HomeMy WebLinkAboutSEACLIFF BLK 3 LT 13Aacliff
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Lot 13A
011-221
-40
Permit Number: OSPl11042
Tax Code Number: 01122140000
Work Type: Septic
Permit Effective Dates: A,pril 28, 2011
On-Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
to April 27, 2012
Design Engineer: A,NDERSON CONSTRUCTION & ENG'G
Subdivision: SEA, CLIFF
Site Legal Address: SEA, CLIFF BLK 3 LT 13A, G:2424
Owner/Address: KIMPTON RANDY LYNN &
KIMPTON MACEY JO 5207 SHORECREST A,NCHORA,GE AK 995151030
Site Mailing Address: 9311 JACLA,IRE LN, Anchorage Lot Size in Sq Ft:
Total Bedrooms:
11014
3
This permit is for the construction of:
Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:~
Issued By:
Date:
Date:
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
UNICIPALITY OF ANCHORAGE
~ ~ ' Phone: 907-343-7904
Fax: 907-343-7997
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. :,,, i ~-
Property owner(s)
Mailing address
\~,,,~ ~,~ (/D- ~ r-~ ? ~--o r'q Day phone
'
Site address
Legal description (Sub'd., Block & Lot) ~'-~ ¢(, L(- ~'~
Legal description (Township, Range & Section)
Lot Size /q'. ~,~ + Sq. Ft. Number of Bedrooms
THIS APPLICATION IS FOR: THIS APPLICATION IS AN:
([~ all that apply)
Initial []
Absorption
Field
\
C ~-'ro h ~ r,, ~ Upgrade []
Septic Tank []
Holding Tank [] Renewal []
Privy []
Private Well []
Water Storage []
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Peri~i~ush Fees:
~"~ate of Payment:
Receipt Number:
Permit No. 'r''' ~ ~
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 )
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4661 Natrona Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
April. 22, 2011
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: Seacliff Subd. Blk 3, Lot 9
To Whom it may concern:
Attached is an application for a cleaning of the existing septic system on the referenced lot. The existing
system has a concrete tank and seepage pit and only need a good cleaning. The leach area around the
concrete seepage pit will be enlarge for the correct size, it is currently 12' x l 2' per the 1971 asbuilt.
Additional sewer rock (18'x 18') will be added to make the system meet the correct 3 bedroom size. All of
the existing cast iron piping will be replaced with plastic pipe.
The subdivision is serviced by community water and all of the slopes within 200 feet are less than 3 percent.
None of the neighboring lots will be impacted by this modification.
If you have any question please call me at 727-8864.
Sincerel~ ~'
Michael'N. Anderson, P.E.
{~ ',~j, MUNICIPALITY OF ANCHORAGE
/: DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
; ENVIRONMEN'I'AL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE I []NEW
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
~ ''Well% 'Ab *'~q~"~' I ~-~ ~sorption area, Dwelling PERMIT NO.
--~ ~ DISTANCE TO:
I- ~ Manufacturer Material No. of compartments
¢ Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth
1~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
'~--k-O Z c~Manufacturer Material Liquid capacity in gallons
~ We,J~::~ PER M~N~/
Foundat~% Nearest lot line
~ ~ ~No.DISTANCEof lines TO: C~Length~.of ~J~ea, li~e~, Total l eng~o~ Ii nes Trench width Distance between H ne,
~ Top of tile to finish grade ~ ¢~ Material beneath tile ~ _~ Total effective ~o~t~ area
Length Width ' Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
"'"',~ .~,V' , l 1
2...% ............ · '~ ~ l~ ~ L
q;gx:.. .;::.,'?
