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PID:015-062-28 PERMIT:OSP241198
FIRST WATER CONSULTING
SILVER CREST BLOCK 1, LOT 6
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
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241198
Work Type: Septic Upgrade
Tax Code Number: 01506228000
Site Legal Address: SILVER CREST BILK 1 LT 6 G:2439
Site Mailing Address: 9246 GROVER DR, Anchorage
Owner: LENCZ JOSEPH J &
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
7/23/2024
7/23/2025
48665
Q Disposal Field Q 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
4
i ,—
Received By: f" fit" Date:
Issued By: Date: 7 ` 3 �' ,
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-062-28
Property owner(s) JOSEPH LENCZ & JACQUELINE SONG Day phone
Mailinq address 9246 GROVER DRIVE, ANCHORAGE, AK 99507
Site address 9246 GROVER DRIVE, ANCHORAGE, AK 99507
Legal description (Sub'd., Block & Lot) SILVER CREST BLOCK 1, LOT 6
Legal description (Township, Range & Section)
Lot Size 48,665 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
Initial ❑
Single Family (SF)
(w/wo ADU)
Septic Tank
RX
Upgrade
Duplex ❑
(D)
Holding Tank
El
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signaturd of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment: 1-0 Z' y
Receipt Number:
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
July 9, 2024
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: SILVER CREST BLOCK 1, LOT 6
The property owner has requested we obtain a permit to upgrade the failed septic system of the
above referenced lot. This is a very deep system exiting the house at approximately 8.5’ from
grade. We propose to install one 1500-gallon HDPE 10-foot burial STEP tank and pressurized
shallow trench to serve the existing 4-bedroom residence. The design is based on the recent test
hole conducted on June 27, 2024. No groundwater was observed at test hole excavation or
monitoring.
The slopes are flat to moderate slopes at 0-3% at the proposed upgrade location. The lot and
area are served by private water. The design will not impact any of the neighboring properties.
Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241198, Curtis Townsend, 07/23/24
FIRST WATER CONSULTING
SILVER CREST BLOCK 1, LOT 6
DESIGN CALCS:
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC SYSTEM
NO SLOPES >25% WITHIN 50'
OF PROPOSED FIELD.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241198, Curtis Townsend, 07/23/24
FIRST WATER CONSULTING
DESIGN DETAILS:
SILVER CREST BLOCK 1, LOT 6
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241198, Curtis Townsend, 07/23/24
3030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL : SILVER CREST B1, L6
PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 7/5/2024
DEPTH
FEET OG
SOILS
1
2
ORG/OL
3
4
5
6
GM/gp
7
8
9
10
11
12
13
14
15
16
BOH
17
18
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
7/2/24 10 min 6” 4 7/16”
“ 6” 4 6/16”
“ 6” 4 6/16”
“ 6” 4 5/16”
“ 6” 4 5/16”
“ 6” 4 5/16”
PERCOLATION RATE 2.3 (MIN / INCH)
TEST RUN BEWTWEEN 4 & 5 FT
PERC HOLE DIAMETER 6”
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: DRY
DATE: 7/5/24
TESTHOLE # 24-1 DATE PERFORMED: 6/27/24
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: JOSEPH LENCZ & JACQUELINE
7/5/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241198, Curtis Townsend, 07/23/24
Municipality of Anchorage ,;� '�•,
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW030426 PID Number. 015-062-28
Name:
Michael & Barbara Hotchkin Wastewater System: ❑ New 1] Upgrade
Address
9246 Grover Dr., Anchorage 99507
ABSORPTION FIELD
Phone: 336-5112 Number of Bedrooms:
4
❑Deep Trench Slalbw Trench ❑Bed ❑Mound QOlrier.
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
Block Lot Lot; 6 Subdivision:
Silver Crest
GPD/Ft'
Depth to pipe bottom from original gra
Ft.
Gravel depth beneath pipe:
TownsNP NA Range: Section:
Fill added above odginal grade:Length:
Fl.
Fl.
Ft.
Wel : ❑ New ❑ Upgrade
cr,vel width:
Number db oislenoe between lines:
tron (Private, A. B, Total Depth: Cased to:
Existing
Ft.
