HomeMy WebLinkAboutGATEWAY TO THE PARK BLK 1 LT 20A Onsite File
Gateway to
the Park
Block 1
Lot 20A
#067 - 611 - 22
At time of COSA , well in driveway will
need to be addressed .
SUBMITTAL
APR 04 2918
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP 16 197 PID Number: 06761122
Dwelling: 1 Single Family(SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New El Upgrade
Name: ABSORPTION FIELD
RANDALL AND CYNTHIA HOFFBECK
Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
1808 MOUNT YUKLA ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 -- GPD/SF -- Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot -- Ft.-- Ft.
GATEWAY TO THE PARK 1 20A Fill added above original grade Gravel length
Township Range Section __ Ft. -- Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES -- Ft. -- -- Ft.
MI
Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
Lift Station
Tank Field --Tank Line
From Ft2 -- --
Ft.
Well +100 -- -- -- --
TANK El
Septic ❑S.T.E.P. ❑Holding 0 Other
Manufacturer Capacity
Surface Water +100 -- -- __ ANCHORAGE 1250 Gal.
Material Number of compartments
Lot Line +5 -- -- NA STEEL 2
Foundation +5 __ __ __ LIFT STATION
Manufacturer Capacity
Curtain Drain +50 -- -- -- -- -- Gal.
Remarks
OLD TANK DISPOSED OF IN PLACE Pump on level at Pump off level at High water alarm at
PER CODE -- in. -- in. -- in.
TANK REPLACEMENT ONLY Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034Tank to 3034
Installer drainfield
GUARANTEED SERVICES Drainfield UNK CO/MTI 3m3
Inspector CHARLES BALZARINI BENCH MARK (Assumed elevation) 1.7O ft /
Inspection 1St 69474 2nd Location and description
dates:
3rd 4' BOTTOM OF SIDING NEAR FCO
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL = 1,1c.:, p ta�c11 II 6
Conditional Approval: Date ''•4.9 T y#j
•
�
,$ Charles G.Balzarini ;
�Q�
E 138 ' �'m
10/5/j-
0 5 '� ��``r FESStO.' may
Approved Date //
Inspection Report_9-1-12.doc
SZRUCTURES OBSERVED \ \
,,�of��• �s>>�
DRp1NAGE �P•
Nt (NO SURFACE wAZER OR �.• it,
20 0RA1NAGE EASEME
SWING TIES /A
A @
c 43.2 ss.a
i ►'AR ALZARIUI /
NEW / F •, 1385 .
1250 GAL SEPTIC #4 .4p.••%•/ •�4 A;I:
TANK GATEWAY TO THE PARK
BLOCK 1 LOT 20A Ik D PROFESS\O
w NEW AFTER TANK • A‘‘‘‘,7% —��
§ I CLE ANOUTSut
��••� �
a'
(E) SEWER
1\ LINE
•
co\ A 3 BEDROOM w
\I D� EXISTING
HOME v
p� `� TRENCH 6
\ `may C. Y
F \ \ WELL 1 I
` I
I-
,., \ \11111111111111 Rgoais
DRIVEWAY
(APPROX)
GATEWAY TO THE PARK
BLOCK 1 LOT 19
(UNDEVELOPED)
&1 Li c I
7 BENCHMARK: 100'
BOTTOM OF SIDING
NEAR FOUNDATION
CLEANOUT
GROUND ELEVATION 99.3 .
+/- 4.2'
COVER
INEW 1250 GAL
TANK
94.77- \_ V 94.37
90.1 90.1
ELEVATIONS IN FEET RELATIVE TO ASSUMED
BENCHMARK ELEVATION OF 100'.
SCALE: NTS
LEGAL DESCRIPTION: GATEWAY TO THE PARK BLOCK 1 LOT 20A
C&M ENGINEERING SERVICES OWNER: HOFFBECK DATE:8/31/17 REV:O DRAWN: CB REF:
907-854-5558
RECORD DRAWING
On -Site Water and/or Wastewater 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: OSP161287
Tax Code Number: 06761122000
Work Type: SepticTank Upgrade
Permit Effective Dates: September 30, 2016 to September 30, 2017
Design Engineer: C & M Engineering
Subdivision: GATEWAY TO THE PARK
Site Legal Address: GATEWAY TO THE PARK BLK 1 LT 20A G:1005
Owner/Address:
HOFFBECK RANDALL J &
CYNTHIA A WANNER 1808 MOUNT YUKLA CIR EAGLE RIVER AK 995779729
Site Mailing Address: 1808 MOUNT YUKLA CIR, Eagle River
Lot Size in Sq Ft: 40893
Total Bedrooms: 3
This permit is for the construction of:
N 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.
