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HomeMy WebLinkAboutTUSTAMENA TERRACE LT 3Tustamena Terrace Lot 3 #017-381-09 Municipality of Anchorage Page of 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 Permit Number: 50'760057- PID Number: O/-7' 381 -09 Name: 1311..1- !✓IASr>Ja Wastewater System: ElNew RUpgrade logy /vof•TFi •rr / 71go� Address: Nt.IY % µ0T SPNdGS ABSORPTION FIELD Phone: 345-'743-f No. of lleddrooms: 19 Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating; O Total Depth from origi��grade: GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 3 1 'TU 57 Arv1E/JA TERR 6 Ft. 9 Ft. Township: Range: Section: Fill added above original grade: Gravel length: 52 —_ -- a. rr Ft. Ft. WELL: ❑New ❑ Upgr • Gravel width: 2.. Number of lines: Distance be _we en lines: -X15TId6 FL Ft. Classification (Private, A,B,C): To epth: Cased To: Total absorption area: Pipe material: Ae,-rrA D 3°3� PRtJY�7E Ft. Ft. SO. Ft. I 10 Driller: Date Drilled: Static Water Level: Installer: C TW EEO EYeAJAT11tG Date installed: �-6-96 Ft. Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES 9Septic ❑Holding ❑S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Aral 0 -� ^ ru IAvll� 1000 WeIY i0ot+ IDo1+ v- -- _ Material: STBE L Number of Compartments: 2 Surface )06 '+ 1 _ _ _ LIFT STATION Water Ion 'f Lot 1 sf t Size in gallons: Manufacturer: Line lC I Foundation "Pump on" level at: "P off" level at: High water alarm at: I81 Curtain ,' tt 944 Pump M odat Electrical Inspections performed by: Drain �'/ Remarks: ` W NkA. G&P rao 4 -I9 -9G BENCH MARK Location and Description: WAwairt- V_E v5&T metal 9ZN(. Oil It _Fis[A = TP op 6y oNE Poc-) bisll-ry D/zpYN EAro Eo¢o pa�j To TH..K ELfv97"'GAt-A6b SLA. ATT4cN£�) tvri,L� Lo G.3 ti orcq,-f- no 0f0R ceK Assumed Elevation: I /On,v Ft Iry T/l£ AR£A , /0 9 140010 7-0 /, 6£ C V 1-r£NG7Al 7u q G6.9/1£NiATr, F'O2 RI(,.. 7N 7��ivG /-�. 1v£LL7 Oi� i10T/iGe�v% ILT ANFC� g��i• z�(� •t9 �7 b. 5 LOTS /f7lJv'I' FG'c.q S£NTC 7gNK 6- Aol'ORP/ri+ry F.EL(>. 5 & 5 ENGINEVRING Inspections performed bA7 1st r.�%t} ,25*tes: Eagle River, Alaska 99577 2nd �'' yb ROBERT C. COWAN Qg �d�f :� CE - $$pl 3r�1 6 -G -9G I F�.Ir Department of Health and Human Services approval as Reviewed and approved by: <5� Date: 72-013 (Rev. 9/91) MOA 25 Permit No. SW960052 Page 2 of 2 Municipality of Anchorage 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 Legal Description: LOT 3, TUSTAMENA TERRACE S/D PID No.: 017-381-09 10' UTIL TY ESMT. YELL i i Zip. N i LOT 3 F i EXISTIN � i 3 BDR AOECK —NEW 10(10 GAL. . SEPTIC TANK —EXISTING TRENCH P NDONED M SUCH THAT R .11\n# ENCH 0■!r: SC 1" = 40' -N CO = 1013' STl _9 ST2 / F AL GRADE TII�02 . 1000 SEPT: TANK IIJ A (Hev. 9/91) MOA 25 C01 & CO2 = 85.5' ♦ 81.5' NO ROUND WATER .5' B.O.H. lk ROBERT C. COWAN CE - 8;01 SEE" ®ems •�1LliJ���r SC 1" = 40' -N CO = 1013' STl _9 ST2 / F AL GRADE TII�02 . 1000 SEPT: TANK IIJ A (Hev. 9/91) MOA 25 C01 & CO2 = 85.5' ♦ 81.5' NO ROUND WATER .5' B.O.H. lk ROBERT C. COWAN CE - 8;01 PAGE 1 OF MUNICIPALITY OF ANCHORAGE `Qcn DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 Q�r�d �c ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960052 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MASINO WILLIAM H JR & SHERRI K OWNER ADDRESS:5701 NAKNEK LN ANCHORAGE, ALASKA 99516 PARCEL ID:01738109. LEGAL DESCRIPTION: TUSTAMENA TERRACE LT 3 LOT SIZE: 14400 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 4/19/96 EXPIRATION DATE: 4/19/97 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ] ISSUED BY DATE : / �- DATE: �_ //-lq(l 1 ®r Municipality of Anehorage Department of Health and Human Services 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor April 19, 1996 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 3 Tustamena Terrace Subdivision Waiver Request #WR960011, PID #017-381-09, HA960119 SW960052 Dear Mr Cowan: Your -request for a waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 1 foot from the absorption field to the lot line. This approval applies to the existing septic system separation only. Any future upgrade to the septic require all separations be met or another approval department. Sincerely, C>r%1 tl� / Daniel J. Roth Civil Engineer On-site Services Program DJR/ljm lot line system will from this ✓' MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# 1 (,_;2gInOfi \ 1 PID # C)\ ()°� HA# OAO lCp '1\\� Permit # Date Received: Pn,� L-\ on(, Legal Description: Engineer: ,\��� �u�c i� o l �( Lr�� f0, v Applicant: Waiver Requested: i� l �,r S ra A a�4�� fa Ylsnc�0)�x Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: X Waiver is NOT Granted: List Conditions or Reasons for. above: EA1CP01KNMENraF AB50I?8710A1 PR40 wac 4 1__ CSF N6149001? TO BE UNr30ie ro (OAaSrVk4r- 14 FurUlfe SYSTPM. oTHee (aT [iNe r_&0?010(HE) Fpowr5 ' R-11-, .'• NGT MA4crfA16 ANJ'ri4/NG. Date: ¢-/q-9(, By: g6A/ Name of Reviewer Rec #: ��.5� I R�1 Amount: $ I,� L�� Date Paid: S& HEALTHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELLINSPECTION & FLOW TEST SITEPIANS ROADOESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSA-SYSTEM DESIGN April 1, 1996 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 3; Tustamena Terrace Subdivision ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694.2979 FAX (907) 694-1211 Request you issue a permit to upgrade the septic system serving the existing three bedroom house on the referenced property and issue a Conditional Health Authority Approval. Septic system to be upgrade no later than 15, June, 1996. A test hole was excavated .and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered and after seven day ground water monitoring, the monitoring tube was found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, ii nnnccere lyC ,, Robert C. Cowan, P.E. RCC/gk Enclosure q *6"'�A tiy7F�'9�7T/- O ape 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 k a \ FN, Q Z ✓ .1 ow oagLL Cf C) jd Z Q > pzzo O U ri ••11 : is W i,� f1 LLJ 0� 0 x zb�no J w �D wi-s S \ upz o F a a a I w CCKY 0Q 0 z�0[if pl w S Z O m zc= _ L, Fp pz OOa� .