HomeMy WebLinkAboutPROSPECT HEIGHTS BLK 2 LT 17A Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231020 PID Number: 015-091-09 Dwelling: *1 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New * Upgrade Name JOHN HALL ABSORPTION FIELD Site Address 0 Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound 9400 PROSPECT HEIGHTS *ANCHORAGE, AK ❑ Other Phone r5u mber of Bedrooms Soil Rating Total depth from original grade 907-346-9402 1.0 GPD/SF 12 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot SEE DWG. Ft. 7.50 PROSPECT HEIGHTS; BLOCK 2, LOT 17A Ft. Fill added above original grade Gravel length Township Range Section SEE DWG. Ft. 50 Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 2.5 Ft. - - Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 750 Ft2 1 N/A Ft. Well 100'+ 100'+ - - 25'+ TANK A Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ 100'+ - _ GREER TANK 1500 Gal. Material Number of compartments Lot Line 5'+ 10'+ - - NA PLASTIC 2 Foundation 10'+ 10'+ - _ LIFT STATION Manufacturer Capacity Remarks PER THE CONTRACTOR OLD TANK WAS DECOMMISSIONED PER UPC Gal. Alarm location Electrical Installed by PIPE MATERIAL House to tank D3034 Tank to Installer D3034 ARM SEPTIC SERVICES dralnfield Drainfield D3034 CO/MT D3034 Inspector GEG BENCH MARK (Assumed elevation) 99.90 ft Inspection 19t 4/26/2023 4/27/2023 Location and description dates: 2n° /4-f po i n -r G nN G 6- 3'd 4/28/202 41h BOTTOM OF TRIM AT NW CORNER OF HOUSE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp o4b�pp Conditional Approval: Date-9ss�o of'?: 4 T ��0� .. Septic System 0� rey A.Games,.. Q fl• CE-79?.3 O Approved Date J / Qp� Pte' 0 Note: this approva�d • es not include well permit requirements. �dpaprOfessi°"°oG' #AECC884 °�DDO�oO (Rev 05/02/18) M PERMIT NUMBER: RECORD DRAWING Y V I N G PARCEL NUMBER: OSP231020 015-099 1-09 PROSPECT HEIGHTS / FCO 2.7 1 27.2 #1; BLOCK 2, LOT 21 MH1 24.9 32.9 i ST1 29.2 36.5 DBLt 31.4 38.4 DBL2 32.7 39.9 C01 j61.9 .1 68.2 MT1 68.4CO2 2.8 114.2MT2 3.1 114.7 / ALL SWING TIES WERE DERIVED / FROM .DWG FILE OF AS -BUILT SURVEY PROVIDED BY FRED WALATKA AND ASSOCIATES, L.L.C. day / Q4 ' EXISTING 5 3� / BEDROOM HOUSE , NEW 1500 GALLON HDPE GREER TANK---,,,\ , I FC q NEW DRAINFIELD PROSPECT HEIGHTS; BLOCK 2, LOT 16A DBL GEG 9T1 OL\Q,RAINFIELD ABANDONED IN PLACE •�` \ .1 � y ENGINEERING - SALES , CONSULTING 3701 E. TUDOR ROAD. SUITE 101 'ANCHORAGE. AK 99507 • PHONE (90713376179 • FAX (907) 336.3246 • WEBSITE•— gam .gine i. cam PREPARED FOR: BARBARA ANN LEGAL DESCRIPTION: PROSPECT HEIGHTS; BLOCK 2, LOT 17A TYPE OF WORK: �,_ SEPTIC SYSTEM RECORD DRAWINGS N SCALE: Ria 1"= 40' `®161p.®®®Tq$ V4 OF C9 ! n • 0. .muK. U.u...•.... e. i... .....•.. .m ONE NUMBER: PAGE NUMBER: o 0_'1 ; !1 ey-A{ess I 907-346-9402 2 OF 3 CF -79 3 ' �w� DRAWN BY: ®®P �, �IZ' `�'-�•••`(` � D.J.G. ®�•................� ••'� DATE: LICENSER® 6/12/2023 #AECC884 PERMIT NUMBER: PARCEL ID NUMBER: OSP231020 RECORD DRAWING 015-091-09 TH#1 TOP OF TANK AT INTLET = 91.91 INVERT OF BUNG AT INLET = 91.20 TOP OF MH = 97.99 r-- FINAL GRADE= 96.92-97.56 NEW 1500 GALLON H.D.P.E. GREER SEPTIC TANK ORIGINAL GRADE AT HIGHEST POINT = 93.9: RELATIVE ELEVATION AT BOTTOM OF T.H. = 75.92 (T.H. DRY ON 4/25/2023) 7.5 -FEET TOP OF TANK AT OUTLET = 91.89 INVERT OF BUNG AT OUTLET = 91.08 GRADE = 94.31-94.81 • FILTER FABRIC INVERT OF PIPE = 89.42 BOTTOM OF TRENCH = 81.92 Ltd rd lid 9 ---m ENG IN EER ING,�SALES CONSULTING 3701 E TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 -PHONE (907) 337-9179' FAX (907) 339-3240' VvEBSRE w,w�.0amessanpneerin9.mm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JOHN HALL 907-346-9402 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: PROSPECT HEIGHTS; BLOCK 2, LOT 17A D.J.G. TYPE OF WORK DATE: SEPTIC TANK PROFILE 5/15/2023 OFaA1 P7,11M A�m C 79 3 .