Loading...
HomeMy WebLinkAboutT12N R3W SEC 33 LT 110BTI2N Lo, 1108 #018-252-36 Municipality of Anchorage. Page I of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage. Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report. Permit Number: SW990271 ' PIDNumber: 018-252-36' ~"~d Souders Wastewater System: [] New [3 Upgrade ~: ABSORPTION FIELD ,2840 Nugget Lane Anch.f AK 99516 I ~ 4.o. ~o~: Phone: 345-1056 our 1 ) r'tDeepTrench r'l Shallow Trench r'lBed 13Mound 13Other LEGAL.DESCRIPTION so~,..,~n0: ~,D~ F,. ,o~, p,p,h~m o~,g-d~: WELl' [] New [] Upgrade G~velwidtl~: Numbefo!lines: 10~s~ceL~;~.~ne~ Existing Class C F~ r~ ~o.~t. ~ GS Ex[~res~ 8/18/99 SEPARATION DISTANCES =Septic n Holding r't S.T.F_P. I:rorn ~..~ ~ s~. ~..~ s~u.~ 'Anchorage Tank 1 ~ 250 ' wel~~ 136' 122' N/A N/A' >25' Steel Two SudaCe . >100' >100' N/A N/A N/A LIFT STATION - N/A Lot >5' N/A 'N/A ' N/A N/A ~zeinga]lons: Manufactum~. Line Foundation >5' N/A' N/A N/A N/A -pumpon#levelat 'j -Pump off' le~el at: jHigh~ater~]a~nat Curtain None NOted P~e&~o~ 'j~ec~c?;,-~9~.~,~b~.. Remarksi. Tank Only Placed Under This ' BENCH MARK ~oca~o. ana~puo~: Garage Slab Permit; See ADEC waiver For. Sepa- · ration to Class C Well. 100.0 ENGIN~E~'& SEAL I~spe~ions pedo~ed'b~ ~ Dates: 1st 8/18/99 .~,~'b 2~,,~].~ Depadment 0f Health and Human Se~ices approval ~e~;. :~ ~" ~*'~ ,.~:~-' "~'~ .N. UGGET LANE A B S1 S2116.2127.2 C2121 c31~.=l~S.o Existing Class C Well NOTE: I Permit Number SW9902~1 J PID No. 018-252-36 Lot 110B, TI2N, R3W, Section 33 Page 2 of 3 IIIIIIII1~ · ' I c2 I ~ ~J~{~_.~~ ,~ -1,25_01Gallon ~ ~' .Septic 'aik Only the Septic Tank " Was-~laced Under This Permit. Existing Absorption Trench Was Not Dlsturbe~.. PLAN .!AS-BUILT SCALE 1" = 30' ~ption Location Unknown) Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, AK 99519-6650 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW990271 PID No. 018-252-36 ~ 101.5~ · /7~1 ,'250 Gal~ 96.8 / ~ep' Tank 96.6 Note: Only the Tank and Post Tank Cleanouts Were Placed Under This Permit. Existing Absorption Crib Remains in Service. PROFILE AS-BUILT SCALE 1" = 10' ANDERSON ENGINEERING P,O. BOX 240773 i ANCHORAGE, AK 99524 · 522-7773 522-6779 (FAX) DATE: TO: FROM: MEMORANDUM November 10, 2000 Jeff Poet Mike Anderson, P.E. '~q/~'"' RECEIVED NOV 14 2000 Municlpalily oi' Anchorage Oept. HeaRh & Human Services SUBJECT: Lot 110B, T12N, R3W, Section 33 Well to Septic Tank Waiver Septic System As-Built Attached is a copy of the separation distance waiver between the Class C well on the subject lot and the septic tank recently installed. This should complete the information required for approval of the as-built for the septic system renovation. Please let me know if you have additional questions. 1~ ~'~! ~,y~I~ p6'~ ~TlOi[~ ~OA~SiFtlRVATION DRINKING WATER and WASTEWATER PROGRAM 555 CORDOVA STREET ANCIIORAGE, AK 99501 http:llwww.statc.ak.usldeelhomelhtm / Telephone: (907) 269-7519 Fax: (907) 269-7650 TONY KNOWLES, GOVERNOR August 28, 2000 Michael E. Anderson, P.E. Anderson Engineering P.O. Box 240773 Anchorage, Alaska 99524-0773 Re: Lot 110B, Ti2N, R.3W, Section 33, Seward Meridian ADEC # 002 I-DW/WW- 197-610 Dear Mr. Anderson: I have reviewed your resent submittal for a waiver at 2840 Nugget lane in South Anchorage. The Public Water System Identification Number 2 i 6960 has been a Class "C' water system approved before April 14, 1993. You requested to improve the site conditions and relocate a septic tank from 117 feet to 125 feet from the well head. This work will change the existing waiver to n° closer than 125 feet per your plan. Attached is the apixoval form with the change listed on this form. This approval does not imply the granting of any additional authorizations, nor obligate any state federal, or local regulatory body to grant required authorizations. Respectfully, William R. Rieth, P.E. Environmental Engineer WRR/lb Enclosures: As Stated CC: ..~ONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL COr;SF. RVATION PUBLIC WATER SYSTEk~ ~PPROVAL TO cONSTRUCt. for the construction of. · ~ka. submitted in ;ccc~danC~d with 15 AAC 80. J00 .,~ rl conditionally approved (see attached co~d;tlons). E/77' ~'--2 'si;i. t~,.,T~. ' . . . .'~ If construction has not started within two yeer~ of the IpFovll date, thh c~fttJ~C&tl ~ans and s~lfl~tlons must ~ ~bmltl~ for I~w'and appr~al ~fote ~nst~tl~ ' " gPPROVED CHA~GE ~RDERS ' ' The "APPROVAL T© OPERATE.