'~?NAL .~ ~ ·
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
9 ::L ':.L :L FFIC:L;;:L'[ F:E
.....l~r-_F' OF: :E;O'Z!... FIB::.E;Cff;~iP'T?.'"I,J '/..:;'./':~'FEFi ..'{'~.:, ' 'TRENC:H
HFii:.,:tMLtf.! i'.,IL.!,~,i[:3E:.F,.: OF E~E.r.>F?"JE¢i:E =
E:;C;!L. RFtTZNG <.:E;(;! FT.-'F:~'= .~,-=':'
"FHE REE:!U]:F-:fED :SZ;:~:F' F'd:' THE ,=,,,-'ri F!E~E;ORF'T'r"'d'., ':;'u'::'TF'~','~ Tq'
]".FIE L. ENG'TH DIMENSION !:E; 'THE L. ENGTH (I!",! F'EET> OF ]"HE TRENCH OR .r-')RF!ZNFZEL. D.
'THE DEF:'TH OF' F':I TRENCH OR PIT' !~1 THE D;[S'TF!NCE 8ETHEEN THE E;UF4:FF:IC:E OF THE
GROLIND RND THE E~OTTOI'.'I, OF THE E:,.fCRVFcTiON (IN FEET).
THEF,.:E .T.f.:; NO SET NIE.',TH FOR TF.'ENCF!E:5.
THE GF-::R',,,'E'L [)EF'TH !B THE i"!INIM, UF! C, EF'TH OF' GRRVE:L BE:TNEEN THE OUTFRLL.
RN[:, THEE BOT'TOH OF' ]"HE EXC¢~',/RTZON .'.'.'IH FEET).
PERi',11 ]" RPF'L !' CF~NT HR:E; THE RE:.'SF'ONE;I 81 L I 'T'-/ 'TO I.NFORH TH 1:5 DEPRR:THENT E:,UR Z i'.,!G 'THE'
!i'.!%TFILL. R'TiCiP,! t N%F'EC:T!ON:'E; OF FtN¥ .~4EL. L.:i.:,' RDJRC.'EN'¥' 'TEl THIS PROF'ERT'.r' RND THE
NUi"!BE:R OF RES:[F..',ENCEE; 'TH,C!"F THE NELL i.4T. LL .E;ERVE.
MIN!HUP'I [:,iSTRNC:E BET!4EEN R NELL RN[> RN"/ ON-Si-FE .'L:.Ei,.!RGE DI::-":;POSRL .'SY?T'EH 15
::LEIE'! FEET FOR R F'R!VFFI"E: NELL. OR f~i;Et T(] 2i._:.ii~.~i FEET F'ROF! g F'UBL. iC HELL DEF'EN'f>i?,iG
L!PON THE 'T"gPE OF' F'UBL:[C NELL.
P!ZN:EHUi"I E:'!STRNC:E F'ROH Fl PRiVR'TE NELL "r'O R F'RIVRTE SE:!,.!ER LiNE .'i.':E; 25 FEE'T RNE:,
'TO R COi"IHLINT. T'9 SEi.4ER LINE l% 75 FEET.
OTHEF,..: F.:E~;RJZF;.:EP!ENT~'; HFI'./ !hF:'F'L'9. 7:;PEC"-rF]:C:FCFIiZ)N% FIND COt"~S;TRUCTT. ON E:,II=!GRFIHE=, Fff;.'.E
RVRZL. FtE:LE:: T'O !NSLtfRE F:'RC~PER INL::TY.R.L_LFFFZON.
T CERT ]: F'V 'THFFI"
F'/R'TF.
.. l,. , THE Ot'-,t-.'.:5!TE SENEZR :.E;'9:E;""ETM HR'./ RE;Z;]U?.RE: E:NL..F~RGE['"IENT IF:' THE
RES .!. [:,E NC~E'.:
E~ [:,FITE ...... ] ......
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAl PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
2
3
4
7
8
10
12
14
17
18
20
COMMENTS
j~/ SOILS LOG
[] PERCOLATION
TEST
Y~t,,.. I,,~ ~ ¢"~ F ~,..i¢~,/~ d DATE PERFORMED:
SLOPE
SITE PLAN
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND -- FT
PERFORMED BY:
72-008 (6/79)
CERTIFIED BY: ·"' '~. ¢' ~~ATE:
"~K~- ~II:K Ai~I(.;I'IORA~E AREA BOP
~ '..~ HEALTH DEPARTMENT '~'
327 EAGLE ST. ANCHORAGE, ALASKA 99501 ' 279-2511
N.° 765
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
MAILING ,_~...
