HomeMy WebLinkAboutATELIER #1 BLK 2 LT 8A
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ..~_~Y./q~ O-o .~/~ PID Number:
"~: Wastewater System: D New ~Upgrade
Address: ~
~Ol H~~ ~ ABSORPTION FIELD
Phone: INo. o~rooms: ~eepTrench ~ShallowTrench ~Bed ~Mound ~Other
L E G A L D E S C R I PT I O N so,, .~,~.~:
Township: I Range: I S~llon: Fill added above original grade: Gravel length;
WELL: D New D Upgrade Gravelwidth: ~ I Ft Numar Of~ lines: .~O'sta~li~:~
)r,ller: Oate~r,lle~: Stahcwater~evel:Fi Instalie~ ~atelmsall~:
SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P.
Well I~ ~0 Material: ~ Numar of Com~dmenl,;
Surface
w~, ~/A H/~ LIFT STATION
LOt Size in gallons: ~ Manufacturer:
I
Remarks: BENCH MARK
Assum~ Etevation:~ ~
ENGINEER'S SEAL
Inspections performed by: ~- Dates: 1st
Department of Healt~d Hu~~ces apprqval ¢~:.;~'['.~ :~:..-~'~
Reviewed and approved Date' ~L,
I
I
£DU£LE CLEANDUI'S
BULL £UA~ y2IVE£SIDN VALVE
1994
INSTALLEB
N
§0 ?S I00 IP$ 1.50
SCALE; 1' = 50 FT.
TOBBEN 5PU~KLAN~ P,E.
203 W 157H. AVENUE
ANCH. AK, 99501
SEPTIC SYSTEM AS point
DATr', MAI2CH P~, 1994
SHEET, gl3 GRID g/42
9IVERTER VALVE
°°
I000 gat Septic tank v~~
Anchorage ronk
EXISTING TRENCH
Standard Trench
6£.$' Long
18' ~eep
8' Se~er rock
4' Cover
Miro Fi 140
8 Ft oF Septic Rock
Under Pipe
Monl~or %
4' Topsoil %
~4' C°ver ~ ~?~. ~
93.2 ~.L ' '.. r ~"m=T~J~ ' 4,33
84.2i-' " ' --~84.5 ~
NB SCALE
79
lO00 gat. septsc, tank
TDBBEN SPURKLAND P.E.
203 ~lSth Ave
Anchorage Ak 99501
LO[ BA 3LOCK 8 ATELIER
7201 MONTANGE CIRCLE
£[CHARD HILL
~ARCH 2~ 1994
2/3 6~ID, 2/4P
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940056
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:HILL CASSIE J
OWNER ADDRESS:ANCHORAGE AK
DATE ISSUED: 3/22/94
EXPIRATION DATE: 3/22/95
PARCEL ID:04103142
LEGAL DESCRIPTION: ATELIER #1 BLK
2 LT
8A
LOT SIZE: 61420 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT:
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ISSUED BY:
SF'LIF(~=~LAND F'_ E{ -
205 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
1907) 279-~916
Fax (907)-276-6015
SEPTIC SYSTEM DESIGN
LOT' 811~ BLOCK 2 ATEL ].ER
RICHARD HILL
No Ground Water or Impervious Layer to 18 ft.
Use Standard Trench
Soil Rating. From test March 7, 1994
60 min/in = 0.45 gat/sq, ft. day
Required Area per Bedroom:
150/ 0.45 = 333.3 sq.ft..
Number of Bedrooms: 3
Required area: 3 x 333.3 = 1000 sq. ft.
Ground Surface at Absorption Field 3 feet
than ground at tank. '¥ap.k outlet 5 feet
ground.
I ower
under
Testhole Total Depth
Less 6 feet
Less 3 feet Cover
18 ft
12 ft
9
Use 8 -Feet of Rock
Length of Trench 1000 / 2x8 = 62.5 ft.
SYSTEM CONFIGURAT ION
STANDARD TRENCH
TOTAL, LENGTH
TOTAL WIDTH
TOTAL DEPTH
ROCK DEPTH
COVER
62.5 FT.
2 FT.
12 FT.
8 FT.
4 FT.
INSTALL BULL RUN DIVERSION VALVE
INSPECT EXISTING SEPTIC TANK,
REPLACE IF REQUIRED
The installation of this septic system will not
from be installed on the adjacent lots.
prevent ~el 1 s
There are no developed or natural surface / sub surface drainage
courses on this or the adjacent lots.
l'he proposed septic system will not change the general slope of
the area. Ponding and/or concentr'ation of surface runoff will not
result from this installation.
F::' (ii) ,, 1
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ~.,.0'"~
~'"i' F--. L I F---. ~-,.,
4-
5-
6-
7-
8
9
10
11
12
13
14
15
16
17
18
20.
COMMENTS ~ '~'~"'~r~'~
Township, Range. Section:
WAS GROUND WATER
ENCOUNTERED?
