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Home My WebLink AboutTALUS WEST #1 BLK 7 LT 2Talus West #1 Block 7 Lot 2 #015-202-46 MUNI iPALFFY OF ANCPORA GE On -S 4e Water & Wastewater Frograrn PO Box 1 J0>m 4700 Elrrorc Road Anchorage, Alaska 09519-66M Pham: f007) 343-7004 Fac X?j 113-71D97 h4tq:1jWw*_W.ij 'i.Vg�0n%de On -Site Wastewater Disposal System Permit Penn it Number O P211342 Work Type; Sep€irTanik UpgMtle Tax Gude Number 0,152-0246001) $ It* Legal Address: TALLJS UVE ST 41 BL K 7 LT 2 0=2730 Site Mailing Address- 4210 FRONTIER LN. Anchorag e Owner, BERG B LAI NIE 0 & LI CODA :S Design Engineer: FIRST WATER C 1 UI_TIHG This permit is for the construction of: Ef active Date - Expiration Data: ocrix, 0 r' � n -� ra ��sartkrk�r�r Lot Size in Sq Ft; Total Bedroomms- 3123021 W2312022 18705 ❑ (Disposal Field ❑ Septic Tank Ed HoUng Tank ❑ Priu}r ❑ Private Well ❑ Water Storage Alf constructi-an shall be in accordance with: 1. The attachad approved design, , All requfrern-ents speoified In Anchorage MunIcIpal code Chappa 15,55 and 15.65 and the Stake of Alaska Wastewater Disposal Rag ulialans (18AAC72) and Drinking VVatar Regulations (18AAC80) 3- The wastewnt,er node regillres inspecuons durlW the Int(altarfon. They ;ngIfkAer Ahall norif'V th,9 aGw,�lopmi�t31 SeTvi-ces Department per AMC 15.65. Provide notification by eallin0 (90T) 343.7904 (24)7). 4- From Octobe r 15 to Apri 115. a su bsurface soil absurptian system un der construction during freezing weather shall to either-, a, Opened and Closed on the sarne day, or b_ Covered, sealed, and heated to pravant freezing Received By: Issued By - $/23/202 1 C ;-e- Date Development Services Department On -Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-202-46 Property owner(s) LINDA & BLAINE BERG Day phone Mailing address 4210 FRONTIER LANE, ANCHORAGE, AK 99516 Site address 4210 FRONTIER LANE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) TALUS WEST #1 B7, L2 Legal description (Township, Range & Section) 2 Lot Size 18705 Sq. Ft. Number of Bedrooms J Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ElUpgrade Z (D) ❑ Holding Tank 0 Renewal F-1Duplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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: 4 a Q5 Waiver Fees: Date of Payment: S ,B1202 1 Date of Payment: Receipt Number: q131'.2 1 Receipt Number: Permit No. O S P z 1 1 3 �i Waiver No. GAIDevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com August 17, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: HOLDING TANK UPGRADE PERMIT LEGAL: TALUS WEST #1 BLOCK 7, LOT 2 The owner has requested that we obtain a septic permit to upgrade the existing aged steel holding tank on the above referenced lot. We propose to install two 1250-gallon HDPE tanks in series with an alarm to serve the existing 3-bedroom residence. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211342, Rebecca Carroll, 08/23/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211342, Rebecca Carroll, 08/23/21 Municipality of Anchorage Page Iola. DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL'SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:_q k)&q6 b'53 g PID Number: 101-i-0 NBTe R- ► TA o MS Wastewater System: New ❑ Upgrade Address:42-10 ABSORPTION FIELD o i tr ac►A a Phone: No. of Bedrooms: p Deep Trench 0 Shallow Trench O Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPD/5 Ft Lot:BIO k: _ /k