HomeMy WebLinkAboutT12N R3W SEC 22 LT 14 PTN N2TI R3W
Lot 14 PTN
N2
#01§- 141-08
Mar~ ~egich
Mayor
,Ancho~, ,AK 99~ !9-6650
(90T) 243-7904
Pump Installation Log
VfeI1 Drilling Permit
D~te of Issue:
parcel Ideniific.~tion Number:
-~-eg,~I Description
'T'/z A/
P---map Inst.~ll~tion
Pump Intake DePth Below Top ofWe~ Cas~g:' bc~ feet
P~_tless Adapter !nstnLler: ~0~
Disinfected ~poo .....
~/iethod of Disinfectio a:
Pump Inst~Ller Y~me:
Arrant%n: Th~ purap msmLl~r shall provide a pump im~taltation log to the DSID within 30 days of pump
Municipality of Anchorage
Development Services Department '~'-¢" ..'"'~,
Building Safety Division ~'~i~
On-Site Water & Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 ~
www.ct.anchorage.ak.us (907) 343-7904 I Poge 1 of `3
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number:. SW060220 PID Number:. 015--141--08
N°me:ANNE SCO'[-]' Wastewater System: I-I New i~ Upgrode
4410 OMALLEY ROAD * ANCHORAGE, AK 99516 ABSORPTION FIELD
Ph°"e:(907) ,346--4039 ,3 O Deep Trench · ShQIlow Trench r't 8ed (3Moum:l r'tOther
LEGAL DESCRIPTION ~, ,~t~9: T~el ~ ,mm ~
- 14, N2 - SEE DWG. ~ [ 2
rownsh;p: T12N Re.ge: R,3W Section: 22 SEE DWG. .. i 5.3
WELL:D New I-] Upgrode 5 ~. 1I --
~ ~ 378 ~.~ D 3034/ F-810
/ ~. GEG, Ltd. 10-,14 2006
SEPARATION DISTANCES .se..c =.o,d~ng =S.T.[... I
tonk ~eld StoUo. Tank S.. U.. ANCHORAGE TANK 1000
Wel~ 100'+ 100'+ - - 25'+ ~ 2
Su,oc, wot,, ~oo'+ ~oo'+ - _ _ LIFT STATION
Foundotion
Cu~oln DroWn NONE KNOWN ~ ~ MOA - GRINDER PUMP
~o~ks: BENCH MARK
OLD SEPTIC T~K ~D CRIB WAS PUMPED, CRUSHED BOSOM OF SEPTIC TANK ~ STI
AND COMPLEXLY ~ANDONED ,
Inspections pedomed by: GEG. Ltd. Dates: 1st 8/10/2oo6
2nd 8~14/2006 ~.~~
3rd 8/14/2006
Development Se~ices Depa~ment Approval ~ ~~...L..J' 4" '"~
R~viewed and approved by: Dote: -~&~¢~- - ~ . ~¢ ~
P~.,~ .u,B~.: AS BUILT DRAWING
5W060220 - 015-141-08
,..'.; I -- - I
· ,, ~.o~ ..o - - /I
~.'.[~'*' ~2 80.1] 44.4 -- -- /'
',': ~ ~2.0 42.7 ~
" O~ ~6.5 41.~ [
~ :~ % [ I
:..:. % [
I '
~" ~ I
, ;~. ',_~1'~""
:~~/~ /// %,,
I ' '. ~ ~ '~. b ." ~"~ .......
, :~~ //,X
I ;, %..~. ~. - ~,' '
P"~ FOR: PHONE NUUBER: I P~ NUUSER: ~ ~ ~1~ .....
,.,~ sco~ s~s-~os9 I 2 or s '~-Z_*~;~./. ~'~
T12N, RSW, SECTION 22, LOT 14, N2, C.J.G. ~h~e,
AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 8/16/2006
A B C D
ST1 83.0 I 44.0
ST2 80.1 44.4
OBL2 87.2 56.6
C01 77.5 I 65.0
MT! 81.1 65.4
C02 101.8 I 60.9
MT2 10.3.1 [ 63.0
PV 32.g 42,7
DB!-3 36.5 41.3
DBL4 35.3 42.0
~ERM~NUMBER: AS BUILT DRAWING ~CE~,0 NUMBER:
5W060220 - 0 ! 5-141-08
98.26-9&29
STI ST2
~ / / ~
NEW 1000 GALLON
SEPTIC TANK
I
I
OUTLET - 93.27
92.83-93.86
5'
OF PtPE
- Bg.33 (AVG.)
8?.32 (AVG.)
E~.[VA~ION OF* 80'~'OM OF'
79.33 (TESTHOLE DRY)
GARNESS .ENGINEERING GROUP, Ltd. [~
PREPARED FOR: [PHONE NUMBER: I PAGE NUMBER: ~
ANNE SCOTT 346-4039 3 OF 3 \v~
LECAL DESCRIPTION: DRAWN BY: ~
T12N, RSW, SECTION 22, LOT 14, N2, C.J.G.
