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HomeMy WebLinkAboutT12N R3W SEC 9 LT 89 PTN NE4 (MID LT)#0 14 4=1, 311 cm 09 Municipality of Anchorage Page of .3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SWO 100 (5 PID Number: D I —311 —09 Name: o$iETrT 5T' f v_P__oGv_ Wastewater System: 13New -13Upgrade Address: ogSlo P13B[TCr IoP po)kD 9g5iABSORPTION FIELD Phone:� 3 � 6 Z78 No. of Bedrooms: m � P6eep Trench ❑ Shallow Trench ❑Bed D Mound ❑Other LEGAL DESCRIPTION Soil Rating. /- t[� Total Depth from original grade: GPD/Sq, Ft. I�r LOt ��� _ofk. `t MID iv o� PAT Depth to pipe Ignan from original grade: Gravel depth beneath pi 0 r Nim Ft. • Ft. Township: (�` 1 1V Range: �, ` ' W Section: q / Fill added above original grade: '%ej 5 Gravel length: q 78 • Ft. Ft. WELL: New ❑Upgrade Gravel width: 5 Number of linea: I Distance between fines:;�J`` I Ft. Ft. classification (Pnvate, 0.8,C : Total Depth: Cased To: Total absorption eros: PIp� material: _500D, RI V OD Ft 00 Ft. IT� SO Ft. FMP4' ik - tfA* 0;Z- Onller. M1"Lr� �J�Pump DateDniviim A_7_2_ 0i Static Water levet installer. Date instaued:�M'' -2&O V S 1rt F-N Yield: (Z Set q3 1 Casing Height Aw" Ground: Z TANK GPM Fl Ft. SEPARATION DISTANCES kSeptic ❑Holding ❑S.T.E.P. To From Sepik Abwrptwn uft Holding aiielianrivate, Manufacturer. I I _r, ,�, NC{•tC iz&tGr Capacity In gallons: 1 eco Tank FWW station Tank sewer Linea Welt, 108r 12-pf � n1ot3G (]pf _I Material: S�yL 11LL�� Number of Compartments: � Surface NSE LIFT STATION Lot' Line ^ !N 1 p f ��r w� i�f Size in gallons: Manu r. Foundation 145i, ?...�J f "CsG k O 1 "Pump on' level at: 'Pum evel a . Hign water alarm at Curtain ,v.�EE Pump Makes Electrical Inspections performed by. Drain Remarks: BENCH MARK Pu' W- s s Ac Loudon and Description:e srrXwA24-_ (2 WZ7s-r su>C Cel )s (tr7� co -3 M'av YaL'tt<rs D� �sg l �JGV / Z5 CA4&CgCMT) . 4eyS� yv AS , ,_ ey� Assumed Elevation: n ca f- Fr ENGINEER'S SEAL ou SEL' Rsc (' ey. SEE CIPU11 JA11 �-SiAl' ( PLAKI • � OF A�,9o�p o �•....... %XlSil}.)C� WeLL DL'C L( I ,t- -CA 5�0� Inspections performed by: Dates:1s -01 • D 6a-w 2n 2-25 -01 D� LENT P. EATON7� Department of HealtA and Human Services approval% CE-9126 00 '••... d� Reviewed and approved by: Data, Z-27-D/ d�p�000� 72-013 (Aw. Well MOA 25 WELLS TO NORTH APP. 170' N 90'00'00"W 140.00' { ; SEPTIC TO N. APP. 130' FROM NEW WELL �� ■p I I � _' I. _.,• Duct � RADIUS �__ F House A N STI 18.8 67.8 ST2 24.6 77.8 " O 80.6 CO2 � 81.1 CO3 30.0 65.5 C04 80.2 137.8 MTI 0 67.0 MT2 o0 136.3 o er;ae WN N I Z Q LOT 3 SP i N/ATE.snmau r4k) lo'y o i J 1 � j I i b MT2, I � . /CO 1 &2� WELL TO SOUTH +200' ll� NOTES: NO NEIGHBORING WELLS +100' NO SURFACE WATER +100' NO KNOWN CURTAIN DRAINS Go ww j¢CC-CW%*0N[D MUL Distances (feet): House A House B STI 18.8 67.8 ST2 24.6 77.8 C01 27.2 80.6 CO2 28.0 81.1 CO3 30.0 65.5 C04 80.2 137.8 MTI 29.3 67.0 MT2 79.1 136.3 WELL TO SOUTH +200' SOUTH LOT SEPTIC AREA PAGE 2 OF 3 SEPTIC PLAN ASBUILT GAL: T12N R3W S9 LT 89 PTN NE4 (MID L J OWNER:` BOB STURROCK DATE: 02/26/01 SCALE: 1" = 40' BRENT P. EATON, P.E. 2670 BROOKSTONE LOOP ANCHORAGE, AK 99515 PH. 229-3777 n =3 WELL a TEST HOLE EXISTING STAND PIPE EX. TRENCH DRAINFIELD NEW TRENCH DRAINFIELD ° NEW CLEANOUT (CO) • NEW MONITOR TUBE (MT) DESIGN ONLY a+ K01 I a 0; o; J� 01 Rll i>7 Q SIDEWALK ® WEST SIDE OF HOUSE ASSUME ELEVATION a 200' 202.4' BOT. EL 191.9' GAL. TANK 7 BOT. EL 191.9' •o • o o °• o o • o 0 • • ° .0 o4L00e ° o o �4� p n o o° o • o •o �O o 0 •o • o o SEPTIC PROFILE ASBUILT LEGAL: T12N R3W S9 PTN LT 89 NE4 (MID LT OWNER: ROBERT STURROCK DATE: 02/26/01 NOT TO SCALE BRENT P. EATON, P.E. 2670 BROOKSTONE LOOP ANCHORAGE, AK 99515 PH. 229-3777 d NEW PERFORATED PIPE IN PAGE 3 OF 3 T A BREN�ATON ti'•• CE -9126 02/26/2001 19:14 9073446278 RCSTIRROOC PAGE 01 HEM DRJLUNG 3310 AKULA' DRIVE ANICHOUG9. AK 99616 (907) !46•0599 : 1T . . WATER Y UL RECORD STATE b► ALASKA DEPARTMENT 0► r ATURAI RESOUR[S ONI1teN of 4161991"1 • OferNT6gel SurN)1 ` I 0011146 Popoff Ne. e LOCATION 01 w[LL (rleele elwwttl *Sight 6, 11 of it.) A -.e. L. Ne. 1., Sepa%@ 9041,10146 Lot Pep u. t/641,1. dN11N N6 TAw"Ghlo 411[.• ./Q 10111110• �.1�.1— 1— ep _V 1.. OIt TAN09 AND OIe[CTION /NON *049147IR9[Cf ION[ ran Tj3�_ S=am 9 �r. P9 7) /vcc�. ;t c r] Hreel Adenit age area 1t well 4.0/41160 i. ewe9N Or W[LL. 4 .. 1q/i SiwA.A f l 8 `.(6 1. WILL 1000 rLeet Palo* .Nee •11611TIN Ts. 011. • WRL p[1TN1 [I") Cf4. OQ1 I A V COMOLCTION 4w� - �.i 0 Av[v OJe11e411 (3 IIe11 ❑ /QII I IH 4�4 114 S*v T. Ut[: ®Oewleft$ 13 ►i111e 014th C Iw/Nlrr !l 13 IrrIf111w Q 114►Iry1 0Oeww9,1N1 1`7Telt ' well 9490: 1. CA1 Nfl O TA/else/ WU4ed 4Iw..�lw. N��to. Depth r41941—6e./f/ �. r 1100. M. It. Oeyl1 Qbtq fl, L rIN1/M Or 118161.1 i Ota/NIIL .flat LIA[Mt l« *beam I1. MH I1. Oa Nf111Af lereltl llll 10. 9TAT14 04794 L[Y[t o Dole O Above 1/ 9014T Mea systole • [1A)IwIAf Ned• . 11. rUN►IN0 L9rIL 11*e11T Iu1 JW1114 led TICLO ' II. dor �6�t, r.gMf.,r�f•r. N. _el. Nbt �lY1. rlw/1e1-1.0.0. • 19.001OUTINO Well 411011e4t Tee O Ne 10119,11: 0N4e1 Oewea Q e11e.i q. ru10n (If Ive1146N) vs,' Lomita d 060 ►IN _YL:_l 1, w0Nl1r f•0.w, 9w►w, 0461 06 i MIII1It41 O a)&##O 14 e110A1U4. ; i11. , �� A/'� WATIR W9LL CONTNACTOOr[ CI NTIIICATIONI Il. Welt 7909,660. ems• I O O I Twl T. 1 Tee •IIIc• •ler f Iob111ww .e4 Ule ybq N Le. N 1.. 6.e1 11 w1 tae•d./p 0.4 611101; .1 i Ae 10,9..1 ewe t N.w. fUL ew16U LI..... NVwgr ,• \ 6110911 • I • A.1.rle he .e. M.11.1 •• •�r.•rr.�r. y ee11� . L U 0900 Oe•WMA III/111 t ' •�.�•C=et.111.1e.14.: WNI/[.1191. seat. .INR •001110. CAM4M•eeelewer Development Services Department .. 