� LICENSE �414PROFEV�`" �. OAF(:rRAA 41 ma"w",' ///YYY Lot 21 i A / 5� N . �,/2 Story Frame House (See Detail A) Lot Lot 20 -o se %o ?o 6, `CO 8° m Wire fence Septic vent (typ) Lot 18A 46.7 Well deok o OH X10p 09 Chain link fence DETAIL A SCALE: V= 50' L'\ Wire fence ptic vent (typ) Lot 16A SCALE: 1 "= 100' 1 , � Chain link fence `SO , QF • A4 4 AW �P• • •S�r- +h 00 �' • 49th •9 ,! Lot 17A 00 00 00 00 rb>\ ®"�, . Elizabeth L Walatko . 18� ,0 ©¢ �� srF�• , • 8036 - LS • •�J7 ��/ 4AW AROFESSI0t4AA- q®� RECERTIFIED 5-09-23 2-0 � J Q AS -BUILT NO CORNERS SET THIS DATE / J I hereby certify that I have performed a Mortgagee's inspection in accordance with ASKS Standards of the following described property: LOT 17A BLOCK 2 SQ PROSPECT HEIGHTS SUBDIVISION / Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 4th day of JANUARY . 2023. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON , FB 22-4 38 40 BE UNLESS OTHERWISE NOTED. p9 907-248-1666 FRED WALATKA & ASSOCIATES, L.L.C. Engineers and Surveyors This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence, structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product 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: OSP231020 Work Type: Septic Upgrade Tax Code Number: 01509109000 Site Legal Address: PROSPECT HEIGHTS BLK 2 LT 17A G:2441 Site Mailing Address: 9400 PROSPECT DR, Anchorage Owner: HALL JOHN C & BARBARA ANN Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: �1»cnt 0 . Q > lle1)artrnet}t Lot Size in Sq Ft: Total Bedrooms: 2/24/2023 2/24/2024 117800 Q 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 s �" . C &_G Date: Issued By: Date: 5 e V, I Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-091-09 Property owner(s) JOHN HALL Mailing address 9400 PROSPECT DRIVE, ANCHORAGE, AK Site address 9400 PROSPECT DRIVE, ANCHORAGE, AK Day phone 907-346-9402 Legal description (Sub'd., Block & Lot) PROSPECT HEIGHTS, BLOCK 2, LOT 17A Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: (N all that apply) Absorption Field ❑ Septic Tank El Holding Tank ❑ Privy ❑ Private Weil ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade 0 Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) x❑ (w/wo AD U) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) 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: ts 5q6~ Waiver Fees: Date of Payment: A1,231;21ja3 Date of Payment: Receipt Number: 09&5-& C7 Receipt Number: Permit No. 510 ,31696 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231020, Curtis Townsend, 02/24/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231020, Curtis Townsend, 02/24/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231020, Curtis Townsend, 02/24/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231020, Curtis Townsend, 02/24/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231020, Curtis Townsend, 02/24/23 / Lot 21 tk� Lot 20 //2 Story Frame House (See Detail a CIS .00 Lot 16A SCALE: V= 100' ,S ' 7 6 ^6o p 3.0 N4. �tamepWUse C,16.0, 26.0 b so 2 Ste CO 0 3 7 iy O Well © ° O O O Y eC 2^O iso k p H Pyo septic vent (typ) Wire fence Chain link fence---_ DETAIL A SCALE: 1" = 50' • : X NOTE: Asphalt and concrete locations d'p are approximate due to snow and ice, p© i\Wire fence / Septic vent (typ) Chain link fence ���..O. ° . q / 0 49th `°y Lot 17A .. .. . . .. .. 