Subdivision; a—I 1.V S M1i Depth to pipe bottom from original grade: Gravel depth beneath pipe e L�/ T Ft Ft Township: Range: Section: FIII added above original grade: Gravel length: Ft FI WELL: ❑ New ❑ Upgrade Gravel width: Numberoflines: Odtance behrem lines Ft Ft Classification (Private. A,B.C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. SO Ft Driller Date Drilled Static water Levee Instal + Date 11 Ft. �t 4 Yield Pump Set at: I Gating Height ADO" Ground. TANK GPM FI Ft. SEPARATION DISTANCES ❑Septic Holding ❑S.T.E.P. To Septic Absorption Lin Holding bIic/PMate Manufacture Capacity Capacity In ggaallloonssi From Tank Field Station Tank sewer Lines / K T N I4- �✓ ✓-1J Well,&�� Materiel:S T'� 1 Number of 00 i rtments: :L Surface Water Water NI N L LIFT STATION Lot Slee In gallons: Manufacturer. Line So Foundation / 5 'Pump on" level at: "Pump oft" level at: High water alarm at: Curtain Pump Make a Moml Electrical Inspections performed by: Drain raid Remarks: BENCH MARK FfiTi/J oak FILLED Location and Description: I TVP or 4204 n^ rr>ti v t rZ Assumed Elevation: s1� ENGINEER'S SEAL . T 5 Inspections performed by: Dates: 1st �G! 4 (I., T. - ....d 2nd Department of Health and Human Services affproval 1k, ',' Reviewed and approved by: Date: iz 72.013 lee+ 990 MOA 25 I S I holding tank D I 7 R100,00 R75.00 i SWING TIfS A8 34.5 TT AC BC 22 ?LS AD 12.5 ` ED AC 23 5 / 'A BE 38.5 l I I o c— 4000 CAL TA NK / I 2000 gal holding to S ABANDONED TRENCH AND SEPTIC TANK --� bur CRUSHED TANK burned debris • OF h .E.......... {c i 49th `/'[\I °•�� . i ....... ......................... i.. 25 0 25 50 75100 125 150 �0 SCALE: 1' = 50\ 0 T. TDB '.:N SPURKLAND 3 I 1 f't No. CE -2225 \ \h.�OFESSI�•• 1 SPURKLAND P.E. I I I I 203 15TH. AVENUE LOT 2 BLOCK 7 TALUS 11EST SEPTIC SYSTEM AS BUILT 203 W .E. E ANCH. AK. 99501 NORMA SARRETT DATE: NOV. 29, 1996 (9"37)279-3olB 4210 FRONTIER SHEET: 1/3 GRID: 1736 SP1960338 PID 015-201-46 TAP107021.DP1G 93.9 lE 93.3 98t FIQ FRAIN CAP I- 6' PUMP IF 1' X 10' CONDUIT I' GALVANIZED LB. I' DIRECT BURIAL WIRE TO ALARM PANEL 9J.9 1' PVC CON HIGH WA TER ALARM I■ MERCURY S WI TCJ AT - 75.5' 17' STANDARD 4000 GAL. HOLDING TANK ��P�•...,, OF- OttANCHORAGE TANK #�� NO SCALE i 49th /\ _°sok ^y TD2j_N SPURKLAND t No. CE -2225 0#T�� ...... .a• •4 0.- FESSION��• BENCH MARK: IOP OF GAS AVER ASSUNEO ELEV. 100.00 Fl. I UDDLIV JrUMNLIANU r.L. LOT 2 BLOCK 7 TALUS WEST SEPTIC SYSTEM AS BUILT 6751 W. DI MOND BLVD. NORMA BARRETT DATE ANCH. AK. 99502-3904 NOV. 29, 1996 .un'l �40--nO 11 4210 FRONTIER LANE SHEET- 3/3 GRID: 27J6 SW960338 PID 015-202-46 TAW07023.DPIG !AOA- ca Y MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 111Ar-196 - 2s' mss!'• Ar7E ZAMN ON-SITE WASTEWATER DISPOSAL SYSTEM.(UPGRADE) PERMIT PERMIT NUMBER:SW960338 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:BARRETT THOMAS W & NORMA OWNER ADDRESS:4210 FRONTIER LN ANCHORAGE, AK. 99516 PARCEL ID:01520246 LEGAL DESCRIPTION: TALUS WEST #1 BLK 7 LT 2 LOT SIZE: 18705 (SQ. FT.)' NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: HOLDING TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:10/04/96 EXPIRATION DATE:10/04/97 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: PROPERLY DECOMMISSION EXISTING SEPTIC SYSTEM SUCH THAT IT MAY NOT BE USED THE FUTURE. RECOVER OR RECEIVED B ISSUED BY: DATE: DATE: 01W% T.SIPME l[ AM P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 2 BLOCK 7 TALUS WEST