· ,etlon m~st be comp eted ~for* any water Is the public. ' ,.. ~c; ~':' _~ Itel._ ' ~ ' · ' ~ ' ":"' watersystemwascompletedon ~ '~ ~ ~ {~l'lr'l-J~'t (date).Thesystem liberal:. " granted interim approval to operate for 90 days following the completion dale. . ' '" ':' As-built plans submitted during the Interim approval period, or an inspect;on by the Department confirmed the system was constructed according to the approved plans. The system is hereby ~'anted {~fsal approval Io ql~erate. ,/? MUNICIPALITY OF ANCHORAGE ~ Depa,'tment ofHeafth and Human Services ~, .~ .q~ ~(~ On-Sire Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 11, 1999 Expiration Date: Aug 10, 2000 Permit Number: SW990271 Legal Description: T12N R3W SEC 33 LT 110B Design Engineer:. 0014 Anderson Engineering Owner Name: David Souders Owner Address: 2840 Nugget Lane Anchorage, AK 99516-3936 Pamel ID: 018-252-36 Site Address: 002840 NUGGET LN Lot Size: 48976 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit Is for the construction of; [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be In accordance with: 1. The attached approved design. 2. Ail 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: I Date: Date: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) July 23, 1999 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 110B, T12N, R3W, Section 33 Septic System Design Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owners of Lot 110B, T12N, R3W, Section 33 is constructing an addition to his house and must move the septic tank from its current location to outside the foundation of the new structure. The existing and proposed location of the tank are shown on The Site Plan shows the location of the Class C Well on the lot which also serves the lot to the west. The existing tank is only 117' from the well. A waiver was issued in the past allowing a separation distance of 114'. The new distance will be approximately 125' from the well. We have petitioned ADEC to allow the waivered distance of 114' to remain in effect as that is the distance to the septic system on Lot 110A. A copy of that request is attached for your review. The ground surface on the lot slopes from the north to the south at a very shallow rate. Placement of the tank in the location shown is not affected by the ground slope. The tank will be further from the well than the present location and still maintain adequate separation from the existing absorption trench. If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be intained. Sincerely, Michael E. Anderson, P.E. Attachments ANDERSON ENGINEERING P.O. Box 240773 ANCHORAGE, AK 99524 (907) 563-7155 (907) 337-8855 ....... ~ .............................................. L ...NUGGET ......... : ............... LANE .....7 .............. : .......... z...__: _~ ...... : .... ' - ............ ~'---"~-?z-'- · ; i ; · : ..... _ J_._: ........ ] ' .................. ?-,.__.. , . = _-11' ' I [ ~ ; : i i , L ................ --> ........................... ~ .... .... --T .......... : : ! , , ~ T.OT_.I..10A.. J ; ~ - Z._:__.~__2__~LOT_I.1 OB .~-- ....... ~ ........... =.---'.- ........ ~ ~ : I ' ' I i ' .......... J ' _4.___:---L--.i--2---~..--: ............... .'--- I i . I i ' J . · · . ...L ................ -' .......... J ~ , I ~ ; Cla~s C Well · , _ ~ .... ~-L--L--. Servfce i ~ I Lot I~OA j ! { ' I j ~ ' I Four --:Bedrdom :- , : ~ome ..... _L ....... ~ : ! : ~...~-..,- ~ ;.~%~ , ~ I .; ... I ;_ . .;- ........ ----"~,:u..r-'..~../-~'~li7J--'r-T[ ~OT~.: , NO Confticts With WeZls or: , J i i : _~j~.~-~-P - "'~ '-- -- 'A ~.~!' ' ' I . .._:__z__ i Septic-.Systems-in-the' -Area~:.--.I---I---?---'---~---T-~- ' ' I ''' '' 'il' ' , ~ . -.~ f, . .......... ~ .............. · . =.--.~. ~ ..........= ................... ~ .......... r .............. ~' , ~ . . : ~ ~ . , . , __ : . . .~..~-.-;--~,'%~'~ '. I ' . : --,---- --~ ~ I~ ....... : .......... J_..I._4__..'_.-L-: .... ~.. ~ ~ ..~ ~:-I' ~ ~ .~ ........... I.--=--: ................ 'J~'m .... ~.~. ' ~ I '. : ~ ' I . · : ' ' · ~ I ,'. .... ~.~ . . , : ' ~ ~_ _ 2 ........ L..,.~ ............. : .......~ ................ ~ .............................................................. : ......... July 15, 1999 State of Alaska Dept. of Environmental Conservation Southcentral District Office 555 Cordova Street Anchorage, AK 99501 Attention: Mr. Bill Reith, P.E. Subject: Lot 110B, T12N, R3W, Section 33 PWSID No. 8321-FA-298 Separation Distance Waiver Septic Tank to Well Dear Mr. Reith: The Class C Well on the subject lot was placed in April of 1983. In May of that year a separation distance waiver was issued allowing the septic system to be 114' from the well. The owner of the property has now decided to construct an addition to the house which will cover the existing septic tank. He is therefore proposing to move the tank outside the limits of the new addition. The attached site plan shows the existing and proposed location of the septic tank. The new location is approximately 125' from the Class C Well. The absorption trench is 122' from the well. We are now requesting a separation distance waiver to allow the new location of the septic tank. The elevation of the well is nearly the same as the location of the new septic tank. The total depth of the well is 369' with casing extending to 367', The well log indicates clay is encountered at depths ranging from 32' to the entire depth of the well. The clay matedal will almost certainly protect the well from septic effluent intrusion. The static water level in the well is at 128' below the ground surface which is more than 115' below the bottom of the new tank, Any contamination emanating from the tank would travel through 115' of clay mixed with sand and gravel before reaching the static water table. It is probable that any contamination would be removed by that time. Separation Distance Waiver Guidelines Water Table 115' Below Tank 7.0 Soil Type Clay and Sand to Clay 5.2 Permeability Clayey Sand · 50 3.0 'Eot 110B, T12N, R3W, S33 July 15, 1999 Page Two Water Table Gradient Nearly Flat - 0 % 2.9 Horizontal Separation 125' 4.0 Total 22.1 The conclusion based on the aforementioned point totals is that almost surely,no form of contamination can be expected from household sewage. It is therefore recommended the waiver be approved to allow placement of the new tank 125' from the existing well. The absorption trench will remain in its current location at 122' from the well. Enclosed is a copy of the well log from the lot along with a site plan showing the existing and proposed location of the septic tank. Thank you for your expeditious review of this waiver request. Sincerely, Michael E. Anderson, P.E. Attachments #- 101710 1 240 6K02 131 PG215 WATER WELL AGREEMENT This Agreement dated this 29th, March 1991 between Gary Layne Nilson aka Care W. NUaon and Edna Jean Nilson aka E. Jeans Nilson, Owners of Lot 110A; a subdiviaiorx oL Section Lot 11.0, Section 33, Twp. 12 North, Range 3 West, plat No. 78-251, Anchorage Recording District, State of Alaska and David W. Souders and Many M. Soxiders, awnera of Lot 110B, a subdivision of Section Lot 110, Section 33, Trap. 1.2 North, Range 3 Wert, Plat No. 78- 251, Anchorage Recording District, State of Alaska. Owners of L.at 1108 agree to supply (via the exisit ing we -11) wat.ar to €wmers/Gccupants of Lnt I10A. far tho life of the well. Owners of Lit I10A agrees to pay a monthly fee to cover electrical charges to be reviowed annually and act by tautual -agreement by owners of Lots 1.10A, and 11GB. Owners of Lot 110A & Lot 1100 mutually agree to share equally the cost of maiaaaer'nnee and repairs to the pump system. Tho agrooment shall he binding on heirs, assignees and successors. This agropment entered into this 29th day of March, 1991. Gary W One Ntivon ka. Gar; W. Nllac+n Edn .learn Nilson aka E. Jean N11wn David W. Souders Mary M. r radars t State of A Yaa e ) Iss : Third Judicial 31{3triet) The foregoing iin3trument was acknowledge before me by Gary Edna Je. CF#1CL1 " ,,Si STATE OF ALA. NOTARY PUISUC OW STAT O' 9USASXi ®i�A L.. �''f Third JudIci.al District i this 29th day of' March, 1991 r PiA1: on aka E. Jean Nl.l:aon. otary Public 1n and for t1le 6tete of Alaska y Commission Expires: 3/24/94 "'he foregoing Instrument was ;acknewledge(i before- m -e thla 29th day of Marchi, :��gi Y DaNrl d W. Souders and Lary M. $711 OF ALA W- Notary Public [qty Corruni:5.31 on RA L. STOW _! 6 z7 ANMRWE FEC. DiSTR[CT " a�,A. REQUESTED BY `31 RPR 1 Fico 8 35 In aCd ror the State of Aalaska Expire,: 3/24/94 AFTC11l HL`X tXI0INC'j RETURN TGd u .Foust Strent SUA0 tG.r Anchofav, Alaska 99503 CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF E~VIRONMENTAL CONSERVATION/ PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT ' _~L C/L.~¢.~ ~ I ~"~ ~ I '~F'r~-,,;~_~ .public water system located in_ /L~/~ ("'_ ?-J'LO ~/~./,z~ ~__.~ ~ , Alaska, submitted in accordance with ].8 AAC 80.].00 by__/~ Ht~/L)'T'~(] ~_.~% ~J/VC'--~J ~'E }'~Z ~,J ~,C~..__have been reviewed and are approved. conditionally approved (see attached conditions). If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract o~<~*r no. Approved by Date The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the ~-*:.',,) ii, i'~,: ;t ~c[;,' "'O~ +,,c ,/~ public water system was completed on.