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HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #1 BLK 6 LT 20Thunderbird Heights #1 Block 6 Lot 20 #051-582-09 Municipality of Anchorage On-Site Water and Wastewater Program - (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 181422 PID Number: 051 582 09 Dwelling: FE11 Single Family (SF) ❑ Duplex (D) F-1 Multiple (SF and/or D) Project: [:1 New ❑ Upgrade Name: CLARK ABSORPTION FIELD Address ❑ Deep Trench F-1 Shallow Trench F-1 Bed 7 Mound 27618 MALLARD E] Other Phone Number of Bedrooms Soil Rating Total depth from original grade GPD/SF: Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot THUNDERBIRD HEIGHTS#1 B6 L 20 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding Lift Station Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft 2 Ft. Well TANK N Septic ED S.T.E.P. 171 Holding 0 Other Manufacturer Anchorage Capacity 1000 Gal. Surface Water 1 +100 Material Number of compartments Lot Line 5' Steel 2 NA LIFT STATION Foundation 82 Manufacturer Capacity Curtain Drain Gal. Remarks TANK REPLACEMENT ONLY Pump on level at Pump off level at High water alarm at -- OLD TANK DISPOSED OF PER CODE in. in. in, Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House totank 3034 drainfield Tank to 3034 Guaranteed Services Drainfield UNK CO/MT 3n3A Inspector Charles Balzarini BENCH MARK (Assumed elevation) 100 ft Inspdates: ection 12/16/18 d Location and description 2 3'c' 4th FRONT PORCH COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL En inetamp 1V Kkk k OF At,,, Conditional Approval: Date * . k�o co ,04.- 49 TH CHARLES G BALZARINI 0 Approved'``'' 6 Date W�2 6,11g CE-13854 ��Oio - inspecuon Nepori_y- i - i z.00c Municipality of Anchorage P.O. Box 196650 0 4700 Elmore Road Anchoraqe, Alaska 995,19-6650 0 (907) 343-7904 0 Fax (907) 343-7997 httl2://www.muni.org/Onsite Devel loment Services Department On -Site Water and Wastewater Section Waiver#: OSVI81102 COSA#: Permit#: OSPI81422 PID#: 051-582-09 Legal Description: Thunderbird Heights #1 Block 6 Lot 20 Engineer: C&M Engineering Applicant: Joshua & Jennifer Clark Ucptrrrvfanr Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. See engineer's waiver request for justifications. Z:� This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. a 12 a rX 0 M M 2 H a 0 a N Z a a a 0 a a a a a a 0 M 2 is a 11 2 2 M a a 0 N a 9 a 0 a a a M a a M a a a M 0 M a a 0 a H M a a a a R a 0 a a a Z a M a a 0 M M I Waiver is Granted: X Waiver is not Granted: Date: Approved by: LeIC-Lk LV Name of Reviewer IN 110, Z, 07 From: CHARLES Balzarini <cgbalzarini@gmail.com> Sent: Wednesday, December 26, 2018 1:38 PM To: Carroll, Rebecca M. Subject: Re: Thunderbird Heights #1 BLK 6 LT 20 Hey Becca, I have answers for those, see below: On Wed, Dec 26, 2018 at 1:17 PM Carroll, Rebecca M.<rebecca.carroil@anchorageak.gov> wrote: Hey Charles, I have a couple questions about Thunderbird Heights #1 Block 6 Lot 20 that I figured I'd ask via e-mail, because they may not require anything to be re -submitted. The old septic tank was partially under a retaining wall. The updated as -built survey shows that portion of retaining wall no longer there. Was it removed and is it not required? It was more of landscaping block than an actual wall. it's no longer required. How does the 2" steel pipe with 4" PVC riser work for the monitoring tube? I'm assuming the steel pipe is not perforated, so would not show how deep the effluent in the drainfield is. Or does "a drilled 2" sch. 40 steel pipe" mean holes were drilled in the pipe? Perhaps the 4" PVC riser goes all the way to bottom of sewer rock, but it seems like it would be difficult to determine the depth of effluent utilizing the 1" space between the steel pipe and the PVC pipe.... The steel pipe was drilled to act like a perforated monitor tube. We drove it into the sewer rock instead of excavating all the way to the bottomm of the trench. The steel pipe didn't stick up far enough beyond finished grade so we placed a piece of pvc pipe over it so the pipe would be accessible and backfilled. In short it's like a 16' steel monitor tube with 6' of pvc pipe slid over it to create a riser with a rubber cap. Thanks, Becca Carroll Onsite Water and Wastewater Municipality of Anchorage C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Thunderbird Heights #1 Block 6 Lot 20 Dear Reviewer, We recently inspected the tank installation and performed an adequacy test