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HomeMy WebLinkAboutLAKE O THE HILLS BLK 4 LT 3Lake O' The Hills Block 4 Lot 3 #015-331-1i Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201491 PID Number: 015-331-11 Dwelling: FM Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New N Upgrade Name Javis & Deloise Odom ABSORPTION FIELD ® Dee ❑ P Trench El Wide Trench El Bed EJ Mound ❑ Other Soil Rating Total depth from original grade Ft. Depth to pipe invert from original epth beneath pipe 1.2 GPD/%Ft.55 3.0 Ft. Site Address 11570 Rockridge Drive Phone LEGAL DESCRIPTION Number of Bedrooms 6 Subdivision Lake O' The Hills Block Lot 4 3 Fill added above original gradength 0.5 Ft. Township Range Section Gravel width 2.5 Ft. Total absorption area 770 Ft' Beds: Number of Lines N/A Number of trenches 1 Distance between lines N/A Ft. Dist. between trenches N/A Ft. SEPARATION DISTANCES To Septic Absorption From Tank Field Holding Sewer Lift Station Tank Line i Well 100'+ I 100'+ I NA ' NA I 25'+ TANK 99 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500, 1000 Gal. Surface Water 100'+ I 100'+ NA NA Material Number of compartments Lot Line I 10'+ I 10'+ I NA I NA NA HDPE 2 EA Foundation i 10'+ i 10'+ NA I NA LIFT STATION Manufacturer Capacity Remarks Coal Alarm location Electrical installed by Installer A+ Home Services PIPE MATERIAL House to tank Tank to 3034 drainfield 3034 Drainfield 3034 co/MT3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100.0 ft Inspection v, 7/15/21 2�d 7/16/21 da:3rd Location and description 7/17/21 4°i 7/19/21 North West Bottom Of House Trim ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date �� OF co Steven F. Panror.e -;a, ', 1�� _Y) , Septic Syste Approved Note: this approval Date oes not include well permit requirements.���`e*= (Rev 05/02/181 ��umi�om��D --ii co 00 F j O r O r x A m m I ���zzF0�D > 0 (n D ZOM -H x-o>,oc)�o- W m z o m o m;o0 in r' Z z rr- m o (n D r OE (� (c m zi D D Z O 00 D 0 X �\ N -I cn IC �pm �_ U) D M � -I Z X zci -I cn --i c �r-zlr) rn D N -� Z r- r- rrimFo;z�Umi r-' D C)TIDm ON� Zv{im�m>z Din;I0'K PANNONE ENG SVC LLC (�JJ(C.J. 1088) PHONE �����\\� �FACA!?'��r�r < CiD-I-I N N co Z7N O -P CA C) DRAWN LJC =OOc�.. Om n 0V.. omZ SITE PLAN V V V O cnr9Q-: (1 c,.im o �o N C) moo o -o M � N D o O O) d1 tO —i -r7 (n (n m -� c1 cD m -D - O U (n nm V -• V -• P Ut p000cn0(Dcp Do 0) O CO V N N D (n (D CA P N N m 4A m (n (D (O V V cn Cn (n Ut U7 U7 N V 00 00 (D m (n W W N V O O -P N U7 V u \I (0 (n zi D D Z O 00 D 0 X �\ N -I cn IC �pm �_ U) D M � -I Z X zci -I cn --i c �r-zlr) rn D N -� Z r- r- rrimFo;z�Umi r-' D C)TIDm r -x �O Zv{im�m>z Din;I0'K PANNONE ENG SVC LLC (�JJ(C.J. 1088) PHONE �����\\� �FACA!?'��r�r < CiD-I-I A(Ti N rr- D F, co Z7N U D ND �rl0zjiirrlOcn ��m �ZjM �-D_I ;c.' ? �mmov) 1 " = 50' DRAWN LJC =OOc�.. Om x 0V.. omZ SITE PLAN V V V O cnr9Q-: (1 c,.im o �o N C) moo o -o M � Icnmo_'�o m (n n) orn `0 (o D o O O) d1 tO —i -r7 (n (n m -� c1 cD m -D - O U (n nm Gi CO �r�I °� o� -0 Z \ Ori> 1. C-) \ M 00 _ '��7 a V Frl 0 = m 0- V O -I � O p o m + r" ;� m K m / o OAO^Orrlp PPS \ V L<—ivm rO r:Tl v m m 2 y p D \ W y. V'i c�;u'� mZDD \ m0Zc) \ 8 O ! oF- N I apo Zo7)r- S -1 �O�\ \\ �Ca Fi~\ omm \ ` p sl D /^(nrn m 0y \ nM -Li/ .miTIW m �' (7 F_ m � rn �Cnz -DIS 0� om �! O 5 LJ \ori =m I Co0 \ ��mF-- z� 1 oN C7 mm \ i/ ED m0 1 I I ��D I / c) x CO z� I �I I I (60 :. O < O Dm -D O m q / f / DO0— — — — — I I m Mm / // / =oTl 1 LZ NOTES: RECORD DRAWINGS PANNONE ENG SVC LLC (�JJ(C.J. 1088) PHONE �����\\� �FACA!?'