Total absorption area:
FL
Pipe Material:
Ft. FL
Ft"
Driller
Onlbc Data
Static Water Level:
Installer:
Date Installed:
FL
Yield:
Pump Set at
Casmp Neign Ground;
GPM
Ft.
TANK
SEPARATION DISTANCES
Aseptic ❑Holding ❑S.T.E.P. ❑Other:
To
Septic
sorption
Lift
Holding
lubliaPrivate
Manufacturer:
From
Tank
'eld
Station
Tank
Sewer Line
Anchorage Tank
1250 Gel
Wed
101.5
Material:
10 ga. steel
Number of Compartments:
2
Surface Wale
100+
LIFT STATION
Lot Line
50
os'
anu acturar:
Gal.
fWnd AM
25
5
'Pump on' level at:
-Pump off -level at:
rogh water alarm at
4
In
IR
in.
GrainCurtain D
NA
Pump Make & Model
Electrcat Inspections performed by
Remarks:
Old tank was removed, and the new tank
BENCH MARK
installed in the same place. Double cleanout
Loratgn and Desmplwn:Threshhold of man door at center
installed after the tank. No change to drainfield.
south side of house. """m`d Elevator:
Engineer's Stamp
Inspections performed by: Watkins Engineering, Inc. Dates: 1`I 10/13/0349TH
rid NA
Developmen Services Department Approval -_-AV2,r,7
Citliy W Ellis
Reviewed and a roved b .
pp y' Date: /� �p o ''•
(Rev. ILat) � •.. CE -10s77
yOFESS104=� �'C�
Permit No. SWO30426
Page 2 of 2
Date: 10/22/03 Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 6, BLOCK 1, SILVER CREST SUBDIVISION PID No.: 015-062-28
y
M LLL
MARK A 8
DRIVEWAY FCO 11.7' 41.6' I
ST1 31.8' 51.0' I
ST2 38.5' 56.2' I
DCot 41.8' 58.9'
DCO2 42.7' 59.7' /
SUMP 87.0' 98.1' /
\ EXISTIN4HOUSE
A FCO I 8M8
i
OLD SEPTIC TANKS I i
REMOVED
STI NEW 1,250 GALLON
� � � STEEL SEPTIC TANK
ST2
DCO1 IX0' RA WELL
100' RADIUS
\\—DCO2
I
I
I SHED
I
I
EXISTING DRAINFIELD I
RETAINED
`SUMP
ASBUILT
SCALE: 1"=30'
SEPTIC SECTION
--TO EXISTING DRAINnELD
ADJACENT WELL
100' RADIUS
�E OF•A4gs\i
01
.•49TH *I iyYCiW. Ellis..*
. No. 105771
l� 'k A
lw
4
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW030426
Legal Description: "SILVER CREST BLK 1 LT;' 6 °
Design Engineer: 0844 Watkins Engineering, Inc
Owner Name: Michael & Barbara Hotchkin
Owner Address: 9246 GROVER DR
ANCHORAGE. AK 99516-6538
Date Issued: Oct 09, 2003
Expiration Date: Oct 08, 2004
Parcel ID: 015-062-28
Site Address: 009246 GROVER DR
Lot Size: 48665 SQ. FT.
Totat Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank Q Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:/6
v
Date: I 03
Municipality of Anchorage
• Development Services Department �'^�"
r f,
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-062-28 Permit Number SW03C424
Property owner(s) Michael & Barbara Hotchkin Day phone 269-5248
Mailing address (1) 9246 Grover Dr.
Mailing address (2) Anchorage, AK Zip Code 99M I (p
Legal description (Lot, Block & Sub'd.) Silver Crest Block 1, Lot 6
Legal description (Section, Township & Range)
Lot Size 48,665 Acre Sq.Ft Number of Bedrooms 4
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade El
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property o'ger or authorized agent)
Permit Fees: 9? Lt U U Waiver Fees:
Date of Payment: I D
1 �(� Date of Payment:
Receipt Number: i -f Zlfl Z I C Receipt Number:
(Rev. 12/00)
Watkins Engineering, Inc.