� 0�-L </ w I U I O Zdy w Z U 0 Mw op �' I w �" 2 O. Q� No 0" y Q N Z O W S> C) O w K J6 yaar inwm we g' UQ (n U(L _� FJ 0111e w4�z Z )j✓ s� I� w W P4 = w w zLL leo a OfIx az�1z�J n �Ty O N OaQ ocy �dJ w < G _rl q \\�-•�\\ p w w >- Fn r � j D IL tz C7gw z o, '_ �rn�zzrow W I O wZJ �waLLJ 0 of �O 0 Xm0 oe�v Q U mom LLI la w wM U F I =-OZ la � j � Q (n > a (n L I - - - - - - - Zi _ I- --------------------T Z 0 �_ Zp 'iWS3 J.imin o f I Z 0. (n (N Q � U Q F V) H � •(tib r J M o o b� Z z God CO w F -I CL a O G Z W 0 n w v���r Zoll � �� OU) oL,3;:0 O� G J \ ��y w rT, m _ O 3ltlOS NJIS3CJ N�-ld 3115 .Ov = „I HEALTHAUTHORITY APPROVALS SEWER&WATER MAINEXTENSIONS SEWER & WATER INSPECTION ENGINEERINGSTUDIES ANDREPORTS WELLINSPECTION & FLOW TEST SITEPLANS ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S& GENERAL: ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CIVILENGINEERS CONSTRUCTION PRACTICES FAX(994-29AX (907) 6944-- 1211 and MATERIAL SPECIFICATIONS Lot 3, Tustamena Terrace SID March 29, 1996 1. The scope of this project includes the installation of a leachfield trench to serve the three bedroom residence located on the referenced property and excavation of the existing 1000 gal septic tank to verify its integrity. If the integrity of the existing septic tank is poor the existing septic tank is to be excavated, pumped, crushed, and abandoned in place and a new 1000 gal septic tank installed. The existing trench is to be abandoned as such that it may be used in the future. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 3, Tustamena Terrace SSD March 29, 1996 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: I. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 3, Tustamena Terrace S/D March 29, 1996 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3`s passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 3, Tustamena Terrace S/D March 29, 1996 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 3, Tustamena Terrace SID March 29, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L•• Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: `t' 1 L- L 1-1 1,4"S 1N O DATE PERFORMED:— LEGAL DESCRIPTION: 1.0 T 3 T U S %HM r A,' 4 Township, Range, Section: -t SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS t9 R&4N, c -S M L- T9.v '1 t- 1— hL 6, J, If, 6 - SILT i, -RA SOr.,� G.RavEL mix WAS GROUND WATER .JVO ENCOUNTERED? S L IF YES, AT WHAT v O DEPTH? P E Depth to Water Aller D• °1 lH l � C Monitoring?- ey Date: ROBERT C. COWAN CE -8301 Reading Date Gross Time Net Depth to Time Water Net Drop P94 SO 4K 3/a 46 7 , 3 g - 3P p 7 '/g PERCOLATION RATE —3-- (minutes/inch) PERC HOLE DIAMETER 6 '/ TEST RUN BETWEEN R FT AND IO FT PERFORMED BY:S &.S ENGINEERING IW1. /,t I/�•� CERTIFY THAT THIS TE T WAS PERFORMED IN w1LT70,3q4�,lEgagle River Loop Road No. 204 t f �� 9 ACCORDANCE Ga94*,4RTAIJWd1""PAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-OOB (Rev. 4,65) 9 � MUNICIPALITY OF ANCHORAGE � .DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME �r/�7. e9 ��2- ev( /'� PH ONE v �/3 �_b NEW ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION qq � /v 6 f Civ v 1 ci dva/CNC NO. OF BEDROOMS lJ Uy DISTANCE TO: Well nL/t * Absorption area �� Dwelling PERJW�T NO. r 0 /G a 1-2 Manufacturer Cr Mater �• / / No. of corPpaLrtments rn Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth o y JUZ DISTANCE TO: Well Dwelling PERMIT NO. = z Fa- Manufacturer Material Liquid capacity in gallons ❑ _IX DISTANCE TO: Well Foundation e d" Nearest lot line rj PERMIT NO. u Z Fzw No. of lines Length of each line Total lengt o lines Trench width s'f inches Distance between lines � F ❑219 Top of tile to finish grade Material beneath tile inches Total effective absorption area w Length Width Depth PERMIT NO. Q F- uJ Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank - Absorption area(s) OTHER PIPE ////MATERIALS A1215 hC 4- Cr SOIL TEST RATING Z- Z 5 -- INSTALLER /1 ai4' Zixc' -Vc A - REMARKS me/ say s)(-Yde,l U lib If 3 o 44 I 1 APPROVED 7DATE LEGAL 72-013 (Rev. 3/78) 10 k_c tool I a. I " 101 L_ I IF "y" e_® F m rA CD E '....:.� & FA CA RK DEPARTMENTS HEALTH AND ENVIRONMENTAL OTECTICN 125 'L' STREET: ANCHORAGE, AK. 9501 264-4720 14E_i_L_ FA6°-JE> EDTA-- I> I IF EE InE=IJEEE" 9=°E lot 10I Ar PERMIT NO. 810160 APPLICANT HERMAN RAMIREZ L=: TUSTAMENA TERRACE 243-0728 LOCATION LEGAL L=: TU TAMENA TERRPiCC b10 LOT SIZE 14400 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM I S : TRENCH MAXIMUM NUMBER: OF BEDROOMS = = _OIL RATING (Su FT/BR)= 225 THE REQUIRED SIZE OF THE _,OIL AB'_ORPTION SYSTEM IS: 1"0=0=15-11= A-10 L E F' o7j -I- 5-9 -_. k- C3F=" 6 =1 %? E= 9L C=� E F�° IF H = �_=a THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCA'VATIU_N (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH I'S THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL. F'IF'E AND THE BOTTOM OF THE EXCAVATION (IN FEET). 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 I-11 6:7 0__ - : I PA 03 F=° En C_ IF _C CD rA K FT 17" E_ F<" Er CA LJ I F= E= E_• — — — BRCKFILLING OF ANY SYS=TEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR: A PRIVATE WELL OR 150.1 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC: WELL. MINIMUM DISTANCE FROM A PR:IVHTE WELL TO H PRIVATE SEWER: LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. 14ELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER: REQUIREMENTS MAY APPLY. SPECIFIC:ATION'_ AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO IP'SURE PROPER INSTALLATION. F"01701 I IF K><F ` I Fes" E = C> E0�. 2 E0F1 E_ E:7 F~: "Ay"I 0 1 "01=011- I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SEF FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. _. I UNDERSTAND THAT THE Ohl -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE 15 REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:--- ��� ----------------- APPLICANT ------------- APPLICANT HERMAN RHN I REQ / ISSUED B'r_ �`_'__=�?�' _ ---__DATE__ l� '';'a. 0 SOILS LOG : MUNICIPALITY OF ANCHORAGE DEPARMENT OF. HEALTH AND ENVIRONMENTAL PROTECTION TERCO CATION V ..v TEST_ `�. Pouch 6650, Anchorage, Alxeka.99502 276-2225: SOILS LOG — PERCOLATION TEST It 78079 PERFORMED FOR: _Q ICf-fl�-R,U W {/�� V/rI r ice' DATE �PERFORMED: � LEGAL DESCHIPTION: !r'CJ/ / �7.IJ"$Fy-1�',y� �'�+�-''`f 4 �z) - - - - SLOPE SITE PLAN pems 41 - 2 3 S;AN®y 511,TY 6tRAvaL WAS GROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? NO S L O P E I I I : I I A _ - J D Y1 E DROP / / �s P .2�/co9 �I 7,3,E 7'y 3; y9 —3/y' -- - `®OtO.�ln4 20 0 ss PERCOLATION RATE __(minutes/inch) TEST RUN BETWEEN 69 FT AND ET iTMMENTS_-rill F --AW ! DPZ,OP %V%z 4-, S 3D MbVY7-�S 'ERFORMED BY + CERTIFIED BY. DATP _ I w. Well. Log For ......... 1. �'� tJS��2tiQ,U . .................................. ............................. .................................. 1 2 Location........ :L.... .......( .� . :�fir�P: ........................................... Date completed....... .................. Depth of well.......... ............................................................................................ Sizeof casing........... ........................ ................................. ................. ....................... Distance to water........... C' F ................................................................................... Distance to water while pumping ............ .<:- ............. at rate ..................... fit. a 9....................gallons per hour. Formation I from I to I I MUNI WALIrY - ENVIR EPi. OF HEAL7.H )NMENrni nn^ $ EI Driller DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE. ALASKA 99507 • Municipality of Anchorage =� , On -Site Water and Wastewater Program c (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 017-381-09 Expiration Date: S-21-/-3 1. GENERAL INFORMATION Complete legal description Tustamena Terrace, Lot 3 Location (site address) 5701 Naknek Lane Current Property owner(s) Genie Rabb Day phone Mailing address 239 Champlain Dr Real Estate Agent Day phone 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request TYPE OF WASTEWATER DISPOSAL: Individual 0 Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: X'41/_r COSA to be released to the enddfeer, unless otherwise requested by the engineer. COSA Fee $ 0 J Date of Payment 513 1 t 3 Receipt Number COSA# Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, 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 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone Date 4/5/13 fix: un 6. DSD SIG ATURE System #1 Approved for bedrooms SlNen Kanr CE -8149 System #2 Approved for bedrooms Disapproved\ W -ft Conditional approval for bedrooms, with the following stipulations: By: c` Original Certificate Date: Theg iclp ta��c orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisdry ' Well Flow Advisory COSAbloesheet r c Other If more than 1 septic system is on the lot: COSA Checklist # + of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Tustamena Terrace, Lot 3 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 10/20/81 Sanitary seal (Y/N) Y Total depth 175 ft. Cased to 175 ft. Parcel ID: 017-381-09 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test 12/20/81 4/5/13 Static water level 34 ft 144 ft Well production 3 g.p.m. 3.3 g.p.m. WATER SAMPLE RESULTS: Coliform iV6& colonies/100 mL Nitrate Lqs mg/L p Arsenic Z O3 ug/L Date of sample: iq vi3 Collected by: T •E B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 6/6/96 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression overtank /(�Y/N) N High water alarm (Y/N) N Date of pumping 0 I 2171'Z Pumper I9 f I ! "W C. ABSORPTION FIELD DATA Date installed 6/6/96 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6GPD/SF System type Deep Trench Length 52 ft. Width 2.5 ft. Gravel below pipe 8 ft. Total depth 16.3 ft. Eff. absorption area 832 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/5/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 460 gal. New depth 0 in. Elapsed Time: 140 min. Final fluid depth 0 in. Absorption rate >= 450+ g p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ Manhole/Access (YIN) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line +* 1 Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 0 F. COMMENTS Tested original field. Original field selected on flow divider. West clean out under driveway. System has 8' cover to prevent freezing. G. ENGINEER'S CERTIFICATION t certify that l 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 Date 4/5/13 COSA brown sheet 10.10-12.doc in. an° Gerald V. Randall.Ir.; r c 1J0.41153 -S /Of GJ77/_/7y' ,-4SL/v1'T- 39 � nl I all �S72J�2'Y ml of Z —7 N. 09 a' so N,Q l<1Y�7� is I VV + !-,4A,l C- (c o eip,1kV) SURVEV'CERTl FICATION: I hraby cortify That I have surveyed the p op +r tl shorn i i i or w' i® 'I V scribed hereon and that tho Improvoman is sl tuptod Thereon are within J o, QI N. 09 a' so N,Q l<1Y�7� is I VV + !-,4A,l C- (c o eip,1kV) SURVEV'CERTl FICATION: I hraby cortify That I have surveyed the p op +r tl shorn i i i i® 'I scribed hereon and that tho Improvoman is sl tuptod Thereon are within the p ur+nrq liens r d o, q "no 0 hm o"" ox lst othar dm""a Ted. GI R'S•PLANNERS • SURV/EYORS PLEASE NOTE: Ii Is the contract LEGEND: SET POUND .or's rEsponslb11,'y to check tan 5/e" HEBAR O O 440 WEST BENSON BLVD. 272-97_31 or founds'I_a In rola tion to +h, each end bundle, HUES R TACK O ANCHORAGE,ALASI<A99503 562-5291 sat- backs In; relation to lot Imes MONUMENT Gd AL -CAP Ga e andea;amontc. PK NAIL X_ - LEGAL DESCRIPTION: IRON PIPE Qa cnlo: C3: \ 2C! 31'i J 1EC�R'T /�/CfL7 �y _ c�=ELEVS,-DATUM YQi�/ 67� �4, J�` � ASSUMED J---N•-J--C_J._._.... n.. .,� �z33 -s �✓ �7 0 �u� 7 ice/ SCALE '/At DATE: - 11111111 1 1 1 11 111111111111111111111111 321629 A s K A 2013-030612-0 Recording District 301 05/31/2013 03:35 PM ENCROACHMENT PERMIT Anchorage Page 1 of 4 1203-27A G-2837 EN13011 017-381-09 This permit is between Chugach Electric Association, hie., an Alaska non-profit electric cooperative, (herein "Chugach"), whose address is P. O. Box 196300, Anchorage, Alaska 99519 and James A. Liszka & Genie Babb (herein "Permittee"), whose address is 239 Champlain Drive, Plattsburgh, New York 12901. 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 Tustamena Terrace Subdivision, according to Plat Number 70- 106, recorded on the 13°i day of May, 1970, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, Described in that certain written instrument recorded on the 5th day of September 1952, Volume 78, Page 246, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, Described in that certain written instrument recorded on the 30th dayofJune 1958, Book E3, Page 358, 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% and the North Ten Feet (N10'), of Lot Three (3), Tustamena Terrace Subdivision, according to Plat Number 70-106, recorded on the 13"' day of May, 1970, 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: Lot Three (3), Tustamena Terrace Subdivision, according to Plat Number 70-106, recorded on the 136 day of May, 1970, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Parcel") Encroachment Permit — Page 1 of 4 111111IIIII 111111111111111111111111 IN 321530 2. Encroachment. Permittee has purchased or constructed the following improvements on or within the real property subject to said Easement: A well that encroaches approximately Two Feet (2.0') into the West portion of said easement approximately Eighteen Point Eight Feet (18.8') South of the North property line, a shed that encroaches approximately Seven Point Three Feet (7.3') into the North portion of said easement for a distance of approximately Thirteen Feet (13% (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 any way from the continuation ofthe 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. 