HomeMy WebLinkAboutAUDUBON HILLS #1 BLK 1 LT 7-"'"7
j
I-
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: OSP231188
Work Type: Septic Upgrade
Tax Code Number: 01523169000
Site Legal Address: AUDUBON HILLS #1 BLK 1 LT 7 G:2739
Site Mailing Address: 12000 TERN CIR, Anchorage
Owner: HRUBES DUANE F & BARBARA A
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date:
Expiration Date
relent
U �
Depai-tnient
Lot Size in Sq Ft:
Total Bedrooms:
7/20/2023
7/19/2024
50094
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: �'i�-c� 1��� Date: Date:
i
Issued By: vL, �'
20 Z� 2
y
MUNICIPALITY OF ANCHORAGE
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. 015-231-69
Property owner(s) DUANE & BARBARA HRUBES Day phone
Mailing address 12000 TERN CIRCLE ANCHORAGE, AK 99516
Site address 12000 TERN CIRCLE ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) AUDUBON HILLS #1 BLOCK 1 LOT 7
Legal description (Township, Range & Section)
Lot Size 50,094 Sq. Ft. Number of Bedrooms_
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
® Initial ❑
Single Family (SF) X❑
(w/wo ADU)
Septic Tank
X❑ Upgrade X❑
(D) El
Holding Tank
❑ RenewalDuplex
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(SignMu"T.6-6f grope y owner or authorized agent)
Permit/Rush Fees: J
Date of Payment: �'� �� 22 3
Receipt Number: 3 / � o0 -
Permit
0 -Permit No. Q5 P 2-31 ( F,
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\ Forms\Cl i e nt Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
July 7, 2023
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: AUDUBON HILLS #1 BLOCK 1, LOT 7
The septic system has been found failed and will be completely decommissioned
and per the owner we request a septic permit to upgrade the existing septic system
on the above referenced lot. We propose to install a shallow trench with an
Advantex system to serve the existing 3-bedroom residence per the attached design.
The design has been generated to allow for up to 4 berdrooms. The design is based
on the recent test hole conducted in the spring of 2023. Groundwater was observed
at excavation at 6’ and 5.5’ at monitoring of this test hole.
The slopes are moderate at 7-13% at the proposed upgrade location. The lot and
area are served by private water with no known private wells within 50’ of the
proposed septic system. Based on visual observations and review of available
information, the design will not impact any of the neighboring properties. Please
contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231188, Curtis Townsend, 07/20/23
FIRST WATER CONSULTING
AUDUBON HILLS #1 BLOCK 1, LOT 7
DESIGN CALCS:
NO WELLS WITHIN
50' OF PROPOSED
SEPTIC SYSTEM.
NO SLOPES >25% WITHIN 35'
OF PROPOSED FIELD.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231188, Curtis Townsend, 07/20/23
FIRST WATER CONSULTING
DESIGN DETAILS:
SITE & AREA SERVED BY PRIVATE
WATER. STAKE ALL REQUIRED
SETBACKS PRIOR TO CONST
(WELL RADII, SURFACE WATER,
PROPERTY LINES,...)
AUDUBON HILLS #1 BLOCK 1, LOT 7
VERIFY EXISTING FIELD & MAINTAIN 10'+
TO PROPOSED FIELD & 5' FROM FIELD TO
ADVANTEX TANK SYSTEM.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231188, Curtis Townsend, 07/20/23
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: AUDUBON HILLS #1 B1, L7
PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 6/21/2023
DEPTH
FEET OG
SOILS
1
ORG/OL
2
3
4
SM/GM
5
6
7
8
9
10
11
BOH
12
13
14
15
16
17
18
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
6/20/23 30 min 6” 1 6/16”
30 min 6” 1 6/16”
30 min 6” 1 5/16”
PERCOLATION RATE 23 (MIN / INCH)
TEST RUN BEWTWEEN 2 & 3 FT
PERC HOLE DIAMETER 6”
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: YES
IF YES, AT WHAT DEPTH: 6’
DEPTH TO WATER AT MONITORING: 5.5’
DATE: 6/20/23
TESTHOLE # 23-1 DATE PERFORMED: 6/12/23
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: DUANE & BARBARA HRUBES
6/21/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231188, Curtis Townsend, 07/20/23
MUNICIPALITY OF O .