4 00: #4 �, *.'Elizabeth L Walatko a �cJ 1p-- , M - LS °°4J AW AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 17A BLOCK 2 PROSPECT HEIGHTS SUBDIVISION / Anchorage Recording Precinct, Alaska, and that the / improvements situated thereon are within the property lines and do not overlap or encroach on the property lying EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON , FB 22 4 39 40 UNLESS OTHERWISE NOTED. p9 adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 4th day of JANUARY , 2023. FRED WALATKA & ASSOCIATES, L.L.C. BE907-248-1666 Engineers and Surveyors This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. J MATERIALS TESTING · QUALITY CONTROL L SOILS [NGINEERING 2204 Clevt d Ave. P.O. Box 10-1126 Anchoroge, AK 99511 277- 0251 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 710 Third Ave. R0. Box 2540 Fairbonks,AK 99707 452-1267 · 456-5155 ACTL-80-1435 Great Alaska Construction ( Jim Bender ) MAI LING ADDRESS 2560 West Tudor LEGAL DESCRIPTION Lot 17-A, Block 2, Prospect Heights LOCATION Prospect Drive NO. OF BEDROOMS 3 [~ NEW [] UPGRADE I Well DISTANCE TO: 110 ~ Manufacturer Liq. capacity Jn gallons 1250 I IF ROMEMADE: DISTANCE TO: J Well I I Well DISTANCE TO: 117 ' No. of lines 1 Length of each line 27½' Top of tile to finish grade Length JAbsorption area 5 7I 54" Width Crib diameter Well Depth Building foundation ' Dwelling Material Width ' PERMIT NO. 800410 Steel 2 Inside length Liquid depth Dwelling 2 2 PERMIT NO. I ! Material Foundation Nearest lot line 22' Total length of lines I Trench width 7,5 '+- 27~ ' / 48-60 inches Material ben~ath tile Depth 8 4 inches Liquid capacity in gallons PERMIT NO. 80n4~ Distance between N/A Total effecti've absorption area 385 PERMIT NO. Type of crib Crib depth Total effective absorption area DISTANCE TO: Building foundation Nearest lot line Class Driller Distance to lot line DISTANCE TO: OTHER PIPE MATERIALS PPVC SOIL TEST RATING 125 SF/BR FNSTALLER REMARKS Able Excavati~q Sewer Pine iSeptic tank PERMIT NO. Absorption area(s) Meets Municipal specifications. LEGAL PERMIT NO. [:EFHRIMENT ~ HERLTH RND EN'v'IRONMENTRL '~'~TECTT¢iN ....... '"L STREET, RNC:Hr~RRGE, RK. ~h-, ~-"4, .-'~_d RPPLICRNT SRYLO~ T. REHM ~. SRFI BOX 2. t5:4 LOC:RTION PF.'Fv-~F'EI.T HTS~%~ .... ~- 3:44-7z~2:9 LEGRL LU~ &,-H ~FROSPECT HEIGHT'~ ~ TVPE OF SOIL RBSORPTION S't'STEM IS: TRENCH MR)':;IMUM NUMBER OF BEDROOMS =: 3: SOIL RRTING (SQ FT,-'"BR)= 125 THE REQUIRE[> SI2E OF THE SOIL HE, z, URPT~!N~_,~z, TEM : / ,/ [:" E F"-rl4 = 11 LE~-413TH= 27/ IS ~: R'.¢" E L [)EF'TH= 7 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SLIRFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET.'.',. THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). F'ERMIT RPPLIC:RNT HRS THE RESPONSIE:ILIT'¢ TO INFORM THIS DEPRRTMENT DI RING THE INSTFILLRTION IN=,FE_.TIuN=, OF RN'¢ WELLS RDJRCENT TO THIS FRoFERT~ RND THE II, ' N.MBER OF RESIDENCES THRT THE WELL WILL SERVE. TI-4C~ .:: 2 ) I ~-4SF'EC:T I ~D~-~S RRB F~E~g~L! BRCKFILLING OF RNV SVSTEM WITHOUT FINRL INSPECTION RN[:, RPPRO'v'RL B'¢ THIS DEF'RRTMENT WILL E:E SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R HELL RND RN'¢ ON-SITE SEHRGE DISPOSRL SVSTEM IS 180 FEET FOR R PRIVRTE WELL OR 158 TO 2~8 FEET FROM R PUBLIC WELL DEPENDING UF'rIN THE TVPE OF FLBLIE. HELL MINIMUM [.I~T~NuE FROt4 R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS ~..