(~'r ' (~l j,) ' C' ' ~'~¢[- /:',4-"~//~.(date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. eY As-built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted f~approval to lperate. . / , NAME 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 PHONE [~'~E~ MAILING ADDRESS LEGAL DESCRIPTION LOCATION Well DISTANCE TO: . //7 IF ROMEMADE: Inside lengtb DISTANCE TO: Well DwelHng DISTANCE TO: No. of lines / Top of tile to finisb grade Lengtb Widtb Type of crib Crib diameter IAbsorption area,~ Total length off.,~ z_,/ines Material beneath tile Dwelling Width '~- Material Material Nearest lot line I Trench widtb NO. OF BEDROOMS PERMIT NO. ~}~:~ Liquid cleptb PERMIT NO. Liquid capacity in gallons PERMIT NO. ~,~0~ 0 0 Distance between lines Deptb Crib depth Total effective absorption area Total effective absorption area PERMIT NO. Well Building foundation Nearest lot line DISTANCE TO: Class Oeptb Driller Distance to tot line IPERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank / Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) MUNICIPALITY 0F ANCHORAaE Department f Health and Environmenta Protection 825 ~ Street, Anchorage, AK, 39501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ,% ~ ~ ~ ~, WELL AND~ ON-SITE SEWER PERMIT --~/ Applicant: ~ ~. Al ~4 Mailing Address. Location: Phone Nu~er: Lot S ze: / Legal Description: ~]'-i';)-,/N~ ~C3~ Type of Soil Absorption System Is: Trench: ~ Drainfield: Maximum Number of Bedrooms: L~ Seepage Bed~ Holding Tank: Soil Rating(sq.ft/br) ~ DEPTH The Required Size of the Soil Absorption System Is: LENGTH ~ ~ GRAVEL DEPTH ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = / ~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is i100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 3L 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. I will install the system in accordance with codes. I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that~/~/ bedrooms. Date: ~ ~ ,~- ~>-A (2) (3) Applicant are SWP/024(1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2221 SOILS LOG- PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: ,N-~"~'~Z47/'/(,' SLOPE 1 2 3 4 6- 7- 8 9 10 11 12 13 14 15 16 17 18 19- 20- DATE PERFORMED: SITE PLAN WAS GROUND WATER S ENCOUNTERED? ~() L o E IF YES, ATWHAT DEPTR? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AN° FT COMMENTS CERTIFIED B Y .~'~ ~)~'-~ DATE: 72 008 (7/76) AHCHORA GE Development Services Department �_ _? Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 018-252-36-000 Expiration Date: 1/15/2025 Legal description T12N R3W SEC 33 LT 110B Site address 2840 NUGGET LN Anchorage AK 99516 Current property owner(s) SOUDERS DAVID W & MARY M XThe On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 2/15/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE 0 Development Services Department` cT Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 018-252-36 Complete legal description T1 2N R3W Section 33 Lot 110B Location (site address) 2840 Nugget Lane, Anchorage, AK 99516 Current property owner(.) David & Mary Souders Day phone (907) 242-1516 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well X Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 24 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ■❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ .-0 Waiver Fee $ Date of Payment '�LDate of Payment COSA # 05C Z � (0 Z G% Waiver # COSA Application_ June 2022 T12N R3W Section 33 Lot 110B 018-252-36 5.5 5/4/83 369 N/A 367 18 8.26 9/26/23 Forge Engineering 128 1/22/24 48" 1/15/24* A+ Home Services* 5/20/83 10.0 N/A N/A N/A 9/26/23 17 1491 25 1440 14 > 600 48 14 34 Benjamin Schiller, P.E.1/23/24 (907) 522-7773 M UHMP U u V OF ANCHORAGE GE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241024 Subdivision: T12N Block:113W, Lot: 11013 907-343-7904 Fax: 343-7997 The septic tank for this property is 24 years old. The average life of an asphalt coated steel septic tank is 20 years: Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. I Lot 110A M r ti O N E.- CY) LO O O O Z M M NUGGET LANE co co N89058'39"E 164.83 (v 1 CY5 f f f -- J 10' Utility Easement N89057'47"E 164.85 LOT 115 EASEMENTS OF RECORD, OTHER THAN Lot 1A Shyrock Subd. SCALE: 111— 50' Note: Asphalt location is approximate due to snow and ice. ��N%%%�1••QF I AW P T AW /� • • ' Uj . 49th00 / �.. .. 