HomeMy WebLinkAboutPROSPECT HEIGHTS BLK 2 LT 6
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241251 Effective Date:
Work Type: Septic Upgrade Expiration Date:
Tax Code Number: 01513319000
Site Legal Address: PROSPECT HEIGHTS BLK 2 LT 6 G:2541
Site Mailing Address: 8221 PROSPECT PL, Anchorage
Owner: GERACE WILLIAM L & SUSAN M Lot Size in Sq Ft:
Design Engineer: FORGE ENGINEERING Total Bedrooms:
This permit is for the construction of:
8/23/2024
8/23/2025
83569
R1 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
3
Received By: 5 �"`' lw%!—La Date:
Issued By: Date:- �-' ty
ON -SITE SEWER/WELL PERMIT APPLICATION
Parcel 1. D. 0 15-133-19
Property owner(s) William & Susan Gerace Day phone
Mailing address 8221 Prospect Place, Anchorage, Alaska, 99507
Site address 8221 Prospect Place
Legal description (Sub'd., Block & Lot) Prospect Heights, Block 2 Lot 6
Legal description (Township, Range & Section)
Lot Size 83,569 _Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
Initial ❑
Single Family (SF) FN
Septic Tank
FN
Upgrade 0(w/wo
AD U)
Holding Tank
0
Renewal ❑
r-1
Duplex (D) EJ
Privy
El
Multiple Dwellings D
(SF and/or D)
Private Well
El
Water Storage
El
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.
(Signature of property owner or authorized agent)
_#
Permit/Rush Fees: 4 Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: Receipt Number:
Permit No. - Opp-2 q /251 Waiver No.
Permit App_'-'- : - :'-.,'c I
August 5, 2024
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Prospect Heights, Block 2 Lot 6 – 8221 Prospect Place
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot has an existing a 3-bedroom home on the property, so we are submitting
this permit application for the construction of a new septic system. The attached site plan identifies
the location of the home as well as the existing well and septic location. No conflicts exist between
this proposed system and any other well or septic system, whether on this lot or adjacent lots.
The ground surface on the lot actually slopes upward slightly to the area where the existing septic
system is, and where the proposed system will be. From there it does drop off at a short slope
greater than 25%. The new trench will be built on relatively flatter slopes less than 20%, and the
attached profile demonstrates that the effluent will not daylight. Contours are shown on the site
plan showing the grade and direction of flow. Stormwater drainage will not impact this septic
system. The new trenches will be constructed parallel to the slope as much as possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached
test hole log, plan and profile pages for the septic design. If this design is followed, there will be
no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241251, Curtis Townsend, 08/23/24
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=50'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
PROSPECT HEIGHTS, BLOCK 2 LOT 6
FEET
0 50 100
SEPTIC PLAN
8/6/2024
PR
O
S
P
E
C
T
DR
I
V
E
P
R
O
S
P
E
C
T
P
L
A
C
E
3-BDR
M
HOM
E
1010
1005
1005
1000
1000
995
990
1010
TH#1
10'
U
T
ILI
TY
EA
S
E
M
E
N
T
(2) 45' LONG x 5' WIDE, 6" EFFECTIVE
DEPTH ABSORPTION TRENCH
NEW 1000-GAL
SEPTIC TANK
EXISTING SEPTIC SYSTEM:
TANK IS TO BE DECOMMISSIONED
PER CODE AND TRENCH IS TO BE
ABANDONED IN PLACE
MTMT
MTMTCO CO
COCO
EXISTING WELL w/ 100' RADIUS
FS
GARAGE
VERIFY WHETHER OR NOT THE
EXISTING SYSTEM HAS AN FCO
NO NEED TO INSTALL 2CO
BEFORE THE TANK IS THE
HOUSE HAS A FCO
2CO
2CO
A
A
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241251, Curtis Townsend, 08/23/24
PROSPECT HEIGHTS, BLOCK 2 LOT 6
