HomeMy WebLinkAboutT12N R3W SEC 27 LT 10
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 995'9-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http:iiwww.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP221314
Work Type: Septic Upgrade
Tax Code Number: 01809211000
Site Legal Address: T12N R3W SEC 27 LT 10 G:2936
Site Mailing Address: 13641 MC DONELL RD, Anchorage
Owner: PHILLIP KAREN C
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
gent Is
off'
r..
r'
fi
v
(I[') i1Tr]Tlellr
1012112022
1012112023
108595
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 (2417).
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 13)
Issued By:
Date: 10/21/2022
Date: 4A 1 Z
If I
4
�1.1�UMCFP UTY OF A HCHOPRA' E
Development Services Department r� Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I. D. 018-092-11
Property owner(s) KAREN PHILLIP Day phone_
Mailing address 13641 MCDONELL RD, ANCHORAGE, AK 99516
Site address 13641 MCDONELL RD, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) T1 2N R3W SEC 27 LT 10
Lot Size 108,595 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
0
Initial ❑
Single Family (SF) El
(w/wo ADU)
Septic Tank
0
Upgrade 0
(D) El
Holding Tank
ElRenewal
ElDuplex
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5G 5
Date of Payment: 0 ) 2
Receipt Number: 7050 C/�
Permit No. OS P2 2 13 l Y
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13021 Montego Circle, Anchorage, AK 99516
907-350-9566 / FirstWaterAK@gmail.com
October 12, 2022
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: T12N R3W SEC 27 LT 10
PHYSICAL: 13641 MCDONELL RD, ANCHORAGE, AK 99516
The septic field has been found failed and we request a septic permit to upgrade the system on the above
referenced lot. We propose to install one deep trench with an Advantex system to serve the existing 4-
bedroom residence. This property was originally proposed to be subdivided. Apparently, this action was not
proceeded with and therefore the original design in conjunction with this proposed platting action and
subsequent ROW authorization is no longer being perused. The design is also based on the recent test holes
conducted on July 12, 2022.
The slopes are basically flat at 0-5% at the proposed upgrade location. The lot and area are served by private
water. 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
OSP221314, Deb Wockenfuss, 10/21/22
FIRST WATER CONSULTING
T12N R3W SEC 27 LT 10
DESIGN CALCS:
NO SLOPES >25% WITHIN 50'
OF PROPOSED FIELD.
PRESSURIZED DIST. LINE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221314, Deb Wockenfuss, 10/21/22
FIRST WATER CONSULTING
NO WELLS WITHIN
50' OF PROPOSED
SEPTIC SYSTEM.
DESIGN DETAILS:
T12N R3W SEC 27 LT 10
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221314, Deb Wockenfuss, 10/21/22
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: T12N R3W SEC 27 LOT 10
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: 7/22/2022
DEPTH
FEET OG
SOILS
1
ORG/OL
2
3
4
5
6
7
8
GM/sm-ml tight
9
10
11
12
13
14
15
BOH
16
17
18
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
7/20/22 30 min 6 11/16
30 min 6 11/16
30 min 6 11/16
PERCOLATION RATE 44 (MIN / INCH)
TEST RUN BEWTWEEN 3 & 4 FT
PERC HOLE DIAMETER 6
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: DRY
DATE: 7/20/2022
TESTHOLE # 22-1 DATE PERFORMED: 7/12/22
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: KAREN C PHILLIP
7/22/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221314, Deb Wockenfuss, 10/21/22
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 firstwaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: T12N R3W SEC 27 LOT 10
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: 7/22/2022
DEPTH
FEET OG
SOILS
1
ORG/OL
2
3
4
5
6
7
8
GM/sm
9
10
11
12
13
14
15
BOH
16
17
18
19
20
Reading Date Gross
Time
Net
Time
Depth
to
Water
Net Drop
7/20/22 30 min 6 1 15/16
30 min 6 1 16/16
30 min 6 1 15/16
PERCOLATION RATE 16 (MIN / INCH)
TEST RUN BEWTWEEN 3 & 4 FT
PERC HOLE DIAMETER 6
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: DRY
DATE: 7/20/2022
TESTHOLE # 22-2 DATE PERFORMED: 7/12/22
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: KAREN C PHILLIP
7/22/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221314, Deb Wockenfuss, 10/21/22
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this w30 Day of� `2"rein'the
� of 20 � `` ' by and between
, "OWNER,'' and the Municipality of
7-1
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)
T12N R3W SEC 27 LOT 10
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Throughout the terns of this Agreement, the Owner shall enter into a service agreement
t
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
�0, accordance with the equipment's approval for operation in the Municipality.
