WEST NO. 1 sUB, ANCHORAGE RBCORDING DISTRICT, ALASF, A AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS _i BTH__ DAY OF OCTOBER -- 2010_, HOLT LA~'D SURVEYING TEL, 345-5513 12'~9, FB 2-26.143.33 HOME SERVICES , INC. ***~, 7501 E. 140th Avenue ' Anchorage, Alaska 99516 345-1890 ;USTOMER ~lock DATE Lot INVOICE # DESCRIPTION AMOU ..:..:.' :~... :.::.....: ' ~,,.~ ...... ~. _ .;~.~ .. ~ .~.. .... ~ .-.:: :,:,~ ..... . ;~.~.. ..... :. ..::: :: > . ': : . : ~ TOTAL 'e . .~D .: -. Gallons /~" _ Septic __. Leach Area ~ Holding Tank [] P~ROBLEM AREA ~ CALL FOR MORE INFORMATION [] NEEDS TO BE DONE AGAIN IN 6 MONTHS ~ Good Shape [] Sludge buildup on bottom [] Jim cap missing or [] Cut standpipe to 1' above ground needs replacing Standpipes //~Ti m e [] FIoater on top [] Needs Septictrine ~dayor Dan Sulliva~ Municipality of Anchorage Anchorage Water & Wastewater Utility Engineering Division http://www.awwu.biz 3000 Arctic Boulevard, Anchorage, Alaska 99503-3898 ' Fax (907) 562-0824 May 11% 2011 Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Attn, Sonja Blewett Re: Talus West #1 BIk 5 Lt 13; 4310 Sunstone Cir. (Grid SW2736) Request for Letter of Non-objection to Encroachment The Anchorage Water & Wastewater Utility received a request on May 11th, 2011, for a letter addressing AWWU's position regarding a septic drain field and fence that encroaches into a utility easement located along the Southwest property line of Talus West #1 BIk 5 Lt 13. AWWU has no utilities located in the utility easement, has no objection to the encroachment, and hereby issues this letter with stipulations to allow the encroachment of the septic site and fence by using the easement the property owner(s) agrees to the following: 1. AVVWU will be held harmless, now and forever, for any damages or injury to any person as a result of the encroachment; 2. Alt applicable codes and regulations will be observed and maintained within the easement; 3. This letter will in no way preclude AWWU from full use and enjoyment of its rights within any portion of the easement; 4. The property owner shall pay any additional and/or extraordinary costs incurred to accommodate the encroachment during any future required construction or reconstruction of AWWU facilities; 5. AWWU's non-objection does not imply other approvals that may be required for this encroachment; and, 6. AVVWU does not provide a position for any other parcel or utility impacted by the encroachment. Should you have any questions, please call the AWWU Planning Section at 564-2739. Sincerely,. ......... Engineering Technician ENSTAR Natural Gas Company A DIVISION OF SEMCO ENERGY Engineering Department Right of Way Section 401 E. International Airport Road P. O. Box 190288 Anchorage, Alaska 99519-0288 (907) 334-7753 FAX (907) 334-7798 May 11,2011 Scott W. Westover 4310 Sunstone Circle Anchorage, Alaska 99516 Grid: A2736 Re: Letter of Non-Objection To whom it may concern: ENSTAR Natural Gas Company has no objection to the existing drain field encroachment into the Ten Feet (10 FT) wide utility easement situated adjacent to and coincident with the westerly boundary line of Lot 13, Block 5, Talus West Addition No. 1 Subdivision, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. Additionally, ENSTAR has no objection to the existing fence encroachment into the Ten Feet (10 FT) wide utility easement situated adjacent to and coincident with the westerly and southerly boundary lines of the aforementioned lot. 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: · Landowner/Contractor working near ENSTAR gas facilities shall contact the Alaska Digline, Inc., (907) 278- 3121 or 811 for line locating two (2) business days prior to any related excavation. · ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a lt.'