NORMA BARRETT Municipality of Anchorage Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 We are submitting an application for the installation of a 4000 gal holding tank for this lot. The existing system, consisting of a let Aeration tank and a trench failed several years ago and have required constant pumping. At present there are no indications of sewage surfacing. The submittal consist of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 113), the proposed improvements of the lot, of which only the holding tank is subject to this permit application, (sheet 2/3), and a schematic of the tank , (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The justification for the holdingtank installation is: Unpercablc soil on this lot and two of the adjacent lots. High groundwater levels during most of the year. The existing system most likely encroaches on ground water. Please expedite this application. Yours LL Tobben S urkland P.E. • v. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED LEGAL DESCRIPTION: {ISA LV -c, �.L/ E n) Fw, r e .. B V- -74 LCA ► O, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS LO 0. t'►'1 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Waer Alter IEonttc6np7 •"(ENGINEER'S SEAL) T! DATE PERFORMED: q f% f b 3, Range, Section: SLOPE SITE PLAN EMEMON MEN ■■■■■■■■■■ ■■■■■■.■■■ ■■■■■■■■■. •`� 11 PERCOLATION RATE L Iw"..•tLmen) PERC MOLE DIAMETER I TEST RUN BETWEEN .5?- FT i..'J �FT IF PERFORMED BY: — I CERTIFY THAT TICS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: - 9I -m L e/.j6 72-008 (Rw. 4/85) III I 50 0 50100 150 200 250 300 SLE., I' = 100 FT. III III I 4;ng tank o FR TIER LAE CQ Well WI ® 0/ 20010 gall ho( ng tank bura�ebr FT -F - - - - - - - - - - - - --- - I - - - Nil I II I II II EXISTING L11PROVEMENTS 996 (Qn7N 77Q-IQIA 1 L TOBBEN SPURKLAND P.E. DESIGN 203 W 15TH. AVENUE ANCH. AK. 99501 OT 2 BLOCK 7 TALUS IFEST NORMA BARRETT DATE: SEPT. JO. � F 4210 FRONTIER SHEET: 1/3 GRID: 2736 I I SEPTIC SYSTEM I I S I holding tank :,F5.0 I R100.0 I 7 R100.00 R75.00 NO. 00 1 Ito�h�LD6 I S 2000 gal holding to I ABANDON£ TRENCH AND SEPTIC TAI/K burried debris CRUSH TANK 1 _ L 4*40 0 25 50 75 100 125 150 AN•iP}•=i SCALE.- 1 50 T. .m...DB :NSURKL \ CE -2225 6� \ \••\�i ss..... PROPOSED IMPROVEMENTS TOBBEN SPURKLAND P.E. LOT 2 BLOCK 7 TALUS KEST SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE ANCH. AK. 99501 NORMA BARRCTT DATE: SM. J0, 1996 ,,,,% ,,,_,e„ 4210 FRONTIER SHEET: 2/3 GRID: 27J6 r 9.St RAIN CAP T 6' PUMP AC MIN. 4 FEET BURY 1' X 10' CONDUIT I' GALVANIZED LB. DIRECT BURIAL WIRE TO ALARM PANEL 90.7 I I90.1i I' PVC CDA INV.ELEV. 90.11 HIGH WATER ALARM MERCURY SWITCH FL AT 18' - 75.5' r r r r r r r r r r 17' STANDARD 4000 GAL, HOLDING TANK `�4P�E,�....,A ��♦♦. ANCHORAGE TANK a ,. # NO SCALE SPURKLAND BENCH MARK. TOP OF DECK ASSUMED ELEV. 100.00 FT. IUDDLry arUKrLNrvU r.L. SEPTIC SYSTEM DESIGN 6751 W. DI MOND DLVD. L BLOCK ALU W 996 ANCH. AK. 99502-3904 NORMA TlFRETT SHEDATET- 31PT, 30, 1ID: ,e,,,. ,.e_�„e� 4P10 FR11NT/FR [ANF SHEET: 3/3 GRID: 2736 196 12/04 FED 14:43 FAS'907"27685.07FORTL'NE P@QP: it I i. BLOCK ��i r !• UCIE IQ, fQ' m MMSCAPMONUMINT o Isom Firc RECORDING DISTRICT • BTBARCORWRFOUND r ■' HUBANDTACK DOWLING R ASSOCIATES ' P.O. BOX.110029 -- ANCIjORAOI„AK 995160029 19n348.USlOR3484WPAX:349.0881 .: REVISION DATE BY =j 8 BY: SCALE: W R DIARY .: '. 