HomeMy WebLinkAboutGALLAGHER LT 1Gallagher
Lot 1
#020-161-10
Municipality of Anchorage
On-Site Water and Wastewater Section • (907)343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191212 PID Number: 020-161-10
Dwelling: 0 Single Family(SF) ❑with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade
Name
Mike Myers & Cassie Toole ABSORPTION FIELD
Site Address
❑ Deep TrenchOther Wide Trench El Bed ❑ Mound
8610 Paine Rd, Anchorage ❑
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
Gallagher 1 Fill added above original grade Gravel length
Township Range Section
Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank j Field Lift Station Tank Line Ft2 Ft.
Well 78' 1 78' NA NA I TANK E Septic ❑S.T.E.P. 0 Holding 0 Other
Manufacturer Capacity
INFILTRATOR 4480— /D100 Gal.
Surface water
100'+ 100'+ NA NA
Material Number of compartments
Lot Line 5'+ 5+ NA NA NA PLASTIC 2
Foundation i 10'-f-, 101+ NA NA I LIFT STATION
Manufacturer Capacity
Remarks waiver on file WR020002 Gal.
Alarm location Electrical installed by
PIPE MATERIAL House to tank Tank to
Installer drainfield
A+ SERVICES Drainfield CO/MT
Inspector ARCTERRA CONSULTING BENCH MARK (Assumed elevation) 100 ft
Inspection
2d 1s, 6/27/19 6/28/19 Location and description
dates:
3rd 41" Corner on deck
ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp
.• OFvitillk111%ii IN 4a
Conditional Approval: Date =J�-<P� �js�i...
1,
— w 4•IH %\ *•0
0 KENNETH M. DU ��. ~
Septics� � �
��
Approved i"�a/'� Date .7"--- )fl ? ♦�•�;� eE 7116 �:+.
Note:this approval does not include well permit requirements. *1111dt"
(Rev 05/02/18)
AS-BUILT SYSTEM DETAILS/SITE PLAN Perr,itl❑SP191212
GALLAGHER S/D LOT 1 PID# 020-161-10
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Aiirr/�cSN `�<Q,S. 1 PREPARED FOR: RCTE�R
1 MIKE MYERS .4114%,,
/ ) 8610 PAINE RD. °ti* 4• TH �� 3 * ANCH❑RAGE, AK /(907)-980-2589
KENNE D US wslOr
/ FIELD BOOKS COMPUTED: Cc ..r w. / _BOUNDARY:N /A DRAWN: KMD Zco " . _\
1 7A//, 'Airt�'/ srAKiNa: N!/A CHECKED: KMD \ r j `���°'
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DATE: 7/2/19 � <^y A 0�
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FESSI_— DWG. FILE: GM: 3441 ce. b \\C oip
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ACAD Fly: FILE JOB No.` 19038 R/`FR SAK:99571'g1ill it NG - '5
/Users/kenduffus/Desktop/19-038 Gallagher Lot 1.dwg
•
N1('PAL . MUNICIPALITY OF ANCHORAGE
• 'x, On-Site Water&Wastewater Program .N° " ;.
PO Box 196650 4700 Elmore Road 7..
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax (907)343-7997 r.
— ; http://www.muni.org/onsite 9 ..
/ cpa r tmen t
4NcNORPVE
On-Site Wastewater Disposal System Permit
Permit Number: OSP191212 Effective Date: 6/18/2019
Work Type: SepticTank Upgrade Expiration Date: 6/17/2020
Tax Code Number: 02016110000
Site Legal Address: GALLAGHER LT 1 G:3441
Site Mailing Address: 8610 PAINE RD, Anchorage
Owner: TOOLE CASSIE K 50% & Lot Size in Sq Ft: 53450
Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: -if / - Date: - /
Issued By: Qedetp, • ' ' ?/ / Date: 18 9
."sent
( F Municipality of Anchorage s^
<< sin lig
. Department
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 o Fax (907) 343-7997
http://www.muni.orq/Onsite
Development Services Department
On-Site Water and Wastewater Section
**** VARIANCE/WAIVER REVIEW ****
Waiver#: WR020002 COSA#: Permit#: OSP191212
PID#: 020-161-10
Legal Description: Gallagher Lot 1
Engineer: ArcTerra
•
Applicant: Michael Myers & Cassie Toole
Your request for a waiver of the required 100 feet horizontal separation from the septic tank to
the private well has been approved. The approved separation distance is 80.0 feet. This waiver is
being renewed based on provision of a plastic septic tank that will not corrode over time. In
addition, recent water sample results indicate that the existing encroachment has not had a
negative effect on the water quality.
This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
t
Waiver is Granted: X Waiver is not Granted:
Date: 00/ Approved by: gi.A
etivte,
Name of Reviewer
*'k** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
4.01
Development Services Department \'• /' Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 020-161-10
Property owner(s) Michael Myers & Cassie Toole Day phone
Mailing address 8610 Paine Rd, Anchorage AK 99516
Site address 8610 Paine Rd
Legal description (Sub'd., Block & Lot) Gallagher Lot 1
Legal description (Township, Range & Section)
Lot Size 53450 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(El all that apply)
Absorption Field [ I Initial ❑ Single Family (SF) ❑x
Septic Tank Upgrade Ixl (w/wo ADU)
Duplex (D) ❑
Holding Tank Renewal
Multiple Dwellings
Privy (SF and/or D)
Private Well [ 1
Water Storage LJ
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: Waiver Fees:
Date of Payment: G`LOf Date of Payment:
Receipt Number: (196/? Receipt Number:
Permit No. QsPicio-a Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
• �RCTE,R 4
i ARC TERRA
i
CONSULTING, INC
§3,44to 20441 Ptarmigan Blvd,Eagle River,AK 99577
Office(907)696-6111, Fax(907)868-3793
°4.��+l+lii NG..„1"
•wen-
June 11, 2019
Municipality of Anchorage
Development Services Department
On-Site Water& Wastewater Program
P.O. Box 196650
Anchorage,AK 99519-6650
Subject: Septic Tank Upgrade Permit- Gallagher L 1
The owner has requested we proceed forward to obtain a septic permit to
upgrade the aged septic tank on the subject lot. The proposed upgrade will serve
the existing 3-bedroom house.
There is a current waiver for the well to septic distance of 78' and we are
requesting that the waiver to be re-issued to a distance of 80'. We will move the
tank away from the well as Ruch as possible while maintaning pipe slope
drainage. New i-a/rr?4 bo /n . raa.,-✓D.Ge,. Due ez/ens)va.na¢.c-lrce 5
nso✓ifi9 ta.n•'a s,
i' de wG i�s
// ra',ius /S fposs.'A/G .
There is no surface water within 100' of the proposed tank. There are no Private
wells within 100'. We do not expect there to be any adverse effect on adjacent lots
by the development of this tank. If you have any questions, please contact me at
696-6111/FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
_ . i.0,
Kenneth M. Duffus, .E.
Attachments: On-Site Sewer Application
Wastewater Absorption System Details/Site Plan
20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • I'Ii (907)868-3791 • FAX(907)868-3793
WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN
, GALLAGHER LOT 1
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Scale: 1"=30'
1:DECOMMISSION EXISTING SEPTIC TANK PER CODE.
2: INSTALL NEW 1000-GALLON SEPTIC TANK WITH TWO
POST TANK CLEANOUTS PER CODE.
