HomeMy WebLinkAboutBIRCH HILLS ESTATES #1 BLK 1 LT 10Birch Hills
Estates #1
Block i
Lot 10
#050-081-11
Municipality of Anchorage
Development Services Department
Building Safety Division +.
- On-Sfte Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of 3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO90122 PID Number: 050-061.11
Nem* JIM FISSORI
Wastewater System: ❑ New ❑ Upgrade
Mdess
PO BOX 242773, ANCHORAGE, AK. 99524
ABSORPTION FIELD
Prana 440-6077 Nurrltar d Batr s
3
O Reap Tmdt D Shallow Trercn [3 SW ❑ Mauq par
LEGAL DESCRIPTIONNIA
B""°
Taai 0001hmma lyaee
GVOIFr'
q.
Buck 1 La 10 sleemson BIRCH HILLS EST.#1
DOPM a P" Pomo from av" 7aea
Gravel In o.aalh ppe
Ft.
FI
Tavmnlp Rarpe $sawn
FJ aeeae darve tx9ml waoe
Gravel Lanpn
FL
Ft.
Well: ❑ New ❑ Upgrade
c7" .,,,zn
NuntardNate,
Dolan,,@ '"ties
Ft.
FI
Casm"im (PMNs. A e C)
Tad Deph
Casae io
Taal aeso"
Pp Materal
PRIVATE
Ft.
FI
FI'
Dow
Dde Draee
SW4 Water Level
aataiw
Date aalallee
Ft
TWEED EXCAVATION
Yea
Plan" sad
Ca" trprq awtle Gana
TANK
GPM
FI.
FL
SEPARATION DISTANCES
El Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
Lilt
Holding
ublicrPnvate
act ew
a'—y
From
Tank
Field
Station
Tank
Sewer Line
PREMIER
1000 Gal
War
100'+
100'+
25'+
Mderal
H.D.P.E
Na tw dCanpanmana
2
safarewai.
100'+
101x+
LIFT STATION
Stl
KAJBI
La Lne
5'+
10'+
N/A Gel
'Punp W. at
'Pump dr elHqh
water aaand
Fpaadan
5'+
10'+
n
in
Curran Dran
NONE
KNOWN
pw,,P"a&
Ea "Mgwt na PeripmM Ey
Remarxa
EXISTING 1000 GALLON STEEL TANK WAS PUMPED,
BENCH MARK
Loulm da D.,%.
CRUSHED AND REMOVED.
TOPOF CONCRETE Q POINT •A'
wntl0 Ebvw.
100' Ft
ngineant tv
Engineer's Stamp
Inspections performed by: 15661 S. Birchwood Lp. Rd. Dates: 1'
O YY201
_a.+► Ad's .
•''�� aa'`�'f rF
Development Services Department Approval
,!g'��{
eat
TN
Conditional Approval Date:
NOW ,�
••M • •••eN•••N•�,IN�
1
eA-A. slaw•.
.•�Na 14=49 a`�'F'
a
Reviewed and approved by: xt, ate:
•/(
PERMIT No. SW090122
PACE 2 OF 3
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www.ci.anchoroge.ak.us
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 10, BLOCK 1, BIRCH HILLS EST.#1 S/D P.I.D. No. 050-081-11
I
LOT 9
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NEW 1000
GALLON
o ' H.D.P.E. SEPTIC TANK
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LOT 2 �J
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PERMIT NO. SW0901 22
PAGE 3 OF 3
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: <907) 343-7904 • www.ci.anchoroge.ak.us
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 10, BLOCK 1,13IRCH HILLS EST.#1 S/D P.I.D. N0. 050-081-11
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 23, 2009
Expiration Date: Jul 23, 2010
Permit Number: SWO90122 Parcel ID: 050-081-11
Legal Description: BIRCH HILLS ESTATES #1 BLK 1 LT 10
Design Engineer: 0003 S & S ENGINEERING Site Address: 012027 DEE LN
Owner Name: JIM FISSORI Lot Size: 0 SQ. FT.
Owner Address: POB 242773 Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE, AK 99524-0000
This permit is for the construction of:
❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
FYI: Although the proposed tank replacement does not meet the requirements of subdivision plat note 8., it is being
approved in accordance with the current version of the On-site code (AMC 15.65) and what has been done in this
subdivision historically.
