HomeMy WebLinkAboutMOUNTAIN SHADOWS BLK 2 LT 2Mountain Shadows Block 2 Lot Z #017-401 - 19 MUNICIPALITY OF ANCHORAGE DE.^RT.£N OF HE^L.TH AND .UMA. SE.WCES J i Environmental Health Division /~ / *~ O -- 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Lot~,~ BIO,~ /'7 Township, Range, Secdon TANKS DISTANCES ~ TO FROM ~ WELL LOT LINE FOUNDATION SEPTIC TANK /dO/ z_.? / ABSORPTION FIELD /¢/ WELL 'AS-BUILT DIAGRAM {Show Iocahon of well, septic system, property hnes. Ioundahon, d~¢veway, waler bodies, etc.) SEPTIC [] HOLDING Material ~-~<3~.~ / NO. OI Lsornp&dments TYPE OF SYSTEM ~TRENCH [] BED [] W. DRAIN [] O'rHER Depth to p~pe bottom from Total depth from original grade ~1 added above original grade G~avel depth beneath p~pe travel w~dth FT Gravel length //,'~ Tolal absorpbon area FT SQ Fl WELLS FT F'f ET [] PRIVATE [] OTHER (I FT REMARKS: ,/(--~o '~ ' "/ ' I, / , /L ¢ ¢ ~ cedily that this inspe~lon Municipal and State · Il. De a.men, A rova, Hea P PP : : ~ - -- ' 72-013 ',77 / N SCALE: 1"=40, J DRAWN BY; ~-~..~- J CHECKEO BY: ~.. 7125 OLD SENARO HWY. ANCHORAGE, ALASKA 09504 I liEREBY CER'fIFY THAT I HAVE SURVEY.ED THE FOLLOWING OESCRIBEO PROPERTY. 1 ANO THAT THE IHPROVEHENTS SITUATE0 THEREON ARE. WITHIN THE PROPERTY LINESI ~.NO 00NOT ENCROACH ON THE t:'ROPEA~Y LYItlG xOJACEHT THERETO. THAT NO I~'~''',,~'" ....... ''""~'¢;'" 1T IS THE RESPONSIBILITY OF THE OWNER ~1 OUILOE~q, PRIOR l0 COHSTRUCTION, f'3 VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH 0gAGE iNO UTILITY :':'!~(~O~t% A~ '] T¢} r !''~ '!,l~;'~ Tt{~ F¥~Ti"~Xr ·" ANY ~ ,'.""~ ~lr!;, C(]V~A~T% Municipa.,tyo Anchorage P.O. BC 96650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 TON Y KNO WL ES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES November 19, 1987 Leroy C. Reid, Jr., P.E. Alaska Environmental Control Services, Inc. 1200 West 33rd. Avenue, Suite B Anchorage, Alaska 99503 Subject: Waiver Request for Lot 2 Block 2 Mountain Shadows Subd. Waiver Number WR87-071 Dear Mr Reid: Your request for waiver of an absorption trench to a lot line has been approved. The required 10 foot setback from a lot line has been waived to 1 foot° In view of the fact that the trench now extends 6 feet onto the neighboring lot, a waiver is desirable to bring the system back onto the subject lot. Another strong point in favor of the issuance of this waiver is that the neighboring lot is established with an on-site septic system approximately 80 feet away from the septic system on the subject lot. This waiver approval is also subject to our receiving a recorded legal easement for ingress and egress to the well servicing the subject lot that is located two feet south of the subject lot. This waiver approval applies to the existing septic system only. Any future upgrade will require that all setbacks be observed or another waiver approval from this department° Sincerely, Daniel J. ~oth Civil Engineer On-Site Services cc: Gus Andress, P.Eo S ' Manager, On-Site ervlces/Water Quality Programs ALASKA I1UIROnlTI:ITAL CONTROL seHulce$, Inc. (~n(li~rinq 6 ~nuironmenlal $1udies Municipality of Auchorage Department of llealth & Iluman Services 825 L Street Anchorage, Al(. 99501 Re: November 13, 1987 ..<.\?~.,,~w o~":.'..,_s,>,w\"~",... ~--,-~ .... After the new survey we found that the system is not 35 feet from the lot line but encroaches 6 feet onto the lot to the north. See attached. This lot has a duplex. A sewer system was inspected by the MOA. The location of this system is uphill aad over 40 feet from the south lot line. Slopes are steep and to the west so ther(; is probably little to no interconnections between the systems. The bani(, North American Savings, of Santa A,m, California wants to leave the system within 'the lot line easelnent. It is doubtful if this easement will ever be used. The agent for the bank understands that it may have to be moved in case someone decides to use 'the easement. As you can see from the surveys, the area for a system upgrade is neglible. An adequacy tes~ showed the current system to be adequate. Seven hundred gallons of water were metered into the system. There was a 0.28 foot; water rise in the standpipe which immediate dropped after stepping the water flow. A check of downslope area revealed no surfacing of water. Were the system to remain in tim easement it would not encroach on the neighbor's used of land as he must be 10 feet from lot line. The reason .is that the existing system has 1.5 feet of rock under the pipe so the 10 feet rule applies to the existing or to his future system. Because of the soils on this lot, it is doubtful that a deep system could be installed. Also, it is not the logical place to install a system for the duplex. In )ny professiona] opinion 'the granting of this waiver would create neithe, r a health hazard nor deprive the neighbor of use of his land. I therefore request a waiver of the 10 feet between the system and the lot line to 1 foot. In addition, I request a modification of the existing permit, No. 870297, to allow for construction of a 7 foot section of five foot wide trench with 1.5 feet of gravel under the pipe. Signed: 1200 Wesl 33rJ Aucnue, Suil~ [~. Anchoraq¢. Alaska 99503.(907) 561-50zi0 -) I ................. /',k'i',o ¢;, ¢o,o ri 13 '~7 '-.,) :;'37'~©):L-_A ?.~') '-4"7',P4.m\O  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEtVI AND/OR WELL INSPECTION REPORT PHONE -~AME~L~XX~I~ John SamecIz4¢-crTz [].P~.ADE ~AILINGADDRESS LEGAL DESCRIPTION LOCATION NO. O~EDROOMS ~' DISTANCE TO: Well/o ~/ Abortion area ' Dwelling q / PE~:~ ~ ~/ ~ ~~ MatorialS~~ ~o. of comoa~onts ~iq~ cap~c~g inflallons~.~ IF HOM[~A~E: lnside len~tl~ ~ ~idtht~ Uquid _ I ff}~ W'e~l Dwelling-- PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~ DISTANCE TO: '~e,l F°undati°n3 O' ~eare~l~Ji~ ~ No, of linesm L~fea~g°_ , T°talle~gd)~Hneso~ Tr~idth ~ Distans~tweenlines P ~ tile to fi~Js~ grade~ ¢ Mat0ri81 beneath tile '* Total elective cbs=¢tio, area ~ F r Top of Length Width Depth PERMIT NO. ~ ~ Type of orib Orib di r Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANOE TO; ~ Class Depth .~ / Or~l~er Distance to lot line PERMITNO. ~ Building found Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER 5.~ -PIPE MATERIALS / (O INSTALLER / ~ ~ . ,//, APPROVED '~% THOMAS R. SMITH ~ DATE LEGAL 77-013 IRev. 3/78) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologi¢ol 8~ GeophysicolSurveys Oril[inB Permit No. LOCATION OF WELL (Please complete either la, lb or lc.) A.D.L.. No. qa~.lBorough Subdivision Lot SIock ih.II I/4qtrs. Section No. TownshiPN[~ Rooge E~-~ t~Jerldioa Ic.~OISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3, OWNER OF WELL: ~ ' Address: Feet Below 4. WgLL DEPTH: (f[nol) 5. OATE OF COMPLETION 2. WELL LOG Surfoce Material Typo Top Bottom ' ", ,,; ': ~Auger ~detted ~Bored ~Other: Set between ft. and ft. Bockfilling Gravel pack I0. STATIC WATER LEVEL: Date ~Above or ~ Selow Iond surface [ ' ~Sb__ i .' fl. after ' hfs, pumping '..g.p.m. ": ~ ft. afler ~hrs. pumping___ ~.p.m. M~~ ~AQE ~3. PUMP: (if available) HP I~FP'r ~ ~A.L'FH ~ Lenglh of Drop Pipe fl. copooity ENVIRONM[NTAL PRO C/ION ~ Sub~. ~ dot ~ Ce,Ir[f [cai ~ Other REC.,v I~, WATE~ WELL BO~TRAOTOR'S BERTIFIOAT[ON: I~. Water T~mperature -- o Form OZ-WWR (11/81) Copy Distri~ulion; WHITE-Stole DGGS~ PINK"Driller~ CANARY-Ouslomer II~"ll IL. Il Ih,41 ~ C~: ]E IF=" ,,"-"~ IL. ][ '"lF' '"'J!g'.' JJZ:]J IF::' ~;~ Ih411LS:~ II--U ~E']J IF::;;'.' ~::'.~ ED iE!] ¥/~/~ DI'~F:'AI:~TMIi!!]qqr' C]J::: I'"IJ~:".AL.TH AND ENVIRONMENTAI.~ F:'I:~OTI~CTIOI~I EJ2.5 I.... !!FI"I:~:I!~]!~]'' , ANCHCJRAGE ~ ~1< 99E~() 1 264'-'472C') 840'735 0t3/~:':~9/Et4 JOHN f:i~AMI~C. I:::' Ct BOX 62. CF7 563- 3430 995()2 ~ SUBD I V 1: S ]: (::}l",J: I'"IOUI',FI"A I N SFIADCIWS E~E[YT' l' ON: 15 TOI/.,II',ISH I F:': 121'q 2zI. EEiK) (SI;!, l:::'"f', C)F;: 3 ' LOT: 2 BL.C)[;I,'::: 2 RAIxlGI!~: ~ 3W I...:i.~.i, rt:.c~:.~d I:)e].c)~,,J are 'Lhe op'Lions ava:i.].al:)ie 'Lo you in des:Lgning your s~ep'k:.i(:: DEF:"/'I.I TO F:'IF:'IE: BO'I"T[)M (F:'T.) GRAVEL DEPTH (F:'T.) TOTAl.. DEF:'TH GF;~AVEEL WIDTH (1:":"1".) GRAVEL LENGTH (F'T,,) E)RAVIEI,,.. LJ[)L..LJME (CU,, YDS. ) TANK S]:ZE (GALS) E;O]:L,. t::~A]']:NE'~ (~3Q. Fr't". /BIR) ()()C:,., 0 · >H~ 'I"ANK IqLJS'I" HAVE A'I" I...I'SAS'I" TW[) C;OIqF:'AI::(TMEN'T'S 4 ,, 0 5,, 0 5";,, C.) 45 ,, 0 :1., ()C.)C:~ ,, 0 cer'J::LFy that: :t.,, I am familiar' L,~:i.'Lh the reqLt:i.r'emerrLs fop (:~n.-..s:i,'t.~:,.: !~;eB~er~i anc;I k,,~e].:L':~ a~:~ ~;~'..