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SPRING HILLS ESTATES #1 BLK 1 LT 10
Spring Hill Estates Block 1 Lot 10 #015-051-80 I MUNICIPALITY OF ANCHORAGE ` On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201258 Work Type: Septic Upgrade Tax Code Number: 01505180000 Site Legal Address: SPRING HILLS ESTATES #1 BLK 1 LT 10 G:2436 Site Mailing Address: 4600 SILVER SPRING CIR, Anchorage Owner: KAUFMAN ROBERTS Design Engineer: CREWDSON ENGINEERING, LLC This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: ti°tirent Deparrment 7/22/2020 7/22/2021 76134 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Drainfields shall be installed on a slope less than 25%, in accordance with recorded plat note (Plat 84-140). Received By: Date: Issued By: `�N C. Cqz1r_,ff Date: /'�� ��� 3 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 015-051-80 ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) Robert & Yael Kaufman Mailing address PO Box 100519, Anchorage, AK 99510 Site address 4600 Silver Spring Cir. Phone: 907-343-7904 Fax: 907-343-7997 Day phone 907-947-1374 Legal description (Sub'd., Block & Lot) Spring Hills Estates #1, Block 1, Lot 10 Legal description (Township, Range & Section) Lot Size 76,134 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade Q Duplex F-1Holding (D) Tank ElRenewal F1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: _# y 46.2' CSU I D Waiver Fees: _ Date of Payment: %�/6�ZQ Date of Payment: Receipt Number: _ 25VZ_GZ Receipt Number: Permit No. 05P ZO )253 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201258, Rebecca Carroll, 07/22/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201258, Rebecca Carroll, 07/22/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201258, Rebecca Carroll, 07/22/20 r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME SAM NrLt PHONE 0NEW ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LitoS QIr1,r IAL fL LOCATION NO. OF BEDROOMS DISTANCE TO: Well NoT IN Absarpuon Brea V Dwellin 9 PER NO. UY 12, Manufacturer�,Qt, A . Material No. of compartments rn~ Liq. caSe Pacify in gallons IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well tw Foundation Nearest lot hse to PERMIT N% ,iii, Ako9t Z No, of lines Length of eachLine� Total length of lues Trench wid h Distance between lines w I lb inches N A H I Top of the to finish gradeneat _.,.. * 0 s Material beh bb pl a AI Total effective abs or ton area inches � til► Length Width Depth PERMIT NO. 4 f� 4 Type of crib Crib diameter Crib depth Total effective absorption area tWyg DISTANCE TO: Well Building foundation Nearest lot line J ? W Class ,M'Y. `� Depth Driller Distance to lot line —71 ERMIT NO. 3 2 DISTANCE TO: Building foundation Sewer line Septic tank Absorption threats) OTHER PIPE MATERIALS 4N vc- SOIL TEST RATING 1 INSTALLER t j 6 REMARKS, N T t 11 11 6-11117- As'Mr i� „ ''; °°� p sftSLu c •.• Dale R. Mer It 'IV ° d •• No. 2055-E DEP EW RCtl ME APPROVED DATE LEGAL MLJN I C I ► aL I TY OF ANC"_ f2AGE • ', - --DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 Oh!—SITE SEWEFT u WE=LL- PERM I T PERMIT NO: 840918 DATE ISSUED: 10/30/84 APPLICANT: DESSE EPPS & POTTS ADDRESS: 2220 E 88TH ANCHORAGE, AK 99507 CONTACT PHONE: 349-6451 LEGAL DESCRIP: SUBDIVISION: SPRING HILLS EST, #1 LOT: 10 BLOCK: 1 SECTION: 15 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 76134 (SQ.FT. OR ACRES) MAX BEDROOMS: 3 - Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. +�* TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: I. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. Z. I will adhere to all MOA and State of Alaska requirements for the set back: distances'from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORE; MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED -�--� ------ DATE: ----------------- --------------- APPLICANT: BESSE < POTTS ISSUED BY J / DATE: /1�--------------------------- / "t ,�c - I'sn ma N �S'�IGYclo3 ri D co S - r� ausc� Yv1 aci rn� TRENCH DEPTH TO PIPE BOTTOM (FT.) 10.0 GRAVEL DEPTH (FT.) 4.0 TOTAL DEPTH (FT.) 14.0 GRAVEL WIDTH (FT.) 2.5 GRAVEL LENGTH (FT.) 57.0 GRAVEL VOLUME (CU.YDS.) 23,8 ' TANK, SIZE (GALS) 1,000.0 ** SOIL RATING (SG.FT./BR) 150 +�* TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: I. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. Z. I will adhere to all MOA and State of Alaska requirements for the set back: distances'from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORE; MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED -�--� ------ DATE: ----------------- --------------- APPLICANT: BESSE < POTTS ISSUED BY J / DATE: /1�--------------------------- / "t ,�c - I'sn ma N �S'�IGYclo3 ri D co S - r� ausc� Yv1 aci rn� Municipality of Anchorage POUCH 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNO WWLES. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840918 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 10 Block 1 Spring Hills Est. #1 Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 n n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST 1� SUILS LOU goo 4/J' ❑ PERCOLATION TEST PERFORMED FOR: JAM /:Ni<L DATE PERFORMED: LEGAL DESCRIPTION: /n 4RIA/6 1/i// -LC 17S1771TiS #/ SEG /< T/ N :13W. DEPTH SLOPE SITE PLAN 1 2- 34 3- 4- L567141- 5- 6- 7 8 9 10 4 11 WAS GROUND WATER (SEO) 6 ENCOUNTERED? E� LO o n 12 P IF YES, AT WHAT E 13 DEPTH? 