~ FEET RND TO R COMMUNITV SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RN[:, MUST BE RETURNED TO THE [:,EF'RRTMENT WITHIN OF THE WELL COMPLETION. OTHER REQUIREMENTS t'lR'¢ RPPLV, SPEC:IFICRTIONS RND CONSTRUF:TION DIRGRRMS RRE RVRILflBLE TO INS_RE FR.FER INSTRLLRTION. F"F~:~-I Z T E:~F" X ~:Eb; E:'E,SEt-IBES: gt.. ~ CERTIF'¢ THRT 1: Z BM FRMZLZRR HZTH THE REQUZREMENTS FOR ON-SZTE SEWERS RND HELLS R5 SET FORTH BV THE MLINZCZF'RLZT~' OF HNE. HLRHBE. 2: Z HZLL ZNbSTRLL TFIE S'~"5TEN ZN RCCORDRNCE HZTH THE CODES. 3:: Z UNDERSTRND THRT THE ON-SZTE SEHER S'T'STEM MFI'¢ RE~ ~F'E ENLRR~EMENT ZF THE RESZDENCE ZS REMODELED TO ZNCLUDE MORE THRN 3: BEDROOMS. LOT .:,I...E 2L17,'::~¢~ _,~...!I.IHRE FEET V4. 0 PERFORMED FOR~ LEGAL DESCRIPTION: THIS FORM REPORTS: CONS-t R. .CTION TEST-LAB Lot 17A Block E~Visual Soils Examihation 1-8.00 , 48TH:;'AVE STE 'C A~CHORAGE, ALASKA ~:: 9950.:5 248:1533 - Subdivision DATE PERFORMED: 8/18/80 Prospect Heights Percolation Test DEPTH SOI L FEET DESCRIPTION ~iO~ES · 3" TOPSOIL Tan Sandy Silt w/ cobbles, · 2.5' dry Tan Gravelly Sand w/ .,. . . Silty Lenses and Cobbles -. 4.0, SP-150 SF/BR ..... Brown Gravelly Coarse Sand, Very clean, dry ... SP 125 SF/BR -15' Z BOTTOM OF HOLE VAS, GROUND WATER ENCOUNIERED : YES, WHAT DEPTH EGEND ~ -- Perc zone ,S - Sample token ~ -- Frozen zone ~- Water table EADING I DATE GROSS TIME I ~RCOLATION RATE: ~OPOSED INSTALLATION: )MMENTS: NO DRAINAGE REQUIREMENTS: See above Et SEEPAGE PIT' ~, DRAIN FIELD [] OTHER ;ST PERFORMED BY: B.P. DATA CERTIFIED BY: Kinney R. Baxter, P.E. DATE: 8~18-80 441 � • �� : �yin �'�'•,-- ��"aiT--:� ""� 7 t'7 a:R''�~~ "'< \t, x� ti - ..xf ifj+r+'�"� ♦vS ... .. :s.. . pi a.wYp ^i'_ 1tv Sim. 264-.,f 4. t �� a� * I" e _ .m _ _ MME -as a�� i3_e 4 •'if.SL"fire t t. i �f f ` arS ' � r • 9 p- ;4' . . ,. WY .. s .. dx . _ .. and ..... r ; .s' ... at .,..'. sem . _ . a. . ' r "a y: •. 13 -5 ryl I/®6/® 6 907® !l j�Loc2tion .............«.6::` ..... ......... .... ..Qr....._.-...... ...L Tate ro p1ete d.._. __.: _ ®.,:,.p:.1 g °-�� ......... ......... 0.1 De elf _ �- : '�:. �..• .�» .�, ...._:» :.�_..... �.:. �_ .� ;�. •�+ [e � 1.:;- 1. - ;� S� .: .,.. � .' . •t. - .. S. `4.' YTS 'R R. Di .� /i�Ci", r »..»+�✓ ... -.mss-_ . ,. ..«-«s»-..._.>--wp.».._.._ N y f16 water while pumping-"~ » � .�� � '.' A a .._'.atrate j;J • t ' w 1 reO Y Yi k y _ 1 IN &1 a4 B� j4 F • : fir. �� .> '� :4 I certify the abov�-tr�ue 'and correct.: •+. �, Via, � „_ t h !► ►CO.f 1 c R ♦ t :i l 1 ! •, SPENARD, ALASKA We advise you to attach this certificate to your deed. i . 1 M1 cr::.. vd+y 'G. •: .s F , wAjQ AM ��• a •s w �z v� F • : fir. �� .> '� :4 I certify the abov�-tr�ue 'and correct.: •+. �, Via, � „_ t h !► ►CO.f 1 c R ♦ t :i l 1 ! •, SPENARD, ALASKA We advise you to attach this certificate to your deed. i . 1 M1 cr::.. vd+y 'G. •: .s ��• a •s w �z v� F • : fir. �� .> '� :4 I certify the abov�-tr�ue 'and correct.: •+. �, Via, � „_ t h !► ►CO.f 1 c R ♦ t :i l 1 ! •, SPENARD, ALASKA We advise you to attach this certificate to your deed. i . 1 M1 cr::.. vd+y 'G. •: .s MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPART~f OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE General Information Application Date 1. (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~bWlo~ ~ ~ Business # Applicants Address Telephone - Home (c) Applicant is (check. one) Lending Institution ~ ; Owner/~u!