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
DESIGN FACTORS:SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW
PERK RATE: <1 MIN/IN
APPLICATION RATE: 1 GPD/SF
5' WIDE TRENCH SYSTEM
1000-GAL SEPTIC TANK
BOTTOM OF TRENCH: 4' BELOW GRADE
FLOW LINE ELEVATION: 3' 6" BELOW GRADE
450 GPD / 1 GPD/SF / 5' WIDE * 1.00 RED FACTOR [6" DEEP] = 90' LF TRENCH REQUIRED
(90' LF SPECIFIED)
8/6/2024
5'
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
6"
3'
6"
GEOTEXTILE FABRIC
6"
PROVIDE ADDITIONAL FILL TO
ACCOUNT FOR SETTLEMENT
2'
MOA APPROVED SAND
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241251, Curtis Townsend, 08/23/24
1"=10'
SLOPE CROSS SECTION A-A
SEPTIC TRENCHES
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
46%
A
NG
L
E
OF
EF
FLU
EN
T
INF
LUEN
C
E
6.0
FEET
0 10 20
8/22/23
SLOPES APPROACH 30% IN PLACES
PROSPECT HEIGHTS, BLOCK 2 LOT 6
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241251, Curtis Townsend, 08/23/24
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 1
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
0.2
7/15 1
2
3
4
5
6
GW (SANDY GRAVEL)
Professional Engineers Stamp:
NO
PROSPECT HEIGHTS B2 L6
7/15/2024 015-133-19
A+ HOME SERVICES
10:35 1 0
16
10:37
10:39
10:40
10:42
10:44
1' OB
0:17
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
PERC TEST LOCATION
TECHNICIAN: J.OPHEIM
7 0
16
-
NONE
7/23/24
COMMENTS:
SITE PLAN
6 0
16
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
7/15/2024
ML (SILT)
GW (SANDY GRAVEL)
ML (SILT)
GM (SILTY GRAVEL)
1 0
160:52 7 0
16 6 0
16
1 0
161:01 7 0
16 6 0
16
1 0
161:14 7 0
16 6 0
16
1 0
161:05 7 0
16 6 0
16
1 0
161:12 7 0
16 6 0
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241251, Curtis Townsend, 08/23/24
S 59025'10" E 234.17' N
— — - PROSPECT PLACE — — — — — — — — -
7.0'
C'
/ '0 3-STORY
FRAME
HOUSE
_ o
P
ASPHALT Go
DRIVEWAY
22.0' WELL N
N
N GARAGE No
0 22.0'
BUILDING DETAIL 1" = 30'
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (64-47) ARE NOT SHOWN HEREON.
THIS DOCUMENT DOES NOT CONSTITUTE BOUNDARY SURVEY AND
IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY
SURVEY MAY DISCLOSE.
UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE
USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR
ESTABLISHING PROPERTY BOUNDARIES.
JOB # 24092 1 NO CORNERS SET THIS DATE I SCALE 1" = 50'
6101
I
50,
OF
�'. B u Sahz �o f
LS-14837
0 25' 50' <11i1`ROFESSI0NP\_
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 6, BLOCK 2, PROSPECT HEIGHTS SUBDIVISION
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE IMPROVEMENTSAS DEPICTED HEREON EXISTAS
SHOWN IN RELATION TO THE PROPERTY LINES.
DATED THIS 4th DAY OF JUNE, 2024, AT ANCHORAGE,
ALASKA.
FIXED HEIGHT, LLC C.O.A.122554
Land Surveying Services 907.290.8949
225 W 23rd Ave., Anchorage, AK 99503 WWW.FIXEDHEIGHTCOM
Apt ^G 19 r09:!;C;a AA 07,12 ncho-agc-'V'Vell & Pump Set S,0724.'' -
p.1
OevefOPfnent Services bepartment
Building.Safety bjvjsjorj
OM -Site Water 4 WaSfekVater PrograM
47,)G,
;more Road
Mark B
P.C, Pox 196650
C�gic?,
'V - -95C
Arx:�.oraqe, AK 9 7
-111AMM-11 - -11MI041; ifl�t
(907! 343-7904
PUmp Installation Log
WellI Drilling 13fral.it
.
Parcell Ideptificat'jol, NTuInUer: 132-
11 S
—, 1.scri
1 Depfii—m
Property OIwnerNatne Address:
kPrO 5f e C L
'�,ill
"Ttlp Intake Depfll Eelow f Op of wull Casing: Z.1/ f
Pt,mp Made], C
'Riess Riess Adaptier Instaijej.:
Wel-1 D'si"fected Vpon Cornpictioll-? r-vyes
Method of Msinfectiow
CDrjam-,,-ws:
Fe, I i L � D
PUMP LUSU)IerNrqe.- ., z
�7,J rr
Attention; 1-betun-,j,; I
I Msta
'ovide a pum
-z3 i,-Isfallatjon log io .he DSD Withi-, 30 days ("Cpamp installatiola.