PROFILE AS-BUILT OF PROPOSED SEPTIC UPGRADE 8/17/2006
From +Zg078308507
Sun Aug 20 Z4~22:27 2006
INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
4700 SOUTH BRAGAW
INSPECTION INFORMATION &HELP: 343-7962
INSPECTION: VOICE 343-~3o0 INSPECTION: FAX (907)249-7777 www.muni.org/BSD/Inspectlons.cfm
NAME: Kevin
COMPANY: Rising Sor~ Electric,
PHONE#: 250-1100 PHONE#:
PERMIT//:
INSPECT DAT~=: 6/21/2oo6 AM
PHONE #:
ADDRESS: 4410 O'MALLEY RD
LOT 14 SUBDIVISION: T12N R3W SEC 2~ GRID #: SW263~
COMMENTS or DIRECTIONS
Underground electrical Thanks Kevln
TYPE OF INSPECTION:
Rotro ElectrlcaJ I Undorground
Flectrtcal
COMMENTS: (FOR INSPECTOR USE ONLY)
DATE:
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-79O4
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 25, 2006
Expiration Date: Jul 25, 2007
Permit Number: SW060220
Legal Description: T12N R3W SEC 22 LT 14 PTN N2
Design Engineer: 0855 GARNESS ENGINEERING GROU~
Owner Name: ANNE SCOTT
Owner Address: 4410 O'MALLEY RD
ANCHORAGE, AK 99516-1507
Parcel ID: 015-141-08
Site Address: 004410 O'MALLEY RD
Lot Size: 28314 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must 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 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.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw St.
P.O. Box 196650
Anchorage, AK 99519-6650
www.ci.a nchorag e.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERHIT ~,PPLICATION
FOR A SINGLE FAHILY DWELLING
Parcel I.D.
Property owner(s) ANNE SCO'IT
Day phone
Mailing address ~-~-10 OMALLEY ROAD * ANCHORAGE. AK
Site address
Zip Code
Legal description (Sub'd, Block & Lot )
Legal description (Township, Section & Range)
LotS zeI q S..Ft.
T12N, E3W. $1:'CTION 22. LOT 14, N2.
Number of Bedrooms
346-4039
99516
THIS APPLICATION IS FOR ( ~;;~all that apply):
Absorption Field
Septic Tank
Holding Tank
Pdvy
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
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 Municipal codes,
CARNESS ENGINEERING GROUP~ Ltd.
PermitJRush Fees:
Date of Payment:
Receipt Number.
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number.
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
July 21, 2006
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref: Proposed Septic Upgrade for TI2N, R3W, Section 22, Lot 14, N2,
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. We are proposing to install a
grinder pump basin, a new I000 gallon septic tank and a 5-wide trench type drainfield. One test hole was
excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole.
Comments regarding the design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system.
4. TOPOGRAPIIY: As can be seen on the attached topography drawing the average topography below
the drainfield is a 1-5 percent slope running approximately northwest to southeast. In short there are no
slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any questions, please contact us at 337-6179. Thank you for your assistance.
Sincerely~/~f
Presi
NOTE: ,4ttached ix a site plan drawing, a design drawing, one soil log, which are all part of the design package for
this septic system. (Contact G. E.G. Ltd. for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineering.com
LOT ,5, SHELl. ~1 SHELL ~11 I $H[3.1. ~11
LOT 6, LOT 6,I LOT 5,
COT e. I
' / OU.A_LLEY AD_ ....
/ \
/ \
/ \
I
SE~C
· J %
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENE~L CONT~CTORS l ~'"'
PREPPED FOR: IPHONE NUMBER: I P~E NUMBER: I~'.~..,~. ~...~ ...........
4 4 ~
SITE P~N FOR PROPOSED SEPTIC UPGRADE 7/21/2006
NUMBER OF BEDROOMS:3
GALLONS PER DAY (GPD): 450
PERCOLA~ON RATE/B: <1 MIN./INCH
PROPOSED APPUCATION RATE: 1,2
DRAINF'IELD DESIGN:
£FFEC~V[: 2 FEET
/
/
/
/!
I
I
I
\
\
\
\
LETTER THAT prRTNNS TO THIS DESIGN.
TO OBTNN A COPY OF THE
CONTACT OEO. BY PROCEEDING FORWARD
WITH THIS IN~'rAu. ATIONo THE ENGINEER,
WELL DRILLER, CONTRACTOR AND
PROPERTY OWNER AGREE THAT 'THEY
NOTE: THE CONTRACTOR SHALLJ
HAVE ALL WELL RADII SHOWN
AND THE SOUTH AND EAST
LOT LINES FLAGGED BY A
REGISTERED LAND SURVEYOR
PRIOR TO CONSTRUCTION.
\
DRNNnELD \
TO BE COMPLETELY
~OC.ED \
\
?0 BE PUMPED. CRUSHED AND
PUMP BASIN
PREPPED FOR: leONE NUMBER: I P~[ NUMBER:
T12N. E3W, SECTION 22, LOT 14, N2, C.J.G.
DESIGN FOR PROPOSED SEPTIC SYSTEM 7/21/2006
feet) ORC~NICS ITEST HOLE #1I
1
"'~'~':'~'~ ~ I ~ 1 SOIL CLASSIFICATIONS I ....
2 ~,",' i,l I II SP-SM ~ ..ff-~
~ ~A~OR T12N. RSW.
GH CL f 22. LOT 14.
,', ,',' ~ SW MH ~. [ I
. ., c.
~,'*~',' SH OH ~- -~ ~ ~ /
7 ' '* DEPTHTO ~{ ~' ~ -~%
-~-,:~ GROUNDWATER DATE
~_%~3r~ CLOCK NET TIME ~WATER LEVEL NET DROP
· ,t,:L~.~ DATE READING
~_~.~3 ~ TIME (MINUTES) READING (INCHES)
~/~4/~ooe ~ ~o:~ - e' -
12--
~_ ~-~2~ r; ~ ~o:~7 - 6- _
4 10:20 D O'
14-- ~ 10:21 -
6 10:24 5 O' 6'
15-- 7 10:25 - 6- -
16-- 8 10:28 5 O' 6'
9 10:29 - 6- _
17-- 10 10:52 5 O' 6'
11 10:55 - 6. -
18-- 12 10:56 5 O' 6'
19-- PERCOLATION RATE <1 (HIN./INCH) PERC. H~E DIA. 6 (INCHES)
TEST RUN BETWEEN 5.0 FT. ~D 5.5 FT.