00 op�•. Izabeth L. Walatka �o ,r �s� • • 8036 - LS ow F .AW 1F AW op ,Qw R'�FFs s I owAt ��► \ `,\N� 2, 2, 0 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 11OB, SECTION 33, T12N R3W, Seward Meridian, AK Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the 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 6th day of February , 2024. THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON BE 907-248-1666 Engineers and Surveyors UNLESS OTHERWISE NOTED, FB 23-4, pg 38-39 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. 1 N f f f f I, LOT �4-A 110B a f E fCn W O Community f �, I`- °Well O (Z N Covered f O storage 1 1 ` deck Shed f O 1.2 Chimney OH r deck f Q ►• N 65.53 Story --�---42.9--- �' ° O FraMe Hou CO ----�3. se 65 5 (0 f Z deck .5 vent (typ) f deck f Wood fence f , (v 1 CY5 f f f -- J 10' Utility Easement N89057'47"E 164.85 LOT 115 EASEMENTS OF RECORD, OTHER THAN Lot 1A Shyrock Subd. SCALE: 111— 50' Note: Asphalt location is approximate due to snow and ice. ��N%%%�1••QF I AW P T AW /� • • ' Uj . 49th00 / �.. .. 00 op�•. Izabeth L. Walatka �o ,r �s� • • 8036 - LS ow F .AW 1F AW op ,Qw R'�FFs s I owAt ��► \ `,\N� 2, 2, 0 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 11OB, SECTION 33, T12N R3W, Seward Meridian, AK Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the 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 6th day of February , 2024. THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON BE 907-248-1666 Engineers and Surveyors UNLESS OTHERWISE NOTED, FB 23-4, pg 38-39 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERALINFORMATION Completelegaldescription 13~.rn &oF ItO ~ _c.¢'c]~c,.~ :~.?.. q'lS./V:¢ ~l.u¢ -E.~. Location (site address or directions) Property owner Mailing address Lending agency Day phone Day phone Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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.: NOTE: Individual on-site ~ Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev 1/91) Fronl MOA ¢121 STATEMENT OF INSPECTION BY ENGINEER As certified by my sea[ affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system [s in compliance with ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspect[on. Name of Firm /=' (~ /- /-0/¢, ?-'~c/~ i c~/ ~e~u"~ c,¢J Phone ~ Address I~t,.¢'_~0 ~c~o _~/.~ ~r~cgoraCCe /~rl~ Engineer's signature 'f~'~ ~' ~'/'Le-¢¢._ Date D ,,H, ,~ SIGNATURE ~ 'X- Approved for Disapproved. ]rooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72q)25 (Rev. 1/91) Back MOA ~f21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 8;/~.~'1 ~,/' IiO ~ %~c ;~3~'TI2..^1 A. WELL DATA Well type ~'(¢z~ '~" If A, B, or C, attach ADEC letter. Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D, ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform O ¢o( /(o0 ~,~ Date of sample: Nitrate ~Zr~,,,~¢c/-~;4~ Other bacteria /,/one, r~/~'J~c~ Collected by: FI~',~¢'o,~ F-~'ch _.Cc,, c B. SEPTIC/HOLDING TANK DATA Date installed ,5'/To IE~3 ~'"~'~ank size ( ~,.¢'o ~,¢/ '¢ _ compartments Cleanouts (Y/N) __ ~ Foundation cleanout (Y/N) V' Depression (Y/N) High water alarm (Y/N) /~' '~ ./ Alarm tested (Y/N) N. Date of pumping ~/¢/9 ,~ t'/"/' Pumper _ ~$c~c.¢ L. N SEPARATION DISTANCES FROM SE~'CiC/HOLDING TANK TO: Well(s) on lot 11'7' ,,¢~-o~-, CO, , '~Onadjacentlots_ '-~ To property line ? lo' _Absorption field Surface water/drainage __~' f 72 026 (Rev 7/91)Fronl Foundation Water main/service line_ CONTINUED ON BACKPAGE C. LIFT STATION ,~. 4. Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water ABSORPTION FIELD DATA Date installed . ,5'/ 8o / 8_7 Soilrating ~¢,~' ~'//3'¢Z~',.~' Systemtype ,E'w,de c~r'~,~,t~:~/~,( Length Total absorption area Z ycj c~' Depression over field (Y/N) N Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Gravel thickness q' ~ Cleanouts present (Y/N) Date of adequacy test for 'Y i<~ocu~ ,¢jc If yes. give date Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot IZE,' To building foundation Onadjacentlots > _7o' Surface water _ ~' ~oo On adjacent lots_ loC' Property line To existing or abandoned system on Cutbank_ N. ,4,, Water main/service line Driveway, parking/vehicle storage area Curtain drain _ b{o-°e 5'een ~ P ~C_ 50oc~r'c~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ,~'-'~ ~ Engineer's Name ~"',~¢o¢/o,"e Date //~/~ ~'~ l / ~/ D ~.