��r�r REVISIONS DATE 08E20/2021 (907)X745-8200�LFAX (907)9745-8201 e%,�P REV: 01/07/2022 S LAKE 0 THE HILLS B4 L3 j TH * �� . ..--.-..... 1 " = 50' DRAWN LJC JAVIS & DELOISE ODOM Steven R.­Pannor...� E 8149—PEI r+114tkC'r/ P.I.D. NO 015-331-11 SITE PLAN SITE: R ANCHORAGE,OAKR9 516 SH05P201491 9 OF 2 DRI VE f O i 0 55 06e,+) „5C, eO 00 N L' J Q m w Q4 .ks`Qoo —� LZZ �: - 3 hl a CJ 42 Cj ✓ Rte., 6 Cii 2 ti 4 W C g 0. b O d y rFw =04 WQZW tt O l� O ,W81> y�DO 4rO2� Seco OD O Ct tt jW04 O hWJW tio=3 Q z�r J Q m w Q4 .ks`Qoo —� z�r MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201491 Work Type: Septic Renewal Tax Code Number: 01533111000 Site Legal Address: LAKE O THE HILLS BLK 4 LT 3 G:2639 Site Mailing Address: 11570 ROCKRIDGE DR, Anchorage Owner: ODOM JAVIS L & DELOISE Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 12/2/2020 12/2/2021 62470 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 a , Special Provisions: Change Order #1 - Groundwater monitoring is required on July 20th or later. Construction may proceed at your own risk. Please submit stamped and signed results with the As -built Inspection Report. ....=5.e.... Received B) Issued By: Date: 7(-5-r Date: I — Lei A-mut-MCIPAUTY OF ANC HORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-331-11 Property owner(s) DELOISE ODOM Day phone Mailing address 11570 ROCKRIDGE DR, ANCHORAGE AK 99516 Site address 11570 ROCKRIDGE DR Legal description (Sub'd., Block & Lot) LAKE O THE HILLS 134 L.3 Legal description (Township, Range & Section) Lot Size 62,470 Sq. Ft. Number of Bedrooms 6 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑ (w/wo ADU) Duplex (D) F-1 Holding Tank ElRenewal ❑x Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / 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: $10g.7 _'5' ca v tD Waiver Fees: Date of Payment: /Zhho Date of Payment: Receipt Number: OZ9ggG Receipt Number: Permit No. 05�P201 `i 9 1 Waiver No. Permit App_:- : ,:_..:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201491, Deb Wockenfuss, 12/02/20 ��`.:°A`--'\R MUNICIPALITY OF ANCHORAGE `�. \ ,•n a r2 t / On-Site Water&Wastewater Program mo '.. S I , . 1 PO Box 196650 4700 Elmore Road . j Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 n ice. http:(/wwtiv.muni.org/onsite • apartment '4eNORAG On-Site Wastewater Disposal System Permit Permit Number: OSP191462 Effective Date: 10/25/2019 Work Type: Septic Upgrade Expiration Date: 10/24/2020 . Tax Code Number: 01533111000 Site Legal Address: LAKE 0 THE HILLS BLK 4 LT 3 G:2639 Site Mailing Address: 11570 ROCKRIDGE DR, Anchorage Owner: ODOM JAVIS L & DELOISE Lot Size in Sq Ft: 62470 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 6 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ 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 Q= Special Provisions: The Engineer needs to do a test hole prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the `": As-built Inspection Report. If the results require a design change, construction of the system will stop pending --„. On-Site review and approval. V Received By: /... / /14 --(-11— ii----1Date: ° / 5 / / Issued By: Y/1-' Date: 104✓��� EPLAVS MUNICIPALITY OF ANCHORAGE • Community Development Department \ Phone: 907-343-7904 Development Services Division \ Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-331-11 Property owner(s) DELOISE ODOM Day phone Mailing address 11570 ROCKRIDGE DR, ANCHORAGE AK 99516 Site address 11570 ROCKRIDGE DR Legal description (Sub'd., Block & Lot) LAKE 0 THE HILLS B4 Ligj Legal description (Township, Range & Section) Lot Size 62,470 Sq. Ft. Number of Bedrooms 6 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ M lltiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ANON (Signature of property owner or authorized agent) Permit/Rush Fees: Sqc Waiver Fees: Date of Payment: 16/4//q Date of Payment: Receipt Number: O4' `T '. .16 Receipt Number: Permit No. Qc3PI`Z`Litt2 Waiver No. Permit App_:-: c: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191462, Deb Wockenfuss, 10/25/19 -n m c) m -n--i -+UnO�.