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HomeMy WebLinkAboutPREUSS #3 BLK 3 LT 7 ?A " MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201219 Work Type: SepticTank Upgrade Tax Code Number: 05057223000 Site Legal Address: PREUSS #3 BLK 3 LT 7 G:0056 Site Mailing Address: 10233 PREUSS LN, Eagle River Owner: RADCLIFFE RICHARD K & Design Engineer: NORTH RIM ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: De partrnent 7/15/2020 7/15/2021 14981 ❑ 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 Special Provisions: ** Prior to construction locate the end of the trench to ensure that the required separation distance be met. Received By: A Issued By: Date: Date: ✓� Id ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-572-23 Property owner(s) RADCLIFFE RICHARD Mailing address 1023.3 Preuss Ln Site address same Day phone 230-4549 Legal description (Sub'd., Block & Lot) Preuss #3 BLK 3 LT 7 Legal description (Township, Range & Section) Lot Size 14,981 _Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field 7 Initial ❑ Single Family (SF) El (,N/wo ADU) Septic Tank F Upgrade FX1 Duplex ❑ (D) Holding Tank R Renewal Multiple Dwellings F-1 Privy ❑ (SF and/or D) Private Well ❑ Water Storage F 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. (Signature of prd-perty owner or authorized agent) Permit/Rush Fees: P�, �. % Date of Payment: Receipt Number: Permit No. ose '0101 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:Oeveloprnent Services\1301ding Safety\On Site Water and WastewaterTon"ns\Client FormsTerrnit Application-doc SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 7/2/20 Number of Pages: To: MOA On-Site Services Subject: Preuss #3 Block 3 Lot 7 Septic Tank Failure The subject septic tank has failed- a new tank will replace the old one. The existing seepage trench appears to be working OK. Please issue a permit so the tank can be replaced. Please review as soon as possible. This is a large lot with no nearby neighbor conflicts. If there is need for additional information or clarification please give me a call. Thanks-Steve Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201219, Deb Wockenfuss, 07/15/20 Preuss #3 Block 3 Lot 7 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: The current septic tank has failed- the seepage trench still functions. No adverse impacts are expected from tank replacement. The easements are depicted on the lot. The slope is indicated in the area of the septic system. No conflicts to neighbor properties. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations.  New 2- compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet.  5 minimum between the tank and trench. 5 to property lines & 10 to house.  4 of cover or insulation is required for tank; an equivalent of 1 insulation for 1 foot soil cover. Tank & solid pipe must be set on well compacted, stable soil.  No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per MOA- sand or pea gravel.  4 diameter cleanouts with airtight caps are required 1 to 4 from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10 from the tank positioned to provide cleanout access towards the tank and towards the absorption field.  All cleanouts must extend to at least ground level.  In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.  Insulation must be placed over any pipe installed under driveways or parking areas.  Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661,  Sewer Service Line is minimum 2% slope.  Septic Tank to be pumped every two years or when required.  Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201219, Deb Wockenfuss, 07/15/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201219, Deb Wockenfuss, 07/15/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201219, Deb Wockenfuss, 07/15/20 ;0 M C N Z M I I 30.0' I Lot 8 � e.rxlz.r SH / I � c an•cMc ,c, i 9.5' Lot 7 z 14,987 S.F. Y U WELL o 2 STORY SHED \ _\CANT w/ PORCH BELOW xF SHED 6.9' 1 STORY RESIDENCE w/ DAYLIGHT BSMT N N Lot 6 u \ 100' PROTECTIVE 1 WELL RADIUS YI 1 SEPTIC PIPES 10' UTILITY EASEMENT F kJ I PLOT PLAN ___ AS BUILT _X— SCALE 11 __ 30' — GRID _ NL 0056—_ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in c , (907) 522-6476 Phone 000p0p�0 (907) 522-4625 Fax Professional Land Surveyors kenOlangsurvey.com c I p F q . 0 jonathanOlangsurvey.com 0'Z-0 I hereby certify that I have surveyed the following described property: LOT 7, BLOCK 3, PREUSS SUBDIVISION — UNIT No. 3 (PLAT No. 71-91) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the __���1 _ Day of __� �a _ ______, "' at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49?H� �*f KENNETH IN Ir I044PFo' ..LS— 202.•' yJOG aR NOo ZFfSSIONAL n AECC963 '.. · 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 PHONE [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION p,~/,,,/~,~'~; ~,~,A~'~" NO. OF BEDROOMS J WelJ Absorption area Dwelling PERMIT NO. ~ DISTANCE TO: /OO / /~ ' ~ ~ ~ ~ Manufacturer ~ < ~~ Material No. of compartments Liq. capacity in gallons Inside length Width Liquid depth /~ ~ IF HOME.DE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO, O Z ~ Manufacturer ~--~ Material Liquid capacity in gallons ~ Well Foundation Nearest ~ot line PERMIT ~O. ~ DISTANCE TO: //~/ ~' JO' 7~ ~ ~ ~ Z No. of lines Length of each line Total length of lines Trench width Distance betweep lines --~ / ~ ~' ~ inches T t I f' ~O~ ~ Top of tile to finish grade ~, Material beneath tile o a~w ~h,~rp~rea ~ inches m Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m ~ DISTANCE TO: Well Building foundation Nearest lot J~ne ~ C~ass Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer Hne Septic tank Absorption area(s} OTHER SOiL TEST RATING INSTALLER A~R~ ~ ~ ~ DATE LEGAL "FHE: [.ENEFI'i-.! D :1: H!EN::!!; :t: Ed'.,! :!: :!!i; 'i"Hti.!: L.E?,iI?i'I'H ,:: 21: N F'EE7 ::, Cd::' THE: 'f'F;:!ENE:H 'THEE E)E:!:::"TH O1::: I:::f TI:E'.EN(31..[ O]:;~: F':£'T' :!::!E; 'i"HE [) ]: :!ii;"F?INC:EE E:E:'T'P.IE%N "I'HE GI:E:E,'I. JN[) FINE:, 't"HE: Ei:CI'F'TCIPI CIF' THE: ET,:':',C:!:::¢v'F:i'T']:Ot'.,I ,::]:N 'T'HE~F;;:!iE: .'1_ fE; I'.,!O :!ii;ETi' i.,.! Lr D'TFJ F:Oi::?. THE E:i!:;i:!:::¢,,,'l_.'i::l._ E)IEt::'TH :1::=; ?',LIE: H):N:[I"iL.ii"'! DEEF:'TH Cd:= EiF;:F:¢v'E:L. E:E/'T!.'.IE:E!:N I:::iND 'I"HE: F!',OTTCIf'! CiF:' THE: liE',:':;(3f::t","F!T :[ ON ':::EN FEET'::'. f::iF'F'L ] Cii;:: F:i T T ~ i'.J LiE G F,:I .... 'THE [..~'~i'.4(~i"i"H I_'), ! MENS :I; O1'.,i ;!; S "FHE I....E '!"i--ii~: DEi:::"T'H Cji:' I:-:i t"t:RE;i'.,iC:H Ot:;;: i::']:'I' Z (~:iF;;:OLii'.,iD Fil'-,l!;) Tt...ii~.; E:OT'T'Ot',I i3I::' Ti-.II-~:7 E; ~t"HI.:~;~iF£ ];S i~,IO SI--TT H]~D'i'H F'OI:;:-: TF;.:.'!:ZN~; 'Tf..iFE (3F;~:Fi',,,'Ei... DEiF:"t"t.-t l:S THE f::ii'.,tD 'i'HiE BOTTCIt',t OF:' THE · Et-,: . -'~ "t'HRT ::I.. ]] FIN ,r': ::'i ','l" ];1::11:;.: .kl;[TH THE f:;...:'J.:..,-J.r-:.l~r.l"h::N .:, F'"I;:' f-~, _.,:"r'~'r- , ....... I--,,'"' . i"U. ,'j Tt"t'~' H,.I',t J..T."'rt~ ...... -~.FF; R",E:"K;II:;::R;~' ' ;2': J' i.,-i];L.I .... t',t.::, I rtL.h. 'I'HE'; .- ,- :il;' 'r t.t'.~DiFt:,~,,z;'T'FtHi~, 'THFCf' TI..-i~ Oi'.~..-S,~TE SEi4Ei~: -'"""""F" · -- ~. ,~;.. -Ir.