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 maytemrinate 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. 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. Encroachment Permit —Page 2 of 4 lu IdlFage 2 ofl 4IF 2013-030612-0 1011111111111 321631 llf tl IIIII !(II 11" 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 ASSSSOOCIATION,, INC r By: ( z4t-1 f3:c&_Iy By: Shelly Schmitt, Senior Manager Distribution Engineering Date: STATE OF L P�II /7�O/frt� j Date: AA� Z% 101.3 PAO The foregoing instrument was acknowledged before me this G r -Z day of 2013, by James A. Liszka & Genie Babb. (PRINT NAME(S) OF PERSON (S) SIGNING DOCUMENT Notary Public in and for the State of /f/" ' O✓ My commission expires: DIANE K. MERKFl Notary Publin, State of New York No.4767104 Encroachment Permit — Page 3 of 4 Qualified in Clinton County©/ Commission Expires February 28, — �lllllf I�II����lllllflilt lu'I�JIII'1111d1�llll���lnlllllllllll' Page 3 of 4 2D13.030612-0 1111111 ILII I III I BI I I III I I II A ►III I II► 321632 STATE OF ALASKA ss: THIRD JUDICIAL DISTRICT The foregoing instrument was acknowledged before me this day of AA �"1 2013, by b,,,C�f<- cjc;�vvi—SA-, Senior Manager, Distribution Engineering of Chugach Electric Association, Inc., an Alaska corporation, on behalf of the corporation. Notary Public in and for the State of Alaska My commission expires: 2 24 ! AFTER RECORDING RETURN TO: Chugach Electric Association, Inc. P.O. Box 196300 Anchorage, Alaska 99519-6300 STATE OF ALASK NOTARY PUBLIC Stephen L. Howe W canenlaalal nmres & Encroachment Permit — Page 4of4 L!Mn IIIIIIi Anchorage Water & Wastewater Utility Engineering Division Mayor Board Chair Dan Sullivan Timothy M. Sullivan, Sr. May 07, 2013 Pannone Engineering Services, LLC Attn.: Steven R. Pannone, P.E., Principal P.O.Box100217 Anchorage, AK 99510 Re: Tustamena Terrace, Lot 3, 5701 Naknek Lane, Anchorage (Grid SW2837) Request for Letter of Non -objection to Encroachment The Anchorage Water and Wastewater Utility received a request from you on May 02, 2013, for a letter addressing AWWU's position regarding a water well that encroaches into the 10 - foot utility easement. AWWU is currently not using this easement and has no objection to the encroachment, and hereby issues this letter with stipulations to allow or not object the encroachment of the water well and by using the easement the property owner(s) agrees to the following: 1. AWWU will be held harmless, now and forever, for any damages or injury to any person as a result of the encroachments; 2. All applicable codes and regulations will be observed and maintained within the easement; 3. This letter will in no way preclude AWWU from full use and enjoyment of its rights within any portion of the easement, if applicable; 4. The property owner shall pay any additional and/or extraordinary costs incurred to accommodate the encroachment during any future required construction or reconstruction of AWWU facilities, if applicable; 5. AWWU's non -objection does not imply other approvals that may be required for this encroachment; and, 6. AWWU does not provide a position for any other parcel or utility impacted by the encroachment. 7. The property owner(s) shall call for utility locates before excavation in the easement; Should you have any questions, please call the AWWU Planning Section at 564-2739. Sincerely, Ali Turker Engineering Technician / Private Development Coordinator Anchorage Water & Wastewater Utility w Clearly 3000ArmcBoifzevard • Anchorage.Alaaka 99503 Phone 907-564-774 - Fax 907 -562-0824 • nm}v.anmmb "•;`.....,: .. May 2, 2013 James Liszka & Genie Rabb 239 Champlain Drive Plattsburgh, NY 12901 Dear James Liszka & Genie Rabb: Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the well encroaching into the utility easement at the west property line of Lot 3, Tustamena Terrace, also known as 5701 Naknek Lane, city grid 2837. This letter of non -objection in no way precludes GCI Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right-of-way, including unlimited aceess for servicing its facilities. Also any additional and extraordinary costs incurred daring any future required construction, repair m• rcoonstntction of GCI's facilities to accommodate any or all of the encroaclmtents shall be paid by the property owner. By signing below, you agree to indemnify and hold GCT Communication Corp harmless, now and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and uniing tter to me the address below. Sincerely, Acce �ptance Date z Markus It ofcid OSP Design Engineer GCI Communication Corp 5151 Fairbanks St. Anchorage, AK 99503 907-868-6168 Office 907-868-8580 Fax ,(laaka 'laP GC)MMUNICgiIUNS :: 1 derma ;':r..r 1 r,: 1:111:1>4 N A: c alaskarommunkMMTIOXW May 3, 2013 Janes Uszka & Gente Rabb 239 Champlain Drive Plattsburgh, NY 12907 518.55"099 Alaska CommunicaMms has no objection to the well encroaching Into the 10' ut ty easement located along the eastem boundary of Lol 3 Tudemens Terrace Subdivision, otherwise known 6701 Naknek Lae as depicted on the drexings submitled. Acceptance, (your signature below), and use of this letter of nonobjection by yoursai, your heirs, your assigns, oryour successors, will constitute agreement to the bNowing stipulations: 1. Alaska CommunicaUae will be held harmless, now and forever, for arty damages or injury to any person or property as a result of this enc roachmem. 2. Any Alaska Communications facility damaged ordestreyed as a result of this enC=dVr entwll be repaired at no cost to Alaska Commis icatlons. 3. Any mate Ir fined by Alaska CommmmlmtWns for special construdron necessitated by this encroachment will be borne by the prop" owner. 4. A5 applicable safety code regulafkms will be observe[ and maintained. 