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Day of.,� of 20, by and between
herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as AN ADVANTEX SYSTEM
located at (legal description)
AUDUBON HILLS #1 BLOCK 1, LOT 7
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Y,W4— Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
D37-- It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
'4y- Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
IW -- Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
>I/*-- Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
;�__l__ Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
e -PI N— Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
->I It-- Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
B -ice __ _ (signature) Date: 77 '
®��w-�.•.� 6a.s (print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The fore oin instrument was ac owl dged before me this LL day of •7l1- ,
fby
NOTARYj�.tMfll�,-FOWALIMAW
.�
My Commission expires: W ) 0 g- -
MUNICIPALITY:
By: L (signature)
V') pn 5 TO wN> (/-s�(print name)
State of A
laska
NOTARY PUBLIC
Mychael Alfaro
My cw niss'ion Fires Wdfh Office
Date: 2'
Title: G l V(6 -
(rev. 05/18/2018) Page 3 of 3
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
- / ENVIRONMENTAL ENGINEERING DIVISION
I,, 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME~-~ /PHONE I --
[] UPGRADE
MAILING ADDRESS
LEGAL DE PTION
NO. OF BEDROOMS
LOCAT,ON
Well I Absorption area Dwelling , PERMIT NO.
,
~ Z~ Manufacturer ~~ M aterial~~ ~ No. of comments
~ ~ Liq. capaCty_in gallons Inside length Width Liquid depth
/ ~ ~ ~ IF HOMEMADE:
W~ Dwelling PERMIT NO.
~ DISTANCE TO:
~--~ Manufacturer / ~/~ Material Liquid capacltyin gallons
Foundation Nearest lot tine PERMIT NO.
O DISTANCE TO: T /~ . ~ I~ /~ I
~Z~ No. oflinesz Leng~h~er Totallen.thoflines~ ' T~d~h inches Distance between lines
~O~ Top of tile to finish grade ~/' Material be th tile / ~ l¢ inches Total effective absorpt,on area
Length Wi~ Depth PERMIT NO.
~ ~ Type of crib meter Crib depth Total effective absorption area
~ Building foundation Nearest lot line
~ DISTANCE TO:
~ Clas~ ' Depth Driller Distance to lot line PERMIT NO.
m/~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
SOIL TEST RATING /~ ~ & 7 e ,
INSTALLER
REMARK8
DATE LEGAL
72-013 (Rev. 3/78)
[:,EF'FIRTMENT 07-HEALTH AND ENV!F'rNMENTAL P.F.~-nTEr:TION
o.-'5 L 51'REET.. ANZ:HOFeFtGE., AK. .:~.a:
· -' ~,4'-4,
~2,¢_ ,.~ ,C' ,'l-- S I T E 5 E '....' E F: F" E F-: r'l I T
PERMIT NO. :: 8{02:9.:: )
RF'PL!CANT [:,UFINE F. HRUE:ES 9]:±E~ SNOWCREST [)R.
LOCATION TERN ST.
p ~'~ LC, T SIZE
LEJRL LOT :.: i RUDUBEN HILLS R[,',[:,i
T"r'F'E AF SOIL RE:SORPTION '-';"r"-TTEM IS' DRFIINFIEL[)
= F.:FI T I I",M ......
MRXtMUM NUME:ER OF BEE:,ROrd"IS 2: SOIL -' ,"'--;'..~ FT,.."BR)= tF;A
THE RECg_IIRED_,'='I..'E AF THE SAIL FtBSF~F.:F'TIF~N :,.-rzTEI'I IS'
[:,,EF'TH= 5 L E I"-.I C-i T H = 7 '._:'~- Ci F-: R"...' E L C, EF'TH= :_1._
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTFINCE BETWEEN THE SURFACE OF THE
GROUND FIND THE BOTTOM OF THE EMCAVATION (IN FEET:..,.
THE T~:Er4mZ:H I-.J I [:.TH IS 5. ~Z~bZ~E~ FEET'.
THE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFFILL PIPE
AND THE BOTTOM OF THE ENCRVRTION (IN FEET).
REL---!!J I F-:E[> '---EF"T I C: TRr-~F=-'.' $ I ZE= 1 L':'--~ L':--~ L-':"~ ~]RLLC~I'--IS.
