HomeMy WebLinkAboutNORTH WOODS BLK 4 LT 14MUNICIPALITY 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
Can -Site Wastewater Disposal System Permit
Permit Number: OSP241083
Work Type: SepticTank Upgrade
Tax Code Number: 05173119000
Site Legal Address: NORTH WOODS BLK 4 LT 14 G:1459
Site Mailing Address: 22635 MC MANUS DR, Chugiak
Owner: STONE STEVEN D & KATHLEEN B
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
S'
r.
f�
DeI)ar,tment
5/13/2024
5/13/2025
22015
❑ 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
Received By: ,S 7;0 Date:
Issued By: Date:
MUNICIPALITY F ANCHORAGE
r
Community Development Department -T Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON -SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-731-19
Property owner(s) Steven & Kathleen Stone
Mailing address 22635 McManus Drive Chugiak, AK 99567
Site address same
Day phone
Legal description (Sub'd., Block & Lot) North Woods 134 L14
Legal description (Township, Range & Section)
Lot Size 22,015 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) ❑x
(w/wo ADU)
Septic Tank
x❑
Upgrade ❑x
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
1�7)40
(Signature of property owner or authorized agent)
Permit/Rush Fees: Z 2 5 Waiver Fees:
Date of Payment: ZO Z Date of Payment:
Receipt Number: Receipt Number:
Permit No. Q S P 2 y I 0 83 Waiver No.
Permit App_'- ::'-..:c
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
Mailing: P.O. Box 1807 Palmer, AK 99645
Telephone: (907) 745-8200 FAX: (907) 745-8201
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, Alaska
Subject: North Woods B4 L14
Septic Tank Upgrade Permit Request
This is a design narrative for a permit to install a 1000-gallon septic tank to replace an existing 1000-gallon septic
tank. The existing tank is 43 years old and is likely perforated and leaking, it will be abandoned per MOA code.
Currently the lot is developed. The proposed replacement will be connected to the existing drain field. This lot and
the surrounding lots are served by AWWU drinking water. There are currently no wells within 200’ of the proposed
upgrade.
1. Septic Tank Design.
A foundation clean out installed or repaired as needed.
The tank will be located: 5’+ from any property line.
5’+ from any deck/stair support.
10’+ from building foundation.
10’+ from any water line.
100’+ from any surface water.
100’+ from any private wells.
200’+ from any public wells.
The proposed installation will not affect the future development of this or the surrounding lots.
If you have any questions or concerns, please contact me at (907) 745-8200.
Sincerely,
SRP
Steven R. Pannone, PE, F. ASCE
Owner/Civil Engineer
7 May 2024
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241083, Curtis Townsend, 05/13/24
FOR
CONSTRUCTION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241083, Curtis Townsend, 05/13/24
FOR
CONSTRUCTION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241083, Curtis Townsend, 05/13/24
,,~.~ MUNICIPALITY OF ANCHORAGE
DEF rMENT OF HEALTH AND HUMAN SERV, ,S
' Environmental Health Division
· . 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
· ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Na~.eDISTANCES
~ "~ A ~___...~7.-,~4-.~.~,.¢~ ! ~ ~ ~ TO SEPTIC ABSORPTION
WELL
AddressFROM ~ TANK FIELD
Per~~ N° °' B~°ms WELL ~0'¢ Z~/~
Township, Range, Section AS-BUILT DIAGRAM tShow location of well septic system, property hnes, foundation,
~anufacturer Capacity m gallons ~ '
~t~.a~ ~ o~ Co,..a~;n~ ~ ~/ 2¢ Z¢~
TYPE OF SYSTEM
~ TRENCH ~D ~ W. DRAIN ~ OTHER
~p~h to p~pe bottom from Total depth from original grade ~ ~
