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HomeMy WebLinkAboutKINCAID ACRES LT 4EKincaid Acres Lot 4E Stand ipes in p utility easement. Need ROW approval #011-121-91 REtfi Bfliltiti6 �f;IRGS .il _. _ i W ±U` LITIL ES IAT 3 ;a,fl ' J M 7 .. _ , ....... g.2 EXISTING ..�. HOUSE f� O VeL 0 1111\\\\ 1 I .O.s 9 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTO N ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SUPVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LYYT 9JRVEY SURVEY TYPE SYMBOLS Pfk,9i5ATt9fi A6- T A IF* REBAR _. DRAINAGE ASPHALT [J PLOT ST?uCNR6 S-WLTT O FO dND R BAR e 9 8 ,MOOD FENCE "' CONCRETE PLaT f'i..W ... AS -&LILT... Ltn6tlRVEY... TIX*4GRMIiY __.. roa—) ASSUMED ELEV. * r X METAL FENCE WOOD DECK PLOT PLASS & LOT SURVEYS Nuim: - IT IS THE RESPONSIBIUTY OF THE SUILOER OR OWNER, PRIOR TO ONLY THOSE IMPRO\riMENTS ABOVE GROUND AND VISIBLE WILL. BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. PENCES, WELLS. SEPTIC C.EANOUTS, SIDEWALKS; DRIVEWAYS. TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC- ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVSMENTS FROM SONO SEEN AND LOCATED) WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHER'MSE NOTED. SURVEY CERT1FiCAlION �{ (7LE1t1� c Prepared 6Y Q PLOT PLAN .���T„, O t����� RolDe~t E. johns, 1.1 �. CT', 'LASSOO. f ir,rmy Fury uwl It oh rmwasa� �ql* - sE# Pi"OiL'SSICSt'I01 Land Survi-VU(S II ma mt am,n ow maN.e as.w .vs mm r r� �� 170D BriM: Drive. M1an Tama r MmNlaea m a1 O,e ut eamec 'l m me m arc dm mamma wt M m• ! ANCHORAGE, ALASKA 93504- Yn=K.esa me meltw. a sane sms aeon! S S 0' Rec. Loi $:F. RN. ?tai Fim No OF FO'.1NDATION AS 6Jf- i si:3 t �Lrs c.�n.a m.mr axi .`. `{.�-. ,•0 Date Sarveysd: Oraxn Ey: i£hsauzd br a.amMam.�u „ms a..., 8118116 REJ im } rma:us. ca mx Ret ma moi aim., ,,dd amszxs aea ccc,rcamx c mam na-Mr,�' - $ ROBERiE JOHNS JR,•:w ehva. mH�� eeaaan,,,em. alae umme .D oy Date Drcam: Gna: a , 81 115 2222 1 10-316 HNAL SIRUCTJRE AS-B:1ilT Vis,$ -., ` `t, �, J •,' ai O� ! eaa: Descn,'lon: I t am«t E s., a.mr rofr met o �°�, re .. ..x• y 4 LOT }} nae ae±«m.a m.w9u.3 a+�v a+me >� eq •... . nb 4� L1 G" I xa t+m , c qo y maua ux® prO'tss'a a [ .__ ���� KINCAID ACRES DocuSign Envelope IE): 377251CC-E559.484F-Ao35-B77CFD1cc3oc August 12, 2015 Tim and Lisa Moyers 7921 Ingram Street Anchorage, Alaska Dear Tim & Lisa Meyers: No. 2417 P. 1 Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the septic system =Mching into the utility easement at Lot 4E, Kincaid Acres, also known as 7921 Ingram Street, city grid 2222. This letter of non -objection in noway precludes GCI Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easemou[ and or the right-of-way, including unlimited access for servicing its facilities, .Also any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of (3CI°s facilities to accommodate any or all of the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now and forever, for any damage, costs, expense (including reasonable attorney's fees), Iiabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to me at the address below. Dooueigned by: Docueigned by. Sincerely, Markus Kofotd OSP Design Engineer GCI Communication Coil) 5151 Pairbanks St. .Anchorage, AK 99503 907-868-6168 Office 907-868-8580 Fax Acceptance 8/17/2015 Date Docu$ign Envelope ID: 2716FC87-DOC3-4264-818D-47073C4DFEFC =LCDJ SkE3 n.'I nnun 1, V. r. PS, -o;a August 21, 2015 Tim & Lisa Meyers 7921 Ingram Street Anchorage, Alaska 99502 Alaska Communications has no objection to the septic system encroaching into the 10' utility easement located along the northern boundary of Lot 4E, Kincaid Acres, otherwise known as 7921 Ingram Street as depicted on the drawing --- -- --- -- submitted by Garness Engineering Group, Ltd. - - - - - - -- - - - - --- - Acceptance, (your signature below), and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: 1. Alaska Communications will be held harmless, now and forever, for any damages or injury to any person or property as a result of this encroachment. 