HomeMy WebLinkAboutHAMPTON HILLS BLK 1 LT 406/133/2'01 -1" 2'�: 26 907-345-0222 raLPIHIE FACE 1.`E,4
Fill 11, 1111111111111rii�iii
Permit Number, OSW Date of Issue: Parcel Identification Nurnber:
Date Started. 9-4-17 Date Cii)mpleted,. 9-6-17 Is well located ai approved pen -rat loca:iori? x 'V'cs M No
Legal DevcrJiptiow Hampton flifts B!o-rl( I b. -;M
Property Owner N'ame &- Addk-esx— 011'6 }6 A UgdahJ
161500 Hatrpton Dive
Ancho,-sge, Aaska :_911507
Borehole Data:
Soil Type, Trikkness Viatej- Strata
Depth
F-orrt TO
Method of Drilling x ai,- rotary M, cabit tool
Casing t; pe- ,step!
Existing well
'Vall Thickness:.250 inches
vile
� y a?74� gr
saw'i
water sand gravel
96, 98
Diameter: 6 incheS Depth-, 98 feet
Liver Type:
j Diameter: ---uichas Depth, feta
I OSingskiekup above groand-2 lees.
Static water level (from gTound level): 161 et
Pattiping level: 94 feut after
2 hours pumning R? g
Recoven; W-te.- 10 gzpai
Method of Testing: py
Vell Intake Opening. Type:
x Opea End [] )pori R,-)Je
Ll Screiined eta, t feet Stopped
feet
Perforations Stasi feel St;.-fppedl
feet
Grout Type- Volume:
stitr 0 feet I
Pump: Intake Depth 9.5 feet
Pump siye j1L'2 Lip lip Brand Na lie
Well Disinfected Upon Com pletimi? x Yes El No
I
Meffiod of Disi-afecdon: ch 111��
i
Cornmeuts, '
Well Driller; -11pine Drilling &- Enterprises
PO.fax .110496
4r ', AK 99jJ 1
IL -
On -Site Wastewater Disposal System Permit
Site Legal Address:
Owner/Address
Site Mailing Address:
HAMPTON HILLS BLK 1 LT 4 G:2540
BOEHMER PATRICIA J AUGDAHL &
BRIAN D 10500 HAMPTON DRIVE ANCHORAGE AK 995161177
10500 HAMPTON DR, Anchorage
This permit is for the construction of:
Lot Size in Sq Ft: 43104
Total Bedrooms: 2-,6-
This
-6
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
CC)
5�.
fn�n v. �
�UPuJ fest
iso � e
mot
MUNICIPALITY OF ANCHORAGE
Development Services Department
.-Along"
r�
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
lle(iar[mcut
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP161026
Tax Code Number:
01513441000
Work Type:
Septic
Renewal
Permit Effective Dates: March 16, 2016
to March 16, 2017
Design Engineer:
NORTHERN GEOTECHNICAL
ENGINES
Subdivision:
HAMPTON HILLS
Site Legal Address:
Owner/Address
Site Mailing Address:
HAMPTON HILLS BLK 1 LT 4 G:2540
BOEHMER PATRICIA J AUGDAHL &
BRIAN D 10500 HAMPTON DRIVE ANCHORAGE AK 995161177
10500 HAMPTON DR, Anchorage
This permit is for the construction of:
Lot Size in Sq Ft: 43104
Total Bedrooms: 2-,6-
This
-6
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
CC)
fn�n v. �
�UPuJ fest
iso � e
/7'/�/ r (7/70 c.P
Municipality ®f Anchorage � `
P
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV161107 COSA#: Permit#:OSP161026
PID#:015-134-41 Receipt#:204691
Legal Description: Hampton Hills Block 1 lot 4
Engineer: Mike N. Anderson
Applicant: Dreux Boehmer
The proposed bed is allowed to be 20' wide.
This waiver approval applies to the proposed 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.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
...............................................................................
Waiver is Granted: X Waiver is not Granted:
Date: Approved by: A
Name of Revi r
......................................................... ....................
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-134-41-000
Property owner(s) Dreux Boehmer
Day phone (907) 947-9807
Mailing address 10500 Hampton Drive, Anchorage, Alaska 99516
Site address 10500 Hampton Drive, Anchorage, Alaska 99516
Legal description (Sub'd., Block & Lot) Hampton Hills Subd., Block 1, Lot 4
Legal description (Township, Range & Section) SW1/4 SEC 13, T12N R3W
Lot Size 43104 Sq. Ft. Number of Bedrooms x 6 At,
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
owner or autrnonzea agent)
Permit/Rush Fees: _'n(ocl Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number:
��(AO y`7 Receipt Number:
Permit No. OS/016/0j6 �_ Waiver No.
Permit App_-.: -
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑X
Initial 0
Single Family (SF)
0
(w/wo ADU)
Septic Tank
Q
Upgrade ❑
Duplex (D)
F-1Holding
Tank
ElRenewal
ElMultiple
Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
owner or autrnonzea agent)
Permit/Rush Fees: _'n(ocl Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number:
��(AO y`7 Receipt Number:
Permit No. OS/016/0j6 �_ Waiver No.
Permit App_-.: -
Sept 1, 2016
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: Septic system Change Order & Waiver
Legal: Hampton Hills Blk 1, Lot 4
To Whom it may concern:
This is a request for a change order and Change Order on the existing septic permit (OSP 161026)
for the above referenced lot. We are requesting a change order to rotate the bed and make it one
single bed (65 x 20). The secondary system will still be located in the new TP #5 per this new plan.
No other design changes are expected for this permit and this CO will not impact any of the
neighboring properties.
Due to the limited area we request a waiver for the 15 foot width requirement. We are requesting
a 20 foot width be used and no equipment will be used on the bed system. The soils are excellent
and will not be compacted due to the good gravels.
Please call me if you have any questions.
Sincerely,
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
RME
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NORTHERN GEOTECHNICAL ENGINEERING, INC. / TERRA FIRMA
March 16, 2016 NGE-TFT Project # 4269-15(G)
MOA On -Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99517
Attn: Onsite Services Engineer
RE: ON-SITE SEPTIC SYSTEM APPLICATION FOR BLOCK 1, LOT 4,
HAMPTON HILLS SUBDIVISION, ANCHORAGE, ALASKA
To Whom It May Concern,
On behalf of our client, we (Northern Geotechnical Engineering, Inc. d.b.a. Terra Firma
Testing) are requesting an on-site septic system permit for Block 1, Lot 4, Hampton Hills
Subdivision, Anchorage, Alaska. There is an existing four-bedroom singly family dwelling
and its on-site disposal system at the site. The owner would like to build a two-bedroom
Accessory Dwelling Unit (ADU) onsite. The owner would like to decommission the
existing disposal system in accordance with the code, and build a new one to serve both
the existing house and its ADU.
We present the site topography map with proposed developments in Figures 1 to 3. These
locations were not surveyed and as such were estimated from local landmarks. The owner
has conducted earthwork activities on-site and leveled the proposed footprint. The 30 feet
radius of TP3 and TP4 are located at lower spot (elevation 836) and are relatively flat
(<10%) based on field observation. The infiltration rate of the GW layer is < Imin/inch.
Providing proper construction in accordance with our design, the system will conform to
the MOA Water and Wastewater System Codes Chapter 15.65 Wastewater Disposal. We,
therefore, request septic permit for Block 1, Lot 4 of the Hampton Hills Subdivision to be
issued. Please feel free to contact us with any questions or comments you may have
concerning the information presented in this letter.
Sincerely,
Northern Geotechnical Engineering, Inc. d. b. a. Terra Firma Testing
l��"��c�'
xOF AkMft .
Eva Ge, E.I.T.
Project Engineer
Keith F. Mobley
ROFES 066Na����.�
Keith F. Mobley,�E.
President
11301 Olive Lane Anchorage, Alaska 99515 -Phone: (907) 344-5934 - Fax: (907) 344-5933 • Email: xge r@r nge-tft.eom
DESIGN CRITERIA
6 BDRM X 150 GPD/BDRM = 900 GPD
PRIMARY LOCATION (TP -4)
PERCOLATION RATE = 0.02 MIN/IN
2 FT SAND FILTER IS APPLIED
APPLICATION RATE = 1 GPD/SF
ABSORPTION AREA = 900 GDP/ (1 GDP/SF) = 900 SF
ABSORPTION BED: ONE 40 FT LONG X 15 FT WIDE, ONE 20 FT LONG X 15 FT WIDE
TRU-FLOW SPLITTER SYSTER (3 OUTLETS) IS PROPSOED FOR BOTH SENARIOS
TO DIVIDE THE FLOW 2:1 (40 FT LONG BED: 20 FT LONG BED) IN VOLUME.
SECONDARY LOCATION (TP -3)
PERCOLATION RATE = 0.02 MIN/IN
ADVANCED WASTEWATER TREATMENT
APPLICATION RATE = 6 GPD/SF
ABSORPTION AREA = 900 GDP/ (6 GDP/SF) = 150 SF
ABSORPTION BED: ONE 15 FT LONG X 10 FT WIDE
P�OF qtgsko�t
Keith F. Mobley
a+FG/• CE -5066
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Municipality of Anchorage
Development Services Department
Building Safety Division
yir On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchorace. ak. us
(907) 343-7904
Soils Log - Percolation Test
Performed For: Dreux Boehmer Date Performed: 11/3/15
Legal Description: Hampton Hills Subd., Block 1, Lot 4 Township, Range, Section: SW1/4 SEC 13
Slope Site Plan
1
1
COMMENTS
�M
WAS GROUND WATER
opt,
ENCOUNTERED? No
TP3
Depth to Water
(F
x t)
L
Depth to Water After
D
Monitoring? N/A
+0 �lL
Date: 11/10/15
6 sec
2-
-
6 in.
3-
34-5-6-
6 in.
4-
5-
12 in.
6 in.
6-
7-
7-
0
-
8-
9-
g_10-11-
12 in.
6 in.
10-
11-
12-
12-
J
13-
j
1
1
COMMENTS
�M
WAS GROUND WATER
Date
ENCOUNTERED? No
Net Time
Depth to Water
S
IF YES, AT WHAT DEPTH? N/A
L
Depth to Water After
D
Monitoring? N/A
e
Date: 11/10/15
T12N R3W
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
11/3/15
10:45
6 in.
6 sec
12 in.
6 in.
6 in.
6 sec
12 in.
6 in.
6 in.
6 sec
12 in.
6 in.
PEHGUTA TUN RATE U.UZ (mint imh) PERC HOLE DIAMETER 6 in.
TEST RUN BETWEEN 5 FT AND 6 FT
PERFORMED BY: Northern Geotechnical Engineering, Inc. I Keith F. Mobley CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 3/8/16
N
Municipality of Anchorage
Development Services Department
Building Safety Division
On -She Water and Wastewater Program
4700 Elmore Road.
P.O. Box 196650 Anchorage, AK 99507
www.cLanchoraoe.ak. us
(907)343-7904
Soils Log - Percolation Test
`�\S\N11111t1
' •tr `g
5._. tcLira?: /awtLy •,��.y, •�
tigtlx�u�a�_
Performed For: Dreux Boehmer Date Performed: 11/3/15
Legal Description: Hampton Hills Subd., Block 1, Lot 4 Township, Range, Section: SWI/4 SEC 13, T12N R3W
TP 4
G W Ck LQ.
5M -t� IAL.
CW
18-
19-
20-
WAS GROUNDWATER
Date
ENCOUNTERED? NO
Net Time
Depth to Water
S
IF YES, AT WHAT DEPTH? N/A
L
Depth to Water After
O
Monitoring? N/A
e
Date: 11/10/15
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
11/3/15
11:00
6 in.
7 sec
12 in.
6 in.
6 in.
7 sec
12 in.
6 in.
6 in.
7 sec
12 in.
6 in.
PERCOLATION RATE U.02 (mtnuteelnch) PERC HOLE DIAMETER 6 in.
TEST RUN BETWEEN 7 FT AND 8 FT
PERFORMED BY: Northern Geotechnical Engineering, Inc. i Keith F. Mobley CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 3/8/16
fiN
NL.-au�_v
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
®.v�
PHONE NEW
NAME t` ''
�1 V V_0VV C-1 J' 6S fi tl �-+ _ �jL1LI"�I.CR'J.'�J ❑UPGRADE
MAILING ADDRESS (�
LEGAL DESCRIPTION
LOCATION
N0. OF BEDROOMS
4 -
Well Absorlition area Dwelling
PERMIT NO.
"l BO ?>"('Z,,,
b Z
uJI.-
Manufacturer
Material
No. of compartments
Liq. rapacity in gallons
IF HOMEMADE:Inside
length
Width
Liquid depth `
N
J0 2
DISTANCE TO: Well Dwelling
+h-
PERMIT NO.
0z<
Manufacturer Material
Liquid capacity in gallons
w g
DISTANCE TO:
Well
\ 1
Foundation
�
Nearest lot line
PERMIT NO.
LBO
J w z
No. of lines
Length of each I'ne
Total length of lines
Trench idtl
Distance between lines '
2W
inches
Top finish
Material beneath tilef
Total effective absorption area
b
p
of tile to grade
ty
!,p ® inches
�%�_�
Length
Width
Depth
PERMIT NO.
W
c7
Q h
Type of crib
ribdiameter
Crib depth
—
Total effective absorption area
Wa
W
well
Building foundation
Nearest lot line
DISTANCE TO:
-
lasS
Depth
Driller
Distance to lot line
PERMIT NO.
r
D
U
W
�
ISTANCE T
DO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
.- -f.f-
.
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER-
�l.-L.-�wrJ�-"Ct3
REMARKS
�O
tl
LEGAL
3'
r
6�
`
Ccs
ALI'
� DATE
RVVD
72-013 (Rev. 3/78)
/ I " l� 'c) ry I
1 VA) pill A
j Won 1 kill " S AT, 1 11 [P I A Ord HITTO Q A W 1 WWI 1
lqQ! III, M I A A E 1) V
QdF 11 "1 jQ)nj 1 II 1 114 W PASSAP )l
Qqq j 1 1 ill hud 1 517 k! 0
%Q51"M 1 1 ilk !1" 11
1 Koo w 1 111 n I if Q: nil 11 IMIT" FA Vo W I r i F mwn - r
Ill R! 1 1 , 1 Wil !L T I i n! WhYrup rl i1:::..
Ph To I'Llp A" : 11% NI vrd 1 a �i A wokywo w iI 1 PA j
"A T ` p" w b A 1 1` i IlI1w -n : 1 ii "w wRwn lips pino mi"M 1 A Q%,
O 1 1 1 .11041 :1 1 if.r::AIA•i.. I f ifi.,i 1! ! ��! - Iii r ::,.-
. D 1 IF - Vit, cq- �' q� �
T.H. No. 1
9-2-78
�-
Or�anics & Organic Silt, 0.0'
moist, loose, dkbrn.
,o
0.5'
q o Organic Silt: w/trc sand &
gravel, moist, loose, dkbrn.
O
Ln
0
�r
N
138
24' I
aJ
w
C c
R a 400 n
Q a
UI M
660
34 '1gn 24' IW
10 ` r
X16 3 tX11 I"ii U)
7 y �-
N 2j0 merit\ `
4136
Lot 4, Block 1, Hampton Hills Subdivision,
Anchorage, Alaska.
NOT TO SCALE
Distances are approximate and have not
been measured by surveying methods as
to location of test hole or proposed
home location.
Michael B. Bergmann
Consulting Geologist
Box 191, Star Route A
Anchorage, Alaska 99502
(907)344-9150
(OL)
------- 3.0'
Sandy Gravel: w/trc Silt
(approx 50), sl moist, occ
cobble, dense, gray.
(GW -GM)
11.0 '
Sand: w/trc Silt (a_pprox 5%) ,
sand vy fn to med, med dense,
' moist to wet, dk gray.
(SW -SM)
15.0'WD
L" 18.0'TD
Water table encounterd at 15.0'
while drilling. Hole caved at 15.0'
after pulling augers.
Test Hole Boring Log represents soils
encountered on Lot 4, Block 1, Hampton
Hills Subdivision, Anchorage, Alaska
5 q Ad5c—
T-aj Dej-6-��
W I D JW
c
30
C- L- ( C-� S b 2LO 12.
303
September 6, 1978
Lot 4, Block 1,
Hampton Hills Subdivision,
Anchorage, Alaska
Percolation test performed on September 2, 1978, by filling the 4 inch diameter,
18.0 feet deep test hole (test hole caved in at 15.0 feet) with water, and measuring
the water level drop periodically for one hour.
Average percolation rate for entire hour = 1.4 minutes per inch
Average percolation rate for last one half hour = 3.2 minutes per inch
Michael B. Bergmann
Consulting Geologist
Box 1.91, Star Route A
Anchorage, Alaska 99502
(907)344-9150
TABULATION OF PERCOLATION TEST
RESULTS
TIME
LEVEL(inches)
DROP(inches)
ET(min)
RATE(min per inch)
1600
2.25"
start
start
start
1610
23.5"
21.25"
10
0.47
1620
30.0"
6.5"
1.0
1.5
1630
35.0"
5.0"
10
2.0
1640
39.0"
4.0
10
2.5
1650
42.0"
3.0"
10
3.3
1700
44.5"
2.5"
10
4.0
Average percolation rate for entire hour = 1.4 minutes per inch
Average percolation rate for last one half hour = 3.2 minutes per inch
Michael B. Bergmann
Consulting Geologist
Box 1.91, Star Route A
Anchorage, Alaska 99502
(907)344-9150
>_pcember 6, 1978
Mr. Jerome Augdahl.
P.O. Box 10711
South Station
Anchorage, AK 9951.1
Subject: Soils investigation for sanitary sewer system on: Lot 4, Block 1,
Hampton Hills Subdivision, Anchorage, Alaska.
Dear Mr. Augdahl
At your request of September 1, 1978, I conducted a soils investigation at the
proposed location of a sanitary sewer sytem on the subject lot.
This investigation, which was accomplished on September 2, 1978, consisted of the
inspection of soils removed during drilling of a 4 inch diameter, 18.0 feet deep
test hole, using solid flight augers, powered by a trailer mounted Mobile B-34
drill rig. After completion of drilling, the test hole was filled with water and a
percolation test performed. The results of this test are tabulated on an accompanying
sheet.
The soils encounterd are graphically shown on the accompanying test hole boring log.
The soils consisted of 3.0 foot thick layer of organics and organic silt, overlying
a sandy gravel with a trace silt, 8.0 feet thick, which is underlain by a sand with
a trace silt, 7.0 feet thick.
A water table was encountered at 15.0 feet while drilling. The hole caved in at 15.0
feet after pulling the augers.
The topography of the lot consists of a northerly facing low hill with a small swale
running in a northerly direction along the east property boundary. The test hole is
located in a higher portion of this swale. Vegetation consists of moderately dense
spruce and birch to 60 feet tall., moderately dense alders and willows to 20 feet tall.,
grasses and bushes to 3 feet tall, and some mosses.
An accompanying sketch shows the subject lot with the approximate location of the test
hole in relation to the property lines and the proposed location of the house.
I appreciate the opportunity to be of service to you. Please contact me if you have
any questions regarding this soils investigation.
Very trulv yours,
Michael Bergmann
Consul ng Geologist.
Be;, 191, Star Route A
Anchorage, Alaska 99502
(907)344-9150
Attachments: Drawing of test hole boring log with location sketch, and tabulation of
percolation test .results.
xc: Department of Health and Environmental Protection
,;,) i t I I , -11 1.0 'l
May 27, 1983
ARCTIC ENGINEERS, INC.
Mr. Jerome Augdahl
Box 110711
Anchorage, Ak. 99511
SEPTIC SYSTEM ADEQUACY TEST
LEGAL:
Lot 4,
Block V
Hampton Hills
OWNER:
Jerome
Augdahl
HOUSE
TYPE: 4 -Bedroom, single family
WATER: On -Site Well
SEPTIC
SYSTEM: From MOA Records
Tank: 1250 gallon, fiberglass
Absorption System: Trench, 3' W x 6'D x 39'L
Absorption Area: 468 ft2
Soil: 115
Approval Date: October 1, 1978
TEST DATE: May 27, 1983
PROCEDURE: 1,000 gallons of water was dumped into the absorption system
cleanout. Liquid level rise was monitored at the absorption
system sump. No backing up into the septic tank was observed,
and the trench absorbed all the water input within 5 minutes.
RESULTS: The system accepted 1.5 times the daily design flow for a four
bedroom house. The absorption system is adequate by Municipality
of Anchorage requirements.
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F�. G os o00oafa4 °e°°
W
5i ey 64
CE-7568=i(,v
Time
APPLI( N'T FILLS OUT UPPER HAI ONLY
PiopertyOwne,:
f/.(li')�i"..
Phone
Mailing Address
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Buyer
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Inspector
Address 1
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Inspector
Lending Institution
MUNICIPALITY ORAG'-
DEPT. Of HSALTH 1161
Phone
Address
Zip Code
Realty Co. & Agent
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Phone
Address
�� �!;� Zip Code
'CONDITIONS OF APPROVAL
Legal Description
( ) CON DITONAL PPROVAL'
Street Location
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Type of Residence
Soils Rating
Single Family
Multiple Family
No. of Bedrooms_
Well Log Received
❑ Other
16--) D
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Well to Tank V " '
Water Supply
Individual
-
ATTACH WELL LOG. A wall log is required for all wells drilled
since June 1975.
Community
_ -
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
Sewer Disposal
�C Individual
Year Individual Installed:
LJ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE: INITIATED.
Time
Time
Time
Time `
Date
Date
Date
Date
4--\C�— ��11ua
Inspector
Inspector
Inspector
Inspector
Field Notes: /
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MUNICIPALITY ORAG'-
DEPT. Of HSALTH 1161
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ENVIRONMENTAL PROTECTION
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RECEIVE®
( APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CON DITONAL PPROVAL'
DATE �� 2-7 0
BY: a_
Soils Rating
Date Sewer Insttaallled
Well To At Area
Well Log Received
16--) D
�1
Well to Tank V " '
Septic Tank Size,
7202] (]182)
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r���_--- — MUNICIPALITY OF ANCHORAGE MUNICIPALITY Of ANCHORAGE
- - DEPARTMENT OF HEALTH.Ri ENVIRONMENTAL PROTECTION D` I' 1, '. - .-7,
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-825 L Street - Anchorage, Alaska 99501 -.A' Lj "i It�
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ENVIRONMENTAL ENGINEERING DIVISION APR
Telephone 264-4720
�J (( �// f_ 11
OF INDIVIDUAL SEV&F(A-II_IG ika)
REQUEST FOR APPROVAL WATER AND
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing.
1. PROPERTY OWNER T. -- - PHO
/ '4 C�
MAI LING ADDRESS
r
PROPERTY RESIDENT (If different from above PHONE
2. 60YEr�/1ti.���—
PHONE
MAILING ADDRESS T-
—
3. LENDININSTITUTION '�- PHONE
MAILING ADDRESS
4. REALTOR/AGENT - - -
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREETLOCAT,ION
-
6. TYPE OF RESIDENCEV
-. NUMBER OF BLDR00 S -
E] one Four ❑ Other _
SINGLEFAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SU .PLY
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 DI�POSAL SYSTEM V
6
VrJNDIVIDUAL/ON-SITE**
*'If individual/on-site, give installation date --
If system is over two (2) years old an adequacy test is required
❑ PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MIDST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
720110(3/78)
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THIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
? (- i
/j(
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size:J nb If Tank is homemade
give dimensions:
SOILS RATING
(�
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
r)`
BY (Title)
-
C
LEGAL DESCRIPTION
72-010 (Rev. 3/78)