9 0 14- 15 4 15 16 17 18 19 20 r Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: ilr LI) . CERTIFIED BY: DATE: 72-008 (6/79) e MUNICIPALITY OF ANCHORAGE \\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION i 825 L. Street, Anchorage, Alaska 89501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ✓ 4 s�CCf.�""� DATE PERFORMED: �+ V `t'i ' y I's LEGAL DESCRIPTION: SOl1 h� r���/'�a�t •sOn gI°CIr L01- 10 •T I'! PERFORMED L72-008 (6/79) Icis gn.rtl /19 f8� O^ .J✓� % ? WAS GROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? /0 `44'x 17 k_ RK 7— s r 4 a( Ae Rd Gtw, / AGa ctd,d PQ 7K .■■■■.■■■■ MENNEEMMEM Reading Date Gross Time SOILS LOG ❑ PERCOLATION GrJca i' TEST PERFORMED FOR: ✓ 4 s�CCf.�""� DATE PERFORMED: �+ V `t'i ' y I's LEGAL DESCRIPTION: SOl1 h� r���/'�a�t •sOn gI°CIr L01- 10 •T I'! PERFORMED L72-008 (6/79) Icis gn.rtl /19 f8� O^ .J✓� % ? WAS GROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? /0 `44'x 17 k_ RK 7— s r 4 a( Ae Rd Gtw, / AGa ctd,d PQ 7K .■■■■.■■■■ MENNEEMMEM Reading Date Gross Time Net Time Depth to Water Net Drop GrJca i' p -2Y 7i //31 /0 30 3p i? 7 iS, �� Y/ n '7 — r 120 /0 ; �D6 2-0 9 zr 2o( /-PeERCO L/CTION RA S rS)/ 2 2-1 (minutes?inc 1 �/ •/ .I -L J ;'1^R� WJEEN FT AND /� FT n ' MVM I C I pAL ITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 O N —SITE E3EWE R Z4 W E L L P E R M I T PERMIT NO: 840663 DATE ISSUED: 02/03/84 APPLICANT: D&S UNLIMITED ADDRESS: 7800 DEBARR #206 ANCHORAGE, AK 99504 CONTACT PHONE: 337-6763 LEGAL DESCRIP: SUBDIVISION: SPRING HILLS EST. SECTION: 15 TOWNSHIP: 12N LOT SIZE: 76134 (SQ.FT. OR ACRES) MAX BEDROOMS: 3 W _ DRA I N Listed below are the opt ons avalab40--to you system. Choose the option that best fits your 5.5 T R E N f_ - DEPTH DEPTH TO PIPE BOTTOM (FT.) 4.0 GRAVEL DEPTH (FT.) 2.0. TOTAL DEPTH (FT.) 6.0 GRAVEL WIDTH (FT.) 2.5 GRAVEL LENGTH (FT.) 104.0 ** GRAVEL VOLUME (CU.YDS.) i"A%) TANK SIZE (GALS) 1,000.0 ** SOIL RATING (SQ.FT./BR) 138 #1 LOT: 10 BLOCK: 1 - RANGE: 3W in designing your septic site. 13 F=- W _ DRA I N 5.0 4.0 0.5 2.0 5.5 6.0 18.0 5.0 35.0 'M 58.0 19000.0 ** 2 1,000.0 ** 138 138 +�* GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on -this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,' THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WOR1: MUST BE DO IE BY�ICENSED ELECTRICIAN. SIGNED DATE: : 7 3' - UNLIMITED ------------------- 3 -------------- APPLICANT: D&S UNLIMITED ISSUED DY DATE• �� ilunlcipa.-fity Q PO L.. ,1 6-650 '� ANCHORAGE. ALASKA 99502-0650 o� (907)264-3111 Anchorage � . - 7ONY P(h 0 V:1 (S. MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840663 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 10 Block 1 Spring Hills Estate N1 Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/0 5 7 Municipality of Anchorage • '� Development Services Department j Building Safety Division -- On -Site Water 8 Wastewater Program t �i 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 e www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL V FOR A SINGLE FAMILY DWELLING V Parcel I.D. DIS - b5I' gy COSA# 0 6 -7-a. 1. GENERAL INFORMATION Expiration Date: D _/ 3- O % Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SPRING HILL ESTATES #1• LOT 10, BLOCK 1 4600 SILVER SPRINGS CIRCLE * ANCHORAGE. AK 99507 EARL do ANN FRAWNER Day phone C/O AGENT Day phone BONNIE MEHNER w/ PRUDENTIAL J.W. Day phone 762-3110 3801 CENTERPOINT DRIVE #200 * ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well a Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage (les and from my investigation and inspection, the on-site watersupply 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. Address 3701 E. TUDOR ROAD, SUITE 101 + ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance oftho system under the conditions encountered at the time ofthe test, and separation distances measured to readily Idontifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any otherperson orpartyIs not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE Phone 337-6179 Date o Q� Approved for L bedrooms. Disapproved. Conditional approval for bedrooms, with the tllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other A. Gars:' E-793 ON-SITE . WATER AND WASTEWATER : PROGRAM By. 4a�-�/ W Original Certificate Date:_ (Rw.1105) GARNESS ENGINEERING GROUP, Ltd. •..,.. - +...- .--.,+ CONSULTANTS & GENERAL CONTRACTORS �= -x- r ' +-•�- +* July 11, 2007 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 (907)343-7904 Ref: Spring Hill Estates #1; Lot 10, Block I To whom it may concern: On January 9, 2007 your department granted a conditional approval for a COSA on the subject lot. In order to receive an unconditional COSA approval, a cleanout located at the south-east side of the field needed to be located and repaired. This has since been completed. The as -built survey has also been updated to show the cleanout. We are requesting that your department grant us an unconditional COSA approval on the subject lot. If you have any questions, please contact us at 337-6179. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246 • Website: www.gamcssengincering.com a� 49TH Y^V R ............................... 4 SHANE A. HOLT: a 0!, LS -6914 • �•4 0n, ..... \ \ \ \ �D,J \ fLC \ C I A pPIVCWI.Y \ l'B L WELL `• E USE OF LENDING INSTITUTIONS SPEC LOT LINES OR EASEMENTS MO IS Not /L / / / / / / / / OF RECORD. OTHER THAN THOSE SHDAN ON THE RECORDED PIAT. ARE NOT SHOWN HEREON LODATEDAPPROM WTELY ANDME NOT TO BE USED TO DETERMINE r, ' SILVER / N SPRING n CIRCLE NOTE: LOCATION OF CREEK MAINT. E•Mi FROM PLAT. EASEMCNT IB CENTERED ON CREEK THREAD AND MAY VARY SLIGHTLY FROM LOCATION SHOWN HEREON. LEGEND : L LIGHT FIXTURE S SEWER PIPE AS -BUILT SURVEY NO CORNERS SET THIS DATE 1 HEREBY CERTIFY THAT I HAVE PERFOR V EDA MORTGAGEE91NSPECTION OF THE FOLLOPING DESCRIBED PROPERTY LOT 10. BLOCK 1. SPRING HILLS ESTATES NO 1 ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT THE IMPROVEMENTS WTUATEO THEREON ARE WTHIN THE PROPERTY UNES AND NO NSIBLE ENCROACHMENTS EXIST OTHER THAN NOTED DATED AT ANCHORAGE. ALASKA TMS_2MD_ DAY OF MAY 7N7_ VE HOLT LAND SURYING INN,FB 12777 TEL UN 012 I s • z v n DECK z I • I u1 I o NI ISOe 13 I In I w I I /' C, / IN I I // a I / o I � Z I I //' A- // I I I / I � I I I I I I � I I I I I I I I I I I 0o- I 1yp. I � tae / / I / I / I / / I / / I / / I / I / I/ I E USE OF LENDING INSTITUTIONS SPEC LOT LINES OR EASEMENTS MO IS Not /L / / / / / / / / OF RECORD. OTHER THAN THOSE SHDAN ON THE RECORDED PIAT. ARE NOT SHOWN HEREON LODATEDAPPROM WTELY ANDME NOT TO BE USED TO DETERMINE r, ' SILVER / N SPRING n CIRCLE NOTE: LOCATION OF CREEK MAINT. E•Mi FROM PLAT. EASEMCNT IB CENTERED ON CREEK THREAD AND MAY VARY SLIGHTLY FROM LOCATION SHOWN HEREON. LEGEND : L LIGHT FIXTURE S SEWER PIPE AS -BUILT SURVEY NO CORNERS SET THIS DATE 1 HEREBY CERTIFY THAT I HAVE PERFOR V EDA MORTGAGEE91NSPECTION OF THE FOLLOPING DESCRIBED PROPERTY LOT 10. BLOCK 1. SPRING HILLS ESTATES NO 1 ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT THE IMPROVEMENTS WTUATEO THEREON ARE WTHIN THE PROPERTY UNES AND NO NSIBLE ENCROACHMENTS EXIST OTHER THAN NOTED DATED AT ANCHORAGE. ALASKA TMS_2MD_ DAY OF MAY 7N7_ VE HOLT LAND SURYING INN,FB 12777 TEL UN 012 Municipality of Anchorage 96-17, • Development Services Department Building Safety Division :. . Onsite Water S Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. P1515�)I-80 COSA# aeDS'4�- 1. GENERAL INFORMATION Expiration Date:y A10 7 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SPRING HILL ESTATES ill: LOT 10, BLOCK 1 4600 SILVER SPRINGS CIRCLE • ANCHORAGE. AK 99507 EARL do ANN FRAWNER Day phone C/O AGENT Day phone BONNIE MEHNER w/ PRUDENTIAL J.W. Day phone 762-3110 3801 CENTERPOINT DRIVE #200 * ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Weil ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite 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 certified by my seal affixed hereto and es of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated heroin. I further verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date ez- 1 o b Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d 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 ofall wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sore benefit of the owner listed above. Any reliance upon or use of this report by any otherperson or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for 3 bedrooms, with the flowing in Iva c� � ��T D `� • WATER AN AZZ Attachments: %�tQF' • .... •�5 ����� COSA Checklist Arsenic Advisory � jOrtl))T1 Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other By: (R".11105) Original Certificate Date: a Municipality of Anchorage • Development Services Department j Building Safety Division ` Onsite Water d Wastewater Program 4700 Bragaw Street II P.O. Box 196650 y Anchorage, AK 995196650 www.munLorg/onslte II (907)343.7904 id CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST a S Legal Description: SPRING HILL ESTATES N1; LOT 10, BLOCK 1 Parcello: 01.5 -05/-8o A. WELL DATA Well type PRIVATE If A, B, or C provide PWSIDN N/A Date completed 3/20/1986 Sanitary seal (Y/N) YES Total depth 201 ft, Cased to 201 ft. FROM WELL LOG Data of test 3/20/1986 Static water ievel 170 ft. Well production 20 g.p.m. WATER SAMPLE RESULTS: Well Log (YM) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 11/16/2006 129 ft. 7.4 g.p.m. Coliform 0 colonle3/1DO ml. Nitrate JW—mg./L. Other bacteria colonies/100 mi. ��n Anionic: 'vri ugJL. Date of sample: 11/16/2006 Collected by: GEG Ltd. S. SEPTIC(HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 11/5/1984 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping 10/26/2006 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA 16BELOW EXISTIN Date installed 11/s/1934 Soil rating (g.p.d./1120r lbdr 150 System type TRENCH Length 83 ft. Width 3 ft. Gravel below pipe 4 ft. Total depth --2,11—ft. Eff. absorption area 504 ft' Monitoring tube YES Depression over field NO Date of adequacy test 11/16/2006 