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Home My WebLink AboutALPINE TERRACE BLK 3 LT 7Alpine Terrace Block 3 Lot 7 #015-243-12 Municipality of Anchorage . Development Services Department ~,.,.:~o On-Site Water & Wastewater Program, 4700 8outh Bragaw SL ~ P.O. Box 19~L50 Anchorage, AK 99519-6~50 www.d.anchomge.ak, us (907) 343-7904 Page 1 of On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:.. SW010212 PID Number:._ 01,5-243-12 Name:coRY SHELTON WastewaterSystem: r-I New · Upgrade A~dre.: ~Sr ABSORPTION FIELD ~SF 11900 CIRCLE DRIVE: Pt'°ne*(907) `346-0644 `3 a Deep Trench 13 Shanow Trench 13 Bed CIMound · Other * 1.45' IdAX LEGAL DESCRIPTION 2.o ~o~ ~ .at: elo~ Sub~M,ion: ~.~ ~, ~ t..t~ ~ ~ ~..: ~ ~ ~-'~"~' P~ 0.46 et 7 .3 ALPINE TERRACE 1' MAX rownlhlp: Range: ~ecUon: nl ~ .ee~ -~.-~ ~ ~ ~ ,~O~L/ - - - SF'E DWG WELL: D New [] Upgrade 12 rt 5~ 2 ~ (~.~ ~a.c): T~ ~ ~" T~ ~ ~ D 3034/ 1.25' HDPE / r~ ~ 350+ s~ ~ ~ ~ ~, ~ ~ ~ L,~ "~ DENALI 7/25/2003 SEPARATION DISTANCES D Septic a Holding "S.T.F...P. n Other ~mm To TS~enUkc Ab~F~ie~d~°~ Sta~onlJft HoldlngTank ~..~/~'~'~ ANCHORAGE TANK 1250 Well 100'+ 100'+ 100'+ -- 25'+ STEEL 2 s~,o=, Wot,r ~00'+ ~00'+ lO0'+ - - LIFT STATION Lot Une 5'+ 10'+ 5'+ - - 1250 ANCHORAGE TANK Foundat;on 5'+ 10'+ 5'+ - - TIMER TIMER 45" Curtain Drain = N(iNE KNOW 1~29 OSI HHF M.O.~. BENCH MARK Remarks: ~ ~ *TO TOP OF SANO SOUTHEAST CORNER OF CONCRETE SLAB AT *OLD SEPTIC TANK WAS ABANDONED PER UPC. BASE OF STAIRS ON WEST SIDE OF HOUSE ?"i Iq/. Inspections performed by: AWWC, INC. Dates: lSt2nd 7/24/20017/25/~001?"'L["~.~,"li~ ......... ~'"'I 3rd 7/25/2001 ""~':~" '~ t.F :.--_--~:~-": .... .; Department of Health and Human Services approval '~, ~,,,.~ ,,-' ....... R~vlewed and approved by:, Date: ,~, BUILT DRAWING ,,t~,.rr .uue~.: AS 01 SW010212 - ST1 57.015 ;.3.305 ST2 60.545 ~8.765 JJ ' MT~ 5~.80C 5~.860 ,,~3~'~ / / ~. I / ENCROACHMENT WAS O~S_._C~R_._E~....Ot~_NO Er J PIPING, ET(:., WAS REM(~/~ FROM 'TH? I / 100 FOOT WEU. RADIUS. I / ?~.~,~',,,?.' ', / / / ... / ./ ~ ~///A~) ~ x~-- .... ~-- ,~./. ~ - x ~",~x \ - "--- ..-. .... ALASKA WATER & WASTEWATER ~,~~.w.u. ?~.?"~9 1 ~~~, ':.,~' 242-9559 I CORY SHELTON (907) 346-0644, 2 OF 3 /0~'.., c~ ...' .~ ~ ~,,~o,= ~{~;.. ............ ..;~ A~INE TERRACE; LOT 7, BLOCK 5 AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE (ISF) BUILT DRAWING A~z~.j -- 015-24~-1 pERMIT NUMBER: SWOI0212 Af ~f' 94~ UON ~ ~ ~L~ F~RIC ~ ~ R~ G~ / / I / --.. - 94.98 / / ~R UNE ~ - 95.~ ~S~ WATER & WASTE~VATER ~ , , GON$ULTANTS, lNG. ~.T.S. PROFILE AS-BUILT OF SEPTIC SYSTEM UPGRADE MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 27, 2001 Expiration Date: Jun 27, 2002 Permit Number: SW010212 Legal Description: ALPINE TERRACE BLK 3 LT 7 Design Engineer: 0041 AK Water & Wastewater Consultan' Owner Name: Cory Shelton Owner Address: 11900 CIRCLE DRIVE Total Bedrooms: 3 ANCHORAGE, AK 99516-2532 Parcel ID: 015-243-12 Site Address: 011900 CIRCLE DR Lot Size: 43000 SQ. FT. Permit Bedrooms: 3 This permit Is for the construction of: [] DisposalField [] SepticTank [] Hold[ngTank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. / Date: ~ --2 7--0/ Municipality of Anchorage Development Services Department Building Safeb/Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (~0~ ~-7~0~ ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-243-12 Property owner(s) Mailing address (1) Mailing address (2) CORY SHELTON 11900 CIRCLE DRIVE. ANCHORAGE. AK 99516 Permit Number Day phone Zip Code Legal descrlpflon (Lot, Block & Sub'd.) ALPINE TERRACE SURDMSION: LOT 7. BLOCK Legal description (Section, Townshlp & Range) N/A Lot Size C/z~ C~O ~ Number of Bedrooms THIS APPUCATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade Well Only [~ Water Storage THIS PROPERTY CONTAINS: Hot Tub [~ Swimming Pool Therapy Pool [] ~E] water Softening Unit I certify that the above Information Is correct. I further certify that this application is being made for a Single Family Dwelling and Is In accordance with applicable Munlclpal codes. ALASKA WATER &: WASTE-WATER CONSULTANTSf INC. Permit Fees: ,.a~,~O Date of Payment: Receipt Number:. ,.