or,gin~araee ¢.~ FT / FT
Fill added above original grade Gravel depth beneath ptpe /
, Gravel ~dth ~
7otal absorpt ...... ~ . j~j ~ Distance between lines /~ , /~,/~ ~ ~ --~
~ PRIVATE ~THER (Identifv~ %~-- ' ~ ~%* / -
nstalle~ Date Installed: ~ ~
ER'S SEAL
. A e ekl~ia~Dl~G cmily t at Ibis inspe ion was pedormed according to ag ~ *. .... ;; "~'
72-013 (3/85)
DEPARTMENT OF:r HEAL.'I"H AND ENVIF:~:ONHE}F[AL. PROTECTIE}N
264-'4.720 ,
87' 007 '7 U P G R A D E
05 / :i. 2
L..EGAL D E:iii;C R I F' ',',
LC)] 8 ;[ ZE ',~
:[7034 EAGLE RIVER LC]OF::' ROAD NO,, 204
EAGLE R:[VER, Al< 99577
694"-- 29'79
SUBDIV]:SION~ NORTH WOODS
!iPi;!iiil{lT;'!" ii ()H ~, 4 'T'C)WNSH 1[ P ~ 1[ 5H
22000 (SQ,, FI',, OR ACF;'.IES}
L.O T = :[ 4
R A NG!i![: ;[ W
B L. 0 C K ::
I (:::er"Lify that,
l}. ,: ]i f:?tf¥1 ~' afT~ ii. ]. ;}. let P ~\~ J. '('.. h t }'](.}}} I" (.}};,c]Ll :i. {" ~}}HJ]E~,I'!'k ~!i~ f (D!' /:){"l...-s :J. t E.} ~6.~w({.:.}t" '~; ,'~d']Cl ~{.:.:~ ]. J. !!~. a~
.. d L).... and the State I::~f' Alaska,,
for'th ,.,,¢ ~, ,e I ,.. .,.cipaiity of' Ar'ichor'age '"""}
2. I ~.~:i. I I :[r'n~cL.al I the system in accor'derice w:i.'L.h al 1 MOA c:cH:Jes arid pegt.ttat :i. or~s~
and in comp.[. ~.ar'H::e with the design c::t- i'Ler'ia (::)f' %["~:J.s per, mit,,
t Mill adhel-e t.o ail MOA au'"~d State of Alaska r'equir'smsr'lts for' the se'L back
(::[i?[~i~r'H:::E. si~ f'l"c:,¢~'~ any existing ~,,le].l, wastet,,~a't:.er' disposal system or' publ:i.c
se~/4,:¢.H"a98 system en 'Lt"li~iii of any adjac:en'L hr' near'by lo'L,,
IF:' A LIF::"I" S'FATION ils INSTAL.I..ED IN AN AREA COVEF;:ED BY MOA
'T'HE'F (1) AN I.L.I::.~..~,I~..,.CAL PERHIT AND INSPECTION MUST BE
,, ...... ..... ...... ,~.~',:;..~ .......... .... ........~ .............. ~.. .............
......
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: L/ ,~/3t ,~_.',~j~..5/,~,t~~ / /t../ ~. DATE PERFORMED:
LEGAL DESCRIPTION: LoT/~ ~c ~ /~ I~T°wnship, Range, Section:~/S'~/' ~[~,,, SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19~
20-
WAS CROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~./ OL
DEPTH? p
E
Depth to Water After
Monitorino? ~' Date:
I-
N
:/
Gross Net Depth to Net
Reading Date Time Time Water Drop
/ / ' ~ /~ ,, ~ ~" ,/~"
I
PERCOLATION RATE /..'/O (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~,,~, ~' FT AND ~' ¢ FT
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE~ E~CT ON THIS DATE. DATE:
72-008 (Rev, 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
/*
PERFORMED FOR: (,~ ~3t
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
Township, Range, Section{ // ¢~1 , /~-/c~., ~c_ ¢
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT t
DEPTH? ~ 0
P
E
· ' D? --Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER __
g TEST RUN BETWEEN FT AND FT
COMMENTS ~/¢.. ~ I ,~.l '~.lt~ /-10¢-~ ~..~¢/57/~.~" I~//~ ~/~T ~ ~1~7~ /~/
S & S ENGINEERING ~ ~ ~
PerFOrMeD BY: ':7::4 :aCa ::v~- L~ :~ ;~. A~ ~// ~ / cem~FY ~A~ m~s TeST WAS P~F~MeD'm
72-008 (Rev. 4/85) /' /
SUBJECT:
DAT~:
SHEET
BY
OF
~ I , = SC,~LE
I
SCAI~E
e - ' " 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 ~ IPHONE EW
MAI LING ADDRESS
LOOAT, ON 3
Mater' ~
Liq cap~a ohs IF HOMEMADE: Inside length Width Liquid deptlq
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ( Manufacturer Meteriel Liquid capacity in gallons
= el Foundation~ Nearestlot~(~ PERMI N .
~ ~ Top of tile to finish ~rade Material beneath tile Total effective absorption aroa
~ inches
Length ~idth ~ Deoth P[~MIT ~0.
( ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class , Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
INSTALLER/
LEGAL
72-013
PERMIT NO.