~ F. /'qoo ~4~A Fee $ / DateofPay~ent- Receipt Number 72 926 (Rev. 3/91) Back Waiver Fee: $ Date of Payment Receipt Number WALTER J. HICKEL, GOVERNOR DEPT. OF I£NVillOi~MENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 April 14, 1993 (907) 349-7755 Mr. Ted Moore Flattop Technical Services 14530 Echo St. Anchorage, AK 99516 Subject: BLM Lot 110 B, Sec 33, T12N, R3W, S.M. Class C Public Water System ID no. 216960 Dear Mr. Moore: The Department has reviewed the information received in this office April 12, 1993, regarding the above public water system, which included a cover letter, water samples analyses, and a copy of a previous operation certificate from this Department. Results from the recent water samples submitted were satisfactory for both total coliform bacteria and inorganics for nitrate. Therefore, for the concerns of this Department, this system is in compliance with State of Alaska Drinking Water Regulations (18 AAC 80). Attached is an "Approval of On-Site Residential Water and Sewer Systems" certificate verifying this Department's approval. Thank you for your cooperation with the Department. If there are any further questions concerning this matter please do not hesitate to call. Sincerely, Michael Lu, E.I.T. Environmental Engineering Assistant II ML/pf Attachments MUNiCiPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~-"~ \ ~., - ~,.X~ r'~ - ~'-.~ ( rg HAAf~ ~..~, C~ 1. GENERAL INFORMATION (Must be completed prior to submittal), (a) Legal Description (include lot, block, subdivision, section, township; range) L.,O'T ttD 1E, S~r~T ~}~ T 12-/',,/ 12, Location (address or directions) (b) Property owner ~Y ~ Mailing Address ¢~O ~U~% (c) Lending institution _ ~/~ Telephone: (home) 2'~"='/" I~"E~usiness Telephone Mailing Address (d) (e) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (or check here,~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family/l~ Number of bedrooms 3. WATER SUPPLY ~L,,~ e~ ~ c:. ~ Individual Well [] Community)~J Public [] Note: If community well system, must have written confirmation, from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ 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. 72-025 (Rev. 7/88) Page 1 of 2 A, WELL DATA Well Classification ~:>M/¢/(JA//7-~ Well Log Present (Y/N) ~ (~) MUNICIPALITY OF ANCHORAGE (MOA) ~ Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: L,C)T' II (~ ~-(---T .~ T' 12-AJ F-- =JPJ If A, B,QD.E.C. Approved (Y/N) y (~ L~-"dr-<~'~ (~) Yield '~O ~ ~PR (Z) Date Completed Total Depth ~'-'-'-'-'-'-'-'-'-~2c1' ~Cased to ~ Depth of Grouting ~j./,,~ Static Water Level ~¢~ ~ Pump Set At Casing Height Above Ground Z. ~ ~ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~ ~ Depression Around Wellhead SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot J ~ ~' ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot IZI~ ~ ; On Adjoining Lots To Nearest Public Sewer Line ~/~ ~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~/~ © Water Sample Collected by ~L ~ ; Date Water Sample Test Results N Comments ~ ~WI~S ~bT~-I ~P~,OV~ B. SEPTIC/HOLDING TANK DATA Date Installed ~-S-¢'~)Size ~-SC>.~,I(~No, of Compartments Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) ~k~ (~ Pumping/Maintenance Contact on File (Y/N) h4/..~. Holding Tank High-Water Alarm (Y/N) ~ (~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well Ii ~ ' ® To Property Line ,,~:~,,,:df ~(~ To Water Main/Service Line hi/'/~N :Foundation Cleanout (Y/N) Date Last Pumped '~-~O- °l f ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course /'J/,,~, (~) Comments 72 026 (Rev 7/88) Front Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata_ Date Installed '~-~ -~ LD Width of Field (¢~:) ¢ (~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Desig.~ Length of Field Depth of Field ~ ~ ® Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM A,J~L.SORPTION FIELD: To Water-Supply Well II~ ® To Property Line IC:)t To Building Foundation Ic)' ® To~ Existl(~ or Abandoned Sys(L~n Lot ~/..,~ (Z) ; On Adjoining Lots 2(c,O+ T~P_~ To Water Main/Service Line N/,,z~ (~) To C¢.~tback (if present) To Stream, Pond, Lake, or Major Drainage Course /xl/...,~. ~ To Driveway, Parking Area, or Vehicle Storage Area lC:) ~ ® Comments 0-~ ¢'¢..~VIO(J~ ¢¢~AL.TCr /'rfc?184)VAL-- on D. LIFT STATION Date Instal[ed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments ~ Dimensions /Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** In~;reticft~otn.~ ec k~' Zf '6~70° n f ° r m ed t ° Signed Company Date MOA No. Receipt No. ~ Date of Payment 72-026 [Rev 7/88) 8ack all MOA and HAA guidelin Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 the date of this SUBJECT -' . ....... OF SURVEY TYPE [] AS-BUILT· [~ PLOT PLAN [] LOT SURVEY [] RECERTIFI~ATION AS-BUILT· ~UG~ET LANE NS~l:SJb3~ E 1~/.83 WELL ~ FOUNI)A't'ION 5 ~'q' 5 7'~¢7"W 16'f. 85 SYMBOLS' · · ELEVATION DRAINAGE ~ C WOOD·FENCE -~ ~ CHAIN LINK FENCE NOTE, FENCER ARE SHOWN IN THEIR APPROXIMATE LOCATIONS ONLY, It ,s Ihe respon$~bilil¥ of the builder or owner, prior fO :on,~lruclion, lo ver~Jy proposed building Df ode ~elalive Lei Survey Carllficcdion .LEGEND hub I~ tack- found · E] set J iron r~bar -found o set -.., ... iron pipe -found ® scl O b~oss cpp -found (~ set alum. COp -foun_d~_.