2. Any Alaska Communications facility damaged or destroyed as a result of this encroachment will be repaired at no cost to Alaska Communications. 3. Any costs incurred by Alaska Communications for special construction necessitated by this encroachment will be borne by the property owner. 4. All applicable safety code regulations will be observed and maintained. 5. This letter of non -objection will in no way preclude Alaska Communications from full use and enjoyment of its rights within any portion of this easement 6. Alaska Communications is under no obligation to restore any structure damaged as a result of Alaska Communications full use and enjoyment of its rights within any portion of easements or right-of-ways. Please sign below, retain this form for your use and return a signed copy back to Alaska Communications. Foreman MS#14 600 Telephone Ave. Anchorage, AK 99503 ACCEPTANCE SIGNATURE: DATE: 0musigned by: oocusigned by: 8/21/2015 RPo@�39Rt�e9h5 1 15 Grid W W C 2222 ENSM ,,_� Natural Gas Company ENSTAR Natural Gas Company A DIVISION OF SEMCO ENERGY Engineering Department Right of Way Section 401 E. International Airport Road P. O. Box 190288 Anchorage, Alaska 99519-0288 (907)277-5551 FAX (907) 334-7798 August 10, 2015 Tim & Lisa Meyers 7921 Ingram Street Anchorage, AK 99502 _ _ Grid: A2222 Re: Letter of Non -Objection To whom it may concern: ENSTAR Natural Gas Company has no objection to the septic system pipe encroaching approximately 5' into the 10' utility easement parallel and coincident with the North lot line on Kincaid Acres Lot 4E, located within the Northwest one-quarter (NW 114) of Section 9, Township 12 North, Range 4 West, Seward Meridian, according to Plat 84-278, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. Acceptance and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: • Landowner/Contractor working near ENSTAR gas facilities shall contact the Alaska Digline, Inc., (907) 278-3121 or 811 for line locating two (2) business days prior to any related excavation. This service is free of charge. • ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. • Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. • Any costs incurred by ENSTAR for special constriction necessitated by this encroachment will be home by the land owner. • All applicable safety code regulations will be observed and maintained. • This letter of non -objection will in no way preclude ENSTAR from full use and enjoyment of rights within any portion of its right-of-way. Sincerely, Ro� ----------- Right of of Way and Permitting Agent ENSTAR Natural Gas Company , .,. Anchorage Water &Wastewater Utility Engineering Division's -M Mayor Board Chair Ethan Berkaudta David M. Richards August 17, 2015 Tim C. & Lisa D. Meyers P.O. Box 30 Bethel, AK 99559 Re: KINCAID ACRES LT 4E (Grid SW2222) Request for Letter of Non -objection to Encroachment (Tax ID# 011-121-91) The Anchorage Water and Wastewater Utility received a request from your Representative Games Engineering on