~~ Buyer~ ; Other~ (explain); (d) Lending ~nstitution ~k/~ P~CI~I~. Telephone (e) (f) Address Real Estate Coo & Agent Address /~--~ Telephone Mail the HAA to the following address: 2. ~ype of Residence Single-Family~ Number of Bedrooms 3. Water Supp_~y_ Individual Well~ Multi-Family Other (describe) Community~-~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. ~ewage Disposal Onsite~ Public~-~ Community~ Holding Tank~-~, Note: If community well system, must have written confirmation from the State Department o~ Enviromnental Conservation attesting to the legality and status. [Page 1 of 2] 5. _Engineering Firm Providing Inspections, Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Z~ ~-~, Telephone ~7~- Address., ~) ~ ~1~ ~.~-.~,=,-,.~,,=R SEAL) ~ .,~.._L;..; ......... ,/'./o · · o"~ 6o / .~- '~ · JUN[: 2~, ~gZl o ~- . , - / c~'~' ':'-:.:.o ,.'~:;.,~ bedrooms By ~--~ ~ ~ ~',"D'a~,A' ....: ° ' '~.t~,'-",,/;~ Disapproved Conditional DHEP A_~_~r ov al Approved Approved Terms of Conditional Approval RR4/e~/D18 [Fage 2 of Z] CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASIQ%o THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. / ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification '~C~, Well Log P~esent (Y/N) y Total Depth ~(p Cased to Static Water Level ~ ~) Casing Height Above Ground ~ H Electrical Wiring in Conduit (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 ~ O MUNICIPALITY OF DEPT. OF HE,LLT:I ENVIRONMENTAL 1985 Legal Description: LDTI7A,~K,~, If A, B, or C, D.E.C. App~oved(Y~) Date Co~leted ~; 9~O Yield ~pth of Grouting Sanitary ~al on Casino (Y~) ~p~ession ~ound ~l~ead (Y~) ; OD. Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ~N~.O ~__.. TO Nearest Sewer Service Line on Lot Water Sample Collected By ~._~ ; Date /' ~'. ~ ~ Water~ Sample Test Pesults ~;,/~ Comments ~ ~' '" "~ ' -- ' . ' Be SEPTIC/HOLDING TANK DATA Date Installed ~zm~ ~O Size Standpipes (Y/N) ~)~ Air-tight Caps (Y/N) y Depression over Tank (Y/N) ~ Date Last Pumped NO. of Q~artments Foundation Cleanout (Y/N) y ' TO Water-Supply Well To Property Line To ~ter Main/Se~vi~ Co~ Counts Pumping/Maintenance Cont/ract on File (Y/N) h~//~ ; for Holding Tank High-Water Alarm (Y/N) ~//.~ Temporary Holding Tank Permit !Y/N) ~//~ Separation Distances f~om Septic/Holding Tank: To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage [Page 1 of 2] Receipt # Date Paid: Amount: 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in _Absorption Strata Date Installed ___~4 /~ ~) Width of Field Square Feet of Absorption A~ea ~ ~ .~ Type of System Design Length of Field ~,~' ~ Depth of Field / ~1 ~ Gravel Bed Thickness ~ I ~ Standpipes Pr, esent (Y/N) 'f'u~) _ Depression over Field (Y/N) ~ . Date of Last Adequacy Test Results of Last Adequacy Test ~~,~ ~' Separation Distance from Absorption Field: To Water-Supply Well_ ~ To P~operty Line /O To Building Foundation ~ V To Existing or Abandoned System on To Water Main/Service Line ;O ~ To CutbaDk(if present) To Stream/Pond/Lake/or Majo~ Drainage Course ~/0 ~ To ~arking Area, or Vehicle Storage Area ; d~ - ~D~ iveway, D. LIFT STATION /~/0~'" Date Installed Size in Gallons "Pump Or1" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Mar~ole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy.. Test. Meets MOA Comments ** Check Permitted Bedrcom Rating Against ~2%A Request I certify that I have checked, verified, or conforme~d to all MOA on the date of this i~_spection. Signed ~-~ Co rap an y-~----/~ ~ KB1/dL/s [Page 2 of 2] NAA Guidelines in effect Date No. ~.~ · 'SEAL ...... %~.,u , JUNE 2u, 1971 .,' ~ ~ ~.,', .'j .