Special Provisions: FYI: The well located in the driveway will need to be addressed prior to future
OSAs.
Received By:
Issued By:
__--on Date: 10)J2— /6
CDate: 1731)/.20I (P
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Phone: 90
Fax: 907 -
ON -SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 067-611-22
Property owner(s) RANDALL AND CYNTHIA HOFFBECK
RUSH!
SEP 2 9 201.3
3�1�i
-7904
Day phone 694-2001
Mailing address 1808 MT YUKLA CIRCLE
Site address 1808 MT YUKLA CIRCLE g'\
Legal description (Sub'd., Block & Lot) GATEWAY TO THE PARK L20A
Legal description (Township, Range & Section)
Lot Size 40,893 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
(® all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
APPLICATION 1S AN:
Initial
Upgrade
Renewal
TYPE OF DWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D)
Multiple Dwellings
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
X❑
E
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable M e;cipal Codes.
GNa RISS t3A-LZ4 Rz PZ at/2_7/ l -
(Signature of property owner or authorized agent)
Permit/Rush Fees: 63 Li • 0
Date of Payment:
Receipt Number:
Permit No. OSPI (01217
Permit App__-
Waiver Fees:
Date of Payment:
Receipt Number: -
Waiver No.
You created this PDF from an application that is not licensed to print to novaPDF printer (http://www.novapdf.com)
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System Repairs for Gateway to the Park Block 1 Lot 20A.
Dear Reviewer,
The above referenced property is currently served by a 3 bedroom septic system. The existing tank has
collapsed and is in need of emergency replacement. We are requesting immediate approval to replace
the existing tank with a new moa approved 1000 or 1250 gallon steel septic tank, as soon as possible.
All work shall be completed in accordance with MOA standards and the following Specifications:
The existing tank will be pumped and disposed of properly, in accordance with moa requirements. The
new 1000 gallon tank shall be of MOA approved construction with two 4" cleanouts. The tank shall be
installed level, and within the excavation created by removing the old tank. The bottom of the excavation
shall be leveled and compacted sufficiently to prevent settling of the tank. The new tank shall be insulated
with no less than 4' of cover, and the manufacturer's maximum burial depth shall not be exceeded. The
ground surface shall be sloped to prevent ponding.
Dual after tank cleanouts shall be installed within 5' of the new tank, between the tank and leachfield.
The new tank shall be installed in accordance with the separation distances required by 15.65.050A. The
tank will be installed:
Greater than 5' from the property line, building foundation, and drain field.
Greater than 10' from any water main or service line.
Greater than 100' from any surface water.
Greater than 100' from any private well, and greater than 200' from any public or community well.