P.0 Box 110443, Anchorage, AK 99511
(907)349-1851 cwellis@gcl.net
October 2, 2003
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
RE: Silver Crest SID, Block 1, Lot 6
Septic Tank Replacement
To Whom It May Concern:
Attached please find an application to install a new 1250 gallon steel septic tank at the
referenced 4 bedroom house in Anchorage. The existing tank was installed in 1977 and
will be abandoned in place. During a repair to the piping between the tank and the
drainfield, numerous holes were discovered in the tank. The drainfield appears to be in
good condition and no work is proposed for it.
There are no surface water concerns, and the new tank will be placed more than 100 ft
away from any private wells. I am not aware of any adverse effect that this upgrade
would have on any adjacent properties' water and wastewater treatment needs.
Thank you for consideration of this permit application. If you have any questions or
need further information, please call me at 349-1851 or 360-3389 (cell).
Yours truly,
Cindy WEllis, P.E.
President
SILVER CREST
BLOCK 2, LOT 1
— ABBOTT ROAD—
SILVER CREST
BLOCK 2, LOT 2
1 — G R 0 V E R D R I V E—
x
0
SILVER CREST i
'" BLOCK 1, LOT 7 /
—4
1
1 �
1 `
1 r �
11 1 PROPOSED TANK
r
SILVER CREST
BLOCK 2, LOT 3
EXISTING WELL
100' RADIUS — TYPICAL
EXISTING HO
1 i
i
i
EXISTING 1
TO BE A&
10I
EXISTING DRAINFIELD,
NO WORK PROPOSED
i
SILVER CREST
i BLOCK 1, LOT 8
I 1
1 I
I 1
SILVER CREST i
ONED 1` BLOCK 1, LOT 5
r � 1
r ` 1
1 � 1
I � I
i NETTLETON ACRES NO.13
11 I BLOCK 1, LOT 4A�
SILVER CREST
BLOCK 1, LOT 9
Septic Design Prepared For
MICHAEL AND BARBARA HOTCHKIN
LOT6, BLOCK 1
SILVER CREST SUBDIVISION
Prepared By: DATE: 10/2/03
Watkins Engineering, Inc. PID NO. 015-062-28
Cindy W. Ellis, P.E., M.S. SCALE: 1"=100'
P.O. BOX 110443 DRAWN: DJR
ANCHORAGE, ALASKA 99511-0443 CHECKED: CWE
PHONE: (907) 349-1851; FAX: (907) 349-1934
OF•A�,
*: 49TH •.*
qo'• Ci y W. Ellis
i•. o. 10577..-4-,,,
(,111,'°ROFESS1fJ'k' �
r \\
r SHEDIf
\�
/
r
r
1
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1
. 1
WELL
DRIVEWAY 1
� I r
\ I 1
\ � r
\ r
\ r
\ \ r
\ \ r
\ \ r
\ \ r
\, EXISTING
\ HOUSE /
I � i
I � i
I ` i
I ♦ i
1 O
o p
`N EXISTING FCO
0
PRgP SED 1,250 GALLON 0 1 --
/ STEEL DEEP BURIAL LJ �fXISTING SEPTIC TANK TO EXISTING WELL
/ (8.0') SEPTIC TANK SCO BE ABANDONED IN PLACE 100' RADIUS
/ I
� I
i SHED
Ef
i I
� 1
� I
I
i 1
I
I
I
Sr' EXISTING DRAINFIELD TO REMAIN,
CO NO WORK PROPOSED
EXIST G ADJACENT
WEL , 100' RADIUS
PROPERTY LINE _ — — — _ _ ::,,---
10, UTILITY EASEMENT
F-- 1�
Septic Design Prepared For _``
MICHAEL AND BARBARA HOTCHKIN �� 0EAtgSIrJ
LOT6, BLOCK 1 .►.�P••' lr—
SILVER CREST SUBDIVISION j * ' 49TH
Prepared By: DATE: 10/2/03
Watkins Engineering, Inc. PID N0. 015-062-28 / "`��U`"
Cindy W. Ellis, P.E., M.S. SCALE: 1 "=30' 4�' c: �'y 057W. 7�s • ��
P.O. BOX 110443 DRAWN: DJR 'ff�'
PHONE: (907) 349-1851 1FAX44(907) 349-1934 CHECKED: CWE Ilk F0 F P?OFESSIO `
MUNZC LI'AI,:L'J.'Y OF ANCHORAGE V=� LJ�>
IIec h and Environmental Prote Lor)
]Fourth Floor West.