SLOPE SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
: ~o ~o Io'1~
PERCOLATION RATE ~
TEST R. UN BETWEEN ~,~ I/~.
__ tm~nutesnnch) PERC HOLE DIAMETER
FTAND '~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-(308 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:' 8,
LDTS~
LOT 6~
LDT ~A ~
SCALE, 1' = lO0 FT,
IDBBEN 5PURKLAND P.E.
E03 ~ 15TH. AVENUE
ANCH. AK. 99501
SEPTIC SYSTEH DESIGN
DATE, 8fI~RCH 4, 1994
SHEET, I/3
I
!
EXISTING TANK
_~ULL £UN £IVE£$ION VALVE
I{ EXI£T. T£ENCIt
ALL $1ANDPIPE$
SCALE; 1' = .50 FT.
125 150
[UBBEN SPUNKLAND
~03 ~ 15TH, AVENUE
ANCH. AK. 99501
LOT 8 BLOCK
SEC. 6
SEPTIC S¥STE~ DESIGN
DATE, /tA~CH~ 1994
SHEET, P/3 GRID, ~14~
"~ ........... "-~/ ND SCALE
EXI$[1NG TRENCH
Stondord Trench
6P.5' Long
12' £eep
8' Se~er rock
4' Cover
ND SCALE
[DBBEN ~PURKLAND P.E.
203 WlS~h Ave
Anchorage Ak 99501
LOT 8A £LDCK 2 ATELIER
7P81 14DNTANG£ CI£CLE
RICHARD HILL
NARCO O, 1994
G~, pI4B
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
PHONE I [] NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
'J Well I Absorption ,rea Dwelling / PERMIT NO.
~ Z Manufacturer ~ Mater~,~ ~ No. of compartments
Liq. capacity in gallons Inside length Width Liquid depth
/~O~ IF HOMEMADE: ~
kiquid cap~ in ~allons
0 ~ ~ Manufacturer Material
Foundation ~earest lot line t
~ DISTANCE TO: Well /~O¢ ~ /O+ /O ~
~ ~ N°'°flines,~ / Length°feachl~ T°tallengt~in~ Trenchwidt, ~/~O inches Distance between lines
~ ~'~°P of tile to finish grade ~ ~ Material beneath~rt ~ ~ t7 inches Total effective~absorption~ f area
Length Width ~epth PERMIT N~. /,¢& ~
b Typ~ of. C~ib di~t~ Crib depth Tota~ ~ff~tive ~b~ o. ~e~ c.~ ~/,_q/¢¢- .~
/ Building foundation Nearest lot line~
~ DISTANCE TO:
~ Class~ / Depth Distance to lot I~e~ PERMIT NO. _
" DISTANCE TO: ,uild,n. fo~at~ S.~o'l,ne ~ Soptic t.nk ~ Absorp~ar~
OTHE~
PIPE ~ATERIALS
Pt~ ~,~ ~7 ,~ ~
SOIL TEST RATING
INSTALLE~
,
, ~ , I~/ ~ ~,.
, . .~...~ ~.~
APPROVED DATE LEGAL -
72-013 /78) ~'~-- ~0~
DE:PIqRI'ME:I'.,IT ,....,.. I-1EFII_TH I::IND EI'.,I',,,' I RONMENTFIL , ROTECT I ON
',:3;..}]5 L. :?'FREI:lT., FINCHORRGE., RK
264-4'?20
PERM I T I'.,10:
[:,FIT E .1: S:E; U Et.'.:,:
H.'2'~ ~"-41 ....... :~;; % '-'If'"
~---
0 5,...' 0 :Z.: ,.., ,_~a4__~
FIFIF-'L I C':f":INT:
R D L'." R E S'.'.-.]:
coNq"F:IE:T PHOI",IE::
CL.. I F'T ON R E:E NNE T'T
2.8]: MUL.[:'OON
FIt",ICHORRGE., FIK .9:~':'5 C'~4
I.. E G Iq L. [:' E S C': R t P:
L. OT :.5 t ZE:
L. CFT LOC:AT I 01'.,t:
SI..Ii::]:D I ',,,' I S I (]N: FI"FEL I ER .t~::l.
SEC:TION: E; TOWNSHIP
E;:t. 42E~ (S6! FT. OF.: FICF.:ES ::,
MOhlTFtGNE B, RI',/E
LOT: 8Ft
RFINGE: 2[,4
BLOCk:: 2
I C:ERTIFh" ]"HI=IT.
:1.. i FtM FFIMIL. II:qF.: 1.4ITH THE REQUIREMENTS FOF.: ON-SITE 5ENER,'5 I::IND [4EL.[.S FIS SET
FOF.:T[.i E:'T' THE MUhlICIPFILIT'¢ OF FII"iCHORFIGE (MOFt) FIN[:, THE STFITE OF FILRSKFI.