~tlll t,l'l]ll', Cllt_ l~qit.)llllUl}[ · 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 construct/on necessitated by this encroachment will be borne by the land 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 an>: portion of its right-of-way. Andrew F Right-of-Way Agent ENSTAR Natural Gas Company cc- file T×I'd HO8 8~±SNB:WOSB ~Z~:TT Iii T TO~-ET-,.t ~l~ May 11,20tl Scott Westover 4310 Sunstone Circle Anchorage, AJaska 99507 Cu~om~r 5er~nce: [8001808-~083 alaskacommunical~ons,com Alaska Communications has no objection to the encroachment of a septic drain f[sld, shed, and fence.int° ~the platted util'~y easement along the western & southern boundary of Lot 13 Block 5, Talus west # 1, otherwise known as 4310 Sunstone Circle as depicted on lhe drawings submitted by GaF~ss Engineering Group, Ltd. Acceptance, (your signature below), and use of this le .tte~, ~non.objection by yourself, your heirs, your assigns, or your sum:essors, will const~ute agreement to the following stipulations: Alaska Commu'nications 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 Commuhications facility damaged or destroyed as a result of this encroachment~v~ll be repaired'at no cost to Alaska Communications. Any costs incurred by Alaska Communications For special construction necessitated by this encroachment will be tx)me by the property owner. All applicable safety code regulations will be Observed and maintained. This letter of non-objection Will in no way preclude Alaska Comm~ni .cations from full use and enjoyment of its rights within any portion of its right-of-way. Please sign both copies, retain one. copy for your use and tatum the other to Alaska Communications. Engineering Foreman Outside Plant Engineering, MS~4 600 Telephone Ave. Anchorage, AK 99503 ACCEPTANCE SIGNATURE: Grid RCWC 2736 DATE: Mav 12, 2011 Scott W. Westover 4310 Sunstone Circle Anchorage, Alaska 99516 Dear Scott Westover: Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the drainfield encroaching into the utility easement of Lot 13, Block 5, Talus West #1 subdivision, otherwise known as 4310 Sunstone Circle, city grid 2736. This [et~re.r of non-objection in no way precludes GCI Communication Corp from f~ll use and enjoyment o'[' any rights it may have within any 1]ortion of the utility easement and or The right-of-way: including unlimited access for servicing its hcilities. Also any additional and extraordinary costs incurred during any ~ture required construction, repair or reconstruction of'GCt's facilities to accommodate any or all of the encroachments shall be paid by the properoa, ox~mer. By signing be[ow, you agree to indemni't~y 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 myself at the address below. Sincerely, / Markus Kofoid OSP Design Engineer GCI Communication Corp 515'I Fairbanks St. Anchorage, AK 99503 907-868-6168 Office 907-868-8580 Fax Date MAY-2U-~Uql MON 11:01 AM 2A LAND SERVICE$ ~1 ~U/ /15~ 4Ub2 P.E)U2 ENCROACHMENT PERMIT 1203-22C' G-2736 ENll017 015-202-33 This permit is between Chugach Electric As§0eiation, Inc., an Alaska non-profit electric cooperative, (herein "Chugach"), whose address isP. O. Box 196300, Anchorage, Alaska 99519 and Scott W. Westover, (herein"Permittee"), whose address is 4310 Sunstone Circle, Anchorage, Alaska 99516. 1. Easement. Chugach is the grantee or user of an easement for the construction and maintenance of electrical facilities, as follows: Dedicated by the plat of the subdivision known as Talus West Subdivision, AdditionNo. 