821_) l Street
Anchorage, Alaska 9950]_
264-4720
INSPECTION REI'URT UWSHT °;i:4" AC1 171SPOS' ,(. Sy";_ V PA
L1„ ,, S�F'_4Hi1NS _Q0w;11zk1ct Q t' nll_wG AOORI Ss _ _ °�� =i U1_ �l _. _ _ _. _ . PlIONE _3A
1-1�mcsmtm
Locnnol:.C�R..Cwc g�recT/elec�C_ LIGAI.OPICRIPTIorl\�UCR�SGST—
SEPI Ic TANK:
(A',] H(A NUMIIILIt OF
n
INOM 1Ji_LL_h4 /1"fCRIAL A7i 5Q__._ __. _._COPA I'AH�IM ENIS
Ifi),I�)1 LCNGIII �_. JW, IDL WIOIII �19 LIQUID DLI'lll ���._.I.IOIIID(;AI'ACIrYl%§ GALLONS.
ILL DRAIN 1 1LLO:
TOTAL I_ENG rlI
UI`-•Il,ll<-f_ I I(OM WLLL .. _._-_FOUNDATION_-_--- _-.HLARFS] LOT I INC -- -OF LINE -
ik of LinesO) C)*E—ulsnwce cLTV/LLN LINEs,�1�A--
. -___.IR('NCII Vll f]711J. 6_ IN. -i OI AI FFf�EC71V[.i
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I I I I I I I I L
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OAIL\.\\I�\'�''APPROVLD
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DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 /L/ STREET, ANCHORAGE, HK. 99501
264~4720 ' /6k/f.
1_41EEL.L. FA 01 Now Oil Ivi.10 X -7- EF: k.E, I'll F-- 11-Z.'!
PERMIT NO. ( 771011 )
APPLICANT STEPHENS CONSTRUCTION 945 W. 77TH 344 0664
LOCATION GROYER ST
LEGR� L6 B1 SILVERCREST LOT SIZE 49767 SQUARE FEET
TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS - 4 SOIL RATING (SQ FT/BR)- 125
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
������� �� �����FE L. Es�F"I�� �
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH DR PIT 15 THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
��IGA k.3 1 00 ITE Now NET IF7 10, -1- X C0 -T- 1=0 141 FQ SE , - E���
���ff-'N C:.i't o"I PA' I [L-9 Fs _T_ :I: CIA 01
H PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE/S OPTION SUBJECT TO THE
FOLLOWING CONDITIONS:
1. EITHER H CLASS I OR lI NSF APPROVED PLANT MAY BE INSTALLED.
2. R CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF H MAINTENANCE
AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL
ABSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION.
�.... ........ ....... ... ���... ....... .... ........ ...
���������������
�9-4 Pill �_-� :1 T 1 f1l;IIIE ITIEECTItj AE FZEE&
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 200 FEET FOR R PUBLIC WELL
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
��Hv !1 1 f" ������� ���VE: ��NEE � It AL ,
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]: l UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
\
SIGHED: ........ _...
HPP ac CONSTRUCTION
TqqHPn
�nP 1" 7:"
AND WELLS AS SET
ENLARGEMENT IF THE
` .)M -W DRILLING, INC. '..�
DRILLING LOG
V
�O eve
4
Well Owner 7i tt:n::uus C Stu: C;: ue Gi'ott -Use of Well liot.I.
Location (address of: Township, Mange, Section, if known; or distance main road -
.1 -0
oad'1.o r. 6 10.1.: '.:.'lvrr.cr<ert SUbd. , Anchornf n
Size of casing 6" Depth of Hole 11' feet Cased to--!'() - 1 feet
Static water level it t) ft. (ABM) (below) land surface. Finish of well (check one) open end ( )1• )
Screen ( ); Perforated ( ).
Describe screen or perforation PUA
Well pumping test at gallons per (ho'GY) (minute) for---L—hours with 'J 001 +t.
of drawdown from static level.