August 10, 2015 in regards to an existing septic system encroaching into the Utility Easement along the north property line of KINCAID ACRES LT 4E. AWWU is currently not using this Utility Easement and has no objection to the encroachment. AWWU hereby issues this letter with stipulations to allow the encroachment of the existing septic system encroaching into the easement, property owner(s) agrees to the following: 1. AWWU will be held harmless, now and forever, for any damages or injury to any person as a result of the encroachment; 2. The property owner(s) shall call for utility locates before excavation in the easement; 3, All applicable codes and regulations will be observed and maintained within the easement; 4. This letter will in no way preclude AWWU from full use and enjoyment of its rights within any portion of the easement; 5. The property owners) shall pay any additional and/or extraordinary costs incurred to accommodate the encroachment during any future required construction or reconstruction of AWWU facilities; & AWWU's non -objection does not imply other approvals that may be required for this encroachment; and, 7. AWWU does not provide a position for any other parcel or utility impacted by the encroachment. Should you have any questions, please call the AWWU Planning Section at 564-2739. 7Sin e1y, aul Hatcher Engineering Technician Anchorage Water & Wastewater Utility[- Clearly 3000AmT1cBou)nwd • AwhomMAiaska 94503 Phone 907.564-2774 - Fax 907-562-0824 . iv w a'AIW4biz 0 ' � 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 PHONE .,::.:_�:-.. - EW - pp U- _ ❑ UPGRADE MAILING ADDRESS - - 13 oy, I I v t.-?` txc_6r•-ct - A I<- LEGAL DESCRIPTION - LOCATION NO. OF BEDROOMS 1 Well Absorption area Dweping PERMIT NO. 'R DISTANCE TO: AO + 8' rro tJ�l'tG�. Uy P Z w Q Manufacturer //�� - r'{{� JIOC'u+• � \ 0.n I� Material S+ela No. of compartments w ~ Liq. capacity in gallons len tcj__ Width Liquid depth i2S IFHOMENIADE: IF Well Dwelling _ PERMII) }�. DISTANCE TO: z Q Manufacturer Material Liquid capacity in gallons p WellFoundation t Nearest lot line , PERMIT NO. ? 3U 6 `•I �= DISTANCE TO: i1v ;n Via i,\ LU J E z No. of lines z Length of each line Total length lines Trench width _r Distance between lines i _ L3 .3 0 J 6G inchesUi ~ � F.. Top of the to finish grade Material beneath tile ?,_ inches Total effective absorption area ✓ 6,3 C O a S- .P "u Length Width - Depth PERMIT NVQ_ w--...—. -_absorption- Q F- Type of crib Crib diameter ,�__ Crib depth Total effective area - a-y w w Well Building foundation Nearest IojLine_- w DISTANCE TO: Clas Depth Driller Distance to lot line PERMIT NO. Lu " 0 C Building foundation Sewer line Septic tank �__. Absorption are. DISTANCE TO: OTHER PIPE MATERIALS Cetst- %ra. 5T p V SOI L TEST RATI NG ISvq`0� INSTALLER Mc Lin "o;x5+rvc*0) E r(5 REMARKS v ^eel d �✓� � u �� -� &AC- 3-ii"Ori,*� 2"-.J&Ock uu51p ,c e tt.' FT&T, P 1- APPROVED - DATE LEGAL `�'%3- K'KCcci`d At-(moo La'f -tl. ��s�i r N •—t'l✓ ,^ \. � M U W X 1:1 1: F" 1L...