F~PPL I CF!NT
LOCRT I ON
LEGRL
DEF'FIRTME:NT ur HEFtLTH RND E!",IVIRONMENTRL F:'ROTEC]"ION
825 "'L'" STREET., RNCHORRGE., FtK.
2.6,':!.- 4 ?;;.2 E~
F'RFINK BETHERD
PETER"S C'REEK
L t4 B 4 NORTH WOODS S,,"D
SRR BOX t698K 995~'?
LOT SIZE
...... IL F.E,::,UF.F , IdN ..... ,.:,! EM .I=,: [:'RF!tNFIELE:'
MRXIMU,~'I NUME:EF~' iF EED~":-P1': ........ = ':;niL RRTING ':S2 FT,. E,F ........ ~.~.~
THE REQUIRED SIZ~ THE SOIL RE:SORPTION SYSTEM IS:
THE LENGTH DIMENSION IS 'THE LENGTH (IN FEET) OF 'THE TRENCH CLR DRFIINFIEL. D.
THE [:,EPTH OF FI TRENCH OR PIT IS THE DISTFINCE BETHEEN -['HE SURFF!CE OF THE
GROUN[:, RNE:, ]"HE BOTTOH OF THE EXCFI',/RTZON (IN FEET:).
THE GRF!',/EL DEPTH IS THE MINIMUM DE:F'TH OF GRFI',,,'EL BETHEEN THE OUTFRL. L PIPE
FIND THE BOTT()H OF ]"HE EXCFWRTZON ,::IN FEE:T).
F'ERMIT RPPLtCF!NT HFIS THE RESPONSIE:ILITY TO INFORM 'THIS E:'EPRRTMENT DURING THE
INS-['F~LL. RTION :[N:.'.E;PFCTZONS OF' FINY WELLS F~D..THCENT 'TO TF'IIS PROF:'E:RTY F~ND THE
NI...I.~'IBER OF: .RESIDENCE:.S 'THRT '['HE F.IELL f4ILL SERYE
BF!CKFILLING OF:' FINY SYSTEM I.,.IITHOUT F!NFIL INSPECTION Rt'.,l[:, FIPPF:O',/FIL BY THIS
DEF'PIRTMEI'.~T HILL BE SUBJECT 'TO PROSECUTION.
MINIMUM DIS]"FINCE BETHEEN FI HELL FIND FINY ON-SiTE SEWFIGE DtSPOSFIL SYSTEM t~,
:LSE~ FEET FOR FI PRI',/FITE HELL OR ±5C'~ "FO ;::'EIEl FEET FF:'.OM Fl PUBLIC WELL [:'EPEN[:'tNG
UPON THE TYPE OF' PUBLIC NELL
MINIMLIM DISTRNCE FROM R PRIYATE HELL TO la PRIVFITE SEWER LINE IS.: 25 FEE'T RN[:,
'TO F! COMFIUNITY SE'WEF.: [..:[NE IS 75 FEET.
OTHER REQUi'REHENT:E; MFIY FIPF'LY. SPECIFICFtTIONS FIND CONSTRUCTION E:,IRGRR!"IS RRE
R',,,'I::iILRBLE TO :ENSURE PROPER INSTFIL. LRTION.
IF-:" E E~." ~"q Z 'T' EE >-:: F:" :E ![&:: E:E S [:. E£ C: E.: ~'l E,", EE F-." ~2: :dL .. :::~,...".ES, ,",~:
! C:ERT I FY THFI"f'
:1: I F4M FFIMtL. IFIF. I WiTH 'T'HE REC.!UIREMENTS FOR ON-SI~f'E SEHERS RN[:' [4ELLS RS SET
FORTH E:Y THE MUNICIPRLITY OF:' RNCHOF.:FIGE.
2: I HILL INSTFtL..L 'THE SYSTEM IN RCCORDf~NCE NITH 'THE: COD, ES.
2: t UNDERSTRNE:, THRT THE ON-SITE :.~i;EP.IER SYSTEM MFIY F.'EQUIF.:E: ENLF:!F.:GEMEN!' IF' '['HE:
RESIE:,ENCE ~~~~INCI2:UE:,E' MORE: TFIF!N 2]: e,E:[:,ROC, MS.
2; I GNP][:,: ....... ~
,dUNiCIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-550, Anchorage, Alaska 99502 276-222~
SOILS LOG -- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR'.
