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HomeMy WebLinkAboutVICKERY LT 2Vickery Lot 2 #017-441-52 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Page A__of a. DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report 10 1 o Z 0 �J S r% 7 157 Permit Number: �1/ 1 PID Number: 9 Name:t tIt► Ptri s Wastewater System: ❑ New)(Upgrade Address: V jy iAv FF MAtm ABSORPTION FIELD Phone: a No. of Be rooms: Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: /y Total Depth from original grade: V GPD/Sq. Ft. V Lot: Block: ubdivisio� Depth to pipe bottom from original grade: Gravel depth beneath pipe me V ; Aaft Ft. Ft. Township: Range: �s Section: Fill added above original grade: Gravel length: 's I t43 tom/ Ft. V Ft. WELL: ❑ New ❑ Upgrade Gravel depth: 7 Number of lines: Distance between lines: Ft Ft Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. FL SO. FL F r-& Driller: Date Drilled: Static Water Level: Installer: Date insta ed: Ft. i Yield:- Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Yseptic O Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private ManuI turer:� AA Capacity in gallons: From Tank Field Station Tank Sewer lines .TAIMY, Well i7 �f%2� ., �Lk� .,�, ,_� -� Material: Siit_ Number of Co artments: Watere N/iN N N N/A N/14 LIFT STATION N Lot Line toff + i17() - N/-\ /-\ Size in gallons: Manufacturer: Foundation -.2-1� � N �- �Il� WA '.Pump on" level at: "Pump off" level at: High water alarm at: Curtain� wit, � I'` 1 N//4 Pump Make &Model Electrical Inspections performed by: Drain / . Remarks: BENCH MARK Location and Description: Assumed Elevation: 100 Ft. ,ENGIkEE�Frt,k'S SEAL '1 Inspections performed by: Dates: 1st 5 AshI 2nd A Department of Heal and H man Services approval b Q' � Date: �-�- ° Reviewed and approved by: 72-013 (1/91) MOA 25 Y Permit No. Ste/9l 01 dZ Page Z of Z. Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report 1 NT I/Jzb%j _._-. f319 NU132_ u'ZI1. 10 R .4 _ Yr'i.✓ 72-013 A (2/91) MOA 25 ENGINEER'S SEAL 14'L/� 4' PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910102 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:PERKINS JOSEPH L & LAURIE OWNER ADDRESS:6140 HUFFMAN RD ANCH. AK 99516-2439 PARCEL ID:01744152 LEGAL DESCRIPTION: VICKERY LT 2 LOT SIZE: 99589 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 DATE ISSUED: 5/16/91 EXPIRATION DATE: 5/16/92 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE: 9:_-:', 1-i F:11�. to i- el PJ 13 F" ., EE� 675lN.0lNUN0BLVD. ANCHORAGE, ALASKA YY502-JY04 (007) 248-5095 SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION 1.0 GENERAL Owner is Joseph Perkins, 6110 E"Mvffman Road 1.2 Engineer is Tobben Spurkland 6751 W Dimond Dlvd, Anchor- age, 99502-3904. Phone 248-5095. All inquiries and communi- cations shall be directed to the Engineer. The Engineer will act as an agent for the Owner. 1.3 Contractor is the person or entity hired by the Owner to install this project. The Contractor must be recognized by the Municipality of Anchorage, Department of Health and Human Services. 1.4 The Drawings, sheets 1 through 3, shall be part of this specification. 1.5 All materials and workmanship shall meet the require- ments of the Municipality of Anchorage, Department of Health and Human Services, the conditions of the permit, and all applicable rules and regulations currently in effect. 1.6 All excavation depths are advisory, and are to be verified and may be modified in the field by the Engineer. 1.7 It is the responsibility of the Owner or the Contractor to adhere to the approved design, to verify that the speci- [ied separation distances are met, and that the required inspections are performed. 1.8 The Contractor or the Owner shall report to the Engi- neer any observed condition which would put the septic system in violation of State or Municipal regulations. 2.0 SEPTIC TANK 2.1 The existing septic tank shall be pumped and abandoned by crushing. Remove standpipes connected to the existing trench. 2.2 A new septic tank shall be one fabricated by either Anchorage Tank and Welding or by Greer Tank The septic tank shall be a UPC -approved two-compartment tank, constructed of 12 gauge, or better, steel with bitu Specifications for septic system installation Lot 2 Vicery Subdivision pg.1 mastic coating. The tank shall be set level on undisturbed soil.The tank shall be covered with the equivalent of four feet of soil. Install all cleanouts shown on drawings, including foundation cleanout. 2.3 The septic tank shall be installed a minimum of five feet from the house foundation and a minimum of five feet from the absorption area. 2.4 The septic tank shall be a minimum of 100 feet from any well serving a single residence; 100 feet from any body of water, creeks or drainage ditches with flowing water; 150 feet from Class "C" wells, and 200 feet from Class A or Class B wells. 2.5 All pipe connections to the tank shall be mechanical watertight calder couplings. Cleanouts shall be installed as designated and capped with air -tight rain caps. Clean - outs shall extend a minimum of 12 inches above final ground elevation. 3.0 ABSORPTION FIELD 3.1 Gravel used in the absorption field shall be 0.5 to 2.5 inch screened and washed rock, with less than 3% passing the No. 20() sieve. 3.2 Sand, used for leveling or for filtering, shall have an effective grain size between No. 40 sieve and No. 18 sieve. Uniformity coefficient shall be less than 4. Not more than 5% by weight shall pass the No. 200 sieve. 3^3 4 -inch perforated pipe shall be ASTM F810. For pres- sure distribution, pipe shall be Schedule 40 PVC or ABS. 3.4 Solid 4 -inch pipe shall be Cast Iron or ASTM D3034, 3^5 Monitor standpipes shall be installed as shown. That section of the pipe penetrating the gravel shall be perfo- rated, either by drilling 0.5" holes on 6 -inch centers or by joining a section of F810 perforated pile to a solid section of pipe" 3^6 Geotextile shall be Mirafi 140. 4"0 INSTALLATION 4^1 Locate all underground utilities, property lines, future driveways, existing or proposed water wells, water ways, surface and sub surface drainage facilities, lakes, ponds, and all other facilities requiring separation dis- tances from the proposed septic system. Notify Owner or Engineer of any observed possible conflict. Specifications for septic system installation Kot 2 Vicery Subdivision pg. 2. 4"2 Stake alignment of system with markers showing the protective distances from wells and water bodies. 4.3 Establish an elevation benchmark. This BM shall be easily identifiable, stable and permanent. An arbitrary elevation of 100 can be assigned. 4.4 Install the tank as shown on the drawings. Record the inlet and outlet elevations of the tank. Tank shall be placed on undisturbed native soil. 4.5 Excavate the absorption field. Bottom of excavation shall be level and scarified. If sidewalls smears, they shall also be scarified. Record elevation of beginning, middle and end of trench. Record elevation of each corner and center point of bed. Construction equipment shall not operate an the floor of the excavation. Any material com- pacted by the operation of the construction equipment shall removed and replaced with uncompacted materials. 4.6 Place the rock to the depth specified. Do not contami- nate rock with native materials or spoils from the excava- tion. Level the rock surface (+- 1") before installing the perforated pipe. 4.7 Install the distribution pipe. Record the elevation of each joint. 4"8 Cover the distribution pipe with rock, and cover the excavation with geotextile before backfilling and placing insulation, if required. 4.9 Record the finished ground elevation at the beginning, middle and end of trench. 4.10 Furnish a copy of all survey notes to the Engineer. 5^0 INSPECTIONS 5.1 A minimum of three inspections are required. The first inspection will be of the open excavation. At this time the soil conditions will be observed and compared to the design assumptions. Ground water conditions or presence of bedrock will be verified. The second inspection will be after placement of gravel, standpipes, distribution piping, tank(s) and other compo- nents as specified. The third inspection will be after completion of the work. Any deficiencies will be noted and the Contractor notified. Such deficiencies shall be corrected within ten days. Specifications for septic system installation Lot 2 ;icery Subdivision pg.3 5^2 All electrical work requires either an MOA electrical inspection or certification by an licensed electrician. Submit proof of inspection or certification to the Engineer. 5.3 Submit catalog data of all mechanical equipment. 5.4 Notify Engineer at least 21 hours in advance of begin- ning any work" Specifications for septic system installation Lot 2 Vicery Subdivision pg^4 X, V VA CA N T LOT l til � WT C' iR1f- yy i . x %r r X77 OX roe 19 /,�-:j ,i �plalp da °aana • o +� .y d�FOf'norrss;o""'m :A hl+ 1,5) eoV ?R? 9719 :hl? _ -f[]f#EFhI aPIJ�KLr;fd7 F.E��R� �w�', �,7 r� r"�f.�'��'��} M ��p+p•�•� SFP1'CC a'YST'EM S@:sa;�� 6751 W, DIMOND BLVD A.I TYLAI P3V nays ,HA t' &? 1;+52 IANGR AK. —.,..._� G ��� w ' PE'ef4;i f1GE:i t P%l SF;Ai O P = 5P FT. f R AAW EUS UN LU C '4`I.1,,,h', C K.1 .3/D SEPTCC :WST'EH TiESI(N 6751 b DIMf]ND EL'vD, ;QUIN 24 TOV PIN na'TF_: A?1 N "l-DANCnH.. '3 SIIG—:3 04 W to �y�t:ify/Y SHUT, L'r:.3 fG1'i?- 296—.�T?"� .,t .e t .J LU C '4`I.1,,,h', C K.1 .3/D SEPTCC :WST'EH TiESI(N 6751 b DIMf]ND EL'vD, ;QUIN 24 TOV PIN na'TF_: A?1 N "l-DANCnH.. '3 SIIG—:3 04 W to �y�t:ify/Y SHUT, L'r:.3 fG1'i?- 296—.�T?"� l4a&, 7 r 7 7e z b SEVER T » A cava » &,gory@+ hi.e-.P rcw.« AArriA, Z Pgat ntw .5\./\KD@mE� £ 2.ex:x;ry I |Dr 6,= a =A# & G, m 9' esu d£r ! � v 2 r „ . 7 �f 'SMF * Baa T+H " 1 A !' (ENGINEER'S SEAL) a Municipality of Anchorage r DEPARTMENT OF HEALTH &HUMAN SERVICES 4— o, 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST I ( "• C- G PERFORMED FOR: iI{_ r.