- J. DEPARTMENT OF HEALTH AND ENVIROMENTAL PROTECTION ' 825 L STREET, ANCHORAGE, AK 99501 264-472O \ 4:1 TV! W X -T- M oil M AM WAR Q W EFE U U., �117-�:! M 1 0- -PERMIT P E F,., 111 NO: 850097 DATE ISSUED: 04/11/85 APPLICANT: RAYMOND T SLAYMAKER ADDRESS: BOX 110787 �NCHORAGE; AK 95 � 91 1 CONTACT P111101NE: 345`2O32 LEGALDESCRIP: SUBDIVISION: KINCAID ACRES LOT: 4E BLOCK: NA SEC0I00 9 TOWNSHIP: 12N RANGE: 4W LOT SIZE: 39452 (SQ.FT. OR ACRES> LOT LOCATION: INGRAM OFF EVENSON MAX BEDROOMS: 4 Listed below are the options available to you in d�signing your septic system. Choose the oIDtion that best Was youY site. ... ..... ... �~FR MAKA ED 1- F. �~... ... . DEPTH TO PIPE BOTTOM (FT.) 4.0 6`0' 4.0 GRAVEL DEPTH (F -F. > 4.5 0.5 3.5 TOTAL DEPTH (FT,) GRAyEL WIDTH (FT,> 2,5 22,0 � GRAVEL LENGTH (FT,) 81"0 ** 41,O 89.0 ** GRAVEL Vi (CU.YDS.) 37.5 33.5 TANK SIZE (GALS) 1,250.0 ** 1�250.0 ** 1�250.0 ** SOIL RATING (SQ"FT./BR) l82 150 2O6 ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS �..... ..... ..... ..... ..... ..... ���������... ... ������`���������� I that: ` certi�y 1, I am familiar with the reguirements for o: -site sewers and wells as set f'orth by the Municipality b[ Anchorage (MOA) and ka^ 2. I will install the system in accordance Wth all MOA rodes and regulations; and in compliance with the design criteria of this permit, 3. I will adhere to all MOA and State of Alaska requJrements {or the set back distances {rom any well� wastewater disp�sal �xi�ting system nr public sewerage system on this or any ad�acent or nearby 1ot. 4. I understand that this permit is 4 bedrooms and any enlargement will reluire an additionalpermit. ' IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE O8TAil N (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPOR!"; )\ND <3) TjrE ELECTRICAL WORK MUST w Y A LICENSED ELECTRICIAN' < SIGNED DATE: J�_.__________.__�~� ~ -~���----�~~--- \APPLICANT: RAYMOND T �il AYMAKER \ W BY ����e.111-11.1 .... .,�.���������.�����~��.-.��.-�.....������..� ,...�..,..�..,c............'. ' \ ~. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & p��flib?�fE1�iPROTf7:Yft�1� '�� _=- • +�+ UL 1 1 IMPARTMENT MUNICIPALITY OF ANCHORAGE OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST - yy 825 L. Street, Anchorage, Alaska 99501 264.4720 Ss«y SAWD .U2aw6C-, DR,`i E C G' Y E D . SOILS LOG — PERCOLATION TEST o PERFORMED FOR: fY1e L7nl Q0NST2uer2&Fj DATE PERFORMED: LEGAL DESCRIPTION: Gdt LIE KzNCaIp Ac ZEA 7-4 {1.2 SLOPE SITE PLAN DEPTH OL OILGWIa, QVwCK, War L P D 11■■■■■■■■■ -Date -Gross Time Net. Time Depth to Water yy SM Ss«y SAWD .U2aw6C-, DR,`i 2 11IN l ENNEN 3 ?.1. t ' 4 ! SM S2LTY SAND, TAN, ATL% 5- 7 7 SP PWQ<y G/LADED SAt.1D' 8 TAN, V6 RN DILY 11■■■N■SI SluFrS F3ADt�{ 9 RATED /}T -, `e !S'OQZ%aR 10 t� L P D 11■■■■■■■■■ -Date -Gross Time Net. Time Depth to Water Net Drop - 11IN l ENNEN RENEE NONE 11■4MOR1■►®■■■ 11■■■N■SI ■■■ 110MENNs■■■ 1101FAMM®■■■■i 11r,■■■■■■■ 'N■■■■■■■■■ M-ClIZZ■■■■■ WAS GROUND WATERS NO 11 ENCOUNTERED? L P 12 - IF YES, AT WHAT E DEPTH? 13 --T Re -Date -Gross Time Net. Time Depth to Water Net Drop - J" 20 iL - PERCOLATION RATE - (minutes/inch) TEST RUN BETWEEN-- FT AND FT COMMENTS I n c L.Y 2r+ i Ea t+, r YO C1` 1'Sn I/7 PERFORMED BY: IZ GODDt l� (`n OR PS'O%N CERTIFIED BY. 7 _•- �i DATE: - MUNICIPALITY OF ANCHORAGE n DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION • -'�.; 2g� TEST ' 825 L. Street, Anchorage, Alaska 99501 MUNJGI�AQITY OF ANCHORAGE SOILS LOG — PERCOLATION TE§§PT• OF HEALTH & ENVIRONMENTAL PROTECTION �af�'iertATE �. ��� PERFORMED FOR:�'�CDATE % PEE M RFORED: 1-7 1P.3 no LEGAL DESCRIPTION: 4C RECEIVED -— SLOPE SITE PLAN L j465 op 1 I'1'd ov, ,Siw W%l\ rje�,i SCxt1C1S --- 1� 2 `Silt W�M 3)de�y�t,25(:.rtd5 4 on brown On,, 5i It 5�, 5ravel� 6 SP c►e..r; x.nd� � l I s I� 9 M 10 brownl�;;,e �rU�t,ed �ul(�v silt 11 —} WAS GROUND WA ENCOUNTERED? 12 CT �� IF YES, AT WHAT /!� DEPTH? 