1, according to Plat Number 80-40, recorded on the 23rd day of April 1980, on file-in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (llerein "Easement") which pertains to the following described real property: The Southwest Ten Feet (SW10') of Lot Thirteen. (I3), Block Five (5), Talus West Subdivision,' Addition No. 1, according to Plat Nuraber 80-40, recorded on the 23~a day of April 1980, on file in hhe office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, Described in that certain written instrument recorded on the 14m day of September 1987, at Book 1650, Page 215, on file inthe office of the District Recorder, Anchorage Recording District, Se,a~rd 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: Lot Thirteen (13), Block Five (5), Talus West Subdivision, Addition No. 1, according to Plat Number 80-40, recorded on the 2? day of April 1980, on file in the office of the District Recorder, Anchorage Record/ng District, Seward Meridian, Alaska, (herein "Parcel"),. Encroackment Permit - Page 1 of 4 MAY-23-2011 MON 11:02 AM OEALAi,SSERV]OES ~1 90/ /rS2 4852 P, L)(O3 2. Encroachment.. Perm~ttee has consU'ucted or purchased the following improvements on or within the real property subject to said Easement: A septic system that encroaches approximately Two Feet (2') into said Easement, located on the southwest ten feet (SW 10') of said lot, for a distance of approximately Twenty-five Feet (25'), as shown on the As-Built by Hok Land Sm,eying dated October 10, 2010. (herein "Encroachment"). 3. permit. Chugach hereby authorizes Permittce to continue thc existence of the Encroachment in its existing 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 logs arising ha any way t~om the continuation of thc 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 wri~en consent of Chugach. Chugachhas no obligation to provide such consent. 6. No Interest in Rea! E~tate Ac~.u[red. Permittee hereby aclmowledges that the Encroachmen~ and any additions thereto, even [fin violation of this permit, has not and shall not in the future give rise m any interest or estate in the real property subj eot to the Easement or any' other real property. 'Without in any way limiting the forego/ng, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its cominuation is entirely Wi.th the permission of Chugach for purposes of the common law do,ctr~ne of adverse possession. This permit creates no interest in thc real property subject to the ea~ement. 7. _M..o.d~ficadon of UtilityFacilides. If the electric utihty facilities located within the Easement are upgraded, added to, replaced or reconstructed, Perrrdttee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. tfsuch payment is not made within thirty (30) days of written demand for same, Chugach may terminate this permh in accordance with paragraph 9, below. 8. Covenants Running with'the L .a~.d.. 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. 9. Termination. Chugach may terminate this permit a.ffer the giving ofthirty (30) days written notice of such termination if: Encroachment Permit - Page 2 of 4 MAY-28-2011 MON 11:02 AM CEA LAND SERVICES ~1 9E)/ /62 4852 P, 004 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. '10. Term. This permit shall, ffnot sooner terminated by Chugaeh, expire fort3, (40) years f~om 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, betweenthe parties. No modifications, amendments, deletions, additions or alterations of the permit shall be effective unless in writing mad sigaed by all of the parties hereto. CHUGAClt ELECTRIC ASSOCIATION, INC. Dale D. Steeby, Acting Director Distribution Engineering- PERMITTEE Rhortda Feblen WestoYer as POA for Scott W. Westover Date: Encroachmen'~ Permit -' Page 3 of 4 tv~AY-28-2011 MON 11'02 At~I CEALANBSEI~VlCES ~1 UOi /62 4Sb2 P. UUb STATE OF ALASKA ) ) SS: TI4]ILD JUDICIAL DISTRICT ) The foregoing instrument was aelmowledged before me this /~/n~tay of. 2011, by /~a~d,~ /~.4 /~' ld/~awv' (PRINT NAME(S) OF PERSON(S) SIGNING DOCUMENT) N~Jy Pnb~,/m and for the State of Alaska My commission expires: AY-'//-g~13 STATE OF ALASKA ) ) Ssi THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this. ! a~ day of C//t/~ ,2011,by Z/~/~ ~, 7?