A record drawing will be submitted after the installation of the new tank.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini(Wamail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
4-
� I\
o I
V 'a
EXISTING
TRENCH
TO REMAIN
I\ V
\\
100' NEIGHBORING WELL RADIUS
SEPTIC AREA
t
GATEWAY TO THE PARK
BLOCK 1 LOT 17A
Sr." WA'IF.R OR ORlanik B/ ,/
SEMENT (NO /
GE EA / /
20' OftAlTa
CONTRACTOR' MAI.--
REPGCE (E) 90 W/(2) 45'S
/ /
NEW 1000 GAL OR
1250 GAL SEPTIC
TANK
NEW AFTER TANK
CLEANOUTS
I RGFND
O CLEANOUT
• MONITOR TUBE
TEST HOLE
0.5% \ SLOPE INDICATOR
NEW CLEANOUT
SWEEP TOWARDS
90
(E) SEWER
LINE
GATEWAY TO THE PARK
BLOCK 1 LOT 20A
k
GATEWAY TO THE PARK
BLOCK 1 LOT 19
(UNDEVELOPED)
DRIVEWAY
(APPROX)
%vs
NOTES:
1. THE PROPOSED SEPTIC SYSTEM IS GREATER THAN:
100' FROM ANY PRIVATE WELLS
200' FROM ANY PUBLIC WELLS
100' FROM ANY SURFACE WATER
50' FROM ANY STEEP SLOPES
10' TO ANY PROPERTY LINE OR FOUNDATION
5' TO ANY TEST HOLES
= an'
C&M ENGINEERING SERVICES
907-854-5558
LEGAL DESCRIPTION: GATEWAY TO THE PARK BLOCK 1 LOT 20A
OWNER: HOFFBECK DATE:9/27/15 REV:0 DRAWN: CB REF:
SITE PLAN
r
• MUNICIPALITY OF ANCHORAGE
•; DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
*,. 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
gP'r l Al- L_ 1--LTrFgtc...K
PHONE
Z( -(77j
MAIM
DuPGRADE
MAILING ADDRESS
03 (o l r-1, STN AVE- ,41 J C AUF.-A tcy
A 1C. 4, 90_S /
LEGAL DESCRIPTION i
LC,—r 2..o A S u< . J �7 ArrE V/ -ru
T1-t� P�'.[_K
LOCATION
NO. OF BEDROOMS 3
VY
DISTANCE TO:
Well/O3 /
I A�ption 7 /
/7�
Dwelling 347 i
PERMu 1�0_ 14s_
f�
W Q
WF
Manufacturer /+
(�
/eei
Mat 'apja 1 _
No. of compartments
w
Liiq {xy-jp gallons
���f�
IF HOMEMADE:
Inside length
Width
Liquid depth
....--_
Y
DISTANCE TO:
Well
�
Dwelling
PERMIT NO.
=002
Z
Manufacturer
/
Material
Liquid capacity in gallons
TILE
ChD
TRENCH
DISTANCE TO:
Well /ori /
Foundation/
Nearest lot line /,.
Sti
PERM O ex
b `between
No. of lines /
Length Witte
7Q
"
Total lents
Trench wig
t JL J inches
Distance
/
Top of tile to finish grade /
Material beneath tile
60 inches
Total ve area
11✓//
W
Length
Width
Depth
PERMI NO.
4a. H
ud
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
co
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class�� /Depth
��
Driller
Distance to lot line
PERMIT NO.
i
DISTANCE TO:
Buddi fou
Sewer line
Septic tank
Absorption area(s)
OTHER
may'
D
-5A
PIPEMAJ R
tut.-
.
pee,
SOIL TEST RATING ,....d
/5-0°7‘ �A
IN
vim`
,`
�V
INSTALLER
sroeaG7701./k
0�
Q�
REMARKS
"
C_O. co/ �f�irJ CY EIVI1//UL
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01S-7; .
c�
pit
jg
dA/
-.,"
4E
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1t
I
/07
* �A ,�•
..._.
MUVIdPALRY of f 4rod w: . _
:.1' A. SWIM
'
Dir,. a H&J.
B.MRONMEMAL • • • ' ' : No- la" �€
IE
% �
AU6 31964 �F��.,r
RECEIVED
Ar61.E
j)Vtic
Q6AO
APPROVED 8 8 a ENGINEOUNG DATE
r AKA W577
z&f/34/
R"11..lfi'+i I G I L I TY OF J=ersiiinwarilm&
DEPARTMENT -OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK( 99501
264-4720
ON—SITE SEWER AL WELL- PERM I T
PERMIT NO:
'DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
840465
06/15/84
RANDALL HOFFBECK
8361 E. 5TH AVE.
ANCHORAGE, AK 99504
264-6776
SUBDIVISION:= LOTAM, BLOCK :
SECTION: 9 TOWNSHIP: 13N RANGE: 1E
40893 (SQ. FT. OR ACRES)
3
LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC
SYSTEM. CHOOSE THE OPTION THAT c IT5 YOUR SITE.
DEPTH TO PIPE BOTTOM (FT. )
GRAVEL DEPTH (FT.)
TOTAL DEPTH (FT.)
GRAVEL WIDTH (FT.)
GRAVEL LENGTH (FT.)