3:TANK TO HAVE MIN.20"MANWAY RISER.
4:MAINTAIN 10'+FROM FOUNDATION&EXISTING FIELD.
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NOTES:
2
✓ NO WELLS ON ADJOINING LOTS ARE WITHIN 100'OF PROPOSED TANK PLACEMENT.
i NO SURFACE WATER NOTED WITHIN 100'OF PROPOSED TANK PLACEMENT.
o CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS,SEPTICS EASEMENTS,PROPERTY LINES,ETC...
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m / (-' MIKE MYERS �, lipm ' 8610 PAINE RD w/*4 g T .__ * ANCHORAGE,AK 99577I I530-721-7586S/ arF _. I'a' NN ' ► •FtiS FIELD 800KS caNauTED: 6, $ �� -;,i 10 V / BOUNDARY:N/A DRAWN: KSD Z '
LJ 1 �`n�c' / �`• V/ STAKING- SLS CHECKED: KMD .ry ''.
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• 1 '?E �7/��•p�F� ' ASBUILT: SLS oAtE: 6/14/19 ~'�Fyc" 0
2 \ ROFF,5..[0 DWG. FILE: GRID: C' C G' 11
SW3441 �Cb �� 90
1414•`�� ACAD FILE: FILE d08 N°.: 19-038 SFR, K.9951—'36
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
Type of crib
ENVIRONMENTAL ENGINEERING DIVISION
Crib depth Total effective absorption area
w
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
DISTANCE TO:
Well
Building foundation
Nearest lot line
PHONE D NEWS
Class
vA F
'��I—"1ri�GRADE
Driller
MAILING ADDRESS
PERMIT NO.
LEGAL DESCRIPTION
DISTANCE TO:
/I /
Sewer line
LOCATION
Absorption area(s)
NO. OF BEDROOMS
V DISTANCE TO:
Y
Well �� f Absorption area Dwelling
PERMIT NO.
'P
F-
d ZQ Manufacturer
w
Material
No. of compartments
F
vJ Liq. capacity in gallons
r
IF HOMEMADE: Inside length Width
Liquid depth
Y
JVZ
DISTANCE TO:
Well Dwelling
PERMIT NO.
_ F
Manufacturer
Material
Liquid capacity in gallons
_i=
w
DISTANCE TO:
Well i Foundation Nearest lot I
l00 !
PERMIT NO. lG
F 2 m
No. of lines
Length of each liP Total length of lines Trench widthO /
Distance bet wgep I'
¢ F
DT
Top of the to finish grade 'L / Material beneath tile
Total effective absorption area
...
Length
inches
Width rlpnth
C7
Q F-
W u
Type of crib
Crib diameter
Crib depth Total effective absorption area
w
y
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
W
Class
vA F
Depth
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
RA
MARKS
OTHER
Z
LEGAL
WE=
NEON
R■.,
N■■,
E -ME
` mur-i I iz, i F=,,1r=iL i Ttir r -.F I=t"i _HrDFrHrE3E L IS
DEPARTMENT + HEALTH AND ENVIRONMENTAL 'NTECTION
225 'L STREET, ANCHORAGE. AK. 99:_,1
264-4720
lDr4—!:ITE 'EWER PEF2r-1 I T ;
PERMIT NO. { 81086:
I'Vlrn►.9- f -91
APPLICANT MARTHA VIRGIN BOY: 4248: SRA: ANCHORAGE 99537 345-17-
LOCATION PAINE ROAD
LEGAL LOT 1 GRLLRGHER SfD LOT SIZE 54450 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD W/5-
9 -aa -9I
MAXIMUM NUMBER OF BEDROOMS 3 SOIL RATING (SQ FT/BR)= 100 fhb la
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
CtiEPTH= IS LEr413TH= r Rf=ls:•EL C•EF� TH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE ESC:AVATION (IN FEET).
THE Tt Er1r H W I CwTH I !F. !:5_ IDCrC3 FEET_
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
RE L-1 I RBC• `--EF'T I C THr.IY_ = I E= 1C3iaE5 r_31=1LLCtI'.1�17
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.
--- TWID <;' > I N<—=;F}E1_ T I i NS FFR E REt�U I REG• ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I4
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.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F}ERM I T aXF > I REQ C}ECEMLgER --Z1 . 1S:a -s�1
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR. ON -=ITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: 1 UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE•MORE THAN 3 BEDROOMS.
fUOtE : UST E XPosE
SIGNED:__ 41A."L �(� AXl577Wi' -r.A' K 7b
----- -
--- -- ---------
APPLICANT MARTHA VIR.GI v Ag -CI Fy sl2e .� _J_F
No�r uio rr�unlic I fi9t�
ISSUED B4 T` �i---------- D A TE41 J�v„____-zofJ C?D /�✓S7 l�✓
'N
ff SOI LS LOG
MUNICIPALITY OF ANCHORAGE
�L DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: mapiza. V/�-O/� / c / _DDATE PERFORMED:
LEGAL DESCRIPTION:O � 7Q /Gc �7/7�h JC %J Cli /l/5/0' %
SLOPE SITE PLAN
D PTH
ML
2 : ov
3-
4-
5-
6-
7
456
0
s .a
9 0-
10
_ WAS GROUND WATER / S
11 ENCOUNTERED? _ L
O
P
12 _ C� 1 E
_ 4'Y J u/ DEPTH? /0 WHAT ja
13
14-
15-
16-
415 1s ��`'r�q�1
17
OoW Q Ttlbot • ty
19 tii• )i0. IDeP-E 0�i
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
20
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
COMMENTS
AR /
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X678970 77 141S1\
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•� Municipality of Anch gtL 3 2019
On-Site Water and Wastewater Prot rt: _ I i
(907) 343-7904 �, ��A -
CERTIFICATE OF ON-SITE SYSTEMS ' LNErs=
Parcel I.D. 020-161-10 Expiration Date: -^ _ R — l l
1. GENERAL INFORMATION
Complete legal description Gallagher Lot 1
Location (site address) 8610 Paine Rd
Current Property owner(s) Michael Myers & Cassie Toole Day phone
Mailing address 8610 Paine Rd, Anchorage
Real Estate Agent _ _ Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
n Duplex
Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ® Holding Tank U
Individual Water Storage Community I I
Community Class Well I Public Sewer ❑
Public Water System
Waiver/Variance request for: Distance:
Received by: _ Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 950'00 k.1330 Waiver Fee $
Date of Payment hL c5/ G4 C 770q Date of Payment
Receipt Number NIC 4-19-. K- ( Receipt Number
COSA# OS CICtl ab __ ____ Waiver#
rie
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 ARCTERRA CONSULTING,INC. Phone 696-6111
Address 20441 PTARMIGAN BLVD. EAGLE RIVER AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 7/2/2019
Engineer's Comments:This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future doo.-.4"
occupants or can ArcTerra guarantee that no unseen01 4L\'1
encroachments,deficiencies or discrepancies exist. <C) 9
•
6. DSD IGNATURE k ��� ��
System #1 Approved for bedrooms. 41 , 7 IS
System #2 Approved for bedrooms. \' \\ _i
Disapproved. \\.+4111.•
Conditional approval for - bedrooms, with the following stipulations:
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By: (- cg*--e Original Certificate Date: -7'1