LEGAL DESCRIPTION.~-/~,~-'~. -~5//_~'~ ~.. r_.C~_ ~/~'~-,,r:~-~,,~ ~r-~-~',~c~,
DISTANCE FROM WELL. ~-~'
.LIQUID CAPACITY ./"/~/~ GALLONS.
NUMBER OF /
MATERIAL ~'~:~'~(5~r~'-T~ zg~/-~r-/~'?~~-- COMPARTMENTS
INSIDE LENGTH/x~z~ x~.~_~ INSIDE WJDTH ~'?'~ .. DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT: ~;r~/~--/~/~_~.~/.~c~:~
NUMBER OF PITS ' / OUTSIDE DIAMETER L_.~. OR WIDTH
LINING MATERIAL ~.~=_/~,~z~j,.~ ~//~/~_~ DISTANCE FROM WELL ~/ ' '-/~-'
NEAREST LOT LINE /'-~ /
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA}
LENGTH. /'~'~. /
, DEPTH
· BUILDING FOUNDAT~ON/~
~:~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTIO RE~/A
~ , ~'---'-..~~, NEAREST LOT LINE
DISTANCE BETWEEN LINES '~ TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES
-------~JI,zlT/TOT~FF-EC.~.I VE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MAIERIAL BENEATH TILE
iN. ABOVE TILE
WELL: ¢~'~)' DISTANCE FROM
TYPE ~'~"~ '~/- DEPTH ' ~"~ , BUILD~NG FOUNDATION.
~ NEAREST SEPTIC SEEPAGE
LOT LINE SEWER LINE ~ TANK ~-'----' SYSTEM
WATER ~
SAMPLE , NEAREST
~ ~ OTHER
· CESSPOOL , SOURCES.
DISTANCES:
DIAGRAM OF SYST~
' . ' ~'~'~'-'~-~ .... ~ ']'~ .... F:"T' H ~ .... ! , , ~ ,
..... ;;F"'~ ...... ~'-'~-.-~ ....... ~:--~-,-,~ .......... ~..,.~..4 ~;~ .... -
' . ~,..~.,.~ ,;.,.L
~ ....... ;.i ...... ;...;..!..~...
~..S...=..:..... .... ~.....:....;.!..!..;.
APPROVED
HEALTH AUTHORITY
N?
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 9950! 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDREssMAILING ~,~-~// J.,~?~_~/~,/>~ (-~ PHONE~2.~ ~,//
SEPTIC TANK:
DISTANCE FROM WEU Vgg~ ~l -- --- MATERIAL COMPARTMENTS
LIQUID CAPACITY / ~ / ~ GALLONS INSIDE LENGTH / INSIDE WIDTH 5~
LIQUID ~z~ ·
DEPTH
N OUTSIDE DIAM OR WIDTH : ,
1NO MATERIAL_ DISTANCE FROM BUILDIN
/NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE ~~ .4~::~:~u/.~/'O~.~ ; ~/
- 7:/
DISTANCE FROM WELL(~ z'"~-*'?')?~'/k?z ' ~-~u~DATION
NUMBER OF LINES /-~ DISTANCE BETWEEN LINES
ABSORPTION AREA ~:~' :/
DEPTH: TOP OF TILE TO FINISH GRADE
/
/
, NEAREST LOT LINE'/
SQ. FT. LENGTHOF EACHLINE :/~
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH /// '
, OF LINES
-IN. TOTAL EFFECTIVE
~ //
IN. ABOVE TILE ~'~
WELL: TYPE ~¢~l~i~i h ~,~';r-[~EPTH DISTANCE FROM WATER
....... , BUILDING FOUNDATION -~--~ SAMPLE , NEAREST
...... -- NEAREST _.-- SEPTIC ~ SEEPAGE OTHER ,
LOT LINE , SEWER LINE ,TANK , SYSTEM , CESSPOOL , SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
'~ _ _~.~,,~:J~Z, CI: ~ - :'..'. · -,~i. :.~ /. ~ ~ ' ' : I
:., ;,. -:: -. - . -~-:: :
Parcel I.D. 011-221-40
Municipality of Anchorage
O ev: In_°S iPt ~s~t~i~p~: ~? e n t ~
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Seacliff Subdivision, Block 3, Lot 13A
Location (site address) 9311 Jaclaire Lane Anchorage, AK 99502
Current Property owner(s) Robert W. Love
Mailing address 9311 Jaclaire Lane Anchorage, AK 99502
Lending agency
Mailing address
Real Estate Agent
, Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: Three (3)
3. TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class A Well []
Public Water System []
Day phone 440-1928
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-Site []
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up 'to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further vedfy 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's 'Printed Name Michael E. Anderson, P.E.
