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Home My WebLink AboutT12N R3W SEC 15 LT 35 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: OSP221096 Work Type: SepticTank Upgrade Tax Code Number: 01505203000 Site Legal Address: T12N R3W SEC 15 LT 35 G:2436 Site Mailing Address: 4440 ABBOTT RD, Anchorage Owner: ALLEGREZZA FAMILY TRUST Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 4/29/2022 4/29/2023 44229 ❑ Disposal Field El Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: I. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development . Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15,:a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. The survey does not show the cleanout at the east end of the field. If it is missing please repair. 2. Locate the south end of the 40' north/south leg of the field to ensure that the tank -to -field separation will be met. Add a monitor tube to identify the end. Received By: Issued By: c v' 2 L_ Date: Date: Z c( Z2 cA USH MUHMPDAUTYOF VICE -FORAGE 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. 015-052-03 Property owner(s) ALLEGREZZA Mailing address 4440 ABBOTT RD, ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) T12N R3W SEC 15 LT 35 Legal description (Township, Range & Section) Lot Size 44,229 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank Q Upgrade El (w/wo ADU) Holding Tank ElRenewal ElDuplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (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. (Signature of property owner or authorized agent) Permit/Rush Fees: -� �_� f I?G- Waiver Fees: Date of Payment: LfA /ZZ Date of Payment: Receipt Number: d _ZGI 47 Receipt Number: Permit No. O� Pz2-ln9 6 Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc April 26, 2022 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: T12N R3W SEC 15 LT 35 To whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The tank will be decommissioned per the Uniform Plumbing Code (UPC). Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221096, Deb Wockenfuss, 04/29/22 1"=40' PROPERTY LINE PROPERTY LINE EXISTING HOUSE REMOVE AND REPLACE 1,250 GALLON PLASTIC SEPTIC TANK, W/ 20" RISER EXISTING DRAINAGE FIELD -ABBOTT ROAD- DRIVEWAY WELL EXISTING WELL 100' RADIUS T12N, R3W, SEC 15 LOT 35 SCALE: DJRDRAWN: DATE: T12N, R3W, SECTION 15, LOT 35 Anchorage, Alaska ALLEGREZZA FAMILY 4/19/2022DRIVEWAYT12N, R3W, SEC 15 LOT 36 T12N, R3W, SEC 15 GOVERNMENT LOT 33A T12N, R3W, SEC 15 LOT 43 EXISTING GARAGE SHED SHED DCO DCO LOT SERVICED BY AWWU WELL MAX SLOPE IS 5% TO THE NORTH Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221096, Deb Wockenfuss, 04/29/22 C ABBOTT ROAD 4 N8959'E16500 OF q jq�;4p C9`49 r SHANE A. HOLT...' p LS -6914 0` Q�a d o �ArO fessiona% foo NOTE NO EASEMENTS APPEAR ON THE CITY GRID MAP (2436) ON THIS LOT A TITLE REPORT WAS NOT PROVIDED FOR THIS SURVEY, AND EASEMENTS OF RECORD MA Y EXIST, NOT SHOWN HEREON THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE: FENCELINES THAT MAYAPPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE OWNER OFRECORD AS OF THEDA TE OF THIS SURVEY ANYUSE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WRITTEN PERMISSION IS PROVIDED. AS-BUILTSURVEY I" =301 NO CORNERS SET THIS