~...:,::. 1_'.~.~4 ];i:' Tt-lf:' F-'~E;S ;f 3'~ iqC:F:~; .il '::: " .......... ' ..... ~ -.F~-.'.t .~uEt....!::.L., "f'O .[.",!'J;_ ":'i~' i"'iOF.:E' THi'::Ib~ ;~: BEDF;;%iOMS. "tr · f .~ . .r-I ', ~ E: ILi... O Er E GEO',~,. Russell Oyster 694-2774 Soils ~ Foundations Performed for: ._2HNICAL Er DEVEL,, ',MENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 CO. Earl Ellis SOIL LOG 688-2280 Land Development \-' o ~%~ Tel. No. Soil Characteristic) Name: Mailing Address: Legal Description: ~,< '7 Depth (feet) 0 1 2 4 5__ llm 12 CG ]_4 15 Z6 Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: If yes, what depth Drain Field ~'~ C: I~!!:t::~ ']' :i: I::: 'd "I"H(.Yf' ~J {c::,r.'Lh by 't. he ~h,.u"l :i c: J, l:~ a ], :L 'Ly c:)f ~nc;hcirag~:,) (lflC)[~i) arid :!: ~.,,iJ. ], ]. :i. rHilrL, a]. ]. 't,h(~:) ~sy~it.i.:~)m :i,n ac::c:(~Pc!anc:e:.~ ~lJ.'~.l"i ~], ]. VIC)[,~ (::c:~(::lra~i and r~(.:egt.l:l.a'l:. :i.c~n~ I ~J.:l.:l. ~:::~(::ll'~,~:~)i'~e t.,(::) al:l. flC)~:l ar'Icl BLat, ca c:)f (.~:l.a~i!.::a P~zeC:ll..~:Lp~:~me?rlt.:~i aJ.~(::) Lu"~dei".~;~rLand 'ILl"ia'[. 'l:.he c::¢~tl::~ac:::i.'Ly (:)~' t. hc~e '~,.~:;'[.a:l. ;:~y~'L~.~m any (.:~.:,!"i],ai'~g(Dlil(.E, Ii[. ~'.i~].]. r',)~,qL~J,r,~,~, a'~r'l add:i.'L.J.J)rJa. 1 . ,.. :~ .................................................................................................... F ............... by OOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION ,'~ DATE- Started :~:~ / ?//":~:? Ended PERMIT NUMBER DEl'TH OF WELL STATIC LEVEL OF WATER FT. '< ~: DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From From From From From From From From :['w? Ft. to )5~ Q Ft. From Ft. to .Ft. From .i;~?" Ft. to ?~:;f',), Fl From / i, i From , : ~ Ft. to;~,? Ft..f'r%.~.L4 :~ ~:,;dd3t~z?z, From__ Ft. to ; ' i' Ft. .':, ~'~ & ~"~,:~."7, c" z ,'-¢ ~ From Ft. to Ft, ~ ','::;':; <~ ) '~]~7-: 5' ' ~ .." :'~, From :,: ,~ Ft. to_. ~'~. Ft.~' ~ c~*~':3' 1.,'1.::,',:'~,,, c~ /* ~ /'q ' ~ i¢~//d ~":~ ('~ ,/~/'f~./5~' From Ft. to Ft. Ft. to Ft. Ft. to Ft. From ;'~ , Ft. to "~ ~ Ft. From ,!, ~ ~' Ft. to, :.i! [i '.)~ Ft. From __ Ft. to Ft. From :'~ ~: Ft. to '~i ~')~ '[ Ft. From : ."~,~ Ft. to From ~.; t., Ft. to .~;~,~ Ft. From ,; ', Ft. to ¢~:}_Ft. From From From From~ From _ Ft. to Ft. Ft. ~ .......... ~' '-'~ ANCHOkA[.~ DEPT. OF HEALTH & Ft. tENV!nON.MI~g, ITAL PROTECT/ON 9 m9 Ft. to Ft. t.,o E!gED Ft. to__.Ft. MISCL. INFORMATION: DRILLER'S NAME PROPERTY MANAGEMENT AGREEMENT MUNJCIPALII'Y OF ANCHOk~AQE L!NVIRONMENTAL SERVIC?. E iSo8 RECEIVED This agreement between Kc'nC R. Houston and Leora S. Houston, owners of 10233 Preuss Lane, Eagle River Ak 99577, and Nancy Jakabosky, leasing agent, is effective on December 13, 1986. Leasing agent will be responsible for collection of security deposits and all rents. Rent checks minus fees will be forwarded to er~ners within 72 hours of receipt. Owners agrees that the leasing agent may act in all matters of a legal nature in behalf of the owners. Owners agrees that the leasing agent may make property repairs of an immediate nature ~pr up to $ ~~ Any repairs beyond~ that amount must be agreed to in writing by owners. In the event the property becomes vacant the leasing agent will immediately and with dilligence proceed to re-lease the property. Fee: O~¢ners agrees to pay agent $ each month. Agent further agrees to post a monthly accounting of all monies received, or spent, in the behalf of the owners. Kent R. Houston, Owner Leora S. Houston, Owner RECEIVED (gertifieb rtllm og A & L COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ADDRESS I DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. __~ GALS. PER HR KIND OF CASING ~ KIND OF FORMATION: From_/-; From From From. From_/ ' From From From From__ From_ '>c~Ft. to From ]',> 6' .Ft. to_ rom ~.:, Ft. to From (~"_Ft. to ~:~") From_ '/.:? Ft. to 'v:) Ft. From_ '~(' Ft. to_l?),) Ft From /o~2~ -Ft. to /.