6. This letter ofnon-objection Will Innoway preclude Alaska CommunicationstromUuse and enjoyment of Its rights within any portion of this easement 8. Alaska Commun't eMons is taller no obggation to restore any structure damaged as a result of Alaska Communications full use and enjoyment of tm dghls within any podion of easeme fs or nlghtbfavays. *ispll.4rlgnb9glllrlDf.Rti!Wn:on60Yfor YairMe.awfi rrrifl.Atli.. 9OM*to'At�lA�pjpip'iliddiU�in. ilds' 0N eamtrtg Foreman Pia$ Eng'reering, 4ASa14 800 Telephone Ave. Anchorage, AK 99503 TV! NA ATE 5613 Geld RCWC 2837 ENSTAR Natural Gas Company May 7, 2013 James Liszka & Genie Rabb c/o Pannone engineering Services, LLC PO Box 100217 Anchorage, Alaska 99510 Re: Letter of Non -Objection To whom it may concern: ENSTAR Natural Gas Company P.O. Box 190288 Anchorage, AK 995190288 (907) 277-5551 ENSTAR Natural Gas Company has no objection to the existing well encroachment into the Ten Feet (10 FT) utility easement situated on Lot 3, Tustamena Terrace Subdivision, Records of the Anchorage Recording District, Third Judicial District, State of Alaska. Acceptance and use of this letter of non -objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: • Landowner/Contractor working near ENSTAR gas facilities shall contact the Alaska Digline, Inc., (907) 278-3121 or 811 for line locating two (2) business days prior to any related excavation. • ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. • Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. • Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the land owner. • All applicable safety code regulations will be observed and maintained. • This letter of non -objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, lk G�fikF-�P"y Andrew Fraiser Right -of -Way Agent ENSTAR Natural Gas Company cc: File MUNICIPALITY OF ANCHORAGE IiL • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ME 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. # C i -7 — 3 81 — c of HAA # r l " l 1 f `1 1. GENERAL INFORMATION Complete legal description Lot 3; T"tarne.na. Te.hkace. Location (site address or directions) 0701 Naknek Lane, I Ar Property owner B.iU. Mas2no Day phone Mailing address 1094 Plo th Hwy. 7 Hot Snking4 AK 71909 Lending agency Mailing add Day phone Agent Ken McKean/ Rewax P,cane, tier Day phone Address 2600 Cokdova Ste. Anchaaoe AK Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX 7 / 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 %X% 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) From MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verifythat based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING G d rY _ Phone Ivero.2Q4 0p oa N Address Eagle River, Alaska 99577 Engineer's signature PLEASE RELEASE THE CONDITIONAL HEALTH SEPTIC SYSTEM HAS BEEN UPGRADED PER HEALTH AUTHORITY APPROVAL. Date G A '` i AUTHORITY ON THIS PROPERTY AT THIS TIME. PERMIT N SW 960052• _rR*&4*&1aSSUE A FYNAL 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments By: �n I ROBERT C. COWAN bedrooms, with the following stipulations: Date Z ::Z9_ yId The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certiflc-Ines 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. 7M25 (Rev. 1/91) Back )AOA k 1 c Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICf�Sc Environmental Services Division ICC VED 825'L" Street, Room 502 a Anchorage, Alaska 995010 (907) 343-4744' 'UN 4 1996 Municipalit of Anchors Health Authority Approval Checklist Dept. Health & Human Services Legal Description: LaT 3 *Js7-4rjf"4 "Tt;vM4cf Parcel I.D.: Qt 7 —3 9,1 — o i A. WELL DATA Well type PR,�iart Log present (91N) Y s Total depth 17 S Sanitary seal (O/I) Y C S If A, B, or C, attach ADEC letter. ADEC water system number Date completed /o /a.a / 8' Cased to ti 0 t FROM WELL LOG Date of test /0 /X0 / 5'1 Static water level 3 2l / Well production 3,0 WATER SAMPLE RESULTS: g.p.m. _ Casing height (above ground) Wires properly protected a" _ AT INSPECTION 3 119 /RG a.7 Irk Yes 9— p.m- Coliform t7 Nitrate 1/ Other bacteria Date of sample: Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTI OLDING TANK DATA Eagle River, Alaska 99577 Date installed 6 / 6 / 9 6 Tank size / 0 o O Number of Compartments )�- Cleanouts (DN) Yt s Foundation cleanout (0/m Y 6 S Depression (Yo N 0 High water alarm (YQ N 0 Date of Pumping Pumper — C. ABSORPTION FIELD DATA Date installed 6 I. / 6 (`l b Soil rating g.p.d./ft2 or ft2(bdrm) O. 6 System type Length S a Width )L- S Gravel thickness below pipe g Total depth / 6 Effective absorption area 93)- Monitoring Tube presento/N) Y6S Depression over field (YO ° Date of adequacy test 7✓ `I _ N e o Results (Pass/Fail) bedrooms Fluid depth in absorption field before test (in.)Z Immediately after_ gal. water added (in.): Fluid depth ___fyw I nutes later: Absorption rate = a.p.d. treatment (past 12 months) (Y/1) If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: �Se tic holding tank on lot / 00 ; On adjacent lots Absorption field on lot / o o / f ; On adjacent lots "Pump off" level at* Public sewer main N /4 Public sewer manhole/cleanout Sewer /septic service line 4 - Lift station /00 f SEPARATION DISTANCES FROM SEPTI OLDING TANK ON LOT TO: Building foundation / Property line /0 f Absorption field S Water main/service line Surface water/drainage 10 0 f Wells on adjacent lots /00 / 1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation x S '` Property Line 1 Water main/service line -Yr wet 8600 i/ Surface water / 0 Driveway, parking/vehicle storage area Curtain drain i ° ¢ i` ° w " Wells on adjacent lots /00 ' 4- F. ENGINEER'S CERTIFICATION I certify that have determined thru field inspections and review of Municipal records in conformance with MOA HAA guideli es in effect on this date. Signature Engineer's Name 2 J a £2'r /C - �e �✓g� °i Date HAA Fee $fa� Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number 3 O 4" V M ti S crc°p4 ashw are ROBERT C. COWAN f/2 CEC 8 V • GO1 ` 03/19/96 17:17 , CTBE ESI ANCHORAGE -r 9076941211 NO. 698 D19 AAMIrMop CME Environmental Services Inc. Laboratory Divisionyi M '.sxsi,dwdwAw Laboratory Analysis Report CT&E Ref.# 960888.6496 Collected Date 03/13/96 Client Sample 10 L3 TUSTAMENA TERRACE 10888-01 Matrix Drinking Water Technical Director 7Lp�, PWS1D 0 Released By G: Sample Remarks: — oc Allowable Prep Analysis Parameter Results dual POL Units Method Llmltc pate Date Init Nitrate -N 1.11 0.1 mg/l, EPA 353,2 03/14/96 ERa 200 W. Potter Drive. Anchorage. AK 9951 B-1605 — Tel: (907) 562-2343 Fax: (907)56 1-530 1 3180 Peger Road, Fairbanks, AK 99709-5471 — Tel: (907) 474.8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY, OHIO, WEST VIROINI/A N MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorade, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D.# 7 - 3:iI c`/ HAA # > 11 ci 1 ._ 1. GENERAL INFORMATION Complete legal description Lot 3; Tutamen Tennace Location (site address or directions) 5701 Naknek Lane M Property owner B,U-e Ma3ino Day phone 145-7437 Mailing address 5701 Na_knelz Lane AncSwaage AK 99516 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site '`XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the leg///ality and status of system. 72-025 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING C/ cj Name of Firm 7'014 Easle River Laeq Read Ne 304 Phone Address Eagle River, Alaska 99577 Engineer's signature _ Ste, , C S Y5 7-i„1 C d ry D, 7/ J .. 