13 C/„ (�^ 14 C- 15 15 1s ND Q�ti3OF•A4;4 ai AW AV C • :s� b 17 ®'* 18- c eroy C. Reid, 19 ®� No. 2251-E 20 Qi0pl PERFORMED 72-008 (6/79) eading Date Gross Time Net Time Depth to Water Net Drop NaU / 7W /! c v •� . // i I 11'i� � �. .9� • N�0 j!7/fr3 Z !I� 25 ` iYi•i. 9 '+ 13/8 li:�� /oi�l;,�. .96 b9 )LATION RATE_ RUN BETWEEN CERTIFIED ' �= SFT ��'. �: - ,y..t•.1.t : DATE: I i r I _i MUNICIPALITY OF ANCHORAGE yE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG PERCOLATION TEST X SOI LS LOG PERCOLATION TEST - /%W/ sir I? -OP S/ PERFORMED FOR: Pkm �('O.t\ ker DATE PERFORMED: LEGAL DESCRIPTION: 11 F4 A' SLOPE SITE PLAN 1 IV 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMM GM fmVA \ome- CIruv �--\ �I;�hfYllt�i`j's WAS GROUND WATER S ENCOUNTERED? NO L O P IF YES, AT WHAT E DEPTH? I Y 1 h )/sty 1n tyro Reading Date Gross Time Net Time Depth to Water Net Drop 14147-0 IitiM J79 , 06 0 5 , 72- ' i, 4) 7 Pa,l9 106 t NZo ia: 3-3 / 0 r 7�— tot a /.t � a �� . o . 7OS PERCOLATION RATE /'1' �� e(% (minutes inch) 1 TEST RUN BETWEEN FT AND �� FT PERFORMED BY: 01mCa - CERTIFIED BY: 72-008 (6/79) DATE: L—tl�E— 9 -3 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 44 On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 011-121 -91 ': HAA # �A �\CISLqC j) 1. GENERAL INFORMATION Complete legal description Lot 4E; Kincaid Acres Location (site address or directions) 7921 Ingram Street Anchorage, AK Property owner Terry & Martha Graybeal Mailing address 7921 Ingram Anchorage, Lending agency Mailing address Agent Carol Douthit/Remax Properties AridrPss Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water Day phone 243-3738 AK 99502 Day phone Day phone 257-0116 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. 72-025 (Rev. 1/91) Front MOA #21 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 c9ppliance with all Municipal and State codes, ordinances, and regulatipns,WAff(LctDog�;hP�cl, inspection. Name of Firm 7320 E Address Engineer's signature ALASKA WATER & WASTEWATER CONSULTANTS INC IS TO BE PAID 1000.00 FOR SERVICES PERFORMED AT CLOSING. 6. DHHS SIGNATURE _t,-*� Approved for E' U IS bedrooms. Disapproved. Conditional approval for Additional Comments M Phone Date -) .:-7 OF. rA/. bedrooms, with the following stipulations: Date T— 11X ' 9 g_ 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 engineers work. 72-025 (Rev. 1/91) Back MOA #21 SEP 17 1998 +i Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICE&NiaPAUTY OF ANCH 1.��.i "'^'1NMFN' "i gPDVjr'F^ 1 L7 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L t y41 /1'7Gaid 4Cr-6 Parcel I.D.: A. WELL DATA Well type Pr/ U If A, B, or C, attach ADEC letter. ADEC water system number i1 �- Log present) Date completed -'1-30-- L5 I/ Total depth s 9 Cased to as 1 Casing height (above ground) Sanitary seal &)N) i Wires properly protected (Y N) Date of test FROM WELL LOG Z/- 36 — e�5 Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: AT INSPECTION 1 aIC9 Nitrate le Y'? Other bacteria J q / el - 91 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 4-2-345 5 Q. Tank size k2 ED D Number of Compartments C;L Cleanout6/N)__X_ Foundation cleanout(ON)/ Depression (Y/& l�� High water alarm (Y/N) Date of Pumping y-lq- %/� U Pumper Iq'�- C. ABSORPTION FIELD DATA / Date installed # "2'3 "8 Soil rating (g.p.d./ft2 or ft2/bdrm) System type ejua1-Arendv Length 360 Width �O©Gravel thickness below pipe j Total depth Ap -/`V Effective absorption area 0 Monitoring Tube presentON)-Y- Depression/over field (Y�V Date of adequacy test-« foo Results Pas /Fail) �i For - / bedrooms rPrc6 02 2-55Sig z ��v it Z Fluid depth in absorption field before tlf (VnGj t_l -9 Immediately afte�`�OO- al. water added (in.): 5> Fluid depth _ (ins) Minutes later: oi& N„H Absorption rate = (Odt� g•P•d• Peroxide treatment (past 12 months) (YO /Y If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons mp on" level at` `Datum "Pump off" level at` SEPARATION DISTANCES FROM WELL ON LOT TO: •_t i Septic/holding tank on lot /00 .