20-- ~ A FO~ HOUR PRESOAK WAS PERFORMED: ~ YES ~ NO
SOILS LOGGED BY: SU~N O~ALT PERCOLATION TEST PERFORMED BY: JORD~ TROISI
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFR~ A. GARNESS, CERTI~ T~T THIS WAS PE~ORMED IN ACCORD~CE
WITH ALL STATE ~D MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE: ~ fit ~
SEPTIC
DESICN PACE 2 OF
T12N. RSW, SEC. 22.
LOT 13.
LOT 14.
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANT~
SCOTT ;-4039
~ESCRtPI1ON:
12N. R3W, 22, LOT N2.
OF WORK:
PLAN F'OF )ROPOSED GRADE
PACE NUMBER:
1 OF'2
DRAWN BY;
7/! 7/2006
MUNICIPALIYY OF ANCFIORAGE
MUNICIPALITY OF ANCHORAGE ~ t]NVIRONMENTAL ?aOTECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION AUG 8 !979
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION ~l~l~l'
LOCATION u;l~ 2 o'H~t~ ~
] ~ell ~ ~bsEr~tion area' Dw~llin~ PE~IT
DISTANOE TO:] b~ .% ~
~ Well Founda¥~O Nearest ~t~ine
-- No. of lines [ Length of~line motallen~in~s~ ~ Trench widths ~ inches Distance between llnes
OTHER
INSTALLER 6 % ~. ~
REMARKS ~ I ~? ~,~.
z./ ~
72-013 {Rev. 3/78)
t
[
PERMIT NO. ( 790~28 )
3~.~IC:IF tL. IT'T' C,F At4C:HL .qFC,SE
PFIRTMENT OF HEFILTH FIND ENVIRONMENTFIL PROTECTION
825 "L~ STREET, ANCHORAGE, FIK. 9~50~
264-47~0
SE~qEE: L~F'~]~:F~[)E F'EE:I~ ·-F
FIPF'L I CFINT
LOCFIT I 0N
LEGFIL
DONALD i"IFIC:INNES
O' MFIL. LEY RD
Nl,-'2 L±4_,,=¢-cc'":" T±2N R--W
_,Rtl E,U,.., ~.72.:4
LOT _,I~-E
]:44 D:,~' b
_,.,~.b, ~-~ SQLIFIRE FEET
I_,: TF..EN_.H
TYF'E OF zLIL FIE,_,uRE, TIuN SYSTEM "-- '
MFIXINUM NLIMBER OF E:EE,ROOMS = .-~
,uIL RRTING ,::S-.]. FT,/BR)= t¢:~
_,uIL FtB'qORF'TION _Y_TEM
THE REQ. UIRED SIZE OF THE '-'-' - ': '-- IS:
[:.EF"'T H= ::L ~-3 L E2 !'-~ CS TI--I--- --::5 ~.3 R R'.¢' E L E:, EF" T~-I= 4
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIEL. D.
THE DEPTH OF FI TRENCH OR PIT IS THE DISTFINCE BETWEEN THE SLIRFFICE OF THE
GROUND FiND THE BOTTOM OF THE EXCFI',/FITION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS TNE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFFILL PIPE
FIND THE BOTTOM OF THE EXCRVFITION (IN FEET).
PERMIT RPPLICFINT HM=, THE F,E.:,F-IN=,IBILIT~r T0 INFORM THIS EEFHRTMENT DURING THE
INS'¥FILLRTION IN.:,FECTIuN_ JIF FINY WELLS RDJFICENT TO THI=q PROPERTY FIN[:, THE
NLIME'ER OF F.E=,I[EN_.E.., THFIT TNE WELL WILL .=,ER,cE.
....... T'I.-~C, .-'. 2 ::. I f-.~::}.';F"EC:T % C~t'4S RF2E F:E~.~L! IRE[:
,~ ....... -~ '~ '-" -' I-I
EHL. KFILLING OF FINY .=,'r_TEM WITHOtJT FINFIL IN.:,FEL. TI_N FIND RPPRO',,,'FIL 8Y THIL-]
DEPFIRTMENT WILL BE SUBJECT TQ PROSEC_TION.
MINIMUM DISTANCE BE'rNEEN FI NELL AND FINY ON-SITE :SEWAGE DISPOSAL SYSTEM IS
100 FEET F'OR FI PRIVFITE WEL. L.~ OR
i50 TO 2C~E~ FEET FROM R PUBLIC WELl_ DEF'ENDING UPON THE TYF'E OF PUBLIC NELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICFITIONS AND CONSTRUCTION [:,IFIGRRMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'EF:~"I Z T E)-::F' Z F.:E]_~--; [:,E':C:Ei"IE:ER ]:it...
I CERTIF'¢ THAT
i: I RM FRMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS FIS SET
FORTH B'¢ THE MUNICIPALITY OF FINCHORFIGE.
2: I WILL INSTFILL THE SYSTEM IN FICCORDFINCE WITH THE CODES.
]:: I UNDERSTFIND THAT THE ON-SITE SEWER SYSTEM MFIY REQUIRE ENLFIRGEMENT IF THE
RESIDENCE IS REMODELED TO INC:L~ MORE THFIN ~ BEDROGMS.
-
':; I GNED' ~ '
.,_,_ .., , , ,_ ¢-? -
. . , . .