DATE I HEREBY CERTIFY THA T I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY SECTION LOT 35, DEPENDENT RESURVEY OF SECTION 15, T 12 N, R 3 W, S M A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENT S SITUATED THEREON ARE WITHIN THE PROPER TYLINESAND NO VISIBLEENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATANCHORAGE,ALASKA THIS 1eTH DAYOF APRIL 2022 NOL T LAND SURVEYING 9309GROVER DRIVE 15408 FB 221-57 223-8615 ANCHORAGE,AK 99507 Name MUNICIPALITY OF ANCHORAGE DEPARTMEN'T OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 'L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/C)R WELL INSPECTION REPORT DISTANCES Address LEGAL uESCRIPT[ON TANKS .~SEPTiC [] HOLDING TYPE OF SYSTEM ,~RENCH [] [)ED [] W. DRAIN [] OTHER bottom Irom Total deplh Jrom original grade or,glnal grade \ (~ 0 FT ~ F1 WELLS [] OTHER (Identllv} I Total Depth I Cased [o Date Installed: FT )~RIVATE A,B,C) WELL SEPTIC ABSORPTION WELL TANK FIELD _ REMARKS: InspecJions Pedormed by: ENGINEERING . cedily Ihat Ibis inspection was ped0rmed according to ag r,)'::'t ( (' ~ ' (! ,' )~'¢j ) ~.~ (::) (:ii:;' Ei ~ !:;(;:!J) t. ;J (::: [ 4:' l ~ J':: ...... Daniel J. Roth, Civil Eng:i. neex, On-Site Service/. Duplex Conversion to Single Family 't'~2~ ~3~ Seo'c±on ].5 Z, ot 35 ~TD #015-052-.03 Be advised that after the conversion from a duplex to a single family dwelling, none of the rooms in 'the downstairs of this house are to be converted back to bedrooms without enlarging the septic system first. 'rhis dwelling is approved as subsequent approvals will be enlarged. a four (/1) bedroom only and a:L1 the same unless the septic system is SCALE PEF~FORMED FOR: LEGAL DESCRIPTION: 1 2. 3- 4 5 6 7 8 9 10 11 13- 14- 15 16 17 18 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: Townsh'p, Range, Sect,on: '""~ i,~:~_i~.~L.~ ~..., ~c~' SLOPE SITE PLAN ~ / WAS GROUND WATER kl ENCOUNTERED? , I~O -- DEPTFI? -- ~oniloring? _ D~Ie: Reading Date Time Not Depth to Time Water PERCOLATION RA1E ~ (mmutesCmch) PERC HOLE DIAMETER TEST RUN BETWEEN (~" FT AND °~ FT Net Drop ~. '/~. ', PERFORMED BY; I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-00~ (Rev. 4/85) Municip~:dity of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L' Street, Aechorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION 'rEST LEGAL DESCRIPTION: 1 2 3 4 5- 6- 7 8 9 10 11 12 13 14 15 16- 17- 18- 19- 2O COMMENTS DATE PERFORMED: SLOPE SITE [:)LAN WAS GROUND WATER ~. I ENCOUNTERED? I'~ 0 S IF YES, AT WHAT ~L DEPTH? P E Deplh to Water Aller Men omo? Reading Date Gross Net Depth to Net Time Tired Water Drop PERCOLATION RA £E TEST RUN BETWEEN __ (m~nutes/~nch) PERC HOLE DIAMETER FT AND __'~ FT PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ONTHI,~ DATE. DATE: 72-008 (Rev. 4/85) Tom Fink, Mayor J unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 March 8, 1990 Robert A. Shafer, P.E. and Richard Sharer S & S Engineering/Tweed Excavating 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: T12N R3W Section 15 Lot 35 PID #015-052-03 Gentlemen: On March 5, 1990 this office made a site visit to the subject property. At that time it was noted that considerable work had been completed in the construction of a new on-site wastewater disposal