Receive(
Issue(
Date
Date
Municipality of Anchorage
--� Development Services Department
Building Safety Division
_ On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, Alaska 99507
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. d Sd- 0 9 f, I I
°Fa
y� G�
s s
s w
Property owner(s) Jim Fissori Day phone 440-6077
Mailing address P.O. Box 242773, Anchorage Ak. Zip Code 99524
Site address 12027 Dee Lane, Eagle River Ak. Zip Code 99577
Legal description (Sub'd., Block & Lot) Birch Hills Estates #1, Block 1, Lot 10
Legal description (Township, Range & Section)
Lot Size _25,700 Sq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field ❑
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
certify that the above
Single Family Dwelliry
(Signature of property owner or
Permit(Rush Fees:
El
Number of Bedrooms 3
THIS APPLICATION IS AN:
ZD
Initial
❑
Upgrade
0
Renewal
❑
ition is correct. I further certify that this application is being made for a
in accordance with applicable Municipal Codes.
Waiver Fees:
Date of Payment: /� Date of Payment:
Receipt Number. ! 57/i C Receipt Number.
(Rev. 11/05)
ROBERT C. COWAN .
CIVIL ENGINEERING
PH: 907-694.2979
FAX: 9 0 76 94-1 211
July 14, 2009
MUNICIPALITY OF ANCHORAGE
HEALANORYY
AMOVAALS
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
SEWER & WATER
AwNE)(TENSIOPB
REFERENCE: Lot 10; Block l; Birch Hills Estates #I Subdivision
It is requested that you issue a permit to install a new 1000 gallon II.D.P.E. septic
SEWER&WATER
PBFEOTION
tank The existing 1000 gallon steel tank serving the existing three bedroom dwelling
on the referenced property has holes/perforations..
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
ENGINEERw48TLCES
ANDREPORTS
areas or drainage patterns by the installation of the proposed septic tank. The construction
of this system will not prevent any future development on any of the adjacent properties.
al information, please contact us.
WELL OBPECr"
&FLOW TEST
LTE PWB
oSince,
afer, P.E.
RDAO DES4N
Enclosure
SM TEST
PERCOLATION
TEST
STRUCTURAL&
kECMANICAL
MPECTIpB
ONSITE
WASTEWATER
DBPOSALSTSTBA
DESJGN
15861 S. Birchwood Loop Road - Chugiak, Alaska 99567
I SITE -PLAN I DESIGN
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ROBERT C. COWAN.
pneeking
CML ENGINEERING
)
PH: 907.694.2979
/
FAX: 907-694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
THAJTHOFM
MPPROVA
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
SEWER & WATER
AWN CaENSXM
REFERENCE: Lot 10; Block 1; Birch hills Estates 41 Subdivision
July 14, 2009
SEWESWATER
PNSPERCTXW
GENERAL:
1. The scope of this project includes the replacement of the existing 1000
gallon steel septic tank with a new 1000 gallon IIDPE septic tank to serve
Ii+ REPORTS rwlEs
l
the existing three bedroom residence located on the referenced property.
2. Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and
WEILWSPECTION
&ROWTEST
all applicable State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary
SITE PL"
underground utility locates.
4. Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
10'DDF9GN
settling.
5. Contractors installing wastewater disposal systems must be certified by the
SORTEST
Municipal Development Services Department or ADEC if required, for
system installations. Owners installing their own systems must also receive
prior approval from the respective agency.
PERCOLATION
TEST
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
uMEo '
. Construction shall include two 4" cleanouts for pumping access. All HDPE`NSPE`nONS
septic tanks are required to have a 4" monitoring pipe installed next to the
tank extending to the bottom of the tank.
ONSITE
WASTEWATER
DePOSAL6WTEM
DESIGN
15861 S. Birchwood Loop Road - Chuglak, Alaska 99567
Page 2
Lot 10, Block 1, Birch Hills Estates #1 Subdivision
July 14, 2009
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final
grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated. All IIDPE septic
tanks are required to be covered with a minimum of 2" direct burial insulation, and a
maximum of 4 feet of cover.
5. A foundation cleanout shall be installed one to four feet from the building foundation.
In the line between the tank and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic tank). These cleanouts
shall be located on undisturbed soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be
to clean toward the septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pike Perforated Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (IIDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the inspecting
engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco,
or equal).
Page S
Lot 10, Block 1, Birch Mills Estates 01 Subdivision
July 14, 2009
INSPECTIONS:
Typically there will be a minimum of two (2) inspections required during the installation of the
septic tank. These inspections will occur as follows:
The first inspection must be conducted after the septic tank is set in place, but
may not be backfilled until after this inspection.