4 L 6. DHHS SIGNATURE Approved for Disapproved. 0 Date '// V/6 Tp. U,L (”,° iZ4Jio 07 TV :g /6 /0C/G, bedrooms. fry/:) —Y Conditional approval for 3 bedrooms, with the following stipulations: MONEY rO DF Pur /.V ESCROW ro RCCOMRG/SH THE 9fioyE CONO/7-/o1v Rina-- 9mr TO /BERM/T /]/UMBER SW9600S2 BY NO 4,9rER rHNA/ TWVE /5 1994 MONEY Pur /N ESCRaw SA1,9n NOT 64E /?ECEHSEO uNr/G Flww HPPROVRL Ngs BEEN /&7,ro Additional Comments 4UTIC Date -/9'-96 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. 72-0 5 (Rev. 1M) Beck MOA p 1 ro Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES y�tiy Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343 �y O Health Authority Approval Checklist R°® Legal Description: Lo T 3 A. WELL DATA T VS7 Rn£ v 4 TERR4Ct Parcel I.D.: ©! -1' 3 g/ _ 0 9 Well type 10'ei ✓A7f If A, B, or C, attach ADEC letter. ADEC water system number Log present a" Total depth YES Date completed ?0 l Da / g' / 175 Sanitary seal ON YE Cased to ND f FROM WELL LOG Date of test t o/ a a 8 1 Static water level 31/1 Well production 3.-0 g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate 1 / Casing height. (above ground) 1 4 Wires properly protected (9/N) AT INSPECTION 3 �1 996 IyH D. 7 YEf g.p.m. Other bacteria 0 Date of sample: �/ 3 Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. B. SEPTIC OLDING TANK DATA Eagle River, Alaska 99577 Date installed -T /a 3 P Tank size i 1 0 Number of Compartments Cleanouts (WN) Y E S Foundation cleanout &N) Ye, 3 Depression (YA " 0 High water alarm (Y/0 /v 0 Date of Pumping s./16 /q,7 Pumper J.0/tr//L4^0 C. ABSORPTION FIELD DATA Date installed 7 ��? / Soil rating (g.p.d./ft` or 2/bdrm a a' Sr System type R E' Gfl Length L/ 3 Width 3 Gravel thickness below pipe �' Total depth 1N Effective absorption area J6 Sk /(c4":44onitoring Tube present6)/N) /El Depression over field (Y/O Mo Date of adequacy test 3l 1 °1 l , C Results (Pass/Fail) FA 'L- tr- For . 3 bedrooms Fluid depth in absorption field before test (in.); Fluid depth (ins.) Minutes Immediately after_ gal. water rate = g.p.d. Peroxide treatme 12 months) (YIN) If yes, give date Co.v A. 7 1 1-f Ifp fl /2 ECe✓E-f7 EO, SYSY',f. 10 BE ✓/'DRAPED St A r74 0 VjaCA6OC- 06lf6,v & 0E,0P,•T 1? y T vmt- 41 10,16. D. LIFT STATION Date installed Manhole/Access (YIN) High water alarm level at* E. SEPARATION DISTANCES Size in *Datum at* "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Se U holding [ark on lot / O 0 f On adjacent lots Absorption field on lot Public sewer main Sewer /septic service line /p0 t N I,� On adjacent lots 100 -t- Public Public sewer manhole/cleanout z✓ Aq Lift station N 14 SEPARATION DISTANCES FROM SEPTI HOLDING TANK ON LOT TO: Building foundation /0 +- Property line 30 f- Absorption field S t i t Water main/service line 90 f Surface water/drainage / a0 f Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i Building foundation 0-0 -t' Water maiiVservice line N0 tt l V t) '-f- ENA OF T2h,C14 Surface water 00 t f Driveway, parking/vehicle storage area v N n i-� "c'" " y 0445 mvt�,-J .ser Curtain drain N 0-C HeNOwh✓ Wells on adjacent lots /00 f Property line /0 F. ENGINEER'S CERTIFICATION / certify that I have determined thru field inspections and review ofiVialicipal records t6Tlt�Ad�f{(ibatg ll(�Sy�'e in conformance with A10A /-/�/1 guide nes in effect on this date. a%'C �.' -1do � � Signature iI ;� �t E'ngineer's Name C Co wH�/ Pr { L'1't SvaFf{efat•��. V� k08F C. COWAN C CE -8801 ;?\. Date `i .\.� HAA Fee '" Date of Payment Receipt Number ( Ce� / Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ C;� z 2-Dp Date of Payment Receipt Number /X,7 • T MUNICIPALITY OF ANCHORAGE 19DEPARTMENT 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. # 017-381-09 HAA If HA920173 1. GENERAL INFORMATION Complete legal description Lot 3 Tustamena Terrace Subdivision Location (site address or directions) 5701 Naknek Lane Property owner Dan & Belinda Hisey Mailing address 5701 Naknek Lane, Anc Lending agency Mailing Agent 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 three (3) xxx . Day phone 265-8962 Alaska 99516 Day phone Day phone 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 xxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Buzdor Engineer Address HC 02 Box 7710, Palmer, Alaska 99645 Engineer's signature DHHS has the original stamp and signature on file this is a re -type of the original Certificate. If there are any questions, please call our office at 343-4744. 6. DHHS SIGNATURE Approved for % �> bedrooms. Disapproved. Conditional approval for Additional Comments 0 M ITIC Phone Date 746-2519 bedrooms, with the following stipulations: Date 3_ 3/: 92� 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 orderto satisfy certain federal and state requirements. Employees of DFIHS 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(Rev.1/91) Back MOAN21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 7y5km-eoa, erreze, /✓w 4, 3 Parcel I.D. 0/ %- 3fl -0/ 000 A. WELL DATA Well type I1y'44f- If A, B, or C, attach ADEC letter. ADEC water system number N9 Log present (Y/N) 7 `S Date completed /0-20- el Driller Vel pr/"" � Total depth Sanitary seal(Y/N) Date of test Static water level Well flow Pump level 5- to )75- Casing height 2011 Wires properly protected (Y/N) FROM WELL LOG /0-- t 3y A. I go _. 9. SEPARATION DISTANCES FROM WELL TO: r Septic/holding tank on lot /V Lv / Absorption field on lot 0 7 AT INSPECTION 3-� - 9z m /y3r ti m y rD- g.p.m. r t�Vl �✓I✓Wk.- co O F)Z tT � n rn f) r�ayy ead Iv D O m On adjacent lots o On adjacent lots /00 Public sewer main Wk- Public sewer manhole/cleanout Sewer service line Petroleum tank 0 �tt� 2i�i% /9YRt 1 WATER SAMPLE RESULTS: Coliform Nitrate �`) Other bacteria__ Date of sample: 3 1 o Collected by: ,70,lvy L41Vo(� y B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) 7-d 1 High water alarm (Y/N) Date of pumping �J (o i Tank size 17- Sri 6' / Compartments Z Foundation cleanout (Y/N) Y Depression (Y/N) A Alarm tested (Y/N) V/14 _ Pumper G 0 h a SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ) O o t On adjacent lots Foundation Z/ t A11A To property line 21? Absorption field � Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical i SEPA Af Well o tt "Pump on" level at E FROM LIFT STATION TO: D. ABSORPTION FIELD DATA Date installed -7-81 Length L) 3 Width 3` On adjacent lots i/Access(Y/N) "Pump off" level at Cycles tested Surface water _ Soil rating Z Z S J + System type -/ —Gravel thickness Total depth 2 Total absorption area ����� Cleanouts present (Y/N) Depression over field (Y/N) 1Vn Date of adequacy test % Z Results (pass/fail) pm %' for 3 bedrooms Peroxide treatment (past 12 months) (Y/N) N0yit a � r2�t.rerov� If yes, give date �- SEPARATION DISTANCE FROM ABSORPTION FIELD TO: t Well on lot I(0 7 On adjacent lots 100 -1 - Property line � z ) To building foundation 7 To existing or abandoned system on lot AIIA Onadjacentlots 2'2� Cutbank /00 Water main/service line__N/X Surface water 100'4- Driveway, parking/vehicle storage area /21d- At Curtain drain �✓�/T /S a �cl�r y cJY;V e 1/cr.