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth In absorption field before test 3 in. Water added 480 gal. New depth 3 In. Elapsed Time: = min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at _in. "Pump otP leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfllfi station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100 + On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *UNKNOWN Building foundation 1o'+ Water main N/A Water service line 102+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS CLEANOUT WAS NOT FOUND AT THE SOUTHWEST PORTION OF THE TRENCH. HOWEVER THERE IS A SUMP AT THE OTHER END WHICH IS FULLY OPERATIONAL. G. ENGINEER'S I cera fy that I have determined through held inspections and i':' review of Municipal records that the above systems are in ....... conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS A Date 1-2-11104 COSA Fee a_f & ( Date of Payment1111 OL Receipt Number (Rev. 71!05) 1 CCoo Nijions Waiver Fee $ Date of Payment Receipt Number ey A. rness. CE -77534 �c4 SGS ReLa 1066825001 Client Name Gamess Engineering Group, Ltd. Project Name/N Spring I fill Est 1 LI O BI Client Sample ID Spring Hill Est 1 LIO E)1 Matrix Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 11/28/2006 12.37 Collected Date/Time 11/16/2006 12:00 Received Date/Time 11/162006 13:14 Technical Director Stephen C. Ede Sample Remarks: 353.2 -The MS for Nitrite recovered above the QC criteria. The batch LCS is within QC limits. Allowable Prep Analysis Parameter Results PpL Units Method Container ID Limits Date Date ]nit Metals by ICP/HS Arsenic Waters Department Nitmtc•N Microbiolocry Laboratory Total Coliform ND ND 0 5.00 ug/L EP200.8 0.100 mg/L EPA 353.2 C (<10) 1120/06 1121/06 TK 0 (<10) col/IOOmL S%12092220 A (<1) 11/17/06 ALR 11/16/06 DPT 'SILVER 5Prinq G.r. SII}en. Lei•baek ,�J OF A ` Iro�a•.?Gat I I �(/ ^r i %t�1 . 25'cA.-k ►w f Eent�, I ^ a� 1 *n�• 00 000 ' �'� �'� �•� �/`�: lerviJohn EFFTfa`�i % Na 3530•S LEGEND 1 0/'• �..• • / ' O CORNERS LOT 1' \\\\" FOUNDATION CRAINAGE ARROWS QICr+ .td 11-7-19Bg %Q / F AE:!11 NOTES, i I / • 7 II L IT (MILL St Tot 1iSF00SISILITV 01 TNI 61111.044 01 00092 TO VERIFY THAT rG11ILOIYS LCOATMA 0#000 01071 ALL S01Y 00ISIOo COVt04MT1 Aug ZONA& T • * I� ORo1NANCCS. �•• // I. If1A TWO IIIFONS111LITV OI TWO IVIL991 TO Yt111T ALL ELEVATION& 01T$ .� at get TD ALL UTILITIES. —': I L THIS FLAT OIN fS4TC THE PARCEL Or FROFQ Tr Ol1CAut0 G[1.00 Vast* AndrTF• p f `, FROM TMS IICONDID FLAT OtSCAHHU THAr PAMCIL. ONSTRUM94TS *&COMES t •rF ., N0. 3514-S per POIOR TO 04 A/TEA rot FILING Or THE 11000690 PLAT Aat ■OT Smawa 0% 1 A •• �,✓�= THIS PLAT. f+k ��BffjSi6111�``�r iPt i e°iuiTTOYGwii:r CONFLICTS Sir,". a.."i:i iTiuctuiili AN, ru TTm Lor OSIT MI L STRUC Tl , s O FLAP u IDT . IS wID roN / f. ✓: /� O°I Cb L//Fl.•.R/•//. rouT1DNUG AOSITgYAt GT#ucruN tt ON r[#Ca. FII/R/er CIRTNV THAT 1 wave SUNV1reD THE 'ROFINrtOSS college 00 THIP PLAT AND ?At OFAOV/MINTS SITUATDO T#c1E0N &Of LOCATED .0 SMO1M ON THIS FLAT. Arco Twit •7 / DAr or:C,I�,IDQ.�Y i 749-64 DRAWN 11 ,as - evi�r •. Lor 10, FLOCK 1 SPRING HILLS ESTATES W, I lrvGnU1(AOE, ALASKA 99507 349-6404 T 9cY January 4, 2007 TO: Whom It May Concern: FROM: Shelly Branscom, Escrow Officer Alyeska Title Guaranty RE: 4600 Silver Spring Circle, Anchorage, Alaska SELLER: Earl D. Frawner and Ann L. Frawner BUYER Yael B. Kaufman and Robert S. Kaufman ALYESKA TITLE GUARANW AGENCY 3801 Centcrpolnt Dr, Suite 102 Anchorage, AK 99503 Phone: (907)569.2842 Fax: (9n 569-2843 Pursuant to the attached Escrowed Funds Agreement, it is the intension of this office to hold the fiords described therein in escrow at the time of the sale of the above described transaction until such time that the septic system cleanout is located and a Certificate of Health Approval is obtained from the Municipality of Anchorage. �Rt4cr- klt,c-S S I I L tb J R I Tricska Cwaranry/�gency, -/`��`. JCR14rB 1IK8/rAf i9� Escrow No. 00018017-001 SB ALYESKA TTME GUARANTY AGENCY 3801 Centerpoint Dr, Suite 102 Anchorage, AK 99503 Phone: (907)569-2&12 Fax: (907) 569.2843 This agreement made this January . 2007 by and between Earl D. Frawner and Ann L. Frawmer (hereinafter referred to as Sella), parry of the fast pert, Yeel B. Kaufman and Robert S. Kaufman (hereinafter referred to as Purchaser). parry of the second part, and Alveska Tide Guar=w Armcy (hereinafter reRrted to as Escrow Agent), parry of the third Part. WITNESSETH: WHEREAS, the Sella owns the following described real estate: Lot 10, Block 1, Spring Hills Estates Add. No. 1. according to the official plat thereof. Bled ander Plat Na M-140, In the Anchorage Recording District, Third Judicial District, State of Alaska. Property Address: 4600 Silva Springs Circle, Anchorage, AK 99507 VaIEREAS, the Appmisal/Earnest Money Receipt and Agreement to purchase, dated Novemba 5.2006 provides for Sella to complete certain improvements to the above property, and WHEREAS, the real estate has been sold to Yael B. Kaufman and Robert S. Kaufman and WHEREAS, weather andlor supply prevent the completion of said items, and WHEREAS, it B the desire of the Sella and Purchaser to close the We prior to the completion of the improvements and at the earliest possible due, and WIMREAS, the Lender is willing to disburse the loan proceeds provided a cash escrow, is established to assure completion of the uncompleted item. NOW. TIIEREFORE, for and in consideration of the premises herein above set forth and in order to make possible the immediate delivery of possession of the property to the Purchaser berelnabove named and at the same time assure the satisfactory completion of said improvements, the parties hereto agree as follows: 1. The Sella covenants and agrees to complete the improvements enumerated below on or before the lune 30.2007. 