~ , ' /~6~t!*¢ I~eotor, Dis~bution En~'e~g of Chugach Elee~e Association, ~c., ~ ~a co~oration,'.on ~of~e co~oration. ~. ' ' ~ ~ '~ -- ~ . . .- _ ~,~i _,~¢~ N~ Pabhc~d for ~e State of ~as~ ~[~OT~X } ~ M~mmissione~kes: AFTER KECORDING RETURN TO: Chugach Electric Assodatlon, Inc. 1~,O. Box 196300 Anehorage~ Alaska 99519-6300 Encroactmaerit Permit - Page 4 of 4 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street 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 Parcel I.D. 015-202-33 GENERAL INFORMATION Complete legal description HAA # Expiration Date: Lot 4, Block 5 Talus West SID Location (site address or directions) 4310 Sunstone Circle Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Ms. Linda Reposa , ll-S-Ol P.O. Box 3976, Soldotna, AK 99667 Residential Mort.qa.qe Co. Day phone 283-8337 Day phone 261-7600 Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class __ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [~ Individual Holding tank [] Community On-site [--] Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. (Rev. 11/99) 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation· Name of Firm Pannone En.q. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 713112001 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DHHS GuidelInes & Regulations. The ~.~-? ~ L~ ~/ re orted results describe 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 _~ ~9..*' /[ *-..'~ ..... ,~' ~ ~.. % sepUc systems depend on the local soil condiUon, ground water levels that may fluctuate during the year, ~ ~: 4 (~ TN ~'~x '- ~> and the water usage of the family being served by the system. These conditions are outside the control of ~. -"' ~ -- F~ ~ the evaluator of this system. All systems eventually fall and satlsfactow test results do not guarantee ~---~-.~ furore performance of the system, nor do they guarantee that there are no hidden defects or encroachments..-~:~;....,,.--~...-....-;~ ........................... · . . ~ PEscantheref~ren~tpr~wdeanywarrantyf~rfutureperf~nnancen~rg~veanyestlmate~fh~w~ngthe ~-x~$teve~ -R. D¢r~r~©ne..~ ~ system vall continue to meet the operaQonal reqmrements of the ADEC or MOA DHHS. The content of ..;~ ,,..~ · , o. ~_N ~ ~, 4o~ ¢' ~ ~ this report is for the sole benefit of the owner listed above. Anv reliance upon or use of this report by any ~,~.oo(:5~[ O'~'~ ~ .,*'>-~ ~' other person or party is not authorized nor will it confer any legal right whatsoever. **i~: .............. ~ "'"'"':L~ 6.DHHS SIGNATURE A..roved for hL Disapproved. · Conditional approval for bedrooms. .... bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: Expiration Date: (Rev. 11/99) X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~ - (~ - ~ I Reissue Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage, ak. us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WELL DATA Well type PRIVATE Date completed 8/2011975 Total depth 70 ft LOT 13, BLOCK 5 TALUS WEST SID If A, B, or C provide PWSID # __ Sanitary seal Y Cased to 70, ft FROM WELL LOG Date of test 8/20/1975 Static water level 40 Well production 6 WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi Date of sample: 81112001 SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 7/30/2001 Tank size Cleanouts _ Foundation cleanout