Date of completion 12/13/77
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
( TO .i Ctunimpt r.f:f.clatp
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2—STATE
�"M-W DRILLING, INC., k
DRILLING LOG 4�
Well Owner t�- �+ri-t� (nn ;tt i�c�L::i_ot.i. Use of Well,
Location (address of: Township, Range, Section, if known; or distance main road —=
.,t Vt ,)i]2e3i; `i UI)d., . AinclLn)" igc
Size of casing i Depth of Hole 8"; —feet Cased to 60 • / feet
Static water level /, ft. ' ifbo4
(below) land surface. Finish of well (check one) open end
Screen ( ); Perforated ( ).
Describe screen or
Well pumping test at-1_gallons per (hduh-) (minute) for _hours with -I (1 (%,, ft
of drawdown from static level.
1.
Date of completion 2/ 1.3/77
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
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COSA Checklist.docx
COSA Checklist
Legal Description: SILVER CREST BLOCK 1, LOT 6 Parcel ID: 015-062-28
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 12/13/1977 Total depth 85 ft
Cased to 80.7 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 6/13/2024
Static water level at beginning of test 49 ft.
Well production at time of test 4+ gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 6.4 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 6/13/24
Comments
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NA – NEW STEP TANK
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station NEW STEP years
Lift station material HDPE
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) NEW SYSTEM
ALL standpipes present per record drawing
Total measured depth from grade 7.6 ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective (ED).
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) N
If yes, enter date
Adequacy test date NEW SYSTEM
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 – NEW SYSTEM NOT TESTED
Effective depth (per record drawings) 48 in (MOA 4’ ED)
Effective depth used 0 in
Effective depth (ED) remaining 48 in
Comments/Deficiencies: Approximate total measured depths from existing grade.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/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 Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 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 > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private 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
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.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/22/2024
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
8/22/24
0
7673A
0' QROViEFR-DR/Vk�
R=820.00
2
6.32
Yard light (typ) M
Ret. wall (typ
� y �.• . •."L+1 A J'{ i^vas
�Y• N6 yj..bM •. _
�: As a•�i' .•0
.*-�'y' S,,Y{,a•' 'fie,-'� _
1}'ys'S n•,^16�tws•vt.haa•r`g4. .Y^ 3. w•.:'ia yt; a•R'�,:
� ni, •�.. a• Via: 1 .y+•y, Y4•`'. -
..ti.'•'•b+..��. �y `yyr••,,,tt1�+,•'•.:* ! �` fit ,y., •�Y'�•1t•:
J`.�g"Lw+'�r5i.•tas'':.r''a►.:..�•�:;•.`amn• r'�..^«.;,-•<•�.
• ty
..Y �`;.r -i:�•. ��•.•r�l„.y�:4.„,a;.++'� a. Ley, ;��. �a.:;+� :'
+a a:` »+.,Pae`+�,y. tiw.1.•':E ` .,".'1'. y5'^,^21'3�"'•�y�^•'t"i- :, ,.,(
,, � 4 %4'. "'' .•. i, is r : •�-• ; � v i-� ..• y ., r�. ,...--'^%tea.. - • y
o We II e
• �;` Asphalt
MM 25.0 0
N, ti� :. ".. Y• -'a• =..:�=e,
.• ....:... S_00
LOT 6
Planter �`b n .»; •,,r . ^� y:.�;: r
LlJ w. • e..
o ,�? .
{^a ; L CO
1L 0 M
CN**4
deck 0 3.6 40. M o =
15.7 n; 12.0
N r 12.0 =' w SCALE: 1 "= 40'
o— d 2' Chimney co o o 2.3 OH
15.7 25.0 Lot 5
Z coo deck \ ♦ \
Storag deck 2.0 OH ° 4%#p
6 c0 �OF • ;4� 1
Lot 7 Z l
Aw'e)* �.gth0-anhole !— .
O / . . . . . . . • • Veit • •
00
Wood & wire fence
� �, . lizabeth L. Walatka
�s� • - 8036 - LS - • e�
F`,Q 5J AW
eptic ventAW
Fo • • . • • • . • •�,o
pR4FE L 01 �
SS I oNA
RECERTIFIED 8-20-24 \►\\'��8 • •
° AS -BUILT NO CORNE S SET THIS DATE
ood fence
10' Utility Easement
, p11 E 149-90
N85°30�
Lot 8
I hereby certify that I have performed a Mortgagee's inspection
in accordance with ASPLS Standards of the following
described property: LOT 6, BLOCK 1,
SILVER CREST SUBDIVISION
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 15th day of August , 1978.