9 -Aja MUNICIPALITY OF ANCHORAGE Hee and Environmental Proteeoo~Dn Fourth Floor West j, 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 PEC NAME LOCATION N REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS LEGAL DESCRIPTION �-� 8 -7 %91u S C_l) ¢ S t 111 SEPTIC TANK: ,D DISTANCE T� "J 1 NUMBER OF FROM WELL 1,'c_1/ MANUFACTURER .1,. MATERIAL-&A:�f—i�e--I�COMPARTMENTS� INSIDE LENGTH � INSIDE WIDTH �= LipUiO DEPTH LIQUID CAPACITY — GALLONS. TOTAL LENGTH 01 DISTANCE FROM WELL _L.Et2 —' FOUNDATION NEAREST LOT LINE -✓?.Op OF LINE # of Lines / DISTANCE BETWEEN LINES 4/4 TRENCH WIDTH{ 3CIN. TOTAL EFFECTIVE d o- ABSORPTJON' AREA 23- SO. FT. LENGTH OF EACH LINE CC / DEPTII OF FILTER DEPTII: TOP OF TILE I'D FINISH GRADE c: MATERIAL BENEATH TILE -4V--41+- ABOVE TILE IN, SEEPAGE PIT: DIAMETER_ORWIDTH_, LENGTH_, DEPTH i Log Crib _Rings_ Crib Size: DIAMETER_DEPTH_DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. Well Class: /eDepth: Well Distance To: Lot Line _ Bldg: SewLine: Pipe Materials:e 4 # of Bedrooms: Installer: 21'�� / Remarks: �.5 O M 11 DATE� U-4/:J7v PPROVI �_IYb �. !Iii 1� IIIIII III11 jIjI-� I j1 a -;-17-1 1-1i-}- M 11 DATE� U-4/:J7v PPROVI �_IYb �. r-lC1r+l I r IE RL I TY OF 1=1rJCHORFi173E CO DEPHP..TME.J. ` HEALTH AND ENVIRONMENTAL/'-�OTECTION 825 ' L' STREET, ANCHORAGE, AK. 279-2511 q WELL f i"Cti Ur.l-�7- I TE SSE 44 EE F='EF 'rrl I PERMIT NO. ( 77213 ) ✓�a�^ APPLICANT BUCK: HIGHT SRA BOY, 1585C 349-3494 LOCATION W iiLi'cFfiE55 LEGAL L2 67 TALUS WEST LOT SIZE 12000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER. OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: IJEF'TH= -1-4 LE"C3-r"= 4�e AGF; -,Fl V EL GEP TH= S+ THE LENGTH DIMENSION IS THE LENGTH CIN 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 EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). F'F 1CF�RtiE F= LF�r+IT FREG!U I RED - --- EITHER A CLASS I OR II NSF APPROVED PLgNT MAY BE INSTALLED. A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY "BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION. j . TWU C �* r I r�i�F'ECT I t�MS RRE F?EG!1_1 I RELY BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. I MINIMUM DISTANCE BETWEE14 A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM 15 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PE: R." -t I T %-8F-1L I G FUR 1=1"E: ',r EFIFR FFtUM I S~SaC1E I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED ISSUED ' 1 /� WELL CONSTRUCTION LOC Drilling Co. A C �"! DY I A, AQQ nn 'U/SCS no. Driller 11nZNCi i./1 / Type of rig ATArr �r y(J)/ma to .ell complalsd-�'�/�� I Well owner lT/�UCZ,;rS Nearest community r4 M. s- /t[ , %SOA Well location: (address g legal description) 4- a 736 location sketch or remarks r.) //.. e U/P c T . S„ A Depth of well1146 it. Casing: depthIt. dlam.In. �— ��7 Static water level It. (shore, elo land surface. Deto Finish o1 well:open-end sermon, perforated, open -hole, other) Describe Intervals and size:', '. Roll yield tested by (pumping, boiling, air at �� gal/min. for, _hours with 0 ft, a1 drawdown from static level. DRILLER'S MATERIAL LOG Depth he low land surface in feet Dire description of strata penetrated (seize of material, color, hardness of drilling, and water content) O to O LA r �" 1�0e CIA 1,1 /0 to SAalc1 `"to 3to `o s t/r 3�10e t a 3-0 /� Z4 r P (-7 Y 4 I'd e-1.1 -50 L,c=l o 1A r el ' ..