;.-]:. I t.4ILL iNSTFtL. L THE: SYSTEM IN FICCORDFINCE $'IITH RLL MOR CODES RND REGULFITIONS.,
FIND, IN COi"ff:'I._IFINCE WITH THE DESIGN CRI'TERIFt OF THIS PERMIT.
].. i I.'.tILL. Ft[:,HERE 'TO FILL MOFI FIND, STFITE OF RLFISKFI REt.';!UIREMEI'iT'S FOR THE: SET BFICK
t:::,ISTFtlqC'.[i.:.'.:; I::'ROM FtN'T' EXISTING 1.4ELL., WFISTE[qRTER DISI='OSFIL S"¢S]"EM OR PUBL. IC
2T, F.'E.WERFIGE S'T'STEPl ON THIS OR FtN'¢ FI[:,,TflC:ENT CIR NEARBY LOT.
IF' FI LIF"T '-=;TFtTION 15; II"4STF'tLLE[:' IN RN FtREFI COVERED B'T' MOFI BLIIL. DING CODES.,
THEN (::L) FIN ELE:CTRIC:[:IL. PERMIT RND INSPECTION MU'-';T BE OBTFIII",IED.~ (2;:, Fr..._-.,-BUIL. TS
I,11L.L. I'.,IOT E:E; FIF'F'F.'.O',,,'EB, .[41THOUT FIN ELECTR I CFIL INSPECT I ON REPORT.~ RI'-,ID ,:.' ]:) THE
ELEI]:T'RICFIL P.tORK MUS;'T' BE DONE E:Y R LIC:ENSED ELECTRICIFIN.
S I GNE[:, [:,RTE:
FIPF'L. I CFINT:
I .'.E;'.:S U E [:,
CI._IF'TDN R E:ENNETT
MUNICIPALITY OF ANCHORAGE
Department ~f Health and Environmental Protection
* * * HANDWRITTEN PERMIT * * *
Permit #' ~ ON-SITE SEWER PERMIT
Applicant: C/~ ~ ~C~t~' Mailing Address: ~8..~ /F~,~/~o.,,~
~v. Phone Number: ~7.- &~z~-~ -
Location: /~o.~ /
Legal Description: ~ ~'~ ~jL /~/~ ~> ~/ Lot Size: ~/~Z>0
Type of Soil Absorption System Is:
Trench: / Drainfield: ~eepage Bed: Holding Tank:
Maximum Number of Bedrooms: /~/(/~_~ Soil Rating (sq. ft/br)
The Requ~r, ed Size_of the Soil Absorpti~_n System Is:
DEPTH LENGTH . GRAVEL DEPTH WIDTH
~Z~ 'ZT~ ,.~z-~ ~--~'~ s ~ ~,' c~ ~ ~f~ '~=~'>1 .
The lengt dimension is the length(in feet) of the trench or drainfield, The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the e×cavation(in feet:), There is no set width for trenches.
~he gravel dept~ is the minimum depth of gravel between the outfall pipe and
the bottom of the e×cavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE : /~-~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well c~mpletion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8" F* * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
Signe~: Issued by: 3~~ ~;-~
Applicant
Date: ~/'/~.,/~
SWP/024 (1/SC)
SOl LS LOG
MUNICIPALITY OF ANCHORAGE
., DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264~4720
SOILS LOG - PERCOLATION TEST
DATE PERFORMED:
PERCOLATION
TEST
LEGAL DESCRIPTION:
6
7
8
9
11
12
13
15
16
17
18
19
2O
SLOPE
Tony D, 8o~ ~ ~GROUND WATER
'"~V~{~>~d~~"' F YES, AT WHAT
DEPTH?
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
............... ii- ~'.,~ ::: ~:- .... (o ~';:> ............... /~ ~,'~"" :~'
_. l ~ ...... ':-~ ::4 ;, q 4:
¢'1 " "" ::; ' ' q '""::
PERCOLATION RATE 4, ~,:' .., ... !t. (minutes/inch)-~ ,.~ / ~ /~ ~
1 ''
TEST RUN BETWEEN ~ . FT AND ,-~ , FT
72-008 (6/79)
~-~ IVlUNICIPA/.ITY OF ANCHOFIAGE
.,?~-==~ .~ DEPARTMENTOFHEALTH&ENVIRONMENTALPROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME 1PHONE /
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF ~EDROOMS
Iwe'l I Absomtion area IDw~ ~ PERM~ ~O0
~ DISTANCE TO: / /~ ~ [ 3~ ~ '
~ Z Manufacturer ~
~ ~ ~~ Material~~
~ ~ Liq.~a~y~ ~l,ons IF HOMEMADE: Inside length Width -- Liquid depth
~ ~ ~anufacturer Materia [iqui~paciW in ~allons
[ ~ DISTANCE TO: ~1OO~ * ~ ~
~ N°' of lines/ Length ~a~. Total length ~ Trench widt~ Distanc~ between lines
~::~ Top of the to f,nish ~rade ¢~ ~ Material beneath t~ ~ ~ inches To,al effe~, ~ a ~o~ o n~
~i0th~
Een~th Depth : PEBMIT ~O.