CERTIFICATE OF ON-SITE SYSTEHS APPROVAL
FOR A SINGLE FAHILY DWELLING
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Parcel I.D.
t. GENERAL INFORMATION
Expiration Date:
T12N, R3W, SECTION 22, LOT 14, N2
4410 OMALLEY ROAD * ANCHORAGE, AK 99516
Complete legal description
Location (site address)
ANNE ScoTr Day phone 346-4039
4410 OMALLE'Y ROAD * ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent
Mailing address
CAROL BUTLER w/ REMAX PROPERTIES Dayphone. 257-0116
110 WEST 38TFI AVENUE * ANCHORAGE, AK 99505
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: ,.3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank'
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On,-Sde Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Cedificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of Issue for properties served by a pdvate or Class C ~vell and may
be reissued with new water samples. (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 engin~er*s work.
4. 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, based on procedures outlined in the Certificate of On-Site Systems 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 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(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm CARNESS ENGINEERING GROUP, Ltd.
Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide e thorough,
conscientious engineering analysis of tho system in accordance with ADEC end MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of ali wells end
septic systems depend on the Iocat soils condition, groundwater levels that may
flucfuate during the year, end the water usage of the family being served by the system.
These condticos are outside the control of the evatuater of the system. Satisfactory lest
results do not guarantee fotura performance of the system, nor do they guarantco that
thera ara no hidden defects or encroachments. GEG, LTD. can therefore not pravido
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is fur
the sole benefit of the owner listed above. Any reliance upon or use of this relX~/l by any
other person or party is not authorized, nor wi//it confer any legal Mght whatseevar.
5. DSD SIGNATURE
~ Approved for ~:~ bedrooms.
Disapproved.
C(~nditional approval for
bedrooms, with the f]lowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory ~""-.'~
Maintenance Agreements '~),,,,:
Supplemental Engineer's Reort
Other
Legal Oesndpt]on:
A. WELL DATA
Well tybe pl~V^~
Date ~ompleted
Total depth 142
Date of te~t
Sta~:= water level
W~ produ~on
Municipality of Anchorage
Development Services Department
Building Safety DNtMOn
On-Site Water & Wssfewafer Program
470O Bragaw 6~et
P.O. BOX lg66E,0
Anctmmge, AK 99519-665O
www.munLarg/ons~
(so'r) ~,3.~o4
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST,
T12N, RSW, SECTION 22, LOT 14, N2, f>7'/qParcallO:()I~";-Ic/I
If A, B, or C provide PWSID# .
Sanitmy seal (Y/N) YES
Cased to 40.+ ft.
FROM WELL LOG
Well Lag (Y/N) I NO
Wlms pn:~e~ty protected (Y/N) YES
Casing height (above ground! 12+ in.
AT INSPECTION
6/15/2006
155 fl*
4.2 g.p.m.'
~1964
ft*
WATER SAMPLE RESULTS:
Cc~lfarm 0 colonies/100 mi.
Arsenic: ND ugJL.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Tank size 1000 gal, Number of Compertments
Foundation deanout (Y/N) YES
Date of pumping NEW
C. ABSORPTION FIELD DATA
Nitrate 2.gl ~. Other bacteria @ oolonies/100 mi.
Date of sample: 6/15/2006 Collected by: GEG~ Ltd.
Date in~talfed 8/10- ~ 4./2006
2 Ctaanouts (Y/N) iYES
Depression over tank (y/N) NO High water alarm (Y/N) ! N/A
Pumper -
PBELOW
System ty~e 'I~RENCH
Gravel below pipe ! 2
Depress on over fie d
Dateinstelled s/to--t4/2oo~ SollmtJng~ft~ndrm)
1,2
Leng~ 55 ft. Width 5 ,ft. It.
Tatal depth .5.~-8.'~ ft. Eft. absorption area 378 fl= Monitoring tube YES , NO
Date of edequacy test 8/10-14/06 Results(Pass/Fall) PASS Far [3 bedroams
Fluid depth in absorption field before test - in. Water added - gal. New depth - in.
Elapsed Time: - min. Final fluid depth - in. - g.p.d.
Any rejuvenation treatment (past 12 rno.) (Y/N & type) - If yes. give date -
O. LIFT STATION
Date installed Size in gallons Manhole/Accese (Y/N) /
'Pump on" level at .in. "umpP ~le~e . ig wa~r alarm ~vel at .in.
.._n.h.~---.~---'--'-- Cycles tested. Meets alarm & circuit requirements?.
E. SEPARATION OISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:.
Septic tenk/lllt station on lot
Abs~ption field on lot 100'+
Public sewer main
Sewer/septic service line 25'+
Animal containment areas 50'+
100'+
On adjacent lots 100'+
On adjacent lots 100'4-
Public sewer manhole/cieanout N//^
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line §'+
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation. 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
Absorption field 5'+
Surface water. 100'+
Water main N/A
.Driveway, peddng/vehide storage 10'+
G, ENGINEER'S CERTIFICATION
I certify that I heve determined through field ins~ end
review of Municipal records that the above ~ystems are in
conformance v, dth MOA COSA guidelines in effect on this
date.
Engineer's Pdnted Name JEFFREY A. GARNEb-"S
Date
Waiver Fee $
Date of Payment
Receipt Number
ZZ~
Z
AS-BUIlT SURVEY
' Day phone'
Road Anchorage, ' AK 99516
As ce~lfi~ by ~y ~e~laffixed hereto a~d as o~the wl~d~tlon d~te ~own,.below,,,l~e~,t~at mY .........
' · ~tion st t~ ~ Health Author ~ Appr0wl ~pph~tlon ~ows t~t,the omslte~te~supp y..,?.. '(r,
~n~astewater d,sposal ,system ,~ ~fe','f~,~ti0n'~l~and ad,quake for the number.of b~rooms
and ~pe of structure Indicated herein, I fu~her veri~ that bas~ on. the information obtained
the Municipali~ of Anchorage files and from my inves~ation and inspection, the on-site water
su and/or wastewater disposal systemis in compliance With all Municipaland State Codes
PP Y ..... . ....., ~ ....... :~ .~,; .... ..:...,
., : o~dinances, and_reg'ulatioq~.ln'.effect on the date ofth~s ~nsp~ion. . .......