~:. ~(::)ri:h by 'Lhe Hun:i. cipal:i, ty of Anchorage (MOA) ar'id i:.he Sta'Le oF Alasl.::a., ~,, ]: Ni],]. :J, I"t f~F[ &t :L ]. thE.) fsyEi'[:.E)IiI :J.l"I E~E:c;(:PpcJal]C:(~ w:i.t.l"} a:l.:t. MOA codes and ~u]d ir'l C:C)[flp].J,~'tFIC:E) w:J, th thE.) C:lE)~;i. gin criter:i.a (::)F this I]ePmi'L. 3,, :1: ~:i. 1'.1. adher'e .to all PIOA ,~l:lct S'[a'L(~, (::ii' A].~sJ-::a PE~.EL.&:J. PE. mE.I"ItE; ~'C:)l" 'I'..AE~ sei:. back !~(,:~v,I(.2r'agE~ E~iyEF~:,E~Ffl (:ll"l th:L~:; o1" arly &u:Jj~C:(~ZFI'JL OP t"lE.}ar'by ].oiL,. 4,, ] Lu]c.te:)Psi:.ar'1d thai:, i:.his per'mit is va].id {'oP a max:i, mL&rfl o~' :]; J:i~,~c:Jr'f3c:)flls ~lt"ly ENq].af'gellli.~rl'[ Nil]. r'(-:~qL,~J,P(~ ~rI a(:JcJi'[~.orlal per'mit,, I Fr A I.,. :[ F'T S'TA'I' I C)N :t: ~ I Iq,C3TAI...I....ED :r. lxi AN AI:~EA COVERI~:D BY MC)A BU :[ L.D I IxlG, UODI ....... 'THEIxl (1) AN IEI..,EC't'I::~]:CAI..., PERIdIT Alxl~) INE~PEE:"FIOIxl MUST BEE OB"FA]:NED~; (2) ASr,,.PUIL."FS WIL,.L,. IxlOT BE APF:'F~OVED N]:'T'H[]LJT AN E.LE,CTI~]C, AI .... I.N,:)I.I=,C,J ,[(.JIl RIEF:'OF~'I~: AN~) (3) TI.-II~:  ~ L I CENSED ISL. EI2'I"F~ I [:: :[ AN. AF:'I:::'I.... I [::;ANT: J OF'Ilxl SAME[:] ,3~¢--0~.~..~ MUNIL;II-'ALITY OF ANCHORAGE ~i"~-(~IL~/d~J~ Department Health and Environmenta3 rotection · 825 ,, Street, Anchorage, AK. ~JE01 264-4720 ~D ~'~ ~,,,_,¢,~.;, ~ HANDWRITTEN PERMIT ~ * * Permit 9 ~o,~.¢ c~')u'P~LL AND/OR ON-SITE SEWER PERMIT ApE l ic an t: ~ ~/~L ~' ~' ~,/,, (~L~%'L~(- EL~ Mailing Address: // Location: Phone Number: Legal Description: ~ ~ ~:~ /'~Q-¢ -:a~(~o~ Lot Size: ~¢~ ~/ Type of Soil Absorption System Is: Trench: Drainfield: ~._ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~% A Soil Rating(sq.ft/br) ~- The Required Size of the Soil Absorption System Is: DEPTH LENGTH ~ c/ GRAVEL DEPTH ~ ~/~5'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(HOb~I-N'8) TANK SIZE = / ~ ~r~ 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 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. 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 are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 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. 2) I will install the system in accordance with codes. 3) I understan¢ thgt the on-site sewer system may require enlargement if t~?eside~e ~ remodeled to include more that 3 bedrooms. Applicant ~'-Y ~1 Da te: ~//~,/~k~ S & S ENGID~EERS, INC 7125 Did Seward Hwy. Anchorage, Alaska 99502 349-6§61 { SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: '~ 0 !-t i~ LEGAL DESCRIPTION: /.,,.-OT 2. 2 3 '4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? __ DATE.ERFOR ED: /~O,,)~dT A /~V :S t:LA DOWS' _Sc)P~ b~ V ~ ..S io~q S L O P E IF YES, AT WHAT DEPTH? , "0FE~SI09, SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE 'k]t ~0./~' L- (minutes/inch) TEST RUN BETWEEN __'~F' to FT AND 6' ¢ FT PERFORMED BY: CERTIFIED BY: DATE: F:IF'F'L :[ CF:It",iT I.;OCFIT l :;1"1 I..JiEGFIL. T'¢F'E OF:' :.:.!; E, ]: L I::iE:'J:J;OI:;;:F'T:[Ed'.,I :BYtS'T'EH ]::B' i'IFB.:::[I'il...IH hlLii'IE:ER EE:' E:Ei::.,Fb::)Ed'IL::; = 3 Ti.'-tE: i:;:E:C.!L.! ]: I:.i:tii:[., :!..:q Z ZE OF' 'THE :BO ]: L FIE :E; Ed;' I::' I" '[ r' i'.,i E;'¢:E;TEI,t Z E;: THE LEI'.4G'FH I]:, :[ l"'lliEl",l:5 ]: ON i :5 THE L. liEI",IGTH ,:: ]: I'.,I I:'EET ', OF THE; TI;::ENE:H C Fi' E:,F.:I::I I i",IFI EL.D. 'T'HE DEF:'TH OF FJ "FI:~:EI'.,ICH FI;.: F'IT :1::~; THE DZ:E;TFINE:E BEI'HEEN THE: 15LF.'F'F~ZE: GF::EH.JNE, FlhtE:, THE Br::'I"T: I','t OF' THIE E:XE:FI',,,'FFI" I ON ,:: I N FEET', THE GF:::F&,'iEL. DEF. TH ]:.:~ THE i,t:[ht~HI.i,I [>EF'"i'H C)F' GF.F','EI.... E',ETI.,]EEI'.,I THE OLFI"F'FIL. L F'.T.F'IE FiND THiE Ei',O'T'"i'Ed"I OF' THE IEXCFi',,,'FIT ]' 3H ,:: :[1'4 FEET ::,. I El .I I.I. I FIF'F'L :[ E:Ffi'.,IT HF:I~; 'T'HE RE'Ji.:,F'OI'-,I5 ]:Iii'.-'; I L Z Th" 'T'O I t",IFORH "FH I S E:,EF'F:II~:TI'IENT E:,t. JI;: I l'-,IEi 'THE :[t",ISTFH..J_I::i'I"]:Ed'.,I ]:N2;F'ECTIEd'.,I:.-7, OF: FIN"r' i4ELL.t.:'_:; F:i[)..'rFICEI'.,H" i"O 1"HI:B F'F;:CF'EF."T"r: FtND THE i'-,ii...ii'lBEi:i;i: Ed::' i:;~:E!::L:; L[ DEi'.,ICE.~; 'TI'"iFI"I" I"HI:~ I.,.iEL. L [,.1:[ LL SERVE. ................... "'¥" iL...li r'"~ ,:'.' ;;:qE:: :::, % ii".ql £-'."_-': E:::" E] EZ: 'T- Z: ,Z' E-.~ ':Ei.::"; ~..':=, F: EE: II;L" E::Z ~%:.~ UI % I,r:,~." EE IE: ..................... E:I::i i.".'; I.:.: F :[ L, L ][ I'.,i G F F' Fi N "r' :E; h"'.'5 'I" E i'l H ;[ T H F' _ T F' :[ 1"4 Fi L. :i' N :5 F'E E: T ;[ (3 N FI t",1E:' F:I F' I":'1;: O',,,'Fi L. DEF'FIF:THENT I.,.I.i;. L..L. E~E :E;I..JEk]'E Z 'T' TO F'FtO'.::;E(:)UT .'[ Oi",!. i'tlN:[Mt...tt,1 [::,iL"E;TFINCE E:E:'I"HtEEi'.,I F:I HEL. L F~N[::' FII'.,I'¢ OI'.,I-~.E;Z"I"IE :,E. klHI~E' ...... J..Eu~ F'EET I:::'OF~: Fi I:'R:[',,,'RTE HELL. OF?. '~: TO 2~3~ FEET FF:Ot'I Fl F:'UBLIE: HELL [:,EF'ENDC[N(3 i...iF:'FN THE 'i'"r'F'E: OF:' i:::'LJE&..:[C. ['.iELJ .... i'iZi",i~l'lUH [:'Z:STFINCE F:ROH R FFtZ, ":I'~:. HELL TO Fi F'RZ',/FITIE %IEP.IER: LZI",IE Z5 ~ FEET Fi¢4[::' "FC) F:l C:CI"Ih'I...H:[T¥ :SEI.,~EF: L.:[h,IE Z:~; 75FE[ET. HEL. L LOG:E; Fff:?.E: [~'.E(~¢.J:[fi:EI3, l::~hE::, t'lt...l~;'r' EdE RETURNED TO THE E:,EPRRTt'IENT I.,i~TH~I'.,t OF THIE HEL. L COHF'L. ETZOi'.,i. OTHEIq: I:;;:IEC¢.J I R:E;i'iE:NTE; i'lFi'¢ F~PPL."r:. :E;F'EC ): [:' t E. FI"F I ON% FtNE:' CCIhlE¢"I"F;:LIC"I" ]: ON I]:' ] Ftl3RFIt'"IL~ Irql;'.E H HZLt E,LE. TO INSIJ[~:E I::'ROF'IEF: ZI",I~STFIL. L.FITZOI",I. Z C.i:Et:;..:T ].' F"r~ :.L: ;[ Fd'l FFiH]:L.:[Fhq: ['.iITH THIE REQLI.~i';?.EIqENT2:; FOF:: ON-SITE SEI.'.IERE; FINE:' HELLS FI:iT, 2;ET F'OI:;.:TH B'T' 'Fi4E HLli",i:[CIF'FH.~.IT'¢ OF FII",ICHOF::FIGE. ,7:i:: .i: i.'.i:[LL ]:hi:T.;'I"F'CJ.... "i"HE: :5"r':7, TEH ;[hi FIE:COI:;..'E.'FiNE:E; I.,.t.ITH "I"HE CF~B,E~;. :;:i.: :[ U?',IE.'ER:STFd",tE:' TI'"IIr:Ff' "i"FtE Ot",I-'~$:I:TE :SEl.,.iEi;~: 5"r%TEH l"tR¥ F:E6!Lt.~F~:E EI",tLF~F?.GEIIEi",IT :IF 'T'HE i';~:E:~i;:i:i3'EhlCE F;-':EHEE)E:L. tE[) 'i"O ]~I",ICI.~.LIDE t'IORE 'I"I'"IRI",! ~: E~Ei)F:OOH~;. 2.'"; I GhlE:D: F'L.. :[ CFIhlT ...~OHN .:Permit ~: 820759 January 31, 1983 TO: Permit Applicant Subject: Lot 2 Block 2 Mounl:ain Shadows Subdivision A permit issued by this department for an individual well_ and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well. log needs to be sent to this department for documentation of the installation date and to c].ose the permit° Jif a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 254-.4720. S ince.reky. Robert C. Pratt, R.S. Acting Program Hanager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 f!'!!::!Z MEhi(!f'FH [)]; HEN:!!; i; ON :[ :iii: -f'HiE L. EN(iiTH ,:; ;i; i",! F:'EEFf' ;:, 0!:::' "rile "i'I:;;:ENC!..! Eii:;i: i:)RF! ;[ NF :I; Fi"ffi; f)E;f::'t'!'i (;;~!::' F! 'rF:l:!!;i'..!f;:H OF: F:';['T' ~;:i;:; "!'FIE; D:['~;'TF:IhE;:E E',E"i'!,!E:E;N qHiE :¢i;i.jl:;i'.i::'Fi(;;:E~ 01::;' (;ii!:;:O!..!i'..E:, f::!h.!!Z) -!'!'"I!E !;!i'.(;)!' i"0t"t Oi::: 'I"HE I::~::':;E:FI',,,'F!TZ[CI!"~ (:[i",l I:::'IZ!?F). "¢'i'"iE Eil;;5::¢v'hJ... DEF'i'I-I :!Z:i~; 'THE i"I;i:i",f;[I"!Ut"I DE;I;:'"i?i E!F' I;!ilq'.l::;!',,¢(i;!... E',E~;'f'Ht:'::iEN 'T'HiE (J)t..iTI:::F!L!_ i:::' ]; !:::'E f::ff,![) T'i'iE EnZ! 'f' i'OH 0!::' TI"lIE l.~;;:':;(;;f::l'v'f::!'T ;i; O1",! ':; ;i; l'q F:'I};E"i" ). i"i i[ i".! ii; Hi_ih! i';:, ]i ':~;Ti;::Ii",IE:E l!!!fi~i;Tl,.!b;(:;i"~ FI I,!Ei...L Fib!I) Filq"/ ('-'fi,l-.'::.'; :[ "r'E :!!;iii;t,.IFiEil..:; D ;;!.i~)E~ I::'!]i;ET f::'Oi;;: !:::t i:::'!:;;: ]: Vl::~T!ii; !,.~ili!;L.L. Ol';i: ;:[.~ji~;!)T'O ;;i!'.!;i!i(~ F'EE;T !:::'Fi%ii'"! !:::I F'I. Ji~',L.~'i..;: !.,.ItEi...I.. Ui:::'Cff,! 'i'i..iiiiil "i".¢i:::'E; ()F F'I...IEL;[E: 14tEi...L.. i,! ;[ i',! ]; Hi Ji,! il)i:!il'F!i'.,!C:ii!!; F:'!:;;'.OH F:l F'l:,i:];'¢l::!i'~ii: i,!EL.i... T()I~::! t::'i~:;i:',,,'l::l"F!!!: SIE!4i!~l:-.". L.];l",lli~i ;([!i; ;i~:!:.;.:.i F:'i~i~i]'! F:ii",![) "!'(i) ~::! CO!'!HUh!;!:'TV ':~ENIEi:;;: i..i;i',iE( ti~:~; ';':'5 i::'fEET. i,fiEi...L t._(](]~i~:i; F:!!:;~:li!i; !:~:FX;!!.t];i:;i:Et.)F~i,E:, i,'tl...l:i~;] E',IE !::;%']'IJI:;'.H!i~Z:, "f'O THE Q !::: '1"i..i E i.,i!i!;!... L. C !:)t"1i:::' L !E"!" ]: Ci H. (YT'H!:ii;Fi l:;hi!i%!t.i [ !:;;:El"!i!:~%!'i"1!ii; I'fii':ff FIF't::'L"/ :~i;F:'l:ii):]: i!i F' i[ C:FIT ;[ Cit',I~!; I:::ti',![) E:Oi',t:E;T!;,~:I..iC:'T i::'i',,,'!:::!];i..Fi!!!'.i..E; -f(1) i[i',!:L:,LIi:,;:Ei f::'I:;i:C!F'iE!:;.: )i (::!~!i!:;i: T ( .:::"." 'F I-..i!:::! T ........-'1. - T i:.:IH i:::'!;:ii'! TI ;[ I:::11.;;: i,J ;I; 'f'H "i'I.!iZ ::'I::' .......... ': Z I;Ui!JI"ilEI',iT';::; r..'-CF,:.", r" 1'-I,,...~!.: .!. f u.'" ."/...,I.-;;"hll;L-'...'i;' FIND i,IFi. ........... ':::; F FO!:;;:'.'!.! ~',r' THE i"i!.Ii'.,!.,;C';[I::'I:::!I,..j[T'-/ OF: I::".,!t"i... "F'i:::I3~:: ,1 ........... .t .... THE :¢;'¢'~Ff'E;H ;',~ ::CE'~F4'..3FIt'.