EASEMENTS OF RECORD, OTHER THAN FRED WALATKA & ASSOCIATES, L.L.C.
THOSE SHOWN ON THE RECORDED FB 24-3, pg 49-50
PLAT ARE NOT SHOWN HEREON Recert 6-14-16 BE Engineers and Surveyors
907-248-1666
UNLESS OTHERWISE NOTED. FB 78-6, pg 2
This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to
establish any fence, structure or other improvements unless otherwise noted. This drawing shall only be used for a single property transaction. Use of this
drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross
negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product.
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R U H!
Municipality of Anch
On -Site Water and Wastewater Progra ':�i \
(907)343-7904
,11' JUN TV 11012
Certificate of On -Site Systems Aprf Val
Parcel I.D. 015-062-28 Expiration D
1. GENERAL INFORMATION
Complete legal description Silver Crest, Lot 6, Block 1
Location (site address) 9246 Grover Drive Anchorage, AK 99507
MA
Current Property owner(s) Hotchkin Revocable Trust Day phone 336-5112
Mailing address 9246 Grover Drive Anchorage, AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
l] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Four
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request
Received by Date:
COSA to be rete a to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5'2 Gd Waiver Fee $
Date of Payment 2 Date of Payment
Receipt Number Receipt Number
COSA# 05C16, -947v Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 6/23/2016
v 49 r
6. DSD SIGNATURE 7./
System #1 Approved for bedrOOmS ® °MICHAEt_Ev,AIVDERSON
g so CE -4381 a=
System bedrooms
Disapproved
Conditional approval for __�L bedrooms, with the following stipulations:®�
By:1� Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet t c
If more than 1 septic system is on the lot:
COSA Checklist # _of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
I
Legal Description: Silver Crest, Block, Lot � G
A. WELL DATA
Well type Private
if A, B, or C provide PWSID
Date completed 11/13/77 Sanitary seal (Y/N) Y
Total depth 85 . ft.
Cased to 80.7 ft.
FROM WELL LOG
Date of test
1 3/1977
Static water level
40 ft
Well production a g.p.m.
WATER SAMPLE RESULTS
Parcel ID: 015-062-28
Well Log (Y/N)* Y
Wires properly protected (Y/N) Y
Casing height (above ground) >12 in.
AT INSPECTION
1/19/2016
38 ft.
10
g.p.m.
Coliform 0 colonies/100 mL Nitrate 4.25 mg/L
Arsenic ND ug/L Date of sam pie: 6/1/16 Collected by:
B. SEPTIC/HOLDING TANK DATA
Garness Eng. Group
Tank Type/Material Septic/Steel Date installed 10/13/03
Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 5/9/16 Pumper Old McDonald Pumping
C. ABSORPTION FIELD DATA
Date installed 11/18/77 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 sF/BDRM System type Deep Trench
Length 44 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 14 ft. Eff. absorption area 528 ft2 Monitoring tube Y Depression over field _N
Date of adequacy test 6/17/16 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 30 in. Water added 861 gal. New depth 42 in.
Elapsed Time: 120 min. Final fluid depth 30 in. Absorption rate , 600 g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
Size in gallons _
"Pump off' level at
Cycles tested _
E. SEPARATION DISTANCES
WELL ON LOT TO:
>100'
Manhole/Access (Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements?
Septic tank/lift station on lot On adjacent lots
Absorption field on lot > 100' On adjacent lots
>100'
>100'
Public sewer main >75 Public sewer manhole/cleanout >100
Sewer /septic service line >25' Holding tank >7�
, ,
Animal containment areas >50' Manure/animal excrete storage areas > 100
SEPTIC/HOLDING TANK ON LOT TO:
,
Building foundation >5 Property line >5
Water main >10, Water service line >10,
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10'
Water Service line >10' Surfacewater >100'
Curtain drain None Noted Wells on adjacent lots >100'
Absorption field >51
Surface water >100'
Water main >10'
Driveway, parking/vehiclestorage >10,
F. COMMENTS
Cleanout at south end of trench is lower than cleanout at north end of trench. Does
not impact the operation of the absorption trench. Absorption Trench is nearly 40
years old.and may be nearing the end of its useful life.