2. The final inspection is to occur upon final grading of the property.
The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If
necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not
coordinate, direct or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S & S Engineering. S & S
Engineering shall be the owners representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor
to carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorage Page of �—
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: Sw91o3➢y PID Number: aSODP///
Name: f Nc a.
Wastewater System: ❑ New Upgrade
Address:
ABSORPTION FIELD
R0, 774 y r e! ,44 qs's»
Phone: No. of Bedrooms:
❑ Deep Trench ❑ Shallow Trench ❑ ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:al
Depth from original grade:
GPD/e F
Lot: Block: Subdivision: 4401x/
Depth to pipe bottom from original gra
Gravel depth beneath pipe
0 N /u S sTATtrT
Ft.
Ft.
Township:
Range: Section:
Fill added above original ads:
Gravel length:
Ft.
Ft.
WELL: ❑ New ❑ Upgrade
Gravel width:
Numberoflines:
Dauneebetweenlines
FL
Ft.
Classification )Private. A.B.C):
Total Depth:
Cased To:
Total sorption area:
Pipe material:
/ '4 < L Clio E%
Ft.
Ft.
SO. Ft.
4X r^ OPO? P✓L•
Dniler.
Date Drilled:
Subs Water Level:
Installer
Date Installed:
Ft.
BO Ae-A v14T/N6—
/i 4
Yield:Pump
Set at:
Calling Height Above Ground:
TAN
K
GPM
Ft.
Ft.
SEPARATION
DISTANCES
06eptic ❑Holding ❑S.T.E.P.
To
Septic
Absorption
Lm
Holding
boaffla ate
Manufacturer.pacity
In gallons:
Ca'06
From
Tank
Field
Station
Tank
sewerU
CNO A
Welt,
/i9'
- --
---'
ZS '
Material:
Number of Compartments:
«`
Z
Watere
--
LIFT STATION
Water
10014•
Lot
6/1-Foundation
l lions:
Manufacturer.
Line
/611-
Foundation
Pump on" level at:
ofr level at:
High water alarm at:
I
Curtain
1 -4
NONF
X.C1 d iV
Pump Make a Model
Electrical Inspections perform
Drain
Remarks:/n/5UL�177u/4 /A/5T71z-�
BENCH MARK
O✓C2 ez-1- �o�770r1S or
Location and Description:
Ar— LOOP of .zRc-e' Sc.aR
SAA6 ovC 2 / �E c,(n/ JE,e.�t x,�2//1 ✓E
/L'-
/•S�� O✓E� SE�IG 7'id /��`
Assumed Elevation:l00.w Ft
ENGINEER'S SEAL
17034 Eagle River Loop Road, No. 401
F' '•%1.' ^. i
Inspections performed by: Eagle River, Alaska 9s577 Dates: 1s 7- 4
r 0
2nd/
„ ., _
_ a!i
• s:a. 11.7-E
��r`F
Department of Heallib and Human 5ervices approvalP.
�•.._...� �� <'
�-2O'
Reviewed and approved by: Date:
7'2-013 (Rev. 991) MOA 25
Permit No. SW930-194 Page 2 of 2
Municipality of Anchorage
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
Legal Description: BIRCH HILLS ESTATES0. BLOCK 1. LOT 10 PID No.:05008111
cot CO2
96.0' 97.8'
INSULATION
NEW i —_ I
93.9' 1000 CAL 93.7*
SEPTIC
TANK
N.T.S.
5
X00 4 j
A _Ge _
/
/
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W1 2 /
00 /
C0 EXI:
I /
SCALE I• - 40'
72-013 A (2A1) MOA 25
A I B
FCO 14.0 25.
cot 65.5 68. ---- -- - -
CO2 67.5 68.
CO3 59.0 64.
N
1000 CAL
'IC TANK
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PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930384 DATE ISSUED: 9/22/93
DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 9/22/94
OWNER NAME:BAGLEY WALTER G JR & NANCY J
OWNER ADDRESS:P.O. BOX 772187
EAGLE RIVER, AK 99577
PARCEL ID:05008111
LEGAL DESCRIPTION: BIRCH HILLS ESTATES UNIT 1 BLK
1 LT 10
LOT SIZE: 25700 (SO. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
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:
RECEIVED
ISSUED BY
DATE • 1 -z /-? /y
DATE Z -Z
September 13, 1993
NEALTNAUTHORITv unicipality of Anchorage
APPROVALS EPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
chorage, Alaska 99519-6650
SEWER A WATER
MAIN EXTENSIONS
Birch Hills Estates Subdivision #1,
Block 1, Lot 10
SEWER & WATER
INSPECTION
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX 694.1211
Request you issue a permit to replace the septic tank serving
the 3 bedroom home on the above referenced property.
ENGINEERING STUDIES
AND REPORTS The existing septic tank is in a state of failure and is
located in the well radius.
If you have any questions or require additional information
WELLINSPEC710N
&FLOW TEST for your review, please contact us.
SITE PUNS
SOIL7EST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTE WATER
DISPOSAL SYSTEM
DES GN
A. Shafer, P.E.
/LSU/lsu
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
. Birch Hills Estates subdivision #1, Block 1, Lot 10
GENERAL:
1. The scope of this project includes the intallation of a
1000 gallon septic tank outside the 100, well protective
radius to serve the three bedroom residence located on
the referenced property. The existing 1000 gallon septic
tank is to be excavated, pumped, crushed, and abandoned
in place.
2. Construction shall be in accordance with the approved
site plan and design drawings; Municipal permit with any
special provisions or conditions; and all applicable
State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any
necessary underground utility locates.
4. Unless specifically agreed otherwise, the property owner
shall be responsible for final grading areas subsequently
depressed from soil settling.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Health Department for
system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic
tank manufacturer. Construction shall include two 4•
cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum
of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover
shall be insulated.
Page Two
Birch Hills Estates subdivision #1, Block 1, Lot 10
September 13, 1993
5. A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the
tank and the leachfield there shall be two adjacent
cleanouts (unless an effluent pumping system exists
within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the
tank. The first cleanout, in line, shall be to clean
toward the leachfield. The second cleanout shall be to
clean toward the septic tank.
6. Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in
septic system installations in the Municipality of
Anchorage:
Type
of Pipe
Perforated
Solid
Cast
Iron
Yes
Yes
ASTM
D3034
(PVC)
Yes
Yes
ASTM
F810
(HDPE)
Yes
No
ASTM
D2662
(ABS)
Yes
Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
Page Three
Birch Hills Estates
September 13, 1993
INSPECTIONS:
subdivision #1, Block 1, Lot 10
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
1. The first inspection must be conducted after the
tank has been set; lines, cleanouts, standpipes,
and insulation are in place; and prior to
backfilling.
2. The final inspection is to occur upon final grading
of the property.
The inspecting engineer is to be contacted at least 24 hours
prior to the start of construction. If necessary, a pre -
construction meeting will take place on-site.
NAME
LOCATION
r --'tUNICIPALITY OF ANCHORAGE---,,
He. n and Environmental Prote on
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
_ MAILING ADDRESS
SEPTIC
SEPTIC TANK:
DISTANCE
FROM WCLL � MANUFACTURER
LEGAL DESCRIPTION L 10
1
JOA
PHON(!1J1_W-Zftk
Zx' , Lf j P Z�. -g -2-
NUMBER OF
MATERIAL COMPARTMENTS
INSIUE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE OF LINE
# of Lines DISTANCE BETWECN LINES TRENCH WIDTH_ IN. TOTAL EFFECTIVE
ABSORPTION AREA y91" SQ. FT
DEPTI I: TOP OF TILE I'D FINISH GRADE
SEEPAGE PIT:
LENGTH OF EACH LINE —
DEPTH OF FILTER
-MATERIAL BENEATH TILE
.i v
IN. ABOVE TILE y IN.
DIAMETER _OR WIDTH _. LENGTH_, DEPTH
Log Crib _Rings_ Crib Size:l DIAMETER_DEPTH_ DISTANCE FROM: WELL
TOTAL CFFECTIVC
BUILDING FOUNDATION_. NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT.
Well
Class: Depth:
Well Distance To: Lot Line
Bldg: Sewer Line:
Pipe Materials:
# of Bedrooms:
Installer:
Remarks:
I
MAW F,
TTT
_I_�
1-
T
I
TTT
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1-
T
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I
1
DATE_.� �,LAPPROVED . f -S illK_Aur1
11
C��e�rift�d �tllin �u;g _
by rr,. ; • ,.
A & L DRILLING COMPAN)',; ,,
BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 6942586
OWNER OF LAND ^i� Al{NC/ n1 ca DEPTH OF WELL
ADDRESS STATIC LEVEL OF WATER FT.
LEGAL DESCRIPTION_!L: L) [ L� � 1i4't N Huts Ff%,�7rT DRAW DOWN FT.
DATE - Started '461/77 Ended /11 GALS. PER HR
PERMIT NUMBER :1 7 G I KIND OF CASING l k , —
KIND OF FORMATION:
From
Ft. to
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MISCL. INFORMATION:
G" CrS/�.j(�
DRILLER'S NAME
Jj
hl L_1t-J I C I F'HL 17'Y 4F Ht-aCHl�l=z"1:3E
DEPARTMENT r""'-1EHLTH AND ENR
VIOtJMEFJTH�
LrTECTIOFJ /9� -7-1 )tlrt
825 STREET, ANCHORAGE, AY.. 95. lpep
' 279-2511
F.J1=LL HMO UI 1—E I TE 5 E4�lEF< F ERM I -v
a PERMIT NO. ('77848 )
,NF'LICHNT P.HDHEY HASTINGS 2710 FAIRBANKS ST 2774182
LOCHTION DEE LHNE EHGLE RIVER.
LEGAL L10 B1 BIRCH HILLS ESTATES #2 LOT SIZE 25136 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MHXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 150
THE REQUIRED
SIZE
OF THE SOIL ABSORPTION
SYSTEM
IS:
L3EF -1-H=
7
LEt IGTH= t57*
U�H'tirk=L
OEF'-F-H= 4
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 (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 OF THE EXCAVATION CIN FEET).
FZ:Ei:;!i I F1E0 EEP T I C THFVF�
F•HCFCHGE F=^FLHt-F"T- N ---------
A PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE
FOLLOWING CONDITIONS:
1. EITHER A CLASS I OR. II NSF APPROVED PLANT MAY BE INSTALLED.
2. H CONTINUOUS MAINTENANCE AGREEMENT I5 REQUIRED. IF A MAINTENANCE
AGREEMENT I5 NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL
ABSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION.
TWO} C 2 7 I t-IS~F'FEE CT I IDt-a5~ HF:IE GV LJ I FZEO ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A I -JELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR R PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS FRE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'EF=ZM I "f, EXFs I F2E:H: OECEt'tE3EF'_
I CERTIFY THAT
1: I NM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SE14ERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IFJ ACCORDANCE WITH THE CODES.
3: I UNDERSTW THAT THE OM -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RES•IDEhJCE IAOVEftD TO jt�CLUDE MORE THAN 3 BEDROOMS.
SIGNED
HASTINGS
r7 �j
!/ LCrv------DATE_Z_ Z -------
ISSUED
/ ti13. O
ISSUED BV ---
�'- 0 Ft E GEG CHNI CAL £r DEVEL�; MENT CO.
Box 90, Davis St., Eagle Siver, Alaska 99577
694-2774 or 6682280 Z
Russell Oyster Earl Ellis
6942774 SOIL LOG _ 688.2280
Soils B Foundations Land Development
Performed for: Name:el. No.
Mailing Address: Z.-7 %o ';F_
Legal Description:_ \_c,c \O -;n \ ��.fLCu �..s tlsc�4S'� Z"
Depth (feet) Soil Characteristics
0
1
2 Gs�o.v �. W ry ^��a t
,j -�
4
5
6
7-
8-
10
8
SP- G`�a..►F.0-7 �aa.fl - Ovtzc�.... vtn�r Q..,fA� ,
a:-LgS,o.�q�. Catszsi.-*ES,t G�v�z.S
10 �'� a -r%
11
12
13
14
15
16
ft_k- —N7'0 .
Ground Water Encountered: Yes No `� If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by: n Date: Q-
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite (907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel 1.D. 050-081-11- COSA # 05(�-) R I3 O
1. GENERAL INFORMATION
Expiration Date: 0 - Z :Z' I?
Complete legal description BIRCH HILLS ESTATES #1 BLOCK 1, LOT 10
Location (site address) 12027 DEE LANE, EAGLE RIVER, AK 99577
Current Property owner(s) JAMES & MICHELE FISSORI Day phone
Mailing address PO BOX 242773, ANCHORAGE AK 99524
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
® Individual On-site
Individual Water Storage
® Individual Holding Tank
❑
Community Class Well
❑ Community On-site
❑
Public Water System
❑ Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further 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 atthe time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 568-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 08/10/12
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow
and absorption rates may change due to subsurface conditions that may not be observed from the surface,
changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the
water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a mo
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen }
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
_AZ Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
COSAChecklist A Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory
Other
By: � Original Certificate Date: 12—
(R.,, 11/05)
t
Municipality of Anchorage
• '� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite (907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: BIRCH HILLS ESTATES #1 BLOCK 1, LOT 10 Parcel ID: 050-081-11
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 9/2211977 Sanitary seal (YM) Y Wires properly protected (YIN) Y
Total depth 340 ft.
Date of test
Static water level
Well production
Cased to 21 ft. (bedrock)
FROM WELL LOG
9/22/77
ft.
9.p -m.
Casing height (above ground) 24 in.
AT INSPECTION
8/3/12
WATER SAMPLE RESULTS:
Coliform NEG colonies/100mL Nitrate 0.492 mg/L
Arsenic: ND mg/I Date of sample: 8/3112 Collected by: ArcTerra
B. SEPTIC/HOLDING TANK DATA
Tank Type/Matedal Septic/HDPE Date installed 8/19/2009 Tank size 1000 gal.
ril
Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
High water alarm (YM) N Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed 1979 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System type Trench
Length 69 ft. Width 3 ft. Gravel below pipe 2 & 5 ft.* Total depth 6 & 9 ft.*
5.75'T.b• WEAsu RED
Eff. absorption area 492 fl? Monitoring tube Y Depression over field N gl71i2
Date of adequacy test 8/7/12 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 6 in.
Elapsed Time: <5 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date -_
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at _in. "Pump off' level at _in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1001+ On adjacent lots 100'+
Absorption field on lot 1001+
Public sewer main
Sewer /septic service line 251+
On adjacent lots 100'+
Public sewer manholelcleanout 1001+
Holding tank
Animal containment areas 501+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 51+ Absorption field 5'+
Water main 101+ Water service line 101+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 10'+ Water main
Water Service line 101+ Surface water 100'+ Driveway, parking/vehicle storage *0'
Curtain drain 501+ (None Known) Wells on adjacent lots 100'+
F. COMMENTS
*Per MOA record documents. Field is in driveway and is insulated with cast iron sewer risers at or
below grade. Vacant system surcharged prior to testing Water storage tanks (4 Greer 25() gallon
.- s.__.. n_ __ ..�.I. _ __ _ ___
G. ENGINEER'S CERTIFICATION
1 certify that l have determined through field 'inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 8/10/12 _
COSA Fee $490.00 1
Date of Payment j�t J o,
Receipt Number 4 0054u
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
013/13/12 12:0£3 PM
L
Sanitary Pumpers
9076180993
-SIUMIARY PUMPERS
20627 UPKR KWERY LANE
CHUGiAK, AK 99567
UUMMEn :, ORDEA NCI I'HOPIi
DATE
NAME
� '
Ti'• 2. ..t2.._ _
t
ADORCSS
12:7 � t 1 A �
SOLD 9YCHA CE ONACCT mneco,.., .,.... ...,_
�aaa bre 4 e.
/ `r') i OU
TAx
RGCF.IVED dY I
"'f
TOTAL
I ,
Zry All claims and returned goods
! MUST bo acr..bmpaniod by this Uilf. Thank You!
PRODUCT?GJI '�'��
Page 1
L �
RSBUILT-N# GQRN%R9 OE"
T"" 4ATE, _8$hAriA 838960
1 H£R£eY CERTIFY THAT 1 HAVE 8URI+EYEp
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1 H£R£eY CERTIFY THAT 1 HAVE 8URI+EYEp
troL60WIN4 pEBrt+ill3£0 °AR 7pERTY
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C. LIFT STATION
Date Installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) 'Pump on' level at 'Pump-eff-re—vel at
High water alarm levet
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCETROM LIFT STATION TO:
tested
lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date Installed I `t17 Cl Soil rating (GPD/Ftz) 1.50* I8 z System type
Length Lo°t Width 3, * Gravel thickness Z'AT Total depth
Total absorption area y92 ¢ Cleanout present LON) Depression over field (YQ
Date of adequacy test '3- - 7 - 5 S Results assXail) for 3 Bedrooms
Water level In absorption field before test D y After test D
�l
Peroxide treatment (past 12 months) CY4Z .1o^34r-- If yes, give date d
Q1L-q ZZF-. P.-f-P"gA L_ s fsre-,.4 IJsuL-«tea
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ( oo r Jr- On adjacent lots 1 Property line %;=:, 00 -
To building foundation l o 4- To existing or abandoned system on lot
��CT&E Environmental Services Inc.
Laboratory Division►iiiiiiiiiiiiiiiiiiioiiiiiiiiiiiiiiiiiiiiiiiiii
CTLE Ref.# 95.0848-1 Laboratory Analysis Report
'\ Matrix WATER
Client Sample ID L10 BLK1 BIRCH HILLS 01
Client Name S L S ENGINEERING WORK Order 13030
Ordered By R. SHAFER Printed Date 03/09/95 • 14:34 hre.
Project Name Collected Date 03/03/95 a 09:45 hrs.
Project# Received Date 03/03/95 a 16:10 hre.
PWSID UA
Technical Director STEPHEN C. EDE
Released By -
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
--------------------------------------------------------------------------------------------------------------------
Nitrate -N 0.10 U mg/L EPA 353.2 30. 03/07/95 CMR
......................................................................................................
• See Special Instructions Above UA . Unavailable
c' See Sample Remarks Above NA Not Analyzed
U . Undetected, Reported value is the practical quantification limit. LT . Less Than
D . Secondary dilution. GT . Greater Than
n
v>
200W. Potter Drive, Anchorage, AK 99518.1605 —Tel: (907) 562.2343 Fax: )907) 561.5301
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
n
'AlL CME Environmental Services Inc.
Laboratory Division>e«ssiie��siiiriiiiiiiiii�iy>iiiii�i����siii
Drinking `Vater Analysis Report for Total Coliform Bacteria a0 W. s°e r Drive
99518.1605
READ LVSTRCCTIO.VSONREVERSESIDEBEFORE COLLECTLNCS-01PLE Tel: (907)562.23*
Fax: (907) 561.5301
MUST BE COMPLETED BY WATER SUPPLIER
0 PUBLIC NVATER SYSTEM I.D. Nn I I
a-- PRIVATE WATER SYSTEM
ae SS"d�etul s G 0 Send Porn;re
0 MMO-MUG
- Nurnber o`colanies
7,11
Lab Re r. No.
Result` Analvst
95.^3;g
ICI J
.... ] :.
0 Send Results 0 Send Invoice
SAMPLE DATE: ® 253 HE -
Month
/ E IMonth Day Year
SA\I?LE TYPE
Rc— Routine 0 Treated Water
0 Repeat Sample (for routine sample 0 Untreated Nater
with lab ref. no. )
C Special Purpose
Time Collected
S:1.NIPLE LOCATION Collected By
r
Ana!ysis show's this Wal!.SAMPLE to be:
y Sa:isfactory
0 Unsatisfactory
0 Sample over 30 hours old. results may
be unreliable
O Sample too long in transit; sample should
not be over hours old a: examination
:o indica:e reliable results. ?!ease send
new sample via special delivery nail.
Date Received
Time Received
Analysis Baan
Analytical Method: ^c^"Memb;ane Filter
Ds: -:Le Tine:
Client notified of unsatisfactory results:
❑
Phoned Spoke .ith
Dare Time
BACTERIOLOGICAL NVATER A:\ALYSIS RECORD
MMO-MI;G Result: Total Coliform
Membrane Filter: Direct Count
U
E. Coli
Verification: LTB BGB . . COLIFIR.M
Fecal Coliform Confirmation
Colonies/100 ml
Final Membrane Filter R I Coliform/100 ml
Reported By Date PARTPKEOF
rs
Comments: TWO TO FOLLOW
Faced
13
Faced
ryrC- r .._,.«, T. C—,
00 -(Mia B.uaw
190 *E 7a7 Member of the SGS Group(Socidtd Gfntrale de Su".illanee)
EYVp9nuMF1L11 en^t r e- / _ -eve ]• __ _ - _
0 MMO-MUG
- Nurnber o`colanies
100 ml.
Lab Re r. No.
Result` Analvst
95.^3;g
ICI J
Sent to A.D.E.C.
Aneh Fbks Jun ❑
Ds: -:Le Tine:
Client notified of unsatisfactory results:
❑
Phoned Spoke .ith
Dare Time
BACTERIOLOGICAL NVATER A:\ALYSIS RECORD
MMO-MI;G Result: Total Coliform
Membrane Filter: Direct Count
U
E. Coli
Verification: LTB BGB . . COLIFIR.M
Fecal Coliform Confirmation
Colonies/100 ml
Final Membrane Filter R I Coliform/100 ml
Reported By Date PARTPKEOF
rs
Comments: TWO TO FOLLOW
Faced
13
Faced
ryrC- r .._,.«, T. C—,
00 -(Mia B.uaw
190 *E 7a7 Member of the SGS Group(Socidtd Gfntrale de Su".illanee)
EYVp9nuMF1L11 en^t r e- / _ -eve ]• __ _ - _
9-160
---._a
. •
i
- POUt.!C•IPALITY 01' AN-I!JI;AGE
— -- --
' PA 1: rr.%4. NT O F N F A LT t I Yr;:NVJ It %1 i v t, rA L Pr OT E CT I nY
_
. .. .� N.t. [ S.revI -A nf NO r41 ,Alofka 9O5o1
LIUN!CIPALITY OF
.�
ANCHORAGE
DEPT. OF I
'- ,r.r E!'JVIROt:%191\IYAL ENGINEERING DiVIS!ON
ENVIRCf'.VE:r.'.: ,;r_CTION
hleohont, "01,!'NO
❑ Two ❑ rv!rt
C'C NIULTIPLE FAMILY
MC1-LYnn
J
FOR APMOVU Or IP!DIVIDUAL 6 A\
VATER w) SEV`EVJJEEn
TN-�.
I
duh:ec
'A.TTAC!IWELL LOG.Avielllogisr-gairedfor ^.4v:elhd[illza
I
❑ CO "P."UNITY
since June 19/5. For walls drilled prier to thct date, give v-9
r a> Cu'r..-;[- al an,s a:, p,::n 1. In compinta tr[ucsts wcI not be prose sod. P c.%te allow len
110,
depth (+.ttach ion if avail b!a.)
ii. 1'iiCa.l.T`:O'•7:JrIl Home 2713=1333
E. GQP,AGE DISP WAL SYSTEr:1
Walter J. and Vivian Bagley Work 862-2180
p{g trot.^.IV:UIJtsL,10N-i'iITE"
"If in[lividual'on site, R:ve insta!:.ainn date—
If system it over M•o (2) Y'='rs ol[! an ederlllaC•/ test is rcgcired
2201 McKenzie _Drive, _Anchorage, AK 99503
—.
❑ PUBLIC UTILI T Y
by this' Department.
—_•—•---•
1'R.: PC: i -re f!- $:: t 1 i.: C'Ln I: II GSI .Ih'��nl—
I_
_- ----I
i p4f'W
!
_ .. _ ... ..
N/A
I
—
I Interim to Long Term Financing
l_--
---_
I rn 41�u.. AUDI'LL�
--
INAITUTwN
Alaska Mutual Savings Bank
274-3561
ext.
---------
ILII,f$ i.DSGF$i
--1-----
' P. 0. Box 1120, Anchorage, AK 99510
N/A
!
rtt Llftf, Ti:CS
,
iI
-- 1
15. L:.,AL D:SCi1IP IION
i
L10,-B1,-BircliHills�stuv-o
— -- --
sit: T: LULAM)N
_
{
---NtIN.Dee�ane.-Zegla R -ye 99577 _
re'. rY.L Or Ic kSiDEXC
t WAIIN Or QitihfiOP,i.. —
RX$ SINGLE FALf!LY
❑ One C7 Foul I�
❑ Two ❑ rv!rt
C'C NIULTIPLE FAMILY
SCR 7h e ❑ S!x
J
i7(7p(INDIGiDUPL'
'A.TTAC!IWELL LOG.Avielllogisr-gairedfor ^.4v:elhd[illza
I
❑ CO "P."UNITY
since June 19/5. For walls drilled prier to thct date, give v-9
C7 -P',, '13 LIC LIT ILT i
depth (+.ttach ion if avail b!a.)
E. GQP,AGE DISP WAL SYSTEr:1
p{g trot.^.IV:UIJtsL,10N-i'iITE"
"If in[lividual'on site, R:ve insta!:.ainn date—
If system it over M•o (2) Y'='rs ol[! an ederlllaC•/ test is rcgcired
❑ PUBLIC UTILI T Y
by this' Department.
NOTE: 1 HE INSPECTION FEE MUST ACCOMPANY EACH REOUEST GEFORE PROCESSING CAN BE IitIITIAT, a
�II
4/7/80
4ary
249
Till!; .'W�F .'OR OFFICIAL Mr. ONLY
LAIC
ATL
UA r L
1. TYPC OF r.ESIDCNCE
NUMBER OF CZ:DFtOO.V.S
ON E THREE [1) FIVE
El OTHER
SINGI-r FAMILY
2. WATER SUPPLY
I`Er�IIT Nlj:,U[F:
-1241 INDIVIDUAL
ucml OF V.FLL
Cl COMMUNITY
-----ZHJO
1-1 PurLICUTILITY
DATE D11ILLFE)
Connection Vcrificd
LOG HECEIVEL)
iE DISPOSAL SYSTEM
F—�PLMLIC UTILITY
Conn�—tion Verified
Size: ---- If Tank is honvinade
SOILS RAwic,
give di-mnsions:
TYPE OF TANK
4. DISTANCES
WELL TO:
5b. M. 74MTS
APPROVED F OR
-3 BEDROOMS
WSAPPnovEo