¢,"~'E' Hi"I"H THE .: ..... ul',!L.'~::.h:..r:, Ir'fi,IL.' !I'"!HI !Hh:. L.u",~J. t!:: ¢::,I::.1,.!f::.1',:: "z,"/'.':, t ~'~!"1 !"!t':!"¢ !:;:!~)]l.,.!);l;~'.t]; i~;i",!L.F:!F;:(]i~SHE!".{f' ;[!::' TI'liE :: ::'F:' 'r~': '. '" . ...,,.. January 4, 1982 James Company 8301 Arctic Blvd. Anchorage, AK 99502 Permit {~ 810082 Subject: L 2 B 2 Mt. Shadows S/D A permit issued by this department for a well and/or sewer systeln has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority ef Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4.720. Sincerely, Sewer and Nater Program Enclosure: Copy of Permit I-E=F .I II 1r' NO t-ff F L..[ .,blJI L,, 0 C FI T I C N L Ei:GI:::tL, · J'FIMli:.' S; C.: C[ H F'I:::I N'¢ ..)' E: FII',II'.,IFZ L '=' E: 2 - ' ,=. _ HT. ::.SHFIF;,OHS .:,,. E. E:5:e:l HF: _. t IL. E:L"E'. :9~502 L..OT S I T'-r'F'E OF SO]'L FIE'Y"F..'F'TIOI'.,I S"r'E;TEH I:5' TF::E:NE:FI "Z:: 4 ,::1,-, 0 5 01 :SQL FIF.:E FEE'I" THE LENGTH [."Ii'4EI",ISII]i',t ZS 'THE LENI3TFI <I1",t FEET) OF THE TF.::ENCH OF,': DRFIINFI'EL.[). THE: [::,EPTFI OF= I=1 TREI'.,tCH OR PIT IS THE [:,IE;TRNCE DETHEEN ]"PIE SURF'F:iC:E OF' THE GI';i:OI.JI'.,II:) Ri'.,l[::, 'TFIE:. E:O'i"TOH OF THE E::.=:E:FI'v'FiT I ON ( I I'.,I F:EET ::,. 'I"HEFi'.E :[ ':!: f',lO :SE'/" W ]; [:,TH F'OFt 'f'RENCHE:S. THE GF4:Ia'v'EL [.':,EF'TH ];S THE HINIHLIH DEPTH OF GF..'RVEL E:ETNEEN "FHE OLITFFILI... PiPE Rl',l[:, THE BOTTCIH OF THE EXCR'v'RTION (.f.l'.,I FEET::,. F:'EF;:H I "F FIF:'F:'I... ]: CFIN"I' HI:IS TFIE F. tE'=: F'C i',l'S I D I L I 'T'"r' "FO I NFOF.':H TH I S [:,EF'FIFJ:THI.ZI'.,Fr' [:,I...tFi: :[ 1'.,11.3 'THE ]:i".ISi;'I"I::II...LF:IT]:CIN 1N.:,FE_.I IUl'.,::, OF i::1i'.,1~,.' P.IELL::.'; FIE:,,.:I'FICEI'.,I'I" TCI "FHIS r F- _ r' ~:.r:.~ FIND THE HLIMEE'F;'... Cfi=. REE.:,IE:'ENCEZ THFIT T'HE ,t,.IE;LL. I.,.IILL ..... ':""E.F..,E., E~RCK,C]:L.L]:NCi Cfi:' FIN'¢ S;"¢E;TIEH HTTHOIJT F':'INFIL. II',IC;F'E'-:TIr"N RI'.,ID z4~,r:,:,'-i,,,~ B"r' ......... ]"HIE; I.. E.F -IF.1 I'11:.1,11 l.,.llt.I... Fi:Fi ':.:1 IE:.TF'-"1' TCI f k. _ :,E. UI..II ION. MINIHIJH [:,.~E;'T'RNE:E DE'T'klEE:N R HEL. L RN[:, FIN"r' CIN-SI'FE .'.-:;EI.,.IRGE ::1.0~;:3 F'EE:T FOR Iq PRI'v'FITE I,JELL OR! :t50 'I"C~ 200 FEE'I" FF::OH FI F:'LIE~L. IC: HEL. L DEF'ENE:,II'.,IG UF'CIN 7'1.'.1[::: T'-,.'PE: OF' F:'IJBL. IC: I.,.IEL..L.. HIi'.,tlHUH [:']:E;TF:INCkT. F'F?Cff"I FI PF'.I'v'FITE WELL TO I=1 PF;?.IVFITE E;EP.IEF: L.:[I",IE iS 25 FEET FII'.,t[:, TO I=1 C':OHHI...INIT'T' SEHER L. INE ]:S ';:'5 FEET. CI]"HEI';;'. I:',i:E:QIJ:[Fq~EHE:I'.,ITS I"lkq¥ F:IPF'L.'.r'. ::.i;F'EC:IF]:CRTICIN':7, Ill'.db C:Cd',IE;I"F;'.LICT.ION DIFtGRFIPI'.'S FI'v'FI .[ LF:IBI....E TO I NSIJ[:i:E F'-'RI:hOEF: I I",I'E, TFIL. LFIT I Ol'.J. I C:ERT I F:"T' ]*IqFIT :1.: I FIN FRHiLIFIP. HITH THE FiE(;!UI.F~IEHENI'"$ P"OfN: ON-SITE: F'OFJ'.TH E-}'¢ THE HUNIC:IF'I=II._IT'¢ OF FINI::HOt;.'.IqCiE. 2: I NII.J... IN':'.i;"FFII...L THE :S'.r':STEM ]:N FIC:C:OF.'.E:,F~NCE P.IITH THE CO[:,ES. 3:: I I. JI'.,I[::,f~I:F..:!~;'T'I::Ii'.,I[::, TFIFI'F THF OI",I-'::SI'I"E: 2;EI.,.IFR E:';'T".S'T'EH I'dR",.' RE:QUIRE ENL..RF::GEHENT .IF' 'r'l...lE [;:ES I [:,ENCE I :.S F.:LEMODELE[:, TO :[ IWC:LIJDE 1"10[;.:[':: THFIN Z BEDF4:OOML:;. FIF'F'L t CFII',IT .]'FII"IEZ C:CIP1F'FIN'¢ MUNICIPALITY OF ANCHORAGE Department Health and Environmental rotection 825 b Street, Anchorage, AK. 99501 264-4720 HANDWRITTEN PERMIT * * * ~/OR ON-SITE SEWER PERMIT Applican~~ ~3.= 4, Mailing Address: ~¢/ ~=~==/~ t~/~_q~= Location: ~~C ~74-. Phone Number: ~V__~-~/ Type of Soil Absorption System Is: Trench: Drainfield: _~.__~'Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /~5~- The Required Size of the Soil Absorption System Is: DEPTH ~ _ LENGTH ~*'~'3 . GRAVEL DEPTH ~ WIDTH _ _L.~~'' ~7- 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 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. 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 are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 1 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is rc~nodeled to include more~that /~ bedrooms. · _ Issued by · Applic~ Date: SWP/024(1/81) December 31, 1979 Ronald Roberts .1650 Edi. nburg Drive Ancherage, Alaska 99 s0.~: Permit ~ 790021 Subject: Lot 2 Block '2 Hountain Shadows Subdivision A permit issued }Dy this departmenh for well a~.d/o._ sewer system has expired. Permits are issued on a calendar }/ear basis, as stated on ,..he oermit, hy authority of }iunicipal ordinance if you have drilled the we!l, a well log should be sent te this diepartment te document the installation date. If an engineer has inspected the installation of the on--site sewer system, please have them send us the as-builts for our files. if there are any further ouestions, please contac~ office at 264-4720. incerely Les N. ~ LNB/ljw enc: Copy of Permit FIE 1~:['"1 :[ '1" "I"FIE: I...[ENI.-:iTH [:, l P1EI".I~:~; :1: ON :[ :-:!; 'I"HE: LENG'f'H ,:: I f',l F'EE'F ::, OF' THE; TRENCH L" I:? I::,I::itFi :1: HF:' ]: [!i:1...I]:,. 'I'HE [:,E'F'TH OF' I::1 TF.:ENC:H O1~'. F':[T :[~!.:, THF: [:, ]: ~;TFINC:E' E,[~:THE[:Et,.,I THE !i;LF?FFI~:E O1::: THE: (Ji~:Ol_lN[:, I:11'.~[) THE: E~CITTOH ElF 'T~]E E,',~FI',/FIT'['"I'.t ,"]'H ~ THE ,2il::~:R,,, EEL. I::,EPTH :i: :E; 'rH[.~ H ): I'.,I :[ r,'~ur,'J ,::,F; n UUTF ::[L.L. [::, :~: r:::,r~: i::1i'.,11::, THE E=O'TTEiPI r' F' 'I"HE E::.:;CF:I',,,'I::IT ]: ON ,' :[ i'.,I I::'EE':T ::,. ~'t'_:::[(:1"1 ]: 'T I::'IF:'i:::'L :[ CF:II'.,IT HFI'.::5 THE: I;i:E:i.~;F'ON:~.:, ]: [:~: Z L :i: T'.? 1'121 :[ I'.,II':'CJFd','I TH :[ :5 I)E'I::'FIFi!'T'i','IEI'.,I T [".:,lJ[;?. :1: NI)i TI.ti!;: ]: N:.:J;TI::IL.LFIT ]: 01'.,I :[ IqSF'EC:T ]: OF,f:. L")F' I::IN'¢ I.,.IEI...L:~: F:Ii%.:fFICEI'.,Ff' TO TH :[ :~; I: [..': ..." I": E~.- '~F F:II'.,t[::, 'I"HI'~i: ",11 ['1[: [:'1:;i'.: OF:' ';:' ~'"~ - · L.E:,:[I::,EhlC:EtE; THFI"f' "f'HE HELL HI.L..L. :,[:.[.": ..... I:'.. "1 ].' I",1 Z HLIr,'I l::, ]: ::.-..;TFli'..!OE'. E:EETHE'EN R HELl... RI'.,ID I::'tf.,1'.,-' EIN.-..:~; ]: TE ::.'~:;E,t,.IFiGE [;:, I SF'O:SF:II... :fi;'¢:STl:Ti:H [.1:._.'1(~1 I:::EE:T I~:'O[?, FI PF.'.i',,,'FITE: HELL.; L.!~!~Ii!) 'l"i~) ~:1.~:1~:1 I~EE!!Ff' FROH I::'I PUE:L.:[E: F.I[:::I~L., E:'IEF'FEHI):I:NG L.IF'ON THE T"/F'E ,.IE!:LL.. L. OI.32:, I::~I:;i'.E REI~::ILI:[F::E:[::, FINE:, i"IUE!;T IF.:E R[ii:TI..II~tNEI::, TO "['1".1[~: [::,E:F'F:IRT~IENT 14 ]; "f'Ff ]'. l'.,I :11:::' THE: HELL. C:OHF"L. ET]JEIN. )'T'HER REg!U :[ [~.:EI"'IENT2; h'lFl'¢ FIF'F'L..'¢. :E; F:' [:_:' C ]: F :[ CFI"f'].' Of.4~5 FINE:, COi'.,I~.'_:;TFitI_ICT :lVFI ].' L.FIEJI~E~ "['O :[ N:'.-.;I.Jt~tE:: F'F;:OF:'E[~t ].' NSTI:'II...I..FIT .I ON. ' C: [E I:;;] "I' :[ F"r' 'I"HI::I .: :t: t::IH FF:IH:I:L.]:FtF(: I-'.I]:Tt"I :OFf. TH E:"r' THEE HI..II",I ]; E: ]: F'FtL :I: T~¢ r.:'F:' !: ]: 14 ]: L.I... :1: Nt~;TF:IL.L TI.*IE: ::5',?E;TEH ]: I'.,I FIC:L"::Ed:;:DFtNr~ [:: H ]: TH THE 'J':r/.)[',l.::":5 ~: ]; LINDEFit?,TI::II'.,I[::, TlaI':YI" TH[.:: C I'.,I.-..:i.:;,]:'I"E ~5EI.,.IEF:'. '.~;"r'$'~;"f'Ei'"l i'"11::1"¢ I:;;:l::Er.::~l. :[I:;:E E:NI...F:II:;?.(:iEH[£hlT ]:F' Tt..I[E :lEri~; :1: [::,l:ii:lqCE :[ rE; Fi:I~.I"IC~DFELE[:, TO ; ]: I;]it"'! [:J t:): 'L~' "'F~FI::' L~ ~:11"~ '[' F':IEfi'I'If:I L. E:' F'E*i';.~H ~ T I"JO. I::II'::'F:'L I CFINI* I...OC:F:IT .'[ Ol"J LEGI::tL lED I I'.JE:LIF;:G H [...1:) T "I"'.¢F'E Of::' rE;OIL. FI[3SORBTIEff.,I :~'i.'~'YI"EH ]:~..;: DRR:[NFIEL.[::, I'"IFIXIi'dL.IH htLli'dE:[!.:.l:;i: OF BE[:,ROO['I~5 = THE L.ENdiTFI [:IItl'IE~",I'-.:.,:[I:]II",I.["'-'::, THIE LEIqI:]TH ,:: :t:i'.J FEET) O1::' THE .......... 1 [ Et'J ...11 O1'~: E:ll.7..!f::l:l:l'.,IF' :1: I~]...[:,. "I"FII::.:: DEPTH OF' 1::t 'I"F~:ENC:H r'~? F':[T :[:~!; THE: I.., .1::..,I-i',J~.l::. E;ETI.,.IEEr.4 THE :F;.,UI:~:F'I:::tE:IE OF' 'T'HIE GF. tOIJI'.4[:, FIN[) 'TI.fiE BOTTCIH O1::' THE EXCIq',,,'FI'I":[ O1'.,t ,:: :[ I'.,I FEET ::,. THE' 6i[~I::I',,,'EL.. [:,EPTH ]:~ THE I"'I :I: I'.,I :[ HUH [::,EF'Tbl C:iF GF:'.FI',,,'EI.. BE'T'HEEN '1"1~.11}!~: i:]I..ITI:::i:::iI..L. I:::' ); F:' [.:!: FIN[:, "f'l.E~. E:Ci'FTOr,'I OF THE EXI:::i::I',?Fi'[' ]: 13i'.,I ,:: I N FEE'f' ). F'Et~:H I T Fff::'F'I_ I C:1::tI'.4"1" [..11::1'.:~; 'FHE [~:E:i!;l':ll.~ll'.,~.., :[ [~:: I L ~ l'l"":" I[*CI ~ I"JF(][;iff"l TH 1% D[~::FII::I[;?. Tr"~[~]"JT [:,IJF;: I HG THE IN.'?.:;TFILL. FIT]:Or.J :[I'.4'.'~';F'IECT]:Oi'.J'.::; I]F' f:li",l"r' I.,.IELL.~; I::I[:,,:rFIC:Et'.,IT TO THIS I:::',~;~:OF'EF?.T'¢ t'.,ILIHEtEF..: OF' RESIC, E:NC[!:~E; THFIT "f'[IE I.,JEt..L.. H:I:LL. '.:~;EI:;:',,,'E. E:RE:I.:::I:' I L.L I t",tG OF' I::l[",l:'r1%":"2;TEf'I bJ ): THOUT F' I NI::II.. I [,I':':~;FiEI~.'T ]~ Cil'..I I:;:IN[) Ffi:::'F'RO',,,'FiL. E:'¢ "I'H :[ C, EF:'I:::II~i:"i"HENT 1.4ItZ.. E:[:': 2;I..IE:..