0 Building Safety Division O On -Site Water & Wastewater Program 4700 Bragaw Street L P.O. Box 196550 Mark tae ieh Anchorage, AK 99519-6650 Mayo www muni nrn/on<,Te (907)343.7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue:9/0 Parcel ldentificationNumber: d4311'6 I Legal Descriptionn 7 Property Owner Name & Address: /r t867 / rX ,1614t f t/O 107J �„ic,v. /4.t, 99to7 mp Installation Date: e-- 0,7 Pump Intake Depth Below Top of Well Casing: F c feet Pump Manufacturer's Name: %2!� � j'p C -&`r' Pump Model: G NS /2 C3 C Pump Size Sly hp Pitless Adapter Burial Depth: / C feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion & Yes ❑ No Method of Disinfection: Comments: Pump Installer Nan ANCHORAGE WELL & PUMP SERVICE, INC 330 EAST 76TH AVE. ANCHORAGE, ALASKA 99518 (907)243-0740 - FAX:(907)243-0742 E-MAIL: pumpmanjim@att.net Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 (wlcc 16C /tisPIE ria�- NR/N6 jrNT1KF- TNSTAW r'0N ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Upgrade Permit Number: SWO10015 Date Issued: Feb 02, 2001 Expiration Date: Feb 02, 2002 Parcel ID: 014-311-09 Legal Description: T12N R3W SEC 9 LT 89 PTN NE4 (MID LT) Design Engineer: 0081 Brent Eaton, PE Site Address: Owner Name: BOB STURROCK Lot Size: 30520 SO. FT. Owner Address: 8818 ABBOTT LOOP RD Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE , AK 99507-3930 This permit is for the construction of. Q Disposal Field Q Septic Tank E] Holding Tank E] Privy Q Private Well ❑ 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. 2-23 EVISeO DE5.j( A9)rEA 2-/4 -O/, WATER W E[ L Skov_ 9E�E -YONAt13/ONE1'f PRIOIj TO CO.vJTRNr r, *" OF ME 1OR000tpp SYS! -em. Received By: I ,- —d— Issued By: Date: Date: 2 " 20 -0/ ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Feb 02, 2001 Expiration Date: Feb 02, 2002 Permit Number: SW010015 Parcel ID: 014-311-09 Legal Description: 12N R3W SEC -9 LT 89 PTN NE4 (MID LT)T' Design Engineer: 0081 Brent Eaton, PE Site Address: Owner Name: BOB STURROCK Lot Size: 30520 SO. FT. Owner Address: 8818 ABBOTT LOOP RD Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE. AK 99507-3930 This permit is for the construction of: Q✓ Disposal Field Q Septic Tank E] Holding Tank E] Privy El Private Well El Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By Issued By Date: 7 2 C2 It Date: 2-2-0/- MUNICIPALITY OF ANCHORAGE r Department of Health and Human Services Y On -Site Services Program t N j /)Q r n� 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Feb 02, 2001 Expiration Date: Feb 02, 2002 Permit Number: SW010015 Parcel ID: 014-311-09 Legal Description: 12N R3W SEC -9 LT 89 PTN NE4 (MID LT)T' Design Engineer: 0081 Brent Eaton, PE Site Address: Owner Name: BOB STURROCK Lot Size: 30520 SO. FT. Owner Address: 8818 ABBOTT LOOP RD Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE. AK 99507-3930 This permit is for the construction of: Q✓ Disposal Field Q Septic Tank E] Holding Tank E] Privy El Private Well El Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By Issued By Date: 7 2 C2 It Date: 2-2-0/- Municipality of Anchorage Development Services Department % Building Safety Division., 1 On -Site Water and Wastewater Program ,. .. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 owwvw.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION L4 FOR A SINGLE FAMILY DWELLING Parcel I.D. 0tL4 1✓ 1 Permit Number SWO/0015 Property owners,)B Day phone Mailing address (1) Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) T afJ �� 59 LOT 89 PTA NE % top it) Legal description (Section, Township & Range) Lot Size qD s, Sq.Ft. Number of Bedrooms O\ THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and WellWater Storage ❑ Sewer Upgrade 4 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information Is correct. I further certify that this application is being made for a Sinale-FamlIv DvMVr6_,+iJ Is in accordance with applicable Municipal Codes. of pr9perty owner or authorized agent) Permit Fees: TWaiver Fees: _ Date of Payment:30 O Date of Payment Receipt Number: /r% Receipt Number: (Rev. 12/00) WELL 105)eA4,1' d9t6 moo 02/zo/0/ BRENT P. EATON, P.E. CIVIL ENGINEER 2670 Brookstone Loop • Anchorage, Alaska 99515 • Phone 229-3777 February 26, 2001 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Subject: T12N R3W S9 PORTION LOT 89 Permit No. SW010015 Dear Mr. Cross: This letter is to request a change to the existing permit referenced above. The system as initially submitted has been constructed. However, due to complications between the property owner of the subject property and the property owner of the lot containing the easement, that system will not be used at this time. The inlet pipe will be capped and the entire system, including the tank will be left in place. The well at the subject property has been moved (see attached plan), giving sufficient room for construction of the new system as shown. will be on site several times throughout construction of the proposed improvements should there be any change in below ground conditions that would require a design modification. A Plus Home Services will be installing the system, Carl is out of state due to a death in his family. If you have any questions, please call me at 229-3777. W ILDERNESS%REVISEONARRDOC BRENT P. EATON, P.E. CIVIL ENGINEER 2670 Brookstone Loop • Anchorage, Alaska 99515 • Phone 229-3777 BPE Project No.: 01-02 Calculated By: BPE Date: REVISED February 26, 2001 Legal: T12N R3W S9 PORTION LOT 89 Test Hole No. 2 Single Family, 5 Bedroom Dwelling