~ ~ ~'~' Walver Fees; Date of Payment: Receipt Number:. ALASKA WATER & WASTEWATER CONSULTANTS, INC. June 13, 2001 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 7, Block 3, Alpine Terrace Subdivision (Bottomless Intermittent Sand Filter - ISF) To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing septic system consists of a 1000 gallon septic tank and a dual trench type drainfield. The existing trenches are surcharged and must be upgraded. We are proposing that a 1250 gallon S.T.E.P. tank and a Bottomless Intermittent Sand Filter (ISF) system be installed. Comments regarding the proposed upgrade are summarized as follows: 1. GENERAL: A test hole was excavated in the south-west end of the property to determine an area suitable for a septic system upgrade. Due to the limited space with suitable soil to support a septic system, it is our opinion that a Bottomless ISF system is the most practical option. 2. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 2 gallons/day/ft2 should be used. 3. DRAINFIELD DESIGN: Bottomless Intermittent Sand Filter (ISF) a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate for ISF: 2 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 225 ft2 f. Effective Depth below pressure pipes: 3+ inches g. Width: 12 feet 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com h. Length: 30 feet. i. Effective absorption area = 360 ft2 j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow' emitterline, 1/2 inch I.D, "Anchorage Tank". I. Sand Material: In accordance with M.O.A. latest standards m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the//8 sieve. We are proposing to excavate down to a depth of 3.5 feet (maximum - remove all organics), place a minimum of 6 inches of sand, install the air supply line, and cover it with i.5 feet of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 4. SURFACE WATERS: There is no surface water within a 100 foot of the proposed septic system upgrade. S. TOPOGRAPIIY: As can be seen on the attached topographical drawing, the area proposed for the septic system upgrade is generally flat. In short, there are no slope concerns. 6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with DtlHS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Development Service Department office (4700 South Bragaw St.). 7. CLOSING: I am open to any suggestions from your department, which would be an improvement to the ~roposed design. I am unaware of any adverse impacts this installation would have on ad: acent wells or septic systems. If you have any questions, please contact me at 337-6179. Thank'tou for your assistance. Jeffr, !}~ ( amess, P.E., M.S. Presitk~t~ NOTE: Attached is a site plan drmving, a design drmving, a detail drmving for the ISF, one soil log, a topographical site plan, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fa,x: (907) 338-3246 * Website: akwwc.com ALPINE TERP~CE ALP~Nr 1T. RR~'E ! / LOT $, BLO¢~ 4 // .............. ~-~ /I ~ ~ ~ I .... ~,~,~ ......... , / ~ ~; ~,.~~; ..- -~.:~ ~ .~ ./~ ;,' ,. ..- /',~~ /~ ~ · / ~ ~2: ~_~...c ~ "-" L 3 foe 0~, / I I~/ ~X' ' ' ' -- [[ ' II // I .%_X - ~,,,~, ,, , . IX'x , "' ' "' " '' ' ~I' '--- _--- , , ~,,.,~,~ [i~ ' ~ ~ ~ LOT 4, BLUE 3 I I ~ ~INE ~R~[ ~T 1, BL~K 4 I ~...w. ~SI~ ~TER & WASTE~TER '~3>..~. ~LP~NE TER~XCE~ LOT ~, BLOCK ~ SITE P~N T~: *,IR Coe~rssa~ $:.~-L ~C ~ ~TmH T~z ~ / / ~ THE WE~ ~11 SHOWN / , / ~ ,.~ / / I I , CONSULTANTS, INC.~ ~ ~ w . ] ~ * CORY SHELTON (907) 546-0644. 242-9559 2 OF ALPINE TERRACE: LOT 7, BLOCK5 DESIGN OF SEPTIC SYSTEM UPGRADE (ISF) '~A%~ ., P~N VIEW / / ~fL~ f~ - /., ~AY N ~ 5~. ...:~~~'-~-' ,,"'~ 2 f~f~N.~ fL~ ~~ 2'. ~g'~ PROFILE VIEW J.w.u. AI~SI~ 5YATER & 5YASTE~YATER ~ >R~ FOR: PHON~ NUMBS: P~[ ~U~B~: CORY SHELTON (:907) ~46-0644. 242-9559 3 OF ALPINE TERRACE; LOT 7, BLOCK ~ '"'" ~[ OF WORK: DETAIL OF BO~OMLESS INTERMI~ENT SAND FILTER (ISF) ALASICz~ WATER & WASTEWATER q~o;." 4; i ~, j~ '..X' CONSULTANTS, INC. - ........ ~o~ O~C~ON: ~N[ ~c¢ SUBO~S~O~; tOT 7, SLiK 3 /~} ~7953......' PERFORMED FOR: CO~ & ~ SHELTON DA~ 5/11/01 '. (f o~cs ITESl HOLE ~1I 3 4 GC 0L GROUNDWATER ~2.0 5/~/01 ~4.0 5/~5/m ~ t ii I ~'=~oo'1 10~~}~ ' ~1 DATE RE.lNG CLOCK NET TIHE WATER LEVEL NET DROP TI~E (HINGES) RE. lNG (INCHES) 12 2/25/01 1 12:56 - 6' - ~ 2 1:26 30 MIN. 2 1/2' 3 1/2' 13 3 1:26 - 6- - 4 1:56 30 MIN. 2 3/4' 3 1/4' 14 5 1:56 - 6- - 6 2:26 30 MIN. 2 3/4' 3 1/4' 15 PERK ~ B~EEN 6.5' · 7.0' W~ NOT U~ BEMUSE 16 MOULD W~ SEEPING ~OM 4.5' ~D RER~NG ~E HO~ THE DUO, ON OF ~E ~. ~IS SEEP ~Y ~ BE~ 17 ~USED ~ ~E O~R ~ON OF ~E O~ ~M. 18 19 PERCO~TION ~TE 9.2 (HIN./INCH) PERC. H~E DIA. 6' (INCHES) TEST R~ BET~EN 3.0 FT. ~D 3.5 2 CO~ENTS: PERC-HOLE W~ PRE-SO, ED FOR 4+ HOURS. BOSOM OF ~E PERK HO~ W~ NOT I~0 ~E ~ ~%R. PERFORMED ~ A~ WATER · W~ATER I. JEF~ ~ ~NESS. CE~ ~T ~IS W~ ~ERFORMED IN ACCORD~CE WI~ A~ ~A~ ~D MUNICIP~ GUIDEUNES IN E~CT ON ~IS DATE: DEPTH TO DATE GROUNDWATER 12.0 S/il/01 14.0 5/~5/m 15.0 5/25/01 Senf By: Alaska Watee an0 Wastewatee Con; 907 338 3246; Jun-14-01 17:15; Page 2/4 PROPERTY OWNER MAINTENANCE AGREEMENT ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated ~,//~"~ ,200J_, is made between the MunicipalRy of Anchorage Department of Health and Human Services (DHHS) and the property owner(s) of This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The properl7 owner(s) agrc~ to the following: The property owner(s) will have an annual inspection of the system performed by a registered professional engineer. This inspection shall verify that all effluent and air pumps, timers, and alarms are functioning as designed. Any deficiencies shall be corrected and the engineer's statement that the system is functioning as designed shall be filed annually with the DHHS. Property Owner Name Property Owner Name . (Notarize Here) State of 7~.~a'.g · ludic~Dis~ct 55. Il year ~, b;for; me, ~ ~d~i~ ~ ~ublic, pc~on~ly ap~cd: wi~ ~s~t ~d ac~owl~ged ~at he/she/~e~ ex<utefl ~e s~¢ for ~e pu~ses ~ereLa con~. In wiJ~ess whereof. I hereunto set [ny hal:~l"a~d (Notary's printed ~e) My co~ssion expkcs: .TLI,I 14 2~1 L::~:19 91~' 338 3246 PAGE.02 /~/- ,~-----~ MUNICIPALITY OF ANCHORAGE (~~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO'[EC'rlON ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-~qlTE SEWAGE DISPOSAL SYSTEM AND/OR WELl_ INSPECTION REPORT [] UPGRADE ' MAILING ADDRESS LEGAL DESCFIIPTION LOCATION C/ ~ · '1. ]Well · DISTANCE TO: ~ M~ufacturer '~ -- M~ ~o. of co~partmeats ~' Liq. cap~city in gallo~s ~ ............. Inside length Width i ~O I~ HUIVI~VlAU~: Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons Q Well Foundation Nearest I~ line PERMIT NO. ;~~ No. of lines~ Lengthen_ of,ach~. ~oline' Total len~¢lines. Trench~i~h__ inches Distance bet ween , i n~ ,~, ~ ~ Top of tile to finish grade I Material beneath tile ~ Total effective absorption area Length Width Depth PERMIT NO. ~ ~ 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 PERMITNO. ~ DISTA~C[ TO: ~uildin~ foundation Se~er line Septic tank Absorption area{s) OTHER PIPE MATERIAL~ SOIL TEST RATING Rev. 3/78) RETURN TO: Division of Geologlcal and 3001 Porcupine Drive (Tele. Anchorage, Alaska 9~501 ~ystcal Surveys (DGGS~ ~ne: 277-6615) WATER WELL RECORD Drilling Company Name STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES U.S.G.S. Local rio. Drilling Permit No. .OCATION OF WELL 1 Please complete either la, lb, or lc, a.u.L. la. Borough Subdivision Lot Block lb, Fraction Section No. Township Range Meridian iml,: 7 , , , .,, lc. Dlstanca and Direction from Road ,ntersectlons 3. 