Y g.p.m Nitrate · ~ mg/I Collected by: Parcel I.D.: 015-202-33 Well Log YES Wires properly protected Y Casing height (above ground) 18 in. AT INSPECTION 8/1/2001 Other bacteda ~ colonies/~ 00 mt L.R. PANNONfi 1250 gal Depression over tank N Date of pumping 713012001 Pumper NEW INSTALLATION C. ABSORPTION FIELD DATA Date installed 7/30/2001 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.48 Length 38/38 ft Width 2/2 ff Total depth 1._~2 ft Effective absorption area 1368 ft2 Date of adequacy test 713012001 Results (Pass/Fail) __ Fluid depth in absorption field before test NEW in Elapsed Time: __ min Final fluid depth ~ Any rejuvenation treatment (past 12 mo.) (Y/N & type) (Rev. 11/99) Number of Compartments 2 High water alarm YES System type DEEP TRENCH Gravel below pipe. 919 ft Monitoring tube Y Depression over field N PASS For 4 bedrooms Water added_0 gal. New depthNEW in. in Absorption rate >= __ g.p.d. If yes, give date D. LIFT STATION Date installed 713012001 Size in gallons 250 "Pump on" level at Z.O in"Pump off" level at Datum 'Tb'-P oF-'TA,~ ~ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 11,5 Absorption field on lot 109 Public sewer main N/A Sewer/septic service line 105 ~q in Manhole/Access YES High water alarm level at /,5- in Meets alarm & circuit requirements? YES On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 9 Property line 28 Water main N/A Water service line 50 Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10.3 Building foundation 10.1 Water Service line 50 Surface water 100+ Curtain drain 100+ Wells on adjacent lots 100+ COMMENTS NEW INSTALLATION ON 7/30/01 N/A Absorption field 23 Surface water 100+ Water main NIA Driveway, parking/vehicle storage 50 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone, P.E. Date 7-31-01 HAA Fee Receipt Number (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number Envlroflmontal Services, Inc. CT&E .'T&£ Ref.# I 0 ! 4967002 :lleut ~,'ame pa.,3flo~c Eng. $r¢. CUent $1m~le ID ~t 13 B~ 5 T~ W~t Matrix Dt~ W~cr O~e~ By ~SID 0 I~QL UnI'm Me(~ 'Lm~.b Da~e D,,te ;nit 0.$00 m~/l~ E~A 300.0 (<101 08/01.;0 i SCI, Mic~obiolog~ ~,aborabo~ 0 col/10~L SMIS 1r2228 ITB-:I 60/~0'd 6~Z-,L 10~i195Z05 A~S 1V,,tN]P(~O~IAN3,91.,L,~-I 6L:BL 10~JOJ~t¥ CT&E Environmental Sewices Inc. L~bomtory DNI.Ion -'..-_-_. ........ ~ ~ ~ --=_ _~7 _ --- 200 W. Parlor Drlw )rinking Water Analysis Report for Total Coliform Bacteria Tel'Anchorage'(907) 562-2343AK 9.B1..1808 RF~ID IN3TRUCTION$ O,Y.P~VEI~E SZDE BEFORE COL[.ECTI,%'G S,4MPZE I:,x: ~J07~ B61-530! MUST BE COMPLETED BY WATER SUPPLU*:K ~ PUBLIC WATER SYSTEM I.D- # ~ PRIVATE WATER SYSTEM SAMPLE LOCATION ITO BECOMPLET~D BY LABORATORY A~=lys~s ,hews this Wate~ SAMPLE lo be: Io~S~dsfactory 0 S~le over ~0 hou~ old. ~suI~ may b~ 5~ple t~ I~g In ~ns~ s~ie should not ~ ov~o.~ old ~t exa~a~on * Num~rofco~onies/lO0 mi. R~ult* Y~r SAMPLE ~PE: ~ 7/ Routine ~ T~t~ W~ tach Repeat Sample (for touche ~le ~ Untre~t~ Water ' ~lth lab rtl. no. -- ) Sp~tnl Purpose BA~ER1OLOGICAL wATER ~ALYSIS ~CO~ MM~MUG Rm~ T~I Col~e~ ~ Cmtl Membrane ~en ~ Count Celon~]Ol mi Ver~catlom LTB ~GB COLIF~M Fe~l Cvlifo~ ~~ Member o~ Iht lOl Group (Soclltl Gan0rale de 5urv~lllnce} Anal~t Client ~otifl~d of unsu/hfoctory results: [] Fl~td [] Fax~ ................. · ,, ,,-~..u,= e, ~,=..,a . j mrac Ma, avl ANi~ MICHtGAH. IdlSGOUR]o NEW JERSEY. OHIO. W~$T VIRGI~/IA IT'8,-.J SO/SO'd 6£Z-1 I0£;t9~206 /~$ 'IY/N"'-'MNC~IAN3 ~J.3=f~d IZ:BI 10-90-'J~lY ~o _a e~. ewe n e_~gJ[b?_.