�= D I I -i ,,n O cn C"_O mDp . W (n 1n yTr'� r x r��rn� m .� CO > FTI �t�nC)m'o-i �7 >Iv Z�X>mmwmm_ �31 POrOprF, p0 Ln m < I I ;a (.n n� O•DO_IDNO-< �moZ rnmO N z n--11*ZZ�-0-D En ' X 2D' Gj o M r0-u>'Om O O -H w JO M Ln O� (AM 0. coo- I - -ii-O-CI M r- 010 I O � rn� (N KOC Lo 2 � �mmc>o (n '� r'm -vim 0(D i Z�r O m mD --• n m Z O r 1 U);;aO p = U \l D > - o z o -m-i FTI n c -m m O .{ - I n I I M _ I M &I.C"v::o,�r 1 ! _i� -• r� J— A D I \ I m> / \\ I a N \ I � z \I I mm x \ I .min I. 0_ Dv) 1 I \ I n to/T' _N Q1 I c I \ Om \00 1 \� Via_= i�Ta A S\" I I �\ \� 0 GJ �/ Amoo \ 13 \ Ocl) „ K�� \ \ 'y1 i F_ I I T �`do \ • -0 1 1, a o yv \ \ \ I o\ • y L wamm \ - \ \ I 3 I o o 41 \ \\ I I �• ' 3 i , N Ln D W , Q ` I OV0 I it I I I I N. m i >i D�z \LL NOTES: PANNONE ENG SVC LLC C.1. '1088) REVISIONS DATE CHANGE ORDER P.O. BOX 1807 PALMER, AK 89645 �P.`�9 REV:1-0f74� SCALE 15/21 PHONE 907) 745-8200 FAX 907 745-8201 60' LAKE 0 THE HILLS B4 L3 "' P.I.D. NO DRAWN JRL DELOISE ODOM "sleven �. annGpo 015-331-11 CE 8149 PERMIT NO. 11570 ROCKRIDGE DR OSP191462 SITE PLAN ANCHORAGE, AK 99516 SHEET 1 OF 2 'ba �;VV7 ac fit bUrrn0w "'Y.. . .. _.... ,W IN - d.3a1r1 /4817SN12 - -J�L'7/2 M cs -7n n N a m I L V s NEzzg w Q 0 F - w U O z C Oc .Q ill 0) 'a = 0 0,0 z -77 '► ��t-� O Q C wiz � .'C.. C C N V1O N N m E CN J V =a'7a� o Qm � .a > % C< m _� m +� QU) J CL Q F -Oz _ _ Zz 2wa d O > E t �"Emro �C)c 'P p( r wOg C co o c cy 0 N o mow, a0� o.0 co C °� �LL W o EEi c w N N 0 EU O '_° Q Ry N p c6 Q N hCD :3 0p, m) i C O. ° U p w C co C = U C U C0 CSO U o) E p .G uj N Q Oco >oLl -O roe,_ U�> 6 p N a d ° O° 0 -S N C - O m Q .E• 'a .�-. N 2O CL o0 ca - W ill z -77 '► i o Nh R i�Pgp wiz o�cc ww ��_ V •f }:.j a ,y � ;^,_ > % +� ccULL � Z J Q F -Oz _ _ Zz z -77 '► i o wiz o�cc ww ��_ V w z O~p > % ccULL � Z J Q F -Oz _ _ Zz 2wa bi -i eO `l a VW1 wOg GRFVR ANCHORAGE AREA BOWGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME -,00?5€/ -eiy Cons/. MAILING ADDRESS 54"4 66X 3772 8 PH0NIE3'77��f "j"�7e-"(o CO LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCE//���J/ //�7 C NUMBER OF FROMWELL�MANUFACTURER vl ✓'-e`eV' MATERIAL J e_e COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /'Se!2 GALLONS. SEEPAGE PIT: NUMBER OF PITS A_ DIAMETER —OR WIDTH ��, LENGTH DEPTH Z LINING MATERIAL CohC CRIB SIZE: DIAMETER_DEPTH._!�_L DISTANCE FROM: WELL. / TOTAL EFFECTIVE C/7SQ. BUILDING FOUNDATION _!!26-9-7 NEAREST LOT LINE © ABSORPTION AREA (WALL AREA) ESQ. FT. ADDITIONAL ABSORPTION 31 k);Cle 2�'Loi+ ✓ 3' „< �- MoD ni- O�✓aiH�,`tia 3'��v,v✓J_=/�KL�'� T.�fa� �ir�% �.. " //Z4 WELL: TYPE Ph VA e CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER LINE—,TANK—,SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS_ -J_r/ bC;, -CC✓i��toi DISTANCES: / /rte ` / zS� DIAGRAM OF SYSTEM INSTALLED BY: & e l L e� PIPE MATERIAL:_rV610s,1e. LOT SLOPE: REMARKS: _ 2 Q P. / Orl //le �YDQ Gi h P Form No. EQ -031 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO 3338 "C" STREET ANCHORAGE, ALASKA 99505 TELEPHONE 274-4581 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT f MAILING ADDRESS ✓ ��/\ ONE INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PlTTr, DRAIN FIELD ,OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY / /,= - ///L-yE,6��-✓1///✓'-r// SOIL TEST RESULTS 50 / / / 7m NOTEe THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY. SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE / -7570 TYPE MINIMUM DISTANCES, REQUIREMENTS I Y IU6UEYYUIC�C E9�JIiNi/9� 1: FOUNDATION TO SEEPAGE PIT 2O , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL I SEPTIC TANK SEEPAGE PIT , DRAIN FIELD B TO NEAREST LOT LINE. WELL TO SEPTIC TANK A//q 141 SEEPAGE PIT hp® DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT SEPTIC TANK, /�JL., SEEPAGE PIT DD DRAIN FIELD le 1. TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER SIZE TYPE DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT. THE ABOVE DESCRIBED SYSTTEEM IS IN ACCORDANCE WITH SAID CODE. iqDATE — ` APPLICANT'S SIGNATURE z FORM NO. EQ -016 CER ANCHORAGE AREA BOROUGH M Depa ent of Environmental Quality 3330 "C" Street Anchorage, Alaska 99503 Performed -for Legal Descript' n• This form report Soils log _ X Depth Feet 1 2- 3- 4a rn— ty 5 E 7- Date performed S- A B e i 10 11 `Q %j 12 - J 5-C 13 14 _ rh — Was ground water encountered? If yes, at what depth? "Reading Date Gross Time I Net Time Depth to H2O1 Net Drop vercoiation rate minute ____ -----' --i Proposed installation: Seepage Pit Drain Field Depth of Inlet Depth to bottom of pit or trench CO 44FNTS: 14D Performed By: ■ APPLI T FILLS OUT UPPER HA ONLY Time - - , Time Property Owner -,q ;1 f s - ':./� .. �'T 6 � tJ �2 Phone Mailing Address S ,`/l/. / Zip Code )r� Buyer. Address - Zip Code Lending Institution. � v11S:.vtL� Inspector- - Phone Field Notes: - / Xy d Address MUNICIPALITY OF. ANCHORAGE Realty Co. & Agent - - _ - - Phone -Address - - - Zip Code - Legal Description RECEIVED (,I;') APPROVED BEDROOMS - Street Location ( ) DISAPPROVED Type of Residence h Single Family - - - - ❑ Multiple Family - No: of Bedrooms l - 71 Other Other - BY: Of I Water Supply- Solis Rating - U,iQividualr Well To Absorption Area /• 90 - ACH WELL LOG. A well log is required for all wells drilled since June 1975. FF E) Community ��.-� wells tlrilled prior to that date, give well depth. (attach log if available). ❑ Public Utility - Sewer Disposal. - - - - Cy ividual. Year Individual Installed: �!�p ❑ Public Utility - - When Connected to Public Utility: - Holding Tank - - - - - - NOTE: THE INSPECTION. FEE MUST ACCOMPANY EACH REQUESTBEFOREPROCESSING CAN BE INITIATED. a Dm,. r P Az, a P,. I � T .Time - - The Time - - Time -Date Date Date_ Date Inspector Inspector Inspector- Inspector Field Notes: - - - Xy d MUNICIPALITY OF. ANCHORAGE _ DEPT OF 8='Vll & / - ENVIRONWNTAL PROTECTION NOV 2 0 1;;v3 RECEIVED (,I;') APPROVED BEDROOMS - *CONDITIONS OF APPROVAL ( ) DISAPPROVED - ( )CONDITIONAL APPROVAL' l DATE BY: Of I Solis Rating - Date Sewer Installed Well To Absorption Area /• 90 - Well Log Received Well to Tank 41V Septic Tank Size S D 5. LEGAL DESCRIPTION DATE RECEIVED l INSPECTION APPOINTMENTS L TIME TIME - TIME 6. TYPE OF RESIDENCE (� nu DATE DATE DATE - , 11 '.1j y' DATE ❑ Two ❑ Five ❑ MULTIPLE FAMILY 59 Three ❑ Six INSPECTOR INSPECTORINSPECTU``L -) rh MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPI. 