The Municipality of Anchorage 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 Advisory
Well Flow Advisory Other
COSA blue sheet 10.10-12 doc
/J // COS//A Checklist
Legal Description: Laalkli,er LD'1'" j Parcel ID: Uofl/
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system I
A. WELL DATA
❑Well log is filed with Onsite(or attached) Well production at time of test 3• / gpm
Date drilled 4.4 K Water storage tank volume gallons
Total depth 1E 11/ ft . Well disinfected for coliform test? ❑ Yes J3,No
Cased to 11 1 ft Coliform bacteria is Negative
Lynnitary seal is functioning correctly Nitrate O'3&&mg/L ❑ Nitrate less than MRL (ND)
❑/Wires are properly protected Arsenic /v b ug/L ❑Arsenic less than MRL(ND)
Casing height(above ground) glg in. Collected by ,4r? 7 rra.Cvr5t4-11-1 ha
Date of flow test for COSA 57,409 Date of Sample 41./7/19
Static water level at beginning of test 51' ft. �� (� /
Comments '6/10 I,JI.�/ 1Dq ;Yl P l_ $ i{�li'D 4a- 11 1 vvt (�DA i't le—
B. TANK DATA C. LIFT STATION /VA
Age of tank(s) lieu),years
L / ❑ Required maintenance completed
Tank type/material /I1fl�T''CLf�✓f;Mai C— Age of lift station years
Measured operating fluid level in septic tank 0 Lift station material
['Standpipes/foundation cleanout per record drawing Comments:
Date of pumping //A-
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6'f si Adequacy test date 5/30 9
1LL standpipes present per record drawing Results ZPass For_ 3 bedrooms
Total measured depth from grade ft(max) Fluid depth prior to test SO- in
Measured depth to pipe invert from grade ,1 1 ft(min) Water added U, gal
❑ N/A-pressurized field New depth in
Monitor tubes go to bottom of effective. If not, state Elapsed time Gy min
depth into effective
E2 Code-required soil cover over field Final fluid depth 3•S in
❑System presoaked Absorption rate o tpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) NA
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot> 100'9 Community Sewer Manhole/Cleanout > 100'
❑Yes if No 78 ft PA Yes if No ft
Neighboring Tank> 100' [I Yes if No cz, ft Private Sewer/Septic Line >25' .Yes if No ft
Absorption Field on Lot> 100' 0 Yeses if No 7v ft Holding Tank> 100' [ .Yes if No ft
Neighboring Absorption Fields> 100' Animal Containment> 50' ca if No ft
[A Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' '3 Yes if No ft $Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations> 10' [ ,Yes if No ft Surface Water> 100' 14 Yes if No ft
Property Line >5' 0 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 21 Yes if No ft Private Wells> 100' IX Yes if No ft
Water Main > 10' IYes if No ft Community Wells>200' (st Yes if No ft
Water Service Line > 10' pzt Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' LSYes if No ft If absorption field is under driveway comment below
Property Line> 10' ® Yes if No ft Wells on Adjacent Lots:
Water Main > 10' ® Yes if No ft Private Wells> 100' El Yes if No ft
Water Service Line> 10' rig Yes if No ft Community Wells>200' (E1 Yes if No ft
Surface Water> 100' IX3 Yes if No ft
F. ENGINEER'S COMMENTS
* Waivet- on Lil1e #vii?DatODD-1 . Ncu1 $a4/,"/0-4-eeI n
e ho fe . A/6u) n &f/ .srv�y a. a.t_L
G. ENGINEER'S CERTIFICATION .4,c C A/N
I certify that t have determined through field inspections and review 1 • 9 •
of Municipal records that the above systems are in conformance with • ; 49 z;,�••.
MOA COSA guidelines in effect on this date. • ,:' II
S�AKENNETH U ,�71,4;a
•4--,-J-,....
�•t - 7 1 i
I.1 q., "V fit'r
• FD ti
COSA Checklist yellow sheet •'f,,111 Ives*-
PAINE ROAD
: '
N 89'42'00"E 139.17'
_ ____ I 7 . ..
/20' UTILITY EASEMENT
•
10.2' x 16.2' SHED
4...
•• SEPTIC PIPES
/ ^.. \SEPTIC MANHOLE
/ GRAVEL .
1.0' x 3.5' CANT
1 STORY
i RESIDENCE
kt.PORCH c, 12.41
Z 'I 4.5
0 y O
O . OI
O O r
\ \ -a• rn M I Lot 2
\ \ �o
.. Q. /
'N\ oO
/
— N / NOTES:
THE DRIVEWAY ENCROACHES ONTO
ADJACENT LOT 2 AS SHOWN.
THE SHED ENCROACHES ONTO
_ I
Lot 1 ADJACENT LOT 4 AS SHOWN.
THE SEPTIC PIPES LOCATED IN
THE 20' UTILITY EASEMENT ARE
ALLOWED PER ENCROACHMENT
PERMITS ON FILE WITH THE
MUNICIPALITY OF ANCHORAGE.
7-10' UTILITY EASEMENTS —
Lot 4 S 89'43'52"W 139.17'
Tract 1
1
i
PLOT PLAN AS BUILT X_ SCALE __1 =50' GRID – SW 3441 Project No. 19-352/R1 _
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates , •Inc . (907) 522-6476 Phone ,400�� O
(907) 522-4625 Fax moo F q ��4
Professional Land Surveyors kenOlangsurvey.com o '
JonathanOlangsurvey.com �OP� S QQ
i hereby certify that I have surveyed the following described property: 0 '�
Q
Lot 1, GALLAGHER SUBDIVISION (Plat No. 77-77) *: 49TH �� '. *D0,1
Anchorage Recording District, Alaska, and that the improvements situated thereon are 0 0
within the property lines and do not encroach onto the property adjacent thereto, that
nonimprovements on the property lying adjacent thereto encroach on the surveyed oOd :l<ENN�H I. I ANQ
remises and that there are no roadways, transmission lines or other visible
easements on sold property except as indicated hereon. Q ,�'±: Q
QQ .•."t_5-5202.•'• c;"
Dated this the Day of s"` _ _, , at Anchorage, Alaska ,o '•"' NoGv
%4("ssioNx -a
It is the responsibility of the owner to determine the existence of any easements, �00400��
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
• �- Municipality of Anchorage
f On -Site Water and Wastewater Program_
(907)343-7904�H*��
Certificate of On -Site Systems Approval
Parcel I.D. 020-161-10
1. GENERAL INFORMATION
Complete legal description GALLAGHER; LOT 1
Location (site address) 8610 PAINE ROAD
Current Property owner(s) Jerusha & Mark Reed
Mailing address
Real Estate Agent
8610 PAINE ROAD
Expiration Date: /0 ` ___2) i7
Day phone 350-8664
Bethany Weiser & Bonnie Mehner Day phone 223-1632
2. TYPE OF DWELLING:
® 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
IR
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
WaiverNariance request for: N/A
Received by: _�=
COSA to be released to the
TYPE OF WASTEWATER DISPOSAL:
Individual
IR
Holding Tank
❑
Community
❑
Public Sewer
❑
requested by the engineer.