}'ECT TEl FI INIPII..IH [:,I~STRIqC:E: E:E:'T'[,IEI~:I'.,I I":1 :I..EI~.Z~ FEET F'OI:;: I:::1 F'Ft:[',,,'FFI'E HEL. L.~ ±!SE~ TO ;'-?.E~E~ FEET F"I;;:OH I::1 F'L.IE:L. IC 1.4EL. L DEF'EN[:,ING UI:::'ON THE: T'T'F'E OF F'LIE',I...):C I.,.ll:!i:l..I... HELL. I.J]G'.:¢ RF:'.E r4'.EC..:!LIIF'.EI::, I::IN[:, I"IUS:;T E:I:~ RETLIRNI'ED TO THE [:,F.:F'FIf;~:THEIqT I,.I ]: TH :I: N :%"~ [:,l:::l"r':!:~; OF THE HEL..L COHF'L.ETION. OTHEF: F%L::!LI :[ i;tEr,lEl'.,Ff'5; HFI'.? FIF't~:'L.'.r', SPEC ]: F ]; CFIT I ON':'; I::IN[:, cor.,!:.'.:.;TFtL~CT I ON [::, i Ffl:!il:;~:l::li',l~i; F:II::i'.I~:: R',,,' F:I ]: l.. FiE:L [~: i CE:I;?.T :[ l:::"r' ']'HI::'I'[' :1..: ]: FIH F:'FiVI:[LIF:IF.'. I.'JITH THE: I;.'".[:!:~;!LIIf;i:E:fqE:i",I"I"~; FOF: OI",I""'SITE :.::;EklE:I;?.~; I:;:lr',ll') ['.IEI.I[...~; I::l~'~i; :E;ICT FORTH E:"r' 'T'HE HLINIE:IF'FIL..]:'T'¢ OF FINCHORRGE. 2: I kl I t.l.. I N'-:.':TFII~L THE % '-? .'..]:71' fF. r,'l :[ I'.,I FICCOF.:[::,FINCE P.I Z TH THE E:O[:,Eti!;. 7~:: :i: t..IN[:,E[.~'.'.:/'rRN[) THRT THE Oi'.~-...%):TE S[.:.]4[E[;;: '..F,"r'~!FI"EH HFt"r' I;~'.E6!I.t:[R[!~: Ei",It..FIf4:GEHE::HT ]:I:::' THE: [~'.E'.::.'; :!: [:'EI".IC[i': ]: E; I;!IEi"IODELED TO I NCL..LI[::,E': HOF~'.L:: THFIN ]: December 29~ 1978 ~780746 Ronald Roberts 4650 Edinburfsh Drive 2tnchorage, Alaska 99502 Subject: Lot 2 Block 2 Mountain Shadows Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. ]~'f you have ¢lrille(! the well~ a well log should be sent to this dep~,rtment to document 'the installation date~ ]~f there are any further questions~ please contact this o.~fice at 2(;4-4720. Sincerely, Les N. Buchholz, RoS. Senior Environmental Specialist I~B/ljw eno: copy of permit ir..;::: Iii;;?. 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I ', '::; :::'[!: :: "1" '[ I:)F,l:ili; QF: I::lH"r' I.,.IEI .I...% F:ff),:tFIC:!~Zi',II' 'f' i: 'rHI :!i; !:::'l';~:Cil:::'li!i:l:;J:'t".r' I::fh!li:, ,11 I','lFil:i::Fi: O1::: :;;[.~'_:; !':,l~:l'.,[r':l::',::: 'i't-tFi'I' '1"III! I.,.IEI..! t.,.1!t...I... :11.:.., :. '1 1 i'.,t I P'iUIq [::, :ii ::i!;'l"l:::ll'4C:l:}~ 1::',~:' I*t.,.lf!:t::i:l'.,l I::'1 I,[r:;I .L I:::tl"q) l::ll",t"r' ijlH-.:~; ! 'TE: :!i;E:I.,.II:::!GI}:: Ii:, 'r '!::;Fi' Z :i!! F:iL. !?'r"::; i I:: I"1 1i; I.~;:!it;;iI l:::'[!i:!;!?i' I::'O1:;:: F!i'"r",: '.,,,i ...... · It:. I,l[ii:Ll_.; Cfi;;: I....it;'.1 I'() ;:?l;:;il::!t I':'ll;t!;Jl' l::'t:;;:Clhl I:i F:'i..l[i',!. '1: Hli:! I... [)IEF'[!i:I'4ii:,iI'.,II:': LIF:'OH 'I'I.[E ' !" '.i-' l:::' l}: CIF:' i'::'1 [:~.]:C: ,.!f):t...[... f. i;'l;ii::i, l::tl:~:[!i: l:ill!ZlZ;:!LIII;i:[i:;!) !.11',1..:, 1',11.::-'t' I::;:!:i: I:d!!:/t'f..ll:;:t'.,ll~;%, 'I'CI FILE!: Ii:,!;i::I:::'I:::II:;?.I'HI;i!;HT !.,.!II"I. tlF! :!:16 !)!:::1'7% ')F' 'IllE H[!.I..I.... i: .'; I"11.::'[ E::' I" '; '" H ) I'HtJ:I:;;: I:;? i:::' E~ "I:;:f::!:l"ll!!J'.l"l :~ t"ll::['.r' I:::1f:;:'1: :'1._ './ . ::!!;l:::'l~(.: I 1::: ); {;:FIT J ;~ i",P!!! till. Il" E:r2H:!!: I'1:;: _. ;: T i !:.Zlt'.,i [::, J i:::llliil:;i:l:::ll,!':_:; .f ,,, H .I.L.I II.J_[:: 'i'O I J'.,!?:~;I..ll;i:[i: F:'i:;;:O!::'I:JZF:;: ;[ f",l:'i;'l"FIi .I._1::!'I" 1: PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4 5 6 7 8 9 ,~' /¢~' /'~/:"~;" ¢ SOILSLOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION TEST Pouch 6-650, Anchora0e, Alaska 99502 276-222f SOILS LOG - PERCOLATION TEST SLOPE SITE PLAN 10 11 12 13 14 15 16 17, 18- 19 20 WAS GROUND WATER S ENCOUNTEREDP. . ~-~2 k .... . IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Crop PERCOLATION RATE (minutes/inch) COMMENTS__ PE~ FORMED BY: /(~'~{ ') r ~'~- ~ CERTIFI-D BY~ DATE: 72 OO8 (7/76) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4'/00 Brag,a~, $;treet P.O. Box 196650 , Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEHS APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 017-4-01-19 1. GENERAL INFORMATION Expiration Date: Complete legal description MOUNTAIN SHADOWS S,/D; BLOCK 2, LOT 2 Location (site address) 12801 JEANNE ROAD * ANCHORAGE, AK * 99516 Current Property owner(s) KRISTIN BACON Day phone Mailing address 12801 JEANNE ROAD * ANCHORAGE, AK * 99516 Lending agency Day phone Mailing address Real Estate Agent TERESA BELL W/ PRUDENTIAL Day phone 240-2248 Mailing address 5801 CENTERPOINT DRIVE, SUITE 200 * ANCHORAGE, AK 99505 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As ced/fled by my sea/ affixed hereto and as investigation, based on procedures outlined in the Certificate of Qn-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 t,~e 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 557-6179 Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, ~<~m%~ ~,~. conscientious engineering analysis of the system in accordance with ADEC and MOA ~ 9 ~o. ~../ DSD Gu/defines & Regulations. The reported results described the performance of the ~/%~... ' sYStem under the conditions encountered at the time of the test, and separation ~..f~_~.." ' ] distancesmeasuredtoreadilyidentifiablefeatures. Theoperationallifeofallwellsand ./,..t~cO..o'~i~ %~_.. septic systems depend on the local soils condition, groundwater levels that may ~ ....... '.' ?' ~¢' '~ 7 " fluctuate during the year, and the water usage of the family being se~ed by the system. ~ These condNOns are outside the control of the evaluator of the system. Satisfacto~ test ~'~,~ ~ ...... ~ ~: .~. .,j .... ~ ........... 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 w/fi continue to meet the operational requirements of the ADEC or MOA DSD. The content of this repoR is for the sole benefit of the owner listed above. Any reliance upon or use of this repo~ by any other person or pady is not authorized, nor will it confer any legal right whatsoever. o DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipul.~t, io.~'~ OF ~', ¢ , ~.: L.-%,,,,\' ..... ~i/,J Attachments: COSA Checklist Septic System Advi,sory -~,/]¢ ",~li/~,,," ., ,,* · , Arsenic Advisory. Maintenance Agreements Well Flow Advisory ,~i~e?e ~u'v'lsory/. (Rev. 11/05) Supplemental Engineer's Report Other Original Certificate Date: A= Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P,O. Box 196650 :Anchorage, AK 99519-6650 www.munLorg/onsite (907) 343-7904 CERTIFICATE OF 0N-SITE SYSTEMS APPROVAL Legal Description: MOUNTAIN SHADOWS S/D; BLOCK 2, LOT 2 WELL DATA *CASED TO BEDROCK. Well type PRIVATE IfA, B, or C provide PWSID# N/A Date completed 8/20/1984 Sanitary seal (Y/N). YES Total depth 1,39 ft. Cased to '10 ft. Date of test Static water level Well production FROM WELL LOG 8/20/1984 104 5 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: ND ug./L. g.p.m. CHECKLIST Parcel ID: Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 9/16/2010 **25+ ,3.92+ **OBSTRUCTION Nitrate 5.79 mg./L. Date of sample: 9/16/2010 Collected by: YES B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments Foundation cleanout (Y/N) YES Date of pumping (~ ABSORPTION FIELD DATA I'BELOW EXISTING (;RADEI 8/~.1~.1984 Date installed 12/2/1987 Soil rating (g.p.d./ft2o~~ 85 29+3o+13 Length 72 TOTAL ,ft. Width 5 ff. Depression over tank (Y/N) NO Pumper YES 12+ in. .ft. g.p.m. PREVENTED ACCURATE READING. Other bacteria. 0 colonies/lO0 mi. GEG Ltd. Date installed 8/51/1984 Cleanouts (Y/N) YES High water alarm (Y/N) N/A MCDONALDS PUMPING System type TRENCH 1.5 ft. Total depth ~ft. Eft. absorption area 280 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 9/1 6/2010 Results (Pass/Fail) PASS For .3 bedrooms Fluid depth in absorptiOn field before test 0 in. Water added 680 .gal. New depth 0 in. Elapsed Time: - min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - NOTE: TESTED 29' NORTH-SOUTH SEGMENT OF TRENCH. Gravel below pipe D. LIFT STATION Date installed "Pump on" level at Size in gallons Manhole/Access ~ __ in. "Pump off" level_.a~, High water alarm level at .in. Cycles tested. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ 100'+ Meets alarm & circuit requirements? NOTE: WELL IS LOCATED OFF PROPERTY SEE ATTACHED INGRESS/EGRESS EASEMENT, On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 100'+ Building foundation 5'+ Property line 5'+ Water main N/A Water service line, 10'+ Wells on adjacent lots 100'+ Absorption field 5'+ Surface water~ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '1 '+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots. 100'+ Water main N/A Driveway, parking/vehicle storag .'~l~ F. COMMENTS *PER EXISTING WAIVER #WR87-071. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ q Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Community Development Department Development Services Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # OSC 101309 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 2 of Mountain Shadows subdivision. This inspection revealed a nitrate concentration of 5.79 milligrams per liter (mg/L) was reported for the property's well water sample. 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. CT-26-2010 08:03 FROM: 6940830 T0:3383246 ASBUILT-NO CORNERS SET THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY .THAT I HAVE SURVEYED THE '~;C~{~E-'. INDICA~D. IT IS THE RES~NSIBILITY OF THE ~N~ ~ D~ERMINE THE ~ISTENCE OF ANY E ~ ~ENTS, COVENANTS, OR RE~ T RICTIONS WHICH DO NOT ~PEAR ON THE RE~D~ ~BDI VISION PLAT. UNDER NO CIRCUMSTANCES S~ FB, ~Y DATA H~N BE USED FOE CONSTRUCTION OF FENCE LIN~, OR ~R EST~LISHING ~ND- - DRAWN, ARY LINES, Municipality of Anchorage Development Services Department 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 Parcel I.D. 017-401-19 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: / ~ - ~.q - O..~ Complete legal description MOUNTAIN SHADOWS S/D: LOT 2, BLOCK 2 Location (site address or directions) 12801 JEANNE ROAD, ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BRYANT SHERMAN Day phone 644-0701 12801 JEANNE ROAD, ANCHORACE, AK 99516 Day phone BARB SCO'Fr W/COLDWELL BANKER FORTUNE Day phone 2525 C STREET, ANCHORAGE, AK 99503 360-9351 'Unlessotherw~e requeste~ HAAwillbeheldbyDSD ~rpNkup. 2. NUMBEROFBEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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. Cedificates of Health Authority Approval ara valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Cedificates 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 OFINSPECTION BY ENGINEER As certified by my seal aftixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authodty 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 ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 337- 6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the 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 ali wells and sept/c systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system wi//continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the so/e benefit of the owner listed ebove. Any reliance upon or use of this report by any other person or party is not authorized, nor wi//it confer any legal fight whatsoever. 5. DSD SIGNATURE L""~ Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: NOTE: THE WELL FOR THIS PROPERTY MEETs EXIS~'I~I~ STATE AND MUNICIPAL CODES. THERE ARE NITRATES PRESENT. IT IS SUGGESTED THAT PERIODIC TESTING BE PERFORMED TO INSURE THE WELLS CONTINUED SUITABILITY. CURRENT NITRATE CONCEN~'RATION IS 6.33 mci//. EPA MAXIMUM CONCENTRATION IS 10.0 m,(~1. MORE INFORMATION ON NITRATES IS AVAILABLE FRO~f THE ON-SITE SERVICES PROGRAM, AT 343-7904. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other (Rev. 12/01) Original Certificate Date: -3-9 -o3 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bregaw St. P.O. Box 196650 Anchorage, AK 995196650 www.ci,anchorege,ak,us (907) 343-;'9O4 HEALTH AUTHORITY /~PPROVAL CHECKLIST Legal Description: MOUNTAIN SHADOWS SUBDNISION; LOT 2~ BLOCK 2t Parcel ID: A. WELL DATA 'CASED TO BEDROCK. Well type pRIVA'I~ If A, B, or C provide PWSID/t Date completed 8,/20/1984 Sanitary seal (Y/N) YES 017-¢01-19 Bo Well Log (Y/N) Wires propedy protected (Y/N) Totaldepth 159 ff. Date of test Stat~ water level Wall production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: N/A mg./L. SEPTIC/HOLDING TANK DATA Tank TypelMatedal Tank size 1000 gal. Cased to . FROM WELL LOG 8/20,/198¢ 5 YES STEEL YES · 10. ff. Casing height (above ground) 12+ .in. AT INSPECTION · * 1,/5,/200.3 ff. **'24+ ff. g.p.m. 5 ,g.p.m. · *TEST DATA FROM S&:S ENGINEERING · *'OBSTRUCTION PREVENTED ACCURATE READING Nitrate 6.5.3 mg./L. Other bacteria. 0 colonies/100 mi. Date of sample: 9,/8,/200,5 Collected by: AKWWC~ INC. Number of Compartments 2 Date, installed 8/51,/198a, Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 11,/29,/2002 Pumper, ABSORPTION FIELD DATA Date installed 12/2/lg87 Length 29+;~0+ t.3-72ff. High water alarm (Y/N) CHUGACH PUMPING PBELOW EXIS'nNO GRADE] Soil rating (g.p.d,/ff~or~'~ 85 Width 5 fl. System type TRENCH Gravel below pipe 1.5 .ft. Total depth .s.22 ff. Eft. absorption area 280 ft= Monitoring tube YES Date of adequacy test 3,/24/2005 Results (Pass/Fall) .PASS Fluid depth in absorption field before test DRY in. Water added 91 `3 gal. Elapsed Time: 2.3 min. Final fluid depth DRY in. Absorption rate >= Any rejuvenation treatment (past 12 mo,) (Y/N & type) NONE KNOWN If yes, give date TESTED THE 29 FOOT NORTH/SOUTH SEGMENT Depression over field NO For 3 bedrooms New depth 5.25in. 450+ g.p.d. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "P~ ~ ~ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ 100'+ High water alarm level at Meets alarm & circuit requirements?. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manholelcleanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Water main .N/A Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line I FT Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS Property line 5'+ Water service line. 10'+ Absorption field 5'+ Surface water. 100'+ Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Water main N/A G. ENGINEER'S CERTIFICATION in. UNDER Driveway, parking/vehicle storage DRIVEWAY I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed~lam7 Date cPi ?-~/~ JEFFREY A, GARNESS HAA Fee $ ~ Date of Payment Receipt Number (Rev. 12/01} Waiver Fee $ Date of Payment Receipt Number Development Services Department 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 Parcel I.D. 017-401-19 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA 3oo _R Expiration Date: Complete legal description MOUNTAIN SHADOWS SUBDIVISION; LOT 2, BLOCK 2, Location (site address or directions) 12925..JEANNE ROAD '* ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DONNA McCREADY Day phone 276-4351 12925 JEANNE ROAD * ANCHORAGEi AK 99516 Day phone NANCY BERG-POLLOCK w/ PRUDENTIAL Dayphone 563-5500 3201 "C" STREEt'. SUITE 200 * ANCHORAGE, AK 99503 Unless otherw~e ~queste~ HAA will be held by DSD ~r pick~. 2. NUMBEROFBEDROOMS: --~--~ 3. 'i~PE OF WATER SUPPLY: Individual Well [~] Individual Water Storage Community Class Well r-~ Public Water System [-1 TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank Community On-site [] Public Sewer [-1 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (I-IAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska, Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples, (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or pfior I to closing for the engineering services provided. I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of tho validation date shown below, I veHfy that my investigation, based on procedures outlined in the Health Authodty Approval Guidelines for this application, shews 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 wasfewater 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 ALASKA WATER & WASTE-WATER CONSULTANTS, INC. Phone Address 3701 E. TUDOR ROADt SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name' JEFFREY A. GARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and seporotJon distances measured to readily identifiable features. The operational life of ali wells and septic systems depend on the local soils condition, groundwater levels that may tTucfuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the e valuator of the system. Satisfactory lest results do not guarantee future perfomtance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKVVWC, Inc. can therefore not provide any warranty or future estimate of how long the system wilt continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~. Approved for ~ Disapproved. Conditional approval for Note: bedrooms. bedrooms, with the fllowing stipulations: The well for this property meets existing State and Municipal Codes. There are httrates present. It is suggested that periodic testing be performed to insure the wel]m continued suitability. Current nitrate concentration is 6.8 mg/1. EPA maximum concentration is 10.0 mg/1. More information on nitrates is available from the on-~[te Services ~[uS[am, aL 343-7904. Affachments: HAA Checklist Z~ Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By: ~ / {Rev. l?J01} Original Certificate Date: ~, - j/~' - (..0,~ Municipality of Anchorage Development Services Department Building Safety Division On,Site Water & Wastewater Program 4700 South 6ragaw BL P.O. Box 196650 Anchorage, AK 99519-6650 ~.cLanchomge.ak.us (907) ~,~-7;04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MOUNTAIN SHADOWS SUBDNISIONi.,LOT 2t BLOCK 2~ Parr, el ID: .... A, WELL DATA *CASED TO BEDROCK. Well type pRIVk~ If A, B, or C provide PWSID~ N/A Well Log (Y/N) 017-401-1.9 Data completed 8/20/1984 Sanitary seal (Y/N) YES. m{~talrid~e~ 159 . lt. '10 ft. Date of test Static water level Well predu=tion , . WATER SAMPLE RESULTS: Coliform ~,0 colonies/100 mi. Amenl~: N/A mgJl.. SEPTIC/HOLDING TANK DATA Tank Type/Matarlal STEEL Cased to FROM WELL LOG 8/20/! 