�N RA✓Wi DATE PERFORHMED�", U LEGAL DESCRIPTION: U34 X i/ t'L-er`/ Township, Range, Section: Sc, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS SLOPE I A WAS GROUND WATER ENCOUNTERED? ,may V S L IF YES, AT WHAT O DEPTH? P E Depth to Water Alter Monitoring? Date: SITE r� 611 PERCOLATION RATE JJL (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: I - -A I CERTIFY THAT THIS TEST WAS PERFOR IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ���� • . ori r� 611 PERCOLATION RATE JJL (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: I - -A I CERTIFY THAT THIS TEST WAS PERFOR IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 01 PERFORMED LEGAL DESCRIPTI 744 w z_ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST I/i G rte/ Township, Ran COMMENTS Net Time Depth to Water 2 a 3 - s�,Nuy 4- 6 6 v Q 7 8 9 a 10 &DT iv 04 Yr— "OL'I 11 12 13- 314151617 14- 15- 16- 17 18- 81920 19- 20- COMMENTS / SLOPE (ENGINEER'S SEAL) `V J DATE PERFORMED: Section: WAS GROUND WATER ENCOUNTERED? d s IF YES, AT WHAT L O DEPTH? p E Depth to Water Ager Monitoring? Dale: .44 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE 10 (minutes/inch) PERC HOLE DIAMETER 1/ 11 S ViI I TEST RUN BETWEEN FT AND FT PERFORMED BY: 7771&% CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Tobben Spurkland P.E. SEPTIC sy-97am Desir,N LOT A I vi cr= p y �os1Pl� �-erkiNS So, C ReIVAvco 4-edfoow ISO z 0.8 - 187.6 U SAC44jad -74AA4v. '13 t/qAI 0. a �cj / P I- NO 6 w or 1144r, La.eol, �4 lott LSM L)AA-7 , 4 ro CL, U For 5 6c.CP Yo," 4ovS 2 , 187.Sx� z. 1V o 7 ` � 71 14 0 Tobben Spurkland P.E. S;ys4e. T4& iSm l3l4► I.v-L a Vic..er-1 a 3 lo"F� i cv-\ci h$ VsE s4a-vioeou / AA44 7o ► eoe'G, = 7 i Caver _ 3 I �S4 N{w- Sep �- C- �j v` 1500 9d cru S Cr � '- 0 Tobben Spurkland P.E. s*-PL;c L -mi-. a 40S.evtl gy4{v'VA'-e.sis�l V%iC2ry �-er k, i NS �XISTtNG, sys�y„H I m tL t4o& Lal t c� 1.4 6) Ir CP u Haj w'a. L-�r sloi �0 ` ,� w a JA OL �tA,c.e�,f/ 10,090. a ot� LO -1- ,,,,r PkA40 A 04,t Y & awn. • I. towhAA 0 .A-�atA, SloPC " ,n,,,t p K t�E �n O�.o�• a,,�iu,i g �'o �g . • 19V.,4,�A 0- � �6� � � �rAA-+l A-5ra- k� �l Tom Fink, Mayor Municipality ®i Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Q "Ib DLAS"A' c'S 1)t b-16-90- MCLLbei LJ�n n `1ns�Ph C, i'FnIGcu3 wwoke , Olq1�1l0. January 10, 1991 Robert Vickery PO Box 230608 Anchorage, Alaska 99523 Subject: Lot 2 Vickery Subdivision Permit #900141, PID #017-441-52 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1990. A new permit must be obtained from this office for a well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as -built inspection report (three-part form) must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any quest Sin er ly, J n Smith/ E. ogram M nager n -site Services JW/1jm:200 enc: Copy of Permit ns, please call this office at 343-4744. "Kids Are Our Future" MoNICIP4L.IT4' O11 #�41CHpRAGF Department of Health & Human Services 325 L Street, Anchorage, Alaska 99501 343- 011~GITE 13EWER FERMIT Permit Numbers 900141 Upgrade )\\ Date lssued: 06/05/vo Engineer Designeds. Owner Nape: ROBERT VICKERY Day Phone: Owner Address: PO BOX 230603 ANCHORAGE, AK 99523 Parcel Xd: 017-441-52 Loi Legal: Subdivision: VICKERY Lot: 2 Block: - Section: 26 Township: 12N Range: 3W Lot Size 90589 (sq.[t, or acres) Max Bedrooms: This Permit: 5 Total Capacity: 5 SEPTIC TANK: Minimum total septic tank capacity: 1,500 gallons. Each septic Lank must have at least 2 compartments, Depth to top of septic tank(s) ( 4,0 feet requires insulation over tank(s). INSTALL PER ENGINEERS ATTACHED DESIGN. NOTIFY DHHS PRIOR Tn EACH INSTIECTTON, EXISTING SLOPE 713 BE CONTOURED TO REMOVE DR4TNA(�� SWALE THROUU3H BEI) AREA. LIFT STATION WILL REQUIRE NECESSARY PERMIT AND INSPECTION BY PUBLIC WORKS. T;IS PERMIT IS lSSUL.D FDR !HE EXISTING SINGLE FAMILY DWELLING ONLY AND 101,11011 DN 12/31/90. l C�RTlFY TH/�T: 1, l a= 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: S. I will adhere to all MOA and State of Alaska requirements for dislances from any existing well, wastewater disposal system sewerage systpm on this or any adjacent or nearby lot' the set back or public 4. l understand at thi mit is valid for a maximum of 5 bedrooms, l also underd that efapacity of the total system is 5 bedrooms and unv Signed: (Owner> Issued By,, DATE: -����7--��----- DATE: tAunicipality. of Anchorage DEPARTh4ENT OF HEALTH & HUMAN SERV, 825'L- Street Anchorage. Alaska 99502-06 SOILS LOG — PERCOLATION TE/j PERFORMED FOR: 1 y LEGAL DESCRIPTIO N: [_()-r Township, SLRange, OPE COMMENTS % 1 I WAS GROUND WATER ENCOUNTERED? �S S IF YES, AT WHAT I OrJ DEPTH? Sin p 1 P E Bepth m w&r trier- 0l a I O kanilrainp? OL ���il-!C•t-i�1��� I ` 1"I 2 .9. v / LISAm. 3- r .� 4- 4SG7 s- 6- 7- A` v SEE p -7' Sa- s`M 8 Sand i/4 - Some 5i14- 10- 1011 11 12 o m 13- 3 14- 14 ICU ICU n is- 51617182 16- 17- 18 - 20 COMMENTS % 1 I WAS GROUND WATER ENCOUNTERED? �S S IF YES, AT WHAT I OrJ DEPTH? Sin p 1 P E Bepth m w&r trier- 0l a I O kanilrainp? PERCOLATION RATE 14 (ti+-tA��2l PERC HOLE DIAMETER TEST RUN BETWEEN a FT AND v FT, ? ^ ( � Ic:PERFORMED BY: S I CERTIFY TKATT THIS T WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 72-008 (Rev. 4651 ���il-!C•t-i�1��� .9. v / LISAm. ► '.. a r .� PERCOLATION RATE 14 (ti+-tA��2l PERC HOLE DIAMETER TEST RUN BETWEEN a FT AND v FT, ? ^ ( � Ic:PERFORMED BY: S I CERTIFY TKATT THIS T WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 72-008 (Rev. 4651 p_0A D 5r�PrrL sys� 0 PROPOSED SYSTEM BED CONSTRUCT BED 24'x58' INSULATE,BED IF FILL COVER IS LESS THAN 3 feet. INSTALL 1500 GAL ANCHORAGE SEPTIC TANK WITH LIFTSTATION. ABANDONE EXIST. SYSTEM INSTALL CLEANOUTS AS NOTED ON DRAWING. ALL CONSTRUCTION TO MEET M.O.A. SPECS 3' FeoN 3' FILL rkuK 3, 3 6 16 061 SED I 'off 1 M 1 J4 0 0 0— o 4"Peer Mou/roe PI Pc P/ve SEr✓Er exK NOTE: All Dimensions And Locations Must Be Field Verified Prior To Construction SEWER SYSTEM 'LOCATION PLAN LO, SECTIONa rrt SCALE, PP f_ DRAWN I NORTH J k ,Ml NOTE, The Accuracy OC Location of Esisiting And Proposed Peoperty Corners, wells, and Septic systms Indicated 1. Net Exact. Dimensions Indicated Nave Been Determined By Use OC Cloth Tape a,d/OC Muni.Cl"l Reeords, AM Not By Y Surveying Techniques ,. PREPARED FOR, DATE, SjZ9 I9() I SHEET k OF ' t,, pea Pose e &er %4'x i x`75" FXlSr. 5557E/f --__, FXlsr. _ a O —LI Q Q ��o co O 1�IF1L t�\ UL \)iOPoSED ,.LST%c. TAiaZ S7"A7 rokL i oL EQUN. �G 5r�PrrL sys� 0 PROPOSED SYSTEM BED CONSTRUCT BED 24'x58' INSULATE,BED IF FILL COVER IS LESS THAN 3 feet. INSTALL 1500 GAL ANCHORAGE SEPTIC TANK WITH LIFTSTATION. ABANDONE EXIST. SYSTEM INSTALL CLEANOUTS AS NOTED ON DRAWING. ALL CONSTRUCTION TO MEET M.O.A. SPECS 3' FeoN 3' FILL rkuK 3, 3 6 16 061 SED I 'off 1 M 1 J4 0 0 0— o 4"Peer Mou/roe PI Pc P/ve SEr✓Er exK NOTE: All Dimensions And Locations Must Be Field Verified Prior To Construction SEWER SYSTEM 'LOCATION PLAN LO, SECTIONa rrt SCALE, PP f_ DRAWN I NORTH J k ,Ml NOTE, The Accuracy OC Location of Esisiting And Proposed Peoperty Corners, wells, and Septic systms Indicated 1. Net Exact. Dimensions Indicated Nave Been Determined By Use OC Cloth Tape a,d/OC Muni.Cl"l Reeords, AM Not By Y Surveying Techniques ,. PREPARED FOR, DATE, SjZ9 I9() I SHEET k OF ' IT a Municipality of Anchorage 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL I December 31, 1980 (�0 Vic Vickery Post office Box 10-1067 Anchorage, Alaska 99511 3 �� 5)� Permit # 800380 Subject: T12N R3W Section 26 Nz NE i NW4 NW4 A permit issued by this department for well and/or sewer system has expired as of this date. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, '4Q /7), 1�" Les N. Buchholz, R.S. "SeB pr.) nvironmental cialist L /ljw enc: Cop f Permit SWP/057 r°'11_I r-4 I9-- I r-"1. I IF ' -e CA F FI t4 ClVA CA Fs Fl C E: DEPARTMENT'_`O HEALTH AND ENVIRONMENTnU''POTECTiON S25 `w STREET: ANCHORAGE, AK. 9 O01 64-4720 PERMIT NO. r.; 800:80 APPLICANT VIC VICKERY PO BOX 10-1067 LOCATION HUFFt9Apa LEGAL T12NR {WS2E�N1;�'2OF NEi/2 f1&3 �Ll (lL� �Ll UST SIZE 225000 SQUARE FEET TYPE OF SGML ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL AB'=ORPTION SYSTEM IS: Ew E F'''F F-1= ;1-20 Ce E= F} T E-1= THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DI?TANi_E BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE E^;C:AVATION CIN FEET). FZE_CAL_1 I F'_E=E• _ E:F=°IF I ED T F1101 I vE:= AvcEl 4 %HLLCAr• ""=. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- IF 44 CA r, on I PA no F° E: c_ "F I C A PA =° FI FT E: Fes: E: CA L_1 I Fes_ E: E> --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPO=AL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F° E= FZ r°1 I IF E= >4 F" I F= E: °"° E> E= CT E: t"1 E. E F' . x nL r JL <1;= ED I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS .ET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: ---------------------------------------- APPLICANT 'v IC VICKERY ISSUED B'i------------------------------ �€t£`ii•� ri�ga��yi,,_.1`!� r'II•�}'�i'!'�tf�3r":tflTrf�,��`T�CTi{{fi x0041 i� k _.tea"-`: c.. ` - b • ��p'���i-vrE�— �+i 6i'�p. -} �+-�f..y a -mss^- a '' �» - S-`��5�.. ; F'•S�e'� r�r_•��_e� .6 4 s� �:,��..i A•.PeG T'i C— �.`a 9"�.[`L L E 4' ' °p�MIT tt "f0_ 1 J l "iSi i d 2 S d Ule IeCr"HTI1XI c 3�e c, (3 � m tom. a tl OF '.^,O,N 855ORPffON SYSTEM 15: - - y (¢yam FTe THE REAVIRED SIZE OF THE SOK PaSORPrION S%Teif TW- LENGTH;DV'106. 10?4 IS THE i EnUTH 0N =0 OF THE TKNC0,24 )fz€4LPkr` INC GERTH OF R TREWH t7R PIT IS THE DISTA'+K O iWEEN THE ai,p'fls or THE 'CROUND FWD' TTOM OF Tt-1E EXCftrrlTTON M4 FEET). TFiepsE is Ney wa WIDTH FOR Tii.._N90HE5: THE GR UEL DFIC'TH is Tt< P3CtiMV DEPTH fly QR€VEQ P rWEEt THE QuTRflLL PIPE FW* INC OOTTON Vr not EXCRYATION CITE # T } F" rfIN ICANT HR5 tHC RESPONSIAIL£.TY TO IY'iyORM THIS .0APPRTMENT DURING INC &STSWVArI`U tWSPECrIaNS OP ANY WELLS POJOCENI PQ rMIS PROPERTY Rt -g-' THE ikutRER QFtt i rX E TH14T THE WELL 14ILL 5C9iF. i Or r ts� 5 Y a�I'� ' € € €�)ECAP4S5 F A .�KFQL[s"wJ v- AI'�'JSVSTE4 WITHOUT pfNAQ tuspECTION AND AFPRIiv'M Qin THIS iIrrirt�ti0+.`;Tij4e`ri'1CCI!`I� tf� WCLC,,i�sNi� ANY f_IM"'9T)C `u'i'�.�'IO3G..OSSdd�._.�+��i�i.,3... .-. FEET FOR 0 PRIStU WELL Ok Q0 TO Zel FEET rPOM A FlwLIC 0104 00.0 t` .0 V 15Tf NC8 FROM I1 U N & wELI„ it) i� FRc i VA TF _ 9,11E ' LINE IS :Z15 Feer AM, TO q COMMUNITY SEWER LINE INE 15 ?5 KV& Wk -1-t- VOK ARC pcw I pr.o p?Pfd 2'ipe r sE RerURNED TO THE cw-- PARTPtaw7 T WITHIN �O 08,e3 Cr IFS �! -,t: (-jXv Lr- T i rift 100' 001-0 500frfoAi`mus AND CONSTRUCTION OTHARRMS ARE :To INSLr p#?t;r .CR tt�alt=�_t ATtt�sf I CERTIFY THRT 1: I fit# FHKILI€4R WITH THE rok Oki- 1-r :=.EJ•ick; ANO WELLS te:. _;ET = t WILL INNTFLL• TN- SYSTEd4 IN WXCIPOA£10C WITH XE COOK, s: £ 'tstlDK'.€AND THRT THE ON--3rrp- ► { SYSTF-m lla-IV 1z9-1-.1UIR IF TrNQ V�E'-;IDEItCAG 15 REMOOELCD TO lumum mom THRu 3 emotax3 P.Pi�L. FCART. � S 4040 " B" STREET ANCHORAGE, ALASKA 99503 A T `TSD (907) 278-1551 July 31, 1980 W.O. #A19391 Grid 2838 QUADRANT CONSTRUCTION P. O. Box 10-1067 Anchorage, Alaska 99510 Attention: Mr. Ray Farmer Subject: Percolation Test Results, N2 of NEI -2 of NW4 of NW4 Section 26, T12N, R3W, SM Gentlemen: At your request -we performed a percolation test at the property referenced above. A 16 -foot deep test hole was drilled at the location shown on Figure 1. The test hole was drilled with a Mobile B-50 drill rig mounted on a Nodwell carrier. The drill is owned and operated by Denali Drilling, Inc. The test hole was logged by Oz Hatch, Alaska Testlab engineering geologist. After the test hole was drilled, a perforated PVC pipe was placed in the hole to prevent caving and the test hole was filled with water and allowed to saturate overnight. The following day the hole and pipe was refilled with water and the percolation, or absorption, of the water was observed for a 60 -minute period. The percolation rate reported is the lowest rate per ten-minute time increment. The test hole log is shown on Figure 2. Soils encountered con- sisted of 5 feet of soft brown silt overlying 7 feet of brown sand with some silt and trace of gravel. At 12 feet depth a brown gravelly sand silt was observed. No ground water was encountered in this test hole. Another test hole on a lower part of the property in a depression encountered water at 8.5 feet however. Therefore, place the septic system backfield as close to the test boring as possible. The measured percolation, rate was 3 minutes per inch with the water level at 7.5 feet depth. Soils above 5 feet can be con- sidered impermeable. For the sand layer from 50 to 12 -foot depth the required absorption area is 100 square feet per bed- room. For the gravelly sandy silt below 12 feet the absorp- tion area requirement is 250 square feet per bedroom. These rates are based on criteria given in the Manual of Septic -Tank Practice, U. S. Department of Health, Education, and Welfare, Public Service Publication 256. Mr..Jerry Farr. Quadra Construction July 31, 1980 Page 2 It is suggested that these recommendations be reviewed when the drain field system has been excavated. In this area, soil and groundwater conditions vary significantly within short dis- tances. If you have any questions, please contact us. JRF:mb2U Attachments Sincerely yours, ALASKA TESTLAB 41V' James R. Finley, Jr., P. E. Geotechnical Engineer A4L Melvin R. Nlchols No. 4113•E , w w w 5 F�t7 Brown Sand W/ Some Si4 f {race Gravel, molsf, medium dense FN ♦?Town Grnve lly Sandy Sill, non-p/asfic dense, rnoisl .Test Bnn nil Complbled 7-28 b��vo�`��l d wafer enro.niered, Percolaf,bn rale PP = .