COSA Fee
Date of PaymentC%-
Receipt Number oci 1RG��Gl
COSA# 0�� J0 1
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 Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179
Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259 /
Engineer's Printed Name Jeffrey A. Gayness Date -7 Vltr
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic
system in accordance with the guidelines and regulations established by the Municipality of
Anchorage and industry practices. The reported results describe the condition of the system/s on the
dates of the evaluation. Separation distances were measured to readily identifiable features.
Hidden defects or encroachments may exist that were not identified during the evaluation. The
operational life of all wells and septic systems depend on a variety of variables including, but not
limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of
construction (materials and workmanship), and the water usage of the family utilizing the systems.
These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the system/s; therefore, GEG makes no warranty (express or
implied) regarding the future performance of the well or septic system. GEG makes no
representation whether an alternative well or septic system can be installed on the property in the
event either of the current systems fail. The content of this report is for the sole benefit of the
persoMparty who retained GEG. Reliance upon the information provided in this report by any other
person or party, including but not limited to subsequent property purchasers, is not authorized. In
short, GEG disavows any legal duty to anyone other than the person/party who paid for this report.
110kk%%Mg1tli tr
6. DSD SIGNATUREJam` ON SITE
System #1 Approved for bedrooms WATER AND Z
o WASTEWATER o;
System #2 Approved for bedrooms
�F PROGRAM \ �=
Disapproved :�o 5����,
Conditional approval for bedrooms, with the following stipulatiorisY)�)SERv��y��l,
0
Original Certificate Date:_,%- 2, 6 1-6
The MuKolKality,66f4*tfiiorage 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
Septic System Advisory
Well Flow Advisory
COSA blue sheet 9-1-12.doc
Nitrate Advisory _
Arsenic Advisory _
Other
If more than 1 septic system Is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: GALLAGHER; LOT 1
ParcellD: 020-161-10
A. WELL DATA *PER ARROW PUMP AND WELL INSPECTION. SEE NOTE ON 2001 COSA
Well type PRIVATE If A, B, or C provide PWSID# N A
Date completed LINK Sanitary seal (Y/N) YES
Total depth *111 ft, Cased to *111 ft,
FROM WELL LOG
Date of test
LOG
Static water level ft.
�0
Well production —
9 -P.M -WATER SAMPLE RESULTS:
Coliform (_ colonies/100 ml.
Arsenic: NVO ug./L.
B. SEPTIC/HOLDING TANK DATA
NitrateQ, 31 Clmg./L.
Date of sample: 7 /6 /15
TankType/Material SEPTIC/STEEL
Tank size 1000 gal Number of Compartments 2
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO
Date of pumping I I Pumper rl
C. ADSORPTION FIELD DATA
Well Log (Y/N)-Yr5-1V
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
7/3/15
L7iM1
5.35+ g.p.m.
Collected by: GEG. Ltd.
Date installed 9/22/81 -
Cleanouts (Y/N) YES
High water alarm (YIN) N/A
Date installed 9/22/81 Soil rating (g.p.d.Wo %bd 100 System type TRENCH
Length 43 ft, Width 5 ft. Gravel below pipe 2 ft.
Total depth*6.08 ft. Eff. absorption area 300 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 7/3/15 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 465 gal. New depth 1 in.
Elapsed Time: 40 min. Final fluid depth 6 in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on level at in. "Pump offleve High 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 *78 On adjacent lob
Absorption field on lot *78 On adjacent lots
Public sewer main 75'+
Sewer /septic service line 25'+
Animal containment areas 50'+
100'+
Public sewer manhole/cleanout 100'+
Holding tank 75'+
Manurelanimal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service
Wells on adjacent lots 100'+
10'+ Surface water 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parkinglvehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*WR#020002
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field Inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engines rs,P/ry' �tedName JEFFREY A. GARNESS
Date -7 ;i�t/)Js
(Rev. 11/05)
Municipality of Anchorage
I Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. sox 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-161-10 COSA#�
1. GENERAL INFORMATION Expiration Date: ! —
Complete legal description GALLAGHER S/D• LOT 1
Location (site address) 8610 PAINE RD * ANCHORAGE AK *99516
Current Property owner(s) DAVID &
KELLI WHITE Day phone
360-0390
Mailing address PO
BOX
111427 * ANCHORAGE, AK * 99511
Lending agency
Day phone
Mailing address
Real Estate Agent MARY
JO
CUNNIFF W/ KELLER WILLIAMS Day phone
317-3187
Mailing address 101
W.
BENSON BLVD. SUITE 503 * ANCHORAGE,
AK * 99503
Unless otherwise requested, COSA
will be held by DSD for pickup.
2.,.::NUMBER OF BtDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
k. STATEMENT OF INSPECTION i Y ENGINEER
As celiified by my seal a,', ixed Hereto acrd as of the valivation date shown below, 1 •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 sup'p4/ and/or wastewater disposal systen? is (are) safe functional and add chat -
for the ,number of bedrooms and type of structure indicated herein. l further verify that based on the
i ^f0"T at(^n obtained from the h;Jun;c:paYty of Anohorage filers and from my investigation and lnspeotion, 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.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance 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 i
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal r ight whatsoever.
5, DSD SIGNATURE
if Approved for bedrooms.
Disapproved.
Phone
337-6179
Date 10 9 !�
Conditional approval for bedrooms, with the following stipulations
4 t: _cIhme^ts:
COSA Checklist
Septic System Advisory
Well Flow Advisory
L----'
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
.....V........:...
A. Garness:
CE —7 53
Pa�o
\nPr
ofesslono�o
c.t lq�lii ltl ./a
OF,q� .
1 Ste: ON-SITE •'•�Gi
WATER AND ; rn=
WASTEWATER
PROGRAM
Nitrate Adviso^
Other
J
Dy— Original Certificate Date:. 13 — `� !
(Rev. 11/05)
Municipality of Anchorage �F
• Development Services Department
H
Building Safety Division S A ; T Y
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: GALLAGHER S/D LOT 1 Parcel ID: 020-161-10
A. WELL DATA *PER AAROW PUMP AND WELL INSPECTION. SEE NOTE ON LAST C.O.S.A. (2002).
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO
Date completed UNKNOWN Sanitary seal (Y/N) YES Wires properly protected (Y/N)_
Total depth *111 ft. Cased to *111 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 8/1/11
Static water level ft. 60 ft,
Well production 9 -P.M. 4.7 —9 -P.M.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 0.282 mg./L. Collected by: GEG, Ltd.
Arsenic: ND ug./L. Date of sample: 7/29/2011
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 9/22/81
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping 8/4/11 Pumper MCDONALDS PUMPING
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 9/22/'1981 Soil rating (g.p.d./ft2o 2/bdr 100 System type TRENCH
Length 43 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth *6.16 ft. Eff. absorption area 300 ftz Monitoring tube YES Depression over field NAS
Date of adequacy test 8/11/11 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 700 gal. New depth 0.5 in.
