The URL can be used to link to this page

Home My WebLink AboutT15N R2W SEC 25 LT 125B 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: OSP221429 Work Type: Septic Upgrade Tax Code Number: 05131237000 Site Legal Address: T1 5N R2W SEC 25 LT 125B G:0653 Site Mailing Address: 15512 HUSKY ST, Eagle River Owner: UPTON JANET G TRUST Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: i»cnt 0%, Department 11/14/2022 11/14/2023 49399 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Tank configuration changed to 2 tanks, Infiltrator 1060 and 540 gallons. Both tanks single compartment. 71 may: 1s5 tAe J to r Date: Issued By: A,f� Date: IV 22 2 MUNICIPALITY OFA CHORALE 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. 051-312-37 Property owner(s) JANET UPTON Day phone 907-240-4820 Mailinq address 15512 HUSKY STREET, EAGLE RIVER, AK 99577 Site address 15512 HUSKY STREET, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) LOT 1258 Legal description (Township, Range & Section) T1 5N, R2W, SECTION 25 Lot Size Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank Upgrade RXDuplex (D) ElHolding Tank ❑ Renewal ❑ 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: Waiver Fees: Date of Payment: Date of Payment: Receipt Number: (35-5 Receipt Number: Permit No. 6'5 f � 2 /-L/a � Waiver No. GMevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221429, Deb Wockenfuss, 11/14/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221429, Deb Wockenfuss, 11/14/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221429, Deb Wockenfuss, 11/14/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221429, Deb Wockenfuss, 11/14/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221429, Deb Wockenfuss, 11/14/22 11/11/2021 11:03 8649870764 THE UPS STORE PAGE 01/03 MUNICI,PALI.TS( OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AG JEMENT, herein the "AGREEMENT' made and entered into as of this �ay of /�" �' of 26L? by and beiween herein the "OWNER," and the Municipality of orage, herein the "MUNICIPALITY", in accordance «rith 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 NVfunicipality grants permission to the Owner to utilize and operate an. Advanced Wastewater Treatment System (AWWTS), described as at, ah i\L5 located at (legal description) T/ 5 /j / 2-W SC- 2_5 � 1Z5�3 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner Shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of perfannin.g as designed, and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of. the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual .maintenance fee (typically $400 w $600). �-'rtJ Owner agrees that only maintenance and repair personnel approved by the Municipality CJ 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 draiufield replacement (rev. 05/18/2018) Page 1 of 3 11/11/2022 11:03 8649870764 THE UPS STORE PAGE 02/03 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 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-b.our notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval, Ov Ower 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 uport 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 tho provisions, nor in any way affect the validity of the Agreement or any part hereof, or tine 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 sbaIl be void. 6. Jurisdiction: Choice of Law. Any civil action arising fzom this .Agreement shall be brought in th.e Superior, Court for the Third Judicial :District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement (rev. 05/18/2018) Page 2 of 3 11/11/2022 11:03 OWNER: 8649870764 THE UPS STORE By: (signature) Date: -' (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT } The foregoin instrument was acknowledged before me this; LLth day of ,[I�(L j 20�? by1f�S�J�ICJEt �1( NOTARY PUBLIC FOR ALAS:K..A My Commission expires: _M�`o, mmis,9ion Expires June 8, 2032 MUNICIPALITY: By: (signature) (print name) YL (rev. 05/18/2018) HCA Date:/ l Y z-Z— Title: PAGE 03/03 Page 3 of 3 S89° 50' 30"E 299.03 REC.N00° 17' 30"E 165.20 