;j~ 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
LEGAL DESCRIPTIO~I ' I/
DISTANCE TO: We(I Absorption area ~ Dwelling PERMIT NO.
~Z Manufacturer ~ 'Materi~lJ ~ No. of compartments
~ N Liq. capacity in gallons ~ ,,~.~.~ ~ Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot line PERMIT NO.
,o. o~ ,i.,, / Of each line Total length of linelc~ · Trench width6 inches :Distance between lines.,~,...
~ ~-- Top of tile to finish grade I ~ ~' Material benea~ tileI ' Total effective absprptid a
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~r p..,, Driller Distanceto lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
PIPE MATERIALS OTHER ~
SOl L TEST RATING
REMARKS
PERMIT NO.
APPLICANT HENRY J. SISK JR.
LOCATION PROSPECT DR
LEGAL L6 B2 PROSDPECT HTS SUB
I C: I PRLI T'T'
DEPRRTMENT OF HERLTH RND ENVIRONMENTRL
825 'L" STREET~ RNCHORR6E., RE. ~50t
264-4720
1844 JUNEAU APT ~
LOT SIZE '887120 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: 'FRENCH
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING (SO FTXBR)= i50
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PI]' IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE 80TTOM OF THE E~CAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
'AND THE BOTTOM OF THE E~CAVATION (IN FEET).
SEPT I C:
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.
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROgAL BY THIS
DEPARIMENI WILL BE SUBJECT 10 PROSECUTION.
MINIMUM DISTANCE BETWEEN 8 WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
±00 FEET FOR A PRIVATE WELL; OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY, SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AYAILABLE TO INSURE PROPER INSTALLATION.
F"ERr.1 I T E;:-~. F' I RES C:.EC:EP'IBE~: _-Z--:±.. ~L9 ?'_..4
I CERTIFY THAT
±: I RM FAMILIAR WITH THE REO. UIREMENTS FOR
gN-'--,ITE -,EWER=, AND WELL, S AS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
~:: I UNDERSTRND THRT THE ON-SITE ~EWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE ~5 REMODELED TO INCLUDE MORE THRN ~ BEDROOMS.
CONSULTANTS, INC.
February 4, 1976
R & M No. 656200
Mr. Walter Sandel
1815 South Braqaw
Anchorage, Alaska
Re: Test Hole and Soil Log Report for Sanitary System
Lot 6 Block 2 Prospect Heights Subdivision
Dear b~r. Sandel:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This
investigation was performed in accordance with your request of
February 2, 1976 and those procedures outlined in a letter dated
July 15, 1975, by Mr. Rolf Strickland of the Greater Anchorage Area
Borough Department of Environmental Quality.
A single test hole was put down within the Lot 6 area for the purpose
of dafining general subsurface soil conditions for the proposed
sanitary system. Excavation was accomplished with an auger type
drilling rig and the test hole was extended to a total depth of
19.0 feet below ground surface. The final log prepared for the
test hole has been included in Drawing A-01.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & M CONSULTANTS, INC.
James W. Rooney
Vice President
JWR/pe
xc: GAAB
T.H.1
0.0'
0.5'
SILTY SAND W/Some Gravel(SM)
1.5'
SAND W/ Some Gravel
Trace Silt (SW)
6.0
GRAVELLY SAND W/
Trace silt
Occasional Cobble (SP)
No Scale
SAND, TP~ACE GP~¥~EL
Trace silt
No Water Table
16.5'
. ~9.0' T.D.
Log represenns
Location of Test Hole
Lot 6 Block 2
Prospect Heights Subdivision
R Consultonfs Inc.
V[ANCHORAGE FAIRBANKS ALASKA
JUNEAU
Walter Sande!
Log of Test Boring
_~nchorage, Alaska
0~,re_. ,_-2 4-7~ ,. IscAL~:, 1"=.3..0, IOwN ~¥ ,V~V~ cH~o aY 1Pa~J. No. low~ No. A-01
~ WATER WELL R~CORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologicol 5 GeophysJcolSurveys
['~ .~ ~%~ Drilling Permit No.