984 5 Wires propedy protected (Y/N) YES Casing height (above ground) ..12+ in. AT INSPECTION , *'1/5/2003 lt. ~*'24+ g.p.m. , 5 . **TEST DATA FROM S&S ENGINEERING g.p.m. ***OBSTRUCTION PREVENTED ACCURATE READING Other bacteria .0 colonies/100 mi. Collected by: AKWWC~ INC. Nitrate 6.8 mgJL. Data of sample: 6/5/2003 Tank size ,1000.,, gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO, Date of pumping 11/29/2002 Pumper . ,, ABSORPTION FiELD DATA I'sELok [X~'1~NO Oe~Og Date ~stalled . t2/2/198~ Soil mUng (g.p.d~fl~or(~85 Length 29+30+13,ff.72ff. Width , .5 , lt. Total depth *s.22 ...ff. Eft. absorption ama 280 ft~ Monitoring tube .YES Oata of adequacy test 3/24/2003 Results (Pass/Fall) PASS Fluid depth in absorption field before test DRY in. Water added 913 gal. Elapsed Time: , 23,, min. Final fluid depth DRY in. Absorption rate >= Arty rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date TE:Stl~ THE 29 FOOT NORTH/SOUTH SEGMENT Date installed 8/31/1984 Cleanouts (Y/N) YES High water alarm (Y/N) N/A CHUC.,ACH PUMPING System type TRENCH Gravel below pipe 1.5 ft. Depression over field NO For 3 bedrooms New depth 5.25 in. 450+ g.p.d. · ' E. LIFT STATION Date installed "Pump on" level at ~ ~'"-- Cycles tested Meets alarm & circuit requirements?. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/'A Public sewer manhole/cieanout Sewer/septic service line 25'+ Holding tank N/A 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, Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 FT Water service line 10'+ Curtain drain NONE KNOWN COMMENTS Size in gallons .. ~ in. "Pump off' .... in. High water alarm level at Water main N/A Building foundation ,10'+ Surface water ! 00'+ Wells on adjacent lots 100'+ 100'+ .in. UNDER Driveway, parkingfvehicie storage DRIVEWAY SB." G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems ere in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed N~me Date ~,/,,/0.~ JEFFREY A. GARNESS HAA Fee $ Date of Payment Receipt Number (Rev. 12ml) Waiver Fee $, Date of Payment Receipt Number ~..03(~!/03 TUE 15:43 FAX 907 502 5485 PRUDENTIAL VISTA REAL E ~004 ASaUI~'I'-.NO CORNERS 3£T THIS DATE:. I HEREBY C£RTIF'Y .THAT I HAVE gURVEYED.THE I~DICATE:D; IT I$ TH[ RE~PON~BILITY D7 THE OWNER 'TO DE'TERMIN~: THE: [~I~J4ClE OF' ~I*JI[,,'H DO NC~T APPEAR ON 'I"H~: r~'c~qmm ~ DATA HEREON aE USF. Z FOR CON..~TRUCT'~gN Or, FENCE LINES, OR FOR EETA~LISHINI~ EC,'JNDo - -~"oJd 9£:H De i )p ent'.ser iC '"' t:. · ....- -.. ,.... :;.'Building Safe.tyD&,ision .. .... .. ....~ On-Site Water an~i W~ste~ater Proaram ;4700 South Br~ga(.,;, St. '" .:,,.:., P.O. Box 196650 Anchorage, AK 99519-6650 -. ,-. v^~v.ci, anchorage.ak, us ,-...- - . (907) 343-7904 'CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY '~ENERAL INFORMATION . Expiration Date: C~:let~;: e~al de'scri ' t 6'n-LO t 2, -'~o,, nta .i ... .... .. p ; ; b°b~a{i6~'(SitS~ci~:~S Ordirectio¥~) ' ':i~-801 Jeanne Rd. Current ProPertY'owner(s) Donna McCready 64'5 >,.hadow,-'.; St:b(:.i. vi sJ o.rt Anchorage 'G' St. /~100 PMB:'668 ~.nchorage, Ak one Real Esi Mailing Unless othen/vise re~ will be held by DSD for pickup NUMBER : 3 TYPE OF WATER suPPlY: ................. Individual Wel :2~ Individual Water Storage [] Community Class '~ :,' 'Well ' [] Public Water System --] )hone ,,.TYPE OF-WASTEWATEi Individual On-site Individ ual Holding tank ' · ' CommunityOn-site · Public Sewer The Municipality of Anchorage Developr~&~t Se~i~;;as Department (DSD) Issues Certificates of Healtt~ 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 was~ewa~er 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 weII 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. STATEMENT OF INSPECTION BY ENGINEER .~, .'. ... .. .~. · ,..., . .:,...' .... ¥, ~... ~ ' . .,'.:... ,:,.- ., ., ...." ,..~ .... . .", · ,..~ , , · .. :... ~.. ' ~ :' . ,'.....,~ . ',,~ ,:, ..,::...,. .... · . . .' '.~ ., ',... ...,';., ... . As certified by my seal affixeci hereto and as.of.the validatiqn, d~te .s. hown below I ve~:!fy that my:im/estigation based on procedures outlined n the Health Authority ~,pprb~al G'~ide'lines fo'r t.his apRl[catipn Shows'that the site water su pCy and/or wast~water disposa! sy§tem is(am) ~f&, functional and .~dequate for the ~um~er of bedrooms and type of struc:ure indicated herein. I further var!fy that based on [he information obtainsd from the Municip~-Iity of Anchorage flies and from my investigati~n.'afld inspect!on, the on-site water supply and/or was[ewater disposa! system is(are) in compli~nde with ~l!'appliq.able Municip. al and State codes ordinances, and regulations in effect at the time of installation. ' Phone 694-g979 ' Ste ?.()~ t,:a?,:le R:i. ver, AK 99~77 5. DSD SIGNATURE " ~/ Approved for ~ 'bedroOms approval for '__ bedrooms, with the Additional Comments Attachments: HAA Checklist Se ptic System Advisory Well Flow Advisory By: ' ~ (Rev. 01102) M~ir~t~n-an~e AgCbemen~s' · SuP,¢er ,i&i 'Eng'in~er,s 'Report Other Original Certificate Date: ....... "'" '"~ ..... ;:' '"- ~" "'"": ':' !,,!.i: "' :.. ~. .... .. ""?i.;" .:~,"'"'. · ge al Descaptom''/-~e,~' "~ '6'~:~. ~' "'~'~' .~o~.~' ~/~ P~rc~tlD :0i"7 ~"~'o!.'-I~ ;..g. :.. .... ~ ..,..% ........ ........ ..:........ ...... ~.. ... .... ..... , :.....:.: ........... ......: .: ....~-....,... --. :...,..: .... .:.:':;- ~.;:,~::.?.': :- . : ;:: . ..:...,~'. weil ~P~:'~:,:~A..:~ ...,~f.A;.BL~t:C:~d~ p~ D.~:.. :.~, -We'll Log.~'~/N:):. ~S:'~ .' ...:: 7f.:.' ..:~:::' ;...',':.'..~ :' ':.'..~: '4: '. ': ~'."':';; ~'?;.;:~;.':'.::;,". " ' '..}, ~.~:~'R.oM',~. EOG.~::~'' ::~"::.'.'?.~'.,? .: ..... .,.~. A~:,I'NSP.EC~ON.. ~".:- ... ' :S~w~er.level;: - '~."0" '~" ~.,';;:::.:)~ : ~ ~ . A.:..:: ..... Well..~Oductieh : ' ': .';",:: '?~'; '.'~':".: . ' WATER-;.SAM~E :RESULTS.:....:': .:~? - · , : ........ ,.-. ~ ,...-~:...r.:~.,':.,::: .:.,.:.',..~..'.. ...... · '~:.-.~~:~;~,,~::,~:,.::.~:.; :.../.: :,...::::.:...~::',:., :~..:,.. ;~:.:: ~'; .~:'; ;'~.. ~., ,,....-...: .., .:.., .. ~...-:.: ... :..:.; .......,::::::..: :. :'.~;}'.":: .)~.. : ' :'. '::.. '?~?;;4: ~'. ::..".~:~;~:,.~'.;'.~:~7' .'. :'.:.:.'.. '"." :"?.;:~'.' .' ':.'~:.. f~.:':.; ...'" 2.'..: ~. : ":~ ':~' r:, .-.::.....'-~ 7' .'::C"'"'t':'~ ": ':.. ' ' ."'"" :' '"'.~'. ':'.':':: :::..'~'";.'"':. :: ':'. '":'":"' .' "' ~'~: :}~ ,":':~/:~./:L'.'~ ::::;::~:'?'~;',C~:1''?'':. '". '.;'-' :'..." '. '.":.. :.',~ "' "'"'"' ::'."?':"::' :: :~ · · : .' ;"~Elap~Ad ~i'me:.~:~N~mih~." ' ' ;"- "'.Fi~a~'.~ai~'~~':~.i~..;..~.-., ':: , ::Absof~ti0n.'ra~e:: ~'= ~...' ~' '~ 0 '. ~.p.d. . . '.L. - :- ~" ..... Size in gallons. at in. "Pump :off'..level at. Cycles tested .: Manhole/Access ('Y/N) Hign water.alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON 'LOT TO: Septic t~i~lift:~0~i'bn lot ].OO ~ Absorption field on lot Public sewer main N Sewer/septic service.'line ~;-~ -~' SEPARATION DISTANCES FROM SE Building foundation Io '4- Wells on adjacent lots ]~ o .r.~ On :adjacent.lOts' On adjacent lots /O Pu61ie.'~ewer man'hole/cleanout Holding'tank: Property. line __ Waterservice line Surface water FROM ABSORPTION FIELD ON LOT TO: I0 ~-'~' ~ Building foundation / o + Water ma Water Service. line / O Surface water ...... C~urt. ai~3 .... d[ain.:~,~/,~,,~...,~.~.I~. , w'~' Wells on' adjacent, lots /O,,~)i~ ~:, G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and rewew of Municipal records that the above systems sre in conformance with MOA HAA guidelines in effec', on this oate. Engineer's Printed Name fl~/~.,t~.~- C. ~o~A~ Date i / ~ J"/0 ~j HAA Fee. $. · Waiver Fee $ Da'~e of Payment (Rev. 12101) Receipt .Number ~ '""' ~ E MUNICIPAL TY OF ANCHORAGE :~' ,. ... : D PARTMENTOFHEALTH &HUMAN SERVICES .... Division of Environmental'Services :::' · ,. ' ' ; ~: .... On-SiteSe~icesSection : ~ ' -- ' ' '1 ' '' ...... ' ' ' P,O' BOX 196650 :;Anchorage, Alaska 99519-6650 .......... 343-4744: . · . :: ''"' :' ' ' L H Y ;.'. CERTIFICATE OF HEA TH AU~ ORIT APPROVAE FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION . Complete legal description ~.pt 2 Bi~A 2 Hr. ..................... ~,..' :i, ,~ ...... .