~~asons-~ .ri_ O[llla o o · _e__s_ _ ~a a ' o a so 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 July 8, 1987 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 13, Blcck 5, Talus West~Subdivision No. Location (address or directions) 4310 Sunstone Circle (b) Applicant NameT-~'b°r Ba%hony Telephone: Home Applicant Address Fairbanks Business (c) Applicant is (check one): Lending Institution [] · Owner/builder [] ' Buyer [] ' Other [] (explain); Se~ler Home Savings (d) Lending Institution Telephone Address (e) Real Estat~ Company and Agent Address Jack White Company 3201 "C" Street 563-5500 Telephone '(f) Mail the HAA to the following address: "C - 2. TYPE OF RESIDENCE Single-Family [~[ Multi-Family [] Number of Bedro(~ms 3 Other WATER SUPPLY -' ' individual Well~] Community [] -Public [] Note: If community well system, must~-I~ave written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~l~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11184) 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 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. NameofFirm QUADRA ]~;ngineeriP~g, Thc. Telephone (907) 276-3770 1057 We. st Fireweed Lane, Suite 230,~ Anchorage, Alaska 99503 Address Date July 8, 1987 DHEP APPROVAL Approved for _,Z/,,.~ ('~>bedrooms by Approved / ' Disapproved (/ Conditional Terms of Conditional Approval Engineer's Seal Date 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 $ above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Lot 13, Legal Description: Ta±us Block 5, West Subdivision Well Classification Private Well Log Present (Y/N) N 426' Total Depth Cased to Static Water Level 22 ' 6" 33" Casing Height Above Ground Y Electrical Wiring in Conduit (Y/N) Separation Distances from Well: 116' To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot .5 mi To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by If A, B, C, D.E.C. Approved (Y/N) Date Completed +_ 1975 Yield 40'+ Water Sample Test Results Comments N/A 9 GPM+ None Depth of Grouting Pump Set At Not Determined Sanitary Seal on Casing (Y/N) Y N Depression Around Wellhead (Y/N) ; On Adjoining Lots 126' On Adjoining Lots To Nearest Public Sewer .5 mi To Nearest Sewer Service Line on Lot McFadden/QUADRA · Date July 3, Acceptable 100'+ 100'+ 98' 1987 Well depth according to owner. B. SEPTIC/HOLDING TANK DATA Date Installed Y Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Y Separation Distances from Septic/Holding Tank: 116' To Water-Supply Well 68' To Property Line 64' To Water Main/Service Line None in area Course Size ~ No. of Compartments 2 Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) N Y N Date Last Pumped · for Temporary Holding Tank Permit (Y/N) N/A To Building Foundation To Disposal Field 14' 10' To Stream, Pond, Lake, or Major Drainage Comments The package treatment plant (Multi-Flc) appears to be operating correctly. Jet aeration system operates for 10 min. on a 50 min. cycle. Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 19 ? 5 Width of Field 3 ' 250 SF 1,233 SF Square Feet of Absorption Area Depression over Field (Y/N) N Results of Last Adequacy Test Adequate Separation Distance from Absorption Field: To Water-Supply Well 132 ' To Building Foundation 24 ' Lot None To Water Main/Service Line 126 ' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Absorption system Type of System Design Length of Field 4 3 ' Depth of Field 16 ' Gravel Bed Thickness 12 ' Standpipes Present (Y/N) Date of Last Adequacy Test Trench Y July 3, 1987 To Property Line 1 5 ' To Existing or Abandoned System on · On Adjoining Lots ], 12 ' Not present To Cutbank (if present) None in area 48' operates adequately D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) . "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** 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 ¢O/~J CompanyQUADRA Eng., Inc,, MOA No. CE87-199 Receipt