REC.N89° 50' 09"W 298.97 REC.S89° 49' 15"E 300.18 MEAS.N00° 04' 18"W 164.59 MEAS. S00° 18' 45"W 165.23 REC.N00° 18' 45"E 164.71 PROR.N89° 47' 54"W 299.07 CALC.N00° 18' 45"E 299.50 MEAS.N00° 18' 45"E 300.44 REC.LOT 125-ALOT 128BLOT 128APLAT #77-254LOT 126-APLAT #80-121 O H U;;; ; ;;;;;;;;℄ HUSKY STREET 30.0R.O.W.EDGE OF PAVEMENTPAVED DRIVEWAYTWSSSBASIS OF BEARINGS 20' UTIL. ESMT.GARAGEGREENHOUSESHEDSTONESTAIRSCO V E R E D P A T H SHEDEG44.331.2 39.3168.539.7 23.3 23.0 52.659.3 6.05.4 20.319.7 23.914.4 10.28.2 26.718.6 12.412.9 4.610.3 9.31.87.733.7 42.818.4 17.412.46.04.29.710.010.0 2.619.5Lot 125-BSE14, SEC. 25,T15N, R2W, S.M.49,399 Sq. Ft. +/-15512 Husky Street1 Story Log HomeWith Detached 1 Car Garage100' WELL RADIUSPREPARED BY:FRONTIER SURVEYS, LLC650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518907-460-1686DRAWN BY: CHECKED BY: DATE: SCALE:DRAWING ID: SHEET 1 of 11.Excepting for gross negligence, the liability for this survey shall notexceed the cost of preparing this survey. Dimensions to property linesare plus/minus 0.1ft.2.This document is created by Frontier Surveys for the purpose of anas-built survey for Janet Upton, only.3.This document is based on Plat No. 76-131, Anchorage RecordingDistrict.General Notes DisclaimerLegend1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visibleimprovements and conditions at the time of the survey. This document does not constitute a boundarysurvey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is theresponsibility of the Owner to determine the existence of any easements, covenants, or restrictionwhich do no appear on the record plat. Under no circumstances should this document be used forconstruction or for establishing a boundary or fence line.PS1" = 25ft09/13/202222-509KCScale 1" = 25'AN AS-BUILT SURVEY OFLOT 125-BSE14, SEC. 25, T15N, R2W, S.M.15512 HUSKY STREETCONTAINING: 49,399 Sq. Ft. +/- (RECORD)RECORD PLAT: 76-131Gas Meter Electric Meter/Outside Power DeckSepticTelephone PoleFenceOverhead UtilityWater WellTel. PedestalGES[TWPierre M. StragierNo. L.S. - 981209/13/2022REGISTEREDPROFESSIONALL A N D S U RVEYORFound 3 1/4" MonumentFound 5/8" Rebar Found 5/8" Rebar w/ YPC Certified Drilling Log OWNER OF LAND: Janet Upton ADDRESS: 15512 Husky St. Eagle River, AK 99577 LEGAL DESCRIPTION T15N R2W SEC 25 LOT 125B DATE: 4-11-19 PERMIT NUMBER: OSP191067 DATE OF ISSUE: 3-29-19 TAX IDENTIFICATION NUMBER 05131237000 Is well located at approved permit location: Yes No Method of Drilling: air rotary cable tool Depth of Well: 340’ Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 104 feet Liner type Static Water Level: 138 feet Recovery Rate 1.3 gpm gph Method of Testing Air Well Intake Opening Type: open end open hole Screened Start feet Stopped Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: yes no Method of Disinfection: Chlorine 50 PPM Comments: Bore Hole Data Depth From To 0 2 Casing Stickup 2 4 Overburden 4 66 Tight Silty Sand & Gravel 66 81 Silty Sand & Gravel w/ Clay 81 91 Hardpan 91 193 Bedrock Gray 193 209 Bedrock Green Hard 209 300 Bedrock Gray 300 310 Bedrock Green Hard 310 340 Bedrock Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. APS 22 191Q:17a Y7 µ mark 8gg9ch -'Mayor :,echo! age LVeii FX Punip Sei D4 r'24_ -s1742 "-'Pve10P nPnt Services bepartment Building Safety bivision 'On -Site Water 4 Wastewater ter Program 4700 Emer? road P.G. Bax 196650 Arcnarage, AK 995f17 c WWAnuni.om orsire (907,'343-7-,0_1 Pump Installation Loi Well Drilling pernlit iVulnber: ` )SP 1 91 0 ,7 Parcel Identifacatio, _ uM ()el-: (j 5O_— S12-31 T15>J P,20 SPS Z-5 L 12 6S f PUTHg Iniake, IDrpth Belaw Top of Well Casin :3p c s t et Ptimo Allnu1'acturer's Name: Pump Made]: Pump Size hp Pitless _Adapter Buria.l Deptt:: ) -"`feel Pities adapter Maroafaetnrer's `game: Pidess Adapter tr35tailez•: !