at the above referenced property. It was noted that the tank was installed within 10’ of the foundation, but outside the bearing prism of the foundation per code requirements. A cross section has been provided on the inspection report drawing. During our inspection, it was noted that the drain field appears to encroach on the property line. Despite previous onsite systems approval for this system, we are requesting a reduced separation distance be approved for 5.5’. Approval of this waiver will not adversely impact adjacent properties as this documents a long term existing condition and neighboring lots are fully developed. The existing cleanout/sump for the drain field was located and extended above grade. A new monitor tube consisting of a drilled 2” sch.40 steel pipe with a 4” pvc riser was installed to full depth of the drain field. The orientation of the drain field was verified via radiographic methods. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 12/26/18/ CHARLES G BALZARINI CE-13854 R E G ISTEREDPROFE S S I O N A LENGINEER12/24/18 P c: 49 TH `9 h'Ae�— o s SHANE A. HOLT �� G LS -6914 ,\,°fessiona� �-Qo SURVEY ORDERED BY: DAR WALDEN @ KELLER VVILLIAMS THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS BUILT SURVEY V" - 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 20, BLOCK 6, THUNDERBIRD HEIGHTS NO. 1( PLAT 78-201) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 24 TH DAY OF DECEMBER , 2018 14103. FB 194-1 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 PAL �I\ C 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: OSP181422 Work Type: SepticTank Upgrade Effective Date: Expiration Date Tax Code Number: 05158209000 Site Legal Address: THUNDERBIRD HEIGHTS #1 BLK 6 LT 20 G:1865 Site Mailing Address: 27618 MALLARD CT, Chugiak Owner: CLARK JOSHUA M & JENNIFER R Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: »�C11t l)ellarCtnc•nl I -Z_ fig a/". 12/5/2018 12/5/2019 Lot Size in Sq Ft: 21229 Total Bedrooms: 3 ❑ Disposal Field 0 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 Received B) Issued By: Date: W�//i Date: 112 5 iF MUNICIPALITY OF ANCHORA Community Development Department Development Services On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 051-582-09 Property owner(s) JOSH & JENNIFER CLARK Mailing address 27618 MALLARD COURT *CHUGIAK, AK 99516 Site address 27618 MALLARD COURT *CHUGIAK, AK 99516 /5 6 789 /� 170 �U 5 Phone: 907 3 Fax: 907- 343 - Day phone 907-350-8535 Legal description (Sub'd, Block & Lot) THUNDERBIRD HEIGHTS #1; BLOCK 6, LOT 20 Legal description (Township, Section & Range) Lot Size APPLICATION IS FOR: ( Nall that apply) Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Sq. Ft. Number of Bedrooms APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ 41 THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: ZLS Waiver Fees: Date of Payment: t L ISI 1*Z Date of Payment: Receipt Number: bV"L1CQ Receipt Number: Permit No CSS P 12 11422 Waiver No. (Rev. 01/11) � �]����T� ��� ~=^��=�`'��� ^��`.�������������`� GROUP, ����ENGINEERING, SALES CONSULTING I f November 20m.2O18 Municipality of Anchorag Development Service Department On -Site Weter& Wastewater Program 47OOElmore Road Anchorage, AK 89507 Ref: Proposed Septic System Upgrade for Thunderbird Heights #1; Block 6, Lot 20 To whom it may concern: The existing 3 -bedroom house is served by AVVVVU water and a private septic nvatexn. The existing septic tank is approximately 37 -year-old. Per MOA memorandum, the existing septic tank must be exposed for inspection and/or replaced. It is our recommendation /o�enthe age) that it be replaced.We are proposing to decommission the existing . -ng aeotict�D per UPC install 8 new 1000-g8|/on steel septic tank. We are unaware of any adverse impacts this installation would have on adjacent wells or septic mvab,DlS. If you have any questions, please contact us at 337-6179. Thank you for your assistance. 3701 East Tudor Road Suite 10°Anchorage, Alaska 99507-1259 Phone: (907) 337-6170^Fax: (987) 338'324G°Website: wwwgume000nginaehng.nom KEYBOX AND WATER LINE TO BE PROFESSIONALLY LOCATED PRIOR TO CONSTRUCTION GEG, Ltd. HAS A 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. LAPPROXIMATE WATER MAIN OCATION PER AWWU RECOR DRAWINGS (ATTACHED) 4 .'•nRll VFWAYI�'.'