�......._._---- KEY Melvin R. Nichols : W UNCONFINED COMPRESSIVE STRENGTH (PENETROMETER)", J TV= ' W. 0. NO. "419'391 t S •. No. 4113-E e, p ,4. ¢ � r F+ LL LOGGED BY O. Na Lh BORING 1 Wa ' N= PkOpESs1��®�;1 z oa 0 U ❑ - m 4 0 ELEVATION = DEPTH O ®- SPT SAMPLE 2.5° I. D. SPOON SAMPLE T 34088 WEIGHT, 30" FALL ALAS!e,I l SSTLAB - SHELBY TUBE - PUSHED - GROUND WATER TABLE F4, Brown 5jLL w1 same $and t ♦race Gravel WHILE DRILLING LOG OF BORING FIGURE �. moisf, non-P/asf;c, sorl- w w w 5 F�t7 Brown Sand W/ Some Si4 f {race Gravel, molsf, medium dense FN ♦?Town Grnve lly Sandy Sill, non-p/asfic dense, rnoisl .Test Bnn nil Complbled 7-28 b��vo�`��l d wafer enro.niered, Percolaf,bn rale PP = .�......._._---- KEY Melvin R. Nichols : W UNCONFINED COMPRESSIVE STRENGTH (PENETROMETER)", J TV= SHEAR STRENGTH (TORVANE) (TSF) t S •. No. 4113-E e, p ,4. MA= MECHANICAL ANALYSIS .° Q.a ���, LL= LIQUID LIMIT (%) PkOpESs1��®�;1 PI = PLASTIC INDEX ``\`®���' ❑ - GRAB SAMPLE ®- SPT SAMPLE 2.5° I. D. SPOON SAMPLE T 34088 WEIGHT, 30" FALL ALAS!e,I l SSTLAB - SHELBY TUBE - PUSHED - GROUND WATER TABLE ' WHILE DRILLING LOG OF BORING FIGURE �. /7. eocoi ---- �_ • vIY ivL.37 -�— HrDnr � I H.�nr i Ito � I TF57 i I �n7 / _�• j r V I -c. 00 I LW I ip j (D I � I JAW co O• • �• .e . e aiward•...d I �. / 5 Util. Es. Hook 175 Pg. 213 S......i .a. sa>ta..•.•c d Melvin R. eholi .4. No. .411 •E o' -- 4�p90FES ---- ---_ �831.0 i _----- Power Poleb�•''f_ .. He Dur \ \\ ` I I `N�. E.nchnQ hlon�ment \10 Ulil Esmt.� \\ Book 175 i q 107 7 JT I }OLE•• L OC,4 TIOIy S>;'� 1 Gly F,�(If e_ I WAT2R WELL LOG �) FOSS DRILLING ASSOCIATED 909 CHUGACH DR. #37 ANCHORAGE, ALASKA 99503 WELL OWNER R.V. Vickery USE OF WELL Domestic WELL LOCATION Sec. 26 T12N R3W SIZE OF CASING 61° DEPTH OF HOLE 125 FT. CASED TO 116 FT. STATIC WATER LEVEL 115 FT. G. P. M. 8 WITH 5 FT. OF DRAWDOWN. REMARKS DATE COMPLETED 9/17/80 PUMP TO BE SET AT 125' 0 to 5 Organic: brown color and soft 5 to 80 Alluvium: grey color, medium hardness 80 to 102 Till: grey and hard 10_2_to112 Alluvium: grey and medium hardness 112 to 115 Till: grey and hard tato 121 121 to 122 122 tom —to- -to- -to- -to- -to- -to- -to- -to- -to- -to- -to— Bedrock: ototototot0t0to_to,toto Bedrock: light grey color, very hard Bedrock: grey, medium hardness, with water Bedrock: light grey color, very hard MUNICIPALITY OF ANc nv — no H'_ALV Q' t4OV 2 5 RECEIV LO Sieven R. Pannone, P.E. Consulting Engineer SEPTIC SYSTEM ADEQUACY TEST Legal: Lot 2 Vickery S/D Owner: Mr John Egenolf Residence: 6941 E. Huffman Ave, Anchorage AK 99516 P.O. Box 102954 Anchorage, Alaska 99510 (907)272-8218 Septic System: Tank Size: 1500 gallons. Absorption System Type: Deep Trench (from Municipal records) Absorption System Size: 76x3x7 Absorption Area: 1064 s.f. Installation Date: 5/29/91 Soil Rating: 188 sf/br Date of Pumping: 7/20/98 By: Isaacs Pumping Date of Test: 4-26-99 Test Procedure: System was inspected visually and measured. Tank was found with 4 feet of cover. Liquid depth was measured to be 59 inches. The drain field was found to have 36" of cover and a total depth of 120". There was 31 inches of liquid measured in the field's monitor tube. Water was at a rate of 3.0 gallons per minute (GPM) to the fields clean-out. Water levels in the tank and drain -field monitor tubes were monitored. A total of 750 gallons of water was added. During the test, the liquid level rose 3 inches in the drain field. There was no rise in the septic tank. The infiltration rate was monitored for 24 hours. During this period, a total of 750 gallons were absorbed. By the observations made, this system has an absorption rate 750 gallons per day at the time of the test. The well was tested at the same time as the septic system. The well had a static water level of 1 ] 9 feet below the top of the casing. It was drawn down to 125 feet below the top of the casing while it was producing water at a rate of 3.0 gallons per minute. The casing stuck-up 30 inches above the ground. PLEASE NOTE, this well draws its water from a bedrock aquifer. There is no gaurentee that this well will continue to produce water at this rate. Shifts in the bedrock formation can increase or decrease the wells flow rate without notice or warning. Water was tested for bacteria and Nitrates. Test results are not available at the time of this writing, and will be forwarded once they are available. TESTS RESULTS: This system meets the code and operational requirements of the Municipality of Anchorage. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee thakhere are no hidden defects or encroachments. We can therefore not give any estimate of how long the systei 'o meet the operational requirements of the Municipality and State. •" �+ �sqf Steven R. Pannone �'R.x oiolLx:� ANY -04-99 03:25 FROAKTE ENVIRONMENTAL 5615301 T-471 P. 03/03 F-354 ME Environmental Services Inc. f aborstory Pivittion Drinking Water Analysis Report for Total Coliform Bacteria A0 ` READ INSTRUCTIONS ON REV6XSESID.E SEFORE COLLECTING SAMPLE Fax NtUST BE COMPLETED BY W -4 -TER SUPPLIi=R TO BE COMPLETI W potter Pore harage, AK 99 51 8-1 60 5 Analysi$ shows this Water SAMPLE to be PUBLIC WATER SYSTEM 0. d SatiSFactory `d PRIVATE WATER SYSTEM p S.ed Resgln 0 Send Invorce G'� VfGL�2-Y 'x arKt �Y.xlm ar aiµn s u r Numb., ro � SrndAesutu ffi Sendlavotce tomp�.ry Pxme '� M ,�„ , to '_• �r a SAMPLE DATE' 0 7 Muneh SAMPLE TYPE: 0 Routine 0 Repeat Sample (for routine sample with tab ref, no. _ ) dE' Special Purpose MAA SAMPLE `LOCATION WG kkS¢ Cornmcros' 4 9' Day Year 0 U'nsausfactory p Sample over 30 hours old, results may be unreliable p Sample too long in transit Sample should not be over 48 hours old ut exammatlon to indicate reliable results. Please send new sample vie special .11v mail. Raw Received ring Received ��++ �il30 -- Analysis Began Aualylical Method: Mcmbmne Filter 46 MMO-MUO !..Numbecaf cplonte•rl nn ml. soft' Auslyst t1 Treated Water -.--.-.-. .._... Fbite Jan Feard 0 Untreated Water Aare T.me. Client uotified-pf unsatisfactory rasults: Time Collected Callealed By Phoned Spa" with Faxr4 Timc pwx hml Pate _ BACTERIOLMCAL WATER ANALYSIS RECORD MMO•MUG Resu6: Total Coliform E. Cell Membrane Filter: Direct Count Colonies/100 ml Verification: LTB SGS - COLIFIItM Fecal Cahrorm Confirmation Finai Membrane Filter Results r CofifortnllDO ml Rtporeed Oy tel`—`—' Date '4(Vi14I Time I ir!2 _ - hrs rnre • ma N.M..., T� I.." pa-rJm,raurrerm V= ell _ Member otthg SGS Group(Sgcieta GARbrale ge Survailianca( ^_ ENVIRONMENTAL. FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, WA06. MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY, OHIO, AST VIRGINIA VAY-04-80 08:25 FROM -CTE ENVIRONMENTAL ME Environmental Services Inc. CT&E ReF.N 991710001 Client Name Pannone Eng Srv. Project Namcf# L2 Vickery Hack Hose Client Sample W L2 Vickery Hack Hose Matflx Drinking Water ordered By PWSIU 0 5615301 T-471 P.02/03 F-364 Client PUN Printed Ante/Time 05/03/99 15:42 Collected Pate/Time 04/26/99 20:00 Received DateM= 04/27/99 11:30 Technical Director: Stephen C. Ede Released By Allowanle Prep Analysis Paremeter ReAUTS PGL units hernod Limits DATe Date IIit Ni trate•a 9.57 0.500 mg/L EPA 300.0 10 max 04/27/99 04/27/99 SCL Total Celifarpi 0 co11100mL SM16 92226 04127/99 KAP LOCATION: N.0[118N0BUD. ANC;UXUH.ALASKA Y?502'JYV4 (90-1) 248-50975 RESIDENTIAL WELL INSPECTION Lot 2, Vickery S/D �140 Hu|fman Coad OWNER: Joseph and Laurie kins TYPE OF WELL- Private, Single Family WELL LOG AVAILABLE: Yes INSTALLATION REQUIREMENTS MET:Yes WELL YIELD FROM WELL LOG: 8 Gallons per Minute PUMP YIELD FROM TEST: DATE OF INSPECTION: 5 Gallons per Minute May ',4, 1991 TEST PROCEDURE: Well was pumped at a constant rate until the pressure dropped in the pressure tank. The acoustic probe could not read the water level. Initially the water level was found at 120 feet, but at 123 feet the probe quit. 350 gallons were pumped before the pressure started to drop. Tke pumping was the stopped for 90 minutes before continuing. This time 210 gallons were delivered !:.jefore the pressure dropped sgain, This indicates that the recharge is at least 2.3 gallons per minute. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E Coli and total nitroclen on May 29, 1991 E.Coli 0. Total Nitrogen S.8 mg/l, Max. allowable Total Nitrogen 10 mg/l" TEST RESULTS: This well meets the requirements of the Municipality of Anchora9e The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. Tho assessment of the condition of the well applies only Lo the conditions as of the day tested. The flnw rate may change due to subsurface condiLions tha� may not. be observed from the surface, and changes in the land use and other factors thilt may iffipacL the aquifer feeding thc well. \\ Watkins Engineering, Inc P.0 Box 110443, Anchorage, AK 99511 (907)349-1851 cwellis@gci.net May 9, 2008 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Vickery Lot 2 Letters of Non -Objection Well in Easement To Whom It May Concern: During a recent asbuilt surrey, it was noted that the private well serving the subject lot is located within a 10 ft Telecommunications and Electric easement. Letters of non- objection were obtained from GCI, ACS, and Chugach Electric to allow this encroachment. The previous survey did not show the well in the easement. Copies of the letters and the new survey are attached. The MOA Right of Way Dept. informed me that they do not have jurisdiction over a T&E easement. If you have any questions, please call me at 349-1851. Thank you. Sincerely, CindyW. Ilis, P.E. President Co 0 eq W 6 0 0 O Y, HUFFMAN ROAD 3' SECTION LINE RESERVATION N 89055'05'W 329.71' — ------------------ ------------- —1---------------------------10—TELE_! I — I DETAIL, SCALE = 1 in = 4 ft I Lu - 8.25 ft w Iz I J ENCROACHMENT 0.5ftx0.5ft 1w I w IN I 1 0 a �Lu r j WELL rL I LL 152.6 ft to south I o I I I 5 property line I I WELL ENCROACHMENT I /INTO EASEMENT SEE DETAIL ct191/ WELL 8.5 ft from center of DECK well to west property line 152.9 ft from center of I well to south property line I Well is 32 inches above ground, ' a 1 125 ft deep, and was drilled in 1980. of II 41 rm- I Fnl ml �I ml P1 m I Based upon a survey by Shane Holt, 3 I Registered Land Surveyor, i I . I I LS -6914; November 29, 2007 I --4 --------------------------------- I 10' UTILITY EASEMENT Vickery Lot 2 Well Encroachment into Easement Jim Pogers Parcel ID: 017-441-52 Grid: SIN 2838 Cindy W. His, P.E. March 3, 2008 Scale 1 inch = 40 ft 89 50'37" E 329.87 Watkins Engineering, Inc. 4 pY pgPlip{.T ASPHALT ORWIIIJAy -------------- OFA (°% o ke4.........A..q�%4 y�? 