~ ~ Total ~ffective absor
~ ~ISTA~CE TO: Buil~undadon ~earest lot line
~ Class De~th Driller Distance to lot line ~[~MIT ~O.
~ DISTA~Cfi TO: Buildin~ foundadon Se~er line Septic tank Absorption area(s)
OTHER I
PIPE MATERIALS~T~~/ I
SOIL TES ~Z~ ~
INSTALLER II.
REMARKS /
I /
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
DEPRRTMENT OF HERLTH FIN[) ENVIRONMENTFIL F'ROTECTION
825 "L" STREE]"., FINCHOF.'.F1GE, RK.
264-4720
Ib,.I E IL_ L R !'-,t [:.
PEF),MIT NO. ( L:',:1.0520 )
CRTHY BENNETT
MONTF'ELIER DR.
LSR B2 RTELIER SUB
RPPLICRNT
LOCRTION
LEGRL
P.O. BOX 24.& 282: MULDOON ]:37-6454
LOT SIZE 46000 SQURRE FEET
TYPE OF SOIL. ABSORPTION SYSTEM IS: TRENCH
1',18',:~;IML.II'd NUMBER OF BEDROOMS
SOIL RRTING (S6! FT,,"BR)= t50
THE REQUIRED SIZE OF THE SOIL RE:SORF'TION SYSTEM IS:
E::, E F' ]" I-t == :'J_ ;;:_' L E ~-~ (] 'T lq == 2 9 ,3 F-: Fi '..-" E L [:, E F' ']- 1,4 ==.
'THE LENGTH DIMENSION IS 'THE LENGTH (IN FEET) OF THE TRENCFI OR DRRINFIELD.
THE [)EPTH OF: R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND 'rHE BOTTOM OF THE EXCR',,,'RTION (IN FEET.".,.
THERE IS NO SET WI[:,TH FOR TRENCHES.
'T'FIE GRR',,,'EL. DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF' THE EXCRVRTION (IN FEET:..'.
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM 'THIS DEPRRTMENT DURING 'THE
INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO 'THIS PROPERTY RND THE
NUMBER OF RESIDENCES THRT TEIE WELL WILL SERVE.
BRCKF'ILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SENRGE DISPOSRL SYSTEM IS
~.00 FEET FOR R PRIVRTE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON 'THE TYPE OF PUBLIC WELL
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST 8E RETURNED 'TO THE DEPRRTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRSLE TO INSURE PROPER INSTRLLRTION.
F' E F-.: I'.1 I T E :,-:: F' I F~: [-2 S [:, E C: E r"l E: E F-: ]: 1 .. :1. L=~-
I CERTIFY TFIRT
i: I 8M FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORFIGE.
2: I WILL INSTFILL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
]:: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE I5 REMO[:,ELED TO INCLU[:,E MORE THRN
SI GNE[,' _~___~~.
RF'F%~RNT C F4 T H'T BENNETT
~ :,.:,UE[. BY_. [',~TE
V4. 0
CONSTRUCTION TEST L~B
"One Test is worth a Thousand Opinions"
22~4 Cleveland Anchorage, Alaska 99503 277-0231
Performed for Shelp, Inc.
Legal Description: Lot SA
This Fomn reports: SOILS TEST
· Block 2
Yes
Date Performed 5/16/79 ~
Subdivision Atelier Sub.
PERCOLATION TEST
Depth
Feet
2.5'
Soil Characteristics
6" Peat and Reddish Silt
Brown Sand with trace of Silt
Brown Silty Sandy Gravel
Brown Sandy Silt with
Occasional Gravel
Bottom of Test Hole
'1
SEE ~Sz[P I,!
Was Ground Water Encountered No
If YES, What depth?
Reading Date Gross Time Net TLme Depth to H20 Net Drainage
Percolation Rate Minute
Proposed Installation: SEEPAGE PIT DRAIN FIELD
Depth of Inlet Depth to Bottom of Pit or Trench
CO~4ENTS: ~ "'15'0 Square Foot drainaqe area recuired Der bedroom from
minus 2.5' to.l__4', - - -
Test Performed by. D.P.
Data Certified By: Construction Test Lab
Date :5/29/79
CHUGIAK, ALASKA
688-3199
KODIAK, ALASKA
4864826
WE SERVE ALL ALASKA
IN)ST OFFICE BOX 42 - CHUGIAKo ALASKA
OWNER OF LAND nO~ ~ e :!.~.e
6821 D~c~ .... r~ :-i'l
ADDRESS ...... %...&;......:..;:.: .................................... ~
w~- mz ....... :...:.~.~:~...~!i...i~::..:.?.~..E~.~.b!.: ..................
DA~E - STARTED ............. ; ..................................... ;.; ............................. '
, -21-~1
DATE - ~NDE~ ........... ~ ..........................................................................