LOCATION OF WELL ~ ~m~eJ~' either Ia, lb or Ic.) ,~Z~
Subdivision;:: Lof;l 8lock ~ /~qtrs Section No. Townlhip N~ Range
AND ~IRECT[ON FROM ROAD INTERSECTIONS 5. OWNER OF WELL:
Street Address and Area of Well Lecafion~/O~3~,~ ~.0. ~OX
~/~¢~:~3 ~.'~ Anchora~;e~ Alaska 99510
'2. WELL LOG ~,: Feet Below
< Surfoce 4. WELL DEPTH: (final) 5. DATE OF COMPLETION
2~0 .. 08 - OB -79
Gravel & sand Brown 0 50 6. ~Cable tool ~Rotary ~Driven ~Dug
Bedrock, so~t~ gray 50 79 ~a.~., ~detfed ~Sored ~Other:
..Softer rock, ~ight gray 134 220 ~,,,w.,
Softer Rock, gray 226 230 d~. 6" ~,. ~o 79 ..o,,m W.~h~ 17 ~b~./~,.
Black Rock, med. hard 230 240 d~m. ~.. ro__..O,,*h
Li~ht ~lue, med. hard 740
Black .....
~ar.~ 260 2f~O ' Set belwe,, ff. ond ft.
:;~~ ' ~/ IS. PUMP: (if available) HP
Lengt~ of Drop Pipe ff. capocify g.p.m.
~,: 70T
16. WATER WELL CONTRACTOR'S CERTIFICATION:
15. Wofer Temperoture o ~ F ~ C
This well wes drilled under my jurisdlclion end this report is true to the best of my knowledge ond belief;
Dotten ~ri l!in~ AA05i2
I ufhorlzed Rapresentalive
Form OZ- WWR Ill/SI) Copy Distribution: WRITE- Stole DGGS, PINK- Driller, CANaRy- Customer
Certified Well
For Mr. Hen.r_,y $isk ,.~.
Location ................... .~..Cl.~.: ..6_~_,.J~_l~i.~;~}.._~6:~i~.~.~-~.:_i~.g'~i~i(~_.::i_~.~ ~-;..'.
Date completed ....... ~.t3g.g~.;...~: .:' "i:
Distance to water._...~Q ...... ~E2$...gEg.~..:
' ' ' -0'' ' ::
D~stance to water while pumping ........... 2.~ ....... ' ........ : ....... ..:...L:_Y2::.._.dat ~ .re ':'-
of .......... ~.0D ......................... gallons per hour.._" '
Description of Formation '-. : ;' from
Weathered bed rock (cased)' , ' ~0'- .
Bed rock; casina seated @ 79'- 79
CasinE perforated between6'0'
& 64'. Sbrae water a~s~'.-cor, es
frome rock below. :. '
I certify the above true and correct. - · _ .~ -- '
...................... "'7/ .......... i~}ii'i~'5'F'"~ .............. ......... "':'
DOTTEN DRILLING, CCi . '':..
John'S Road -
.SPENARD, ALASKA
We'advise you, to attach this certificate to yo~r deed. .
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1, GENERAL INFORMATION
Complete legal description
LOt 6; Block 2; Prospect Heights Subdivision
Location (site address or directions) 10300 Prospec~ Drive, Anchorage
Property owner Hank Fisk
Mailing address
Lending agency
Mailing address
Agent ('b~_ry.¢
Day phone 272-2431
Finton Young Mortgage Corporation Day phone
16300 Christian Road Suite 106,
Pn.Han/ CFNTIIi?V 71 :P~,E'IFIC N~3~?TH
1206)248-9744
Se~e, WA. 98188
Day phone
Address 1120 Huffman Road Anchorage.: Alaska 99515
Unless otherwise requested, HAA will be held for pickup:
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well XX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding ;~ank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72~)25 (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 Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Phone
Name of Firms & ~ ~;,~,.~
; -~ ,~ River Loop Road No, 204
Address 1703,,
Engineer's signature
DHHS sIGNATURE
~.~ '7~ 4--f~-~(~) bedrooms.
Approved for
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:- ,~"~'~" ~"'~-~'~"~
Date __?J/~-~?~/ _
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.
72q)25 (Rev. 1/91) Back MOA
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
A. WELL DATA
Well type~lf A, B, or C, attach ADEC letter.
Log present (Y/N) ~1
Total depth 2 ~
Sanitary seal (Y/N)
Date completed
Cased to __
FROM WELL LOG
Date of test f~ --I'"~ = ~
I
Static water level '~/0
Well flow ¢2. '~
Pump level ~
Parcel I.D. MAY
ADEC water system number
Casing height (
Wires properly protected (Y/N) C/
AT INSPECTION
g.p.m.
g.p.m.