F'ERMIT FIPPLIC:FINT FIFIS THE RE'--;F'ONzqlBILIT"r' TO INFORM THIS DEF'ARTMENT DURING THE
II",ISTALLFITION INSPECTIONS OF FII"',IY WELLS RD.TRr:Et'..IT TO THI'-- FF.._FEF-.T"r AN[:' THE
NLME, EF.. OF RESI[)EI",tCES THFIT THE WELL WILL SERVE.
T 1-4 Iz! ,:: '--: ':"
Z I I'-.ISPEC:T I C~I'-.I -":'- RF:E F:EI-'::,I i I I~:E[:,
BFICKFILLING OF FII'.,IY S"r'STEM I.,.IITHOUT FINAL II'.,ISPECTION AN[) RF'F'F.:OVRL BY THIS
DEPFIRTMEI'.IT WILL BE SUE:JEE:T TO PROSECLITION.
MINIMUM DISTFINCE BETWEEN FI WELL FIND FINY ON-SITE SEHAGE DISPOSAL SYSTEM IS
iOA FEET FOR FI PR IVFITE WELL OR t50 TO 20E~ FEET FROM R PUBLIC WELL DEPENDING
UPON THE T'¢PE OF PUBLIC WELL.
MINIMUM DISTANCE FROM FI PRIVATE WELL TO FI PRIVATE SEWER LINE IS 25 FEET AND
TO FI COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY FIPPLY. SPECIFICATIONS FIND CONSTRUCTION [:,IRGRRMS FIRE
FIVFIILABLE TO INSURE PROPER INSTALLFITION.
F'EF-:f.1 I T E::-::F' I RES E)EC:EI"'IE:EF-: _---::1..
I CERTIFY THAT ~ '
!: I RM FFIMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS FIS SET
FORTH BY THE MUNICIPFILITY OF FINCHORFIGE.
2: I WILL INSTALL THE SYSTEM IN FICCORDFINCE WITH THE CODES.
3' I UNDERSTFIND THAT THE ON-SITE SEWER SYSTEM MAY REQI_IIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THFIN 3 BEDROOMS.
ISSUED
,~' SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6.650, Anchorage, Alaska 99602 276-2224
SOl LS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
LEGAL DESCRIPTION: ~ 1 ~ i l~J~' _~0~ ffl~/~
DAT~ P~RFOR,~D: -] °/Y
SLOPE
SITE PLAN
2
3
4
5
6
7
8
~0
12
13
~4
17
18
20:
~-Ii
ltl
WAS GROUND WATER
ENCOUNTERED?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN
FT AND FT
PERFORMED By:O(2{t ~~'
72-008 (7/76)
RETURN TO: Division of G~ological and - ~',slcal Surveys (OGGS)
]OOl .Porcupine Drive (Teley : 277-6615)
Anchorage, Alaska 99501
WATER WELL RECORD
Drilling Company Name
STATE OF ALASKA
DEPARTMENT OF NATUAAL RESOURCES
U.S.G.S. Local No.
Drilling Permit No.
,]
ILOCATION OF WELL Please complete either la. lb, or lc. A.D.L. NO.
la. Borough Subdivisi.~I Lot Rlock lb. Fraction Section No. Township Range Meridian
lc. Distance and D~rectlon From Road ,ntersectlons 3. OWI~ER OF WELL: ~,(,n~
Add tess:
Street Address and Area of Wel) Location
2. WELL LOG Feet Bel~ ~. WELL DEPTH: (completed) Surface Elevation Date of
7. CASING: ~ Thr~ded ~lded
in, to ft, Depth
8, FINISH OF ~ELL:
Slot/Mesh Size: Length:
Set bet~en ft. and ft.
Fittings:
~A~ve ~aelow land surface
Type of Measure. nt: ~)
10. PUMPING LEVEL be)ow land rface
~ ft. after ~ hrs. pumping ~ g.p.m.
11. ~ELL H~D COMPLETION: ~ In Approved P)t
DEPT. O~ ~FL~',L2:~ ~, ~PJtless Adapter ~ inches above grade
~atmrlal: ~Neat Ce~nt ~ Other:
Ago 198'1
13. PUMP: (tf available) HP
~ ~ ~ r m t I r~ ~ Length of Drop Pipe ~ ft. ca,city
K ~ L E i V E U Type: ~Sub~rslbie ~Reciprocatlng
lq, RENARKS:
5. WATER WELL CONTRACTOR'S CERTIFICATION:
This well was drilled under my jurisdiction and th~s re~rt is true to the best of my knowledge and be) ief:
leg i stared B~s i n~s~a~ Contract License Number
AuChor~ze~ Representat~e
Form 02-~R Copy Distribution: ~HITE - S~ate DGGS, PINK - Driller, CANARY - Customer
ALASKA ENVIRONMENTAL
CONTROL SERVI~, INC.
1200 West 33rd Ave~. ~, Suite B
ANCHORAGE, ALASKA 99503
(gOD 561-.~040
SHEET NO -- OF
CHECKED BY DATE.
SCALE I //
= 2.0'
2 g',,,5' Hou$£
~q, 5
L~LL
_ '9
FINCH
4
Sol,.-.
~oLd
.solo~
, 5
Location (add~ess or directions) .':i';'
.,'.;...::: .::~::: (b):~ ~ppli~ant Name, 0'~ ~' M ~O6~&'_~ Telephone: HbmO''Z ~-~¢/~--'":~ B~S'iness ~' , Applicant Address I~0 "~~""C/~~
(c):' .Applicant is (check one): Le~ding Institution ~ ;' owne?b~il~er ~; Buyer ~'~ Othtr 0 (explain);
': (d) Lending institution . ' Telephone-.~-~
Address,
(e):..Real Estate Company and Agent
(f)-~ Mail the HAA to the following ad0ress:. '
OF RESIDENCE
WATER SUPPLY ~:::~::i' :' :=~ ~:`
individual Well ~-i:::.:CommunitY pUblic I-I.
:~ ~LNote: If community well system, mUSt have writter estate De
::"~ aitesting to the ~egality and status.
SEWAGE DISPOSAL '"~ "~' '~
Onsite~i~? Public FI., Commun
'.' Note: If community we I system, ~ written m~ ~'from the state De
"attesting to ity and status~
:ment of, Environmental Conservation
,';':i ~!
:"..!~ :. ,.. '; ,
"Lrtmentof Envi~°nmental )nservation
'ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FII*E SEARCH, DATA AND INFORMATION
As certified by my seat 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 regulations in effect on
the date of this inspection.
Name of Firm
Address
Date
CAUTION
The Muncipality of Anchorage Department of Health and Enwronmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska, The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. 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. "'
Page 2 of 2
72-025 [11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
MUNICIPALITY OF ANa-IORAGE /2
I
DEPT. OF HEALTH & Legal Description:
ENVIRONMENTAL PROTECTIOI~
L. I R ~DI,' BON
WELL DATA
MAY 2 2 1986
Well Classification ~-- If A, B, C, D.E.C. Approved (Y/N)
Well Log Present ~)N) Date Completed ¢/~/~ / Yield
Cased to t"~0 /
1~,1'~
-' '/
Depth of Grouting
Pump Set At
Sanitary Seal on Casing t~N)
Depression Around Wellhead (Y/~)
Total Depth ('¢2. /
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot I
To Nearest Public Sewer Line ~f/~ To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments ~
I/0/¢-
100/+ 'On Adjoining Lots I00
· On Adjoining Lots
To Nearest Sewer Service Line on Lot
,
4, .14_~I TE.[-'/-d~/'~ 'Date
B. SEPTIC/HOLDING TANK DATA
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Date Installed ~'~/~/~ ~
Standpipes ~N) Air-tight Caps ~)U)
Depression over Tank (Y(~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~//~r
! -
Separation Distances from Septic/Holding Tank:
ld)O/'/''
Size i 0OO No. of Compartments
Foundation Cleanout (~N)
/~/'/~r 'for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
!,50
Square Feet of Absorption Area
Depression over Field (Y~i
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well //Or''lc'
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present II~N)
Date of Last Adequacy Test
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
,5' 14,'1
To Property Line
To Existing or Abandoned System on
· On Adjoining Lots '7
To Cutbank (if present)
I0o~¢-
Comments
D. LIFT STATION
Date Installed Dimensions /
Size in Gallons Manhole/Access (Y/N)
"Pump On"Levelat .~ / / ~ "Pump Off"L re..uef'~'~-~
High Water Alarm Level at iV/ /~'~Y/_N, _.n~t'YN
Tested for ~/ Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N) ~
Comments ~
** Check Permitted Bedroom Rating Against HAA Request **
I certify that Lhave~c~egkcd, vgrifjed, or,conformed to all MpA and HAA guidelines in effect on the date of this inspection.
Signed q&~ Date ~.~///
I .... /
Company /' ./~__~--~ //'~(~-.- MOA No.
Receipt No. B~,~ }... \ ~:~
Date of Payment C~-.~.~; -
Amount:
Page 2 of 2
72-026 (11/84)
~3 - Putvte,,5,'¢ fiEce,?r
¢; q .- .51 TE PzAH
ALASKA B, UII OFlmeI TAL COI1TROL $1 l dlCl $, IFIC.
~n§ineerin§ 6 ~nuironmenlol Slu~Jics
DWANE HRUBES
1200 TERN CIRCLE
ANCHORAGE ALASKA
99518
SELLER-SAME
DWANE HRUBES
1200 TERN CIRCLE
ANCHORAGE ALASKA
99518
5/21/86
60206
LEGAL:AUDOBAN BLOCK i LOT 7
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE-5/19/86
THE TYPE OF ABSORPTION SYSTEM IS A 5 WIDE WITH AN AREA OF 460 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 663 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 5/6/86
THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER
SUPPLY OR WASTEWATER SYSTEM.
FLOW TEST ON WELL
WELL FLOW DATE-5/19/86
A FLOW TEST WAS PERFORMED ON THE WELL. 663 GALLONS OF WATER WAS
PUMPED AT A RATE OF 7.36 GPM OVER A DURATION OF 2.15 HOURS.
THE DRAWDOWN WAS 24.9 ' WITH A RECOVERY TIME OF 30 MINUTES
AND THE STATIC WATER LEVEL WAS 12.1 FEET.
THE WELL IS ADEQUATE FOR THIS $ BEDROOM HOME.
D, .. RECEIVED
· INSPECTION APPOINTMENTS , ~
TI,ME TIME / TIME / /
DATE DATE ~/ DATE
,NSPECTO? NSPECTOA /, , NSPECTOR
MUNICIPALITY OF ANCHORAGE ' D?T C,;: i "...,¢.,,
DEPARTMENT OF HEALTH & ENVl RONMENTAL PROTECTION
825 L Street- Anchorage, Alaska 99~01
( ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RECEIVED
REOUEST FOR APPROVAL OF INDIVIDUAL ~ATER AND SE~ER FAClLITII=$
DIRECTIONS: Complete all parts on page 1. Incomplete ~eq,,~sts will not be processed. Please allow ten (10) days for processing.
PHONE
1. PROPERTY OWNER .~-.~ ~
MAILING ~DORESS
PROPERTY RESIDENT (If different from above) PHONE
PHONE
MAILING A D D R E'~'rs
, PHONE
3. LENDING INSTITUTION
MAILING ADDRESS '
4. REALTOR/AGENT PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION /?.~_)../~
STREET LOCATION .-~'(~'/ r' ]
6. TYPE OF RESIDENCE
'~ SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY
--j~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
NUMBER OF BEDROOMS
[] One [] Four [] Other~
[] Two [] Five
_~,,~. Three [] Six
* 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**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: TH'E 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 NUMBER OF BEDROOMS
[] ...~NGLE FAMILY [-I ONE ~THREE [] FIVE I--I OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
~INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[[~OIVlDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ~ .~" -~" ('
Connection Verified INSTA LLER..~/
[]Septic Tank or []Holding Tank
Size: I ~ If Tank is homemade SOILS BATING
give dimensions: / ~ (~
TYPE OF TANK MANUFACTURE~_~.
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: S~t,c/"oldine T..kIJAbs°rPtJ°~l AreaIISewer LJhe [ N~lr.t Lot Li~le
6. COMMENTS
APPROVED FOR ~ ~'~ BEDROOMS
CONDITIONAL APPROVAL (Ietter must accompany certificate)
[] DISAPPROVED
?2.010(Rev. 6/?9)