2. The Sella agrees to pay for all labor and material necessary to complete the work and improvements. The sella further agrees to pay for the final inspection performed by the approved appraiser or lender hereinabove named, if applicable. 3. The Sella additionally agrees that he is personally liable to the Purchaser for the satisfactory completion of the work, Bee and clear of W material and labor liens, and lodemailies the Purchaser and the Escrow Agent for any liability for Claims of Lim filed against said property for the improvements mentioned herein after the closing of this We. 4. The Sella herewith deposits with the Escrow Agent and the Escrow Agent acknowledges receipt of the auto of Eight Thorusmd and 001100 Dollars ($8000 ) which said sum shall be held by the Escrow Agent in an interest bearing account and disbursed as follows: (a) In the event the Sella completes the work and improvements in Poll accordance with this agreement and to the satisfaction of the Purchaser and upon mutual written instructions provided by the Sella and the Purchaser, the Escrow Agent shall thereupon pay to the Sella the sum deposited, plus the accrued interest. (b) In the event the Sella fails to complete all or airy part of the improvements enumerated below, on or before the due specified in Paragraph 1 hereof. the Purchaser shall have the right to enter into a contract with any third parry for the completion of such part of the work as the Seller has failed adequately to perform. In such event Escrow Agent shall pay over. at the direction of Purchaser, all or any part of the escrowed Binds in such amounts and to such persons as may be specified in the presentation of bills for work performed. The Sella hereby releases the Escrow Agent from my liability whatsoever to pay over or account for W or such part of the funds deposited hereunder as may be expended at the direction of the Purduser as provided herein. (c) Its dispute arises regarding the disbursement of the escrowed funds, the Escrow Agent shall not be required to take my action or disburse my Bunds but may withhold and stop all father proceedings without liability mill such time a mutually agreeing written instructions have been delivered to the Escrow Agent or court order. (d) In the event the auto herewith deposited proves insufficient for airy reason to effectuate completion of said work, the Sella agrees to pay my and all sums needed ova and above the amount of this deposit to complete said work. Escrow No. 00018017 -001 -SB 5. It Is the intention of the parties than this Agreement is made for the benefit of the Purchaser. The Escrow Agent, in the execution thereof, shall act solely on the request and instructions of the parties as specified herein with respect to all sums deposited hereunder and for so doing, the Sena hereby expressly, releasor and relieves the Escrow Agent of any and all liability or claim of any nature. 6. The Escrow Agent shall be" a prior nen on the funds deposited herewith for any costs, including costs and reasonable attorney's fees which may be incurred by it coos quent to its being made a part to all legal or equitable proceeding which is brought by my of the parties hereto, concerning the disposition of the Ends held SCHEDULE OF MIPROVEMENTS TO BE COMPLETED ITEM COST TOTALESCROWED 1. location of septic system cleanout with any repairsto landscaping 4000.00 8000A0 TOTAL COST OF LMPROVEhIENTS: S4000.00 TOTALESCROWED: $8000.00 IN ORDER TO RELEASE ESCROWED FUNDS THE FOLLOWING IS REQUIRED: ® Final Certificate of Health Approval from MOA O Presentation of Paid Receipts ® Written lrumuctiom from Buya & Sena O Written Instructions from Lender IN WITNESS WHEREOF. the parties hereto have hereunto caused these presents to be executed on them behalf and their seals affixed the day and year fust above written. SEL.