G. ENGINEER'S CERTIFICATION
OFA �
(�......A�
I certify that t have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. * I N FI.
Michael E. Anderson, P.E.
Engineer's Printed Name �........
6/23/2016 � • MICHAEL E.•ANDERSON . 0
�.
Date + CE -4381 .:
COSA brown sheet 10-10-12.doc
GROVE
=v ;:
RIVE
820.00 L=216.32
_.; M
IS,^4_y
rn A o Well
:.c� Asphalt �:.;t_.nn :-�;:,:;;� ;
:g
Cf)' `,sx- "r'1i:;:-+:� 25.0`0
Do
=
N
co LOT 6
E 3.5
W 120
u_ ni
tV deck04 o= 3:5
0' 15.7 12.0 85
o o
N N o 7.90 I m
0 2' Chimney 19.5 0 �- X25.3
:4
Lot 7
CO° deck
a
a
10' Utility Easement
..or-°,inVnn"E 149.90
Lot 8
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED FB 78-8, pg
PLAT ARE NOT SHOWN HEREON,
�P�� OF • qL�s �,
�r
s* 49th00 .
00 00
/ 1°9 .Fred Walatka:
3255 - S
2�' 'rES510NA� 4%, BE
_W
A
N
2
Lot 5
7673A
SCALE: V= 40'
RECERTIFIED 6-14-181w,
\ AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have perloneed a Mortgagee'sin
Anchorage Recording PrecinctAlaska and that the
Improvements situated thereon are vnthin the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as Indicated
hereon
Dated at Anchorage. Alaska
this 15th - dayof August 1978
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
MUNICIPALITY OF ANCHORAGE
0*
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. #f 01 S—' 0 6 1 — a- V � HAA # A-.
1. GENERAL INFORMATION
Complete legal description Lot 6, Block 1, Silvercrest S/D
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing
Agent
Address
9246 Grover Drive
"Nova Pearl Day phone
9246 Grover Drive, Anchorage, AK 99516
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: _ 4 �
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
Day phone
Day phone
/.7 J (:1-4 u—
261-7224
NOTE: If community well system, provide written confirmation frorn State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL.:
XXX
Individual on-site -
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (H.V. 1101) Front MOA N21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm 5 & s ENGINEERING
Phone b 9 q -;-ct 79
Address Eagle River, Alaska 99577
Engineer's signature
6. DHHS SIGNATURE
—L/ Approved for FO vR bedrooms.
Disapproved.
Conditional approval for
Additional Comments
M
Date 6/IS /clq
E OF
moo' ROBERT C. COWAN
c CE -8807
bedrooms, with the following stipulations:
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineers work.
72-M (Rev. V81) Rack MOA p1
RECEIVED
Municipality of Anchorage JUN' 18 1999
DEPARTMENT OF HEALTH &HUMAN SERVICES
Environmental Services Division MjjNtCjp4kUiY OF ANCHOR
ce*3WES Di
825 L Street, Room 502 • Anchorage, Alaska 99501 • (6"W-Jry'4V
Health Authority Approval Checklist
Legal Description: t -o i G 13 L O C K / S /L. v rcA, CA645 r '/Parcel I.D.: (91 5- — 0 G a- X%
A. WELL DATA
Well type P I"3 T`< If A, B, or C, attach ADEC letter. ADEC water system number
Log present &N) _y4-1 Date completed 1 3 % 7 7
Total depth $ � _ Cased to _ 2 0 • 7 _ Casing height (above ground)
Sanitary seal &N)
Date of test
Static water level
Well production
FROM WELL LOG
II �13/77
L/ o
WATER SAMPLE RESULTS:
Coliform
v
6
Wires properly protected &N) _ Y4 S _
AT INSPECTION
S' y
g.p.m. i . 9 g.p.m.
Nitrate ") • G 7 Other bacteria
Ed
Date of sample: //0 `� °l _ Collected by: S & S ENGINEERING
17034 Engle River .00nTTiTlC� B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577
Date installed it // g /77 _ Tank size 1 aY Number of Compartments _- Cleanouts 02VN)_
Foundation cleanout (2)N) Y& S _ Depression (Y)o N High water alarm (Ya
Date of Pumping _ 4 meq_ Pumper I SS 9 L S
C. ABSORPTION FIELD DATA
Date installed 11 1 Y 7 7
/
Length -Width.