Elapsed Time: 10 rein. Final fluid depth 0 in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date –
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off' level High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot *78' On adjacent lots 100'+
Absorption field on lot *78' On adjacent lots 100'+
Public sewer main' N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*WR#020002
G. ENGINEER'S CERTIFICATION
/ certify that l have determined through field inspections and
review of Municipal re6ords that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 15
COSA Fee $ (49!b
Date of Payment
Receipt Number cis
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
OSED FNISRED FLOOR
(ASSUMED)
OSED BUILDING CORNER
(ASSURED)
ID CSIRICT
T BURDINO SETBACK
BUILDING SETBACK
BmLDINO SETBACK
M PAI N E ROAD
UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
El LOT SURVEY SURVEY TYPE SYMBOLS
❑ FOUNDATION AS—BUILT ^ SET REBAR°- D ASPHALT
171FINAL STRUCTURE AS—BUILT DRAINAGE
0 FOUND REBAR g8$ WOOD FENCE "' CONCRETE
�
PLOT PLAN ... AS—BUILT ... LOT SURVEY ... TOPOGRAPHY Aum
•c - T Nn r MFRS scT n RFr.FRTIRPATMW AS -atm T Nn 0ARNFRc sDD a ASSUMED ELEV.
oT '1t—!<—x METAL FENCE ® WOOD DECK
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
SURVEY CERTIFICATION I —Walaur._
PLOT PLAN
1 handy Certify that i how physically —yed
d
the lot drawn and deearMd nonan, and that 1
now found at aataOWAM all of 0% lot cement
44V
M
a oan an the plan and to the boat of my
AT
knowledge and ONIAla . all dif—Mi— haw been
T.r
AVY
measumd We and teasel
FOUNDATION AS—BUILT
1. Robert E. Janna, Jr.. ltreby ow" that I
haw prfamad an Ar-Bu1t s rwy of Ma
foundation an NY tot awl that ae Ns
dW~Wwe and Infa nation as ehaen hrean
�•••
ars true and no a waftleawte 0" ualese
.
Hawn othrwlN.
..
FINAL STRUCTURE AS—BUILT
1. Robot L Jotas, Jr., hewy ow" that I
,
haw prtormed an Ae-Buat eurwy of the
1
ehvctura an We lot and that it the
dwnenaane and InformaUm ce droen hraan
ts Mat ..e
an We and no anaaudwnanw
ala.n ath—l-
9 ..
OB.. .... NS. ....
ROB E
4121
a, p� o
I'.:OfeSSlona\ '-./
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
SHOWN. FENCES. WELLS. SEPTIC CLEANOUTS. SIDEWALKS. DRIVEWAYS.
ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors
1700 Brink Drive.
ANCHORAGE, ALASKA 99504
Scale: 1 TI _ 70' Rec. Lot S.F. Rec. Plot File No.
Date Surveyed: g/11/11 Drawn by. REJ Checked bMK
Date Drawn: 8/11 /11 Grid: 3441 W.O. 11-239
LOT 1
GALLAGHER
Nl
Municipality of Anchorage .•• "
• Development Services Department3:
Building Safety Division .. ..
Onsite Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.sk.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING n n,.
Parcel I.D. 020-161-10 HAA# 'dA0,-20M t,I
1. GENERAL INFORMATION Expiration Date: 4
.1506 2 -
Complete legal description 'r"GALLAGHER SUBDIVISION: LOT 1
Location (site address or directions) 8610 PAINE ROAD, ANCHORAGE AK
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
ROBERT do PATRICIA FOGUA Day phone 562-0670
P.O. BOX 102024 ANCHORAGE, AK 99510-2024
Day phone
EV HONEGGER w/ PRUDENTIAL VISTA Day phone
4241 "B" STREET. ANCHORAGE. AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
227-5822
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 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 less than 30 days old. (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.
rc/670—
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,870.00 at, orprior
to closing for the engineering services provided.
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 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 ALASKA WATER do WASTEWATER CONSULTANTS, INC.
Phone_ 337-6179
Address 6901 DEBARR ROAD. SURE 2B • ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 12 Z6 D/
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. 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 ofthe 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. AWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the flowing stipulations: YfOFf�
• WATER AND
"�AQTFIHGTF
_ PROGRAM
Attachments: jir SO
(�`
HAA Checklist X Manitenance Agreements ����I1/11111111�
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other WAIVER L ETiEl2
BY; Original Certificate Date:?—
(Rw. 1uo)
Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite Water 6 Wastewater Program
4700 South Bragaw, St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.denchorsge.ak.ua
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: GALLAGHER SUBDIVISION: LAT 1 Parcel to: 020-161-10
A. WELL DATA
Well type PRIVATE H A. B, or C provide PWSID# N/A
Date completed UNK Sanitary seal (YM)`33
Total depth •111 ft. Cased to •111 ft.
FROM WELL LOG
Data of test UNK
Static water level UNK ft.
Well Log (YIN) NO
Wires properly protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
10/16/2001
061 ft.
Well production UNK g,p,m. 5.6 g.p.m.
WATER SAMPLE RESULTS: 'PER BRIAN WILLIE WITH AAROW WELL AND PUMP
Conform d colonies/100 mi. Nitrate ,b 5mgJL. Other bacteria 0 coionies/100 ml.
Date of sample: 12/20/2001 Collected by: AWWC. INC.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material STEEL Date Installed 9/22/81
Tank size 1000 gal. Number of Compartments 3 Cteanouts (YIN) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YM) N/A
Data of pumping 11/7/2001 Pumper DENALI SEWER AND DRAIN
C. ABSORPTION FIELD DATA
'Data installed 9/22/2001 Sop rating (g.p.dJftiDr bdmr 100 System we TRENCH
Length w w 43 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth --A_fL Eff. absorption area 300 fe Monitoring tube YES Depression over field NO
Date of adequacy test 10/16/2001 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 3 In. Water added930 gal. New depth 4_5 in.
Elapsed Time. 110 min. Final fluid depth 3 in. Absorption rate >= 450+ g.p.d.
Arty rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed
"Pump on' level at _(n.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at
Cycles tested Meets alar 6 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllift station on lot •87'+
Absorption field on lot '87'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout - N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: *WAIVER REQUESTED
Building foundation 5'+
Property line
5'+
Absorption field
5'+
Water main N/A
Water service line
100+
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, parling/vehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Na a JEFFREY A I ARNESS
Date I t_ (m al
U � i�, r1 �
HAA Fee $ ?�d�Walver Fee $ `�" qao _
Date of Payment 19% I ` tO Date of Payment a 441A
Receipt Number 39 910 Receipt Number j ��
1/9/2002
Municipality of .Anchorage
George P. Wuerch, Mayor Department or
Public Works
Bttilding Safety Di -vision
P.O. Box 196650 • 4700 S. Bragaw Strcet
Anchorage, Alaska 99519.6650 • (907) 343.8301
http://%w .ci.=cliomgc.ak.us
Jeffrey A. Gamess, PE
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B
Anchorage, Alaska 99504
Subject: Waiver Request for Gallagher Subdivision Lot 1
Waiver Request #WR020002
Parcel ID #020-161-10
HAM HA020004
Dear Mr. Gamess:
Your request for a waiver of the required 100 feet horizontal separation from the
absorption field and septic tank to private well has been approved. The approved
separation distance is 78.0 feet.
This waiver approval applies to the existing absorption field and septic tank to
private well separation only. Any future upgrade to the on-site wastewater disposal
system will require all separation distances be met or another approval from this
department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sin rely,
PV*_
Daniel J. Roth
Civil Engineer
On -Site Water & Wastewater Program
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.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: 020002 PID#: 020-16140 HAM HA020004 Permit#:
Date Received: 12128/01
Legal Description: Gallagher Lot 1
Engineer. Jeffrey A. Gamess
Alaska Water & Wastewater Consultants. Inc.