V-] It shall be the responsibility of the Owner during the term of this P
Agreement to pay for all
.
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
r includes an annual maintenance fee (typically $400 to $600).
J 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
r v
rs
Owner acknowledges that the Municipality may request records of maintenance and
°°`} repairs from the manufacturer's representative or maintenance provider.
-:' Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
r' assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
14\1� Owner agrees that any sale or transfer of title of the property will not occur without a new
I) ) Certificate of On -Site Systems Approval.
r4AI 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.
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. Severabilitv. 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: ., 11
� o
By: ! (signature) Date:
(print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this 'So day of PO405T
20zZ , by P N►t-tg- '
LN
NOTARY PUBLIC FOR ALASKA
My Commission expires: J u LY 13 -7,oCZOZ ,C6 Anr se.4&3 u0►ss!11o3 An
Notary Pilb,, ^muo N .IN
M. N. ANDRES ON -I'd fJ81ON
State of Alaska
?i. '-ion Expkas July 13, 2023
Date: C-07- 1 ZZ
int name) Title:
(rev. 05/18/2018) Page 3 of 3
TRACT B-2
HILL — N — DALE SUED.
TRACT A
Lot 11
Lot 31
Lot 9B
G
S�J� J00
Lot 9A
Lot 32
$ 114 8 2 HAY 0 3 2006
PLOT PLAN _ AS BUILT X SCALE 1 = 50' GRID 2936 Project No. 06-011
Lang & Associates, inc, 11500 Daryl Avenue, Anchorage. Alaska 99515-3049
(907) 522-6476 Phone
Registered Land Surveyors (907) 522-4625 Fax —o`�OF q o�4
kglanglsOalasko.net / jclonglsOalasko.net ` ...
I hereby certify that I have surveyed the following described property:
BLM LOT 10, SEC 27, T12N, R3W t
Anchorage Recording District, Alaska, and that the Improvements situated thereon aro :49TH ........ y*:...
within the property tines and do not encroach onto the property adjacent thereto, that
no Improvements on the property lying adjacent thereto encroach on the surveyed
promises and that there aro no roadways, transmission lines or other visible KENNETH ..
easements on sold property except as indicated hereon.
Dated this the I4t Day of . MbR .Ak 2c�lo, at Anchorage, Alaska OQ ''•'� 14-io�0• 0 �
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
0
CSEPTIC
ARE�D
• MULLBERRY S/D;
TRACT 82, \
FA
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,�QRo'�• �' I
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T12N, R3W, SEC. 27, LOT 11/
/
/
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APPROX.
LOCATION
T12N, R3W, SEC. 27, LOT 30
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HILL—N—DALE S/D; TRACT A,
NO ENCROACHMENT CONCERNS
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I 511482 MAY 0 22001
I
NOTE: TEST HOLE LOCATIONS
II ARE APPROXIMATE.
!L--------------------- — ----
50' ROAD AND IUTILITY EASEMENT
(TO BE VACATED)
I
---1---------
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SCHUMACHER S/D;
LOT 9B,
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T12N, R3W, SEC. 27, LOT 31
WELL
T12N, R3W, SEC. 27, LOT 32
o
GARNESS ENGINEERING, GROUP, Ltd p cl) : T .�
r x v s�x�x CONSULTANTS & GENERAL CONTRACTORS c a _ w Q• • • • : • .f.. t ... ................