___(~_____se~t __ ~ ..... ' M PH .' Professi~ol Land Surveyors :' ~om Surveyed: ~C~ ~: JUN[ 9~ ]9R3 m RF,1 Dm eDm~ ' Grid: w.o. .' ..... I[INF .$~83 I .-~3~ I 83-049 Legal ~crlpIl~: LOT IlO-B, Sec.33, T12N, R3W, SM DI~PT. 01~ ~N¥1RONMi~NTAi~ CONS~I~VATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHOP~AGE: A.LAS I<A 99503 March 29, ].991 Mr. Dee High, P.E. High Phukan Consulting Engineers, 2702 Gan~ell, Suite 103 Anchorage, Alaska 99503 Inc. WALTER J, HICKEL, GOVERNOR 563-6775 RECEIVED APR 0 2 1991 Municipality of Anchorage Dept, Health & Human Services RE: Lots 110 A and 110 B Gary Nilson Subdivision, Class C Public Water, ADEC Project Number 9121-FA-042; Review Dear Mr. High: This is in response to your submittal, received in this office during the weak of March 18, 1991, in which you requested verification that the above-referenced Class C Public Water System was in compliance with State Drinking Water Regulations. Based on my review of the submitted information, it appears that the Class C Public Water Serving Lots 110 A and 110 B Gary Nilson Subdivision is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. At this time, the Department is assigning Public Water System Identification (PWSID) Numbers to all Public Water Systems in the State. As a result, the PWSID Number assigned to this system is 216960. The current State Drinking Water Regulations do not require any routine water sampling for Class C Public Water Systems; however, if the regulations change, the Department will notify your clients. In order for the Department to contact your client on the changes to the State Drinking Water Regulations, please have them complete the highlighted areas on the enclosed "Inventory Update Form" and return it to this office. Thank you for your cooperation with this Department. any questions, please do not hesitate to contact me. If you have Sincerely,/j , Keven K. Kleweno Environmental Engineer Enclosures: As Stated cc: John Smith, DHHS, w/o Enc. KKK/skpf CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA00518 TELEPHONE (~07)5~2.2343 A~A[TSIS ~£POR~ ~ S~E Eot WO~[ordorl 32562 PWSID ¢olleoted Ell 12 91 I 12~00 hze, FAX: (907) 501-5301 BPO;t PO t Che~lb h~£ it g[0906 Lab Smpl ID~ I )t~trlx, WATER klloonble ?~I~meter ~emted Reault Umtm ~thod Llmtm H1TRA~I-N ~D(O.iO) ~l~j/~ KPA 353.2 iO Sample ROUTINE SA}~LE COLLECIED BY: C.A. ~A. )lot Analyzed LT.Leae Th*n, OZ.Oreat~r ~hon MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEAl_TH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4?20 (b) Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name_ ~gz:oz.) (c) Telephone: Flome Business Applicant Address ~/t:~ one): Lending Institution ~ Owner/builde¢~; Buyer ~ ', Other D (explain); Applicant is (check (d) Lending Institution ___ Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OP RESIDENCE Sin gle-Far'nily~L~ Multi-Family E] Number of Bedrooms ,2.~_ Other WATER SUPPLY (~ICP..E,.%. '~'~ Individual Well~ Community~ Public ~ Note: If community well system, must have written coefirrnation from the State Department of Environmental Conservation attesting to tile legality and status. SEWAGE DISPOSAL Onsite ~/~ Public [~ Community E] Holding Tank ~ Note: If community well system, must have written confirmation from the State Department of EevJronmental Conservation attesting to the legality and status. Page 1 of 2 72.025nl/84) ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation da e shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal sys em is safe, functional and adequate for tile number of bedrooms and type of structure indicated herein. I further varify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, tbe on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations JR effect on the date of this inspection. Name of Firm'~.~,.%-%~,.~-~- --~' Address Date Enc~ Approved for ¢/~:i- ~' ~ bedrooms by ? J~.4.~-t~L.?,.{! ate :.