Applicant: Robert & Patricia Foalla
Waiver Requested: 78 Feet from Well to tank and Well to drelnfleld
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Points:
Waiver Is Granted: X_ Waiver is not Granted:
List Conditions or Reasons for above: 5CE I ICHED
Date: /9002 By: P14AI
Name of Reviewer
Rec#: 13920 Amount: $M Date Paid: 12/28/01
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ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
December 18, 2001
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Waiver Request and Health Authority Approval for
Gallagher Subdivision; Lot 1,
The existing 3 bedroom house is served by a private well and septic system. We -request you
(grant a 78 feet separation distance waiver from the well on the referenced property to the septic
@tank and the drainfield on the property. There is no well log for the subject well. The total depth
of the well is 111 feet and it is cased to the bottom per Brian Willie with Aarow Well and Pump
Services.
The lot slopes steeply away from the well. There is level area where the house sits between
the well and the septic system. If the septic system was to overflow, it is not physically
possible for the effluent to travel toward the well head.
The location of the septic system is in a very visible area so that if any effluent was to
surface, it would be noticed and the problem corrected.
The other path of contamination is subsurface migration wastewater. There is not a well log for
the well on the subject property. Well logs from several surrounding properties are attached. As
can be seen on these attached logs, there are some confining layers of clay and hardpan soils that
should serve to inhibit the subsurface migration of wastewater contaminants. Recent water
sample results indicated nitrate levels and coliform bacteria results to be satisfactory. Based
upon the aforementioned facts, it appears that there is minimal risk associated with the 78 feet
separation distance waivers. x
We also request that your department issue a Health Authority Approval
If you have any questions, please contact us at 337-6179. Thank you for your assistance.
P.E., M.S.
6901 Debarr Road, Suite 2B • Anchorage, AK 99504
Ph: (907) 337-6179 " Fax: (907) 338-3246 • Website: akwwc.com
COSTING DRAjNnaD
LOCATK
(EXACTLOCAPPOSIS AU--
IS UNKNOWN) I
Xp
2O
cqr-�
Jog
EYISTING 1000 GALLON
SEPTIC TANK
.GRAVEL DRIVE'
Isr C.
WELL
4 0 I SHED
LOT 2
LOT I
DATE.
12/18/01 F pp
DRAWN BY:
J.W.M.
ALASKA WATER & WASTEWATER SCALE.
CONSULTANTS, INC. 1 = 40' ...... . . ... . .. ... .....
6901 DFRAM 7)337-6179 - PAX (907)338-3?,6
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:' . ... .....
ROBERT AND PATRICIA rOGUA (907) 562-0670 1 OF 1_�Q r A. ess:
FFG
LEGAL DESCRIPTION: -7953
GALLAGHER S/D; LOT I .........
TDA E OF WORK:
SITE PLAN FOR SEPERATION DISTANCE WAIVERS
Sent by:AAROW PUMP.AND WELL Nov -06-01 12:34pm from 9073338976+907 338 3246 page 1/ 1
ARROW PUMP & WEII SERVICE, LLC
P.O. Box 110496
Anchorage, AK 99511
Office: (907) 346-9355 • Fax (907) 333-9976
E-mail: aarowpumpandwellsvc®hotmail.com
MOCK
5699
CUSTOMER JOB SITE
F o� Paf Fog I/q r x'6/0 UQ 4e d.
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OUANIM
DESCRIPTION
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LABOR HOURS
RATE
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PAY THIS AMOUNT
j) y
Thank You
SIGNATURE
(I Hereby Acknowledge the Satisfactory Completion of the Above Described Work.)
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.
ACSIM
Alaska Communications Systems
December 11, 2001
Mr. Jeffrey A. Garness, P.E., M.S.
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B
Anchorage, Alaska 99504
ACS has no objection to the encroachment of the septic system ten (10)
feet into a twenty (20) foot platted easement located on Lot 1,
Gallagher Subdivision, as depicted on the as -built drawing submitted.
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:
1. ACS will be held harmless, now and forever, for any damages
or injury to any person or property as a result of this
encroachment.
2. Any ACS facility damaged or destroyed as a result of this
encroachment will be repaired at no cost to ACS.
3. Any costs incurred by ACS for special construction
necessitated by this encroachment will be borne by the
property owner.
4. All applicable safety code regulations will be observed and
maintained.
5. This letter of non -objection will in no way preclude ACS
from full use and enjoyment of its rights within any portion
of its right-of-way.
Sincerely,
Greg chmid, Foreman
Outside Plant Engineering
ACCEPTANCE:
6f\eb\Y�\4rt\btt,t\YanelyeUanW.... Y.U. t Yuawn4a. be
DATE:
600 Telephone Avenue Anchorage, Alaska 995036091 ••1907.564.1000 wv w acsalaskaco•a
-10-01 TJ; 10;07 d'd
rM CABLE FAX N0. 907666:6: F. Z
December 10, 2001
Robert or Patricia Foglia
8610 Paine Road
Anchorage, Alaska 99516
Dear Mr. or Mrs. Foglia,
Subject to your agreement to indemnify the company as set forth below, OCT Cable Tnc.
of Alaska has no objection to the septic system encroaching into the 20' utility casement
that parallels the north property line of Lot 1, Gallagher Subdivision. Known as 2610
Paine Road in city grid 3441.
This letter of non -objection in no way precludes GCI Cable 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 access for servicing its facilities. Also any additional and
extraordinary costs incurred during any future required construction, repair or
reconstruction of GCI's facilities to accommodate any or all of the encroachments shall
be paid by the property owner.
By signing below, you agree to indemnify and hold GCI Cable harmless, now and
forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities
and injury to any person or property occturing as a result of thaencroachment.
Pleasc indicate your acceptance by signing and returning this letter to myself at the
address below.
Sincerely.
��e ��
e ecca Coltton
OSP Design Engineer
T
11 cy;tance
Date le
5151 Fairbanks Street • Anchorage, Alaska 99503.907 / 786.9200
Page 1 of 1
Jeff Gamess
From: Johnson, Mio S. pohnsonMS@ci.anchorage.ek.us]
Sent: Wednesday, December 05,200110:51 AM
To: teff@akwwc.com'
Subject: FW: Letter of non -objection. Lot 1 Gallagher Subdivision
-----Original Message—
From: Johnson, Mio S.
Sent: Wednesday, December 05, 200110:42 AM
To: 'info@akwwc.com'
Subject: Letter of non -objection, Lot 1 Gallagher Subdivision
5 December 2001
Jeffery Garness
Alaska Water & Wastewater
6901 Debarr Road, Suite 2-B
Anchorage 99504
RE: Lot 1, Gallanger Subdivision, Request for letter of non -objection
Dear Mr. Garness,
Gallanger Subdivision is not in the ML&P service area. Therefore, you do not need
a letter of non -objection from ML&P.
The Municipality of Anchorage is served by three electric providers: Chugach
Electric Association that roughly serves in the bowl south of Tudor Road, east of
Boniface and west of the railroad; ML&P serves the core of Anchorage; and
Matanuska Electric Association Serves Eagle River and north. A letter of non-
objection on behalf of an electric utility for a utility easement is needed only from the
electric provider whose service area the location is in.