~' Location (site address .or d. irections) Property owner . Day phone Mailing address "'t~?' ~ ' 3 .... TYPE_OF WATER SUPPLY: . --.'.., .,. ~,E:: '' " If" ~mmunity well system, provide written confirmation from State ADEC attest- :, ...... "~ ~to ,the ~egafity and status of system. 4.'",',"~,~PE OF WAST EWATER DISPOSAL: ...... . ........ . ........... Individual on-site ......... ,~' ~ H0 ding tank ........ NOTE: If community wasteWater system, prowde written conhrmat~o fr~m State 5. STATEMENT. OF INSPECTION. BY'ENGINEER :'<'~',.~??~:' .~ . ~ , , . ':..:~..':~ .; As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves.ti_gation and inspection, the on-site water supply and/or wastewater disposal system is in compliancewith all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm BRT C'~n~l~-'ing Enq~n~rR ' Phone 34421}85 ":;' :'" · ' ......... ' .~ ' "."* .,.?~*;.:F :: : -, _ 6., ,:,DHHS SIGNATURE ...... : ........................... ';'~,', · Appr(~;;~ :~o~'~""'~-~ " bedrooms.' ............ :., ~ _ .-* DisapProved. ·; '*'~T'~.;:,-': ........ 7". ......................... . (} '.~ ~ 1-.~ ~ · . - { ~ ~ *N'~ ','.; bedrobms,'"~ith ~the'following stipulations: '. Conditional approval for ..: \ h Additional Comments By: The Municipality of Anchorage Departmeni 0f Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given tn'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 professi0r~';Iengineer's' ...... work. 7~(R~v. 1/91) Oe~k MOA~! Legal Description: A. Well Data Well type RES, Log present (Y/N) No Total depth / ~(/' / Sanitary seal (Y/N) 95206 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Lot 2 Block 2 Mt. Shadows Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed fC/~O/f~ u( ® Driller ~ Cased to /,0." (~) Casing height Yes ® FROM WELL LOG [)ate of test N/A Static water level [',]'/A Well flow N/A Pump level1 ~ 5.~' ~ 2,0) Wires properly protected (Y/N) Yes (b AT INSPECTION 7-6-95 ® 111.6'~ g.p.m. 5.0 ® g.p.m. N/A SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot __ Absorption field on lot Public sewer main N/A Sewer service line N/A 104 ' © ; On adjacent lots 105 ' + 6J 110 ' ® · On adjacent lots 105 ' + dC Public sewer manhole/cleanout N/A Petroleum tank N/A WATER SAMPLE RESULTS: Coliform O [)ate of sample: 7-6-95 Nitrate .~c:_-~,~ ~.:~ __ Other bacteria Collected by: Dustin Hiqh B. SEPTIC/HOLDING TANK DATA Date installed /~ ~' "7' ~) 'Tank size Cleanouts (Y/N) Yes d.) Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping 1000gal.® Compadments Yes ® Depression (Y/N) Alarm tested (Y/N) Pu mper-~-'~70 2® No ® SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ~[® Well(s) on lot 104 "/-~ On adjacent lots ~"'/ Foundation To properly line 30' ® Absorption field 4 · 5 ® Sudace water/drainage None® 72-026 (3/93)° Front ~ [,)1'{- 1~-5 Fx1,-C,-¢6'1.o'1 F'e 0¢~ ~ 5 24' 03 Water main/service line N/A CONTINUED ON BACK PAGE C. LIFT STATION Size in gallons ~'"~._., Manufacturer Manhole/Access (Y/N) Vent (Y/N) "~FaL,.. "Pump off" Level at High waler alarm level ~'~'*q~cles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on Ioi On adjacent lots D. ABSORPTION FIELD DATA "~'~'""' Date installed Soil rating (GPD/FF) Length '?0' O 5' ® Width .Gravel thickness Total absorption area 3,~'-0' Cleanout present (Y/N) Yes Date of adequacy test. 7-6-95 Results (pass/fail) X Water level in absorption field before test 0.1 '/0 ' Peroxide treatment (past 12 months) (Y/N) /d SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1.1,(~ 5¢~ To building foundation 32 ' ® On adjacent lots.. 105' + Surface water NO~S 6~ Curtain drain N/A System type Trench ® 18" ® Tolal depth 5,5 ' ® .Depression over field (Y/N) No d~ for 3 Bedrooms After test ~, ~ / If yes, give date ~%" %(;~ '"P (~ Properly On adjacent Pots '~:~: '~1 line To existing or abandoned syslem on Io! Cutbank 4 ' ® Water main/service line Driveway, parking/vehJcle storage area 5 ' E. ENGINEER'S CERTIFICATION I certify that checked, verified, or conformed to ail MOA and HAA. Signature ~._ _ Engineer's Name ~'"~,~-. ~: te of this inspection. HAA Fee $ t~O~.'D Date Of Payment Receipt Number, Waiver Fee $ Date of Payment Receipt Number ROTC~ROOTER SERVICE CALL HR~;. ~ :Sq'EAM THAWING HRE~ mlP CHARGE HRS, @ OVER'ME CHARGE HRS. @ ADDIT{ONAL LABOR CHARGE HRS. @ PUMPING SE_RVIC~ L~,,~ ~._~,/,~AL1 TV CAMERA INSPECTION }iris, ,~) MATFJ~AL~ UNE CLEANF.~ JOB NOT GUARAN1F..J~D/D'OR FO~.O.W.~I~i~F..,A~O,~ ~ MUNICIPALITY OF ANCHORAGE ~/ DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~'~/~ -- J~c~O~ / OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) (c) Properly O~vner '/b',./;g~.,,~,¢~.,., .~,/.~? j. Telephone: Home Mailing Ad~l~'ess ,~ I,~o ...g~,[/( 2(/~,-~,~ 3/vd ~..,,~z~ ~..z C,,¢ · ¢ / ~ending Institution ~z~z¢'~,~ .~7,,/~¢. ,. Telephone Maili6g Address. ' ' ¢ Business (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followin~ address: or: Check here~, if hold for pick up. List contact person and day phone number below. [ TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms ~7 WATER SUPPLY IndividuaIWell~ Community[] Public[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL OnsiteJ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 trey 81861 Front f ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposaJ system is in compliance with all Municipal and State codes, ordinances, and reguJations in effect on the date of this inspection. Name of Firm ,'52L~ ~' g --'~'~ Telephone Address ,/,~ ©0 ~ ~,~ ~ ~ ~ /~ ~4,¢~ DHHS APPROVAL Approved for "~ Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 ..cf 2 72-025 fRev 8/861 Back "~Nr4L ~[~LCt~t,r~,THORITY APPROVAL (HAA) [')~.:.~ ~I~E~AIST - FEBRUARY 1984 - "~' ~ ~ ON 264-4744 Legal Description: WELL DATA Well Classification /~l ~' o~. /(* , Well Log Present ~//~1) Total Depth /-.~ ~? Cased to / Static Water Level /// Casing Height Above Ground ?' ~/ Electrical Wiring in Conduit~?N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line _ Cleanout/Manhole ~ Water Sample Collected by Z Water Sample Test Results ("%~F"~¢ Comments /_.~,.'~./( ~,/~'~-, If A, B, C, D.E.C. Approved (Y/N) Date Completed _¢'/z~-¢,/¢'-~/ Yield /~ Depth of Grouting ¢^¢: '~'~'" '~ ' Pump Set At Sanitary Seal on Casing~"~/N) Depression Around Wellhead (Ye / /jo o-b ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date ~/~/~,~ ; On Adjoining Lots /~ ~ .t SEPTIC/HOLDING TANK DATA Date Installed /~'/2-./¢-_~2 '~' Size Standpipes I~N) Air-tight Caps ~-'~N) Depression over-rank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ~ ~ 'to Water Main/Service Line ~ - Course /OZ:~C r¢~:'¢-~-~ /g'~ : Comments ¢ '~%¢,~'/'(¢ "/'~"'/:' No. of Compartments Foundation Cleanout~(~/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 77 026 fRev 8'86/ Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~--~- Date Installed ~: / ,.,~,.-,,.2 ~-'/'/ /z//~,/~-? Width of Field ?~- Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test ,'¢ Separation Distance from Absorption Field: To Water-Supply Well /~¢¢-/- ,c- To Building Foundation .%~ / Lot /2 To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course Type of System Design Length of Field ¢5" Depth of Field ~; Gravel Bed Thickness /. ,~T Standpipes Present (C/N) Date of Last Adequacy Test To Property Line / To Existing or Abandoned System on ; On Adjoining Lots _.~ -/~ / To Cutbank (if present) -</,/',,-4- To Driveway, Parking Area, or Vehicle Storage Area ~;~¢¢./z,~i~. y,.2¢.~...~ ~..,.¢~._. ;.-c./~/_ LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments ,~ Dimensions ¢~ ~ Man hole/Acces~s-(-Y~ Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA ** Check Permitted Bedroom Rating Against HAA Request I certify that~-/¢ .¢1 have c.h~ccked, verified, or conformed to all MOA and HAA guidelines in effect on.Lh~, Signed .'.~d-"-~,~'~.¢~..~.///' Date /"z_//?