. ,-'.~ r ~',,, r':~'~;]":~:'~'~ , ' ~"'' ~ ~'~ ~' '~'' :J ' ' ' ' ' ' ' ";
......... NA~&'of Firm ......... ~S & S ~I~RIN~ -" ......... ~none ...... i' --
.... -.'-" -'-' .: ,~-~'~,, ^-~- .... ,- m-,,o,+,-ent of ilea th and Human Serv ces (DHHS) issues. Health,Authority
' "' ,~: ~gg;~',,~, '~,ert f ~t~ 'i~edr~dn y'~pon the 'representatlon_s gl~f~,,q,,Ln,~ p,a~g ,rapn,, ~ so~,~e Dy at~,, n,a.~pen~e,n~, i L
, . i .."..~^,o;;~,;F.~.,~;'~'~i~i~,;~d n~heState'ofAasl(~ TheDHHSdoesthisasacourtesytopurchaser~?h0~es'"~v:
: ~-', ~' · "2., ',.' 2~*ii'i~'~i~'~ iff ~r/:t&'i'i6 ~atlsht Certa n'fod0ra and state ~10[rements. Employes of DHHS do nm .: '..:;
anolnelF snamg ,.,.:7.....-. ~ . . ~ ; ,. . . , ,
:' ,:~ ~ ,~' .... ,u-'~":-~ x-;a--.edata before a*¢erUflcate ~s ~u~l The Mummpality of ~nch0rage s not-
..... ,., .s','" ~,., t~,~g,~, ,~ ~, ~,, ;, ,,,.~; ~, ~ ~ ~:~ g~?t~P~ , tI ~.= ~ . ,, ~ ~ ,,,
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:N///z- ~-i= L~7- J~ ~'s~2-Q./ T I~-,-~ /~$~ar(~el I.D.
A. Well Data
Well type
Log present (Y/I~
Total depth
Sanitary seal
If A, B, or C, attach ADEC letter. ADEC water system number.
Date completed "~ / '/ 4' 3 Driller
Casedto ¥o "/- Casing height
Wires properly protected (~/N)
FROM WELL LOG
Date of test
Static water level J
Well flow J
Pump level1 J
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot (~ ~' ' ¢;
Absorption field on lot ~' '~' ' 4~
AT ,.sPEcT, o.
Public sewer main
Sewer service line
g.p.m. ,~'-. o --Y- g.p.m.
,,IA
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
z
WATER SAMPLE RESULTS:
Coliform 0 Nitrate
Date of sample: -7 / ~ ¥ / ~/5~
B. SEPTIC/HOLDI~.,G,T~NKDATA,, ':. , . . .
Date ~nstalled · .. ~.. Tank s~ze __.
Cleanouts ((~/Ni _ J-' ~ ''¢ ~ .EOQndation cleanout ¢¢..~N) .
H gh water alarm (Y/e .... )v.i) .. Alarm tested (Y/N)
Date of pumping cf/~-~ /~ Pumper
~ ' 'SEPTIC/HOLDING TANK TO:
SEPARATION DISTANCES FROM
Well(s) on lot .... ~"~'/'~' '" /~-
On adjacent lots
To property line / o !-/- Absorption field S"
Su rtace water/drainage / ~ ~) / -f
~* *~ Other bacteria O
Collected by: S & ~
"17034 Eagte River ~ R~d No, Eagle RNer, Alaska ~5~
Compa~ments
7~ ~ Depression (Y~) ~ o
~/~
Foundation
Vater m~in/service line /o ' -/-
72-026 (3/93)' Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level / ,....--'""""~Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATIO~IFI STATION TO:
Well on~J~t~ On adjacent lots
Manufacturer
Manhole/Access
"Pump on" level at ....-~'""~ump off" Level at
Sudace water.
D. ABSORPTION FIELD DATA
Date installed )~6) / ~ /-/¢! Soil rating (GPD/Ft2) /~-5-~r'~//r~o~.Systemtype c-~,~//~r/~'~,~'cs-I
, , ,)' /
Length u ~ / /
'~ (;,F' Width u ~. / ~ Gravel thickness ~' Total depth
Total absorption area. v ~,- / I~';,/:r Cleanoutpresent(~N) 'l~J Depression over field (Y/l~ /,.,o
Date of adequacy test ~' / t / ~'
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Results ~fail) Pg' $-s for ~. Bedrooms
'3 ' ,~ /~ Aftertest '3- ~ 7 s~
yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
' ~,,)/o>' ~n '
Well on lot ~' t,'- (: (r~ ~'~ adjacent lots /oo ']- Property line
To building foundation / ~ ~ '~- To existing or abandoned system on lot
On adjacent lots / ~, ~ +- Cutbank ~' //-I Water main/service line
Sudace water
Curtain drain
],.o "..4-
Driveway, parking/vehicle storage area S- ~ (~,.~')/o~
E. ENGINEER'S CERTIFICATION
ave c c ed,"
Signature '::/:
Engineers Name ~O~/~r
Date ~/~
C~.8BO
HM Fee $
Date of Payment
Receipt Numar
72.026 (~)' ~ck
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE DEPT. OF H['3ALTB &
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION JUl_' ~ 9 1979
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER ND S
~~~ . - ,.~'&~ ..- .