Sincerely,
Mio Johnson
Projects Engineer
Municipal Light and Power
12/5/01
Page 1 of 1
Kevin Wotring
From: Johnson, Mio S. [JohnsonMS@ci.anchorage.ak.us]
Sent: Wednesday, December 05, 2001 10:42 AM
To: 'info@akwwc.com'
Subject: Letter of non -objection, Lot 1 Gallagher Subdivision
5 December 2001
Jeffery Garness
Alaska Water & Wastewater
6901 Debarr Road, Suite 2-13
Anchorage 99504
RE: Lot 1, Gallanger Subdivision, Request for letter of non -objection
Dear Mr. Garness,
Gallanger Subdivision is not in the ML&P service area. Therefore, you do not need
a letter of non -objection from ML&P.
The Municipality of Anchorage is served by three electric providers: Chugach
Electric Association that roughly serves in the bowl south of Tudor Road, east of
Boniface and west of the railroad; ML&P serves the core of Anchorage; and
Matanuska Electric Association Serves Eagle River and north. A letter of non-
objection on behalf of an electric utility for a utility easement is needed only from the
electric provider whose service area the location is in.
Sincerely,
Mio Johnson
Projects Engineer
Municipal Light and Power
12/5/2001
ANCHORAGE WATER & WASTEWATER UTILITY
George P. 6Wuerch,
Mayor
Robert & Patricia Foglia
P O Box 102024
Anchorage, AK 99510
Engineering Division
3000 Arctic Boulevard
Anchorage, Alaska 99503-3898
http://www.awwu.ci.anchorage.ak.us
December 3, 2001
Re: Gallagher, Lot 1 (Grid 3441) Tax ID 020-161-10
Encroachment into Easement
Dear Property Owner:
Owned by the
Municipality ojAncltorage
The Anchorage Water & Wastewater Utility received a request from Jeffrey Garness of
Alaska Water & Wastewater Consultants, Inc. on December 3, 2001, for a letter addressing
AWWU's position regarding the existing septic system that encroaches into a utility
easement located on a north 20' portion of the referenced lot. An asbuilt drawing dated
November 16, 2001, was submitted with the request.
The subject area is outside the AWWU certificated water service area.
Wastewater facilities are to be in accordance with the Hillside Wastewater
Management Plan (HWMP).
AWWU is not using the utility easement and has no objection to the encroachment.
If you have any questions, please call me at 343-8009 or the AWWU Planning Section at
564-2739.
Sincerely,
qz4l4.t e_."w
Hallie Stewart
Engineering Technician
Cc: Alaska Water & Wastewater Consultants, Inc.
G:tEngineedng%Planning\PlanningWMstencmachmentsteasemenl-Gaitagher L-1.doc
ENSTARNaturalGas Company
tng neefIO ENERGY
Fg `parrtment
n nee n
.. 401 E. International Airport Road
V_ c i_ ' _ .. ' :. P.O. Box 190288 1'.
.. , „
Anchorage. Alaska 99519-0288
C„ _ ....' .'_.'..(907)264-3740
"
_ _ . , " _ ... '+ ^! ' .. 'FAX(907)563-4085
r
12/04/01'-
Jeffrey
2/04/01'
Jeffrey A. Garness
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2-13
Anchorage, AK 99504
To whom it may concern:
ENSTAR Natural Gas Company has no objection to the encroachment of the septic
system in the 20 foot utility easement on the north side of Lot 1, Gallagher
Subdivision. See attached as -built survey dated 11/16/01.
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:
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 property 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,
ENSTAR Natural Gas Company
_44/r �Tv_r
Dave Titus, Engineer
cc: File
12-20-01:11:41AM:CEA LANO SERVICES :7624852 0 1/ 4
ENCROACHMENT PERMIT 1103-12A
G-3441
EN01077
020-161-10
This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric
cooperative, (herein "Chugach'), whose address is P. 0. Box 196300, Anchorage, Alaska 99519 and
Robert and Patricia Foglia, (herein "Permittee'), whose address is 8610 Paine 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 Gallagher Subdivision, according to Plat
Number 77-77, recorded on the 4a' day of May, 1977, on file in the office of the District
Recorder, Anchorage Recording District, Seward Meridian, Alaska,
Described in that certain written instrument recorded on the 9t° day of December, 1960, in
Miscellaneous Book 21, Page 250, 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 South Twenty Feet (S 20') of the North 58.92 Feet of Lot One (1), Gallagher
Subdivision, according to Plat Number 77-77, recorded on the 4th day of May 1977, on file
in the Office of the District Recorder, Anchorage Recording District, Seward Meridian,
Alaska.
Permittee acknowledges the validity of the Easement. Pennittee 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 One (1), Gallagher Subdivision, according to Plat Number 77-77, recorded on the 40'
day of May 1977, on file in the office of the District Recorder, Anchorage Recording
District, Seward Meridian, Alaska,
(herein "Parcel").
Page 1 of
12-20-01;11141AM;CEA LAND SERVICES ;7624852 K 2/ 4
2. Encroachment. Permittee has purchased or constructed the following improvements on or
within the real property subject to said Easement:
A septic system that encroaches approximately Ten Feet (10') into the easement
for a distance of approximately Fifteen Feet (15'),
(herein "Encroachment").
3. Permit. Chugach hereby authorizes Permittee to continue the existence of the
Encroachment in its present 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 pcmrit, 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, Pcnnittee 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
pemtit 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.
Encroachment Permit - Page 2 of 4
:2-20-0I;11:41AM;CEA LAND SERVICES ;7524852 • 3/ 4
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. EntireAgreement. 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:
Thibert, Executive Manager
T&D Network Services
Date: /.Z —Z'p —L
PERMITTEE
Robert and Patricia Foglia
0
Date: /0? .. / � 0/
By: to
Patricia Foglia
Date: Ia .1q — C) I
Encroachment Permit - Page 3 of 4
12-20-01:11:41AM;CEA IANO SERVICES ;7824552 M 4/ 4
STATE OF ALASKA )
) ss:
THIRD JUDICIAL DISTRICT )
The
G
:lam
instrument was acknowledged before9 me s / 9 day of
2001, by RebCRIAh.0- P.4 R/GI A
.mot A.#;
STATE OF ALASKA )
) ss:
THIRD JUDICIAL DISTRICT )
Notary Public in and for the State of laska 7'
My commission expires:
The foregoing instrument was acknowledged before me this �2 day of
cCEIme aeA .2001, by 7 ;j6om
Executive Manager, Transmission and DistributionNetwork Services of Chugach
Electric Association, Inc., an Alaska corporation, on behalf of the corporation.
Notary Public in and for the Staff oolaska
My commission expires: !
1 t1 4
s -
N� AFTER RECORDING RETURN TO:
• F OF N%.-* .rr Chugach Electric Association, Inc.
•.,,, „ P.O. Bo: 196300
Anchorage, Alaska 99519-6300
Encroachment Permit - Page 4 of 4
T
5. LEGAL DESCRIPTIO
DA iti RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
TIME 1e:3-
6. TYPE OF RESIDENCE
— V
DATE
DATE 1
0z
DATE
INSPECTOR
INSPECTOR
INSPECTOR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONIRONMENTAL KOTECTION
825 L Street - Anchorage, Alaska 99501
•
JUL 3 1 1,981
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 I.YAD
WATER AND SEW I
REQUEST FOR APPROVAL OF INDIVIDUAL
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNEFPHONE
1
�T[L_-
� 19-6f 1
AIL YEAR ON-SITE SYSTEM WAS INSTALLED.