Deep Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 750 gallons Percolation Rate = 25 minutes per inch Wastewater application rate = 0.6 gallons per day per square foot Required absorption area = 1,250 square feet Gravel depth = 7 feet Required length = 90 feet Total Excavation Depth = 11 feet a WELLS TO NORTH APP. 170' N 90000'00"W 140.00' 8 SEPTIC TO N. APP. 130' FROM NEW WELL S S 5 RADIUS 100' WELL _ �,.. W P�`N' EX. SEPTIC TANK APP. LO AT ON REMOVE & REPLACE W/NE 11501 GAL. OLUDOUDBLEO0' WELL AS WSTALTANK CLEANOU�SUS UTLETHOW� aH keg LOT 3 MAY HEICHTS SUB. 4. h i F -Tv i 1,,ri.m w. Unume -0-11, K KK l WELL TO SOUTH +200' WELL TO SOUTH +200' NOTES: SOUTH LOT SEPTIC AREA NO NEIGHBORING WELLS +100' �� NO SURFACE WATER +100' NO KNOWN CURTAIN DRAINS EXISTING TRENCH TO BE ABANDONED PLAN REVISED 02/26/01 SEPTIC SITE PLAN LEGAL: T12N R3W S9 PORTION LOT 89 OWNER: BOB STURROCK DATE: 02/01/01 SCALE: 1 " = 40' BRENT P. EATON, P.E. 2670 BROOKSTONE LOOP ANCHORAGE, AK 99515 PH. 229-3777 14*13(ml ITT Q a Q O a 0 0 J H H 0 w w WELL ® TEST HOLE EXISTING STAND PIPE �- EX. TRENCH DRAINFIELD HH PROP. TRENCH DRAINFIELD ° PROPOSED CLEANOUT (CO) • PROPOSED MONITOR TUBE ONLY Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 `L" Street. Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST STf I�QDGIL ?giS/C PERFORMED FOR: DA PERF( 1 LEGAL D J RIPTION: Township, Range, Section: Tt� 9. 3W S PplC, lEN L.a DEPTH ���sn sc sLOPE SITE PLAN 1 /i 2- 3- 4 34 v a 5- 6- 7 67 8 °• • o 9 10 •. tt • o 12 O O 13 14- is- 16 - 0 415 16O 17 0 18-- 19- 20- COMMENTS 8 1920 COMMENTS i WAS GROUNDWATER ENCOUNTERED? S l LT{ 51t, --Lo ENCOUNTERED? WlcL1VaL IF VES, AT WHAT L DEPTH? O P E Oeptlt to weer AIIcr Mmtumg7 r,11A Date 9-?� OI Reading Date Grou Net Time Time Depth to Net Water Drop %11b/CI •yS l• ` w '+ I • D r l0 :CO N a S.Zy 1 5. 91 r PERCOLATION RATE �C (mmutevmch) PERC HOLE DIAMETER N �0 TEST RUN BETWEEN v FT AND 9 FT PERFORMED BY: FJfzry'r- F l' �r- I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE �• �-3' oI 72-008 (Rev. 4,85) Hea_ '~UNICIPALITY OF ANCHORAGE and Environmental Prote¢ Fourth Floor West 825 L Street ~nchorage,. Alaska2 9950 ~4,~ 264-47 0 ~ / INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM DISTANCE ¢ ~ ] ~:~/~ NUMBER OF -- '~] '';N ...... tJRFR ~¢~ MATERIAl ~ ~ COMPARTMENTS INbIDE LENGTH ...... INSIDE WJD] H ..... LIQUID DEPTH LIQUID CAPACITY /~ALLON5. TILE DRAIN FIELD: At~SORPIION AREA ..... $Q. FT. [ ENGTN OF EACH LINE DEPIII: lOP OF TILL IO FINISII GRAE)EJz~ MATERIAl_ BENEATH TILE._ 7 ~ ABOVE TILE ~ IN, SEEPAGE PIT: OIAME'FER OR WIDTH LENGTH__, DEPI'I I Log Crib Rings BUILDIN(~ FOUNDA FION Crib Size: DIAMETElt .... DEPFH. DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE ABSORPTION ARL-A (WALL AREA) .SQ. Fl'. Well Class: S,~ Depth: Well Distance To: Lob Line Bldg: Sewer Line: Pipe Materials: ~t.~ # of Bedrooms: ~ Installer: Remarks: t"IH-L d .FIILI[ LLII_:H J.L., ",l L.,I~: I..~ I-[ L_ '1 J. I'::. I:: I HI.:. L[:'.I",IL~ I H L.) .L r'lbl'.4:::, .I.i..IF,i l :::, I I'-11~: L:I::.(',I[~ I H i:. ]L J",l I-"E: :: I .) LI~- ' ] I-'if-". I I'~E:.'I",II.::H - U/'¢. 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I ,v~UNICIPALITY OF ANCHORAGE DEPAR'rMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-550, Anchorage, Alaska 99502 276-2221 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: /:~ ~ ,,~ LEGAL DESCRIPTION: SLOPE 2 SITE PLAN 11 12 14- 15 16 17 18 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) FT 72 008 (7/76) 7-A certain 'parce~i~pr tract of l~mni lyJ.n&' within Section Lot Ei$:nty-r~in~ (89), Section 9, To,.mship 12 North, Ihu%'e ~ West, Sewar5 Zeridi~., Alaska, Records off the ~mchorage Recording District, Third Judici~ Disvrict, State of ~aska, more particularly described as follows: From the Southeast (SE) co~ner of said Section 9, thence North 00°0~' Wes~ 899.55 feet 2o a point on the exist~g' center line of Abbot Loop Road; thence Yfest 50.00 fee~ So '~he .tz-~e point off begi~inff; thence West 140.00 feet 2o a point; thence North 00°03~ Wes2 218.00 fee~ to a point; thence East 140.00 feet to a point; thence~Sou~h 00°03~ East 2!8,00 f~e2 to the 2rae poiu~ of beginning. EMENTS OF RECORD, OTHER THAN 'SE SROWN ON THE RECORDED P'.,C"TJ-~['.~'~' eye,/ T ARE NOT SHOWN HEREON, AS-BUILT NO CORNERS SET THiS DATE I hereby certify that I have perforzned a Mortagee's in- spection o~ the following described property: Anchorage Recording Precinct, Alaska, and that the improve- ments sitnated thereon are within tile property lines and do not overlap or encroach on the property lying adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Da~ed at Anchorage, ~aska FRED WALATKA & ASSOCIA'£ES Engineers and Surveyors }r • . 4, G 8iJJ Municipality of Anchofe444*. , . ° `°On-Site Water and Wastewater Prog / - .. l "�� (907) 343-7904 5 a.ETY , ,�„ 4. 4 . Certificate of On-Site Systems Approv = - Parcel I.D. 014-311-09 Expiration Date: 7^2/-IQ 1. GENERAL INFORMATION: Complete legal description T12N, R3W,Section 9, Lot 89 PTN NE4 Location (site address) 8818 Elmore Road*Anchorage,AK Current Property owner(s) Behrooz Raeesi Day phone 602-8890 Mailing address Real Estate Agent Mike McClane Day phone 227-1533 2. TYPE OF DWELLING: q4 EI Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank 0 Community Class Well 0 Community 0 Public Water System 0 Public Sewer ❑ WaiverNariance request for: Distance: Received by: �� Date: rA ,/18 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 5? c,, - Waiver Fee $ Date of Payment l't- .i - 1 i? Date of Payment Receipt Number ti1Iak G Receipt Number COSA# 0SC-\�1\6b Waiver# • 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: y /1 BVI 8 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system , 0 in accordance with the guidelines and regulations established by the Municipality of Anchorage and o6 4� o� Or .; � p� industry practices. The reported results describe the condition of the system/s on the date/s of the Oo,'`•• ' �S4-1 evaluation. Separation distances were measured to readily identifiable features. Hidden defects or O T. .. ...