0~ER OF WELL: ~¢ e/e,~ Address: Street Address and Are~ of ~ell Location 2. WELL LOG Feet Bel~ q. WELL DEPTH: (completed) Surface Elevation gate of Surface ~ C~pletion Haterlal Type Top Bottom ~ ft' -i~ ~ ~ ' U /a 1~ ~Auger ~Jetted ~red ~Other: ~ ~.~ /, / -~ ~ ~ ~.USE: ~ '- ~ ~' ' in. to ft. Depth 8. FINISH OF WELL: Type: ~ ~ / Slot/Mesh Size: Length: - Set bet~en ft. and ft. Fittings: e. STA~mC VRT~R ~VE~: /~ ft. ~A~ve ~eelow land surface Type of ,e.s.r~.t: ~uj ~m 10. PUMPING LEVEL below land surface ft. after hrs. pumping ,,, g,p.m. 11, ~ELL H~O COMPLETION: ~ In Approved Pit ~PJtless Adapter ~ lnches above grade 12. GROUTING: ~el) Grouted: ~Yes ~'~ ........ ~Neat Leant ~Other: ,,,~%1rfiLII Y ~F ANCHORA~ ~E ~a ter la 1: DE~T. OF ~EAe~n ~ 13. PUMP: (if available) HP ENVIRON~NTAL PROTECT:C,; ~ ~ ~ ~ Ty~e: Sub~rsJbie U~l ~ ~ I~gU ~ Jet ~Other: RECEiVk ) ,~. RE.ARKS: t5. WATER WELL CONTRACTOR'S C[RTIFICATION: This well was drilled under my jurisdiction and this re~rt ts true ~o the best of my knowledge and belief: ' ~egJstered BusL~ssCNa~ - Contrect License Number Au:horized Representative [Form 02-~R Copy. Distribution: ~HITE - State DGGS, PINK - Driller, CANARY - Customer PERI',', I T NO. APPLICANT BEETER CONST. LOCATION CIRCLE DR. LEGAL ~~. DEPRF.'.TMEf'~T r HEALTH RN~ EN,/I~.ONME~TRL '0TEE:TION 825 '"L STREET., ANCHORAGE., Ak.. . ~64-4720 klELL Rf~[-, ,3f4--5 I TE =.EL..IE~. PEF.~I I S. R. R. ~541-E LOT SIZE 4eeee SQUARE FEET TYPE OF SOIL RESORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING 7'HE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:,EF' T H= }'. -'5 LENGTH= 84 GR R'...'E L DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND RND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCRVRTION (IN FEET). F.:E,3. LI I RE[:, SEPT I C TFtr-IK S I ZE= :1.250 ,]FtLLOr-IS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTRL. LATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. Th.lO (2) I NSPECTIO~S ARE REm~IJIRE[) BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR ~50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM 8 PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. NELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE NELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERfd I T E)~P I RES DEL]E~IBER 3:L.. 198E'~ I CERTIFY THAT I: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. . ~IGNED:_ RF'PLICANT ~ETER CONST. / ! I__, UED BY__ _DATE_."7 / 6-- V4. O SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2224 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 -7 8 9 0.--- 4. S- SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS PERFORMED BY 72-008 (7/76) __ Il- Ij.l,,~ ~L.., ENCOUNTERED' Il,s-- I ~' DEPTH?IF YES, ATWHAT Gross Net Depth to Net Reading Date Time Time Water Drop RATE (minutes/inch) TEST RUN BETWEEN . FT AND FT CERTIFIED BY:. -- DATE: Municipality of Anchorage ~' ~. Development Services Department ~"' Building Safety Division On-Site Water & Wastewetar Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Expiration Date: [ ! -,,,~. - o I Complete legal description ALPINE TERRACE SUBDIVISION; LOT 7, BLOCK 3 Location (site address or directions) 11900 CIRCLE DRIVE Current Property owner(s) Mailing address Lending agency CORY AND KATHY SHELTON Day phone 348-0644 11900 CIRCLE DRIVE~ ANCHORAGE, AK 99516 Day phone Mailing address Real Estate Agent Mailing address MANY E$COBEDO JACK WHITE Day phone 762-5854 Unless otherwise requested, HAA will be held by DSD for plckup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTE'WATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paregreph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: ,4/aska Water and Wastewater Consultants, Inc. shall be pald $1,400.00 at, or pdor to closing for the engineering ean/fcas provided. 4. STATEMENT OF INSPECTION BY ENGINEER , As ca~'fied by my seal affixed hereto and as Of the validation date shown below, I redly that my Investigation, based on procedures outlined in the Health Authodty Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and ~ of stn~cture Indicated herein. I further vedfy that based on the information obtained from the Municipality of A~chorage files and from my Investigation and InspecEon, the on-site water supply and/or wastswater disposal system Is(are) In Compliance ~th all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm., ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Address . 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Phone. 337-6179 Date ~//////~' Engineer's Comments: In conducting this evaluation, AMiWC, In~ attempted to provfde a thorough, conscJentious engineering anal~ls of the ~/stem in accordance ~ ADEC and MOA DSD Guid~lines & Regulations. The reported results desctfbed the performance of the system under the conditions ancounter~d at the time of the test, and separation di'stences measured to readily identifiable toatums. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate dudng the ~,ser, and the water usage of the family being son/ed by the system. These conditions are ~utslde the conb'ol of the evaluator of the system. ~atisfactoq/ ~est results do not guarantee future perton'nance of the system, nor do they guarantee ~at there are no hidden defects or encroachments. AWWC. Ir;c, can therefore not pro~de any warranty or fu~re estimate of how long the system Mil continue to meet the operattonal requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any o~her person or I~arty Is not auther~zed, nor v~ll It confer any legal dght whatsoever. DSD SIGNATURE - ~ Approved for, '~ bedrooms. Disapproved. CondiUona, approval for . bedrooms, with the fllowing sUpulatlons: ~.~ ,,,, ,, ~.;. Note: The welZ for this property meets exfst~n~ S~ate add Municipal nitrates Present. I~ ~s sue~ested ~hat oer~od~c te~t~n? he pPr~n~ed ~m ~snre ~hff conc~ntration is JO.O mg/1. Mor~ infom~ion on nitrstes is avntlnble from the Om-S~te Services Program, at 343-7904. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date:, Municipality of Anchorage Development Services Department 8u~O Saf~y DM~n ~ W~ter & Wastwmter Program 4700 South Bmgaw 6L P.O. Box 196650 Anchorage, AK e9519-6850 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescfl~on: ALPINE TERRACE SUBDNI$1ON; LOT 7~ BLOCK 3 ParcellD: 015-243-12 A. WTrJ.L DATA Well type PmVAT~ If k 8, or C provide PWSID~ N/A Well Log (Y/N) YES Oatecompleted 9/15/80 Sanltary~eal(Y/N)YES Wlrespropertypmtected(Y/N) YES Total depth 48 It. ~ to 48 It. Caalng height (above ground) 34 In. FROM WELL LOG AT INSPECTION Date of test 9/15/80 4/20/2001 Stelic water level 19 It. 31 ft. Well product]on 13 . g.p.m. WATER SAMPLE RESULTS: Caliform 0 colonies/100 Date of ~ample: 7/25/2001 B. SEPTICMOLDING TANK DATA 4.98 g.p.m. Nitrate 6.91 mgJg Otherbacte~a 0 colortles/100mL Collected by: AWWC, INC. Tank Type/Material Tank size 125o gal. FoundalJon cleanout (Y/N) YES Date of pumping NEW C. A~$ORPTION FIELD DATA Date Installed 7/25/2ooi $.T.E.P./STEEL Number of Comparlments 2 Dapresalon over tank (Y/N) NO Pumper Soil rating ~ ~/txtrm) 2.0 Width 12 ft. Date Installed 7/25/2001 Cteanouts (Y/N) YES High water alarm (Y/N). 'rES Totaldepth 2.~7-3.45~t. Eff. absorpl]on ama 350+ It= Monltodngtube YES Date of adeduacy tost NEW Results(Pass/Fall) PASS Water added - gal. Fluid depth In absorption field before test - In. Elapsed Time: - ndn. Final fiuld depth - Any reJuvenndon tmalment (past 12 mo.) (Y/N & type) In. Abso~:~on rate NONE KNOWN b'~m b'Pe BOTt'0MI. ESS ISF Gravel below pipe 0.33 lt. Oepresalon over field NO For 3 bedrooms New depth - In. - g.p.d. If y~s, give date - D. UFT STATION Date Installed 7/25/2001 'Pump on' level at TIMER In. Datum ~ E. SEPARATION DISTANCES Size In gallons 1250 S.T.E.P. Manhole/Access (Y/N) YES "Pump oft' level at TIMER In. High water alarm level at 45 Cycles tested NEW Meets alarm & alrcuti requlmmente9 YrR SEPARATION DI~I'ANCES FROM WELL ON LOT TO: Septlo tank/lift station on lot. 100'+ Absoqotion field on lot 100' Publlo sewer main N/A Sewer/septic aervtce line. 25'+ Curtain drain NONE KNOWN F. COMMENT8 On adjacent lots 100'+ On adjacent lots. 100'+ Publlc sewer manhole/deanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property Ilne 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100% SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Prober[y line 10'+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots. 100% Abeoq~on field. 