•. ER(S): Earl D. Frowner Ann L Frawaa TLV: -(W-9 ATTACHED) Address: _ PURCHASER(S): Yul B. Kaufman Robert S. Kaufman Address: Municipality of Anchorage Development Services Department • +� Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: harness Engineering Legal description: Spring Hill Estates #1. Block 1 Lot 10 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. _ ❑ Additional soils information needed. _ ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. _ ❑ Topographic Information missing or inadequate. _ ❑ Incomplete; missing ❑ Incomplete; missing ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ® Other. The original inspection report shows a cleanout at the sout Name of reviewer: beb Date: 12/5/06 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK M -W DRILLING, Inc. 86-149 P.O. Box 110378 • 10330 Old Seward Highway (907) 349.8535 - ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner DESIGNS IN WOODUse of Well Domestic Location (address of: Township, Range, Section, if known; or distance main road _Lot 10. Block 1 Spring Hills Subd. Size of casing 6" nepth of Hole 201 feet Cased to 201.3 feet Static water levet 170 tt. hYb#M (below) land surface. Finish of well (check one) open end ( X ) ; Screen ( ); Perforated Describe screen or perforation None Well pumping test at 9f) pet OW (minute) for___1hours with 100'/. ft. of drawdown from static level. is c. Date of completion March 20;' 1986 ` WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 2 Casing stickup 2 TO 18 Silty gravel 18 TO 33 Sandy' grave 1 P F ( F I,/ F n 33 TO 51 Sandy gravel & water SI To 75Silty:gravel 75 110 Sande& silt Dept. Has;:: u H pan Seniices TO 110 TO125 _ Silty gravel 125_To 150 Silty hardpan 150 TO 177 Silty gravel 177 TO 188 Silty gravel & water 1RR TO 2(11 Waterbearing gravel TO TO TO TO Certilied Contractor Certificate No's. 814 & 973 I —CUSTOMER MUNICIPALANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1.D. # n 16- 0St -1-1 1. GENERAL INFORMATION Complete legal description Lot 10; Stock 1; Spring Hitta Estates Location (site address or directions) 9621 Spni.ng 14, Y ; V4i.ve Property owner Cutt iA FoA.tp_2 Day phone wk 265-1500 hm 346-1154 Mailing address Lending agency Mailing address Day phone. AgentV.ucginia Johnson FORTUNE PROPERTIM INC. Day phone 562-7653 Address 3000 A Street Anchorage. Ataska 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: _ v 3. TYPE OF WATER SUPPLY: Individual well XX Community well _ Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank _ Community on-site _ Public sewer _ NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 73-075(Rw. 1/91) From MOA K7 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 investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S 8 S ENGINEERING Phone 17034 Eagle River Loop Road No. 20.4 Address Eanle River. Alaska 99577 Engineer's signature Date I_`j-f1Z By: J014(\f .521 ►?} Date f 3 42 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 purchasersof homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work. 724025(R".1,91) ew• MOAm 9; • s 00 � * 49TH A• P05ER A St.1FER PZ W 00"ROFESSO V S. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: a Additional Comments By: J014(\f .521 ►?} Date f 3 42 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 purchasersof homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work. 724025(R".1,91) ew• MOAm Municipality of Anchorage Department of Health & Human Services' HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: -U%7 10 , 3tA(LC J, Parcel I.D. SPRING 1 A. WELL DATA Well type+�e-3E If A. B, or C, attach ADEC letter. ADEC water system number . N/ Log present &N) S> Date completed 3 °ZU " .Driller MW DAWA>I_ Total depth - a�� r Cased to Ao l •3 r Casing height r2 N+ Sanitary sea lCY)N) 7nS Wires properly protected &N) %S WATER SAMPLE RESULTS: Coliform Nitrate�e Other bacteria Date[?,19-2'of sample: I Collected by: S �n��NEea�Nc B. SEPTIC/HOLDING TANK DATA Date installed I LcIr. Tank size Compartments Cleanout' iy N) y Foundatio cleanout a/N) y� Depression (Y/0, N t. High water alarm (Y/6 , Np A/ Alarm tested (Y/N) N/Q r^` Date of•pumping 1+1c6- Pumper i� t i'itlttp rlCCei/rc6r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on iiS - r b r On adjacent lots ��� } Foundation q Topropertyline 5o Absorptiorifield as Watermain/service line Surface water/drainage 72-026 (Rev. 7M) From CONTINUED ON BACK PAGE FROM WELL LOG .. AT INSPECTION 31�o�$C I[ -t19L Date of test Ino Static water level j < aY Well flow a0 g.p.m. �r5 -I g.p.np LU (ANKtJOwri — z W Pump level . - - O 0 tY SEPARATION DISTANCES FROM WELL TO: • - Septic/holding tank on lot r �b0 ` ; On adjacent lots 10 c rf W Absorption field on lot r /64 ; On adjacent lots , NO f �o^'� Public sewer main Public sewer manhole/cleanout %L%uivF Sewer service line Petroleum ank /1,10A; FL kMUJ WATER SAMPLE RESULTS: Coliform Nitrate�e Other bacteria Date[?,19-2'of sample: I Collected by: S �n��NEea�Nc B. SEPTIC/HOLDING TANK DATA Date installed I LcIr. Tank size Compartments Cleanout' iy N) y Foundatio cleanout a/N) y� Depression (Y/0, N t. High water alarm (Y/6 , Np A/ Alarm tested (Y/N) N/Q r^` Date of•pumping 1+1c6- Pumper i� t i'itlttp rlCCei/rc6r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on iiS - r b r On adjacent lots ��� } Foundation q Topropertyline 5o Absorptiorifield as Watermain/service line Surface water/drainage 72-026 (Rev. 7M) From CONTINUED ON BACK PAGE C. LIFT STATION n I Date installed Iy Manufacturer— Size anufacturer_Size In gallons \� Manhole/Access.