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707 E. MOOR ROAD, SURE 101 •ANCHORAGE. AK 99507 •PHONE (907)337-6179 •EAI( (907)338-3246 ' WEBSRE: rwvr.gomeasengineering.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ?
SUSAN MCCREADY 907-230-5758 1 OF 1 OO . Je Jr y G ess.
LEGAL DESCRIPTION: DRAWN BY: Q4 s1 E-7953
T12N, R3W, SEC. 27, LOT 10, J. L. "'(a- �AoG
TYPE OF WORK: DATE: DOa�'�ofessiono�o
SITE PLAN FOR WELL AND SEPTIC RESERVE SITES 3/28/2006
(Rev. 01/05)
GARNESS ENGII�TEERIN GR®1CTI' Ltd.
CONSULTANTS & GENERAL CONTRACTORS�* 4 T— D
0
3701 E TUDOR ROAD, SUrtE 101 • ANCHORAGE, AK. 99507 •PHONE: (907)337-6779 • FAX:(907)338-3246 • WEBSRE: gamessengineering.com .......... . .... ............ .D D
SOIL LOG - PERCOLATION TEST Q
LEGAL DESCRIPTION: T12N, R3W, SEC 27, LOT 10, f ey . Garness:'
CE -7953 4 p�
PERFORMED FOR: SUSAN MCCREADY DATE: 3/16/2006 Q4'rc�O
DEPTH — _� i z-t��a� <ov�
(feet) ORGANICS TEST HOLE1 '1' mesfsi°�°���
1 Owe s
SOIL CLASSIFICATIONS
2GW ORG
NOTE: TEST HOLE LOCATIONS
3 GP ML
GM CL 50' ROAD AND UTILITY EASEMENT
4 GC OL N
o SW MH
5°•;• SP CH �' ,,SEPTIC RESERVE
SM .'; OH
6 Sc
7 DEPTH O
GROUNDWATER DATE
GM TO SM
8 MORE SILT AND DRY 3/16/2006
DENSER w/ DRY 3/23/2006NOY
9 DEPTH AND
SOME LARGE SCALE: I
BOULDERS
10 THROUGHOUT _
11 DATE READING CLOCK NET TIME WATER LEVEL NET DROP
12
13 3 1:32 — 6" —
14
15
B.O.H. 7 1:36 — g" —
16
17 10 1:40 2 0" 6"
18
19 PERCOLATION RATE *<1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.0 FT. AND 4.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: [—]YES NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: BENJAMIN MAUS
COMMENTS: *THE INSITU SANDY SOILS WILL ACT AS A SAND FILTER.
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERF RMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 3LZ , 06 _
ARE APPROXIMATE.
-- -=-------------------------------------__T__
(MINUTES)
READING
�
(TO BE
VACATED)
1:30
—
6"
—
2
1:32
2
0"
6"
4
1:34.
2
0"
g"
5
1:34
—
g"
—
6
1:36
2
0"
6"
8
1:38
2
0"
i
goo'
TIME
(MINUTES)
READING
(INCHES)
3/17/2006
1
1:30
—
6"
—
2
1:32
2
0"
6"
4
1:34.
2
0"
g"
5
1:34
—
g"
—
6
1:36
2
0"
6"
8
1:38
2
0"
g"
9
1:38
—
g"
—
0
GA.RNESS ENGINEERING GROUP, Ltd..