[~1RECTIONS: Complete ail parts on page 1. I ncomp eta requests will not be processe~~'_ ~,
[ PHONE
1. PROPERTY OWNER
PHONE
MAILING ADDRESS
'ROPER'FY RESIDENT (If different from above)
BUYER
MAI LING ADDR ESS
LENDING INSTITU,FION. ~ ~
MAILING ADDRESS
4. REALTOR/AGENT
MAI LING ADDR ESS
PHONE
5. LEGAL DESCRIPTION
STREET LOCATION ~ ~
6 TYPE OF RESIDENCE ..,) NUMBER OF BEDROOMS
[] One [~ Four
~) SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
[] Other__
7. WATER SUPPLY
INDIVIDUAL'
[] COMMUNITY
[] PUBLIC UTI LITY
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 Icg if available.) I L~ ~ )
S. SEWAGE DISPOSAL SYSTEM
[~ INDIVIDUAL/ON-SITE** **if individual/on-site, give installation date_ / c/(~ .~ ..
If system is over two (2) years old an adequacy test is required
[] PUBLIC UTI LITY by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSIN~ CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME , TIME TIME
DATE DATE DATE
INSPECTOR ~NSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [~] ONE [] THREE [] FIVE [] OTHER
E~] MULTIPLE FAMILY E~] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified tNSTALLER
[~]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~'~APPROV E D FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72~010 (Rev. 3/78)
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ~ \ ~ - /L/~ ~ i~ HAA # ~¢:~6"~
1. GENERAL INFORMATION
Complete legal description
Portion of N ~ Lot 14~ Section 22l TI2N~ R3W; S.M.
Location (site address or directions)
4400 O'Ma~ey
Property owner _ G~u~.y Anderson
Mailing address 4400 0'M~£1¢_y,
Lending agency
Day phone
Anchorag~, Alaska 99516
Day phone
346-2866
Mailing address
Agent _Carolyn Abney/FORTUNE PROPERTIES, INC. Day phon~62-7653
Address 3000 A S~eet. Anchorage. Alaska 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 2
TYPE OF WATER SUPPLY:
Individual well XX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
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
Address
Engineer's signature
s & S ENGINEERING
Eagle River, Alaska 99577
Phone
Date
Se
DHHS SIGNATURE
Approved for
Disapproved.
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~)25(Rev. l/91) 8ack MOA#21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ¢/~- [- ~¢' iq ,~e¢---3-l''' ~-r'~'z.,.J,: fz-'5'~Parcel I.D.
A. WELL DATA
Well type
Log present (Y~
Total depth
Sanitary seal~'4)
If A, B, or C, attach ADEC letter. ADEC water system number A'IA,
Datecompleted ~ /'~'~' Driller ¢,~'
Cased to '¢0~,~' Casing height /~ ~'
Wires properly protected (~/N) y
FROM WELL LOG
Date of test
static water level
Well flow
Pump level
g,p.m.
AT INSPECTION
t\ ~ 1..~' ~ ~ ~ MuNIcIPALITY OF ANCHORAGE
~:NViEONMENTAL.SERVICES DIVISION
't"',~' ~' b/OV 2 7 1991
g.p.m.
RECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~ ~--¢~'~
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform ~ ~'~ ~/tO-%v-~ Nitrate
; On adjacent lots
Ye' ~¢"~-~'~' "~ ~ 1~2'; On adjacent lots
~IN- Public sewer manhole/cleanout
~J ~"~' Petroleum tank
Date of sample:
B. SEPTIC/HOLDING TANK DATA
' ' Collected by: ·
Other bacteria /~o,*J~
S & S ENGINEERING . .
17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
Date installed ~ ¢1 L~'> Tank size ~ ~c~c> Compartments J
CleanoutsJ~/N) ~J Foundation cleanout ~/N) ? Depression (Y~ /~
High water alarm (Y~[:) ""/ Alarm tested (Y/N) /J~A-
Date of pumping Il - J ~ ?il Pumper /L~'o~-o ~oo T'K~V--
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot :.~-
To property line to
Surface water/drainage
On adjacent lots
Absorption field
Foundation
Water main/service line
72-026 (Rev. 7191) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level _.~"-'~"~ Cycles tested
Meets MOA el~__
~ DISTANCE FRO M L' F~nS;~:lc~t 7o~;
Manufacturer
Manh~
Surface water
D. ABSORPTION FIELD DATA
Date installed
~ ¢~/~1 Soil rating
Length' ~-- /~l~'/z~ Width
Total absorption area
Depression over field (Y~;)
Res u It s~[]).~fail)
Peroxide treatment (past 12 months) (Y/~
~'7"5' ~' /
GravelthicknessUff-/?-"'/~' Totaldepth ~1/--/ ~ ~/~'
Cleanouts presen¢/N)
Date of adequacy test
for
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot ¢¢¢5 ~.¢~ ~,Ol~.,l"¢.~J~n adjacent lots
To building foundation
On adjacent lots "5 c;,
Surface water
Curtain drain
E. ENGINEER'S CERTIFICATION
Property line
To existing or abandoned system on
Cutbank ~&l,~ Water main/service line
Driveway, parking/vehicle storage area
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines
this inspection,
S & S ENGINEERING
Signature '17034 Eagle Ri,vet Loop Roa¢l No. 204
~gle l~iver, Alaska
Engineer's Name
Date \ ~ '"'~-"~
HAAFee$ /70
Date of Payment
Receipt Number
/
72-026 {Rev. 3/91) 8~ck MOA 21
Waiver Fee: $
Date of Payment
Receipt Number -
ON SITE SEWER EVALUATION
N~,GOV. LOT 14, SEC 22, T12N, R3W, S.Mo
D~a~ul Mac Innes
SRA 1734
Anchorage, Alaska, 99507
Building
Bath~
~dro~s
Se~r Syst ~
~st ~d
Wa~er
Systems I~st~led
~ute of Ev~uatiom
Per fo~ed By
Re~
Met h~d U~ed
O~e story, f~ll basement, finished
T~o
Septic Tank and Concrete Rimg Pit, 72-inch diameter
July 25, 1979
July 24, 1979
Private Well
1963
July 24, 1979
T. Spmrkla~d
SlmoTt~M IS NOT ADEQUATE
After pumping and cleaning the septic tank the waterlsvel i~
the pit was measured and recorded° The depth was foun~ to be
52 inches.