� t4�40 Lam . Well Dishifected Upon C:ompletipn7 :/, Y � Nu 'Nleth%d of Di5111fection. Date of issue: pr,opFrtr C7Wner Name ,& Address: .Puw,,o l<nstzllerName: r, ck�ra P•2 4t:te.ntipn: TUel;u::�p i_:staile: �:ali pr��l�cie a p,1st�p instil?anon ia9 to tnw DSD 30 days az put, r in,tsllaticr.:. Municipality of Anchorage Community Development Department On -Site Water & Wastewater Program 4700 Elmore St. E P.O. Box 196650 m Anchorage, AK 99507-6650 m wwwxnunior onsite im (907) 343-7904 MSX Legal Address: Subdivision Block Lot T t r5 K R 2-V\j Section es Lot On-site Water & Wastewater Program certified contractor performing the well decommissioning: Name: �tj !t tic Signature Company:C /15 t�rl �t G�cti� ��,�r i/ Well decommissioning date: L� _ ICI Method of decommissioning: AMC 15:55.060L1 a. ❑ b. ❑ cX Location: Use the space below to provide a drawing of the property showing the following items; • North Arrow • Decommissioned well, • Other water wells on the property, • Two separate swing -tie distances for each well shown in the drawing, Note: The swing -tie distances shall be measured from either permanent structures of property corners. New MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program .N` ;. PO Box 196550 4700 Elmore Road . Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax (907)343-7997 hltp://te. w.muni.orglonsile Or 1)ch�irritrcnC •echo.."6. On-Site Water System Permit Permit Number: OSP 191067 Effective Date: 3/29/2019 Work Type: Well Upgrade Expiration Date: 3/28/2020 Tax Code Number: 05131237000 Site Legal Address: T15N R2W SEC 25 LT 125B G:0653 Site Mailing Address: 15512 HUSKY ST, Eagle River Owner: UPTON JANET G TRUST Lot Size in Sq Ft: 49399 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 2 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy Q Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing [Special Provisions: close this permit please submit: . Well Log . Pump Install Log . Water sample results . Well Decommissioning Log Received By: r . Date: C� Issued By: /6)/1-: Date: 2q'( /1 PLAJS MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-312-37 Property owner(s) Janet Upton Day phone Mailing address 15512 Husky Street, Eagle River, AK 99577 Site address 15512 Husky Street Legal description (Sub'd., Block & Lot) Lot 125B Legal description (Township, Range & Section) T15N, R2W, Sec 25 Lot Size 4g399 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (IX)all that apply) Absorption Field n Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank n Upgrade ❑X Duplex (D) fI Holding Tank ❑ Renewal ❑ Multiple Dwellings Li Privy [ (SF and/or D) Private Well Water Storage THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 1 (Signature of property owner or authorized agent) Permit/Rush Fees: ra.,� Waiver Fees: Date of Payment: 312119 Date of Payment: Receipt Number: No 'q",q Receipt Number: Permit No. OS P/gI(y1 Waiver No. Permit App_.•• ::...c. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191067, Deb Wockenfuss, 03/29/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191067, Deb Wockenfuss, 03/29/19 MUNICIPALITY OF ANCHORAGE ' ' DEPARTMENT OF HEAL'rH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~E ~.~ ii]NEW ~"~.., '[~,L~__~ ~.~ ~.~,~ ~~~ . ~PGRADE MAILING ADDRESS LEGAL ~ESCRIPTION LOCATION ~0. OF BEDROOMS ~ ~ Manufactursr Material No. of compartments ~ N Liq. capacity in gallons Inside length Width Liquid depth ] ~ IF HOME.DE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~ DISTANCE TO: Trench wJd h Distance bet we~ ~ ~ ~ No. of l ir les ~ Length Total I e~[ Ilo es ~inches ~ ~, T°p°ftilet°finishgrade I'~in~s Total effective absor ion area Length Width Depth PERMIT NO. ~ P Type of crib Crib diameter ~ib depth Total effective absorption area ~ Well Building foundation Nearest lot line m DISTANCE TO: ~ Cla~t~ ~ ~ Driller Distance to lot llne PERMITNO. ~ DISTANCE TO: Budding foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING . L,, Y. F" ~-~-~ L...l] -f" DEPARTMEI',IT E~F HEAL. TH 825 L ~IREE1 PERM I-[ NS: DATE I ~.:;SLIED: 6]}8 / 13/8,5 AND ENVIRONMENTAL PROTEiCTION ANCHORAGE, AK 99501 264-47~Z0 AF'PL I CANT: DEN I SE ANDERSEN ADDRESS: % S&S ENGINF=EIRING EAGL. E RIVER, Al< 99577 CGNTAC] PNGNE: 694~-~979 I,.,,EE~AL DESCRIP: SUBDIVISI[}N: NA L~]T: SECTION: ~5 '¥SWNS~IP: 1'5N RANGE: LOT SIZE: I OA (SQ.FF. OR ACRES) MAX BEDROOMS: I BLGCK: NA Listed be].ow are the options ava].lable t.o you ~n designing your septic syst~m. Choose the option that best J{i'[s your site. DEPTH TO PIPE BOTTOM (FT. GRAVEL DEPTH (FT.) TOTAL DEPTH (FT.) GRAVEl... WIDTH (FT.) GRAVEL LENGTI.