CONSULTANTS & GENERAL CONTRACTORS
101 E TUDOR ROAD. SUGE 101 • ANCHORAGE AK. 99507 • PROW! (9071-17-f,179 • FAT mn7111A_11— wca<nc. ..,,...rm_.......-_...
LEGAL DESCRIPTION
PERFORMED FOR:_
DEPTH
SOIL LOG - PERCOLATION TEST
T12N, R3W, SEC 27, LOT 10,
SUSAN MCCREADY DA
4
6
7
8
9
10
11
12
13
14
15
16
17
18
GM TO SM
MORE SILT AND
DENSER w/
DEPTH AND
SOME LARGE
BOULDERS
THROUGHOUT
TEST HOSE #2
SOIL CLASSIFICATIONS
DEPTH TO
GROUNDWATER
DATE
DRY
3/16/2006
DRY
3/23/2006
(TO BE
�s�
ANN
•
2
1:44
-- ---------------
-[-----------------------
-I--
'i�.�
•
�
6"
_
4
1:46
2
DEPTH TO
GROUNDWATER
DATE
DRY
3/16/2006
DRY
3/23/2006
(TO BE
VACATED)
6"
N
Sgi482MY02
NOTE: TEST HOLE LOCATIONS
ARE APPROXIMATE.
-A-----------------------------------------
50' ROAD AND
UTILITY EASEMENT
3/17/2006 1
(TO BE
VACATED)
6"
N
2
1:44
-- ---------------
-[-----------------------
-I--
3
''::'SEPTIC RESERVE AREA'S
�
6"
_
4
1:46
2
0"
6"
5
1:46
—
6"
—
6
1:48
2
0"
6"
7
1:48
—
6"
—
8
1:50
2
0"
I
9
1
OP0v0 �u5
6"
—
I SCALE:
,
2
0"
100'
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
3/17/2006 1
1:42
—
6"
-
2
1:44
2
0"
6"
3
1:44
—
6"
_
4
1:46
2
0"
6"
5
1:46
—
6"
—
6
1:48
2
0"
6"
7
1:48
—
6"
—
8
1:50
2
0"
6"
9
1:50
—
6"
—
10
1:52
2
0"
6"
19 PERCOLATION RATE *<1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.0 FT. AND 4.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: BENJAMIN MAUS
COMMENTS: *THE INSITU SANDY SOILS WILL ACT AS A SAND FILTER.
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAPE FORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: .31 If, u
· Gl'' 'I'ER ANCHORAGE AREA B'--DUGH
Department of Quality
Environmental
3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ViAl LING ADDRESS ~¢~¢ ~
LEGAL DESCRIPTION ~[ /Z]
SEPTIC TANK:
DISTANCE ~
FROM WELL
INSIDE LENGTH
MAN U FACTU R E R~
MATERIAL
NUMBER OF
COMPARTMENTS.
NSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /,~tO GALLONS.
SEEPAGE PIT: ,/LENGTH
NUMBER OF PITS / DIAMETER __ OR WIDTH //~ '//, / DEPTH /'~/
LINING MATERIAL ? /~ ~RIB SIZE: DIAMETER DEPTH ~' / DISTANCE FROM: WELL_
·
BUILDING FOUNDATION NEAREST LOT LINE ~'~ '~/- TOTAL EFFECTIVE
· ABSORPTION AREA (WALL AREA)
/
SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL.
APPROVED
CONSTRUCTION ~/ ~'''~' '5~'''[' '~
qEAREST NEA REST
~OT LINE ~ '''~''' SEWER LINE
OTHER SOURCES
/
DEPTH. /'~'~/ DISTANCE FROM:
SEPTIC ~ / SEEPAGE
TANK "~ '~-, SYSTEM
· DISAPPROVED
REMARKS
DISTANCES:
INSTALLED BY: .Z)Z,/~'2'?' ,~,/~,,~2~"
PIPE MATERIAL:
LOT SLOPE:
DIAGRAM OF SYSTEM
TYPE
:~.-?OUNDATION TO SEEPAGE PiT 20 fi;,~ DRAIN FIELD
].0
2'~?~EPTIC TAN K TO SEEPAGE PIT '~¥ALL --
DRAIN FI~L~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include Iot~ block, Subdivision, section, township, range)
_~ i - Location (address or direct 0nb)'} ' -
--- (c) Applicant is (check on~): Lendi~ Institution ~; 0~nedbuilder Buyer ~; Other ~ (explain};
(d)
(e)
' Lendin~ institution/-~'r'/~~-~
Real Estate Company and Age"t ' ~//A '
Address
Telephone
(f)
Mail the HAA to the following aaaress:
- Z.'7 -53
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Well~ Community [] Public []
Individual
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite/~ 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.