DSD SIGNATURE
't,,,,/ Approved for 3
Disapproved.
Conditional approval for
bedrooms.
Phone 522-7773
Date 3/17/2011
~, ,e ·
CE.43Si
bedrooms, with the ~ollowing stipulations:
By:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type PWS ~t~
Date completed ~
Total depth ft.
Seacliff Subdivision, Lot 13A, Block 3
Parcel ID: 011-221-40
If A, B, or C provide PWSID # ~- I O~-~- Well Log (Y/N)
Sanitary seal (Y/N) Wires properly protected (Y/N)
Cased to ft. Casing height (above ground)
FROM WELL LOG AT INSPECTION
in.
Date of test
· Static water level
~ Well production
WATER SAMPLE RESULTS:
Coliform colonies/100 mL
Arsenic: ug/I
e. SEPTIClHOLDING TANK DATA
Tank Type/Material Septic/Concrete
g.p.m.
Nitrate mg/L
Date of sample: ~
Other bacteria
Collected by:
Date installed 1970
Cleanouts (Y/N)
High water alarm (Y/N)
g.p.m. .
colonies/100 mL
Tank size 1,312 gal. Number of Compartments 'One
FOundation cleanout (Y/N) Y*** Depression over tank (Y/N) N
Date of pumping 3/18/2011 ~r'~ ~//)~c,"~umper No Sludge Noted in Tank
C. ABSORPTION FIELD DATA
Date installed 1981 Soil rating (g.p.d./~ or ~/bdrm)85 SF/BDRM
Length 21 ft. Width 5 ~t.
Total depth 9 ft. Eft. absorption area 252 ft2 Monitoring tube
Date of adequacy test 3/15/2011 Results (Pass/Fail) Pass
Fluid depth in absorption field before test o
ElapSed Time: 975 min. Final fluid depth 0
Any rejuvenation treatment (past '12 mo.)(Y/N & tyPe)
System type DeepTrench
Gravel below pipe 6 ft.
Y Depression over field N
For 3 bedrooms
in. Water added 570 ' gal. New depth 28 in.
in. Absorption rate >= 450 g.p.d.
N If yes, give date
LIFT STATION
Date installed
"Pump on"' level at
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at
Cycles tested
in.
SEPARATION. DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Animal containment areas
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5' Absorption field >5'
Water main >10' Water service line >10' Surface water >100'
Wells on adjacent lots >200'
Property line >10'
Water Service line >10'
Curtain drain None Noted
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation >1o'
Surface water >1oo'
Wells on adjacent lots >2oo'
COMMENTS: Foundation Cleanout is Inside the House. No Sludge was Noted in the Septic Tank.
Water main >1o'
Driveway, parking/vehicle storage
>25'
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.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 3/17/2011
COSA Fee $ ~ O1 ~--" Waiver Fee $
Date of Payment '~\ t ~ / ~ I Date of Payment
Receipt Number ~-~ ~3c~ ~o Receipt Number
(Rev. 11/05)
LOT 14A
145,00' N89° 58' 00"W
.... ], . ' ... · =
30' ¢ W ~ ,~ I
II .....
~ 145,01' 889° 45' 00"E
LOT 1'~
PLO~, PLANS ~ LO~_SUR~Y~ ~;' '
.............. ~ ~r~r~d by
~,~ ~,~,~o,_,:~~'"' ~, RObert~E. Johns. Jr. A Assoc.