-7_ . encroachments may exist that were not identified during the evaluation. The operational life of all wells ��* — 1' K' .�00 and septic systems depend upon a variety of variables, including but not limited to, soil conditions, /, groundwater levels (that may fluctuate during the year), quality of construction (materials and /i rA workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and j ... .. are outside the control of GEG. Satisfactory test results do not guarantee future performance of the / � system/s;therefore, GEG makes no warrantyh ., '' "i es s.: G (express or implied)regarding the future performance of d,1'�9 '•• CE-795 „OG the well or septic system. GEG makes no representation whether an alternative well or septic system VVV s z can be installed on the property in the event either of the current systems fail to perform adequately in G�/F, •••11/-1 i.• •� A5� the future. The content of this report is for the sole benefit of the person/party that retained GEG to %Zeo.prp ess opo\.• perform the evaluation. Reliance upon the information provided in this report by any other person or 4��00�0�� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE \QP-\I.Y Gt , vCy K System #1 Approved for bedrooms J� ON-SITE G . System #2 Approved for bedrooms S WATER AND �" Disapproved WASTEWATER o c� PROGRAM Conditional approval for bedrooms, with the follow113.9 stipulations: ��• 3k "Pr..c !zG\I\C. • � _ t^ — r / Original Certificate Date: y^ -l 4 P-7 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 Nitrate Advisory /r Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: T12N, R3W, Section 9, Lot 89 PTN NE4 Parcel ID: 014-311-09 A. WELL DATA Log A Well type Private If A, B, or C provide PWSID# N/A (Y/N) Yes Date completed 2/21/2001 Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes Total depth 100 ft. Cased to 100 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 2/21/2001 4/9/2018 Static water level 80 ft. 82.3 ft. Well production 12 g.p.m. 5+ g.p.m. WATER SAMPLE RESULTS: pp Coliform cn colonies/100 ml. Nitrate S• (, arng./L. Collected by: GEG. Ltd. Arsenic: NCug./L. Date of sample: 4/9/2018 B. SEPTIC/HOLDING TANK DATA *Inside house per 2005 COSA by Lars Spurkland, P.E. Tank Type/Material Septic/Steel Date installed 2/24-25/2001 1500 2 Cleanouts Y/N Yes Tank size gal. Number of Compartments ( ) Foundation cleanout (Y/N) *Yes Depression over tank (Y/N) No High water alarm (Y/N) N/A Date of pumping �f l Pumper •► , t C. ABSORPTION FIELD DATA Date installed 2/24-25/2001 Soil rating p.d./f or ft2/bdrm) 0.6 System type Deep Trench Length 78 ft. Width 2.5 ft. Gravel below pipe *8.1 ft. Total depth **13.5 ft. Eff. absorption area 1264 ft2 Monitoring tube *Yes Depression over field No Date of adequacy test 4/9/2018 Results(Pass/Fail) Pass For 5 bedrooms Fluid depth in absorption field before test 0 in. Water added 960 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) None Known If yes, give date - *South MT extends approximatley 7.97 feet below invert of distribution line North MT extends approximatley 7.06 feet below invert of distribution line **Below existing grade at South MT. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at .• wa er alarm level at in. 9- . " Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75 + Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation *5'+ Property line 5'+ Absorption field 5' (Assumed) Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *8'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain None Known Wells on adjacent lots 100'+ F. COMMENTS *Met code at time of installation **WR#OSP121384 oo�oop‘ G. ENGINEER'S CERTIFICATION �� OF A X04 oP . ..si000 I certify that I have determined through field inspections and , if/\ ..00 review of Municipal records that the above systems are in V conformance with MOA COSA guidelines in effect on this date. i0 Engineer's Printed Name JEFFREY A. GARNESS vOn1 Gar ss, � 1 9's I ' • Date II/lit t3 p�e,,e 4•�E1 :.l'1°0,4,"\ / a rofessio�ao �O�O000�� #AECC884 (Rev. 11/05) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ( • `. I 907-343-7904 On-Site Water and Wastewater Section \ Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # oSC181150 Subdivision: T12N R3W Sect 9, Block: , Lot: 89 PTN NE4 A water sample revealed a nitrate concentration of 5.68 milligrams per liter (mg/L). 