[� -to 00 / r14 onto / 2 /izta /G Ware s to to to to to to to to to to to to to to MUNICIPALITY OF ANCHORAGE ARL • DEPARTMENT OF HEALTH & HUMAN SERVICES 4111-1 -41 Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# _n15' -aLQ9— 116 HAA # 4 DSI % 1. GENERAL INFORMATION Complete legal description 1-6 11 ��a�`7 t �ALVS i1//P'S t Location (site address or directions) q L 0 F Q-0 011 1�— R 1 -AN>` Property owner Q-An2ATIS - TkAo MA S Day phone Mailing address Lending agency Day phone Mailing address Agent hOrZ70r C: NIEL- TNotga.S- Dayphone 263-- Z_'/O/_ Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank ✓ Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. non (Ra. iA» From MOAN21 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm %0 rV_ la kd� ? E Phone Address O Li'! /51-1 oLa Engineer's signature 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments 0 Date ((12q/gA bedrooms, with the following stipulations: Date/ 2 -4' 2Z The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engi neer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. rrms (w.. +Au 6« AOA /21 Magttcu'Alm of arta.oVAGt iWiloNA IMAL BMICES DIVISION Municipality of Anchorage D E. VO 0 = 1996 a ~�, DEPARTMENT OF HEALTH & HUMAN SERVICESjak Environmental Services Division E C E IV- E 825"L" Street, Room 502 • Anchorage, Alaska 995010 (907) 343-47 Health Authority Approval Checklist Legal Description: LI I At 7 1 ALUS LYj F— S,— Parcel I.D.: © IS-- 202. A. WELL DATA Well type _z If A, B. or C, attach ADEC letter. ADEC water system number Log present (YIN) y Date completed ?//%/7 7 / Total depth HL I 1 Cased to 1163 Casing height (above ground) _2 Sanitary seal (Y/N) Wires properly protected (YIN) V Date of test Static water level Well production FROM WELL LOG 9/tvl» AT INSPECTION llll&,gb togI lb g.p.m. 5 g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate —B 3 fM Other bacteria Date of sample: I t l 18 � 4 b Collected by: � S B.a6Hf"elHOLDI[NG TANK DATA Date installed 1 i Tank size 11000 Number of Compartments I Cleanouts (YN_ Foundation cleanout (YIN) Depression (YIN) 1-4- High water alarm (Y/N) Date of Pumping Y4& Pumper �/a C. ABSORPTION FIELD DATA Date installed Length Width Effective absorption area _ Date of adequacy test 1•ln1a� Soil rating (g.p.d./112 or ft'/bdrm) System type Gravel thickness below pipe Total depth Monitoring Tube prasent(Y/1)_ Depression over field (Y/N) Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); Immediately after_ gal, water added (in.): Fluid depth (ins.) Minutes later: Absorption rate = e.p.d. Peroxide tream ew (past 12 swaths) (YIN) If yes, give date a D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at' Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at• rDatm "Pump off' level at' SEPARATION DISTANCES FROM WELL ON LOT TO: Saptiwtholding tank on lot S `—� 1 : On adjacent lots ) 020 t t Absorption field on lot ✓ On adjacent lots 1-/ &-w Public sewer main r4AA Public sewer manholeteleanout KVAC Sewer /septic service lute > .2 S Lift station t& SEPARATION DISTANCES FROM4;=C/HOLDING TANK ON LOT TO: ►► Building foundation / � Property litre b 0 Absorption field t Water main/service line Surface wateddminage _ Wells on adjacent lots /A U f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain F. ENGINEER'S CERTIFICATION Water main/service line NA Driveway, parking/vehicle storage area Wells on adjacent lots Property line I certify that 1 have determined thru fte/d inspections and review oj,L/anicipal records that the above systems are in conformance with 1/0.4 I L4 guidelines in effect on this date. Signature _ f %� std �Lc , Engineer's Name t 6+ v v '� -8 g Sea) Here' <. . Date I V✓ t g 9 b t HAA Fee S 0 0-0 c Qa Date of Payment Receipt NumberpZ Rev. 8/95 OSS: haa.wk.doc Waiver Fee S Date of Payment Receipt Number r 1 t1 �W MUNICIPALITY OF ANCHORAGE DEPT. OF 1:=ALTH 8 VA STREET LOCATION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTedZ11011s NMENTAL F.