~"~ ~.~.. "~ ~.~P~ofessionai Lond Surveyors
'~-~-~-- !~.,' ~ ~.-.I ~.' ":~,,_3o, "
:~ ~ .. ' ~ 03,/16/11 SW2424 11-52
--= BLOCK 3 LOT 13A
~* \ ~ ..~/ Form Approved
FHA Form 2573 '~- ~
Rev. July 1958 FEDERAL HOUSING ADMINISTRATION Budgel Bureau No. 63-R296.8
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
INSURING OFFICE
Anchorage, Alaska
MORTGAGOR OR SPONSOR
Belmar Sumner
MORTGAGEE
MATANUSKA VALLBY BANK
PROPERTY ADDRESS
9311 JaClair ,
SERIAL NO.
011026
Anchorage, Alaska
UBDIVISION NAME BLOCK NO. LOT NO.
SIiACLI FF SUBDIVISION 3 13-A
TOTAL NUMBER:
BASEMENT J'~ New installation
BATHS
LIVING UNITS BEDROOMS
I 3
WATER SUPPLY BY:
[] Public system
SEWAGE DISPOSAL BY:
]Public system
~Yes [] No
[~ Community system
]Community system
Con attic ar other area bo made into
additional bedrooms?
(If Yes, how many~)
[] Individual
[-'~] Individual
[]Yes [~] No
PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the F--] State [] County [] Local Department of Health that this individual water-supply system
[] is [] is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the [~ State [-'] County ~ Local Department of Health that this individual sewage-disposal sys-
tem with proper maintenance:
~-~ Can be expected to function satisfactorily, and N Cannot be expected to function satisfactorily
' is not likely to create an insanitary condition
March 17, 1971 y///~?//; ?. 4~/~..- Sanitarian
1,, t? ~,;y
NOTE: Tte beth
spaces Provided./
Use of ~h~above grid for Health Department Inspector's sketch as well as use of the back of this form is at the option of the
health autho~.
PART Ill.--FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
! have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the
Individual water-supply system be considered [~ Acceptable [~ Not Acceptable
Sewage disposal be considered [~ Acceptable [] Not Acceptable.
DATE
SIGNATURE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
FHA Form 2573
Rev. JuLy 1958
REPORT OF INSPECTIONmlNDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMARY TREATMENT consists of [] Septic tank. [] Cesspool.
Septic Tank~
Distance from well,
Total liquid capacity,
Inside length,
Cesspool:
Distance from: XY/ell,
Inside diameter,
feet. Material
Number of compartments
gallons. Capacity inlet compartment,
feet. Inside width, feet. Liquid depth, feet.
gallons.
feet; foundation, __ feet; nearest lot line at [] front, [] side, [] rear,.
feet. Depth,. feet. Liquid capacity, gallons. Lining material
SECONDARY TREATMENT consists of [] Tile disposal field. [] Seepage pits. Other
Tllo Disposal Field:
Distance from: Well,
Total length of tile lines,
Trench width.
Length of each line
feet; foundation, feet; nearest lot line at [] front, [] side, [] rear,.
feet. Number of lines, Distance between lines,
inches. Total effective absorption area in bottom of trenches feet. Depth, top of tile to finish grade,
Type of filter material: [] Gravel. [] Broken stone. Other_
Depth of filter material beneath tile, inches. Depth of filter material over tile,
Seepage Pits:
Number of pits . Outside diameter, feet. Depth,
Distance from: Well, feet; building foundation,
Inspection made by: [] State.
feet.
.square feet.
inches.
Date of inspection
inches.
__ feet.
.feet. Lining material
feet; nearest lot line at [] front, [] side, [] rear,
[] County. [] Local Health Authority.
Inspected by-
19_
(TIT[lO
REPORT OF INSPECTIONMINDIVIDUAL WATER-SUPPLY SYSTEM
Distance to nearest public water main, feet. Size of main, inches.
Individual wells [] are [] are not customary in neighborhood.
Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water
Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems.