-I , E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in Signa Engin Date HAA Fee $ / �� "�y Waiver Fee: $ Date of Payment `< z Date of Payment Receipt Number ``L�z ���� Receipt Number 72-026 (Rev. 3/91) Back MOA 21 g this inspection. - ' 4Pth •,�(�� ' a� CE -7 rc`,4`" ,PROFESS\ON�TmC\ v 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 Z�/ZA_ 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) G3 f3� Tus��svasr�re� Tdrac� T/Z�/ P3 W Srtc Z7 Location (address or directions) s7o 1 Na 1wk Lame (b) Applicant Name A/1Z / Telephone: Home,/3�+'eW{/5�73� Business Z63- Applicant Address 570 , lyazlw¢ iii (c) Applicant is Scheck one): Lending Institution E] ; Owner/builder.; Buyer[] ; Other E7 (explain); (d) Lending Institution _,��lis�" ,1�ciC (} �L., x�l�lc Telephone Address j (e) Real Estate Company and Agent e Na d Address Telephone Z7to-Z76i (f) Mail the HAA to the following address 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms • 3 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite( Public E7 Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 - 72-025 (17784) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date X7.`177 5! /- 5040 Approved Approved �_ bedrooms by Disapprov tl Conditional Terms of Conditional Approval CAUTION 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 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) FEB 1 3 t1 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 284-4720 C EIV E D Legal Description: L 0 rClS 2h2Gi1A %ldiCCG� % /z Al 1,!73 k/ 5Q 7 A. WELL DATA Well Classification RrIll o'- If A,,B, C, D.E.C. Approved (Y/N) Well Log Present (91N) - Date Completed /D�ZO� y - / Yield Total Depth 175Cased to /95 Depth of Grouting N�A Static Water Level .37 r Pump Set At 41AIKN6WM r v Casing Height Above Ground — ElectricalWiringin Conduit (Y/N) Separation Distances from Well: To Septic/Heldmg Tank on Lot /00r'k Sanitary Seal on Casing (YIN) — Depression Around Wellhead (Y/N) ; On Adjoining Lots >/,9D To Nearest Edge of Absorption Field on Lot 107'e ;On Adjoining Lots 7 �0b To Nearest Public Sewer Line N_1A To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot / / Water Sample Collected by L C'E/A^� AECS, to Date Z�/b16?6 Water Samp Comments B. SEPTIC/HOLDING TANK DATA Date Installed ZI/8/ Size /Z t5O No. of Compartments Z Standpipes (Y/N) Y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) ` y Depression over Tank (Y/N) Date Last Pumped -r Pumping/Maintenance Contract on File (Y/N) NIA ; for NIA Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /0O r ill" To Property Line To Water Main/Service Line ZO 7A Course Comments Page 1 of 2 72-026111/84) To Building Foundation To Disposal Field S� Z/r ')k To Stream, Pond, Lake, or Major Drainage 43 '50 lusle"al`/at Terrace C. ABSORPTION FIELD DATA r / Soils Rating in Absorption Strata Z ZS %K Type of System Design ��QP /7zwn/7 -_ 23/ ' Date Installed //� Length of Field 93 349 /kcks Width of Field Depth of Field �Z Gravel Bed Thickness Square Feet of Absorption Area ��� r p Standpipes Present (Y/N) y Depression over Field (Y/N) N Date of Last Adequacy Test !/ 1-1011-101—e601 Results of Last Adequacy lest �rA�<S GtG �O? BUY -3 f5g?10 0?k1 Separation Distance from Absorption Field: To Water -Supply Well /0 7' To Property Line r To Building Foundation -37To Existing or Abandoned System on Lot Y ; On Adjoining Lots ZZ ;K r To Water Main/Service Line ;'40 To Cutbank (if present) IV ,A To Stream/Pond/Lake/or Major Drainage Course SOD X, To Driveway, Parking Area, or Vehicle Storage [iy! SG6�Cc�e%� IrV�Z ��9lc/ Stora geArea Comments STy7T�/ 2L i? e& iit_ D. LIFT STATION Date Installed Size in Gallons _ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions '" Check Permitted Bedroom Rating Against HAA Request " Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that ave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed _ 1 Date Z11-1Z/8� Company 1467M ZW, MOA No. 8s__02 4 Receipt No. 315)T7 Date of Payment oZ - 13 -8k - Amount: $ S0-0� Page 2 of 2 72-026 (11,84) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application atep r6' �' (a) Legal De n (include lot, block, subdivision, , township, range) Location (address or directions) a o 1 ti A!1 �ci� /_4M �' nTelephone3`�5 -SOS` (b) Applicants Name - Home Business i Applicants Address 57y t PL K (c) Applicant is (check one) Lending Institution;�e builder; Buyer ; Other.' (explain); -- (d) Lending Institution Address. (e) Real Estate Co. & Agent 22-7!%/i �e✓� �/ //2%C- _ __— i Address Telephone %� ' Q� `'� /Gt�e%� `6E.�c�✓ (f) Mail the HAA to the following address: 2. Type of Residence Single -Family F�d Multi -Family F. Other (describe) _ Number of Bedrooms _ 3. Water Supply Individual Well Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Holding Tank Note:I community -well system, must have written confirmation from the State Department of Environmental Conservation attesting to ,the legality and status. [/ Page 1 of 2] As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address Date 6. DHEP Approval Approved for iG bedn Approved Di Terms of Conditional Appr Telephone �Z/ _5- 'D CAUTION THE 14UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/DlS [Page 2 of 2] 7-1.9-54 5. Engineering Firm Providing Inspections Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address Date 6. DHEP Approval Approved for iG bedn Approved Di Terms of Conditional Appr Telephone �Z/ _5- 'D CAUTION THE 14UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/DlS [Page 2 of 2] 7-1.9-54 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR 1706 RECEIVED Well Classification {^tv If A, B, or C, D.E.C. Approved(Y/N) N�A T4e11 Log Present Y ) Date Completed /a/&Z—V/ Yield Total Depth/ Cased to Depth of Grouting�� Static Water Level 17" Pump Set At 144y4wrl>? Casing Height Above Ground Sanitary Seal on Casing /N) Electrical Wiring in Conduit(2)11) Depression Around Wellhead (Y-0 Separation Distances from Well: ...