(/NI Vent(Y/N) High water alarm level "Pump on" Meets MOA electrical codes (Y/N) SEPARATION DISTANCE Well on lot D. ABSORPTION FIELD DATA LIFT STATION TO: On adjacent lots "Pump off" level at Cycles tested Surface water Date installed ((I (� I gs Soil rating i 50 SF /[3i2, System type D Length- 90 Width a3 Gravel thickness bt. D1re Totaldepth g Total absorption area 9a 0 sr- Cieanouts present ON) -S Depression over field (Y/6) NO 'YE Date of adequacy test —1� ,'Results(pass/fail) _ fpSC for Y bedrooms Peroxide treatment (past 12 months) (Y/© CIIf yes, give date K oW SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 160 -I On adjacent lots X00 r f Property line /0 To building foundation To existing or abandoned system on lot NIA On adjacent lots f�GI'F Cutbank ^air Watermain/service line WA Surface water (o 430 Driveway, parking/vehicle storage area Curtain drain kinNs- Cuz-QAJr, ' Cane(s4s or-'- A NonutA- - 0_RAf-1OtL IN &k"e Excaft OF a.l*%, tuo E. ENGINEER'S CERTIFICATION /�IN EF� Aetar No,(r.ru, AAfACI vB 71044o,rs Cur&*+ t C vaam. 41 r'+. OF S. -Jaw Cove) I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect oQtV date of this inspection. S 8 S ENGINEERING Signature - 17034 Eagle River Loop Read No. 2" -Eagle River, Alaska 99577 Engineer's Name Date 1 HAA Fee $ 7d Waiver Fee: $ Date of Payment Date of Payment Receipt Number •� 3 3 �� % 7, Receipt Number 72-M (A-. Yat(Onk MOA 21 OF At r P.• P *. 49TH ,, a RW_ `' j, Arr�i!p %Wrw -, T MUNlClPALITV FAN56' RAGE S . - 16ES DEPARTMENT OF HEALTH & HUMAN ERV DiAslo � of Envli6iir�iniil Siivlcei;',; n On-SlteServi Services Sil6iil. ec "'P.O. Box 196650: Anchorage, Alaska 99519-6650. 4 '343-47447' f: CERTIFICATE OF HEALTH AUTHORITY.. APPROVAL FOR A SINGLE FAMILY DWELLING . Parcel I.D.#!-In SSO 1 t.,Z!,:'1HAAi 1. GENERAL INFORMATION'- - Coniplete legal description 107- /0 1p� 5 P A4 4 1 14 t LA -s rs rAre s Aw, Location (site add . ress or directions) . 41kQQ 5,L4ca' 5-P J6 bt;2,ac Property owner Mailing address A. I 1JA2A-C ^'I Day p . hone SL4- 1OLN Lending agency Day phone Mailing address Agent--* /YIA+J" JAY& Day phone 74 Z 31OT: Address % .r Unless otherwise requested, "HAA will be -'held for pick' Up -7 2.__ NUMBER OF BEDROOMS -.7.. 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site, V, Holding tank t., 3 �7- Community on site Public sewer.;;... !4 NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-=(Aw.1191) Fm UOA#21 - 9 .Lts Von Wom s�ae6l6u6 luu61m;ojd eyi ul suolsslwo Jo sioug ioj olglsuodsai yo Alleolu%4 e4,•pensis! elvollpiao a aJojaq glep pm Jo suojioedsul ionpuoo IOU $l e6eioyouw.. . _ iouopSHHaloswAoldw3.sjuaweJl"'GlelspugIMPajuleveoNsliesoiJepioulsuolinigsul6ujpueiJleyipue '- sewoy jo siaseyoJnd of Asevnooe se slyl saop SHH(3eyl •e�Isely io eieiS eyl ui pajeis!6a»eaul6ua leuoissejwd ivapuadepu-I up Ag enoge g i{deJ6eJed Lj uanl6 suolielussaide� 1eyi uodn Aluo peseq sajeog!iJeO IgnoJddy puoyin d y11eaH sanss! (SHHCl)S80Vuas uewnH pug ylleaH jo luaurlJedep e6eJoyouy jo Ai!ledlolunW ey1 _ . sjuawwo01euoll!pP`d, t . suo!ielnd!is 6ulmopo; eyl yl!m 'swooJpaq. JO; Ienadde leuo!i!Puo� ,a , AcUddust 7. (3 swooJpaq/ Joj pano.lddV •�oee saeo�ee� :< 38MVNJIS SHHa •9 • .. od��olydo�e' '•11111••11• d� AV _ „ elec) oinjeu6!s sjaaul6u3 LL "2 YDY -04 Ssaippv . auoyd y 0116._ 9 .1_..._.. r - r r7 tw!j 10 ewEN " •uopoadsul slyi jo ejpp eyi uo ioajje u! suoljeln6aJ pue'saoueWpid' . 'sepoo e3p1S pup ledlolunW Ile iji!m eouplldwoo ul sl walsh jusodslp Jalemalsem jo/pue Alddns., ielemois-uoeyi'uoji0edsul pus uollp6lisenU! Aui woJj pup sel!j e6eioyouV jo lqualo!unyy syi_; woJj pau!ejgo uoljeuuojul eyi uo peseq le4lAjuariiaylJnj •ulaiay paieolpul eJnioruis jo edAj pue' sW00JpegjOJagwnuegjjolelEnbapepup ILuotiounj'bjusSIWaiSASIESOdSIpialumalsemio/pUL - Alddns jaiem ej!s-uo eyi ieyj smogs Uolle0!jdd8 Ienoiddy AjuoylnV ylleaH slyl 10 uolje6llsenul Aw ieyi Ajuan 1 'molaq umoys ejep UoljeP!len eyi jo se pus oiaJay paxljje leas Aw Aq pa!j!iJao sy'. " ' ' . d33NIDN3 Ae N01103dSNl d0 1N3W31V1S' 'S " Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LAOParcel I.D. D/- - .00/-60 A. WELL DATA I Well type If A, B. or C. attach ADEC letter. DEC water system number Log present (Y/N) Date completed Driller Totaldepth lgcy Casedto JM:' Casingheight �M Sanitary seal (Y/N) Wires properly protected (Y/N) Ma leRASE NVIRONMENTAL SERVICES DIVISION FROM WELL LOG AT INS ECTION Date of test ��85 �0 �{ NOV 0 5 1991 Static water level Ir �lYr RECEIVED Well flow Pump level 76.11 g.p.m. SEPARATION DISTANCES FROM WELL TO: �,(�j r t 7 100 Septic/holding tank on lot I"I'� ; On adjacent lots rr r Absorption field on lot +�'/ ; On adjacent lots 7100 Public sewer main LAI I Public sewer manhole/cleanout Public sewer service line !�y1 Petroleum tank IyLI WATER SAMPLE RESULTS: Coliform Nitrate �� ND Qtherbacteria Date of sample: 101MIql Collected by: B. SEPTIC4 DATA Date Installed —1 Cleanouts (Y/N) . High water alarm Date of pumping Tank size - now Compartmentsy ..11 .Foundation cleanout (Y/N) Y Depression (Y/N) N Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTICW, TANK TO: Well(s)onlot Onadjacentlots 7If/�/ Foundation Topropertyline �QrX AbsorptiontieId 2 Water-waic/serviceline rJZ, tµAf . Surface water/drainage �h'/ 72-M (R". 