MAILING,AMORESS ri
T 4- S9 t)
PROPERTY RESIDENT (If different from above) /
PHONE
BUY-ER2.
PHONE
DrWo- 3�0
MAILING ADDRESS
v IZ bra � rz� � L lL �i
3. LENDING INSTITUTION
PHONE
MAILING ADDRESS
4. REALTOR/AGENT
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTIO
lot Q
STRE O A ION
e - -- /v iz
Kt1
(1
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
[__1 One Cl Four [11 Other
SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
Three ❑ Six
7. WATER SUPPLY
1)k 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
INDIVIDUAL/ON-SITE**
AIL YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-070 (Rev. 6/79) � I �
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
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL T0:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
APPROVEDFOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany ertificate)
❑ DISAPPROVED
DATE /
�� ��l
BY
61 /0j
r Municipality
Of
Anchorage
'1
825 "L" STREET YQ �cr
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M. SULLIVAN,
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
August 4, 1981
Martha Virgin
Star Route A Box 424B
Anchorage, Alaska 99507
Subject: Lot I Gallagher Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
1) The water analysis report needs to be submitted to
1� this office .from the Chem -Lab, 5633 B Street, for
our review.
(2) Expose the septic tank for our inspection. If there
is not a septic -tank, one will need to be installed.
(3) The seepage area appears to be failing and will need
to be upgraded. A soils test will need to -be obtained
and a permit issued by this-�department.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist n n
RCP/ljw AA
O�
May 26, 1977
Robert C. Gallagher
Star Reoile A Hoz 424
Anbhorage, Alaska 99507
Subject: W1/3 of Gallagher tract 1 subdivision
Dear Mr. Gallagher:
The water sample drawn on the above location on
May 25, 1977 is satisfactory.
The construction of that well is sati/iectory.
The serer system serving the subject lot seems to be
functioning properly, although a full comprehensive
approval can not be granted until an adequacy test
is run. there is no evidence of overflowing sewage.
If there are any further questions, please contact
this orifice at 279-2511, extension 224 or 22S.
sincerely,
Robert C. Pratt, R.B.
Sanitarian
RCP/ljh
cc: Alaska Mutual savings Hank
stormy
r, MUNICIPALITY OF ANCHORAGE.
• DEPARTME OF HEALTH AND ENVIRONMEN. PROTECTION
825 L Street, Anchorage, Alaska -99501
279-2511, ext. 224 or 225
Date Received: May 20, 1977
#1: Time �J #2: Time #3 : Time
Date - Date 5 _ a 5 7 % Date
Insp Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
rn_LA -Aim cz i b CudJeli.
1. Lending Institution Request- Alaska Mutual Savings Bank % Stormy
Mailing Address: Post Office Box 1120
2. Property Owner: Robert C. Gallagher
Mailing Address: Star Route A Box 424
99510 Phone: 274-3561/245
Phone: 277-5712
3. Legal Description: W1/3 of Gallagher Tract 1 Subdivision
4: Single Family Residence: (x) Number of Bedrooms: 3
Multiple Family Residence: ( ) Number of Bedrooms:
5. Well System: Individual Well (x) Community/Public System ( )
Permit #
Construction
Depth of Well
Well Log on File ( )
Bacterial Analysis
6. Sewage Disposal System: On-site System (x�
Permit #
Septic Tank Size
Absorption Area
Installed
Public Utility ( )
Installer
Manufacturer
Soils Rate
7. Distances: Well to Septic Tank
to Sewer Line
to Nearest Lot Line
Nearest Lot line
Material
to Absorption Area
Absorption Area
2.
3.
4.
5.
MUNICIPALITY
DEPT. Or I:
\� MUNICIPALITY OF ANCHORAGE 'rrn.',0N.+EtJi\l.
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501 r4,NY 2 C 1J/7
279-2511, ext. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES RECEIVED
Type of Inspection:
Property Owner: GALLAGHER, Robert C.
VA FHA CONV 2�
Mailing Address: Box 424 B, St Rt A Day Phone: 277-5712
Name of Buyer: none 2=0 ,
U
Mailing Address: n/a
Day Phone: n/a
Name of Lending Institution: Alaska Mutual Savings Bank
Mailing Address: P. 0. Box 1120 Phone: 274-3561 ex: 245
Name of Realtor or Agent:
Mailing Address:
a
Phone: n/a
6. Legal Description:_ W 1/3 of Gallagher Subd. Tract 1
Location: NHN Paine Road
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply
Q
well
No. Bdrms. 3
Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
72-00313/76)
Individual (on-site) XXX
'Pace _TWO
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: W1/3 of Gallagher Tract 1 Subdivision
Comments:
Affadavit Attached: ( )
Approved:
Disapproved:
Department Worksheet:
Letter Attached: ( )
Date:
Date:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
6. Date Received February 2, 1977
Time of Inspection
ai1
c' �P Date of Inspection
u aU REQUEST FOR APPROVAL OF F� /� )CL �.
INDIVIDUAL SEWER & WATER FACILITIES
FOR
I. Approval requested by: Alaska Mutual Savings Bank
Mailing Address: Past Office Box 1120 Phone: 274-3561 x217
2. Property Owner: Rohert C/Joy P Gallagher Phone: 279-3578
Mailing Address: Gtar Route A Box 424E
3. Legal Description: T14N R3w section 12 JANE. NE.
4. Location: NHN Pane Road
5. Type of facility to be inspected Sinqle Family No. of bedrooms 2
6. Well Data:
A. Type Tndividual
C. Construction
7. Sewage Disposal System: on—site system
A. Installed
C. Septic Tank: 1. Size
B. Depth
D. Bacterial Analysis
B. Installer
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
8. Distances:
2. Manufacturer
2. Material
A. Well to: Septic tank , Absorption area Sewer Lines ,
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Paqe 1 of two Daaes
MUNICIPALITY OF ANCHORAGE
. DEPT. OF HEALTH &
ENVIRONMENTAL PROTC{71ON
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION F E a 21977
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF RECEIVED
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA CONY
2. Property Owner: GALLAGHER, Robert C. h Joy P.
Mailing Address: Bog 424B, St. Rt. A/ NHN Paine Day Phone- 279-3578
Rd.
3. Name of Buyer:
4.
5.
6.
7
refinance
Mailing Address: Day Phone:
Name of Lending Institution: Alaska Mutual Savings Bank
Mailing Address: P.O. Bog 1120 Anchorage Phone: 274-3561 ex: 217
Name of Realtor or Agent: = none
Mailing Address: Phone:
Legal Description: NW 1/4, NE 1/4, NE 1/4 of section 12 T11N, R3W, Seward Meridian
Location: NHN Paine Road
Type of Facility to be Inspected:— Well S Septic No. Bdrms. 2
8. Water Supply
Type of Supply: Public Utility Individual XKx
If Individual, number of dwellings presently served
If Individual, depth of well 200'
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
72-003(3(76)
Individual (on-site) xW
Page 2 of two pages - Rec ^st for Approval of Individual F" '-r & Water Facilities
Legal Description
Comments
Approved
T11N R3W Section 12 NW4 NE4 NE;
Disapproved
Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
Date
61M,U C)
r^ new 111-A%