5'+ Surface water. 1 oo'+ Driveway, parldng/vehlcle atomga .5;+ Water main In. HAAFee$ oeteofP, ,nt Receipt Number Waiver Fee $. Date of Payment Receipt Number. 15:45 FROk~-CT&E EtIVI~NTAL CT&E Environmental Servlce~ Inc. 90~5515301 T-U2 P.02/03 F-281 C~&E Ret.# C'~IeM Name Project Name/ti Client Sample ID Matflx Ordered By PWSID Sample Remarks: 1014656001 AK. Water & Wastewater Consultants Inc. 10900 Circle Lt ? Bk 3 Alpine 10900 Circle Lit ? Bk '~ Alpine Dr'talcing Water 0 Client Printed Dare,rime 07/~0/2001 14:09 Cnllected Date/Time 07/2'~/200! 1'~:20 Received Date/Titan 07/25/2001 14:3'~ Technical Director · Stephen C. £de Released ~ ~ Results PQL Units Method Allowable Psep Analys~ Limits Date Date Init Nitrate-N 6.91 0.500 mg/L EPA 300.0 (<10) 07/2~/01 SCL M~.= z'ob 't o~.o~F~' La, ora t. oz~ Total Colito~n 0 co~/100mL SMIS9222B (<1) O7/25/OI g. AP 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 -- .-~/.L!..~. -- ! ',..~ HAA# ~'~ ~----~cl U'-~ GENERAL INFORMATION Complete legal description Location (site address or directions) I1~00 C~,"c¢¢ ~,..,',.,~ Property owner B~)/ ~e~ Day phone Mailing address I I ~t O0 ~r'e.(e Dr:~,e..~ ~r~cJ~or,~.~., /o,.~ Lending agency /}/r.x/'le~. (.X_CA ~o~ ~.o~;/' ~7~'~r~ Day phone Mailing address qUoO (~r'~',~i/ (./~,oo Or" i~,.~ .,, /~cko~,V¢~ Agent D'~ F~rt~ ~,u~ F¢~/ ~.~)~1-~_ Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well ~" Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I fu~her 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. Nameof Firm F'tc~/-A:,? 'r'~c/-,n~'c~r[ ..C¢~'~,',c,,,~- Phone Address /~/5'.~' ~_c/,~ _('~"~ /)-~c~'~'~/ /~' Engineer's signature ~"'-'~~ ~' ~ Date ,-///I / ~' DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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. 72-025 (Rev. 1/91) Back MOA 1t21 Legal Description: A. WELL DATA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist 1 i 996 Well type ~'c,i v~/"e, If A, B, or C, attach ADEC letter. ADEC water system number Log present Date completed Total depth if ~ J Cased to ~ 8' Casing height (above ground) Sanitary seal (Y/N) y' Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production 1,3' g.p.m. ~,.c-, ~ ,/. g.p.m. WATER SAMPLE RESULTS: Col[form ~.~ col/toorn.~ Date of sampl¢: ,~ /~/'~( Nitrate Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (Y/N) Date of Pumping Tanksize I~C~I Number of Compartments ~ Cleanouts(Y/N) Y' ~) Depression (Y/N) N High water alarm (Y/N) bt, A, Pumper C. ABSORPTION HELD DATA Date installed 7 ! P-3 180 Length ~0"'~'5'~' = ~s'" Width Effective absorption area ,,CIO Date of adequacy test ff / ~ Gravel thickness below pipe Monitoring Tube present(Y/N) 9' Results (Pass/Fail) ~ Soil rating (g.p.d./fl2 or f&bdrm) ~ System type ~A tt Ilooo :~ ' Total depth '~.,S' ~ __ Depression over field (Y/N) N For ~/' bedrooms Fluid depth in absorption field before test (in.); 37~. ~3" Immediately after 7~9 gal. water added (in.): Fluid depth ~; ~.~ (ins.) Minutes later: ff'~q' Absorption rate = ~, gOO g.p.d. Peroxide treatment (past 12 months) (Y/N) /~/on¢ ~.notoo If yes, give date ~. ~,,. D. LIFt STATION N. ~-. Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holdingtankonlot ~' I 0 ~ ' t-~ ¢. o. ;Onadjacentlots Absorption field on lot 'l> t O,$" ; On adjacent lots Public sewer main N.A. Public sewer manhole/cleanout Sewer/septic service line'~ ~0"' Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main/service line · SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain C lmnCnTION in conformance with MOA HAA guidelines in effect on this date. , Date A'/',"', HAA Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number 04/10/96 12:10 CT&E ESI ANCHORAGE * 90?3451355 N0.~44 Q03 CT&E Environmental Services Inc. Laboratory Division ............... · ..................... Laboratory Analysis Report CT&E Ref,# 961 i72.9176 Collected Date 04/02/96 Client SampLe ID L7 1~3 ALPINE TERRACE] 1172-01 Matrix Ddrtking Water T~chnical Director Sampi6 Remarks: oue[ L;m;~s 0ate Date Nttrete. N ~.28 0.500 mg/L EPA 353.2 0~/03/9& 0~/03/96 EHB 200 W. Potter Orive. AnehoTage, AK 99618-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Peger Roed, Fairbanks, AK 99709-6471 --Tel: (907)474-0656 Fax: (007) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND, MICHIGAN. MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 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 Location (site address or directions) Property owner Ho~L¥ I~L'OOG '~ 8'~eT CA~IPi~ZL Mailing address ~ ~r~ Lending agency N.~. '' Mailing address Address ~1o~ T~NA6~ ~Lvb Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Day phone % a,f,e'-r'7/7 Day phone Day phone 2~8- I-//'7 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. 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. Name of Firm Ic/-/}TTO~° "1-£¢1.t. Er'cS, Address )q 5' 3o __cc ~ o ~'T, /~ NC/-/. Engineer's signature _¢"~~ ~, ~ DHHS SIGNATURE __~ Approved for Disapproved. Phone ;3/-/S' - / 35'5- Date d-'-~n~ E~/ 1~9 ~. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. 72-025 (Rev. 1/91) Back MOA Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Let '7, 8L~' 3 /~L?~Ng Tg~c£ Parcel I.D. A. WELL DATA Well type ~I~¢A'rE If A, B, or C, attach ADEC letter. ADEC water system number N,/~, Log present (Y/N) ~/ Date completed 7/l~ / 80 Driller Totaldepth L~8' Cased to ~&' Casing height ,3 ' Sanitary seal (Y/N) ~/ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: ! Septic/holding tank on lot Absorption field on lot "~ I ; On adjacent lots ~/oo ; On adjacent lots Public sewer main Sewer service line Public sewer manhole/cleanout ~ ~oo / Petroleum tank HoNE WATER SAMPLE RESULTS: Coliform Date of sample: (o//8/?2 Nitrate 3. 3 /~ff//.~ Other bacteria Collected by: F/ATTOP T~cH B. SEPTIC/HOLDING TANK DATA Date installed 7/23/8 0 Cleanouts (Y/N) ~' High water alarm (Y/N) Date of pumping ~'/i~t [ ~/2; Tank size 12~0 GA~ Compartments ;2. Foundation cleanout (Y/N) ¥ Depression (Y/N) Alarm tested (Y/N) Pumper ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well (s) on lot / 0.5' ' To property line Surface water/drainage Onadjacentlots ~/00 ' Foundation 12.¢ Absorption field UNK. ' Water main/service line ~6o~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 7/~3/~ Length ~£' ('$o, 3~") Width ,~ ' Total absorption area ~'co ~' PE~ Depression over field (Y/N) Results (pass/fail) Soil rating 12,5 ='//$DRM Systemtype t Gravel thickness ~ Total depth t~Po~'r Cleanouts present (Y/N) Y Date of adequacy test ~,/,,~ l ~ z for ~' Peroxide treatment (past 12 months) (Y/N) _~leN£ /<.o~v~ oF If yes, give date N./I.. bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~/o To building foundation On adjacent lots Surface water '7 On adjacent lots '~/oo Property line To existing or abandoned system on lot Cutbank ~/~___~o' Water main/service line Driveway, parking/vehicle storage area ~$0 Curtain drain 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. Signature ~-'_~ Engineer's Name Date ~'~/~ ~ HAA Fee $ ,/,/'~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99516 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS fez- INVO!C~ ~ 54984 Chemlab Ret,~ 92.2902 ~ample $ 1 b{atzix: WATER Client Sample ID : L? B3 ALPINE TERRACE NORTH HOSE BIB PWSID : UA Collected ~ @ Received : JUN 