No. Date of Payment "'~ - \ Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal Job: Lot 13, Block 5 Talus West Subdivision Date: July 3, 1987 Name: Wayne McFadden Well Static Level: 22'6" 12:20 - Well on @ 9 GPM TIME WELL LEVEL 12:30 22' 9.0" 12:45 22' 6.5" 1:00 22'6.0" 1:30 22'7.5" 2:00 22'8.0" 3:00 22'8.5" Water Off 3:15 3:30 3:45 SEPTIC LEVEL UP 4.25" 8.00" 12.00" 1 .'25 ' 1.45' 2~05' 1.65' 1.25' 10.5" COMMENTS Aeration pump on @ 1:00 Aeration pump off @ 1:10 Aeration pump on @ 1:50 Aeration pump off @ 2:00 On at 2:40, Off at 2:50 On @ 3:30 Off @ 3:40 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID ~ 92-0040440 Client POw : V~DBAL Req Ciient~rnpl iD: 42t0 SUNi'ONE CIRCLE WELL Sample~ec'd : JUL 6 87 Send ~ork Order No. : 1468 Client Account : OUAu~A~ g~te Report Printed: JUL y 87 Released ~y : 2 Reports Address ti2 1057i,! FIREbirD LhN~ 8230 Spec~ai ROUTINESAIdPLECOLLECT~:DY-3-8'?B¥ W. MCFADIJgN& SUBt,HTYEDTO &ilowabie Parameter Tested Result/Units l~ethod Limits NITRATg-i{ 1,8 ~/1 to Tests Per~ormed ~ ~ee Special instructionsAbove None Detected ~-~ See S~,' cie Remarks' Above Not Analyzed LI-Less ~i~an, 6T=~[e~tecT an " ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ ~ ,~PHONE MAILING ADDR E'S~ - PROPERTY RESIDENT (If differe6t from above) PHONE MAILINGA~ESS - '- ~ ~ 3. LEN~ INSTITUTION ~ ~ ~ ~ ~ STREET LOCATION 6, TYPE OF R~ESIDI~NCE [~SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATE R.~SU~ELY ,1-~~ IND VIDUAL* [] COMMUNITY [] PUBLIC UTILITY *~~H WELL LOG~, A well log is required for aim wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [[~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date / ~--'~?~- . If system is over two (2) years old an adequacy test is required by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ON ~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE [] PUBLIC UTI LITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER MATERIAL Septic/Holding Tank IAbsorption Area ]Sewer Line INearest Lot Line 5. COMMENTS []~"' APPROVED FOR 'z~ BEDROOMS ~ CON DITIONAL APPROVAL (letter must accompany ~rt~fica;~ DISAPPROVED '--~) f ~C, /~V~"- LEGAL DESCRIPTION 72-010 (Rev. 3/78) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received ~-~, Time of Inspection Date of Inspection ~-'~r~, ~-~-~, \©~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Mailing Address: Property Owner: Mailing Address: 3. Legal Description: 4. Location: 5. Type of facility to be inspected 6. Well Data: A. Type {,~,~ 7. Sewa§e Disposal Sy~em: A. Installed ~ C. Septic Tank: 1. Size Phone: ~r)q_ Phone: ~'~¢-¢~, NO. of bedrooms/s~~ D. Bacterial Analysis B. Installer 2. Manufacturer J D. Seepage Pit: E. Disposal Field: Distances: 1. Absorption Area Total length of lines 2. Material A. Well to: Septic tank Nearest lot line , Absorption area , Other contamination , Sewer Lines B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re ~st for Approval of Individual f .er & Water Facilities Legal Desc~'iption ~0.~ ,~ ~/Ch~) ~ ~~ ~ ~o~ Comments Approved~_ ~y_~ Disapproved Date /~ A~roval :,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) DATE ~ OFFICE PUBLIC SEMI-PUBLIC INDIVIDUAL OTHER REPOR.T RESULTS TO ~ Sofis~fory ~ Questionable ~ Unsefi~fory S~nlfe~y Status. ~/~/~ x~ ~ If an "Unsatisfactory" or "Questionable" status i~'i~icafed CITY ~ ~ ~ you should take rmmediate action ~ recommended below. treat this wa~r as ouHined iff the encl~ed leaflet .... Drink It Pbre." S~PLE BY ~J ..... 2, I~crease,~blorlnation'~ffic~y=~meet recommended residuat~ndards .' ~ ,~ " ' ' .~- ~ Determi~ source ~-contami~tlon and take a~ion necessary to,maintain 'DATE COLLECTED //',-' "~ "'/'~) TIME COLLECTED- ~ pm-j asafewater,~_~.;~Otal~tmes ~- . . From Tap ~ :~th~om T~' ~ ~semen~?