LEGAL DESCRIPTION:
__.~2
3-
4
~5
6
7
8
9
Lot-/~ 8/k 4-
SLOPE
I~urde~
DATE PE.FORMED:
SITE PLAN
10
11
12
'13
WAS GROUND WATER
ENCOUNTERED? ~*~ ~ ' pO
E
IF YES, AT WHAT
DEPTH?
14
15
16
17
18
19
2O
COMMENTS
PERFORMED BY:
2_50 .~.
Gross Net Depth to Net
Reading Date Time Time Water Drop
ALASKA IIUIROnm nTAL CONTROL I[1C.
April 6, 1982
Bethard Construction
SRA Box 1698K
Anchorage, Ak. 99507
Dear Mr. Bethard:
On April 5, 1981, I checked to see if water was standing
in the three homes in Block 4. Below are my co~nents:
Lot 14- Sump pipe is dry. All standpipes are in place.
Lot 15- Sump pipe dry but standpipe broken off.
Lot 17- Sump pipe dry but standpipe broken off.
I also checked ~th~9~.water level in the sump pipes on Lots
34 Block 3 and Lot l~ock 1.
The water depth on Lot 34 was 34 inches down from 41
inches on January 28, 1982. On Lot 16 the water level was 12
inches down frcm 25 inches on January 28, 1982. It appears
that the water traveling through the ground is dropping
drastically. If there is no increase during break up then it
appears that the systems may be good.
If you have any questions please let me know.
Sincerely
President
1220 U Jest 25th Auenu¢ ,. Anchora§e. Alask(~ 99503., (9071 276-1361
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
H87-0033
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 14 Block 4 North Woods Subdivision
Location (address or directions)
(b) Property Owner Dick Brown Telephone: Home
Mailing Address 17034 Eagle River Loop, Suite 201
(c) Lending Institution Telephone
Mailing Address
(d)
Business 694-2388
Eagle River 99577
Real Estate Company and Agent Vista Realty/TArget Realty
Address Eagle River
Telephone
(e)
Mail the HAA to the followina address: or: Check here r'q, if hold for pick up.
List contact person and day phone number below.
S & S Engineering
17034 E gle River Loop, Suite 204
Eagle River Alaska 99577
TYPE OF RESIDENCE
Single-Family []xx
Number of Bedrooms three (3)
WATER SUPPLY
Individual Well [] Community l'gxXPublic []
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 [~:X~Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 tRey 8/86~ Front
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 disposat system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
NameofFirm S & S Engineerinq Telephone 694-2979
Address 17034 Eaqle River Loop, Suite 204 Eaqle River, Alaska
Date
Engineer'sSeal
This department has received written confirmation form the engineer
regarding the Conditional Approval of January 26, 1987. The
corrections have been accomplished and an inspection has been completed
by the engineer. (See attached copy of as-builit inspection report).
The subject property meets with Municipal standards is now a'pprovedo
DHHS APPROVAL
Approved for three (3}bedrooms by
Approved XXXXXXXXXXXDisapproved Conditional
Terms of Conditional Approval
Date May 21, 1987
CAUTION
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
engineer's work.
Page 2 of 2 72-025 fRev 8/86) Back
ROBERT A. SHAFER
May 19, 1987
CIVIL ENGINEER
694-29Z9
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501
REFERENCE: Lot 14~ Block 4; Northwoods Subdivision
A conditional Health Authority Approval was issued on the referenced
property on January 26, 1987. An on-site sewer permit #87007 was issued
to upgrade this system to satisfy the conditions of the HAA.
Attached is a copy of the on-site sewage disposal system inspection
report for the work performed under the upgrade p~rmit.
Since all conditions of the conditional HAA have been satisfied, we
request you issue a final HAA at this time.
SRB 196X EAGLE RIVER, ALASKA 99577
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
264-4720
Application Date January 20, 1987
GENERAL INFORMATION
(al Legal Description (include lot, block, subdivision, section, township, range)
Lot 14; Block 4; Northwoods Subdivision
Location (address or directions)
(b) Applicant Name Dick Brown Telephone: Home Business 694-2388
Applicant Address 17034 Eagle River Loop Road¢ Suite 201, Eagle River, ~,las]~ 9957?
(c) Applicant ts (check one): Lending Institution []: Owner/builder []; Buyer []; Other r~ (explain);
Bank foreclosure
(d) Lending Institution Telephone
Address
(e)
Real Estate Company and Agent Vista Realty/Target R~l ty
Address Eaqle River ~ Alaska
lelephone
(f) ~ the HAA to the following address:
S & S ENGI~ERING
17034 Eagle River Loop Road, S~]{te 204
Eaqle River, Alaska 99577
TYPE OF RESIDENCE
Single-Family [~ Multi-Family []
Number of Bedrooms 3
Other
WATER SUPPLY
Individual Well [] Community [] Public'F''l'
Note: If community well system, must have written confirmation from the State Depar[ment of Enwronmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (i 1/84)
Page 1 of 2
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qll~eH s~q~ ~o uo~i~6!lse~u~ ~ mq~ X~HeA I '~oleq u~oqs amp UO!l~Pflea eq~ ~o s~ pu~ OleJeq pex~;e lees X~ Xq pe~i!peo sv
.g
ITY F ANCHORAGE
~I~NICIPAL O (
c~,O%~.'IrEALTH_ AUTHORITY APPROVAL (HAA)
~.~-.~ ~ <~O~CHECKLIST FEBRUARY 1984
o~ h~',:,~c" '
~ ._ ,~,% ~%O 264-4720
Legal Description
WELL DATA
Well Classificatior Y~ .~. ~:;~. ~>V ~,7~ ~ I~ A, B, C D.E.C. Approved (Y/N)
Well Log Present (Y/N) Date Completed Yield
Tot~'~'l"D~ Cased to Depth of Grouting
Static Water Le~eL...~~ Pump Set At
Casing Height Above Gr~ Sanitary Seal on Casing (Y/N?N.~)..~
Electrical Wiring in Conduit (Y/N) '~ ~ Depression Around....~/efl/Tead (Y/N)
Distances from Well:
Separation
To Septic/Holding Tank on Lot ~-'"--~Q_n Adjoining Lots __
To Nearest Edge of Absorption Fieldon~..~~- ..; On A..d~--~--
To Nearest Public Sewer Line ~ To Nearest Public Sewer
Cleanout/Manhole~ To Nearest Sewer Service Line on Lot"'~
Water Sam pie C~d~by : Date
Water Sa~st Results
Gem-'~ents
B, SEPTIC/HOLDING TANK DATA
Date Installed/c:~ - ~
Standpipes (~N)
Depression over Tank (Y~)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line /
To Water Main/Service Line
Course ~//~
Size /c,c,c, No. of Compartments
Air-tight Caps (¢N) Foundation Cleanout (Y/I~
Date
Last
Pumped
: for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
c:
ABSORPTION FIELD DATA J:~3///3 ~
Soils Rating in Absorption Strata ~--~J~> Type of System Design
Date Installed / ~ - ~ - ~ t Length of Field
Width of Field ~ t~.. Depth of Field
,~Gravel Bed Thickness
'~(~'(~ Standpipes Present (~}'N)
Date of Last Adequacy Test
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
i c~ t..f
/
To Property Line ./~
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present) ~/~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify$ & sthatEN~INEER~ul h av_e_c_bge.,.ked, verified, or conformed to all M(~A and HAA guidelines' ' in effect on the date of this inspection.
Sig~4 ~.gL: R[¥-
Co ~tver, Alask
Receipt NO, /~
Date of Payment
*mount: $
Page 2 of 2 .,.~'
72-026 (11/84)
Time Time ,~e
Date Dete Date
Inspector lnepector Inepector
Comments Conditional Approval
Date Sewer Installed Permit No. Septic Tank Size
Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY ·
Property Owner Be~hard ConstrUct±on, Inc; Phone
MaillngAddress SRA BOX 1698-K, Anchorage, AK 99507 345-1615
Buyer Walter and ~fitzi Crow ·
Address 2369 ~access, Anchorage, AK 9950~
Lending Institution Peoples Bank and Trust Phone
644 W. 8th, Anchorage, AK 276-8080
Address
Realty Co. & Agent RE/NA~ Properties, Inc., ATTN: Will Eason... Phone
~2702 Gambell St., suite 101, An~hora§e, AK 99503 276-2761
Address r
Legal Description . ROt 14, Block 4, North: I4oods .... - ,
NI'-IN ~c~{anus Drive
Street Location
Type,pf Residence
'E~ Single Family
[] Multiple Family No. of Bedrooms 3
[] Other
Water Supply
~ Individual ATTACH WELL LOG. A well Icg is required for all wells drilled since June
1975. For wells drilled prior to that date, give well depth (attach Icg if
available.)
Sew~ .
I~ Individual Year Individual Installed: 1 98 IL
[] Public Utility When Connected to Public Utility:
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING 0AN BE INITIATED.