�/ L e To Septic/Holding Tank on Lot ((��A!' d ; On Adjoining Lots /DO -t To Nearest Edge of Absorption Field on Lot j0J-/ -X-; On Adjoining Lots To Nearest Public Sewer Line 421 - To Nearest Public Sewer Cleancut/Manhole_ A) To Nearest Sewer Service Li on Lot N� v1 Water Sample Collected By Date4-1 V3 Water Sample Test Results f Fly L"� Ccmmnts ® LmoOp !o B. SEPTIC/HOLDING TANK DATA Date Installed _ Size J-, Sp No. of Compartments .Standpipes a) Air -tight Caps /&) ) Foundation Cleanou (Y ) Depression over Tank (Y Date Last Pined gZ ) '--- Pumping/Maintenance Contract on File (YM) for 1J Holding Tank High -Water Alarm (YM) mporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply 4Ab ll //0 To Building Foundation lot �70 To Property Line P� To Disposal Field To Water Main/Service Line �j-.(Of To Stream, Pond, Lake, or Major Drainage Course Comment Vf Receipt # Date Paid: V-17-85 Amount: 45 9t -a- [Page 1 of 21 2-15-84 C 4 - ABSORPTION FIELD DATA Soils Rating in Absorption Strata 225 � Type of System Design '96,, rl-1 Date Installed / Length of Field k13 / _ Width of Field y Depth of Field /,2/46 Gravel Bed Thickness Square Feet of Absorption Area ba ja Standpipes Present J-%) Depression over Field (YODate /of Last Adequacy Test /D 8 _ ✓ Results of Last Adequacy Test `Ct�P ccu�E 3'Qfolimnzs,. Separation Distance from Absorption Field: To Water -Supply �b ll /0 7 � To Property Lire To Building Foundation Existing or Abandoned System on Lot �/� `; On Adjoining Lots 2-2-1-)6 To Water Main/Service Line ¢3-'f' To Cutbank(ifresent) .F / aO To Stream/Pond/Lake/or Major Drainage Course 4 -/DD l -f To Driveway, Parking Area,o/ Vehicle Storage Area PwjbF hV A pmekt eku-v_«t comments N�ar�wv.vV W>r`m ®�G 041W Amr W (IG7__49711 GAJ=L D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at 'rested for Electrical Comments Dir-nsions Level at � Vent (Y/N) ng Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedrocm Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date /0 g�, Company llS MOA No. ��[m� KB1/d5/s (Page 2 of 21 2-15-84 BUZDOR ENGINEERING HCO2 Box 7710 Palmer, AK 99645 PH: 746-2519 March 5, 1992 To Whom it May Concern: RECEIVED MAR 18 1992 i. Municipaliy of Anchorage Oept. Health & Human Services I will be out of state March 7 through March 27, 1992. In my absence Sandor Manoky is authorized to act as project manager for all Buzdor Engineering projects requiring review by the Municipality of Anchorage/Department of Health and Human Serv- ices. Should any matter arise during my absence that requires my immediate attention, Mr. Manoky has the means to contact me.. V cc: file A. Buzdyr, P. E. MAR 16 '92 13:47 NORTHERN TESTING„ ANCHORAGE F.3i3 NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE 2505 FAIRBANKS STREET FAIRBANKS, ALASKA 99701 (907) 456$116 • FAX 4583125 ANCHORAGE, ALASKA 99503 (907) 27/8378 • FAX 274-9645 Dan. & Belinda Hisey Report Date: 03/16/92 5701 Naknek Lane Anchorage AK 99516 Date Arrived: 03/10/92 oJy SAL. ` • w u^ ^+-.- Cr; Reported By: Susan C. Tifental Microbiology Supervisor Date Sampled: 03/09/92 Time Sampleds 1730 Attn: - Collected By: SM MDL - Method Detection Limit Flag Definitions Our Lab #: A116478 B = Below Regulatory Min. Lo : cation/Project- H - Above Regulatory Max. Your sample ID: 5701 Naknek E = Below Detection Limit Sample Matrix: water Estimated Value Comments; Date Method Parameter Units Result Flag MDL Analyzed ----------------------------- ---------------------------------------------_------------- EPI; 353.3 Nitrate -N mg/1 0.7 0.1 03/12/9.2 oJy SAL. ` • w u^ ^+-.- Cr; Reported By: Susan C. Tifental Microbiology Supervisor I/T zq- 7�0 14 If �U,q2 HARS ASSOCIATES INC. TEL No.907-349-8791 Mar.25,92 17:30 P.01 �T7� #WPM a � NI-, -, 41% 1 � RECEIVED MA" 51992 . MunlGilaiiiy of Anchorage nchorage J)ept, Health & Human SeTviceS S� 4 . D11- -MpIli iil - 014 I",' W VV AP Pj �, 4bq • I I I I i � � � I. .. I 1 I i 1 I i 1 U d w RECEIVED 1 • x•.. .. .d MAR 2 5 1992 .,.n .....d..r_v,•..,e:..'.., .. ••...•.�Tw..�Yrr:a,:... lUfliui¢3'dluyofAnchorage. . bopt. Health & Human Services ...:....................... n: .= W !I I . i r1z _Cho -K, t'1 i i\j j I I I j de A. 97' fo RECEIVED MAR 2 51992 w1u,"cipalay of Anchorage Dept, Health & Human Servi, !04, 0 1 'r 104 .,`t it �� Ir�lll%' . j ..' • i 9: Ii I-AIf 4' {{ 'It II•�.�• e t .Iii �'• .�; ; i {iP'Ir. cFI'ED MAR 2 5 1992 IkiUgiL`ivaLb Pit, H,eatth Human g rage ervices 6,0 C�3 e6eaoua:,� Z66L L Z UVIN ^,j V I•' // I I) l ld - ALASKA ENVIRONMENTAL CONTROL SERVI( S, INC. 1200 West 33rd Aven,.e, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOB d 3 TL/STEM4,-1A T�.PAGE SHEET NO. / OF CALCULATED BY SF 5 DATE ZAZ"w CHECKED BY DATE B 13 ro NA&NE/c a,gwE —" PRJYn T.:.1' ter"' 11 r v- elu: ALASKA 01ROWnTAL COnTROL SeW INS, InC. Engineerinq & Enuironmental Studies MILLIE CLUBB 5701 KNAC KNAK ANCHORAGE AK SELLER — MIKE AND VALERIE KINNY SUBDIVISION — TUSTENENA TERRACE ADEQUACY TEST FOR SEWER SYSTEM OCT 30 1984 ✓" BUYER — BRIAN FULLER BLOCK — LOT — 3 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 688 SCAT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 512 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HONE. FLOW TEST ON WELL THE WELL FLOW RATE WAS 2.7 GPM FOR 3 HOURS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. 1200 LUesf 33rd Auenue, Suite 3 • Anchorage, Alaska 99503 • (907) 561-5040 Time APPLICr NT FILLS OUT UPPER HAI17ONLY Time f Property Owrig; -' `�� F -Y A/� cs-C\Sml t L Date Phone Mailing Address y) -- —_c�, Aril n ) i Zip Code (' <:.�;�t� 1. Z .— 02"j Ihspector nsp�ci Buyer _ Address Zip Cade Field Notes: Q Lending Institution r - (-. �Cl.� \ O "�"� - v— Phone Address - Zip Code Realty Co. &Agent r - Phone Address r ) \ ! G (.. ,', �' _ Zip Code\/� L• >-' Legal Description 'CONDITIONS OF APPROVAL _ CO�iNN-D-ITIONAL APPROVAL' - - DA 6' Y Street Locati BY: Type of Residence Soils Rating ❑- Single Family - - - - Well Log Received ❑ Multiple Family No. of Bedrooms - - Well to Tank (o'L ❑ Other Water Supply .Q Individual - - ATTACH WELL LOG. A well log is required for all wells drilled since. June, 1975. 71 Community - For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal / EJ Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utili y: ❑ Holding Tank - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE- PROCESSING CAN BE INITIATED. - Time IITVme Time f Time Date Dat D Datt(el? Insp or Ihspector nsp�ci Inspector �-'� Field Notes: Q 3 ��O ?V01—ON— 14 ( )APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED CO�iNN-D-ITIONAL APPROVAL' - - DA 6' Y BY: Soils Rating Date Sewer Installed Well To Absorption Area 10�+ Well Log Received Septic Tank Size '7 Well to Tank (o'L 72 023 (XU) l