GRAVEL VOLUME (CU. YDS. )
TANI( SIZE (GALS)
SOIL RATING (SQ. FT. /BR)
T-EFtiICH
4. 0
5. 0
9. 0
2. 5
45. 0
22. 9
1, 0800 **
150
** TANK MUST HAVE AT LEAST T
0 COMPART
TS
BEO W. C?FZA I itis
5.0 4.0
0.5 3.5
5.5 7.5
19.0 5.0
36.0 49.0
25.3 36.2
1, 900.0 ** 1, 008.0 **
150 150
I CERTIFY THAT:
1. I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOR) AND THE STATE OF ALASKA. '
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3: I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND
ANY ENLARGEMENT WILL REQUIRE RN ADDITIONAL PERMIT.
IF R LIFT STATION IS INSTALLED IN RN AREA COVERED BY MOR BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN:
SIGNED
APPLICANT: R HOFFBECK
ISSUED BY
DATE:
DATE 40CPY
Otrifirb!rilting
DOC Co. dba
MILLIVAVWATER WELLS
P. floc 272. CHUGIAK,ALASKA 99567 • TELEPHONE 668-2759
W`NER OF LAND "14,44
DDRESS �' >
I
DEPTH OF WELL C? OO . i.1 N re.
STATIC LEVEL OF WATER FT
EGAL DESCRWTION AR G I rfH'',-00 7 TSE /4F4iCDRAW DOWN FT
ATE -stated 7/-1,fy Ended
%ri
ERMIT NUMBER 1411 Ut i , ler t` -',k
GALS. PER HR 4°6
KIND OF CASING 6 4- o9
IND OF FORMATION:
om 0 Ft. to Ft f%+ 46'-x=`l= "' From Ft to Ft
-om 71 Ft. to 9-3 FL C,t,,�t `�4#4'.d • ` From Ft to Ft.
,I
rom Ft. to ft. uL't 6f'X c - From Ft to Ft.
r
rom /S Ft to Ft. 1.-%.:Y.1-41., c.e.-A--;t- *,5' From ArtLite;CIPALDY
DEER HEALTH
rom Ft. to Ft CG From Ff. RONMENj PROTECTION
6S -it. C441. r ,.40,4-0,e... From Ft. to_�-`'�FI 2
rom .2/ Ft. to 1985rom rN Ft. to r TJ Pt. s..(14.44 �Q `'6 4 . 4.4"9 /From Ft. to�' • V. ��
rom Ft. to Ftp From Ft. to
rom 14r Ft. to /4=:"1- Ft. 11"'.1 6.2 A st 5,2_ From Ft. to Ft.
rom Ft to Ft r - w"4re--2._ From Ft to Ft.
rom - Ft to 3'r 1 Ft. 2 e of — . { Ada "'/4 From Ft to Ft ��
rom Ft to Ft From_ Ft to Ft 'c44C�
rom Ft to Ft. From Ft. to Ft
f
rom Ft. to Ft' From Ft to Ft
rom Ft. to Ft. From Ft. to Ft.
:om Ft. to• Ft. From Ft. to Ft.
rom Ft to Ft. From Ft. to Ft
€ ISCL. INFORMATION:
4
DRILLER'S NAME-'-
MUNICIPALITY OF ANCHORAGE
[] PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
I
/
f
/
11
WAS GROUND WATER )~ SL
ENCOUNTERED? O
12
13-
IF YES, AT WHAT
DEPTH?
14-
15-
16-
17-
18-
COMMENTS
PERFORMED BY' 8 ~1~ 8 ~
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
r AND
(minutes/inch)
~ FT
z•
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
Application Date 2- Z —
1. General Information
a) Legal Description (inc�l de lot, block, subdivision, section, township, range)
1
Location (address or directions)
Gtas 7 ''d ry t r G eti✓ yrs rWin.f u /—S 7,46444co a
(b) Applicants Name moi, L / Tele hone - Home
Applicants Address 2- 1, J % '
Business
(c) Applicant is (check one) Lending Institution ; Owner/builderlc ;
Buyer) I ; Other (explain);
(d) Lending Institution fJ : . Telephone
Ad3i*ss
(e) Real Estate Co. & Agent A.,'u
Address
Telephone
(f) Mali the HAA to the following address:
S,5 S l< ee2/7Z/
2. Type of Residence
Single-Familyfxr Multi -Family Other (describe)
Number of Bedrooms `3
3. Water Supply
Individual Well Community n 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 Disposal
Onsite Public Community Holding Tank
1 1
l
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]
5. Engineering Firm Providing Inspections, 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 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 regula-
tions in effect on the date of this inspection.