KIND OF FORMATION:
FROM ...................... FT. TO ......................
FROM .!~ .................. FT. TO ...~..~ ...............
·: FROM ..¥./. ............. FT. TO ..~..~ ...............
";: -- -A ~0
FROM ..; ................... r I. ~u ......................
'],. DEPTH OF WELL ..~. ................ '.:).: ..............................
'l, ,.':, ,STATIC__ LEYEL OF WATER FT.....; .......... ~ ......... ; ......................................
· ~ DRAW DOWN ~- ~ :~,.t.
, W~D OF C~mG ......................... :.U.~.::.:...r.:.::...::,.~. .................... .: ....
FT . ,:r~nd. 4- C~el i
FROM ...................... FT. TO ...................... FT ....................................
FROM ........... : ......... FT. TO ..~ ...................
FROM ...................... FT. TO ......................
FROM ...................... FT. TO ..., .................
FROM ...~ .............. :.. rt.'To ......................
FROM ...................... FI'.TO ................... FT .......................... L ........
FROM ...................... FT. TO .......... ~'..~ ....... FT .................................. ~
FROM ....................... FT. TO ....................... Fl' ..................................
FROM ......................FT. TO ...................... ;.FT .................................
FROM ....................... FT. TO ........................ FT .............. ~ .................
FROM ....................... FT. TO ...................... FT ..............................
FROM ....................... FT. TO ........................ FT ................................
FROM.[ ..................... FT. TO ........................ FT .................................
FROM ......................FT. TO ........................ FT .................................
FROM ........
FROM'2 ..................... FT. TO ....................... FT ................................
-FROM,.., .................. FT. TO ...................... FT .................................
FROM ....................... FT. TO ....................... FT ..................................
FROM ....................... FT. TO ...................... Fl' .................................
MISCL. INFORMATION:
]x~mp chculd be 3' off botto~.
DEPARTMENT oF H~[TH&HuMAN SER~i01~S
.: ?i '- DiVisioni...::" ' "'°f:Envir°nmental"'--~ Services;
,.-:.. ? ::..,.:~ .. ~.. · -'.~ ...,,:..' un,~,te ~e~,ceS Section -. ~.
', P.O.-Box 196650; AnchOrage,~Alaska ,_~99519-6650
,.~'?~'~. ,, -',.-~-:.. -. , ~ , , ~ ,? . ~ ·
CERTIFICATE OF'HEALTH AUT~'RI~
' APPROVAL~ FOR A SINGLE FAMILYDWELLING
;~,?parcel'l.D.~ ~-O~J; W~"' '.. ',
HAA
Location (site addreS$'or~di:rection;)
C;'
'Property owner [-t., [[; ~__.o..~[; ~
,?"':'Mailing addre§s
Day phone
Lending agency
Mailing address
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: '~ '~
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
.ing to the' legality and status ofsystem.
OF WASTEWATER DISPOSAL:
Individual on-site
· Holding tank ,'.
NOTE: If written Confirmation from,
~, : attesting to the,legalitY and:status of system........
72-025 (Rev, 1/91) Front MOA ~21
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 Munici pal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Address ~-o~
Engineer's signature
Phone
Date
DisapproVed.
Conditional approval 'for
with the following
Additional Comments
By: /
The Municipality of Anchorage Department of Health and Human Services (DHH$) i~ues Health Authority
Approval Certificates based only upon the representatiOns giVen in paragraph 5 above by an independent
Pr°fe~i°nal engineer register°d in the State°f Alaska''The DHHS d°es this as a c°urtesyt° purchasem °f h°m~
and their lending institutiOns in order to satisfycertain federal and State requirements. EmplOyees of DHHS d° nOt
condUct inspections or analyze ~data before ia certificate is issued, :The Municipality of AnchOrage is not
reSponsible for errors or omissions in the prOfessional engineer's work,-
72-025(Rev. 1/91) Back MOA~I21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
LoT ~"~14, ~l /~TE.[.J~/'~-. Parcel I.D. ~ Lit-- ¢)'5 I - LJ 'Z..
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ,~ ,,2.J ,c~! Driller
Cased to ~' O Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date.of test ~'o~1-~/
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public seWer` main
Sewer service line
J2.a
.g.p.m.
AT INSPECTION
77
~UNICIPALITY OF ANCHORAGE
ENVIR. ONMENTAL,SERVICES DI¥1$1QN
'' g.p[r~.R ~ 0 1994
RECEIVED
; On adjacent lots
; On adjacent lots '~, I
PUblic sewer manhole/cleanout
Petroleum tank J'q ~ 14 ..e..._
WATER SAMPLE RESULTS:
Coliform
Date of sample: ~/"7/'~ ~/
Nitrate
~), ~ J Other bacteria
Collected by: T~. ,-~
B. SEPTIC/HOLDING TANK DATA
Date installed '~/,f-¥ j/~ ?