/v U
Soil rating (g.p.d./tt2 orft2/bcF!_ Y �� System type
3 __ Gravel thickness below pipe _ 6 Total depth _ ) I
Effective absorption area 6'6 g' rr'LMonitoring Tube presente/N)`/—iJ Depression over field (YAt /' u
Date of adequacy test G %/ o/ q q Results &OFail) P d S f _ For Ll bedrooms
Fluid depth in absorption field before test (in.); py_ Immediately after i ft gal. water added (in.): 1 0 '/X
Fluid depth $ _ (ins) Minutes later:—?, I _ Absorption rate = (9C) n f g.p.d.
Peroxide treatment (past 12 months) (Y/N) /`' 6^ 4, tz Nou,.i If yes, give date
72.026 (Rev. 3/96)'
D. LIFT STATION
Date installed
Manhole/Access (Y/N) "Pump on"
High water alarm level at* l *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot too
Size in gallons
O "Pump off' level at*
On adjacent lots
Absorption field on lot J00 + On adjacent lots
Public sewer main Public sewer manhole/cleanout
/
Sewer /septic service line S + Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation /(3 + Property line / 0 Absorption field
Water main/service line /0 + Surface water/drainage 100 Wells on adjacent lots
N JA
S`
10 0 -}
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line 10 4" Building foundation 3 0 —1- Water main/service line ) C
Surface water % t) 0 "4- Driveway, parking/vehicle storage area S 0 -t
Curtain drain Na, KNo� )"J
F. ENGINEER'S CERTIFICATION
i
Wells on adjacent lots / 00
1 certify that / have determined thru field inspections and review of Municipal
in conformance with MOA HAA guid7,,, in effect on this date.
Signature t✓��
Engineer's Name a 9 C o tv/9,.�
Date / / 8 / clq
HAA Fee $ d p o
Date of Payment 0 d
Receipt Number 07
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
I ROBERT C. COWAN f Q-
�c3.ti CE -8807
are
—�'----�
APPOINTMENTS
DA'I`E RECEIVED
INSPECTION
TIME TIME
TIME:
DATE -
DATE
�
�-I —11 • aLr VaIL.t.LA.$
INSPECTOR
INSPEC O
INSPECTpJ` �l1
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE
DEPT. OP I:': LTI1
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE%RRONMENIAL i., ;iLCTION
825 L Street - Anchorage, Alaska 99501
APR I INK)
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-477.0
����,/���
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND
SE LI
DI 11 ECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. FRjO�PERRTTY�OWNEiR
PHONE
MAIL NGQDDj2 ES�/�
PROPERTY RESIDENT (If dif�rt from above)
PHONE
—
---�--�— -- --
2. BUYER
P HONE
MAI WNG ADDRESS
3. LENDING INSTITUTION
PHONE
MAILING ADDRESS
4. REALTOR/AGENT
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION `— ---i--- —v
STREET LOCATION
6. TYPE. OF RESIDENCE NUMBER OF,BEDROOMS
SINGLE FAMILY
El One � Four El Other
❑ Two ❑ Five
❑ MULTIPL.E FAMILY ❑ Three ❑ Six
-------- ----- —
7. WATER SUPPLY
X 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 v— depth (attach log if available.) -- --
8. SEWAGE DISPOSAL SYSTEM —
A INDIVIDUAL/ON-SITE** 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)
�� V
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
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER
-yl„
❑Septic Tank or ❑ Holding Tank
SizeIf Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELLTO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
APPROVED FORBEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY
72-010 (Rev. 6/79)
April 18, 1980
William G. Basham
Star Routo A Box 77,17
Anchorage, lahba 99507
Sutioct, plot G Block 1 Silvorarest Subdivision
Approval for your individual sewer and water facilities
can not be grantV untilt:tho following items have been
(1) Tho Water analysin rupor.t be delivered to this
office from Chow Lab, 5633 B atroet, for our.
review.
(2) The septic tank pumped with a rocApt submitted
to this office.
Xf t.hore are any further questions, please contact thN''
offiue at 264-4720.
sincerely,
Robert C. Pravt, R.L.
Associate 5peci:alist
acr/ljw