Absorption field on lot
Public sewer main
Public sewer service line
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot / ~_.Z.J
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample: ~' - / - ¢/J
Nitrate -.~f~'~.T~oto~'~ ~' %.~%
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed ~ - /~ - ~./. c/ Tank size
Cleanouts (Y/N) ~1 Foundation cleanout (Y/N)
High water alarm (Y/N) /~/¢~
Date of pumping ~-~ ~ ~ -- ~ J
~, ~ J Compartments
~/ Depression (Y/N)
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot / Z ~ On adjacent lots
To property line ~ ~ Absorption field
I
Surface water/drainage / 630 ¢"
!
Foundation - 1-' /~_.
Watermain/serviceline / 0 P
72-0~6 (Rev. 3/91) Front MOA 21 CONTI NU ED ON BACK PAGE
C. LIFT STATION ~ Manufacturer _
Date installed
Size in gallons ~ Manhole/Access (Y/N)
. "Pump off" level at
Cycles tested
Vent (Y/N) "Pump on"~vel at
High water alarm level ~,,~% ~
Meets MOA electrical codes (Y/N)
SEPARAtiON DISTANCE FROM LIFT sTATION T°:
Well on lot On adjacent lots
Surface water
D, ABSORPTION FIELD DATA
Date installed ~ - I ~- - -~' ~
Length /--//. O _ Width
Total absorption area I,¢/Jr'o ¢'
Depression over field (Y/N) kJ
Results (paSs/fail) --v
Peroxide treatment (past 12 months) (Y/N) --
'~ I ~--O ~///~";~-System type T~¢tO¢-~-
Gravel thickness- ~ Total depth l 2.. ~-
Cleanouts present (Y/N) u[
Date of adequacy test -~--- / - ~ I
for ~ bedrooms
~/J~ If yes, give date /d/F~
Soil rating
SEPARATION DISTANCE FROM ABSORPTION FIELD TO: /~-
I o(2
Property line_
Well on lot_ t 2- ~
To building foundation.
On adjacent lots
Surface water
Curtain drain
On adjacent lots /
-~ f~ To existing or abandoned system on lot ~.~
.Cutbank. ~'~ ' 'f' Water main/service line_ ~ O
. Driveway, parking/vehicle storage area - ~:;~rO ¢'
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Waiver Fee: $
Date of Payment
Receipt Number
UNIFORM~ ~ ASSOC'r_ATES
UNIFO! RESIDENTIAL APPRAISAL REPORT
Drive ~- ~ .28.01
LENOER ~.~,'~m~tlONARy v~
~ ~ . ~ ~ I~' ~
Post-It~ brand fax transmittal memo 7671
· _ ,"~ . ~ ~'1~131 ·
I'~ ~.~ ~, ,~.~..~.~_.
-' .~. " 'MUNICIPALITY OF ANCHORAGE ~ ':~' ".
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH .-~:-~
. CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY ~PF~'0~L~:: ~
· OF ON-SITE SEWER AND WATER FACILITY ::~' .~..:~'~'¢~':%:~;';:;~- ":: .. '~."? .
..... -' . . - 264-4720 ' - ' '~:.: ;-.?:.~*[~:~':.?'~/'~':.~:~'~: ,':/~';. ~, ;."."' -. '; ~': :'
'J- ~ ' Applicat;O~:~ate ..: ~. ~~ ~--;- · '
~ :' E v:'-' ~' ~
,1, '. G NERAL INFORMATION . ~ '"' ' ')A'"'- ' '-:; ;'-:":" "?;: -? ":-:~- :, ':? '/ · ':
:" ;?":" (a) Eegal Description (include J°t~block sub'ai~isig~ section township,.range)',? ?,, -::'::'-?~:~:'~:~F,::'~.":~'-.:'L~::'}~ '.':;.~.~"?:~
.., ; :--/ ~ ~ [~:, , ~~_ .... ~:..,,,... ? .F::'-;~7~';;- ~:'.. .--. : ~:._ '_.
-... / / . , , / . , . :.,,:. g:. ~. .../~._--. , - .... ,~. . ,.: ..
' '.:-: ;' ~' Location (address'~r'direcfi'0ns)-~: L /:~.:~. '::~.' :"~'~ ?'~ "-" "-':'~'~'~,~'~?~}"
~ Apphcant Name '~~-,..-~ b~ ....... Telephone: Home .~.~ ,-~ '%Bus,ness ,?~7~ ..-,~/-~.v: ?.