49!Hw U : CIN W. ELLIS P.O. Box 110443 Opo; 10677 Anchorage, Alaska 99511-0443 pp➢ - Phone: (907) 349-1851, Fax: (907) 349-1934 ------- WFEMAN-ACIAD OPC --- T SECTION LINE RESERVATION FND. NO. 6 ------ 10'TELEBEIEC. ESMT.------------ — -----_ I II I II I SII I �I I IV I III I III 0 low,, 4m�" I II II II II II I FOUND 2112" BRASS CAP(DISTURSED). SET OPC ON NO.6 REBAR A.` 49 TH A "' .............—.............. S.,C, 11,411 -- SHANE A. HOLT m LS -6914 Rm O Yllw a. ...... r90 AS -BUILT SURVEY NO CORNERS SET THIS DATE SCALE: 1" = 60' THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADOMONAL STRUCTURES OR FENCEUNES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. NOTE: ANY FENCEUNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 2, VICI(ERY SUB. DATED ATANCHORAGE, ALASKA THIS 29TH DAVOF NOVEMBER 209]. — HOLT LAND SURVEYING 10829, FB 13"1 TEL. 3455513 I I I CENTER OF WELL CASING I IS 8.5' FROM PROP. LINE ° n I WELL �W I io Ng / � rrI I� ml �^I 1- �Il y ml �I I ----------------- 70'UTILITY EASEMENT FND. NO.6 589.52 VE 329.87 NEBAR S 89 50' 3T' E 329.87 ! I 0 low,, 4m�" I II II II II II I FOUND 2112" BRASS CAP(DISTURSED). SET OPC ON NO.6 REBAR A.` 49 TH A "' .............—.............. S.,C, 11,411 -- SHANE A. HOLT m LS -6914 Rm O Yllw a. ...... r90 AS -BUILT SURVEY NO CORNERS SET THIS DATE SCALE: 1" = 60' THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADOMONAL STRUCTURES OR FENCEUNES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. NOTE: ANY FENCEUNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 2, VICI(ERY SUB. DATED ATANCHORAGE, ALASKA THIS 29TH DAVOF NOVEMBER 209]. — HOLT LAND SURVEYING 10829, FB 13"1 TEL. 3455513 3' SECTION LINE RESERVATION SET OPc ON NO.5 REaAR _Z N B9°55'❑5°W 329.711 ( REC. AND FNO. NO. 5 —----------_--------------------------------T---p—_�-----�I IO TELEfiEL--------------------------— E9MY. — - ----- — �-- — — — — — — — — — — — — — - — — — — — — — — — — — — — — — — — — — — O �I I ISI I Is I yIN I Atli I b�lO I Iml� CENTER OF WELL CASING s IIN IS C.5 FROM PROP. LINE 4y I 3 I / DEGK � ° I �............................................99.0............... .... /I I � III ----------------------- � ASP ITI RIVEWAY I 1 O' UTILITY EASEMENT I— ( F FNB. No. s S B9°52'21 "E 329.87' ( MEAS. REaAR S 89 50' 37° E 329.67 ( REC.) oOF q 40 1 o0 ps SHANE A. HOLT: �I 04 PR LS -6914 JPG 4�pa............. 0 RO�ss sloNA� p ��OODo�oo THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES, EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON, NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. ❑ J w Z Q r u FOUND 2 1/2' 9RA55 CAP(CI.TLG.E.I. SET OPG ON NO.S RECAR AS -BUILT SURVEY NO CORNERS SET THIS DATE SCALE :1" = 40' I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 2, VICKERY SUB. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS _29TH_ DAY OF NOVEMBER 2007 HOLT LAND SURVEYING 10624, FB 130-51 TEL. 345-5513 ACS Alaska Communications Systems March 28, 2008 Rogers Revocable Trust P.O. Box 110443 Anchorage, Alaska 99511-0443 Attention: Cindy Ellis Subject: Non -Objection letter request Vickery Lot 2; 12450 McLain Rd, Anchorage, AK 99516 Grid 2838 Dear Rogers Revocable Trust; Alaska Communications Systems has reviewed your request to utilize an existing T&E easement for the placement of a private communications cable to place a fence and water well within the 10' easement. Your location is at 12450 McLain Rd. in Anchorage, Alaska. The water well is located on the West easement and the fence easement is located along the East easement. ACS has no objection to this encroachment. Please be advised that ACS does have existing facilities within this easement. The location of these facilities may be determined by calling One Call Locate Center at 278-3121 for afield locate. If you have any additional questions, please contact me at 564-1420. Sincerely Jay Lamkin, Acting Foreman Alaska Communications Systems Outside Plant Engineering 907-564-1420 600 Telephone Avenue Anchorage, Alaska 99503-6091 tel 907.564.1000 www.acaalaska.com A 2008-022169-0 L A Recording Dist: 301 - Anchorage s 4/18/2008 1:59 PM Pages: 1 of 4 K A IIIIIilllllllllillilllllllllllliillllllllllllllllllllllllliillllllllillllllllli ENCROACHMENT PERMIT �- 1203-26B G-2328 EN08012 017-441-52 This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric cooperative, (herein "Chugach"), whose address is P. O. Box 196300, Anchorage, Alaska 99519 and the Rogers Revocable Trust (herein "Permittee"), whose address is 12450 McLain Road, Anchorage, Alaska 99516. 1. Easement. Chugach is the grantee or user of an easement for the construction and maintenance of electrical facilities, as follows: Dedicated by the plat of the subdivision known as Vickery Subdivision, according to Plat Number 84-468, recorded on the 17th day of December, 1984, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, Described in that certain written instrument recorded on the 4" day of August 1952, at Volume 76, Page 275, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, Described in that certain written instrument recorded on the 29th day of May 1958, at Easement Book 2, Page 273, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, herein "Easement") which pertains to the following described real property: The West Ten Feet (W 10') of Lot Two (2), Vickery Subdivision, according to Plat Number 84-468, recorded on the 17th day of December 1984 on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska. Permittee acknowledges the validity of the Easement. Permittee warrants and represents that Permittee is the owner of the fee simple interest in the land subject to the Easement and the following described real property to which the Easement is adjacent: Encroachment Permit - Page 1 of 4 Lot Two (2), Vickery Subdivision, according to Plat Number 84-468, recorded on the 17th day of December t984 on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Parcel") 2. Encroachment. Permittee has constructed or purchased the following improvements on or within the real property subject to said Easement: A water well that: encroaches approximately Two Feet (2') into said Easement for a distance of approximately One Foot (1'), (herein "Encroachment"). 3. Permit. Chugach hereby authorizes Permittee to continue the existence of the Encroachment in its existing location subject to the covenants set forth in this permit. 4. Indemnification. Permittee shall indemnify and hold Chugach harmless from any claims for personal injury, property damage or other loss arising in anyway from the continuation of the Encroachment. 5. No Expansion or Increase. Permittee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior written consent of Chugach. Chugach has no obligation to provide such consent. 6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit, has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any other real property. Without in any way limiting the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes of the common law doctrine of adverse possession. This permit creates no interest in the real property subject to the easement. 7. Modification of Utility Facilities. If the electric utility facilities located within the \ Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. If such payment is not made within thirty (30) days of written demand for same, Chugach may terminate this permit in accordance with paragraph 9, below. 8. Covenants Running with the Land. The obligations of the Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the land subject to the Easement and shall benefit the Easement. Encroachment Permit - Page 2 of 4 I IIIIIIII III IIIIIIIIillil 2 of 4 2008-022169-0 9. Termination. Chugach may terminate this permit after the giving of thirty (30) days written notice of such termination if: a. The Encroachment is enlarged, increased or extended within the real property affected by the Easement. b. The Encroachment is damaged by any means to an extent of more than thirty percent (30%) of its replacement cost at the time of destruction. c. Permittee fails to make the payment described in paragraph 7, above. 10. Term. This permit shall, if not sooner terminated by Chugach, expire forty (40) years from the date hereof. 11. Entire Agreement. This written permit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all other prior or contemporaneous agreements, oral or written, between the parties. No modifications, amendments, deletions, additions or alterations of the permit shall be effective unless in writing and signed by all of the parties hereto. CHUGACH ELECTRIC ASSOCIATION, INC. By:—'e '4.9 / Dora L. Gropp, A ting bifector Engineering Services Division Date: ��(%�2yo? PERMITTEE By: James rj. Roger , o -Trustee Date: �// Michelle N. Rogers, Co - Date: Y(n�p3� Encroachment Permit - Page 3 of 4 III IIIIIIIIIIIIIII IIIIIIIIIII I III 3 of 4 2008-022169-0 STATE OF ALASKA ) ) ss: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this _LD-kay ofrte( , 2008, by (PRINT NAME(S) OF PERSONS SIGNING DOCUMENT ,�...................„,,,,.,,,,µ.,.,,..,..ms.,.,.. 0"'CIAL SEAL I STATE OP ALASKA NOTARY PUBLIC LOIS A. HENANS(�/Yl MyµµCommi expires` µebroery X74 `µ2011 p Notary Public in and for the State of Alaska My commission expires: a/ / i i I STATE OF ALASKA ) \ ) ss: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this/ 17 _I k day of ai , 2008, by l�� L GV D o a k Director, Engineering Services Division of Chugach Electric Association, Inc., an Alaska co ration, on behalf of the corp tion. AFTER RECORDING RETURN TO: Chugach Electric Association, Inc. P.O. Box 196300 Anchorage, Alaska 99519-6300 Notary public in and for the State of Alaska My commission expires: k v / k4 -- I � ° Encroachment Permit - Page 4 of 4 III IIIIIIIIIIIIII IIIIIIIIIIIIIIIII 4 of 4 2008-022169-0 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 64 gy pP I V 2 x n SA 8TY S,y/ CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING j Parcell.D. 017-441-51 COSA# aloe Expiration Date: S 1. GENERAL. INFORMATION Complete legal description Vickery, Lot z Location (site address) 124SO McLain Road Current Property owner(s) James & Michelle Rogers Day phone Mailing address Lending agency Mailing address Real Estate Agent 1245o McClain Road, Anchorage, AK 99516 Day phone Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF,BEDROOMS: 3. TYPE OF WATER SUPPLY:` TYPE OF WASTEWATER DISPOSAL: Individual Well ;, - ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class - Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 thAbbased on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinanc6s, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 100217 Anchorage, AK ggSio Engineer's Printed Name Steven R. Pannone, P.E. Date —,2>11 l /'Z Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. ."