-.OTECTION US L Street • Andwraes, Alaska 99501 a 1/ FEB 1 K 19 S. TYPE OF RESIDENCE ENVIRONMENTAL ENGINEERING DIVISION ' 1 Telephone 2644720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be pracesaiii Re18►t9tew fen (10) deals im nr sfassi g. 1. PROPERTY OWNER Three ❑ Six PHONE INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled MAI LI since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY i PROPERTY RESIDENT lit different from above) P NE 2. BUYER ##++�� "If individual/on•site,give installation date 411 PHONE GA If system is over two (2) years old an adequacy test is required MAI LI by this Department. 3. L DI 1 S ITUTI PHONE L 'C— MAIL ADDRESS 4, REAITORJAOENT IV AILING ADDRESS IL S. LEGAL DEICRIPTION S STREET LOCATION � J S. TYPE OF RESIDENCE NUMBER BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM ##++�� "If individual/on•site,give installation date 411 INDIVIDUAL/ONSITE" 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. 72-01013/78) t'1 THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE �I SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE __-E) THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX Z WATER SUPPLY INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL 1 DATE DRILLED q-jq-1-7 LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED _ 1 ALLE Septic Tank or ❑ Holding Tank Size: 46045 If Tank is homemade give dimensions: SOILS RATING 1 Qkdo TYPE OF TANK MANUFACTURER TOTAL ABSORPTIONAREA 160 r MATERIAL _ _ r 4. DISTANCES WELL TO: Sic Holding Tank am Absorption Area Lim ns Lot i Absorption Area to rwret Lot Lim S. COMMENTS r;�'APPROVEDFOR �_ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE (� BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) �1 MUNICIPALITY OF ANCHORAq_1_., DEPARTM OF HEALTH AND ENVIRONMEI _ PROTECTION 825 L Street, Anchoraaa. Alaska 99501 264-4720 #1: Time IC')- q M Date Irsp #2: Time Date Insp Date Received: #3: Time Date,��v t i REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: Phone: 2. Property Owner: L %rV khi_�fl Phone: ? Pu3e Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Comments: Affadavit Attached: A') Letter Attached: ( ) r 41 Approved: Date: Date: — :;L Disapproved: Date: Department Worksheet: r*�A'2quest MUNICIPALITY OF ANCHORAGE Department of Health and Environmental Protection'. 825 L Street, Anchorage, Alaska 99501 264-4720 for Approval of Individual Sewer and Water Fa6.jl1ties,,j 1. Property Owner: Mailing Address 2. Name of Buyer: Mailing Address: 3. Lending Institution: Mailing Address: 4. Realtor/Agent: Mailing Address: Phone: Phone: Phone: 5. Legal Description:�� / 4Li o0 mze� Street Location: 6. Single Family Residence: V/t Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well (h' Public/Community System ( ) If Individual Well, well depth 01 1 If Community System, name of system 8. Sewage Disposal System: *'On-site System (.Ar (P�unblic System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2j years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77