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. Mailing Address: P.0. Box 196650* Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage . r On -Site Water & Wastewater Program - 44' (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 014-311-09 Expiration Date: AO IS° .3 1. GENERAL INFORMATION Complete legal description T12N, R3W, SEC 9, LOT 89 PTN NE4 CMI© gr Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 8818 ELMORE ROAD *ANCHORAGE, AK 99507 RICKY & BEVERLY SMITH Day phone 8818 ELMORE ROAD *ANCHORAGE, AK 99507 344-2519 MIKE MCCLANE W/ PRUDENTIAL Day phone 227-1533 ❑ Single Family (w/wo ADU) E Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site N Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ golo f DateofPayment_ fologha c Receipt Number C�F 3:�a COSA* 0SC1P\Lffl Date: Waiver Fee $ 0 Date of Payment I®It�`L i�a CJ`s Receipt Number 0, a6 Waiver# o51P 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. l further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 10 1 2 ( 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 DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system These conditions are outside the control of the evaluator of the system. Satisfactory te6 results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by an other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for S bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Wel low Advis Other Original Certificate Date: (Rev. 11105) If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: T1 2N, R3W SEC 9 LOT 89 PTN NE4 Parcel ID: 014-311-09 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 2/22/01 Sanitary seal (Y/N) YES Total depth 100 ft. Cased to 100 ft. FROM WELL LOG Date of test 2/22/01 Static water level 80 ft. Well production 12 g.p.m. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 10/18/12 81 6.59 WATER SAMPLE RESULTS: Coliform a colonies/100 ml. Nitrate mg./L. Collected by: GEG. Ltd. Arsenic: IJ D ug./L. Date of sample:, Q [ '7Z1 -2-t B. SEPTIC/HOLDING TANK DATA *INSIDE HOUSE PER 2005 COSA SUBMITTED BY LARS SPURKLAND, P.E. Tank Type/Material SEPTIC/STEEL Date installed 2/24-25/01 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *NO Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 10/20/12 Pumper MCDONALDS PUMPING SERVICE C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE TO BOTTOM OF NORTH MT Date installed 2/24-25/01 Soil rating (g.p.d./ftcr lbdrm 0.6 System type DEEP TRENCH Length 78 ft. Width 2.5 ft. Gravel below pipe 8.1 ft. Total depth * 1 1.16+ ft. Eff. absorption area 1264 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 10/18/12 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 0 in. Water added 950 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 750+ g,p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankffi t station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *8' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *SEE ATTACHED WAIVER REQUEST THERE IS NO DOCUMENTATION IN MOA RECORDS REGARDING DECOMMISSIONING OF THE OLD WELL. G. ENGINEER'S CERTIFICATION I cerfify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date liuhq,'I2, (Rev. 11105) A A L-'-� V CE795 P C72!{14;, Municipality of Anchorage P.O. Box 196650 • 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 went .P Departeuent **** VARIANCE/WAIVER REVIEW **** Waiver#: osp121384 PID#:014-311-09 COSA#: osc121488 Permit#: Legal Description: T12N R3W Section 9 Lot 89 PTN NE4 MID LT Engineer: Garness Engineering Group Applicant: Rick & Bev Smith 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 future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ® The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: 11 / Approved by: �&° Ioiq Name of Reviewer •..........................................•................................. Rec#: 08392G Amount: $200.00 Date Paid: 10124/12 **** VARIANCE/WAIVER REVIEW **** October 22, 2012 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Lot Line Waiver Request for T12N, R3W, See9, Lot 89 PTN NE4, To whom it may concern: We request that your department issue an 8 -foot lot line waiver from the west property line to the existing drainfield. The existing drainfield on Lot 89 has a separation distance of approximately 8 feet and neighboring property (May Heights Lot 3) has a separation distance of 10 feet per moa records. In short, the drainfield on the subject lot has a separation distance of at least 10 feet to the drainfield on the neighboring property. We are unaware of any adverse impacts this waiver would have ondjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Tha you for your assistance. M. S. 3701 E. 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Iowo i'-3' yt'Fi7'''cmin omFFF�)11 0� a W m A �.......-..I.. 2 i C K 6 m_ ;�o o? z-��- fIl 1 �o —_ Y i MA q mY O A 90 job "mv gz g _ g 5 @0 Y O F N V W d 9 p I L y A O O O O O O O N Slim 64 11[ 1953 R Nn Sol 1,201 SIR �- a A certain parcel or tract Of land lying within Section Lot 7�i,;hty-nine (89), Section 9, Township Rance North, Rane 3 ;lest, Sew,_' ieridian, Alaska, iecords of the Anchorage Recording District, Third Judicial District, State of Alaska, more particularly described as follows: From the Southeast (3-1) corner of said Section 91 thence North 00003' ',lest 899.55 feet to a point on the existin,�; center line of Abbot Loop Road; thence West 50.00 feet to the true Point of beginning; thence S;est 140.00 feet to a point; thence North 000031 blest 218.00 feet to a point; thence .^east 140.00 feet to a point; thence South 00°031 East 21�8.00 feet to the true point of begiming. CwIfthd 741 -00//•3 -15 -O5 -,?W. ^^� � t�'i 001Ur1i tlT TMK DAtl OF At'\� r 1QS�''.....,,,, li r ,, •~•ti9i�A 0 49 L+. * i ;d...� .....�':. .:i...01 , ,.. Frod Wulotkc a 0 �J;. 