Twenty four hours later the water level was found to have dropped
12 inches° Percolation rate was determined to be 180 gal. per
24 hours° The required rage is 450 gale
LOCATION A LOT
FHA NU~BER
TEST ttOLE NO..._~
ANCHORAOE t. AU;FIAN KS 'f[:'CHNICIAN
pERCOLATION [Esi'
TEST ltOLE LOG
F '.'::O S T
LEGEND
READING IDATEI GROSS TtME
....... ·
I , . / t, 2 ,') ......... i · , , -
....................
- ~ L
.............. , ,_- ·
PERCOLATION RATE f'I.._~_MIN,
GRAVEL
I.
~ SAND
t., ,'
~/',-" .×,, CLAY
[~i , PEAT
7 " Z."?-O ' . 7" 2' ~,¢,. -
,~ro I3onald
4225 Sp~uard
;mchorage,
SUI~J~::CT* Popcolation Toot - £ovor~nc. nt Lot-~,
Sir,
In aoco~Mmlce .'.r~th youP ~eznla,~;t, a .... o.~l_a,olon l,s~b l~as been
1~ m I;oi].s ].o',j, .npi~i~:,:~:na~ location, mid
perfol~u~ on tho s/~bz}e~t lot~ '~',
test data are aho~m on. the ~$t~oael sheoto
Tho percol~d,~on z'ato
ANCHORAGE Ai-~ ~-'R Al S A L
ADDEh'DU~ TO F~LE #0~3 ~ VA
ADDiTiONAL FEATURES OF SUBJECT PROPET¥~
This iS a well built custom home which has two rook f~repl~ with built-in
shelvin~ and cabinets, extensive oak £1oortng, tongue and groove vaulted
ceili~es, tongue and ~roove wall panelin~, wallpaper accents, intercom
system, indirect lighting valanca~ breakfast bau, handmade kitchen cabinets,
Jennair ranse, Kohler kitchen sink, built-in closet shelving and lights,
laundry room wi~h sink, build-in shelving, counter and built-In ironin~
board, ~edwood siding, deck, l~ndscaplnE, large aluminum shed, two
workbenches and lof~ storage in ~arage.
· This ho~e was recently remodeled with new paint and stain th~ouRhout,
hardwood floorinE refinished, new carpet and vinyl floorcove:,in~. The
bathroom and en~r~ were remodeled.
The Sub~eat home is &vePage- in £unotional utility, due to its two-b~d~oom
desisn. Th~s is curable functional obsolescence, as the basemen~ bedroom
could be converted to two bedrooms at an estimated oos~ of $2,000 or less.
The large ~asement bedroom now has a folding room divider door across the
center, and has closets at either end, and two entry doo~s. It could be
converted b~ adding a window.
SITE COMMENTS~
The Sub,eot site fronts on O~MalleF Road, which is a public ~oad, and
publicly maintained.
The Subject's AsB~ilt Survey, dated 9/7/91, reflects a driveway encroachment
on the northern portion o£ tho sub~eet's ~ite. Tract A~ th~ site adjacent to
the Sub,eot site to the North/Northeast, has a driveway sho~ enoroaohin~
OntO the Sub, eot property,
The northern portion of the Sub,eot sits is basically a driveway which
provides access to the Sub,eot from.O~F~lley Road. via an unpaveO driveway
not onl~ to the SubSect home. but past it in a southern direction,
apparently providing access [o other prope~ties as well. Th~s dciYeway
access encroaches alon~ the Western boundamy of the Subseot sl~e. onto the
property adJaaen~ to ~he We=t, £or nearly its entire length (280').
not known by the appraiser how many property owners utilize this private
driveway for aooesa~
It appears that it is necessary ~o drive on the encroachment into
property to the West in order to reach the Subject house. It is not known
how this encroachment has been handled with the owner of ~he property
directly adjacent to the West of Subject.
The property owner stated that maintenance of the com~on driveway is a mutual
2.
3.
4,
5,
J
REQUEST FOR APPROVAL OF ~2~. ~.~
(Fill out in T~iplicate)
Water Analysis:
a. Bactemial
b. Detemgent..
Well data:
a. Type
b. Depth_
c. Casing Size
dj
Distance from well to closest existing or proposed:
1. Sewer line
2, Saptic ts~k ~0I
Seepage Area [001
Cesspool'
5. Property Line
6. Other sources of possible contamination, i.e.~ creeks, lakes,
houses, barn, drainage ditch, etc.
Sewage disposal system.
c. ~ame of septio ~ank manu~actu~ ....
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepaKe pit size and type
1. Distance to property llne ....... to house foundation
e, PercolationxTest results
f. Percolation Test performed by
Use the reverse side of this form to show diagram. Diagram should include
the foJlowing information: p~operty lines~.well location, house location~
e~ptic tank location, disposal area location, location of percolation teat,
m~ direction of ground slope,
9. The h~for.matlon On this form is true and correct to the best of my knowledge.
Signature 'of Appilc~nt
date Signed
~O B_~EFILLED OUT BY HEALTH DEPART~-~ENT PERSONNEL
e"'- above escrlbed sanitary facilities are hereby approved, subject to the
.......... ~llowing con~ions
Conditions:_
The above described sanitary facilities are disapproved for the following
reasons:
' Signature of ~;fie~.f~%.~ ~" ":~ :' ~ 'Date r!~, .
Approval is valid for one year following the date of approval.