•. EXISTING 3 � BEDROOM HOME -APPROXIMATE KEYBOX LOCATION PER AWWU RECORD DRAWINGS (ATTACHED) NOTE: THE CONTRACTOR SHALL HAVE THE NORTH LOT LINE AND WEST EASEMENT FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION THUNDERBIRD HEIGHTS #1; BLOCK 6, LOT 21 SUMP LOCATION PER SURVEY IN MOA RECORDS;SUMP COULD NOT BE PHYSICALLY LOCATED; DRAINFIELD LOCATION IS ASSUMED, DRAINFIELD MAY BY LOCATED IN THE EASEMENT. EXACT LOCATION IS UNKNOWN. CONTRACTOR TO LOCATE BEGINNING AND END OF TRENCH AND INSTALL A CLEANOUT AND MONITORING TUBE 5 I PROPOSED 1000 GALLON DEEP BURIAL STEEL SEPTIC TANK; INSTALL DOUBLE CLEANOUT BEFORE AND AFTER APPROXIMATE LOCATION OF EXISTING 1000 j_ GALLON STEEL SEPTIC TANK PER CLEANOUT LOCATION: TO BE DECOMMISSIONED PER UPC THUNDERBIRD HEIGHTS #1; BLOCK 6, LOT 19 COMMUNITY WATER GARNESS ENGINEERING GROUP, Ltd PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JOSH AND JENNIFER CLARK 907-350-8535 1 OF 1 PROJECT/LEGAL DESCRIPTION: DRAWN BY: THUNDERBIRD HEIGHTS #1; BLOCK 6, LOT 20 D.J.G. TYPE OF WORK: DATE: �, SEPTIC SYSTEM DESIGN UPGRADE 11/23/2018 N SCALE: 1"=40' ***\lL\■1 OF •awl ;.................... ..................0 ♦♦' . . A. Gamess� Jr W i .• i ♦ j ���•.,� •. 79.3 LICENse ��%FESSVJ � li" #AECC884 `, / �oOF m K cir p 5 J Om 8F V gyp' R ►- `-�, cng f- m e t- m Lei b 1w wgim m� R«R< iI� 0 (GLIZT) 850•T£ A3 -11V 133HIS HIHON 31VO(CIN! H013NS AS NOIIVoOi 3NII 3O1A83S (3NV X08 Aix MUNICIPALITY OF ANCHORAGE WATER CONNECTION — Location Record ACCT. NO. 1 SZ - NAME ADDRESS LOT BLOCK ADDITION REPLACEMENT CONN. SIZE CONN. DATE MADE SHOW SKETCH ON REVERSE SIDE LOCATION: ALLEY Q STREET Q.. TYPE OF MAIN THAW PLATE PERMIT NO. CORP STOP KEARNY WIRE CONNECTOR W. CURB STOP C TOC OTHER: CONN. CURB STOP C TO I INSP. CORP CONNECTOR PERMIT COUPLING C TO I TOTAL BRASS BUSHING MAIN, EXT. CONNECTION, EXTRA PIPE COMMENTS: BROKEN GALVANIZED BUSHING FT. DELAYS, ETC. 2 PART UNIONCASING PILA 3 PART UNION ED PAID PREV. SERVICE CLAMP x COPPER PIPE ❑ PAID CASH 1 11411 KEY BOX❑SUB AGREEMENT 2" KEY BOX ALT. # DISCONNECTS THAW WIRE [--I IMP DIST. LOCATION CONNECTION MADE BY 31.058 (12/77) EXCAVATOR APPOINTMENT TIME: TIME READY: INSPECTED BY E3 EXT. AGREEMENT # ZOS66 'AV'39VKHDNV 3ADK MIAMD 6026 9NIA3AVS GNV" i?OH -jo AVO SIHI VNSVlV'39'V'd0H.-)NV iV GiV',l '03iON NVHi 'd3HiO iSIXII S-LN3WHD'V0Y)N3 398ISIA ON CJNV S3N Tj AUOdOlid 3Hi NIHiIM 3dAff N0383Hi c3ivniis SIN3kJ3A0)jdWIL TISISIA 3Hl. iVH-1 CINV �V�SVIV 'i'MI-ISIT(I 9NI—Gd0D3d 3DVK)H3NV UOZ-84L iVIdi )i ON SiFIDID-H NnHi (9,)�100-ls OZ -10-1 Ai'j3dO'dd 038DDSM 9NIM0T!03 3Hi dO A3A)JnS V 03WKA-83d 3AVH I iVH-I A3MJD ABR:3H I 31V0 SlHi 13S SH3N'dOO ON jN'j" MONS 3AISS3-M o.L nc 3i4,`WIXO2ddV 32 4VIq NOld3H NMCIHS DNIAVd AW *Sj,.N34-,'3A0i4,dW`I -IVN0I.LIGC-V NIOUISOd K, S4NJD ',-!213JCdd 7NIA0,30 01 ll]Sf, 30 Oi iON -]W DN-MV'V' IG S.-I.H-L NO d'3ddV AVW it/Hl SINIFI3:)N]4 :310N (113JV-)TGNT SS3W1 ) NOTHH WICHS LON 3dV i'lld Qui X3Hi N0 DNIVAddV 3504! NVHL NDHA "CUPKI-16 dO SiN3WDSV3 -gNI!JONI� r 10 'SIN]WIND,�dWT `S31ifU)Mjic -IVN0IiIdGlf 9NINO-,'JTSGd 80i n.3 -n d8 01 1ON H i Sl CNV !SiNTW35V' KAUNV SMT1 JOI OqiiV!d QNV S:iKi.)P,eiS 9NLLSIX3 N13,11,11 -HO S'Dl-!jNI)D ANV MOHS 01 kl--V)!d!-)3dS SNOI linilisNI 9NIGN3 I do 3sn 3Hi doST, N03183H %0IiVA0jNl 3H-1 SINVI-1-11M U3 -1-1:4A @ N30 -]VM UVCI AS 03HDG�O A3AHns IIOH'V3NVHS Gtr -40 i . E r MUNICIPALITY OF ANCHORAGE s�Y • .r DEPARTMENT OF HEALTH B ENVIRONMENTAL PROTECTION 1 ENVIRONMENTAL ENGINEERING Dl%'ISiON 82S L Stn.l • Anchon9P, Alalia 99501 Td<Phona 2Gd4720 --- ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT M F/+1'I{'� ✓1"11K.^S ac ✓ h ° Q NEW C• p /�O a UPORAD[ WAILING ADDRESS / Q 30� ,u �✓ / & ( � `1 / LEGAL DESCRIPTION L L z.o 96 9C1�! l•�i/� �/ S LOCATION zl / [S /G/ NO. BEDROOM DY 1 DISTANCE TO: AInMY1nm M•• Dnflnn9 IERMIT NO. �t Nr.ul�wrw JG ( P• Mwwll'r'• Nn of con.pwlmmN N~ L Lin talon IF HOMEMADE. InlvM Nrprn W�UIn L.Wa eleln dtlZY Z �2` � W.. U+.•'I'M D'STaNUUCE TO: Mr.•IP:1Y•w � - IA.Nr.M PERN'.IT NO. L4Wq llps.lY mENIW �= DISTANCE TO: � tri Z W.wMI� t N«...... 1.M� � ,�t t IO ry AL/�O,�G/J Z No. el Bon L nsl I,W. w� Toa'{'`��) nnl T nrn � phl,n«bp.}rw. Iv gra OF en 01 i{ -1e �n,4. * M,I i�-Z nylcl NICw� E YMrw V oaP I.jS �4 / « L•.qm W.e.n m MI Nu. w tl ,TY«ol.r.o :P• r= C..ea _ Cl.beV,n oa lllwlp. MTwe11M rN l" DISTANCE TO: W.1I Bmlt�.q 0.o coMYN«r«t lol lm. CMII Opm Dnlw.c•lo loa.« PERMIT NO. DISTANCF. TO: BZ alp lwro.uon un• Scow I. % AlNwe.ion w«hl OTHER I � rT-- 1 II IAA FRILLS SOL TEST RA-ING .�, I TP INSTALLS27 At REMARKS kR �t AY ;4 � I I ,..