�L On adjacent lots RX) f s , Absorption field on lot /DO '/-- On adjacent lots X00 '- Public sewer main Public sewer manhole/cleanout Sewer/septic service line off• - '4 - Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: " i I Foundation 13• � o Property line /6 f Absorption field Water main/service line A5 •a— Surface water/drainage /00 -'- Wells on adjacent lots r dU •!- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation :30 Water main/service line a Surface water Driveway, parking/vehicle storage area i Curtain drain 196117e 440&J17 Wells on adjacent lots R ENGINEER'S CERTIFICATION gib,®°®�®�� A 1 I certify that I h e e ine Jrls tions and review of Municipal reco a are in conforms e wit AHA fect on this date. Signature � ° °"`°° ° '° '°"" Engineer's Name effre A.Garn �® E•7953?00 Date `9/I Le�i3' .• 0 e° Fir v40, FOpROFESS10NP4 HAA Fee $ U � U Waiver Fee $ Date of Payment `l �� % / '� Date of Payment Receipt Number ��' _ l <� J �7 Receipt Number 72-026 (Rev. 3/96)* �r t-ra �-ter t MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES 9 �2 '1 DIVISION OF ENVIRONMENTAL SERVICES )AI f CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date� I� I9gq 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) tyr Location (address or directions) --/,92/ _J:�7grothrn Si. (b)Property Owner Pay" v Fraf)y" Telephone: Home 2 YS - /7/3 Business Mailing Address %92/ SRy—o r"—tit"'—� A"��"��9't A/T 9452 J (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent N-ert G e t( Fsfufc - P,-Av- TctrrocH Address 3 23a C`' S><. All 0 Telephone (e) Mail the HAA to the following address: or: Check here ®, if hold for pick up. List contact person and day phone number below. ec2 /-(more 2, TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well ® 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. SEWAGE DISPOSAL Onsite 1�1 Public ❑ Community ❑ Holding Tank ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev 81861 Front Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION t my As certified by my seal affixed hereto and as of the validation wastewatee shown bdisposal system is afe, functional and ion of this Authority Approval shows that the on-site water supply for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained on water supply and/or investigation and inspection, the from the Municipality of Anchorage files and from my 9 wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. 3 ys- l3 S-5 _ieaFfd Tulrn�car Ser'aYcy Telephone Name of Firm h 9Sl6 Address 1�1S3o Echo Sf• A'ncho✓' e JJ'- 9 Date 8/ / `/ / 89 .4'.41Wa VA �°�ao ` AV ••.•••..•.... ,,,,,,,,,,Epgineer's Seal ', THEODORE F. NN900RE ` �j .,, CE - 3539 0 a •''�• o 6. DHHS APPROVAL. /J _ _ 9 — / % — pu -_�`� bedrooms by Date Approved for �- Approved /��i Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (by an issuende Health Authority epgioval given certificates based only upon the representations g paragraph g Ph eer urchasers ons in registered in the State of Alaska. The DHHS does this as a co r tofpDHHS do Hoot homes condanct tlnspectiondsnor analyze data order to satisfy certain federal and state requirements. Employees s before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 11 ma rom, WAR) Rark Oar ,\5 JOS M t � A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) i CHECKLIST - FEBRUARY 1984 – 343-4744 Legal Description: Well Classification If A, B, C, D.E.C. Approved (Y/N) > 6 yPm m eaf &/9189 Well Lo Present (Y/N1 l—Date Completed `1130l e Yield 3 zq..