4, NO 32555 IF � +qF•a''. GJ�L� ��t'30t 1 Dap ••.......... P�r, EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. rj�Ii•3mg4a - 1%w 306,'4 I hereby certify that I have performed a Mortagee's in- spection of the following described property: L�L a ov Anchorage Recording Precinct, Alaska, and that the Improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska/ thi TN day of_b I 19 FRED WALATKA & ASSOCIATES Engineers and Surveyors 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 -y"!4 CERTIFICATE OF HEALTH AUTHORITY APPROVAL '04y FOR A SINGLE FAMILY DWELLING Parcel I.D. 014 - 311- 01 1. GENERAL INFORMATION Complete legal description HAA# ()5CDI(/_-) Expiration Date: SEC q LT 89 Location (site address or directions) gels Al., N- Lm� Roar Current Property owner(s) Ro6t STU RROCK. Day phone 344- 6278 Mailing address e$16 Aho}( Lop Lending agency Day phone Mailing address Real Estate Agent J4�ie, pace. Day phone 5GI- `/94�( Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site 9 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Weil ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality, oG nchorage files and from my investigation and inspection, the on-site water supply and/or wastewater'd'sWal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regylatloris in effect at the time of installation. "I. .: F''101aiti'te of Firm _ .$nurkls Address IDS W 15µk Engineer's Printed Name 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory 0 (Rev 01N2) 0 bedrooms. Phone 29-391(0 , bedrooms, with the following stipulations: X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage • Development Services Department 1 Building Safety Division On -Site Water &Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: TILN RW SECS LI 'B9 /VEi¢ ParcellD: 0Iq_30-09 A. WELL DATA L] G M ID L7� Well type Frio Je. If A, B, or C provide PWSID # = Well Log (YIN) y Date completed12-22- O1 Sanitary seal (YIN) Y Wires properly protected (YIN) Y to Total depth 100 ft. Cased to I DO ft. Casing height (above ground)in. FROM WELL LOG AT INSPECTION Date of test �Z'ZZ"01 I-y"OS Static water level 180- ft. 03 ft. Well production 12 g.p.m. 7 g.p.m. WATER SAMPLE RESULTS: Coliform _0—colonies/100 ml. Nitrate 1.91 mg..Ll -A.. Other bacteria _ 0 colonies/100 ml. /t Arsenic: — mg.A. Date of sample: 5 Collected by: � uo '; R�'^ 6J C ^4 B. SEPTIC/HOLDING TANK DATA TankType/Material Anc4g&gt ,,mk lSFce Date installed Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) Zns:de Foundation � cleanout (YIN) aDepression over tank (YIN) n! High water alarm (YIN) I✓ Date of pumping !w UoS _ Pumper A'+ C. ABSORPTION FIELD DATA Date installed I-_Z5-gJ Soil rating (g.p.d./fe or feIbdrm) D_b System type VEEP "1"RENC H Length '7$ ft. Width 2'5 ft. Gravel below pipe ft. Total depth J" _ ft. Eff. absorption area I Zbyft2 Monitoring tube Y Depression over field N Date of adequacy test 1-4-25 Results (Pass/Fail) PM65 For 5 bedrooms Fluid depth in absorption field before test Q in. Water addedi�z gal. New depth i in. L he Ns1w:n Elapsed Time: _ min. Final fluid depth Q in. Absorption rate >= 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) A✓O If yes, give date '—" D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on' level _ in. 'Pump oft levet a ---Jin. High water alarm level in, Datum Cycles lest Meets alarm 8 uic+rcr t requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot . IOR r Absorption field on lot t 121)r Public sewer main N/A r Sewer /septic service line f 90 I On adjacent lots 100 ir On adjacent lots 1004 - Public sewer manhole/cleanout Holding tank Y/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r , Building foundation x I S Property line t201 Absorption field Water main t q5 r Water service line =45 r Surface water /V41 Wells on adjacent lots = 110 r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line = 12 ' Building foundation S3O r Water main SS r Water Service line t .SS Surface water N A Driveway, parking/vehicle storage Curtain drain f% fj Wells on adjacent lots IDZ r F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in ; conformance with MOA HAA guidelines in effect on this date. n Engineer's Printed Name 1 lobGvfy v Lc l.� w6C Date _ _ 11 6 10 i HAA Fee S 30 aO f %S°U Rv.5-H Date of Payment Receipt Number o 6 2 73.E (Rev. 12/01) Waiver Fee S Date of Payment Receipt Number • 1 / i 1 / 1 ' 1 � 1 433 ne�K Zt: I `,V O HCl`- T V - 1.4NAAY W \3 • 24' • plot z J Y yl , I i4r_1<iHEv v` rel %)l hG' I 0 A cartain parcel or tract of lana lying within Section Lot 2ifhty-nine (69), Section 9, Township 12 Borth, Ran;;e 3 :Jest, Seward ISeridian, Alaska, Records of the Anchora;,•e Recording District, Third Judicial District, State of Alaska, more particularly described as follows: From the Southeast (SD) corner of said Section 9, thence North 00°03' %lest 899.55 feet to a point on the existin;; center line of Abbot Loop Road; thanca West 50.00 feet to the true point of boUinnin,;; thence !fest 140 -CO feet to a point; thence North 00°03' hest 21B.00 feet to a point; thence :act 140.00 feet to a point; thence South 00°03' Eaat 218.00 feet to the true point of beCinnino. Correcfcd ,•zz-tiO a}{ AS -BUILT NO CORNERS SET THIS DATE OF At to 10 Fr ',r, ••• w0. 97553 a,• EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED ro7I.3m44y ew PLAT ARE NOT SHOWN HEREON. 