„�„ The operational life of all wells and septic systems depend on the local soil condition, ground water Ww �4 levels that may fluctuate during the year, and the water usage of the family bei served b the ” "••/• ", Y g Y g Y n8 Y system. OSP..•..• ;may �� These conditions are outside the control of the evaluator of this system. All systems eventually fail and : �`d• ~"a.` �1 satisfactory test results do not guarantee future performance of the system, nor do they guarantee that i {' a qg ni there are no hidden defects or encroachments. PES can therefore not provide any warranty for future �•••n••••y performance nor give any estimate of how long the system will continue to meet the operational _,, •-• _. , 9 requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed ���Y Stevens R , Pannone above. Any reliance upon or use of this report by any other person or party is not authorized nor will it �1� q No. CE 8149 i confer any legal right whatsoever. 1��.,,4N ..•'°d.� 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report )they Original Certificate Date: ,<-/ Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description:yickerv. Lot z Parcel ID: 017-441-52 A. WELL DATA Well type Private Date completed q/17liqft Total depth 1_ a5 ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N) Y_ Cased to 1i6 ft. FROM WELL LOG 0/1712980 WATER SAMPLE RESULTS: Coliform Neg_colonies/100 mL ft. 9.p -m. Nitrate 2.77 mg/L Well Log (Y/N) Wires properly protected (YIN) Y Casing height (above ground) 1a in. AT INSPECTION 2/28/2012 Arsenic: ND ug/l Date of sample: 2/2-4/2012 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 2a/1991 in Tank size 15oo gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 1o/26/2o11 Pumper Isaacs Pumping C. ABSORPTION FIELD DATA Date installed 5/29/1001 Soil rating (g.p.d./ft2 or ftz/bdrm) o.8 GPD/SF System type Deep Trench Length 76.0 ft. Width ft. Gravel below pipe 7.o ft. Total depth 9.6 ft. Eff. absorption area 1062 ff Monitoring tube Y Depression over field N Date of adequacy test _2/2812012 Results (Pass/Fail) Pass For 5 bedrooms Fluid depth in absorption field before test 37 in. Elapsed Time:36o min. Final fluid depth 37 in. Water addedM gal. New depth5i in. Absorption rate >= 75o+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 3.00+ Absorption field on lot ioo+ Public sewer main 7S+ Sewer /septic service line 25+ Animal containment areas 50+ Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots ioo+ On adjacent lots ioo+ Public sewer manhole/cleanout ioo+ Holding tank ioo+ Manure/animal excrete storage areas ioo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation s+ Property line io+ Absorption field s+ Water main io+ Water service line 25+ Surface water ioo+ Wells on adjacent lots ioo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line zo+ Building foundation io+ Water main 75+ Water Service line io+ Surface water Curtain drain 50+ Wells on adjacent lots ioo+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone, P.E. Date /y�/Z-- COSA Fee $ Y G'�d 1-2 Date of Payment 3 ,2 r,,, Receipt Number twfJ- (Rev. 11/05) Driveway, parking/vehicle storage io+ Waiver Fee $ Date of Payment Receipt Number 0 ien R. Panni No. CE 8149 in. Municipality of Anchorage • Development Services Departm Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 4 ent '6R° V ' CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 615-Jtfl - 52- COSA# b1t^0 �(0 1. GENERAL INFORMATION Expiration Date: L 2 — 0 7 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address %ACKERY SUBDMSION: LOT 2 6140 E. HUFFMAN ROAD • ANCHORAGE. AK 99516 BRIAN BRODERICK Day phone 6140 E. HUFFMAN ROAD ' ANCHORAGE. AK 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone 748-4900 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-sfte ❑ Public Sewer ❑ 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 axed 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 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 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, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of 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 bonefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 67� bedrooms. Disapproved. 337-6179 Date g1n{/ob Conditional approval for bedrooms, with the illowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Reort Nitrate Advisory / Other By: IRnr TIMI ntl MTC WATER AN[ PROGRAM .w� Original Certificate Date: 10-2—,9 (o Municipality of Anchorage Development Services Department 4.01, Building Safety Division ` On -Site Water & Wastewater Program 4700 Bragew Street P.O. Box 196650 Anchorage, AK 995198850 www.muni.mWonalte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: VICKERY SUBDIVISION: LOT 2 Parcel ID: D 11 '1=f/ —S'-?, A. WELL DATA 'WELL TESTED BY AAROW PUMP AND WELL SERVICE Well type PATE If A, B, or C provide PWSID# N/A Well Log (YM) YES Date completed 9/17/1980 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 125 ft. Cased to 116 ft. FROM WELL LOG Date oftam 9/17/1980 Static water level 115 ft. Well production 8 9— p.m-WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1 85_mg.IL. Casing height (above ground) 12"+ in. AT INSPECTION "9/5/2006 119 ft. 2.5 g.p.m. Other bacteria 0 colonies/100 ml. Arsenic: ND_ug./L. Date of sample: 7/28/2006 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date Installed 5/29/1991 Tank size 1500 gal. Number of Compartments 2 Foundation cleanout (YM) YES Depression over tank (Y/N) NO Cleanouts (Y/N) YES High water alarm (Y/N) N/A Date of pumping 10/27/2005 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA Date installed 5/29/1991 Soil rating .p.d. ft'/bdrm) 0_8 System type DEEP TRENCH Length 76 ft. Width 2.5 ft. Gravel below pipe 7.0 ft. Total depth 9.9 ft. ER. absorption area 1064 ft' Monitoring tube YES Depression over Heid NO Date of adequacy test ' 10/25/2004 Results (Paw/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 51 in. Water added 891 gal. New depth 64.5 in. Elapsed Tune: 292 min, Final fluid depth 50.5 in. Absorption rate >= 750+ g,p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date DRAINFIELD HAD 43" OF LIQUID IN MONITORING TUBE ON 7/28/2006. TESTED BY CINDY ELUS PE o,+ 10/7-S/ia'rt, D. LIFT STATION Date installed Size in gallons Manhole/Access(YIN) "Pump on" level at _in. "Pump oft 111:111lig water alarm level at in. Cycles tested Meets alarm $ circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ On adjacent kits 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhola/deanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Properly line 5'+ Absorption fteld 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 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parldnglvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S I certify that I have determined through field insperdlons and review of Munic pal records that the above systems are in conformance with MOA COSH guidelines In effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 71/y /01, COSA Fee $ �(nn7. DC? Date of Payment Receipt Number. (Rev. 11105) 1. Waiver Fee $ Date of Payment Receipt Number ■09/10/2006 09:44 FAS 9075625449 Alaska Pump & Supply Q1001 on ■ AAROW PUMP & WER SERVICE, LLC OMMOO OC G ■ P.O. Box'110496 Anchorage, AK 99511 74,S6 Office: (907) 346-9355 • Fax (907) 333-8976 Palmer. (907) 745-9077 • Eagle River. (907) 622-9335 (1 Jru4l4 l k6:1 MER #G &' r horn roAorlr. A.A A G4 tiO3 JOB SITE L t_• D -73 J L J ► IMDDD f/ WELLDO" WL CHLORMATED SUMP OEM /57 SAUSPERSON :moo �� i I '� 1. fb �f►r Pr i� %MA 1 H ! ` -1 0 s !' 'I A a � a T 7fr° S G 1 LABOR HOURS RATE---:- AMOUNT TOTAL -MATERIAL TOTAL LABOR. WORK ORDERED BY DATE COMP. TOTAL LABOR , PAY THIS AMOUNT Thank You ' SIGNATURE ' it Hereby AcknovAedBe the Saddactory Complatlon Dt the'Above'Desclbed Work.) TERMS: ACCOUNT$.PAYARLt AT 10TH OF MONTj4 FOLLOWING PURCHASE. SERVICE CHAYIGE AT RATE •OF 1,511 PER MOM WILL BE CHARGED ON OVERDUE ACCOUNTS. SEP -14-2006 1029 PRUDENTIAL VISTA REAL EST 907 562 5485 P.03 Art PIT-� th rPll'ORMM �"Y�T �� Y 1 • rMKL 4-2- • U IQ� •M \f01 k I rel ,. % } e.0• ♦ I � Al -� � � • ,i Cif � I I ill b I O WaR NO 0 TK aoR .yw TM" fF3- FW J2l. 07' Prepared by & A530C. Robert Johns, Jr. profee9lonol Lond SuNeyora - Un 2 KT RCI,A 1�•� .. •oJ.•. ly.r '�'r FM ^ a + I�m5ftNtTW IURK'1. TOTAL P.03 t I Art th rPll'ORMM �"Y�T �� Y 1 • rMKL ww• U IQ� •M \f01 0 T\ www A%► Kt XasM T • --% N ... J115' WaR NO 0 TK aoR .yw TM" fF3- FW J2l. 07' Prepared by & A530C. Robert Johns, Jr. profee9lonol Lond SuNeyora - Un 2 KT RCI,A 1�•� .. •oJ.•. ly.r '�'r FM ^ a + I�m5ftNtTW IURK'1. TOTAL P.03 t SEP -14-2006 1029 PRUDENTIAL VISTA REAL EST Isaacs Pumping Service p 6218 Quinhagak St= Aacbmge„ AK 99507 Bit To BrodeftKCandy 6140 E Hultman Road •gneho W,Alaska 99516 Pumped Septic SYSMM P.O. Na Tann 907 562 5485 P.02 Invoice DIM laraio 8 W006 11113 8114/06 Due on receipt DwaWw P400 Total amain 110.00 110.00 4110.00 SEP -13-2006 11:10 PRUDENTIAL VISTA REAL EST A.,I IWAS[VSTµ-prygnq%*MCI 1aU.Y4 ? ftdlft Ggon.W'111 w•.l�(P'1 .dJORTHLAND?eP.tNPumEA I C; G EJN Your Professional cg �Servi4ce CompAny • '7S01 E. 14M Avenue ^' ' 'ANCHORAGE. ALASKA 99516 ;• Q7)=-7146 FAX (g07) 868-6770 TO( '•iy L"aady,l3cDdertck ,7. •.: Y• Huf%Ro'ad` rKell : a: a �1'ncti'orage,,AyK 995116 907 562 5485 P.02 MM f (!: 16:839 ' +�I'�-` •i.'Ih� I -fes- .• ' 11 .00 1 P=p Septic _ • v �� ! Dank you for' '�oosin;g,� .d is a list Dp s anti;LnEbat$E ° i' _.m!da car iara`y"d' me forPon Z.. you hav 248-2518,7 10/0415 0 gallons, 6 hoses —very hard pull Tani: locked 23'W of NW corner of house 5' W of edge of deck in back yard 1' drive on Rig t an Mccaic .,. 'fi.# L7r;tAi-rrx+t N1act r•rX •, ''a• .. .. ,,.d•`t�..,, »;7; .pw r; ' �J•ai.i"yi,'•fwrl,r•Vr..• r- .n�4t•I••!•o*k•.•11<...i .w4\..r. •.•.1eY•f'-'!'nwi„•nb • • • .' TOTAL P.02 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 017-441-52 114 HAA #_ C ! 5 Expiration Date: 1. GENERAL INFORMATION Complete legal description Vickery Lot 2 Location (site address or directions) 6140 E. Huffman Rd., Anchorage Current Property owner(s) Jeff Hittson & Mary Pacheco Day phone Mailing address Lending agency Mailing address 6140 E. Huffman, Anchorage, AK 99516 Day phone Real Estate Agent Bob Baer / Dynamic Properties Day phone 727-6025 Mailing Address 3111 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Wellr ❑ Individual On-site ❑✓ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑' Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for 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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein.I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Watkins Engineering, Inc. Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis 5. DSD SIGNATURE _vll� Approved for �_ bedrooms. Disapproved. Phone 349-1851 Date 11/2/04 I'PR 0 F .q 49LH' °• City W. Ellis XV-._ CE -1057 Conditional approval for bedrooms, with the following Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By, 66 � ee 1� Original Certificate Date: f (Rev. 01102) inunieipality of Anchorage Developnfiil Services Department Building Safety DMiGr On Site Water' Niitewa er rogram ESouh Bragaw St fox i Ano orage /fiK 99519 6650 �t�S n�i`i"org/onsite pt r� HEALTH�A�UTHOR)TY APPROV1fiL CHECKU�1` ' Parcei(D 017-441-52 r xi 'r'_ _ If A Boor C prow rhe F 1 SiD CNeffog t.H -777, a leted ��rreo' aritary seal Y properly ro p p p y protected (Y/N) Y =a�'"a�., ft` Ca`s'edio iib ft Casing height (aboveground) 32 in R AT fhT `�Cl`t . at;9 10125/04 ft 124 ft �8pm 22712 `9Pm S � � -... w „. , , 9 �O ear acten colonies/100 m1 •,` a..,q" } 1d�ln'✓{�"+`di S' -,a. �' #3r�S:i°l�:uwu�5}imavv'"�uRw4...<Sw.�', 2:' Date of sample: in¢eioa Collected by Doear a eria ee Date installed 5/29/91 gal. Number o Compartments 2 Cleanouts (Y/N) Y .. , p"Vc�s•� � �s-'�"�t^"'�r�s,�i�w.�.'�s�`+a,�'�'��S``�a u'^'���°�,w"u>�z�4� s��u� c'�.r c eanout ! Depression over tank (Y/N) N High water alarm (Y/N) NA ipin9 1 Pum„per Northland Pumpi�cn _ +�'i' ° .amu” TM�`iC+'RZ�' ' a,.,:'^_%�.��,=°��'�.f.:;'�',v�,."a'�"K„•��'`. �i`..'=".'a�,b% ,_��,}.''. id }+;�n'rc`:'.,.n., ,� ..5:: ON"FfECtS'U%i�'d y g (g:p.d:/ft or it /bdrm) 0 System type ` eep renc _�%«fi�„c".c< "'.,v$�aa�`'%,„`". 'R�'' ':,v�.vs,{.xr�..�X"w.,.u....*_. ,''✓r.'..><x "v ff. Width 25 ft Gravel below'pipe 7.0 ft _ ft, + ff a sorption area 64' Monitonng tube Depression over field N luacy test 10/2 !0 Results (Pass/Fail) PASS For 5 bedrooms n'a sorp ion e e ore test fn "' a er a ed �` gal ,New depth sa 5 ,n �e:; min Final fluid depth c 5 in Absorption rate > 750 d ifion treatment (past 17mo.) (Y! & fvoel "�'o= Yves_ Give r�farw ^PU`m in. High water alarm level at in. ° W HAo.f. n Hilt renuirement5? 4 • on oerermineu unuuyu -- --i .,... w„ in TIt 9TH Y il records that the above systems are MOA HAA guidelines in effect on this date •• ., •• :* Name Cindy W Ellis m :... Ct Y IN. Ellis CE- .,• $ R•......... G O rSl2 S , Waiver Fee Jl Z. /© Date of Payment Receipt'Number NOV-03-2004 WED 03:04 PM FROM: FAX: PAGE 2 FROM 'JIM80 _ FAX No. :34seeal Now \ 7k. T/laQr1CriG'� Nov. 03 20134 92:34?M p1 .;tz? 7/ Lt �O Ot v J��wA11 1WrNov - /G � of ' °•.C, � ( . �� a �. .+.� r �w .�� � . +� r.. �.w �.. .� � .! � �a.rT-. ,•! ti, .• ! Cl &a 4&t ' /We 9'S4'37 4W{ It is the responsibility of the owner to"'• determine the existence of any easements, covenants, or re- Y •7Ca�,. �j � •1a4es. strictions which do not appear on'the recorded'sub-'.' division plat. Under no, circumstances, should any - data hereon be used for constructsgn or for estab- sHowH ON TNe R9040!'o rur . li'shinp boundary or fente lines. The surveyor take? SHOWN MUM R ctton only. LOT 6LOCK _ l e=�exn . �— -- • • W eRAae 1 CAP MoxeArexr'. , �4ic:,rt �-c� Y S.�6a.•/ aGAr HO.pp_ ��I/ __tRQW NPE :r • :•''r -.343 • • Re AR PAOROoR•PNP •, ANCHORAGE RECORDING DISTRICT ci Aug a rAAKRWPAW AMP " MNO assvcrarFs - AMCHCRAQF9 AL'JISKA' 99511 aAra': J3+Y1.ay i%.. av SCAEel1=.Sc� ' wosx�x 1 D Alaska Testlab 4040 "B" Street Anchorage, Alaska 99503 Quadrant Construction 621 West Dimond Blvd. Anchorage, Alaska 99502 Attention: Sharon Wodrich MUNICIPALITY OF ANCHOR , I_ 1 ` �. DEPT. OF HEALTH & �,, '.- ENVIRONMENTAL Pf,OTECTIO Phone (907) 27a jlpl� r( TeleMg y (907) 272-5742) May 29, 1981 W.O. #A19815 RECEIVED Subject: Vickery Residence Septic System, N 1/2, NE 1/4, NW 1/4, NW 1/4, Sec. 26, T 12N, R 3W, Seward Meridian Dear Sharon: This letter is in response to items that need to be clarified for the Municipality of Anchorage, Department of Health and Environmental Protection, asked to be classified regarding the above subject. The original inspection of the septic system was performed by Terry Barber, engineering geologist with Alaska Testlab. After consulting further with Mr. Barber, he was able to confirm the following items. 1. A four inch diameter, plastic waste line, with no perfora- tions, led into and out of the septic tank, and the same type of pipe was used for the cleanout pipes. 2. Pipe placed in the gravel in the trench were perforated, and were installed with the perforations down. 3. The gravel was brought up from the bottom of the excavation to six inches above the perforated pipe, and was at least six feet in depth. The cleanout pipes projecting above the ground surface were found to be four inch, plastic PVC sewer pipe, ASTM D -3034E19. The pipes into and out of the septic system were also of this type, as affirmed by Mr. Barber. The installation of the system was performed by Able Excavating. The septic tank was purchased from Greer Tanks. The attached invoice confirms that a 1500 gallon, two compartment tank was picked up from Greer Tanks by Able Excavating on October 2, 1980. Also, Malcolm Stickley of Able Excavating confirms this as being the type of tank installed in his attached affidavit. Quadrant Construction May 29, 1981 Page Two Regarding the standing water in the excavation at a depth of 10 feet, as observed by Mr. Barber when inspecting the system March 3, 1981, the following clarifications can be made regarding its source. 1. No ground water was encountered while drilling our test hole of July 28, 1980, to a depth of 16 feet. The septic system was placed within 60 feet of the test hole, but at a lower elevation. 2. The water found standing in the excavation on October 3 was reported to have resulted from a plumber's line test, which had inadvertently drained into the leach pit. This was affirmed by Mr. Ray Farmer of Quadrant Construction in his signed affidavit, included in our report of October 6, 1980. We also include in this report an affidavit from Mr. Malcolm Stickley of Able Excavating, who installed the system, testifying to the source of the water. Due to the silty and therefore relatively impermeable nature of the soil below 12 feet in this location, water drained into an excavation could be expected to seep quite slowly into the ground, and could give the appearance of a false water table. Since the septic system is in use at this time, the effluent from the system makes it impossible to establish the true position of the ground water table using a test hole near the system. We trust the foregoing clarifies the items on which there were questions. If you have any questions regarding this report, please feel free to call. Very truly yours, ALASKA TEST,LAA�B C� eGG� Carl A. Bassler Geotechnical Engineer Approved by: FE Melvin R. Nichols, P.E. Manager CAB/mg Attachments �® 1A.� Melvin R. Nichols No, 44134 _ May 28, 1981 W.O. #A19815 Alaska Testlab 4040 "B" Street Anchorage, Alaska 99503 Re: Septic System Installation and Inspection on October 3, 1980, for the Vickery Residence Gentlemen: When the inspection was performed for the subject sewage system, a 12 foot deep pit with a 25 foot length was noted, with water standing in the pit at a depth of 10 feet. According to Mr. Malcolm Stickley, of Able Excavating, who installed the septic system, this water was not ground water, but was water that had escaped during a water test by the plumbers and had run into the excavation. He verifies this as being the source of the water and that the septic tank installed at this site was a two compartment, 1500 gallon tank, by his signature below. ery tru Malcolm tickley October 3, 1980 W.O. #A19544 Alaska Testlab 4040 "B" Street Anchorage, Alaska 99503 Re: Septic System Inspection on October 3, 1980 Gentlemen: On inspection of the pit for a sewage wastewater disposal system, the pit was excavated to 12 feet and 25 feet in length. Water was observed at 10 feet depth, but according to Mr. Ray Farmer of Quadrant Construction this was due to a. water test by the plumbers during construction of the building. Water flowed into the test pit and giving the appearance of a false water table. He verifies this by his signature below. ery truly yours, . Ray Farmer October 6, 1880 W.O. #A19391 Grid 2838 QUADRANT CONSTRUCTION P. O. Box 10-1067 Anchorage, Alaska 99510 Attention: Mr. Ray Farmer Subj ect: Percolation Test Results, N'k of NEI -2 of NW4 of W4 Section 26, T12N, R3W, SM Gentlemen: At your request we performed a percolation test at the property referenced above. A 16 -foot deep test hole was drilled at the location shown on Figure 1. The test hole was drilled with a Mobile B-50 drill rig mounted on a Nodwell carrier. The drill is owned and operated by Denali Drilling, Inc. The test hole was logged by oz Hatch, Alaska Testlab engineering geologist. After the test hole was drilled, a perforated PVC pipe was placed in the hole to prevent caving and the test hole was filled with water and allowed to saturate overnight. The following day the hole and pipe was refilled with water and the percolation, or absorption, of the water was observed for a 60 -minute period. The percolation rate reported is the lowest rate per ten-minute time increment. The test hole log is shown on Figure 2. Soils encountered con- sisted of 5 feet of soft brown silt overlying 7 feet of brown sand with some silt and trace of gravel. At 12 feet depth a brown gravelly sand silt was observed. No ground water was encountered in this test hole. Another test hole on a lower part of the property in a depression encountered water at 8.5 feet however. Therefore, place the septic system backfield as close to the test boring as possible. The measured percolation rate was 3 minutes per inch with the water level at 7.5 feet depth. Soils above 5 feet can be con- sidered impermeable. For the sand layer from 50 to 12 -foot depth the required absorption area is 100 square feet per bed- room. For the gravelly sandy silt below 12 feet the absorp- tion area requirement is 250 square feet per bedroom. These rates are based on criteria given in the Manual of Septic - Tank Practice, U. S. Department of Health, Education, and Welfare, Public Service Publication 256. Mr. Ray -.Farmer (',� quadrant Construt_ion October 6, 1980 Page 2 it is suggested that these recommendations be reviewed when the drain field system has been excavated. in this area, soil and groundwater conditions vary significantly within short dis- tances. If you have any questions, please contact us. Sincerely yours, ALASKA TESTLAB James R. Finley, Jr., P. E. Geotechnical Engineer JRF:mb2U Attachments h / 4040 "B" STREET l ANCHORAGE, ALASKA 99503 AI dSi(A �ES�� (907) 278-1551 i`October 6, 1980 W. O. A19544 Grid 2838 QUADRANT CONSTRUCTION P. O. Box 10-1067 Anchorage, Alaska 99510 Attention: Mr. Ray Farmer Subject: Inspection of an On-site Waste Water System of N32 of NEh of NWA Section 26, T12N, R3W, SM Gentlemen: Transmitted herein are the results of the above referenced inspection. Included in this transmittal are: 1. Septic Tank, Leach Field and Test Hole and Well Location Sketch, Figure 1; 2. Affidavit on water encountered; 3. Soil Report - July 31, 1980. The inspection program entailed two separate inspections of the installation of the septic system, and was performed on October 3 and 5, 1980 by Terry L. Barber, Engineering Geolo- gist with Alaska Testlab. At the time of our first inspection a 1500 gallon septic tank had been set approximately 22 feet north of the house with its top four feet below the ground surface. A four -inch diameter plastic waste line had been laid from the north corner of the house to the septic tank. Four cleanouts had been installed to elevations above the ground surface. One cleanout was located adjacent to the house, two were located at both ends of the septic tank, and one was located at the beginning of the leach field. A leach field pit had been excavated to 12 feet below the ground surface with an average width of 5.5 feet. Standing water was observed in the leach field pit at about 10 feet below the ground surface. Mr. Ray Farmer October 6, 1980 Quadragt Constrj­�tion Page 2 The source of the standing water in the leach field pit was reported by Mr. Ray Farmer of Quadrant Construction to be waste water from a plumber's line test, which had inadvertently drained into the leach pita We were not on the site at the time this took place and are thus unable to verify this. How- ever, and affidavit from Mr. Farmer is attached. At the time of our second inspection washed gravel (1 inch) had been placed in the leach pit., A P.V.C. perforated pipe had been laid in the gravel with the perforations down, and covered with approximately six inches of washed gravel. (Vis- gueen had been placed over the gravel surface, and.a cleanout had been installed 25 fee3 inches north of the cleanout at the end of the leach field. A We trust this report meets your present needs. if we can be of further service, please feel free to contact us. TLB:mb3D Sincerely yours, A A TESTLAB Terry L. Barber Engineering Geologist Approved: Melvin R. Nichols, P. E. + \ Com. om �r. 3J, I I . 