system. The septic tank had already been set in the ground and backfilled and excavation for the new trench systera had commenced. At the time of the site visit, a permit for construction of the wastewater disposal system had not yet been issued by this office. Anchorage Municipal Code, Chapter 15.65.120, Subsection A, states: "A person may not install, nor modify an on-site wastewater disposal system, earth privy or vault ]privy without first obtaining a permit from the department. A separate permit is required for each installation, modification of an on-site wastewater disposal system, or vault privy." This office expects the highest standards of from engineers and excavators who design and systems on a regular and frequent basis. (:ode compliance install on-site Please be advised that this office takes exception to construction of wastewater disposal systems without first obtaining a permit. Future violations may result in a citation being issued to you and attendant court action. "Kids Are Our Future" Robert A.Shafer, Richard Shafer February 8, 1990 Page Two ]?. E. Also, during the s£te visit, it was visually apparent that the structure on the property was a duplex. Although we understand that the structure is currently being converted to a single family residenue, we would like to remind you that this office does not have authority to issue permits for the construction of on-site wastewater systems which serve more that a single famil3 residence. In the future, please make sure that the physical conversion of the structure, from duplex to single family, is completed prior to submitting a permit application for a single family system. If there are any questions, Sincerely'~ J'~ ~~SmSth, P.E. Program Manager, On-site please call our office at 343-4744. Services cc: Lee Browning, P.E., Manager, Environmental Services Dan Roth, Civil Engineer, On-site Services MUNICIPALITY OF ANCHORAGE DEPARTIViENT OF HEALTH & ENVIRONMENTAL. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Ancltora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/QR WELL INSPECTION REPORT I I UPG.ADE MAILING ADDRESS LEGAL DESCRIPTION L$S~ %iS, TI~ v~3co LOCATION DISTANCE TO: Manufacturer DISTANCE TO: DISTANCE TO: No. of lines c,. ,f.i n, gjs h grade Material Width NO. OF BEDROOMS Dwell n9 PERMIT NO. Liquid depth Liquid capacity in gallons i.~.~o ' PERMIT NO. Length of ea~;J.~ li~- Width PERMIT NO, Crib diameter ! Total effective absorption area Foundation Total lengtl.~o~Jines -Mnteri~ be,neath tile Depth Crib depth ltuilding foundation Driller Sewer line Well : DISTANCE TO: Class Depth Nearest lot line D~ istance to I~t line DISTANCE TO: [Juilding foundation OTHER 8OIL TEST RATING INST~,[LER REMARKS DATE LEGAL eGR, TER ANCHORAGE AREA gtJGH Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATiON~'~ 7~' /'~L~-~')~('(~'L~ LEGAL DESCRIPTION ~t.) ~/_',/ ~'.~-- SEPTIC TANK: .k~F~.~r.,)/I,~2/'/r"i?.~ DISTANCE FROM WELL MANUFACTURER MATERIAL INSIDE LENGTH INSIDE WI)TN .LIQUID DEPTN NUMBER OF COMPARTMENTS LIQUID CAPACITY .GALLONS. SEEPAGE PIT: NUMBEROF PITS. / _. DIAMETER_ OR WIIDTH//~, LENGTH~/~, DEPTH :' LINING MATERIAL. 4':?*C/q- CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL/---) ¢,,-- / '-~.