Cleanouts (Y/N) ~'
High water alarm (Y/N)
Date of pumping
Tank size 1 ~
Foundation cleanout (Y/N)
Compartments
y Depression (Y/N)
Alarm tested (Y/N) bt
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /~,~.3 On adjacent lots
Foundation
To property line /.~'
Surface water/drainage
Absorption field
Water main/service line
72-026 (3/93)' Front CONTINUED ON BACK PAGE
C. LIFT STATION ,~//~.
//--~
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
. "PumP off;' Level at
!
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION .TO: ·
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed ~,~/? ~
Length 'b ~., ~
Total absorption area
Date of adequacy test
Width
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF)
Gravel thickness
Cleanout present (Y/N)
Results (pass/fail)
System type "~"~
Total depth
Depression over field (Y/N)
for '~' Bedrooms
After test c~E,, ~,
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot / "70
To building foundation
On adjacent lots ,,~
Surface water
Curtain drain /'~//o
On adjacent lots ~ / ~ Property line
To existing or abandoned system on lot
Cutbank /~ ~,/~ Water main/service line
Driveway, parking/vehicle storage area '7 0
E. ENGINEER'S CERTIFICATION
I cer~fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspect'on.
Engineers Name
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
254-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range) Lot 8A; Block 2; Atilier S~bdivi~ion
August 12, 1986
Location (address or directions)
7201 Montagn¢ Circle
(b) Applicant Name Cassi6 HiZZ Telephone: Home 338-4523 Business
Applicant Address 7201 Monta~nc Circlc, Anchoragc, Alaska 99507
(c) Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain);
(d) Lending Institution First ~)a,~io;~a?. Bank of Anch0a~l~.phone
Address main §ranch
(e) Real Estate Company and Agent
Address
non6/r~? ~nan~ng
Telephone
(f)
the HAA to the following address:
S ~ S Engineering
SRB 196X
Eagl6 Riv~[, Alaska 99577
TYPE OF RESIDENCE
Single-Family.~ Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Individual Well ~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
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 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDING b..,PECTIONS, TESTS, FILE SEARCH, DAT/~ ,~ID 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 inspe~ti~n~ ENGINEERING
Name of Firm
~ 19~X
Address
EAGLE
~iV~-~, AK ~9~1~
Date
Telephone
DHEP APPROVAL
Approved for ~/~' ~r) ~edrooms ~y
Approved ~ Disapproved
Terms of Conditional Approval
Conditional
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)
WELL DATA
Well Classification
Well Log Present~.~'N)
MUNICIPALITY OF ANCHORAGE
HEALTH AUTHORITY APPROVAL (HAA)
Legal Description: L...
Date Corn pleted
~ 7-/~/~P__
3 / D
Total Depth _~ _,"~b /
Static Water Level ~.~.~.~.~.~.~.~.~.~O '
Casing Height Above Ground
Electrical Wiring in Conduit(~)/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot I ~,..O /
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line~ . _/~//~
/fi
Cleanout/Manhole
Water Sample Collected by ~ ~, S
Cased to _,~ /
If A, B, C, D.E.C. Approved (Y/N)
:~'/~_~. / (C~/' Yield
Depth of Grouting ~
Pump Set At C,~ /c_
Sanitary Seal on Casing~N)
Depression Around Wellhead (Y~
Water Sample Test Results
Comments
, On Adjoining Lots
· On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/H~ TANK DATA
Date Installed (~./'~-~/~ !
Standpipes ~N)
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) "'--
Separation Distances from Septic/,~etdmg"Tank:
Size /~_TO ~t~., No. of Compartments ~
Air-tight Caps (~N) Foundation Cleanout (~N)
Date Last Pumped ~///~'/~'~' "-
To Water-Supply Well ! ~--~ '
To Property Line ~.(_-)
To Water Main/Service Line
Course ./()(b/
Comments
./~") //~' 'for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Ponct, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in AbsOrption Strata
Date Installed
Width of Field
Square Feet of AbsOrption Area
Depression over Field (Y(~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot ~//~
To Water Main/Service Line
.z./l/~ ,/,~ Type of System Design
Length of Field ,..~ ~' /
Depth of Field / ~- /
Gravel Bed Thickness ~ /
Standpipes Present (~N)
Date of Last Adequacy Test
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Cutbank (if present)
/oo'/-/--
Comments
To Property Line / ~
To Existing or Abandoned System on
; On Adjoining Lots ~ / ~
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
p,~~ Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test, Meets MOA
Electrical Codes (YYN)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
certify tl~t~l~t~:t~j~~l~[ip,.d, or conformed to all MpA and~AA guidelines
-'~"'"-"'~ ~/~/~
Sianed ¢~ ~ Date ~/ - / -
ComDanEA~l ¢ DIt~h A ~ ~.~ MOA No. ~'~ ~
.ece~pt No. ~ ~ ~ ~ ~ (
~te o~ ~a~ment ~ / ~ ~ ~
Amou.~: ~ ~~
Page 2 of 2
72-026 (11/84)
in effect on the date of this inspection.