•.. r,E ��:� Wla7T2 �'•r 1 tS�ARCtf '.Y � i•:.I APP DJ DAIS y LEGAL '•^��/A1 (J ,/ t & S EDgineoTin'; i . E . t MUrJ I C:Ir'RL_ I TY OF FINCh� .RI9OE • ` DEPARTMEYT OF HEALTH AND ENVIRONMENTAL PROTECTION 8£5 'L' STREET. ANCHORAGE. AK. 99301 i . 264-47220 O N —S I T E SEWER P E RM I T - PERMIT NO. < 810620 ) ' APPLICANT ERICKSON'S BACKHOE SR BOX 903C 99567 638-9280 LOCATION .. ' LEGAL .7U72rjI {,;::.THUNDERBIRDHEIGHTS LOT SIZE 43560 SQUARE FEET T'rPE OF SOIL ABSOPPTION SYSTEM IS: TRENCH " MAXIMUM NJMBER OF BEDROOMS - 3 SOIL RATING (SQ FT/BR)- 100 ' ' THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: LEVOTH— 24 ORRVEL E>EPTH— 7 i THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIF-LD. - THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE I5 NO SET WIDTH FOR TRENCHES. ' THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE • AND THE BOTTOM 0l' THE EXCAVATION (IN FEET). j REQU I REr> SEF—Tic 'rnr4K S I ZE— 1000 ORL_l_ONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEFMTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADTACENT TO THIS PROPEKTY AND THE � NUMGER OF RESIDENCES THAT THE WELL WILL SERVE. - - r --- -rwo G z? INSPECTIONS FIRE REQUIREp --- . t BACKFI_LING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS ! DEPARTMENT WILL BE SUBJECT TO PROSECUTION. 1 _.;�•�.• MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS '•!' "• 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING .y "•' UPON THE TYPE OF PUBLIC WELL. j MINIMUM DISTANL'E FROM R PRIVATE WELL TO R PRIVHTE SEWER LINE IS 25 FEET RM TO R COMMUNITY SEWER LINE IS 75 FEET. 1 OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS PRE - AVAILABLE TO INSURE PROPER INSTALLATION. .� PCRrJ I T ETSP I RES G+F0Er+II3ER 31.. 1991 I CERTIFY THAT; `� +t• " is I AM FAMILIAR WITH THE REQUIREMENTS FOR OK -SITE SEWERS AND WELLS AS SET • FORTH BY THE MVN4ICIPALITY OF ANCHORAGE. ` ' 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE '4ITH THE CODES. ., 3: I UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE ENLARGEMENT IF THE I .' RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. •. ,� STONED:--------------- ----------------------- APPLICANT ERICKSON'S BACKHOE .: . DRTEl'.iaS_uL------ V4. 0 ...." i ISSUED BY -------- —-------------------- t I (")JNICIPALITY OF ANCHORAGE n ` Department o[,Health and Environmental`.rotection 825 .L..Street, Anchorage, AK. 99501 264-4720 ` w • • HANDWRITTEN PERMIT WELL A /OR ON-SITE SEWER PERMIT /� C Mailing Address: ' �. Applicant: .�%.� b ' Phone Number: ' iR� ' Location:: Lr, 11�a PI. Legal Descriptions G�� Pl�.o Lbr}7r. .otSizas Type of Soil Absorption System Is: ' Trench: P__� Drain field: _ Seepage Bed: _ Holding,Tank: Naximum Number of.Bedrooms: Soil Ratinq(sq.ft/br)) The Required Size of the Soil Absorption System.Zss e� �. GRAVEL DEPTH HIDTH Z— t DI.P1H _C�_ LENGTH drainfield.; The t The length dimension is the length(in feet) of the trench or ahe;gronnd and depth,of.a trench or pit.is'the distance between the.,surface,o! is widtkifor trenches the bottom of the excavation(In feet). There no set depth of gravel between the outfall pips' Tne gravid depth Ss the:mininum .,the bottom of the excavation(in feet). / f' I «:., •'w. REQUIRED=SEPTICiHOLDING) TANK SIZE GALLONS < ' Permit applicant has the responsibility to inform this departmentiduringahe the number; - installation inspections of.any wells adjacent to this property, and y of rusidences that.tho well'will,serva. ;• w'• v TWO(P) INSPECTIONS ARE RECUIRED.:w • • Backfilling of any system without final inspection and approval by this department l will be subject to prosecution. ,1 v Minimum distance between a wail and any on-site sewage disposal 'byatem Ya 100 feet from well 'dependinq upon the type %•� ,for a private well or 150!to 200 feet a public distance from a private well to a private;sewor:linex of publico well. .,Minimum is 25 feet and to a community sewer line is 75 feet. Well logs.are required r and moat be returned to this department within 30 days of.theiwell Completion,."..', .aze' ,'r f Other requirements may apply.' Specifications and construction'diagrams available to insure proper installation. •• w;PERMI7 EXPIRES DECEMBER 31, 1 -;J Z,eertify that II familtar.with',tha requiremonts for on-site sewers and yellsasy Z am set'forth'by.tha Municipality of Anchorage.': i, (2) ''1 will'.'install;the'syste.