^—� 9 Total Depth 2 29 Cased to 2 29 Depth of Grouting Static Water Level 1490' Casing Height Above Ground 2vrr Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: Pump Set At Sanitary Seal on Casing (Y/N) un k, Depression Around Wellhead (Y/N) N To Septic/Holding Tank on Lot ! so ; On Adjoining Lots 7 too' To Nearest Edge of Absorption Field on Lot 130 ; On Adjoining Lots (GO To Nearest Public Sewer Line (00' To Nearest Public Sewer Cleanout/Manhole rvG To Nearest Sewer Service Line on Lot 2S Water Sample Collected by rluf/br 7-echn/ca.i Se��«� ; Date B19 /89 Water Sample Test Results 5c ( fzlc�y 0 co%o(&irn 100A!e 0 87 en9l-e nrf�afe - N Comments S—�Caa;e;";r o� (oB9 gcrllov c./ mc�x�ump oufp«f �>r 6:o��g��n uureaQ u.,afer l-ead rn u,el/ /o drecwe�ac�,.> .h Igo' ,6 /82` dv� na Qur-her: B. SEPTIC/HOLDING TANK DATA Date Installed `//23/85 SizeI ZEE, a d No. of Compartments 2 Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped &irr X69 6r Stua� Pumping/Maintenance Contact on File (Y/N) Nr A. ; for N`A. nl• 4. Temporary Holding Tank Permit Y/N N'A' Holding Tank High -Water Alarm (Y/N) P Y 9 ( ) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well /is-' To Building Foundation To Property Line 36 To Disposal Field To Water Main/Service Line 2s To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 /31 5 � C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / 2.3 / Width of Field J ' ro (y ao(rm Type of System Design 7ien�h Length of Field S3 Depth of Field Gravel Bed Thickness 6 Square Feet of Absortion Area 15's6 StcVndpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test i9-de'9uccA- fc- r </ 6edr001nJ Y 619199 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 13,01 To Property Line 6 To Building Foundation 30' To Existing or Abandoned System on Lot NSA. ; On Adjoining Lots > 3a' To Water Main/Service Line 7 25" To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course > Coo' To Driveway, Parking Area, or Vehicle Storage Area 75 ' Comments'" No :5�ar.na( cc,a(neeote t orr clucuu rco) w p l30 -M 6ecckwe SYS /-eM IrrAffe-cr ernes Gt/I�/rriueoC �rrvr �o ne�u war%tcc.a�el o ral�anr C D. LIFT STATION fklA Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 0 A4 ©0 Company Te_cin/ca/ Date 7 wf J y� /989 ,>.................... h�jneer's Seal � MOA No 8%`oS2 0� ...... ......�.°....... °. THEODORE F. MOORE ff �� f•° •• CE - 3589 .'° `mom No. Receipt / C�S�� •,• B,SY�512�° �' � Receipt No. Date of Payment U �� (�/ Waiver Fee: $ Amount: $ l 216 o a Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 a MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Dates - (a) Legal Descr/iption (include lot, block3//subdivision, sectslpn, township, rrange) \ NC�� C��> 11I t_^,CCkkn� 1�1K�fC) i CIES Location (address or directions) (b) Applicants Name�uc_;M L�Telephone - Home,378�:Business ®T Applicants Address (c) Applicant is (check p -one) Lending Institution ; Owner/builder ; Buyer ; Other [-�� (explain); (d) Lending Institution ���aS �A /zU/L/ �u�� L � Telephone3_ 390 Address (e) Real Estate Co. & Agent E Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Number of Bedrooms 3. Water Supply - Individual Well 1 11 Community Other (describe) Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite � Public =1 Community F=1 Holding Tank I 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 21 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 regula- tions in effect on the date of this inspection. Name of ,Address Date /0 99593 i\ `tt (ENGINEER SEAL) �� 6. DHEP Approval Approved for;.bedrooms By Approved Disapproved Terms of.Conditional Approv CAUTION 4� ephone � AZ��4 >. 