-{ (FT.) GRAVEL VOI__UME (CGiYD~. ) TANK SIZE (SAL.S) SGIL RATING (SQ.FT. /BR) 4.0 4.0 4.0 3.0 0.5 · 3.0 7.0 4.5 7,0 ~'.5 14.0 5.0 45.0 26. G 3~.:'. ,, 0 14.6 13.5 20.8 1,000 .. 0 -x-~,'- 1,000.0 -~'~ 1 ~ 000.0 268 239 2.68 -~-~ TANk: MUST J{'IAVI:~: AT I..EA,.)F TWO COFIPAF~]"MENTG cer t il'~ t.l"~a't: 1. I am familiar With the {',equir-ements ~er on-site sewers and wel]l.~.~ as set. ~'orth by the Municipality o~ Anchorage (MGA) and the State o£ A].aska. ~,~. I will install the system in accordance with all MOA codes and i, egu].ations, and in cempliance with the design criteria o{' this permit.. 3~ I will aclhere to al.]. MBA and State o~ Alaska requirement~-] {'or the set back .distances ~'rom any e~.,'isting wel]., wastewater disposal system or public sewerage system on this or any adjacent or nearby lc~t~ 4. I understand that tbis permit is valid ~or a ma>,'imum of" i bedrooms and any enlargement, will r-equire an additional permit.. Il: A THEN WIL. L ELECTRICAL WSRK MUST BE DGNE BY A LICEN~,-]ED ELECTRICIAN. LIF:T STATION IS iNSTAL. LED IN APl AREA COVERED BY MOA t. UILDING (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE ]BTAINED; NS'l" BE APPRGVED WITHGUT AN F_..L,Ef2]RI,,AL 1NSFEC] ISN REF!ORT; AND (...~) THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] SOILS LOG PERCOLATION TEST PERFORMED FOR: ~-"~ "~;;:~;~ ~'7'~~ DATE PERFORMED: LEGAL DESCRIPTION: 1 2 3 7 g SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS 72-008 (6/79) WAS GROUND WATER ~ ENCOUNTERED? ~zr~_ -~ E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE 5 , ET TEST RUN BETWEEN FT AND CERTIFIED~? (minutes/inch) MUNICIPALITV 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 lot, block, subdivision, section, township, range) ,~ ~;_~ ~.~- ~'~_L~:~£'~ ~ ~:-~-.__£Z~_~-3 ,..._ Location (address or directions) (b) Applicant Name ~'..t,%4;. Z~_Jz-=-b~.~-~¢d%"-,)Telepi~one: Home '~ Business ~ (c) Applicant is (check one): Lending Institution ~; Owner/builder ¢; Buyer []; Other ~ (explain); (d) Lending Institution _JL), ,"~'~._.~ ~'~-/~. ~%'.C_.,_~.,L,, _Telephone Address (e) Real Estate Company and Agent Address Telephone (f) ~¢r'~[ the HAA to the following address: TYPE OF RESIDENCE Single-Family ~¢- Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 72 025 (11/84) Page 1 of 2 FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORC,~ATION ~ rr, yce~ afb×ed hereto and as of the validation date shown below, I verify that my investigation of this t-ioalt~ ~.h~7 ~prova~ ~h~w5 ~hat the on-site water supply and/or wastewater disposal system is sate. functional and adequate ~f b~Jrooms aed type of structure indicated herein. I fudher verify that based on the information obtained ~c~pa~y of Anchorage files and from my investigation and inspection, the on-site water supply a~d/or · ~!~,'a~¢ d~po~a~ ~/~em ts ~n compliance with all Municipal and State codes, ordinances, and regulations in effect on for (~_/~_'~__~_... bedrooms by ate D~appro Conditional ............. ~,~_ ....... CAUTION Department of Health and Environmental Protection (DHEP) issues Health Authority solely upon the representations given in paragraph 5 above by an independent professional c,f Alaska. 'lhe DHEP does this as a courtesy to purchasers of homes and their lending r. ertam federal and state requirements. Employees of DHEP do not conduct inspectioes or i3 issued. The Municipality of Anchorage is not responsible for errors or omissions in the ~-~¢.-2of2 ALASKA EFIUIROnMfllTAL CONTROL SERUICE$, Inc. (~nqincerinq ~ {~nuironmentel Stu~{ies MUNIC{PALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PY, OTECTION AUG ~ ? I981 RECEIVED 8/21/8L DAVE LOWE P.O. BOX 1833 ANCHORAGE AK 99510 SELLER - DAVE LOWE SUBDIVISION-T 15N R2W BLOCK-SECTION 25 LOT-125B ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN UNKNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEPTING 250 GALLONS OF WATER PER DAY. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 1 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 8/21/81 SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 1 BEDROOM HOUSE. 1000 IS ADEQUATE FOR 1220 LUest 25th J~uenu¢ · J~ncbrciq¢,/~kska 99503 · (907) 276-1361 MUNiCiPALiTY OF ANCHORAGE , DI~PT. OF HEALTH & · > ENVIRONMENTAL PROTECTION RECE!W£,D -~ A, WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ 1'~.4~ ~ ~ ~-~.~.~.~.~.~.~.~.~~) Well Classification Well Log Present (Ye Total Depth ~f.~ ~ Static Water Level ~ ~ i Casing Height Above Ground Electrical Wiri~)g in Conduit ~Y,'~N) Separation Distances from Well: To Septic/HeNi~a4j..Tank on Lot To Nearest Edge of Absorption Field on Lot ~'~ ' ~'~ If A, B, C, D.E.C. Approved (Y/N) Date Completed '-.J ~ - Yield Cased to ~ ~ Depth of Grouting ~ Pump Set At J~' ~ Sanitary Seal on Casing ~N) Depression Around Wellhead (Y/~ ; On Adjo.ining Lots Adjoining Lots To Nearest Public Sewer Line ¢//~ To Nearest Public Sewer Cleanout/Manhole I~..)//~. To N'e~cest Sewer Service Line on Lot sample ColleCted by --~"'( ~' ~-'~,/~//2~'~-~./(.~.~ ; Date Water Water Sample Test Results ~'.,¢~ ,-~-/V ~'~J~ ~z-~-~' Comments /~- B. SEPTIC/HOL'OIl~iG TANK DATA Datelnstalled ~/~---///~¢¢- Size Standpipes ~)N) Air-tight Caps~N) Depression over Tank (Y~]~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/....~!~i~g Tank: To Water-Supply Well ~ \ C:~ ! '~ To Property Line To Water Main/Service Linde Course No. of Compartments '~- Foundation Cleanout 42~N) Date Last Pumped ~ /A. ; for ~ 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 Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y,~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ~ · ,~..&c,,f~c'¢, Ir..~..¢.l,.~ Type of System Design '~¢-J~*~¢C,~~ Length of Field ~'~r'1 Depth of Field ~ Gravel Bed Thickness '~'~- Standpipes Present~N) Date of Last Adequacy Test ¢"~¥*.~.,% To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~ t..¥ To Existing or Abandoned System on ; On Adjoining Lots '~t.~ ~ ~ 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) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company .,, · Receipt No. Date of Payment Amount: $ g5 Page 2 of 2 /_ / MOA No. 72-026 (1 W84) 'TIME f) TIME TIME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~UNICIPALI~ OF ANCHORAGE 825 L Street - AncAorage, Alaska 99501 D~PT, OF HEALTH & ~ E~IRONMENTAL PROTECTION ENVl RONMENTAL SANITATION DIVISION AU6 3 0 1981 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER DIRECTIONS: Complete all parts ou page 1, Incomplete requests will not be processed, Please allow ten {10} days for pro~ssing, 1, PROPERTY OWNER PHONE David T. Lo~e 278.3204 MAILING ADDRESS Box 1833. Ancho~aqe. Ak 99510 PROPERTY RESIDENT (If different from above) PHONE None 2, BUYER PHQNE Dave Hanson 333-9397 MAILING ADDRESS S~ace 269, 7800 DeBa~r, Anchoraqe 3, LENDING INSTITUTION ~ PHONE ALASKA F~RST HORTGAgF CORP: 207 F MAI LING AD DR ESS Chuaiak-Eaqle River Reality ~- 69A-g3B~ MAI LING ADDRESS Eagle River 5. LEGAL DESCRIPT[ON Lot 125B, Sec 25, T15N, R2W STREET LOCATION San Baufel Rd., Eagle River TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [~ Other__ ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six Single Room Cabin 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled Drior to that date, give well depth (attach log if available.) Approx' 50 feet. 197~; ?? YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-O10 (Rev. 6/79) ,/ i' THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] 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 E~ INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified. INSTALLER q'd-~ i -~ r '.' ' ' []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Absorption Area to nearest Lot Line ~ ' ' 5, COMMENTS ~D~IEoDN ~ ~ P P R O V~l eBt :eDt RmOu ~ Ma cSco m p a n y certificate) [] DISAPPROVED