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEAL'I'H
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CE~'~IFICATE
1. General Information Application Date
(a) Legal De. scription (include 1ct, block, subdivision, secticn, township, range)
Lot 8A Block 2 Atelier Subdivision Sec 6 T12 N R 2 W
Location (add, ess or directions)
7201 Montagne Circle
(b) Applicants Name Clifton R. & Cathy A. Bennett Telephone 337-6454
Applicants AdCk, ess 283 Muldoon Rd #241 Anchorage, Ak 99504
(C) Applicant is (check one) Lending Institution ~ ; Owner/builde, r~-.~.;
Buyer~--~ ; Other~ (explain); owner
(d) Lending Institution First National Bank of Anchorage Telephone
Address Parkway Brapch Northern Lights & Boniface
(e) Real Estate Co. & Agent
Address
Te le phone
2. ~e of Nesidenoe
Single-Family
Number of Bedrooms
3. Water Supply
Mult i-Fami ly ~
3
Other (describe)
Individual Well ~ C~nity ~-~ Public
Note: If cc~munity ~11 system, must ~ ~it~n ~nf~tion ~ ~ Sta~
~p~nt of ~viro~ntal Con~rvation attesting to t~ legality ~d s~tus.
Is ~e ~11 ade~a~ f~ the D~r of ~~ s~cified in this ~ (y~) Y
~ge Dis~sal
Onsite ~ ~blic ~ ~nity ~ Holding
Is ~ ~s~water dis~sal system a~qua~ f~ ~ ~ of ~~ ~)~ V
On 4/25/84 drainfield accepted 300+ gallons before backing into septic tank, 450 gallons
required for 3 bedroom house. Absorption system was upgraded on 5/18/84 to include
an additional 150 gallon capacity. This system now meets the minimum requirements set
[Pa~ 1 of 2] by the MOA of 450 gallons per day.
2-15-84
5. Engineerinq Firm Providin~ Inactions, Tests, Data and Information
I certify that I have checked, verified, c~ conformed to all ~DA HAA Guidelines in
effect on the date of this inspection.
Signe . ~ ~.)~k~] '~ ~.
Barter:' & Associates
Name of Firm
5331 Tudor Top Circle
Address
Date
Da t e__?/~/~,, ,~
563-71~'~
Telephone
(ENGINEER SEAL)
6. DHEP Approval
Approved for
Appro~d .~
Disappro~d [----]
Conditional~
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Envirorm~ntal P~otection does
not guarantee the ccntinued satisfactory performance of the water supply and/or the
wastewater disposal system. This approval indicates that, as of the validation date
shown abo~, based on the data and infc~mation furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal .system is safe and func-
tional for the number of bedrocms and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
OWNER TO PICK-UP 337-6454 Cathy Bennett
KB2/d5/s
[Page 2 of 2]
2-15-84
ae
Nell
~11 ~ ~e~ne (7~) Y
Total
Static ~te= ~1 30 feet
Casin~ ~i~ht ~ G~nd 8"
Elee~i~l ~ing in ~n~it (Y~) Y
~p~ation Distan~s ~ ~11:
To ~ptic~oldi~ Ta~ ~ ~t 120 feet
To ~a~st
To ~est ~blic ~ Line N/A
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH Ab/MORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
Atelier Subdivision
Lot 8A Block 2
%1
If A, B, c~ C, D.E.C. App=oved(Y/N) Y
Date C~leted 5/21/81 Yield 600 gph
Depth of G~outing
Pump Set At 3 feet off bottom
Sanitary Seal on Casing (Y/N) Y
Depression A~ound Wellhead !Y/N) N
; On AdjoiningLots 150 feet
130 feet ; On AdjoiningLots 100+ feet
To Nea=estPublic Se~sr
Cleancut/Manhole To Nearest Se%mr Service Line on Lot
Water Sample Collected By Tony .D. Barter ; Date 4/24/8..4
Water Sa/~le Test Besul~~ss MOA Standards '% ,~ ~ f/~J~/
B. _S,E,pTI,C/HOLDING TANK DATA
Date Installed 5121/81 Size 1000 gal NO. cf Ccmpa=tments 2
Standpipes (Y/N) Y Air-tight Caps (.y/N) Y Foundation Cleanout {y/N) Y
Depression over Tank (Y/~..) N Date Last Pumped 5/12/84
Pumping/~intenance Cont=act on File (Y/N) N ; for , ,
Holding Tank High-Water Alarm .(Y/N)N/A Ten~orary Holding Tank Permit (Y/N) N/A
Separation Distances f=cm Septic/Holding Tank:
To Water-Supply Well 120 Feet
To P~operty Line 20 feet
To Water Main/Service Line N/A
Cot~Se None present
TO Building Foundation 17 feet
To Disposal Field 10 to 52 feet
To Stzeam, Pond, Lake, c~ Major D=ainage
Con, rents
[Page 1 of 2]
2-15-84
ABSORPTION FIELD DATA
150sf Permit 810520
Soils Rating in Absorption Strata419sf Permit840269Type of System Design
Date Installed 5/29/81 / 5/18/84 upgrade
Width of Field 30"
Squa=e Feet of Absc~ption A~ea
Depression over Field (.Y/N)
N
624 + 396
Date of Last Adequacy Test
Trench
Length of Field 39 ft/33ft upgrade add'l
Depth of Field 12ft/lO ft upgrade
Gravel Bed Thickness 8 ft/6 ft upgrade
Standpipes P=esent (Y/N). Y
4/25/84
Results of Last Adequacy Test Rated at 300 gal/day on 4/25/84 u~g~ed 5/18/84 permit
840269
Separation Distance frcm Abso~ption Field:
To Water-SupplY Well 130 feet TO P=operty Line 25 feet
To Building Foundation
Lot N/Ai
TO Water Main/Service Line
To Stream/Pond/Lake/c~ Major Drainage Course N/A.
TO Driveway, Pa~king A~ea, c~ Vehicle Storage Area
15 feet To Existing or Abandoned System cn
; On AdjoiningLots 100 + feet
TO Cutbank(if present)
10 + feet
Comments
D. LIFT STATION
Date Installed N/A
Si~ in Gallons
"Pump On" Level at
High [~k~ter Al~.m Level at
Tested for
Electrical Codes(Y/N)
Dims ns ions
Manhole/Access !.Y/N )
"Pump Off" Level at
vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Cc~m~nts
** Check Permitted Bed~ocm Rating Against HAA P~quest
I certify that I have checked, verified, or confc~n~ed to all MOA HAA Guidelines in effect
on the date of this _inspection.
Si~ned ~ J~?u_a i ~~ Date
Company Barte0 & Associates '~A N°' ~T'~B4~
[Page 2 of 2]
2-15-84
BUSH ENGINEERING
BOX 4.-2964
ANCHORAI~E, AK 99509
**SEWER ADEQUACY TEST*
Date
Residence: ~r~e
water: ~//
Sewer': (From Municipal Records)
Tank: /aoo
Test Procedure:
"rest Results:
DAT~:
RECEIVED
, INSPECTION APPOINTMENTS
TIME '
DATE DATE DATE
INSPECTOR
INSPECTOR I NSPECTO~
MUNICIPALI~ OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~iRONMENTAL PkOTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION SEP 1981
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proce~ed. Please allow ten (10) days for processing.
1. PROPERTY OWNER j PHONE
MA~ ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
2, BUYER PHONE
~AI LING ADDRESS
3. LENDING INSTITUTION I PHONE
MAILING ADDRESS '
4. REALTOR/AGENT
J PHONE'
MAI LINg ADDRESS
5, LEG.~L DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
~ SINGLE FAMILY [] One [] Four
[] Two [] 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 UTI LITY depth (attach log if available.)
[] Other
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
.,~' SINGLE FAMILY
[] MULTIPLE FAMILY
[] ONE
[] TWO
NUMBER OF BEDROOMS
.~THREE [] FIVE
[] OTHER
[] FOUR [] SIX
2. WATER SUPPLY
I~NDIVIDUAL !
[] COMMUNITY;
[] PUBLIC UTI LITY
Con nection Verified
3. SEWAGE DISPOSA~ SYSTEM
[] fl~DlVl DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified ·
[]Septic Tank or []Holding Tank
Size: f/~..2<:20 If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AR~EA~,,
4. DISTANCES
WELL TO:
Absorption Area to nearest! Lot Line
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
Sewer Line
Nearest Lot Line
5. COMMENTS
DATE
APPROVED FOR '~'~ BEDROOMS
CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
72-010 (Rev. 6/79)
unic pality
Ancho -age
[:,Z.~ STREET - '
ANCt.iORAGE, ALASKA 99501
(907) 264-4111
MEN'[OF HEAL. 1H AND ENVIR(')NMFNTAI.
September 11, 1981
Clifton R. Bennett
Post Office Box 241
Anchorage, Alaska
99510
Subject: Lot 8A Block 2 Atelier Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
i (1) The water analysis report submitted to this office
2 from the Chem Lab, 5633 B Street, for our review.
) A well log submitted to this office for our files
and review.
(3)
(4)
The area along the septic tank and leaching area
needs to be filled in with dirt.
A cap is missing from one of the standpipes to the
sewer system, and needs to be replaced.
Please notify this office for a re-inspection when the
noted descrepancies have been corrected. If there are
further questions, please call this office at 264-4720.
Sincerely,
James;S. Roberts
Associate Environmental Specialist
JSR/ljw
cc: First Federal Savings and Loan
Post Office Box 4-2200 99509