^: in accordance with codes i system may:requira;an�argament i1 �. (])`.Z and atand;that't a on-site sewer that bedrooms th siden is re' doled to include more (" ` Irsued by: Si"nads .:. Applicant �;• Date: 14 `. ,' SWI`/024 (1/81) ; . Performed br. OF A1IL 11 PLOT PLAN A 10 Dais, 1A, wca� TY 4 9 T I Is -0, 4 Y 0 & E ENCNEERING & DEVELO. MENf 60. 12 C,1w Ile 4A O&I-C" :5:,A A14 PERC.TE Box 90. Davis St. Eagle Alver. Alaska 99577 I r, .. 1 It 894-2714 of OW2250 1111~1! Orator Ead EMS 7.. A 894-2774 SOIL LOG we 22W 15 J Performed for. game , Nc. f7LJ.,e —Tat. z Ground Water Encountered: ,Yee_No —4' If yes. What depth Mslllny Address: -�A Proposed In3tallAflon: Seepage Legal Dmc.1ptlon: r Plf Draln Fleld A own (fest) Performed br. OF A1IL 11 PLOT PLAN A 10 Dais, 1A, wca� TY 4 9 T I Is -0, 4 12 C,1w Ile 4A O&I-C" :5:,A A14 PERC.TE I r, .. 1 It C,a,r4. At ¢ e-00-1- 7.. A r Performed br. OF A1IL 11 PLOT PLAN A 10 Dais, 1A, wca� TY 4 9 T I Is -0, 12 C,1w Ile H� AME 13 e -7— - , do — PERC.TE I r, .. 1 It A .7 15 J 7 s. z Ground Water Encountered: ,Yee_No —4' If yes. What depth -�A Proposed In3tallAflon: Seepage r Plf Draln Fleld A Performed br. A Dais, 1A, wca� TY Ile 1 It Dais, 1A, wca� TY 1 It Parcel I.D. 051 58209 1 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: )e. C � (,- , a (D A9 GENERAL INFORMATION Complete legal description THUNDERBIRD HEIGHTS #1 BLOCK 6LOT 20 Location (site address) 27618 MALLARD Current Property owner(s) CLARK Mailing address Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 3(4 it . (d) Date of Payment i g� 1 octl! 3 Receipt Number 00.Q35p COSA # 05G 17140 5D 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 C&M ENGINEERING Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI 6. DSD SIGNATURE .\/ System #1 Approved for —a— bedrooms System #2 Approved for bedrooms Disapproved Phone 907-854-5558 Date 12/20/18 *�P TH •'f,9 �� :* CHARLE G BALZARINI �'F•• CE -13854 •• 4%i }��►:'AFD ao.,: AW 004W Conditional approval for bedrooms, with the following WATER AND JASTEWATER By: �x &V' s Original Certificate Date: Z L C 1. 8 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—C '- ': c Ifmore than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 111 Jill 11 1111111111111 q Legal Description: THUNDERBIRD HEIGHTS#1 B6 L20 Parcel ID: 051-582-09 A.WELL DATA Well type NARILIBLIS |fA.B.orCprovide PVVS(D# Well Log (Y/N)--�______ Dat000mp|etad-Sanitary sea[ (YYN)-Wires properly protected (YYN)-_______ Tota|depth-_ft. Cased to_ -ft. Casing height (above ground) -in. FROM WELL LOG AT INSPECTION Date of test Static water level - Well production WATER SAMPLE RESULTS: 0 mom Coliform -oo|oniee/1OOmL Nitrate - Arsenic -- uQ8' Date ofsample: - 8.SEPTIC/HOLDING TANK DATA TankType/yWahaho| Tank size l{}U{lgal. Number ofCompartments 2 Foundation cleanout (Y1N)ygs_ Depression over tank (Y7N) no Date oypumping Pumper ft. Date installed 12/16/2018 Cloanouto(YYN) yes High water alarm (Y/N) no C. ABSORPTION FIELD DATA Date installed tiC2//8^i_ Soil rating fo,p-d_Ift2orft^8bdrm) 100 System typetrench Length 2 ft. Width 3.25 ft. Gravel below pipe 7 ft. Total depth _ltft. Eff. absorption area 336 ft2 Monitoring tube yes �_ Depression over field [o�_ Date ofadequacy test Results (Paan/Fai|)pass For bedrooms Fluid depth in absorption field before teat 0 in. Water added 450 gal. New depth 0 in. Elapsed Time: min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12mo.)(Y7N&type) none known |fyes, give date na�_____ D. LIFT STATION DateinstoUed--__ ^Pumpon^leve|at-- Datum -- WELL ON LOT TO: Size in gallons -- in. "Pump off" level at -- Septic tank/lift station on lot - Absorption field on lot - Public sewer main - Sewer /septic service line - Animal containment areas - Cycles tested -- Manhole/Access (YYM)-- in. High water alarm level at -- in. Meets alarm & circuit requirements? -_ Onadjeoont|ots - On adjacent lots - Public sewer monho|e/o|eanout - Holding tank - Manure/animal excrete storage areas - Building foundation 8.2 Property line Absorption field +5 VVatermain +10 Water service line Surface water Wells onadjacent lots +.K}U____' ABSORPTION FIELD ONLOT TO: Property line ° Building foundation Water main Water Service line +10 Surface water Driveway, parkingkmhidestomge Curtain drain Wells onadjacent lots +100 F. COMMENTS ° WAIVER REQUESTED. [}RAiNFIELD IS NOT UNDER DRIVEWAY \ Municipality of Anchorage *AC Development Services Department Building Safety Division4' On -Site Water and Wastewater Program 4700 Bragaw Street 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 Parcel l.D. . r 1- . - M COSA # 0 D3Co Expiration Date: - / (i- 0 1. GENERAL INFORMATION Complete legal description %fiyf/AIQr'/ I/moi f��( 'm/ &06ko' 167'20 Location (site address) Current Property owner(s) 01lej(,E4 'r` H/h�2 r <f/IGi/l�$ay phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System eff Day phone Day phone ZMro TYPE OF WASTEWATER DISPOSAL: Individual On-site Z10 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ 5! 