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL F:;JT ECTIUN • ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES' DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE za ;�S INDIVIDUAL/ON-SITE** MAILINGADDRESS ❑ PUBLICUTILITY PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING,A,lDDR ESS 3. LENDING INSTITUTION PHONE MAILI G ADDRESS o A"4 4,9 y a A. REATOR/AGENT PHONE ! w a to -b`90 MAILING ADDRESS -O/ v���7SOA� %� 9 y24 ZZ_ �� O 5. LEGAL DESCRIPTION Cev.0 L STRE T LOCATIO 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ELI Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY 59 Three ❑ Six 7. WATER SUPPLY 151 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.) S. SEWAGE DISPOSAL SYSTEM ;�S INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) a Q0r­c� THIS SIDE FOR OFFICIAL USE ONLY ' 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED �— L INSTALLER ❑Septic Tankor ❑Holding Tank Size: 1715% If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER' TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Ta nk Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE `\ BY 72-010 (Rev. 6/79) i 4L -k . OLA 4Lkj.0 ciaP ` '� - MUNICIPALITY OF ANCHORAGEDEPT. OF HEALTH & pNV� - DEPARTMENT OF HEALTH & ENVIRONMENTAL pW6'T@j?W6WTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 SEP 19 1980 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not he processed. Please a)"ke'n r70) days for processing.? - 1. PROPERTY OWNER PHONE MAILING ADDRESS 7. WATER SUPPLY PROPERTY RESIDENT (If different from above) PHONE c�tnIE AS ACDC)VC= E-1COMMUNITY 2. BUYER i-� iZ C 1 M j2 C j. of % PHONE 33 03 vZ MAILING ADDRESS ,.Igje TN 3. LENDING INSTITUTION Ae,-u),rA-rIL_ +SON PHONE 2-79 - '/!3&/S/ MAILING ADDRESS **If individual/on-site, give installation date 'E5201 C- S'riZ�-C-f If system is over two (2) years old an adequacy test is required 4. REALTOR/AGENT �uv2S PHONE z-7 jl� z525' MAILING ADDRESS - 4-791/ ZUS/nJESS P^2 -%e (ALL) 7. t3L-PC+.F- IA 5. LEGAL DESCRIPTION LO K(= LL ! ( �t; CJ H� SCC LS STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑4—SINGLE FAMILY 1:1One EDFour EJOther EJTwo `R' Five EDMULTIPLE FAMILY ElThree El six 7. WATER SUPPLY ❑ifs INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled E-1COMMUNITY since June 1975. For wells drilled prior to that date, give well ElPUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 1;1� INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date ❑ If system is over two (2) years old an adequacy test is required PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. OP-) ---, 4a -6 THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME - TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLEFAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank,4�, Size: If 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 ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) DISAPPROVED DATE rr� ` 1—1� �r v BY (Title) n LEGAL DESCRIPTION 72-010 (Rev. 3/78) I E Municipality of Anchorage ;. 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION September 25, 1980 Wayne Gardner Star Route A Box 25A Anchorage, Alaska 99507 Subject: Lot 3 Block 2" Lake O' the Hills Subdivision Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: d `n(1) The water analysis report be delivered to this V department from Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this department. The total number of gallons pumped need to be on the receipt to verify the size of the tank. This will need to be verified by a registered engineer prior to submittal. (3) An adequacy test 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 report needs to be submitted to this department for our review. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska National Bank of the North 3301 C Street - Calais II 99503 Skell Goens, % Area Realtors