7191) hoot MOA 21 _CONTINUED ON BACK PAGE Date installed Manufacturer Size in gallons Manhole/Access (Y/N Vent (Y/N) "Pump on el at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANC OM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Soil rating 7� System type Length Width 3� Gravel thickness Totaldepth Tot alabsorptionr� eal tl� Cleanouts present(Y/N) Depression over field (Y/N) N Date of adequacy test a� Results (passg&4e for 3 bedrooms Peroxide treatment (p1st 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I On adjacent lots '71yo Property line To building foundation ) ��R To existing orabandoned system on lot i 0f ��I� I/ Onadjacentlots Cutbank_t�1L1Waterseefn/service line / t / Surface water I7� Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that t have checked, verified, or conformed to all MOA and HAA guidelines in effect Signature Engineers Name /✓l7GNACc- /fA/��SO^� Date he date of this Inspection. Michacl E. An&rson A381 -E ��� /'60FESS10'•�"v"� HAA Fee $ 7D 4 Waiver Fee: S Date of Payment Date of Payment Receipt Number o�3a2�J 94�% Receipt Number 72-M (R". 3191) Beck MOA 21 MUNICIPALITY ANCHORAGE O Department of Healthth 8 Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. #l�0 HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) d/000 si[ vE e : pAogy v6 el,eict,E (b)PropertyownerEr�s_EL A1,0Zf"AAJ Telephone: (home) 346-3488 Business s4 -r-5578 Mailing Address 1/&00 'S /L v6r2 faRRI16 0IE64C 99507 (c) Lending Institution NBA Telephone Z65- ZR EP Mailing Address R. 0,15OX /00 &00 4Ae',&e 4d6. . 4454* 993/O-aGoo (d) Real Estate Company and Agent -T efAf 1.41h!/TE — OeZle,-.v 11Z6vviv.4 Address 3201 e? 5T. Telephone 5eo3- 5600 (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family Number of bedrooms_ 3. WATER SUPPLY Individual Well Dd Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72 -MS iftw. 7/68) i Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm '�^^I "C7Z5C'j G;nlei'R7x/L Telephone ,�37- 19 7 Address PO. /?G>< y0 7Z3 RNtJ rr,/sG A- 9VszV Date /o Michael c Andenon •, 431-E :.� Engineer's Seal 6. DHHS APPROVAL / Approved for _bedrooms by ' `— Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 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 orderto satisfy certain federal and state requirements. Employeesof 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. 72-025 IRW. 7M) But Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 MUNICIPALITY OF A\uiO:.ACE ENVIRONMENTAL SERVICES DIVISION OCT 1 1 1988 RECEIVED Legal Description: /oT /o FY/C/ 5pe/nG 'WIMS S E514A—T '040",, 00/ A. WELL DATA Well Classification P.e/v.9Te' If A, B. C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield > L. 2 Total Depth IBL, S' to!BLSDepth of Grouting A14 lie' Static Water Level 139 Pump Set At A/or DEt6Pxnvf� Casing Height Above Ground 29 Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N) u SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot yJ' ; On Adjoining Lots /oo' To Nearest Edge of Absorption Field on Lot 11!T ; On Adjoining Lots > Idd Ifo Nearest Public Sewer Line / +' Mile To'Nearest Public Sewer Cleanout/Manh6le To Nearest Sewer Service Line on Lot /nom Water Sample Collected by FLArroP TECH SVCS ; Date 9-36-98 Water Sample Test Results SAT1S VA cro r_y - o C61 4rM c 0.1 MJL rw4rA+E Comments DzAwooww To 1q?_' 6.7- V'OM B. SEPTIC/HOLDING TANK DATA Date Installed III--VA'LSize JzSo No. of Compartments 7 - Standpipes Standpipes (Y/N) i Air -tight Caps (Y/N)y Foundation Cleanout (Y/N) y_ Depression over Tank (Y/N) til Date Last Pumped -LBB Pumping/Maintenance Contact on File (Y/N)y ;for /9B8 Holding Tank High -Water Alarm (Y/N) Y,& Temporary Holding Tank Permit (Y/N) NV4A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well �'LS� To Building Foundation it, To Property Line LC To Disposal Field 2 To Water Main/Service Line SZ� To Stream, Pond, Lake or Major Drainage Course yG { Comments St RnC- TA"le 15 AOElf DATE nan (R... T/N) From Page 1 of 2 C. ABSORPTION FIELD DATA I _P� Soils Rating in Absorption Strata /50 Type of System Design DEEP TRE e -ii Date Installed &A4,1 Length of Field G 3' Width of Field 34" Depth of Field Gravel Bed Thickness Square Feet of Absortion Area SD y 5r Statndpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test 0ASeE 0 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Property Line /0� To Building Foundation /DTo Existing or Abandoned System on Lot uouE ou Lor ; On Adjoining Lots > /06 To Water Main/Service Line To Cutback (if present) A/cuE IOR_=�EAtr To Stream, Pond, Lake, or Major Drainage Course f 73 To Driveway, Parking Area, or Vehicle Storage Area 55' Comments ABSO epr/O,V SVSrFhr rs AOEn yArE. D. STATION Date Insta Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA gZINo ui%ijt effect on the date of this inspection.n j �v OF 1 % �" •t 9 �0 Signed Company A/vAe►t-to 4 E'ivt.rr3ex- ruvG 00 !497-4 �.t iO Engineer's Seal Date 00 MOA No. i� 7� Michael E. Andenon 4781-E Receipt No. 3/ ?s/3 Date of Payment /0 -//- Amount: $ /5�j•oo 72-0M (Rev. 7/N) Beck Receipt No. _ Waiver Fee: $ Date of Payment Page 2 of 2 6. - � \ �• 10 Elcc.� Tele a• .I U I Q1 LILVER Z ,Ua ' I p1JC:.rc`F.: sed+,� p��J• S' 6AS ES"ifT, LEGEND \ O LOT CORNERS FOUNDATION :; `l, '-!— DRAINAGE ARROWS / II = 50,