Name of Firm
Address -
.J ..
S.e :�
V i�11� 1J'rtr'l�
h, _/ `r..:J:�
^•
Date 2
6. DHEP Approval
Approved for
Approved
uf AL ‘to
Telephone
bedrooms
Disapproved
Terms of Conditional Approval
Conditional
Date -2///
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY 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 MTD 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]
7-19-84
A. WELL DATA
Well Classification e"vli', If A, B, or C, D.E.C. Approved(Y/N)
Well Log Present ( Date Completed
Total Depth 242 ( Cased to 20 o r Depth of Grouting
Static Water Level /3 `f Pump Set At u
Casing Height Above Ground Z 44 `` Sanitary Seal on Casing
Electrical Wiring in Conduit (Y Depression Around Wellhead (Y
Separation Distances frau Well:
To Septic/HblA4pug Tank on Lot /0,3 ; Cn Adjoining Lots /00 f
To Nearest Edge of Absorption Field on Lot /62-7 ' ; on Adjoining Lots /00 /
To Nearest Public Sewer Line f11`4 To Nearest Public Sewer
Cleanout/Manhole
.% / t To Nearest Sewer Service Line on Lot Z5 r�
Water Sample Collected By S,' S ljJy 4leni`l, ; Date 2/01/61)--
Water Sample Test Results ,�� 7/ s',�. c 72,7? 7-,
Comments Al s /s7f'
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
LZof4 eC- c
-/4 71E" THT ,ie.< ,S"/j9
Yield-0_y�.,
B. SEPTICS TANK DATA
Date Install -d �/g 'f Size OC7c7 No. af Compartments 2_
Standpipes(v/N) Air -tight Ca. /N) Foundation Cleanou 1/10)
Depression over Tank (Y( Date Last Pumped A --)e.
Pumping/Maintenance Contract on File ( A- ; for
Holding Tank High -Water Alarm (Y/N)N /" Temporary Holding Tank Permit
Separation Distances from Septics -Tank: i
To Water -Supply Wail /03 ` To Building Foundation --3
To Property Lire /0 To Disposal Field // r
To Water Main/Service Lire sO To Stream, Pond, Lake, cr Major Drainage
(Y/Ni6,4
Course A! nl E
Comments
2>0 ik-IE
Receipt # 333 7 +
Date Paid:
Amount: �{ ��-
(Page 1 of 2)
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Abs tion S ata
Date Installed O y/
Width of Field 30
/!5() ,/Q Type of System Design 75'.'7C
Square Feet of Absorpti
Depression over Field
Length of Field 44S f
Depth of Field
Gravel Bed Thickness D7 `/
Area V..Z Standpipes Present (Y )
Results of Last Adequacy Test
/c/0 Date of Last Adequacy T1st Ne (.<J
Separation Distance from Absorption Field:
To Water -Supply Well /D r% " To Property Line /0 /
To Building Foundation ' To Existing or Abandoned System
Lot ,AJ r - E ; On Adjoining Lots /0 0 7t
on
To Water Main/Service Line /a To Cutbank(if present)
To Stream/Pond/Lake/or Major Drainage Course
A.) o
To Driveway, Parking Area, or Vehicle Storage Area
Comments /v D n / F
D. LIFT STATION
Date Installed
Sime in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
le Access (YEN)__
f vel at
nt (Y/N)
Electrical Codes(Y/N)
Comments
Pumping Cycles during Adequacy Test. Meets MDA
** **
Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified,
on the date of this inspection.
Signed
8 & : E GINEERINQ
ono 130X
Company C.2LE RIVER. ALASKA a'577 MOA No.
or conformed
to all
Date 2—?--d2.-
KB1/d5/s
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P14. 691 21370
MOA HAA Guidelines in effect
2-15-84