~ 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 274-2533 January 22, 1985 Mr. Tobben Spurkland, P.E. 203 W. 15th Avenue, "C" Suite 203 Anchorage, Alaska 99501 SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Lot 17A, Block 2, Prospect Heights, Anchorage, Alaska (8521-WA-093) Dear Mr. Spurkland: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 86 feet and between the well and absorption field to 98 feet on the subject pro- perty for a~bedroom single family residence only. Sincerely, District Engineer SWE/msm DATE'RECEiVED , INSPECTION APPOINTMENTS TIME 1 ~, TIME n TIME DATE DATE J DATE MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~iRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION MAR 3 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~~I[~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROP~Y OWNER PHONE PROPERTY RESIDENT (If different from above) PHONE 2. BUYER MA~UNO ADDRESS ~. LE~mNe~ST~TpT~Op I .HONE MAILING ADDRESS 4, REALTOR/AGENT MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCA~ O 6. TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM NUMBER OFtBEDROOMS [] One [] Four [] Other, [] Two [] Five ,~' Three [] Six *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.) /~ INDIVIDUAL/ON-SITE** [] PUBLIC 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) ,~. ~ - ~ THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX ~ERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY : DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE. DIspOsAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED ~3PUBLiC UTILITY Connection Verified INSTALLER [~Septic Tank or [~]Holding Tank / (J -- Size:. f ~ ~--~ . If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS E~APPROVED FOR, ~'/ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) 1. Name of person requesting approval br'~;~ncy eno ~on~ 2. Name of propemty owner on, ney a~o. ~oni urort ~. Legal description Lot~-/A~ omocK 2, Prospect ~eights ~. Number of bedrooms in house 3 5. Water Analysis: a. Bacterial b. Detergent · Well data: ~f~ ~eti nas not Oeen dug. a. Type ouO~:,~rslO~ Pun~p b. Depth ~/ c. Casing Size 6~ dw ~nis ~s whaL we ~xpect i5 Distance from well to closest existing or proposed: 1. Sewer llne 2. Septic tank i20 f 3, Se~:page Area l JO f 4. Cesspool~ 130' 5. Property Line 60 ~ 6. Other sources of possible contamination, i.eo, creeks, lakes, houses, barn, drainage ditch~ etc. no~e Sewage disposal system. a. b. C, Age of system__ proposea Septic tank capacity in gallons 15OO a - Name of septic tank manufacturer 1. If "home made" show diagram on reverse side of this form. Disposal field or seepage pit size and type~, Distance to property line O~to house foundation__6O e. Percolation Test results~~y_q_d____o_eo.atlse cf lac~. of access f. Percolation TeSt Performed by~.~st, lab .. Use the reverse side Of this form to show diagram. Diagram should include the following information: tS?oper'ty tines~ .well location, house iocation, septic tank location, disposal area location, location of percolation test, and direction of ground slope. ~ The information on this form is true and correct to the best of my knowledge. Siymature~ ~ate Signed TO BE FILL_=ED OUT BY HEALTH DEPART~.~ENT PERSONNEL The above described sanitary facilities are hereby approved, subject to the ........... ~6'lJ_owing con~fions: ..... The above described sanitary facilities are disapproved for the following reasons: ' _. Approval ~s valid for one y~ar following the date of approval. C PJ: cw i /