5liq The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 Onsite 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. l 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 AddressI 7_07 /.� Phonea -?a-76-eji Engineer's Printed Name STfv'E +I C Date 2 /49"/C OF At rCDX ,t r1 � s1.+.n W. ego 5. DSD SIGNATURE 't s.'.. PE 62:6 Approved for bedrooms. ..... N' Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Pev 11105) Municipality of Anchorage • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 19WW Anchorage, AK 995196650 www.muni.org/onske (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A WELL DATA A1ISL IC W ATV;e- Wen type Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform — J/ If A, B, or C provide S Sanitary s (YM) _ Cased ft. FROM WE OG ft. g.p.m. JLTS: nies1100 mL Nitrate Arsenic: / mgA Date of B. SEPTIC/HOLDING TANK DATA Tank Type/Materiai "'14,vc f�/S Tic L # _ Well Log (YM) _ Wires properily protectE Casing height (a a ground) in. AT INSPECT N ft. Other bacteria colonies/100 mL �r Date installed _orlZ 7/4?/ Tank size 1006 gal. Number of Compartments Z Cleanouts (YIN) Foundation cieanout (YM) V Depression over tank (Y/N) _/_�,L High water alarm (Y/N) Al Date of pumping .T (C, T Pumper C. ABSORPTION FIELD DATA Date kistailed 0�/'? ZIA& Sol rating 49.j4 Ye or ft?/bdrm) i60 System type 7-/<- F41C fi Length Z- ft. Width 3 ft. Gravel below pipe 7 ft. Total depth /L ft. Eft. absorption are33.3i fe Monitoring tube * Depression over field /V Date of adequacy test Results (Pass/Fad) P.4 --)-S For .3 bedrooms Fluid depth in absorption field before testin. Water added 566 gal. New depth in. Elapsed Time: /F 0 min. Final fluid depth /Z in. Absorption rate >= cYG 6 g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) t/A/k. If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Aocess (Y/N) 'Pump on' level a _ in. 'Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm & rements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: PaguC i4�2 Septic tankflift station on r On adjacent lots Absorption field o410 Public :/sep r m Sewer service line Animalainment areas On adjacent lots Public sewer Holding excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation �Property line /�f Absorption field S 1 't Water main 6 �� Water service line /d �r Surface water / O a < Wells on adjacent lots ZOO rf SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /O Building foundation /B Water main /Q i Water Service line Surfaoe water /OG "f Dray, peft4venide storage Wk Curtain drain 1A V (4 Wells on adjacent lots ZOO .*' F. COMMENTS G. ENGINEER'S CERTIFICATION i?� •" �� h; �A l certify that I have determined ttw h field oug inspections and / . G!•....!t y �, t �) review of Municipal records that the above systems are in o conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name S T6ff w1 e5ei••n w. E� .i PE �21 Date Z�l d S 4t :; "•�. , %`.W .J COSA Fee $ 00 Date of Payment Ih 10L Receipt Number oi 39 Gib (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number ^� w °j°' J� � ped« O ,... 9 rd. 1'/,' AC / hereby oerUy that l ba" aureeyed the Moving dwedbed property lot 20. Black S. Thunderb Bdtbta >lubdlelalon IddlUon No. 1. Peals Croak. Anchorage Raoordtnt DletAet. dark& am that " aocroachmanta Mat moept u Indlostad herson. Tbla 4—butlt vtR only abos the ammo ante. aoeeamts. ar w4letiom that appear m the rood dad subdMNan peat rre—t% mdar m atra®alames ahoaW my data harsoo be mod for eomtrucUm or for establishing boundary ar feme Haas. mlr mtod Dated at taale Ryer. Teak► Tbla _ day of 20 _ AS—BUILT Survey Lot 20,EDRAWN 1" = 40' Prepared By: Block 6, Thunderbird Hgts./14/06 Anthony P. Boneta Add. No. 1, Plat #78-19BY: APB Updated: septic pipe Municipality of Anchorage Development Services Department • +� Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Steve Eno Legal description: Thunderbird Heights #1 Block 6 Lot 20 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on ❑ Calculation error in design. _ ❑ Additional soils information needed. ❑ Water monitoring results inadequate. _ ® Discrepancy