-* - Approved ~'~' Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Depa';tment of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska, The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11184) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA, HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Classification ~- If A, B, C, D E.C. Approyed (Y/N) Well Log Present (Y/N)~ Date Completed _~(~-/~//~7)~ Yield_ Total Depth _ ~"'~('o'~ Cased to _,~'~'X'o'7 / Depth of Grouting Static Water Level /2,~;;) ~¢' Pump Set At .z/b Casing Height Above Ground 2~'-, % Electrical Wiring in Conduit (Y/N) . Separation Distances from Well: To Septic/Holding Tank on Lot //,¢~ '~' ; On Adjoining Lots _ //~' / To Nearest Edge of Absorption Field on Lot ~/~¢ '~ ; On Adjoining Lots / Sanitary Seal on :Casing (Y/N) ~ Depression Around Wellhead (Y/N) To Nearest Public Sewer Line .y/~'~.,~ To Nearest Public Selwer Cleanout/Manhole _ /v, zzt To Nearest Sewer Service Line on Lot Water Sample Collected by ,~, /Yl~ect,.~.~J~/.~L?~:~' ~, ~.??,,,. r~,~.~ ', Date_ '1 Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed 'L//5'~/~:~ Size /~-'$~ '(~ No. of Compartment.s Standpipes (Y/N) ~'~ Air-tight Caps (Y/N) _ ~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) )k~ Date Last Pumped -~ /I"'(/~ Pumping/Maintenance Contract on File (Y/N) ~ /'3//J- ; for 4D//'~ Holding Tank High-Water Alarm (Y/N) ~,J /1~ Temporary Ho!ding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well _ ,) 2~;D To Property Line '~- ~' To Water Main/Service Line _ ,.~ Course Comments _ To Building Foulndation /t') ~' To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area L~ ,~ ~'~ Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field; To Water-Supply Well To Building Foundation /~"~'~¢/" Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design ,~--~-L~-",~O/ Length of Field Depth of Field Gravel Bed Thickness ~ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line /O To Existing or Abandoned System on To Cutbank (if present) ~//~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) ~ Comments ~ Dimensions ~ Manhole/Access (Y/N)~~ _ 'Pump Off" Level at ~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checb4~d,~v, crilie~, ,'~¢~conformed to all MOA and HAA guidelines in effect on the date of this inspection Signed .~.~-~2~0~//~T ~ate q/ll/~ ' Company ~'~ ~ ~ MOA No. Receipt No. Date of Payment Amount: $ ~ ~eal / v~ % _ ' ...... ~' 4~,~ BF~SSE~ EPP~ & 2220 F.J~ST 88 A~PJ~ ANCI{O~LAGE, AK 99507 WATE~ I~.~,r, TF~ Subdivision: Lot: Block: client's Name: Initial Readir~ co Meter: I'b-&O ~,, j q ;(.~"- ~.~ D~PT. OF £N%'IRONMENTAI, CONSERVAT]ON ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 003 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 274-2533 September 9, 1986 Besse, Epps & Ports ATTN: Dave Merrell 2220 East 88th Avenue Anchorage, Alaska 99516 SUBJECT: Lots llOA & 1108, T12N, R3W, Section 33, SM, Anchorage 8721-WA-014 Dear Mr. Merrell: The Department has reviewed the in?ormation submitted by you along uith the updated plan vieu as-built uhich we requested. The reported distance of 112 ~eet to the neighboring septic tank appears to meet the intent of our May 23, 1983 waiver approval uhich allo~ed a separation distance to 114 feet. Therefore, the septic tank separation on Lot 110A to the Class C well on Lot 1108 is approved to 112 feet. This approval is valid only for a 4 bedroom home on Lot 110A. The Class C uell meets State requirements at this time and the operation certi¢icate issued in September 6, 1983 is valid and current. In future submittals, please submit your request on a state application form or provide a cover letter explaining what it is you are requesting. Sincerely, Steven .Ifl/~/Eng, PE Distric~ Engineer SWE:pkk ~U~6 ET LA~£ · ,n N ~ 5B3~ ~ )6q83 ~- IO~ UTIL.E.S~AT APPLI(' NT FILLS OUT UPPER HAl ONLY Pro~,arty Owner ~ J Mailing Address ~.:';~,fi~ /~ O / /~ `y (~) ¢-""~ Zip Code ~"~ '~;.~ Buyer Phone Address Zip Code Lending Institution /~.~ ~ ~/ ~/~ :/~ /¢.~' ,~/~. Phone Address Zip Code Phone Zip Code Realty Co. & Agent Address Type el Residence l~/q-.Single Family ~J Multiple Family No. el Bedrooms ~g Other Water Supply Individual ATTACH WELL LOG, A weg log 'is required for aH wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). Public Utility Sewer Disposal ~ individual E] Pubfic Utility LJ Holding Tank Year Individual Insta]led: __/'~ ~'' ~' When Connected to Public Utility: . . NOTE: TRE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Date Inspector Field Notes: Time Date APPROVED BEDROOMS DISAPPROVED ) CONDITIONAL APPROVAL' Time Date Inspector Time Inspector BY: RECEIVED 'CONDITIONS!OF APPROVAL Soils Rating Date Sewer tnstallod Well To Absorption Area Well to Tank ~j - /_ Welt Log Received Septic Tank Size ¢ ,, j\ ;, ";~