/~ .2 Company ~7_~ - ~' MOANo. Receipt No. ~ ~,/ ~ ~ ~ ~. ' Date of Payment Amount: $ ~ ~ Page 2 of 2 72-026 fRev 8/861 Back Anchorage P.O. BO' 96650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES December 8, 1987 North American Savings 3130 South Harbor Boulevard Santa Ana, California 92704 Subject: Lot 2 BLock 2 Mountain Shadows Subdivision H87-0591 Dear Gentlemen: Please be advised of the following information regarding the subject property. Note: The well for this property meets existing State and Municipal Codes. There are nitrates present, however, it is suggested that periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 7.0 mg/1. EPA maximum concentration is 10.0 mg/1. A second test showed a concentration of 5.8 mg/1. If there are further questions, please write or call this office at 907-343-4744. Sincerely, / Daniel No Bolles On-site Services DNB/ljw cc: Lee Reid, P.E. Alaska Environmental Control Services, Inc. 1200 West 33 Avenue, Suite B Anchorage, Alaska 99503 RECIPROCAL EASEMENT FOR INGRESS AND EGRESS, AND WELL EASEMENT This Agreement is made this ~ day of ~e~°~ , 1987 by and between Fred F. Farjami (hereinafter "Farjami") whose address is ].2850 Jeanne Road, Anchorage, Alaska 99516 and Andrew K. Sorensen (hereinafter "Sorensen") whose address is 12925 Jeanne Road, Anchorage, Alaska 99516. Recitals Farjami is the current owner of the following real property: Lot Three (3), Block Two (2), Mountain Shadows Subdivision, according to Plat No. 71-168, filed in the Anchorage Recording District, Third Judicial District, State of Alaska. Sorensen is the current owner of the following real property: Lot Two (2), Block Two (2), Mountain Shadows Subdivision, according to Plat No. 71-168, filed in the Anchorage Recording District, Third Judicial District, State of Alaska. There is currently a common driveway which crosses both of the above lots~ This driveway is used by the owners of both lots. The grade of each of the above lots would make it difficult and expensive to construct a separate driveway on each lot. It is beneficial to each of the parties to this Agreement that they, and all subsequent owners of the above-described real property have the right to use the common driveway. There has been previously recorded a document titled Municipality of Anchorage Agreement to Provide Access, which document was recorded August 8, 1985 in Book 1305 at Page 588 in the records of the Anchorage Recording District, Third Judicial District, State of Alaska. The parties to this Agreement wish to clarify and supplement that previous document to more fully set. forth their intentions and agreement. There is currently a well located approximately two (2) feet South of the North boundary line and fifty-five and 7/10 (55.7) feet along the North boundary line West of the East boundary line of Farjami's lot. This well supplies water to Sorensen's lot. The well does not cause any significant imposition or problem, and Farjami is willing to allow the well to remain in its current location. It is understood and agreed that if Sorensen should ever dig a new well, nothing herein shall give Sorensen any right to dig a well on Farjami's lot, nor shall this Agreement prohibit Sorensen from repairing, deepening, shortening and/or maintaining the existing well. NOW THEREFORE, in consideration of the mutual benefits running to each of the parties to this Agreeme~%t, including neighborly good will and friendship, the parties agree as follows: 1. Farjami and Sorensen hereby grant and convey to each other reciprocal easements for ingress and egress over the portions of their respective lots presently used as a common driveway. The portions of the lots affected are generally depicted by the diagram attached as Exhibit "A" hereto. Only those portions of the existing driveways reasonably necessary for ingress and egress to the respective lots are included in this reciprocal easement. Those portions are hereinafter described as the common driveway area, and are generally depicted by the checkered area on the attached Exhibit "A". 2. No alterations or obstructions shall be allowed to the common driveway area which materially hamper ingress or egress from either lot. 3. Farjami and Sorensen agree to share equally any and all repairs to the common driveway area which become reasonably necessary. 4. Farjami grants and conveys to Sorensen a well easement covering the above-described well, along with the right to use as much of the surface, not to exceed a ten (10) foot radius from the well, as may be necessary for maintenance and repair of the well. -2- This Agreement shall run with the land and inure to the benefit and detriment of the respective parties hereto, their heirs, successors and assigns. Fred F. Farjami STATE OF ALASKA ) ) SS. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this ~___ day of , 1987 by Fred F. Farjami. Notary Public in and for Alaska My Commission Expires: STATE OF ALASKA ) ) SS. THIRD JUDICIAL DISTRICT ) The foreg.Qing instrument was acknowledged before me this day of ~~h~.f'- , 1987 by Andrew K. Sorensen. -3- o~ % 'X As Built Exhibit Common Driveway = ----I .I TH~$~- SHOWN ON THE . ~% ARE NOT SHOWN lying .djlc~t th~eto en~ ~ tM ~emi~ Ih LOT 3 ~r~': c1~Av~t. No Corners Sit This' Date Anchorl91, Alilkl -I MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF ~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) (b) Location (address or directions) Applicants Name Applicants Address Telephone- Home Business ~-"mV ~,q~ V 60 (c) Applicant is (check one) Lending Institution ~ ; O~mer/builder ~ ; Buyer ~ ; Other [~ (explain); (d) Lending Institution Address Telephone (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. T_~ of Residence Number of Bedrooms Individual Well ~ Multi-Family .~--~ Other (describe) Community~-~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Onsite [[[~ ~ublie ~2 Comm.nity [~ aolding '~a:kn'--[ Note: If community well system, must have written confi~ation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. EA~neerin~ Firm Providi_ns_!_nspectio_n~, Tests, File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify Shat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and 'adequate for the number of bedrooms and type of structure indicated herein.- I further verify that, based on the inforuultion 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 regula- tions in effect on the date of this inspection. Name of Firm ~6_--OL~Y-~ Telep one !Z_ 6. DHEP ARproval' Approved for ,/~x', ~ bedrooms '"** Approved ~ Disapproved Tenus of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTmeNT OF ~EALTH AND ENVIRONM~NTA3~ PROTECTION (])HEP) ISSUES hIFALTH AIFI'HORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEWI- ATIONS GIVEN IN PA/tAGRAt~ 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. TttE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- b~NTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERR~IS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19 -84 Well Classification Well Log P~esent (Y./N) Total Depth. ~q Static Water ~1 Casing ~ight A~ Elec~ical Wiring in ~p~ation Distance To ~ptic~oldi~ Ta~ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUI~HORITY APPROVAL (PLEA) CHECKLIST - FEBRUARY 1984 Legal Description: ~_39~L~9C3< ~-~ If A, B, c~ C, D.E.C. Approved(Y/N) Date Completed ~- ~;-f~'- S~ ~ Yield . . .I ~) / Depth of G~outing AJ At I Sanitary Seal on: Casing (.Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot i~~ ; On Adjoining Lots To Nearest Public ~we~ Line . ~/~r To Nearest Public Se~r Cleancut/Manhole. ~/~ To Nearest Sewe~ Service Line on Lot Wate~ Sample Collected By ~ ~; /~te ,2. ~3~W ~4 Wate~ Sample TeSt Results ~T~3;r~cTO~',~/~/ C~t~f~nts SEPTIC/HOLDING TANK DATA Date Installed ~l ~u~ ~ Size tOc~J ~ No. of Co~.artm~nts ___~_. Standpipes (Y/N) ~ -~ Aid-tight Caps ~ Foun(~tion Cleanout (Y~) ~ ~te ~st p~d ~/~ ~p~ession o~r Ta~ JY~) ~O _ P~ing~intenan(~ ODn~act on File (Y~) ~/~ ; for _A).~ Holding Ta~ High-Wate~ ~a~% (Y~) ~/~ ~a~y Holdi~ Tank ~t (Y~) ~/~_ ~p~ation Distan(~s ~ ~ptic~°lding Ta~: To Water-Supply ~11 ~; To ~ilding Foundaticn q ' To ~o~rty Li~ ~ ~.~7 TO Dis~sal Field ~ To ~ter ~i~Se=vi~ Li~ &)/~' To S~e~, ~nd, ~e, ~ ~jor D=aina~ Comments Receipt ~ ~C[.[%(> ~ .,. Date Paid- Amount: ~ ~J' .00 [Page 1 of 2] 2-15-84 ~. A~SORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~ Standpipes P~esent (Y/N) Date of Last Adequacy Test Square Feet of Absc~ption A~ea ~/~ Depression over Field !Y/N) MO Results of Last Adequacy Test /~,/~ .~/~ ~4J ~~ Separation Distance f~cm Ab~sorpt~on Field: To ~ter-Supply Wall ~ ~--O' To P~operty Line To Building Foundation _~C>~ To Existing or Abandoned System cn Lot.. ~ [~ ; On Adjoining Lots To Water Main/Service Line .. ~./~% To Cutbank(if present) To Stream/Pond/Lake/ocr Major D~ainage Course To D~iveway, Parking A~ea, o~ Vehicle Sto~age A~ea Co~ents D. LIFT STATION /~7~ /$/~/~L [ C~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Acce ss . (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets Comments Check Permitted Bed~°om Rating Against HAA Request ** I certify that I have checked, verified, or confcc~red to all MOA HAA Guidelines in effect on the date of this inspection. KB1/d5/s [Page 2 of 2]