2 3 4 5 FIELD LOG .:�'�.. Jta i' i=�1 �o.RINc�10 WORK ognr;rt NO IK� FLEVATION: �2�rn t3Y- - DATE b Itl O m ; .a I INC CONTRACtOR h. ia. %J N w S I I I pRIt�4FR .• .._ TIME -FINISH _ .1 � � i r a e� I a --EQUIPMENT J ,� - WATER LEVEL %/i .>TIMF. i.I F at tj w o a u � - SHFCT__OF W= Nw w o a _' _ --'- -10 i- o G m w N SOIL DESCRIPTION COMMENTS ` cc w4 LL 2LL �ii• 3 5 0 3J, I I . 2 3 4 5 0 Alaska Testlab 4040 "n" Street Anchorage, Alaska 99503 Quadrant Construction 621 West Dimond Blvd. Anchorage, Alaska 99502 Attention:Sharon Wodrich Phone (907( 270-1551 May 29, 1981 W.O. NA19815 ( Telecopier (9U7) Z7Z-5/9[ ) Subject: Vickery Residence Septic System, N 1/2, NE.1/4, NW 1/4, NW 1/4, Sec. 26, T 12N, R 3W, Seward Meridian Dear Sharon: This letter is in response to items that need to be clarified for the Municipality of Anchorage, Department of Health and Environmental Protection, asked to be classified regarding the above subject. The original inspection of the septic system was performed by Terry Barber, engineering geologist with Alaska Testlab. After consulting further with Mr. Barber, he was able to confirm the following items. 1. A four inch diameter, plastic waste line, with no perfora- tions, led into and out of the septic tank., and the same type of pipe was used for the cleanout pipes. 2. Pipe placed in the gravel in the trench were perforated, and were installed with the perforations down. 3. The gravel was brought up from the bottom of the excavation ix inches above the perforated pipe, and was at least six feet in dept . The cleanout pipes projecting above the ground surface were found to be four inch, plastic PVC sewer pipe, ASTM D -3034E19. The pipes into and out of the septic system were also of this type, as affirmed by Mr. Barber. The installation of the system was performed by Able Excavating. The septic tank was purchased from Greer Tanks. The attached invoice confirms that a 1500 gallon, two compartment tank was picked up from Greer Tanks by Able Excavating on October 2, 1980. Also, Malcolm Stickley of Able Excavating confirms this as being the type of tank installed in his attached affidavit. Quadrant Construction May 29, 1981 Page Two Regarding the standing water in the excavation at a depth of 10 feet, as observed by Mr. Barber when inspecting the system March 3, 1981, the following clarifications can be made regarding its source. 1. No ground water was encountered while drilling our test hole of July 28, 1980, to a depth of 16 feet. The septic system was placed within 60 feet of the test hole, but at a lower elevation. 2. The water found standing in the excavation on October 3 was reported to have resulted from a plumber's line test, which had inadvertently drained into the leach pit. This was affirmed by Mr. Ray Farmer of Quadrant Construction in his signed affidavit, included in our report of October 6, 1980. .We also include in this report an affidavit from Mr. Malcolm Stickley of Able Excavating, who installed the system, testifying to the source of the water. Due to the silty and therefore relatively impermeable nature of the soil below 12 feet in this location, water drained into an excavation could be expected to seep quite slowly into the ground, and could give the appearance of a false water table. Since the septic system is in.use at this time, the effluent from the system makes it impossible to establish the true position of the ground water table using a test hole near the system. We trust the foregoing clarifies the items on which there were questions. If you have any questions regarding this report, please feel free to call. Very truly yours, ALASKATESTLLAB 6"A 5.44& - Carl A. Bassler Geotechnical Engineer Approved by: dcCir rP f`. • e.e.e.y'Y P or C ,` ', Nichols,r8 Melvin R. Nichols, P.E. :..i1 Manager P. to,� l ff , CAB/mg � J C l Melvin R. Nichols •.' .W Attachments 0 61. 0� No. 4113E Obi �orFss+•�_.� May 28, 1981 W.O. #A19815 Alaska Testlab 4040 "B" Street Anchorage, Alaska 99503 Re: septic system Installation and Inspection on October 3, 1980, for the Vickery Residence Gentlemen: When the inspection was performed for the subject sewage system, a 12 foot deep pit with a 25 foot length was noted, with water standing in `the pit at a depth of 10 feet. According to Mr. Malcolm Stickley, of Able Excavating, who installed the septic system, this water was not ground water, but was water that had escaped during a water test by the plumbers and had run into the excavation. lie verifies this as being the source of the water and that the septic tank installed at this site was a two compartment, 1500 gallon tank, by his signature below. �ery tru Malcolm tickle�y` �1 l e` i 4: '1 IAT ^r,+.n^ •+�a-1 1 ,-� w<� _a..+�- > .�qi�,p .«ni;nvtY.Z4a�. o-urndi_5 <�an.'.£:Jyiw .a »; x.u�ie;..�n. F :.tb:;•.,+�xG.i...:5{..0 e.Li._i'Y�sda'siui.� I P.O. DOX 6709 • 2021 INTERNATIONAL AIRPORT ROAD • ANCHORAOE.ALASK 49502 Customer's TELEPHONE 243-2455 Order No. Date �Ci '" "��. 19� Name Address 0 BY1 CAS1j CO D I CHARGE I ON ACCT. MDSE RETD. PAID OUT !'CQUAN.. -': DESCRIPTION '- - PRICP` - AMOUNT (•'i!', � . .-' l�•. ��' �-moi �.-f I ' 4 % _✓y. r, ;.�.. 1 CERTIFIED COPY OF ORIM * TOTAL ALL Claims and returned goods MUST be accompanied by this bill PAST DUE ACCOUNTS SUBJECT TO 11/3% SERVICE CHARGE PER MON1 H. Ar Recd by L `l 1 — ._..__ .--- ------- I ...... ......... -- - - -- ....-- EACHERRTITATAK 2zUND (BENEFICIARY ASSIGNEE) -, IB NOTARY ACKNOWLEDGEMERT SUBSCRIBED AND SWORNfTO BEFORE ME THIS 12*h DAY OFOcfder 1984 L FOR Mo.✓tu GNtZ ._.� MT PK \ \ NOR T&N 1959 2 1/2"BCM ON 1-1121. P. 0.3'BELOW GR. (C -N -N -NW 1/256th Cor.) vied by the Municipality of ,own on this plat have bbee�en �SdS1u 6L a Authooz d Olbcral Date m � 12�-f24 �4..n_ «Q-cVuGt S N TI 1) AT ", P',. '1 MY COMMISSION EXPIRES NQTARY PUBL n. VICINITY MAP SCALE: I' = I MILE T12N cc 20 21 2 2 o 23 - 2 4 1 9 p k x HUF MAN ROAD N THIS PLAT x 29 '28 27 26 25 �+ M N 30 � (r DEA MOUN R0A- - 32 33 34 35 36 31 T 12 LOTS 1 and 2 VI CKERY SUBDIVISION A SUBDIVISION OF NI/2 NE 1/4 NW114 NW1/4 SEC26, T12NIR3W ` S. m. CONTAINS 218,822 S•f- ° 5.024 AC. DOWLING AND ASSOCIATES 804 EAST 15TH AVE SUITE 2 ANCHORAGE ALASKA 99501 Grid 2838 Sca/ells = 100' Date JULYM4 Book alk P Page 40 Drawn J K D Fite No.84-I O I I W O No. S-7 cc -7-139 1984 1 p k X.Wma..w .o 1 V Q m O • J ` O ca a } O O K R' zm W Z t7 v N 2 LL a 2 1 1 1 v b 1 1 I�Of I. a N O b O O Oi ph h Ip b Y1 h IN 1 � I �M 1 F a rc EOC om0co. � F Z W 2 Q Y r LL bl } 10 , W m = Q ; m h o h ti e } m W Jz m N m m I r a 0 F— m ro,%CDI •__ U (W),61 -FEE W (W)M,GY�,OOoN N-.. H m m N m W rill O O .m w O •:1 '.'� _ � y o b 1) W C W � 0 �+ 3 3 I' 1 o ro,%CDI •__ U (W),61 -FEE W (W)M,GY�,OOoN N-.. H m m N m W rill O O .m w O •:1 '.'� _ � y 0 1) W C 0 30 m .3�9 "7� D Teluo••r• ;Elcc r 7 i I Ili " i U ky IN I �NrsY1 I � - JCA — r-yf G �I\I 1°•� �J ' •k° 54 I I °O 19; I 1 I c 011 Q � N89 °5o`37' W ice- 3Z`7 87 OF a4 /VO'Al' 10 sem{- a s r�(c a s a lo. �c�a,<k '� f•49Z;y�°�i ': �! crape» C✓J1� • s[ i01A., Karl Dowling it is the responsibility of the owner to determine p'� :, 156" ••,gy m' the existence of any easements, covenants, or re- LARCE74.. �a�F9F�:.,��•��••••,:•�SJo� strictions which do not appear on'the recorded sub- NOTE ��;AO'fsSI°Ra,��"`' division plat. Under no circumstances. should any EASEMENTS OFRECORD,OTF LtAAhi SE data hereon be used for construction or for estab- SHOWN ON THE RECORDED PLAT,; ARE Nor lishinq boundary or fence lines. The surveyor tales SHOWN HEREON. res�ensib�li#31 r +po initial *raneacti.on D.nly• LEGEND LOT z BLOCK BRASS CAP HONUMENT I 0 IRON PIPE PLAT NO.8� 41,25 O REDAR PROP. COR.iND -.ANCHORAGE RECORDING DISTRICT o Nue a TACK 'REPARIED`6Y DOWLING & ASSOCIATES ,. _ . 904�EAST 15fh=Ava. Sulfa 2 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# C�i _�(�(� 52 HAA# L`i`',r k 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 611-10 &• l4UFF-Mto,v Property owner Day phone Mailing address t ua 0 , L(JT—P�'AA Lending agency Day phone Mailing address Agent vA s . i3 L Y tfor- K),US Day phone z La 76-53 Address ':StI( C S nL-_L-rd Sucr lcso t /q,UCfl ( V_ 91g'5-6_-? Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: '!5`' 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_ 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) 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 ofFirmQAN^�Nca C3�4 L Phone Z2 _3- -� Address n,o,Low !OZ4s4 ANCA- Acc g9Sla Engineer's signatures Q� Date 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments M_ IMU6 bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Pe 1/91) Back MOA 021 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES RECAP c Environmental Services Division n 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-474 R Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: L_6- ' 'Z V (c IG �Y 5(1,3 Parcel I.D.: O L 4'1/ / — S -Z- A. A. WELL DATA Well type Trt %vA-r is If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ` Date completed a! 00 Total depth Cased to 116 Casing height (above ground) 3c " v: Sanitary seal (Y/N) ( Wires properly protected (Y/N) it FROM WELL LOG AT INSPECTION Date of test -1 (7/P_)o e4 1261 q Static water level q Well production —9 -P.M. Z.0 g.p.m. WATER SAMPLE RESULTS: Coliform — ®— Nitrate L &7 Other bacteria Date of sample: Collected by: S t' B. SEPTIC/HOLDING TANK DATA Date installed Tank size /fix) Number of Compartments Z Cleanouts (Y/N)� Foundation cleanout (Y/N) v Depression (Y/N) A -I High water alarm (Y/N) Date of Pumping :12o 4�i,r Pumper C. ABSORPTION FIELD DATA Date installed s/2 1? Y / Soil rating (g.p.d./ftp or ft2/bdrm) o • 5 System type —17tZL,,-, c If - Length Width ? Gravel thickness below pipe ,z Total depth !v ` Effective absorption area !b(, 4 Monitoring Tube present (Y/N) Y Depression over field (Y/N) Date of adequacy test 'W26/ IF 9 Results (Pass/Fail) Qod 5S For S bedrooms Fluid depth in absorption field before test (in.); 31 Immediately afterO gal, water added (in.): 34 Fluid depth 30' (ins) Minutes later: 14(gy Absorption rate g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main GM t If - Size in gallons at* On adjacent lots On adjacent lots "Pump off" level at* 00 -f ti(da Public sewer manhole/cleanout /�( (A Sewer /septic service line /c70_(_ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: f Foundation 2 I Property line / b Z Absorption field y Is- Water Water main/service line v' -o fi Surface water/drainage !06r Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 7e Building foundation ask Water main/service line "001 61:> -f- Surface water ��� Driveway, parking/vehicle storage area vrU T low Wells on ad � Curtain drain adjacent lots t C9v F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records I in conformance with OA HAA guidelines in effect on this date. i Signab�P��i ; a Engineer's Names a, y�Z949, Date Z HAA Fee $ co Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Date of Payment Receipt Number are • MUNICIPALITY OF ANCHORAGE Ad! 