Lot size: feet wide, feet deep. Dwelling set back from front property line, feet.
Individual water supply from: [] Drilled well. [] Driven well. [] Dug well. [] Bored well.
Distance of well from:
Building foundation
cast iron sewer, feet; tile sewer,
seepage pit, feet; cesspool,.
Well construction:
Diameter, inches. Total depth,
Approximate depth to pumping level of water in well,
Sealed watertight to depth of~ feet.
feet; nearest lot line at [] front, [] side, [] rear,
.feet; septic tank, .feet; disposal field,
feet; other sources of possible pollution, feet.
.feet. Type of casing, Depth of casing,
feet. Approximate yield, gallons per minute.
Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill.
Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No.
Pump~ [] Shallow well. [] Deep well. Length of drop pipe,, feet. Pump capacity,
Located in: [] Basement. [] Pumproom off basement. [] Pumphouse above ground. [] Pump pit.
Pumproom properly drained: [] Yes. [] No. Pnmp mounting watertight: [] Yes. [] No.
Type of storage: [] Pressure. [] Gravity. Capacity, gallons.
Has bacteriological examination of water been made? [] Yes. [] No. If answer is "yes," give date
Quality of water [] is [] is not satisfactory for hnman consumption.
Installation [] does [] does not comply with approved exhibits, if any.
Inspection made by: [] State. [] County. [] Local Health Authority.
Inspected by
Date of inspection 19
gallons per minute.
19
(TITLE)
feet~
feet;
· , APPLI(, 'NT FILLS OUT UPPER HAl "-ONLY
P~r~)perty. Ow. ner ~,~ t..J"~ -'~, ~o p Phone
Buyer [.~ d ~
Address ~ ~, L.~('~.. ~G ZipCode
Lending Institution ~.~.- ~ ~m~, ,~) ~ ~_' ~ ~ ~zc.~'.z.,.._.k~' Phone
Address, Zip Code
Realty Co. & Agent ~G ~7~ ~ ~ L. ~ ~[. Phone
Address '1~ Cc~ ~. ~~
Street Locati~ ~/~ ~C ~
Type of Resi~nce
~Single Family
~ Multiple Family No. of Bedrooms
~ Other
Water Supply
Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer Disposal . ;~ ,.: ~:~: .~ , -:
Individual Year individual Installed:
Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
DEPT
I.i ~-- o.
~ ., ENVIRON,','.:r,.,~,- ·
RECEIVED
(~,~ ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE
Soils Rating Date Sewer Installed Well To Absorption Area WeN Log Received
(~ / ~ ~ ~" ~ ~ I Well to Tank Septio T~k Size
72.023 (3182)
'" ' '-- ] DA'~'RECEIVED
'INSPECTION APPOINTMENTS .
TiME TIME TIME
DATE DATE DATE
MUN;C;FAL;~,'
~UNICIPAMTYOF ANCHORAGE DEPT. OF HEALTi{ &
DEPARTMENT OF HEALTH & E~VIRON~E~TAL PROTECT~[RONMENTAL PJ~OTECTION
825 ~ Street - Anchorage. Alaska 99501
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DI RECTIO~8: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER ~ .~.~ . ( PHONE
MAI~NG ADDRESS _ ~'~ . ~ ~
PROPERTY RESIDENT (If ¢ifferent from above)
2, BUYER ~ PHONE
MAILING ADDRESS
3, LE~I~GINSTITUTIO~ ~ PHONE
4, REALTOR/AGENT ~ PHONE
MAIUNG ADDRESS
5. LEGAL DESCRIPTION
STR E ET 'LO~C,~TI ON
6. TYPE OF RESIDENCE
'[~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
I~ One I~ Four
[~ Two [] Five
[~;]/' Three [~] Six
[] Other
7. WATER SUPPLY
;// INDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. Awell Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** 'zJ ~q,~ (:
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY E~3 ONE E~ THREE E~ FIVE [~3 OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY l(~ --'~ ~)
Connection Verified INSTALLER
[]Septic_Ta.nkor [] Holding Tank
Size: ,]?~[,~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL /~-~ /~
4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line
I
I
WELL TO: ·
Absorption Area to nearest Lot Line
5, COMMENTS
PROVED FOR _3 BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev, 6/79)
J~4UNI(JIPALI I ¥
MUNICIPALITY OF ANCHORAGE DEPT. OF H~ALTH &
) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'~j~(JJ{ONMENTAL pF;OTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION JAN 5 1979
Telephone 264-4720R E C E 1 V E D
REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (~0) days for processing.