~t "' ' 3/Check :~orinafion and' ,o~er mechenlcal equipment. 'Make Certain jrt ~ . , f. un~oning p~opedy. -- ~.. l~.qft~c~ng~.equ~pment'a d,s,~qctmg~res,~al ,s'-nm::ebtaine~ .~lease. . 5:. This ~ a.su~c~ wafer source.and subject to: p~lution by..man and ani.mals.~ S~URCE: .... .~ Spring ~ Cistern ~.~ Other .Anappcoved-water ~upply ~ource shou~be.developed. Dug Well'or .Ci~ern Con~ructiom . ~ ~.Brick or' . 6. Improve your ~ spring. ~ dug well ~. driven well Wale- ~ Wood ~ Co~rete .~ ~'Me~[ ~ T~ ~-C~nc~6 . ' Top- ~ Wo~ ~ Co~rete --~:Me~l - ~ Open Top ~ drilled we~ ~ cistern LOC~TION: ~ In Ba~em~t ~ ~sement ~ ~.Un~r House ', 7.; Relo~te your~well to a safe I~afion 'in relationship to your sewage. ~. ~ln Yard~ ~ Other ~ dlsposalsystem. ~ see enclosure DISTANCE TO: .or O~er',Dminage pipe. · Fe~. To~ , "~ 48~,,S~ple t6o long in tran~b 'sampe should fiat :be o~ ~.hou~, old at, Tile Seepage C~s- - ' Find'.. Fe~. Pil ' Eeet~' P~ol" ' EeM. ~[~ ' ~eet. '* examination to in~cate refia~e.results, ~ease ~end new sample.-. Other.Possible ' ~ Baffle Bro~n in transit, please send new sampl~ Sourc~ of Contamination ~ERIAL: Bui~ing Sewe'~ - ' ~. ~asl .~ .Wa~ ~ Tile ~ ~ Fibre ~ As~stos ~ . . iron ~ 'C~ent ':' 9. Conta~ yo~r-ae6rest ~ Local Health'Department or. ~ .Alaska. 'GENERAL: Does Water Become Muddy. or DiscOlored? When? [] Yes .. J~], NO Diameter of Well Depth F~ee.t. Well 'Casing Material Diameter .Depth Length of - ' Water Depth ':~ Drop Pipe- From Bottom Feet~ PUMP LOCATION: [] In Well []BasementOffset In [] In Basement [] 'Roomln Utility. '.' On Top [] Of Well [] O~her PURPOSE OF EXAMINATION: Illness Suspected? [] Yes [] No' New Source of Supply? [] Yes [] No Repairs to System? [] Yes ,[] No ' Division of Public Health, sanitation office for. bulletias, consultation and assistance~ · :SANITA'RfAN~S REMA:RKS Signature r'~;'~ ®L READ INSTRU_~..IONS ON REVERSE SIDE BE FO R E COL LE CTI:NG SA;MPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Date Received Time Received pm Lab. No.. Lactose Broth.24 hours ''~ .----10cc .__l°cc J --1°cc ,,---1°cc J 10cc.~ 1.0cc 0.i ~:~ 48 hours .'R- .., Brilliant Green ;,,, .-: 24 hours 48 .hours .. EMB. AGAR · Lactose Broth, 24 hrs. · 48 hrs. Gram's stain Coliform Density.. · (Most probable No. per 100cc.) MF results This ana ysis indicates Colif.orm Organisms to, be: ' Present 'GREATER ANCHORAGE AREA BOROUGH' Department of Environmental Quality 2330 "C" St., Anchorage, Alaska 99503 - 274-4561 .REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Ins'pect~on: _~CMRO VA FHA CONV Property .Owner:-~./.~ ~. ~/~ '~? ~ f.~~ ' . ~,.. Mailing Address: Phone Type of Facility to be inspect'ed: Water Supply Type of Supply: .Public Utility No. Bdrms. Individual If Individual, number of dwellings presently served ./ if Individual, depth of well Sewage Disposal-System Type .of S>stem: Public Utility individual (on-site) If individual, date of installation t of Environmental Water and Sewer Questionnaire Subdivision Owner's Name: Mailing Address: Questions: 1. How many bedrooms are now in your house? ~ 2. How many bedrooms were in the house at the time of purchase? 3. Were the basement bedroom walls "roughed in" at the time of purchase? 4. Was the basement bathro,~ plumbing "roughed in" at the time of purchase? 5. Did the realtor or builder inform you that you would have to enlarge the existing sewer system if you finished the basement bedroom (s) ? 6. If on a public water supply, do you always have an adequate supply of water? /~/~4~ 7. Is the pressure always adequate?. 8. Who was the builder? ~/¢~'~,~c// / 9. Who was the home purchased from? _~'~' ~-/ y/ ~y/~ OTHER COMMENTS: