HomeMy WebLinkAboutKNIK HEIGHTS BLK J LT 1Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1
ON
-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP251316
PID Number: 018-232-23
Dwelling: RN Single Family (SF)
El with ADU R Duplex (D) El Two Single Family Project: El New W Upgrade
Name
Robert C. & Eileen A. Pierce Trust
ABSORPTION FIELD
n Deep Trench F-1 Wide Trench F-1 Bed [:1 Mound
Site Address
13345 Ridgewood Circle
El Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
1 3
GPD/SF
JTotal
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
Knik Heights
J 1
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
I Ft2
Ft.
Well
100'+
NA
NA
NA
25'+
TANK 9 Septic [I S.T.E.P. F-1 Holding El Other
Manufacturer
Greer
Capacity
1000 Gal.
Surface Water
100'+
NA
NA
NA
Material
Number of compartments
Lot Line
5'+
NA
NA
NA
NA
HDPE (Deep Burial Model)
2
Foundation
10'+
NA
NA
NA
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Arctic Terra, LLC.
Drainfield CO/MT D3034
BENCH MARK (Assumed elevation) 100.0 ft
Inspector PES
im 09/29/25
Inspdates:
nd 10/09/25
Location and description
31d
2ection
4 th
See Record Drawing, Top Of Gas Meter Line
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
Engineers Stamp
0AL_4V4
Conditional Approval:
Date��P,��
49 TH
A
Steven. pan'n*one'
.
Septic System
Approved
Date 2-// b,-1,z
_P1 I CEO 419
12/03/2025
k 4— - .-
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
10' Util Esmt
R
I
D
G
E
W
O
O
D
C
I
R
C
L
E
SEPTIC
AREA
10' Util Esmt
LOT 1
LOT 5
3 BR
SFD
PAVED
DRIVE (E)
16.8'
11.5
DECOMMISSIONED 1000gal SEPTIC
TANK & DCO (E) PER MoA CODE
WELL (E)
WELL (E)
WELL (E)
ABSORPTION FIELD (E)
(TO REMAIN)TH-1 (PES)
ABSORPTION FIELD (E)
(TO REMAIN)
MONITOR TUBE REPAIRED
INSTALLED 1000gal SEPTIC TANK (N)
INSTALLED W/NEW DCO AFTER &
CONNECTED TO DV - SET TO
DISCHARGE TO 1981 FIELD
REPLACED EXISTING FC & DRAIN
LINE FROM FOUNDATION
(LINES FROM HOUSE TO TANK
FOUND BY CONTRACTOR TO
HAVE NO GLUE ON JOINTS)
DV (E)A
B
DC2
DC1
FC (N)
MH1
T2
BM
DECK (E)
BOARDWALK (E)
FC
DC
1
PROFILE
SCALE: NTS
DC
2
T2
MH
1
90.6
90.4
DV
1000 GAL GREER
POLY SEPTIC TANK
OG/FG:
95.7
PER CONTRACTOR: BULL RUN VALVE RE-USED
(REPLACED VERTICAL STANDPIPE ONLY)
PA
N
N
O
N
E
E
N
G
S
V
C
,
L
L
C
(
C
.
I
.
1
0
8
8
)
LJ
C
RE
C
O
R
D
D
R
A
W
I
N
G
S
KN
I
K
H
E
I
G
H
T
S
B
L
O
C
K
J
L
O
T
1
RO
B
E
R
T
C
&
E
I
L
E
E
N
A
P
I
E
R
C
E
T
R
U
S
T
SI
T
E
:
1
3
3
4
5
R
I
D
G
E
W
O
O
D
C
I
R
C
L
E
AN
C
H
O
R
A
G
E
,
A
K
11
/
1
7
/
2
0
2
5
01
8
-
2
3
2
-
2
3
OS
P
2
5
1
3
1
6
AC
P
12
/
0
3
/
2
0
2
5
SI
T
E
P
L
A
N
1"
=
4
0
'
1
O
F
1
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 3(450 gpd)
TANK SIZE: 1000gal
USED:
1000gal GREER POLY SEPTIC TANK
A B
FC 13.5 1.7
MH1 24.0 14.3
T2 26.4 18.0
DC1 27.1 19.4
DC2 26.8 19.9
RECORD DRAWING
THIS RECORD DRAWING REPRESENTS THE AS-BUILT CONDITION OF THE PROPERTY IMPROVEMENTS DESCRIBED ABOVE.
THE DRAWING AND ANY OTHER SUBSEQUENT ATTACHED OR INCLUDED INFORMATION IS BASED ON PERIODIC VISUAL OBSERVATION
BY A REPRESENTATIVE OF PES ALONG WITH NOTES, PHOTOS, AND OTHER INFORMATION PROVIDED BY THE INSTALLER OF THE SYSTEM.
THE INFORMATION PROVIDED IN THE RECORD DRAWING APPEARS REASONABLE AND REPRESENTS THAT THE PROJECT WAS DESIGNED AND CONSTRUCTED IN GENERAL
CONFORMANCE OF 18 AAC 72, THE ADEC ONSITE WASTEWATER SYSTEM INSTALLATION MANUAL, AND AMC 15.65 WHERE APPLICABLE. PES SHALL NOT BE HELD LIABLE
FOR SYSTEM DEFICIENCIES WHICH FALL OUTSIDE THE SCOPE OF THE REQUIRED VISUAL OBSERVATIONS OR SUBSEQUENT OBSERVATIONS IF REQUESTED BY THE INSTALLER.
SEPTIC SYSTEM INSTALLERS ARE TRAINED AND APPROVED BY THE MUNICIPALITY OF ANCHORAGE AND OR ADEC AS APPLICABLE. INSTALLERS ARE RESPONSIBLE FOR
CONSTRUCTING THE SEPTIC SYSTEM AS DESIGNED AND ENSURING THEIR WORK CONFORMS TO THE CODES AND POLICIES STATED ABOVE.
NEW SEPTIC
WATER LINE / WELL
RADIUS
ESMT/SETBACK
STREAM/DRAINAGE
WAY CENTERLINE
FLOW PATH
ABBREVIATIONS
CO CLEAN OUT NO.
DCO DOUBLE CLEANOUT
DV DIVERTER VALVE
(E)EXISTING
FC FOUNDATION CLEANOUT
FS FLOW SPLITTER
MT MONITOR TUBE NO.
MH MANHOLE NO.
(N)NEW
NIC NOT IN CONTRACT
(P)PROPOSED
R.I. RIGID INSULATION
TH TEST HOLE
TYP TYPICAL
R
I
D
G
E
W
O
O
D
C
I
R
C
L
E
Taylor L. Dosch
No. 189892
R
E
GISTEREDPROFESSIO N A L L A N D S U R
VEYOR∆
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: OSP251316
Work Type: SepticTank Upgrade
Tax Code Number: 01823223000
Site Legal Address: KNIK HEIGHTS BLK J LT 1 G:2936
Site Mailing Address: 13345 RIDGEWOOD CIR, Anchorage
Owner: PIERCE ROBERT C &
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date:
Expiration Date:
� 111 i n
f
�. 17c•i���r[ut`•ttt
Lot Size in Sq Ft
Total Bedrooms
9/8/2025
9/8/2026
22400
❑ Disposal Field 2 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 By: PG p�q,-2 ✓"f (G 96--9VC45 Date:
Issued By: Date:
3
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 018-232-23
Property owner(s) Robert Pierce & Eileen A Trust Day phone
Mailing address 13345 Ridgewood Circle Anchorage, AK
Site address 13345 Ridgewood Circle Anchorage, AK
Legal description Knik Heights Block J Lot 1
Number of Bedrooms 3
Engineering Firm Pannone Engineering Services, LLC.
Building Permit Number Not Applicable 01
APPLICATION IS FOR: APPLICATION IS AN:
(® all that apply)
Disposal Field ❑ Initial ❑
Septic Tank M Upgrade ED
Holding Tank ❑ Renewal ❑
Privy ❑
Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
Permit/Rush Fees: Y2,1 f Waiver Fees:
Date of Payment: KN4 S Date of Payment:
Permit No. 0s/)Zsl?/(a Waiver No.
May 2025
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, Alaska
Subject: Knik Heights Block J Lot 1
13345 Ridgewood Circle
Septic Tank Upgrade Permit Request
29 August, 2025
This is a design narrative for a permit to install a 1000 -gallon septic tank to replace an existing 1000 -gallon septic tank
to be issued for this property. The baffles on the existing tank have rusted through and are allowing solids to leave the
tank and enter the drain field. The existing tank will be decommissioned per code. Currently the lot is developed. The
proposed replacement will be connected to the existing drain fields. This lot and the surrounding lots are served by
private wells. There are currently no wells within 100' of this upgrade.
1. Upgrade Tank Design.
A foundation clean out installed if needed.
The tank will be located: 5'+ from any property line.
5'+ from any deck/stair support.
10'+ from building foundation.
10'+ from any waterline.
100'+ from any surface water.
100'+ from any private wells.
200'+ from any public wells.
The proposed installation will not affect the future development of this or the surrounding lots.
If you have any questions, please contact me at (907) 745-8200.
Sincerely,
TR -P
Steven R. Pannone, PE, F. ASCE
Owner/Civil Engineer
29 August 2025
zJOz
133HSI
Szoz6zed .
7 sitB M
Q ,�o �^�is..
��
�
>W30V1 10HONV
3102110 a00M39dR! Sb££6 :311S
ismJ1302131d V N33113 T O 12138021
101 r N0018 S1H913H NIN>1
tOZ2-9bL L06 XV3 OOZ9-9bL L06 3NOHd
S3iO N
XXXXXXdSO,�pA
'ON
IIN83d
EZ ZEONW TI'dL
ori
03H33H0
Ofl/d Ob
NMvaO
31VOS ON
31VOS
SZOZ/6Z/80
4 iwnl
szoz/90/60. naa
9b96 HV '83P]Vd L021 X08 '0'd
(880L TO O'i'i OAS JN3 3NONNVd
NOIlOfR11SN00 2104
SNOISln3a
:S31ON
w
p N 2= o z a
g zM, WwCzoo N
Zo 2�w do -EQ a=Om -6 0rrVo
0o2-
g o Z
jma z0 wod,.
ZVj U12 VM,j Www } I-.OJYN4 Zra U�
o P o N W m � Z 3 2- m Z F Z V w z F w W
Wa oszwofZZ�S �¢ z
N Z O Y W O w l U W J S¢ O O N O O r .�
WWw Ind aVlKwz WNW
=as�Jw�O Ohm Oa jmvi a00 i2 fn2
S �O0z03z m0J zz NZ�IS-UU w0ti ln�a
3�wV Owa �Wi ¢O O�W<LL,K mOW zL.
Wmz-zat2-3 w10VI Q< Qp-'o3� Jzw
r 0 Dow 2 s NWU 3=¢ a
V
w3puiw �ZJa UZQ W� 0=�'¢da KJm ==Z
0vizUa�-�¢Q wgLLr?r
h�Oo•�VraZ-aroZ=OOwLzaz
,WOO62p WR rNOopQ,U
NwWwOOQ QQQU UW a WZWZp WWW O r~Oa�NzWOW =O¢zQza
W�} OZ
Wwaz
wm U>
OmO - r 0
O}JNwF0
r0
vim WZD n W C s U Q O
NO Wm25NNaNN¢ UNUM, OCN�JN OzMmW Z Qas (z/IpN
Z ����0=gcori~Qcorio=,�oagu�o Boz oma
Nigazw�a993M,�p�opoa�mur 2RJ z=z
00pO�OWO~OOOZDjOwJ=�wZ �2=W "!Jw
O Q 4 U J 31% U w u u,, U, W= M, U D W Z W j� Z Q m
¢ W. w J O V w 2 w w Q r W a w I z W J m O S- s <Y<
s rwar23 v2i=tiOMMvri zt2-a2Q¢OtiV� OrmN
Z waw
O =~V10 Ua 6.
_r3¢U aQ¢
N M ON 10 h m p
vi ma`s
O W s }¢ 2 z N Z O W W
y vM,-i o F W <�OM, ¢ o ZpOz cril uI u) W ina ¢O
1 W
w o ,o a,..p<��� J w„
�= a p o ¢ i+-�n„w-�UJaz¢ - '^ ao w a¢F o w -
W K O ¢ 2 U 0� N M W Z S Z 0 a Q 0 Q z¢ K � s U ,t DM, w W r 3 s 2 x
U sOZ SwWrW Sa Q W w0 M, n 4M, Q m Z w0 mU z C
O W JO w ¢ U m J U F V1 M, W z w J O K N N Q U H ti W O H Z S M Z z 0 W J U N O W o N W p 3
W S W O¢ oz M< Q�V>�!2-5 �X,W Z -UO wW V4^LL wZ w r prZ 2 M, O 5 ¢lam Q J Ali o Z 5 y
r W w c� Dos �j I-WJ¢NwwrWsw vii z m OZOU 3z O Kp^ 3 N< ZW U alma a
W O m Z JW ZZV--'a2 .r Z-� W OF 0J, w
p 0 Ur pW3wOws0<Za o WX o Q2wJ N os r w o2 U jn 0
s N a J oa zF2 0 oa tow o� Wvo-is J= o< ¢ o aw z J ^� -aaz } p
= z o z 6: ?� = W% S W t '- w m g 0- a o �� 3 w a r D M, p v ¢ Z p �" 3 rxN
r O i O J W w v 2\ W U U W W W w Z Z 0 0 0 z m 000 O p V1W a 2 Q N w s O W � Q W 0--u
= Q
2 1 U rjnw Imp Ss OQ Z w U W > 2 s za
zo s 5 ¢ o ozz5 ,— Ne <UW 3 �wrro m > z� ow o a M8 ooJZ Qam
a o az OSZ-w= r } ow zZm O¢ Wr�zZJW Or N a o a 5Z no on pWo
¢ w IS- o VO'}WZ Va1J NiwwN �O U' VjW JY} m U�O¢W O Ky W U a Q NU O a Z,r
W 2 7 s 3 z G \J Z m o z Z lob N X W Ow ; Z WO m Q v 0 Z w 2 0 W
Q yy W W ¢ J W
a O 5 w �F-p=s NIi OVOJ .aii W 2U J aWW ¢Q JI'M M J WJ w W m JM Z Q�rO -Z
JO
} U o nJa zF J om6r�ZWWomoa� oZ a pOi =N MwzWa:2< a o NN 0 W wN E¢ aa�s awN
m K w V aN W VVI v>viO QFK�rw r¢ Za 00 � U w wm N 56on EcYi gM W wzM
W> 0 a z az U WZwQ x, -W Vi0 r� Umz w a WOW27- r x >} s s zwjU NO r -8t J-3
> W O 0 w p 0 2 a 0 y O p s 2 N N r z j ¢ N < ¢ O s O>> 2 M,1- U 0¢ W W W O RI O m O Q O¢
O m r `Z U Wr M,VIW w>rU Ws 50 �3t%I 2 W0 wM,WUM,a 0 U N E > r sm s fNM rW oOY
s 5 Q p WSIw-oUW Z WW a�+- pOV)�i-i)r Z wpJ�}a0r Z w Cj O Q s aN OW Up U i Z
a U U Z a U O K r Q N �+ O a Wr Q W E W W N (wll o W J O W M, W Z
Z ski Z LLVI UJ K W m E O LLZ a� ZZ ¢ WQ
¢ Z Z ¢ Z os ai s2w WO w2 ¢Ja v=GW zs OmVjp OrU s p N 03¢0 HVj caaa �js Zrt,)
m > O W - �2 2OJ3�O�Q�O�mQ a0 KazS"�U) jm mVwIQOVOOO O U W� N '1 pNW2 OO OOpo VI ZZ,
O ¢ a vriwNca �m ¢ N�oa=�>¢OM,In3 az a�Q3oo opw ooxv2i <zo- o mZ w z ?O�z wOinpw waz
r z }JNaN�<P N O=Q¢W�WzwWw= W� NOUWSQ fwn-0 rr z 200l2NU > Z dw 7 Q ZOWO N� W WW mOO
W N N ml¢ -Y a\pW2 -0
r o -az 3mos Qz- xh- 2 r- V > WHO U-20 a O 20 O s --� u Oli. W S
W s inzl1--Docs 50°,., a0W Ws ro W U2wu �>W soF�J3as o M w Ws� aO w� W
Z O_ O_ WZIa-IiIW_W30 Ut UW WsWUW Z ZSow.Q OX WW ¢W>maOWwJ O sV O OwOK \Oi ZZW z0
z 0 m Y O W Z U O w Q w O a w Q Q r W a 0 O w W m p o¢ W Q Q Z = K X U W U p> p m j Z = J = a O Z p F� J�� � ( w- W O K
d N WY4 Zw�� } IJ-OWO �IAwa�}O lis �z¢V Or 2� Z5 r>wWid.Ll L4- Z4JJOZ f" = i�a0 �m;liZ9WL U
ZO-� >W s Z ¢JJQV 2 O"'1 N O U
O O NMrz82ZZ N ¢QF'UOOUJJWQCr-J wU K0, p<o, as }UIO a}KVZ V1w SOJ0 V 0-,0, YWr�N zoQ
a' Z 2 W O r 0 z r z w O m Ow O W K ¢ J O� W Q U Q O w N
w U Q Q¢ W J UZ WJ a O W Q � s WO 00�W ¢Oa 1= QO MY W5 Z�.a <N Q V ss 1-a0
U O O Uwe xw VlO �n ZOY� aWm3aON NN W�j t02p>-}CJ NFOO ZV1¢ Np Z � >O U14�= a�2m ZQO Q>
2rJCi 1- r Ozml Z_UrKw tt//��O Z} WM,ZJVIa >p aWQ 0002>�1¢- OVI- N p CpWQW0 WZVI
¢ Y p 2 W w W 0 W U Uf 3 Z W 0 W O Z 0 Q E O N 0 N 0¢ 1w W¢ Q 2 p O Z p 2 U s _)o 0 a U Z� U wm V i Z 3'Z m O Z 3 W W p
E Z�Z WVj2-OJFz Oa OOUp2W a- WW M,s¢}OZ¢2 OmW�WM,W Ja a��= V --'Emm NzaQJ s0 U
iN�Z=10 U Z Z 6� ¢ sN U pr'W WU > O s Z OW NWJm 00-1 O
W } �rsviz r`j+J00 '.0— -WZ m� �QOJZOW w gp�Oj
Z d0 l
133HS
Sioz/ez✓sd .
awouuo �n911..
>W30V210HONV
3102110 GOOM30CM] 9t7M :311S
1smi 3M2331d V N33-113 '8 012130023
NVd 311S
xxxxxxdso
'ON
iIN83d
Orl
03NO3H0
EZ-ZE
N '0'I'd
ON
O
.......6tt8
WE�Vr�►
6 101
f >10010 S1H913H NINN
orvdOV
NMVaO
.0t=
31vosa�
lug-SbL L06 XVj OOZE-SbL L06 3NOHd
Stm NV 'N3 lVd L091 X08 '0'd
'1O� BOAS
9ZOUeorso :� n3a
NoaomUSNOO 800
szozlszleo
31V0
SNOISIA38
18806
O'1'i JN3 3NONNVd
;S310N
/ �•
WV)0
w
Q a
Q�
w~ w Jp,w'o
U)
~
SZ
W N Q
wa aao
�Z
I
I...
I
I
ZUw�
'lQJ Z a
Z Z d
nWpz
Z I
Wo
¢ U O
30
U
Z
I I I
No <aW=
\
i
Q� Ow0'-
31
J
£ I
ox oaC-O
I�
4-
Na <>OU
OOLL,
�j �oZo
zr
I
CL U ¢
j W
I I
=z o o >o
F'w
�co
u
Ox OwZ11
zo3za
C)
Zi
I
zwo J
0}3 Zooa
Z
\
ZZ
o,
C)-
m
—m�Q
x w
Amo
rl)
I J
II�III
goy F- �Lim
Z L,
—W
\�mQ
12
LL,
IIII
Ll�
,O4�o z
ZZ��Z�WQ�g�4��
O
0...
-W W
� )a
wh0r-�Wc
L
�>3
�w
\�O~..
W�p< oMwa
>Uz
Q
ow
:23z
w
ooz-
-a -zgoz¢}
•
Zwoan
Jo, �
o
mo E5gz w
Q�¢wD)
Z_
\•~�
f�J
o
ZOO I I
a�o�ao a8ZZ0
z a z N
Q) I
x>ZNw� 2 Z OQL'
ti ��
W Z C) O O > 0 lkf
n C �� I
O
�`oe�¢
3�3: aJ�'-'muwi
D
Q
��UW
W> 00
J�JO
�zzro� oZmoo
Z
�O
3
OQ�dvnoxo
6�
a� J<o
UIQ
O
0
om�jU
I
ONww00 OCLgz
C O I
'
�
tiW
L
O
OZLuO
lv I
dwa00z, z ¢rwr
=�oaO�X�or
00
OOQZ I
�m¢U)
O
�O�U I
oza,p0 ZOX- --
Z •
O ti
65
W
Q�L
(nWQ W I I
o�wzz, zwt;
¢awv'-i�a '-Fes "-'�zz
3
p O
_
ZCt ( ri
Z
v�mxo
OQ'wuU-,,o ~woa�
I
OaW
v}�L,M nwz000�
¢ o a
¢��L
w ZooCL
Xw
zoz�vUiz�Qor-zo
OQ
Lu L'i
U)
tnOujofw Y(/>
N u,W<Z
CLO-�Mo
Y
Z
\ Y
C)m
U
W= O
zjo n~
w
d
~�
(L/j, N
H
~
W
W
(n
Of\
ui J
D
O
F- O
}C
LLJZ
3� z w
=F,Qj OZCf)
Q
Lr)
(� 0)O�
��
U) zO¢OJ OHO
U Mp
Z W o QUO>F-O
O
O
~ �2
L1JLj Cf)
3 o N (� O W Q W ZF- 0 J
z(�W
ry
(.D LU
0- in o>p�a
�w0xWOLLJ
Z
Wr0-Lj 0o���
rQN
w (n
p ?.
3
Q m
o)o
m
W
p Q
NIp W
00 = d
m x a Co > F-
0-zP
-CL
Qr .Uo�o���
J
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP161071
Tax Code Number:
01823223000
Work Type:
Septic Upgrade
Permit Effective Dates: April 28, 2016 to April 28, 2017
Design Engineer:
PANNONE ENGINEERING SERVICE
Subdivision:
KNIK HEIGHTS
Site Legal Address: KNIK HEIGHTS BLK JILT 1 G:2936
Owner/Address: PIERCE ROBERT CHARLES &
EILEEN A 13345 RIDGEWOOD CIRCLE ANCHORAGE AK 995162940
Site Mailing Address: 13345 RIDGEWOOD CIR, Anchorage Lot Size in Sq Ft: 22400
Total Bedrooms: 3
This permit is for the construction of:
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.
Receiv(
Issued
Q
MUNICIPALITY OF ANCHORAGE (a� APF? 1 2016
Community Development Department
Development Services Division 6
On -Site Water & Wastewater Program
Phone: 907-343-799
Fax: 907-343-7997
ON-SITE SEWERIWELL PERMIT APPLICATION
Parcel I.D. 018-232-23
Property owner(s) Robert Pierce Day phone
Mailing address 13345 Ridgewood Circle, Anchorage AK 99516
Site address 13345 Ridgewood Circle, Anchorage AK 99516
Legal description (Sub'd., Block & Lot) KNIK HEIGHTS BLOCK J LOT 1
Legal description (Township, Range & Section)
Lot Size 22,400 So. Ft.
APPLICATION IS FOR:
(® all that apply)
Absorption Field
❑X
Septic Tank
❑X
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms 3
APPLICATION IS AN:
TYPE OF DWELLING:
Initial ❑
Single Family (SF) ❑X
Receipt Number: OOb(AG
(w/wo ADU)
Upgrade ❑X
Duplex (D) ❑
Renewal F-1
Multiple Dwellings ❑
(SF and/or D)
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.
property owner or autnorized agent)
Permit/Rush Fees: Jam`
Waiver Fees:
Date of Payment: 1-190-1(0
Date of Payment:
Receipt Number: OOb(AG
Receipt Number:
Permit No. 05010.1 b1 1
Waiver No.
Permit App__- :
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve0i)aneneak.com
April 27, 2016
Subject: KNIK HEIGHTS BLOCK J LOT 1
Septic System Upgrade Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade septic system to be issued for this property.
The proposed system will serve an existing three (3) bedroom house. Currently the lot is developed. The
existing tank and existing drain field is in failure. The existing drain field will be re -used as a reserve. The
system will utilize a new 10002 septic tank and new conventional drain field. This lot bnd the surrounding
lots are served by private wells. There are no wells within 100' of the proposed septic system
1. Soils. One test hole was performed in the vicinity of this system by Pannone Engineering Services in
April 2016, and groundwater was monitored for at least seven days. Ground water was not observed
to a depth of 14.0' below the surface in the test hole monitor tube in April 2016. Bedrock was not
encountered in the test hole. Based on the results of the percolation tests and overall soils
appearance; an application rate of 1.2 gallons/day/square was used for a conventional wastewater
system in the area of these test holes.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field.
The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The existing topography for the majority of the property is level with slight slopes
from the east to the west at approximately 2%-4% in the area of the septic system. There are no steep
slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all
steep slopes.
S. Drawing Markings: The Drawings are marked "For MoA Review Only'. When written notification that
the review is complete and that there are no further comments is received from MoA On -Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
/ WELL E
RIDGEWOOD CIRCL
\ W —
W
SEPTIC
AREA
40LFx5.0'Wx4ffE.D., 5.5T.D.
W/ 2" RIGID INSULATION, CO & MT SEP
AT ENDS OF FIELD �AR
Q
w
SEPTIC >
/ N\-� nn AREA Q o
REMOVE 10OOg EPTIC
TANK IAW MOA CODE(E)
INSTALL NEW 1000g SEPTIC TANK(P), 3BR 3BR
i W/ DCO & DV AFTER TANK
VERIFY INTEGRITY OF LINE TO FC \
UtJ I ESmt�_ — WELL —-- — — --— WELL E
iw
3
NOTES: PAMONE ENG SVC, LW
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
AS RESERVE \
KNIK HEIGHTS BLOCK J LOT 1
DRAWN JRL ROBERT PIERCE
13345 RIDGEWOOD CIRCLE
SITE PLAN ANCHORAGE, AK 99516
CE 8149
I
K
z
z
04/27/2016
Scale
k
1"=50'
P.I.D. NO -
•
018-232-23
9
PERMIT NO.
i
OSPI61071
Sheet
1 OF 4
SECTION
1000 g SEPTIC
TANK (P)
PROFILE
DESIGN PARAMETERS
TEST HOLE
PRIMARY SEPTIC SYSTEM
PROPOSED
J
EXISTING
TANK SIZE: 1000g
ao
s
s
SOIL RATING: 1.2 GPD/SF -
>
AREA ROD: 375 SF
-
Qo0
-
0
;
MIN LENGTH: 38 LF
- WELL RADIUS
USE:
40LFx5.0'Wx4.0' E.D., 5.5' TD
oW
TOTAL AREA: 200 SF (380 SF EQUIV)
m
PMNONE ENG SVC, LLC
FOR CONSTRUCTION
�U
w
w
PHONE (907) 272-8218 FAX (907) 272-8211
U
U
�jjj
o FILTER FABRIC
EL.. 10
n
n
jaj
Ian
I I
o
a �r BRAIN ROCK 6" ABOVE PIPE INV
',4" m DRAIN PIPE
1000 g SEPTIC
TANK (P)
PROFILE
DESIGN PARAMETERS
TEST HOLE
PRIMARY SEPTIC SYSTEM
PROPOSED
NO. BEDROOM: 3(450 gpd)
EXISTING
TANK SIZE: 1000g
CLEAN OUT NO.
-PERC RATE: 1.66 MPI
_ MONITOR TUBE NO.
SOIL RATING: 1.2 GPD/SF -
TYPICAL
AREA ROD: 375 SF
-
REDUCTION FACTOR: 0.5
-
SYS. TYPE: WIDE TRENCH 4.0'ED
WATER LINE /
MIN LENGTH: 38 LF
- WELL RADIUS
USE:
40LFx5.0'Wx4.0' E.D., 5.5' TD
NEW SEPTIC
TOTAL AREA: 200 SF (380 SF EQUIV)
NOTES:
PMNONE ENG SVC, LLC
FOR CONSTRUCTION
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
KNIK HEIGHTS BLOCK J LOT 1
DRAWN JRL ROBERT PIERCE
13345 RIDGEWOOD CIRCLE
SITE PLAN ANCHORAGE, AK 99516
61110100
ABBREVIATIONS
TH
TEST HOLE
(P)
PROPOSED
(E)
EXISTING
CO
CLEAN OUT NO.
MT
_ MONITOR TUBE NO.
TYP
TYPICAL
04/27/2016
Scale
CE `8149....T. & IPERMIT NO
T
2 OF
SOILS LOG — PERCOLATION TEST
SLOPE SITE P j
w W I
5\
7i
13
14 WAS GROUND WATER
BOH ENCOUNTERED? N
DATE PERFORMED: 04APR16 IF YES, AT WHAT
DEPTH? —0—'
DEPTH TO WATER AFTER
MONITORING? — DRY —
DATE: 11APR2016
WATER
READING DATE
TEST HOLE 1
NET
TIME
FILL
FILL
1
1 04APR16
OR
ORGANICS
2
6.260"
2
3
8.72
MIN
Orange/Brown
6.000"
1.45
GP
Silty SAND &
4
6.260"
GRAVEL w/
4
1406
Cobbles
5
DRY
6.000"
1.62
6
1407
6.260"
7
6
1417
j 9.98
MIN I
s
1 6.000"
1.fi6
9
GRAY Silty
10
GP
SAND &
GRAVEL
11
12
SOILS LOG — PERCOLATION TEST
SLOPE SITE P j
w W I
5\
7i
13
14 WAS GROUND WATER
BOH ENCOUNTERED? N
DATE PERFORMED: 04APR16 IF YES, AT WHAT
DEPTH? —0—'
DEPTH TO WATER AFTER
MONITORING? — DRY —
DATE: 11APR2016
WATER
READING DATE
a
1 \M\
SFD3BRL N\
SBD
SLOPE
TH 1
SOIL TEST RESULTS/ANALYSIS
• PERCOLATION RATE 1.66(minlinch)
(Hydrologic Soils Group: HSG A)
• -PERC HOLE DIAMETER 6"
• TEST RUN BETWEEN 4FTAND5FT.
• TEST RUN FOR OVER AN HOUR, LAST
-THREE READINGS PROVIDED.
COMMENTS: Test hole excavated by A+ HOME SERVICES. Test Hole was presoaked before Perc test.
PERFORMED BY: Joseph Lawendowski. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES: PANNONE ENG SVC, LLC
UCTION P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
KNIK HEIGHTS BLOCK J LOT 1
DRAWN JRL ROBERT PIERCE
13345 RIDGEWOOD CIRCLE
SITE PLAN ANCHORAGE, AK 99516
CE 8149
Date
04/27/2016
Scale
NTS
P.I.D. NO
018-232-23
DERMIT NO.
OSP161071
3 OF
a
CLOCK
NET
TIME
LEVEL
READING
NET DROP
(MPI)
1 04APR16
1348
6.260"
2
1356
8.72
MIN
DRY
6.000"
1.45
3
1357
6.260"
4
1406
9.72
MIN
DRY
6.000"
1.62
5
1407
6.260"
6
1417
j 9.98
MIN I
DRY
1 6.000"
1.fi6
a
1 \M\
SFD3BRL N\
SBD
SLOPE
TH 1
SOIL TEST RESULTS/ANALYSIS
• PERCOLATION RATE 1.66(minlinch)
(Hydrologic Soils Group: HSG A)
• -PERC HOLE DIAMETER 6"
• TEST RUN BETWEEN 4FTAND5FT.
• TEST RUN FOR OVER AN HOUR, LAST
-THREE READINGS PROVIDED.
COMMENTS: Test hole excavated by A+ HOME SERVICES. Test Hole was presoaked before Perc test.
PERFORMED BY: Joseph Lawendowski. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES: PANNONE ENG SVC, LLC
UCTION P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
KNIK HEIGHTS BLOCK J LOT 1
DRAWN JRL ROBERT PIERCE
13345 RIDGEWOOD CIRCLE
SITE PLAN ANCHORAGE, AK 99516
CE 8149
Date
04/27/2016
Scale
NTS
P.I.D. NO
018-232-23
DERMIT NO.
OSP161071
3 OF
a
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: INSTALL NEW 1000g SEPTIC TANK, AND SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 14 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE
ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND _.
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION,
TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
1 1. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER
(OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE
CONTRACTOR.
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED. -
CONTRACTOR:
BY: TITLE:
NOTES:
PA O0�4 ENG
9955110C
PHONE (907) 272-8218 FAX (907) 272-8211
'�'
p' �
�C,
*� *
.... ... .. ....
even nnone
CE 8149 ,(}
jj f�aY
Date
04/27/2016
016
FOR CONSTRUCT ON
Scale
NTS
eNTS
KNIK HEIGHTS BLOCK J LOT 1'
ROBERT PIERCE
13345 RIDGEWOOD CIRCLE
ANCHORAGE, AK 99516
P.I.D. NO
018-232-23
PERMIT NO.
osPlslo7l
DRAWN JRL
SITE PLAN
Sheet
4 OF
MUNICIPALITY OF ANCHORAGE
r
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
Il ENVIRONMENTAL ENGINEERING DIVISION
825 L Street -Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL_ SYSTEM AND/OR WELL INSPECTION REPORT
NAMEW
W�- -
❑ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
_. l 8�ocl� `f � -/!Y,f -- —
NO. OF BROOMS
LOCATION }!�� ,,/
Well Absorption area Dwelling PERMIT NO.
DISTANCE TO: �/
U —
t-' 2
0.Q
Manufacturer
Material ��//' /
�J
No. of compartments
—
N
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
�^
Liquid depth
CI K7
W
DISTANCE TO: Well Duelling
PERMIT NO,
U Q
Manufacturer Material
Liquid capacity in gallons
X b
p
UJ 2
DISTANCE TO:
Well
_
Foundation
�-74
Nearest lot line
PERMIT NO —
L Z
6- 2 w
No. of lines Length of eaacc�h line
Total length f lines Trench wi Itl
Distance between Imes
F•ett�
N
A
—
Top of file to finish grade
Material beneath rile
inches
Total effective absorp area
Length �
INidth �
Depth
PERMIT NO.
w
—
U
Q F
Type of crib
—
Crib diameter
Crib depth
—
Total effective absorption area
a�
w Well Building foundation
rn DISTANCE TO:
J Class Depth Driller
Nearest
Distance
lot line
to lot
lire
PERMIT
NO.
w Building Foundation Sewer line
DISTANCE TO:
Septic.
tank
Absorption
area(s)
OTHER
PIPE MATERIALS
--
SOIL TEST RATING
INSTALLER
REMARKS
—
---
--
OF
30 lot
�g
-
ZIP 6
ODDO ama WOO
n--
�-
earth ®.
p
_
Qn 4064-E-0
APPROVED DAIE[/j,J
LEGAL
d
P1 U Pol X Q 1:W=o L.. 1: W "o I CT H Fil 141 min 1-11 -1 fit Q Ch EH
DEPHRTMENT O. 1EHLTH HND ENVIRONMENTHL F /TECTION
825 'L' STREET/ HNCHORHGE. HK99501
264�4720
���R_ 6 Pr_4 �J� 1" Ei7i- E 11 - 11��
PERMIT NO. ( 8106]6 )
HPPLICAM STEWHRT BHRWcS CIR. P.H ]:',R]-.8895
LOCHTION RIDGEWOOD CIRCLE
LEGHL L1 8J KNIK HTS. LOT SIZE 20000 SQUARE FEET
TYPE OF SOIL HBSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBTR OF BEDF! OOMS� ] SOIL RHTING (SQ FT/BR)� 175
THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS:
�BEE ��11- A �� �PA 0:1 W 1-1 -to A: Q ��Q "W" RE: L.. �RE. 1=1 -V M = 71
THE 1 DIMENSION IS THE LENCiTH (IN FEET) OF THE TRENCH OR INFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE
GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE
HND THE BOTTUM OF THE EXCHVHTION (IN FEET).
�1",�11�.j 9 -IS, �;; 1 If H - �1�7_1 C.E'H C1 II:::*".ii L_ H__ Y:-*-n��
PERMIT RPPLICHNT HAS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE
INSTHLLHTION INSPECTlONS OF HNY HDJHCENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES TMHT THE WEE -LL WILL SERVE
��is �����... F, 1. r"D f1_11 IEEE' �����E�u
BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION
MINIMUM DISTHNCE BETWLEEN H WELL HND HNY CIA -SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTHNCE FROM H PRIVATE WELL TO H PRIVATE SEWEER LINE IS 25 FEET HND
TO H COMMUNITY SEWER LINE IS 75 FEET,
WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 �HYS
OF THE WELL COMPLETION
OTHER REQUIREMENTS MHY HPPLY. SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE
HVHILHBLE TO INSURE PROPER INSTHLLHTION
Q K Fit 1-1 1. W ���1�F._.: C_,:- EHE": P-9 13 Ell 15". ��� ��_1_.
I CERTIFY THHT
1: I HM FHMILIHR WITH THE FOR ON-SITE SEWERS AND WELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORT1GE.
2: I WILL INSTHLL THE SYSTEM lN HCCORDHNCE WITH THE CODES
]� I UNDERSTHND THHT THE ON-SITE SEWER SYSTEM MAY IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS.
offuum
HPPLICHNT STEWFIRT BHRDES
ISSUED BY _~..~~DHTE _.
t?r, I--Pv i4"' !070-10 AND ii'r}SFrr�,di��l1i �ttr:tTF;s'i #ts�6
_
C .. ' .." [ gg gg g ( 3 •tib'+ _: _'-F� � �! i �F d a[ /� g- y' ,[
f' � : 5i 53 ..5....�#-_- �-`��n',$Nr'° �Y,.�'d�"2 "-'.`":d �' .-�.".}^ ^.�_�+.�-Y3-.s 8."•i �"'-�d`_�'i`.5 eii � f7�
51_31 1-ilfi�'PrEP t -JR.- OR-'•?�-;�:>��
;:W 4SO TL S `r"3 T'• -Ji t'..: Tie"' • -0 #-€
It•11.,111 Iil.}i`!? f €, c-
(�71r1riP•i3
i'I_ �sf i:t•Js£: 's ty,?S`3
i=+
Q
i_.a ',�--_i 3'-+1
$
$.---- ..�".-F i__�'3-P a E'[+ L.__...�9.._.'�F"'
j� {
fW L.EJ-P i T :-i f> I r•iAto I (4 V; r
i_JEt-P13T H EN POE TDF !
► rf E71 R -M 133 ()RR [Pr- CO3 __ID
I -who dt52'Fti c n
rplb,�-•ti :ix ,tetT
I•= TI*s= 01 170r -j C* PRErWE4fii
rI- w)jR'FFw.�i OF n-39
+3;:O11¢I'. r§P T' i'��` ! 11i T t 1jPi r „H �'t `•fit }i'�f?i! [ r)I# tE# t t T'.
TIF?_ 13RAV l_ OEPTIJ QV +AqsfiW-� f,ETl•t F,PI iFP rj1_tTi=t4tt Y,t •'
}v-jo T#It-n rormm r'V THE s :;s_H's IF1,M ( M FIEFED_
'1- _,c $ -I' 3 K --._-J_3n:W-f g P � �� '•5' k
0-9270,Rti VMS )!F €`ifs rt lv-N Y tSU I M3 r#- ,
T';�illi'> iF^ ift'r` !•I'€ Y_'r Y-1(e.Jtf:t'dT TCi 114 1,:; PROPERTY rT?i 127
r•IIJr e*--Rlye- € t ' € %`.i ism �° MW TIA:* I•Y [_E. t•I i i_l_ SZ- R :E_
11F ANY W f Tl 101_19 i~ (t -O.. €'.f� i'�f T !ISN 191A• ;:4P '><"13%A=0_ 13Y t'"V.;
W I t_t $E- 'n!_lt? IC : { TO 1 }DRi
i'? C PI GII M[i [ ` . I"€1t"di :L t �: 3'i [ ;i :Pl ti i J 3 ' €�P t } !'c� i )T 3' t I i t•113+ _` O I" ,r t;0`,i-
-
loo f=d=c i i'3T+ ri litt'ti'} Ti is#I:3 [_ rjR 't itis I it 200 7=�,1I '.SON, A S U mossy 1� i i.._ DEF ��IE'IfI�I
i,[rPtP•lit ii I";Tr01011 THY WF -E OF PIAN, 1C WE- -L-
1rlr;:t I=t`;iP# r, F-,R[VHTF t.k-i_i- TO et t'�'3:'�'r�Tm `A� tl�=f I__It� is �� PEET t-?P#p
I_1 9t j F#r ' Tz,'1;� 1 l I P< 'f.? nr•lt P 11 �`w j �: i;i� Itl€ P r -r. Tt t TI -r- Tt 1 li i t'I PdT 1€ [ i' i i li _- L:�YS's":i
s # r lam`_I.lIJg Pit P!T' P'Ili't' Y1# l' 'r'. 3 LC W Iir,fli IOt- MIT-) l�:ONS,TFs'.l.}iceTtON 0t�1r:3R} R4i i RV
w''!�'1:!}'ER I P'#'a T r"li„i_A T t 1--i
saves' -.m f W i VA " i;. I1 I-2.`
_ t�` 014: ; fiiC [r`i WITH "€ii ,;1r�1t s PiI�PII Y1:1;; RNO iii
MAR
a 44Tl_.i_ f P`t'? FN_4- F! 'r''_ T`c i PI AC.031ROT'ii.: t•I UP I 1'I r0.1iC s ti;.
mor no 13�3 ':I. TE SEWER '31e$€`�;O t°9A �rtrlll�c� �tll_NI*t��Ft�PdT I� T; Yz_
ro trb_i iIts+? t•1ti#�,'F Pi€" i 8�H-'RCt+73'1
1- ,.. It� Illi` 'aT�:l•Iri�, i sa,;`i�cs�.�
f ?
lot. c3'�,i�A..}�.__`'.`S° jl � l�F 7' a...� Y.f if A7
l\' �"^�;1�«•Il �%
_~I� /�
`I/I
Ir
� I1 �!I,.����...:+�„
)
.., �
UJ
11
L
12
L / b 5'�
CUN;UI_
I II 1,1 0
cx,i , l
3 /S -/.5G a
oox a7c-1.1, srnrr
uouTc. n
ANC11'')?W.r,
nl-A;,l<'A 91107
PHONE 3n4-7071
SOILS LOG
Performed for �- i\Ao-,i
Location NocV e .,vsw isce o�ti� S']Je
Soil Type
�
0 5 M
2
5w�
6
Nater Level 1'emar.ks
J
c
10
L
12
v M
14
-
�w
• �s
16
'
18
v,.. ..20
Total Depth of Excavatio
Groundwater
(X) Not Reached
Depth, if Reached
Classificaeion Method
�) Visual
( ) Sieve Analysis
SoNol s,l brown (C)
_ Sv✓`nd-�-j y�r�u [ I - u�w�/ S O %a J�s atM .
(i-12' )
Gvo.-.gel J G�-ea.v�, so�w�, �135 �- IS•/
�S Material at Total. Depth
Bedrock
(X) NOL Peached
Depth, if Reached
MUNICIPALITY OF ANCHORAGE
DEPT. OF i z'
ENVIRONNiENIA.L ;'-CTIONQQ
Cary F. Player, Consulting, Geologist
O O O O O O O O O O O O
l a] Ml k3 �3 ! 3 !•3 �3 H rel �3 ; 3
0:0: O O O O O O ,� O O O
O
Z/1
F" N : y
� ' N
N :ct
o w :m
o ! rt i:r,'
a :w
ND :y
� ;rt
ll N
m
01
Yy-1
r=i
N
o
co
J �
rn
V
}
WWIW
rt
'N
:N
In
m
car
;�
O
m
:a
AMA
:N
;a
O
a
O
^
Ic-\
/O
yO
H
N
N
N
N
Q
'O
V
-W
N:
O
:ln
O
CO
V
O
: 1�0
W
: N
J '
N
: N
iln
:V
W
.N
?O
Vi
i0
i Co
V
i
O
:O
to
: co
:N
i
W
:U)
co
n
'W
' O
'O
? td
O
'y
a
a
wC
wC
Iri
i
a
C
r�
C
R.ID
N
:O
H
N
C
w
:w
N
:C
C
iN
iN
O O O O O O O O O O O O
l a] Ml k3 �3 ! 3 !•3 �3 H rel �3 ; 3
0:0: O O O O O O ,� O O O
O
Z/1
F" N : y
� ' N
N :ct
o w :m
o ! rt i:r,'
a :w
ND :y
� ;rt
ll N
J
m
01
0
r=i
N
o
co
J �
rn
�
}
WWIW
rt
'N
:N
In
m
car
;�
O
m
:a
AMA
:N
;a
a
in
^
Ic-\
J
m
01
0
N
o
co
J �
f-.
}
WWIW
m
car
�
m
AMA
0
a
^
Ic-\
01
N
J �
f-.
}
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Parcel ID 018-232-23
Certificate of On -Site Systems Approval
OSC251539
Expiration Date:
Legal description KNIK HEIGHTS BLK J LT 1
Site address 13345 RIDGEWOOD CIR
Current property owner(s) PIERCE ROBERT C &
X The On -site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
By: Curtis Townsend
F-or4
C-0 C, C. I-- r _
Original Certificate Date: 12/16/2025
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
6 +V_�)J
Development Services Department Phone: 907-343-7904
nn-Site Water & Wastewater Section 1: 907-343-7997
Certificate, of On -Site Systems Approval Application
1. GENERAL. INFORMATION
Parcel I.D. 018-232-23
Complete legal description Knik Heights Block J Lot 1
Location (site address) 13345 Ridgewood 'Circle
Current property owner(s) Robert C. Pierce pay phone
2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY:'❑ Private Well serving # 1 dwelling units
❑ Other Non-public well as regulated by MOA ❑ Water Storage
❑ Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units
Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑'Plastic ❑ Concrete ❑ Fiberglass
Age <1 - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed Fm� Deep Trench ❑ Wide Trench '❑ Seepage Pit
Waiver request for: f # G 0 4-17 Distance: �' f
Expedited review requested: ❑
By applying for this entitlement, this property is; subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA'Fee Waiver Fee $
Date of Payment ��(( Date of Payment
COSA # 0562�f;q Waiver #
COSAAppiication Ap2025.doc
COSA Checklist_May2025.docx
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D.DISPOSAL FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Disposal Field on Lot > 100’ Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10’ Yes if No ft
Field to Foundation > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main/Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F.ENGINEER’S COMMENTS
G.CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
Phone Name of Firm
Engineer’s Printed Name
COSA Checklist_May2025.docx
Date
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, indicates that the on-site
water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
In conducting an adequacy test, I attempt to provide a thorough, conscientious
engineering analysis of the system in accordance with ADEC & MOA guidelines and
regulations. The reported results describe the performance of the system under the
conditions encountered at the time of the test, and separation distances measured to
readily identifiable features. The operational life of all wells and septic systems depend
on the local soil condition, ground water levels that may fluctuate during the years, and
the water usage of the people served by the system. These conditions are outside the
control of the evaluator of this system. All systems eventually fail, and satisfactory test
results do not guarantee future performance of the system, nor do they guarantee
that there are no hidden defects of encroachments. Therefore, we cannot provide
any warranty of future performance, nor can we estimate the remaining life of the
system. The content of this report is for the sole benefit of the owner listed above.
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
Mailing: P.O. Box 1807, Palmer, AK 99645
Telephone: (907) 745-8200 FAX: (907) 745-8201
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK
Subject: Knik Heights Block J Lot 1
COSA Informational Letter
Ladies and Gentlemen:
This letter is intended to provide a summary of the on-site wastewater system history for the subject property
and to document observed conditions contributing to its current state .
The original on-site wastewater system, consisting of a two-compartment steel septic tank and deep-trench
absorption field, was installed in July 1981. In April 2016, the system was found to be in failure, with significant
biomat buildup observed in the absorption field. Under Permit No. OSP161071, the septic tank was replaced
with an equivalent steel tank, and a new wide-trench absorption field was installed. The original 1981 deep -
trench absorption field remained in place for reserve capacity, with a diverter valve installed post-septic tank.
PES performed a well and septic adequacy inspection on July 24, 2025. At that time, the 2016 wide -trench
absorption field was observed to be at the end of its useful life, with standing water and excessive solids
observed in the drain field cleanouts, and evidence of hydraulic backup to the septic tank. Camera inspection
documented no horizontal drain line separations anywhere in the system. A vertical separation was observed
at the foundation cleanout, the deep-trench lateral-to-vertical fitting of its cleanout was found to be cracked,
and the existing steel septic tank exhibited significant internal corrosion of its outlet baffle, and minor
corrosion around the standard water operating level. PES is unaware of how long the system maintained these
conditions. The absence of an outlet baffle at the septic tank would allow excessive suspended solids from the
dwelling as well as the ground at locations of drain line separations; to discharge directly into the absorption
fields— significantly accelerating biomat formation, reducing soil infiltration capacity, and substantially
shortening the functional lifespan of the drain fields.
Following these findings, the septic tank was replaced with an equivalent -size composite tank on September
29, 2025, under Permit No. OSP251316. During replacement, deficiencies were documented in the existing
drain line connections from the dwelling, including non-glued joints, improperly installed couplings, and
vertical separation of the foundation cleanout standpipe from its fitting. The existing diverter valve was
adjusted at the time of tank replacement to discharge toward the original 1981 deep-trench absorption field.
Based on available information and observations made in the field, it is unknown whether the deep-trench
absorption field has been actively utilized since the 2016 system replacement —with the observed levels of
standing water indicating a highly used state. 479 gallons of fresh water was added to this drain field over a
period of 150-minutes, and per MoA COSA guidelines is considered to pass. All observations and conclusions
herein reflect site conditions at the time of inspection only; future system performance and remaining service
life cannot be predicted, and all wastewater treatment systems are subject to eventual failure. Due to the
observed degree of saturation, prolonged and continued use of this system at design flow will eventually lead
to failure of the wastewater treatment system.
Page 2 of 2
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
PES recommends the septic tank be pumped annually, or at minimum every other year. Each pumping event
should include inspection of both absorption fields to verify operating conditions and to confirm proper
diverter valve configuration as necessary (See COSA Checklist Certification & Statement of Inspection by
Engineer).
If you have any questions, please contact me at (907)-745-8200.
Sincerely,
Steven R. Pannone, P.E., F. ASCE
Owner/Civil Engineer
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT t� 907-343-7904
�Fe �
On -Site water and wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC251539
Subdivision: KNIK HEIGHTS, Block: J, Lot: 1
A water sample revealed a nitrate concentration of 8.61 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
t
Mailing Address P Box 196650 "°-Anchorage, Alaska 99519-655Q * www.mu'rti org ,;
l
Municipality of Anchorage
t •parhnrnt
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV251057 COSA#:OSC251539 Permit#:
PID#: 018-232-23
Legal Description: KNIK HEIGHTS BILK J LT 1
Engineer: Pannone Engineering Services
Your request for a waiver of the required 10 feet horizontal separation from the disposal field to
the foundation has been approved. The approved separation distance is 6.6 feet.
This waiver approval applies to the existing disposal 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.
Waiver is Granted: X Waiver is not Granted: n
Date: l 5 Approved by: 1,
Name of Reviewer
**** VARIANCE/WAIVE R REVIEW ****
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
Mailing: P.O. Box 1807, Palmer, AK 99645
Telephone: (907) 745-8200 FAX: (907) 745-8201
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK
Subject: Kink Heights Block J Lot 1
Drain Field to Foundation Waiver Request
Ladies and Gentlemen:
We hereby request a separation distance waiver for the existing drain field location in relation to the existing foundation
on the subject property, to an approximate distance of six-point-six (6.6) feet. Based on available inspection records, the
existing 1981 absorption field was installed with more than twenty feet of horizontal separation from the foundation at
that time. It appears that the drain field may predate an addition to the dwelling —likely the garage—which reduced the
current distance.
The native receiving soil in the area of the trench consist primarily of granular material, including gravely sand and sandy-
gravel with silty-gravel (SW/GW & GM). These soils exhibit relatively favorable infiltration characteristics. If the assumed
addition was constructed on a turn-down slab foundation, then under worst-case infiltration conditions (46% infiltration
from above the drain field lateral), the vertical zone of influence from the drain field is projected to extend approximately
seven-point-five (7.5) feet below the estimated elevation of the bottom of the foundation footing. Under these conditions,
vertical separation would mitigate structural or sanitary impacts.
If the structure was constructed on a stem-wall and footer foundation, the same infiltration assumptions indicate the
vertical zone of influence from the drain field would extend at least five-point-five (5.5) feet below the assumed elevation
of the bottom of the foundation footing. This also maintains a reasonable buffer and mitigates structural risk to the
foundation.
The drain field has remained in this location with documented use since its installation in July of 1981. There are no
documented or current observable impacts to the foundation. In addition, bio -mat or effluent build up within receiving
soils typically develops within a limited distance of a drain field boundary, preventing the extent of contaminated soils
reaching toward the foundation.
Based on the existing conditions, the approximate six-point-six-foot separation provides adequate protection to the
structure and granting this waiver is not likely to affect the health and safety of this lot or the surrounding lots now or in the
future. Furthermore, granting this waiver should not hinder the future development of this lot or surrounding lots beyond
the constraints already established.
If you have any questions, please contact me at (907) 745 8200.
Sincerely,
Steven R. Pannone, P.E., F. ASCE
Owner/Civil Engineer
16 December, 2025
MUNICIPALITY OF ANCHORAGE G Z ,1
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO i'ECTION I o
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL !�I Dias
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date "��3�rO
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
4a� Bi�-oc2- J, �1je-" 6(7s 5'Aet0Pr 2'iiz� 2,3 w
Location (address or directions) 9
/.6�3�5 Xlc("euea� _
(b) Applicant Name / ts. lt/Siern� Telephone: Home � '�f�0� Business
Applicant Address /,33¢5 L' 51&
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other (explain); -
(d) Lending Institution Telephone —
Address
(e) Real Estate Company and Agent
Address
Telephone
- (f)- Mail the HAA to the following address.
2. TYPE OF RESIDE E
�j
Single -Family Multi -Family ❑ Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well lit Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE D OSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025(M84)
5. ENGINEERING FIRM PROVIDIN%. ,NSPECTIONS, TESTS, FILE SEARCH, DA,,. AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this -Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate,
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection. �J
Name of Firm �d �1- /-'dd��%�er ° Telephone 3��F44f�
Address zoa 66 SE'S
Date 4Zi3,Arr
C:
T
%.
a J. Corwin o` �1":,
°e o. CE -6233
�,'3 �•zy/,/�� Engigd,errs Seal
�+°< ��' •tee, '., �-�
6. DHEP APPROVAL
Approved for bedrooms by ' Date
Approved— Disapproved Conditional
Terms of Conditional Approval
dhe�
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11,84)
MUNICIPALITY OF ANCHORAGE (MOA) -�
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-•4720
Legal Description: Z-6� J3CVC C J 1'�/w/4 /1L /O/; 's
A. WELL DATA
Well Classification P�'/V54 Z If A, E3, C, D.E.C. Approved (Y/N) AlIj;
41
Well Log Present (Y/N) t L-5 Date Completed (��/d'/ Yield 54
Total Depth 3- c' — Cased to 170 Depth of Grouting 1V0A,1C_
Static Water Level ✓tea — Pump Set At— 4,0/✓
Casing Height Above Ground — Z -v Sanitary Seal on Casing (Y/N) A -S
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot .t On Adjoining Lots
To Nearest Edge of Absorption Field on Lot — �oora ; On Adjoining Lots —
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments + coir! Gtl�
i
1--O / IL
1t/'o1v4_To Nearest Public Sewer
r �
d'JE To Nearest Sewer Service Line on Lot k7p
�(/� ; Date — Y AJ9
B. SEPTIC/HOLDING TANK DATA
Date Installed Jul-, 19R/ Size /000 674C. No. of Compartments
Standpipes (Y/N) _��:k Air -tight Caps (Y/N) V&� — Foundation Cleanout (Y//N) le� _
Depression over Tank (Y/N) _ �o Date Last Pumped / %ZC 7
Pumping/Maintenance Contract on File (Y/N) A" _ ; for — /�4
Holding Tank High -Water Alarm (Y/N) _ &A - Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank: /
To Water -Supply Well To Building Foundation
i
To Property Line _ %'5 To Disposal Field
To Water Main/Service Line — �U� %� To Stream, Pond, Lake, or Major Drainage
Course //o IV(_ -
Comments
Page 1 of 2
79_n9ai1 1/ani
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /7 Type of System Design
��/
Date Installed / ?16 / Length of Field 0
Width of Field �Depth of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
1S'&G
Gravel Bed Thickness
— Standpipes Present (Y/N)
Date of Last Adequacy Test/
Separation Distance from Absorption Field:
To Water -Supply Well /00 (� To Property Line le / to
To Building Foundation
nnn��� 25-/1- To Existing or Abandoned System on
AX'
Lot ; On Adjoining Lots 30/
i
To Water Main/Service Line /0 14 To Cutbank (if present) X&il/-
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons
Manhole/Access (Y/
"Pump On" Level at
"P ff" Level at
High Water Alarm Level at
Vent (Y/N)
Tested for
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
ENineer's Seal
Comments
%
3
roo
** ChecAthack
ting Against HAA Request *'
I certify , v rified, or conformed to all MO/A� amend HAA guidelines in effect on the date of this inspection.
/-ZeComoa
Signed
Datey
MOA No.f�%'�7
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Yfuc J. CoMir)
o c/mac/5zsa �•
`� � ``!?ram" "��T��•� 'rr.l�l
ENineer's Seal
%
3
Yfuc J. CoMir)
o c/mac/5zsa �•
`� � ``!?ram" "��T��•� 'rr.l�l
CHEMICAL & GEOLOGICAL LABORATORIES OFf1LASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
FEDERAL TAX ID N 92-0040440
IABOR.TORIE
ANALYSIS REPORT BY SAMPLE for Work Order # 6034
Date Report Printed: APR 12 88 @ 09:03
Client Sample ID:BACKYARD WELL
PWSID :UA
Collected @ hrs.
Received APR 8 B8 @ 13:15 hrs.
Preserved with :NONE
Analysis Completed :APR 8 88
Laboratory Supervisor STEPHEN C. EDE
Released By : C�'-.r(�/�
Special
Instruct:
Chemlab Ref #: 9617 Lab Smpl ID: 1 Matrix: Water
Client Name CORWIN & ASSOC
Client Acct CORWINP
P .0. # NONE REC D
Rey #
Ordered By
Send Reports to:
I)CORWIN & ASSOC
2)
Allowable
Parameter Tested Result/Units Method Limits
NITRATE -N 0.39 my/l EPA 353.2 10
Sample ROUTINE SAMPLE
Remarks:
1
Tests Performed
See
Special Instructions Above UA=Unavallabie
ND=
None Detected
See
Sample Remarks Above
NA-
Not Analyzed
LT=Less
Than, GT=Greater Than
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTI-I AUTHORITY APPROVAL CERTIFICATE
1
I. General Information Application Date I? s ��mq
(a) Legal. Description (include lot, block, subdivision, section, totownship,�range)
�TL ,.— .� - ! L ia. I` �.o.^• o.`_. ���., _' {s. �4q� �A .r..� •.�� .,�,_.a._ .
Location (address or directions)
(b) Applicants Name_mnlHome Business_
Applicants AddressT L4 KLC
(c) Applicant is (check one) Lend
Buyer . ; Other M (,expl
(d) Lending Institution
Address
..Insti"tution ;'-Otmer(bdOmier ;
Telephone
(e) Real Estate Co. &Agent AC=VL1p",�f F�.?�m.� T1:.M Vie!
Address < J' Nk)y_7j rx.2_ ` ___,LL ! � ,
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single --Family j Multi—Family
Number of Bedrooms
3. Water Suy
Individual Well r Community 1-1
Other (describe)_
Public M
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4„ Sewage Disposal
Onsite Public Community Holding Tank
Note: If community well system, must have written confirmation from the State
Department of Environmental. Conservation attesting to the legality and status.
[Page I of 2]
Amount: y0 a -^
[Page 1 of 21
2-15-84
ea_r�®sem b..s b a.� W , , uvacxan nspecrions, Tests File Search, Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the onsite
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm % ja; _ '[> � ��� Telephone_M -- Ldq/
Address i sA:�4
Date f;;i
(ENGINEER SEAL)
6o DHEP Approval is -^ , v. 222 - [_
Approved for '� 64
JUNE 2a, 1ji1
A
PP #� bedrooms BY hirt��. � ,% Date°
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DI:IEP) ISSUES HEALTH AUTIiORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2 ] 7--19•x84
03AHD3c
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) �86'
CHECKLIST - FEBRUARY 1984 NC IKWOad IViN]WNoa]AN3
q HIIV]H do 'LACI.`.—
A. WELL DATA Legal Description
. .�.� _......., we.
Well Classification_ J>el VArt* If A, B. or C. D.E.C. Approved(YM) W
Well Log Present (Y/N) Y _ Date Completed 6/.218'% " Yield xy
Total Depth r'p Cased to /70Depth of Grouting /yc9N L
Static Water Level (Gp t Pump Set At 601%i
Casing Height Above Ground 42,11 le Sanitary Seal on Casing (Y/N) y
Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N).j�L
Separation Distances from Voll:
To Septic/Holding Tank on Lot 1004 On Adjoining Lots 156
To Nearest Edge of Absorption Field on Lot 100 ; On Adjoining Lots (3d `I'
To Nearest Public Sewer Line NONLE To Nearest Public Sewer
Cleanout/Manhole pAlE To Nearest Sewer Service Line on Lot Ja f
Water Sample Collected By I- -e- Date—
Water SP
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed? I� 191 Size ID&O No. of Compartments Tt.&o _
Standpipes (Y/N) !�o Air -tight Caps (Y/N) > Foundation Cleanout (Y/N)
Depression over Tank (Y/N) N Date Last Pumped 'k-13195
Pumping/Maintenance Contract on File (Y/N) M,a4 ; for N/A
Holding Tank High -Water Alarm (Y/N) IV/,y Temporary Holding Tank Permit (Y/N) tyl^
Separation Distances from Septic/Holding Tank:
To Water -Supply TAbll /Do To Building Foundation 10
To Property Line Irk To Disposal Field - 1D1
To Water Main/Service Line 10+ To Stream, Pond, Lake, or Major Drainage
Course N 0 N [_
Comments
Receipt # 3,22 65 7 _
Date Paid: _J_tE;.,q5
Amount: —yoc*
[Page 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1-75 Type of System Design --,f, ta
Date Installed 7/111,g/ Length of Field 0
Width of Field NO Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area 5 4.0 Standpipes Present (Y/N) O N S _
Depression over Field (YIN) N Date of Last Adequacy Test IlLf/* s
Results of Last Adequacy Test Pgtsg i m
Separation Distance from Absorption Field:
To Water -Supply T\b ll ! o o 'f To Property Lire to Ap
To Building Foundation 95 To Existing or Abandoned System on
Lot N D N E 1 On Adjoining Lots N5? 30
To Water Main/Service Line 1 b '- To Cutbank (if present) N ON L
To Stream/Pond/Lake/or Major Drainage Course 1\1 O N �=
To Driveway, Parking Area, or Vehicle Storage Area 51
Comments
D. LIFT STATION N O N t^
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes
Comments
Dimensions
Manhole/Access (YM)
"Pump Off" Level at
Vent
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conform d to all MOA HAA Guidelines in effect
on the date of this inspection.% %
Signed Date !/ 2.Zl � a_
Company MOA No. 9 yS (`-Q l /
Y.B1/d5/s
[Page 2 of 21
n _9.0
M C Ai
�`�..��°'• e• ori ,��.
y, a ��(/f{,,y/J • • rSE • e Yee ;i`
2225-F
UNE 25, 1971 ,
2-15-a4
P
O n E 1P VIN W I�lr�1U�,I �a o o ANCHORAGE, ALASKA
203 W. '15tb V I x99501
CONSULTING ENGINEER TELEPHONE: (907) 279.3916
PETE JARRET
HERITAGE INVESTMENT
207 E. NORTHERN LIGHTS BLVD.
ANCHORAGE, ALASKA 99503
JANUARY 22,1985
S E P T I C S Y S T E M A D E Q U A C Y T E S T
LEGAL: LOT 1, BLOCK J, KNIK HEIGHTS
LOCATION: 13345 RIDGEWOOD CIRCLE
OWNER: EDWARD ORTEGUS
RESIDENCE: THREE BEDROON, SINGLE FAMILY
WATER SYSTEM: ON SITE WELL
SEPTIC SYSTEM: FROM MUNICIPAL RECORDS:
TANK: 1000 gal. Greer. Steel
ABSORPTION SYSTEM: Trench
ABSORPTION AREA: 560 sq. ft.
SOIL RATING: 175
INSTALLATION DATE: July 1981
DATE OF PUMPING: January 21, 1985
DATE OF TEST: January 21, 1985
TEST PROCEDURE: Tank was pumped and water added to the sump
of the trench at a steady rate of 7 gallons
per minute. The water level in the sump was
monitored and the following readings taken:
Water Volume
Gal.
-0-
100
200
300
450
Water Depth
In.
48
53
56
58
60
After 24 hours the water level was checked.
The level was 36 inches.
TEST RESULT: This system absorbed more than 450 gallons of
water in a 24 hour period. The Municipal
requirement is that 150 gallons per bedroom
must be absorbed in a 24 hour period. Thio'
system surpasses this requirement.
Tobben Spurkland P.E.
Pete Jarret
Heritage Investments
Lot 1, Block J Knik Heights
Jan. 22, 1985
Page two
The operational life of all
septic systems depends on the local soil
conditions, groundwater levels that may fluc-
tuate during the year, and the water usage of
,; ;•°• %`a
the family being sereved by the system. These
Fpi ,:' ,
conditions are outside the control of the
`.•••
evaluator of this septic system. We can there-
fore not give any estimate of how long the
��,^`• t'�. 2225-E
system will continue to meet the operational
a� :' 1 NE 25, 1911
requirements of the Municipality and State.
203
10 o �'r A �GD�NU a, ND® VQ�Q AN HORAGE,VALASKAIT
o99501
CONSULTING ENGINEER TELEPHONE: (907) 279.3916
PETE JARRET
HERITAGE INVESTMENTS
207 E. NORTHERN LIGHTS BLVD.
ANCHORAGE, ALASKA 99503
JANUARY 21, 1985
R E S I D E N T
I
A L
W
E L L
I N S P E C T I O N
LEGAL: LOT
1,
BLOCK
J,
KNIK
HEIGHTS
LOCATION: 13345 RIDGEWOOD CIRCLE
OWNER: EDWARD ORTEGUS
TYPE OF WELL: RESIDENTIAL, SINGLE FAMILY
WELL LOG AVAILABLE: YES
INSTALLATION REQUIREMENTS MET:YES
WELL YIELD FROM WELL LOG: 5 GPM
PUMP YIELD: 7 GPM
DATE OF INSPECTION: JANUARY 21, 1985
TEST PROCEDURE: WELL WAS PUMPED AT A STEADY RA'Z'E OF 7 GALLONS
PER MINUTE FOR 65 MINUTES. DURING THAT TIME
450 GALLONS WAS DELIVERED.
TEST FOR COLIFORMS: TEST WAS PERFORMED JAN. 18, 1985. TEST WAS
NEGATIVE.
TEST RESULT:
� 4s
°p -
i.•.• •♦ •• a°ti4
�. No 2225-E:
lU lb, 1971
E ;•
rye[ ,•.•
The Municipal requirement for well flow
is 150 gallons of water per bedroom per 24
hours.This well surpasses this requirement.
The assessment of the condition of this well
applies only to the conditions as of this
date. The flow rate of the well may change
due to subsurface conditions that may not be
observed from the surface, and changes in
land use and other factors that may impact,
the conditions of the aquifer feeding the
well.
Time
APPLIC JT FILLS
OUT UPPER HAL )NLY
Propert, Owner
-:;.a __
kj, Aj
Phone
Mailing Address
'j '�� i il��_-�.
Zip Code )
Date
Date
Date
Buyer
Inspector
Inspector
Address
Inspector
Zip Code
Lending Institution
Phone
Address
Field Notes:
O v
Zip Code
Realty Co. & Agent
,,-�
," q
Phone
MAY
ECEIVED
(3 ) APPROVED BEDROOMS
Address
( ) DISAPPROVED
Zip Code
( ) CONDITIONAL APPROVAL'
Legal Description'.,
j
Street Location
? 'r�—�<'3a�T-�
�'-� EST-iIVl{X.
Type of Residence
_
R
Ingle Family
-"-
Septic Tank Size /tic`/L_%
11 Multiple Family
No. of Bedrooms—
edrooms❑
ElOther
Water Supply
1 C
ClArtdividual
_
��� .�
ATTACH WELL LOG. A well 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).
O Public Utility
Sewer Disposal
EYfndividual
Year Individual Installed: ' �
El 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 I
Date
Date
Date
Dat
— �-.C? 3 C, --Df Cl
Inspector
Inspector
Inspector
Inspect r
Field Notes:
O v
MUNICIPALITY OF ANCHORAGE
DEPT. OF H- A.LTH P,.
ENVIRONMENTAL PROTECTION
MAY
ECEIVED
(3 ) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE CA -_ �. - �•}
Soils Rating
Date Sewer Installed
Well To Absorption AreaWell
Log Received '•:y''t�-...-
'
Well to Tank �(.:.�
Septic Tank Size /tic`/L_%
72023 (3182)
D T
5. LEGAL DESCRIPTION
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
TIME
6. TYPE OF RESIDENCE
�DL °e X00 � O
DATE
DATE -
DATE -
❑ Two CI Five
❑ MULTIPLE FAMILY
-1-2 l
INSPECTOR
INSPECTOR
INSPECTOR ��)) ��11
P\RAGE
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
MUNICIPALITY
❑ PUBLIC UTILITY
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL PROTE❑ION
825 L Street - Anchorage, Alaska 99501
- p r,- /r'tt 1.1981
[II J L/ I;7 %%I
ENVIRONMENTAL SANITATION DIVISION RECEIVED F
Telephone 264.4720 G�1 IC D
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10)daysfor processing.
1. PROPERTY OWNER
vOA,2T2t�}�5�
- PHONE
MAILING ADDRESS
5l31 ;ice �C}?i=.2 C'�rZ f\Nc.4luPiaC�c
-
1�C`
PROPERTY RESIDENT (If different from above)q' -
PHONE - -
L YiN1bL_ �-W _ _ _E)•a_ z� w15tu�
--- -
2. 13UYER
'5A
�'
PHONE
MAILING ADDRESS -
- -- -
3. LENDING INSTITUTION'
�
PHONE
AV,`1 s �T iytu�1
Z'7(a 8180
MAILING ADDRESS
12 �t(ZPocZ� - H t l'—F N"iceLz_ rJG o�z�
4. REALTOR/AGENT
�1V
�iONE
MAILING ADDRESS - -
-
5. LEGAL DESCRIPTION
L i b a i�1.r> tc_
STREET LOCATION
_UTS
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS ®^
❑ One ❑ Four ❑ Other
SINGLE FAMILY
❑ Two CI Five
❑ MULTIPLE FAMILY
;&�- Three ❑ Six
7. WATER SUPPLY
INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM-
t-_ INDIVIDUAL/ON-SITE**
19?)) _YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) � -
THIS SIDE FOR OFFICIAL USE ONLY
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
Ll PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
10 -
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: I OD6 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 FORy BEDROOMS
L_I CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY
u
ij-'Culsljjelr ilf
I U tH
chorviriv ,
1; n I I i C2 C t 1 Id 110 WIN: I Its
f0c Uh, ilulivi,111j,j TIMICIr and w;jf:fj,.
revivo. i_j
ry 11lu tOP CQ tl]Q yy], I (1,11;i IQ Suplivil
thM. it is vattal: higim.
"rhe" at -'j-)1 f {,t:t:l. )1 or !At aroilliel tKi W!] t,-. 5:711 nuncio to)
MUICACT wil:tl sO tiait it: gjrnqlq m:
tha we
'Ale"I'll (Nishin nowls
,51MV�� 'IYoun'!
I I, vc,
C I u I r ATMicilt 10.17CIT; j;(] tIM MAJ 11p;AO; 01140 ill
0 1 1: 1110 L i p n,wig
J.11 Imi OlICK16nj
ANY th.2 UL
Too vloto.c L
I: o
C' 1
3 3
U t.� V
I A, rh j
clot laINWIM
L
11SIOW,
dimITWINADvioc
blicin
L Yont
!1(', I1 t SO
14113111kti-
11 Nwrn
IUQ om,
HIS
O-Ulc.!
1i_
l'tA,r
(ICIZ a
i
;nod Il ialhy