3v'�'4 I hereby certify that I have performed a Mortagee's in- specAtion of the following described property: 1-E AA' E`iOyE _ Anchorage Recording Precinct. Alaska, and that the Improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there. to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 114' day of N Y 19 eo FRED WALATKA & ASSOCIATES Engineers and Surveyors OF ORAGE MUNICIPALITY HEALTH & HUMAN O DEPARTMENT of HEALTH d HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0IL4 —V( .09 HAA # HA 010051 dam GENERAL INFORMATION ( / Complete legal description T P-0 P --3u) �� 9 L-� 09 � KC `'f 1µv LT) Location (site address or directions) 0810 ABBoar d x�ff ROAD Property owner IZQSEP-r 9EV ER4TGiL Day phone 344 '62Z 0 Mailing address Reis A-F'6CTF W P -D & 5!RSD7 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 73-035(Rw.1/91) Front MOA171 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 investigatiorrof this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system Is safe, functional and adequate forthe 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 thisInspection. ab l— Name of Firm _ YJR-F9.rT P- V$A I'�C• Phone Address Engineer' 6. DHHS SIGNATURE x Approved for OF Jam': • ON -SIT z : WATER A WASTM J O• PROGR JJ���J ���1ENTSE Disapproved. Conditional approval for Additional Comments M bedrooms, with the following stipulations: Date 2-27-01 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an Independent professional engineer registered in the State of Alaska.The DHHS does this as a courtesy to purchasers of homes and their lending institutions In order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate Is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72-MM".1/91) Back MOA M S19- The lS 6 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division A§ 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: 'r [Z hl (Z3U J S9 Parcel I.D.: 0tq -3(l - og A. WELL DATA fx� V -3r 4 Well type cRuiff-r� If A. B, or C, attach ADEC letter. ADEC water system number t�E Log present (YM) *E i Date completed _ oZ -�;LQ --O 1 Total depth (DD / Cased to (co f Casing height (above ground) Sanitary seal (Y/N) yds Wires property protected (Y/N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION -0 SOS a WATER SAMPLE RESULTS: g.p.m. Collform © Nitrate .:2- • 27 Other bacteria D Date of sample: 2 - 2-7 rJK -rte t - O f Collected by: E�k 1 4::0 B. SEPTICIHOLDING TANK DATA g.p.m. Date installed -%L -Oi Tank size 1500 Number of Compartments Z' Cleanouts (Y/N)-4!-E-5 14 SIITC HousF / Foundation cleanout (Y/N) -K1G Depression (YM) I-10 High water alarm (YM) 0 Date of Pumping ►JAA Pumper 1 �L)q C. ABSORPTION FIELD DATA Date installed 2-2-4-01 Soil raUn p.d m° r ft corm) System type CmP:[FA2xt( Length 16' Width � ' S / Gravel thickness below pipeCS�—Total depth �z / 2 Effective absorption area �a `i Monitoring Tube present (Y/N)* Depression over field (Y/N) Date of adequacy test �_ Results (�M For bedrooms Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.): _ Fluid depth (ins) Minutes later: Absorption rate = a.p.d. Peraodde treatment (past 12 months) (YM) If yes, give date 72-026 (Rev. 3/90)' D. LIFT STATION Date Manhole/Access (YM) High water alarm 'Datum Size 'Pump otf level at' -L4mes iesreo LocA•Clo+.l cF tJt:ll,N$vrii'�+ stiPTlc- E. SEPARATION DISTANCES "1>f nw li ww SEPARATION DISTANCES FROM WELL ON LOT TO: Septiciholding tank on lot 100 I On adjacent lots I G Or-(- Absorption field on lot 120 t On adjacent lots I DU 4 - Public sewer main Pi JA Public sewer manhole/cleanout iJ t Sewer /septic service line 9 O Litt station 0 Ltk SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1 / ' Foundation S Property line %D Absorption field g �I� 1 f -Watem"awservice line `f ✓ Surface water/drainage LA Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: I / Property line to I Building foundation ;Z5 Water main/service line 55 / Surface water NIA Driveway. parkingNehicle storage area 7� r Curtain drain 0 LAWellson adjacent lots 10-2- F. ENGINEER'S CERTIFICATION I certify that I a ete irne Id inspections and review o/ Munldpal recd 67plre in confonnan t M ld Tines in effect on this date. 4 Signature -�� Engineers Name 'p .. ""' CA Date � , � O � CE -02 6 'y,' HAA Fee $ 3co ' 0 0 Date of Payment ' a 7-7— I Receipt Number Q 0 I a / 72-0213 (Rev. 3/98)• Waiver Fee $ Date of Payment Receipt Number ~ * DATE RECEIVED INSPECTION APP~IIINTM ENTel TIME TIME TIME DATE DATE DATE ,NSPECTOR ,NSpECTOR ,,SPECTOR I r MUNICIFAL[T',' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH ~ ENVIRONMENTAL PROTECTIO~NVIRONMENi ) 82~ L Street - Anchorage, Alaska 99~01 J'iIAY 1 1980 ENVIRONmEnTAL SA~ITATIO~ ~IVISlO~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACIL. ITIE~ DI RE~TION~: Oomplote all parts oil pa,e 1. Incomplet~ r~qu~slJ will not be processed. Please ~11o~ ten (10) days for processing. 1. P~OPERTY OWNER PHONE ~AILING ADDRESS PROPERTY RESIDENT(If different from above) ~ PHONE ~c~, ~q' PHONE 2, BUYER ~AI LING ADDRESS ~ LENDING INSTITUTION I PHONE I MA~LING ADDRESS 4, REALTOR/AGENT PHONE ~AILING ADDRESS STREET LOCATION 6, TYPE OF RESIDENCE NUMBER OFtBEDROOMS [] One [z:~Four [] Other__ [] SINGLE FAMILY [] Two [] Five I~'~MU LTl PI.E FAMILY [] Three [] Six 7. WATER SUPPLY ~¢~"'~NDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975, For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) ~, ~ ,:~7~, S. SEWAGE DISPOSAL SYSTEM ~/'i'NDIVIDUAL/ON-S(TE** ~/"~ '~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2, WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY 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 OATEINSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line 5. COMMENTS t~"~'APPROV ED FOR ~ BEDROOMS CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED ~ DATE BY ¢ 72-010 (Rev, 6/79) Time Date Insp DEPARTMEN 825 MUNICIPA ,'TV OF AMC:! ,r,,,¢ JE liEALTI AND ENVIRON, PROTEETION L Street, Anchorage, Aiask~ 99501 264-4720 Date ReceLved: October 12, 1977 ~2: Time #3: Time Date Date Insp Insp 2 o 3 o REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Inst.