18 92 @ [2:30 bxs, Pzesezved with : AS REQUIRED Client Name :FLATTOP TECHNICAL Client Acct :FLATTOT BPO~ : PO~ :NONE RECEIVED Req~ : O~de~ed ~y :TED MOOR~ Analysis Completed : JUN 20 92 t. abo~atozy Super'visp~ ; S%EPHEN C. EDE Send Repo~ts to: 1)FLAITOP TECHNICAL SRV Pa~ameteg Results IJ~ts Method Allowable Limits NITRATE-N 3.3 mO/1 EPA 353.2 10 Sample ROUTINE SA}4PLE COLLECTED BY: UA. NO TAG ~OR THiS SA~LE. Remarks: I Tests Performed ' See Special In~tzuctions Above UA-Unavailable ND~ None Detected *' See Sample Re~azks Above NA- Not Analyzed LT~Less Than, GT~Gzeataz Ttmn t _ SGS Member of the SGS Group (Soci~t~ Gbn~rale de Surveillance) APPLIC IT FILLS OUT UPPER HAL' .)NLY Pm'~eriY O",~er 4/c%/~ ~'~ ~-'~..~, /~-~'/~ NI. ~.o~ Phone ( ~..~ Mailing. Address ,,,'/ ,, ~ L' ..... ' ~ t _ I t,,t[~ ,~"/~ ~ _..L, . i~ /'~ Zip Code ..~__.__..._.__.-~- ~ ~/~ ~///,~/~.~- .~...,~. ........ Z~..~/..-., z,pcode ~,o~-~,,.:.._.C.; Lending ~o-/ ¢2.,/v,,..¢¢'~.¢, ,~,,~t,'/_~ 'gl,,',-~'., ~,~,'/~ ~Otz,pcode Of9~_.~.3 Address ,z~ ..... /, Type of Residence Single Faintly ' Multiple Family ,o. of Bedrooms ~'~ 4,¢ > /UO~,/~/ ¢4:~. Az/ [] Other "' / Water Supply ,,~ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal ~ Individual Year Individual Installed: Public Utility When Connected to Public Utility: /¥! .~ [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, Time Time Time Time Date Date Date Date Inspector Inspector Inspeclor Inspector Field Notes: -~.~,.~ ~~ --_'~ .~'...~,~, ~ ~ DEPT, OF ~ ~ ~~ ENVIRONMENTAL PROTeCtION ~ ~ '~ NOV ~ 1983 o. RECE I VE · ~ I ROYAL < > O~SA.mOV~D < ) CO~.mO,A~ A..nOVAU DATE Ii - 3G--~ ~ - Soils Rati~ ~ Date ~wer Installed Well To Absorp~on Are~ ~ ~ ~ ~ 1 ~ ~' Well Log Received 72-023 (3182) November 14, i9~3 Ald~ll f~. al'Id Paul,~ iv',. Itoo}7 P. O. box ~152 ~'~la::~nington, D.C. 20044 Sklbject: Lot 7, Block 3, Alpil'le 'retrace ~:{ubdivlszort A.t2provai for the individua], sewer and vlat~r ~aczli~ies ~.lnnot be granted until the foliowing itenls i~ave been completed: o ~i~le septic ~"~ pu~ped with a receipt subi~itted to tills {'~e ?a rtment. Please notify this Department ~or a reinspection v;hen tile noted discrepancic~s have been corrected. I~ there are any further quest:~ons~ l)lease ~i~11 this office at 264-4720. Sincerely, Cory ',:~ittis, ?,.S. Acting Sewer & ';~ac,~.r Pro,,3ra~ i,,ia ~lager ~ DATERECEIVED - INSPECTION APPOINTMENTS ~ ~ ~_p ~..,., .~~ IT,ME TIME DATE !DATE ~ DATE ,~s~c~-o~ MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RONMENTAL PROTECTION 825 L Street - Anchora~, A~ka 99501 ENVIRONMENTAL SANITATION revision SEP 2 5 1980 Telephone 264~720 DElE I ~IE~ REQUEST FOR A~PROVAL OF INDiVIDuAL WATER AND SE~~m~m~ DIRECTIONS= Complete all parts o~ page 1. Incomplete reques~ will not be preceded. Please allow ten (10) days for processing. PROPERTY RESIDENT (If ~iffe~nt from above) PHONE MAILING ADDRESS ' ~.. ~.~,.o,.~,,.u.,o. ~~ ~ MAILING ADDRESS ' ,~~~"',.,u..~ _~ .~ ,~e.e__~ ~,x ._~ 17'WAT~'P/NDIvI DUAL* *ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY [] PUBLIC UTILITY since June 1975. For wells drilled prior to that date, give well 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY depth (attach log if available.) ~~.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 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified i--ISeptic Tank or []Holding Tank Size: /~.~ If Tank is homemade give dimensions: [] ONE [] TWO PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER NUMBER OF BEDROOMS [] THREE [] FIVE [] FOUR [] SlX [] OTHER TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: DATE INSTALLED INSTALLER Absorption Area to nearest Lot Line SOl LS RATING MANUFACTURER ~ MATERIAL Septic/Holding Tank ~Absorption Area I ISewer Line Nearest Lot Line 5. COMMENTS DATE I PPROVED FO. BEDROOMS// [] CONDITIONAL APPROVAL (letter must ac/~e'mpany certificate) [] DISAPPROVED ~ (~ /t~~ 72-010 [Rev. 6/79)