- // ~--TOTAL EFFECTIVE BUILDING FOUNDATION~ NEAREST LOT LINE~'''/,2 /0~ ABSORP'FION AREA (WALL AREA) -~///(//~ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ~L~Il BUILDING FOUNDATION CESSPOOL f t"} DEPTH C20 CONSTRUCTION U~ J~'~)('~/. ) ~1~) NEAREST .--- NEAREST / "? / SEPTIC LOT LINE___ , SEWER LINE ~ / TANK OTHER SOLJRCES . DISTANCE FROM: SEEPAGE /~.~ /' SYSTEM APPROVED DISAPPROVED __REMARKS. DISTANCES: DIAGRAM OF SYSTEM G.A.A.B. ~? · MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AN[) ENVIRONMENTAL PROTECTION Pouch G650, Anchoraga, Alaska 99502 276-222'[ SOILS LOG -- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR:_ 4- 5- 6~ ? 8 SLOPE SITE PLA~I 10 11 o---12 13' 14-~ 15- 16- 17 18 19 2O WAS GROUND WATER ENCOUNTERED? ~ 0 IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN /?I 7'// (minutes/inch) FT AND ---- FT 72-008 (7/76) GREATER ANCHORAGE ARrEA F~OROUGH DEPARTMENT OF' ENVIRONMENTAL (DUALITY SEWAGE DISPOSAL SYSTEM --- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK ~-/~k)~ SEEPAGE PIT .- TYPE AND SIZ~ OF ~ACILITY TO BE SERVED COMPLETION DATE ANTICIPATED ~/ /~: PEDMTT VAI ID [3NE VFAR HEALTH DEPARTMENT AU'rHORI~ WILL ~E ~UBJECT 1tO pROSECUTION. 5 FOUNDATION 'rD 8£EPAGE PIT 20 ~tl DRAIN FIELD ].0 ft. DRAIN FIELD ~--~ ~ ALSO CON~IDER AREA WELLS. WATER MAIN TO SEPtiC TANK -- [0 ~. ~EP~Gg PIT ~ DRAIN FIELD 10 ft. GI~AV£L BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. , HEALTH AUTHORITY OR LICENSED DESIGNER SEPTIC GAAB-HD-2 GREATEh 327 Eagle St. ',NCHORAGE AREA ROUGH ItEALTlt DEPARTMENT Anchorage, Alaska 99501 279-2511 Case No. /o'""""""""~¢'~ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADORES8 LEGAL. DESCRIPTION APPLICATIONT0 INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCE[) THROUGH ~ F: PERCOLATION TEST RESULTS__ , SEEPAGE PIT. _MAILINGADORESS.~O'b- ~¢8~ LOCATION OF INSTALLATION '~'./5'ZA",5' , ORAIN FIELD PHONE :%-- ,OTHER TO BE INSTALLED BY ~-~ -~/-~i~--' ANTICIPATED DA'rE OF COMPLETION_ BELOW TO BE FILLED OUT IIY HEALTH DEPARTMENT THIS IS T0 SERVE AS f'~ ~, "~-'~JO fY) B. ~ , PEFIMIT T0 INSTALL A ASDESCBIBEO BELOW. SIZE OF UNIT TO BF SERVED . SEPTIC TANK SIZE ~ ~) ~-) TYPE ~-,, ~ 60(-~EEPAGE AREA DISTANCES: TYPE __. DIAGRAM OF SYSTEM I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 antl that the above described system is in accordance with said code. BATE :-- /(:f> '- '-~ / APPUCANTS SIGNATURE ~?~/-~ Leqal r~escrinTion: L/ot 3~ B~-o~,, ~Su-~-b-~-~-on This Form Re~orts Soils LDo ~,~_ Percolation Test neath Feet Soil Characteristics Was Ground Water Encountered? I~ Yes, At what Denth? Readinq Date Percolatio Proposed De~th of Cm~MENTS~ Test Performed Gross Time Net Time Depth to H20 Net ProD Rate ~li nute Installation: SeeDaoe Pit 2~~ Drain Pield Inlet_. Depth To Bottom Of Pit Or Trench By ~1~ ~ Data Certified By: II~atad Ihareon ara within the propot~ Iln.s ond do not overlap ot encroach en'e~ eh'the premhe~ In quOlllon and Ihal lhere aro no (oadwoyl, tton*mi~*lon line,'or ' · ; ;- December 31, 1979 Barry B~idges Star Route A Box 1505L Anchorage, A]aska 99507 Permit {~ 790537 Subject: T]2N R3W Sect i. on /.5 ]hot 3!3 A permit issued by this department fer well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to thJ_s department to document the instellation date. If an enginee~ has inspected ~ the on-site sewer system, please have for our files. installation of the them send us the as-buitus :Iff there are any further questions, please contact this office at 264~4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Speci~t LNB/ljw enc: Copy of Permit ]111~ l.