~tution Request: Security Pacific Mortgage Corporation Mailing Address: 1011 East Tudor Road, Suite 190 Phone: 276-1933 Proper~y Owner: Gary L./Jo Ann Stromberg Mailing Address: Star Route A Box 64-A 99507 Phone: 344--2104 Legal Description: T12N R3W ~ection 9 Lot 89 Single FamJ_ly Residence: ( Number of Bedrooms: Multiple Family Residence: ~ ) Number of Bedrooms: Five Well System: Individual well 6(~ Co~nunity/Public System ( ) Permit ~ l)epth of Well Well Log on File Construction Bacterial Analysis ( ) Sewage Permit Septic Tank Size Absorption Area Disposal System: On-site System Installed 1977 Soils Public Uti].ity Installer Manufacturer Rate Material ( ) Distances: Well to Septic Tank to Absorption Area Lo Sewer Line NearesE Lot lille Absorption Area to Nearest Lot Line Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: T12N R3 W Section 9 Lot 89 Comments: Affadavit Attached: ( ) Letter Attached: ( ) Approved: · Disapproved: Date: ~_~/? ]~. /q~'7 Date: Department WorksheeL: MUNICIPALITY OF ANCHORAGE C ~,~ DEPARTMENT OF ENVIRONMENTAL QUALITY · 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 ,', REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 239-912 1. Type of Inspection: CMRO (V~ FHA 2. Property Owner: Stromberg, Gary L. & Jo Ann CONY Mailing Address: S~(~ -~0:F ~9 ,'-t-~ 3. Name of Buyer: _ CALLAWAY. Michael W. Mailing Address: 8818 Abbott Loop Rd. 4. Name of Lending Institution: Day Phone SECURITY PACIFIC MORTGAGE CORPORATION Mailing Address: Name of Realtor or Agent: Mailing Address: 1011 E. Tudor, Suite 190 NONE Phone 276-1933 Phone 6. Legal Description: Location:. 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Duplex Public Utility No. Bdrms. 5 Individual X If Individual, number of dwellings pre~qntly served If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation Public Utility /o'-' ~- 7'7 Individual (on-site) X EQ.037 (1/74) A certain parcel or tract of land lying within Section Lot Eighty ne (89), Section 9, Township ].2 North, Range 3 West, Seward Meridian, in the Anchorage Recording Distr:i_ct, Third District, State of Alaska, more particularly described as follows: From the Southeast corner of said Section 9; thence North 00o03' West 899.50 feet to a point on the existing centertine of Abbott Loop Road; thence West 50.00 feet to the true point of beginning; thence West 140.00 feet to a point; thence North 00003' West 218.00 feet ho a point; thence East. ].40.00 feet to a point; thence South 00°03' East 218.00 feet to the true point of beginning. N 0° 0~' 0o" ~,~, ,I i /20 A/. 0° 0~' 0::2,* id/. 504 mACE 0 8 6 9 TEMPORARY EASEMENT FOR VALUE RECEIVED, JOHN LOWE, an unmarried man, does hereby grant to MICHAEL W. CALLAWAY, an unmarried man, his heirs, successors and assigns, a full and unrestricted easement and right-of-way over, across and under 'the following described real property: The South sixty feet (S 60') of Lot Three (3), MAY HEIGHTS SUBDIVISION, according to the official plat thereof, filed under Plat Number 66-153, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. The temporary easement and right-of-way over, across and under said strip of land is for the purpose of access to and maintenance of an existing sewage septic tank which serves the below described real property and said maintenance shall be done mn a reasonable manner and no unnecessary waste shall occur. The property served by said septic tank is described as follows: A certain parcel or tract of land lying within Section Lot Eighty-nine (89), Section 9, Township 12 North, Range 3 West, Seward MeridJ_an, Alaska, Records of the Anchorage Recording District, Third Judicial District, State of Alaska, more particularly described as follows: From the Southeast corner of said Section 9, thence North 00°03' West 899.55 feet to a point on the existing center line of Abbot Loop Road; thence West 50.00 feet to the true point of beginning; thence West 140.00 feet to a point; thence North 00003' West 218.00 feet to a point; thence East 140.00 feet to a point; thence South 00°03' East 218.00 feet to the true point of beginning. This easement and right-of-way shall inure to the owner or owners of the property inunediately described above, his heirs, executors, administrators and assigns. Except as herein granted, Grantor shall continue to have the full use and enjoyment of the property. This easement and right-of-way shall run with said property and be binding upon the undersigned, his heirs, executors, administrators and assigns, and any person who shall hereafter acquire title to said property. THIS EASEMENT IS TEMPORARY and shall terminate at such time as public sewer lines are made available by the Municipality of Anchorage, or other requisite governmental authority, to replace the existing sewage septic tank. DATED this ~_~_~-~ .~'~day of _~//~.~__~ , 1980. 5 O 4 [PADE 0 8 7 0 STATE OF ALASKA ) )ss. THIRD DISTRICT ) 1980, before me the undersigned Notary Public,Per~ ap- peared JOHN LOWE, known to me and to me known to be the individual described in and who executed the foregoing instrument; he acknowledged to me that he signed the same freely and voluntarily for the uses and purposes therein set forth. WITNESS my hand and official seal. My commission expires: - 2 - © }~ D!SI'R~CT Prepared b't: GERALD V. RANDALL, JR Rl!q. Land Surveyor 2820 "C" STREET . StJ[TE ~ ITIS TIlE CONTRACI-OR'S RESPONSIBILII'Y lO CtlECK TOP OF FOUNDA liON IN RELA. SET BACKS IN RELATION 1-O LOT LINES AND EASEMENTS LEGAL DESCRIPTION: LEGEND: · 5/8 REBAR RECOVERED o 5/8 REBAR SET THIS SURVEY ri 2'N2" HUB & TACK SET [-J EXISTING ELEVATIONS DATUM ASSUMED SCALE: