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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" ).
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;;!.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",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
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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
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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.
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LEGI::tL
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"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;;?. PT1
II'IE I:;i:IiX;:!UII:.::I!:Ii:, t!i!;I?l:!;: C[t:::' 'l'i. IFi: :i:i;O]:l. F:IEh'::;E$1:i:::'T:!:EIh( !::;"r':!i;'f'El"l
Fl'ti:i: IJ!i:t",lG I'1'"1 [:' I I"'IL~:i",I~; 1[ Ohl ]: '_'ii; i I"!li:: LE:F,IG'I'I-! ':: i [":I l:::'l!:!:[!!:-I" ::, O1::' -1'1'11!! 'l"t:;;:t:i!:hlC:l'[ O1:';: I::'1;;:1:::! i I",11:::' I liiL.D.
l"H!:ii: [:'I!:F"i'H Cd:::' I:::t l'!:;i:[!!:F,l(::l.t O1:;:
QI::[:OUNI) I::lt",~[::, I'1-[I:: E~O'I' I'Cd"l OF:'
!'HE GI:;:FI',,,'IEI,, [::,[Z!:::'TH i ~; 'i'I lie I'"1
FIf',I[:' l'l'"ll~ [?,CI"t"TOh'! il)t::: 'Il'lEi EJ"::C:I';:I",,'I:::I-i'
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t hl'.i?l'l::~l.l..l'::l"!' I "d".! 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]