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 I.D.# 0717-y 1. GENERAL INFORMATION HAA # H h" ! l 62Z)l Complete legal description i^o'T V 16% l2y S-ec 2-6, i la N i 12.3 I>,// Location (site address or directions) %l 4 D ! i U )=1= P(A ISI t20 Property owner. Ifo t ep �� Y V,ew s Day phone Mailing address (a/ VQ E tfvFFHAJj Lending agency Day phone Mailing address Agent rd✓rTyN P1Lui', SuF 1)Vo)2AK Day phone 62—'76-� Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 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 tK 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 MOAa21 tU4 VOW NOe8 46At DH)SZUZL •worn s, Oau!6ua puo!ssa;oid ayl ui suo!ss!wo ao saoaaa ao; apsuodsai IOU s! a6eaoyouy ;o Al!led!o!unyj ayl 'panss, s, aleog!Uao a aao;aq elep azA!eue ao suo!loedsui lonpuoo IOU op SHHO to saoAoldw;3 sluewaimbei olels pue!eaapa; u!epoo Als!les olaapio ui suo!lnl!;sui bu!pual a!ayl pue sawoy;o siaseyoand of Asal)noo a se. sigl saop SHHO a41'e�selV to ale1S aql ul paaals!6aa aaauibue !euo!ssa;oid luepuedepu! ue Ag anoge 9 ydw5wed ui uaA!b suo!leluasaadaa agl uodn A!uo paseq saleo!JIVOC) !enoiddV Al!ao4lnV 43IeaH sonss! (SHHO) sao!ruag uewnH pue yl!eaH 10 luawpi3daa 96eaoyouy;o Al!!ed!o!unVj ayl mo!le!nd!ls bu!Mo!!o; a41 pm 'swooapaq OIL)(] q W sluawwo(] !euo!1!ppy a01 !enoidde !euo!1!puo0 •panoaddes!(] 'swooapaq ao; panoaddy — 3anlVNJIS SHHd '9 aanlvu6!s s,Aeau!6u3 1�-bL% auogd tiq.�y� wa!d;oaweN S •uo!loadsui s!yl;o alep eql uo loal;a ui suo!leln6ai pue 'saoueu!pao 'sapoo 91v1S pue !ed!o!un!N Ile Ul!M aoue!!dwoo ul s! walsAs !esods!p aalemelsem ao/pue A!ddns aalern a1!s-uo ayl'uo!loadsui pue uo!1e6!lsanu! Aw woe; pue sa!!1 a6eaoyouy;o Al!!ed!o!unw a4l woe; pau!elgo uo!lewao;ui ayl uo paseq le4lA;uaAa9ylan; ! .u!aaay poleo!pul aanlonils;o adA1 pue swooapaq;o aagwnu eq1 ao; alvnbape pue !euo!loun;'a;vs s! walsAs !esods!p aalerAalsM Jo/pue A!ddns aalum al!s-uo a41 }e41 smOLls uo!lvo!!dde !vnoaddy Al!aoglnV 4lleaH 8!41;o u01le6!lsanu! Aw lvyl A;IAaA ! 'rno!aq uMo4s alep uo!lep!!eA ay1;o se pue olaaaq pax!;;e Ives Aw Aq pa!;!laao sy 833NION3 A9 N01103dSNl d0 1N3W31V1S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 44 Legal Description: Vi -e- e Parcel I.D. (t % c/L/ A. WELL DATA Well type f? e�p If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed 7117 y Driller F0 SS Total depth Casedto 4& Casing height 05 .t Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Wires properly protected (Y/N) v FROM WELL LOG AT INSPECTION 17/1 l/h i�0 g.p.m. a2.J 1025 16617 � AM NOISIAIO S3JIA83S 1V1NMNOWAN3 .1 ,.v"t , ^„,r :n A I-9Vdt�)INtIW g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot V 16-0 ; On adjacent lots i X0-0 Absorption field on lot ii /&.0 Public sewer main I� On adjacent lots >% %G Public sewer manhole/cleanout Public sewer service line �`� Petroleum tank t_/�/`\ WATER SAMPLE RESULTS: Coliform 0 / Nitrate Qv Z Date of sample: '�/�gL R ( Collected by: B. SEPTIC/HOLDING T K DATA Date installed !��'I/qj Tank size Cleanouts (Y/N) >/ Foundation cleanout (Y/N) High water alarm (Y/N) i', Date of pumping L Other bacteria N `� Compartments Depression (Y/N) 1-11 Alarm tested (Y/N) I -//A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots >> Foundation To property line Absorptionfield Water main/service line �� O Surface water/drainage N//IN 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION A Date installed -- Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access(Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots "Pump off" level at Cycles tested Surface water _ D. ABSORPTION FIELD DATA � .s Date installed`1 ( Soil rating ' c System type u`G1 _' I Length—Width? Gravel thickness 7 Total absorption area /O G tZ Cleanouts present (Y/N) — Total depth /0 Depression over field (Y/N) ty Date of adequacy test — Results (pass/fail) N for XS Peroxide treatment (past 12 months) (Y/N) �� If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot > 10'0_ On adjacent lots Property line N bedrooms .7J i'_ Tobuilding foundation 4 - To existing or abandoned system on lot `JO h On adjacent lots_ /00 01. Cutbank t41/N Water main/service line 'T l) Surface water f'///A1 Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION %(-0 I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ,pp,the date of this inspection. �' c iL Fix Signature Engineer's Name tf d �� {' �� . �t+�0 Ft 2 Date h_L3LL`� I (t C ' HAA Fee $ ov Waiver Fee: $ Date of Payment " -2>�_ c, Date of Payment Receipt Number 9 - ` Receipt Number 72-026 (Rev. 3/91)Back MOA 21 'Ili I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location ,(address or directions) (b) Applicant Name Vic Vickery Telephone: Home 3yS- S X00.3 Business Applicant Address 6140 McLane Street, Anchorage �/ (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder El ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address p Real Estate Company and Agent / Q' E / �� N�/JVC% �It Address 3 �C'�` Telephone 56-J-) (.S3 (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE L✓dEN Single -Family Multi -Family ❑ r Jr r.S Number of Bedrooms 3. WATER SUPPLYEK 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. SEWAGEDISPOSAL Onsite Q-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 (11184) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA,ND INFORMATION As certified by my seal affixed hereto and as of the validation date shown bblow, 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 abtained 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 Address Date — Telephone JJCei S J. Corin o. CE -5283 °•LSC pR0FESS\) yam' Yo/ -6/ 6. DHEP APPROVAL C5� C � Approved for �/ Ll [ _bedrooms by �� �L"t--t � Date Approved— Disapprovp Conditional Terms of Conditional Approval CAUTION Engineer's Seal The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/80) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY �F k� W XAIS'I`HORITY APPROVAL (HAA) DEPT. Of fiEAL7H ENVIRONMENTAL PRGI 94441ST - FEBRUARY 1984 264-4720 MAY 0 8 19K LegalDescription: �I t�Cg �b• (1z' RECEIVED TJZ A3W1,'S :z6,Iq�2,,vCr�,INWYg,14WV Well Classification ri�V�0. � If A, B, C, IDI,'.E.C. Approved (Y/N) A Well Log Present (Y/N) r� 6 Date Completed UM Ft10W Yt Yield z• q a fYt Total Depth X15 ' Cased to 5" Depth of Grouting N/A Static Water Level 30 X2Pump Set At SOr Casing Height Above Ground 31 Sanitary Seal on Casing (Y/N) qR.5 Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot )Oc)t + Depression Around Wellhead (Y/N) On Adjoining Lots loo 1 4 - To To Nearest Edge of Absorption Field on Lot ) oO ' f ; On Adjoining Lots (00 1 { To Nearest Public Sewer Line4 A To Nearest Public Sewer Cleanout/Manhole i�IfR To Nearest Sewer Service Line on Lot /f�A Water Sample Collected by L-• I©a,� i � ; Date ( Water Sample Test Results Comments * ?6--6,6 B. SEPTIC/HOLDING TANK DATA f Z � G iE Date Installed Wknowrt Size 500 No. of Compartments — Standpipes (Y/N) � 4.5 Air -tight Caps (Y/N)N2 — Foundation Cleanout (Y/N) 7 Depression over Tank (Y/N) _ A%o Date Last Pumped Pumping/Maintenance Contract on File (Y/N)N11A for I11 A- Holding Tank High -Water Alarm (Y/N) tJIPr Temporary Holding Tank Permit (Y/N) ti Separation Distances from Septic/Holding Tank: To Water -Supply Well /00,1- To Building Foundation JO 1 r To Property Line 105 To Disposal Field /0 To Water Main/Service Line N%H" To Stream, Pond, Lake, or Major Drainage Course Comments Id Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Ult] km0wn Type of System Desiign- Date Installed tW known Length of Field W00" Width of Field kdu%m Depth of Field UkmknOwn, Gravel Bed Thickness Gil_ Square Feet of Absorption Area SAAII Standpipes Present(Y/N) —W 5 Depression over Field (Y/N) JVD Date of Last Adequacy Test 1 Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 100 / L To Building Foundation — �v Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments // Check Pep itIted Bedro6m I certify the I E Signed Company Osf Receipt No. f /r Date of Payment L Amount: $ Page 2 of 2 72-026 (11/84) V Y 7 I To Property Line To Existing or Abandoned System on On Adjoining Lots )- lOUr To Cutbank (if present) 611A 1AA 14 - Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Rating Against HAA Request ** ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date (Q Ma j«�6 r MOA No. , m- J. Corwin CE -5283 Engineer's Seal s S. I,EISADESCRIPTIO DATE RECEIVED INSPECTION APPOINTMENTS 6. TYP&DY RESIDENCE TI��iE SINGLE FAMILY TIME TIM ❑ Two ❑ Five ❑ MULTIPLE FAMILY - i 1 L:) ('el- I��sc1Lo DATE ❑ COMMUNITY DATE DATE Ie _ INSPECTOR 8. SEWAGE DISPOSAL SYSTEM INSPECTOR INSPECTO ' YEAR ON-SITE SYSTEM WAS INSTALLED. 11< ❑ PUBLIC UTILITY P)n-Pd I c1 0 Pi -A /)1,f Y . NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNI IPALIW OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOWNVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • APR 2 1 1381 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 VFD ND E FAT It -sr REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERT R HON MA ADDR M7 •Y _ RO RES E T (If dif r nt fro Bove) ` P O WE f / 2. BUYER P N MAILING ADDRESS 3. L I G INSTIT W'44 fflv-z PHONE MAI NG RE / 4. REALT A ENT PHONE MAIL N ADDRESS - s S. I,EISADESCRIPTIO STR LO ION,- r /] •NUMBER 6. TYP&DY RESIDENCE OF,BEROO SINGLE FAMILY ❑ One Four I --]Other Vg ❑ Two ❑ Five ❑ MULTIPLE FAMILY - ❑ Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 1 INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. 11< ❑ PUBLIC UTILITY P)n-Pd I c1 0 Pi -A /)1,f Y . NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) % v THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS - ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified_ PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑Holding,rank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic /Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR _ -�BEDROOMS ❑ CONDITIONAL APPROVAL (letter mus a company certificate) ❑ DISAPPROVED / DATE U r. Z>' BY c 72-010 (R eV. 6/79)