[il'..l(il'll D]:P'IE:Iq~i;:[Cff.,t ]:::-.'; FI.iii: I E:H[:3-r'H ,:: .T_ t'-,I 'l'l-'lli~: E:,[ii:t::"['tl [3F t::1 'I'F:'[i!:t",ICII Ot:;~: l:::':['l- :IF:; TI'II::: [::' ]: :!i;'lr'f'~l'"l~:::~:!: [ii"Z'['l'!li!:[ii:N 'i'fll!: :~;t,l['~:f:'t:::l(::[~: OF: Tiff': GF:Cd_II'"][::' I:::li'"lt:::' TILE: t!!"O[ FOH OF THE: t~::';:CFI".'~F:IT]:ON 'IHI:::I:;;:[::: ]:::; I'"10 :!!;E:T I"t]:I::'TH [:OF~: 'I"F":[i~IqCHE:'.!~:. t'[IE' 12i['~'J::l","[ii:l. [.:'E:I:::'TI'I '[';'~: TH[: H:[F'I]:P1LIh'I Cd'!:.F:'TII CIF:' FtI'"I[) -[14[i: [i:l::l l'll:)l'"t Cfi: 'FIt[: [E::<:C:I:::I"/FIT F'FJ;?I'I :[ I' I t I I · - I,I I I-IFI'Z THE: f~:[~:ZF'Cq",t'Z ]: i",f:ii; I'1::I[., I I:::1'1 ]: [flq i'-,f'::.;I::'I:::T:'I' [ Ol",P. ii; OF' FIN"? I,.l[i:l. I,.:~'; I:::IE:,..]'I~::II::::[~:t'.,IT 'l"-i TH :[ ~-~ I::'F:OI::'Ii~:I';[: ! "r' FI!',I[) I'!"lli F,IUr'l[9[i:l:~: Cq:: Fit[~:!i;:[I:::,I:!~I'.,ICE:Z THFt't ~tlIE: HE:I..I.. I,t]L.! ..... I,,.., I I',l:[H]:r,lllr,,i [::,:i:ii~;r'F:II'.,ICE: [i~[!~-t'l.,IE:[:~i'.,I 1:::1 I,IZt_L FIND I:::l~'.,l'.d ::t.~!l~) !::'[~:t~:-I [:Cfi.: F:I f:'[,:: :[ ',,,'[::l'['~i: l.qE:[.l; :l.!~:.;li:il 1'O ~:::Ii:.iCi [:l:!:l!iT I::F:OH Fi F:'I,I[?,I..]:C I,.1[!:1.1_ E:,[~:F'E:N[::~:[t'.,ICi l..l[::'Of.,I /I.I1: "I-'.r'F'E: Cfi:: F'Ufi!',I_:[C I,li~:l.t O?l,ff!:F: [;i:l:i:l:;.!l_,l ]: [;?.[i:Pll!l'.,[ l:!i; Hl::l"r' F:II::'F'L 'T'. '-:~;[:'E)Z: Z F: I:::l",,'l::lZl. f::l[i',L[i: ['[) ]:N:!i;l_,l[~'.tj: [:'F~!I::IF:'[~:I;?. :[t'-,1'_:!; Oecember 14, 1971 ,,,'Ir. Earl Thomas Box Anchorage. Alaska St b,Jo(,),. 011-si te S ow ~'~ r 3 5. Installation, Government LoC Dear ),~r, Thomas: On February l~, 1971 you obtained a permit from t:i~is F)epartmen~ for the i)~s'~;~t'lation of an ']n.-sii;e sewer s~si;em to b(- installed a~, the above 'location, Please advt~;e this Department if th~.~ systom has been irlsl;a'lled or if you wish your pe)'mf~ kepB w~'l'id in our files. Si rice, ret!/~ Environm,~n'~,al Control Officer s i: 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 35; Sec'15~ T12N;R3W; S.M. Location (site address or directions) 4440 Abbott Road Property owner Mailing address Lending agency Mailing address Agent Address Mark Alleqrezza Day phone 4440 Abbott Road Anchorage, AK 99507 346-2244 346-1411 (h) Day phone_ Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: _ XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 ch.-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type 9f structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site'water supply and/or wastewater disposal system is in compliance with all MunicipaJ and State codes, ordinances, and regulations in effect on ~he date of this inspection. NameofFirm Phone~ ~ Address ~ ~ S ~'~ ' ~°aa "°'"~ ~,~~ , DHHS SIGNATURE .~_ Approved-for Disapproved, bedrooms, Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Departrnent 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 omissio,~s in the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAl. CHECKLIST Legal Description: ~.0~3% A. Well Data Well type ~1~-~7~ If A, B, or C, attach ADEC letter. ADEC water system number Date of test Static water level Well flow Pump level1 Log present (Y/~__~") Total depth ~-/J~ Sanitary seal ~'N) ¢EpE'FL /00/4 Y~Edo/Z~. FROM WELL LOG Date completed ~/'~r) / ~ Driller Cased to ~0c¢- Casing height Wires properly protected YL~N) ATINSPECTION g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/hetdi¢~ tank on lot Absorption field on lot / Public sewer main /UO''u~C Sewer service line ~-~/_iL ; On adjacent lots _ _; On adjacent lots /"CO ~' Public sewer manhole/cleanout Petroleum tank / WATEFt SAMPLE RESULTS: Coliform Date of sample: _ / O/ ~/~'-~ B. SEPTIC/~ TANK DATA Date installed Nitrate O,~ "'~' '/f ,~,'"//-'~ Other bacteria Collectedb' by: Tank size //2..FO ~'~(~ Compartments__'~¢ _Foundation cleanout~,N) _ F~--~¢ Depression ("~ Alarm tested (Y/N) Foundation ,-~ "~/~' Water main/service line CONTINUE[) ON BACK PAGE High water alarm (Y/~') ~ Date of pumping ~_~/~'('2/~,-~ Pumper SEPARATION DISTANCES FROM SEPTIC/14~4~t~C~itTANK TO: Well(s) on lot ~0~- ~"~k- On adjacent lots /00 To property line ~'(2 Surface water/drainage 72-026 (3/93)* Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Manufacturer Manhole/Access (,.~.~ ~ "Pump on" level at .~-~'~ump off" Level at Meets MOA electrical codes (Y/N) ~....~..~..~'~Cycles tested SEPAR~ FROM LIFT STATION TO: ~¢lPo~ lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/¢/ Length Total absorption area Date of adequacy test /0//// ¢.~, Resultsd~il) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Width Gravel thickness Cleanout presort Yt~) /~,'~' 3" for After test If yes, give date Soil rating (GPD/Ft~) ~?%~",/~F~ System type Total depth /O fMc DepressJon over field (Y~ ,,'~--'~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //~ / ~ On adjacent lots To building foundation On adjacent lots .~O Surface water Curtain drain E. ENGINEER'S CERTIFICATION Property line To existing or abandoned system on lot Cutbank /L'/¢/L/~ /~,,¢_(..~E/U~'Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Date l~4,..E, agle River Loop Road NO. HAA Fee $ ~£'~' ¢ (/~ Waiver Fee $ Date of Payment /~ -//d~ - ~',~ Receipt Number ~ ,~-,~,~ ~ ~'-'~ .2~_ 2 Date of Payment Receipt Number 72-026 (3/93)* Sack MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # (- ~ ~.,~ - ,~-"X~'~-~ - ~ HAA # l=i 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 35; Sec. 15, TI2N~ R3W S.M. Location (address or directions) 4440 Abbott Road (b) Property owner Freddie. Mac #$2-752589-4C Telephone : (home) Mailing Address Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address _ 32,01 C Str~.et Telephone __ 563~550Q Jack W~te Company ATTN: George McCoy Suite 100 Anchorage. Alaska 99503 (e) Mail the FtAA to the following address: (or check here E~xif hold for pick up.) List contact person and day phone number below: $ & S ENGINEERING 17034 Ea,qle River Loop Road No. 204 Eagle ~iver, Alaska 995:77 2. TYPE OF RESIDENCE Single-Family B{× Number of bedrooms 4 3. WATER SUPPLY Individual Well,~ Community [] Public [] Note: If community well system, must have written confirmation h'om the State Department of Envh'onmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site E~X Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. o25 i,ev. 7/a8) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATIOH 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. [ 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 17034 Eagle River Loop Road No. 204 Date Telephone 6. DHHS APPROVAL~ Approved for Approved Disapproved Conditional Terms of Conditional Approval ~ Date The Municipality of Anchorage Department of Health and Human Services (DH HS) issues Health Authority Approval cerificated 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 DH HS 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 7/88) Back Page 2 of 2 c,~o MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) ~,/,uh, ~/,; loll ',AC~ECKLIST ' FEBRUARY 1984 FN\ IRONME'N'[;\ SERVICES DIVISION 343-4744 A. WELL DATA Well Classification _ If A, B, C, D.E.C. Approved (Y/N) ~/J~ Well Log Present (Y/j:g~_~_ Date Completed ~ I ~ ~ ~ Total DepthS- Cased to _~o~'t¢_ Depth of Grouting Static Water Level ~ ¢~'~ -- Pump Set At Casing Height Above Ground \'2~1J¢~ Sanitary Seal on Casing ¢~/N) Electrical Wiring in Conduit (~'N) ___,¢ Depression Around Wellhead SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot __ ~ ¢::~¥ ; On Adjoining Lots To Nearest ledge of Absorption Fiell~Or~ Lot ___ \ ~'¢~ ; On Adjoining Lots To Nearest Public Sewer Line J-~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~ Water Sample Collected by ~,~.~ ~,~,~l~l~=~a,Z~l,.c~K~~ ;Date WaterSampleTestResults--~'/~'A~"'~Fz'-'"t '- %'~/'~:~1~.' ,¢~_ ~'"~.~"'~-¢,,.'~ Comments B. SEPTIC/HOt. I)ING TANK DATA Date Installed ~ - '~o Size Standpipes ~'~i~N) "~ __ Air-tight Caps Depression over Tank (Y/J~ Pumping/Maintenance Contact on Fife (Y/N) ~ Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: _ No. of Compartments Y I'4 l,~e Foundation Cleanout(L.~N) Last Pumped To Water-Supply Well __ / ~ ~¢) To Property Line ~0t '~¢ To Water Main/Service Line ,~ ~t To Stream, Pond, Lake or Major Drainage Course Comments ; for .Temporary Holding Tank Permit (Y/N) . To Building Foundation To Disposal Field f 72 028 (Rev 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata ____ Date installed '~ - '¢'~' f'¢'l ~ Width of Field ¢" '~' ' Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test ~.J¢~'f~;~'~-~.. - Type of System Design Length of Field __ Depth of Field Gravel Bed Thickness -- ~,.~ ~c;:~ -cC _ Statndpipes Present (~N) ~ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: \ "~----1 I To Property Line ~ '~ To Water-Supply Well To Building Foundation '"'~'~" To Existing or Abandoned System on Lot "'~'c;~f ~ ; On Adjoining Lots TO Water Main/Service Line \ (:pt ~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course _ \ ~:~:::~ To Driveway, Parking Area, or Vehicle Storage Area Comments Date Installed "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guideli~es~in~ffe6t, on the date of this inspection. Signed $ . - ,=-' .rLoo¢~dNo-20'1 Company Eagle R%ver~ Alaska 99577 Date _ , MOA No. Receipt No. ~- /? -~ /~ ~ '~''~'~ Date of Payment '~22 ~'/ L//~ ~'(~_ Amount: $ ./~';'(~) ' ~-~ 72 026 (Rev 7/88} Back Receipt No Waiver Fee: $. Date of Payment Page 2 of 2