CPJ: cw
QGREA?Q ANCHORAGE AREA BORCr H
D epar t me n t ;~3E0n~i rs~2~ n t a I Quality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME /-'~/~') ~;~ "~LO,~--~ MAILING ADDRESS
LOCAT'ON 0/~ ~/¢E /, ¢ LEGAL DESCRIPTION
SEPTIC TANK:
NUMBER OF
DISTANCE -~-O /¢" ,,~"~ ~/ ~ ~/~,]~-
FROM WELL MANUFACTURER .~---v'~/-b':'z~', MATERIAL
COMPARTMENTS
INSIDE WIDTH LIQUID DEPTH
INSIDE LENGTH
LIQUID CAPACITY/¢'-/'~ GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL
FOUNDATION
NEAREST LOT LINE
TOTAL LENGTH
OF LINES ~0 /
NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE ~__~ F.~) /
DEPTH OF FILTER ~b ~
DEPTH: TOP OF TILE TO FINISH GRADE -~/// MATERIAL BENEATH TILE__ IN. ABOVE TILE IN.
WELL:
TYPE _~-~/L/O / ~ CONSTRUCTION ~/7~ ~- //-~ DEPTH
BUILDING NEAREST NEAREST
FOUNDATION LOT LINE /~} 1~
. SEWER LINE
CESSPOOl ~7 o~' ! OTHER SOURCES
APPROVED_ DISAPPROVED / REMARKS
DISTANCE FROM:
SEPTIC o~-~ / ¢' SEEPAGE
TANK '~f'" , SYSTEM
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH: ~ /
PIPE MATERIAL:
LOT SLOPE: /~0/¢z9 ~--~4~r A/O/C-T-?'/
Form ~Q-03~
DIAGRAM OF SYSTEM
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO,
3330 "C" STREET ANCHORAGE, AL. ASEA 99503
TELEPHONE 274-4561~c/' ~/ ~ ~- /~ /~/~Z~
SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PER~IT
INSTALLATION OF: SEPTIC TANK '~ SEEPAGE PIT DRAIN FIELD ~f
TYPE AND SIZE OF FACILITY T0 BE SERVED
FINANCED THROUGH TO
cOmPLetiON u~e A~mmat~D ~Z-*-
OTHER
NOTE= THIS PERMIT IS NOT VALID WITHOUT BOIL TEST
FINAL INSPECTION: 24 HOUR NOT~CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE/"- ~/~ TYPE'~E~L *
SEEPAGE AREA SIZE
MININIUM DIS"rANCE~, REQUIREMENT~
FOUNDATION TO SEPTIC TANK
., DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK -, SEEPAGE PIT , DRAIN FIELD
TO I~JEAREST LOT LINE.
WELL TO SEPTIC TANK , SEEPAGE PIT
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
SEPTIC TANK, /~/ , SEEPAGE PiT
[0/
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
-, DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 fEETINTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVAE~LE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
TYPE
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAG.E AREA BOROUGH ORDINANCE NO. 28~68 AND THAT THE ABOVE
DESCRIBED ~YSTEM IS IN ACCORDANCE WITH SAID CODE. ~/ 7~ ~-~
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
pERMIT NO.
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK \ SEEPAGE PIT-- , D.AIN FIELD
TYPE AND SIZE OF FACILITY TO BE ~ER¥~D
FINANCED THROUGH TO BE iNSTALLED BY
SOIL TEST RESULTS //~ ~::~/f~J~ ~~2/~ NOTE: THIS PERMIT
COMPLETION DATE ANTICIPATED
MINIMUM UISTANCES, REQUIREMENTS ', ~ ~ ~ :~AGRAM OF SYSTE~
DRAINFIELD. \ t
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRiB CROSSING GAP OF
EXCAVATION D FEET INTO UNDISTURBED SOIL.
4 INCH D[AMETER CAST ]RON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRT]GHT REMOVABLE CAPS.
I CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
Mr. Henry Taylor
4211 Cope Street #3
Anchorage, Alaska
SUBJECT: ?ortion Government Lot 14, Section 22, T12N, R3W, SM
,,r. Taylor:
~h~s office; can no~ grant approval of yotlr se~¥er system on the subject
Until the well is upgraded, however, we will not .qrant approval on the wa~er
for loan purposes only.
ShlCerely,
Stlsan Eo Dtckerson,
Sanitarian
S~D/ko
cc: Building Safety (Pe~ntt Desk)
December 5, 1973
Hr. Henry Taylor
4211 Cope Street ~3
Ancilorage, Alaska
~. Portion of GoverF~laent Lot 14, Sec. 22, T12.1, Rdt~, SM
Taylor:
This department is still holding the
sewer systeia serving the ~bove lot.
entire system until the follo~Hng is
final tn~,,~_.ctten~-;'¢, ' for the
done:
1, The clEanout pipe on the septic tank :~ust be
covered ~tth an air-tight cap.
2. Ti)c existing cesspool must he dug t)~, cav~:d in
and mack¢illed.
~e i~ave requested the buildi;)fl depart~nent to ~Hthhold your
construction permit until cms;pi/anco ~.~Ith the above is ob-
tai)ied. .Hr. HcGee has already beer notified of the violation.
Sincerely,
San/tar/an
5ED/ko
cc; Building Department
[;~Jr,.i f'led ilO. 740
SENDER: Be sure to fellew instructions an ether side r~
I PLEASE FURNISH SERVICE(S) INDICATED BY CHECKED BLOCK(S)
F-- Shew address
where delivered [] Deliver ONLY
to addressee ~;~
RECEIPT l
Received the f~umbered article described belevl m
REGISTERED J~O. ~iI~IGNATURE OR NAME OF ADDRESSEE
740072 ~ Un ~ SIGNATUREOFADDRES~EES~GEHT~FAHY