in information submitted. _ ❑ Topographic information missing or inadequate. ® Incomplete; missing All septic pipgs must be located by surveyor, ❑ Incomplete; missing ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. ❑ Omission in narrative. _ ❑ Insufficient fill over tank or field._ ® Other. Is any part of trench under drive, Name of reviewer: Jeff Date: 2/7/06 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK tea. ,j MUNICIPALITYOFANNORAGE DEPARTMENT OFHEALTHAHUMAN St 7�[ RvJV,.' .C1E / t,er• Division of Environmental Servlces..J n „7 Ori:SiteSBrvicis Section 1. �vt? " f Yggw t -a;.;:..' r -n:, v '7 P.O. Box 198650 I'Aneftorage: Alaska 0519-66.50 L•• ..,,343-4744 cu';..,, Sb i• :'. f^.Q �, ,�.yr ! ',' �1 r.it-. �,, „r. C ., •r ...i. �::c rO JT i'hf, •a -CERTIFICATE OF HEALTH AUTHORITY „ 3 1:'7.. !, .r•:, f . r 1t :t•:II IO rLf'o'll APPRO JAL FOR A SINGLE FAMILY DWELLING r Parcel I.D. N OSI -ti K 2 - Opt 'Ayor> HAA N 'W tN1�Li(1 SLI_ n,r, ..`..GENERAL INFORMATION.. „ c. ,rl Io ::•ntcV __.-Complete legal description. �.r glc - YilttiaDr�[.(3izA' Fi•6ihwr-S ••SD''• .,,.� Location (site address or directions)477LL��o erd- S3[ Property owner Day phone _ 7d'6 >2s-03 Mailing address .-t 7L /_y _A1',4t. A,e n 4 O jr., a,. At 9 902,'7 Lending agency Day phone Mailing address Agent X Ve -Z Day phone 69•51f-.%6100 ; Address Unless otherwise requested, HAA will be held for pickup. - 3 -. 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. TYFE OF WASTEWATER DISPOSAL: Individual on-site �.�..._.. - -Holding tank t, i Community on-site ,:,•... r: • ; ,• Public sewer ' ' NOTE: If community wastewater system, provide written corifirnistion'from State ADEC ' attesfirig to the legalltyand status of system. r , - , �:•;, m ;• r , . ;a it rYt�t is -.) ..A �--,, '.: I , ? �R• �_-..ssrrTrask' 11 r •.i,J i.,BOAR044.�:tA40'rJL1A91jlNUAI j 5" STATEME INSPECTION ,13Y]ENO1NEER10 j113R",7?10-jn t-DbrvtsC tShlmmnctiJrt? :o .Holt v10. As certwed by seal atftxed hereto and as of the validation date shown glow, I verify that my InGestigetion of this Health Authority Approvalapplicationshows that the on-site water supply -.: anal/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verifyMat based on the information obtained from r7'.. VTtnrl, 1,,%.,� -r',u1 �:• t..•...-.,... the Municipality of Anchorage ,. files from. my investigation and Inspection, the on-site water Jt.�.. supply and/or wastewaterU,.JJ disposal system::is..in compliance with all Municipal and State codes, _ordinances;ano regulations in effect on the date of this inspection. Dayld R. Dayton P.E. Name of Firm - ^M+o oonPaa st ' Phone -zy� Chvglak, Alaska "S67 _._Address -6.-. DHHS SIGNATURE , Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments Date/Lys w � , . Meq•, � 1aj' of '• ,..lf OU -, bedrooms, with the following stipulations: Date:`' /--.0 .. a The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificate:; based only upon the representations given in paragraph'5'aboye by an Independent professionaf engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes andttr_irlendinginstitutionsinordertosatisfy certain federal andstaterequirements.Ern to p yeesofDHHSdonot conCuct inspections or a'nalyz'e data before a certificate is Issued;The Municipal —of Anchorage is not responsible for errors or omissions in professional engineees work ' 710XIV%, tml a.ca MOA m. ,c a+n+s�ft.h� ,w-p�6Ce• �s.t• t V{ . )F �; f r777 .... 1 s t } Munlcipa i of Anchorage r..::. 1,1017At2 T3:...0 Y nc Department•of Health and Human Services HEALTH AUTHORITY APPROVAL -CHECKLIST - `ju Legal Description: L 2,01 .8, Parcel LD ^oTl� 58Z - 09 - oov' ,.,. • A. Well Data.`__--- Well type If A, B, or C, attach ADEC lottor, ADEC water system number�///JZ 1 > ` Log present (YM) Date completed Driller Total depth Cased to —Casing height Sanitary seal (Y/N) Wires properly protected (YIN) FROM WELL LOG AT INSPECTION Z Dale of test �7 ' - m Static water level (� N Well flow g.p.m. " cn m. Pump levell SEPARATION DISTANCES FROM WELL TO: " - SeptWhoiding tank on lot ; On adjacent lots Absorption field on lot ; On adjacent lots Public sewer main _ Public sewer manholo/cleanout - Sewer serv!co line Petroleum tanK WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date o.' sample:_ Collected by: B. SEPTICMOLDING TANK DATA Data installed / Tank size I ooa Compartments 'Z•• Cteanouts (YM) Y Foundation cleanout (YIN) Y Depression (YM) N Nigh water alarm (YM) N1,4 _Alarm tested (YM) Data of pumping —9 Ag ha Pumper Je'S y rI&M O,, A SEPARATION DISTANCES FROM SEPTICMOLDING TANK TO: Welt s) on lot — -On adjacent lots `^- Foundation _ • I L- .. .. __. _ To property line 10" Absorption Geld f L Water main/service line z s � _ Surface w^tor/drainago -72402e lM' im+ -"- CONTINUED ON BACK PAGE _ . �.... ..0 .V {•'• f. 1. ♦ •\ � 'V.V r■ V_ I4 / 4 C.L1 STATION epsiorwA to yI .,,JoinuliA .+� • �-...,: :,, ,y - i9:,(VIC �nfr^l. t'I fJili.� file Date Installed +;.•.% Manufacturer �.._•�.. _u 1�. �.. V v n'II. i V 1111 Uii 1"UH I-lIj4l Size In gallons Manhole/Access (YIN) Vint (Y/N) _ 'Pump on' level at 'Pump,df• Level nt,•- - High water alar level Cycles tested + Meets MOA electrical c000s (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: - Wali on let On adjacent lots Surface water D. ABSORPTION FIELD DATA r .. 'Data installed Soil rating (GPD/Ft') 10015f h L System typo Length Width 3, 3 _Gravel thickness __Total depth // -IU Total absorption area 3 3 t. Cleanout present (Y/N) Y Depression over field (Y/N) t� 'Date of adequacy test 4 z.-19-/ Results (passlfail) 00A --Z,5- for 3 Bedrooms Water level in absorption field before test Al,,r test 3.7%/ 'Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent Iota: Property line r.% • _ To building foundation 20 To .vi; ing or abandoned system on let A.%,� s On adjacent'..Its. ?o,.- Cutbank N/n Water main/servlco line -z.si- Surface water _ 10-0+- Driveway, parkingtvehicle storage area Z 57 r 'Curtain drain /).Na /1,,,OW.) E. ENGINEER'S CERTIFICATION I certify that I have checked, vedred, or conformed to all MOA and HA4 guidelines " Devid R. Dayton P.E. 20210 Dontlar St. .... Signature -- 25A7 Engineer's Name / Data HAA Fee S/�P Date of Payment 6 r y 1 Tiodetpt Number' •,' nme tsnt• a.a . t t Waiver Fee S Date of Payment Receipt Number. ap(hVate cf this inspection. L r Doig [. Cayfan f ^ . No. :.C12 lir ,�• "FESS f ..• ■ AL I r IKPECTION APPOINTMENTS, time TIME TIME I DATE UxTr-, Ca ;.SINGLE Fw.AMILY-4',, 0 -wo I ' t. ':C3 k -`MULTIPLEFAMILY Thurnu A— IN31ECIII. 7. WATER SUItTLY, I INDIVIDUAL' �-ATTACHWELLLOG.AwvIIIapI9r@wI W fmafl �rf !.i �'C V. f3i 1, PAUTY OF ANCHORAGE. MUNICIPALITYOi'A146HCIRAGC P?. OF Ici-L", DIEFARTMENTOF HEALTH& INVIROMMINTALtROT1 &I NMENTP. KCILCT)ON t ENVIRONMENTAL. ANITATION DIVISION IVAU t irk i,..,*'REQUEST FOR APPROVAL OF INDIVIDUAL WATER ANO SE&U-MLI(a, 1981 YEAR ON-SITE SYSTEM IN N j DIRECTIONS: CO-PIWOMI P" llitppe 271.4 0571Q �OI�ReIi4- A MA!L'2"4 I E AVE,,�,,,,, Cho doe Ai 99301 7 I th i, 4 r PAOPER TY RESIDENT III d-It.9 ll"e :. ILI 11 L GUYAR_,...;• J.L. MAILING ADDRESS A 8420 HONE kit, r Alas Statebank �,A ,!Do, MAIUNGAOORESS .;viirc'•3*iihern Ll Itht k.AEALTORIAGENT, MAI LING A D DR ESS V�15th*,A�anuti;– 74M Choi 9; ;0 AL I r t 6, RkbTLOCATIOKJ-- I • Numaln OF alumoomi, C3 Ca ;.SINGLE Fw.AMILY-4',, 0 -wo I ' t. ':C3 k -`MULTIPLEFAMILY Three ClSIX'Qo 7. WATER SUItTLY, I INDIVIDUAL' �-ATTACHWELLLOG.AwvIIIapI9r@wI W fmafl �rf !.i �'C V. f3i 1, — I . ... 1975. For drilled 01cir 6 6 . . 4 COMMUNITY11-1. ♦6 3 MrVIPUMCLMLITY7, sia Jum ""s dopth lattach log If "ItIlAble.) 04 IVAU INDIVIDItAb6N-SITE 1981 YEAR ON-SITE SYSTEM IN N TALL NOTE I NSPICTION FE9 KUST ACCOMPANY EACH REQUEST DEFOAN PROCII TYPEOF TANK` r MANUFACTURER !Y •Y ZS? ra N ;{ TOTAL ABSORPTION AREA MATERIAL THIS SIDE FOR OFFICIAL USE ONLY... iT ✓I..;'•! �A,.:I ..r ..ir .: '.j • '''. ..� •.. �, r�r: t..DISTANCES!\++• 1' w,E " 1. TYPE OF RESIDENCE :.." •" " ' �NIAwtR oP B[DRooMB'� ,,.{��/' `.ti•"Y;a•l WELL TO ~C ' ' ❑ SINGLEFAMILY„ V' t ❑.;ONE ❑ ,.THREE 1 ❑ FIVE ti ' ❑MULTIPLEFAMILY ': "' ❑ TWO. ❑ FOUR ❑:.SI%� V�'t,�l LE.` e. Z: Y. t/li V f.',''.. +I.�1.'�.••t�� zo -4 . t WATER SUPPLY IERMIi NUMBER , ♦ }'�F 4•.,/ ❑ INDIVIDUAL DEPTH Or WELL w.i,? •w 7rryla.. Y I F �- � . -❑;' COMMUNITY- -, � \ .µY1 f\✓�' Y.T '�l1 ?� 1 A \ .. AY f�� \ - ❑.;)PUBLIC IRI:ITY DATE DRILLED , �-"' } �: 14 �>• ,5; ,;:;, /. y� { r,>•I '%,i, Connettlon VeriRod LOG PEEIVEDC ?M/-APPROVEO ,`}}� } y, r,r, y j. x ❑ ��ISAPPROVED/ r- SBy/ CA' 9• 4..- S 3. SEWAGE DISPOSAL SYSTEM •: PERMIT NUMBER t_ ?'..• ❑INDIVIDUAL/ON SITEr •ATZTS-. TAT 1 • ..'•F 4}I. 119 ,�'!Y< ❑PUBLICUTILITY + '� •.,+•. •.;1 \..'r -r!ow.r ,:: }.p'q: yr , Commion Verined its?j IN LLEH '•f`;- t,I.Ir,. ❑S.ptil7Jnk or ❑Hoidirp Tick T"* t4"•.;:`r, ' ro,, ,'.ii'� ,�."' y ':'rl Stt.:'"•"�'''� I I Tank IB Aomtmedt SOIU RATIMat ,. •. f:. 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