/~ , . . ,.- .-. . ,~ ,-, ~,~;.-.- .~,: .'~.~:,-..~:.: ~,~:~.-~-.;~.._~ . :
)licant Address ..... ~ O,'.~ - '~8 ''" '~~~;'~
cant ~s (cheek pne):.Lend~ng ~nsbtuh0~ ~; Ownedbudde~; Buyer.~ .;:Othe~.~;(exp~ln);.~.,Z:'~-,-'-~;, .'.. ~';:'.~ - ~-~
I8^OJ~d¥' leUO!~!PU°O ~o suJJai
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO~i
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Leg al D escri Pt i ° n: ./¢~. f~'~-7¢'
Well Classification
Well Log Present (Y/N)
Total Depth ~-~-~ Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
/~/~'~'¢'~-~'/-~ If A, B, C, D.E.C. Approved (Y/N)
/ Date Completed
.,~.~., Z/~¢' 7~ Yield "~"
Depth of Grouting
Pump Set At ~-~-L-'~
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
//,~L,¢~ / ; On Adjoining Lots
/~/~/ ; On Adjoining Lots
To Nearest Public Sewer
//,J/.7,~ To Nearest Sewer Service Line on Lot
Comments
xJ ,4
B. SEPTIC/HOLDING TANK DATA
Date Installed '~/'~"~'/'7~ Size /,;¢?...~'0 No. of Compartments 2-
Standpipes (Y/N) Y Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) /f~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ~ ~'~/~ ;for '/~-~,"~
Holding Tank High-Water Alarm (Y/N) /~]7/~ Temporary Holding Tank Permit (Y/N)
To Property Line
To Water Main/Service Line
Course
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /*~"¢" /
To Building Foundation ~'~ ¢:~ /
To Disposal Field ~ ?
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11184)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
'7/'/
Date Installed ~;~
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field: .
To Water-Supply Well //'~'~
To Building Foundation
Lot
TO Water Main/Service Line _
To Stream/Pond/Lake/or Major Drainage Course --
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field __
Depth of Field _ ¢¢
Gravel Bed Thickness (~
Standpipes Present (Y/N)
._ Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots _
To Cutbank (if present) _
Comments
LIFT STATION
Date installed Dimensions
Manho e/Access (Y/N)
Size in Gallons ,"'.
"Pump On" Level at_ j l~,~ "Pump O~--
" ' I at /~._)///~ .~ent (Y/N) ~
High Water A~arm Leve / ~/ / ~¢
Tested for _ /~~ Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N) ~
** Check Pe~i~a Bedroo~ating Against HAA Request
i certify th~/¢c/,~¢~fied, or conformed to all ~OA~nd HAA guidelines in effect °n the date °f this inspecti°n'
Signed ///~///~/~ate- ~ ¢ -
com 4
Date of Paymem _ f ' _ .. ~¢ ' ~ ' %;~.? '~ Engineer's
Amount:S- ~-~ ' ~ ¢
Page 2 of 2
72-026 (11/84)
MUNJCIPALtT¥ OF ANCHORAGE
ENVIq, oNMENTAL SERVICES DIVISION
At.IG 4 1987
THIS SIDE FOR OFFICIAL USE ONLY "
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~..
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC U?ILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ~--~'~
Connection Verified INSTALLER
[]Sep~ic~Tank or [] Holding Tank
Size' 1~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AR EA MATERIAL
4. DISTANCES S~pt,~/Ho,di.g T~nk iAb.orp~o. Ar.~ iS.~e. L,n. ] Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
~ CONDITIONAL APPROVAL <letter must accurate)
· ~ D~,~-E.~ ECEIV ED
INSPECTION APPOINTMENTS [~j~L-P-J ~)~-/
TIME' TIME TIME
DATE DATE DATE
INSPECTO. B INSPECTOR NSPECTOR
...UNIC ........
DEPT, OF HEALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
0CT 1 9 1979
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 R E C E I V ~ D
REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10} days for processing.
1. PROPERT. Y,,OWNER 1 PHONE
MAILING ADDRESS ~ /
PROPERTY' RESI~ _DENT, (If "~-different fromm__ ~ab°ve)~/' ~') __/~./_j_~ ~-~ PHONE
2. BUYER PHONE
MAILING ADDRESS
MAILING ADDRES~j ~.~.~.~.]z~_~ Z~/~./z/
4. REALTOR/AGENT ~]//~ I PHONE
MAILING ADDRESS
STREET . O..2b T, ON-
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four [] Other~
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
7, WATER SUPPLY
I
NDIVIDUAL~
COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date. give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE**
[] .LIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)