0 3 e. 9TH �° o• .oeo ° °°ap /U°� Robert D. Boush CE - 5333 e • yyy ZP �(yv�4°° e•oe•°°1���6�y /1 Date�� nd i ttfon al THE MUNICIPALITY OF,ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS".IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT 'CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA 1,,4U{14ICIPALiT( OF ANICHOF,Ae DEPT. OF HEALTH & erMRO I.*'A_ ;TAL RRCIFCT;ord E CINE Well Classification TAJ. If A, B. or C. D.E.C. proved(Y/N) Well Log Present (Y/N) y Date Completed 20 S Yield SGPInrt Total Depth ZZ � Cased to 2 Z Depth of Grouting /V o n/e Static Water Level /dQ Pump Set At ZZU Casing Height Above Ground /, s f Sanitary Seal on Casing (Y Electrical Wiring in Conduit (Y/N) Depression Around Fbllhead (YIN)/-/ Separation Distances from Well: To Septic/Holding Tank on Lot /,Sy On Adjoining Lots /30 To Nearest Edge of Absorption Field on Lot /6 G On Adjoining Lots To Nearest Public Sewer Line /V //�9- To Nearest Public Sewer Cleanout/Manhole A/ Z,47 To Nearest Sewer Service Line on Lot /VZZ� Water Sample Collected By 9,3 r,. ;Date Water Sample Test Results SG l ,' S �s c io v - Comments B. SEPTIC/HOLDING TANK DATA Date Installed 2 A 5 Size /2'5-0 No. of Compartments 7-(,j O Standpipes (Y/N) I/ Air -tight Caps (Y/N) I/ Foundation Cleanout (Y/N) Depression over Tank (Y/N) tl Date Last Pump/ed Ale t/ 6 v.5 /ern J Pumping/Maintenance Contract on File (Y/N) N for Holding Tank High -Water Alarm (Y/N)V// - Temporary Holding Tank Permit (Y/N) N Separation Distances frau Septic/Holding Tank: i To Water -Supply Well /SO To Building Foundation To Property Lire _��/ 2 / To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comnents /6/04h6 - [Page 6/04 6 -[Page 1 of J66"� 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / SD Type of System Design i'C'nic �S Date Installed 4 /3Z,3 Length of Field (233o) width of Field ! GU f Depth of Field Gravel Bed Thickness 2 i Square Feet of Absorption Area 3 6 Standpipes Present (Y/N) Depression over Field (Y/N) 11J Date of Last Adequacy Test 9L"J 5)_/ 5 � rrl •- „) ti Results of Last Adequar_y rlbst N e W s7 y57�¢ W. Separation Distance from Absorption Field: To Water -Supply Vbll / (06 To Property Line / (� To Building Foundation 2 /� To Existing or Abandoned System rri Lot )�J�f� On Adjoining I..ots To Water Main/Service Line {4 To Cutbank(if present) AJ To Stream/Pond/Lake/or Major Drainage Course /V To Driveway, Parking Area, or Vehicle Storage Area Conine nts D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On” Level at "Pump Off" Level at High Water Alarm Level at Vent E - /N -) -Tested for Pumping Cycles during Adequacy Test. Meets QUA Electrical Codes(Y/N) Comments ** Check Permitted Bedrocm Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA in effect on the date of this inspection. �- r °•a °.ops+3 aY�� Date F4ja� o Signed /O B5o Y *•:... I� Company —� MOA No. S%8S-o33 0 ` 406041R,o1R, n��Sl� 6AIGiN6ER4N� ( 7// P. 0. BOX 4-2964 oe6e° o KB1/d5/s ANCHO AGEt LASS 99509 Robert D. Bush I��••. OE a 5333 (Page 2 of 21 2-15-84