~[~' Ft. From From From From From From ~ From___ From From /.~'?~' Ft. to_J'7[.,) rt.~g~''vd) g?/ (f/,;/~c)~;g_ From '::l ~ _Ft. to '>~00 Ft.~'L~F' ~,)~. ~' ~oo~d(:::5 From From ,):TP Ft. to ?'[~J Ft..Oe",.~,O ' ' ~' O ~Z,~t::k'. ~"d'~l :~ From From Ft. to_ Ft From Ft. to Ft Ft. to. Ft. Ft. to___Ft. Ft. to_ _Ft _Ft. to__ _Ft,_ ___Ft. to___Ft. ___Ft. to _Ft. Ft. to Ft. Ft. to__Ft. ~_Ft. to__ Ft. _Ft. to___ Ft. Ft. to____ Ft.. Ft. to__ _Ft._ ~.Ft. to__Ft._ Ft. to Ft. __ Ft. to _Ft. .Ft. to _Ft_ DRILLER'S NAME "' :" :": , · ' May 17, 1978 ~77298 Bill Forem~mn G~neral Delivery Eagle River, Alaska 99577 Subject: Permit Expiration A pe~nit issued by this department for well and/or on-site sewer installation on Lot 7 Block 3 Preuss Subdivision has expired since the issue date exceeds one(l) year. In the event you still plan to install tho well and/or on-site sewer system, a new permit is required. The original soil test may be used to obtain a current pe~ito If the well has been drilled, a well log should be sent to this department to document the installation date. If you have any questions regarding tho above matter~ please contact this office ~nediately at 264-4720. Sincerely, Les N. Buehholz, R,S. Senior Environmental Specialist MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 7; Block 3; ~reuss Subdivision ~ o Location (address or directions) 10233 Preuss Lane, Eagle River, Alaska (b) Property owner Kent Houston Mailing Address Telephone: (home) Business (c) Lending Institution SEATTLE MORTGAGE Telephone Mailing Address ATTENTION: Kevin Breeland (d) RealEstate Company and Agent RE/MAX OF EAGLE RIVER - Audrey Mason Address 16600 Centerfield Drive, Suite 201, Eaqle River, Alaska Telephone 694-4200 99577 (e) Mailthe HAAtothefollowing address:(orcheckhere:~,ifholdforpick up.) Listcontactperson and day phone numberbelow: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 4 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~ 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 (Rev. 7/88) Page 1 of 2 '~IJOM S,Ja@U!aUe leUO!SSaboJd @4~ u! suo~ss~ LUO JO S JO J J@ JOb alq!suodseJ ~ou s! a6eJoqouv bo ,~!lBdio[un~ aq/'panss! s! atBo!bBJeo e eJojaq elep ezXIBUe Jo suoi],o~dsu! ]onpuoo lou ap SHHE] jo saeXojdu~a 'sluaLuaJ!nbaJ a~els pub IBJepel u!B1Jeo ,~tsBes al Jap Jo u! suoRn~Rsu! 5u!puel J!eql pub satuoq bo sJaseqoJnd al Asa]Jnoo e sB s!ql seop SHHQ aqJ. 'B)tSelV to alB1S aql u! paJe~st6aJ Jaau~l~ue iBuo!ssaloJd ~uapuadepu! 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SI ~a~sXs lesodslp ]a~e~a~se~ Jo/pue Xlddns Ja~e~ a~!s-uo a~ 'uoBoedsu! pue uoBe6BsaAu~ X~ ~o~J pue sal[~ a6eJo~ouv ~o X~!ledp!unbl a~ ~oJ~ peu~elqo uol~e~Jojul e~ ua peseq ~BM~ X~[JeA ]e~Jn~ I 'u!aJaq Pa~eo!pu! aJn~onJ~s ~o adX~ pue s~oo~peq ~o Jaq~nu a~ Jo~ a~enbepe pue leuoBoun~ 'ales s~ ~a~sXs lesodslp ja~e~a~se~ JO/pue Xlddns Ja]e~ a~!s-uo aM~ ]e~ s~oqs leAoJddV X~po~]nv ~leaH si qt ia ~o!~eS[]gaAUi ~ leq~ ~l~JaA I 'Moleq uMoqs atep UoBep!IeA aqt jo se pue olaJaq pax!~Je IBaS X~ Xq Pa!~BJaO sv NOII~O~NI QN~ ~a 'HO~a8 ~1~ '3.LS3& '3HO~AO~dSNI ONIQIAO~Jd ~1~ ONI~aaNION~ 'g 4 ~4~----~-'% MUNICIPALITY OF ANCHORAGE (MOA) ~ ..~C'60~,~_ ,~ Health Authority Approval (HAA) //~. · ~.~ 0~ ~C~5~ CHECKLIST- FEBRUARY 1984 ~ ~.,c,~h~~ ~ 343-4744 ~ Well ClaSsifl~ation~~~O~ If A, B, C, D.E.C. Approved (Y/N) ~ Well Log Prese,t~N) ~. Date Completed &'~ ~ Yield ~' ~ ~9~ Total Depth ~' Cased to~,~~ Depth of Grouting ~ ~ ~ - ~ - ~o) . Static Water Level ~ ~ ~ Pump Set At 1_~ ~ Casing Height Above Ground ~ ~ Sanitary Seal on Casing ~N) ~ Electrical Wiring in Conduit~N) ~ Depression Around Wellhead (Y~ ~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~ 0~+ ; On Adjoining Lots ~o~ + To Nearest Edge of Absorption Field on Lot ~ OO ~ ~ ; On Adjoining Lots ~ 0 0 ~ ~ To Nearest Public Sewer Line N ~ To Nearest Public Sewer Cleanout/Manhole ~ To Nearest Sewer Service Line on Lot ~ ~ Water Sample Collected by ~ ~ ~ ~,~~ ; Date ~-~~ Water Sample Test Results ~~~ -- ~~ ~ ~ I~~ Comments ~Z~ ~~ ~ ~~~~ ~ . ~ B. SEPTIC/HOLDING TANK DATA Date Installed/,O-'~-'-~ Size Standpipes N) y Air-tight Caps Depression over Tank Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) IA.- No. of Compartments y Foundation Cleanout(~)'N) Date Last Pumped ~ / ~' ; for ' Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line I. ~ ~.'~ To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation ~-7---! To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _ Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/~ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well \ C::~::~ ~ A- Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present?Al) Date of Last Adequacy Test To Property Line To Building Foundation \(.~x..~ Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments '~')~..4,-.~'~."~, '~::~\,~ To Existing or Abandoned System on ; On Adjoining Lots '~ / To Cutback (if present) D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) ~ ..... "Pump Q~ ~ High Water Alarm Level a~A'F'----~-~ f.----~'- Vent (Y/N) Tested for ~~....._.~ Pumpin9 Cycles during Adequacy Test, Meets MOA Electrical~ Comments ~ ~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date _ MOA No. p.'a~le River, Alaska 99577 72-026 (Rev. 7/88) Back Receipt No.. Waiver Fee: $ Date of Payment Page 2 of 2 ~ C,~1'~'-~ ~ MUNICIPALITY OF ANCHORAGE ' ENVIRONME G D ~ REQUEST FOR APPROVAL OF INDIVIDUAL WAT ~ 'FACI~~ ~ ' ' dRECTION8: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing, pROPERTY OWNER BUYER DDRESS (If different from ab ~pJaON E p~©NE ESS ION 1 PHONE ~,1 LING ADDRESS I REALTOR AGE"T -- I P,ONE TYPE OF RESIDENCE -- [] One [] Four [] ~/SINGLE FAMILY []/. Two [] Five [~ MULTIPLE FAMILY ,~ Three ~ Six Other_ 7. WATER SUPPLY ~-~NDIVIDUAL* [~ COMMUNITY [] PUBLIC UTILITY SEWAGE DISPOSAL SYSTEM ~1N DIVI DUAL/ON"SiTE** * ATTACH WELL LOG. Awell log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ~ -*if individuai/on-s re, g Ye instaHati°n :ate,~/~--~'/' - '~': If system is over two (2) years old an adequacy test is require [] PUBLIC UTILITY by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS INSPECTOR DIRECTIONS: TIME D~TE RECEIVED TIME DATE INSPECTOr--- 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLy [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [~INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified. []Septic Tank or [] Holding Tank Size:~Z_.~'~ ~L3 If Tank is homemade give dimensions; TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] OTNER [] TWO [] FOUR [] SIX PERMIT~UMBER ~EPTH OF WELL DATE DRILLED LOG RECEIVED ~ ~; .~r~ ..... PERMIT NUMBER -DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Lot [~ APPROVED FOR ~')~"' BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) __ [] DISAPPROVED /~ LEGAL DESCRIPTION 72-010 (Rev, 3/78)