72-025 (11/84)
Page 1 of 2
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MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
.MUNICIPALITY OF ANCHO~]~ LIST FEBRUARY 1984
WELL DATA
AUG 1 0 1987
RECEIVED
Legal Description:
Well Classificatiorv/A//;~/V//~//~/-~/~/*'~--&E~//~JV'~,4~f A, B, C, D.E.C. Ap~oved (Y/N)
Well Log Present (Y/N)~ Date Comple~ ~//~-/~ ~ Yield
Total Depth / 7~ Cased to . 7~Depth of Grouting
Static Water Level /~ ~ ~ Pump Set At
Casing Height Above Ground /~// ~ Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N)
Depression Around Wellhead (Y/N)
Separation Distances from Well:
T0 Septic/Holdi'ng Tank on Lot /~ ~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /~/~ ; On Adjoining Lots
To Nearest Public Sewer Line ~/~ ~ To Nearest Public Sewer
CleanouVManhole ~/~' ~ To Nearest Sewer Service Line on Lot
Water Sample Test Results ~'r/~
SEPTIC/HOLDING TANK DATA ~/~' ~r'~ /
Date Installed ~'~../~:~7~, Size "7-.~4~:~,,~-4~. No. of ~mpa~ments /
Standpipes (Y/N) Y ~ Air-tight' Caps (Y/N) ~ ~ Foundation Cleanout (Y/N)
bepressio~ over Tank (Y/N) ~ ~ Date Last Pumped ~/~/~7
Pumping/Maintenance Contract on File (Y/N) ~¢ ;for /~ ~
Holding Tank High-Water Alarm (Y/N) ,/"Y//,~ (~
Separation Distances from Septic/Holding Tank:
To Water-supply Well /2~ ~ ~'~' (~
TO Property Line ~ 2 ~ ~'T' ~
TO Water Main/Service Line /'V*//~ (~)
Course /'~///~ (~
Temporary Holding Tank Permit (Y/N) /~//,/~
To Building Foundation
TO Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72 026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~/'~ ~ ,~/-~//~/¥¢ (~)Type of System Design
Date installed ~"'7~ /~'~ (~ Length of Field //..~ F~'(~)
Width of Field //,c~/~7- ~ Depth of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Gravel Bed Thickness ~ ~-'7-' ~
Standpipes Present (Y/N) ,,y/~J
Date of Last Adequacy Test (4~/j~/(~.;.~ ~'
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot ./~/,,~
TO Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Properly Line
To Existing or Abandoned System on
; On Adjoining Lots /~)7~
To Cutbank (if present) //~//~
Comments
D. LIFT STATION
Date Installed __
Size in Gallons
"Pump On" Level at __
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Rating Against Request **
I certif
Signed Date
Company ~'~-~'/~ __ MOA No. __
Receipt No. / O O / <~ 0//,/42
Date of Payment C~//y ~'--~
Amount: $
Page 2 of 2
uidelines in effect on the date of this inspect on
72-026 (11/84)
CHEMICAL & GEOLOGICAL LABORATORIES OF ALA~KA, INC.
~,\' ~m~s ~ STREET ^NC.ORA~E. ^'ASK^ 99~9 TELE.HONE ¢O71 ~m2-2m43
~.~-,~e'o~;,~,',~sn'~% FEDERAL TAX ID # 92-0040440
ANALYSIS F;EFORI' BY E;~qMF'LE
Cl!ent POe : VERBAL
Client Sm, pi II): 1364]
Sample Ree'd : AUO 14 D?