1. PROPERTY OWNER PHONE
MAILING ADD--SS
PROPERTY RESIDENT (If different from above) PHONE
2, BUYER ,, ~ ~..~ ~ PHONE
MAILING ADDRESS
3. LENDING INSTITUTION J PHONE
I
MAILING ADDRESS
MAILING ADDRESS
5. LEGAL DESCRIPTION
TREET LOCATION
TYPE OF RESIDENCE / NUMBER OF BEDROOMS
[] One [] Four
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
[] Other
7. WATER SUPPLY [] INDIVIDUAL*
~ COMMUNITY
[] PUBLIC UTI LITY
8. SEWAGE DISPOSAL SYSTEM
J~;~"'-I N DI V I DUA L/O N-SI TE**
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is requ'ired for all wells drilled
since June 1975. For wells drilled prior to_ / .nthato~ate' give well
depth (attach log if available.) /..f//,/~
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
= r
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIViDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[:]Septic Tank or [] Holding Tank
Size: I .~ I ~-~ If Tank is homemade SO~LS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AR EA MATERIAL ~}~
4, DISTANCESwELL TO: Septic/Holding Tan~ Absorp~on Area Sewer Line Nearest Lot Line
_
.. .... : , '. ~:::~?~.. , .~,~.:,~,.
~ APPROVED FOR .~ BEDROOMS
~/~NDITIONAL APPROVAL (letter must accompany certificate)
~ DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
825 "L" S-I-REET
ANCHORAGE, ALASI(A 99501
(907) 264 4111
GI-ORGE M. ~-~U[ LtVAN,
MAYOR
I)EPA[TTMENTOF HEALT'H AND ENViI~ONMENTAL PROFECi'ION
September 24, 1981
Joan N. Mc Farland
9311 Jaclaire
Anchorage, Alaska
99502
Subject: Lot 13 Block 3 Seacliff Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(1)
(2)
A cleanout to the septic tank needs to be installed
above ground level. This will need to be reinspected
by this office.
The septic tank pumped with a receipt submitted to
this office.
(3)
An adequacy test needs to be performed on the existing
leaching area. This test will determine if the system
is adequate according to National Standards. A listing
,of private firms performing the test is enclosed. This
test report needs to be submitted to this office for
our review.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Home Federal Savings and Loan
535 D Street 99501
Tobben Spurkland P.E.
8155 Cranberry St.
Anchorage, Alaska 99502
Phone (907) 243-5302
Joan McFarland
9311 Jaclaire
Anchorage, ~'~laska 99602
Oct° 12,1981
SEWER ADEQU~CY TEST
Legal
Locat ion
Owner
Residence
Water
Sewer
Date: of Test
Test Procedure
Lot 13, Block 3, Sea Cliff S/D
9311Jaclaire
Joan McFarland
Three Bed~bpms, Single ~mily
Community System
~¥om Municipal Records;
Tank
Absorption System
Absorption Area
Soil Rating8
Installation Date
Oct. 6, 1981
Concrete Block 7xSx4, 1312 gal
Seepage bed with three lines
( Seepage pipes buried in onsite soil,
no sand or gravel for backfill )
85
Oct° 1970
System was inspected on Oct, 6. The liquid depth in tank was
found to be61~ inches, a strong indication that the tank was
surcharged. 5 gal ~s added to the tank this caused the water
to come to the top of the stand pipe, substantiating the fact
that the system was not absorbing water. The leach lines were
dug up and by inspection it was found that they were plugged
with silt and sludge. The seepage bed was replaced with a
20 feet long trench with 6 feet of gravel.