Ordered By : DOD ~RIg[l?
Reports To: 0.-HIUE ENOR
i¢ock Order No, : 2254
Client Account :DBIGtIE~
Date Report Printed: A0G 14 87 9 14:44
Re]eased By,r% : 3
Report9 Add:em9 ~2
3605 ARCTIC $~ ~993
F~]CEO~AGB, AK. 99503
Special ROUTINE SA))PLK COLLKC~KO 8-14-87 BY Il-HIGH ENGIN~RRS.
instruct:
Chemlab Ref ~: 7324 Lab ~npl I0: I Matrix: ~ater
AIIo~able
P~rameter Tested Result/Units ~lethod Limits
1.1 mg/1
~UNICIPALITY OF ANCHORA(~I~
DEPT. OF HEALTH &
r=~IRONMENTAL PROTECTION
~AUG 1 4/987
RECEIVED
Sallie ROUTINE SANPLE
Remarks:
! Tests Performed ~ See Special Instructions Above
Nl~ ~one Detected *~ See Sample Remarks Above
NA: Not Analyzed L?=Les9 ?hah, O?=Greater ~)an
· ftX .. B.o roR Es
~ .....~ Drinkin0 Water Analysis Beport for Total Coliform Bacteria
TO BE OOMPLETEDiBY WATER SUPPLIER
X"mV^TE~'^*E" SVS~rEM ~
Name ~ Phone No,
~o. Day ~ Year
SAMPLE TYPE:
Routine
Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
.) [] Treated Water
[] Untreated Water
SAMPLE Time Collected
NO. . . ! LOCATION Collected
21
3 I I
41 I
' READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[~ Satisfactory
[] Unsatisfactory
[] Sample too Iorig in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received <~Ta~ '~ ~ ~
Time Received /"r~ ~ ~
?
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref.~o- Result*
BACTEFIIOLOGICAL V~AT£RtAMAL¥$1$ Rr=CORD
Membrane Filter. Direct Count
Verification: LTB !BGB
Final Membrane F~r~sults .
Reported By nato
TNTC = Too Numberous T° Count
OB = Other Bacteria
line:
Analyst
CoilformllOOml
O Collformll00ml
INVOICE "
EWER AND DRAIN
".'~W' ~o, '7,'u,.~r,~ CLEANING SERVICE
P.O BOX 112688 PHONE 345-2513 ANCHORAGE, ALASKA 99511-2688
ROTO- ROOTER SERVICE CALL
STEAM THAWING
TRIP CHARGE
OVERTIME CHARGE
ADDITIONAL LABOR CHARGE
PUMPING SERVICE "'~) (GAL) HRS
HRS. (G, ~ "---"~.
HRS.
HRS.'
HRS. ~
HRS ~
HYDRO-JET SERVICE
MATERIALS
PLEASE PAY FROM THIS INVOICE
TOTAL FOOTAGE CLEANED OR THAWEd- BLADES USED
LINE CLEANED
[] JOB NOT GUARANTEED~C~R F~LOWING ~'~/SQ~~
® N-° 021501
~¢~¢~:~ ~¢~~SEWER AND DRAIN
",~,w-f ~a ~,u~_~ CLEANING SERVICE
P.O. BOX 112688 PHONE 345-2513 ANCHORAGE, ALASKA 99511-2688
ROTC- ROO~ER SbHVlOb ~ Llb "R SI / ¢
STEAM THAWING HRS. ~
TRIP CHARGE HRS. ¢
OVERTIME CHARGE HRS. ~
ADDITIONAL LABOR CHARGE HRS. ~
HYDRO-JET SERVICE HRS ~
MATERIALS
TOTAL
PLEASE PA* FROM THIS INVOICE .
TOTAL FOOTAGE CLEANED OR THAWED ~ BLADES/D
PRDBABLE CAUSE O/: STOPPAGE J/~